Audrey Lyndon

Faculty

Audrey Lyndon Headshot

Audrey Lyndon

PhD RNC FAAN

Executive Vice Dean
Vernice D. Ferguson Professor in Health Equity

1 212 922 5940

433 First Ave
New York, NY 10010
United States

Accepting PhD students

Prof. Lyndon is the Vernice D. Ferguson Professor in Health Equity and Executive Vice Dean at NYU Rory Meyers College of Nursing. Her work focuses on three key areas: maternal health equity, community health engagement, and developing the nursing science and healthcare workforce. Lyndon’s maternal health work has focused on patient safety and quality in maternity and neonatal care, including improving communication and teamwork among clinicians; identifying parents’ perspectives on safety during labor, birth, and neonatal care; developing nurse-sensitive outcomes for labor and birth; researching severe maternal morbidity and maternal mortality; and holistic perinatal wellbeing. Her team has conducted groundbreaking research on the differences in clinicians’ and parents’ perspectives on speaking up about safety concerns, as well as developing an understanding of how women and parents conceptualize safety during childbirth and neonatal intensive care. Lyndon co-chaired the development of the CMQCC Obstetric Hemorrhage Toolkit, which became a national and international model for maternal safety bundles and collaborative quality improvement. Lyndon led an interdisciplinary research study funded by the Agency for Healthcare Research and Quality that established hospital-level exclusive breastfeeding rates and cesarean birth rates as nurse-sensitive outcomes. Lyndon’s current work focuses on understanding the experiences of communities that have faced higher rates of severe maternal morbidity and mortality. She and her team seek to gain a deeper understanding of the support needs and research priorities of severe maternal morbidity survivors, and to develop community-driven prevention targets for SMM and maternal health complications. Lyndon’s dedication to developing the nursing science and healthcare workforce includes mentoring and sponsoring clinicians and scientists from underserved communities. Her goals are to develop effective pathway programs for these individuals to pursue careers in nursing, nursing science, and clinical specialties.

 

PhD, University of California
MS, University of California
BA, University of California
Health Services Research
Qualitative Research
Women's health
American Academy of Nursing
American College of Obstetricians and Gynecologists (ACOG), Educational Affiliate
American Nurses Association
Association of Women’s Health Obstetric and Neonatal Nurses
Vernice D. Ferguson Professor in Health Equity, Rory Meyers College of Nursing (2021)
PhD Program Mentor of the Year, University of California, San Francisco School of Nursing (2019)
James P. and Marjorie A. Livingston Chair in Nursing Excellence, University of California, San Francisco (2018)
Reviewer of the Year, Journal of Obstetric, Gynecologic, and Neonatal Nursing (2017)
Irving Harris Visiting Professor, University of Illinois, Chicago College of Nursing (2015)
Distinguished Professional Service Award, Association of Women's Health, Obstetric and Neonatal Nurses (2013)
Fellow, American Academy of Nursing (2012)
Award of Excellence in Research, Association of Women's Health, Obstetric and Neonatal Nurses (2011)

Consequences of Delayed, Unfinished, or Missed Nursing Care during Labor and Birth

Simpson, K. R., & Lyndon, A. (2017). In Journal of Perinatal and Neonatal Nursing (Vols. 31, Issue 1, pp. 32-40). 10.1097/JPN.0000000000000203
Abstract
Abstract
The purpose of this study was to examine the concept of delayed, unfinished, or missed nursing care when patient census and acuity exceed nurse staffing resources with nurses who care for women during labor and birth. Focus groups were held during which labor nurses were asked about aspects of nursing care that may be regularly delayed, unfinished, or completely missed during labor and birth, including possible reasons and potential consequences. Seventy-one labor nurses participated in 11 focus groups in 6 hospitals. Nurses focused on support and encouragement as aspects of care that they felt are essential but often not able to be performed when the unit is busy. Nurses seemed to assume technical features of care as a "given" in the background and not always noticed unless missed. They voiced concerns about risks to maternal and fetal well-being when they were short-staffed. Potential outcomes were discussed including cesarean birth, depressed infants at birth, hemorrhage, and negative effects on patient satisfaction, successful breast-feeding, and the overall patient experience. Conclusion: When essential aspects of nursing care are delayed, unfinished, or completely missed, there are potentially negative implications for numerous patient outcomes and patient safety is at risk.

Consequences of Delayed, Unfinished, or Missed Nursing Care During Labor and Birth

Lyndon, A., Simpson, K. R., & Lyndon, A. (2017). In The Journal of perinatal & neonatal nursing (Vols. 31, Issue 1, pp. 32-40).
Abstract
Abstract
: The purpose of this study was to examine the concept of delayed, unfinished, or missed nursing care when patient census and acuity exceed nurse staffing resources with nurses who care for women during labor and birth. Focus groups were held during which labor nurses were asked about aspects of nursing care that may be regularly delayed, unfinished, or completely missed during labor and birth, including possible reasons and potential consequences. Seventy-one labor nurses participated in 11 focus groups in 6 hospitals. Nurses focused on support and encouragement as aspects of care that they felt are essential but often not able to be performed when the unit is busy. Nurses seemed to assume technical features of care as a "given" in the background and not always noticed unless missed. They voiced concerns about risks to maternal and fetal well-being when they were short-staffed. Potential outcomes were discussed including cesarean birth, depressed infants at birth, hemorrhage, and negative effects on patient satisfaction, successful breast-feeding, and the overall patient experience.

Infant Feeding Decision-Making and the Influences of Social Support Persons Among First-Time African American Mothers

Asiodu, I. V., Waters, C. M., Dailey, D. E., & Lyndon, A. (2017). In Maternal and Child Health Journal (Vols. 21, Issues 4, pp. 863-872). 10.1007/s10995-016-2167-x
Abstract
Abstract
Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.

Infant Feeding Decision-Making and the Influences of Social Support Persons Among First-Time African American Mothers

Lyndon, A., Asiodu, I. V., Waters, C. M., Dailey, D. E., & Lyndon, A. (2017). In Maternal and child health journal (Vols. 21, Issues 4, pp. 863-872).
Abstract
Abstract
Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.

Labor nurses' views of their influence on cesarean birth

Simpson, K. R., & Lyndon, A. (2017). In MCN The American Journal of Maternal/Child Nursing (Vols. 42, Issues 2, pp. 81-87). 10.1097/NMC.0000000000000308
Abstract
Abstract
Background: As part of an ongoing study about nurse staffi ng during labor and birth sponsored by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), outcomes that may be linked to aspects of labor nursing were considered. The purpose of this study was to see if labor nurses felt they influenced whether a woman has a cesarean birth. These data were used to determine if cesarean birth should be included as an outcome measure in the multistate labor nurse staffi ng study. Methods: Focus groups were used to explore the role of labor nurses and cesarean birth. Participants were attending the AWHONN national convention in 2015. Two open-ended questions were asked: 1) Do labor nurses influence whether a woman has a cesarean? 2) What specifi c things do you do as a labor nurse to help a woman avoid a cesarean? Results: Two focus groups were held (n = 15 and n = 9). Nurses overwhelmingly agreed nursing care can influence mode of birth. They described multiple strategies routinely used to help a woman avoid a cesarean, which were categorized into three main themes: support, advocacy, and interactions with physicians. Support was emotional, informational, and physical. Advocacy involved advocating for women and helping women advocate for themselves. Nurses tried to focus on positive aspects of labor progress when communicating with physicians. Descriptions of interactions with some physicians implied less than optimal teamwork and lack of collaboration. Conclusion: Labor nurses are likely infl uential in whether some women have a cesarean. They reported consistently taking an active role to help women avoid a cesarean. Promoting vaginal birth as appropriate to the clinical situation was a high priority. Trust, partnership, and respect for roles and responsibilities of each discipline were not evident in some of the clinical situations nurses described.

Labor Nurses' Views of Their Influence on Cesarean Birth

Lyndon, A., Simpson, K. R., & Lyndon, A. (2017). In MCN. The American journal of maternal child nursing (Vols. 42, Issues 2, pp. 81-87).
Abstract
Abstract
As part of an ongoing study about nurse staffing during labor and birth sponsored by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), outcomes that may be linked to aspects of labor nursing were considered. The purpose of this study was to see if labor nurses felt they influenced whether a woman has a cesarean birth. These data were used to determine if cesarean birth should be included as an outcome measure in the multistate labor nurse staffing study.

Parents' Perspectives on Navigating the Work of Speaking Up in the NICU

Lyndon, A., Wisner, K., Holschuh, C., Fagan, K. M., & Franck, L. S. (2017). In JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing (Vols. 46, Issues 5, pp. 716-726). 10.1016/j.jogn.2017.06.009
Abstract
Abstract
Objective To describe parents' perspectives and likelihood of speaking up about safety concerns in the NICU and identify barriers and facilitators to parents speaking up. Design Exploratory, qualitatively driven, mixed-methods design. Setting A 50-bed U.S. academic medical center, open-bay NICU. Participants Forty-six parents completed questionnaires, 14 of whom were also interviewed. Methods Questionnaires, interviews, and observations with parents of newborns in the NICU were used. The qualitative investigation was based on constructivist grounded theory. Quantitative measures included ratings and free-text responses about the likelihood of speaking up in response to a hypothetical scenario about lack of clinician hand hygiene. Qualitative and quantitative analyses were integrated in the final interpretation. Results Most parents (75%) rated themselves likely or very likely to speak up in response to lack of hand hygiene; 25% of parents rated themselves unlikely to speak up in the same situation. Parents engaged in a complex process of Navigating the work of speaking up in the NICU that entailed learning the NICU, being deliberate about decisions to speak up, and at times choosing silence as a safety strategy. Decisions about how and when to speak up were influenced by multiple factors including knowing my baby, knowing the team, having a defined pathway to voice concerns, clinician approachability, clinician availability and friendliness, and clinician responsiveness. Conclusion To engage parents as full partners in safety, clinicians need to recognize the complex social and personal dimensions of the NICU experience that influence parents' willingness to speak up about their safety concerns.

Parents' Perspectives on Navigating the Work of Speaking Up in the NICU

Lyndon, A., Lyndon, A., Wisner, K., Holschuh, C., Fagan, K. M., & Franck, L. S. (2017). In Journal of obstetric, gynecologic, and neonatal nursing : JOGNN (Vols. 46, Issues 5, pp. 716-726).
Abstract
Abstract
To describe parents' perspectives and likelihood of speaking up about safety concerns in the NICU and identify barriers and facilitators to parents speaking up.

Thematic analysis of barriers and facilitators to implementation of neonatal resuscitation guideline changes

Lyndon, A., Lee, H. C., Arora, V., Brown, T., & Lyndon, A. (2017). In Journal of Perinatology (Vols. 37, Issues 3, pp. 249-253). 10.1038/jp.2016.217
Abstract
Abstract
Objective:To evaluate experiences regarding implementation of Neonatal Resuscitation Program (NRP) guideline changes in the context of a collaborative quality improvement (QI) project.Study Design:Focus groups were conducted with local QI leaders and providers from nine sites that participated in a QI collaborative. Thematic analysis identified facilitators and barriers to implementation of NRP guideline changes and QI in general.Results:Facilitators for QI included comparative process measurement and data tracking. Barriers to QI were shifting priorities and aspects of the project that seemed inefficient. Specific to NRP, implementation strategies that worked involved rapid feedback, and education on rationale for change. Changes that interrupted traditional workflow proved challenging to implement. Limited resources and perceptions of increased workload were also barriers to implementation.Conclusion:Collaborative QI methods are generally well accepted, particularly data tracking, sharing experience and education. Strategies to increase efficiency and manage workload may facilitate improved staff attitudes toward change.

Thematic analysis of US stakeholder views on the influence of labour nurses' care on birth outcomes

Lyndon, A., Simpson, K. R., & Spetz, J. (2017). In BMJ Quality and Safety (Vols. 26, Issues 10, pp. 824-831). 10.1136/bmjqs-2016-005859
Abstract
Abstract
Background Childbirth is a leading reason for hospital admission in the USA, and most labour care is provided by registered nurses under physician or midwife supervision in a nurse-managed care model. Yet, there are no validated nurse-sensitive quality measures for maternity care. We aimed to engage primary stakeholders of maternity care in identifying the aspects of nursing care during labour and birth they believe influence birth outcomes, and how these aspects of care might be measured. Methods This qualitative study used 15 focus groups to explore perceptions of 73 nurses, 23 new mothers and 9 physicians regarding important aspects of care. Transcripts were analysed thematically. Participants in the final six focus groups were also asked whether or not they thought each of five existing perinatal quality measures were nurse-sensitive. Results Nurses, new mothers and physicians identified nurses' support of and advocacy for women as important to birth outcomes. Support and advocacy actions included keeping women and their family members informed, being present with women, setting the emotional tone, knowing and advocating for women's wishes and avoiding caesarean birth. Mothers and nurses took technical aspects of care for granted, whereas physicians discussed this more explicitly, noting that nurses were their 'eyes and ears' during labour. Participants endorsed caesarean rates and breastfeeding rates as likely to be nurse-sensitive. Conclusions Stakeholder values support inclusion of maternity nursing care quality measures related to emotional support and providing information in addition to physical support and clinical aspects of care. Care models that ensure labour nurses have sufficient time and resources to engage in the supportive relationships that women value might contribute to better health outcomes and improved patient experience.