Mikki Meadows-Oliver

Abstract

Among the many lessons that have been reinforced by the SARS-COVID-19 pandemic is the failure of our current fee-for-service health care system to either adequately respond to patient needs or offer financial sustainability. This has enhanced bipartisan interest in moving forward with value-based payment reforms. Nurses have a rich history of innovative care models that speak to their potential centrality in delivery system reforms. However, deficits in terms of educational preparation, and in some cases resistance, to considering cost alongside quality, has hindered the profession’s contribution to the conversation about value-based payments and their implications for system change. Addressing this deficit will allow nurses to more fully engage in redesigning health care to better serve the physical, emotional, and economic well-being of this nation. It also has the potential to unleash nurses from the tethers of a fee-for-service system where they have been relegated to a labor cost and firmly locate nurses in a value-generating role. Nurse administrators and educators bear the responsibility for preparing nurses for this next chapter of nursing

Abstract

Reflective functioning (RF), the capacity to envision thoughts, feelings, needs and intentions within the self and others, is thought to be central to sensitive parenting, yet this capacity has been unexamined among pregnant adolescents. We explored how RF was related to the emotional experience of adolescent pregnancy. Design and Methods: This qualitative study was guided by interpretive description. Participants were 30 Latina and African-American adolescents (mean age 17.7 + 1.5 years) residing in a low-income urban community. All adolescents were interviewed with the Pregnancy Interview (a 22 question semi-structured interview) in their third trimester of pregnancy. Interview transcripts had been previously coded for levels of RF (1-9 with higher levels denoting higher reflectiveness), and this secondary analysis focused on the teens' experience of pregnancy and their emerging reflective capacities. We used a priori and inductive coding with all interviews and developed patterns and themes. Results: These interviews provided an in-depth understanding of the complex adolescent emotional experiences of pregnancy. We identified five themes that create a picture of how the participants reflected upon their pregnancies, unborn babies, emerging parental roles, and complicated relationships with family and partners. Conclusions and Practice Implications: Adolescent developmental issues and harsh family and neighborhood environments permeated the teens' experience of pregnancy and limited capacity for RF. Understanding distinctive features of RF in pregnant adolescents may contribute to developing conceptual models and tailored clinical approaches for enhancing parental reflectiveness and sensitivity in these vulnerable young women as they enter into the transition to parenthood.