Date of Award

12-2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Nursing Science

Research Advisor

Sarah J. Rhoads, PhD

Committee

Xueyuan Cao, PhD; Lacretia Carroll, PhD; Kate Fouquier, PhD; Danielle Tate, MD

Keywords

Black mothers;communication;hypertension;intersectionality;postpartum;preeclampsia

Abstract

For Black American mothers, postpartum stressors are magnified as about half of this population are single mothers, and many suffer from inadequate social and healthcare needs. Expected postpartum stressors, coupled with social stressors that Black American mothers face, can mask or influence patient reporting of early postpartum hypertensive crisis symptoms. Patients diagnosed with preeclampsia risk developing even more severe complications, such as cardiovascular disease, which is the leading cause of pregnancy-related deaths in the United States. Black American women face the challenge of inadequate communication with their healthcare providers, medical mistrust, and perceived discrimination when accessing health care. Pregnant women, in general, report informational needs and relationships as highlighted factors when exploring patient-clinician communication. Therefore, this dissertation research aimed to understand Black American mothers' perceptions of care and communication with their clinicians after being diagnosed with an acute hypertensive crisis and the findings will provide knowledge that will improve maternal outcomes for this population. Three projects were conducted: a manuscript consisting of a literature review, a methods manuscript, and a convergent mixed-methods study. The first manuscript consisting of the literature review revealed that early detection of acute hypertensive crisis among the postpartum mother’s interdisciplinary care team improves maternal neonatal outcomes. This manuscript proposes an example protocol for facilitating emergency care to those. symptomatic postpartum mothers who are visiting their neonate in the neonatal intensive care unit (NICU). Also in this manuscript, a literature review was conducted on the etiology, pathophysiology and treatment recommendations for acute hypertensive crisis. The findings of this review led to the importance of investigating those diagnosed with acute hypertensive crisis, specifically those who were most at risk- Black Postpartum Mothers. The next project, a methods paper on qualitative interview techniques, was written to inform qualitative researchers on how to amplify the voices of Black postpartum mothers diagnosed with an acute hypertensive crisis during qualitative interviews. Techniques were shared based on lessons learned during qualitative data collection. The third project, a convergent mixed-methods study, was conducted to explore the perceptions of care and patient-clinician communication from Black postpartum mothers diagnosed with an acute hypertensive crisis in the Mississippi Delta region of the United States. Findings from this study revealed that most participants rated higher satisfaction with their doctor-patient communication during their outpatient prenatal visits and hospital stay, but still voiced repeated experiences of being dismissed and their symptoms being minimized by their obstetric clinicians. To meet the needs of Black postpartum mothers who experience high risk disorders such as acute hypertensive crises, obstetric clinicians must understand their experiences with patient-clinician communication and the adjustive communicative behaviors they adopt to navigate healthcare spaces. Obstetric clinicians must be intentional about providing detailed information early in pregnancy and establish a trusting relationship in order to improve their perceptions of care and patient-clinician communication.

Declaration of Authorship

Declaration of Authorship is included in the supplemental files.

ORCID

0000-0002-1043-2697

DOI

10.21007/etd.cghs.2023.0639

Additional Files
2023-027-Fant-DOA.pdf (193 kB)
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