Posted: April 24th, 2025

proposal 1 (colorectal cancer),

(colorectal cancer), but you need to choose a minority population to examine in relation to colon cancer.

3 OBJECTIVE SUMMARIES 

Complete Literature review 

1

Racial Disparities in Healthcare among Pregnant Women in the United States

Tamifer Lewis

Department of Public Health, Monroe College, King Graduate School

KG604-144: Graduate Research and Critical Analysis

Dr. Manya Bouteneff

December 4, 2022

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Literature Review

Introduction to the Literature Review

Research suggests that racial disparities in healthcare among pregnant women persists in

the United States (Zhang et al., 2013). Due to this continuous occurrence, it is vital to examine

the factors that contribute to the adverse outcomes in maternal health. The literature review

contained only research articles about factors that impacted and influenced disparities in

pregnancy outcomes. Factors that were reviewed were socioeconomic status, public health

insurance, race/ethnicity, and poverty status. The literature review was conducted using EBSCO

Host and ProQuest databases from the Monroe College Library. The search terms used to

compile pertinent articles were racial disparities maternal health, adverse pregnancy outcomes,

and maternal health outcomes.

Review of the Literature

Adverse Pregnancy Outcome Factors

Darling et al. (2021) conducted a study between 2001 and 2018 to examine the efficiency

of qualified interventions in preterm birth, small for gestational age, low birth weight, neonatal

death, cesarean deliveries, maternal care satisfaction, and coast effectiveness programs. A

systematic review was used to collect data from the United States, France, Spain, and the

Netherlands. The studies consisted of mostly non- Caucasian women from low-income

population ranging from 12 to 46 years of age and being between 20 to 32 weeks’ gestation.

Interventional programs were implemented into three categories: group prenatal care, augmented

prenatal care, or a combination of both group and augmented prenatal care (Darling et

al., 2021).

The researchers found that certain interventions, such as prenatal care and augmented care, or a

combination of both, may decrease adverse outcomes in small-for-gestational-age and preterm

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birth, and could aid in increasing maternal care satisfaction. Interventions that worked on

enhancing coordination of care were found to result in providing more effective cost savings.

The researchers also found disparities in the quality of access to care in the vulnerable

population. There was insufficient evidence of suitable quality to confirm that the interventions

were successful at enhancing clinical outcomes in prenatal care for at risk populations (Darling et

al., 2021).

Similar observations were made in a study conducted by Nichols and Cohen (2020),

between 2006 and 2018 to examine the methods used to improve the results of maternal

mortality in California. The study was conducted using a scoping review to evaluate research on

women and maternal health in the United States. The researchers used information from the US

Maternal Fetal Medicine Network to measure the percentage of studies where pregnant women,

women, and children were the main focus. The researchers also reviewed documentation on

healthcare policies and practices from California’s public health department, healthcare

foundation, and Maternal Quality Care Collaborative. Nichols and Cohen (2020) found that

although the health of fetus and children could be adversely affected by the health of the mother,

the majority of maternal programs in the United States places emphasis on the child. The

researchers also found four areas of concern in women health experiences, both in pre and

postnatal care. The problem areas entailed inadequate investment in women’s health, inefficient

quality of care and avoidable caesarean delivers, expanding disparities in minority women and

women living in rural areas, and contradictory collection and distribution of data (Nichols &

Cohen, 2020).

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Approaches to Improving Pregnancy Outcomes

In contrast to the preceding studies, Zhang et al. (2013) conducted a study between 2005

and 2007 to calculate the excessive rate of unfavorable outcomes in pregnancy within racial and

ethnic groups. The study also aimed to measure the possibility of Medicaid savings that are

linked to paid maternal care claims resulting from the inequalities that contribute to unfavorable

maternal outcomes. A cross-sectional study using Medicaid Analytic eXtract (MAX) data was

used to gather pregnancy outcome information from inpatient hospitals from 14 states (Florida,

Alabama, Arkansas, North Carolina, Georgia, Louisiana, Kentucky, Mississippi, Maryland,

Missouri, Tennessee, South Carolina, Virginia, and Texas). The study consisted of a little over 2

million patients who were insured with Medicaid and had a delivery code of maternal delivery

stay. Zhang et al. (2013) found that, with the exception of gestational diabetes, African American

women showed the worst outcomes out of all unfavorable pregnancy outcomes. These disparities

are postulated as being multi-factorial, having causes stemming from complicated experiences

with racism, poverty, and complex healthcare interactions. It was also found that women covered

under Medicaid health insurance were more likely to have consistency in care from prenatal care

through delivery compared to their counterparts. However, due to participation in Medicaid

programs being influenced by reimbursement rates, some providers may choose to stop

accepting Medicaid patients because of reimbursement delays and low payment rates, which

could contribute to negative birth outcomes (Zhang et al., 2013).

Analysis of the Literature

In the United States, the persistence of maternal mortality continues to be a problem area

in public health. The contributing factors that impact pregnancy outcomes persist in burdening

the U.S., leading to poor healthcare quality, and increasing health disparities. The studies used in

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this literature review each used a different form of research methodology to collect data,

including systematic and scoping reviews and cross-sectional studies. Similarly, Darling et al.

(2021), Nichols and Cohen (2020), and Zhang et al. (2013) have emphasized the correlation

between race/ethnicity and financial status playing a part in influencing quality of care, access of

care, and pregnancy outcomes in pregnant minority women. To mitigate the disparities in

maternal health Darling et al. (2021) and Zhang et al. (2013) suggested that interventions should

be inspected and geared towards determining and eradicating the racial and ethnic disparities that

affect pregnancy-related outcomes. Whereas Nichols and Cohen (2020) suggested focusing on

exploring the distinctive experiences of particular at-risk subgroups of women, such as women in

prison, who are of childbearing age, and the pregnant women who are less likely to pursue

prenatal care, such as undocumented women.

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References

Darling, E. K., Cody, K., Tubman-Broeren, M., & Marquez, O. (2021). The effect of prenatal

care delivery models targeting populations with low rates of PNC attendance: A

systematic review. Journal of Health Care for the Poor and Underserved, 32(1), 119-

136. https://www.proquest.com/scholarly-journals/effect-prenatal-care-delivery-models-

targeting/docview/2507722229/se-2

Nichols, C. R., & Cohen, A. K. (2021). Preventing maternal mortality in the United States:

Lessons from California and policy recommendations. Journal of Public Health Policy,

42(1), 127-144. https://doi.org/10.1057/s41271-020-00264-9

Zhang, S., Cardarelli, K., Shim, R., Ye, J., Booker, K. L., & Rust, G. (2013). Racial disparities in

economic and clinical outcomes of pregnancy among Medicaid recipients. Maternal and

Child Health Journal, 17(8), 1518+.

https://link.gale.com/apps/doc/A344827866/PPNU?u=nysl_me_moncol&sid=bookmark-

PPNU&xid=51747d52

Your assignment this week is to read, analyze, and prepare an analysis based on directions at the end of the reading for Comprehensive Case Study 5 in your textbook, 

The

Stress

of Caring
.

Assignment 5 specifics:

· Your response should be a maximum of 3 pages. With the title and references page, your assignment will likely be 5 pages long.

·
You must include at least 3 scholarly references.

· Your response should NOT be in question and answer format, it should be written in essay form. 

· Ensure you are using terminology that we have discussed in class to support your stance.

Assignment formatting specifications:

· Assignments must be formatted in proper APA formatting.

· American Psychological Association. (2010). Concise Rules of APA Style. 7th ed. Washington, DC: Author. ISBN: 9781433805608

· https://owl.english.purdue.edu/owl/resource/560/01/

· Assignments must include a title page, running header, in-text citations, and a complete reference page.

· Assignments must be written in Times New Roman, 12 font, and double-spaced throughout.

· Please refer to the grading rubric in each assignment for more details on how to obtain the optimal grade.

Case 5 The Stress of Caring

Learning Goals

One of the most consistent changes in work structure over the past few decades has been a shift from a manufacturing economy to a service economy. More workers are now engaged in jobs that include providing care and assistance, especially in education and medicine. This work is satisfying for some people, but it can also be highly stressful. In the following scenario, consider how a company in the nursing care industry responds to the challenges of the new environment.

Major Topic Areas

Stress

Organizational change

Emotions

Leadership

The Scenario

Parkway Nursing Care is an organization facing a massive change. The company was founded in 1982 with just two nursing homes in Phoenix, Arizona. The company was very successful, and throughout the 1990s, it continued to turn a consistent profit while slowly acquiring or building 30 more units. This low-profile approach changed forever in 2003 when venture capitalist Robert Quine decided to make a major investment in expanding Parkway in return for a portion of its profits over the coming years. The number of nursing homes exploded, and Parkway was operating 180 homes by the year 2010.

The company now has 220 facilities in the southwestern United States, with an average of 115 beds per facility and a total of nearly 30,000 employees. In addition to health care facilities, it also provides skilled in-home nursing care. Parkway is seen as one of the best care facilities in the region, and it has won numerous awards for its achievements in the field.

As members of the baby boom generation become senior citizens, the need for skilled care will only increase. Parkway wants to make sure it is in a good position to meet this growing need. This means the company must continue expanding rapidly.

The pressure for growth is one significant challenge, but it is not the only one. The nursing home industry has come under increased government scrutiny following investigations that turned up widespread patient abuse and billing fraud. Parkway has always had outstanding patient care. No substantiated claim of abuse or neglect in any of its homes has ever been made. However, the need for increased documentation will still affect the company. As the federal government tries to trim Medicare expenses, Parkway may face a reduction in funding.

The Problem

As growth continues, Parkway has remained committed to maintaining the dignity and health of all residents in its facilities. The board of directors wants to see a renewed commitment to the firm’s mission and core values, not a diffusion of its culture. Its members are worried there might be problems to address. Interviews with employees suggest there is plenty to worry about.

Shift leader Maxine Vernon has been with Parkway for 15 years. “Now that the government keeps a closer eye on our staffing levels, I’ve seen management do what it can to keep positions filled, and I don’t always agree with who is hired. Some of the basic job skills can be taught, sure, but how to care for our patients—a lot of these new kids just don’t pick up on that.”

“The problem isn’t with staff—it’s with Parkway’s focus on filling the beds,” says nurse’s aide Bobby Reed. “When I started here, Parkway’s reputation was still about the service. Now it’s about numbers. No one is intentionally negligent—there just are too many patients to see.”

A recent college graduate with a BA in psychology, Dalton Manetti is more stressed than he expected. “These aren’t the sweet grannies you see in the movies. Our patients are demanding. They complain about everything, even about being called patients, probably because most of them think they shouldn’t be here in the first place. A lot of times, their gripes amount to nothing, but we have to log them in anyway.”

Carmen Frank has been with Parkway for almost a year and is already considering finding a new job. “I knew there were going to be physical parts to this job, and I thought I’d be able to handle that. It’s not like I was looking for a desk job, you know? After every shift, I go home with aches all over—my back, arms, and legs. I’ve never had to take so much time off from a job because I hurt. And then when I come back, I feel like the rest of the staff thinks I’m weak.”

Year Number of Patients Injuries per Staff Member Incidents per Patient Certified Absences per Staff Member Other Absences per Staff Member Turnover Rate

2010 21,200 3.32 4.98 4.55 3.14 0.31

2011 22,300 3.97 5.37 5.09 3.31 0.29

2012 22,600 4.87 5.92 4.71 3.47 0.28

2013 23,100 4.10 6.36 5.11 3.61 0.35

2014 23,300 4.21 6.87 5.66 4.03 0.31

2015 23,450 5.03 7.36 5.33 3.45 0.28

2016 23,600 5.84 7.88 5.28 4.24 0.36

2017 24,500 5.62 8.35 5.86 4.06 0.33

2018 24,100 7.12 8.84 5.63 3.89 0.35

2019 25,300 6.95 9.34 6.11 4.28 0.35

“I started working here right out of high school because it was the best-paid of the jobs I could get,” says Niecey Wilson. “I had no idea what I was getting myself into. Now I really like my job. Next year I’m going to start taking some night classes so I can move into another position. But some of the staff just think of this as any other job. They don’t see the patients as people, more like inventory. If they want to work with inventory, they should get a job in retail.”

Last month, the company’s human resources department pulled the above information from its records at the board of directors’ request. The numbers provide some quantitative support for the concerns voiced by staff.

Injuries to staff occur mostly because of back strain from lifting patients. Patient incidents reflect injuries due to slips, falls, medication errors, or other accidents. Certified absences are days off from work due to medically verified illnesses or injuries. Other absences are days missed that are not due to injuries or illnesses; these are excused absences (unexcused absences are grounds for immediate firing).

Using Organizational Development to Combat Stress and Improve Performance

The company wants to use organizational development methods such as appreciative inquiry (AI) to create change and re-energize its sense of mission. As the chapter on organizational change explains, AI procedures systematically collect employee input and then use this information to create a change message everyone can support. The human resources department conducted focus groups, asking employees to describe their concerns and suggestions for the future. The focus groups highlighted many suggestions, although they do not all suggest movement in the same direction.

Many suggestions concerned schedule flexibility. One representative comment was this: “Most of the stress on this job comes because we can’t take time off when we need it. The LPNs [licensed practical nurses, who do much of the care] and orderlies can’t take time off when they need to. Still, many of them are single parents or primary caregivers for their own children. When they have to leave for child care responsibilities, the work suffers, and there’s no contingency plan to help smooth things over. Then everyone who is left has to work extra hard. The person who takes time off feels guilty, and there can be fights over taking time off. If we had some way of covering these emergency absences, we’d all be a lot happier, and I think the care would be a lot better.”

Other suggestions proposed better methods for communicating information across shifts. Most of the documentation for shift work is done in large spiral notebooks. When a new shift begins, staff members say they don’t have much time to check on what happened in the previous shift. Some younger caregivers would like to have a method that lets them document patient outcomes electronically because they type faster than they can write. The older caregivers are more committed to the paper-based process, in part because they think switching systems would require a lot of work. (Government regulations on health care reporting require that any documentation be made in a form that cannot be altered after the fact to prevent covering up abuse, so specialized software systems must be used for electronic documentation.)

Finally, the nursing care staff believes its perspectives on patient care are seldom given an appropriate hearing. “We’re the ones who are with the patients most of the time, but when it comes to doing this the right way, our point of view gets lost. We really could save a lot of money by eliminating some of these unnecessary routines and programs. Still, it’s something management always just says it will consider.”

Staff members seem to want some way to provide suggestions for improvement, but it is unclear what method they would prefer.

Your Assignment

Parkway has taken some initial steps in this new direction, but clearly, it has a lot of work left to do. As a change management consultant, you have been brought in to help the company change its culture and respond to the stress that employees experience. Remember to create your report as if it is for the leadership of a major corporation.

When you write your recommendations, make sure you touch on the following points:

CC-30. What do the data on employee injuries, incidents, absences, and turnover suggest to you? Is there a reason for concern about the company’s direction?

CC-31. The company will be making some significant changes based on the AI process, and most change efforts are associated with resistance. What are the most common forms of resistance, and which would you expect to see at Parkway?

CC-32. Given the board of directors’ desire to re-energize the workforce, what advice would you provide for creating a leadership strategy? What leader behaviors should nursing home directors and nurse supervisors demonstrate?

CC-33. What are the major sources of job stress at Parkway? What does the research on employee stress suggest you should do to help minimize the experience of psychological strain for employees? Create a plan for how to reduce stress among employees.

CC-34. Based on the information collected in the focus groups, design a survey to hand out to employees. What sort of data should the survey gather? What types of data analysis methods would you like to employ for these data?