Becoming Tied: A Theory of Adolescent Maternal-Infant Interaction

The purpose of this study was to describe the interaction that occurs between adolescent mothers and their newborns while situated together in the immediate postpartum period. The researcher sought to determine: 1) What are the interactive process (es) that occur between adolescent mothers and their newborns while situated together in the immediate postpartum period, 2) What categories emerge from the adolescents’ descriptions of the mother infant situation?, and 3) How do the emergent categories relate? Ten primiparous adolescent mothers age 17 years or less were purposively sampled to participate in this qualitative Grounded Theory study. Face to face interviews about what participants had been doing to get to know their babies were conducted either the in-patient setting or the home of each participant at their request within one week of delivery The adolescent mothers described a distinct process that begins at the moment of birth and encompassed them forming a relationship with their newborn, recognizing self-change based on that relationship, and moving forward with their baby as the central component of their life. Three core concepts, “Connecting Together,” “Taking Baby into the Inner Being,” and “Embarking Together” emerged from the rich descriptions provided by the participants to represent the theory “Becoming Tied.” The theory provides a new way of viewing the process of how adolescent mothers and their newborns relate in the immediate postpartum period

Paediatric nurses’ and parents’ perceptions of busyness in paediatric acute care: an ethnography

University of Technology Sydney. Faculty of Health.: Busyness within modern health care has often been defined as time constraints and increased workload, leading to individualised perceptions of stress. To date, no published studies have sought to explore busyness as a construct within therapeutic relationships in a paediatric acute care setting or how cultural dimensions of paediatric nursing fosters perceptions of busyness within everyday care practices. : To explore a notion of busyness within the context of paediatric acute care and how this influences the therapeutic relationship between paediatric nurses and families. : Ethnography was the research design selected for the study. Semi-structured interviews with 10 paediatric nurses and 10 parents, and 40 hours of non-participant observations were conducted. Brewer’s (2000) framework for ethnographic analysis and interpretation was utilised and findings were presented as a realist tale. : Seven themes emerged, which detailed cultural dimensions of busyness that influenced paediatric acute care. Perceptions of busyness challenged teamwork and re-shaped therapeutic relationships between paediatric nurses and families. During perceived busyness task focused care became the dominant culture and hindered family centred care. Instead, challenges emerged that required role negotiation, balancing expectations and re-forming of collaborative partnerships. The emotional cost of busyness created a sense of personal conflict that surfaced within nurses and care activities. Similarly, parents were challenged during times of busyness, leading to feelings of frustration and powerlessness. : This ethnography has identified a culture of care that was influenced by busyness. Roles within therapeutic relationships, paediatric nurse and parental expectations and collaborative partnerships were re-shaped by busyness. The findings highlighted the importance of family centred care to paediatric nurses and gave social understandings and insights into the complexities of the paediatric nurse – parent partnerships, which assisted to define dimensions of the therapeutic relationship. Importantly, the ethnography has brought to the surface how paediatric nurses and parents negotiated and balanced their partnership to achieve a desired therapeutic relationship. This ethnography has addressed a significant research gap and provided new insights into nursing, paediatric nursing practice, education and research

Predictors of Shared Decision Making and Level of Agreement between Consumers and Providers in Psychiatric Care

The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock’s Informed Decision Making Scale (Braddock et al., 1997; 1999; 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was “exploration of consumer preference,” with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM

Predictors of Shared Decision Making and Level of Agreement between Consumers and Providers in Psychiatric Care

The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock’s Informed Decision Making Scale (Braddock et al., 1997; 1999; 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was “exploration of consumer preference,” with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM

Medical nutrition therapy for gestational diabetes mellitus in Australia : what has changed in 10 years and how does current practice compare with best practice?

Background: The present study aimed to report Australian dietetic practice regarding management of gestational diabetes mellitus (GDM) and to make comparisons with the findings from a 2009 survey of dietitians and with the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guidelines (NPG). Methods: Cross-sectional surveys were conducted in 2019 and 2009 of dietitians providing medical nutrition therapy (MNT) to women with GDM in Australia. The present study compares responses on demographics, dietetic assessment and interventions, and guideline use in 2019 vs. 2009. Results: In total, 149 dietitians (2019) and 220 (2009) met survey inclusion criteria. In both surveys >60% of respondents reported dietary interventions aiming for >45% energy from carbohydrate, 15%–25% energy from protein and 15%–30% energy from fat. Many variations in MNT found in 2009 continued to be evident in 2019, including the percentage of energy from carbohydrate aimed for (30%–65% in 2019 vs. 20%–75% in 2009) and the wide range in the recommended minimum daily carbohydrate intake (40–220 and 60–300 g). Few dietitians reported aiming for the NPG minimum of 175 g of carbohydrate daily in both surveys (32% in 2019 vs. 26% in 2009). There were, however, some significant increases in MNT consistent with NPG recommendations in 2019 vs. 2009, including the minimum frequency of visits provided (49%, n = 61 vs. 33%, n = 69; p < 0.001) and provision of gestational weight gain advice (59%, n = 95 vs. 40%, n = 195; p < 0.05). Conclusions: Although many dietitians continue to provide MNT consistent with existing NPG, there is a need to support greater uptake, especially for recommendations regarding carbohydrate intake

Influence of providers and nurses on completion of non-targeted HIV screening in an urgent care setting

Introduction: Despite recommendations by the Centers for Disease Control (CDC) that all adults be offered non-targeted HIV screening in all care settings, screening in acute-care settings remains unacceptably low. We performed an observational study to evaluate an HIV screening pilot in an academic-community partnership health center urgent care clinic. Methods: We collected visit data via encounter forms and demographic and laboratory data from electronic medical records. A post-pilot survey of perceptions of HIV screening was administered to providers and nurses. Multivariable analysis was used to identify factors associated with completion of testing. Results: Visit provider and triage nurse were highly associated with both acceptance of screening and completion of testing, as were younger age, male gender, and race/ethnicity. 23.5% of patients completed tests, although 36.0% requested screening; time constraints as well as risk perceptions by both the provider and patient were cited as limiting completion of screening. Post-pilot surveys showed mixed support for ongoing HIV screening in this setting by providers and little support by nurses. Conclusions: Visit provider and triage nurse were strongly associated with acceptance of testing, which may reflect variable opinions of HIV screening in this setting by clinical staff. Among patients accepting screening, visit provider remained strongly associated with completion of testing. Despite longstanding recommendations for non-targeted HIV screening, further changes to improve the testing and results process, as well as provider education and buy-in, are needed to improve screening rates

A Coding System to Measure Elements of Shared Decision Making During Psychiatric Visits

Objective: Shared decision making is widely recognized to facilitate effective health care. The purpose of this study was to assess the applicability and usefulness of a scale to measure the presence and extent of shared decision making in clinical decisions in psychiatric practice. Methods: A coding scheme assessing shared decision making in general medical settings was adapted to mental health settings, and a manual for using the scheme was created. Trained raters used the adapted scale to analyze 170 audio-recordings of medication check-up visits with either psychiatrists or nurse practitioners. The scale assessed the level of shared decision making based on the presence of nine specific elements. Interrater reliability was examined, and the frequency with which elements of shared decision making were observed was documented. The association between visit length and extent of shared decision making was also examined. Results: Interrater reliability among three raters on a subset of 20 recordings ranged from 67% to 100% agreement for the presence of each of the nine elements of shared decision making and 100% for the agreement between provider and consumer on decisions made. Of the 170 sessions, 128 (75%) included a clinical decision. Just over half of the decisions (53%) met minimum criteria for shared decision making. Shared decision making was not related to visit length after the analysis controlled for the complexity of the decision. Conclusions: The rating scale appears to reliably assess shared decision making in psychiatric practice and could be helpful for future research, training, and implementation efforts

Real-Time Feedback of Air Quality in Children’s Bedrooms Reduces Exposure to Secondhand Smoke

Introduction:Secondhand smoke (SHS) exposure creates health risks for nonsmokers and is especially detrimental to children. This study evaluated whether immediate feedback in response to poor indoor air quality in children’s bedrooms can reduce the potential for SHS exposure, as measured by adherence to a World Health Organization (WHO) indoor air standard.Methods:Homes that contained children and an adult who regularly smoked inside (n=298) had an air particle monitor installed in the child’s bedroom. These devices measured the concentration of particulate matter (PM2.5) for approximately three months and, for half of the participants, immediately provided aversive feedback in response to elevated PM2.5. Hierarchical linear models were fit to the data to assess whether the intervention increased the probability that: 1) a given day was below the WHO guideline for daily exposure, and 2) a household established and maintained a smoke-free home (SFH), operationalized as achieving 30 consecutive days below the WHO guideline. The intervention’s impact was calculated as groupby- time effects.Results:The likelihood that a child’s bedroom met the WHO indoor air quality standard on a given day increased such that the baseline versus post-baseline odds ratio (OR) of maintaining indoor PM2.5 levels below the WHO guideline was 2.38 times larger for participants who received the intervention. Similarly, the baseline versus post-baseline OR associated with achieving an SFH was 3.49 times larger for participants in the intervention group.Conclusions:The real-time intervention successfully drove clinically meaningful changes in smoking behavior that mitigated indoor PM2.5 levels in children’s bedrooms and thereby reduced SHS exposure. These results demonstrate the effectiveness of targeting sensitive microenvironments by giving caregivers actionable information about children’s SHS risks. Future extensions should examine additional microenvironments and focus on identifying the potential for SHS exposure before it occurs

Why coordinated distributed experiments should go global

The performance of coordinated distributed experiments designed to compare ecosystem sensitivity to global-change drivers depends on whether they cover a significant proportion of the global range of environmental variables. In the present article, we described the global distribution of climatic and soil variables and quantified main differences among continents. Then, as a test case, we assessed the representativeness of the International Drought Experiment (IDE) in parameter space. Considering the global environmental variability at this scale, the different continents harbor unique combinations of parameters. As such, coordinated experiments set up across a single continent may fail to capture the full extent of global variation in climate and soil parameter space. IDE with representation on all continents has the potential to address global scale hypotheses about ecosystem sensitivity to environmental change. Our results provide a unique vision of climate and soil variability at the global scale and highlight the need to design globally distributed networks.Fil: Yahdjian, María Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; ArgentinaFil: Sala, Osvaldo Esteban. Indiana University; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Piñeiro Guerra, Juan Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; ArgentinaFil: Knapp, Alan K.. State University of Colorado - Fort Collins; Estados UnidosFil: Collins, Scott L.. University of New Mexico; Estados UnidosFil: Phillips, Richard P.. State University of Colorado - Fort Collins; Estados UnidosFil: Smith, Melinda D.. State University of Colorado - Fort Collins; Estados Unido