Potential Economic Impact of a Coordinated Home Visitation Program: Preventing Adverse Birth Outcomes

Background and Purpose Evidence about the efficacy of healthy pregnancy home visitation programs is needed in California’s underserved Hispanic population, where preterm birth rates are higher than nonHispanic Whites. This study describes birth outcome data in a sample of families participating in the MOMS Orange County home visitation program. Methods: A descriptive comparative design was used. Birth outcome data for 1,102 women who participated in MOMS Orange County and had a live birth in 2010 were compared with data from the county of Orange (N = 38, 237) and the state of California (N = 509, 979) for the same time period, derived from county and state birth and death reports. Measures included social background, birth outcomes, and potential cost savings. Results: Although MOMS program mothers were less educated and had a higher level of poverty compared to both county and state samples, they had significantly fewer preterm births compared with the countywide and statewide samples. It was estimated that the provision of a home visitation program both countywide and statewide would result in a potential cost saving that $1.1 and$ 2.1 million, respectively. Conclusion: This coordinated prenatal program may improve birth outcomes among communities of impoverished women at potentially reduced costs

Impact of a disease-management program on symptom burden and health-related quality of life in patients with idiopathic pulmonary fibrosis and their care partners

Patients were recruited from the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, located within the University of Pittsburgh Medical Center. Idiopathic pulmonary fibrosis results in scarring of the lung and respiratory failure, and has a median survival of 3 to 5 years from the time of diagnosis. The purpose of this study was to determine whether patients with idiopathic pulmonary fibrosis and their care partners could be more optimally managed by a disease-management intervention entitled “Program to Reduce Idiopathic Pulmonary Fibrosis Symptoms and Improve Management,” which nurses delivered using the format of a support group. We hypothesized that participation would improve perceptions of health-related quality of life (HRQoL) and decrease symptom burden

Irritability: A concept analysis

Irritability is a term used to describe feelings of anger, annoyance and impatience, and is commonly experienced by individuals in daily life. However, there are diverse conceptualizations of irritability in public and clinical research, which often result in confusing irritability with anger and other overlapping concepts. This, in turn, leads to a lack of conceptual clarity. Accordingly, the purpose of this concept analysis was to explore the irritability concept, including its definitions, defining characteristics, antecedents, consequences and empirical referents. The findings showed that irritability is predominantly conceptualized as a psychophysiological concept in the literature. We demonstrated that irritability can be differentiated from overlapping concepts like anger by qualities, such as 'unpredictability and lowered emotion control', 'lowered threshold for negative emotional stimuli', 'being manifested in response to frustrative situations or physiological needs' and 'experience of disproportionate and unjustified emotional irritation'. Importantly, severe irritability prospectively predicts psychiatric disorders and greater impairments in health, financial, educational and social functioning in individuals. Taken together, our analysis showed that one should take into account the context, duration, intensity and importantly outcomes, when assessing irritability in an individual. Considering these findings and the presence of irritability in nursing practice, it is crucial for nurses to recognize and successfully identify this concept in the nursing care they provide within the diverse settings and patient populations

Feasibility of a Caregiver Assisted Exercise Program for Preterm Infants

PurposeMounting evidence shows that low birth weight and prematurity are related to serious health problems in adulthood, including increased body fat, decreased fitness, poor bone mineralization, pulmonary problems, and cardiovascular disease. There is data to suggest that increasing physical activity in preterm infants will have effects on short term muscle mass and fat mass, but we also hypothesized that increasing physical activity early in life can lead to improved health outcomes in adulthood. Because few studies have addressed the augmentation of physical activity in premature babies, the objective of this study was to evaluate the feasibility of whether caregivers (mostly mothers) can learn from nurses and other health care providers to implement a program of assisted infant exercise following discharge.Study Design and MethodsTen caregivers of preterm infants were taught by nurses, along with occupational therapists and other health care providers, to perform assisted infant exercise and instructed to conduct the exercises daily for approximately three weeks. The researchers made home visits and conducted qualitative interviews to understand the caregivers’ (mostly mothers’) experiences with this exercise protocol. Quantitative data included a caregiver’s daily log of the exercises completed to measure adherence as well as videotaped caregiver sessions, which were used to record errors as a measure of proficiency in the exercise technique.ResultsOn average, the caregivers completed a daily log on 92% of the days enrolled in the study and reported performing the exercises on 93% of the days recorded. Caregivers made an average of 1.8 errors on two tests (with a maximum of 23 or 35 items on each, respectively) when demonstrating proficiency in the exercise technique. All caregivers described the exercises as beneficial for their infants, and many reported that these interventions fostered increased bonding with their babies. Nearly all reported feeling “scared” of hurting their babies during the first few days of home exercise, but stated that fears were alleviated by practice in the home and further teaching and learning.Clinical ImplicationsCaregivers were willing and able to do the exercises correctly, and they expressed a belief that the intervention had positive effects on their babies and on caregiver-infant interactions. These findings have important implications for nursing practice because nurses are in key positions to teach and encourage caregivers to practice these exercises with their newborn babies

Maternal perceptions of infant exercise in the neonatal intensive care unit.

ObjectiveTo identify important factors that influence mothers' perceptions of engaging in exercise with their preterm infants.DesignQualitative, semistructured individual interviews.SettingNeonatal Intensive Care Unit.ParticipantsThirteen mothers of preterm infants who were in the Neonatal Intensive Care Unit.MethodsTwo researchers conducted interviews with mothers in English or Spanish. Interviews were recorded, transcribed, and analyzed.ResultsMothers tended to view infant exercise as beneficial but feared for the safety of their infants. They perceived nurses as experts who could safely exercise their infants but feared that they themselves might harm their infants. Factors that influenced their beliefs included previous experiences with infant exercise and views regarding the fragility or the strength of their own infants. Mothers identified nurses, doctors, family members, and research studies as trusted sources of information on exercise efficacy and safety.ConclusionUnderstanding and addressing mothers' perceptions is a crucial component of a nursing intervention that teaches parents to do assisted exercises at home with their preterm infants