Delayed Cord-clamping in Term and Preterm Infants: Nursing Strategies to Facilitate Implementation

Newborns have been shown to benefit from delayed umbilical cord clamping after birth by the extra transfusion of placental blood. Enhanced placental transfusion is known to increase blood volume, red blood cells and improve the oxygenation of vital organs in both term and preterm infants. There continues to be however, a need for further research including issues such as optimal timing of the delay, eligibility and appropriateness of those newborns requiring resuscitation, and the ideal position to hold the infant prior to cord clamping. Changes in clinical practice have been slow to take hold because of these issues, along with lingering opinions about personal practice and resistance to change. This paper reviews the literature for gaps in research and knowledge and examines the baiters to practice change. Nurses can contribute to facilitating delayed cord clamping by understanding the research, providing education, advocating for patients and collaborating with care providers and staff. Labor and delivery staff education is included in the form of a PowerPoint presentation which outlines the research, known barriers to change and practical ways that nurses can continue to be leaders in patient car

Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions

BACKGROUND: Patient delay in seeking health care for heart attack symptoms is a continuuing problem in the United States. METHODS: Investigators conducted focus groups (N = 34; 207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative evaluation to develop a multi-center randomized community trial (the REACT Project). Target groups included adults with previous heart attacks, those at higher risk for heart attack, and bystanders to heart attacks. There were also subgroups reflecting gender and ethnicity (African-American, Hispanic-American, White). FINDINGS: Patients, bystanders, and those at higher risk expected heart attack symptoms to present as often portrayed in the movies, that is, as sharp, crushing chest pain rather than the more common onset of initially ambiguous but gradually increasing discomfort. Patients and those at higher risk also unrealistically judge their personal risk as low, understand little about the benefits of rapid action, are generally unaware of the benefits of using EMS/9-1-1 over alternative transport, and appear to need the permission of health care providers or family to act. Moreover, participants reported rarely discussing heart attack symptoms and appropriate responses in advance with health care providers, spouses, or family members. Women often described heart attack as a male problem, an important aspect of their underestimation of personal risk. African-American participants were more likely to describe negative feelings about EMS/9-1-1, particularly whether they would be transported to their hospital of choice. CONCLUSIONS: Interventions to reduce patient delay need to address expectations about heart attack symptoms, educate about benefits and appropriate actions, and provide legitimacy for taking specific health care-seeking actions. In addition, strategy development must emphasize the role of health care providers in legitimizing the need and importance of taking rapid action in the first place