Nurses\u27 Own Birth Experiences Influence Labor Support Attitudes and Behaviors

Objective To describe the attitudes of intrapartum nurses about the importance of and intent to provide professional labor support (PLS); barriers to PLS, such as perceived subjective norms and perceived behavioral control; and relationships among attitudes, behaviors, and nurse and site characteristics. Design A cross-sectional, mixed-methods, descriptive design was guided by the Theory of Planned Behavior. Setting Three hospital sites in one region of a single Midwestern state. Participants Sixty intrapartum nurses participated. Methods The Labor Support Questionnaire and demographic questionnaire were administered online. The Labor Support Questionnaire is used to measure attitudes about the importance of and intended behaviors associated with labor support. Results Nurse Caring Behaviors was the highest rated PLS dimension. Participants\u27 own personal birth experiences and length of current intrapartum experience were positively correlated with attitudes about and intent to provide PLS. Barriers to PLS included staffing, documentation, physicians, use of epidural analgesia, doulas, and birth plans. Conclusion Personal birth and work experience influenced attitudes about and intent to provide PLS and demonstrated the relationships described in the Theory of Planned Behavior. Intrapartum nurses may benefit from an examination of their personal experiences to see how they might influence attitudes about PLS. Enhanced training and expanded labor and birth experience for novice nurses or students may improve attitudes and intended behavior with regard to PLS. Further investigations of the factors that affect integration of PLS into care are important to promote healthy birth outcomes

Pilot Evaluation of an Internet-based Natural Family Planning Education and Service Program

Objective: To evaluate the efficacy, knowledge of fertility, and acceptability of a web-based natural family planning (NFP) education and service program. Design: A 6-month repeated measure longitudinal evaluation pilot study. Setting: A university based online website. Participants: The website was piloted with 468 volunteer women seeking NFP services. Of these participants, 222 used the automatic online fertility charting system to avoid pregnancy. The 222 charting participants had a mean age of 29.9 years (SD=5.6), 2.2 children (SD=1.9), 37% were postpartum, and 47% had regular menstrual cycle lengths. Intervention: Nurse-managed web-based NFP education and service program. Outcomes: Pregnancies were confirmed by an online self-assessed pregnancy evaluation form. A 10-item fertility quiz and 10-item acceptability survey was administered online. Results: Among the 222 users avoiding pregnancy, at 6 months of use, there were two correct-use unintended pregnancies that provided a pregnancy rate of 2% and seven total unintended pregnancies providing a typical use pregnancy rate of 7%. Mean knowledge of fertility increased significantly from time of registration (8.96, SD=1.10) to 1 month of use (9.46, SD=.10), t=4.60, pSD=8.98) to 6 months of use (48.4; SD=8.77). Conclusion: The nurse-managed online NFP system seems to provide adequate knowledge of fertility and help participants meet pregnancy intentions. Acceptability of such a system of NFP is still in question

Perinatal Nurses: Key to Increasing African American Breast-Feeding Rates

Breast milk is the ideal source of nutrition for infants for at least the first 6 months of life. Despite women in the United States reaching national objectives for breast-feeding initiation (75%), racial disparities persist. According to the most recent data, 83% of white mothers initiated breast-feeding whereas only 66% African American mothers did so. Breast-feeding initiation may be amenable to perinatal nursing intervention. Breast-feeding may be a practice that helps bridge the racial divide in perinatal outcomes among African American families. Nurses have an essential role in embracing breast-feeding promotion and support to patients who are least likely to initiate

Parents' consent to neonatal decisions about feeding and discharge

English law requires health care practitioners to obtain parents' consent before all touching of their child. However, nurses tend to leave doctors to request parents' consent to intensive care interventions, and it is generally assumed that before parents can start to care for their baby, they need to have practitioners', mainly nurses', permission. This paper reviews examples of neonatal feeding and discharge decisions that illustrate how consent can be an undeveloped concept in nursing care. Through the sharing of information and medical decision making, the consent process involves implicit or explicit negotiation of anxiety, trust and risk. Decisions about neonatal feeding and discharge can also involve anxiety and risk, and it is suggested that, while avoiding legalistic formalities, more overt sharing of information and decisions about the options could be to the advantage of nurses, babies and parents. © 2005 Neonatal Nurses Association

Listening to the parent voice to inform person-centred neonatal care.

Family integrated care (FIC), where parents are an integral part of their baby’s care and decision-making can enhance parental involvement and empowerment, contributing to decreased parental separation and stress. It follows that parents can also be a central part of neonatal education for staff in the neonatal speciality. This paper focuses on what students and staff can learn from parents about what they feel is important to make their experience better. A narrative, interpretive approach was undertaken to collect and analyse parent interview narratives. A specific question was posed to a purposive sample of parents who have had premature babies about what health professionals can learn from them. Thematic analysis revealed five key themes relating to the importance of: communicating; listening; empathising; acknowledging (the parent’s role); realising (what matters to parents). These elements were incorporated into a framework named by the mnemonic, ‘CLEAR’. This highlights what parents want staff to be cognisant of when caring for them and their babies. Learning from the parents in our care enables a greater understanding of their experiences at difficult and challenging times. Having a deeper understanding of parents’ experiences can contribute to enhanced empathic learning.Peer reviewedFinal Accepted Versio

An approach that helps break down gender stereotypes: Research and Commentary

Globally, the use of the skin to skin (STS) contact, also known as kangaroo care, has become widely used within neonatal units. Evidence suggests that STS has a number of significant benefits for both premature infants and their parents. Benefits include physiological stabilization of the infant such as improvement of gas exchange and body temperature regulation, and can provide pain relief. STS has also been found to promote the development of human attachment and bonding and facilitates and improves breastfeeding. Despite well researched benefits of STS, little evidence is available on the psychological benefits of STS for parents, in particular fathers

Expectations for nursing care in newborn units in Kenya: moving from implicit to explicit standards.

Neonatal mortality currently accounts for 45% of all child mortality in Kenya, standing at 22 per 1000 live births. Access to basic but high quality inpatient neonatal services for small and sick newborns will be key in reducing neonatal mortality. Neonatal inpatient care is reliant on nursing care, yet explicit nursing standards for such care do not currently exist in Kenya. We reviewed the Nursing Council of Kenya 'Manual of Clinical Procedures' to identify tasks relevant for the care of inpatient neonates. An expert advisory group comprising major stakeholders, policy-makers, trainers, and frontline health-workers was invited to a workshop with the purpose of defining tasks for which nurses are responsible and the minimum standard with which these tasks should be delivered to inpatient neonates in Kenyan hospitals. Despite differences in opinions at the beginning of the process, consensus was reached on the minimum standards of neonatal nursing. The key outcome was a comprehensive list and grouping of neonatal nursing task and the minimum frequency with which these tasks should be performed. Second, a simple categorisation of neonatal patients based on care needs was agreed. In addition, acceptable forms of task sharing with other cadres and the patient's family for the neonatal nursing tasks were agreed and described. The process was found to be acceptable to policy-makers and practitioners, who recognised the value of standards in neonatal nursing to improve the quality of neonatal inpatient care. Such standards could form the basis for audit and quality evaluation

Predictors and Outcomes of Postpartum Mothers\u27 Perceptions of Readiness for Discharge after Birth

Objective: To identify predictors and outcomes of postpartum mothers\u27 perceptions of their readiness for hospital discharge. Design: A correlational design with path analyses was used to explore predictive relationships among transition theory-related variables. Setting: Midwestern tertiary perinatal center. Participants: One hundred and forty-one mixed-parity postpartum mothers who had experienced vaginal birth or Cesarean delivery of normal healthy infants. Methods: Before hospital discharge, patients completed questionnaires about sociodemographic characteristics, hospitalization factors, quality of discharge teaching, and readiness for discharge. Three weeks postdischarge, mothers were contacted by telephone to collect coping difficulty and health care utilization data. Main Outcome Measures: Readiness for Hospital Discharge Scale, Post-Discharge Coping Difficulty Scale, Utilization of postdischarge services. Results: Quality of discharge teaching, specifically the relative difference in the amount of informational content needed and received and the skills of nurses in delivering discharge teaching, explained 38% of the variance in postpartum mothers\u27 perceptions of discharge readiness. Readiness for discharge scores explained 22% of the variance in postdischarge coping difficulty scores. Nurses\u27 skills in delivery of discharge teaching, coping difficulty, patient characteristics, and birth hospitalization factors were predictive of utilization of family support and postdischarge health care services. Conclusion: A trajectory of influence was evident in the sequential relationships of quality of discharge teaching, readiness for discharge, postdischarge coping, and utilization of family support and health care services. Transitions theory provided a useful framework for conceptualizing and investigating the transition home after childbirth

Cohort Efficacy Study of Natural Family Planning among Perimenopause Age Women

Objective: To determine the efficacy of using natural family planning (NFP) methods to avoid unintended pregnancy among women of perimenopause age (i.e., age 40-55 years). Design: A secondary analysis of subset data from two prospective observational cohort studies. Setting: A university based in-person and online NFP service program. Participants: One hundred and sixty couples who used either a website or an in-person NFP service to learn how to avoid pregnancy from January 2001 to November 2012. Methods: A prospective 12-month effectiveness study among 160 women (between ages 40-55) who used NFP to avoid pregnancy. The women used either a hormonal fertility monitor, cervical mucus monitoring, or both to estimate the fertile phase of their menstrual cycles. Survival analysis was used to determine the pregnancy rate over 12 months of use. Results: There were a total of five unintended pregnancies among the participants. The typical use pregnancy rate was six per 100 women over 12 months. The monitor alone participants (n = 35) had a 12-month pregnancy rate of three, the participants (n = 73) who used mucus alone had a pregnancy rate of four, and the participants (n = 42) who used the fertility monitor plus mucus had a pregnancy rate of six. Conclusion: Natural family planning methods can be effective for older women to avoid an unintended pregnancy with correct use and adequate instructions. The pregnancy rate most likely was affected by diminished fertility and motivation to limit family size

“An unsuitable job for a woman? Gender and mental health nursing.”

On the evening of Wednesday 12th May 1920 a demonstration took place in the city of Wakefield, in West Yorkshire. According to the ‘Wakefield Express,’ a large procession with banners flying, and with the city’s band at its head, marched through the streets of Wakefield to the Green Market, where a large crowd had assembled. Two lorries acted as platforms for a series of speakers. Speakers on the platform included union officials, local councillors and representatives from the Discharged Sailors’ and Soldiers’ Association. Mr GW Newsome, secretary of the Wakefield branch of the National Asylum Workers’ Union (NAWU), proposed the following motion, ‘That this mass meeting … deplores the continued employment of female labour in male wards at the West Riding Mental Hospital – work which prior to the war was performed by men.