Showing papers in "MCN: The American Journal of Maternal/Child Nursing in 1998"

Prevalence of Feeding Tube Placement Errors & Associated Risk Factors In Children

Abstract: PURPOSE The purpose of this study was to determine the prevalence of feeding tube placement errors in children. DESIGN AND METHODS The hospital records of 201 children having both an enteral tube and at least one radiograph showing tube placement were retrospectively reviewed. Chart review was also used to determine the risk factors associated with these errors. Tube placement error was defined as tube tip or orifices in the esophagus or intestine (if the tube was supposed to be in the stomach) or tip or orifices in the esophagus or stomach (if the tube was supposed to be in the intestine.) RESULTS On the first day, a radiograph documenting tube placement showed that 32 of the 201 children (15.9%) had tube placement errors. Overall, 53 tube placement errors were evident during the 385 observation days on which radiographs were obtained (13.8%). Of the 201 children, 42 (20.9%) had experienced tube placement errors at some time during the period reviewed. Over all radiograph days, activity level was independently related to radiographic tube placement (p = < 0.02), with more errors among active children. Also, classification regression tree analysis showed that age, level of consciousness (alert or comatose versus semicomatose), abdominal distention, vomiting, and orogastric tubes were associated with more tube placement errors. NURSING IMPLICATIONS Nurses need to be especially careful in assessing tube placement if the pediatric client has one or more of the identified risk factors. Health care providers need to carefully weigh the benefits and risks of feeding by nasal or oral enteral tubes versus the benefits and risks of feeding by endoscopically or surgically placed enteral tubes.

School-based intervention to promote coping in rural teens

Abstract: PURPOSE: To evaluate a program designed to help high school students with depressive symptomology to effectively cope. DESIGN: Two-phase experimental study. METHODS: Rural high school students (N = 222), ages 14 through 19 years, were surveyed to identify teens with depressive symptomatology, identify stressful life events and coping styles of at-risk subjects, and evaluate a cognitive-behavioral group intervention to enhance students' coping and affect levels of depression. Students with depressive symptomatology were randomized into control (n = 18) or intervention (n = 23) groups. Intervention subjects were treated with a nurse-led, 8-week cognitive skills group, conducted at school. RESULTS: On posttesting, the intervention groups demonstrated reduced depressive symptoms in females and a wider range of coping compared with controls. CLINICAL IMPLICATIONS: School-based nurses are in an ideal position to provide assessment, referral, and intervention programs in the natural setting of the school. Results of this study indicate that such programs can be implemented successfully in schools and have the potential to promote mental health in teenagers. Language: en

Abuse among Pregnant Adolescents: Differences by Developmental Age

Abstract: 72 pregnant female adolescents aged 13-15 years, 166 aged 16-17, and 341 aged 18-19 attending prenatal clinics in the greater metropolitan area of a northwestern city participated in a study to assess the incidence of abuse, including physical and sexual abuse, in that subpopulation and to determine whether such abuse is related to pregnancy planning, high school participation, substance use during pregnancy, pregnancy complications, and infant birth weight. 52% of the subjects were White, 30% were Black, 4% Native American, 4% Hispanic, 3% Asian, and 6% other. They had completed an average of 10.7 years of education, although 47% had dropped out of high school. 8.6% were married and living with their partner, 28% reported being single and cohabiting with a partner, and this was the first pregnancy for 57%. Abuse was measured using the Abuse Assessment Screen, substance abuse was measured by self-report, and birth weights were obtained from hospital records. More than 37% reported abuse, with the middle adolescents reporting the highest incidence and the oldest adolescents the least. In every age group, the incidence of low birth weight was higher among subjects who had been abused, although that difference was not statistically significant. Compared to nonabused subjects, those abused were significantly more likely to be high school dropouts, to smoke, and to have experienced bleeding during the second trimester. No differences were observed between the abused and nonabused subjects in pregnancy planning and reported use of marijuana, alcohol, or other drugs. Language: en

Reducing preterm and low birthweight births: still a nursing challenge.

Abstract: Preterm birth and low birthweight are correlated with much of the infant death seen in the United States. Despite 15 years of research, both preterm birth rates and low birthweight rates continue to increase. This article describes what is known about the prevention of preterm birth and low birthweight, and offers advice to nurses for nursing interventions that could prove effective in preventing such tragedies in the future.

Preventing abuse during pregnancy: a clinical protocol

Abstract: Routine screening for abuse with appropriate intervention during pregnancy is essential to interrupt the cycle of violence and prevent future trauma. Over a decade ago, the Surgeon General called for routine abuse assessment of pregnant women (10). If women are not assessed for abuse, violence will remain undetected and untreated, placing women at risk for escalating abuse and further trauma. Additionally, if follow-up interventions are not implemented once abuse has been confirmed, the cycle of violence will continue. Routine assessment and expanded intervention strategies that includes case management and multi-agency collaboration must become standard care for all pregnant women.

a Review of Research Instruments for Use During The Postpartum Period

Abstract: Locating existing instruments available to measure key variables is critical to the success of a research study. However, this process can be a time-consuming activity. In this article, selected instruments available for use in research during the postpartum period are reviewed. These instruments are divided into two categories. The first category deals with instruments that focus on mothers only. These questionnaires measure mothers' perceptions of their deliveries, their adaptation to motherhood, and their breastfeeding experiences. The second category centers on instruments that both parents can complete. These instruments measure parents' perceptions of their parenting role, sense of competence, problem-solving ability, and perceptions of their newborns. The psychometric properties of each instrument are described, and selected nursing research studies that used the instrument are reviewed.

International nursing and world health. Essential knowledge for the 21st century nurse.

Abstract: As the world becomes a smaller place through international travel and instant communication, nurses must expand their notions of the populations for whom they will care and the nursing colleagues with whom they will work. This article describes some of the reasons why all nurses must become more knowledgeable about international health issues, the practice of nursing in other countries, international nursing research, and nursing education in other countries.

Lessons from an evaluation of the effectiveness of an asthma day camp

Abstract: Purpose To evaluate the effectiveness of applied teaching methodologies in a camp setting on asthma self-management skills in school-age children. Design This was a descriptive pilot study using a one-group pretest-posttest design. Sample Thirty-four subjects, ages 6 to 12 years, representing a typical clinical population of children with asthma. Methods Children's asthma knowledge, symptoms, behavior, and mastery, as well as peak-flow technique, were measured 2 to 3 weeks before camp and then again on the last day of camp. Baseline measures of parents' asthma knowledge and family stress related to asthma were obtained. Outcomes specific to asthma management, such as missed school days, emergency room visits, and hospitalizations, were evaluated by parent report the year before and after the intervention. Results Significant improvement in peak-flow technique and a reported reduction in emergency room visits and missed school days after camp were found. Clinical implications In this pilot study, the use of an applied teaching format for school-age children in an asthma day camp resulted in some learning. More rigorous design and instrumentation are important for better evaluation of programs such as this. Nurses working with these populations should plan structured evaluations of the programs so they can best meet the children's needs.

Caring and healing in the 21st century.

Abstract: As the 21st century approaches, nurses must be prepared to offer new treatment methods when caring for children. The purpose of this article is to familiarize nurses with human caring theory and complementary and alternative medicine, and to offer a practical way of integrating these methods into nursing care. Nurses can learn to choose simple, conservative, noninvasive, nonintrusive healing methods that are met with little resistance by other health care professionals. Clinical implications of the Nurse's Tool Box suggest methods such as drawing, acupressure, guided imagery, storytelling, therapeutic touch, soft music, and humor as ways to help children heal. By tapping into certain frequency currents through the use of these tools, nurses may build, repattern, or facilitate human energies to replenish children's minds, bodies, and souls, creating wholeness and harmony. By understanding human caring theory and complementary and alternative medicine, and by using a practical approach to healing, nurses in the new century can mend children in ways they never have before.

Proactive nursing: the evolution of a task force to help women with postpartum depression.

Abstract: In response to several women who presented with postpartum depression in 1 year, a group of nurses developed a task force made up of hospital nurses, obstetricians, psychiatrists, pediatricians, family practitioners, lactation specialists, home care nurses, and mental health counselors. The purposes of this task force were to educate health care professionals about postpartum depression, to help identify women who might be affected, and to develop interventions for adjusting to parenthood. This article details the evolution of that task force, and how it has assisted not only the women but also the health care providers involved.

Guiding mothers of high-risk infants in obtaining social support.

Abstract: The purpose of this article is to describe how nurses can assist the new mother of a high-risk infant, especially a preterm infant, in identifying and obtaining the social support needed to help the family adapt in the first few weeks after the birth. The interventions recommended are based on a research study conducted by the authors and colleagues and summarized within this article. Because support was more important than these mothers expected it to be, it is important that nurses in prenatal, postpartum, neonatal, home health, and extended care settings recognize the need to assist women in identifying their support needs. In addition, nurses can help the mothers identify individuals within their social network who could assist them with those needs. Meeting the social support needs of a mother is important for her own mental and physical health and well-being. It also helps her meet the social and developmental needs of her infant.

Walking a thin line : managing care for adolescents with anorexia and bulimia

Abstract: Anorexia nervosa ranks third among common chronic disorders in adolescents, surpassed only by asthma and obesity. Unfortunately, recent changes in health care and insurance have resulted in fewer resources for these vulnerable clients. Anorexia and bulimia are best managed by a treatment team, but frequently it is the nurse who manages much of the eating-disordered client's care, especially when there is no available team, or when the nurse is the primary care provider or therapist. Nurses can and do care for adolescents with anorexia and bulimia. All it takes is commitment, knowledge, and networking.

Being prepared for a pregnant code blue.

Abstract: Cardiopulmonary arrest is rare in pregnancy. To provide the most proficient care to a pregnant woman requiring cardiopulmonary resuscitation, nurses must first understand the physiologic changes that normally occur in pregnant women. This article reviews the physiologic adjustments made by the human body during pregnancy and the manner in which these can affect efforts during resuscitation. Preparation and organization are essential in implementing care during resuscitation of a pregnant woman, which is a crisis situation for everyone involved.