Showing papers in "MCN: The American Journal of Maternal/Child Nursing in 2002"

Oral health during pregnancy.

Abstract: The purpose of this article is to explore how poor oral health affects pregnancy and to review current recommendations for dental care during pregnancy. While nurses are concerned with numerous aspects of the health of pregnant women, the health of maternal and fetal dentition may be overlooked. However, due to recent findings that periodontal disease may be a risk factor for preterm low birthweight, nurses and other maternal healthcare providers are becoming more aware of oral health during pregnancy. It is important to understand that establishing a healthy oral environment is the most important objective in planning the dental care for the pregnant patient. This objective is achieved by adequate plaque control (brushing and flossing) and professional prophylaxis including coronal scaling, root planing, and polishing. Nurses, nurse practitioners, and nurse-midwives should include assessment of maternal dentition and referral for dental problems as part of their prenatal practice. Patients should be encouraged to schedule elective dental treatment during the second trimester but seek prompt care for acute dental problems. Teaching related to oral health during pregnancy should include the importance of proper nutrition to ensure maternal and fetal oral health, including taking prenatal vitamins and eating foods high in protein, calcium, phosphorus, and vitamins A, C, and D. Potential teratogens that may be encountered during dental care should also be discussed. Nurses can be vital in improving perinatal outcomes and maternal/fetal dental health through screening, referral, and education of their pregnant clients.

Kangaroo care: National Survey of Practice, Knowledge, Barriers, and Perceptions.

Abstract: Purpose A national survey was conducted to assess practice, knowledge, barriers, and perceptions regarding Kangaroo Care (KC)--the holding of diaper-clad preterm infants skin-to-skin, chest-to-chest by parents. Design A descriptive survey was conducted. Methods Kangaroo Care Questionnaires (KCQs), developed for the study, were sent to nurse managers in all hospitals in the United States that were identified as providing neonatal intensive care services (N = 1,133), and were to be completed by the nurse most familiar with the practice of KC in that unit. A second KCQ was sent to non-respondents. Descriptive statistics were used to summarize the data. Results A response rate of 59% (N = 537) was achieved. Over 82% of the respondents reported practicing KC in their neonatal intensive care units (NICUs). Nurses were knowledgeable about KC. Major barriers to practicing KC for certain types of infants were infant safety concerns, as well as reluctance by nurses, physicians, and families to initiate or participate in KC. Many NICUs do not permit KC for certain types of infants (e.g., those on vasopressors or high-frequency ventilation). Over 60% of respondents agreed that low gestational age or weight were not contraindications. Respondents from NICUs in which KC is practiced were more positive in their perceptions than respondents from NICUs that do not practice KC. Clinical implications The findings suggest that in order to overcome barriers to the practice of KC, nurses need educational offerings highlighting the knowledge and skills needed to provide KC safely and effectively. These educational offerings should also emphasize the value of KC to infants and parents. In addition, knowledgeable practitioners need to develop evidence-based policies and procedures that will lead to successful KC.

Theoretical perspectives of postpartum depression and their treatment implications.

Abstract: Approximately 13% of new mothers experience postpartum depression. This crippling mood disorder wreaks havoc not only on the mothers themselves but also on their entire families. Between 25% and 50% of mothers with postpartum depression have episodes lasting 6 months or longer. The most significant factor in the duration of the postpartum depression is the length of delay to adequate treatment. The purpose of this article is to describe five different theoretical perspectives of postpartum depression and the interventions for treatment derived from each: the medical model, feminist theory, attachment theory, interpersonal theory, and self-labeling theory. Crucial to clinicians' choice of treatment of postpartum depression is the theoretical lens they use to view this devastating mood disorder. Nursing implications derived from these theoretical perspectives are addressed.

Mothering multiples: a meta-synthesis of qualitative research.

Abstract: Increasing numbers of qualitative studies in maternal-child nursing are being published. However, clinical application and knowledge development based on those studies will be hampered unless the rich understandings gleaned from these individual studies can be synthesized. Meta-synthesis is one technique to help accumulate knowledge from qualitative research. The first section of this article explains the technique of meta-synthesis and reviews meta-syntheses published in nursing. The focus then becomes an illustration of a meta-synthesis in maternal-child nursing: Mothering multiples during the first year of life. Six qualitative studies comprised the sample for the meta-synthesis. The meta-synthesis revealed a shared set of five themes that help increase our understanding of mothering multiples: "bearing the burden," "riding an emotional roller coaster," "lifesaving support," "striving for maternal justice," and "acknowledging individuality." Implications for practice derived from this meta-synthesis are addressed.

An exploration of health concerns & health-promotion behaviors in pregnant women over age 35.

Abstract: PURPOSE To explore the specific health concerns and health-promotion behaviors of childbearing women 35 years of age or older. STUDY DESIGN AND METHODS Semistructured interviews with women ( = 50) ages > or =35 in their third trimester of pregnancy. Interviews lasted approximately 1 hour, were conducted by two nursing faculty, and were scheduled to accommodate participant needs. Process recording was used to document participant responses. Verbatim statements were recorded, and subjects were redirected to clarify responses when necessary. Content analysis and coding were completed by an independent researcher, based upon techniques derived from Miles and Huberman (1994). Data reduction was accomplished by the identification of categories of responses that described the participants' meaning. RESULTS Study participants reported concerns reflecting both fetal well-being and maternal health-related issues. The majority of childbearing women (86%) reported engaging in multiple health-promotion behaviors focusing on daily nutritional intake, lifestyle activities, and rest patterns. Participants reported conscientious decisions to eliminate substances recognized as harmful, and to alter exercise, employment, or daily responsibilities to accommodate physical changes during pregnancy. Participants were "proactive healthcare seekers," accessing information from a variety of sources and seeking services to meet their individualized needs. CLINICAL IMPLICATIONS The multitude and frequency of health-promotion behaviors adopted by those > or =35 years of age during pregnancy is indicative of this group's ability to independently initiate change, and exceeds the percentages previously reported. The nurse can be influential in supporting lifestyle modifications adopted during the childbearing period as permanent health-promotion behaviors.

Comparing pregnant women's nutritional knowledge to their actual dietary intake.

Abstract: PURPOSE The purpose of this study was to describe differences between low-and middle-income pregnant women's general nutritional knowledge, usual dietary intake and weight gain. STUDY DESIGN AND METHODS A descriptive design employing a questionnaire with a convenience sample of women (N = 109) from both childbirth education classes and a free prenatal clinic. RESULTS Women with a low prepregnant body mass index (BMI) gained less weight, and women with high BMI tended to gain more weight than recommended. Most women had inadequate general nutritional knowledge, and their dietary intake did not meet all the nutritional requirements of pregnancy. Women attending the free prenatal clinic had more accurate knowledge of the recommended number of servings for some food groups (fruits and vegetables, meats and dairy) than women in childbirth education classes. No differences were noted between the groups in total weight gain. CLINICAL IMPLICATIONS Further research is needed to evaluate pregnant women's nutritional knowledge and actual dietary practices, to develop effective strategies designed to promote adequate nutritional intake in pregnant women, and to help women remain within the Institute of Medicine (IOM) weight gain recommendations. Consistent individualized nutritional assessment and counseling during pregnancy could provide a foundation for continued healthy eating habits during the postpartum period and possibly throughout the woman's life.

Health beliefs and practices among Arab women.

Abstract: The purpose of this article is to describe the healthcare beliefs and practices of Arab American women, specifically those regarding menstruation, pregnancy, childbirth, and family planning. The information in this paper is derived from the author's experience as a researcher, as an Arab healthcare provider, and from the literature. Guidelines for nurses who provide care to Arab American women are also presented.

An ecological approach to breastfeeding.

Abstract: Purpose Current numbers of breast-feeding mothers are well below Healthy People 2010 goals of 75% in the early postpartum period, 50% at 6 months, and 25% at 1 year. A promising line of research is the use of an ecological model for breastfeeding that includes factors traditionally examined in breastfeeding (mother/infant and family) as well as mesosystem and exosystem sources of influence on families (healthcare delivery system, community, and societal/cultural). Study design and methods A telephone survey was conducted with 95 primiparous, postpartum women using closed and open-ended items. Content analysis was used with the transcribed comments from these telephone interviews, to test the fit of a preexisting ecological model for breastfeeding. Results The comments of postpartum women provided a rich source of information about the many mother-infant, family, healthcare delivery system, community, and societal/cultural factors that influence breastfeeding. These all fit the ecological breast-feeding model proposed. Clinical implications Efforts to improve rates of breastfeeding in this country to meet year 2010 goals must consider the many contextual factors that influence feeding. Interventions to promote breastfeeding should exceed the individual level, and occur at many layers simultaneously. The ecological model provides direction for the multiple interventions needed to increase rates and duration of breastfeeding.

Weighing preterm infants before & after breastfeeding: does it increase maternal confidence and competence?

Abstract: Purpose To determine whether weighing preterm infants before and after breastfeeding ("test weighing") affects maternal confidence and competence. Methods A longitudinal, repeated measures control group study. Sixty mothers of preterm infants were randomly assigned to a test weight or nontest weight group. In the test weight group, nurses weighed infants before and after every breastfeeding while they were in hospital. Maternal confidence and competence were measured four times: (a) at 3 days after the initiation of breastfeeding, (b) at infants' discharge from hospital, (c) at 1 week postdischarge, (d) at 4 weeks postdischarge. Results No significant differences in maternal confidence and competence at any of the measurement times were found. When change over time was examined using MANOVAs, the levels of competence and confidence in both groups had increased significantly. Clinical implications The development of maternal confidence and competence in this group was independent of test weighing during hospitalization and calls into question claims that such interventions are necessary to develop competence or confidence in mothers of preterm infants.

Strategies to promote medication adherence in children with asthma.

Abstract: Asthma, the most common chronic disease in childhood, continues to be associated with high rates of morbidity and mortality, despite improved treatment protocols. Lack of adherence to individual treatment plans has been implicated in these poor outcomes. The purpose of this article is to assist the nurse in identifying obstacles that might limit adherence to treatment, and offer practical suggestions for promoting adherence in pediatric patients. The reasons that children and children's families fail to adhere to individual treatment plans include financial barriers, misconceptions about asthma, cultural influences, and mistaken health beliefs. In addition, family education about asthma management can be inadequate. An efficiently run asthma program, which includes family education, easy telephone access to the provider, prompt attention during exacerbations, and frequent follow-up, can improve adherence. By eliminating barriers to adherence and maintaining open communication and consistent positive support, nurses can help children with asthma attain and maintain the highest quality of life.

Primary care of the premature infant discharged from the neonatal intensive care unit.

Abstract: Premature infants require varying degrees of newborn intensive care and have a wide range of physical and developmental outcomes. Subsequent ambulatory care for these infants is often complex. Although tertiary hospitals often provide multidisciplinary follow-up clinics, the pediatric nurse practitioner (PNP) responsible for primary care has a unique opportunity to influence the lives of these special babies and their families. While the basic principles of well child care and health maintenance apply to this special population, there are several inherent challenges. The transition from neonatal intensive care unit (NICU) to home can be stressful for families. Infants born prematurely often have unpredictable behavior and present with cues that are vague and unclear to caregivers. Growth must be monitored adjusting for prematurity, and nutrition must be tailored to the physical and developmental level of the infant. Assessments of development, vision, and hearing must also be adjusted for prematurity. Fortunately, the majority of premature infants discharged from the NICU thrive and develop normally. However, some will experience medical problems and developmental delay. Knowledge of complications common to premature infants will be helpful to the PNP providing primary care. These include difficulties of growth and feeding, gastroesophageal reflux, apnea and bradycardia, chronic lung disease, fine and gross motor abnormalities, and other learning problems. Providing care to the NICU graduate is one of the challenges faced by PNPs in primary care, but one that is both rewarding and enjoyable.

"I felt violated": women's experience of childbirth-associated anger.

Abstract: Purpose To investigate the lived experience of childbirth-associated anger. Design Descriptive phenomenology. Methods Open-ended interviews were conducted with 10 women who had experienced the phenomenon of interest and volunteered to participate. All of the women had experienced vaginal delivery of term or near-term infants without anomalies or birth sequelae of note. Interviews were recorded on audio tape, transcribed verbatim, and analyzed for themes by an interdisciplinary group of researchers. Results Women’s narratives described violation of the implicit relational contract with their healthcare providers. Themes focused on the anger experienced when their expectations about trust, power, control, and being kept informed were not met. Clinical Implications Nursing implications include the need to educate women prenatally about the process of labor and delivery, establish relationships that convey care and concern, keep women informed about events and progress, and treat women as full participants in the decision-making process.

"Waiting" as experienced by women hospitalized during the antepartum period.

Abstract: PURPOSE To better understand the lived experience of "waiting" among women who are hospitalized during the antepartum period. STUDY DESIGN AND METHODS Phenomenology based on Parse's theory of human becoming. Audiotapes were made of dialogues between the participants and the researcher. Participants were asked to respond to this question: "Tell me what your experience of 'waiting' is like." The sample consisted of 14 hospitalized women. RESULTS Unpredictable as well as paradoxical realities of waiting evolved that differed person to person, yet each participant's dialogue reflected waiting as an enduring vigil of burdening toil while engaging-disengaging with close others in cherishing the can-be. CLINICAL IMPLICATIONS Listening to what antepartum women really feel about waiting can give direction to nursing care. Women wanted to know that nurses supported their efforts to carry their babies to full term. This study helps us to see that although most of western society does not value waiting, perhaps there is unseen value in waiting. The women in this study realized the agony of waiting, but understood its importance for the health of their babies. Research such as this which encourages active listening and reflecting on women's stories can help to improve nursing practice and healthcare for women.

Keep a blank face. I need to tell you what has been happening to me

Abstract: PURPOSE: To explore adolescents' experiences of abuse in the year before and during pregnancy. METHODS: This prospective study used structured and focused interviews and content analysis. Forty teens' stories of abuse were extracted from focused interview questions during a larger study of pregnant adolescents aged 18 to 20. Elements of the stories were coded and categorized according to content and meaning. Seven themes were identified using a generalized qualitative approach that blended content and thematic analysis. RESULTS: Teens reported abuse from a variety of individuals, including intimate partners, former partners, and family members. Thirteen of the 40 teens reported being pregnant in the year before the index pregnancy, with 11 of the pregnancies ending in miscarriage, elective abortion, or fetal demise. Four of the pregnancy losses were directly attributed to abuse. Seven themes were identified that reflected the teens' stories of violence: seeking safety (self-protection with risks and benefits); losing faith (negative experiences with police and social justice institutions); experiencing loss (compromised reproductive health); living on the edge (substance abuse concerns); taking the next step (developmental concerns); crying out for help (suicide attempts); and changing and temporary relationships (loss of family bonds and serial monogamy). CLINICAL IMPLICATIONS: Routine screening for violence prior to and during pregnancy should include questions about past pregnancies, sexual abuse, and multiple perpetrators, as well as perpetrators other than intimate partners. Adolescent developmental concerns should be incorporated in safety planning and advocacy interventions. Language: en

A call to action. Acculturation level and family-planning patterns of Hispanic immigrant women.

Abstract: Purpose: To describe family-planning patterns of Hispanic women and to determine their relationship to acculturation level and to selected maternal demographic pregnancy and infant birth indices. Design: Descriptive correlational. Methods: A convenience sample of 376 Hispanic women was drawn from prenatal clinics in a large public teaming hospital in the Southwest United States. Acculturation status was assessed during the prenatal period using the Acculturation Rating Scale for Mexican Americans II. Maternal data concerning pregnancy infant birth postpartum and family planning were abstracted from the hospital record. Data were analyzed using descriptive correlational and multiple regression procedures. Results: Most women were of Mexican origin first generation in the United States and oriented toward traditional Mexican cultural beliefs and values. Most were married had less than an eighth-grade education and experienced a first or second healthy pregnancy with healthy birth outcomes. Over 66% of the women returned for at least one visit in the first year postbirth; compliance at 1 yr declined to 28%. Five variables were significantly correlated with family-planning visit compliance: number of pregnancies generation in the United States acculturation level trimester of first prenatal visit number of prenatal visits and gestational age of newborn. Clinical implications: Nurses are in a pivotal position to educate the Mexican immigrant woman about healthcare for herself and for her family but need to recognize cultural influences on family-planning behavior. Effective interventions build on existing knowledge beliefs and practices of traditional immigrant women. It is important to include the generation in the United States as an indicator of adherence to traditional values and beliefs. (authors)

A descriptive study of women's perceptions of their asthma during pregnancy.

Abstract: PURPOSE To determine the impact of asthma during pregnancy from the perspective of the pregnant woman. STUDY DESIGN AND METHODS A descriptive survey using the Internet for subject recruitment and data collection was conducted using an adaptation of the Cancer Survivors Survey Questionnaire. Women with asthma who were pregnant or who had recently given birth (n = 166) were the sample. Women responded from the United States, Canada, Europe, and Asia. Physical symptoms, emotional responses, and coping strategies to deal with the asthma were queried. RESULTS Women reported a variety of respiratory difficulties including wheezing, coughing, and shortness of breath. They were concerned about avoiding triggers leading to acute asthma, the effect of the asthma medications on the fetus, and losing their jobs due to absenteeism. They wanted to know more about how to prevent an asthma attack and what effect their disease could have on their unborn infants. CLINICAL IMPLICATIONS Women need education and support to help them deal with asthma during pregnancy. Nursing can have an important role in teaching these women and helping them monitor their asthma status during pregnancy.

Self-hypnosis: alternative anesthesia for childbirth.

Abstract: The purpose of this article is to inform nurses about the use of self-hypnosis in childbirth. Hypnosis is a focused form of concentration. Self-hypnosis is one form of hypnosis in which a certified practitioner or therapist teaches an individual to induce his or her own state of altered consciousness. When used for childbirth pain, the primary aim of self-hypnosis is to help the woman maintain control by managing anxiety and discomfort though inducing a focused state of relaxation. Before the widespread use of pharmaceuticals for pain, hypnosis was one of the few pain relief methods available for labor. However, as new technologies for pain relief emerged, hypnosis received less attention. Most nurses have little experience with hypnosis, and there is limited information available in the literature. However, because nurses are at laboring women's bedsides, it is important that nurses learn about self-hypnosis to be able to inform pregnant women fully about all pain control options and to maximize the benefits for the woman choosing hypnosis.

The nurse practitioner role in the NICU as perceived by parents.

Abstract: Purpose The aim of this study was to understand and describe the nature of nurse practitioner care delivery in the newborn intensive care unit (NICU) as perceived by parents of critically ill neonates. Design This qualitative study used a phenomenologic approach to answer the research question: "What is the lived experience of parents whose babies were cared for by a nurse practitioner in the NICU? Methods Consistent with phenomenologic methods, eight parents were asked: "What was it like for you to have a nurse practitioner care for you and your baby?" Parents whose babies had within the last 8 months spent at least 2 weeks in the NICU and had been discharged to home were asked to participate by letter. Consent of interested parents was obtained and interviews were conducted in the parents' homes. All interviews were audiotaped and transcribed. Results In addition to being able to effectively manage the medical care of the complex neonate, nurse practitioners were consistently perceived as: "being positive and reassuring," "being present," "caring," "translating information," and "making parents feel at ease." Implications Nurse practitioners working in the NICU can feel validated by the fact that they are clearly appreciated by parents. Inclusion of NPs in the NICU care team enhances the care provided to infants and their families.

Attitudes and perceptions of body image in postpartum African American women. Does weight make a difference

Abstract: PURPOSE To describe the attitudes and perceptions of body image of African American postpartum women, and the differences in these measures when body mass index (BMI) was considered DESIGN Descriptive comparative METHODOLOGY Secondary analysis of a larger study The sample was 45 African American women Body image was assessed using the Attitude to Body Image Scale (ABIS) and the topographic device Participants were grouped according to BMI categories Body image differences by BMI category were determined using ANOVA RESULTS The mean ABIS score for the total sample was 28 (range = 10-58) Although not statistically significantly different, the mean ABIS score for the overweight/obese group was 34 (SD = 042), for the normal weight group the mean score was 28 (SD = 022) and for the underweight group it was 26 (SD = 024) The mean amount of perceived space occupied was 300 while the mean amount of actual space occupied was 210 in (N = 45) When the perceptual component was assessed, all women, irrespective of size, considered themselves larger than they actually were However, perceptions did not differ by body mass category IMPLICATIONS Nurses can use this information to plan culturally sensitive postpartum care relative to body image and weight Healthcare providers may wish to develop interventions that foster healthy lifestyle behaviors, such as healthy eating habits, based on health promotion rather than on weight loss With this caveat in mind, performing a 24-hr recall of foods eaten would be an appropriate assessment strategy

Project BART: Effectiveness of a behavioral intervention to reduce HIV risk in adolescents.

Abstract: PURPOSE: To examine the effectiveness of Project BART (Becoming a Responsible Teen [St. Lawrence 1998]) a behavioral-based curriculum for adolescents at risk for developing HIV. The purpose of BART was to help adolescents acquire the skills needed to reduce risks thus encouraging them to make safe healthy choices concerning sexual behaviors. METHODS: This was a one-group pre- and post-test intervention study with 105 adolescents (ages 12 to 18) of culturally diverse backgrounds. RESULTS: Results of the main effects varied. Significant differences were found between pre- and post-test means of the score on the HIV Attitudes (P=0.018) and between the means of the AIDS Risk Knowledge Test (P=0.001) but no significant difference was found between the pre- and post-test means of two other questionnaires: the Condom Attitude Scale (CAS) and Risk Behavior Survey. Process evaluation of the program indicated positive reactions toward the content and presentation methods of the program. CLINICAL IMPLICATIONS: The need for programs to which adolescents’ have positive reactions is vital to community-based participation by teens. Nurses can implement this comprehensive theory-based program in community settings. Implementation should include a modification of the instruments for better clarity and more one-on-one instruction/attention during data collection. More research with clarified instruments and facilitated data collection is needed to further substantiate the effectiveness of the Project BART with adolescents.

Using evidence to educate birthing center nursing staff about infant states, cues, and behaviors.

Abstract: The authors sought to apply evidence from research to nursing practice. Research about infant states, cues, and behaviors was presented to a birthing center nursing staff and expectant parent class instructors. Posttest results indicated that the staff's knowledge and skill in interpreting infant behavior for parents increased after an educational session. The results are important, for research supports the idea that parent-infant attachment affects both parents and infants by promoting a loving relationship and improved infant development, a healthy self-image, and better relationships later in life. Cue sensitivity has been documented as the origin of parent-infant attachment. Cue sensitivity involves recognition of individualized infant body language and provision of an appropriate response. Parents who are sensitive to their infant's needs and who respond consistently and appropriately foster a mutually satisfying reciprocal interaction that leads to a healthy relationship. Incorporating information about infant states, cues, and behaviors into prenatal education can provide parents with an introduction to quality parent-child interactions.

Maternal discipline of children with Asperger Syndrome and nonverbal learning disorders.

Abstract: PURPOSE: This study investigated how often mothers of children with Asperger Syndrome and nonverbal learning disorders reported using either psychological aggression (shouting, cursing, name calling) or corporal punishment (spanking, hitting) when disciplining their children, and also examined the correlates of these methods of discipline. DESIGN AND METHODS: A descriptive study of 41l mothers with children between ages 4 and 17 years. Mothers were recruited by placing an invitation on two national Web sites; one for parents of children with Asperger syndrome and one for parents of children with nonverbal learning disabilities. An anonymous, mailed survey was used and a 70% response rate was obtained. The Conflict Tactics Scale-Child Form was used to measure psychological aggression and corporal punishment. Univariate analyses were used to describe the child and maternal characteristics and maternal rates of discipline. The correlates of maternal discipline were measured using bivariate analyses. RESULTS: The overall reported use of any corporal punishment (slaps on the hand, arm, and leg; hitting on the buttocks with a belt or brush; spanking on the buttocks with a hand; pinching and shaking) during the past year was 58%. The yearly use of any psychological aggression (screaming and yelling, cursing, threatening to hit or spank, threatening to kick out or send away, calling the child "dumb" or "lazy") was 95%. Spanking declined with increasing age of the child and the mother. Mothers who used psychological aggression were more likely to use corporal punishment with their child. CLINICAL IMPLICATIONS: Informed nurses working with these populations can use the results of this study to help address the stresses felt by these mothers, and to teach alternative strategies of coping to mothers who are in danger of using psychological aggression and corporal punishment.

Kangaroo care for adoptive parents and their critically ill preterm infant.

Abstract: In this case study kangaroo care (KC) was facilitated for an adoptive mother and father who were planning to attend the birth of the infant they had arranged to adopt. Unexpectedly, the birth mother delivered at 27 weeks gestation. The infant was critically ill and required mechanical ventilation. However, in this neonatal intensive care unit where all adoptive parents and parents of mechanically ventilated infants are offered KC, these adoptive parents began KC on Day 3 while their infant daughter was still mechanically ventilated. She thrived thereafter and the entire experience was profoundly beneficial for this beginning family both at the hospital and after discharge home.

Management of fetal airway obstruction: an innovative strategy.

Abstract: This article describes a planned ex utero intrapartum treatment (EXIT) procedure at the Children's Hospital of Philadelphia for a fetus with an airway obstruction resulting from a giant neck mass. The EXIT procedure is a technique that establishes a fetal airway while the utero-placental circulation is maintained for up to 1 hour. As a part of the planned EXIT procedure, a multidisciplinary, highly skilled team was developed to care for both mother and baby. This team consisted of obstetric and surgical personnel to care for the mother during the procedure, the birth, and the recovery, and a neonatal surgical team to care for the newborn. Nursing expertise necessary to conduct this procedure and safely care for the woman and fetus are discussed.

The experience of Therapeutic Touch in the lives of five postpartum women.

Abstract: PURPOSE To examine the experience of therapeutic touch in the lives of postpartum women. METHODS Qualitative study of five postpartum women who participated in therapeutic touch for 2 months during home visits that focused on postpartum issues and concerns. The visits were audiotaped and transcribed. Data were coded and classified; linkages between categories were sought. RESULTS Five themes or essences of the experience emerged: Feeling Relaxed, Feeling Open, Feeling Cared For, Feeling Connected, and Feeling Skeptical. CLINICAL IMPLICATIONS The women and the researcher experienced many positive emotions during the home visits. Although it is unknown whether it was the visit, the interaction, or the therapeutic touch that helped the women feel cared for, the experience of participating in therapeutic touch seemed to add a dimension of mutual caring that added a special and unique quality to the home visit.

Perceived health status in urban minority young adolescents.

Abstract: Purpose: To describe perceptions of health status among a sample of urban minority adolescents and the contribution of demographics intrinsic motivation general self-efficacy risk taking and stressful life experiences on the adolescent’s perception of health status Method: Correlational design A total of 71 adolescents were studied using the Adolescent Health Chart for perceived health status the Health Self-Determinism Index for Children the Self-Efficacy Scale the Risk Taking Instrument and the Life Events Checklist Results: There were no statistically significant effects of demographics on perceived health status Scores of Perceived Health Status correlated with scores of self-efficacy (r= 056; p< 0001) risk-taking (r= 039; p< 001) negative events (r= 032; p< 01) and violent events (r= -041; p< 001) Clinical Implications: The study findings suggest that self-efficacy risk taking and life events are predictive of perceived health status in urban minority adolescents The results contribute to the present body of knowledge about patterns of adolescent health as perceived by the adolescent In addition to expanding the understanding of the minority adolescent experience in relation to health promotion attributes and health compromising behaviors the results identify antecedents that are predictive of improved perceived health status for the urban adolescent (authors)

Neonatal predictors of school-based services used by NICU graduates at school age.

Abstract: BACKGROUND Ill or premature newborns are at increased risk for ongoing morbidity throughout childhood. Federal legislation now mandates that states provide early intervention, special education, and disability accommodations for children with special needs. Because all children born prematurely do not require all services, targeting services to the children with greatest risk is essential. This study examined whether neonatal characteristics could predict special school-based service use (speech, occupational, physical therapy, special education) in later childhood. METHODS Subjects were 53 children, ages 7 to 11 years, graduates of one Midwest Level 3 neonatal intensive care unit (NICU). Neonatal data were used to calculate Neurobiologic Risk Scores (NBRS), a sum of illness factors related to brain damage. Birth weight, length of NICU stay, and NBRS were compared to the children's school performance on standardized tools and to report cards. RESULTS Most children studied were not receiving special school services. The NBRS and parent report of child competency were related (p = 0.01). Length of NICU stay correlated with teachers' reports of children's academic performance (p = 0.04), and to use of special school services use (p = 0.03). As the NBRS score increased, report card performance decreased. CONCLUSIONS Neonatal characteristics predicted school-age service use. This is important for nurses because predicting which children are most likely to need special services can aid in tracking children at high risk for prompt assessments and referrals. Parents, healthcare providers, educators, advocacy groups, and funding agencies need accurate outcome data to influence health, educational, and social policy decisions.