To review the research findings for mental and physical health outcomes and health behaviors of African American women and adolescents after sexual assault.
Searches of the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO, and PubMed from January 2001 through May 2012 using the terms Blacks, African Americans, sexual abuse, sexual offenses, and rape.
Criteria for inclusion included (a) results of primary research conducted in the United States and published in English, (b) African American females age 13 and older, (c) sexual assault or sexual abuse reported as distinct from other types of abuse, and (d) health status as an outcome variable. Twenty-one publications met inclusion criteria.
Articles were reviewed for the mental and physical health and health behavior outcomes associated with sexual assault of African American women and adolescents.
Sexual assault was associated with increased risk of poor mental and physical health outcomes in the general population of women and adolescents. There was an increased risk of unhealthy behaviors (e.g., drinking, drug use, risky sexual behaviors) for all women and adolescents, with the highest risk reported for African American women and adolescents. Help seeking from family and friends demonstrated conflicting results. Cumulative effects of repeated assaults appear to worsen health outcomes.
Sexual assault has significant effects on the physical and mental health and health behaviors of women and adolescents in the general population. Less evidence is available for differences among African American women and adolescents. More research is needed to understand the influence of race on women's and adolescents’ responses to assault.
Providers of women's health services are often confronted with questions about cancer genetic testing. The provision of these services is complex. The process begins with accurate risk assessment and identification of individuals who might benefit from genetic testing services. There are practice, administrative, legal, and ethical considerations that should be considered when developing policies for the referral of at-risk individuals or before deciding to provide genetic services.
To test the efficacy of the relationship-focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum.
Randomized clinical trial (RCT) with three phases.
In this three-phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants.
Phase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse-led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants’ homes.
Postpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty-five mother/infant dyads were fully retained in the 9-month protocol.
Treatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self-reflection during data collection, directions for video-recorded interaction, and assistance with referrals likely contributed to improvements for both groups.
Efficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse-led home visits had a positive effect on outcomes for all participants.
To compare maternal competence and responsiveness in mothers of late preterm infants (LPIs) with mothers of full-term infants.
A nonexperimental repeated-measures design was used to compare maternal competence and responsiveness in two groups of postpartum mothers and the relationship of the theoretical antecedents to these outcomes.
Urban academic medical center.
Mothers of late preterm infants (34–36, 6/7-weeks gestation) and mothers of term infants (≥37-weeks gestation), including primiparas and multiparas. Data were collected after delivery during the postpartum hospital stay and again at 6-weeks postpartum.
Descriptive and inferential analysis.
A total of 70 mothers completed both data collection periods: 49 term mothers and 21 LPI mothers. There were no differences between the two groups related to their perception of competence or responsiveness at delivery or 6-weeks postpartum. At 6-weeks postpartum, none of the assessed factors in the model was significantly related to competence or responsiveness.
The results, which may have been limited by small sample size, demonstrated no difference in the perceptions of LPI and term mothers related to competence or responsiveness. Maternal stress and support were significantly related to other factors in the model of maternal competence and responsiveness.
To describe how nurse-midwives verbally support nulliparous women during second-stage labor and document specific details of each second stage.
Descriptive qualitative study.
A university hospital labor and delivery unit in the southwestern United States.
Nulliparous women (n = 14) older than age 18 and their attendant midwives (n = 9).
A single research midwife observed the entire second stage of each woman and used a standardized data collection form to record spontaneous or directed pushing, position changes, open and closed glottis pushing. A digital audio recorder was employed to capture verbal communication between the midwife and laboring woman. The research midwife and two qualitative experts employed content analysis to analyze the audio transcripts and identify categories of verbal support.
Analysis revealed four categories of verbal support: affirmation, information sharing, direction, and baby talk. The vast majority of verbal communication by nurse-midwives consisted of affirmation and information sharing. Nurse-midwives gave direction for specific reasons. Women pushed spontaneously the majority of the time, regardless of epidural use.
Nurse-midwives use a range of verbal support strategies to guide the second stage. Directive support was relatively uncommon. Most verbal support instead affirmed a woman's ability to follow her own body's lead in second-stage labor, with or without epidural.
To discover the impact of perinatal loss on obstetric nurses.
In the parent study, obstetric nurses were provided with an open-ended statement asking them to describe in writing the experience of being present during a traumatic childbirth. For this study, a secondary qualitative analysis was performed on those cases in which a perinatal loss was described as traumatic to answer new research questions.
A total of 464 cases were included in the parent study; 150 cases included either fetal or infant death. Of those, 91 cases had rich descriptions that we analyzed for this study.
The data were analyzed using Krippendorff's (2013) method for qualitative content analysis. Responses were clustered to allow themes to emerge. Nurses’ experiences of fetal and infant loss were analyzed individually and then compared and contrasted for overarching themes.
Six themes emerged from the fetal and infant loss experiences, with the final overarching themes from perinatal loss including getting through the shift, symptoms of pain and loss, frustrations with inadequate care, showing genuine care, recovering from traumatic experience, and never forgetting.
Perinatal loss can have a lasting effect on nurses, and thus continued support may be needed.
To confirm content validity of GutCheckNEC, a risk index for necrotizing enterocolitis (NEC) and to determine the level of agreement among experts about NEC risk factors in premature infants.
Electronic Delphi method (e-Delphi).
Online electronic surveys and e-mail communication supported by an interactive study website.
Nurses and physicians (N = 35) from four countries and across the United States who rated themselves as at least moderately expert about NEC risk.
e-Delphi involved three rounds of surveys and qualitative thematic analysis of experts’ comments. Surveys continued until criteria for consensus and/or stability were met.
Of 64 initial items, 43 were retained representing 33 risk factors (final GutCheckNEC Content Validity Index [CVI] = .77). Two broad themes about NEC risk emerged from 242 comments: the impact of individual physiologic vulnerability and variation in neonatal intensive care unit (NICU) clinicians’ practices. Controversy arose over the impact of treatments on NEC, including probiotics, packed red blood cell (PRBC) transfusions, and patent ductus arteriosus (PDA) management using indomethacin.
GutCheckNEC achieved borderline content validity for a new scale. The e-Delphi process yielded a broad perspective on areas in which experts share and lack consensus on NEC risk. Future testing is underway to reduce the number of risk items to the most parsimonious set for a clinically useful risk tool and test reliability.
To compare the incidence and reasons for nonelective removal of percutaneously inserted central catheters (PICC lines) between centrally and noncentrally placed PICC lines in neonates.
Prospective cohort study.
A 60-bed, tertiary-level neonatal intensive care unit in a private hospital in São Paulo, Brazil.
Neonates who were born at the hospital and underwent successful insertion of 237 PICC lines. They were divided into two groups, central and noncentral, according to tip position.
Neonates were monitored daily from insertion of the PICC until its removal. Data were collected from medical records.
Of the 237 PICCs analyzed, 207 (87.4%) had their tip in a central position and 30 (12.6%) in a noncentral position. The incidence of nonelective PICC removal was similar between the central and noncentral groups (p = .48). The reasons for nonelective removal were significantly different between the groups (p = .007), with a higher incidence of extravasation in the noncentral group.
Noncentrally placed PICCs can provide vascular access in neonates requiring venous access for the administration of intravenous solutions. Many potential catheter-related complications can be prevented by careful bedside nursing. Frequent monitoring of noncentral PICCs is necessary to detect and prevent extravasation in neonates.
To compare the interactive behaviors of American Indian mothers and their premature infants with those of African American mothers and their premature infants.
Descriptive, comparative study.
Three neonatal intensive care units and two pediatric clinics in the southeast.
Seventy-seven mother/infant dyads: 17 American Indian mother/infant dyads and 60 African American mother/infant dyads.
Videotapes of mother/infant interactions and the Home Observation for Measurement of the Environment (HOME) were used to assess the interactions of the mothers and their premature infants at 6 months corrected age.
American Indian mothers looked more, gestured more, and were more often the primary caregivers to their infants than the African American mothers. American Indian infants expressed more positive affect and gestured more to their mothers, whereas African American infants engaged in more non-negative vocalization toward their mothers. African American mothers scored higher on the HOME subscales of provision of appropriate play materials and parental involvement with the infant. American Indian mothers scored higher on the opportunities for variety in daily living subscale.
Although many of the interactive behaviors of American Indian and African American mother/infant dyads were similar, some differences did occur. Clinicians need to be aware of the cultural differences in mother/infant interactions. To optimize child developmental outcomes, nurses need to support mothers in their continuation or adoption of positive interactive behaviors.
To report the state of the science since 1995 on the concept of palliative care for parents who opt to continue a pregnancy after receiving a life-limiting fetal diagnosis.
PubMed, Ovid, PsycInfo, CINAHL, and Medline were searched from 1995 to July 2012 using the terms perinatal palliative care and perinatal hospice.
Inclusion criteria included empirical studies written in English that focused on experiences of parents who opted to continue a pregnancy in which the fetus had a life-limiting condition or on perinatal palliative care. Twenty studies met inclusion criteria.
Results from empirical studies contributing to the knowledge base of perinatal palliative care are presented.
Women are confronted with powerful emotions, challenging decisions, and considerable uncertainty following the news of a life-limiting fetal anomaly. Women choose to continue their pregnancies for a variety of reasons and when doing so embark on a search for meaning. The science suggests that perinatal palliative care is welcomed by parents and is a medically safe and viable option. Women voiced positive feedback about their decisions to continue their pregnancies, and parents cited personal growth in the aftermath. Perinatal palliative care programs provide services that incorporate early and integrative care beginning in the antenatal period. A multidisciplinary coordinated approach provides parents with comprehensive, holistic support.
More research is needed to elucidate the factors that will benefit parents who continue their pregnancies. Investigating the needs and perceptions of clinicians and their willingness to participate in this new model of care is necessary as is examining barriers that may undermine care. Nurses can lead research on these topics and implement evidence-based practice grounded on study findings.
In Western culture, feeding is viewed as symbolic of life, and nonfeeding at the end of life is often considered unacceptable. This sentiment is magnified for infants. Reframing nonfeeding into comprehensive care can be achieved by anticipatory guidance, which can make the experience of infant death meaningful for parents. Since 2004, the George Mark Children's House, an inpatient pediatric palliative care center, has offered this model of care and supported families with challenging clinical experiences. A case study is provided.
Guidelines have not been established to address the needs of parents with imperiled newborns due to the infrequency of this obstetric situation. In this article we offer an approach to prenatal care planning for imperiled newborns and their families. Use of an interdisciplinary team and family involvement are the foci of the care planning process, which result in a perinatal birth plan that reflects parental values and ethical guidelines.