Nursing research and responsible partnership in the global setting.

PURPOSE: In light of the increased research priorities set forth by both national and global funding sources, the goal of this project is to take a step towards deeper understanding of the responsibility of high-resource nurses conducting research in low-resource environments. A secondary goal is to understand the role of local collaboration partners in the development and implementation of research in their setting. DESIGN: A review of recent nursing research where the primary investigator was from a top-ranking U.S. university and the data collection took place in a low- or middle-income setting. METHODS: The literature was examined for two areas of interest: 1) the presence of local partners as authors, and 2) the role of local partners in development of the research question and study design. This review is through the lens of a collaborative work between an American nurse who conducted her doctoral research in sub-Saharan Africa and an African nurse who is a faculty member at a U.S. university. Ten nursing schools were reviewed for faculty involved in global health research. Ninety-nine faculty were reviewed for global interests and thirty-two were found to conduct research in low-resource settings. Inclusion criteria for publications: Authorship of nurse researcher; Data collection in an LMIC; Published between 2013 and 2019; Full-text available. EXCLUSION CRITERIA: Systematic or literature review. RESULTS: Of the abstracts reviewed (N = 248), 141 publications were excluded due to duplicates and research design, for a total of 107 articles included in this review. Seventy-nine percent of publications (N = 85) included local authors, while 84% (N = 90) included local ethical approval. Of publications with local authors, 53% did not state the role played, 27% stated local authors were involved in study conception, 40% stated local authors were involved in data collection/analysis, and 35% stated local authors reviewed/approved the final manuscript. CONCLUSIONS: More than half of published studies did not state the role of their local partners. Data collection/analysis are the major roles reported in the literature. To design more effective local studies and promote positive health outcomes, international partners should be involved in all stages of the research process, particularly study conception, and their roles acknowledged in all publications.

Strategies to promote and sustain baccalaureate students' interest in pursuing a PhD degree in nursing.

PhD-prepared nurses are integral to the delivery of cost-effective, safe, and high-quality care to the increasingly diverse population in the U.S. Nurses with a PhD are needed to develop knowledge that informs and directs nursing care, promote positive health outcomes, and train the next generation of nurses and nurse scientists. Unfortunately, less than 1% of nurses have their PhD in nursing and there is an ongoing shortage of nurses in the U.S. that has not been effectively addressed. The PhD in nursing pipeline needs to be bolstered to address the escalating nursing shortage. This is especially important considering the importance of having an adequate number of well-prepared nurses to address the increasing complexities of health conditions and patient populations in the U.S. This paper presents strategies to promote and sustain interest in PhD in nursing among baccalaureate nursing students and discusses the importance of meaningful engagement in research and engaged faculty mentorship. It is important to incorporate research into undergraduate experiences, promote engaged mentorship during undergraduate level and beyond, and provide a conducive environment for undergraduate students to address their fears, misconceptions, and myths about PhD in nursing.

Barriers for BSN students to pursue a PhD in nursing and recommendations to address them: A scoping review.

BACKGROUND: Increasing the BSN-PhD pipeline could address the shortage of nursing faculty to conduct research, develop nursing science, and train new nurses and faculty. PURPOSE: To identify barriers to BSN students' pursuit of PhD education, and to compile recommendations to increase their numbers. METHODS: This scoping review follows PRISMA guidelines, including articles in English that discussed barriers to BSN students' pursuit of PhD education and recommendations to address them. FINDINGS: Barriers to pursuing a PhD include misunderstanding PhD education and its impact on population-level health, insufficient funding for PhD studies, and perceived need for clinical experience. BSN program recommendations include education on doctoral and postdoctoral options, mentorship, and hands-on research experiences. PhD programs should be accessible, fully funded, and address students' perceived need for clinical experience. DISCUSSION: The nursing profession must take coordinated action across individual, interpersonal, program, policy, and cultural levels to increase the pipeline of well-prepared BSN-PhD students.

Husbands' knowledge and attendance at wives' postpartum care among rural farmers.

We examined husbands' knowledge and attendance at their wives' postpartum visit in a sample of rural husband-and-wife farmer dyads in central Malawi. A cross-sectional matched-pairs survey of 70 husband-and-wife farmer dyads, who lived in rural communities in Ntcheu district, and had a live birth in the past year was conducted. Data were collected using an interviewer-administered, structured postpartum questionnaire adapted from WHO Safe Motherhood Needs Assessment Questionnaires. Many husbands did not know about postpartum assessments and education their wives received from health facilities. Percent agreement between dyads' responses was lower on questions referring to assessments than to education. The odds of reporting that the woman received postpartum assessments were greater among husbands than among wives. Fifty-nine percent of husbands did not go with their wives for 1-week postpartum visits. Top three reasons for not attending visits were: at work, out of town, and did not see the need.

Promoting the Future of Nursing by Increasing Zest for Research in Undergraduate Nursing Students.

Nurses are expected to deliver cost-effective, high-quality care. In order to provide this care, nurse researchers are needed to evaluate and research effective health care models and interventions. By including research concepts within a baccalaureate nursing program, interest in nursing research can be increased. The purpose of this article is to present a case study of strategies used in an undergraduate liberal arts nursing program to promote zest in research and increase the pursuit of graduate studies among baccalaureate nursing students. Using the Bronfenbrenner ecological framework, the promotion of research is categorized into microsystems (individual), mesosystems (multiple setting), exosystems (program), and macrosystem (institutional culture) levels. The microsystem level includes engagement in the classroom, engagement in one-on-one meetings, and faculty members as role models. The mesosystem involves engagement outside the classroom and encouragement from faculty members. The exosystem level describes specific learning activities and programs the nursing department utilizes such as community assessments, preconception reproductive knowledge promotion, and women supporting women. Finally, the macrosystem includes a supportive and encouraging environment. By working together, each system contributes to the students' zest for nursing research and interest in graduate studies in nursing to pursue the role of a nurse researcher.

Use and Evaluation of Postpartum Care Services in Rural Malawi.

PURPOSE: The purpose of this study was to examine women's evaluation of postpartum care services (postpartum clinical assessments, health education, and midwife kindness) received from midwives prior to discharge in rural health facilities, and to examine husband-and-wife-farmer dyads' reasons for their decisions to return or not return for 1-week postpartum care visits in rural central Malawi. DESIGN: Cross-sectional matched-pairs survey design. METHODS: Participants included a convenience sample of 70 husband-and-wife-farmer dyads living in rural communities who had a live birth in the past year at one of four health facilities in Ntcheu district, central Malawi. Data were collected using an interviewer-administered postpartum care questionnaire from the World Health Organization (WHO) Safe Motherhood Needs Assessment Questionnaires. Data analysis included univariate and multivariate statistics. FINDINGS: Women's evaluation of postpartum care assessments received from midwives in rural health facilities prior to discharge included partial assessments of blood pressure (44%), temperature (41%), abdominal examination (50%), vaginal examination/bleeding (46%), breast examination/soreness (34%), and baby examination (77%). Only 16% of the women received all six of these postpartum clinical assessments prior to discharge, while 11% received none. Women also reported that midwives did not: introduce themselves (50%); ask if patients had questions (44%); explain what they were doing (43%); or explain what to expect after delivery (50%). Despite this, 77% of women felt midwives paid close attention to them and 83% gave an overall positive evaluation (3.5-5 on a scale of 1-5). Numbers of postpartum clinical assessments (p = .09) and overall evaluation (p = .71) did not differ between the four health facilities. The top three reasons for husbands' and wives' decisions to return for 1-week postpartum care visits were: being advised to return for care, wanted the mother to be examined, and wanted the baby to be examined. Participants stated prior negative experiences, or not perceiving a need for care (feels fine), may potentially prevent them from returning for postpartum care visits in a health facility. CONCLUSIONS: Most women reported they received only partial postpartum clinical assessments; thus, it is important for health facilities to address the adequacy of postpartum clinical assessments provided to women by midwives before discharge. Women returned for 1-week postpartum care visits because they were advised to return for care, and also to make sure their babies were examined. However, the principal reason why husbands permitted their wives to return for postpartum care was because they wanted their wives to be examined. CLINICAL RELEVANCE: Midwives need to advise all patients to return for postpartum care visits consistent with WHO or country guidelines, and continue to educate husbands and wives regarding the importance of postpartum care even when the wife feels fine. Refresher in-service trainings on postpartum care are recommended for midwives to encourage them to perform the recommended postpartum clinical assessments.

Preconception Health Behaviors of Low-Income Women.

PURPOSE: Preconception behaviors have a significant impact on birth outcomes, particularly among low-income minority groups, and women with unplanned pregnancies. This study examined women's perceived health status and behaviors such as drinking, smoking, exercise, and use of multivitamins and folic acid. STUDY DESIGN AND METHODS: This was a descriptive study based on a convenience sample of women living in urban underserved neighborhoods. Univariate and bivariate analyses were conducted using STATA 13. RESULTS: The sample consisted of 123 women ages 18 to 51 years (mean = 30.57); 51.22% were Hispanic, 36.59% African American, and 12.2% Caucasian. Over 70% had a household income of less than $20,000, 57.72% had no health insurance in the last year, and 58.54% were not married. These women were below the Healthy People 2020 goals for drinking, smoking, and multivitamin use, especially those who were planning to get pregnant in the next 6 months or not sure of their pregnancy planning status. There were no significant differences on any of the preconception health behavior variables based on pregnancy intention. CLINICAL IMPLICATIONS: Nurses and healthcare providers should emphasize importance of practicing healthy behaviors during the preconception period among low-income ethnic minority women specifically those living in urban medically underserved areas who are unsure of their pregnancy planning status or are at risk of unintended pregnancy.

Women's Knowledge of Ovulation, the Menstrual Cycle, and Its Associated Reproductive Changes.

BACKGROUND: The purpose of this study was to examine women's knowledge of female reproduction-anatomy, hormones and their functions, ovulation, the menstrual cycle and its associated reproductive changes, conception, and signs of pregnancy. METHODS: A survey was completed by 125 women of childbearing age as part of a larger "Women's Health Promotion Program." Descriptive statistics, mainly univariate and bivariate analyses were conducted using STATA 13. RESULTS: The women in the study were ages 18-51 years, 52.0 percent were Hispanic, 36.0 percent African American, and 12.0 percent White. The majority, 70.4 percent, had a household income of less than $20,000, 58.4 percent were not married, 83.2 percent were not trying to get pregnant at the time, and 37.6 percent had sexual intercourse that may have put them at risk for pregnancy in the past month. Less than one-third knew about the reproductive hormones. Over 80.0 percent knew their reproductive anatomy, 68.8 percent were not keeping any log to track their menstrual flow, 53.6 percent did not know when their next menstruation would be, and 49.6 percent did not know the average number of days for a regular menstrual cycle. Many did not know what ovulation is (47.2%), the ovulation timing (67.2%), the number of eggs released from an ovary each month (79.2%), and how long an egg or sperm could live in a woman's body (62.4%). CONCLUSIONS: Reproductive knowledge should be assessed during preconception visits and women should be taught comprehensive reproductive education-not just selected topics-to be adequately equipped to make informed reproductive decisions.

A Feasibility Study of Women's Confidence and Comfort in Use of a Kit to Monitor Ovulation.

INTRODUCTION: The focus of this study was to examine whether low-income adult women will use ovulation test strips, a menstrual calendar chart, thermometer, temperature graph, and cervical mucus assessment to monitor their ovulation time and other menstrual changes. Women's confidence in their ability to detect ovulation time and understand the menstrual cycle changes were also examined. METHODS: This is a descriptive study. Twenty-two low-income women aged 18 to 39 years living in medically underserved neighborhoods participated in this study. The women were introduced to and taught how to use a knowing your body (KB) kit, which consisted of ovulation test strips, monthly calendars for menstrual logs, digital thermometer for basal body temperature, and graphs to chart temperature. The women were interviewed 6 to 8 weeks later to confirm their experiences with the use of the KB kit. RESULTS: Ninety-one percent of the women used the ovulation test strips (mean, 3.8 strips); 77.3% were very to extremely confident that they could properly use the ovulation strip, 54.6% knew when they ovulated, and 31.8% could use the thermometer to confirm when they were ovulating. Seventy-three percent of the women were very to extremely comfortable using the ovulation test strips, 81.8% using the thermometer, 45.5% using the temperature graph, and 31.8% using the TwoDay Method (cervical mucus observation). DISCUSSION: The use of the ovulation test strip and other content of the KB kit provides a new opportunity for low-income women to learn about their bodies by monitoring their ovulation time and other menstrual changes as a pregnancy planning and early pregnancy recognition tool.

Impact of Integrating Community-Based Participatory Research Into a Baccalaureate Nursing Curriculum.

BACKGROUND: Community-based participatory research (CBPR) is rapidly gaining respect within the health care community as a means to promote public health and address health disparities. It has also recently been named as one of the competencies needed by public health professionals to be effective. METHOD: This article describes an educational innovation where CBPR is integrated into a baccalaureate nursing curriculum as a strategy to create meaningful learning experiences for nursing students while benefitting the health of the community. RESULTS: The impact of this approach was analyzed over a period of 12 years. The positive outcomes for the community, students, and faculty are described, along with the unique challenges. CONCLUSION: Integrating CBPR into a nursing curriculum is an innovation that is worthy of further assessment.

Conducting Research With Community Groups.

Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. Although several barriers to conducting research with community groups exist, community-based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This article presents case studies that demonstrate how CBPR principles guided the development of (a) a healthy body weight program for urban, underserved African American women; (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women; and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research-intensive academic environments.

Late Recognition of Unintended Pregnancies.

OBJECTIVE: Late recognition of pregnancy and unintended pregnancy has been associated with adverse pregnancy outcomes such as preterm birth, low birth weight, and admission to neonatal care. This study examined the factors associated with late recognition of pregnancy among women reporting unintended pregnancy. DESIGN AND SAMPLE: A secondary analysis of a population-based survey, the Pregnancy Risk Assessment Monitoring System of the United States. A total of 143,303 women of childbearing age. Analyses included descriptive statistics and multivariate analysis using logistic regression. RESULTS: Exactly, 42.4% described their pregnancies as unintended and 28.3% recognized their pregnancies late. Women with unintended pregnancy took longer, 7.2 weeks (99% CI = 7.07-7.24) to recognize their pregnancies compared to 5.2 weeks (99% CI = 5.18-5.27) for women with intended pregnancy. Late recognition of pregnancy was significantly higher among women who were not married (adjusted odds ratio [AOR] = 1.29, p < .01), had more arguments with their partners (AOR = 1.08, p < .01), were smokers (AOR = 1.15, p < .01), and belonged to an ethnic minority group. CONCLUSIONS: Public health nurses and other health professionals can promote early recognition of pregnancy among women who are not married, belong to ethnic minority groups, or have more arguments with their husbands or partners.

Embedding Research in Undergraduate Learning Opportunities.

As a means of promoting scholarship, faculty are increasingly including undergraduate nursing students as team members in faculty-led research projects. Research involvement is a high-impact educational practice that enhances student engagement and retention rates and enables the reflection and integration of learning. The purpose of this article is to describe the benefits and innovative ways of directly involving undergraduate nursing students in faculty-guided research projects. Case examples from four non-research-intensive nursing programs are presented to illustrate the benefits of undergraduate student research involvement to students, faculty, their communities, as well as the nursing profession. Student assistance in all phases of the research process, ranging from research question generation, literature reviews, methods development, and data collection and analysis, to presentations and manuscript publication, motivates and helps faculty progress with their research programs. Benefits also include the creation of effective learning experiences that build nursing knowledge and potentially contribute to community health.

Contraceptive use among low-income women living in medically underserved neighborhoods.

OBJECTIVE: To describe the rate of contraceptive use and types of contraception used by low-income women. DESIGN: A descriptive study was used to survey women about their contraceptive use and sexual behaviors 12 months prior to the time of the interview. PARTICIPANTS AND SETTING: A convenience sample of 110 low-income women living in three urban medically underserved neighborhoods who enrolled in a larger study was included. METHODS: Univariate and bivariate descriptive analyses were conducted using STATA 10. RESULTS: Forty-eight (43.6%) of the women were African American, 43 (39.1%) were Hispanic, and 17 (15.5%) were White. The women were age 18 to 55 years (Mean = 31 years). Forty percent of these women who were not pregnant or planning to get pregnant had sex without contraceptives in the past 12 months. The percentage of women who used contraception decreased from 77.3% users in the last 12 months to 63.6% current users. The most common methods used within the last 12 months were condom use by male partner (28.2%), birth control pills (14.6%), contraceptive injection (12.7%), intrauterine device (10.9%), and the patch (1.8%). CONCLUSIONS: Many of the low-income women from medically underserved neighborhoods did not use contraceptives and of those who used contraceptives, the majority used the least effective methods.

Low-income women's recommendations for promoting early pregnancy recognition.

INTRODUCTION: This study explored low-income women's perspectives on how to promote early recognition of pregnancy as one strategy to address community residents' concerns related to unintended pregnancy. Unintended pregnancy, which is more prevalent among low-income women and minorities, has been associated with various adverse pregnancy outcomes. METHODS: This study used the ideological perspective of community-based participatory research. Six focus groups were conducted in 3 low-income, urban, medically underserved neighborhoods with ethnically diverse populations. Neighborhood women who were either pregnant or had experienced a pregnancy within 3 years were invited to participate in the study. A structured interview guide focused the discussion on how to promote early recognition of pregnancy within the existing context of unintended pregnancies in the neighborhoods. Focus-group sessions were audiotaped, then transcribed verbatim; the data were analyzed using an open-coding template approach assisted by QSR NVivo 8 software. RESULTS: Forty-one women aged 18 to 44 years participated in the study. Thirty-nine percent were African American, 24.4% were Hispanic/Latino, 19.5% were American Indians, and 17.1% were white. Three primary themes were identified: 1) women should know the menstrual/ovulation and pregnancy-related changes that occur in their bodies; 2) women should be prepared to confirm their pregnancies early, as soon as they suspect they may be pregnant; and 3) both information and emotional support are needed for pregnancy-related issues. "Knowing your body" was the strongest advice to promote early recognition of pregnancy. DISCUSSION: The participants in this study suggested that education about reproductive changes should be initiated during early adolescence and in the preconception period. Early testing and confirmation of pregnancy should also be promoted, especially for women who have unprotected intercourse. Local resources for information and emotional support during pregnancy should be accessible to women.

Promoting individualized breastfeeding experiences.

Breastfeeding is beneficial for the baby and the mother, but is yet to be successfully practiced by newly delivered women as proposed in the Healthy People 2020 goal. Most breastfeeding education during the prenatal or postpartum period provides adequate information for interested women. However, mothers need individualized client-professional interactions and follow-up after hospital discharge. This article describes the breastfeeding experiences of two women and the implications for nurses and other healthcare professionals in relation to efforts to promote breastfeeding. Two anecdotal case studies are presented illustrating that even when mothers have resources and education, the breastfeeding education can be frustrating and misunderstood. Nurses can master the skill of closing the feedback loop in breastfeeding education by assessing and clarifying women's interpretation of breastfeeding information they received. This nursing skill can empower mothers to make informed decisions for effective and sustained breastfeeding.

Synthesis of nursing care across the life span using laboratory simulation: a senior-level course.

The use of simulation activities in nursing education helps students develop critical thinking skills and also enhances student learning and confidence in the practicum setting. As students complete their education, they need to integrate all they have learned to design care for patients across the life span. This article describes a senior-level skills laboratory simulation course in a baccalaureate nursing program designed to foster the shift toward independent critical thinking. The primary goal of the course was synthesis and application of students' cumulative knowledge through teamwork, assessing, critical thinking, prioritizing, and decision making in care for diverse patients across the life span. Specifics of course development and design are included along with student responses and lessons learned.

Time from pregnancy recognition to prenatal care and associated newborn outcomes.

OBJECTIVE: To examine the relationship between newborn outcomes and late prenatal care initiation after recognition of pregnancy. DESIGN: Secondary data analysis of the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. SETTING: Twenty-nine states. PARTICIPANTS: Women of childbearing age (135,623) who resided in 29 states in the PRAMS study who received prenatal care and had live births. METHODS: Population-based survey from 2000 through 2004 that examined four newborn outcomes: prematurity, low birth weight (LBW), admission into Neonatal Intensive Care Unit (NICU), and infant mortality. RESULTS: The average time lag (difference between the time of pregnancy recognition and initiation of prenatal care) for the study was 3.2 weeks (99% CI [3.12, 3.21]). Women who recognized their pregnancies before 6 weeks had a longer lag time (3.5 weeks, 99% CI [3.43, 3.53]) than women who recognized their pregnancies later (2.1 weeks, 99% CI [1.96, 2.15]). After adjusting for confounders including the timing of pregnancy recognition, longer time lag was associated with reduced risks of prematurity (odds ratio [OR]=0.99, 99% Confidence Interval [CI] [0.97, 1.00], p<.01), LBW (OR=0.98, 99% CI [0.97, 0.99], p<.01) and NICU admission (OR=0.99, 99% CI [0.98, 1.00], p<.01) but not with infant mortality (OR=1.00, 99% CI [0.95, 1.05], p>.01). CONCLUSION: Average time lag from pregnancy recognition to prenatal care was not associated with poor newborn outcomes once results were adjusted for time of pregnancy recognition and other confounders.

Time of pregnancy recognition and prenatal care use: a population-based study in the United States.

BACKGROUND: A woman who does not recognize her pregnancy early may not initiate prenatal care early. This study examined the relationship between the time of pregnancy recognition and the time of initiation of prenatal care, and the number of prenatal visits among women of childbearing age. METHODS: This study analyzed the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. The analysis sample was representative of resident women of childbearing age in 29 U.S. states who had live births within 2 to 6 months before being contacted. The data were weighed to reflect the complex survey design of the PRAMS, and binary and multinomial logistic regressions were used for the analyses. RESULTS: Most (92.5%) of the 136,373 women in the study had recognized their pregnancy by 12 weeks of gestation, and 80 percent initiated prenatal care within the first trimester. Early pregnancy recognition was associated with significantly increased odds of initiating prenatal care early (OR = 6.05, p < 0.01), after controlling for sociodemographic and prior birth outcome data, and was also associated with lower odds of having fewer than the recommended number of prenatal visits and higher odds of having more than the recommended prenatal visits (OR: <11 visits = 0.71 and >15 visits = 1.17, p < 0.01). CONCLUSIONS: Early pregnancy recognition was associated with improved timing and number of prenatal care visits. Promotion of early pregnancy recognition could be a means of improving birth outcomes by encouraging and empowering women to access prenatal care at a critical point in fetal development.