Family social support and prenatal care among unmarried African American teenage primiparas.

This study determined the relation of family social support and the receipt of adequate prenatal care among 25 unmarried African American teenage primiparas residing in the home. The study also investigated the strength of the family social support system compared to nonfamily support systems. Using the Personal Resource Questionnaire, Part II to measure social support, participants were provided the questionnaire 1 to 2 days after birth, but immediately prior to leaving the hospital. Results of the study determined no significant difference in social support scores among those women who received either adequate or inadequate prenatal care, although the 17- to 18-year-old age group had higher support scores than the 15- to 16-year-old age group. However, findings from the study indicated that family social support between both groups was significantly greater than nonfamily support systems. Thus, interventions by community health nurses to involve family members in all aspects of birthing and parenting can be essential in promoting positive health outcomes.

Infant death rates and animal-shed delivery in remote rural areas of Nepal.

This article outlines a community-based retrospective study in a remote area of Nepal and describes local birth practices and their impact on infant mortality. Data collection was carried out in two steps, a household survey from September to October 1996 and a qualitative research phase. Data collected include socio-economic background, reproductive history, birth practices and child survival. Among 3007 live-born children, 660 (22%) died before their first birthday. In keeping with local customs, approximately half of the children were delivered in an animal shed and the other half in the home. Children born in an animal shed were at significantly higher risk of dying than were those born in the home even after adjusting for socio-economic status and biological variables. The association was stronger in the neonatal period (OR = 2.8, 95% CI 1.9-4.1) than during the post-neonatal period (OR= 1.3, 95% CI 1.02-1.6). The preparation of the delivery place was inadequate and thereby facilitated infection of both the newborn and the mother. Traditional norms and animal-shed delivery practices are common in the Jumla community. The reasons addressed for giving birth in the animal shed included (1) Household Deity's anger if delivery takes place in the home and (2) easy to clean the shed following the birth.

Characteristics of nursing doctoral programs in the United States.

The expansive growth of doctoral programs in the United States has necessitated a need to determine demographic attributes of the academic program, characteristics of the students, admission criteria, and curriculum patterns. Seventy-eight doctoral programs were sent a researcher-designed survey and 48 (62 per cent) responded. Results show an increasing shift away from clinical doctorates to the research doctorate, although few differences exist within the research focus of doctoral nursing programs. Consistent with previous reports in the literature, curricula are fairly standard and few differences were noted based on a number of criteria including geographic location, type of degree granted, Carnegie classification of the university, or by the length of time the program has been in existence. Discussion of these findings is included.

Triangulation research among culturally diverse populations.

There exists an ongoing challenge in the health sciences to develop research methods that effectively describe patterns of health beliefs and actions in different cultures. While the dominant framework for research has traditionally been the quantitative paradigm, qualitative methods place more emphasis on holistic descriptions of the human phenomena and thus may be more appropriate for transcultural research. Triangulation offers an alternative for investigators studying transcultural health by integrating the inherent strengths of both quantitative and qualitative data while minimizing their limitations. This article discusses six approaches for employing triangulation research in transcultural health.

The changing role of grandparenthood.

For many grandparents in America, caring for grandchildren has become a full-time responsibility that has led to multiple stresses. Raising grandchildren may cause financial stress, cramped living quarters, role restriction, and social isolation among this group. However, advantages to this role among grandparents can include greater life satisfaction and a positive influence on the other generations within the family. Nurses and other health providers can play an essential role in assisting grandparents caring for grandchildren by strategically building family strengths and cohesiveness.

Caring behaviors by nurses: women's perceptions during childbirth.

OBJECTIVE: To identify nursing behaviors perceived as caring by women during childbirth. DESIGN: Descriptive research design using a structured questionnaire. SETTING: Interviews were conducted after vaginal birth and before hospital discharge. PARTICIPANTS: A convenience sample of 31 childbearing women. RESULTS: Women's perceptions of caring behaviors used by nurses were measured via the Caring Behavior Assessment, an instrument that lists 63 nursing behaviors in seven subscales and is congruent with Watson's (1988) caring factors. Mothers who had uncomplicated vaginal births were asked to rate behaviors of their nurses. Behaviors in the human needs assistance subscale, which included items such as "help me with my care until I'm able to do it for myself," "give my treatments and medication on time," and "check my condition closely," were perceived as the most caring. CONCLUSION: Identification of nursing behaviors that are perceived as caring will help nurses working in managed care environments where time spent with patients is decreased.

Neglected aspects of the learning process.

While many health care professionals are aware of basic principles of learning, the hurried health provider too often neglects essential pedagogical components that could facilitate learning. This article focuses on frequently neglected aspects of learning that can be used by the materials management department manager to maximize the learning process and ultimately optimize efficiency.

Disaster planning and resource allocation in health services.

The increasing prevalence of natural disasters, environmental tragedies, and depraved human behavior has generated excessive costs in both human and material resources at a time when cost-efficiency and control is continually emphasized by managed care contracts, business, and government agencies. As a result, increasing pressure has been placed on hospital material managers to do more with less, while also providing the necessary resources to respond efficiently and effectively during an emergency. A successful comprehensive, risk-based emergency management program of preparedness, response, and recovery will reduce the loss of life and resources.

Responding to the cultural and spiritual needs of clients.

Spirituality has been central to nursing practice since the time of Florence Nightingale although for many years spiritual care has fallen into disuse. With the increasing movement toward holistic nursing care within a multicultural community, the need to integrate cultural sensitivity with spirituality has become essential. By incorporating spirituality and cultural dimensions into the plan of care, nurses can more holistically provide efficient and quality care within both the hospital and community environment.

Enhancing self-esteem among cardiac patients.

This study examined the development, implementation, and evaluation of a module to enhance self-esteem among patients in an outpatient cardiac clinic. Eighty percent of the subjects reported that activities such as exercise and social functions helped them feel better about themselves. This data supported the use of spirituality, interpersonal relationships, self-care activities, and self-preservation concepts to enhance self-esteem in cardiac patients.

Combining the arts: an applied critical thinking approach in the skills laboratory.

The quality of care that nurses provide to patients is strongly influenced by the nurses' ability to think critically and to solve problems. In response to the dynamic changes in healthcare and rapid technological advancements, nursing educators must prepare nursing students to meet the challenges. Baccalaureate nursing students must be taught to utilize critical thinking skills for problem solving during the application of the nursing process. Nursing students who use critical thinking skills will provide high quality and efficient patient care in the acute care and community settings. During the simulated laboratory experience, incorporating creative teaching strategies to promote critical thinking and enhance problem-solving skills can enable nursing graduates to enter the workforce feeling confident and competent.

Problem-based learning in a competency-based world.

This article addresses the needed shift in nursing education from an information-driven approach in teaching to a process that promotes higher level thinking and clinical judgement. Strengths and weaknesses of problem-based learning and competency-based education in nursing are presented. Whereas the former focuses on critical thinking and clinical judgement, the latter's emphasis is on clinical competency. The appropriateness of the philosophies in both academic and practice settings is discussed.

Health and quality of life within Colonias settlements along the United States and Mexico border.

The Colonies settlements along the United States-Mexican border are reflective of third-world communities. Although most of the residents are U.S. citizens, they lack the basic educational and work opportunities found in most parts of the country. Because of the limited infrastructure, diseases controlled in most parts of the world are epidemic within these communities. Using the Giger and Davidhizar Transcultural Assessment Model, public health nurses can be instrumental in coordinating services in partnership with community members to enhance health and social service programs.

Chronic sorrow: the experience of parents with children who are developmentally disabled.

1. Adaptation mechanisms differ between mothers and fathers of developmentally disabled children. 2. Mothers' emotions radiate into chronic sorrow while fathers' reactions move toward resignation. 3. Patterns of grief and sadness reemerge and are most often precipitated by a health care crisis in women and comparison with social norms in fathers.

Future realities in nursing: partnerships, practice, and economics.

Health care reform, innovations in technology, and the need to make health care cost-effective have affected all aspects of health care practice and education. Critical thinking skills, interpersonal and communication skills, leadership and motivation skills, computer literacy, and cultural sensitivity are all capabilities nursing graduates must now possess if they are to practice effectively in the complex and competitive contexts that today define the health care marketplace. Partnerships with community agencies are essential if faculty are to prepare a new generation of nurses who will be proficient in the skills that 21st-century nursing practice will demand. Although academic institutions have made some changes to meet marketplace demands, nursing educators, practitioners, and researchers must thoroughly reconceptualize their philosophies and retool their curricula in response to these changes.

Traditional birth attendants' advice toward breast-feeding, immunization and oral rehydration among mothers in rural Bangladesh.

Traditional birth attendants (TBAs) are regarded as essential child health care providers in Bangladesh. A community-based cross-sectional study was completed using questionnaires and interviews to compare trained and untrained TBAs' advice on (1) breast-feeding, (2) immunizations and (3) oral rehydration therapy as an extended part of their maternity care training. Twenty-eight trained TBAs (TTBAs) and 27 corresponding untrained TBAs (UTBAs) in the Dhaka district were interviewed to investigate the effect of their advice on the three outcome variables of maternal health care. Additionally, 276 questionnaires were distributed to the mothers cared for by these TBAs to determine their knowledge of infant-care practices. In-depth interviews with 25 mothers provided additional insight. While TTBAs may have more knowledge and be more willing to disseminate health care information to mothers with new infants than UTBAs, the mother's health practices were independent of the advice provided by the two groups of TBAs. Additionally, the mother's health practices equaled or exceeded expected norms.

PIP: A cross-sectional study conducted in rural Bangladesh's Dhaka District compared the appropriateness and accuracy of advice given by 28 trained and 27 untrained traditional birth attendants (TBAs) on breast-feeding, immunization, and oral rehydration. In addition, perceptions of care provided by trained and untrained TBAs were analyzed through a questionnaire administered to 276 clients of these TBAs. TBAs in both groups tended to be poor, married, Islamic women with no formal education. Although the trained TBAs provided more accurate information than their untrained counterparts in terms of breast-feeding, colostrum, and when to introduce solid foods, mothers' breast-feeding knowledge and practices were unrelated to whether they had been cared for by a trained or untrained TBA. Similarly, while trained TBAs provided more correct information on both immunization and oral rehydration therapy, mothers' adherence to immunization schedules and use of rehydration when their child had diarrhea were not affected by the type of TBA who provided care. Both groups of TBAs reported providing more information to mothers about these three issues than mothers reported receiving from the TBAs. In general, maternal health practices met or exceeded expected norms.