Knowledge, attitudes, and practices of baccalaureate nursing students regarding oral health assessment.

Good oral health is important to overall health. Oral and pharyngeal cancers account for 2% of all cancers, yet no significant improvement in mortality has been demonstrated over the past 30 years. Nurses are in a unique position to integrate and conduct oral health assessments across a wide range of practice settings. Although nursing programs include health assessment and promotion in their curricula, there is poor integration of oral health as a focus. This study aimed to identify the knowledge, attitudes, and practices of baccalaureate nursing students about oral health assessment. A convenience sample of 163 students in two undergraduate courses within a baccalaureate nursing education program was surveyed. Findings indicated that these nursing students felt that oral health was essential to their nursing practice; however, they did not have a full understanding of the key components of an oral health examination or about effective smoking cessation strategies.

The significance of motherhood for adolescents whose mothers have breast cancer.

PURPOSE/OBJECTIVES: To describe adolescents' experiences of living with mothers with breast cancer. RESEARCH APPROACH: Qualitative. SETTING: Northeastern United States. PARTICIPANTS: 11 adolescents aged 13-19 years whose mothers were diagnosed with breast cancer within a year prior to the study. METHODOLOGIC APPROACH: With Van Manen's phenomenologic interpretive paradigm, multiple levels of analysis of transcribed semistructured interviews yielded common themes and a unique account and understanding of adolescents' lives when their mothers have breast cancer. MAIN RESEARCH VARIABLES: Adolescent coping and maternal breast cancer. FINDINGS: Five distinct themes were identified: life changed, turning to self, learning to be with my mother, needing to normalize, and speaking openly--the importance of communication. Study findings uncovered the powerful role mothers held in the adolescents' lives. CONCLUSIONS: The depth of the feelings and conflicts expressed by the adolescent participants, who appeared to be coping with their mothers' breast cancer, emphasizes the need to explore coping responses used in adolescent adjustment to maternal breast cancer. Given that all the adolescents reported some level of anxiety and conflict in their lives, further research should address factors that underlie their coping mechanisms. INTERPRETATION: Study findings and insights underscore the significance of the maternal-adolescent relationship. Healthcare professionals need to ask more directed questions and develop interviewing and counseling skills to support mothers through this difficult illness. Adolescent children require support and guidance in coping with their mothers' breast cancer journey.

Geriatric nursing education in community health: CareLink--partnering for excellence.

The purpose of the study was to evaluate how participation in the CareLink program influenced the community health knowledge and skill of baccalaureate nursing students regarding the care of community-dwelling older adults. Students were assigned three to four clients each during their 14-week clinical placement with a home care agency, situated in a naturally occurring retirement community or senior center. Students contracted with their clients to set goals and provided standardized health assessments and teaching. Students completed pretest and posttest surveys, and attended focus groups to address their learning. Students' public health nursing and cultural competence improved significantly. The CareLink program provides a meaningful learning experience for baccalaureate nursing students. Attitudes toward older adults and community health nursing in general shifted to acknowledge that older adults have strengths and resilience not previously acknowledged.

Cervical cancer: patterns of long-term survival.

PURPOSE/OBJECTIVES: To describe the quality of life (QOL) experienced by long-term survivors of cervical cancer and the factors that promoted their adaptation. DESIGN: Qualitative. SETTING: Homes and offices in the northeastern United States. SAMPLE: 19 women diagnosed with cervical cancer from 1975-1995. METHODS: Semistructured interviews were tape recorded. Interviewers asked the participants questions regarding their cancer experience, recovery, and long-term survival. Qualitative content analysis was used to identify themes that characterized participants' accounts. Participants varied in regard to how the themes were manifested in their accounts. MAIN RESEARCH VARIABLES: Meaning, impact on identity, impact on QOL, coping strategies, and future expectations. FINDINGS: Three distinct patterns of response emerged from participants' accounts of long-term survivorship with cervical cancer. Women categorized in the "moving on" pattern described their cancer as a difficult period taking place in the past, women in the "renewed appreciation of life" pattern focused on the positive outcomes of their cancer experience, and women in the "ongoing struggles" pattern emphasized the continuing negative outcomes of their cancer experience. Despite their overall distinctness, some common qualities in the patterns emerged, including the shock of the diagnosis, the pivotal role of healthcare providers, and the importance of support from family and friends. CONCLUSIONS: Cervical cancer survival, for most of the study participants, brought with it some degree of long-term complications, with differences in reported QOL attributed to an ability or choice to reframe the cervical cancer experience. IMPLICATIONS FOR NURSING: QOL and depression measures alone do not uncover embedded meanings of women's experiences with longterm survivorship. Clinicians can use a variety of interview probes and evidence-based psychosocial and educational approaches to assist the target population in the journey. Findings suggest that nurses play a key role in responding to cervical cancer survivors' unique experiences with illness and recovery.

CARELINK: partners in a caring model: a cardiac management program for home care.

As a model of care, CARELINK promotes self-care and self-management of chronic illnesses for homebound older adults no longer eligible for skilled nursing services. A case-study method is used to highlight the key constructs and outcomes related to the model. The benefits of applying the CARELINK model as a cardiac management program for home care are discussed.

Improving oral health in women: nurses' call to action.

The purpose of this article is to discuss the most significant oral health and related problems experienced by women, and to provide a Nurse's Plan of Action to respond to these largely preventable diseases. Oral health is integral to women's overall health and well-being, with poor oral health being associated with cancer, heart disease, diabetes, depression, and the birth of preterm, low-birthweight babies. Poor nutrition and lifestyle, principally tobacco and heavy alcohol use, can further increase the risk for oral diseases. Disparities are evident in women's reported poor access of regular dental care related to lack of dental insurance and low income. These facts are disturbing because most oral diseases are preventable. The Surgeon General's report on oral health in America (U.S. Department of Health and Human Services, 2000) and, more recently, the "National Call to Action to Promote Oral Health" (U.S. Department of Health and Human Services, 2003) emphasized the need for partnerships of key stakeholders, including nurses, to get involved in oral disease prevention. Nurses are in an ideal position to provide health promotion education and screening across the multitude of settings in which they work regarding oral health and risk factors for oral disease. Nursing interventions aimed at promoting healthy outcomes and preventing disease should include a focus on oral health.

Promising outcomes in teen mothers enrolled in a school-based parent support program and child care center.

BACKGROUND: This study described a cohort of teen mothers and their children attending an urban high school with a parent support program and school-based child care center. Specific aims of the study were to describe maternal characteristics and outcomes, and child developmental and health outcomes. METHODS: A volunteer sample of 65 adolescent mothers enrolled in the parent support program and their children were interviewed, surveyed, and assessed. Fifty-three mothers had children enrolled in the school-based child care center and 12 mothers had their children cared for by family members. Maternal characteristics assessed included self-esteem and depressive symptoms, social stressors and support, self-perceived parental competence, parent-child teaching interactions, and subsequent childbearing and maternal educational outcomes. Child outcomes included child developmental assessments and health outcomes. RESULTS: About 33% of teen mothers were mildly to moderately depressed and 39% of the sample had experienced transitional homelessness. Social support networks were small; in the past 12 months, mothers experienced a mean number of 13.2 +/- 11.9 negative life events. Maternal self-report measures and mother-child observation measures indicated positive levels of parental competence. Maternal educational outcomes were positive, and only 6% of mothers had subsequent childbirths within 2 years. The mean scores on developmental assessments of children fell within the normal range, although there were 7 children identified with developmental delays. CONCLUSIONS: For at-risk teen mothers, this parent support program and school-based child care setting appears to offer promising opportunities to help young mothers with parenting, avoid rapid subsequent pregnancies, and stay engaged with school, while their children are cared for in a close and safe environment.

Increasing activity to reduce obesity in adolescent girls: a research review.

OBJECTIVE: To provide a systematic review of physical activity intervention research conducted with adolescent girls (12-19 years of age and/or in middle or high school) in the United States and Canada during the past two decades. DATA SOURCES: Published articles in English were identified in searches using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, EMBASE, Science Citation Index, and the Cochrane Controlled Trials Register, with the keywords adolescent health, obesity, physical activity, and exercise, between the dates of May 1980 and November 2003. STUDY SELECTION: Research studies with interventions that started within the adolescent time period. Only 7 studies met the inclusion criteria. DATA EXTRACTION: The publication year, sample description, study design, interventions used, and outcomes were extracted from each study. DATA SYNTHESIS: The 7 studies were published between 1989 and 2003, included girls and boys in the overall sample (no studies with girl-only samples), used randomized controlled trial or quasi-experimental designs, and included multicomponent interventions. Body mass index, fitness levels, exercise, and weight were measured as outcomes. CONCLUSIONS: Although the results were not consistent across studies, they suggest that school-based, multicomponent interventions that were also designed to decrease sedentary behavior were effective in increasing physical activity in adolescent girls. Future research should focus on determinants of long-term adherence and the duration and intensity of interventions necessary to prevent obesity in adolescent girls.

Learning and living health: college students' experiences with an introductory health course.

Despite the Healthy People 2010 initiative and the national focus on promoting healthy lifestyle strategies, studies indicate that U.S. citizens are becoming more obese, and that rates of depression, diabetes, hypertension, homicide, and suicide are increasing. The college campus provides a microcosm of the health issues facing the nation, with college students' reports of increased risk behaviors evident in higher rates of smoking and binge drinking. Faculty in schools of nursing are in an ideal position to develop and provide health promotion and illness prevention programs, both for their own nursing students and for a broader campus-wide student population. This article describes a research study that course faculty conducted during the first year of implementation, designed to evaluate the extent to which participation in the "Introduction to Health" coursework and related activities influenced students' health-related behaviors.

Postpartum depression as profiled through the depression screening scale.

PURPOSE: To describe in greater depth the profiles of the dimensions of the Postpartum Depression Screening Scale (PDSS), with a focus on those women identified with postpartum depression (PPD), and to provide a discussion of the implications for early detection in the community. METHOD AND DESIGN: Subanalysis of data from 150 new mothers who completed the PDSS and had a DSM-IV diagnostic interview conducted by a nurse psychotherapist. Data analysis focused on exploring the profiles of women who were diagnosed with PPD as well as those who were not. RESULTS: The respondents within the major PPD group averaged scores twice as high as those in the nondepressed group, and described more profound emotional responses to their maternal role transitions. CLINICAL IMPLICATIONS: PPD should be conceptualized as occurring in a continuum, with symptoms worsening over time for some women. Nurses working across healthcare settings can use the PDSS for identifying women with PPD. All healthcare providers who are in contact with postpartum women should be open to discussing these women's emotional needs, and should assess women on an ongoing basis. Using all opportunities to listen to women's unique stories that unfold during the postpartum period can help identify women who require treatment for this curable illness.

Adolescent motherhood: a meta-synthesis of qualitative studies.

PURPOSE: To synthesize qualitative studies on the phenomenon of adolescent motherhood. METHODS: Databases were searched for qualitative studies regarding the experience of adolescent motherhood (years 1990-2001). Noblit and Hare's (1988) meta-ethnographic comparative method was used for synthesizing the research. A total of 251 citations were found, with a subgroup of 50 studies on "adolescent motherhood" and "qualitative studies." Twenty-five studies conducted in the United States, Canada, China, England, and Australia met the sample inclusion criteria. The combined sample of participants across studies was 257 adolescent mothers. RESULTS: Certain characteristics are common to the studies of adolescent motherhood. Five overarching metaphors were found: (1) the reality of motherhood brings hardship; (2) living in the two worlds of adolescence and motherhood; (3) motherhood as positively transforming; (4) baby as stabilizing influence; and (5) supportive context as turning point for the future. CLINICAL IMPLICATIONS: Nurses working in hospital, home care, community, and school settings can use the results of this metasynthesis to obtain a clearer picture of how adolescents feel during pregnancy, and the types of nursing interventions that can be developed to help them.

Adolescent mothers' depression after the birth of their babies: weathering the storm.

This phenomenological study explored the experiences of adolescent mothers with depression following the birth of their babies. A sample of 20 English-speaking participants, between the ages of 16 and 18, were asked to reflect upon and describe their thoughts, feelings, and perceptions about being depressed after the birth of their babies. Significant statements were extracted from each of the transcribed interviews and meanings formulated that reflected the intent of the statements. The meanings were organized into six theme clusters. A written, exhaustive description was reviewed by study participants for credibility and trustworthiness of the findings. The metaphor of being hit by a nor'easter storm emerged from the participants' descriptions of their experiences and was threaded throughout the description of the themes. Implications for practice and directions for future research are presented.

Epidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review.

The purpose of this article is to profile research findings targeting the intrapartum care implications of the most common side effects and co-interventions that go along with the use of epidural analgesia during labor. Randomized, controlled trials published in English from 1990 to 2000 that addressed each of the targeted side effects and 3 specified co-interventions were evaluated for inclusion in this report. Side effects such as pruritus, nausea, and hypotension during labor are common, but they are usually mild and necessitate treatment infrequently. However, even with the advent of newer low-dose epidurals, the extent of impaired motor ability remains variable across studies. The incidence of "walking" epidurals during labor is likely to be complicated by multiple factors, including individual patient desires, safety considerations, and hospital policies. In response to risks for a decrease in uterine contractions that could prolong labor, oxytocin augmentation is likely to be administered after epidural analgesia. The use of "delayed" pushing may be an effective way to minimize the risk for difficult deliveries. Upright positioning even when confined to bed may be advantageous and desirable to women; however, additional research to determine actual outcome benefits with epidurals is needed. Implications for further research linked to epidural analgesia also include informed consent, modification of caregiving procedures, and staffing/cost issues.