Mothers' ranking of clinical intervention strategies used to promote infant health.

PURPOSE: To support evidence-based practice for infant health promotion by determining mothers' preferences among eight clinical intervention strategies. METHOD: A sample of 138 mothers of 4-month-old infants who received care through a county health department used a card sort method to rank order intervention strategies and identified advantages and disadvantages of each method. FINDINGS: The mothers' rank ordering of the clinical intervention strategies, beginning with the most preferred, was: 1. Nurse home visitation; 2. Group session with mothers, led by a nurse; 3. Community lay worker home visitation; 4. Classes in the clinic; 5. Health diary; 6. Videotapes at home; 7. Brochures; and 8. Videotapes in the clinic. CONCLUSIONS: Intervention strategies that use interpersonal communication, including the opportunity for mothers to ask questions, were most preferred. Strategies that involve one-way messages to mothers were least preferred. Investment in strategies that do not appeal to mothers are likely be ineffective in promoting infant health and wasteful of health care dollars.

Infant exposure to environmental tobacco smoke.

PURPOSE: To identify infant health outcomes that have been empirically associated with environmental tobacco smoke (ETS) exposure in current international research literature. METHODS: Reports of infant ETS exposure, obtained using computerized searches of CINAHL and Medline databases, were reviewed. Studies of infant health outcomes published between 1995 and 2000 were included if they met specific criteria including the selection of infant ETS exposure as a major study variable. FINDINGS: The 10 studies in this integrative review of the literature were conducted in a variety of international health care settings. Positive associations were found between infant ETS exposure and gastroesophageal reflux, colic, sudden infant death syndrome, lower respiratory tract infections, and other infant morbidities. Parental self-reports were the predominant measures of ETS exposure. Maternal smoking was reported as a significant predictor of infant health outcomes. CONCLUSIONS: Nurses who care for mother-infant dyads in the first year of life are needed to support the development of a "gold standard" for the measurement of ETS exposure that is reliable, valid, and economical. In the interim, the global nursing community may use the findings of these current studies as justification for directing infant health care resources to smoking cessation interventions specifically tailored to meet the needs of mothers who smoke.

Assessing infant health promotion: a cross-cultural comparison.

The purpose of this cross-cultural, correlational study was to evaluate two popular clinical/research assessment tools, the NCAST Teaching Scale and the Home Observation Measurement of the Environment (HOME) Inventory, as measures of infant health promotion behaviors for low-income, foreign-born Hispanic mothers in the United States. Based on the assumption that both measures tap universal attributes of the mother-infant relationship, it was hypothesized that maternal performance for the study group and a comparison group of U.S.-born, low-income mothers would be similar. Comparable performance on the NCAST Teaching Scale included a full range of scores, including the capacity to identify mothers most in need of clinical intervention. Study fundings supported the clinical use of this assessment scale with mothers represented by the study sample. Consistently lower scores by the foreign-born Hispanic mothers on the HOME Inventory led to the conclusion that the instrument may not tap cultural universals in the mother-infant relationship.

Prenatal risk factors among foreign-born Central American women: a comparative study.

The purpose of this study was to compare the incidence of empirically established prenatal risk factors for low birthweight (LBW) outcomes among two groups of low-income mothers: foreign-born Central American women and nonimmigrant, non-Hispanic women. Two hundred ninety-six women who were part of a larger study of maternal role sufficiency were included in the present study: 127 Central American women and 169 nonimmigrant, non-Hispanic women who identified themselves as Black (n = 59) or White (n = 110). Data were collected by public health nurses (PHNs) during home visits and by research nurses in prenatal health department clinics. Comparisons were made between the two groups in areas of demographic characteristics, prenatal health behaviors, and prenatal stressful life-events. Foreign-born Central American mothers were found to be less educated, more likely to be living with their partners, less likely to engage in prenatal health risk behaviors, and less likely to identify stressors in their lives. The initiation of prenatal PHN services by the target group was similar to the comparison group. Their rate of LBW deliveries did not reflect the protective effect often attributed to foreign-born Hispanic mothers. Findings are discussed in light of the paradox of LBW and Hispanic heritage. Recommendations for practice, clinical research, and public policy are also addressed.

Encouraging collaborative learning among culturally diverse students.

With the dramatic increase in the number of foreign-born residents in many U.S. communities, it is increasingly important that nursing education address the requirements of culturally competent care, The author describes the experience of establishing a teaching and learning environment to foster this concept. The setting was a health assessment course with students from 13 countries of origin. Emphasis is placed on effective teaching strategies, student contributions to the process, and the challenges that remain.

Tobacco smoke exposure and pediatric otitis media: an empirical basis for practice.

Tobacco smoke exposure has been attributed to a myriad of pediatric clinical outcomes, with a staggering financial burden to society. This article is an examination of published research that has focused on the relationship between tobacco smoke exposure and pediatric otitis media. The weight of evidence presented supports a positive relationship between the two clinical entities. Further clinical studies are needed so primary care providers may continue to build a strong empirical base for interventions directed at helping parents reduce tobacco smoke exposure in their children's home environments. Interventions based on the Ask, Advise, and Assist framework are recommended.

Stressful events among pregnant Salvadoran women: a cross-cultural comparison.

OBJECTIVE: To compare stressful events, including violent episodes, experienced by pregnant Salvadoran women with those experienced by two other groups of low-income, pregnant women living in the United States (non-Salvadoran Hispanics and non-Hispanics) and to examine the association between episodes of violence and drug or alcohol use among the three groups. DESIGN: Comparative, descriptive study. SETTING: Public health prenatal clinics. PARTICIPANTS: One hundred four Salvadoran, 69 non-Salvadoran Hispanic, and 187 non-Hispanic pregnant women. MAIN OUTCOME MEASURES: Difficult Life Circumstances (DLC) scale and psychosocial history assessment. RESULTS: Statistically significant differences were found among the three groups in total DLC scores, F(2, 357) = 14.98, p < .001; reported episodes of violence, F(2, 357 = 17.82, p < .001; and drug or alcohol use, F(2, 357) = 6.33, p < .001. A significant difference was found to the extent that alcohol or drug use accounted for the variance in violence among the three groups, F(3, 360) = 6.28, p < .001. CONCLUSIONS: Cross-cultural comparisons revealed group differences in the number of stressful events, including episodes of violence and alcohol or drug use.

PIP: A comparative, descriptive study was conducted among 104 Salvadoran, 69 non-Salvadoran Hispanic, and 187 non-Hispanic pregnant women concerning the stressful events including episodes of violence experienced. Furthermore, it also compared the relationship between episodes of violence and drug or alcohol use among the three groups. The measures used are the Difficult Life Circumstances scale and psychosocial history assessment. Results showed that stressful events were found to occur more frequently among the non-Hispanic mothers than among either Hispanic subgroups. However, cultural distinctions between Salvadoran and non-Salvadoran Hispanic mothers did not emerge. Alcohol and drug use differed significantly among the groups in this study. In conclusion, cross-cultural comparisons revealed group differences in the number of stressful events, including episodes of violence and alcohol or drug use.

Prenatal assessment for childhood discipline experiences.

PURPOSE: To explore relationships between pregnant women's childhood experiences with discipline and 1) prenatal plans for disciplining own child and 2) later maternal-infant interactions DESIGN: Prospective correlation study. SETTING: Prenatal clinics and home visits PARTICIPANTS: Low-income pregnant women (N = 205) with a mean educational level of 12 years MAIN OUTCOME MEASURES: Adapted Ways of Handling Irritating Behaviors (Mother and You) Scales, NCAST Teaching Scale, Home Observation for Measurement of the Environment Scale RESULTS: Correlations between childhood experiences with discipline and 1) plans for later discipline strategies with own child and 2) infant components of maternal-infant interactions, including clarity of cues and responsiveness to the mother CONCLUSIONS: Prenatal assessment for childhood experiences with discipline may uncover factors associated with a break in the trajectory for optimal maternal-child interactions described by Barnard's theoretical framework.

Testing Orem's theory of self-care deficit: dependent care agent performance for children.

The purpose of this study was to test Orem's theory of self-care deficit, one of three constituent theories included in her general self-care deficit theory of nursing. Specifically, the relationship between dependent care agent performance and basic conditioning factors was examined. Dependent care agent performance for children was defined as health promotion and self-care activities provided by a responsible adult on behalf of the child. The Dependent Care Agent Questionnaire was used with a sample of 380 mothers of children from ages 1 to 16 years. The hypothesis that basic conditioning factors influenced dependent care agent performance was supported (R2 = .13, p = .0001).

"Think TB:" new focus for family assessment.

The growing incidence of tuberculosis (TB) among childrearing families introduces new challenges to pediatric nurses. The following four clinical stories have been developed from the authors' experiences with Hispanic families from high prevalence regions in order to emphasize the characteristics and conditions that nurses need awareness of when caring for patients with possible TB. These stories highlight common themes in families from other high-risk groups as well that may surface in pediatric nurses' practice. Collaboration between pediatric and TB control nurses becomes essential for vigilant control of the spread of this reemerging old disease.

Nursing practice model for maternal role sufficiency.

In 1975 Meleis set forth a conceptual framework for nursing practice centered on the concepts of role insufficiency and role supplementation. Later, Millor introduced a parental role sufficiency model for nursing research in child abuse and neglect. Based on the works of Meleis and Millor, a nursing practice model is proposed that focuses on maternal role sufficiency. It includes assessment of prenatal characteristics, measurement of developmental and health-illness outcomes, and preventive role supplementation intervention.

Development of an instrument to measure mothers' performance of self-care activities for children.

One who performs self-care activities for another is known as a dependent care agent, according to Orem. Attempts to study mothers' performance of self-care activities for children have been impeded by the lack of an instrument with which to measure dependent care agent performance. Findings based on a sample of 475 women indicate that the Dependent Care Agent (DCA) questionnaire developed in this study had a coefficient alpha of .91, with item-total correlations ranging from .27 to .63. Although Orem's expected dimensions of universal, developmental, and health deviation requisites were not represented in the factor analysis, individual requisites for self-care were clearly present.

Maternal-fetal attachment in relation to self-concept and anxiety.

This study investigates the association that maternal-fetal attachment has with self-concept, state anxiety, and trait anxiety. One hundred third trimester pregnant women attending prenatal classes were studied. Data were collected by using three psychometric instruments: Maternal-Fetal Attachment Scale, the Tennessee Self-Concept Scale, and the State-Trait Anxiety Inventory. The findings do not show a significant relationship between the overall level of maternal-fetal attachment and self-concept. The findings do show significant inverse correlations between state (temporary) anxiety and the overall Maternal-Fetal Attachment Scale. An inverse but non-significant relationship between maternal-fetal attachment and overall scores representing trait (long-term) anxiety was found. The study failed to demonstrate the strong association between anxiety and maternal-fetal attachment described by other theorists. The author speculates that the chosen instrument does not adequately differentiate between the mother's anxieties regarding self and those related to the fetus.