Beyond bus fare: deconstructing prenatal care travel among low-income urban mothers through a mix methods GIS study.

OBJECTIVE: Guided by critical theory, this study illustrates the value of interpretative mapping to deconstruct bus travel to publicly funded prenatal care in a city marked by health and social inequities. METHODS: This mixed methods study used GIS maps based on 61,305 births to study the known barrier of transportation to prenatal care among urban mothers most at risk for preterm birth. RESULTS: Among 350 census tracts, 36 census tracts had preterm rates between 25 -36.9%. Modeling travel time for the case vignette for routine prenatal care took 21 visits to different geographically located facilities. This burden increased to 32 visits if the case vignette was high-risk. CONCLUSIONS: Interpretative GIS mapping is an important tool to ground truth spatially linked data into real world meanings. Promoting optimal health requires innovative and feasible approaches that take into consideration daily maternal functioning as pregnant mothers care for their children and themselves.

Exploratory Study of Childbearing Experiences of Women With Asperger Syndrome.

Increasing numbers of girls have been diagnosed with Asperger syndrome and other autism spectrum disorders (ASDs) over the past two decades; therefore, more women with ASDs are entering the childbearing phase of their lives. Little is known about the childbearing experiences of women with ASDs. This qualitative study describes the childbearing experiences of eight women with Asperger syndrome. Four major themes emerged: Processing Sensations, Needing to Have Control, Walking in the Dark, and Motherhood on My Own Terms. Clinicians can provide sensitive, individualized care by asking women with Asperger syndrome about their specific sensory experiences, counseling them about coping strategies for sensory intrusions, providing targeted support, and modifying the clinical environment to decrease distressing stimuli.

Survey of Nursing Faculty Preparation for Teaching About Autism Spectrum Disorders.

The prevalence of autism spectrum disorders (ASDs) has increased significantly in children and adults. Nursing faculty's ability to teach students about best practices in their care across the lifespan is important. This study explored nurse educators' perceived knowledge of, and levels of comfort in, their abilities to teach nursing students about nursing care of people with ASD. Strategies are proposed to incorporate competencies for care of people with ASD into nursing curricula.

Low-income, urban minority women's perceptions of self- and infant care during the postpartum period.

OBJECTIVE: To describe low-income, urban, first-time mothers' perceptions about self-care and infant care during the first 6-months postpartum. DESIGN: Naturalistic approach. SETTING: Recruitment from community centers and churches. PARTICIPANTS: Thirteen Hispanic and African American women who delivered their first infants within the past 6 months. METHODS: Demographic and health information data were collected and analyzed using descriptive statistics. Semistructured interviews were conducted; data were coded and then clustered conceptually into categories. RESULTS: Postpartum maternal self- and infant care issues included four categories: preparedness for discharge, confidence and satisfaction with mothering, concerns about infant care, and indifference to maternal self-care. Women were confident in caring for themselves and their infants and reported few unmet learning needs or health concerns. External sources of stress included finances, uncertain living arrangements, and relationship issues. CONCLUSION: Health care providers who care for low-income postpartum women need to acknowledge the influence of external stressors that contribute to health outcomes in this population. It is vital that nurses collaborate with other health care providers to make certain that community connections are made for women who might need additional services beyond the postpartum check-up visit.

Maternal caregiving and strategies used by inexperienced mothers of young infants with complex health conditions.

OBJECTIVE: To describe maternal caregiving and related strategies used by first-time mothers of young infants with complex health conditions (CHC) in the first 6 months after discharge. DESIGN: Grounded theory. SETTING: Data were collected in participants' homes in the Northeast United States. PARTICIPANTS: Eight first-time mothers of infants age 6 months or younger with CHC. METHODS: Purposive and theoretical sampling were used. Semistructured interviews were completed at 2-month intervals, beginning 2 weeks after their infants' discharge. Analysis of 28 interviews was done with the constant comparative method. RESULTS: A grounded theory of maternal caregiving was conceptualized from the data. This time-and-experience-mediated process involved three phases of increasing confidence and expertise, developing in the context of decision-making responsibility. Related maternal strategies included appraising, normalizing, organizing, assessing, practicing, validating, experimenting, nurturing, and negotiating. Mothering became predictable and integrated in everyday life by about 6 months after the infant's discharge home. CONCLUSION: Findings can help clinicians and researchers better understand what happens over time as new mothers care for infants with CHC. Exploration of these patterns in a more diverse group of mothers of children with CHC can support the development of targeted interventions for this specialized population.

Feeding tolerance in preterm infants on noninvasive respiratory support.

To evaluate differences in feeding tolerance between infants maintained on continuous positive airway pressure (CPAP) and those receiving high-flow (nasal) cannula (HFC) with or without CPAP. This is a retrospective, cross-sectional study. Two groups of very low-birth-weight infants (750-1500 g) were compared on the basis of respiratory support: (1) infants born between the January 2002 and December 2004 treated with CPAP; and (2) infants born between January 2005 and December 2006 treated with HFC with or without CPAP. The groups were compared to determine which of the two attained full feedings sooner. Successful achievement of full feedings was measured in days from birth and defined by discontinuation of hyperalimentation-supplementation and attainment of 120 mL/kg/d of enteral feedings. A total of 185 infants met inclusion criteria (103 who received CPAP exclusively and 82 who received HFC with or without CPAP). There was no statistical difference in time to full enteral feedings between the 2 groups. There was also no difference in time of initiation of oral feeding or days to full oral feedings between 2 groups. The use of HFC was not associated with changes in feeding tolerance in premature infants. Further studies are needed to investigate efficacy and potential advantages and disadvantages to the use of HFC in the very low-birth-weight infant population.

Understanding access to care and health needs of Hispanic women from an urban community.

As a first step in a proposed program of community-based participatory research, this study investigated access to care and specific health needs in a population of Hispanic women from a medically underserved, urban community. There were 66 Hispanic women recruited at a local church to complete a 94-item researcher-developed survey. Thirty-two percent of women in the study were not U.S. citizens. Being insured, being a citizen, and having a medical diagnosis were significant in satisfaction with care. The most prevalent health issue for this population was being overweight or obese. This study demonstrates the use of the community needs assessment process in the development of interventions to improve a community's health and health care. This is especially true in the Hispanic community in which large variations based on culture and country of origin will impact the success of planned interventions.

Nursing faculty preparedness for clinical teaching.

Nursing faculty who teach in clinical settings face complex situations requiring evidence-based educational and evaluative strategies, yet many have had limited preparation for these tasks. A convenience sample of 74 nursing faculty participated in a survey about clinical teaching in prelicensure nursing programs. Most faculty developed teaching skills through conferences (57%), orientation at their educational institution (53%), or exposure in graduate school (38%). Thirty-one percent reported having no preparation for clinical teaching. Faculty felt least prepared to manage students with learning, physical, or emotional disabilities and incivility. Twenty-six percent had no preparation for evaluating students in the clinical setting, and only 17% had worked with a faculty mentor. Few evidence-based teaching strategies were used by the faculty. These findings indicate gaps exist in the preparation of clinical faculty. Graduate education, comprehensive orientation programs, and continuing professional development may help to ensure faculty are effective in managing and evaluating student learning.

Preparing nurses to care for people with developmental disabilities: perspectives on integrating developmental disabilities concepts and experiences into nursing education.

The argument that nursing curricula have not adequately prepared graduates to provide appropriate care for individuals with intellectual disabilities and developmental disabilities (DDs) has been put forward for a decade or more. This is of concern because the number of individuals with DDs has been increasing at a rapid rate. Undergraduate and graduate nursing curricula should address concepts of care for DDs across the lifespan and develop strategies to provide students with clinically relevant experiences to support development of competencies for care of this population. Exemplar strategies from the literature are described along with recommendations for further work.

Conceptual, holistic, and pragmatic considerations for interviewing research participants.

Interviews are commonly used as data collection method in many types of studies. Interviewers and researchers may be challenged to take a holistic view of the interviewing process and to acknowledge participants' perspectives and experiences, understand the implications of dialogue between interviewers and participants, guide data collection to address research questions and aims of a study, and ensure that high-quality data is collected for analysis. This article addresses the need to integrate a holistic perspective into data collection and reviews general and specific interviewing considerations, including assessment and conceptualization of potential research vulnerability of participants, factors that may influence the quality of data collected through interviews, interviewing strategies, interview facilitation, and specific strategies to acknowledge a specialized population in terms of vulnerability, dialogue, power, and study rigor. Data and exemplars from a grounded theory study of mothers of medically fragile infants are used to illustrate some of the challenges inherent in the use of interviews for data collection.

Fostering a smooth transition to the faculty role.

Both new and experienced nursing faculty across the United States are struggling to meet the individual needs of an increasingly diverse and growing population of nursing students, while simultaneously attempting to balance the research, scholarship, and stewardship requirements of their institutions. Faculty development is part of the professional career journey, and involves mentorship, guidance, and more formal educational experiences. One university's faculty development program is described and addresses the role of mentors and administrators in the faculty development process, the recognized need for continued development and partnering opportunities, and outcome data from two cohorts of new nursing faculty.

The standardized patient experience in undergraduate nursing education.

Drexel University College of Nursing and Health Professions was the first Undergraduate Nursing Program to incorporate the Standardized Patient Experience as a requirement for the completion of the Undergraduate Nursing Degree. This requirement has resulted in positive student outcomes and increased student satisfaction.

Understanding interventions and outcomes in mothers of infants.

The first two years after an infant's birth is a time of transition for mothers as changes in roles, responsibilities, expectations, and behaviors occur in response to the demands of caring for newborn infants and young children. Mothers play pivotal roles in overall child development and health and may benefit from nursing intervention that assists in the transition to motherhood. A review of the intervention literature related to the promotion of effective mothering was performed in order to examine the range of interventions and evidence of their usefulness for maternal-child and pediatric nursing practice. Five broad categories of interventions appropriate for nursing practice were identified through the literature review. Home visiting, skin-to-skin contact, individual, infant-focused education/counseling, and theory-based group intervention have a specific applicability for the promotion of mothering in particular populations of mothers. Based on the evidence, nurses can incorporate selected strategies into nursing care to promote effective mothering during the first years of a child's life.

Outcomes in children experiencing neurologic insults as preterm neonates.

Germinal matrix-intraventricular hemorrhage, periventricular hemorrhagic infarction, and periventricular leukomalacia are common brain injuries in preterm infants that can have significant long-term influences on children's development, physical skills, and cognitive functioning. Characteristics of preterm infants, including immature cerebrovascular autoregulation, fragility of blood vessels, and the presence of the germinal matrix, increase their vulnerability to neurologic injury. Grades I-II germinal matrix-intraventricular hemorrhage tends to have little-to-moderate long-term impact on cognitive and neuromotor development after the neonatal period, while more severe hemorrhage is associated with less optimistic developmental prognoses. Periventricular leukomalacia and ventriculomegaly in the neonate are associated with severe cognitive disabilities as well as with cerebral palsy. Neurodevelopmental strategies emerging from both the neonatal developmental care and early intervention models may have a place in the post-acute care of newborns who experienced these insults. Vigilant developmental screening and early developmental intervention are essential components of the follow-up nursing care for children whose medical histories include neonatal brain injury.