A curriculum self-study of writing assignments and reflective practice in nursing education.

Reflective practice is an ongoing process of purposeful thinking about one's clinical practice to develop understanding, insight, and clinical judgment. It can be enhanced through careful use of writing assignments that require reflection, evaluation, and thoughtful analysis. The uses of writing assignments in the undergraduate nursing programs at a midwestern college of nursing were studied over a 2-year period, using survey methodology. A purposive sample of all faculty who taught in baccalaureate or associate of science (ASN) programs (n=21) completed a questionnaire and were interviewed about the number and purpose of writing assignments in courses they taught. Quantification of the results in tabular form allowed the faculty to look at all writing assignments required of students across both programs with regard to the number, length, and nature of those assignments. Results were then recategorized by type of assignments, changes needed, and faculty assessment of the usefulness of these writing assignments. The summary of written assignments was then cross-referenced according to program, semester, and program level. This produced a working document that illustrated the quantity and type of writing assignments that each student, in each program, at a given level and semester must complete. Information was used by faculty teaching across courses to make changes that more effectively linked course writing assignments by association, themes, concepts, or areas of study. This process enables faculty to collaboratively develop writing assignments that facilitate the adult student's linking and associating concepts across courses, as a true exercise in critical thinking.

Parenting education as family support for low-income families of young children.

Parenting education programs can strengthen the family unit as a nurturing center of child development. The Establish Rapport-Offer Information-Promote Attachments-Initiate Outreach guide provides a framework that addresses individual and family needs. Any parenting class should include opportunities for referral and out-reach efforts to help parents who are facing multiple stressors.

Risk factors, attendance, and abstinence patterns of low-income women in perinatal addiction treatment: lessons from a 5-year program.

The purpose of this article is to describe the risk factors, attendance, and abstinence patterns of 40 women who attended a model outpatient perinatal addiction treatment program throughout the 5 years it was funded. Data were regularly collected through use of semistructured interviews, randomly scheduled urine toxicology tests, document reviews, and self-reports, in a descriptive field study design. Mean age of the women was 29 years. They remained in the program an average of 7.89 months. A majority had two or more children, most (90%) were single parents, and 70% were currently in an abusive relationship. Abstinence was positively associated with length of time in the program (r = .4208; p < .01). Attendance was also positively correlated with length of stay (r = .6723; p < .001) as well as abstinence (r = .4454; p < .01). Results suggest that program attendance can be a powerful influence on abstinence, even in the face of the environmental stressors and developmental risk factors that place each woman at increased risk of relapse.

The use of a multicultural conceptual model in perinatal addiction treatment.

Using a culturally competent approach to address perinatal addiction is essential for promoting a positive response to nursing interventions. Such a health care approach would include sensitivity to cultural values beliefs, and practices specific to the backgrounds of ethnically diverse clients. Clients of Project Hope, a government-funded perinatal addiction treatment program in a midwestern city, are low-income, predominantly African American single parents with a history of substance, family, and/or environmental abuse. A majority had been treated at least once previously for a sexually transmitted disease, placing them in high-risk category for hepatitis and HIV infection. Women remain in the intensive outpatient program an average of 8 months. During that time, the multidisciplinary treatment team use a variety of interventions to address the needs of the clients, which include stable housing, health care, parenting resources, and ongoing social support. The Rooda Conceptual Model of Multicultural Nursing provides a framework for enhancing nurses' understanding of the unique needs of this ethnically diverse population.

Use of the transverse cerebellar diameter/abdominal circumference ratio in pregnancies at risk for intrauterine growth retardation.

A prospective study was conducted to evaluate the ability of the transverse cerebellar diameter/abdominal circumference ratio to identify growth-retarded fetuses. Of the cases analyzed, 48 of 87 (55%) were growth retarded by birth weight. The transverse cerebellar diameter/abdominal circumference ratio identified growth retardation with a sensitivity of 71%, specificity of 77%, positive predictive value of 79%, and negative predictive value of 68%. Fourteen growth-retarded fetuses were missed by the ratio; however, 57% of the missed cases were severely growth retarded. The transverse cerebellar diameter/abdominal circumference ratio can be useful for the assessment of fetal growth retardation; however, the ratio may be normal in cases of severe fetal growth retardation.

Parent-infant interaction during perinatal addiction treatment.

Studies of parent-child interactions during perinatal addiction treatment are needed to offer insights into the nature of child development outcomes for this population. A purposeful sample of 17 women in a drug and alcohol addiction treatment program and their infants was studied over the course of their first year in the program. The purpose of this naturalistic field study was to examine parent-child interactions during addiction treatment. The following research question guided the inquiry: What is the nature of parent-infant interaction during the first year in a perinatal addiction treatment program? This study combined grounded theory methodology with the quantitative methods of descriptive and differential statistics. Open-coding of interviews, field notes, and the treatment records followed grounded theory methodology. A time-sampling procedure was used to examine stability of interactions at the beginning of program participation, again when each infant was 6 months old, and when each infant was 12 months. Results are used to describe parent-child interactions across samples and over time. Chi-square procedures were performed on number of children in each family, length of time in the program, sobriety, and mutual enjoyment of interaction. A significant difference in interaction by length of time in the program (chi 2 = 7.0801, df = 1, p < .00) as well as in interaction by percent sobriety (chi 2 = 4.1538, df = 1, p < .04) was evident. Behaviors of the infants reflected the emotional tone and parenting responses of their mothers. Dyads whose interactions showed a pattern of mutuality were more likely to continue in the treatment program and to maintain sobriety. The ability of a mother to enjoy her infant seemed to be the one factor that made the most difference in child behaviors. Results can be used by clinicians to guide the choice of treatment approaches that support the parent-child relationship during addiction treatment.

Comparison of humerus length with femur length in fetuses with Down syndrome.

A recent report by FitzSimmons et al. demonstrated a greater frequency of upper- versus lower-extremity shortening in autopsies of second-trimester fetuses with trisomy 21. We undertook this study to determine whether this upper-limb shortening could be detected by prenatal ultrasonography in the second trimester and therefore identify fetuses at risk for trisomy 21. A retrospective review of all prenatal sonograms preceding genetic amniocentesis was conducted. Between 1987 and 1990 11 consecutive fetuses between 15 and 22 weeks' gestation with trisomy 21 were identified by genetic amniocentesis. Femur and humerus lengths were plotted on growth curves created from 1470 normal patients between 12 and 26 weeks. Gestational age was confirmed by last menstrual period and biparietal diameter. In fetuses with trisomy 21, seven of 11 humeri were less than 5th percentile, for a sensitivity of 64%, whereas only two of 11 femurs were less than 5th percentile, for a sensitivity of 18%. Biparietal diameter/femur length and biparietal diameter/humerus length ratios were also tested to predict Down syndrome. In only 2 of 11 cases was the biparietal diameter/femur length ratio greater than 95th percentile, whereas the biparietal diameter/humerus length ratio was greater than 95th percentile in 7 of 11. Since all seven were identified by shortened humerus alone, we conclude that humerus length versus gestational age is the simplest and most effective screen. The positive predictive value of an abnormally short humerus length in detecting Down syndrome was 6.8% in our population where the prevalence of Down syndrome was 1 of 173. The present study supports the observations of FitzSimmons et al. that shortened humerus length has a greater sensitivity than femur length in cases of trisomy 21. We conclude that in fetuses at risk for trisomy 21 humerus length should be determined, because it may, if shortened, aid in the prenatal diagnosis.

Elevated maternal serum alpha-fetoprotein and mild fetal uropathy.

Sixty-one consecutive patients referred because of elevated maternal serum alpha-fetoprotein (MSAFP) levels and 80 referred for second-trimester ultrasound for other reasons were examined. Ultrasound examination of the genitourinary tract and assignment of phenotypic sex was done by ultrasonographers blinded to the MSAFP results. Among male fetuses with elevated MSAFP, 33% had pyelectasis compared with only 5% of controls. Among female fetuses, pyelectasis was seen in 16% of cases and no controls. Increased MSAFP not caused by an open neural tube defect may be seen in conjunction with mild benign uropathy in the second trimester.

A course in empathy.

The purpose of this project was to determine whether an empathy skills training course would produce an improvement in student nurses' Empathy Scale scores. Empathic skills were defined as the ability to communicate an accurate understanding of another's feeling and experience, and were operationally measured with a paper-and-pencil test (the Empathy Scale, Gazda, et al., 1977). In a posttest-only control group experimental design, a random sample of two groups of nursing students completed these measures. Empathy Scale scores were the dependent variable and the empathy skills course was the independent variable. A t-test demonstrated that students who had completed the empathy skills course had significantly lower (more empathic) scores on the Empathy Scale (p less than .05). Analysis of demographic data using Pearson's correlation coefficient showed no significant relationship between scores on the Empathy Scale and age (r = -.16), nor between scores and years in the health care field (r = .06).

Obstetrical applications of computer technology.

Computer technology and the use of personal computers in obstetrics, particularly antepartum, and intrapartum fetal evaluation, are discussed. The future direction of computer technology in fetal assessment is also addressed.

Maternal smoking and accelerated placental maturation.

In a prospective study of 367 patients referred for obstetric ultrasound evaluation, maternal cigarette smoking was found to have an important effect on the rate of placental maturation. The frequencies of grades 0, I, II, and III placentas throughout gestation were determined for both smoking and nonsmoking groups. Overall, the smoking mothers had more mature placentas than the nonsmoking mothers. This was reflected by the earlier mean gestational age at appearance of each of the placental grades in the smoking group as compared with the nonsmoking group. The mean gestational ages at appearance of grades 0, I, II, and III placentas for smoking mothers were 23.5, 27.9, 32, and 34.4 weeks, respectively, as compared with 26, 31.6, 35.7, and 38.3 weeks in the nonsmoking group. Smokers had a greater frequency of grade II placentas from 22-35 weeks than nonsmokers, and a greater frequency of grade III placentas beyond 25 weeks.