Trends in preterm labor.

Preterm birth has been identified by the National Commission to Prevent Infant Mortality (1988) as the primary cause of the increased infant mortality rate in the United States. An analysis of what is currently known about four areas of preterm labor including (1) definition and causes, (2) identification of patients at risk, (3) management techniques, and (4) use of patient education in labor is presented in this paper. Preterm labor is defined as uterine contractions that occur between 20 and 37 weeks' gestation with progressive cervical dilatation or effacement or both. Directions for future research are discussed.

Positioning and skin care of the low-birth-weight neonate.

An analysis of investigations related to positioning and skin care of the low-birth-weight infant, tempered with the authors' clinical experience, is presented. Protocols for positioning the low-birth-weight neonate and care of immature skin are provided. The nursing management plans are theoretically based and provide a foundation for testing the ability of nurses to improve developmental outcomes for this population of infants and reduce the cost of their care. A comprehensive reference list is provided.

Antecedents of behavior: parents of high-risk newborns.

The Theory of Reasoned Action (Ajzen & Fishbein, 1980) was used to develop an instrument to measure antecedents of parental behavior. The subjects, a convenience sample of 10 parents of high-risk newborns were interviewed 24 to 36 hours after their infant's admission to the neonatal intensive care unit (NICU). Likert and semantic differential scales (Osgood, Suci & Tannenbaum, 1956) were developed based on salient themes identified from the qualitative analysis of the interview transcripts to measure parents': (a) attitudes, (b) social norms, (c) previous experiences and (d) expectations. The instrument was evaluated on 30 parents using a repeated measures design. Results reflect the reliability and validity of the instrument, an emerging model of antecedents of parent's behavior and the presence of differences in antecedents of parent's behavior.

Prevalence of illicit drug use among prenatal patients and predictive validity of nurses' judgments.

The purposes of this investigation were to: (1) estimate the prevalence of illicit drug use within the prenatal population of a midwestern suburban ambulatory care center; (2) explore the relationship between nurses' judgments of patient illicit drug use and urine toxicology results; and (3) determine if a difference exists between nurses' judgments of illicit drug use by private physicians' patients (PPP) and nurses' judgments of illicit drug use by resident physicians' patients (RPP). For a 16-week period, all new prenatal patients (N = 189) were included in this study; 78 (41%) were in the RPP group and 111 (59%) were in the PPP group. Urine remaining from routine urinalysis was assayed for seven drugs or drug classes. Fourteen (7.5%) subjects tested positive for illicit drugs, 8 (10.3%) in the RPP group, and 6 (5.4%) in the PPP group (chi 2, P greater than .33). Using a Likert-type scale, nurses rated the likelihood of a positive result of each patient's urine test. Nurses' judgments of patient illicit drug use and positive results were related, r = .28. Nurses were more likely (P less than .0001) to suspect residents' patients of illicit drug use than private physicians' patients.

Pain control after cesarean birth. Efficacy of patient-controlled analgesia vs traditional therapy (IM morphine).

A clinical trial compared the efficacy of a mechanical device to deliver patient-controlled analgesia (PCA) (n = 25) with intramuscularly administered morphine (n = 17) for postcesarean pain management. Hypotheses were: (1) patient-controlled administration of narcotics will be superior (increased satisfaction, reduced pain, decreased sedation, increased ambulation, decreased length of stay), and (2) functional vital capacity will increase post-operatively with PCA. No differences in demographic variables were identified (P = less than or equal to .001). Differences in satisfaction (greater in PCA group, P = less than or equal to .05), ambulation (greater in PCA group, P = less than or equal to .001), amount of medication used (greater in PCA group, P = less than or equal to .001), and sedation level (less in PCA group, P = less than or equal to .05) were identified. No differences in vital capacity were identified. The hypothesis related to the superiority of PCA was accepted, while the association between PCA and increased vital capacity was not supported. The use of mechanical PCA devices provides an effective and safe means of managing postcesarean pain.

Children's admissions to the intensive care unit: parents' attitudes and expectations of outcome.

A reliable instrument based on the Expectancy-Value Model of Attitude was developed using responses of 30 parents to assess parental attitudes toward the intensive care unit admission of children. The instrument was then administered to 50 parents whose children were in the intensive care unit to examine relationships between parents' previous experiences/knowledge and their attitudes/expectations about their child's critical illness outcome. Qualitative and quantitative data analysis demonstrated that parents' attitudes toward the event of their child's admission and parents' expectations for their child's illness outcome were influenced by previous knowledge of similar situations, previous exposure to intensive care units, and previous knowledge of similar illnesses. Knowledge of factors associated with the development of parental attitude is essential to the development of models that can be tested for predictive validity. Such models may eventually assist in identifying parents who are at risk and in need of intervention. Further studies to assess the reliability and validity of the instrument in other populations is warranted.