Facilitators and Barriers of Human Milk Donation.

PURPOSE: The purpose of this study is to examine perceptions and experiences of women who donate human milk and highlight various aspects of the breast milk donation process. STUDY DESIGN: A cross-sectional descriptive study. METHODS: An online survey was conducted with a convenience sample of women who donated milk at several milk banks in the United States. A questionnaire of 36 closed and open-ended items were developed and validated by the research team. Descriptive statistics and content analysis were used. Semantic content analysis involved three procedures: coding, categorizing text units, and refining the identified themes. RESULTS: A total of 236 women who donated breast milk completed the questionnaire. Mean age of participants was 32.7±4.27 and 89.40% were non-Hispanic White women with a bachelor's degree (32.20%) or graduate degree (54.70%). Most participants were women who actively donated breast milk, ranging from one to four times. Two themes, facilitators and barriers of milk donation, were identified. Facilitators to milk donation included attitudes toward milk donation, commitment for donating, motivation in donating, and support. Barriers included personal factors, environment, milk donor process, and psychosocial factors. CLINICAL IMPLICATIONS: Nurses, health care providers, and lactation professionals should educate women about milk donation resources and opportunities. Strategies to increase awareness about milk donation among underrepresented groups such as women of color are highly recommended. Future research is needed to further explore specific factors that increase milk donation awareness and minimize barriers to potential donors.

Breastfeeding Outcomes, Self-Efficacy, and Satisfaction Among Low-Income Women With Late-Preterm, Early-Term, and Full-Term Infants.

OBJECTIVE: To assess breastfeeding exclusivity and rate of breastfeeding, breastfeeding self-efficacy, and satisfaction with breastfeeding after hospital discharge among low-income women with late-preterm and early-term infants compared with women with full-term infants. DESIGN: Prospective, comparative, with repeated measures. SETTING: Four Midwestern U.S. Special Supplemental Nutrition Program for Women, Infants, and Children offices. PARTICIPANTS: Participants included 270 mother-infant dyads. METHODS: We assessed breastfeeding exclusivity, rate of breastfeeding, and breastfeeding self-efficacy at 2 weeks, 2 months, and 5 months and satisfaction with breastfeeding at 5 months after birth or when participants stopped breastfeeding. RESULTS: More than 50% of women in each subgroup were non-Hispanic White. Late-preterm and early-term infants had lower breastfeeding exclusivity rates than full-term infants across the three time points (40%, 51%, and 65% at 2 weeks, p = .029; 22.5%, 34%, and 58% at 2 months, p < .001; and 7%, 15%, and 28.46% at 5 months, p < .001, respectively). The overall exclusive breastfeeding rate for all groups was 55.93% at 2 weeks, 44.07% at 2 months, and 20.37% at 5 months; 55.56% continued any breastfeeding at 5 months. Breastfeeding self-efficacy during the first 5 months after birth, satisfaction with breastfeeding, level of education, and attending breastfeeding classes were positively correlated with breastfeeding exclusivity. We found significantly less exclusive breastfeeding, lower breastfeeding self-efficacy, and lower satisfaction with breastfeeding among participants with late-preterm and early-term infants compared to those with full-term infants. CONCLUSION: Ongoing professional breastfeeding support for women is needed to improve and promote breastfeeding exclusivity and continuation among their late-preterm and early-term infants.

Team-Based Approach to Managing Postpartum Screening of Women with Gestational Diabetes for Type 2 Diabetes.

INTRODUCTION: Approximately 6% of pregnant women develop gestational diabetes mellitus (GDM), which is a strong risk factor for developing type 2 diabetes mellitus. It is recommended that women with GDM complete a 75-g oral glucose tolerance test (OGTT) 4 to 12 weeks postpartum to screen for type 2 diabetes. A 3-month retrospective chart review in 2 patient-centered medical homes found that postpartum screening for type 2 diabetes was performed in only 39% of eligible women, despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association. Thus, a quality improvement project was initiated to improve the postpartum type 2 diabetes screening rate. PROCESS: This quality improvement project involved an education session that described current ACOG recommendations for diabetes screening. The education session included a pretest and posttest that evaluated participants' understanding about development of type 2 diabetes after GDM. A team-based postpartum guideline designed to enable women to complete a 75-g OGTT at the 4-to-12-week postpartum appointment was implemented. A postintervention chart review was conducted to determine the postintervention rate of type 2 diabetes screening. OUTCOME: The mean pretest score for the clinical team was 57%, and the mean posttest score was 99%. Postpartum screening for women with GDM was improved from 39% of women for whom screening was indicated to 77% with the implementation of the team-based guideline. DISCUSSION: The quality improvement project results demonstrated that improved understanding of ACOG recommendations combined with the implementation of a team-based guideline significantly improved postpartum screening for type 2 diabetes. Team-based management of care, including education of team members about the rationale for change, may also improve outcomes in other quality improvement projects.

Evidence-based practice knowledge, attitudes, and practice of online graduate nursing students.

OBJECTIVES: This study aimed to evaluate changes in evidence-based practice (EBP) knowledge, attitudes, and practice of nursing students before and after completing an online, graduate level, introductory research/EBP course. DESIGN: A prospective one-group pretest-posttest design. SETTINGS: A private university in the Midwestern, USA. PARTICIPANTS: Sixty-three online nurse practitioner students in Master's program. METHODS: A convenient sample of online graduate nursing students who enrolled in the research/EBP course was invited to participate in the study. Study outcomes were measured using the Evidence-Based Practice Questionnaire (EBPQ) before and after completing the course. Descriptive statistics and paired-Samples t-test was used to assess the mean differences between pre-and post-test scores. RESULTS: Overall, students' post-test EBP scores were significantly improved over pre-test scores, t(63)=-9.034, p<0.001). Statistically significant differences were found for practice of EBP mean scores t(63)=-12.78, p=0.001). No significant differences were found between pre and post-tests on knowledge and attitudes toward EBP scores. Most frequently cited barriers to EBP were lack of understanding of statistics, interpretation of findings, lack of time, and lack of library resources.

Moving It Along: A study of healthcare professionals' experience with ethics consultations.

BACKGROUND: Ethics consultation is the traditional way of resolving challenging ethical questions raised about patient care in the United States. Little research has been published on the resolution process used during ethics consultations and on how this experience affects healthcare professionals who participate in them. OBJECTIVES: The purpose of this qualitative research was to uncover the basic process that occurs in consultation services through study of the perceptions of healthcare professionals. DESIGN AND METHOD: The researchers in this study used a constructivist grounded theory approach that represents how one group of professionals experienced ethics consultations in their hospital in the United States. RESULTS: The results were sufficient to develop an initial theory that has been named after the core concept: Moving It Along. Three process stages emerged from data interpretation: moral questioning, seeing the big picture, and coming together. It is hoped that this initial work stimulates additional research in describing and understanding the complex social process that occurs for healthcare professionals as they address the difficult moral issues that arise in clinical practice.

Effects of an empowerment program on health behaviors and stroke risk reduction of at-risk group in Thai rural community.

BACKGROUND: Unhealthy behaviors such as being overweight, have hypertension, diabetes, and dyslipidemia increase the risks of stroke. Promoting healthy behaviors could reduce the incidence of stroke, death, and disabilities. Empowerment was used in this study to help people change their health behaviors. OBJECTIVE: To determine the effects of an empowerment program on health behaviors and stroke risk factors reduction of people at-risk for stroke in a rural community in Thailand. MATERIAL AND METHOD: A quasi-experimental study was conducted in sixty participants identified with moderate risk for stroke, according to the Standard Operation Procedure to Prevent and Control of Stroke 2007 of the Bureau of Non Communicable Disease, from two villages in Phitsanulok. Participants were enrolled in experimental (n = 30) and control (n = 30) groups using match pair for sex, age, blood pressure, and blood sugar. The experimental group received empowerment based on the Gibson's model of empowerment (discovering reality, critical reflection, taking charge, and holding on) at week 1, 4, and 8 while the control group received routine care. The study duration was 12 weeks. Instruments used were a questionnaire regarding health behaviors and a form for recording the BMI, blood pressure, blood sugar cholesterol, and triglyceride. Data analyses included the Analysis of Variance (ANOVA), repeated measure, and independent t-test. RESULTS: Following the implementation of the empowerment program, health behaviors of participants in the experimental group were significantly better than those of the control group (p < 0.001). Risk factors, body mass index, blood pressure, blood sugar, cholesterol, and triglyceride of participants in the experimental group were significantly lower than those in the control group (p < 0.01, p < 0.001). CONCLUSION: The empowerment program was effective in decreasing stroke risk behaviors and stroke risk factors. Future research using this empowerment intervention program should be conducted in high cardiovascular risk group and patients with other chronic diseases.

Attrition of on-line graduate nursing students before and after program structural changes.

This study assessed attrition rates and reasons for withdrawal among on-line graduate students before and after the implementation of program structural changes in 2008. A descriptive retrospective cohort study was conducted using the academic and advising records of 853 on-line graduate nursing students enrolled between 2005 and 2010. Three student cohorts were examined: (Cohort 1) students who entered and withdrew prior to 2008, (Cohort 2) students who entered before and withdrew after 2008, and (Cohort 3) students who entered and withdrew after 2008. The proportions of student attrition from each cohort were 43% (97 out of 225 students), 19% (52 out of 277 students), and 7.4% (26 out of 351 students), respectively. Results indicated that students' attrition rates in Cohorts 2 and 3 were significantly less than Cohort 1. Supported by Alexander Astin's input-experience-output model, 2 major themes emerged as reasons for withdrawal--personal and academic. Findings from this study provided a critical view for further investigation and serve as an evaluation tool to identify trends and develop appropriate supportive interventions that facilitate positive student outcomes. Further research is warranted to investigate the effects of the program structural changes on students' attitudes and program satisfaction.

A pilot study of home-based videoconferencing for breastfeeding support.

BACKGROUND: Research on using videoconferencing for breastfeeding support is limited. PURPOSE: Although European case reports have described videoconferencing for providing lactation support, this was the first study to assess the reliability and feasibility of home videoconferencing for breastfeeding assessment and support in the United States. METHOD: The study used 4 real-time, secure videoconferencing sessions to deliver lactation support to 10 mothers in the home. To assess interrater reliability, percentage agreement was calculated on LATCH assessment scores from telehealth and home-visit International Board Certified Lactation Consultants (IBCLCs) during the first 2 visits. Participants' perceptions of satisfaction and the overall experiences were documented. RESULTS: The percentage agreement on the 5 LATCH score dimensions ranged between 40% to 100% during the first visit and 80% to 100% during the second visit. To assess feasibility, participants reported their satisfaction with the technology and their perceptions of the videoconference consultation. All participants "strongly agreed" that they were comfortable talking about breastfeeding concerns using home videoconferencing. CONCLUSION: The findings suggest videoconferencing can potentially be used to support breastfeeding mothers in their homes.

Assessment of emotional status of orphans and vulnerable children in Zambia.

PURPOSE: To describe the emotional status of orphans and vulnerable children (OVC) in two communities in Zambia. METHODS: The Health Ed Connect Adaptation Questionnaire (HECAQ) was used to interview 306 OVC and 158 primary caregivers in Zambia in 2010. FINDINGS: Child participants and caregivers reported evidence of emotional distress behaviors in the majority of OVC. CONCLUSIONS: More research to evaluate the efficacy of intervention programs for loss and grief, normal and abnormal reactions to grief, and positive coping skills is needed to assist both children and their caretakers. In the population studied, caregivers and OVC could benefit from additional support for promoting emotional health and managing emotional distress in vulnerable children. CLINICAL RELEVANCE: Healthcare professionals play a key role in promoting the emotional health of OVC through identification of deviant behaviors and the development of interventions to alleviate emotional and psychological distress.

Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline.

RATIONALE, AIMS AND OBJECTIVES: The diversity of the population worldwide suggests a great need for cross-culturally validated research instruments or scales. Researchers and clinicians must have access to reliable and valid measures of concepts of interest in their own cultures and languages to conduct cross-cultural research and/or provide quality patient care. Although there are well-established methodological approaches for translating, adapting and validating instruments or scales for use in cross-cultural health care research, a great variation in the use of these approaches continues to prevail in the health care literature. Therefore, the objectives of this scholarly paper were to review published recommendations of cross-cultural validation of instruments and scales, and to propose and present a clear and user-friendly guideline for the translation, adaptation and validation of instruments or scales for cross-cultural health care research. METHODS: A review of highly recommended methodological approaches to translation, adaptation and cross-cultural validation of research instruments or scales was performed. Recommendations were summarized and incorporated into a seven-step guideline. Each one of the steps was described and key points were highlighted. Example of a project using the proposed steps of the guideline was fully described. CONCLUSIONS: Translation, adaptation and validation of instruments or scales for cross-cultural research is very time-consuming and requires careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population.

A randomized controlled trial of breastfeeding support and education for adolescent mothers.

Despite substantial evidence of maternal and infant benefits of breastfeeding, adolescent mothers initiate breastfeeding less often and maintain breastfeeding for shorter durations when compared to their adult counterparts. A randomized controlled trial drawing on the theory of planned behavior and developmental theory was conducted to determine if an education and counseling intervention provided by a lactation consultant-peer counselor team increased breastfeeding initiation and duration up to 6 months postpartum among adolescent mothers. Study participants ( N = 289) enrolled from multiple prenatal clinic and school settings, were 15 to 18 years old, and predominately African American, single, and primiparous. The intervention, which started in the second trimester of pregnancy and extended through 4 weeks postpartum, positively influenced breastfeeding duration (p < .001) within the experimental group, but not breastfeeding initiation or exclusive breastfeeding rates. This education/support intervention was partially effective in enhancing breastfeeding outcomes. Implications for research and practice are described.

Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA.

AIMS AND OBJECTIVES: To describe the perceptions of breastfeeding in low-income pregnant women to understand their needs better as they plan to return to work or school. BACKGROUND: Maternal employment has a negative impact on breastfeeding duration. Yet there is insufficient research on challenges and facilitators regarding breastfeeding and employment issue among low-income women in the USA. Knowing the perceptions of breastfeeding among low-income pregnant women and their plan to return to work or school may have implications for nurses and midwives in providing quality care. DESIGN: Qualitative study using focus group interviews. METHODS: The research setting consisted of three Women, Infants and Children clinics (WIC) in a midwestern city of the USA. Seventeen pregnant women (aged 19-35) participated in focus group interviews. Data were coded and analysed for themes and patterns using the QSR software - NVivo 6. RESULTS: Eleven participants were single. Ten women were primigravida, and seven were multipara. The following five themes were identified: (1) perceived benefits of breastfeeding; (2) general perceptions of breastfeeding; (3) maternal concerns; (4) having the right support; and (5) anticipated challenges of combining breastfeeding and work. Conclusions. Low-income women anticipated substantial barriers for breastfeeding when they planned to combine breastfeeding and work or school. The results of this study have many implications for public health practice, research and policy. Educating employers and the public at large about the health and economic benefits derived from long-term breastfeeding could help promote breastfeeding awareness. RELEVANCE TO CLINICAL PRACTICE: Strategies supporting breastfeeding among low-income working women must be provided at multiple levels to help overcome the barriers they concern. Health care providers should help women gain confidence by minimising their uncertainties and fears about breastfeeding to prepare them to continue breastfeeding successfully after returning to work.

Psychometric evaluation of the Employer Support for Breastfeeding Questionnaire (ESBQ).

The purpose of this descriptive methodological study was to develop and evaluate the psychometric properties of the Employer's Support for Breastfeeding Questionnaire (ESBQ). The convenience sample consisted of 380 business owners, managers, or supervisors from the Midwestern United States. Data were collected using Web and paper-based questionnaires from January to March 2008. Psychometric evaluation included item analysis, scale reliability, and construct validity. The ESBQ subscales had Cronbach's alphas ranging from 0.85 to 0.92. Most inter-item and item-to-total correlations were above the recommendation of 0.30. The test-retest reliability of each subscale ranged from 0.93 to 1.0. Confirmatory factor analysis supported the construct validity of the scale. The comparative fit index (CFI) and the non-normal fit index (NNFI) were 0.90 and 0.91, respectively, and the root mean square error of approximation (RMSEA) was 0.05. Findings supported the ESBQ as reliable, valid, and theoretically consistent with the theory of planned behavior.

Cancer therapy-related symptoms and self-care in Thailand.

PURPOSE: The aim of the study was to examine patient-reported symptoms and self-care strategies in Thai patients with cancer. METHODS: The study was descriptive using a cross-sectional design. It was carried out at the National Cancer Institute, Thailand (Bangkok; Lopburi). 202 patients undergoing combined radiotherapy and chemotherapy (RT-CT), n=52; or CT alone, n=103; or RT alone, n=47 participated. Data was collected with the use of a 25-item Therapy-Related Symptom Checklist, TRSC (Thai); a Self-Care Method scale; the Karnofsky Scale, and a Health Data form. RESULTS: Patients on combined RT-CT reported more symptoms on the TRSC, with greater severity than those receiving RT or CT alone (F=7.2; p<0.01); and lower Karnofsky score (F=4.2, p<0.05); Karnofsky and TRSC scores were inversely correlated. Using complementary care categories, self-care methods reported were six types: (a) Diet/nutrition/life-style changes (e.g. modify food) to manage Eating and Fatigue symptoms; (b) Mind/Body Control to relieve Fatigue and other symptoms; (c) Biologic treatment (e.g. vitamins) for eating difficulties; (d) Herbal treatments for hair loss; (e) Other methods, and (f) taking prescribed medicines to control pain and other symptoms. Some patients reported "doing nothing" as coping. CONCLUSIONS: Self-care including complementary care use as an adjunct to cancer treatments could help patients deal with the side effects of therapy. Assessment of symptoms using the TRSC (Thai) version and their alleviation could enable the health care providers to enhance patients' coping during cancer treatments.

Working women's breastfeeding experiences.

PURPOSE: To describe the breastfeeding experiences of women who returned to work after childbirth. DESIGN AND METHODS: Descriptive, using questionnaires with 50 women. Content analysis of data obtained from women who responded to open-ended questionnaires at 16 weeks postpartum. Three procedures were used: coding data, categorizing text units, and refining the emerging themes. RESULTS: Four categories emerged from the data:support, attitude, strategic plan, and psychological distress. The women expressed a need for support such as an accepting environment, spatial issues, modeling, and time allowance. They needed to maintain a positive attitude so they could commit to and accomplish their breastfeeding goals. The women developed strategic plans to help prevent breastfeeding problems as well as continue breastfeeding successfully. Finally, they described psychological distress as a conflict between the demands of work and the breastfeeding process. Associated feelings included guilt, stress, or having to sacrifice. CLINICAL IMPLICATIONS: These findings can help nurses and other healthcare professionals in providing anticipatory guidance to women who plan to continue breastfeeding after returning to work. Further research should investigate the relationship between psychological distress, work productivity, family functioning, and breastfeeding activities of working women who breastfeed.