Lessons learned conducting breastfeeding intervention research in two northern plains tribal communities.

AIM: The overall purpose of this article was to describe the challenges and benefits of conducting breastfeeding intervention research with two Native American Tribal communities. METHODS: A focus group with an interpretive approach was used to collect data within this qualitative study as a means of incorporating a complex, holistic, subjective interpretation of the case managers' perceptions and experiences. In addition, researchers' field notes were used. Findings are discussed in relation to Rogers' Diffusion of Innovation Framework. RESULTS: Themes that emerged during the focus group discussions were related to innovation, relative advantage, complexity, compatibility, trialability, and observability. CONCLUSIONS: Conducting research in Native American Tribal communities was both enriching and challenging. The research protocol needs to be culturally appropriate, and complex components need to be videotaped for review on an ongoing basis. Time constraints of case managers need to be examined prior to development of the research protocol.

Job satisfaction in rural public health nurses.

OBJECTIVE: The purpose of this study was to determine whether nurse managers and staff nurses in rural public health offices were satisfied with their jobs, whether managers were more satisfied than staff nurses, and whether their achieved educational level impacted their job satisfaction. DESIGN: A nonexperimental comparative study was conducted of currently employed public health nurses (PHNs) to determine job satisfaction levels by using Stember's Web-based 80-question job satisfaction survey. SAMPLE: The sample consisted of 88 PHNs employed as either managers or staff nurses in county public health office settings during April 2006. RESULTS: In general, both nurse managers and staff nurses reported high job satisfaction. No significant differences existed between the composite job satisfaction scores of the managers and staff nurses. Significant differences existed between managers' and staff nurses' job satisfaction in the categories of "influence" and "interpersonal relationships" with managers less satisfied than staff nurses. CONCLUSIONS: Both staff nurses and managers in public health were satisfied with their jobs. Managers attributed any sense of decreased job satisfaction in the areas of influence and interpersonal relationships. Further study is needed to determine what contributes to satisfaction of PHNs in order to promote positive work environments conducive to retention and recruitment.

The relationship between breastfeeding test weights and postpartum breastfeeding rates.

This secondary analysis was conducted to determine the relationship between test weights and days of breastfeeding. Test weights were performed with a scale (accurate to 2 grams) before and after feeding. Days of breastfeeding was measured by self-reporting. All test weights were interrelated and were associated with higher days of breastfeeding. Test weights at day 2 to 4 and at 2 weeks were not correlated significantly with either intention or self-efficacy at any time. However, 6-week test weights were correlated with intention at all 3 times, and self-efficacy at 6 weeks. Women with higher breastfeeding self-efficacy scores tended to report higher intention to breastfeed for 6 months.

Screening Native American children for asthma: findings from focus group discussions.

CONTEXT: Because of the past history among the Indian people related to research, it is incumbent upon those of us who wish to conduct research with these groups to protect them from exploitation, to conduct research that will be beneficial to the tribal community, and to work together to make the research as meaningful and as successful as possible. The process of conducting research among Native American tribes can appear to the novice as very time-consuming and full of barriers. These are necessary guards to protect their people. Additionally, many people of these tribes want to make sure that the research is going to benefit them. Focus groups provide a way for researchers to identify what the wishes of the tribal communities are in relation to the proposed research. PURPOSE: The overall purpose of this study was to understand some of the concerns the tribal communities had regarding asthma among their children, as well as their perceptions of how best to implement an asthma screening program in their community. METHODS: This was a qualitative study. An interpretative approach was selected for this research because such an approach emphasizes how a phenomenon is perceived and how meaning is constructed in situations. FINDINGS: Findings from the focus group are discussed according to themes that surfaced during the focus group discussion. CONCLUSIONS: Tribal community leaders and parents are interested in their children's health and do want to be involved in research to help children and others in their communities. Nurses working in tribal communities need to gain an understanding of the tribal communities' perspective prior to conducting research.

Testing protocols: care of biological samples in a rural setting.

The purpose of this study is to evaluate collection, transport, and storage protocols of urine and air allergen samples from infants in a rural setting. Infant urine and aeroallergen samples (n = 21) are collected in the home setting in rural areas where time and distance to the central laboratory is a consideration. Urine samples are analyzed using ELISA tests after being transported using three different techniques: (a) ambient temperature, (b) dry ice, and (c) packaged on dry ice and shipped commercially. Following initial ELISA testing for levels of cytokines, urine samples are frozen at -70 degrees Celsius for 6 months. Samples are then reanalyzed for levels of cytokines. Dust samples are analyzed for levels of aeroallergens, stored at 4 degrees for 6 months, and reanalyzed. The integrity of samples varies by biomarker, shipment temperature, and storage time, creating a high degree of variability in results.

Negotiating three worlds: academia, nursing science, and tribal communities.

PURPOSE: The purpose of this article is to use a cross-cultural model to guide the exploration of common issues and the dynamic interrelationships surrounding entrée to tribal communities as experienced by four nursing research teams. METHOD: Members of four research teams discuss the primary lessons learned about successful strategies and challenges encountered during their projects' early stages. RESULTS: Understanding the cultural values of relationship and reciprocity is critical to the success of research projects conducted in Native American communities. DISCUSSION: Conducting cross-cultural research involves complex negotiations among members of three entities: academia, nursing science, and tribal communities. The lessons learned in these four research projects may be instructive to investigators who have the opportunity to conduct research with tribal communities.

Influence of intention and self-efficacy levels on duration of breastfeeding for midwest rural mothers.

OBJECTIVES: The purpose of this study was to explore the relationship of two modifiable factors (intention to breastfeed for 6 months and breastfeeding self-efficacy) with the duration of breastfeeding in primiparous women. FINDINGS: Analyzed by logistic regression in a single prediction model, stronger intention (odds ratio = 1.89) and higher levels of self-efficacy at 2 weeks postpartum (odds ratio = 1.04) were significantly (p < .05) associated with an increased probability of breastfeeding for 6 months. CONCLUSIONS: The combined influence of higher intention and self-efficacy increased the likelihood of breastfeeding for the recommended 6 months. Interventions to reinforce both should be designed and evaluated.

Screening for asthma: results from a rural cohort.

BACKGROUND: Asthma, the leading cause of chronic illness in children, must be managed in both the home and school environments. Identification of children who have risk factors associated with asthma is the first step toward achieving one of the Healthy People 2010 (2000) objectives, which identifies that 25 states will establish a system of surveillance to track asthma mortality, morbidity, access to care, and asthma management. PURPOSE: The purposes of this research were to: a) identify rural children who are at risk for asthma through written screening; b) assess parameters of respiratory health status of rural school-aged children as indicated by forced expiratory volume at l second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), mean mid-expiratory flow (FEF(25-75)); and c) identify the number of rural school-aged children who sought and obtained follow-up from their primary health care provider and were given a definitive diagnosis of asthma. FRAMEWORK: The Vulnerable Populations Framework (Flaskerud and Winslow, 1998) was used to organize this study. METHODOLOGY: A prospective descriptive design was utilized for this research. RESULTS: Approximately 12% of the children screened were referred to their primary care provider (PCP) for follow-up care. Of these approximately half of the children were seen by their PCP. Barriers to seeking follow-up care were: a) the child was not symptomatic all the time, b) reluctance to be diagnosed with asthma, and c) others, such as cost and time. Children who were not well controlled identified that they ran out of medicine and their parents did not refill their prescription. CONCLUSION: Results from this descriptive study indicate that screening for asthma in school may be a way to identify those children who are at risk for asthma, and who are not diagnosed as well as those who are diagnosed with asthma but are not optimally managed. While many parents wanted their children to be screened, follow-up care was not critical to them. IMPLICATIONS: Nurses working in a school setting are in a prime position to help identify those children with signs and symptoms of asthma. In addition, use of written screenings with or without spirometry may be helpful in identifying children at risk for asthma. Further studies need to be undertaken to determine if written screening is as efficacious as spirometry for school and other ambulatory care settings.

Smoking hygiene: reducing infant exposure to tobacco.

The American Academy of Pediatrics recently removed nicotine from the list of drugs contraindicated during breastfeeding. The objective of this study was to evaluate the feasibility of determining the effect of a smoking hygiene intervention on infants of breastfeeding mothers who smoke cigarettes. An experimental design with repeated measures was used. A convenience sample of 35 mother-infant dyads from seven sites was recruited and randomly assigned to the intervention or control group. Of the 27 dyads completing the study, 16 were in the experimental group and 11 were in the control group. Smoking hygiene was introduced when infants were 2 weeks old and reinforced when they were 3 and 5 weeks old. At these three data points, infant health and urinary nicotine and cotinine levels were measured, as well as the mothers' breast-milk nicotine and cotinine levels and smoking hygiene behaviors. Recruiting and retaining a sample of breastfeeding mothers who smoke proved difficult. Only 27% of women in the intervention group implemented all aspects of the smoking hygiene intervention behaviors. Repeated-measures ANOVA revealed no difference in a) infant urinary nicotine and cotinine levels or b) breast-milk nicotine and cotinine levels between the two groups. The McNemar test for related samples revealed no difference between frequency of respiratory symptoms in either the control or intervention groups when Week 2 levels were compared with levels at Weeks 3 and 5. Mothers were not successful in adhering to the smoking hygiene intervention. To adequately test interventions, strategies must be developed to help women incorporate health-promoting behaviors into their lives.

Motivational interviewing to promote sustained breastfeeding.

OBJECTIVE: To explore the feasibility of using motivational interviewing to promote sustained breastfeeding by increasing a mother's intent to breastfeed for 6 months and increasing her breastfeeding self-efficacy. DESIGN: A longitudinal experimental two-group design with repeated measures was selected to explore the feasibility of using motivational interviewing to promote sustained breastfeeding in primiparous mothers. SETTING: Three Western rural community hospital sites. PARTICIPANTS: Convenience sample of 73 primiparous breastfeeding mothers ranging between the ages of 19 and 38, M = 25 (SD = 4.5). MAIN OUTCOME MEASURE: Mothers reported the date of their last day of breastfeeding, defined as any breastfeeding during the previous 24-hour period. Breastfeeding behavior was confirmed at each visit by infant test weights. RESULTS: The motivational interviewing group (M = 98.1 days, SD = 75.2) breastfed longer than the comparison group (M= 80.7 days, SD = 71.9); however, this difference was not significant, t(69) = 0.991, p = .325, Cohen's d = 0.24, related to the variability in the sample. CONCLUSIONS: Although not a statistically significant difference, the mean number of days that mothers in the intervention group breastfed was 98 days compared to the mean of 81 days by the comparison group; therefore, motivational interviewing may be useful as a strategy to test in a comprehensive intervention plan.

Early consumption of human milk oligosaccharides is inversely related to subsequent risk of respiratory and enteric disease in infants.

A pilot study tested the relationship between human milk oligosaccharide consumption, oligosaccharide content of feces, and subsequent disease in breastfed infants. Forty-nine (49) mother-infant pairs provided milk and fecal samples 2 weeks postpartum; infant health was assessed through 2, 6, 12, and 24 weeks. LNF-II (lacto-N-fucopentaose II), a major human milk oligosaccharide, was measured to represent levels of total oligosaccharides consumed in milk and remaining in feces. LNF-II levels in milk at 2 weeks postpartum were associated with fewer infant respiratory problems by 6 weeks (p = 0.010), as were LNF-II levels in infant feces (p = 0.003). LNF-II levels in milk at 2 weeks were also associated with fewer respiratory problems by 12 weeks (p = 0.038), and fewer enteric problems by 6 weeks (p = 0.004) and 12 weeks (p = 0.045). Thus, consumption of human milk oligosaccharides through breastfeeding, represented by LNF-II, was associated with less reported respiratory and gastrointestinal illness in infants.

First-time mothers' selection of infant supine sleep positioning.

The incidence of Sudden Infant Death Syndrome (SIDS) has decreased dramatically since the inception of the "Back to Sleep" campaign initiated by the American Academy of Pediatrics in 1992. However, that decrease has leveled off and many new parents cease to follow the recommendation to place their infants in the supine position for sleep between 1 and 3 months of age, the peak age for the incidence of SIDS. Shortened hospital stays for new mothers and the overwhelming amount of required patient teaching dictate the need to find the best method of instruction. The purpose of this study was to determine if a one-on-one teaching intervention improved the effectiveness of patient education and led to an increase in the desired behavior of placing the infant to sleep in the supine position. A quantitative experimental approach was used to examine the difference in compliance of supine infant positioning. Participants were drawn from a convenience sample of 61 primiparous women between the ages of 18 and 35 years with random assignment to either the experimental or control group. Compared to mothers in the control group, mothers in the experimental group demonstrated greater compliance in selecting supine sleep position in the first week home from the hospital and on the day of follow-up 6 weeks later. However, no difference in "usual position" was reported at 6 weeks and for the night previous to follow-up.

A model for the HELLP syndrome: the maternal experience.

OBJECTIVE: To describe the experience of mothers whose pregnancies were complicated with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) and to determine if such experiences could be clustered by common themes from which a model could emerge. DESIGN: Retrospective, descriptive, qualitative study utilizing grounded theory analysis. SETTING: Participants were interviewed in their homes via telephone. Participants were from Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, South Carolina, Utah, and Wyoming, representing both urban and rural settings. PARTICIPANTS: Nine self-selected survivors of HELLP syndrome. RESULTS: The essential structure of the experience of HELLP syndrome can be expressed as a circle of no control and not knowing, which included the five themes of premonition, symptoms, betrayal, whirlwind, and loss. The pervading emotions expressed were fear (of death), frustration, anger, and guilt. HELLP syndrome represents a unique maternal experience that can be expressed in a model.

A comparison of blood pressure in term, low birth-weight infants of smoking and nonsmoking mothers.

Infants exposed to the components of cigarette smoke in utero are at an increased risk for perinatal death, low birth weight, sudden infant death syndrome, and premature delivery. The purpose of this pilot study was to compare blood pressure values in term low-birth weight infants (

Students' perspective of the effectiveness of an asynchronous on-line seminar.

This study was conducted to understand students' perceptions of the usefulness of on-line discussion for a nursing seminar. The interpretative approach was selected to explore the students' perceptions of the effectiveness of the on-line discussion. The participants were recruited from maternity nursing courses on two rural campuses in Nebraska. A convenience sample of 31 participated in the study with a purposive sample of 10 representing extreme views selected for in-depth interviews. Eight patterns emerged as a plausible interpretation of the on-line experience. These patterns were exemplified by the themes of engagement theory (relate, create, and donate). The pattern that was identified as relational was learner-to-learner learning without face-to-face communication. However, isolation was found to inhibit relating. Creating, the second theme, was exemplified by multiperspective opinions, however, frustration with the technology and anxiety/information overload inhibited the creative aspects. Finally, the third theme, donate, was represented by having time for critical thinking/reflection while participating in the on-line discussions. The findings of this research support the need for more studies to explore students' perception of the usefulness of on-line discussion.

Application of Neuman's framework: infant exposure to environmental tobacco smoke.

The purpose of this article is to demonstrate how Neuman's systems model can be applied to nursing practice and research through the examination of the problem of infant exposure to environmental tobacco smoke. By operationalizing Neuman's framework, it was possible to develop a research-based theory investigating the interaction between the infant's physiological variable and the environment. A nursing process tool and theoretical model developed from Neuman's framework are utilized to examine the problem. Further theory development could identify relationships among Neuman's other variables and create a theoretical basis for providing holistic nursing care to infants exposed to environmental tobacco smoke.

The role of the nurse on a transdisciplinary early intervention assessment team.

Assessing young children with disabilities is a complex process requiring the expertise of a team of professionals from several disciplines. Team members often include the child's family members, early childhood special educators, clinical psychologists, speech-language pathologists, social workers, physical and occupational therapists, pediatricians, and nurses. A team approach meets standards of best practice in early childhood intervention and encourages full family participation in the assessment process. This article explores the process of team building, role release through a transdisciplinary approach, and a nurse's role on a transdisciplinary assessment team.

How do NPs make clinical decisions?

The authors conducted a study to explore the process primary care NPs use in making clinical decisions and the factors that influence the process. By delineating the process used by primary care NPs in therapeutic decision making, we can enhance clinical decision making in students and practicing NPs.

Smoking hygiene: an educational intervention to reduce respiratory symptoms in breastfeeding infants exposed to tobacco.

The American Academy of Pediatrics recently removed nicotine from the category of drugs contraindicated during breastfeeding. Little evidence demonstrates that infants exposed to nicotine through breastfeeding experience increased health risks beyond the airborne risks associated with passive smoking. The purpose of this longitudinal, five-week, quasi-experimental pilot study was to determine whether "smoking hygiene," an educational intervention, reduces the frequency of respiratory symptoms experienced by infants whose mothers both smoke and breastfeed. Twenty-nine mother-infant pairs entered the study with 28% dropping out. Of the 21 mother-infant pairs who completed the study, 66% of the nine infants in the control group experienced respiratory illness, compared to 42% of the 12 infants in the intervention group (x2 = .814; p > .05). Thus, the difference was statistically nonsignificant in this small sample, but the trend worsened the anticipated direction. The study demonstrates some of the difficulties of intervening with this group of mothers.