A public health nursing early intervention program for adolescent mothers: outcomes from pregnancy through 6 weeks postpartum.

BACKGROUND: Adolescent pregnancy and parenting remain a major public concern because of their impact on maternal-child health and on the social and economic well-being of the nation. Federal welfare reform legislation has created an urgent need for community-based nursing intervention programs to improve health and social outcomes for disadvantaged adolescent mothers and to promote their self-sufficiency. OBJECTIVE: To evaluate the effects of an early intervention program (EIP) that uses a public health nursing model on health and social outcomes of adolescent mothers and their children and on the quality of mother-child interaction. METHODS: Pregnant adolescents referred to a county health department were randomly assigned to an experimental (EIP) or control (traditional public health nursing [TPHN]) group. The sample included 121 adolescents from predominantly minority and impoverished backgrounds who were followed from pregnancy through 6 weeks postpartum. Intense and comprehensive home visitation by public health nurses and preparation-for-motherhood classes were provided to adolescents in the EIP. Health outcomes were determined on the basis of medical record data. Other measures included maternal self-report on selected behaviors, nurse interviews, and the Nursing Child Assessment Teaching Scale (NCATS). RESULTS: Early findings indicate reduced premature birth and low-birth-weight (LBW) rates for young mothers receiving both forms of public health nursing care. No significant differences between groups were found for infant birth weight or type of delivery. Infants in the EIP had significantly fewer total days of birth-related hospitalization and rehospitalization than those in the TPHN group during the first 6 weeks of life (chi2(1) = 6.41; p = 0.01). Adolescents in the EIP demonstrated significantly more positive educational outcomes (e.g., lower school dropout rates) than those in the TPHN group (chi2(1) = 6.76; p < 0.009). CONCLUSIONS: The early findings of this study demonstrate that pregnant adolescents benefit from both traditional and more intense public health nursing care in terms of prenatal and perinatal outcomes. The EIP was associated with decreased infant morbidity during the first 6 weeks of life and decreased maternal school dropout. Long-term outcomes for the EIP are being evaluated.

An early intervention program for adolescent mothers: a nursing demonstration project.

OBJECTIVE: To improve health outcomes in a vulnerable population of adolescent mothers and their infants. DESIGN: Effects of an intensive early intervention program (EIP) are compared with those of traditional public health nursing (TPHN) care. SETTING: A large California county with urban and rural communities, an ethnically diverse population, and a high teen birth rate. PARTICIPANTS: One hundred twenty-one young mothers and their children from impoverished and predominantly minority backgrounds. INTERVENTIONS: During pregnancy and through 1 year postpartum, participants (n=63) in the EIP were provided with 4 prenatal classes and approximately 17 home visits by specially trained public health nurses. Interventions addressed health issues, sexuality and family planning, life skills, the maternal role, and social support systems. Participants in TPHN (n=58) received three home visits (for intake, prenatal care, and postpartum/well-baby care information). MAIN OUTCOME MEASURES: Antepartum, intrapartum, and newborn medical records; maternal responses to written questionnaires; and nurse interviews. RESULTS: Early program outcomes indicate reduced premature birth rates for both groups compared with national data on adolescent mothers, and fewer days of infant hospitalization during the first 6 weeks postpartum for the EIP participants. CONCLUSION: Public health nurse care (both traditional and intensive) significantly improved perinatal outcomes; the intensive intervention significantly reduced the number of infant hospitalization days.

The relationship between parental ratings of child behaviors, interaction, and the home environment.

PROBLEM: What is the relationship between child behaviors as perceived by the mother and father, mother-child interaction, and the home environment? SUBJECTS: A subsample of 28 families of healthy, full-term newborns recruited from a larger longitudinal study. METHODS: Mothers and fathers completed the Eyberg Child Behavior Inventory when their child was 24 months old. NCATS and HOME Inventory were administered. The Neonatal Perception Inventory was previously completed by the mother within 72 hours of birth and at 1 month postpartum. FINDINGS: Significant interparent correlations for intensity of child behaviors; however, the association for behaviors considered to be problematic was not significant. Fathers tended to report fewer behavior problems and less frequent occurrences. Several significant relationships were found between child behavior ratings, interaction, and the home environment. Gender of child and maternal employment status did not significantly influence parental perceptions of child behavior. CONCLUSIONS AND IMPLICATIONS FOR NURSING: While parents may share perceptions of child behaviors, they may differ in interpretation of whether those behaviors are problematic. Administering behavior inventories to both parents may help them identify and respect each other's differing opinions. These same inventories can be used to measure effects of interventions, and are adjuncts to direct behavioral observations of parent-child interaction.

Longitudinal effects of unimodal and multimodal stimulation on development and interaction of healthy infants.

The effects of unimodal and multimodal stimulation on mental, psychomotor, and behavioral development of healthy full-term infants were examined longitudinally. Subjects were randomly assigned to a control group or one of three experimental conditions: daily administration of a stroking procedure, placement on a multisensory hammock during sleep periods, or a combination of the two treatments. Interventions were conducted during the first 3 months of life. Data are presented on 49 infants who were available for 24-month follow up. The experimental conditions did not significantly affect scores on the Bayley Scales of Infant Development. Eyberg's Child Behavior Inventory, the Nursing Child Assessment Teaching Scales, or the HOME. These findings suggest that supplementary stimulation provided no benefits beyond those associated with natural caregiving and raise questions about the value of the interventions with nonrisk infants in middle-class families. Additional studies need to be conducted with larger samples of healthy infants to test sensory stimulation protocols before they are advocated for widespread consumer use.

Relationship between patterns of infant temperament, child behavior ratings, and interactions during toddlerhood.

This longitudinal study examined the relationship of temperament ratings during infancy, subsequent child behavior problems, and mother-child interaction. The authors considered the effect of change in mothers' perceptions of their infants' temperament during infancy (e.g., from easy to difficult or from difficult to easy) on subsequent developmental outcomes. Data from a predominantly middle-class Caucasian sample of 49 mother-child dyads are presented here. Findings revealed that children with discontinuities in 4 and 8-month ratings on the Revised Infant Temperament Questionnaire (e.g, Easy/Difficult or Difficult/Easy) had significantly higher problem and intensity scores on the Eyberg Child Behavior Inventory than those with stable temperament ratings (Carey & McDevitt, 1978a). No significant differences were found in maternal behaviors between mothers of children rated easy or difficult at 4 or 8 months. These results suggest that continuity of infant temperament ratings is an important factor for consideration in subsequent maternal identification of toddler behavior problems, and that difficult temperament alone may not predict such problems.

Using videotape instruction and feedback to improve adolescents' mothering behaviors.

The effects of videotape instruction and feedback (videotherapy) on mothering behaviors were evaluated in this longitudinal study. In this study, 31 adolescents and their healthy infants were randomly assigned to experimental and control groups. All subjects were videotaped during structured mother-infant teaching episodes in their homes at 1 and 2 months postpartum. Experimental group subjects reviewed the videotaped 1-month teaching episode and received feedback from a specially trained professional nurse who emphasized positive aspects of maternal behavior. Instruction was individualized according to the mother's needs. Results of a repeated measures MONOVA revealed significant differences in the pattern of change over time between subjects in the experimental and control groups on a measure of actual maternal behaviors. Adolescents receiving videotape instruction and feedback obtained significantly higher maternal behavior scores at 1 and 2 months postpartum.

Effects of nursing intervention on adolescents' maternal role attainment.

The purpose of this study was to evaluate the effects of a nursing intervention program on affective and behavioral dimensions of maternal role attainment. The sample comprised 20 primiparous adolescents, ages 12-19 years, from predominantly black and Hispanic backgrounds. Adolescents were randomly assigned to either an experimental or a control group. Participants in the experimental group received an intervention that included four 1 1/2 hour classes held at weekly intervals, selected maternal-fetal interactive activities, recording of fetal movements, and maintaining of maternal diaries. Five instruments were used in the study: Cranley's Maternal-Fetal Attachment Scale (MFAS); the two Semantic Differentials, Myself as Mother and My Baby; the Pharis Self-Confidence Scale; and the Nursing Child Assessment Feeding Scale (NCAFS). Adolescents receiving intervention demonstrated a significant increase in prenatal attachment (MFAS scores) but showed no differences in actual mothering behaviors (NCAFS scores) as compared with adolescents in the comparison group. Although significant correlations existed among the affective measures, they were not significantly related to the measures of mothering behaviors. These results suggest that the intervention program was primarily beneficial to adolescents' achievement of the maternal role through enhancement of maternal-fetal attachment. The data also raise questions about theoretical assumptions concerning the relationship between affective and behavioral components of mothering.

Comparison of survivors and nonsurvivors in pediatric intensive care.

PURPOSE: To identify characteristics of survivors and nonsurvivors among critically ill children admitted to a pediatric intensive care unit. METHOD: A retrospective chart review of 91 children (64 survivors and 27 nonsurvivors) compared age, gender, diagnostic category, and number of days in the ICU. Data were analyzed by Fisher's Exact Test and ANOVA. RESULTS: There were no significant differences among groups. CONCLUSIONS: Data contribute to the development and testing of predictive models for decision-making in pediatric intensive care.