Maternal expectations of the child health nurse.

The main aim of this study was to identify what first-time mothers in Sweden expected of Child Health Nurses. A further aim was to investigate what help and support was received by the new mothers and whether they felt that anything was missing. Twenty new mothers were interviewed according to grounded theory and the data were analyzed by the constant comparative method. It was found that first-time mothers expected Child Health Nurses to have faith in a new mother's own strength and to be accessible, approachable and knowledgeable, providing advice and support. New mothers indicated that they had experienced most of these characteristics, especially accessibility and approachability, but some felt that there were deficiencies (e.g. a lack of continued interest in their own bodies and health, as well as a lack of support when they ceased to breast-feed). The Child Health Service was taken for granted by new mothers. First-time mothers indicated that they appreciated the service, particularly those mothers who did not have a good social network. However, some of the new mothers expressed negative feelings regarding the Child Health Service provided.

The process of decision-making on abortion: a grounded theory study of young men in Sweden.

PURPOSE: To gain knowledge of the attitudes, questions, and problems in decision making on abortion by young men recently informed about the positive pregnancy tests of their girlfriends. This knowledge will be used as a basis for developing a service for such young men. METHODS: A grounded theory approach was used for interviews at an outpatient clinic for adolescents in Sweden with 18 individuals faced with sharing the decision about abortion. RESULTS: In a suggested model, the decision-making process can be understood by three concepts: reactions (including feelings, apprehensions, and moral conflicts), impact factors (including quality of relationship, consideration for girlfriend, and psychosocial factors), and tools for process (including communication, secrecy/confidentiality, and organized support). CONCLUSIONS: This study suggests the importance of helping the male adolescent with his reactions as a condition for using the equipment constituting impact factors and tools for process on the way to decision about abortion.

The staffs' views regarding young men involved in decisions on abortion: preliminary information from a study of outpatient clinics for adolescents in Sweden.

The purpose of this study was to obtain knowledge about the opportunities available to Swedish teenage boys and young men for obtaining advice and support during the process involved in making decisions on abortion. The study was carried out at Swedish Outpatient Clinics for Adolescents. We also wanted to obtain knowledge about the staffs' views of male attitudes and feelings regarding abortion. This knowledge is intended for use in developing models for advice and support in this difficult situation. A questionnaire focused on current management routines and staff experiences of questions and problems taken up by the male partner concerning abortion. Questionnaire answers indicated that the potential father, as well as the mother, requires active care and information together with the partner. There was also a need for individual support and information for male partners requiring engagement of health care professionals who are familiar with the problems involved.

The experience of pregnancy: a hermeneutical/phenomenological study.

The aim of this study was to describe women's experience of pregnancy. The setting was the Alternative Birth Center at Sahlgrenska University Hospital in Göteborg, Sweden, from 1996 to 1997. Anonymous diaries were written by 12 women and analyzed using a hermeneutical/phenomenological approach. The essential structure and interpretation of women's experience of pregnancy can be expressed as "transition to the unknown," which includes three themes: (1) meeting one's life situation, (2) meeting something inevitable, and (3) preparing for the unknown.The essential structure and interpretation of women's experience of pregnancy can be expressed as "transition to the unknown" …

Women's experience of the encounter with the midwife during childbirth.

OBJECTIVE: to describe women's experience of the encounter with the midwife during childbirth. DESIGN: a qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews. SETTING: the Alternative Birth Care Centre, Sahlgrenska University Hospital, Gothenburg, Sweden in 1994. PARTICIPANTS: 18 women, six primiparous and 12 multiparous who were two to four days post delivery. KEY FINDINGS: the essential structure of the studied phenomenon was described as 'presence' and included three themes: to be seen as an individual, to have a trusting relationship and to be supported and guided on one's own terms. IMPLICATIONS FOR PRACTICE: the need to be seen as an individual can be realised by affirmation and familiarity with the midwife and surroundings. A trusting relationship can be obtained by good communication and proficient behaviour. By providing a sense of control the women can be supported and guided on their own terms. Above all they must feel that the midwife is present.

Physiologic measures of kangaroo versus incubator care in a tertiary-level nursery.

OBJECTIVE: To determine the safety and feasibility of kangaroo care in a tertiary-level nursery as defined by apnea, bradycardia, and oxygen desaturation. DESIGN: Prospective, long-term, repeated measures with a convenience sample. SETTING: A 20-bed, tertiary-level nursery with approximately 400 admissions a year. PARTICIPANTS: Eight mother-infant pairs. INTERVENTIONS: Researchers compared incubator care with kangaroo care for 4 hours a day, 6 days a week, for 3 weeks. Physiologic variables were monitored daily and recorded continuously on a polygraph for 8 hours each week. MAIN OUTCOME MEASURES: Amount of apnea, bradycardia, and oxygen desaturation. SECONDARY OUTCOME MEASURES: Heart rate, respiratory rate, percent sleep time, and skin temperature. RESULTS: Apnea, bradycardia, oxygen saturation, heart rate, and respiratory rate were similar during both kangaroo (K) and incubator (I) care. The infants experienced a lower percent (mean +/- standard deviation, K versus I) of total sleep (47 +/- 15 versus 64 +/- 19, p < .003) during kangaroo care. The infants' mean +/- standard deviation temperature during the kangaroo care (36.5 degrees C +/- 0.64 degrees C) was lower (p < .03) than that of the control periods before (36.8 degrees C +/- 0.27 degrees C) or after (36.7 degrees C +/- 0.26 degrees C). Percent sleep time and skin temperature were slightly lower during kangaroo care, but the differences were not clinically significant. CONCLUSION: Kangaroo care is safe and feasible for selected mothers and infants in a tertiary-level nursery.

Drug consumption among elderly--a four-year study.

The aim of the study was to analyse whether a radical structural change in the provision of care for the elderly, including changes in the pattern of drug administration, might influence drug consumption among residents in a Danish nursing home. A comprehensive reorganization of the care of the residents took place in the mid-1980s. The general approach to self-care, with greater autonomy and influence over one's own life was also disseminated to the area of administration of medication. Previously the nurses had been responsible for this area but a new model was introduced in 1986 in principle permitting all residents to be in charge of their own medication. The study was carried out as a survey over four consecutive years from 1985 to 1988, and included 48 residents in a nursing home of whom 24 participated in all four surveys. A minimum of drugs were administered immediately after the change in regimen. Although a slight increase was recorded in the subsequent years, the level of drug consumption did not reach pre-intervention levels. The total number of regularly administered drugs per day in survey 1 averaged 4.6 drugs/person. In survey 2 this had decreased to average 3.6 (p < 0.05).

Sociodemographic differences in the prevalence of self-reported headache in Icelandic school-children.

The study considers the prevalence of headache experiences in a random national sample of 2140 Icelandic 11-12 and 15-16 year-old school-children. The study finds an overall 21.9% prevalence of "at least weekly" headache. The prevalence is significantly higher among younger children and among girls. The gender difference is found to be related to the fact that older boys have a markedly lower prevalence than younger boys. No gender difference is observed in the younger group. Social class interacts with gender, with the gender difference leveling out in the upper class. The frequency of headache experiences correlates with last months use of medication to relieve headache. The high overall prevalence of headache found in this study agrees with earlier findings, and is a matter of concern since little is being done to counter this problem of discomfort among school-children.

Reconciliation and healing for mothers through skin-to-skin contact provided in an American tertiary level intensive care nursery.

Feasibility and safety of skin-to-skin contact through the Kangaroo method of care in a modern American tertiary intensive care was studied, as well as effects of this innovative care on mother's emotional reactions. Eight mother infant dyads participated in skin-to-skin contact a minimum of 4 hours each day for six days per week during a period of three consecutive weeks. The cognitive adaptation framework was used to identify themes in maternal responses. During the first week, mothers were preoccupied with childbirth events in attempts to understand their sense of loss and victimization. During the second week, maternal emotions intensified and manifested in fears for the baby's well-being and a need to discuss negative and positive emotional reactions to having a premature and sick baby. All mothers requested respite time from skin-to-skin contact, so they could deal with their emotional crises. By the third week, mothers had an increased sense of meaning, mastery, and self-esteem about what had happened to themselves and their infants. Themes of reconciliation and healing occurred when mothers placed their infant skin-to-skin in the Kangaroo position over the three consecutive weeks that this type of nursing care was experienced.

Nursing students' attitudes towards abortion and family planning in Italy and Sweden.

In the last two decades family life and family planning have developed in a similar way in different European countries although legal and social background factors were very different in the past. Countries like Italy and Sweden are bipolar when compared. In this study nursing students' attitudes towards abortion and family planning in Italy and Sweden are described, to identify general characteristics of students that could be of interest to compare and to identify reasons for approval and/or disapproval of abortion. Some social characteristics of the students are similar, like fathers' profession/activity. Italian nursing students are more religious. Some factual knowledge is low in both samples. The nursing student's feelings, attitudes towards abortion are expressed differently in the countries. Many Italian students believe abortion is justified only on medical grounds, Swedish students indicate psychological effects as the most likely consequence both for woman and for man.

PIP: Studies in the US and the United Kingdom about nursing student attitudes toward abortion have shown negative or undecided attitudes which were not correlated with the level of knowledge about abortion. Older and better educated nurses and those in contact with abortion patients were less negative. Sweden and Italy had no comparable studies. This study proposed to describe the attitudes and knowledge of abortion and family planning (FP) among nursing students in Italy and Sweden. Social, religious and cultural factors were used to differentiate the countries as well as the reasons for approval or disapproval. 229 1st-year students from Stockholm, Sweden and 124 from Rome, Italy participated voluntarily in a 24 item questionnaire on social conditions (5), religious background (2), menstrual and puberty experiences (2), family planning (8), and abortion (7). Validity and clarity of questions was assured. Italian students were 85% female and Swedish 89%. 26% of Swedish students were 30 years whereas only 3% of Italian students were. 71% of Italian students had a religious education and only 28% of Swedish students. 89% of Italian and 25% of Swedish students had a current Christian belief. Most father's occupation was employees/workers. 70% of Italian and 16% of Swedish mothers were housewives. 63% of Italians justified abortion on medical grounds, and 79% of Swedes justified abortion on social grounds, even though both countries legally permit abortion for social reasons. 62% of Italian and 42% of Swedish student defined abortion in a disapproving/negative way, while 7% of Italian and 25% of Swedish students defined it positively. 30% in both countries gave a technical or neutral definition. 93% of Italian and 33% of Swedish students though both partners should decide. 93% of Swedish student said females had psychological effects; 51% felt there were male psychological effect. Only 23% of Italians saw some male psychological effects, but only social problems were recognized. Italian student knew less about sex education and FP. 50% in both countries underestimated the abortion number/year. Both gave mothers and friend as important information sources; FP training is recommended for both countries

Health professionals' opinions regarding abortions and the abortion law in samples from Italy and Sweden.

The present study was undertaken to investigate the opinions of health professionals working in family planning clinics in Italy and Sweden. The comparison of two such different countries seemed of interest both to describe differences and/or similarities between the samples as well as to analyze factors that could influence professionals' opinions regarding abortion. A questionnaire was distributed to doctors, nurses and social workers in family planning clinics in Rome, Italy and in Gothenburg, Sweden. The opinions of the health professionals in the two countries investigated were similar in many respects, both regarding their attitudes to abortion as well as their considerations concerning the care offered to the woman/couple undergoing an abortion. Fifty-nine percent of the Italian sample and 68% of the Swedish sample considered abortion justifiable on the same indications as those laid down in the laws, while 36% of the Italian and 32% of the Swedish professionals considered it justifiable only on medical grounds and 5% in the Italian sample did not justify abortion at all. In both Italy and Sweden, doctors as well as nurses suggest that the preventive work should be increased and that the psychological care for women undergoing abortion has to be improved.

Adolescents' attitudes to abortion in samples from Italy and Sweden.

Both Italy and Sweden have legislated abortion without grounds since the 1970s but background conditions in the two countries are bipolar. The overall purpose of the present study was to investigate a sample of adolescents from Italy and Sweden regarding their attitudes towards abortion and their knowledge of family planning and to compare the results from the two countries. A questionnaire was distributed among 400 adolescents, 177 from Stockholm, Sweden and 223 from Rome and Locri, Italy. Whereas Sweden is a relatively homogeneous country. Italy has large regional differences regarding social and other aspects. For this reason two regions of Italy were studied separately. The participants were all secondary school students. The results indicated that nearly all adolescents in both countries were concerned about abortion and its consequences, although their concern was expressed differently, in accordance with their religious and cultural norms and also with their background in sexual education. The present study raises questions concerning the knowledge level as an outcome of sex education programs. In fact comparing the answers between the Italian and the Swedish samples no particular difference, in favour of the Swedish adolescents was noticed.

Interruption of pregnancy: motives, attitudes and contraceptive use. Interviews before abortion, at a family planning clinic, Rome.

Since 1978 when the law on legal abortion came into force, approximately 35% of all pregnancies in Italy have ended in abortion (illegal abortions excluded). Presently about 25% (national average) of the women who interrupt pregnancy get their medical certificate at a family planning clinic. The general aim of the present study was to describe women's situation on the occasion of their first visit to the family planning clinic, their problems and their motives to abortion. Over a period of 6 months, 65 women were interviewed during their visit to a family planning clinic before interruption of their pregnancy. A semistructured questionnaire was used concerning their motives for interruption of pregnancy, contraceptive habits, their attitudes to abortion and the male partner's participation. The women arrived in an early stage of the pregnancy, 46 women said that they had considered the possibility to interrupt the pregnancy almost at the same time as they got the message that they were pregnant. Twenty-eight women had already a previous abortion, the use of contraceptives did not differ among these women and was generally scarce. Twenty-one women said they had been against abortion before their own experience or said they had never believed themselves to be in need of an abortion.

Short-term effects of early suckling and touch of the nipple on maternal behaviour.

The objective was to evaluate the effects of suckling within 30 min after birth when skin-to-skin body contact for mothers and infants was held constant in both cases (n = 32) and control groups (n = 25). Mother-infant interaction during breast-feeding, infants' time spent in nursery and different aspects of breast-feeding were evaluated. Prolactin and gastrin were measured in maternal serum before and after breast-feeding on day 4 post partum. The aim to evaluate effects of early post delivery suckling failed since only six of the 32 case infants did suck at this time. In spite of this, we found three significant differences among cases and controls. In the case group where all infants had touched or licked the areola and nipple, the mothers left the infants in the nursery for a significantly shorter time and significantly more mothers talked to their infants during the short breast-feeding observation. Median gastrin levels were significantly lower in cases than in controls both before (P less than 0.01) and after (P less than 0.03) breast-feeding. In conclusion, the infant's early touch of the mother's areola and nipple seemed to have positively influenced the mother/infant relationship during the first four days after birth. It was also associated with lower maternal gastrin levels which suggests that maternal neuroendocrine functions were also influenced. Ten months after birth, we found no differences between cases and controls.