The significance of breastfeeding practices on postpartum depression risk.

OBJECTIVE: Examine the relationship between breastfeeding practices (breastfeeding status and breastfeeding length) and postpartum depression (PPD) risk, after controlling for significant risk factors for PPD. DESIGN: A cross-sectional, correlational study design was used. Data was used from a national dataset using a subsample of women (n = 29,682) residing in 26 states in the United States that answered the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire. A secondary analysis was conducted using descriptive and bivariate analyses, and a multiple logistic regression model. RESULTS: Women currently breastfeeding (AOR = 0.87 CI: 0.79-0.95, p = .001), and women who breastfed for longer periods of time (p = < .002) had a statistically significantly lower PPD risk compared to their counterparts, even after accounting for significant covariates. CONCLUSIONS: Study findings suggest breastfeeding as a cost efficient and healthy behavior that can decrease a woman's risk for PPD. Nurses should educate and promote the maternal mental health benefits of breastfeeding in addition to the health benefits for the infant.

Work activities of primary health care nurses in Poland: National Survey Results.

BACKGROUND: In some countries, including Poland, nurses have acquired autonomy from being a designated "ancillary staff" to "professional staff" only in recent decades. No prior published studies have examined, however, whether the actual nursing practice in primary health care (PHC) has evolved with the advancement of education and professional autonomy. The aim of this study is to assess the scope of practice of a PHC nurses and their actual work activities. METHODS: A cross-sectional study design using an investigator-developed survey was conducted in Poland, in 2018. The survey was sent to professionally active PHC nurses in Poland. Of the 225 questionnaires distributed, 202 (89.8%) were returned. RESULTS: Out of 44 work activities examined, the most often performed activity was administering medications. Less frequent activities included recognizing patients' nursing needs and health problems and monitoring, assessing, and interpreting basic vital signs. A correlation was found between the length of work experience and the following three activities: performing nursing care, issuing referrals for specific diagnostic tests, and ordering of specific treatments, medications, and nutritional supplements. The longer was the work experience, the more often the nurses performed nursing care (r = 0.15; p = 0.035) but less often issued referrals for diagnostic tests (r = - 0.24; p = 0.001) or orders within their scope of practice (r = - 0.23; p = 0.002). CONCLUSION: While nurses in general are most likely to carry out physician orders, junior nurses tend to be more likely to work toward professional autonomy and pursuing new challenges. PHC nurses in Poland perform work associated more with carrying out physicians' orders and less with what they were prepared to do. Engaging nursing students in interprofessional education, dissemination of nursing research, and advocacy of nursing professional organizations on behalf of the profession may be an effective strategy to overcome the current barriers for PHC nurses to work the top of their license.

The shared decision-making model: Providers' and patients' knowledge and understanding in clinical practice.

BACKGROUND: Shared decision making (SDM) is a collaborative approach to patient care that facilitates patient engagement in self-care by upholding the patient's values and perspectives. The Affordable Care Act (2010) offers provisions for using SDM in clinical practice to improve care outcomes; however, inconsistent evidence exists about the provider-patient satisfaction and effectiveness of using SDM in Federally Qualified Health Centers (FQHCs), which offer care predominantly to the underserved. PURPOSE: This study assessed providers' and patients' knowledge and understanding of SDM in two FQHC in the Pacific Northwest. METHODOLOGICAL ORIENTATION: Descriptive phenomenological approach guided the investigation. Data were gathered through in-person interviews. Interviews were analyzed using the method discussed by Colaizzi (1978). SAMPLE: A purposive sample of 13 providers and 6 patients. CONCLUSIONS: Although providers and patients had divergent understandings of SDM, they highly valued this approach to care. An overarching theme "We use SDM as a Cornerstone of Patient Centered Care" and two subthemes: "We are partners in care" and "Being in the driver seat may not be comfortable but necessary" captured the providers' experiences. "They tell you what's up and we do it together" was a key theme that emerged from the patients' narratives. Several processes further described provider and patient experiences with SDM in the FQHC. IMPLICATIONS FOR PRACTICE: Findings suggest that the use of SDM in FQHC contributes to provider and patient satisfaction and improved patient engagement in self-care. Providers should therefore strongly consider using SDM model when working with the underserved.

A Dedicated Education Unit and a Novel Resident Nurse Transition-to-Practice Program in an Ambulatory Oncology Setting.

OBJECTIVE: To summarize an innovative initiative in oncology nurse workforce development that addresses critical current and future gaps and encompasses use of dedicated education units for student nurse rotation and a transition-to-practice residency program. DATA SOURCES: Review of institutional data including original pilot analysis and ongoing programmatic metrics (N=8 years), consensus, professional guidelines, and published literature. CONCLUSION: The dedicated education unit serves as a conduit for recruitment into institutional oncology nurse residency positions, and retention rates in the residency program continue to exceed national averages. Subsequent mentoring of these nurses in transition to practice has manifested high rates of promotion into nurse leadership roles year over year. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurse practice incorporates state-of-the-science approved therapies, early phase clinical trial implementation, and evidence-based complex oncology patient care management. A new model of student clinical nurse rotations in ambulatory settings, nurse resident transition to practice, and ongoing leadership mentoring is essential in creating a sustainable, highly skilled, and robust oncology nurse work force.

Integrating population health into nursing education: The process of gaining commitment from Washington's nursing deans and directors.

The achievement of health equity requires the expansion of nursing roles to include assessing burdens of disease, practicing cultural humility, implementing prevention strategies, and developing partnerships. In 2017, deans and directors of schools and programs of nursing in Washington State came together to commit to the integration of population health concepts and social determinants of health into all areas of nursing curricula. Through online communications and in-person meetings, facilitated in part by the authors of this paper, and with subcommittee representation from several baccalaureate nursing programs, Washington State academic nursing leaders identified new strategies to increase faculty awareness of population health and how to inspire related curricular changes to their programs. This Washington-wide initiative resulted in a white paper that was formally endorsed by 38 deans and directors representing all 14 baccalaureate and higher degree nursing programs in the state.

Behavioural categories of professionalism of nurses in Poland and Belarus: A comparative survey.

AIM AND OBJECTIVES: To compare the self-reported level of professionalism among nurses in Poland and Belarus and to indicate the areas in which differences in professional behaviours of nurses in both countries exist. BACKGROUND: Nurses constitute the largest group of healthcare providers, and the term professionalism is closely related to nursing profession. DESIGN: This investigation is a comparative survey and descriptive analysis of professional behaviours among nurses in Poland (n = 205) and Belarus (n = 236). The study was reported according to the STROBE checklist. METHODS: The Professionalism in Nursing Behaviors' Inventory Image Survey adapted from Adams and Miller (2001) was used to collect the data. The questionnaire contains 46 questions addressing the following behavioural categories: educational preparation, publications, research, professional organisation, community service, competence, code for nurses, theory and autonomy. RESULTS: The mean total score of professionalism was significantly different between the two countries (p < .0001). Significant differences, with higher scores in the group of respondents from Belarus, were also revealed in the following subscales of professionalism: "Professional organisation," "Community service," "Competence" and "Publication." Nurses from Poland had higher levels of "Educational preparation" and "Use of theory." No statistically significant differences were indicated in the "Autonomy" and "Research" subscales. CONCLUSION: Differences in the professionalism level of nurse practitioners in Poland and Belarus are related to nurses' professional position and the context in which they practice. RELEVANCE TO CLINICAL PRACTICE: The results of the present study can help the healthcare management and nursing leaders to support the professional development of nurses and strive for a higher level of professionalism.

Breastfeeding Support Guided by Swanson's Theory of Caring.

PURPOSE: Many women struggle with initiation of breastfeeding. The purpose of this study was to explore mothers' perceptions of care and support received from clinicians during breastfeeding initiation and the utility of Swanson's (1991) Theory of Caring to provide person-centered care to breastfeeding mothers and infants. STUDY DESIGN AND METHODS: Directed content of secondary analysis of data obtained from 11 women via in-person interviews at three time points: before birth, a week after giving birth, and 6 to 8 weeks after giving birth. All women were breastfeeding at the end of the study interview series. Swanson's Theory of Caring provided the theoretical framework for the analysis. RESULTS: Two overarching themes The Acts of Caring and The Lapses in Caring summarized women's experiences of care received during the initiation of breastfeeding. Five subthemes supported the Acts of Caring theme, and three subthemes supported the Lapses in Caring theme. CLINICAL IMPLICATIONS: Although all study participants chose to breastfeed after hospital discharge and the majority felt well supported, some received care that was perceived as uncaring, unsupportive, or harmful. Providing breastfeeding support consistent with research evidence and underpinnings of Swanson's Theory of Caring may help women build trusting relationships with clinicians and feel confident in meeting their breastfeeding goals.

Hearing Distressing Voices Simulation: Students' Perspectives.

The aim of this qualitative study was to describe nursing students' experiences of hearing distressing voices through content analysis of essays regarding changes they encountered during simulation. Data, obtained from undergraduate (n = 237) and graduate (n = 128) students' short self-reflection papers, were analysed using a six-step thematic analysis. The following six themes emerged: (a) experiencing cognitive and perceptual challenges, (b) feeling unpleasant emotions, (c) dealing with functional changes and hardships, (d) experiencing somatic changes, (e) making attempts to cope, and (f) facing lingering impact. The findings suggest that students' experiences of voice-hearing simulation closely resembled the voice-hearers' actual experience. Simulation is an effective teaching modality to introduce nursing students to the world voice-hearers live in and to prepare them for clinical practice enlightened through understanding of what it is like to hear distressing voices.

Somali Families' Experiences of Parenting in the United States.

The purpose of this study was to gain an understanding of first-generation Somali families' experiences of parenting in the United States to discover potential barriers to effective parenting with the goal to design supportive interventions. Using descriptive phenomenological design, 20 Somali families in Seattle, Washington, were interviewed. Interview transcripts were then analyzed using steps outlined by Colaizzi. The overarching theme that emerged was "Parenting: A Balancing Act," which represents Somali parents trying to balance traditional cultural values and parenting traditions with dominant cultural expectations. Participants expressed fear of losing their children to American lifestyle choices, such as drugs or gangs, and misuse of the American system to turn on their parents. Parents also acknowledged the benefits of access to education and health care for children. To cope with the stressors of their new life, participants sought to preserve traditional cultural and religious values, thus strengthening their Somali community.

Preparing nursing students for enhanced roles in primary care: The current state of prelicensure and RN-to-BSN education.

BACKGROUND: With the current emphasis on including registered nurses (RNs) on the primary care teams, it is essential that nursing programs prepare students for employment in these settings. PURPOSE: This study explored the current state of prelicensure and RN-to-Bachelor of Science in Nursing (BSN) online education regarding the implementation of primary care content in the curricula. METHODS: A sample of 1,409 schools and/or colleges from across the United States was invited to participate in an online survey. About 529 surveys were returned for an overall response rate of 37.5%. Summative content analysis was used to analyze survey data. DISCUSSION: Although most respondents have implemented some primary care content, some found it challenging and others have demurred from incorporating primary care content altogether. CONCLUSION: Nursing leaders and faculty in academia must collaborate with clinical partners to design and expand didactic and clinical learning experiences that emphasize primary care content in the prelicensure and RN-to-BSN education.

Culturally Embedded Risk Factors for Cambodian Husband-Wife HIV Transmission: From Women's Point of View.

PURPOSE: The purpose of this study was to use interview data to examine the validity of a recently published theoretical model of HIV transmission between husband and virginal wives in rural Cambodia. DESIGN: This study used a qualitative description method with a sample of women diagnosed with HIV/AIDS in Phnom Penh, Cambodia. METHODS: Data were collected through in-depth interviews conducted with 15 women who self-identified as having contracted HIV from their HIV-positive husbands. Interviews were conducted in Khmer, translated and back-translated for accuracy, and then coded using deductive content analysis. Trustworthiness of study results was protected through peer debriefing, coding to consensus, and maintaining an audit trail. FINDINGS: Each conceptual domain of the prior published theoretical model of HIV transmission was validated and further elaborated by current study data: wives' acceptance of their husbands' involvement with commercial sex workers, the common practice of unprotected sex between HIV-infected spouses and uninfected wives, and wives' beliefs about the value of the ideal Khmer woman. In addition, the current study findings identified a new domain that substantially distinguished between the beliefs and attitudes held about marriage and sex by wives and spouses. CONCLUSIONS: Women were not passive recipients of HIV transmission; they reciprocated with behaviors that were consistent with being a good Khmer woman in rural Cambodia, all of which increased their vulnerability to HIV transmission from their HIV-infected spouses. Future interventions or programs should consider all these factors and not overly rely on simplistic educational messages about wearing barriers for HIV transmission during sex. CLINICAL RELEVANCE: The refined theoretical model of HIV transmission from this qualitative research can be used to formulate culturally sensitive and embedded programs for curbing intramarital HIV transmission in Cambodia among the rural poor.

Becoming a person with HIV: experiences of Cambodian women infected by their spouses.

We conducted an interpretive phenomenological investigation in order to understand, within a Cambodian sociocultural context, the lived experiences of women infected with HIV by their husbands as they navigated the tasks of discovering, disclosing and dealing with the diagnosis. Using an open-ended interview protocol and an interpretive phenomenological approach, data were analysed from 15 women (aged 28-42 years) who self-identified the HIV transmission as coming from their spouses. Using qualitative inductive analysis, we were able to identify three main themes: (1) finding oneself to be HIV-positive, (2) encountering HIV--accepting an unwelcomed guest and (3) going public--dealing with the fear of discrimination. Participants consistently delayed testing for HIV and, after receiving an HIV-positive diagnosis, had to deal with painful emotions and discrimination within their social network. The complexity of gender roles and the sociocultural status of the women acted as behavioural determinants of their responses to HIV transmission from their spouses.

Life changes in women infected with HIV by their husbands: an interpretive phenomenological study.

HIV transmission from husbands to wives in stable marital relationships has increased. Our study explored women's perspectives on their life changes after being infected with HIV by their husbands. The interpretive phenomenological approach guided the study. Cambodian women (n = 15) who self-identified their infections as coming from their husbands participated in two in-depth interviews. The participants underwent significant changes in interpersonal and intimate relationships with their spouses, reporting that their partners became more devoted husbands and agreed to follow safer sex practices within the marriage. However, families suffered from hunger and poverty due to the parents' physical weaknesses. Both the husbands' changed behavior and their children gave these women the strength to not only go on with their life routines, but also to report that life was better than before the HIV diagnosis. These results inform health policies and programs targeting families where HIV affects both spouses.

Perinatal experiences of Somali couples in the United States.

OBJECTIVE: To explore the perspectives of Somali couples on care and support received during the perinatal period in the United States. DESIGN: Descriptive phenomenology. SETTING: A private room at the participants' homes or community center. PARTICIPANTS: Forty-eight immigrant women and men from Somalia (26 women and 22 men) who arrived in the United States within the past 5 years and had a child or children born in their homelands or refugee camps and at least one child born in the United States. All of the participants resided in the Pacific Northwest. METHODS: Semistructured individual interviews, interviews with couples, and a follow-up phone interview. Colaizzi's method guided the research process. RESULTS: Data analysis revealed an overarching theme of Navigating through the conflicting values, beliefs, understandings and expectations that infiltrated the experiences captured by the three subthemes: (a) Feeling vulnerable, uninformed, and misunderstood, (b) Longing for unconditional respect and acceptance and (c) Surviving and thriving as the recipients of health care. CONCLUSIONS: Integration of new Somali immigrant couples into the Western health care system can present many challenges. The perinatal experience for new Somali immigrant couples is complicated by cultural and language barriers, limited access to resources, and commonly, an exclusion of husbands from prenatal education and care. Nurses and other health care providers can play an important role in the provision of services that integrate Somali women and men into the plan of care and consider their culture-based expectations to improve childbirth outcomes.

Role of the registered nurse in primary health care: meeting health care needs in the 21st century.

There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered.

Conception, pregnancy, and birth experiences of male and gender variant gestational parents: it's how we could have a family.

INTRODUCTION: Like members of any other population, transgender and gender variant people--individuals whose gender identity varies from the traditional norm or from the sex they were assigned at birth--often seek parenthood. Little is known about the decision making and experiences of these individuals, including male-identified and gender-variant natal females who wish to achieve parenthood by carrying a pregnancy. This pilot qualitative study used grounded theory methodology to explore the conception, pregnancy, and birth experiences of this population of parents. METHODS: A grounded theory methodology was used to guide data collection and analysis. Eight male-identified or gender-variant gestational parents participated in the study. Data collection included individual 60-minute to 90-minute interviews conducted by recorded online video calls, as well as a self-administered online demographic survey. Data were collected from September 2011 through May 2012. Data saturation was achieved at 6 interviews, after which 2 more interviews were conducted. The interviews were transcribed verbatim, and a constant comparative method was used to analyze the interview transcripts. RESULTS: Loneliness was the overarching theme that permeated participants' experiences, social interactions, and emotional responses during every stage of achieving biologic parenthood. Within this context of loneliness, participants described complex internal and external processes of navigating identity. Navigating identity encapsulated 2 subthemes: undergoing internal struggles and engaging with the external world. The preconception period was identified as participants' time of greatest distress and least involvement with health care. DISCUSSION: The findings of this study suggest that culturally-sensitive preconception counseling could be beneficial for transgender and gender-variant individuals. The grounded theory produced by this pilot investigation also provides insights that will be useful to health care providers and others working with male-identified and gender-variant prospective parents.

Outcomes of the Evidence-Based Pitocin Administration Checklist at a Tertiary-Level Hospital.

Pitocin, a synthetic form of the hormone oxytocin, is a high-alert medication that heightens patient harm when used incorrectly. This investigation examined the outcomes of an evidence-based Pitocin administration checklist used for labor augmentation at a tertiary-level hospital. Data came from patient records. Using the Perinatal Trigger Tool, N = 372 clinical records (n = 194 prior to and n = 178 following checklist implementation) were reviewed. Checklist implementation resulted in statistically significant reductions in the duration of hospitalization (1.72 vs. 2.02 days, p = .0005), presence of meconium (23.7% vs. 6.7%, p < .001), maternal fevers (7.2% vs. 2.3%, p = .030), and episiotomies (8.8% vs. 1.7%, p = .002), and clinically important reduction in APGAR scores < 7 at 5 min (3.6%-0.6%, p = .069) and instrumented deliveries (11.9%-8.4%, p = .307). A universal Pitocin checklist implementation can improve birth outcomes and costs of care.

Experiences of preconception, pregnancy, and new motherhood for lesbian nonbiological mothers.

OBJECTIVE: To describe the experiences of preconception, pregnancy, and new motherhood from the perspective of lesbian nonbiological mothers. DESIGN: Descriptive phenomenology. SETTING: A private room at the study site and participants' homes. PARTICIPANTS: Twenty-four self-identified lesbian nonbiological mothers in a committed relationship and whose partner gave birth within the past 2 years participated. All of the participants were from urban or suburban areas in the Pacific Northwest. METHODS: Women participated in semistructured in person interviews that were audio recorded and transcribed verbatim for analysis. Coliazzi's method guided the process. RESULTS: An overarching theme of "feeling different" permeated the experiences of preconception, pregnancy, and new motherhood for the participants. The women's narratives revealed seven themes that illustrated their experiences: (a) Launching pregnancy: A roller coaster ride; (b) Having legal and biological concerns: Biology prevails; (c) There is a little person in there: Dealing with pregnancy issues; (d) Losing relationships over pregnancy: The elephant in the room; (e) Feeling incomplete as a mother; (f) Carving a unique role: There are very few of us out there; and (g) Sadness and regret: Nonbiological mothers get the postpartum blues, too. CONCLUSIONS: The experience of preconception, pregnancy, and new motherhood for nonbiological lesbian mothers is complicated by the lack of biological and legal substantiation to the infant, few role models, and limited social support. Nurses and health care providers cognizant of these issues can play an important role in facilitating a positive transition to motherhood for this population.

Peripherally inserted central catheter: compliance with evidence-based indications for insertion in an inpatient setting.

A randomized, retrospective chart review was conducted at a medium-sized community hospital to verify appropriateness of peripherally inserted central catheter (PICC) use in 49 inpatient patients. Study results support the Infusion Nurses Society recommendation to use PICCs to facilitate either short- or long-term intravenous therapy of vesicants, irritants, and any medications with a pH less than 5 or greater than 9 and osmolarity greater than 600 mOsm/L. All PICC insertion criteria recommended by the Centers for Disease Control and Prevention were met except one--the intended duration of intravenous therapy of more than 6 days. Identical PICC selection criteria are needed to standardize clinical practice.

Infant feeding buddies: a strategy to support safe infant feeding for HIV-positive mothers.

BACKGROUND: Prior to 2010, the World Health Organization recommended that HIV-positive mothers exclusively breastfeed for the first 6 months of life unless replacement feeding was acceptable, feasible, affordable, sustainable, and safe. Community pressure to practice mixed feeding, lack of knowledge on safe feeding, and shame regarding HIV status discourage mothers from breastfeeding exclusively and contribute to South Africa's low exclusive breastfeeding prevalence of 7% for infants under 6 months. OBJECTIVE: This pilot study explored the feasibility of implementing a feeding buddy system to provide a mother with support to achieve her infant feeding goal. METHODS: A convenience sample of 14 HIV-positive mothers and their buddies was recruited from the Butterworth Gateway Clinic in South Africa. HIV-positive mothers selected a buddy who accompanied them on clinic visits and counseling sessions on safe infant feeding. The research team conducted in-depth interviews to gather qualitative information on participants' experiences at 3 points in time. RESULTS: Buddy selection was influenced by the mother's relationship to the buddy, trust, and previous disclosure of HIV status. The 3 most cited forms of support were the buddy's accountability, teaching, and help in feeding the infant correctly. CONCLUSIONS: Buddies were successfully integrated into routine Prevention of Maternal-to-Child Transmission visits. Study participants confirmed that having a buddy was a helpful support for HIV-positive mothers.