Effects of maternal employment and prematurity on child outcomes in single parent families.

BACKGROUND: Effects of maternal employment for preschool children vary based on specific characteristics of the mother's employment, the family's economic status, and the mother's attitudes about employment. However, there is limited research on a growing group of children at developmental risk-those born prematurely and living in a single-parent family. OBJECTIVE: To examine the effects of maternal employment and prematurity on child cognition and behavior in single-parent families. METHODS: Sixty preterm and 61 full-term preschool children were recruited through NICU admission records and birth records. Data were collected with the Kaufmann Assessment Battery for Children, Peabody Picture Vocabulary Test, Child Behavior Checklist, Parenting Stress Index, and the Life History Calendar. RESULTS: Greater hours employed was related to higher achievement and mental processing scores only. Less discrepancy between actual and desired employment was related to higher achievement, mental processing, and language scores and lower behavior scores. Prematurity was not related to child cognitive and behavioral performance. Only the relationship between discrepancy and language remained after statistical control. CONCLUSIONS: The concerns about negative effects of maternal employment on young children may be overstated, especially in low-income, single-mother families. These findings are especially important in the context of welfare reform.

A randomized trial of nurse specialist home care for women with high-risk pregnancies: outcomes and costs.

OBJECTIVE: To examine prenatal, maternal, and infant outcomes and costs through 1 year after delivery using a model of prenatal care for women at high risk of delivering low-birth-weight infants in which half of the prenatal care was provided in women's homes by nurse specialists with master's degrees. STUDY DESIGN: Randomized clinical trial. PATIENTS AND METHODS: A sample of 173 women (and 194 infants) with high-risk pregnancies (gestational or pregestational diabetes mellitus, chronic hypertension, preterm labor, or high risk of preterm labor) were randomly assigned to the intervention group (85 women and 94 infants) or the control group (88 women and 100 infants). Control women received usual prenatal care. Intervention women received half of their prenatal care in their homes, with teaching, counseling, telephone outreach, daily telephone availability, and a postpartum home visit by nurse specialists with physician backup. RESULTS: For the full sample, mean maternal age was 27 years; 85.5% of women were single mothers, 36.4% had less than a high school education, 93.6% were African American, and 93.6% had public health insurance, with no differences between groups on these variables. The intervention group had lower fetal/infant mortality vs the control group (2 vs 9), 11 fewer preterm infants, more twin pregnancies carried to term (77.7% vs 33.3%), fewer prenatal hospitalizations (41 vs 49), fewer infant rehospitalizations (18 vs 24), and a savings of more than 750 total hospital days and $2,496,145 [corrected]. CONCLUSION: This model of care provides a reasoned solution to improving pregnancy and infant outcomes while reducing healthcare costs.

Evidence-based nursing practice: why is it important?

Evidence-based practice has gained momentum in nursing, and definitions vary widely. Research findings, knowledge from basic science, clinical knowledge, and expert opinion are all considered "evidence"; however, practices based on research findings are more likely to result in the desired patient outcomes across various settings and geographic locations. The impetus for evidence-based practice comes from payor and healthcare facility pressures for cost containment, greater availability of information, and greater consumer savvy about treatment and care options. Evidence-based practice demands changes in education of students, more practice-relevant research, and closer working relationships between clinicians and researchers. Evidence-based practice also provides opportunities for nursing care to be more individualized, more effective, streamlined, and dynamic, and to maximize effects of clinical judgment. When evidence is used to define best practices rather than to support existing practices, nursing care keeps pace with the latest technological advances and takes advantage of new knowledge developments.

Factors influencing single mother's employment status.

Changes in the welfare system limit the length of time a person can receive welfare benefits, thus mandating employment for many current welfare recipients. Single mothers with young children who do not become employed will lose financial support for housing, food, clothing, and health care and place their own and their children's health and safety at risk. The purpose of this qualitative study was to explore women's experiences of being unemployed and to examine the barriers to employment perceived by single mothers who expressed a desire to be employed. Nine mothers were recruited from a larger sample of single mothers who had participated in a quantitative study about employment conducted 1 to 2 years earlier. Using focus group interviews, mothers were asked what it was like to be a single mother, and then what barriers to their employment they perceived. Two dimensions were identified from the mothers' statements. The first, a sense of obligation, included themes of "being there" for their own and their child's benefit and doing what it takes to optimize the child's growth and development. The second, negotiating the obstacles, referred to problems regarding child care, lack of involvement of the child's father and lack of support from relatives and friends for the mother's efforts toward securing employment. These findings have important implications for welfare reform, namely, that efforts aimed at moving nonemployed single mothers into the workforce will fail if these factors are not considered.

Employment patterns and timing of birth in women with high-risk pregnancies.

OBJECTIVE: To describe the characteristics of employed women with high-risk pregnancies, their pattern of employment prenatally and postpartum, and the relationship of prenatal employment to preterm or full-term birth. DESIGN: Secondary analysis with a sample of 171 women with high-risk pregnancies. SETTING: Women's homes and a tertiary care hospital. PARTICIPANTS: Women who were primarily single, African American, and poor; 33% worked or attended school during their pregnancies. MAIN OUTCOME MEASURES: Gestational age at birth, employment, and school attendance. RESULTS: Preterm delivery was not related to when the women stopped working or attending school or were prescribed bed rest. Women employed prenatally were older, had higher incomes, and were more likely to be white or of ethnicity other than African American. Fifty-seven percent of women with a history of prenatal employment and 85% of the women who intended to work after delivery returned to work during the first postpartum year. CONCLUSIONS: Women employed during high-risk pregnancies are similar demographically to women with low-risk pregnancies in other studies. Most of the women stopped working or attending school because of prescribed bed rest. Bed rest, however, was not related to preterm delivery. Most women who planned to return to work did so. Factors other than the women's high-risk pregnancies, such as attitudes toward employment, employability, and family circumstances, most likely influenced their employment status. Current welfare reform initiatives will increase the number of women working while pregnant. This article provides pre-welfare-reform baseline data concerning patterns and effects of employment for women with high-risk pregnancies. These data will enable nurses to examine the effects of welfare reform on employment during pregnancy and preterm birth.

Effects of pediatric head trauma for children, parents, and families.

Severe pediatric head injury has negative consequences for children of all ages. Even mild and moderate head injury results in residual impairment for school-age children and adolescents. Data are needed on the effects of these less severe insults, especially for preschoolers. Although research on the impact of the child's head injury on the parent-child relationship and family functioning is limited, the experience is likely to be very stressful for the parent and the family. Indeed, family integrity may be at risk. Research is needed that examines the effects of a child's head injury for the parent and the family over time and identifies factors related to these outcomes.

Alternate child care, history of hospitalization, and preschool child behavior.

BACKGROUND: With more single mothers entering the workforce due to welfare reform efforts, more hospitalized children from single-parent families will have experienced alternate child care arrangements where routine care is provided by adults other than the child's mother. OBJECTIVES: To investigate with secondary analysis of data whether experience with alternate child care has a moderating effect on the relationship between hospitalization and behavior of preschool children living in female-headed single-parent families. METHOD: A sample of 60 preterm and 61 full-term children who were 3, 4, or 5 years old was recruited for the larger longitudinal study. Behavior problems were measured with the Child Behavior Checklist. History of hospitalization and alternate child care arrangements were measured with the Life History Calendar. RESULTS: Preschool children who experienced hospitalization without alternate child care experience had more somatic complaints, but those with both hospital and alternate child care experience had fewer aggressive behaviors than other children. For children with a history of hospitalization, aggressive behaviors decreased as the proportion of the child's life in alternate child care increased. CONCLUSIONS: Experience with alternate child care may ameliorate some of the negative effects of hospitalization, and potentially other novel and negative experiences, for preschool children. This could be due to child care providing positive experiences with separation from the mother, a peer group with which to talk about the novel experience, or actual instruction about the novel experience.

The Children's Cognitive Triad Inventory: reliability, validity, and congruence with Beck's cognitive triad theory of depression.

Depression, once thought rare in children, is now more widely recognized and believed to arise from negative views of self, world, and future, according to Beck's cognitive theory of depression. The Cognitive Triad Inventory for children measures the three negative views, and although reported as psychometrically adequate, this study extended previous analyses with confirmatory factor analysis in a sample of 122 school-aged children. Internal consistency was .82 (total scale) but ranged from .54 to .76 for subscales reflecting the views of self, world, and future. Confirmatory factor analysis revealed factors reflecting three aspects of the self rather than the three negative views. The findings suggest that Beck's theory about the negative cognitive triad may be less suitable for children than adults.

Frequency, timing, and diagnoses of antenatal hospitalizations in women with high-risk pregnancies.

OBJECTIVE: To examine the frequency, time of gestation, and reasons for antenatal hospitalizations in women with medically high-risk pregnancies. STUDY DESIGN: This secondary analysis reports all antenatal hospitalizations from a clinical trial testing transitional care to women with high-risk pregnancies. Data were collected from 1992 to 1996. Pregnant women with pregestational (n = 16) or gestational diabetes (n = 21), hypertension (n = 29), and diagnosed (n = 47) or at high risk for preterm labor (n = 37) were included. Diagnoses for each hospitalization and lengths of stay were collected from chart review and validated by attending physicians. Gestation was determined via ultrasonography. The sample (N = 150) consisted of predominantly African-American women, never married, between the ages of 15 and 40 with Medicaid insurance. RESULTS: Eighty-three percent (n = 125) of the women had one or more antenatal hospitalization with a mean length of stay of 123 hours. All women with diabetes were hospitalized at least once. Women with pregestational diabetes had the greatest number of hospitalizations whereas those with gestational diabetes had the least. Major reasons for hospitalizations were preterm labor, glucose control, premature cervical dilation, and preeclampsia. CONCLUSION: Some hospitalizations could potentially be avoided or reduced through expanded patient education, improved screening, and more aggressive monitoring for early signs and symptoms of impending complications.

Maternal employment and parent-child relationships in single-parent families of low-birth-weight preschoolers.

BACKGROUND: The influence of premature birth of an infant in female-headed, single-parent families together or in conjunction with family environment factors, such as employment of the mother, on the mother-premature child relationship has not been considered in past studies. OBJECTIVES: To explore differences in parent-child and family relationships for employed and nonemployed single mothers of low-birth-weight (LBW) and full-term preschool children and to describe the relationships of the mother's employment status, employment history, and employment attitude-behavior consistency to parent-child and family relationships. METHODS: Single mothers with LBW (n = 60) and full-term (n = 61) preschool children provided data on their employment situation, the Parenting Stress Index, the Feetham Family Functioning Survey, and the Home Observation for Measurement of the Environment. RESULTS: Employed mothers had more positive perceptions and provided more enriching home environments for their children. Greater attitude-behavior consistency was associated with more positive perceptions of the parental role. CONCLUSION: Thus, in single-parent families, employment and consistency are positive influences on the mother-child relationship.

Home care of high risk pregnant women by advanced practice nurses: nurse time consumed.

This study examined the time spent by advanced practice nurses (APNs) in providing prenatal care to women with high risk pregnancies. The results indicate that the overall mean APN time spent in providing prenatal care was 51.3 hours per woman. The greatest amount of time was spent in the clinic and women with pregestational diabetes consumed the most APN time and required the most contacts. Historically, home care services have been measured by number of visits or contacts. This study assists home care nurses and administrators to consider additional measurements including time spent.