The role of trust and health literacy in nurse-delivered point-of-care STI testing for pregnant women living with HIV, Tshwane District, South Africa.

BACKGROUND: Sexually transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of HIV. Yet the World Health Organization's current syndromic management guidelines for STIs leaves most pregnant women undiagnosed and untreated. Point-of-care (POC) diagnostic tests for STIs can drastically improve detection and treatment. Though acceptable and feasible, poor medication adherence and re-infection due to lack of partner treatment threaten the programmatic effectiveness of POC diagnostic programmes. METHODS: To engender patient-provider trust, and improve medication adherence and disclosure of STI status to sexual partners, we trained study nurses in compassionate care, good clinical practices and motivational interviewing. Using qualitative methods, we explored the role patient-provider communications may play in supporting treatment adherence and STI disclosure to sexual partners. Nurses were provided training in motivational interviewing, compassionate care and good clinical practices. Participants were interviewed using a semi-structured protocol, with domains including STI testing experience, patient-provider communication, and HIV and STI disclosure. Interviews were audio-recorded, transcribed and analyzed using a constant comparison approach. RESULTS: Twenty-eight participants treated for Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and/or Neisseria gonorrhea (NG) were interviewed. Participants described strong communications and trusting relationships with nurses trained in patient-centered care training and implementing POC STI diagnostic testing. However, women described a delayed trust in treatment until their symptoms resolved. Women expressed a limited recall of their exact diagnosis, which impacted their ability to fully disclose their STI status to sexual partners. CONCLUSIONS: We recommend implementing patient health literacy programmes as part of POC services to support women in remembering and disclosing their specific STI diagnosis to sexual partners, which may facilitate partner treatment uptake and thus decrease the risk of re-infection.

Incidental Fetal Ultrasound Findings: Interpretation and Management.

Ultrasonography is a common component of prenatal care worldwide and is often used in early pregnancy to determine gestational age, number of fetuses, fetal cardiac activity, and placental location. Patients and their families may also consider ultrasonography a social event, as it provides confirmation and reassurance of a normal pregnancy. Ultrasound screening is typically scheduled in the second trimester to visualize fetal anatomy and confirm gestational age. Most ultrasound examinations are reassuring, but some incidentally identify structural anomalies and soft markers for aneuploidy, making it necessary for health care providers to correctly interpret these findings. The health care provider's ability to prepare patients prior to the ultrasound and deliver the necessary information needed to make informed decisions regarding any follow-up screening or diagnostic testing is critical to reducing parental anxiety. Preparation for the anatomic survey should include counseling for normal and abnormal findings. The ethical concepts of patient autonomy and shared decision making are used as a guide in providing this critical information and enabling informed choices during follow-up for incidental ultrasound findings.

Parent Experiences and Preferences When Dysmelia Is Identified During the Prenatal and Perinatal Periods: A Qualitative Study Into Family Nursing Care for Rare Diseases.

Several rare diseases are regularly identified during the prenatal and perinatal periods, including dysmelia. How these are communicated to parents has a marked emotional impact, but minimal research has investigated this. The purpose of this study was to explore parent experiences and preferences when their baby was diagnosed with dysmelia. Mothers and fathers were interviewed. Data were analyzed using thematic analysis. The overriding emotion parents experienced was shock, but the extent of this was influenced by several factors including their previous experience of disability. Four key needs of parents were identified, including the need for signposting to peer support organizations, for information, for sensitive communication, and for a plan regarding their child's care. Parents wanted immediate information provision and signposting to peer support, and for discussions regarding possible causes of the dysmelia or termination (in the case of prenatal identification) to be delayed until they had processed the news.

Addressing the Global Zika Epidemic Locally: An Interprofessional Model of Universal Screening at One Center.

Escalating evidence for the fetal impact of Zika virus infection required a change in care by all prenatal providers. This article describes an effective model of rapid implementation of universal prenatal screening at one hospital and its network of community health centers for a large and diverse immigrant population exploring the challenges, experiences, and lessons learned. Implementation of national recommendations required a workflow change, challenging a system with a heterogeneity of settings and providers. Using a physician clinical champion and advanced practice nurses in the roles of logistical coordinator and liaison to the network, Zika screening was embedded into prenatal intake visits at both the hospital and community health centers. Challenges addressed include varied medical record systems, acceptance by patients, providers, and community health center leadership, as well as culturally appropriate outreach to diverse ethnic and linguistic communities. In 6 months, the prenatal screening rates increased from 20% to 88%, which resulted in the identification of more than 300 pregnant patients at risk of exposure to Zika virus. This model offers key lessons for emergency preparedness in heterogeneous, safety net hospital settings.

Afrontamiento ante el diagnóstico de una anomalía fetal. Revisión de la bibliografía / Afrontment for the diagnosis of a fetal anomaly. Bibliography review

Objetivo. Identificar las respuestas psicológicas de una mujer ante la detección prenatal de una anomalía fetal y analizar los factores que influyen en el afrontamiento. Material y métodos. Se ha realizado una revisión bibliográfica de artículos, guías de práctica clínica y otras revisiones basadas en la evidencia científica. Resultados. El afrontamiento está condicionado por la cultura y la sociedad en la que están integradas las mujeres. Estos factores influyen en las consecuencias psicológicas, en un primer momento principalmente negativas, pero que determinan el afrontamiento negativo o positivo de las mujeres y las estrategias empleadas a la hora de continuar con el embarazo o ponerle fin con el aborto. Este proceso puede verse beneficiado por el acompañamiento de la pareja y la atención especializada e integral de los profesionales sanitarios. Conclusión. Se debe prestar atención en el momento del diagnóstico, en el transcurso del embarazo o en la interrupción de este y en la prevención de un nuevo embarazo (AU)

Objective. Identify woman psychological responses at a prenatal diagnosis of fetal abnormality and to analyze the factors that influence in confrontation. Material and methods. It has been done a systematic review of articles, clinical practice guidelines and other reviews based on scientific evidence. Results. Confrontation is conditioned by culture and society where women are integrated. These factors are taking influence in psychological consequence, firstly there are negatives, but the positive or negative confrontation of women and the strategies employed when they continue the pregnancy or to finish with abortion. This process can be benefited by the couple accompanying and specialized and comprehensive care of health professionals. Conclusion. We must provide medical attention at the time of diagnosis, during pregnancy or the interruption and the prevention of a new pregnancy (AU)

Diagnóstico precoz y proceso de atención en enfermería en pacientes pediátricos con fibrosis quística / Early diagnosis and nursing process of care in pediatric patients with cystic fibrosis

Introducción. La fibrosis quística (FQ) o mucoviscidosis, considerada una enfermedad extraña, hoy día se diagnostica a un número creciente de niños en todo el mundo y la cantidad de niños aquejados de esta enfermedad que llegan a la adolescencia y a la adultez es cada vez mayor. Objetivos. Facilitar aspectos importantes que tener en cuenta por parte del personal de enfermería en la detección precoz de la fibrosis quística y desarrollar un Plan de Cuidados de Enfermería estandarizado con los diagnósticos más frecuentes en estos pacientes. Método. Revisión bibliográfica. Se utilizaron bases de datos como EBSCO, SciELO y Medline bajo descriptores como «enfermería », «cuidadores» y «fibrosis quística». Conclusiones. El diagnostico precoz es fundamental para lograr una mejor calidad de vida y disminuir la mortalidad y el Proceso de Atención de Enfermería (PAE) se encarga de identificar los problemas reales y potenciales, siendo el documento guía que utiliza el personal de enfermería para trabajar las expectativas que cada paciente ha de lograr. En el nuevo PAE confeccionado se formularon 11 diagnósticos de enfermería, 11 expectativas y 63 acciones, que solucionan total o parcialmente los problemas y necesidades de estos pacientes (AU)

Introduction. An increasing amount of children worldwide are currently diagnosed with cystic fibrosis (CF), or mucoviscidosis, still considered a rare disease. The number of children suffering from this disease reaching adolescence and adulthood is likewise increasing. Objectives. To present important aspects to be considered by nursing staff in the early detection of cystic fibrosis and develop a standarized Nursing Care Plan for these patients’ most common diagnoses. Method. Literature review using databases such as EBSCO, SciELO and Medline using searching keawords including nursing, caregivers and cystic fibrosis. Conclusions. Early diagnosis is crucial to achieve a better life quality and reduce mortality. Nursing Care Plan (NCP) is responsible for identifying actual and potential problems and is the guiding document used by the nursing staff to work out the achievement of each patient’s expected evolution. The resulting new NCP developed included 11 nursing diagnoses, 11 expected evolutions and 63 actions that fully and / or partially address patients’ problems and needs (AU)

Implantação de testes rápidos de HIV, sífilis e hepatite no pré-natal nos municípios da XI região de saúde ­ PE / Implementation of rapid tests for HIV, syphilis and hepatitis in prenatal care in the municipalities of the XI health region - PE

Os TRs são mecanismos que valorizam o caráter acolhedor que deve se dar na APS. No contexto da XI Região de Saúde, supõe-se haver enfermeiros das eSF que necessitam de capacitação para que possam realizar os TRs para HIV/Sífilis/Hepatites B e C, durante a consulta de pré-natal. Capacitar esses profissionais para que estejam habilitados a executarem TRs nesse nível de atenção à saúde, contribuirá para reverter essa situação de que ainda existem profissionais sem capacitação para realização desses tipos de testes; aptos a intervirem oportunamente com ações adequadas que possibilitem a eliminação da transmissão mãe-bebê, dessas doenças. A realidade epidemiológica expressa em números absolutos, gestantes HIV +, com Sífilis e Hepatites Virais; ainda, Sífilis Congênita; leva-se a considerar a indagação sobre a realização dos TRs; bem como, a qualidade da assistência prestada pelos enfermeiros da AB. O PI tem objetivo de implantar TRs de HIV/Sífilis/Hep B e C. A intervenção será realizada na XI Região de Saúde ­ PE. A população da intervenção serão enfermeiros que atuam na ESF, nos municípios dessa Região, que não estão capacitados para a realização dos TRs. Serão capacitados através da Vigilância em Saúde dessa Região de Saúde. Esperam-se enfermeiros da ESF capacitados para realizarem TRs de HIV/Sífilis/Hep B e C, no momento da consulta de pré-natal; acesso das gestantes aos TRs, no pré-natal; melhoria da assistência e cuidado à saúde da mulher e da criança; redução dos casos de transmissão vertical e Sistema de Informações atualizado com as produções dos TRs pelos profissionais da AB.(AU)

Factores perinatales asociados con los valores de pH de sangre de cordón umbilical / Perinatal factors associated with umbilical cord blood pH values

Objetivo: El análisis del pH de sangre arterial de cordón umbilical sigue siendo un criterio objetivo usado para determinar el estado metabólico del recién nacido tras el parto, y por tanto del bienestar fetal. El objetivo de este estudio fue identificar los factores perinatales asociados con los valores de sangre arterial de cordón umbilical. Material y métodos: Se realizó un estudio descriptivo y analítico entre Enero de 2010 y Enero de 2013 en un hospital de tercer nivel en el sur de España, con mujeres atendidas por parto. Los criterios de inclusión fueron: embarazo sin complicaciones y parto vaginal único, a término, con presentación cefálica. Las variables independientes con gran significación tras un análisis univariante fueron: edad, paridad, edad gestacional, analgesia epidural, plan de parto, episiotomía, duración de la primera fase del parto, y uso de oxitocina. Como variable dependiente se consideró: los valores de pH de sangre arterial de cordón umbilical (< = 7.24; > 7.24). El número total de mujeres fue de 165. El análisis estadístico se realizó mediante regresión logística múltiple. Resultados: La analgesia epidural y la edad gestacional mayor o igual a 41 semanas influyeron negativamente en el pH de cordón umbilical neonatal, mientras que haber presentado un plan de parto tuvo una influencia protectora. Conclusiones: Los hallazgos de este estudio proporcionan a los profesionales más evidencias sobre los elementos que pueden influenciar en el bienestar neonatal, con el fin de actuar en consecuencia, anticipándose a las situaciones de riesgo y aplicando una atención más eficaz (AU)

Objective: Perinatal asphyxia is the mayor cause of neonatal morbidity and mortality. The analysis of umbilical arterial cord blood pH remains an objective criterion used to determine the metabolic state of the newborn after birth, and therefore of fetal wellbeing. The aim was to identify the perinatal factors associated with umbilical arterial cord blood pH values. Materials and methods: A descriptive and analytical study was conducted between January 2010 and January 2013 at a tertiary hospital in the Southern Spain. The inclusion criteria were: Uncomplicated pregnancy and vaginal single delivery at term with vertex presentation. Independent variables with greater significance after the univariate analysis were: Age, parity, gestational age, epidural analgesia, birth plan, and episiotomy, duration of first labor stage and oxytocin use. It was considered as a dependent variable the umbilical arterial blood pH values (< = 7.24; > 7.24). The total number of women was 165. Statistical analysis was performed using logistic regression. Results: Epidural analgesia and gestational age more than or equal to 41 weeks have negatively influence the neonatal umbilical cord pH, while having presented a birth plan could have a protective influence. Conclusions: findings of this study provide to the professionals more evidence on the elements that may influence neonatal wellbeing, in order to act accordingly, anticipating risk situations and applying more effective care (AU)

Testing HIV positive in pregnancy: A phenomenological study of women's experiences.

OBJECTIVE: globally women receive HIV testing in pregnancy; however, limited information is available on their experiences of this potentially life-changing event. This study aims to explore women's experiences of receiving a positive HIV test result following antenatal screening. DESIGN: a qualitative, phenomenological approach. SETTING: two public National Health Service (NHS) hospitals and HIV support organisations. PARTICIPANTS: a purposive sampling strategy was used. Thirteen black African women with a positive HIV result, in England, participated. METHODS: data were collected using in-depth semi-structured interviews. An interpretive phenomenological approach to data analysis was used. FINDINGS: the emergent phenomenon was transition and transformation of 'being,' as women accepted HIV as part of their lives. Paired themes support the phenomenon: shock and disbelief; anger and turmoil; stigma and confidentiality issues; acceptance and resilience. Women had extreme reactions to their positive HIV diagnosis, compounded by the cultural belief that they would die. Initial disbelief of the unexpected result developed into sadness at the loss of their old self. Turmoil was evident, as women considered termination of pregnancy, self-harm and suicide. Women felt isolated from others and relationship breakdowns often occurred. Most reported the pervasiveness of stigma, and how this was managed alongside living with HIV. Coping strategies included keeping HIV 'secret' and making their child(ren) the prime focus of life. Growing resilience was apparent with time. KEY CONCLUSIONS: this study gives midwives unique understanding of the complexities and major implications for women who tested positive for HIV. Women's experiences resonated with processes of bereavement, providing useful insight into a transitional and transformational period, during which appropriate support can be targeted. IMPLICATIONS: midwives are crucial in improving the experience of women when they test HIV positive and to do this they need to be appropriately trained. Midwives need to acknowledge the social and psychological impact of HIV and pathways should be developed to support early referral for appropriate support.

Atención prenatal: acciones esenciales desempeñadas por los enfermeros / Assistência pré-natal: ações essenciais desenvolvidas pelos enfermeiros / Prenatal care: essential actions developed by nurses

Objetivo: Investigar el perfil, el conocimiento y la práctica de las enfermeras que trabajan la atención prenatal de bajo riesgo. Métodos: Estudio cuantitativo, descriptivo, transversal realizado en las Unidades Básicas de Salud Familiar Campina Grande / Paraíba, Brasil. Se incluyeron quince UBSF’s del distrito sanitario I de Campina Grande, totalizando 15 enfermeros que respondieron a un cuestionario. La colecta de datos se llevó a cabo entre marzo y junio de 2013. El análisis de datos se realizó de forma manual, en mapa resumen, según la población estudiada y posteriormente se analizaron mediante estadística descriptiva y organizados en gráficosy tablas de frecuencias absoluta y relativa. Resultados: Se puede considerar satisfactoria la atención prenatal realizada por los enfermeros, ya que además de los procedimientos y las pruebas de rutina, se observó que también llevan a cabo los procedimientos y pruebas consideradas como complementaria, de acuerdo con el Ministerio de Salud Conclusión: Es necesario proporcionar un mayor número de orientación con respecto al uso de métodos anticonceptivos tras el periodo gestacional. Se revela también la necesidad de estudios de evaluación de la calidad y el impacto de la atención prenatal realizados por enfermeros especializados en la reducción de la morbilidad y mortalidad materna y neonatal en el municipio, este enfoque sería de gran importancia para la consolidación de una práctica exitosa en Campina Grande (AU)

Objetivo: investigar o perfil, o conhecimento e prática dos enfermeiros que atuam na atenção pré-natal de baixo risco. Método: pesquisa quantitativa, descritiva, transversal, realizada nas Unidades Básicas de Saúde da Família do município de Campina Grande/Paraíba, Brasil. Foram incluídas quinze UBSF's do distrito sanitário I de Campina Grande, totalizando 15 enfermeiros que responderam a um questionário. A coleta dos dados ocorreu entre os meses de março a junho de 2013. A análise dos dados foi realizada manualmente, em mapa resumo, de acordo com a população estudada e posteriormente foram analisados através da estatística descritiva e organizados em gráficos e tabelas de frequência absoluta e relativa. Resultados: pode-se considerar satisfatória a assistência pré-natal realizada pelos enfermeiros, uma vez que além dos procedimentos e exames de rotina, observou-se que estes realizam os procedimentos e exames considerados como complementares, de acordo com o Ministério da Saúde. Conclusão: faz-se necessário o fornecimento de um maior número de orientação no que tange ao uso de métodos contraceptivos após o período gestacional. Revela-se ainda a necessidade da realização de estudos sobre avaliação de qualidade e impacto do atendimento pré-natal realizado por enfermeiros na redução de morbimortalidade materna e neonatal no município, abordagem esta que seria de grande relevância para a consolidação de uma prática bem-sucedida em Campina Grande

Objective: Investigating the profile, knowledge and practice of nurses who work in low-risk prenatal. Methods: This is a quantitative, descriptive, cross-sectional study conducted at the Family Health Basic Units of the city of Campina Grande/Paraiba, Brazil. The study included fifteen Basic Health Units of the Family of the sanitary district I of Campina Grande, totaling 15 nurses who responded to a questionnaire. Data were collected between March and June 2013. Data analysis was performed manually in map summary, according to the population studied and later the results were analyzed through descriptive statistics and organized into charts and tables of absolute and relative frequency. Results: the data analysis revealed satisfactory the prenatal care performed by nurses, since in addition to procedures and routine tests it was observed that they also carry out the procedures and tests considered as complementary, according to the Ministry of Health. Conclusion: it becomes necessary to give a larger guidance regarding the use of contraceptives after pregnancy. Also the study revealed the need for studies about evaluation of quality and impact of prenatal care conducted by nurses in decreasing maternal and neonatal morbidity and mortality in the municipality. This approach would be of great relevance for the consolidation of a successful practice in Campina Grande (AU)

Advancing maternal age and trisomy screening: the practice challenges of facilitating choice and gaining consent.

Antenatal screening for chromosomal anomalies such as Trisomy 13, 18 and 21 (Patau's, Edward's and Down's syndrome respectively) is offered to all pregnant women in the first two trimesters.This article explores the varying considerations of consent for this type of screening, particularly in relation to women of advancing age who are at increased risk of carrying a pregnancy affected by a trisomy. The practical challenges or barriers of gaining valid, meaningful informed consent are discussed.

Genetic testing in infants.

Genetic testing has made diagnosis and treatment possible for many infants. With the addition of many new tests over the past few years, it is important to understand the clinical usefulness of each of these tests. Selecting the correct method of genetic testing assists in obtaining an accurate diagnosis and development of a plan of care for the infant.

Innovations in prenatal genetic testing beyond the fetal karyotype.

Current trends in prenatal genetic testing will affect nursing practice, education, research, and policy making. Although fetal genetic testing has been the traditional focus, new technologies open the possibility of acquiring genomic information for both parents and offspring, revealing windows onto individuals' lifelong health. Noninvasive prenatal testing of cell-free fetal DNA also has become a reality. Some of the recent advances in detecting cytogenetic and heritable molecular variants in pregnancy are overviewed. Exemplars of prenatal tests are presented and related ethical, legal, and social implications are considered. Educating clinicians with updated genomic knowledge has been outpaced by new technologies and direct-to-consumer marketing of prenatal tests. Implications for nursing are discussed.