Birth and death: opportunities for self-transcendence.

One thing that is often absent in childbirth education classes is a discussion of the spiritual aspect of giving birth. Birth offers women a wonderful opportunity to awaken their spirituality. Natural childbirth, in particular, has the potential for self-transcendence, offering an even greater appreciation for the miracle of life. The normal, natural pain in labor can challenge the core of one's being-it is a healthy sensation that provides direction for women moving through the maze of labor. The challenge of giving birth today is to develop confidence and trust in one's inner wisdom and allow nature to do its thing. When this is accomplished, a woman's body is often permeated and nourished by spiritual energy and guidance. She emerges from her labor bed with a renewed sense of her body's strength and power and with an enhanced spirituality.

Breast cancer: education, counseling, and adjustment--a pilot study.

The feasibility of a randomized clinical trial to implement and compare the effectiveness of three components of an intervention for women with breast cancer and their partners was tested. The intervention components, standardized education by videotape (SE), telephone counseling (TC), and education with telephone counseling (SE+TC), were designed with a complementary approach to disease management of breast cancer at each of four phases of the breast cancer experience: diagnostic, postsurgery, adjuvant therapy, and ongoing recovery. A standardized Telephone Counseling Training Manual was developed. A nonprobability sample of 12 patient-partner pairs was accrued. Four pairs were randomly assigned to each of the three intervention components. A set of questionnaires was completed by each patient and partner at baseline and following each intervention for assessment of emotional, physical, and social adjustment, and perceived support. Attrition was minimal and return rate for the completed questionnaires at all five data-collection points was high. Validation of the SE and the TC, one of the objectives, was by data from the preliminary descriptive study (Hoskins, 1990-1994), pretests and posttests for standardized education, audiotapes for each phase-specific telephone counseling session, and evaluation forms for each intervention session. The positive findings included significant changes from pre- to postmeasurement in patients' and partners' scores for the standardized education in each of the four phases. Even with the limited statistical power, the effects were marked, lending support for a full-scale randomized clinical trial, to understand better the relative treatment efficacy and differential benefit of one or some interventions over others.

Measurement of psychosocial adjustment to breast cancer: a unidimensional or multidimensional construct?

Using data from a longitudinal study of Hoskins' 'Patterns of Adjustment to Breast Cancer among Women and their Partners', a conceptually derived multidimensional formulation of psychosocial adjustment was empirically tested. The Psychosocial Adjustment to Illness Scale was administered to both patients and partners at six times post-definitive surgery, i.e., 7-10 days, 30 days, 60 days, 90 days, 180 days, and one year. Extensive factor analytic studies were performed on data from the Psychosocial Adjustment to Illness Scale at four of the collection times when complete data sets were available for 128 patients and 121 partners. Results of the principal components analysis with varimax rotation were compared to factor analyses reported by the developers of the scale. The seven-factor matrix reported by Derogatis was not reproduced; instead, one factor was consistently identified at each of the four time periods as the best solution. Although items from all seven domains of the scale loaded on the single factor, items pertaining to psychological distress and role performance in the domestic and social environments were most prominent. These data support the need to validate empirically hypothesized separate dimensions of psychosocial adjustment to breast cancer in both patients and partners as proposed in a number of widely used tests.

Programs for adolescent mothers are needed.

This column reviews the article "The Door's Perinatal Program for Pregnant and Parenting Teens" [Journal of Perinatal Education, 9(2), 39-46] and acknowledges the need for innovative programs to help reduce the risks associated with adolescent pregnancy and teen births.

Even a "princess of a program" may face challenges.

Commentators discuss the merits of the article "Developing a Family Centered, Hospital-Based Perinatal Education Program" [Journal of Perinatal Education, 9(4), 28-39]. They also point out the challenges of developing, implementing, and maintaining a comprehensive, family-centered perinatal education program in urban and rural hospitals.

Boosting social support in caregivers of children with HIV/AIDS.

Providing care for a child that is infected with human immunodeficiency virus (HIV) is challenging for the child's caregiver and affects the entire family system. Research has demonstrated that social support has the potential to buffer caregiver stress and facilitate caregiver coping. A two-group experimental study was implemented to test the effect of a social support boosting intervention on caregiver stress, coping and social support among caregivers of children with HIV/acquired immune deficiency syndrome (AIDS). The subjects in the study were caregivers of children with HIV/AIDS. The sample strata included seropositive caregivers (biological parents) and seronegative caregivers (foster parents and extended family members). The measures for the study included the Derogatis Stress Profile, The Family Crisis Oriented Personal Evaluation Scale, and the Tilden Interpersonal Relationship Inventory. These data were then analyzed descriptively and then with a repeated measure MANOVA. Initially, there were no statistically significant differences found between the control and intervention groups. However, when subject HIV status was included in the analysis, the combined dependent variables of stress, coping, and social support were significantly related to the interactions of group by HIV status over time. F values were then computed and no statistically significant differences were found for stress or coping. There were, however, significant differences in measures of social support between groups when adjusting for HIV status of caregivers. In this study, social support levels over time for seronegative caregivers were significantly different from those of seronegative caregivers in the control group. Three case studies are presented that illustrate differences between seronegative and seropositive caregivers. The case studies describe the problems identified by caregivers and the effectiveness of problem solving using the social support boosting intervention. Finally, the mobilization of social support is discussed. Contrasts between the problems of caregivers are made relative to their HIV status. The potential for the effectiveness of the social support boosting intervention is discussed within the context of the caregiver's HIV status.

Implementing coteaching in childbirth education classes.

In response to the article "Innovative Service: Quality Perinatal Nursing Education Through Coteaching" [Journal of Perinatal Education, 8(4), 27-35], the author of this column conducts an interview with two Lamaze Certified Childbirth Educators who share their experiences as coteachers.

The effect of a social support boosting intervention on stress, coping, and social support in caregivers of children with HIV/AIDS.

BACKGROUND: Caring for the human immunodeficiency virus (HIV)-infected child is challenging and affects the entire family system. Studies have shown that social support can mitigate caregiver stress and enhance coping; however, social support may not always result in a positive outcome for the recipient. OBJECTIVES: To measure caregiver stress, coping, and social support, and to test the effect of a social support boosting intervention on levels of stress, coping, and social support among caregivers of children with HIV/acquired immune deficiency syndrome (AIDS). METHODS: An experimental design was used with monthly social support boosting interventions implemented. The stratified randomized sample included 70 primary caregivers of children with HIV/AIDS. The sample strata were seropositive caregivers (biological parents) and seronegative caregivers (foster parents and extended family members). Study measures included the Derogatis Stress Profile, Family Crisis Oriented Personal Evaluation Scale, and the Tilden Interpersonal Relationship Inventory. Data were analyzed using descriptive statistics and repeated measure MANOVA. RESULTS: Statistically significant differences between the experimental and control groups were found on changes in the dependent variables over time when caregiver strata were included as a factor in the analysis; no statistically significant results were found when caregiver strata were combined. Univariate Ftests indicated that the level of social support for caregivers who were seronegative in the experimental group was significantly different from seronegative caregivers in the control group and seropositive caregivers in both groups. No significant treatment group differences were found for seropositive caregivers. CONCLUSIONS: Seronegative caregivers derived substantial benefit from the social support boosting intervention. Seronegative caregivers who acquire a child with HIV/AIDS are confronted with a complex stressful situation; the critical need to enhance their social support is achievable through the intervention tested in this study.

Psychosocial adjustment to breast cancer in unmarried women.

Breast cancer is a significant health problem that can affect many aspects of a woman's life. Although there is growing evidence that women with supportive husbands seem to adjust reasonably well, little is known about the impact of breast cancer among unmarried women. Relationships among primary treatment alternatives, symptom distress, perceived social support, and psychosocial adjustment to breast cancer in 101 unmarried women were investigated using data collected during the late postoperative recovery phase. The women experienced relatively low levels of psychosocial adjustment problems and perceived moderately high levels of social support. Social support and symptom distress each accounted for significant proportions of the variance in psychosocial adjustment, whereas primary treatment alternatives did not. Symptom distress emerged as the variable accounting for the most variance in psychosocial adjustment to breast cancer. Implications for health care providers to facilitate positive adjustment to breast cancer in unmarried women and directions for future studies are suggested.

Social support and patterns of adjustment to breast cancer.

The effect of marital support and support from other adults on the emotional and physical adjustment of 128 women with breast cancer was examined. Role function and satisfaction with health care also were evaluated as predictors of adjustment. Intact data series were obtained at 7-10 days, at 1, 2, 3, and 6 months, and 1 year postsurgery. Emotional adjustment could be predicted by satisfaction with a spouse's response to interactional and emotional needs and by support from other adults. The relationships were significant at concurrent times, across contiguous times, and predicting from the 7-10 day postsurgical period to both the 6-month and 1-year end points. Physical adjustment was not predicted by support but satisfaction with health care was predictive of perceived overall health status. Functional status in vocational, domestic, and social roles was significantly related to emotional and physical adjustment at all phases with few exceptions.

A descriptive summary of New Jersey's 1985 burn population.

Data obtained from the New Jersey State Department of Health on the 1985 hospitalized patients with burns and data collected from the National Burn Victim Foundation's standard burn reporting form were analyzed to gather information about the epidemiology of burns. Children (0 to 4 years of age) continue to be the largest percentage of the 0- to 18-year-old age group who sustain burn injuries, and 67% of those injuries are sustained by children under the age of 5. Males accounted for 69% of the total burn population; 58% of admissions were white; 69% of patients were admitted for partial-thickness burns, and 31% were admitted for full-thickness burns; the largest primary payer was third-party payers; and 92% of patients with burns were discharged to home or self-care. Data were also analyzed by examination of selected age groups to determine individual needs of specific groups. An analysis of burn injuries reported to the National Burn Victim Foundation confirmed previous reports that the home is the most likely place for a burn injury to occur and that flame and scald injuries predominate; scald injuries comprise 50% of all sustained burns. Gasoline vapors accounted for 54% of burn injuries caused by flames. The data supported efforts to develop programs that address the needs of the urban child, the 17- to 19-year-old age groups, and the elderly. The information that was collected served to redefine objectives for burn prevention programs.