Exclusive Breastfeeding Experiences among Mexican American Women.

BACKGROUND: According to the Centers for Disease Control and Prevention, Hispanic breastfeeding mothers begin early formula supplementation at higher rates than other ethnic groups, which can lead to shorter breastfeeding duration and decreased exclusive breastfeeding. Acculturation, the process of adopting beliefs and behaviors of another culture, appears to influence breastfeeding practices of Hispanic women in the United States. Little is known about Mexican American mothers' formula use and exclusive breastfeeding within the context of acculturation. OBJECTIVE: Our study identified perceived benefits and barriers to exclusive breastfeeding and levels of acculturation among Mexican American women living in a Midwestern city. METHODS: We used a qualitative descriptive design integrating Pender's Health Promotion Model concepts. Individual interviews were conducted in English or Spanish (N = 21). The revised Acculturation Rating Scale for Mexican Americans was used to examine acculturation levels. RESULTS: Acculturation scores indicated that the majority (66%) of the sample was "very Mexican oriented." Most women exclusively breastfed, with a few using early supplementation for "insufficient milk production." Three themes emerged: (1) It is natural that a woman give life and also provide the best food for her baby; (2) Breastfeeding is ultimately a woman's decision but is influenced by tradition, guidance, and encouragement; and (3) Breast milk is superior but life circumstances can challenge one's ability to breastfeed. CONCLUSION: Strong familial/cultural traditions supported and normalized breastfeeding. Barriers to exclusive breastfeeding were similar to breastfeeding women in general, in the United States. Findings support the need for culturally competent and individualized lactation care.

Creating a Bridge of Understanding between Two Worlds: Community-Based Collaborative-Action Research with Sudanese Refugee Women.

OBJECTIVE: To explore the process of partnership between university researchers, students, and South Sudanese refugee women to address the health challenges associated with their resettlement transition to the United States. DESIGN AND SAMPLE: This qualitative study used a community-based collaborative action research (CBCAR) framework in the design, collection, and analysis of the qualitative data. Twenty refugee women participated in this study. INTERVENTION: Five health education seminars followed by an audio-recorded focus group were held over 9 months. A final focus group was held to confirm derived themes and develop an action plan. RESULTS: The partnership between the refugee women and researchers resulted in awareness of how power structures and differing expectations affected the process. The dialog in the focus groups provided an opportunity for refugee women to voice challenges to their health in resettlement. A pattern was recognized about how political and sociocultural events affected the process of CBCAR. Dialog and sharing differing worldviews and perspectives led to insights about ways to improve the health of the South Sudanese refugee community. CONCLUSIONS: CBCAR is a useful framework to address health concerns of a refugee community. Insights from this study provided a foundation for a future intervention research project with the refugee women.

A randomized controlled trial of breastfeeding support and education for adolescent mothers.

Despite substantial evidence of maternal and infant benefits of breastfeeding, adolescent mothers initiate breastfeeding less often and maintain breastfeeding for shorter durations when compared to their adult counterparts. A randomized controlled trial drawing on the theory of planned behavior and developmental theory was conducted to determine if an education and counseling intervention provided by a lactation consultant-peer counselor team increased breastfeeding initiation and duration up to 6 months postpartum among adolescent mothers. Study participants ( N = 289) enrolled from multiple prenatal clinic and school settings, were 15 to 18 years old, and predominately African American, single, and primiparous. The intervention, which started in the second trimester of pregnancy and extended through 4 weeks postpartum, positively influenced breastfeeding duration (p < .001) within the experimental group, but not breastfeeding initiation or exclusive breastfeeding rates. This education/support intervention was partially effective in enhancing breastfeeding outcomes. Implications for research and practice are described.

Factors influencing mothers' abilities to engage in a comprehensive parenting intervention program.

OBJECTIVE: This research identified the possible factors influencing the ability of mothers perceived to be at the highest risk for child maltreatment to engage in a home visitation program. This study holds significance to public health nursing since home visitation is an integral component of public health nursing practice, with engagement being essential for human interaction and thus nursing care to occur. DESIGN AND SAMPLE: A qualitative descriptive design was used to offer a thematic summary of the experiences of program engagement from the perspective of 4 home visitation coach interventionists from health-related fields and a small sample of purposefully selected mothers involved in a longitudinal prevention study. RESULTS: Qualitative content analysis revealed 3 major themes related to engagement: (1) mothers struggle to meet the emotional needs of the self and the child; (2) mothers lack support in navigating complicated and stressful life events; and (3) mothers' consistency with program engagement is mediated through a trusting and caring relationship with coaches. CONCLUSIONS: Home visitation coaches in this study demonstrated a continuous process of engagement by supporting mothers to explore and discover self-care strategies and ways to navigate life struggles. Over time, a foundation of trust and caring was developed, which in turn increased relationship building and program engagement.

Creating a curtain of protection: nurses' experiences of grief following patient death.

PURPOSE: To describe the lived experience of nurses surrounding the death of their patients. DESIGN: A qualitative phenomenologic approach was used for the interview and analysis framework. Methods to ensure trustworthiness and rigor were incorporated into the design. METHODS: Using semistructured interviews and phenomenologic concepts, the investigators interviewed 11 registered nurses where data was analyzed using methods of Heideggerian hermeneutical analysis and van Manen's progression of reflection, description, writing, and rewriting. FINDINGS: Four themes were identified: (a) Reciprocal relationship transcends professional relationship; (b) initial patient death events are formative; (c) nurses' coping responses incorporate spiritual worldviews and caring rituals; and (d) remaining "professional" requires compartmentalizing of experience. CONCLUSIONS: Nurses create a curtain of protection to mitigate the grieving process and allow them to continue to provide supportive nursing care. CLINICAL RELEVANCE: By developing understanding of the grieving and coping processes, nursing faculty, administrators, and leaders can provide better learning opportunities and more supportive practice environments for the professional nurse.

Communication themes in families of children with chronic conditions.

This qualitative study identified communication themes among well siblings, parents, and others within families of children with chronic conditions. Semi-structured interviews of 30 parent-well sibling dyads were content analyzed from a larger study of families of children with chronic conditions. Four themes emerged: communication as a reflection of family roles and relationships, giving voice, staying connected, and struggling for normalcy.

Faculty-agency partnering for improved client outcomes.

Implications for practice and education include recognition of the value of clinical outcome studies to clinicians and administrators in clinical agencies, as well as to nursing education. This project provides an example of the opportunity for mutually beneficial education and practice partnerships. Faculty, staff, and students demonstrated their ability to use the basic model for outcome studies developed by the United Way of America (1996). Teams of staff, faculty, and students were able to design small scale outcome studies that provided valuable information for clinicians and administrators about evaluating and improving the quality of clinical services, as well as for seeking continued funding. It is anticipated that further benefits may be discovered when faculty work with agencies to target program outcomes that will yield the most powerful effect for these agencies.