Quality improvement: Antimicrobial stewardship in pediatric primary care.

BACKGROUND: Antimicrobial resistance is the resistance of microorganisms to antibacterial, antiviral, antiparasitic, and antifungal medication resulting in increased healthcare costs with extended hospital stays in the United States. The goals of this quality improvement project were to increase the understanding and importance of antimicrobial stewardship by nurses and health care staff and increase pediatric parents'/guardians' knowledge of the proper use of antibiotics and differences between viruses and bacterial infections. METHODS: A retrospective pre-post study was conducted in a midwestern clinic to determine if an antimicrobial stewardship teaching leaflet increased parent/guardian antimicrobial stewardship knowledge. The two interventions for patient education were a modified United States Center for Disease Control antimicrobial stewardship teaching leaflet and a poster regarding antimicrobial stewardship. RESULTS: Seventy-six parents/guardians participated in the pre-intervention survey, with 56 being included in the post-intervention survey. There was a significant increase in knowledge between the pre-intervention survey and the post-intervention survey with a large effect size, p < .001, d = 0.86. This effect was also seen when comparing parents/guardians with no college education, who had a mean knowledge increased change score of 0.62, to those parents/guardians with a college education, whose mean knowledge increase was 0.23, p < .001 with a large effect size of 0.81. Health care staff thought the antimicrobial stewardship teaching leaflets and posters were beneficial. PRACTICE IMPLICATIONS: The use of an antimicrobial stewardship teaching leaflet and a patient education poster may be effective interventions for improving healthcare staff's and pediatric parents'/guardians' knowledge of antimicrobial stewardship.

Preventing Medical Device-Related Pressure Injuries Due to Noninvasive Ventilation Masks and Nasal Cannulas.

BACKGROUND: Medical device-related pressure injuries attributed to oxygen delivery devices are common yet preventable. Pressure injuries increase hospital costs, patients' length of stay, and mortality rates. OBJECTIVE: To decrease medical device-related pressure injuries by transitioning patients from an over-the-nose noninvasive ventilation mask to a single-headset, interchangeable under-the-nose and over-the-nose noninvasive ventilation mask; replacing polyvinyl chloride nasal cannulas with a softer nasal cannula; and providing staff education on preventing pressure injuries related to oxygen delivery devices. METHODS: The project was implemented on 4 adult inpatient units with a total of 75 inpatient beds at an academic medical center. Interventions included implementing the trial noninvasive ventilation masks and nasal cannulas, alternating masks every 4 hours, relocating protective dressings, promoting the use of protective dressings for over-the-nose oral-nasal masks, and educating health care staff. RESULTS: In the 2 months before implementation (September and October 2020), 1 medical device-related pressure injury was caused by a noninvasive ventilation mask and 4 injuries were caused by nasal cannulas. During the 2 months of trial implementation (November and December 2020), no pressure injuries developed in patients using the trial devices. DISCUSSION: The interventions implemented had clinically relevant results. A larger sample size would be necessary to determine statistical significance. Postintervention data indicated a need for further education on evidence-based practice guidelines on mask alternation and use of preventive dressings to bolster compliance. CONCLUSION: Following institutional approval, all noninvasive ventilation masks and nasal cannulas were transitioned to the trial devices at the study institution.

Habit and Routine Interventions with Emerging Adults with Diabetes: An Integrative Review.

Although theoretical and empirical writings on habits and routines are a promising body of science to guide interventions, little is known about such interventions among emerging adults with type 1 diabetes. Thus, an integrative review was conducted to describe interventions in relation to habits and routines, their influence on outcomes, and users' perspectives. A medical librarian conducted a search. Teams screened titles, abstracts, and articles based upon predefined criteria. Evidence from the final 11 articles was synthesized. A minority of investigators explicitly articulated habits and routines theoretical underpinnings as part of the interventions. However, text messaging or feedback via technology used in other interventions could be implicitly linked to habits and routines. For the most part, these interventions positively influenced diabetes self-management-related behaviors and health outcomes. In general, the interventions were perceived positively by users. Future research is advocated using habit and routine theoretical underpinnings to guide interventions.

A Scoping Review of Transitions, Stress, and Adaptation Among Emerging Adults.

This scoping review examined research on transitions among emerging adults, 18- to 30-year-olds, to identify designs, populations, frameworks, transition types, and transition outcomes. A librarian conducted the search, yielding 2067 articles. Using predefined criteria, teams screened abstracts and reviewed articles, with 82% to 100% interrater agreement. Data from the final 160 articles were placed in evidence tables and summarized. Most frequently, the studies had exploratory-descriptive designs (69%), nondiagnosed samples (58%), no theoretical frameworks (58%), developmental transitions (34%), and health-related behavior outcomes (34%). This transition research is in an early stage of knowledge development and would benefit from further theory development.

Social Support, Parenting Competence, and Parenting Satisfaction Among Adolescent, African American, Mothers.

This secondary analysis explored how social support changed during the first 6 months postpartum and examined the relationships among social support, parenting competence, and parenting role satisfaction. Single, low-income, adolescent, new mothers ( N = 34) completed measures of perceived parenting competence, parenting role satisfaction, and four types of received social support (emotional, informational, tangible, problematic) from the entire social network at 1 week, 6 weeks, 3 months, and 6 months postpartum. Results indicated that social support did not change over time. Emotional, informational, and tangible social support were significantly correlated, concurrently and predictively, with perceived competence and satisfaction at most data collection points. Future social support intervention studies using social support as a modifiable variable with this high-risk group of African American adolescent new mothers are advocated. Health care professionals are encouraged to examine existing social support within these mothers' identified family units.

Enhanced New Mothers Network Cell Phone Application Intervention: Interdisciplinary Team Development and Lessons Learned.

Single, low-income, African American mothers experience challenges caring for themselves and their infants. Nurse researchers, providing creative and theoretically based approaches for complex client health care, are increasingly becoming interdisciplinary leaders on research teams. The first purpose of this article was to describe this interdisciplinary team's development of a cellular (cell) phone application (app), the Enhanced New Mothers Network (ENMN). The second purpose of this article was to describe lessons learned by nursing members of the interdisciplinary team members about developing a cell phone app for delivery of the ENMN intervention. Interdisciplinary research is beneficial where providing interventions to assist patients to achieve optimal health outcomes is rarely dependent on the work of one profession.

An Integrative Review of Postpartum Depression in Rural U.S. Communities.

AIM: This study's aim is to synthesize and summarize the literature on postpartum depression (PPD) in U.S. rural populations. BACKGROUND: Internationally, PPD has a high prevalence in rural communities. Although women in rural U.S. communities have higher rates of depression outside of the postpartum time period, little study has been conducted on PPD in U.S. rural populations. It is unknown whether rural women in the United States have high rates of PPD as is common in rural populations internationally. DESIGN: We used integrative literature review using Whittemore and Knafl's (2005) methodology. DATA SOURCES AND METHODS: We searched the databases MEDLINE, CINAHL, PsycINFO, and Academic Search Premier with the words "postpartum depression" or "postnatal depression" and the word "rural." RESULTS: We found 11 articles with empirical data that met the criteria and thus were included in the review. Seven articles were quantitative, two were qualitative, one was mixed methods, and one was a nonexperimental design. Five foci emerged in the literature including (a) screening and prevalence, (b) demographic factors, (c) program creation and implementation, (d) mental health care seeking, and (e) social support. The results suggest that prevalence of PPD may be higher in rural U.S. areas, that implementing PPD prevention and screening programs for rural women is feasible, and that women in rural areas rely on informal networks and may face a stigma for seeking mental health care. CONCLUSIONS: Further research is needed on PPD in rural U.S. POPULATIONS: Specifically, this research should focus on the mix of variables found throughout this review such as race and income level. Nurses should lead for changes in clinical practice and policy that increase screening and interventions for PPD in rural communities.

Lived Experience of the Warrior Nurse as an Advisor.

PURPOSE: Described the lived experience of U.S. warrior nurses who served as advisors to host nation officials in Afghanistan. METHOD: The phenomenological approach was applied to obtain comprehensive descriptions from 10 warrior nurses. The modified Stevick-Colaizzi-Keen data analysis method was utilized as the researcher had performed in the role of interest. DISCUSSION: Textural themes included (a) challenging role, (b) challenging place, and (c) changed. One of two structural themes representing the core traits included four subthemes (a) be careful, (b) be powerful, (c) be courageous, and (d) be resourceful. The other structural theme representing the skin or outer traits included four subthemes (a) be impeccable, (b) be malleable, (c) be caring, and (d) be resilient. CONCLUSION: The findings provided validation of previous information and new insight for nursing and military professions in terms of advancement of the practice of military nursing and enhancing the understanding of personnel who participate in the complexities of health care transformation. The need to apply the information gained in this study to enhance role player preparations and support was confirmed.

Social Support and Psychosocial Well-being Among Low-Income, Adolescent, African American, First-Time Mothers.

AIMS: The aims of this study are to describe for single, low-income, adolescent, African American new mothers how (1) primary sources of social support changed over time, (2) the level of social support (emotional, informational, tangible, and problematic) from these primary sources changed over time, and (3) social support from the primary supporter was associated with mothers' psychosocial well-being (self-esteem and loneliness) over time. DESIGN: A secondary analysis was conducted of data from a previous social support intervention study. SAMPLE: The sample consisted of 35 single, low-income, adolescent (mean [SD] age, 18.3 [1.7] years), African American new mothers. METHODS: Mothers completed social support, self-esteem, and loneliness instruments at 1 and 6 weeks and 3 and 6 months postpartum. RESULTS: Most mothers (64.7%) had changes in their primary social support provider during the first 6 months postpartum. The combination of the adolescent's mother and boyfriend provided the highest level of support, no matter the type, relative to any other source of support. At every time point, positive correlations were found between emotional support and self-esteem and between problematic support and loneliness. CONCLUSION: Single, low-income, African American, adolescent new mothers are at risk for not having a consistent source of support, which may lead to lower self-esteem and greater loneliness. IMPLICATIONS: Clinical nurse specialists could facilitate care guidelines for these new mothers to identify their sources of support at each home visit and advocate for the adolescent's mother and boyfriend to work together to provide support. Bolstering the mothers' natural sources of support can potentially improve self-esteem and reduce loneliness. Improvement in these sources of support could prevent a decline in the mothers' psychosocial well-being. Development and testing support interventions are advocated; findings could guide clinical nurse specialists in addressing these new mothers' needs.

Behavior-Specific Influences for Physical Activity Among African American Women.

The purpose of this study was to describe physical activity (PA) behaviors and physical functioning of prehypertensive and Stage I hypertensive African American Women (AAW) and to examine the relationships between PA behavior, physical functioning, personal factors, and behavior-specific influences. Pender's Health Promotion Model was the conceptual framework for the study. A cross-sectional design and convenience sample were used. The PA domain where the greatest amount of time was spent was in work-related activity, followed by household, leisure time, and transportation activity. Personal factors most strongly correlated to lower PA were greater body mass index and waist circumference. AAW perceived moderate barriers to PA and minimal family and friend social support for PA. Future interventions need to focus on removing barriers to and improving social support for PA among AAW.

Awakening: a qualitative study on maintaining weight loss after bariatric surgery.

AIMS AND OBJECTIVES: To describe the experiences of adults who were successful in maintaining weight loss after bariatric surgery. BACKGROUND: The majority of studies examine a homogenous demographic group of postbariatric surgical patients who have gone through initial weight loss, which occurs within the first 12-24 months post surgery. Maintenance of weight loss begins 24 months after bariatric surgery; however, there is a paucity of research examining experiences during this period. The lack of conclusive research related to interactions between intrapersonal, behavioural and environmental influences suggests a need to develop a better understanding of patients' experiences related to weight loss maintenance post bariatric surgery. DESIGN: Bandura's Social Cognitive Theory provided the framework for the semi-structured interviews for this qualitative descriptive study. METHODS: In-person interviews with n = 14 participants who were able to maintain weight loss at least 24 months after a bariatric surgery. RESULTS: Participants experienced an awakening and gained a new perspective on their life. They identified negative attitudes, influences and behaviours and modified their environment to support their desired healthy behaviour. CONCLUSIONS: To maintain weight loss, an individual must seek out and be surrounded by positive family and peer support influences. Positive support may provide the opportunity for an individual to place personal health needs as a priority. RELEVANCE TO CLINICAL PRACTICE: Therapeutic education and counselling for individuals, couples and families should occur during all phases of bariatric surgery. Communication techniques may empower clients to deflect negative comments and influences in a constructive manner. Support groups should accommodate the various phases of bariatric surgery. Clients should be prepared for how to work through emotions associated with weight fluctuations.

Nurse-Led Trauma-Informed Correctional Care for Women.

PURPOSE: Incarcerated women are a vulnerable and unique population of special concern to nurses as they have high rates of mental illness. In this article, the authors discuss how trauma exposure contributes to mental illness in incarcerated women through abuse, socioeconomic factors, and the prison environment, how this trauma exposure manifests in the inmate survivor, and the related implications for practice. CONCLUSIONS: A history of trauma and victimization is related to complex mental health issues which affect the majority of justice-involved women. The correctional environment can exacerbate these issues. PRACTICE IMPLICATIONS: Nursing implications include discussion of the trauma-informed care model. The authors recommend a model of trauma-informed care named "the 4 Es" that can guide nurses in preparing a trauma-informed correctional environment and discuss the importance of nurse-led policy change in finding alternatives to incarceration for women with mental illness.

Low-Income, African American, Adolescent Mothers' Depressive Symptoms, Perceived Stress, and Social Support.

The purpose of this descriptive repeated-measures study was to describe depressive symptom patterns and report changes over time in levels of perceived stress and social support depending on patterns of depressive symptoms in single, low-income, African American, adolescent mothers during the initial, 6-month postpartum period. Thirty-five adolescent subjects between the ages of 16 and 22 years old were recruited at health care clinics in two Midwestern cities. Data collections by advanced practice nurses were completed at 1 week, 6 weeks, 3 months, and 6 months postpartum at mothers' homes. Established instruments were used to measure depressive symptoms, perceived stress and social support. Results indicated 63% of adolescent mothers' experienced depressive symptoms sometime during this transition period and 11.4% of these subjects had depressive symptoms at all 4 time points. Depressive symptoms were associated with perceived stress at each time point. Emotional support was inversely associated with depressive symptoms at 2 of the 4 time points. Depressive symptoms and problematic support were significantly related at 3 months and 6 months. Although single, low-income, African American, adolescent mothers are considered a high risk group, some are at even greater risk. This extremely high risk group have depressive symptoms throughout the first 6 months postpartum with the highest level of perceived stress and the most variability in social support relative to groups that were never depressed or were in and out of depression. More studies are needed to understand how to best help these high risk adolescents successfully transition to motherhood.

Health promotion text blasts for minority adolescent mothers.

PURPOSE: To examine use of technology for delivering a health promotion intervention via text blasts in single, low-income, adolescent, minority mothers and to describe their perceptions and experiences with the intervention. STUDY DESIGN AND METHODS: A qualitative descriptive design was used for this study. Health promotion information was sent weekly in the form of text blasts and/or pictures to five mothers during the first 6 months postpartum. Topics included promotion of breastfeeding, effects of breast milk on infant growth and development, information about infant immunizations, and reminders about infant and maternal follow-up and well-being. Qualitative interviews occurred monthly with mothers about their perceptions and experiences with the health promotion intervention and their health promotion behaviors. Data were analyzed using qualitative analytic techniques to generate themes from the mothers' interviews. RESULTS: Four themes emerged: (a) Trustworthy Support System, (b) Overcoming Barriers to Health Promotion, (c) Parenting Validation, and (d) Preferred Mode of Communication. All mothers used breast milk through 6 months postpartum and were adherent with childhood immunizations and maternal and infant follow-up appointments, unlike lower proportions in the general population. CLINICAL IMPLICATIONS: Health promotion text blasts can improve single, low-income, adolescent, minority mothers' health behavior outcomes such as adherence with recommended immunizations for their infants, breastfeeding success, and recommended maternal and infant healthcare visits. Further, it is the preferred mode of communication for these mothers. Future studies are needed for examining the use of technology to deliver healthcare to a larger sample of minority adolescent mothers.

You can't put a dollar amount on presence: young, non-resident, low-income, African American fathers.

AIMS AND OBJECTIVES: The purpose of this transcendental phenomenological study was to describe the lived experiences of young, non-resident, low-income, African-American fathers. METHODS: Semi-structured interviews were conducted with a convenience sample of 6 men enrolled in the Omaha Healthy Start, Fathers for a Lifetime Program. RESULTS: The following themes were identified: (a) A Work in Progress: Fatherhood Investment; (b) A Little Island by Myself: Barriers to Fathering; (c) I'm Going to be There From Day One to Infinity: Presence; and (d) The Tomorrow Dad: Not Like my Dad. Barriers to fathering created resource-poor environments posing challenges to involvement. CONCLUSIONS: Dispelling the myth of the "hit-and-run" father or the "package deal" remains a concern for fathers and their children. Nurses can develop early assessment strategies and interventions to help African American fathers with their parenting involvement. Fathers can be encouraged to attend community-based fathering programs to increase investment opportunities.

Effects of an internet intervention on mothers' psychological, parenting, and health care utilization outcomes.

AIMS AND OBJECTIVES: The purpose of this pilot study was to test the effects of an Internet-based intervention, the New Mothers Network, on single, low-income, adolescent, African American mothers' psychological, parenting, and health care utilization outcomes. BACKGROUND: The study was based on social support theory. METHODS: For mothers in the Intervention Group, MSNTV™ was installed in subjects' homes and connected to the Internet. Data were collected at 1 week, 6 weeks, 3 months, and 6 months following the infant's birth. RESULTS: For infant health services utilization, 70.6% of those in the Control Group took their infant to the emergency room at least once during the study compared to 35.7% of mothers in the Intervention Group. The New Mothers Network allowed mothers to share their experiences and acquire information from nurses about caring for themselves and their infants. CONCLUSION: The New Mothers Network Web site is well poised for nursing driven social support intervention via the Internet, even though access devices are evolving over time.

Compadrazgo: a literature review.

Compadrazgo, "coparenthood," is a traditional ritual fictive kinship system that provides a network of mutually supportive relationships in the Mexican American culture. A literature search of CINAHL, Medline, PsychoInfo, and Web of Science was used to identify peer-reviewed journals and original sources. Keywords included comadre, compadrazgo, fictive kin, social support, Mexican, and Mexican American. Additional resources were identified through a focused review of references. Findings from this study indicate knowledge about compadrazgo, is limited to the social organization, historical practices, and a preliminary description of the compadres role. Minimal information is available about the relationship between compadrazgo, and health, and variations in roles and responsibilities of compadrazgo, participants. Frequency of enactment of compadrazgo, responsibilities and barriers to the enactment of social support by compadres remain unknown. Variations in practice have not been explored. Nursing implication include the recommended ways that compadrazgo, can be encouraged or promoted in patient care.

Mexican American mothers' eating and child feeding behaviors.

OBJECTIVE: The purpose of this study of Mexican-American mothers of 2-6 year old children was to explore the relationships among maternal attitude, perceived behavioral controls, mother's intent, mother's regulation of her own Simple Carbohydrate Intake (SCI), and mother's child feeding behaviors. The overall objective was to increase understanding of the complex process of intention to eat healthy. METHODS: A prospective exploratory design using a convenience sample of a cohort of 82 Mexican-American mothers was used in this study. Structured questionnaires were selected to measure cognitive restraint, disinhibition, hunger, intent to regulate SCI, and mothers' monitoring, restricting, and pressuring of children's diets. Descriptive statistics and correlations were analyzed for each relationship. RESULTS: The relationships between disinhibition, hunger, cognitive restraint, and the intent variable were significant. More than half of these mothers reported limiting soda and candy for themselves. According to the Food Frequency Questionnaire, mothers were regulating only one-third of simple carbohydrate items they intended to regulate. Significant relationships were found between mothers' regulation of her specific SCI and her control of child feeding behaviors including pressuring, monitoring, and restricting. CONCLUSION: The findings support the idea that mother's eating behaviors, attitudes, and intent may affect how they feed their pre-school children. Nurses need to develop and test interventions targeted at educating Mexican-American mothers about healthy food choices and healthy child feeding behaviors.

Online support for single, low-income, African American mothers.

PURPOSE: To enhance understanding of the phenomenon of being a single, low-income, African American mother through their discussions and use of an Internet-based social support intervention. STUDY DESIGN AND METHODS: The New Mothers Network discussion forum was made available to 20 mothers in their homes for 6 months after the infant's birth. Nineteen mothers posted 174 messages to research nurses and to one another. Thematic analysis of the written messages was completed. RESULTS: The following themes emerged from discussion forum comments: (a) dealing with the father of the baby, (b) mourning losses, (c) positive and negative support, (d) financial needs and concerns, (e) career and educational goals, (f) balancing act, (g) trust issues, and (h) tuned in to baby. CLINICAL IMPLICATIONS: The New Mothers Network allowed these African American mothers to share their experiences and assimilate information from nurses about caring for themselves and their infants. Other nurses can create similar Internet discussion forums for the purposes of providing social support to mothers who have access to computers. Computer software for creating discussion forum sites can be purchased at a reasonable cost, and some are available free of charge.

Community leaders' perceptions of Hispanic, single, low-income mothers' needs, concerns, social support, and interactions with health care services.

Hispanic, single, low-income mothers are a vulnerable population who are often identified as having difficult transitioning to motherhood and successfully using the U.S. health care system. The purpose of this study was to examine needs, concerns, and social support of Hispanic, single, low-income mothers during the transition to motherhood through the eyes of community leaders serving this population in the U.S. Two focus groups were conducted, and 16 Midwestern community leaders working or volunteering with the Hispanic population expressed their opinions. Two investigators and two graduate nursing students evaluated the data. The process of word and context interpretation was completed using a combination of Tesch (1990) and Creswell (2007) techniques. Data were compared to field notes and debriefing summaries were completed during focus group discussions. Four themes and 12 subthemes evolved from the group discussions. Themes were (a) mothers' social support, (b) interactions with health care providers, (c) barriers in trust, and (d) practical life issues. A conclusion was drawn from these data that these women have difficulty accessing social support and information regarding care of themselves and their newborn infants due to limited social networks and barriers to health care. Nurses are in key positions to offer culturally sensitive social support and identify health care barriers with Hispanic, single, low-income mothers during the transition to motherhood. Further research is needed on interventions that effectively deliver information, lower health care barriers, and meet social support needs of Hispanic, single, low-income mothers and their infants.