Tips for better visual elements in posters and podium presentations.

CONTEXT: The ability to effectively communicate through posters and podium presentations using appropriate visual content and style is essential for health care educators. OBJECTIVES: To offer suggestions for more effective visual elements of posters and podium presentations. METHODS: We present the experiences of our multidisciplinary publishing group, whose combined experiences and collaboration have provided us with an understanding of what works and how to achieve success when working on presentations and posters. Many others would offer similar advice, as these guidelines are consistent with effective presentation. FINDINGS/SUGGESTIONS: Certain visual elements should be attended to in any visual presentation: consistency, alignment, contrast and repetition. Presentations should be consistent in font size and type, line spacing, alignment of graphics and text, and size of graphics. All elements should be aligned with at least one other element. Contrasting light background with dark text (and vice versa) helps an audience read the text more easily. Standardized formatting lets viewers know when they are looking at similar things (tables, headings, etc.). Using a minimal number of colors (four at most) helps the audience more easily read text. For podium presentations, have one slide for each minute allotted for speaking. The speaker is also a visual element; one should not allow the audience's view of either the presentation or presenter to be blocked. Making eye contact with the audience also keeps them visually engaged. CONCLUSIONS: Health care educators often share information through posters and podium presentations. These tips should help the visual elements of presentations be more effective.

Intractable diarrhea in hyperthyroidism: management with beta-adrenergic blockade.

OBJECTIVE: To describe a patient with intractable diarrhea and thyrotoxic Graves' disease, for whom b-adrenergic blockade ultimately proved to be effective therapy for the diarrhea, and to review the types of hyperthyroidism-associated diarrhea. METHODS: We present the clinical course of a young man with a prolonged siege of diarrhea that proved elusive to diagnostic inquiries and resistant to all means of management until its endocrine basis was discovered. Control of such cases with b-adrenergic blockade is discussed, as are the pathophysiologic bases of intestinal hypermotility in hyperthyroidism. RESULTS: A 26-year-old man with Down syndrome, and no prior gastrointestinal disorder, had insidious, chronic, constant diarrhea, which was associated with loss of 14 kg during a 5-month period. Numerous laboratory and imaging studies and endoscopic examinations failed to disclose the cause of the diarrhea. Furthermore, a broad range of antibiotics and other empiric remedies failed to control the problem. No other symptoms of hyperthyroidism were reported, but when the endocrinopathy was suspected and identified, the diarrhea was promptly controlled by treatment with propranolol. In patients with hyperthyroidism, two types of diarrheal disorders have been described-secretory diarrhea and steatorrhea; bile acid malabsorption may have a role in either of these settings. CONCLUSION: In addition to its capacity for blocking the peripheral effects of thyroid hormone on the heart and central nervous system, b-adrenergic blockade is effective in slowing intestinal transit time and ameliorating the uncommon diarrhea associated with hyperthyroidism. Thyroid hormone in excess, among its other possible effects on the gastrointestinal tract, may exert a stimulatory effect by means of intermediary sympathetic activation, as it does with the heart. Thus, sympathetic blockade can mimic the salutary effects on the gastrointestinal tract conventionally brought about by direct antithyroid therapy, and well before the hyperthyroid state per se is eliminated. The current patient illustrates the value of considering hyperthyroidism in the differential diagnosis of diarrhea of unknown cause.

Nurses' description and evaluation of reproductive health counseling for adolescent females.

Nurses have been providing reproductive health counseling to adolescent females for over 20 years. Yet, we found no studies in the nursing literature in which the investigator examined the types of reproductive health counseling nurses provide to adolescent females. Therefore, the purpose of this study was to examine nurses' description and evaluation of the types of reproductive health counseling they used for adolescent females. Five registered nurses, with at least 10 years experience in providing reproductive health counseling to adolescent females, were interviewed using a semi-structured guide. Four areas were explored: type of information provided, barriers to providing counseling, adolescent female decision-making capacity, and nursing recommendations. Two general themes emerged from the respondents' evaluations: frustration and unused potential of nurses to affect the reproductive health of adolescent females, and the inappropriateness of current reproductive health strategies for adolescent females.

PIP: In response to a lack of research on the topic, this study gathered data from nurses in the US on the types of reproductive health counseling (RHC) they offer adolescent females. A review of the literature provides background information on the use of contraceptive/prophylactic technology by adolescents, on the dictates of informed consent, and on the empowering value of RHC delivered by registered nurses to adolescents. The description of the methodology explains that, using a qualitative approach known as naturalistic inquiry, data were collected via intensive interviews with 5 nurses who had at least 10 years of experience providing RHC to adolescent females. Data analysis followed a case study approach. As the respondents evaluated their RHC efforts, they generally reported the inappropriateness of current RHC strategies used for adolescent females and their frustration with the unused potential of nurses to affect the reproductive health of adolescent females. The nurses recommended that RHC could be improved if careful attention were given to nurse-patient interaction, staff education, adolescent empowerment education, and adolescent mentoring. They also thought that creation of adolescent clinics would be helpful. The article concludes that additional research is needed on ways to 1) involve parents and increase community investment in youth, 2) determine if the sexual activity of adolescent females is consensual, 3) develop a nursing instrument for fostering critical thinking skills in youth, and 4) examine the value of current RHC strategies.

Recurrent perinatal loss: a case study.

To date, investigators have not demonstrated a clear relationship between a parent's history of prior perinatal losses and intensity of grief response following a subsequent perinatal loss. Examining this relationship for low-income, African-American parents is important because they are a vulnerable population due to the high incidence of perinatal mortality in Blacks and their other life stressors that can impact on grief response and caring needs. The purpose of this case study was to examine the impact of recurrent perinatal loss on a low-income African-American parent. The research design for this study was case report, using interview data collected from a mother who had recently experienced her fourth perinatal loss, which occurred at twenty-five weeks of gestation. Transcripts from two open-ended interviews were analyzed. The theoretical framework used to guide analysis of this case study was Lazarus and Folkman's stress and coping theory. Results demonstrated that the prior perinatal losses did not appear as critical components of the way the mother responded to her most recent loss. Instead, perception of the care she received from healthcare providers and how that care related to her experiences with her one living child who was born at the same gestational age was an important determinant in how she responded to her loss. The results of this case study demonstrate the importance assessing a person's perception of their experience and those factors which contribute to the way they respond.

Nursing interventions to reduce stress in parents of hospitalized preterm infants.

Parental stress related to having a neonate in a Newborn Intensive Care Unit (NICU) has been well documented in the nursing literature. Yet, as nurses we need to be reminded of strategies that can combat this stress and ease the transition to home.

Supporting parents during and after a pregnancy subsequent to a perinatal loss.

The experience of perinatal loss can be devastating for couples who want children. The decision and desire to attempt another pregnancy may be too much for parents to bear, yet the majority of women who experience perinatal loss do become pregnant again soon after the loss. A pregnancy after a perinatal loss can be mentally, emotionally, and physically taxing. The anxiety experienced by mothers during a subsequent pregnancy has been documented consistently by investigators, but less is known about the effects of perinatal loss on parenting subsequent children. Perinatal and neonatal nurses play a critical role in supporting parents during and after a subsequent pregnancy and need an understanding of the research to direct their practice.

"Not as bad as it could have been": assessing and mitigating harm during research interviews on sensitive topics.

Research on sensitive subjects such as perinatal loss places participants at particular risk for psychological distress. Although authors have discussed strategies for minimizing distress during interview research, less is known about the ways participants communicate and investigators respond to psychological pain incurred during the interview itself. Therefore, we describe both verbal and nonverbal indicators of distress during a phenomenological study on perinatal loss. We also offer suggestions for interviewers on ways to minimize participants' discomfort. We believe this account will help other researchers identify and reduce respondent distress during their own research.

Reliability of head circumference measurements in preterm infants.

PURPOSE: To describe and compare the intra- and interexaminer reliability of head circumference measurements obtained with paper and cloth tape measures. METHOD: Two experienced neonatal nurses each obtained head circumference measurements using both paper and cloth tape measures twice each, from 49 clinically stable, preterm infants. The nurses were blind to their own and to each other's measurements. The order in which the measurements were obtained was randomized. The differences within and between examiners for cloth and paper tape measurements were described using mean absolute differences, standard deviation of net differences, technical error of measurement, minimal and maximal differences, percentage of differences 0.25 and 0.5 cm, and percentage of error. RESULTS: Wilcoxon matched-pairs, signed-ranks tests demonstrated significantly greater intraexaminer reliability for measurements obtained with the paper tape for both of the nurses. Wilcoxon matched-pairs, signed-ranks tests also demonstrated significantly greater interexaminer reliability for measurements obtained with the paper tape for both the first and second measurement sets. CONCLUSIONS: Intra- and interexaminer differences were consistently smaller when the examiners used paper tape measures.

The rewards outweigh the efforts: breastfeeding outcomes for mothers of preterm infants.

This study describes the rewards and efforts of breastfeeding for mothers of preterm infants. Using a semi-structured interview guide, 20 mothers of preterm infants were interviewed in their homes approximately 1 month after infant discharge from a Level III NICU. Mothers described the following rewards of breastfeeding: knowing they were providing the healthiest nutrition for the infant, enhancing closeness between the mother and infant, perceiving infant contentment and tranquility during breastfeeding, providing convenience for the mother, and giving the mother a tangible claim on the infant. Most mothers identified some "efforts" associated with breastfeeding their preterm infants, but indicated that overall, breastfeeding was a rewarding experience. These data provide scientific support for the promotion and facilitation of breastfeeding for mothers of preterm infants, in that mothers perceive specific emotional advantages that they relate to the breastfeeding experience.

Breastfeeding patterns of low-birth-weight infants after hospital discharge.

OBJECTIVE: To examine the feeding patterns of low-birth-weight infants (1,500-2,500 g) on the day of hospital discharge and 4 weeks after birth. DESIGN: Prospective, descriptive survey. SETTING: Eight hospitals in the Midwest. PARTICIPANTS: One hundred ten mothers who intended to breastfeed their low-birth-weight infants. MAIN OUTCOME MEASURES: Two different tools were used to address infant breastfeeding patterns and effectiveness of infant feeding at the breast as reported and rated by the mothers. RESULTS: At hospital discharge, 38% of the infants were exclusively fed at the breast. Only 52% of the full-term, low-birth-weight infants and 52% of the preterm low-birth-weight infants had effective vigorous feedings at the breast at hospital discharge as rated by the mothers. At 4 weeks, 40% of the infants were fed exclusively at the breast and 19% were weaned to formula. CONCLUSIONS: The several feeding patterns and modes of feeding identified with low-birth-weight infants suggest that appropriate tools be designed and tested with mothers of low-birth-weight infants. In addition, the definition of breastfeeding must be explored.

Parents' experience surrounding the death of a newborn whose birth is at the margin of viability.

OBJECTIVE: To describe the experience of parents surrounding the death of a newborn weighing less than 500 g at birth. DESIGN: Descriptive, using an eidetic phenomenologic approach. SETTING: Interviews were conducted in the parents' homes or by telephone between 4 and 15 weeks after the loss. PARTICIPANTS: Eight parents (five mothers and three of their husbands) who had experienced the death of a newborn weighing less than 500 g at birth. MAIN OUTCOME MEASURES: The lived parental experience of the death of a newborn consists of a number of parental processes, responses, and activities that occur over time. RESULTS: Five themes were generated from the data: (a) realization that the loss is occurring; (b) initial response to the loss; (c) decision making at the time of the loss; (d) components of supportive relationships with others; and (e) the adjustment at home. CONCLUSIONS: The findings demonstrate the unique experience of having a newborn who is born at the margin of viability and support the need for individualized, caring-based interventions for parents.

Parental evaluation of a tour of the neonatal intensive care unit during a high-risk pregnancy.

OBJECTIVE: To describe parents' reaction to a prenatal tour of the neonatal intensive care unit (NICU) during a high-risk pregnancy and identify advice they have for other parents and health care professionals who participate in a such a tour. DESIGN: Naturalistic inquiry, a qualitative approach. SETTING: Semistructured interviews were conducted in the hospital or parents' home. PARTICIPANTS: Thirteen expectant parents who had toured a NICU during a high-risk pregnancy. MAIN OUTCOME MEASURES: Three categories of information were described by the parents: (a) a description of the tour; (b) benefits of the tour; and (c) an evaluation of the way that the tour was arranged and conducted, including advice to health care professionals and other parents. RESULTS: All parents recommended that parents diagnosed with a high-risk pregnancy be offered a prenatal tour of the NICU. The tour benefited parents and (a) decreased fears, (b) inspired hope for the infant's prognosis, (c) provided reassurance about the care in the NICU, and (d) prepared parents for their infant's hospitalization in the NICU. CONCLUSIONS: Parents experiencing a high-risk pregnancy benefit from a tour of the NICU. The tour familiarized parents with the NICU and the type of care that their newborn would require. However, during the tour, more attention should be given to the parental role in the NICU.

Reliability of in-bed weighing procedures for critically ill infants.

The purpose of this study was to describe the intra- and interexaminer reliability of weight measurements obtained from critically ill infants on an in-bed electronic scale. Weight measurements were obtained using the in-bed scale (Smart Model 35, Olympic Medical, Seattle, Washington) for 32 infants; 16 were in an incubator, and 16 were under a radiant warmer. Two nurses each obtained two weight measurements for each infant for three consecutive days, for a total of 96 data collection sessions. The nurses were blinded to their own and to the other nurse's weight measurements. The average mean absolute difference for individual nurses' weight measurements (interexaminer reliability) was 12.58 gm for weights obtained in the incubator and 19.19 gm for weights obtained under the radiant warmer. The average mean absolute difference for pairs of nurses' weight measurements (interexaminer reliability) was 14.29 gm for weights obtained in the incubator and 24.42 gm for weights obtained under the radiant warmer. The average mean absolute differences for weights obtained in the two bed types differed significantly for both intra- (Z = -2.46, p = .0141) and interexaminer (Z = -3.11, p = .0019) reliability. The number of pieces of equipment that had to be held during the weight measurement was weakly correlated with both the intra- (rs = .1878, p = .0091) and interexaminer (rs = .1600, p = .0266) mean absolute differences. These findings suggest that weight measurements of critically ill infants obtained using the Smart Model 35 in-bed electronic scale are sufficiently reliable for calculation of medication, parenteral fluid, blood replacement, and nutritional requirements.(ABSTRACT TRUNCATED AT 250 WORDS)

Getting enough: mothers' concerns about breastfeeding a preterm infant after discharge.

OBJECTIVE: To describe maternal concerns about breastfeeding a preterm infant in the postdischarge period and to delineate the strategies mothers used in managing these concerns. DESIGN: Naturalistic inquiry was used. SETTING: A semistructured interview was conducted with the mother in the home 1 month after discharge of the infant. PARTICIPANTS: Twenty mothers of preterm infants; the infants had been in a level 3 hospital nursery, and the mothers had received individualized breastfeeding support services in the hospital. MAIN OUTCOME MEASURES: Three categories of maternal concerns emerged from the data: adequate milk consumption by infants; milk composition; and problems with the mechanics of breastfeeding a preterm infant. Mothers identified strategies for these concerns. RESULTS: The mothers' main concern was whether infants consumed an adequate volume of milk by breastfeeding alone. Strategies for managing concerns about getting enough included using supplemental and complemental feeding, using ongoing cues to tell that the infant is getting enough, and persevering with breastfeeding. CONCLUSIONS: Mothers of preterm infants have unique concerns about breastfeeding in the postdischarge period and need individualized interventions.