Science and midwifery: paradigms and paradoxes.

The everyday world of clinical practice is filled with paradigms and paradoxes that stem from the issues of who defines knowledge, how it is generated, and how the individual midwife applies it when providing care for women and families. Research useful for clinical practice should provide evidence to support scientific approaches (models) or strategies (interventions) in caring for women. In a clinical discipline, the answers to research questions should eventually inform clinical decision-making by providing practical clinical knowledge. This article presents an application of Stevenson's research steps for the development of clinically applicable knowledge that the midwife can use to analyze and evaluate research findings as a basis for practice decisions. Specific examples of midwifery research are used to illustrate each stage in the process and the circular nature of knowledge development. The challenge is to prepare midwives who can apply research findings skillfully using the best evidence to support clinical practice, as well as to groom midwife researchers who will develop systematic programs of relevant research about midwifery practice and outcomes.

Military women's perspectives on health care during deployment.

Approximately 367,000 women serve in the U.S. military and regularly deploy with their units to austere military environments. A survey was used to describe 841 military women's perceptions about the health care provider that is available them during deployment and their perceptions of barriers to adequate diagnosis and treatment of gynecologic infections in these austere environments. The study findings have implications for military provider training, sick call policy, predeployment training, and development of self-care alternatives for military women during deployment.

Self-efficacy for labor and childbirth fears in nulliparous pregnant women.

In this secondary analysis, the relationship between self-efficacy for labor and childbirth fears in healthy nulliparous women was investigated during the third trimester of pregnancy. The sample consisted of 280 predominantly white, well-educated, middle-class nulliparae enrolled in childbirth classes. Consistent with Bandura's self-efficacy theory, outcome expectancies for childbirth were unrelated to childbirth fears while self-efficacy expectancies were significantly correlated with childbirth fears. When the sample was divided into a low-fear and a high-fear group, significant differences were found between groups on a number of psychological variables. The women in the high-fear group were characterized by significantly higher learned helplessness, chance health locus of control and powerful others health locus of control, and significantly lower self-esteem and generalized self-efficacy. The most common fears of the high-fear women were of losing control during delivery, of the birth itself, of something being wrong with the baby and of painful contractions.

A clinical test of women's self-diagnosis of genitourinary infections.

Vaginitis and cystitis result in 8 million ambulatory health care visits annually. For military women deployed to austere environments, gynecological problems are more likely to occur yet unlikely to be adequately diagnosed and managed. The Institute of Medicine has recommended that self-care kits be made available to military women under these circumstances. In this clinical comparative study, women's (N = 86) self-diagnoses of vaginitis and cystitis using an investigator-designed, self-diagnostic decision-making guide and kit were compared with clinical diagnoses by advanced practice nurses (APN). The vaginitis guide had a sensitivity of 84% for candida vaginitis (CV) and 91.3% for bacterial vaginosis (BV) and a specificity of 81.5% for CV and 82.8% for BV. The women consistently agreed with the APN's diagnosis of presence or absence of cystitis. These findings suggest that women are capable of making reliable self-diagnostic decisions given appropriate cues. Continued development of a self-diagnosis and treatment kit for military women deployed to austere environments is warranted.

Over-the-counter medications and self-care.

More than 100,000 over-the-counter (OTC) products are now sold in drugstores, convenience stores, gas stations, and supermarkets. In 1997, the OTC retail market was responsible for an estimated $20.6 billion in health care savings. This article discusses the methods by which drugs are approved for OTC use by the Food and Drug Administration. The article also reviews trends and issues related to self-care with OTC medications, including cost-effectiveness, managed care, advertising, and safety. The clinician should assume that OTC use is a common patient self-care behavior; therefore, information regarding the patient's OTC use should be collected during the history taking. Other implications of OTC use for primary care providers are proposed.

Parturition and fetal adaptation.

The fetus as "patient" during labor and birth has become an increasingly important concept during the past 20 years. However, what is understood about fetal status during labor and how the fetus prepares for its approaching separation from its mother? Current information indicates that not only is the term fetus well prepared for the adaptation to extrauterine life, but this transition is facilitated by normal labor.

The pain and discomfort of labor and birth.

One unique aspect of childbirth is the association of this physiologic process with pain and discomfort. However, the experience of pain during labor is not a simple reflection of the physiologic processes of parturition. Instead, labor pain is the result of a complex and subjective interaction of multiple physiologic and psychological factors on a woman's individual interpretation of labor stimuli. An understanding of labor pain in a multidimensional framework provides the basis for a woman-centered approach to labor pain management that includes a broad range of pharmacologic and nonpharmacologic intervention strategies.

Breastfeeding care in Ohio hospitals: a gap between research and practice.

OBJECTIVE: To assess current breastfeeding care in Ohio hospitals and compare that care to research-based principles. DESIGN: Survey. SETTING: Ohio hospitals that provide maternity care. PARTICIPANTS: All 141 Ohio hospitals that provide maternity care were invited to participate. One-hundred sixteen (83%) hospitals returned usable surveys completed by obstetric nurse managers. MAIN OUTCOME MEASURE: A 38-item questionnaire provided data on hospital demographics and information regarding the care of breastfeeding mother-infant dyads. RESULTS: Research-based practices common in Ohio's hospitals include demand feeding, breastfeeding education, and breastfeeding as the initial neonatal feeding. Common non-research-based practices include supplemental fluid administration, postpartum nipple treatments, mandatory initial nursery stays, limited sucking time, restricted maternal-infant contact, distribution of formula packs, minimal follow-up care, and the suspension of breastfeeding for hyperbilirubinemia. CONCLUSIONS: Despite positive changes in perinatal care, a number of non-research-based practices persist in Ohio hospitals for the care of the breastfeeding mother-infant dyad.

Maternal confidence for labor: development of the Childbirth Self-Efficacy Inventory.

The Childbirth Self-Efficacy Inventory (CBSEI) is a self-report instrument that measures outcome expectancies and self-efficacy expectancies for coping with an approaching childbirth experience. The CBSEI scales have excellent internal consistency reliability (.86 to .96) and factor analysis suggested that each CBSEI scale is unidimensional. Validity of the CBSEI was supported by significant positive correlations with the criterion variables of generalized self-efficacy, self-esteem, and internal health locus of control; and significant negative correlations with external health locus of control and learned helplessness. Validity was also supported by significantly higher self-efficacy scores for multiparous as compared to nulliparous pregnant women.

The biophysical profile: antepartal assessment of fetal well-being.

The assessment of fetal well-being is a primary consideration for perinatal nurses. The biophysical profile is a clinical evaluation of the status of the fetus based on assessment of multiple discrete variables. This article describes current biophysical profile scoring systems, the physiologic basis of the fetal variables, and factors that may affect the variables. It also discusses issues related to future applications and refinement of the biophysical profile, as well as nursing implications of the technology.

Beyond Campbell and Fiske: assessment of convergent and discriminant validity.

While it is not an innovation in the more established social sciences, the multitrait multimethod (MTMM) technique (Campbell & Fiske, 1959) and additional, more powerful statistical methods of interpreting a MTMM matrix of correlations, have not been used extensively in nursing to assess construct validity of new instruments. This article reviews the Campbell and Fiske method for the assessment of convergent and discriminant validity, reviews the application of the method in the nursing literature, and describes the limitations of the original method. In addition, the procedures, strengths, and limitations of the analysis of variance and confirmatory factor analytic approaches to the quantification of Campbell and Fiske's criteria are described.

Maternal confidence in coping with labor. A self-efficacy concept.

The clinical study of labor pain suggests that a woman's confidence in her ability to cope with labor contributes significantly to her perception of pain during labor. Self-efficacy theory is examined as a framework for evaluating women's confidence in their ability to cope with labor. The major propositions of self-efficacy theory are described and related to the experience of women approaching labor. The implications for nursing practice are presented, and directions for the study of maternal confidence are proposed.

A critical review of visual analogue scales in the measurement of clinical phenomena.

Visual analogue scales (VAS) have been used in the social and behavioral sciences to measure a variety of subjective phenomena. The VAS method has potential utility for the measurement of a variety of clinical phenomena of interest to nurse investigators. In this review a description of the various forms of the VAS and an historical overview of their development are presented. In addition, conceptual, psychometric, and statistical aspects of the VAS are considered. Finally, strengths and limitations of the VAS method are addressed.

Explaining the pain of active labor: the importance of maternal confidence.

This study was designed to investigate the relationships between the perception of pain during active labor and nine predictor variables: age, parity, childbirth preparation, state anxiety, confidence in ability to handle labor, concern regarding the outcome of labor, fear of pain, cervical dilatation and frequency of uterine contractions. The sample included 134 low-risk women at term with a normal singleton pregnancy. Standard and stepwise regression was used to examine the ability of the selected variables to explain the variance in the sensory, affective, and evaluative components of pain as measured by the subscales of the Pain Rating Index of the McGill Pain Questionnaire. Although significant proportions of variance were explained for each component of pain, the study variables were most powerful in their ability to explain the variance in the affective component of active labor pain. The stepwise analysis suggested that of the nine variables, confidence in ability to handle labor was the most significant predictor of all components of pain during active labor.