Perinatal crack users becoming temperant: the social psychological processes.

According to the National Household Survey on Drug Abuse, on average in 1994 and 1995, 269,000 pregnant women self-reported the use of an illicit drug within the past year. Drug use during pregnancy continues to have a significant impact on infant mortality in the United States. Using the feminist perspective and grounded theory method, a grounded theory of temperance was discovered for perinatal crack users. Nineteen women participating or interfacing with a psychiatric-obstetrical clinic within a maternal and infant project in a large Southeastern city were interviewed. Staying clean was the social-psychological problem generated from the data. Becoming temperant was identified as the process by which the women manage to stay clean. This substantive theory provides a broader understanding of the experiences of addicted pregnant women. Implications for improved treatment and further research are suggested.

Use of telemedicine for children with special health care needs.

OBJECTIVE: In 1995, the Children's Medical Services (CMS) of the State of Georgia contracted with the Department of Pediatrics of the Medical College of Georgia (MCG) and the MCG Telemedicine Center to develop telemedicine programs to provide subspecialty care for children with special health care needs. This article presents project statistics and results of client evaluation of services, as well as physician faculty attitudes toward telemedicine. DESIGN: A demonstration project using telemedicine between a tertiary center and a rural clinic serving children with special health care needs was established. Data were collected and analyzed for December 12, 1995 to May 31, 1997, during which 333 CMS telemedicine consultations were performed. RESULTS: Most CMS telemedicine consultations (35%) involved pediatric allergy/immunology. Other subspecialties included pulmonology (29%), neurology (19%), and genetics (16%). Overall, patients were satisfied with the services received. Initially, physician faculty members were generally positive but conservative in their attitudes toward using telemedicine for delivering clinical consultation. After a year's exposure and/or experience with telemedicine, 28% were more positive, 66% were the same, and only 4% were more negative about telemedicine. The more physicians used telemedicine, the more positive they were about it (r =.30). CONCLUSIONS: In terms of family attitudes and individual care, telemedicine is an acceptable means of delivering specific pediatric subspecialty consultation services to children with special health care needs, living in rural areas distant to tertiary centers. Telemedicine is more likely to be successful as part of an integrated health services delivery than when it is the sole mode used for delivery of care.

Coping in young women: theoretical retroduction.

Although there is increasing interest in women's health, there remains little empirical evidence concerning concepts related to health and women's life trajectory. Our purpose in conducting this research was to examine women's developmental stressors and coping during young adulthood. Lazarus and Folkman's coping model provided sensitizing concepts for data generation in a retroductive research methodology. The sample included 26 women of diverse perspectives who participated in interviews and groups. Philosophical concerns of subjectivity, context and gender sensitivity were actualized in iterative stages of data collection, analysis and comparison to extant theory. Rapidly expanding multiple roles were identified as developmental stressors for young women. Decontextualized coping strategies are arranged on a behavioural continuum: avoidance, distraction, and confrontation. Contextualized descriptions of coping are presented in two representative accounts: Lauren and Mary Ellen. A philosophical stance, assumed at about the age of 30, provides a lens for assessing developmental stressors that influence the appraisal process. Rich descriptions of young women's coping and developmental influences move beyond abstract theory to a contextual understanding of young women's experiences.

Intervening with prenatal crack cocaine users.

Nurses in primary care, maternal child health, and community health practice settings are in a unique position to intervene with clients who are prenatal crack cocaine users. Clinical assessment is considered in both the context of the pregnancy and the crack cocaine use. A synthesis model of intervention related to both the pregnancy and the drug use are outlined to support a healthy baby and a healthy recovery.