Midlife mothers favor `being with' children over work and careers.

BACKGROUND: The majority of American women juggle careers and the demands of mothering. The experiences of midlife mothers on the issues of work and motherhood are important to explore because birth rates for older women continue to rise in the United States and in other countries including the U.K. and Canada. OBJECTIVE: To present a unique viewpoint on work and mothering from the perspectives and experiences of older first-time mothers. METHODS: A purposive sample of thirteen women aged 45-56 years old participated in two in-depth interviews. Findings emerged in the context of a larger hermeneutic phenomenological study that aimed to understand older first-time mothers' perceptions of health and mothering during the transition to menopause. RESULTS: A paradox emerged in which the realities of motherhood did not meet the women's expectations. They were surprised by the centrality of commitment they felt towards the child and voiced strong ideals about how to do mothering right that included making changes to work schedules to be more available to their children. CONCLUSION: Health care professionals should be aware of specific issues that exist for older first-time mothers including adjustments to work. This knowledge will inform the support, education and care provided for these women.

Women's experience of decision-making with medication abortion.

BACKGROUND: Medication abortion received regulatory approval in 2001 in the United States with healthcare providers increasingly offering this method. However, most studies in the United States have only explored acceptability and decision-making with women who participated in clinical trials. Overall, the literature on women's experience with a method that it is now widely available is under research in the United States. OBJECTIVE: To describe and analyze the women's experience as they choose the option of and experienced the process of medication abortion. DESIGN: A constructivist grounded theory study. SETTING: Outpatient clinical offices in a three-state area in the northeast region of the United States. PARTICIPANTS: A purposive sample of 22 women aged 16 to 45 who experienced a medication abortion. METHODS: Data were collected by in-depth, open-ended, face-to-face interviews. The constant comparative method was used for analysis. RESULTS: Five interwoven categories emerged regarding women's initial decision to have a medication abortion: choosing a natural process, avoiding "surgery," respecting the "baby," scheduling to meet needs, and appreciating the home setting. The enhanced sense of personal control associated with the medication abortion option was the overriding reason given for choosing this method. CONCLUSION: This study contributes to the paucity of literature on the reasons why women choose medication abortion. It is important for nurses to understand the complexity of medication abortion decision-making so that they can effectively support women through this process.

A qualitative study of women's decision to view or not view an ultrasound image before early medication abortion.

BACKGROUND: Transvaginal ultrasounds are commonly performed for gestational dating of pregnancy before a medication abortion. This paper presents findings regarding women's perspectives on viewing the gestational dating ultrasound image, which arose from a study exploring women's medication abortion experience. By providing women the opportunity to talk about their medication abortion experience through open-ended interviews, women reported their experience of viewing or not viewing the ultrasound in detail, which to date has been underexplored. METHODS: A constructivist, grounded theory approach was used. The purposive sample consisted of 18 women in the United States who experienced a medication abortion in the preceding 4 months. FINDINGS: Not all women wanted to view the ultrasound; however, they all wanted a choice. Women wanted to view the image to confirm health and fertility, satisfy curiosity, and process their decision regarding the pregnancy. None of the women stated that they wanted to view the image as a prerequisite to making their decision to terminate the pregnancy; rather, viewing was a way to process their decision. CONCLUSIONS: Women wanted a choice of whether to view the ultrasound image because they felt it was their right to decide whether to access this aspect of their personal health information. They wanted providers to engage in a dialogue about viewing the image or not and to respect their decision. Providers need to be appropriately prepared to offer women the choice to view and to support women in their decision.

Triple whammy: women's perceptions of midlife mothering.

PURPOSE: To understand women's experiences as older first-time mothers during the transition to menopause. STUDY DESIGN AND METHODS: A hermeneutic, phenomenological study exploring the lived experiences of 13 women aged 39 to 47 when they achieved first-time motherhood. Women were mothering one or more children aged 12 or younger and experiencing symptoms of perimenopause. Data were generated through two in-depth interviews with each woman. Meaning was mutually negotiated through dialogue with the women and simultaneously with the text, as well as through ongoing data analysis. RESULTS: Four themes emerged: Achieving First-Time Motherhood at Midlife, Intensive Mothering, Out of Sync, and Perimenopause as a State of Uncertainty. CLINICAL IMPLICATIONS: Increasingly, nurses and nurse midwives will be caring for women aged 40 and older as they navigate motherhood during the transition to menopause. Through their stories, women can share concerns they have about mothering at an older age, and the effect of perimenopausal symptoms on their mothering experiences. Nurses should offer anticipatory guidance to women who delay motherhood until midlife, provide information about the transition to menopause, and assess the older mother's level of social support. Nurses can help build capacity for support within community and professional resources, such as hospital supported mother/baby and breastfeeding support groups.

Uncertainty during perimenopause: perceptions of older first-time mothers.

AIM: This article is a report of a study exploring older first-time mothers' perceptions of health during their transition to menopause. BACKGROUND: Increasing numbers of women world-wide are delaying motherhood, yet little is known about the unique phenomenon created when midlife motherhood is closely followed by the transition to menopause. A literature search revealed that the effect of these overlapping life transitions on women's health was unknown. DESIGN: A hermeneutic phenomenological approach utilizing Gadamer's philosophical underpinnings guided the study. METHOD: A purposive sample of thirteen women aged 45-56 years who were mothering children aged 12 years or younger and experiencing symptoms of perimenopause was recruited. Two in-depth interviews were conducted with each woman and meaning was mutually negotiated through participative dialogue with the women, ongoing construction and thematic analysis of data collected between 2004 and 2007. FINDINGS: The key theme 'Perimenopause as a State of Uncertainty' is an interpretation of older first-time mothers' perceptions of health during perimenopause and is the focus of this article. Hermeneutic interpretation culminated in the construct 'uncertainty' as theoretical embodiment of the women's lived experience. An uncertain temporality, projection of the lifespan and valuing health as precious enabled these women to transform uncertainty into opportunities for health promotion to 'be there' for their children. CONCLUSION: Nurses, nurse practitioners and midwives will increasingly be caring for midlife mothers and need to understand the unique issues of older mothers to offer education and health promotion that support healthy transitions to menopause.

Evaluation of undergraduate students using Objective Structured Clinical Evaluation.

This study proposed to develop an Objective Structured Clinical Evaluation (OSCE) for senior undergraduate nursing students. This evaluation process uses a simulated and standardized format to measure synthesis of knowledge and clinical skills. The benefit of OSCE is that it provides a formative evaluation for both students and the educational institute. The study included developing case studies, identifying or developing assessment tools, hiring and training standardized patients, obtaining a testing site, and analyzing data. A total of 49 students were assessed on three of six patient simulation stations and one of two nonpatient stationary stations. Both formative and summative evalu-

Pregnant adolescents' perspectives of pregnancy.

PURPOSE: To gain a clearer understanding of teens' perspectives on pregnancy and parenting. DESIGN Descriptive qualitative study using grounded theory. METHODS: The sample was comprised of 20 pregnant 15- to 19-year-old teens in the second or third trimester of pregnancy who planned to keep their child. A taped interview of each participant was performed either in the school the teen was attending or in the privacy of her home. Data were analyzed using the constant comparative method. Interviews were compared with each other to confirm/disconfirm emerging themes. RESULTS: The comparison of the data from the 20 interviews resulted in themes clearly describing the teens' perceptions of the changes related to pregnancy, how they managed these changes, and their views on mothering. Three major themes emerged: "The pregnant me--unexpected changes," "Transformed relationships," and "Envisioning mothering." CLINICAL IMPLICATIONS: Nurses caring for pregnant adolescents who have made the decision to keep their babies should carefully assess each individual's strengths, weaknesses, hopes, and goals prior to developing a plan of care. Identifying the teens' living situations and support from family, father of the baby, and/or friends and recognizing and building upon the strengths the teens bring to the pregnancy may influence the pregnancy's outcome. Encouraging attendance and participation in programs specifically designed for pregnant adolescents and adolescent parents may be a helpful strategy for these teens.