- Email: [email protected]
Pregnancy Intention and Contraceptive Use Among Low Income Women
RESEARCH Proceedings of the 2014 AWHONN Convention
The Impact of Maternal Comorbidities on the Cost of Care for Pregnant Women and Newborns Objective o examine the prevalence of maternal comorbidities and their effect on pregnancy, delivery, and newborn-related health care costs.
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Design Retrospective analysis. Richard Lynen, MD, Bayer HealthCare Pharmaceuticals, Wayne, NJ
comparative
cohort
database
Setting Truven Health MarketScan Commercial Claims and Encounters Database, 2007 to 2011. Sample
Amy Law, PharmD, MS, Bayer Women aged 15 to 49 with commercial health care HealthCare Pharmaceuticals, insurance, a medical claim of live birth, and conWayne, NJ Mark McCoy, PharmD, MBA, Bayer HealthCare Pharmaceuticals, Wayne, NJ
tinuous medical and drug benefit coverage 12 months before the first medical claim for pregnancy and 3 months following the birth.
Methods Comorbid conditions among women with live births were identified during the 12 months prior to the first pregnancy claim (index date) using an adaptation of the AHRQ Clinical Classification. Matthew Shevrin, MM, Truven Women and their newborns were linked using a Health Analytics, Ann Arbor, unique family identifier; the first live-birth event in MI the study period was retained for analysis. Medical (inpatient and outpatient) and pharmacy costs Paul Juneau, MS, Truven accrued between the index date and the day beHealth Analytics, Ann Arbor, fore delivery for the mothers and 3 months followMI ing delivery for the mothers and newborns were assessed. Health care utilization and costs were Pamela Landsman-Blumberg, DrPH, MPH, Truven Health descriptively analyzed for the women with one Analytics, Ann Arbor, MI or more prespecified comorbidity and compared to women without the comorbidity during pregKeywords Suellen Curkendall, PhD, Truven Health Analytics, Ann Arbor, MI
nancy and 3 months following delivery. The incremental pregnancy or newborn costs associated with the comorbidity were assessed using multivariable regression controlling for maternal demographics, all comorbidities evaluated, and compared to mothers without comorbidities. Results A total of 322,141 mothers with live births were included in the database. Of these, 135,572 were linked to 137,040 newborns after applying the inclusion criteria. The most prevalent comorbidities among all mothers included back disorders (9.5%), mental disorders (excluding psychoses; 6.4%), allergic rhinitis (5.9%), headache/migraine (5.6%), osteoarthritis (4.9%), hypertension (2.1%), and diabetes (1.1%). The estimated costs of care for mothers without a comorbid condition and their newborns were $10,221 (SE = 219) and $1,653 (SE = 171), respectively. The presence of maternal nongestational diabetes and hypertension were associated with the highest incremental costs of care in the mother ($6,211 [CI 5,7206,702] and $3,367 [CI 2,935-3,799], respectively) and newborn ($2,067 [CI 1,515-2,618] and $1,210 [CI 725-1,695], respectively). Inpatient care was the largest single contributor to incremental costs across all comorbidities. Conclusion/Implications for Nursing Practice Particular comorbidities lead to significant incremental costs of care for the mother during pregnancy and the newborn. Comorbidities with the highest cost represent opportunities for additional focus that may potentially improve care and reduce costs.
comorbidities pregnancy costs newborn care prenatal care
Poster Presentation
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2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
http://jognn.awhonn.org
Gray, S., Berggren, E., and Lauver, L.
RESEARCH Proceedings of the 2014 AWHONN Convention
Pre-Pregnancy Obesity and Weight Gain During Pregnancy: Relationship to the Development of Gestational Diabetes Mellitus and the Birth of a Large for Gestational Age Neonate Shawana Gray, DNP, CRNP, Thomas Jefferson University, Philadelphia, PA Erica Berggren, MD, MSCR, Thomas Jefferson University Hospital, Philadelphia, PA Lori Lauver, PhD, RN, CPN, CNE, Thomas Jefferson University, Danville, PA Keywords maternal neonate obesity large for gestational age gestational diabetes gestational weight
Women’s Health Poster Presentation
Objective o compare the prevalence of gestational diabetes mellitus (GDM) and large for gestational age (LGA) neonates in pregnant obese women who gain less than, within, and greater than the 2009 recommended weight gain guidelines of the Institute of Medicine (IOM).
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Design A retrospective cohort study. Setting Data from the University of North Carolina (UNC) Perinatal Database. Sample Women with singleton pregnancies and body mass indices (BMI kg/m2 ) ࣙ 30 delivering between January 2012 and December 2012 who underwent routine screening for GDM at UNC Women’s Hospital. Methods We measured the association between early weight gain (EWG) and diagnosis of GDM and the association between total gestational weight gain (TWG) and LGA neonate. To determine EWG and TWG, respectively, we subtracted prepregnancy weight from weight at GDM screening or weight at last prenatal visit >37 weeks. We calculated and classified EWG as less than, greater than, and within based on IOM guidelines for first trimester (1.1 pounds) and second trimester weekly weight gain (0.4-0.6 pounds; <0.4 = below, 0.4-0.6 = within, >0.6 = above). Women were separately classified as gaining less than (<11 pounds), within (11-20 pounds), and greater than (>20 pounds) IOM guidelines for TWG. We com-
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pared maternal demographics and medical history data using Pearson chi-square and t test. We reported unadjusted and adjusted risk ratios (RR, aRR) with 95% confidence intervals (95%CI) for GDM and LGA with women gaining less than IOM guidelines as reference. Final adjusted models included prepregnancy BMI, EWG within guidelines, and gestational age at 1-hour screening. Results Among 778 obese women, 67% (524/778) had full data for EWG analysis; 33% (171/524) gained less than, 17% (90/524) within, and 50% (263/524) greater than IOM recommendations. EWG adherence was not associated with a GDM diagnosis (p = .9). Seventy-one percent (549/778) had full data for TWG analysis; 24% (130/549) gained less than, 20% (108/549) within, 55% (304/549) greater than IOM guidelines. Compared with women gaining less than, those gaining within IOM guidelines were more likely to have an LGA neonate (RR = 2.88, 95% CI 1.05-7.95; aRR = 3.36, 95% CI 1.1010.31). Compared with women gaining less than, those gaining greater than IOM recommendations were more likely to have an LGA neonate (RR = 3.25, 95% CI 1.30-8.08; aRR = 3.54, 95% CI 1.1011.79). Conclusion/Implications for Nursing Practice Among obese women, EGW adherence to IOM guidelines did not affect GDM diagnosis in our data. Total gestational weight gain within and greater than the IOM recommendations was associated with birth of LGA neonate. Using arenas of practice, health policy, and education nurses can assist in decreasing the incidence of LGA and GDM.
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Mammography-Seeking Practices of Central Illinois Amish Women Objective o explore possible explanations for differences in mammography rates between Amish women in Arthur, Illinois, and other populations.
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Design In this cross-sectional study, primary data were collected through a mail questionnaire focusing on breast cancer history, mammography-seeking practices, and beliefs surrounding breast health. Setting Arthur is a small, rural community in central Illinois. Though most residents are Amish, the Arthur Amish community expands beyond the Arthur city limits into several other small, neighboring towns, including Arcola, Atwood, Humboldt, Lovington, Sullivan, and Tuscola, Illinois. Sample Female members of the Arthur, Illinois, Amish community (N = 143), aged 40 to 70. Methods Data were collected from this unique, socially isolated group through a mail questionnaire. Sample mammography adherence and rates of ever having a mammogram were compared with
the general population and other U.S. Amish Sarah Dee Geiger, PhD, Northern Illinois University, communities. DeKalb, IL
Results Logistic regression on the ever having a mammogram variable showed that compared to those who did not have knowledge of screening guidelines, Amish women with knowledge of screening guidelines had an odds ratio (OR) of 5.26 (confidence interval [CI] 1.79-15.45) for mammography screening compared to those without that knowledge. Participants who believed nutrition/diet causes breast cancer had an OR of 4.27 (CI 1.39-13.11) for mammography, and those who believed physical injury causes breast cancer had an OR of 3.86 (CI 1.24-12.04) compared to women who do not hold these beliefs.
Diana Grigsby-Toussaint, PhD, University of Illinois, Urbana, IL Keywords breast cancer mammography Amish disparities
Women’s Health Poster Presentation
Conclusion/Implications for Nursing Practice Pre-existing research and data from this study indicate that rates of mammography in Amish women and ideas about mammography lag far behind the rest of the U.S. population. Future research is needed to confirm these results and further explore the role of nurses in providing outreach and education to Amish women regarding the benefits of mammography and breast cancer risk.
An Internet-Based Education/Support Program for Menopause Symptoms of Korean American Midlife Women Objective o describe development of an Internet-based education/support program for menopausal symptom management of Korean American midlife women based on findings from a larger study on midlife women’s experience of menopause symptoms.
walkthrough method. The records of the experts’ evaluation were analyzed using content analysis. Then, as a group, the research team made decisions on the development of specific areas and incorporated them into further development of the program.
Eun-Ok Im, PhD, MPH, FAAN, The University of Pennsylvania, Philadelphia, PA
Design An intervention development study.
Results Based on the findings of previous studies, seven predictors were identified to influence the experience of menopause symptoms of Korean American midlife women. Then, the focus of the program development was given to the women’s attitudes because other predictors were nonmodifiable. Among the nonmodifiable predictors, only the country of origin, the length of time in the United States, and the immigration generation were incorporated into the program development. The program was designed to have three
Eunice Chee, Undergraduate, Research Assistant, The University of Pennsylvania, Philadelphia, PA
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Setting Not applicable. Sample Not applicable. Methods The program was developed using the information-mapping approach and the cognitive
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JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
Wonshik Chee, PhD, The University of Pennsylvania, Philadelphia, PA
http://jognn.awhonn.org
RESEARCH
Im, E-O., Chee, W., and Chee, E.
Proceedings of the 2014 AWHONN Convention
Keywords intervention midlife women menopause symptom management Internet-based web-based
Women’s Health Poster Presentation
components as follows: interactive online message board; interactive online educational sessions; and online resources. Graphic user interface controls were used, and the presentation styles were tailored to Korean American culture. As technological tools, the Ruby on Rails framework and the Xen hypervisor were used. All experts positively evaluated the program but had several suggestions to make the structure more user-friendly. Two experts made some suggestions for the educational contents of the program (hormone replacement therapy and serotonin reuptake inhibitors). Based on the findings, the program has been further refined.
Conclusion/Implications for Nursing Practice Asian American midlife women, including Korean American midlife women, rarely seek help for their menopausal symptoms until the symptoms become intolerable, which frequently results in unnecessary burden to these women and subsequent disparities in symptom management. Thus, it is imperative to provide information and support for Korean American midlife women so that they can transition through menopause smoothly and successfully. Researchers need to make continuous efforts to develop and evaluate Internet-based education and support programs.
Pregnancy Intention and Contraceptive Use Among Low Income Women Yenupini Joyce Tonlaar, BSN, Objective RN, Michigan State University, o describe pregnancy intention and proper East Lansing, MI
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Adejoke B. Ayoola, PhD, RN, Calvin College, Grand Rapids, MI
use of contraceptive methods among low income, mostly minority women living in underserved neighborhoods to provide appropriate contraceptive education.
Keywords pregnancy intention contraceptive use unintended pregnancies Preconception Reproductive Knowledge Promotion Project
Design A descriptive study using baseline survey data from an ongoing randomized controlled trial, the Preconception Reproductive Knowledge Promotion Project (PREKNOP). Social Cognitive Theory and the Health Promotion Model were used as the guiding frameworks for the study.
Women’s Health Poster Presentation
Setting Three racially diverse, low income, underserved, urban neighborhoods in a Midwestern state. Sample Participants were women of childbearing age who were enrolled in PREKNOP. Women who completed the baseline survey and reported not planning on getting pregnant in the next 6 months (n = 61) were included in the analysis. Methods A descriptive design was used to collect baseline survey data. Questions were asked about participants’ plans to get pregnant in the next 6 months and incorrect use of contraception during sexual intercourse within the past month. Univariate and bivariate analyses were conducted using STATA 11.
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Results Approximately 50% of the women had a household income of less than $10,000; 65% were not married; 44% were Hispanic; and approximately 38% were Black. Women’s ages ranged from 18 to 51 years (mean = 30 years). More than one third of the women (34%) reported having sex without using contraceptives properly. Most Black (70%) and Hispanic (89%) women definitely did not want to become pregnant but were more likely to have sexual intercourse without proper use of contraception (43% Black, 30% Hispanic).
Conclusion/Implications for Nursing Practice About half of all pregnancies in the United States are unintended. Unintended pregnancy often results from lack of, inconsistent use of, or incorrect use of contraceptive methods. Rates of unintended pregnancies are greatest among poor and minority women and are associated with increased health risks for the mother and infant. Limited research has been done on pregnancy intention and proper contraceptive use in low income and minority women. Our findings suggest a need for education on the importance of using contraceptives properly to prevent unintended pregnancies, especially in low income Black and Hispanic women. In addition, there is a need to investigate further reasons why some low income and minority women fail to use contraceptives properly and put themselves at risk for unwanted pregnancies.
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Identifying the Health Needs of Hispanic Women From a Church Community Objective o examine knowledge, attitudes, and beliefs regarding access to health care services and health issues among an underserved community of Hispanic women in the Northeast United States.
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Design Cross-sectional exploratory. Setting Primarily Hispanic church in the Northeast United States. Sample Hispanic women (N = 66). Methods A 94-item Health Needs Assessment was used to collect data. Descriptive statistics, chi-square, and t tests were used to analyze the data. Results The most common health issue among this population was obesity/overweight. Thirty two percent of the women were not U.S. citizens. Satisfaction with care was significant among those with insurance, who were U.S. citizens, and who had a medical diagnosis. Thirty seven percent of the women used the emergency room as their usual
source of care, 41% reported their health as fair to Patricia Suplee, PhD, RNC-OB poor, and preventive service rates were less than and Bonnie Jerome-D’Emilia, PhD, MPH, RN, Rutgers what has been reported in the literature. University, Camden, NJ
Conclusion/Implications for Nursing Practice In the absence of adequate primary care, the uninsured go without care, utilize the emergency department as a primary care facility, and ultimately experience health disparities. Accurate assessments of present service use by the poor and underserved will allow for improved planning of services and the development of policy that will target the needs of invisible populations. In the United States, two of the most salient factors determining access to care are whether or not a person has health insurance and the person’s race or ethnicity. Hispanics account for about one third of the uninsured in the United States.
Marcia Gardner, PhD, RN, CPNP, CPN, Seton Hall University, South Orange, NJ Keywords access to care health needs Hispanic women disparities
Women’s Health Poster Presentation
Health needs assessments are useful in understanding subpopulations within communities. Advanced practice nurses and nurses need to gain insight into issues that affect the women they care for, including access to and satisfaction with care, how preventive services are utilized, and specific health needs. Culturally appropriate interventions can then be designed and implemented for specific populations of women served.
Dimensions of a Woman’s Experience of Inevitable Miscarriage Objective o explore a woman’s experience of early pregnancy loss when she is diagnosed with an inevitable miscarriage through understanding her description of symptoms and treatment decisions.
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Design This qualitative study consisted of transcribed data from a recorded telephone interview lasting from 30 to 45 minutes. Researchers used a semistructured interview guide.
Setting Nurses recruited the participants from an obstetrics/gynecology outpatient clinic at a Midwestern medical center.
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Sample A purposive sample of women who experienced a miscarriage at or before 14 weeks of pregnancy, needed to make a treatment decision (medical, surgical, expectant management), were at least 18 years old, and spoke English were recruited.
Rana K. Limbo, PhD, RN, PMHCNS-BC, CPLC, FAAN, Gundersen Health System, La Crosse, WI Jo K. Glasser, PhD, MBA, MS, Gundersen Health System, La Crosse, WI Maria E. Sundaram, MSPH,
Marshfield Clinic, Marshfield, Methods Dimensional analysis, a method generic to WI grounded theory but appropriate for existing data, was used to analyze transcripts. Women were asked, “Tell me about your miscarriage” with follow-up questions such as, “How did you decide what to do next?” or “What went into knowing what to do next?” Using line-by-line analysis, the research team identified dimensions and related conditions.
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
http://jognn.awhonn.org
Limbo, R. K., Glasser, J. K., and Sundaram, M. E.
RESEARCH Proceedings of the 2014 AWHONN Convention
Keywords miscarriage medical decision making perinatal loss ultrasonogram
Women’s Health Poster Presentation
Results Participants ranged in age from 23 to 40 years, with a mean age of 31. All were married. Fifteen women decided on surgical intervention, one chose medical, and seven chose expectant management. The women described two central dimensions: being sure they were miscarrying and being sure they chose the right treatment option. Making decisions about treatment were compelling due to potential for pregnancy viability. Conditions for being sure included relationship with their health care provider (physician or nurse midwife), severity or extent of symptoms (bleeding and cramping, absence or change in pregnancy symptoms), medical technology, personal intuition, and input and advice from others (e.g., friend who had miscarried).
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Conclusion/Implications for Nursing Practice Women wanted to know what to watch for (e.g., how to determine how much bleeding is too much) when they learned their miscarriage was inevitable. They were also traumatized by miscarrying in the toilet and either retrieving or flushing the products of conception. Findings support the critical role of nurses in health care of women with early pregnancy loss. Understanding symptoms, helping women know what to expect, the importance of confirmed nonviability of pregnancy, and the need for support from the woman’s health care team are key to evidence- and relationship-based nursing care.
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Barriers to Implementation of Skin-to-Skin Care Objective o determine the perceptions of perinatal nurses of barriers to implementation of skinto-skin care (SSC) in the acute care setting.
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Design Quantitative, descriptive, correlational study. Darcy Gepilano, MSN, RNC, EFMCC, Kaiser Permanente/Sutter Medical Center, Elk Grove, CA Keywords skin-to-skin breastfeeding nursing culture
Poster Presentation
Setting Two Northern California hospitals that have committed to breastfeeding and SSC with similar delivery rates and geographical location, but different Baby-Friendly certification status. Sample The sample consisted of 76 labor and delivery and neonatal intensive care unit registered nurses from the two medical centers. Methods Nurses were anonymously surveyed using a 20question Likert-style survey developed by the researcher. The survey’s reliability was established by performing a pilot study of ten perinatal nurses. Cronbach’s alpha reliability coefficient was applied with a result of a .76 reliability coefficient, indicating that the survey would reflect fine discriminations in the levels of the construct. The Mann-Whitney U test was applied to the sample with further calculations of z and p values to determine significance of responses.
Results Using standard values to reject the null hypothesis, calculations revealed that 15 of the 17 nondemographic questions demonstrated a more favorable response to the implementation of SSC per Baby-Friendly standard from nurses employed at the Baby-Friendly certified facility.
Conclusion/Implications for Nursing Practice As hospitals make a commitment to assist mothers with successful breast feeding, additional research is needed to examine the effect of nursing culture on this goal. We examined hospital practices, procedures, and routines that affect SSC and ultimately the question Does having a Baby-Friendly Hospital Certification affect the nursing culture on the perinatal unit? Our results hold implications for facilities attempting to implement SSC and change practice from taskoriented to evidenced-based nursing care. By first evaluating the nursing culture, educators can implement training specific to the needs of the group they serve. Any successful attempt to promote evidence-based practice must consider research that addresses barriers and facilitators to the adoption of the practice by nurses. Therefore, identifying barriers should be considered a primary step in implementing evidence-based practice changes.
Improving Outcomes of Preeclampsia in California: From Review of Maternal Death to Quality Care Collaboratives Christine H. Morton, PhD, Stanford University, Palo Alto, CA Nancy Peterson, RNC, PNNP, MSN, IBCLC, Stanford University, Palo Alto, CA Keywords preeclampsia/eclampsia pregnancy-related mortality severe hypertension quality improvement
Childbearing Poster Presentation
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Objective o describe characteristics of women in California who died from preeclampsia/eclampsia in 2002 to 2004, identify contributing factors and quality improvement opportunities, and report on process and outcome measures from a multihospital, statewide learning collaborative that implemented a Maternity Care Improvement Preeclampsia Toolkit.
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Design In 2004, the California Maternal, Child and Adolescent Health Division developed an enhanced surveillance method to identify maternal deaths from administrative data; women’s abstracted medical records were reviewed by an expert committee to determine causes of death and opportunities for prevention.
Setting Data were collected as part of the California Pregnancy-Associated Mortality Review (CAPAMR) and from CA-PAMR committee determination after case review. Data collection included classification of pregnancy-relatedness, contributing factors, and quality improvement opportunities. Learning Collaborative participants submitted process and outcomes measures related to the implementation of the Preeclampsia Toolkit.
Sample Cases of pregnancy-related deaths (145) from preeclampsia/eclampsia in California between 2002 and 2004 from 26 hospitals in a statewide learning collaborative.
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
http://jognn.awhonn.org
Morton, C. H., Lyndon, A., and Singleton, P.
RESEARCH Proceedings of the 2014 AWHONN Convention
Methods Mixed methods analysis was conducted of the CA-PAMR data; Learning Collaborative data were analyzed using frequency and trend charts. Results After case review, 145 maternal deaths from 2002 to 2004 were determined to be pregnancy-related. Preeclampsia was the second leading cause of death accounting for 17% of all pregnancy-related deaths in 2002 to 2004. The women who died from preeclampsia in California from 2002 to 2004 were more likely to be Hispanic, multiparous, and have normal body mass index (BMI) compared to women who died of other pregnancy-related causes. Nearly all (n = 24/25) of these deaths were determined to have some degree of preventability, with half having a good-to-strong chance. Analysis of the opportunities to improve quality and reduce preventable maternal deaths revealed themes re-
lated to the need for recognition and response to clinical triggers (i.e., warning signs) in clinical status and care coordination. Learning collaborative participants reported increased levels of awareness and education regarding the importance of treating severe hypertension in pregnant women as a result of debriefing activity. Sites improved methods for medical chart documentation and coding, and overall data quality improvements as they apply to women with hypertensive disorders, including preeclampsia. Conclusion/Implications for Nursing Practice Implementation of the Preeclampsia Toolkit in the multihospital, statewide Learning Collaborative is intended to reduce rates of severe maternal morbidity and prolonged postpartum length of stay. Learning Collaborative participants who adopted the Toolkit showed measurable improvement in the ability of their sites to respond to this leading cause of pregnancy-related morbidity and mortality.
Peripartum Cardiomyopathy Narratives: Lessons for Obstetric Nurses Christine H. Morton, PhD, Stanford University, Palo Alto, CA Audrey Lyndon, PhD, RNC, FAAN, University of California, San Francisco, CA Paula Singleton, PhD, MBPsS, Leeds Metropolitan University, Leeds,UK Keywords peripartum cardiomyopathy maternal morbidity pregnancy complications women’s experience
Childbearing Poster Presentation
Objective o contribute to the theoretical understanding of diagnosis peripartum cardiomyopathy (PPCM) and inform the clinician and patient education components of the Maternity Care Improvement Toolkit on Cardiovascular Disease in Pregnancy.
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Design Qualitative descriptive study using publically available Internet narratives posted by women diagnosed with PPCM. Setting Three online support groups for women diagnosed with PPCM.
Sample Unique narratives (N = 94).
Methods We conducted an online search using the terms PPCM and support. We found three websites that contained publicly accessible stories or biographies (narratives) posted by women diagnosed with PPCM, yielding narratives from 94 women. Narratives were downloaded and deidentified prior to analysis. Narratives were analyzed thematically according the methods of Braun and Clarke.
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Results The primary themes included symptom experience, dismissal of symptoms by health care providers, including obstetric providers, cardiology providers, and emergency department providers, and a degree of fragmentation in care that endangered women in potentially lifethreatening situations. Symptoms such as shortness of breath, fatigue or exhaustion, fluid retention, and excessive weight gain overlap with normal discomforts of pregnancy, creating space for clinicians to overlook the seriousness of their situation. This analysis highlights missed opportunities for timely, potentially lifesaving, diagnosis of PPCM; the importance of valuing women’s knowledge of their bodies; the importance of positive interactions with maternity clinicians; and the critical role of ongoing social support throughout treatment and recovery. Conclusion/Implications for Nursing Practice Cardiovascular disease, especially PPCM, is the leading cause of death among California women, based on the California Pregnancy-Associated Mortality Review, 2002 to 2004. Taking women seriously and valuing their knowledge as authoritative is critical to prompt accurate diagnosis. Women who receive this diagnosis, similar to other severe morbidities, are likely to experience posttraumatic stress disorder and require additional supportive care and resources as they adjust to postpartum life and recover from life-threatening illness.
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Childbearing Experiences of Women With Asperger Syndrome Objective o explore the childbearing experiences of mothers with Asperger syndrome (AS).
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Design Secondary analysis study. Setting Online AS support groups. Sample Eight women. Methods Existing narrative data acquired from participants from online AS support groups who assisted in creating the online questionnaire were analyzed. All identifiers were removed by an honest broker before the narrative data were given to the researchers. An exploratory interpretive qualitative analysis using a constant comparative approach with data immersion was used. Triangulation of data through lay literature and parent-organized websites was confirmatory. Results Several key themes emerged from the analysis of data from the eight women with AS who had given
birth: (a) hypersensitivities to sound, light, and touch throughout prenatal and intrapartum care; (b) increased anxiety during face-to-face interactions causing shutdown and interference with understanding health teaching and counseling; (c) excellent health promotion behaviors and dedication to being good mothers; (d) medical and behavior therapies for AS were often altered during the childbearing cycle; and (e) rewarding motherinfant attachment and breastfeeding reported.
Conclusion/Implications for Nursing Practice As knowledge about autism has substantially increased over the last two decades and more individuals have been formally diagnosed with AS, caring for childbearing women who present with this diagnosis may be a relatively new phenomenon for obstetric health care providers, and no published research exists to guide clinicians on caring for these women. Nurses are in key positions to integrate what they already know about women with AS and postulate what their needs may be when providing care during the childbearing period. Clinically significant information was identified that has implications for tailoring nursing care to women with AS.
Patricia Suplee, PhD, RNC-OB, Rutgers University, Camden, NJ Marcia Gardner, PhD, RN, CPNP, CPN, Seton Hall University, South Orange, NJ Joan Bloch, PhD, CRNP, RN, Drexel University, Philadelphia, PA Karen Lecks, MSN, CRNP, University of Pennsylvania, Philadelphia, PA Keywords Asperger syndrome childbearing cycle secondary analysis
Childbearing Poster Presentation
The Meaning, Experiences, and Behaviors of Nurses Caring for Women With a Perinatal Loss Objective o explore the experiences of obstetric, postanesthesia, and emergency nurses in caring for women after fetal death.
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Design Qualitative study using focus group (FG) interviewing. Setting Two large, acute care hospitals with level 3 nurseries. Sample Four FGs were conducted involving 24 total participants. Participants were registered nurses currently working in labor and delivery, antepartum, postanesthesia, and emergency depart-
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ments who have been employed for at least 1 Janice E. Hill, RNC, BSN, year and had experience in caring for a patient Norton Hospital, Louisville, KY with fetal loss. Methods The FG questions were carefully constructed based on the major concepts of Swanson’s Theory of Caring: open-ended, clear, appropriately sequenced, and supportive of the group process and response maximization. Participants also completed a brief demographic questionnaire. Interviews were audio-taped, transcribed verbatim, and deidentified. Transcripts were then uploaded for coding by research team members. Analysis was conducted using a continuously emergent process of data collection, reduction, display, and interpretation. Team members coded the transcripts that were then compared
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
Susan White, RN, MS, CNM, IBCLC, Norton Hospital, Louisville, KY Marianne Hopkins Hutti, PhD, WHNP-BC, University of Louisville, Louisville, KY Barbara Polivka, PhD, RN, University of Louisville School of Nursing and Norton Healthcare, Louisville, KY
http://jognn.awhonn.org
RESEARCH
Levine, M. S. and Lowe, N. K.
Proceedings of the 2014 AWHONN Convention
Paul R. Clark, RN, PhD, MA, Norton Healthcare, Louisville, KY Catherine Cooke, RN, MSN, CEN, Norton Suburban Hospital, Louisville, KY Margaret Mariella, BA, University of Louisville, Louisville, KY Savannah Clemens, University of Louisville, Louisville, KY Keywords compassion fatigue secondary traumatic stress obstetrics emergency operating room and recovery room nurses
for agreement. Any discrepancies in coding and theme identification were resolved through discussion and group consensus.
Results Nurses in all areas of specialty demonstrated Swanson’s nurse caring behaviors but used them preferentially according to situational exigencies and level of rapport developed with the patient. Themes that emerged from the data included Strategies for Coping in the Moment, Making Meaning of the Experience, Situations That Make Care Easier, Situations that Make Care More Difficult, and Priority of Care. Symptoms of compassion fatigue described by nurses included anger, intense sorrow, feeling incompetent, over-
whelmed, exhausted, inconsolable, and having a desire to avoid patient care. Conclusion/Implications for Nursing Practice Nurses who are indirectly exposed to trauma through their work are at high risk of developing compassion fatigue. There is limited research to identify whether nurses in obstetrics, emergency departments, and postanesthesia units who provide care to women who have experienced fetal death are at increased risk of developing compassion fatigue. Nurses try very hard to give the best care they can to women after fetal loss. In doing so, they make themselves vulnerable to compassion fatigue. Further research is needed to identify ways to support nurses as they provide care to these traumatized patients.
Childbearing Poster Presentation
Measuring Nurses’ Attitudes and Beliefs About Childbirth Martha S. Levine, MS, RNC-OB, C-EFM, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO Nancy K. Lowe, CNM, PhD, FACNM, University of Colorado Health Science Center, Denver, CO Keywords nurse attitudes labor and delivery nurses childbirth
Childbearing Poster Presentation
Objective o develop a reliable and valid instrument to measure nurse attitudes and beliefs about childbirth.
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Design The Nurse Attitudes and Beliefs Questionnaire Revised (NABQ-R) contains 42-items in five theoretically derived domains. Each item is scored with a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). A higher score indicates more positive attitudes toward physiological birth.
Setting An e-mail invitation containing a link to a secure electronic survey was sent to all AWHONN members in Colorado.
Sample The response rate was 21.6% with complete surveys returned from 84 labor and delivery nurses with a mean age of 46.7 years and 18.9 years of perinatal nursing experience. The sample was 98% White with an educational distribution of 17.9% diploma/associate, 42.9% baccalaureate, and 39.3% graduate degrees.
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Methods This online survey study provided an initial psychometric test of the NABQ-R. Results The NABQ-R scores ranged from 82 to 156 with a mean of 121.99 + 12.77. Cronbach’s α internal consistency reliability estimate was .90. Analysis of variance demonstrated a significant effect of education on NABQ-R scores such that nurses with graduate degrees had significantly more positive attitudes than nurses with baccalaureate (p = .003) or diploma/associate degrees (p = .002). To study construct validity, an exploratory factor analysis (EFA) using principal component analysis and varimax rotation was conducted. Factors with an eigenvalue ࣙ 1 were retained and the scree slope suggested a five-factor solution. Next, a varimax rotation was used with five specified factors that accounted for 46.11% of the variance with all items loading on at least one factor. We named the factors Women’s Experience of Birth, Women’s Autonomy, Medical Model Conflict, Breech Safety, and Intervention Influence. Conclusion/Implications for Nursing Practice Researchers have found that nursing care can influence patient outcomes during childbirth. The attitudes and beliefs of labor and delivery nurses
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RESEARCH Proceedings of the 2014 AWHONN Convention
may affect their care decisions and interventions. We consider this analysis preliminary to a more robust psychometric testing of the NABQ-R with a larger sample. Our results support acceptable initial psychometric properties for the NABQ-R, and the EFA results were consistent with existing the-
Newborn Care
Mothers’ Intentions to Breastfeed and Hospital Practices on Breastfeeding: A Longitudinal Study at 6 Months After Birth on Predictors of Breastfeeding in a Cohort of Mothers From a Large Northern New England Medical Center Objective o examine the effects of mothers’ intentions to breastfeed and hospital practices on breastfeeding rates at 6 months.
Methods Mothers completed a survey about infant feeding and hospital experiences before discharge between December 2010 and June 2012. Demographic and hospital practices data were collected through chart review. Follow-up calls were made at 6 months. Data were analyzed with logistic regression.
(60/181, 33%) were cited as most common reasons for no longer exclusively breastfeeding. No effects on 6-month breastfeeding rates were found for type of delivery, gravidity and parity, or a five predictor model: health problems (e.g., gestational diabetes), birth interventions (e.g., induction), antibiotics, spinal, and epidural/intrathecal anesthesia. Older age, greater education, being married or with a life partner (χ2 = 49.92, p < .001), and mothers’ intention to breastfeed predicted 6month breastfeeding (χ2 = 6.23, p = .044). Hospital practices that favorably predicted breastfeeding were early skin-to-skin contact (χ2 = 11.24, p = .024), avoiding supplements (χ2 = 13.87, p = .001), and avoiding pacifier use (χ2 = 7.25, p = .027). The odds of not breastfeeding at 6 months were higher if supplements (odds ratio [OR] = 2.01, CI 1.34-3.02) or pacifiers (OR = 1.65, CI 1.14-2.39) were used and if physicians suggested supplements (OR = 7.2, CI 2.47-21.09) while in the hospital, or if solid foods were started before 6 months (OR = 1.67, CI 1.17-2.39). Rooming-in (χ2 = 5.52, p = .238) and putting-to-breast early (χ2 = 1.64, p = .440) did not affect 6-month breastfeeding rates.
Results Seventy-seven percent (921/1200) completed the discharge survey and 60% (556/921) completed the follow-up. At 6 months, 25% (139/556) were exclusively breastfeeding, and 24% (133/556) were breastfeeding and/or pumping breast milk. Also, 20% (111/556) were using a combination of breastfeeding and/or pumped milk and formula, whereas 31% (173/556) were feeding formula only. Low milk supply (78/181, 43%) and return to work
Conclusion/Implications for Nursing Practice These findings demonstrate the need to further educate providers and encourage newborn care practices to sustain breastfeeding beyond the early postpartum period. The results may also be used to inform expectant parents (e.g., during childbirth classes) of hospital practices and personal decisions that may influence successful breastfeeding duration.
T
Design Predictive, longitudinal. Kara L. Kaikini, MS, IBCLC, Maine Medical Center, Portland, ME
Setting Hospital birth center in a large northeastern U.S. city.
Kristiina Hyrkas, PhD, LicNSc, Sample MNS, Maine Medical Center, A convenience sample of 1,200 mothers who gave Portland, ME Keywords breastfeeding breastfeeding duration hospital practices intention to breastfeed
Poster Presentation
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ory. The development of a theoretically and psychometrically sound instrument to measure nurse attitudes toward physiological birth will foster additional research to expand our understanding of how nurse attitudes affect the process and outcomes of labor and birth.
birth to full-term healthy infants and planned to breastfeed.
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
http://jognn.awhonn.org
RESEARCH
Simon-Burrell, M.
Proceedings of the 2014 AWHONN Convention
Infant Safe Sleep: An Evaluation of Infant Safe Sleep Practices in the Hospital Setting Marci Simon-Burrell, DNP, RN, WHNP-BC, Hutzel Women’s Hospital Detroit Medical Center, Detroit, MI Keywords infant safe sleep nursing practice
Newborn Care Poster Presentation
Objective o evaluate nurses’ knowledge and beliefs about best practices for infant safe sleep. To determine the degree to which the recommendations of the American Academy of Pediatrics’(AAP) for infant safe sleep were modeled and parent education was given by nurses at Hutzel Women’s Hospital (HWH).
T
Design Mix methods, qualitative and quantitative descriptive study. Setting Hutzel Women’s Hospital in Detroit, Michigan, one of Michigan’s largest birthing institutions delivering 5,000 infants each year. Sample The sample included 50 mothers, 50 infants, and 41 nurses. Methods Qualitative and quantitative methods such as structured interviews with mothers (N = 50), observing infants (N = 50) in their cribs, and assessing nurses’ (N = 41) beliefs and knowledge about best practices for infant safe sleep using the Infant Safe Sleep Knowledge questionnaire were used. Descriptive statistics were used to describe nurses’ beliefs about risk factors for Sudden Infant Death Syndrome and Sudden Unexpected Infant Death (SIDS/SUID) and knowledge about AAP infant safe sleep recommenda-
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tions. Chi-square analyses were used to examine relationships between nurses’ beliefs about SIDS/SUID risk factors and nurses’ personal characteristics. Pearson correlations and analysis of variance (ANOVA) were conducted to describe relationships between nurses’ beliefs and knowledge of AAP infant safe sleep risk practices. Results The nurses were very knowledgeable about the AAP recommendations, and few areas of knowledge deficit were identified. The quantitative observation data and the qualitative data from mothers’ comments indicated that nurses modeled best practices and taught parents about infant safe sleep recommendations by strongly encouraging parents to place their infants on their backs. Conclusion/Implications for Nursing Practice Perinatal nurses at HWH teach, model, and reinforce safe sleep practices to new mothers and families during hospitalization and prior to discharge. The nurses’ practice is appropriate and is consistent with the AAP infant safe sleep recommendations. Nurses play significant roles in working with families of newborn infants, and they are in key positions to affect rates of sudden infant death syndrome. Hospitals should provide nurses with ongoing continuing education to ensure that they remain current with safe sleep recommendations to educate patients and model safe sleep practices.
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Professional Issues
The Development and Evaluation of a Lactation Rotation for a Pediatric Residency Program at a Tertiary Care Teaching Hospital Objective o evaluate the effect of a Lactation Rotation on pediatric residents’ knowledge and clinical confidence about breastfeeding.
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Design Pretest-posttest design. Jennifer Albert, MSN, APN/CNP, WHNP-BC, RNC-OB, IBCLC, RLC, Advocate Lutheran General Hospital, Park Ridge, IL
Setting Tertiary care teaching center in Illinois. Sample Convenience sample of 12 first-year pediatric residents.
Jody Heinrichs-Breen, BSN, RNC-OB, RNC-MNN, IBCLC, RLC, Advocate Lutheran Methods General Hospital, Park Ridge, The participating 12 residents were provided IL Keywords breastfeeding physician knowledge clinical confidence
Professional Issues Poster Presentation
educational materials, including the American Academy of Pediatrics (AAP) policy statement on breastfeeding and the use of human milk, Wellstart International Self-Study Modules, Academy of Breastfeeding Medicine Protocols, and Hale’s Medications and Mothers’ Milk. Each resident spent a minimum of 50 hours with an International Board Certified Lactation Consultant (IBCLC). Training included inpatient rounding, hands-on management, observation with the neonatal intensive care unit IBCLC, answering helpline calls, and viewing breastfeeding videos. In addition, each resident created an evidence-based lactation presentation for staff. Residents were evaluated to measure proficiency in providing breastfeeding care. In turn, they evaluated their rotation in terms of strengths,
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weaknesses, and suggestions for improvement. To measure breastfeeding knowledge and clinical confidence levels, each resident completed the AAP’s Breastfeeding Residency Curriculum Pretest four times: the first and last day of the rotation and at 6 and 12 months postrotation. Results Pretest and confidence scores were evaluated. Statistically significant differences were found between test 1 and 2 (M = 74.67, SD = 8.41 vs. M = 87.33, SD = 7.78, p = .001), test 1 and 3 (M = 74.67, SD = 8.41 vs. M = 89.33, SD = 5.48, p < .001), and test 1 and 4 (M = 74.67, SD = 8.41 vs. M = 89.0, SD = 7.65, p < .001). No significant differences were found between tests 2, 3, and 4 (p values >.05), demonstrating retention of knowledge gained. With regards to clinical confidence, the ability to adequately address parent’s questions about breastfeeding differences between test 1 and 2, 1 and 3, and 1 and 4 were significant with confidence increasing in tests 2, 3, and 4 (p values being .003, .020, and .009, respectively), and the ability to completely manage common breastfeeding problems differences between test 1 and 2, 1 and 3, and 1 and 4 were significant with confidence increasing in tests 2, 3, and 4 (p values being <.001, .010, and p<.001, respectively). Conclusion/Implications for Nursing Practice As a result of an innovative, comprehensive educational lactation program, the pediatric residents’ knowledge and clinical confidence related to breastfeeding significantly increased.
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
http://jognn.awhonn.org
The Impact of Maternal Comorbidities on the Cost of Care for Pregnant Women and Newborns Objective o examine the prevalence of maternal comorbidities and their effect on pregnancy, delivery, and newborn-related health care costs.
T
Design Retrospective analysis. Richard Lynen, MD, Bayer HealthCare Pharmaceuticals, Wayne, NJ
comparative
cohort
database
Setting Truven Health MarketScan Commercial Claims and Encounters Database, 2007 to 2011. Sample
Amy Law, PharmD, MS, Bayer Women aged 15 to 49 with commercial health care HealthCare Pharmaceuticals, insurance, a medical claim of live birth, and conWayne, NJ Mark McCoy, PharmD, MBA, Bayer HealthCare Pharmaceuticals, Wayne, NJ
tinuous medical and drug benefit coverage 12 months before the first medical claim for pregnancy and 3 months following the birth.
Methods Comorbid conditions among women with live births were identified during the 12 months prior to the first pregnancy claim (index date) using an adaptation of the AHRQ Clinical Classification. Matthew Shevrin, MM, Truven Women and their newborns were linked using a Health Analytics, Ann Arbor, unique family identifier; the first live-birth event in MI the study period was retained for analysis. Medical (inpatient and outpatient) and pharmacy costs Paul Juneau, MS, Truven accrued between the index date and the day beHealth Analytics, Ann Arbor, fore delivery for the mothers and 3 months followMI ing delivery for the mothers and newborns were assessed. Health care utilization and costs were Pamela Landsman-Blumberg, DrPH, MPH, Truven Health descriptively analyzed for the women with one Analytics, Ann Arbor, MI or more prespecified comorbidity and compared to women without the comorbidity during pregKeywords Suellen Curkendall, PhD, Truven Health Analytics, Ann Arbor, MI
nancy and 3 months following delivery. The incremental pregnancy or newborn costs associated with the comorbidity were assessed using multivariable regression controlling for maternal demographics, all comorbidities evaluated, and compared to mothers without comorbidities. Results A total of 322,141 mothers with live births were included in the database. Of these, 135,572 were linked to 137,040 newborns after applying the inclusion criteria. The most prevalent comorbidities among all mothers included back disorders (9.5%), mental disorders (excluding psychoses; 6.4%), allergic rhinitis (5.9%), headache/migraine (5.6%), osteoarthritis (4.9%), hypertension (2.1%), and diabetes (1.1%). The estimated costs of care for mothers without a comorbid condition and their newborns were $10,221 (SE = 219) and $1,653 (SE = 171), respectively. The presence of maternal nongestational diabetes and hypertension were associated with the highest incremental costs of care in the mother ($6,211 [CI 5,7206,702] and $3,367 [CI 2,935-3,799], respectively) and newborn ($2,067 [CI 1,515-2,618] and $1,210 [CI 725-1,695], respectively). Inpatient care was the largest single contributor to incremental costs across all comorbidities. Conclusion/Implications for Nursing Practice Particular comorbidities lead to significant incremental costs of care for the mother during pregnancy and the newborn. Comorbidities with the highest cost represent opportunities for additional focus that may potentially improve care and reduce costs.
comorbidities pregnancy costs newborn care prenatal care
Poster Presentation
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2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
http://jognn.awhonn.org
Gray, S., Berggren, E., and Lauver, L.
RESEARCH Proceedings of the 2014 AWHONN Convention
Pre-Pregnancy Obesity and Weight Gain During Pregnancy: Relationship to the Development of Gestational Diabetes Mellitus and the Birth of a Large for Gestational Age Neonate Shawana Gray, DNP, CRNP, Thomas Jefferson University, Philadelphia, PA Erica Berggren, MD, MSCR, Thomas Jefferson University Hospital, Philadelphia, PA Lori Lauver, PhD, RN, CPN, CNE, Thomas Jefferson University, Danville, PA Keywords maternal neonate obesity large for gestational age gestational diabetes gestational weight
Women’s Health Poster Presentation
Objective o compare the prevalence of gestational diabetes mellitus (GDM) and large for gestational age (LGA) neonates in pregnant obese women who gain less than, within, and greater than the 2009 recommended weight gain guidelines of the Institute of Medicine (IOM).
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Design A retrospective cohort study. Setting Data from the University of North Carolina (UNC) Perinatal Database. Sample Women with singleton pregnancies and body mass indices (BMI kg/m2 ) ࣙ 30 delivering between January 2012 and December 2012 who underwent routine screening for GDM at UNC Women’s Hospital. Methods We measured the association between early weight gain (EWG) and diagnosis of GDM and the association between total gestational weight gain (TWG) and LGA neonate. To determine EWG and TWG, respectively, we subtracted prepregnancy weight from weight at GDM screening or weight at last prenatal visit >37 weeks. We calculated and classified EWG as less than, greater than, and within based on IOM guidelines for first trimester (1.1 pounds) and second trimester weekly weight gain (0.4-0.6 pounds; <0.4 = below, 0.4-0.6 = within, >0.6 = above). Women were separately classified as gaining less than (<11 pounds), within (11-20 pounds), and greater than (>20 pounds) IOM guidelines for TWG. We com-
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pared maternal demographics and medical history data using Pearson chi-square and t test. We reported unadjusted and adjusted risk ratios (RR, aRR) with 95% confidence intervals (95%CI) for GDM and LGA with women gaining less than IOM guidelines as reference. Final adjusted models included prepregnancy BMI, EWG within guidelines, and gestational age at 1-hour screening. Results Among 778 obese women, 67% (524/778) had full data for EWG analysis; 33% (171/524) gained less than, 17% (90/524) within, and 50% (263/524) greater than IOM recommendations. EWG adherence was not associated with a GDM diagnosis (p = .9). Seventy-one percent (549/778) had full data for TWG analysis; 24% (130/549) gained less than, 20% (108/549) within, 55% (304/549) greater than IOM guidelines. Compared with women gaining less than, those gaining within IOM guidelines were more likely to have an LGA neonate (RR = 2.88, 95% CI 1.05-7.95; aRR = 3.36, 95% CI 1.1010.31). Compared with women gaining less than, those gaining greater than IOM recommendations were more likely to have an LGA neonate (RR = 3.25, 95% CI 1.30-8.08; aRR = 3.54, 95% CI 1.1011.79). Conclusion/Implications for Nursing Practice Among obese women, EGW adherence to IOM guidelines did not affect GDM diagnosis in our data. Total gestational weight gain within and greater than the IOM recommendations was associated with birth of LGA neonate. Using arenas of practice, health policy, and education nurses can assist in decreasing the incidence of LGA and GDM.
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Mammography-Seeking Practices of Central Illinois Amish Women Objective o explore possible explanations for differences in mammography rates between Amish women in Arthur, Illinois, and other populations.
T
Design In this cross-sectional study, primary data were collected through a mail questionnaire focusing on breast cancer history, mammography-seeking practices, and beliefs surrounding breast health. Setting Arthur is a small, rural community in central Illinois. Though most residents are Amish, the Arthur Amish community expands beyond the Arthur city limits into several other small, neighboring towns, including Arcola, Atwood, Humboldt, Lovington, Sullivan, and Tuscola, Illinois. Sample Female members of the Arthur, Illinois, Amish community (N = 143), aged 40 to 70. Methods Data were collected from this unique, socially isolated group through a mail questionnaire. Sample mammography adherence and rates of ever having a mammogram were compared with
the general population and other U.S. Amish Sarah Dee Geiger, PhD, Northern Illinois University, communities. DeKalb, IL
Results Logistic regression on the ever having a mammogram variable showed that compared to those who did not have knowledge of screening guidelines, Amish women with knowledge of screening guidelines had an odds ratio (OR) of 5.26 (confidence interval [CI] 1.79-15.45) for mammography screening compared to those without that knowledge. Participants who believed nutrition/diet causes breast cancer had an OR of 4.27 (CI 1.39-13.11) for mammography, and those who believed physical injury causes breast cancer had an OR of 3.86 (CI 1.24-12.04) compared to women who do not hold these beliefs.
Diana Grigsby-Toussaint, PhD, University of Illinois, Urbana, IL Keywords breast cancer mammography Amish disparities
Women’s Health Poster Presentation
Conclusion/Implications for Nursing Practice Pre-existing research and data from this study indicate that rates of mammography in Amish women and ideas about mammography lag far behind the rest of the U.S. population. Future research is needed to confirm these results and further explore the role of nurses in providing outreach and education to Amish women regarding the benefits of mammography and breast cancer risk.
An Internet-Based Education/Support Program for Menopause Symptoms of Korean American Midlife Women Objective o describe development of an Internet-based education/support program for menopausal symptom management of Korean American midlife women based on findings from a larger study on midlife women’s experience of menopause symptoms.
walkthrough method. The records of the experts’ evaluation were analyzed using content analysis. Then, as a group, the research team made decisions on the development of specific areas and incorporated them into further development of the program.
Eun-Ok Im, PhD, MPH, FAAN, The University of Pennsylvania, Philadelphia, PA
Design An intervention development study.
Results Based on the findings of previous studies, seven predictors were identified to influence the experience of menopause symptoms of Korean American midlife women. Then, the focus of the program development was given to the women’s attitudes because other predictors were nonmodifiable. Among the nonmodifiable predictors, only the country of origin, the length of time in the United States, and the immigration generation were incorporated into the program development. The program was designed to have three
Eunice Chee, Undergraduate, Research Assistant, The University of Pennsylvania, Philadelphia, PA
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Setting Not applicable. Sample Not applicable. Methods The program was developed using the information-mapping approach and the cognitive
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Wonshik Chee, PhD, The University of Pennsylvania, Philadelphia, PA
http://jognn.awhonn.org
RESEARCH
Im, E-O., Chee, W., and Chee, E.
Proceedings of the 2014 AWHONN Convention
Keywords intervention midlife women menopause symptom management Internet-based web-based
Women’s Health Poster Presentation
components as follows: interactive online message board; interactive online educational sessions; and online resources. Graphic user interface controls were used, and the presentation styles were tailored to Korean American culture. As technological tools, the Ruby on Rails framework and the Xen hypervisor were used. All experts positively evaluated the program but had several suggestions to make the structure more user-friendly. Two experts made some suggestions for the educational contents of the program (hormone replacement therapy and serotonin reuptake inhibitors). Based on the findings, the program has been further refined.
Conclusion/Implications for Nursing Practice Asian American midlife women, including Korean American midlife women, rarely seek help for their menopausal symptoms until the symptoms become intolerable, which frequently results in unnecessary burden to these women and subsequent disparities in symptom management. Thus, it is imperative to provide information and support for Korean American midlife women so that they can transition through menopause smoothly and successfully. Researchers need to make continuous efforts to develop and evaluate Internet-based education and support programs.
Pregnancy Intention and Contraceptive Use Among Low Income Women Yenupini Joyce Tonlaar, BSN, Objective RN, Michigan State University, o describe pregnancy intention and proper East Lansing, MI
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Adejoke B. Ayoola, PhD, RN, Calvin College, Grand Rapids, MI
use of contraceptive methods among low income, mostly minority women living in underserved neighborhoods to provide appropriate contraceptive education.
Keywords pregnancy intention contraceptive use unintended pregnancies Preconception Reproductive Knowledge Promotion Project
Design A descriptive study using baseline survey data from an ongoing randomized controlled trial, the Preconception Reproductive Knowledge Promotion Project (PREKNOP). Social Cognitive Theory and the Health Promotion Model were used as the guiding frameworks for the study.
Women’s Health Poster Presentation
Setting Three racially diverse, low income, underserved, urban neighborhoods in a Midwestern state. Sample Participants were women of childbearing age who were enrolled in PREKNOP. Women who completed the baseline survey and reported not planning on getting pregnant in the next 6 months (n = 61) were included in the analysis. Methods A descriptive design was used to collect baseline survey data. Questions were asked about participants’ plans to get pregnant in the next 6 months and incorrect use of contraception during sexual intercourse within the past month. Univariate and bivariate analyses were conducted using STATA 11.
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Results Approximately 50% of the women had a household income of less than $10,000; 65% were not married; 44% were Hispanic; and approximately 38% were Black. Women’s ages ranged from 18 to 51 years (mean = 30 years). More than one third of the women (34%) reported having sex without using contraceptives properly. Most Black (70%) and Hispanic (89%) women definitely did not want to become pregnant but were more likely to have sexual intercourse without proper use of contraception (43% Black, 30% Hispanic).
Conclusion/Implications for Nursing Practice About half of all pregnancies in the United States are unintended. Unintended pregnancy often results from lack of, inconsistent use of, or incorrect use of contraceptive methods. Rates of unintended pregnancies are greatest among poor and minority women and are associated with increased health risks for the mother and infant. Limited research has been done on pregnancy intention and proper contraceptive use in low income and minority women. Our findings suggest a need for education on the importance of using contraceptives properly to prevent unintended pregnancies, especially in low income Black and Hispanic women. In addition, there is a need to investigate further reasons why some low income and minority women fail to use contraceptives properly and put themselves at risk for unwanted pregnancies.
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Identifying the Health Needs of Hispanic Women From a Church Community Objective o examine knowledge, attitudes, and beliefs regarding access to health care services and health issues among an underserved community of Hispanic women in the Northeast United States.
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Design Cross-sectional exploratory. Setting Primarily Hispanic church in the Northeast United States. Sample Hispanic women (N = 66). Methods A 94-item Health Needs Assessment was used to collect data. Descriptive statistics, chi-square, and t tests were used to analyze the data. Results The most common health issue among this population was obesity/overweight. Thirty two percent of the women were not U.S. citizens. Satisfaction with care was significant among those with insurance, who were U.S. citizens, and who had a medical diagnosis. Thirty seven percent of the women used the emergency room as their usual
source of care, 41% reported their health as fair to Patricia Suplee, PhD, RNC-OB poor, and preventive service rates were less than and Bonnie Jerome-D’Emilia, PhD, MPH, RN, Rutgers what has been reported in the literature. University, Camden, NJ
Conclusion/Implications for Nursing Practice In the absence of adequate primary care, the uninsured go without care, utilize the emergency department as a primary care facility, and ultimately experience health disparities. Accurate assessments of present service use by the poor and underserved will allow for improved planning of services and the development of policy that will target the needs of invisible populations. In the United States, two of the most salient factors determining access to care are whether or not a person has health insurance and the person’s race or ethnicity. Hispanics account for about one third of the uninsured in the United States.
Marcia Gardner, PhD, RN, CPNP, CPN, Seton Hall University, South Orange, NJ Keywords access to care health needs Hispanic women disparities
Women’s Health Poster Presentation
Health needs assessments are useful in understanding subpopulations within communities. Advanced practice nurses and nurses need to gain insight into issues that affect the women they care for, including access to and satisfaction with care, how preventive services are utilized, and specific health needs. Culturally appropriate interventions can then be designed and implemented for specific populations of women served.
Dimensions of a Woman’s Experience of Inevitable Miscarriage Objective o explore a woman’s experience of early pregnancy loss when she is diagnosed with an inevitable miscarriage through understanding her description of symptoms and treatment decisions.
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Design This qualitative study consisted of transcribed data from a recorded telephone interview lasting from 30 to 45 minutes. Researchers used a semistructured interview guide.
Setting Nurses recruited the participants from an obstetrics/gynecology outpatient clinic at a Midwestern medical center.
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Sample A purposive sample of women who experienced a miscarriage at or before 14 weeks of pregnancy, needed to make a treatment decision (medical, surgical, expectant management), were at least 18 years old, and spoke English were recruited.
Rana K. Limbo, PhD, RN, PMHCNS-BC, CPLC, FAAN, Gundersen Health System, La Crosse, WI Jo K. Glasser, PhD, MBA, MS, Gundersen Health System, La Crosse, WI Maria E. Sundaram, MSPH,
Marshfield Clinic, Marshfield, Methods Dimensional analysis, a method generic to WI grounded theory but appropriate for existing data, was used to analyze transcripts. Women were asked, “Tell me about your miscarriage” with follow-up questions such as, “How did you decide what to do next?” or “What went into knowing what to do next?” Using line-by-line analysis, the research team identified dimensions and related conditions.
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
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Limbo, R. K., Glasser, J. K., and Sundaram, M. E.
RESEARCH Proceedings of the 2014 AWHONN Convention
Keywords miscarriage medical decision making perinatal loss ultrasonogram
Women’s Health Poster Presentation
Results Participants ranged in age from 23 to 40 years, with a mean age of 31. All were married. Fifteen women decided on surgical intervention, one chose medical, and seven chose expectant management. The women described two central dimensions: being sure they were miscarrying and being sure they chose the right treatment option. Making decisions about treatment were compelling due to potential for pregnancy viability. Conditions for being sure included relationship with their health care provider (physician or nurse midwife), severity or extent of symptoms (bleeding and cramping, absence or change in pregnancy symptoms), medical technology, personal intuition, and input and advice from others (e.g., friend who had miscarried).
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Conclusion/Implications for Nursing Practice Women wanted to know what to watch for (e.g., how to determine how much bleeding is too much) when they learned their miscarriage was inevitable. They were also traumatized by miscarrying in the toilet and either retrieving or flushing the products of conception. Findings support the critical role of nurses in health care of women with early pregnancy loss. Understanding symptoms, helping women know what to expect, the importance of confirmed nonviability of pregnancy, and the need for support from the woman’s health care team are key to evidence- and relationship-based nursing care.
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Barriers to Implementation of Skin-to-Skin Care Objective o determine the perceptions of perinatal nurses of barriers to implementation of skinto-skin care (SSC) in the acute care setting.
T
Design Quantitative, descriptive, correlational study. Darcy Gepilano, MSN, RNC, EFMCC, Kaiser Permanente/Sutter Medical Center, Elk Grove, CA Keywords skin-to-skin breastfeeding nursing culture
Poster Presentation
Setting Two Northern California hospitals that have committed to breastfeeding and SSC with similar delivery rates and geographical location, but different Baby-Friendly certification status. Sample The sample consisted of 76 labor and delivery and neonatal intensive care unit registered nurses from the two medical centers. Methods Nurses were anonymously surveyed using a 20question Likert-style survey developed by the researcher. The survey’s reliability was established by performing a pilot study of ten perinatal nurses. Cronbach’s alpha reliability coefficient was applied with a result of a .76 reliability coefficient, indicating that the survey would reflect fine discriminations in the levels of the construct. The Mann-Whitney U test was applied to the sample with further calculations of z and p values to determine significance of responses.
Results Using standard values to reject the null hypothesis, calculations revealed that 15 of the 17 nondemographic questions demonstrated a more favorable response to the implementation of SSC per Baby-Friendly standard from nurses employed at the Baby-Friendly certified facility.
Conclusion/Implications for Nursing Practice As hospitals make a commitment to assist mothers with successful breast feeding, additional research is needed to examine the effect of nursing culture on this goal. We examined hospital practices, procedures, and routines that affect SSC and ultimately the question Does having a Baby-Friendly Hospital Certification affect the nursing culture on the perinatal unit? Our results hold implications for facilities attempting to implement SSC and change practice from taskoriented to evidenced-based nursing care. By first evaluating the nursing culture, educators can implement training specific to the needs of the group they serve. Any successful attempt to promote evidence-based practice must consider research that addresses barriers and facilitators to the adoption of the practice by nurses. Therefore, identifying barriers should be considered a primary step in implementing evidence-based practice changes.
Improving Outcomes of Preeclampsia in California: From Review of Maternal Death to Quality Care Collaboratives Christine H. Morton, PhD, Stanford University, Palo Alto, CA Nancy Peterson, RNC, PNNP, MSN, IBCLC, Stanford University, Palo Alto, CA Keywords preeclampsia/eclampsia pregnancy-related mortality severe hypertension quality improvement
Childbearing Poster Presentation
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Objective o describe characteristics of women in California who died from preeclampsia/eclampsia in 2002 to 2004, identify contributing factors and quality improvement opportunities, and report on process and outcome measures from a multihospital, statewide learning collaborative that implemented a Maternity Care Improvement Preeclampsia Toolkit.
T
Design In 2004, the California Maternal, Child and Adolescent Health Division developed an enhanced surveillance method to identify maternal deaths from administrative data; women’s abstracted medical records were reviewed by an expert committee to determine causes of death and opportunities for prevention.
Setting Data were collected as part of the California Pregnancy-Associated Mortality Review (CAPAMR) and from CA-PAMR committee determination after case review. Data collection included classification of pregnancy-relatedness, contributing factors, and quality improvement opportunities. Learning Collaborative participants submitted process and outcomes measures related to the implementation of the Preeclampsia Toolkit.
Sample Cases of pregnancy-related deaths (145) from preeclampsia/eclampsia in California between 2002 and 2004 from 26 hospitals in a statewide learning collaborative.
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
http://jognn.awhonn.org
Morton, C. H., Lyndon, A., and Singleton, P.
RESEARCH Proceedings of the 2014 AWHONN Convention
Methods Mixed methods analysis was conducted of the CA-PAMR data; Learning Collaborative data were analyzed using frequency and trend charts. Results After case review, 145 maternal deaths from 2002 to 2004 were determined to be pregnancy-related. Preeclampsia was the second leading cause of death accounting for 17% of all pregnancy-related deaths in 2002 to 2004. The women who died from preeclampsia in California from 2002 to 2004 were more likely to be Hispanic, multiparous, and have normal body mass index (BMI) compared to women who died of other pregnancy-related causes. Nearly all (n = 24/25) of these deaths were determined to have some degree of preventability, with half having a good-to-strong chance. Analysis of the opportunities to improve quality and reduce preventable maternal deaths revealed themes re-
lated to the need for recognition and response to clinical triggers (i.e., warning signs) in clinical status and care coordination. Learning collaborative participants reported increased levels of awareness and education regarding the importance of treating severe hypertension in pregnant women as a result of debriefing activity. Sites improved methods for medical chart documentation and coding, and overall data quality improvements as they apply to women with hypertensive disorders, including preeclampsia. Conclusion/Implications for Nursing Practice Implementation of the Preeclampsia Toolkit in the multihospital, statewide Learning Collaborative is intended to reduce rates of severe maternal morbidity and prolonged postpartum length of stay. Learning Collaborative participants who adopted the Toolkit showed measurable improvement in the ability of their sites to respond to this leading cause of pregnancy-related morbidity and mortality.
Peripartum Cardiomyopathy Narratives: Lessons for Obstetric Nurses Christine H. Morton, PhD, Stanford University, Palo Alto, CA Audrey Lyndon, PhD, RNC, FAAN, University of California, San Francisco, CA Paula Singleton, PhD, MBPsS, Leeds Metropolitan University, Leeds,UK Keywords peripartum cardiomyopathy maternal morbidity pregnancy complications women’s experience
Childbearing Poster Presentation
Objective o contribute to the theoretical understanding of diagnosis peripartum cardiomyopathy (PPCM) and inform the clinician and patient education components of the Maternity Care Improvement Toolkit on Cardiovascular Disease in Pregnancy.
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Design Qualitative descriptive study using publically available Internet narratives posted by women diagnosed with PPCM. Setting Three online support groups for women diagnosed with PPCM.
Sample Unique narratives (N = 94).
Methods We conducted an online search using the terms PPCM and support. We found three websites that contained publicly accessible stories or biographies (narratives) posted by women diagnosed with PPCM, yielding narratives from 94 women. Narratives were downloaded and deidentified prior to analysis. Narratives were analyzed thematically according the methods of Braun and Clarke.
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Results The primary themes included symptom experience, dismissal of symptoms by health care providers, including obstetric providers, cardiology providers, and emergency department providers, and a degree of fragmentation in care that endangered women in potentially lifethreatening situations. Symptoms such as shortness of breath, fatigue or exhaustion, fluid retention, and excessive weight gain overlap with normal discomforts of pregnancy, creating space for clinicians to overlook the seriousness of their situation. This analysis highlights missed opportunities for timely, potentially lifesaving, diagnosis of PPCM; the importance of valuing women’s knowledge of their bodies; the importance of positive interactions with maternity clinicians; and the critical role of ongoing social support throughout treatment and recovery. Conclusion/Implications for Nursing Practice Cardiovascular disease, especially PPCM, is the leading cause of death among California women, based on the California Pregnancy-Associated Mortality Review, 2002 to 2004. Taking women seriously and valuing their knowledge as authoritative is critical to prompt accurate diagnosis. Women who receive this diagnosis, similar to other severe morbidities, are likely to experience posttraumatic stress disorder and require additional supportive care and resources as they adjust to postpartum life and recover from life-threatening illness.
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RESEARCH Proceedings of the 2014 AWHONN Convention
Childbearing Experiences of Women With Asperger Syndrome Objective o explore the childbearing experiences of mothers with Asperger syndrome (AS).
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Design Secondary analysis study. Setting Online AS support groups. Sample Eight women. Methods Existing narrative data acquired from participants from online AS support groups who assisted in creating the online questionnaire were analyzed. All identifiers were removed by an honest broker before the narrative data were given to the researchers. An exploratory interpretive qualitative analysis using a constant comparative approach with data immersion was used. Triangulation of data through lay literature and parent-organized websites was confirmatory. Results Several key themes emerged from the analysis of data from the eight women with AS who had given
birth: (a) hypersensitivities to sound, light, and touch throughout prenatal and intrapartum care; (b) increased anxiety during face-to-face interactions causing shutdown and interference with understanding health teaching and counseling; (c) excellent health promotion behaviors and dedication to being good mothers; (d) medical and behavior therapies for AS were often altered during the childbearing cycle; and (e) rewarding motherinfant attachment and breastfeeding reported.
Conclusion/Implications for Nursing Practice As knowledge about autism has substantially increased over the last two decades and more individuals have been formally diagnosed with AS, caring for childbearing women who present with this diagnosis may be a relatively new phenomenon for obstetric health care providers, and no published research exists to guide clinicians on caring for these women. Nurses are in key positions to integrate what they already know about women with AS and postulate what their needs may be when providing care during the childbearing period. Clinically significant information was identified that has implications for tailoring nursing care to women with AS.
Patricia Suplee, PhD, RNC-OB, Rutgers University, Camden, NJ Marcia Gardner, PhD, RN, CPNP, CPN, Seton Hall University, South Orange, NJ Joan Bloch, PhD, CRNP, RN, Drexel University, Philadelphia, PA Karen Lecks, MSN, CRNP, University of Pennsylvania, Philadelphia, PA Keywords Asperger syndrome childbearing cycle secondary analysis
Childbearing Poster Presentation
The Meaning, Experiences, and Behaviors of Nurses Caring for Women With a Perinatal Loss Objective o explore the experiences of obstetric, postanesthesia, and emergency nurses in caring for women after fetal death.
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Design Qualitative study using focus group (FG) interviewing. Setting Two large, acute care hospitals with level 3 nurseries. Sample Four FGs were conducted involving 24 total participants. Participants were registered nurses currently working in labor and delivery, antepartum, postanesthesia, and emergency depart-
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ments who have been employed for at least 1 Janice E. Hill, RNC, BSN, year and had experience in caring for a patient Norton Hospital, Louisville, KY with fetal loss. Methods The FG questions were carefully constructed based on the major concepts of Swanson’s Theory of Caring: open-ended, clear, appropriately sequenced, and supportive of the group process and response maximization. Participants also completed a brief demographic questionnaire. Interviews were audio-taped, transcribed verbatim, and deidentified. Transcripts were then uploaded for coding by research team members. Analysis was conducted using a continuously emergent process of data collection, reduction, display, and interpretation. Team members coded the transcripts that were then compared
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
Susan White, RN, MS, CNM, IBCLC, Norton Hospital, Louisville, KY Marianne Hopkins Hutti, PhD, WHNP-BC, University of Louisville, Louisville, KY Barbara Polivka, PhD, RN, University of Louisville School of Nursing and Norton Healthcare, Louisville, KY
http://jognn.awhonn.org
RESEARCH
Levine, M. S. and Lowe, N. K.
Proceedings of the 2014 AWHONN Convention
Paul R. Clark, RN, PhD, MA, Norton Healthcare, Louisville, KY Catherine Cooke, RN, MSN, CEN, Norton Suburban Hospital, Louisville, KY Margaret Mariella, BA, University of Louisville, Louisville, KY Savannah Clemens, University of Louisville, Louisville, KY Keywords compassion fatigue secondary traumatic stress obstetrics emergency operating room and recovery room nurses
for agreement. Any discrepancies in coding and theme identification were resolved through discussion and group consensus.
Results Nurses in all areas of specialty demonstrated Swanson’s nurse caring behaviors but used them preferentially according to situational exigencies and level of rapport developed with the patient. Themes that emerged from the data included Strategies for Coping in the Moment, Making Meaning of the Experience, Situations That Make Care Easier, Situations that Make Care More Difficult, and Priority of Care. Symptoms of compassion fatigue described by nurses included anger, intense sorrow, feeling incompetent, over-
whelmed, exhausted, inconsolable, and having a desire to avoid patient care. Conclusion/Implications for Nursing Practice Nurses who are indirectly exposed to trauma through their work are at high risk of developing compassion fatigue. There is limited research to identify whether nurses in obstetrics, emergency departments, and postanesthesia units who provide care to women who have experienced fetal death are at increased risk of developing compassion fatigue. Nurses try very hard to give the best care they can to women after fetal loss. In doing so, they make themselves vulnerable to compassion fatigue. Further research is needed to identify ways to support nurses as they provide care to these traumatized patients.
Childbearing Poster Presentation
Measuring Nurses’ Attitudes and Beliefs About Childbirth Martha S. Levine, MS, RNC-OB, C-EFM, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO Nancy K. Lowe, CNM, PhD, FACNM, University of Colorado Health Science Center, Denver, CO Keywords nurse attitudes labor and delivery nurses childbirth
Childbearing Poster Presentation
Objective o develop a reliable and valid instrument to measure nurse attitudes and beliefs about childbirth.
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Design The Nurse Attitudes and Beliefs Questionnaire Revised (NABQ-R) contains 42-items in five theoretically derived domains. Each item is scored with a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). A higher score indicates more positive attitudes toward physiological birth.
Setting An e-mail invitation containing a link to a secure electronic survey was sent to all AWHONN members in Colorado.
Sample The response rate was 21.6% with complete surveys returned from 84 labor and delivery nurses with a mean age of 46.7 years and 18.9 years of perinatal nursing experience. The sample was 98% White with an educational distribution of 17.9% diploma/associate, 42.9% baccalaureate, and 39.3% graduate degrees.
JOGNN 2014; Vol. 43, Supplement 1
Methods This online survey study provided an initial psychometric test of the NABQ-R. Results The NABQ-R scores ranged from 82 to 156 with a mean of 121.99 + 12.77. Cronbach’s α internal consistency reliability estimate was .90. Analysis of variance demonstrated a significant effect of education on NABQ-R scores such that nurses with graduate degrees had significantly more positive attitudes than nurses with baccalaureate (p = .003) or diploma/associate degrees (p = .002). To study construct validity, an exploratory factor analysis (EFA) using principal component analysis and varimax rotation was conducted. Factors with an eigenvalue ࣙ 1 were retained and the scree slope suggested a five-factor solution. Next, a varimax rotation was used with five specified factors that accounted for 46.11% of the variance with all items loading on at least one factor. We named the factors Women’s Experience of Birth, Women’s Autonomy, Medical Model Conflict, Breech Safety, and Intervention Influence. Conclusion/Implications for Nursing Practice Researchers have found that nursing care can influence patient outcomes during childbirth. The attitudes and beliefs of labor and delivery nurses
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RESEARCH Proceedings of the 2014 AWHONN Convention
may affect their care decisions and interventions. We consider this analysis preliminary to a more robust psychometric testing of the NABQ-R with a larger sample. Our results support acceptable initial psychometric properties for the NABQ-R, and the EFA results were consistent with existing the-
Newborn Care
Mothers’ Intentions to Breastfeed and Hospital Practices on Breastfeeding: A Longitudinal Study at 6 Months After Birth on Predictors of Breastfeeding in a Cohort of Mothers From a Large Northern New England Medical Center Objective o examine the effects of mothers’ intentions to breastfeed and hospital practices on breastfeeding rates at 6 months.
Methods Mothers completed a survey about infant feeding and hospital experiences before discharge between December 2010 and June 2012. Demographic and hospital practices data were collected through chart review. Follow-up calls were made at 6 months. Data were analyzed with logistic regression.
(60/181, 33%) were cited as most common reasons for no longer exclusively breastfeeding. No effects on 6-month breastfeeding rates were found for type of delivery, gravidity and parity, or a five predictor model: health problems (e.g., gestational diabetes), birth interventions (e.g., induction), antibiotics, spinal, and epidural/intrathecal anesthesia. Older age, greater education, being married or with a life partner (χ2 = 49.92, p < .001), and mothers’ intention to breastfeed predicted 6month breastfeeding (χ2 = 6.23, p = .044). Hospital practices that favorably predicted breastfeeding were early skin-to-skin contact (χ2 = 11.24, p = .024), avoiding supplements (χ2 = 13.87, p = .001), and avoiding pacifier use (χ2 = 7.25, p = .027). The odds of not breastfeeding at 6 months were higher if supplements (odds ratio [OR] = 2.01, CI 1.34-3.02) or pacifiers (OR = 1.65, CI 1.14-2.39) were used and if physicians suggested supplements (OR = 7.2, CI 2.47-21.09) while in the hospital, or if solid foods were started before 6 months (OR = 1.67, CI 1.17-2.39). Rooming-in (χ2 = 5.52, p = .238) and putting-to-breast early (χ2 = 1.64, p = .440) did not affect 6-month breastfeeding rates.
Results Seventy-seven percent (921/1200) completed the discharge survey and 60% (556/921) completed the follow-up. At 6 months, 25% (139/556) were exclusively breastfeeding, and 24% (133/556) were breastfeeding and/or pumping breast milk. Also, 20% (111/556) were using a combination of breastfeeding and/or pumped milk and formula, whereas 31% (173/556) were feeding formula only. Low milk supply (78/181, 43%) and return to work
Conclusion/Implications for Nursing Practice These findings demonstrate the need to further educate providers and encourage newborn care practices to sustain breastfeeding beyond the early postpartum period. The results may also be used to inform expectant parents (e.g., during childbirth classes) of hospital practices and personal decisions that may influence successful breastfeeding duration.
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Design Predictive, longitudinal. Kara L. Kaikini, MS, IBCLC, Maine Medical Center, Portland, ME
Setting Hospital birth center in a large northeastern U.S. city.
Kristiina Hyrkas, PhD, LicNSc, Sample MNS, Maine Medical Center, A convenience sample of 1,200 mothers who gave Portland, ME Keywords breastfeeding breastfeeding duration hospital practices intention to breastfeed
Poster Presentation
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ory. The development of a theoretically and psychometrically sound instrument to measure nurse attitudes toward physiological birth will foster additional research to expand our understanding of how nurse attitudes affect the process and outcomes of labor and birth.
birth to full-term healthy infants and planned to breastfeed.
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
http://jognn.awhonn.org
RESEARCH
Simon-Burrell, M.
Proceedings of the 2014 AWHONN Convention
Infant Safe Sleep: An Evaluation of Infant Safe Sleep Practices in the Hospital Setting Marci Simon-Burrell, DNP, RN, WHNP-BC, Hutzel Women’s Hospital Detroit Medical Center, Detroit, MI Keywords infant safe sleep nursing practice
Newborn Care Poster Presentation
Objective o evaluate nurses’ knowledge and beliefs about best practices for infant safe sleep. To determine the degree to which the recommendations of the American Academy of Pediatrics’(AAP) for infant safe sleep were modeled and parent education was given by nurses at Hutzel Women’s Hospital (HWH).
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Design Mix methods, qualitative and quantitative descriptive study. Setting Hutzel Women’s Hospital in Detroit, Michigan, one of Michigan’s largest birthing institutions delivering 5,000 infants each year. Sample The sample included 50 mothers, 50 infants, and 41 nurses. Methods Qualitative and quantitative methods such as structured interviews with mothers (N = 50), observing infants (N = 50) in their cribs, and assessing nurses’ (N = 41) beliefs and knowledge about best practices for infant safe sleep using the Infant Safe Sleep Knowledge questionnaire were used. Descriptive statistics were used to describe nurses’ beliefs about risk factors for Sudden Infant Death Syndrome and Sudden Unexpected Infant Death (SIDS/SUID) and knowledge about AAP infant safe sleep recommenda-
JOGNN 2014; Vol. 43, Supplement 1
tions. Chi-square analyses were used to examine relationships between nurses’ beliefs about SIDS/SUID risk factors and nurses’ personal characteristics. Pearson correlations and analysis of variance (ANOVA) were conducted to describe relationships between nurses’ beliefs and knowledge of AAP infant safe sleep risk practices. Results The nurses were very knowledgeable about the AAP recommendations, and few areas of knowledge deficit were identified. The quantitative observation data and the qualitative data from mothers’ comments indicated that nurses modeled best practices and taught parents about infant safe sleep recommendations by strongly encouraging parents to place their infants on their backs. Conclusion/Implications for Nursing Practice Perinatal nurses at HWH teach, model, and reinforce safe sleep practices to new mothers and families during hospitalization and prior to discharge. The nurses’ practice is appropriate and is consistent with the AAP infant safe sleep recommendations. Nurses play significant roles in working with families of newborn infants, and they are in key positions to affect rates of sudden infant death syndrome. Hospitals should provide nurses with ongoing continuing education to ensure that they remain current with safe sleep recommendations to educate patients and model safe sleep practices.
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RESEARCH Proceedings of the 2014 AWHONN Convention
Professional Issues
The Development and Evaluation of a Lactation Rotation for a Pediatric Residency Program at a Tertiary Care Teaching Hospital Objective o evaluate the effect of a Lactation Rotation on pediatric residents’ knowledge and clinical confidence about breastfeeding.
T
Design Pretest-posttest design. Jennifer Albert, MSN, APN/CNP, WHNP-BC, RNC-OB, IBCLC, RLC, Advocate Lutheran General Hospital, Park Ridge, IL
Setting Tertiary care teaching center in Illinois. Sample Convenience sample of 12 first-year pediatric residents.
Jody Heinrichs-Breen, BSN, RNC-OB, RNC-MNN, IBCLC, RLC, Advocate Lutheran Methods General Hospital, Park Ridge, The participating 12 residents were provided IL Keywords breastfeeding physician knowledge clinical confidence
Professional Issues Poster Presentation
educational materials, including the American Academy of Pediatrics (AAP) policy statement on breastfeeding and the use of human milk, Wellstart International Self-Study Modules, Academy of Breastfeeding Medicine Protocols, and Hale’s Medications and Mothers’ Milk. Each resident spent a minimum of 50 hours with an International Board Certified Lactation Consultant (IBCLC). Training included inpatient rounding, hands-on management, observation with the neonatal intensive care unit IBCLC, answering helpline calls, and viewing breastfeeding videos. In addition, each resident created an evidence-based lactation presentation for staff. Residents were evaluated to measure proficiency in providing breastfeeding care. In turn, they evaluated their rotation in terms of strengths,
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weaknesses, and suggestions for improvement. To measure breastfeeding knowledge and clinical confidence levels, each resident completed the AAP’s Breastfeeding Residency Curriculum Pretest four times: the first and last day of the rotation and at 6 and 12 months postrotation. Results Pretest and confidence scores were evaluated. Statistically significant differences were found between test 1 and 2 (M = 74.67, SD = 8.41 vs. M = 87.33, SD = 7.78, p = .001), test 1 and 3 (M = 74.67, SD = 8.41 vs. M = 89.33, SD = 5.48, p < .001), and test 1 and 4 (M = 74.67, SD = 8.41 vs. M = 89.0, SD = 7.65, p < .001). No significant differences were found between tests 2, 3, and 4 (p values >.05), demonstrating retention of knowledge gained. With regards to clinical confidence, the ability to adequately address parent’s questions about breastfeeding differences between test 1 and 2, 1 and 3, and 1 and 4 were significant with confidence increasing in tests 2, 3, and 4 (p values being .003, .020, and .009, respectively), and the ability to completely manage common breastfeeding problems differences between test 1 and 2, 1 and 3, and 1 and 4 were significant with confidence increasing in tests 2, 3, and 4 (p values being <.001, .010, and p<.001, respectively). Conclusion/Implications for Nursing Practice As a result of an innovative, comprehensive educational lactation program, the pediatric residents’ knowledge and clinical confidence related to breastfeeding significantly increased.
JOGNN, 43, S68-S80; 2014. DOI: 10.1111/1552-6909.12444
http://jognn.awhonn.org