Fordyce happiness training program on the competence of mothers of premature infants admitted to the NICU from Middle East: A quasi-experimental study.

The purpose of this study was to determine the effect of the Fordyce Happiness Training Program on the parental competence of mothers of premature infants admitted to the neonatal intensive care unit (NICU). This quasi-experimental study was performed on 80 mothers of premature infants who were admitted to a NICU in Iran. Mean Parenting Sense of Competence Scale (PSOC) scores of participants in the intervention group before and after training were 61.32 ± 6.44 and 68.52 ± 2.52. Mean PSOC scores for those in the control group before and after the intervention were 64.47 ± 11.08 and 65.30 ± 6.90, respectively. The two groups showed significant differences in terms of parental competence after the happiness training program (p = 0.0001). NICU admission of a premature baby not only has a negative effect on the mother's emotional state but it can also adversely affect the parental sense of competence. Therefore, considering the psychological needs of mothers of premature infants, it is worth considering implementation of programs such as Fordyce Happiness Training, to promote and maintain the mental health of mothers.

Effect of Rubus idaeus L. Consumption During Pregnancy on Maternal Mice and Their Offspring.

The trigger for human labor is a scientific mystery. This research examined Rubus idaeus (RI), commonly referred to as red raspberry, which is widely purported to be efficacious in promoting parturition processes and favorable birth outcomes. This randomized controlled trial sought to determine the influence of RI consumption during gestation on C57BL/6N Tac mice and their offspring. The aims of this study were to (1) determine differences in the length of gestation, gestational weight gain, and litter size where RI is consumed daily at varied strengths and (2) determine differences in offspring characteristics and behavior where maternal RI consumption occurred. Once paired, mice were randomly assigned to one of three groups: placebo (n = 10) receiving plain water, RI aqueous extract fluid of 1.78 mg/mL (n = 10), or RI aqueous extract fluid of 2.66 mg/mL (n = 10). All received the same standardized diet throughout gestation. Pregnant mice were weighed with chow intake and fluid consumption determined daily. Gestation length and litter size were recorded at the time of birth. Differences in offspring characteristics were also determined and included physical characteristics (weight, physical development) and neuromotor reflexes and behaviors (locomotive abilities, geotaxis reflex, cliff avoidance reflex, and swimming development). When compared with controls, high-dose RI ingestion resulted in shorter length of gestation and smaller litter size (P ≤ .05). There was also an increase in fluid consumption and a decrease in pup weights on postnatal day 4 and 5 with RI treatment (P ≤ .05). Altogether, results suggest that RI influences parturition and fecundity processes with transplacental exposure impacting offspring characteristics.

Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study.

BACKGROUND: Midwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care. AIM: This research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings. SETTING: Midwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital. METHODS: A convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: 'How is it for you to be a midwife in South Africa?' Transcribed interviews were analysed using thematic coding. RESULTS: Five themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife. CONCLUSION: Midwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services. CONTRIBUTION: This research provides evidence of the midwifery experience with implications for needed health policy change.

A concept analysis of self-leadership: The "bleeding edge" in nursing leadership.

AIM: To explore the concept of self-leadership in nursing. Self-leadership, while frequently referenced, has not been clearly defined in either the literature or within nursing. DESIGN: Common language sources were reviewed, along with literature searched from 2017 to 2019 using seven electronic databases: CINAHL, EbscoHost, Sabinet, ScienceDirect, ProQuest, Nexus, and Academic Complete. Database searches yielded 10 articles. REVIEW METHODS: Walker and Avant's method of concept analysis was modified, as suggested by Risjord. RESULTS: Reviews of the broad literature demonstrated that self-leadership is the creation of a space for the individual with self-awareness to live a better self through reflective consciousness. The multidimensionality of work and blurring of boundaries between work and living has prompted the individual to understand their own qualities or abilities. The individual has a true sense of who they are and what they think and feel. This shift in leadership refocuses on a more desirable way of living and envelopes being a master of one's own destiny. CONCLUSION: Analytic work provides support for a middle-range explanatory theory that engenders self-awareness, taking the lead, and personal satisfaction. Explication of the concept and the relevance to professional nursing gives direction for future research.

Traditional Chinese Medicine: A Qualitative Study for Reconsidering Nursing Care in the United States.

Purpose: Traditional Chinese medicine (TCM) proposes the world as a holistic unity of energy. With a long history of use, TCM is generally accepted in the Chinese health care system. Despite growing global interest and use, TCM has received a mixed response from Western health care systems. This study aimed to describe the underpinnings of TCM, compare TCM and Western medicine, and suggest how key modalities might be applied to strengthen holistic nursing care in the United States. Design: A qualitative, descriptive exploratory investigation employing a constructivist grounded theory. Method: Interview of TCM healers in Hong Kong (n = 5). Transcripts were reviewed to identify common themes and categories. Findings: Five themes were identified: improvement in energy flow and health, TCM as "a way of knowing," curing source versus symptoms of disease, declining TCM practice in Hong Kong, and need for interprofessional education. Conclusions: TCM is considered useful in chronic illnesses, whereas those with acute illnesses often seek Western medicine. Failing to address the holistic care needs and preferences of individuals results in less than optimal health outcomes. Nurses need explicit TCM content and would benefit from a restructuring of curricula and clinical experiences to foster integration into caring practices.

Interprofessional Communication and Collaboration During Emergent Birth Center Transfers: A Quality Improvement Project.

INTRODUCTION: Midwifery care in the birth center setting has proven to be a safe and ideal option for some low-risk women. Although rare, perinatal complications that require emergent transfer to a higher level of care can occur in community birth settings. Optimal perinatal outcomes during emergent transfers depend on excellent interprofessional communication and collaboration. The purpose of this quality improvement project was to implement interprofessional emergent birth center transfer mock drills in order to improve communication and collaboration among birth center midwives, local paramedics, and receiving hospital staff during emergent birth center transfers. PROCESS: Birth center midwives and hospital staff provided education sessions on perinatal emergencies and the scope of practice for midwives for local paramedics. Paramedics' knowledge level was assessed with pretests and posttests, before and after the education sessions, respectively. An interprofessional, collaborative mock drill was then organized and included birth center, paramedic, and hospital staff. All participants received a questionnaire after the drill. OUTCOMES: Mean test scores after paramedic education sessions increased by 43.5% (n = 95, P <.001). The Likert-type scale questionnaire given to mock drill participants after drill completion revealed that 97% indicated probable support for the sustainability of future mock drills in the birth center setting (n = 10). DISCUSSION: Health care providers can help improve perinatal outcomes during emergent transfers from the community setting by having clearly outlined guidelines and procedures and communicating efficiently with interprofessional members of the health care team. Both interprofessional education sessions and collaborative mock drills are effective methods to increase knowledge of perinatal emergencies, thus improving interprofessional communication and collaboration during emergent birth center transfers.

The lived experience of women with a high-risk pregnancy: A phenomenology investigation.

BACKGROUND: Pregnancy is a time of transformation, hope, expectation, and worry for women and their families - none more so than when the pregnancy is at-risk. The objective of this study was to describe the lived experience of women during high-risk pregnancy. METHODS: This qualitative investigation utilized a hermeneutic phenomenology study. The study was conducted in a public health center in a large urban area in southeast Iran. Purposive sampling of 20 women with a high-risk pregnancy. Participants included both nulligravid and multigravid women in the second and third trimesters of pregnancy with varied medical conditions. Data collection used face-to-face interview with transcribed data analyzed using Braun and Clarke's six stage thematic analysis approach. RESULTS: Four themes were extracted and included challenge of family in high-risk pregnancy, challenge of anticipation for motherhood, and challenges for future pregnancies, and challenge of adaptation. CONCLUSIONS: Findings demonstrate that women with a high-risk pregnancy struggle to adapt with burdens related to successful maternal role attainment and family functioning. Fears about pregnancy outcome and future pregnancies are dominant.

Exploration of the Vaginal and Gut Microbiome in African American Women by Body Mass Index, Class of Obesity, and Gestational Weight Gain: A Pilot Study.

OBJECTIVE: This study determines the differences in the distal gut and vaginal microbiome in African American (AA) women by prepregnancy body mass index and gestational weight gain (GWG) comparing women with and without obesity and by obesity class. STUDY DESIGN: We prospectively sampled the vaginal and distal gut microbiome in pregnant AA women at two time points during pregnancy. Samples were analyzed using high-throughput sequencing of the V4 region of the 16S ribosomal ribonucleic acid gene. RESULTS: Distinct differences in vaginal and distal gut α-diversity were observed at time point 1 between women with and without obesity by total GWG. Significant differences in distal gut ß-diversity were also found at time point 1 in obese women by GWG. Within the Bacteroides genus, a significant association was observed by total GWG among obese women which was absent in nonobese women. Women with class III obesity who experienced low GWG had the lowest abundance of distal gut Bacteroides and appreciably higher relative abundance of a consortia of vaginal taxa including Atopobium, Gardnerella, Prevotella, and Sneathia. CONCLUSION: These results contribute new evidence showing that GWG in combination with obesity and obesity class is associated with an altered distal gut and vaginal composition early in pregnancy among AA women.

Experience of neonatal intensive care unit nurses in providing developmentally-supportive care: A qualitative study.

Many challenges have been noted in the implementation of developmentally-supportive care principles in neonatal intensive care units, despite evidence that adhering to such care principles achieves positive results for the neonate. The aim of this study was to explore and describe compliance in adhering to developmentally-supportive care principles implemented in one neonatal intensive care unit in South Africa. An exploratory design was used in this qualitative study with purposive sampling to select eligible neonatal intensive care registered nurses (n = 14) as participants. Participants all worked in a 10 bed neonatal intensive care unit at a large tertiary care public hospital. Six audio-recorded interviews were conducted, with recordings subsequently transcribed and analyzed. Three main themes were identified: value of developmentally-supportive care, nature of developmentally-supportive care, and barriers to developmentally-supportive care. One of the main themes had subthemes, which substantiated the findings, and included parent involvement, nurse engagement, and holistic care. Study outcomes offer insight into the development or revision of policies and practices, which are crucial when implementing developmentally-supportive care, particularly in resource-poor settings where challenges are magnified.

Effect of aromatherapy on post-partum complications: A systematic review.

INTRODUCTION: and purpose: Aromatherapy is a known popular method to reduce the symptoms of various physiologic processes and diseases. The aim of the study was to determine whether aromatherapy improves symptoms commonly experienced by women during the postpartum period. METHODS: In the present systematic review, four international databases (PubMed, Google Scholar, Web of Science, and Scopus) were searched from inception of databases through August 2018. References for each study were manually reviewed to ensure that relevant works were included. RESULTS: Thirty-four (34) articles were identified with 17 studies meeting eligibility criteria and included a total of 1400 women using a variety of aromatherapies. Results demonstrated that aromatherapy can improve symptoms commonly experienced in post-partum period, including depression, stress, pain, anxiety, and fatigue. CONCLUSION: There are therapeutic effects in use of aromatherapy during the post-partum period. Aromatherapy, however, should be used with caution as safety concerns have not been conclusively demonstrated.

A Comparative Workforce Study of Midwives Practicing in the State of Texas.

INTRODUCTION: Access to quality care is a problem in Texas, an ethnically diverse state with large birth numbers. The state has over 300 areas designated as medically underserved, and a severe lack of obstetricians and midwives. Minimal data exist on midwifery's contribution, and no known study compares the work environment and clinical practice of the 2 state-recognized midwifery paths, licensed midwives (LMs) and certified nurse-midwives (CNMs). The purpose of this study was to determine the differences in practice by CNMs and LMs, the latter of whom are generally certified professional midwives. The specific aims were to 1) describe the differences in demographic and employment characteristics of CNMs and LMs, 2) identify the geographic areas and population groups served by CNMs and LMs, and 3) compare the nature and scope of CNM and LM clinical practices. METHODS: Online parallel surveys of Texas LMs and CNMs were conducted in December 2015 and January 2016. The REDCap data management system housed the 123- and 125-item surveys for LMs and CNMs, respectively, addressing demographics, populations served, and clinical practice. A comparative statistical analysis, using Fisher's exact test, Pearson's chi-squared test, and Independent Samples t-tests, was performed. RESULTS: The survey response rates of LMs and CNMs were 35.4% (n = 75) and 31.9% (n = 143), respectively. Differences in demographics, employment status, workload, scope of practice, risk assessment, time-based care management, and technology use were observed. DISCUSSION: Findings represent the first attempt to describe the Texas midwifery workforce. In a large state with health care provider shortages, this step is pivotal in addressing strategies for providing services for women and infants. This groundwork can provide the foundation for including midwifery in a state health plan.

Nature and scope of certified nurse-midwifery practice: A workforce study.

AIMS AND OBJECTIVES: To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. BACKGROUND: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. DESIGN: Mixed methods research utilising prospective descriptive survey and interview. METHODS: An online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed. RESULTS: The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years. CONCLUSIONS: An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice. RELEVANCE TO CLINICAL PRACTICE: Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.

Screening for postpartum anxiety: A quality improvement project to promote the screening of women suffering in silence.

BACKGROUND: Postpartum anxiety is a mental health problem that has largely been ignored by maternity care providers despite an estimated incidence as high as 28.9%. Though postpartum anxiety may or may not be accompanied by depression, and while screening for postpartum depression has become more common place, postpartum anxiety is often not assessed or addressed. PURPOSE: The purpose of this pilot quality improvement project was to implement a screening, treatment and referral program for postpartum anxiety in the birth centre environment. PROCEDURES: Midwives from 10 geographically diverse birth centres, and all members of the American Association of Birth Centres, were recruited to participate in the project. An online video was developed which detailed postpartum anxiety, screening through use of the anxiety subscale of the Edinburgh Postnatal Depression Scale and a toolkit for treatment and/or referral for screen positive patients. Participants entered patient scores into the Perinatal Data Registry of the American Association of Birth Centres. Individual interviews of midwives were conducted following the 10-week pilot period. MAIN FINDINGS: There were a total of 387 participants across 9 participating sites. Among all screened participants with follow-up data, (n = 382), 9.69% (n = 37) were lost to follow-up. Among all participants screened with the Edinburgh Postpartum Depression Scale -3A and Edinburgh Postpartum Depression Scale (n = 318), 12.58% (n = 40) had a positive Edinburgh Postpartum Depression Scale -3A score of greater than six. Of all screened participants with an Edinburgh Postpartum Depression Scale score, 15 (6.98%) had a Edinburgh Postpartum Depression Scale score of less than 12 and an Edinburgh Postpartum Depression Scale -3A score greater than six, and would have not received follow up care if only screened for postpartum depression. Midwife participants expressed heightened awareness of the need to screen and felt screening was easy to integrate into clinical practice. CONCLUSIONS: The Edinburgh Postpartum Depression Scale -3A is a valid, easy-to-use tool which should be considered for use in clinical practice. Modification of the electronic health record can serve as an important impetus triggering screening and treatment. It is important that clinicians are educated on the prevalence of postpartum anxiety, its risk factors, symptoms and implications.

Knowledge, attitude and use of complementary and alternative medicine among nurses: A systematic review.

OBJECTIVES: The purpose of this study was to systematically review the literature to describe the knowledge, attitude and practice of CAM by nurses. METHODS: Three databases were searched for relevant studies from launch through September of 2017 and included MEDLINE, Scopus and Web of science. RESULTS: The average knowledge of CAM therapies by nurses was 62.2% with attitude about use averaging 65.7%. Close to two-thirds (65.9%) reported use of CAM therapies with patients. The primary reasons nurses suggested use of CAM were for stress and anxiety reduction and health improvement. CONCLUSION: Current evidence demonstrates the need for nurse education programs to integrate and strengthen CAM content into existing curricula. Similarly, documentation of the nature and extent of nurse use of CAM therapies in the clinical setting, as well as patient-reported use and preferences for CAM therapies, would provide valuable prospective data.

Birth stories from South Africa: Voices unheard.

BACKGROUND: The manner that birth events unfold can have a lasting impact on women. Giving voice to women's experiences is key in the creation of care that embodies humanistic, family-centred service. AIM: The aim of this research was to describe the experiences of women receiving care during childbirth. METHODS: The design was qualitative and descriptive using thematic analysis to analyse women's birth stories. A purposive sample of women (N=12) who had recently given birth in South Africa was selected. Participants were recruited who had delivered across a variety of settings: public, private, and maternity hospital, as well as at home. Data were collected using in-depth interviews and field notes. FINDINGS: Four themes were noted: cocoon of compassionate care, personal regard for shared decision-making, beliefs about birth, and protection. Themes demonstrated both caring and non-caring behaviours including feelings of sadness, loneliness and being unwanted, being scared and uncertain, and overall dissatisfaction with the birth experience. Irrespective of setting, patients felt the absence of shared decision-making; the exception was where care was with midwives in an independent maternity hospital or at home. DISCUSSION: A period of high vulnerability, birth is often met with care perceived as non-caring and lacking in compassion. Many women reported failure to be included as a partner in decision-making where birth occurred in private or public hospital settings. Where a midwifery model of care was in place, experiences were uniformly positive. CONCLUSIONS: Fundamental change is needed in midwifery education and scope of practice, with overhaul of health system resourcing.

Implementation of Robert's Coping with Labor Algorithm© in a large tertiary care facility.

OBJECTIVE: to implement use of Roberts' Coping with Labor Algorithm© (CWLA) with laboring women in a large tertiary care facility. DESIGN: this was a quality improvement project to implement an alternate approach to pain assessment during labor. It included system assessment for change readiness, implementation of the algorithm across a 6-week period, evaluation of usefulness by nursing staff, and determination of sustained change at one month. Stakeholder Theory (Friedman and Miles, 2002) and Deming's (1982) Plan-Do-Check-Act Cycle, as adapted by Roberts et al (2010), provided the framework for project implementation. SETTING: the project was undertaken on a labor and delivery (L&D) unit of a large tertiary care facility in a southwestern state in the USA. The unit had 19 suites with close to 6000 laboring patients each year. PARTICIPANTS: full, part-time, and per diem Registered Nurse (RN) staff (N=80), including a subset (n=18) who served as the pilot group and champions for implementing the change. FINDINGS: a majority of RNs held a positive attitude toward use of the CWLA to assess laboring women's coping with the pain of labor as compared to a Numeric Rating Scale (NRS). RNs reported usefulness in using the CWLA with patients from a wide variety of ethnicities. A pre-existing well-developed team which advocated for evidence-based practice on the unit proved to be a significant strength which promoted rapid change in practice. IMPLICATIONS FOR PRACTICE: this work provides important knowledge supporting use of the CWLA in a large tertiary care facility and an approach for effectively implementing that change. Strengths identified in this project contributed to rapid implementation and could be emulated in other facilities. Participant reports support usefulness of the CWLA with patients of varied ethnicity. Assessment of change sustainability at 1 and 6 months demonstrated widespread use of the algorithm though long-term determination is yet needed.

The Gut Microbiome, Obesity, and Weight Control in Women's Reproductive Health.

The microbes residing in the human gut, referred to as the microbiome, are intricately linked to energy homeostasis and subsequently obesity. Integral to the origins of obesity, the microbiome is believed to affect not only health of the human gut but also overall health. This microbiome-obesity association is mediated through the process of energy extraction, metabolism, and cross talk between the brain and the gut microbiome. Host exposures, including diet, that potentially modify genetic predisposition to obesity and affect weight management are reviewed. The higher prevalence of obesity among women and recent evidence linking obesity during pregnancy with offspring health make this topic particularly relevant. Current limitations in microbiome research to address obesity and future advances in this field are described. Applications of this science with respect to applied nursing and overall health care in general are included, with emphasis on the reproductive health of women and their offspring.

Compassion fatigue in nurses: A metasynthesis.

AIMS AND OBJECTIVES: To interpret the body of qualitative work focusing on compassion fatigue to distil a common understanding that could then be applied to nursing care. BACKGROUND: Complex demands place extraordinary stress on nurses struggling to work in overburdened healthcare systems. The result can be the inability to care well for others, leading to compassion fatigue, burnout and increased numbers leaving the profession. Metasynthesis offers a means of more fully illuminating compassion fatigue and further understanding of practices which might reduce its negative consequences. DESIGN: Metasynthesis. METHOD: As a method designed to facilitate knowledge development, metasynthesis allowed for integration of qualitative study findings conducted between 1992-2016 using defined search terms. Six databases were searched for articles published in English. Nine papers met the criteria for review and metasynthesis was conducted using the meta-ethnographic approach detailed by Noblit and Hare. RESULTS: Four themes related to compassion fatigue were found by consensus discussion. The themes included: physical ("just plain worn out") and emotional symptoms ("walking on a tightrope"), triggering factors ("an unbearable weight on shoulders" and "alone in a crowded room"), and measures to overcome/prevent ("who has my back?"). CONCLUSIONS: Compassion fatigue is a concept of documented relevance to those in nursing and represents a basic inability to nurture others and engenders a temporal component. Synthesis of studies provides evidence of the veracity of the concept for application to clinical practice and research related to nursing care. RELEVANCE TO CLINICAL PRACTICE: Findings provide insight into the clinical milieu needed to prevent compassion fatigue. A theoretical model is presented which can be used to guide future research, as well as the creation of clinical practice policies which might mitigate the development of compassion fatigue and its potential consequences.

Mindfulness-Based Stress Reduction for Military Women With Chronic Pelvic Pain: A Feasibility Study.

INTRODUCTION: One of the most common reasons women seek gynecologic health care services is for chronic pelvic pain (CPP) and women in the military are no exception. For women diagnosed with CPP, the burden can be difficult as they struggle to perform military obligations. A chronic low-grade systemic disease believed triggered by inflammation, CPP is difficult to diagnose and treat. With limited treatment strategies available, this study sought to examine the feasibility of implementing a mindfulness-based stress reduction (MBSR) program in a military population. METHODS: This prospective study evaluated the feasibility of a standard 8-week MBSR training program in a population of active duty women previously diagnosed with CPP (N = 15). Participants also completed the Kentucky Inventory of Mindfulness survey and the Brief Pain Inventory, did home practice and kept a daily diary. Vaginal swabs were obtained at baseline and at study completion. CONCLUSIONS: A standard MBSR program is difficult to implement in a military population; other delivery formats should be considered. There was a trend suggestive that program participation promotes mindfulness, reduces pain, and promotes modulation of select pro-inflammatory cytokines. On the basis of results of this pilot feasibility study, further research is warranted.