Hemodynamic changes associated with neuraxial anesthesia in pregnant women with covid 19 disease: a retrospective case-control study.

BACKGROUND: Neuraxial blocks is the recommended mode of analgesia and anesthesia in parturients with Coronavirus 19 (COVID-19). There is limited data on the hemodynamic responses to neuraxial blocks in COVID-19 patients. We aim to compare the hemodynamic responses to neuraxial blocks in COVID-19 positive and propensity-matched COVID-19 negative parturients. METHODS: We conducted retrospective, cross-sectional case-control study of hemodynamic changes associated with neuraxial blocks in COVID-19 positive parturients in a Tertiary care academic medical center. Fifty-one COVID-19 positive women confirmed by nasopharyngeal reverse transcription-polymerase chain reaction (RT-PCR), were compared with propensity-matched COVID negative controls (n = 51). Hemodynamic changes after neuraxial block were recorded by electronic medical recording system and analyzed using paired and unpaired T- test and Wilcoxon-Mann-Whitney Rank Sum tests. The primary outcome was ≥ 20% change in MAP and HR after neuraxial block placement. RESULTS: In the epidural group, 7% COVID-19 positive parturients had > 20% decrease in mean arterial pressure (MAP) from baseline compared to 15% COVID-19 negative parturients (P = 0.66). In the spinal group, 83% of COVID-19 positive parturients had a decrease in MAP more than 20% from baseline compared to 71% in control (P = 0.49). MAP drop of more than 40% occurred in 29% COVID positive parturients in the spinal group versus 17% in COVID-19 negative parturients (P = 0.5465). In COVID-19 positive spinal group, 54% required vasopressors whereas 38% in COVID-19 negative spinal group required vasopressors (P = 0.387). We found a significant correlation between body mass index (BMI) > 30 and hypotension in COVID ( +) parturient with odds ratio (8.63; 95% CI-1.93 - 37.21) (P = 0.007). CONCLUSION: Incidence and severity of hypotension after neuraxial blocks were similar between COVID-19 positive and COVID-19 negative parturients. BMI > 30 was a significant risk factor for hypotension as described in preexisting literature, this correlation was seen in COVID-19 positive parturients. The likely reason for parturients with BMI > 30 in COVID negative patients not showing similar correlation, is that the sample size was small.

Outcome of exposure to community violence in female adolescents.

STUDY OBJECTIVE: The purpose of the study was to describe outcomes related to exposure to community violence in 2 samples of female adolescents. DESIGN: The design was cross-sectional. SETTING: Data were collected by home visit and on a college campus. PARTICIPANTS: The female adolescents were recruited from a teen clinic (n=39) and from freshman orientation classes at a large urban university (n=61). MAIN OUTCOME MEASURES: Depressive symptoms. RESULTS: Although the 2 groups differed by age, race, and socioeconomic status, there were no differences in social support, depressive symptoms, or being a victim of violence. Adolescents recruited from the teen clinic had higher scores on witnessing violence and were exposed to more aggressive acts of violence. CONCLUSIONS: Exposure to community violence is a significant predictor of depressive symptoms in both college students and adolescents from a teen clinic.

Psychosocial predictors of postpartum depression in diverse groups of women.

The purpose of this study was to test the extent to which a causal model developed from a theoretical formulation of postpartum depression was consistent with data collected from three groups of postpartum women. In this cross-sectional, correlational design, the samples consisted of primarily middle-class, Caucasian mothers of term infants and preterm infants, and low-income, African American mothers of term infants. Instruments included the CES-D Depression instrument, the Postpartum Support Questionnaire, Rosenberg's Self-Esteem instrument, and a question regarding closeness to partner. The causal model was tested with structural equation modeling. Importance of support, support received, and closeness to partner were significant predictors of both self-esteem and depression. Predictors of postpartum depression are the same across diverse samples of women, as proposed in the causal model.

Helping women caregivers obtain support: barriers and recommendations.

Women frequently assume the role of caregiver, and the demands of the caregiving role may lead to stress. Social support may moderate the effects of this stress. This article describes characteristics of effective social support, barriers to obtaining adequate support, and recommendations for how a woman in a caregiving role can obtain the support she needs. Nurses caring for women and families throughout the life span can use this information to help caregivers to obtain the necessary social support.

The link of social support and postpartum depressive symptoms in African-American women with low incomes.

PURPOSE: To describe the relationship between postpartum support and depressive symptoms in a sample of African-American women of low socioeconomic status. DESIGN: Descriptive correlational design using a convenience sample. METHOD: Fifty-seven African-American women at 4 to 6 weeks' postpartum were interviewed as they waited for their infant to receive a well-baby exam. Identification of amount and type of postpartum support received, as well as the importance of each type of support was measured using the Postpartum Support Questionnaire. Depressive symptoms were measured using the CES-D depression instrument. RESULTS: There was a high incidence of symptoms of depression, and depressive symptoms were associated with support being very important to the woman. CLINICAL IMPLICATIONS: Importance of support is a better predictor of outcomes than how much support a woman receives. Communication of need for support and establishing boundaries with family members are recommended.

Continuing education in nursing: a 10-year retrospective study of CE offerings presented by the Kentucky Nurses Association.

BACKGROUND: The purpose of this retrospective study was to evaluate continuing education (CE) offerings presented by the Kentucky Nurses Association during a 10-year period. METHOD: Data were collected and analyzed from 37 CE offerings (N = 474 respondents). RESULTS: Findings revealed that the majority of the respondents reported that the CE offerings were useful, stimulated them to seek further information, and resulted in acquisition of significant knowledge or skills for nursing education or practice. However, fewer than half of the respondents reported they were able to implement changes in nursing education or practice as a result of the CE offerings. CONCLUSION: Findings supported the usefulness of CE in nursing education and practice and the need for further research evaluating CE and the correlation between CE and nursing education and practice.

Guiding mothers of high-risk infants in obtaining social support.

The purpose of this article is to describe how nurses can assist the new mother of a high-risk infant, especially a preterm infant, in identifying and obtaining the social support needed to help the family adapt in the first few weeks after the birth. The interventions recommended are based on a research study conducted by the authors and colleagues and summarized within this article. Because support was more important than these mothers expected it to be, it is important that nurses in prenatal, postpartum, neonatal, home health, and extended care settings recognize the need to assist women in identifying their support needs. In addition, nurses can help the mothers identify individuals within their social network who could assist them with those needs. Meeting the social support needs of a mother is important for her own mental and physical health and well-being. It also helps her meet the social and developmental needs of her infant.

Service-learning for graduate students.

Although service-learning is gaining momentum in academic settings across the country, it has not been described as a feature of graduate education. This project incorporated a ten-hour service requirement into a unit on theories of nurse caring as part of a course for graduate nursing students, Theories and Concepts of Nursing. The authors describe the service-learning experience, as well as the extensive class reflection process and written synthesis with caring theory and the University mission after completion of the service.

Social support and adjustment in women following coronary artery bypass surgery.

Social support expected, discrepancies in support (differences between support expected and received), and self-esteem were used to predict emotional (tension and depression) and functional outcomes (recreation, housework, and social life) in a sample of women who had coronary artery bypass surgery (N = 86). Women were interviewed before hospital discharge (T1) and 1 (T2) and 3 (T3) months later. Higher self-esteem was associated with lower depression and tension (T3) and less disruption in social interaction (T2 and T3) and recreation (T3). Results suggest that social support may influence outcomes through enhancement of self-esteem. Directions for further study are given.

A comparison of the level of hope in patients with newly diagnosed and recurrent cancer.

PURPOSE/OBJECTIVES: To compare levels of hope in patients with newly diagnosed and recurrent cancer. DESIGN: Descriptive study. SETTING: Three oncology practices in two urban areas of the southern United States. SAMPLE: Convenience sample of 20 newly diagnosed patients with cancer and 16 patients with recurrent cancer (mean age = 56 years). The majority of the patients were Caucasian, female, and married; had a high school degree; and had a religious affiliation. METHODS: Subjects completed the Herth Hope Scale and answered the open-ended question "What gives you the most hope at the present time?" Analysis included descriptive statistics (i.e., frequency, means, standard deviations, percents), t-tests, Chi-square, and analysis of variance. MAIN RESEARCH VARIABLES: Level of hope each subject had in relation to the stage of the cancer at the time of diagnosis. FINDINGS: Contrary to expectations, patients with newly diagnosed and recurrent cancer did not differ in regard to their level of hope. However, significant differences were found related to the type of hope utilized. Married patients and male patients experienced higher levels of hope. Recurrent themes in response to the open-ended question were family support, nonfamily support, faith, outlook, and health professionals/care. CONCLUSIONS: Patients with newly diagnosed cancer use their treatment and nurses, physicians, and other healthcare professionals as sources of hope and support. Patients with recurrent cancer reported drawing hope from faith. IMPLICATIONS AND NURSING PRACTICE: Heightened awareness of the patient-healthcare professional relationship will enable healthcare professionals to provide care that is more sensitive to one congruent with patients' needs. Healthcare professionals need to assess the meaning of faith for each individual patient and offer services to foster this source of hope.

The Neonatal Skin Risk Assessment Scale for predicting skin breakdown in neonates.

An instrument was developed to assess neonates at risk for skin breakdown, based on the Braden Scale for Predicting Pressure Sore Risk in adults. Using such an instrument to predict, and thus prevent, skin breakdown could decrease costs associated with prolonged hospital stays in neonates. The Neonatal Skin Risk Assessment Scale (NSRAS) was piloted with 32 neonates. Reliability was high for the subscales of general physical condition, activity, and nutrition, but low in the other three subscales. For predictive validity, sensitivity was 83% and specificity was 81%. The NSRAS appears to be useful in predicting days most likely for skin breakdown to occur.

Types of support expected and received by mothers after their infants' discharge from the NICU.

This descriptive study examined specific types of social support that mothers of preterm infants expected before, and received after, their infant's hospital discharge. The convenience sample consisted of 37 mothers of hospitalized preterm infants. The Postpartum Support Questionnaire, developed as a measure of perceived support specific to the postpartum situation, was used. The women found that material, emotional, and comparison support were more important than they had expected prior to bringing their infants home from the hospital. In addition, the women received less than they had expected of all types of support except comparison. In view of the results, mothers of preterm infants should be assisted in identifying individuals in their environments who can best meet their specific needs. In addition, maternity and pediatric nurses need to be involved in the follow-up care of these women and their infants.

The Postpartum Support Questionnaire: reliability and validity.

Support has been found to be related to perinatal health, resulting in the development of the Postpartum Support Questionnaire based on the four categories of support (informational, material, emotional and comparison) identified by House (1981) and Cronenwett (1985). Data from four studies (N = 207) provided evidence of the psychometric properties of the instrument. Internal consistency reliability was demonstrated (alpha = .90 to .94 for total instrument). Test-retest reliability ranged from .69 to .79 for total scores and .30 to .79 for for categories of support. Measures of concurrent validity with the Personal Resource Questionnaire .85 were .42 and .48 at 6 and 8 weeks postpartum. Confirmatory factor analysis using LISREL 7 supported the four categories of support, but the use of these factors separately remains to be demonstrated.

Exposure to blood and body fluid: factors associated with non-compliance in follow up HIV testing among health care workers.

Due to lack of previous research, this study examined the factors associated with non-compliance in follow up human immunodeficiency virus (HIV) testing among health care workers after blood and/or body fluid exposure. A descriptive correlation design was used with 178 health care workers who did not return for recommended follow up HIV testing post-blood and/or body fluid exposure at three urban hospitals. The 36 question Likert scale was designed to measure the five concepts of the Health Belief Model: susceptibility, seriousness, benefit, barriers, and health motivation. The internal consistency reliability measured .48. Forty five subjects (25%) returned the questionnaire. The most significant factor determined to affect return rate for follow up testing was related to benefits and susceptibility (F = 4.57, df = 2.42, R = .42, P = .02). Return rate was most significantly correlated with the idea of decreasing the chance of dying from acquired immunodeficiency syndrome (AIDS) (r = .31, P = .04). Similar results of recommended future studies may indicate changes in post-exposure education or institutional policies and procedures.

Social support and postpartum depression.

Discrepancies between prenatal social support expectations and subsequent perceptions of support actually received were examined in relation to postpartum depression. Low-risk primiparous women (N = 105) were surveyed 1 month before and 1 month after delivery. Almost half of the women prenatally and one third postpartially had depression scores which would lead them to be classified as possibly depressed (CES-D scores of 16 or greater). In multiple regression, two social support discrepancy measures, prenatal depression and postpartal closeness to husband, correlated with postpartal depression and accounted for nearly 40% of its variance. The generalizability of the findings should be further explored, but the findings suggest the need for attention to prenatal expectations of postpartum support as a way to influence the incidence of postpartum depression. In addition, continued efforts to identify causes of postpartum closeness with the spouse are needed.