Assessment, Education, and Access: Kona Hawai'i WIC Oral Health Pilot Project.

The Kona WIC oral health pilot project was developed to assess the oral health beliefs and behaviors of parents of children and pregnant women at the Kona WIC site and to demonstrate the ease of providing oral health education to families in order to improve oral health behaviors. Data were collected from 50 families about the oral health behaviors and dental care of a total of 73 children, including 5 pregnant women, four of whom had a child enrolled in WIC and one pregnant woman without any previous children. Data revealed that 68% of children with teeth had been seen by a dentist within 6 to 12 months of the study visit. Mothers were seen less often, with 55% stating that they had not been seen for a dental visit for over one year. Parental knowledge about the effects of fluoride on teeth was limited; however, 90% of the parents would allow fluoride varnish applied to their child's teeth, 88% would give daily fluoride drops/tablets to their child, and 78% would support water fluoridation if it would help to improve their children's oral health. Additionally, for children old enough to receive fluoride supplementation, 60% were not given a prescription by their health care providers, and 58% had not received any fluoride varnish applications. By offering oral health education in a WIC clinic and assisting clients to seek out comprehensive care within a dental home, children and caregivers can be provided essential education and resources early in a child's life or women's pregnancies to reduce poor oral health outcomes.

Prevalence, self-care behaviors, and self-care activities for peripheral neuropathy symptoms of HIV/AIDS.

As part of a larger randomized controlled trial examining the efficacy of an HIV/AIDS symptom management manual (n = 775), this study examined the prevalence of peripheral neuropathy in HIV-infected individuals at 12 sites in the USA, Puerto Rico, and Africa. Neuropathy was reported by 44% of the sample; however, only 29.4% reported initiating self-care behaviors to address the neuropathy symptoms. Antiretroviral therapy was found to increase the frequency of neuropathy symptoms, with an increased mean intensity of 28%. A principal axis factor analysis with Promax rotation was used to assess the relationships in the frequency of use of the 18 self-care activities for neuropathy, revealing three distinct factors: (i) an interactive self-care factor; (ii) a complementary medicine factor; and (iii) a third factor consisting of the negative health items of smoking, alcohol, and street drugs. The study's results suggest that peripheral neuropathy is a common symptom and the presence of neuropathy is associated with self-care behaviors to ameliorate HIV symptoms. The implications for nursing practice include the assessment and evaluation of nursing interventions related to management strategies for neuropathy.

Big dreams, little sleep: dreams during pregnancy after prior pregnancy loss.

Sleep patterns and dream content may be affected by stressful life events such as pregnancy loss. Women who are pregnant subsequent to a prior pregnancy loss tend to have anxious and emotionally charged experiences during their pregnancies. Dreams can affect pregnancy outcomes, specifically premature birth. This qualitative study is the first investigation to explore sleep disturbances caused by dreams as experienced by a diverse group of women pregnant subsequent to a pregnancy loss. Our analysis resulted in the identification of 4 categories of dreams. We offer clinical assessment and intervention strategies to support these women prenatally and present suggestions for research to facilitate our understanding of their experiences.

Keeping birth normal: research findings on midwifery care during childbirth.

OBJECTIVE: This study describes processes and outcomes of midwifery care through narratives told by exemplary midwives. DESIGN: Narrative analysis. SETTING: Midwifery practices in hospital, birth center, and home settings. PARTICIPANTS: Purposive sample of 14 midwives drawn from a large national Delphi panel on exemplary midwifery practice. DATA ANALYSIS: Systematic analysis of interview data was conducted until interpretive consensus was achieved across all text and codes. Results were compared with two prior qualitative studies conducted by the first author on midwifery practice for congruence and emergence of new findings. RESULTS: The support of normalcy was identified as a significant process of midwifery care during labor and birth. CONCLUSIONS: The midwives believed that birth is normal, and many of their actions were specifically aimed toward the support of it as a physiologic, rather than pathologic, process. Through their words, we see subtle care processes focused on meeting a woman's individual needs and tapping into her personal strength. Implications for practice and further research to link their approach to caring for women with perinatal outcomes are reviewed.

The landscape of caring for women: a narrative study of midwifery practice.

Our purpose was to expand knowledge on the process and outcomes of midwifery care. Narrative analysis was used to interpret stories provided by midwives to illustrate their practice and recipients of midwifery care about their experience. A purposive sample of 14 midwives and four recipients of midwifery care was recruited as a subsample from a prior Delphi study on midwifery practice. Three broad themes were identified: 1) the midwife in relationship with the woman, 2) orchestration of an environment of care, and 3) the outcomes of care, called "life journeys" for the woman and the midwife. The findings are discussed from the perspectives of therapeutic landscapes described in cultural geography and prior research on midwifery practice. The challenge is to confirm the associations between the processes of care identified in these narratives with both short- and long-term outcomes in the health of women and their families. These appear to go well beyond the usual perinatal measures currently used in health care research and hold implications for how care is delivered, measured, and evaluated.