X-Ray and CT Scan Based Prediction of Best Fit Tracheostomy Tube-A Pilot Study.

Tracheostomy is a commonly performed intervention in patients requiring ventilatory support. The insertion of inappropriately sized tracheostomy tubes carries a risk of decannulation, tissue damage, ventilatory difficulties, premature tube change or discomfort. Currently, no clear guidelines exist in determining the most appropriate size tube. Imaging of the airway preoperatively could aid clinical judgement and reduce risk. Patients included adult critical care patients who had appropriate preoperative imaging. The computed tomography scans and chest radiographs of patients were reviewed. Measurements of the airway were taken and scaled to the known internal diameter of an endotracheal tube. A four-point scoring system was developed to identify patients better suited to a non-standard sized tracheostomy tube. Data from 23 patients was analyzed using the Statistical Package for Social Sciences™ (SPSS). Four measured points on imaging corresponded to the patients' appropriate tracheostomy tube size. Appropriate tracheostomy size correlates with tracheal diameter at endotracheal tube tip (r2 = 0.135), carina (r2 = 0.128), midpoint of larynx to carina (r2 = 0.146), bronchial diameter at the left mainstem (r2 = 0.323), and intrathoracic tracheal length (r2 = 0.23). Among our cohort, a score of 4 predicts the need for a larger tracheostomy tube. Simple imaging provides accurate measurement of patients' airway dimensions. Our method ensures tube size is selected according to patient airway size, and potentially reduces the risks associated with inappropriate sizing.

A Fourth Trimester Action Plan for Wellness.

Expectant mothers/couples often report planning for early parenting is overwhelming. Lack of anticipatory planning makes evident the need for providers, like childbirth educators, to assist expectant parents in minimizing or eliminating the problems associated with the transition to the fourth trimester, early parenthood. Planning for birth should extend beyond labor and birth to include the weeks following. The author's purpose is to explore the problems associated with the fourth trimester, to review the current health-related literature, and to propose an integrated behavioral action plan as an effective strategy. Self-efficacy constructs support a wellness plan approach to enable expectant mothers/couples to be proactive in preparing for their physical and emotional needs after the arrival of their newborn.

Effect of Peanut Ball and Position Changes in Women Laboring With an Epidural.

OBJECTIVE: To examine the effect of a nurse-driven intervention using a peanut ball (PB) with position changes on length of labor and incidence of cesarean birth among women who receive epidural anesthesia. DESIGN: Quasiexperimental comparison group design. SETTING/LOCAL PROBLEM: A 407-bed, nonprofit, Magnet-designated, Baby-Friendly Hospital Initiative-designated hospital with 8 labor and delivery suites and an average of 100 births per month. PARTICIPANTS: A total of 343 participants were included, with 164 women in the PB group. INTERVENTION/MEASUREMENTS: The PB was placed after epidural administration; women were repositioned a minimum of every 1 to 2 hours, and the PB was removed at second stage of labor; duration was recorded. RESULTS: Overall, women in the PB group were 50% less likely to have cesarean birth. For women with cervical dilation of 4 cm or less, rates of vaginal birth were 61% with use of the peanut ball. A multivariate analysis of outcomes was used. A multiple linear regression model showed, after adjusting for other variables, that PB placement alone did not shorten labor length (p = .4684). However, a stratified analysis indicated that for women with cervical dilation of 4 cm or less, length of the first stage of labor was affected by parity (p = .0042) and frequency of position change (p < .001). For women with cervical dilation greater than 4 cm, length of the first stage of labor was influenced by frequency of position changes (p = .0130) and effacement (p = .0050). Length of the second state of labor was affected by the frequency of position change (p = .0416). CONCLUSION: The PB may be an effective intervention to reduce the incidence of cesarean birth. Changing position frequently was associated with reduced length of first and second stages of labor.

Mental health and worries of pregnant women living through disaster recovery.

The health and well-being of pregnant women during and after natural disasters remains an international concern. In this mixed methods study we described pregnant women's mental health, psychosocial concerns and sources of stress living in New Orleans during long term recovery from Hurricane Katrina. Our survey of 402 pregnant women indicated poor social support was associated with higher levels of depression symptomology, post-traumatic stress disorder, anxiety, and stress. Women were interviewed and described seven common areas of worry. We concluded that pregnant women living in post-disaster communities have stressful lives years after the event, needing innovative models of care to build resilience.

Experiences of Intimate Partner and Neighborhood Violence and Their Association With Mental Health in Pregnant Women.

Both intimate partner violence and neighborhood crime have been associated with worse mental health outcomes, but less is known about cumulative effects. This association was studied in a sample of pregnant women who were enrolled in a study of disaster exposure, prenatal care, and mental and physical health outcomes between 2010 and 2012. Women were interviewed about their exposure to intimate partner violence and perceptions of neighborhood safety, crime, and disorder. Main study outcomes included symptoms of poor mental health; including depression, pregnancy-specific anxiety (PA), and posttraumatic stress disorder (PTSD). Logistic regression was used to examine predictors of mental health with adjustment for confounders. Women who experienced high levels of intimate partner violence and perceived neighborhood violence had increased odds of probable depression in individual models. Weighted high cumulative (intimate partner and neighborhood) experiences of violence were also associated with increased odds of having probable depression when compared with those with low violence. Weighed high cumulative violence was also associated with increased odds of PTSD. This study provides additional evidence that cumulative exposure to violence is associated with poorer mental health in pregnant women.

Association of Complementary and Alternative Therapies With Mental Health Outcomes in Pregnant Women Living in a Postdisaster Recovery Environment.

PURPOSE: The objective of this study was to determine if complementary and alternative medicine therapies are associated with mental health in postdisaster environments. DESIGN: Pregnant women (N = 402) were interviewed between 2010 and 2012 as part of a larger cross-sectional study on hurricane recovery and models of prenatal care. METHODS: Symptoms of depression (Edinburgh Postnatal Depression Screen), prenatal anxiety (Revised Prenatal Distress Questionnaire), posttraumatic stress (PCL-S), and perceived stress (PSS) were examined. Logistic regression was used to adjust for income, race, education, parity, and age. The most commonly reported therapies were prayer, music, multivitamins, massage, and aromatherapy. FINDINGS: Mental illness symptoms were common (30.7% had likely depression, 17.4% had anxiety, and 9.0% had posttraumatic stress). Massage was protective for depression (Edinburgh Postnatal Depression Index [EDSI] >8; adjusted odds ratio [aOR] = 0.6, 95% confidence interval [CI] = 0.3-0.9), while use of aromatherapy (aOR = 1.9, 95% CI = 1.1-3.2) and keeping a journal (aOR = 1.9, 95% CI = 1.1-3.2) were associated with increased odds of depression. Aromatherapy was associated with symptoms of pregnancy-related anxiety (aOR = 2.0, 95% CI = 1.1-3.8). CONCLUSIONS: Symptoms of mental illness persist after disaster, when untreated. Nurses should consider assessing for complementary and alternative medicine utilization in pregnancy as a potentially protective factor for mental health symptoms.

Birth Outcomes in a Disaster Recovery Environment: New Orleans Women After Katrina.

OBJECTIVES: To examine how the recovery following Hurricane Katrina affected pregnancy outcomes. METHODS: 308 New Orleans area pregnant women were interviewed 5-7 years after Hurricane Katrina about their exposure to the disaster (danger, damage, and injury); current disruption; and perceptions of recovery. Birthweight, gestational age, birth length, and head circumference were examined in linear models, and low birthweight (<2500 g) and preterm birth (<37 weeks) in logistic models, with adjustment for confounders. RESULTS: Associations were found between experiencing damage during Katrina and birthweight (adjusted beta for high exposure = -158 g) and between injury and gestational age (adjusted beta = -0.5 days). Of the indicators of recovery experience, most consistently associated with worsened birth outcomes was worry that another hurricane would hit the region (adjusted beta for birthweight: -112 g, p = 0.08; gestational age: -3.2 days, p = 0.02; birth length: -0.65 cm, p = 0.06). CONCLUSIONS: Natural disaster may have long-term effects on pregnancy outcomes. Alternately, women who are most vulnerable to disaster may be also vulnerable to poor pregnancy outcome.

Healthy start: description of a safety net for perinatal support during disaster recovery.

Publicly funded programs and safety net organizations have key roles during post disaster recovery to care for vulnerable populations, including pregnant women with low resources. The objective of this study was to compare the health of prenatal women who accessed the New Orleans Healthy Start program to those women who only used traditional prenatal care (PNC) during long-term recovery from the Hurricane Katrina disaster. During 2010-2012, this descriptive, cross-sectional study recruited 402 prenatal women (24-40 weeks) from prenatal clinics and classes. All women were enrolled in PNC, with 282 experiencing only traditional PNC, while 120 women added Healthy Start participation to their usual PNC. Measures were obtained to determine, past hurricane experience, hurricane recovery, perceptions of prenatal care, mental health, and birth outcomes. Women accessing Healthy Start-New Orleans were more socially "at risk" (younger, lower income, not living with a partner, African American), lived through more hurricane trauma, and had a higher incidence of depression (40 %) and post-traumatic stress disorder (PTSD) (15 %) than women in traditional PNC (29 % depression; 6.1 % PTSD). Women using Healthy Start reported more mental health counseling and prenatal education than did women in only traditional PNC. Birth outcomes were similar in the two groups. The Healthy Start participants with less resources and more mental health difficulties after disaster, represented a more vulnerable population in need of additional support. This study underscores the necessity for community and governmental programs to develop disaster response plans that address needs of vulnerable populations during prolonged recovery.

Disaster research: a nursing opportunity.

Nurses working or living near a community disaster have the opportunity to study health-related consequences to disaster or disaster recovery. In such a situation, the researchers need to deal with the conceptual and methodological issues unique to postdisaster research and know what resources are available to guide them, even if they have no specialized training or previous experience in disaster research. The purpose of this article is to review issues and challenges associated with conducting postdisaster research and encourage nurses to seek resources and seize opportunities to conduct research should the situation arise. Current disaster studies and the authors' personal experiences conducting maternal-child research in post-Katrina New Orleans (2005-2013) provide real-life examples of how health professionals and nurses faced the challenges of doing postdisaster research. After catastrophic events, nurses need to step forward to conduct disaster research that informs and improves future disaster planning and healthcare responses.

Post-Katrina perinatal mood and the use of alternative therapies.

PURPOSE AND DESIGN: The purpose of this cross-sectional, exploratory study is to describe perinatal moods and complementary alternative therapy (CAT) use among childbearing women living in New Orleans, post-Hurricane Katrina. How women coped with the disaster with limited access to mental health services was not known. METHOD: A convenience sample of 199 postpartal/expectant mothers completed two questionnaires. The Edinburgh Postnatal Depression Scale measured risk for perinatal depression (>10 for depression risk) and the Perinatal Alternative Therapy Index (PATI) obtained subjects' self-perceived overall scores for anxiety and overall mood, frequency and type of use of alternative therapies, and health behaviors. Open-ended questions solicited qualitative data. FINDINGS: The mean EPDS score was 8.47, yet 37% of the postpartum subjects had scores >or=10, indicating risk for depression, while 25% of the women in the prenatal group had scores >or=10. Ninety-five percent of women reported using CATs to improve their mood during pregnancy. Two themes emerged from the qualitative data: (a) Distress and Instability: The Katrina Effect and (b) Life Transitions. CONCLUSION: Post-Katrina, most women were proactive in seeking ways to improve their mood. Knowing that there are effective, alternative therapies to improve mood during the perinatal period, nurses and other care providers can offer more information about these nonmedical, accessible interventions.

Perinatal nursing in uncertain times: the Katrina effect.

PURPOSE: To make explicit the perinatal nurses' shared meanings of their lived experience while providing nursing care in the New Orleans area during the disaster of Hurricane Katrina. STUDY DESIGN: Interpretative phenomenology. METHODS: Semi-structured, in-depth interviews were conducted with 16 perinatal nurses 9 to 18 months after they worked in obstetrical and newborn hospital settings in the Greater New Orleans area during the Hurricane Katrina disaster. Van Manen's process of reflective thematic analysis-guided data analysis was used. RESULTS: Themes and subthemes included (1) duty to care (back to the basics, empathy, and advocacy in action); (2) conflicts in duty; (3) uncertain times: chaos after the storm (evacuation: routes through uncertainty, hopelessness, abandonment, and/or fear); (4) strength to endure; (5) grief: loss of relationships, identity, and place; (6) anger; and (7) feeling right again. CLINICAL IMPLICATIONS: Nurses who work during disasters must live through the uncertainty of the situation and be prepared to adapt to the needs that arise in patient care situations and self-preservation. Excellent basic nursing skills, intuitive problem solving, and a sense of staff unity are primary resources. Nurses and other caregivers need ongoing supportive interventions to rebound from the experience and cope with symptoms associated with trauma exposure.

Nursing students' perceptions of ethical behavior in undergraduate nursing faculty.

Ethical dilemmas in clinical nursing practice and areas of nursing research have been reported, but a paucity of current nursing research exists pertaining to ethical concerns between undergraduate nursing students and nurse educators. The study examined students' perceptions of ethical behavior in faculty of undergraduate nursing. Using an exploratory, mixed-methods approach, 101 members of a student nursing organization in the southeastern region of the United States participated in the study by completing the 16-item, anonymous questionnaire. Thirteen participants also submitted narratives describing their personal experiences with nursing faculty as it related to ethical interactions in the learning environment. The majority reported their experiences with nursing instructors to be ethical with no reports of sexual involvement with students. Instructor expectations of gifts from their students were almost non-existent. The narrative analysis yielded the following themes: bias: racial, gender, and other; humiliation, confidentiality, grading, uncaring, and cheating. Faculty-student interactions in nursing education are extremely complex. Instructors' increased awareness of their interaction with students and the adoption of ethical guidelines by schools of nursing are suggested.

The lived experience of knowing in childbirth.

Research on knowing in childbirth has largely been a quantitative process. The purpose of this study was to understand the ways first-time mothers learn about birth. A phenomenological approach, using a feminist view, was used to analyze two in-depth interviews and journals to understand nine first-time expectant mothers' experiences of knowing in childbirth. The findings demonstrated a range of knowledge that contributed to issues of control and conflict. The participants also described an increased dependency on their mothers and a lack of their own intuition contiguous to the birth process. These findings contribute understanding to how expectant mothers know birth, suggesting that their knowing does not diminish conflict surrounding the event and may even exacerbate it when not combined with learning skills to manage conflict. Childbirth educators may want to include instruction on negotiating power differential in relationships encountered during childbirth in order to strengthen a first-time mother's ability to receive the care she wants. Educators may also want to assess the expectant mother's view of birth and her expectations for birth. Schools of nursing should consider the inclusion of women-centered care curricula at both the undergraduate and graduate levels. The mothers' responses in this study clearly reveal that the politics surrounding birthing remain in place and must be removed in order to provide a supportive environment for normal birth.

Social, legal, and institutional context of heterosexual aggression by college women.

This review concerns women's heterosexual aggression. Social context considers prevalence and incidence, gender roles and social norms, reactions to receiving aggression, and alcohol and drugs. Legal context focuses on state law and institutional context focuses on college and university codes of conduct. Primary findings: women engage in the full range of sexually aggressive behaviors attributed to men; the language of many legal codes place women's heterosexually aggressive behaviors below the threshold for rape even when it involves physical force or the use of a weapon; many men, similar to many women, do not report receiving sexual aggression and may not define themselves as victims; regardless of reporting status or self-perception, some men do suffer physical and psychological symptoms as a result of receiving sexual aggression from women; and women's heterosexual aggression may be more socially acceptable than men's.