Value of Nurse Residency Programs in Retaining New Graduate Nurses and Their Potential Effect on the Nursing Shortage.

BACKGROUND: More than 1 million nurses are expected to retire in the next 10 to 15 years. Retaining new nurses is important to help decrease turnover, vacancies, and organizational cost. The objective of this review was to explore what the literature informs us regarding nurse residency programs implementation in acute care settings and their ability to retain nurses. METHOD: Through a search of the Cumulative Index to Nursing and Allied Health Literature, Ovid Nursing Journals, and ProQuest Health and Medical Complete databases, 42 articles were selected for full review. RESULTS: Twenty-six articles met the inclusion criteria; most studies were descriptive. Established programs with at least a 12-month time frame were slightly more effective at retention. However, retention was not sustained at year two. CONCLUSION: Future research should focus on the issues of sustaining retention in year two. If using proxy measurement tools, reliability and validity of those tools must be conducted. In addition, robust studies are needed to explore the effect of nurse residency programs on retention. J Contin Educ Nurs. 2018;49(6):282-288.

Factors influencing use of family planning in women living in crisis affected areas of Sub-Saharan Africa: A review of the literature.

BACKGROUND: far too many women continue to die from pregnancy and childbirth related causes. While rates have decreased in the past two decades, some areas of the world such as sub-Saharan Africa continue to have very high maternal mortality rates. One intervention that has been demonstrated to decrease maternal mortality is use of family planning and modern contraception, yet rates of use in sub-Saharan countries with the highest rates of maternal death remain very low. AIM: to review available research and summarize the factors that inhibit or promote family planning and contraceptive use among refugee women and women from surrounding areas living in Sub-Saharan Africa. DESIGN: a review of the literature. DATA SOURCES: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID, power search, and PubMed databases. REVIEW METHODS: studies included were: (1) published in English from 2007 to present; (2) primary research; and (3) focused on family planning and contraceptive use among refugee women and women in surrounding areas. Findings were discussed within the framework of the Interaction Model of Client Health Behavior. FINDINGS: twelve studies met the inclusion criteria. Utilization of modern contraceptive methods was low. Women were socially influenced to avoid the use of contraceptives by husbands and others in the community. Reasons were a lack of trust in western medicine and the desire to have large families. Low socioeconomic status and proximity of family planning clinics were barriers to access. Women believed that health care providers were unqualified, many described being treated with disrespect in the health clinics. Knowledge and understanding of contraceptives was low; while most women knew different methods were available, there were many misconceptions. Believing that certain contraceptives cause death, infertility and side effects, contributed to fear of use. This lack of knowledge and fear, even with the desire to space and limit births, affected motivation to use contraception. CONCLUSIONS: developing new approaches to educating women, men (husbands), community leaders as well as healthcare providers is needed to address the multi-factorial issues that contribute to underuse of family planning services, thus contraceptive use. IMPLICATIONS FOR PRACTICE: while lack of access to family planning is a barrier to use, interventions that improve access must be affordable and include education regarding contraceptive methods, preferably from those within the community. However, education and access is not sufficient unless the issue of disrespect by healthcare providers is addressed. Respectful and culturally sensitive care for all women, regardless of socio-economic status or country of origin, must be provided by midwives and other women health providers.

Psychometric Testing of the Pap Smear Belief Questionnaire: Measuring Women's Attitudes and Beliefs Toward Cervical Cancer Screening.

BACKGROUND AND PURPOSE: Some women avoid routine Pap testing because of negative attitudes and beliefs. The ability to measure these factors is limited by lack of valid and reliable tools. Therefore, this article describes steps taken to test a measure. METHODS: Validity and reliability testing of psychometric scales was conducted. RESULTS: Sample consisted of 344 women. Using principal component analysis resulted in 4 components: Exam-Related Factors, Benefits, Vulnerability, and Risks and Barriers. Revised scale included 28 items explaining 46% variance, with good internal consistency (α = .84). Women who did not routinely screen exhibited significantly more negativity. CONCLUSIONS: The measure demonstrates validity and reliability across different groups of women and can be used to inform the design of individualized interventions to promote repeat screening.

Planned home birth: benefits, risks, and opportunities.

While the number of women in developed countries who plan a home birth is low, the number has increased over the past decade in the US, and there is evidence that more women would choose this option if it were readily available. Rates of planned home birth range from 0.1% in Sweden to 20% in the Netherlands, where home birth has always been an integrated part of the maternity system. Benefits of planned home birth include lower rates of maternal morbidity, such as postpartum hemorrhage, and perineal lacerations, and lower rates of interventions such as episiotomy, instrumental vaginal birth, and cesarean birth. Women who have a planned home birth have high rates of satisfaction related to home being a more comfortable environment and feeling more in control of the experience. While maternal outcomes related to planned birth at home have been consistently positive within the literature, reported neonatal outcomes during planned home birth are more variable. While the majority of investigations of planned home birth compared with hospital birth have found no difference in intrapartum fetal deaths, neonatal deaths, low Apgar scores, or admission to the neonatal intensive care unit, there have been reports in the US, as well as a meta-analysis, that indicated more adverse neonatal outcomes associated with home birth. There are multiple challenges associated with research designs focused on planned home birth, in part because conducting randomized controlled trials is not feasible. This report will review current research studies published between 2004 and 2014 related to maternal and neonatal outcomes of planned home birth, and discuss strengths, limitations, and opportunities regarding planned home birth.

Home birth after hospital birth: women's choices and reflections.

INTRODUCTION: The number of US women choosing home birth is increasing. Little is known about women who choose home birth after having experienced hospital birth; therefore, the purpose of this research was to explore reasons why these women choose home birth and their perceptions regarding their birth experiences. METHODS: Qualitative description was the research design, whereby focus groups were conducted with women who had hospital births and subsequently chose home birth. Five focus groups were conducted (N = 20), recorded, and transcribed verbatim. Qualitative content analysis was undertaken allowing themes to emerge. RESULTS: Five themes emerged from the women's narratives: 1) choices and empowerment: with home birth, women felt they were given real choices rather than perceived choices, giving them feelings of empowerment; 2) interventions and interruptions: women believed things were done that were not helpful to the birth process, and there were interruptions associated with their hospital births; 3) disrespect and dismissal: participants believed that during hospital birth, providers were more focused on the laboring woman's uterus, with some experiencing dismissal from their hospital provider when choosing to birth at home; 4) birth space: giving birth in their own home, surrounded by people they chose, created a peaceful and calm environment; and 5) connection: women felt connected to their providers, families, newborns, and bodies during their home birth. DISCUSSION: For most participants, dissatisfaction with hospital birth influenced their subsequent decision to choose home birth. Despite experiencing challenges associated with this decision, women expressed satisfaction with their home birth.

A history of interpersonal trauma and the gynecological exam.

Cervical cancer is preventable, in part, by routine Papanicolaou (Pap) testing, but some women avoid routine screening. African American women have the greatest mortality among all groups of women in the United States. Personal reasons have been found to contribute to screening avoidance behavior, such as a history of sexual abuse and intimate partner violence. Fifteen African American women with a trauma history participated in personal interviews. The Interaction Model of Client Behavior was employed for exploring the women's social influence, previous health care experience, cognitive appraisal, affective response, and motivation associated with routine Pap testing. Study findings suggest that providers need to assess and provide accurate information about Pap testing and cervical cancer to increase patients' knowledge. Personally reflecting on one's approach to conducting a woman's gynecologic exam (and how it is performed) might prevent triggering unwanted memories, making that visit a positive experience and facilitating repeat screening behavior.

Interactive model of client health behavior and cervical cancer screening of African-American women.

OBJECTIVE: Explore inductively African American women's use of Pap smear screening services and consider how well the data did or did not affirm the usefulness of the interaction model of client health behavior (IMCHB). DESIGN AND SAMPLE: The IMCHB guided this qualitative study designed to explore women's social influence and previous health care experience and their influence on the women's cognitive appraisal associated with Pap smears and cervical cancer. Interviews were conducted with 24 women, resulting in 2 groups: routine-use (n = 11) (Pap smears every 1-3 years) and non-routine-use (n = 13). MEASURES: Content analysis approach to data analysis was used, where interview data were considered in relation to elements of IMCHB. RESULTS: Analysis revealed that the IMCHB was useful for framing cervical cancer screening health behavior research. Both groups' data fit well onto the framework. The routine-use group fit the entire model, with iterative (repeat) behavior in cervical cancer screening. The non-routine-use group also fit the model, but their iterative behavior in cervical cancer screening was intermittent due to negative personal influences. CONCLUSIONS: This model can provide a focus to the delivery of gynecological care based on a client's unique characteristics that can be addressed with individualized nursing interventions designed to promote positive health outcomes.

Feasibility of a longitudinal study of women anticipating first pregnancy and assessed by multiple pelvic exams: recruitment and retention challenges.

OBJECTIVE: To better understand the relationship between childbirth and pelvic floor disorders the ideal study design would begin with data collection prior to but close in time to first pregnancy and follow participants through postpartum. We conducted a feasibility study to determine the following: a) whether women desiring to get pregnant would agree to pre-pregnancy data collection including a one-time urethral catheter measure and repeat pelvic exams to ascertain a baseline within 6 months of pregnancy; b) effectiveness of various recruitment and retention methods, c) number achieving pregnancy, and then d) number expressing willingness to continue follow-up through pregnancy and postpartum. METHODS: Advertising included newspaper ads, targeted emails and flyers. Post-enrollment, four data collection visits were scheduled and occurred every 6 months or until pregnant. If pregnancy occurred, women were asked to indicate their willingness to continue assessments. RESULTS: The most successful advertising strategy for both recruitment and retention was local newspaper ads. Ninety-four women inquired about the study, 30 enrolled. Post-baseline retention was 23 women at 6 months, 17 at 12 months, and 13 at 18 months. Nine of the 30 women achieved pregnancy; two remained eligible and willing to participate through pregnancy and postpartum. CONCLUSIONS: This study provides data on feasibility of recruiting women to establish near-pregnancy clinical baseline measures that include pelvic exams. Close to 30% reached pregnancy within 2 years of study start and within 6 months of most recent pelvic exam measure. Of those who became pregnant, 22% expressed willingness to continue follow-up into the childbearing year.

Personal influences that affect motivation in pap smear testing among African American women.

OBJECTIVE: To explore personal influencing factors that contribute to Papanicolaou (Pap smear) testing in African American women who do (routine-use group) and do not (non-routine-use group) obtain routine testing. DESIGN: Qualitative using the interaction model of client health behavior. SETTING: Community programs, homes, and churches. PARTICIPANTS: Twenty four African American women aged 19 to 60. METHODS: Face-to-face interviews. Data were analyzed using a constant comparison approach. RESULTS: Routine-use group was socially influenced to value preventive health care while the non-routine-use group was not. Previous health care experiences with having a Pap smear and pelvic exam were positive for routine-use group and negative for non-routine-use group. Cognitively, both groups believed Pap smears tested for cancer and sexually transmitted diseases. Vulnerability to cervical cancer was thought to run in families; participants believed they were either safe from risk or hoped that the odds were in their favor. In addition, there was a link between avoiding routine preventive care and a trauma history (sexual, physical, medical), eliciting negative perceptions towards Pap smears and pelvic exams. CONCLUSION: Differences and similarities in personal influencing factors associated with cervical cancer screening were found in the two groups. Further research is needed to explore these differences and similarities because they may contribute to the reason that African American women have a greater mortality rate from cervical cancer than White women.

A decision theory perspective on why women do or do not decide to have cancer screening: systematic review.

AIM: This paper is a report of a review in which decision theory from economics and psychology was applied to understand why some women with access to care do not seek cancer screening. BACKGROUND: Mammography and cervical smear testing are effective modes of cancer screening, yet many women choose not to be screened. Nurses need to understand the reasons behind women's choices to improve adherence. DATA SOURCES: Research papers published between January 1994 and November 2008 were identified using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PsycINFO data bases. The search was performed using the following terms: cervical cancer screening, breast cancer screening, decision, choice, adherence and framing. Forty-seven papers were identified and reviewed for relevance to the search criteria. METHODS: Nineteen papers met the search criteria. For each paper, reasons for obtaining or not obtaining cancer screening were recorded, and organized into four relevant decision theory principles: emotions, Prospect Theory, optimism bias and framing. FINDINGS: All women have fears and uncertainty, but the sources of their fears differ, producing two main decision scenarios. Non-adherence results when women fear medical examinations, providers, tests and procedures, do not have/seek knowledge about risk and frame their current health as the status quo. Adherence is achieved when women fear cancer, but trust care providers, seek knowledge, understand risk and frame routine care as the status quo. CONCLUSION: Nurses need to address proactively women's perceptions and knowledge about screening by openly and uniformly discussing the importance and benefits.

Personal influencing factors associated with pap smear testing and cervical cancer.

Pap smear is a screening test that detects abnormal cells before they advance to cancer. Unfortunately, not all women obtain routine screening. The method used was a qualitative study exploring personal influences regarding Pap smears. Face-to-face interviews with 7 low-income African American women who do and do not obtain Pap smears (between 21 and 37 years of age) were conducted at a health department about their social influence, previous health care experience, and cognitive appraisal regarding Pap smears and cervical cancer. Women were found to be socially influenced by their family and their physician. Previous health care experience with the Pap and pelvic was perceived as negative. Cognitively, Pap smears were believed to test for sexually transmitted diseases, including HIV, and the women also felt that if one took good care of oneself it reduced the risk for cervical cancer. It was concluded that exploring beliefs associated with Pap smears and perceptions of vulnerability to cervical cancer and giving correct information and counseling may increase Pap smear screening in women.

Factors influencing cancer screening practices of underserved women.

PURPOSE: This integrated review was conducted to evaluate the factors that inhibit or promote decisions by African American and Hispanic women to obtain cervical cancer screening. DATA SOURCES: Research articles were identified using MEDLINE, PubMed, and Cumulative Index to Nursing and Allied Health literature, published between 1999 and 2005. CONCLUSIONS: Cervical cancer screening practices of African American and Hispanic women were influenced by extrinsic motivators including lack of insurance, no usual source of health care, acculturation, and socioeconomic factors. Intrinsic motivators were related to beliefs and perceptions of vulnerability, such as ignoring cervical cancer screening when no symptoms were present; believing that not knowing if one had cervical cancer was better; and thinking that only women who engage in sexual risk-taking behaviors need to obtain Papanicolaou (Pap) smear testing. IMPLICATIONS FOR PRACTICE: Nurse practitioners (NPs) have an opportunity to impact the incidence and mortality of cervical cancer by improving screening practices of minority women. They can emphasize the importance of obtaining Pap smears regularly, teach patients the risks for and signs and symptoms of cervical cancer, and provide recommendations for obtaining screening at low cost or no cost to the patient. To improve cancer screening practices, NPs need to address minority women's beliefs about cervical cancer and provide information and services in a culturally sensitive manner at an appropriate level of learning.