Insights into fear: A phenomenological study of Black mothers.

AIM: The aim of the study was to explore the lived experience of stress as described by Black childbearing women. DESIGN: A phenomenological approach was used. METHODS: Seven mothers who met inclusion criteria participated in both individual and group interviews between August 2018 and August 2019. Each session was audio recorded and professionally transcribed. Consistent with van Manen's phenomenological approach, three rounds of reflective transcript analysis were conducted over several months. RESULTS: Several stress themes were identified from the data. However, the most pervasive theme was the fear of having a son and keeping him safe. In this paper, the themes of Living in Fear and Living with Fear are detailed. CONCLUSION: Previous research has found that Black populations in America fear for their safety. This study identified a pervasive and profound fear for their children, specifically sons who are at a higher risk of being killed in normal daily activities. Mothers also expressed fears about their responsibility to keep them safe by providing the right tools. IMPACT: Although scientists have long studied poor pregnancy outcomes for Black American women, the disparity persists. This study sought to identify stressors acknowledged by Black mothers themselves. For the first time, Black mothers stated that their primary stress is fear for their children's lives. The role this fear has in adverse pregnancy outcomes, if any, is yet to be determined.

Introduction to the Online Nursing Education Best Practices Guide.

INTRODUCTION: As online nursing education programs continue to increase to meet the demands of the growing market, nursing faculty are challenged to develop and deliver courses based on best practice principles. The Online Nursing Education Best Practices Guide (ONE Guide) builds on and extends the nationally recognized Quality Matters® program and serves as a roadmap guiding course development and delivery. The fundamental principle for success in online teaching is instructor presence; the teacher as a facilitator of learning is illustrated throughout the guide. An Online Instructor Checklist facilitates systematic implementation of best practice principles. METHODS: This article is based on a focused literature review and concept analysis resulting in a comprehensive guide for delivery of effective, quality nursing education through best practices in the online learning environment. A broad search of databases focused on articles during 2014 to 2019 was completed. The literature review included articles that examined over 1200 student perceptions of instructor presence in the online setting. CONCLUSION: Nurses carry a direct responsibility for the health and well-being of patients. Nursing quality education proves fundamental to the profession's long-term outcomes. The ONE Guide and Online Instructor Checklist apply comprehensive, evidence-based teaching strategies to give a roadmap for success in the online teaching environment.

Message Heard: Insights for Doctoral Program Design From Community Partners.

Developing a nursing doctoral program requires, among other considerations, thoughtful reflection on opportunities for graduates, and needs of the health-care community. To educate nurse clinicians, scientists, and leaders prepared to address complex health-care issues, colleges of nursing must engage with community stakeholders during program development. One college embraced this opportunity to dialogue through a series of semistructured focus groups and surveys to inform community partners of the developing doctoral program plan and to hear their related ideas and opinions. Themes arising from qualitative data analysis included driving forces, the value of education, and differing doctoral roles. The findings were far more enlightening than anticipated and ultimately guided the direction of program development. This study affirmed the power of meaningful dialogue with community partners to ensure a well-educated nursing workforce with the skills needed to advance nursing practice in the changing health-care environment.

Finding My Way: A Phenomenology of Fathering in the NICU.

BACKGROUND: Historically, the relationship between infant and mother in the neonatal intensive care unit (NICU) has been the main focus of parenting research, leaving a gap in the literature regarding the paternal experience. PURPOSE: The purpose of this study was to gain an understanding of the lived experience of fathering an infant born at less than 28 weeks' gestation admitted to a level III NICU. METHODS: Seven fathers of premature infants (25-27 weeks' gestation) participated in a semistructured interview about the experience of becoming a father to a premature infant at least 1 to 2 weeks after the NICU admission. Data were collected in 2015. FINDINGS: The primary themes identified were looking in, persevering, holding, and finding my way. Fathers in this study described feeling like an outsider in the NICU while learning to trust strangers, protect the mother and the child, and continue to work and provide for the family. Holding for the first time is pivotal in this journey, as the moment of solidifying the connection with the child. IMPLICATIONS FOR PRACTICE: The findings from this study bring awareness of the experiences of fathers during the NICU journey of having a premature infant. Nurses should encourage paternal participation and involvement, visitation, and facilitate kangaroo care opportunities early and often. IMPLICATIONS FOR RESEARCH: The findings from this study allow nurses to better understand the paternal experience of having a premature infant born at less than 28 weeks. However, future research should continue to investigate the paternal experience with other gestational ages as well as the influence of stress of fathers during this experience.

Dementia Care Content in Prelicensure Nursing Curricula: A Pilot Mixed-Methods Study.

BACKGROUND: Having a nursing workforce equipped to provide quality care for patients living with dementia is essential. The purpose of this study was to investigate how undergraduate nursing programs integration of dementia care content into their curricula. METHOD: Using sequential explanatory mixed methods, a stratified sample of 137 representatives of programs in 11 states with dense elderly populations completed a quantitative survey. A subsample (n = 8) completed qualitative e-mail interviews. RESULTS: Most respondents indicated dementia care content was integrated into their curricula (n = 103, 92.8%). Clinical partnership with dementia care centers was associated with a greater proportion of students interacting with individuals having dementia (p = .02). Curriculum overload was the most significant challenge to integrating dementia content (n = 61, 43.9%). Qualitative themes supported the quantitative results. CONCLUSION: Future research is needed to identify best practices to ensure that nursing curricula provide essential content to meet the care needs of the growing population of individuals with dementia. [J Nurs Educ. 2018;57(2):88-95.].

Menopausal symptoms among four major ethnic groups in the United States.

The purpose of the study was to explore ethnic differences in symptoms experienced during the menopausal transition among four major ethnic groups in the United States. This study was done via a cross-sectional Internet survey among 512 midlife women recruited using a convenience sampling. The instruments included questions on background characteristics, ethnicity-related factors, health, and menopausal status and the Midlife Women's Symptom Index. The data were analyzed using descriptive and inferential statistics. Significant ethnic differences were found in the total number and severity of the symptoms. The most frequently reported symptoms and predictors of the total number and severity of the symptoms differed by ethnic identity. More in-depth cultural studies are needed to understand the reasons for the ethnic differences in menopausal symptom experience.

A national multiethnic online forum study on menopausal symptom experience.

BACKGROUND: Little is known about how culture influences menopausal symptom experience, and few comparative qualitative studies have been conducted among multiethnic groups of midlife women in the United States. OBJECTIVES: The purpose of this study was to explore commonalities and differences in menopausal symptom experience among four major ethnic groups in the United States (Whites, Hispanics, African Americans, and Asians). METHODS: This was a secondary analysis of qualitative data from a larger national Internet-based study. The qualitative data from 90 middle-aged women in the United States who attended four ethnic-specific online forums of the larger study were examined using thematic analysis. RESULTS: The themes reflecting commonalities across the ethnic groups were just a part of life, trying to be optimistic, getting support, and more information needed. The themes reflecting the differences among the ethnic groups were open and closed, universal and unique, and controlling and minimizing. Overall, the findings indicated positive changes in women's menopausal symptom experience and supported the existence of cultural influences on women's menopausal symptom experience across the ethnic groups. DISCUSSION: Systematic efforts need to be made to empower midlife women in their management of menopausal symptoms.

Menopausal symptom experience of Hispanic midlife women in the United States.

Using a feminist approach, we examined the menopausal symptom experience of Hispanic midlife women in the United States This was a qualitative online forum study among 27 Hispanic midlife women in the United States. Seven topics related to menopausal symptom experience were used to administer the 6-month online forum. The data were analyzed using thematic analysis. Four themes were identified: (a) "Cambio de vida (change of life)," (b) "being silent about menopause," (c) "trying to be optimistic," and (d) "getting support." More in-depth studies with diverse groups of Hispanic women are needed while considering family as a contextual factor.

The effects of hormone therapy decision support for women with mobility impairments.

Deciding about hormone therapy (HT) use is particularly complex for women with mobility impairments. While HT controls menopausal symptoms, the potential increased risk of blood clots resulting from physical inactivity can contraindicate HT use. These women, therefore, may benefit from interventions to help them tailor standard information about HT. We randomly assigned women to receive either a tailored decision support intervention or standard menopausal information. Both groups (n = 176) significantly decreased their decisional conflict and uncertainty and increased knowledge after receiving the treatment materials. We interpret the findings in the context of limited medical information about HT for women with disabilities.

Complementary and alternative medicine use for vasomotor symptoms among women who have discontinued hormone therapy.

OBJECTIVES: To explore the use and perceived usefulness of complementary and alternative medicine therapies and nonhormonal conventional medicine alternatives to treat vasomotor symptoms occurring after withdrawal from hormone therapy. DESIGN: Retrospective, single cross sectional descriptive study. SETTING: Study volunteers were recruited via a direct mailed questionnaire sent to a sample of women throughout the United States. Additional respondents were recruited through flyers and postcards advertising the study placed with permission at several health care provider offices and other locations. PARTICIPANTS: A sample of 563 menopausal women who had discontinued the use of hormone therapy completed a questionnaire describing their experiences with the use of complementary and alternative medicine. MAIN OUTCOME MEASURES: Responses to an investigator developed survey. RESULTS: Nearly half of the women surveyed used complementary and alternative medicine. The most common choices of complementary and alternative medicine were (a) multivitamins and calcium, (b) black cohosh, (c) soy supplements and food, (d) antidepressants, (e) meditation and relaxation, (f) evening primrose oil, (g) antihypertensives, and (h) homeopathy. Of the alternative therapies that were used by at least 5% of the sample, antidepressants were perceived as the most useful. CONCLUSIONS: With the increased adoption of complementary and alternative medicine, it is important for health care providers to be familiar with the various methods so they are comfortable discussing the benefits and risks with their patients to assist them in making informed decisions.

The potential role of glucose transport changes in hot flash physiology: a hypothesis.

PURPOSE: The purpose of this article is to detail a novel hypothesis regarding the role of changes in brain glucose delivery in menopausal hot flashes. ORGANIZING FRAMEWORK: The impaired glucose delivery hypothesis of menopausal hot flashes is presented as a potential model of hot flash physiology. As foundational to the hypothesis, brain glucose physiology, specifically neurobarrier coupling, is presented in detail. With brain activation, glucose needs immediate increase; additional glucose is supplied through increased production of glucose transporter 1 (GLUT1) at the blood-brain barrier (BBB) and through vasodilation. Estrogen is important to this system in stimulating production of GLUT1. As estrogen declines at menopause, upregulation of GLUT1 is less efficient. As a consequence, neurobarrier coupling overcompensates with an excess neurovascular response, or a hot flash. Research supporting this hypothesis is briefly reviewed and new questions raised are reviewed. CONCLUSIONS: The impaired glucose hypothesis of menopausal hot flashes proposes an inadequate neurobarrier response to neurometabolic stimulation as estrogen declines, resulting in additional neurometabolic stimulation with consequent neurovascular stimulation. In this model, the menopausal woman has diminished ability to respond to fluctuations in blood glucose over the course of the day, which results in hot flashes as a counter-regulatory response. This perspective accounts for observed physiological changes that have not been previously detailed. New research directions are identified.

Menopausal symptom experience: an online forum study.

AIM: The aim of the study was to explore the menopausal symptom experience of White midlife women. BACKGROUND: Recent cross-cultural investigations have indicated important ethnic differences in menopausal symptoms and have challenged the universality of these symptoms. Currently available cultural knowledge on menopausal experience, however, is inadequate to guide appropriate and adequate care even for White women in the menopausal transition. METHOD: A cross-sectional qualitative online forum study was conducted in 2007 with 23 midlife women who self-identified as non-Hispanic Whites using convenience sampling. Seven topics related to menopausal symptom experience were used to guide the online forum for 6 months. The data were analysed using thematic analysis. RESULTS: The experiences of menopause caused women to redefine themselves within their busy daily life schedules. They were optimistic about their symptoms, and tried to laugh at the experience to boost their inner strength and motivate themselves to persevere. Many thought that both generational and life-style differences were much more important than ethnic differences in menopausal symptom experiences. In seeking assistance with the symptoms of menopause, women were not satisfied with the guidance of their physicians. CONCLUSION: Nurses need to listen carefully to what women themselves say about their own experiences with menopausal symptoms and avoid imposing predetermined symptom management strategies. Further studies of women's perceptions of life-style influences are needed to guide symptom management. In addition, studies of generational changes in menopausal symptom experience are needed.

The effect of dietary intake on hot flashes in menopausal women.

OBJECTIVES: To describe the relation between dietary intake and menopausal hot flashes. DESIGN: Two studies are reported: a controlled, repeated-measures study and a descriptive study. SETTING: The controlled study was conducted in a general clinical research center of a large Midwestern university. The descriptive study was conducted in a metropolitan community in the Southwest. PARTICIPANTS: Ten healthy symptomatic postmenopausal women participated in the controlled study and 21 symptomatic women completed the observational study. INTERVENTIONS: The controlled study included a 30-hour intensive blood sampling protocol of two sequential experimental phases with an observational phase between them. In the observational phase, each participant served protocol-specific meals and snacks at predetermined times. MAIN OUTCOME MEASURE: Skin conductance monitoring provided continual assessment while blood glucose levels were analyzed every 30 minutes in the controlled study. RESULTS: Eating provided a hot flash-free period that averaged 90 minutes in both studies. Also, hot flash frequency increased as time between meals increased. CONCLUSIONS: Our evidence indicates that hot flash frequency is suppressed after eating, while hot flashes are experienced when blood glucose falls between meals. Nursing interventions aimed at maintaining stability in blood glucose level may be effective in reducing menopausal hot flashes.

Menopause health decision support for women with physical disabilities.

Menopausal women with disabilities present health care providers with unique and challenging health issues. Many women with disabilities already face an ongoing struggle to promote their health and prevent secondary disabling conditions, which may be exacerbated by menopause. This article highlights some of the special health concerns of this population and to suggest ways in which a health care professional might tailor general clinical guidance to meet these women's needs.

Factors associated with use of hormone therapy among women with mobility impairments.

The purpose of the study was to examine the factors associated with hormone therapy (HT) use among women with mobility impairments. A non-probability sample of 188 menopausal women (average age = 53 years) from 38 states was recruited in 2004 for the study. Twenty-two percent of participants were currently taking HT; 33% were past users. Using multinomial logistic regression, this study found that those most likely to be taking HT now or in the past were older women, knowledgeable about HT, had had a hysterectomy, had bone loss, and had their provider's encouragement. Implications for health care providers are discussed.

Midlife women's responses to a hospital sleep challenge: aging and menopause effects on sleep architecture.

OBJECTIVE: To distinguish aging from menopause effects on sleep architecture, we studied an episode of disturbed hospital sleep in asymptomatic midlife women during the follicular phase of an ovulatory cycle and three control groups differing by age or menopause status. METHODS: Fifty-one studies were conducted in four groups of volunteers: young cycling (YC, 20-30 years, n = 14), older cycling (OC, 40-50 years, n = 15), ovariectomized receiving estrogen therapy (OVX, 40-50 years, n = 12), and spontaneously postmenopausal (PM, 40-50 years, n = 10). Subjects were admitted to the University Hospital General Clinical Research Center (GCRC) for a first-night sleep study conducted during a 24-hour, frequent blood sampling protocol. RESULTS: Despite similar estrogen concentrations in the YC (28 +/- 4 pg/ml) and OC (34 +/- 6 pg/ml) groups, OC women had reduced sleep efficiency (79% +/- 2%) vs. YC (87% +/- 3%; p = 0.009). In the OVX and PM groups where estrogen concentrations were markedly different, sleep efficiency was also reduced vs. the YC group (OVX vs. YC, 79% +/- 3% vs. 87% +/- 3%, p = 0.05; PM vs. YC, 75% +/- 3% vs. 87% +/- 3%, p = 0.007). Wake time was longer in the three older groups (103 +/- 10 minutes, 101 +/- 12 minutes, 123 +/- 12 minutes for OC, OVX, PM, respectively) vs. YC (63 +/- 13 minutes, p < 0.05). The number of stage shifts was positively associated with advancing age (rho = 0.3, p < 0.03) but not with estrogen concentration. CONCLUSIONS: Aging-related sleep deficits in response to an experimental stressor occur in midlife women prior to menopause.

Menopausal hot flash frequency changes in response to experimental manipulation of blood glucose.

OBJECTIVE: Although a majority of women (80%) at menopause experience hot flashes, the symptoms' physiological trigger has yet to be identified. To determine the relationship between glucose availability and hot flashes in menopausal women, hot flash frequency was compared between intervals while the subjects were fasting and/or infusing in a sample of menopausal women (38-55 years of age). DESIGN: An experimental study was conducted in 10 postmenopausal women taking hormone therapy (HT) between the ages of 38 and 55. Following a clinic visit to screen for general health and absence of diabetes, HT participants were asked to stop the medication for 7 to 10 days and to maintain a diary of hot flash frequency. When hot flashes were experienced at least four times per day in a consecutive 3-day period, participants were admitted to the General Clinical Research Center for a 30-hour experimental protocol, including frequent blood sampling and two experimental periods of intravenous infusion of glucose or normal saline. Blood glucose levels were manipulated to provide conditions of postprandial versus fasting states. RESULTS: There was a significant reduction in the incidence of hot flashes during the experimental elevation of glucose concentrations (130 to 140 mg/dl) compared to the fasting state (<110 mg/dl) (t= -2.4, df= 9, p=.04). CONCLUSIONS: Conditions of fasting may stimulate the trigger mechanism for menopausal hot flashes.

What we know about managing menopausal hot flashes: navigating without a compass.

Hot flashes and night sweats are frequently experienced as the cardinal symptoms of menopause. However, their physiological basis has not been explained; nor have any potential risks been explored. Current knowledge and theoretical perspectives regarding hot flashes will be presented and contrasted with evidence for an emerging hypothesis of altered brain glucose availability as the hot flash trigger. Perspectives regarding hormone therapy and alternative therapies for treatment of hot flashes will be presented and directions for future research reviewed.