Health Care Providers' Perceived Barriers to Screening for Substance Use During Pregnancy.

OBJECTIVE: To explore health care providers' perceived barriers to conducting standardized screening processes for substance use during pregnancy. DESIGN: Descriptive survey. SETTING/LOCAL PROBLEM: A health system in the northwestern United States where there was a lack of consistent substance use screening in prenatal clinics. PARTICIPANTS: A convenience sample of 12 women's health care providers from two hospitals in the health system, including obstetricians/gynecologists, women's health nurse practitioners, women's health physician assistants, and certified nurse-midwives. INTERVENTION/MEASUREMENTS: We created a 16-item questionnaire that identified potential barriers to screening, such as education/resources for providers, screening tools, referral processes, legal implications, patient relations, and infrastructure. RESULTS: A majority (n = 8, 66.7%) of participants indicated they had received adequate training regarding substance use during pregnancy and felt comfortable asking pregnant women about their substance use. All (n = 12, 100%) providers indicated that women would feel safe disclosing their substance use but might feel offended if their provider asked them about it. Although most reported screening women for substance use, they did not use a consistent screening tool or process. Participants identified lack of time, legal concerns, and lack of access to resources for referrals as other barriers to screening. CONCLUSION: Clinicians perceive barriers to screening for substance use during pregnancy, and they may be unaware of legal implications for patients related to perinatal substance use. Identifying barriers to universal screening may facilitate development of best practices related to counseling patients about substance use during pregnancy.

The influence of undergraduate research assistant experiences on future nursing roles.

Undergraduate nursing students have difficulty comprehending the relevance of research to their future as nurses. Working as an undergraduate research assistant may provide opportunities to develop an appreciation of research. The purpose of this study was to explore former undergraduate research assistants' perceptions of their experience and its effects on their practice as professional nurses. This study used a qualitative descriptive design. Seven former undergraduate research assistants were interviewed. Interview transcripts were analyzed for themes using content analysis. Data analysis yielded three main themes: immersion in the research process, empowered to practice evidence-based nursing, and future nurse scientists and educators. Immersion in the research process increased participants' understanding of research and its importance to nursing practice. This experience facilitated acquisition of skills they used in their current clinical settings to practice evidence-based nursing. Close relationships with a faculty mentor and exposure to a community of nurse scientists at a regional research conference inspired some to consider a future as nurse scientists and educators. An undergraduate research assistant program may be an effective approach to preparing baccalaureate nursing students for clinical practice and for graduate education. Positive experiences with conducting research are essential to nurturing the next generation of nurse scientists and educators.

No Longer Expert: A Meta-Synthesis Describing the Transition From Clinician to Academic.

BACKGROUND: Recruitment of nurse clinicians into academic nursing has been important in addressing the faculty shortage. A description of their experiences as novice faculty could provide insights into easing their transition and improving faculty retention. METHOD: A systematic review of existing qualitative evidence was conducted to describe how nurses experience the transition from clinical practice to nursing academic. Criteria established by the Joanna Briggs Institute guided the review. RESULTS: The meta-synthesis of the 12 selected qualitative studies yielded 11 themes and four meta-themes, which included: Unprepared, No Longer an Expert, In Search of Mentoring, and Beginning to Thrive. CONCLUSION: The transition from expert clinician to novice faculty is difficult as teaching is different than practicing nursing. The expert clinicians often were unprepared for the demands of their faculty role and missed being experts. To begin to thrive, they needed orientation to the academic culture, intentional mentoring, and professional development in teaching and learning. [J Nurs Educ. 2020;59(7):366-374.].

Development and Psychometric Testing of the Nurses' Confidence Scale: Unique Families.

OBJECTIVE: To develop and evaluate an instrument designed to measure the confidence of nurses in their ability to provide neutral, compassionate care to unique families in perinatal settings: the Nurses' Confidence Scale: Unique Families. DESIGN: Prospective instrument development and psychometric study. SETTING: Health system in the U.S. Mountain West region. PARTICIPANTS: Convenience sample of 62 perinatal/neonatal nurses. METHODS: We developed a two-part scale to measure the confidence of nurses in their ability to care for complex/nontraditional families, termed unique families. Part A was focused on nursing care behaviors for any unique family; Part B was focused on providing care to seven specific unique family populations. Five experts in perinatal nursing or adoption evaluated the scale's content validity. To test the psychometric properties of the scale, we used item analysis, reliability analysis, and exploratory factor analysis. RESULTS: The content validity index was 0.82. The Cronbach's alpha coefficient estimate of internal consistency for Part A was .92. Principal component analysis resulted in two factors that explained 64% of the total variance: skills and resources (Cronbach's alpha coefficient = .89) and awareness and sensitivity (Cronbach's alpha coefficient = .87). Part B had a Cronbach's alpha coefficient of .90. Parts A and B showed a strong positive relationship with one another (r = .77). The general self-efficacy measure was strongly and positively correlated with Part A (r = .81) and moderately and positively correlated with Part B (r = .48). CONCLUSION: The Nurses' Confidence Scale: Unique Families is a new tool with which to measure the confidence of perinatal/neonatal nurses in providing sensitive, specific care to complex/nontraditional families. Results of our psychometric evaluation supported initial acceptable reliability and validity of the scale.

Partnership Between a Health System and a Correctional Center to Normalize Birth for Incarcerated Women.

Women of childbearing age make up a growing segment of the prison population; many are pregnant while incarcerated. The care this population has received during pregnancy often has been characterized by inattention to nutritional needs, failure to provide for safe sleeping in lower bunks, and lack of childbirth education. These women may be unprepared for childbirth and the early postpartum period. To improve care for these women, staff from a health system and a correctional center collaborated to develop an infrastructure that offered supportive care to incarcerated childbearing women in their community. Organizational policies and processes were aligned to promote a normal birth and early postpartum experience for incarcerated women and provide them with opportunities to bond with their newborns. Family-centered care offers incarcerated women the opportunity to be mothers rather than simply prisoners giving birth.

Evaluation of a Designated Family Bonding Time to Decrease Interruptions and Increase Exclusive Breastfeeding.

OBJECTIVE: The purpose of this quality improvement project was to plan and implement a daily family bonding time on our mother/baby care unit and evaluate its effect on interruptions, mothers' perceptions of interruptions, and exclusive breastfeeding rates. DESIGN: A separate sample pre-/postintervention design conducted in three phases. SETTING/LOCAL PROBLEM: Healthy breastfeeding newborns had double the odds of receiving supplementation before discharge if they stayed more than 1 night or were born at night. Night nurses suggested implementing a daily quiet time as a strategy for limiting interruptions. PARTICIPANTS: A convenience sample of 60 postpartum women. INTERVENTION/MEASURES: During Phases 1 and 3, data were collected on interruptions (number, duration, and by whom), women's perceptions of interruptions, and exclusive breastfeeding rates. Family bonding time was launched in Phase 2 during the hours of 2 p.m. to 4 p.m. Women were encouraged to rest with their newborns in their rooms; interruptions were limited to those that were urgent, medically necessary, or requested by the women. RESULTS: Outcome data were analyzed using descriptive statistics, a repeated-measures analysis of variance, t test, and chi-square test. Analysis of interruptions by the unit nursing staff indicated a decrease in interruptions between 2 p.m. and 4 p.m. that could be attributed to family bonding time (F(1, 58) = 7.50, p = .008). Analysis of interruptions by other hospital staff and visitors indicated a significant interaction of time with interruptions; interruptions decreased in both phases between 2 p.m. and 4 p.m. (F(3, 174) = 4.83, p = .0029; F(3, 174) = 2.95, p = .034). Exclusive breastfeeding rates increased significantly (χ2(4) = 21.27, p = .0003); there were no significant differences in women's perceptions of interruptions. CONCLUSION: New mothers experience many interruptions during their hospital stays, particularly when visitors arrive in large groups and stay more than 60 minutes. Documenting sources of interruptions before launching family bonding time helps identify hospital staff who need to be informed. Addressing their concerns before implementation can facilitate project sustainability.

Education for WIC Peer Counselors About Breastfeeding the Late Preterm Infant.

Mothers of late preterm infants need ongoing support because they often find establishing breastfeeding (BF) to be complex and difficult. Special Supplemental Nutrition Program for Women, Infants and Children peer counselors provide BF information and emotional support to new mothers in many communities. However, their current training does not include education about BF for the late preterm infant. The purpose of this report is to present important information about BF and the late preterm infant that can enhance peer counselors' ability to offer appropriate support. The effect of this education on outcomes such as BF rates, maternal self-efficacy, infant hospital readmissions, and peer counselors' self-efficacy needs to be investigated.

A Community Partnership to Support Breastfeeding Mothers of Late Preterm Infants.

Mothers of late preterm infants need timely breastfeeding support after hospital discharge. Breastfeeding peer counselors with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) can provide this support, but communication with hospitals is needed to facilitate early contact with women. We aimed to develop and implement a sustainable organizational process that would expedite support by providing WIC peer counselors access to mothers of late preterm infants before hospital discharge. Key strategies included creating a workable process; addressing barriers and stakeholder concerns; planning a pilot program to test the process; and inviting the WIC breastfeeding peer counselors to tour the hospital, meet nursing staff, and practice scripting their initial encounter with mothers. The organizational pathway currently is being implemented throughout the health system.

Beyond the Dedicated Education Unit: Using Cognitive Load Theory to Guide Clinical Placement.

BACKGROUND: Navigating multiple instructors and clinical agencies can impair students' learning by increasing their cognitive load and perceived stress. This study used cognitive load theory to guide the home base clinical model (HBCM), which assigned students to the same faculty and hospital unit for two consecutive medical-surgical clinical courses. METHOD: The study used a quasi-experimental three-group design to evaluate the effects of the HBCM on students' perceived stress, compared with groups who changed hospital or instructor. A 10-point visual analog scale measured students' perceived stress on nine clinical tasks. RESULTS: The study recruited 140 participants. Reductions in mean stress were greater for the HBCM groups than the other two groups. CONCLUSION: The study findings challenge the current practice of placing students with changing faculty and facilities. The HBCM demonstrates potential as an effective model for increasing students' ability to learn by decreasing their cognitive load and subsequent stress in their clinical placements. [J Nurs Educ. 2017;56(2):105-109.].

Game-based online antenatal breastfeeding education: A pilot.

AIM: The aim of this study was to evaluate the effect of the Healthy Moms intervention on antenatal breastfeeding self-efficacy and intention and to determine the feasibility of using an online game-based learning platform to deliver antenatal breastfeeding education. BACKGROUND: The Internet has potential for improving breastfeeding rates through improving women's access to antenatal breastfeeding education. METHODS: Twelve computer-based breastfeeding education modules were developed using an online learning platform. Changes in participants' breastfeeding self-efficacy and intention pre- and post-intervention were measured using descriptive statistics and a one-way ANOVA. RESULTS: Of the 25 women submitting the pretest, four completed zero quests; seven, orientation only; eight, one to six breastfeeding quests; and six, 10 to 12 breastfeeding quests. No significant differences in breastfeeding self-efficacy and intention were found among the groups. CONCLUSIONS: Online antenatal breastfeeding education is feasible; however, further research is warranted to determine if it can affect breastfeeding outcomes.

An Institutional Ethnography of Nurses' Support of Breastfeeding on the Night Shift.

OBJECTIVE: To describe nurses' support of breastfeeding on the night shift and to identify the interpersonal interactions and institutional structures that affect this support. DESIGN: Institutional ethnography. SETTING: The mother/baby unit of a tertiary care hospital with 4200 births per year. PARTICIPANTS: Registered nurses (N = 16) who provided care on the night shift to mother/infant dyads in the immediate postpartum period. METHODS: Data were collected using focus groups, individual and group interviews, and mother/baby unit observations. The focus groups were held before the night shift and had five participants. The nine individual and group interviews were conducted between 0100 and 0230 on the mother/baby unit. Three unit observations were conducted. Interviews were recorded, professionally transcribed, and analyzed using a content analysis method. RESULTS: Data analysis yielded three themes that described these nurses' support of breastfeeding on the night shift: competing priorities, incongruent expectations, and influential institutional structures. The need of visitors to see their new family members competed with the needs of mothers to rest and breastfeed their newborns. Helping breastfeeding dyads who experienced difficulties competed with providing care to other patients. Parents' expectations regarding newborn behavior were incongruent with the reality of newborn feeding and sleeping patterns. Institutional structures that affected the provision of breastfeeding support by nurses included hospital breastfeeding practices, staffing, and policies. CONCLUSION: Nurses' support of breastfeeding on the night shift encompasses a complex interplay of interpersonal interactions with new families and visitors regarding priorities and expectations and negotiating institutional structures such as feeding policies and staffing.

Easing the Transition From Clinician to Nurse Educator: An Integrative Literature Review.

BACKGROUND: Experienced clinicians who choose to become academic nurse educators bring to their new faculty role strong clinical skills and a desire to influence the next generation of nurses. However, many find themselves unprepared for the challenges they encounter. Intentional mentoring is needed to ease their transition from clinician to nurse educator. METHOD: An integrative literature review was conducted to identify the essential components of a comprehensive mentoring program to facilitate a positive transition experience from expert clinician to novice nursing faculty. Searches were conducted of the ProQuest Central and CINAHL databases for peer-reviewed articles. RESULTS: A review of 17 publications and seven Web sites identified formal preparation for teaching, guidance navigating the academic culture, and a structured mentoring program as essential to clinicians' successful transition to academic nursing faculty. CONCLUSION: Sustainable mentoring programs require recognition of mentoring as central to nursing education and administrative investment of resources.

Characteristics of child sexual assault within a child advocacy center client population.

This descriptive study summarized data from a child advocacy center to illustrate how such information might be used to profile the scope and character of child sexual abuse (CSA) at the community level. This detailed information is not available from national or state data but is needed to understand the circumstances of the children receiving services and the type of care they may need. Variables included victim demographics, type of sexual abuse and relationship to the perpetrator, and the person to whom the victim was most likely to disclose their sexual assault. A total sample of 841 case reports was reviewed. Chi-square tests were used to determine if there were statistically significant associations between the age groupings, type of abuse, and the perpetrator according to age grouping. Those children most often seen at this child advocacy center were girls (73%); White (67%); and living with their mothers, with both parents, or with parent and stepparent (80%). The incidence of CSA increased for girls across age groups. However, boys aged 6-10 years comprised the greatest percentage of the male sample (56%) who experienced CSA. For all three age groups, over half of the perpetrators were identified as relatives. Most children (85%) experienced high-impact sexual abuse behaviors of fondling, penetration, or some combination thereof. Children most often disclosed CSA to their mothers. Understanding patterns of CSA at the local level provides guidance beyond national and state data to forensic nurses regarding child and family needs within their communities.

Implementing skin-to-skin contact in the operating room following cesarean birth.

Immediate skin-to-skin contact (SSC) after birth benefits the health of mothers and newborns by increasing breastfeeding rates, stabilizing the newborn's temperature, and encouraging bonding (Moore, Anderson, Bergman, & Dowswell, 2012). Although immediate SSC after a vaginal birth was common practice at our hospital, it was rare in the operating room (OR) following a cesarean birth. To address this practice problem, we conducted a project to evaluate the feasibility of implementing SSC in the OR.

Reasons for initial formula supplementation of healthy breastfeeding newborns.

In a retrospective review of 302 hospital charts, 38 percent of newborns whose mothers planned to exclusively breastfeed received formula before hospital discharge. Those breastfeeding infants who did not receive formula were significantly younger at first breastfeeding than infants who received formula. Significantly more infants born by cesarean (51 percent) received supplementation than those born vaginally (31 percent). Birth between 9 p.m. and 10 a.m. and a hospital stay for more than 24 hours increased odds of supplementation. Nurses can explore barriers to exclusive breastfeeding unique to their hospitals to develop strategies that facilitate breastfeeding support and decrease formula supplementation.

Adolescents' needs for nurses' support when initiating breastfeeding.

BACKGROUND: Increasing the number of infants who are breastfed has become a worldwide health priority because of the extensively documented health and economic benefits of breastfeeding for mothers and their children. It is unfortunate that adolescents initiate and continue breastfeeding at rates lower than adult women. Health care providers can improve these breastfeeding rates through the social support they offer adolescent mothers as they initiate breastfeeding. OBJECTIVE: The purpose of this study was to explore the needs of adolescents for social support from nurses when initiating breastfeeding. METHODS: Secondary qualitative content analysis of 90 adolescents' responses to 2 open-ended questions was conducted using social support theory as a framework. The 2 researchers independently categorized each response as informational, instrumental, emotional, and/or appraisal social support. RESULTS: Adolescent mothers wanted nurses to take the time to explain breastfeeding, answer their questions, and provide consistent information that supported their informational needs. Emotional needs were met as the nurse provided for the adolescents' privacy, treated them with respect, and stayed calm. Nurses met adolescents' appraisal support needs through praise and encouragement. Participants valued instrumental support that included being given opportunities to work out breastfeeding under a nurse's guidance. CONCLUSION: Adolescents needed a combination of informational, instrumental, emotional, and appraisal support. Adolescent mothers appreciate and value nurses who take the time to dialogue with them about breastfeeding.

Gerontology found me: gaining understanding of advanced practice nurses in geriatrics.

Examining the meanings of the experiences of advanced practice nurses (APNs) who chose to work with older adults and why they continue to work with this population was the focus of this hermeneutic qualitative research study. Twelve geriatric APNs currently practicing in two South Central states were interviewed using an open-ended interview guide. Using Gadamerian hermeneutics, the researchers identified Gerontology Found Me as the significant expression that reflected the fundamental meaning of the experience as a whole. Four themes emerged that further described the meanings of the participants' personal, educational, and professional experiences: Becoming a Gerontology Nurse, Being a Gerontology Nurse, Belonging to Gerontology, and Bringing Others to Gerontology. This study concluded that APNs' personal and professional experiences were more influential than educational experiences to become geriatric nurses, and having these personal and professional experiences of being in relationship with older individuals further contributed to their choice of gerontology.

African American women and breastfeeding: an integrative literature review.

The purpose of this article is to present a review of literature regarding factors that influence breastfeeding intentions, initiation, and duration in the African American population. Research related to health disparities experienced by African Americans in the United States, as well as research regarding the protective benefits of breastfeeding for those specific health disparities, are also presented. Community and institutional interventions and promotional campaigns aimed at increasing initiation and duration of breastfeeding in the African American population are discussed. Future research regarding African American women's breastfeeding experiences using Black feminist thought as a theoretical foundation is recommended.

The development and psychometric testing of the Supportive Needs of Adolescents Breastfeeding Scale.

AIM: To report the development and psychometric testing of the Supportive Needs of Adolescents Breastfeeding Scale. BACKGROUND: Nurses worldwide can influence adolescent mothers' decisions to initiate and continue breastfeeding through understanding their social support needs in the early postpartum. Review of the literature reveals a lack of instruments that measure adolescents' perceptions of supportive nursing behaviours when initiating breastfeeding. METHOD: An instrument development and psychometric evaluation study was conducted. In phase 1, scale items were developed from the literature using social support theory. Eight lactation consultants evaluated the scale's content validity in phase 2. During phase 3, the psychometric properties of the scale were tested using item analysis, scale reliability, and exploratory factor analysis. A convenience sample of 101 adolescents, aged 15-20 years old, was recruited during their postpartum stay at three hospitals in the USA between July 2009-July 2010. RESULTS: Content validity index was 0·82. Alpha estimate of internal consistency was 0·83. Principal components analysis resulted in a 3 factor scale that explained 48% of the total variance: Practical support, Informational support and Miscellaneous. CONCLUSION: The findings suggest evidence of the scale's adequate internal consistency. The factor analysis suggests two clear underlying dimensions of support: instrumental/emotional/appraisal and informational/emotional/appraisal, and a third miscellaneous dimension related to immediate skin-to-skin care and mothers' support persons. Further exploration of the possible global implications of the scale's dimensions is needed.

The lived experience of giving spiritual care: a phenomenological study of nephrology nurses working in acute and chronic hemodialysis settings.

The purpose of this study was to explore the lived experiences of nephrology nurses giving spiritual care in acute and chronic hemodialysis settings. Ten nurses were interviewed. Five themes were identified: a) drawing close, b) drawing from the well of my spiritual resources, c), sensing the pain of spiritual distress, d) lacking resources to give spiritual care, and e) giving spiritual care is like diving down deep. The study findings suggest that patients and nurses draw close during the giving of spiritual care, that nurses have spiritual resources they use to prepare for and give spiritual care, and that giving spiritual care can have an emotional cost. These findings have implications for nursing practice, nursing education, and nursing research.