Use of an intensity ratio to describe breastfeeding exclusivity in a national sample.

Breastfeeding behavior in a sample of 1863 mother-infant pairs was examined using data from the 1988 National Maternal-Infant Health Survey. Breastfeeding behavior was operationalized as an intensity ratio, calculated as the number of breast milk feeds (on average in 24 hours) divided by the total number of all liquid feeds (on average in 24 hours), with a range from 0 to 1.0. During the first month postpartum, 61% of the sample reported exclusive breastfeeding, declining to 31% during months 2-3 postpartum and to 13% during months 4-6 postpartum. This decline was consistent with the linear decline in the mean intensity ratio, .82, .55, and .31, respectively, during the same three time periods. A higher breastfeeding intensity ratio was significantly associated with longer duration of breastfeeding, up to 1 year of life. Intensity ratio, as a measure of exclusivity, is a useful outcome measure for monitoring breastfeeding behavior.

Clinical approaches in the assessment of childbearing fatigue.

Modifications of the Fatigue Symptoms Checklist can be used clinically to assess fatigue during the childbearing year. Data from a series of studies provide beginning norms that can be used to interpret clinical scores and point to the potential importance of assessments to pregnancy complications and maternal performance. Consistent with North American Nursing Diagnosis Association (NANDA) definition of fatigue and the theory of unpleasant symptoms, fatigue and performance are important phenomena critical to the experience of pregnancy and assumption of the maternal role.

What happens when fatigue lingers for 18 months after delivery?

OBJECTIVE: To understand the consequences when mothers experience fatigue throughout the first 18 months after birth. DESIGN: Secondary analysis of data from a longitudinal study. Fatigue was measured five times between birth and 18 months after delivery. SETTING: Data for the longitudinal study were collected in different settings (hospital, telephone, and homes). PARTICIPANTS: White mothers who delivered full-term neonates of normal birth weight in a community hospital (N=229). MAIN OUTCOME MEASURES: Persistent fatigue was operationally defined as the report of at least one symptom of fatigue at all five time periods. The association between persistent fatigue and performance outcomes (maternal health, infant health, and infant development) was tested. RESULTS: Results were significant using alpha of .05. Persistent fatigue is associated with perceived maternal health and infant development at 18 months but not infant health. CONCLUSIONS: Findings suggest that persistent fatigue may have a negative effect on performance outcomes for mothers and infants. Assessment for fatigue symptoms should be part of each nursing contact and interpreted as a pattern. Helping mothers choose methods of symptom relief and energy conservation can benefit both the mother and the infant.

Evaluation of two intervention strategies to stimulate quality improvement projects in the hospital: the H. pylori example.

A multistate quality improvement project conducted to improve the care of hospitalized Medicare patients with peptic ulcer disease is described. This randomized control study design compared the effectiveness of two intervention strategies (mailed information vs. on-site presentations with feedback) in stimulating hospitals to conduct diagnostic journeys to determine root causes for performance deficits and to develop and implement plans to improve performance.

Measuring women's fatigue during the postpartum period.

The Fatigue Symptom Checklist (FSC) (Yoshitake, 1978), developed in Japan, was selected to measure postpartum fatigue among American women. Minor wording changes and a change in the reference time frame were made. Reliability and validity of this modification of the FSC were tested in this reanalysis of data from a longitudinal study of 285 mothers. Internal consistency reliability for the total 30-item FSC was acceptable. Evidence for criterion-related and construct validity was found. Original FSC subscales were not confirmed in these analyses. Using factor analysis, a shortened 10-item postpartum scale and two postpartum subscales, physical and mental fatigue, were identified. LISRAEL confirmatory factor analysis supported the subscales. Results support appropriateness of the total 30-item FSC, the shortened 10-item postpartum scale, and postpartum subscales for measuring postpartum fatigue in American women.

Predicting the duration of lactation: evidence from a national survey.

BACKGROUND: Despite caregiver and policy support for breastfeeding, rates for initiating and duration of breastfeeding fell far short of Healthy People 2000 goals during the 1980s. METHODS: Data from the 1988 National Maternal-Infant Health Survey, collected from January 1989 through June 1991, were analyzed to examine predictors of duration of lactation for a sample of 2372 breastfeeding women. We conducted comparisons between women who fully breastfed and those who partially breastfed using logistic regression analysis. RESULTS: Mothers were more likely to breastfeed for longer than six months if they fully breastfed during the first month postpartum, were nonsmokers, were of higher parity, were consistent in their prenatal intent to breastfeed fully or partially and in their postpartum behaviors, participated in childbirth education classes, and delayed their return to work postpartum. CONCLUSIONS: In this study sample, although rates did not meet Healthy People 2000 goals for duration of breastfeeding, some predictors of duration were identified that can be affected by programmatic support or public policy. Our findings indicated that variables that are associated with breastfeeding and longer duration of the practice are typically correlated with social status. To support the development of breastfeeding as the cultural norm, interventions targeting breastfeeding outcomes should consider social status, ethnicity, and cultural factors.

Cholesterol levels in children: to screen or not to screen.

Universal screening and targeted screening are the two approaches used in pediatric practice to identify children with elevated cholesterol levels. This study reports total cholesterol levels in 415 2-year-old children and the relationship of these results to risk factors. Based on these data, universal screening for total cholesterol (TC) does not appear to be necessary. Targeted screening for TC may be the more practical method for identifying children with dangerously high TC elevations.

Postpartum fatigue: clarifying a concept.

This paper describes the multifaceted approach employed to clarify the concept of postpartum fatigue. The process began with a literary analysis, which gave rise to questions about the defining characteristics of postpartum fatigue and its differentiation from related concepts such as tiredness and depression. A series of qualitative and quantitative studies were carried out to examine new mothers' characterizations of their fatigue, the indicators and predictors of postpartum fatigue, and the differences between fatigue and depression. The evolving concept clarification suggests that postpartum fatigue is most effectively conceptualized as a multidimensional concept with physical and mental aspects that is different from tiredness and can be differentiated from postpartal depression or milder "baby blues," with which there is some overlap.

Teaching nursing research using two-way video technology.

Schools of nursing are meeting the needs of students by instituting distance education courses that use two-way video technology. This article describes the structural features of the classroom that are changed and provides strategies that can be effective for teaching nursing research. These strategies are related to: teaching and demonstrating use of statistical formulas; selecting and teaching use of software for data analysis; teaching about research design, sampling, and data collection procedures; and critiquing empirical articles.

Prevention strategies for infant walker-related injuries.

The estimated number of walker-related injuries to infants increased during the 1980s, and standards for walker design safety remain voluntary with no monitoring to assess compliance. Although banning the walker has been proposed, this prevention strategy has not been employed. The most recent statistics available indicate that there were an estimated 27,804 walker-related injuries requiring emergency room attention among ages 0-4 years in 1991. Results of a survey of parents of 3-12-month-olds indicated considerable use of walkers, with greater use among parents with lower educational levels. Reported reasons for using walkers were for the infant's entertainment, enjoyment, and containment, as well as to help infants learn to walk. The authors recommend the consideration of a series of preventive strategies according to the epidemiologic framework for injury control and prevention designed by William Haddon, Jr. These include, but are not limited to, prohibiting the manufacture and sale of the walker, mandatory standards, redesign of the walker, design of an alternative to the walker, and consumer education to reduce use and to change patterns of use.

Description and initial applications of the Staggers & Parks Nurse-Computer Interaction Framework.

The authors developed a nurse-computer interaction framework by integrating concepts from human-computer interaction, nursing informatics, and developmental psychology. In this framework, nurses and computers interact in a system of mutual influences, with information being the medium of exchange between them. Nurse behaviors and computer interface actions occur according to their respective characteristics. In turn, the nurse-computer dyad is embedded within a nursing context and moves along a nursing informatics developmental trajectory. A sample of findings from empirical studies is placed in the framework, and framework uses are described.

The role of social support and stressors for mothers and infants.

This correlational study of mothers and their 6-month-old infants examined the importance of social support and stressors for parenting and infant development. Mothers (n = 79) were primarily White, married, and ranged in socio-economic status from low to high. All data were collected in mothers' homes when infants were 6 months old. Diversity of sources of social support and diversity of father support were positively related to parenting (quality of stimulation in the home). Diversity of sources of social support buffered the negative relationship of maternal fatigue (stressor) to parenting. Parenting was related to social, hearing-speech, locomotor, and general development. Additionally, social support and aggravation (people in the mother's said network who make life difficult) were related to infant development, independent of parenting.

Collaboration between unlikely disciplines in the creation of a conceptual framework for nurse-computer interactions.

A unique conceptual framework for the study of nurse-computer interaction was created through the collaboration of two researchers in seemingly diverse fields: nursing informatics and developmental psychology. The framework depicts nurses and computers interacting in a system of mutual influences, exchanging information during a particular task, and proceeding on a developmental trajectory. The conceptual framework can help guide research within nursing informatics and help build a cohesive body of knowledge for the future.

Differences between adolescent and adult mothers of infants.

Samples of adolescent and adult mothers of 6-month-old infants were compared on parenting knowledge, quality of stimulation in the home, and family involvement with the infant. Adolescents perceived that care-giving had less influence on infant outcome and they provided a lower quality of stimulation in the home environment than did adults. For both groups, greater knowledge was associated with higher quality of stimulation in the home. Adolescents were more likely to live with their own mother/grandmother, less likely to live with the infant's father, and more likely to live in larger households. The adolescent's infant was more likely to have daily involvement with the maternal grandmother. Approximately 50% of the fathers in both groups were involved on a daily basis. The fathers were involved to a greater extent if the mother of the infant was an adult. Services to adolescents with infants should include an assessment of family participation in infant care and provide support to the mother.

Levels of computer education for professional nursing. Development of a prototype graduate course.

Leveling computer education for professional nurses at the undergraduate and graduate levels is presented via a four-tiered model. Foundational course content at level 2 for all graduate nursing students preparing for advanced nursing roles is described. A quasi-experimental study (N = 80) demonstrated the effectiveness of the course in terms of the attitude changes toward computerization and perceived knowledge about computer applications in nursing.

Life change and instrumental support as predictors of illness in mothers of 6-month-olds.

The extent to which life change after birth of a baby and instrumental support of parenting predict the occurrence of illness in mothers of 6-month-olds was studied. Mothers (N = 155) were selected from an urban clinic and from the birth records of a suburban hospital. All data were collected with questionnaires and interviews in mothers' homes when infants were 6 months old. Age, race, socioeconomic status, and prior illness were used as control variables in the analyses. Life change and intensity of support were positively related, and size of the support network was negatively related to illness. There was no evidence for the buffering effect of support. Findings confirmed that life change helps predict postpartal illness, and revealed that characteristics of instrumental support differ in their importance as predictors.

Parenting knowledge among adolescent mothers.

The parenting knowledge of first-time adolescent mothers who chose to receive special services from the public school system was measured. These data are thought to be the first reported on the adolescent's awareness that parenting influences the present and future well-being of the infant and mother. Knowledge level was high and no different from that of adult primiparous mothers of comparable socioeconomic status. Correct response to individual items on the infant Caregiving Inventory (ICI) ranged from 84% to 96% for adolescents. These results are contrary to the previous reports of deficient parenting by adolescents. They reflect the need for continuing investigation of adolescent mothers' parenting knowledge in evaluating their effectiveness as parents.

PIP: The parenting knowledge of 1st time adolescent mothers who chose to receive special services from the public school system was measured. These data are thought to be the 1st reported on adolescent's awareness that parenting influences the present and future well-being of the infant and mother. Knowledge level was high and no different from that of adult primiparous mothers of comparable socioeconomic status. Correct response to individual items on the Infant Caregiving Inventory (ICI) ranged from 84% to 96% for adolescents. These results are contrary to the previous reports of deficient parenting by adolescents. They reflect the need for continuing investigation of adolescent mothers' parenting knowledge in evaluating their effectiveness as parents.