In-hospital survival skills training for type 1 diabetes: perceptions of children and parents.

PURPOSE: When a child is diagnosed with type 1 diabetes, parents and/or children must gain significant knowledge and learn specific skills to maintain health. Children in the United States who experience diabetic ketoacidosis (DKA) at the time of diagnosis typically spend 3 days in the hospital learning these life-saving skills. The purpose of this study was to gain knowledge concerning children's and parents' perceptions of this hospitalization period and of the initial education and support received from nurses. STUDY DESIGN AND METHODS: The study used qualitative descriptive methods. A child interview guide and written parent survey were used to elicit children's and parents' perceptions. Two outside experts reviewed these tools. Twenty children aged 8 to 15 years along with 25 parents participated. Reductionistic and constructionistic steps were used to analyze the qualitative data. RESULTS: During this hospitalization, children were most disturbed by the invasiveness of the required interventions while parents reported significant emotional distress related to the diagnosis. Children and parents alike felt the Survival Skills Training they received was effective. Education involving demonstration and return demonstration, supervision of skill performance, positive feedback from nurses about skill performance, and reassurance for long-term quality of life were nurse behaviors found to be helpful. CLINICAL IMPLICATIONS: Implications for care include age-appropriate information in a variety of formats, minimizing the invasive nature of the treatment, providing opportunities for demonstration/return demonstration of skills, providing positive support and reassurance, and delivering concentrated instruction related to carbohydrate counting.

Success of an educational intervention on maternal/newborn nurses' breastfeeding knowledge and attitudes.

OBJECTIVE: To test the effect of a breastfeeding educational program for improving breastfeeding knowledge, attitudes, and beliefs of maternal/newborn nurses, and to improve their intentions to provide breastfeeding support to new mothers. DESIGN: Quasi-experimental, pretest/posttest design. SETTING: Maternity units of 13 hospitals located in midwestern and east coast states. PARTICIPANTS: Nine experimental and three control hospital sites resulted in a convenience sample size of 240 registered nurses (RNs); 206 RNs in the experimental sites and 34 RNs in the control sites. METHODS: Participation in the experimental groups involved the completion of two questionnaires upon study entry and then again after completion of a self-study module. Participants in the control groups completed the two questionnaires twice with a 4- to 6-week interval between them without access to the self-study module. MAIN OUTCOME MEASURES: Nurses' breastfeeding knowledge, attitudes, beliefs, and intentions to support postpartum mothers who are breastfeeding. RESULTS: Findings suggest that this educational strategy was effective in improving maternal/newborn nurses' breastfeeding knowledge, attitudes, and beliefs, and intentions to support breastfeeding mothers. CONCLUSION: This self-paced, study module, which is guided by an on-site, trained staff member, may be a cost-effective strategy for improving nurses' breastfeeding knowledge and support to new breastfeeding mothers. Nurses may find this type of teaching modality to be less intimidating than a structured classroom setting, and more desirable for their busy schedules.

Success of a lactation education program on NICU nurses' knowledge and attitudes.

OBJECTIVES: To test an educational intervention designed to improve lactation knowledge, attitudes, and beliefs of NICU nurses and to improve their intentions to provide mothers with lactation support. DESIGN: Quasi-experimental, time-series pretest/posttest. SETTING: NICU of a Midwestern, free-standing, tertiary-care children's hospital. PARTICIPANTS: Convenience sample of 64 NICU nurses and 2 separate convenience samples of mothers of infants hospitalized in the NICU (n=19 and 13, respectively). METHODS: Nurses were measured on study outcomes at multiple time points, beginning with 2 weeks before and ending at 3 months after attendance to a 4-hour educational program. Mothers were sampled before and 3 months after the intervention. MAIN OUTCOME MEASURE(S): Nurses' lactation knowledge, attitudes, beliefs, and intentions to support lactation and mothers' perceptions of lactation support in the NICU. RESULTS: Findings suggest that this educational intervention was effective for improving NICU nurses' lactation knowledge and attitudes, and that these improvements were maintained over time. Further, the supportive atmosphere for lactation in this NICU significantly improved following the implementation of the educational intervention for nurses. CONCLUSION: Intermittent, short educational programs which include practical how-to's and motivational encouragement for staff may provide the empowerment nurses need in order to be supportive of lactation.

The NICU experience of lactation and its relationship to family management style.

PURPOSE: To describe the impact of having a premature infant hospitalized in the neonatal intensive care unit (NICU) on the parents' management of the lactation experience. STUDY DESIGN AND METHODS: A descriptive study using interviews was conducted with nine couples who had decided to breastfeed, and who were parents of premature infants, 24 to 32 weeks gestation, hospitalized in a large, Midwestern NICU. The family management style conceptual framework guided the study. Qualitative descriptive methods were used to analyze the transcribed data. RESULTS: The situational context of having a premature infant in the NICU was defined as "stressful," "frightening," and "difficult," while the experience of providing breast milk was defined in terms of "altered expectations," "difficulties," and "rewards." These definitions along with the management behaviors of each parent validated three family management-style typologies for lactation in families of premature infants: facilitating, maintaining, and obstructing. CLINICAL IMPLICATIONS: The family management style of lactation, which can be easily ascertained by interviewing families, may be a useful tool in planning appropriate interventions to promote lactation success.

Fathers' perceptions of supportive behaviors for the provision of breast milk to premature infants.

PURPOSE: To explore fathers' perceptions of behaviors used to support the provision of breast milk to hospitalized premature infants. SUBJECTS: Sixteen English-speaking fathers who, each were at least 15 years of age, had a hospitalized premature infant between 24 and 32 weeks gestation and a partner who had decided to provide breast milk. DESIGN: As part of a larger, exploratory study, a qualitative descriptive study was conducted to analyze fathers' perceived contributions to the process of providing breast milk. METHODS: Fathers were interviewed with a semi-structured interview guide. All interviews were audiotaped, and verbatim transcripts were analyzed by using qualitative descriptive methods. MAIN OUTCOME MEASURE: Supportive behaviors as identified by fathers of hospitalized premature infants. PRINCIPAL RESULTS: Fathers described 3 types of behaviors used to support the provision of breast milk to their hospitalized premature infants: assistance with the pumping process, assumption of additional daily domestic responsibilities, and provision of moral support. CONCLUSIONS: Results from this study suggest several significant behaviors that fathers perceived they performed to support their partners' efforts to provide breast milk to their hospitalized premature infants.

Obesity and physical activity in college women: implications for clinical practice.

PURPOSE: To investigate the relationships between levels of physical activity, health attitudes and behaviors, and specific health indicators in women attending college. DATA SOURCES: A convenience sample of 116 college women, ages 18 to 24 years, participated in this research study at a moderate-sized midwestern university. The data were obtained through a self-administered questionnaire; trained technicians collected physiological measurements. CONCLUSIONS: The young women in this study had, on average, normal body mass indexes (BMIs) and reported activity levels consistent with or greater than the Centers for Disease Control and Prevention/American College of Sports Medicine guidelines. Items used to assign participants into the appropriate stage of the transtheoretical model of change were correlated with participants' perceived personal physical activity levels. Similarly, the participants, whose scores fell in the higher stages of the transtheoretical model, reported greater levels of physical activity; consumption of more fruits, vegetables, and water; and less consumption of high-fat/high-calorie foods. IMPLICATIONS FOR PRACTICE: The years between ages 18 and 24 are a critical time in the lives of young women. During this period, they develop physical activity and nutrition habits that will affect their health across the life span. Because of the sometimes insidious development of major health problems, young women's current health status may not accurately reflect the possible long- term results of negative health habits. Nurse practitioners (NPs) have many opportunities to identify and address major factors that, if unattended, may threaten the life-long health status of women. Health teaching in the areas of physical activity and dietary habits may be useful even in young women who appear to be healthy, are of normal weight, and are physically active. Poor dietary habits, if unattended, may eventually contribute to the development of obesity and related illnesses.