Nursing Diagnosis of Grieving in Cases of Perinatal Loss: A Preliminary Clinical Validation.

PURPOSE: To develop a preliminary clinical validation the NANDA-I nursing diagnosis "Grieving" in cases of perinatal loss. METHODS: Descriptive cross-sectional study using the Fehring model. FINDINGS: The overall clinical validity index for the diagnosis was 0.15. Only four defining characteristics and five manifestations identified in the literature were validated. CONCLUSIONS: The variability of manifestations identified in the study participants is considered to be detrimental to the overall clinical validity index. IMPLICATIONS FOR NURSING PRACTICE: The clinical validity of the diagnosis could not be substantiated by the preliminary results of this study and, therefore, additional research is necessary to determine the ability of the diagnosis to adapt to perinatal loss situations in real contexts. Some manifestations have been proposed to NANDA-I for inclusion as defining characteristics in the nursing diagnosis of grieving. OBJETIVO: Validar clínicamente de forma preliminar el diagnóstico enfermero NANDA-I duelo en caso de pérdida perinatal. MÉTODOS: Estudio descriptivo transversal usando el modelo de Fehring. RESULTADOS: El índice de validez clínica global del diagnóstico fue de 0.15. Se validaron únicamente cuatro características definitorias y cinco manifestaciones identificadas en la literatura. CONCLUSIONES: Se considera que la variabilidad de las manifestaciones presentadas por los participantes actuó en detrimento del índice de validación clínica global. IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: La validez clínica del diagnóstico no pudo ser corroborada por los resultados preliminares de este estudio y, por tanto, se necesita investigación adicional para terminar la capacidad de este diagnóstico para adaptarse a las situaciones de pérdidas perinatales en contexto reales. Se han propuesto a NANDA-I algunas manifestaciones para que sean incluidas como Características Definitorias del diagnóstico enfermero Duelo.

A Student Assessment Tool for Standardized Patient Simulations (SAT-SPS): Psychometric analysis.

BACKGROUND: The evaluation of the level of clinical competence acquired by the student is a complex process that must meet various requirements to ensure its quality. The psychometric analysis of the data collected by the assessment tools used is a fundamental aspect to guarantee the student's competence level. AIM: To conduct a psychometric analysis of an instrument which assesses clinical competence in nursing students at simulation stations with standardized patients in OSCE-format tests. METHOD: The construct of clinical competence was operationalized as a set of observable and measurable behaviors, measured by the newly-created Student Assessment Tool for Standardized Patient Simulations (SAT-SPS), which was comprised of 27 items. The categories assigned to the items were 'incorrect or not performed' (0), 'acceptable' (1), and 'correct' (2). PARTICIPANTS: 499 nursing students. Data were collected by two independent observers during the assessment of the students' performance at a four-station OSCE with standardized patients. Descriptive statistics were used to summarize the variables. The difficulty levels and floor and ceiling effects were determined for each item. Reliability was analyzed using internal consistency and inter-observer reliability. The validity analysis was performed considering face validity, content and construct validity (through exploratory factor analysis), and criterion validity. RESULTS: Internal reliability and inter-observer reliability were higher than 0.80. The construct validity analysis suggested a three-factor model accounting for 37.1% of the variance. These three factors were named 'Nursing process', 'Communication skills', and 'Safe practice'. A significant correlation was found between the scores obtained and the students' grades in general, as well as with the grades obtained in subjects with clinical content. CONCLUSIONS: The assessment tool has proven to be sufficiently reliable and valid for the assessment of the clinical competence of nursing students using standardized patients. This tool has three main components: the nursing process, communication skills, and safety management.

Maternal underweight and perinatal outcomes: a restrospective cohort study / Infrapeso materno y resultados perinatales: estudio de cohortes retrospectivo.

Introduction: Some studies have linked maternal underweight with adverse perinatal outcomes such as spontaneous abortion, abruptio placentae, small for gestational age newborn, intrauterine growth retardation and preterm birth. Objective: To determine the influence of maternal underweight in the onset of labor, route of delivery, birth weight, Apgar score and preterm birth. Methods: Retrospective cohort study. We included pregnant women from the Hospital Universitario de Puerto Real. Period of study: 2002-2011. Study group: underweight at the beginning of gestation (BMI < 18.5 kg/m2). Control group: pregnant women with normal body mass index (BMI) at the beginning of gestation (18.5-24.9 kg/m2). The risk (OR) of induction of labor, cesarean section, small for gestational age newborn, macrosomia, 5' Apgar score < 7, and preterm birth was calculated. Results: The prevalence of underweight was 2.5% versus 58.9% of pregnant women who had a normal BMI. We found no significant differences in the rate of induction of labor, fetal macrosomia, Apgar at 5' < 7 or preterm delivery. Maternal underweight was associated with a decreased risk of caesarean section (adjusted OR 0.45, 95% CI 0.22 to 0.89) and an increased risk of small for gestational age newborn (adjusted OR 1.74; 95% CI 1.05 to 2.90). Conclusions: Maternal underweight at the start of pregnancy is associated with a lower risk of caesarean section and a greater risk of small for gestational age newborns (birth weight < P10).

Introducción: algunos estudios han asociado el infrapeso materno con resultados perinatales adversos tales como aborto espontáneo, desprendimiento placentario, feto pequeño para edad gestacional, crecimiento intrauterino retardado y parto pretérmino. Objetivos: determinar si el infrapeso materno al inicio de la gestación influye sobre la forma de inicio y vía del parto, peso al nacer, índice de Apgar al minuto 5 y edad gestacional en el momento del parto. Métodos: estudio de cohortes retrospectivo en gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Grupo de estudio: infrapeso al inicio de la gestación (índice de masa corporal [IMC] < 18,5); grupo control: IMC normal al inicio de la gestación (18,5-24,9). Analizamos el riesgo (OR) de inducción de parto, cesárea, bajo peso al nacer, macrosomía, Apgar a los 5' < 7 y parto pretérmino. Resultados: la prevalencia de infrapeso fue del 2,5% frente al 58,9% de gestantes que presentaron un IMC normal. No encontramos diferencias significativas en la tasa de inducción de parto, macrosomía fetal, Apgar a los 5' < 7 ni parto pretérmino. El infrapeso materno se asoció a una disminución en el riesgo de cesárea (OR ajustada 0,45; IC 95% 0,22-0,89) y a un riesgo aumentado de presentar recién nacido pequeño para su edad gestacional (OR ajustada 1,74; IC 95% 1,05-2,90). Conclusiones: el infrapeso materno al inicio de la gestación se asocia a una menor probabilidad de que el parto finalice mediante la realización de una cesárea y a un mayor riesgo de que el recién nacido presente un peso al nacer por debajo del percentil 10.

Infrapeso materno y resultados perinatales: estudio de cohortes retrospectivo / Maternal underweight and perinatal outcomes: a restrospective cohort study

Introducción: algunos estudios han asociado el infrapeso materno con resultados perinatales adversos tales como aborto espontáneo, desprendimiento placentario, feto pequeño para edad gestacional, crecimiento intrauterino retardado y parto pretérmino. Objetivos: determinar si el infrapeso materno al inicio de la gestación influye sobre la forma de inicio y vía del parto, peso al nacer, índice de Apgar al minuto 5 y edad gestacional en el momento del parto. Métodos: estudio de cohortes retrospectivo en gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Grupo de estudio: infrapeso al inicio de la gestación (índice de masa corporal [IMC] < 18,5); grupo control: IMC normal al inicio de la gestación (18,5-24,9). Analizamos el riesgo (OR) de inducción de parto, cesárea, bajo peso al nacer, macrosomía, Apgar a los 5’ < 7 y parto pretérmino. Resultados: la prevalencia de infrapeso fue del 2,5% frente al 58,9% de gestantes que presentaron un IMC normal. No encontramos diferencias significativas en la tasa de inducción de parto, macrosomía fetal, Apgar a los 5’ < 7 ni parto pretérmino. El infrapeso materno se asoció a una disminución en el riesgo de cesárea (OR ajustada 0,45; IC 95% 0,22-0,89) y a un riesgo aumentado de presentar recién nacido pequeño para su edad gestacional (OR ajustada 1,74; IC 95% 1,05-2,90). Conclusiones: el infrapeso materno al inicio de la gestación se asocia a una menor probabilidad de que el parto finalice mediante la realización de una cesárea y a un mayor riesgo de que el recién nacido presente un peso al nacer por debajo del percentil 10 (AU)

Introduction: Some studies have linked maternal underweight with adverse perinatal outcomes such as spontaneous abortion, abruptio placentae, small for gestational age newborn, intrauterine growth retardation and preterm birth. Objective: To determine the influence of maternal underweight in the onset of labor, route of delivery, birth weight, Apgar score and preterm birth. Methods: Retrospective cohort study. We included pregnant women from the Hospital Universitario de Puerto Real. Period of study: 2002-2011. Study group: underweight at the beginning of gestation (BMI < 18.5 kg/m2). Control group: pregnant women with normal body mass index (BMI) at the beginning of gestation (18.5-24.9 kg/m2). The risk (OR) of induction of labor, cesarean section, small for gestational age newborn, macrosomia, 5’ Apgar score < 7, and preterm birth was calculated. Results: The prevalence of underweight was 2.5% versus 58.9% of pregnant women who had a normal BMI. We found no significant differences in the rate of induction of labor, fetal macrosomia, Apgar at 5’ < 7 or preterm delivery. Maternal underweight was associated with a decreased risk of caesarean section (adjusted OR 0.45, 95% CI 0.22 to 0.89) and an increased risk of small for gestational age newborn (adjusted OR 1.74; 95% CI 1.05 to 2.90). Conclusions: Maternal underweight at the start of pregnancy is associated with a lower risk of caesarean section and a greater risk of small for gestational age newborns (birth weight < P10) (AU)

Sobrepeso y obesidad maternos como factores de riesgo independientes para que el parto finalice en cesárea.

Introducción: el sobrepeso y la obesidad se asocian a una mayor probabilidad de que el parto finalice en cesárea. Dado que dicho incremento del riesgo podría estar sesgado por variables de confusión como la diabetes o la hipertensión, en el presente trabajo pretendemos determinar si este riesgo persiste tras ser ajustado por numerosas variables de control.Objetivo: determinar si el sobrepeso y/o la obesidad son factores de riesgo independientes para que el parto finalice en cesárea.Métodos: estudio de cohortes retrospectivo. Se han incluido gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Se incluyeron dos grupos de estudio: sobrepeso al inicio de la gestación (IMC entre 25 y 29,9) y obesidad al inicio de la gestación (IMC ≥ 30). Grupo ontrol: IMC al inicio de la gestación normal (entre 18,5 y 24,9). El riesgo de cesárea fue analizado mediante un estudio de regresión logística múltiple incluyendo como covariables: edad materna, parto inducido, diabetes gestacional, diabetes pregestacional, macrosomía, hipertensión arterial, nuliparidad, cesárea anterior, parto pretérmino y parto postérmino.Resultados: de los 18.243 partos registrados, el IMC al inicio de la gestación constaba en 4.711 casos (25,8%). El 26,1% presentaban sobrepeso, el 12,4% obesidad y el 58,9% IMC normal. Sin ajustar por variables control, se asociaron a un incremento del riesgo de cesárea: sobrepeso (OR 1,48; IC95% 1,27-1,73); obesidad grado 1 (OR 2,09; IC95% 1,66-2,64); obesidad grado 2 (OR 3,23; IC95% 2,31-4,53); obesidad grado 3 (OR 2,57; IC95% 1,56-4,22). El riesgo aumentado se mantuvo significativo en el análisis multivariante: sobrepeso (OR 1,51; IC95% 1,24-1,84); obesidad (OR 2,15; IC95% 1,67-2,76).Conclusiones: encontramos una asociación significativa e independiente entre el sobrepeso/obesidad maternos y la finalización del parto mediante cesárea incluso ajustando por numerosas variables de control como: edad materna, nuliparidad, cesárea anterior, hipertensión, diabetes, peso al nacer y edad gestacional al parto.

Sobrepeso y obesidad maternos como factores de riesgo independientes para que el parto finalice en cesárea / Maternal overweight and obesity as independent risk factors for cesarean delivery

Introducción: el sobrepeso y la obesidad se asocian a una mayor probabilidad de que el parto finalice en cesárea. Dado que dicho incremento del riesgo podría estar sesgado por variables de confusión como la diabetes o la hipertensión, en el presente trabajo pretendemos determinar si este riesgo persiste tras ser ajustado por numerosas variables de control. Objetivo: determinar si el sobrepeso y/o la obesidad son factores de riesgo independientes para que el parto finalice en cesárea. Métodos: estudio de cohortes retrospectivo. Se han incluido gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Se incluyeron dos grupos de estudio: sobrepeso al inicio de la gestación (IMC entre 25 y 29,9) y obesidad al inicio de la gestación (IMC ≥ 30). Grupo control: IMC al inicio de la gestación normal (entre 18,5 y 24,9). El riesgo de cesárea fue analizado mediante un estudio de regresión logística múltiple incluyendo como covariables: edad materna, parto inducido, diabetes gestacional, diabetes pregestacional, macrosomía, hipertensión arterial, nuliparidad, cesárea anterior, parto pretérmino y parto postérmino. Resultados: de los 18.243 partos registrados, el IMC al inicio de la gestación constaba en 4.711 casos (25,8%). El 26,1% presentaban sobrepeso, el 12,4% obesidad y el 58,9% IMC normal. Sin ajustar por variables control, se asociaron a un incremento del riesgo de cesárea: sobrepeso (OR 1,48; IC95% 1,27-1,73); obesidad grado 1 (OR 2,09; IC95% 1,66-2,64); obesidad grado 2 (OR 3,23; IC95% 2,31-4,53); obesidad grado 3 (OR 2,57; IC95% 1,56-4,22). El riesgo aumentado se mantuvo significativo en el análisis multivariante: sobrepeso (OR 1,51; IC95% 1,24-1,84); obesidad (OR 2,15; IC95% 1,67-2,76). Conclusiones: encontramos una asociación significativa e independiente entre el sobrepeso/obesidad maternos y la finalización del parto mediante cesárea incluso ajustando por numerosas variables de control como: edad materna, nuliparidad, cesárea anterior, hipertensión, diabetes, peso al nacer y edad gestacional al parto (AU)

Introduction: Overweight and obesity both are associated with an increased risk of cesarean section. Since this increased risk could be biased by confounding variables such as diabetes or hypertension, in this study we aim to determine whether this risk persists after adjusting for numerous control variables. Objective: To determine if maternal overweight and/or obesity are independent risk factors to cesarean section. Methods: Retrospective cohort study. We included pregnant women from the University Hospital of Puerto Real. Period of study: 2002-2011. Two study groups were included: overweight at the beginning of the gestation (BMI between 25 and 29.9 kg/m2) and obesity at the beginning of the gestation (BMI ≥ 30 kg/m2). Control group: pregnant women with normal BMI at the beginning of the gestation (Between 18.5 and 24.9 kg/m2). Multiple logistic regression analysis was conducted in order to evaluate the risk of caesarean. The variables included in the model were maternal age, induced labor, diabetes (gestational and pregestational), macrosomia, arterial hypertension, nulliparous, previous caesarean section, preterm birth and post-term childbirth. Results: Initial BMI was registered in 4,711 cases (25.8%) of a total of 18,243 births. Of these, 26.1% were overweight; 12.4% obesity and 58.9% normal BMI. Without adjusting by control variables, both overweight and obesity are associated to an increase in the risk of caesarean section: overweight (OR 1.48; CI95% 1.27-1.73); type 1 obesity (OR 2.09; CI95% 1.66-2.64); type 2 obesity (OR 3.23; CI95% 2.31-4.53); type 3 obesity (OR 2.57; IC95% 1.56-4.22). The risk remained significantly increased in the multivariate analysis: overweight (OR 1.51; CI95% 1.24-1.84); obesity (OR 2.15; IC95% 1.67-2.76). Conclusions: In conclusion, a significant and independent association was found between maternal overweight/obesity and cesarean section, even including numerous control variables such as age, nulliparous, previous cesarean section, hypertension, diabetes, birth weight and gestational age at birth (AU)

Tackling perinatal loss, a participatory action research approach: research protocol.

AIM: The aim of this study was to promote changes to improve the care provided to parents who have experienced a perinatal loss through participatory action research. BACKGROUND: The birth of a child is a joyful event for most families, however, unfortunately some pregnancies end in loss. Perinatal loss creates a heavy emotional impact not only on parents but also on health professionals, where in most cases there is an evident lack of skills, strategies and resources to cope with these kinds of situations. DESIGN: Participatory action research is the methodology proposed to achieve the purpose of this study. METHODS: Participatory action research consists of five stages: outreach and awareness, induction, interaction, implementation and systematization. The working group will include professionals from the Mother and Child Unit for patients at a tertiary level public hospital in Spain. The duration of the study will be 3 years since the approval of the protocol in January 2011. The qualitative techniques used will include group dynamics such as the SWOT analysis the nominal group technique, focus groups and brainstorming, among others that will be recorded and transcribed, generating reports throughout the evolution of the group sessions and about the consensus reached. Content analysis will be conducted on the field diaries kept by the participants and researchers. This project has been funded by the Andalusian Regional Ministry of Health. DISCUSSION: Participatory action research is a methodological strategy that allows changes in clinical practice to conduct a comprehensive transformative action in the care process for perinatal loss.