Developing a hand-held Pap test card to improve cervical cancer screening.

We identified an educational deficit among clients at a community health clinic regarding the latest cervical cancer screening recommendations. A literature search on Pap testing and problems with compliance or screening indicated multiple barriers to cervical cancer screening. Education, health promotion and the use of a hand-held health card/record were identified as methods to educate women regarding cervical cancer prevention. We developed a hand-held Pap test card to be similar to an immunization card. The card was designed to fulfill the needs of both clients and practitioners.

Oral health and oral health care practices among low-income pregnant women.

INTRODUCTION: Access to dental care is a problem in California as in many parts of the United States. Many women, including half of those having dental problems, do not see a dentist during pregnancy. The objective of this study was to describe the oral health status and oral health practices of low-income pregnant women in San Diego, California, and to determine the needs for oral health care education in this population. METHODS: This descriptive, retrospective, correlational study examined oral health and oral health care practices by age, ethnicity, and gravidity by using medical records from a convenience sample of 380 low-income pregnant women. RESULTS: Most participants were primigravida, aged between 19 and 29 years, of Hispanic ethnicity, and insured by the state (Medi-Cal). All women received education on oral health. The majority (84%) were encouraged to get a dental examination. It had been more than 1 year since the last dental visit for most women (55%). Hispanic women were in need of dental care more than Filipina women or women of other ethnicities. A broken tooth was the primary reason for immediate dental referrals. Regularity of flossing and brushing teeth differed significantly (P= .015, P < .001) across ethnic groups, with Filipina women reporting better oral care practices. DISCUSSION: The results provide information for the future planning of effective dental health promotion programs. Findings suggest that low-income pregnant women have some healthy oral health care practices but are in need of dental services and oral health education. An oral health history, oral health education, dental screening, and dental referral, if needed, should be a routine part of prenatal care and annual examinations.

Patient satisfaction with retail health clinic care.

PURPOSE: To analyze patient satisfaction with care provided at two retail clinics by family nurse practitioners (FNPs) and physician assistants (PAs). To analyze patient characteristics and preferences of those patients seeking care at two retail clinics. DATA SOURCES: Anonymous, voluntary, self-report surveys completed by patient, or parents of minor patients, in one of two medical retail clinics located in grocery stores in Arizona between May 2006 and July 2007. CONCLUSIONS: We found that clients with varied incomes and different ethnicities valued the same attributes of retail health clinic care as those found in initial studies: convenient location, no appointment necessary, short wait time, and low cost. IMPLICATIONS FOR PRACTICE: The high degree of patient satisfaction found for retail health clinic care indicates that this type of entrepreneurial primary health care will continue to increase in numbers. Retail health clinics are a viable source of employment for FNPs.

A descriptive study of "being with woman" during labor and birth.

The objective of this study was to learn more about women's perceptions of the nurse-midwifery practice of "being with woman" during childbirth. The descriptive, correlational design used a convenience sample of 238 low-risk postpartum women in a hospital nurse-midwifery practice, with two childbirth settings: a standard labor and delivery unit and an in-hospital birth center. The main outcome measure was a 29-item seven-response Likert scale questionnaire, the Positive Presence Index (PPI), administered to women cared for during labor and birth by nurse-midwives to measure the concept of being with woman. Statistical analysis demonstrated women who gave birth in the in-hospital birth center or who began labor in the in-hospital birth center prior to an indicated transfer to the standard labor and delivery unit gave higher PPI scores than women who were admitted to and gave birth on the standard labor and delivery unit. Parity, ethnicity, number of midwives attending, presence of personal support persons, length of labor, and pain relief medications were unrelated to PPI scores. Two coping/comfort techniques, music therapy and breathing, were found to be correlated with reported higher PPI scores than those of women who did not use the techniques. These results can be used to encourage continued use of midwifery care and for low client to midwife caseloads during childbirth, and to modify hospital settings to include more in-hospital birth centers.

A selective review of maternal sleep characteristics in the postpartum period.

OBJECTIVE: To determine the current knowledge of postpartum women's sleep patterns, sleep disturbances, consequences of sleep disturbances, and known strategies for prevention in order to provide best practice recommendations for health care providers. DATA SOURCES: A literature search from 1969 through February 2008 was conducted using the CINHL, Index of Allied Health Literature, Ovid, PsycINFO, and PubMed electronic databases in addition to reference lists from selected articles and other key references. Search terms included sleep, postpartum, sleep deprivation, and sleep disturbance. STUDY SELECTION: A critical review of all relevant articles from the data sources was conducted with attention to the needs of postpartum women's sleep and implications for health care providers. DATA EXTRACTION: Literature was reviewed and organized into groups with similar characteristics. DATA SYNTHESIS: An integrative review of the literature summarized the current state of research related to sleep alterations in postpartum women. CONCLUSIONS: Postpartum women experience altered sleep patterns that may lead to sleep disturbances. The most common reasons for sleep disturbances are related to newborn sleep and feeding patterns. Although present, the relationships among sleep disturbance, fatigue, and depression in postpartum women lack clarity due to their ambiguous definitions and the variety of the studies conducted. Providers should encourage prenatal education that assists the couple in developing strategies for decreasing postpartum sleep deprivation. Alterations of in-hospital care and home care should be incorporated to improve the new family's sleep patterns.

The relationship between sleep characteristics and fatigue in healthy postpartum women.

BACKGROUND: Postpartum sleep is a difficult and complicated concept to measure owing to the intrusive nature of research at a sensitive and private time for new families. Nurses often find themselves advising mothers on ways to improve sleep and reduce fatigue based on teachings that are not evidence based. The purpose of this secondary analysis of a larger study of postpartum fatigue patterns was to examine the relationship between sleep characteristics and postpartum fatigue during the first 6 weeks after delivery. METHODS: A prospective, longitudinal, descriptive study was conducted of 109 postpartum women. Sleep and fatigue were measured using a 16-item subjective sleep characteristics scale and a 30-statement subjective fatigue instrument. Three measurement points were used: 1) 1-2 days after delivery (before hospital discharge); 2) 2 weeks postpartum; and 3) 6 weeks postpartum. RESULTS: Fatigue had a positive correlation with sleep disturbance at all three measurement points, indicating that higher levels of fatigue are associated with more disturbed sleep. No association was found between levels of fatigue and sleep supplementation. Levels of fatigue had a negative correlation with sleep effectiveness at all measurement points, indicating that the women were more fatigued if they perceived their sleep quality and adequacy to be poor or if they perceived the time spent sleeping to be short. CONCLUSIONS: To reduce fatigue, nurses should focus on exploring ways to reduce maternal sleep disturbance and improve maternal sleep effectiveness. It is unclear whether the age-old advice to "nap when your baby naps" is effective in reducing postpartum fatigue.

Paternal fears of childbirth: a literature review.

To date, most studies on paternal childbirth fears have been exploratory or descriptive, conducted outside of the United States, and focused mainly on White, first-time fathers. Identified fears include harm to the mother or newborn, partner pain, feelings of helplessness, lack of knowledge, and fear of high-risk intervention. Fathers often report that childbirth classes are not helpful and, in some cases, even increase their fears. Some fathers view birth as traumatic, changing their perception of and relationship with their partner. Fathers also voice the need for more information and for reassurance that they are doing the right things for their partner during childbirth. This article summarizes the research findings on paternal childbirth fears and recommends topics for future study.

A hermeneutic phenomenological analysis of midwives' ways of knowing during childbirth.

OBJECTIVE: to explore the ways of knowing used by the midwife while attending women during childbirth through textual analysis of poems written by American midwives. DESIGN: a hermeneutic phenomenology and human science research method inspired by van Manen was used. Midwifery ways of knowing during childbirth were thematically derived from 10 poems written by midwives about attending childbirth or the experience of being a midwife. Textual analysis included examination of the poems as a whole, via verse and metaphor, and via individual lines of prose. PARTICIPANTS: 10 American midwives wrote the poems used in this study. The poems were discovered through online searches of many databases using the key words 'poetry, poems, midwifery and childbirth' and through a national call for poetry by the researcher over a period of 4 years (1996-2000), undertaken in order to publish an anthology of poetry written by midwives. FINDINGS: three authoritative ways of knowing that guided the care given by the midwife to women during childbirth were discovered. They were self-knowledge from the belief system of the individual midwife, grounded knowledge from the midwife's personal lived experience with childbirth, and informed knowledge from objective and scholarly sources. KEY CONCLUSIONS: midwives must continue to develop their own body of knowledge in order to move the profession forward. Multiple ways of knowing including the use of experiential/contextual and intuitive knowledge is legitimate and humane, if provision of care is holistic. Care of women during childbirth can be enhanced with the use of multiple knowers and multiple ways of knowing. This study captured a unique and fresh interpretation of the lived experience of midwifery knowledge. Midwifery educational programmes should offer opportunities for students to explore the artistry as well as the science of midwifery practice.

Storytelling as an educational strategy for midwifery students.

This article describes the use of purposive storytelling as a creative teaching strategy in the nurse-midwifery education program at San Diego State University and the University of California, San Diego. Student evaluations over a 4-year period showed overwhelming support for the inclusion of storytelling into a weekly didactic midwifery course. Benefits, such as increased cognitive learning, enhanced role transition, and emotional clarification were identified in the students' comments. The students' comments further supported the efficacy of incorporating storytelling into midwifery education. A review of the literature confirms the growing popularity of storytelling in both health care and education, and a conceptual framework is also provided. Further research is needed to examine the benefits of this worthwhile technique in promoting learning, stimulating interest, and facilitating the development of critical thinking.

Women give birth and pizzas are delivered: language and Western childbirth paradigms.

This article examines two differing health paradigms, their language, and their effect on the culture of Western childbirth practices. Specifically, the differences in perspectives and language between the dominant paradigm/culture (the biomedical model of curing) and the alternative paradigm/culture (a holistic model of caring) are explored. Examples of language from the medical, midwifery, and nursing literature that affect childbirth culture and the care of childbearing women and their families are examined. The use of language as a tool of power and its known and postulated effects on the childbirth experience, nursing care, midwifery practice, and holistic care are explored. The author argues for the use of a woman-centered paradigm for childbirth experiences.

Lesbian experiences and needs during childbirth: guidance for health care providers.

OBJECTIVE: To provide an overview of the literature regarding lesbian experiences of childbirth and to offer health care providers guidance in supporting the childbearing lesbian couple. DATA SOURCES: A search of the literature from 1980 through 2004 was conducted using PsycINFO, Ovid, PubMed, Ebscohost, and Cinahl, and the key words, lesbian, childbirth, parenting health care providers, pregnancy, artificial insemination, parental rights. DATA EXTRACTION: A critical review of all articles from relevant journals was included with attention to the needs of lesbian women concerning childbirth and implications for health care provider care. DATA SYNTHESIS: The four areas of concern identified for lesbians considering parenting were (a) the pros and cons of disclosing sexual orientation to caregivers and finding lesbian-sensitive caregivers, (b) the options available when deciding how to conceive, (c) assurance of the desired level of partner involvement, and (d) the legal considerations for the conception process and for the protection of both parents as well as the child. Methods and strategies to assist health care providers to meet the needs of lesbian clients were gleaned from the literature. CONCLUSION: A growing numbers of lesbian women are becoming consumers of childbirth health care. Health care outcomes of lesbian women and their infants are affected by experiences during pregnancy and childbirth and by the attitudes and actions of health care providers. Evidence exists that health care outcomes for lesbians are improved when health care providers are knowledgeable about and sensitive to the unique needs of lesbian clients.

Being with woman: A guiding concept for the care of laboring women.

OBJECTIVE: To review the literature concerning the midwifery concept of being with woman and the related nursing concepts of presence and social support during childbirth. DATA SOURCES: Literature in the English language from 1985 through 2000, using MEDLINE and CINAHL. DATA EXTRACTION: Discussion of articles from relevant journals and textbooks were included. Pertinent older sources, which enhanced the understanding of the concepts, were reviewed. DATA SYNTHESIS: Being with woman is defined as the provision of emotional, physical, spiritual, and psychological presence/support by the caregiver as desired by the laboring woman. Ample evidence exists for including being with woman as a central concept of the model of care for women in labor. The qualitative review indicates that women value and desire the attributes of the concept during childbirth. The qualitative and quantitative literature demonstrate beneficial physiological and psychological outcomes for women who experience being with woman. CONCLUSIONS: Obstetric units would be wise to incorporate the being with woman model of care as routine policy for the care of laboring women by midwives and nurses. Being with woman provides psychological and physiological benefits for women, client satisfaction, and potential cost savings.

Poetry as an aesthetic expression for nursing: a review.

OBJECTIVE: To provide the reader with a basic understanding of the elements of poetry and to review poetry's contribution to nursing. The review will examine the poetry written by nurses, poetry's effect on the profession, and its use in education, patient care, and research. DATA SOURCES: Classic and current sources of poetry, which enhance the understanding of poetry and how poetry has changed over time are reviewed. The review of nursing literature was conducted in works published in the English language using the keywords: poetry, nursing, and aesthetics. The initial search included all nursing literature with the above keywords from 1960 to 2001. Articles from relevant journals and textbooks, which could contribute to the understanding of the use of poetry in the field of nursing, were included. CONCLUSION: The use of poetry in the nursing profession provides us with the opportunity to gain new meaning and understanding about the profession and the clientele served. Poetry is a rich textual medium that can assist in illuminating nursing's core belief about the uniqueness of the nurse-patient relationship, and enhance the 'art' of nursing and 'ways of knowing'.