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

ObjectiveTo 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.DesignProspective instrument development and psychometric study.SettingHealth system in the U.S. Mountain West region.ParticipantsConvenience sample of 62 perinatal/neonatal nurses.MethodsWe 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.ResultsThe 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).ConclusionThe 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.     

Preterm meconium-stained amniotic fluid is an ominous sign for the development of chorioamnionitis and for in utero cord compression

Purpose: Meconium-stained amniotic fluid (MSAF) is rarely observed in preterm pregnancies, and its clinical significance is undetermined. We evaluated the correlation between MSAF and obstetrical and perinatal complications prior to 34 weeks’ gestation.

Materials and methods: Pregnancies complicated with MSAF between 24 and 34 weeks of gestation were compared with same gestational age-matched controls. The variables measured were: obstetrical complications: clinical chorioamnionitis, Intrahepatic Cohlestasis of Pregnancy – ICP, Intra Uterine Growth Restriction – IUGR, preeclampsia, gestational diabetes; nonobstetrical complications; and perinatal complications: cord around neck/body, Apgar <7 at 5?min, cord pH, Neonatal Intensive Care Unit – NICU admission, complications during NICU hospitalization, and composite outcome.

Results: Higher incidence of clinical chorioamnionitis (15% versus 4.3%; p?=?0.041) and higher incidence of cord around the neck/body were found in the MSAF group in comparison with the clear AF group (27.4% versus 18.4%; p?=?0.04). No significant differences between the study’s groups were found in nonobstetrical complications or other perinatal complications investigated in our study.

Conclusion: MSAF in preterm pregnancy is an ominous sign for the occurrence of chorioamnionitis and for in utero cord compression. Therefore, MSAF in preterm pregnancies should be considered as a non-reassuring sign.     

Validation of the Maternal and Partner Sex During Pregnancy Scales (MSP/PSP) in Portugal: Assessing Dyadic Interdependence and Associations with Sexual Behaviors

BackgroundThe Maternal and Partner Sex During Pregnancy Scales (MSP/PSP) are self-report measures of expectant couples’ attitudes towards sex during pregnancy.AimThis study aimed to examine dyadic non-independence of MSP/PSP scores in a sample of expectant couples, while providing an evaluation of factor structure, validity, and reliability of the Portuguese versions of the MSP/PSP. The association between partners’ attitudes and frequency of sexual behaviors was also examined.MethodsA total of 189 expectant couples completed a survey that included a sociodemographic questionnaire, the MSP/PSP, frequency of sexual behaviors, as well as validated measures of attitudes to sex, sexual function, sexual satisfaction, depression, and perceived social support.OutcomesDyadic interdependence was tested via Pearson correlation between MSP/PSP scores; between-dyads variability was tested via intraclass correlation of the unconditional model including only MSP/PSP scores using a multi-level model. Associations between attitudes and sexual behavior were tested using regression analysis (between-dyads outcomes) or APIM (mixed outcomes).Factor structure, internal consistency, and validity (convergent, discriminant, and concurrent) of the Portuguese versions of the scales were assessed.ResultsMSP/PSP scores were interdependent within-dyads. Male partners presented significantly more positive attitudes towards sex during pregnancy than pregnant women. Attitudes were linked to indices of sexual well-being for both partners (sexual functioning, sexual satisfaction) and, for both partners, more positive attitudes were associated with higher frequencies of most partnered sexual behaviors. The Portuguese MSP/PSP scales showed good factor structure, and good to excellent indices of reliability and validity.Clinical ImplicationsThe Portuguese MSP/PSP is adequate for use in couples. The scales can be used to screen partners with negative attitudes towards sex during pregnancy and evaluate how these attitudes relate to intra- and inter-individual sexual well-being during pregnancy.Strengths & LimitationsA strength of this study is the inclusion of both expectant partners and the use of dyadic analysis. Couples who participated in the study were all in mixed-gender/sex relationships, although this was not defined as an inclusion criterion. Future studies should use the MSP/PSP in more diverse samples in order to further determine how the scale performs for couples with different characteristics.ConclusionScores in the MSP/PSP are interdependent between mixed-sex/gender expectant couple members. More positive attitudes towards sex during pregnancy are linked to higher frequencies of partnered sexual behaviors and to both partners’ greater sexual well-being.Tavares Inês M., Heiman Julia R., Rosen Natalie O., et al. Validation of the Maternal and Partner Sex During Pregnancy Scales (MSP/PSP) in Portugal: Assessing Dyadic Interdependence and Associations with Sexual Behaviors. J Sex Med Rev 2021;18:789–799.     

Hospital‐Based Perinatal Nurses Identify the Need to Improve Nursing Care of Adolescent Mothers

ObjectiveTo determine whether hospital‐based perinatal nurses with expertise in adolescent mother‐friendly care identify a need to improve inpatient nursing care of adolescent mothers and how well perinatal units support nurses’ capacity to provide adolescent mother‐friendly care. Design/Setting/Participants: A key informant survey of nurses from eight perinatal units at three hospitals (four separate sites) in a Canadian city.MethodsPerinatal nurses expert in the care of adolescent mothers were identified by their managers and colleagues. These nurses and all perinatal clinical educators were invited to participate. Twenty‐seven of 34 potential key informants completed the survey.ResultsKey informants rated their own skill in caring for adolescent mothers higher (median 8.0) than they rated the skill of other nurses (median 6.0) on their units. They attributed their expertise working with adolescent mothers to their clinical and life experiences and their ability to develop rapport with adolescents. A common reason for the assigned lower peer‐group ratings was the judgmental manner in which some nurses care for adolescent mothers. Key informants also identified that hospital‐based perinatal nurses lack adequate knowledge of community‐based resources for adolescent mothers, educational programs related to adolescent mother‐friendly care were insufficient, and policies to inform the nursing care of adolescent mothers were not available or known to them.ConclusionA minority of perinatal nurses have expertise in adolescent mother‐friendly care. There is a need for perinatal unit‐level interventions to support the development of nurses’ skills in caring for adolescent mothers and their knowledge of community‐based resources. Peer mentoring and self‐reflective practice are promising strategies.     

Psychometric properties of the modified breastfeeding self-efficacy scale–short form (BSES-SF) among Chinese mothers of preterm infants

ObjectivePreterm mother-infant dyads face more challenges than healthy term infants in breastfeeding initiation and continuation due to maternal health status, preterm infant's immaturity or comorbidities, and breastfeeding policy of the neonatal units. Breastfeeding self-efficacy affects breastfeeding outcomes in preterm infants. No specific instrument in Chinese is available to assess maternal breastfeeding self-efficacy of preterm infants. This study aims to assess the psychometric characteristics of the modified Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among Chinese mothers of preterm infants.DesignA cross-sectional study was conducted.SettingTwo tertiary hospitals in China.ParticipantsA total of 153 women who gave birth before 37 weeks of gestation.MeasurementsThe instrument was translated and back translated. The internal consistency reliability was investigated using Cronbach's alpha coefficient. The content validity, construct validity, and criterion validity were conducted to evaluate the validity of the scale. Exploratory factor analysis was used to investigate the factor structure.FindingsThe scale had good reliability with Cronbach´s alpha above the acceptable level of 0.7. The Item-Content Validity Index (I-CVI) ranged from 0.800 to 1.000, and the Scale-Content Validity Index (S-CVI) is 0.950. The principal component analysis revealed the presence of two factors with eigenvalues greater than 1, explaining a total variance of 74.665%. The modified BSES-SF scores were correlated with women's parity, breastfeeding knowledge, previous breastfeeding experience, perceived support from the spouse and health professionals, and amounts of expressed milk. Key conclusions and implications for practice: The Chinese version of modified BSES-SF is a reliable, valid screening instrument to evaluate the maternal breastfeeding self-efficacy of preterm infants. It is recommended to provide interactive, face-to-face breasting education and support to help mothers of preterm infants maintain high level of breastfeeding self-efficacy and further to achieve satisfactory breastfeeding outcomes.     

Evaluation of the Perinatal Grief Intensity Scale in the Subsequent Pregnancy After Perinatal Loss

ObjectivesTo evaluate the reliability and validity of the Perinatal Grief Intensity Scale (PGIS) for identifying a woman's grief intensity in the immediate subsequent pregnancy after a miscarriage, stillbirth, or neonatal death.Design/Setting/ParticipantsA web‐based approach was used to collect data from 227 pregnant women after each woman had experienced a perinatal loss in her previous pregnancy.MethodsParticipants completed a demographic information form and the 14‐item PGIS.ResultsCronbach's alphas for the PGIS total scale and subscales were high: 0.75 (PGIS total), 0.80 (Reality), 0.82 (Confront Others), and 0.80 (Congruence), which indicated good internal consistency reliability. Validity was supported by factor analysis of the PGIS, which accounted for 66.94% of the total variance. Mothers in the neonatal death group experienced more intense grief, as measured by the PGIS, when compared with mothers in the miscarriage or stillbirth groups.ConclusionsData from this study provided initial support for the reliability and validity of the PGIS in women in their immediate subsequent pregnancies after perinatal loss as well as the concepts of the grief intensity theoretical framework.     

Experiences of Parents Whose Newborns Undergo Hypothermia Treatment Following Perinatal Asphyxia

ObjectiveTo describe and interpret experiences of parents whose newborns are treated with induced hypothermia following perinatal asphyxia.DesignA qualitative exploratory study.SettingData collection in parental home environments (n = 8) and in a study room in a university library (n = 2).ParticipantsA total of 10 parents, seven mothers and three fathers, participated in the study. Their newborns were treated with induced hypothermia 4 to 12 months prior to the interviews.MethodsRecorded open‐ended interviews with the participants lasted from 60 to 90 minutes. Field notes were made after each interview. The interviews were transcribed verbatim and inductive content analysis was used in the analyzing process.ResultsFour main themes emerged from the data: emotional landscapes, adaptation to a new situation (with subthemes creating control, external and internal support in a difficult situation, normalizing the abnormal and reconciling oneself to uncertainty), moments of rebirth, and change in attitude toward life and existence.ConclusionTerm newborns are treated with induced hypothermia treatment due to perinatal asphyxia. During the hospitalization of newborns in neonatal intensive care units (NICUs), parents experience high levels of stress. Parents use several strategies for adapting to this situation, and nurses play a pivotal role in providing individual support and acting as advocates for parents in the NICU. After the infants are rewarmed, parents experience a moment of rebirth that might help them attach to their infants. Further research is warranted in this area to provide holistic care and support to families whose neonates undergo this treatment.     

Adapting the Pregnancy Physical Activity Questionnaire for Japanese Pregnant Women

ObjectiveTo assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese.DesignThis longitudinal study used a self-report questionnaire and quantitative biometric and instrumental measurements (actigraph) to assess the reliability and criterion validity.SettingA university hospital in Tokyo, Japan.ParticipantsSixty-nine pregnant women living in Tokyo and its suburbs were recruited.MethodsThe test–retest reliability of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ-J) was evaluated through intraclass correlation coefficients (ICCs) between PPAQ-J results administered three times (at recruitment, 7 and 14 days later). Criterion validity was assessed by comparing results to actigraph measures using Spearman's correlation coefficients. Participants wore the actigraph over the 2-week research period. Data from 58 participants were analyzed for test–retest reliability. The data of 54 participants were used to analyze criterion validity.ResultsThe ICCs for the first and second and for the first and third PPAQ-J questionnaires were ≥0.56 for total activity and activities broken down by intensity and type (in metabolic equivalents [METs] × hours/day). To evaluate criterion validity, Spearman's correlation coefficients were calculated between the first measurement of the PPAQ-J and three published cut-points used to classify actigraph data (minutes/day); correlations ranged from .02 to .35 for total activity, −.21 to −.25 for vigorous activity, −.09 to .38 for moderate activity, and .01 to .28 for light activity.ConclusionThe PPAQ-J is a psychometrically sound and comprehensive measure of physical activity in pregnant Japanese women.     

Development and Psychometric Testing of the Attitude Toward Potential Pregnancy Scale

ObjectiveTo develop and test a comprehensive tool for measuring women's attitudes toward the possibility of becoming pregnant.DesignCross‐sectional mixed methods study.SettingTwo obstetric/gynecologic (OB/GYN) clinics and one family planning clinic in Baltimore, Maryland.ParticipantsOne‐hundred thirty (130) nonpregnant, primarily African American women (84%) age 18 to 29.MethodsParticipants completed a computer‐based survey as part of a larger retrospective mixed‐methods study. The Attitude Toward Potential Pregnancy Scale (APPS) was assessed using exploratory factor analysis and hypothesis testing.ResultsCronbach's alpha for internal consistency for the APPS was 0.86. Item‐total correlations ranged from 0.56 to 0.75. All items loaded on one factor. Support for construct validity was demonstrated using logistic regression, where the odds of being a highly effective contraceptive user decreased by 8% with each one‐point increase in score on the APPS (odds ratio = 0.92; confidence interval [0.87, 0.98]).ConclusionsThis study provides support for reliability and validity of the APPS. The APPS may be a useful tool for understanding pregnancy attitude in future studies and in clinical practice. Further research is needed to assess the usefulness of the scale with other groups of women, its utility in the clinical practice setting, and its potential predictive validity for unintended pregnancy.     

The City MISS: development of a scale to measure stigma of perinatal mental illness

Objective: This study aimed to develop and validate a scale to measure perceived stigma for perinatal mental illness in women.

Background: Stigma is one of the most frequently cited barriers to seeking treatment and many women with perinatal mental illness fail to get the treatment they need. However, there is no psychometric scale that measures how women may experience the unique aspects of perinatal mental illness stigma.

Method: A draft scale of 30 items was developed from a literature review. Women with perinatal mental illness (n = 279) were recruited to complete the City Mental Illness Stigma Scale. Concurrent validity was measured using the Internalised Stigma of Mental Illness Scale. Factor analysis was used to create the final scale.

Results: The final 15-item City Mental Illness Stigma Scale has a three-factor structure: perceived external stigma, internal stigma and disclosure stigma. The scale accounted for 54% of the variance and had good internal reliability and concurrent validity.

Conclusion: The City Mental Illness Stigma Scale appears to be a valid measure which provides a potentially useful tool for clinical practice and research in stigma and perinatal mental illness, including assessing the prevalence and characteristics of stigma. This research can be used to inform interventions to reduce or address the stigma experienced by some women with perinatal mental illness.     

Admission volume is associated with mortality of neonatal respiratory failure in emerging neonatal intensive care units

Objective: The aim of this survey was to explore the relationship between admission volume and mortality of neonates with hypoxemic respiratory failure (NRF) in emerging neonatal intensive care units (NICUs).

Methods: NRF from 55 NICUs were retrospectively included with death risk as the major outcome. Perinatal comorbidities, underlying disease severity, respiratory support, facility utilization, and economic burden in the early postnatal period were compared among five NICU admission volume categories defined by NRF incidence, with score for neonatal acute physiology perinatal extension II (SNAPPE-II) also assessed as initial severity.

Results: Compared to NICUs with NRF?p?r?=?.282, p?p?Conclusions: Neonates in NICUs with smaller NRF admission volume and decreased magnitude of ventilator use had a higher risk of death as assessed by SNAPPE-II, which should be targeted in the quality improvement of newly established, resource-limited NICUs.