Patterns and frequency of anxiety in women undergoing gynaecological surgery

Aims. Within a gynaecological surgical setting to identify the patterns and frequency of anxiety pre‐ and postoperatively; to identify any correlation between raised anxiety levels and postoperative pain; to identify events, from the patients’ perspective, that may increase or decrease anxiety in the pre‐ and postoperative periods. Background. It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient outcomes. Few studies have been conducted to obtain the patient's perspective on the experience of anxiety and the events and situations that aggravate and ameliorate it. Method. The study used a mixed method approach. The sample consisted of women undergoing planned gynaecological surgery. Anxiety was assessed using the State Trait Anxiety Inventory. Trait anxiety was measured at the time of recruitment. State anxiety was then assessed at six time points during the pre‐ and postoperative periods. Postoperative pain was also measured using a 10 cm visual analogue scale. Taped semi‐structured telephone interviews were conducted approximately a week after discharge. Results. State anxiety rose steadily from the night before surgery to the point of leaving the ward to go to theatre. Anxiety then increased sharply prior to the anaesthetic decreasing sharply afterwards. Patients with higher levels of trait anxiety were more likely to experience higher levels of anxiety throughout their admission. Elevated levels of pre‐ and postoperative anxiety were associated with increased levels of postoperative pain. Telephone interviews revealed a range of events/situations that patients recalled distressing them and many were related to inadequate information. Conclusion. This study found higher rates of anxiety than previously reported and anxiety levels appeared raised before admission to hospital. This has important clinical and research implications. Relevance to clinical practice. Patients with high levels of anxiety may be identified preoperatively and interventions designed to reduce anxiety could be targeted to this vulnerable group. Patient experiences can inform the delivery of services to meet their health needs better.     

Difficult diagnosis in the emergency department: Hyperemesis in early trimester pregnancy because of incarcerated maternal diaphragmatic hernia

Hyperemesis gravidarum is a frequent presentation to the ED, which usually resolves with fluid rehydration and antiemetics. Early incarcerated maternal diaphragmatic hernia might be misdiagnosed as relatively benign hyperemesis gravidarum in the first two trimesters of pregnancy. Diagnosis is missed because of non‐specific presentation with abdominal pain, nausea and vomiting. Hernias rarely become symptomatic even in latter stages of pregnancy, as the uterus increases in size with each trimester and with raised intra‐abdominal pressure from uterine contraction during labour. Symptoms progress with incarceration and strangulation of abdominal contents within the thoracic cavity, compression of the lung and disruption of caval venous return. A woman at 19‐week gestation presented with delayed diagnosis of strangulated diaphragmatic hernia, representing the earliest gestation in the published literature when this has occurred. She had repeatedly been misdiagnosed with hyperemesis gravidarum. It is worthwhile considering incarcerated maternal diaphragmatic hernia as an unusual cause of refractory vomiting in pregnancy, when associated with clinically significant upper abdominal pain and progressive respiratory embarrassment. This might occur as early as the mid‐second trimester, and without uterine contraction.     

Conscientious objection to termination of pregnancy: the competing rights of patients and nurses

Aims  To highlight the potential difficulties in the management of staff with a conscientious objection to abortion, in light of expanding role of nurses.
Background  Recent years have seen changes in the provision of abortion services. Medical procedures are now gaining popularity and some areas are seeing the integration of outpatient clinics into ward settings. This may involve nurses being required to provide care to women undergoing termination of pregnancy, which may not have previously been within their remit. This has implications for staff with a conscientious objection.
Methods  A review of the academic literature.
Results  The advent of medical abortion has led to changes in the way in which abortion services are provided which in turn has re-ignited the debate of the competing rights of nurses with a conscientious objection and those of the patient accessing abortion services.
Conclusions  This extended role of nurses creates challenges for staff working in clinical areas offering termination of pregnancy and these are further compounded when staff have expressed a conscientious objection to abortion.
Implications for Nursing Management  Managers face new challenges in achieving the fine balance between the rights of staff with a conscientious objection to abortion and women accessing abortion services.     

重度妊娠高血压疾病终止妊娠时机及方式对母婴预后及并发症的影响

目的探讨重度妊娠高血压综合征(PIH)患者妊娠时机对母婴预后及并发症的影响。方法 128例PIH患者根据终止妊娠时间分为A组(孕28~31周)38例,B组(孕32~33周)48例和C组(≥34周)42例;根据分娩方式分为自然分娩组20例,剖宫产组68例,引产40例。分析不同分娩时机及分娩方式对母婴并发症的影响。结果 A组新生儿并发症发生率显著高于B组、C组(P0.05)。A组、B组孕妇并发症发生率显著低于C组(P0.05)。剖宫产组新生儿窒息发生率低于自然分娩及引产组(P0.05)。不同孕周新生儿出生体质量、住院时间比较有显著差异(P0.05),而A组新生儿阿氏评分低于B组、C组(P0.05)。结论重度PIH患者母婴并发症发生率较高,将孕周延长至32周会使得母婴获得更好的妊娠结局。     

Enhancing decolonization and knowledge transfer in nursing research with non-western populations: examining the congruence between primary healthcare and postcolonial feminist approaches

This article is a call for reflection from two distinct programs of research which converge on common interests pertaining to issues of health, social justice, and globalization. One of the authors has developed a research program related to the health and well-being of non-western populations, while the other author has expanded the field of Aboriginal and international research in Canada and abroad. Based on examples drawn from our respective programs of research, we suggest conciliating the philosophy of primary healthcare to postcolonial feminism for decolonizing research and enhancing knowledge transfer with non-western populations. We contend that applying the theoretical and methodological strengths of these two approaches is a means to decolonize nursing research and to avoid western neocolonization. In conciliating primary health care and postcolonial feminism, the goal is to enhance the pragmatic relevance of postcolonial feminism to generate resistance through transformative research for achieving social justice. In tapping into the synergistic and complementary epistemological assumptions of the philosophy of primary health care and postcolonial 'feminisms', nurse researchers reinforce the anti-oppresive goals of postcolonial feminist research. Consequently, this approach may enhance both decolonization and knowledge transfer through strategies like photovoice.     

妊娠期高血压病患者终止妊娠时机及分娩方式临床观察

目的探讨妊娠期高血压疾病患者的终止妊娠时机及分娩方式对妊娠结局的影响。方法选取本院产科于2011年11月-2013年10月收治的妊娠期高血压疾病孕妇156例,根据终止妊娠时机分为3组：A组（〈34周,22例）、B组（34-36周,41例）、C组（〉36周,93例）;根据分娩方式分为2组：经阴道分娩组（38例）和剖宫产组（118例）。分别对比不同妊娠时机、不同分娩方式新生儿出生体质量、新生儿窒息发生率、新生儿死亡率以及产妇并发症发生率。结果A组新生儿出生体质量显著低于B、C组（P〈0．01）,B组显著低于C组（P〈0．01）;A组新生儿窒息发生率及新生儿死亡率显著高于B、C组（P〈0．01或P〈0．05）,B组显著高于C组（P〈0．05）。不同终止妊娠时机产妇并发症发生率比较差异无统计学意义（P〉0．05）。经阴道分娩组新生儿出生体质量显著低于剖宫产组（P〈0．01）;而经阴道分娩组新生儿窒息发生率、死亡率以及产妇并发症发生率均显著高于剖宫产组（P〈0．01）。结论孕周较小的妊娠期高血压疾病患者应给予合理的治疗以适当延长妊娠时间,于妊娠36周左右时终止妊娠,并应尽可能选择剖宫产,从而降低经阴道分娩对产妇及胎儿造成的伤害,降低新生儿及产妇围生期并发症发生率。     

Working with families experiencing violence: the Ploeger Model of enhanced maternal and child health nursing practice

This paper describes the Ploeger Model of enhanced maternal and child health (EMCHN) nursing practice that has been operationalised since 1997. These EMCHNs work with families whose infants and children are exposed to violence. Family violence is complex and many layered. It presents a situation of fear and unpredictability that is difficult to identify and manage. If this situation continues during the child rearing years the effect on the health and wellbeing of infants and children may range from death to life long disabilities. Maternal, siblings and families' health and wellbeing can also be impacted upon for life. The need for enhanced skills for identifying and supporting vulnerable families and safeguarding children at risk has been highlighted by the Department of Health (2004). The Ploeger Model provides an example of early identification and intervention using both secondary and tertiary prevention strategies to identify and make referrals within a multidisciplinary, collaborative partnership, and a process of mutual clinical supervision. Another feature of the model is 'assertive outreach', which assists with early engagement with the family focusing on social support. Each of these helps achieve positive outcomes for children and their families. Such front line professionals must have the knowledge, skills, time and management support to work effectively with these families.     

孕早期和待产孕妇血清蛋白质含量分析

目的调查分析孕妇孕早期和待产时血清蛋白质含量,探讨建立孕妇血清蛋白参考范围的必要性。方法奥林巴斯全自动生化分析仪定量检测1082例孕早期孕妇和963例待产孕妇血清中总蛋白（双缩脲法）、清蛋白含量（溴甲酚绿法）。统计各组均值伍）与标准差（S）,以2s建立相应的参考范围。单一样本t检验与健康成人血清蛋白含量进行统计学比较。结果孕早期总蛋白x为73．90g／L,S为4．60,参考范围为64．90～82．90g／L;清蛋白x为42．30g／L,s为4．39,参考范围为33．70～50．00g／L。待产时总蛋白x为64．90g／L,5为6．06,参考范围为53．00～76．80g／L;清蛋白x为34．20g／L,s为4．29,参考范围为25．80～42．60g／L。与健康成人血清总蛋白（63．00～83．00g／L）、清蛋白（35．00～50．00g／L）进行单一样本t检验,孕早期清蛋白与健康成人清蛋白含量差异无统计学意义,孕早期总蛋白以及待产时血清总蛋白和清蛋白与健康成人血清蛋白含量差异均有统计学意义。结论在孕早期,清蛋白含量与健康成人清蛋白差异无统计学意义,总蛋白含量统计学上虽有差异,但数值上相差不大,无实际临床价值,可以通用健康成人参考范围。待产时,孕妇血清蛋白含量与健康成人血清蛋白含量在统计学和临床上差异有统计学意义,有必要另行建立其相应的参考范围。     

妊娠晚期女性盆膈裂孔结构及大小的三维超声观察

Objective To study the variation of the urogenital hiatus dimension in late pregnancy women by three-dimensional(3D) pelvic floor ultrasonography,to provide imaging evidence in the study of the relationship between pregnancy and pelvic floor dysfunction diseases.Methods Twenty nulliparas and forty late pregnancy women were examined by 3D pelvic floor ultrasonography to obtain the image of urogenital hiatus in which anteroposterior diameter of urogenital hiatus (AP),left to right diameter of urogenital hiatus (LR) and area of urogenital hiatus (HA) were measured and compared.AP,LR and HA were also compared between the late pregnancy women with stress urinary incontinence symptom and those without stress urinary incontinence symptom.Results AP,LR and HA in late pregnancy women were greater than those in nulliparas(all P ＜0.05) and had no difference between the late pregnancy women with stress urinary incontinence symptom and those without stress urinary incontinence symptom(all P ＞0.05).Conclusions 3D pelvic floor ultrasonography is an effective imaging method to observe pelvic support in pregnancy women.     

A critical realist approach to knowledge: implications for evidence-based practice in and beyond nursing

This paper will identify some of the key conceptual tools of a critical realist approach to knowledge. I will then apply these principles to some of the competing epistemologies that are prevalent within nursing. There are broadly two approaches which are sometimes distinct from each other and sometimes inter-related. On one side, there is the view that all healthcare interventions should be judged on the principles of randomised controlled trials and the other is a preoccupation with language in which healthcare interventions are subjected to a discursive interrogation. These debates are configured through the idea of a hierarchy of knowledge that is accorded uncritical acceptance by some and virulent distaste by others. I will argue that the notion of hierarchy is problematic and is largely argued for in unproductive epistemological terms. What is required is a shift towards a theory that emphasises the contextual nature of the ways that knowledge is produced and disseminated. In other words, there is no single hierarchy of knowledge, but there are multiple hierarchies of knowledge.     

中孕引产中胎盘粘连者胎盘血管生成素1,2的表达

目的:探讨中孕引产后胎盘粘连与胎盘血管生成素1 (Ang-1)和血管生成素2(Ang-2)表达的关系.方法:孕13～24周来我院要求终止妊娠的孕妇中,入院后按知情同意的原则选择利凡诺引产及水囊引产的61例分为两组,A组:利凡诺组40例;B组:水囊组21例,采用免疫组化方法检测胎盘中Ang-1和Ang-2的表达情况,比较胎盘Ang-1、Ang-2与胎盘粘连的关系.结果:A组与B组的胎盘粘连发生率分别为50％及47.62％,两者间差异无显著性(P＞0.05);两组中胎盘粘连者Ang-1的表达均高于无粘连者,Ang-2的表达粘连者低于无胎盘粘连者,差异有显著性(P＜0.05).结论:中孕引产后胎盘粘连可能与胎盘Ang-1的表达增强、Ang-2的表达减弱有关,可能与Ang-1/Ang-2的比率改变有关.     

妊娠晚期女性盆膈裂孔结构及大小的三维超声观察

目的 应用盆底三维超声观察妊娠晚期女性盆膈裂孔大小变化情况,为研究妊娠与盆底功能障碍性疾病之间的关系提供影像学依据.方法 对20例正常未育女性及40例晚孕女性进行盆底三维超声检查,获得盆膈裂孔声像图,测量盆膈裂孔前后径、左右径和面积并进行两组对比,比较晚孕尿失禁组和晚孕无尿失禁组的盆膈裂孔前后径、左右径和面积.结果 晚孕组盆膈裂孔前后径、左右径、面积均较正常未育组大(均P＜0.05).晚孕尿失禁组和晚孕无尿失禁组间盆膈裂孔前后径、左右径、面积无明显差别(均P＞0.05).结论 盆底三维超声是一种有效的观察妊娠期女性盆底支持系统的影像学方法.

Abstract：

Objective To study the variation of the urogenital hiatus dimension in late pregnancy women by three-dimensional(3D) pelvic floor ultrasonography,to provide imaging evidence in the study of the relationship between pregnancy and pelvic floor dysfunction diseases.Methods Twenty nulliparas and forty late pregnancy women were examined by 3D pelvic floor ultrasonography to obtain the image of urogenital hiatus in which anteroposterior diameter of urogenital hiatus (AP),left to right diameter of urogenital hiatus (LR) and area of urogenital hiatus (HA) were measured and compared.AP,LR and HA were also compared between the late pregnancy women with stress urinary incontinence symptom and those without stress urinary incontinence symptom.Results AP,LR and HA in late pregnancy women were greater than those in nulliparas(all P ＜0.05) and had no difference between the late pregnancy women with stress urinary incontinence symptom and those without stress urinary incontinence symptom(all P ＞0.05).Conclusions 3D pelvic floor ultrasonography is an effective imaging method to observe pelvic support in pregnancy women.     

Contraceptive self‐efficacy and contraceptive knowledge of Hong Kong Chinese women with unplanned pregnancy

Aim and objectives. The purpose of this study was to explore contraceptive practice, the level of knowledge and self‐efficacy of contraception among Chinese women with unplanned pregnancy and to determine the relationships between these variables. Background. The construct of self‐efficacy can be employed as a theory to design a nursing intervention to prevent sexually active women from unplanned pregnancy. Only a few western studies have investigated the relationships between self‐efficacy and contraception behaviour yet none targeted at the Chinese population. Design. Cross‐sectional survey. Methods. This study employed a cross‐sectional survey design. A convenience sample of 117 eligible Chinese females completed all the questionnaires, which included the Chinese version of the Contraceptive Self‐efficacy Scale and Contraceptive Knowledge Scale. Results. The findings in this study suggested that younger, unmarried women at the lower income group, who adopted male condoms are at risk for unplanned pregnancy. The sample demonstrated an above medium level of knowledge and self‐efficacy in contraception. However, no significant relationship was found between contraceptive self‐efficacy and knowledge (p>0·05). Conclusions. Contraceptive obstacles were revealed by participants’ moderate level of contraceptive self‐efficacy and contraceptive knowledge. The relationship between contraceptive knowledge of specific methods and contraceptive self‐efficacy need further exploration in future studies. Relevance to clinical practice. The dominant use of male condoms by the sample of this study sheds light on future direction in the development of educational programmes and contraceptive promotion strategies appropriate for women with unplanned pregnancy.     

自护理论在异位妊娠病人护理中的应用及效果评价

目的探讨对异位妊娠病人运用自护理论的方法和临床效果。方法通过对143例异位妊娠病人护理,根据其自护能力缺陷程度,采用由护理专家Orem提出的3种基本护理方法,即完全补偿系统、部分补偿系统和辅助-教育系统进行护理。结果运用自护理论进行护理的病人,术后肛门排气时间和下床活动时间较常规方法护理的病人显著提前(P<0.005)。143例病人平均住院日为5~7d。结论3种基于自护理论的基本护理方法,在异位妊娠患者护理中是非常实用和有效的。     

Effects of a family‐support programme for pregnant women with foetal abnormalities requiring pregnancy termination: A randomized controlled trial in China

Aim

We examined the effects of a family‐support programme for pregnant women with foetal abnormalities in terms of family support, depression, and post‐traumatic stress symptoms.

Method

A randomized controlled trial was conducted from November 2016 to June 2017. A total of 124 pregnant women with foetal abnormalities were recruited and randomly assigned to the intervention group that received a family‐support programme or control group that received only routine care. Self‐reported questionnaires including the Family Adaptation Partnership Growth Affection and Resolve Index, the Edinburgh Postnatal Depression Scale, and the Impact of Event Scale‐Revised were administered before and after intervention.

Results

Relative to the control group, posttest Family Adaptation Partnership Growth Affection and Resolve Index scores and scores on the intimacy domain were significantly higher in the intervention group, the Edinburgh Postnatal Depression Scale and Impact of Event Scale‐Revised scores and the scores on all subscales except the intrusion subscale were significantly lower in the intervention group.

Conclusion

The findings of this study suggest that family‐support programme represents an effective and feasible support approach of improving family support and reducing depression and post‐traumatic stress symptoms for pregnant women with foetal abnormalities requiring pregnancy termination.     

Student nurses' knowledge, skills and attitudes towards the use of portfolios in a school of nursing

Aims. The aims of this study are to examine the knowledge, skills and attitudes of student nurses about the value and purpose of portfolios and their relevance for professional development. Background. Portfolios have become an integral aspect of student centred learning within nursing. The literature is generally positive about the benefits of portfolios but questions remain about their effective implementation. Method. A questionnaire was used to survey student nurses about the use of portfolios as a learning tool. The questionnaire was developed specifically for this study and was structured around a knowledge skills and attitude framework. Results. The sample was 413 preregistration student nurses in one school of nursing in the UK across course, year of study and branch of nursing. The main findings reveal that students are unclear but positive about the purpose and use of portfolios. Specifically, academic tutors do not provide sufficient direction in the development of their portfolios. There is also evidence that students found portfolios more useful for exploring the ‘art’ of nursing, rather than the ‘technical’ skills of nursing. Students also reported that they would welcome a dedicated portfolio module. Conclusion. Students struggle with what is useful about portfolios and are unsure about its purpose. Nonetheless, they are positive towards portfolios as a learning tool and seem to acknowledge the usefulness of portfolios for professional development. Relevance to clinical practice. The importance of portfolios for professional development is now being emphasized but how academic tutors and clinical mentors support their development remains unclear. This study provides understanding about what support students would value.