The Effects of Gestational Age and Pregnancy Planning Status on Obstetrical Nurses'Perceptions of Giving Emotional Care to Women Experiencing Miscarriage

Obstetrical nurses (N=292) were surveyed regarding the influence of gestational age and pregnancy planning on nurses'emotional care for women who had experienced miscarriage. Three measures of emotional care were used as the dependent variables: emotional seriousness, priority of care and emotional support. Both gestational age and whether the pregnancy was planned or unplanned had a significant effect on the nurses'perceptions of emotional seriousness and priority of care. Planning status was significant in the nurses'perception of emotional support.     

A Comprehensive Approach to Care of Women of Advanced Maternal Age

Advanced maternal age, historically defined as ages 35 years and older, is used to describe the later years in the female reproductive life span when rates of adverse pregnancy outcomes increase. The preconception period represents an opportunity to ensure the use of safe medications and optimize care for medical comorbidities. Routine prenatal care should be augmented with counseling on fetal aneuploidy with a detailed anatomic survey. Surveillance for preterm labor and preeclampsia is recommended. Growth assessment and antepartum testing for specific women are advised, particularly those ages 40 years and older and those with select medical problems. Despite an increased incidence of complications, most women of advanced maternal age will have normal pregnancies and will benefit from the compassionate care provided by midwives, advanced practice registered nurses (including nurse practitioners and clinical nurse specialists), and perinatal nurses.     

Parity and the Association With Diabetes in Older Women

OBJECTIVE

To examine the relationship of parity with diabetes and markers of glucose homeostasis in older women.

RESEARCH DESIGN AND METHODS

We used data from the female participants in the Cardiovascular Health Study, a longitudinal cohort of adults aged ≥65 years. These data included an assessment of parity (baseline) and fasting serum levels of glucose, insulin, and medication use (baseline and follow-up). We estimated both the cross-sectional relationship of parity with baseline diabetes and the relationship of parity with incident diabetes.

RESULTS

In unadjusted analyses, women with grand multiparity (≥5 live births) had a higher prevalence of diabetes at baseline compared with those with fewer births and with nulliparous women (25 vs. 12 vs. 15%; P < 0.001). In regression models controlling for age and race, grand multiparity was associated with increased prevalence of diabetes (prevalence ratio 1.57 [95% CI 1.20–2.06]); with addition of demographic and clinical factors to the model, the association was attenuated (1.33 [1.00–1.77]). In final models that included body anthropometrics, the association was no longer significant (1.21 [0.86–1.49]). In those without diabetes at baseline, parity was not associated with incident diabetes or with fasting glucose; however, there was a modest association of parity with fasting insulin and homeostasis assessment model of insulin resistance.

CONCLUSIONS

Grand multiparity is associated with diabetes in elderly women in cross-sectional analyses. This relationship seems to be confounded and/or mediated by variation in body weight and sociodemographic factors by parity status. In older nondiabetic women, higher parity does not pose an ongoing risk of developing diabetes.Pregnancy is a time-limited condition; however, there is evidence that child-bearing could have a long-term impact on the health of women. The dramatic alterations in physiology and metabolism associated with the state of pregnancy have sparked questions about the association of child-bearing with the subsequent risk of conditions such as diabetes.Pregnancy induces a state of insulin resistance in a woman''s peripheral tissues. In susceptible nondiabetic women, insulin resistance may be severe enough to cause gestational diabetes mellitus. It is generally assumed that pregnancy-associated insulin resistance resolves after parturition, but subtle metabolic changes could persist, leading to increased risk for diabetes in the future.Researchers examining the relationship between parity and risk of diabetes have come to discordant conclusions. Some studies have suggested a link between higher parity and increased risk of future diabetes (1–5). However, other studies have demonstrated no increased risk of diabetes associated with child-bearing (1,6). In the face of conflicting data, some researchers have suggested that the relationship of increased parity with higher diabetes risk that is observed in some studies is confounded or mediated by other factors, such as body weight and socioeconomic status (6).The aim of our study was to examine the relationship between parity and diabetes in older women, who have the highest prevalence of diabetes. We hypothesized that higher parity was positively associated with the prevalence of diabetes in older women. We studied the influence of potential confounding variables, such as education, race, and alcohol intake, on our hypothesized association between parity and diabetes as well as possible mediators of the association, such as BMI and waist circumference. Finally, we tested the influence of parity on biochemical markers of glucose homeostasis, such as fasting serum glucose and insulin levels, and the homeostasis model assessment of insulin resistance (HOMA-IR) in those without diabetes.     

Emotional Care of the Pregnant Woman

Prenatal care affords an unparalleled opportunity, with a captive audience, to engage in prevention of primary mental health problems. Pregnancy and birth are family crises with much overt marital pathology and deviant parent-child relationships starting at this time. There is unfortunately little awareness of normal emotional reactions to pregnancy or of the pregnant woman's needs, and physician's attitudes and my ths can perpetuate this. The author suggests a range of interventive methods including use of community resources and involvement of other professionals.     

Effects of Parity and Breastfeeding Duration on Bone Density in Postmenopausal Women

PurposeThis study aimed to identify the effect of parity and breastfeeding duration and the occurrence of lumbar vertebral and femoral neck osteoporosis in Korean postmenopausal women.MethodsThis study analyzed the data of 1,770 women based on the 2010–2011 results of the Korea National Health and Nutrition Examination Survey. Extracted data concerning bone density included variables known to be associated with osteoporosis. Complex sample multivariate logistic regression analysis was conducted to determine whether parity and breastfeeding duration were associated with osteoporosis in postmenopausal women.ResultsParity was not associated with postmenopausal osteoporosis in the femoral neck or lumbar vertebrae; however, the risk of femoral neck osteopenia was significantly higher in women with a history of 12–24 months of breastfeeding than in women who breastfed for less than 12 months (odds ratio = 2.12, 95% confidence interval = 1.07–4.21). In women who breastfed for 24 months or longer, the risk of lumbar vertebral osteoporosis was significantly higher than in those who breastfed for less than 12 months (odds ratio = 2.73, 95% confidence interval = 1.18–6.32).ConclusionBreastfeeding duration may affect the occurrence of lumbar vertebral or femoral neck osteopenia or osteoporosis. Therefore, women who breastfeed for one year or more require education on the risk of bone loss and the need for preventive measures such as adequate calcium intake and physical exercise.     

Emotional and Birth Outcomes Associated With Different Types of Prenatal Care for Women With Low Income

This article summarizes findings from the literature on the emotional and birth outcomes of women with low income receiving different types of prenatal care. This literature review included studies published between 2015 and 2020. The results indicated that women with low income have challenging experiences in traditional models of prenatal care. Evidence of improved birth outcomes with nontraditional prenatal care is mixed, but qualitative findings indicate that it is associated with better emotional outcomes for women with low income when compared to traditional prenatal care. Future research should investigate ways to improve the negative interpersonal and structural dimensions that can characterize prenatal care for women with low income.     

Pediatric Oncology Providers' Perceptions of a Palliative Care Service: The Influence of Emotional Esteem and Emotional Labor

Context

Pediatric palliative care consults for children with cancer often occur late in the course of disease and close to death, when earlier involvement would reduce suffering. The perceptions that pediatric oncology providers hold about the pediatric palliative care service (PPCS) may shape referral patterns.

Medical Respite and Linkages to Outpatient Health Care Providers among Individuals Experiencing Homelessness

Medical respite programs provide nursing care and case management to individuals experiencing homelessness following hospitalization for an acute medical problem. One goal of these programs is to link clients to outpatient providers to decrease their reliance on hospital services. Through qualitative interviews with staff members (n = 8) and clients (n = 14) at a medical respite program, we explored processes of, and challenges associated with, linking clients to outpatient care. Six themes were identified, which offer insight about important considerations when linking clients to outpatient providers and highlight the value of medical respite programs for this population.     

Impact of Parity on Obesity: A Cross-Sectional Study in Iranian Women

Objective

The aim of the present study was to analyze whether or not parity influenced the prevalence of obesity in both pre- and postmenopausal women.

Subjects and Methods

A cross-sectional study was conducted on characteristics of urban women regarding parity. A total of 1,620 women aged 45-63 years were selected using cluster sampling. A face-to-face household interview was conducted by trained, skillful personnel. A risk factor questionnaire was used to obtain information on reproductive history and sociodemographic factors. Statistical associations between parity and obesity using logistic regression were then investigated.

Results

The mean BMI was 29.1 ± 5.1, and 96.8% of the sample population were parous, with a median of 4 births. Of the total women enrolled, 216 (13.3%) had <3 parities, while 1,404 (86.7%) had ≥3 parities. The prevalence of obesity (BMI ≥30) was 38.3%, diagnosed at a mean age of 51.4 ± 5.2 years. After adjustment for a range of potential confounders (age, marital status, employment, education, smoking status, abortion history, savings situation and menopausal status), women with ≥3 parities were at higher risk of being obese (OR 1.74, 95% CI 1.24-2.45; p = 0.001).

Conclusion

A positive association was observed between the number of parities and obesity. The findings of this study suggest that the BMI is associated with high parity in Babolian women. Health policymakers should work with health providers to develop appropriate postpartum weight loss interventions.Key Words: BMI, Pregnancy, Women''s health     

Mothers' Responses to Care Given by Male Nursing Students during and after Birth

Purpose: To describe the rationale maternity patients use in determining whether to accept care by a male student nurse. Information about the activities that women are comfortable having male nursing students perform is inconsistent and the reasons for women's comfort or discomfort are unclear. Furthermore, little is known about what factors patients consider when assigned a male nursing student. Yet, knowledge of such factors can enhance understanding and guide the selection of students in maternity units.
Design: Focused ethnography using a purposive convenience sample of 32 women, aged 20 to 40 years, who spoke English, and who had given birth to normal newborns in one small community hospital in the mid-Atlantic region of the United States. Patients were excluded if they or their infants were in an unstable physical or mental condition. The study was conducted in 1995.
Methods: The women were interviewed using a semi-structured format.
Findings: Data from participants pertained to personal and contextual factors. Personal factors were perception of postpartum self and personal feelings. Contextual factors were student characteristics, establishment of relationships, nursing care activities, and partner viewpoint.
Conclusions: Women during and after giving birth have definite thoughts about male student nurses caring for them. Nurse educators should consider these when assigning men. Educators should encourage professionalism and competence in their students.     

一对一助产陪护模式对初产妇心理状态、满意度及分娩结局的影响

目的探讨一对一助产陪护模式对初产妇心理状态、对护理工作满意度及分娩结局的影响。方法将480例正常分娩的初产妇按随机数字表法分为观察组和对照组,每组240例。对照组在传统助产模式下,按照常规护理方式进行分娩;观察组采取一对一全程助产陪护模式进行分娩。对2组产妇的心理状态(焦虑、恐惧),产后出血、对护理工作满意度及新生儿Apgar评分进行比较。结果观察组产妇的焦虑、恐惧情绪,产后出血、产程异常及新生儿窒息发生率均显著少于对照组,对护理工作的满意度明显高于对照组(均P<0.05)。结论在产科护理中实施一对一全程助产陪护,可明显缓解产妇的恐惧、焦虑情绪,减少产后出血和新生儿窒息的发生,有利于母婴健康以及整体护理质量的提高。     

母亲情绪心理及家庭管理对早产儿校正12月龄低体质量的影响分析

目的 分析母亲情绪心理因素及家庭管理对早产儿校正12月龄体质量的影响。方法 采用便利抽样法,选取2016年7月—2017年11月上海市某三级甲等妇婴保健院新生儿科住院的早产儿及其母亲各264例作为研究对象。在早产儿校正1月时采用焦虑自评量表、围产期创伤后应激障碍问卷以及中文版家庭管理量表对母亲进行评估,采用一般资料调查表收集早产儿及其父母的相关资料。采用二分类Logistic回归分析早产儿校正12月龄体质量的影响因素。结果 早产儿校正12月龄时低体质量的发生率为27.3%。二分类Logistic回归分析结果显示,校正1月时患儿认可（OR=0.855,P=0.045）、校正1月时照护能力（OR=0.904,P=0.019）是早产儿校正12月龄时低体质量的保护因素;男孩（OR=3.409,P=0.002）、校正1月时母亲焦虑（OR=1.085,P=0.032）、校正1月时照护负担（OR=1.183,P=0.043）是早产儿校正12月时低体质量的危险因素。结论 影响早产儿校正12月龄低体质量的因素有校正1月时患儿认可低、校正1月时照护能力低、男孩、校正1月时母亲焦虑得分高、校正1月时照护负担得分高。建议在早产儿出院前,教会其母亲照护的知识及基本技能;与社区医院联动,建立并完善早产儿随访体系;随访时尤应注意男孩体质量情况,找出发生低体质量的原因,并给予相应处理;心理咨询师介入,帮助早产儿母亲建立照护信心,同时利用同伴间交流及互助,缓解母亲的焦虑情绪及照护负担,提高母亲对早产儿的认可度,从而保障早产儿顺利完成追赶生长,减少低体质量的发生。     

Emotional Numbness Modifies the Effect of End-of-Life Discussions on End-of-Life Care

ContextOverall, end-of-life (EOL) discussions are unrelated to psychological distress and associated with lower rates of aggressive care near death. Nevertheless, patients who report that they feel emotionally numb about their illness might encounter difficulties cognitively processing an EOL discussion.ObjectivesWe hypothesized that emotional numbness would modify the effect of EOL discussions on the receipt of less aggressive EOL care.MethodsData were derived from structured interviews with 290 participants in the federally-funded Coping with Cancer Study, a multisite, prospective cohort study of patients with advanced cancer followed-up till their death. Patients' reports of EOL discussions with their physician and emotional numbness were assessed at a median of 4.6 months before their death. Information about aggressive EOL care (i.e., ventilation, resuscitation in the last week of life, death in the intensive care unit) was obtained from postmortem caregiver interviews and medical charts. Main and interactive effects of EOL discussions and emotional numbness on aggressive EOL care, adjusting for potential confounds, were evaluated using multiple logistic regression.ResultsThe likelihood of aggressive EOL care associated with having EOL discussions increased by a factor of nine (adjusted odds ratio = 9.02, 95% CI 1.37, 59.6, P = 0.022) for every unit increase in a patient's emotional numbness score.ConclusionEmotional numbness diminishes a patient's capacity to benefit from EOL discussions. The EOL decision making may be more effective if clinical communications with emotionally numb patients are avoided.     

70例育龄妇女宫内放置节育环不良反应的护理

在参加省扶贫工作期间 ,对关岭布依族、苗族自治县 30 0例已婚育龄妇女避孕现状进行了调查 ,对其中 70例宫内放置金属单环发生不良反应者给予护理指导。现报告如下。1　资料和方法采用问卷式调查方式对某地区 30 0例已婚育龄妇女进行调查 ,问卷由专科医师现场询问填写 ,对其中 70例采用宫内金属单环发生不良反应者进行分析 ,其中 2 1岁～ 30岁 2 0人 ,31岁～ 40岁 39人 ,≥ 41岁 11人 ;未生产 1人 ,分娩 1胎 5 3人 ,分娩 2胎 12人 ,分娩 3胎以上 4人 (其中分娩 7胎 1人 ) ,上环时间 <5a 2 3人 ,5a～ 10a 2 9人 ,>10a 18人。上环时间与不良反…     

护生对生活护理情感体验的研究

目的了解护生对生活护理的情感认知情况及其心理体验。方法采用质性研究中的现象学研究方法,按照目的性抽样法选择福州市某三级甲等医院护理大专、本科实习生14名进行深入访谈,并用现象学分析法进行资料分析。结果得到2个主题:护生对生活护理认知不足,护生对生活护理体验具有多样性。结论护生执行生活护理,可提高临床实践动手能力、观察能力和培养职业情感,因此生活护理的专业教育和培训亟待开展,且要高度关注生活护理意识的养成。     

Use of the Interpersonal Support Evaluation List (ISEL) to Guide Intervention Development with Women Experiencing Abuse

Effective intervention strategies for abused women must be developed that match women's perceived needs. The purpose of this study was to examine the associations among age, race, employment status, education levels, and women's perceptions of social support. Women ( n = 40) from 19 to 68 years of age in a family court setting or domestic violence shelter completed the Interpersonal Support Evaluation List (ISEL), which was used to measure subscales of companionship, self-esteem, emotional support, and instrumental support. Abuse was documented by patient reports and protocols of the referring agencies. Significant associations were found between age and self-esteem (r =. 47, p =. 002) companionship (r =. 29, p =. 07) and emotional support (r =. 27, p =. 09). Also significant were the associations between race and self-esteem (r =. 27, p =. 10) and employment and instrumental support (r = &#109. 32, p =. 08). These significant findings may aid in the development of interventions for abused women that are matched to their social support needs, particularly if the findings are consistent in larger studies.