Effects of a Community Outreach Program for Maternal Health and Family Planning in Tigray,Ethiopia

Purpose

We examined the effects of a community outreach program for maternal health in Tigray, Ethiopia, on women’s knowledge about pregnancy, childbirth, postpartum care, and family planning, and assessed their participation in antenatal care, postpartum checkups, institutional childbirth, and contraceptive use.

自然避孕法与宫内节育器效果比较

目的：探讨比林斯林（Billing)与测定基础体温（BBT）相结合自然避孕法（NFP）与IUD效果比较,解决IUD失效又不宜使用口服避孕药物并拒绝使用外用避孕药具的育龄妇女的节育问题,方法：对163例适宜NFP的妇女传授使用Billing法和BBT相结合的NFP,即根据观察宫颈粘液及外阴部感觉,进行自我监测排卵日的方法与测定BBT相结合,找出可孕期,完全期,指导性生活,与同期163例健康IUD妇女进行跟踪观察和比较,结果,两组妇女避孕有效率相近,无明显统计学差异,结论：对于部分不宜使用避孕药具有的妇女,在有条件的地区进行推广应用NFP,解决由于避孕药具有副作用与失败给妇女带来不必要的痛苦,达到节育与生殖健康的目的,不失为较好的方法之一,随着社会的进步和人们生活化水平的提高,有较好的推广使用前景。     

Perspectives of Family Members on Planning End-of-Life Care for Terminally Ill and Frail Older People

ContextAdvance care planning (ACP) is the process by which patients, together with their physician and loved ones, establish preferences for future care. Because previous research has shown that relatives play a considerable role in end-of-life care decisions, it is important to understand how family members are involved in this process.ObjectivesTo gain understanding of the involvement of family members in ACP for older people near the end of life by exploring their views and experiences concerning this process.MethodsThis was a qualitative research study, done with semistructured interviews. Twenty-one family members were recruited from three geriatric settings in Flanders, Belgium. The data were analyzed using the constant comparative method as proposed by the grounded theory.ResultsFamily members took different positions in the ACP process depending on how much responsibility the family member wanted to take and to what extent the family member felt the patient expected him/her to play a part. The position of family members on these two dimensions was influenced by several factors, namely acknowledgment of the imminent death, experiences with death and dying, opinion about the benefits of ACP, burden of initiating conversations about death and dying, and trust in health care providers. Furthermore, the role of family members in ACP was embedded in the existing relationship patterns.ConclusionThis study provides insight into the different positions of family members in the end-of-life care planning of older patients with a short life expectancy. It is important for health care providers to understand the position of a family member in the ACP of the patient, take into account that family members may experience an active role in ACP as burdensome, and consider existing relationship patterns.     

Implementing Substance Use Screening in Family Planning

Although substance use has negative health effects on women, especially during the reproductive years, family planning practices in which nurse practitioners are key care providers, generally do not adequately screen and intervene for alcohol and drugs. Screening, brief intervention, and referral to treatment (SBIRT) can limit the effects of substance use on women and families. This study explored barriers and facilitators to SBIRT through qualitative analysis of focus groups with family planning providers. Results suggest family planning providers are favorable to implementation. Barriers include training and organizational support; facilitators include use of electronic health records and setting patient expectations.     

Highlights From the U.S. Selected Practice Recommendations for Contraceptive Use

The U.S. Centers for Disease Control and Prevention recently updated the U.S. Selected Practice Recommendations for Contraceptive Use to foster a reduction in unplanned pregnancy rates and to provide clinicians an evidence-based guide for contraception management. Nurses play an important role in helping women and families with reproductive life planning. By bridging knowledge gaps and removing access barriers with regard to contraception, nurses can contribute to reducing rates of unintended pregnancy. Nurses and other clinicians are encouraged to use the U.S. Selected Practice Recommendations for Contraceptive Use when counseling women about safe and effective contraception management.     

家庭支持对母乳喂养的影响

目的研究家庭支持对母乳喂养的影响,探讨提高母乳喂养率的有效途径。方法方便性抽样选取某三级甲等医院产科100例初产妇,采用问卷调查及电话随访相结合的方法,获得其家庭支持及母乳喂养情况,所得数据采用SPSS 16.0进行分析。结果初产妇的母乳喂养率低,家庭支持度得分为中度水平,不同喂养方式初产妇的家庭支持得分的差异具有统计学意义(F=29.28,P<0.01)。结论家庭支持与母乳喂养密切相关,护士应重视家庭支持系统对提高母乳喂养率的作用,有针对性地开展对孕产妇及其家属的健康教育,以提高母乳喂养的成功率。     

The Relationship of Spirituality and Family Functioning to Recidivism: An Investigation with Incarcerated Adolescent Males

Family functioning has been strongly linked to adolescent problematic behavior, including delinquency and subsequent recidivism. Adolescent spirituality however, while demonstrating some evidence as a protective factor against some problematic outcomes, such as delinquent behavior, has not been explored to the same degree as other more well-established factors. There is little understanding, for example, as to whether spirituality may act as a protective factor for adolescent recidivism, particularly in the presence of other identified protective factors. This study sought to examine the relationship of adolescent spirituality and family functioning with recidivism in a sample of incarcerated adolescent males. A longitudinal design was employed to measure both spirituality and family functioning during and post discharge from a boot camp. Results support the likely importance of adolescent spirituality as a protective factor for recidivism.     

非意愿妊娠妇女避孕与终止现况的调查与分析

目的了解因意外妊娠实施人工流产妇女所采用的避孕方法、紧急避孕知识的掌握和应用，以及人工流产的原因，为计划生育提供参考依据。方法随机选择在泰山医学院附属医院妇产科门诊做人工流产的妇女200例，进行问卷调查。结果有1次以上流产史的为46％；使用避孕措施的为96％；采用紧急避孕措施的为24％；其中6％的妇女认为如果再次妊娠会再次实施人工流产。结论调查人群中，意外妊娠率高并把人工流产作为控制生育的方法，紧急避孕知识的知晓率低。应加强计划生育教育及对避孕方法的咨询和指导，特别是未婚青年，从而降低意外妊娠率。     

家庭任务干预对提升恶性肿瘤患儿家庭功能及父母自我效能感的效果

目的探讨家庭任务干预对恶性肿瘤患儿家庭功能及父母自我效能感的效果。方法选取2012 年8~12 月在唐山市4家三级综合性医院内就诊的白血病等恶性肿瘤患儿的母亲或父亲58 名为研究对象,分为对照组(n=28)和干预组(n=30),两组患儿均进行常规治疗和护理,干预组同时进行家庭任务干预,时间为1 个月。在干预前后分别采用家庭功能量表(FFFS)和家长自我效能量表(SEPTI)进行评测。结果干预后,干预组的FFFS 总均分(1.01±0.55)、家庭与个体的关系(0.79±0.64)、家庭与社会的关系(1.21±0.92)得分均低于对照组(P<0.05);干预组父母在SEPTI约束/限制(4.19±0.55)、游戏(4.09±0.32)和教育(4.17±0.78)方面的得分均高于对照组(P<0.05)。结论家庭任务干预能改善恶性肿瘤患儿的家庭功能,提高患儿父母的自我效能感。     

Elephant in the room - Family members´ perspectives on advance care planning

Objective To explore family members’ experiences of advance care planning in nursing homes.Design Individual interviews. Thematic analysis.Setting Four nursing homes in Sweden.Subjects Eighteen family members of deceased nursing home patients.Main outcome measures Family members’ experiences of advance care planning in nursing homes.Results Family members’ experiences of advance care planning in a nursing home context involved five themes: Elephant in the room, comprising end-of-life issues being difficult to talk about; Also silent understanding, e.g. patient’s preferences explicitly communicated, but also implicitly conveyed. In some cases family members had a sense of the patient’s wishes although preferences had not been communicated openly; Significance of small details, e.g. family members perceive everyday details as symbols of staff commitment; Invisible physician, supporting nurse, e.g. nurse being a gatekeeper, providing a first line assessment in the physician’s absence; and Feeling of guilt, e.g. family members wish to participate in decisions regarding direction of care and treatment limits, and need guidance in the decisions.Conclusion Our study stresses the significance of staff involving the patient and family members in the advance care planning process in nursing homes, thereby adapting the care in line with patient’s wishes, and for the patient to share these preferences with family members. Education in communication related to the subject may be important to shape advance care planning.

Key points

• Knowledge on advance care planning (ACP) in a nursing home (NH) context from the perspective of family members is limited.
• Role of the nurse in ACP is seen as central, whereas physician involvement is often perceived to be lacking.
• Significance of small details, perceive to symbolize staff competence and respect for patient autonomy.
• To limit family members’ feeling of guilt, communicating end-of-life issues is important in order to align ACP with patient preferences.

     

The social construction of 'reproductive vulnerability' in family planning clinics

AIM: The aim of this paper is to report a study exploring the discursive construction of contraceptive use within nurse consultations with women in family planning clinics. BACKGROUND: This paper takes as its starting point the lack of a contraceptive 'strand' to the literature on the discursive construction of the female body generally, and the female reproductive system specifically, within health care practice. The literature in this field concentrates on pregnancy, menstruation and menopause, and the manner in which contraceptive use is discursively constructed is under-explored. Furthermore, the literature on nurse-women consultations in family planning clinics is also limited, with the current literature concentrating on assessing clinical skills rather than discourse. METHODS: Using a grounded theory methodology to explore how nurses educate women about contraception in family planning clinic, 49 consultations were audio-taped in two large family planning clinics in the United Kingdom (UK). FINDINGS: Open coding and subsequent axial coding resulted in the emergence of three elements of contraceptive education. One concerned reproductive anatomy, another reproductive physiology and a third education about contraceptive functioning. These three axial codes were formed into a core category: 'body education/reproductive vulnerability'. Within the consultation, nurses linked the 'vulnerable' reproductive system with the requirement for contraceptive 'protection'. This approach seems linked to ensuring women's future contraceptive use. CONCLUSION: The discourse employed by nurses differs from the body discourse aimed at menopause and menstruation. These areas of women's health were constructed as disintegrating, malfunctioning and failing, whereas reproductive vulnerability suggests a fully functioning, active system, in need of restraint. However, this discourse still constructs the female body as fundamentally weak and unstable, requiring contraception to protect it and prevent transgression.     

Task-shifting in the delivery of hormonal contraceptive methods: validation of a questionnaire and preliminary results

In order to palliate the access problem to effective contraceptive methods in Quebec, Canada, as well as to legitimate nurses' practices in family planning, a collaborative agreement was developed that allow nurses, in conjunction with pharmacists, to give hormonal contraceptives to healthy women of reproductive age for a 6 month period. Training in hormonal contraception was offered to targeted nurses before they could begin this practice. A questionnaire, based on Rogers's theory of diffusion of innovations, was elaborated and validated to specifically evaluate this phenomenon. Preliminary results show that the translation of training into practice might be suboptimal. The validated questionnaire can now be used to fully understand the set of factors influencing this new practice.     

早期家庭干预对早产儿智力发育的影响

目的:探讨早期家庭干预对早产儿智力发育的影响。方法:将240例早产儿随机分为两组:干预组125例和对照组115例。两组患儿均采用常规治疗,在此基础上,对照组仅给予一般的喂养常识和疾病的指导,并进行智能、运动、发育监测;干预组采用早期家庭干预。早期给予触摸(头颅、躯干、四肢等),定时播放轻柔背景音乐、摇铃,床旁悬挂红色气球等刺激,指导在家庭中进行视听、感知觉以及运动方面的综合干预训练。两组分别在3、6、12、18个月应用Gesell婴幼儿发育量表监测其发育商(DQ)。结果:干预组在适应性、大运动、精细运动、语言和社会交往等5个能区与对照组比较,均有显著性差异(P<0.05,P<0.01)。结论:早期家庭干预经济、方便、可行,能明显增进早产儿智能方面的发育。     

导乐式家庭化产科护理模式的应用及效果分析

目的探讨导乐式家庭化产科护理服务模式,提高产科护理质量和效果。方法组建待产、分娩、恢复三位一体的家庭式产房（labor delivery recovery,LDR）,实行导乐式家庭化产科护理模式。结果实行导乐式家庭化产科护理组产妇焦虑评分、新生儿评分及患者满意度明显高于以往普通产科病房护理组。结论导乐式家庭化产科护理模式有利于降低孕产妇焦虑情绪,保障母婴安全和健康,有助于提升产科服务质量,提高产妇及其家属的服各满膏席．     

Chronic Pain,Functional Status,and Life Satisfaction Are Associated With Patients Living With HIV Discussing Advance Care Planning With Their Family or Friends

Context

In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV from a universally fatal disease to a serious chronic illness, warranting discussions between patients and their loved ones about advance care planning (ACP). Evidence is needed on factors associated with patients' likelihood to discuss ACP with loved ones.