A Pediatric Nurse Practitioner in the Neonatal Unit

In January 1972 a Pediatric Nurse Practitioner was hired at a metropolitan hospital to do initial physical examinations and daily followup of the staff-care well newborn infants. She was also to provide improved communication between the Pediatric Department and the staff-care mother whether her infant was full-term, sick, or premature. The position was created on a one-year trial basis. It bas now become a permanent job classification, and the PNP has been accepted by patients, physicians, and the nursing staff as a needed member of the neonatal team.     

A Maternity Nurse Practitioner In Public Health Clinics

When a nurse-midwife was employed as a maternity nurse practitioner for four public health clinics in a metropolitan area, "maternity nursing clinics" evolved. Described are resultant refinements in clinic operations, the role of the practitioner, and the integration of her duties with those of other clinic personnel.     

Understanding the Impact of Health Literacy on Women's Health

Low health literacy negatively affects a woman's health knowledge, preventive behavior, ability to navigate the health care system, and ability to care for her children. Interventions to increase a woman's heath literacy include written education materials with proper reading level and design, clear communication, and education to increase health knowledge, self-efficacy, and self-advocacy skills. Health literacy should also be incorporated in nursing education programs.     

A Pilot Study of a Nursing Intervention Protocol to Minimize Maternal-Infant Separation After Cesarean Birth

Objective: To pilot test a standardized intraoperative and postoperative nursing intervention protocol to minimize maternal-infant separation after Cesarean.
Design: Randomized-controlled trial.
Setting: A 250-bed acute care community hospital labor/delivery/recovery/postpartum unit with approximately 150 repeat Cesarean deliveries per year.
Participants: Fifty women having a live, term, singleton, repeat Cesarean delivery and their newborns.
Intervention: A standardized nursing intervention protocol was designed and administered to minimize the amount of maternal-infant spatial, tactile, olfactory, auditory, and visual separation post-Cesarean.
Main Outcome Measures: Maternal outcomes included maternal pain, anxiety, and childbirth perception. Infant outcomes included respiratory rate, temperature, stress (infant salivary cortisol), and breastfeeding rates.
Results: Compared with the control group, the intervention group experienced earlier first physical contact and feedings and a longer interval until the infant first bath. Differences were found between treatment groups for infant temperatures and respiratory rates. Three infants in the control group experienced suboptimal temperatures. Infants in the intervention group had significantly higher salivary cortisol levels but were within the normal upper level range. No differences were noted in maternal pain, maternal anxiety, or perception of birth experience among treatment groups.
Conclusions: The pilot was valuable in examining intervention feasibility, appropriate outcome measures, and data collection strategies. The standardized intervention protocol shows promise for positively affecting maternal-infant outcomes after Cesarean delivery and merits further testing.     

Effect of Previous Adverse Reproductive Health Outcomes on Young Women's Engagement in a Health Coaching Intervention to Improve Contraceptive Continuation

Study ObjectiveNonadherence in sexual risk reduction interventions might be common among adolescents. We compared intervention completion rates among adolescent and young adult women with and without a previous pregnancy or sexually transmitted infection (STI) participating in a program to improve contraceptive continuation.DesignSecondary data analysis from a feasibility study of a health-coaching intervention to improve contraceptive continuation.SettingThree urban pediatric clinics in Philadelphia.ParticipantsWomen ages 14-22 years who were English-speaking, sexually active in the past year, not desiring pregnancy in the next year, and starting a new contraceptive method.InterventionsAt baseline, participants completed a sociodemographic questionnaire and semistructured interview, followed by 5 monthly coaching sessions. Interviews and coaching sessions were audio-recorded, transcribed, and coded for thematic content.Main Outcome MeasuresIntervention completion was defined as the number of completed coaching sessions. Secondary outcomes were qualitatively explored group differences in reproductive knowledge, attitudes, and risk perception.ResultsParticipants with a previous adverse outcome (a previous STI and/or a previous pregnancy) completed fewer coaching sessions than those without such history (median: 2 vs 4; P = .03). Both groups had low HIV/STI knowledge, negative attitudes toward pregnancy, and low HIV/STI risk perception. Those with a previous adverse reproductive outcome held more negative attitudes toward condoms.ConclusionDespite similar reproductive knowledge, attitudes, and risk perception, young women who have experienced an adverse reproductive outcome might be less likely to fully engage in sexual risk reduction interventions. Future studies should confirm these findings and consider strategies to optimize the intervention's reach for vulnerable youth.     

Predicting Nurse Staffing Needs for a Labor and Birth Unit in a Large‐Volume Perinatal Service

This project was designed to test a nurse staffing model for its ability to accurately determine staffing needs for a large‐volume labor and birth unit based on a staffing gap analysis using the nurse staffing guidelines from the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). The staffing model and the AWHONN staffing guidelines were found to be reliable methods to predict staffing needs for a large‐volume labor and birth unit.     

A Continuous Quality Improvement Project to Implement Infant-Driven Feeding as a Standard of Practice in the Newborn/Infant Intensive Care Unit

Objective: To increase the number of neonates who were fed according to cues prior to discharge and potentially decrease length of stay.Design: Continuous quality improvement.Setting: Eighty-five bed level IV neonatal intensive care unit.Patients: Surgical and nonsurgical neonates of all gestational ages. Neonates younger than 32 weeks gestation, who required intubation, continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), or did not have suck or gag reflexes were excluded as potential candidates for infant-driven feeding.Intervention/Measurements: The project was conducted over a 13-month period using the following methods: (a) baseline data collection, (b) designation of Infant Driven Feeding (IDF) Champions, (c) creation of a multidisciplinary team, (d) creation of electronic health record documentation, (e) initial staff education, (f) monthly team meetings, (g) reeducation throughout the duration of the project, and (h) patient-family education.Results: Baseline data were collected on 20 neonates with a mean gestational age of 36 0/7^th weeks and a mean total length of stay (LOS) of 43 days. Postimplementation data were collected on 150 neonates with a mean gestational age of 36 1/7^th weeks and a mean total LOS of 36.4 days. A potential decrease in the mean total LOS of stay by 6.63 days was achieved during this continuous quality improvement (CQI) project.Conclusions: Neonates who are fed according to cues can become successful oral feeders and can be safely discharged home regardless of gestational age or diagnosis.     

Development of the Role of Nurse Health Educator in a Private Ob/Gyn Medical Practice

The experiences of a graduate student in Community Nursing in establishing the role of nurse health educator in a private Ob/Gyn medical office are outlined. The author discusses the objectives, problems, and human interactions with which she worked and presents two brief case studies to illustrate the different manners in which two primiparas experienced the transition to parenthood. Included also is a review of the literature on this role, crises of parenthood, and role transition. Conclusions suggest that the nurse educator in an obstetrical/gynecological practice can teach infant and self care to new mothers, as well us act as a caring person throughout the four trimesters of the childbearing experience and as facilitator for patients in the office, hospital, and home environments.     

Addressing Poverty,Education, and Gender Equality to Improve the Health of Women Worldwide

The Millennium Development Goals (MDG) that target alleviating poverty, improving primary education, and fostering gender equity are important as a foundation to promote world health. Achieving these goals will create an environment for healthy lives for women and children. Poverty, education, and gender equality, although undeniably linked, need to be addressed individually. Nurses have the capacity and political will to address MDGs and to contribute to the health and well‐being of the world population.     

Preoperative Teaching on a Gynecology Unit

The patient undergoing gynecologic surgery may have many questions and concerns. The nurse, whose role includes teaching and counseling, can provide important information to help allay patient fears and answer questions. A preoperative class on a gynecology unit, presented by nurses, is described below. Recommendations are given for problems that may be encountered when implementing such a class.