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.     

Integrative Review of Fathers’ Perspectives on Breastfeeding Support

ObjectiveTo critically review and summarize the results of published articles on fathers’ perspectives regarding breastfeeding support for their partners.Data SourcesWe searched the following databases for articles published between January 2010 and May 2019: CINAHL, MEDLINE, PubMed, Scopus, Web of Science, ThaiJo, and ThaiLis. We included articles published in English and Thai.Study SelectionAfter duplicates were removed, our initial search yielded 3,927 articles. We excluded articles in accordance with pre-established criteria. We performed a quality appraisal of the selected full-text articles and ultimately included 27 in this review.Data ExtractionWe analyzed studies that met inclusion criteria and extracted and organized data related to fathers’ perspectives on breastfeeding support into a structured table.Data SynthesisThe data were synthesized into three themes: Attitude Toward Breastfeeding, Knowledge of Breastfeeding, and Fathers’ Perceptions of the Breastfeeding Support They Provided.ConclusionOur results showed that fathers’ perspectives on breastfeeding support were shaped by their knowledge of breastfeeding and participation in the breastfeeding process. To promote breastfeeding, further research is required to design and implement appropriate interventions to help fathers effectively support their breastfeeding partners.     

Hospital Education in Lactation Practices (Project HELP): Does Clinician Education Affect Breastfeeding Initiation and Exclusivity in the Hospital?

ABSTRACT: Background: A woman’s decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates. Methods: Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4‐hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding‐related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns. Results: Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03–1.69). Conclusions: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates. (BIRTH 36:1 March 2009)     

Fathers’ Thoughts on Breastfeeding and Implications for a Theory‐Based Intervention

ObjectiveTo explore male partner's perceptions of breastfeeding to inform the development of interventions to increase their support of breastfeeding.DesignQualitative grounded theory.SettingParticipants were recruited and interviewed in two Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics located Honolulu, Hawai‘i.ParticipantsFourteen male partners of low‐income pregnant women or new mothers.MethodsMale partner attitudes, knowledge, and feelings were collected through private interviews. Interviews were transcribed verbatim and data were analyzed using grounded theory methods.ResultsAll men appreciated breastfeeding's health benefits, acknowledged that it was natural, and were empathetic to the efforts of their partners. The men also discussed not being involved in the breastfeeding decision, believing formula feeding was more convenient than breastfeeding, feeling left out of the infant‐feeding process, and being uncomfortable with breastfeeding in public.ConclusionsFindings suggest that an intervention to increase male partner support of breastfeeding should include multiple components to enhance knowledge, to empower men to be more engaged in the breastfeeding decision, to provide specific tips on how men can be involved in breastfeeding, and to increase comfort with breastfeeding in public. A multicomponent framework such as the social cognitive theory could be useful in guiding the development of such an intervention.     

Nurses’ Perspectives on the Intersection of Safety and Informed Decision Making in Maternity Care

ObjectiveTo explore maternity nurses’ perceptions of women's informed decision making during labor and birth to better understand how interdisciplinary communication challenges might affect patient safety.DesignConstructivist grounded theory.SettingFour hospitals in the western United States.ParticipantsForty‐six (46) nurses and physicians practicing in maternity units.MethodData collection strategies included individual interviews and participant observation. Data were analyzed using the constant comparative method, dimensional analysis, and situational analysis (Charmaz, 2006; Clarke, 2005; Schatzman, 1991).ResultsThe nurses’ central action of holding off harm encompassed three communication strategies: persuading agreement, managing information, and coaching of mothers and physicians. These strategies were executed in a complex, hierarchical context characterized by varied practice patterns and relationships. Nurses’ priorities and patient safety goals were sometimes misaligned with those of physicians, resulting in potentially unsafe communication.ConclusionsThe communication strategies nurses employed resulted in intended and unintended consequences with safety implications for mothers and providers and had the potential to trap women in the middle of interprofessional conflicts and differences of opinion.     

Positive Effect of Kangaroo Mother Care on Long‐Term Breastfeeding in Very Preterm Infants

ObjectiveTo investigate the use of Kangaroo Mother Care (KMC) and its association with breastfeeding at 1 to 6 months of corrected age in mothers of very preterm (VPT) and preterm (PT) infants.DesignProspective longitudinal study.SettingNeonatal Intensive Care Units in four counties in Sweden.ParticipantsThe study included 103 VPT (<32 gestational weeks) and 197 PT (32‐36 gestational weeks) singleton infants and their mothers.MethodsData on KMC, measured in duration of skin‐to‐skin contact/day during all days admitted to a neonatal unit, were collected using self‐reports from the parents. Data on breastfeeding were obtained by telephone interviews.ResultsVPT dyads that breastfed at 1, 2, 5, and 6 months had spent more time in KMC per day than those not breastfeeding at these times. A trend toward significance was noted at 3 and 4 months. In the PT dyads no statistically significant differences were found in the amount of KMC per day between those dyads that breastfed and those that did not.ConclusionsThis study shows the importance of KMC during hospital stay for breastfeeding duration in VPT dyads. Hence, KMC has empowering effects on the process of breastfeeding, especially in those dyads with the smallest and most vulnerable infants.     

Development of a Neonatal End‐of‐Life Care Education Program for NICU Nurses in Japan

We developed the first end‐of‐life care education program for neonatal intensive care unit (NICU) nurses in Japan. It focused on ethical decision making, care of dying neonates, bereavement, and cultural communication. The program improved nurses’ knowledge, F(2.16, 62.5) = 260.6, p < .001, and understanding, F(2.05, 59.4) = 29.1, p < .001, and significantly reduced weaknesses in neonatal end‐of‐life care. It was considered well designed and may provide further mentoring support for NICU nurses.     

“Sexplorando”: Sexual Practices and Condom Use among an Internet‐Based Sample of Men and Women in Puerto Rico

IntroductionDespite the wealth of literature addressing sexual practices and condom use among men and women, very little data are available among Hispanic/Latino populations and in the Caribbean Region. This study adds to the existing literature on sexual practices and condom use in Puerto Rico (PR) and provides comparisons based on sex given the need for more current information on the sexual characteristics and condom use rates among understudied populations.AimThe aim of this study was to assess the rates of sexual practices and condom use among adults, aged 21–49, in PR.MethodsWe report the prevalence of lifetime and recent (past 3 months) sexual practices by sex, as event‐level condom use rates, and condom familiarity and accessibility in an online‐based sample of adult men and women in PR.Main Outcome MeasuresThe main variables assessed include sociodemographic characteristics, solo and partnered sexual practices, and condom use frequencies, as well as familiarity and accessibility to male and female condoms.ResultsOverall, 93% of the sample reported having been sexually active (engaged in oral, vaginal, and/or anal sex) in their lifetime and 78% reported sexual practices in the past 3 months. As in other studies Hispanic/Latino populations, reported rates of anal intercourse (AI) among both men and women were relatively high. Overall, a greater proportion of men reported condom use during all sexual practices (41% vaginal intercourse (VI); 65% receptive AI; 46% insertive AI) than women (22% VI; 18% AI).ConclusionsThese findings provide current sexual practice and condom use frequency rates that can aid in the understanding of the particular sexual health needs of Hispanic/Latino populations as well as of other groups in the Caribbean. It also serves for the development of future studies and sexual health promotion programs, including comprehensive sexual health care. Rodriguez‐Diaz CE, Collazo E, Dodge B, Roman‐Rivera A, Candelaria‐Rosa E, Colon‐Colon M, and Herbenick D. “Sexplorando”: Sexual practices and condom use among an Internet‐based sample of men and women in Puerto Rico. J Sex Med 2014;11:2385–2395.     

Therapeutic Potential of Adipose‐Derived Stem Cells‐Based Micro‐Tissues in a Rat Model of Postprostatectomy Erectile Dysfunction

IntroductionStem cells (SCs) show significant benefits in the treatment of postprostatectomy erectile dysfunction (ED). However, the low retention rate of the traditional single‐cell strategy at the injection sites limits its therapeutic potential.AimThis study aims to investigate the feasibility and mechanism of adipose‐derived stem cells (ADSCs)‐based micro‐tissues (MTs) in the treatment of ED in a rat model of bilateral cavernous nerves (CNs) injury.MethodsADSCs labeled with 5‐ethynyl‐2‐deoxyuridine (EdU) were used to generate MTs with hanging drop method. 10 Sprague‐Dawley (SD) rats underwent sham surgery and intracavernous (IC) injection of phosphate buffer solution (PBS) (the sham group). Another 70 rats underwent bilateral CN crush and were then treated with PBS (n = 10, the crush group), dissociated ADSCs (n = 30, the ADSCs group), and MTs (n = 30, the MTs group), respectively. At day 1, 3, 7, 14 (n = 5), and 28 (n = 10) postsurgery, specimens were harvested for histology. At day 28, 10 rats in each group were examined for erectile function before tissue harvest.Main Outcome MeasuresLight microscopy of the dynamic aggregation of the MT, immunohistologic examination of the MTs, the retention and distribution of EdU + ADSCs in the corpus cavernosum (CC), and the penis histological analyses of collagen content, Western blot of functional proteins in MTs, intracavernous pressure recording on CN electrostimulation.ResultsThree‐day‐old MTs became stable and expressed nerve growth factor, vascular endothelial growth factor, C‐X‐C chemokine receptor type 4, Wnt5a, and collagen IV. More EdU + ADSCs retained in the CC in the MTs group than that in the ADSCs group. IC injection of MTs resulted in significant restoration of the erectile function and histopathological changes compared with the ADSCs group.ConclusionIC‐injected MTs resulted in a better restoration of erectile function than traditional single‐cell strategy. The underlying mechanisms of recovery appear to involve enhanced cellular retention in the penis and upregulation of some paracrine factors. Xu Y, Guan R, Lei H, Li H, Wang L, Gao Z, Song W, and Xin Z. Therapeutic potential of adipose‐derived stem cells‐based micro‐tissues in a rat model of postprostatectomy erectile dysfunction. J Sex Med 2014;11:2439–2448.     

A Pilot Randomized Controlled Trial of a Breastfeeding Self‐Efficacy Intervention With Primiparous Mothers

ObjectivesTo pilot test a newly developed breastfeeding self‐efficacy interventionDesignPilot randomized controlled trial (RCT).SettingAn acute care hospital located in Northwestern Ontario that is the sole provider of maternity care for the city and referral center for the regionParticipantsOne‐hundred‐and‐fifty primiparous women intending to breastfeed their healthy, term, singleton infantInterventionA standardized, individualized nursing intervention protocol was designed and administered to increase mothers' breastfeeding self‐efficacy. Participants were randomly allocated to the intervention group or control group using sealed, opaque envelopes. Participants in the intervention group received three individualized, self‐efficacy enhancing sessions with the researcher: two in‐hospital and one by telephone. Participants in the control group received standard in‐hospital and community careMain Outcome MeasuresFeasibility, compliance, and the acceptability of the breastfeeding self‐efficacy intervention. Other outcomes assessed were breastfeeding self‐efficacy, duration, and exclusivityResultsFindings suggest that the intervention was feasible; there was a high degree of protocol compliance, and the majority of mothers reported that the intervention was beneficial. Mothers in the intervention group had higher rates of breastfeeding self‐efficacy, duration, and exclusivity at 4 and 8 weeks postpartum. However, the differences between groups were not statistically significantConclusionThe pilot RCT provided valuable information in examining the feasibility of the trial design and intervention