Change in Concerns of First-Time Mothers After One Week at Home

Thirty first-time mothers completed a checklist questionnaire ranking their concerns related to self infant, husband, family, and community on the third day postpartum and again, after one week at home with their infants. The results suggest a maternal focus on self and baby Recognition of maternal concern can be used by nurses to develop care law that reflect the patient's priorities. Recognition of a change in concern can also Be used to develop community programs and provide continuity of care.     

Coping With Endometriosis

Endometriosis not only has physical implications for women but also may affect their sexuality, self-image, and hopes for childbearing. This article discusses the role of parish nurses in a community faith-based setting collaborating to provide comprehensive care for women who are diagnosed with endometriosis. Physical, emotional, and spiritual dimensions of care are highlighted. Traditional and complimentary treatments are described. Examples of outcomes for women in the described program are included in case study exemplars.     

Family Centered Intrapartum Care: Revisiting an Old Concept

The historic development of family centered care to the present time is traced, and future development is proposed. A family systems approach can help nurses focus on the family as a unit and on individual members. This requires nurses to develop skills in working with multiple family members, provide care and advocacy for varying and sometimes conflicting family needs, and promote family clarification of their own values and priorities. Such an approach can help intrapartum families add to their experience of coping with stress in a way that builds family cohesion and mutual support.     

A Perinatal Center Based Antepartum Homecare Program

Homecare for the high-risk antepartum client is a rapidly growing specialty of perinatal nursing. In a tertiary care center, a homecare component staffed by specially trained obstetric nurses with fetal monitoring expertise provides for comprehensive home visits. Home visits by nurses enable the client to remain safely in her own environment during the experience of a high-risk pregnancy. Nursing care for this population includes the provision of physical care, home fetal monitoring, education, and support throughout the pregnancy.     

Community Health Nursing Assessment of Neurodevelopment in High-risk Infants

All infants discharged from designated perinatal center neonatal intensive care units in Illinois are referred for follow-up home visits by community health nurses. These visits provide parental support, teaching, and anticipatory guidance plus physical and developmental assessment of the infant. The maternal and child nursing consultants who coordinate this follow-up program are frequently called upon to assist the community health nurses in physical/developmental assessment techniques. The neurodevelopmental component of the assessment, including areas of alertness, tone, head circumference, vision and hearing screening, plus primitive reflexes, is described.     

A Perinatal Continuing Education Program: Its Effects on the Knowledge and Practices of Health Professionals

Objectives: To determine whether there was an increase in knowledge when an interdisciplinary group of health care providers participated in the same comprehensive perinatal continuing education program and to determine whether care practices followed before the program differed from those followed 1 year after its completion.
Design: Administration of a 100-item comprehensive pretest and a similar posttest measuring knowledge before the continuing education program and 1 year after taking it, as well as an ex post facto audit of medical records of newborns who were sick and at risk.
Setting: Hospitals throughout the state of Oklahoma that provide perinatal care. Test data were derived from health care providers in 24 hospitals; data on care practices were obtained from 12 hospitals.
Intervention: A comprehensive program of perinatal continuing education.
Participants: Physicians, nurses, and other providers of perinatal health care.
Main outcome measures: Scores on a 100-item test measuring knowledge of perinatal care and newborn care practices taught in the educational program.
Results: Pretest and posttest scores demonstrated an increase in scores at the p < 0.001 level for each group of providers studied. There was a statistically significant increase in use of two care practices and a definite trend toward an increase in the use of three others.
Conclusion: A continuing education program delivered to a multidisciplinary group of health care providers can increase knowledge and improve perinatal care to newborns who are sick and at risk.     

Use of the Problem-Oriented Medical Record by Nurses Caring for High-Risk Anteparturn Patients

This is a report on how nurses, as part of team, provide antepartal care for high-risk gravidas in a maternity and infant care project. A case history is given to illustrate how the use of a problem-oriented medical record improves communication among team members and, consequently, improves quality of care.     

Screening for the major malignancies affecting women: current guidelines

Throughout their lifetimes, many women rely on the obstetrician-gynecologist to provide them with regular health care. Therefore the obstetrician-gynecologist should be able to provide comprehensive information regarding consensus screening recommendations for the major malignancies that occur in women. Additionally, a woman's health care provider should continually refine his or her cancer risk--assessment skills and should remain apprised of high-risk habits, family histories, and other cancer-predisposing factors that allow identification of those women in whom heightened surveillance or intervention may be appropriate. This article reviews the epidemiologic and risk factors associated with the major malignancies that affect women today and provides screening guidelines.     

Partnerships in Neonatal Care: A Model in Reverse Neonatal Transport

An agreement between a pediatric tertiary-care center and a community hospital provides a model of a program that has facilitated appropriate, cost-effective, high-quality care for high-risk neonates through reverse transport. This agreement has established trust between the professionals at both hospitals, increased communications to ensure continuity of care and psychosocial support for families, and obtained supplemental financia1 resources for families of high-risk neonates.     

Evaluating the Effectiveness of a Perinatal Outreach Education Program

Quality care for high-risk mothers and neonates is achieved only after quality perinatal care on all levels can be realized. In order to attain this goal in southern Illinois, a perinatal outreach education program was designed for health professionals within the region. An evaluation provided documentation of changes in perinatal care at the community hospital level.     

Telemedicine use in neonatal follow-up programs – What can we do and what we can't – Lessons learned from COVID-19

Little empirical data support the use of telemedicine to provide medical and developmental follow-up care to preterm and high-risk infants after hospital discharge. Nevertheless, the COVID-19 pandemic temporarily rendered telemedicine the only means by which to provide essential follow-up care to this population. In this article we discuss our institution's experience with rapid implementation of telemedicine in a multi-site neonatal follow-up program as well as benefits and limitations of the use of telemedicine in this context. Finally, we discuss the current problems that must be solved in order to optimize telemedicine as a tool for providing comprehensive, multidisciplinary medical and developmental care to high risk infants and their families.     

Developmental care for high-risk newborns: emerging science, clinical application, and continuity from newborn intensive care unit to community

Neonatology has optimized medical outcomes for high-risk newborns yet neurodevelopmental outcomes continue to be a concern. Basic science, clinical research, and environmental design perspectives have shown the impact of the caregiving environment on the developing brain and the role of professional caregivers in providing supportive intervention to both infants and their families. This recognition has prompted a focus on early developmentally supportive care (DSC) for high-risk newborns both in the hospital and in community follow up. DSC has emerged as a recognized standard of care in most neonatal intensive care units. Still, many questions remain and much integrative research is needed.     

Flight to Life …

Through the Arizona State Premature Transport Project, all Arizona–born high–risk infants can get the best available intensive care at one of four centers. A radio–telephone dispatch system, helicopter ambulance, and tight teamwork figure in the speedy transport of an infant to a regional center. Community residents, state and county health departments, hospitals, transport companies, insurance agencies, social workers, physicians, and nurses cooperated and coordinated efforts to provide the center services. The program, which has significantly reduced neonatal mortality, hinges on the role of the nurse. Nurses originated the idea for regionalization in Arizona; they precipitated and were involved in the planning. Specially trained nurses transport the patients, provide the intensive monitoring and care, and perform some diagnoses and complicated treatments. The public health nurse reports to the center on the paternal home, supports and guides the parents, and follows the infant after discharge. Part I of this report relates the history, funding, and growth of the program. It includes an overview of admission. and transport operations and of the interrelation of center, referring, and public health personnel which allows total continuous services. Part II focuses on operations at one center, St. Joseph's Hospital in Phoenix. It details the nurse's role and continuing education and the special equipment and procedures in the intensive care nursery, where all surgery and treatments are performed. Also touched on are education progrms for non-center nurses, parent participation, and community involvement.     

Part II: Ground Operations

Through the Arizona State Premature Transport Project, all Arizona–born high–risk infants can get the best available intensive care at one of four centers. A radio–telephone dispatch system, helicopter ambulance, and tight teamwork figure in the speedy transport of an infant to a regional center. Community residents, state and county health departments, hospitals, transport companies, insurance agencies, social workers, physicians, and nurses cooperated and coordinated efforts to provide the center services. The program, which has significantly reduced neonatal mortality, hinges on the role of the nurse. Nurses originated the idea for regionalization in Arizona; they precipitated and were involved in the planning. Specially trained nurses transport the patients, provide the intensive monitoring and care, and perform some diagnoses and complicated treatments. The public health nurse reports to the center on the paternal home, supports and guides the parents, and follows the infant after discharge. Part I of this report relates the history, funding, and growth of the program. It includes an overview of admission. and transport operations and of the interrelation of center, referring, and public health personnel which allows total continuous services. Part II focuses on operations at one center, St. Joseph's Hospital in Phoenix. It details the nurse's role and continuing education and the special equipment and procedures in the intensive care nursery, where all surgery and treatments are performed. Also touched on are education progrms for non-center nurses, parent participation, and community involvement.     

A Perinatal Education Consortium: Improved Resource Utilization

Maternal Newborn Nurse Professionals of Southeastern Michigan is an organization of nurses from more than 30 hospitals. The organization formed a committee to provide a comprehensive, cost-effective educational program for new nurses or nurses who were being cross trained, which would improve resource utilization in the region. Twice a year the organization offers a 5-day educational program covering antepartum, fetal monitoring, intrapartum, postpartum, and neonatal issues. The development, implementation, and evaluation of the program are outlined.     

The frontier nursing service. Family nursing in rural areas

The frontier nursing service (FNS) was established to help meet the health needs of rural areas, using nurse midwives who have been given extra training enabling them to provide health care for the whole family. 6 FNS nursing outposts are located within an hour from Hyden Hospital and Health Clinic in Kentucky. Community participation in the program helped maintain its succcess. By supplying integrated health care, the FNS has decreased stillbirths, maternal and neonatal mortality rates between 1950 and 1970. Thus by utilizing nurses as primary health practitioners, effective health care to rural and indigent populations can be offered at a feasible cost.     

Perinatal Behavioral Health,the COVID-19 Pandemic,and a Social Determinants of Health Framework

The United States has greater prevalence of mental illness and substance use disorders than other developed countries, and pregnant women are disproportionately affected. The current global COVID-19 pandemic, through the exacerbation of psychological distress, unevenly affects the vulnerable population of pregnant women. Social distancing measures and widespread closures of businesses secondary to COVID-19 are likely to continue for the foreseeable future and to further magnify psychosocial risk factors. We propose the use of a social determinants of health framework to integrate behavioral health considerations into prenatal care and to guide the implementation of universal and comprehensive psychosocial assessment in pregnancy. As the most numerous and well-trusted health care professionals, nurses are ideally positioned to influence program and policy decisions at the community and regional levels and to advocate for the full integration of psychosocial screening and behavioral health into prenatal and postpartum care as core components.     

浅谈我国社区护理产后访视工作

目的:社区护理为一门结合护理和公共卫生的实践,以促进和维持群体健康的一个专科护理。产后访视是社区护理工作的重要组成部分,其工作特点有连续性、综合性和协调性等。因为这些工作特点来阐述社区护理产后访视工作做到位还需要多方努力。方法:分析我国社区护理产后访视的现状,提出了如何做好社区护理产后访视的对策及建议。结论:通过提高护士的业务素质和职业道德,达到提高产后护理干预的质量。     

Perinatal outreach education. A continuation strategy for a basic program

The Perinatal Continuing Education Program consists of a nine-month intervention with community hospital nurses, physicians, and support personnel. Components include a hospital self-inventory of resources, coordination by community hospital staff, a skills workshop, and self-instructional books. This article outlines a follow-up strategy to the basic program and describes changes in community hospital knowledge and care practices that occur between programs. The follow-up program presented includes a modified coordinators' workshop, identification of updated self-instructional materials for careful study by past participants, and a self-survey of "recommended routines" intended to facilitate change in hospital policies. Otherwise, except for the deletion of the resources inventory, the follow-up program is similar to the basic program. Testing of participants and detailed review of 1435 hospital charts at sequential time periods revealed a decline in mean knowledge scores between programs, higher scores by new participants before follow-up when compared to pre-basic program, a plateau of patient care quality between programs, and a further improvement in patient care quality after the follow-up program. We conclude that a follow-up program is best accepted after three years but that timing is not critical. Evaluation measures suggest that new knowledge and care practices become institutionalized as a result of this program and that altered care practices are not simply a result of improved performance by individuals.     

Follow-up of At-Risk Infants in the Home Setting: Consultation Model

Infants are discharged from intensive care nurseries with varied risk levels and care needs that require a multilevel resource network. This article describes a consultation model that evolved from the collaborative effort of two regional hospitals with state funding support. A hospital-based clinical nurse specialist provides consultation to community health nurses and other providers of local follow-up services. Individualized mentoring, group educational sessions, and program consultation are adapted to the practice level and resource needs in each urban and rural community.