Barbara Hansen Cottrell

Vaginal Douching Among University Women in the Southeastern United States

Objective: The authors assessed the knowledge, beliefs about, and practices of vaginal douching among women attending 2 universities in the southeastern United States. Participants: There were 416 participants in this study; 46.9% were black and 44.5% were white. Methods: The authors administered a 30-item questionnaire to women enrolled in health-related and social science courses at 2 southeastern universities. Results: Approximately 38% of participants reported vaginal douching, mostly for hygienic reasons (70.7%). Most women first learned about douching from their mother. Douching was more common and more frequent among black women (48%) than among white women (27%). Age of first douche correlated positively with age of first sexual intercourse and age of first period. Conclusion: Women who had been informed not to douche by a healthcare professional were less likely to have douched within the past 6 months than were women who were not given this information. Misconceptions about douching are common and should be addressed by healthcare professionals.

Effect of the Birth Chair on Duration of Second Stage Labor, Fetal Outcome, and Maternal Blood Loss

The effect of delivering in a birth chair on duration of second stage labor, fetal outcome, and maternal blood loss was examined in a retrospective study. The sample consisted of 60 primiparous women, 37 to 41 weeks gestation with a normal pregnancy and labor, 30 delivering on a traditional delivery table and 30 delivering in a birth chair. Comparisons were made between groups for mean duration of second stage labor, mean Apgar scores at one and five minutes, and mean maternal hemoglobin and hematocrit values during the pre- and postpartum periods. No significant difference was found between delivery table and birth chair groups for mean duration of second stage labor (birth chair, X = 60 minutes versus delivery table, X = 43 minutes, t = 1.66, p = .10). Mean Apgar scores at one and five minutes were nearly identical. Statistically significant differences existed between groups in mean maternal hemoglobin and hematocrit values. Both the mean hemoglobin and the mean hematocrit upon admission were significantly higher in the birth chair group (p < .027). However, postpartally the birth chair group had significantly lower mean hemoglobin and hematocrit values (p < .025). These findings suggest that the birth chair, as an alternate delivery method, is safe in terms of fetal outcome but presents no advantage to the mother in terms of shorter second stage labor. Further investigation of maternal blood loss is recommended to rule out possible untoward effects.

A clinical evaluation tool for nursing students based on the nursing process.

An integrated curriculum was implemented in an upper division baccalaureate nursing program which required letter grades for clinical courses. The second semester clinical course involved student evaluation in four different settings. The original evaluation tool lacked both the discrimination needed for letter grades and the competencies common to all the settings. A computerized evaluation tool was developed to identify behaviors which could be evaluated and assigned a letter grade in all four clinical settings, and to provide formative and summative evaluation of performance for students throughout the semester. The tool focuses on the four areas of the nursing process, each of which is weighted according to the conceptual framework of the curriculum and the ability of a student at this level. In each of these four areas, entry level behaviors were identified and then built upon by progression from fundamental skills to more complex and independent behaviors. Students are rated on a criterion-referenced rating scale. A statistician verified that the tool was mathematically sound. Once developed, the tool was placed on computer where both students and faculty evaluate student clinical performance every two to four weeks. Because the tool was placed on computer, students receive immediate feedback, which facilitates formative evaluations. Trends in student performance can be identified easily, and faculty paperwork is decreased. The tool also promotes objectivity in evaluation and student awareness of expected behaviors. Finally, faculty and students have become more familiar and more comfortable with computers.

Rectal or axillary temperature measurement: effect on plasma bilirubin and intestinal transit of meconium.

Physiologic jaundice (5-6 mg/100 ml plasma bilirubin) is common and considered normal in newborn infants during the first week postbirth, but is considered abnormal in older infants. Early meconium passage correlates with lower plasma bilirubin concentrations. Rectal stimulation during rectal temperature measurement may aid passage of meconium containing potentially toxic, absorbable bilirubin. In this study, 100 clinically normal infants were assigned randomly to groups for rectal or axillary temperature measurement. The time of first meconium passage, time of first all-yellow stool, and total plasma bilirubin were compared between groups. Bilirubin was measured during metabolic screening at 48-80 h postbirth (mean 69 h in both groups). By this time 30 infants in the rectal group, but only 17 in the axillary group, had passed yellow stools (p = 0.011). The rectal group had lower mean (+/- 1 SD) bilirubin (5.5 mg/100 ml +/- 2.7 vs. 6.5 +/- 3.0, p = 0.042), and a trend toward earlier first meconium (5.9 h +/- 5.0 vs. 7.3 +/- 5.9, p = 0.096). For clinically normal infants in the first 48-80 h postbirth, these data suggest that rectal stimulation accompanying rectal temperature measurement enhances intestinal bilirubin excretion because of more rapid meconium passage.

The Effects of Birth Chair Delivery on Maternal Perceptions

A prospective quasi-experimental study was conducted to determine womens perceptions of their childbirth experiences using a birth chair. The sample consisted of 55 primiparas, from 37 to 41 gestational weeks, with normal pregnancy and labor; 22 women delivered on a traditional delivery table (DT), and 33 women used a birth chair (BC). A questionnaire consisting of 21 items on a five-point scale (the higher the score, the more positive the perception) was self-administered by subjects during postpartum hospitalization. No significant differences were found between groups on overall score. However, women using the birth chair had a significantly higher score on the comfort subscale, as did women who had attended prepared childbirth classes.

A Review of Opioid-Induced Itching after Cesarean Birth

Currently, about one-third of all women giving birth have a cesarean surgical birth, and the majority are given an epidural or spinal anesthetic containing an opioid for surgery. An unpleasant side effect experienced by many of these women is itching. This article reviews the literature on itching after spinal and epidural administration of opioids and how nurses can best manage this side effect.

Home care concerns for the normal newborn

Four of the most common problems encountered with newborns in the home include feeding difficulties, jaundice, gastrointestinal problems, and inconsolable crying. This article suggests assessment measures and intervention strategies to deal with these problems and evaluate the home environment for safety. This article also includes suggestions to promote safe infant feeding, bathing, sleeping arrangements, car safety seats, firearm and poison storage, fall prevention, concerns about pets, pest control, heating and cooling, and a nonsmoking environment.

The Influence of Skin‐to‐Skin Contact after Cesarean on Breastfeeding Rates, Infant Feeding Responses, and Maternal Satisfaction

Paper Presentation Objective To determine whether the initiation of skin‐to‐skin contact (SSC) between mothers and newborns in the operating room and thereafter would enhance infant feeding responses, decrease the time of breastfeeding initiation, increase the rates of breastfeeding duration and exclusivity, and promote maternal satisfaction with the cesarean birth process and breastfeeding practices. Design Quasi‐experimental design with convenience sampling and a mixed‐methods approach. Setting This study was implemented at the Womens Pavilion of the participating hospital, which is a private, not‐for‐profit community health care center. Sample The experimental group ( n = 25) was given SSC immediately after cesarean on the operating table and during recovery. The comparison group ( n = 16) was given routine standard care with/without delayed SSC in the recovery room. The experimental group was recruited during the preop admission period by registered nurses, whereas the comparison group was recruited during their 6‐week postpartum checkups from a large physicians’ office in Tallahassee. The same inclusion and exclusion criteria were used for both groups. Methods The outcomes measured included breastfeeding initiation, duration, and exclusivity, infant feeding responses, and maternal satisfaction. During the delivery and recovery periods, a project data sheet was completed on the experimental group and included data on breastfeeding initiation and length of time, latch quality, and infant feeding cues. Maternal satisfaction and overall breastfeeding duration and exclusivity were measured by phone survey at 4 to ‐12 weeks postpartum. Participants in the comparison group were provided with the same postpartum survey as the experimental group and were asked about SSC after cesarean and breastfeeding outcomes (e.g., initiation, duration, and exclusivity). Results The participants who experienced immediate SSC had significantly earlier breastfeeding initiation, significantly longer durations of overall breastfeeding, and significantly greater rates of exclusive breastfeeding than participants in the comparison group. The qualitative analysis of maternal satisfaction was multifactorial and influenced by several perioperative and postpartum factors. Conclusion/Implications for Nursing Practice The findings suggest that SSC after cesarean may decrease breastfeeding initiation time, increase the rates of breastfeeding duration and exclusivity, enhance infant feeding responses, and further promote maternal satisfaction. The incorporation of SSC immediately after birth is considered beneficial for all newborns and mothers and should be implemented in all hospital environments.

clinical studiesThe Effects of Birth Chair Delivery on Maternal Perceptions

A prospective quasi-experimental study was conducted to determine womens perceptions of their childbirth experiences using a birth chair. The sample consisted of 55 primiparas, from 37 to 41 gestational weeks, with normal pregnancy and labor; 22 women delivered on a traditional delivery table (DT), and 33 women used a birth chair (BC). A questionnaire consisting of 21 items on a five-point scale (the higher the score, the more positive the perception) was self-administered by subjects during postpartum hospitalization. No significant differences were found between groups on overall score. However, women using the birth chair had a significantly higher score on the comfort subscale, as did women who had attended prepared childbirth classes.