Christopher S. Lee

The Effect of Childbirth Self-Efficacy on Perinatal Outcomes

OBJECTIVEnTo synthesize and critique the quantitative literature on measuring childbirth self-efficacy and the effect of childbirth self-efficacy on perinatal outcomes.nnnDATA SOURCESnEligible studies were identified through searches of MEDLINE, CINAHL, Scopus, and Google Scholar databases.nnnSTUDY SELECTIONnPublished research articles that used a tool explicitly intended to measure childbirth self-efficacy and that examined outcomes within the perinatal period were included. All articles were in English and were published in peer-reviewed journals.nnnDATA EXTRACTIONnFirst author, country, year of publication, reference and definition of childbirth self-efficacy, measurement of childbirth self-efficacy, sample recruitment and retention, sample characteristics, study design, interventions (with experimental and quasiexperimental studies), and perinatal outcomes were extracted and summarized.nnnDATA SYNTHESISnOf 619 publications, 23 studies published between 1983 and 2015 met inclusion criteria and were critiqued and synthesized in this review.nnnCONCLUSIONnThere is overall consistency in how childbirth self-efficacy is defined and measured among studies, which facilitates comparison and synthesis. Our findings suggest that increased childbirth self-efficacy is associated with a wide variety of improved perinatal outcomes. Moreover, there is evidence that childbirth self-efficacy is a psychosocial factor that can be modified through various efficacy-enhancing interventions. Future researchers will be able to build knowledge in this area through (a) use of experimental and quasiexperimental design, (b) recruitment and retention of more diverse samples, (c) explicit reporting of definitions of terms (e.g., high risk), (d) investigation of interventions that increase childbirth self-efficacy during pregnancy, and (e) investigation about how childbirth self-efficacy-enhancing interventions might lead to decreased active labor pain and suffering. Exploratory research should continue to examine the potential association between higher prenatal childbirth self-efficacy and improved early parenting outcomes.

The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission

INTRODUCTIONnGroup prenatal care, an alternate model of prenatal care delivery, has been associated with various improved perinatal outcomes in comparison to standard, individual prenatal care. One important maternity care process measure that has not been explored among women who receive group prenatal care versus standard prenatal care is the phase of labor (latent vs active) at hospital admission.nnnMETHODSnA retrospective case-control study was conducted comparing 150 women who selected group prenatal care with certified nurse-midwives (CNMs) versus 225 women who chose standard prenatal care with CNMs. Analyses performed included descriptive statistics to compare groups and multivariate regression to evaluate the contribution of key covariates potentially influencing outcomes. Propensity scores were calculated and included in regression models.nnnRESULTSnWomen within this sample who received group prenatal care were more likely to be in active labor (≥ 4 cm of cervical dilatation) at hospital admission (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.03-2.99; P = .049) and were admitted to the hospital with significantly greater cervical dilatation (mean [standard deviation, SD] 5.7 [2.5] cm vs. 5.1 [2.3] cm, P = .005) compared with women who received standard prenatal care, controlling for potential confounding variables and propensity for group versus individual care selection.nnnDISCUSSIONnGroup prenatal care may be an effective and safe intervention for decreasing latent labor hospital admission among low-risk women. Neither group prenatal care nor active labor hospital admission was associated with increased morbidity.

Role of Prophylactic Oxytocin in the Third Stage of Labor: Physiologic Versus Pharmacologically Influenced Labor and Birth

Introduction: Maternity care providers administer oxytocin prophylactically to prevent postpartum hemorrhage (PPH). Prophylactic oxytocin is generally considered effective and safe and is promoted by national organizations for standardized use. In this article, the evidence supporting prophylactic oxytocin administration for women undergoing spontaneous labor and birth compared with women whose labors included administration of exogenous oxytocin for induction or augmentation is explored. Methods: Using data from randomized controlled trials included in 2 recent Cochrane meta‐analyses papers, only studies with women in spontaneous labor were selected for inclusion (N = 4 studies). Outcomes of immediate postpartum bleeding volumes (≥ 500 mL or 1000 mL), risk for blood transfusion, and risk for administration of more uterotonic medication were pooled from these 4 studies. Focused random effects meta‐analytics were used. Results: Compared to women without prophylactic oxytocin, women who received prophylactic oxytocin had a lower risk of having a 500 mL or higher blood loss. However, prophylactic oxytocin did not lower risk of PPH (≥ 1000 mL), blood transfusion, or need for additional uterotonic treatment. Discussion: Prophylactic oxytocin may not confer the same benefits to women undergoing spontaneous labor and birth compared to women laboring with oxytocin infusion. Reasons for this difference are explored from a pharmacologic perspective. In addition, the value of prophylactic oxytocin given recent changes in the definition of PPH from greater than or equal to 500 mL to 1000 mL or more after birth is discussed. Finally, gaps in research on adverse effects of prophylactic oxytocin are presented. More research is needed on reducing risk of PPH for women in spontaneous labor.

Care Values in Dementia: Patterns of Perception and Incongruence Among Family Care Dyads

BACKGROUND AND OBJECTIVESnPersons with dementia (PWDs) often place greater importance on their care values (i.e., maintaining autonomy and social relations, choosing caregivers, avoiding being a burden) than family caregivers (CGs) perceive, which can detract from dementia care planning (e.g., care arrangements or surrogate decisions). Notable variability has been found across family care dyads (PWD and CG) in their perceptions of care values, suggesting that there may be multiple patterns of perception. The purpose of this study was to characterize distinct patterns of perception of care values in family care dyads.nnnDESIGN AND METHODSnUsing cross-sectional data from 228 community-dwelling family care dyads, we quantified dyads average perceptions and incongruence in perceptions of the importance of everyday care values using multilevel modeling. These scores were then used in a latent class analysis to identify distinct patterns of perception, with the dyad as the unit of analysis.nnnRESULTSnTwo distinct patterns of care value perception were identified. 25% of dyads were labeled as CG underestimating due to lower average estimations of the importance of PWDs care values, and a significant amount of dyadic incongruence. Underestimating dyads were characterized by a confirmed diagnosis of dementia, lower cognitive function, and younger age in PWDs, and higher relationship strain in the dyad.nnnIMPLICATIONSnCare dyads that fall into an underestimating pattern may be at greater risk for inadequate dementia care planning. Interventions to improve care planning in this higher-risk group may include care values identification with the PWD, strategies for alleviating relationship strain, early-stage planning, and disease education.

Effects of Connective Tissue Massage on Pain in Primiparous Women After Cesarean Birth

Objective To evaluate the efficacy of connective tissue massage to reduce postoperative pain in primiparous women on Postoperative Day 1 after unplanned cesarean birth. Design A randomized controlled trial with three groups: intervention (Group 1), control or standard care (Group 2), and individualized attention (Group 3). Setting Family/newborn units of a large teaching hospital in the Northeastern United States. Participants A total of 165 women who experienced unplanned cesarean births of singleton newborns at term gestation. Methods Participants were randomized to three groups: those in Group 1 received a 20‐minute massage, those in Group 2 received the usual standard of care, and those in Group 3 received 20 minutes of individualized attention. On Postoperative Day 1, participants completed questionnaires to measure overall pain, stress, and relaxation at Time 1 and again 60 minutes later. Daily numeric pain ratings and medication consumption data were retrieved from the electronic health care records. Latent growth modeling and analysis of variance were used to analyze data, as appropriate. Results Participants in Group 1 had increased relaxation (p < .001), decreased pain (p < .001), decreased stress (p < .001), and decreased opioid use on Day 1 (p = .031) and Day 2 (p = .006) of the hospital stay after the intervention compared with the other groups. Additionally, opioid use in Group 1 decreased linearly, whereas the control groups had a nonlinear pattern of change. Conclusion Using massage therapy during postoperative hospitalization improved relaxation and decreased pain, stress, and opioid use in this sample of women after unplanned cesarean births.

Factors Influencing Nurses’ Willingness To Lead

AIMnTo identify factors influencing nurses willingness to lead.nnnBACKGROUNDnGiven the ageing workforce and the projected retirement of nurse leaders, there is a concern about nursing leadership shortages in the next decade. Several studies have shown that nurses are not interested in pursuing leadership positions, but studies investigating nurses willingness to lead and related predictors remain limited.nnnMETHODSnA workforce survey of 1,201 direct-care nurses was conducted in Oregon. Logistic regression modelling was used to identify factors influencing the likelihood of nurses willingness to lead.nnnRESULTSnFifty-three percent of nurses were willing to pursue leadership roles. Years of experience, job burnout, the perception of the work environment, adequacy of leadership preparation, and the amount of salary and compensation were significant predictors of nurses willingness to lead.nnnCONCLUSIONnIncreasing nurses participation in hospital affairs and providing adequate leadership preparation, parts of the work environment, prior to engaging them in leadership roles is recommended to improve their attitudes about leading.nnnIMPLICATIONS FOR NURSING MANAGEMENTnRecruitment of future nursing leaders should not be based solely on demographics such as age and gender. Rather, recruiters should focus on creating more favourable work environments in which to lead.

Exploring the relationship between β-adrenergic receptor kinase-1 and physical symptoms in heart failure

Background: The relationship between physical heart failure (HF) symptoms and pathophysiological mechanisms is unclear. Objective: To quantify the relationship between plasma &bgr;‐adrenergic receptor kinase‐1 (&bgr;ARK1) and physical symptoms among adults with HF. Methods: We performed a secondary analysis of data collected from two studies of adults with HF. Plasma &bgr;ARK1 was quantified using an enzyme‐linked immunosorbent assay. Physical symptoms were measured with the HF Somatic Perception Scale (HFSPS). Generalized linear modeling was used to quantify the relationship between &bgr;ARK1 and HFSPS scores. Results: The average age (n = 94) was 54.5 ± 13.1 years, 76.6% were male, and a majority (83.0%) had Class III or IV HF. &bgr;ARK1 was significantly associated with HFSPS scores (&bgr; = 0.22 ± 0.10, p = 0.038), adjusting for other predictors of physical symptoms (model R2 = 0.250, F(7, 70) = 3.34, p = 0.004). Conclusions: Higher &bgr;ARK1 is associated with worse physical HF symptoms, pinpointing a potential pathophysiologic underpinning.

Nursing research in heart failure care: A position statement of the american association of heart failure nurses (AAHFN)

Background Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States. Objectives A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes. Methods A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF. Results Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science. Conclusions Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research.

Physiologic childbirth and active management of the third stage of labor: A latent class model of risk for postpartum hemorrhage

BACKGROUNDnPostpartum hemorrhage (PPH) is a threat to maternal mortality worldwide. Evidence supports active management of third stage labor (AMTSL) for preventing PPH. However, trials of AMTSL include women at varying risk levels, such as women undergoing physiologic labor and those with labor complications. Counseling women about their risk for PPH and AMTSL is difficult as many women who appear low-risk can still have PPH.nnnMETHODSnThis study uses outcomes of 2322 vaginal births from a hospital midwifery service in the United States to examine risks for PPH and effectiveness of AMTSL. Using a latent class analysis approach, physiologic birth practices and other risk factors for PPH were analyzed to understand if discrete classes of clinical characteristics would emerge. The effect of AMTSL on the PPH outcome was also considered by class.nnnRESULTSnA four-class solution best fit the data; each class was clinically distinct. The two largest Classes (A and B) represented women with term births and lower average parity, with higher rates of nulliparity in Class B. Class A women had more physiologic birth elements and less labor induction or labor dysfunction compared with Class B. PPH and AMTSL use was higher in Class B. In Class B, AMTSL lowered risk for PPH. However, in Class A, AMTSL was associated with higher risk for PPH and delayed placental delivery (>30xa0minutes).nnnDISCUSSIONnAMTSL may not be as beneficial to women undergoing physiologic birth. Further study of the etiology of PPH in these women is indicated to inform preventive care.

Government continues to have an important role in promoting cardiovascular health

Government investment has facilitated remarkable advances in cardiovascular science and medicine. It is vitally important that government engagement and investment continue as the US population faces unprecedented rates of obesity, diabetes, hypertension, sedentary behavior, and poor diet. Importantly, health disparities are increasing by geography, race/ethnicity, and income. These poor health metrics threaten to erode the tremendous gains in life expectancy achieved in recent decades. Government investment in population health, research, clinical outcomes, and access to care is critically important.We examine how government investment in research has promoted ideal cardiovascular health and can now promote the development of new and effective approaches to both cardiovascular health and better disease management for all. This paper responds to the commonly raised concerns of paternalism regarding government intervention and outlines the potential benefits and risks to society of government-industry partnerships and industry initiatives that may supplement government efforts in improving cardiovascular health. Cardiovascular disease (CVD) remains the number 1 killer of Americanmen andwomen.With the aging of the population, the prevalence and cost of care associated with CVD conditions like heart failure and stroke will increase markedly over the next several decades. By the year 2035, nearly half of the US population is projected to have CVD, generating