Elaine Williams Domian

A Randomized Controlled Trial of Breastfeeding Support and Education for Adolescent Mothers

Despite substantial evidence of maternal and infant benefits of breastfeeding, adolescent mothers initiate breastfeeding less often and maintain breastfeeding for shorter durations when compared to their adult counterparts. A randomized controlled trial drawing on the theory of planned behavior and developmental theory was conducted to determine if an education and counseling intervention provided by a lactation consultant—peer counselor team increased breastfeeding initiation and duration up to 6 months postpartum among adolescent mothers. Study participants ( N = 289) enrolled from multiple prenatal clinic and school settings, were 15 to 18 years old, and predominately African American, single, and primiparous. The intervention, which started in the second trimester of pregnancy and extended through 4 weeks postpartum, positively influenced breastfeeding duration (p < .001) within the experimental group, but not breastfeeding initiation or exclusive breastfeeding rates. This education/support intervention was partially effective in enhancing breastfeeding outcomes. Implications for research and practice are described.

Communication Themes in Families of Children with Chronic Conditions

This qualitative study identified communication themes among well siblings, parents, and others within families of children with chronic conditions. Semi-structured interviews of 30 parent–well sibling dyads were content analyzed from a larger study of families of children with chronic conditions. Four themes emerged: communication as a reflection of family roles and relationships, giving voice, staying connected, and struggling for normalcy.

Exclusive Breastfeeding Experiences among Mexican American Women

Background: According to the Centers for Disease Control and Prevention, Hispanic breastfeeding mothers begin early formula supplementation at higher rates than other ethnic groups, which can lead to shorter breastfeeding duration and decreased exclusive breastfeeding. Acculturation, the process of adopting beliefs and behaviors of another culture, appears to influence breastfeeding practices of Hispanic women in the United States. Little is known about Mexican American mothers’ formula use and exclusive breastfeeding within the context of acculturation. Objective: Our study identified perceived benefits and barriers to exclusive breastfeeding and levels of acculturation among Mexican American women living in a Midwestern city. Methods: We used a qualitative descriptive design integrating Pender’s Health Promotion Model concepts. Individual interviews were conducted in English or Spanish (N = 21). The revised Acculturation Rating Scale for Mexican Americans was used to examine acculturation levels. Results: Acculturation scores indicated that the majority (66%) of the sample was “very Mexican oriented.” Most women exclusively breastfed, with a few using early supplementation for “insufficient milk production.” Three themes emerged: (1) It is natural that a woman give life and also provide the best food for her baby; (2) Breastfeeding is ultimately a woman’s decision but is influenced by tradition, guidance, and encouragement; and (3) Breast milk is superior but life circumstances can challenge one’s ability to breastfeed. Conclusion: Strong familial/cultural traditions supported and normalized breastfeeding. Barriers to exclusive breastfeeding were similar to breastfeeding women in general, in the United States. Findings support the need for culturally competent and individualized lactation care.

Creating a Bridge of Understanding between Two Worlds: Community-Based Collaborative-Action Research with Sudanese Refugee Women.

OBJECTIVE To explore the process of partnership between university researchers, students, and South Sudanese refugee women to address the health challenges associated with their resettlement transition to the United States. DESIGN AND SAMPLE This qualitative study used a community-based collaborative action research (CBCAR) framework in the design, collection, and analysis of the qualitative data. Twenty refugee women participated in this study. INTERVENTION Five health education seminars followed by an audio-recorded focus group were held over 9 months. A final focus group was held to confirm derived themes and develop an action plan. RESULTS The partnership between the refugee women and researchers resulted in awareness of how power structures and differing expectations affected the process. The dialog in the focus groups provided an opportunity for refugee women to voice challenges to their health in resettlement. A pattern was recognized about how political and sociocultural events affected the process of CBCAR. Dialog and sharing differing worldviews and perspectives led to insights about ways to improve the health of the South Sudanese refugee community. CONCLUSIONS CBCAR is a useful framework to address health concerns of a refugee community. Insights from this study provided a foundation for a future intervention research project with the refugee women.

Infected Lives Lived Experiences of Young African American HIV-Positive Women

This hermeneutic phenomenological study explored the lived experiences of young African American HIV-infected women. Eleven women between the ages of 21 and 35 participated. One pattern, Infected Lives, and three themes—Living Alone With HIV, Living With Unresolved Conflicts, and Living With Multiple Layers of Betrayal—emerged. The pattern and themes portray the very complex and challenging experiences faced by these young women living with HIV infection. They have experienced isolation, abandonment, betrayal, and discrimination in their interpersonal and social systems. They often dealt with conflicts of hope and anguish in the relationships with their children, and portraying strength, while feeling fragile. These complexities negatively influence the ability to fully engage in self-care activities. Implications for future research include further investigation about the experiences of psychological distress experienced post-diagnosis, development and evaluation of holistic nursing interventions, and evaluative research on mass media educational campaigns to reduce HIV-related stigma.

A phenomenological study of nurses' experience of grief following patient death.

Registered nurses have long provided end-of-life care and support to patients and their families. As the baby boomer generation continues to age, nurses will be exposed to an increasing number of patient deaths. Understanding the grief experienced by nurses will facilitate effective support and coping mechanisms within the work environment. Although nursing leaders recognize that nurses experience grief when their patients die, there is little research about the experiences of nurses following the death of a patient. Nurses’ training about the grief process is minimal and generally related to supportive interventions for patients and families. Education pertaining to the grief nurses may experience in caring for dying patients and their families is rare in nursing curricula. This qualitative study uses phenomenology to investigate the lived experience of nurses’ grief resulting from the death of patients in their care. The participants for this study consist of 11 nurses recruited through purposive sampling. Nurses who have experienced the death of a patient were eligible to participate in the study. The investigators use semistructured interviews to learn about the feelings, beliefs, and emotions that nurses experience during the grief process and the coping mechanisms enacted by nurses during and after their care of the patient. Data are analyzed using methods of Heideggerian hermeneutical analysis and van Western Journal of Nursing Research 31(8) 1078 –1079