Elizabeth T. Jordan

Text4baby: Development and Implementation of a National Text Messaging Health Information Service

Text4baby is the first free national health text messaging service in the United States that aims to provide timely information to pregnant women and new mothers to help them improve their health and the health of their babies. Here we describe the development of the text messages and the large public-private partnership that led to the national launch of the service in 2010. Promotion at the local, state, and national levels produced rapid uptake across the United States. More than 320,000 people enrolled with text4baby between February 2010 and March 2012. Further evaluations of the effectiveness of the service are ongoing; however, important lessons can be learned from its development and uptake.

Text4Baby: Using Text Messaging to Improve Maternal and Newborn Health

North America adopt new technologies and methods of communication, pregnant women and new mothers are no different. Text4baby, a free mobile information service of the National Healthy Mothers Healthy Babies Coalition, provides timely health information to women from early pregnancy throughout their baby’s fi rst year. The service sends important educational messages that are timed to the mother’s stage of pregnancy or to the baby’s age. <<

A Review of Factors Associated with Unprotected Sex among Adult Women in the United States

OBJECTIVE To provide an updated review of research since 2005 on factors associated with unprotected sex among women in the United States. DATA SOURCES PubMed, CINAHL, and PsychINFO were searched from January 2006 through April 2011 using the terms unsafe sex, sexual risk taking, contraception, contraception behavior, birth control, condoms, and condom utilization. STUDY SELECTION Inclusion criteria included studies written in English on adult women in the United States age ≥ 18. Forty-five publications met inclusion criteria. DATA EXTRACTION All factors associated with engagement in unprotected sex are presented. DATA SYNTHESIS Unprotected sex has been associated with increasing age, being married, establishment of trust, recent experience of intimate partner violence, contraceptive side effects, infrequent sexual intercourse, and decreased arousal and pleasure due to contraceptive use. Religion, depression, history of abortion, number of children, having children, and number of pregnancies have not been associated with unprotected sex in recent studies. Several other variables have been studied with mixed results, possibly due to differences in research methods and sample characteristics. CONCLUSIONS More research is needed to elucidate the impact of cultural factors, relationship factors, attitude to pregnancy and motherhood, and reproductive coercion on prevention of pregnancy and sexually transmitted infections. Nurses can lead research on these topics and implement evidence-based practice based on study findings.

A Critical Pathway for Intimate Partner Violence Across the Continuum of Care

Objective: The authors developed an interdisciplinary critical pathway for intimate partner violence (IPV) assessment and intervention for use across health care settings. Intimate partner violence may be emotional, physical, and/or sexual and involves coercion and control by one partner over the other. Design: A pathway developed with input from focus groups of battered women was subjected to a modified Delphi technique to improve the pathways scientific accuracy and feasibility. Setting: The study was conducted in one urban, one suburban, and one rural hospital with IPV advocacy programs in the mid-Atlantic region of the United States. Patients/Participants: Four researchers and 13 clinicians participated in the validation, with at least one physician, one nurse, and one social worker or IPV counselor from each hospital. Main Outcome Measures: Each element of the pathway was analyzed for the degree of consensus on scientific accuracy and feasibility. Results: Consensus on the scientific accuracy and feasibility of the pathway was achieved after three rounds of the Delphi process. Conclusions: This is the first known critical pathway for IPV. It addresses physical and mental health and safety and has content validity affirmed by an interdisciplinary panel of experts. Further process and outcome evaluation is warranted and invited.OBJECTIVE The authors developed an interdisciplinary critical pathway for intimate partner violence (IPV) assessment and intervention for use across health care settings. Intimate partner violence may be emotional, physical, and/or sexual and involves coercion and control by one partner over the other. DESIGN A pathway developed with input from focus groups of battered women was subjected to a modified Delphi technique to improve the pathways scientific accuracy and feasibility. SETTING The study was conducted in one urban, one suburban, and one rural hospital with IPV advocacy programs in the mid-Atlantic region of the United States. PATIENTS/PARTICIPANTS Four researchers and 13 clinicians participated in the validation, with at least one physician, one nurse, and one social worker or IPV counselor from each hospital. MAIN OUTCOME MEASURES Each element of the pathway was analyzed for the degree of consensus on scientific accuracy and feasibility. RESULTS Consensus on the scientific accuracy and feasibility of the pathway was achieved after three rounds of the Delphi process. CONCLUSIONS This is the first known critical pathway for IPV. It addresses physical and mental health and safety and has content validity affirmed by an interdisciplinary panel of experts. Further process and outcome evaluation is warranted and invited.

Encouraging Influenza Vaccination Among Text4baby Pregnant Women and Mothers

INTRODUCTION Pregnant women, postpartum women, and infants are at high risk for complications from influenza. From October to November 2012, Text4baby, a free national text service for pregnant women and mothers of infants aged <1 year, implemented a module of interactive messages encouraging maternal influenza vaccination. A program evaluation examined whether a text-based reminder or tailored education improved self-reported influenza vaccination or intent to be vaccinated later in the influenza season among Text4baby participants. METHODS Nearly one third (28,609/89,792) of enrollees responded to a text asking about their vaccination plans. Those planning to receive vaccination were randomly assigned to receive an encouragement message or an encouragement message plus the opportunity to schedule a reminder (n=3,021 at follow-up). Those not planning to be vaccinated were randomly assigned to receive general education or education tailored to their reason for non-vaccination (n=3,820 at follow-up). The effect of the enhanced messages was assessed using multinomial logistic regression in 2013-2014. RESULTS A reminder increased the odds of vaccination at follow-up among mothers (AOR=2.0, 95% CI=1.4, 2.9) and of continued intent to be vaccinated later in the season (pregnant, AOR=2.1, 95% CI=1.4, 3.1; mother, AOR=1.7, 95% CI=1.1, 2.5). Among mothers not planning to be vaccinated because of cost, those who received a tailored message about low-cost vaccination had higher odds of vaccination at follow-up (AOR=1.9, 95% CI=1.1, 3.5). Other tailored messages were not effective. CONCLUSIONS Text reminders and tailored education may encourage influenza vaccination among this vulnerable population; both have now been incorporated into Text4baby.

A Clinical Academic Practice Partnership: A Clinical Education Redesign

The clinical academic practice partnership (CAPP), a clinical redesign based on the dedicated education unit concept, was developed and implemented by large, private school of nursing in collaboration with 4 clinical partners to provide quality clinical education, to explore new clinical models for the future, and to test an innovative clinical education design. An executive steering committee consisting of nursing leaders and educators from the school of nursing and the clinical institutions was established as the decision-making and planning components, with several collaborative task forces initiated to conduct the work and to accomplish the goals. This article will describe methods to initiate and to organize the key elements of this dedicated education unit-type clinical model, providing examples and an overview of the steps and elements needed as the development proceeded. After 18 months of implementation in 4 different nursing programs in 4 different clinical institutions, the clinical redesign has shown to be a positive initiative, with students actively requesting CAPP units for their clinical experiences. Preliminary findings and outcomes will be discussed, along with nursing education implications for this new clinical redesign.

Evaluation of a student-nurse doula program: an analysis of doula interventions and their impact on labor analgesia and cesarean birth.

INTRODUCTION The aim of this study was to describe specific doula interventions, explore differences in doula interventions by attending provider (certified nurse-midwife vs obstetrician), and examine associations between doula interventions, labor analgesia, and cesarean birth in women receiving doula care from student nurses. METHODS A secondary analysis of data from the Birth Companions Program at the Johns Hopkins University School of Nursing was conducted using t tests, chi-square statistics, and logistic regression models. RESULTS In the 648 births in the sample, doulas used approximately 1 more intervention per labor with certified nurse-midwife clients compared to obstetrician clients. In multivariate analysis, the increase in the total number of interventions provided by doulas was associated with decreased odds of epidural (adjusted odds ratio [AOR] 0.92; 95% confidence interval [CI], 0.86-0.98) and cesarean birth (AOR 0.90; 95% CI, 0.85-0.95). When examined separately, a greater number of physical interventions was associated with decreased odds of epidural (AOR 0.85; 95% CI, 0.78-0.92) and cesarean birth (AOR 0.80; 95% CI, 0.73-0.88), but number of emotional/informational interventions was not. DISCUSSION Student nurses trained as doulas have the opportunity to provide a variety of interventions for laboring clients. An increase in the number of interventions, especially physical interventions, provided by doulas may decrease the likelihood of epidural use and cesarean birth.

What's new in sexually transmitted infection management: changes in the 2010 guidelines from the Centers for Disease Control and Prevention.

Screening, treatment, and follow-up of sexually transmitted infections (STIs) are an important part of the role of womens health care providers. Keeping abreast of new and changing treatment guidelines is crucial to providing competent care. The Sexually transmitted diseases treatment guidelines, produced every 4 years by the Centers for Disease Control and Prevention, summarize current evidence on prevention, diagnosis, and treatment of STIs. The purpose of this article is to review the changes in the 2010 guidelines from the previous 2006 guidelines. These changes include new diagnostic tests for bacterial vaginosis, Neisseria gonorrhoeae, and human papillomavirus; new treatment recommendations for bacterial vaginosis, gonorrhea, and genital warts; the increasing prevalence of antimicrobial-resistant N gonorrhoeae; new criteria for spinal fluid examination to evaluate for neurosyphilis; and the emergence of azithromycin-resistant Treponema pallidum.

Educating Undergraduate Nursing Students as Birth Companions

Abstract Birth companions, or doulas, are labor attendants who are taught to provide emotional support to the laboring woman and hands-on skills that help reduce pain and enhance labor progress. Students in this baccalaureate nursing program may take an elective course that combines theoretical and experiential components of the Doulas of North America certification requirements. Following the didactic portion of the course, they may participate as doulas in community settings and receive a stipend for their services. They conduct prenatal and postpartal visits with assigned clients and provide intrapartal care.

Pregnancy After Cardiac Transplantation: Principles of Nursing Care

The number of cardiac transplants for chronic end-stage disease, congenital heart disease, and primary pulmonary hypertension has increased during the past 20 years. Decreased symptoms, decreased incidence of rejection, and greater tolerance of medical regimens have improved the quality of life for heart transplant recipients. Women of childbearing age who have undergone cardiac transplantation may now consider pregnancy. The principles of nursing care for pregnant women who have undergone heart transplantation are presented in this article. A case report of pregnancy after cardiac transplantation is included.