Ira Kantrowitz-Gordon

Advanced practice nursing education: challenges and strategies.

Nursing education programs may face significant difficulty as they struggle to prepare sufficient numbers of advanced practice registered nurses to fulfill the vision of helping to design an improved US healthcare system as described in the Institute of Medicines “Future of nursing” report. This paper describes specific challenges and provides strategies to improve advanced practice nursing clinical education in order to ensure that a sufficient number of APRNs are available to work in educational, practice, and research settings. Best practices are identified through a review of classic and current nursing literature. Strategies include intensive interprofessional collaborations and radical curriculum revisions such as increased use of simulation and domestic and international service work. Nurse educators must work with all stakeholders to create effective and lasting change.

Metaphors of Distress Photo-Elicitation Enhances a Discourse Analysis of Parents’ Accounts

In research on sensitive topics, photo-elicitation can be a profound aid to data collection and interpretation processes. Photo-elicitation methods were used in this manner in a discourse analysis of parents’ distress at least 6 months after preterm birth. After an initial interview, participants were asked to take digital photographs representing their distress and to return for a second interview to discuss the photographs. The elicited photo representations supported participants’ engagement with their current or past distress and generated new meanings from the reappraisal of old photographs. Photo-elicitation demonstrated the embodiment of parents’ distress in the child and the placement of distress in specific locations. Photographs of documents showed the power of the written word in generating and maintaining distress. Participants used existing photographs from their child’s photo history to generate rich metaphors for their distress as parents. These findings have implications for enhancing interpretive health research by incorporating photo-elicitation methods.

Internet Confessions of Postpartum Depression

Women with postpartum depression may suffer in silence due to the stigma of depression and failed motherhood. It is important to consider how mothers are able to talk about postpartum depression and what strategies they use. Foucaults idea that confession is a widespread technique for producing truth in Western societies was tested through discourse analysis of posts on an Internet forum for women with postpartum depression. The Internet forum showed womens use of confessionary language and self-judgments as well as their sense of disconnected mothering, shame, and disembodiment. Discourses of depression included the good mother, biomedical illness, and social dysfunction. Findings have implications for creating safe spaces for helping mothers with postpartum depression.

Expanded care for women and families after preterm birth.

Prematurity is a complication of pregnancy for 1 in 8 families in the United States. The focus of care after preterm birth shifts to the fragile newborn, while the needs of the woman and her family may be overlooked. There are many challenges for parents, including impaired parent-newborn attachment, difficulties with breastfeeding, postpartum mental health, and family disruption. Premature birth may even risk the developing relationship between parents and their child. Comprehensive care is recommended for parents who have experienced a preterm birth, including support of effective lactation, promotion of skin-to-skin care, reflection on the birth experience, support and evaluation of postpartum mental health, and provision of family-centered care. Preconception care after preterm birth needs to include guidance about the recurrence risk for preterm birth as well as recommendations for risk reduction.

Student Midwives’ Duty Hours: Risks, Standards, and Recommendations

INTRODUCTION A growing body of literature has emerged describing the risks of extended-duty shifts and sleep deprivation. Worldwide, midwifery organizations have not adopted standards for practitioner or student duty shifts. This project reviews the literature related to extended-duty shifts in an effort to develop evidence-based recommendations for student nurse-midwives/student midwives (SNMs/SMs). METHODS A comprehensive literature search was conducted through electronic databases, major journals, and reference lists published in English since January 2001. Primary research studies evaluating sleep deprivation and shift duration were included. Studies that did not include the target population (shift workers) and those that formed conclusions related to extended-duty shifts greater than 30 hours were excluded. In addition, an extensive worldwide review of duty-hour recommendations from more than 300 health care organizations was conducted. RESULTS A total of 40 studies met the inclusion criteria. Extended-duty shifts (those greater than 12 hours) increased the risk for cognitive and physical functional errors, safety concerns, and decreased quality of life from sleep deprivation. Cognitive function errors included attention lapses, visual tracking errors, decreased mentation and immediate recall, and decreased learning capacity. Physical errors included decreased motor skills and slowed reaction times in clinical simulations. These deficits led to an increased risk of motor vehicle accidents, needle sticks, and performance equivalent to unsafe blood alcohol concentrations. An overall decrease in quality of life and job satisfaction was linked to extended-duty shifts. Seven organizations for medical residents or advanced practice nurses have developed policy statements on duty shifts, with extended-duty shift limitations between 12 and 24 hours. DISCUSSION The risks associated with extended-duty shifts may inhibit the development of SNMs/SMs into competent practitioners and place patients at risk. It is recommended that midwifery education programs adopt evidence-based limitations for the duty shifts of SNMs/SMs.

MIDWIFERY EDUCATION ROUNDTABLE DISCUSSION: TRANSITIONS TO THE WORKPLACE

A snapshot of four graduates’ views on their educational experience at a research institution as well as their perspective on how it prepared them for the challenges they faced in entering the workplace is presented. Discussants stated that research knowledge is a critical aspect to clinical practice. Their educational experience provided them with the ability to understand information technology applications, identify and access relevant scientific research, evaluate the integrity and comparability of research findings, and apply research findings to clinical practice. Areas within the curriculum that were identified as needing more content and/or greater emphasis included primary health care, how to work competently and effectively with persons from diverse cultural, socioeconomic, and racial and ethnic backgrounds, experience with public health providers, and content such as intimate partner violence and adolescent behaviors.

Prednisone Pharmacokinetics During Pregnancy and Lactation

To evaluate the steady‐state pharmacokinetics of prednisone and its metabolite prednisolone in pregnant and lactating female subjects, 19 subjects received prednisone (4‐40 mg/day orally) in early (n = 3), mid (n = 9), and late (n = 13) pregnancy as well as postpartum with (n = 2) and without (n = 5) lactation. Serial blood and urine samples were collected over 1 dosing interval. Prednisone and its metabolite, prednisolone, steady‐state noncompartmental pharmacokinetic parameters were estimated. During pregnancy, prednisone apparent oral clearance increased with dose (35.1 ± 11.4 L/h with 5 mg, 52.6 ± 5.2 L/h with 10 mg, and 64.3 ± 6.9 L/h with 20 mg, P = .001). Similarly, unbound prednisone apparent oral clearance increased with dose. In addition, prednisolone renal clearance increased with dose (0.3 ± 0.3 L/h with 5 mg, 0.5 ± 0.4 L/h with 10 mg, and 1.3 ± 1.1 L/h with 20 mg, P = .002). Higher prednisone (r = 0.57, P ≤ .05) and prednisolone (r = 0.75, P ≤ .05) concentrations led to a higher percentage of unbound drug. Breast‐milk/plasma area under the concentration‐time curve ratios were 0.5‐0.6 for prednisone and 0.02‐0.03 for prednisolone. Relative infant doses were 0.35% to 0.53% and 0.09% to 0.18%, for prednisone and prednisolone, respectively. Prednisone and prednisolone exhibit dose‐ and concentration‐dependent pharmacokinetics during pregnancy, and infant exposure to these agents via breast milk is minimal.

Experiences of Postpartum Women after Mindfulness Childbirth Classes: A Qualitative Study

INTRODUCTION The postpartum period can be a challenging experience for many women as they adjust to the physical and social changes after childbirth. Mindfulness-based interventions have been developed for stress reduction in a variety of health contexts, including pregnancy. These interventions provide strategies that may help new mothers handle the physical, emotional, and relationship challenges of the postpartum period and increase acceptance of postpartum physical changes and body image. Limited research has explored whether women use skills learned in prenatal mindfulness classes for the postpartum experience and parenting. The purpose of this study was to explore womens experience with mindfulness in the year after childbirth. METHODS Twelve women who participated in a Mindfulness for Childbirth and Parenting course during pregnancy were interviewed between 2 and 16 months postpartum. The semistructured interview guide included questions on how participants may have used mindfulness to approach a variety of positive and negative postpartum experiences. Qualitative description methodology guided the research team to code the transcripts independently. The team met to review and achieve consensus in the development of codes, categories, and themes from the data. RESULTS Four themes were identified in womens postpartum experiences: 1) developing a new relationship with postpartum challenges, 2) formal practices of mindfulness to address postpartum challenges, 3) informal practices to address postpartum challenges, and 4) life-changing and transformative experiences. These themes showed a pathway by which participants used mindfulness skills to address postpartum challenges and to transform these challenges with a positive perspective. DISCUSSION Mindfulness skills helped class participants cope with physical and emotional challenges postpartum and fostered positive meaningful relationships with partners and newborns. Findings have implications for future research on mindfulness-based interventions and the postpartum experience.

Competing Discourses of Scientific Identity among Postdoctoral Scholars in the Biomedical Sciences.

The postdoctoral period is generally one of low pay, long hours, and uncertainty about future career options. To better understand how postdocs conceive of their present and future goals, we asked researchers about their scientific identities while they were in their postdoctoral appointments. We used discourse analysis to analyze interviews with 30 scholars from a research-intensive university or nearby research institutions to better understand how their scientific identities influenced their career goals. We identified two primary discourses: bench scientist and principal investigator (PI). The bench scientist discourse is characterized by implementing other people’s scientific visions through work in the laboratory and expertise in experimental design and troubleshooting. The PI discourse is characterized by a focus on formulating scientific visions, obtaining funding, and disseminating results through publishing papers and at invited talks. Because these discourses represent beliefs, they can—and do—limit postdocs’ understandings of what career opportunities exist and the transferability of skills to different careers. Understanding the bench scientist and PI discourses, and how they interact, is essential for developing and implementing better professional development programs for postdocs.

Synergy Among Multiple Methodologies: Investigating Parents’ Distress After Preterm Birth

Interpretive methodologies require a level of introspection and engagement that is different from that used in empirical and analytical methodologies. The use of multiple interpretive methodologies to explore a phenomenon, in the context of a single study, is a unique perspective for undertaking qualitative research. The purpose of this article is to illustrate the synergistic nature of combining interpretive methodologies to capture multiple facets of a phenomenon. We used two different philosophical orientations, Heideggerian hermeneutic phenomenology and Foucauldian discourse analysis not only to describe the differences in research questions, methods, and analyses, but also to illustrate the added insight gained from a multiple-methodological approach. The differences between interpretive methodologies, as well as the analytic value of this innovative approach, are nuanced and are best demonstrated through the analysis of an exemplar transcript using both methodologies. Although subtle methodological differences exist, the interpretations combined create a deepening understanding of the phenomenon. Awareness of how each interpretive tradition influences the language around the research question, the data collection and analysis, and overall integrity of the level of inquiry is crucial to maintaining a rigor in both traditions, yet recognition of multiple “truths” allows for a more holistic representation to be created.