Jacqueline Fawcett

Changes in functional status after childbirth.

Changes in functional status after childbirth were examined over a 6-month postdelivery period in 97 women who had delivered healthy full-term infants. Functional status was defined as the womans readiness to assume infant care responsibilities and resume her usual activities. Functional status was found to improve steadily from 3 weeks to 3 months postpartum, but no statistically significant changes were found between 3 and 6 months. However, by 6 months postpartum 6% of the women had not yet fully assumed the desired or required level of infant care responsibilities, nearly 20% had not yet fully resumed usual levels of household activities, 30% had not fully resumed usual levels of social and community activities, and more than 80% had not yet fully resumed usual self-care activities. Of the 57 women who had returned to work or school by 6 months postpartum, over 60% had not fully resumed their usual level of occupational activities. Canonical analysis revealed that different sets of health, psychosocial, family, and demographic variables were associated with functional status at each data collection point.

DEVELOPMENT OF THE INVENTORY OF FUNCTIONAL STATUS AFTER CHILDBIRTH

Abstract The Inventory of Functional Status After Childbirth (IFSAC) contains five subscales designed to measure the mothers readiness to assume infant care and to resume selfcare, household, social and community, and occupational activities following childbirth. Content validity was established at 96.7%. Cronbachs alpha internal consistency reliability coefficients ranged from 0.56–0.98 for the five subscales. Average correlations for the subscale item to subscale total scores ranged from 0.51–0.78. Subscale to total IFSAC score correlations ranged from 0.53–0.90. Test-retest reliability coefficients for a 4–7 day interval ranged from 0.48–0.93. Initial construct validity testing was accomplished by comparing recovery rates for vaginally and cesarean delivered women. The multidimensionality of the concept of functional status after childbirth was supported empirically, with the magnitude of IFSAC subscale correlations ranging from 0.01–0.53. Further psychometric testing of the IFSAC with large samples of childbearing women is warranted. Clinicians may use the IFSAC to assess functional status following childbirth.

Effect of support groups with coaching on adaptation to early stage breast cancer

The effects of 8-week cancer support groups (CSGs) with and without coaching on adaptation were tested in a sample of 181 women with newly diagnosed early stage breast cancer. CSG participation with coaching resulted in higher quality of relationship with significant other at CSG conclusion; this effect was not sustained 8 weeks later. CSG participation had no effect on symptom distress, emotional distress, or functional status. On average, symptom distress was low, emotional distress was moderate, and functional status was relatively high. Independent of CSGs, symptom distress decreased and functional status increased over time from entry into the study to 16 weeks later. Further research is needed to determine the optimal starting time and length for CSGs.

Return of functional ability after childbirth.

Recovery of functional ability after childbirth was examined in a sample of 30 women who had vaginal deliveries and 40 who had cesarean births. Recovery of functional ability after childbirth was defined as the resumption of household, social and community, and occupational activities and assumption of infant care responsibilities. Only 51% of the women reported they had regained their usual level of energy by the end of the 6-week postpartum period; 72% of the vaginally delivered women reported regaining their physical energy within this period, but only 34% of the cesarean delivered women had done so. Differences were also noted between cesarean- and vaginally delivered women in the interval until assumption of infant care responsibilities and resumption of certain household tasks, socializing with friends, and participation in religious organizations. Recovery of functional ability was also found to be affected by maternal and neonatal complications, and their presence was associated with postponed return to employment. Findings suggest that the traditional 6-week recovery period from childbirth needs to be reconsidered, particularly for women experiencing cesarean deliveries or maternal or neonatal postdelivery complications.

Spouses' physical and psychological symptoms during pregnancy and the postpartum

This cross-sectional descriptive study investigated the type and frequency of physical and psychological symptoms experienced by pregnant and postpartal women and their spouses. The sample of 70 married couples included 23 pairs in an early pregnancy group, 24 in a late pregnancy group, and 23 in a postpartum group. Both spouses completed a symptoms checklist of 20 physical and 3 psychological symptoms and the Beck Depression Inventory. Findings indicate that both spouses experienced some physical and psychological symptoms during pregnancy and the postpartum, although the women reported many more symptoms than did the men. Women in the late pregnancy group reported the highest number of physical symptoms; those in the postpartum group, the lowest number. No differences, however, in reports of psychological symptoms were found among the three groups of women. No significant differences in reports of either physical or psychological symptoms were found among the three groups of men.

Exploring a pedagogical approach to integrating research, practice and teaching

Application of evidence is accepted as an important component of clinical practice. Teaching research to undergraduate students has been reported internationally as a challenge, particularly for nurse educators. In this paper, reported is a strategy designed to enhance research learning for undergraduate midwifery students at one university, which formed part of a larger, international investigation into womens responses to caesarean birth. Following theory classes and briefings, students worked with their clinical educators in practice to interview women using existing tools, and were engaged in qualitative data analysis. A number of challenges were encountered throughout the process, both for the educators and students. However, the teaching approach provided benefits for students in learning about midwifery research. Recommended as essential is for continued development of pedagogical approaches that make research tangible for students. Furthermore, provision of support for clinical staff working with students is important for success of such approaches.

The Future of Nursing

Nurses have long attempted to secure a unique identity for the profession. Many scholars are now promoting an interdisciplinary framework for nursing practice. Fawcett is convinced that interdisciplinary practice poses a danger for nursing to lose its identity and that interdisciplinary practice cannot be successful if members of each discipline do not understand the conceptual models, practice, and research of their own discipline. Dr. Janie Butts and Dr. Karen Rich interviewed Dr. Jacqueline Fawcett about her views related to discipline-specific knowledge and nursing’s future. The authors conclude that Fawcett’s scientific foundation gives nursing the solidarity and power necessary to determine the unique internal goods of its practice.

Criteria for Evaluation of Theory

This column presents criteria for evaluation of nursing theories specified by Jacqueline Fawcett and Rosemarie Rizzo Parse. Fawcett’s criteria are significance, internal consistency, parsimony, testability, empirical adequacy, and pragmatic adequacy. Some of those criteria are differentiated for grand theories and middle-range theories but are not differentiated by type of data—qualitative or quantitative—used to develop the theory. Parse’s criteria are structure and process. Structure encompasses historical evolution, foundational elements, and relational statements. Process encompasses correspondence, coherence, and pragmatics. Parse’s criteria are appropriate for the critical appraisal of all frameworks and theories, regardless of level of abstraction. Parse also presents a comparison of her own and Fawcett’s criteria.

Recovery from childbirth: Looking back 6 months after delivery

Womens perceptions of their recovery from childbirth were investigated by open-ended interviews of 96 mothers of health, full-term infants 6 months after delivery. Data included factors affecting physical, mental, and emotional recovery; sources of help and hindrance; ideas of what each women would do differently after the delivery of another child; and overall evaluation of how the months after delivery compared with expectations. Content analysis of the data revealed that 25% of the women did not feel physically recovered from childbirth at 6 months postpartum. Husbands and other family members were major sources of help. Prolonged labor and cesarean delivery were the major hindrances to recovery. More household and child-care help was desired after delivery of another child. Almost half of the women found the first 6 months after delivery more difficult than anticipated. The findings suggest that pregnant women need more information about lifestyle adjustments after childbirth.

The Conceptual Model for Nursing and Health Policy Revisited

A conceptual model of nursing and health policy was proposed by the authors in 2001. Revisions in the model have been made, and the model has been used to guide the evolution of a nursing doctoral program and doctoral dissertation research. The revised model provides a framework for analysis and evaluation of public, organizational, and professional polices influencing the quality, cost, and access to nursing and other health care services, as well as for nursing-discipline specific and health services research at any one of four interacting levels: Level 1—efficacy of nursing practice processes; Level 2—effectiveness of nursing practice processes and effectiveness and efficiency of health care delivery subsystems; Level 3—equity of access to effective and efficient nursing practice processes and efficient nursing practice delivery systems, and equity in distribution of costs and burdens of care delivery; Level 4—justice and the social changes and market interventions addressing equity.