Jeanne DeJoseph

A randomized trial of an empirically-derived social support intervention to prevent low birthweight among African American women

Previous clinical trials of social support interventions to reduce low birthweight (LBW) have not fully capitalized on findings from social science research, and therefore have not used empirically-derived criteria to define a low social support population or to develop the intervention. To overcome limitations of previous studies, this randomized clinical trial tested the hypothesis that an empirically-derived social support intervention would reduce LBW among African American women. Based on prior work, African American women were identified as at-risk for LBW due to inadequate social support if they lacked support from their mothers or male partners. Focus groups were used in this study to develop a culturally-relevant intervention. Adult low-income African American pregnant women (n = 319) were tested for inadequate social support in mid-pregnancy. Of these, 114 (36%) low-support women were identified and randomly assigned to the intervention group (n = 56) or control group (n = 58). The intervention was designed to provide the support usually provided by the pregnant womans mother or male partner. It consisted of four standardized face-to-face sessions at two week intervals and telephone contact in the intervening weeks. Birthweight was obtained blinded from charts or birth certificates, with 99% follow-up. The rate of LBW (below 2500 grams) was 9.1% in the intervention group compared to 22.4% in the control group (P < 0.05). Contrary to previous studies, this social support intervention was effective in reducing the rate of LBW. It is promising that this intervention was successful for African Americans because the rate of LBW is twice as high among African Americans than among Caucasians.

Nursing's silence on lesbian, gay, bisexual, and transgender issues: the need for emancipatory efforts.

The purpose of this study was to selectively review the nursing literature for publications related to lesbian, gay, bisexual, and transgender health, using (1) a key word search of CINAHL, the database of nursing and allied health publications; (2) from the top-10 nursing journals by 5-year impact factor from 2005 to 2009, counting articles about lesbian, gay, bisexual, and transgender issues; and (3) content analysis of the articles found in those journals. Only 0.16% of articles focused on lesbian, gay, bisexual, and transgender health (8 of nearly 5000 articles) and were biased toward authors outside of the United States. We discuss the impact of this silence.

Nurse-midwifery care to vulnerable populations: Phase I: Demographic characteristics of the National CNM sample

The purpose of this article is to describe the extent to which certified nurse-midwives (CNMs) provide care to vulnerable populations in the United States and the source of reimbursement for this care. The data were obtained from the first phase of a national study to address the characteristics of women served and cost of care provided by CNMs. Results were analyzed nationally and by American College of Nurse-Midwives regions. Certified nurse-midwives in all types of practices are providing care to women from populations that are vulnerable to poorer than average outcomes of childbirth because of age, socioeconomic status, refugee status, and ethnicity. Ninety-nine percent of CNMs report serving at least one group of vulnerable women, and CNMs in the inner city and rural practices serve several groups. The vast majority of CNMs are salaried; only 11% receive their primary income from fee-for-service. Fifty percent of the payment for CNM services is from Medicaid and government-subsidized sources whereas less than 20% comes from private insurance. Source of income varies by type of setting in which the CNM attends births. The results suggest that CNMs, as a group, make a major contribution to the care of vulnerable populations.

Effect of stress on family functioning during pregnancy.

A theoretical model hypothesized to predict family functioning was tested in four groups of expectant parents, followed by exploratory model building. The groups studied during the 24th to 34th weeks of pregnancy included 153 high-risk hospitalized women, 75 of their partners, 218 low-risk women from the general obstetric clinic, and 147 of their partners. Both partners in the high-risk situation reported greater discrepancy in family functioning than partners in the low-risk situation. The hypothesized models proved to have low explanatory power, accounting for 13% to 15% of the variance. The final empirical models developed explained 33% of the variance in family functioning among high-risk women and 48% among their partners, 23% among low-risk women, and 32% among their partners. The empirical models differed from the hypothesized models in that variables postulated to have only indirect effects were shown to have direct effects on family function and inter-generational variables significantly expanded the theoretical model.

Theoretical Models for Studying the Effect of Antepartum Stress on the Family

Three models are proposed to predict the effect of antepartum stress on the family. These models consider external and internal family environments and individual characteristics as they influence an individual family members health status, dyadic relationships within the family, and the familys functioning as a unit. Research to date validates the complex interrelationships between antepartum stress, social support, self-esteem, sense of mastery, anxiety, depression, and their effect on health status, dyadic relationships, and family functioning. The theoretical models presented identify relationships between these important variables that can guide much-needed research on the effects of antepartum stress on the childbearing family.

Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Nurses' Experiences in the Workplace

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) nurses constitute one of the largest subgroups within the profession of nursing, yet there is very little empirical research in the nursing literature and virtually no attention to issues of discrimination and exclusion in the workplace by nursing education or professional nursing organizations. This study reports the findings of an online survey of 261 LGBTQ nurses from a database of an LGBTQ health advocacy organization. The survey contained both quantitative and qualitative items and revealed that many workplaces lacked policies and procedures that would make LGBTQ nurses feel safer and more included and that many coworkers, supervisors, and patients had exhibited discriminatory behavior or verbal harassment, sometimes leading to significant consequences for the LGBTQ worker. LGBTQ nurses expressed a need for a professional organization that would educate the nursing profession and the general population about LGBTQ issues and address their advocacy and health care policy needs. Efforts to correct the current workplace climate for LGBTQ employees would involve (a) changes in workplace policies, (b) education of the health care workforce, and (c) advocacy from nursing professional organizations.

The Development of a Social Support Intervention among African American Women

The purpose of this feminist qualitative study was the development of a psychosocial intervention to reduce the number of low birthweight babies among lower income, socially isolated, pregnant, African American women. Using data from both group and individual interviews, we constructed a series of interactive sessions. The focus of these sessions was skill building, both to develop self-esteem and to access social support; and acknowledgment of the pregnant womens lives and experiences.

The Personal Experience of Pregnancy for African-American Women

This study describes the personal experiences of pregnancy for African-American women. Data were obtained from two group interviews with four African-American nurse-midwives who had experienced pregnancy and had extensive professional experience in the provision of health care services to pregnant African Americans. Three major themes were constructed from the interview narratives. The first concerned the experience of pregnancy as a transition experience from childhood to adulthood and from womanhood to motherhood, involving heightened senses of maturity, self-esteem, and intimacy. The second identified stresses experienced by African-American women, including the lack of material resources and emotional support. The last theme concerned the provision of effective support in pregnancy. The significance of interpersonal relationships with the pregnant women’s mothers, other significant women, and their partners was described. Implications for practice included suggestions for the provision of effective emotional support from health care professionals such as attentive listening and the elimination of environmental factors that communicate lowered personal value.

A Comparison Of Visits And Practices Of Nurse‐Midwives And Obstetrician‐Gynecologists In Ambulatory Care Settings

With more than 5 million patient visits annually, certified nurse-midwives (CNMs) substantially contribute to womens health care in the United States. The objective of this study was to describe ambulatory visits and practices of CNMs, and compare them with those of obstetrician-gynecologists (OB/GYNs). Sources of population-based data used to compare characteristics of provider visits were three national surveys of CNMs and two National Ambulatory Medical Care Surveys of physicians. When a subset of 4,305 visits to CNMs in 1991 and 1992 were compared to 5,473 visits to OB/GYNs in similar office-based ambulatory care settings in 1989 and 1990, it was found that a larger proportion of CNM visits were made by women who were publicly insured and below age 25. The majority of visits to CNMs were for maternity care; the majority of visits to OB/GYNs were for gynecologic and/or family planning concerns. Face-to-face visit time was longer for CNMs, and involved more client education or counseling. This population-based comparison suggests that CNMs and OB/GYNs provide ambulatory care for women with diverse demographic characteristics and differing clinical service needs. Enhancing collaborative practice could improve health care access for women, which would be especially beneficial for those who are underserved and vulnerable.

Characteristics of nurse-midwife patients and visits, 1991.

OBJECTIVES This study describes the patient populations served by and visits made to certified nurse-midwives (CNMs) in the United States. METHODS Prospective data on 16,729 visits were collected from 369 CNMs randomly selected from a 1991 population survey. Population estimates were derived from a multistage survey design with probability sampling. RESULTS We estimated that approximately 5.4 million visits were made to nearly 3000 CNMs nationwide in 1991. Most visits involved maternity care, although fully 20% were for care outside the maternity cycle. Patients considered vulnerable to poor access or outcomes made 7 of every 10 visits. CONCLUSIONS Nurse-midwives substantially contribute to the health care of women nationwide, especially for vulnerable populations.