JoAnne Herman

Hydrotherapy in labor

PURPOSE To review the literature on hydrotherapy in labor to direct prescription of the intervention and design studies to test its effectiveness. METHODS Studies of hydrotherapy were identified via searching literature and electronic databases. FINDINGS A primary effect of immersion is a central blood volume bolus, which occurs almost immediately after bathing begins. Subjective maternal responses to bathing in labor have been favorable. No maternal or infant infections have been attributed to bathing by parturients with either intact or ruptured membranes. Maternal bathing in labor does not appear to affect infant Apgar scores or stress hormones at birth. No clear evidence exists to indicate that hydrotherapy increases cervical dilation, increases fetal descent, reduces uterine dyskinesia, shortens labor, decreases use of epidurals or analgesia, or decreases rates of operative delivery or hemorrhage. CONCLUSIONS Study findings indicate support for using hydrotherapy for relief of rapid pain and anxiety in labor. A methodical approach must be taken to determine for whom and under what circumstances intervention with hydrotherapy in labor is efficacious. Studies of the maternal and fetal effects of hydrotherapy in labor, including mechanisms of action, as well as large, prospective, randomized clinical outcome trials with control for intervening variables, are needed to help practitioners decide whether to prescribe hydrotherapy.

A middle range theory for generative quality of life for the elderly.

Decades of quality of life (QOL) research has failed to produce widely recognized QOL definitions or measurements. The inconsistency may be due to an ontological error in the perspective of researchers. Most researchers portray QOL as a given or inherent condition that declines in the face of challenges. We believe QOL is a cumulative process that results from a series of connections and disconnections that elders experience in their daily lives. The Register theory of Generative Quality of Life for the Elderly offers an alternative ontological perspective by placing elder QOL in a generative context.

Use of a Pregnancy Support Web Site by Low-Income African American Women

OBJECTIVE To examine the feasibility and usage pattern of a social support Web site by low-income pregnant African American women. DESIGN Descriptive. SETTING Homes of participants. PARTICIPANTS Nineteen pregnant African American women who were pregnant for the first time, were low risk, and attending a prenatal clinic. INTERVENTION Culturally congruent Web site providing information on pregnancy-related health behaviors and other pregnancy issues. MAIN OUTCOME MEASURES Number of visits to Web site, most popular pages, content analysis of postings, and e-mails to a nurse. RESULTS Participants were able to learn to use the Web site easily. They accessed the discussion board the most frequently, followed by changes during pregnancy by month, ask-a-nurse feature, ultrasound, stories about pregnant women, and spirituality. CONCLUSIONS The discussion board is the most effective way to deliver informational social support on a comprehensive social support Web site.

THE EFFECT OF AURICULAR ACUPUNCTURE ON PSYCHOPHYSIOLOGICAL MEASURES OF COCAINE CRAVING

This study used a randomized pretest/posttest control group design to test the effectiveness of auricular acupuncture interventions in diminishing psychological and physiological changes associated with cocaine craving in 30 treatment-seeking cocaine-dependent patients. The experimental group received the real auricular acupuncture intervention, insertion of needles into ear point locations specifically targeted for drug withdrawal. The control group received sham or placebo auricular acupuncture, insertion of needles into ear point locations not targeted for any specific therapeutic benefit. Psychological (Cocaine Craving Questionnaire - Now) and physiological (skin conductance activity) changes associated with cocaine craving were measured. Results showed no differences between the control and the experimental group in diminishing psychological and physiological measures associated with craving. There were differences from pre- to posttest on measures of psychological but not physiological craving for the combined experimental and control groups.

Quality of life revisited: the concept of connectedness in older adults.

Viewing quality of life from a generative context gave rise to a new perspective and the old term quality of life failed to capture the essence of the new idea. Creation of a new term required a series of deliberate studies to develop the concept of connectedness. This article traces the conceptual progression and presents the concept synthesis of connectedness using literary synthesis, qualitative synthesis, and quantitative synthesis. Based on the concept synthesis, connectedness in community-dwelling older adults can be defined as engaging life by self-regulating, facing aging, being part of a family, having friends, and being spiritual.

Development and psychometric testing of the Register - Connectedness Scale for Older Adults.

Connectedness, maintaining active engagement with life, is crucial to successful aging. Yet, no instruments were found to measure connectedness. The purpose of this study was to develop and test a connectedness scale for older adults. A 72-item instrument was administered to 428 community-dwelling older adults. The sample was largely female, White widows/widowers, with a mean age of 76 (SD 6.95) years. The instrument was reduced to 45 items representing five factors with loadings ranging from .40 to .86. The factor labels and their reliability estimates were: (a) self-regulating (.86), (b) facing aging (.85), (c) being part of a family (.87), (d) having friends (.87), and (e) being spiritual (.88). This promising instrument may advance the science of successful aging.

A multidisciplinary management program in primary care to improve hypertension control and healthy behaviors in elderly patients.

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Collaborative practice agreements for advanced practice nurses: what you should know.

Advanced practice nurses (APNs) seeking employment are often presented with employment practice agreements. A collaborative practice agreement is a written statement that defines the joint practice of a physician and an APN in a collaborative and complementary working relationship. It provides a mechanism for the legal protection of the APN and sets out the rights and responsibilities of each party involved. All APNs, regardless of practice setting, should be knowledgeable about aspects of a collaborative practice agreement before they sign one. The purposes of this article are to delineate basic guidelines for evaluating and developing a collaborative practice agreement and to identify areas of special concern for APNs.

Documenting Acute Care Nurse Practitioner Practice Characteristics

Acute care nurse practitioners are functioning in a health care system that is changing rapidly. Simultaneously, the ACNP role is evolving. It is imperative that ACNPs document practice characteristics to communicate effectively within the health care system. The purpose of this article is to describe the process of documenting ACNP practice. Content includes rationale for documenting ACNP practice characteristics, a description of types and sources of data to collect, a discussion of barriers to documentation, and a format for a documentation tool.

Skin temperature and chronic venous insufficiency

Abstract Objective: This study compared lower leg skin temperatures in adults age 50 years and older with and without chronic venous insufficiency (CVI). Norms and ranges of skin temperature were also established. Design: A descriptive comparative design was used. Setting and subjects: Sixty-six adults recruited from hospital clinics and senior community dwellings participated in the study, which was conducted in an examination room of an outpatient clinic. To be included in the study, those with CVI showed stage 4 and 5 clinical signs. Those without CVI had no clinical signs. Instruments: Skin temperature was measured with an infrared dermal thermometer. Methods: Subjects were seated with legs extended, free of clothing and socks, and loosely covered with a draped sheet for 10 minutes to acclimatize to room temperature. The skin temperature of 4 sites on the lower legs was measured. Analysis of variance and independent t tests were used to compare groups. Results: There was a significant increase in skin temperature at all 4 sites in the ankle area in the group with CVI compared with the comparison group (89.9°F ± 2.7°F versus 88.1°F ± 2.1°F, P=.004). Conclusions: Elevated skin temperature may be an important nursing assessment parameter to evaluate worsening or impending CVI complications such as venous ulcers.