Lynn Clark Callister

Prevalence of postpartum depression among Hispanic immigrant women

Purpose: To determine the prevalence of postpartum depression (PPD) among Hispanic immigrant women seeking healthcare services at a community health clinic. Data sources: Of the 116 Hispanic immigrant women recruited, 96 comprised the final sample. Using the Beck PDSS‐Spanish version, participants were screened for symptoms of PPD. Conclusions: The prevalence of significant symptoms of PPD was 54.2% for the entire sample. Nearly 66% of women who screened positive for symptoms of PPD scored above the listed cutoff score for suicidal thoughts. Women were divided into four postpartum age groups from 2 to 48 weeks; rates of symptoms of PPD ranged from 50% to 60.9% among the groups. There were no statistically significant demographic predictors for PPD. Implications for practice: Given that a large number of Hispanic women do not return for postpartum appointments, along with the high rates of PPD symptoms, it is strongly recommended that healthcare providers implement universal screening for all Hispanic women in pregnancy and across the first postpartum year to ensure prompt diagnosis and culturally appropriate treatment. Further research is needed to assess the cultural components of PPD and to determine if the prevalence is consistent in other community settings.

Reasons Parents Exempt Children From Receiving Immunizations

School nurses are on the front lines of educational efforts to promote childhood vaccinations. However, some parents still choose to exempt their children from receiving vaccinations for personal reasons. Studying the beliefs of parents who exempt vaccinations allows health care workers, including school nurses, to better understand parental concerns which may, in turn, help prepare school nurses for effective communication with these parents. The objective of the study was to explore personal beliefs of parents living in Utah, who exempted their children from receiving vaccinations. A cross-sectional, descriptive design was implemented. Data were collected from a convenience sample of 287 parents responding to an open-ended question about why they exempted their children from receiving at least one vaccination. The qualitative data included parental comments, concerns, or suggestions regarding childhood vaccinations. Five categories were identified regarding reasons for personal exemptions: parental perceptions, health care systems issues, chronic disease concerns, immune system concerns, adverse reaction concerns and other reasons not classified. The number of parents refusing childhood vaccinations remains relatively low; however, despite public health efforts, the percentage increases each year.

EMERGENCY NURSES' SUGGESTIONS FOR IMPROVING END-OF-LIFE CARE OBSTACLES

INTRODUCTION More than 123 million ED visits are reported annually. Many patients who arrive for care to help extend their lives instead die while in the emergency department. Emergency departments were designed to save lives rather than to provide optimal end-of-life (EOL) care. Emergency nurses care for these dying patients and their families. The purpose of this study was to determine what suggestions emergency nurses have for improving EOL care. METHODS Emergency nurses were asked which aspects of EOL care they would like to see changed to improve how patients die in emergency departments. Of the 1000 nurses surveyed, 230 provided a total of 295 suggestions for improving EOL care. Content analysis was used to identify categories of qualitative responses. Responses were coded individually by research team members and then compared with ED EOL literature. Clusters of data were formulated to form themes with sufficient data returned to reach saturation. RESULTS Five major themes and four minor themes were identified. The major themes were increasing the amount of time ED nurses have to care for dying patients, allowing family presence during resuscitation, providing comfortable patient rooms, providing privacy, and providing family grief rooms. CONCLUSION Large numbers of patients seek care in emergency departments. Emergency nurses are often called on to care for dying patients and their families in this highly technical environment, which was designed to save lives. Emergency nurses witness the obstacles surrounding EOL care in emergency departments, and their recommendations for improving EOL care should be implemented when possible.

Giving birth: the voices of women in Tamil Nadu, India.

Purpose:The purpose of this qualitative descriptive study is to describe the perceptions of childbearing women living in Tamil Nadu, India. This study can increase cultural understanding and foster cultural competence in nurses caring for Indian women. Study Design and Methods:Women were invited to share their childbearing experiences. Following institutional review board approval, interviews were held with 22 women who had given birth in the previous 18 months to a viable infant. The women were grateful for the opportunity to share their perspectives with an interested nurse investigator. Data collection proceeded concurrently with data analysis. Themes were generated collaboratively by the research team. Results:This research provides insights into the perspectives of mothers living in Tamil Nadu, India. Themes included anticipating becoming a mother, following the advice of mothers-in-law and other “wise” women, fear of childbirth related to lack of knowledge, and valuing support during labor and birth. Others included having the greater blessing of giving birth to a son, making the transition to motherhood, following postpartum rituals/ceremonies, and having a desire to give their child the best that life circumstances allow. Clinical Implications:Nurses should be sensitive to the social determinants of health, which frame giving birth. Listening to the voices of women is helpful in guiding clinical practice. Understanding of childbirth practices in culturally diverse women is essential. Potentially harmful practices can be changed through appropriate educational offerings.

Integrating Advanced Writing Content into a Scholarly Inquiry in Nursing Course

Since there are few data examining methods to help students learn to write in a scholarly manner, the purposes of this project were to (1) evaluate students’ learning of writing content integrated into a Scholarly Inquiry in Nursing course by examining differences in scores on a writing assessment taken at the beginning and end of the course; and (2) examine student confidence ratings relative to writing to see if it improved during the course. After obtaining IRB approval and informed consent, the CLIPS pre and post assessment mean scores of 82 students in a Scholarly Inquiry in Nursing course were compared using the Wilcoxon signed-rank test. Confidence ratings in formal and informal writing were also obtained from a subsample of 47 students. Mean scores improved in 12 out of 26 assessment categories related to punctuation, correct usage of words, and sentence construction. Student mean confidence ratings increased each month.

Giving birth with epidural analgesia: the experience of first-time mothers.

The purpose of our qualitative descriptive study was to describe the birth experiences of women using epidural analgesia for pain management. We interviewed nine primiparas who experienced vaginal births. Five themes emerged: (a) coping with pain, (b) finding epidural administration uneventful, (c) feeling relief having an epidural, (d) experiencing joy, and (e) having unsettled feelings of ambivalence. Although epidural analgesia was found to be effective for pain relief and may contribute to some women’s satisfaction with the birth experience, it does not guarantee a quality birth experience. In order to support and promote childbearing women’s decision making, we recommend improved education on the variety of available pain management options, including their risks and benefits. Fostering a sense of caring, connection, and control in women is a key factor to ensure positive birth experiences, regardless of pain management method.

Teaching physiologic birth in maternal-newborn courses in undergraduate nursing programs: current challenges.

For low-risk childbearing women, fewer technological interventions are associated with better physical and psychosocial outcomes; yet, the number of unmedicated physiologic births is decreasing. As a result, fewer undergraduate nursing students experience caring for women who choose physiologic birth, which presents a challenge for nurse educators and implications for preparing students to provide appropriate care for all childbearing women after the students graduate. This exploratory descriptive qualitative study was conducted among 150 randomly selected undergraduate nursing programs in the United States to explore the challenges of educating nursing students about low-intervention birth. Four themes described current challenges: lack of placement opportunities, education versus clinical practice, evidence-based support of physiologic birth, and the need for more research on pedagogical strategies that effectively educate future nurses to advocate for minimal intervention birth options for all women.

Childbearing women and intimate partner violence.

Violence against women is a complex global health, social, and cultural crisis that is often exacerbated during pregnancy when women (and their unborn children) may be most vulnerable. The prevalence of gender-based violence against women who are pregnant is underreported but is estimated that at least 3% to 19% of pregnant women are abused (Rose, Alhue, Bhandari, Soeken, Marcantoio, Bullock, & Sharps, 2010). Prevalence appears higher in African and Latin American countries (Devries, Kishor, Johnson, Stookl, Bacchus, Garcia-Moreno, & Watts, 2010). Violence against childbearing women is well documented as a cause of maternal and fetal morbidity and mortality (Shah & Shah, 2010). There are strong positive correlations between gender-based violence, women’s lack of social power, inequality, lack of access to basic resources such as healthcare, and lack of maternal education, which promotes illiteracy (Benagiano, Carrara, & Filippi, 2010). It is essential for nurses to work toward the creation of a global social environment that promotes gender equity with shared power between

Let there be light: WE CARE Solar.

In many rural areas globally, access to reliable power sources is inadequate, with frequent, unpredictable, and long-lasting power outages. This means that midwives attending births often do not have an adequate source of light. Caregivers use a small fl ashlight, kerosene or batteryoperated lanterns, or candles. Generators are sometimes available, but are expensive to use because of the cost of fuel. A Nigerian community health offi ce described attending a breech birth with a dim kerosene lantern. In desperation the husband held up a candle, which hardly improved the lighting. A clinic supervisor said, “If there is no light, anything can happen. [The health worker] cannot see the person she is [attending]. You can try to clamp the cord and clamp the wrong thing. You can mistakenly cut the woman. Even the health worker can be wounded, and if the patient is HIV positive, this is especially dangerous” (http://wecaresolar. org/stories-from-the-night). A few years ago in Uganda’s Igana District, local women noticed that Safe Mothers, Safe Babies had a solar unit in the roof of their offi ce. They approached this nonprofi t organization to request a solar unit at the local health center. After one was installed to provide electricity for the facility and community education was provided on safe births, the number of women accessing prenatal care increased, and the number of births in the center doubled rather than women giving birth at home. There was a dramatic reduction in preventable maternal and neonatal morbidity and mortality (www.womendeliver.org/ updates/entry/celebrate-solutionssolar-energy-for-safer-birt). Midwives could now see clearly as they attended births, started intravenous lines, or examined newborns. In 2009, a California obstetrician, Dr. Laura Stachel, and her solar engineer husband were concerned about the lack of basic resources in Nigerian healthcare facilities. They developed a solar light system, including solar panels, a battery, and an LED light kit packed in a small solar suitcase. The lights consisted of 9 to 18 LEDs encased in a waterproof plastic brick that was impervious to water and could be dropped without damaging the unit. Not only does the LED provide lighting for safe births, the kit also powers mobile communication devices and refrigeration for blood banks. Partnering with Safe Mothers, Safe Babies, the Women’s Emergency Communication and Reliable Electricity (WE CARE) Solar nonprofi t organization is now bringing solar power to underresourced areas in 14 countries including African nations, Afghanistan, Burma, Haiti, India, Nepal, Nicaragua, Tibet, and Thailand. WE CARE Solar has teamed up with ONE HEART to aid Tarahama Indians in Mexico, an example of how nonprofi t organizations can combine efforts to make a difference. This initiative, called “Light for Life” or “Light the Night,” is an immediate solution reducing maternal and neonatal morbidity and mortality (http://wecaresolar.org/liberia-lightup-a-life-project/). For example, Sierra Leone has among the highest rates worldwide of maternal mortality. Most of the country’s 1,120 rural health centers have no electricity at all. WE CARE Solar came to the country, bringing solar suitcases to provide the fi rst electricity in many villages. In addition, classes were taught in basic obstetric skills and fetal Dopplers were provided. Communities partnered with global organizations to reduce energy poverty and promote safe healthcare for women and newborns. In Liberia, where more than 50% of the country does not have electricity, a team brought solar-powered light to 20 rural clinics. After attending a birth of 20-year-old Mapu in a Liberian clinic that had just received power, Dr. Stachel said, “who would have guessed that bringing a little suitcase full of light could do so much.” A commentator who observed that birth noted, “It is a hopeful moment, a chance for more babies to be born into a brighter Liberia” (http://wec aresolar.org/abc-news-million-momschallenge-reporters-notebook-lightin-liber). In Haiti WE CARE Solar has provided solar suitcases for disaster relief teams, mobile clinics, tent city clinicians, and maternal/newborn clinics. In Madhya Pradesh, India, malnutrition center for mothers and infants, the solar suitcases are saving lives and improving the quality of those lives. WE CARE Solar has been designated as one of Women Deliver’s 2012 most inspiring ideas and solutions. A research grant funded by the UBS Optimus Foundation is facilitating documentation of the impact of providing electrical power in rural maternal health clinics in underserved areas of the world. These sustainable interventions are making a difference in the health of vulnerable women and newborns. Let there be light! ✜

Mothers without borders.

This article describes Mothers Without Borders a nonprofit organization that sponsors a home for vulnerable children ranging from five to eighteen years of age and mostly orphaned because of HIV/AIDS in Zambia. Mothers Without Borders provides shelter food clothing access to healthcare the opportunity to learn English education and vocational training and counseling.