Margaret Comerford Freda

The History of Preconception Care: Evolving Guidelines and Standards

This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preconception health services; standards and guidelines for numerous professional organizations, therefore, are explored. The professional nursing organization with the most highly developed preconception health standards is the American Academy of Nurse Midwives (ACNM); for physicians, it is the American College of Obstetricians and Gynecologists (ACOG). These guidelines and standards are discussed in detail.

Blinding in peer review: the preferences of reviewers for nursing journals

AIM This paper is a report of a study to assess the beliefs and preferences of reviewers for nursing journals about blinding of authors to reviewers, reviewers to authors, neither or both. BACKGROUND Blinding of author and reviewer names in the manuscript review process has been of interest to nursing editors, but reports that are based on data rather than simply opinion concern the editorial practices of biomedical rather than nursing journals. There has been no study of nursing journal reviewer beliefs and preferences related to blinding. METHOD A descriptive web-based survey was conducted. The sample included 1675 anonymous reviewers, recruited through 52 editors of nursing journals from their review panels. Data were collected in 2007. FINDINGS Double-blinding of reviews was the most common method reported. Ninety per cent of respondents reported that the papers they received to review did not include author names. When author names were blinded, 62% of reviewers could not identify the authors of papers; another 17% could identify authors < or =10% of the time. Double-blinding was the method preferred by 93.6% of reviewers, although some identified some advantages to an unblinded open review process. CONCLUSION Nursing journal reviewers are generally very satisfied with double-blinding and believe it contributes to the quality of papers published. Editors or editorial boards interested in a more open review process could consider alternatives such as offering authors and reviewers the option to unblind themselves. Simply announcing that the review process will henceforth be unblinded would probably lead to loss of reviewers.

The lived experience of miscarriage after infertility.

Purpose To describe women’s experiences of miscarriage after infertility treatments. Published studies in which fertile women were interviewed after miscarriage have found that the women universally look to another pregnancy as the solution to their grief. However, for women undergoing infertility treatments, the possibility of another pregnancy is not a certainty. Despite this, little is known about the unique experience of this group of women. Appropriate interventions based on evidence require research to discover these women’s needs. Design Phenomenology Method Eight women who had experienced miscarriage after infertility were interviewed. Interviews were audiotaped and transcribed verbatim. Data saturation guided the sample size. Colaizzi’s methods for phenomenologic analysis were used. Analyzed data were brought back to the women for fact checking and to ensure trustworthiness and reliability of the data. Results Themes included: going back to “square one,” an inner struggle between hope and hopelessness for future fertility, running out of time, anger/frustration, lack of understanding by others, guilty feelings, feeling alone/numb with their grief, and gaining strength from adversity. Clinical Implications This study provides a first glimpse of women who miscarry after infertility treatments, and demonstrates that they feel profoundly alone, and grieve intensely. They worry that they caused the miscarriage, and find it difficult to hope that they will ever become pregnant again. Several women described being hospitalized for their miscarriage on postpartum units. This was unbearable for them, and should remind all of us in healthcare that this type of unthinking treatment of women who miscarry after infertility is not acceptable.

Cocaine use during pregnancy and low birth weight: The impact of prenatal care and drug treatment

Cocaine use in pregnancy has been associated with low birth weight. Large population-based studies suggest that 5 to 7% of pregnant women have used cocaine, with much higher rates in low income inner-city women. Among 140 births at our institution of cocaine-using women, we found a lower rate of low birth weight in those who received prenatal care compared with those without prenatal care: 33 of 96 (34.3%) versus 23 of 44 (52.3%), P

Ethical Issues Faced By Nursing Editors

This study reports on ethical issues faced by editors of nursing journals, a topic which has not appeared in the nursing literature. A survey of nursing editors (n = 88)was conducted via e-mail; this article is the content analysis of survey questions about ethics. Eight categories of ethical issues emerged: problems with society/association/publisher; decisions about inflammatory submissions; informed consent or IRB issues; conflicts of interest; advertising pressures; duplicate publications and/or plagiarism; difficult interactions with authors; and authorship. Some issues were similar to those published about medical editors; however, others were unique. This study can assist authors to better understand some of the ethical issues in publishing, can help editors to view their issues in the context of what others experience, and can assist societies and publishers to work toward avoiding these ethical issues in the future. Professional discussions about ethics in nursing publications should be the subject of ongoing research and scientific inquiry.

REDUCING PRETERM AND LOW BIRTHWEIGHT BIRTHS: STILL A NURSING CHALLENGE

Preterm birth and low birthweight are correlated with much of the infant death seen in the United States. Despite 15 years of research, both preterm birth rates and low birthweight rates continue to increase. This article describes what is known about the prevention of preterm birth and low birthweight, and offers advice to nurses for nursing interventions that could prove effective in preventing such tragedies in the future.

Ethical concerns of nursing reviewers: An international survey

Editors of scientific literature rely heavily on peer reviewers to evaluate the integrity of research conduct and validity of findings in manuscript submissions. The purpose of this study was to describe the ethical concerns of reviewers of nursing journals. This descriptive cross-sectional study was an anonymous online survey. The findings reported here were part of a larger investigation of experiences of reviewers. Fifty-two editors of nursing journals (six outside the USA) agreed to invite their review panels to participate. A 69-item forced-choice and open-ended survey developed by the authors based on the literature was pilot tested with 18 reviewers before being entered into SurveyMonkeyTM. A total of 1675 reviewers responded with useable surveys. Six questions elicited responses about ethical issues, such as conflict of interest, protection of human research participants, plagiarism, duplicate publication, misrepresentation of data and ‘other’. The reviewers indicated whether they had experienced such a concern and notified the editor, and how satisfied they were with the outcome. They provided specific examples. Approximately 20% of the reviewers had experienced various ethical dilemmas. Although the majority reported their concerns to the editor, not all did so, and not all were satisfied with the outcomes. The most commonly reported concern perceived was inadequate protection of human participants. The least common was plagiarism, but this was most often reported to the editor and least often led to a satisfactory outcome. Qualitative responses at the end of the survey indicate this lack of satisfaction was most commonly related to feedback provided on resolution by the editor. The findings from this study suggest several areas that editors should note, including follow up with reviewers when they identify ethical concerns about a manuscript.

INTERNATIONAL NURSING AND WORLD HEALTH : ESSENTIAL KNOWLEDGE FOR THE 21ST CENTURY NURSE

As the world becomes a smaller place through international travel and instant communication, nurses must expand their notions of the populations for whom they will care and the nursing colleagues with whom they will work. This article describes some of the reasons why all nurses must become more knowledgeable about international health issues, the practice of nursing in other countries, international nursing research, and nursing education in other countries.

Interdisciplinary development of a preconception health curriculum for four medical specialties.

A group of obstetricians and gynecologists, along with physicians from three other medical specialties, nurses, and midwives, developed a curriculum on preconception health care for women. This curriculum was specifically aimed at residents in obstetrics and gynecology, internal medicine, pediatrics, and family medicine. The curriculum was designed to convince these physicians that they needed to participate in promotion of preconception health for many reasons, such as the need to teach women to take folic acid daily because it significantly decreases the incidence of neural tube defects. Because over 50% of all pregnancies are unplanned, it is imperative that all physicians think of themselves as preconception health providers. Our group then taught the curriculum to medical students, residents, fellows, and attending physicians in all specialties at four hospitals affiliated with the medical college. Evaluation of the curriculum in 171 physicians who participated revealed that only a small percentage of physicians took folic acid daily themselves. Almost 36% of the obstetricians did not currently provide preconception care for their patients. Most physicians in all specialties believed that the curriculum provided them with useful information for their practice. The March of Dimes is currently distributing this curriculum on its Web site.

Orientation of OB/GYN residents to ambulatory care: A nurse-midwifery approach

Although certified nurse-midwives collaborate with ob/gyn residents in teaching settings, they are rarely given the opportunity to have input into how residents learn to deliver ambulatory care. This study is a preliminary evaluation of a program in which one nurse-midwife was assigned responsibility for the orientation and preceptorship of all post-graduate year 1 residents to the ambulatory care setting in an inner-city womens health center. At the end of the academic year, all of the post-graduate year 1s completed an evaluation of their orientation. Findings included positive responses to the preceptorship orientation and agreement that the residents were comfortable with the competence and educational background of the CNM preceptor. The recurring theme was that orientation by a CNM was an appropriate learning experience. Suggestions for improvement of the program are included.