Marie Hastings-Tolsma

Complementary medicine use by nurse midwives in the U.S

The purpose of this prospective descriptive study was to understand 1) the extent to which certified nurse midwives (CNMs) utilize complementary and alternative medicine (CAM), 2) how knowledge regarding CAM is gained, and 3) characteristics of these providers. A survey was designed to determine use of CAM treatment modalities: herbal preparations, pharmacologic/biologic treatments, manual healing/bioelectromagnetic applications, mind-body interventions, and diet and lifestyle. Random sampling was used to select participants (n=500) who were members of the American College of Nurse Midwives. Of those CNMs responding (n=227, 45%), 78% (n=178) reported use of CAM. Herbal preparations were most commonly used (85%), followed by pharmacologic/biologic treatments (82%), mind-body interventions (80%), and manual healing/bioelectromagnetic therapies (47%). Virtually all CAM user respondents utilized at least one diet and lifestyle therapy.

Maternal obesity: improving pregnancy outcomes.

Approximately 30% of pregnant women are obese (body mass index [BMI] ≥ 30) and are at risk for adverse pregnancy outcomes. In this article, we review the literature on select obstetrical risks associated with maternal obesity and assess the recommended prevention and management strategies. The selected risks include infertility, fetal anomalies, gestational hypertensive diseases, gestational diabetes, intrauterine fetal death, cesarean birth, macrosomia, and long-term risks of adult disease for the fetus. The causes of these adverse outcomes include maternal body habitus, the proinflammatory state of obesity, and metabolic dysfunction. We also discuss how nurses, nurse practitioners, and nurse-midwives can make a difference in the prenatal care and immediate pregnancy outcomes of pregnant women with obesity and influence future health for these women and their children.

Getting through birth in one piece: protecting the perineum.

PurposeTo identify factors related to perineal trauma in childbirth, replicating the work of Albers et al. (1996). Study Design and MethodA retrospective descriptive analysis of pregnancy and birth data recorded into the Nurse Midwifery Clinical Data Set for women (N = 510) with a singleton pregnancy and largely uncomplicated prenatal course. Prenatal care occurred at four prenatal clinics with births at a tertiary care facility during 1996–1997, with care provided by nurse midwifery faculty. Multivariate statistics detailed clinical characteristics associated with perineal trauma. ResultsEpisiotomy was related to parity, marital status, infant weight, fetal bradycardia, prolonged second stage labor, and lack of perineal care measures. Factors related to laceration were age, insurance status, and marital status. For all women, laceration was more likely when in lithotomy position for birth (p = .002) or when prolonged second stage labor occurred (p = .001). Factors that were protective against perineal trauma included massage, warm compress use, manual support, and birthing in the lateral position. Albers et al. (1996) found that ethnicity and education were related to episiotomy and that warm compresses were protective. In this study, use of oils/lubricants increased lacerations, as did lithotomy positioning. Laceration rates were similar in both studies. Episiotomy use was lower in this study. Clinical ImplicationsSide-lying position for birth and perineal support and compress use are important interventions for decreasing perineal trauma. Strategies to promote perineal integrity need to be implemented by nurses who provide prenatal education and care for the laboring woman.

Gestational weight gain and preterm birth in obese women: a systematic review and meta‐analysis

Prepregnant obesity is a global concern and gestational weight gain has been found to influence the risks of preterm birth.

The Midwifery Workforce: ACNM 2012 and AMCB 2013 Core Data.

INTRODUCTION Core data are crucial for detailing an accurate profile of the midwifery workforce in the United States. The American College of Nurse-Midwives (ACNM) and the American Midwifery Certification Board, Inc. (AMCB), at the request and with support from the US Health Resources and Services Administration (HRSA), are engaged in a collaborative effort to develop a data collection strategy (the Midwifery MasterFile) that will reflect demographic and practice characteristics of certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. METHODS Two independent datasets, one collected by ACNM in 2012 and one by AMCB in 2013, were examined to determine key workforce information. ACNM data were collected from the online Core Data Survey sent to ACNM members. AMCB data were extracted from information submitted online by applicants seeking initial certification in 2013 and applicants seeking to recertify following 5 years of initial certification. RESULTS The ACNM 2012 survey was partially or fully completed by 36% (n = 2185) of ACNM members (N = 6072). AMCB respondents included 100% of new certificants (N = 539) and those applying for recertification in 2013 (n = 1323) of the total 11,682 certificants in the AMCB database. These two datasets demonstrate that midwives remain largely white, female, and older in age, with most engaged in clinical midwifery while employed primarily by hospitals and medical centers. Differences were reported between the ACNM membership and AMCB certification datasets in the numbers of midwives holding other certifications, working full-time, attending births, and providing newborn care. DISCUSSION The new collaboration among HRSA, ACNM, and AMCB, represented as the Midwifery MasterFile, provides the opportunity to clearly profile CNMs/CMs, distinct from advanced practice registered nurses, in government reports about the health care workforce. This information is central to identifying and marketing the role and contribution of CNMs/CMs in the provision of primary and reproductive health care services.

Knowledge, attitude and use of complementary and integrative health strategies: a preliminary survey of Iranian nurses

BACKGROUND BACKGROUND Disagreement exists regarding the need for knowledge about complementary and integrative health (CIH) strategies, as well as for the need to consider such strategies in clinical nursing practice. OBJECTIVE This study was conducted to assess the knowledge, attitude and use of CIH strategies among nurses in Iran. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS A cross-sectional study of nurses working in two hospitals of Zabol University of Medical Sciences, in southeast Iran, was conducted from October 2014 to April 2015. The questionnaire, developed specifically for this research, was used to assess the knowledge, attitude and use of CIH by nurses. Descriptive and inferential statistics were used to interpret the survey responses. RESULTS Most nurses (n=95, 60.5%) have average knowledge about CIH strategies with most holding a positive attitude about use (n=81, 51.6%). The majority (n=90, 57.3%) of nurses, however, never applied CIH methods. Where CIH was used, massage was most often clinically applied (n=129, 82.2%) and a large percentage believed it useful for treating illness (n=136, 87.9%). Other CIH methods commonly used included prayer and herbal medicine. CONCLUSION Nurses have positive attitudes about CIH though knowledge was typically weak. Educational programs should carefully consider how knowledge about CIH methods could be strengthened within curricula.

The Impact of Physical Activity on Sleep during Pregnancy: A SecondaryAnalysis

Disturbed sleep is independently associated with adverse pregnancy outcomes. The primary aim of this research which tested Pender’s Model of Health Promotion was to evaluate the contribution of physical activity (PA) to sleep parameters in pregnant women, with pre-pregnant body mass index (BMI) as a confounder. Sleep and physical activity data were drawn from a parent study in which 29 sedentary women in the second trimester were enrolled in an 8-week PA intervention pilot study and randomly assigned to intervention or control group. Steps per day, as measured by pedometer, and sleep parameters (sleep onset latency [SOL], wake time after sleep onset [WASO], sleep duration, and sleep quality), obtained from sleep diaries, were used to evaluate the daily interaction between PA levels and sleep. Hierarchical linear modelling (HLM) was used for analysis, as data were nested within persons. Pre-pregnant BMI contributed negatively to PA levels (p=0.003). PA levels were positively predictive (p=0.037) of sleep onset latency (SOL) and negatively predictive (p=0.01) of sleep quality, demonstrating a negative effect of PA on sleep during pregnancy when measured daily. These results confirm results from the only other published study that looked at daily measures, but contradict findings from other studies that evaluated the PA level-sleep relationship over a week or month. Both PA and sleep are modifiable factors that affect pregnancy outcomes. Further studies are needed to understand the complex relationship between PA, sleep, and weight in pregnancy.

Reconceptualising failure to rescue in midwifery: A concept analysis

AIM to reconceptualise the concept of failure to rescue, distinguishing it from its current scientific usage as a surveillance strategy to recognise physiologic decline. BACKGROUND failure to rescue has been consistently defined as a failure to save a patient׳s life after development of complications. The term, however, carries a richer connotation when viewed within a midwifery context. Midwives have historically believed themselves to be the vanguards of normal, physiologic processes, including birth. This philosophy mandates careful consideration of what it means to promote normal birth and the consequences of failure to rescue women from processes which challenge that outcome. DATA SOURCES the Medline, CINAHL, PsycINFO, PubMED, Web of Science and Google Scholar databases were searched from the period of 1992-2014 using the key terms of concept analysis, failure-to-rescue, childbirth, midwifery outcomes, obstetrical outcomes, suboptimal care, and patient outcomes. English language reports were used exclusively. The search yielded 45 articles which were reviewed in this paper. REVIEW METHOD a critical analysis of the published literature was undertaken as a means of determining the adequacy of the concept for midwifery practice and to detail how it relates to other concepts important in development of a conceptual framework promoting normal birth processes. FINDINGS failure to rescue within the context of the midwifery model of care requires robust attention to a midwifery managed setting and surveillance based on a caring presence, patient protection, and midwifery partnership with patient. CONCLUSION clarifying the definition of failure to rescue in childbirth and defining its attributes can help inform midwifery providers throughout the world of the ethical importance of considering failure to rescue in clinical practice. Relevance to midwifery care mandates use of failure to rescue as both a process and outcome measure.

Pregnancy outcome after transcervical hysteroscopic sterilization.

BACKGROUND: Hysteroscopic, transcervical sterilization involves placement of microinserts in tubal ostia. As with any contraceptive method, pregnancy can occur. This case reports the outcome when pregnancy occurred after microinsert placement. CASE: A multiparous woman presented at 16 weeks of gestation. Hysteroscopic sterilization was performed 2 years earlier, although a postprocedure hysterosalpingogram was not done to verify tubal occlusion. The patient had a normal-term pregnancy. Postpregnancy hysterosalpingogram revealed both microinserts were embedded in the uterine fundus and myometrium. CONCLUSION: This case demonstrates how pregnancy can occur after hysteroscopic microinsert placement and details how it might be avoided.

Levine's Conservation Model: A Framework for Advanced Gerontology Nursing Practice

PURPOSE Growing numbers of older adults place increased demands on already burdened healthcare systems. The cost of managing chronic illnesses mandates greater emphasis on management and prevention. This article explores the adaptation of Levines Conservation Model as a structure for providing care to the older adult by the adult-gerontology primary care nurse practitioner (AGNP). CONCLUSION The AGNP role, designed to provide quality care to adult and older adult populations, offers the opportunity to not only manage health care of the elderly, but to also advocate, lead in collaborative care efforts, conduct advanced planning, and manage and negotiate health delivery systems. The use of nursing models can foster the design of effective interventions that promote health of the older adult, particularly in the long-term care environment. PRACTICE IMPLICATION Levines Conservation Model provides a useful structure for older adult care in the long-term care setting. As an ideal care manager, the AGNP would be well served to consider use of the model to guide advanced nursing practice. Recommendations for clinical practice, research, and health policy.