Marilyn Stringer

Human Papillomavirus, Current Vaccines, and Cervical Cancer Prevention

Human papillomavirus infection, the most common sexually transmitted infection in the United States, is associated with the development of cervical cancer. The new human papillomavirus vaccine advances cervical cancer prevention; however, provider-recommended screening with Papanicolaou tests and lifestyle modifications are still needed. Widespread implementation of the vaccine and delivering cervical cancer screening to underserved populations remain a challenge. Nurses are ideally suited to address these needs by providing education to patients and families.

Personal Costs Associated With High-Risk Prenatal Care Attendance

Personal costs associated with attending prenatal care may influence womens care-seeking behavior, particularly poor, pregnant women and those with complicated pregnancies who receive more visits. This study described personal costs incurred by poor, high-risk pregnant women while attending care. Personal costs included direct out-of-pocket and time costs. Also, the relationship between personal costs and attendance was examined. Mean direct costs throughout pregnancy were

The Health of Women and Girls Determines the Health and Well-Being of Our Modern World: A White Paper From the International Council on Women's Health Issues

101.96 per patient. Women waited a mean of 3.22 hours per visit for care and received direct physician care for a mean of 5 minutes. As child care costs increased, attendance decreased significantly (r = 0.60, p ≤ 0.05). As transportation costs, meal costs, wages lost, and time spent awaiting care increased, attendance decreased. Prenatal care has associated dollar and time costs for patients. Problem solving these issues with patients is critical. System changes to decrease waiting times and to address child care issues are needed.

Limited Obstetric Ultrasound Examinations: Competency and Cost

The International Council on Womens Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of womens health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girls health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.

The Cost of Prenatal Care Attendance and Pregnancy Outcomes in Low-Income Working Women

OBJECTIVE To determine both the actual dollar cost and the amount of time required per nurse to establish competency in limited obstetric ultrasonography (LOBU). DESIGN Descriptive. SETTING A tertiary care setting. PARTICIPANTS Registered nurses who were taught in LOBU. RESULTS Nurses who attained competency in LOBU completed 12 hours of didactic education and a clinical practicum consisting of 6 to 9 hours and approximating 15 ultrasound scans. For five nurses to concurrently attain competency in LOBU, the cost per nurse was

Comfort care of neonates at the end of life.

1,037.55 (includes salaries and employee benefits). CONCLUSION Registered nurses are able to acquire competency in LOBU at a reasonable cost, thus enhancing the ability of the professional nurse to deliver a fuller scope of services in an obstetric setting. For institutions that have limited access to individuals with this skill, nurses trained in LOBU may present a high-quality, cost-efficient solution to providing needed obstetric services.

Nursing care of the patient with preterm premature rupture of membranes.

OBJECTIVE To examine personal costs (dollar costs and time spent) associated with prenatal care (PNC) attendance and outcomes (gestation length, PNC adequacy, and birth weight) for low-income, working women (N = 165). DESIGN Prospective, descriptive study. SETTING Participants were recruited from a pre-natal clinic located at an inner city tertiary care center. PARTICIPANTS A convenience sample of 165 low-income, working women. MAIN OUTCOME MEASURES Personal costs were measured as dollar costs and time spent associated with PNC attendance. Perinatal outcomes were measured as gestation length, PNC adequacy, and birth weight. RESULTS Per visit, the mean cost associated with PNC was 33.31 dollars (range 1-125.60 dollars, SD = 32.33 dollars) and the time needed to attend care was 228 min (20-720, SD = 205). Women delivered at 37.8 (18-42) weeks; 17.6% of the women received inadequate PNC, and 17.0% of the women delivered low-birth-weight newborns. CONCLUSIONS The findings indicated that personal costs associated with PNC attendance were not associated with inadequate care attendance.

Response to Homeless Childbearing Women’s Health Care Learning Needs

Most neonatal intensive care units have approaches to manage patients at the end of their lives. Published guidelines to help direct practitioners are lacking, and these management approaches, commonly referred to as comfort care, are often based on tradition. Recently, our neonatal staff experienced a unique situation that involved giving comfort care to a previable neonate who lived much longer than anticipated. Our staff identified the need for an evidence-based practice guideline to focus on four key care issues: provision of warmth, close physical contact, nutritional support, and sedation and pain management. The purpose of this article is to supply health care providers with evidencebased comfort care guidelines for neonates at the end of life who either are previable or have had life support withdrawn. The process used for developing the guidelines is included.

Acceptance of hepatitis B vaccination by pregnant adolescents.

Preterm premature rupture of the membranes (PPROM) is diagnosed when rupture of the amniotic membranes occurs prior to the completion of the 36th week of gestation. PPROM accounts for 25% of all cases of premature rupture of the membranes and is responsible for 30%-40% of all preterm deliveries. In mothers diagnosed with PPROM without evidence of infection, active labor, or fetal compromise, the current standard of care is expectant management. The goal of expectant management is the prolongation of the pregnancy to increase fetal gestational age thus potentially decreasing the effects of prematurity. Expectant management consists of ongoing observation for signs and symptoms of infection, active labor, and/or nonreassuring fetal status. This article provides clinical nursing guidelines for the mother diagnosed with PPROM who is managed expectantly. Eight targeted areas for nursing assessment and intervention are described: preterm labor, side effects of tocolytic therapy, maternal/fetal infection, fetal compromise, side effects of extended bed rest, maternal stress, educational needs, and routine prenatal care.

Classifying Perinatal Advanced Practice Data With the Omaha System

The study findings showed that homeless childbearing women are at greatest risk for cancer, violence, poor nutrition, sexually transmitted infections, unplanned pregnancy, and adverse pregnancy outcomes. Collaborating with personnel at a women’s shelter, the authors studied homeless childbearing women’s knowledge, attitudes, and beliefs about general health promotion, healthy pregnancy promotion, and preterm labor prevention. Guided by the Integrative Model of Behavioral Prediction and Change, 45 homeless women participated in focus groups. They were 28.7 years old (range 18-44 years), and approximately 87% of these women had custody of their children. Three themes identified included things you do to stay healthy during pregnancy, where you learned about staying healthy, and women’s knowledge about preterm labor and general health promotion. These findings informed an 8-week educational session (1 hr/week). During the past year, four 8-week sessions were conducted with attendance between 8 and 14 participants. Each week a different health topic was discussed incorporating the associated unique challenges of homelessness.