Maureen Kelley

Female Farmworkers’ Perceptions of Pesticide Exposure and Pregnancy Health

Occupational pesticide exposure may be hazardous to pregnant farmworkers, yet few studies have focused on the health of female farmworkers distinct from their male counterparts or on the impact of agricultural work tasks on pregnancy outcomes. In the current community-based participatory research study, researchers conducted five focus groups with female nursery and fernery workers in Central Florida to enhance knowledge of attitudes about occupational risks and pregnancy health and to gather qualitative data to help form a survey instrument. This article presents the results from questions focused on pesticide exposure and its impact on general, reproductive, pregnancy, and fetal health. Workers reported a belief that pesticide exposure could be hazardous to pregnancy health; descriptions of symptoms and health concerns believed to be related to farmwork and to pesticide exposure; and descriptions of barriers preventing them from practicing safer occupational behaviors.

Nursing and midwifery regulatory reform in east, central, and southern Africa: a survey of key stakeholders

BackgroundIn sub-Saharan Africa, nurses and midwives provide expanded HIV services previously seen as the sole purview of physicians. Delegation of these functions often occurs informally by shifting or sharing of tasks and responsibilities. Normalizing these arrangements through regulatory and educational reform is crucial for the attainment of global health goals and the protection of practitioners and those whom they serve. Enacting appropriate changes in both regulation and education requires engagement of national regulatory bodies, but also key stakeholders such as government chief nursing officers (CNO), professional associations, and educators. The purpose of this research is to describe the perspectives and engagement of these stakeholders in advancing critical regulatory and educational reform in east, central, and southern Africa (ECSA).MethodsWe surveyed individuals from these three stakeholder groups with regard to task shifting and the challenges related to practice and education regulation reform. The survey used a convenience sample of nursing and midwifery leaders from countries in ECSA who convened on 28 February 2011, for a meeting of the African Health Profession Regulatory Collaborative.ResultsA total of 32 stakeholders from 13 ECSA countries participated in the survey. The majority (72%) reported task shifting is practiced in their countries; however only 57% reported their national regulations had been revised to incorporate additional professional roles and responsibilities. Stakeholders also reported different roles and levels of involvement with regard to nursing and midwifery regulation. The most frequently cited challenge impacting nursing and midwifery regulatory reform was the absence of capacity and resources needed to implement change.DiscussionWhile guidelines on task shifting and recommendations on transforming health professional education exist, this study provides new evidence that countries in the ECSA region face obstacles to adapting their practice and education regulations accordingly. Stakeholders such as CNOs, nursing associations, and academicians have varied and complementary roles with regard to reforming professional practice and education regulation.ConclusionThis study provides information for effectively engaging leaders in regulatory reform by clarifying their roles, responsibilities, and activities regarding regulation overall as well as their specific perspectives on task shifting and pre-service reform.

Strengthening maternal and newborn health in rural Ethiopia: Early results from frontline health worker community maternal and newborn health training

OBJECTIVE to describe early results from the Community Maternal and Newborn Health (CMNH) training programme of the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project. DESIGN a non-experimental, descriptive design was employed to assess training implementation. SETTING six rural districts of Amhara and Oromiya regions, Ethiopia. PARTICIPANTS 91 Health Extension Workers (HEWs) and 626 Guide Team members including Traditional Birth Attendants (TBAs) and volunteer Community Health Promoters (vCHPs). INTERVENTION CMNH is one aspect of a broader strategy to improve maternal and newborn health at the community level in rural areas of Ethiopia where pregnant women have limited access to health facilities. MEASUREMENTS performance testing of HEWs, TBAs, and vCHPs was conducted to assess transfer of knowledge and skills from CMNH Master Trainer level to CMNH Trainer level, and from CMNH Trainer level to CMNH Guide Team (GT) level on the topic areas of Prevent Problems before Baby is Born and Prevent Problems after Baby is Born. FINDINGS post-training performance scores were significantly higher than immediate pre-training scores for Amhara and Oromiya regions on both topic areas (p<0.001). For HEWs and GT members, respectively, average scores increased over 250% and 300% for Prevent Problems before Baby is Born, and over 300% and 400% for Prevent Problems after Baby is Born. KEY CONCLUSIONS CMNH was successful in transferring knoweldge to HEWs at the CMNH Trainer level and to Guide Team members at the community level. In order for gains to be realised and sustained, the CMNH programme will be nested within an enabling environment created through behaviour change communication to increase demand for CMNH services, emphasising evidence-based maternal and newborn care practices, teamwork among frontline health workers, and an enhanced role of HEWs in provision of safe care during pregnancy, birth, and the early postnatal period.

Social responsibility: conceptualization and embodiment in a school of nursing.

This paper describes how a school of nursing has conceptualized and embodied social responsibility in its core values, curricular design, admission standards, clinical practice, and service learning opportunities. The schools engagement in the process of practicing social responsibility and clarifying its meaning and application has made apparent the natural linkage between social responsibility and professionalism and the deep and complex relationship between social responsibility and nursing itself. It has also revealed how a commitment to social responsibility impacts and determines for whom nurses care. Claiming social responsibility as a core value and working to refine its meaning and place has increased the schools commitment to it, concomitantly impacting education, practice, and recruitment and evaluation of faculty and students. The school views the conceptualization of social responsibility as a deepening and unfolding evolution, rather than as a formulaic understanding, and expects that its ongoing work of claiming social responsibility as a core value will continue to be enriching.

Development of a framework to measure health profession regulation strengthening

This paper describes the development of a framework to evaluate the progress and impact of a multi-year US government initiative to strengthen nursing and midwifery professional regulation in sub-Saharan Africa. The framework was designed as a capability maturity model, which is a stepwise series of performance levels that describe the sophistication of processes necessary to achieve an organizations objectives. A model from the field of software design was adapted to comprise the key functions of a nursing and midwifery regulatory body and describe five stages of advancing each function. The framework was used to measure the progress of five countries that received direct assistance to strengthen regulations and to benchmark the status of regulations in the 17 countries participating in the initiative. The framework captured meaningful advancements in regulatory strengthening in the five supported countries and the level of regulatory capacity in participating countries. The project uses the framework to assess yearly progress of supported countries, track the overall impact of the project on national and regional nursing regulation, and to identify national and regional priorities for regulatory strengthening. It is the first of its kind to document and measure progress toward sustainably strengthening nursing and midwifery regulation in Africa.

TELEPHONE TRIAGE IN THE OFFICE SETTING

During a six-month period in 1988, two nurse-midwives documented the telephone calls they received in an OB/GYN/CNM practice. Calls were then tallied and categorized for analysis. A discussion of the numbers and types of calls is presented as well as a review of the literature on telephone triage/management.

Competence and drug use: theoretical frameworks, empirical evidence and measurement.

Statistics show that use of harmful substances (alcohol, cigarettes, marijuana, cocaine) among women of childbearing age is widespread and serious. Numerous theoretical models and empirical studies have attempted to explain the complex factors that lead individuals to use drugs. The Social Stress Model of Substance Abuse [1] is one model developed to explain parameters that influence drug use. According to the model, the likelihood of an individual engaging in drug use is seen as a function of the stress level and the extent to which it is offset by stress modifiers such as social networks, social competencies, and resources. The variables of the denominator are viewed as interacting with each other to buffer the impact of stress [1]. This article focuses on one of the constructs in this model: that of competence. It presents a summary of theoretical and conceptual formulations for the construct of competence, a review of empirical evidence for the association of competence with drug use, and describes the preliminary development of a multi-scale instrument designed to assess drug protective competence among low-income Hispanic childbearing women. Based upon theoretical and empirical studies, eight domains of drug protective competence were identified and conceptually defined. Using subscales from existing instruments with psychometric evidence for their validity and reliability, a multi-scale instrument was developed to assess drug protective competence. Hypothesis testing was used to assess construct validity. Four drug protective competence domains (social influence, sociability, self-worth, and control/responsibility) were found to be statistically associated with drug use behaviors. Although not statistically significant, expected trends were observed between drug use and the other four domains of drug protective competence (intimacy, nurturance, goal directedness, and spiritual directedness). Study limitations and suggestions for further psychometric testing of the instrument are described.

Triage and Management of the Pregnant Hypertensive Patient

Hypertension during pregnancy is a leading cause of maternal and perinatal mortality and morbidity. Current thinking on the diagnosis and management of the hypertensive disorders of pregnancy is presented, along with triage and risk management issues.

Cross-sectional description of nursing and midwifery pre-service education accreditation in east, central, and southern Africa in 2013

BackgroundIn 2013, the World Health Organization issued guidelines, Transforming and Scaling Up Health Professional Education and Training, to improve the quality and relevance of health professional pre-service education. Central to these guidelines was establishing and strengthening education accreditation systems. To establish what current accreditation systems were for nursing and midwifery education and highlight areas for strengthening these systems, a study was undertaken to document the pre-service accreditation policies, approaches, and practices in 16 African countries relative to the 2013 WHO guidelines.MethodsThis study utilized a cross-sectional group survey with a standardized questionnaire administered to a convenience sample of approximately 70 nursing and midwifery leaders from 16 countries in east, central, and southern Africa. Each national delegation completed one survey together, representing the responses for their country.ResultsAlmost all countries in this study (15; 94%) mandated pre-service nursing education accreditation However, there was wide variation in who was responsible for accrediting programs. The percent of active programs accredited decreased by program level from 80% for doctorate programs to 62% for masters nursing to 50% for degree nursing to 35% for diploma nursing programs. The majority of countries indicated that accreditation processes were transparent (i.e., included stakeholder engagement (81%), self-assessment (100%), evaluation feedback (94%), and public disclosure (63%)) and that the processes were evaluated on a routine basis (69%). Over half of the countries (nine; 56%) reported limited financial resources as a barrier to increasing accreditation activities, and seven countries (44%) noted limited materials and technical expertise.ConclusionIn line with the 2013 WHO guidelines, there was a strong legal mandate for nursing education accreditation as compared to the global average of 50%. Accreditation levels were low in the programs that produce the majority of the nurses in this region and were higher in public programs than non-public programs. WHO guidelines for transparency and routine review were met more so than standards-based and independent accreditation processes. The new global strategy, Workforce 2030, has renewed the focus on accreditation and provides an opportunity to strengthen pre-service accreditation and ensure the production of a qualified and relevant nursing workforce.

NURSE‐MIDWIFERY MANAGEMENT OF PREECLAMPSIA Two Case Studies

Abstract Two nurse-midwifery case studies of preeclamptic patients are presented along with a discussion of their management.