Melissa D. Avery

Effects of a partially home-based exercise program for women with gestational diabetes**

Objective To examine the effectiveness of a partially homebased, moderate-intensity aerobic exercise program for women with gestational diabetes. Methods This was a randomized experimental design. Thirty-three women with gestational diabetes were randomly assigned to the exercise or the no-exercise group. Subjects underwent hemoglobin A1C assay and submaximal cycle ergometer fitness tests at baseline and at study conclusion. Subjects kept diaries of home fasting and 2-hour postprandial blood glucose determinations. Exercise subjects were asked to exercise for 30 minutes three to four times weekly at 70% of estimated maximal heart rate for the weeks of study participation. Two exercise sessions weekly were supervised by the investigator, and two were unsupervised at home. Control-group subjects were asked to maintain their current activity level. Results Daily fasting and postprandial blood glucose levels, hemoglobin A1C, incidence of exogenous insulin therapy, and incidence of newborn hypoglycemia were not different between the groups. There was a training effect in the exercise group (P = .005) but not in the control group (P = .25). A significant decline in daily grams of carbohydrate consumed was observed in the control group (P = .03), but not in the exercise group (P = .97). No complications were found in the subjects who exercised. Conclusions A partially home-based exercise program did not reduce blood glucose levels, but did result in a modest increase in cardiorespiratory fitness. The intervention appeared safe.

Factors associated with very early weaning among primiparas intending to breastfeed.

Objectives: The major objective of this study was to identify predictor variables that accurately differentiated breastfeeding women who weaned during the first 4 weeks, those who weaned between 5 and 26 weeks, and those who weaned after 26 weeks. Predictors were demographic variables, Theory of Planned Behavior (TPB) variables, breastfeeding knowledge, and difficulties experienced during the first month. Methods: Primiparas who delivered healthy infants in an urban midwestern hospital provided initial data prior to discharge. Follow-up occurred at 1,3,6,9, and 12 months. Following appropriate bivariate analyses, polychotomous logistic regression was used to determine predictors of weaning group. Linear multiple regression was used to predict intended duration. Results: Most of the 84 women who weaned very early had intended to breastfeed considerably longer. According to the multivariate analysis, women who weaned earlier were younger, had completed fewer years of education, had a more positive bottle-feeding attitude and a less positive breastfeeding attitude, intended to breastfeed less time, had lower knowledge scores, had higher perceived insufficient milk scores, and planned to work outside the home. Variables postulated by the TPB to be direct predictors of intention explained 36% of the variance in intended duration. Conclusions: Women at risk for early weaning can be identified with reasonable accuracy using a TPB-based conceptual framework expanded to include breastfeeding specific variables. Casefinding using empirically derived screening methods and careful postpartum follow-up, along with professional intervention, should be used to avert unintended early weaning.

Teaching Pharmacology to Graduate Nursing Students: Evaluation and Comparison of Web-Based and Face-to-Face Methods

As nursing schools develop Web-based courses to increase access to programs, evaluation of all aspects of these courses, from student learning to effectiveness of the course and instructor, becomes important. This article describes the evaluation of a 3-credit, semester-based, online graduate pharmacology course, and compares these student outcomes with those in the face-to-face course taught simultaneously. Eighteen students chose to participate in the Web-based course, and 52 chose to participate in the face-to-face course. The same instructor taught both courses, and the same examinations were administered. Students in the two courses were not different in age or in number of years of nursing practice prior to taking the course. There was no association between the course chosen and the type of basic nursing preparation or if the student had taken a pharmacology course in their basic nursing program. There were no significant differences between the mean examination scores of students enrolled in the two courses. Overall, students in the online course were positive about their experience. Student comments highlight the need to be aware of effectiveness of communication among faculty and students, the clarity of instructions, and the amount of information provided on course Web sites.

Women's Experiences With Combining Breast‐Feeding and Employment

A group of primiparas who combined breast-feeding and employment are described in terms of how they felt about the experience, the difficulties they encountered, factors that affected their total duration of breast-feeding, and patterns of feeding while separated from their infant. These women are contrasted with primiparas who weaned prior to returning to work and those who remained homemakers. Of the 619 women included in the analyses, 499 (80.6%) of the women returned to work or school by 12 months postpartum and 288 (46.5%) continued to breast-feed after returning to work. Women who combined breast-feeding and employment were older, had more years of education, worked fewer hours per week, and more worked in professional jobs than those who weaned prior to returning to work. A number of women who chose to express breast milk only at home thought they would have had problems with having enough time and finding a place to express and to store expressed milk had they tried to express breast milk at work. The overwhelming majority of women who combined breast-feeding and employment felt that it was worth the trouble, that they would recommend it to others, and that they had done something special for their infants that no one else could do. The findings suggest that nursing interventions and workplace accommodations could assist more women to experience the benefits and rewards of continuing to breast-feed after returning to employment.

Acute effect of exercise on blood glucose and insulin levels in women with gestational diabetes

Objective : To evaluate the effect of a single session of exercise (cycling), at rest (control condition) and at two intensity levels (low- and moderate-intensity exercise conditions), on blood glucose and insulin in pregnancy complicated by gestational diabetes mellitus (GDM). Methods : A one-group repeated measures design was used. Women aged 18-38 with GDM, no other complications, not on insulin, and not exercising regularly were recruited. The women rested or exercised at the two intensities for 30 min and rested for 2 h after each session. Blood was sampled for blood glucose, insulin and hematocrit at baseline and every 15 min. Results : There was no difference at baseline in blood glucose levels. The blood glucose level was significantly lower for each exercise condition compared to rest, and for moderate compared to low-intensity exercise (5.2 vs. 4.3 vs 3.9 mmol/l) at the end of exercise (30 min), and for the two exercise conditions compared to rest at 15 min after exercise (4.9 vs 4.4 vs. 4.0 mmol/l). By 45 min after exercise, the blood glucose values were nearly identical. The area under the curve for blood glucose was significantly lower for low- and moderate-intensity exercise than for rest ( p = 0.01). The slope of change in insulin among the three conditions, from baseline to the 30-min session, approached significance ( p = 0.065). The power for that analysis was 0.51. A sample of 23 would have been required to increase the power to 0.80. Conclusions : Significant declines in blood glucose level were observed during low- and moderate-intensity exercise compared to rest. These differences were gone by 45 min after exercise. Continued research should examine those with high body mass index and more pronounced hyperglycemia for further evaluation of the effect of exercise on blood glucose and insulin levels in women with GDM.

The Effect of Exercise During Pregnancy on Maternal Outcomes: Practical Implications for Practice

The American College of Obstetricians and Gynecologists recommends that women with low-risk pregnancies participate in moderate-intensity exercise during their pregnancy. Currently, only 15.1% of pregnant women exercise at the recommended levels, which is significantly lower than the general populations 45%. One potential reason is that exercise during pregnancy is perceived as risky. In this article, the authors provide a critical review of the literature examining the effect of exercise on preeclampsia, gestational diabetes, weight gain, labor and birth, and other issues associated with pregnancy. Overall, the evidence indicates that exercise during pregnancy is safe and perhaps even reduces the risk of preeclampsia and gestational diabetes. The evidence for weight gain and labor and birth (rates of cesarean sections, duration of labor) is mixed. Unfortunately, much of the research examining exercise during pregnancy is observational, and the few randomized controlled trials that do exist are small and inadequately powered. Taken together, given the potential benefits of exercise during pregnancy and the lack of evidence for harmful effects on the mother and newborn, practitioners should encourage their healthy pregnant patients to exercise. Practical guidelines for recommending exercise to pregnant women are presented.

Effect of perineal massage on the incidence of episiotomy and perineal laceration in a nurse-midwifery service

In a prospective randomized study, women who practiced perineal massage during the last 6 weeks of pregnancy (n = 10) were compared with a control group (n = 10). The experimental group was comprised of healthy parous and nulliparous women. Control subjects were matched for parity, fetal weight, gestational age, and maternal age. Chisquare analysis for independence was significant (ξ2 = 9.89 p < .01). This study supported the hypothesis that women who practice perineal massage at least four times per week will have a lower incidence of episiotomy and lacerations than those who do not.

Essential Components of Successful Collaborative Maternity Care Models. The ACOG-ACNM Project

The American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) asked ACNM member midwives and ACOG Fellows with successful and sustainable collaborative practices between obstetricians and midwives to describe their care models in jointly written articles. This review analyzes 12 of the 60 articles submitted. Five main themes were identified: impetus for new collaboration, basic foundations of collaborative care, commitment to successful partnership, care integration, and health professions education in an interprofessional practice environment. The analysis provides evidence of the extent to which committed clinicians are working together to provide excellent, women-centered maternity care.

Perineal massage-Effect on the incidence of episiotomy and laceration in a nulliparous population

This prospective study compared 29 nulliparous women who practiced perineal massage in the last 6 weeks of pregnancy with a control group of 26. Episiotomy and/or second degree (or greater) perineal laceration occurred in 48% of experimental subjects and 77% of controls. Chi square analysis showed a significant difference between the groups (p < 0.05). Perineal massage may be one technique that will decrease the need for episiotomy. Suggestions for further research are discussed.

Incorporating cultural competence content into graduate nursing curricula through community-university collaboration.

Health professionals are reorienting workforce education to better prepare students for working with increasingly diverse populations. The authors describe a community-based curriculum deliberation process in which community leaders and health workers deliberated with faculty and students to make recommendations about a graduate nursing curriculum. There were five areas of competencies recommended for graduate nursing to improve care of diverse populations: self-awareness, basic knowledge of culture and identity, attitudes that promote cross-cultural communication, cross-cultural clinical skills, and advocacy skills. The school now is in the process of phasing in recommendations gained from the deliberation.