Nancy J. MacMullen

Adverse maternal outcomes in women with asthma: differences by race.

PurposeTo examine the relationship between race and adverse maternal outcomes in women with asthma. Study Design and MethodsThis retrospective cohort study examined 11 adverse maternal outcomes across racial groups of 13,900 pregnant women with asthma (age 13 to ≥ 40) who gave birth between 1998 and 1999. The data were abstracted from a national database, The National Inpatient Sample (NIS), available through Health Care and Utilization Project (HCUP) maintained and disseminated by the Agency for Healthcare Research and Quality (AHRQ). Maternal age and comorbidities were adjusted in multivariate analysis. ResultsFor women with asthma, African Americans were more likely than Whites to have preterm labor and infection of the amniotic cavity; Hispanic women had comparable outcomes with the exception that postdate pregnancy was less likely to be 42 weeks; and Asian/Pacific Islander women had a higher risk of having gestational diabetes and infection of the amniotic cavity. Clinical ImplicationsAs adverse maternal outcomes for women with asthma were higher in minorities, and as minorities have traditionally had more barriers to healthcare, the study results indicate that more effort needs to be made to educate nurses, consumers, and government officials about the potential adverse maternal outcomes of asthma during pregnancy. Public awareness may assist in overcoming the barriers to healthcare experienced by minorities.

Perinatal implications of sickle cell disease.

AbstractSickle cell disease (SCD) affects millions of people across the globe. In the United States, approximately 70,000 to 100,000 people have the disease, and 2 million have the sickle cell trait. SCD occurs once in every 500 African American births, and once in 36,000 Hispanic American births. Women with SCD can have more adverse maternal outcomes such as preeclampsia, eclampsia, preterm labor, placental abruption, intrauterine growth restriction, and low birthweight. Providing comprehensive nursing care to women with SCD is a challenge, particularly during labor and birth, with nursing management aimed at attaining healthy birth outcomes while preventing or treating manifestations of the disease. Labor and delivery nurses are responsible for specific knowledge and care practices for these women, including differentiating the pain of sickle cell crisis from contraction pain and monitoring maternal and fetal oxygenation, as oxygenation is jeopardized in laboring sickle cell patients. Intrapartum nursing care also requires vigilance in the need for emergency cesarean birth. Nursing interventions include symptom management, pain management, ensuring patient safety, and educating patients. Coordination of care and clear communication between the members of the healthcare team, patient, and family are essential elements to ensure a positive outcome for perinatal patients with SCD.

Chorionic villus sampling: counseling your patient.

Chorionic villus sampling is a technique for prenatal genetic screening that has been widely publicized by the print and television media. Although not yet commonly available, women may seek additional information about the procedure from nurse practitioners. This article discusses the women for whom this procedure is most appropriate, the procedures accuracy, sampling techniques, safety records and the procedures accessibility and cost. The NPs role in counseling and anticipatory guidance is also discussed.

The perinatal: special care unit: expert care for high-risk patients.

Labor and delivery units are often used to provide care for nonlaboring patients requiring intensive medical and nursing care. The utilization of labor beds in this manner, however, can result in a shortage of beds for those patients who are truly in labor. Unfortunately, patient dissatisfaction, use of supplemental staffing, and ill-prepared, overworked nurses can then become the result of this practice. Clearly, an improved, innovative model of providing care for high-risk perinatal patients is needed. The purpose of this article is to describe how one hospital and its interdisciplinary team met the challenge of providing expert care for complex perinatal patients by creating a unique model of patient care delivery, the perinatal special care unit (PSCU). An advanced practice nursing role, the perinatal nurse practitioner (PNNP) was implemented to provide collaborative care for these patients. This article includes a discussion of positive and negative outcomes that occurred after the PSCU became a reality. Overall, housing patients on the PSCU has eliminated inappropriate use of labor and delivery beds and has led to a more satisfying childbearing experience for all involved.

Clinical StudiesFactors Related to Sucking Ability in Healthy Newborns

Objective To identify maternal, infant, and environmental factors related to newborn sucking ability. Design Prospective, descriptive, exploratory study using a convenience sample. Setting Normal newborn nursery in an urban tertiary-care medical center. Participants Two hundred three healthy newborns admitted to the normal newborn nursery after delivery. The newborns were between 30 minutes and 11 hours of age, and between 34 and 42 weeks gestation. Main Outcome Measures: This study examined 15 variables related to newborn sucking ability: infant state, age, gestational age, Apgar scores, birth weight, labor medications, type of delivery, elapsed time since last feeding, infant sex, perinatal complications, infant vital signs, birth esuscitation, clothing, room temperature, and length of labor. Sucking ability was measured by the Neonatal Oral Motor Assessment Scale (NOMAS). Results The variables of gestational age, weight, and state were positively correlated with sucking ability (NOMAS scores). Newborns age postdelivery and minutes to the quiet alert state were inversely correlated with sucking ability. Conclusions Newborn weight and gestational age are related to sucking ability. Younger newborns had better sucking ability than did older newborns.

Health insurance: a summary of basic types.

An understanding of the basic types of health insurance and the terminology will help the nurse educate and care for patients in a more responsible and holistic manner.