Renea L. Beckstrand

Postpartum Depression and Help Seeking Behaviors in Immigrant Hispanic Women

OBJECTIVES To describe perceptions of immigrant Hispanic women experiencing symptoms of postpartum depression (PPD) and to identify barriers to seeking mental health services. DESIGN Qualitative descriptive. SETTING Community health clinic. PARTICIPANTS Twenty immigrant Hispanic women scoring positive for symptoms of PPD receiving health care at a community health clinic who declined mental health services participated in audiotaped interviews held in their homes. METHODS Following Institutional Review Board approval and informed consent, interviews were conducted with study participants. Transcribed data were analyzed as appropriate for qualitative inquiry. RESULTS Some of the women did not recognize and/or denied their symptoms attributing their sadness to financial concerns, family relationships, and/or work stressors. Study participants articulately described their symptoms and identified personal barriers including beliefs about emotional health, the perceived stigma of mental illness, hesitancy to seek treatment for symptoms of PPD, and cultural beliefs about motherhood and the role of women. Social barriers included inadequate social support, immigration status, and limited English proficiency. Health care delivery barriers included financial and time constraints and lack of child care and transportation. CONCLUSION Limited social networks and barriers to health care should be addressed to foster positive outcomes. Mental health services should be embedded with primary health care or obstetric care clinics to facilitate access. Personal and professional support can make a significant contribution to the reduction of symptoms of PPD.

Parental hesitation as a factor in delayed childhood immunization.

INTRODUCTION One reason for lower immunization rates is that some parents hesitate to have their children immunized. A hesitancy questionnaire was developed to identify reasons parents hesitate in having their children immunized. METHODS The hesitancy questionnaire was distributed from local pediatric and family practice offices and from the areas county health department. To be eligible, participants needed to be present in the clinic with a child needing a minimum of one immunization that was at least 6 months overdue. RESULTS When questioned why their child was overdue for immunizations, the most common response was that participants were confused about the immunization schedule and not sure when to return. Of the participants who reported having concerns regarding immunizations, the childs pain/crying/anxiety was the most commonly occurring answer. When asked where they receive the majority of childhood immunization information, participants frequently identified their health care provider as the main source of information. DISCUSSION Health care providers may be missing opportunities to educate hesitant parents about immunizations. Parents may not have ample opportunities to discuss their immunization concerns in detail with their health care provider during regularly scheduled clinic visits. It is important for health care providers to suggest ways parents can cope with their childs pain/crying/anxiety when receiving immunizations.

Dutch women's perceptions of childbirth in the Netherlands.

PurposeTo explore the lived experience of childbirth in Dutch women who had given birth at home in the Netherlands. MethodsQualitative study using audiotaped interviews with 14 women. ResultsThemes included the advantages of giving birth in the home, where the women felt more in control of their environment; the difficulty and normalcy of the pain associated with giving birth; the feelings of fulfillment and empowerment that come with childbirth and motherhood; and the importance of the supportive role of the midwife–caregiver. Nursing ImplicationsWomen in a culture different from that of the United States who gave birth at home felt fulfilled and empowered by the experience. These results can help U.S. nurses more fully understand the meaning of childbirth in a different culture and may help identify possible improvements in the design of care for women and newborns in the United States.

A Comparison of the Use of Tympanic, Axillary, and Rectal Thermometers in Infants

This study examined the relationship between three instruments used in measuring tympanic, axillary, and rectal temperatures in infants less than 1 year of age. Temperatures were measured by Oto-temp Pedi Q tympanic thermometers, Becton Dickinson axillary thermometer, and rectal thermometers. A convenience sample of 5 infants less than 90 day and 54 greater than 90 days with fever, as well as 34 infants less than 90 days and 27 infants greater than 90 days without fever were studied. Correlations of infants less than 90 days and greater 90 days of age, as well as differences between infant temperature with and without fevers as variables, were examined. Results indicated a strong statistical relationship between Oto-Temp Pedi Q, Becton Dickinson axillary temperatures, and rectal temperatures, but not strong enough to base critical clinical decisions. Age and presence or absence of fever significantly affected the relationships between thermometers.

Analysis of end-of-life content in critical care nursing textbooks

Nurses have identified a need for improving their knowledge and skills in providing end-of-life care. Critical care nursing textbooks can serve as an important source of information on end-of-life care for critical care nurses. Hence, an analysis of end-of-life content in 14 critical care nursing textbooks was conducted. Critical care nursing textbooks used for review were published in 1995 or later and identified from the libraries at the University of Wisconsin-Madison and Brigham Young University. The end-of-life content areas identified by the American Association of Colleges of Nursing (AACN), under which the AACN end-of-life competencies for undergraduate nursing students can be taught, were used as a framework for assessing the presence or absence of end-of-life content in the textbooks. When end-of-life content was present, two reviewers judged whether the information was helpful. Four additional end-of-life content areas were identified in some textbooks during the study, and reviewers also judged whether these were helpful. None of the textbooks had end-of-life content in all the content areas used for the analysis. Three textbooks did not contain any end-of-life content.

Parental Hesitation in Immunizing Children in Utah

OBJECTIVES To determine why parents in a Utah community hesitated in immunizing their children. DESIGN AND SAMPLE Cross-sectional descriptive study. Data were collected from a convenience sample of 86 parents of under-immunized children in the county health department and local pediatric and family practice offices. MEASURES Participants were asked to complete an immunization hesitancy survey including questions regarding why parents hesitated to immunize their children, parental concerns regarding immunizations, and what advice they would give to a friend or family member who had concerns about childhood vaccines. Parents could also write in any other comment, concern, or suggestion they had regarding childhood immunizations. RESULTS 2 major themes were identified: concerns regarding immunization safety and lack of perceived need. The most commonly reported concerns regarding immunization safety included autism, immune system overload, and other adverse reactions. Many parents did not recognize the need for childhood immunizations, especially multiple immunizations given simultaneously on a strict timeline. CONCLUSIONS The manner in which immunization information is shared with hesitant parents can be particularly important. There is a need for health care providers to assess and increase parental knowledge regarding immunizations.

Prevalence of postpartum depression among Hispanic immigrant women

Purpose: To determine the prevalence of postpartum depression (PPD) among Hispanic immigrant women seeking healthcare services at a community health clinic. Data sources: Of the 116 Hispanic immigrant women recruited, 96 comprised the final sample. Using the Beck PDSS‐Spanish version, participants were screened for symptoms of PPD. Conclusions: The prevalence of significant symptoms of PPD was 54.2% for the entire sample. Nearly 66% of women who screened positive for symptoms of PPD scored above the listed cutoff score for suicidal thoughts. Women were divided into four postpartum age groups from 2 to 48 weeks; rates of symptoms of PPD ranged from 50% to 60.9% among the groups. There were no statistically significant demographic predictors for PPD. Implications for practice: Given that a large number of Hispanic women do not return for postpartum appointments, along with the high rates of PPD symptoms, it is strongly recommended that healthcare providers implement universal screening for all Hispanic women in pregnancy and across the first postpartum year to ensure prompt diagnosis and culturally appropriate treatment. Further research is needed to assess the cultural components of PPD and to determine if the prevalence is consistent in other community settings.

Treatment of Hypertriglyceridemia With Omega‐3 Fatty Acids: A Systematic Review

Purpose To (a) critically appraise available randomized controlled trials (RCTs) addressing the efficacy of long‐chain omega‐3 fatty acids as secondary agents for prevention of hypertriglyceridemia and (b) make recommendations for clinical practice. Data Sources Two independent reviewers examined all RCTs from 1994 to 2003 identified in several databases, extracted data from each study, and used the previously tested Boyack and Lookinland Methodological Quality Index (MQI) to determine study quality. Conclusions Ten studies reported long‐chain omega‐3 fatty acids to be effective in the treatment of hypertriglyceridemia. The average decrease in triglycerides was 29%, total cholesterol 11.6%, very low density lipoprotein (VLDL) 30.2%, and low‐density lipoprotein (LDL) 32.5%. One study found LDLs to increase by 25%. The average increase in highdensity lipoprotein was 10%. The overall average MQI score was 36% (range = 26% to 54%). Many of the RCTs had serious shortcomings, including short duration, lack of a power analysis, no intention‐to‐treat analysis, no report of blind assessment of outcome, and lack of dietary control as a confounding variable. Implications for Practice Overall study methodology was weak. Although the evidence supporting use of long‐chain omega‐3 fatty acids in the secondary prevention of hypertriglyceridemia is reasonably strong, until there are larger RCTs of better methodological quality, it is not recommended that practitioners treat hypertriglyceridemia with omega‐3 fatty acid supplementation in lieu of lipid‐lowering medications.

Postpartum depression and culture: Pesado Corazon.

The purpose of this article is to describe what the -literature has shown about postpartum depression (PPD) in culturally diverse women. The majority of qualitative studies done with women identified as -having PPD have been conducted with Western -women, with the second largest group focusing on Chinese women. This article reviews the qualitative studies in the literature and discusses how the management of PPD in technocentric and ethnokinship cultures differs. Social support has been shown to be significantly related to fewer symptoms of PPD, and culturally prescribed practices may or may not be -cultural mediators in decreasing the incidence of PPD. Nurses should be sensitive to the varied ways in which culturally diverse women perceive, explain, and report symptoms of PPD. Exemplary interventions for culturally diverse women suffering from PPD are examined in this article as well, although it is clear that additional research is needed to develop models for culturally competent interventions for PPD in culturally diverse women and to document the outcomes of such interventions.

Reasons Parents Exempt Children From Receiving Immunizations

School nurses are on the front lines of educational efforts to promote childhood vaccinations. However, some parents still choose to exempt their children from receiving vaccinations for personal reasons. Studying the beliefs of parents who exempt vaccinations allows health care workers, including school nurses, to better understand parental concerns which may, in turn, help prepare school nurses for effective communication with these parents. The objective of the study was to explore personal beliefs of parents living in Utah, who exempted their children from receiving vaccinations. A cross-sectional, descriptive design was implemented. Data were collected from a convenience sample of 287 parents responding to an open-ended question about why they exempted their children from receiving at least one vaccination. The qualitative data included parental comments, concerns, or suggestions regarding childhood vaccinations. Five categories were identified regarding reasons for personal exemptions: parental perceptions, health care systems issues, chronic disease concerns, immune system concerns, adverse reaction concerns and other reasons not classified. The number of parents refusing childhood vaccinations remains relatively low; however, despite public health efforts, the percentage increases each year.