Ruth York

Spouses' physical and psychological symptoms during pregnancy and the postpartum

This cross-sectional descriptive study investigated the type and frequency of physical and psychological symptoms experienced by pregnant and postpartal women and their spouses. The sample of 70 married couples included 23 pairs in an early pregnancy group, 24 in a late pregnancy group, and 23 in a postpartum group. Both spouses completed a symptoms checklist of 20 physical and 3 psychological symptoms and the Beck Depression Inventory. Findings indicate that both spouses experienced some physical and psychological symptoms during pregnancy and the postpartum, although the women reported many more symptoms than did the men. Women in the late pregnancy group reported the highest number of physical symptoms; those in the postpartum group, the lowest number. No differences, however, in reports of psychological symptoms were found among the three groups of women. No significant differences in reports of either physical or psychological symptoms were found among the three groups of men.

A randomized trial of early discharge and nurse specialist transitional follow-up care of high-risk childbearing women.

In a randomized clinical trial, quality of health care as reflected in patient outcomes and cost of health care was compared between two groups of high-risk childbearing women: women diagnosed with diabetes or hypertension in pregnancy. The control group (N = 52) was discharged routinely from the hospital. The intervention group (N = 44) was discharged early using a model of clinical nurse specialist transitional follow-up care. During pregnancy, the intervention group had significantly fewer rehospitalizations than the control group. For infants of diabetic women enrolled in the study during their pregnancy, low birth weight (< or = 2,500 g) was three times more prevalent in the control group (29%) than in the intervention group (8.3%). The postpartum hospital charges for the intervention group were also significantly less than for the control group. The mean total hospital charges for the intervention group were 44% less than for the control group. The mean cost of the clinical specialist follow-up care was 2% of the total hospital charges for the control group. A net savings of

Postnatal Care in Low-Income Urban African American Women: Relationship to Level of Prenatal Care Sought

13,327 was realized for each mother-infant dyad discharged early from the hospital.

The impact of personal problems on accessing prenatal care in low-income urban African American women.

OBJECTIVE:This study examined the relationship between level of prenatal care utilization and postnatal patterns of health care behavior among high-risk minority women. The primary hypothesis was that prenatal care utilization predicts subsequent levels of both the maternal and child health services used in the postnatal period.METHODS:The study population consisted of 297 low-income African American women who were recruited at delivery at an urban tertiary medical center in the Mid-Atlantic region. They were followed monthly for 1 year using telephone interviews to determine their use of maternal and child health services. Four levels of prenatal care were identified retrospectively based on reviews of health records and screening interviews using the Kessner Index. Data regarding pregnancy outcomes, maternal postnatal visits, and well-child and acute care child visits were collected.RESULTS:Women who sought inadequate or no prenatal care had greater infant morbidity and mortality in the postnatal period and significantly lower levels of attendance at maternal postnatal visits, well-child visits, immunization completions, and acute care visits.CONCLUSION: This study confirms that the level of prenatal care is indicative of the level of postnatal care women seek for themselves and their children in the first year after delivery.

Very low birth-weight infants: parental visiting and telephoning during initial infant hospitalization.

OBJECTIVE:The purpose of this study was to investigate the nature and contribution of personal factors related to the use of prenatal care in a sample of high-risk women residing in an urban environment where care was accessible and free.STUDY DESIGN:The sample consisted of 297 African American women with low socioeconomic status and a high school education or less who were newly delivered of neonates. The level of prenatal care was classified according to the Kessner 3 Parameter Index (adequate, intermediate, inadequate). Women who received no prenatal care made up a fourth group. Subjects responded to the “Ten-Item Checklist” of Richwald, Rhodes, and Kersey and an in-person interview that queried their reasons for obtaining different levels of prenatal care.RESULTS:Both personal and structural reasons were described by women for not obtaining care earlier in pregnancy or at all. The mean number of personal and structural problems reported per subject was inversely correlated to the level of prenatal care obtained. However, personal problems were the single most important reason cited by these women. Personal problems that were statistically significant different among the groups were drug use and desire for an abortion. The structural barriers that exhibited statistically significant differences among the groups were trouble scheduling an appointment, access totransportation, dislike of health care professionals and institutions, access to child care, and not knowing where to go.CONCLUSION:Both personal and structural problems were cited as reasons for not obtaining adequate prenatal care. Structural barriers to prenatal care have been identified and extensively studied. These barriers to care continue to persist, despite innovations in program delivery and access. This study demonstrates that the significance of personal problems has not been adequately considered as a major factor associated with insufficient prenatal care.

Functions of the CNS in early discharge and home followup of very low birthweight infants.

The purposes of this study were to examine visiting and telephoing patterns of families of very low birth-weight (VLBW) infants during their initial hospitalization and to identify factors related to visiting and telephoning. The sample of 65 VLBW infants (< 1,500 gm) and their families was followed for 6 weeks in the special care nurseries. Mothers were the primary visitors, with the typical mother visiting the nursery twice per week. Fathers and other family members made most of their visits in the first few weeks with minimal involvement thereafter. During a typical week the number of telephone calls to the nursery from mothers ranged from one to three. Fathers and other family members made minimal calls. Significantly fewer visits were made by families in which the mother was unmarried, the mother was younger, Medicaid was the type of insurance, annual income was less than

Weight, Nutrition, And Immune Status in Postpartal Women

10,000, and private transportation was unavailable. There were no significant relationships between total number of telephone calls made and maternal demographic variables.

From Diagnosis to Home Management: Nutritional Considerations for Women With Gestational Diabetes

Dr Dorothy Brooten and her colleagues have been widely recognized for their impact on advanced practice nursing through their studies of affect of advanced practice nurses (APNs) on both quality and cost of care. Their work has been cited as an outstanding example of testing an innovative model of healthcare delivery. They developed and tested a model of transitional nursing care in which APNs provide direct patient care both before and after discharge. The following article describes the functions of clinical nurse specialists (CNSs) in the first test of the model, which was with very low birthweight infants (VLBWs), and funded by the Robert Wood Johnson (RWJ) Foundation. The VLBW study was followed by a Program Grant funded by the National Institute for Nursing Research (NINR) that supported 3 studies: women undergoing unplanned cesarean sections and their infants, high-risk pregnant women and their infants, and women after hysterectomy surgery. Brooten and her colleagues recognized the need to test models for care and to include measures of cost, as well as other patient outcomes. Their work has demonstrated time and again that improved quality in relation to patient outcomes and decreased cost are associated with the interventions of APNs. Given the financial constraints that exist currently, there is even more reason to continue to test outcomes related to APN practice. Thanks to Brooten, we have a body of work related to transitional nursing care. What we need are studies related to other aspects of APN practice. Barbara Hazard Munro, PhD, RN, FAAN Various studies have been conducted which explore the different functions of the clinical nurse specialist (CNS). This study details the functions of CNSs providing direct patient care before and following hospital discharge of very low birthweight infants and effect on patient outcome. The study reports on CNS interactions with 36 families whose infants were discharged early from the hospital, and who received discharge planning, teaching, and home followup for 18 months.

The development of nursing in Thailand and its relationship to childbirth practices.

Postpartal weight loss, nutritional intake, and immune status were examined in 65 women. Although 80% of the women lost weight and were not overweight by the 4th postpartal month, the majority had diets that were inadequate in fat content (> or = 30% of calories from fat) or protein content (< or = 12% of calories from protein), or in terms of caloric intake (< or = 1,200 calories or > or = 2,200 calories). Differences in some immune cell subsets were noted between women with high-fat and normal-fat diets. Women with high-fat diets had lower percentages of specific immune cell subsets than women with normal-fat diets. Protein intake was not related to immune cell phenotypes.

Pattern of postpartum blues

Each year 90,000 women in the United States are diagnosed with gestational diabetes. The transition from diagnosis to home management is a time of high stress for these women. Anxiety may lead to difficulty with self-care in general and the diabetic diet in particular. Follow-up education by a diabetes educator can help clients plan meals that comply with the nutritional meal plan without disrupting the familys eating habits. The client should be taught to measure portions, to recognize sugar as an ingredient in foods and medicines, and to deal with special occasions such as holiday meals, travel, and illness. If extended home care is not feasible, the creative diabetes educator will devise other educational opportunities, such as home videos, telephone support networks, special childbirth classes for women with gestational diabetes, and luncheon meetings at which nutritionally correct meals are served.