Suzanne C. Smeltzer

Pregnancy in Women With Physical Disabilities

Women with disabilities are growing in number and increasingly interested in becoming mothers and raising children. However, health care providers are often unfamiliar with the health care needs of this group of women and overlook the important issues that make the difference between positive and negative experiences of these women. This article describes the preconception, antenatal, pregnancy, and postpartum issues of women with disabilities and suggests approaches to ensuring that women with disabilities have successful reproductive experiences.

Prevalence of current pregnancy among US women with and without chronic physical disabilities.

Background:The number of US women of childbearing age who have chronic physical disabilities (CPD) is increasing. However, little is known about their reproductive experiences. Historically, women with physical disabilities have confronted stigmatized attitudes about becoming pregnant. Objectives:To explore the national prevalence of current pregnancy among women with and without CPD; examine differences in current pregnancy prevalence between these 2 groups of women. Research Design:Bivariable and multivariable analyses of cross-sectional, nationally representative National Health Interview Survey data from 2006 to 2011. Subjects:Forty-seven thousand six hundred twenty-nine civilian, noninstitutionalized women aged 18–49 years. Measures:National Health Interview Survey asks women ages 18–49 if they are currently pregnant; it also asks about various movement difficulties. We used responses from 8 movement difficulty and other questions to identify women with CPD. Results:Six thousand forty-three (12.7%) sampled women report CPD. Compared with other women, women with CPD are significantly: older; more likely to be black and less likely to be Asian or Hispanic; more likely to be divorced or separated; more likely to have less than a high school education; less likely to be employed; and have much lower incomes. Across all women, 3.5% report being currently pregnant: 3.8% of women without CPD and 2.0% with CPD. Controlling for sociodemographic factors, the adjusted odds ratio (95% confidence interval) of current pregnancy is 0.83 (95% confidence interval, 0.65–1.05; P=0.12) for women with CPD compared with nondisabled women. Conclusions:Women with CPD do become pregnant, and their numbers will likely grow. Obstetrical practitioners therefore require training about the special needs of these women.

Reproductive decision making in women with multiple sclerosis.

&NA; Multiple sclerosis (MS), the most common acquired neurological disorder of young adults, often strikes young women in their childbearing years. Despite the overlap of MS onset with the childbearing years of women, little is known about how women with MS make decisions about pregnancy and childbearing. In an effort to understand the process of decision making in these women, an exploratory descriptive qualitative study was undertaken; 15 pregnant women with MS were interviewed about their decisions to become pregnant and the factors that entered into their decision‐making processes. Content analysis was used to identify and describe the fears and concerns of women with MS around the process of making decisions and about how the presence of MS had influenced that process. The unpredictability of MS and the effect that pregnancy might have on MS was a strong theme that emerged from the analysis. Although participants in this study had proceeded to become pregnant despite their fears related to the effect of pregnancy on the course of their MS, they continued to perceive their decision as risky. The diagnosis of MS affected their previous plans for number of children as well as spacing of pregnancies.

Perspectives of women with disabilities on reaching those who are hard to reach.

&NA; Healthcare needs of women with disabilities are often neglected, even for women who are well connected to the community and to the healthcare system. So‐called “hard‐to‐reach” women, whose degree of disability impedes use of community resources, have even greater difficulty obtaining health care. The purpose of this study was to gain insight into the perceptions of women with mobility and sensory limitations about several healthcare issues that may affect them: barriers to obtaining care, sources of information about health issues, ways to improve access to care, and ways to help hard‐to‐reach women overcome barriers to health care and health information. Researchers conducted six focus groups, comprising 43 women with limitations of mobility, hearing, or vision. To validate the womens input, researchers conducted two additional focus groups: the first comprised female physicians with special interest in the health care of women with disabilities, and the second included professional administrative staff of agencies that provide services for people with disabilities. In several cases, members of the physician and agency focus groups were themselves women with disabilities. In addition, 16 women with disabilities participated in an online survey; their responses were used to validate the findings of the face‐to‐face focus groups. Transcribed data were content analyzed and 10 themes identified. Seven of those themes are discussed in this article: communication barriers; lack of knowledge and awareness among healthcare providers; access issues; working the system; system issues; outreach to healthcare providers; and reaching hard‐to‐reach women. The findings of this study can provide direction to development of more effective outreach to hard‐to‐reach women with disabilities, resulting in better integration of healthcare services for this population.

Integration of Disability-Related Content in Nursing Curricula

Despite evidence that health care professionals, including nurses, do not perceive persons with disabilities in a positive light and fail to attend to their health care needs, it is not known how nursing programs address the topic of disability. This descriptive study was conducted to examine the extent to which schools of nursing in the United States address disability-related issues and the strategies used to integrate disability-related content in their curricula. A 27-item investigator-developed survey was sent to a national stratified random sample of 1,000 schools of nursing. Questions pertained to curricular content, specific groups of persons with disabilities, and teaching methods and resources used to teach nursing students about disability. Respondents indicated that they included some content related to disability in their curricula. Nursing textbooks were the most common source of information used. Barriers to including disability-related content were lack of time and lack of faculty interest or expertise. These findings can serve as a stimulus to increase the extent and breadth of disability-related issues in nursing curricula.

Challenges to research productivity of doctoral program nursing faculty

The Institute of Medicine, responding to a national health care crisis and related nursing labor force concerns, has called for an increase in the proportion of registered nurses with baccalaureate or higher degrees to 80% and a doubling of the number of nurses with doctorates by 2020. Simultaneously, large numbers of senior faculty are starting to retire, whereas the movement of doctorally prepared nurses into academia is insufficient to replace them. Issues associated with the efforts of nursing programs to increase their capacity to respond to the Institute of Medicines recommendations, particularly the effect on scholarly productivity among nursing faculty in doctoral programs, are examined in this article. Creative strategies for promoting scholarly productivity among doctoral program faculty are identified.

Maternal characteristics, pregnancy complications and adverse birth outcomes among women with disabilities

Objectives:The objective of this study is to describe the maternal characteristics, pregnancy complications, and birth outcomes among a representative sample of Rhode Island women with disabilities who recently gave birth. Methods:Data from the 2002–2011 Rhode Island Pregnancy Risk Assessment Monitoring System survey were analyzed. Results:Approximately 7% of women in Rhode Island reported a disability. Women with disabilities reported significant disparities in their health care utilization, health behaviors, and health status before and during pregnancy and during the postpartum period. Compared with nondisabled women, they were significantly more likely to report stressful life events and medical complications during their most recent pregnancy, were less likely to receive prenatal care in the first trimester, and more likely to have preterm births (13.4%; 95% CI, 11.6–15.6 compared with 8.9%; 95% CI, 8.5–9.3 for women without disabilities) and low–birth-weight babies (10.3%; 95% CI, 9.4–11.2 compared with 6.8%; 95% CI, 6.8–6.9). There was no difference in the rates of cesarean section between women with and without disabilities. Conclusions:These findings support the need for clinicians providing care to pregnant women with disabilities to be aware of the increased risk for medical problems during pregnancy and factors that increase the risk for poor infant outcomes.

General health, health conditions, and current pregnancy among U.S. women with and without chronic physical disabilities

BACKGROUND Although increasing numbers of reproductive-age U.S. women with chronic physical disabilities (CPD) are becoming pregnant, little is known about their general health or comorbid health conditions. OBJECTIVES To explore general health and comorbid health conditions among women with and without CPD by current pregnancy status. METHODS We analyzed responses of 47,629 civilian, noninstitutionalized women ages 18-49 from the 2006-2011 National Health Interview Surveys. The survey asks about: various movement difficulties; selected adult health conditions; self-reported general health; and current pregnancy. We identified women with CPD using responses from 8 movement difficulty questions. RESULTS 6043 (12.7%) women report CPD. Among nondisabled women, 3.8% report current pregnancy, as do 2.0% of women with CPD. Among currently pregnant women with CPD, 29.1% report fair or poor health, compared with only 3.2% of nondisabled pregnant women. Currently pregnant women both with and without CPD are significantly less likely to report coexisting health conditions than nonpregnant women. Nonetheless, among currently pregnant women with CPD, only 24.5% report no coexisting conditions, while 28.7% report 1, 22.8% report 2, 13.2% report 3, and 10.8% report 4-6 health conditions. In a multivariable regression controlling for age category, health status, and health conditions, CPD is not statistically significantly associated with current pregnancy. CONCLUSIONS According to national survey data, it appears that pregnant women with CPD may have a complex mix of health problems and often experience fair or poor health. Better understanding the obstetrical and subspecialty needs of these women with multimorbidities requires additional investigation.

Effects of disability on pregnancy experiences among women with impaired mobility

Little is known about how functional impairments might affect the pregnancies of women with mobility disability. We aimed to explore complications that arise during pregnancy that are specifically related to physical functional impairments of women with significant mobility disabilities.

A Profile of U.S. Nursing Faculty in Research- and Practice-Focused Doctoral Education

PURPOSE This study, which is part of a larger project, was conducted to profile the nursing faculty in the United States teaching in PhD and DNP programs. DESIGN This is a descriptive study. A sample of 554 nursing faculty who teach in PhD and DNP programs was recruited by email solicitation to represent all geographic regions of the United States. Data were collected from November 2013 through January 2014 using an online survey instrument. METHODS The instrument was developed based on results of review of the literature and of focus groups of doctoral faculty (faculty teaching in doctoral programs) to ascertain characteristics of faculty teaching in doctoral programs and of the schools in which they teach. Frequencies and descriptive statistics are reported. FINDINGS Growth in DNP programs has outpaced growth in PhD programs, and DNP graduates have moved into doctoral education in greater numbers than PhD graduates. DNP faculty report less prior experience and current productivity scholarship than faculty in PhD programs only or both types of programs. CONCLUSIONS Strategies are needed to ensure that doctoral programs are staffed by faculty who are prepared for doctoral education and the development of nursing science. CLINICAL RELEVANCE The Institute of Medicine has recommended doubling the number of doctorally prepared nurses in the United States by 2020 to ensure that sufficient numbers of faculty are available to prepare the nursing labor force that is needed for delivery of healthcare services. Nurse scientists are needed to contribute to improvement in patient care quality and safety, and practice leaders are needed to facilitate the translation of research into safe, high-quality, and cost-effective care. The landscape of doctoral education in nursing is rapidly changing.