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It is important for nurse educators to develop deliberate experiences within the curriculum to educate future nurses not only on the benefits of breastfeeding but also on how to advocate and support the breastfeeding woman. A breastfeeding workshop utilizing innovative teaching strategies was implemented during an obstetrical nursing course in the fall 2017 semester. After the workshop, students reported an increase in knowledge, skills, and attitudes surrounding breastfeeding. The students were able to aptly demonstrate their new breastfeeding knowledge during simulation.

To examine access to perinatal nurse home visiting services for high-risk pregnant women who have diabetes or hypertension.Secondary data analysis.Philadelphia, PA.Pregnant women who had a live birth during 2012 and those referred to a community-based agency for perinatal nurse home visiting because of their diagnosis of diabetes or hypertension.Access to services was measured by examining referral information (dosage, diagnosis, gestational age at time of referral, and insurance type) retrieved from administrative logs of the community-based organization that provides perinatal home visiting to high-risk pregnant women. The population-based prevalence rates of hypertension and diabetes were calculated from birth record data provided by the Philadelphia Department of Public Health.During 2012, 595 pregnant women were referred for perinatal nurse home visiting services. The mean gestational age when referred for services was 24.9 weeks (standard deviation = 8.5) with a mean number of 8.8 authorized visits (standard deviation = 8). Associated with more authorized visits was having Medicaid as the insurance type and medical diagnoses that included hypertension (p .01). Philadelphia prevalence rates for diabetes and hypertension varied by race and ethnicity (p .001); Asian mothers had the greatest rates for diabetes and Black mothers the greatest rates for hypertension.Various models of home visiting programs exist to improve maternal and child health outcomes. Because maternal morbidity and mortality rates are rising in the United States, further research about perinatal nurse home visiting programs for pregnant women with diabetes and hypertension is warranted.

Palliative care is an integral part of neonatal care. Nurses are key to the integration of the family in this type of care. Nurses are also key players to improved communication among the health care team. This article will discuss palliative care as a part of family-centered care and the critical role nurses play.

Pregnancy in an early adolescent carries with it specific ethical considerations, in some ways different from pregnancy in an adult and from medical care of a non-pregnant adolescent. Obstetrical ethics emphasizes the right of the patient to autonomy and bodily integrity, including the right to refuse medical intervention. Pediatric ethics recognizes the right of parents, within limits, to make medical decisions for their children, and the right of a child to receive medical or surgical interventions likely to be of benefit to her, sometimes over her own objections. As the child gets older, and particularly during the years of adolescence, there is also a recognition of the right to an increasingly prominent role in decisions about her own healthcare. Pediatric obstetrical ethics, referring to ethical decisions made by, with, and for pregnant early adolescents, represents the intersection of these different cultures. Principles and approaches from both obstetrical and pediatric ethics, as well as a unified understanding of rights, obligations, and practical considerations, will be needed.

Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized.

Objective To determine the satisfaction of pregnant women who presented at a triage unit in an obstetric birthing careunit with obstetric triage services. Design Qualitative descriptive with conventional content analysis. Setting Individual audio recorded telephone interviews with women after discharge from a tertiary care hospital’sobstetric triage unit. Participants Purposive sample of 19 pregnant women who had received obstetric triage services. Methods A semi-structured interview guide was used for data collection. All interviews were audio-taped and transcribed verbatim. Data analysis was consistent with qualitative content analysis with open coding to categorize anddevelop themes to describe women’s satisfaction with triage services and care. Results Five themes, Triage Unit Environment, Triage Staff Attitude and Behavior, Triage Team Function, Nursing Care Received in Triage and Time Spent in Triage, illustrated the women’s recent triage experiences. Overall the women werevery satisfied with the triage services. Women appreciated a caring approach from triage nurses, being informed aboutthe well-being of themselves and their fetuses, being closely monitored, and effective teamwork among the membersof the health care team. Conclusions The results indicated that a humanizing, caring approach by the inter-professional team offering obstetrictriage services contributed to women’s satisfaction and woman-centered care.

Health care technology can generate massive amounts of data. However, when data are generated from disparate, uncoordinated systems, using them to make decisions related to staffing can be a challenge. In this article, I describe the importance of data standardization, system interoperability, standard terminologies that support nursing practice, and nursing informatics expertise as tools for improving the usefulness of electronic systems for informing staffing decisions.

This project was designed to test a nurse staffing model for its ability to accurately determine staffing needs for a large-volume labor and birth unit based on a staffing gap analysis using the nurse staffing guidelines from the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). The staffing model and the AWHONN staffing guidelines were found to be reliable methods to predict staffing needs for a large-volume labor and birth unit.

The purpose of this study was to assess the effectiveness of instituting a comprehensive protocol for the treatment of maternal hemorrhage within a large health care system. A comprehensive maternal hemorrhage protocol was initiated within a health care system with 29 different delivery units and with60,000 annual births. Compliance with key elements of the protocol was assessed monthly by a dedicated perinatal safety nurse at each site and validated during site visits by system perinatal nurse specialist. Outcome variables were the total number of units of blood transfused and the number of puerperal hysterectomies. Three time points were assessed: (1) 2 months before implementation of the protocol, (2) a 2-month period that was measured at 5 months after implementation of the protocol, and (3) a 2-month period at 10 months after implementation. There were 32,059 deliveries during the 3 study periods. Relative to baseline, there was a significant reduction in blood product use per 1000 births (-25.9%; P.01) and a nonsignificant reduction (-14.8%; P = .2) in the number of patients who required puerperal hysterectomy. Within a large health care system, the application of a standardized method to address maternal hemorrhage significantly reduced maternal morbidity, based on the need for maternal transfusion and peripartum hysterectomy. These data support implementation of standardized methods for postpartum care and treatment of maternal hemorrhage and support that this approach will reduce maternal morbidity.

Research about the effects of nurse staffing in the perinatal setting has been limited. To guide practice and ensure optimal outcomes, data are greatly needed on the type and amount of nursing care needed by women and their fetuses during labor. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) is sponsoring a study about nursing care during labor and birth with a focus on potential relationships between missed care (delayed, unfinished, or completely missed nursing care that was expected as part of routine care for childbearing women and their fetuses/newborns during the labor and birth process and the 2-hour postpartum recovery period) and nurse staffing and selected patient outcomes. Findings may support practice recommendations and suggest directions for future research.

Background Antenatal care is an important component of maternity care. In many parts of the world, midwives are the primary caregivers for childbearing women, providing a high level of continuity of care during a normal pregnancy. While in China, obstetricians are the primary providers of antenatal care for all childbearing women; and midwives only provide intrapartum care to labouring women. Today midwifery as a profession in China has been marginalised. Pregnant women usually lack individualised continuity of care from midwives during the perinatal period. There have been few randomised controlled trials of midwifery care practice in mainland China. Objective (1) To develop and implement a model of Chinese midwives' antenatal clinic service and (2) to explore its effect on childbirth outcomes, psychological state and satisfaction, for primiparae. Design and methods Two-group randomised controlled trial. One hundred and ten pregnant women were assessed for eligibility and invited to participate in either the intervention group (midwives' antenatal clinic service) or the control group (routine antenatal care) in the Obstetrics and Gynaecology Hospital of Fudan University from September 2011 to December 2011. Baseline data were collected, and then women were randomised to individual midwives' antenatal clinic care (intervention group) or regular antenatal clinic service by obstetricians and obstetric nurse (control group). The research hypothesis was that compared with regular obstetrician-led antenatal care, the midwives' antenatal clinic service would decrease the caesarean section rate, produce more favourable birth outcomes and women's greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. The sample size of 110 was calculated to identify a decrease in caesarean birth from 70% to 40%. Birth outcomes, satisfaction and anxiety score in the two groups were compared. Setting The midwives' antenatal clinic in the Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China. Participants 55 women, attending the midwives' antenatal clinic (the intervention group) and 55 women, entering the control group. Results Women in the intervention group were more likely than women in the control group to have a vaginal birth (35 [66.04%] versus 23 [43.40%]; 95% CI for difference 3.69–41.60). Women in the intervention group had a higher perinatal satisfaction but lower anxiety score than those in the control group. No differences were seen in neonatal Apgar score and in the amount of bleeding 2h post partum. Conclusion and implications for practice The midwives' antenatal clinic can decrease the rate of caesarean section and enhance women's satisfaction with midwifery care. Further research needs to be conducted to implement this model of care more widely. We will attempt to make midwifery care a true choice for Chinese women.

Background Oral health may plan an important role in the general health of adolescents who are pregnant and parenting. However, little is known about the socio-behavioral and environmental experiences that may affect the adolescent woman's oral health and quality of life. Objectives The purpose of this study was to explore oral health experiences among adolescent women who were pregnant and parenting. Design This was a qualitative descriptive study. Participants Twenty-four adolescent women who were pregnant and parenting, 14–18 years of age, who read and spoke English and were enrolled in an alternative school-based program. Methods Manifest and latent content analysis were conducted by hand with data from face-to-face interviews, observations, field notes, and reflective journaling. Member checks confirmed credibility of the qualitative findings. Results Four themes emerged from the oral health data: perceptions, knowledge and practices, myths and misconceptions, and values. Conclusion Nurses may play a key role in improving the oral health status of adolescents who are pregnant and parenting. Oral health should be a routine part of every general health assessment.

ResumenObjetivoDemostrar que la revisión de la cavidad uterina instrumental gentil previene mayor-mente, la hemorragia posparto en comparación con la revisión manual de la cavidad uterina.MétodosEstudio observacional, transversal, descriptivo y asociativo. Se llevó a cabo en las pacientes que ingresaron a las unidades toco-quirúrgicas de 2 hospitales públicos en el Estado de México. Muestreo por conveniencia (aquellas pacientes a quienes se les realizó revisión de cavidad uterina, durante la atención del parto). Muestra integrada por 236 pacientes.ResultadosHubo 76 casos de hemorragia posparto, que se analizaron por grupos de edad, distinguiendo entre adolescentes, en edad reproductiva óptima y en edad materna avanzada, encontrándose mayor incidencia en el primer y tercer grupo, con el 34.4% y 48.3% de los casos, respectivamente. La relación entre hemorragia posparto y tipo de técnica de revisión de cavidad uterina, mostró mayor incidencia en la revisión manual. Los casos analizados según la instrucción del personal que brindó la atención, mostraron mayor número de casos de hemorragias, en quienes fueron atendidos por personal en formación. Los especialistas de Enfermería Perinatal, llevaron a cabo 97 procedimientos de atención de parto, 25 presentaron hemorragia posparto, frente a 72 que no presentaron la patología.ConclusionesLa revisión manual de cavidad uterina se asocia estrechamente con la aparición de hemorragia posparto, en contraste con la revisión instrumentada gentil, en la que se registró menor incidencia de esta complicación. La revisión de cavidad uterina debe practicarse bajo indicaciones precisas, hecho que contribuye a la disminución de complicaciones en el posparto.AbstractObjectiveTo demonstrate that the gentle instrumental uterine cavity assessment largely prevents postpartum hemorrhage in comparison to the manual assessment.MethodsCross-sectional, observational, descriptive, and associative study on patients admitted to the labor-surgical units of two public hospitals in the State of México, using a convenience sample (patients to whom a uterine cavity assessment was performed during their labor process) of 236.ResultsThere were 76 total cases of post-partum hemorrhage. Patients were classified in three age groups: adolescents, optimal reproductive age, and advanced maternal age. Post-partum hemorrhage cases were prevalent in the first and third groups with 34.4% and 48.3% respectively. The manual uterine cavity assessment technique resulted in a higher prevalence of postpartum hemorrhage. More post-partum hemorrhage cases were also found in those patients attended by inexpert staff. Perinatal Nursing Specialists, conducted 97 childbirth care procedures, 25 had Postpartum Hemorrhage, compared to 72 who did not have the pathology.ConclusionsThe manual uterine cavity assessment technique, is closely associated with the onset of Postpartum Hemorrhage, Gentle instrumented uterine cavity assessment resulted in a lower incidence of post-partum hemorrhage. In order to decrease post-partum complications, the uterine cavity assessment must be performed through precise procedures.

Adolescent pregnancies are higher-risk pregnancies, and standard obstetrical care environments may not meet their needs. The objective of this study was to determine if adolescents followed in a community-based adolescent outreach obstetrical program had improved perinatal outcomes compared with provincial control subjects.We conducted a matched cohort study. Adolescent women who received prenatal care in the outreach program between 2004 and 2010 (intervention group, n = 206) were identified and matched 1:4 to adolescent control subjects in the provincial perinatal database (n = 831). Chi-square and Student t tests were performed for categorical and continuous variables. Regression models assessed the association between the intervention and pregnancy/perinatal outcomes.The intervention cohort had significantly higher rates of smoking, drug use, and alcohol use than control subjects P0.001); however, rates of first trimester visits (76.7% vs. 64%, P = 0.009), prenatal class attendance (52.8% vs. 30.3%; P0.001), and group B streptococcus screening (P = 0.01) were also higher. Although the intervention cohort had higher risk behaviours than control subjects, there were no significant differences between the groups in the proportion of preterm or very preterm births, low birth weight or very low birth weight infants, or intrauterine growth restricted/small for gestational age infants. The intervention cohort had a significantly higher mean gestational age at delivery (P = 0.005) and higher mean birth weight (P = 0.002) than control subjects. The adjusted relative risk of low birth weight was significantly lower in the intervention group (RR 0.41; 95% CI 0.18 to 0.95) and a decreased risk of preterm delivery was seen (RR 0.47; 95% CI 0.22 to 1.00).Pregnant adolescents may engage in higher-risk behaviours that can affect perinatal outcomes. Early prenatal care and education in adolescent-friendly programs may mitigate the effect of these behaviours on perinatal outcomes. Multidisciplinary adolescent-focused outreach programs that facilitate early and regular access to care are important models for future adolescent obstetrical care.

Objective To solicit input from registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) on critical considerations for review and revision of existing nurse staffing guidelines. Design Thematic analysis of responses to a cross‐sectional on‐line survey question: "Please give the staffing task force your input on what they should consider in the development of recommendations for staffing of perinatal units." Participants Members of AWHONN ( N = 884). Results Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. Consistent themes identified included the need for revision of nurse staffing guidelines due to requirements for safe care, increases in patient acuity and complexity, invisibility of the fetus and newborn as separate and distinct patients, difficulties in providing comprehensive care during labor and for mother‐baby couplets under current conditions, challenges in staffing small volume units, and the negative effect of inadequate staffing on nurse satisfaction and retention. Conclusion Participants overwhelmingly indicated current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on significant changes that had occurred since 1983 when the original staffing guidelines were published.

Objective To determine whether hospital‐based perinatal nurses with expertise in adolescent mother‐friendly care identify a need to improve inpatient nursing care of adolescent mothers and how well perinatal units support nurses' capacity to provide adolescent mother‐friendly care. Design/Setting/Participants: A key informant survey of nurses from eight perinatal units at three hospitals (four separate sites) in a Canadian city. Methods Perinatal nurses expert in the care of adolescent mothers were identified by their managers and colleagues. These nurses and all perinatal clinical educators were invited to participate. Twenty‐seven of 34 potential key informants completed the survey. Results Key informants rated their own skill in caring for adolescent mothers higher (median 8.0) than they rated the skill of other nurses (median 6.0) on their units. They attributed their expertise working with adolescent mothers to their clinical and life experiences and their ability to develop rapport with adolescents. A common reason for the assigned lower peer‐group ratings was the judgmental manner in which some nurses care for adolescent mothers. Key informants also identified that hospital‐based perinatal nurses lack adequate knowledge of community‐based resources for adolescent mothers, educational programs related to adolescent mother‐friendly care were insufficient, and policies to inform the nursing care of adolescent mothers were not available or known to them. Conclusion A minority of perinatal nurses have expertise in adolescent mother‐friendly care. There is a need for perinatal unit‐level interventions to support the development of nurses' skills in caring for adolescent mothers and their knowledge of community‐based resources. Peer mentoring and self‐reflective practice are promising strategies.

Background For most of the population in Africa, district hospitals represent the first level of access for emergency and essential surgical services. The present study documents the number and availability of surgical and obstetrical care providers as well as the types of surgical and obstetrical procedures being performed at 10 first-referral district hospitals in Ghana. Materials and Methods After institutional review board and governmental approval, a study team composed of Ghanaian and American surgeons performed on-site surveys at 10 district hospitals in 10 different regions of Ghana in August 2009. Face-to-face interviews were conducted documenting the numbers and availability of surgical and obstetrical personnel as well as gathering data relating to the number and types of procedures being performed at the facilities. Results A total of 68 surgical and obstetrical providers were interviewed. Surgical and obstetrical care providers consisted of Medical Officers (8.5%), nurse anesthetists (6%), theatre nurses (33%), midwives (50.7%), and others (4.5%). Major surgical cases represented 37% of overall case volumes with cesarean section as the most common type of major surgical procedure performed. The most common minor surgical procedures performed were suturing of lacerations or episiotomies. Conclusions The present study demonstrates that there is a substantial shortage of adequately trained surgeons who can perform surgical and obstetrical procedures at first-referral facilities. Addressing human resource needs and further defining practice constraints at the district hospital level are important facets of future planning and policy implementation.

Obesity is a major risk factor for many obstetrical complications, including pre-eclampsia, gestational diabetes, indicated preterm birth, macrosomia, and stillbirth. Clinicians should be aware of the unique obstetrical management considerations related to obesity, including recommendations for alterations in prenatal care. In addition, obese gravidas commonly have underlying medical conditions that can impact pregnancy and must be appreciated to optimize care. Obese women should be educated about these risks, ideally before pregnancy. Awareness of the complications that can arise for these women and potential changes in management offer opportunities to improve both prenatal and lifelong health.

to evaluate the amount of social support offered to Finnish mothers and fathers by nursing professionals in the postnatal ward, identify the type of additional support that mothers and fathers desire, and analyse the factors associated with support that mothers and fathers received in the postnatal ward.data were collected as part of a larger collaborative project called 'Urban Parenthood-Enhancing Well-being of Infants' Families' involving the well-being of families in the postnatal wards of two Finnish university hospitals during the winter of 2006-2007. Data were collected using a questionnaire designed to measure social support on a scale from 1 to 6. The questionnaire included two open-ended questions. Mothers and fathers completed the questionnaire independently, either in the postnatal ward or immediately after discharge.questionnaires were returned by 863 (66%) mothers and 525 (40%) fathers. The amount of support received from nursing professionals was moderate or little. Of the three types of support, mothers and fathers experienced 'affectional support' most strongly [mothers' mean 4.12, standard deviation (SD) 1.04; fathers' mean 3.98, SD 1.25] and 'concrete support' least strongly (mothers' mean 3.08, SD 1.17; fathers' mean 3.03, SD 1.43). Least social support was received by parents in families where the mother was multiparous (p0.001) or older (p ≤ 0.001), and by fathers who were not able to stay in the ward around the clock (p0.001). Open-ended questions indicate that mothers and fathers desire greater social support in all its forms.health care during the postnatal period should be developed such that it becomes more family centred, encouraging and resource strengthening.Attention must be paid to the support received by older mothers and parents in families where the mother is multiparous. In addition, possibilities for fathers to participate in postnatal care must be increased.

Over the past three decades, ultrasound has played an increasing role in perinatal nursing. In obstetric triage, many clients present with indications for ultrasound. In one institution's triage unit, restrictive policies, lack of opportunities for learning skills, and an unstructured method of verifying competence created barriers to nurses learning ultrasound. A revised approach using learner portfolios and a hands-on workshop resulted in improved acquisition of skills, learner confidence, and increased accessibility of ultrasound to clients.

Background Factors previously shown to influence patient care include effective decision making, team work, evidence based practice, staffing and job satisfaction. Clinical rounds have the potential to optimise these factors and impact on patient outcomes, but use of this strategy by intensive care nurses has not been reported. Objectives To determine the effect of implementing Nursing Rounds in the intensive care environment on patient care planning and nurses' perceptions of the practice environment and work satisfaction. Design Pre-test post-test 2 group comparative design. Settings Two intensive care units in tertiary teaching hospitals in Australia. Participants A convenience sample of registered nurses ( n =244) working full time or part time in the participating intensive care units. Methods Nurses in participating intensive care units were asked to complete the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Nursing Worklife Satisfaction Scale (NWSS) prior to and after a 12 month period during which regular Nursing Rounds were conducted in the intervention unit. Issues raised during Nursing Rounds were described and categorised. The characteristics of the sample and scale scores were summarised with differences between pre and post scores analysed using t -tests for continuous variables and chi-square tests for categorical variables. Independent predictors of the PES-NWI were determined using multivariate linear regression. Results Nursing Rounds resulted in 577 changes being initiated for 171 patients reviewed; these changes related to the physical, psychological – individual, psychological – family, or professional practice aspects of care. Total PES-NWI and NWSS scores were similar before and after the study period in both participating units. The NWSS sub-scale of interaction between nurses improved in the intervention unit during the study period (pre – 4.85±0.93; post – 5.36±0.89, p =0.002) with no significant increase in the control group. Factors independently related to higher PES-NWI included intervention site and less years in critical care ( p Conclusions Implementation of Nursing Rounds within the intensive care environment is feasible and is an effective strategy for initiating change to patient care. Application and testing of this strategy, including identification of the most appropriate methods of measuring impact, in other settings is needed to determine generalisability.

The article discusses the process of curriculum development, delivery and evaluation of a post-registration neonatal surgical care module for neonatal nurses. The module was set up in response to the Neonatal Taskforce recommendations published in 2009 and the first intake of 28 attendees has now completed. The issues discussed in this paper aim to inform and add to knowledge in the field of neonatal education in relation to broadening the scope of content within neonatal Continuous Professional Development (CPD) curricula. This has, to date, been mainly medical focused and dedicating CPD modules to neonatal surgical practice specifically is a recent positive development in this speciality.

Summary Assessing nurses' practical capability was a challenge in the past as it is today. In 1901 New Zealand established state registration of nurses, with a standardised three-year hospital-based training system and state final examinations. Nurses' practical capability was assessed in an oral and practical examination and in general nursing questions in written medical and surgical nursing papers. This historical research identifies the practical component of nursing assessed in these examinations, categorising it as nursing the patient, the room and the doctor. It considers changes in the nursing profession's view, 1900–1945, of the best way to assess nurses' practical capability. This shifted from the artificial setting of the oral and practical examination held by doctors and matrons, to a process of senior nurses assessing candidates in the more realistic setting of a ward. The research also considers whether the nursing or medical profession defined nursing practice. By the end of the time period, the nursing profession was claiming for itself the right to both determine and assess the practical component of nursing.

Objective The aims of this study were to explore pressure ulcer incidences and practice variations in the nursing intervention provided for preventive pressure-ulcer care to patients either with pressure ulcers or at risk of pressure ulcers, and to examine them in relation to the patients’ medical problems and the characteristics of the nurses who cared for them. Methods The narrative nursing notes of 427 intensive-care patients who were discharged in 2007 that were documented at the point-of-care using standardized nursing statements were extracted from a clinical data repository at a teaching hospital in Korea and analyzed. The frequencies of five nursing interventions for pressure-ulcer prevention were compared between pressure-ulcer and pressure-ulcer risk groups, as were the characteristics of the nurses who were treating the patients in these two groups. Nursing interventions for pressure-ulcer prevention were also assessed relative to the patients’ medical problems. Results The overall incidence of pressure ulcers was 15.0%. Position change was the most popular nursing intervention provided for pressure-ulcer prevention in both the pressure-ulcer and at-risk groups, followed by skin care. There was a statistically significant tendency toward a greater frequency of providing skin care and nutritional care in the at-risk group than in the pressure-ulcer group. There was no statistically significant difference in the mean frequencies of nursing interventions relative to the patients’ medical problems in the pressure-ulcer group. However, frequencies of nursing interventions did differ significantly between patients with neurological problems and those with other medical problems in the at-risk group. Analysis of the nurses’ characteristics revealed that more nursing interventions were documented by those who were younger, less experienced, and more educated. Conclusion A standardized nursing-terminology-based electronic nursing record system allowed us to monitor the variations in nursing practice with regard to preventive pressure-ulcer care in intensive-care patients with and at risk of pressure ulcers. We found that pressure-ulcer prevention care was provided at frequencies much lower than the recommended guidelines. Further studies on identifying the factors affecting pressure-ulcer prevention care and ways to improve the quality of that care are needed.

All nurses have a duty to maintain a complete and accurate recording of all care they provide in accordance with acceptable standards of care. Nurses working in specialty areas of nursing practice such as the neonatal intensive care unit are at greater risk for exposure to litigation simply by the nature of the complexities of the care required of patients. Being aware of common areas of malpractice litigation in neonatal nursing increases the awareness and recognition of potential vulnerable charting practices of nurses. Knowing the “how,” “what,” and “when” of documentation can decrease exposure to litigation by strengthening the accuracy of medical record entries; this is the nurse's best defense.

Nurses play a vital role in providing care to mothers and infants during a disaster, yet few are fully prepared for the challenges they will encounter under extreme conditions. The ability to provide the best possible care for families begins with understanding the perinatal issues in relation to each phase of the disaster management process. This article reviews the hospital and perinatal nursing role in the mitigation, preparedness, response, and recovery phases of disaster management.

Teaching nurses to care for the woman and fetus during the intrapartal period presents unique challenges for educators in both the academic and clinical setting. Understanding nursing care needs and developing the professional judgment needed to provide safe care don't happen in a single moment or through the discrete event of hearing, reading or watching. Responding to a complex phenomenon requires learning opportunities that are cumulative, integrative and multifaceted.

This paper presents methods for identifying and analyzing associations among nursing care processes, patient attributes, and patient outcomes using unit-level and patient-level representations of care derived from computerized nurse documentation. The retrospective, descriptive analysis included documented nursing events for 900 Labor and Delivery patients at three hospitals over the 2-month period of January and February 2006. Two models were used to produce quantified measurements of nursing care received by each patient. The first model considered only the hourly census of nurses and patients. The second model considered the size of nurses’ patient loads as represented by computerized nurse-entered documentation. Significant relationships were identified between durations of labor and nursing care scores generated by the second model. In addition to the clinical associations identified, the study demonstrated an approach with global application for representing the amount of nursing care received at the individual patient level in analyses of patient outcomes.

Objectives This paper reports on a survey documenting physicians' assessment of current levels of care in the nursing home and of the importance and feasibility of strategies to improve care. Design This is a descriptive study presenting responses to a Web-based questionnaire that asked about treatment of behavior problems in nursing homes as well as about perceptions of quality of care. Setting Nursing home. Participants Participants were 110 physicians who provide services in a nursing home environment. Measurements Likert-type ratings of perceived levels of care in the facility and of the importance and feasibility of strategies to improve care. Results These physicians perceived current levels of care in the nursing home to be acceptable, but not good or outstanding. Overall care in the facility and the level of staff care for residents were seen as better than the level of administration care for nursing assistants or for physicians. The importance of specific strategies to improve care was rated higher than the feasibility of these strategies actually being employed. The item rated the most important for improving care was having the administration show respect, support, and caring for front line staff; this item was also rated the most feasible. Other items rated as highly important concerned either front line staff or families. The feasibility of improving care, but not the importance of improvement, was associated with the perception of current levels of care. Conclusion These findings can be used as guidelines for improving the culture of care in nursing home facilities.

Summary Emergency nurses are expected to work under pressure to many standards, guidelines and protocols related to patient care, and often in an advanced practice role. These expectations can sometimes take priority over basic nursing care once emergency/resuscitative intervention has occurred. However posing the question ‘How would I want this patient to be cared for if they were my grandmother/father/child?' sets a benchmark for nursing practice [Fulbrook P, Grealy B. Essential nursing care of the critically ill patient. In: Elliot D, Aitken L, Cheboyer W, editors. ACCCN Critical Care Nursing . Sydney: Elsevier; 2006.]. How well patients are cared for has a direct effect on their sense of wellbeing and their recovery. Effective communication is essential to good nursing care and patient outcomes. The length of stay of the patient in the ED may be extended, and the use of "holding" wards while waiting for investigation results of patients for probable discharge necessitates the ED nurse to consider basic but essential aspects of nursing care that will be discussed.

Objectives to explore an experiential understanding of the relationships that perinatal nurses fostered with birthing women within their clinical practices. Design a feminist phenomenology provided the methodological framework for the research study. Participants/setting interviews were conducted with eight perinatal nurses and eight postpartum women from a low-risk obstetrical hospital in Western Canada. Participant observation was also conducted with the eight nurses after their interviews. Findings embodied trust, one of the major themes reflected in the research, highlighted the ways in which a trusting relationship with a perinatal nurse simultaneously established a birthing woman's self-trust, thus enabling her to develop her own bodily abilities to birth her baby into the world. Conclusions because feminist phenomenology takes seriously the embodied practices of the female subject, this research attends to the practices of women and nurses in ways that other non-feminist or non-experiential methods dismiss or reject. Future research is needed, however, to further explore these relationships in other situations, particularly in places of difference. Only then will nurses, midwives and other perinatal health-care providers have the knowledge required to work with women in empowering and embodying ways during their experiences of birth.

Summary Emergency nurses are expected to work under pressure to many standards, guidelines and protocols related to patient care, and often in an advanced practice role. These expectations can sometimes take priority over basic nursing care once emergency/resuscitative intervention has occurred. However, posing the question ‘How would I want this patient to be cared for if they were my grandmother/father/child?' sets a benchmark for nursing practice [Fulbrook P, Grealy B. Essential nursing care of the critically ill patient. In: Elliot D, Aitken L, Cheboyer W, editors. ACCCN critical care nursing . Sydney: Elsevier; 2006]. How well patients are cared for has a direct effect on their sense of well-being and their recovery. Effective communication is essential to good nursing care and patient outcomes. The length of stay of the patient in the ED may be extended, and the use of "holding" wards while waiting for investigation results of patients for probable discharge necessitates the ED nurse to consider basic but essential aspects of nursing care that will be discussed. Other essential aspects of care such as psychosocial; including culture, pain management and infection control are beyond the scope of this paper.

The acute-care hospital is rapidly changing with respect to both patients and the nursing workforce, and has challenged traditional models of nursing care delivery. Patients spend less time in the hospital, the acuity level is higher, and the aging patient population is more vulnerable to iatragenic complications when hospitalized. The Miriam Hospital has implemented a new and holistic model of nursing care delivery, incorporating the principles of primary nursing and geriatric nursing in a professional practice framework. The project has provided a geriatric model based on the prevailing literature showing that simple nursing measures such as optimizing nutrition, mobility, and sleep can improve outcomes in older surgical patients. Preliminary findings reveal a decrease in injurious falls and hospital-acquired pressure ulcers, as well as a decrease in restraint and sitter use.

Student guidelines that are specific to patient populations in clinical units can provide a welcomed specificity to planning nursing care. When these guidelines also interrelate with previous learning, such as nursing diagnoses, nursing interventions, classifications, and nursing outcomes, they add reinforcement and reassurance for learners who can be easily distracted in new clinical environments. The Perioperative Nursing Data Set provides a standardized language for use with perioperative patients to meet patient-focused outcomes that reflect use of nursing diagnoses, interventions, and outcomes.

Objective To describe policies, practices, and associated rationales of hospital obstetric units regarding mothers’ support person options during childbirth and to explore practices concerning support of breastfeeding initiation after cesarean delivery. Design Descriptive telephone survey. Setting Hospitals in the southeastern region of the United States. Participants Convenience sample of 154 obstetric nurse manager and nurse representatives employed by the participating hospitals. Main Outcome Measures Types of policies regarding mothers’ support person options during childbirth and immediate postpartum stage, initiation of breastfeeding after cesarean birth, and attitudes about policies. Results All hospitals allowed two or more support persons during vaginal births, 89% permitted only one support person during nonemergent cesareans, and 58.0% of the nurse representatives believed that mothers should be allowed a second support person. Less than one third (31.2%) of the hospitals considered a mother’s request to breastfeed in the operating room, and most (78.6%) allowed mothers to breastfeed in the recovery room. Conclusions Overall, maternal support policies, practices, and nurse representatives’ attitudes were mother and family friendly, particularly related to vaginal births. Though breastfeeding initiation after cesarean birth was encouraging, support person options during nonemergent cesarean births and related rationales warrant further examination. JOGNN, 35, 634‐643; 2006. DOI: 10.1111/J.1552‐6909.2006.00078.x

Obstetric and neonatal nurses are expected to provide an abundance of guidance, support, monitoring, and education to women and their babies during and after delivery. Nurses should adhere to standards of professional nursing practice. This will ensure that optimal and safe care is provided for the mother and fetus or neonate. Perinatal nurses are vulnerable to litigation should complications occur. Perinatal nurses are responsible for providing routine assessments as well as initiating and performing emergency interventions. This includes recognition of the symptoms of complications in the mother and the neonate, resuscitation, and activation of the emergency system. Occasionally, nurses are obliged to question the practice of other health care providers. Although perinatal nurses continue to be at risk for malpractice vulnerability, risk reduction techniques are available to them. This article provides the nurse with knowledge of legal proceedings and strategies to reduce liability when caring for pregnant women and newborns.

In its guideline on intrapartum fetal surveillance, the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommended the availability of 1:1 nursing care (1 nurse to 1 patient) for women in active labour. The common perception is that the majority of women in labour and delivery units are in active labour. Identifying the proportion of women in active labour versus those who are not in active labour is crucial for the allocation of nursing care resources.We sought to obtain a quantitative description of our obstetrical population to determine the distribution of women in the labour and delivery (LD) unit, the obstetrical triage unit, and the labour, delivery, recovery, and postpartum (LDRP) unit and to determine the proportion of women in active labour who were receiving 1:1 nursing care.We randomly sampled and surveyed nursing care activities and patient distribution in a 1-hour period each day over a period of 4 months; each hour of the day was assessed on 5 separate occasions. The 3 units (LD, LDRP, and obstetrical triage) were surveyed simultaneously.In the LD unit, 31% of women were in active labour; of those, 92% received 1:1 nursing care. The remaining women (69%) were either in the early phase of labour, had significant obstetrical complications, were undergoing Caesarean section, or had just delivered. In the LDRP unit, 13% of women were in active labour, and 87% were postpartum. Almost one-half the women (45%) in the obstetrical triage unit were being assessed for possible labour or possible rupture of membranes, while the remainder were being assessed for other pregnancy-related problems.Contrary to common perception, the majority of women in the LD unit were admitted for reasons other than active labour but required care in that unit. The concept of providing 1:1 nursing care solely to women in active labour would leave the labour units understaffed. We recommend that institutions use a more precise classification system, rather than the presence or absence of labour, to determine individual patient risk and the appropriate nursing resource requirements.

Oncology patients are generally treated on therapeutic research protocols that detail medical treatment. Nursing care is not clearly defined in these protocols; therefore, the need to develop a set of guidelines specifically for nursing care was identified. To further enhance the specialized care that our pediatric oncology patients receive, we developed nursing care guidelines to accompany specific protocols. One of our most highly accruing protocols is designed to treat patients diagnosed with Hodgkin's disease. In an effort to increase understanding of this clinical trial, decrease potential for errors, and improve overall quality of patient care, nursing care guidelines were created. To develop the nursing care guidelines, nurses created a seven-step process: (1) studied the therapeutic protocol, established ongoing interactions with the principal investigator (brainstorming), reviewed benchmarking, (2) created the first draft of the guidelines, compared the formatting of this particular set of guidelines with those previously developed at this setting (drafting), (3) field tested guidelines, (4) revised the guidelines and subjected them to additional field testing, (5) examined the guidelines for implications related to teaching tools, (6) implemented the guidelines through in-services, and (7) developed an evaluation plan with pre- and post-tests that indicated improved disease and treatment knowledge among participating nurses. Potential contributions from implementing nursing care guidelines that parallel therapeutic protocols include more accurate and complete research data collection and a more defined role for nurses in the protocol development process. The guidelines also offer a useful, detailed resource to deliver complex protocol-directed care.

During the last century the perception of pregnancy and childbirth has changed from a normal, physiological life-event to a potentially dangerous condition. Maternity care has become more and more obstetrical care, focussed on pathology and complications. The involvement of general practitioners (GPs) in maternity care is strongly reduced and almost everywhere the same reasons are found: interference with lifestyle and interruption of office routine, fear of litigation and costs of malpractice insurance, insufficient training and insufficient numbers of cases to retain competency. In Canada, the USA, and to a lesser extent in Australia and New Zealand, GPs still providing intrapartum care are GP-obstetricians rather than maternity care providers. They provide low-risk as well as high-risk obstetrical care, especially in rural areas with few specialist obstetricians. In Europe, GPs do not provide high-risk obstetrical care. Instead they emphasize their role as generalist, and compete with midwives for a central role in maternity care for women with an uncomplicated pregnancy. The ongoing medicalisation of childbirth and the changing attitudes towards the demands of maternity care practice have diminished the role of GPs or family physicians. If they want to stay involved in maternity care in the future they need to cooperate with midwives, preferably in shared care programs.

Objective: To compare childbirth outcomes of women prospectively randomized to receive early labour assessment and support either through a home visit or by telephone triage. Methods: Women in early labour, upon seeking prior telephone advice on whether or not they were ready to be admitted to BC Women's Hospital (as was standard hospital practice), were voluntarily randomized to receive either a home visit by an obstetrical nurse or telephone triage. Results: One hundred seventeen women were randomized to receive home care and 120 to receive telephone triage. Significantly fewer women in the home care group arrived at hospital in the latent stage of labour, compared to women in the telephone triage group (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.19–0.72). Significantly fewer women in the home care group received narcotics (OR, 0.55; 95% CI,0.32–0.96). Differences observed in use of epidural analgesia (OR, 0.64; 95% CI, 0.36–1.16) were not statistically significant. Newborns in the home care group were significantly less likely to be admitted to a level II observation nursery (OR,0.13;95% CI, 0.03–0.60). More women in the home care group would recommend this type of care to a friend (P = 0.001). Conclusion: Our findings suggest an association of early labour assessment at home with both admission to hospital in the active phase of labour and reduction in use of analgesia during labour. Early labour support at home was associated with reduced rates of admission of neonates to a level II observation nursery, possibly secondary to reduced exposure to analgesics. Early labour care at home by hospital-based obstetrical nurses is safe and acceptable to women, and may offer advantages in terms of reduced interventions and more vigorous neonates.

Although the physical care of pregnant adolescents is similar to that required by adult women, adolescents have additional unique needs. Adolescents often need more support and extensive teaching during pregnancy and the postpartum. Moreover, adolescents often have fewer life experiences than do adult women, making them less able to cope with the life changes they are experiencing related to pregnancy and birth. Nonjudgmental and developmentally appropriate interactions are essential to the care of pregnant adolescents. This article explores nursing care for the physical, emotional, and educational needs of adolescents during the prenatal, intrapartum, and postpartum periods.