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Introduction The purpose of this study was to evaluate how a scripted counseling intervention affected the experience of decision making and actual choice for trial of labor after cesarean (TOLAC) or elective repeat cesarean birth (ERCB) in a cohort of women receiving care from nurse-midwives. Methods A pilot study of scripted counseling for women who had a previous cesarean about TOLAC versus ERCB was conducted at Boston Medical Center. Candidates for a TOLAC, receiving prenatal care from nurse-midwives in 2012 and 2013, were enrolled before 28 weeks' gestation. The women received 4 scripted counseling sessions during the routine prenatal visit, evidence-based information pamphlets, and an opportunity to review the hospital TOLAC consent form. Pre and post questionnaires were completed regarding birth preference, information sources, and decision factors. A midpoint assessment of the participants' knowledge of risks and benefits of TOLAC versus ERCB was conducted, and satisfaction with the intervention and outcome were assessed after the birth. Results Twenty-two women participated in the study, and 20 completed all study questionnaires. More of the participants believed they had enough information after the intervention (95% after intervention vs 70% before the intervention). Reasons for choosing ERCB included being afraid of vaginal birth complications, having prior positive experience with cesarean, and convenience of knowing when the neonate will be born. Reasons for choosing a TOLAC included the personal importance of having a vaginal birth and that recovery is faster and easier. Few women cited concerns for their own safety and that of their newborns when choosing TOLAC. Discussion Women were satisfied with the scripted counseling and found it useful in helping them make a birth mode decision. While the scripted counseling did not appear to influence preferred mode of birth, it appeared to help women follow through with the mode of birth they chose prenatally.

Purpose: In this article, we will trace the beginnings of this nurse practitioner specialist, illustrating with the stories of women's health nurse practitioners who were some of the pioneers in developing the role and models of care to meet the unique needs of women across their lifespan. Data sources: Oral history interviews with pioneers in the role who graduated from both certificate and master's programs preparing nurse practitioners informed and shaped the story. Additional data came from the literature on the evolution of advanced practice nurse roles and education and documents from early educational programs and the legal and regulatory literature affecting the roles and practices of advanced practice nurses. Conclusions: Women's health nurse practitioners have evolved to fill an important role in healthcare delivery, caring for women across generations often within the same families. Implications for practice: Women's health nurse practitioners, as do all nurse practitioners, offer a unique approach to care. To paraphrase the words of one participant, I think we address a major healthcare need because if women are educated about themselves and what they need to do to take care of themselves, the result is a better community

Frontier nursing in the public health model might invoke images of school nurses on horseback in rural Kentucky or the wilds of the western prairies. Northern Minnesota was a frontier in the last decade of the 19th century, due to the discovery of one of the richest seams of iron ore on the North American continent. Immigrants from Europe responded to the opportunities this discovery created. Among the many Finns arriving on the Iron Range of Minnesota, as it came to be named, were the parents of Lillian Augusta Wilhelmena Beck, John and Hulda Beck. Over her more than nine decades of life, their daughter became one of the most well known school nurses on the Iron Range. Her story evokes memories of the creation of school nursing in the public health model by nurses at the Henry Street Settlement in New York City.

The purpose of this column is to explicate two points of view-the novice and the expert nurse practitioner (NP) faculty member, highlighting the importance of mentoring new faculty NP members into the diverse faculty roles relating to both general academic requirements and those particular roles related to NP education. For example, arranging clinical placements is one of the most important and time-consuming responsibilities of NP faculty. Learning to juggle all the roles is a challenge to new faculty members. Such mentoring may help alleviate the phenomenon of young faculty members leaving academia and returning to full-time clinical practice. Mentoring is crucial to integrating new NP faculty members into academic life.

Objective: In response to escalation of community violence, the U.S. Department of Commerce funded Home Health VNA (HHVNA), serving the Merrimack River valley communities in Massachusetts and New Hampshire, for a project demonstrating innovative use of technology in screening for abuse and neglect. Design: All health care providers in the HHVNA were trained in screening through tools loaded on their personal digital assistants. Sample: The sample was comprised of patients served by HHVNA during the study period. Intervention: When a patient screened positive, the health care provider mobilized resources, including social workers, the office of elder services, or the local department of social services office for same-day follow-up. Outcomes: Screening for abuse and neglect was mainstreamed into routine care. Health care providers noted significant reduction in redundant domestic abuse data collection. The close communication networks created enabled health care providers to mobilize resources, initiating same-day in-depth social work assessment and referrals to appropriate community agencies. Health care providers now transmit selected encrypted health information and mandated reports to official agencies. Conclusions: Wedding technology with health care professionals' skills and knowledge can move prevention of and early intervention for domestic abuse and neglect to a new level of efficacy.

Purpose: To answer the question how do faculty nurture and reward clinical preceptors and what supports do preceptors require? Data sources: Data came from the literature and from surveying a purposive sample of 26 faculty members teaching clinical courses and arranging precepted experiences for nurse practitioner (NP) students at 26 public and private institutions across the United States. The vehicles for the survey were personal contact and e-mail. Conclusions:Schoolsofferpreceptorrewardsvaryingwidelyintheirmonetary value, from tuition and continuing education vouchers, verification of hours toward recertification, accesstoservicesand eventsoncampus, reducedprice or free admission to museums, cultural and sports events, and lectures. Faculty nurture preceptors by nominating them for awards, providing letters of reference, editing manuscripts, and collaborating on research projects. Supports for preceptors from the literature reflected National Organization of Nurse Practitioner Faculties guidelines (2000), and the policies of schools and clinical agencies,suchasprovidingcopiesofprogramobjectivesandstudentcredentials. Implications for practice and education: As NP programs have proliferated, there is increased pressure on faculty to find, nurture, reward, and retain good preceptors. Faculty must continue to work with program and agency administrators to comply with policies and create preceptor rewards to recognize their gifts to us, to our schools, and to the profession.

Purpose: This project evolved from a partnership between an advanced practice nurse (APN) graduate program and a care management insurer. The purpose of this Delphi survey was to identify (a) role components germane to the practice of APNs in managed care and (b) topics reflecting these components in the curriculum. Data sources: Data were gathered from two expert panels, clinician preceptors and faculty members. Each panel had 11 members: 11.3% and 100%, respectively, of the target populations of clinicians and faculty in the partnering agencies. Conclusions: There was considerable congruence between the panels on the survey. Implications for practice: Case vignettes could be used as a vehicle for discussion of the broader issues of population approaches to specific problems. Faculty could partner with clinicians to develop cases for discussion of evidence-based practice. Faculty and clinicians could create preceptorships focused on business management, postgraduate fellowships within managed care systems, and regular opportunities to dialogue about curriculum and essential attributes of APN graduates.

Jane Elizabeth Hitchcock was one of many distinguished nursing leaders of the 19th and early 20th centuries who attended a women's college before enrolling in a nurse training school. Like many of her contemporaries with equally impeccable family credentials, Hitchcock was something of an enigma to her family for choosing nursing over teaching, the most common acceptable career for women of her social class. Hitchcock's endowment of character, according to contemporary Lavinia Dock, exemplified the best of her Puritan roots. Her contributions to the evolution of public health nursing and the integration of public health nursing content into curriculums of training schools rivalled the achievements in higher education of her famous father, grandfather, and brother but garnered no comparable recognition. Her life presents an interesting case for analysis of an independent woman, a characteristic shared by many pioneers in the early years of public health nursing: 1893 to 1920.

Hispanic women constitute one of the fastest growing and most diverse groups in the United States, representing many countries of origin and cultural practices. The purpose of this evaluation study, using an ex post facto design, was to examine well-being during pregnancy and pregnancy outcomes for a cohort of 113 Hispanic women receiving perinatal care at the clinic of a community hospital in an old industrial city in the Northeast. The received adequacy of prenatal care for the study sample women was very high. The low-birthweight rate was lower than for the study hospital, the study city, the state, and the entire United States. The results of this study demonstrate the favorable effects of a comprehensive, interdisciplinary, and culturally sensitive model of prenatal care on these women's well-being and birth outcomes. Findings also support the need for an outreach program targeted at hard-to-reach women in the inadequate, received-care group and women with later initiation of care.

In October 1902, Lina Lavanche Rogers began her work in the New York City schools as the first school nurse in the United States. The purpose of this research was to examine the evolution of school nursing as it exemplifies development of a public health nursing specialty. Historiographic methodology was used. Primary sources included materials written by pioneers in school nursing. Secondary sources included journals, books, newspapers, biographical materials, and unpublished materials from the archives of health care and educational institutions and agencies. Public health nurses in 1902 had a model for practice that was considerably more independent and interdependent than that characterizing the practice of hospital nurses. From its origins in public health nursing, the role of the school nurse shrunk in many school systems to that of dispenser of bandages and aspirins, only to return once more to an advanced practice model. HIV, tuberculosis, sexually transmitted diseases, addiction, and violence have returned and/or replaced the contagious diseases of 1902 and the early years of school nursing. New immigrants, poverty, homelessness, and lack of primary care offer challenges to school nurses to meet the needs of schoolchildren and their families in the 1900s.

The purpose of this study was to examine relationships between role attitudes and values of nurse practitioners and their level of confidence about practice knowledge and skills. The stratified random sample comprised 482 nurse practitioners representing the specialty areas of certified nurse practitioners. Findings indicate a relationship between level of confidence and role orientation. The sample also rated themselves as more confident about hands-on skills than about indirect role components such as utilization of research, change theory, and evaluation of practice outcomes.

This investigation examined the content of advertisements in medical and nursing journals to determine if the images of nurses reflect the roles nurses play in health care. The method used was content analysis. Thirty-five nursing journals and 48 medical journals yielded 313 different advertisements picturing nurses. Data were analyzed using descriptive statistics, chi-square, correlation coefficients, and interpreted for overall impressions of the portrayals. Nurses are portrayed as sex objects, ornaments and as handmaidens to physicians. The findings demonstrate a freezing of the image of nurses in the print media.

In 1991 we will mark the 50th anniversary of the Japanese attack on Pearl Harbor. Few nurses know that the Chief Nurse aboard the USS Solace, the only hospital ship in port on that fateful day, played a critical role in caring for the survivors. Grace Lally's calm, professional manner, along with her sensitivity to the needs of her patients, her 12 nurses, and the crew of the Solace made her a hero. This study is an investigation of her role on December 7, 1941, and her contributions as a career military nurse.