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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.

The purpose of this study was to examine the effect of traditional acupuncture compared with acupuncture with percutaneous electrical nerve stimulation (PENS) on postoperative surgical pain relief in gynecologic oncology patients. Twenty postoperative gynecologic oncology patients were randomly assigned into the two groups, and the intervention was initiated within 24 hours after surgery. The patients in each group received four treatments in the subsequent 48 hours, with 12 hours between each treatment. Either traditional acupuncture needles or acupuncture needles with a pulsed electric current were applied to stimulate the area of points Sp6 and Sp8 near the saphenous nerve. Pain measurement instruments included a visual analog scale and the McGill Pain Questionnaire. Although the PENS treatment group demonstrated a consistent decrease in pain with each treatment application compared with the traditional acupuncture group, after 48 hours both groups experienced equivalent pain relief.

Children are witnesses to violence far too often in their daily lives. To elicit information on the needs of children and adolescents living in the United States who have witnessed violence in their homes, neighborhoods, or communities, we held focus groups with mothers who have survived interpersonal violence and whose family included child witnesses to violence (CWV), professionals who work with families affected by violence, and with adolescents who have witnessed violence. Based on four separate focus group discussions held in Massachusetts, involving a total of 45 participants, recommendations for screening, programming, and the development of healing interventions are offered to mental health professionals.

Incarceration rates for women in the United States are at least three times greater than those of any other nation (National Council on Crime and Delinquency, 2006). Recidivism, reoffense following prior conviction for a crime, compounds this problem, with nearly seven out of 10 convicted persons in the United States rearrested within 3 years of release (Hughes & Wilson, 2003). Our purpose in this article is to present a grounded theory of recidivism from the perspective of incarcerated women and to discuss the public health and other societal implications. While the participants in this research were U.S. women, we hope to provide a new perspective on the decision making of some women that results in recidivism, in order to initiate dialogue that could lead to more effective interventions worldwide.

The purpose of this study was to test the psychometric properties of a vertical version of horizontally oriented three Appraisal of Violent Situation scales that elicit women's subjective appraisals of severity, dangerousness, and controllability of violence. Construct validity of the vertical scale eliciting 64 abused women's perceptions of severity of violence experienced was supported by a low to modest correlation between that scale and the Severity of Violence Against Women Scale. Concurrent validity between the horizontal and vertical versions of the scales was demonstrated with a subsample of 26 abused women completing both. Results provide preliminary support for the revised scales.

To characterize my relationship with Phyllis, I would choose the term mentor in its broadest meaning: friend, advisor, advocate, role model, and a mentor's mentor (Dumas, 1998). For more than 20 ye...

Cervical cancer ranks second among all cancers in women world-wide, and the rate of invasive cervical cancer among women under 50 is rising in the United States. Risk factors for abnormal Papanicolaou (Pap) smears and invasive cervical cancer include genital tract infections. This study was designed to compare the rates of genital tract infections and the contraceptive choices of a random sample of 800 women, using an ex post facto design. The Pap positive women had a significantly higher rate of genital tract infections than did the Pap negative women but did not differ significantly in use of contraceptive methods. Findings support those of other researchers suggesting genital tract infections as risk factors for abnormal Pap smears and are consistent with the literature in suggesting a role for oral contraceptive pills (OCPs) in acquisition of the human papillomavirus (HPV). Caregivers can help empower women to reduce their risks through informed choices about protection and sexual behaviors.

Our purpose in conducting this research was to examine women's patterns of contraceptive use. Records for 800 women receiving care at a private, nonprofit agency providing well-woman and contraceptive care over a 15-year period constitute the data set. The records were examined for patterns of reported method choice and use, method destinations, first method choice, and demographic variables. Women reported making 1,889 method choices from among 16 different methods. Seventy-five percent of the women changed methods at least once and the women gave 1,036 reasons for changing methods. Oral contraceptives and condoms were the methods most commonly tried by the women. The women's patterns of contraceptive use were very individualized, were neither linear nor predictive as other investigators have reported, and method destinations could not be predicted from previous method use.Patterns of contraceptive use were investigated in a retrospective review of the records of 800 US women receiving well-woman and family planning care at a private, nonprofit agency in Massachusetts. Overall, women made 1889 method choices from among 16 different methods during the 15-year study period. Oral contraceptives and condoms were the methods most commonly selected. 75.2% changed methods at least once (mean number of changes, 2.2) and gave 1036 reasons for their method switching. The 55.5% of women whose first contraceptive method was hormonal reported fewer methods of any type over the 15-year study period than those who began with a non-hormonal method. This factor accounted for 12% of the variation in total number of methods women reported using. Overall, contraceptive use patterns were individualized and non-linear, with few women choosing the same methods in the same order. Method choices could not be predicted from previous method use. Contrary to the findings of other studies, no trend from less effective to more effective methods was observed.

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.

The purpose of this study was to explicate the concept of cognitive dissonance as experienced and reported by nurse practitioner (NP) faculty members.Responses from NP faculty members to an online survey about their experiences with cognitive dissonance.The respondents detailed their experiences with cognitive dissonance, citing differences between expectations for which they are rewarded and those for which they are paid.Expecting all faculty members to excel in practice, research, teaching, and service may create unrealistic workloads for NP faculty members. Examining expectations and considering creation of a clinical track for faculty who practice may be options administrators of NP programs might explore.

In recent decades, the prevalence of abuse against women, older persons, and persons with disabilities has become a major public health problem. Health professionals, urged by their professional associations to universally screen these groups, have employed various tools in an effort to identify individuals in need of help. Yet many of the tools used widely in clinical settings have limitations in terms of empirical soundness. This article presents tools used to screen women, older persons, and persons with disabilities as well as data on the reliability and validity of these instruments. These properties and the resources needed to reduce harm are important factors to consider before implementing screening. The article concludes with a summary of the risk–benefit issues related to the use of these tools and universal screening in general.

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.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.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.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.

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.

Concept analysis allows us to examine the attributes and characteristics of a concept. The concept of decision making is central to the practice of nursing. Decision making occurs at all levels of human thought and action, so it has been explored in many disciplines. It is important to explore this concept from the perspective of the discipline of nursing, so that we can determine how definitions and theories apply to our practice. Investigating a concept adopted from other disciplines will eventually provide the profession with a basis for knowledge development.

Screening for abuse at every healthcare visit is a standard of practice promulgated by many healthcare professional organizations. The need for such screening is underscored by reports of homicide as a leading cause of maternal mortality during pregnancy and the first year of the baby's life in Massachusetts and Maryland, and by the calculation of the costs of intimate partner violence in the United States. This article discusses how we addressed problems that arose in implementing screening for abuse in 13 different sites as a part of a clinical nursing research project. Engaging in clinical nursing research necessitates close relationships with clinical agencies and their staff members. This often means establishing and maintaining relationships with all nurses caring for patients in each clinical unit serving as a study site. For research on abuse during pregnancy, our study team members were engaged in interactions with prenatal care providers at 13 different study sites. Central to the study was implementing use of a standardized abuse screening tool, the Abuse Assessment Screen, at each study site. This article also describes the lessons we learned in attempting to implement such a large scale change in clinical practice.

Purpose: To compare the effects of recent intimate partner abuse on maternal and infant health in publicly versus privately insured pregnant women. Design: Exploratory descriptive analysis in 13 Massachusetts prenatal care sites from records of 2,052 women who had been screened during pregnancy for domestic violence. Methods: Clinicians screened pregnant women for domestic violence using the Abuse Assessment Screen. After delivery, prenatal and birth outcome data and abuse screening results were extracted from medical records by project staff. Odds ratios were used to compare maternal and infant health indicators in abused and nonabused women. Data from women with public and private health insurance then were examined separately, using logistic regression to control for low education and single marital status while examining the odds of adverse maternal and infant outcomes in abused and nonabused women. Findings: In the sample as a whole, recently abused women were more likely to be publicly insured and unmarried, to have less than 12 years of formal education, and to have medical and obstetrical complications. Parity, ethnic background, and infant birth outcomes did not differ in relation to abuse. In separate analyses for women with public and private health insurance, after controlling for marital status and education, abuse increased the odds of low infant Apgar scores, poor nutrition, hyperemesis, hypertension, and substance abuse in publicly insured women, and abuse increased the odds of poor nutrition and bleeding during pregnancy for privately insured women. Conclusions: The different correlates of abuse in publicly and privately insured women might be important for clinicians caring for these different populations. Screening for abuse and providing abuse-related services are indicated for pregnant women.

BACKGROUND: Intimate partner abuse of pregnant women has been linked to the delivery of low-birth-weight infants. Also, abused pregnant women have reported a greater prevalence of substance abuse, poor nutrition, and demographic risk factors for poor birth outcomes. These factors may play a role in the reported relation between intimate partner violence and birth weight. OBJECTIVES: To explore the role of substance abuse (smoking, alcohol, and drug use) and weight gain of less than 15 pounds during pregnancy as potential mediators of the relation between recent partner abuse and infant birth weight, and to investigate the role of demographic risk factors as potential moderators for the impact of abuse on birth weight. METHODS: Data were extracted on abuse screening results, demographics, birth outcomes, and a range of medical and obstetric risks and complications from the medical records of 1969 women who had been screened by clinicians for domestic abuse during pregnancy. Hypotheses were tested using multiple regression analysis. RESULTS: Recent physical or psychological abuse had a small but significant effect on birth weight in this sample. Smoking and low weight gain were weak but significant mediators of the relation between recent abuse and infant birth weight. Single marital status was the strongest demographic predictor of decreased birth weight. No moderator effects were found. CONCLUSIONS: Although prospective studies are warranted, nursing care to reduce smoking and promote adequate weight gain in all women along with support for women's efforts to seek safety from abuse may help to improve birth outcomes and promote maternal well-being. Language: en

Investigators encounter many legal and ethical issues when they conduct research on partner abuse. Balancing abused women’s rights to privacy with legally mandated reporting requirements involves considerable thought and planning. Failure to protect participants may result in escalation of abuse as well as loss of children to protective services. Various perspectives on maintaining participant privacy while conforming to legal mandates to report child abuse, homicidality, and suicidality are discussed. The role of confidentiality certificates in providing legal immunity for researchers and the method of obtaining the certificates are presented. In addition, the authors describe the strategies for participant protection that are implemented in a federally funded study of abuse, women’s self-care, and pregnancy outcomes. The decision to clearly and specifically inform abused women of the limits of confidentiality allows participants to make informed decisions about disclosures, but may result in diminished recruitment.

The evolution of advanced practice nurses to care for women and newborns has its roots in public health nursing of the latter decades of the 19th century. As we consider the challenges of practicing as advanced practice nurses in the 21st century, it is instructive to look back on 100 years of creating new programs and systems for delivering care. Such reflection helps us to clear our vision to imagine the future.

Responsibility for self-care is the purview of the pregnant woman. Her self-care behaviors are influenced by her quest for a healthy pregnancy and by her health care providers and social network. Our purpose in this descriptive ex post facto study was to examine women's reported self-care behaviors during pregnancy. The 100 women in the study sample reported engaging in self-care behaviors that were both positive and negative. More than half of the women reported activities to keep healthy that included walking or jogging, 48 changed their diets, 25 reported working out, exercising, and/or mediating. Of the 32 women experiencing a medical problem with their pregnancies, none reported engaging in behaviors to keep healthy. Assessing reported self-care behaviors early in pregnancy might help identify women who can benefit from advice about self-care strategies to increase their chances of healthy outcomes.

Each woman in a sample of 800 women from a nonprofit, private family planning clinic reported using at least one contraceptive method at some time in her life. Over the 15‐year period that the sample represented, women made from 1 to 26 family planning visits. The women reported using as many as eight different methods and making up to 11 changes in method. The reasons for changing methods were, for the most part, logically related to the method, at least as far as common user complaints and side effects were concerned, but they also reflected misperceptions regarding relative risk of methods and a low tolerance for a method's disadvantages. A lack of congruence between choice and use was revealed, as women returned for care and reported that they had not used the contraceptive method they had chosen at the last family planning visit or had changed methods one or more times since that visit.

This study was designed to examine the content of advertisements in medical journals to determine if the images of women are different than those of men. The method for this investigation was content analysis of a stratified random sample of issues of selected medical journals that regularly include picture advertisements. Advertisements were analyzed according to criteria and characteristics derived from a review of the literature. Interrater reliability was computed as a function of agreements. The results indicate that readers of medical journals are still being exposed to images of women that are negative and outdated. Until portrayals of women are consistently positive and timely, the images can have a negative effect on the health care women receive.

Oral contraceptives have been in use since the 1960s. Over the past 20 plus years, the risks and benefits of oral contraceptives have captured the attention of the press and the public. According to current data, oral contraceptives seem to pose the greatest risk for women in their 40s who smoke cigarettes. They have the least risk and greatest benefit for young women, especially nonsmokers. This article focuses on a reexamination of the issues. Are oral contraceptives safe? If so, for whom? How can risk be predicted? What are noncontraceptive benefits? Implications for practice and for the future of oral contraceptives research are presented.

The self care/health maintenance/contraceptive information needs and knowledge of women utilizing the women's health clinic at a large New England university were investigated. The investigation was designed to elicit information about the level of knowledge, expressed learning needs, contraceptive use, satisfaction, and self health care needs of the clients. A questionnaire was devised to elicit data about self health care information needs and contraceptive use, information, and needs of the population of women who seek health care or attend educational sessions offered by women's health clinics. The information (knowledge) portion of the questionnaire was readministered after the educational sessions as a posttest at the time women came for their clinic appointments. Women utilizing the services of the women's clinic were, for the most part, resident students. More women making a 1st visit to the clinic were 20 years old or younger; women returning for care were more likely to be 20 or older. Use of a contraceptive method at the time of completing a questionnaire was indicated by 82.6% of respondents. Of the new clients using contraception, most were using oral contraceptives (OCs), condoms, or withdrawal. Of the returning clients, 93% were using OCs, diaphragm, condoms, or cream/jelly. The majority of new clients expressed dissatisfaction with their present method; the majority of returning clients were satisfied. The outstanding reasons for both groups were fear of pregnancy and inconvenience. Repeat clients also indicated worry about side effects. Nearly 62% of the respondents reported that they had used another method. Most common reasons for a change to present method included fear of pregnancy, fear of dangers, and side effects. Of the clients who indicated they had a problem with a method, side effects, pregnancy, and pain or discomfort were prevalent. Although women who had become pregnant in the past were, for the most part, using a contraceptive method at the time of conception, the majority were using the least effective methods, such as rhythm and withdrawal. Sources of information on contraception included pamphlets and books, classes, friends, clinics, and to a lesser degree, health care providers (except for old clients) and parents. The women in the study indicated a need for information. The women were fairly knowledgeable, at least about contraceptive methods, according to the results of the pretests and posttests, but knowledge is insufficient if they fail to operationalize or internalize it. It seems appropriate to shift the class focus to correct use of the method chosen to render it as effective as possible.

(1982). Evolution and Dimensions of a Women's Clinic in a University Setting. Journal of American College Health Association: Vol. 30, No. 5, pp. 240-241.