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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.

With increased mobility, it is important that individuals keep their own personal health records (PHRs). Nurse practitioners are encouraged to assume greater responsibility for PHR adoption and recognize the key role they play in recommending PHR use. This article also briefly discusses college students' perceptions of their exposure to online PHRs.

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.

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.

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 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.

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.

Building a community-wide coalition to address violence evolved out of a five-year federally funded project on abuse during pregnancy. The setting for this coalition building is Haverhill, Massachusetts, a city of about 60,000, located northeast of Boston in the Merrimack River Valley. For nearly eight years, representatives of more than 30 agencies and institutions have been meeting monthly and creating programs and strategies to address violence in homes, schools, and neighborhoods, and designing interventions for children witnessing this violence. The purpose of this article is to describe the process of coalition building and provide an analysis of this work.

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.

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...

The Abuse Assessment Screen, Severity of Violence Against Women Scales, and Appraisal of Violent Situations scales were translated into versions for women originating from Brazil, Haiti, the Dominican Republic, and Puerto Rico. The procedure of back translation was chosen as the most reliable method for translation of these three instruments. The translated instruments were used to screen women for abuse during pregnancy and to determine the prevalence and severity of that abuse. This article discusses the translation process and illustrate with versions of the instruments for use with pregnant women from Puerto Rico.

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.

Objective To determine whether pregnant women's perceptions of abuse severity and danger, and their ability to control the abuse, are significantly correlated with the acts of abuse they experience, and to find out whether relationships exist among women's appraisals of abuse severity, danger, and their perceived ability to stop the abuse. Design A correlational design was used to compare the abusive acts experienced by the women and their perceptions of that abuse. Setting Nine prenatal clinics in urban areas of the northeastern United States. Participants: Sixty-one ethnically diverse, pregnant abused women were interviewed. Main Outcome Measure: Pearson's product-moment correlations were used to examine relationships between abusive experiences and women's perceptions of abuse. Results Women's perceptions of abuse severity were modestly correlated with threatened (r = .25) and actual violence (r = .36). Perceptions of abuse severity and danger were correlated (r = .41). Conclusions Women's beliefs about abuse severity, danger, and their ability to control abuse cannot be fully comprehended by exploring the discrete acts they experience. Further research is needed to identify additional factors that influence those beliefs. JOGNN , 30 , 283–290; 2001.

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 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.

To determine the images of women in picture advertisements, a stratified random sample of 32 medical journals, representing approximately 12% of medical journals published in the United States that are directed toward physicians in clinical practice, was subjected to content analysis. The sample consists of 209 different ads. The subjects of the ads included men, women, and children representing a variety of ethnic, racial, and socioeconomic groups. Notable, however, was the preponderance of Caucasian males pictured as physicians and the absence of women and people of color in this role. Women are pictured as 68.1% of consumers and men as 31.9%, a significant difference. Statistically significant differences also occur in the images of men and women as consumers. Most of the workers are men (68.2%), another significant difference. When women depicted are workers, they are secretaries and waitresses. Portrayals of women in medical advertisements continue to be stereotyped and outdated.

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.

Healing is an unfulfilled potential in the current healthcare system. Although illness is a ritual that necessitates the social support of natural networks and healers, the organization of hospitals impedes support and healing. In this article, the authors analyze the ritual of illness, the hospital as a technological bureaucracy, social networks, and social support, and make recommendations for action by nurses who identify themselves as healers.

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.

Data coding and entry can be a tedious and error-prone component of research. Statistical packages for a microcomputer are now available that enable the researcher to create data entry forms in a spread sheet format. In this article the use of software that can be used for data entry, manipulation, and analysis is discussed. In a practice setting these features are particularly useful, because the nurse practitioner can take the microcomputer to the clinical facility and enter data directly from client-provider interactions or from records. In clinical settings where client data are entered directly into a computer database as part of assessment and care giving, data can be downloaded onto this or similar programs for manipulation and analysis.