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The COVID-19 pandemic has led to disruptions in health care in the perinatal period and women's childbirth experiences. Organizations that represent health care professionals have responded with general practice guidelines for pregnant women, but limited attention has been devoted to mental health in the perinatal period during a pandemic. Evidence suggests that in this context, significant psychological distress may have the potential for long-term psychological harm for mothers and infants. For infants, this risk may extend into early childhood. In this commentary, we present recommendations for practice, research, and policy related to mental health in the perinatal period. These recommendations include the use of a trauma-informed framework to promote social support and infant attachment, use of technology and telehealth, and assessment for mental health needs and experiences of violence.

Perinatal nurses and pre-licensure nursing students may lack knowledge of postpartum depression and appropriate interventions. Nurses and students may also have decreased self-efficacy in assessing for postpartum depression and providing education on this potential complication to new mothers. This project examined the use of a web-based educational module to increase perinatal nurses’ and pre-licensure nursing students’ knowledge of postpartum depression and postpartum depression interventions. Participants’ self-efficacy in assessing for postpartum depression and providing education was measured before and after viewing the module. Results of this study indicate a web-based module can be effective for increasing perinatal nurses’ and pre-licensure nursing students’ knowledge of postpartum depression interventions and self-efficacy in providing this vital care to new mothers.

PURPOSE Elevated blood pressure is frequently associated with adverse health issues among women during and after childbirth in the United States. The purpose of this study was to describe incidence of and determine predictors of prehypertension and hypertension among women of childbearing age in the United States. STUDY DESIGN AND METHODS Using secondary data analysis, existing data from the National Health and Nutrition Examination Survey (NHANES; 2013-2018) were used to address study aims. Inclusion criteria were women in the age range commonly considered to be of childbearing age, 15 to 44 years of age. Simple random sampling was to select subjects from the 2,932 women in the NHANES dataset who met inclusion criteria. We calculated a sample size as adequate for the statistical group comparison to be significant with a power of 95% to detect a difference among groups. An ordinal logistic regression model was created to discriminate predictors of normotensive blood pressure, prehypertension, and hypertension. RESULTS The sample (n = 393) included 300 women with normal blood pressure, 46 women with prehypertension, and 47 with hypertension. Older women (within childbearing age range), women with high body mass index, and African American women are highly likely to have prehypertension and hypertension. CLINICAL IMPLICATIONS Contrary to previous research, poverty income ratio was not associated with prehypertension and hypertension. Future research should test interventions that include promoting heathy lifestyles and address elevated body mass index. Interventions should be tailored to be culturally appropriate for African American women and older women within this age range.

In the United States, approximately 700 women die annually from pregnancy-related complications in the first year after birth; a significant number of the deaths occur after hospital discharge. Although postpartum monitoring is important, the standard practice is for one healthcare evaluation at 6 weeks post-birth. Most women are not aware of signs of postpartum complications.The aim of the pilot study was to develop a prototype of a mobile app aimed at increasing a new mother's ability to monitor her own health after childbirth.The design used mixed methods and procedures from human-centred design in an iterative process.Data were collected by the researchers from January - May 2019 in a hospital that serves primarily low income and underserved women in the southern US. Three groups of women provided data related to health education preferences or their reaction to a mock-up or prototype mobile app. Several women completed the Mobile App Rating Scale (MARS; N = 22).Themes from interviews indicated that women (N = 5) preferred electronic health education and that they used apps to monitor their pregnancies. Other new mothers (n-5) described their overall reaction to the proposed features of the app which was incorporated into the design of the app that was tested by the third group of new mothers (N = 22) who were positive about interactions with the app. The MARS scores for the app were positive.New mothers indicated that they would be willing to use an app to monitor their own postpartum health.Data from the pilot study informed the development of a prototype mobile app that can now be used in a clinical trial with new mothers to monitor their own health and report concerns to healthcare providers.背景: 在美国,每年约有700名女性在产后第一年死于妊娠相关并发症;大量死亡事件发生在她们出院后。产后监测虽然很重要,标准做法却是在产后6周进行一次医疗评估。大部分女性没有察觉产后并发症的迹象。 目的: 试点研究的目的是开发一款旨在提高新手妈妈们产后监控自身健康的能力的手机应用程序的雏形。 设计: 该设计在迭代过程中使用了以人为中心的混合方法及种种程序。 方法: 研究人员搜集了美国南部一家主要服务于低收入及受到低质量服务的女性的医院2019年1月至5月期间的数据。 三组女性提供了与健康教育偏好或她们对模型或手机应用程序雏形的反应相关的数据。几名女性完成了手机应用程序评分量表(MARS; N = 22)。 结果: 访谈主题表明,女性( N = 5 )更偏向电子健康教育并使用手机应用程序来监控怀孕情况。其他的新手妈妈( n - 5 )描述了她们对该手机应用程序已有功能的整体使用感受,这些感受也被写入该手机应用程序的设计中并由第三组女性进行了测试(N = 22),这些女性对该手机应用程序的使用持肯定态度。这款手机应用程序在评分量表中的得分也很高。 结论: 新手妈妈们表示她们很乐意用手机应用程序来检测自己的孕期健康。 影响: 试点研究的数据为手机应用程序雏形的开发提供了信息,该应用程序现在可以用于新手妈妈的临床试验,以监测她们自己的健康状况,并向医务人员报告问题。.

Using robots capable of collaboration with humans to complete physical tasks in unstructured spaces is a rapidly growing approach to work. Particular examples where increased levels of automation can increase productivity include robots used as nursing assistants. In this paper, we present a mobile manipulator designed to serve as an assistant to nurses in patient walking and patient sitting tasks in hospital environments. The Adaptive Robotic Nursing Assistant (ARNA) robot consists of an omnidirectional base with an instrumented handlebar, and a 7-DOF robotic arm. We describe its components and the novelties in its mechanisms and instrumentation. Experiments with human subjects that gauge the usability and ease of use of the ARNA robot in a medical environment indicate that the robot will get significant actual usage, and are used as a basis for a discussion on how the robot’s features facilitate its adaptability for use in other scenarios and environment.

Purpose The primary purpose of this study was to evaluate acceptability by new mothers of postpartum depression (PPD) screening and education about community resources by hospital-based perinatal nurses. A secondary purpose was to determine further screening for PPD that women received by community providers in the first few weeks after birth. Methods The study design was descriptive. As per standard practice on the unit, all new mothers were screened for depression the night before hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). New mothers identified as high risk for depression by EPDS scores greater than or equal to 10 (n = 75) and a comparison group of mothers at low risk for depression with EPDS scores less than 10 (n = 26) were recruited from an academic health sciences center. Participants were contacted by telephone 2 to 4 weeks later and asked about the acceptability of screening for depression and education about community resources by hospital-based perinatal nurses, as well as if they had received further screening for depression by community providers. Descriptive and correlational statistics were used to analyze data. Results The majority of new mothers found it acceptable to be screened for depression and educated about community resources by hospital-based perinatal nurses. Many new mothers were not asked about depressive symptoms by community providers. There was no significant correlation between demographics and depression risk. Clinical implications New mothers viewed depression screening and receiving information on community resources as a positive part of their care. Communication between inpatient and community caregivers should be improved so that new mothers can benefit from seamless depression assessment, evaluation, and treatment.

Purpose The purpose of this study was to describe new mothers' knowledge related to maternal mortality. Study design and methods Using a cross-sectional design, new mothers were recruited from a postpartum unit of an academic health sciences center where the population was predominately low-income women. Before hospital discharge, they answered questions on their knowledge of potential postpartum complications that could lead to maternal mortality. Questions were based on recommendations from an expert nursing panel. Descriptive statistics were used for data analysis. Results One hundred twenty new mothers participated. Results indicated that most new mothers knew that they should watch for heavy bleeding, a severe headache, and swelling after hospital discharge. However, fewer participants knew that a new mother could experience feelings that she could harm herself or her baby, have blood clots larger than a baby's hand, a temperature of 100.4 °F or higher, and odor with vaginal discharge. Courses of action new mothers would take if experiencing any of the warning signs included 18% of mothers would take no action, 76.7% would tell their boyfriend/husband/partner, 72.5% would inform their mother. Only 60% who would call the labor and delivery unit. Only 38% of the sample knew that pregnancy-related complications can occur for up to 1 year after birth, and 13% of mothers reported not knowing that complications can occur for up to 6 weeks postpartum. Clinical implications Our findings provide a foundation to enhance postpartum education for new mothers and their families and to potentially decrease rates of maternal mortality in the United States.

Purpose To determine if findings from our preliminary study related to patient and nursing satisfaction with a pain management intervention could be replicated in a changed environment, and if contextual factors could impact the effectiveness of a pain management intervention on patient satisfaction with nursing staff's management of pain. Methods A prospective, experimental design was used with six monthly assessments before, during, and after the intervention. Data were collected from 540 patients admitted to eight medical surgical and progressive care units and nurses that worked in these units at an academic health sciences center in the southern United States, from March to July 2015. The script-based, pain management communication intervention included three specific tactics: script-based communication, use of white boards, and hourly rounding. The Hospital Consumer Assessment of Healthcare Providers and Systems survey was used to assess two items: “pain is well controlled” and “staff did everything they could to help with pain.” Contextual factors focused on the practice setting. Findings Both scores for “pain is well controlled” (β = .028, p = 0.651) and scores for “staff did everything they could to help with pain” (β = .057,p = .385) did not change initially but then increased significantly and were sustained over time. Nurses had high levels of satisfaction with the intervention (M = 7.9, SD = 2.1) and compliance with the intervention (M = 8.0, SD = 1.9), and had little difficulty in implementing the intervention (M = 8.3, SD = 1.4). In terms of contextual factors, the number of beds on the unit and the number of patients being discharged negatively impacted scores for “pain is well controlled” and “staff did everything they could to help with pain.” Hospital length of stay positively impacted scores for “pain is well controlled” by staff. Conclusions Despite challenging contextual variables, the study extended the findings of an early preliminary study in showing the effectiveness of pain management intervention on patient satisfaction with staff's management of pain. In evaluating the impact of an intervention, it is essential to examine the contextual environment. Clinical Relevance Using simple, clear, and consistent communication between patients and nurses related to pain can positively impact patient satisfaction with pain management over time. The health care environment can enhance nursing practice and patients’ outcomes.

BACKGROUND According to the US Bureau of Labor Statistics, nurses will be the largest labor pool in the United States by 2022, and more than 1.1 million nursing positions have to be filled by then in order to avoid a nursing shortage. In addition, the incidence rate of musculoskeletal disorders in nurses is above average in comparison with other occupations. Robot-assisted health care has the potential to alleviate the nursing shortage by automating mundane and routine nursing tasks. Furthermore, robots in health care environments may assist with safe patient mobility and handling and may thereby reduce the likelihood of musculoskeletal disorders. OBJECTIVE This pilot study investigates the perceived ease of use and perceived usefulness (acceptability) of a customized service robot as determined by nursing students (as proxies for nursing staff in health care environments). This service robot, referred to as the Adaptive Robotic Nurse Assistant (ARNA), was developed to enhance the productivity of nurses through cooperation during physical tasks (eg, patient walking, item fetching, object delivery) as well as nonphysical tasks (eg, patient observation and feedback). This pilot study evaluated the acceptability of ARNA to provide ambulatory assistance to patients. METHODS We conducted a trial with 24 participants to collect data and address the following research question: Is the use of ARNA as an ambulatory assistive device for patients acceptable to nurses? The experiments were conducted in a simulated hospital environment. Nursing students (as proxies for nursing staff) were grouped in dyads, with one participant serving as a nurse and the other acting as a patient. Two questionnaires were developed and administrated to the participants based on the Technology Acceptance Model with respect to the two subscales of perceived usefulness and perceived ease of use metrics. In order to evaluate the internal consistency/reliability of the questionnaires, we calculated Cronbach alpha coefficients. Furthermore, statistical analyses were conducted to evaluate the relation of each variable in the questionnaires with the overall perceived usefulness and perceived ease of use metrics. RESULTS Both Cronbach alpha values were acceptably high (.93 and .82 for perceived usefulness and perceived ease of use questionnaires, respectively), indicating high internal consistency of the questionnaires. The correlation between the variables and the overall perceived usefulness and perceived ease of use metrics was moderate. The average perceived usefulness and perceived ease of use metrics among the participants were 4.13 and 5.42, respectively, out of possible score of 7, indicating a higher-than-average acceptability of this service robot. CONCLUSIONS The results served to identify factors that could affect nurses’ acceptance of ARNA and aspects needing improvement (eg, flexibility, ease of operation, and autonomy level).

Background According to the US Bureau of Labor Statistics, nurses will be the largest labor pool in the United States by 2022, and more than 1.1 million nursing positions have to be filled by then in order to avoid a nursing shortage. In addition, the incidence rate of musculoskeletal disorders in nurses is above average in comparison with other occupations. Robot-assisted health care has the potential to alleviate the nursing shortage by automating mundane and routine nursing tasks. Furthermore, robots in health care environments may assist with safe patient mobility and handling and may thereby reduce the likelihood of musculoskeletal disorders. Objective This pilot study investigates the perceived ease of use and perceived usefulness (acceptability) of a customized service robot as determined by nursing students (as proxies for nursing staff in health care environments). This service robot, referred to as the Adaptive Robotic Nurse Assistant (ARNA), was developed to enhance the productivity of nurses through cooperation during physical tasks (eg, patient walking, item fetching, object delivery) as well as nonphysical tasks (eg, patient observation and feedback). This pilot study evaluated the acceptability of ARNA to provide ambulatory assistance to patients. Methods We conducted a trial with 24 participants to collect data and address the following research question: Is the use of ARNA as an ambulatory assistive device for patients acceptable to nurses? The experiments were conducted in a simulated hospital environment. Nursing students (as proxies for nursing staff) were grouped in dyads, with one participant serving as a nurse and the other acting as a patient. Two questionnaires were developed and administrated to the participants based on the Technology Acceptance Model with respect to the two subscales of perceived usefulness and perceived ease of use metrics. In order to evaluate the internal consistency/reliability of the questionnaires, we calculated Cronbach alpha coefficients. Furthermore, statistical analyses were conducted to evaluate the relation of each variable in the questionnaires with the overall perceived usefulness and perceived ease of use metrics. Results Both Cronbach alpha values were acceptably high (.93 and .82 for perceived usefulness and perceived ease of use questionnaires, respectively), indicating high internal consistency of the questionnaires. The correlation between the variables and the overall perceived usefulness and perceived ease of use metrics was moderate. The average perceived usefulness and perceived ease of use metrics among the participants were 4.13 and 5.42, respectively, out of possible score of 7, indicating a higher-than-average acceptability of this service robot. Conclusions The results served to identify factors that could affect nurses’ acceptance of ARNA and aspects needing improvement (eg, flexibility, ease of operation, and autonomy level).

Purpose: To identify a relationship between patient satisfaction with the hospital experience and health-related quality of life (HRQOL), as well as determine predictors of each variable. Participants & Setting: 50 patients with cancer in two adult oncology units in an academic health sciences center. Methodologic Approach: A descriptive, cross-sectional design was used. Patient satisfaction was measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and HRQOL was assessed using the Quality of Life Patient/Cancer Survivor (QOL-CS) version. Findings: Patients who were single, diagnosed for 6–10 years, and diagnosed for 11 years or longer had significantly lower patient satisfaction scores. Patients with public insurance, diagnosed for 6–10 years, and diagnosed for 11 years or longer had lower QOL-CS scores. Physical and social well-being scores were associated with higher HCAHPS scores. There was a positive relationship between patient satisfaction and physical and social functioning. Patient demographics were related to patient satisfaction and HRQOL. Implications for Nursing: Nurses should have measurable goals to provide high-quality care to patients with cancer, including satisfaction during hospitalization and promotion of HRQOL.

Background Parental depression has been associated with adverse child outcomes. However, the specific parenting behaviors that may result in such child outcomes and the effect of family-centered care (FCC) on positive parenting behavior of depressed parents has not previously been examined. Methods Data from the National Survey of Early Childhood Health was used ( n = 2,068). Groups were stratified by the presence of parental depression and compared with regard to demographics and the mean number of specific positive parenting behaviors. Generalized linear models were developed based on testing whether individuals performed more or less than the median number of positive behaviors. Lastly, we tested whether depression independently predicted each outcome after adjustment for FCC, coping, social support, and ethnicity to evaluate if depression independently predicted each outcome after adjustment. Results No difference was found in demographic variables between parents who were depressed and not depressed. Parents who were not depressed performed significantly more routines ( p = .036); reported coping better with parenting ( p p = .022); and needed/had less social support ( p = .002) compared with parents who were depressed. Individual items and scale scores were associated in the expected directions. FCC was independently associated with study variables but did not moderate the effect of depression. Conclusions These data identify specific parenting behaviors that differ between parents who report depressive symptoms compared with parents who do not have depressive symptoms. More targeted interventions coordinated through a medical home are needed for parents with depressive symptoms to reduce the child health disparities often associated with parental depression.

Postpartum depression in Latina immigrant mothers can lead to adverse outcomes in both mothers and babies, yet depression treatment remains suboptimal.The aims were to determine predictors of intention to seek depression treatment and to determine if intention to seek depression treatment differed in those with significant symptoms of depression.Based upon the theory of planned behavior (TPB), a cross-sectional study design was used. A convenience sample of Latina immigrant mothers (n = 50) were interviewed in Spanish. Certified translation services were used to translate study instruments to Spanish. Descriptive analysis and multivariable logistic regression techniques were used for data analysis.While increases in attitudes were associated with intention to seek depression treatment, increased social support and perceived control were associated with a decrease in intention to seek treatment.The differing role of social support in Latina immigrant mothers should be explored.

Objective To describe how participation in the Sigma Theta Tau International Maternal-Child Health Nurse Leadership Academy positioned the authors to lead an interdisciplinary team through implementation and evaluation of a change project related to patient education based upon national health literacy standards. The project goal was to improve patient satisfaction with nurse communication and preparation for hospital discharge. Design Quality improvement. Setting/Participants Mother/-baby unit of an academic medical center serving a high percentage of patients of a minority population and underserved clients. Intervention The five- step intervention included (a) review of current health literacy standards, (b) formation of an infrastructure for development and evaluation of existing patient education materials, (c) assessment of patient education materials currently in use, (d) assessment of literacy level and learning styles of new mothers, and (e) provision of continuing education to increase knowledge of nurses as patient teachers and of health literacy. Measurement Mean scores of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in the domains of patient satisfaction with nurse communication and discharge information were used to measure patient satisfaction with health communication. Results Patient satisfaction with nurse communication increased from 75.9% to 84.6%. Satisfaction with discharge information increased from 84.6% to 98.6%. Conclusion The leadership academy successfully positioned the authors to guide an interdisciplinary team through development of a process to meet the education and communication needs of patients and improve their health literacy As a result, a positive effect was noted on patient satisfaction with health communication.

Key wordsAdolescent, depression, research recruitmentAbstractPurpose: Adolescent mothers have high rates of depressive symptoms and inadequate rates of depression evaluation and treatment. The purpose of this qualitative study was to identify characteristics of effective recruitment ads for an Internet-based depression intervention for pregnant and parenting adolescents.Methods: Using focus group methods, participants (N = 35) were recruited and enrolled at a teen parent program, part of the public school system. Focus group sessions were analyzed for participant preferences, rationale for choices, key words, and the frequency of words within the videotapes and audiotapes.Results: Findings indicated that adolescent mothers preferred pictures in which everyone looked happy, narrative that clearly indicated cost and eligibility, and words that they would use in conversation.Clinical Relevance: The study filled an important gap in the literature by soliciting from pregnant and parenting adolescents their preferences regarding visual appeal, content adequacy, and message clarity of advertisements that would motivate them to visit an Internet intervention for depression. Results could be extrapolated to education of pregnant and parenting adolescents in clinical settings.National experts agree that adolescent mothers have high rates of depressive symptoms and inadequate rates of depression evaluation and treatment (Substance Abuse and Mental Health Services Administration, 2005; Williams, O'Connor, Eder, & Whitlock, 2009; Yozwiak, 2010). Internet-based interventions for depression have been successful in overcoming barriers to treatment in adolescents (Christiansen, Griffiths, & Jorm, 2004; O'Kearney, Kang, Christensen, & Griffiths, 2009). However, the best ways to recruit adolescent mothers for an Internet-based intervention for depression are not known. The purpose of this study was to identify characteristics of effective recruitment ads from the perspective of adolescents for an Internet-based depression intervention for adolescent mothers.BackgroundSuccessful and cost-effective recruitment is one of the greatest challenges for researchers, particularly in underserved and minority populations (Logsdon & Gohmann, 2008; Pinto-Foltz, Logsdon, & Derrick, 2011). Difficulty with recruitment is often cited as the reason for failure to reach an estimated sample size, resulting in underpowered studies and serving as a barrier to using research in practice. Strategies to improve research recruitment have been disseminated by the Cochrane Library (Treweek et al., 2010) as well as by noted researchers (Nguyen et al., 2012), but challenges remain.Recently, researchers have begun to use the Internet for research recruitment and interventions (Fenner et al., 2012; Morgan, Jorm, & McKinnon, 2013; Smith, Wilde, & Brasch, 2012). In a recent systematic review, Park and Calamaro (2013) noted the potential of social media for research study recruitment with adolescents and young adults. For example, Facebook has been successfully used to recruit young adults for studies of young adult smokers (Ramo & Prochaska, 2012) and Google ads have been successfully employed to recruit adults to health research websites (Gross, Liv, Contreras, Munoz, & Leykin, 2014). However, the effective characteristics and qualities of the recruitment ads were not discussed, leading to the need for this study.MethodsSampleParticipants were recruited and enrolled at two locations of a teen parent program, which is part of the public school system. The study was approved by the institutional review boards of the university and the site. Eligibility criteria included (a) currently pregnant or adolescent mother who is 13 to 18 years of age; and (b) child lives with adolescent mother. Three groups of adolescent mothers (total N = 35) participated in the study. …

PURPOSE Educational materials used by healthcare agencies frequently do not follow national health guidelines for plain talk. Adolescent mothers are a vulnerable population in need of accurate and accessible health information to promote their own health and that of their baby. The aims of our study were to: Determine acceptability of simple, written educational pamphlets to adolescent mothers; Determine efficacy of simple, written educational pamphlets in improving an adolescent mother's knowledge related to breastfeeding, infant care, postpartum depression, and mother-infant relationship; Determine if higher knowledge scores are maintained after a 2-week period; and Determine general parenting health literacy of adolescent mothers. STUDY DESIGN AND METHODS Using a prospective, experimental design, students enrolled in a teen parent program (n = 123) completed a pretest and The Parent Health Literacy Activities Test (PHLAT), read the health educational materials, and completed an immediate posttest of knowledge and acceptability. Two weeks later, the same participants completed a second posttest of knowledge. RESULTS Adolescent mothers found the intervention (simple, written educational materials) to be acceptable. The intervention was initially effective in improving knowledge scores in all four content areas. However, knowledge was not retained and scores were not significantly different from baseline at the 2-week assessment. The mean health literacy of the adolescent mothers was poor. CLINICAL IMPLICATIONS A booster session may be necessary for knowledge retention. Other methods of education should be studied to evaluate efficacy for adolescent mothers' knowledge retention of important health information.

OBJECTIVE/BACKGROUND: Approximately 400,000 adolescents give birth in the US annually. Although one-half experience depressive symptoms, less than 25% comply with referrals for depression evaluation and treatment. The current study tested the effectiveness of an internet based depression intervention on seeking depression treatment. METHODS: Based upon the Theory of Planned Behavior (TPB), the intervention included vignettes, questions and answers, and resources. Before the intervention, immediately after the intervention, and two-weeks later the adolescent mothers (n=151) answered questions related to TPB variables and depression treatment. Data were compared to adolescent mothers (n=138) in the control group. Data were collected in community organizations or home visits for the control group. Adolescent mothers in the intervention group answered questions and completed the intervention from a computer of their choice. RESULTS: The adolescents were primarily African American (89.2%); less than high school educated (51.7%); had given birth in last year (97.1%); with a mean age 18.2 years. The intervention led to significant changes in attitude, perceived control, intention to seek mental health treatment, and actually seeking depression treatment. CONCLUSIONS/DISCUSSION: Untreated postpartum depression dramatically impacts a mother’s relationships with her child, her functioning at work and school, health care seeking behaviors, mothering skills, and her development as well as the development of her child. An Internet based depression intervention is an inexpensive method to increase rates of depression treatment.

Objective The aim of this study was to test predictors of nursing empowerment and job satisfaction in nurses. Background Nursing professional development leaders and Magnet® coordinators need foundational data on which to build interventions that will support and empower nurses on the journey toward American Nurses Credentialing Center Magnet® designation. Method Secondary data analysis methods were used. Results Overall, nurses perceived that they had moderate empowerment and were satisfied with their jobs. Conclusions Study results support predicted relationships and can be used to guide interventions for, and development of, nurses.

The purpose was to critique existing parenting apps using established criteria and health literacy guidelines.Descriptive methodology was used.The Apple App Store was searched using the terms parenting, child health, and infant health. To be included, the apps had to have relevant content (parenting, child health, or infant health), be in English, and contain parent education. After eliminating apps that failed to meet inclusion criteria from the original 203 apps, 46 apps were reviewed. The Patient Education Materials Assessment Tool was used to evaluate the health literacy subscales called Understandability and Actionability. Content analysis included Authority, Objectivity, Accuracy, Timeliness, and Usability.The majority of the apps (70%) were in English only. The price ranged from free to $4.99. The purpose, target audience, and topics varied. Although all included apps were for parents, some were for more targeted groups of parents. The source of the information was not presented in 26% of the apps. Most apps took the user to a Web site or an article to read. Functionality of the apps was limited, with none of them providing a customized experience.Much development and research is needed before mobile health (mHealth) solutions can be recommended by nurses caring for new parents. It is critical that consumers and interdisciplinary professionals be involved in the early design phase of the product to ensure that the end product is acceptable and usable and that it will lead to healthy behaviors.

To determine if findings from our preliminary study related to patient and nursing satisfaction with a pain management intervention could be replicated in a changed environment, and if contextual factors could impact the effectiveness of a pain management intervention on patient satisfaction with nursing staff's management of pain.A prospective, experimental design was used with six monthly assessments before, during, and after the intervention. Data were collected from 540 patients admitted to eight medical surgical and progressive care units and nurses that worked in these units at an academic health sciences center in the southern United States, from March to July 2015. The script-based, pain management communication intervention included three specific tactics: script-based communication, use of white boards, and hourly rounding. The Hospital Consumer Assessment of Healthcare Providers and Systems survey was used to assess two items: "pain is well controlled" and "staff did everything they could to help with pain." Contextual factors focused on the practice setting.Both scores for "pain is well controlled" (β = .028, p = 0.651) and scores for "staff did everything they could to help with pain" (β = .057,p = .385) did not change initially but then increased significantly and were sustained over time. Nurses had high levels of satisfaction with the intervention (M = 7.9, SD = 2.1) and compliance with the intervention (M = 8.0, SD = 1.9), and had little difficulty in implementing the intervention (M = 8.3, SD = 1.4). In terms of contextual factors, the number of beds on the unit and the number of patients being discharged negatively impacted scores for "pain is well controlled" and "staff did everything they could to help with pain." Hospital length of stay positively impacted scores for "pain is well controlled" by staff.Despite challenging contextual variables, the study extended the findings of an early preliminary study in showing the effectiveness of pain management intervention on patient satisfaction with staff's management of pain. In evaluating the impact of an intervention, it is essential to examine the contextual environment.Using simple, clear, and consistent communication between patients and nurses related to pain can positively impact patient satisfaction with pain management over time. The health care environment can enhance nursing practice and patients' outcomes.

Replicating a research study that described the work of nurse scientists in children's hospitals, the purpose of the study was to describe the role, activities, and outcomes of nurse scientists employed in a national health care organization. The characteristics of nurses filling the nurse scientist role in clinical settings and outcomes associated with the role have not been extensively described. The setting of this study is ideal since the organization includes facilities of various sizes located in rural, urban, and suburban areas in 18 states. Names and contact information of nurse scientists were obtained from nurse executives at each of the 110 affiliated organizations. Nurse scientists completed an anonymous survey. The primary role of the nurse scientists is to facilitate the work of others. Recommendations to strengthen the research infrastructure are provided.

Problem Little is known about how adolescent mothers use social media and the Internet, especially to access health information. Methods In this cross-sectional, descriptive study, adolescent mothers were recruited from an academic medical center after the birth of their child (n = 94) or from a state-funded, home visitation program during the first year after birth (n = 91). They completed the Pew Internet Survey: 37 questions related to use of social media and Internet, particularly in regard to obtaining health information. Findings All adolescent mothers used a computer and almost all went online. Most accessed the Internet by cell phone (67.4%) and used social media. The health topics searched most frequently were pregnancy/birth control (85.8%), sexually transmitted diseases (n = 134, 72.6%) and HIV (66.3%). Response to survey questions differed between the two groups (adolescent mothers surveyed after birth from academic medical center and adolescent mothers surveyed in the first postpartum year in the community). Conclusions Adolescent mothers spend significant time on the Internet including searching for health information. Cell phones are their preferred methods for accessing the Internet, and they use social media. Thus, social media and the Internet are potentially feasible and acceptable vehicles to deliver health interventions to adolescent mothers.

Purpose Millions of adults lack adequate reading skills and many written patient education materials do not reflect national guidelines for readability and suitability of materials, resulting in barriers to patients being partners in their own health care. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to health care providers for how to improve the materials. Methods Materials (N = 97) from three clinical areas that represented excellence in nursing care in our organization (stroke, cancer, and maternal-child) were reviewed for a composite reading grade level and a Suitability Assessment of Materials (SAM) score. Results Twenty-eight percent of the materials were at a 9th grade or higher reading level, and only 23% were 5th grade or below. The SAM ratings for not suitable, adequate, and superior were 11%, 58%, and 31%, respectively. Few materials were superior on both scales. The SAM scale was easy to use and required little training of reviewers to achieve interrater reliability. Conclusions Improving outcomes and reducing health disparities are increasingly important, and patients must be partners in their care for this to occur. One step to increasing patient understanding of written instructions is improving the quality of the materials in the instruction for all patients and their families, especially those with limited literacy skills. Clinical Relevance Using materials that are written in a manner that facilitates the uptake and use of patient education content has great potential to improve the ability of patients and families to be partners in care and to improve outcomes, especially for those patients and families with limited general literacy or health literacy skills.

Background One percent of women experience bipolar disorder and are likely to suffer from mood disorders during the postpartum period, potentially impacting interaction with their infants. The purpose of this study was to describe maternal–infant interactions in women with bipolar depression at 12months postpartum and to compare interactions to women with unipolar depression and a control group. Methods Using a descriptive design, maternal–infant interactions in women with bipolar disorder (n=40) were videotaped, coded, and analyzed for maternal sensitivity and maternal–infant reciprocity and compared to maternal–infant interaction in women with unipolar depression (n=50) and women without depression (n=40). Results Women with bipolar depression had lower scores on both maternal sensitivity and infant reciprocity, but differences were nonsignificant. Conclusions This research is the first study to examine maternal–infant interaction in women with bipolar disorder, and important trends were noted. Future research should examine maternal–infant interaction at earlier time periods.

Health literacy has been shown to predict health behaviors and outcomes above the effects of education or socioeconomic status. Much remains unknown about the health literacy of parents and the role it plays in children’s health outcomes or in health disparities. The current study explored the health communication needs and health literacy indicators in a diverse sample of parents (n = 75) to identify potential areas for future interventions. The sample consisted of parents of children 18 to 36 months old who were visiting 3 different pediatric medical offices, 2 of which served low-income families and 1 located in an affluent suburb. When comparisons were made between 2 educational attainment groups, there were variations in indicators of health literacy and health communication needs. These data can be used to guide the development of interventions by primary care providers to improve parent education.

In most families in the western world, mothers make decisions related to the family’s use of health care (Gross & Howard, 2001), including health care for their adolescent daughters. However, normative changes and realignments in the parent–child relationship lead to greater adolescent behavioral autonomy over time, including the adolescent’s desire for greater involvement in decision making for her health care (Gordon, 1996). The cognitive capacity for autonomous healthcare decision making has been documented among adolescents 15 years of age (Gordon, 1996). In the United States, most states recognize an adolescent’s ability to independently make healthcare decisions for select medical services such as testing and treatment of sexually transmitted infections and obtaining contraception without parental consent (English & Kenney, 2003; Gordon, 1996). However, by law, adolescents cannot independently make decisions to receive mental health treatment (English & Kenney, 2003). Parental consent is required for adolescents under the age of 18 to obtain treatment in nearly all states, making parents the gatekeepers to mental health treatment. As children mature into adolescents, they tend to be more expressive to their mothers about their healthcare needs and desires, and they attempt to exert influences over their mothers’ decisions about their health care (Miller & Harris, 2012). The adolescent’s influence on the mother’s decisions is impacted by characteristics of the mother–adolescent relationship, including parent–adolescent conflict (Kern, Klepac, & Cole, 1996; Prinz, Foster, Kent, & O’Leary, 1979) and parenting style of the mother (Steinberg, Lamborn, Dornbusch, & Darling, 1992). Promoting concordance and shared decision making between mothers and daughters in respect to mental health treatment is not only essential for seeking care, but also for the adolescent’s active engagement in care (Miller & Harris, 2012). Adolescent girls believe that they have tremendous influence on their mothers’ decision making for their health care, and that their perspectives on mental health treatment are similar to that of their mothers (Pinto-Foltz, Hines-Martin, & Logsdon, 2010). Without concurrent and independent assessments of mothers and their adolescent daughters regarding their intention to seek mental health treatment, these assertions by adolescent girls are unfounded. This study fills a gap in scientific knowledge by use of the theory of planned behavior (TPB) and expanded TPB (Hutchinson & Wood, 2006) to examine predictors of intention to seek mental health treatment for adolescent girls, from the perspective of mothers and their adolescent daughters themselves. Roughly 75% of adolescents with mental disorders do not receive mental health treatment at symptom onset, and the usual onset of mental disorders is during the adolescent and young adult years (Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993). Adolescent girls are at highest risk for mood disorders during these early years, and understanding predictors of mothers and daughters’ intentions are necessary to promote early treatment and optimize short- and long-term mental health outcomes (Modi et al., 2012; Logsdon, 2004).

Background Parents of infants hospitalized in the neonatal intensive care unit (NICU) frequently need guidance to prepare them for the care and health promotion of their child after hospital discharge. The health literacy of the parents should be considered so that education can be tailored to meet their needs. It is also important to understand the parents' preferences for how, and from whom, they receive education. Purpose The purpose of this study was to identify health literacy levels of parents of infants in an NICU and preferences for who they want to provide them with education. Methods An exploratory, descriptive design was used to assess participant health literacy and preferences for obtaining child health information. Only mothers (no fathers) with babies in the NICU were available to complete the survey. Mean participant age was 26.4 years (SD = 6.7). Results Participants had a mean Rapid Estimate of Adult Literacy in Medicine, Revised, score of 5.64 (SD = 2.4), indicating a low level of health literacy. Questions regarding when to administer medication were correctly answered by 69% of participants. Proper medication dosage was understood by 92% of participants; however, only 30% were able to correctly convert measurements. One-on-one discussions with a physician were the preferred source of health information for 80% of participants. Implications for practice/research The current exploratory study provides new information that will help inform the development of future studies and increase awareness of nurses regarding health literacy and the specific types of skills for which parents need the most help.

The implementation of the Research Champions program was an effective strategy to increase the confidence of direct care nurses in research skills, a goal for staff development educators. Postprogram questionnaires conducted at 12 months assessed participants' confidence in specific areas: critique of research manuscripts, comprehension of research statistics, knowledge of the ethics of research, and using research in practice. Data supported that participants' confidence increased in all areas assessed.

The Revised Attribution Questionnaire (r-AQ) measures mental illness stigma. This study’s purpose is to evaluate the factor structure of the (r-AQ) and examine the validity of the factor structure in adolescents. A convenience sample (n = 210) of adolescents completed the r-AQ and these data were used in exploratory (EFA) and confirmatory factor analyses (CFA). The EFA established a five item single factor structure, which we called the modified r-AQ and captures the negative emotional reactions to people with mental illness, a domain of mental illness stigma. The CFA established the validity of the factor structure (χ2 = 2.4, df = 4, p = .659, TLI = 1.042, CFI = 1.00, RMSEA = .000). Internal consistency reliability for the scale was acceptable (α = .70). The modified r-AQ is a reliable and valid measure of the emotional reaction to people with mental illness.

Background: In women with major depressive disorder (MDD), maternal role functioning is negatively impacted but has been shown to improve with treatment; however, most investigations have not included a control group or studied women longitudinally. We hypothesized that women with MDD who responded to serotonin selective reuptake inhibitors (SSRIs) would have overall functioning and maternal role functioning scores similar to that of the control group and superior to women with MDD (either untreated or nonresponsive to SSRIs). Methods: This prospective, longitudinal observational study (n = 215) included postpartum assessments at 2 1/2 weeks, 3 months, 6 months, and 12 months. Postpartum women were categorized into four mutually exclusive exposure groups by depression and medication status: (1) Control group (no SSRI, no MDD; (2) Responder (SSRI, no MDD); (3) Untreated (MDD, no SSRI); and (4) Nonresponder (Both MDD and SSRI). Outcome variables include a measure of overall functioning (Global Assessment Scale, GAS) and three measures of maternal role functioning (Maternal Self Efficacy, ICS; Gratification in Maternal Role, GRAT; and overall maternal role functioning, IFSAC). Results: The study hypothesis was supported. Responders had scores related to overall functioning and maternal role functioning that were similar to the control group and superior to nonresponders and untreated women with MDD, as measured by the GAS and the GRAT. Conclusion: Postpartum depression treatment optimally targets both symptom improvement and maternal functional recovery. The GRAT is a simple, self-administered instrument that can be used with a depression measure to assess maternal role functioning. Depression and Anxiety, 2011. © 2011 Wiley Periodicals, Inc.

The purpose of this school-based cluster-randomized trial was to determine the initial acceptability, feasibility, and efficacy of an existing community-based intervention, In Our Own Voice, in a sample of US adolescent girls aged 13-17 years (n = 156). In Our Own Voice is a knowledge-contact intervention that provides knowledge about mental illness to improve mental health literacy and facilitates intergroup contact with persons with mental illness as a means to reduce mental illness stigma. This longitudinal study was set in two public high schools located in a southern urban community of the U.S. Outcomes included measures of mental illness stigma and mental health literacy. Findings support the acceptability and feasibility of the intervention for adolescents who enrolled in the study. Findings to support the efficacy of In Our Own Voice to reduce stigma and improve mental health literacy are mixed. The intervention did not reduce mental illness stigma or improve mental health literacy at one week follow up. The intervention did not reduce mental illness stigma at 4 and 8 weeks follow up. The intervention did improve mental health literacy at 4 and 8 weeks follow up. Previous studies have assessed the preliminary efficacy In Our Own Voice among young adults; rarely has In Our Own Voice been investigated longitudinally and with adolescents in the United States. This study provides initial data on the effects of In Our Own Voice for this population and can be used to further adapt the intervention for adolescents.

Little is known about recruiting and retaining adolescent mothers in research studies. Investigators who study adolescent mothers have been guided by trial and error, clinical experience, qualitative inquiry, literature of special populations, or the advice of stakeholders. This paper describes the challenges and lessons learned in engaging adolescent mothers in a longitudinal community-based mental health intervention study. Audio-recorded data that describes the circumstances of five adolescent mothers lost to attrition were extracted from a longitudinal mental health intervention study. Adolescent mothers described a chaotic home environment with multiple demands, family conflict, health issues, limited access to a telephone, transportation, financial, and social support. Utilizing a multidisciplinary community advisory group, dedicated telephone, and free electronic media may assist in overcoming modifiable barriers to recruitment and retention of adolescent mothers. Exploring a waiver of informed consent and the engagement of mothers of adolescents in research are indicated.

Spivak M., Smith A. & Logsdon M.C. (2011) Journal of Nursing Management 19, 92–97 Developing expert clinical nurses: grow them, hold them and let them walk away Aim The aim of the present study was to describe three case studies that exemplify decision making by a nursing leader related to retention of expert clinical nurses in the Emergency Department. Background Further understanding of decision-making processes that help nursing leaders to retain (or let go of) expert clinical nurses is needed so that sufficient numbers of expert nurses are available in the workforce to provide high-quality and safe patient care. Evaluation Decision processes related to retention of expert clinical nurses are exemplified in three case studies. Key issues Orienting nurses to specialty areas is costly and retention of nurses is an important international issue. Conclusions Expert clinical nurses across the skill continuum need guidance from nursing leaders related to their work behaviours and best choice for employment. Implications for Nursing Management Nursing leaders who are well acquainted with the skills and motivations of their employees are in the best position to promote the health of individual nurses and of specialty nursing units.

Screening for symptoms of postpartum depression (PPD) is an important preliminary step to diagnosis and treatment, but the effectiveness of depression screening is dependent on the reliability and validity of the screening instruments in the population. Both the Edinburgh Postnatal Depression Scale (EPDS) and the Center for Epidemiologic Studies of Depression instrument (CES-D) have been used to screen adolescent mothers for PPD, but it is not clear which instrument best predicts a diagnosis of PPD, leading to the need for the current study.Adolescent mothers (n = 59) at 4-6 weeks postpartum completed the EPDS and two versions of the CES-D in random order, followed by a mental health diagnostic evaluation for PPD. The diagnostic evaluation was completed by a mental health professional who was blind to study aims and screening scores. Performance measures were evaluated for all instruments.The mental health clinician diagnosed 16.9% of adolescent mothers as depressed. Using the established cutoff scores for major depression for the instruments, the EPDS achieved the best performance measures. For example, the EPDS had the highest area under the receiver operating characteristic (ROC) curve. None of the results from the screening instruments were related to the mental health diagnostic evaluation.EPDS may be the best screening tool for PPD in adolescent mothers. Considering only a clinical diagnosis of depression in adolescent mothers, however, may underestimate the number who experience psychological difficulty; assessment of anxiety should also be included.