This research generated theory related to women's self-treatment of vaginal symptoms utilizing the grounded theory method. Data collection guided by theoretical sampling consisted of interviews with women and pharmacists, consumer literature related to vaginal conditions, and advertisements for non-prescription vaginal antifungal products. Data analysis identified that the basic problem experienced by the women was relief of symptoms. Because of many competing demands on their personal time, the women needed to resolve their problem in a way that was uncomplicated and involved minimal use of time and resources. In order to accomplish this, women used the process of Bypassing the Middleman. The use of this process enabled women to resolve the problem in a convenient and timely manner, and provided the least disruption to their current lifestyles and beliefs. Bypassing the middleman consisted of four stages: Noticing Vaginal Symptoms, Making Sense of Symptoms, Choosing a Treatment Path, and Bypassing the Middleman. The pace and progression through the stages is influenced by each women's unique attributes and circumstances. Several conditions that facilitated this process were low degree of uncertainty about cause of symptoms and low need to know specific cause, judgment that the symptoms were low-risk and minor, feeling capable of solving the problem, perception that the time and effort to access the middleman (health care provider) were beyond her resources, a high priority for convenience, the belief that self-treatment (non-drug) was safer than medical treatment, and low congruence of beliefs between woman and health care provider. Analysis of advertisements and consumer literature provided the context for understanding environmental influences on women's knowledge and decision-making about self-treatment. Four principal factors emerged as the primary reasons for variance in participants' behavior during bypassing the middleman: symptom characteristics, available resources, knowledge and experience, and beliefs about symptom management. This theory contributes to nursing knowledge about women's self-care because it is grounded in data, and provides nurses with the ability to explain and predict which women will choose to use this process. In addition, this theory identifies controllable conditions for designing nursing interventions to enhance women's self-care skills.

Breech malpresentation is associated with maternal-infant morbidity and mortality. Maternal knee-chest posture is a clinical practice intended to reduce the incidence of breech presentation and its concomitant risks in pregnancy. However, research on postural management has been inconclusive. This randomized clinical trial investigated whether knee-chest posture is associated with a higher proportion of breech infants converting to cephalic presentation during pregnancy. The study was conducted with 25 pregnant women whose infants were in breech presentation at 34–38 weeks gestation. Gestational age, parity, race, and treatment were evaluated for effect on version using Fisher exact tests. Gestational age, parity and treatment met screening criteria (p ≤ .25) for significance in the univariate analyses. Logistic regression was not employed due to zero cells in some of the univariate contingency tables. Effects of the intervention on infant presentation in labor, mode of delivery, birthweight, and 5-minute Apgar were examined by Fisher exact tests. There was no significant effect of intervention on birth outcomes at the p ≤ .05 level. Data from this study of 25 women were combined with data from two previous randomized trials for the same intervention. There was no effect of knee-chest posture on breech presentation in pregnancies over 36 weeks gestation. Implications for nurses and obstetric care providers include knowing that postural management of breech pregnancy is not yet adequately tested, advising clients accordingly and participating in the research to establish whether knee-chest posture promotes cephalic version of breech presentation.

A consistent trend in global migration has resulted in a rapidly growing multicultural population here in the United States. This trend highlights the importance of increasing nurses' cultural awareness since they will increasingly interact with the diverse populations migrating here from around the globe. This is particularly relevant for providers of obstetrical care since childbirth, being an experience fundamental to human existence and thus a most significant life event, is largely influenced by the culture in which the birthing woman is most familiar. The American Academy of Nurses and the American College of Nurse Midwives, recognize that there is yet no theoretical framework regarding migration and its implications for nursing care during pregnancy and childbirth. Therefore, this investigation seeks a greater understanding of the out-of-culture birth experience from the perspective of Cambodian mothers in the United States. It is hoped this research will contribute to nursing knowledge by extending one's understanding of childbirth as it occurs as an out-of-culture experience for women who have emigrated here from Cambodia.