<p> Every patient has a right to be treated with dignity, respect and high quality pain management (Olivier, et al., 2012). Pain continues to be inadequately treated by healthcare providers (Zuccaro, et al., 2012). The purpose of this DNP project was to determine if perinatal nurses&rsquo; intent to medicate pregnant women with chronic pain was affected by knowledge of pain, attitude, or demographics. This will explore the theoretical application of Ajzen&rsquo;s theory of planned behavior which suggests that attitude correlates with intention to act.</p><p> A quantitative, cross-sectional correlation study used a pencil and paper survey to measure knowledge about pain, attitudes, and intent to medicate pregnant women with chronic pain. One hundred perinatal nurses who worked in labor and delivery, mother baby, or the neonatal intensive care unit from four hospitals in northern New Jersey participated in the study. Each hospital provided a different level of perinatal care from community basic, to intermediate, intensive, and regional perinatal center.</p><p> Increased levels of education positively impact perinatal nurses&rsquo; knowledge of pain, attitude, and intent to medicate pregnant women with chronic pain. The perinatal nurse&rsquo;s intent to medicate was not statistically correlated to age, years of nursing experience, or level of perinatal care. The perinatal nurse&rsquo;s intent to medicate a pregnant woman with chronic pain is positively correlated to increased knowledge of pain (<i>r</i> (100) = 0.463, <i>p</i> &le; 0.001). Attitude scores were positively correlated with an increased intent to medicate a pregnant woman with chronic pain (<i>r</i> (100) = 0.583, <i>p</i> &le; 0.001).</p><p>

<p> Breast cancer is the second leading cause of cancer death and the leading cause of premature death of women in the United States (US). It was estimated that 231,840 women were expected to develop breast cancer in the US in 2015 and approximately 40,290 women were estimated to die of the disease. Even though most breast cancers are sporadic, 5-10% of women are at an increased risk for developing breast cancer due to a hereditary risk. Too few healthcare providers are identifying women with family histories suggestive of hereditary cancer syndromes. An efficient way to identify high risk women in the primary care setting is through an easy to understand, self-administered family history risk assessment tool. The Pedigree Assessment Tool (PAT) family history questionnaire was offered to women age 18 and over at a primary care clinic in northern Louisiana. A PAT score of 8 or above prompted a cancer family history discussion by the physician or nurse practitioner and was followed by a genetic counseling referral. A total of 428 women completed the risk assessment tool during a 4 month period, 32 were high risk as evidenced by scoring 8 or higher on the PAT. Fourteen women were referred for genetic counseling. Twelve declined testing due to lack of insurance coverage, previous completion of genetic testing or felt the information would not improve their health. Six of the thirteen women completed genetic counseling and genetic testing. Lack of insurance coverage was identified as a major barrier to genetic counseling referrals. Utilization of the PAT identifies high risk women who would benefit from a genetic counseling referral. Genetic testing provides information that allows the patient and primary care provider to make informed decisions regarding surveillance protocols or prophylactic surgeries to diagnose cancer at an early stage or prevent cancer from developing.</p>

<p> Maternal and infant mortality rates in developing countries are significantly higher than rates in developed countries with sepsis contributing to mortality. Cleanliness at birth has been identified by the World Health Organization (WHO) as a key element to reducing the risk of maternal-infant morbidity and mortality. There is evidence to support the importance of clean birth practices and use of clean delivery kits (CDKs) to promote improved maternal-infant health outcomes. The purpose of this quantitative study was to evaluate an intervention providing CDKs and clean birth education to examine the effect on knowledge and understanding of clean birth practices among women in Grand Goave, Haiti. A total of 18 Haitian women of childbearing age were enrolled in the study. The hypothesis of the study stated that maternal education of clean birth practices and use of the CDK contributes to improved knowledge of clean birth practices. Evaluation of the intervention showed that provision of a CDK with the educational intervention was associated with improved mean scores of the pre-and post-test surveys (N=17, pre-test summary mean=6.35, post-test summary=7.71, p=0.000). The role play evaluation further indicated that there was a knowledge improvement of use of the CDK and clean birth practices. An educational intervention with use of a CDK can improve knowledge in relation to clean birth practices and use of CDKs are vital to improving maternal-infant outcomes in low resource settings.</p>

<p> Mothering in a variety of healthcare settings is a significant process studied by nurse researchers. Mothering during recovery from a drug addiction is important to study because of its health and mental health consequences for women, their infants and children, as well as the impact on society especially the financial burden. The process of recovery from drug addiction for mothers has not been well studied. Findings from such a study can shed light on the important nursing role regarding interventions and prevention strategies to mitigate some of the health consequences. The purpose of this study was to explore the process of mothering for women recovering from a drug addiction. The conceptual framework of symbolic interaction and the Grounded Theory Methodology (Glaser &amp; Strauss, 1967) were used to guide the study.</p><p> Data were collected through 10 semi-structured interviews of women residing in a rehabilitation residential facility for drug addiction who had at least one child under the age of 18. The results indicated that the process of mothering while in recovering from a drug addiction was non-linear. Phases emerged from data collected using the constant comparative analysis of transcripts, levels of coding, categorizing and conceptualizing. Three final phases emerged from the subcategories, which explained the process: <i>mothering as influencing sobriety, anticipatory struggling and hopeful ideal mothering. Anticipatory Struggling</i> identified the final substantive theory that emerged. The women in this study were committed to changing to claim or reclaim the role of motherhood. The participants were aware of the challenges and overwhelming responsibilities that were ahead as they recovered and they anticipated the struggles, fearing relapse or again losing custody of their children. However, they were hopeful about their future mothering role, albeit in an idealized way, as they began to make their re-entry into the community. The study's findings have important implications for nursing practice, education and for influencing health policy.</p>

<p> The purpose of this study was to describe the lived experience of nurses who care for hospitalized women outside of an addiction treatment setting who have a problem with drugs and / or alcohol. The relational experiences of ten registered nurses who had cared for women with drug and alcohol problems were elicited. Heideggerian hermeneutic phenomenology was the method used to interpret the nurse participants&rsquo; meaning of their experience. The theoretical framework that was used to explore the nurses&rsquo; experience of caring for women who abuse or are dependent on alcohol was Boykin and Schoenhofer&rsquo;s <i> Nursing as Caring</i> (1993). The relational themes that emerged were: Caring in the dark; Intentionally knowing the woman with AOD as a unique person; and Experiencing sisterhood.</p>

<p> Breastfeeding has been identified as the perfect source of infant nutrition. Improving the rates and duration of breastfeeding is a global public health concern. Even though facilitators and barriers to successful breastfeeding have been identified in the literature, rates of breastfeeding fall below desired targets. Maternal characteristics such as body image and eating attitudes have been examined with respect to pregnancy and birth outcomes, yet have been less studied with respect to infant feeding choice. Based on existing literature it is possible that poor body image and /or disordered eating may affect the intention to breastfeed. The purpose of this study was to compare body image, eating attitudes, and breastfeeding intention of breastfeeding to non-breastfeeding mothers. A secondary aim was to determine if breastfeeding intention, body image, and/or eating attitudes predicted actual behavior. A two group, comparative design was used to analyze data for first time mothers (n = 66) recruited through a large pediatric practice with multiple offices. Instruments included the 34 item self-report Multidimensional Body Self Relations Questionnaire-Appearance Scales (MBSRQ-AS), the Eating Attitudes Test (EAT-26), and items from a Demographic and History form. Data analysis revealed that there was no significant difference in the body image or eating attitudes between breastfeeding and non-breastfeeding mothers. Breastfeeding intention was a strong determinant of actual breastfeeding (p = 0.001). Neither body image and/or eating attitudes predicted infant feeding method. It has been well established that personal and contextual factors affect breastfeeding intention. As a result, body image and eating attitudes can have an impact on a woman's health during childbearing. The present study highlights the need for improved instruments designed for pregnant and lactating women that measure the cognitive and behavioral aspects of body image. Subsequently, women who display disordered eating tendencies or body image dissatisfaction during the perinatal period can be identified.</p>

<p> Women involved with the criminal justice system face higher rates of unintended pregnancy than the general population, yet less than one-third use a consistent method of contraception. One study found that among women leaving detention, 43% had conceived within one year of release. Pregnancies that do occur are often high risk and result in poor outcomes for both mother and child. Lack of focus on family planning needs post-incarceration are due to competing factors women face related to daily survival and the added demands of meeting the requirements of probation.</p><p> This study examined the influences of pregnancy attitude, reproductive autonomy, personal factors and prior related behaviors on the use of effective birth control among women on probation living in southern New Mexico including the U.S.- Mexico border region. Using a quantitative correlational design framed by Pender's Health Promotion Model, 52 women were surveyed at five different Adult Probation and Parole Offices in two U.S.-Mexico border counties and two additional counties in southern New Mexico. Data analysis was conducted using descriptive statistics and logistic regression (single, multivariate, and hierarchical) to answer the following questions about women on probation: Do personal characteristics (contraceptive self-efficacy, birth control method prior to incarceration, age, ethnicity, and parity) significantly predict current birth control method? Which combination of personal characteristics (ethnicity, contraceptive self-efficacy, age, and parity) best predicts higher negative pregnancy attitudes and higher reproductive autonomy? Do pregnancy attitude and reproductive autonomy significantly predict current birth control method.</p><p> Results indicated a significant relationship between increased levels of reproductive autonomy (an interpersonal influence) and effective use of birth control among women on probation. While statistical significance was attained for two additional variables, contraceptive self-efficacy and prior birth control use, the results were not decisive due to widened confidence intervals. Use of a hierarchical logistic regression was effective for entering predictor variables into the regression based upon Pender's theoretical framework as a guide. Implications for nursing research, education, and practice were discussed. Future studies using larger sample sizes and additional settings would increase validity and generalizability.</p><p>

<p> Postpartum depression (PPD) is linked to diminished maternal, pediatric, and family health outcomes and is designated as the most common childbirth complication. PPD is an international public health concern and found in most populations. Studies suggest that American Indian/Alaska Native (AI/AN) women suffer higher PPD prevalence (14% to 29%) than other United States' women, revealing a racial/ethnic disparity. Health disparities research is a national public health priority and substantiates the need to explore PPD in AI/AN women. Clinicians define PPD as an episode of major depressive disorder with a "peripartum onset" specifier that occurs within the first year after delivery. </p><p> This dissertation work explored and synthesized PPD research about AI/AN women, where there remains considerable mystery surrounding the causes and consequences of PPD. Even with federal regulations in place requiring the inclusion of minorities and women and other underrepresented groups in research, AI/AN women have been mostly excluded, as evidenced by few studies and small sample compositions that include AI/AN women in PPD research. </p><p> Using a comparative analysis approach, validation studies of the EPDS and the PHQ-9 were examined. While possessing excellent concurrent validity, the low predictive accuracy of both tools in non-Western samples suggests cultural bias. No PPD screening instrument has been validated in samples of AI/AN women. Cross-cultural adaptation advances the science of comparative effectiveness research, and is therefore a logical next step. Using a phenomenological methodology with a community-based participatory approach, AI/AN women's "lived" PPD experiences were described. AI/AN women who experienced PPD now or in the past were interviewed using a semi-structured interview guide. De-identified demographic data were collected. Thematic analysis guided by Moustakas' (1994) procedure followed and seven major themes emerged. </p><p> This dissertation has advanced nursing science by providing an understanding of PPD in AI/AN women. Future research for AI/AN women with PPD should focus on: 1) their access to and use of PPD services; 2) the cross-cultural adaptation for PPD screening; 3) the possible relationship between PPD and intimate partner violence; 4) their preferences for PPD treatment; and 5) the possible relationship between PPD and acculturation.</p><p>