Biomedical subjects

Marilyn Stringer

Publications and source records attributed to Marilyn Stringer.

7 recordsLinked to original sources

PubMed2002

Technology in the birthing room.

The use of technology is not benign. As with any health care intervention, there are associated risks and benefits. The practitioner needs to constantly consider the benefits of the technology versus the naturalistic birth experience. The use of technology should optimize birth outcomes while maintaining a balance that provides for the best possible human birth experience. Technology, however, does have merit in the birth setting, regardless of location, but its use should be evaluated on an individual, as needed, basis. The most common technological advances currently available for assessment and maternal/fetal care during birth include electronic fetal monitoring, ultrasonography, blood pressure screening, maternal/fetal pulse oximetry, and infusion pumps. All obstetrical care providers must be familiar with the forms of technology currently available and be aware of emerging technologies for use during the birthing process.

Biomedical Technology↗

PubMedDate not supplied

Pain assessment and intervention for term newborns.

A baseline assessment of pain should occur as part of a newborn's health assessment within the first few hours of life. Validation and assessment of pain in the term newborn is important for providing care because newborns may experience pain from a multitude of procedures, ranging from heel sticks to circumcisions. Current assessment tools evaluate both behavioral and physiologic parameters. In addition, providing individualized care requires a knowledge base of the interventions available to reduce or eliminate pain, such as breastfeeding, non-nutritive suck, skin-to-skin contact, and sucrose pacifiers. This article describes three newborn pain assessment tools, the use of valid assessment tools, and evidence-based interventions that are recommended to effectively manage newborn pain.

Clinical Competence↗

PubMedDate not supplied

Nursing care of the patient with preterm premature rupture of membranes.

Preterm premature rupture of the membranes (PPROM) is diagnosed when rupture of the amniotic membranes occurs prior to the completion of the 36th week of gestation. PPROM accounts for 25% of all cases of premature rupture of the membranes and is responsible for 30%-40% of all preterm deliveries. In mothers diagnosed with PPROM without evidence of infection, active labor, or fetal compromise, the current standard of care is expectant management. The goal of expectant management is the prolongation of the pregnancy to increase fetal gestational age thus potentially decreasing the effects of prematurity. Expectant management consists of ongoing observation for signs and symptoms of infection, active labor, and/or nonreassuring fetal status. This article provides clinical nursing guidelines for the mother diagnosed with PPROM who is managed expectantly. Eight targeted areas for nursing assessment and intervention are described: preterm labor, side effects of tocolytic therapy, maternal/fetal infection, fetal compromise, side effects of extended bed rest, maternal stress, educational needs, and routine prenatal care.

Female↗

PubMedDate not supplied

Acceptance of hepatitis B vaccination by pregnant adolescents.

PURPOSE: To determine (1) the rate of prenatal hepatitis B virus (HBV) vaccine acceptance in HBV nonimmune pregnant adolescents, (2) if postulated behavioral and attitudinal factors are associated with HBV vaccine, and (3) the rate of actual receipt of HBV vaccine postpartum in eligible subjects. DESIGN AND METHODS: During 1999-2000, at an inner-city tertiary-care center prenatal clinic, 160 HBV nonimmune adolescents <18 years who were receiving prenatal and delivery care at the center were identified. The research nurse provided an HBV information pamphlet and offered immediate in-hospital postpartum HBV vaccination. Risk factors for nonacceptance of the vaccine were measured with structured questionnaires and medical record review documenting care attendance. Subsequently, all subjects, irrespective of prenatal acceptance of vaccine, were offered vaccine before postpartum discharge, and the rate of actual acceptance was determined. RESULTS: In these predominantly African American (95%) adolescents, the rate of vaccine acceptance was 91%. Actual vaccination rate was 86%, but it was not associated with prior acceptance of vaccination or behavioral or attitudinal factors. CLINICAL IMPLICATIONS: Acceptance of vaccination and actual vaccination were high in this population of high-risk adolescents. The authors found that reoffering vaccine was a successful intervention, even with adolescents who had less-than-optimal attendance at prenatal visits. Given the high rate of acceptance and vaccination in this setting, the authors would encourage public health programs to implement vaccination programs in adolescent prenatal clinics and to offer vaccination postpartum to those who do not receive it prenatally.

Adolescent↗

PubMedDate not supplied

Limited obstetric ultrasound examinations: competency and cost.

OBJECTIVE: To determine both the actual dollar cost and the amount of time required per nurse to establish competency in limited obstetric ultrasonography (LOBU). DESIGN: Descriptive. SETTING: A tertiary care setting. PARTICIPANTS: Registered nurses who were taught in LOBU. RESULTS: Nurses who attained competency in LOBU completed 12 hours of didactic education and a clinical practicum consisting of 6 to 9 hours and approximating 15 ultrasound scans. For five nurses to concurrently attain competency in LOBU, the cost per nurse was $1,037.55 (includes salaries and employee benefits). CONCLUSION: Registered nurses are able to acquire competency in LOBU at a reasonable cost, thus enhancing the ability of the professional nurse to deliver a fuller scope of services in an obstetric setting. For institutions that have limited access to individuals with this skill, nurses trained in LOBU may present a high-quality, cost-efficient solution to providing needed obstetric services.

Clinical Competence↗

PubMedDate not supplied

The cost of prenatal care attendance and pregnancy outcomes in low-income working women.

OBJECTIVE: To examine personal costs (dollar costs and time spent) associated with prenatal care (PNC) attendance and outcomes (gestation length, PNC adequacy, and birth weight) for low-income, working women (N = 165). DESIGN: Prospective, descriptive study. SETTING: Participants were recruited from a pre-natal clinic located at an inner city tertiary care center. PARTICIPANTS: A convenience sample of 165 low-income, working women. MAIN OUTCOME MEASURES: Personal costs were measured as dollar costs and time spent associated with PNC attendance. Perinatal outcomes were measured as gestation length, PNC adequacy, and birth weight. RESULTS: Per visit, the mean cost associated with PNC was 33.31 dollars (range 1-125.60 dollars, SD = 32.33 dollars) and the time needed to attend care was 228 min (20-720, SD = 205). Women delivered at 37.8 (18-42) weeks; 17.6% of the women received inadequate PNC, and 17.0% of the women delivered low-birth-weight newborns. CONCLUSIONS: The findings indicated that personal costs associated with PNC attendance were not associated with inadequate care attendance.

Absenteeism↗

PubMedDate not supplied

Comfort care of neonates at the end of life.

Most neonatal intensive care units have approaches to manage patients at the end of their lives. Published guidelines to help direct practitioners are lacking, and these management approaches, commonly referred to as comfort care, are often based on tradition. Recently, our neonatal staff experienced a unique situation that involved giving comfort care to a previable neonate who lived much longer than anticipated. Our staff identified the need for an evidence-based practice guideline to focus on four key care issues: provision of warmth, close physical contact, nutritional support, and sedation and pain management. The purpose of this article is to supply health care providers with evidence-based comfort care guidelines for neonates at the end of who either are previable of have had life support withdrawn. The process used for developing the guidelines is included.

Algorithms↗