Clinical Nursing Research

The purpose of this study was to compare the behavioral responses of term newborns of insulin-dependent diabetic mothers (NDMs) with newborns of nondiabetic, healthy mothers. The research design involved matched controls with repeated measures. Participants included 40 NDMs matched with 40 newborns of nondiabetic, healthy mothers. The main outcome measures were the seven dimensions of the Neonatal Behavioral Assessment Scale (NBAS) and the modal response score. The results showed that NDMs performed significantly poorer than their matched controls on motor processes and reflex functioning. For all newborns, motor processes, autonomic stability, reflex functioning, and the modal performance score were better on Day 2 than Day 1. It was concluded that although NDMs’ behavioral responses improved by Day 2, their overall pattern of responses could be described as listless or sluggish. Due to their poorer motor and reflex responses, NDMs may require increased efforts to facilitate sensitive maternal responding during their first days of life.

This study examined the relationship between method of pain management during labor and birth outcomes. A retrospective comparative chart review of 233 primiparous deliveries was conducted and group assignment was based on method of pain control (nonnarcotic, narcotic, or epidural). Epidural analgesia or anesthesia was associated with increased rates of instrumental and cesarean delivery. Augmentation of labor using a synthetic oxytocin was reported in more charts than expected, and the length of the second stage of labor was longer in those who received epidural analgesia or anesthesia. Apgar scores for those who received early epidural analgesia or anesthesia were lower than for those who received late or no epidural analgesia or anesthesia, although Apgar scores were satisfactory across all groups. Between-groups differences were unrelated to time of epidural placement or maternal temperature. Findings are relevant for maternal child nurses who serve as a resource for families wishing to make informed decisions about pain management in labor.

It has been assumed that women recover from pregnancy and childbirth within 6 weeks. Recent research shows that women’s fatigue levels are the same, or higher, at 6 weeks postpartum as at the time of delivery. This study determined the differences in primiparous women’s fatigue and energy levels at 6 weeks and 14 to 19 months postpartum. Determinations of how some contributing factors and outcomes of postpartum fatigue relate to each other and to fatigue and energy at 14 to 19 months postpartum were also made. Analyses revealed that women are more fatigued and less energetic at 14 to 19 months than they were at 6 weeks postpartum. Quality of sleep did not correlate with fatigue or energy. At 14 to 19 months postpartum return to full functional status is almost complete, with household and infant care responsibilities being most complete. The women were experiencing mild life crises of various sorts, were somewhat depressed, and were gratified in the mothering role.

This study compared differences in knowledge of pain assessment and pharmacologic and nonpharmacologic pain management strategies among 232 L.P.N.s and R.N.s from three hospitals. Twenty-three adult medical, surgical, and special care units were represented. The “Knowledge of Pain Management” tool measured knowledge of pain assessment, drug and nondrug strategies, and was based on AHCPR guidelines. Scores ranged from 24% to 92%. There were significant differences in scores across hospitals and between R.N.s and L.P.N.s. The mean score was 72% for L.P.N.s and 75% for R.N.s. There was a significant difference in pharmacologic scores between L.P.N.s versus A.D./A.A.-R.N.s, B.S.N-R.N.s, and M.S.N.-M.S.-R.N.s but not between L.P.N.s and diploma-R.N.s. There were significant differences in overall knowledge scores between L.P.N.s versus B.S.N.-R.N.s but not A.D./A.A.-R.N.s, diploma-R.N.s, and M.S.N./M.S-R.N.s. Findings suggest the need for aggressive nursing education programs offered in academic and clinical settings to assist nurses in effectively managing the universal phenomenon of pain.

This experiment examined the accuracy of capillary blood glucose monitoring using the visual glucose oxidase strip (Chemstrip) procedure. Also, the effects of a certification program for nurses on the accuracy of glucose oxidase strip monitoring by registered nurses were analyzed. Seventy nurses and 123 patients participated. Data were collected from nurses’ recordings of visual Chemstrip procedure results and from the concurrent laboratory blood glucose determinations for 3 months. The data included 70 Chemstrip recordings and 70 concurrent laboratory blood glucose recordings in the experimental group and 68 Chemstrip and 68 concurrent laboratory glucose recordings in the control group. Data analysis revealed that the accuracy of the nurses’ performance of the glucose oxidase strip procedure was inadequate. A certification program did, however, dramatically improve the accuracy of the procedure. Proximity of time between the certification program and the performance of the glucose oxidase strip procedure did not affect accuracy.

The purpose of this study was to determine the importance of knowledge of clinical background data on nursing assessments of infant pain. In a quasiexperimental design, the infant pain assessments of two groups of pediatric nurses were compared. Both groups assessed the levels of pain of the same videotaped infants. One group also read clinical background data about each infant; the other group did not. The group who read clinical background data evidenced higher mean levels of assessed pain per videotaped infant than did the group who only viewed the videotapes. Findings underscore the importance of clinical data and clinical context in the process of assessing infant pain and the risk of underestimating pain when all factors are not considered.