Staff evaluation of a high-risk pregnancy program

A southeastern state implemented a multidisciplinary health care program for Medicaid eligible, medically high-risk pregnant women and their infants as part of a statewide effort to reduce perinatal morbidity and mortality. The purpose of this study was to obtain the staff's evaluation of this high-risk-pregnancy program. Clinical, supervisory, and clerical staff (N = 182) completed a questionnaire about the operation of the program and its perceived benefits. Staff identified program strengths: nurse case management, interdisciplinary structure, quality care, and positive health outcomes. Staff also identified program limitations including limited staff and time, inflexible protocols, administrative tasks, and narrow enrollment criteria. The majority of staff reported that the following barriers interfered with the effective operation of the program: paperwork, limited support, time, difficulty locating patients, and mandated time frames for patient contact. The majority of staff also reported that transportation most interfered with patient access to the program. The findings of this study support the need for ongoing staff evaluation of all perinatal health care programs.

Age-structured and two-delay models for erythropoiesis

An age-structured model is developed for erythropoiesis and is reduced to a system of threshold-type differential delay equations using the method of characteristics. Under certain assumptions, this model can be reduced to a system of delay differential equations with two delays. The parameters in the system are estimated from experimental data, and the model is simulated for a normal human subject following a loss of blood. The characteristic equation of the two-delay equation is analyzed and shown to exhibit Hopf bifurcations when the destruction rate of erythrocytes is increased. A numerical study for a rabbit with autoimmune hemolytic anemia is performed and compared with experimental data.

Women's evaluation of their childbirth performance

OBJECTIVE

To describe women's evaluation of their own performance during labor and delivery.

METHODS

Participants (N = 60) were Lamaze-prepared, married multigravidae, aged 21-37 years who responded to open-ended questions in tape-recorded interviews during their postpartum hospital stay. Qualitative data analysis was used to identify themes.

FINDINGS

Women evaluated their childbirth performance as managing well (45%), having difficulty (35%), and managing poorly (20%). The following helped them to manage well: short, fast labors; minimal pain; Lamaze; husband's encouragement; being informed; feeling strong; medication; and nurses' and physicians' encouragement, help with Lamaze, and information. Women who had managed well before and who were confident about managing well again tended to evaluate their childbirth performance positively. A significant difference was seen in mean labor length: Women who managed well had the shortest labors and women who managed poorly had the longest.

CONCLUSIONS & IMPLICATIONS FOR NURSING

The women confirmed the notion that they had important work to do; they identified their own performance as one of the most important or the most important component of the childbirth experience.

Global stability in a delayed partial differential equation describing cellular replication

Here we consider the dynamics of a population of cells that are capable of simultaneous proliferation and maturation. The equations describing the cellular population numbers are first order partial differential equations (transport equations) in which there is an explicit temporal retardation as well as a nonlocal dependence in the maturation variable due to cell replication. The behavior of this system may be considered along the characteristics, and a global stability condition is proved.

Fluctuations in circulating cell numbers following chemotherapy or bone marrow transplant

We study the effect of noise on the behaviour of a dynamic cell population model in which cell replication and maturation take place simultaneously. We assume that the maximum proliferative potential v fluctuates uniformly about a mean value of v, and show that a decrease in v and/or the input flux uin into the population can lead to an increase in the variance in the cellular efflux uf. We draw a qualitative correspondence between this behaviour and the commonly observed increase in the variance of circulating blood cell numbers following chemotherapy and radiotherapy, both of which lead to a decrease in v and uin, and bone marrow transplant which probably corresponds to a decrease in uin.

Women's evaluations of their labor and delivery nurses

OBJECTIVE

To document women's evaluations of their labor and delivery nurses.

DESIGN

An exploratory, qualitative study using open-ended, intensive, tape-recorded interviews.

SETTING

Postpartum unit of a 400-bed midwestern hospital, except for two interviews in the women's homes.

PARTICIPANTS

Sixty-one Lamaze-prepared, married, multigravidae, aged 21-37 years.

RESULTS

Ninety percent of the women evaluated their nurses favorably, 10% unfavorably. Nurses were evaluated favorably because of their positive participation (80%), acceptance (78%), information giving (75%), encouragement (65%), presence (53%), and competence (7%).

CONCLUSIONS

Although technical competence is important, manner, provision of supportive care, and acceptance of each woman as a unique human being may be a nurse's most important characteristics.

Women's views of the preterm labor experience

This study used a naturalistic approach to describe the childbearing woman's views of her preterm labor and delivery experience. Specifically, the aim was to identify how women describe, interpret, and manage preterm labor and subsequent preterm or term delivery. The views of 20 women who were hospitalized for preterm labor (before 37 weeks) were documented with semistructured, tape-recorded, in-depth interviews during their hospitalization for preterm labor and after delivery. Qualitative data analysis focused on the process of becoming a preterm labor patient and on living with a diagnosis of preterm labor. Women either waited for a period of time before seeking care or sought care immediately for the symptoms they were experiencing. Women interpreted the experience by identifying causes of preterm labor and by worrying about the outcome for the baby. Managing preterm labor required extensive, moderate, or limited changes in their lives. Women who delivered at term appeared to have more tangible help than those who delivered preterm. A better understanding of women's preterm labor experiences will provide clues to nurses on how to improve the care they provide.

Strategies for change: nursing implementation of the birthing room

Nurses were primary participants in introducing the birthing room for maternity care in their respective institutions. Based on tape-recorded interviews, this paper is a report on how the idea of a birthing room was initiated, the resistance it encountered, the eight strategies used to implement the idea, and appropriation of the idea by physicians. Although the examples are specific to the development of a birthing room, the strategies can be used by nurses to initiate other changes in perinatal health care delivery. In addition, increased collaboration between nurses and physicians may make some strategies obsolete.

Stability properties of proliferatively coupled cell replication models

To address the possibility that proliferative disorders may originate from interactions between multiple populations of proliferating and maturing cells, we formulate a model for this process as a set of coupled nonlinear first order partial differential equations. Using recent results for the asymptotic behaviour of the solutions to this model, we demonstrate that there exists a region of coupling coefficients, maturation rates, and proliferation rates that will guarantee the stable coexistence of coupled cellular populations. The analysis shows that increases in the coupling between populations may ultimately lead to a loss of stability. Furthermore, the analysis indicates that increases (decreases) in the maturation and/or proliferation rates above (below) critical levels will lead either to instability in the populations or the destruction of one population and the persistence of the other.

A deterministic approach to survival statistics

Survival functions of the form p(t) = exp[-(lambda t) gamma], gamma greater than 0 can be generated by deterministic nonlinear, asymptotically stable (chaotic) dynamical systems. These systems thus provide an alternative to stochastic interpretations of failure time data. We use this approach to analyze cancer patient survival statistics. In this manner we are able to obtain fresh insights into the implications of negative and positive clinical trials.

Women's choice of childbirth setting

As part of a larger study on women's views of the childbirth experience, this study was focused on women's choice of childbirth setting. Sixty-one Lamaze-prepared, married multigravidae between the ages of 21 and 37 and experiencing a normal pregnancy were interviewed twice: at 36-38 weeks gestation in their homes and during their postpartum stay in the hospital. Data were collected using (a) two semistructured interview guides consisting of open-ended questions about choosing a caregiver and the place of birth and about describing the actual childbirth experience, (b) a self-administered sociodemographic questionnaire, and (c) an obstetrical and infant data form. The tape-recorded interviews were transcribed verbatim. Qualitative data analysis was focused on reasons for choosing a hospital and a physician, reasons for choosing or not choosing a birthing room, and the outcomes of the decisions. An understanding of women's childbirth needs as reflected in their choices can suggest areas where flexibility might be built into maternity care programs.

Women's expectations of the labor and delivery nurse

Sixty-one, Lamaze-prepared, married multigravidae identified their expectations of the labor and delivery nurse in semistructured interviews conducted at 36 to 38 weeks' gestation. Findings indicate variations in the amount of involvement women expected from the nurses during labor and delivery: limited (n = 17), moderate (n = 22), or extensive (n = 22). Women varied in the amount of time they wanted nurses present, who they expected to make caregiving decisions, and whether or not they wanted nurses to assist them in managing labor and delivery.