Category Archives: Early Childhood Development
This is part of the September 2014 issue of Sharing Nursing’s Knowledge.
Nurse-midwifery took a turn in the media spotlight last month during a television talk show in Kentucky, the “birthplace” of midwifery and family nursing practice in America.
In a half-hour segment on Kentucky Educational Television, TV host Renee Shaw interviewed officials from Frontier Nursing University, the longest continuously operating and largest midwifery program in the country. The university will mark its 75th anniversary in October.
Nurse midwives and nurse practitioners “really want to make their community a better place, and they know from working in the system that, as nurses, they can do that,” said Julie Marfell, DNP, APRN, FAANP, dean of nursing at Frontier Nursing University.
Midwifery got its official start in America thanks to Mary Breckenridge, a nurse from a prominent political family who was born in the 1880s. After the deaths of her first husband and both of her children, Breckinridge decided to devote her life to improving health and health care. In 1925, she founded the Frontier Nursing Service in Hyden, Ky., a remote and unserved part of the country, so she could bring British midwifery practices to the United States. The Frontier Nursing Service later added the nation’s first schools of midwifery and family nurse practice.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
Hurricanes Katrina and Rita significantly increased the number of stillbirths in the Louisiana parishes most affected by the storms, according to a study by RWJF Health & Society Scholar Sammy Zahran, PhD. The research team concluded that 117 to 205 fetal deaths could be attributed to distress caused by the storms, the New York Times blog Well reports. “You can have two mothers with equal characteristics—age, race, and so on,” Zahran said. “[B]ut if one happens to be in a more severely destroyed area, the risk of stillbirth is higher.” The study was also covered by Daily Mail and HealthDay. Read more about Zahran’s work on the Human Capital Blog.
Genetics play an important role in whether stress makes people depressed, and in how quickly they recover, Madison.com reports. RWJF Health & Society Scholars alumnus Jason Fletcher, PhD, looked at data before and after the 9/11 attacks and correlated it with DNA information reported by survey respondents. He found that 60 percent of participants who carried a particular gene appeared to be at an increased risk for sadness after the attacks. “Overall, the evidence suggests that genetic endowments are an important source of variation in response to a stressful event, in producing some depressive symptoms in young adults,” Fletcher said. MedicalXpress also covered the study.
Annik Sorhaindo, MSc, is a senior program researcher with the Population Council’s Reproductive Health Program in Mexico. A 1997 alumna of the Robert Wood Johnson Foundation-funded Project L/EARN initiative, she conducts research to provide evidence that helps inform government policy. This post reports on her work.
Fifty-five percent of all pregnancies in Mexico are unplanned.
That dramatic statistic, from a report by the Guttmacher Institute, can be mapped to the limited access women have to contraception.
“Many women can’t readily obtain contraceptive methods,” says Annik Sorhaindo. As part of a five-organization alliance working to improve reproductive health in the world’s 11th most populous country, the council directs research and analysis for the effort.
“My work focuses on answering research questions: Which occurrences in daily life impact women’s decisions about contraception? What are the impediments to preventing teen pregnancy? What are the challenges to using contraception post-abortion?”
Sorhaindo is quick to note that the council stays above the political fray. “We do the research and interpret the results, and the advocacy organizations address the politics,” she says.
Robin Knobel, PhD, RN, is an associate professor at the Duke University School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2010-2013). The University of Carolina at Chapel Hill (UNC-CH) School of Nursing recently recognized her with its Distinguished Alumna award.
Human Capital Blog: Congratulations on the award! What does it mean for you and for your research?
Robin Knobel: I was truly honored to receive this award from UNC-CH because it recognizes my achievement thus far in my career in my area of research around improving thermal stability with premature infants. I was given great support as a doctoral student at UNC-CH through mentorship in research from faculty who are leaders as nurse scientists. To be recognized by alumni and faculty of the UNC-CH School of Nursing is a tremendous honor.
HCB: You received the award for your research into physiologic processes related to thermoregulation and perfusion in extremely premature infants. Can you explain what this means in lay terms?
Knobel: Yes. Premature infants are born too early to be able to keep themselves warm through the normal methods of heat production. Normally, infants up to one year of age do this through a metabolic production of heat, instead of shivering. Premature infants lack necessary components to accomplish efficient production of heat and consequently can become very cold if exposed to cold air after birth and through stabilization in the neonatal unit. They often experience hypothermic body temperatures during the early weeks after birth, which can lead to instability and possible lasting insults such as brain hemorrhage, infection, or even death. My research is studying the mechanisms around thermal stability in premature infants and ways to prevent bad outcomes from hypothermia.
A Doctor and Mother of a Premature Baby Helps Test a Mobile App for Parents of Special-Needs Infants
Nwando Eze, MD, MPH, is a neonatal fellow and mother of two practicing in Orange, California. When she was a pediatric resident, she helped test Estrellita, a smartphone app designed to support parents of infants with special health needs. Estrellita is supported by the Robert Wood Johnson Foundation (RWJF).
I smile as I note the increase in weight Ozuli has had in the last month. Having spent two-and-a-half months with Ozuli in the neonatal intensive care unit (NICU), I learned quickly that weight gain with minimal to no other problems was as close to an ideal situation as any parent could ask for in the NICU.
Ozuli was born two months early at 29 weeks unexpectedly. I was in my second year of pediatric residency and had a three-year-old already and had no problems with my previous pregnancy. So it was quite a surprise when at 29 weeks I began contracting intermittently and the contractions didn’t stop until Ozuli was born. I was put to sleep for the delivery and so did not get to see her until the next day, which just happened to fall on Mother’s Day. That day was the beginning of our two-month journey in the NICU—a journey I found to be the scariest and yet most blessed time in my life.
A few weeks before we were discharged, I agreed to enroll in a study testing a mobile health application that allowed parents of preterm infants to record ongoing health-related information about their infants. I was given a smartphone with the app in which I was to record events like daily diaper counts, daily weights, how fussy Ozuli was that day, my own daily moods, doctor’s appointment times, and follow-up visits.
This is part of the August 2013 issue of Sharing Nursing's Knowledge.
“I had a very romanticized, idealized view of nursing [growing up], as did many nurses at that time ... The Army provided all of my education for that initial nursing degree. It was an incredible program ... I was able to put it all together with the nursing background and the leadership from the military and to land the first public health leadership job in my career ... There weren’t that many people in (the field) and the funding really wasn’t there at the time. To me, that was very attractive. It was like pioneering in an area, at least in Ohio ... What I did have the ability to do [as chief nursing officer with the American Red Cross] was go in and design the nursing system so it would work a little better, not just in disasters but across all of the business lines.”
-- Sharon Stanley, PhD, RN, alumna, RWJF Executive Nurse Fellows program, Accomplished Nurse’s Career has Roots in Military, Chillicothe, Chillicothe Gazette, July 29, 2013
“Journos [journalists] who say they’re hard-boiled cause they see so much should know ICU nurses see more in a week. And come out kind.
I just want to say that ICU nurses are remarkable people. Thank you for what you do for our loved ones.
ICU seems to be staffed by good, smart young docs who think they know everything, and wise RNs who really do.”
-- Scott Simon, host of NPR’s Weekend Edition, in tweets from his dying mother’s bedside, @nprscottsimon, July 23, 2013
It’s made of glass, and it glows and changes colors—but it’s not a crystal ball. It’s an “orb” and it’s poised to revolutionize the way providers assess and treat pain in premature infants.
Martin Schiavenato, PhD, RN, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar, has invented a revolutionary tool to assess pain in premature infants and potentially protect them from its negative developmental effects.
The glass orb translates behavioral and physiological signs of pain in infants—such as body gestures and physiological signals like heart rate metrics—into a “real time” visual display of pain levels. It changes color depending on the subject’s pain levels, giving clinicians readouts on infant pain.
Vernell DeWitty, PhD, RN, is the deputy program director for New Careers in Nursing, a program of the Robert Wood Johnson Foundation and the American Association of Colleges of Nursing.
Every now and then a television program gets it right, and so it is with “Call the Midwife.” This BBC-produced program aired on PBS this fall, and will be back with a new episode in December. Set in London's very pre-revitalized East End during the late 1950s, and based on the memoirs of Jennifer Worth, the series chronicles the adventures of a group of midwives working at the Nonnatus House, a nursing convent named for the early cesarean-surviving patron saint of childbirth.
The series is blunt about the medical practices of the day and the state of birth control and female empowerment at the time. But the strange pull of this series is its humanity, not its horrors.
It is easy to think that women were always tended to during pregnancy, childbirth and delivery; however, this is not the case. We tend to forget the number of women who died in childbirth and the high rate of infant mortality due to lack of proper care not that many years ago.
But with the appearance of the nurse mid-wife, we realized significant decreases in maternal and infant mortality. Indeed, nurse midwives were the forerunners of the advanced practice nurse practitioners of today.
Pamela K. Xaverius, PhD, is an assistant professor in the Department of Epidemiology at Saint Louis University, and a former grantee with the Robert Wood Johnson Foundation (RWJF) New Connections program. This post is part of a series in which RWJF scholars, fellows and alumni who are attending the American Public Health Association annual meeting reflect on the experience.
As a former New Connections grantee from the Robert Wood Johnson Foundation, I was asked to blog about my experience with one of my posters at the 140th annual conference of the American Public Health Association (APHA) in San Francisco this week. The poster was entitled “Prevalence of Preconception Lifestyle Behaviors Between Women With and Without Diabetes.”
There has been a groundswell of activity across the U.S. around the idea that if women want to have healthy babies, they need to be healthy before they get pregnant (aka, preconception health). This idea fits well with the overall theme of the APHA conference this year: Prevention and Wellness Across the Lifespan.
My co-authors and I presented a poster on secondary analysis of data that looked at the relationship between lifestyle behaviors and diabetes status among women of reproductive age. The biggest takeaway that we wanted people to have from this poster was that 93 percent of women with diabetes are not intending a pregnancy, and 73.2 percent of them are not using any birth control method (40.5 percent) or using less effective birth control methods (32.7 percent). This is a recipe for significant public health concern, with the growing rates of diabetes coupled with the potentially deleterious consequences of unmanaged diabetes during pregnancy.
The U.S. Department of Health and Human Services, Office on Women’s Health has designated May 13 to May 19 as National Women’s Health Week. It is designed to bring together communities, businesses, government, health organizations and others to promote women’s health. The goal in 2012 is to empower women to make their health a top priority. The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is launching an occasional series on women’s health in conjunction with the week. This post is by Rebekah Gee, MD, MPH, RWJF Clinical Scholars alumna and an assistant professor of public health and obstetrics and gynecology at Louisiana State University (LSU). She is director of the Louisiana Birth Outcomes Initiative.
Louisiana is a fantastic place to live. It’s one of the most culturally rich and enchanting places in the United States. The state, however, also faces some of the greatest challenges in our nation.
Louisiana has a long history of poverty, poor education, and social problems that affect the health of too many of its citizens. And for women—particularly African American women—the challenges are even greater. We are 49th in the nation in terms of overall birth outcomes, like infant prematurity and mortality, and we get failing grades on report cards that measure those indicators of health.
In 2010, Bruce Greenstein, Secretary of the Louisiana Department of Health and Hospitals (DHH), recognized the importance of poor birth outcomes as a crucial public health issue—and named it his top priority. We were the first state in the nation to offer birth outcomes this kind of backing from our government officials. In November, 2010, we launched the Birth Outcomes Initiative, which I direct. It engages partners across the state—physicians, hospitals, clinics, nurses—and provides them with the best evidence and guiding principles to achieve change. We have made significant progress already.
We are working with the state’s hospitals on maternity care quality improvements, including ending all medically unnecessary deliveries before 39 weeks gestation. We have partnered with 15 of the largest maternity hospitals to provide them with the support and resources to make this a reality. Now, every maternity hospital in the state (there are 58) has signed on to the 39-Week Initiative.
Soon, we will be publishing perinatal quality scores—available to the public—so hospitals and physicians are held accountable for outcomes. In our pioneer facilities, we have seen the rates of elective deliveries drop by half. Many facilities have had as much as a 30-percent drop in the number of babies who needed to go to the NICU. The efforts of the Birth Outcomes Initiative are improving lives day after day.