Journal of nurse-midwifery最新文献

The purpose of this study was to determine how accurately clinicians can identify the uppermost border of the uterine fundus when they obtain fundal height measurements. Clinicians were instructed to identify the uppermost border of the uterine fundus in their usual manner and make a small pen mark on the maternal abdomen at that point Real-time ultrasonography was then used to locate the actual level of the fundus and measure the distance between the clinician's assessment and the actual level of the fundus. Measurements were obtained from 126 women. Six clinicians participated in the study, and the differences between the clinicians' errors were not statistically significant (F = 1.26; d.f. = 5,120; P = .2873). For the entire series, the mean error was −.45 cm (SD = 1.99 cm), the mean absolute error was 1.25 cm, the maximal error was 8.6 cm, the percentage of errors that exceeded 1 cm was 42.1%, and the percentage of errors that exceeded 2 cm was 20.6%. Examiner error was not associated with factors such as maternal height, prepregnancy weight, present weight, prepregnancy body mass index, parity, gestational weeks, the amount of fat on the anterior abdominal wall, or the presence of the placenta or fetal parts in the fundus. Examiner error was influenced by thickness of the uterine wall and fetal presentation. These findings indicate that clinicians make errors in identifying the uterine fundus in a significant number of cases and that the methods used by clinicians to identify the uterine fundus need to be evaluated and improved.

Higher education is seen as a step in the right direction for credentialing health care providers. The difficulty lies in the continuation of nurse-midwifery certificate programs to increase the number of practicing certified nurse-midwives while maintaining high-quality care. The author offers some pragmatic solutions to this dilemma.

Published reports of the effectiveness of preterm birth prevention programs have produced mixed results. Many larger observational studies suggest benefit. The randomized trials, however, suggest no effect on reducing rates of preterm birth in high-risk populations. This article reviews and critiques these reports and suggests areas for further research.

Circumcision is a practice that dates back to the Stone Age, when flint knives were used to perform this delicate task. Since that time, different implements and techniques for their use have been employed. In 1935, an instrument that reduced the incidence of hemorrhage and infection, which continued to complicate circumcisions, was first described in the medical literature of this country; for nearly 60 years, the Gomco clamp has met and exceeded expectations despite the emergence of other clamps and devices. This article addresses refinements that have evolved in the Gomco clamp technique. These refinements combine the highest degree of safety with the least trauma to the newborn. Step-by-step detailing of this surgical skill and implications for practitioners are explored in depth.

Nurse-midwifery practice has been defined by the American College of Nurse-Midwives (ACNM) as “the independent management of essentially normal newborns and women … occurring within a health care system which provides for medical consultation, collaborative management or referral. …” As the health care delivery system in the United States becomes increasingly complex and reliant on new forms of technology, it has become necessary to clarify roles and responsibilities for the nurse-midwife. In addition, mechanisms for acquiring new skills and for collaborating with physician colleagues must be well understood. A question frequently asked is where the boundaries of nurse-midwifery practice end and those of medical practice begin. Although practice scenarios vary for individual nurse-midwives and nurse-midwifery services, recent statements approved by the ACNM Board of Directors discuss these issues in an attempt to clarify the potentially confusing areas of collaboration and skill acquisition. This article explores the areas of expanded nurse-midwifery practice and collaborative management. Although individual clinical skills are not necessarily endorsed, a step-by-step approach that nurse-midwives can use for incorporation of new skills is presented. The concepts discussed will be a valuable tool to nurse-midwives in their practice.