AWHONN's clinical issues in perinatal and women's health nursing最新文献

Nurses often work in settings in which they may be exposed to a wide array of psychosocial, chemical, biological, and physical hazards. The authors outline several ways in which occupational exposures occur and the general process for reducing or preventing workplace hazards. Several commonly encountered workplace hazards and their potential health risks are identified and discussed. Specific health hazards that are addressed include the chemical hazards of antineoplastic and antiviral drugs; the biological hazards of human immunodeficiency virus, hepatitis B, herpes viruses, rubella, and tuberculosis; and the physical hazards of noise and ionizing and nonionizing radiation. The authors suggest specific preventive measures that nurses can take to make their workplaces safer.

Cancer will be diagnosed in more than a half a million women this year. Prognosis and curability are associated with the stage of the cancer at diagnosis. If cancer is detected at an early stage, more than 75% of women can expect long-term survival or cure for the most common cancers, excluding lung. Promoting health behaviors that reduce risk and recommending screening tests are critical activities for the practitioner that may affect survival rates and quality of life of women with cancer diagnoses. Risk factors, incidence, presenting symptoms, staging, treatment and 5-year survival rates associated with 12 major cancer sites in women are presented. Diagnosis and survival for minority populations are reviewed, highlighting the need to improve cancer screening and detection for this group of women.

The experience of moral distress can be distinguished from the experience of moral dilemmas. In moral distress, a nurse knows the morally right course of action to take, but institutional structure and conflicts with other co-workers create obstacles. A nurse who fails to act in the face of obstacles also may have reactive distress in addition to the initial distress. Both kinds of distress pose dilemmas about individual and collective moral responsibility. Coping with these dilemmas effectively requires taking at least some successful actions to resolve distress.

This article contrasts two popular approaches to nursing ethics: the principle-based approach and the care perspective. The care perspective is situated within the general schema of ethical theory and described. Its contributions to nursing and clinical ethics are highlighted, as are the challenges it poses to nursing practice, education, and research. The author concludes that the caring perspective provides an orientation to persons that grounds professional relationships and ethics in all of the helping professions. As such, it provides an insufficient basis for establishing a distinct theory of nursing ethics.

Research using human fetal tissue is well established in biomedical science and indicates promising results in clinical transplantation for some diseases. Because the most optimal tissue for use in transplantation is obtained from fetuses resulting from elective abortions, this technology provokes ethical controversy. Societal concern about the ethical feasibility of human fetal tissue transplantation research (HFTTR) culminates with its investigative use in the treatment of Parkinson's disease. Reflective of such concern in the United States was the 1988 ban on federal funding for HFTTR using tissue obtained from electively terminated abortuses and the establishment of the HFTTR Panel. Considerations generating ethical debate about HFTTR include the moral status of the fetus, who should consent to use of fetal tissue in transplantation research, and issues related to complicity in, and legitimization of, abortion. The moratorium on federal funding for HFTTR has been lifted, but ethical issues and societal concerns remain unresolved.

Childbirth education can have an enormous positive effect on the maternal health and birth experience of women in shelters. The childbirth educator can empower economically disadvantaged pregnant women to take personal responsibility for their childbirth outcome. The characteristics of women in shelters pose unique challenges to childbirth educators. Transient populations, different stages of pregnancy, substance abuse, nutrition deficiencies, and difficulties with the skills required for being a good parent present unusual problems and rewarding educational opportunities. With understanding, sensitivity, and commitment, the childbirth educator can prepare women in shelters to participate more actively in a healthy and informed birth experience.

Recently, attention has been given to the area of preconceptional health education and promotion of improved pregnancy outcomes through risk assessment and planning. This article identifies successful teaching strategies for preconceptional health education by health care providers and identifies class content and methods for preconceptional health education, with an emphasis on the interdisciplinary team approach.

Domestic violence is a highly prevalent event in the United States. Health providers frequently treat abused patients; however, many do not routinely assess for family violence or suspect it when the injuries seem fairly obvious. Because abused women feel stigmatized by the violence, they are hesitant to volunteer the abuse. In 1990, the Joint Commission on the Accreditation of Healthcare Organizations added requirements for emergency and ambulatory care services to develop and use protocols for the identification of violence among patients. This article addresses the ethical and legal dilemmas facing nurses that influence their assessment and intervention in family violence.

Women are the fastest growing population with newly diagnosed acquired immune deficiency syndrome (AIDS) in the United States. Although little is known of specific female manifestations, research trends suggest an increase in genital tract infections and neoplasms that may be recurrent and difficult to treat. The initial presentation of early human immunodeficiency virus (HIV) infection in many women is recurrent and chronic vaginal candidiasis. Abnormal cervical cytology is common, and biannual Papanicolaou (Pap) smear screenings are recommended, preferably with a colposcopic examination. Because such human papillomavirus (HPV)-related dysplasias often are multifocal, anal Pap smears also are recommended. This article addresses the gynecologic problems and care of HIV-positive women.

Coronary heart disease is reaching epidemic proportions in women. With increased longevity, more women are living many years beyond menopause, the time when heart disease peaks in women. For midlife women, it is important to determine a personal profile of unmodifiable (family history, age, and race) and modifiable risk factors. The goal for every woman must be to control coronary risk factors such as smoking, hyperlipidemia, diabetes, sedentary life style/weight control and stress, which have been proven to be amenable to modification strategies. Many women also may consider hormonal replacement but must be counseled to make informed choices concerning the benefits and risks. Finally, as nurses and as leaders in the health care of women, we must model heart healthy behaviors to encourage each other and to increase our effectiveness with the clients we serve.