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

Children of battered women are at risk for a variety of emotional, cognitive, and behavioral difficulties. However, a growing body of research has described the important mediating effects on children of even one positive relationship with a significant person. Nurses need to be aware of family violence and to assess every client and family for this problem. Early identification and interventions can stem detrimental effects and help mothers and children recover.

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.

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.

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.

Physical examinations can be positive patient experiences, providing reassurance, education, and case finding. However, examinations also can be extremely anxiety provoking because of feelings of shame and embarrassment about visible injuries from an abuser. They also may provoke flashbacks related to incest, child sexual abuse, and rape. Nurses involved in clinical assessment of any kind need to be aware that a patient's history often affects her response to clinical evaluation. Asking a patient about abuse before evaluation is respectful and empowering and often establishes a valuable opportunity for intervention.

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.

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.

This exploratory study was designed to determine the reasons men might beat their female partners during pregnancy from the perspectives of women who had experienced this form of violence. Seventy-nine battered women were recruited by newspaper advertisement and bulletin board postings to take part in a larger study of women's responses to relationship problems. Women battered in their relationships were asked if they had ever been beaten during pregnancy. The 27 (34%) women who had a pregnancy with the abusive partner as the father and had experienced physical abuse during the pregnancy were compared with 24 (30%) women who also had been pregnant by the abuser but had not been abused during pregnancy. The only significant difference between the two groups was that the women battered during pregnancy were more frequently and severely beaten throughout the course of the relationship. Those abused during pregnancy were asked why they thought that had happened. Their answers were thematically analyzed into the categories: (1) jealousy of the unborn child; (2) anger toward the unborn child; (3) pregnancy-specific violence not directed toward the unborn child; and (d) "business as usual." Implications for nursing assessment and interventions for abuse during pregnancy are derived from this analysis.

One of the most perplexing issues for nurses working with abused women is the extent of violence experienced by teen-agers. This article presents research findings from a study of pregnant women and teen-agers in Baltimore and Houston that found 32% of pregnant teen-agers reported having been physically or sexually abused in the prior year. The rate of abuse during pregnancy was 22% for teen-agers. Teen-age violence is discussed in terms of possible reasons for teen-agers to be reluctant to report abuse and nursing considerations in the assessment and intervention of adolescents experiencing abuse.