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- Go to article: Including Nature and Alternative Methods to Treat Postpartum Hemorrhage: State of the Science
Postpartum hemorrhage (PPH) is the leading cause of global maternal death. PPH affects roughly 5% of births worldwide. PPH rates are increasing at alarming rates in many developed countries. This manuscript aims to explore the natural, therapeutic, and economical approaches to breastfeeding, breast and nipple stimulation, and skin-to-skin contact (SSC) as a conventional practice, along with commonly used methods for managing PPH.
A total of five articles published in the last 8 years were reviewed, focusing on breastfeeding or breast and nipple stimulation to prevent or treat PPH.
SSC and breast and nipple stimulation successfully managed PPH just as well or better than the standard treatment of synthetic oxytocin.
Allowing the newborn to have SSC with the new mother through breastfeeding or using a breast pump releases natural oxytocin. Along with standard PPH treatment, this could prove to be an effective standard of care in the event of PPH.
- Go to article: Living in Stealth: A Grounded Theory Study of Transgender Women’s Barriers to HIV-Prevention Services and Interventions
Living in Stealth: A Grounded Theory Study of Transgender Women’s Barriers to HIV-Prevention Services and Interventions
Background and Purpose:
HIV infection is a health disparity among transgender women. Despite limited HIV-prevention interventions and services, many transgender women do not access these interventions and services. The purpose of this study was to identify the process by which barriers may prevent transgender women from receiving HIV-prevention interventions and services and to have participants propose ideas on how to overcome these barriers.
Utilizing a grounded theory approach, 25 in-depth, semistructured interviews were conducted with transgender women aged 20–69 years. After providing written informed consent, participants completed an in-depth individual interview. Interviews were audio-recorded and transcribed verbatim. Categories and subcategories were identified from the data using open, axial, and selective coding.
A theory grounded in the data named Living in Stealth emerged that described this central phenomenon that underpinned the other main categories of Encountering Social Barriers and Encountering Structural Barriers. Generating Ideas for Restructuring HIV-Prevention for Transgender Women was the final category in which participants provided ideas to overcome HIV-prevention barriers.
Clinicians and researchers providing HIV-prevention services and interventions for transgender women need awareness of the complex nature of HIV prevention for this subpopulation of women. More research is needed to incorporate findings from this study into HIV-prevention interventions for transgender women.
- Go to article: “Be Your Own Doctor” Experiences of Patients With Transcatheter Aortic Valve Implantation During the Pandemic: A Qualitative Study
“Be Your Own Doctor” Experiences of Patients With Transcatheter Aortic Valve Implantation During the Pandemic: A Qualitative Study
Background and Purpose:
although patients have had reduced access to healthcare institutions due to the COVID-19 pandemic and the related preventive measures, there is no current data on how the pandemic has affected patients who underwent transcatheter aortic valve implantation (TAVI), despite their need for close follow-up. This study investigated TAVI patients’ experiences with self-care management during the pandemic.
this study adopted a descriptive qualitative design. The sample consisted of 24 patients recruited using purposive sampling. Data were collected by telephone and analyzed using inductive content analysis.
the data were grouped under three themes: “vulnerability,” “worsening of psychological condition,” and “expectations.” The most challenging self-care behaviors reported by TAVI patients were determined to be doing regular physical activity, managing their symptoms, complying with treatment, and attending regular check-ups. They also reported experiencing psychological problems such as fear, concern, and abandonment and stated a need for better communication and follow-up at home during the pandemic.
Implications for Practice:
the pandemic has more than ever demonstrated the importance of effective self-care for cardiovascular patients. Nurses should plan individualized interventions regarding the problems in self-care management that we identified in this study. In this regard, the use of secure digital applications such as telerehabilitation can be effective. Also, nurses should develop community-based and political initiatives to allow sustainable self-care management to be effectively implemented in special patient groups in extraordinary circumstances such as pandemics.
- Go to article: The Dimensions of Desire Among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM): An Evolutionary Concept Analysis
The Dimensions of Desire Among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM): An Evolutionary Concept Analysis
Background and Purpose:
within nursing discourses, the concept of desire among gay, bisexual, and other men who have sex with men (gbMSM) is not well understood. Among nurses, this concept is often constructed as being synonymous with sexual and other risk-taking behaviors, which can influence the type of care nurses provide to gbMSM and affect how this group engages with nurses – and their health. This misinterpretation of what desire represents has resulted in gbMSM becoming the target of public health campaigns and nursing interventions aimed at curbing their deviant behaviors. Such an approach by nurses, however, overlooks the meaning of desire among gbMSM.
to enhance nursing knowledge about, and improve nursing practice for, gbMSM, a concept analysis of desire specific to this group was undertaken using Rodger’s evolutionary model. For this analysis, 90 articles reviewed from the disciplines of nursing and allied health, medicine, and psychology.
findings from this analysis revealed a complexity to desire among gbMSM that extended well beyond engagement in radical sexual practices and into dimensions of desire for connection, freedom, and acceptance. These revelations were applied to demonstrate how nurses’ beliefs about desire and subsequent regulations for “good health” can inhibit the ways in which desire is produced among gbMSM.
Implications for Practice:
such findings demonstrate a need to develop future approaches for nursing practice that recognize the innate value and individual perspectives about desire held by this group, which can be uniquely tailored to meet their health needs.
- Go to article: Analgesic Role of Breastfeeding: Analysis of Effectiveness, Implementation Barriers, and Strategies to Promote Evidence-Based Practice
Analgesic Role of Breastfeeding: Analysis of Effectiveness, Implementation Barriers, and Strategies to Promote Evidence-Based Practice
Exposure to painful stimuli serves as toxic stress for infants, increasing their subsequent pain sensitivity and resulting in neurodevelopmental impairments. Besides offering nutritional, psychological, immunological, and economic benefits, breastfeeding is reported as the most effective analgesia for the management of minor procedural pain in infants. Although breastfeeding holds several advantages, implementation of this nonpharmacological intervention is still uncommon in many clinical settings.
This scoping review presents an analysis of 29 clinical trials that compare the effectiveness of breastfeeding with other nonpharmacological methods.
Breastfeeding is an efficacious analgesia compared with sucrose, sweet solutions, and other nonpharmacological methods. When used alone or in combination with other nonpharmacological interventions, breastfeeding reduces infants’ biobehavioral responses to pain and promotes faster physiologic recovery after painful procedures. Breastfeeding is recommended as the first choice whenever feasible. Barriers to the uptake of this effective pain management method in clinical practice include misinformation/inconsistent use of evidence, an infant’s impaired sucking reflex, maternal–child separation, the workload of healthcare professionals, a lack of parental involvement, assumptions of healthcare providers, and a lack of adequate information/guidance for parents. Strategies to promote the uptake of breastfeeding for the management of procedural pain in infants include an effective partnership between healthcare providers and breastfeeding mothers, knowledge mobilization resources in multiple languages, informational support and media campaigns, and experiential learning opportunities for breastfeeding mothers.
Successful implementation of baby-friendly hospital initiatives, a patient-centered approach, family-centered care, and the collaborative efforts of healthcare providers in all healthcare settings is recommended to promote the uptake of breastfeeding as analgesia.
Breastfeeding provides health benefits, but women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are less likely to breastfeed than those not enrolled. This study aimed to investigate the forms of messaging that occur in WIC lactation support.
Ethnographic methods were used over a 3-month period in 2021. Observations were collected at WIC lactation care counseling sessions and were complemented with interviews, observations of other interactions, and archival documents.
The findings of this study indicate women received mixed messages about breastfeeding, including the advice, personal experience, and policies discussed in lactation counseling.
This study suggests women’s personal experiences may conflict with the messages they receive from lactation support. Recommendations for lactation support programs and training are discussed.
The article presents a lactating patient who contacted the pharmacy office to inquire about the safety of coronavirus disease 2019 (COVID-19) therapy. She was given remdesivir, dexamethasone, and ceftriaxone during the 5-day hospital stay.
The patient was worried about maintaining her milk supply during her hospital stay and the safety of the medication she received. At the hospital, she was given no information on when she could resume breastfeeding after discharge.
The pharmacist conducted an interview, determined the patient’s needs, assessed the safety of the drugs administered during the hospital stay in lactation, provided information to the patient, and stayed in touch with her during the hospital stay. As a result of the consultation, the patient decided to resume breastfeeding her baby 3 hours after discharge (or as soon as possible). The treatment did not impact the milk supply or affect the breastfed baby during a 6-day observation period. Follow-up focused on the mother’s health, potential adverse events in the baby, and the overall impact of COVID-19 infection and hospitalization on breastfeeding in this dyad.
COVID-19 treatment with remdesivir, a low dose of dexamethasone, and ceftriaxone might be considered in lactating individuals without breastfeeding cessation or any other intervention apart from close observation of the infant. A change in the color of the milk might be concerning, but it is not a contraindication for breastfeeding. The effect of the maternal therapy, in this case, caused no apparent adverse reactions in the baby and did not impact the milk supply. The situation did not affect the mother’s ability to breastfeed.
To conduct a synthesis based on a realist perspective, investigating how professional breastfeeding support can sometimes be ineffective and/or unsatisfactory from the viewpoint of the mother and fail to address the needs of the breastfeeding dyad.
An innovative, targeted “quasi-realist” synthesis technique was used to explore the context of the interpersonal relationships through which professional breastfeeding intervention is delivered and identify any unintended mechanisms and/or consequences.
Multiple expressions of failed breastfeeding support were revealed which had a negative impact on maternal empowerment, informed decision-making, and breastfeeding self-efficacy. The overarching theme, inadequate breastfeeding information/ support, was elucidated by several subthemes: giving inconsistent/contradictory advice, use of the hands-on approach, provision of insensitive care, and making parents feel scrutinized/judged. Mothers who experienced inadequate breastfeeding information/support often resorted to the mechanism of duplicity/evasion and withdrew from seeking or following further professional advice. Finally, unintended consequences of not breastfeeding as recommended included feelings of guilt and a sense of failure. This was particularly true for mothers who intended to exclusively breastfeed.
Implications for Practice:
The findings of this unique synthesis suggest that to sustain breastfeeding support relationships and prevent unintentional consequences of inadequate support, professionals must pay more attention to the manner in which breastfeeding intervention is provided. The findings also suggest that they must strive to provide more consistent, engaging, sensitive, and nonjudgmental care that better meets the needs of breastfeeding dyads.