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Fatherhood Beyond Conception: Fostering Paternal Attachment

Michael Aldridge, BSN, RN, CCRN (Student), Dianne Burkes, BSN, RN (Student), Anne Martin, MSSW, RN (Student), Jennifer Murray, BA, RN (Student), and Sharon D. Horner, PhD, RN (Faculty Advisor), University of Texas at Austin, School of Nursing, Austin, Tex


Purpose: To develop nontraditional materials or media for promoting effective paternal attachment. To facilitate the use of these materials in diverse settings that serve young and poorer families.


Significance: Paternal attachment has been shown to foster children's development, self-esteem, and success in school and other social situations. Paternal competence in performing infant care tasks and providing for the infant's needs are strongly correlated with paternal attachment. Although most fathers desire a nurturing relationship with their children, they often lack good male role models for developing these skills. Teenage and low-income fathers are at higher risk for poor paternal attachment because of fewer positive role models, lower levels of education, and less resources (financial and social) to facilitate their learning. Currently efforts to facilitate paternal attachment focus on written materials. Literacy is an issue with many teenagers and low-income fathers; therefore nontraditional methods are needed.


Description: A 3-minute music-video presentation that demonstrates paternal attachment behaviors was developed with music and images appropriate for teenage and low-income fathers.


Implementation and Potential Application: This music-video could be used as a public service announcement in movie theaters, as educational offerings in healthcare clinics, and as part of parenting education classes in public schools. Close collaboration with community stakeholders will be needed for acceptance and distribution of this video.


Implication for Practice: Using media formats that are familiar to the target population can increase the acceptance of the message. Developing more effective approaches for fostering paternal attachment among high-risk populations (teenage and low-income fathers) can benefit children's health and development.


Application of Complexity Science Influencing Neonatal Pain Management

Margie A. Campbell, BS, RNC (Student), and Marsha L. Ellett, DNS, RN, CGRN (Faculty Advisor), Indiana University School of Nursing, Indianapolis, Ind


Purpose/Objectives: The team identified the following objectives: pain assessment will be completed on all neonates undergoing circumcision; analgesia will be provided for all neonates undergoing circumcision; neonates will demonstrate pain relief postprocedure; perinatal nursing staff will demonstrate knowledge regarding evidence-based neonatal pain assessment options and adherence to postprocedural pain management clinical practice guidelines.


Background/Rationale: Challenges to identification and management of neonatal pain includes provider knowledge of assessment and management of neonatal pain, misconceptions of neonatal pain and responses, utilization of evidence-based assessment tools, and adoption of national standards regarding neonatal pain. Inadequate identification and management contributes to undertreatment among this vulnerable population.


Description of the Project: Plesek's process improvement framework, based on a "few simple rules," was followed. All work was patient-centered and evidence-based and solutions were derived from the sharp-end.


Outcomes: Retrospective review demonstrated that pain assessment was completed and analgesia was used in 100% of neonates undergoing circumcision, and 100% of nursing staff demonstrated knowledge and confidence regarding neonatal pain assessment and management.


Interpretation/Conclusion: Plesek's process improvement framework worked well.


Implications for Nursing Practice: Team members embarked upon additional neonatal pain management improvements facilitating completeness, spread, and sustainability in other areas of pain management.


Black Cohosh as a Treatment of Menopausal Hot Flashes: Implication for the CNS

Gretchen McCracken Inman, BA, RN (Student), Anne W. Martin, MSSW, RN (Student), and Sharon Dormire, PhD, RN (Faculty Advisor), University of Texas at Austin, School of Nursing, Austin, Tex


Problem: By 2010, approximately 50% of all women will be menopausal. Currently, 80% of women experience hot flashes. Evidence suggests that black cohosh is the most extensively studied and widely used herbal therapy for hot flashes.


Purpose: To critique literature on black cohosh as a hot flash remedy. Safety and efficacy are reported in order to provide the clinical nurse specialist with current knowledge and practice guidelines.


Significance: Since publication of the Women's Health Initiative, more women are seeking alternative therapies for symptom relief. The clinical nurse specialist plays an integral role in patient education, facilitating individual clients in making sound decisions about menopause, based on current clinical evidence.


Methods: A literature review of clinical trials on black cohosh through the use of medical, nursing, and alternative health electronic databases was conducted. Additionally, the current investigators in black cohosh studies were contacted for input. GlaxoSmithKline provided additional publications.


Description of Analysis: The literature suggests that black cohosh may be effective in the treatment of hot flashes. Clinical trails have not found toxicity, major adverse effects, or drug interactions except for potential interaction with tomoxifen. Although recent studies suggest that the herb does not have estrogenic effects, further investigation is recommended.


Implication for Nursing Practice: Black cohosh can be a useful treatment alternative for some women; however, caution is warranted for use in patients with estrogen-sensitive cancers. Black cohosh is not yet indicated for the treatment of other menopausal issues such as cardiovascular and bone health.


Discharge Teaching for a Patient With Complex Health Problems in a Critical Care Setting: A Case Study

Lisa M. Mullins, BSN, RN, CCRN (Student), and Marsha L. Ellett, DNS, RN, CGRN (Faculty Advisor), Indiana University School of Nursing, Indianapolis, Ind


Purpose/Objectives: A ventilator-dependent infant was to receive discharge teaching from the pediatric critical care unit. Developing a home health educational plan was a new experience for the unit. The goal was to have each parent successfully demonstrate basic care skills prior to being discharged home.


Background/Rationale: The pediatric critical care team needed to assess and strategize a plan of care for the complex patient. The best way to implement discharge teaching with the family was to examine the stressors and coping strategies. On the basis of McCubbin's Double ABCX Model, the parents tended to be defined as maladaptive in their coping strategy secondary to their lack of resources, misconception of the patient's actual condition, and the stressors present in their lives.


Description of the Project: The plan of care was to closely work with the parents over a 6-week period to acquire the needed skills. The goal was to assess learner readiness and demonstrate critical topics.


Outcomes: With the skills demonstration, the parents did a satisfactory performance; however, the problem became evident during the "rooming in" experience, as both parents slept through alarms on numerous occasions.


Interpretation/Conclusion: The final outcome of the educational experience was mixed in nature; it was defined by the results of the skill check off, the "rooming in" experience, and the family adaptation analysis.


Implications for Nursing Practice: This family scenario caused questions about management in the critical care. The need to have a well-established educational outline initially in place when conducting learning lessons with the parents became apparent.