1. Mahlmeister, Laura R. PhD, RN
  2. Tillet, Jackie ND, CNM

Article Content

The publication of the 20th anniversary issue of The Journal of Perinatal & Neonatal Nursing (JPNN) affords an opportunity for looking back and evaluating what has been accomplished. Advances and positive achievements in the profession are always built upon the work of our predecessors. It is not only appropriate but also important to honor the nurses who have contributed to the success of the journal and to the quality of perinatal nursing care. It permits reflection about the development of the specialty and how far perinatal nurses have come in their enduring efforts to improve the health of women and infants around the globe.


When the decision was made to select the "Top 10" published articles of the past decade, the first question that had to be asked was, "what criteria will be used to single out articles for recognition?" This was a challenging task. Dozens of nurse scholars labored to produce the outstanding manuscripts that were published in the past 10 years. How does one identify "the best of the best?" To paraphrase Alfred North Whitehead, a British mathematician and philosopher, the importance of an individual thinker's ideas depends, in part, upon the ideas in the minds of his successors. What is viewed as novel, revolutionary, radical, unthinkable, unworkable, or inconceivable at one point in time may be generally, if not universally, accepted in relatively short order. Many nurses still in active practice today can remember the time when the idea of fathers in the delivery room, couplet care, and early discharge of mothers and newborns was unthinkable!!


The contributing editors decided to divide the articles into 2 major categories: articles that advanced nursing knowledge in the realm of clinical practice and articles that addressed important professional issues for perinatal nurses. The ability of perinatal nurses to provide care is predicated upon knowledge of the basic sciences, pathophysiology, pharmacology, and other clinical sciences. Exceptional articles have been published that have enhanced the capacity of perinatal nurses to provide quality care in low-risk and high-risk settings with women in all phases of the childbearing cycle. Many of the manuscripts published in the past 10 years extended and refined the knowledge base of perinatal nurses and enhanced their ability to provide safe and effective care. Criteria for the selection of articles that focused on clinical topics are elaborated in Box 1.

Box 1 - Click to enlarge in new windowBox 1. Selection criteria: Clinical papers

The ability to provide family-centered perinatal care is founded upon an agreement about the philosophical, legal, and ethical underpinnings of practice. The second category of articles reviewed included articles that examined the underlying belief systems about perinatal nursing and articles that put forth recommendations for novel systems for the provision of care. The articles to be evaluated included discussions about the roles of perinatal nurses, leadership initiatives, and collaborative practice models. Criteria for the selection of articles focusing on professional issues are described in Box 2.

Box 2 - Click to enlarge in new windowBox 2. Selection criteria: Professional papers

Once the criteria for the selection process were determined, 5 editorial board members were recruited to begin the process of review. A scoring system was developed, and the top 10 articles were identified. Two articles were tied for 10th place and are both included in the final recognition list. The Top 10 list is truly impressive. Each reviewer briefly synopsized the rationale for the selection of articles, providing insight into the decision-making process. The range of articles is impressive and encompasses topics from the basic sciences, health promotion, and clinical practice, reflections on the state of perinatal practice, and discourses on legal and ethical dimensions of perinatal care. The diversity of topics and the quality of scholarship clearly illustrate the richness of perinatal nursing practice. Some of the topics are as fresh today as they were when originally submitted and published. All of the articles are still relevant to practice and provide historical commentary of where we hoped to go, how successful we have been in reaching our goals, and where we are heading tomorrow. Readers of JPNN are encouraged to revisit these truly memorable articles, to share them with colleagues, and reflect upon the contributions that these nurse scholars have made to perinatal practice.


With that in mind, here are the Top 10 articles of the past decade with commentary by the reviewers. The articles are listed in chronological order, beginning with the earliest article.


Kowalski K, Gerraro S, McGee D, Murphy CR, Littleton L. High-risk obstetric nursing role: perinatal nurse practitioner. J Perinat Neonatal Nurs.1995;9(3):2231.


This article takes an innovative approach to healthcare education and delivery. The authors described a new and unique role for advanced practice perinatal nurses in the management of patients. The authors delineated a nursing response to the growing problem of providing quality care to high-risk maternity patients. The information is helpful for nurses and administrators who would like to identify roles and competencies for advanced practice perinatal nurses.


Arnold LS, Angelini DJ, Possinger T. The state of perinatal nursing: current and future profiles as described by perinatal nursing service directors. J Perinat Neonatal Nurs.1997;10(4):2735.


The authors surveyed perinatal service directors regarding their opinions on the current and future states of perinatal healthcare. The article remarkably predicts the areas of concern affecting perinatal services not only in 1997 but in the present environment as well. The reviewer noted that the information in the article remains pertinent to clinical settings even today. It was noted that the ideas discussed in the article still need implementation today.


Bocar DL. Combining breast-feeding and employment: increasing success. J Perinat Neonatal Nurs.1997;11(2):2343.


Bocar recognized that perinatal and neonatal nurses have a tremendous influence on a woman's decision to breast-feed. The article clearly delineated strategies that nurses can use to assist employed mothers as they prepare for continued breast-feeding. Practitioners need reliable information on accommodating breast-feeding and employment, and this article continues to be relevant, topical, and practical even 10 years after its publication.


Dixon LR. The complete blood count: physiologic basis and clinical usage. J Perinat Neonatal Nurs.1997;11(3):118.


This article described the components of the complete blood count in detail, with a listing of normal values and information regarding the differential diagnoses with abnormal values. While the complete blood count is a routine test, many clinicians have limited ability in understanding the implications of abnormal laboratory findings. This article provided an excellent review of the complete blood count even for the experienced practitioner.


McCartney PR. Internet communication and discussion lists for perinatal nurses. J Perinat Neonatal Nurs.1999;12(4):2640.


On the eve of the 21st century, McCartney described the utility of Internet connections for perinatal nurses. The article made a significant contribution by disseminating information about the Perinatal Discussion List, a very useful resource for perinatal nursing that promotes communication among perinatal nurses throughout the world.


Tiedje LB. Moral distress in perinatal nursing. J Perinat Neonatal Nurs.2000;14(2):3643.


Moral distress is an area of ethics that focuses on the nurse's ability or inability to do what is right. Nurses often face institutional constraints on the actions they can take in the face of a moral dilemma. Tiedje's article provided inspiration and guidance to nurses in difficult clinical situations that posed ethical and moral dilemmas for perinatal nurses. The article provided information that was both timely and timeless.


Lothian JA. Back to the future: trusting birth. J Perinat Neonatal Nurs.2001;15(3):1322.


This article used an evidence-based framework to compare the technology utilized during birth with a more physiological approach to labor support. The author delineated practices that have been found useful for facilitating normal birth. She made the point that many routine nursing and medical interventions have no proven benefit for the mother or the infant, and that some of these interventions may even be harmful. The article called for a paradigm shift in future perinatal care with an emphasis on natural childbirth processes. This article provided an exceptional summary of perinatal care and should be mandatory reading for new and experienced perinatal nurses.


Simpson KR, Knox GE. Common areas of litigation related to care during labor and birth: recommendations to promote patient safety and decrease risk exposure. J Perinat Neonatal Nurs.2003;17(20):110125.


The authors made a very critical point that all members of the healthcare team need to agree on basic tenets of clinical practice. The 2 principles the authors stressed were that the team should use applicable evidence and/or published standards and guidelines as the foundation for care and that whenever a clinical choice is presented, patient safety should be paramount. The authors gave specific examples of common areas of litigation in the perinatal setting and made specific recommendations for process improvement and standardization in these areas. The information is so clear and pertinent that the reviewers rated this article the number 1 article of the last 10 years. This article is a resource for fast tracking process improvement, and addressing patient safety, quality of care, and risk management.


Miller LA. Safety promotion and error reduction in perinatal care: lessons from industry. J Perinat Neonatal Nurs.2003;17(2):128138.


Miller, a nurse attorney, reviewed key strategies used by industries other than healthcare, including team building, error reduction, and standardization. She made concrete illustrations of the ways in which safety promotion techniques in industry can be applied with success to healthcare. The article was thought-provoking and skillfully illustrated how disparate environments could be joined to create a cohesive safety-oriented system for care.


Moos MK. Preconceptional health promotion: progress in changing a prevention paradigm. J Perinat Neonatal Nurs.2004;18(1):213.


Preconceptional health promotion is a relatively new concept. This article reviewed provider and patient knowledge of preconceptional health counseling, discussed barriers to practice, and presented a framework for moving the preconceptional health agenda forward. The article asserted that the greatest concerns in perinatal care are low birth weight and congenital anomalies, and the author skillfully explored these. She challenged readers to become active proponents for a changing perinatal care paradigm.


Allison SK. Psychotropic medication in pregnancy: ethical aspects and clinical management. J Perinat Neonatal Nurs.2004;18(3):194205.


As psychotropic medications are increasingly prescribed in the United States, the use of these drugs by pregnant women presents social and ethical dilemmas for women and practitioners. This article described specific fetal risks associated with maternal psychotropic drug use and with untreated maternal psychiatric illness. Specific psychotropic agents were discussed along with strategies for reducing fetal and maternal risks for pregnant women with mental illness. The article was a thoughtful and thorough review of the complexities of care for this group of women.