ABSTRACT Several studies noted a positive association between maternal depression and child hospi... more ABSTRACT Several studies noted a positive association between maternal depression and child hospitalizations. However, the mechanisms for this association are not clear. We tested the hypothesis that depressed mothers with low self-efficacy will be more likely to delay seeking care for their children, thus bringing about more hospitalizations. Data from the Nurse-Family Partnership trial in Memphis, TN were used (n=432; control group only). Women were recruited at an obstetrical clinic and interviewed 12 months after their first child's birth. Depressive symptoms were measured by the Mental Health Inventory-5. A 10-item Likert scale, developed and validated for this study, measured self-efficacy. Child hospitalization data from birth to 24 months were available from medical records. All models controlled for children's chronic conditions, birth weight, and demographic factors. Twenty-two percent of children were hospitalized once and 9% were hospitalized two or more times, 14% of mothers had consistently high depressive symptoms, and 48% had lower maternal self-efficacy than the sample mean. Using linear regression, increased maternal depressive symptoms were found to predict lower self-efficacy (-0.188, 95% CI: -0.280, -0.097). Using ordered logistic regression, lower maternal self-efficacy was found to predict more child hospitalizations (OR: 1.54, 95% CI: 2.37, 0.995). When these two paths were combined by multiplying the coefficients, maternal self-efficacy was shown to be a mediator (p<0.001) between maternal depression and child hospitalizations in this urban, mostly minority, population. Interventions targeting maternal self-efficacy and adequate maternal depression treatment should be considered to decrease child hospitalizations.
Objective: To ascertain how women's psychological characteristics influence their use of hom... more Objective: To ascertain how women's psychological characteristics influence their use of home visitation services in programs for mothers and infants. Design: Regression analyses of number of completed home visits on psychological resources in groups of home-visited ...
We reviewed randomized trials of prenatal and infancy home-visitation programs for socially disad... more We reviewed randomized trials of prenatal and infancy home-visitation programs for socially disadvantaged women and children. Some home-visitation programs were effective in improving women's health-related behaviors during pregnancy, the birth weight and length of gestation of babies born to smokers and young adolescents, parents' interaction with their children, and children's developmental status; reducing the incidence of child abuse and neglect, childhood behavioral problems, emergency department visits and hospitalizations for injury, and unintended subsequent pregnancies; and increasing mothers' participation in the work force. The more effective programs employed nurses who began visiting during pregnancy, who visited frequently and long enough to establish a therapeutic alliance with families, and who addressed the systems of behavioral and psychosocial factors that influence maternal and child outcomes. They also targeted families at greater risk for health problems by virtue of the parents' poverty and lack of personal and social resources.
JAMA The Journal of the American Medical Association
A home visitation program using nurses to improve maternal and child outcomes had favorable resul... more A home visitation program using nurses to improve maternal and child outcomes had favorable results in a randomized trial with a primarily white, semirural population. Many of the short-term findings have been replicated with urban blacks, but whether the program will continue to demonstrate effectiveness after its conclusion is uncertain. To determine the effectiveness of a prenatal and infancy home visitation program on the maternal life course of women in an urban environment 3 years after the program ended. Three-year follow-up of a randomized controlled trial of women seen consecutively between June 1990 and August 1991 at an obstetrical clinic in Memphis, Tenn, who were enrolled in a visitation program for 2 years after the birth of their first child. A cohort of 743 women who were primarily black, were pregnant for less than 29 weeks, had no previous live births, and had at least 2 sociodemographic risk factors (unmarried, <12 years of education, or unemployed). An average...
The 2001 Surgeon General's Report on Youth Violence states that while the prevalence of self-... more The 2001 Surgeon General's Report on Youth Violence states that while the prevalence of self-reported violence among adolescents has remained relatively constant from 1980 1998, these rates are still high with approximately 30% of high school seniors reporting having committed a violent act in the past year. Of additional concern is the fact that the prevalence of violence among females has markedly increased from 1983 to 1998. In 1983, the male:female violent incident ratio was 7.4 which decreased to 3.5 by 1998. Because the overall prevalence rates have remained relatively stable over that same time period, this decrease in the male:female violent incident ratio indicates that females are engaging in violent acts more frequently. Numerous studies demonstrate that individuals exhibiting violence during adolescence and adulthood also had problems with aggressive behavior during childhood and that a high level of childhood aggression was an important predictor of both adolescent ...
Several studies noted a positive association between maternal depression and child hospitalizatio... more Several studies noted a positive association between maternal depression and child hospitalizations. However, the mechanisms for this association are not clear. We tested the hypothesis that depressed mothers with low self-efficacy will be more likely to delay seeking care for their children, thus bringing about more hospitalizations. Data from the Nurse-Family Partnership trial in Memphis, TN were used (n=432; control group only). Women were recruited at an obstetrical clinic and interviewed 12 months after their first child's birth. Depressive symptoms were measured by the Mental Health Inventory-5. A 10-item Likert scale, developed and validated for this study, measured self-efficacy. Child hospitalization data from birth to 24 months were available from medical records. All models controlled for children's chronic conditions, birth weight, and demographic factors. Twenty-two percent of children were hospitalized once and 9% were hospitalized two or more times, 14% of mot...
We examined visit attendance patterns in the Memphis trial of the Nurse-Family Partnership and as... more We examined visit attendance patterns in the Memphis trial of the Nurse-Family Partnership and associations between these patterns and family characteristics, outcomes, and treatment-control differences in outcomes. We employed repeated measures latent class analysis to identify attendance patterns among the 228 mothers assigned to receive home nurse visits during pregnancy and until the child was aged 2 years, associated background characteristics, outcomes, and treatment-control differences by visit class. Home visits were conducted from June 1990 to March 1994. We collected outcome data from May 1992 to April 1994 and July 2003 to December 2006. We identified 3 visit attendance patterns. High attenders (48%) had the most visits and good outcomes. Low attenders (33%) had the most education and the best outcomes. Increasing attenders (18%) had the fewest completed visits during pregnancy, the poorest intake characteristics, and the poorest outcomes. Treatment-control group differen...
This paper describes the multifaceted approach employed to clarify the concept of postpartum fati... more This paper describes the multifaceted approach employed to clarify the concept of postpartum fatigue. The process began with a literary analysis, which gave rise to questions about the defining characteristics of postpartum fatigue and its differentiation from related concepts such as tiredness and depression. A series of qualitative and quantitative studies were carried out to examine new mothers' characterizations of their fatigue, the indicators and predictors of postpartum fatigue, and the differences between fatigue and depression. The evolving concept clarification suggests that postpartum fatigue is most effectively conceptualized as a multidimensional concept with physical and mental aspects that is different from tiredness and can be differentiated from postpartal depression or milder "baby blues," with which there is some overlap.
In this qualitative descriptive study, 30 young, unmarried, low-income African American mothers i... more In this qualitative descriptive study, 30 young, unmarried, low-income African American mothers in Memphis, TN, were interviewed in 2011-2012 about their discipline strategies with their 12- to 19-month-old children. Using content analyses, their strategies were described and compared with those from a similar sample in 1992. Findings suggest both continuity and change during that 20-year period. More mothers in 2011-2012 described the use of distraction and time out, suggesting a wider variety of strategies than were used in 1992. These findings may help clinicians to better understand disciplinary methods in young low-income African American mothers such as these in Memphis. Approaching mothers in a respectful and culturally sensitive manner will help them focus on effective, developmentally appropriate strategies consistent with their own parenting goals.
Pregnancy among unmarried adolescents has been linked to negative personal control beliefs. In co... more Pregnancy among unmarried adolescents has been linked to negative personal control beliefs. In contrast, self-agency beliefs about control over future possibilities have been linked to delay in subsequent childbearing. In this secondary analysis, we examined factors associated with self-agency change in 429 unmarried adolescent mothers from intervention and control groups of a nurse home visitation study. Adolescent mothers who participated in a sustained relationship with a nurse made greater gains in self-agency than did control group mothers (p = .034). Adolescents with lower cognitive ability who were behind their age-appropriate grade level in school made the greatest self-agency gains.
Expert systems in nursing are developed with traditional knowledge engineering techniques. These ... more Expert systems in nursing are developed with traditional knowledge engineering techniques. These techniques focus on the behavior and logic of the expert, not qualities of expertise. Expertise has been described but not explained. This article proposes a theoretical framework for the study of expertise that can be used to facilitate the development of expert systems.
ABSTRACT Several studies noted a positive association between maternal depression and child hospi... more ABSTRACT Several studies noted a positive association between maternal depression and child hospitalizations. However, the mechanisms for this association are not clear. We tested the hypothesis that depressed mothers with low self-efficacy will be more likely to delay seeking care for their children, thus bringing about more hospitalizations. Data from the Nurse-Family Partnership trial in Memphis, TN were used (n=432; control group only). Women were recruited at an obstetrical clinic and interviewed 12 months after their first child&#39;s birth. Depressive symptoms were measured by the Mental Health Inventory-5. A 10-item Likert scale, developed and validated for this study, measured self-efficacy. Child hospitalization data from birth to 24 months were available from medical records. All models controlled for children&#39;s chronic conditions, birth weight, and demographic factors. Twenty-two percent of children were hospitalized once and 9% were hospitalized two or more times, 14% of mothers had consistently high depressive symptoms, and 48% had lower maternal self-efficacy than the sample mean. Using linear regression, increased maternal depressive symptoms were found to predict lower self-efficacy (-0.188, 95% CI: -0.280, -0.097). Using ordered logistic regression, lower maternal self-efficacy was found to predict more child hospitalizations (OR: 1.54, 95% CI: 2.37, 0.995). When these two paths were combined by multiplying the coefficients, maternal self-efficacy was shown to be a mediator (p&lt;0.001) between maternal depression and child hospitalizations in this urban, mostly minority, population. Interventions targeting maternal self-efficacy and adequate maternal depression treatment should be considered to decrease child hospitalizations.
Objective: To ascertain how women's psychological characteristics influence their use of hom... more Objective: To ascertain how women's psychological characteristics influence their use of home visitation services in programs for mothers and infants. Design: Regression analyses of number of completed home visits on psychological resources in groups of home-visited ...
We reviewed randomized trials of prenatal and infancy home-visitation programs for socially disad... more We reviewed randomized trials of prenatal and infancy home-visitation programs for socially disadvantaged women and children. Some home-visitation programs were effective in improving women&#39;s health-related behaviors during pregnancy, the birth weight and length of gestation of babies born to smokers and young adolescents, parents&#39; interaction with their children, and children&#39;s developmental status; reducing the incidence of child abuse and neglect, childhood behavioral problems, emergency department visits and hospitalizations for injury, and unintended subsequent pregnancies; and increasing mothers&#39; participation in the work force. The more effective programs employed nurses who began visiting during pregnancy, who visited frequently and long enough to establish a therapeutic alliance with families, and who addressed the systems of behavioral and psychosocial factors that influence maternal and child outcomes. They also targeted families at greater risk for health problems by virtue of the parents&#39; poverty and lack of personal and social resources.
JAMA The Journal of the American Medical Association
A home visitation program using nurses to improve maternal and child outcomes had favorable resul... more A home visitation program using nurses to improve maternal and child outcomes had favorable results in a randomized trial with a primarily white, semirural population. Many of the short-term findings have been replicated with urban blacks, but whether the program will continue to demonstrate effectiveness after its conclusion is uncertain. To determine the effectiveness of a prenatal and infancy home visitation program on the maternal life course of women in an urban environment 3 years after the program ended. Three-year follow-up of a randomized controlled trial of women seen consecutively between June 1990 and August 1991 at an obstetrical clinic in Memphis, Tenn, who were enrolled in a visitation program for 2 years after the birth of their first child. A cohort of 743 women who were primarily black, were pregnant for less than 29 weeks, had no previous live births, and had at least 2 sociodemographic risk factors (unmarried, <12 years of education, or unemployed). An average...
The 2001 Surgeon General's Report on Youth Violence states that while the prevalence of self-... more The 2001 Surgeon General's Report on Youth Violence states that while the prevalence of self-reported violence among adolescents has remained relatively constant from 1980 1998, these rates are still high with approximately 30% of high school seniors reporting having committed a violent act in the past year. Of additional concern is the fact that the prevalence of violence among females has markedly increased from 1983 to 1998. In 1983, the male:female violent incident ratio was 7.4 which decreased to 3.5 by 1998. Because the overall prevalence rates have remained relatively stable over that same time period, this decrease in the male:female violent incident ratio indicates that females are engaging in violent acts more frequently. Numerous studies demonstrate that individuals exhibiting violence during adolescence and adulthood also had problems with aggressive behavior during childhood and that a high level of childhood aggression was an important predictor of both adolescent ...
Several studies noted a positive association between maternal depression and child hospitalizatio... more Several studies noted a positive association between maternal depression and child hospitalizations. However, the mechanisms for this association are not clear. We tested the hypothesis that depressed mothers with low self-efficacy will be more likely to delay seeking care for their children, thus bringing about more hospitalizations. Data from the Nurse-Family Partnership trial in Memphis, TN were used (n=432; control group only). Women were recruited at an obstetrical clinic and interviewed 12 months after their first child's birth. Depressive symptoms were measured by the Mental Health Inventory-5. A 10-item Likert scale, developed and validated for this study, measured self-efficacy. Child hospitalization data from birth to 24 months were available from medical records. All models controlled for children's chronic conditions, birth weight, and demographic factors. Twenty-two percent of children were hospitalized once and 9% were hospitalized two or more times, 14% of mot...
We examined visit attendance patterns in the Memphis trial of the Nurse-Family Partnership and as... more We examined visit attendance patterns in the Memphis trial of the Nurse-Family Partnership and associations between these patterns and family characteristics, outcomes, and treatment-control differences in outcomes. We employed repeated measures latent class analysis to identify attendance patterns among the 228 mothers assigned to receive home nurse visits during pregnancy and until the child was aged 2 years, associated background characteristics, outcomes, and treatment-control differences by visit class. Home visits were conducted from June 1990 to March 1994. We collected outcome data from May 1992 to April 1994 and July 2003 to December 2006. We identified 3 visit attendance patterns. High attenders (48%) had the most visits and good outcomes. Low attenders (33%) had the most education and the best outcomes. Increasing attenders (18%) had the fewest completed visits during pregnancy, the poorest intake characteristics, and the poorest outcomes. Treatment-control group differen...
This paper describes the multifaceted approach employed to clarify the concept of postpartum fati... more This paper describes the multifaceted approach employed to clarify the concept of postpartum fatigue. The process began with a literary analysis, which gave rise to questions about the defining characteristics of postpartum fatigue and its differentiation from related concepts such as tiredness and depression. A series of qualitative and quantitative studies were carried out to examine new mothers' characterizations of their fatigue, the indicators and predictors of postpartum fatigue, and the differences between fatigue and depression. The evolving concept clarification suggests that postpartum fatigue is most effectively conceptualized as a multidimensional concept with physical and mental aspects that is different from tiredness and can be differentiated from postpartal depression or milder "baby blues," with which there is some overlap.
In this qualitative descriptive study, 30 young, unmarried, low-income African American mothers i... more In this qualitative descriptive study, 30 young, unmarried, low-income African American mothers in Memphis, TN, were interviewed in 2011-2012 about their discipline strategies with their 12- to 19-month-old children. Using content analyses, their strategies were described and compared with those from a similar sample in 1992. Findings suggest both continuity and change during that 20-year period. More mothers in 2011-2012 described the use of distraction and time out, suggesting a wider variety of strategies than were used in 1992. These findings may help clinicians to better understand disciplinary methods in young low-income African American mothers such as these in Memphis. Approaching mothers in a respectful and culturally sensitive manner will help them focus on effective, developmentally appropriate strategies consistent with their own parenting goals.
Pregnancy among unmarried adolescents has been linked to negative personal control beliefs. In co... more Pregnancy among unmarried adolescents has been linked to negative personal control beliefs. In contrast, self-agency beliefs about control over future possibilities have been linked to delay in subsequent childbearing. In this secondary analysis, we examined factors associated with self-agency change in 429 unmarried adolescent mothers from intervention and control groups of a nurse home visitation study. Adolescent mothers who participated in a sustained relationship with a nurse made greater gains in self-agency than did control group mothers (p = .034). Adolescents with lower cognitive ability who were behind their age-appropriate grade level in school made the greatest self-agency gains.
Expert systems in nursing are developed with traditional knowledge engineering techniques. These ... more Expert systems in nursing are developed with traditional knowledge engineering techniques. These techniques focus on the behavior and logic of the expert, not qualities of expertise. Expertise has been described but not explained. This article proposes a theoretical framework for the study of expertise that can be used to facilitate the development of expert systems.
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