Melanie Lutenbacher | Vanderbilt University (original) (raw)

Papers by Melanie Lutenbacher

Research paper thumbnail of Using Community Health Workers to Improve Health Outcomes in a Sample of Hispanic Women and Their Infants: Findings from a Randomized Controlled Trial

Hispanic Health Care International

Introduction: The Maternal Infant Health Outreach Worker (MIHOW) program, an early childhood home... more Introduction: The Maternal Infant Health Outreach Worker (MIHOW) program, an early childhood home visiting program, uses community health workers (CHWs) to improve health outcomes in underserved communities. Methods: This randomized clinical trial evaluated the impact of MIHOW's use of CHWs on selected maternal/infant outcomes up to 15 months postpartum. We hypothesized outcomes would be better among Hispanic women receiving MIHOW compared to a similar group of women eligible for MIHOW who received only a minimal education intervention (MEI). The study also expanded earlier research testing MIHOW's efficacy among Hispanic families using criteria set forth by federal guidelines. Women living in middle Tennessee enrolled during pregnancy (≤26 weeks gestation) and continued through 15 months postpartum. Results: Enrolled women ( N = 132) were randomly assigned, with 110 women completing the study ( MEI = 53; MIHOW = 57). Positive and statistically significant ( p < .01) effe...

Research paper thumbnail of Negative Correlation Between Health Care Coverage and Postpartum Depression Among Hispanic Women

Hispanic Health Care International, 2021

Postpartum depression (PPD) affects women across all races with serious health consequences for m... more Postpartum depression (PPD) affects women across all races with serious health consequences for mothers and infants. Maternal factors may increase PPD risk, but research in exclusive Hispanic populations is limited. This secondary analysis evaluated the associations between maternal sociodemographic characteristics and reliable decrease in depressive symptoms in Hispanic women between prenatal study enrollment and 2 months postpartum. Data from all women (n = 178) who completed a randomized control trial assessing the efficacy of a home-visitation program were included. Most women were from Mexico (66.9%), had incomes <$10,000/year (68.5%), had health insurance (58.4%), and intended to breastfeed (84.2%). Few women had high school education/graduate equivalency degree (19.3%) or a health care provider (2.3%). Using multivariate logistic regression and controlling for baseline Edinburgh Postnatal Depression Score, gestational age at enrollment, and group assignment, health care co...

Research paper thumbnail of Clinical strategies for addressing obesity in infants and toddlers

The Nurse Practitioner, 2021

ABSTRACT Babies' earliest food experiences have a lifelong impact on eating preferences and d... more ABSTRACT Babies' earliest food experiences have a lifelong impact on eating preferences and dietary habits, laying the foundation for obesity risk. NPs have the opportunity to provide education about healthy infant feeding practices before the growth trajectory becomes abnormal and focus intensive education on at-risk families.

Research paper thumbnail of Evaluation of two academic practice partnerships for chronic disease management in nursing education

Public Health Nursing, 2020

More clinical sites are essential to meeting the learning needs of nursing students who will care... more More clinical sites are essential to meeting the learning needs of nursing students who will care for patients with chronic disease after graduation. Partnerships between schools of nursing and academic practices can increase clinical training capacity, allow future nurse practitioners (NPs) to apply knowledge and skills in the context of care delivery, and potentially improve patient outcomes with little associated risk. This article describes the experiences of primary care NP students (n = 37), NP faculty (n = 2), and clinic providers (n = 2) in an academic practice partnership performing home visits with complex pediatric asthma and adult heart failure (HF) patients. A 14-item postexperience survey was used to obtain student feedback. Over 75% (n = 28) of student participants responded. Most respondents, 80% assigned to pediatric asthma patients and 90% assigned to adult HF patients, reported the home visit experience prepared them to care for patients with chronic diseases. Clinic providers indicated the extra attention to both patient groups reduced barriers to care and improved care continuity. This partnership offers a model for developing clinical skills in advanced practice nursing students and enhancing scarce clinical placement resources. Findings were used to refine the program and expand to include all 150 students in the subsequent academic year.

Research paper thumbnail of Family-Centered Care: How Close Do We Get When Talking to Parents of Children Undergoing Diagnosis for Autism Spectrum Disorders?

Journal of Autism and Developmental Disorders, 2020

Autism spectrum disorder (ASD) affects 1:59 children, yet little is known about parents’ percepti... more Autism spectrum disorder (ASD) affects 1:59 children, yet little is known about parents’ perceptions of family-centered care (FCC) during the diagnostic process leading up to diagnosis. This mixed-methods study explored key elements of FCC from 31 parents of children recently diagnosed with ASD using parallel qualitative and quantitative measures. Parents rated highly their receipt of FCC and discussed ways providers demonstrated FCC. However, the majority of parents indicated that the period when their child was undergoing diagnosis was stressful and reported symptoms of depression and anxiety. The study points to ways in which health care providers can enhance FCC provided to families when a child is undergoing ASD diagnosis.

Research paper thumbnail of The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial

Maternal and Child Health Journal, 2018

Introduction The Maternal Infant Health Outreach Worker (MIHOW) program is a home visiting progra... more Introduction The Maternal Infant Health Outreach Worker (MIHOW) program is a home visiting program, utilizing peer mentors to improve maternal/child health outcomes in underserved communities. Findings are presented from a randomized clinical trial (RCT) testing the efficacy of the MIHOW model in a sample of Hispanic women in Tennessee. We hypothesized maternal and infant outcomes would be better in women assigned to MIHOW than women assigned to the minimal education intervention (MEI) group (receipt of educational materials). Methods Women entered the study during pregnancy (< 26 weeks gestation) and were followed through 6 months postpartum. A total of 188 women were enrolled and randomly assigned (MEI = 94; MIHOW = 94), with 178 women completing the study (MEI = 87; MIHOW = 91). Results Positive and statistically significant (p < 0.01) effects of MIHOW were observed on breastfeeding self-efficacy and exclusivity, levels of depressive symptoms and parenting stress, safe sleep practices, and infant stimulation in the home. No statistically significant differences were noted in number of prenatal visits. Discussion Results expand limited empiric evidence and provide strong support of the effectiveness of MIHOW on improving health outcomes in this sample of Hispanic mothers and their infants. MIHOW is a viable option for providing culturally sensitive services to immigrant and underserved families.

Research paper thumbnail of Correction to: The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial

Maternal and Child Health Journal, 2018

Research paper thumbnail of A comparison of maternal and neonatal health outcomes: Women enrolled and not enrolled in an evidence-based nurse home visitation program

Research paper thumbnail of Demographics of Heart Failure Patients 18-64 Admitted to An Academic Center: Lessons Learned

Heart & Lung: The Journal of Acute and Critical Care, 2014

Research paper thumbnail of The Baby‐Friendly Hospital Initiative as an Intervention to Improve Breastfeeding Rates: A Review of the Literature

Journal of Midwifery & Women's Health, 2016

Introduction: The Baby-Friendly Hospital Initiative (BFHI) is considered to be an evidence-based ... more Introduction: The Baby-Friendly Hospital Initiative (BFHI) is considered to be an evidence-based program that improves breastfeeding outcomes, but primary research on the topic has been limited. The purpose of this review was to evaluate the literature and synthesize findings to determine the effectiveness of the BFHI as an intervention to improve breastfeeding initiation, duration, and exclusivity. Methods: A review of literature published from 1991 to October 2014 using MEDLINE, CINAHL, PsycINFO, and Web of Knowledge with the search term "Baby-Friendly Hospital Initiative." The 724 titles initially identified were reviewed using these inclusion criteria: English language, primary research, and available electronically or via interlibrary loan. Studies were excluded if they explicitly stated that they had omitted specific portions of the BFHI or did not fully implement the intervention; considered breastfeeding rather than the BFHI as an intervention; used the BFHI to improve neonatal intensive care unit outcomes specifically; or measured outcomes other than breastfeeding initiation, duration, or exclusivity. This yielded 25 studies for review. Results: There are more studies that support the BFHI as an intervention to increase breastfeeding than there are studies that demonstrate no effect of the intervention. However, design weaknesses, settings outside the United States, and disparate methods impede the ability to reach firm conclusions regarding the effectiveness of the BFHI in improving breastfeeding initiation, duration, and exclusivity rates in the United States. Discussion: Many of the studies regarding the effectiveness of the BFHI have been hampered by weak designs or methodologic limitations. Research conducted in the United States and employing experimental designs would help to more conclusively determine the effectiveness of the BFHI as an intervention to improve breastfeeding rates.

Research paper thumbnail of Reflections of Black Women Who Choose to Breastfeed: Influences, Challenges and Supports

Maternal and child health journal, Jan 23, 2015

Black women continue to have the lowest rates of breastfeeding. Of those who choose to breastfeed... more Black women continue to have the lowest rates of breastfeeding. Of those who choose to breastfeed up to half cease nursing within the first few days or months postpartum. This study identified factors that influence and challenge Black women who choose to breastfeed, and supportive strategies that facilitate successful breastfeeding experiences. Four focus groups were conducted in 2013 with 16 self-identified Black women aged 21-46 (M = 31.35 years), with 11-18 (M = 14.94) years of education, and were either pregnant or had given birth to an infant within the prior 5 years (range of pregnancies 1-7; M = 2.44). A standard set of questions guided discussions. Data saturation occurred after three groups. All discussions were audiotaped and transcribed. Qualitative methods were used to identify categories and subthemes. Reviewers met periodically to resolve ambiguities and coding discrepancies. Member checking was conducted. Four major categories emerged: Balancing the influences: Peopl...

Research paper thumbnail of Preventing recurrent preterm births and improving maternal infant health via a home visitation system of care: A randomized clinical trial

Background: High probability of recurrent preterm birth (PTB) with history of prior PTB. Interact... more Background: High probability of recurrent preterm birth (PTB) with history of prior PTB. Interaction of multiple risk factors and health behaviors may contribute to PTB; some may be amenable to intervention. Home visitation is promising method to deliver evidence based interventions within a system of care (SOC). We evaluated a SOC designed to: 1) reduce preterm births and associated health care costs, and 2) improve the health in pregnant women with a history of a PTB. Methods: Randomized, parallel-group study in regional medical center. Eligibility: >18 years with prior live birth > 20 - < 37 weeks gestation; < 24 weeks gestation at enrollment; spoke and read English; received care at the medical center. All participants (N = 211) received standard prenatal care. Intervention participants (N = 109) also received home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data collected via multiple ...

Research paper thumbnail of Implementing an Academic-Clinical Partnership to Promote Successful Transition of Heart Failure Patients from Hospital to Home

Heart & Lung: The Journal of Acute and Critical Care, 2014

Research paper thumbnail of Leveraging Resources to Improve Clinical Outcomes and Teach Transitional Care Through Development of Academic-Clinical Partnerships

Nurse educator, Jan 16, 2015

Nurse educators need to provide students with clinical experiences that prepare them for our rapi... more Nurse educators need to provide students with clinical experiences that prepare them for our rapidly changing health care environments. This article describes how nurse educators used academic and clinical resources to develop a partnership between a school of nursing and clinical entity to facilitate successful transitions from hospital to home for adult heart failure and pediatric asthma patients.

Research paper thumbnail of Do We Really Help? Perspectives of Abused Women

Public Health Nursing, 2003

Findings are presented from focus group data collected during a larger study describing factors t... more Findings are presented from focus group data collected during a larger study describing factors that inhibit, support, and sustain women's abilities to leave and stay out of abusive relationships. A subset (n ¼ 24) of the larger study sample (N ¼ 40) participated in one of four focus groups. Participants had left or were currently in abusive intimate relationships. Women reported diverse experiences and were in various stages of abusive relationships. Ages ranged from 21 to 51; 67% were Caucasian, and 20% African American. Most women (71%) had at least a high school education and were employed (60%), but 83% reported annual incomes less than $20,000. NVIVO software facilitated content analysis of transcriptions. After initial synthesis of data, 20 women participated in one of two confirmatory focus groups. Four primary themes emerged from the content analysis: (1) Living an Unnatural Experience included maladaptive physical and emotional responses to chronic violence; (2) The Experience of Telling included multiple intrapersonal, interpersonal, and societal barriers to disclosure; (3) The Experience of Leaving included descriptions of acute and long-term experiences and difficulties; and (4) Reducing Barriers included participant ideas on ways to reduce barriers to assistance. Recommendations are made to improve community interventions and programs that will facilitate the choices and enhance the successes of women who have experienced domestic violence.

Research paper thumbnail of Planning of Youth Violence-Prevention Programs: Development of a Guiding Measure

Public Health Nursing, 2003

This article describes the development and pilot testing of the Good-Fit Measure (GFM), a measure... more This article describes the development and pilot testing of the Good-Fit Measure (GFM), a measure that public health nurses and other providers involved with planning multidisciplinary violence prevention efforts can use. Themes derived from a series of focus group discussions from a larger study, including individuals (n ¼ 83) from multiple community sectors, guided development of the measure. Participants in three follow-up focus groups (n ¼ 32 participants) reviewed the measure, which was then pilot tested in two phases. Guided by information from the first phase, in which respondents indicated the measure was too complex, the measure was simplified and field tested in phase two. Results from both phases were similar. The GFM score was significantly higher for the program selected by the respondent before completing the measure than the nonselected program (p < 0.01). Participants indicated that the tool was helpful in articulating the specific factors for their decisions. Participants underscored the utility of the tool in facilitating program planning by individual providers and interdisciplinary or multidisciplinary teams. The GFM provides systematic consideration of multiple factors that motivate public health nurses and other community providers in their decision-making process when planning prevention strategies, increasing the likelihood of successful programs.

Research paper thumbnail of Are Services to Tennessee Children with Special Health Care Needs Comparable with National Achievement of MCHB Objectives?

Public Health Nursing, 2012

We assessed experiences of families with children with special health care needs already engaged ... more We assessed experiences of families with children with special health care needs already engaged with Tennessee Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Special Services or a family advocacy agency, family voices, and compared their experiences with national data to determine achievement of national maternal-child health objectives. Using a descriptive/comparison design, Tennessee families engaged with the state or advocacy agency (n = 816) were compared with the 2005-2006 sample of the National Survey of Children with Special Health Care Needs (n = 40,840) and the Tennessee subsample (n = 794). Primary data were obtained from a survey of families associated with either Tennessee agency. Secondary data analysis used raw data from the national survey. All families reported challenges related to time, finances, and family interactions. Most were satisfied with health care services received. Dental care was an issue for all families, but more so for the agencies&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; sample. Those families also reported more problems with continuous screenings of their affected child and less coordination of care than the national sample. Examining the experiences of families with special needs children who receive services from state agencies in the national context contributes to improving family-centered services and achieving Maternal-Child Health Bureau objectives.

Research paper thumbnail of The Effects of Maternal Psychosocial Factors on Parenting Attitudes of Low-Income, Single Mothers With Young Children

Nursing Research, 1998

Although recent evidence implies linkages among depression or depressive symptoms, self-esteem, h... more Although recent evidence implies linkages among depression or depressive symptoms, self-esteem, history of childhood abuse, and parenting attitudes, the evidence does not clearly elucidate the relationships among these variables. To investigate the relationships among maternal psychosocial factors (history of childhood abuse, everyday stressors, self-esteem, and depressive symptoms) and parenting attitudes of low-income, single mothers who have young children. Secondary analyses of data from in-home interviews with 206 low-income, single mothers from a southeastern United States urban area were conducted. A variety of scales, including the Adult-Adolescent Parenting Inventory (AAPI), were used to measure maternal psychosocial factors. Using the AAPI, a Modified Parenting Attitudes Measure (MPAM), and subscales, a three-stage regression procedure was used to test the model. For stages 1 and 2, everyday stressors were the strongest predictor of self-esteem. Childhood sexual abuse, everyday stressors, low self-esteem, and control variables accounted for 58% of variance in depressive symptoms. In the third stage for the AAPI, only control variables were retained except in the Lack of Empathy subscale, where depressive symptoms and control variables accounted for 16% of the variance. The third stage for the MPAM yielded, by subscale: Only control variables predicted Corporal Punishment Beliefs; depressive symptoms were the strongest predictor for the total MPAM (19% of variance) and of the Inappropriate Emotional Expectations subscale (17%); and childhood physical abuse was the only predictor of Role Reversal. Depressive symptoms mediated the effects of childhood abuse, everyday stressors, and self-esteem and provided the linkage between these variables and at-risk parenting attitudes. Self-esteem decreased as everyday stressors increased but did not directly affect parenting attitudes. A relationship was not found between childhood abuse and low self-esteem. This study highlights the complexity of parenting and the need to identify other factors of at-risk parenting not accounted for in this study.

Research paper thumbnail of Breaking the cycle of family violence: understanding the perceptions of battered women

Journal of Pediatric Health Care, 2004

Research paper thumbnail of Childhood Physical and Sexual Abuse: Their Relationship with Depressive Symptoms in Adulthood

Image: the Journal of Nursing Scholarship, 1993

Research paper thumbnail of Using Community Health Workers to Improve Health Outcomes in a Sample of Hispanic Women and Their Infants: Findings from a Randomized Controlled Trial

Hispanic Health Care International

Introduction: The Maternal Infant Health Outreach Worker (MIHOW) program, an early childhood home... more Introduction: The Maternal Infant Health Outreach Worker (MIHOW) program, an early childhood home visiting program, uses community health workers (CHWs) to improve health outcomes in underserved communities. Methods: This randomized clinical trial evaluated the impact of MIHOW's use of CHWs on selected maternal/infant outcomes up to 15 months postpartum. We hypothesized outcomes would be better among Hispanic women receiving MIHOW compared to a similar group of women eligible for MIHOW who received only a minimal education intervention (MEI). The study also expanded earlier research testing MIHOW's efficacy among Hispanic families using criteria set forth by federal guidelines. Women living in middle Tennessee enrolled during pregnancy (≤26 weeks gestation) and continued through 15 months postpartum. Results: Enrolled women ( N = 132) were randomly assigned, with 110 women completing the study ( MEI = 53; MIHOW = 57). Positive and statistically significant ( p < .01) effe...

Research paper thumbnail of Negative Correlation Between Health Care Coverage and Postpartum Depression Among Hispanic Women

Hispanic Health Care International, 2021

Postpartum depression (PPD) affects women across all races with serious health consequences for m... more Postpartum depression (PPD) affects women across all races with serious health consequences for mothers and infants. Maternal factors may increase PPD risk, but research in exclusive Hispanic populations is limited. This secondary analysis evaluated the associations between maternal sociodemographic characteristics and reliable decrease in depressive symptoms in Hispanic women between prenatal study enrollment and 2 months postpartum. Data from all women (n = 178) who completed a randomized control trial assessing the efficacy of a home-visitation program were included. Most women were from Mexico (66.9%), had incomes <$10,000/year (68.5%), had health insurance (58.4%), and intended to breastfeed (84.2%). Few women had high school education/graduate equivalency degree (19.3%) or a health care provider (2.3%). Using multivariate logistic regression and controlling for baseline Edinburgh Postnatal Depression Score, gestational age at enrollment, and group assignment, health care co...

Research paper thumbnail of Clinical strategies for addressing obesity in infants and toddlers

The Nurse Practitioner, 2021

ABSTRACT Babies' earliest food experiences have a lifelong impact on eating preferences and d... more ABSTRACT Babies' earliest food experiences have a lifelong impact on eating preferences and dietary habits, laying the foundation for obesity risk. NPs have the opportunity to provide education about healthy infant feeding practices before the growth trajectory becomes abnormal and focus intensive education on at-risk families.

Research paper thumbnail of Evaluation of two academic practice partnerships for chronic disease management in nursing education

Public Health Nursing, 2020

More clinical sites are essential to meeting the learning needs of nursing students who will care... more More clinical sites are essential to meeting the learning needs of nursing students who will care for patients with chronic disease after graduation. Partnerships between schools of nursing and academic practices can increase clinical training capacity, allow future nurse practitioners (NPs) to apply knowledge and skills in the context of care delivery, and potentially improve patient outcomes with little associated risk. This article describes the experiences of primary care NP students (n = 37), NP faculty (n = 2), and clinic providers (n = 2) in an academic practice partnership performing home visits with complex pediatric asthma and adult heart failure (HF) patients. A 14-item postexperience survey was used to obtain student feedback. Over 75% (n = 28) of student participants responded. Most respondents, 80% assigned to pediatric asthma patients and 90% assigned to adult HF patients, reported the home visit experience prepared them to care for patients with chronic diseases. Clinic providers indicated the extra attention to both patient groups reduced barriers to care and improved care continuity. This partnership offers a model for developing clinical skills in advanced practice nursing students and enhancing scarce clinical placement resources. Findings were used to refine the program and expand to include all 150 students in the subsequent academic year.

Research paper thumbnail of Family-Centered Care: How Close Do We Get When Talking to Parents of Children Undergoing Diagnosis for Autism Spectrum Disorders?

Journal of Autism and Developmental Disorders, 2020

Autism spectrum disorder (ASD) affects 1:59 children, yet little is known about parents’ percepti... more Autism spectrum disorder (ASD) affects 1:59 children, yet little is known about parents’ perceptions of family-centered care (FCC) during the diagnostic process leading up to diagnosis. This mixed-methods study explored key elements of FCC from 31 parents of children recently diagnosed with ASD using parallel qualitative and quantitative measures. Parents rated highly their receipt of FCC and discussed ways providers demonstrated FCC. However, the majority of parents indicated that the period when their child was undergoing diagnosis was stressful and reported symptoms of depression and anxiety. The study points to ways in which health care providers can enhance FCC provided to families when a child is undergoing ASD diagnosis.

Research paper thumbnail of The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial

Maternal and Child Health Journal, 2018

Introduction The Maternal Infant Health Outreach Worker (MIHOW) program is a home visiting progra... more Introduction The Maternal Infant Health Outreach Worker (MIHOW) program is a home visiting program, utilizing peer mentors to improve maternal/child health outcomes in underserved communities. Findings are presented from a randomized clinical trial (RCT) testing the efficacy of the MIHOW model in a sample of Hispanic women in Tennessee. We hypothesized maternal and infant outcomes would be better in women assigned to MIHOW than women assigned to the minimal education intervention (MEI) group (receipt of educational materials). Methods Women entered the study during pregnancy (< 26 weeks gestation) and were followed through 6 months postpartum. A total of 188 women were enrolled and randomly assigned (MEI = 94; MIHOW = 94), with 178 women completing the study (MEI = 87; MIHOW = 91). Results Positive and statistically significant (p < 0.01) effects of MIHOW were observed on breastfeeding self-efficacy and exclusivity, levels of depressive symptoms and parenting stress, safe sleep practices, and infant stimulation in the home. No statistically significant differences were noted in number of prenatal visits. Discussion Results expand limited empiric evidence and provide strong support of the effectiveness of MIHOW on improving health outcomes in this sample of Hispanic mothers and their infants. MIHOW is a viable option for providing culturally sensitive services to immigrant and underserved families.

Research paper thumbnail of Correction to: The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial

Maternal and Child Health Journal, 2018

Research paper thumbnail of A comparison of maternal and neonatal health outcomes: Women enrolled and not enrolled in an evidence-based nurse home visitation program

Research paper thumbnail of Demographics of Heart Failure Patients 18-64 Admitted to An Academic Center: Lessons Learned

Heart & Lung: The Journal of Acute and Critical Care, 2014

Research paper thumbnail of The Baby‐Friendly Hospital Initiative as an Intervention to Improve Breastfeeding Rates: A Review of the Literature

Journal of Midwifery & Women's Health, 2016

Introduction: The Baby-Friendly Hospital Initiative (BFHI) is considered to be an evidence-based ... more Introduction: The Baby-Friendly Hospital Initiative (BFHI) is considered to be an evidence-based program that improves breastfeeding outcomes, but primary research on the topic has been limited. The purpose of this review was to evaluate the literature and synthesize findings to determine the effectiveness of the BFHI as an intervention to improve breastfeeding initiation, duration, and exclusivity. Methods: A review of literature published from 1991 to October 2014 using MEDLINE, CINAHL, PsycINFO, and Web of Knowledge with the search term "Baby-Friendly Hospital Initiative." The 724 titles initially identified were reviewed using these inclusion criteria: English language, primary research, and available electronically or via interlibrary loan. Studies were excluded if they explicitly stated that they had omitted specific portions of the BFHI or did not fully implement the intervention; considered breastfeeding rather than the BFHI as an intervention; used the BFHI to improve neonatal intensive care unit outcomes specifically; or measured outcomes other than breastfeeding initiation, duration, or exclusivity. This yielded 25 studies for review. Results: There are more studies that support the BFHI as an intervention to increase breastfeeding than there are studies that demonstrate no effect of the intervention. However, design weaknesses, settings outside the United States, and disparate methods impede the ability to reach firm conclusions regarding the effectiveness of the BFHI in improving breastfeeding initiation, duration, and exclusivity rates in the United States. Discussion: Many of the studies regarding the effectiveness of the BFHI have been hampered by weak designs or methodologic limitations. Research conducted in the United States and employing experimental designs would help to more conclusively determine the effectiveness of the BFHI as an intervention to improve breastfeeding rates.

Research paper thumbnail of Reflections of Black Women Who Choose to Breastfeed: Influences, Challenges and Supports

Maternal and child health journal, Jan 23, 2015

Black women continue to have the lowest rates of breastfeeding. Of those who choose to breastfeed... more Black women continue to have the lowest rates of breastfeeding. Of those who choose to breastfeed up to half cease nursing within the first few days or months postpartum. This study identified factors that influence and challenge Black women who choose to breastfeed, and supportive strategies that facilitate successful breastfeeding experiences. Four focus groups were conducted in 2013 with 16 self-identified Black women aged 21-46 (M = 31.35 years), with 11-18 (M = 14.94) years of education, and were either pregnant or had given birth to an infant within the prior 5 years (range of pregnancies 1-7; M = 2.44). A standard set of questions guided discussions. Data saturation occurred after three groups. All discussions were audiotaped and transcribed. Qualitative methods were used to identify categories and subthemes. Reviewers met periodically to resolve ambiguities and coding discrepancies. Member checking was conducted. Four major categories emerged: Balancing the influences: Peopl...

Research paper thumbnail of Preventing recurrent preterm births and improving maternal infant health via a home visitation system of care: A randomized clinical trial

Background: High probability of recurrent preterm birth (PTB) with history of prior PTB. Interact... more Background: High probability of recurrent preterm birth (PTB) with history of prior PTB. Interaction of multiple risk factors and health behaviors may contribute to PTB; some may be amenable to intervention. Home visitation is promising method to deliver evidence based interventions within a system of care (SOC). We evaluated a SOC designed to: 1) reduce preterm births and associated health care costs, and 2) improve the health in pregnant women with a history of a PTB. Methods: Randomized, parallel-group study in regional medical center. Eligibility: >18 years with prior live birth > 20 - < 37 weeks gestation; < 24 weeks gestation at enrollment; spoke and read English; received care at the medical center. All participants (N = 211) received standard prenatal care. Intervention participants (N = 109) also received home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data collected via multiple ...

Research paper thumbnail of Implementing an Academic-Clinical Partnership to Promote Successful Transition of Heart Failure Patients from Hospital to Home

Heart & Lung: The Journal of Acute and Critical Care, 2014

Research paper thumbnail of Leveraging Resources to Improve Clinical Outcomes and Teach Transitional Care Through Development of Academic-Clinical Partnerships

Nurse educator, Jan 16, 2015

Nurse educators need to provide students with clinical experiences that prepare them for our rapi... more Nurse educators need to provide students with clinical experiences that prepare them for our rapidly changing health care environments. This article describes how nurse educators used academic and clinical resources to develop a partnership between a school of nursing and clinical entity to facilitate successful transitions from hospital to home for adult heart failure and pediatric asthma patients.

Research paper thumbnail of Do We Really Help? Perspectives of Abused Women

Public Health Nursing, 2003

Findings are presented from focus group data collected during a larger study describing factors t... more Findings are presented from focus group data collected during a larger study describing factors that inhibit, support, and sustain women's abilities to leave and stay out of abusive relationships. A subset (n ¼ 24) of the larger study sample (N ¼ 40) participated in one of four focus groups. Participants had left or were currently in abusive intimate relationships. Women reported diverse experiences and were in various stages of abusive relationships. Ages ranged from 21 to 51; 67% were Caucasian, and 20% African American. Most women (71%) had at least a high school education and were employed (60%), but 83% reported annual incomes less than $20,000. NVIVO software facilitated content analysis of transcriptions. After initial synthesis of data, 20 women participated in one of two confirmatory focus groups. Four primary themes emerged from the content analysis: (1) Living an Unnatural Experience included maladaptive physical and emotional responses to chronic violence; (2) The Experience of Telling included multiple intrapersonal, interpersonal, and societal barriers to disclosure; (3) The Experience of Leaving included descriptions of acute and long-term experiences and difficulties; and (4) Reducing Barriers included participant ideas on ways to reduce barriers to assistance. Recommendations are made to improve community interventions and programs that will facilitate the choices and enhance the successes of women who have experienced domestic violence.

Research paper thumbnail of Planning of Youth Violence-Prevention Programs: Development of a Guiding Measure

Public Health Nursing, 2003

This article describes the development and pilot testing of the Good-Fit Measure (GFM), a measure... more This article describes the development and pilot testing of the Good-Fit Measure (GFM), a measure that public health nurses and other providers involved with planning multidisciplinary violence prevention efforts can use. Themes derived from a series of focus group discussions from a larger study, including individuals (n ¼ 83) from multiple community sectors, guided development of the measure. Participants in three follow-up focus groups (n ¼ 32 participants) reviewed the measure, which was then pilot tested in two phases. Guided by information from the first phase, in which respondents indicated the measure was too complex, the measure was simplified and field tested in phase two. Results from both phases were similar. The GFM score was significantly higher for the program selected by the respondent before completing the measure than the nonselected program (p < 0.01). Participants indicated that the tool was helpful in articulating the specific factors for their decisions. Participants underscored the utility of the tool in facilitating program planning by individual providers and interdisciplinary or multidisciplinary teams. The GFM provides systematic consideration of multiple factors that motivate public health nurses and other community providers in their decision-making process when planning prevention strategies, increasing the likelihood of successful programs.

Research paper thumbnail of Are Services to Tennessee Children with Special Health Care Needs Comparable with National Achievement of MCHB Objectives?

Public Health Nursing, 2012

We assessed experiences of families with children with special health care needs already engaged ... more We assessed experiences of families with children with special health care needs already engaged with Tennessee Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Special Services or a family advocacy agency, family voices, and compared their experiences with national data to determine achievement of national maternal-child health objectives. Using a descriptive/comparison design, Tennessee families engaged with the state or advocacy agency (n = 816) were compared with the 2005-2006 sample of the National Survey of Children with Special Health Care Needs (n = 40,840) and the Tennessee subsample (n = 794). Primary data were obtained from a survey of families associated with either Tennessee agency. Secondary data analysis used raw data from the national survey. All families reported challenges related to time, finances, and family interactions. Most were satisfied with health care services received. Dental care was an issue for all families, but more so for the agencies&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; sample. Those families also reported more problems with continuous screenings of their affected child and less coordination of care than the national sample. Examining the experiences of families with special needs children who receive services from state agencies in the national context contributes to improving family-centered services and achieving Maternal-Child Health Bureau objectives.

Research paper thumbnail of The Effects of Maternal Psychosocial Factors on Parenting Attitudes of Low-Income, Single Mothers With Young Children

Nursing Research, 1998

Although recent evidence implies linkages among depression or depressive symptoms, self-esteem, h... more Although recent evidence implies linkages among depression or depressive symptoms, self-esteem, history of childhood abuse, and parenting attitudes, the evidence does not clearly elucidate the relationships among these variables. To investigate the relationships among maternal psychosocial factors (history of childhood abuse, everyday stressors, self-esteem, and depressive symptoms) and parenting attitudes of low-income, single mothers who have young children. Secondary analyses of data from in-home interviews with 206 low-income, single mothers from a southeastern United States urban area were conducted. A variety of scales, including the Adult-Adolescent Parenting Inventory (AAPI), were used to measure maternal psychosocial factors. Using the AAPI, a Modified Parenting Attitudes Measure (MPAM), and subscales, a three-stage regression procedure was used to test the model. For stages 1 and 2, everyday stressors were the strongest predictor of self-esteem. Childhood sexual abuse, everyday stressors, low self-esteem, and control variables accounted for 58% of variance in depressive symptoms. In the third stage for the AAPI, only control variables were retained except in the Lack of Empathy subscale, where depressive symptoms and control variables accounted for 16% of the variance. The third stage for the MPAM yielded, by subscale: Only control variables predicted Corporal Punishment Beliefs; depressive symptoms were the strongest predictor for the total MPAM (19% of variance) and of the Inappropriate Emotional Expectations subscale (17%); and childhood physical abuse was the only predictor of Role Reversal. Depressive symptoms mediated the effects of childhood abuse, everyday stressors, and self-esteem and provided the linkage between these variables and at-risk parenting attitudes. Self-esteem decreased as everyday stressors increased but did not directly affect parenting attitudes. A relationship was not found between childhood abuse and low self-esteem. This study highlights the complexity of parenting and the need to identify other factors of at-risk parenting not accounted for in this study.

Research paper thumbnail of Breaking the cycle of family violence: understanding the perceptions of battered women

Journal of Pediatric Health Care, 2004

Research paper thumbnail of Childhood Physical and Sexual Abuse: Their Relationship with Depressive Symptoms in Adulthood

Image: the Journal of Nursing Scholarship, 1993