http://hdl.handle.net/10027/7 UIC College of Nursing Sat, 25 May 2013 22:45:43 GMT 2013-05-25T22:45:43Z http://hdl.handle.net/10027/9782 The Symptom Experience of Postpartum Pain after Cesarean Birth The Symptom Experience of Postpartum Pain after Cesarean Birth Emily G. Chin, Ph.D. Department of Women, Children, and Family Health Science University of Illinois at Chicago Chicago, Illinois 2012 Dissertation Chairperson: Dr. Catherine Vincent Pain is a common experience after all births, particularly after cesarean birth, where pain has been reported as more intense and longer lasting when compared to vaginal birth. Postpartum pain has detrimental implications for both the infant and mother by interfering with infant care, breastfeeding exclusivity, and maternal sleep. This study was guided by the University of California at San Francisco (UCSF) symptom management theory, focusing on the symptom experience components of perception, evaluation, and response. The study aim was to comprehensively describe the symptom experience of postpartum pain after cesarean birth, reflecting the 4 dimensions (sensory, affective, cognitive, and behavioral) and 2 types (nociceptive and neuropathic) of pain. In this concurrent mixed-methods study, thirty participants scheduled for a cesarean birth at an academic medical center were recruited. Data were collected at 24 to 48 hours after birth and at 6 weeks postpartum. Through the PAINReportIt (computerized McGill Pain Questionnaire) and an open ended interviews, participants described their pain in terms of the 3 symptom experience components, 4 pain dimensions, and words reflective of the 2 pain types. Regarding pain symptom experience, participants perceived the change in sensation, evaluated the impact on their lives, and responded with behavioral changes. For pain dimensions, participants reported mild pain intensity; on a 0-10 scale, at 24 to 48 hours mean pain score was 2.75 (+/- 1.8) and at 6 weeks 1.1 (+/- 2.4). In spite of these mild pain scores, most participants described their pain as aching, cramping, tender, and sore; for many, these descriptions persisted at 6 weeks. Most participants expected their pain and were satisfied with their pain level. Pain affected participants’ actions such as lifting and affected their roles with partners and children. Participants selected pain descriptors associated with nociceptive (e.g., cramping, tender, and sore) and neuropathic (e.g., aching) pain at both visits. The symptom experience of pain is multidimensional, individual, and complex. The symptom management theory provided a valuable framework and PAINReportIt and interview comprehensive measures to describe this phenomenon. Thu, 21 Feb 2013 06:00:00 GMT http://hdl.handle.net/10027/9782 2013-02-21T06:00:00Z http://hdl.handle.net/10027/9759 The Quality of Life of Caregivers of Children with Chronic Conditions This dissertation is comprised of two papers that address the quality of life (QOL) of caregivers of children with chronic conditions. The first paper is a literature review that critically evaluates study findings pertaining to the quality of life of primary caregivers of children with chronic conditions to determine current findings and gaps. Using a systematic approach, findings were categorized, organized and synthesized using the four domains of the Ferrans Conceptual Model for Quality of Life (QOL). This review showed that the time commitment associated with caring for a child who has a chronic condition affects the reported QOL of the primary caregivers. The QOL of the caregiver as it relates to health, psychological well-being, social networks and support, and the family dynamic can be negatively impacted when a significant amount of time is being committed to the care of the child with a chronic condition. The noted outcomes of QOL among caregivers can vary based on the severity of the child’s condition and the caregiver’s perceived QOL. It was concluded that more studies on quality of life in childhood chronic illness would add to the body of knowledge and hopefully increase the awareness of these caregivers’ needs for clinicians who care for these children. The second paper is a mixed methods study that assessed the relationship between the caregiver’s QOL, the child’s functional status and the well-being of the family unit. Results of the Ferrans and Powers Quality of Life Index Generic Version (QLI), the Functional Status Measure II and the Family APGAR were analyzed. The caregivers’ overall QOL scores were divided into upper and lower quartiles which facilitated the inspection of the qualitative data collected from the caregiver. This analysis was conducted to better understand the aspects of the caregiver’s own life and daily routine that affected their self-reported QOL. This study shows that the reported functioning of a child with a chronic condition and the well-being of the family unit were directly related to their QOL. The quantitative analysis showed that the measures of QOL, child’s functional status and family well-being were strongly positively correlated. The overall QOL mean scores of the upper and lower quartile were significantly different. QOL was impacted by financial strains within the family as a result of the child’s condition, support within the family unit and psychological stressors of the genetic nature of the child’s condition. Thu, 21 Feb 2013 06:00:00 GMT http://hdl.handle.net/10027/9759 2013-02-21T06:00:00Z http://hdl.handle.net/10027/9751 Outcomes of Mentoring Interventions for New Graduate Nurses New graduate nurses report lack of support as a key antecedent of their turnover intent within their first year of employment. Mentoring interventions are one way to foster support and socialization of newcomers. The purpose of this study was to assess the effect of two different mentoring interventions (one-on-one versus group mentoring) on new graduate nurse turnover using the theory of job embeddedness as the framework for analysis. This paper presents the findings from an exploratory comparative cross sectional design study of 2032 new graduate nurses who completed a formalized nurse residency program between 2007 and 2010. Two proxy measures were used to assess job embeddedness. Forward stepwise regression was used to analyze the data. Results demonstrated that one on one mentoring actually lowers new graduate nurses’ perceptions of group cohesion and work empowerment while mentor circles (group mentoring) have a positive effect. Findings also indicate that group cohesion, work empowerment, and mentor circles are all significantly associated with turnover intent. With the prospect of the continued nursing shortage, it is critical that nurse leaders invest in evidence based interventions to increase new graduate nurse retention. Mentor circles appear to be an intervention worth exploring. Thu, 21 Feb 2013 06:00:00 GMT http://hdl.handle.net/10027/9751 2013-02-21T06:00:00Z http://hdl.handle.net/10027/9746 The Influence of Social Environment Characteristics on Depressive Symptoms of Low-income Urban Mothers Purpose: This research examined low-income, urban mothers’ social support environments as predictors of depressive symptoms from late pregnancy through six months postpartum. Background: The lack of a supportive social environment has been shown to increase risk for women’s depressive symptoms during pregnancy and postpartum, with serious potential outcomes for women and their children. The mechanisms of effect for social support remain unclear, though a buffering (moderating) effect has been theorized. Methods: A longitudinal design was used for secondary analysis of data for 279 low-income women of Mexican American or African American ethnicity. Data had been collected for a previous, randomized trial of a home-visit intervention program. The theoretical model incorporated social environmental factors and guided hierarchical linear multiple regression analyses to predict depressive symptoms. Results: In this sample, 33% at pregnancy, and 21% at 2 and 6 months postpartum reported severe symptoms. The final predictive model showed that depression at pregnancy and at 2 months postpartum, and perceived social support were strong predictors of depressive symptoms at 6 months postpartum. Social integration at pregnancy, network size, stability of support from the father of the baby, and difficult life circumstances also were significant predictors of symptoms at 6 months. Demographic factors were not predictive. The final model predicted 56% of the variance in women’s symptoms. The buffering effects of social support for the effects of life difficulties were not significant at any time point. Conclusions: A substantial proportion of low-income women had severe depressive symptoms during pregnancy compared to postpartum. Stable support from the father of the baby can be a protective factor. Perceived social support had a direct effect on women’s postpartum symptoms. Thu, 21 Feb 2013 06:00:00 GMT http://hdl.handle.net/10027/9746 2013-02-21T06:00:00Z