R E S E A R C H

Proceedings of the 2014 AWHONN Convention

A Phenomenological Approach to Describe the LivedExperience of Ovarian Cancer

Joanna L. Guenther, PhD, RN,FNP-BC, CNE, Texas TechUniversity Health SciencesCenter, Lubbock, TX

Keywordsovarian cancerlived experiencephenomenologywomen’s health

Paper Presentation

Objective

To explore and illuminate the lived experienceof women diagnosed with ovarian cancer.

DesignA phenomenological approach in which individu-als tell their stories to make meaning of their truths,realities, and experiences. Phenomenology allowsresearchers to interpret the meaning of the expe-riences through hearing and observing the wordsand descriptions of participants.

SettingThe women were interviewed for an hour or moreat their homes or workplaces. Each interview wasaudio-recorded and transcribed.

SampleEleven women aged 23 to 66 were interviewedbeginning with the open-ended question “Tell meabout events leading up to your diagnosis of ovar-ian cancer.” The women were diagnosed withstages II (n = 1), III (n = 8), and IV (n = 2) ovariancancer within the past 5 years. Stages III and IVare advanced stages.

MethodsThe narrative responses were analyzed for consti-tutive patterns and relational themes according tothe hermeneutic phenomenological process. Byilluminating the memories and recollections of thewomen, the meanings and particulars of the ovar-ian cancer experience were identified.

ResultsPrior to diagnosis, most women were not awareof the symptoms of ovarian cancer. Even thoughsymptoms were present, they were often attributedto gastrointestinal and renal problems by thewoman and provider. There was an average de-lay in diagnosis of at least 6 months. Six con-stitutive patterns evolved from the experiencesof the 11 women: the revelation, jeopardy, onthe lookout, becoming normal, and living everymoment.

Conclusion/Implications for Nursing PracticeThe women participated in this study with the ex-pectation that their experiences would be passedon to health care providers who care for women.They wanted the information to contribute to im-provement in the care provided with hopes for ear-lier diagnosis. They wanted others to know aboutthe difficulties they experienced when they sensedsomething was wrong with their bodies and theneed to search for answers by going from providerto provider. Once they were correctly diagnosed,they faced complex physical, spiritual, and psy-chological needs associated with an incurable ill-ness. The women’s symptoms are described toenable nurses to educate women about the symp-toms of ovarian cancer and to evaluate their riskfactors. In addition, the women provided key in-sights into approaches and strategies for facingdeath while embracing life.

JOGNNhttp://jognn.awhonn.org C© 2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses S81

R E S E A R C HProceedings of the 2014 AWHONN Convention

Continuing Psychometric Evaluation of the Perinatal GriefIntensity Scale in the Subsequent Pregnancy After PerinatalLoss

Marianne Hopkins Hutti, PhD,WHNP-BC, University ofLouisville, Louisville, KY

Deborah S. Armstrong, PhD,RN, University of Louisville,Louisville, KY

John Myers, PhD, University ofLouisville, Louisville, KY

KeywordsPerinatal grief intensitysubsequent pregnancy

Paper Presentation

Objective

To examine the relation of grief intensity, psy-chological wellbeing, and the quality of inti-

mate partner relationships of women in the subse-quent pregnancy after a miscarriage, stillbirth, orneonatal death.

DesignDescriptive, cross-sectional, correlational re-search design. Based on the theoretical frame-work of perinatal grief intensity developed by theauthor, we examined the reliability and convergentvalidity of the Perinatal Grief Intensity Scale (PGIS)in the subsequent pregnancy after a perinatal loss.

SettingWeb-based study.

SampleCurrently pregnant women (N = 227) who had ex-perienced a perinatal loss in their immediate pastpregnancies. Analysis indicated the sample of 227women who completed the instruments (48% oftotal) afforded sufficient power to test the hypothe-ses.

MethodsInstruments included the Pregnancy OutcomeQuestionnaire (POQ) for pregnancy-specificanxiety; Impact of Event Scale (IES) for posttrau-matic stress; Center for Epidemiologic Studies-Depression Scale (CES-D) for depression symp-toms; Autonomy and Relatedness Inventory (ARI)for quality of intimate primary relationship; and thePGIS for perinatal grief intensity. Data were ana-lyzed using descriptive statistics.

ResultsCronbach’s alphas for all total scales and sub-scales used in the study were high and rangedfrom .75 (PGIS total) to .95 (ARI total). Increasedgrief intensity was associated with significantly in-creased pregnancy-specific anxiety; depressionsymptoms; posttraumatic stress; and poorer, pri-mary, intimate relationships. Participants in allthree groups (miscarriage, stillbirth, and neonataldeath) reported significantly higher mean CES-Dscores (range 25.2-29.6, p < .001) than the tradi-tional cutoff score of 16 used for suggesting de-pression symptoms. Similarly, all mean loss groupscores were significantly higher than 23 (range34.4-35.5, p < .001), the IES cutoff score used tosuggest posttraumatic stress.

Conclusion/Implications for Nursing PracticeThe consequences associated with intense griev-ing may include significant couple relationshipissues, depression, pregnancy-specific anxiety,and posttraumatic stress that may also extendinto the subsequent healthy pregnancy. The PGISdemonstrated total and subscale internal con-sistency reliability when used with all types ofperinatal loss within the context of subsequentpregnancy. It demonstrated convergent validityby establishing statistically significant and ap-propriate directional relationships with conceptsthought to be associated with intense grief, includ-ing pregnancy-specific anxiety, depression symp-toms, posttraumatic stress, and the quality of theprimary intimate relationship. It may eventually beuseful as a clinical instrument to help health careproviders identify parents at risk for intense griefreactions and other clinically relevant symptoms.

S82 JOGNN, 43, S81-S85; 2014. DOI: 10.1111/1552-6909.12438 http://jognn.awhonn.org

Baxter, J. M. S., Kavanaugh, K., and Vonderheid, S. R E S E A R C HProceedings of the 2014 AWHONN Convention

ProfessionalIssues

Response to the Call to Action: A National Picture ofBreastfeeding Support Provided in Neonatal Intensive Care

Sunny G. Hallowell, PhD,PCPNP-BC, IBCLC,University of Pennsylvania,Philadelphia, PA

Diane L. Spatz, PhD, RN-BC,FAAN, University ofPennsylvania School of Nursingand Children’s Hospital ofPhiladelphia, Philadelphia, PA

Eileen Lake, RN, PhD, FAAN,University of Pennsylvania,Philadelphia, PA

Alexandra L. Hanlon, PhD,University of PennsylvaniaSchool of Nursing,Philadelphia, PA

Keywordsnurse work environmentpractice environment scorebreastfeeding supporthuman milkNICU

Paper Presentation

Objective

To measure the frequency of breastfeedingsupport by nurses and receipt of human milk

by very low birth weight (VLBW) infants in theneonatal intensive care unit (NICU), which is notknown and to determine if the numbers and qual-ifications of nurses, their professional practiceenvironments, and the availability of lactation con-sultants increased the number of infants who re-ceived this care.

DesignCross-sectional, observational study.

SettingOne hundred four NICUs.

SampleParticipants included 6,060 nurse survey respon-dents, 15,233 infants who were card for by nurseson their last shifts worked, and 7,886 VLBW infantscared for in participating NICUs.

MethodsSecondary analysis was used to examine nursesurvey data collected in 2008 from the parentstudy and infant hospitalization data from 104NICUs in the Vermont Oxford Network (VON),an NICU quality collaborative. Analysis was con-ducted using bivariate and multiple general linearregression models.

ResultsThe majority (54%) were discharged on formulaonly. Few infants (6%) were discharged on exclu-sive human milk. The remaining infants (42%) re-ceived human milk mixed with fortifier or formula.Nurses reported providing breastfeeding supportto one in five infants whose parents were present.Sixty percent of infants had parents present forpart or the entire shift. Only half of the NICUs hada lactation consultant (51%). Significantly greaternumbers of infants received breastfeeding sup-port and human milk (p < .05) in NICUs withsupportive professional practice environments,baccalaureate-prepared nurses, and nurses withat least 5 years NICU experience.

Conclusion/Implications for Nursing PracticeNational health care agencies including the U.S.Surgeon General and American Academy of Pe-diatrics have described breastfeeding and humanmilk as the normative standard for infant feed-ing and nutrition. However, the country is fallingfar short of the Surgeon General’s recommenda-tion for this high-risk pediatric population. Thefindings suggest NICU nurses provide breast-feeding support around the clock, typically with-out a lactation consultant available. Our resultsdemonstrate that nurses are essential to provid-ing lactation care to NICU infants for whom thereceipt of human milk is an issue of patient sat-isfaction, quality patient care, effectiveness, andsurvival.

Exploring the Lived Experience of Trauma Among ObstetricRegistered Nurses

Jennifer M. S. Baxter, PhD,BSN, SUNY DownstateMedical Center, New York, NY

Karen Kavanaugh, PhD, RN,FAAN, Wayne State University,Detroit, MI

Susan Vonderheid, PhD, RN,University of Illinois atChicago, Chicago, IL

Objective

To describe and analyze the lived experiencesof obstetric registered nurses (RNs) encoun-

tering trauma while providing direct care.

DesignHermeneutic phenomenology.

SettingNew York City.

SampleTen eligible obstetric nurses were recruited inusing convenient, purposive, and snowball sam-

pling. We also collected other data, including ety-mological history of the words, idiomatic phrasesrelated to the phenomenon, and experiential de-scriptions in literature, biographies, diaries, art,and phenomenological literature.

MethodsInstitutional review board approval and a Certifi-cate of Confidentiality from the National Institute ofNursing Research were obtained prior to collect-ing data. Interviews were recorded, transcribed,and analyzed based on van Manen’s stages of re-flective analysis to arrive at the essential meaningof the phenomenon.

JOGNN 2014; Vol. 43, Supplement 1 S83

R E S E A R C HProceedings of the 2014 AWHONN Convention

Keywordsbirthtraumanursingexperience

Professional IssuesPaper Presentation

ResultsThough experiences with trauma varied, the mostcommon experiences included maternal death, in-trauterine fetal demise (IUFDs), and emergencycesarean. Seven essential themes were uncov-ered as follows: (a) an internal process, (b) be-ing faced with the unexpected, (c) going throughthe motions, (d) feeling helpless, (e) engagingothers, (f) a visceral imprint, and (g) a damagedperson.

Conclusion/Implications for Nursing PracticeTrauma is the emotional or psychological stateof discomfort or stress resulting from an over-whelming event or series of events while provid-ing direct care. Exposure to trauma has nega-tive consequences for nurses, including mental,

physical, and/or emotional health issues leadingto problems such as posttraumatic stress disorder(PTSD), burnout, poor nursing care, and patientsafety risk.

For participants, trauma was an unforgettable,deeply personal, and complex experience. It is im-portant that obstetric RNs and outsiders recognizethat trauma is ever present in the obstetric spe-cialty. The critical insight gained from this studyprovides valuable information to enrich our aware-ness about the vulnerability of obstetric nurses totrauma, to begin a conversation about how to im-prove the work environment for nurses, and to en-hance the care they provide to their patients. Weprovide recommendations for practice, education,and research.

The Maternal-Newborn Assessment Study: Can SimulationReplicate the Clinical Learning Experience in UndergraduateNursing Education?

Linda M. Veltri, PhD, RN,Oregon Health and ScienceUniversity, Ashland, OR

Joanna M. Rowe, PhD, RN,Linfield College, Portland, OR

Kathleen J. Bell, RN, MSN,CNM, AHN-BC, MS1-BC,Northern Light, Cannon Beach,OR

Ellyn L. Arwood, EdD,University of Portland,Portland, OR

Lindsay L. Kindler, PhD, RN,CNS, Kaiser PermanenteNorthwest, Portland, OR

Keywordsmaternal-newbornundergraduatenursing studentssimulation

Professional IssuesPaper Presentation

Objective

To compare high-fidelity simulation and prac-tice in the clinical laboratory to hospital-based

clinical learning on the ability of undergraduatenursing students to assess, intervene, and criti-cally think in the obstetric setting.

DesignQuasi-experimental, nonequivalent comparisongroups, post test only; power analysis for threevariables, medium effect size required 76 in eachcomparison group for a total of 152 participants;alpha level .05 and power of .8.

SettingPrivate university in the Pacific Northwest.

SampleUndergraduate, senior nursing students (80) in thematernal-child course: 39 in an obstetric hospitalrotation and 41 in a pediatric clinical rotation vol-untarily participated and comprised the two com-parison groups.

MethodsEach student demonstrated simulated postpar-tum and newborn assessments, whereas an ob-stetric faculty member trained as an observerevaluated performance using check-off forms.Following and prior to debriefing, students pro-vided written responses to questions designedto assess critical thinking during the simulation.Questions and items on check-off forms were as-signed points to obtain assessment, written, andtotal scores. Scores <92% required remediation.

Check-off forms, developed by study researcherswere tested for inter-rater reliability and contentvalidity, and questions were pilot tested. t Testswere used to compare scores of students com-pleting an obstetric hospital rotation versus thosein a pediatric clinical rotation, and frequencies forpassing assessments were calculated.

ResultsNo significant difference was detected betweenstudents in the pediatric clinical rotation who onlypracticed assessments in the laboratory settingand students completing a hospital-based obstet-ric rotation related to ability to assess, intervene,or critically think. The p-value for comparisonsranged from .41 to .93 (all nonsignificant); lessthan one third of students passed either assess-ment.

Conclusion/Implications for Nursing PracticeSimulation is a widely used teaching strategy. Re-searchers have found simulation increases un-dergraduate nursing students’ knowledge, skills,self-efficacy, and confidence. Our findings indi-cate that simulation was as effective as clinicalpractice in terms of students’ performance out-comes. Well-designed simulations can replacepart of nursing students’ hands-on clinical timewith positive learning outcomes. Evaluating in-dividual student performance facilitates designof remediation activities targeting identified ar-eas of weakness. Future researchers should com-bine simulation with hospital-based clinical ex-perience to determine if student competencyimproves.

S84 JOGNN, 43, S81-S85; 2014. DOI: 10.1111/1552-6909.12438 http://jognn.awhonn.org

Veltri, L. M. R E S E A R C HProceedings of the 2014 AWHONN Convention

Experiences of Staff Nurses during Clinical Learning

Linda M. Veltri, PhD, RN,Oregon Health and ScienceUniversity, Ashland, OR

Keywordsclinical learningundergraduate nursing studentsstaff nursesmaternity nursing

Professional IssuesPaper Presentation

Objective

To understand the unstructured experiences ofstaff nurses in an obstetric unit with under-

graduate nursing students present.

DesignNaturalistic inquiry.

SettingFamily birth center in Pacific Northwest.

SampleConvenience sample, 12 English speaking,baccalaureate-prepared registered nurses (RNs)who worked in unstructured manner with nursingstudents.

MethodsSemistructured interviews were conducted andrecorded. Participants shared their experiencesof working with students. Data were analyzed us-ing an interpretive continuous approach accord-ing to Lincoln and Guba’s elucidation of Glaserand Strauss’s constant-comparative method, anddata were stored, organized, and coded. Data col-lection and analysis ceased when categories weresaturated and no new information surfaced. De-mographic data were analyzed using descriptivestatistics. An experienced qualitative researcherprovided oversight to ensure accuracy. Credibility,transferability, dependability, confirmability wereused to ensure trustworthiness.

ResultsFive themes emerged as follows: giving and re-ceiving: working with students provided nurses

opportunities to give back to their profession—nurses learned from students; advancing profes-sionally and personally: many nurses took ad-vantage of workplace incentives to gain addi-tional compensation and opportunities; balanc-ing act: nurses balanced their typical work-loads with student learning needs and pro-vision of safe, quality care—students slowednurses down; getting to know and working withyou: nurses worked to know student personallyand tailored the learning experience—nurses de-sired students be prepared; past and present:clinical experiences exert long lasting impress-ions.

Conclusion/Implications for Nursing PracticeClinical learning is integral to nursing educa-tion and preparation for professional practice.Increased enrollments in baccalaureate nursingprograms require more staff nurses to super-vise students in the workplace. Researchers havefound students’ learning, impressions of nursing,and perceptions of clinical learning are greatly in-fluenced by nurses in the workplace, and workingwith students is a benefit for many nurses. Work-place learning may increase when students areprepared prior to entering clinical settings. Nursesworking with students should be judiciously se-lected. Future research should be aimed at dis-covering tangible rewards and benefits that mo-tivate nurses to work in an unstructured mannerwith students and determine how students in theworkplace influence patient safety and quality ofcare.

JOGNN 2014; Vol. 43, Supplement 1 S85