The paper presents an overview of the recent change from norm-referenced to criterion-referenced score interpretation for the ACNM certification examination for entry level practice in nurse-midwifery. The advantages of criterion-referenced interpretation are presented. A successful adaptation of the Nedelsky method for the calculation of the minimum pass index, based on the identification of acceptable error, is discussed. Implications for the nurse-midwifery profession and for the national certification examination in nurse-midwifery are considered.

Certification↗

PubMedDate not supplied

Role of nutrition in the prevention of preeclampsia. Review of the literature.

Preeclampsia has been called a disease of theories. One theory proposes a complex relationship between nutritional imbalance and the pathophysiology of this disease. The theoretical importance of selected nutrients is considered through reference to several recent basic research studies and clinical trials. With the clinical prevention of preeclampsia as a focus, suggestions for outpatient nutritional counseling, dietary alteration, and nutrient supplementation will be offered.

Female↗

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Assessment of the process and outcomes of the first 1,000 births of a nurse-midwifery service.

This article is a retrospective descriptive analysis of the first 1,000 births conducted by the Nurse-Midwifery Group of Fresno County, California, over the period from 1980 to 1985. The multiethnic patient population was of mixed obstetric risk. Nurse-midwifery care was offered within the context of a comprehensive maternity care program in close collaboration with a perinatal health care team. Patient care outcomes were quite favorable when compared with county and state statistics. A perinatal mortality rate of 7.0/1,000 was observed. The incidence of low birth weight infants (5.7%) and the cesarean section rate (7.7%) were also lower than county and state statistics. These data add to the growing body of literature that suggests that nurse-midwifery care, within the structure of collaborative practice, can be effective and advantageous. The nurse-midwifery service made a contribution to access to perinatal care for the residents of this community.

Adolescent↗

PubMedDate not supplied

Prevention of infant mortality. An agenda for nurse-midwifery.

A major health objective of the United States government and the World Health Organization is the reduction of infant mortality by the year 2000. Significant progress in the reduction of infant mortality has been made internationally simply as a consequence of general improvements in public health and nationally as a consequence of increased technological sophistication. Recently, however, there has been an attenuation in the rate of decline, and it becomes necessary to address the unsolved issues that continue to affect morbidity and mortality in the first year of life. Year 2000 objectives related to infant mortality include the reduction of low birth weight and increasing access to prenatal care. Socioeconomic, behavioral, medical, and obstetric factors associated with low birth weight and lack of prenatal care are cited. Personal and political agenda targeted to the achievement of the public health goals are proposed.

Health Services Accessibility↗

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In-hospital care for low-risk childbirth. Comparison with results from the National Birth Center Study.

The largest prospective study of freestanding birth centers was reported in 1989. This article reports on data from a comparison group of over 2,000 low-risk women who were admitted to hospital-care settings during the same period. The data on the hospitalized women were collected using the research methodology and data collection instruments developed for the birth center study. Consequently, these data offer the opportunity to observe differences that can be associated with birth site. Both groups of women experienced similar rates of serious antepartum and intrapartum health problems and maternal morbidity. However, even when controlling for complications and differences in sociodemographic characteristics, women in hospitals were more likely to receive an interventive style of labor and birth management. Neonatal outcomes were also similar, although the incidence of sustained fetal distress, prolapsed cord, and difficulty in establishing respirations were significantly greater in the hospital sample. Hospital care did not offer any advantage for women at lowest risk, and it was associated with increased intervention. The results of this study provide support for the National Birth Center Study's conclusion that birth centers offer a safe and acceptable alternative for selected pregnant women.

Adolescent↗

PubMedDate not supplied

Development of a single component of a performance evaluation protocol. The faculty impression score.

The issues of uniformity, consistency, and fairness in the measurement of behavioral skills constitute the ongoing debate of clinical evaluation. Evaluation tools, particularly those that propose to measure observed phenomena, have been judged to be limited in validity or reliability and are, therefore, more subjective than is desirable. Nurse-midwifery educators are challenged to identify or develop clinical and professional performance instruments, and to achieve interfaculty reliability in their application. In addition, nurse-midwifery educational programs that make use of nonsalaried and/or off-site preceptors to contribute to student education must accept the dual challenges of development of clinical teaching skills and also the consistent application of the program's evaluation instruments and methods. The development of the "faculty impression score" as a supplemental, but critical, element within a behaviorally anchored, criterion-referenced evaluation protocol is presented.

Attitude of Health Personnel↗

PubMedDate not supplied

Development and translation of an English-Spanish dual-language instrument addressing access to prenatal care for the border-dwelling Hispanic women of San Diego County.

The health of populations residing on either side of the United States-Mexican border has public policy implications for both border communities. A study of barriers to prenatal care for residents of the San Diego, California-Tijuana, Mexico region was conducted. The study was designed specifically to address the availability of health services for women who crossed the border in either direction. This article reports the methodology used in the construction and validation of a dual-language (as opposed to a Spanish language form) survey instrument that was developed for the study. Particular attention is given to the methodology used for language translation to ensure that it would reflect the idiomatic diversity of the multicultural population.

California↗

PubMedDate not supplied

Evaluation of research studies. Part IV: Validity and reliability--concepts and application.

The concepts of validity and reliability are defined within the context of applied clinical research. Validity concerns what an instrument measures and how well it does so. Reliability concerns the faith that one can have in the data obtained from use of an instrument, that is, the degree to which any measuring tool controls for random error. The researcher selects a measure that demonstrates content, criterion, or construct validity, according to the intended use of the measurement tool. Similarly, the researcher selects a measure that demonstrates a degree of reliability that is needed for its application. It is possible to have reliability without validity, but it is logically impossible to demonstrate that an unreliable test is valid.

Bias↗

PubMedDate not supplied

Factors that predict performance on the national certification examination for nurse-midwives.

The ACNM Certification Council is responsible for determining that the national certification examination in nurse-midwifery is not biased toward any protected group. Educational programs of nurse-midwifery have an interest in knowing that their admissions criteria and educational design have validity. Policy makers have an interest in both of these issues. Nine demographic and preadmission factors were investigated to identify their ability to predict performance on the nurse-midwifery national certification examination. This retrospective analysis included 1,046 candidates who took any one of five criterion-referenced, modified essay forms of the examination between January 1988 and April 1994. Multiple-regression analysis revealed that five factors explained 16.2% of the variance in certification examination performance. These factors included age (as age increased, scores decreased slightly), ethnicity (white and Hispanic candidates received higher scores compared with other groups), years of nursing practice prior to nurse-midwifery education (a slight positive influence for each additional year), highest educational degree obtained (those whose highest degree was the baccalaureate performed slightly better than candidates with no degree and candidates with graduate degrees), and academic level of the nurse-midwifery education program (certificate, master's, and doctoral level candidates all performed better than candidates from precertification programs; certificate candidates performed slightly better than master's candidates). However, even though these variables contributed to a statistically significant model, the actual degree of predicted difference in scores was of little practical significance. Variables that were not predictive of performance included marital status, U.S. versus foreign education either in nursing or in midwifery, and academic level of the registered nursing educational program [corrected].

Adult↗

PubMedDate not supplied

Reflections on nurse-midwifery role and functions.

The role and functions of nurse-midwifery are currently being studied by the American College of Nurse-Midwives Certification Council. The remarks that were included on the comment sheet and comments included on the margins of the survey forms were subjected to content analysis. These narrative data complement the quantitative data derived from the research. They reflect a capsule view of contemporary role conflict in nurse-midwifery.

Data Collection↗

PubMedDate not supplied

Use of the nurse-midwifery clinical data set for classification of subjects in birth center research.

Current literature on the safety and efficacy of freestanding birth centers suggests that these centers are safe and have reduced costs for delivery of low-risk women compared with hospitals. Despite these findings, birth centers continue to arouse controversy and remain limited in number. Potential inequality of birth center and hospital subjects as to perinatal risk is cited as the major methodologic flaw in the current research on birth centers. Defining an appropriate comparison group is arguably the most important methodologic issue encountered in these investigations. Defining women as "low risk" according to standard perinatal risk tools is not an adequate measure of comparability, as these criteria are generally not equivalent to those defining birth center eligibility. The key is to identify groups for comparison that, at baseline, would be expected to have similar outcomes. To address this concern, a tool based on the American College of Nurse-Midwives' Nurse-Midwifery Clinical Data Set was developed to identify valid comparison subjects for birth center research. This tool focuses on birth center eligibility as opposed to traditionally defined risk. This article reviews the issues of population comparability in birth center research and presents the results of a validation study using this newly developed tool.

Birthing Centers↗

PubMedDate not supplied

1994 task analysis of American certified nurse-midwifery.

The ACNM Certification Council is responsible to the American College of Nurse-Midwives for the development, administration, and evaluation of a psychometrically sound and legally defensible certification examination in nurse-midwifery. A task analysis study was conducted to investigate the knowledge, skills, and abilities that define American nurse-midwifery practice. A stratified sample of 825 American College of Nurse-Midwives members was asked to rate the frequency of performance and the criticality of 189 nurse-midwifery activities and 109 discrete diagnoses that the nurse-midwife might encounter while providing clinical care. The frequency and critically ratings were combined to generate an importance weight for each activity. Study data will be used as the basis of the examination blueprint in order to ensure job-related content validity. Aggregate data can also be used for curriculum development, self-assessment, and evaluation research purposes.

Adult↗