VOLUME 33 NUMBER 1 JANUARY/FEBRUARY 2004 EDITORIAL CLINICAL RESEARCH 9 Revisiting Commitment 44 A Model for the HELLP Syndrome: The Maternal Experience Thoughts for the new year on commitment to the nursing profession. Common emotions of women experiencing Nancy K. Lowe HELLP syndrome include fear of death, frus- tration, anger, and guilt. Maria C. Kidner and Mary Beth Flanders-Stepans PRINCIPLES & PRACTICE 12 Spinal Muscular Atrophy in the 54 Prenatal Predictors of Intimate Partner Neonate Abuse Almost 11% of this sample of pregnant Type I, or Werdnig-Hoffman disease, is the women in Alabama reported physical abuse most common hereditary cause of neonatal during the current pregnancy. mortality and requires expert nursing care for these fragile infants and their families. Linda L. Dunn and Kathryn S. Oths Jennifer A. Markowitz, Mindy B. Tinkle, and Kenneth H. Fischbeck 64 Parents' Perspectives on Decision Making After Antenatal Diagnosis of 21 Calcium in Women: Healthy Bones Congenital Heart Disease and Much More Decisions regarding further testing and preg- A clinical review of the physiology of calcium nancy continuation become the first parenting provides a solid basis for effective bone decisions when a fetus is diagnosed with con- health promotion throughout life. genital heart disease. Jane H. Kass-Wolff Gwen R. Rempel, Loryle M. Cender, M. Judith Lynam, George G. Sandor, and Duncan 34 The Future of Professional Education Farquharson in Natural Family Planning 71 More Than Just Menstrual Cramps: A systematic approach to training health care Symptoms and Uncertainty Among professionals in natural family planning is Women With Endometriosis needed to bring effective counseling to cou- ples. Information seeking and uncertainty may cause significant emotional distress in women Richard J. Fehring with endometriosis. Gail Schoen Lemaire 80 Giving Birth: The Voices of Orthodox 93 Maternal or Fetal Heart Rate? Jewish Women Living in Canada Avoiding Intrapartum Cultural competence is enhanced through an Misidentification understanding of the cultural and spiritual Most labor and delivery nurses assume that meaning of childbirth for Orthodox Jewish the heart rate being recorded on the electronic women. monitor tracing is that of the fetus, but that Sonia E. Semenic, Lynn Clark Callister, and Perle may not always be the case. Feldman Michelle L. Murray 105 VBAC: Safety for the Patient and the SPECIAL REPORTS Nurse 88 Resources for Evidence-Based Vaginal birth after cesarean delivery is an Practice, January/February 2004 evolving area of practice that demands contin- This column reviews resources available to ual nursing vigilance and advocacy for safe support the provision of evidence-based care care. for women and infants. Joan Drukker Dauphinee Carol Sakala 116 Malpractice and the Neonatal Intensive-Care Nurse CLINICAL ISSUES Case examples are used to highlight common Legal Issues in OGN Nursing areas of NICU nursing liability, and steps to avoid errors and maintain the standard of GUEST EDITOR care are discussed. M. Terese Verklan M. Terese Verklan, PhD, CCNS, RNC 124 Liability in the Care of the Elderly 92 Legal Issues Women are the most common victims of sub- A legal consultant and expert NICU nurse standard nursing practice in nursing homes. introduces a series of articles about liability Simple steps can increase safety in the envi- risks that may occur in common obstetric, ronment and the delivery of care. neonatal, and women's health practice scenar- Patricia Iyer ios. M. Terese Verklan 10 LETTERS 132 AUTHOR GUIDELINES JOGNN is the official journal of AWHONN. A peer-reviewed journal, JOGNN reflects practice, research, policies, opinions, and trends in the care of women, childbearing families, and newborns. JOGNN presents the clinical schol- arship that is the driving force behind nursing practice. EDITORIAL Revisiting Commitment and a profession, frame our understanding of our Part of beginning a new year is revisiting the com- profession. It can also be used to inform other col- mitments I have made in my life. The interesting leagues in the health care industry, consumers of our thing about human life in the modern developed care, policy makers, legislators, employers, insurers, world is that we have choices about most of our funding organizations, and others about the nature commitments and the opportunity to change them if of professional nursing (ANA, 2003). we choose. I have certain unalterable commitments, For me, one of the most important elements of and these represent the core of my personal life. My ANA’s statement is the definition of nursing. I have commitments to my faith, my husband, my children followed the evolution of the definition of nursing and their spouses, my grandchildren, and other fam- from its historical roots in the writings of Florence ily and friends are in that category. The majority of Nightingale and mid-20th century nurse scholars the rest of my life and activities are based on a com- through ANA’s three definitions in 1980, 1995, and mitment I made many years ago to become a profes- 2003. This new definition is the most comprehensive sional nurse. That commitment is the foundation of and resonates with my own understanding of the all the education, employment, and service that I breadth and depth of our profession: have undertaken since the tender age of 17. Nursing is the protection, promotion, and opti- Whether or not I understood that commitment mization of health and abilities, prevention of ill- when I began my journey in nursing is no longer crit- ness and injury, alleviation of suffering through ical. I have been grateful over the years, however, for the diagnosis and treatment of human response, different experiences that have helped me to review and advocacy in the care of individuals, families, and deepen my understanding of that commitment. communities, and populations. (ANA, 2003, p. 6) Recently, a short publication from the American Nurses Association (ANA), Nursing’s Social Policy I can grasp this definition and find my place as a Statement (2nd ed.) (2003), reminded me again of practitioner, researcher, and educator within it. This my commitment to nursing and all the opportuni- definition and the other parts of ANA’s document ties, joys, and challenges that I have experienced have given me the opportunity to again reflect on since 1967 when RN was affixed to my name. this profession and my personal commitment to it. I What is a social policy statement and why does am proud to be a nurse and a nurse-midwife and am nursing need one? For those of us in the United again amazed at the foresight I had at age 17 to States, ANA’s statement expresses nursing’s social make the commitment to this profession. I am hum- contract with the society we serve. It defines what bled to personally recommit to nursing’s social con- we do in the context of our relationship with socie- tract with the public and am grateful for the oppor- ty at large and our obligation to the recipients of our tunity to do so. care. We practice at the will of the public because society has legally granted us the authority to self- Nancy K. Lowe regulate our practice and ourselves with consider- Editor able autonomy. Whether we are beginning generalist nurses, specialized expert nurses, advanced practice REFERENCE nurses, nurse clinicians, nurse researchers, nurse educators, or nurse administrators, we function American Nurses Association. (2003). Nursing’s under the umbrella of this same professional com- social policy statement (2nd ed.). Washington, DC: mitment and global contract with the public. This Author. succinct document is useful to help us, as individuals January/February 2004 JOGNN 9 LETTERS Sjogren’s Syndrome in women. Sometimes health care providers focus only on the common causes and treatments of dry eyes, dry mouth, dry skin, and vaginal dryness, espe- I am so grateful that Schoofs (September/October cially in postmenopausal women. Because SS mimics 2003 JOGNN) brought up the topic of Sjogren’s the symptoms of estrogen deficiency, we owe it to syndrome (SS) in nursing. Believed to be the number our patients to explore the underlying cause of these one autoimmune disorder, SS affects approximately symptoms and refer our patients for appropriate 2 to 4 million Americans, mostly postmenopausal care. For those interested in learning more about SS, women (Carsons & Harris, 1998). Unfortunately, along with the resources in the article by Schoofs little is known about this syndrome. I would like to (2003), I also recommend an excellent book, The share my personal experience with SS. New Sjogren’s Syndrome Handbook, edited by Car- My 76-year-old mother had been complaining of sons and Harris. the signs and symptoms of SS for approximately 10 years. She went to many physicians with the com- Cyndi Roller, WHNP, CNM, PhD plaint of dry eyes, dry mouth, vaginal dryness, dry Kent State University itchy skin, joint pain, fatigue, and malaise, all of Kent, OH which are manifestations of SS (Carsons & Harris, 1998). At first, various care providers recommended many different treatments for the symptoms. My REFERENCES mother was told that her symptoms were age-related Carsons, S., & Harris, E. K. (Eds.). (1998). The new Sjo- and due to decreased estrogen levels. Even after gren’s syndrome handbook. Oxford, UK: Oxford treatment with plugs in her tear ducts, eye drops, University Press. vaginal estrogen, and many dry skin lotions, she still Schoofs, N. (2003). Caring for women living with Sjo- was not feeling well. So she went back to her pri- gren’s syndrome. Journal of Obstetric, Gynecologic, mary physician, who labeled her a “hypochondri- and Neonatal Nursing, 32, 589-593. ac.” His response to my mother’s repeated concern was, “I don’t know what’s wrong with you. What do Preconception Care you think I am, G-d?” One day while reading a national tabloid maga- zine, my mother came across an article on SS.