Nursing Research-Analysis & Interpretation Phase

This article discusses a randomized control trial conducted to determine the effects of home visitation services on pregnancy childhood injuries and repeated childbearing in a community. It also talks about the effectiveness of internet-based interventions for new mothers moderated by nurses.

Running head: ARTICLE ANALYSIS
Nursing Research-Analysis & Interpretation Phase
Name of the Student
Name of the University
Author Note

1ARTICLE ANALYSIS
Internet based nursing intervention
Part 1
A randomized control trial was conducted in order to determine the effects of infancy and
prenatal home visitation services on the outcomes related to pregnancy childhood injuries and
repeated childbearing in a community. The study was based on findings that home visitation
services have proved effective in bringing about an improvement in child and maternal outcomes
in different populations (Olds et al., 2014). The randomized control trial was conducted in the
public system that focused on obstetric care in Memphis. An average of seven visits was made
during pregnancy, followed by 26 visits from birth of the child to the second birthday. The
intervention primarily composed of adherence to a detailed visit-by-visit protocol that guided the
women in enhancing their health related behavior, steps of taking care of their children and life
goals development such as, educational achievement, pregnancy planning, and workforce
participation (Kitzman et al., 1997).
The intervention also made the nurses provide assistance to the women to complete a day
long diet history on regular basis, followed by plotting the gain of weight on every visit.
Smoking cigarettes and use of alcohol or other illegal drugs were also measured by the nurses,
followed by a behavioral analysis, which made the women reduced their adherence to substance
abuse. The home visit programs also helped in teaching the women the early signs and
symptoms, which should be identified in relation to pregnancy complications, and also
encouraged them to take necessary steps for informing office staff about the prevailing
conditions, thus facilitating their treatment. Following delivery of the child during home visits,
the nursing professional also supported the caregivers and mothers to improve the emotional and

2ARTICLE ANALYSIS
physical care of the children, followed by teaching the parents the strategies that should be
adopted to recognise signs of illness and other disease among the children, recording of
temperatures and communicating with office staff about the presenting complaints. Home visits
also focused on promotion of child-parent interaction with the use of communication signals,
enhancement of interest in children's play and promoting the cognitive and emotional
development. The intervention also placed due focus on helping women gain a sound
understanding of the objectives and goals, which in turn helped in solving the problems that they
had encountered while finding work, planning for education, or family planning. Hence, it can be
said that the development and implementation of the program plan that focused on home visits
were discussed in details by the researchers (Kitzman et al., 1997).
While the researchers did not elaborate on presence of one treatment and one control
group, they explained in details the four treatment groups to which the women were randomized.
Treatment 1 comprised of 166 women who were given free round-trip cab transportation for the
prenatal appointments. However, they did not get any postpartum assessment of services.
Treatment 2 comprised of 515 women who were given free transportation for prenatal and
developmental screening, besides referral services for children during 6, 12 and 24 months. 231
women present in treatment 3 also received the free screening and transportation services like
treatment 2, in addition to intensive nurse home visitation programs during pregnancy,
postpartum visits in the hospital prior to discharge, and at their homes. 228 women were placed
in treatment 4 who received same services as that of treatment 3. However, the nurses continued
to visit them in their houses till the second birthday of the child. Thus, it can be stated that the
authors took all possible efforts in order to determine the effectiveness of the home visitation

3ARTICLE ANALYSIS
program by randomizing the target population into four different groups, each being subjected to
a different scenario (Kitzman et al., 1997).
Owing to the fact that the researchers identified and assessed all the dependent variables
including substance abuse, cigarette smoking, urinary tract infection, yeast infection, previous
abortion, child abuse, mastery, mental health, and maternal psychological state, it can be
suggested that they took efforts in monitoring the safety of the women who were given home
visitation services. All the dependent variables that might have played an important role in the
effects of intervention were taken into account (Kitzman et al., 1997).
The study might have been improved by conducting an assessment of the extent to which
postnatal effects were largely dependent on the prenatal initiation of home visitation services.
Conducting a careful examination of the same would further help in elaborating on the
immediate impacts of home based visitation on the maternal and child outcomes. Furthermore,
conducting a randomized control trial with an intervention group and the control group would
also have helped in providing more clarity regarding the results (Tappen, 2015). Subjecting the
intervention group to home based visitation programs from pregnancy state till a year after
childbirth, and the control group to usual doctor appointments and care services might have
elaborated more on the mechanism by which the home visits help in enhancing the quality of
life of both women and their children.
Part 2
Internet based interventions that are conducted by nurses working in the community have
been found to have the potential to provide assistance and supports to mothers who seek help
from the internet on different aspects of child care. The randomized control trial was based on

4ARTICLE ANALYSIS
findings that elaborated on the effectiveness of internet based interventions and tried to assess the
non-inferiority of outcome for infants and mothers, who were subjected to a postnatal health
check that was moderated by nurses and conducted in a clinic (Aardoom et al., 2016). The
researchers compared this internet based support group at a time when the infants were 1-7
months of age, with a control group, where the infants had received usual care services that
comprised of postnatal home support delivered by community nurse. The recruitment of the
participants was entirely based on the use of internet. Most participants for new mothers who had
been referred by the burning hospitals present in CaFHS community located in Adelaide, South
Australia for the postnatal health checkup. The new mothers with telephoned from March still
December 2013 by the administrative officers, in order to arrange for their health checkup,
following which their verbal consent was obtained for consultation with the research team. The
research team members telephoned all the mothers in order to obtain their informed consent,
after providing them elaborate details on the objective and probable benefits of the study. This
was followed by arranging visit to the mothers in their homes at different locations by research
assistant, which was concomitant with the delivery of an in-depth description, prior to obtaining
consent and conducting pre-intervention assessment.
This was followed by informing the women about the primary goal of their study to
ascertain whether new internet+clinic based support programs were helpful to infants and their
mothers. Mothers who expressed a strong desire for this program or usual home based support
were allocated to the intervention group. Nonetheless, mothers who did not have any strong
preference were randomly allocated to the two groups, which followed serial assignment based
on service identification number (even vs. odd). 819 women of the total 1827 mothers who were
contacted agreed to participate in the study. The researchers also excluded women from the study

5ARTICLE ANALYSIS
if they did not have any access to internet, needed an interpreter or suffered from different
problems such as, domestic violence, ill health of the infants, or substance abuse (Sawyer et al.,
2017).
The major challenges faced by the researchers were that all mothers who participated in
the study belonged to socially advantage group. Hence, it was not possible for them to recruit
women belonging to different social economic background in their study, in order to determine
the effectiveness of internet based interventions. The authors also failed to analyze the cost
effectiveness of internet based interventions in the study. Hence, future research is needed in
order to overcome these challenges. However, some of the potential benefits that the internet
based intervention offered to the authors were related to improving and maintaining the reach of
the population, thereby ensuring quality control of all the information that was provided, and
facilitating access to all kinds of referral services, during the first year of the infant. Other
potential benefits that were elucidated by the researchers were related to the fact that the internet
provided them the opportunity to track the engagement level of the mothers to the support
program. Use of different feedback and online quizzes helped in assessing their knowledge
acquisition. However, the researchers also stated that the necessity of replacing fixed review with
other approaches that are more sensitive towards the development and modifications of children
posed great challenges for research (Sawyer et al., 2017).
Future research must take into account persuasive designs that will improve retention of
the mothers by incorporating larger control and sample group, with the aim of conclusively
determining feasibility of internet based interventions. Additionally, in order to appropriately
comment on effectiveness of such intervention, future studies should report the incidence data of
different health related complications, with the use of standardized interview (Tappen, 2015).

6ARTICLE ANALYSIS
Efforts must also be taken by public health policies in order to promote research for reducing
associated healthcare costs in the long run. Healthcare providers should also try to implement
effective and existing interventions into routine care practices, in order to enhance the health and
well-being of the target population.
Population estimates
European
American
20%
African Amercian
30%
Native American
20%
Hispanic
American
30%
Percentage
Figure 1- Pie chart showing population estimates

7ARTICLE ANALYSIS
References
Aardoom, J. J., Dingemans, A. E., van Ginkel, J. R., Spinhoven, P., Van Furth, E. F., & Van den
Akker‐van Marle, M. E. (2016). Cost‐utility of an internet‐based intervention with or
without therapist support in comparison with a waiting list for individuals with eating
disorder symptoms: a randomized controlled trial. International Journal of Eating
Disorders, 49(12), 1068-1076.
Kitzman, H., Olds, D. L., Henderson, C. R., Hanks, C., Cole, R., Tatelbaum, R., ... & Engelhardt,
K. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy
outcomes, childhood injuries, and repeated childbearing: a randomized controlled
trial. Jama, 278(8), 644-652.
Olds, D. L., Kitzman, H., Knudtson, M. D., Anson, E., Smith, J. A., & Cole, R. (2014). Effect of
home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up
of a randomized clinical trial. JAMA pediatrics, 168(9), 800-806.
Sawyer, M. G., Reece, C. E., Bowering, K., Jeffs, D., Sawyer, A. C., Mittinty, M., & Lynch, J.
W. (2017). Nurse-Moderated Internet-Based Support for New Mothers: Non-Inferiority,
Randomized Controlled Trial. Journal of medical Internet research, 19(7).
Tappen, R. M. (2015). Advanced nursing research. Jones & Bartlett Publishers.