The student is encouraged to consult the APA Publication Manual Crib Sheet link for the appropriate presentation style.   Do not use this sample as a model of style for your presentation.   The sample on these pages is an exemplar research application paper in terms of meeting the goals of the assignment for your classes.

Running head: PERCEPTIONS OF BED REST
 
 

During a high-risk pregnancy, bed rest is a common intervention used to prolong the pregnancy. Although bed rest reduces the physiological stress of a high-risk pregnancy, it can cause other stresses which interfere with compliance. One of the clients this nursing student cared for during her family reproductive health clinical experience had been on bed rest for two weeks. In order to facilitate and promote her compliance with the needed bed rest, the student applied the nursing interventions suggested by the authors of a research study that investigated the perceptions of women who were on bed rest because of a high risk pregnancy. The student's primary rationale for selecting this research study as a resource in planning client care was that the nursing implications were based on pregnant women's perceptions of the stresses associated with bed rest. The student reasoned that interventions based on clients' perceptions of the problem would be effective in promoting compliance.

The student identifies the client care problem and the specific rationale for applying the interventions based on the results of this research study. She uses APA style by writing the paper in third person.

The setting for the White, Collins, and Long (1997) study included an antepartum high risk unit in a Level III hospital in midwestern Canada and a home health care agency caring for high risk mothers. The student applied the suggested nursing interventions on an antepartum care unit at a Level III hospital in a midwestern metropolitan area in the United States. Therefore, the two settings were very similar.

The student very succinctly compares the two settings.

The sample subjects in the selected research study included 24 married white women aged 26 - 36 with educational levels ranging from high school diplomas to graduate degrees. The subjects were experiencing high-risk pregnancies with 20% experiencing pregnancy-induced hypertension and 51% experiencing preterm labor. Sixty percent of the subjects were multiple gravida and 11% of those subjects had been on activity restrictions during their previous pregnancies. Criteria for subject selection included bed rest for at least one week and a minimum gestation age of 26 weeks. The average length of bed rest was 20 days and the average gestational age was 32.5 weeks. All but two of the subjects were on modified bed rest and were allowed bathroom privileges or short periods of standing. None of the subjects were taking tocolytic drugs.

The student's client was a 38-year-old married white woman with a graduate degree. She was a gravida four, para 012. She had a molar pregnancy with a dilatation and curettage in 1995; severe preeclampsia in 1996 resulting in a 28 week preterm baby born by a classic C-section; and miscarried twins in 1996. None of the previous pregnancies had included activity restrictions. During the 34^th week of her fourth pregnancy, she was admitted to the hospital with preeclampsia and placed on bed rest with bathroom privileges. The client had been on bed rest for two weeks when cared for by the student. The client was not taking tocolytic drugs. It was anticipated that if the ultrasound at the end of the third week of bed rest indicated the fetus's lungs were mature, the baby would be delivered by C-section at 37 weeks. This client was very similar to the subjects in the selected research study.

The student describes the demographic characteristics, pregnancy history / high-risk status, and selection criteria for the study subjects. Then in a parallel way, she describes her client's demographic characteristics, pregnancy history and present high-risk status. It is very clear to the reader that the study's subjects and student's client are similar.

Based on the results of their research study, the investigators suggested several nursing interventions to decrease the situational, environmental, and family stresses associated with bed rest during a high-risk pregnancy. Situational stress includes the perception of loss of control when an individual is placed in the "sick role". The investigators recommend that nurses decrease this perception by allowing the client to participate in her own self care and to wear her own street clothes instead of gowns. Environmental stress includes the perception of boredom from not actively participating in one's normal routine. The investigators recommend that nurses assess the client's interests and provide learning materials, videos, and selected exercises to decrease boredom. Finally, family stress includes role reversal and not being able to spend time with one's children and spouse. The investigators recommend that the stress of a wife / mom being hospitalized can be decreased by encouraging frequent family visits and including family members in the client's care. 

The investigators provided sufficient information for the student to apply their recommended nursing interventions. The student's client had already addressed some of the situational stress related to the "sick role" by wearing her own street clothes. The student further facilitated the client to decrease the situational stress of "loss of control" by teaching her to assist in monitoring the fetus's status. The client was encouraged to read the fetal monitor strips with the student and record each time the baby kicked. The client was managing part of her environmental stress by arranging with her employer to complete some of her paperwork at the hospital. She did state that that the most difficult part of the bed rest for her was "not going anywhere and not doing something to stimulate my mind." Therefore, the student suggested that she read a fictional action book or travelogue that would engage her mind and simulate "going somewhere". The client experienced minimal family stress because her mother, daughter, and husband visited very frequently and she knew her daughter was well cared for by her husband and mother. Therefore, either through self initiated actions or student suggested activities, the client was able to decrease the situational, environmental, and family stresses associated with bed rest and to comply with the protocol. The client's compliance was greatly influenced by her positive attitude and self-directed initiatives. The study subjects were initially much more anxious and compliance with bed rest more of a challenge for nurses than was the case with the student's client.

The student is very specific in her responses to each question regarding how she applied the nursing interventions based on the results of the identified study. She provides sufficient information from the study so that the reader could link the results of the study with the recommended interventions.

As previously noted, the student selected this study's suggested interventions to apply because they were based on the high risk pregnant women's perceptions of the stresses related to bed rest. Because the study setting and sample were very similar to the student's setting and client, implementing the interventions was appropriate. However, the small, homogeneous sample decreases the reliability and validity of these subjects' perceptions being generalized to a larger population. Therefore, the student does not recommend that the specific interventions suggested by the investigators be implemented in all antepartum care units with all high-risk clients. However, the student does recommend that nurses caring for high risk clients on bed rest assess the situational, environmental, and family related stresses that might be interfering with bed rest compliance and individualize the plan of care based on each client's perceptions. Moreover, the student recommends that the study be replicated with a larger, diverse random sample so that some generalizable approaches to facilitating bed rest can be documented. In addition, the student recommends that further research be done to describe the perceptions of bed rest of high-risk pregnant women maintained in the home setting versus those maintained in the hospital setting. Although the identified study did include subjects maintained on bed rest at home, the investigators did not compare the perceptions of those at home with those in the hospital. Although home care may be more cost effective, it is important to document how women perceive bed rest maintained in the home setting and how those perceptions impact compliance with the protocol.

The student demonstrates a good understanding of how to determine what study implications are appropriate to apply. Her suggested research is specific and extends the knowledge gained from the identified study. 
 

White, L., Collins, V., & Long, M. (1997). High risk pregnant women's 

perceptions of bed rest. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 24(3), 

234 - 240. 

NRS 317/318 Research Application Homepage