Objective-This study aimed to identify and compare differences in temperament and maternal stress between infants with complex congenital heart disease (CHD) and healthy controls at 3 months of age.Methods-Study sample was drawn from an existing longitudinal study examining growth in infants with CHD as compared to healthy controls. Infant temperament and parental stress were measured in 129 mother-infant dyads. Inclusion criteria for infants with CHD were ≥ 36 weeks postmenstrual age, ≥ 2500 grams at birth, surgery in first 6 weeks of life, and no major congenital anomalies or genetic syndromes. The Early Infancy Temperament Questionnaire and Parent Stress Index were the assessment tools used.Results-Infants with single ventricle (SV) physiology were more negative in mood (F=7.14, p<0.001) and less distractible (F=5.00, p<0.008) than the biventricular physiology (BV) or control (C) infant groups. The demands of care for infants with CHD was a source of stress as compared to control infants (p<.05). Five of six subscales of the Child Domain were significant sources of stress in the SV group compared to BV and Control groups. Negative mood and difficulty to soothe were predictors for Child Domain and Total Life Stress in SV infants. Conclusion-The demands of parenting an irritable infant with SV physiology puts these mothers at risk for high levels of stress. Results suggest the need for pre-discharge anticipatory guidance for parents to better understand and respond to the behavioral style of their infants, in particular, infants with SV physiology. Key Termsinfant temperament; parent stress; complex congenital heart disease; burden of care OBJECTIVEApproximately 32,000 babies are born with congenital heart disease (CHD) each year in the United States (1). Of those, 2.3 of every 1000 live births will require some form of intervention before the age of one or the infant will die (2). With advances in medical and surgical management increasing infant survival, CHD is becoming the most common chronic illness of childhood (3). Infants with complex CHD are often classified as having either having single Infants with complex heart disease, particularly infants with SV physiology, are often described by caregivers as difficult to soothe, irritable, and more negative in mood. Irritable infants have been linked to maternal feelings of inadequacy, fatigue and resentment (4), and are described as more challenging to parent (5). The stress experienced by parents, mothers in particular, is well recognized (6,7). The burden of care that manifests in the early stages of initial diagnosis and treatment, medical and surgical intervention(s), prolonged and/or multiple hospitalizations, various diagnostic procedures, numerous medications, and the emotional rollercoaster experienced by parents all contribute to the degree of parent stress (3).To address the paucity of data on the relationship between infant temperament and parental stress in mothers of infants with complex CHD this study addressed the following questions: 1...

In health care, as in society, racism operates on multiple levels and contributes greatly to health and social inequities experienced by black Americans. In addressing racism, however, health care has primarily focused on interpersonal racism rather than institutionalized forms of racism that are deeply entrenched and contribute to racial inequities in health. In order to meaningfully address health inequities, health care must extend its focus beyond the interpersonal level. The purpose of this integrative literature review is to identify how and to what extent peer-reviewed nursing literature and professional nursing organizations have explicitly addressed institutionalized racism. A systematic search of relevant nursing literature published since 2008 yielded 29 journal articles that focused on black Americans' experience of institutionalized racism in health and health care; the articles explicitly named racism as institutionalized, institutional, systemic, systematic, or structural. This review summarizes author-identified implications of institutionalized racism for nursing education, research, and practice, and offers suggestions for use by the nursing profession to dismantle racist policies, practices, and structures.

The rapidly changing demographics of the United States require nurses who are equipped with knowledge and skills to meet the needs of an increasingly diverse patient population. Nurse educators seek to meet this challenge through integrating cultural competence into nursing course curricula. Few studies have examined student perceptions of the integration of this material. As part of a larger school wide assessment, this qualitative descriptive study utilized focus groups of PhD and BSN students to evaluate their perceptions of the integration of cultural competence in the nursing curriculum. We sought to answer two questions: 1.) what the students' perceptions were and 2.) what recommendations they had for improvement. The results of the focus groups yielded three themes: 1.) Broadening definitions, 2.) Integrating cultural competence, and 3.) Missed opportunities. Student suggestions and recommendations for enhancing cultural competence in the curricula are provided.

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