Background: Access to consultation or referral for decisions about advance care planning (ACP) is limited, particularly for nonmalignant models pertinent to palliative care in heart failure (HF).Objectives: The aim of this study was to solicit professional opinions about the feasibility of using an exemplary context-oriented communication algorithm for ACP discussions.Methods: Using a panel of expert physicians and nurses in cardiovascular care, a 3-round Delphi study was conducted to evaluate the proposed model.Results: A consensus was determined based on a content validity ratio (CVR) of 0.318 or greater, a critical value for selection of an item scored as important (≥4 on a 5-point Likert scale). A total of 50, 44, and 38 experts in Korea completed each round, respectively. Item evaluation did not differ across rounds (Friedman χ²>P= .05), except for timing of the ACP discussion. A lack of consensus was observed on the issue of after HF diagnosis for right timing of the ACP discussion across rounds (CVRs from −0.80 to −0.83); consensus was reached on the expectation of a terminal state (CVRs from 0.60 to 0.78). Content validity ratios were moderately high for Korean advance directive, ranging from 0.59 to 0.91. Experts also reached consensus about each of 5 steps of a communication model—patients’ determination of decisional capacity (CVR, 0.72–1.0), awareness (CVR, 0.95–1.0), willingness for advance care planning (CVR, 0.76–0.84), family dynamics (CVR, 0.92–1.0) and patient readiness for advance care planning (CVR, 0.76–0.95).Conclusions: A context-oriented communication model could be used to facilitate the decision-making process for palliative care and continuity of care in HF.

Ahn S, et al. Korean J Women Health Nurs. 2012 Dec;18(4):237-247. http://dx.doi.org/10.4069/kjwhn.2012.18.4.237

Purpose: This study aimed to examine the effect of a newborn care education program using ubiquitous learning (UL-NCEP) on exclusive breastfeeding and maternal role confidence of first-time mothers.Methods: This quasi-experimental study with a nonequivalent control group design was conducted at a university hospital in Hue city, Vietnam between June and July 2018. Eligible first-time mothers were conveniently allocated to the experimental (n=27) and the control group (n=25). Mothers in the control group received only routine care, whereas mothers in the experimental group received UL-NCEP through tablet personal computers in addition to routine care in the hospital. Then, the educational content was provided to mothers by their smartphone for reviewing at home. UL-NCEP was developed based on the World Health Organization’s “Essential Newborn Care Course” guidelines. The exclusive breastfeeding rate and maternal role confidence level after birth and at 4 weeks postpartum were assessed in both groups to assess the effect of UL-NCEP.Results: At 4 weeks postpartum, the experimental group showed a significantly higher level than the control, for exclusive breastfeeding rate (p<.05) as well as mean maternal role confidence (p<.05).Conclusion: UL-NCEP was a feasible and effective intervention in increasing first-time Vietnamese mothers’ exclusive breastfeeding rate and maternal role confidence level. This program may be integrated into routine care for postpartum mothers to promote mother and infant health among first-time mothers in Vietnam.

Along with the low birth rate in Korea, the aging of mothers is progressing very rapidly. Recent studies have reported that the obstetric infrastructure is crumbling due to the accelerating closures of obstetric medical institutions resulting from the low birth rate and low reimbursement rates for obstetric procedures. The number of birth centers has also decreased, but women’s interest in natural birth has actually increased, such that deliveries at birth centers now account for 11.8% of deliveries in obstetric clinics. In the Netherlands, Japan, and the United Kingdom, initiatives to promote natural birth through care provided by midwives increased the rate of natural births, decreased the number of cesarean sections, and lowered the rate of postpartum complications. In light of these examples, South Korea should also encourage natural delivery by midwives. A national support system for midwife applicants is necessary, and the requirements for institutions that train midwives should be revised. Independent birth centers should have emergency prescription privileges, and women should be given the choice to have a natural delivery by creating birth centers within hospitals.