Her alma mater has long understood that professor emerita and alumna Karen Pridham, PhD, RN FAAN, possessed the “it factor” in research and teaching—the UW–Madison School of Nursing’s alumni organization awarded her its most distinguished honor of achievement fifteen years ago. This spring, the Midwest Nursing Research Society (MNRS) followed suit by recognizing Pridham for a lifetime of distinguished achievements—fifty-plus years of dedication to teaching and research excellence in the care of infants and families.
Simply put, Pridham’s contributions have shaped the world of maternal-infant health care.
From her early years as a UW researcher, Pridham used a participatory-based learning approach as the cornerstone for studying the feeding of high-risk infants. “If you want to learn to be a tailor, begin tailoring,” says Pridham. “A baby born with low birth-weight or diagnosed with congenital heart disease just doesn’t start to suck and swallow and breathe automatically. Healthy babies need practice. For a high-risk infant, practice and support to develop feeding skills is even more crucial.”
Pridham developed a theory-based nursing tool called guided participation to help mothers and families in caring for their infants in the first year of life who are born prematurely or with a chronic condition. Pridham studied in detail the mother’s feeding practices and the baby’s responses as well as the mother’s understanding, fears, expectations, and intentions of the feeding. The mother’s awareness of these details and her readiness to adapt her “internal working model of caregiving” to the baby’s needs made the feeding a “meaningful activity kind of learning,” Pridham says.
“Guided participation helps the mother observe, sensitively and with interest, what the baby is telling her through his or her behavior,” says Pridham. “She and the baby can then have a ‘conversation’ that’s very worthwhile to the baby, and she can observe what the baby gains from it. Reflecting on what is happening and why ultimately determines the quality of caregiving and nutritional health support in the baby’s first year.”
Pridham’s focus on maternal-infant care began as a nurse in public health after graduating from UW-Madison in 1957. “I knew I was in over my head,” she says, when recognizing the kinds of caregiving issues for a child with chronic illness.
Pridham circled back to Madison to enroll in the School of Nursing’s MS program. There, she learned from nursing pioneer Florence Blake. “Her focus was the child, parent, and nurse and the kind of relationship that supported healthy development of the child,” Pridham says. “It expanded my understanding of the kind of work that needed to be done.”
Later, Dean Helen Bunge helped Pridham tailor a PhD curriculum through the School of Education; at the time, a PhD in nursing did not exist. Post-PhD, Pridham traveled the state to implement the Nurse-Physician Team Program, a continuing education offering that supported development of the nurse practitioner (NP) and equipped nurses working in primary care settings.
“I learned early on that feeding a baby was a major issue that physicians often didn’t have time for,” says Pridham. “In my mind, it was perfect for nursing: process orientation, caregiving, development to advance growth, good nutrition, and the relationship of parents and baby.”
These experiences kept driving Pridham’s research interest in feeding of high-risk infants. She joined the School of Nursing faculty in 1966. In 1973, through the Department of Family Medicine in Madison, Pridham had the opportunity to research feedings of families in southern Wisconsin who had recently brought their infants home.
She and a master’s student traveled southern Wisconsin roads with a video camera, interviewing mothers and trying to identify the sticking points of infant feedings. “The challenges varied from mom to mom, Pridham says. “‘Do I try to keep the baby awake during feedings? Do I breastfeed or bottle feed? Is the baby getting enough milk and nutrition? The baby is cranky and won’t feed; I’m so tired.’
“We showed the video to the mom, asking her why she took the direction she did, what she wanted to happen, and why the feeding looked like it did. Both clinician and mom learned from these exchanges,” says Pridham.
Later, Pridham conducted descriptive studies of mothers’ feeding of babies who were born very prematurely and babies with complex congenital heart disease. Each case served to inform guided participation—an approach to feeding the baby in the most useful way.
Pridham recalls seeing the rewards of her research.
She was working with a group of public health nurses in Milwaukee who were assisting moms and families in adaptive feeding of very prematurely born babies. Pridham explained her guided participation approach. One skeptical nurse responded that she was going to “wait and see” how this program developed.
This nurse was linked with a nineteen-year-old mom who had a second baby, born very prematurely, and lived in her parents’ home. Her bedroom contained all of her possessions, including a TV. The mom would sit on the edge of the bed and watch TV while bottle-feeding the baby, who was still on oxygen.
“Initially, the mother made beautiful eye contact, so the baby was feeding nicely, engaged, and breathing quite well,” recalls Pridham. “But, at one point, the mom looked away to watch TV and the baby’s eyes drifted away from the mom’s face; she wasn’t able to reposition or engage her. The mom corrected it, but it happened again.
“When we showed the young mom the video and asked what seemed to be happening, and what does she think she could have done,” says Pridham, “she commented, ‘I want to watch soaps, and the baby is hungry, so I’ll get someone else to feed the baby.’
“After numerous home visits over a year’s time, we made the final visit, Pridham says. “We saw the young mother’s little girl feeding a doll baby with a bottle and being very gentle about it—undoubtedly, having learned this from her mother. When asked what she got out of the program, the young mother replied, ‘I learned that I needed to pay attention to my baby.’”
The once-skeptical nurse later told Pridham that she believed Pridham had changed public health nursing in Milwaukee. “That experience sums up what I think GP is about,” says Pridham. “It’s a relationship-based process—the parent and child, the nurse and parent. Each is learning different things.”
This spring’s MNRS award honored Pridham’s prolific career, which produced more than seventy scholarly articles and garnered years of extramural federal funding, including, for twelve years, a pediatric nursing training grant, initially awarded to Florence Blake and lasting thirty years into the mid-nineties. It supported countless graduate students’ education. “I’m reaping the benefits of those graduates in numerous ways,” Pridham says. “They’re now national leaders whose influence ripples internationally in the nursing of infants, children, and adolescents.
“Wisconsin has always been a national leader in education of nurses with a focus on children and their families,” adds Pridham. “I’d love to see that tradition continue.”
–Kathleen Corbett Freimuth