Supporting resilience in foster families: A model for program design that supports recruitment, retention, and satisfaction of foster families who care for infants with prenatal substance exposure

As the health, social, and developmental needs of infants in foster care become more complex, foster families are challenged to develop specialized knowledge to effectively address these needs. The goal of this qualitative research study was to identify the process of becoming a foster family and providing family foster caregiving within the context of caring for infants with prenatal drug and alcohol exposure. A constructivist grounded theory approach was used to study foster families (including mothers, fathers, and birth and adoptive children) who specialized in caring for infants within a Canadian provincial child welfare system. This article describes an infant foster care model, applies resilience theory to the model, and provides recommendations for program development for foster families that specialize in the infant population.

DEVELOPMENTAL EVALUATION OF THE SAFE BABIES PROJECT: APPLICATION OF THE COECA MODEL

The Safe Babies project was developed and implemented in Victoria, British Columbia in response to an increased awareness of the unique needs of infants exposed prenatally to drugs and alcohol and the education and support needs of the foster parents who frequently care for them. This article describes development of the project from within the context of health and child welfare systems and the political environment of the time. A formative evaluation process was designed and organized within the COECA (Charting the Outcomes of Education and Clinical Approaches) model. This model provided a useful method of not only organizing evaluative efforts, but also targeting efforts that might contribute to maintaining the sustainability and profile of the pilot project.

(Ad)ministering love: providing family foster care to infants with prenatal substance exposure

A significant percentage of children in foster care in North America are younger than 1 year of age and are in foster care because of parental substance use and other social challenges. Infants might present with specific health and behavioral issues that are challenging to manage within the foster family home environment; foster families require specialized skills and knowledge to manage these issues. In this article, the author describes a constructivist grounded theory of the process of becoming and providing family foster caregiving in the context of caring for infants with prenatal alcohol and/or drug exposure. The basic social process of (ad)ministering love was identified. The author further describes the three phases of this process and the core concepts within each phase.

Is meconium screening appropriate for universal use? Science and ethics say no

Researchers have been actively looking to biomarker development as a way to improve diagnosis in conditions such as fetal alcohol syndrome (FAS) that have typically been difficult to identify at an early stage. Meconium testing is considered a potentially useful newborn screening method. Screening for alcohol (and other drug) use is unique from all other types of newborn screening in that there is a greater element of social risk for parents, particularly mothers (public exposure of substance use with potential for child welfare involvement). There are many factors related to the science and ethics of the meconium screening process to consider before implementing universal or targeted screening. As care providers who participate in the screening and counseling process and as advocates for infants and their families, neonatal nurses should be active participants in discussions surrounding the ethical and clinical appropriateness of meconium screening program development and expansion. The science behind meconium screening at present is not strong enough to warrant widespread implementation of screening; neonatal nurses are cautioned to approach screening carefully because of the critical social implications for mother and baby.

Looking at families in nursing research: strategies for study design

Pediatric nurses have identified the importance of studying children within the context of their families. There have been calls for attention to the family as the focus of study and unit of analysis in nursing research. One of the most important strategies for designing a study that keeps the focus on the family is the maintenance of study integrity. All the strategic choices made by the researcher when developing the research design need to reflect the theoretical premises on which the study is built. Throughout the study design, components of well-constructed family research will demonstrate consistency with the overall conceptual framework.

Neonatal abstinence syndrome: reconstructing the evidence

Neonatal abstinence syndrome (NAS) is the term used to describe the presence of withdrawal symptoms in neonates exposed prenatally to opiates. Much of what is known about NAS is based on the biomedical model of illness. There is less consideration of the social, historical, and political influences on knowledge development about the NAS phenomenon. Social construction presents an alternate framework within which to consider the diagnosis of NAS and on which to strengthen theoretical foundations, expand research programs, and improve practice.

The ethics of relation: public health nurses and child protection clients

AIM

The aim of this paper is to show how a framework of relational ethics may be used in establishing trusting relationships with at-risk families.

BACKGROUND

Public health nurses have historically carried out assessment and monitoring of parenting within the family home, particularly with at-risk families. In this role, they are placed in the position of simultaneously supporting and policing the family. A trusting relationship may be difficult to develop if parents feel threatened by the surveillance aspect of home visiting and the threat of action (such as removal of children) being taken against the family.

DISCUSSION

Development of optimal trust relationships may be a challenge when families are experiencing powerlessness and oppression. The four themes of relational ethics--mutual respect, engaged interaction, embodiment and creating environment--provide a framework for developing trusting relationships with families.

CONCLUSION

It is possible to have a moral and trusting relationship with at-risk families, but this needs to based on critical self-reflection by nurses and mutually respectful nurse-family relations.

The Grounded Theory Method and Maternal-Infant Research and Practice

Perinatal nurses have found qualitative methods helpful in capturing the social, cultural, and relational aspects of their work with women and their families. This article describes the components of the grounded theory method and illustrates each with examples from recent maternal-infant studies. Grounded theory is an inductive method of qualitative analysis that generates theory from data. The grounded theory method includes several key strategies such as theoretical sensitivity, theoretical sampling, constant comparison, increasingly abstract consideration of the data, and discovery of a core variable or basic social process that describes the pattern of the phenomenon under study. This method may strengthen qualitative nursing studies because of its generalizability and applicability across settings. By remaining grounded in and connected to the data, grounded theory can be adapted to many contexts, making it useful to the practicing nurse. Knowledge generated from grounded theory has great potential to assist us in our inquiry into the needs of mothers, fathers, infants, and their families.

Tiny cripples and the sunshine of life: 15 years of children's nursing at Vancouver Island's Queen Alexandra Solarium 1927-1942

The establishment of children's hospitals became one of the most important legacies of the child-saving movement in the early 20th century. As children's hospitals became more focused on acute and curable illnesses, facilities were developed to provide care and support for "crippled" or "incurable" children. The Queen Alexandra Solarium provided long-term care for crippled children in Western Canada and was developed to augment the acute care services of the British Columbia Children's Hospital. The staff of the solarium provided "healing by nature's method"-rest, fresh air and sunshine, nutritious food, and gentle nursing care-in the calming beachside location of Saanich Inlet on Vancouver Island. Examination of available hospital documentation from the years 1927 through 1942 shows that nurses played a key, yet silent role, in the extended care of chronically ill children.

Foster families who care for infants with prenatal drug exposure: support during the transition from NICU to home

Infants exposed prenatally to drugs and alcohol tend to enter the child welfare system at a younger age than many other foster children and often directly from the hospital following birth. This article examines three concepts from the postpartum family adaptation literature: transition to parenthood, maternal and paternal role identities, and attachment. It applies these concepts to the experiences of foster parents who care for infants with prenatal drug and alcohol exposure. Also reviewed are recommended strategies to promote development of the foster parent-infant relationship and to increase parental knowledge within the NICU setting and during the period of transition from hospital to home. Nurses within the NICU have a unique knowledge and experience of caring for infants in withdrawal. This knowledge needs to be shared beyond the hospital with community professionals, who may have limited training in infant health, mental health, or development.

Feminist ethics must inform practice: interventions with perinatal substance users

Substance use during pregnancy is a major health and social issue in countries around the world. Even though many health professional associations recommend a voluntary health promotion approach to treatment, some professionals and legislators have pursued mandatory treatment, or protective intervention. A feminist ethic perspective of treatment invites us to consider a broader notion of autonomy, which includes the contexts in which women live, the difficulty they often have in accessing treatment services, and their endurance of systematic oppression related to ethnicity, socioeconomics, and politics. A punitive approach to treatment is not associated with improved outcomes for the fetus; in fact, the fetus may be at greater risk as women are fearful of accessing health services. Treatment is best pursued on a common ground basis within an embodied model of maternal-fetal relationship that will help support women and at the same time help ensure fetal health.

Are we missing anything? Pursuing research on attrition

Attrition, or loss of participants over the course of a study, presents a significant threat to the integrity of a longitudinal research study and theory development resulting from the study. Although there has been a recent resurgence of interest in attrition, it is an underreported and understudied phenomenon despite its potential to introduce bias. Internal and external validity, reliability, and statistical validity are all impacted by a small sample and, most likely, a non-randomness in the study sample. Development of a theory of attrition will assist researchers in development of sampling strategies that will enhance the quality of their data in longitudinal designs. An ecological theoretical model of research participation is proposed and described.

Determination of positional skin-surface pressures in premature infants

PURPOSE

To describe the skin-surface pressure distributions and points of maximal pressure that are generated by healthy premature infants in the supine, prone, and right side-lying positions.

DESIGN

A descriptive, repeated-measures design.

SAMPLE

Four medically stable premature infants of 34 weeks postconceptional age. The mean weight was 2,180 gm, and the mean age was 24.5 days.

RESULTS

Similar regions of increased skin-surface pressures were identified for the four infants. Within areas of peak pressure, some sensor cells reached 28-32 millimeters of mercury, which is considered to be the critical compressive pressure for obstruction of nutritive flow to the underlying body tissues. These descriptive results may be a starting point for development of research studies to determine positioning strategies to optimize the skin integrity of premature infants while minimizing unnecessary handling.

Care of substance-exposed infants: the current state of practice in Canadian hospitals

Many practices related to care of infants exposed to drugs and alcohol during th e prenatal period have been developed on an anecdotal basis. There are few available research studies to validate these interventions. This study describes current practices used in daily care, discharge planning, and community support for drug- and alcohol-exposed infants, their families, and alternate caregivers in one country. A survey of Canadian hospitals with annual birth rates of greater than 500 was conducted with a 51% return rate. Variations were noted in the perception of the importance of the issue of perinatal substance use, nursery care, discharge planning, and community support. Nurses are encouraged to consider these results within the context of their own communities to evaluate and develop standards of practice for substance-exposed infants and their families and caregivers.

The infant with Pierre Robin sequence: review and implications for nursing practice

Pierre Robin sequence (PRS) is associated with long-term respiratory, nutritional, and developmental difficulties. Hypoxic complications, including cerebral impairment, cor pulmonale, and failure to thrive may be prevented or minimized with early detection and comprehensive care. This article reviews the embryological development of PRS and outlines the medical and nursing implications for treatment. Partnership with parents and a coordinated community care team are essential for successful management of infants and children with PRS.