'It Was Easier Because I Had Help': Mothers' Reflections on the Long-Term Impact of Sustained Nurse Home Visiting

Being connected: Exploring the needs of mothers during the postnatal period in Queensland, Australia

This project explored the needs of mothers beyond the immediate postnatal period in Queensland, Australia, for the development of improved models of care. Data were collected through group and individual interviews. A qualitative methodology using thematic analysis captured the experience of 58 participants. Four key themes were generated: Caring for self, Being connected, Getting direction and Having options. Being connected with care providers and peers was highly valued by participants as was having a sense of direction. Having a relationship with a carer who knew them personally throughout pregnancy and postnatal care avoided retelling stories and facilitated information sharing. Relationship-based care enabled mothers to better meet their personal needs necessary to fulfil the parenting role. Yet, many points of disconnect were identified including inconsistencies in information and gaps in care. These findings demonstrate a range of unmet needs, situated within a lack of relational continuity. Maternity and child health professionals, service managers and policy makers must reorient systems by listening, acknowledging and keeping the voice of mothers at the centre of care.

Evidence of the acupuncture points stimulation for the treatment of hypogalactia: A systematic review and meta-analysis

OBJECTIVE

To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity.

METHOD

Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis.

RESULTS

A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI = 1.63 [1.13-2.13]; p < 0.0001).

CONCLUSION

The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.

"This has changed me to be a better mum": A qualitative study exploring how the Australian Nurse-Family Partnership Program contributes to the development of First Nations women's self-efficacy

BACKGROUND

The Australian Nurse-Family Partnership Program is based on the Nurse-Family Partnership program from the United States, which was designed to support first-time mothers experiencing social and economic disadvantage from early in pregnancy until their child's second birthday. International trials have demonstrated this program measurably improves family environment, maternal competencies, and child development. The Australian program has been tailored for mothers having a First Nations baby.

AIM

This study aimed to understand how the program impacts self-efficacy using a qualitative interpretive approach.

METHODS

The study took place in two sites within one Aboriginal Community Controlled Health Service in Meanjin (Brisbane), Australia. Twenty-nine participants were interviewed: first-time mothers having a First Nations baby who had accessed the program (n = 26), their family members (n = 1), and First Nations Elders (n = 2). Interviews were conducted either face-to-face or by telephone, using a yarning tool and method, to explore women's experiences and perceptions. Yarns were analysed using reflexive thematic analysis.

FINDINGS

Three main themes were generated: 1) sustaining connections and relationships; 2) developing self-belief and personal skills; and 3) achieving transformation and growth. We interpret that when the program facilitates the development of culturally safe relationships with staff and peers, it enables behaviour change, skill development, personal goal setting and achievement, leading to self-efficacy.

DISCUSSION

Located within a community-controlled health service, the program can foster cultural connection, peer support and access to health and social services; all contributing to self-efficacy.

CONCLUSION

We recommend the program indicators are strengthened to reflect these findings and enable monitoring and reporting of activities that facilitate self-efficacy, growth, and empowerment.

Does customised care improve satisfaction and positively enable parents in sustained home visiting for mothers and children experiencing adversity?

Background

The Maternal Early Childhood Sustained Home-visiting program (MECSH) is a structured nurse-delivered program designed to address health inequities experienced by families experiencing significant adversity. There is strong evidence for the effectiveness of this program, but limited research exploring the practice and process elements that are core to positive parent outcomes. This study aimed to examine the relationship between customised care related to the mother’s risk factors and parent satisfaction and enablement in the delivery of a MECSH-based program.

Methods

A cross-sectional study design was used. Program delivery data collected as part of a large randomised controlled trial of a MECSH-based sustained nurse home visiting program in Australia (right@home) were analysed. This study used the data collected from the intervention arm in the trial (n = 352 women). Parent satisfaction was measured at child age 24 months using the modified short-form Patient Satisfaction Questionnaire. Parent enablement was measured at child age 24 months by a modified Parent Enablement Index. Customised care was defined as appropriate provision of care content in response to four maternal risks: smoking, mental health, domestic violence and alcohol and drugs. Logistic analysis was performed to assess the impact of customised care on parent satisfaction and enablement while adjusting for covariates such as sociodemographic factors. A significance level of 95% was applied for analysis.

Results

Our results indicated high levels of satisfaction with the care provided and positive enablement. There were several sociodemographic factors associated with satisfaction and enablement, such as language spoken at home and employment experience. The mothers who received customised care in response to mental health risk and domestic violence had significantly greater satisfaction with the care provided and experienced an increase in enablement compared to those who did not receive such care.

Conclusion

This study contributes to the existing body of empirical research that examines the relationship between care processes and client outcomes in the delivery of home visiting services. It is essential for the sustained nurse home visiting service model to be flexible enough to cater for variations according to family circumstances and needs while maintaining a core of evidence-based practice.

Parent satisfaction with sustained home visiting care for mothers and children: an integrative review

AIM

To synthesise and analyse the existing literature regarding parent satisfaction with sustained home visiting care for mothers and children.

BACKGROUND

Sustained home visiting is a service delivery mechanism of both prevention and intervention, in which people receive structured support services within their home environment over an extended period of months or years. For the purposes of this paper, sustained home visiting refers to in-home nursing support to address health inequities for mothers and young children. Sustained home visiting programs have been found to support improved health, wellbeing, and developmental outcomes for children and families. However, there is limited knowledge with regards to the level of parent satisfaction with care provided at home, and the factors and elements of care parents perceive to be critical to their satisfaction. It is important for healthcare practitioners to understand what practices and process parents consider to be a priority in securing their ongoing engagement.

DESIGN

Integrative review.

DATA SOURCES

PubMed/Medline, CINAHL, Embase, and PsycINFO.

METHODS

A multi-step approach was used to search and retrieve peer-reviewed studies from the databases. Study selection, data extraction, data synthesis and critical appraisal were undertaken by two independent researchers.

RESULTS

A total of 13 studies met the inclusion criteria, including nine quantitative and four qualitative studies. The review found that parents provided with home visiting interventions had higher levels of satisfaction with care than those who received routine or facility-based care. Service dose was a factor associated with parent satisfaction, however, the direction of impact on parent satisfaction was mixed. Other elements of care parents perceived as important to service satisfaction included the nurse-client relationship, being treated with respect, empowerment, and emotional support.

CONCLUSION

While it is critically important that home visiting practitioners provide evidence-based care and interventions, it is equally important that services are delivered in the context of positive and empowering relationships. Further research is recommended to understand the care process and mechanisms that enhance parent satisfaction and positive experiences, providing optimal quality of care.

Improving interagency service integration of the Australian Nurse Family Partnership Program for First Nations women and babies: a qualitative study

Background

The Australian Nurse Family Partnership Program (ANFPP) is an evidence-based, home visiting program that offers health education, guidance, social and emotional support to first-time mothers having Aboriginal and/or Torres Strait Islander (First Nations) babies. The community-controlled sector identified the need for specialised support for first time mothers due to the inequalities in birthing and early childhood outcomes between First Nations’ and other babies in Australia. The program is based on the United States’ Nurse Family Partnership program which has improved long-term health outcomes and life trajectories for mothers and children. International implementation of the Nurse Family Partnership program has identified interagency service integration as key to program recruitment, retention, and efficacy. How the ANFPP integrates with other services in an Australian urban setting and how to improve this is not yet known. Our research explores the barriers and enablers to interagency service integration for the Australian Nurse Family Partnership Program ANFPP in an urban setting.

Methods

A qualitative study using individual and group interviews. Purposive and snowball sampling was used to recruit clients, staff (internal and external to the program), Elders and family members. Interviews were conducted using a culturally appropriate ‘yarning’ method with clients, families and Elders and semi-structured interview guide for staff. Interviews were audio-recorded and transcribed prior to reflexive thematic analysis.

Results

Seventy-six participants were interviewed: 26 clients, 47 staff and 3 Elders/family members. Three themes were identified as barriers and three as enablers. Barriers: 1) confusion around program scope, 2) duplication of care, and 3) tensions over ‘ownership’ of clients. Enablers (existing and potential): 1) knowledge and promotion of the program; 2) cultural safety; and 3) case coordination, co-location and partnership forums.

Conclusion

Effective service integration is essential to maximise access and acceptability of the ANFPP; we provide practical recommendations to improve service integration in this context.

Knowledge of and Attitudes Toward Perinatal Home Visiting in Women with High-Risk Pregnancies

INTRODUCTION

Published research indicates that some perinatal home visiting programs are highly effective. However, there is a dearth of information regarding how these services apply to women experiencing a high-risk pregnancy. The aim of this study was to determine the potential acceptability of home visiting services within this vulnerable population and identify what services women want.

METHODS

Four focus groups (N = 32) were conducted with a population of low-income, pregnant individuals in medically underserved central Georgia (United States). Participants were evaluated based on their current exposure to home visiting, receptiveness to home visiting, and reasons for apprehension regarding home visiting.

RESULTS

The results of this study were mixed, with women expressing both interest in and reluctance about home visiting programs. Themes of distrust and fear of judgment or persecution existed. Women also varied with regard to what home visiting services they would like offered. Those discussed included assistance with maternal or infant medical needs, maternal function tasks, household tasks, and child care.

DISCUSSION

Home visiting programs can be effective for improving maternal and child health outcomes. However, not all home visiting programs effectively reach their target population. More research is needed to determine what women who have high-risk conditions during pregnancy want help with and how to increase receptiveness. The results of this study could be informative to health care providers who treat persons with high-risk conditions in identifying adjunctive services for those in need of additional support.

Systematic review: An exploration of core componentry characterizing effective sustained nurse home visiting programs

AIMS

To identify the core components or potential 'active ingredients' of sustained nurse home visiting (SNHV) programs that have demonstrated positive effects on maternal or child health, psychosocial development, or self-sufficiency outcomes among disadvantaged families in high-income countries.

DESIGN

Systematic review with narrative summary.

DATA SOURCES

Programs were identified from searches of several reputable evidence clearing houses and the following bibliographic databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Cochrane Central Register of Controlled Trials. Year of publication was originally restricted from 2008 -2018, with additional searches conducted up to 2019.

REVIEW METHODS

This review of SNHV program componentry builds on a previous evaluation of program effectiveness. Programs were selected for inclusion if they had been tested in a randomized or cluster-randomized controlled trial (RCT/CRCT). Componentry characteristics related to program delivery, nurse provider, and outcome-specific intervention content were then extracted.

RESULTS

Comparison of the seven eligible programs showed seven common core components: antenatal commencement, support to child age 2 years, at least 19 scheduled visits and experienced or highly qualified nurses with program-specific training, caseloads of approximately 25 families, regular supervision, and multidisciplinary supports. Outcome-specific program content was generally not well reported.

CONCLUSION

The findings from this review have utility in guiding the development of minimum standard benchmarks and best-practice recommendations for SNHV programs and call for more detailed publication of core content componentry in the SNHV literature.

IMPACT

Identification of the core componentry underpinning program effectiveness should inform policy decisions on program selection, adaptation for specific populations, and quality control. Such evidence-based decision-making should in turn lead to better maternal and child outcomes among disadvantaged families in high-income countries, reducing societal and economic burdens of inequity.

Experiences of interaction between teenage mothers and visiting nurses: a phenomenological study

OBJECTIVE

To understand the experiences of interaction between teenage mothers and visiting nurses in the Young Mothers Caregivers Program.

METHOD

Qualitative research using the theoretical-methodological framework of Social Phenomenology, with phenomenological interviews with visiting nurses and teenage mothers.

RESULTS

Three visiting nurses and nine teenage mothers participated. The understanding of the experiences led to the elaboration of three categories of contexts of meanings related to the past and present: "Experiences of participation in the PJMC"; "The interaction experienced by visiting nurses and teenage mothers"; "Parenting and maternal role".

CONCLUSION

The interaction between visiting nurses and teenage mothers in the program was characterized as positive, as it provided the mother with greater security in her maternal and parental role. The attitudes of nurses and adolescent mothers were fundamental for establishing a positive interaction.

Estratégias de avaliação da visita domiciliar: uma revisão de escopo

Resumo Objetivo Explorar a literatura relacionada às estratégias de avaliação da visita domiciliar nos programas de visitação para a primeira infância. Métodos Revisão de escopo baseada na metodologia proposta pelo Instituto Joanna Briggs. Foram analisadas as seguintes bases: PubMed, Web of Science, Scopus, CINAHL, Embase, Biblioteca Virtual da Saúde e acrescentados estudos de outras fontes. Após revisão por dois revisores independente quanto aos critérios de inclusão, foram selecionados 19 estudos para compor a amostra. Resultados Os programas de visita domiciliar para a primeira infância utilizam a análise dos cadernos de anotação do visitador, a entrevista com participantes e a aplicação de instrumentos de medida como estratégias para avaliar a visita. Conclusão A revisão trouxe uma gama de abordagens que podem ser adotadas segundo o objetivo de cada programa e a disponibilidade de recursos. Carecem de estratégias efetividade comprovadas, além de instrumentos e métodos validados.

Look to Norway: Serving new families and infants in a multiethnic population

Despite recognition that immigrant women face significant health challenges, addressing the healthcare needs of immigrants is a source of debate in the United States. Lack of adequate healthcare for immigrants is recognized as a social justice issue, and other countries have incorporated immigrants into their healthcare services. Oslo, the fastest growing capital in Europe, is rapidly shifting to a heterogeneous society prompting organizational action and change. The New Families Program serves first-time mothers and their infants in an Oslo district serving 53% minorities from 142 countries. Anchored in salutogenic theory, the program aims to support the parent-child relationship, children's development and social adaptation, and to prevent stress-related outcomes. Formative research has informed the successful program development and implementation within the existing maternal and child healthcare service. Implications for addressing maternal and child health needs of an immigrant population are presented.

How Do Nurses Keep Children Safe From Abuse and Neglect, and Does it Make a Difference? A Scoping Review

OBJECTIVES

To explore the extent of child protection work performed by nurses and identify which interventions hold the strongest evidence for future practice.

DESIGN

This scoping review was guided by Arksey and O'Malley's framework for scoping reviews.

DATA SOURCES

Electronic databases (CINAHL, Medline, Scopus, Web of Science) and grey literature were searched in August 2017. Further studies were identified through manual literature searching.

RESULTS

Forty-one studies from seven countries met the inclusion criteria. The studies showed nurses keep children safe primarily through the prevention of abuse (n = 32), but also through detection of abuse (n = 1) and interventions to mitigate the effects of abuse (n = 8). Nurses' specific interventions most frequently involved post-natal home visiting (n = 20), parent education (n = 10) and assessment and care of children or adolescents following sexual abuse (n = 4). The main findings showed that although nurses did have positive impacts upon some measures of abuse and neglect, results were not consistent across studies. In addition, some studies used indirect measures of abuse and neglect, which may not impact children's experiences of abuse. It is difficult to extrapolate these findings to the broader nursing profession as literature did not accurately represent the range of ways that nurses keep children safe from abuse and neglect.

CONCLUSIONS

This review demonstrated nurses prevent, detect and respond to abuse and neglect in many ways. However, given mixed evidence and absence of some nurse interventions in the literature, further research is needed to represent the range of ways that nurses keep children safe and determine their effectiveness.

Formative research in the development of a salutogenic early intervention home visiting program integrated in public child health service in a multiethnic population in Norway

BACKGROUND

Few early intervention programs aimed at maternal and child health have been developed to be integrated in the existing Child Health Service in a country where the service is free, voluntary and used by the majority of the eligible population. This study presents the process and the critical steps in developing the "New Mothers" program.

METHODS

Formative research uses a mixed method, allowing us to obtain data from multiple sources. A scoping review provided information on early intervention programs and studies, clarifying key elements when framing a new program. Key informant and focus group interviews offered insight of existing challenges, perceptions, identified power structures and offered reflections germane to the identified framework, securing user involvement at all stages. Monthly meetings with the project group enabled feedback loops for the data, securing program advancement.

RESULTS

The "New Mothers" program was formed based on a salutogenic theory, emphasizing resistance and strengths. Public health nurses in the existing Child Health Service were to offer universally all first-time mothers and children home visits from gestational week 28 until the child reached 2 years, with motivational interviewing and empathic communication as methods to mentor the mothers, help them identify their strengths and resources, and provide support and information.

CONCLUSIONS

Using formative research as mixed method ensures incorporation of detailed information from multiple resources when an early intervention program is developed. This method secured program appropriateness, both culturally and at system level, when integrating new elements in the existing service.

Adaptation and Fidelity: a Recipe Analogy for Achieving Both in Population Scale Implementation

Balancing adherence to fidelity of evidence-based programs and adaptation to local context is one of the key debates in the adoption and implementation of effective programs. Concern about maintaining fidelity to achieve outcomes can result in replication of research-based models that can be a poor fit with the real world. Equally, unplanned adaptation can result in program drift away from the core elements needed to achieve outcomes. To support implementation of the Maternal Early Childhood Sustained Home-visiting (MECSH) program in multiple sites in three countries, an analogy was developed to identify how both fidelity and adaptation can be managed and successfully achieved. This article presents the Commonsense Cookery Book Basic Plain Cake with Variations recipe analogy to articulate the dual requirements of both fidelity and adaptation to achieve quality implementation of the MECSH program. Components classified by the analogy include identification of core ingredients, methods, and equipment that contribute to fundamental outcomes and fidelity to the evidence-based program, and a planned, collaborative approach to identification of needed variations to suit locally sourced capacity, needs, and tastes. Quality is achieved by identifying and measuring the core ingredients and the variations. Sourcing local ingredients and honoring of context support sustainability of quality practice. Using this analogy has assisted adopters of the MECSH program to understand that effective implementation requires uncompromised commitment to expectations of fidelity to the core components and methods; planned, proactive adaptation; systematic monitoring of both core program and agreed variations; and local ownership and sustainability.