Maternal Child and Family Health Nurses: Delivering a Unique Nursing Speciality

Applying Learning Principles Within Parent Education: Exploring Nurses' Practice and Parents' Experiences

Purpose

In parent-education practice nurses use Learning Principles (LPs) when helping parents to develop the knowledge and skills required to care for their children. LPs are basic precepts of learning, comprising people's beliefs, behaviors and reasoning processes. LPs underpin parents' active engagement, confidence building and decision-making, as information provided becomes usable knowledge. However, the ways nurses apply LPs in parent-education practice are poorly explained in healthcare. Likewise, descriptions of parents' learning experiences, associated with the use of LPs in nurse/parent-education interactions, are lacking. This study aimed to explore and describe nurses' perceptions and use of LPs, and parents' learning experiences in one healthcare organization.

Participants and Methods

Using an action research design, 25 nurses and 18 parent participants were purposively recruited across metropolitan Adelaide, Australia. Data were collected through observations and semi-structured interviews and thematically analyzed simultaneously June-December 2017.

Results

The LPs nurses used, and those important to parents' learning experiences created three overarching themes: 1) collaborative relationships, 2) deepening learning insights, 3) the learning environment. Despite their apparent use, nurses struggled to explicitly describe how they perceived LPs, believing their knowledge and use was sub-conscious - tacit. However, tacit knowledge hinders communication and explanation of LPs used within parent-education to other nurses. The member-checking of interview data helped to stimulate the nurses' metacognition (thinking about their thinking), unlocking their LPs awareness.

Conclusion

Nurses used LPs in practice but their knowledge was tacit. Through metacognition, nurses started to recognize the ways LPs influenced their practice and parents' learning capabilities. Increasing healthcare constraints, including time allowed for parent-education, require nurses to optimize their use of LPs. Future research should identify ways nurses can communicate their use of LPs, potentially enhancing parents' active learning experiences and concordance with health recommendations.

Interventions co-designed by healthcare providers and clients for improving therapeutic relationships in maternal and child healthcare: a pilot study using human centered design in rural Tanzania

BACKGROUND

Research shows that poor provider-client interactions in maternity and child health (MCH) continue to affect health outcomes, service uptake, continuity of care, and trust in formal healthcare systems.

OBJECTIVE

The study's objective was to jointly create a prototype intervention package for enhancing nurse-client relationships using human centered design (HCD) approach.

METHODS

A five-step HCD methodology was used: (1) Community-driven discovery through qualitative descriptive research methods using 9 focus groups with nurses and clients and 12 key informant interviews with MCH administrators; (2) consultative ideation and co-creation meetings with 10 nurses, 10 clients, and 10 administrators to co-design a rough prototype model; (3) rough prototype validation through qualitative insight gathering using 6 FGDs with nurses and clients; (4) refinement and adaptation meetings with 14 nurses, 14 clients and 12 administrators; and (5) documentation and sharing of lessons learnt.

RESULTS

According to the community-driven research, poor service, a lack of concern, poor communication, a bad attitude, and unhappiness at work are the nurse factors that affect the relationships between nurses and their patients. Non-compliance with procedures, unfavorable attitudes, poor communication, low education, poverty, and faith in conventional healers were among the client-related factors. Inadequate funding, bad management techniques, improper policy execution, and a lack of an independent institution for handling complaints are the health system factors that affect nurse-client relationships. In response, three ideation and co-creating meetings resulted in 24 interventions. Seven (7) of these were rated as more acceptable and feasible in the local context and formed a rough prototype. During validation, there were some disagreements on the feasibility of curriculum and resource-related interventions. Refinement meetings resulted in a final prototype including four interventions: (i) promotion of patient-centred care; (ii) awards and recognition for nurses; (iii) strengthening complaints mechanisms and (iv) disciplinary measures for abusive nurses and clients. The lessons learnt have been shared through publications and institutional research meetings.

CONCLUSIONS

HCD approach provides a novel entry point for providers and clients to examine the problems and design interventions for strengthening their therapeutic relationships in MCH care. Researchers, practitioners, and policy developers are welcome to consider the emerging prototype as it was deemed acceptable and potentially feasible in rural African contexts.

Improving nursing education curriculum as a tool for strengthening the nurse-client relationships in maternal and child healthcare: Insights from a human-centered design study in rural Tanzania

Background

There are growing evidence of poor nurse-client relationships in maternal and child health (MCH). The nursing curriculum forms an important entry point for strengthening such relationships, consequently improving client satisfaction with nurses' competencies, confidence in the formal healthcare system, healthcare-seeking practices, continuity with care, and MCH outcomes.

Objective

MCH nurses and clients were invited to design an intervention package (prototype) to improve nurse-client relationships using a human-centered design (HCD) approach.

Methods

A multi-step HCD approach was employed to first examine the contributors of poor nurse-client relationships using nine focus group discussions with nurses and clients and 12 key informant interviews with MCH administrators. Then, three meetings were held with 10 nurses, 10 clients, and 10 administrators to co-develop an intervention package to address the identified contributors. The solutions were validated by collecting qualitative information through six focus groups with nurses and MCH clients who were not involved in the initial HCD stages. Finally, refinement and adaptation meetings were held with 15 nurses, 15 clients, and 10 administrators. The data were managed with NVivo 12 software and analyzed thematically.

Results

Nursing curriculum challenges contributing to poor nurse-client relationships in MCH care included inadequate content on nurse-client relationships specifically topics of customer care, communication skills, and patient-centered care; an inadequate practice on communication skills within nursing schools; and the absence of specific trainers on interpersonal relationships. Consequently, improving the nursing curriculum was one of the interventions proposed during the co-design and rated by participants as highly acceptable during validation and refinement meetings. Suggested improvements to the curriculum included increasing hours and credits on communication skills and patient-centered care, including customer care courses in the curriculum and creating a friendly learning environment for clinical practice on strengthening interpersonal relationships.

Conclusion

Improving the nursing curriculum was considered by nurses and clients as one of the acceptable interventions to strengthen nurse-client relations in MCH care in rural Tanzania. Nursing education policy and curriculum developers need to ensure the curriculum facilitates the development of much-needed interpersonal skills among nursing graduates for them to have positive therapeutic interactions with their clients.

Influence of the implementation of strengths-based nursing and healthcare on early childhood nurses' competencies: a mixed-method study

BACKGROUND

The scope of practice for nurses caring for families has evolved to meet the challenges presented by societal changes and increasing needs. In 2015, early childhood nurses from a Swiss region decided to implement a new model of care to guide their practice. The aim of this study was to explore the changes to early childhood nurses' practices following the implementation of the strengths-based nursing and healthcare (SBNH) approach to care.

METHODS

This study of early childhood nurses' (N = 61) practices used a pre-post intervention design and a mixed-method approach. Nurses' competencies and changes in practice were measured using the Nurse Competence Scale (NCS). The quantitative data were analysed using descriptive statistics, Kruskal Wallis tests and logistic regression. Thematic analysis was used to derive themes from the qualitative data.

RESULTS

After the intervention, frequency of competency use increased in all domains of the NCS except the "teaching-coaching" domain; perceived levels of competencies also increased in all areas except "helping role" and "diagnostic functions". Age and length of employment at the current post hindered improvement in the "teaching-coaching" competency. Interviews revealed themes related to the implementation process: "adaptability", "implementation process", "ambivalence" and "engagement to change". Other themes were related to practice changes: "developing a disciplinary identity", "path with families" and "strengths".

CONCLUSION

This study showed that the use of perceived competencies changed over time after the introduction of SBNH into practice. Nurses questioned and adapted their routines based on SBNH. Nurse's vision of care also changed; they felt that their care was congruent with their values. For families, this approach allowed a change of vision with a resource-centred approach. Implementation of models of care such as the SBNH in the early childhood context is innovative, as little research in the literature addresses the early childhood community home-visiting context is still modest. This research underlines the added value of this approach on early childhood nurses' competencies.

Factors shaping good and poor nurse-client relationships in maternal and child care: a qualitative study in rural Tanzania

Background

Evidence indicates that poor nurse-client relationships within maternal and child health (MCH) continues to impact trust in formal healthcare systems, service uptake, continuity with care and MCH outcomes. This necessitates contextualized innovative solutions that places both nurses and clients at the forefront as agents of change in optimizing intervention designs and implementation. This study explored nurses and clients’ perspectives on the factors shaping nurse-client relationships in MCH care to generate evidence to guide subsequent steps of human centered design (HCD) that involve designing effective strategies for improving therapeutic relationships in Shinyanga, Tanzania.

Methods

Qualitative descriptive design was employed. About 9 Focus Group Discussions (FGDs) and 12 Key Informant Interviews (KIIs) with purposefully selected nurses and midwives, women attending MCH services and administrators were conducted using semi-structured interview guides in Swahili language. Data were transcribed and translated simultaneously, managed using Nvivo Software and analyzed thematically.

Results

Factors shaping nurse-client relationships were heuristically categorized into nurse, client and health system factors. Nurse contributors of poor relationship ranged from poor reception and hospitality, not expressing care and concern, poor communication and negative attitudes, poor quality of services, job dissatisfaction and unstable mental health. Client contributors of poor relationship include being ‘much know’, late attendance, non-adherence to procedures and instructions, negative attitudes, poor communication, inadequate education and awareness, poverty, dissatisfaction with care, faith in traditional healers and unstable mental health. Health system contributors were inadequate resources, poor management practices, inadequate policy implementation and absence of an independent department or agency for gathering and management of complaints. Suggestions for improving nurse-client relationship included awards and recognition of good nurses, improving complaints mechanisms, continued professional development, peer to peer learning and mentorship, education and sensitization to clients, improving service quality and working conditions, improving renumeration and incentives, strengthening nursing school’s student screening and nursing curriculum and improving mental health for both nurses and clients.

Conclusions

The factors shaping poor nurse- client relationships appear to extend beyond nurses to both clients and healthcare facilities and system. Implementation of effective interventions for addressing identified factors considering feasibility and acceptance to both nurses and clients using novel strategies such as HCD could pave the way for employing good nurse-client relationships as a tool for improving performance indicators and health outcomes within MCH care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01021-x.

Child and family health nurses' roles in the care of infants and children: A scoping review

Child and family health nurses (CFHNs) work in a variety of settings with families to promote optimal growth and development in infants and children from birth to 5 years. Literature is available about models of care that CFHNs use in their work, but there is limited information about how CFHNs enact care specifically for infants and children. The aim of this scoping review was to identify and contextualize existing knowledge of how CFHNs, both in Australia and internationally, care for infants and children. Arksey and O'Malley's (2005) framework was used to review 27 studies from Australia, Sweden, Finland, United Kingdom (UK), United States of America (USA), Ireland, Netherlands, Denmark and Canada. It was identified that CFHNs, equipped with a range of assessment tools for early intervention and health promotion, use a partnership approach when working with parents to promote the health and well-being of infants and children. The literature revealed the complexity of the roles undertaken by CFHNs when caring for infants and children. Review findings indicated that CFHNs' work is distinctive because it is conducted in home and community settings, is relational and salutogenic in nature and is also located in the domain of preventative health and early intervention.

Bottle-feeding, a neglected area of learning and support for nurses working in child health: An exploratory qualitative study

Breastfeeding is the ideal infant feeding modality; however, the reality is some parents need or choose to use bottles to feed their infants. Parents who bottle-feed have been identified as not receiving adequate levels of bottle-feeding information and advice from health professionals. This study's aim was to explore nurses' knowledge of the components in the bottle-feeding act. Twenty-one nurses working in early parenting residential units participated in three focus groups. Three themes were identified relating to nurses' bottle-feeding knowledge: experience not evidence-based, it is hard to know what to advise, we will support whatever choice they make. The nurses identified a deficit in their knowledge, education and training related to the components of bottle-feeding. The nurses struggled with their interpretation of infant feeding policies and the provision of bottle-feeding information to parents. Nurses working in child and family health were motivated to inform, educate and enable parents to confidently make decisions concerning infant feeding. The healthcare system and the infant feeding policy drivers appear to have a mixed and at times negative impact on nurses' practice. Further research is required across a larger population of nurses.

Paediatric nursing clinical competences in primary healthcare: A systematic review

AIMS

To identify and critically appraise the available evidence on paediatric nurses' clinical competencies performed autonomously regarding disease prevention and health promotion activities for children and adolescents in primary healthcare worldwide.

DESIGN

A systematic review design in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

The search was conducted through MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, SCOPUS, The Cochrane Library, Scientific Electronic Library Online, Web of Science and The Joanna Briggs Institute EBP (Ovid) databases. The grey literature was reviewed at OpenGrey. Additional studies were located through a references list of selected studies identified on first search.

REVIEW METHODS

Database search employed MeSH terms: (paediatric nursing) AND (primary healthcare) AND ((clinical skills) OR (clinical competences)). Studies published from inception to October 2019 exploring paediatric nurses' clinical competencies in primary healthcare were eligible for inclusion. No language restrictions were applied in the main search. Selection was made by two reviewers independently. Three independent reviewers assessed the methodological quality of included studies.

RESULTS

Eighteen studies were included from six countries. The most common nursing competencies independently performed identified and described in studies were Health education and advice, Child and adolescent health and development assessment, Immunizations and Child health checks.

CONCLUSION

Studies describe clinical competencies of nurses in children care. No consistent scientific evidence is available about clinical competencies of paediatric nurses performed autonomously in primary care.

IMPACT

Few scientific studies identifying and assessing nurses' child primary healthcare skills were found and therefore recorded. Studies describe nurses' clinical skills in childhood, but results do not show firm consistency assessing their practice scope. Health policy-makers should encourage the development of nurses' competencies if they wish to preserve quality and equity of healthcare services to children. Therefore, the first step is to identify the autonomous competencies of paediatric nurses in primary care.

Survey of Maternal, Child and Family Health Nurses' attitudes and practice relating to preconception health promotion

Environmental factors including poor nutrition, obesity, smoking, exposure to toxins and drug and alcohol use at the time of conception can adversely affect the future health of the offspring. As primary health care (PHC) professionals who interact with women of reproductive age, Maternal, Child and Family Health Nurses (MCaFHNs) are ideally placed to promote preconception health to women who want another child. The aim of this study was to assess MCaFHNs attitudes towards preconception health promotion, whether and under what circumstances they talk to their families about this, and what might help them start a conversation about preconception health. Of the 192 respondents, most (65%) agreed it is part of the MCaFHNs role to promote preconception health but only one in eight (13%) felt very confident that they knew as much as they needed and less than half (46%) ‘routinely’ or ‘sometimes’ promoted preconception health in their clinical practice. Almost all agreed that more information and education on the topic would increase their confidence to discuss preconception health. The findings suggest that, with adequate educational and structural support, most MCaFHNs are willing to deliver preconception health promotion in their clinical practice. As most new mothers access MCaFHNs, the potential health benefits of this are considerable.

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.

Psychometric evaluation of the Family Focused Mental Health Practice Questionnaire in measuring home visitors' family focused practice

Background

Worldwide maternal mental illness poses a major public health issue. Supporting maternal mental health and family health is a core aspect of home visiting. Increasingly the benefits of family focused treatments to maternal mental illness are being recognised. However, there are few reliable and valid measures that attempt to assess this type of practice.

Objectives

To explore the psychometric properties of the Family Focused Mental Health Practice Questionnaire in a population of home visitors.

Methods

Home visitors (n = 230) from across a single region of the United Kingdom completed the Family Focused Mental Health Practice Questionnaire. Participants were all females, had a mean age of 44 years, and had an average of 11 years’ experience of home visiting. Exploratory factor analysis was used to explore the factor structure of the questionnaire in this population while Cronbach’s alpha was used to assess the internal consistency of questionnaire subscales.

Results

Exploratory factor analysis revealed a 3-factor solution where each factor contained at least three questionnaire items and had eigenvalues ≥ 1.0. Checks for internal consistency revealed that one factor was unsatisfactory (α < 0.6), which was subsequently discarded. A further exploratory factor analysis supported a 2 factor solution. The factors were named: professional influences on family focused practice and organisational influences on family focused practice. Cronbach’s alpha for the new scale was 0.949.

Conclusion

As home visitors play a key role in supporting parents who have mental illness and their families, it is important to assess their practice using a reliable measure. Our psychometric evaluation has created a more valid, reliable and concise measure that can be used to examine home visitors’ family focused practice.