Evaluation of a web-based course for community nurses on postpartum emotional distress

Evaluating an Online Intervention to Improve Provider Management of Prenatal Depression: A Randomized Controlled Trial

INTRODUCTION

Prenatal depression is associated with numerous deleterious maternal and child health outcomes. Providers play a significant role in managing (i.e., identifying and treating or referring to care for) prenatal depression. We conducted a randomized controlled trial to test the effects of a brief online training on self-reported provider management practices related to prenatal depression.

METHODS

Providers (i.e., physicians, nurses, mental health specialists, and public health educators) were randomized into intervention (i.e., online training) or waitlist control arms. The online training covered guidelines and evidence-based practices related to managing prenatal depression. Changes in providers' knowledge, attitudes, and self-reported practices were assessed by the Management of Maternal Depression Inventory at baseline (T1), 6 weeks after baseline (T2), and 12 weeks after baseline (T3).

RESULTS

A total of 108 providers from Colorado and Virginia participated in the trial. Over the three time periods, repeated measures analysis of variance revealed Time × Group relative improvements for the intervention group with respect to satisfaction with working with mental health services, F(1,97) = 10.89, p = .001, partial η² = 0.10, and increased self-reported screening, counseling, and referral for prenatal depression, F(1,97) = 6.25, p = .014, partial η² = 0.06. A similar improving pattern was observed for self-efficacy, F(1,99) = 2.48, p = .13, partial η² = .02.

CONCLUSIONS

Findings from our study suggest a brief online training may enhance the likelihood of providers screening, treating, and/or referring at-risk patients for follow-up care for prenatal depression.

Evaluation of psychological training for nurses and midwives to optimise care for women with perinatal depression: a systematic review and meta-analysis

Objective Perinatal depression is linked to poor maternal health and infant development outcomes. The World Health Organization recommends expanding the mental health education and training of primary care providers to improve the quality of perinatal depression care. The present study evaluated the effect of various psychological training methods on nurses' and midwives' competence in administering care to and alleviating symptoms in patients with perinatal depression. Methods A comprehensive search of the PubMed, MEDLINE, Cochrane Library, EMBASE, Web of Science, and CINAHL databases was performed. The data were independently extracted by two reviewers, and the critical appraisal tools of the Joanna Briggs Institute were used for quality assessment. Random-effects meta-analysis was conducted using Review Manager 5.4 software. Findings A total of 13 articles including 246 nurses and midwives and 4,381 perinatal women were reviewed. Care administered through both face-to-face (relative risk [RR] 0.70, 95% confidence interval [CI] 0.61-0.74) and digital training (RR 0.44, 95% CI 0.26-0.74) significantly mitigated symptoms of perinatal depression. Significant benefits were observed after 3- to 5-day and 8-day training, for which the RR were 0.75 (95% CI 0.59-0.97) and 0.72 (95% CI 0.66-0.85), respectively. Studies with high intervention fidelity more effectively reduced the risk of depressive symptoms in perinatal women than those with low intervention fidelity. Key conclusions and implications for practice Compared with face-to-face, digital training methods were more effective in reducing the risk of depressive symptoms. High intervention fidelity and 3- to 5-day and 8-day training resulted in better outcomes. The present findings can serve as a reference for the design of psychological training programs for nurses and midwives to equip them with effective strategies for administering care to patients with perinatal depression.

Effectiveness of nurses and midwives-led psychological interventions on reducing depression symptoms in the perinatal period: A systematic review and meta-analysis

Aim

To evaluate the effectiveness of nurses and midwives‐led psychological interventions on the perinatal depressive symptoms.

Design

A systematic review and meta‐analysis based on the PRISMA guidelines.

Methods

Six databases were searched, including PubMed, MEDLINE, Cochrane Library, EMBASE, Web of Science and CINAHL. The search date range was before 30 September 2019. We used the Cochrane risk of bias tool to evaluate the quality of the included studies and Review Manager software 5.3 to conduct a meta‐analysis. The data were pooled using a random‐effect model.

Results

Studies (N = 827) were retrieved with 12 studies included. Psychological interventions provided by nurses and midwives have a significant effect on reducing perinatal depressive symptoms (RR: 0.72, 95% CI [0.64–0.82]). Among the approaches of psychological intervention, supportive counselling was the most effective (RR: 0.58, 95% CI [0.42–0.80]). The best intensity of intervention was six to eight sessions (RR: 0.66, 95% CI [0.55–0.79]).

Uptake of referrals for women with positive perinatal depression screening results and the effectiveness of interventions to increase uptake: a systematic review and meta-analysis

AIMS

Perinatal depression threatens the health of maternal women and their offspring. Although screening programs for perinatal depression exist, non-uptake of referral to further mental health care after screening reduces the utility of these programs. Uptake rates among women with positive screening varied widely across studies and little is known about how to improve the uptake rate. This study aimed to systematically review the available evidence on uptake rates, estimate the pooled rate, identify interventions to improve uptake of referral and explore the effectiveness of those interventions.

METHODS

This systematic review has been registered in PROSPERO (registration number: CRD42019138095). We searched Pubmed, Web of Science, Cochrane Library, Ovid, Embase, CNKI, Wanfang Database and VIP Databases from database inception to January 13, 2019 and scanned reference lists of relevant researches for studies published in English or Chinese. Studies providing information on uptake rate and/or effectiveness of interventions on uptake of referral were eligible for inclusion. Studies were excluded if they did not report the details of the referral process or did not provide exact uptake rate. Data provided by observational studies and quasi-experimental studies were used to estimate the pooled uptake rate through meta-analysis. We also performed meta-regression and subgroup analyses to explore the potential source of heterogeneity. To evaluate the effectiveness of interventions, we conducted descriptive analyses instead of meta-analyses since there was only one randomised controlled trial (RCT).

RESULTS

Of 2302 records identified, 41 studies were eligible for inclusion, including 39 observational studies (n = 9337), one quasi-experimental study (n = 43) and one RCT (n = 555). All but two studies were conducted in high-income countries. The uptake rates reported by included studies varied widely and the pooled uptake rate of referral was 43% (95% confidence intervals [CI] 35-50%) by a random-effect model. Meta-regression and subgroup analyses both showed that referral to on-site assessment or treatment (60%, 95% CI 51-69%) had a significantly higher uptake rate than referral to mental health service (32%, 95% CI 23-41%) (odds ratio 1.31, 95% CI 1.13-1.52). The included RCT showed that the referral intervention significantly improved the uptake rate (p ＜ 0.01).

CONCLUSIONS

Almost three-fifths of women with positive screening results do not take up the referral offers after perinatal depression screening. Referral to on-site assessment and treatment may improve uptake of referral, but the quality of evidence on interventions to increase uptake was weak. More robust studies are needed, especially in low-and middle-income countries.

Management of Prenatal Depression: Effectiveness of an Online Training Module Across Health Care Disciplines

INTRODUCTION

Maternal depression is associated with numerous deleterious maternal and child health outcomes. Although there are several treatment options for prenatal depression, many depressed women remain untreated. This study tested the effects of a low-intensity online training module on providers' attitudes, beliefs, and management practices of prenatal depression across a diverse group of providers.

METHODS

Health care providers who were providing care to pregnant women completed a 64-item survey consisting of items from the Management of Maternal Depression Inventory. Upon completion of the survey, providers were randomized into the intervention or the active control arm (wait-listed). The intervention consisted of an online training, which targeted knowledge and skills related to providing guidance on prenatal mood disorders. Approximately 6 to 8 weeks after randomization, all providers completed the survey again, and a general linear model framework was used to test change from baseline.

RESULTS

The final sample was comprised 74 compliant providers (intervention arm: n = 41; control arm: n = 33). Providers in the intervention arm reported significant increases in the sense of responsibility and self-efficacy when compared with their counterparts in the active control arm (all P < .001). Providers in the intervention arm also reported an increase in satisfaction related to communication with mental health specialists when compared with their counterparts in the active control arm (P = .05).

DISCUSSION

Our findings suggest that a brief, online training improved the attitudes, confidence, and communication of diverse providers related to the management of prenatal depression. Provider online training may help encourage patient-provider dialogue and in turn, enhance the management of prenatal depression.

Approaches to health-care provider education and professional development in perinatal depression: a systematic review

Background

Perinatal depression is the most common mental illness experienced by pregnant and postpartum women, yet it is often under-detected and under-treated. Some researchers suggest this may be partly influenced by a lack of education and professional development on perinatal depression among health-care providers, which can negatively affect care and contribute to stigmatization of women experiencing altered mood. Therefore, the aim of this systematic review is to provide a synthesis of educational and professional development needs and strategies for health-care providers in perinatal depression.

Methods

A systematic search of the literature was conducted in seven academic health databases using selected keywords. The search was limited to primary studies and reviews published in English between January 2006 and May/June 2015, with a focus on perinatal depression education and professional development for health-care providers. Studies were screened for inclusion by two reviewers and tie-broken by a third. Studies that met inclusion criteria were quality appraised and data extracted. Results from the studies are reported through narrative synthesis.

Results

Two thousand one hundred five studies were returned from the search, with 1790 remaining after duplicate removal. Ultimately, 12 studies of moderate and weak quality met inclusion criteria. The studies encompassed quantitative (n = 11) and qualitative (n = 1) designs, none of which were reviews, and addressed educational needs identified by health-care providers (n = 5) and strategies for professional development in perinatal mental health (n = 7). Consistently, providers identified a lack of formal education in perinatal mental health and the need for further professional development. Although the professional development interventions were diverse, the majority focused on promoting identification of perinatal depression and demonstrated modest effectiveness in improving various outcomes.

Conclusions

This systematic review reveals a lack of strong research in multi-disciplinary, sector, site, and modal approaches to education and professional development for providers to identify and care for women at risk for, or experiencing, depression. To ensure optimal health outcomes, further research comparing diverse educational and professional development approaches is needed to identify the most effective strategies and consistently meet the needs of health-care providers.

Trial registration

A protocol for this systematic review was registered on PROSPERO (Protocol number: CRD42015023701), June 21, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-017-1431-4) contains supplementary material, which is available to authorized users.

What Is the Status Quo of Evidence-Based Community Health Nursing?

Background and Purpose:With an increasing emphasis on evidence-based nursing in general,evidence-based practicehas become a buzzword among community health nurses in many countries. Despite the global interests, evidence-based community health nursing is not even clearly defined in the literature and very little is known about the current status of evidence-based community health nursing. Therefore, the purpose of this article is to identify the status quo of evidence-based nursing in community health nursing through an integrative literature review.Methods:Four electronic databases were searched from the earliest year to 2016 with combinations of keywords. Twenty-six eligible articles were reviewed, and the characteristics reflecting the current status of evidence-based community health nursing were extracted.Results:Through the content analysis process, 6 characteristics were identified. First, in evidence-based community health nursing, the needs of clients, families, caregivers, and health care professionals were identified and assessed. Second, interventions were planned based on systematic reviews on various relevant sources. Third, various types of research methods were used. Fourth, available resources were assessed and used, and the findings of cost estimation, cost/effectiveness, or cost/benefit analyses were reported. Fifth, training, support, monitoring, and coordination were included as major components. Finally, the evidence used and/or found in the studies was evaluated, disseminated, and updated as the last step.Implications for Practice:Community health nurses are required to continuously integrate, implement, evaluate, disseminate, and update their evidence for future evidence-based community health nursing.

Effect of educational software on self-efficacy of pregnant women to cope with labor: a randomized controlled trial

AIM

The aim of this study was to determine the effect of educational software on self-efficacy of Iranian pregnant women to cope with labor.

METHODS

This study was a randomized controlled trial which was carried out on 150 Iranian nulliparous pregnant women randomly assigned to two groups of 75 women each. The control group routinely did not receive any kind of childbirth education and the intervention group only received the childbirth educational software for 6-8 weeks. In order to determine self-efficacy, the Childbirth Self Efficacy Questionnaire (CBSEI) was used which measures the outcome expectancy and the self-efficacy expectancy of the first and second stages of labor separately. This questionnaire was completed at 28-32-week gestation as a pre-test and at 36-38 weeks as a post-test by the participants. Data were analyzed using Chi-square, Mann-Whitney U and Wilcoxon tests.

RESULTS

After the intervention, the median and mean of CBSEI scores for the intervention and the control groups were 607, 604/20 ± 16/630 and 394, 392/51 ± 16/758, respectively. There was a statistical difference between the two groups (p = 0.001). Also, statistically significant differences existed in the median of outcome expectancy and self-efficacy expectancy after intervention in both stages of labor between the two groups (p = 0.001).

CONCLUSIONS

The educational software program significantly increased self-efficacy of Iranian pregnant women to cope with labor. Despite lack of educational childbirth classes in Iran, the use of this method is recommended. However, to find whether this technique can be substituted for the educational classes, further studies are needed.

The impact of an interactive Web-based module on residents' knowledge and clinical practice of injury prevention

OBJECTIVE

To determine the effectiveness of an interactive Web-based module on knowledge acquisition, retention, and clinical practice by residents.

METHODS

Residents were randomized to complete an interactive Web-based module on injury prevention or a noninteractive Web-based module of identical content. Acquisition and retention of medical knowledge were measured by pretest, posttest, and long-term test scores, and change in clinical practice was measured by videotaped clinical encounters.

RESULTS

Fifty-seven residents completed the modules. The control group had higher posttest scores than the intervention group (P = .036). Thirty-seven residents completed the long-term test with scores that were significantly higher than pretest scores (P = .00). Thirty-six residents had videotaped encounter scores (232 visits), with no difference in these scores after the intervention (P = .432).

CONCLUSION

The noninteractive module was more effective in promoting knowledge acquisition. Residents successfully demonstrated knowledge retention with completion of either module. The modules were insufficient to change clinical practice.

Evaluation of the clinical effect of an on-line course for community nurses on post-partum emotional distress: a community-based longitudinal time-series quasi-experiment

About 14% of Icelandic women suffer post-partum from frequent depressive symptoms, and of those, 12% also report a high degree of parenting stress. Education of nurses and midwives on post-partum distress is crucial in reducing its degree. The purpose of the study is to evaluate the clinical effect of an on-line course for community nurses on post-partum emotional distress. A community-based, longitudinal, time-series quasi-experiment was conducted in four stages from 2001 to 2005. Mothers attending 16 health centres throughout Iceland and scoring ≥ 12 on the Edinburgh Postnatal Depression Scale (EPDS) at the 9th week post-partum were eligible to participate. Health centres were divided into experimental (EHC) and control centres (CHC), and control centres were crossed over to experimental centres the following year and new control centres recruited. Nurses at EHC attended an on-line course on post-partum emotional distress. Participating mothers answered the EPDS; the Parenting Stress Index/Short form and the Fatigue Scale. Nursing diagnoses and interventions were recorded at all study centres. Of the women who were eligible (n = 163), 57% (n = 93) participated. At baseline, 9 weeks post-partum, there were no significant differences between groups of women in the rate of depressive symptoms, fatigue or parenting stress. Women in all groups improved on all distress indicators over time; however, those from the EHC improved statistically and clinically significantly more on depressive symptoms than those from the CHC. Documentation of particular nursing diagnoses and interventions was significantly more frequent at the EHC, but referrals to specialists were significantly less frequent. On-line education for nurses on post-partum emotional distress is feasible and is related to improvement in post-partum depressive symptoms.

Iranian nursing students' comprehension and experiences regarding evaluation process: a thematic analysis study

In this study, a qualitative design based on a thematic analysis approach was employed to explore the comprehension and experiences of Iranian nursing students regarding evaluation process in both classroom and clinical setting. After utilising purposeful sampling to choose 13 bachelor's degree nursing students, semi-structured interviews were held for data gathering. During the data analysis, three main themes emerged: 'definition of evaluation process', 'unfair evaluation' and 'ideal evaluation'. The second theme consisted of two sub-themes: 'problematic process' and 'unexpected outcome'. Our study findings showed a gap between what Iranian nursing students depicted as a fair and equitable evaluation and what they experienced during their academic career. There is a need to bring a change to process of evaluation to increase the feeling of fairness and justice regarding evaluation among nursing students. The findings can be helpful for international nurse instructors to be exposed to the unheard perspectives of nursing students and reconsider the weaknesses of evaluation process conducted by them.