Learning the baby: a maternal thinking and problem-solving process

The First Steps Program: a case study of a new model of community child health service

Community Child Health Nursing Services provide support for new mothers; however, the focus has often been on individual consultations, complemented by a series of group sessions soon after birth. We describe a new model of community care for first-time mothers that centres on group sessions throughout the whole contact period. The model was developed by practicing child health nurses for a large health service district in south-east Queensland, which offers a comprehensive community child health service. Issues identified by clinicians working within existing services, feedback from clients and the need for more resource-efficient methods of service provision underpinned the development of the model. The pilot program was implemented in two community child health centres in Brisbane. An early individual consultation to engage the family with the service was added in response to feedback from clinicians and clients. The modified model has since been implemented service-wide as the ‘First Steps Program’. The introduction of this model has ensured that the service has been able to retain a comprehensive service for first-time parents from a universal population, while responding to the challenges of population growth and the increasing number of complex clients placing demands on resources.

Understanding Interventions and Outcomes in Mothers of Infants

The first two years after an infant's birth is a time of transition for mothers as changes in roles, responsibilities, expectations, and behaviors occur in response to the demands of caring for newborn infants and young children. Mothers play pivotal roles in overall child development and health and may benefit from nursing intervention that assists in the transition to motherhood. A review of the intervention literature related to the promotion of effective mothering was performed in order to examine the range of interventions and evidence of their usefulness for maternal-child and pediatric nursing practice. Five broad categories of interventions appropriate for nursing practice were identified through the literature review. Home visiting, skin-to-skin contact, individual, infant-focused education/counseling, and theory-based group intervention have a specific applicability for the promotion of mothering in particular populations of mothers. Based on the evidence, nurses can incorporate selected strategies into nursing care to promote effective mothering during the first years of a child's life.

Reconceptualizing the nurse's role in the newborn period as an "attacher"

In the first few days and weeks after a child's birth, attachment is a major task for the mother and her newborn. Success in this long-term psychological process is associated with positive life-long outcomes for both the parenting mother and her child. This article proposes a relational approach to newborn nursing grounded in the principles of attachment theory. Understanding this "attacher" approach can benefit nurses by bringing a gratifying depth to their practice and can benefit families by helping mothers and newborns address the most compelling task before them.

Development of Relationship Competencies Through Guided Participation for Mothers of Preterm Infants

OBJECTIVE

To explore the effects of a guided participation (GP) intervention on mothers' development of competencies in relating to their preterm infants in neonatal intensive-care units.

DESIGN

Mothers were enrolled in a randomized, longitudinal clinical trial to compare the effectiveness of GP with standard care teaching. Baseline data were collected when the infants were 29 weeks postconceptional age. The intervention (GP or standard care teaching) was administered, and relationship competencies were assessed through observation once per week for the next 6 weeks.

SETTING

Two neonatal intensive-care units in the Midwest.

PARTICIPANTS

A convenience sample of 16 mothers of low-birthweight infants, 8 in each group.

INTERVENTIONS

GP of mothers in relating to their infants in the context of caregiving activities was compared with standard care teaching.

RESULTS

Mothers in the GP group had expectations and intentions that were more attuned and adaptive to their infants' needs. In addition, the GP group was consistently higher in relationship competencies than the standard care teaching group.

CONCLUSIONS

GP can effectively support mothers in developing relationships with their preterm infants in the context of neonatal intensive-care unit caregiving activities.

Minor illness education for parents of young children

BACKGROUND

A number of previous studies on minor illness have concentrated on nurse-led clinics and the role of nurse practitioners. This study examines the effect of a minor illness education programme which aimed to increase parents' confidence and knowledge in managing childhood illnesses.

AIM

The primary aim of this study was to evaluate the effectiveness of a home visit and booklet in providing education to parents about minor infant illnesses.

DESIGN

A randomized controlled trial was conducted. The intervention involved a home visit to discuss parents' concerns and provide advice and information, and a booklet advising parents what to do and when to consult about infant illnesses.

METHOD

A total of 120 parents of 6 week old babies were identified over a 6 month period, using health visitors' caseloads, and randomized to an intervention group (60), that received a visit and a booklet, or a control group (60) that received standard care. Groups were compared on entry to the study and at 7 months, in terms of parental knowledge and confidence about childhood illnesses, the intended use of home care activities, intention to consult professionals and actual use of health services. Data were collected by self-completed questionnaire and case note review.

FINDINGS

The educational intervention resulted in a reduction in visits to the child health clinic but had little effect on use of other services. Parents in the intervention group showed a general trend towards greater certainty about the home care options they would choose, and a reduction in intention to consult a doctor. However, they also indicated a feeling of reduced confidence and knowledge.

CONCLUSION

The trial showed no effect on use of services but did demonstrate reduction in parents' intentions to consult a doctor, which appeared to be because of increased certainty about home care. However, it is of concern that they indicated feeling less confident and knowledgeable. It is not possible to clarify whether this represented anxiety that was constructive, enhancing decision-making or was destructive. Further work into the role of education in parental decision-making, anxiety levels and enhancement of confidence is required.

Change in maternal concerns during the 6 weeks postpartum period: a study of primaparous mothers in Dar es Salaam, Tanzania

The purpose of this study was to describe the postpartum concerns of primiparas. A cohort study included 79 mothers in Dar es Salaam, Tanzania. Mothers sorted topics into worry, interest, and confidence. Trends of decreasing worry and increasing interest and confidence for baby-related and mother-related topics were observed from 1 to 6 weeks. At 1 week mothers worried about baby's eyes, respiration, temperature, safety, and crying; but, at 6 weeks only crying was a problem. Need for information was constant about general health, baby behavior, and care of the baby. At 1 week mothers worried about swollen perineum, and feeling tired and nervous. They wanted information about preventing hemorrhage and infection and taking care of the perineum, breasts, and nipples. Trends of increasing worry and decreasing confidence were observed with respect to family relationships. At 6 weeks, mothers worried about the husband/partner's reaction to themselves and to the baby. Confidence in relatives' reaction to themselves and the baby decreased. Being aware of the changes in the way concerns are expressed may guide nursing/midwifery interventions for mothers as to the content and timing.