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Sæther KM, Holmberg Fagerlund B, Glavin K, Jøranson N. First-Time Parents' Support Needs and Perceived Support From a Child Health Service With the Integrated New Families Home Visiting Programme. QUALITATIVE HEALTH RESEARCH 2024; 34:20-32. [PMID: 37923302 PMCID: PMC10714706 DOI: 10.1177/10497323231208972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The transition to parenthood is complex and influenced by interacting factors related to society, the parents and the child. Professional support is considered to be one of the societal factors affecting this transition by facilitating parents' sense of confidence and their competence as parents. In this study, we aimed to explore first-time parents' support needs and experiences of support from a child health service with the integrated New Families home visiting programme, in the context of their transition to parenthood in the first year postnatally. Interpretive description guided this qualitative study. Six couples and one mother, all well-educated and employed, were interviewed individually (N = 13). The parents were recruited from the research project 'New Families - Innovation and Development of the Child Health Service in Oslo'. We found that being a first-time parent is perceived as overwhelming and that defining support needs may be challenging, particularly in the first period postnatally. In addition, the support needs are constantly changing due to the complexity of interacting factors and the ongoing development of confidence in the parental role. Retrospectively, the parents were satisfied overall with the support from the child health service. The home visit during pregnancy facilitated management and relational and informational continuity. However, we identified a need for even more proactive information provision and communication to optimise the service's availability and efficiency postnatally. In addition, the importance of peers and of approaching both mothers and fathers must be acknowledged in facilitating parental confidence.
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Affiliation(s)
| | | | - Kari Glavin
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| | - Nina Jøranson
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
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Brekke M, Småstuen MC, Glavin K, Amro A, Solberg B, Øygarden AMU, Sæther KM, Haugland T. The impact of New Families home visiting program on first-time mothers' quality of life and its association with social support: a non-randomized controlled study. BMC Public Health 2023; 23:2457. [PMID: 38066502 PMCID: PMC10704737 DOI: 10.1186/s12889-023-17285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The transition to motherhood is characterized by physical, psychological, social, and relational changes. Quality of life (QoL) changes substantially during this transition. Higher QoL is associated with social support, essential for coping with the challenges and changes of becoming a mother. An early universal home visiting program (New Families) is developed to strengthen and support families. The study aims to evaluate the impact of New Families on first-time mothers' QoL and to investigate the association between their QoL, social support, and selected possible predictive factors. METHODS A prospective non-randomized controlled study with parallel group design. Child Health Services in five city districts of Oslo were matched in intervention and control groups. First-time mothers were allocated based on the residential area and assessed at pregnancy week 28 (N = 228), six weeks postpartum (N = 184), and three months postpartum (N = 167). Measures of the World Health Organization Quality of Life brief, Perinatal Infant Care Social Support Scale, and background variables were collected from October 2018 to June 2020. Multivariate linear regression models were applied to examine intervention impact and assess associations. RESULTS Our data did not reveal a significant association between New Families intervention and the QoL levels of first-time mothers at three months postpartum. Thus, we analyzed the whole sample together. Emotional support was significantly associated with higher QoL levels in the physical health (B = 0.19, 95%CI [0.04 to 0.34]) and social relationships (B = 0.40, 95%CI [0.20 to 0.60]) domains. Appraisal support was significantly associated with higher QoL levels in the psychological (B = 0.34, 95%CI [0.18 to 0.50]) and environment (B = 0.33, 95%CI [0.19 to 0.48]) domains. QoL levels in pregnancy were significantly associated with QoL levels postpartum, showing small to medium effect size (ES = 0.30 to 0.55), depending on the domain. CONCLUSIONS Further research, including qualitative interviews, could provide more insights into the impact of New Families on QoL. A positive association between QoL levels in pregnancy and postpartum suggests that postnatal interventions targeting improved QoL could potentially improve postpartum QoL. Emotional and appraisal support seems beneficial for first-time mothers' QoL and could be provided and facilitated by public health nurses. TRIAL REGISTRATION clinicaltrial.gov NCT04162626.
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Affiliation(s)
- Malene Brekke
- Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway.
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway.
| | - Milada Cvancarova Småstuen
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
- Oslo Metropolitan University, Oslo, Norway
| | - Kari Glavin
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
| | - Amin Amro
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
| | - Beate Solberg
- Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway
| | | | - Kristin Marie Sæther
- Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
| | - Trude Haugland
- Faculty of Health Sciences, VID Specialized University, Postboks 184 Vinderen, Oslo, 0319, Norway
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Leirbakk MJ, Engebretsen E, Dolvik S, Bratli E, Wiborg K, Magnus JH. Changing praxis from within - an in-depth qualitative exploration of how home visits affected statutory service at a Child Health Clinic. J Pediatr Nurs 2023; 72:e27-e32. [PMID: 37349227 DOI: 10.1016/j.pedn.2023.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE This study aims to define critical domains of salutogenic home visits conducted by public health nurses, and how thevisits can supplement a universal Child Health Clinic. DESIGN AND METHOD A qualitative grounded theory study was conducted among three public health nurses in Stovner district, Oslo, Norway. The nurses were followed for 26 months offering home visits to all first-time parents. Data from focus group discussions, monthly reflection notes and bi-weekly meeting minutes were analysed using qualitative content analysis. RESULTS Three critical themes emerged: building trust, prenatal visits and maintaining a salutogenic, strength-based approach. Extended public health nurse autonomy facilitated tailored support based on individual family needs. This promoted proportionate universalism to naturally be the gradient of the home visit intensity and kept actions at a universal level. CONCLUSIONS The key component of family access and utilizing support was building and maintaining trust. Conducting prenatal visits was an important part of the nurse-family relationship, positively affecting later Child Health Clinic follow-up and continued care. PRACTICE IMPLICATIONS Critical domains and benefits of practicing home visits emerged in this study and disclosed important aspects necessary for family access and utilizing support. By changing the point of entry from postnatal to prenatal, public health nurses-family relationship gets an important head start, positively affecting later follow-up and continued care. A tailored support to new families without using a predefined agenda and a salutogenic, strength-based philosophy can fit the public health nurses' professional beliefs and extend their autonomy.
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Affiliation(s)
- Maria J Leirbakk
- City of Oslo, Department of Health, 0985 Oslo, Norway; University of Oslo, Department of Health and Sciences, Harald Schjelderups hus, Forskningsveien 3a, 0373 Oslo, Norway.
| | - Eivind Engebretsen
- University of Oslo, Department of Health and Sciences, Harald Schjelderups hus, Forskningsveien 3a, 0373 Oslo, Norway.
| | - Stina Dolvik
- City of Oslo, Department of Health, 0985 Oslo, Norway
| | - Elisabeth Bratli
- City of Oslo, District Stovner, Child health services, 0985 Oslo, Norway.
| | - Kersti Wiborg
- City of Oslo, District Stovner, Child health services, 0985 Oslo, Norway.
| | - Jeanette H Magnus
- University of Oslo, Management Section, Klaus Torgårds vei 3, Sogn Arena, 0372 Oslo, Norway.
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Høgmo BK, Alstveit M, Bondas T. Being a "Warrior" to Care for the New Family: A Meta-ethnography of Nurses' Perspectives on Municipal Postnatal Healthcare. Glob Qual Nurs Res 2023; 10:23333936231218843. [PMID: 38149124 PMCID: PMC10750548 DOI: 10.1177/23333936231218843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Care in the postnatal period is a goal for all families with a newborn baby, and support from nurses might prevent long-term health problems and contribute to a positive postnatal experience. This meta-ethnography aims to integrate and synthesize qualitative studies that illuminate and describe nurses' perspectives on municipal postnatal health care in high-income countries. Systematic literature searches for qualitative studies were conducted and 13 articles were included. The analysis followed the seven phases of Noblit and Hare. Being a "warrior" to care for the new family was identified as an overarching metaphor accompanied by three main themes: Stretching human boundaries, Stretching system boundaries, and Stretching knowledge boundaries. The overarching metaphor offers a deeper understanding of the nurses as "warriors" who despite tight timeframes and heavy workloads are stretching toward a caring relationship with the families. Being a warrior continuously pushing system boundaries puts the nurses in risk of being overstretched, balancing between their ideals and the reality. As more knowledge and clearer policies and procedures regarding the inclusion of fathers and LGBTQ parents in municipal postnatal healthcare are needed, more focus placed on the father or non-birthing parent, different cultural traditions and family constellations in practice and education is suggested.
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Dol J, Hughes B, Tomblin Murphy G, Aston M, McMillan D, Campbell-Yeo M. Canadian Women's Experience of Postnatal Care: A Mixed Method Study. Can J Nurs Res 2022; 54:497-507. [PMID: 34704508 PMCID: PMC9596944 DOI: 10.1177/08445621211052141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The postnatal period remains unstandardized in terms of care and postnatal visits with a dearth of information on the experience from Canadian women. PURPOSE To explore (1) with whom and how often women receive postnatal follow-up visits and (2) the postnatal care experiences of Canadian mothers. METHODS Using a cross-sectional design, women who had given birth within the past 6 months were recruited to complete an online survey. Frequencies were computed for quantitative outcomes and thematic analysis was used for qualitative responses. RESULTS A total of 561 mothers completed the survey. Women saw on average 1.9 different postnatal healthcare providers, primarily family doctors (72.4%). 3.2% had no postnatal visits and 37.6% had 4 or more within 6 weeks. 76.1% women were satisfied with their postnatal care. Women's satisfactory care in the postnatal period was associated with in-person and at home follow-ups, receiving support, and receiving timely, appropriate care for self and newborn. Unsatisfactory care was associated with challenges accessing care, experiencing gaps in follow-up visits, and having unsatisfactory assessment for their own recovery. CONCLUSION There is considerable variation in the timing and frequency of postnatal visits. While many women are experiencing satisfactory care, women are still reporting dissatisfaction and are facing challenges.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Brianna Hughes
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Megan Aston
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Douglas McMillan
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
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Mothers' Experiences with Child Protection Services: Using Qualitative Feminist Poststructuralism. NURSING REPORTS 2021; 11:913-928. [PMID: 34968278 PMCID: PMC8715453 DOI: 10.3390/nursrep11040084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The postpartum period is often portrayed as a blissful, calm and loving time when mothers, partners and family members bond with their newborn babies. However, this time may be experienced quite differently when mothers are monitored by Child Protection Services. Having a baby under these circumstances can be very difficult and traumatizing. While all new parents require support and information to help them through the transition to parenthood and address physical and psycho-social changes, mothers who are involved with Child Protection Services require more specialized support as they encounter higher incidences of postpartum stressors and higher rates of poverty, mental illness and substance abuse. The impact of support for mothers involved with Child Protection Services is not well-understood from the perspective of mothers. AIM The aim of the study was to understand how new mothers in Nova Scotia prioritized their postpartum needs and where they went to obtain information and support. METHODS Feminist poststructuralism was the methodology used to understand how the experiences of five mothers who accessed a family resource center and had been involved with Child Protection Services in Nova Scotia Canada had been personally, socially and institutionally constructed. RESULTS Themes include: (1) We are Mothers, (2) Being Red Flagged, (3) Lack of Trust, (4) Us Against Them and (5) Searching for Supportive Relationships. CONCLUSION Personal stories from all participants demonstrated how they experienced stigma and stereotypes from healthcare workers and were often not recognized as mothers. They also struggled to find information, supports and services to help them keep or regain their babies.
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Giltenane M, Sheridan A, Kroll T, Frazer K. Identifying the role of public health nurses during first postnatal visits: Experiences of mothers and public health nurses in Ireland. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2020.100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Giltenane M, Sheridan A, Kroll T, Frazer K. Work environment challenging Irish public health nurses' care quality: First postnatal visit. Public Health Nurs 2021; 39:202-213. [PMID: 34672017 DOI: 10.1111/phn.12993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Exploring views and experiences of public health nurses of their work environment and measurement of care practices at first postnatal visits. DESIGN An exploratory qualitative design. Data collected using four focus groups and analyzed using thematic analysis. SAMPLE Nineteen public health nurses from four health service regions in Ireland participated. RESULTS Two themes emerged. Theme one identified "challenges of providing a quality service." Public health nurses identified workload demands and that the working environment can detract from the ability to provide a quality service. Challenges within the home, language barriers, and lack of support from management were key issues. Theme two identified "challenges of measuring quality of public health nursing practice." While Measuring practice through quantitative outcomes such as key performance indicators were viewed as inadequate to measure the quality of care provided, positive views of using quality process indicators to measure the quality of their practice emerged. CONCLUSIONS Key issues concern the working environment of public health nurses and challenges of providing and measuring care practices. Absence of appropriate supports and resources means public health nurses work hard to provide quality care. Public health nurses were confident they would score high on quality process measurements of their practice.
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Affiliation(s)
- Martina Giltenane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Ann Sheridan
- Mental Health. Subject Head-Mental Health Nursing, Irish Institute of Mental Health Nursing, UCD School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
| | - Thilo Kroll
- Health Systems Management, Research, Innovation and Impact, UCD School of Nursing, Midwifery and Health Systems, UCD Geary Institute for Public Policy, UCD Health Sciences Centre, University College Dublin (UCD), Belfield, Dublin, Ireland
| | - Kate Frazer
- Public Health and Community Nursing, European Academy Nursing Science, UCD Geary Institute Public Policy, UCD School of Nursing, Midwifery and Health Systems, UCD College of Health and Agricultural Sciences, Belfield, Dublin, Ireland
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Postpartum women's experiences of social and healthcare professional support during the COVID-19 pandemic: A recurrent cross-sectional thematic analysis. Women Birth 2021; 35:511-520. [PMID: 34756734 PMCID: PMC8553649 DOI: 10.1016/j.wombi.2021.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
Problem Disrupted access to social and healthcare professional support during the COVID-19 pandemic have had an adverse effect on maternal mental health. Background Motherhood is a key life transition which increases vulnerability to experience negative affect. Aim Explore UK women’s postnatal experiences of social and healthcare professional support during the COVID-19 pandemic. Methods Semi-structured interviews were conducted with 12 women, approximately 30 days after initial social distancing guidelines were imposed (T1), and a separate 12 women were interviewed approximately 30 days after the initial easing of social distancing restrictions (T2). Recurrent cross-sectional thematic analysis was conducted in NVivo 12. Findings T1 themes were, ‘Motherhood has been an isolating experience’ (exacerbated loneliness due to diminished support accessibility) and ‘Everything is under lock and key’ (confusion, alienation, and anxiety regarding disrupted face-to-face healthcare checks). T2 themes were, ‘Disrupted healthcare professional support’ (feeling burdensome, abandoned, and frustrated by virtual healthcare) and ‘Easing restrictions are bittersweet’ (conflict between enhanced emotional wellbeing, and sadness regarding lost postnatal time). Discussion Respondents at both timepoints were adversely affected by restricted access to informal (family and friends) and formal (healthcare professional) support, which were not sufficiently bridged virtually. Additionally, the prospect of attending face-to-face appointments was anxiety-provoking and perceived as being contradictory to social distancing guidance. Prohibition of family from maternity wards was also salient and distressing for T2, but not T1 respondents. Conclusion Healthcare professionals should encourage maternal help-seeking and provide timely access to mental health services. Improving access to informal and formal face-to-face support are essential in protecting maternal and infant wellbeing.
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Blessings and Curses: Exploring the Experiences of New Mothers during the COVID-19 Pandemic. NURSING REPORTS 2020; 10:207-219. [PMID: 34968364 PMCID: PMC8608056 DOI: 10.3390/nursrep10020023] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to explore the postpartum experiences of new parents during the COVID-19 pandemic. The postpartum period can be a time of significant transition, both positive and negative, for parents as they navigate new relationships with their babies and shifts in family dynamics. Physical distancing requirements mandated by public health orders during the COVID-19 pandemic had the potential to create even more stress for parents with a newborn. Examining personal experiences would provide health care professionals with information to help guide support during significant isolation. Feminist poststructuralism guided the qualitative research process. Sixty-eight new mothers completed an open-ended on-line survey. Responses were analyzed using discourse analysis to examine the beliefs, values, and practices of the participants relating to their family experiences during the pandemic period. It was found that pandemic isolation was a time of complexity with both ‘blessings and curses’. Participants reported that it was a time for family bonding and enjoyment of being a new parent without the usual expectations. It was also a time of missed opportunities as they were not able to share milestones and memories with extended family. Caring for a newborn during the COVID-19 pandemic where complex contradictions were constructed by competing social discourses created difficult dichotomies for families. In acknowledging the complex experiences of mothers during COVID-19 isolation, nurses and midwives can come to understand and help new parents to focus on the blessings of this time while acknowledging the curses.
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McLeish J, Harvey M, Redshaw M, Alderdice F. A qualitative study of first time mothers' experiences of postnatal social support from health professionals in England. Women Birth 2020; 34:e451-e460. [PMID: 33153952 PMCID: PMC8396053 DOI: 10.1016/j.wombi.2020.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 10/28/2022]
Abstract
PROBLEM Many women experience the transition to motherhood as stressful and find it challenging to cope, contributing to poor emotional wellbeing. BACKGROUND Postnatal social support from health professionals can support new mothers in coping with this transition, but their social support role during the postnatal period is poorly defined. AIM To explore how first time mothers in England experienced social support from health professionals involved in their postnatal care. METHODS A qualitative descriptive study, theoretically informed by phenomenological social psychology, based on semi-structured, in-depth interviews with 32 mothers from diverse backgrounds. These were analysed using inductive thematic analysis, with themes subsequently mapped on to the four dimensional model of social support (emotional, appraisal, informational, practical). FINDINGS There were nine themes connected to social support, with the strongest mapping to appraisal and informational support: for appraisal support, 'Praise and validation', 'Criticism and undermining', and 'Made to feel powerless'; for informational support, 'Is this normal?', 'Need for proactive information', and 'Confusion about postnatal care'; for emotional support, 'Treated as an individual and heard' and 'Impersonal care and being ignored'; for practical support, 'Enabling partners to provide practical support'. CONCLUSIONS Health professionals can play an important role postnatally in helping first time mothers to cope, develop confidence and to thrive, by taking every opportunity to give appropriate and personalised appraisal, informational and emotional social support alongside clinical care. Training and professional leadership may help to ensure that all health professionals are able and expected to offer the positive social support already offered by some.
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Affiliation(s)
- Jenny McLeish
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK.
| | - Merryl Harvey
- School of Nursing and Midwifery, City South Campus, Birmingham City University, Westbourne Road, Birmingham B15 3TN, UK
| | - Maggie Redshaw
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK
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Sunkwa-Mills G, Rawal L, Enweronu-Laryea C, Aberese-Ako M, Senah K, Tersbøl BP. Perspectives and practices of healthcare providers and caregivers on healthcare-associated infections in the neonatal intensive care units of two hospitals in Ghana. Health Policy Plan 2020; 35:i38-i50. [PMID: 33165583 PMCID: PMC7649666 DOI: 10.1093/heapol/czaa102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 12/17/2022] Open
Abstract
Healthcare-associated infections (HAIs) remain a serious threat to patient safety worldwide, particularly in low- and middle-income countries. Reducing the burden of HAIs through the observation and enforcement of infection prevention and control (IPC) practices remains a priority. Despite growing emphasis on HAI prevention in low- and middle-income countries, limited evidence is available to improve IPC practices to reduce HAIs. This study examined the perspectives of healthcare providers (HPs) and mothers in the neonatal intensive care unit on HAIs and determined the major barriers and facilitators to promoting standard IPC practices. This study draws on data from an ethnographic study using 38 in-depth interviews, four focus group discussions and participant observation conducted among HPs and mothers in neonatal intensive care units of a secondary- and tertiary-level hospital in Ghana. The qualitative data were analysed using a grounded theory approach, and NVivo 12 to facilitate coding. HPs and mothers demonstrated a modest level of understanding about HAIs. Personal, interpersonal, community, organizational and policy-level factors interacted in complex ways to influence IPC practices. HPs sometimes considered HAI concerns to be secondary in the face of a heavy clinical workload, a lack of structured systems and the quest to protect professional authority. The positive attitudes of some HPs, and peer interactions promoted standard IPC practices. Mothers expressed interest in participation in IPC activities. It however requires systematic efforts by HPs to partner with mothers in IPC. Training and capacity building of HPs, provision of adequate resources and improving communication between HPs and mothers were recommended to improve standard IPC practices. We conclude that there is a need for institutionalizing IPC policies and strengthening strategies that acknowledge and value mothers' roles as caregivers and partners in IPC. To ensure this, HPs should be better equipped to prioritize communication and collaboration with mothers to reduce the burden of HAIs.
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Affiliation(s)
- Gifty Sunkwa-Mills
- Ghana Health Service, Central Region, Ghana
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - Lal Rawal
- School of Health Medical and Applied Sciences, CQUniversity, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | | | - Matilda Aberese-Ako
- Institute of Health Research, University of Health and Allied Sciences, Ghana
| | - Kodjo Senah
- Department of Sociology, University of Ghana, Accra, Ghana
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Lines MLE, Grant JM, Hutton A. 'How can we work together?' Nurses using relational skills to address child maltreatment in Australia: A qualitative study. J Pediatr Nurs 2020; 54:1-9. [PMID: 32473486 DOI: 10.1016/j.pedn.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nurses working with children often encounter child maltreatment. Nurses' roles in mandatory reporting are well-documented, but less is known about additional ways nurses respond to child maltreatment. This is important because children experiencing less extreme maltreatment may have unmet needs without receiving a child protection intervention. OBJECTIVES This paper reports one key finding from a qualitative study exploring nurses' perceptions and experiences of keeping children safe from maltreatment. Specifically, it reports nurses' perspectives of their relational skills used to support children experiencing maltreatment. DESIGN AND METHODS Qualitative inductive thematic analysis followed by a secondary analysis using a social constructionist framework. Data were collected through in-depth, semi-structured interviews and data saturation was achieved. Transcripts were inductively analysed with support of NVivo software. PARTICIPANTS Registered nurses (n = 21) working with children in Australia. RESULTS Nurses saw relational practice as core to addressing child maltreatment. Key themes were: 1) 'Walking the line': relationships in the context of surveillance, 2) 'You are a good mum': focusing on the positives and 3) Seeing and being the voice of the child. CONCLUSIONS Nurses are uniquely positioned to identify and respond to child maltreatment through relational practices. Nurses maintained therapeutic relationships with parents to ensure ongoing access to vulnerable children. Although nurses recognised the importance of a child-centred approach, its enactment was varied and required ongoing critical reflection. This highlights the importance of supporting nurses to develop, maintain and continually improve their relational practices to enhance outcomes for children.
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Affiliation(s)
| | - Julian Maree Grant
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia; School of Nursing, Midwifery & Indigenous Health, Charles Sturt University, Bathurst, New South Wales, Australia.
| | - Alison Hutton
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia; School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.
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Kett PM. The individual focus of nursing research in breastfeeding: Perpetuating a neoliberal perspective. Public Health Nurs 2020; 37:281-286. [PMID: 31965619 DOI: 10.1111/phn.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 01/14/2023]
Abstract
In this paper, I argue for the need to shift the focus of nursing research regarding breastfeeding from that of individual responsibility to include a more system-focused, population health approach. In the 2011, "Call to Action to Support Breastfeeding," the U.S. Surgeon General called attention to the pervasive disparities in breastfeeding outcomes in the United States. A plethora of nursing research exists aimed at addressing these disparities; however, this research leans toward a neoliberal perspective, mainly focusing on individual factors and failing to address the systemic inequities contributing to these disparities. A shift in nursing science that focuses research at a population level would more effectively support addressing disparities in breastfeeding outcomes and embrace a commitment to social justice. In focusing at a population level, specific inequities that must be addressed include the negative history of breastfeeding in the Black population, systemic racism, and gender inequality. Critical research methodologies are proposed as useful approaches to address these inequities. By engaging in this level of research and using a critical lens, nurse scientists broaden their scope of care to include the entire population, motivate needed social and policy change, facilitate the choice to breastfeed, and ultimately eliminate breastfeeding disparities.
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Affiliation(s)
- Paula M Kett
- School of Nursing, University of Washington, Seattle, WA, USA
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15
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Giraldo Osorio A, Betancurth Loaiza DP, Castillo LO, Mejía Alarcón AM. Fundamentación de la visita domiciliaria desde un enfoque de enfermería familiar y cultural. ACTA ACUST UNITED AC 2020. [DOI: 10.22463/17949831.1624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introducción: la visita domiciliaria permite el abordaje de la salud desde un enfoque biopsicosocial y de determinantes sociales. El objetivo fue analizar la evidencia científica sobre las teorías, modelos y enfoques para la enfermería familiar y cultural que permitan la fundamentación de la visita domiciliaria. Metodología: se realizó una investigación documental entre 2007 y 2017 en inglés, español y portugués; sobre bases de datos de salud y de ciencias sociales y humanas. Los términos utilizados fueron: teoría de enfermería, visita domiciliaria, cuidado de enfermería, cultura, familia. Se hallaron 671 artículos científicos. Para el análisis se utilizó el software Atlas ti. Resultados: El concepto de visita domiciliaria se configura desde una visión plural, se destaca la inclusión de una dimensión política y se plantea la necesidad de trascender el predominante modelo médico hegemónico y proponer la visita desde un abordaje comprensivo y cultural. Conclusiones: se identificaron teorías/modelos de enfermería y de psicología utilizados en el abordaje de la visita domiciliaria desde un enfoque familiar y cultural. Prima el modelo biomédico, por lo que se plantean enfoques alternativos para la praxis y es relevante profundizar sobre los postulados de la teoría de la diversidad y universalidad: cuidados culturales propuesta por Madeleine Leininger.
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Walker SB, Rossi DM, Sander TM. Women's successful transition to motherhood during the early postnatal period: A qualitative systematic review of postnatal and midwifery home care literature. Midwifery 2019; 79:102552. [PMID: 31605940 DOI: 10.1016/j.midw.2019.102552] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To undertake a systematic review of available qualitative research literature to determine what women need to successfully transition to motherhood during the early postnatal period and whether postnatal home care delivered by midwives supports this process. DESIGN The transition from woman to mother is a significant occurrence, one that requires adjustments on physical, psychological and social levels. A qualitative systematic review design was chosen to ensure both humanistic and interactive concepts related to what women need to successfully transition to motherhood during the early postnatal period were identified. The systematic and structured search uncovered 33 research articles for detailed review. Two team members, using the qualitative research checklist from the Critical Appraisal Skills Programme, appraised the quality of the research articles. A total of 19 articles met the quality criteria and were included in the data evaluation process. SETTING AND PARTICIPANTS Research teams from Asia-Pacific, Europe, Middle East and North America generated the 19 qualitative journal articles. MEASUREMENTS AND FINDINGS Data evaluation included identification of research aim, presence of a research question, type of methodology, data collection processes, sample information, data analysis techniques and study outcomes. Data was analysed using an inductive content analysis approach. Four themes were identified from the qualitative systematic review process including: women and midwives connecting, identification and meeting of women's individual needs, family and cultural influences and, education and support. KEY CONCLUSIONS The ability of women to connect with midwives during the early postnatal period assisted them overcome barriers and to successfully transitioning to motherhood. Although all four themes were determined to be key to effective postnatal transition, overwhelmingly the findings showed postnatal midwifery home care to be important in women's successful transition to motherhood in the early postnatal period. IMPLICATIONS FOR PRACTICE Strategies are needed ensure women have access to midwives in the early postnatal period.
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Affiliation(s)
- Sandra B Walker
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Bruce Highway, Rockhampton, Queensland 4702, Australia.
| | - Dolene M Rossi
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Bruce Highway, Rockhampton, Queensland 4702, Australia.
| | - Teresa M Sander
- Maternity Unit Rockhampton Hospital, Canning Street, Rockhampton, Queensland 4700, Australia
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17
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Ollivier R, Aston M, Price S. Let's talk about sex: A feminist poststructural approach to addressing sexual health in the healthcare setting. J Clin Nurs 2018; 28:695-702. [PMID: 30302844 DOI: 10.1111/jocn.14685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/17/2018] [Accepted: 09/15/2018] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore the use of feminist poststructuralism (FPS) as a way to critique, understand and improve sexual health care and policy in healthcare settings. BACKGROUND Sexual health is an important aspect of health; however, in healthcare settings, it often goes unaddressed by both healthcare providers and patients due to stigma, taboo, fear of embarrassment or uncertainty. Lack of attention to sexual health has been stated as a legitimate concern for patients across the lifespan; there remain gaps in implementing sexual health care discussions into practice in healthcare settings. DESIGN A critical analysis will be presented to explore sexual health care and attitudes in the healthcare setting from patient and nursing perspectives using FPS. METHODS Feminist poststructuralism is used to examine the meaning of experience that is personally, socially and institutionally constructed through relations of power. FPS will also be applied to understand how sexual health discourses are negotiated in healthcare settings. SQUIRE guidelines were used in the preparation of this paper (See Appendix S1). RELEVANCE TO CLINICAL PRACTICE The application of a feminist poststructural lens to sexual health care in healthcare settings may be used by healthcare professionals to understand, question and challenge how social and institutional beliefs, values and practices surrounding sexual health, inclusive of a patient's sexual pleasure or sexual activity, are experienced by healthcare professionals and patients. This theoretical and methodological approach could lead to identifying possibilities for change in healthcare settings that are inclusive and supportive of sexual health care.
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Affiliation(s)
- Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheri Price
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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18
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Price SL, Aston M, Monaghan J, Sim M, Tomblin Murphy G, Etowa J, Pickles M, Hunter A, Little V. Maternal Knowing and Social Networks: Understanding First-Time Mothers' Search for Information and Support Through Online and Offline Social Networks. QUALITATIVE HEALTH RESEARCH 2018; 28:1552-1563. [PMID: 29281945 DOI: 10.1177/1049732317748314] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The postpartum period is an exciting yet stressful time for first-time mothers, and although the experience may vary, all mothers need support during this crucial period. In Canada, there has been a shift for universal postpartum services to be offered predominantly online. However, due to a paucity of literature, it is difficult to determine the degree to which mothers' needs are being effectively addressed. The aim of this study was to examine and understand how first-time mothers accessed support and information (online and offline) during the first 6 months of their postpartum period. Using feminist poststructuralism methodology, data were collected from focus groups and e-interviews, and analyzed using discourse analysis. Findings indicate that peer support is greatly valued, and mothers often use social media to make in-person social connections. Findings highlight how accessing support and information is socially and institutionally constructed and provide direction for health professionals to provide accessible postpartum care.
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Affiliation(s)
| | - Megan Aston
- 1 Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Meaghan Sim
- 1 Dalhousie University, Halifax, Nova Scotia, Canada
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Susanto T, Arisandi D, Kumakura R, Oda A, Koike M, Tsuda A, Kimura R, Tabuchi N, Sugama J. Development and Testing of the Family Structure and Family Functions Scale for Parents Providing Adolescent Reproductive Health Based on the Friedman Family Assessment Model. J Nurs Meas 2018; 26:217-236. [DOI: 10.1891/1061-3749.26.2.217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose:To describe the development and testing of a psychometric of Family Structure and Functions (FSF) that measures parents’ ability to provide adolescent reproductive health (ARH).Methods:A cross-sectional study of Indonesian parents (n = 525). Multifactors FSF-ARH were examined using construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]) and content validity (Content Validity Index [CVI]). Internal consistency was explored using Cronbach’s α coefficient.Results:EFA revealed nine factors with 26 items accounting for 61.64% of explained variance and CFA validity testing fit for the construct validity of FSF-ARH. The CVI indicated adequate content validity (0.80–0.10) and acceptable internal consistency (0.70).Conclusions:FSF-ARH contains valid, reliable, and robust measures although some subscales performed moderate reliability, establishing the purpose for further research.
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20
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Richardson B, Goldberg L, Aston M, Campbell-Yeo M. eHealth versus equity: Using a feminist poststructural framework to explore the influence of perinatal eHealth resources on health equity. J Clin Nurs 2018; 27:4224-4233. [PMID: 29964310 DOI: 10.1111/jocn.14592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/28/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022]
Abstract
AIMS AND OBJECTIVES To explore whether and how eHealth resources targeted to families during the perinatal period effectively reach a diverse population or further oppress marginalised groups. BACKGROUND eHealth is often intended to reach a broad population, thus health content must be relatively generalised which limits the ability to tailor health education and interventions to individual needs. Generalisation of health information has historically represented a hegemonic depiction of the health consumer, especially within the perinatal period, often disregarding the diversity that exists in the world and perpetuating heteronormative constructs within healthcare systems as a result. DESIGN A critical review of the literature regarding perinatal eHealth resources was conducted using a feminist poststructuralist approach for analysis. Included literature addresses the development, implementation and/or evaluation of perinatal eHealth resources. DISCUSSION This approach uncovered hegemonic discourses related to the current state of perinatal eHealth resources. Nurses and midwives have the unique advantage of interacting and understanding diverse populations. Thus, nurses and midwives are integral to the development, implementation and evaluation of eHealth resources to reduce social health inequity. RELEVANCE TO CLINICAL PRACTICE This paper acts as an exemplar on how to apply feminist poststructuralism to highlight inequities that exist and identifies strategies for nurses and midwives to become involved in the development of eHealth resources or advocate for greater visibility within current resources.
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Affiliation(s)
- Brianna Richardson
- Dalhousie University School of Nursing, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Lisa Goldberg
- Dalhousie University School of Nursing, Halifax, NS, Canada
| | - Megan Aston
- Dalhousie University School of Nursing, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- Dalhousie University School of Nursing, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
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21
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Aston M, Price S, Monaghan J, Sim M, Hunter A, Little V. Navigating and negotiating information and support: Experiences of first-time mothers. J Clin Nurs 2018; 27:640-649. [PMID: 28722771 DOI: 10.1111/jocn.13970] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine how first-time mothers in Nova Scotia identified and prioritised their own postpartum needs and where they went for information and support, inclusive of informal or formal programmes and services, social media, family and friends. BACKGROUND The early postpartum period is an exciting, yet stressful life experience for first-time mothers. Mothers have often turned to families, friends and healthcare professionals for support and information; however, these social networks look differently today due to changes in institutional policies and postpartum healthcare practices, as well as the emergence of online resources and networks. There is currently limited understanding of how online resources have shifted mothers social networking practices and the degree to which programmes and resources are currently meeting the needs of mothers and families. METHODS Data were collected through focus group interviews in rural and urban Nova Scotia communities (n = 19) and online electronic interviews (n = 18). Data were analysed using feminist poststructuralism and discourse analysis to understand issues of inclusion and health equity for mothers and how relations of power were negotiated by first-time mothers in their search for support and information. RESULTS Most participants were savvy as they critiqued, compared, navigated and negotiated advice and information from various sources, including health professionals, family, friends and online forums. However, they unanimously wanted face-to-face support with other mothers and healthcare professionals. Participants enacted their agency to critically analyse information and support to ensure it matched their own beliefs, values and practices. CONCLUSIONS It is important to understand first-time mothers' practices and need for face-to-face support, as well as a need for further research with more diverse or marginalised demographics of mothers.
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Affiliation(s)
- Megan Aston
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheri Price
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joelle Monaghan
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Meaghan Sim
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Hunter
- Department of Journalism, Concordia University, Montreal, Quebec, Canada
| | - Victoria Little
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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22
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How Tanzanian Nurse-Midwives and Obstetricians Develop Postpartum Relationships With Women. INTERNATIONAL JOURNAL OF CHILDBIRTH 2018. [DOI: 10.1891/2156-5287.8.1.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nurse-midwives and obstetricians are the primary postpartum health-care providers for mothers and babies in Tanzania. It is imperative that mothers and babies receive adequate information and support in order to save lives. Feminist poststructuralism and discourse analysis were used to conduct and analyze 13 semi-structured interviews from nurse-midwives and obstetricians at three clinics in Dar es Salaam, Tanzania. Establishing friendly supportive relationships enabled nurse-midwives and obstetricians to work effectively with mothers postpartum. Participants explained the importance of including family members in postpartum care and about the strategies they used in a clinic environment that was not always supportive of including family. Effective relational maternity care focused on families during the postpartum period can facilitate the delivery of information and save lives.
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23
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Peckover S, Aston M. Examining the social construction of surveillance: A critical issue for health visitors and public health nurses working with mothers and children. J Clin Nurs 2017; 27:e379-e389. [PMID: 28815762 DOI: 10.1111/jocn.14014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada. BACKGROUND The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs. DESIGN We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings. METHODS Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance. RESULTS Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power. CONCLUSIONS Healthcare providers need to understand the different meanings and practices associated with surveillance to effectively inform practice. RELEVANCE TO CLINICAL PRACTICE Healthcare providers should be aware of how their positions of expert and privilege within healthcare systems affect relationships with mothers. A more comprehensive understanding of personal, social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families.
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Affiliation(s)
- Sue Peckover
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Megan Aston
- Dalhousie University School of Nursing, Halifax, Nova Scotia, Canada
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24
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Brownell MD, Nickel NC, Enns JE, Chartier M, Campbell R, Phillips-Beck W, Chateau D, Burland E, Santos R, Katz A. Association between home visiting interventions and First Nations families' health and social outcomes in Manitoba, Canada: protocol for a study of linked population-based administrative data. BMJ Open 2017; 7:e017626. [PMID: 29018072 PMCID: PMC5652461 DOI: 10.1136/bmjopen-2017-017626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION First Nations people are descendants of Canada's original inhabitants. In consequence of historical and ongoing structural injustices, many First Nations families struggle with challenging living conditions, including high rates of poverty, poor housing conditions, mental illness and social isolation. These risk factors impede caregivers' abilities to meet their children's basic physical and psychosocial needs. Home visiting programmes were developed to support child developmental health in families facing parenting challenges. However, whether home visiting is an effective intervention for First Nations families has not been examined. We are evaluating two home visiting programmes in Manitoba, Canada, to determine whether they promote nurturing family environments for First Nations children. METHODS AND ANALYSIS This research builds on new and established relationships among academic researchers, government decision-makers and First Nations stakeholders. We will link health, education and social services data from the Manitoba Population Research Data Repository to data from two home visiting programmes in Manitoba. Logistic regression modelling will be used to assess whether programme participation is associated with improved child developmental health, better connections between families and social services, reduced instances of child maltreatment and being taken into out-of-home care by child welfare and reduced inequities for First Nations families. Non-participating individuals with similar sociodemographic characteristics will serve as comparators. We will use an interrupted time series approach to test for differences in outcomes before and after programme implementation and a propensity score analysis to compare differences between participants and non-participants. ETHICS AND DISSEMINATION Approvals were granted by the Health Information Research Governance Committee of the First Nations Health and Social Secretariat of Manitoba and the University of Manitoba Health Research Ethics Board. Our integrated knowledge translation approach will involve disseminating findings through government and community briefings, developing lay summaries and infographics, presenting at academic conferences and publishing in scientific journals.
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Affiliation(s)
- Marni D Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nathan C Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Rhonda Campbell
- Maternal Child Health, First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Wanda Phillips-Beck
- Maternal Child Health, First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Elaine Burland
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Rob Santos
- Ministry of Education and Training, Healthy Child Manitoba, Manitoba Government, Winnipeg, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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25
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Ehrenthal DB, Gelinas K, Paul DA, Agiro A, Denemark C, Brazen AJ, Pollack M, Hoffman MK. Postpartum Emergency Department Visits and Inpatient Readmissions in a Medicaid Population of Mothers. J Womens Health (Larchmt) 2017; 26:984-991. [DOI: 10.1089/jwh.2016.6180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Deborah B. Ehrenthal
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Katie Gelinas
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David A. Paul
- Christiana Care Health System, Newark, Delaware
- Sidney Kimmel Medical College at Jefferson University, Philadelphia, Pennsylvania
| | | | - Cynthia Denemark
- Department of Health and Social Services, Division of Medicaid and Medical Assistance, State of Delaware, Dover, Delaware
| | - Anthony J. Brazen
- Department of Health and Social Services, Division of Medicaid and Medical Assistance, State of Delaware, Dover, Delaware
| | | | - Matthew K. Hoffman
- Christiana Care Health System, Newark, Delaware
- Sidney Kimmel Medical College at Jefferson University, Philadelphia, Pennsylvania
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26
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Searle J, Goldberg L, Aston M, Burrow S. Accessing new understandings of trauma-informed care with queer birthing women in a rural context. J Clin Nurs 2017; 26:3576-3587. [PMID: 28071870 DOI: 10.1111/jocn.13727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Participant narratives from a feminist and queer phenomenological study aim to broaden current understandings of trauma. Examining structural marginalisation within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships. BACKGROUND Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have an increased risk of trauma due to structurally marginalising processes that create and maintain socially constructed differences. DESIGN Analysis of the qualitative data was guided by feminist and queer phenomenology. This was well suited to understanding queer women's storied narratives of trauma, including disempowering processes of structural marginalisation. METHODS Semistructured and conversational interviews were conducted with a purposeful sample of thirteen queer-identified women who had experiences of birthing in rural Nova Scotia, Canada. RESULTS Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that reconstructs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality. CONCLUSIONS Normative practices were found to further the effects of structural marginalisation suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces. RELEVANCE TO CLINICAL PRACTICE New trauma-informed assessment strategies reconstruct the relationality within historically disempowering perinatal relationships through potentiating difference which avoids retraumatising women with re-experiencing the process of coming out as queer in opposition to the expectation of heterosexuality.
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Affiliation(s)
| | - Lisa Goldberg
- Dalhousie University School of Nursing, Halifax, NS, Canada
| | - Megan Aston
- Dalhousie University School of Nursing, Halifax, NS, Canada
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27
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Noonan M, Galvin R, Doody O, Jomeen J. A qualitative meta-synthesis: public health nurses role in the identification and management of perinatal mental health problems. J Adv Nurs 2016; 73:545-557. [DOI: 10.1111/jan.13155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Noonan
- Department of Nursing and Midwifery; University of Limerick; Ireland
| | - Rose Galvin
- Department of Clinical Therapies; University of Limerick; Ireland
| | - Owen Doody
- Department of Nursing and Midwifery; University of Limerick; Ireland
| | - Julie Jomeen
- Faculty of Health and Social Care; University of Hull; UK
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28
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Aston M, Etowa J, Price S, Vukic A, Hart C, MacLeod E, Randel P. Public Health Nurses and Mothers Challenge and Shift the Meaning of Health Outcomes. Glob Qual Nurs Res 2016; 3:2333393616632126. [PMID: 28462331 PMCID: PMC5342652 DOI: 10.1177/2333393616632126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 11/16/2022] Open
Abstract
Maternal, child, and newborn health is a priority area in Canada and around the world. The work of public health nurses (PHNs) is often invisible and misunderstood. The purpose of this qualitative research project was to explore how universal and targeted home visiting programs for mothers and babies were organized, delivered, and experienced through the everyday practices of PHNs (n = 16) and mothers (n = 16) in Nova Scotia, Canada. Feminist poststructuralism and discourse analysis were used to analyze interviews. Concepts of relations of power enabled an understanding of how health outcomes had been socially and institutionally constructed through binary relations. PHNs and mothers spoke about the importance of "softer" health outcomes, including maternal self-confidence and empowerment that had been constructed as less important than health outcomes that were seen to be more tangible and physical. Findings from this research could be used to guide practice and planning of postpartum home visiting programs.
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Affiliation(s)
- Megan Aston
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Sheri Price
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adele Vukic
- Dalhousie University, Halifax, Nova Scotia, Canada
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29
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Chartier MJ, Attawar D, Volk JS, Cooper M, Quddus F, McCarthy JA. Postpartum Mental Health Promotion: Perspectives from Mothers and Home Visitors. Public Health Nurs 2015; 32:671-9. [DOI: 10.1111/phn.12205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mariette J. Chartier
- Manitoba Centre for Health Policy; Department of Community Health Sciences; College of Medicine; Faculty of Health Science; University of Manitoba; Winnipeg Manitoba Canada
| | - Dhiwya Attawar
- Department of Community Health Sciences; College of Medicine; Faculty of Health Sciences; University of Manitoba; Winnipeg Manitoba Canada
| | - Jennifer S. Volk
- Healthy Child Manitoba Office; Government of Manitoba; Winnipeg Manitoba Canada
| | - Marion Cooper
- Mental Health Promotion; Winnipeg Regional Health Authority; Winnipeg Manitoba Canada
| | - Farzana Quddus
- The Towards Flourishing Project; Department of Community Health Sciences; College of Medicine; Faculty of Health Science; University of Manitoba; Winnipeg Manitoba Canada
| | - Julie-Anne McCarthy
- The Towards Flourishing Project; Department of Community Health Sciences; College of Medicine; Faculty of Health Science; University of Manitoba; Winnipeg Manitoba Canada
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