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Barrett EO, Laholt H, Lorem GF, Wang CEA. Exploring public health nurses' acceptability of clinical assessment tools in a Norwegian child health centre. Prim Health Care Res Dev 2024; 25:e10. [PMID: 38343358 PMCID: PMC10894717 DOI: 10.1017/s146342362400001x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Infants' symptoms of mental struggle are often diffuse and undifferentiated, and health services do not identify many infants at risk of poor development. However, primary health care is advantageous for early identification, given there are frequent consultations during the infant's first two years. Health policy encourages using evidence-based screening but use varies in primary health care. The Alarm Distress Baby Scale (ADBB) is an assessment tool targeting social withdrawal in infants 2-24 months of age. AIM To explore contextual factors related to public health nurses' (PHNs) acceptability of clinical assessment tools in a Norwegian child health centre. METHODS Prior to an upcoming ADBB training, we used focus group discussions with PHNs to explore their views on their professional role and practice and how this concurs with using assessment tools. FINDINGS Thematic analysis resulted in the following themes: (1) A Role requiring Supporting the Parents and Safeguarding the Infant; (2) The Challenge of Interpreting Infant Expressions; and (3) Organisational Preconditions for Accepting New Methods. CONCLUSION Our findings show that PHNs regard assessment tools as an aid to detect infants at risk, but that systematic use of such tools can hinder their ability to be flexible, egalitarian, and resource-focused. We also find that acceptability of assessment tools requires a system for continuous training and a well-established referral routine.
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Affiliation(s)
- Elisabeth Ovanger Barrett
- Faculty of Health Sciences - Department of Psychology/Specialist in Clinical Community Psychology, UiT - The Arctic University of Norway, Municipality of Tromsø, Norway
| | - Hilde Laholt
- Faculty of Health Sciences - Department of Health and Care Sciences, UiT - The Arctic University of Norway, Municipality of Tromsø, Norway
| | - Geir Fagerjord Lorem
- Faculty of Health Sciences - Department of Psychology, UiT - The Arctic University of Norway, Municipality of Tromsø, Norway
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Kohlhoff J, Tooke S, Philipov M, Hickinbotham R, Knox C, Roach V, Barnett B. Antenatal depression screening and psychosocial assessment in an Australian private hospital: An evaluation. Aust N Z J Obstet Gynaecol 2023; 63:42-51. [PMID: 35754379 DOI: 10.1111/ajo.13550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Universal mental health screening and psychosocial assessment during pregnancy have been recommended as best practice, but uptake of universal programs in the private hospital system has been slow. AIM The aim of this study was to evaluate the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. MATERIALS AND METHODS In this mixed-methods design study, PMAP interview data were collected for a consecutive series of 485 women who attended the PMAP during a 10-month period. Women also completed two postnatal telephone interviews (10 weeks and 9 months postpartum). The interviews involved depression screening and questions about the program. RESULTS Of the 485 participants, 4.1% screened positive for depression on the Edinburgh Postnatal Depression Scale. In total, 19% were identified as currently suffering from, or at risk of developing, perinatal mental health issues; referrals to support services were provided for the 13% who were not already linked in with appropriate supports. All women displayed a decrease in depressive symptom severity from pregnancy to 10 weeks and 9 months postpartum. The PMAP was viewed positively by consumers, with >93% viewing the program as helpful and >98% saying that they would recommend the program to others. Additional program benefits identified included opportunities to gain practical information and prepare for motherhood and to think/reflect on their emotional well-being. CONCLUSIONS Given the observed rates of psychosocial risk among this sample, related referral opportunities and positive consumer feedback, we recommend other Australian private hospitals consider implementing PMAP or similar programs.
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Affiliation(s)
- Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia.,Karitane, Carramar, New South Wales, Australia
| | - Sarah Tooke
- The Mater Hospital, North Sydney, New South Wales, Australia
| | | | - Rachael Hickinbotham
- North Shore Private Hospital and the Mater Hospital, Sydney, New South Wales, Australia
| | - Catherine Knox
- University of Sydney, Sydney, New South Wales, Australia
| | - Vijay Roach
- North Shore Private Hospital and the Mater Hospital, Sydney, New South Wales, Australia
| | - Bryanne Barnett
- Gidget Foundation Australia, North Sydney, New South Wales, Australia
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A mixed-methods evaluation of a state-wide outreach perinatal mental health service. BMC Pregnancy Childbirth 2023; 23:74. [PMID: 36707763 PMCID: PMC9881293 DOI: 10.1186/s12884-022-05229-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/21/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Access to perinatal mental health services in rural and remote areas is scarce, particularly perinatal psychiatry services. Telehealth, together with psychiatry consultation-liaison services are one way to improve access to areas of need. The New South Wales State-wide Outreach Perinatal Services - Mental Health (SwOPS) program is a Sydney-based program, offering specialist perinatal consultation-liaison services to rural and remote community mental health clinicians caring for perinatal women with significant mental health problems. This study aimed to evaluate healthcare practitioners' perceptions of the SwOPS program. METHOD Healthcare practitioners (N = 31) were purposely recruited to participate in the study. Data were analysed using a mixed-methods cross-sectional design. RESULTS Most participants reported being familiar with and satisfied with the service. As a result of accessing the service, participants reported an increase in knowledge and confidence regarding caring for women with moderate-to-severe or complex mental health conditions. Qualitative comments highlight the participant's perceptions of the program. CONCLUSION This study provides useful insights about a state-wide telehealth psychiatry consultation-liaison service from the perspective of practitioners. It highlights the benefits, facilitators, and barriers associated with implementing such services.
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Preis H, Whitney C, Kocis C, Lobel M. Saving time, signaling trust: Using the PROMOTE self-report screening instrument to enhance prenatal care quality and therapeutic relationships. PEC INNOVATION 2022; 1:100030. [PMID: 35465253 PMCID: PMC9020232 DOI: 10.1016/j.pecinn.2022.100030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/25/2022] [Accepted: 03/17/2022] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Comprehensive screening of psychosocial vulnerabilities and substance use in prenatal care is critical to promote the health and well-being of pregnant patients. Effective implementation of new screening procedures and instruments should be accompanied by an in-depth investigation to assess their feasibility and impact on care delivery. METHODS In 2020, following implementation of the Profile for Maternal and Obstetric Treatment Effectiveness (PROMOTE) an innovative self-report screening instrument developed for outpatient prenatal clinics in the U.S., we conducted individual interviews and focus groups with twenty-two midwives, nurse practitioners, and obstetric residents focused on the PROMOTE and its impacts on care delivery. We used interpretive description for the qualitative analysis of the interviews. RESULTS Five themes were identified: Guiding Time Efficiently: "The Time I Don't Have," Preventing Missed Care, Signaling Trustworthiness, Establishing Trauma-Informed Foundations, and Promoting "Honest" Patient Disclosure. CONCLUSION Interviews suggest that patient completion of the PROMOTE before the medical encounter helps reduce previously reported barriers, is more time-effective, and makes history-taking easier. It also facilitates the patient-provider relationship. INNOVATION Findings offer insight into the breadth and depth of clinical impact resulting from the PROMOTE, and provide guidance for the implementation of such tools to optimize health outcomes.
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Obstetrics and Gynecology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Clare Whitney
- School of Nursing, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Christina Kocis
- Department of Obstetrics and Gynecology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Obstetrics and Gynecology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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Arefadib N, Cooklin A, Shafiei T. Barriers and enablers to postpartum depression and anxiety screening: A qualitative study of Victorian maternal and child health nurses' practices. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5434-e5444. [PMID: 35924699 PMCID: PMC10087436 DOI: 10.1111/hsc.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 06/17/2023]
Abstract
In Victoria, Australia, Maternal and Child Health nurses (MCHNs) play a key role in facilitating the timely identification of Postnatal Depression and Anxiety (PNDA). Understanding MCHNs' screening practices, and the factors which impact them, is central to ensuring that future screening policy agendas are evidence-based and able to support MCHNs in carrying out this critical work. Yet, little is known about this subject. The purpose of this study was to gain an in-depth understanding of MCHNs' screening practices, and the factors which impact them. Qualitative descriptive design with semi-structured interviews were used. Participants were MCHNs who had been practicing for a minimum of 6 months and regularly saw new mothers. Purposeful sampling was used to facilitate diversity across participant characteristics. Twelve MCHNs were interviewed between March and May 2021. Thematic analysis was conducted to identify patterns across our data. Qualitative content analysis was then used to identify issues which were most emphasised by MCHNs. Two themes were identified. Theme one, 'variations in screening practices', pertained to MCHNs' various screening practices (i.e., who, when, how) and the factors which influence them. Theme two, 'systemic barriers hinder equitable screening', pertained to factors which hindered equitable screening practices. Results indicate that systemic barriers contribute to inconsistent and inequitable screening practices, with women from culturally and linguistically diverse backgrounds less likely to be screened in line with best practice. Our findings emphasise an urgent need for MCHNs to be allocated with the resources required to screen all women equally, regardless of their cultural background.
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Affiliation(s)
- Noushin Arefadib
- Judith Lumley Centre, School of Nursing and MidwiferyGeorge Singer Building, La Trobe UniversityBundooraVictoriaAustralia
| | - Amanda Cooklin
- Judith Lumley Centre, School of Nursing and MidwiferyGeorge Singer Building, La Trobe UniversityBundooraVictoriaAustralia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing and MidwiferyGeorge Singer Building, La Trobe UniversityBundooraVictoriaAustralia
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Kemp L, Bruce T, Elcombe EL, Byrne F, Scharkie SA, Perlen SM, Goldfeld SR. Identification of families in need of support: Correlates of adverse childhood experiences in the right@home sustained nurse home visiting program. PLoS One 2022; 17:e0275423. [PMID: 36190969 PMCID: PMC9529103 DOI: 10.1371/journal.pone.0275423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/31/2022] [Indexed: 11/07/2022] Open
Abstract
Background Little is known about the efficacy of pregnancy screening tools using non-sensitive sociodemographic questions to identify the possible presence of as yet undiagnosed disease in individuals and later adverse childhood events disclosure. Objectives The study aims were to: 1) record the prevalence of risk disclosed by families during receipt of a sustained nurse home visiting program; and 2) explore patterns of relationships between the disclosed risks for their child having adverse experiences and the antenatal screening tool, which used non-sensitive demographic questions. Design Retrospective, observational study. Participants and methods Data about the participants in the intervention arm of the Australian right@home trial, which is scaffolded on the Maternal Early Childhood Sustained Home-visiting model, collected between 2013 and 2017 were used. Screening data from the 10-item antenatal survey of non-sensitive demographic risk factors and disclosed risks recorded by the nurse in audited case files during the subsequent 2 year intervention were examined (n = 348). Prevalence of disclosed risks for their child having adverse experiences were analysed in 2019 using multiple response frequencies. Phi correlations were conducted to test associations between screening factors and disclosed risks. Results Among the 348 intervention participants whose files were audited, 300 were noted by nurses to have disclosed risks during the intervention, with an average of four disclosures. The most prevalent maternal disclosures were depression or anxiety (57.8%). Mental health issues were the most prevalent partner and family disclosures. Screening tool questions on maternal smoking in pregnancy, not living with another adult, poverty and self-reporting anxious mood were significantly associated with a number of disclosed risks for their child having adverse experiences. Conclusions These findings suggest that a non-sensitive sociodemographic screening tool may help to identify families at higher risk for adverse childhood experiences for whom support from a sustained nurse home visiting program may be beneficial.
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Affiliation(s)
- Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- * E-mail:
| | - Tracey Bruce
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Emma L. Elcombe
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Fiona Byrne
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sheryl A. Scharkie
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Susan M. Perlen
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Sharon R. Goldfeld
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Chan AW, Reid C, Skeffington P, Gorman E, Marriott R. Experiences of using the Edinburgh Postnatal Depression Scale in the context of antenatal care for Aboriginal mothers: Women and midwives' perspectives. Women Birth 2021; 35:367-377. [PMID: 34531165 DOI: 10.1016/j.wombi.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
PROBLEM Routine administration of the Edinburgh Postnatal Depression Scale (EPDS) is intended to promote early detection and preventative support for those who may be at risk of perinatal depression and anxiety. The cultural suitability of the EPDS has not been validated in the Aboriginal Australian context. BACKGROUND Marked differences in health outcomes and service access between Australian Aboriginal and non-Aboriginal women and infants continue to exist. AIM This study aimed to explore the cultural validity of the EPDS through understanding the experiences of Aboriginal women and midwives. METHODS Qualitative data was drawn from semi-structured interviews/yarns with 13 Perth-based Aboriginal antenatal women and 10 non-Aboriginal midwives. FINDINGS Utilising a grounded theory approach, thematic analysis of verbatim transcripts revealed that, surprisingly, women expressed generally favourable views of the EPDS, especially when the relationships between women and midwives were focused on. Midwives, however, expressed reservations about administering the EPDS and used the EPDS as a conversation-starter rather than as a standardised, standalone tool. DISCUSSION In attempt to reconcile conflicting perspectives, analysis of recordings extended to evaluate micro-processes in the interviews. At the process level, it was clear that demand characteristics operated in some interviews, including socially desirable response biases, demand biases and acquiescent response styles. CONCLUSION This highlights the need for researchers and clinicians to be trained in non-leading interview questioning techniques and in yarning methodology. Researchers and clinicians should also be aware of the cognitive biases and demand characteristics that may influence responding, likely perpetuated by dominant forces of a colonised society.
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Affiliation(s)
| | - Corinne Reid
- Victoria University, Australia; Ngangk Yira: Research Centre for Aboriginal Health and Social Equity, Murdoch University, Australia
| | - Petra Skeffington
- Murdoch University, Australia; Ngangk Yira: Research Centre for Aboriginal Health and Social Equity, Murdoch University, Australia
| | | | - Rhonda Marriott
- Murdoch University, Australia; Ngangk Yira: Research Centre for Aboriginal Health and Social Equity, Murdoch University, Australia
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Kohlhoff J, Cibralic S, Tooke S, Hickinbotham R, Knox C, Roach V, Barnett B. Health professional perspectives on an antenatal mental health screening program in a private hospital. Aust N Z J Obstet Gynaecol 2021; 61:891-897. [PMID: 34121178 DOI: 10.1111/ajo.13394] [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: 12/28/2020] [Revised: 04/11/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal mental ill-health is a global health priority. Mental health screening during pregnancy is a routine part of clinical practice in many public hospital obstetric services across Australia, but implementation in the private hospital system has lagged. AIMS This study explored health professionals' perspectives on the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. MATERIALS AND METHODS Nine midwives and three medical specialists participated in focus groups or individual interviews; key themes were determined using thematic qualitative analysis. RESULTS Five major themes and three sub-themes were identified: immediate benefits to women (identifying women at risk; referrals to support services; supporting and educating women); enhanced overall quality of care at the hospital; the dilemma of partners attending; factors that make the program successful; and recommendations for improvement. CONCLUSIONS Results will inform the implementation of antenatal mental health screening programs at other private hospitals across Australia.
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Affiliation(s)
- Jane Kohlhoff
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Karitane, Sydney, New South Wales, Australia
| | - Sara Cibralic
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah Tooke
- The Mater Hospital, Sydney, New South Wales, Australia
| | - Rachael Hickinbotham
- North Shore Private Hospital and the Mater Hospital, Sydney, New South Wales, Australia
| | | | - Vijay Roach
- North Shore Private Hospital and the Mater Hospital, Sydney, New South Wales, Australia
| | - Bryanne Barnett
- Gidget Foundation Australia, Sydney, New South Wales, Australia
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Arefadib N, Cooklin A, Nicholson J, Shafiei T. Postnatal depression and anxiety screening and management by maternal and child health nurses in community settings: A scoping review. Midwifery 2021; 100:103039. [PMID: 34058681 DOI: 10.1016/j.midw.2021.103039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the range and nature of primary research evidence on postnatal depression and anxiety screening and management by maternal and child health nurses within community settings. BACKGROUND Maternal and child health nurses are well-placed to identify and support women at risk of, or experiencing, postnatal depression and anxiety- a prevalent public health issue which remains largely undetected. METHODS Scoping methodology, guided by the Arksey and O'Malley (2005) framework, was used. The following electronic databases were searched in June 2019 and again in July 2020: Cumulative Index of Nursing and Allied Health Literature, MEDLINE, PsycINFO, and COCHRANE Library. Primary studies that were published in English, between 2008 and 2020, were included. PRISMA checklist and PRISMA flow diagram were used to adhere to best practice guidelines. RESULTS Twenty-three articles, relating to 22 studies, met the inclusion criteria. Two principal themes were identified: 'screening for postnatal depression and anxiety' and 'factors that influence postnatal depression and anxiety management'. Subthemes in the former related to attitudes toward screening, routine screening practice, screening efficacy, and attitudes toward the Edinburgh Postnatal Depression Scale. Subthemes in the latter included availability of formal care pathways, referral options, knowledge and confidence, and multiagency collaboration. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE While maternal and child health nurses value their role in identifying and supporting mothers at risk of postnatal depression and anxiety, certain individual and organisational factors contribute to a gap between best practice and clinical practice. Narrowing the gap between evidence and practice is unlikely without directly addressing these barriers. Gaps in maternal and child health nurses' knowledge, skills and confidence regarding effective screening and management of mothers experiencing, or at risk of, postnatal depression and anxiety, impacts the quality of care provided. Ongoing training and professional development which adequately addresses these gaps is required.
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Affiliation(s)
- Noushin Arefadib
- Judith Lumley Centre, School of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Amanda Cooklin
- Judith Lumley Centre, School of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, VIC 3086, Australia
| | - Jan Nicholson
- Judith Lumley Centre, School of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, VIC 3086, Australia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, VIC 3086, Australia
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Layton H, Bendo D, Amani B, Bieling PJ, Van Lieshout RJ. Public health nurses' experiences learning and delivering a group cognitive behavioral therapy intervention for postpartum depression. Public Health Nurs 2020; 37:863-870. [PMID: 32924183 DOI: 10.1111/phn.12807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Public Health Nurses (PHNs) often provide support to women with postpartum depression (PPD) in the absence of specialized training. The objective of this study was to explore the experiences of six PHNs who were trained to deliver a group cognitive behavioral therapy (CBT) intervention for PPD in the public health setting, and to describe how learning and delivering this intervention affected their professional roles and personal lives. DESIGN This qualitative study employed a phenomenological approach. SAMPLE Six PHNs who completed the CBT training program and delivered at least one CBT group in their community. MEASUREMENTS Individual in-depth interviews were conducted and transcribed verbatim. Transcripts were analyzed according to thematic derivation procedures. RESULTS The themes that emerged from the interviews with the PHNs included: (a) components of the CBT training program that nurses most valued, (b) benefits of training for their professional role as a PHN, (c) implications for practice, and (d) using CBT skills in their personal lives. CONCLUSIONS The provision of CBT training to PHNs may not only positively impact their work with clients with mental illness, but may also have the potential to provide broader clinical and professional benefits for these skilled professionals and their other clients.
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Affiliation(s)
- Haley Layton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Daniella Bendo
- Department of Interdisciplinary Programs, Kings University College at Western University, London, Ontario, Canada
| | - Bahar Amani
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Peter J Bieling
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Schmied V, Reilly N, Black E, Kingston D, Talcevska K, Mule V, Austin MP. Opening the door: midwives' perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study. BMC Pregnancy Childbirth 2020; 20:451. [PMID: 32767969 PMCID: PMC7412833 DOI: 10.1186/s12884-020-03133-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background One in five women experience psychological distress in the perinatal period. To support women appropriately, Australian guidelines recommend routine depression screening and psychosocial risk assessment by midwives in pregnancy. However, there is some evidence that current screening processes results in higher rates of false positives. The Perinatal Integrated Psychosocial Assessment (PIPA) Project compared two models of psychosocial assessment and referral – Usual Care and the PIPA model – with a view to improving referral decisions. This paper describes midwives’ perspectives on psychosocial assessment, depression screening and referral at the antenatal booking appointment and compares midwives’ experiences with, and perspectives on, the two models of care under investigation. Methods A two-phase, convergent mixed methods design was used. Midwives providing antenatal care completed a self-report survey in phase one prior to implementation of the new model of psychosocial assessment (n = 26) and again in phase two, following implementation (n = 27). Sixteen midwives also participated in two focus groups in phase two. Quantitative and qualitative data were compared and integrated in the presentation of results and interpretation of findings. Results Midwives supported psychosocial assessment believing it was a catalyst for ‘Opening the door” to conversations with women. Midwives were comfortable asking the questions and tailored their approach to build rapport and trust. Overall. midwives expressed favourable views towards the PIPA model. A greater proportion of midwives relied mostly or entirely on the suggested wording for the psychosocial questions in the PIPA model compared to Usual Care (44.4% vs 12.0%, χ2=5.17, p=.023, φ =-.36). All midwives reported finding the referral or action message displayed at the end of the PIPA psychosocial assessment to be ‘somewhat’ or ‘very’ helpful, compared to 42.3% in Usual Care (χ2 = 18.36, p < .001, φ = −.64). Midwives were also more likely to act on or implement the message often or all of the time) in the PIPA model (PIPA = 69.2% vs Usual Care = 32.0%, (χ2 = 5.66, p < .017, φ = −.37). Conclusion The study identified benefits of the new model and can inform improvements in psychosocial screening, referral and related care processes within maternity settings. The study demonstrates that psychosocial assessment can, over time, become normalised and embedded in practice.
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Affiliation(s)
- V Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, NSW, 2751, Australia.
| | - N Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - E Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills NSW 2010 and Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW, 2006, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney, 2052, Australia
| | - D Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - K Talcevska
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - V Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - M-P Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
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12
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Moss KM, Reilly N, Dobson AJ, Loxton D, Tooth L, Mishra GD. How rates of perinatal mental health screening in Australia have changed over time and which women are missing out. Aust N Z J Public Health 2020; 44:301-306. [PMID: 32510784 DOI: 10.1111/1753-6405.12999] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To report rates of perinatal mental health screening from 2000 to 2017 and investigate factors associated with not being screened both antenatally and postnatally more recently (2013-2017). METHODS A longitudinal community-based study of self-reported perinatal mental health screening with a national sample of 7,566 mothers from the Australian Longitudinal Study on Women's Health reporting on 9,384 children. The main outcome measure was whether mothers were asked about their emotional wellbeing by a health professional, including completing a questionnaire. RESULTS From 2000 to 2017, the percentage of women not screened decreased from 40.6% to 1.7%. The percentage of women screened both antenatally and postnatally increased from 21.3% to 79.3%. From 2013 to 2017, women who were older (aOR, 0.65; 95%CI, 0.52-0.81) or had reported emotional distress (aOR, 0.77; 95%CI, 0.60-0.99) were less likely to have been screened both antenatally and postnatally. CONCLUSIONS Despite improvements, perinatal mental health screening is not yet universal. One-in-five women are not screened both antenatally and postnatally, including women in high-risk populations such as those who have reported emotional distress. Implications for public health: Women are in regular contact with health professionals in the perinatal period. This opportunity to detect women at risk of perinatal mental health issues is too important to be missed.
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Affiliation(s)
- Katrina M Moss
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland
| | - Nicole Reilly
- Research Centre for Generational Health and Ageing, University of Newcastle, New South Wales.,School of Nursing and Midwifery, University of Newcastle, New South Wales
| | - Annette J Dobson
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, University of Newcastle, New South Wales
| | - Leigh Tooth
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland
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13
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Understanding barriers to women seeking and receiving help for perinatal mental health problems in UK general practice: development of a questionnaire. Prim Health Care Res Dev 2019; 20:e156. [PMID: 31826794 PMCID: PMC7003527 DOI: 10.1017/s1463423619000902] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: To develop a questionnaire to measure quantitatively barriers and facilitators to women’s disclosure of perinatal mental health problems in UK primary care. To pilot and evaluate the questionnaire for content validity and internal consistency. Background: Around 15% of women develop a mental illness in the perinatal period, such as depression, anxiety or post-traumatic stress disorder. In the United Kingdom, 90% of these women will be cared for in primary care, yet currently in as many as 50% of cases, no discussion of this issue takes place. One reason for this is that women experience barriers to disclosing symptoms of perinatal mental illness in primary care. These have previously been explored qualitatively, but no tool currently exists with which to measure these barriers quantitatively. Methods: Questionnaire items, drawn from qualitative literature and accounts of women’s experiences, were identified, refined iteratively and arranged in themes. The questionnaire was piloted using cognitive debriefing interviews to establish content validity. Women completed a refined version online. Responses were analysed using descriptive statistics. Internal consistency of subscales was calculated using Cronbach’s alpha. Findings: Cognitive debriefing interviews with five women showed the majority of questionnaire items were relevant, appropriate and easy to understand. The final questionnaire was completed by 71 women, and the majority of subscales had good internal consistency. The barrier scoring most highly was fear and stigma, followed by willingness to seek help and logistics of attending an appointment. Family/partner support and general practitioners’ (GPs) reaction were the lowest scoring barriers. Factors facilitating disclosure were GPs being empathetic and non-judgemental and listening during discussions. In the future, this questionnaire can be used to examine which barriers are most important for particular groups of women. This may enable the development of strategies to improve acknowledgement and discussion, and prevent under-recognition and under-treatment, of perinatal mental health problems in primary care.
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14
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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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15
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Barriers to antenatal psychosocial assessment and depression screening in private hospital settings. Women Birth 2018; 31:292-298. [DOI: 10.1016/j.wombi.2017.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022]
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16
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Leonard RA, Linden M, Grant A. Family-Focused Practice for Families Affected by Maternal Mental Illness and Substance Misuse in Home Visiting: A Qualitative Systematic Review. JOURNAL OF FAMILY NURSING 2018; 24:128-155. [PMID: 29683021 DOI: 10.1177/1074840718770612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Maternal mental illness is a major public health issue and can adversely affect the whole family. Increasingly, research and policy are recognizing the benefits of a family-focused approach to practice, an approach that emphasizes the family as the unit of care. This review was conducted with the aim of systematically analyzing the qualitative literature surrounding health visitors' family-focused practice with mothers who have mental illness and/or substance misuse. Through the synthesis, we developed three main findings: (a) parents' needs regarding health visitors' family-focused practice, (b) the ambiguity of mental illness in health visiting, and (c) the challenges of family-focused practice in health visiting. Above all, health visitors, families, and mothers with mental illness experience many challenges in family-focused practice, even though it is both desirable and beneficial. This calls for a deeper understanding of how family-focused practice can be effectively practiced in health visiting.
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17
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Dahlen HG, Munoz AM, Schmied V, Thornton C. The relationship between intimate partner violence reported at the first antenatal booking visit and obstetric and perinatal outcomes in an ethnically diverse group of Australian pregnant women: a population-based study over 10 years. BMJ Open 2018; 8:e019566. [PMID: 29695386 PMCID: PMC5922470 DOI: 10.1136/bmjopen-2017-019566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/17/2018] [Accepted: 02/15/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Intimate partner violence (IPV) is a global health issue affecting mainly women and is known to escalate during pregnancy and impact negatively on obstetric and perinatal outcomes. The aim of this study is to determine the incidence of IPV in a pregnant multicultural population and to determine the relationship between IPV reported at booking interview and maternal and perinatal outcomes. DESIGN This is a retrospective population-based data study. We analysed routinely collected data (2006-2016) from the ObstetriX system on a cohort of pregnant women. SETTING AND PARTICIPANTS 33 542 women giving birth in a major health facility in Western Sydney. PRIMARY OUTCOMES Incidence of IPV, association with IPV and other psychosocial variables and maternal and perinatal outcomes. RESULT 4.3% of pregnant women reported a history of IPV when asked during the routine psychosocial assessment. Fifty-four per cent were not born in Australia, and this had increased significantly over the decade. Women born in New Zealand (7.2%) and Sudan (9.1%) were most likely to report IPV at the antenatal booking visit, with women from China and India least likely to report IPV. Women who reported IPV were more likely to report additional psychosocial concerns including Edinburgh Postnatal Depression Scale scores > 13 (7.6%), thoughts of self-harm (2.4%), childhood abuse (23.6%), and a history of anxiety and depression (34.2%). Women who reported IPV were more likely to be Australian born, smoke and be multiparous and to have been admitted for threatened preterm labour (Adjusted Odds Ratio (AOR) 1.8, 95% CI 1.28 to 2.39). CONCLUSIONS A report of IPV at the first antenatal booking visit is associated with a higher level of reporting on all psychosocial risks, higher antenatal admissions, especially for threatened preterm labour. More research is needed regarding the effectiveness of current IPV screening for women from other countries.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Ana Maria Munoz
- Blacktown Mount Druitt Hospitals, Blacktown, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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18
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Higgins A, Downes C, Carroll M, Gill A, Monahan M. There is more to perinatal mental health care than depression: Public health nurses reported engagement and competence in perinatal mental health care. J Clin Nurs 2017; 27:e476-e487. [DOI: 10.1111/jocn.13986] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery Trinity College Dublin Ireland
| | - Carmel Downes
- School of Nursing and Midwifery Trinity College Dublin Ireland
| | | | - Ailish Gill
- School of Nursing and Midwifery Trinity College Dublin Ireland
| | - Mark Monahan
- School of Nursing and Midwifery Trinity College Dublin Ireland
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19
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Dauber S, Ferayorni F, Henderson C, Hogue A, Nugent J, Alcantara J. Substance Use and Depression in Home Visiting Clients: Home Visitor Perspectives on Addressing Clients' Needs. JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 45:396-412. [PMID: 28408768 PMCID: PMC5385706 DOI: 10.1002/jcop.21855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/07/2016] [Indexed: 06/07/2023]
Abstract
Substance use and depression are prevalent among mothers enrolled in home visiting programs and are significant risk factors for child maltreatment, yet most home visiting programs are staffed by workers who lack the training and clinical skills to address these risks. Emanating from one state network's interest in advancing its practice in this area, the current study surveyed 159 home visitors on their current practices, training, knowledge, and perceived self‐efficacy, and perceived system‐ and client‐level barriers regarding client substance use and depression. Home visitors reported managing maternal depression more extensively than substance use, though overall management of both risk areas was low. More training was associated with more extensive management of both risk domains, as was greater home visitor knowledge and self‐efficacy. Implications for the development of strategies to improve home visitor management of client behavioral health risks, including enhanced skills‐based training and supervision, are discussed.
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Affiliation(s)
- Sarah Dauber
- The National Center on Addiction and Substance Abuse
| | | | | | - Aaron Hogue
- The National Center on Addiction and Substance Abuse
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20
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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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21
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Rossiter C, Schmied V, Kemp L, Fowler C, Kruske S, Homer CSE. Responding to families with complex needs: a national survey of child and family health nurses. J Adv Nurs 2016; 73:386-398. [PMID: 27624334 DOI: 10.1111/jan.13146] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families. BACKGROUND Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families. DESIGN The descriptive study used cross-sectional data from the first national survey of child and family health nurses in Australia, conducted during 2011. METHODS Survey data reported how often, where and how child and family health nurses worked with families with complex needs and their confidence in nursing tasks. FINDINGS Many, but not all, of the 679 respondents saw families with complex needs in their regular weekly caseload. Child and family health nurses with diverse and complex caseloads reported using varied approaches to support their clients. They often undertook additional professional development and leadership roles compared with nurses who reported less complex caseloads. Most respondents reported high levels of professional confidence. CONCLUSION For health services providing universal support and early intervention for families at risk, the findings underscore the importance of appropriate education, training and support for child and family health professionals. The findings can inform the organization and delivery of services for families in Australia and internationally.
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Affiliation(s)
- Chris Rossiter
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith South DC, New South Wales, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Penrith South DC, New South Wales, Australia
| | - Cathrine Fowler
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Sue Kruske
- Maternal Child Health, Institute of Urban Indigenous Health, Bowen Hills, Queensland, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Caroline S E Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, New South Wales, Australia
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22
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Blurring reality with fiction: Exploring the stories of women, madness, and infanticide. Women Birth 2016; 30:e24-e31. [PMID: 27444643 DOI: 10.1016/j.wombi.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/21/2022]
Abstract
PROBLEM Often, there is a sense of shock and disbelief when a mother murders her child. BACKGROUND Yet, literary texts (plays, poems and novels) contain depictions of women experiencing mental illness or feelings of desperation after childbirth who murder their children. AIM To further understand why a woman may harm her child we examine seven literary texts ranging in time and place from fifth century BCE Greece to twenty-first century Australia. METHODS A textual analysis approach examined how the author positioned the woman in the text, how other characters in the text reacted to the woman before, during, and after the mental illness or infanticide, and how the literary or historical critical literature sees the woman. FINDINGS Three important points about the woman's experience were revealed: she is represented as morally ambiguous and becomes marginalised and isolated; she is depicted as murdering or abandoning her child because she is experiencing mental illness and/or she is living in desperate circumstances; and she believes there is no other option. CONCLUSION Literary texts can shed light on socio-psychological struggles women experience and can be used to stimulate discussion by healthcare professionals about the development of preventative or early intervention strategies to identify women at risk.
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23
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Rollans M, Kohlhoff J, Meade T, Kemp L, Schmied V. PARTNER INVOLVEMENT: NEGOTIATING THE PRESENCE OF PARTNERS IN PSYCHOSOCIAL ASSESSMENT AS CONDUCTED BY MIDWIVES AND CHILD AND FAMILY HEALTH NURSES. Infant Ment Health J 2016; 37:302-12. [PMID: 27111339 DOI: 10.1002/imhj.21562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 12/22/2015] [Accepted: 01/30/2016] [Indexed: 11/10/2022]
Abstract
Universal screening for maternal depression and assessment of psychosocial risks has been integrated into the routine perinatal care provided in many Australian hospitals, but to date, partners/fathers have been largely excluded from the process. This study explored the ways in which clinicians in health service settings include partners who attend antenatal and postnatal visits with women. Qualitative data were collected using observations (n = 54), interviews (n = 60), and discussion groups (n = 7) with midwives and child and family health nurses who conducted the appointments. Transcripts from observations, interviews, and discussion groups underwent qualitative analysis, and key themes were identified. Results showed partners to have little or no involvement in psychosocial assessment and depression screening. Thematic analysis revealed four key themes: negotiating partner exclusion, partial inclusion, women's business or a couple concern? and they know anyway. Partner involvement appeared to be challenged particularly by mandatory interpersonal violence screening, which, according to health service policy, is to be conducted confidentially. Overall, results highlighted partner involvement in perinatal depression screening and psychosocial assessment processes and identified some of the benefits such as partner disclosure, but also the challenges and complexities of inclusion of partners. Clinical implications and directions for further education and research are discussed.
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24
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Psaila K, Kruske S, Fowler C, Homer C, Schmied V. Smoothing out the transition of care between maternity and child and family health services: perspectives of child and family health nurses and midwives'. BMC Pregnancy Childbirth 2014; 14:151. [PMID: 24766674 PMCID: PMC4016663 DOI: 10.1186/1471-2393-14-151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 04/14/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In Australia, women who give birth are transitioned from maternity services to child and health services once their baby is born. This horizontal integration of services is known as Transition of Care (ToC). Little is known of the scope and processes of ToC for new mothers and the most effective way to provide continuity of services. The aim of this paper is to explore and describe the ToC between maternity services to CFH services from the perspective of Australian midwives and child and family health (CFH) nurses. METHOD This paper reports findings from phase two of a three phase mixed methods study investigating the feasibility of implementing a national approach to CFH services in Australia (the CHoRUS study). Data were collected through a national survey of midwives (n = 655) and CFH nurses (n = 1098). Issues specifically related to ToC between maternity services and CFH services were examined using descriptive statistics and content analysis of qualitative responses. RESULTS Respondents described the ToC between maternity services and CFH services as problematic. Key problems identified included communication between professionals and services and transfer of client information. Issues related to staff shortages, early maternity discharge, limited interface between private and public health systems and tension around role boundaries were also reported. Midwives and CFH nurses emphasised that these issues were more difficult for families with identified social and emotional health concerns. Strategies identified by respondents to improve ToC included improving electronic transfer of information, regular meetings between maternity and CFH services, and establishment of liaison roles. CONCLUSION Significant problems exist around the ToC for all families but particularly for families with identified risks. Improved ToC will require substantial changes in information transfer processes and in the professional relationships which currently exist between maternity and CFH services.
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Affiliation(s)
- Kim Psaila
- School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia
| | - Sue Kruske
- Director Queensland Centre for Mothers & Babies, The University of Queensland, Brisbane, Queensland, Australia
| | - Cathrine Fowler
- Tresillian Chair for Child & Family Health, Centre for Midwifery, Child & Family Health, Faculty of Nursing, Midwifery & Health, University of Technology Sydney, Australia
| | - Caroline Homer
- Faculty of Nursing, Midwifery & Health, University of Technology Sydney, Sydney, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery & the Family and Community Health Research Group, University of Western Sydney, Sydney, Australia
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25
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Kershaw T, Murphy A, Divney A, Magriples U, Niccolai L, Gordon D. What's love got to do with it: Relationship functioning and mental and physical quality of life among pregnant adolescent couples. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 52:288-301. [PMID: 24091562 PMCID: PMC3995023 DOI: 10.1007/s10464-013-9594-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The study objective was to describe relationship adjustment and its association with mental and physical quality of life for young couples expecting a baby. 296 young pregnant couples recruited from urban obstetric clinics reported on relationship strengths (e.g., equity, romantic love, and attractiveness), relationship risks (e.g., attachment, intimate partner violence), external family support, relationship adjustment, and mental and physical quality of life. Using the Actor Partner Interdependence Model we assessed both actor and partner effects of relationship variables on relationship adjustment and quality of life. Sixty-one percent of couples had at least one member with moderate or severe relationship distress. Lower attachment avoidance, lower attachment anxiety, higher relationship equity, lack of intimate partner violence, feelings of love, perceived partner attractiveness, and family support of the relationship related to better relationship adjustment. Associations were fairly consistent across gender. Better relationship adjustment related to more positive mental and physical quality of life for both young women and men. Our results highlight the potential importance of strong relationships on the well-being of expecting parents. Our results suggest that secure attachments, equitable relationships, feelings of love, and a lack of violence may be particularly important in having strong relationships and improved mental and physical health during pregnancy.
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Affiliation(s)
- Trace Kershaw
- Yale School of Public Health, Room 415, 60 College, New Haven, CT, 06510, USA,
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26
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Milgrom J, Gemmill AW. Screening for perinatal depression. Best Pract Res Clin Obstet Gynaecol 2013; 28:13-23. [PMID: 24095728 DOI: 10.1016/j.bpobgyn.2013.08.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 06/20/2013] [Accepted: 08/22/2013] [Indexed: 01/03/2023]
Abstract
Perinatal depression is prevalent, under-diagnosed and can have serious long-term effects on the wellbeing of women, their partners and infants. In the absence of active identification strategies, most women with perinatal depression will neither seek nor receive help. To enable early detection and timely intervention, universal screening is coming to be seen as best practice in many settings. Although the strength of recommendations and the preferred methods of identification vary in different countries (e.g. the Edinburgh Postnatal Depression Scale, brief case-finding questions), appropriate training for health professionals in wider psychosocial assessment is essential to maximise usefulness while minimising potential harms. Clear pathways of systematic follow up of all positive screening results with a diagnostic procedure and access to effective treatment are centrally important both for the clinical effectiveness of screening and for health system costs. It is also necessary to further build on the emerging evidence base for the clinical effectiveness of screening.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Department of Clinical and Health Psychology, Austin Health, Melbourne, Victoria 3081, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
| | - Alan W Gemmill
- Parent-Infant Research Institute, Department of Clinical and Health Psychology, Austin Health, Melbourne, Victoria 3081, Australia
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