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Eið RC, Strøyer de Voss S, Wilson P, Overbeck G. Collaboration between general practitioners and health visitors about children of concern in Denmark: a qualitative study. J Interprof Care 2024:1-9. [PMID: 38813754 DOI: 10.1080/13561820.2024.2357118] [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: 03/21/2023] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
Primary health care services are responsible for preventive measures to optimize child development in the first years of life. In Denmark, these services are shared between general practitioners and municipality health visitors. National guidelines mandate collaboration between these professionals but in reality, they work in parallel. We aimed to explore how professionals experience collaboration and communication regarding children with professional concern about their wellbeing. Seventeen semi-structured interviews were conducted with general practitioners, and health visitors. Both professions considered closer collaboration to be important in meeting children's needs. Barriers to collaboration and communication included differing legal obligations, Information Technology-systems (IT), lack of financial incentives, lack of mutual professional acknowledgment and respect, and absence of routines for sharing knowledge. The traditional division of responsibilities between physicians and nurses in which all professionals involved in preventive child health care are acculturated seems to impede collaboration based on unequal professional status. IT infrastructure needs to support information sharing and structures to support informal meetings between professionals are warranted to support more collaborative practice.
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Affiliation(s)
- Rebekka Consuelo Eið
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Sarah Strøyer de Voss
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Philip Wilson
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Centre for Rural Health, University of Aberdeen, Aberdeen, UK
| | - Gritt Overbeck
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
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Penny RA, Hardiman L, Toohill J. Being connected: Exploring the needs of mothers during the postnatal period in Queensland, Australia. J Child Health Care 2024; 28:104-115. [PMID: 35638751 DOI: 10.1177/13674935221090356] [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] [Indexed: 11/15/2022]
Abstract
This project explored the needs of mothers beyond the immediate postnatal period in Queensland, Australia, for the development of improved models of care. Data were collected through group and individual interviews. A qualitative methodology using thematic analysis captured the experience of 58 participants. Four key themes were generated: Caring for self, Being connected, Getting direction and Having options. Being connected with care providers and peers was highly valued by participants as was having a sense of direction. Having a relationship with a carer who knew them personally throughout pregnancy and postnatal care avoided retelling stories and facilitated information sharing. Relationship-based care enabled mothers to better meet their personal needs necessary to fulfil the parenting role. Yet, many points of disconnect were identified including inconsistencies in information and gaps in care. These findings demonstrate a range of unmet needs, situated within a lack of relational continuity. Maternity and child health professionals, service managers and policy makers must reorient systems by listening, acknowledging and keeping the voice of mothers at the centre of care.
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Affiliation(s)
- Robyn A Penny
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Leah Hardiman
- Mothers and Babies Queensland, Brisbane, QLD, Australia
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Gopisetty DD, Shaw JG, Gray C, Frayne S, Phibbs C, Shankar M. Veteran Postpartum Health: VA Care Team Perspectives on Care Coordination, Health Equity, and Trauma-Informed Care. Mil Med 2023; 188:e1563-e1568. [PMID: 36151892 DOI: 10.1093/milmed/usac275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/21/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A growing number of veterans are having children, and pregnancy is an opportunity to engage with health care. Within the Veterans Health Administration (VA), the VA maternity care coordination program supports veterans before, during, and after pregnancy, which are periods that inherently involve transitions between clinicians and risk care fragmentation. Postpartum transitions in care are known to be especially tenuous, with low rates of primary care reengagement. The objective of this study is to better understand this transition from the perspectives of the VA care teams. MATERIALS AND METHODS Eight semi-structured qualitative interviews with VA team members who work in maternity care were conducted at a single VA center's regional network. Interviews explored the transition from maternity care to primary care to understand the care team's perspective at three levels: patient, clinician, and systems. Rapid qualitative analysis was used to identify emergent themes. RESULTS Participants identified facilitators and opportunities for improvement in the postpartum transition of care. Patient-clinician trust is a key facilitator in the transition from maternity to primary care for veterans, and the breadth of VA services emerged as a key system-level facilitator to success. Interviewees also highlighted opportunities for improvement, including more trauma-informed practices for nonbinary veterans, increased care coordination between VA and community staff, and the need for training in postpartum health with an emphasis on health equity for primary care clinicians. CONCLUSIONS The Department of Veterans Affairs Healthcare System care team perspectives may inform practice changes to support the transition from maternity to primary care for veterans. To move toward health equity, a system-level approach to policy and programming is necessary to reduce barriers to primary care reengagement. This study was limited in terms of sample size, and future research should explore veteran perspectives on VA postpartum care transitions.
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Affiliation(s)
- Deepti Divya Gopisetty
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA 94025, USA
- Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jonathan G Shaw
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA 94025, USA
- Division of Primary Care & Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Caroline Gray
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA 94025, USA
| | - Susan Frayne
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA 94025, USA
- Division of Primary Care & Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ciaran Phibbs
- VA Palo Alto Health Care System, Health Economics Resource Center (HERC), Palo Alto, CA 94304, USA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304-5660, USA
| | - Megha Shankar
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA 94025, USA
- Stanford University School of Medicine, Stanford, CA 94305, USA
- Division of General Internal Medicine, Department of Medicine, UC San Diego, La Jolla, CA 92093, USA
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Boertien S, Franx A, Jansen DEMC, Akkermans H, de Kroon MLA. Connecting Obstetric, Maternity, Pediatric and Preventive Child Health Care: A Comparative Prospective Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6774. [PMID: 35682355 PMCID: PMC9180713 DOI: 10.3390/ijerph19116774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/16/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022]
Abstract
Collaboration between birth care and Preventive Child Health Care (PCHC) in the Netherlands is so far insufficient. The aim of the Connecting Obstetric; Maternity; Pediatric and PCHC (COMPLETE) study is to: (1) better understand the collaboration between birth care and PCHC and its underlying mechanisms (including barriers and facilitators); (2) investigate whether a new multidisciplinary strategy that is developed as part of the project will result in improved collaboration. To realize the first aim, a mixed-method study composed of a (focus group) interview study, a multiple case study and a survey study will be conducted. To realize the second aim, the new strategy will be piloted in two regions in an iterative process to evaluate and refine it, following the Participatory Action Research (PAR) approach. A prospective study will be conducted to compare outcomes related to child health, patient reported outcomes and experiences and quality of care between three different cohorts (i.e., those that were recruited before, during and after the implementation of the strategy). With our study we wish to contribute to a better understanding of collaboration in care and develop knowledge on how the integration of birth care and PCHC is envisioned by stakeholders, as well as how it can be translated into practice.
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Affiliation(s)
- Silke Boertien
- Department of Obstetrics and Gynecology, Erasmus MC—Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC—Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
| | - Danielle E. M. C. Jansen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands;
| | - Henk Akkermans
- Department of Management, Tilburg University, 5037 AB Tilburg, The Netherlands;
| | - Marlou L. A. de Kroon
- Department of Obstetrics and Gynecology, Erasmus MC—Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Department of Public Health and Primary Care, Centre for Environment and Health, Catholic University Leuven, 3000 Leuven, Belgium
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Slåtten T, Lien G, Mutonyi BR. Precursors and outcomes of work engagement among nursing professionals-a cross-sectional study. BMC Health Serv Res 2022; 22:21. [PMID: 34983510 PMCID: PMC8725263 DOI: 10.1186/s12913-021-07405-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/13/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Health services organizations must understand how best to lower nursing professionals' turnover intentions, and increase their job satisfaction and the quality of care provided to patients. This study aims to examine whether work engagement (WE) is a significant predictor of the achievement of these preferred organizational goals. The study also aims to examine whether organizational culture and organizational climate can manage the WE of nursing professionals and indirectly contribute to the accomplishment of the preferred organizational goals. METHODS In detail, a cross-sectional questionnaire survey study was conducted through a convenience sampling of a total of N = 164 nurses, from four Norwegian public hospitals. Structural equation modeling was employed in testing the hypothesis in the conceptual model, using Stata software. Furthermore, mediation analyses were achieved through use of the "medsem" package in the Stata software, in testing whether the proposed direct and indirect effects were statistically significant, and the type of mediation found. RESULTS The three key findings from this study are: i) WE of nursing professionals was found to be positively related to service quality of care (β = 0.551) and job satisfaction (β = 0.883). Job satisfaction fully mediates the relationship between WE and turnover intention and in itself explains almost 60% (R2 = 0.59) of turnover intention; ii) nursing professionals' perception of organizational culture (β = 0.278) and collaboration climate (β = 0.331) were both directly related to their WE; and iii) WE fully mediates the relationship between organizational culture/climate and service quality of care and job satisfaction. Moreover, WE partially mediates the relationship between collaborative climate and job satisfaction. CONCLUSIONS The WE of nursing professionals is highly correlated to their job satisfaction. WE and turnover intentions are (fully) mediated by job satisfaction. Employers should therefore focus on improving the job satisfaction of nursing professionals. The WE of nursing professionals is a common key factor for such improvement. Consequently, leaders and managers should continuously manage nursing professionals' WE, focusing on such areas as organizational culture and climate, because WE is an effective means of enabling multiple desirable outcomes for hospital organizations.
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Affiliation(s)
- Terje Slåtten
- Inland School of Business and Social Science, Inland Norway University of Applied Sciences, Campus Lillehammer, 2604, Lillehammer, Norway.
| | - Gudbrand Lien
- Inland School of Business and Social Science, Inland Norway University of Applied Sciences, Campus Lillehammer, 2604, Lillehammer, Norway
| | - Barbara Rebecca Mutonyi
- Inland School of Business and Social Science, Inland Norway University of Applied Sciences, Campus Lillehammer, 2604, Lillehammer, Norway
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D'haenens F, Van Rompaey B, Swinnen E, Dilles T, Beeckman K. The effects of continuity of care on the health of mother and child in the postnatal period: a systematic review. Eur J Public Health 2021; 30:749-760. [PMID: 31121019 DOI: 10.1093/eurpub/ckz082] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Continuity of care (COC) is essential for high-quality patient care in the perinatal period. Insights in the effects of COC models on patient outcomes are important to direct perinatal healthcare organization. To our knowledge, no previous review has listed the effects of COC on the physical and mental health of mother and child in the postnatal period. METHODS A search was conducted in four databases (PubMed, Web of Knowledge, CENTRAL and CINAHL), from 2000 to 2018. Studies were included if: participants were healthy mothers or newborns with a gestational age between 37-42 weeks; they covered the perinatal period and aimed to measure breastfeeding or any outcome related to the maternal/newborn physical or mental health. At least one of the three COC types (management, informational and relationship) was identified in the intervention. The methodological quality was assessed. RESULTS Ten articles were included. COC is mostly present in the identified care models. The effects of COC on the outcomes of mother and child in the postnatal period seem mostly to be positive, although not always significant. The relation between COC and the outcomes can be influenced by confounding factors, like the socio-economic status of the included population. Interventions with COC during pregnancy appear to be more effective for all the studied outcome factors. CONCLUSION COC as management, relational and informational continuity starting antenatal has the most impact on the postnatal outcomes of mother and child.
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Affiliation(s)
- Florence D'haenens
- Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Brussels, Belgium
| | - Bart Van Rompaey
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Eva Swinnen
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tinne Dilles
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Katrien Beeckman
- Nursing and Midwifery Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and University Hospital Brussel, Brussels, Belgium
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Ridgway L, Hackworth N, Nicholson JM, McKenna L. Working with families: A systematic scoping review of family-centred care in universal, community-based maternal, child, and family health services. J Child Health Care 2021; 25:268-289. [PMID: 32602735 DOI: 10.1177/1367493520930172] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children's long- and short-term health and developmental outcomes can be improved when families are engaged and supported, and inform care planning. Family-centred care (FCC) underpins policy directions for universal, community-based, child and family health services in the early years, although its implementation in this context is poorly understood. This systematic scoping review of the current literature aimed to improve understanding of FCC implementation in maternal, child, and family health universal services. Key databases and grey literature were searched using descriptors of maternal, child, and family health population and context, and FCC concept. Reference checking identified further literature for analysis. Thirteen included papers reported on nine studies from Australia, New Zealand, and the United Kingdom. Limited participant representation of fathers and diverse community members was evident. Deductive thematic analysis identified four areas of FCC demonstrated in this literature: respectful relationships, effective communication to foster shared understanding, flexible and contextualized care, and support for autonomy and agency. The literature demonstrated the interplay between organizational, professional, and recipient factors and their impact on the implementation of FCC. For successful FCC implementation, all these elements should be considered.
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Affiliation(s)
- Lael Ridgway
- 110497School of Nursing and Midwifery La Trobe University, Australia.,Judith Lumley Centre, 2080La Trobe University
| | - Naomi Hackworth
- Judith Lumley Centre, 2080La Trobe University.,435100Parenting Research Centre, Australia.,Murdoch Childrens Research Institute, Australia
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Rosander M, Berlin A, Forslund Frykedal K, Barimani M. Maternal depression symptoms during the first 21 months after giving birth. Scand J Public Health 2020; 49:606-615. [PMID: 33308010 PMCID: PMC8512257 DOI: 10.1177/1403494820977969] [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] [Indexed: 11/25/2022]
Abstract
Aims: The first year after childbirth involves a major transition for women, which
can accentuate inadequacies and feelings of powerlessness, making them
vulnerable to depression. The aim of this study was to investigate the
prevalence and frequency of maternal postpartum depressive symptoms at
different times after giving birth (0–21 months). Methods: Data were collected cross-sectionally using a web questionnaire containing
the Edinburgh Postnatal Depression Scale (EPDS). A total of 888 mothers with
children in the age range 0–21 months responded. Results: The results showed different levels of depression over the range of months
included in the study. The overall prevalence using EPDS ⩾ 12 was 27.8%.
There were higher levels at 9–12 months and 17–21 months. The highest levels
of symptoms of depression were found at nine, 12, and 17 months after birth,
and the lowest levels at two and 16 months. Conclusions: Many mothers experience symptoms of depression after giving birth that
can continue well beyond the child’s first year. We have identified
different levels of depression at different points in time after giving
birth, with highs and lows throughout the first 21 months. This
highlights a need to screen for depression more than once during the
first years, as well as a closer cooperation between midwives and child
healthcare nurses in supporting mothers in the transition to motherhood.
This is an important aspect of public health, which not only involves
mothers with symptoms of depression, but also their ability to care for
their child and a possible negative impact on the child’s
development.
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Affiliation(s)
- Michael Rosander
- Department of Behavioural Sciences and
Learning, Linköping University, Linköping, Sweden
- Michael Rosander, Department of Behavioural
Sciences and Learning, Linköping University, 581 83 Linköping, Sweden. E-mail:
| | - Anita Berlin
- Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Karin Forslund Frykedal
- Department of Behavioural Sciences and
Learning, Linköping University, Linköping, Sweden
- Department of Social and Behavioural
Studies, University West, Trollhättan, Sweden
| | - Mia Barimani
- Academic Primary Care Centre, Region
Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary
Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet,
Stockholm, Sweden
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Brandstetter S, Rothfuß D, Seelbach-Göbel B, Melter M, Kabesch M, Apfelbacher C. Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study. BMJ Open 2020; 10:e037745. [PMID: 33109648 PMCID: PMC7592309 DOI: 10.1136/bmjopen-2020-037745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate mothers' knowledge and utilisation of antenatal and perinatal support services as well as predictors of knowledge and service utilisation. DESIGN Cross-sectional study. SETTING Prospective birth cohort in Regensburg, Eastern Bavaria, Germany. PARTICIPANTS 2455 mothers after delivery. OUTCOME MEASURES Participants' knowledge of distinct antenatal and perinatal support services (poor vs good, defined by median split). Participants' use of antenatal services provided by midwife (yes, no) and of any other antenatal support services (yes, no). RESULTS The vast majority of mothers knew at least some support services. Two-thirds of women (68.4%) reported to have used the services provided by midwives. 23.6% of women reported to have used at least one of the other antenatal services. Good knowledge of services was associated with higher education (OR 1.37, 95% CI 1.13 to 1.67), no migration background (OR 2.26, 95% CI 1.76 to 2.90), better health literacy (OR 1.04, 95% CI 1.03 to 1.06), while being primiparous (OR 0.72, 95% CI 0.60 to 0.86) and being unmarried/living with a partner (OR 0.71, 95% CI 0.57 to 0.89) reduced the chance. Predictors of service utilisation differed with regard to the services considered. CONCLUSIONS Overall, mothers had a good level of knowledge of antenatal and perinatal support services. However, we found that some groups of women were less well informed. This inequality in social predictors of knowledge of services was also partly reflected in differences in service utilisation during pregnancy.
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Affiliation(s)
- Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - David Rothfuß
- Coordinating Center for Early Interventions, City of Regensburg, Regensburg, Germany
| | - Birgit Seelbach-Göbel
- Clinic of Obstetrics and Gynecology St Hedwig, University of Regensburg, Regensburg, Germany
| | - Michael Melter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Jones E, Southwood H, Cook C, Nicholson T. Insights into paediatric tube feeding dependence: A Speech-language pathology perspective. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:327-337. [PMID: 32366127 DOI: 10.1080/17549507.2020.1754910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose: To explore possible factors contributing to paediatric tube feeding dependency from the speech-language pathology perspective. Tube feeding dependency can have serious repercussions for children and their families with failed or slow weaning/transitioning from tube to oral feeding, more likely after the age of five.Method: A mixed methods approach was conducted. During the first quantitative phase, an online national survey of speech-language pathologists (SLPs) from the health and non-health sectors was carried out followed by interviews with a subset of the respondents. Forty-three SLPs completed the survey. In the second qualitative phase, 10 participants from the survey were interviewed in depth as to their opinions about why tube dependency occurs. Survey data from phase one were analysed using descriptive statistics and chi square comparisons. Interview data were categorised using thematic analysis. Findings from both methodologies were combined to report the results.Result: Two interlinking meta-themes were identified from the combined data sets. These were: (1) Medicalisation of tube fed children in infancy as a root cause of tube feeding dependency and (2) Fragmentation of the tube fed child's continuity of care. The specific results indicated several possible reasons for tube feeding dependency including medical emphasis on weight gain, prolonged nasogastric tube feeding and waiting too long for transition from tube to oral feeding. A lack of integrated care and clinician confidence in non-health settings also appeared to be a factor contributing to tube feeding dependency.Conclusion: Early and ongoing biomedical focus on weight gain affected long-term goals for transitioning leading, subsequently, to tube feeding becoming normalised by school age.
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Affiliation(s)
- Emily Jones
- Institute of Education, College of Humanities and Social Sciences, Massey University, Auckland, New Zealand
| | - Helen Southwood
- Institute of Education, College of Humanities and Social Sciences, Massey University, Auckland, New Zealand
| | - Catherine Cook
- School of Nursing, College of Health, Massey University, Auckland, New Zealand
| | - Tom Nicholson
- Institute of Education, College of Humanities and Social Sciences, Massey University, Auckland, New Zealand
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Olander EK, Aquino MRJR, Chhoa C, Harris E, Lee S, Bryar RM. Women's views of continuity of information provided during and after pregnancy: A qualitative interview study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1214-1223. [PMID: 30989764 DOI: 10.1111/hsc.12764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/08/2019] [Accepted: 03/17/2019] [Indexed: 06/09/2023]
Abstract
Straightforward transfer of care from pregnancy to the postpartum period is associated with health benefits and is desired by women worldwide. Underpinning this transfer of care is the sharing of information between healthcare professionals and the provision of consistent information to women. In this qualitative study, two aspects of continuity of information were examined; first the information passed on from midwife to health visitor regarding a woman and her baby before the health visitor meets the woman postnatally and second, the consistency of information received by women from these two healthcare professionals (the main healthcare providers during and after pregnancy in England). To be eligible for the study, women had to have had a baby in England within 12 months prior to the interview. Participants also needed to be able to read and speak English and be over 18 years old. Recruitment of participants was via word of mouth and social media. Twenty-nine mothers were interviewed of whom 19 were first time mothers. The interviews took place in the summer and autumn of 2016 and were transcribed verbatim and analysed using Framework Analysis. Two overarching themes were identified: not feeling listened to and information inconsistencies. Women reported little experience of midwives and health visitors sharing information about their care, forcing women to repeat information. This made women feel not listened to and participants recommended that healthcare professionals share information; prioritising information about labour, mental health, and chronic conditions. Women had mixed experiences regarding receiving information from midwives and health visitors, with examples of both consistent and inconsistent information received. To avoid inconsistent information, joint appointments were recommended. Findings from this study clearly suggest that better communication pathways need to be developed and effectively implemented for midwives and health visitors to improve the care that they provide to women.
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Affiliation(s)
- Ellinor K Olander
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Maria Raisa Jessica Ryc Aquino
- Strangeways Research Laboratory, The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Celine Chhoa
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Erica Harris
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Suzanne Lee
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Rosamund M Bryar
- School of Health Sciences, Centre for Maternal and Child Health Research, City, University of London, London, UK
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12
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Fealy S, Chan S, Wynne O, Dowse E, Ebert L, Ho R, Zhang MWB, Jones D. The Support for New Mums Project: A protocol for a pilot randomized controlled trial designed to test a postnatal psychoeducation smartphone application. J Adv Nurs 2019; 75:1347-1359. [PMID: 30740767 DOI: 10.1111/jan.13971] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/13/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
Abstract
AIM To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers. DESIGN A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design. METHOD This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6 weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016. DISCUSSION The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618001580268.
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Affiliation(s)
- Shanna Fealy
- School of Nursing and Midwifery, The University of Newcastle Australia, Callaghan, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle Australia, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle Australia, Callaghan, NSW, Australia
| | - Sally Chan
- School of Nursing and Midwifery, The University of Newcastle Australia, Callaghan, NSW, Australia.,Priority Research Centre for Brain & Mental Health, The University of Newcastle Australia, Callaghan, NSW, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, The University of Newcastle Australia, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Science: Mothers and Babies, University of Newcastle Australia, Callaghan, NSW, Australia
| | - Eileen Dowse
- School of Nursing and Midwifery, The University of Newcastle Australia, Callaghan, NSW, Australia
| | - Lyn Ebert
- School of Nursing and Midwifery, The University of Newcastle Australia, Callaghan, NSW, Australia
| | - Roger Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Melvyn W B Zhang
- Institute of Mental Health Singapore, National Addictions Management Service, Singapore
| | - Donovan Jones
- School of Nursing and Midwifery, The University of Newcastle Australia, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle Australia, Callaghan, NSW, Australia.,Priority Research Centre for Brain & Mental Health, The University of Newcastle Australia, Callaghan, NSW, Australia
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Aquino MRJV, Olander EK, Bryar RM. A focus group study of women's views and experiences of maternity care as delivered collaboratively by midwives and health visitors in England. BMC Pregnancy Childbirth 2018; 18:505. [PMID: 30587163 PMCID: PMC6307134 DOI: 10.1186/s12884-018-2127-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Research suggests that collaboratively delivered maternity care can positively impact health outcomes. However, women's perspectives on models of care involving interprofessional collaboration between midwives and health visitors are not well understood. Accounts of women's maternity care experiences are key to improving maternity services. This study considered women's views and experiences of maternity care as collaboratively provided by midwives and health visitors in England. METHODS A qualitative focus group study with an exercise exploring women's ideal maternity care pathway was conducted. Three focus groups were conducted in London, England between June and August 2017 with women who had had a child within 18 months prior to the study. The participants (n = 12) were recruited from two Children's Centres in London, England. Data were analysed using thematic analysis. RESULTS Four themes were identified: 'Women's experiences of maternity care from midwives and health visitors', 'Midwife-health visitor communication', 'Midwife-health visitor collaboration for tailored care', and 'Women's ideal maternity care pathway'. Regarding women's experiences of interprofessional collaboration between midwives and health visitors, this was rarely encountered, but welcomed by women. Women's observations of limited tailored care and co-ordination led to several suggestions to improve maternity care, including secure, shared medical recordkeeping systems, clarity on midwives' and health visitors' roles, as well as increased communication. CONCLUSIONS Maternity care that is collaboratively delivered by midwives and health visitors, from the perspectives of the women in this study, is not routinely provided. However, women recognise the potential benefits of midwife-health visitor collaboration. Future research should explore service configurations that support integrated maternity care pathways, and evaluate the impact of midwife-health visitor collaboration on health and service outcomes.
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Affiliation(s)
| | - Ellinor K. Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Rosamund M. Bryar
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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Nasiriani L, Rahimparvar SFV, Farajkhoda T, Bahrani N. The related factors of compliance to professional codes of ethics from midwives' perspective working in healthcare centers of Tehran-Iran. Pan Afr Med J 2018; 30:40. [PMID: 30167067 PMCID: PMC6110552 DOI: 10.11604/pamj.2018.30.40.14436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/08/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Professional ethics is an important issue in every organization. This study was designed to define compliance level to professional codes of ethics and some of its related factors in midwives working at healthcare centers. Methods This cross sectional study was conducted in 2013 Tehran Iran. 125 midwives from the governmental healthcare centers of Tehran were selected through stratified quota sampling method. Data gathering tool was a self-reporting questionnaire which included: demographic characteristics, Iranian version of ethical codes of reproductive health providers, applicability of these ethical codes and awareness about the professional codes of ethical. Data analysis was conducted using SPSS v.16. p level at 0.05. Results Compliance to the professional ethical codes were directly correlated to the income level of the midwives, the applicability of the codes and the midwives' awareness about them. Conclusion It is necessary to pay attention to professional ethics and its teaching as such. It is also important to monitor compliance to the ethical codes. Moreover, living conditions of the midwives should be one of the priorities to enhance their performance.
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Affiliation(s)
- Leila Nasiriani
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Tahmineh Farajkhoda
- Research Center for Nursing and Midwifery Care, Shahid Sadoghi University of Medical Sciences, Yazd, Iran
| | - Naser Bahrani
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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15
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Vikström A, Johansson S, Barimani M. Postnatal
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visits within 30 days—Pattern, risk factors and implications for care. J Clin Nurs 2017; 27:769-776. [DOI: 10.1111/jocn.14090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Vikström
- The Division of Family Medicine Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
| | - Sven‐Erik Johansson
- The Division of Family Medicine Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
| | - Mia Barimani
- Division of Reproductive Health Department of Women′s and Children′s Health Karolinska Institutet Stockholm Sweden
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16
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Hesson A, Fowler C, Rossiter C, Schmied V. ‘Lost and confused’: parent representative groups’ perspectives on child and family health services in Australia. Aust J Prim Health 2017; 23:560-566. [DOI: 10.1071/py17072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/09/2017] [Indexed: 11/23/2022]
Abstract
Consumer involvement in health care is widely accepted in policy and service delivery. Australia offers universal health services for families with children aged 0 to 5 years, provided by child and family health nurses and general practitioners. Services include, but are not limited to, monitoring and promoting child health and development, and supporting parents. This paper reports consumer representatives’ perspectives on Australian parents’ needs and experiences of child and family health services, identifying facilitators and barriers to service utilisation. Twenty-six representatives from consumer organisations explored families’ experiences through focus groups. Qualitative data were analysed thematically. Consumer representatives identified several key implications for families using primary health services: feeling ‘lost and confused’ on the parenting journey; seeking continuity and partnership; feeling judged; and deciding to discontinue services. Participants highlighted accessible, timely, non-judgmental and appropriate interactions with healthcare professionals as vital to positive consumer experiences and optimal health and developmental outcomes. Representatives indicated that families value the fundamentals of well-designed health services: trust, accessibility, continuity, knowledge and approachability. However, both consumers and service providers face barriers to effective ongoing engagement in universally provided services.
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17
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Aquino MRJ(RV, Olander EK, Needle JJ, Bryar RM. Midwives’ and health visitors’ collaborative relationships: A systematic review of qualitative and quantitative studies. Int J Nurs Stud 2016; 62:193-206. [DOI: 10.1016/j.ijnurstu.2016.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 11/26/2022]
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18
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Fowler C, Schmied V, Dickinson M, Dahlen HG. Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia. J Clin Nurs 2016; 26:524-534. [PMID: 27461911 DOI: 10.1111/jocn.13478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015. BACKGROUND For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care. DESIGN A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups. RESULTS Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity. CONCLUSIONS There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers. RELEVANCE TO CLINICAL PRACTICE Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families.
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Affiliation(s)
- Cathrine Fowler
- Centre for Midwifery, Child & Family Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | | | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Ingham Institute, Liverpool, NSW, Australia
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19
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Olley H, Psaila K, Fowler C, Kruske S, Homer C, Schmied V. 'Being the bridge and the beacon': a qualitative study of the characteristics and functions of the liaison role in child and family health services in Australia. J Clin Nurs 2016; 26:91-102. [PMID: 27647750 DOI: 10.1111/jocn.13373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This article explores the characteristics and functions of the liaison role in child and family health services in Australia. BACKGROUND Liaison roles are increasingly being used to improve communication between health services and professionals and to facilitate access to support for individuals and families in need. Nurses are commonly, although not always, the professionals who undertake these roles. Research on the role and outcomes of liaison positions in child and family health services is limited in Australia and internationally. DESIGN A qualitative interpretive design informed this study. Interviews and focus groups were conducted with 40 liaison and other health professionals, primarily nurses, working with families with newborn and young children in two Australian States. Data were analysed thematically. RESULTS Three major themes were identified reflecting the importance of defining the role and tasks which included building bridges between services and professionals, supporting families during transition between services and supporting clinicians. Several facilitators and barriers were identified, including concerns about sustainability of the roles. CONCLUSIONS Professionals working in a liaison role in child and family health services emphasise that these positions have the potential to link services and professionals, thereby providing more effective care pathways for children and families especially for those with complex and multiple vulnerabilities. While a few children and family health services in Australia provide liaison services, the extent of liaison support and the outcomes for families in Australia is unknown. RELEVANCE TO CLINICAL PRACTICE Nurses working with children and families are the most likely health professionals to undertake a liaison role. In many nursing contexts, liaison roles are relatively new and those in the role have the responsibility to define the key purpose of their role. Liaison roles are multifaceted requiring the nurse to have excellent communication and negotiation skills to effectively link diverse professionals and services, while simultaneously engaging with and supporting vulnerable families and children. Nurses in these roles also support and educate clinical colleagues.
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Affiliation(s)
- Hannah Olley
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Kim Psaila
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Cathrine Fowler
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sue Kruske
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
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20
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Pascal MC, Homer CSE. Models of Postnatal Care for Low-Income Countries: A Review of the Literature Abstract. INTERNATIONAL JOURNAL OF CHILDBIRTH 2016. [DOI: 10.1891/2156-5287.6.2.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE:This review aims to identify the key features of effective models of postnatal care involving midwifery personnel and to determine which models may be appropriate for implementation in low-income countries.STUDY DESIGN:A narrative synthesis of English language, peer-reviewed articles from 2004 to 2014 was undertaken. Four online library databases were searched. Inclusion/exclusion criterion and a quality appraisal were applied.MAJOR FINDINGS:Twenty-two studies were included in the review, but only 4 were from low-income countries. Midwifery-led models of postnatal care are cost-effective to provide high-quality care in every settings for every women in respect of 2 core components of quality care that are woman-centered care and continuity of care. Midwifery postnatal care is provided at hospital, in community settings, and at home, all presenting different strengths and weaknesses. Combinations of models of midwifery postnatal care and collaboration between stakeholders have had positive impacts on the quality of postnatal care. To be completely effective, this requires a better management and support of midwifery personnel though. Women and midwifery personnel’s satisfaction needs to be considered to identify the local means and needs and to plan a suitable model of midwifery postnatal care at each location.MAIN CONCLUSION:Low-income countries could develop a midwifery-led model of postnatal care. This will require identifying women and midwifery personnel’s needs and the available resources and involving the stakeholders collaboratively to provide a suitable model of midwifery postnatal care. Education and practice will need to be addressed as well as promotion to the population. There is a need to conduct more research on midwifery postnatal care in low-income countries to evaluate how to best use them and what aspect of the midwifery postnatal care can be strengthened.
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21
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Brodribb WE, Mitchell BL, Van Driel ML. Continuity of care in the post partum period: general practitioner experiences with communication. AUST HEALTH REV 2016; 40:484-489. [DOI: 10.1071/ah15144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/06/2015] [Indexed: 11/23/2022]
Abstract
Objectives Informational and management continuity of care assists in providing a seamless transition for women and infants from tertiary or secondary to primary care during the post partum period. Few studies have evaluated the interaction between different aspects of the health system following a woman’s discharge from hospital after the birth of her infant. The present study describes how general practitioners (GPs) experience communications with hospitals and other post partum care providers relevant to continuity of care. Methods In the present cross-sectional study, a 52-item questionnaire adapted from a previously used survey was mailed to 932 GPs in southern Queensland, Australia, between February and July 2013. Questionnaire items included participant demographics, the timeliness and usability of discharge summaries, communication with other post partum care providers and consultation practices. Results The response rate was 17.4%. Nearly one-quarter of participants never or rarely received a hospital discharge summary in a timely manner and most considered the summaries somewhat useful. Few GPs (14.3%) had contact with or received information from domiciliary midwives who conducted post partum home visits. A higher proportion (38%) had some communication with a Child and Family Health nurse in the month before the survey. Conclusions Information flow from hospital to general practice and between other post partum care providers is less than ideal and may affect ongoing care for mothers and infants, especially those at risk. Knowledge exchange between healthcare services and initiatives to improve information sharing needs to be developed and implemented. What is already known on this topic? Transitions from tertiary or secondary care to primary care and between primary care providers are often times of vulnerability for patients, including women and infants in the post partum period. There is little information documenting communications between different maternity services and GPs that facilitate ongoing care. What does this paper add? There are significant gaps in the exchange of information about post partum women and infants from hospitals to GPs and a lack of communication between GPs and other post partum care providers, such as domiciliary midwives and Child and Family Health nurses. What are the implications for practitioners? Improvements in the timeliness, presentation and content of hospital discharge summaries, as well as enhancing channels of communication, collaboration, cooperation and information sharing between providers of community post partum care, are necessary if mothers are to receive the best care possible.
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22
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Vikström A, Barimani M. Partners' perspective on care-system support before, during and after childbirth in relation to parenting roles. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 8:1-5. [PMID: 27179370 DOI: 10.1016/j.srhc.2015.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 11/07/2015] [Accepted: 11/26/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore (i) ways in which partners experience support from care systems before, during, and after childbirth in relation to their parenting roles and (ii) ways in which support can improve. METHODS Four focus group interviews (n = 17; median age = 35; age range = 24-46) and inductive content analysis. RESULTS Analysis revealed the following three categories: (1) Care staff include or exclude in relation to partners' parenting role; (2) Care systems continuity; (3) Being a supportive partner. The latent content of the categories was formulated into a theme: being engaged and wanting to be included. CONCLUSIONS Because partners are engaged parents, who support the woman giving birth, they must feel included during pregnancy, birth, and postpartum care and during encounters within child health care units. This would require (i) information that directly targets partners before and after childbirth, (ii) specially adapted venues for parent education, and (iii) personal, partner-focused discussions with care staff.
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Affiliation(s)
- Anna Vikström
- Department of Neurobiology, Care Sciences and Society, Academic Primary Health Care Centre, Karolinska Institutet, SE-141 83 Huddinge, Sweden.
| | - Mia Barimani
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, SE- 171 76 Solna, Sweden
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Myors KA, Cleary M, Johnson M, Schmied V. A mixed methods study of collaboration between perinatal and infant mental health clinicians and other service providers: Do they sit in silos? BMC Health Serv Res 2015; 15:316. [PMID: 26260057 PMCID: PMC4531515 DOI: 10.1186/s12913-015-0977-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women at risk of poor perinatal mental health benefit from coordinated approaches to care. Perinatal and infant mental health (PIMH) services have been established to support women with social and emotional needs. This paper examines the nature and extent of collaboration within two PIMH services in Australia. METHODS A convergent, embedded, mixed methods design was used. Two hundred and forty four medical records were reviewed, 13 professionals (six PIMH clinicians, two PIMH service managers, and five key stakeholders) and 11 women service-users participated in semi-structured interviews. RESULTS Three broad themes were drawn from the data, Theme 1: We don't sit in silos … but they do, Theme 2: We need to enhance communication, and Theme 3: Collaboration is hard work. Perinatal and infant mental health clinicians believe they work collaboratively with other service providers. Key stakeholders and documentation in the medical records reveal that collaboration is nominal. CONCLUSIONS Professionals believe that collaboration is essential for women with complex needs. Perinatal and infant mental health clinicians are skilled at building relationships with women, however further support is needed to build trusting relationships with other service providers. Women service-users also need to be involved in the collaborative process to become equal partners in their care.
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Affiliation(s)
- Karen A Myors
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
| | - Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
| | - Maree Johnson
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
- Centre for Applied Nursing Research, Affiliated with the Ingham Institute of Applied Medical Research, Sydney South West Local Health District, Liverpool, NSW, 2170, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
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24
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Yelland J, Riggs E, Szwarc J, Casey S, Dawson W, Vanpraag D, East C, Wallace E, Teale G, Harrison B, Petschel P, Furler J, Goldfeld S, Mensah F, Biro MA, Willey S, Cheng IH, Small R, Brown S. Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities. Implement Sci 2015; 10:62. [PMID: 25924721 PMCID: PMC4425879 DOI: 10.1186/s13012-015-0251-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/18/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities. METHODS/DESIGN A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services. Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families' experiences of specific initiatives and service providers' views and experiences of innovation and change. DISCUSSION It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources.
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Affiliation(s)
- Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
| | - Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia.
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia.
| | - Wendy Dawson
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
| | - Dannielle Vanpraag
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
| | - Chris East
- Monash Women's Maternity Services, Monash Health, Clayton, VIC, Australia.
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
- The Ritchie Centre, Monash University, Clayton, VIC, Australia.
| | - Euan Wallace
- Monash Women's Maternity Services, Monash Health, Clayton, VIC, Australia.
- The Ritchie Centre, Monash University, Clayton, VIC, Australia.
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
| | - Glyn Teale
- Women's and Children's Services, Western Health, Sunshine, VIC, Australia.
- Department Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.
| | - Bernie Harrison
- Maternal and Child Health, City of Greater Dandenong, Dandenong, VIC, Australia.
| | - Pauline Petschel
- Maternal and Child Health, City of Wyndham, Wyndham, VIC, Australia.
| | - John Furler
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
| | - Fiona Mensah
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Mary Anne Biro
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
| | - Sue Willey
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
| | - I-Hao Cheng
- South Eastern Melbourne Medicare Local, Dandenong, VIC, Australia.
- Southern Academic Primary Care Research Unit, Monash University, Dandenong, VIC, Australia.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
- School of Population Health, University of Melbourne, Parkville, VIC, Australia.
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Barimani M, Vikström A. Successful early postpartum support linked to management, informational, and relational continuity. Midwifery 2015; 31:811-7. [PMID: 25982847 DOI: 10.1016/j.midw.2015.04.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/01/2015] [Accepted: 04/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to explore ways in which parents experience support from health professionals in the early postpartum period and understand how parenting support is related to management, informational, and relational continuity. DESIGN a qualitative study consisting of focus group interviews followed by deductive content analysis. SETTING AND PARTICIPANTS a large city in Sweden; 18 women and 16 men. FINDINGS study participants reported that parenting support occurs by providing consistent advice; indicating who to ask when care questions arise; enabling access to the care system when needs surface; providing sufficient information about self-management for mother or baby; involving parents in discharge planning; distributing information that empowers parents; enabling team/clinical care consistency; and appointing persons in the care system who can foster parents׳ feelings of trust--in short: by enabling management, informational, and relational continuity. KEY CONCLUSIONS care continuity experiences lead to perceived parenting support in the early postpartum period. Effective health care organisations within the postpartum care system must embody these types of continuity: management, informational, and relational. There is a need for researchers to design tools for measuring continuity and for policymakers to enable coherence and co-ordination among professionals. IMPLICATIONS FOR PRACTICE identify parents׳ needs so that health professionals can plan for parents׳ first few weeks at home and ensure that parents get access to appropriate care.
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Affiliation(s)
- M Barimani
- Department of Women׳s and Children׳s Health, Division of Reproductive Health, Karolinska Institutet, Retsius väg 13 A, SE:17177 Stockholm, Sweden.
| | - A Vikström
- Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden
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Fowler C, Schmied V, Psaila K, Kruske S, Rossiter C. Ready for practice: what child and family health nurses say about education. NURSE EDUCATION TODAY 2015; 35:e67-e72. [PMID: 25466794 DOI: 10.1016/j.nedt.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Australia has a well-established universal child and family health service predominately staffed by specialist/qualified child and family health nurses. Two common and interrelated concerns are the need for nurses to be ready for practice after completing a nursing education program and the means to ensure ongoing nursing competence. OBJECTIVE To investigate the readiness of CFH nurses to practise after qualification and their continuing engagement with learning. DESIGN The study used an interpretive descriptive approach. SETTING This paper presents data from four questions from a larger survey of child and family health nurses across Australia. PARTICIPANTS 1098 child and family health nurses responded to the survey. METHOD Qualitative survey responses from the four education questions were analysed using inductive thematic content analysis. RESULTS Five significant themes were identified: hands-on experience (student clinical practice/placement); drawing on prior experience; learning on the job; learning (learning over time); and barriers to learning. CONCLUSION This paper provides insights into nurses' readiness for practice at the completion of a postgraduate child and family health nursing qualification and their maintenance of competence and specialist knowledge. It highlights: the need for clinical placement to be retained and enhanced; the significant contribution of more experienced child and family health nurses mentoring newly graduated child and family health nurses; the need for minimum education standards; the importance of reviewing education courses in relation to graduates' readiness for child and family health nursing practice; the importance of supporting ongoing professional development; and the removal of barriers to accessing education opportunities.
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Affiliation(s)
- Cathrine Fowler
- University of Technology, Sydney and Tresillian Family Care Centres, PO Box 123 Broadway, NSW 2007 Australia.
| | - Virginia Schmied
- University of Western Sydney, Locked Bag 1797, Penrith NSW 2751 Australia.
| | - Kim Psaila
- University of Western Sydney, Locked Bag 1797, Penrith NSW 2751 Australia.
| | - Sue Kruske
- School of Nursing and Midwifery, University of Queensland, St Lucia Campus, University of Queensland, Brisbane, Queensland 4072 Australia.
| | - Chris Rossiter
- University of Technology, Sydney, PO Box 123, Broadway Sydney, NSW 2007 Australia.
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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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