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Welborn AC, Nichols T, Gringle M, Lewallen L. Neonatal intensive care nurses' accounts of care for mothers/families with substance-exposed pregnancies: A critical discourse analysis. J Adv Nurs 2024; 80:566-579. [PMID: 37545100 DOI: 10.1111/jan.15807] [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] [Received: 09/07/2022] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023]
Abstract
AIMS To explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance-exposed pregnancy (SEP). DESIGN This secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship-building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique. METHOD Nine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty-one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery. RESULTS Study findings revealed nurses experienced challenges providing high-quality, family-centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care. CONCLUSION The study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high-quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments. IMPACT This study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high-quality care in stressful healthcare environments. REPORTING METHOD EQUATOR guidelines were followed, using the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION NICU nurses were interviewed about their care-provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.
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Affiliation(s)
- Amber C Welborn
- Department of Nursing, Appalachian State University, Boone, North Carolina, USA
| | - Tracy Nichols
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Meredith Gringle
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Lynne Lewallen
- School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Kock LS, Melbostad HS, Heil SH. Prevalence of Psychosocial Issues Among Pregnant Women Who Do and Do Not Use Illicit Substances. RESEARCH SQUARE 2023:rs.3.rs-2845911. [PMID: 37163000 PMCID: PMC10168477 DOI: 10.21203/rs.3.rs-2845911/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Objective It is often believed that pregnant women who use illicit substances are more likely to experience psychosocial issues like smoking, depression, and inadequate health care compared to pregnant women who do not. However, the prevalence of these psychosocial issues has rarely been calculated and compared using nationally representative data. Methods Important psychosocial issues identified by the American College of Obstetricians and Gynecologists were operationalized using variables in the National Survey on Drug Use and Health. We report weighted prevalence and age-adjusted odds ratios for these issues in pregnant women who did vs. did not report past-month illicit substance use. Results Pregnant women (n = 3,657) who reported past-month illicit substance use (6.3%; 95% CI 5.4-7.0) had significantly higher rates of almost all psychosocial issues examined, including past-month cigarette smoking (44.9% vs. 6.5%; age-adjusted odds ratio (AOR) = 7.14 (95% CI 4.98-10.20)); past-month alcohol use (36.1% vs. 7.8%; AOR = 6.80 (4.69, 9.86)); serious past-month distress (23.0% vs. 5.0%; AOR = 4.99 (3.07-8.11)); no health insurance (11.7% vs. 6.2%; AOR = 1.79 (1.07-2.99)); and receipt of food stamps (45.0% vs. 24.0%; AOR = 2.26 (1.55-3.29)). Moving 3 + times in the past year followed a similar pattern, but results were compatible with there being no difference between groups (10.6% vs. 5.5%; AOR = 1.59 (0.95-2.66)). In contrast to other issues examined, English language proficiency was higher among those who reported illicit substance use (4.7% vs. 0.4%; AOR = 0.08 (0.01-0.63)). Conclusions Pregnant women who use illicit substances experience higher rates of most psychosocial issues compared to those who do not, reinforcing recommendations for multidisciplinary approaches to care.
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Universal Postpartum Naloxone Provision: A Harm Reduction Quality Improvement Project. J Addict Med 2022:01271255-990000000-00121. [DOI: 10.1097/adm.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Young SL, Steane SE, Kent NL, Reid N, Gallo LA, Moritz KM. Prevalence and Patterns of Prenatal Alcohol Exposure in Australian Cohort and Cross-Sectional Studies: A Systematic Review of Data Collection Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13144. [PMID: 36293721 PMCID: PMC9603223 DOI: 10.3390/ijerph192013144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
This study sought to determine data collection approaches in Australian cohort studies and explore the potential impact on reported prenatal alcohol exposure (PAE) prevalence and patterns. Inclusion criteria were that studies related to a general Australian antenatal population where PAE was assessed and reported. Studies were excluded if they were not peer reviewed, examined the prevalence of PAE in pregnancies complicated by alcohol-use disorders, or were published in a language other than English. A systematic search of five electronic databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) was conducted. Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. Results were synthesised using MetaXL. Data from 16 separate birth cohorts (n = 78 articles) were included. Included cohorts were either general cohorts that included alcohol as a variable or alcohol-focused cohorts that were designed with a primary focus on PAE. PAE prevalence was estimated as 48% (95% CI: 38 to 57%). When subgroup analysis was performed, estimates of PAE prevalence when self-administered surveys and interviews were used for data collection were 53% (95% CI: 41% to 64%) and 43% (95% CI: 28% to 59%), respectively. Use of trained assessors was an influencing factor of the prevalence estimates when data were collected via interview. Alcohol-focused studies reported higher prevalence of PAE, regardless of method of survey administration. Where interviewer training is not possible, self-administered questionnaires will likely provide the most reliable PAE estimates. No funding sources are relevant to mention. Review was registered with PROSPERO (CRD42020204853).
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Affiliation(s)
- Sophia L. Young
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Sarah E. Steane
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Nykola L. Kent
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Linda A. Gallo
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, QLD 4502, Australia
| | - Karen M. Moritz
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
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Developments in Nursing Practice to Address Substance Use in the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2022; 51:361-376. [PMID: 35568096 DOI: 10.1016/j.jogn.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/30/2022] Open
Abstract
Since 1972, the year of the inaugural issue of Journal of Obstetric, Gynecologic, & Neonatal Nursing, substance use during pregnancy has remained a public health concern in the United States. This concern is currently exacerbated by factors such as the opioid and stimulant use crisis and widening health and social inequities for many women and families. The purposes of this historical commentary are to describe trends in the perception of women with substance use disorder and their infants and related sociolegal implications and to trace the evolution of related nursing practice and research during the past 50 years. We provide recommendations and priorities for practice and research, including further integration of support for the mother-infant dyad, cross-sectoral collaborations, and equity-oriented practices and policies.
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Welborn AC, Lewallen L, Nichols T. Exploration of the Care Giving Dynamic Between NICU Nurses and Mothers with a Substance-Exposed Pregnancy. Neonatal Netw 2022; 41:11-20. [PMID: 35105791 DOI: 10.1891/11-t-664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the caregiving dynamic between NICU nurses and mothers with a substance-exposed pregnancy (SEP) by examining how nurses view these mothers compared to mothers without an SEP. DESIGN A qualitative design using interviews with NICU nurses who care for infants and families with an SEP. SAMPLE The sample (n = 9) was all female, with an average of approximately 10 years of nursing experience in the NICU, with two-thirds having achieved a Bachelor of Science in Nursing (BSN) or higher. MAIN OUTCOME VARIABLE Perceptions of nurses working with families affected by an SEP. RESULTS Stigmatized views and trust issues shaped nurses' views of mothers with an SEP as different from other mothers. Empathy levels toward mothers differed related to nurses' views of substance use as either a moral decision or chronic disease. These viewpoints shaped the nurse's judgment of the mother's potential to provide a safe environment and independently care for the infant at home. Nurses described personal distress when caring for these families.
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Investigating Healthcare Provider Bias Toward Patients Who Use Drugs Using a Survey-based Implicit Association Test: Pilot Study. J Addict Med 2022; 16:557-562. [PMID: 36201677 PMCID: PMC9537726 DOI: 10.1097/adm.0000000000000970] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Negative bias against people who use illicit drugs adversely affects the care that they receive throughout the hospital. We hypothesized that emergency providers would display stronger negative bias toward these patients due to life-threatening contexts in which they treat this population. We also hypothesized that negative implicit bias would be associated with negative explicit bias. METHODS Faculty, nurses, and trainees at a midwestern tertiary care academic hospital were invited (June 26, 2019-September 5, 2019) to complete an online implicit association test and explicit bias survey. RESULTS Mean implicit association test results did not vary across demographics (n = 79). There were significant differences in explicit bias scores between departments regarding whether patients who use drugs deserve quality healthcare access (P = 0.017). We saw no significant associations between implicit and explicit bias scores. CONCLUSION Though limited by sample size, the results indicate that emergency and obstetrics/gynecology providers display more negative explicit bias toward this patient population than other providers.
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Nurses' Descriptions of Interactions When Caring for Women With Perinatal Substance Use Disorders and Their Infants. Nurs Womens Health 2021; 25:366-376. [PMID: 34478736 DOI: 10.1016/j.nwh.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/02/2021] [Accepted: 07/22/2021] [Indexed: 01/15/2023]
Abstract
The purpose of this review is to describe health care interactions between nurses and women with perinatal substance use disorders, including interactions with their infants from the perspective of the nurses. Findings from 11 qualitative inclusion articles were synthesized using a metasummary approach. The majority of articles showed that nurses experience problematic interactions when providing care to women with perinatal substance use disorders and their infants, although some results indicated that some nurses engage in interactions that are assuring. Six types of conflictual interactions were identified: inadequate care, distressing, condemning, deficient knowledge, rejecting, and dissatisfying. Two types of therapeutic interactions were identified: compassionate and supportive. The findings underscore the importance of managing stigma, enhancing knowledge of the science of addiction processes, and promoting best practices when caring for this population.
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Busse MM, Kim J, Unite M, Kantrowitz-Gordon I, Altman MR. Nurses' Priorities for Improving Pregnancy and Birth Care for Individuals with Opioid use Disorder. J Midwifery Womens Health 2021; 66:656-663. [PMID: 34398507 DOI: 10.1111/jmwh.13267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The motivation to seek treatment for opioid use disorder (OUD) can increase during the perinatal period. However, several identified barriers, such as poor access to services, lack of trained providers, stigma, and legal ramifications of OUD, limit the ability for individuals with OUD to receive safe and supportive care during pregnancy and birth. During the birth hospital stay in particular, nurses provide the majority of care for pregnant and birthing families. We aimed to engage nurses, with experience caring for pregnant and postpartum individuals with OUD, in priority setting as a way to identify areas of need in the current health care systems. METHODS Using community-engaged priority setting methods, we recruited a sample of 47 nurses (phase 1) and 20 nurses (phase 2), including nurse-midwives and other advanced practice nurses, at a statewide nursing conference, who reported regularly providing care for pregnant and postpartum individuals with OUD. We invited participants to submit questions and concerns regarding the provision of care for individuals with OUD (phase 1). A selection of those who submitted questions attended a focus group to rank and prioritize submitted questions into a set of priorities for research, policy, and care improvement (phase 2). RESULTS In phase 1, participants submitted a total of 165 questions and concerns. In phase 2, participants prioritized the following: funding to support improvements in OUD care in the perinatal period, increased access to services, supportive housing for individuals in recovery, standardization of care for individuals with OUD, and efforts to destigmatize care. DISCUSSION Nurses who work with pregnant and postpartum individuals with OUD have a unique insight as to how health care providers, including midwives, can better support this community and should be engaged setting priorities for research, changes to policy, and improvement in care.
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Affiliation(s)
- Morgan M Busse
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
| | - Jane Kim
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
| | - Marianne Unite
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
| | - Ira Kantrowitz-Gordon
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
| | - Molly R Altman
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
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Reese SE, Riquino MR, Molloy J, Nguyen V, Smid MC, Tenort B, Gezinski LB. Experiences of Nursing Professionals Working With Women Diagnosed With Opioid Use Disorder and Their Newborns: Burnout and the Need for Support. Adv Neonatal Care 2021; 21:32-40. [PMID: 33055519 PMCID: PMC11160478 DOI: 10.1097/anc.0000000000000816] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As the rate of opioid use in pregnancy escalates, there are a growing number of women diagnosed with opioid use disorder (OUD) and their newborns being cared for in inpatient settings. PURPOSE In this study, we sought to better understand the experiences of nurses and nursing assistants working with women diagnosed with OUD and their newborns. By identifying the needs of nurses and nursing assistants, the findings from this study may contribute to reductions in stigma and improved patient care. METHODS Nurses and nursing assistants were recruited from a postpartum unit at a large urban hospital in Utah. Participants (n = 30) attended up to 4 semistructured focus groups. We utilized Braun and Clarke's 6-phase approach to thematic analysis to analyze transcribed interviews. FINDINGS/RESULTS Themes identified during the data analysis process included negative feelings and reactions toward patients; preferential concern for the newborn over maternal well-being; and identification of organizational and training needs to overcome these challenges. IMPLICATIONS FOR PRACTICE These findings identify strategies for addressing challenges faced by nurses and nursing assistants in caring for women diagnosed with OUD and their newborns. IMPLICATIONS FOR RESEARCH Future research should examine the effectiveness of approaches to reduce behaviors influenced by stigma among nurses and nursing assistants working with women diagnosed with OUD and their newborns, as well as employee and patient satisfaction, and long-term health outcomes.
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Affiliation(s)
- Sarah E Reese
- School of Social Work, University of Montana, Missoula (Dr. Reese); School of Social Welfare, University of Kansas, Lawrence (Dr Riquino); School of Social Work, University of Montana, Missoula (Dr Molloy); independent researcher, Salt Lake City, UT (Dr. Nguyen); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City (Dr Smid); and Labor & Delivery and Obstetrical Emergency Services, University of Utah Hospital, Salt Lake City (Ms Tenort). Dr Gezinski is an independent researcher, Amsterdam, the Netherlands
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Nguemeni Tiako MJ, Sweeney L. The Government's Involvement in Prenatal Drug Testing May Be Toxic. Matern Child Health J 2021; 26:761-763. [PMID: 33392931 DOI: 10.1007/s10995-020-03110-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
In 25 U.S. states, healthcare professionals are mandated to report pregnant people for substance use to child protection service (CPS) agencies. This practice is not evidence-based, and we believe it harms the patient-provider relationship, opposes reproductive autonomy, and contributes to racial disparities in CPS referrals and their outcomes. Black patients are more often screened and reported than white patients for prenatal substance use; besides the impact on their obstetric care, this may be a barrier to seeking treatment for substance use disorders. Furthermore, strict, punitive state-level policies are associated with greater odds of neonatal abstinence syndrome. The treatment of substance use disorders in pregnancy under the Child Abuse Prevention and Treatment Act opposes robust evidence understanding substance use disorders as chronic illnesses. Among non-pregnant people seeking healthcare, substance use is not a "reportable offense." This double marginalization of pregnant patients limits their autonomy and unduly exposes them to the criminal-legal system. Given disparities in prenatal drug screening, Black pregnant patients are at greater risk of such double-jeopardy. Public health and medical organizations have released policy statements against states' punitive laws, but little has changed. Healthcare providers and institutions should prioritize evidence-based care to benefit the health and wellbeing of birthing person and their infant and combat "legal" interference at the clinic and public-health scale.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Yale School of Medicine, 367 Cedar Street, New Haven, CT, 06511, USA.
- Department of Emergency Medicine, Center for Emergency Care and Policy Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - Lena Sweeney
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, USA
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Knowledge of and Perceived Competence in Trauma-Informed Care and Attitudes of NICU Nurses Toward Mothers of Newborns With Neonatal Abstinence Syndrome. J Obstet Gynecol Neonatal Nurs 2020; 49:373-387. [PMID: 32553592 DOI: 10.1016/j.jogn.2020.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore how knowledge of and perceived competence in trauma-informed care inform the attitudes of NICU nurses toward mothers of newborns with neonatal abstinence syndrome (NAS). DESIGN A cross-sectional survey study. SETTING A southern U.S. metropolitan children's hospital with 145 NICU beds. PARTICIPANTS Convenience sample of 150 NICU nurses. METHODS Participants completed an online survey questionnaire adapted from the Attitudes About Drug Abuse in Pregnancy questionnaire and the Trauma-Informed Pediatric Care survey. Participants also responded to one open-ended question about their experiences in working with mothers of newborns with NAS. We used descriptive and inferential statistics and content analysis to analyze the survey data. RESULTS Participants demonstrated low to moderate knowledge about and perceived competence in trauma-informed care and showed more judgmental attitudes toward mothers of newborns with NAS. Level of knowledge about mothers with substance use disorder and perceived competence in trauma-informed care were associated with participants' attitudes toward mothers of newborns with NAS. Emergent themes from qualitative data included the following: Mother-Newborn Dyads Shape Nurses' Judgmental Attitudes, Caring for Mothers of Newborns With NAS Is a Challenging Experience, and Need to Refine Care for Mothers Through Intra- and Interdisciplinary Collaboration. CONCLUSION NICU nurses need further education about mothers of newborns with NAS. Improved knowledge about these women and adaptation of the principles of trauma-informed care may influence NICU nurses' judgmental attitudes toward mothers of newborns with NAS.
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Welborn A. Moral distress of nurses surrounding neonatal abstinence syndrome: Application of a theoretical framework. Nurs Forum 2019; 54:499-504. [PMID: 31246289 DOI: 10.1111/nuf.12362] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
TOPIC Neonatal nurses who care for infants with symptoms of neonatal abstinence syndrome (NAS) may experience moral distress through conflicting professional ethics. The nurse may find it difficult to simultaneously exemplify beneficence and nonmaleficence. OBJECTIVE The purpose of this paper is to explore the moral distress of nurses in the context of infants experiencing symptoms of NAS and apply a new conceptual model to this phenomenon. Understanding how nurses navigate moral dilemmas may provide insight into strategies to better support them to address moral conflict. METHODS Moral distress was explored in the context of nurses who care for infants with symptoms of NAS. A literature review was completed, followed by the application of the model onto the derived themes. RESULTS The theoretical application resulted in a framework that exemplifies the experience of caring for infants with symptoms of NAS and their families described by many nurses within the literature. If moral distress is not resolved, negative outcomes may be experienced by the nurse, with additional negative outcomes experienced by the family. CONCLUSION This theoretical model provided insight into the experience of moral distress surrounding nursing care for infants with symptoms of NAS. Additional research is needed to investigate moral residue and moral resilience in this particular caregiving dynamic.
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Affiliation(s)
- Amber Welborn
- The University of North Carolina at Greensboro, Greensboro, North Carolina
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14
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Fonti S, Davis D, Ferguson S. The attitudes of healthcare professionals towards women using illicit substances in pregnancy: A cross-sectional study. Women Birth 2016; 29:330-5. [DOI: 10.1016/j.wombi.2016.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/15/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
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Levin L, Schwartz-Tayri T. Attitudes towards poverty, organizations, ethics and morals: Israeli social workers' shared decision making. Health Expect 2016; 20:448-458. [PMID: 27271784 PMCID: PMC5433538 DOI: 10.1111/hex.12472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Partnerships between service users and social workers are complex in nature and can be driven by both personal and contextual circumstances. This study sought to explore the relationship between social workers' involvement in shared decision making with service users, their attitudes towards service users in poverty, moral standards and health and social care organizations' policies towards shared decision making. METHODS Based on the responses of 225 licensed social workers from health and social care agencies in the public, private and third sectors in Israel, path analysis was used to test a hypothesized model. RESULTS Structural attributions for poverty contributed to attitudes towards people who live in poverty, which led to shared decision making. Also, organizational support in shared decision making, and professional moral identity, contributed to ethical behaviour which led to shared decision making. CONCLUSION The results of this analysis revealed that shared decision making may be a scion of branched roots planted in the relationship between ethics, organizations and Stigma.
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Affiliation(s)
- Lia Levin
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Using Peer-Referral Chains with Incentives to Promote HIV Testing and Identify Undiagnosed HIV Infections Among Crack Users in San Salvador. AIDS Behav 2016; 20:1236-43. [PMID: 26687093 DOI: 10.1007/s10461-015-1267-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In El Salvador, crack users are at high risk for HIV but they are not targeted by efforts to promote early HIV diagnosis. We evaluated the promise of peer-referral chains with incentives to increase HIV testing and identify undiagnosed HIV infections among networks of crack users in San Salvador. For 14 months, we offered HIV testing in communities with a high prevalence of crack use. For the following 14 months, we promoted chains in which crack users from these communities referred their peers to HIV testing and received a small monetary incentive. We recorded the monthly numbers of HIV testers, and their crack use, sexual risk behaviors and test results. After launching the referral chains, the monthly numbers of HIV testers increased significantly (Z = 6.90, p < .001) and decayed more slowly (Z = 5.93, p < .001), and the total number of crack-using testers increased nearly fourfold. Testers in the peer-referral period reported fewer HIV risk behaviors, but a similar percentage (~5 %) tested HIV positive in both periods. More women than men received an HIV-positive diagnosis throughout the study (χ(2)(1, N = 799) = 4.23, p = .040). Peer-referral chains with incentives can potentially increase HIV testing among networks of crack users while retaining a focus on high-risk individuals.
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Abstract
PURPOSE To describe the hospital experiences of mothers who give birth to substance-exposed infants. STUDY DESIGN AND METHODS Secondary analysis of data from a larger study that was focused on the experiences of Mexican-American mothers in the neonatal intensive care unit (NICU) was conducted. Semistructured interviews with five women who were recovering addicts on methadone were analyzed. Each of their infants spent time in an NICU following birth. The transcribed interviews were analyzed using qualitative content analysis. RESULTS Four themes were identified: (a) "try not to judge," (b) "scoring" the baby, (c) "share with me," and (d) "I'm the mother here!" CLINICAL IMPLICATIONS The quality of the relationship between the mothers and the nurses in the NICU was a crucial aspect of the mothers' experiences and may have an effect on long-term outcomes. Women with addictions often have other significant risk factors that may further jeopardize their ability to mother; therefore, it is essential to develop a strong support network. Nurses can be instrumental in organizing resources for this population of women. Judging behaviors may have a detrimental effect on women with addictions. Maternal adaptation to the mothering role can be enhanced by making reasonable efforts to include the mother in the care of the infant.
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Seybold D, Calhoun B, Burgess D, Lewis T, Gilbert K, Casto A. Evaluation of a Training to Reduce Provider Bias Toward Pregnant Patients With Substance Abuse. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2014; 14:239-249. [PMID: 26207103 PMCID: PMC4508864 DOI: 10.1080/1533256x.2014.933730] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The objective of this article is not to present a scientific or systematic study, but to provide an initial framework for designing a training workshop to enhance health practitioners' (nurses, social workers, physicians, etc.) knowledge regarding substance abuse treatment and to decrease their bias toward substance-abusing women, particularly pregnant women in rural communities. We incorporated the 4 Transdisciplinary Foundations from the Substance Abuse and Mental Health Services Administration Competencies Model, with specific competencies targeted that related to provider bias. After the conference, 52 of the 70 participants completed a questionnaire to self-assess knowledge level and confidence in skill related to substance abuse management. Participant mean scores were statistically significantly higher following the conference than 1 week prior ( p < .001) in the area of "gender difference with substance abuse," moving from an average of 2.6 to 4.5 on a 5-point Likert scale. Our conference was successful in increasing attendees' knowledge about gender difference and substance abuse among pregnant patients.
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Affiliation(s)
- Dara Seybold
- CAMC Health Education and Research Institute, Charleston, West Virginia, USA
| | - Byron Calhoun
- Department of Obstetrics & Gynecology, West Virginia University-Charleston, Charleston, West Virginia, USA
| | - Denise Burgess
- CAMC Women and Children's Hospital, Charleston, West Virginia, USA
| | - Tammi Lewis
- CAMC Family Resource Center, Charleston, West Virginia, USA
| | - Kelly Gilbert
- CAMC Family Resource Center, Charleston, West Virginia, USA
| | - Angie Casto
- CAMC Women and Children's Hospital, Charleston, West Virginia, USA
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Abstract
There is little empirical evidence that guides management of infants with neonatal abstinence syndrome. The standard of care first described in the 1970s is still prevalent today, although it has never been tested in this population. Standard of care interventions include decreasing external stimulation, holding, nonnutritive sucking, swaddling, pressure/rubbing, and rocking. These interventions meet the goals of nonpharmacologic interventions, which are to facilitate parental attachment and decrease external stimuli. Many nursing interventions used in infants with neonatal abstinence syndrome have been tested in low-birth-weight infants, whose treatment often includes the same goals. Those interventions include music therapy, kangaroo care, massage, and use of nonoscillating water beds. Nursing attitude has also been shown to be impactful on parental attachment. The American Academy of Pediatrics recommends breast-feeding in infants whose mothers are on methadone who do not have any other contraindication. It also provides guidelines for pharmacologic management but cannot provide specific recommendations about a standard first dose, escalation, or weaning schedule. Buprenorphine has some evidence about its safety in newborns with neonatal abstinence syndrome, but high-powered studies on its efficacy are currently lacking. There are many opportunities for both evidence-based projects and nursing research projects in this population.
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Cleveland LM, Bonugli R. Experiences of mothers of infants with neonatal abstinence syndrome in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs 2014; 43:318-29. [PMID: 24754258 DOI: 10.1111/1552-6909.12306] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To describe the experiences of mothers of infants with neonatal abstinence syndrome (NAS) in the neonatal intensive care unit (NICU). DESIGN Qualitative description. SETTING We recruited participants from community-based, out-patient, addiction treatment facilities in a large urban city in the southwestern region of the United States. PARTICIPANTS A convenience sample of 15 Hispanic, substance addicted mothers of infants with NAS participated. METHODS We conducted semistructured, individual, interviews and analyzed the data using qualitative content analysis. First, we analyzed the data independently and then discussed the themes until a consensus was reached. RESULTS We identified four themes: (a) understanding addiction, (b) watching the infant withdraw, (c) judging, and (d) trusting the nurses. The participants felt there was a lack of understanding concerning addiction that was particularly noted when interacting with the nurses. They shared their feelings of guilt and shame when observing their infants withdrawing. The participants felt judged by the nurses for having used illicit drugs during pregnancy. Feeling judged interfered with the participants' ability to trust the nurses. CONCLUSION These findings provide nurses with a better understanding of the experiences of mothers who have addiction problems and may lead to more customized nursing care for this high-risk population of mothers and their infants.
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Zoorob RJ, Durkin KM, Gonzalez SJ, Adams S. Training nurses and nursing students about prevention, diagnoses, and treatment of fetal alcohol spectrum disorders. Nurse Educ Pract 2014; 14:338-44. [PMID: 24393607 DOI: 10.1016/j.nepr.2013.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 11/13/2013] [Accepted: 11/29/2013] [Indexed: 11/29/2022]
Abstract
Alcohol consumption during pregnancy can result in birth defects known as fetal alcohol spectrum disorders. This study examined whether 1-h training sessions on alcohol screening, brief intervention, diagnoses, and treatment of fetal alcohol spectrum disorders could increase practical knowledge and confidence in nurses and student nurses. Data were collected from 420 nurses (n = 95) and student nurses (n = 325) in the southeastern United States, from 2009 to 2011. Pre- and post-test data were analyzed using chi-square tests and t-tests. The post-training response rate was 84%. Nurses were more likely to know what constitutes binge drinking, facial abnormalities associated with fetal alcohol syndrome, and criteria for diagnosis. Nurses were also more confident in educating about effects of prenatal alcohol use, identifying fetal alcohol spectrum disorders and utilizing resources. Training materials may need to be improved and/or longer training programs developed for student nurses, and nursing school programs should place more emphasis on educating and preparing student nurses regarding this topic area.
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Affiliation(s)
- Roger J Zoorob
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
| | - Kristy M Durkin
- Department of Social Work, University of West Florida, Pensacola, FL, USA; University of Alabama, Tuscaloosa, USA
| | - Sandra J Gonzalez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, 37208-3599 TN, USA.
| | - Susie Adams
- PMHNP Program, Vanderbilt University School of Nursing, Nashville, TN, USA
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22
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Abstract
When women addicted to opioids seek prenatal care, the treatment of choice is methadone. Methadone mediates the addiction by reducing fluctuations in maternal serum opioid levels and protecting the fetus from repeated withdrawal episodes. Methadone maintenance is associated with increased maternal weight gain, decreased illegal drug use, and improved compliance with prenatal care. Although the risks are less when compared with street drugs, the risk to the fetus is physical dependence. Despite the magnitude of this national problem, there is a dearth of literature to guide NICU nurses on how to best support mothers of infants with neonatal abstinence syndrome (NAS) in the care of their infants. The purposes of this article are to review what is known about women in methadone treatment who have a history of opioid addiction and apply that evidence to guide neonatal nurses to support mothers of infants with NAS in the NICU.
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Chang YP, Yang MS. Nurses' attitudes toward clients with substance use problems. Perspect Psychiatr Care 2013; 49:94-102. [PMID: 23557452 DOI: 10.1111/ppc.12000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 07/30/2012] [Accepted: 08/06/2012] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aimed to examine factors associated with nurses' attitudes toward clients with substance use problems. DESIGN AND METHODS A cross-sectional design was used, and 489 nurses working in two medical centers in Taiwan participated in this study. FINDINGS Age, total nursing experience, work unit, personal experience, experience of taking care of clients with substance use problems, substance use education in school, and continuing education were significantly associated with nurses' attitudes. Hierarchical regression revealed that continuing education predicted nurses' overall attitudes. However, the model explained a low variance. PRACTICE IMPLICATIONS Education-focused training alone may not be adequate. Nursing workforce development needs to incorporate multiple strategies, including clinical supervision, when designing substance use education for clinical nurses in order to generate better improvements on attitudes.
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Affiliation(s)
- Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York, USA
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25
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McKenna L, Boyle M, Brown T, Williams B, Molloy A, Lewis B, Molloy L. Levels of empathy in undergraduate midwifery students: An Australian cross-sectional study. Women Birth 2011; 24:80-4. [DOI: 10.1016/j.wombi.2011.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 02/15/2011] [Accepted: 02/16/2011] [Indexed: 12/30/2022]
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Tsai YF, Tsai MC, Lin YP, Weng CE, Chen CY, Chen MC. Facilitators and barriers to intervening for problem alcohol use. J Adv Nurs 2010; 66:1459-68. [DOI: 10.1111/j.1365-2648.2010.05299.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Biley FC. The arts, literature and the attraction paradigm: Changing attitudes towards substance misuse service users. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890412331334400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Morton J, Konrad SC. Introducing a caring/relational framework for building relationships with addicted mothers. J Obstet Gynecol Neonatal Nurs 2009; 38:206-13. [PMID: 19323716 DOI: 10.1111/j.1552-6909.2009.01006.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Health care practice with addicted mothers requires health professionals to both desire and acquire knowledge, skills, and attitudes geared toward developing relationships that foster trust. In this article, nursing and social work theories are used to offer an integrated and interdisciplinary framework for building relationships with addicted mothers in health care settings. Embracing and utilizing caring/relational concepts serve as an impetus to the development of effective relationships with this vulnerable population.
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Affiliation(s)
- Jennifer Morton
- University of New England, College of Health Professions, Department of Nursing, 716 Stevens Avenue, Portland, ME 04103, USA.
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29
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Hecksher D, Hesse M. Women and substance use disorders. Mens Sana Monogr 2009; 7:50-62. [PMID: 21836779 PMCID: PMC3151455 DOI: 10.4103/0973-1229.42585] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 08/11/2008] [Accepted: 08/13/2008] [Indexed: 11/04/2022] Open
Abstract
Substance use disorders belong to the class of externalizing behaviours that are generally more common among men than women. Those women who do have substance disorders therefore deviate more from the norms of society compared with men, tend to live in an environment characterized by high risk of violence and other forms of abuse, and tend to be survivors of childhood trauma. In terms of seeking treatment, women often have difficulty acknowledging their problems with substance use disorders, and professionals are reluctant to ask women about drug or alcohol use. Even when they do seek treatment, women in many countries face practical and financial barriers to access treatment. For women who do enter treatment, outcomes are generally comparable to outcomes for men, suggesting that facilitating entry into treatment can yield substantial benefits for women with addictions.
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Affiliation(s)
- Dorte Hecksher
- Aarhus University Centre for Alcohol and Drug Research, Nobelparken bygning 1453, Jens Chr. Skous Vej 3, 8000 Århus C, Denmark
| | - Morten Hesse
- Aarhus University Centre for Alcohol and Drug Research, Nobelparken bygning 1453, Jens Chr. Skous Vej 3, 8000 Århus C, Denmark
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30
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Fraser JA, Barnes M, Biggs HC, Kain VJ. Caring, chaos and the vulnerable family: experiences in caring for newborns of drug-dependent parents. Int J Nurs Stud 2006; 44:1363-70. [PMID: 16938299 DOI: 10.1016/j.ijnurstu.2006.06.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 06/19/2006] [Accepted: 06/27/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infants exposed to intrauterine drugs present a number of challenging features with which the new mother is faced. They can be irritable, unresponsive, and unpredictable. Available treatments require specialised neonatal care for the first four to six weeks of life; a critical time for the parent-infant attachment relationship to develop. Neonatal nurses have the opportunity to promote this development and ameliorate the effect of other developmental risk factors the baby is likely to experience. OBJECTIVES The aim of this study was to explore neonatal nurses' experiences of providing care to drug-exposed newborns and their parents throughout treatment for neonatal abstinence syndrome (NAS). DESIGN, SETTING AND PARTICIPANTS This study used interpretive methods by conducting group interviews with eight neonatal nurses in each of four Special Care Nursery Units in South-East Queensland, Australia. RESULTS Barriers to promoting the parent-infant attachment relationship were found to be both attitudinal and organisational. These barriers were significant, and were seen to impact negatively on optimal care delivery to this vulnerable population. CONCLUSIONS Unfortunately, the results of this study indicated that management of these babies and their parents is compromised by a range of attitudinal and organisational factors. There is a need to address these barriers to optimise care delivery and improve the way in which neonatal nurses impact on parent-infant relationships.
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Affiliation(s)
- Jennifer A Fraser
- School of Nursing, Queensland University of Technology, Brisbane, Qld., Australia.
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