Immigrant women's experience of maternity services in Canada: a meta-ethnography

OBJECTIVE

to synthesise data on immigrant women's experiences of maternity services in Canada.

DESIGN

a qualitative systematic literature review using a meta-ethnographic approach

METHODS

a comprehensive search strategy of multiple databases was employed in consultation with an information librarian, to identify qualitative research studies published in English or French between 1990 and December 2011 on maternity care experiences of immigrant women in Canada. A modified version of Noblit and Hare's meta-ethnographic theoretical approach was undertaken to develop an inductive and interpretive form of knowledge synthesis. The seven-phase process involved comparative textual analysis of published qualitative studies, including the translation of key concepts and meanings from one study to another to derive second and third-order concepts encompassing more than that offered by any individual study. ATLAS.ti qualitative data analysis software was used to store and manage the studies and synthesise their findings.

FINDINGS

the literature search identified 393 papers, of which 22 met the inclusion criteria and were synthesised. The literature contained seven key concepts related to maternity service experiences including social (professional and informal) support, communication, socio-economic barriers, organisational environment, knowledge about maternity services and health care, cultural beliefs and practices, and different expectations between health care staff and immigrant women. Three second-order interpretations served as the foundation for two third-order interpretations. Societal positioning of immigrant women resulted in difficulties receiving high quality maternity health care. Maternity services were an experience in which cultural knowledge and beliefs, and religious and traditional preferences were highly relevant as well but often overlooked in Canadian maternity settings.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

in order to implement woman-centered care, to enhance access to maternity services, and to promote immigrant women's health, it is important to consider these women's social position, cultural knowledge and beliefs, and traditional customs in the health care.

Effects of nursing process-based simulation for maternal child emergency nursing care on knowledge, attitude, and skills in clinical nurses

BACKGROUND

Since previous studies on simulation-based education have been focused on fundamental nursing skills for nursing students in South Korea, there is little research available that focuses on clinical nurses in simulation-based training. Further, there is a paucity of research literature related to the integration of the nursing process into simulation training particularly in the emergency nursing care of high-risk maternal and neonatal patients.

PURPOSES

The purpose of this study was to identify the effects of nursing process-based simulation on knowledge, attitudes, and skills for maternal and child emergency nursing care in clinical nurses in South Korea.

PARTICIPANTS

Data were collected from 49 nurses, 25 in the experimental group and 24 in the control group, from August 13 to 14, 2013.

METHODS

This study was an equivalent control group pre- and post-test experimental design to compare the differences in knowledge, attitudes, and skills for maternal and child emergency nursing care between the experimental group and the control group. The experimental group was trained by the nursing process-based simulation training program, while the control group received traditional methods of training for maternal and child emergency nursing care.

RESULTS

The experimental group was more likely to improve knowledge, attitudes, and skills required for clinical judgment about maternal and child emergency nursing care than the control group. Among five stages of nursing process in simulation, the experimental group was more likely to improve clinical skills required for nursing diagnosis and nursing evaluation than the control group.

CONCLUSION

These results will provide valuable information on developing nursing process-based simulation training to improve clinical competency in nurses. Further research should be conducted to verify the effectiveness of nursing process-based simulation with more diverse nurse groups on more diverse subjects in the future.

[Effects of an integrated self-management program on self-management, glycemic control, and maternal identity in women with gestational diabetes mellitus]

PURPOSE

The purpose of the study was to investigate the effects of an integrated self-management program on self-management, glycemic control, and maternal identity in women with gestational diabetes mellitus (GDM).

METHODS

A non-equivalent control group non-synchronized quasi-experimental design was used. A total of 55 women with GDM were recruited from Cheil General Hospital, Seoul, Korea and were assigned to an experimental (n=28) or control group (n=27). The participants were 24-30 weeks pregnant women who had been diagnosed with GDM as of July 30, 2010. The program was conducted as a 1 hour small group meeting 3 out of 5 times and by telephone-counseling 2 out of 5 times. The integrated self-management program was verified by an expert panel.

RESULTS

Although there was no significant reduction in HbA1c (U= -1.17, p=.238), there were statistically significant increases in self-management (U= -3.80, p<.001) and maternal identity (U= -4.48, p<.001), and decreased 2-h postprandial glucose levels (U= -2.43, p<.015) in the experimental group compared to the control group.

CONCLUSION

These findings suggest that an integrated self-management program for women with GDM improves self-management, maternal identity, and glycemic control. Further studies are needed to identify the effects of an integrated self-management program on pregnancy and neonatal outcomes.

The Waterbirth Project: São Bernardo Hospital experience

INTRODUCTION

The following quantitative observational study aimed to analyse the maternal and neonatal outcomes of 90 low-risk pregnant women who gave birth in water at São Bernardo Hospital.

METHODS

A form containing information on the obstetric history of the parturient, the type of immersion, and the labour and birth follow-up was used by midwives to collect the data.

BACKGROUND

The Apgar score (at 1min after birth) used in this study, called Aqua Apgar, was adapted by Cornelia Enning.

RESULTS

The mean water immersion time was 1h and 46min and had an influence on the duration of labour (mean 5h and 37min), with a statistically significant difference (P=0.004). There was a decreased cervical dilatation time and a shorter duration of the expulsion phase. In the immersion scenario, 30% of the women did not undergo any examination to assess the length of the cervix, and 57.8% presented intact perennial areas or first-degree tears. As for neonatal outcomes, during maternal immersion, 97% maintained normal fetal heart rates (between 110 and 160 beats per minute) and Aqua Apgar was higher than 7, both in the first minute (mean of 9.4) and in the fifth minute of life (mean of 9.9).

CONCLUSION

These safety outcomes, based on sound scientific evidence, should increasingly support and inform clinical decisions and increase the number of waterbirths in health facilities. The results of this study align with growing evidence that suggests waterbirth is a safe delivery option and therefore should be offered to women.

Parental, Perinatal, and Childhood Risk Factors for Development of Irritable Bowel Syndrome: A Systematic Review

Background/Aims

Adverse early life experiences are associated with the development of stroke, cancer, diabetes, and chronic respiratory and ischemic heart diseases. These negative experiences may also play a role in the development of irritable bowel syndrome (IBS)--a functional gastrointestinal disease. This review discusses the research to date on the parental, perinatal, and childhood risk and protective factors associated with the development of IBS.

Methods

A literature search was completed for studies published between 1966 and 2018 that investigated premorbid factors occurring during the perinatal and childhood periods as well as parental factors that were associated with the development of IBS.

Results

Twenty-seven studies fulfilled the review criteria. Risk factors that appeared in more than one study included: (1) parental IBS, substance abuse, parental punishment, and rejection as parental risk factors; (2) low birth weight as a perinatal risk factor; and (3) crowded living conditions in low-income families, childhood anxiety, depression, or child abuse as childhood risk factors. Protective factors for IBS were emotional warmth from the parents and being born to an older mother.

Conclusions

More effort is needed to identify what fetal and maternal factors are associated with low birth weight and IBS. A well-executed prospective birth cohort with a collection of bio-samples and functional data will provide a better understanding of how adversity and the interplay between genetics, epigenetics, and numerous risk factors affect the development of IBS.

[Development and effects of a labor nursing education program using a high-fidelity simulator for nursing students]

Purpose

This study was conducted to investigate the effects of an education program using a high-fidelity simulator of labor and delivery on nursing knowledge, critical thinking, and clinical performance among nursing students who had not yet experienced clinical practicum.

Methods

The development of a 5-week maternity nursing education programs using high-fidelity simulators included modules containing case-oriented scenarios, knowledge, and skills required for maternity care. A randomized controlled study was conducted to verify the effects of the developed program. Data were collected from October 21 to December 9, 2019. The experimental group (n=36) participated in a 5-week high-fidelity simulation program on care for the woman in labor, whereas the control group (n=36) received standard education as lecture and practice with delivery model. The collected data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation), the Chi-square test, Fisher exact test, and t-test.

Results

For participants who received education using the high-fidelity simulation program, nursing knowledge (t=2.33, p=.011), critical thinking (t=3.73, p<.001), and clinical performance (t=2.53, p=.006) were significantly higher than in the control group.

Conclusion

Even for students with no clinical experience, high-fidelity simulation-based nursing education was effective in improving nursing knowledge, critical thinking, and clinical performance among nursing students. Nurse educators will be able to use this high-fidelity simulator effectively, especially in situations where direct clinical practicum may not be feasible.

Nursing simulation practicum for delivery care: A scoping review

OBJECTIVES

The purpose of this scoping review was to explore the state of the current body of knowledge on the use of nursing simulation for maternal nursing practicum with a focus on content and measured outcomes.

DESIGN

This is a scoping review.

DATA SOURCES

The literature search was performed using five databases (CINAHL, Cochrane, EMBASE, PubMed, and Web of Science).

REVIEW METHOD

The review was conducted on quantitative and reflection/review studies that evaluated or described nursing simulation for delivery care, published between 2000 and 2020 in English and Korean. Two authors independently reviewed the studies and their references for additional literature search. Selected studies were charted to describe the study characteristics, and content and outcome of nursing simulation for delivery care.

RESULTS

Fifteen articles were included in the review, of which twelve were intervention studies and three were reflection/review studies. The duration of the nursing simulations for delivery care ranged from 20 min to 4 h, with two to eight students in each simulation group. All nursing simulations focused on the normal, uncomplicated delivery process, with nine studies engaging in debriefing, but without pre- and/or post-assessments. The most frequently measured outcomes were knowledge, satisfaction, and clinical practice competency.

CONCLUSIONS

Studies investigating nursing simulation pedagogy for delivery care were scarce, with limitations in the study designs and large variations in nursing simulation time across studies. Scenarios for nursing simulation for delivery care were rudimentary, and they usually focused on normal uncomplicated deliveries. The development of scenarios for high-risk deliveries and integration of pre-and/or post-assessments and debriefing into the nursing simulation are recommended to improve learning outcomes.

Development of the Conversational Health Literacy Assessment Tool for maternity care (CHAT-maternity-care): participatory action research

BACKGROUND

Limited health literacy in (expectant) parents is associated with adverse health outcomes. Maternity care providers often experience difficulties assessing (expectant) parents' level of health literacy. The aim was to develop, evaluate, and iteratively adapt a conversational tool that supports maternity care providers in estimating (expectant) parents' health literacy.

METHODS

In this participatory action research study, we developed a conversational tool for estimating the health literacy of (expectant) parents based on the Conversational Health Literacy Assessment Tool for general care, which in turn was based on the Health Literacy Questionnaire. We used a thorough iterative process including different maternity care providers, (expectant) parents, and a panel of experts. This expert panel comprised representatives from knowledge institutions, professional associations, and care providers with whom midwives and maternity care assistants work closely. Testing, evaluation and adjustment took place in consecutive rounds and was conducted in the Netherlands between 2019 and 2022.

RESULTS

The conversational tool 'CHAT-maternity-care' covers four key domains: (1) supportive relationship with care providers; (2) supportive relationship within parents' personal network; (3) health information access and comprehension; (4) current health behaviour and health promotion. Each domain contains multiple example questions and example observations. Participants contributed to make the example questions and example observations accessible and usable for daily practice. The CHAT-maternity-care supports maternity care providers in estimating (expectant) parents' health literacy during routine conversations with them, increased maternity care providers' awareness of health literacy and helped them to identify where attention is necessary regarding (expectant) parents' health literacy.

CONCLUSIONS

The CHAT-maternity-care is a promising conversational tool to estimate (expectant) parents' health literacy. It covers the relevant constructs of health literacy from both the Conversational Health Literacy Assessment Tool and Health Literacy Questionnaire, applied to maternity care. A preliminary evaluation of the use revealed positive feedback. Further testing and evaluation of the CHAT-maternity-care is required with a larger and more diverse population, including more (expectant) parents, to determine the effectiveness, perceived barriers, and perceived facilitators for implementation.

The effects of a maternal nursing competency reinforcement program on nursing students' problem-solving ability, emotional intelligence, self-directed learning ability, and maternal nursing performance in Korea: a randomized controlled trial

Purpose

The purpose of this study was to develop a maternal nursing competency reinforcement program for nursing students and assess the program's effectiveness in Korea.

Methods

The maternal nursing competency reinforcement program was developed following the ADDIE model. This study employed an explanatory sequential mixed methods design that applied a non-blinded, randomized controlled trial with nursing students (28 experimental, 33 control) followed by open-ended interviews with a subset (n=7). Data were analyzed by both qualitative and quantitative analysis methods.

Results

Repeated measures analysis of variance showed that significant differences according to group and time in maternal nursing performance; assessment of and intervention in postpartum uterine involution and vaginal discharge (F=24.04, p<.001), assessment of and intervention in amniotic membrane rupture (F=36.39, p<.001), assessment of and intervention in delivery process through vaginal examination (F=32.42, p<.001), and nursing care of patients undergoing induced labor (F=48.03, p<.001). Group and time improvements were also noted for problem-solving ability (F=9.73, p<.001) and emotional intelligence (F=4.32, p=.016). There were significant differences between groups in self-directed learning ability (F=13.09 p=.001), but not over time. The three themes derived from content analysis include "learning with a colleague by simulation promotes self-reflection and learning," "improvement in maternal nursing knowledge and performance by learning various countermeasures," and "learning of emotionally supportive care, but being insufficient."

Conclusion

The maternal nursing competency reinforcement program can be effectively utilized to improve maternal nursing performance, problem-solving ability, and emotional intelligence for nursing students.

Looking for zebras and finding horses: A qualitative narrative study of pre-RN licensure nursing Students' experience of a "normal" postnatal simulation

BACKGROUND

Simulation-based learning may be particularly useful in specialty nursing clinical rotations, such as maternal-newborn care, where pre-RN licensure nursing students typically have fewer clinical hours or 'hands-on' opportunities. Although simulated obstetric emergencies are frequently reported in the literature, childbirth and the postnatal period involve normal physiologic processes, and therefore a focus on "normal" challenges in immersive perinatal simulations may provide students with vital uniform clinical learning experiences.

OBJECTIVE

To explore the value and meaning of an uncomplicated immersive postnatal simulation-based experience for pre-RN licensure nursing students.

DESIGN

Qualitative design using narrative analysis.

SETTING

Pre-RN licensure nursing program at a university in the northeastern United States.

METHODS

Narrative analysis was used to assess 229 written reflections from students following an uncomplicated, immersive postnatal simulation experience.

RESULTS

Themes identified through the analysis demonstrated that students experienced high anxiety in anticipation of the scenario, expecting a crisis to occur; students described looking for zebras as they searched for pathology but found "normality". Students derived confidence from performing assessments and making clinical decisions, moving from anxiety to relief as they concluded that the mother and infant were experiencing normal, rather than emergent, challenges of the postnatal period.

CONCLUSION

Most students found value in the experience, recognizing the importance of learning maternal-newborn nursing from a physiologic rather than pathologic perspective.

Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis

BACKGROUND

Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes.

METHODS

Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software.

RESULTS

Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials.

CONCLUSION

More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care.

TRIAL REGISTRATION

PROSPERO Registration No: CRD42023399626.

Education for family-centred care: A qualitative study with educators of advanced practice child and family health nurses

AIM

Explore academics' perspectives of theoretical and practical education for family-centred care in postgraduate child and family health nursing courses.

BACKGROUND

Education for advanced nursing practice in child and family health relies on understanding underlying principles of care and application in practice. Family-centred care fosters engagement and promotes child and family health and wellbeing. Key to its implementation are principles of creating respectful relationships, ensuring effective communication, supporting autonomy and contextualising care in service provision. However, little is known about how these are addressed in advanced practice nurse education.

DESIGN

Qualitative descriptive study METHODS: Semi-structured interviews with academic coordinators from six Australian universities providing child and family health nurse education were conducted between December 2020-January 2021 and analysed using framework analysis.

RESULTS

Family-centred care was embedded throughout all curricula. However, differences existed in curriculum (entry requirements, duration, delivery mode, practical experience) and employer expectations (qualification requirements, practice scope). Educators aim to ensure students develop core skills for safe, appropriate and responsive care. Although professional standards support family-centred care, they do not routinely guide curriculum development.

CONCLUSIONS

Educational expectations for advanced practice in child and family health nursing reflect local differences. Education for family-centred care predominantly focused on strengths-based and partnership approaches. Aligning agreed practice standards with curriculum design and clinical oversight would enable more consistent practice across the country, even when service structures differ. We encourage educators to address the broader drivers of family-centred care in child and family health nursing education.

Factors influencing critical thinking in simulation-based maternal-child nursing education among undergraduate nursing students: a mixed methods study

BACKGROUND

Critical thinking constitutes a multifaceted and dynamic process to make appropriate decisions and solve problems. In simulation-based learning, critical thinking can be influenced by personal factors, facilitators, and design.

OBJECTIVE

This study was conducted to investigate the experiences and factors associated with critical thinking in simulation-based maternal-child nursing education.

METHODS

This study utilized an explanatory sequential mixed-methods approach. In the quantitative phase, convenience sampling was employed to select 400 undergraduate nursing students who met the following inclusion criteria: no history of repeating the maternal-child nursing and midwifery practicum course and class attendance of at least 80% of the total instructional hours. Following the completion of quantitative data collection, purposive sampling was used to recruit 80 students who had participated in and completed the initial survey to participate in focus group discussions.

RESULTS

Half of the nursing students had moderate scores of critical thinking on maternal-child nursing simulation. The regression analysis revealed that perception of professional identity, a personal factor, was statistically significantly associated with a high level of critical thinking (Beta = 0.207, t = 4.607, p = 0.000). Additionally, the attitude toward simulation (Beta = 0.139, t = 2.731, p = 0.007) and perceived stress (Beta = -0.103, t = -2.269, p = 0.024) were statistically significantly associated with critical thinking level. In the simulation design, the support aspect toward simulation design (Beta = 0.265, t = 2.943, p = 0.003) and the problem-solving aspect toward simulation importance (Beta = 0.239, t = 2.288, p = 0.023) were statistically significantly associated with a high level of critical thinking. The multiple linear regression model accounted for 35% of the variance in critical thinking with maternal-child nursing simulated learning. Qualitative data revealed the following themes: (1) a well-planned approach enables me to optimize my learning; (2) allow me to make mistakes, but please don't leave me with failure; and (3) emulating practice shapes my growth as a nursing professional.

CONCLUSIONS

The personal factor and simulation design factors were important for increasing critical thinking level. Promoting effective learning strategies, such as the use of simulated experiences, is useful in enhancing midwifery and nursing students' competencies.

Clinical and Demographic Characteristics of Patient-Initiated Encounters Before the 6-Week Postpartum Visit

OBJECTIVE

To identify characteristics associated with a higher likelihood of patient-initiated encounters with a health care professional before the scheduled 6-week postpartum visit.

METHODS

We performed a retrospective cohort study of postpartum persons who received prenatal care and delivered at a single academic level IV maternity care center in 2019. We determined associations between maternal sociodemographic and obstetric characteristics and the likelihood of patient-initiated early postpartum encounters with χ2 tests for categorical variables and Wilcoxon rank sum tests for continuous and ordinal variables.

RESULTS

A total of 796 patients were included in our analysis, and 324 (40.7%) initiated an early postpartum encounter. Significantly more postpartum persons who initiated early postpartum encounters were primiparous persons (54.3%) than multiparous (33.8%) persons (P < .001). Postpartum persons who desired breastfeeding or who had prolonged maternal hospitalization, episiotomy, or cesarean or operative vaginal delivery were also significantly more likely to initiate early postpartum encounters (all P≤.002). Of postpartum persons who initiated early encounters, 44 (13.6%) initiated in-person visits, 138 (42.6%) initiated telephone or patient portal communication, and 142 (43.8%) initiated encounters of both types. Specifically, 39.2% of postpartum persons initiated at least one early postpartum encounter for lactation support, and nearly half of early postpartum encounters occurred during the first week after hospital discharge.

CONCLUSION

Early postpartum encounters were more common among primiparas and postpartum persons who were breastfeeding or had prolonged hospitalization, episiotomy, cesarean delivery, or operative vaginal delivery. Future studies should focus on the development of evidence-based guidelines for recommending early postpartum visits.