CE: Postpartum Depression: A Nurse's Guide

ABSTRACT

Despite extensive research, the etiology behind postpartum depression (PPD) remains a mystery. Experts have theorized about various potential risk factors, including hormonal fluctuations, genetics, prior history of depression, low socioeconomic status, adolescent pregnancy, and certain personality traits. This article provides foundational information about PPD, reviewing the risk factors for and the consequences of this mood disorder. Postpartum blues and postpartum psychosis are briefly discussed for context, although they differ from PPD. Screening and treatment options are explained, and nursing implications for practice are presented.

Training maternal and child health nurses in early relational trauma: An evaluation of the MERTIL workforce training

BACKGROUND

Parents who experience relational trauma may inadvertently create contexts of care that undermine secure beginnings to life for their young children. Universal health services such as Maternal and Child Health (MCH) services offer a unique whole-of-population platform for prevention through early detection and intervention. To date however, relevant workforce training has been minimal.

OBJECTIVES

We report on an evaluation of state-wide workforce training to support MCH nurses to identify and respond to early relational trauma within parent-child dyads.

DESIGN

Process and learning evaluation data were obtained at baseline (N = 1450), exit (n = 734) and follow-up (n = 651).

SETTINGS AND PARTICIPANTS

Specialist training was developed and delivered to 1513 MCH staff in Victoria, Australia, via a 20-hour program of online learning and clinical skills workshops.

RESULTS

At baseline, across eight measures of confidence in recognizing and responding to relational trauma, 30-49% of nurses rated their confidence as low. Significant increases in all areas of self-rated learning were found post-training. Three months post-training, gains in confidence and capability were sustained, with no significant variations by participant role or setting. Overall program satisfaction was >90%. Continuing concerns at follow-up focused on pragmatic concerns about inadequacy of referral networks and appropriate intervention pathways.

CONCLUSIONS

In this evaluation of a state-wide training program for nurses working with early relational trauma, we found excellent uptake and program satisfaction, and results support learning impact and retention. Findings are discussed with regard to translation potential across early childhood settings.

What Do Women Want? Looking Beyond Patient Satisfaction

OBJECTIVE

To hear the voices of women, their partners, and nurses about expectations and priorities during the postpartum hospitalization.

DESIGN

Focus groups using semistructured interview questions.

SETTING

A 12-bed labor-delivery-recovery-postpartum unit at a small urban hospital in the U.S. Northeast.

PARTICIPANTS

Women who planned to or had given birth, their partners, and the maternity nurses who cared for them.

MEASUREMENTS

Qualitative thematic analysis of focus group transcripts.

RESULTS

Thematic analysis produced the following themes for women's priorities: Need for individualized attention to maternal physical and emotional care; Fear of providing inadequate care for the newborn, including establishing infant feeding; and Transitioning to parenting as a new mother versus as an experienced mother. Themes for nurses' priorities included Safety issues around sleep and breastfeeding, Transitioning to parenting with an emphasis on maternal self-care, and Addressing barriers to effective discharge education. Response comparisons between the women/partners and nurses suggest that there is a disconnection between women's and nurses' priorities and expectations for care during the postpartum period.

CONCLUSION

Women and nurses identified unmet needs in the postpartum period, consistent with the current literature. Providing standardized education during the transitional period around discharge from the hospital to home may not be optimal and may even detract from meeting the needs for rest and connection with family and the health care team. Nursing care that extends beyond the maternity hospitalization may be needed to individualize care and meet previously unmet needs.

Effect of hands-on interprofessional simulation training for local emergencies in Scotland: the THISTLE stepped-wedge design randomised controlled trial

OBJECTIVE

To assess whether the implementation of an intrapartum training package (PROMPT (PRactical Obstetric Multi-Professional Training)) across a health service reduced the proportion of term babies born with Apgar score <7 at 5 min (<7^5mins).

DESIGN

Stepped-wedge cluster randomised controlled trial.

SETTING

Twelve randomised maternity units with ≥900 births/year in Scotland. Three additional units were included in a supplementary analysis to assess the effect across Scotland. The intervention commenced in March 2014 with follow-up until September 2016.

INTERVENTION

The PROMPT training package (Second edition), with subsequent unit-level implementation of PROMPT courses for all maternity staff.

MAIN OUTCOME MEASURES

The primary outcome was the proportion of term babies with Apgar<7^5mins.

RESULTS

87 204 eligible births (99.2% with an Apgar score), of which 1291 infants had an Apgar<7^5mins were delivered in the 12 randomised maternity units. Two units did not implement the intervention. The overall Apgar<7^5mins rate observed in the 12 randomised units was 1.49%, increasing from 1.32% preintervention to 1.59% postintervention. Once adjusted for a secular time trend, the 'intention-to-treat' analysis indicated a moderate but non-significant reduction in the rate of term babies with an Apgar scores <7^5mins following PROMPT training (OR=0.79 95%CI(0.63 to 1.01)). However, some units implemented the intervention earlier than their allocated step, whereas others delayed the intervention. The content and authenticity of the implemented intervention varied widely at unit level. When the actual date of implementation of the intervention in each unit was considered in the analysis, there was no evidence of improvement (OR=1.01 (0.84 to 1.22)). No intervention effect was detected by broadening the analysis to include all 15 large Scottish maternity units. Units with a history of higher rates of Apgar<7^5mins maintained higher Apgar rates during the study (OR=2.09 (1.28 to 3.41)) compared with units with pre-study rates aligned to the national rate.

CONCLUSIONS

PROMPT training, as implemented, had no effect on the rate of Apgar <7^5mins in Scotland during the study period. Local implementation at scale was found to be more difficult than anticipated. Further research is required to understand why the positive effects observed in other single-unit studies have not been replicated in Scottish maternity units, and how units can be best supported to locally implement the intervention authentically and effectively.

TRIAL REGISTRATION NUMBER

ISRCTN11640515.

Strategies to Overcome Gender Bias in Maternity Nursing

Male nurses and nursing students who work in maternity care often experience role strain, reverse discrimination, and gender bias. There are various strategies that clinical instructors, floor nurses, nursing school faculty, and nurse managers can implement to help maintain gender equality in maternity nursing while still considering how to honor the wishes of some women who may be uncomfortable with a male presence.

High-Fidelity Simulation for Senior Maternity Nursing Students

: This retrospective study examined the effectiveness of high-fidelity simulation (HFS) in a senior maternity baccalaureate nursing program. The study specifically focused on whether students who received instruction through HFS in addition to traditional hospital-based clinical instruction achieved greater practical learning, critical thinking skills, and NCLEX performance potential. Bandura's theory of self-efficacy guided the study. Simulation students (n = 132) were found to score significantly better than nonsimulation students (n = 147) in each area. Use of HFS may foster the development of competent and clinically prepared nurses.

Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence

BACKGROUND

Although maternal-child care is a pillar of primary health care, there is a global shortage of maternal-child health care providers. Nurse educators experience difficulties providing undergraduate students with maternal-child learning experiences for a number of reasons. Simulation has the potential to complement learning in clinical and classroom settings. Although systematic reviews of simulation are available, no systematic reviews of qualitative evidence related to maternal-child simulation-based learning (SBL) for undergraduate nursing students and/or educators have been located.

OBJECTIVES

The aim of this systematic review was to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate nursing students and nursing educators in educational settings to inform curriculum decision-making. The review questions are: INCLUSION CRITERIA TYPES OF PARTICIPANTS: Pre-registration or pre-licensure or undergraduate nursing or health professional students and educators.

PHENOMENA OF INTEREST

Experiences of simulation in an educational setting with a focus relevant to maternal child nursing.

TYPES OF STUDIES

Qualitative research and educational evaluation using qualitative methods.

CONTEXT

North America, Europe, Australia and New Zealand.

SEARCH STRATEGY

A three-step search strategy identified published studies in the English language from 2000 until April 2016.

METHODOLOGICAL QUALITY

Identified studies that met the inclusion criteria were retrieved and critically appraised using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) by at least two independent reviewers. Overall the methodological quality of the included studies was low.

DATA EXTRACTION

Qualitative findings were extracted by two independent reviewers using JBI-QARI data extraction tools.

DATA SYNTHESIS

Findings were aggregated and categorized on the basis of similarity in meaning. Categories were subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings.

RESULTS

Twenty-two articles from 19 studies were included in the review. A total of 112 findings were extracted from the included articles. Findings were grouped into 15 categories created on the basis of similarity of meaning. Meta-synthesis of these categories generated three synthesized findings.Synthesized finding 1 Students experienced simulated learning experiences (SLE) as preparation that enhanced their confidence in practice. When simulation was being used for evaluation purposes many students experienced anxiety about the SLE.Synthesized finding 2 Pedagogical practices thought to be appropriate and meaningful included: realistic, relevant and engaging scenarios, a safe non-threatening learning environment, supportive guidance throughout the process, and integration with curriculum.Synthesized finding 3 Barriers and enablers to incorporating SLEs into maternal child education were identified including adequate resources, technological support and faculty development. Students and educators recognized that some things, such as relationship building, could not be simulated.

CONCLUSIONS

Students felt that simulation prepared them for practice through building their self-confidence related to frequently and infrequently seen maternal-child scenarios. Specific pedagogical elements support the meaningfulness of the simulation for student learning. The presence or absence of resources impacts the capacity of educators to integrate simulation activities throughout curricula.

A Qualitative Study to Explore the Male Nursing Student's Coping with Experiences in a Maternal-Newborn Nursing Course

Nursing today is predominantly a female profession; however, men are reentering the profession in record numbers and challenging the perspective that they are inappropriate in caregiver roles, or incapable of providing compassionate and sensitive care. This study investigated the perceptions and experiences of male nursing students in a maternal-newborn nursing course and their coping strategies in dealing with the clinical rotation role stress. A purposive sample included 11 male nursing students who completed a survey, and 6 out of the 11 participated in individual interviews. Written responses and verbatim audio narratives were analyzed using qualitative content analysis to identify themes that described their perceptions and experiences. The results identified 7 themes, suggesting a need for nurse educators to develop theory-guided instructional strategies to support male nursing students' academic goals, which may be at stake because of the maternity learning environment.

Using Quantitative Literacy to Enhance Critical Thinking Skills in Undergraduate Nursing Students

BACKGROUND

Critical thinking and quantitative literacy (QL) are similarly grounded: both focus on analyzing and evaluating evidence, identifying implications and consequences, drawing inferences, and communicating information. This teaching strategy was based on those commonalities and was designed so that undergraduate nursing students would enhance their critical thinking skills as they used their QL skills.

METHOD

QL skills are most effective when taught, learned, and used to solve significant, pertinent problems. Using the principles of learner-centered, team-based learning, QL was integrated into the curriculum of the Maternal-Newborn Nursing course at an urban community college with a diverse student population.

RESULTS

Students were engaged and demonstrated enhanced and ongoing development of their critical thinking and problem-solving skills. They also reported a better understanding of data interpretation and use.

CONCLUSION

The positive outcome of this project revealed further opportunities for incorporating QL into nursing curricula and highlighted the need for research on the use of QL in nursing education. [J Nurs Educ. 2017;56(4):240-242.].

Virtual versus face-to-face clinical simulation in relation to student knowledge, anxiety, and self-confidence in maternal-newborn nursing: A randomized controlled trial

BACKGROUND

Clinical simulations can provide students with realistic clinical learning environments to increase their knowledge, self-confidence, and decrease their anxiety prior to entering clinical practice settings.

OBJECTIVE

To compare the effectiveness of two maternal newborn clinical simulation scenarios; virtual clinical simulation and face-to-face high fidelity manikin simulation.

DESIGN

Randomized pretest-posttest design.

SETTING

A public research university in Canada.

PARTICIPANTS

Fifty-six third year Bachelor of Science in Nursing students.

METHODS

Participants were randomized to either face-to-face or virtual clinical simulation and then to dyads for completion of two clinical simulations. Measures included: (1) Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale (NASC-CDM) (White, 2011), (2) knowledge pretest and post-test related to preeclampsia and group B strep, and (3) Simulation Completion Questionnaire. Before and after each simulation students completed a knowledge test and the NASC-CDM and the Simulation Completion Questionnaire at study completion.

RESULTS

There were no statistically significant differences in student knowledge and self-confidence between face-to-face and virtual clinical simulations. Anxiety scores were higher for students in the virtual clinical simulation than for those in the face-to-face simulation. Students' self-reported preference was face-to-face citing the similarities to practicing in a 'real' situation and the immediate debrief. Students not liking the virtual clinical simulation most often cited technological issues as their rationale.

CONCLUSIONS

Given the equivalency of knowledge and self-confidence when undergraduate nursing students participate in either maternal newborn clinical scenarios of face-to-face or virtual clinical simulation identified in this trial, it is important to take into the consideration costs and benefits/risks of simulation implementation.

Development of a Multilingual Resource Manual

Providing culturally competent health care is a growing need as the population of culturally diverse women continues to rise. Compilation of a multilingual resource manual about maternal-child and women’s health topics that can be used by health educators to provide care to non-English-speaking and limited English proficiency (LEP) clients was achieved to address this need. In this article, significant details of this process are described allowing the reader to produce a similar version of the manual.

Nurses' Perspectives on the Process of Attaining Baby-Friendly Designation

The Baby-Friendly Hospital Initiative is a global initiative that aims to protect, promote, and support breastfeeding. This study explores and describes the process of attaining Baby-Friendly designation from nurses' perspectives. A purposive sampling design was used to recruit registered nurse participants in a large, safety-net, tertiary care facility. Data were collected via semistructured interviews and were analyzed using descriptive interpretative analysis. The following themes were revealed: Resistance, Culture, Investment in the Journey, Teamwork, and Source of Pride. Results indicate that comfortable yet antiquated practices led to fear of change and resistance. Initial culture shock was mediated by a successful education model, powerful experiences, and positive outcomes.

A Comprehensive Initiative to Prevent Falls Among Newborns

Our hospital experienced seven instances of newborns falling over a 7-month period. Until that time, there had been no reported newborn falls. We formed a committee to study the situation and make recommendations for change. Common factors observed were early morning hours and an exhausted parent, usually the mother, falling asleep while feeding the newborn. The committee developed a policy and procedure addressing falls among newborns, created staff education and tools, and posted signage in mothers' rooms. We also updated crib cards to include information about falls and safe sleep, and we revised newborn admission education for parents with additional information about falls. The incidence of newborns falling has decreased since we implemented these changes.

The effects of Team-Based Learning on learning behaviors in the maternal-child nursing course

BACKGROUND

The Team-Based Learning (TBL) method has been used as a teaching strategy in many disciplines. It is instructor-led, learner-centered learning with functions similar to those of problem-based learning, but it is more cost-effective. However, little is known about the application of TBL to nursing education.

OBJECTIVES

The objectives of the study are to employ the TBL approach in a Maternal-Child Nursing course and to evaluate its effects on learning outcomes.

DESIGN

We present one-group pretest-posttest research design with the intervention of the TBL teaching strategy.

SETTINGS

The study was conducted in one of the nursing universities in Taiwan.

PARTICIPANTS

One-hundred-four students in 2011 and 103 students in 2012 in an RN-to-BSN program who enrolled in the Maternal-Child Nursing course participated in this study. These students had graduated from a five-year nursing diploma program before enrolling in the RN-BSN program.

METHODS

Data were collected before and after the implementation of the TBL, which included active learning, in-class activities, and application exercises. The Class Engagement Survey (CES), Value of Teams (VTs), Self-Directed Learning Instrument (SDLI), and exam scores were used to measure students' learning outcomes.

RESULTS

TBL significantly influenced the students' learning outcomes. Students who expressed that TBL increased their learning interests had a higher score on VT; and students who had high achievement from the current TBL course had higher scores on the CES, VT, and SDLI. The means of the group test scores and the final examination score were significantly higher than the individual scores from the in-class tests in both 2011, 2012, and the combination of 2011 and 2012.

CONCLUSION

The TBL design requires out-of-class preparation before all classes, which requires active and self-directed learning. TBL provides opportunities to foster learner-to-learner interactions, which lead to more active engagement and teamwork among learners. It also promotes the students' class engagement and teamwork values, and it increases academic performance. The TBL is suggested to have a greater effect on academically weaker students.

The Virtual Maternity Clinic: a teaching and learning innovation for midwifery education

BACKGROUND

There are challenges for midwifery students in developing skill and competency due to limited placements in antenatal clinics. The Virtual Maternity Clinic, an online resource, was developed to support student learning in professional midwifery practice.

OBJECTIVES

Identifying students' perceptions of the Virtual Maternity Clinic; learning about the impact of the Virtual Maternity Clinic on the students' experience of its use and access; and learning about the level of student satisfaction of the Virtual Maternity Clinic.

DESIGN

Two interventions were used including pre and post evaluations of the online learning resource with data obtained from questionnaires using open ended and dichotomous responses and rating scales. The pre-Virtual Maternity Clinic intervention used a qualitative design and the post-Virtual Maternity Clinic intervention applied both qualitative and quantitative approaches.

SETTINGS

Three campuses of Deakin University, located in Victoria, Australia.

PARTICIPANTS

Midwifery students enrolled in the Bachelor of Nursing/Bachelor of Midwifery and Graduate Diploma of Midwifery were recruited across three campuses of Deakin University (n=140).

METHODS

Thematic analysis of the pre-Virtual Maternity Clinic intervention (return rate n=119) related to students' expectations of this resource. The data for the post-Virtual Maternity Clinic intervention (return rate n=42) including open-ended responses were thematically analysed; dichotomous data examined in the form of frequencies and percentages of agreement and disagreement; and 5-rating scales were analysed using Pearson's correlations (α=.05, two-tailed).

RESULTS

Results showed from the pre-Virtual Maternity Clinic intervention that students previously had placements in antenatal clinics were optimistic about the online learning resource. The post-Virtual Maternity Clinic intervention results indicated that students were satisfied with the Virtual Maternity Clinic as a learning resource despite some technological issues.

CONCLUSIONS

The Virtual Maternity Clinic provides benefits for students in repeated observation of the practice of the midwife to support their professional learning and practice development.

Are students' impressions of improved learning through active learning methods reflected by improved test scores?

PURPOSE

To report the transformation from lecture to more active learning methods in a maternity nursing course and to evaluate whether student perception of improved learning through active-learning methods is supported by improved test scores.

METHODS

The process of transforming a course into an active-learning model of teaching is described. A voluntary mid-semester survey for student acceptance of the new teaching method was conducted. Course examination results, from both a standardized exam and a cumulative final exam, among students who received lecture in the classroom and students who had active learning activities in the classroom were compared.

RESULTS

Active learning activities were very acceptable to students. The majority of students reported learning more from having active-learning activities in the classroom rather than lecture-only and this belief was supported by improved test scores. Students who had active learning activities in the classroom scored significantly higher on a standardized assessment test than students who received lecture only.

IMPLICATIONS

The findings support the use of student reflection to evaluate the effectiveness of active-learning methods and help validate the use of student reflection of improved learning in other research projects.

Increasing exclusive breastfeeding rates in the well-baby population: an evidence-based change project

This article describes an evidence-based project that increased the rate of exclusive breastfeeding in a well-baby population by providing breastfeeding basics to nursing staff on the Mother Infant Services (MIS) units. The clinical implications are that nurses' attitudes and care significantly influence exclusive breastfeeding rates. We contend that resources should be allocated to provide nurses with current evidence-based breastfeeding education.

Antenatal screening: an on line learning tool

The U.K. National Screening Committee has introduced a new "one-stop" online resource to update NHS staff quickly and effectively on all six NHS antenatal and newborn screening programmes. This article describes how the module was developed and its benefits for staff.

Learning maternity: the experiences of rural nurses

Two research studies explored rural nurses' experience with the provision of maternity care in rural British Columbia, Canada. Frontline nurses, managers, and health-care providers were interviewed and their practices observed. One of the main challenges identified by rural nurses was ensuring that a knowledgeable/skilled maternity or perinatal nurse was always available at the local hospital. Learning how to provide safe and supportive maternity care is difficult for nurses working in small rural hospitals today due to declining birth rates, increased workloads, and a decrease in opportunities for mentoring. Decisions about the allocation of time off and resources for rural nurses' continuing professional education (CPE) were structured by discourses of personal responsibility for "continuing competence." These institutional work processes increase the burden on rural nurses, negatively affecting their opportunities for CPE and their experiences of providing maternity care, with implications for both patient safety and nurse retention.

Online multimedia delivery of the European Union directive within adult nursing education

The use of online multimedia content in nurse education is still in its infancy with limited research about its role and acceptance by students and staff within nursing courses. This paper describes the development of interactive web-based delivery for the European Union directive (77/453/EEC) for maternity, child care and mental health within adult nursing education. An evaluative study carried out by an online questionnaire with students, using both structured questions and free text, and a focus group with staff whilst identifying areas for further development found general acceptance of this approach. The study has provided important insights into both the content and delivery of the packs, and the format of the material. The use of IT, with multimedia elements, was seen as being beneficial by both students and staff. The findings will be useful in improving and developing the packs for future cohorts.

Problem-based learning (PBL): assessing students' learning preferences using VARK

OBJECTIVE

This study was conducted to describe learning styles of third year nursing students.

DESIGN

An interventional study Setting: a public university in Jordan.

SUBJECTS

Used a purposive sample of 92 nursing students who were enrolled in maternity nursing course.

MAIN OUTCOME MEASURES

Measure the difference in learning styles of nursing students after introducing an intervention of PBL as a teaching methodology.

RESULTS

The dominant learning preference of the students was the read/write preference followed by the kinesthetic, still most of the students represented a multimodal learning preference. No significant difference was found between males and females. A significant difference in the learning preferences of the students in the pre-post test was found. In the pretest the mean of the total VARK score 13.9 (SD=2) where as in the post test the mean of the total VARK score=16.5 (SD=3.5). In the pre-test 54% of students had a multimodal preference whereas 68% of students have a multimodal preference post-test.

CONCLUSIONS

Most students are able to learn effectively as long as the instructor provides different learning activities in the areas assessed in VARK. Active learning might be enhanced in large classrooms by presenting models and demonstrations, discussions, debates, answering questions, and role playing.

Outcomes of a breastfeeding educational intervention for baccalaureate nursing students

Educational institutions have the responsibility to provide students with knowledge and practical experiences of best practices and international standards of care. Worldwide, international standards for appropriate and effective breastfeeding promotion and services often have not been met. The aim of this study was to determine the effectiveness of an infant feeding educational intervention on student nurses' knowledge levels about (1) evidence-based breastfeeding promotion, (2) evidence-based beliefs about outcomes of breastfeeding and formula-feeding, (3) evidence-based attitudes toward breastfeeding and formula-feeding, and (4) intention to perform evidence-based breastfeeding promotion behaviors. A quasi-experimental intervention with a non-equivalent control group was conducted at a major university in Hong Kong. The intervention group (n=111) received 10h of didactic instruction and an 8-week perinatal clinical rotation while the control group (n=162) did not. The intervention group was significantly more likely to associate breastfeeding with positive maternal and child outcomes. Attitudes toward breastfeeding and formula-feeding were not significantly affected by the educational intervention. On the 19-item knowledge survey, the control group (M=6.84; SD=2.95) scored significantly lower than the intervention group (M=10.30; SD=2.51). A public health breastfeeding promotion strategy frequently overlooked is professional-level curricular interventions. Improving evidence-based practices in nursing programs has the potential to impact many breastfeeding families in the hospital and the community.

Teaching Reproductive Options Through the Use of Fiction: The Cider House Rules Project

Alternative teaching strategies such as storytelling and the critical reading of literature are thought to help students develop their critical thinking, emotional intelligence, and cultural sensitivity and thereby better understand the context in which their patients live and make decisions. Such teaching methods are ideally suited for examining morally complex issues such as reproductive options. This article describes an alternative approach to teaching the complex personal, social, and moral issues surrounding the topic of reproductive options. The critical reading of the book, The Cider House Rules, provides a unique opportunity for students to obtain insight and understanding of the complex circumstances under which women and their families make reproductive decisions.

Competencies and skills for remote and rural maternity care: a review of the literature

AIM

This paper reports a review of the literature on skills, competencies and continuing professional development necessary for sustainable remote and rural maternity care.

BACKGROUND

There is a general sense that maternity care providers in rural areas need specific skills and competencies. However, how these differ from generic skills and competencies is often unclear.

METHODS

Approaches used to access the research studies included a comprehensive search in relevant electronic databases using relevant keywords (e.g. 'remote', 'midwifery', 'obstetrics', 'nurse-midwives', education', 'hospitals', 'skills', 'competencies', etc.). Experts were approached for (un-)published literature, and books and journals known to the authors were also used. Key journals were hand searched and references were followed up. The original search was conducted in 2004 and updated in 2006.

FINDINGS

Little published literature exists on professional education, training or continuous professional development in maternity care in remote and rural settings. Although we found a large literature on competency, little was specific to competencies for rural practice or for maternity care. 'Hands-on' skills courses such as Advanced Life Support in Obstetrics and the Neonatal Resuscitation Programme increase confidence in practice, but no published evidence of effectiveness of such courses exists.

CONCLUSION

Educators need to be aware of the barriers facing rural practitioners, and there is potential for increasing distant learning facilitated by videoconferencing or Internet access. They should also consider other assessment methods than portfolios. More research is needed on the levels of skills and competencies required for maternity care professionals practising in remote and rural areas.

Incorporating Geriatric Content into an Undergraduate Parent–Child Nursing Course—An Innovative Approach

The purpose of this article is to describe the development of an innovative educational strategy for incorporating geriatric content into an undergraduate parent-child nursing course. Faculty supervised the development of an interactive media-based module that met content objectives for the parent-child course and included the functional assessment of the geriatric client living in a home setting. Students found this module to be a creative, user-friendly, and practical application of theory to a realistic clinical situation. This strategy successfully infused geriatric content into a pediatric course to enhance students' abilities to care for older adults.

Midwifery curriculum for auxiliary maternity nurses: a case study in the Dominican Republic

Although most deliveries in the Dominican Republic occur within hospitals, maternal mortality in that nation remains high. In nonteaching hospitals, almost all of the vaginal births are attended by maternity auxiliary nurses. This article reports on a series of educational conferences for maternity auxiliary nurses in 1 hospital that were developed in response to the maternal mortality rate there. These conferences, taught by a team of midwives from the continental United States and Puerto Rico, used a midwifery curriculum with a participatory action methodology. The educational initiative has developed into a nongovernmental organization named Proyecto ADAMES to build capacity among auxiliary nurses. A qualitative evaluation of the effectiveness of Proyecto ADAMES in improving the knowledge, skills, and attitudes of the auxiliary nurses revealed positive behavioral changes despite weak documentation of their newly acquired knowledge and skills. Findings suggest that midwifery education for auxiliary maternity nurses in the Dominican Republic may contribute to maternal mortality reduction.

First assisting in obstetrics: a primer for women's healthcare professionals

As the cesarean rate rises nationwide, many maternity nurses, certified nurse-midwives, certified midwives, and other women's health nursing professionals are expanding their scope of practice to include first assisting with cesarean delivery. Becoming qualified to assist with cesarean section requires evaluation of facility, state, regulatory, and professional standards related to first assistants. First assisting education programs offer didactic education and clinical experience designed to ensure that surgical assistants are competent. Surgical first assistants for cesarean section are expected to be knowledgeable regarding the procedure, the relevant surgical anatomy, potential complications, and options for treatment. Acquiring clinical skills requires significant intraoperative experience under the tutelage of a knowledgeable mentor. In this article, the cesarean section procedure and the role and expectations of the surgical first assistant are described to provide the women's health nursing professional with the information needed to determine whether to include surgical first assisting with cesarean section as part of their professional practice.

Decision making by auxiliary nurses to assess postpartum bleeding in a Dominican Republic maternity ward

OBJECTIVE

To understand the process of decision making by auxiliary nurses regarding postpartum bleeding among women in the Dominican Republic.

DESIGN

An ethnographic qualitative design of semistructured interviews and participant observation.

PARTICIPANTS

Twenty four auxiliary nurses on a maternity unit of a referral hospital in the Dominican Republic.

FINDINGS

Auxiliary nurses use specific criteria and logic to decide if postpartum maternal bleeding is excessive. However, systematic postpartum assessments are not routinely conducted on every woman.

MAIN OUTCOME MEASURES

A decision tree that traces how auxiliary nurses evaluate postpartum bleeding indicates that they have knowledge of contemporary obstetric nursing care, but the organization of care delivery is not structured for them to apply it routinely.

CONCLUSIONS

A collaboration of U.S. midwives and Dominican nurses will build on the assets of the auxiliary nurses. Rather than focusing the content of educational conferences on current knowledge of labor and delivery, an important next step is modeling woman- and family-centered care. The U.S. midwives and Dominican nurses are committed to finding empowering and effective ways to improve maternity care.

Student nurses' attitudes and beliefs about breast-feeding

This study explored the breast-feeding attitudes and beliefs of students newly enrolled in an urban university baccalaureate nursing program. A qualitative approach was used to conduct in-depth semistructured interviews with 12 students prior to their formal course work in maternal-child nursing. Four themes emerged from the data analysis: 1. Personal experiences are important in the development of breast-feeding attitudes and beliefs. 2. The students generally believed that breast-feeding offered benefits for babies and mothers, but the beliefs were stronger for those who grew up with breast-feeding as the norm. 3. All the students believed that there were barriers to breast-feeding in the United States that they identified as the societal view of the breast, dependence/independence conflicts, and concerns about intimacy. 4. The students identified an educational rather than promotional role for nurses in breast-feeding because of conflicts about personal choice. This study suggests that students need help identifying their attitudes and beliefs about breast-feeding and reflecting how their personal experiences influence breast-feeding promotion.

Professional nurses' perceptions of the skills required to render comprehensive primary health care services

As multidisciplinary health team members, professional nurses play a vital role in the delivery of primary health care services. They require specific knowledge and skills to function effectively in the primary health care settings. In South Africa, however, professional nurses followed various training programmes. This has made it difficult for the professional nurses to be competent in rendering the full spectrum of comprehensive primary health care services, focussing on preventive, promotive, curative as well as rehabilitative care. In a setting where professional nurses have different qualifications it is possible that they do not recognise their own limitations. The research aimed to explore and describe the perceptions of professional nurses about the skills required and their own level of skills to render comprehensive primary health care services. A further aim of the research was to formulate guidelines for the facilitation of trained professional nurses to truly render quality comprehensive primary health care services, based on the findings. A qualitative design was followed. Participants were identified by means of purposive voluntary sampling and data was collected by utilising a semi-structured interview schedule. Twenty two participants were interviewed. After each interview field notes were written. Ethical aspects and confidentiality were taken into consideration. The researcher and a co-coder analysed the transcribed interviews by means of open coding. The findings indicated that the more comprehensively the professional nurses were trained, the more competent they felt. The less comprehensively trained, the more negative they experienced their work. They viewed their skills as ranging from adequate to inadequate, depending on their training. The conclusion was drawn that professional nurses' perceptions were congruent with the skills they possessed. Recommendations for nursing research, education and practice, including guidelines to facilitate trained professional nurses to truly render comprehensive primary health care, were formulated.

Evaluation of a multiple component intervention to support the implementation of a 'Therapeutic Relationships' best practice guideline on nurses' communication skills

OBJECTIVE

To determine if there was an improvement in nurses' communication skills 5 months after a multiple component intervention to implement the Registered Nurses' Association of Ontario best practice guideline 'Establishing Therapeutic Relationships'.

METHODS

A matched pair, before and after design was used. Eight client scenarios with corresponding client comments were read aloud to nurses who were asked to respond verbally, as though they were interacting with the client. Responses were audio-taped and transcribed. The frequency and quality of nurses' active listening, initiating and assertiveness skills were measured pre- and post-implementation of the guideline.

RESULTS

Twenty-two nurses responded at both time points. Active listening skills were most frequently used. There was a statistically significant decrease in the number of active listening skills used, but a statistically significant improvement in the quality of active listening and initiating statements and frequency of initiating skills.

CONCLUSION

Nurses demonstrated improvements in selected communication skills following the implementation of a multiple component intervention that included a best practice guideline.

PRACTICE IMPLICATIONS

A combination of strategies that support the implementation of a best practice guideline is described. Results indicate some improvement in communication skills that are essential to the establishment of therapeutic nurse-client relationships.

A mother's feelings for her infant are strengthened by excellent breastfeeding counseling and continuity of care

OBJECTIVE

Continuous support during the childbirth process ultimately may strengthen the mother's self-esteem and her capacity to interact with and nurture her infant and also may improve paternal involvement in general. In the present study, we investigated whether mothers, who were attended by midwives and nurses who had had a process-oriented training program in breastfeeding counseling, perceived stronger maternal feelings for their infant than mothers who had received only routine care.

METHODS

In a previous study, an intervention that included a process-oriented program on breastfeeding counseling for health professionals and continuity in family classes through childbirth was conducted. The 10 largest municipalities were classified in pairs that were similar in size and had similar figures of breastfeeding duration. The municipalities were randomized pairwise to either an intervention or a control group. The present study is a follow-up study on women's feelings for their infants in relation to the kind of care that they had had and was undertaken between April 2000 and January 2003. The sampling frame was based on women who were cared for at either the intervention clinic or control clinics. The mothers at the control clinics had received standard routine care and had attended family classes through the point of birth. Data collection for control group A started before effects of the intervention could be studied. Data for control group B were collected simultaneously with data collection for the intervention group (n = 540). The mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. Background data of the mothers were collected. The perception of support that was provided by the health professionals and the perception of mother-infant relationship and feelings for the infant were rated on Likert scales.

RESULTS

At 3 days postpartum, both the intervention group and control group B versus the control group A thought that their understanding of the infant was better, they perceived more strongly that the infant as their own, and they enjoyed more breastfeeding and resting with the infant. Although there was no significant difference between the intervention group and control group B at 3 days and 3 months observation, mothers in the intervention group talked more to their infant, perceived their infant to be more beautiful than other infants, and perceived more strongly that the infant was their own than did the mothers in control group B at 9 months observation. In addition, the mothers in the intervention group felt significantly more confident with the infant and felt the infant to be closer than did the mothers in control group B.

CONCLUSION

A process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention that guaranteed continuity of care strengthened the maternal relationship with the infant and the feelings for the infant.

Maternity care in the bush: using the Internet to provide educational resources to isolated practitioners

INTRODUCTION

Telecommunication infrastructure is being rolled out across Australia with little knowledge about the uptake by health professionals in remote areas. Computer mediated communication has the potential to offer educational support to remote practitioners; however, the viability of this is uncertain. The aim of this research was to establish and evaluate an internet-based resource library targeting the needs of remote area maternity service providers.

METHODS

A participatory action research (PAR) approach was used to involve remote area maternity service providers in the Northern Territory of Australia. The evaluation of the resource library included its performance on reach, agency affiliation and richness, factors identified to affect the sustainability and utility of such a resource. An additional component of the evaluation framework documented the facilitators of and barriers to using an information technology strategy to reduce the isolation of remote area maternity service providers.

RESULTS

Overall, the evaluation of the resource library was very positive. Feedback from the PAR team described the resource as contemporary, useful and relevant. Practitioners in leadership and education positions identified the resource library as a valuable tool that enabled them to access professional knowledge, which could then be distributed to any remote-based practitioners, who experienced difficulties with access themselves. The evaluation found that logistical issues were a major problem for potential users. Hardware inadequacies, access difficulties, unfamiliarity with computers, and a lack of management support for nursing and midwifery staff to utilise the resource, were all identified barriers. Remote-area practitioners highlighted education, training and 24 hour support as key priorities.

CONCLUSIONS

Results from this research clearly showed the potential of web-based resources to offer educational support through access to clinical guidelines, reports and research, thus reducing the isolation of the remote practitioner. However, it highlighted the need for clear strategic direction at policy level, whereby all stakeholders unite to synchronise the rollout of information technology infrastructure with the necessary education, training and support as an integral component.

Addressing domestic violence through maternal-child health home visiting: what we do and do not know

Domestic violence (DV) has been described as a public health epidemic. Health care providers of all disciplines encounter victims of DV in every practice setting. However, the vast majority of DV health care research has focused on care provided to victims in traditional acute care and clinic settings. Few investigators have conducted studies with community health nurses (CHNs) who visit DV victims in their homes. CHNs, providing preventive maternal-child health (MCH) care through home visits with families, have been described by some as key providers in DV prevention. However, there is a dearth of knowledge about the actual practice and related outcomes of these nurses when working with families experiencing DV. The purpose of this article is to provide a baseline view of the current state of knowledge on which nurses may begin building future research that leads to evidence-based practice. The article describes the potential role of home-visiting MCH nurses in DV prevention and intervention, provides a critical review of the existing research, identifies primary gaps in scientific knowledge, proposes future research priorities, and makes recommendations for practice.