Parents’ Experiences With a Model of Integrated Maternity and Neonatal Care Designed to Empower Parents

ObjectiveTo explore the experiences of parents with an integrated maternity and neonatal ward designed to empower parents by providing family-integrated care (FICare) to mother–newborn couplets in single-family rooms.DesignA qualitative analysis with a contextual constructivist approach.SettingAn integrated maternity and neonatal level 2 ward designed to empower parents in a teaching hospital in Amsterdam, the Netherlands. Maternity and neonatal care, up to and including highly complex care, is provided to mother–newborn couplets in single-family rooms according to the principles of FICare.ParticipantsTwenty-seven mothers and nine fathers of newborns who were hospitalized for at least 7 days.MethodsWe held four focus group discussions and eight semistructured interviews 1 to 3 months after discharge of the newborn to explore which experiences (mechanisms) facilitated or impeded aspects of parent empowerment (outcomes) under which specific conditions of the integrated infrastructure (contexts). We used the realist evaluation model to analyze the data.ResultsOur analysis revealed five themes of parent empowerment (outcomes): Feeling Respected, Gaining Self-Management Tools, Insights Into the Newborn’s Condition, Perceived Control, and Self-Efficacy. For each theme, participants reported facilitating and impeding experiences (mechanisms) that were initiated and influenced by the combination of single-family rooms, couplet care, rooming-in, and FICare (contexts). Unrestricted physical proximity to their newborns, 24 hours per day, in a safe private environment offered parents intensive learning experiences through active participation in care. It helped them to achieve independent parenthood at the time of discharge, but it also generated challenges such as power conflicts with the staff; prioritizing care for themselves, siblings, or the newborn; feelings of isolation; and lack of sleep.ConclusionProviding FICare to mother–newborn couplets in single-family rooms offers parents an intensive learning context for independent parenthood at the time of discharge. Health care professionals should be aware of the challenges and facilitators experienced by parents in the context of close physical proximity to their newborns 24 hours per day in single-family rooms. This awareness will allow them to better support parents in their empowerment process toward independent parenthood at the time of discharge.     

Integrative Review of Parents’ Perspectives of the Nursing Role in Neonatal Family-Centered Care

ObjectivesTo identify the perceptions of mothers and fathers of newborns admitted to NICUs regarding the role of neonatal nurses in the provision of family-centered care and how neonatal nurses were able to interpret and meet parents’ needs.Data SourcesWe conducted literature searches in the CINAHL, MEDLINE, Embase, PsycINFO, Dissertations and Theses Global, and Maternity and Infant Care databases.Study SelectionArticles on qualitative and quantitative studies were selected if they were published in English from 2009 to 2018; they were set in countries with similar health care resources in Australasia, Canada, Europe, Scandinavia, the United Kingdom, and the United States; and the data were collected from parents. We identified 31 studies for analysis.Data ExtractionWe used the thematic analysis method of Braun and Clarke to extract data elements that were grouped and coded into themes and subthemes.Data SynthesisThrough ongoing iterative analysis, we generated six themes from the 18 subthemes that in combination presented the experiences of parents in the context of family-centered care provided by neonatal nurses: Process of Becoming a Parent, Neonatal Nurses Supporting Parents, Infant Safety, Communication, Barriers to Parenting, and Parenting Inhibited by Neonatal Nurses.ConclusionThe six themes reflected the contribution made by neonatal nurses to family-centered care in the NICU. The parents’ perspectives of nurses were mostly positive, but some negative aspects attributed to nurses identified in earlier studies persisted.     

Qualitative Interpretive Metasynthesis of Parents’ Experiences of Perinatal Loss

ObjectiveTo identify and synthesize common, experiential themes from qualitative studies of parents who experienced perinatal loss.Data SourcesWe searched PubMed, CINAHL, and PsycINFO for qualitative articles about parents’ experiences of perinatal loss.Study SelectionWe included research on parents’ experiences of perinatal loss published in English in the last 10 years. We excluded articles on the perspectives or experiences of health care professionals or persons other than the biological parent who experienced the perinatal loss, systematic reviews, outcome studies, and gray literature.Data ExtractionWe used a priori inclusion and exclusion criteria and identified five articles in which perinatal loss was described from the parents’ perspectives. We extracted thematic findings and supporting quotes from each article and documented them in a table for subsequent synthesis.Data SynthesisWe used a qualitative metasynthesis and interpretive model to synthesize findings from the included studies. Findings were synthesized into one overarching theme, The Paradox of Perinatal Loss, and four subthemes: Complex Emotional Responses, Prenatal Bonding–Acknowledging Personhood, Interactions With Health Care Professionals, and Traversing the Social Sphere.ConclusionOur findings indicate that perinatal loss is often a transformative event during which parents experience multiple losses and intense, complex emotions. Interactions with health care professionals greatly affected the pregnancy experience, which places professionals in a unique position to positively influence parents’ overall experiences. Therefore, it is important to develop protocols related to perinatal loss and ensure that staff are adequately trained and equipped to care for parents during this experience. Findings from this synthesis may also inform the future development of theory related to bereavement surrounding perinatal loss.     

Systematic Review and Meta-Analysis of the Prevalence of the Maternity Blues in the Postpartum Period

ObjectiveTo determine the prevalence of maternity blues among women in the postpartum period.Data SourcesWe conducted our systematic review and meta-analysis by searching the literature for relevant articles published in three international databases, PubMed, Web of Science, and Scopus, from date of inception through December 11, 2019, using the keywords prevalence, incidence, maternity blues, and baby blues.Study SelectionFrom 336 articles initially screened, we included 26 articles in the systematic review and meta-analysis.Data ExtractionTwo independent reviewers used a standardized form to extract data from eligible articles. We evaluated the quality of individual studies and the overall evidence according to Hoy et al.’s risk of bias tool.Data SynthesisThe prevalence of maternity blues in the 26 included studies was 13.7% to 76.0%. Based on the results of the random effects model, the prevalence of maternity blues in 5,667 women was 39.0% (95% confidence interval [32.3, 45.6]; I² = 96.6%). The prevalence of maternity blues among women in Africa was greatest at 49.6%.ConclusionConsidering the great prevalence of maternity blues in women after childbirth, paying attention to the key symptoms of maternity blues and implementing educational programs for health care providers and mothers after childbirth are essential.     

The impact of human trafficking in relation to maternity care: A literature review

ObjectiveTo map the relevant literature and inform future research on the issues related to and experiences of pregnancy and maternity care for women who have been trafficked.DesignA scoping review was undertaken to identify literature on the issues and experiences of pregnancy and maternity care for women who have been trafficked.Results45 papers were identified and six key themes were derived from the literature: the impact of trafficking on health; access to maternity care; experiences of maternity care; social factors; knowledge and experience of staff; and identification and referral.Key ConclusionsWomen who have been trafficked are at risk of physical and emotional health issues that may affect maternal and fetal outcomes. Multiple barriers to care exist for women who have been trafficked, and social factors including housing, poverty and dispersal policies may impact upon both health and access to care. Healthcare staff do not feel adequately prepared to respond to the needs of this vulnerable group and no midwifery-specific guidance exists.Implications for PracticeMidwives need awareness of the complex range of health and social factors that may affect women who have been trafficked. Midwives and maternity care professionals require more specialised training to better identify, refer and support women who have been trafficked.     

‘No more strangers’: Investigating the experiences of women,midwives and others during the establishment of a new model of maternity care for remote dwelling aboriginal women in northern Australia

Objectiveto describe the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women transferred to a regional centre in northern Australia for maternity care and birth.Designa mixed method design within a Participatory Action Research approach was used. Qualitative findings are presented here. Data for this paper were collected from semi-structured interviews, field notes and observations and analysed thematically.Settingthe ‘top end’ of the Northern Territory of Australia.Participantsa total of 66 participants included six MGP midwives, two Aboriginal Health Workers and one Senior Aboriginal Woman working in the new model; eight hospital midwives; 34 Department of Health staff, three staff from other agencies; and 12 remote dwelling Aboriginal women who used the service.Findingsthe study generated one overarching theme, it's not a perfect system but it's changing. This encompassed improvements to the services evident to all participants. Core themes related to the previous maternity service which was described as the arduous journey, the new model was seen as a new way of working and a resultant very different journey occurred for Aboriginal women using the service.Key conclusions and implications for practicethere was a dissonance between the previous culture of maternity services and the woman centred focus of the new model. Over 12 months initial resistance to the new model diminished and it became highly valued. The transfer of information between the regional service and remote community health centres improved as did the safety and quality of care. Aboriginal women can access continuity of carer in the regional centre for the first time and reported a more positive experience with maternity services. The new model appears to have changed the cultural responsiveness of the regional maternity service; and care provided for remote dwelling women within this service. The qualitative findings inform others seeking to implement a similar model of care for remote dwelling women transferred to a regional centre for birth.     

Meta-Synthesis of the Needs of Women Cared for by Midwives During Childbirth in Hospitals

ObjectiveTo identify and meta-synthesize results of qualitative studies on the needs of women cared for by midwives during childbirth in hospitals.Data SourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and the Cochrane Library.Study SelectionWe restricted the bibliographic search to articles published in English to July 31, 2020. The initial search yielded 6,407 articles, and after 2,504 duplicates were removed, we screened the titles and abstracts of 3,903 articles. We conducted a full-text review of 89 articles and included 13 qualitative studies about the needs of women who were hospitalized during childbirth and had midwives as their primary maternity care providers.Data ExtractionWe extracted data (e.g., authors, publication date, type of study, sample size, results, and quotes) from the full text of each article into a standardized table. Two authors reviewed all articles using the Critical Appraisal Skills Programme tool to assess study quality and to independently score each study.Data SynthesisWe analyzed the findings of each study and synthesized them to develop themes. We found 14 major themes that reflected the needs of women during hospitalization for childbirth: Nutrition, Hygiene, Privacy, Information, Bodily Respect, Respect for Social Role, Family Intimacy, Shelter, Pain Management, Partnership, Movement, Reassurance, Support, and Empowerment. We categorized these themes in Maslow’s hierarchy of needs to better understand the phenomenon.ConclusionWe identified 14 needs that midwives and nurses can meet when they care for women in hospitals during childbirth. Standardized methods to assess these needs and to link them to specific interventions can be used by midwives and nurses, which will likely affect women’s satisfaction with their experience and overall quality of care.     

Impact of bereavement care and pregnancy loss services on families: Findings and recommendations from Irish inquiry reports

BackgroundPregnancy loss and the death of their baby can be overwhelming for families, especially when the loss is unexpected. The standard of bereavement care families receive around the time of pregnancy or early infant loss can have a significant impact on their psychological recovery. At times external inquiries are carried out to identify issues in the maternity care provided and make recommendations to improve its’ standard.ObjectiveThis study aims to describe the impact of bereavement care provided to families around the time of pregnancy and/or early infant loss as stated in ten published inquiry reports related to Irish maternity services.MethodsUsing thematic analysis, issues with care encountered by bereaved parents as outlined in the reports were identified. These focussed around five main themes (communication, healthcare staff skills, maternity unit environment, post-mortem/coronial process, local incident reviews).FindingsBereavement care, as described by families in the ten reports, was not consistently individualised or respectful, resulting in additional feelings of anger and upset. Problems with clear communication of complex issues, in a manner that is understandable to bereaved families, were identified in several reports. Recommendations from the inquiry reports included that experienced and skilled staff should always be available to provide immediate support to bereaved families as appropriate, and assist families in understanding and processing information around the time of their loss.Conclusions and implications for practiceConsistent, individualised bereavement care facilitates a seamless transition for bereaved families from diagnosis through the hospital stay to discharge and follow-up, allowing them to focus on their baby, their bereavement and their family's wellbeing. The process of consent for a perinatal post-mortem and associated concerns have evolved over the timeframe of the ten inquiries. We reflect further on this and the impacts of the other issues highlighted, as well as discussing possible improvements to address them as described in the scientific literature.     

Narrative Inquiry Into Nursing Care of Pregnant Women and Families in Specialized Fetal Diagnosis and Treatment Settings

ObjectiveTo examine how nurses describe caring for women and families in specialized fetal diagnosis and treatment settings.DesignWe used narrative inquiry.SettingA secure online survey platform.ParticipantsWe recruited 26 nurses from the Fetal Therapy Nurse Network as a subsample from a prior Delphi study on the essential structures, processes, outcomes, and challenges of nursing practice in the emerging field of fetal diagnosis and treatment.MethodsWe used narrative inquiry and Clandinin’s three-dimensional space narrative analysis to interpret the stories provided by participants to illustrate their practice and the relationship between their practice and care quality and health outcomes.ResultsParticipants described three primary types of fetal diagnoses and management scenarios: prenatal intervention (maternal–fetal surgery to treat a fetal anomaly), postnatal intervention (neonatal surgery), and perinatal palliative care (continuation of a pregnancy after a life-limiting fetal diagnosis). We identified three overarching themes related to nursing processes: A Sounding Board: Counseling the Pregnant Woman and Family, A Care Coordinator: Orchestrating a Complex Journey, and A Constant Presence: Being With the Pregnant Woman and Family. We also identified specific outcomes related to nursing care.ConclusionWe used narrative inquiry to expand on prior research and advance the conceptualization of a model of nursing practice in fetal diagnosis and treatment settings. Our results provide a basis to begin to test theories that connect nursing practice to care quality and outcomes in clinical practice settings. To comprehensively evaluate and enhance care as it evolves and expands, the immediate and long-term effects of nursing practice must be identified.