Hospital‐Based Perinatal Nurses Identify the Need to Improve Nursing Care of Adolescent Mothers

ObjectiveTo determine whether hospital‐based perinatal nurses with expertise in adolescent mother‐friendly care identify a need to improve inpatient nursing care of adolescent mothers and how well perinatal units support nurses’ capacity to provide adolescent mother‐friendly care. Design/Setting/Participants: A key informant survey of nurses from eight perinatal units at three hospitals (four separate sites) in a Canadian city.MethodsPerinatal nurses expert in the care of adolescent mothers were identified by their managers and colleagues. These nurses and all perinatal clinical educators were invited to participate. Twenty‐seven of 34 potential key informants completed the survey.ResultsKey informants rated their own skill in caring for adolescent mothers higher (median 8.0) than they rated the skill of other nurses (median 6.0) on their units. They attributed their expertise working with adolescent mothers to their clinical and life experiences and their ability to develop rapport with adolescents. A common reason for the assigned lower peer‐group ratings was the judgmental manner in which some nurses care for adolescent mothers. Key informants also identified that hospital‐based perinatal nurses lack adequate knowledge of community‐based resources for adolescent mothers, educational programs related to adolescent mother‐friendly care were insufficient, and policies to inform the nursing care of adolescent mothers were not available or known to them.ConclusionA minority of perinatal nurses have expertise in adolescent mother‐friendly care. There is a need for perinatal unit‐level interventions to support the development of nurses’ skills in caring for adolescent mothers and their knowledge of community‐based resources. Peer mentoring and self‐reflective practice are promising strategies.     

Effect of Fathers’ Presence and Involvement in Newborn Care in the NICU on Mothers’ Symptoms of Postpartum Depression

ObjectiveTo determine the prevalence of symptoms of postpartum depression (PPD) and examine how fathers’ presence and involvement in the care of their newborns affect symptoms of PPD within the first 2 weeks after birth among mothers with newborns in the NICU.DesignObservational cohort study.SettingOpen-bay, 40-bed, tertiary level NICU in Eastern Canada.ParticipantsMothers (N = 105) of newborns who were anticipated to survive and required more than 5 days of hospitalization in the NICU.MethodsParticipants completed the Postpartum Depression Screening Scale (PDSS) 14 days after they gave birth. They kept daily diaries to record the amount of time that fathers spent by the newborns’ bedsides (i.e., presence) and actively caring for their newborns (i.e., involvement such as skin to skin). Participants completed daily diaries from the time of enrollment in the study until their newborns were discharged home. We analyzed the data using linear regression; score on the PDSS was the dependent variable, and fathers’ presence and involvement were the independent variables. We adjusted for covariates.ResultsThe prevalence of positive screening for symptoms of major PPD was 24.1% (n = 20), and the prevalence of significant symptoms of PPD was 27.7% (n = 23). Participants reported that fathers were present in the NICU an average of 3.8 hours per day and were actively involved with their newborns 53% of the time. Fathers’ involvement was significantly associated with lower scores on the PDSS (adjusted β = −3.85; 95% confidence interval [CI] [−6.10, −1.60]). A history of anxiety was significantly associated with greater scores on the PDSS (adjusted β = 12.06, 95% CI [2.07, 22.05]). Maternal age and income less than $50,000 CAD were marginally associated with greater scores on the PDSS (adjusted β = −0.86, 95% CI [−1.77, 0.05] and adjusted β = 10.69, 95% CI [−0.73, 22.11], respectively). The overall explained variance in the PDSS scores with the independent variables was R² = 0.35.ConclusionFathers’ involvement in the care of their newborns in the NICU was significantly associated with fewer symptoms of PPD among mothers. We recommend research with targeted interventions to promote fathers’ involvement in the NICU to potentially mitigate the symptoms of PPD among mothers of newborns in the NICU.     

Factors Associated with Differences in Canadian Perinatal Nurses’ Attitudes Toward Birth Practices

ObjectiveTo test whether demographic characteristics predict registered nurses’ attitudes toward birth practices.DesignA secondary analysis of a cross‐sectional survey, the National Maternity Care Attitudes Survey.SettingA national survey conducted with health care providers providing maternity care in Canada.ParticipantsA convenience sample of 545 registered nurses.MethodsHierarchical regression analysis was used to examine three hypotheses about nurses’ demographic differences in relationship to their attitudes toward birth practices. Attitude scales included acceptability of doulas, effects of routine electronic fetal monitoring, factors decreasing cesarean birth rates, the importance of vaginal birth for women, safety of birth, episiotomy, and epidural analgesia.ResultsTertiary hospital–level of employment was associated with more positive attitudes toward epidural analgesia and less positive attitudes toward the importance of vaginal birth. Nurses working at a tertiary hospital were more likely to select an obstetrician for their own maternity care. Those who worked at a community hospital were more likely to select a family physician. Nurses’ selection of an obstetrician was associated with less positive attitudes toward the safety of birth and importance of vaginal birth and more positive attitudes toward electronic fetal monitoring, episiotomy, and epidural analgesia.ConclusionNurses’ attitudes may be influenced by exposure in their workplaces to predominant care providers’ birth practices. Research examining the relationships between nurses’ workplace exposures, attitudes, and practice behaviors is needed to develop understanding about how nurses contribute to rates of intervention in maternity care.     

Mexican Adolescents' Experience of Menarche and Attitudes Toward Menstruation: Role of Communication Between Mothers and Daughters

ObjectivesFirst, to explore the kind of information that Mexican mothers give their daughters about menstruation before their menarche, and to study the impact of this communication on how prepared the daughters felt when they experienced their menarche. Second, to investigate the influence of the menarcheal experience on attitudes toward menstruation.DesignCross-sectional survey.SettingsSample of adolescents attending 3 different public schools.Participants405 Mexican postmenarcheal adolescents, aged 12-15 years.InterventionParticipants answered a questionnaire that had 3 parts: (a) General data, (b) topics related to menses that participants had discussed with their mothers prior to menarche, and (c) menarcheal experience. They also answered a questionnaire about menstrual attitudes.ResultsAlthough most of the participants knew what they should do when they experienced their menarche, only 39% stated they had felt prepared to start menstruating. Regarding menstrual attitudes, adolescents scored highest on Negative Feelings and Secrecy rather than on Positive Feelings. Participants who had previously discussed the emotional aspects of menses with their mothers were more likely to claim they had felt prepared to start menstruating when they got their first period (OR = 3.45). The fact that adolescents felt prepared to start menstruating predicted positive attitudes toward menstruation (β = .19)ConclusionsDiscussing the emotional aspects of menses prior to menarche is crucial to being prepared for menarche, and to holding positive attitudes toward menstruation. Information on biological knowledge and practical aspects of menses needs to be supplemented with emotional issues.     

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.     

Mothers’ experiences of the NICU and a NICU support group programme

Objective: to understand both the maternal experience of the NICU and mothers’ views of a NICU Parent Support Group. Background: mothers of babies who are born prematurely have their first experiences of parenting while their infant is in the neonatal intensive care unit (NICU). This presents multiple challenges and a range of stresses related to their role as a mother and concerns about their baby’s survival and growth. Thus, various supportive interventions have been trialled with this NICU parent population. However, the focus of this support and how it should be delivered lacks research as an evidence base for practice. Mothers’ experiences of the NICU and a professionally facilitated NICU support group at a city hospital were explored in this qualitative research study. Method: nine mothers were interviewed in 2010 while their babies were NICU inpatients. Interviews were recorded, transcribed and analysed thematically. Results: the NICU admission resulted in participant mothers facing challenges in getting to know their baby, forming their parenting role while in the NICU, and a reliance upon, but resentment toward, nursing staff. Positive feelings about their baby’s strengths were also apparent. The parent support group was an important part of managing the experience of the NICU and was reported to meet the emotional support needs of these NICU parents. Conclusion: the implications and recommendations for NICU-based emotional support are discussed. In particular, modifications to support group structures to ensure professional staff involvement and a balance between education and emotional care are reviewed.     

Anxiety Screening During Assessment of Emotional Distress in Mothers of Hospitalized Newborns

Objectives

To examine the incremental identification of emotional distress in mothers of hospitalized newborns by screening for anxiety in addition to depression and to provide practical information about anxiety screening scales to facilitate instrument selection and screening implementation by nurses in the NICU.

Low Levels of Knowledge and Preventive Practices Regarding Vertical Hepatitis B Transmission among Perinatal Nurses

ObjectiveTo evaluate current levels of hepatitis‐B‐related knowledge and clinical practice among perinatal nurses.DesignCross‐sectional study.SettingSanta Clara County, California, home to one of the largest U.S. populations at risk of perinatal hepatitis B transmission.ParticipantsPerinatal nurses (N = 518) from eight birthing hospitals.MethodsIn 2008–2010, nurses completed a baseline survey evaluating existing hepatitis‐B‐related knowledge and preventive clinical practices, participated in an educational seminar, received instructional materials about hepatitis B, and completed a follow‐up knowledge survey.ResultsEighty percent of perinatal nurses had provided health care to a pregnant woman with chronic hepatitis B, but only 51% routinely provided patients with educational information about hepatitis B. While 75% routinely informed patients about effective methods to prevent mother‐to‐child transmission, only a small minority (17–34%) educated infected women about standard recommendations for protecting themselves and household members. One fourth or fewer nurses correctly answered most questions about hepatitis B prevalence, risks, and symptoms. After the educational seminar, knowledge increased statistically significantly.ConclusionExisting knowledge about hepatitis B is limited, and nationally recommended preventive clinical practices are commonly overlooked by perinatal nurses. This lack of knowledge and preventive care represents a noteworthy gap and an opportunity for targeted training and education to improve perinatal hepatitis B prevention and medical management of infected mothers.     

Disordered eating attitudes during pregnancy in mothers of newborns requiring Neonatal Intensive Care Unit admission: a case control study

Objective: The aim of the study was to assess disordered eating attitudes and other related factors in mothers of newborns requiring Neonatal Intensive Care Unit (NICU) admission compared to those of mothers who delivered healthy infants.

Methods: An anonymous self-report study conducted among 199 mothers of newborns hospitalized in NICU, and a control group of 127 mothers of healthy newborns. Eating Attitudes Test-26 (EAT-26) and a survey regarding other perinatal health issues were used.

Results: Women in the study group (SG) gained significantly less weight during pregnancy when compared to control group (CG; p?=?0.001). There were fewer women with appropriate pre-gestational BMI in the SG (p?=?0.052). Women who feared weight-gain during pregnancy were younger (p?0.001) and had higher EAT-26 scores (p?0.001). Women with EAT-26 scores >20 smoked significantly more often during their last pregnancy in the SG (p?=?0.010). Cesarean section was more frequent in the SG (p?=?0.017).

Conclusions: Disordered eating attitudes in gestation may significantly influence the pregnancy outcomes and newborns’ health. Hence, it is vital for perinatal counseling and obstetrical care to focus on these issues to facilitate early diagnosis and intervention.     

Evaluation of an educational intervention on breastfeeding for NICU nurses.

The effect of breastfeeding education on breastfeeding knowledge and attitudes of nurses in a neonatal intensive care unit (NICU) was evaluated. NICU nurses (intervention) and pediatric nurses (untreated control) working at a northeastern US children's hospital participated in the pretest/posttest design study. Both groups answered the same breastfeeding questionnaire on 2 occasions. NICU nurses completed the questionnaire the second time after attending the education session. Outcome measures evaluated by questionnaire items were (1) breastfeeding knowledge, (2) pro-breastfeeding attitudes, (3) baby-focused care attitudes, and (4) nurse-focused care attitudes. Comparison groups were similar at pretest on demographic variables and remained so despite attrition between pretesting and posttesting. A significant increase (P < .001) occurred in NICU nurses' breastfeeding knowledge after the education session. Findings suggest that an educational intervention has potential for improving NICU nurses' knowledge and certain attitudes about breastfeeding but may not alter other attitudes of interest in the desired direction.     

The Attitudes of Canadian Maternity Care Practitioners Towards Labour and Birth: Many Differences but Important Similarities

ObjectiveCollaborative, interdisciplinary care models have the potential to improve maternity care. Differing attitudes of maternity care providers may impede this process. We sought to examine the attitudes of Canadian maternity care practitioners towards labour and birth.MethodsWe performed a cross-sectional web- and paper-based survey of 549 obstetricians, 897 family physicians (400 antepartum only, 497 intrapartum), 545 nurses, 400 midwives, and 192 doulas.ResultsParticipants responded to 43 Likert-type attitudinal questions. Nine themes were identified: electronic fetal monitoring, epidural analgesia, episiotomy, doula roles, Caesarean section benefits, factors decreasing Caesarean section rates, maternal choice, fear of vaginal birth, and safety of birth mode and place. Obstetrician scores reflected positive attitudes towards use of technology, in contrast to midwives’ and doulas’ scores. Family physicians providing only antenatal care had attitudinal scores similar to obstetricians; family physicians practising intrapartum care and nurses had intermediate scores on technology. Obstetricians’ scores indicated that they had the least positive attitudes towards home birth, women’s roles in their own births, and doula care, and they were the most concerned about the consequences of vaginal birth. Midwives’ and doulas’ scores reflected opposing views on these issues. Although 71% of obstetricians supported regulated midwifery, 88.9% were against home birth. Substantial numbers of each group held attitudes similar to dominant attitudes from other disciplines.ConclusionTo develop effective team practice, efforts to reconcile differing attitudes towards labour and birth are needed. However, the overlap in attitudes between disciplines holds promise for a basis upon which to begin shared problem solving and collaboration.     

Status and Factors of Menstrual Knowledge,Attitudes, Behaviors and Their Correlation with Psychological Stress in Adolescent Girls

Background and ObjectiveAdolescent girls perceive menstruation as a negative experience, which can affect adolescents’ physical and mental health. The aims of this study were to describe the menstrual knowledge, attitudes, and behaviors of adolescent girls in China and to examine their association with psychological stress.Design, Setting, Participants, Interventions, and Main Outcome MeasuresA cross-sectional study was conducted among 1349 adolescent girls aged 11-14 years in Changsha, China. Participants anonymously completed questionnaires that assessed sociodemographic characteristics, menstrual knowledge and attitudes, dysmenorrhea self-care behaviors, and perceived stress. One-way analysis of variance and Pearson r correlation and multiple linear regression analyses were conducted to examine the differences and associations among variables.ResultsThe mean age of menarche was 11.70 (±0.82) years. A total of 1053/1349 (78.1%) of girls had a knowledge of menstruation before menarche and their mothers were the main source 931/1349 (69.0%) of their knowledge. More than half (53.4%) of adolescent girls experienced different degrees of dysmenorrhea. The mother's education, family monthly income, family type, and the girls' age, grade, menstrual status, age at menarche, sanitary napkin change frequency, menstrual restrictions, and dysmenorrhea influenced menstrual knowledge, attitudes, and practice. Psychological stress was affected by age, grade, age at menarche, sanitary napkin change frequency, menstrual restrictions, dysmenorrhea, and menstrual knowledge, attitudes, and practices.ConclusionPsychological stress management during menstruation should be a focus of health education programs for adolescent girls. During adolescence, health care providers should not only pay attention to the physical changes of adolescence girls, but also provide stress management skills to help them cope with menstrual-related concerns.     

Success of a Lactation Education Program on NICU Nurses' Knowledge and Attitudes

Objectives: To test an educational intervention designed to improve lactation knowledge, attitudes, and beliefs of NICU nurses and to improve their intentions to provide mothers with lactation support.
Design: Quasi-experimental, time-series pretest/posttest.
Setting: NICU of a Midwestern, free-standing, tertiary-care children's hospital.
Participants: Convenience sample of 64 NICU nurses and 2 separate convenience samples of mothers of infants hospitalized in the NICU ( n =19 and 13, respectively).
Methods: Nurses were measured on study outcomes at multiple time points, beginning with 2 weeks before and ending at 3 months after attendance to a 4-hour educational program. Mothers were sampled before and 3 months after the intervention.
Main Outcome Measure(s): Nurses' lactation knowledge, attitudes, beliefs, and intentions to support lactation and mothers' perceptions of lactation support in the NICU.
Results: Findings suggest that this educational intervention was effective for improving NICU nurses' lactation knowledge and attitudes, and that these improvements were maintained over time. Further, the supportive atmosphere for lactation in this NICU significantly improved following the implementation of the educational intervention for nurses.
Conclusion: Intermittent, short educational programs which include practical how-to's and motivational encouragement for staff may provide the empowerment nurses need in order to be supportive of lactation.