Nurse Home Visits Improve Maternal/Infant Interaction and Decrease Severity of Postpartum Depression

ObjectiveTo test the efficacy of the relationship‐focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum.DesignRandomized clinical trial (RCT) with three phases.MethodsIn this three‐phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants.SettingPhase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse‐led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants’ homes.ParticipantsPostpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty‐five mother/infant dyads were fully retained in the 9‐month protocol.ResultsTreatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self‐reflection during data collection, directions for video‐recorded interaction, and assistance with referrals likely contributed to improvements for both groups.ConclusionsEfficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse‐led home visits had a positive effect on outcomes for all participants.     

Pilot Evaluation of an Internet‐Based Natural Family Planning Education and Service Program

ObjectiveTo evaluate the efficacy, knowledge of fertility, and acceptability of a web‐based natural family planning (NFP) education and service program.DesignA 6‐month repeated measure longitudinal evaluation pilot study.SettingA university based online website.ParticipantsThe website was piloted with 468 volunteer women seeking NFP services. Of these participants, 222 used the automatic online fertility charting system to avoid pregnancy. The 222 charting participants had a mean age of 29.9 years (SD=5.6), 2.2 children (SD=1.9), 37% were postpartum, and 47% had regular menstrual cycle lengths.InterventionNurse‐managed web‐based NFP education and service program.OutcomesPregnancies were confirmed by an online self‐assessed pregnancy evaluation form. A 10‐item fertility quiz and 10‐item acceptability survey was administered online.ResultsAmong the 222 users avoiding pregnancy, at 6 months of use, there were two correct‐use unintended pregnancies that provided a pregnancy rate of 2% and seven total unintended pregnancies providing a typical use pregnancy rate of 7%. Mean knowledge of fertility increased significantly from time of registration (8.96, SD=1.10) to 1 month of use (9.46, SD=.10), t=4.60, p<.001). Acceptability increased nonsignificantly from 1 month of use (45.6; SD=8.98) to 6 months of use (48.4; SD=8.77).ConclusionThe nurse‐managed online NFP system seems to provide adequate knowledge of fertility and help participants meet pregnancy intentions. Acceptability of such a system of NFP is still in question.     

Nurses’ Perspectives on the Intersection of Safety and Informed Decision Making in Maternity Care

ObjectiveTo explore maternity nurses’ perceptions of women's informed decision making during labor and birth to better understand how interdisciplinary communication challenges might affect patient safety.DesignConstructivist grounded theory.SettingFour hospitals in the western United States.ParticipantsForty‐six (46) nurses and physicians practicing in maternity units.MethodData collection strategies included individual interviews and participant observation. Data were analyzed using the constant comparative method, dimensional analysis, and situational analysis (Charmaz, 2006; Clarke, 2005; Schatzman, 1991).ResultsThe nurses’ central action of holding off harm encompassed three communication strategies: persuading agreement, managing information, and coaching of mothers and physicians. These strategies were executed in a complex, hierarchical context characterized by varied practice patterns and relationships. Nurses’ priorities and patient safety goals were sometimes misaligned with those of physicians, resulting in potentially unsafe communication.ConclusionsThe communication strategies nurses employed resulted in intended and unintended consequences with safety implications for mothers and providers and had the potential to trap women in the middle of interprofessional conflicts and differences of opinion.     

Maternal Satisfaction with Administering Infant Interventions in the Neonatal Intensive Care Unit

ObjectiveTo examine mothers’ satisfaction with administering interventions for their preterm infants and with the helpfulness of the study nurse by comparing massage with auditory, tactile, visual, and vestibular stimulation (ATVV intervention), kangaroo care, and education about equipment needed at home and to explore whether mother and infant characteristics affected maternal satisfaction ratings.DesignThree‐group experimental design.SettingFour neonatal intensive care units (NICUs) (two in North Carolina, two in Illinois).ParticipantsTwo hundred and eight (208) preterm infants and their mothers.MethodsWhen the infant was no longer critically ill, mother/infant dyads were randomly assigned to ATVV, kangaroo care, or the education group all taught by study nurses. At discharge and 2 months corrected age, mothers completed questionnaires.ResultsAll groups were satisfied with the intervention and with nurse helpfulness, and the degree of satisfaction did not differ among them. Intervention satisfaction, but not nurse helpfulness, was related to recruitment site. Older, married, and minority mothers were less satisfied with the intervention but only at 2 months. Higher anxiety was related to lower intervention satisfaction at discharge and lower ratings of nurse helpfulness at discharge and 2 months. More depressive symptoms were related to lower nurse helpfulness ratings at 2 months.ConclusionsMothers were satisfied with interventions for their infants regardless of the intervention performed. Maternal satisfaction with the intervention was related to recruitment site, maternal demographic characteristics, and maternal psychological distress, especially at 2 months. Thus, nursing interventions that provide mothers with a role to play in the infant's care during hospitalization are particularly likely to be appreciated by mothers.     

Improving Practice at the Point of Care Through the Optimization of the Breastfeeding Resource Nurse Model

ObjectiveTo describe and understand the Breastfeeding Resource Nurse (BRN) role and program.DesignThe primary study was a multimethod prospective study in which quantitative surveys and qualitative interviews of nurses who received education through the BRN program were used. Results presented herein are from the quantitative arm of the primary study.SettingA large free‐standing urban children's hospital with a birthing unit for specialized deliveries and a primary and specialty care network.ParticipantsA total of 425 of 600 nurses who took the BRN course responded to the survey. These nurses worked in all settings throughout the enterprise.MethodsThe research team created a Survey Monkey interview that was e‐mailed to all current nurses with valid hospital e‐mail addresses who had taken the BRN course. Monthly e‐mail reminders were sent and nurse managers were asked to encourage their staff to fill out the survey.ResultsNurses who received specialized education through BRN course integrated the provision of evidence‐based breastfeeding support and care into their daily routines. Furthermore, nurses became breastfeeding advocates and supported family, friends, and members of their communities in their breastfeeding experiences.ConclusionsThe type of education needed for nurses who work at children's hospitals and in neonatal intensive care units is different than traditional breastfeeding education for birth hospitals. Implementation of the BRN course resulted in positive outcomes for staff; the course is transferrable to other facilities worldwide.     

Does Supplementary Prenatal Nursing and Home Visitation Support Improve Resource Use in a Universal Health Care System? A Randomized Controlled Trial in Canada

ABSTRACT: Background: The addition of supplementary prenatal support may improve the health and well‐being of high‐risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community‐based population of pregnant women. Methods: Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling). Results: Overall, those in the nurse intervention group were more likely to attend an “Early Bird” prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy‐related topics but had little impact on resource use for mental health and poverty‐related needs. Among those with added support, resource use among low‐risk women was generally greater than among high‐risk women. Conclusions: Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community‐based resources. This finding was true even for high‐risk women, although this intervention did not reduce the difference in resource use between high‐ and low‐risk women. (BIRTH 33:3 September 2006)     

A Nurse Leadership Project to Improve Health Literacy on a Maternal-Infant Unit

ObjectiveTo describe how participation in the Sigma Theta Tau International Maternal-Child Health Nurse Leadership Academy positioned the authors to lead an interdisciplinary team through implementation and evaluation of a change project related to patient education based upon national health literacy standards. The project goal was to improve patient satisfaction with nurse communication and preparation for hospital discharge.DesignQuality improvement.Setting/ParticipantsMother/-baby unit of an academic medical center serving a high percentage of patients of a minority population and underserved clients.InterventionThe five- step intervention included (a) review of current health literacy standards, (b) formation of an infrastructure for development and evaluation of existing patient education materials, (c) assessment of patient education materials currently in use, (d) assessment of literacy level and learning styles of new mothers, and (e) provision of continuing education to increase knowledge of nurses as patient teachers and of health literacy.MeasurementMean scores of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in the domains of patient satisfaction with nurse communication and discharge information were used to measure patient satisfaction with health communication.ResultsPatient satisfaction with nurse communication increased from 75.9% to 84.6%. Satisfaction with discharge information increased from 84.6% to 98.6%.ConclusionThe leadership academy successfully positioned the authors to guide an interdisciplinary team through development of a process to meet the education and communication needs of patients and improve their health literacy As a result, a positive effect was noted on patient satisfaction with health communication.     

The Effect of Language on Lesbian Nonbirth Mothers

ObjectiveTo explore how language affects the transition of social (nonbirth) mothers into motherhood.DesignNonexperimental, qualitative design.SettingThis study took place in large, urban city located on the East Coast. Interviews were conducted in a private location within the social mother's home or in a private room at a coffee shop.ParticipantsTwenty women who became social mothers through donor insemination with their female partners within the previous 24 months.MethodsIn depth, semistructured interviews lasting from 45 minutes to 90 minutes.ResultsThe transition to motherhood for social mothers is influenced by the use of language at the individual (social mother), family (mommy, mama, or something else), community (heterosexism of health care providers), and societal (education equals validation) levels. At present, a common language for or understanding of nonbirth mothers and their motherhood roles does not exist. Health care providers, including doctors, nurses, and office personnel working in maternal and child health settings, can help social mothers transition into motherhood by validating and recognizing their maternal roles through the use of written and spoken language.ConclusionBy understanding how language affects the transition of social mothers to motherhood and by addressing their needs, health care providers can deliver better support to social mothers and their families.     

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.     

An Institutional Ethnography of Nurses’ Support of Breastfeeding on the Night Shift

ObjectiveTo describe nurses’ support of breastfeeding on the night shift and to identify the interpersonal interactions and institutional structures that affect this support.DesignInstitutional ethnography.SettingThe mother/baby unit of a tertiary care hospital with 4200 births per year.ParticipantsRegistered nurses (N = 16) who provided care on the night shift to mother/infant dyads in the immediate postpartum period.MethodsData were collected using focus groups, individual and group interviews, and mother/baby unit observations. The focus groups were held before the night shift and had five participants. The nine individual and group interviews were conducted between 0100 and 0230 on the mother/baby unit. Three unit observations were conducted. Interviews were recorded, professionally transcribed, and analyzed using a content analysis method.ResultsData analysis yielded three themes that described these nurses’ support of breastfeeding on the night shift: competing priorities, incongruent expectations, and influential institutional structures. The need of visitors to see their new family members competed with the needs of mothers to rest and breastfeed their newborns. Helping breastfeeding dyads who experienced difficulties competed with providing care to other patients. Parents’ expectations regarding newborn behavior were incongruent with the reality of newborn feeding and sleeping patterns. Institutional structures that affected the provision of breastfeeding support by nurses included hospital breastfeeding practices, staffing, and policies.ConclusionNurses’ support of breastfeeding on the night shift encompasses a complex interplay of interpersonal interactions with new families and visitors regarding priorities and expectations and negotiating institutional structures such as feeding policies and staffing.     

High-risk Infants The Need for Nursing Follow-up

The goal of perinatal care can no longer focus only on the medical management of mother and infant, but instead must take a more global approach and focus on the entire family. One aspect of family care is to provide comprehensive nursing follow-up to the high-risk family at the time of the mother's and infant's discharge. To meet this need, a program was developed to educate all interested community nurses to the specific needs of the high-risk family. Evaluation indicates that the program helped nurses to provide consistent comprehensive care to these families, who were very grateful for home visits by a community nurse.     

Adolescent Mothers' Breastfeeding Social Support Needs

Objective:To define aspects of social support that adolescents need from nurses when initiating breastfeeding in the early postpartum.Data Sources:MEDLINE and CINAHL databases for years 2000 to 2009.Data Extraction:Three searches were done using the following subject terms:adolescent mothers and breastfeeding (12 studies),adolescent mothers and breastfeeding and support (24 studies), andbreastfeeding and adolescent mothers and attitudes (15 studies). The 18 studies that were chosen for this synthesized review illuminated the dimensions of social support identified by House.Data Synthesis:The four types of supportive behavior categories identified by House were described in these studies (informational, instrumental, emotional, and appraisal). Esteem support as defined by Sarafino seemed to be synonymous with appraisal support. Many studies identified the importance of network support as a fifth category of supportive behavior in increased breastfeeding duration among adolescents; network support was included in this synthesis. These five types of social support provide a framework for defining supportive nurse behaviors.Conclusions:Nurses in the early postpartum can promote the long‐term health of adolescents and their children through the social support they offer adolescent mothers as they initiate breastfeeding. Network support appears to be essential to adolescents' breastfeeding experiences and needs to be included with informational, instrumental, emotional, and esteem/appraisal support when investigating support for this population. By integrating the five dimensions of social support into their care, nurses play an essential role in providing adolescents with the positive experiences that are so important to establishing breastfeeding.