Nurses' and nurse educators' experiences of a Pediatric Nursing Continuing Professional Development program in Rwanda.

OBJECTIVES: In 2016, a Pediatric Nursing Continuing Professional Development (PNCPD) program was created and implemented in Kigali, Rwanda, through the Training, Support, and Access Model (TSAM) for Maternal, Newborn, and Child Health (MNCH). This partnership project between Canada and Rwanda provided pediatric nursing education to forty-one Rwandan nurses and nurse educators in 2018 and 2019. The objective of this research study was to explore the experiences of nurses and nurse educators applying pediatric knowledge and skills to academic and clinical settings after participating in the PNCPD program. METHODS: This study was situated within an interpretive descriptive perspective to explore the ways in which knowledge gained during the PNCPD program in Rwanda was applied by nurses and nurse educators in their nursing practice, both academically and clinically. Data was collected through individual interviews. Inductive content analysis was used for data analysis. RESULTS: The analysis of the interviews resulted in the emergence of five themes: Transformations in Pediatric Nursing Practice, Knowledge Sharing, Relationship-Based Nursing, Barriers and Facilitators to Knowledge Implementation, and Scaling-up PNCPD within the Health System. CONCLUSIONS: The results of this study have the potential to inform positive changes to child health care in Rwanda, including scaling up pediatric nursing education to other areas of the healthcare system.

Promising Results From a Video-Feedback Interaction Guidance Intervention for Improving Maternal-Infant Interaction Quality of Depressed Mothers: A Feasibility Pilot Study.

BACKGROUND: Mothers and infants affected by postpartum depression are known to have (1) reduced quality interactions and (2) elevated cortisol levels, both of which are linked to negative developmental outcomes in children. Parent training promoting sensitive and responsive maternal-infant interactions may help optimize development in children of mothers with postpartum depression. OBJECTIVES: This pilot study tested a video-feedback interaction guidance intervention designed to improve maternal-infant interaction, depressive symptoms, and cortisol patterns of depressed mothers and their infants. METHOD: An experimental, pre-test, post-test design was employed to randomly assign mothers with postpartum depression to intervention (n = 6) and control (n = 6) conditions. Intervention mothers received three video-feedback sessions during home visits, provided at three-week intervals. Control participants received three home visits on the same schedule. RESULTS: Significant differences favoring the intervention group were observed in maternal-infant interaction quality, especially maternal sensitivity and cognitive growth fostering activities, and in reduced infant diurnal cortisol. CONCLUSION: Professionally guided video-feedback intervention appears to support improvements in interactions between depressed mothers and their infants and optimizes infants' diurnal cortisol patterns. The findings from this feasibility pilot study have been used to support a large-scale follow-up exploration.

Nursing Child Assessment Satellite Training Parent-Child Interaction Scales: Comparing American and Canadian Normative and High-Risk Samples.

PURPOSE: Many nurses rely on the American Nursing Child Assessment Satellite Training (NCAST) Parent-Child Interaction (PCI) Teaching and Feeding Scales to identify and target interventions for families affected by severe/chronic stressors (e.g. postpartum depression (PPD), intimate partner violence (IPV), low-income). However, the NCAST Database that provides normative data for comparisons may not apply to Canadian families. The purpose of this study was to compare NCAST PCI scores in Canadian and American samples and to assess the reliability of the NCAST PCI Scales in Canadian samples. METHODS: This secondary analysis employed independent samples t-tests (p < 0.005) to compare PCI between the American NCAST Database and Canadian high-risk (families with PPD, exposure to IPV or low-income) and community samples. Cronbach's alphas were calculated for the Canadian and American samples. RESULTS: In both American and Canadian samples, belonging to a high-risk population reduced parents' abilities to engage in sensitive and responsive caregiving (i.e. healthy serve and return relationships) as measured by the PCI Scales. NCAST Database mothers were more effective at executing caregiving responsibilities during PCI compared to the Canadian community sample, while infants belonging to the Canadian community sample provided clearer cues to caregivers during PCI compared to those of the NCAST Database. Internal consistency coefficients for the Canadian samples were generally acceptable. CONCLUSIONS: The NCAST Database can be reliably used for assessing PCI in normative and high-risk Canadian families. PRACTICAL IMPLICATIONS: Canadian nurses can be assured that the PCI Scales adequately identify risks and can help target interventions to promote optimal parent-child relationships and ultimately child development.

Approaches to salivary cortisol collection and analysis in infants.

Salivary cortisol is becoming more commonly utilized as a biologic marker of stress in observational studies and intervention research. However, its use with infants (12 months of age or younger) is less widespread and poses some special challenges to researchers. In order to decide on the most suitable collection procedure for salivary cortisol in infants, a number of criteria should be considered. This article will aid investigators interested in integrating salivary cortisol measurement into their research studies by presenting (1) an overview of the patterns of cortisol secretion in infancy including the development of diurnal rhythm and response to stress; (2) a comparison of the most commonly used approaches for collecting salivary cortisol samples in infants including cotton rope, syringe aspiration technique, filter paper, hydrocellulose microsponge, and the Salimetrics children's swab; (3) a discussion of the factors contributing to heightened cortisol variability in infancy and how these can be limited; (4) analytical issues associated with cortisol measurement; and (5) examples of criteria to consider when choosing a saliva sampling method and lab for conducting assays.

Attachment and caregiver-infant interaction: a review of observational-assessment tools.

The relationship between maternal-infant interaction and attachment quality to infant developmental outcomes has long been established. As children mature, problems stemming from troubled caregiver-infant relations may result in referral to mental health or child protection services. The accurate and appropriate assessment of attachment is critical for early recognition of problematic relations and for informing suitable treatment modalities. Evaluating the quality of attachment poses a challenge for researchers and clinicians seeking to explore the association between infant development and the quality of early caregiving experiences. Although providing a definitive answer to the question of which of these assessment procedures is the single universal standard for measuring attachment quantity is beyond the scope of this article, readers will be provided with a description and comparison of strengths and limitations of the most commonly used measures of attachment, including the Strange Situation Procedure (M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978), Attachment Q-Sort (E. Waters & K.E. Deane, 1985), Toddler Attachment Sort (TAS-45; J. Kirkland, D. Bimler, A. Drawneek, M. McKim, & A. Scholmerich, 2004), CARE-Index (P. Crittenden, 1985), Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; E. Bronfman, E. Parsons, & K. Lyons-Ruth, 1999), Massie-Campbell Scale of Mother-Infant Attachment Indicators During Stress Scale (Attachment During Stress Scale; H.N. Massie & B.K. Campbell, 1983), and the Risky Situation Procedure (D. Paquette & M. Bigras, 2010).

Postpartum depression is a family affair: addressing the impact on mothers, fathers, and children.

The purpose of this paper is to present research on the effects of postpartum depression (PPD) on mothers, fathers, and children that point to a re-conceptualization of PPD as a mental health condition that affects the whole family. As such, the objectives of this paper are to discuss: (1) the incidence and effects of PPD on mothers and fathers; (2) common predictors of PPD in mothers and fathers, and (3) the effects of PPD on parenting and parent-child relationships, and (4) the effects of PPD on children's health, and their cognitive and social-emotional development. Finally, the implications for screening and intervention if depression is re-conceptualized as a condition of the family are discussed.

Support intervention needs and preferences of fathers affected by postpartum depression.

The effect of postpartum depression (PPD) on mothers has been extensively studied. But even though up to 50% of men whose partners suffer from PPD also have depressive symptoms, little is known about the impact of maternal PPD on fathers. Depressive symptoms are likely to decrease fathers' ability to provide maternal support. Children with 2 depressed parents are at significantly greater risk for poor developmental outcomes than those with 1 affected parent. The objective of this Canada-wide exploratory/descriptive study was to describe the support needs and preferences for support of fathers whose partners have had PPD. Qualitative methods and community-based research approaches were used, and one-to-one telephone interviews were conducted between 2009 and 2011 with a total of 40 fathers. Fathers desired support from both formal (professional) and informal (friends and family) sources and noted that ideal support interventions should cover a number of key topics including information on PPD and practical tips on how to cope with their partner's PPD. Fathers reported that the ideal PPD intervention program does not favor any one setup and, to reach the full spectrum of parents, the program must be multitiered, accessible, and as flexible as funding allows.