Planning, implementation and evaluation of antenatal weight management programmes: What are the key components? A mixed methods study.

OBJECTIVE: To provide an understanding of the influential components required for the planning, delivery and evaluation of antenatal weight management programmes for women who are overweight or obese. DESIGN: Two phase sequential explanatory mixed methods design comprising of an online survey and one-to-one telephone interviews. SETTING AND PARTICIPANTS: All UK maternity services (n = 168) and local government councils (n = 417). FINDINGS: From the 378 responses, 49 maternity services and 28 local government councils reported having an antenatal weight management programme. Of the 62 responses that specified BMI as an inclusion criterion only two-fifths (40.3% n = 25) adhered to the recommended threshold to include women with a BMI ≥30 kg/m2. Although having a multi-disciplinary team was identified as fundamental when planning a programme, only 20.6% (n = 14/68) of the programmes involved service users during the planning phase. How the programme was communicated to a woman was a key factor which determined whether she partook in the programme or not. Having administrative support and staff with expertise in data collection were essential when evaluating a programme. Staff having protected time was identified as important when planning, delivering and evaluating a programme. Three overarching themes were identified from the individual interviews (n = 14) 'choices and decisions', 'demands and resources' and 'engagement and disengagement'. KEY CONCLUSIONS: National guidelines recommendations regarding service user involvement when planning programmes and the BMI threshold used for inclusion are not being met. In addition to having adequate time, personnel and finances, successful programmes are dependent on the confidence and communication skills of midwives to raise the issue of obesity with these women at the booking appointment. Without staff having the time and necessary knowledge and skills, evaluation, and hence demonstrating programme impact, will likely remain difficult. Organisational support is needed to release resources to plan, deliver and evaluate these programmes. Strategic communication strategies are needed to promote the programme to both women and staff within organisations. Future programmes need to ensure there is engagement with service users from the planning of the programme through to evaluation.

Nursing interventions for patients with postpartum psychosis hospitalized in a psychiatric mother-baby unit: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT: If women suffer from postpartum psychosis, treatment in a specialist facility like a psychiatric mother-baby unit is recommended and should focus on the maternal health, mother-baby outcomes and the care for the next of kin. The role of mental health nurses on a mother-baby unit is essential but challenging, given the complex problems and care needs of the patient, the baby and family members. To date, very little evidence about effective nursing interventions for patients with postpartum psychosis is available. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This paper systematically describes nursing interventions and their rationale for patients with postpartum psychosis admitted to a specialized mother-baby unit. Given the limited scientific evidence for effective nursing interventions for patients with postpartum psychosis, knowledge was obtained from a best-practice setting (i.e., a specialized mother-baby unit), thus providing a basis for the systematic development of nursing interventions to be tested on effectiveness in future studies. IMPLICATIONS FOR MENTAL HEALTH NURSING: Mental health nurses play an essential role in the multidisciplinary treatment team in providing information on the patient's personal functioning and her ability to take care for the baby, in order to determine the appropriate amount of guidance and protection, in order to prevent harm and promote recovery. To provide integrated and personalized nursing care, mental health nurses should tailor their interventions to the needs of the patient, the baby and the next of kin, adapted to the successive stages of treatment. Abstract Introduction Postpartum psychosis is one of the severest psychiatric disorders to occur in the postpartum period. If it requires a woman's admission, a psychiatric mother-baby unit is recommended, where care will focus on the mother's health, the mother-baby dyad and their next of kin. To date, few studies have examined nursing interventions for patients with postpartum psychosis. Aim Identifying nursing interventions used at a psychiatric mother-baby unit, when a patient is hospitalized with postpartum psychosis. Method A qualitative design using thematic analysis. Data were collected using semi-structured interviews (N = 13) with expert nurses working at such a unit. Results The analysis identified three themes: (a) treatment of the mental disorder, which involves interventions to improve the mother's mental and physical well-being; (b) care for the mother-baby dyad, which involves interventions intended to promote safe interactions between mother and baby; and (c) care for the partner, which involves interventions to improve the partner's well-being. Discussion Overall, within each of these themes, nurses described the urgency to tailor interventions to the needs of the patient, baby and partner. Implications to practice Our comprehensive description of interventions can be used for the improvement of nursing care for patients hospitalized with postpartum psychosis.

Postnatal psychosocial assessment and clinical decision-making, a descriptive study.

AIMS AND OBJECTIVES: To describe experienced child and family health nurses' clinical decision-making during a postnatal psychosocial assessment. BACKGROUND: Maternal emotional well-being in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy and the interventions used are determined by the standard of nursing decision-making. DESIGN: A qualitative methodology was employed to explore decision-making behaviour when conducting a postnatal psychosocial assessment. METHODS: This study was conducted in an Australian early parenting organisation. Twelve experienced child and family health nurses were interviewed. A detailed description of a postnatal psychosocial assessment process was obtained using a critical incident technique. Template analysis was used to determine the information domains the nurses accessed, and content analysis was used to determine the nurses' thinking strategies, to make clinical decisions from this assessment. RESULTS: The nurses described 24 domains of information and used 17 thinking strategies, in a variety of combinations. The four information domains most commonly used were parenting, assessment tools, women-determined issues and sleep. The seven thinking strategies most commonly used were searching for information, forming relationships between the information, recognising a pattern, drawing a conclusion, setting priorities, providing explanations for the information and judging the value of the information. CONCLUSION: The variety and complexity of the clinical decision-making involved in postnatal psychosocial assessment confirm that the nurses use information appropriately and within their scope of nursing practice. The standard of clinical decision-making determines the results of the assessment and the optimal access to care. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the information domains and the decision-making strategies that experienced nurses use for psychosocial assessment potentially improves practice by providing a framework for education and mentoring.

Effect of VAPE about mother and infant health on knowledge among primary caregivers of patients with postpartum psychiatric illness:- A pre-experimental study.

Post partum psychiatric illnesses are quiet common nowadays, which can interfere with postnatal care of both mother and infant. The present study was a one group pre-test - post-test design, adopted with an aim to enhance the knowledge on mother infant health among primary caregivers of mothers with postpartum psychiatric illnesses conducted in the mother-baby unit, NIMHANS, Bengaluru. Twenty five subjects who met the inclusion criteria were recruited through convenience sampling. After the pilot study, data was collected with a researcher developed tool. The Video Assisted Psycho-Education [VAPE] consisted of three sessions lasting for thirty minutes, taken over three consecutive days following the pre-test. Post-test was done immediately after the last session. Effectiveness of the intervention was established by McNemar test, Paired t-test and Wilcoxon Sign Ranks test. Analysis revealed statistically significant (p<0.001) increase in the post-test mean knowledge scores following the VAPE sessions. There was no statistically significant association between the pre-intervention knowledge score and the socio-demographic variables of the study subjects. The study findings revealed that the VAPE programme was effective in increasing the knowledge of the primary caregivers on mother infant health.

Identification and assessment of intimate partner violence in nurse home visitation.

AIMS AND OBJECTIVES: To develop strategies for the identification and assessment of intimate partner violence in a nurse home visitation programme. BACKGROUND: Nurse home visitation programmes have been identified as an intervention for preventing child abuse and neglect. Recently, there is an increased focus on the role these programmes have in addressing intimate partner violence. Given the unique context of the home environment, strategies for assessments are required that maintain the therapeutic alliance and minimise client attrition. DESIGN: A qualitative case study. METHODS: A total of four Nurse-Family Partnership agencies were engaged in this study. Purposeful samples of nurses (n = 32), pregnant or parenting mothers who had self-disclosed experiences of abuse (n = 26) and supervisors (n = 5) participated in this study. A total of 10 focus groups were completed with nurses: 42 interviews with clients and 10 interviews with supervisors. The principles of conventional content analysis guided data analysis. Data were categorised using the practice-problem-needs analysis model for integrating qualitative findings in the development of nursing interventions. RESULTS: Multiple opportunities to ask about intimate partner violence are valued. The use of structured screening tools at enrolment does not promote disclosure or in-depth exploration of women's experiences of abuse. Women are more likely to discuss experiences of violence when nurses initiate nonstructured discussions focused on parenting, safety or healthy relationships. Nurses require knowledge and skills to initiate indicator-based assessments when exposure to abuse is suspected as well as strategies for responding to client-initiated disclosures. CONCLUSION: A tailored approach to intimate partner violence assessment in home visiting is required. RELEVANCE TO CLINICAL PRACTICE: Multiple opportunities for exploring women's experiences of violence are required. A clinical pathway outlining a three-pronged approach to identification and assessment was developed.

Assessment and Care of Childbearing Women With Severe and Persistent Mental Illness.

Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians. This article provides an overview of SPMI during pregnancy and challenges for clinicians, including early identification, accuracy of diagnoses, and appropriate management through care coordination among an interdisciplinary team that includes obstetric providers, psychiatrists, nurses, and others.

Group A Streptococcal Infection in Pregnancy and the Puerperium.

There has been an increasing incidence worldwide of invasive group A streptococcal disease in pregnancy and the puerperal period over the past 30 years. Group A Streptococcus (GAS) was identified as the major cause of maternal morbidity and mortality from sepsis before the identification that hand washing techniques could prevent the transmission of the bacteria. Hand washing remains the cornerstone of prevention as transmission can occur directly from an asymptomatic colonized healthcare provider, other patients, or a community-acquired source. Pregnancy and the puerperal period are associated with significant maternal physiologic changes that must be identified and clarified to identify signs and symptoms of GAS so that treatment can be initiated at the earliest moment. Treatment of group A streptococcal sepsis follows the guidelines developed under the Surviving Sepsis Campaign model. Maternal outcomes are improved by identifying risk factors and working with the perinatal team to implement rapid intervention. Even with prompt treatment of invasive group A Streptococcus, it remains the most common cause of infection that results in severe maternal morbidity and death in the world.

Frequency, severity and persistence of postnatal dyspareunia to 18 months post partum: A cohort study.

OBJECTIVE: to describe the frequency, severity and persistence of dyspareunia in the first 18 months after the birth of a first child. DESIGN: prospective pregnancy cohort study. SETTING: Melbourne, Victoria, Australia. POPULATION: 1507 nulliparous women. METHODS: women ≤24 weeks gestation were recruited from six public hospitals. Self-administered written questionnaires were completed at recruitment and at three, six, 12 and 18 months post partum. OUTCOME MEASURES: study-designed self-report measure of dyspareunia on first vaginal sex, and on second and subsequent sex at all time-points, utilising the rating scale from the McGill Pain Intensity Scale. FINDINGS: overall, 961/1122 (85.7%) of women experienced pain on first vaginal sex postnatally. The proportion of women experiencing dyspareunia reduced over time, from 431/964 (44.7%) at three months post partum to 261/1155 (22.6%) at 18 months post partum. Of the women who reported dyspareunia at each time-point, around 10% of women described the pain as׳distressing׳,׳horrible׳ or׳excruciating׳. Women who had a caesarean section were more likely to report more intense dyspareunia at six months post partum (aOR=2.35, 95% CI=1.2-4.6). CONCLUSIONS: postnatal dyspareunia decreases over time, but persists beyond 12 months for one in five women. Caesarean section appears to be associated with more intense dyspareunia.

Posttraumatic Stress Disorder After Birth: A Metaphor Analysis.

PURPOSE: Nine percent of mothers screened positive for meeting the diagnostic criteria for posttraumatic stress disorder (PTSD) due to childbirth in a recent study of childbearing women in the United States. The purpose of this study was to analyze the language used by mothers experiencing PTSD after traumatic birth for metaphors as a rich source of insight into this mental illness for maternal-child nurses. STUDY DESIGN AND METHODS: A secondary analysis was conducted of the corpus of 124 typed pages from the primary qualitative study of women's experiences of PTSD following traumatic childbirth. The Pragglejaz Group's metaphor identification procedure was the method used for identifying metaphorically used words in the mothers' discourse. RESULTS: Nine metaphors emerged. These metaphors portray PTSD due to childbirth as a mechanical robot, a ticking time bomb, an invisible wall, a video on constant reply, enveloping darkness, a dangerous ocean, a thief in the night, a bottomless abyss, and suffocating layers of trauma. CLINICAL IMPLICATIONS: Metaphors that mothers used to describe their experiences of PTSD following a traumatic birth provide rich insight for maternal-child nurses. These metaphors give a new voice to women's experiences of PTSD and are a perfect match for a valuable source for nurses' evidence-based practice.

Sleep, Depression, and Fatigue in Late Postpartum.

PURPOSE: To study the relation of infant characteristics and home environment on maternal sleep, depression, and fatigue in late postpartum. STUDY DESIGN AND METHODS: Forty-two healthy mother-infant dyads completed a home-based study at infant age 32 weeks. Maternal measures included Patient Reported Outcomes Measurement Information System (PROMIS) sleep and wake disturbance, depression, and fatigue scales. Home regularity was assessed using the Confusion, Hubbub, and Order Scale (CHAOS). Infant sleep and regulation were measured respectively by the Brief Infant Sleep Questionnaire (BISQ) and Infant-Toddler Symptom Checklist (ITSC). RESULTS: Significant correlations among maternal sleep and wake disturbance, fatigue, and depression were detected (r = .519 to .746, p < .01), but not with infant variables. Home regularity was significantly related with maternal variables (r = .597 to .653, p < .01). CLINICAL IMPLICATIONS: Regularity of the home environment appears to contribute to maternal sleep, depression, and fatigue. Implications for intervention include establishment of daily routines and household management to improve regularity and consequently improve maternal outcomes.

Effect of auricular acupressure for postpartum insomnia: an uncontrolled clinical trial.

AIMS AND OBJECTIVES: This study examined the effects of auricular acupressure therapy on women with postpartum insomnia. BACKGROUND: Postpartum women generally have poor sleep quality because of frequent night-time breastfeeding during the first month after giving birth. DESIGN: A one-group pretest/post-test quasi-experiment was conducted. METHODS: A convenience sampling method was used to recruit participants at a postpartum centre (doing-the-month centre) in Northern Taiwan, from January 2014-July 2014. Thirty women with postpartum insomnia received auricular acupressure therapy on one auricular point (Shenmen point pressing) four times a day for 14 days. The Chinese version of the Pittsburgh Sleep Quality Index was used to assess sleep quality before and after the 14-day treatment. RESULTS: After the 14-day auricular acupressure treatment, the Pittsburgh Sleep Quality Index total scores of the women decreased from 8·7 (pretest) to 5·57 (post-test, 36% reduction). Scores on the subscales of the Pittsburgh Sleep Quality Index, including sleep quality, sleep latency, sleep duration and sleep disturbance, also statistically improved (p < 0·05). CONCLUSIONS: Hormone changes and frequent breastfeeding were identified as characteristics that may exacerbate poor sleep quality of postpartum women, for whom the auricular acupressure intervention may effectively improve sleep quality. RELEVANCE TO CLINICAL PRACTICE: Auricular acupressure can be an alternative complementary therapy to aid postpartum women with insomnia in improving sleep quality.

Puerpério e suas vivências como um processo de transição à luz da teoria de Afaf Meleis / Postpartum and their experiences as a process of transition to the theory of Afaf Meleis

Meleis (2000) afirma que a gestação, o parto e o puerpério devem ser vistos como processos de transição desenvolvimental e situacional que requerem uma definição ou redefinição dos papéis a que o cliente ou familiar está envolvido. As demandas de cuidado de enfermagem para essas mulheres vão além das questões biológicas, a enfermeira obstetra deve dar ouvidos às demandas que as puérperas apresentam, a fim de facilitar o processo de transição no puerpério. Diante do exposto, este estudo tem por objeto o puerpério como um processo de transição. Objetivos: Descrever as vivências das mulheres no processo de transição puerperal; Analisar as vulnerabilidades que surgem nesse processo; Sugerir um modelo de cuidado de enfermagem a mulheres que estejam vivenciando o processo de transição puerperal à luz da Teoria das Transições de Afaf Meleis. Metodologia: A pesquisa foi um estudo do tipo descritivo e exploratório com abordagem qualitativa. Os participantes desta pesquisa foram mulheres que passaram por um parto normal e consequentemente vivenciaram a experiência do puerpério. Decidiu-se utilizar o método Narrativa de Vida e a análise temática. Este estudo respeitou os princípios éticos conforme preconizado na Resolução CNS-466/12. Resultados e discussão: A maternagem é um fenômeno do processo de transição puerperal, que traz consigo vivências tais como sentir-se mais responsável após o nascimento do bebê; abrir mão de suas necessidades em prol do bebê; a amamentação, com suas vivências positivas e negativas; sentimento de posse pelo bebê; e (re)sigificação do corpo; a maternagem apareceu como um indicador de processo. Esta pesquisa demonstrou que o puerpério põe a mulher em situação de vulnerabilidade e estes são fatores de inibição para uma transição saudável, são as vulnerabilidades sociais e individuais.

Meleis (2000) states that pregnancy, childbirth and the postpartum period should be viewed as developmental and situational transition processes that require a definition or redefinition of the roles that the client or family is involved. The nursing care demands for these women go beyond biological questions, the midwife must heed the demands that mothers can have in order to facilitate the transition process in the postpartum period. Given the above, this study is engaged in the postpartum period as a transition. Objectives: To describe the experiences of women in the puerperal transition process; Analyze the vulnerabilities that arise in this process; Suggest a nursing model of care to women who are experiencing the puerperal transition process in the light of the theory of transitions Afaf Meleis Methodology: The research was a descriptive and exploratory study with a qualitative approach. The subjects were women who had a vaginal delivery and therefore experienced the postpartum experience. It was decided to use the Life History method and thematic analysis. This study complied with the ethical principles as recommended in Resolution CNS-466/12 (BRAZIL, MS, 2012). Results and discussion: The mothering is a phenomenon of puerperal transition process that brings experiences such as feeling more responsible after the baby's birth; give up their needs for the sake of the baby; breastfeeding, with their positive and negative experiences; sense of ownership for the baby; and (re)significance of the body; the mothering appeared as a process indicator. This research demonstrated that postpartum puts women in vulnerable situations and these are inhibiting factors for a healthy transition, they are the social and individual vulnerabilities.

Mental illness in pregnancy: midwives supporting women and safeguarding babies.

The relationship between parental mental illness and safeguarding concerns is well documented. The role of the midwife in supporting women with mental health problems can sometimes be a balancing act, especially when perinatal mental health services are few and far between. The midwife needs to be able to remain objective with regards to safeguarding and be proactive in instigating early help assessments. There should be organised joint working within a multi disciplinary team including social workers and psychiatric nurses which addresses the needs of both mother and baby. This can lead to a less problematic handover to health visiting services. Continuity of care and an open honest approach will be instrumental in providing a supportive relationship that doesn't lose sight of the baby.

Perineal pain in focus: reviewing topical anaesthetic treatments.

Midwives have opportunities to help postnatal mothers to minimise perineal discomfort associated with perineal trauma following vaginal birth. Perineal trauma and associated pain is common and can have a negative impact on the physical, psycho-social transition to motherhood and family life. This article considers the role local anaesthetic agents have in helping women to relieve perineal pain. Key evidence is presented with associated practice considerations, and future research areas are suggested to broaden our understanding of this important aspect of postnatal care.

Mind the gap: diastasis of the rectus abdominis muscles in pregnant and postnatal women.

This article looks at the abdominal physiology of pregnant and postnatal women, the incidence of diastasis recti abdominis and the possible risk factors for this condition. The longer-term implications of this condition, the effects of exercise, indicators for referral and future pregnancies are discussed. Key practice points and resources for midwives and women are offered.