Psychometrics of the breastfeeding self-efficacy scale and short form: a systematic review.

BACKGROUND: The Breastfeeding Self-Efficacy Scale and its short-form were developed in Canada and have been used internationally among numerous maternal populations. However, the psychometric properties of the scales have not been reviewed to confirm their appropriateness in measuring breastfeeding self-efficacy in culturally diverse populations. The purpose of this research was to critically appraise and synthesize the psychometric properties of the scales via systematic review. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Three databases (EMBASE, MEDLINE, and PsycINFO) were searched from 1999 (original publication of the Scale) until April 27, 2022. The search was updated on April 1, 2023. Studies that assessed the psychometric properties of the BSES or BSES-SF were included. Two researchers independently extracted data and completed the quality appraisals. RESULTS: Forty-one studies evaluated the psychometrics of the BSES (n = 5 studies) or BSES-SF (n = 36 studies) among demographically or culturally diverse populations. All versions of the instrument demonstrated good reliability, with Cronbach's alphas ranging from .72 to .97. Construct validity was supported by statistically significant differences in mean scores among women with and without previous breastfeeding experience and by correlations between the scales and theoretically related constructs. Predictive validity was demonstrated by statistically significant lower scores among women who ultimately discontinued breastfeeding compared to those who did not. CONCLUSION: The BSES and BSES-SF appear to be valid and reliable measures of breastfeeding self-efficacy that may be used globally to (1) assess women who may be at risk of negative breastfeeding outcomes (e.g., initiation, duration and exclusivity), (2) individualize breastfeeding support, and (3) evaluate the effectiveness of breastfeeding interventions.

Postpartum Depression Screening Scale: Its Availability for Use.

OBJECTIVE: A silent health crisis in the United States is the underdiagnosed and undertreated mental health of women related to childbirth. This discussion paper describes the Postpartum Depression Screening Scale (PDSS) with its scoring and interpretation along with its psychometric testing and translations. METHOD: In addition to the studies conducted by the instrument developers, databases were searched for studies where other researchers used the PDSS to assess postpartum depressive symptoms. Studies were included that measured the psychometrics of the scale and studies that reported the translation of the PDSS into other languages. RESULTS: Evidence is presented that the PDSS is a reliable and valid screening scale for use by psychiatric mental health nurses and other health care providers. The scale also has been translated into 14 languages, so it is available to screen non-English speaking mothers. CONCLUSION: Childbirth is one of the most powerful triggers of psychiatric illness in a woman's life. Postpartum depression is a treatable mental health condition, but first, women need to be screened so they can be identified and referrals made. Screening for this devastating mood disorder in new mothers is an essential role of psychiatric mental health nurses and other clinicians so that treatment can be started as early as possible to avoid harmful consequences.

Lexicon of Metaphors: An Innovative Approach to Detect the Aftermath of Traumatic Childbirth.

An innovative approach to help mental health providers identify individuals who may be struggling with the aftermath of birth trauma is to become vigilant in listening for metaphors women may use to describe how they have been feeling. Metaphors can provide a safe bridge for individuals to share and work through painful and challenging feelings. This lexicon of metaphors has four sections: impact birth trauma had on breastfeeding, impaired mother-infant interaction, anniversary of birth trauma, and subsequent childbirth. Examples of these metaphors include empty affair, head in a vise, short fuze, severed ties, great pretender, and mental baggage.

The experience of the nurse during the COVID-19 pandemic: A global meta-synthesis in the year of the nurse.

PURPOSE: From its beginnings in China in December of 2019, the novel coronavirus COVID-19 spread and quickly became the center of nursing care and conversation across the globe (WHO, 2020). This meta-ethnographic study was conducted in order to provide the profession of nursing interpretative explanations of a common experience during the care of patients with COVID-19. DESIGN AND METHOD: A literature review focused on the experience of the nurse during the COVID-19 pandemic revealed a total of 13 qualitative studies conducted in China, Spain, Turkey, Iran, Brazil, and the United States. A meta-ethnographic review of these qualitative works, using the method of Noblit and Hare, was then conducted which revealed the experience of the nurse across the globe during the COVID-19 pandemic. FINDINGS: The review revealed strong similarities between the experiences of the nurse across the 13 studies. Given this reciprocal relationship, translations were constructed and synthesized until four new themes emerged outlining the global experience of the nurse during the COVID-19 pandemic. CONCLUSIONS: Despite the differences between the structures of healthcare and government of the six countries represented in this meta-ethnography, the experience of the nurse emerged into a narrative shared by those represented in this study. As the profession of nursing continues to work through ongoing waves of COVID-19, these results will help guide the resources and training provided to nurses on the frontline of care. CLINICAL RELEVANCE: Despite great personal risk, nurses across the globe stepped up to the challenge of upholding and improving the health of the world's people during the COVID-19 pandemic. As health policy, education, and system leaders, we must listen to the common experience revealed in this meta-synthesis and respond by providing the resources needed to improve nursing practice and care.

Postpartum Depression: A Metaphorical Analysis.

BACKGROUND: The reported incidence of postpartum depression in healthy women without a history of depression was 12%, and the prevalence was 17%. A silent health crisis in America is the undiagnosed and untreated mental health of women related to childbirth. Unfamiliar with medical terminology, persons may communicate more effectively by means of metaphors to describe what they are experiencing. AIMS: To examine the language women used to describe their experiences of postpartum depression with metaphors that can provide a valuable source of insight for psychiatric nurses and other clinicians. METHODS: Secondary qualitative data analysis of three primary datasets of postpartum depression was conducted. Metaphor identification procedure was the approach used to analyze the texts for metaphorical expressions. RESULTS: Eleven metaphors were identified that women used to help explain their postpartum depression: being hit by a ton of bricks, being a tightrope walker, living in a nightmare, feeling trapped, being in the middle of the sea, feeling like an alien, being a loner, being a basket case, having cobwebs in the brain, feeling like garbage, and hitting rock bottom. CONCLUSIONS: These 11 metaphors provide a new voice for women's experiences of postpartum depression. As a result, they provide rich insights for psychiatric nurses and other clinicians to help identify women struggling with postpartum depression.

Postpartum onset of panic disorder: A metaphor analysis.

Prevalence rates of postpartum panic disorder range from 0.5% to 2.9%. New mothers may not know the medical terminology to describe what they are experiencing. Metaphors can provide women with a different voice to help provide a basis for shared understanding with clinicians. The purpose of this secondary qualitative data analysis was to examine the metaphors used by women to describe their panic disorder after birth. Metaphor Identification Procedure was used to analyze the primary dataset. The process revealed the following eight metaphors: caged animal, Coke in my veins, bone-tired, imposter, escape artist, magnifying glass, detective, and hermit.

Subsequent Childbirth After a Previous Birth Trauma: A Metaphor Analysis.

Minimizing the risk of women experiencing a subsequent birth as another traumatic event needs to be a priority for psychiatric-mental health nurses. One approach to identifying women struggling with a subsequent pregnancy is to be attentive to metaphors women use to describe what they are experiencing. The purpose of this secondary qualitative data analysis was to identity the metaphorical expressions women use to describe a subsequent birth after a prior birth trauma. The following five metaphors identified paint a vivid picture of what women experienced: a head buried in the sand, mental baggage, emotional torture, waves of panic, and a back and forth battle. Being knowledgeable about metaphors childbearing women use during a pregnancy following a previous birth trauma can help clinicians to recognize struggling mother-infant dyads and to initiate appropriate interventions. Necessary referrals can be made to psychiatric-mental health nurse practitioners.

Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis.

OBJECTIVE: The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores ≥7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 ≥7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID). METHODS: We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 ≥7, pooled SCID major depression prevalence, and the pooled difference in prevalence. RESULTS: A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 ≥7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times. CONCLUSIONS: Prevalence estimated based on EPDS-5 ≥7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence.

Vicarious Posttraumatic Growth in NICU Nurses.

BACKGROUND: When posttraumatic growth occurs in clinicians as a result of their caring for patients and families who are traumatized, it is termed vicarious posttraumatic growth. PURPOSE: (1) To determine the level of vicarious posttraumatic growth and the disruption of core beliefs in neonatal intensive care unit (NICU) nurses who have cared for critically ill infants and their families. (2) To explore those quantitative findings through nurses' qualitative descriptions of their growth. METHODS: A mixed method with a convergent parallel design was used to address the study aims. A targeted sample of neonatal nurses was recruited from the National Association of Neonatal Nurses (NANN) through the MyNANN Community message board. The sample consisted of 109 NICU nurses who completed the quantitative strand and 61 (55%) who completed the qualitative strand. Nurses completed the Posttraumatic Growth Inventory, the Core Beliefs Inventory, and described their experiences of any positive changes in their beliefs or life as a result of caring for critically ill infants. IBM SPSS 25.0 and Krippendorff's content analysis were used to analyze the quantitative and qualitative data, respectively. RESULTS: NICU nurses reported a moderate degree of vicarious posttraumatic growth and disruption of their assumptive world. Appreciation of Life was the Posttraumatic Growth Inventory dimension that reflected the highest growth and Spiritual Change the lowest. IMPLICATIONS FOR PRACTICE: Providing posttraumatic growth interventions has the potential to help NICU nurses find meaning through their experience. IMPLICATIONS FOR RESEARCH: Future surveys need to include a higher response rate to generalize the findings. A video abstract is available.Video Abstract available at: https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=36.

Pentadic Cartography: Mapping Postpartum Psychosis Narratives.

Writing online narratives of postpartum psychosis allows both self-analysis and catharsis and can also be viewed as a type of sociopolitical expression. Eight narratives posted on the Action on Postpartum Psychosis website were analyzed using Burke's narrative analysis. This method focuses on a pentad of key elements of story: scene, act, purpose, agent, and agency. What drives this narrative analysis is the identification of problematic areas referred to as ratio imbalances between any two of these five terms. The ratio imbalance between Agent and Act appeared most often in these eight narratives. The agent was the mother and the act most often was either her hallucinations or delusions. The second most frequent area of tension was between Scene and Agent. Problematic scenes for the agent (mother) involved admission to the psychiatric ward, entering the electroconvulsive therapy room, or nighttime. These ratio imbalances pinpoint places where clinicians can target specific interventions.

Evaluation of Interprofessional Teaching Strategy for Nursing Students on Perinatal Trauma-Informed Care.

Little research exists on secondary traumatic stress for obstetric nurses and best educational strategies. Mixed-methods analysis was conducted to evaluate use of interprofessional panel debriefing to prepare nursing students for trauma-informed care. A pretest and posttest paired-samples design evaluated student experience and internalization of communication techniques. Students (n = 54) gained communication techniques from the learning activity; they felt simulations were realistic and applicable and described the learning activity as emotional with support from faculty. This innovative learning activity is a valuable teaching method and may be applicable to clinical agencies for new staff.

Secondary Traumatic Stress in Maternal-Newborn Nurses: Secondary Qualitative Analysis.

BACKGROUND: Secondary traumatic stress can be the cost for clinicians when caring for persons who have been traumatized. Secondary traumatic stress is a syndrome of symptoms similar to posttraumatic stress disorder (PTSD). AIMS: To conduct a secondary qualitative data analysis of three primary data sets of secondary traumatic stress in nurses. METHODS: Cross validation was the type of qualitative secondary analysis used to compare qualitative findings across these multiple data sets. In the three primary studies, the data were analyzed for themes. In this secondary qualitative analysis, a different defining unit was chosen. This time, the four categories of PTSD symptoms (intrusions, avoidance, arousal, and negative alterations in cognitions and mood) were used to analyze the data sets using content analysis. RESULTS: For all three groups of maternal-newborn nurses, the intrusions category was ranked first and the negative cognitions and mood category was ranked second. The remaining two symptom categories were where their rankings differed. The labor and delivery and neonatal intensive care unit nurses ranked arousal symptoms third and avoidance symptoms fourth. For the nurse-midwives, the rankings for these two categories were reversed. The neonatal intensive care unit nurses comprised the one group that did not report any avoidance symptoms. CONCLUSIONS: This secondary qualitative analysis confirmed the presence of PTSD symptoms that maternal-newborn nurses struggled with as a result of caring for either critically ill infants or women during traumatic births. Hospital preventive strategies and interventions for secondary traumatic stress in nurses are discussed.

Striatal neuronal death mediated by astrocytes from the Gcdh-/- mouse model of glutaric acidemia type I.

Glutaric acidemia type I (GA-I) is an inherited neurometabolic childhood disorder caused by defective activity of glutaryl CoA dehydrogenase (GCDH) which disturb lysine (Lys) and tryptophan catabolism leading to neurotoxic accumulation of glutaric acid (GA) and related metabolites. However, it remains unknown whether GA toxicity is due to direct effects on vulnerable neurons or mediated by GA-intoxicated astrocytes that fail to support neuron function and survival. As damaged astrocytes can also contribute to sustain high GA levels, we explored the ability of Gcdh-/- mouse astrocytes to produce GA and induce neuronal death when challenged with Lys. Upon Lys treatment, Gcdh-/- astrocytes synthetized and released GA and 3-hydroxyglutaric acid (3HGA). Lys and GA treatments also increased oxidative stress and proliferation in Gcdh-/- astrocytes, both prevented by antioxidants. Pretreatment with Lys also caused Gcdh-/- astrocytes to induce extensive death of striatal and cortical neurons when compared with milder effect in WT astrocytes. Antioxidants abrogated the neuronal death induced by astrocytes exposed to Lys or GA. In contrast, Lys or GA direct exposure on Gcdh-/- or WT striatal neurons cultured in the absence of astrocytes was not toxic, indicating that neuronal death is mediated by astrocytes. In summary, GCDH-defective astrocytes actively contribute to produce and accumulate GA and 3HGA when Lys catabolism is stressed. In turn, astrocytic GA production induces a neurotoxic phenotype that kills striatal and cortical neurons by an oxidative stress-dependent mechanism. Targeting astrocytes in GA-I may prompt the development of new antioxidant-based therapeutical approaches.

Secondary Traumatic Stress in NICU Nurses: A Mixed-Methods Study.

BACKGROUND: Secondary traumatic stress is an occupational hazard for healthcare providers who care for patients who have been traumatized. This type of stress has been reported in various specialties of nursing, but no study to date had specifically focused on neonatal intensive care unit (NICU) nurses. PURPOSE: (1) To determine the prevalence and severity of secondary traumatic stress in NICU nurses and (2) to explore those quantitative findings in more depth through nurses' qualitative descriptions of their traumatic experiences caring for critically ill infants in the NICU. METHODS: Members of NANN were sent e-mails with a link to the electronic survey. In this mixed-methods study, a convergent parallel design was used. Neonatal nurses completed the Secondary Traumatic Stress Scale (STSS) and then described their traumatic experiences caring for critically ill infants in the NICU. SPSS version 24 and content analysis were used to analyze the quantitative and qualitative data, respectively. RESULTS: In this sample of 175 NICU nurses, 49% of the nurses' scores on the STSS indicated moderate to severe secondary traumatic stress. Analysis of the qualitative data revealed 5 themes that described NICU nurses' traumatic experiences caring for critically ill infants. IMPLICATIONS FOR PRACTICE: NICU nurses need to know the signs of secondary traumatic stress that they may experience caring for their critically ill infants. Avenues for dealing with the stress should be provided. IMPLICATIONS FOR RESEARCH: Future research with a higher response rate to increase the external validity of the findings to the population of neonatal nurses is needed.

Caring for a Child With an Obstetric Brachial Plexus Injury: A Metaphor Analysis.

PURPOSE: The purpose of this study was to examine the metaphors used by mothers to describe their experiences caring for their children with obstetric brachial plexus injuries. DESIGN AND METHODS: A secondary qualitative data analysis was conducted from the primary data set of a phenomenological study of mothers' experiences caring for their children with obstetric brachial plexus injuries. The type of secondary qualitative data analysis approach used was analytic expansion. Metaphor Identification Procedure was used to analyze the corpus of 132 pages of typed transcription. RESULTS: This metaphorical analysis yielded seven metaphors mothers used to describe their experiences caring for their children with obstetric brachial plexus injuries. These metaphors portrayed mothers' lives as involving a heavy weight, a maze, a juggling act, a simmering pot, a dagger to the heart, a rollercoaster, and a constant battle. CONCLUSION: The seven metaphors helped women express what they could not completely capture using only medical jargon and provide valuable insight for clinicians. Using secondary qualitative data analysis to mine for any metaphors in a primary data set gives researchers another valuable and creative opportunity to discover new knowledge from the data they had previously collected. PRACTICE IMPLICATIONS: Specific interventions can be developed to target each of these seven metaphors to help mothers in their daily care for their children with obstetric brachial plexus injuries.

Posttraumatic Stress in Mothers Related to Giving Birth Prematurely: A Mixed Research Synthesis.

BACKGROUND: Globally the preterm birth rate for 184 countries in 2010 was 11.1%. Preterm births can be a traumatic experience for mothers. OBJECTIVE: This article provides a mixed research synthesis of the quantitative and qualitative studies on posttraumatic stress in mothers who have given birth prematurely. DESIGN: Narrative synthesis was the mixed research synthesis approach used. RESULTS: Included in this narrative synthesis were quantitative prevalence studies ( n = 19), quantitative intervention studies ( n = 6), and qualitative studies ( n = 5). Prevalence rates ranged from 14% to 79%. Four of the intervention studies had significant results and two did not. Qualitative data synthesis revealed five themes: (a) shocked and horrified, (b) consuming guilt, (c) pervasive anxiety and hypervigilance, (d) intrusive thoughts, and (e) numbing and avoiding reminders. CONCLUSIONS: Women's traumatic experiences of preterm birth are clearly important issues for psychiatric nurses to address.

Compassionate Care: Listening Visits Provided by Neonatal Intensive Care Unit Nurses.

PURPOSE: Although mothers of infants hospitalized in a neonatal intensive care unit (NICU) often experience clinically significant levels of depression symptoms, accessing mental-health treatment may be difficult. NICU mothers need emotional support that is conveniently delivered at the infant's point-of-care by a trusted professional who is knowledgeable about the medical and nursing care in the NICU. Listening Visits are an effective and accessible, nurse-delivered depression intervention, yet little is known about what mothers discuss during these sessions. This analysis of sessions recorded during the randomized controlled trial evaluation of Listening Visits in the NICU provides a glimpse into NICU mothers' concerns and experiences. STUDY DESIGN AND METHODS: This is a secondary, qualitative case analysis of the recorded Listening Visits sessions of four depressed NICU mothers as indicated by a score of 12 or above on the Edinburgh Postnatal Depression Scale. The mothers, who were all White, varied in their economic resources, educational level, availability of support, and infant illness severity. RESULTS: Mothers discussed similar concerns and experiences, often at analogous temporal points in the six Listening Visit sessions, as well as one common concern they voiced throughout: family and friends do not understand what it is like to have an infant in the NICU. CLINICAL IMPLICATIONS: For mildly to moderately depressed mothers of infants hospitalized in the NICU, Listening Visits provide a way for bedside nurses to deliver compassionate care by listening to mothers' concerns and experiences.

Postnatal parental education for optimizing infant general health and parent-infant relationships.

BACKGROUND: Many learning needs arise in the early postpartum period, and it is important to examine interventions used to educate new parents about caring for their newborns during this time. OBJECTIVES: The primary objective was to assess the effects of structured postnatal education delivered to an individual or group related to infant general health or care and parent-infant relationships. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013). SELECTION CRITERIA: We included randomized controlled trials of any structured postnatal education provided to individual parents or groups of parents within the first two months post-birth related to the health or care of an infant or parent-infant relationships. DATA COLLECTION AND ANALYSIS: Two review authors (JB, CTB) assessed trial quality and extracted data from published reports. MAIN RESULTS: Of the 27 trials (3949 mothers and 579 fathers) that met the inclusion criteria, only 15 (2922 mothers and 388 fathers) reported useable data. Educational interventions included: five on infant sleep enhancement, 12 on infant behaviour, three on general post-birth health, three on general infant care, and four on infant safety. Details of the randomization procedures, allocation concealment, blinding, and participant loss were often not reported. Of the outcomes analyzed, only 13 were measured similarly enough by more than one study to be combined in meta-analyses. Of these 13 meta-analyses, only four were found to have a low enough level of heterogeneity to provide an overall estimate of effect. Education about sleep enhancement resulted in a mean difference of 29 more night-time minutes of infant sleep in 24 hours at six weeks of age (95% confidence interval (CI) 18.53 to 39.73) than usual care. However, it had no significant effect on the mean difference in minutes of crying time in 24 hours at six weeks and 12 weeks of age. Education related to infant behaviour increased maternal knowledge of infant behaviour by a mean difference of 2.85 points (95% CI 1.78 to 3.91). AUTHORS' CONCLUSIONS: The benefits of educational programs to participants and their newborns remain unclear. Education related to sleep enhancement appears to increase infant sleep but appears to have no effect on infant crying time. Education about infant behaviour potentially enhances mothers' knowledge; however more and larger, well-designed studies are needed to confirm these findings.

Is there still gender bias in nursing research? An update.

Data from 300 studies published in four research journals in 2010-2011 were analyzed to assess whether nurse researchers continue to oversample females. One-third of the studies had samples that were 100% female and, on average, 74% of all study participants were female. As was found for studies published 5 years earlier, the bias against male participants was consistent across studies differing in methods, specialty areas, funding, and sample characteristics. Studies with male first authors, however, were significantly less likely to have biased samples. Authors of only 23.6% of studies with mixed-sex samples provided information about sex differences in outcomes. Because of gender bias, the evidence base for nursing practice may suffer from problems with generalizability.