First week of integral health for the newborn: nursing actions of the Family Health Strategy. / Primeira semana saúde integral do recém-nascido: ações de enfermeiros da Estratégia Saúde da Família.

OBJECTIVE: To describe the nurses' actions of the Family Health Strategy about the First Week for Integral Health regarding the care devoted to the newborn. METHOD: It is a descriptive, exploratory research with qualitative approach carried out from October 2014 to February 2015, through a semi-structured interview, with nine nurses from the Family Health Strategy of João Pessoa-PB. Data were submitted to thematic analysis. RESULTS: The actions identified at the first visit to the newborn child are based on maternal guidance on basic newborn care, breastfeeding, neonatal screening, immunization and childcare, as well as evaluation of the puerperal, but it was sometimes performed outside the period recommended and with incomplete and outdated guidelines. CONCLUSION: Although there are potentialities in nurses' actions to this population, the fragilities compromise the care of the newborn and the puerperium, and it is necessary to sensitize these professionals about the importance and effectiveness of First Week for Integral Health.

Primeira semana saúde integral do recém-nascido: ações de enfermeiros da Estratégia Saúde da Família / Primera semana salud integral del recién-nacido: acciones de enfermeros de la Estrategia Salud de la Familia / First week of integral health for the newborn: nursing actions of the Family Health Strategy

Resumo OBJETIVO Descrever as ações de enfermeiros da Estratégia Saúde da Família acerca da Primeira Semana Saúde Integral no cuidado ao recém-nascido. MÉTODO Pesquisa descritiva, exploratória com abordagem qualitativa realizada de outubro de 2014 a fevereiro de 2015, por meio de entrevista semiestruturada, com nove enfermeiros da Estratégia Saúde da Família de João Pessoa-PB. Os dados foram submetidos à análise temática. RESULTADOS As ações identificadas na primeira visita ao bebê se baseiam nas orientações maternas acerca dos cuidados básicos ao recém-nascido, aleitamento materno, testes de triagem neonatal, imunização e puericultura, bem como avaliação da puérpera, no entanto, por vezes eram realizadas fora do período recomendado e com orientações incompletas e desatualizadas. CONCLUSÃO Embora haja potencialidades nas ações dos enfermeiros prestadas a essa população, as fragilidades comprometem a assistência ao neonato e à puérpera, sendo necessário sensibilizar esses profissionais acerca da importância e eficácia da Primeira Semana Saúde Integral.

Resumen OBJETIVO Describir las acciones de enfermeros de la Estrategia Salud de la Familia acerca de la Primera Semana Salud Integral en la atención al recién-nacido. MÉTODO Investigación descriptiva, exploratoria con abordaje calitativo, realizada de octubre de 2014 hacia febrero de 2015, por medio de entrevista semiestructurada, con nueve enfermeros de la Estrategia Salud de la Familia de João Pessoa-PB. Los datos fueron sometidos al análisis temático. RESULTADOS Las acciones identificadas en la primera visita al bebé se basan en las orientaciones maternas sobre los cuidados básicos al recién nacido, la lactancia materna, las pruebas de selección neonatal, la inmunización y la puericultura, así como la evaluación de la puérpera, pero a veces se realizaban fuera del período recomendado y con directrices incompletas y obsoletas. CONCLUSIÓN Aunque hay potencialidades en las acciones de los enfermeros prestadas a esa población, las fragilidades comprometen la asistencia al neonato y a la puérpera, siendo necesario sensibilizar a esos profesionales acerca de la importancia y eficacia de la Primera Semana Salud Integral.

Abstract OBJECTIVE To describe the nurses' actions of the Family Health Strategy about the First Week for Integral Health regarding the care devoted to the newborn. METHOD It is a descriptive, exploratory research with qualitative approach carried out from October 2014 to February 2015, through a semi-structured interview, with nine nurses from the Family Health Strategy of João Pessoa-PB. Data were submitted to thematic analysis. RESULTS The actions identified at the first visit to the newborn child are based on maternal guidance on basic newborn care, breastfeeding, neonatal screening, immunization and childcare, as well as evaluation of the puerperal, but it was sometimes performed outside the period recommended and with incomplete and outdated guidelines. CONCLUSION Although there are potentialities in nurses' actions to this population, the fragilities compromise the care of the newborn and the puerperium, and it is necessary to sensitize these professionals about the importance and effectiveness of First Week for Integral Health.

Maternal Experiences of Their Unborn Child's Spiritual Care: Patterns of Abstinence in Iran.

Preparing for pregnancy and childbirth has significant association with spirituality. Review of the literature shows that the spirituality of the "unborn child" has not yet attracted much critical attention. This study was conducted with the aim of exploration of maternal behaviors associated with the spiritual health of the unborn child. A qualitative approach was used to investigate the research question. Twenty-seven in-depth unstructured interviews were conducted with 22 Iranian mothers in Tehran city (Iran) who were pregnant or had experienced pregnancy in 2012-2013. Data analysis was carried out using a conventional content analysis approach. "Refusing to eat forbidden food," "Overcoming mental adversity," "Regulating one's social interactions," "Preventing the effects of harmful environments on the senses," "Avoidance of using insulting and abusive language," "Keeping one's mind and spirit free from evil traits," and "Refraining from damaging behaviors" were important experiences that the mothers used for "Holistic Abstinence." The results provide new information about the subjective experiences of Iranian women on the patterns of abstinence for the midwives, research community, policy makers, and planners of maternal and child health care services in order to contribute to holistic, culturally, and religiously competent prenatal care for Muslim pregnant women throughout the world.

Organisation of emergency transfer in maternity care in the Netherlands.

OBJECTIVE: to gain more insight in the perceptions and experiences of care providers and clients with the organisation of emergency transfer in maternity care, with regard to transportation, responsibilities and communication between caregivers. BACKGROUND: in the Netherlands a woman with an uncomplicated pregnancy can choose to give birth at home, assisted by her own midwife. However, when complications arise, she needs to be referred to a hospital. In case of an emergency this referral must be effectuated quickly, often with ambulance support. DESIGN: a mixed methods' study consisting of semi-structured interviews and surveys. METHODS: qualitative data of the current organisation of emergency transfer in maternity care, including experiences of caregivers were collected through 21 semi-structured interviews. On the basis of the qualitative data questionnaires for a survey were developed. These questionnaires were sent to 181 caregiver organisations and an unknown number of clients. The response among caregivers was 108 (60%), the response among clients was 42. FINDINGS: the overall result from the interviews as well as from the questionnaires is that at the personal level cooperation is often adequate, but mostly informal. Care providers from different professions explained in the study that in emergency situations they usually know how to find each other but they are not always aware of existing agreements or protocols, are unsure of each other's competencies and do not always know what to expect from other care providers. Looking back at their experiences the majority of the clients responded that they were taken very good care of at the hospital. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: because transfer of care from one care provider to another during labour or birth is not unusual in the Dutch maternity care system it is necessary for care providers involved in this transfer to know and trust each other, to be able to give an adequate reaction when needed. Recommendations given are to devise a protocol for midwives when calling an ambulance dispatch centre, to improve the knowledge about each other, for instance by providing combined courses for emergency obstetrics, preferably at the regional level, so people who actually may work together can train together, and to improve the referral process from midwife to obstetrician.

The high impact actions for nursing and midwifery 8: ready to go--no delays.

In recent years, discharge initiatives that aim to free up hospital beds have become commonplace. However, new systems, such as bed management, have left many nurses feeling disengaged from the management of patient admission and discharge. They feel pressurised into speeding up discharge by the increasing focus on bed capacity and patient turnover, which can make them feel distanced from their primary role of caring for patients. Although new roles and initiatives can be valuable, changing the way nurses engage with discharge is key. Ensuring that the process is nurse led will lead to a faster discharge and less frustration for patients who are waiting to go home. This article, the last in our series on the high impact actions for nursing and midwifery, looks at how nursing staff can respond to the issue of discharge planning.

From 'postnatal depression' to 'perinatal anxiety and depression': key points of the National Perinatal Depression Plan for nurses and midwives in Australian primary health care settings.

BACKGROUND: Perinatal anxiety and depression constitute one of the long term major public health issues in Australia and for too long they has been bundled under the over-arching term of 'postnatal depression'. However, the generation, funding, and implementation of the National Perinatal Depression Plan (NPDP) (Australian Government Department of Health and Ageing, 2008), across all Australian States and Territories, are proving to be wide-reaching and influential. Not only does the NDPD move from the umbrella term of 'postnatal depression' to establish the reality of perinatal anxiety and depression which women can experience from conception to the first year of the infant's life but also all States and Territories have made Individual Investment Plans for the implementation of the NPDP. IMPLEMENTATION: In these Investment Plans, each State and Territory will address the following three major goals of the NPDP differently and mainly within a primary health care setting: (1) Psychosocial assessment in addition to screening of women antenatally and postnatally; (2) Education of health professionals about the complexity of perinatal depression and the need for early assessment and intervention; (3) Development of quality pathways of care for follow-up support and care of women who are depressed and who are assessed as being at the risk for depression. IMPLICATIONS FOR NURSES AND MIDWIVES: General nurses, maternal child health nurses, midwives, and mental health nurses are spread throughout primary health care settings. Three essential aspects of the NPDP are pertinent to their practice: (1) the Edinburgh Postnatal Depression Scale (EPDS); the 2008 beyondblue National Action Plan for Perinatal Mental Health (NAP); and the Draft beyondblue Clinical Practice Guidelines for depression and related disorders - anxiety, bipolar disorder, and puerperal psychosis - in the perinatal period (March 2010). The author addresses these three aspects of the NPDP by citing two personal accounts by women who have experienced perinatal anxiety and depression; these accounts are available in the public domain.

The impact of choice of maternity care on psychological health outcomes for women during pregnancy and the postnatal period.

RATIONALE: Psychological factors are acknowledged to impact on pregnancy, birth, neonatal outcomes and maternal mental health. The importance of psychological well-being is now recognized within maternity care and UK maternity policy advocates choice and control, equating this to increased quality of experience and improved psychological outcomes. There remains, however, lack of substantive and consistent evidence with regard to the psychological benefits of choice in maternity care. The aim of this study is to investigate the impact of choice of maternity care on psychological health outcomes. METHODS: 165 antenatal women were recruited and sampled according to their choices for care. Women were assessed utilizing the Hospital Anxiety and Depression Scale (HADS), Edinburgh Postnatal Depression Scale (EPDS), Cambridge Worry Scale (CWS), Multidimensional Health Locus of Control (MHLC), SF-36, Pittsburgh Sleep Quality Index (PSQI) and Culture Free Self-esteem Inventory (CFSEI) at 12 and 32 weeks pregnant and 14 days and 6 months postnatal. RESULTS: No significant differences between groups were revealed on any of the scales or subscales measured. Significant and corresponding differences were identified within groups over time for CWS socio-medical worries, MHLC 'powerful others', SF-36 bodily pain, vitality personal health and change in health, PSQI global sleep. An interaction effect for CFSEI general and social self-esteem was revealed between birth centre and midwifery-led care/main unit women at 14 days postnatal. CONCLUSIONS: These results demonstrate that pregnancy represents a psychological challenge regardless of care type chosen and choice of no one care option confers greater psychological benefit across the maternity experience as a whole. It is possible, however, that differences in experience or environment at critical times can affect psychological status.

The crisis in human resources for health care and the potential of a 'retired' workforce: case study of the independent midwifery sector in Tanzania.

The human resource crisis in health care is an important obstacle to attainment of the health-related targets for the Millennium Development Goals. One suggested strategy to alleviate the strain upon government services is to encourage new forms of non-government provision. Detail on implementation and consequences is often lacking, however. This article examines one new element of non-government provision in Tanzania: small-scale independent midwifery practices. A multiple case study analysis over nine districts explored their characteristics, and the drivers and inhibitors acting upon their development since permitted by legislative change. Private midwifery practices were found concentrated in a 'new' workforce of 'later life entrepreneurs': retired, or approaching retirement, government-employed nursing officers. Provision was entirely facility-based due to regulatory requirements, with approximately 60 'maternity homes' located mainly in rural or peri-urban areas. Motivational drivers included fear of poverty, desire to maintain professional status, and an ethos of community service. However, inhibitors to success were multiple. Start-up loans were scarce, business training lacking and registration processes bureaucratic. Cost of set-up and maintenance were prohibitively high, registration required levels of construction and equipping similar to government sector dispensaries. Communities were reluctant to pay for services that they expected from government. Thus, despite offering a quality of basic maternity care comparable to that in government facilities, often in poorly-served areas, most private maternity homes were under-utilized and struggling for sustainability. Because of their location and emphasis on personalized care, small-scale independent practices run by retired midwives could potentially increase rates of skilled attendance at delivery at peripheral level. The model also extends the working life of members of a professional group at a time of shortage. However, the potential remains unrealized. Successful multiplication of this model in resource-poor communities requires more than just deregulation of private ownership. Prohibitive start-up expenses need to be reduced by less emphasis on facility-based provision. On-going financing arrangements such as micro-credit, contracting, vouchers and franchising models require consideration.