Development and validation of the Cannabis Exposure in Pregnancy Tool (CEPT): a mixed methods study.

BACKGROUND: Evidence of associations between prenatal cannabis use (PCU) and maternal and infant health outcomes remains conflicting amid broad legalization of cannabis across Canada and 40 American states. A critical limitation of existing evidence lies in the non-standardized and crude measurement of prenatal cannabis use (PCU), resulting in high risk of misclassification bias. We developed a standardized tool to comprehensively measure prenatal cannabis use in pregnant populations for research purposes. METHODS: We conducted a mixed-methods, patient-oriented tool development and validation study, using a bias-minimizing process. Following an environmental scan and critical appraisal of existing prenatal substance use tools, we recruited pregnant participants via targeted social media advertising and obstetric clinics in Alberta, Canada. We conducted individual in-depth interviews and cognitive interviewing in separate sub-samples, to develop and refine our tool. We assessed convergent and discriminant validity internal consistency and 3-month test-retest reliability, and validated the tool externally against urine-THC bioassays. RESULTS: Two hundred fifty four pregnant women participated. The 9-item Cannabis Exposure in Pregnancy Tool (CEPT) had excellent discriminant (Cohen's kappa = -0.27-0.15) and convergent (Cohen's kappa = 0.72-1.0) validity; as well as high internal consistency (Chronbach's alpha = 0.92), and very good test-retest reliability (weighted Kappa = 0.92, 95% C.I. [0.86-0.97]). The CEPT is valid against urine THC bioassay (sensitivity = 100%, specificity = 82%). CONCLUSION: The CEPT is a novel, valid and reliable measure of frequency, timing, dose, and mode of PCU, in a contemporary sample of pregnant women. Using CEPT (compared to non-standardized tools) can improve measurement accuracy, and thus the quality of research examining PCU and maternal and child health outcomes.

Mothering Work and Perinatal Transfer: An Institutional Ethnographic Investigation.

BACKGROUND: While maternal or infant transfer is generally the safest course of action when health complications arise, the process of shifting from one hospital to another is stressful for mothers and their infants. There is limited understanding of how institutional processes coordinate patient transfer in ways that increase tensions for women and their families who are trying to navigate the institutional systems during health crises. METHODS: This institutional ethnographic study explored womens' experience of transfer. Interviews were conducted with a purposive sample of six childbearing women. The analysis highlights tensions and contradictions between patient care and institutional demands and shows how ordinary institutional decision-making practices impacted participants in unexpected ways. RESULTS: Women experienced uncertainty and stress when trying to convince health-care providers they needed care. Before, during, and after transfer, participants navigated home responsibilities, childcare, and getting care closer to home in difficult circumstances. CONCLUSION: The effort and skill women need to care for their infants and families as they are transferred is extraordinary. This study offers insight into the resources and support childbearing women need to accomplish the work of caring for their families in the face of perinatal crisis and multiple transfers.

Perceptions about cannabis use during pregnancy: a rapid best-framework qualitative synthesis.

OBJECTIVE: A rapid review was conducted in order to produce a streamlined and time-limited systematic evidence review to understand women's perceptions, beliefs, and knowledge of the risks associated with cannabis use during pregnancy. METHODS: MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, EMBASE, PsycINFO (OVID interface), and CINAHL (Ebsco interface) databases were searched from inception to March 2019. Qualitative and descriptive studies, and reviews that addressed pregnant women's perceptions, beliefs, and attitudes about personal cannabis use were included. The methodological quality of the included studies was appraised using valid tools and data extraction was guided by suitable checklists. Full text of 18 citations was retrieved and reviewed, and 5 studies met the inclusion criteria. SYNTHESIS: Women who continued to use cannabis during pregnancy often perceived less risk compared with nonusers. Their uncertainty regarding adverse consequences, perceived therapeutic effects, and lack of communication with health care providers contributed to cannabis use. Women perceived this lack of counselling as an indication that outcomes of cannabis use while pregnant were not significant. CONCLUSION: This synthesis highlights important factors in women's decision-making processes regarding use or cessation of cannabis during pregnancy. In addition, the importance of health care providers providing information, education, and appropriate counselling to childbearing women is highlighted as these conversations may influence women's perceptions of risk and help them make informed choices.

RéSUMé: OBJECTIF: Une revue rapide a servi à produire un examen systématique des données probantes, abrégé et limité dans le temps, afin de comprendre les perceptions, les convictions et les connaissances des femmes sur les risques associés à la consommation de cannabis durant la grossesse. MéTHODE: Les bases de données MEDLINE® Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE® Daily, Embase et PsycInfo (interface OVID) et la base de données CINAHL (interface Ebsco) ont été interrogées depuis le démarrage du projet jusqu'en mars 2019. Ont été incluses les études qualitatives et descriptives et les revues de la littérature portant sur les perceptions, les convictions et les attitudes des femmes enceintes au sujet de la consommation personnelle de cannabis. La qualité méthodologique des études incluses a été évaluée à l'aide d'outils validés, et l'extraction des données a été guidée par des listes de vérification pertinentes. Sur les 18 études citées dont le texte intégral a été récupéré et examiné, 5 études respectaient les critères d'inclusion. SYNTHèSE: Les femmes ayant continué à consommer du cannabis durant la grossesse percevaient souvent un moindre risque que celles qui n'en avaient pas consommé. L'incertitude des femmes quant aux conséquences négatives, les effets thérapeutiques perçus et le déficit de communication avec le personnel soignant ont contribué à la consommation de cannabis. Les femmes ont interprété ce déficit de counseling comme une indication des effets négligeables de la consommation de cannabis durant la grossesse. CONCLUSION: Notre synthèse fait ressortir les facteurs importants dans le processus décisionnel des femmes sur la consommation ou l'arrêt de consommation du cannabis durant la grossesse. Elle souligne aussi l'importance que le personnel soignant informe, sensibilise et conseille correctement les femmes enceintes, car de telles conversations peuvent influencer la perception du risque chez ces femmes et les aider à faire des choix éclairés.

The Social Organization of Neonatal Nurses' Feeding Work.

PURPOSE: We report findings from an institutional ethnography (IE) of nurses' work of feeding infants within an increasingly technical organization of NICUs. SAMPLE: Five primary informants; 18 secondary informants. DESIGN: The institutional ethnographic approach included field observations, interviews, and phone and e-mail conversations. Our analysis followed accounts of what actually happened within the textual organization of nurses' work. MAIN OUTCOME: Nurses' feeding practices are directed by protocols that arise within multiple documentation systems and clinical technologies. These systems produce barriers to nurses' efforts to skillfully feed infants. RESULTS: Prioritization of quality and safety perspectives can obscure and constrain the ordinary yet critical clinical reasoning neonatal nurses employ during feeding work. Clinical technologies that have been developed to improve safety can paradoxically disrupt the ability of nurses to respond in the moment to neonatal feeding cues. This finding provides nurses, leaders, and policymakers with insight into why policies and procedures may not be followed as expected.

Narratives and embodied knowing in the NICU.

The author draws on narratives as an illustration of embodied knowledge and argues for the importance of using embodied knowing to inform ethical decisions in the neonatal setting. Nurses have a unique perspective of the complex care associated with neonatal intensive care (NIC). NIC nurses listen to parent's stories and share their own practice stories, leading to an intimate appreciation of a family's particular response to their health care experience. These narratives can deepen understanding of how nurses go about doing their everyday work, describe experiences in everyday practice, and help the writer come to terms with traumatic events. Moreover, nurses' narratives provide a voice, an expression of their embodied knowledge. By telling and listening to nurses' stories, we can better understand how embodied knowledge supports families in crisis. The narratives in this article are examples of the challenges neonatal nurses face in using embodied knowing to enhance relationships with families. These narratives may help nurses to reflect on their practice and cultivate relationships with families in the NICU.