Communication barriers in maternity care of allophone migrants: Experiences of women, healthcare professionals, and intercultural interpreters.

AIM: To describe communication barriers faced by allophone migrant women in maternity care provision from the perspectives of migrant women, healthcare professionals, and intercultural interpreters. BACKGROUND: Perinatal health inequality of migrant women hinges on barriers to services, with a major barrier being language. Their care is often also perceived as demanding due to conflicting values or complex situations. Potentially divergent perceptions of users and providers may hinder efficient communication. DESIGN: Qualitative explorative study. METHODS: A convenience sample of 36 participants was recruited in the German speaking region of Switzerland. The sample consisted of four Albanian and six Tigrinya speaking women, 22 healthcare professionals and four intercultural interpreters (March-June 2016) who participated in three focus group discussions and seven semi-structured interviews. Audio recordings of the discussions and interviews were transcribed and thematically analysed. RESULTS: The analysis revealed three main themes: the challenge of understanding each other's world, communication breakdowns and imposed health services. Without interpretation communication was reduced to a bare minimum and thus insufficient to adequately inform women about treatment and address their expectations and needs. CONCLUSION: A primary step in dismantling barriers is guaranteed intercultural interpreting services. Additionally, healthcare professionals need to continuously develop and reflect on their transcultural communication. Institutions must enable professionals to respond flexibly to allophone women's needs and to offer care options that are safe and in accordance to their cultural values. IMPACT: Our results give the foundation of tenable care of allophonic women and emphasize the importance of linguistic understanding in care quality.

Barrier-free communication in maternity care of allophone migrants: BRIDGE study protocol.

AIM: To describe communication and access barriers encountered by allophone women of different migration backgrounds in the Swiss maternity care services, from the perspective of users, healthcare professionals and intercultural interpreters. BACKGROUND: In addition to the challenges of maternal adjustment, pregnant migrant women must also deal with an unfamiliar health service system. Some must overcome language barriers and the stress of uncertain residence status. Limited access to maternity care increases perinatal morbidity and mortality. Almost 10% of foreigners speak none of Switzerland's official languages. Factors that facilitate or hinder communication between migrant women and perinatal healthcare professionals are under-studied and must be understood if we are to overcome those barriers in clinical practice. DESIGN: Qualitative exploratory study with quantitative sub-study. METHODS: Participants will be drawn from German to speaking regions of Switzerland. We will conduct focus group discussions and semi-structured interviews with users in their own language (Albanian and Tigrinya) and with healthcare professionals and intercultural interpreters (March-June 2016), then perform Thematic Analysis on the data. In the sub-study, midwives will report their experience of using a telephone interpreting service during postnatal home visits in a questionnaire (October 2013-March 2016). Data will be analysed with descriptive statistics. DISCUSSION: Our study will reveal patterns in communications between allophone migrant women and healthcare providers and communication barriers. By incorporating multiple perspectives, we will describe the challenges all parties face. Our results will inform those who draft recommendations to improve provision of maternity care to allophone women and their families. TRIAL REGISTRATION: ClinicalTrials.gov ID: BernUAS NCT02695316.

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.

Did the structure of work in the public health nurse service of the Republic of Croatia change in the period 1995-2012?

In Croatia, public health nurses (PHN) have been members of family doctor (FD) teams for decades, conducting a multifunctional and polyvalent scope of activities, including health promotion, prevention, as well as part of the treatment for the inhabitants of a defined catchment area. The main aim of the study was to investigate the trends in the number and structure of PHN visits in the period from 1996 to 2012. The main sources of data were Croatian Health Service Yearbooks. The results strongly indicate that PHN's are overloaded by a high number of visits, especially to chronic patients. While mothers and new-born children are in the PHN care, pregnant women and small children are rather neglected. Considering different working conditions and differences in population needs, a review of the standard is recommendable.

The experience of maternal and child health nurses responding to women with postpartum depression.

Previous studies have shown that maternal and child health nurses (MCH nurses) are in a unique position to help mothers with postpartum depression (PPD), but little has been done to understand the MCH nurses' day-to-day experience. This Australian study addresses that issue by analyzing the results of eight in-depth interviews with MCH nurses. The data obtained from these interviews was analyzed using the phenomenological method described by Creswell, adapted from Moustakas. From this analysis five themes emerge: how MCH nurses recognize symptoms of PPD; the importance of having treatment options available; the role of rapport; the limits of MCH nurses in responding to PPD; and how MCH nurses respond when recognizing new cases of PPD. The results of the study reveal several areas for policy review, most significantly the need for more MCH nurse training to recognize the symptoms of PPD and identify the appropriate treatment option. In addition, a review of staff retention and mobility policies is recommended to improve rapport with mothers and maintain and grow knowledge of local treatment options.

We cannot staff for 'what ifs': the social organization of rural nurses' safeguarding work.

Rural nurses play an important role in the provision of maternity care for Canadian women. This care is an important part of how rural nurses safeguard the patients who receive care in small rural hospitals. This study utilized institutional ethnography as an approach for describing rural nursing work and for exploring how nurses' work experiences are socially organized. Rural nurses advocated for safe healthcare environments by ensuring that skilled nurses were available for every shift, day and night, at their local hospital. Rural nurses noted that this work was particularly difficult for the provision of maternity care. This article explores two threads or cues to institutional organization that were identified in our interviews and observations; namely staffing and safety standards, and the need for flexibility in staffing in small rural hospitals. Rural nurses' concerns about ensuring that skilled nurses are available in small rural hospitals do not enter into current management discourses that focus on efficiency and cost savings or find a home within current discourses of patient safety 'competencies'.

Breastfeeding: how to increase prevalence.

Increasing breastfeeding prevalence is essential to reduce health inequalities and improve health outcomes for all mothers and babies. Evidence-based services need to be commissioned and developed in line with UNICEF's Baby Friendly Initiative Seven Point Plan, to ensure positive outcomes for breastfeeding. Support services offered early in the neonatal period can increase prevalence at 6-8 weeks of age and encourage longer-term breastfeeding, recommended by the World Health Organization and Department of Health. This article describes how an early intervention infant feeding service successfully supported mothers to continue breastfeeding and increased prevalence.

Comparing maternal child health problems and outcomes across public health nursing agencies.

To use aggregated data from health informatics systems to identify needs of maternal and child health (MCH) clients served by county public health agencies and to demonstrate outcomes of services provided. Participating agencies developed and implemented a formal standardized classification data comparison process using structured Omaha System data. An exploratory descriptive analysis of the data was performed. Summary reports of aggregated and analyzed data from records of clients served and discharged in 2005 were compared. Client problems and outcomes were found to be similar across agencies, with behavioral, psychosocial, environmental and physiological problems identified and addressed. Differential improvement was noted by problem, outcome measure, and agency; and areas for enhancing intervention strategies were prioritized. Problems with greatest improvement across agencies were Antepartum/postpartum and Family planning, and least improvement across agencies were Neglect and Substance use. Findings demonstrated that public health nurses address many serious health-related problems with low-income high-risk MCH clients. MCH client needs were found to be similar across agencies. Public health nurse home visiting services addressed important health issues with MCH clients, and statistically significant improvement in client health problems occurred consistently across agencies. The data comparison processes developed in this project were useful for MCH programs, and may be applicable to other program areas using structured client data for evaluation purposes. Using informatics tools and data facilitated needs assessment, program evaluation, and outcomes management processes for the agencies, and will continue to play an integral role in directing practice and improving client outcomes.

Exploring the role of uterine artery embolization in the management of postpartum hemorrhage.

Postpartum hemorrhage is a potentially life-threatening obstetric emergency that requires prompt nursing and medical interventions. In the majority of cases, initial strategies such as fundal massage and uterotonic medications will effectively stop excessive bleeding. Unfortunately, the incidence and severity of postpartum hemorrhage are on the rise and peripartum hysterectomy remains a life-saving intervention in cases of intractable bleeding. As an emerging alternative to hysterectomy, uterine artery embolization (UAE) has demonstrated success rates of more than 90% in controlling postpartum hemorrhage unresponsive to other therapies. Research to date has shown UAE to be a safe, minimally invasive procedure with few reported complications and minimal effects on future fertility. For patients who are hemodynamically stable with access to an interventional radiology suite, UAE is an important consideration in the treatment of severe postpartum bleeding. This article explores the role of UAE as a part of this management algorithm. The technical aspects of this procedure, reported complications, and effects on future fertility are described. The prophylactic use of intra-arterial balloon catheters in the management of abnormal placentation is also discussed.

Maternal child home visiting program improves nursing practice for screening of woman abuse.

OBJECTIVE: This study investigated changes in public health nurse practices and the incidence of abuse inquiry and disclosure. DESIGN AND SAMPLE: A retrospective record review of cross-sectional data was collected before and after implementation of the Routine Universal Comprehensive Screening (RUCS) protocol within a maternal child home visiting program. Records of postpartum women receiving a universal home visit within 48 hr of discharge from the hospital were reviewed (pre-RUCS, n=459; post-RUCS, n=485). Also reviewed were the records of women receiving a family assessment for at risk home visiting (pre-RUCS, n=79; post-RUCS, n=66). MEASURES: The variables collected consisted of abuse inquiry, abuse disclosure, and the alone status. RESULTS: Documentation of women's alone status significantly improved for both types of home visits: the 48-hr home visits ( p<.001) and the at risk home visits ( p<.01). Disclosures of abuse significantly increased in both types of home visits ( p<.01). Ensuring privacy by not asking abuse questions if women were not alone during a visit significantly improved ( p<.001). CONCLUSIONS: Implementing a protocol to screen for woman abuse into an existing maternal child home visiting program demonstrated improved practices related to the safety and privacy of women, and an increase in abuse disclosures.

Team process in community-based participatory research on maternity care in the Dominican Republic.

A cross-cultural team consisting of US trained academic midwife researchers, Dominican nurses, and Dominican community leaders have partnered in this international nursing and midwifery community-based participatory research (CBPR) project in the Dominican Republic to understand the community experience with publicly funded maternity services. The purpose of the study was to understand community perceptions of maternity services. This article highlights the activities that the research team carried out during each phase of the research process, and how they established team identity, team trust, and team efficacy. This research has created a platform for new avenues for health providers and community to partner to improve maternal-newborn care. Community-based participatory research is one way forward to address the past and present inequities constitutive of global health disparities.

The First Steps Program: a case study of a new model of community child health service.

Community Child Health Nursing Services provide support for new mothers; however, the focus has often been on individual consultations, complemented by a series of group sessions soon after birth. We describe a new model of community care for first-time mothers that centres on group sessions throughout the whole contact period. The model was developed by practicing child health nurses for a large health service district in south-east Queensland, which offers a comprehensive community child health service. Issues identified by clinicians working within existing services, feedback from clients and the need for more resource-efficient methods of service provision underpinned the development of the model. The pilot program was implemented in two community child health centres in Brisbane. An early individual consultation to engage the family with the service was added in response to feedback from clinicians and clients. The modified model has since been implemented service-wide as the 'First Steps Program'. The introduction of this model has ensured that the service has been able to retain a comprehensive service for first-time parents from a universal population, while responding to the challenges of population growth and the increasing number of complex clients placing demands on resources.

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 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.

Supporting mothers in recovery: parenting classes.

Drug addiction is a serious issue in today's society. Women are giving birth to infants who are born addicted to illicit drugs, and these mothers are not able to care for their infants safely and competently without training and support. This article examines the prevalence of the problem. It also discusses the possible impact of parenting skills classes, as part of recovery efforts, for women seeking recovery who have recently given birth. Several programs already in place in the U.S have shown positive results for these mothers and their infants. Infants exposed in utero to illicit drugs need to be given all of the resources society can provide in an effort to stop the intergenerational cycle of drug addiction.

Advocacy for mothers with psychiatric illness: a clinical perspective.

Motherhood is a challenging role and a life-changing experience. For women living with psychiatric illness, the challenge of motherhood is amplified. Psychiatric illness (including schizophrenia, affective and personality disorders) is associated with multiple adversities that can impair the capacity to parent. Social adversity, fluctuating symptoms, and medications and their related side-effects, can create difficulties for the new mother as she adjusts to her role. The risk for relapse among women who are unwell is heightened during the post-partum period. For many other women, the post-partum period is when psychiatric symptoms emerge for the first time. Equally important are the continuing concerns pertaining to infant well-being where maternal psychiatric illness is present. For mothers who exhibit symptoms at this time, a very real threat of protective removal exists. In the mother-infant setting, child protection legislation is biased towards the rights of the child. While there are cases for which this bias is clearly appropriate, there are less clear situations from which the infant is removed with little regard for the mother. Often mothers with psychiatric illness struggle to meet the cognitive, emotional, and financial demands of drawn-out custody proceedings. For these mothers, there is a paucity of appropriate support available, as will be evidenced throughout the present paper. There is an urgent need for professional advocacy to support women who are unwell in their transition to motherhood. The mental health nurse is able to fill a key advocating role in the perinatal psychiatric setting. Nurses in this role hold a unique position whereby social and community supports can be activated, while guidance is imparted from a ground-level standpoint. The nurse in this role has the capacity to liaise with authorities, negotiate service provision, and ensure that key parenting skills are acquired by the mother as she works to secure her role. Through the provision of proactive advocacy during this time, the nurse has the potential to ameliorate the outcomes of mothers who are unable to cope alone and the well-being of their infants.

Greater Manchester: reducing infant mortality and promoting child health.

Targeting services in order to reduce health inequalities is a key national priority.This paper describes a project funded by the Greater Manchester Public Health Network looking at service provision to reduce infant mortality and promote child health across Greater Manchester. The aim of this was to improve standards of care by setting a standard service provision for targeting services toward the most deprived groups. It involved the production of child health indicators, a literature review, standard setting, dissemination of findings, collation of data and production of a service pathway for breastfeeding, smoking cessation, nutrition and postnatal depression.