Nursing students' experience of a transformative approach to teaching cross cultural clinical decision making.

OBJECTIVES: This study reveals the learning gained by Canadian and Rwandan nursing students from a course to enhance cross cultural clinical decision-making skills using a collaborative approach across two countries. METHODS: A qualitative descriptive study was conducted using thematic analysis. The study included analysis of end of course reflections of 94 students. RESULTS: Students became more open-minded, curious, strengthening teamwork, increasing their critical thinking, and identifying cross-cultural similarities in practice. They challenged their previous beliefs about others. CONCLUSIONS: Students achieved a transformation of previous knowledge and decision-making skills. Results indicate the value of underpinning courses with theories and being open in allowing students to develop their own means to achieve expected learning outcomes. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE: Creating learning environments designed to stimulate open mindedness and exploration of cultures among students can be achieved through online learning. Providing opportunities for students to learn across other countries about their nursing practices and health systems are critical to understanding how future patients who are immigrants and refugees from other countries differing perspectives to their health care needs.

Primary health care clinics as catalyst to community building and health among residents in low income housing units.

BACKGROUND: This paper focuses on the identified value of a community-based project (CBP), including residents' living within low income housing units and their reported experiences of receiving health and social services within two communities by nurse practitioners (NPs) and its impact on their communities. OBJECTIVE: To gain insight into the lived experience of residents in the housing units from a collaborative interprofessional care approach provided in a clinic situated within each housing unit, in integrating health and social services within the residents' own 'community' and its outcomes. DESIGN: A qualitative descriptive study to gain insight into the shared views of care informants. SETTINGS: Two low income housing units in xxxxxxxxxxxxxxxxxxxx. PARTICIPANTS: Twenty-two residents representing all genders who lived in the housing units. METHODS: A purposive sampling of willing residents participated in a focus group interview. Each group comprised from 4 to 6 persons. Two focus group interviews occurred in each of the two housing units. RESULTS: Their voices resulted in identification of two themes - clinic as a catalyst to creating a sense of community and clinic as assisting them in managing their overall health. Two subthemes were also identified within each theme. CONCLUSION: Findings provide insight into the value of CBP, that a strengths-based and interprofessional care approach can serve as a catalyst for an evolving community.

Influencing factors for prevention of postpartum hemorrhage and early detection of childbearing women at risk in Northern Province of Rwanda: beneficiary and health worker perspectives.

BACKGROUND: Reduction of maternal mortality and morbidity is a major global health priority. However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for prevention of PPH and early detection of childbearing women at risk as perceived by beneficiaries and health workers in the Northern Province of Rwanda. METHODS: A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed methods study. Semi-structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women's partners or close relatives (2 focus groups), community health workers (CHWs) in charge of maternal health (2 focus groups) and health care providers (3 focus groups). A socio ecological model was used to develop interview guides describing factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. RESULTS: We generated four interrelated themes: (1) Meaning of PPH: beliefs, knowledge and understanding of PPH: (2) Organizational factors; (3) Caring and family involvement and (4) Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH. CONCLUSIONS: Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. Involvement of all levels of the health system was recommended for a proactive prevention of PPH. Further quantitative research, using case control design is warranted to develop a screening tool for early detection of PPH risk factors for a proactive prevention.

Nurses' use of conscientious objection and the implications for conscience.

AIMS: To explore the meaning of conscience for nurses in the context of conscientious objection (CO) in clinical practice. DESIGN: Interpretive phenomenology was used to guide this study. DATA SOURCES: Data were collected from 2016 - 2017 through one-on-one interviews from eight nurses in Ontario. Iterative analysis was conducted consistent with interpretive phenomenology and resulted in thematic findings. REVIEW METHODS: Iterative, phased analysis using line-by-line and sentence highlighting identified key words and phrases. Cumulative summaries of narratives thematic analysis revealed how nurses made meaning of conscience in the context of making a CO. RESULTS: Conscience issues and CO are current, critical issues for nurses. For Canadian nurses this need has been recently heightened by the national legalization of euthanasia, known as Medical Assistance in Dying in Canada. Ethics education, awareness, and respect for nurses' conscience are needed in Canada and across the profession to support nurses to address their issues of conscience in professional practice. CONCLUSION: Ethical meaning emerges for nurses in their lived experiences of encountering serious ethical issues that they need to professionally address, by way of conscience-based COs. IMPACT: This is the first study to explore what conscience means to nurses, as shared by nurses themselves and in the context of CO. Nurse participants expressed that support from leadership, regulatory bodies, and policy for nurses' conscience rights are indicated to address nurses' conscience issues in practice settings.

Conscientious objection and nurses: Results of an interpretive phenomenological study.

BACKGROUND: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. RESEARCH QUESTION: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? RESEARCH DESIGN: Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. PARTICIPANTS AND RESEARCH CONTEXT: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. ETHICAL CONSIDERATIONS: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent. FINDINGS: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support. DISCUSSION: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed. CONCLUSION: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses' ethical concerns giving rise to objections. Conscience emerged as an informant to nurses' conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice.

Conscience, conscientious objection, and nursing: A concept analysis.

BACKGROUND:: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses' ethical care provision. Conscientious objection is one such strategy for addressing nurses' personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. RESEARCH AIM:: To analyze the concepts of conscience and conscientious objection in the context of nurses. DESIGN:: Concept analysis using the method by Walker and Avant. RESEARCH CONTEXT:: Data were retrieved from Philosopher's Index, PubMed, and CINAHL with no date restrictions. ETHICAL CONSIDERATION:: This analysis was carried out per established, scientific guidelines. FINDINGS:: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. DISCUSSION AND CONCLUSION:: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.

A moral profession: Nurse educators' selected narratives of care and compassion.

BACKGROUND:: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. OBJECTIVE:: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators' selection and use of published texts and film. METHODOLOGY:: This study employed discourse analysis. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. FINDINGS:: The desire to understand others and how to care compassionately characterised educators' choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those 'deserving' often understood as the suffering person doing enough to help themselves. DISCUSSION:: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). CONCLUSION:: To feel cared about people need to feel 'visible' as though they matter. Nurses need to be alert to problems that may arise if their 'moral vision' is influenced by ideas of desert and how much the patient is doing to help himself or herself.

Barriers to Utilization of Mental Health Services amongst Male Child Sexual Abuse Survivors: Service Providers' Perspective.

Most research on child sexual abuse has been on survivors to the exclusion of service providers. This paper focuses on one group of findings from a larger qualitative study. The aim of the paper is to identify existing services and highlight the gaps in the current programs available for male CSA survivors from the perspective of service providers. Semi-structured interviews were conducted with 11 mental health service providers, recruited from two Southern and Central Ontario cities. Findings presented here report service providers' perspective of gaps in services for male CSA survivors. "Limited Male CSA Programs", "Institutional Barriers", "Attitudinal Barriers", and "Systemic Gaps" emerged as four major themes from the data analysis. Findings demonstrate the need to re-evaluate currently available service and highlights gaps in mental health service available for male CSA survivors. Implications for policy, practice, and research are discussed.

Clinical Research With Pregnant Women: Perspectives of Pregnant Women, Health Care Providers, and Researchers.

Limited clinical research with pregnant women has resulted in insufficient data to promote evidence-informed prenatal care. Charmaz's constructivist grounded theory methodology was used to explore how research with pregnant women would be determined ethically acceptable from the perspectives of pregnant women, health care providers, and researchers in reproductive sciences. Semistructured interviews were conducted with a purposive sample of 12 pregnant women, 10 health care providers, and nine reproductive science researchers. All three groups suggested the importance of informed consent and that permissible risk would be very limited and complex, being dependent on the personal benefits and risks of each particular study. Pregnant women, clinicians, and researchers shared concerns about the well-being of the woman and her fetus, and expressed a dilemma between promoting research for evidence-informed prenatal care while securing the safety in the course of research participation.

Approaches to health-care provider education and professional development in perinatal depression: a systematic review.

BACKGROUND: Perinatal depression is the most common mental illness experienced by pregnant and postpartum women, yet it is often under-detected and under-treated. Some researchers suggest this may be partly influenced by a lack of education and professional development on perinatal depression among health-care providers, which can negatively affect care and contribute to stigmatization of women experiencing altered mood. Therefore, the aim of this systematic review is to provide a synthesis of educational and professional development needs and strategies for health-care providers in perinatal depression. METHODS: A systematic search of the literature was conducted in seven academic health databases using selected keywords. The search was limited to primary studies and reviews published in English between January 2006 and May/June 2015, with a focus on perinatal depression education and professional development for health-care providers. Studies were screened for inclusion by two reviewers and tie-broken by a third. Studies that met inclusion criteria were quality appraised and data extracted. Results from the studies are reported through narrative synthesis. RESULTS: Two thousand one hundred five studies were returned from the search, with 1790 remaining after duplicate removal. Ultimately, 12 studies of moderate and weak quality met inclusion criteria. The studies encompassed quantitative (n = 11) and qualitative (n = 1) designs, none of which were reviews, and addressed educational needs identified by health-care providers (n = 5) and strategies for professional development in perinatal mental health (n = 7). Consistently, providers identified a lack of formal education in perinatal mental health and the need for further professional development. Although the professional development interventions were diverse, the majority focused on promoting identification of perinatal depression and demonstrated modest effectiveness in improving various outcomes. CONCLUSIONS: This systematic review reveals a lack of strong research in multi-disciplinary, sector, site, and modal approaches to education and professional development for providers to identify and care for women at risk for, or experiencing, depression. To ensure optimal health outcomes, further research comparing diverse educational and professional development approaches is needed to identify the most effective strategies and consistently meet the needs of health-care providers. TRIAL REGISTRATION: A protocol for this systematic review was registered on PROSPERO (Protocol number: CRD42015023701 ), June 21, 2015.

Heterosexual female adolescents' decision-making about sexual intercourse and pregnancy in rural Ontario, Canada.

INTRODUCTION: Rural female adolescents experience unique circumstances to sexual health care and information as compared to urban adolescents. These circumstances are largely due to their more isolated geographical location and rural sociocultural factors. These circumstances may be contributing factors to an incidence of adolescent pregnancy that is higher in rural areas than in urban cities. Thus, this higher incidence of pregnancy may be due to the ways in which rural adolescents make decisions regarding engagement in sexual intercourse. However, the rural female adolescent sexual decision-making process has rarely, if ever, been studied, and further investigation of this process is necessary. Focusing on rural female adolescents aged 16-19 years is especially significant as this age range is used for reporting most pregnancy and birth statistics in Ontario. METHODS: Charmaz's guidelines for a constructivist grounded theory methodology were used to gain an in-depth understanding of eight Ontario rural female adolescents' decision-making process regarding sexual intercourse and pregnancy, and how they viewed rural factors and circumstances influencing this process. Research participants were obtained through initial sampling (from criteria developed prior to the study) and theoretical sampling (by collecting data that better inform the categories emerging from the data). Eight participants, aged 16-19 years, were invited to each take part in 1-2-hour individual interviews, and four of these participants were interviewed a second time to verify and elaborate on emerging constructed concepts, conceptual relationships, and the developing process. Data collection and analysis included both field notes and individual interviews in person and over the telephone. Data were analyzed for emerging themes to construct a theory to understand the participants' experiences making sexual decisions in a rural environment. RESULTS: The adolescent sexual decision-making process, Prioritizing Influences, that emerged from the analysis was a complex and non-linear process that involved prioritizing four influences within the rural context. The influences that participants of this study described as being part of their sexual decision-making process were personal values and circumstances, family values and expectations, friends' influences, and community influences. When influences coincided, they strengthened participants' sexual decisions, whereas when influences opposed each other, participants felt conflicted and prioritized the influence that had the most effect on their personal lives and future goals. Although these influences may be common to all adolescents, they impact the rural female adolescent sexual decision-making process by influencing and being influenced by geographical and sociocultural factors that make up the rural context. CONCLUSIONS: This study reveals important new and preliminary information about rural female adolescents' sexual decision-making process and factors that affect it. Findings improve understanding of how rural female adolescents make choices regarding sexual intercourse and pregnancy and can be used to guide future research projects that could facilitate effective development of sexual health promotion initiatives, inform rural health policy and practices, and enhance existing sexual education programs in rural communities.

Moral distress in the resuscitation of extremely premature infants.

OBJECTIVE: To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature. DESIGN: A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants. SETTING: A regional, tertiary academic referral hospital in Ontario offering a perinatal program. PARTICIPANTS: A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants. METHODS: Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis. RESULTS: Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses' perceived lack of power and influence in the neonatal resuscitation decision-making process. CONCLUSION: Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration.

Laboring to mother in the context of past trauma: the transition to motherhood.

The occurrence of interpersonal trauma is a reality for many women, with effects that often persist long after the traumatic events end. The purpose of this feminist grounded theory study was to examine how past trauma shaped the lives of women as they became new mothers. We recruited a purposive sample of 32 women from two Canadian communities and conducted semistructured, dialogic interviews during the second trimester of pregnancy. We analyzed data using thematic content analytic methods, including open coding whereby we read transcripts line by line and applied codes to portions of text that illustrated concepts or themes. The substantive grounded theory, "laboring to mother in the context of past trauma," describes the exceedingly difficult emotional and cognitive work undertaken by pregnant women with histories of trauma as they anticipate becoming mothers. In this article, we present key components of the theory and offer recommendations for health and social service providers.

Teaching family planning to nurse and midwife students: A constructivist grounded theory study.

AIM: This study aimed to describe nurse/midwife educators' understanding and enactment of teaching family planning methods with nursing/midwifery students in educational programs in Rwanda. More precisely, the aim of this study was to generate a substantive theory that explains how nurse/midwife educators introduce family planning methods into their teaching practice to facilitate learning among nurse/midwife students in Rwanda. BACKGROUND: High maternal mortality remains a global health issue. In 2017, approximately 295,000 women worldwide died from complications related to pregnancy or childbirth and 94% of these maternal deaths occurred in low-income countries. Evidence shows that family planning improves maternal health outcomes and significantly contributes to reducing maternal mortality. Low family planning uptake is partly attributed to inadequate education of healthcare providers to provide family planning services. DESIGN: This study followed the constructivist grounded theory methodology articulated by Kathy Charmaz (2006; 2014). METHODS: The primary data source was individual semi-structured interviews with 25 nurse/midwife educators recruited from all the schools/faculties/departments of nursing and midwifery in Rwanda, augmented with written documents related to family planning education in nursing/midwifery preservice programs. RESULTS: The substantive Theory that emerged from the data analysis indicated that the process of teaching family planning in preservice nursing/midwifery education among nurse/midwife educators has three phases: preparing, facilitating and evaluating. Factors that had an impact on the process and actions that nurse/midwife educators undertook to address the challenges related to those factors were identified. The main influential factors that had a significant impact on nurse/midwife educators' ability to teach family planning are contextual factors and personal factors related to the nurse/midwife educators. The contextual factors included the availability of resources, student-teacher ratio, number of students in clinical placements and the time allocated to the family planning unit. The personal factors related to the nurse/midwife educators included knowledge, skills, confidence, attitude, beliefs and moral values toward family planning methods. CONCLUSION: These study findings generated valuable knowledge that can guide the improvement of teaching family planning in preservice nursing/midwifery programs in Rwanda and other limited-resource countries and contexts. With the insights provided by this study, future research should investigate strategies to overcome highlighted barriers, increase nurse/midwife educators' expertise in teaching family planning and enhance the preparedness of nurse/midwife students on some family planning methods identified in this study.

The mandala: first-year undergraduate nursing students' learning experiences.

The mandala is a circular art form used by psychologists to access subconscious thought through symbolism and it has recently been adopted by nurse educators as a learning strategy for self-awareness. The lived experiences of six first-year undergraduate nursing students who completed a mandala assignment for emotional learning were explored using hermeneutic phenomenology. Participants experiences diverged from their original expectations that the mandala assignment would allow for a fun and free expression of 'self'. Participants did describe experiences of self-discovery; however, their experiences also resembled those associated with socialization in nursing education. Participants described both self-reflection and critical-reflection while completing the mandala assignment. Nurse educators and researchers can gain insight regarding the use of this assignment as an integrated transformative learning approach for emotional learning.

Recruitment Strategies to Engage Newcomer Mothers of African Descent in Maternal Mental Health Research in Canada.

INTRODUCTION: Newcomer mothers of African descent are at risk for maternal mental stress because of inadequate social support, newcomer status, and stress of motherhood. Limited participation of newcomer African mothers in mental health research contributes to a knowledge gap in this area further impacting culturally competent health services. This article reports recruitment strategies to better engage African newcomer women in maternal mental health research. METHODS: In-depth discussion of recruitment strategies, used in a qualitative descriptive study conducted with Black African newcomer mothers in Canada. RESULTS: Ten African newcomer mothers were successfully recruited using recruitment strategies such as engagement with religious organizations, snowballing, and the use of social media. DISCUSSION: Cultural beliefs on motherhood, resilience, and mental illness may account for hesitancy to engage in maternal mental health research. Recruitment strategies could help overcome the challenges and potentially diversify maternal mental health research in Canada through the engagement of African newcomer mothers.

Risk factors for postpartum haemorrhage in the Northern Province of Rwanda: A case control study.

BACKGROUND: Postpartum haemorrhage (PPH) remains a major global burden contributing to high maternal mortality and morbidity rates. Assessment of PPH risk factors should be undertaken during antenatal, intrapartum and postpartum periods for timely prevention of maternal morbidity and mortality associated with PPH. The aim of this study is to investigate and model risk factors for primary PPH in Rwanda. METHODS: We conducted an observational case-control study of 430 (108 cases: 322 controls) pregnant women with gestational age of 32 weeks and above who gave birth in five selected health facilities of Rwanda between January and June 2020. By visual estimation of blood loss, cases of Primary PPH were women who changed the blood-soaked vaginal pads 2 times or more within the first hour after birth, or women requiring a blood transfusion for excessive bleeding after birth. Controls were randomly selected from all deliveries without primary PPH from the same source population. Poisson regression, a generalized linear model with a log link and a Poisson distribution was used to estimate the risk ratio of factors associated with PPH. RESULTS: The overall prevalence of primary PPH was 25.2%. Our findings for the following risk factors were: antepartum haemorrhage (RR 3.36, 95% CI 1.80-6.26, P<0.001); multiple pregnancy (RR 1.83; 95% CI 1.11-3.01, P = 0.02) and haemoglobin level <11 gr/dL (RR 1.51, 95% CI 1.00-2.30, P = 0.05). During the intrapartum and immediate postpartum period, the main causes of primary PPH were: uterine atony (RR 6.70, 95% CI 4.78-9.38, P<0.001), retained tissues (RR 4.32, 95% CI 2.87-6.51, P<0.001); and lacerations of genital organs after birth (RR 2.14, 95% CI 1.49-3.09, P<0.001). Coagulopathy was not prevalent in primary PPH. CONCLUSION: Based on our findings, uterine atony remains the foremost cause of primary PPH. As well as other established risk factors for PPH, antepartum haemorrhage and intra uterine fetal death should be included as risk factors in the development and validation of prediction models for PPH. Large scale studies are needed to investigate further potential PPH risk factors.

Ethical decision making in the resuscitation of extremely premature infants: the health care professional's perspective.

Across Canada, the rate of preterm birth (i.e., at < 37 weeks' gestation) has been steadily increasing. Advances in perinatal medicine and neonatal intensive care have resulted in an increased capacity to intervene at the extremes of prematurity, leading to an increase in the overall survival of infants born at early gestations. There has been little corresponding decrease in long-term complications. As a result, additional stresses are placed on neonatal intensive care units across the country, impacting families, health care professionals, and society as a whole. Moral distress and moral residue are often cited in the neonatal-perinatal literature as stressors experienced by those who participate in the resuscitation decision-making process. They are directly related to the challenge of making a concrete decision about life and death at extremely early gestations in the context of long-term uncertainty. In this review, we performed a systematic search of medical and ethics literature pertaining to resuscitation at the extremes of prematurity. The perspective of health care professionals is explored, including how definitions of viability and parental perspectives contribute to the decision-making process. We argue for the necessity of further research exploring the inter-professional context of ethical decision making at the extremes of prematurity.

Black African Newcomer Women's Perception of Postpartum Mental Health Services in Canada.

STUDY BACKGROUND: The stress of immigrating, settling into Canada, and being a new mother, may place newcomer women at risk of mental health challenges. However, little is known on Black African newcomer women's perspectives of postpartum mental health care after experiencing childbirth in Canada. PURPOSE: To explore sociocultural factors that impact Black African newcomer women's perception of mental health and mental health service utilization within a year after childbirth in Canada. METHODS: This qualitative study, set in Southern Ontario, purposively sampled 10 African newcomer women who birthed a baby in Canada within the past year. Open-ended, semistructured interviews were conducted individually, transcribed and analyzed using thematic analysis. RESULTS: Black African newcomer women rely on mental strength, nonmedical treatment preferences, spirituality, and spousal support for fostering postpartum mental health. Furthermore, cultural beliefs, racial discrimination, and temporary immigration status impact their decision making around postpartum mental health services utilization. CONCLUSION: Our findings suggest that Black African newcomer women use mental strength to minimize maternal mental illness. Also, the spouses of Black African newcomer women are crucial in their postpartum mental health support. There is an urgent need for culturally safe interventions to meet the postpartum mental health needs of Black African newcomer mothers.

Translating developmental origins of health and disease in practice: health care providers' perspectives.

Currently, there is limited knowledge on how health care providers perceive and understand the Developmental Origins of Health and Disease (DOHaD), which may impact how they inform patients and their families throughout the perinatal period. This qualitative descriptive study explored if and how health care providers counsel on in utero programming and future health outcomes with parents, both preconception and during pregnancy. One-on-one, semi-structured interviews were conducted with 23 health care providers from varying health disciplines including obstetrics and gynaecology, midwifery, paediatrics, endocrinology and internal medicine. Audiotaped interviews were transcribed verbatim and analysed using inductive thematic analysis. Three themes were identified: Knowledge about DOHaD, Counselling on DOHaD in Practice Settings and Impact of DOHaD on Health. Health care providers not only expressed excitement over the potential health benefits of DOHaD counselling but also indicated barriers to knowledge translation, including a lack of knowledge among providers and a disconnect between basic scientists and practitioners. All health care providers expressed concerns on how and when to introduce the concept of DOHaD when counselling patients and called for the development of practice guidelines. Counselling on DOHaD needs to be framed in a way that is empowering, minimising the potential of coercion and guilt. More interaction and collaboration are needed between health care providers and researchers to identify strategies to support knowledge translation generated from DOHaD research into practice settings.