A systematic review of qualitative evidence: Perspectives of fathers whose partner experienced postpartum psychosis.

AIMS: This study aimed to systematically identify, appraise and synthesize qualitative evidence which explored fathers' experiences and perspectives of their partners' postpartum psychosis. DESIGN: Qualitative evidence synthesis (QES). DATA SOURCES: Seven databases (CINAHL, PsycINFO, Medline, Scopus, Google Scholar, ProQuest Dissertations and Open Grey) were systematically searched for qualitative studies from each database's inception to the 17th of February 2022. REVIEW METHODS: Studies that utilized a qualitative research design to explore fathers' experiences and perspectives of their partners' postpartum psychosis were included. Studies were appraised using the Critical Appraisal Skills Programme to determine their methodological quality. Qualitative data were extracted and synthesized using the process of thematic synthesis to form analytical themes. RESULTS: Eleven reports (seven journal articles and four theses), representing six unique qualitative studies were included in the review. Two analytical themes and eight subthemes were identified. The analytical themes were 'a sense of loss across multiple domains of their lives', and 'informational and emotional support needs'. CONCLUSION: Postpartum psychosis is a severe mental health condition which also impacts the woman's partner. Fathers experienced an array of emotions which they attributed to a lack of knowledge and understanding of postpartum psychosis. The development of appropriate support structures is needed to better support fathers in supporting their partners. REPORTING METHOD: This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and ENTREQ reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution. IMPACT: WHAT PROBLEM DID THIS STUDY ADDRESS?: Fathers play a pivotal role in supporting their partner who has postpartum psychosis, and a supportive father has a positive impact on the mental health of the mother. Several qualitative studies have explored fathers' experiences of their partners' psychosis. This QES integrated findings from these studies to gain a deeper understanding and knowledge of the father's experience. WHAT ARE THE MAIN FINDINGS?: Fathers reported a significant sense of loss across multiple domains of their lives, from a perceived loss of their relationship with their partner to a loss of the future they had planned together. Fathers experienced an array of emotions, such as fear and shock which they attributed to their lack of knowledge and awareness of postpartum psychosis. WHERE AND ON WHOM WILL THIS RESEARCH HAVE AN IMPACT?: This review provides a deeper insight and understanding into the father's experiences and perspectives of their partners' postpartum psychosis. This insight can inform healthcare professionals and policymakers in the development of appropriate support structures which meet the needs of this population. The provision of appropriate support structures could have a positive impact on the father's well-being and ability to support their partner.

Women's experiences of specialist perinatal mental health services: a qualitative evidence synthesis.

PURPOSE: Specialist perinatal mental health services identify and treat women experiencing mental health conditions during pregnancy and up to one year post birth. There is limited knowledge about women's experiences of care from specialist services. Evaluation and optimisation of service delivery requires knowledge of women's care experiences. This review aimed to systematically identify, appraise, and synthesise qualitative evidence exploring women's experiences of specialist perinatal mental health services. METHODS: A systematic literature search of five databases: Medline (OVID), EMBASE (Elsevier), PsycINFO (EBSCO), CINAHL (EBSCO) and Scopus (Elsevier), grey literature searching, and backward citation, identified a total of 1035 papers of which sixteen met inclusion criteria. Methodological quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) tool. RESULTS: Thematic synthesis identified three themes: connected relationships; new beginnings; and meaningful service delivery. Findings identified that relationships developed with clinicians were significant to women and their experience of care. Women valued continuity of care from dedicated non-judgemental clinicians. Peer support from other mothers was perceived as meaningful to women. Through service interventions women gained new insights into their infant's needs and grew in confidence as a mother. CONCLUSIONS: Women require provision of flexible and accessible specialist services with clinicians who are sensitive to their individual psychosocial needs and preferences. Examining discharge practices and continuing care needs is essential to ensure the best outcomes for women and their families.

Fourth year intellectual disability student nurses' journey and future work intention: a qualitative study.

BACKGROUND: The aim of this qualitative study is to explore the views and experiences of final year BSc intellectual disability nursing students' journey, future work plans and examine factors influencing their migration intentions following graduation. METHODS: A qualitative component of a mixed methods study where a focus group interview was conducted with final year BSc intellectual disability nursing students (n = 10) from one University in Ireland in June 2019. A topic guide was utilised, and participant's were interviewed about their programme, future work plans and migration intentions. An inductive approach was utilised, and data were analysed using a pre-existing framework for initial coding and thematic development. Duffy's conceptual model of identity transformation provided a structure to analyse the data and map themes onto the conceptual framework. RESULTS: The findings were mapped onto the five stages of Duffy's (2013) conceptual model of identity transformation: Pre-Entry; Reaffirming; Surmounting; Stabilising and Actualising. Findings indicate that further work is required to promote intellectual disability nursing and address professional esteem issues, support for education and professional development, such as providing career guidance opportunities prior to course completion, development of clinical skills within their education programme and support for the professional development of new graduates. Participant's identified uncertainty about career opportunities and saw scope for future professional development opportunities particularly in community-based work. CONCLUSION: This study has identified that final year intellectual disability nursing students are uncertain about career options and opportunities for intellectual disability nurses in other country's. There is an urgent need for the intellectual disability nursing profession to articulate their practice and advocate for their role and contribution to the care of people with intellectual disability. This study identified a clear need for direction and information regarding intellectual disability nursing roles and career opportunities.

Physiological track-and-trigger/early warning systems for use in maternity care.

BACKGROUND: A considerable challenge for maternity care providers is recognising clinical deterioration early in pregnant women. Professional bodies recommend the use of clinical assessment protocols or evaluation tools, commonly referred to as physiological track-and-trigger systems (TTS) or early warning systems (EWS), as a means of helping maternity care providers recognise actual or potential clinical deterioration early. TTS/EWS are clinician-administered (midwife, obstetrician), bedside physiological assessment protocols, charts or tools designed to record routinely assessed clinical parameters; that is, blood pressure, temperature, heart rate, urine output and mental/neurological alertness. In general, these systems involve the application of scores or alert indicators to the observed physiological parameters based on their prespecified limits of normality. The overall system score or alert limit is then used to assist the maternity care provider identify a need to escalate care. This, in turn, may allow for earlier intervention(s) to alter the course of the emerging critical illness and ultimately reduce or avoid mortality and morbidity sequelae. OBJECTIVES: To evaluate the clinical- and cost-effectiveness of maternal physiological TTS/EWS on pregnancy, labour and birth, postpartum (up to 42 days) and neonatal outcomes. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (28 May 2021), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (7 June 2021), OpenGrey, the ProQuest Dissertations and Theses database (7 June 2021), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials (RCTs), including cluster-RCTs, comparing physiological TTS/EWS with no system or another system. Participants were women who were pregnant or had given birth within the previous 42 days, at high risk and low risk for pregnancy, labour and birth, and postpartum complications. DATA COLLECTION AND ANALYSIS: Two review authors (VS and MN) independently assessed all identified papers for inclusion and performed risk of bias assessments. Any discrepancies were resolved through discussion and consensus. Data extraction was also conducted independently by two review authors (VS and MN) and checked for accuracy. We used the summary odds ratio (OR) with 95% confidence intervals (CIs) to present the results for dichotomous data and the mean difference (MD) with 95% CI to present the results for continuous data. MAIN RESULTS: We included two studies, a parallel RCT involving 700 women and a stepped-wedge cluster trial involving 536,233 women. Both studies were published in 2019, and both were conducted in low-resource settings. The interventions were the 'Saving Mothers Score' (SMS) and the CRADLE Vital Sign Alert (VSA) device, and both interventions were compared with standard care. Both studies had low or unclear risk of bias on all seven risk of bias criteria. Evidence certainty, assessed using GRADE, ranged from very low to moderate certainty, mainly due to other bias as well as inconsistency and imprecision. For women randomised to TTS/EWS compared to standard care there is probably little to no difference in maternal death (OR 0.80, 95% CI 0.30 to 2.11; 1 study, 536,233 participants; moderate-certainty evidence). Use of TTS/EWS compared to standard care may reduce total haemorrhage (OR 0.36, 95% CI 0.19 to 0.69; 1 study, 700 participants; low-certainty evidence). For women randomised to TTS/EWS compared to standard care there may be little to no difference in sepsis (OR 0.21, 95% CI 0.02 to 1.80; 1 study, 700 participants; low-certainty evidence), eclampsia (OR 1.50, 95% CI 0.74 to 3.03; 2 studies, 536,933 participants; low-certainty evidence) and HELLP (OR 0.21, 95% CI 0.01 to 4.40; 1 study, 700 participants; very low-certainty evidence), and probably little to no difference in maternal admission to the intensive care unit (ICU) (OR 0.78, 95% CI  0.53 to 1.15; 2 studies, 536,933 participants; moderate-certainty evidence). Use of TTS/EWS compared to standard care may reduce a woman's length of hospital stay (MD -1.21, 95% CI -1.78 to -0.64; 1 study, 700 participants; low-certainty evidence) but may result in little to no difference in neonatal death (OR 1.06, 95% CI 0.62 to 1.84; 1 study, 700 participants; low-certainty evidence). Cost-effectiveness measures were not measured in either of the two studies.  AUTHORS' CONCLUSIONS: Use of TTS/EWS in maternity care may be helpful in reducing some maternal outcomes such as haemorrhage and maternal length of hospital stay, possibly through early identification of clinical deterioration and escalation of care. The evidence suggests that the use of TTS/EWS compared to standard care probably results in little to no difference in maternal death and may result in little to no difference in neonatal death. Both of the included studies were conducted in low-resource settings where the use of TTS/EWS might potentially confer a different effect to TTS/EWS use in high-resource settings. Further high-quality trials in high- and middle-resource settings, as well as in discrete populations of high- and low-risk women, are required.

COVID-19 healthcare policies in Ireland: A rapid review of the initial pandemic response.

AIMS: Healthcare systems urgently required policies to guide the response to the COVID-19 pandemic. The aim of this review was to document the healthcare policies developed during the initial wave of widespread COVID-19 transmission in Ireland. We further sought to determine the key focus and impact of these policies. METHODS: We conducted a rapid review of COVID-19 healthcare policies published from 28 January to 31 May 2020. Key information including the focus of the policy, target population and impact on service delivery was extracted from included policies. During analysis, data was grouped under descriptive categories and narrative summaries were developed for each category. RESULTS: We identified 61 healthcare policies relating to COVID-19. We developed six category headings to describe the focus and impact of these policies: infection prevention and control (n = 19), residential care settings (n = 12), maintaining non-COVID-19 healthcare services and supports (n = 12), testing and contact tracing (n = 7), guidance for healthcare workers concerning COVID-19 (n = 6), and treating COVID-19 (n = 5). CONCLUSIONS: This review has identified lessons for policy development and implementation to help prepare for future healthcare emergencies. Factors to consider include support of vulnerable groups during and in the aftermath of the pandemic, providing psychological supports for healthcare workers and investment in public healthcare services such as contact tracing for future emergencies. While pandemic conditions necessitate the speedy development of policies, effective communication and adequate resourcing is required to ensure policy implementation.

Public health nurses' perinatal mental health training needs: A cross sectional survey.

AIM: To examine public health nurses' education, training, and professional support needs in perinatal mental health. BACKGROUND: Public health nurses have a key role in supporting maternal mental health including screening, support, referral, and decreasing stigmatization. DESIGN: A cross-sectional survey. METHODS: Data were collected from a convenience sample of Irish public health nurses (N = 105) from December 2016-February 2018. The anonymous postal survey consisted of the Perinatal Mental Health Questionnaire, Mental Illness: Clinician's Attitudes scale and Perinatal Mental Health Learning Needs questionnaire. RESULTS: Public health nurses reported good levels of knowledge (77.2%) and confidence (83.8%) in recognising women experiencing stress, anxiety and depression. They indicated less confidence in caring (50.5%) for women. The average score for the Mental Illness: Clinician's Attitudes scale was 35.9 (SD 5.9), suggesting positive attitudes towards women with significant mental illness. CONCLUSION: Public health nurses require educational opportunities to explore expressions of psychological distress across cultures and their own personal attitudes to mental health, systems of clinical supervision, and support pathways. IMPACT: Generating new knowledge on the importance of incorporating an attitude component in perinatal mental health education for public health nurses.

Life-story work in long-term care facilities for older people: An integrative review.

AIM: To systematically review the literature regarding the experience of older people, families and staff using life-story work in residential care facilities for older people. BACKGROUND: Life-story work has been promoted as an approach to enhance care provided and involves collecting memories and moments that are important to the person assisting them to regain their sense of self. DESIGN: An integrative review utilising the PRISMA reporting guidelines where seven databases, Scopus, EMBASE, CINAHL, MEDLINE, PsychInfo, PsychARTICLES, and Cochrane, were searched within the timeframe; 1 January 2006 to 14 March 2016. Data were reviewed using Whittemore and Knalf's (Journal of Advanced Nursing, 2005, 52:546) methodological approach for integrative reviews. Analysis was conducted utilising Braun and Clarke's (Qualitative Research in Psychology, 2006, 3:77) six phases to identify, analyse and record themes within the data. RESULTS: Thirteen articles were reviewed, and the review found that life-story work has been introduced using a range of different approaches, with no common approach. Thematic analysis identified two: maintaining identity and building and maintaining relationships. CONCLUSION: The review extends the current evidence on the experience of using life-story work in long-term aged care facilities for older people. Life-story work has the potential to enhance person-centred care in long-term care. However, improving the process of implementation of life-story work will require education, time and resources and a commitment from service providers and managers. RELEVANCE TO CLINICAL PRACTICE: Staff who undertake life-story work with residents need to be equipped with the skills to recognise and manage the challenges and issues that may potentially arise. Further research into the successful implementation of life-story work and how it can be resourced is required.

Family physicians perceived role in perinatal mental health: an integrative review.

BACKGROUND: Responding to and caring for women who experience mental health problems during the perinatal period, from pregnancy up to one year after birth, is complex and requires a multidisciplinary response. Family physicians are ideally placed to provide an effective response as it is recognised that they are responsible for organising care and supports for women and their families. This paper reports an integrative review undertaken to examine family physicians' perceived role in perinatal mental health care and concludes with recommendations for health policy, research and practice. METHOD: A systematic search of literature in seven databases from January 2000 to March 2016 identified a total of 1125 articles. Qualitative, quantitative and mixed-method studies were eligible for inclusion if they explored family physicians' experiences of caring for women who experience perinatal mental health problems. RESULTS: Thirteen articles reporting 11 studies met the inclusion criteria for this review and quality of included studies were assessed using published criteria for the critical appraisal of qualitative and quantitative research methods. Cross-study narrative syntheses of quantitative and qualitative findings are presented under three themes: identification of perinatal mental health problems, management of perinatal mental health problems and barriers to care provision. While family physicians recognise their role in relation to perinatal mental health the collective interpretation revealed that; they receive variable levels of preparation for this role, no consistent approach to screening exists, pharmacological management of mood disorders is the main treatment modality and limited access to specialist perinatal mental health services exists which impacts on pharmacology decisions. CONCLUSION: Family physicians require timely access to local integrated care pathways that provide a wide range of services that are culturally sensitive, perinatal mental health specific, support psychological well-being and infant/family mental health. Family physicians are open to incorporating a brief validated screening tool into primary practice supported by succinct guidelines. Research that examines training needs in relation to perinatal mental health could be used to inform family physician training programmes and curriculum development around perinatal mental health.

Irish general practitioners' view of perinatal mental health in general practice: a qualitative study.

BACKGROUND: Identification of perinatal mental health problems and effective care for women who experience them are important considering the potentially serious impact that they may have on the wellbeing of the woman, her baby, family and wider society. General practitioners (GPs) play a central role in identifying and supporting women and this study aimed to explore GPs' experiences of caring for women with perinatal mental health problems in primary care. The results of this study may provide guidance to inform policy, practice, research and development of curriculum and continuous professional development resources. METHOD: In-depth semi-structured interviews were undertaken between March and June 2017 with GPs (n = 10) affiliated with a University training programme for general practice in Ireland. Thematic data analysis was guided by Braun and Clarkes (2013) framework. RESULTS: Data were categorised into three themes with related subthemes: identification of perinatal mental health problems, decision making around perinatal mental health and preparation for a role in perinatal mental health. GPs described the multifaceted nature of their role in supporting women experiencing perinatal mental health issues and responding to complex psychological needs. Inbuilt tools on existing software programmes prompted GPs to ask questions relating to perinatal mental health. Limited access to referral options impacts on assessment and care of women. GPs desire further continuous professional development opportunities delivered in an online format and through monthly meetings and conference sessions. CONCLUSIONS: GPs require access to culturally sensitive; community based perinatal mental health services, translation services and evidence based perinatal psychological interventions. A standardised curriculum on perinatal mental health for trainee GPs needs to be established to ensure consistency across primary care and GP education should incorporate rotations in community and psychiatry placements.

A qualitative meta-synthesis: public health nurses role in the identification and management of perinatal mental health problems.

AIM: To report findings of a systematic review and meta-synthesis of qualitative studies exploring public health nurses' perceptions and experiences of identifying and managing women with perinatal mental health (PMH) problems. BACKGROUND: Public health nurses play a key role in supporting women who experience PMH problems and several qualitative studies have explored their role. DESIGN: Systematic review and meta-synthesis DATA SOURCES: A comprehensive search was developed and multiple databases were searched from 2000-2015. REVIEW METHODS: Studies that employed qualitative methods to explore experiences of public health nurses in identifying and managing women with PMH problems were included. Two reviewers independently assessed the methodological quality of studies. Themes, concepts and interpretations were extracted and synthesized using the process of thematic analysis. RESULTS: Fifteen papers including 14 unique qualitative studies were included. Two overarching themes were identified: 'conceptualization and detection of PMH problems' and 'barriers and facilitators to management'. The former of these comprised several subthemes including the use of formal screening tools vs. clinical intuition and challenges encountered in detection. The latter theme, barriers to management included availability of referral pathways and time. In terms of facilitators, training, public health nursing interventions, support groups and referral pathways were identified as factors that optimize management. CONCLUSIONS: Public health nurses use a variety of methods to identify women with PMH problems. However, several support structures are needed to optimize management including access to appropriate referral pathways, support groups and relationship continuity.

Nursing research ethics, guidance and application in practice.

Ethics is fundamental to good research practice and the protection of society. From a historical point of view, research ethics has had a chequered past and without due cognisance there is always the potential for research to do harm. Research ethics is fundamental to research practice, nurse education and the development of evidence. In conducting research, it is important to plan for and anticipate any potential or actual risks. To engage in research, researchers need to develop an understanding and knowledge of research ethics and carefully plan how to address ethics within their research. This article aims to enhance students' and novice researchers' research ethics understanding and its application to nursing research.

Preparing and conducting interviews to collect data.

AIM: To describe three styles of interviews and discuss issues regarding planning and conducting interviews. BACKGROUND: Interviews are probably the approach most used to collect data in studies. They are particularly useful in uncovering the story behind a participant's experiences. Researchers can follow a line of questions to gain information about a topic, or further explore responses or findings. But the researcher needs to plan and decide the format of the interview before collecting data. REVIEW METHODS: The authors included papers on structured, unstructured and semi-structured interviews published in a peer-reviewed joumrnal and in English. DISCUSSION: Interviews are one of the most common metods of data collection in qualitative research. However they require the researcher to have a sound understanding of their use and appropriateness. The ability to conduct interviews is one that develops over time and to aid the researcher in developing their interview skills they should consult with other researchers, seeking comments and advice and, critically, to appraise audio recordings. CONCLUSION: This article aims to support students who are undertaking research modules as part of their academic studies, writing a research proposal or novice researchers who are about to use interviews as a means of data collection. IMPLICATIONS FOR RESEARCH/PRACTICE: To conduct a successful interview, researchers need to develop their interview technique, choose the right method and carefully plan for all aspects of the process.

Parents experiences of pregnancy following perinatal loss: An integrative review.

BACKGROUND: Pregnancy following perinatal loss has a profound effect on parents and may contribute to intense psychological distress including grief, post-traumatic stress disorder, anxiety and depression. The subsequent pregnancy may also be perceived as more stressful due to the fear of recurrent loss. Midwives and other health care professionals need to be sensitive and empathetic to the needs of these parents when providing care in a pregnancy subsequent to a loss. METHODOLOGY: The aim of this integrated literature review was to explore parents' experiences of pregnancy following a previous perinatal loss using a systematic approach. This is presented in a five-stage process that includes problem identification, literature search, data extraction and evaluation, data analysis and presentation of results. A systematic search of seven electronic databases was conducted (Jan 2009 -Jan 2023) to identify relevant primary research which addressed parents' experiences of pregnancy following a previous perinatal loss. Seven papers met the eligibility criteria and were assessed for quality using Crowe's Critical Appraisal Tool (CCAT). Thematic analysis identified two themes. FINDINGS: The key themes identified from the literature were; the psychosocial needs and challenges faced by previously bereaved parents in subsequent pregnancies; and the need for specialist care and support in a subsequent pregnancy. Psychological needs and challenges included continued grief, depression, anxiety, and disparities in the grief process between men and women. The importance of specialist care with an increased level of support from competent, confident and compassionate health care providers was highlighted. CONCLUSION: The experience of pregnancy following a perinatal loss can be a complex emotional experience for parents. The review identifies the need for post pregnancy loss debriefing and counselling and care pathways specific to caring for women and their partners in a pregnancy subsequent to a perinatal loss. Care in pregnancy subsequent to loss should be provided by empathetic, competent health care providers and include additional antenatal clinic appointments, pregnancy monitoring and psychological support in order to meet the needs of these expectant parents.

Midwifery students' experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study.

OBJECTIVE: To explore the impact of the COVID-19 global pandemic on midwifery students' experiences of clinical internship placement in the final year of their midwifery programme. DESIGN: A qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated. SETTING AND PARTICIPANTS: To prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study. FINDINGS: Four overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students' ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Midwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.

Experiences and perspectives of women who have committed neonaticide, infanticide and filicide: A systematic review and qualitative evidence synthesis.

WHAT IS KNOWN ON THE SUBJECT?: The phenomenon of child killing (neonaticide, infanticide or filicide) is a rare event that cannot be fully explained by a single construct as each case involves the unique life circumstances of each woman who committed the act(s). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of women who committed neonaticide, infanticide or filicide regretted the act and regretted not seeking help from family and healthcare professionals. Women who committed neonaticide, infanticide or filicide in the main had complex circumstances characterised by poverty, abusive relationships, poor family and social support or over reliance on family supports and mental health issues. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Women require a clear plan of what to do if they feel overwhelmed with caring for a baby or child. Healthcare professionals involved with women in the perinatal period need to explore further women's expressions of "not being ready to be a mother" which for some women may be pathological and require further assessment. Women need to be made aware of the support service pathways available to them during the perinatal period and beyond. Further research is needed to explore and learn from women's experiences to reduce child homicide mortality and support women and their families. ABSTRACT: INTRODUCTION: Meaning and personal experiences of the acts of neonaticide, infanticide and filicide have rarely been investigated from the perspectives of the women who committed those acts. AIMS: To identify and synthesise evidence on the perspectives of women directly involved in the complex phenomena of neonaticide, infanticide or filicide from the evidence available on their unique point of view and how these experiences have affected women's lives. To understand how the experiences and perceptions of women who engaged in child killing present similarities or differences according to the child's age at time of death. METHODS: Qualitative primary studies published in English were included if they explored the experiences of women who engaged in neonaticide, infanticide or filicide. Methodological quality was assessed using the qualitative Critical Appraisal Skills Programme (CASP) checklist. A thematic analysis framework guided the synthesis. RESULTS: Seven papers reporting on five studies met the inclusion criteria for the review. Three analytical themes were identified: Not ready to be a mother; Intentionality and premeditation in the context of trauma and mental health issues; Sorrow of regret. DISCUSSION: The majority of women who committed neonaticide, infanticide or filicide had complex psychological, social and personal circumstances and in the main regretted the act and regretted not seeking help from family and healthcare professionals. Healthcare professionals in contact with women during the perinatal period and beyond need to be aware of the profiles of vulnerable women and undertake holistic integrated assessments to identify the woman's personal context, changes in interpersonal relationships, social isolation or over reliance on family supports and changes in mental health status or new onset of mental health conditions. IMPLICATIONS FOR PRACTICE: Women require a clear plan of what to do if they feel overwhelmed with caring for a baby or child. Healthcare professionals involved with women in the perinatal period need to explore further women's expressions of "not being ready to be a mother" which for some women might be pathological and require further assessment. Women need to be made aware of the support services pathways available to them during the perinatal period and beyond. Further research is needed to explore and learn from women's experiences of each of the phenomena separately to reduce child homicide mortality and support women and their families.

"Stranger in a mask" midwives' experiences of providing perinatal bereavement care to parents during the COVID-19 pandemic in Ireland: A qualitative descriptive study.

OBJECTIVE: To explore the experiences and perceptions of midwives providing perinatal bereavement care during the COVID-19 pandemic and to identify the barriers and facilitators to providing compassionate bereavement care. DESIGN: A qualitative descriptive design was utilized to address the research question. Following ethical approval, in depth, semi structured interviews were undertaken to explore midwives' experiences of providing care to parents following perinatal bereavement. Narrative data was analyzed using thematic analysis. SETTING: A standalone regional maternity hospital located in a large metropolitan center in the Republic of Ireland. PARTICIPANTS: A purposeful sample of eleven midwives, who cared for bereaved parents during the COVID-19 pandemic volunteered to participate in the study. FINDINGS: Two main themes were identified, each with associated subthemes (1) Challenges of providing compassionate bereavement care during a pandemic (2) Psychological effect and coping strategies utilised by midwives during a pandemic. CONCLUSION: The COVID-19 pandemic brought unprecedented challenges when providing perinatal bereavement care. The mandatory infection prevention and control measures significantly disrupted human communication and connections. Participants in the study utilized techniques to optimize care while adhering to COVID-19 guidelines, and simultaneously putting their own fear and anxieties aside.

Fostering Collective Approaches in Supporting Perinatal Mental Healthcare Access for Migrant Women: A Participatory Health Research Study.

Perinatal mental health is a growing public health concern. The mounting evidence examining the prevalence of perinatal mental illness identifies specific vulnerabilities and risk factors among migrant women. We know that migrant women experience persistent and systematic barriers in accessing healthcare and that healthcare services do not always respond appropriately to migrant women's needs, highlighting the need for targeted interventions in supporting positive perinatal mental health among migrant women. The purpose of this participatory health research study was to explore perinatal mental healthcare for migrant women in Ireland, from the perspectives of a diverse range of stakeholders (healthcare service providers, community organisations/networks/associations and migrant women). A key focus of this study was to collaboratively explore solution-focused approaches to improving access to supports and healthcare services for migrant women experiencing perinatal mental illness. Following ethical approval, data were collected during three key convenings, utilising the design principles of world café philosophies. Thematic analysis led to the generation of the following two themes: Building Capability and Capacity and Empowering Migrant Women. The main conclusions lie in the provision of whole-system approaches in collectively, collaboratively and proactively planning strategies that address the many factors that affect access to healthcare services for migrant women experiencing perinatal mental illness. Drawing on the collective perspectives of a wide range of stakeholders, our innovative solution focused on providing recommendations aimed at strengthening supports and healthcare services for migrant women.

Service User and Service Provider Perceptions of Enablers and Barriers for Refugee and Asylum-Seeking Women Accessing and Engaging with Perinatal Mental Health Care Services in the WHO European Region: A Scoping Review Protocol.

There is a need to understand the specific perinatal mental health care needs of migrant subgroups who often have differing health care needs and specific barriers to accessing and engaging with health care services. It is important to have evidence about the WHO European context given the rising numbers of refugees and asylum seekers in the region. The aim of this scoping review is to map the factors that enable and prevent access and engagement of refugee and asylum-seeking women with perinatal mental health care services in the WHO European Region, from the perspectives of service providers and service users. The database search will include PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL complete, Scopus, Academic Search Complete, and Maternity and Infant Care (OVID). Search results will be exported to an online tool that provides a platform to help manage the review process, including title, abstract, and full-text screening and voting by reviewers independently. Data concerning access and engagement with health care services will be mapped on to the candidacy framework. Systematically searching evidence within the WHO European region and examining this evidence through the candidacy lens will help develop a more comprehensive and a deeper conceptual understanding of the barriers and levers of access and engagement with perinatal mental health care services, whilst identifying gaps in existing evidence. Exploring factors that influence access and engagement for refugee and asylum-seeking women from the perspective of key stakeholders in the service provision and/or service utilisation of perinatal mental health care services will add a more comprehensive understanding of the recursive relationship between service provision and use.

A Review of the Involvement of Partners and Family Members in Psychosocial Interventions for Supporting Women at Risk of or Experiencing Perinatal Depression and Anxiety.

A maternal experience of perinatal mental health conditions can have serious short- and long-term consequences for child development and family relationships. Women with perinatal depression and/or anxiety are primarily supported by their partner/spouse and family. The aim of this review was to synthesise data from studies that have examined the inclusion of partners or family members in psychosocial interventions for women at risk of or experiencing perinatal depression and/or anxiety. A systematic search of five databases was conducted to identify literature published between 2010 and 2020. Nine empirical studies met the eligibility criteria and were independently assessed by two authors using the National Heart, Lung and Blood Institute Quality Assessment Tools and data were extracted and narratively synthesised guided by TIDieR (Template for Intervention Description and Replication) checklist. Eligible studies detailed diverse interventions facilitated by a variety of programme facilitators, with no central model of intervention or study outcome measures evident across the studies. All studies except one reported a significant change in maternal depression and anxiety scores. The interventions had limited evaluation of the woman's, partner's or family member's experiences of involvement in the intervention. Further research is required to firmly establish the effectiveness of co-designed interventions to support the sustainable integration of such interventions into routine perinatal mental health services.

The Paternal Experience of Fear of Childbirth: An Integrative Review.

BACKGROUND: It is estimated that approximately 13% of expectant fathers experience a pathological and debilitating fear of childbirth. OBJECTIVE: The aim of this integrative review was to examine and synthesise the current body of research relating to paternal experience of fear of childbirth. METHODS: A systematic literature search of five databases-CINAHL, Cochrane Library, MEDLINE, PsycArticles and PsycInfo-identified seventeen papers. Methodological quality of studies was assessed using the Crowe Critical Appraisal Tool. RESULTS: Thematic data analysis identified three themes: the focus of fathers' childbirth-related fears, the impact of fear of childbirth on health and wellbeing, and fear of childbirth as a private burden. DISCUSSION: Fear of childbirth is a significant and distressing experience for expectant fathers who may benefit from an opportunity to express their childbirth-related fears in an environment where they feel validated and supported. Antenatal education is recommended to enhance fathers' childbirth-related self-efficacy to reduce fear of childbirth. CONCLUSIONS: Fear of childbirth may negatively impact the lives of men and consequently their families. Further investigation into methods and models for identifying and supporting men at risk of or experiencing fear of childbirth is required to improve outcomes for this population of men.