How do maternal and child health nurses incorporate infant mental health promotion into their clinical practice? Experiences of an Australian municipality.

The field of infant mental health (IMH) has offered valuable insights into the critical importance of social-emotional development, including the enduring influence of early experiences throughout life. Maternal and Child Health (MCH) nurses are ideally placed to facilitate knowledge sharing with parents. This Australian-based qualitative exploratory descriptive study explored how MCH nurses incorporate IMH in their clinical practice, and how they share this information with caregivers. Ten community-based MCH nurses participated in voluntary, semi-structured interviews which were transcribed verbatim and analyzed thematically. Findings identified five themes that characterized how MCH nurses incorporated IMH concepts into their practice. These themes were: prioritizing physical health promotion activities, highlighting infant communications, variations in knowledge and application of IMH concepts, workplace time schedules, and the relational nature of the work. Recommendations include encouraging IMH as a health promotion activity, facilitating IMH assessment, further education, reflective supervision, and extension of predetermined appointment times to enable knowledge and skill sharing. Further research is also recommended to provide additional insights into how nurses with IMH training promote and share IMH concepts with caregivers. Adoption of these recommendations would further enhance the care given to families and the role of the MCH nurses.

El campo de la salud mental infantil (IMH) ha ofrecido perspectivas valiosas sobre la suma importancia del desarrollo socioemocional en los primeros años para el desarrollo social y emocional posterior. Las enfermeras de la salud materno-infantil (MCH) se encuentran en posición ideal para facilitar el proceso de compartir conocimiento con los progenitores. Este estudio cualitativo, exploratorio y descriptivo, llevado a cabo en Australia, exploró cómo las enfermeras MCH incorporan IMH en sus prácticas clínicas y cómo ellas comparten esta información con los cuidadores. Un grupo de enfermeras MCH de base comunitaria participó en entrevistas voluntarias semiestructuradas. Las entrevistas se transcribieron palabra por palabra y se analizaron temáticamente. Los resultados identificaron cinco temas que caracterizaban cómo incorporaron los conceptos de IMH en su práctica. Estos temas fueron: actividades para promover el darle prioridad a la salud física, enfatizar las comunicaciones del infante, variaciones en el conocimiento y la aplicación de conceptos de IMH, tablas de horarios del lugar de trabajo y la naturaleza relacional del trabajo. Entre las recomendaciones se incluyen el fomentar IMH como una actividad de promoción de la salud, facilitar la evaluación de IMH, más educación, supervisión con reflexión, así como extensión del horario de citas predeterminado para permitir el proceso de compartir conocimiento y habilidades. También se recomienda más investigación para ofrecer perspectivas adicionales de cómo las enfermeras con entrenamiento de IMH promueven y comparten los conceptos de IMH con los cuidadores. La adopción de estas recomendaciones mejoraría más el cuidado que se ofrece a familias y el papel de las enfermeras MCH.

Le domaine de la santé mentale du nourrisson (IMH en anglais) a permis de mieux comprendre l'importance critique du développement socio-émotionnel dans les premières années pour le développement social et émotionnel ultérieur. Les infirmiers et infirmières de la Santé Maternelle et de l'Enfant (MCH en anglais) sont idéalement situées pour faciliter le partage des connaissances avec les parents. Cette étude Qualitative Exploratoire Descriptive, en Australie, a exploré comment les infirmier/infirmières MCH incorporent l'IMH dans leur pratique clinique et comment ils/elles partagent cette information avec les personnes prenant soin des enfants. Une cohorte de 10 infirmiers/infirmières MCH basées dans leur communauté ont participé à des entretiens volontaires semi-structurés. Les entretiens ont été transcrits verbatim et analysé de manière thématique. Les résultats ont identifié cinq thèmes qui ont caractérisé les concepts IMH dans leur pratique. Ces thèmes étaient: donner la priorité à la promotion d'activités de santé physique, la mise en évidence des communications du nourrisson, les variations dans les connaissances et l'application des concepts IMH, les emplois du temps du lieu de travail et la nature relationnelle du travail. Les recommandations incluent la nécessité d'encourager l'IMH en tant qu'activité de promotion de la santé, la facilitation de l'évaluation IMH, une formation supplémentaire, une supervision de réflexion et l'extension de rendez-vous pour développer les connaissances et partager les compétences. De plus amples recherches sont recommandées afin d'éclairer la manière dont les infirmiers/infirmières formées en IMH promeuvent et partagent les concepts IMH avec les personnes prenant soin des enfants. L'adoption de ces recommandations pour améliorer davantage le soin offert aux familles et les rôles des infirmiers/infirmières MCH.

Consultation to review clinical placement processes: A quality assurance project.

AIM: Working in partnership is a key goal for nursing and community health practice. This case study reports the quality assurance process employed to enhance the process of allocating clinical places for postgraduate Maternal and Child Health nurses in Victoria, Australia. BACKGROUND: The review of the clinical placement process occurred because councils (placement providers) reported being overwhelmed with inquiries and applications for places, time-line issues and some confusion about processes. This situation was further compounded as these clinical placements were provided by Councils at no cost to universities or students. DESIGN: The Quality Assurance consultation process was guided by an action research approach and systematically explored the experience of municipalities hosting students. METHOD: This involved five discrete phases: Online survey 1, Focus group, Draft consultation report, Online survey 2 and Distribution of Maternal and Child Health clinical placement process packages. Feedback was reported regarding what was working well, challenges with existing student placements and suggested strategies to improve the student placement process. RESULTS: Collaboration led to improvements in the clinical placement process and produced key resources for stakeholders. An unexpected outcome of the process was the development of a List of Expectations and Responsibilities for all stakeholders. CONCLUSION: The councils providing MCH clinical experience are highly valued by the universities and their students as clinical placement is provided voluntarily as a contribution to the MCH profession. All parties indicated it was very beneficial to collaborate to optimise this process.

Enablers and Barriers to Identifying Children at Risk of Developmental Delay: A Pilot Study of Australian Maternal and Child Health Services.

BACKGROUND: Twenty per cent of Australian children enter primary school with at least one area of developmental vulnerability (Commonwealth of Australia. (2018). Australian early development census [AEDC]. Retrieved from https://www.aedc.gov.au/.). This statistic is in the context of Maternal and Child Health (MCH) services offering regular developmental screening up to 8 times between 2 weeks and 3.5 years of age. OBJECTIVES: This study investigated: (1) enablers and barriers influencing MCH nurses in identifying children from birth to school age at risk of developmental delay. This focused on their experience, knowledge, attitudes and skills regarding the use of developmental screening tools. And (2) strategies to support MCH nurses and parents to identify children at risk of delay. METHOD: This mixed-methods study combined an online questionnaire and three focus groups and participants were MCH Nurses (N = 19) from one Australian municipality. RESULTS: MCH nurses surveyed (N = 19) reported more confidence in screening older children compared to children younger than 12 months. 15 of 19 nurses did not have accurate knowledge and skill in using PEDS and Brigance screens. In the focus group interviews (N = 16), time restraints, language used in developmental screening tools, and excessive waiting time for referral were raised as key barriers to identifying children at risk. LIMITATIONS: While the study provides rich insight, caution needs to be exercised when making generalisations from the findings given the small number of participants from one municipality. CONCLUSION: Recommendations for practice, service management, and further research are provided to improve the process of early detection.

Preceptor Education for Specialty Community-Based Nurses: A Pre- and Postevaluation.

BACKGROUND: Quality preceptorship is an integral aspect of nursing education. Evidence suggests that preceptor education programs can be designed to support RNs in their capacity as preceptors. Little has been reported on the effectiveness of preceptor programs for community-based nurses who provide primary health care for preschool children and their families. METHOD: The project evaluated the effectiveness of a 4-hour face-to-face tailored preceptor education program undertaken by 59 nurses in Victoria, Australia. Pre- and postsurveys were undertaken to evaluate the program. RESULTS: Participants had improved understanding of the role of preceptor after the education program. They had increased confidence in their ability to give feedback, assess clinical skills, and use the clinical assessment tool. They were also surer of the standard of performance expected of students. CONCLUSION: A strategically designed preceptor program was effective in improving some preceptorship skills of community-based nurses who supervise postgraduate nursing students. J Contin Educ Nurs. 2018;49(3):111-118.

The interaction of pregnancy, substance use and mental illness on birthing outcomes in Australia.

BACKGROUND: this study aimed to (1) assess the prevalence, and demographic features of women with a history of mental illness during pregnancy and childbirth, (2) investigate maternal and perinatal outcomes in relation to mental illness and substance use, and (3) determine the effects of maternal characteristics, history of mental illness and substance use on birth outcomes. METHODS: the records of 22,193 pregnant women who gave birth at one tertiary level health service comprising three maternity settings in Victoria, Australia from 2009 to 2011 were reviewed.Univariate comparisons for socio-demographic and birthing outcome variables by substance use and mental illness category were performed. A multivariable logistic regression model was developed to examine the effects of maternal characteristics on birth outcomes. RESULTS: mental illness was recorded for 1.08/1,000 delivery hospitalisations.Mothers with a history of mental illness had a significantly higher proportion of babies born with low birth weight (OR = 1.85, 95% CI 1.64 -2.09) and low Apgar 1 scores<7 (OR = 1.47, 95% CI 1.26 - 1.70).Differences in health behaviours were also noted between the two groups.Babies born to women with an illicit and poly substance use history reported an average birth weight at 2,951 (SD 777) grams compared to birth weight of approximately 3,300 g of smoking and alcohol user groups, as well as shorter gestational age and lower birth weight. There was a statistically significant interaction between the effects of mental illness and substance use on birth weight. This interaction effect was not significant for gestational age. Logistic regression showed the strongest predictor of reporting a premature birth and low birth weight was using substances, recording an odds ratio of 1.95 (95% CI 1.50-2.53) and 2.73 (95% CI 2.15-3.47) respectively. CONCLUSIONS: mental health history should be highlighted as being a common morbidity and the increased risk of poorer birth outcomes especially when the women were also using substances, alcohol or tobacco should be acknowledged by the health practitioners.

Women's experiences of learning to breastfeed.

AIM: This research explores women's experiences of learning to breastfeed. DESIGN: A purposive cohort of healthy mothers participated in individual audio recorded interviews late pregnancy and then 2 and 8 weeks after birth. All interviews were transcribed verbatim and analysed using van Manen's approach. SETTING AND PARTICIPANTS: Participants were 13 first time mothers based in a rural municipality in Victoria, Australia. KEY FINDINGS: Women's voices gave rich descriptions of their experience of learning to breastfeed. Women shared the physicality of having 'great big engorged breasts' or 'sore nipples', and 'learning to latch' while 'having so very many things happening'. CONCLUSION: Many participants felt overwhelmed with learning to breastfeed at the same time as coping with caesarean wounds, perineal trauma, uterine bleeding and extreme fatigue. FUTURE IMPLICATIONS: Parenting education needs to be offered early in pregnancy so couples can explore birthing and its potential outcomes and to introduce infant cues and behaviours as a base for understanding how these impact on breastfeeding and problem solving.