The Biomedical and Health Informatics Recommendation Domains in Relation to the Nurse Competence Scale Categories.

The purpose of this mapping review was to examine the Recommendations of the Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics (BMHI) in relation to the contents of the Nurses' Competency Scale (NCS). The BMHI domains were mapped to the NCS categories to find analogous competence areas. As a conclusion, a consensus is presented on what each of the BMHI domain could mean on a responding NCS category. The number of the relevant BMHI domains were two for the Helping role, the Teaching and coaching, the Diagnostics functions, the Therapeutic interventions, and the Ensuring quality domains. The number of the relevant BMHI domains was four for the Managing situations and the Work role domains, of the NCS. The essence of nursing care has not changed, however, current means and equipment in practice require updated knowledge and digital skills for nurses. Nurses have a special role in narrowing the view gap between the views related to clinical nursing and informatics practice. Documentation, data analyses, and knowledge management are essential parts in nurses' competence today.

Palliative-care nurses' and physicians' descriptions of the competencies needed in their working units.

BACKGROUND: Specialists were asked to describe the most essential palliative and end-of-life care competencies needed in their working units, in order to deepen the understanding of the phenomenon. AIM: To describe the most essential competencies of palliative-care nurses and physicians. METHODS: The data was collected using an open-ended question in a survey sent to registered nurses (n=129) working within palliative care and to physicians (n=64) with a special competency in palliative care. The data was analysed using content analysis. RESULTS: The description of the most essential competencies included 16 main categories and 63 subcategories in total. The three strongest main categories were 'clinical competence', 'competence in social interactions' and 'competence in giving support'. Eleven main categories were based on both nurses' and physicians' data, while five main categories were created from nurses' data only. CONCLUSION: Interprofessional palliative-care education is recommended for the undergraduate and postgraduate education of nurses and physicians.

Palliative Nursing Competencies Required for Different Levels of Palliative Care Provision: A Qualitative Analysis of Health Care Professionals' Perspectives.

Background: Nurses must possess adequate competencies to provide high-quality palliative care. Earlier statements have described certain competencies that are relevant for palliative care, yet only limited empirical research has focused on the perspective of health care professionals to clarify which competencies are required for different levels of palliative care provision. Objective: The aim was to describe the required palliative nursing competencies of registered nurses aligned to different levels of palliative care provision, from the perspectives of multiprofessional groups. Design: A qualitative study design. Setting/Subjects: A purposive sample of professionals, working in different levels of palliative care across various settings in Finland, was used to gain information about the aim of the study (n = 222). Measurements: Content analysis was applied to describe the competencies of registered nurses. Results: Competencies relevant to basic palliative care were categorized under 17 main categories, which included a total of 75 subcategories. "Competence in managing the most common symptoms" was the main category that contained the largest number of reduced expressions (f = 75). An analysis of specialist palliative care data yielded 10 main categories, including 49 subcategories, with "Competence in maintaining expertise and taking care of own well-being at work" containing the most reduced expressions. Conclusion: The study provided new knowledge; more specifically, competencies related to encounters and maintaining hope were described as palliative care nursing competences. The results can be used to ensure that palliative nursing education focuses on the competences that are necessary in practice.

Effectiveness of Evidence-Based Practice (EBP) Education on Emergency Nurses' EBP Attitudes, Knowledge, Self-Efficacy, Skills, and Behavior: A Randomized Controlled Trial.

BACKGROUND: Emergency care clinicians are expected to use the latest research evidence in practice. However, emergency nurses do not always consistently implement evidence-based practice (EBP). An educational intervention on EBP was implemented to promote emergency nurses' use of EBP, and the effectiveness of it was evaluated. AIMS: This study aimed to evaluate the effectiveness of an EBP educational intervention on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The study also examined learners' satisfaction with the EBP educational intervention. METHODS: A randomized controlled trial with parallel groups with evaluations before the education, immediately after it, and 6 and 12 months after the education was conducted at four emergency departments in two university hospitals. The experimental group (N = 40) received EBP education while the control group (N = 40) completed self-directed EBP education. The primary outcomes were emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior, while the secondary outcome was satisfaction with the EBP education. RESULTS: Thirty-five participants of an experimental and 29 participants of a control group completed the study. There were no statistically significant (p < .05) improvements and differences between groups in EBP attitude, self-efficacy, or behavior immediately after the EBP education. At the 6-month measurement point, the experimental group showed significantly better EBP attitudes, behavior, knowledge, and self-efficacy than the control group. At the 12-month measurement point, the improvements began to decrease. The groups also differed significantly in terms of participant satisfaction with how the teacher encouraged learners to ask clinical questions. LINKING EVIDENCE TO ACTION: The EBP educational intervention implemented in this study had a positive effect on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The effects of the education appeared the best 6 months after the education. After this point, the results began to decrease and approached baseline levels. EBP educational interventions designed for emergency nurses should apply various teaching strategies to improve their EBP attitude, knowledge, self-efficacy, skills, behavior, and satisfaction with the education.

The required competencies of physicians within palliative care from the perspectives of multi-professional expert groups: a qualitative study.

BACKGROUND: Although statements on the competencies required from physicians working within palliative care exist, these requirements have not been described within different levels of palliative care provision by multi-professional workshops, comprising representatives from working life. Therefore, the aim of this study was to describe the competencies required from physicians working within palliative care from the perspectives of multi-professional groups of representatives from working life. METHODS: A qualitative approach, using a workshop method, was conducted, wherein the participating professionals and representatives of patient organizations discussed the competencies that are required in palliative care, before reaching and documenting a consensus. The data (n = 222) was collected at workshops held in different parts of Finland and it was analyzed using a qualitative content analysis method. RESULTS: The description of the competencies required of every physician working within palliative care at the general level included 13 main categories and 50 subcategories in total. 'Competence in advanced care planning and decision-making' was the main category which was obtained from the highest number of reduced expressions from the original data (f = 125). Competence in social interactions was another strong main category (f = 107). In specialist level data, six main categories with 22 subcategories in total were found. 'Competence in complex symptom management' was the main category which was obtained from the biggest number of reduced expressions (f = 46). A notable association between general level and specialist level data was related to networking, since one of the general level categories was 'Competence in consultations and networking' (f = 34) and one of the specialist level categories was 'Competence to offer consultative and educational support to other professionals' (f = 30). Moreover, part of the specialist level results were subcategories which belonged to the main categories produced from the general level data. CONCLUSIONS: The competencies described in this study emphasize decision-making, social interactions and networking. It is important to listen to the voices of the working-life representatives when planning curricula. Moreover, the views of the working-life representatives inform how the competencies gained during their education meet the challenges of the ordinary work.

A Quasi-Experimental Study of a Basics of Evidence-Based Practice Educational Intervention for Health and Social Care Professionals.

Education is one of the central interventions to promote evidence-based practice (EBP) in service organizations. An educational intervention to promote EBP among health and social care professionals was implemented in a Finnish hospital. The aim of this study was to explore the outcomes of an educational intervention, focusing on the basics of EBP for health and social care professionals, using a quasi-experimental study design. The data were collected with a questionnaire before, immediately after, and 6 months after the education (n = 48). The data were analyzed with descriptive statistics and nonparametric tests. Immediately after the education, an increase was found in the EBP knowledge of participants, in participants' confidence in their own ability to conduct database searches and read scientific articles, and in the number of participants using databases at work. Six months after the education, improvements were still found between the first and the third measurement in the participants' knowledge and confidence in their own ability to conduct database searches and read scientific articles. The number of those who had made an initiative about a research topic regarding the development of their own work had increased from the first to the third measurement. The educational intervention produced a statistically significant improvement on most of the areas evaluated. Significant improvements were often found even 6 months after the education was finished. However, the low completion rate and a quasi-experimental before and after design limit the conclusions that can be derived from this study.

A Typology of Breastfeeding Mothers of Preterm Infants: A Qualitative Analysis.

BACKGROUND: Breastfeeding is an important element of motherhood with a preterm infant, but the role of maternal emotions in relation to breastfeeding is vague. PURPOSE: To describe maternal emotions regarding and insights into breastfeeding during the first year after a preterm birth. METHODS: In total, 80 mothers of preterm infants (<35 gestational weeks) participated in this secondary analysis of a larger study. The data were collected with an open question at discharge and 3, 6, and 12 months after the expected birth date and analyzed using thematic analysis. FINDINGS: A typology of breastfeeding mothers of preterm infants was created. The group of survivors wished to be breastfeeding mothers, but after some unexpected difficulties, they had to give up their dream. The disappointment alleviated with time, but some of the mothers still harbored self-accusations after a year. The highfliers were mothers who succeeded in breastfeeding because of their own persistence. They described breastfeeding as enjoyable for both the mother and the infant. The pragmatist mothers breastfed because it was the general norm and a practical way to feed the infant; breastfeeding caused neither passion nor discomfort. The group of bottle-feeding-oriented mothers expressed that breastfeeding did not interest them at any point. IMPLICATIONS FOR PRACTICE: Being aware of the typology could help nurses and midwives carefully observe mothers' individual counselling needs. Mothers' wishes and decisions regarding breastfeeding need to be respected and supported without any judgment. IMPLICATIONS FOR RESEARCH: The possibilities to tailor breastfeeding interventions based on the typology should be investigated.

Educational interventions promoting evidence-based practice among emergency nurses: A systematic review.

INTRODUCTION: Emergency nurses are expected to adopt evidence-based practice (EBP). The aim of this systematic review was to describe educational interventions promoting EBP and their outcomes among emergency nurses, compared with no education, to inform clinicians and researchers about effective educational interventions suitable for use in emergency departments (EDs). METHODS: CINAHL, Cochrane, PubMed and Scopus were systematically searched to identify studies published between January 1, 2006 and October 20, 2016 describing educational interventions designed to promote EBP among emergency nurses. 711 studies were identified and screened; 10 were selected for inclusion and quality assessment. The studies were analyzed using deductive content analysis, and the review's results are presented in accordance with the PRISMA guidelines. RESULTS: Ten relevant studies on nine different self-developed educational interventions were identified. Eight studies had highly significant or significant results. Interventions involving face-to-face contact led to significant or highly significant effects on patient benefits and emergency nurses' knowledge, skills, and behavior. Interventions using written self-directed learning material led to significant improvements in nurses' knowledge of EBP. All the descriptions of the interventions were incomplete, and the reported details varied considerably between the studies. CONCLUSIONS: There have been few studies on educational interventions to promote EBP among emergency nurses but the available results are promising.

Development of evidence based practice in academic service partnerships: Experiences of working life representatives from social and health care sectors.

Learning about how to develop and lead the implementation of evidence based practice (EBP) in services is an important part of the education of developers and managers for the social and health care sectors. In order to develop this teaching and to support the development of EBP in services, a Teaching Development Effort (TDE) was conducted by establishing academic service partnerships (ASPs) and connecting Master's students' assignments with them. The TDE was conducted as a part of a larger project whose main aims were to strengthen, develop and renew transfers of knowledge and competence between higher education institutions and workplaces, and to strive for a more multidisciplinary quality in workplace innovations. The purpose of this qualitative study was to describe the experiences of working life representatives regarding the development of EBP in ASPs within the social and health care sectors. The data were collected by email interviews. Eight working life representatives' participated in the study. The informants were asked to describe the usefulness of the plan that had been prepared by the students regarding the implementation of EBP, and to describe the significance of this ASP for the development of working life. A qualitative content analysis method was used when analyzing the data. Virtually all the informants stated that the plan prepared by the students, for the implementation of EBP, was entirely ready to be taken into use in the form they had finished it. The significance of the ASP was described in terms of the ASP assisting in improving the quality of the service. Furthermore, the workplace-based student assignment topics, external views to support the development of EBP, and the theoretical approach used by the students were valuable. The ASP provided opportunities for the practitioners to learn new things, inspiration to look to the future, and assistance in the implementation of time management practices. ASPs have potential to support EBP in services and the use of them is recommended.

A systematic review of the outcomes of educational interventions relevant to nurses with simultaneous strategies for guideline implementation.

AIMS AND OBJECTIVES: To systematically review the literature on the outcomes of educational interventions relevant to nurses with regard to guideline implementation. BACKGROUND: Previous reviews on interventions to implement guidelines have focused on particular clinical problems, but only one included nursing studies. DESIGN: A systematic review based on the procedure of the Centre for Reviews and Dissemination. METHODS: We searched for papers published from 1 January 2008 to 26 February 2015 using the Cochrane, CINAHL and PubMed MEDLINE databases and paper references were searched manually. Quality appraisal was conducted with tools developed by Thomas et al.(Worldviews on Evidence-based Nursing, 1, 2004, 176) and National Heart, Lung, and Blood Institute. Data were analysed with qualitative content analysis and narrative synthesis. RESULTS: The data included 13 studies based on a quasi-experimental study design of 13 different educational interventions, described according to their development and realisation, learning content and teaching and learning methods. Seven interventions were supported by simultaneous strategies, 12 studies reported statistically significant outcomes for the interventions on at least one measurement area and six studies reported improvements in the quality of patient care. Interventions with multi-dimensional content, teaching and learning methods produced several good outcomes. CONCLUSION: Guidelines were implemented in a heterogeneous way and the interventions were delivered once and mainly on a local basis. In the future, we need to test these interventions in different nursing contexts, measure the outcomes on patient care and carry out randomised controlled trials on their effectiveness. It is important to standardise interventions, as this will allow them to be replicated and compared. RELEVANCE TO CLINICAL PRACTICE: Educational interventions to implement guidelines could be beneficial in enhancing nurses' evidence-based decision-making and care practice. The combination of teaching and learning methods proved useful, and educational interventions should be supported with simultaneous strategies. There remains a lack of strong evidence on the subject.

Educational interventions on evidence-based nursing in clinical practice: A systematic review with qualitative analysis.

AIMS: To gather, assess and synthesise the currently available evidence of educational interventions on evidence-based nursing (EBN). BACKGROUND: Previous systematic reviews have focused on the items used in reporting educational interventions for facilitating evidence-based practices in medicine and health care or teaching research literacy in nursing as well as on the outcomes of these interventions. DESIGN: A systematic review based on a procedure of the Centre for Reviews and Disseminations for conducting a systematic review of health interventions. DATA SOURCES AND METHODS: Texts from 2008 to 2015 were sought from the Cochrane, CINAHL and PubMed Medline databases. Eight studies were selected for the final data and reviewed for quality. Data were analysed with narrative synthesis including qualitative content analysis. RESULTS: Four main categories and sixteen subcategories were identified. The learning contents included principles of EBN and research, the process of EBN, and planning a change in practice. The most popular teaching/learning methods were lectures/didactic presentations and group work. The interventions encouraged learners to critically examine and evaluate their practice. The interventions also improved participants' capacity to identify the need for research evidence in clinical practice. CONCLUSION: The educational interventions were fairly similar and had promising results. However, as the level of evidence was modest in the studies, there are several development needs for interventions and further research challenges. Interventions should provide participants with sufficient competences for implementing every step of EBN, with special focus on the implementation of evidence in patient care. The assessment of the outcomes of interventions should cover all learning categories of EBN with focus on medium to long-term effectiveness. The influence of different teaching/learning methods and learning contexts and settings should be investigated further.

Breastfeeding preterm infants - a randomized controlled trial of the effectiveness of an Internet-based peer-support group.

AIMS: The aim of this study was to examine whether an Internet-based peer-support intervention has an effect on the duration of breastfeeding or breast milk expression or maternal breastfeeding attitude compared with routine care in the mothers of preterm infants. In addition, the feasibility of the intervention was examined. BACKGROUND: A few peer-support interventions conducted face-to-face or by telephone have given promising results in promoting breastfeeding in preterm infants. DESIGN: A randomized controlled trial with a 1-year follow-up was conducted in one hospital in Finland in 2011-2015. METHODS: Altogether 124 mothers of preterm (<35 weeks) infants were recruited; 60 in an experimental and 64 in a control group. The intervention was a closed peer-support group in social media. Data were collected by structured questionnaires. Neonatal and breastfeeding data were collected from patient records. RESULTS: The duration of overall breastfeeding was on average 3·0 and 4·3 months, in the experimental and control groups respectively. The intervention had no effect on breastfeeding or expressing the breast milk or maternal breastfeeding attitude. A breastfeeding-favourable attitude and at least two previous children predicted longer duration of breastfeeding. Attitude-score decreased during the follow-up. The mothers in the experimental group enjoyed peer support, but only a few reported it as having some impact on breastfeeding. CONCLUSION: Although the Internet-based peer-support intervention had no effect, the importance of breastfeeding attitude for the duration of breastfeeding in mothers of preterm infants was shown. In future, interventions in social media should be studied more and attitude-focused interventions be developed.

Predictors of Breastfeeding Initiation and Frequency for Preterm Infants in the NICU.

OBJECTIVE: To determine factors that predict the initiation and frequency of breastfeeding, attitudes about breastfeeding, and the self-efficacy of mothers of preterm infants in a neonatal intensive care unit. DESIGN: A structured survey using two measurement points. SETTING: A university hospital in Finland. PARTICIPANTS: Mothers (N = 124) and their infants born at less than 35 weeks gestation. METHODS: Structured questionnaires were used during the first week postpartum and at discharge of infants from the hospital. Neonatal and breastfeeding data were collected from patient records. RESULTS: Preterm infants initiated breastfeeding at the median postnatal age of 4 days (range = 0-70 days). The factors that predicted earlier initiation of breastfeeding were greater gestational age, no ventilator treatment, early physical contact, and greater maternal education level. Greater gestational age, early physical contact, and a breastfeeding-favorable attitude also predicted the frequency of breastfeeding. The attitudes of the mothers regarding breastfeeding immediately after birth were generally positive but decreased during their infants' hospital stays. CONCLUSION: Gestational age and early physical contact seemed to be the strongest predictors of breastfeeding initiation and frequency in the NICU. In addition, the role of the mother's attitude regarding breastfeeding was significant. Current care practices should be critically reviewed with emphasis on early physical contact at the time of birth.

A Systematic Review of Journal Clubs for Nurses.

BACKGROUND: Two previous systematic reviews describe studies on journal clubs from 1995 to 2007. AIMS: To gather, assess, and synthesize the current empirical evidence on implementation of journal clubs, influencing factors, and outcomes of journal clubs in promoting evidence-based nursing. DESIGN: A systematic review based on the procedure of the Centre for Reviews and Dissemination. DATA SOURCES AND METHODS: Cochrane, CINAHL, and PubMed Medline databases were sought from 2008 to 2015. The final data consisted of 10 studies. Articles' references were searched manually. The quality appraisal was made according to study design. Data were analyzed by qualitative content analysis and narrative synthesis. RESULTS: The analyses produced four main categories with 14 subcategories that described the journal clubs: organization, conduct of meetings, influencing factors, and intervention outcomes. Journal clubs had been carried out in a fairly uniform manner in different nursing communities. There remains a lack of evidence on journal clubs' impact on evidence-based nursing (EBN) implementation, which challenges the development of journal clubs' content and methods. LINKING EVIDENCE TO ACTION: Because journal clubs have achieved a uniform and easy-to-follow manner that is suitable for different nursing contexts and provide multiple positive outcomes, they are recommended for EBN. In work communities, journal clubs should be combined with other well-known factors that promote EBN implementation. The assessment of the outcomes of journal clubs should cover all learning categories of EBN with a focus on medium- to long-term effectiveness. The evaluation of the effectiveness of journal clubs on patient care is of great importance for future studies.

Developing preceptorship through action research: part 2.

Clinical preception in practice plays a significant role in the education of both Registered Nurses and practical nurses. This study presents the evaluation of an interprofessional research and development project (2009-2103) on clinical preceptorship between two universities of applied sciences, two vocational institutes and four healthcare organisations in western Finland. The research question was as follows: How did the participants evaluate the process and outcomes of developing preceptorship through an action-research approach? The primary target group consisted of professionals within the healthcare sector and nursing teachers at the universities of applied sciences and the vocational institutes. The five units represented in the healthcare organisations functioned as clinical practice placements for both nursing and practical nursing students, with Registered Nurses and practical nurses acting as their preceptors. Each unit developed a unique preceptorship model to answer their specific needs. The models were implemented and tested during one academic year followed by a quantitative (a 4-point scale) and qualitative evaluation of the process. The models are presented in another article, and the evaluation results are presented in this article. The evaluation showed that preceptorship has become an important and accepted part of work, including the practice of starting any preception at a unit with a thorough introduction. The project's emphasis on critical thinking, reflection and focus on ethics were valued by the staff. Pedagogical further education should be arranged on a regular basis to strengthen the knowledge base of the preceptors. Furthermore, enough time for preceptorship should be allocated, as it is a pedagogical duty. The implication of this project is that more cooperation between different stake holders is needed, in order to narrow the gap between theory and praxis.

Developing preceptorship through action research: Part 1.

Clinical preception in practice plays a significant role in both registered and practical nurse studies. As such, the cooperation between the faculty and working life is important to narrow the theory-practice gap, with emphasis being placed on a student-oriented approach promoting self-direction and lifelong learning. The aim of this project was to develop the preceptorship at five different units within the health-care sector in western Finland by implementing an action research (AR) approach. This article is the first of a two-part article on the project, focusing on a cultural analysis and the development of preception models conducted within the project. The five units participating in the study were the following: a long-term care ward in the community, a ward for people with dementia, a geriatric ward, a medical ward and a surgical ward representing specialised care. The starting point of the study was a cultural analysis, which was made in all the five units to obtain a 'bottom-up' perspective. In each of the five units 3-5 nurses were appointed to become members of the core groups. This meant that all the units would start from the perspective of their own working environment when creating a preception model that would fit into their particular workplace. During this process, the participants received continuous support from the researchers. Several workshops and seminars were also arranged to further support the core groups and staff. The models were implemented and tested during the academic year 2010-2011 followed by an evaluation of the project. The evaluation results will be presented in the second part of the two-part article. The project showed that reflective practice and critical thinking can be improved through an AR approach.

Aiming to be a breastfeeding mother in a neonatal intensive care unit and at home: a thematic analysis of peer-support group discussion in social media.

Preterm infants are usually breastfed less than full-term infants, and successful breastfeeding requires a supportive environment and special efforts from their mothers. A breastfeeding peer-support group, utilising social media, was developed for these mothers in order to support them in this challenge. Mothers were able to discuss breastfeeding and share experiences. The purpose of this study was to describe the perceptions of breastfeeding mothers of preterm infants based on the postings in peer-support group discussions in social media. The actively participating mothers (n = 22) had given birth <35 gestational weeks. They were recruited from one university hospital in Finland. The social media postings (n = 305) were analysed using thematic analysis. A description of the process of breastfeeding a preterm infant from the point of view of a mother was created. The process consisted of three main themes: the breastfeeding paradox in hospital, the 'reality check' of breastfeeding at home and the breastfeeding experience as part of being a mother. The mothers encountered paradoxical elements in the support received in hospital; discharge was promoted at the expense of breastfeeding and pumping breast milk was emphasised over breastfeeding. After the infant's discharge, the over-optimistic expectations of mothers often met with reality - mothers did not have the knowledge or skills to manage breastfeeding at home. Successful breastfeeding was an empowering experience for the mothers, whereas unsuccessful breastfeeding induced feelings of disappointment. Therefore, the mothers of preterm infants need evidence-based breastfeeding counselling and systematic support in a neonatal intensive care unit (NICU) and at home.

Internet-based peer support for parents: a systematic integrative review.

OBJECTIVES: The Internet and social media provide various possibilities for online peer support. The aim of this review was to explore Internet-based peer-support interventions and their outcomes for parents. DESIGN: A systematic integrative review. DATA SOURCES: The systematic search was carried out in March 2014 in PubMed, Cinahl, PsycINFO and Cochrane databases. REVIEW METHODS: Two reviewers independently screened the titles (n=1793), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) an Internet-based community as an intervention, or at least as a component of an intervention; (2) the participants in the Internet-based community had to be mothers and/or fathers or pregnant women; (3) the parents had to interact and communicate with each other through the Internet-based community. The data was analysed using content analysis. When analysing peer-support interventions only interventions developed by researchers were included and when analysing the outcomes for the parents, studies that focused on mothers, fathers or both parents were separated. RESULTS: In total, 38 publications met the inclusion criteria. Most of the studies focused on Internet-based peer support between mothers (n=16) or both parents (n=15) and seven focused on fathers. In 16 studies, the Internet-based interventions had been developed by researchers and 22 studies used already existing Internet peer-support groups, in which any person using the Internet could participate. For mothers, Internet-based peer support provided emotional support, information and membership in a social community. For fathers, it provided support for the transition to fatherhood, information and humorous communication. Mothers were more active users of Internet-based peer-support groups than fathers. In general, parents were satisfied with Internet-based peer support. The evidence of the effectiveness of Internet-based peer support was inconclusive but no harmful effects were reported in these reviewed studies. CONCLUSIONS: Internet-based peer support provided informational support for parents and was accessible despite geographical distance or time constraints. Internet-based peer support is a unique form of parental support, not replacing but supplementing support offered by professionals. Experimental studies in this area are needed.