Desafios no cotidiano de cuidados domiciliares às crianças com necessidades es-peciais de saúde na voz de cuidadoras familiares / Desafíos en la atención domiciliaria diaria para niños con necesidades especiales de salud en la voz de los cuidadores familiares / Challenges in everyday home care to children with special health needs in the voice of caregivers family

This study aims to describe the daily challenges of caring for children with special healthneeds by family caregivers in the home. Research with a qualitative, descriptive and exploratoryapproach, mediated by the semi-structured interview conducted at home with 15 family caregiversof children. Saturation sampling was used, the statements were double transcribed, and submittedto content analysis. The results reveal that the care provided to children with special health needsis carried out exclusively by women in the family, mothers and grandparents, children between 0and 10 years of age, who need medication care for their survival. From the statements, two thematiccategories emerged: "Challenges faced by family caregivers of CRIANES" and "Care and strategiesfor medication administration". It is noteworthy that the challenges of daily care involve food, bodyhygiene, constant surveillance and the administration of medications. It is suggested that the familyof these children, be supported by health services and oriented, in order to minimize the challengesof daily care in the home space. (AU)

Este estudio tiene como objetivo describir los desafíos del cuidado diario de los niñoscon necesidades especiales de salud por parte de los cuidadores familiares en el hogar. Investigacióncon enfoque cualitativo, descriptivo y exploratorio, mediada por la entrevista semiestructurada realizada en el hogar a 15 familiares cuidadores de niños. Se utilizó muestreo de saturación, lasdeclaraciones se transcribieron doblemente y se sometieron a análisis de contenido. Los resultadosrevelan que la atención que se brinda a los niños con necesidades especiales de salud es realizadaexclusivamente por mujeres de la familia, madres y abuelos, de niños entre 0 y 10 años, quienesnecesitan atención con medicamentos para su supervivencia. De las declaraciones surgieron doscategorías temáticas: “Retos que enfrentan los cuidadores familiares de CRIANES” y “Cuidados yestrategias para la administración de medicamentos”. Es de destacar que los desafíos del cuidadodiario involucran la alimentación, la higiene corporal, la vigilancia constante y la administración demedicamentos. Se sugiere que la familia de estos niños, sea apoyada por los servicios de salud yorientada, con el fin de minimizar los desafíos del cuidado diario en el espacio del hogar. (AU)

Este estudo objetiva descrever os desafios do cotidiano de cuidados às criançascom necessidades especiais de saúde por cuidadores familiares no espaço domiciliar. Pesquisa de abordagem qualitativa, descritiva e exploratória, mediada pela entrevista semiestruturada realizada no espaço domiciliar com 15 cuidadoras familiares de crianças. Utilizou-se amostragem por saturação, as enunciações foram duplamente transcritas, e submetidas à análise de conteúdo. Os resultados revelam que o cuidado exercido às criançascom necessidades especiais de saúde é realizado exclusivamente por mulheres da família,mães e avós, de crianças entre 0 a 10 anos de idade, que necessitam de cuidados medicamentosos para sua sobrevivência. Das enunciações emergiram duas categorias temáticas“Desafios enfrentados por cuidadoras familiares de CRIANES” e “Cuidados e estratégiaspara administração de medicamentos”. Ressalta-se que os desafios do cotidiano de cuidados envolvem a alimentação, higiene corporal, vigilância constante e a administração demedicamentos. Sugere-se a que a família dessas crianças, sejam amparadas pelos serviçosde saúde e orientadas, a fim de minimizar os desafios do cuidado cotidiano no espaço domiciliar. (AU)

Maternity Nursing Stops Too Soon.

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times. In this article from October 1975, Reva Rubin provides a fascinating historical overview of maternity nursing. She recounts the social and medical transformation of maternity care in the 20th century, emphasizing the nearly nonexistent support for pregnant, laboring, and postpartum women during much of that time. Rubin ends her article with a passionate plea to nurses for attention to "our big failure . . . the postpartum period." She hints at the causes of what we now know to be postpartum depression, calling the postpartum period "unbelievably cruel," and noting that "tissue recovery is fairly simple. Recovery of the whole person, however, is much more complex and requires much more skilled nursing." In this issue, Barbara Marie Alba carries on the work of Rubin and other maternity nursing pioneers, providing a detailed overview of this subject in "Postpartum Depression: A Nurse's Guide."-Betsy Todd, MPH, RN.

CE: Postpartum Depression: A Nurse's Guide.

ABSTRACT: Despite extensive research, the etiology behind postpartum depression (PPD) remains a mystery. Experts have theorized about various potential risk factors, including hormonal fluctuations, genetics, prior history of depression, low socioeconomic status, adolescent pregnancy, and certain personality traits. This article provides foundational information about PPD, reviewing the risk factors for and the consequences of this mood disorder. Postpartum blues and postpartum psychosis are briefly discussed for context, although they differ from PPD. Screening and treatment options are explained, and nursing implications for practice are presented.

Experiences of maternity care among women at increased risk of preterm birth receiving midwifery continuity of care compared to women receiving standard care: Results from the POPPIE pilot trial.

BACKGROUND: Midwifery continuity of care models for women at low and mixed risk of complications have been shown to improve women's experiences of care. However, there is limited research on care experiences among women at increased risk of preterm birth. We aimed to explore the experiences of care among women with risk factors for preterm birth participating in a pilot trial (POPPIE) of a midwifery continuity of care model which included a specialist obstetric clinic. METHODS: A total of 334 pregnant women identified at increased risk of preterm birth were randomly allocated to either midwifery continuity of care (POPPIE group) or standard maternity care. Women in both groups were followed up at six-to-eight weeks postpartum and were invited to complete a postnatal survey either online or by post. An equal status exploratory sequential mixed method design was chosen to collect and analyse the quantitative postnatal survey data and qualitative interviews data. The postnatal survey included measures of social support, trust, perceptions of safety, quality of care, control during childbirth, bonding and quality of life. Categorical data were analysed with chi-squared tests and continuous data were analysed with t-tests and/or Mann-Whitney U test to measure differences in measures scores among groups. The qualitative interview data were subjected to a thematic framework analysis. Data triangulation brought quantitative and qualitative data together at the interpretation stage. FINDINGS: A total of 166 women completed the survey and 30 women were interviewed (90 and 16 in POPPIE group; 76 and 14 in standard group). We found survey respondents in the POPPIE group, compared to respondents in the standard group, were significantly more likely to report greater trust in midwives (Mann-Whitney U, p<0.0001), greater perceptions of safety during the antenatal care (t-test, p = 0.0138), have a particular midwife to contact when they needed during their pregnancy (t-test, p<0.0001) and the postnatal period (chi-squared, p<0.0001). They reported increased involvement in decisions regarding antenatal, intrapartum and postnatal care (t-test, p = 0.002; p = 0.008; p = 0.006 respectively); and greater postnatal support and advice about: feeding the baby (chi-squared, p<0.0001), handling, settling and looking after the baby (chi-squared, p<0.0001), baby's health and progress (chi-squared, p = 0.039), their own health and recovery (chi-squared, p = 0.006) and who to contact about any emotional changes (chi-squared, p = 0.005). There were no significant differences between groups in the reporting of perceptions of safety during birth and the postnatal period, concerns raised during labour and birth taken seriously, being left alone during childbirth at a time of worries, control during labour, bonding, social support, and physical and mental health related quality of life after birth. Results from qualitative interviews provided insight and depth into many of these findings, with women in the POPPIE group reporting more positive experiences of bonding towards their babies and more positive physical health postnatally. CONCLUSIONS: Compared with standard maternity care, women at increased risk of PTB who received midwifery continuity of care were more likely to report increased perceptions of trust, safety and quality of care. TRIAL REGISTRATION: ISRCTN (Number: 37733900); UK CRN (ID: 31951).

Implementing Patient-Centered Trauma-Informed Care for the Perinatal Nurse.

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.

Planning for high-risk maternity patients: A new approach.

Having a plan in place before an expectant mother comes to the healthcare facility for delivery is an important step toward quality care. Read about how one medical center in New Jersey launched an initiative to identify high-risk expectant mothers early and plan accordingly months ahead of their delivery date.

High-Fidelity Simulation and Clinical Judgment of Nursing Students in a Maternal-Newborn Course.

Clinical judgment, one's ability to think like a nurse, is an essential skill for safe nursing practice. With the rise of simulation to replace clinical experiences, there is limited evidence regarding the effectiveness of simulation on the development of clinical judgment. This study explored differences in clinical judgment in maternal-newborn courses between undergraduate nursing students participating exclusively in simulation and those participating in hospital-based clinical experiences. Following completion of the clinical rotation, students participated in an evaluative maternal-newborn high-fidelity simulation experience that was recorded and evaluated using the Lasater's Clinical Judgment Rubric (2007). Lasater's Clinical Judgment Rubric scores between the simulation and clinical practice groups were compared using an independent sample t-test. There was no statistical difference in clinical judgment scores between the simulation and hospital-based clinical groups (t = -1.056, P = .295). Our findings suggest that simulation may be a comparable alternative to clinical experience in nursing education.

Quality of labour and uncomplicated delivery care: a formative assessment of selected health facilities in Ebonyi and Kogi States, Nigeria.

Maternal Child Survival Program (MCSP) worked in Ebonyi and Kogi States between 2014 to 2018 to improve quality of maternal, child and newborn health care. A formative assessment was conducted in selected health facilities to examine the quality of care received by mothers and their newborns at all stages of normal birth on the day of birth. Health providers attending deliveries at 13 facilities in the two states were observed by trained health professionals. Forty health facilities with a high volume of at least 50 Antenatal Care visits per month and deliveries were purposively selected from 120 quality improvement health facilities. Screening for danger signs at admission was conducted for only 10.5% cases in labor and providers adhered to most recommended infection prevention standards but only washed hands before birth in 19.5% of cases. Chlorhexidine gel was applied to the newborn's umbilical stump in only 2% cases while partograph was used in 32% of the cases. No newborns received the full package of essential care. Potentially harmful practices were observed especially holding newborn babies upside down in 32% cases. Improved provider training and mentoring in high-quality care on the day of birth and strengthened supportive supervision may help to reduce maternal and newborn morbidity and mortality.

Maternity Nurses' Knowledge about Sudden Unexpected Postnatal Collapse and Safe Newborn Positioning.

PURPOSE: Sudden unexpected postnatal collapse (SUPC) of healthy newborns in the first 2 days of life is increasing. These types of adverse events are known to be associated with unsafe positioning during skin-to-skin contact and breastfeeding. The purpose of the study was to determine maternity nurses' knowledge about SUPC and safe newborn positioning. DESIGN: Nurses who participate in a hosted listserv were solicited to complete a questionnaire. METHODS: An email with an embedded link to a 20-item questionnaire, the SUPC and Safe Positioning Knowledge Assessment Tool, and 16 demographic questions was sent to 605 maternity nurses in the United States who are part of a Perinatal Listserv for members of the Association of Women's Health, Obstetric and Neonatal Nurses. Scores were analyzed by mean, standard deviation, and percent correct answers. RESULTS: Fifty questionnaires were initiated (response rate of 8.2%), and 36 completed questionnaires (response rate of 5.9%) were analyzed. Maternity nurses' knowledge of SUPC was less than their knowledge of safe newborn positioning (61% correct vs. 72% correct; p < 0.001). CLINICAL IMPLICATIONS: Maternity nurses need more information about SUPC and safe newborn positioning, including risk factors, and effective strategies to reduce risk of preventable newborn harm.

Evaluación de competencias específicas de profesionales de enfermería en la atención al neonato crítico / Assessment of Specific Competencies of Nursing Professional in the Care of the Critical Neonate

Introducción: La evaluación de las competencias específicas del profesional de enfermería en la atención al neonato crítico permite diagnosticar su nivel de desarrollo para proponer alternativas que dinamicen la superación profesional en las Unidades de Cuidados Intensivos Neonatales. Objetivo: Evaluar las competencias específicas de los profesionales de enfermería a cargo de la atención al neonato crítico en las Unidades de Cuidados Intensivos Neonatales. Métodos: Estudio descriptivo-observacional, participaron 161 profesionales de enfermería de Unidades de Cuidados Intensivos Neonatales de Santiago de Cuba, de enero 2017 a enero 2018. Las competencias fueron evaluadas a partir de una parametrización para descomponer la variable en dimensiones e indicadores, se aplicaron tres instrumentos evaluativos al universo de profesionales y se realizó una triangulación metodológica a partir de los resultados de las dimisiones obtenidos por los instrumentos. Resultados: Las dimensiones de mayores afectaciones fueron la clínico-quirúrgica y la actualización científica. En la triangulación metodológica se obtuvo 4,17 de media ponderada, significa que la variable se encuentra afectada con un nivel medio de desarrollo. Conclusiones: La evaluación de las competencias permitió declarar que la variable evaluada se encuentra en un nivel medio de desarrollo. Del análisis de los indicadores se obtuvo un inventario de problemas y potencialidades que justifican una propuesta metodológica que dinamice la superación profesional para el desarrollo de las competencias específicas de profesionales de enfermería para la atención al neonato crítico(AU)

Introduction: The assessment of the nursing professional's specific competencies in the care of the critical neonate allows to diagnose their level of development in view of proposing alternatives that boost professional improvement in neonatal intensive care units. Objective: To assess the specific competencies of nursing professionals in charge of critical neonate care in neonatal intensive care units. Methods: Descriptive-observational study, 161 nursing professionals from the Neonatal Intensive Care Units of Santiago de Cuba participated, from January 2017 to January 2018. The competencies were assessed based on a parameterization for decomposing the variable into dimensions and indicators. Three assessment instruments were applied to the study group of professionals and a methodological triangulation was carried out based on the dimensional results obtained by the instruments. Results: The most affected dimensions were the clinical-surgical and scientific update. In the methodological triangulation, 4.17 was obtained as weighted average, which means that the variable is affected with a medium level of development. Conclusions: The assessment of the competences allowed to declare that the assessed variable is in a medium level of development. From the analysis of the indicators, an inventory of problems and potentialities was obtained that justify a methodological proposal that stimulates the professional improvement for the development of the specific competencies of nursing professionals for the care of the critical neonate(AU)

What Do Women Want? Looking Beyond Patient Satisfaction.

OBJECTIVE: To hear the voices of women, their partners, and nurses about expectations and priorities during the postpartum hospitalization. DESIGN: Focus groups using semistructured interview questions. SETTING: A 12-bed labor-delivery-recovery-postpartum unit at a small urban hospital in the U.S. Northeast. PARTICIPANTS: Women who planned to or had given birth, their partners, and the maternity nurses who cared for them. MEASUREMENTS: Qualitative thematic analysis of focus group transcripts. RESULTS: Thematic analysis produced the following themes for women's priorities: Need for individualized attention to maternal physical and emotional care; Fear of providing inadequate care for the newborn, including establishing infant feeding; and Transitioning to parenting as a new mother versus as an experienced mother. Themes for nurses' priorities included Safety issues around sleep and breastfeeding, Transitioning to parenting with an emphasis on maternal self-care, and Addressing barriers to effective discharge education. Response comparisons between the women/partners and nurses suggest that there is a disconnection between women's and nurses' priorities and expectations for care during the postpartum period. CONCLUSION: Women and nurses identified unmet needs in the postpartum period, consistent with the current literature. Providing standardized education during the transitional period around discharge from the hospital to home may not be optimal and may even detract from meeting the needs for rest and connection with family and the health care team. Nursing care that extends beyond the maternity hospitalization may be needed to individualize care and meet previously unmet needs.

Behind the Scenes: Publishing in the Maternal and Child Health Journal.

The Editors of the Maternal and Child Health Journal offer an inside look at publishing in the journal, including advice for potential authors and reviewers.

Unexpected Influences-A Maternity Nursing Career and the Next Generation.

A nurse reflects on what her daughters have picked up from her career in maternity nursing, education, and research.

Traditional clinical training combined with high-fidelity simulation-based activities improves clinical competency and knowledge among nursing students on a maternity nursing course.

BACKGROUND: Providing adequate and quality clinical training to student nurses is a major issue in nursing education. In the Middle East, this issue is more prominent because providing intimate healthcare to women in maternity nursing, especially by male nursing students, remains a challenge. PURPOSE: This study compared the effects of a combination of traditional clinical training with high-fidelity simulation (TCT+HFS) activities vs TCT alone on the clinical competency and knowledge among students enrolled in a maternity nursing course in a Middle Eastern public university. METHOD: A quasi-experimental research design was adopted in the study. The sample consisted of 74 students (40 in the TCT group and 34 in the TCT+HFS group) from a cohort of nursing students in a Middle Eastern university. The Creighton Competency Evaluation Instrument and a 29-item, researcher-designed knowledge scale was used to measure the relevant outcomes. RESULTS: No significant difference was observed in the knowledge (F = 1.064, P = 0.306) or clinical competency scores (F = 0.168, P = 0.683) between the TCT+HFS group and the TCT group. CONCLUSION: Substituting 25% of the clinical hours with HFS may yield similar learning outcomes (knowledge and clinical competency) as TCT.

Maternity and postpartum care: perspectives.

EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes.

ICNP® terminology subset for care of women and children experiencing breastfeeding. / Subconjunto terminológico da CIPE® para assistência à mulher e à criança em processo de amamentação.

OBJECTIVE: To describe the development of a terminology subset of the International Classification for Nursing Practice for care of women and children in process of breastfeeding. METHOD: Methodological study developed in six stages according to the guidelines recommended by the International Council of Nurses. RESULTS: Seventy-four nursing diagnoses/outcomes and 213 nursing interventions were performed and classified according to the theoretical model Interactive Theory of Breastfeeding. CONCLUSION: The subset is expected to safely and systematically steer nurses that work in this area, promoting the implementation of the nursing process and quality of care, focusing on women, children and families that are experiencing the breastfeeding process.