'Feeling Ready': A Feminist Poststructural Analysis of Postpartum Sexual Health.

There exists a lack of literature surrounding how postpartum individuals define feeling 'ready' to resume sexual activities after childbirth. Many factors may influence feelings of desire or readiness for sexual activities, such as breastfeeding. Therefore, it is important to understand why and how postpartum individuals understand and make meaning of their experiences surrounding postpartum sexual activities, as well as how those experiences are influenced or negotiated through relations of power. This study was guided by feminist poststructuralism and discourse analysis. Eleven participants who were between 1 and 6 months postpartum and living in Nova Scotia, Canada, were interviewed using semi-structured interviews. Participants challenged certain discourses surrounding sexual activities postpartum, including the social discourse that positions sexual activities as a requirement within romantic relationships and the discourse that positions health care providers as the authority on postpartum sexual health. 'Feeling ready' centered on four main issues: (1) navigating physical recovery; (2) personal knowing and emotional readiness; (3) the 6-week check; and (4) redefining intimacy. This article describes one branch of the findings within the overall study. Choosing to resume sexual activities postpartum, or feeling ready to do so, is individual, fluid, and complex. This research has important implications for practice and policy, specifically as it pertains to postpartum care.

"I feel broken": Chronicling burnout, mental health, and the limits of individual resilience in nursing.

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of "Breaking Point," in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future.

"There's an Etiquette to Zoom That's Not Really Present In-Person": A Qualitative Study Showing How the Mute Button Shapes Virtual Postpartum Support for New Parents.

Virtual spaces that allow parents in the postpartum period to connect, support each other, and exchange information have been increasing in popularity. With the COVID-19 pandemic, many parents had to rely on virtual platforms as a primary means to connect with others and attend to their postpartum health. This study explored virtual postpartum support sessions through the web-based videoconferencing software, Zoom. Guided by feminist poststructuralism and sociomaterialism, we held seven virtual support sessions for parents caring for a baby 0-12 months in age, in Canada, and interviewed 19 participants about their experiences in the sessions. Our methodological approach allowed us to analyze discourses of (1) parenthood, (2) material realities of virtual environments, and (3) support and information on this virtual platform. The purpose of this research was to understand how technology influences postpartum support and learning through online videoconferencing for parents. Our findings document an overarching discourse of Zoom etiquette by which muting was a discursive practice that all participants used. The consistent use of the mute button while not talking structured conversation in virtual postpartum sessions and resulted in three themes: (1) minimizing disruptions; (2) taking turns; and (3) staying on task. The norm of using the mute button changed how parents received and gave support and information. Based on findings and broader literature, we discuss considerations for facilitation of virtual postpartum support sessions.

From uniprofessionality to interprofessionality: dual vs dueling identities in healthcare.

Healthcare systems are at times still viewed as siloed performances of single professions, wherein some groups hold hierarchical positions based on their expertise and prestige, rather than a collective functioning of interprofessional teams. Current policies, procedures, and regulations in healthcare education and practice seem to contribute to this context in which the various health and social care professions are set in opposition to one another. The historical, and still prominent, uniprofessional education and socialization practices position health and social care professions to view each as rivals and threats toward achieving their profession/al advancement and growth. The transformation from uniprofessionality to interprofessionality in healthcare requires the application of interprofessional socialization not just at the individual level, but also at the professional and system levels. In this process of interprofessional socialization, we need to embrace the uniqueness of each profession while cultivating an interprofessional collaboration culture in the system (dual identity). In so doing, we can facilitate a shifting mind-set, culture, operations, and policies in healthcare to recognize and foster the contribution and accountability of each profession toward achieving the quadruple aim of better care, better health, better value, and better work experience.

A longitudinal, narrative study of professional socialisation among health students.

PURPOSE: Interprofessional collaboration (IPC) among health professionals is well-recognised to enhance care delivery and patient outcomes. Emerging evidence suggests that the early socialisation of students in health professional programmes to teamwork may have a positive impact on their future as collaborative practitioners. With a purpose of contributing to growing evidence on the processes of professional identity construction, and to explore how early expectations and perceptions of IPC develop during professional socialisation and pre-licensure education, our study examined the early professional socialisation experiences among five groups of health professional students. METHOD: A qualitative, narrative approach was used to examine early professional socialisation among five programmes of health professional students (dentistry, medicine, nursing, pharmacy, physiotherapy) at an Atlantic Canadian University. In March and October 2016, students participated in interviews after first term (n = 44) and first year of study (n = 39). Interviews focused on participants' professional identify formation, as well as their perceptions and experiences of IPC. The authors analysed interview transcripts using narrative analysis. RESULTS: Findings identify that despite the espoused importance of IPC within health professional training, students have a limited understanding of their professional roles and are largely focused on developing a uniprofessional, vs. interprofessional identity. Clinical experiences, role models and exposure to teamwork are critical to contextualise collaborative practice and enhance the development of an interprofessional identity. CONCLUSIONS: Findings can be used to guide the development of curricula that promote interprofessional identity development and IPC during early professional socialisation.

A poststructural analysis: Current practices for suicide prevention by nurses in the emergency department and areas of improvement.

AIMS AND OBJECTIVES: To use a poststructuralist framework to critique historical, social and institutional constructions of emergency nursing and examine conflicting discourses surrounding suicide prevention. The aim is to also demonstrate practical guidance for enhancing emergency nursing practice and research with regard to suicide prevention. BACKGROUND: Emergency departments have been historically constructed as places for treating life-threatening physical crises, thereby constructing other "nonurgent" health needs as less of a priority. Physical needs take priority over psychological needs, such as suicide-related thoughts and behaviours, negatively impacting the quality of care that certain groups of patients receive. DESIGN: A theoretical analysis of the published literature on the topic of emergency nursing and suicide prevention was conducted and analysed using a poststructuralist framework. METHODS: Relevant literature on the topic of emergency nursing related to suicide prevention was analysed for a poststructuralist construct of power, language, subjectivity and discourse. Implications to practice and research were identified, as well as expanding emergency nursing using a poststructuralist framework. SQUIRE guidelines were used (see Supporting Information). DISCUSSION: The emergency department is a critical point of intervention for patients with urgent and life-threatening needs. However, the biomedical model and historical, social, and institutional expectations that influence emergency nurses' beliefs and values do not effectively respond to the needs of suicidal patients. One step to address this issue is to deconstruct the current understanding of emergency nursing as a treatment for only life-threatening physical crises in order to become inclusive of psychological crises such as suicide-related thoughts and behaviours. RELEVANCE TO CLINICAL PRACTICE: How a poststructural framework can be used to expand emergency care is discussed. Examples include empowering nurses to challenge the "taken-for-granted" emergency nursing and recognizing the health needs that fall outside of the dominant discourse of emergency care.

Pre-entry perceptions of students entering five health professions: implications for interprofessional education and collaboration.

Dysfunctional interprofessional teams are a threat to health system performance and the delivery of quality patient outcomes. Implementing strategies that prepare future health professionals to be effective collaborators requires a comprehensive understanding of how early professional socialization and professional identity formation occur. We present findings from a qualitative study, grounded in narrative methodology, examining early professional socialization among students across five health professional programs (dentistry, medicine, nursing, pharmacy, physiotherapy) in the first year of health professional training. Between April and September 2015, students (n = 49) entering programs at an Atlantic Canadian University participated in one-on-one, audiotaped interviews starting before formal program orientation. Pre-entry interviews focused on factors influencing students' career choice and expectations of future profession and interprofessional collaboration (IPC). Findings revealed that many different experiences influenced participants' career choice and framed the social positioning of their future career (e.g., leadership, prestige, autonomy). Participant narratives revealed the existence of stereotypes pertaining to their chosen and other health professions. Study findings provided insights that may help strengthen initiatives to promote positive professional identity formation within the context of IPC. Implications of this research highlight the need for the early introduction of IPC including pre-entry recruitment messaging for prospective health professionals.

Snap shot: Achieving better care through a one-page personal health profile.

Children with intellectual disabilities (IDs) can have complex health conditions that require intense and ongoing care management by multiple healthcare professionals (HCPs). Families often experience frustrations and challenges sharing necessary information about their children's unique emotional and communicative needs with HCPs. In turn, these needs are often poorly documented and shared with other HCPs. This contributes to compromised care and frustrations for families and HCPs. We conducted a qualitative study using focus groups to examine how 10 parents and 3 HCPs experienced provision of care for children with ID, as well as their suggestions for developing a one-page personal health profile (PHP) to improve communication. Parents suggested including behavioural descriptors rather than diagnoses. All participants believed a one-page PHP that was child and parent led would be very helpful and would improve communication between HCPs, parents and children leading to effective and supportive care.

Mapping the peer-reviewed literature on accommodating nurses' return to work after leaves of absence for mental health issues: a scoping review.

BACKGROUND: The complexity of nursing practice increases the risk of nurses suffering from mental health issues, such as substance use disorders, anxiety, burnout, depression, and posttraumatic stress disorder (PTSD). These mental health issues can potentially lead to nurses taking leaves of absence and may require accommodations for their return to work. The purpose of this review was to map key themes in the peer-reviewed literature about accommodations for nurses' return to work following leaves of absence for mental health issues. METHODS: A six-step methodological framework for scoping reviews was used to summarize the amount, types, sources, and distribution of the literature. The academic literature was searched through nine electronic databases. Electronic charts were used to extract code and collate the data. Findings were derived inductively and summarized thematically and numerically. RESULTS: Academic literature is scarce regarding interventions for nurses' return to work following leaves of absence for mental health issues, and most focused on substance use concerns. Search of the peer-reviewed literature yielded only six records. The records were primarily quantitative studies (n = 4, 68%), published between 1997 and 2018, and originated in the United States (n = 6, 100%). The qualitative thematic findings addressed three major themes: alternative to discipline programs (ADPs), peer support, and return to work policies, procedures, and practices. CONCLUSIONS: While the literature supports alternative to discipline programs as a primary accommodation supporting return to work of nurses, more on the effectiveness of such programs is required. Empirical evidence is necessary to develop, maintain, and refine much needed return to work accommodations for nurses after leaves of absence for mental health issues.

Exploring postpartum sexual health: A feminist poststructural analysis.

Postpartum sexual health has historically been viewed and discussed in specific ways, often dominated by biomedical discourse. There is a need to expand understandings of sexual health for postpartum women in the context of interdisciplinary health care. Research surrounding postpartum sexual health is largely focused on physical measures, such as vaginal lubrication or initiation of intercourse, without accounting for the diverse and subjective ways that sexuality and sexual health are experienced during the postpartum period. This critical analysis uses feminist post-structuralism to critique and analyze current health research and practice surrounding postpartum sexual health. Agency, subjectivity, gender and sex considerations, relations of power, and discourse are essential to understanding postpartum sexual health in a more holistic, woman-centered way. This includes awareness of dominant discourses that have shaped how health researchers, practitioners, postpartum women, and health institutions care for, support, and promote postpartum sexual health. There is a need to move beyond physically focused, reductionist, heteronormative understandings of sexual health to better promote overall postpartum health and wellbeing.

Geographically mobile healthcare workers and the conditions of their travel: The perspectives of managers.

Many healthcare workers are "on the road" traveling to and from fixed sites (eg, patients'/clients' homes). Qualitative interviews with nine Nova Scotian managers of mobile healthcare workers explored the conditions of workers' travel. Findings highlight challenges such as changing schedules, as well as positive features including flexibility over the travel schedule. Some managers noted worker mobility-related responsibilities including having to decide if travel is too dangerous due to poor weather. A few managers suggested that workers may not receive adequate economic reimbursement for travel costs (eg, wear and tear on vehicle), and in some instances, workers need to use a benefit (eg, vacation day) or are not paid if they cannot drive due to poor weather. Reported organizational supports for workers' travel were variable. This research indicates a need for supportive mobility-related policies and practices across all organizations, including policies that cover economic costs related to travel for all workers.

Experiences With Managing the Workplace Social Environment: A Qualitative Study.

OBJECTIVE: This study aims to examine 1st-line managers' (FLMs') experiences in managing the workplace social environment (WSE). BACKGROUND: FLMs are responsible for the establishment and maintenance of supportive WSE essential for effective teamwork. Poorly managed WSE and dysfunctional teams hold negative implications for patients, teams, and organizations. METHODS: This was a qualitative descriptive study, using content analysis of individual and focus group interviews with FLMs and directors. RESULTS: FLMs play a critical role in the management of the WSE; however, the task is fraught with constraints and challenges including competing demands, lack of support, and insufficient training. Findings explicate how competing demands and communication challenges impede the successful management of the WSE. CONCLUSIONS: Given the importance of a healthy WSE to patient, professional, and organizational outcomes, FLMs need support, training, and resources to assist them in managing the social environment alongside other competing priorities.

Redefining perinatal experience: A philosophical exploration of a hypothetical case of gender diversity in labour and birth.

OBJECTIVE AND AIMS: Using a queer phenomenological approach, the objective of this philosophical analysis was to explore the transgender experience in highly gendered clinical areas, such as the birth unit, and make recommendations on how to provide perinatal care that is inclusive of gender diversity within these areas. This study aims to describe a hypothetical clinical experience to provide insight on the institutional barriers that currently exist and to provide nurses and midwives with pragmatic strategies to enhance gender-diverse care in general and gendered clinical areas. BACKGROUND: Currently, general healthcare providers are not sufficiently educated on how to care for and meet the needs of people who identify as lesbian, gay, bisexual, trans, queer or questioning and other communities (LGBTQ+). This vulnerable population continually faces stigma, discrimination and marginalisation, which act as barriers to accessing healthcare services. Although transgender people often have difficulty accessing health care in general settings, they experience an even greater challenge within traditionally gendered clinical care areas. DESIGN: Queer phenomenology was used to guide a critical philosophical analysis of hypothetical case reflecting a clinical scenario regarding a transgender man's experience in labour and birth. DISCUSSION: Healthcare professionals often provide insufficient care to transgender persons, inadvertently leading to further marginalisation of this vulnerable population. Special consideration to provide gender-diverse care throughout the perinatal period is needed. Structures and supports are essential to enhance the care from providers in attending to the unique needs of transgender individuals and reduce oppressive effects from heteronormative environments. RELEVANCE TO CLINICAL PRACTICE: Nurses and midwives are leading exemplars of providing person-centred care and are capable of advocating for equitable care amongst all populations to influence systemic change. Strategies for implementing changes that address LGBTQ+ health needs and specific recommendations for providing gender-diverse care in the perinatal settings are discussed.

Let's talk about sex: A feminist poststructural approach to addressing sexual health in the healthcare setting.

AIMS AND OBJECTIVES: To explore the use of feminist poststructuralism (FPS) as a way to critique, understand and improve sexual health care and policy in healthcare settings. BACKGROUND: Sexual health is an important aspect of health; however, in healthcare settings, it often goes unaddressed by both healthcare providers and patients due to stigma, taboo, fear of embarrassment or uncertainty. Lack of attention to sexual health has been stated as a legitimate concern for patients across the lifespan; there remain gaps in implementing sexual health care discussions into practice in healthcare settings. DESIGN: A critical analysis will be presented to explore sexual health care and attitudes in the healthcare setting from patient and nursing perspectives using FPS. METHODS: Feminist poststructuralism is used to examine the meaning of experience that is personally, socially and institutionally constructed through relations of power. FPS will also be applied to understand how sexual health discourses are negotiated in healthcare settings. SQUIRE guidelines were used in the preparation of this paper (See Appendix S1). RELEVANCE TO CLINICAL PRACTICE: The application of a feminist poststructural lens to sexual health care in healthcare settings may be used by healthcare professionals to understand, question and challenge how social and institutional beliefs, values and practices surrounding sexual health, inclusive of a patient's sexual pleasure or sexual activity, are experienced by healthcare professionals and patients. This theoretical and methodological approach could lead to identifying possibilities for change in healthcare settings that are inclusive and supportive of sexual health care.

The Intergenerational Impact of Management Relations on Nurse Career Satisfaction and Patient Care.

OBJECTIVE: This article provides insights into the role of management relations on nurses' career satisfaction across different career stages. BACKGROUND: Managers and positive relations with staff are critical to improving job satisfaction, career development, and retention for new graduates to mid- to late-career nurses. METHODS: Using a descriptive qualitative approach, we conducted a thematic analysis of 18 focus groups held in 8 Canadian provinces with 185 student, early-career, and mid- to late-career nurse participants. RESULTS: Student participants expressed the need for a supportive environment to enable successful transition to practice. Early-career nurses expected effective leadership at the unit level, effective communication, and positive working relationships to enable best care outcomes. Mid- to late-career nurses were most dissatisfied with management interactions and relationships. CONCLUSIONS: Management relations are important across all career stages, affecting patient care and job satisfaction. Findings provide insight into how nurse-manager relations can be enhanced from new graduate support to guidance in career development and ongoing recognition and respect for nurses throughout their careers.

Navigating and negotiating information and support: Experiences of first-time mothers.

AIMS AND OBJECTIVES: To examine how first-time mothers in Nova Scotia identified and prioritised their own postpartum needs and where they went for information and support, inclusive of informal or formal programmes and services, social media, family and friends. BACKGROUND: The early postpartum period is an exciting, yet stressful life experience for first-time mothers. Mothers have often turned to families, friends and healthcare professionals for support and information; however, these social networks look differently today due to changes in institutional policies and postpartum healthcare practices, as well as the emergence of online resources and networks. There is currently limited understanding of how online resources have shifted mothers social networking practices and the degree to which programmes and resources are currently meeting the needs of mothers and families. METHODS: Data were collected through focus group interviews in rural and urban Nova Scotia communities (n = 19) and online electronic interviews (n = 18). Data were analysed using feminist poststructuralism and discourse analysis to understand issues of inclusion and health equity for mothers and how relations of power were negotiated by first-time mothers in their search for support and information. RESULTS: Most participants were savvy as they critiqued, compared, navigated and negotiated advice and information from various sources, including health professionals, family, friends and online forums. However, they unanimously wanted face-to-face support with other mothers and healthcare professionals. Participants enacted their agency to critically analyse information and support to ensure it matched their own beliefs, values and practices. CONCLUSIONS: It is important to understand first-time mothers' practices and need for face-to-face support, as well as a need for further research with more diverse or marginalised demographics of mothers.

Maternal Knowing and Social Networks: Understanding First-Time Mothers' Search for Information and Support Through Online and Offline Social Networks.

The postpartum period is an exciting yet stressful time for first-time mothers, and although the experience may vary, all mothers need support during this crucial period. In Canada, there has been a shift for universal postpartum services to be offered predominantly online. However, due to a paucity of literature, it is difficult to determine the degree to which mothers' needs are being effectively addressed. The aim of this study was to examine and understand how first-time mothers accessed support and information (online and offline) during the first 6 months of their postpartum period. Using feminist poststructuralism methodology, data were collected from focus groups and e-interviews, and analyzed using discourse analysis. Findings indicate that peer support is greatly valued, and mothers often use social media to make in-person social connections. Findings highlight how accessing support and information is socially and institutionally constructed and provide direction for health professionals to provide accessible postpartum care.

Saving lives with caring assessments: How Tanzanian nurse-midwives and obstetricians negotiate postpartum practices.

AIMS AND OBJECTIVES: To explore the nurse-midwives' and obstetricians' experiences delivering postpartum care assessments and how it was constructed through personal, social and institutional discourses. INTRODUCTION: The Tanzanian Government has prioritised maternal and child health as an urgent healthcare issue. Nurse-midwives and obstetricians are the two main providers of care throughout the prenatal and postpartum periods. DESIGN: A qualitative design guided by a feminist poststructuralist methodology. METHODS: Ten nurse-midwives and three obstetricians from three Regional Hospitals in Dar es Salaam participated in individual semi-structured in-depth interviews. RESULTS: Assessment emerged as a significant theme with three subthemes. Nurse-midwives shared their beliefs and values about assessments that focused on the safety of mothers and babies. They felt proud working with mothers and babies and shared their frustrations having to deal with inadequate working conditions. Guidelines and practices were part of the institutional discourse that impacted the day-to-day experiences of nurse-midwives and obstetricians. The nurse-midwives held the belief that it was vital to complete a comprehensive assessment to identify danger signs, keep mothers and babies safe and look for any abnormalities. They were concerned that mothers were being sent home too early. CONCLUSIONS: Nurse-midwives' experiences in the provision of postpartum care portray that these health providers work heartedly to make sure that the mothers and their newborns receive the best care they can provide. The health system is challenged to address the needed supplies and equipment for reproductive health in particular postpartum care services. RELEVANCE TO CLINICAL PRACTICE: Institutional health discourses significantly affect the practice of nurse-midwives and obstetricians to deliver timely and effective postpartum assessments. Immediate and ongoing postpartum assessments conducted by nurse-midwives and obstetricians can save lives. This study presents the first theme of the study: Caring assessments save lives.

The Challenges of Providing Postpartum Education in Dar es Salaam, Tanzania: Narratives of Nurse-Midwives and Obstetricians.

Postpartum education can save lives of mothers and babies in developing countries, and the World Health Organization recommends all mothers receive three postpartum consultations. More information is needed to better understand how postpartum education is delivered and ultimately improves postpartum health outcomes. The purpose of this qualitative study was to examine how postpartum care was delivered in three postnatal hospital clinics in Dar es Salaam, Tanzania. Semistructured interviews with 10 nurse-midwives and three obstetricians were conducted. Feminist poststructuralism guided the research process. Postpartum education was seen to be an urgent matter; there was a lack of supportive resources and infrastructure in the hospital clinics, and nurse-midwives and obstetricians had to negotiate conflicting health and traditional discourses using various strategies. Nurse-midwives and obstetricians are well positioned to deliver life-saving postpartum education; however, improvements are required including increased number of nurse-midwives and obstetricians.