Access to health care for undocumented migrant children and pregnant women confronts human rights and professional values with political and institutional regulations that limit services. In order to understand how health care professionals deal with these diverging mandates, we assessed their attitudes toward providing care to this population. Clinicians, administrators, and support staff (n = 1,048) in hospitals and primary care centers of a large multiethnic city responded to an online survey about attitudes toward access to health care services. Analysis examined the role of personal and institutional correlates of these attitudes. Foreign-born respondents and those in primary care centers were more likely to assess the present access to care as a serious problem, and to endorse broad or full access to services, primarily based on human rights reasons. Clinicians were more likely than support staff to endorse full or broad access to health care services. Respondents who approved of restricted or no access also endorsed health as a basic human right (61.1%) and child development as a priority (68.6%). A wide gap separates attitudes toward entitlement to health care and the endorsement of principles stemming from human rights and the best interest of the child. Case-based discussions with professionals facing value dilemmas and training on children's rights are needed to promote equitable practices and advocacy against regulations limiting services.
This prospective study examined how characteristics of infants (i.e., birth weight and perinatal illness severity), mothers (i.e., anxiety and level of education), and the social context (i.e., maternal received and perceived helpfulness of support) related to mother-very low birth weight (VLBW) infant interaction in 72 dyads. Infant, mother, and contextual factors were assessed at 3 and 9 months of age, and mothers and infants were observed in teaching interactions at 9 months. Dyads whose interaction was more sensitive and responsive included mothers who were better educated and less anxious at 3 months and reported higher perceived support at 3 months. The findings highlight the importance of maternal education and well-being in the parenting of VLBW infants.
To compare the psychosocial adjustment and the quality of interaction with their infant of mothers and fathers of very low-birthweight infants at two time points in the first year of the infant's life.
Quantitative, longitudinal design.
Neonatal Intensive Care Unit of two Canadian urban hospitals.
Sixty-one couples who had an infant born weighing less than 1,500 g.
State-Trait Anxiety Inventory, Parenting Sense of Competence questionnaire, and the Support in Parenting Questionnaire were completed at 3 and 9 months of age. Parent-infant interaction was observed at 9 months and scored with the Nursing Child Assessment Teaching Scale.
Fathers' reported parenting self-efficacy was significantly lower than mothers' at both 3 and 9 months of age. Fathers reported more received support than mothers, and the amount of support that both mothers and fathers reported increased significantly from the 3-month to the 9-month assessment. Mothers and fathers reported similar levels of anxiety and perceived helpfulness of the support they received and were equally sensitive and responsive in interactions with their infants at 9 months of age.
Similarities and differences between mothers and fathers were observed. It is important for nurses to assess mothers and fathers, how any differences are perceived by the couple, and how any differences might be affecting them during the neonatal intensive care unit hospitalization and in early months after discharge.
Although maternal depression is a common emotional disorder, assessment and intervention rates are low. Using a cross-sectional survey design, we examined attitudes, beliefs, and practices of obstetrical and neonatology nurses toward the management of symptoms of maternal depression (SMD). Nurses believed they were responsible to assess for SMD and intervene with women showing SMD. However, only 50% assessed for SMD at least once monthly. Identified barriers to care were: lack of time, training, language, and patient and family beliefs. NICU nurses reported lower confidence, knowledge, and skills, than other nurses who participated in this study. This study shows there is a need to enhance nurses? confidence in assessing and intervening with SMD, and to clarify the referral process.
This study examined psychosocial risk factors for depressive symptomatology in a community sample of pregnant immigrant women in Montreal, Canada. One hundred and nineteen participants were recruited through hospitals and responded to questionnaires assessing depression, somatic symptoms, functional status, social support, stressful life events and marital adjustment. Forty-two percent of participants scored above the cut-off for depression. Depressive symptoms were associated with poorer functional status and more somatic symptoms. Depressed women reported a lack of social support, more stressful life events and poorer marital adjustment. Transitions associated with migration may place pregnant immigrant women at high risk for depression.