International agencies are required to adapt, pilot and then evaluate the effectiveness of the Nurse-Family Partnership (NFP) prior to broad implementation of this public health intervention. The objectives of this qualitative case study were to: 1) determine whether the NFP can be implemented in Canada with fidelity to the US model, and 2) identify the adaptations required to increase the acceptability of the intervention for service providers and families.
108 low-income, first-time mothers in Hamilton, Ontario, received the NFP intervention. In-depth interviews were conducted with NFP clients (n=38), family members (n=14) and community professionals (n=24).
Hamilton, Ontario.INTERVENTION AND DATA COLLECTION: An intensive nurse home visitation program delivered to women starting early in pregnancy and continuing until the child was two years old. Processes to adapt and implement the NFP were explored across seven focus groups with public health nurses and managers. Eighty documents were reviewed to identify implementation challenges. Data were analyzed using directed content analysis.
The NFP model elements are acceptable to Canadian health care providers, public health nurses and families receiving the intervention. The primary adaptation required was to reduce nurse caseloads from 25 to 20 active clients. Recommendations for adapting and implementing all model elements are described.
The NFP model requires minor adaptations to increase the acceptability of the intervention to Canadian stakeholders. A consistent approach to adapting the NFP program in Canada is necessary as provincial jurisdictions commit themselves to supporting an experimental evaluation of the effectiveness of the NFP.
The authors used a transcendental phenomenological approach to describe adolescent mothers' satisfactory and unsatisfactory inpatient postpartum nursing care experiences. They analyzed data from 14 in-depth interviews and found that adolescent mothers' satisfaction is dependent on their perceptions of the nurse's ability to place them "at ease." Nursing care qualities that contributed to satisfactory experiences included nurses' sharing information about themselves, being calm, demonstrating confidence in mothers, speaking to adolescent and adult mothers in the same way, and anticipating unstated needs. Nursing care was perceived to be unsatisfactory when it was too serious, limited to the job required, or different from care to adult mothers, or when nurses failed to recognize individual needs. In extreme cases, unsatisfactory experiences hindered development of an effective nurse-client relationship. These findings illustrate the value of qualitative inquiry for understanding patients' satisfaction with care, can be used for self-reflection, and have implications for nursing education programs.
Data were collected by telephone interviews with 178 mothers of full-term patients in a NICU (neonatal intensive care unit) concerning advice on facilitation of the initiation of breastfeeding. The main advice to the first author as a nurse in the NICU concerned the environment, advice on breastfeeding, distance between units, work organization and nurse behaviour. The advice to other mothers of patients centred on persistence, physical contact with the infant, and not to let nurses take over maternal role functions. The data were structured into themes and categories, classified by one author and two research assistants according to Roy's adaptation theory, and analysed for degree of interrater agreement. The overall agreement of classification was high, reaching 92.5%. It was easily applied by nurses after a brief introduction and proved useful for structuring interview data. It also contributed to clarification of nurse behaviour and division of roles between nurses and mothers. As the four adaptation modes showed considerable overlap, this kind of classification seems inadvisable for application to the assessment of patient/parent situations in the nursing process. For use in a clinical setting, the theory needs the addition of the interactive aspect of nurse and patient/family role functions, and may then be used as a framework for the development of assessment tools.
INTRODUCTION: Postnatal care of the healthy term newborn and the mother has, in modern times, taken place in the hospital setting. As a result of tightened hospital budgets as well as maternal preferences the duration of hospital stay has successively been shortened. Most women in Scandinavia today leave the hospital within four days after delivery. Postnatal care in a hotel like setting has emerged as an alternative to the well-baby nursery unless medical conditions makes this option inappropriate. MATERIAL AND METHODS: To evaluate the safety of postnatal care a study was undertaken to investigate whether correct criteria were being used for referral of the newborn to the hotel. We also wanted to document the duration of stay, unexpected medical complications, and weight development of the infants. Data from 865 infants were used for analysis. RESULTS: Ten (1.1%) newborns had to be readmitted to the hospital due to medical complications. 488 (56%) of the mothers went home within 96 hours, and only 23 (2.6%) stayed more than 120 hours. The weight of the infants reached a nadir on the fourth day post partum (-5.2% of birth weight). INTERPRETATION: The patient hotel is a medically safe alternative to the traditional well-baby nursery, provided that appropriate criteria for referral are used.
To compare alcohol cleaning and natural drying of newborn umbilical cords.
Prospective, randomized controlled trial.
Tertiary-level university teaching hospital and level II community hospital.
Of 1,876 singleton full-term newborns enrolled, 1,811 completed the study.
Newborns, from birth until separation of the cord, were randomized to either (a) umbilical cleansing with 70% isopropyl alcohol at each diaper change or (b) natural drying of the umbilical site without special treatment.
Umbilical infection, cord separation time, maternal comfort, and cost.
No newborn in either group developed a cord infection. Primary care providers obtained cultures for cord concerns in 32 newborns (1.8%), with colonization for normal flora, Staphylococcus aureus, and Group B streptococcus proportionately equal in alcohol and air dry groups. Cord separation time was statistically significantly different (alcohol group, 9.8 days; natural drying group, 8.16 days; t = 8.9, p =
Our aim in this study was to describe the perspectives, experiences, and reasoning about becoming and being a teenage mother by Swedish teenage girls. Twenty pregnant and parenting teenage girls, aged 15 to 19 years, were interviewed. The teenagers described a pattern of early childbirth in their families, lack of opportunity in life, and ambivalence in contraceptive use as reasons for becoming a teenage mother. They experienced being pregnant and a teenage mother as both a positive transition into adulthood but also as a physiological and psychological hardship. Furthermore, the teenagers emphasized the importance of supportive relationships with families, friends, and society as a prerequisite for successful parenting. The results of our study may be viewed as generating a working hypothesis that can be transferred to other settings on the basis of the information gathered.
It has been established that the birthing experiences and outcomes of rural women are shaped by poverty, isolation, limited economic opportunities, and diminishing maternity services. We lack research into how these dynamics are compounded by intersecting forms of oppression faced by Aboriginal women, to impact on their birthing experiences and outcomes. The findings of this study of rural Aboriginal maternity care in 4 communities in British Columbia show how diminishing local birthing choices and women's struggles to exert power, choice, and control are influenced by centuries of colonization. The research questions focus on rural Aboriginal women's experiences of birthing and maternity care in this neocolonial context and their desire for supportive birthing environments. A community-based participatory and ethnographic design was employed. Individual interviews, focus groups, and participant observation were the primary data sources. Although the women's experiences in each community were shaped by distinct histories and traditions, economics, politics, and geographies, the impacts of colonization and medical paternalism and the struggle for control of women's bodies during birth intersect, placing additional stress on women. The implications for nurses of accounting for the intersecting dynamics that shape Aboriginal women's experiences and birth outcomes are discussed.