Ailsa Munns

Community-based child health nurses: An exploration of current practice

Abstract The purpose of this research was to define, the practice domain of community-based child health nursing in light of widespread political, economic and social changes in Western Australia. The project was conducted by a group of nurse researchers with experience in child health nursing from the School of Nursing and Midwifery at Curtin University and the Child and Adolescent Community Health Division at the Department of Health, Western Australia. The overall aim of the project was to map the scope of nursing practice in the community child health setting in Western Australia and to identify the decision making framework that underpins this nursing specialty. Given the widespread social, economic and health service management changes, it was important for nurses involved with, or contemplating a career in, community-based child health to have the role accurately defined. In addition, consumer expectations of the service needed to be explored within the current climate. A descriptive qualitative study was used for this project. A purposive sample of 60 participants was drawn from the pool of child health nurses in the South Metropolitan Community Health Service, North Metropolitan Health Service and Western Australian Country Health Service. Following ethical approval data was collected via participants keeping a 2-week work diary. The data was coded and thematic analysis was applied. Several themes emerged from the analysis which were validated by follow up focus group interviews with participants. This clearly demonstrated common, recurring issues. The results identified that the community-based child health nurses are currently undertaking a more complex and expanded child health service role for an increasingly diverse client population, over their traditional practices which are still maintained. Excessive workloads and lack of human and non human resources also presented challenges. There are increasing requirements for child health nurses to engage in community development and capacity building, often through a multidisciplinary partnership, which requires them to have sound brokerage and facilitation skills to enable community inclusion and inter-agency collaboration at the local level. The study has highlighted the importance and multifaceted nature of the role of the community-based child health nurse. To enable them to function optimally, the following suggestions/recommendations are offered. These being: More physical resources be allocated to communitybased child health nursing More resources allocated to assist community-based child health nurses to support culturally and linguistically diverse families Mapping of child health nurses’ workloads The development of community health client dependency rating criteria reflecting the social determinants of health in order for health service refinement of staffing allocations based on an acuity scale Specific staff development opportunities to reflect the increased workload complexity Managerial support for the implementation of formal clinical (reflective) supervision Additional clerical assistance with non-nursing duties.

Peer-led Aboriginal parent support: Program development for vulnerable populations with participatory action research

Background: Participatory action research (PAR) is a credible, culturally appropriate methodology that can be used to effect collaborative change within vulnerable populations. Aim/objective: This PAR study was undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting programme. A secondary aim, addressed in this paper, was to explore and describe research methodology used for the study and provide recommendations for its implementation in other similar situations. Methods: PAR using action learning sets was employed to develop the parent support programme and data addressing the secondary, methodological aim were collected through focus groups using semi-structured and unstructured interview schedules. Findings were addressed throughout the action research process to enhance the research process. Results: The themes that emerged from the data and addressed the methodological aim were the need for safe communication processes; supportive engagement processes and supportive organisational processes. Conclusions: Aboriginal peer support workers (PSWs) and community support agencies identified three important elements central to their capacity to engage and work within the PAR methodology. This research has provided innovative data, highlighting processes and recommendations for child health nurses to engage with the PSWs, parents and community agencies to explore culturally acceptable elements for an empowering methodology for peer-led home visiting support. There is potential for this nursing research to credibly inform policy development for Aboriginal child and family health service delivery, in addition to other vulnerable population groups. Child health nurses/researchers can use these new understandings to work in partnership with Aboriginal communities and families to develop empowering and culturally acceptable strategies for developing Aboriginal parent support for the early years. Impact Statement Child health nurses and Aboriginal communities can collaborate through participatory action research to develop peer-led support for the early years. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal.

Effectiveness and experiences of families participating in peer led parenting support programs delivered as home visiting programs and the meaning they attribute to these support programs: a systematic review protocol

Review question/objective What is the effectiveness and experience of families participating in peer led parenting support programs delivered as home visiting programs? The objective of this review is to identify the effectiveness and experience of families participating in peer led parenting support programs delivered as home visiting programs. The quantitative objective is to identify the effectiveness of peer led home visiting parent support for families. More specifically, the objectives are to identify: The types of peer led home visiting programs that are, or have been undertaken. The effectiveness of peer led home visiting parent support programs on families. The qualitative objectives are to identify the experiences and meanings of peer led parenting support programs for families. More specifically, the objectives are to identify the evidence on: The meaning that families place on peer led home visiting parent support programs. The experiences of families with regard to peer led home visiting parent support programs. The successful components of peer led home visiting parent support programs. The differences between peer led home visiting programs offered to Indigenous and non‐Indigenous families. Background This review will examine peer led home visiting parenting support for families with young children, including Indigenous families. The age range for children is from birth to four years, after which it is anticipated that they will have more sustained contact in the preschool environment. In Australia, support for Indigenous and non‐Indigenous families with young children has been traditionally undertaken by community child health nurses working as sole practitioners or in conjunction with Aboriginal Health Workers within the states Departments of Health (DOH) or Aboriginal Community Controlled Health Services (ACCHS). The service provision has been traditionally defined by DOH or ACCHS policies and protocols, focussing on universal first home visits after discharge from hospital and client clinic attendance for developmental screening. Families in contemporary societies have become increasingly diverse in their structure and function, with more vulnerabilities being identified. To minimize risks of early disadvantage and lifelong psychosocial health impacts, active, alternate engagement strategies addressing barriers to participation in support services are needed. Designing child and family health services to meet these needs include the use of home visiting.1 While community nurse led home visiting is an established strategy to support parents, there is increasing recognition of the value of peer led home visiting from parents in local communities. However, the evidence around models for peer led home visiting requires systematic evaluation to review effectiveness and the elements of successful implementation. An evaluation of family support in South Australia by Community Matters Pty Ltd. highlights the necessity for responsive programs that adapt to varying circumstances, also allowing families to create their own change.2 Community members engaged in effective peer support have been acknowledged as having open, non‐judgemental, reflective and positive modelling behaviors. One study researched the interactions of paraprofessionals supporting families of mixed race in North America, who had low psychological resources.3 Paraprofessional positions may include trained paid or unpaid supplementary assistants to professionals such as nurses. Volunteers may also be used in these positions. This research demonstrated that these parents provided home environments that enhanced early learning and produced positive effects on mother‐child interaction. Recent studies and reviews by Larson & Bradley, Boulton, Brown and Long and Walker, in Western Australia have identified the need for improved, innovative ways of parent support and child health service delivery for Indigenous families, including home visiting.4‐6 There is recognition that support needs to include trans‐generational aspects and be embedded within culture, language and lore. Central to the effectiveness of home visiting is the need to develop, implement and evaluate programs within the broader context of impacting social and cultural factors. However, there is little supporting evidence in relation to this sociocultural approach.6 While this background information talks about ‘home visiting,’ the visit may not always be in the family home. Rather, in consultation with the family, the place of meeting can be the home, or it could be another place chosen by the parent such as the local park, the swimming pool or other location. The main emphasis is on a place where the parent feels secure. There have been few recent (2003‐2013) mixed methodology or qualitative studies investigating peer led parenting support programs delivered as home visiting programs. Studies by Olds et al., have reviewed the use of paraprofessionals in home visiting programs in North America for families where paraprofessional impact was lower on maternal and child health outcomes.3,7 However, the results of these studies were from randomized controlled trials (RCTs), not taking into account qualitative research methods where the experiences of families participating in peer led parenting support programs and their self‐perceived meaning could be explored. Similarly, an RCT in North America by Vogler et al., with no inclusion of qualitative evidence, demonstrated little differences in results of home visiting between nurses and paraprofessionals.8 Rigorous non‐statistical research approaches such as community‐based participatory action and Most Improved Change Technique have the potential to fill knowledge gaps around concepts of empowerment and capacity building for families and communities in cross‐cultural contexts.6 The population for this comprehensive systematic review will be Indigenous and non‐Indigenous families and parents with children 0‐4 years of age. The quantitative component will consider studies evaluating the effectiveness of peer led home visiting parent support programs for families in developed and underdeveloped countries, while the qualitative component will consider studies investigating the meaning and experiences of these programs. The expected outcomes will be to identify the types of peer led home visiting programs that are/or have been undertaken, their effectiveness and meaning for Indigenous and non‐Indigenous families and the components of the programs that facilitate success. Peer led support for families delivered as home visiting programs is important as local parents working as peers are cognizant of the lived experiences of families in their immediate geographical area, along with contemporary psychosocial impacts. Research evaluation is imperative to maximize the impact of these programs on parenting support and their outcomes. Examination of Joanna Briggs and Cochrane reviews have not found any current or planned reviews on the same topic.

Changing focus of practice for community health nurses: Advancing the practice role

Many parents lack support in their parenting role that was once provided through extended families and community structures. Thus, some new parents experience high levels of stress and low self-esteem associated with the challenges of parenting. The lack of support also results in family discord and breakdown with the family environment having the potential to adversely impact children’s mental and physical wellbeing and development. The Community Mothers Program (CMP) was initially developed in England and offers support to families during the first year of parenting. The program aims to provide parents with the support once experienced from within the extended family. It also aims to enrich community development by building the capacity of community members living in local communities to support parents. This paper describes the impact of the CMP when implemented into Western Australian as well as the changes to the professional practice role of community child health nurses involved in the program. The Community Mothers Program has proved to be very successful. The success is attributed to the partnership model established between community members, parents, and child health nurses.

Perinatal depression and screening among Aboriginal Australians in the Kimberley

Problem: Adhoc culturally questionable perinatal mental-health screening among Aboriginal women in the Kimberley. Background: Mental-health issues, substance abuse and suicide attempts are high among young Aboriginal women in Australia. There is no evidence that the Edinburgh Postnatal Depression Scale (EPDS) is effective or culturally safe. Screening practices are complicated by limited understanding of the complex cultural interface between Western and Aboriginal beliefs and notions about health and mental-health. Question: What is the current context of perinatal mental-health screening practices among Aboriginal women in the Kimberley and what might be considered a culturally safe approach? Methods: A review of the literature and exploration of current screening practices preceded community participatory action research (CPAR) of perinatal mental-health screening. Results: More than 100 Kimberley women and 72 health practitioners contributed to this joint strategic body of work. Recommendations for practice include one single culturally appropriate Kimberley version of the EPDS.

Effectiveness and experiences of families and support workers participating in peer-led parenting support programs delivered as home visiting programs: a comprehensive systematic review

Background Designing child and family health services to meet the diverse needs of contemporary families is intended to minimize impacts of early disadvantage and subsequent lifelong health and social issues. Innovative programs to engage families with child and family support services have led to interest in the potential value of peer-led home visiting from parents in local communities. There is a range of benefits and challenges identified in a limited number of studies associated with home visiting peer support. Objectives The objective of the review is to identify: The effectiveness of peer-led parenting support programs delivered as home visiting programs to indigenous and non-indigenous families and the characteristics of successful programs. The experiences of families and support workers participating in parenting support programs delivered as home visiting programs including the relationships between the program participants. Inclusion criteria Participants Families/parents with one or more children aged zero to four years, peer support workers and their supervisors. Intervention and phenomenon of interest Peer-led home visiting parenting support programs that use volunteer or paraprofessional home visitors from the local community compared to standard community maternal-child care. The phenomenon of interest will be the relationships between participants in the program. Types of studies Quantitative studies: randomized control trials (RCTs). Qualitative studies: grounded theory and qualitative descriptive studies. Outcomes Parental attitudes and beliefs, coping skills and confidence in parenting, parental stress, compliance with child health checks/links with primary healthcare services, satisfaction with peer support and services and the nature of the relationship between parents and home visitors. Search strategy The search strategy will include both published and unpublished studies. Seven journal databases and five other sources will be searched. Only studies published in the English language from 2000 to 2015 will be considered. Methodological quality Studies were assessed by two independent reviewers using standardized critical appraisal tools from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) as appropriate. Data extraction Both quantitative and qualitative data were independently extracted by two reviewers using standardized data extraction tools from the JBI-MAStARI and the JBI-QARI, respectively, including qualitative and quantitative details about setting of interventions, phenomena of interest, participants, study methods and outcomes or findings. Data synthesis For quantitative findings, statistical pooling was not possible due to differences in interventions and outcome measures. Findings were presented in narrative form. Qualitative findings were aggregated into categories based on similarity of meaning from which synthesized findings were generated. Results Quantitative results from two RCTs demonstrated positive impacts of peer-led home visiting parent support programs including more positive parenting attitudes and beliefs, and more child preventative health care visits. Fifteen qualitative findings from two studies were aggregated into five categories from which two synthesized findings emerged. Parents and home visitors identified similar components as contributing to their programs success, these being quality of relationships between parents and home visitors with elements being mutual respect, trust and being valued within the partnership. In addition, home visitors identified importance of enabling strategies to develop relationships. They also needed supportive working environments with clinical staff and management. Conclusion The current review indicates a positive impact of peer-led home visiting parent support programs, incorporating a framework of partnership between parents and home visitors, on mother-infant dyads. Positive changes in parenting attitudes and beliefs, and increased number of child preventative healthcare visits are supported by the quality of the relationship between parent and home visitor, and home visitors’ working environments. Implications for practice The essential characteristics of an effective parent support program are strategies for relationship building between parents and home visitors; ongoing staff and home visitor education to enhance communication, collaboration and working in partnership; supervision by team leaders; and continuous quality improvement. Implications for research The focus of further research should be on confirmatory studies using an action research methodology and the cost-effectiveness of these models.

Home oxygen therapy for infants and young children with acute bronchiolitis and other lower respiratory tract infections: the HiTHOx program.

Background: Acute lower respiratory tract infection (LRTI) including bronchiolitis, is one of the leading causes of pediatric hospital admissions worldwide. Recent studies have demonstrated that some children with acute bronchiolitis can be successfully managed using home oxygen therapy. Aim: To report the impact of a Hospital in The Home Oxygen therapy program (HiTHOx) for selected infants and young children with acute bronchiolitis and other LRTI. Findings: The HiTHOx program appears to be a safe model of care for carefully selected infants and young children with acute bronchiolitis and LRTI that reduces the hospital length of stay. Conclusions: The HiTHOx program provides an alternative model of care for infants and young children with acute LRTI. Implementation of models of care similar to that of the HiTHOx program in other pediatric health services may have the potential to create additional bed capacity, at the time of year when it is most needed.

The Relevance of Aboriginal Peer-Led Parent Support: Strengthening the Child Environment in Remote Areas

ABSTRACT This participatory action research study was situated within a larger research study, which investigated the development of a peer-led Aboriginal parent support program in the remote setting of Halls Creek in Western Australia. The aim of this smaller research component was to explore the self-perceived role of home visiting peer support workers in this remote area. Participatory Action Research methodology was employed, within which eleven Action Learning Sets were used to facilitate participant collaboration (n = 8). All participant data was collected in focus groups during the Action Learning Sets where culturally appropriate home visiting parent support strategies were developed and examined in partnership with a child health nurse researcher. Data were analyzed using thematic analysis with three themes relating to the peer support workers’ self-perceived role being identified: Helping parents be strong for their children; Strengthening culture; and Facilitating effective communication. These elements support peer support worker activities, helping parents to enhance their children’s physical and psychosocial developmental environment. This research highlights the critical emerging role of peer support workers in home visiting family support in a remote area of Australia.