Maree Johnson

Maternal mental health in Australia and New Zealand: A review of longitudinal studies

AIM The aim of this paper is to describe the factors that impact on the mental health of Australian and New Zealand (NZ) women in the perinatal period (pregnancy and the year following birth), and to determine the impact of perinatal mental health on womens subsequent health by summarising findings from prospective longitudinal studies conducted in Australia and NZ. METHODS A systematic search was conducted using the databases, Scopus, Medline, PsychInfo and Health Source to identify prospective longitudinal studies focused on womens social and emotional health in the perinatal period. Forty-eight papers from eight longitudinal studies were included. RESULTS The proportion of women reporting depressive symptoms in the first year after birth was between 10 and 20% and this has remained stable over 25 years. The two strongest predictors for depression and anxiety were previous history of depression and poor partner relationship. Importantly, womens mood appears to be better in the first year after birth, when compared to pregnancy and five years later. Becoming a mother at a young age is by itself not a risk factor unless coupled with social disadvantage. Women report a high number of stressors in pregnancy and following birth and the rate of intimate partner violence reported is worryingly high. CONCLUSION Midwives have an important role in the identification, support and referral of women experiencing mental health problems. As many women do not seek help from mental health services, the potential for a known midwife to impact on womens mental health warrants further examination.

Professional Identity in Medical Students: Pedagogical Challenges to Medical Education

Background: Professional identity, or how a doctor thinks of himself or herself as a doctor, is considered to be as critical to medical education as the acquisition of skills and knowledge relevant to patient care. Summary: This article examines contemporary literature on the development of professional identity within medicine. Relevant theories of identity construction are explored and their application to medical education and pedagogical approaches to enhancing students’ professional identity are proposed. The influence of communities of practice, role models, and narrative reflection within curricula are examined. Conclusions: Medical education needs to be responsive to changes in professional identity being generated from factors within medical student experiences and within contemporary society.

Nurses discuss bedside handover and using written handover sheets

Background  The analysis of nursing errors in clinical management highlighted that clinical handover plays a pivotal role in patient safety. Changes to handover including conducting handover at the bedside and the use of written handover summary sheets were subsequently implemented. Aim  The aim of the study was to explore nurses’ perspectives on the introduction of bedside handover and the use of written handover sheets. Method  Using a qualitative approach, data were obtained from six focus groups containing 30 registered and enrolled (licensed practical) nurses. Thematic analysis revealed several major themes. Findings  Themes identified included: bedside handover and the strengths and weaknesses; patient involvement in handover, and good communication is about good communicators. Finally, three sources of patient information and other issues were also identified as key aspects. Conclusions  How bedside handover is delivered should be considered in relation to specific patient caseloads (patients with cognitive impairments), the shift (day, evening or night shift) and the model of service delivery (team versus patient allocation). Implications for nursing management  Flexible handover methods are implicit within clinical setting issues especially in consideration to nursing teamwork. Good communication processes continue to be fundamental for successful handover processes.

Periodontal treatment during pregnancy and birth outcomes: a meta‐analysis of randomised trials

OBJECTIVE The objective of this review was to conduct a meta-analysis of all up-to-date randomised control trials to determine whether periodontal treatment during pregnancy has the potential of reducing preterm birth and low birth weight incidence. METHODS Bibliographic databases MEDLINE (1966-present), EMBASE (1980-present), CINAHL (1982-present) and the Cochrane library up to and including 2010 Issue 10 were searched. The reference list of included studies and reviews were also searched for additional literature. Eligible studies were, published and ongoing randomised control trials that compared pregnancy outcomes for pregnant women who received periodontal treatment during the prenatal period. Two of the investigators independently assessed the studies and then extracted and summarised data from eligible trials. Extracted data were entered into Review Manager software and analysed. RESULTS A total of 5645 pregnant women participated in the 10 eligible trials. Meta-analysis found that periodontal treatment significantly lowered preterm birth (odd ratio 0.65; 95% confidence interval, 0.45-0.93; P = 0.02) and low birth weight (odd ratio 0.53; 95% confidence interval, 0.31-0.92; P = 0.02) rates while no significant difference was found for spontaneous abortion/stillbirth (odd ratio 0.71; 95% confidence interval, 0.43-1.16; P = 0.17). Moderate heterogeneity was observed among the studies for preterm birth and low birth weight. Subgroup analysis showed significant effect of periodontal treatment in pregnant women with low rate of previous preterm birth/low birth weight (odd ratio 0.35; 95% confidence interval, 017-0.70; P = 0.003) and less severe periodontal disease (odd ratio 0.49; confidence interval, 028-0.87; P = 0.01) as defined by probing depth. CONCLUSION The cumulative evidence suggests that periodontal treatment during pregnancy may reduce preterm birth and low birth weight incidence. However, these findings need to be further validated through larger more targeted randomised control trials.

Promoting oral health during pregnancy: current evidence and implications for Australian midwives.

AIMS AND OBJECTIVES The aim of this paper is to examine current evidence supporting the promotion of oral health during pregnancy and proffer aspects of a potential role for Australian midwives. BACKGROUND Research continues to show that poor oral health during pregnancy can have an impact on the health outcomes of the mother and baby. Poor maternal oral health increases the chances of infants developing early caries and is strongly associated with adverse pregnancy outcomes such as preterm and low birth-weight babies. Unfortunately in Australia, no preventive strategies exist to maintain the oral health of pregnant women. DESIGN Systematic review. METHOD This review examines all literature on oral health during pregnancy published to date in the English language and focuses on whether preventive oral health strategies during the prenatal period are warranted in Australia and if so, how they could be provided. RESULTS Maintaining oral health is important during pregnancy and many developed countries have implemented preventive strategies to address this issue using non-dental professionals such as prenatal care providers. However, despite the positive international evidence, limited importance is being given to the oral health of pregnant women in Australia. It is also evident that the unique potential of prenatal care providers such as midwives to assess and improve maternal oral heath is not being thoroughly utilised. Compounding the issue in Australia, especially for pregnant women from socioeconomically disadvantaged backgrounds, is the limited access to public dental services and the high cost of private dental treatment. CONCLUSION Promoting and maintaining oral health during pregnancy is crucial, and preventive prenatal oral health services are needed in Australia to achieve this. RELEVANCE TO CLINICAL PRACTICE Midwives have an excellent opportunity to offer preventive oral health services by providing oral health assessments, education and referrals for pregnant women attending antenatal clinics.

Measuring perinatal mental health risk

The purpose of this review was to critically analyse existing tools to measure perinatal mental health risk and report on the psychometric properties of the various approaches using defined criteria. An initial literature search revealed 379 papers, from which 21 papers relating to ten instruments were included in the final review. A further four papers were identified from experts (one excluded) in the field. The psychometric properties of six multidimensional tools and/or criteria were assessed. None of the instruments met all of the requirements of the psychometric properties defined. Some had used large sample sizes but reported low positive predictive values (Antenatal Risk Questionnaire (ANRQ)) or insufficient information regarding their clinical performance (Antenatal Routine Psychosocial Assessment (ARPA)), while others had insufficient sample sizes (Antenatal Psychosocial Health Assessment Tool, Camberwell Assessment of Need—Mothers and Contextual Assessment of Maternity Experience). The ANRQ has fulfilled the requirements of this analysis more comprehensively than any other instrument examined based on the defined rating criteria. While it is desirable to recommend a tool for clinical practice, it is important that clinicians are made aware of their limitations. The ANRQ and ARPA represent multidimensional instruments commonly used within Australia, developed within large samples with either cutoff scores or numbers of risk factors related to service outcomes. Clinicians can use these tools, within the limitations presented here, to determine the need for further intervention or to refer women to mental health services. However, the effectiveness of routine perinatal psychosocial assessment continues to be debated, with further research required.

The role of anxiety and other factors in predicting postnatal fatigue: from birth to 6 months.

OBJECTIVE to explore the role of anxiety and other factors in predicting postnatal fatigue from birth to 6 months. DESIGN a prospective longitudinal correlational survey design. SETTING Canberra, Australian Capital Territory, Australia. PARTICIPANTS 504 well women, 233 primipara and 271 multipara, aged 20-40 years who gave birth during the study period. MEASUREMENT the Postpartum Fatigue Scale, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the Support Behavior Inventory were used to measure the relationship between the predictive factors and the intensity of fatigue at the various time points. FINDINGS an explanatory model of fatigue development was applied to all participants, and then to primiparas and multiparas, explaining 27-44% of the variance in fatigue from 1 to 24 weeks in the total sample (p>.001). State anxiety was a consistently strong predictor of fatigue intensity across time and group. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE the contribution that state anxiety made to the development of fatigue in this group of low risk women highlights the importance of assessing symptoms of anxiety in all childbearing women. Focusing on depressive symptoms limits the extent to which anxiety symptoms, which occur in parallel with depressive symptoms, are addressed. Anxiety is a normal response to the changes in roles and responsibilities that occur following birth. However the belief that all new mothers worry excessively and that anxiety is not as harmful as depression may have influenced the way midwives and maternal child health nurses view postnatal anxiety. Assessment of anxiety, and use of interventions such as cognitive and behavioural strategies and self-care practices, can be used to assist women to reduce anxiety levels.

Exploring the structure and organization of information within nursing clinical handovers

Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress.Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress.

How Do Dental and Prenatal Care Practitioners Perceive Dental Care During Pregnancy? Current Evidence and Implications

BACKGROUND Poor maternal oral health may be associated with adverse pregnancy and infant outcomes. However, women seldom seek dental care during pregnancy, and misconceptions by prenatal care practitioners about oral health care during pregnancy may contribute to the problem. The aim of this study was to review current knowledge, attitudes, and behavior of dental and prenatal care practitioners about oral health care during pregnancy. METHODS This review examined all studies published in English that explored the knowledge, attitude, behavior, and barriers faced by dentists, general practitioners, midwives, and obstetricians/gynecologists with respect to oral health care during pregnancy. RESULTS Despite acknowledging the importance of maternal oral health, many dentists are uncertain about the safety of dental procedures and are hesitant in treating pregnant women. General practitioners and midwives are poorly informed about the impact of poor maternal oral health and rarely initiate this topic during prenatal care. Many general practitioners also believe that dental procedures are unsafe during pregnancy. Obstetricians/gynecologists are well informed about perinatal oral health and are supportive of dental procedures, but because of lack of training in this area and competing health demands they seldom focus on oral health care during their prenatal care. CONCLUSION No real consensus exists among dentists and prenatal care practitioners with respect to oral health care during pregnancy. This issue poses a significant deterrent for pregnant women seeking dental care. Practice guidelines in perinatal oral health are needed for health professionals to emphasize this important aspect of prenatal care.

Models of care in nursing: a systematic review

OBJECTIVE This review investigated the effect of the various models of nursing care delivery using the diverse levels of nurses on patient and nursing outcomes. METHODS All published studies that investigated patient and nursing outcomes were considered. Studies were included if the nursing delivery models only included nurses with varying skill levels. A literature search was performed using the following databases: Medline (1985-2011), CINAHL (1985-2011), EMBASE (1985 to current) and the Cochrane Controlled Studies Register (Issue 3, 2011 of Cochrane Library). In addition, the reference lists of relevant studies and conference proceedings were also scrutinised. Two reviewers independently assessed the eligibility of the studies for inclusion in the review, the methodological quality and extracted details of eligible studies. Data were analysed using the RevMan software (Nordic Cochrane Centre, Copenhagen, Denmark). RESULTS Fourteen studies were included in this review. The results reveal that implementation of the team nursing model of care resulted in significantly decreased incidence of medication errors and adverse intravenous outcomes, as well as lower pain scores among patients; however, there was no effect of this model of care on the incidence of falls. Wards that used a hybrid model demonstrated significant improvement in quality of patient care, but no difference in incidence of pressure areas or infection rates. There were no significant differences in nursing outcomes relating to role clarity, job satisfaction and nurse absenteeism rates between any of the models of care. CONCLUSIONS Based on the available evidence, a predominance of team nursing within the comparisons is suggestive of its popularity. Patient outcomes, nurse satisfaction, absenteeism and role clarity/confusion did not differ across model comparisons. Little benefit was found within primary nursing comparisons and the cost effectiveness of team nursing over other models remains debatable. Nonetheless, team nursing does present a better model for inexperienced staff to develop, a key aspect in units where skill mix or experience is diverse.