Olive Wahoush

Postpartum Depression Symptoms in Newcomers

Objectives: To determine if postpartum depression (PPD) symptoms are more common in newcomer women than in Canadian-born women. Methods: Refugee, nonrefugee immigrant, asylum-seeking, and Canadian-born new mothers were administered questionnaires for depression, social support, interpersonal violence, and demographic information. We created a PPD variable based on a score of ⩾10 on the Edinburgh Postnatal Depression Scale (EPDS) and performed a logistic regression analysis for PPD. Results: Immigrants (35.1%), asylum seekers (31.1%), and refugees (25.7%) were significantly more likely than Canadian-born (8.1%) women to score ⩾10 (P = 0.008) on the EPDS, with the regression model showing an increased risk (odds ratio) for refugee (4.80), immigrant (4.58), and asylum-seeking (3.06) women. Women with less prenatal care were also more likely to have an EPDS of ⩾10 (P = 0.03). Newcomer women with EPDS scores of ⩾10 had lower social support scores than Canadian-born women (P < 0.0001). Conclusions: Newcomer mothers have an increased risk for PPD symptoms. Social support interventions should be tested for their ability to prevent or alleviate this risk.

The childbearing health and related service needs of newcomers (CHARSNN) study protocol

BackgroundRefugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (e.g., war, rape or abuse histories), are separated from their families, have limited knowledge of the host country languages, and are visible minorities. Asylum-seekers face additional stresses related to their unknown future status and are marginalized with regards to access to provincial health care systems. The prevalence and severity of health issues in this population is not known nor is the extent of response from social service and health care systems (including variation in provincial service delivery). Understanding the magnitude of health and social concerns of newcomers requires data from a representative sample of childbearing refugee and asylum-seeking women resettling in Canada to permit comparisons to be made with non-refugee immigrant and Canadian-born women. Our research questions are: (1) Do refugee or asylum-seeking women and their infants, experience a greater number or a different distribution of harmful health events during pregnancy, at birth, and during the postpartum period than non-refugee immigrant or Canadian-born women? (2) Are the harmful health events experienced postpartum by asylum-seeking women and their infants, addressed less often (compared to refugees, non-refugee immigrants, and Canadian-born women) by the Canadian health care system as delivered in each of the three major receiving cities for newcomers?Methods/designThis is a four-year multi-site prospective cohort study (pregnancy to 4 months postpartum). We will seek to recruit 2400 women [200 in each of 4 groups (refugees, asylum-seekers, non-refugee immigrants, and Canadian-born) from 1 of 12 postpartum hospital units across the 3 largest receiving cities for newcomers to Canada – Montreal, Toronto, and Vancouver].DiscussionKnowledge of the extent of harmful health events occurring to asylum-seeking, refugee, immigrant, and Canadian-born women, and the response of the health care system to those events and group differences, if they exist, will inform immigration and health policy makers as well as providers of services.

Information literacy during entry to practice: Information-seeking behaviors in student nurses and recent nurse graduates

BACKGROUND The ability to locate information pertinent to guide clinical practice is important for quality nursing care and patient safety. To date, little is known about the transfer of information literacy skills as student nurses transition to clinical practice as new graduates. This study begins to address this gap from the perspective of student nurses, recent nurse graduates (RNs), nurse leaders and library staff. OBJECTIVES To describe the information-seeking behaviors of student nurses and RNs within their clinical settings. DESIGN AND PARTICIPANTS This is a descriptive study that included both cross-sectional surveys and key informant interviews. Participants were senior-level undergraduate students and recently graduated RNs (graduated since 2008), and nurse leaders and library staff employed in one of the clinical sites accepting undergraduate students from the McMaster Mohawk and Conestoga BScN program. The study was completed in two large hospital corporations in Hamilton, Ontario, Canada. METHODS Student nurses and RNs were invited to complete online surveys to assess their access to and use of information sources and resources within clinical practice. Students completed a survey comprised of five open-ended questions, while RNs completed a survey comprised of 13 fixed choice and open-ended questions. Nurse leaders and library staff participated in qualitative interviews to verify the extent and availability of information resources. RESULTS Eighteen RNs and 62 students completed their respective surveys. Three categories of information sources and resources were identified: electronic, print and interpersonal. Electronic sources of information were the most used resource by both students and RNs. More RNs reported using interpersonal sources, while students reported using more print sources of information. CONCLUSIONS Recent RN graduates meet the Canadian Association of Schools of Nursing performance indicators related to information access for the entry to practice Nursing Informatics competencies.

Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses

BackgroundThe Nurse-Family Partnership (NFP) is a targeted, nurse home visitation program for young, low-income, first-time mothers. While the effectiveness of the NFP has been established in the United States, and is currently being evaluated in the Canadian public health care system, we have minimal understanding of how work of this nature impacts public health nurses (PHNs), an essential component of this program delivery model, on both professional and personal levels.MethodsThis two-phase study consisted of a qualitative secondary analysis of data from five focus groups conducted with PHNs (N = 6) who delivered the NFP intervention as part of a pilot study assessing feasibility and acceptability conducted in Hamilton, Ontario. The second phase, an interpretive description of individual interviews with the PHNs (N = 10) who have delivered the NFP in this context, further explored themes identified in the first phase. A practice, problem and needs analysis was conducted to describe and understand the phenomenon and promote sustainability of PHNs in this practice environment. Conventional content analysis was used to code and categorize data in the two datasets.ResultsThe nurse-client relationship, the core elements and structure of the NFP program and support of NFP colleagues were described as rewarding factors, while workload and workplace factors were identified as significant contributors to stress. PHNs described transforming their nursing practice through redefining success and shifting to a philosophy where the client is the expert of her own life. PHNs described the personal impact of worry about clients and doubt about their effectiveness in addressing client concerns. High levels of satisfaction were described in relation to the depth and intensity of relationships with clients and seeing them succeed over time.ConclusionsPHNs are impacted in multiple ways by their work with vulnerable, young mothers. The study findings have implications for identification of strategies to support PHNs in reducing staff turnover, PHN burnout, secondary traumatic stress and compassion fatigue, and improving program delivery.

A descriptive phenomenology study of newcomers' experience of maternity care services: Chinese women's perspectives

BackgroundMaternity health care available in Canada is based on the needs of women born in Canada and often lacks the flexibility to meet the needs of immigrant women. The purpose of this study was to explore immigrant Chinese women’s experiences in accessing maternity care, the utilization of maternity health services, and the obstacles they perceived in Canada.MethodsThis descriptive phenomenology study used in-depth semi-structured interviews to examine immigrant Chinese women’s experiences. Fifteen participants were recruited from the Chinese community in Toronto, Canada by using purposive sampling. The interviews were digitally recorded and transcribed verbatim into written Chinese. The transcripts were analyzed using Colaizzi’s (1978) phenomenological method.ResultsSix themes were extracted from the interviews: (1) preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, (2) strategies to deal with the inconvenience of the Canadian healthcare system (3) multiple resources to obtain pregnancy information, (4) the merits of the Canadian healthcare system, (5) the need for culturally sensitive care, and (6) the emergence of alternative supports and the use of private services.ConclusionsThe findings provide new knowledge and understanding of immigrant Chinese women’s experiences in accessing maternity health services within a large metropolitan Canadian city. Participants described two unique experiences within the themes: preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, and the emergence of alternative supports and the use of private services. Few studies of immigrant maternity service access have identified these experiences which may be linked to cultural difference. Further investigation with women from different cultural backgrounds is needed to develop a comprehensive understanding of immigrant women’s experiences with maternity care.

Body image dissatisfaction among immigrant children and adolescents in Canada and the United States: A scoping review

OBJECTIVE To systematically summarize the literature examining body image dissatisfaction (BID) among immigrant children and adolescents living in Canada and the United States (US). METHOD Sources were identified by entering search terms into six electronic databases and by completing an electronic hand search of research journals focusing on body image. Eligible sources were those published between 1946 and November 2012, conducted within Canada or the US, included immigrant children or adolescents (<18 years), and measured BID through self-report. Synthesis followed the principles of thematic and content analysis (Vaismoradi et al., Nurs Health Sci, 2013,15,398-405). RESULTS A total of 12 sources were included in our synthesis, spanning years 1991 to 2010. These studies indicate that immigrant children and adolescents experience BID. However, the literature is plagued by a disproportionate focus on females, Latino/Hispanic immigrants, and inadequate attention to issues of measurement. DISCUSSION There is no evidence about the BID experiences of immigrant children and adolescents in Canada and limited information has stemmed from the US. A more robust evidence-base should include the use of advanced methods to examine the influence of acculturation and acculturative stress on BID among immigrant male and female children and adolescents.

Feasibility and Acceptance of a Novel Nutrition and Exercise Intervention to Manage Excess Gestational Weight Gain: Focus group study in Ontario,Canada

In preparation for designing a randomized clinical trial aimed to manage gestational weight gain during pregnancy, we conducted a qualitative study using focus groups of women and health care providers for the purpose of identifying the enablers or barriers that support or limit nutrition and exercise modifications for women during pregnancy and to determine the feasibility of such a program in the community. A purposeful sample of pregnant or recently pregnant (within the last year) women (n=21) and health care providers (n=7) were recruited from community health clinics in Hamilton, Canada. A semi-structured focus group guide was tailored to each target group. Qualitative analysis was completed using NVivo 9 software and key conceptual categories of behavioural, control and normative beliefs were identified from transcribed interview texts and field notes. The results indicated that to make nutrition and exercise interventions more accessible to women of various backgrounds, key facilitators should include: behavioural beliefs of the importance of nutrition and exercise in pregnancy, family support and nutritional education. Identified barriers included: communication with healthcare providers, inter-professional collaboration, language, and lack of specific instructions in currently available guidelines. Collectively, information from women and health providers enabled a clear understanding of barriers, enablers and opportunities for the successful implementation of the planned nutrition and exercise intervention for gestational weight gain management. The identified factors were used to design a clinical randomized trial of a structured and monitored nutrition and exercise program for women beginning in early pregnancy. *Corresponding author: Dr. Stephanie Atkinson, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada, Tel: 905-521-2100; Fax: 905-308-7548; E-mail: satkins@mcmaster.ca Received April 03, 2013; Accepted May 25, 2013; Published May 28, 2013 Citation: Walji R, Wahoush O, Atkinson SA (2013) Feasibility and Acceptance of a Novel Nutrition and Exercise Intervention to Manage Excess Gestational Weight Gain: Focus group study in Ontario, Canada. Primary Health Care 3: 134. doi:10.4172/2167-1079.1000134 Copyright:

Selection and Use of Health Services for Infants’ Needs by Indigenous Mothers in Canada: Integrative Literature Review

In Canada, Indigenous infants experience significant health disparities when compared to non-Indigenous infants, including significantly higher rates of birth complications and infant mortality rates. The use of primary health care is one way to improve health outcomes; however, Indigenous children may use health services less often than non-Indigenous children. To improve health outcomes within this growing population, it is essential to understand how caregivers, defined here as mothers, select and use health services in Canada. This integrative review is the first to critique and synthesize what is known of how Indigenous mothers in Canada experience selecting and using health services to meet the health needs of their infants. Themes identified suggest both Indigenous women and infants face significant challenges; colonialism has had, and continues to have, a detrimental impact on Indigenous mothering; and very little is known about how Indigenous mothers select and use health services to meet the health of their infants. This review revealed significant gaps in the literature and a need for future research. Suggestions are made for how health providers can better support Indigenous mothers and infants in their use of health services, based on what has been explored in the literature to date.

Human Right to Healthcare: Equitable, Evidence-Informed Policy on Refugee Healthcare in Canada

In 2015, Canada received 32,000 refugees seeking asylum from the endemic violence and human rights violations of their homelands. These individuals included government-assisted refugees (GARs), privately sponsored refugees (PSRs) and refugee claimants, all of whom receive healthcare coverage under Canada’s Interim Federal Health Program (IFHP) policy. The federal government limited access to essential healthcare services through retrenchments to the IFHP in 2012. In response to the federal court’s decision that the policy changes were “cruel and unusual,” some services were restored in 2014 for select categories of refugee populations through a more complex system of health coverage.

Street Smarts ↔ Book Smarts

This article describes the development, implementation, and evaluation of an interdisciplinary undergraduate course embedded within a campus–community partnership initiative involving McMaster University School of Nursing, and three urban priority neighborhoods in Hamilton, Ontario, Canada. Students worked together with community residents and faculty to address selected priority community issues identified by neighborhood members. Using the qualitative interpretive description method, the evaluation explored different partners’ (students, community residents, and faculty) perceptions of the course (SWOT analysis: strengths, weaknesses, opportunities, and threats, as well as outcomes) as a community engagement and knowledge exchange intervention. Results provide lessons learned and recommendations for future campus–community engaged courses that can be transferred to similar contexts.