Shefaly Shorey

A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on self-efficacy, social support and postnatal depression among primiparas

AIM To examine the effectiveness of a postnatal psychoeducation programme in enhancing maternal self-efficacy and social support and reducing postnatal depression among primiparas. BACKGROUND Primiparas experience various challenges during the early postnatal period with low self-efficacy, depression and lack of social support. Support in the form of postnatal educational programmes is needed to improve these outcomes of primiparas. DESIGN A randomized controlled two-group pre-test-post-test design was adopted. METHODS Data were collected from June-December 2012 in a public hospital in Singapore from 122 primiparas, who were randomly assigned to the intervention (n = 61) or control group (n = 61). The intervention group received postnatal psychoeducation programme and routine care while the control group received routine care only. The Maternal Parental Self-Efficacy scale, Perinatal Infant Care Social Support scale and Edinburgh Postnatal Depression Scale were used to measure outcomes of maternal parental self-efficacy, social support and postnatal depression. The mean percentage changes of all three outcome variables from baseline to 6 and 12 weeks postpartum between groups were used when performing repeated measures multivariate analysis of covariance. RESULTS The intervention group had significantly higher scores of maternal parental self-efficacy and social support and lower scores of postnatal depression at 6 and 12 weeks postpartum when compared with the control group. CONCLUSION The postnatal psychoeducation programme was effective in improving maternal outcomes and hence could be introduced as routine care with ongoing evaluation in the postnatal period. Future studies could focus on the effects of this programme on other populations. TRIAL REGISTRATION NO ISRCTN15886353.

Predictors of Maternal Parental Self-Efficacy Among Primiparas in the Early Postnatal Period:

Maternal parental self-efficacy is a crucial factor for facilitating the smooth transition into motherhood, particularly for primiparas. The aims of this study were to examine the predictors of maternal parental self-efficacy and its relationship with social support, postnatal depression (PND), and socio-demographic variables of primiparas during the early postnatal period. A descriptive correlational study design was adopted. The instruments, Perceived Maternal Parental Self-Efficacy, Perinatal Infant Care Social Support, and Edinburgh Postnatal Depression Scale, were used to collect data from a purposive sample of 122 primiparas on the day of discharge (1-3 days post delivery) in a tertiary public hospital in Singapore. There were significant correlations among maternal parental self-efficacy, social support, and postnatal depression. The main predictors of maternal parental self-efficacy were social support, ethnicity, maternal age, and family income. The maternal parental self-efficacy, social support, and PND should be routinely assessed to provide necessary support to needy mothers.

Salivary Cortisol Reactivity in Preterm Infants in Neonatal Intensive Care: An Integrative Review

Recently, more and more researchers have been using salivary cortisol reactivity to evaluate stress in preterm infants in the neonatal intensive care unit (NICU). The aim of this integrative literature review was to summarize the evidence of interventions leading to a change in salivary cortisol from the baseline in preterm infants in the NICU. The electronic databases of PubMed, CINAHL, Web of Science, and Scopus were searched for relevant studies. The inclusion criteria were studies with preterm infants exposed to an intervention evaluated by salivary cortisol reactivity before discharge from the NICU, which were published in English. In total, 16 studies were included. Eye-screening examination and heel lance provoked an increase in the salivary cortisol level. Music, prone position, and co-bedding among twins decreased the salivary cortisol level. Several studies reported a low rate of successful saliva sampling or did not use control groups. Future studies need to focus on non-painful interventions in order to learn more about salivary cortisol regulation in preterm infants. Moreover, these studies should use study designs comprising homogenous gestational and postnatal age groups, control groups, and reliable analysis methods that are able to detect cortisol in small amounts of saliva.

Job satisfaction, demands of immigration among international nursing staff working in the long-term care setting: A cross-sectional study

• Myanmar nurses working in the long-term care setting reported the highest job satisfaction level.

The impact of negative childbirth experience on future reproductive decisions: A quantitative systematic review

AIM The aim of this study was to systematically retrieve, critique and synthesize available evidence regarding the association between negative childbirth experiences and future reproductive decisions. BACKGROUND A childs birth is often a joyous event; however, there is a proportion of women who undergo negative childbirth experiences that have long-term implications on their reproductive decisions. DESIGN A systematic review of quantitative studies was undertaken using Joanna Briggs Institutes methods. REVIEW METHODS A search was carried out in CINAHL Plus with Full Text, Embase, PsycINFO, PubMed, Scopus and Web of Science from January 1996 - July 2016. Studies that fulfilled the inclusion criteria were assessed by two independent reviewers using the Joanna Briggs Institutes Critical Appraisal Tools. Data were extracted under subheadings adapted from the institutes data extraction forms. RESULTS Twelve studies, which examined either one or more influences of negative childbirth experiences, were identified. The included studies were either cohort or cross-sectional designs. Five studies observed positive associations between prior negative childbirth experiences and decisions to not have another child, three studies found positive associations between negative childbirth experiences and decisions to delay a subsequent birth and six studies concluded positive associations between negative childbirth experiences and maternal requests for caesarean section in subsequent pregnancies. CONCLUSION To receive a holistic understanding on negative childbirth experiences, a suitable definition and validated measuring tools should be used to understand this phenomenon. Future studies or reviews should include a qualitative component and/or the exploration of specific factors such as cultural and regional differences that influence childbirth experiences.

Negative childbirth experiences and future reproductive decisions: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify, appraise and synthesize quantitative evidence on the effect of negative childbirth experiences on future reproductive decisions of women aged 18 years and above. More specifically, the review question is: what is the impact of negative childbirth experience on future reproductive decisions, including.

Informational interventions on paternal outcomes during the perinatal period: A systematic review

PROBLEM The perinatal period is a stressful transition for new parents. BACKGROUND Various forms of educational interventions are available and are found to be efficacious in improving maternal and child outcomes. Such interventions for fathers were scarce and western-centric. Fathers should be educated as they have an impact on maternal and child outcomes. AIM This review aims to evaluate the efficacy of quantitatively-studied informational support-focused interventions for fathers using paternal outcomes only. METHODS The search was carried out in six databases: Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, Embase, Psychological Information Database, and MedNar. Cochrane Collaborations tools were used to assess the eligibility of the studies. FINDINGS A total of 17 studies with 18 interventions were identified and included in the narrative synthesis. Most interventions were delivered to the Western population during the antenatal or postpartum period. The method of delivery for these interventions was mainly face-to-face, with inconclusive findings on various paternal psychosocial outcomes. DISCUSSION Limited father-inclusive interventions were available. Technology-based longitudinal studies with interventions carried out across the perinatal period with longer follow-up periods were recommended for interventions providing informational support for fathers. Future studies can also examine paternal physical health and behavioural outcomes. Interventions in culturally-diverse populations should be designed and tested for their efficacies as fathers have different informational needs, especially in Asia. CONCLUSION Informational interventions for fathers were found to be lacking and recommendations for future studies on educational interventions for fathers were discussed.

Does building resilience in undergraduate nursing students happen through clinical placements? A qualitative study

BACKGROUND The shortage of nurses has become a global phenomenon, and methods of decreasing the attrition rate of nurses have been explored. Resilience was one of the important factors that increased the retention rate of nurses who stayed in this highly stressful profession. OBJECTIVES To understand how undergraduate nursing students perceive and experience their clinical placements and to identify the factors that helped them build resilience. DESIGN A qualitative design utilizing focus group interviews was adopted for this study. PARTICIPANTS Nineteen third- and fourth-year undergraduate nursing students in a Bachelor of Nursing program participated in this study. SETTING This study was conducted at a local university in Singapore. METHOD Four audio-taped focus group interviews were conducted. RESULTS Students reported that they were stressed while facing challenges head-on during their first clinical placements, mainly due to a lack of peer and clinical support. Gradually, students built resilience overtime and were able to adapt to the ward culture through peer support and reframing coping strategies. CONCLUSION Nursing students gradually built resilience after accumulating experiences from their clinical placements. Although they eventually adapted well, peer, clinical, and informational support during clinical placements were lacking. Resilience programs that teach positive coping strategies and mindfulness training could be implemented in the undergraduate nursing curriculum.

Self-Efficacy and Health-Related Quality of Life Among Heart Failure Patients in Singapore: A Descriptive Correlational Study

Introduction: Heart failure (HF) accounts for 30% of all global deaths and Asians are likely to suffer from HF 10 years earlier than their Western counterparts. Low self-efficacy and poor health-related quality of life (HRQoL) have been reported in patients with HF. Methodology: A descriptive correlational design was adopted to investigate the associations between self-efficacy and HRQoL in 91 patients with HF in Singapore. Results: Patients with HF demonstrated moderately good self-efficacy (M = 3.05, SD = 0.61) and HRQoL (M = 22.48, SD = 18.99). Significant differences were found between total self-efficacy scores and education levels (p = .05), and between overall HRQoL and smoking status (p < .05). Self-efficacy was not significantly correlated to HRQoL. Smoking status, HF classification, and self-efficacy in maintaining function predicted HRQoL. Discussion: Health care professionals should assess each patient’s demographics, smoking status, and clinical condition before delivering individualized education to enhance their self-efficacy and, in turn, overall HRQoL.

Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis

This review aims to examine the prevalence and incidence of postpartum depression among healthy mothers without prior history of depression including postpartum depression and who gave birth to healthy full-term infants. A systematic search of ClinicalTrials.gov, CINAHL, EMBASE, PsycINFO, and PubMed was performed for English articles from the inception of the database to November 2017, as well as a manual search of the reference lists of the included articles, and an expert panel was consulted. Across 15,895 articles, 58 articles (N = 37,294 women) were included in the review. The incidence of postpartum depression was 12% [95% CI 0.04-0.20] while the overall prevalence of depression was 17% [95% CI 0.15-0.20] among healthy mothers without a prior history of depression. Prevalence was similar regardless of the type of diagnostic tool used; however, there were statistical differences in the prevalence between different geographical regions, with the Middle-East having the highest prevalence (26%, 95% CI 0.13-0.39) and Europe having the lowest (8%, 95% CI 0.05-0.11). There was no statistical difference in prevalence between different screening time points, but an increasing prevalence was observed beyond six months postpartum. Intervention studies often neglect healthy mothers. This review reports a similar prevalence rate of postpartum depression among mothers without history of depression when compared to mothers with history of depression. Thus, future studies should place equal emphasis on this neglected group of mothers so that targeted interventions and follow-ups can be introduced at appropriate time points.