Housing instability: Exploring socioecological influences on the health of birthing people

STUDY AIM

To describe how socioecological influences of housing instability affect pregnancy health among birthing and postpartum people.

DESIGN

We used the socioecological framework to guide this exploratory descriptive study using semi-structured, in-depth interviews.

METHODS

We purposively recruited birthing people in the southern mid-Atlantic region. Seventeen one-time, semi-structured interviews were conducted between February 2020 and December 2021 with English-speaking unstably housed participants ≥18 years old, currently pregnant, or recently postpartum. Qualitative and quantitative content approaches were used to analyse transcribed interviews. Dedoose software was used to identify code patterns and refine the codebook until group consensus. The team examined code patterns, explored meaning in text and codified code-generated categories to describe experiences.

RESULTS

Majority (82.4%) of participants were African Americans between 22 and 41 years, and most were postpartum (76.5%). Participants described multiple forms of housing instability, reasons for losing housing, challenges with finding housing and strategies for finding housing. Participants did not describe housing instability as a barrier to receiving prenatal care. Building and sustaining individual relationships and social support were prominent factors affecting their housing challenges. Participants also reported a lack of obstetric provider inquiry about housing status during pregnancy. Many reported that challenges with housing triggered mental health issues, especially depression.

CONCLUSION

Nurses and other obstetric providers are key points of contact in the prenatal care setting for assessing housing stability. Additionally, refining social structures and funding support services within communities and prenatal health systems should be a strategy for future programme and policy planning improvement.

IMPACT

This study highlights critical areas for consideration when addressing social determinants for birthing people and reinforces the need for more comprehensive assessment in the prenatal setting.

PATIENT OR PUBLIC CONTRIBUTION

Members of the public participated in this study as key informants for study interviews.

The effectiveness of telemedicine interventions on women with postpartum depression: A systematic review and meta-analysis

BACKGROUND

Postpartum depression (PPD) is a public health problem that has significant adverse effects on mothers, couple's relationships, newborn neurodevelopment, and child emotional and cognitive development. This study reviewed the effectiveness of telemedicine interventions in postparturient women with postpartum depression.

AIMS

To evaluate the effectiveness of telemedicine intervention in women with postpartum depression.

METHODS

Cochrane Library, PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO were searched for relevant articles published between 2003 and March 2021. We also manually reviewed the reference lists of the retrieved articles. The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias for individual studies was evaluated according to the Cochrane Handbook. RevMan 5.4 software was used to carry out the meta-analysis.

RESULTS

The meta-analysis included 20 randomized controlled trials with a total of 3252 patients. The results demonstrated that telemedicine was an effective intervention for treating PPD and anxiety and for improving functional impairment in women during their postpartum period.

LINKING EVIDENCE TO ACTION

This meta-analysis provided evidence that telemedicine was an effective intervention for treating PPD in women. Telemedicine also has significant effects on anxiety and improved functional impairment in women during their postpartum period. Our findings may provide accurate evidence-based guidance for postpartum women's mental health management. In the future, more high-quality studies are required for verifying these results.

The Second Triennial Systematic Literature Review of European Nursing Research: Impact on Patient Outcomes and Implications for Evidence-Based Practice

BACKGROUND

European research in nursing has been criticized as overwhelmingly descriptive, wasteful and with little relevance to clinical practice. This second triennial review follows our previous review of articles published in 2010, to determine whether the situation has changed.

OBJECTIVE

To identify, appraise, and synthesize reports of European nursing research published during 2013 in the top 20 nursing research journals.

METHODS

Systematic review with descriptive results synthesis.

RESULTS

We identified 2,220 reports, of which 254, from 19 European countries, were eligible for analysis; 215 (84.7%) were primary research, 36 (14.2%) secondary research, and three (1.2%) mixed primary and secondary. Forty-eight (18.9%) of studies were experimental: 24 (9.4%) randomized controlled trials, 11 (4.3%) experiments without randomization, and 13 (5.1%) experiments without control group. A total of 106 (41.7%) articles were observational: 85 (33.5%) qualitative research. The majority (158; 62.2%) were from outpatient and secondary care hospital settings. One hundred and sixty-five (65.0%) articles reported nursing intervention studies: 77 (30.3%) independent interventions, 77 (30.3%) interdependent, and 11 (4.3%) dependent. This represents a slight increase in experimental studies compared with our previous review (18.9% vs. 11.7%). The quality of reporting remained very poor.

LINKING EVIDENCE TO ACTION

European research in nursing remains overwhelmingly descriptive. We call on nursing researchers globally to raise the level of evidence and, therefore, the quality of care and patient outcomes. We urge them to replicate our study in their regions, diagnose reasons for the lack of appropriate research, identify solutions, and implement a deliberate, targeted, and systematic global effort to increase the number of experimental, high quality, and relevant studies into nursing interventions. We also call on journal editors to mandate an improvement in the standards of research reporting in nursing journals.

Planetary Health and the Role of Nursing: A Call to Action

PURPOSE

To discuss the drivers of planetary health, responses, and the role of nursing in making health systems more resilient in an era of increasing stresses. As health providers, scientists, educators, and leaders, nurses have an obligation to prepare for climate change and other impacts of ecosystem strain on human health.

DESIGN AND METHODS

Review of literature relevant to a planetary health framework.

FINDINGS

Population displacement, new disease patterns and health needs, stresses on air quality, food production and water systems, and equity concerns, as well as the generation of sustainable energy, are all intimately related to health.

CONCLUSIONS

Nurses are key to achieving the sustainable development goals that, like the planetary health framework, focus on environmental sustainability and human well-being. Nurses contribute to resilient health systems, as trusted leaders and providers of health care, and as advocates and change makers impacting the world.

CLINICAL RELEVANCE

It is critical that nurses and other health professionals consider the multiple effects of ecosystem strain on human health, and anticipate population health and health system planning and response.

Women's expectations and experiences of rupture of membranes and views of the potential use of reagent pads for detecting amniotic fluid

AIMS

To explore first-time mothers' expectations and experiences regarding rupture of membranes at term and their views on the potential use of reagent pads that detect amniotic fluid.

BACKGROUND

There is little information available on women's experiences of spontaneous rupture of membranes, or interest in using methods to confirm rupture of membranes (e.g. reagent pads).

DESIGN

Descriptive qualitative study, using focus groups and telephone interviews with women during pregnancy and after the birth of their first baby. Thematic analysis was undertaken to analyse women's responses.

METHODS

Ethics committee approval was obtained. Twenty-five women participated in the study of whom 13 contributed both during pregnancy and postpartum between October 2015-March 2016.

FINDINGS

Three overarching themes were identified from the data from women's expectations and experiences: uncertainty in how, when and where membranes may rupture; information which was felt to be limited and confirmation of rupture of membranes. The potential use of reagent pads met with varied responses.

CONCLUSION

Women were interested in having facts and figures regarding rupture of membranes, such as characteristics of liquor; volume and probability of membranes rupturing spontaneously at term. Use of a pad as a means of confirmation was viewed as helpful, although the potential for increasing anxiety was raised.

Delphi Survey of Clinical Nursing and Midwifery Research Priorities in the Eastern Mediterranean Region

PURPOSE

As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region.

DESIGN

A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016.

METHODS

Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau.

FINDINGS

Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections.

CONCLUSIONS

Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives.

CLINICAL RELEVANCE

Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally.

Cost analysis of prenatal care using the activity-based costing model: a pilot study

The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.