Abstract

BackgroundThere is growing recognition internationally of the need to identify women with risk factors for poor perinatal mental health in pregnancy and following birth. In the state of New South Wales, Australia the Supporting Families Early policy provides a framework of assessment and support for women and families and includes routine psychosocial assessment and depression screening. This study investigated the approach taken by Child and Family Health Nurses (CFHNs) following birth to assessment and screening as recommended by state policy. This was a qualitative ethnographic study that included 83 CFHN and 20 women. Observations occurred with thirteen nurses; with 20 women, in the home or the clinic environment. An additional 70 nurses participated in discussion groups. An observational tool (4D&4R) and field notes were used to record observations and analysed descriptively using frequencies. Field notes, interview data and discussion group transcripts were analysed thematically.MethodsThis was a qualitative ethnographic study that included 83 CFHN and 20 women. Observations occurred with thirteen nurses; with 20 women, in the home or the clinic environment. An additional 70 nurses participated in discussion groups. An observational tool (4D&4R) and field notes were used to record observations and analysed descriptively using frequencies. Field notes, interview data and discussion group transcripts were analysed thematically.ResultsCFHNs demonstrated a range of approaches to assessment and screening. Psychosocial assessment was conducted in 50% (10 out of the 20) of the interactions observed; however, all the women were screened using the Edinburgh Depression Scale. Four major themes that represent the approach taken to the assessment process were identified: ‘Engagement: getting that first bit right’, ‘Doing some paperwork’, ‘Creating comfort’ and ‘Psychosocial assessment: doing it another way’. Nurses utilised other skills such as observing the women interacting with their baby, taking note of non verbal communication and using intuition to develop a clinical decision.ConclusionOverall, nurses’ took a sensitive and caring approach to assessment and screening, however, there were differences in interpretations of the policy recommendations across the two sites. Nurses adopt a flexible, relationship-based approach to the assessment process; however, they experience tension when required to incorporate structured psychosocial assessment processes. To undertake assessment and screening effectively, CFHNs require ongoing support, training and supervision to maintain this sensitive and emotionally challenging work.

Highlights

  • There is growing recognition internationally of the need to identify women with risk factors for poor perinatal mental health in pregnancy and following birth

  • The process of assessment and Child and family health nurse (CFHN) role is examined in the context of the above debates and policy that requires both the use of structured tools and assessments and a flexible, partnership approach to working with families

  • The content analysis of the data recorded on the observation tool is presented first, reporting the frequency of assessment and screening. This is followed by a detailed explication of the four major themes that describe and interpret the approach that CFHNs take to assessment and screening

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Summary

Introduction

There is growing recognition internationally of the need to identify women with risk factors for poor perinatal mental health in pregnancy and following birth. This study investigated the approach taken by Child and Family Health Nurses (CFHNs) following birth to assessment and screening as recommended by state policy. This was a qualitative ethnographic study that included 83 CFHN and 20 women. All Australian states and territories provide universal child and family health nursing services free of charge to all children from birth to 5 and their families. While the policy platform and schedule of services vary across states and territories, all offer routine monitoring of child development, health promotion activities focused on both children and families and the provision of support for early parenting and families [7]. Known in most Australian jurisdictions as child and family health nurses (CFHNs), they are similar to health visitors in the UK [9], child health nurses in Sweden [10] and plunkett nurses in New Zealand [11]

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