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This article draws on an Australian project engaging with families with complex support needs as their children start school. The project itself is focused on developing collaborative research relationships between families, community support agencies and researchers with the aim of investigating what happens for families during the transition to school. In particular, the project has focused on developing strategies that promote recognition of family strengths, as well as challenges, and that support a positive start to school education. This article reports a range of ethical issues and situations encountered throughout the project. The aim of reporting these is to share some of the critical reflections about the assumptions underpinning the research, ethical engagement with research participants, and the responsibilities researchers have. In particular, the authors share reflections about the nature and implications of conducting research with families, accessing research participants and strategies for engaging with research participants. The approach taken in the project, and this article, reflects assumptions about research as an ethical process and the need for researchers to consider the ethical issues and situations they meet within research contexts. (Contains 4 notes.)

Aim: The aim of this study is to explore how immigrant women and men from India construct mental health and mental illness in the perinatal period. Design: Qualitative interpretive design. Methods: Data were collected by conducting in‐depth interviews with 19 participants. Photo elicitation, free listing and pile sorting were used during the interviews. Purposive sampling was used, and data were collected in 2018 and 2019. Data were analysed using thematic analysis. Finding/Results: One major theme and three subthemes were identified. 'We do not talk about it' was the major theme and the subthemes: (1) 'living peacefully and feeling happy' described the views on mental health; (2) 'that's the elephant in the room still' captures how participants felt when talking about mental illness; and (3) 'why don't we talk about it' offers reasons why the Indian community does not talk about mental health and illness. Conclusion: The findings of this study have highlighted the importance of understanding the impact of immigration and being culturally sensitive when assessing mental health in the perinatal period. Impact: The findings of this study identify some of the reasons for non‐disclosure of mental health issues by immigrants. Incorporating these findings during psychosocial assessment by health professionals in the perinatal period will help translate the cultural aspects into more effective communication. Patient or Public Contribution: Patient and public contribution to the study was provided by the Community Stakeholders Group; these were members of the immigrant community from India who had expertise in mental health. They contributed to the study design and the key terms and phrases for the free list used in interviews. [ABSTRACT FROM AUTHOR]

Aims: To map the pathway and service provision for pregnant women whose newborns require admission into the surgical neonatal intensive care unit at or soon after birth, and to examine the nature of continuity of care (COC) provided and the facilitators and barriers to woman‐ and family‐centred care from the perspective of women/parents and health professionals. Background: Limited research exists on current service and care pathways for families whose babies are diagnosed with congenital abnormality requiring surgery. Design: A mixed method sequential design adhering to EQUATOR guidelines for Good Reporting of a Mixed Methods Study. Methods: Data collection methods included: (1) a workshop with health professionals (n = 15), (2) retrospective maternal record review (n = 20), prospective maternal record review (17), (3) interviews with pregnant women given a prenatal diagnosis of congenital anomaly (n = 17) and (4) interviews with key health professionals (n = 7). Results/Findings: Participants perceived care delivered by state‐based services as problematic prior to admission into the high‐risk midwifery COC model. Once admitted to the high‐risk maternity team women described care 'like a breath of fresh air' with a 'contrast in support', where they felt supported in their decisions. Conclusion: This study highlights provision of COC, in particular relational continuity between health providers and women as essential to achieve optimal outcomes. Relevance to Clinical Practice: Provision of individualised COC offers an opportunity for perinatal services to reduce the negative consequences of pregnancy‐related stress associated with diagnosis of foetal anomaly. Patient or Public Contribution: No patient or public was involved in the design, analysis, preparation or writing of this review. [ABSTRACT FROM AUTHOR]

Beliefs, practices and perceptions of early child development informing school readiness were examined for parents of preschool‐aged children living in one multicultural suburb in Western Sydney, Australia. Survey data (N = 87) and semi‐structured interviews (N = 52) with parents were collected in public spaces (e.g., parks, libraries, church halls and community centres) in mid‐2019. Participants, primarily migrants of South Asian background, believed children learn through practical activities, prioritising academic and social development, with less focus on emotional development and communication skills. Parents' approached school readiness through the engagement of children in shared activities that maintained traditional cultural practices while simultaneously seeking to create community connection. Raising awareness of and engagement in both formal (e.g., early education services) and informal services (e.g., playgroups, library groups) could provide migrant and refugee parents with supportive networks in their local communities. Offering subsidies for attendance at early childhood programmes may reduce costs and encourage attendance, particularly for outdoor activities, helping to establish support networks for parents and children before starting primary school. These connections may provide families with a pathway for the identification and access of other local services and supports for their children. Programmes could also offer a platform for raising parental awareness of a holistic approach to child development and its importance for school success. Incorporating multicultural activities into early childhood programmes and settings could further assist parents in maintaining traditional cultural ties while creating essential local community connections. [ABSTRACT FROM AUTHOR]

Introduction: Transgender (trans) women of color navigate the intersected identity frames of gender, race, social class and sexuality, whilst facing multiple layers of stigma, discrimination and violence during and following gender affirmation. However, little is known about the ways in which trans women of color negotiate gender affirmation, in the context of the risk of social exclusion and violence. Aim: This article discusses the experience and construction of gender transitioning and gender affirmation for trans women of color living in Australia, associated with the risk of social exclusion or violence. Method: In-depth interviews and photovoice were conducted with 31 trans women of color, analyzed through theoretical thematic analysis informed by intersectionality theory. Results: The following themes were identifed: 1) 'Gender affirmation: A bittersweet experience', with three subthemes: 'Self-empowerment is tempered by family rejection', 'Migration facilitates gender affirmation' and 'Gender affirmation and social support'; 2) 'Being a trans woman of color', subthemes: 'Bodily agency and passing', 'Femininity as pleasure and cultural self-expression', and 'Resisting archetypal White hetero-femininity'; 3) 'Hormones, surgical intervention and navigating the health system'. Conclusion: Gender transitioning and gender affirmation involved the intersection of gender, cultural, social class and sexual identities, accomplished through personal agency and with the support of significant others. To ensure that policy and support services meet the needs of trans women of color, it is critical that the voices of such multiply-marginalized women are at the center of leadership, program and policy development. [ABSTRACT FROM AUTHOR]

Background: Pregnant women and partners with psychological and/or social challenges are exposed to adverse health outcomes. It is therefore recommended that they receive targeted maternity care services. The relationship between parents and professionals is key to help parents engage with services and experience them as supportive. However, more knowledge is needed on parents' care experiences during encounters with professionals to further understand when and how these are experienced as supportive. Objectives: This study aimed at identifying the key elements of supportive care practices by exploring how parents in vulnerable positions experience their relationship and encounters with the professionals involved in their pregnancy and postnatal care. Design: Ethnographic fieldwork was conducted in a Danish municipality, including 50 semi‐structured interviews with parents and 51 field visits during parent‐professional encounters, including informal interviews and participant observation. Using a purposive recruitment strategy, 26 women and 13 men were recruited, who varied in age, socioeconomic background and vulnerability factors. COREQ reporting guidelines were used. Results: The analysis identified five themes: (a) Having a voice: Feeling listened to, (b) Being met with empathy: Feeling understood, (c) Worthy of attention: Feeling taken seriously, (d) On equal terms: Feeling like a normal family and (e) Moving in the right direction: Feeling reassured. Conclusion: Positive care experiences facilitate engagement with services and professionals as this contribute to parents feeling included, respected and safe. Conversely, negative care experiences leave parents feeling excluded, judged and anxious, potentially reinforcing and adding to existing feelings of anxiety and stigma. This requires that professionals have good communication skills and are able to approach parents in an open and non‐judgmental way. Relevance to clinical practice: Understanding the significance of supportive care practices is paramount for health visitors, midwives and other professionals involved in providing for parents in vulnerable positions during pregnancy and the postnatal period. [ABSTRACT FROM AUTHOR]

An online forum analysis was conducted to explore experiences of sexual violence and safety among transwomen, with a particular focus on transwomen of colour. Four online forums were chosen for the analysis. Three key themes were identified: dating and violence in intimate relationships; fear of violence and safety strategies; and coping after sexual assault. Forum posters faced heightened gender policing and scrutiny, due to not conforming to normative ideals of femininity. Femininity was also predicated on white, middle-class status, and associated with domesticity and romance. As a result, expressions of femininity from non-white backgrounds could be read as deviant or excessive. The intersection of deviation from gender norms and femininity based on whiteness meant that transwomen of colour faced disproportionate levels of violence, both in public and private spaces. Transwomen of colour also faced disadvantage due to participation in higher-risk forms of sex work, low socioeconomic status and employment, and institutional discrimination. Coping mechanisms to deal with cumulative disadvantage included seeking support from health professionals and transgender community networks. However, it also included more harmful forms of self-medicating such as heavy alcohol and drug use, self-harm and suicide attempts. [ABSTRACT FROM AUTHOR]

Purpose: Government strategies are putting increasing emphasis on sustaining the capacity of older persons to continue living independently in their own homes to ease strain on aged care services. The aim of this study was to understand the experiences and strategies that older people utilize to remain living at home from their own perspective. Methods: A grounded theory methodology was used to explore the actions and strategies used by persons over the age of 65 to enable them to remain living in their own homes. Data were collected from 21 women and men in three focus group discussions and 10 in-depth semi-structured interviews. Results: The data revealed that the central process participants used to hold momentum and sustain living at home involves a circular process in which older people acknowledge change and make ongoing evaluations and decisions about ageing at home. Conclusion: These findings have implications for informing policy and service provision by identifying appropriate resources and services to promote successful ageing at home. [ABSTRACT FROM AUTHOR]

Aims and objectives: This qualitative study explored the experiences of neonatal nurses with facilitating closeness between parents and babies with congenital abnormalities in the neonatal intensive care unit (NICU). Background: Babies with congenital abnormalities often require admission to the neonatal intensive care unit. Parents may experience emotional distancing from their baby, due to their response to their baby's congenital abnormality, as well as physical separation due to their baby's hospitalisation in the NICU. NICU nurses can help facilitate the development of closeness between babies and parents in the NICU. Method: This qualitative interpretive description study involved face‐to‐face, semi‐structured interviews with twelve neonatal nurses following which the data collected were thematically analysed. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in preparing this paper. Results: Three major themes emerged from the analysis—"Everyone copes differently," "You have to focus on what is the normal thing" and "It's very much an individualised approach." Participants often felt unprepared to care for babies with congenital abnormalities and implemented coping mechanisms to overcome the emotional labour they experienced. Skin‐to‐skin cuddles were considered the most beneficial strategy for parents to develop closeness with their baby. Participants recognised that they sometimes "pushed" parents into engaging with their baby. Participants highlighted the importance of individualised, supportive care for these parents. Conclusions: Neonatal nurses require increased education about congenital abnormalities and individualised care to support them in caring for babies with congenital abnormalities. Relevance to clinical practice: Further research is needed on parental experience of developing closeness with a baby with a congenital abnormality in the NICU. [ABSTRACT FROM AUTHOR]

Objectives. Continuing to live at home is arguably one of the most important challenges older persons face as they age. The aim of this study was to clarify how older adults conceptualise home through age-related lifestyle changes. Methods. Principles from grounded theory were used to examine the perspectives of 21 older adults obtained from three focus group discussions and 10 in-depth semistructured interviews. Results. Four major categories were developed: "anchoring self," "enabling freedom," "being comfortable," and "staying in touch." Discussion. For the participants in this study remaining at home enabled a sense of independence and freedom, self-worth and identity, comfort, and an ongoing active role in the community. However, some aspects of home could be renegotiated despite changes to living location, with new social connections able to be forged and personal comforts being transferrable. This holds important implications for supporting older persons to both sustain living at home and to adjust to changing circumstances, suggesting the importance of drawing on the experiences of older persons themselves in developing strategies to promote successful aging. [ABSTRACT FROM AUTHOR]

Background: Improving breastfeeding support to mothers has been the focus of several national and international health organisations. There is evidence that theoretical and clinical education improves breastfeeding knowledge and attitudes among nursing and other health professional students prior to clinical placement, to support women who are breastfeeding. Aims and objectives: To explore the expectations and experiences of Taiwanese nursing students in supporting breastfeeding on clinical placement. To gain additional insight into student experience, we also sought the perspectives of mothers, nursing staff and teachers about the role of nursing students in supporting breastfeeding mothers. Design: A qualitative descriptive approach guided this study. Methods: Focus groups and small group interviews were conducted with four participant groups in southern Taiwan. Ethical approval was obtained prior to data collection. The consolidated criteria for reporting qualitative research checklist was used. Findings: Three main themes emerged from the data that captured the nursing students' experiences during clinical practice, which were "High expectations"; "The reality is different"; and "Improving confidence in students." The study found that students lacked confidence in supporting breastfeeding in the clinical setting. Students were expected to support women to achieve their breastfeeding goals under the supervision. The students highlighted the importance of establishing trust to effectively support mothers, and for the students to feel confident to provide the breastfeeding information. Conclusions: Despite structured theoretical breastfeeding education prior to clinical placement, students did not feel they were adequately prepared to support women who are breastfeeding during their clinical placement. The findings demonstrated the need for further support in developing effective communication skills and building confidence prior to clinical placement. Relevance to clinical practice: Enhancing the content of theoretical and simulated breastfeeding education to incorporate women's breastfeeding experience combined with realistic clinical student allocation could serve to improve students' confidence in supporting breastfeeding. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the characteristics and service needs of women and babies admitted to residential parenting services (RPS) in the first year following birth in New South Wales, Australia. Background: In Australia, there is a tiered system to support maternal, child and family health, which includes RPS. Design: Sequential explanatory mixed‐methods design. Methods: Individual patient data were obtained from a random review of 10% of all medical records (n = 300 of 3,011 admissions) of women with an infant of <12 months of age who were admitted to RPS in 2013. Following review of the medical records, qualitative data were collected via interviews with eight women who accessed RPS. Chi‐square analysis and Student's t test were used to analyse quantitative data. Qualitative data were analysed using a descriptive interpretive approach. An integrative approach was taken in reporting the findings. Results: Women admitted to the RPS were on average 32 years of age, were Australian born (72%) and had a university qualification (40%), and most were employed. The majority of women were primiparous (60%) and had a vaginal birth (61%). Women with male infants were much more likely to be admitted to the RPS (58%) compared to the NSW male‐to‐female ratio (51.3% vs. 48.7%). Over 50% of women reported mental health issues with 27% having an Edinburgh Postnatal Depression Scale score ≥13 on admission. The primary reason women sought parenting support was for sleep and settling (83%). During their stay, services used by women included social workers (44%), psychologists (52%) and psychiatrists (4.5%). Conclusion: Women who access RPS report psychosocial and mental health issues. Services provided by RPS support women during this challenging early parenting period by providing multidisciplinary, holistic and peer support. Relevance to clinical practice: A high prevalence of mental health issues identified in this study indicated a need for ongoing training and support for RPS staff. Ensuring clinicians have the appropriate skill sets to best support their clientele will maximise the outcomes for women and families who access RPS during the early parenting period. [ABSTRACT FROM AUTHOR]

Infant well-being is intrinsically linked to maternal physical and emotional well-being. Internationally health services have implemented policies to identify women at risk of mental health problems and developed effective care pathways. The aim of this paper is to describe how perinatal and infant mental health clinicians perceive their role and the attachment-based interventions they use in their work. The study comes from a larger mixed methods study, which examined two specialist perinatal and infant mental health services in New South Wales (Australia). Two hundred and forty-four medical records were reviewed, and six perinatal and infant mental health clinicians participated in in-depth semi-structured interviews. Data were analysed by content and thematic analysis. One overarching theme, modelling a secure base and three supporting themes, enhancing reflective capacity, enhancing emotional regulation and enhancing empathy emerged from the analysis. These findings demonstrate how perinatal and infant mental health clinicians use attachment theory to inform practice by modelling "holding" and being a secure-base for women. They also provide a clearer understanding of perinatal mental health practice and can be used to inform educational programs for multidisciplinary mental health professionals particularly those working with women and infants. [ABSTRACT FROM AUTHOR]

Background: Studies examining psychosocial and depression assessment programs in maternity settings have not adequately considered the context in which psychosocial assessment occurs or how broader components of integrated care, including clinician decision-making aids, may optimise program delivery and its cost-effectiveness. There is also limited evidence relating to the diagnostic accuracy of symptom-based screening measures used in this context. The Perinatal Integrated Psychosocial Assessment (PIPA) Project was developed to address these knowledge gaps. The primary aims of the PIPA Project are to examine the clinical- and cost-effectiveness of two alternative models of integrated psychosocial care during pregnancy: 'care as usual' (the SAFE START model) and an alternative model (the PIPA model). The acceptability and perceived benefit of each model of care from the perspective of both pregnant women and their healthcare providers will also be assessed. Our secondary aim is to examine the psychometric properties of a number of symptom-based screening tools for depression and anxiety when used in pregnancy.Methods: This is a comparative-effectiveness study comparing 'care as usual' to an alternative model sequentially over two 12-month periods. Data will be collected from women at Time 1 (initial antenatal psychosocial assessment), Time 2 (2-weeks after Time 1) and from clinicians at Time 3 for each condition. Primary aims will be evaluated using a between-groups design, and the secondary aim using a within group design.Discussion: The PIPA Project will provide evidence relating to the clinical- and cost- effectiveness of psychosocial assessment integrated with electronic clinician decision making prompts, and referral options that are tailored to the woman's psychosocial risk, in the maternity care setting. It will also address research recommendations from the Australian (2011) and NICE (2015) Clinical Practice Guidelines.Trial Registration: ACTRN12617000932369. [ABSTRACT FROM AUTHOR]

Breastfeeding mothers returning to work often feel exhausted as they must feed on demand and attend to family and employment responsibilities, leading to concerns for their personal health. This study was prompted by a desire to understand and identify barriers to mothers' health. We describe the experiences of 12 Iranian breastfeeding and employed mothers through in-depth and semi-structured interviews and thematic analysis. Two main themes emerged: (i) working and mothering alone and (ii) facing concerns about health. The findings highlight the need for a support system for breastfeeding mothers within the family and in the workplace. Family-friendly policies targeting mothers' and employers' views are needed to support working mothers and promote breastfeeding. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families. Background Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families. Design The descriptive study used cross-sectional data from the first national survey of child and family health nurses in Australia, conducted during 2011. Methods Survey data reported how often, where and how child and family health nurses worked with families with complex needs and their confidence in nursing tasks. Findings Many, but not all, of the 679 respondents saw families with complex needs in their regular weekly caseload. Child and family health nurses with diverse and complex caseloads reported using varied approaches to support their clients. They often undertook additional professional development and leadership roles compared with nurses who reported less complex caseloads. Most respondents reported high levels of professional confidence. Conclusion For health services providing universal support and early intervention for families at risk, the findings underscore the importance of appropriate education, training and support for child and family health professionals. The findings can inform the organization and delivery of services for families in Australia and internationally. [ABSTRACT FROM AUTHOR]

Aim and objectives To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015. Background For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care. Design A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups. Results Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity. Conclusions There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers. Relevance to clinical practice Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families. [ABSTRACT FROM AUTHOR]

Risk factors for poor perinatal mental health are well known. Psychosocial assessment and depression screening during the perinatal period aim to identify women at risk for poor perinatal outcomes. Early intervention programmes are known to improve the mental health outcomes of women and infants. Key to any intervention is initial and ongoing engagement in the therapeutic process. This mixed-methods study reports the proportion of women who engage/do not engage with services and their characteristics, as well as the strategies clinicians use to engage women. Data were collected by reviewing medical records, interviewing perinatal and infant mental health (PIMH) clinicians, their managers, key stakeholders, and women service users. Analyses identified that most (71.3%) women referred engaged with the PIMH service. Themes related to non-engagement are 'time to rethink' and 'stigma'. Themes reflecting the engagement strategies used by PIMH clinicians are initial engagement: 'back to basics' and 'building trust', therapeutic engagement: 'making myself useful', engagement at discharge: 'woman or clinician led', and models that facilitate engagement. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine collaboration in the provision of universal health services for children and families in Australia from the perspective of midwives and child health and family health nurses. Background Collaboration is identified as a key concept contributing to families' smooth transition between maternity and child health services. However, evidence suggests that collaboration between services is often lacking. Few studies have explored how maternity and child health and family health services or professionals collaborate to facilitate a smooth transition. Design This study reports on data collected in phases 1 and 2 of a three-phase mixed-methods study investigating the feasibility of implementing a national approach to child health and family health services in Australia (Child Health: Researching Universal Services study). Methods In phase 1, consultations (via discussion groups, focus groups and teleconferences) were held with 45 midwives and 60 child health and family health nurses. Themes identified were used to develop phase 2 surveys. In phase 2, 1098 child health and family health nurses and 655 midwives returned surveys. Results Midwives and child health and family health nurses reported 'some collaboration'. Midwives and child health and family health nurses indicated that collaboration was supported by having agreement on common goals and recognising and valuing the contributions of others. Organisational barriers such as poor communication and information transfer processes obstructed relationships. Good collaboration was reported more frequently when working with other professionals (such as allied health professionals) to support families with complex needs. Conclusion This study provides information on the nature and extent of collaboration from the perspective of midwives and child health and family health nurses providing universal health services for children and families. Relevance to clinical practice Both professional groups emphasised the impact of service disconnection on families. However, their ability to negotiate professional differences is affected by system constraints and differing perspectives of what constitutes collaboration. Developing the capacity to collaborate is essential to ensure smooth transition of care given ongoing changes to the system. [ABSTRACT FROM AUTHOR]

Perinatal mental health disorders potentially have long-term negative sequelae for women, their infants and their families. Multidisciplinary perinatal and infant mental health (PIMH) services are an emerging specialty in mental health designed to improve mother-infant outcomes. This mixed methods study explored the characteristics of women referred to a specialist PIMH service and the therapeutic interventions that PIMH clinicians use. Women referred to the service were identified with multiple and complex risk factors. Perinatal and infant mental health clinicians use a range of interventions, dependent upon their training, such as family of origin work/genograms, non-directive counseling, and strategies to manage anxiety and depression. Clinicians also emphasized the therapeutic relationship and the interventions they use within an attachment-based framework, which warrants further research. [ABSTRACT FROM AUTHOR]

Studies of women's experiences of being overweight and pregnant are limited in the literature. Given the increasing rates of obesity in pregnant women, and the impact of being overweight on the health of the mother and the child, this qualitative descriptive study aimed to explore the perceptions and experiences of overweight pregnant women attending two maternity units in Sydney, Australia. Fourteen women aged between 25 and 42 years with a body mass index greater than 30 kg/m2 participated in a face-to-face interview in their third trimester of pregnancy or in the early post-natal period. All interviews were recorded and transcribed. Field notes were also recorded following each interview. Data were analysed using thematic analysis. Four themes were identified in the data: 'being overweight and pregnant', 'being on a continuum of change', 'get alongside us' and finally 'wanting the same treatment as everyone else'. Most women recognised their weight as an issue both for their own health and well-being and for its impact on the baby. Women believed health professionals should address the issue of obesity with them but do so in a supportive and positive way that recognised their individual needs and expectations. Health professionals need to consider new approaches or models of care for overweight women that give them support and enable individual needs and expectations to be met. Culturally specific programs may also need to be developed. [ABSTRACT FROM AUTHOR]

Aim: To report on the development of an observation tool that can help a single researcher to collect field data about clinician and client interactions. Background: Qualitative studies from a range of disciplines investigate the dynamics of interactions between clinicians and clients. These studies share and report findings but rarely provide details on the practical challenges and methods involved in managing such interactions when collecting rich ethnographic data. Review methods: Development of the observational tool was informed by the study's requirements and context, previous research, and the authors' cross-disciplinary knowledge and experience. Discussion: In relation to how clinicians interact with clients and how clients respond, four domains have been identified and integrated into the observational tool. These domains act as prompts during observations of interactions between clients and nurses. Use of the tool has indicated its effectiveness in assisting with observations and the recording of field notes. Conclusion: The article shows how to develop a tool for qualitative field-data collection. The method can be adapted to studies that require observations of interactions and its components can be modified to suit their fields of study. Implications for practice or research: The 4D&4R tool discussed in this article provides indicators of clinician-client interactions and is transferable to other research and practice contexts [ABSTRACT FROM AUTHOR]

Background: In a General Practitioner (GP) setting, preventative medicine is reported as the predominant source of health care for the well-child. However, the role of the GP in well-child health care is not well understood in Australia. The aim of this study was to describe the role of the GP in providing services for well-children and families in Australia. Methods: This was a qualitative descriptive study. Face-to-face interviews were held with 23 GPs to identify their role in the provision of well-child health care. Participants worked in a variety of general practice settings and 21 of the 23 GPs worked in the Greater Western Sydney area. Results: Five main themes were identified in the analysis: 'prevention is better than cure', 'health promotion: the key messages', 'working with families', 'working with other health professionals', and 'barriers to the delivery of well-child health services'. Conclusions: Participating GPs had a predominantly preventative focus, but in the main well-child care was opportunistic rather than proactive. The capacity to take a primary preventative approach to the health of children and families by GPs is limited by the increasing demands to manage chronic disease. Serious consideration should be given to developing collaborative models of care where GPs are joined up with services funded by State and Territory governments in Australia, such as the universal maternal child and family health nursing services that have well children and families as their prime focus. [ABSTRACT FROM AUTHOR]

Providing support and parenting education through home visiting is a key early intervention strategy with young parents. Less is known about what home visitors do that makes a difference. The purpose of this paper is to describe the role and experiences of professional staff working with young parents participating in a multicomponent parent support programme (home visiting and supported parenting groups) provided by a non-government organisation in a socially disadvantaged area of Sydney, Australia. This was a qualitative descriptive study. Data were collected through three focus groups conducted with the same six staff over an 18-month period. Participant descriptions of their role and experiences working with young mothers were analysed thematically. Additional data from 20 anonymised client records were analysed through content analysis. Analysis of the focus group data revealed two themes, 'Connecting' and 'Facilitating Learning'. The theme 'Connecting' reflected the development of a relationship with the young mother commencing with 'how do we engage them?', 'building trust' through to formation of a relationship described as 'they know we're not friends, they know we're workers'. The second theme, 'Facilitating Learning' was informed by the analysis of both group and client record data and comprised a number of themes around what and how mothers learnt, through to 'ending the relationship' as the mothers left the programme. The quality of a mothers' learning was dependent on the quality of the connection between herself and the staff, similarly their capacity and, or confidence to leave the programme was dependent on the relationship, 'connecting' and the learning undertaken. Role modelling through interactions with children as well as with each other was seen as the most effective way to facilitate social and parenting skill development, while formal education sessions were evaluated by the workers to be less successful than informal ones. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study is to explore neonatal nurses' perspectives of their role in facilitating family centred care in the neonatal intensive care unit. Background. The philosophy of family centred care focuses on the health and wellbeing of the newborn and their family, through the development of a respectful partnership between the health care professional and the infant's parents. Many studies report family centred care in the context of paediatric care; however, few studies explore neonatal nurses' perspective of family centred care in the context of neonatal care. Design. Qualitative interpretative approach. Methods. Four focus groups and five individual face-to-face interviews were conducted with neonatal intensive care nurses (total n = 33) currently practicing in a tertiary Neonatal Intensive Care Unit in Australia. Each focus group and face to face interview was audio-taped and transcribed. Data was analysed using thematic analysis. Results. Four dominant themes emerged from the data: (1) Getting to know parents and their wishes (2) Involving family in the day to day care (3) Finding a 'happy' medium (4) Transitioning support across the continuum. Conclusion. These findings revealed a general understanding of family centred care principles. Nurses reported the potential benefits and challenges of adopting a family centred care approach to deliver optimal care for neonates and their families. The study highlighted that nurses need ongoing organisation support, guidance and further education to assist them in delivering family centred care effectively. Relevance to clinical practice. Family centred care is a central tenet underpinning neonatal care. Understanding neonatal nurses' perspectives will be useful when developing strategies to strengthen family centred care in the neonatal intensive care unit, and potentially improve neonatal care and family outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives. To report the findings of a service review - specifically the strategy to provide early childhood services 'on site' at opioid treatment clinics to address access difficulties. Background. Child and family health nurses are skilled in the assessment and support of families during early childhood. However, women with a history of substance abuse are often cautious when engaging with universal and other health services, with the result that the infant may miss recommended developmental screening and early referral to improve health outcomes. Design. In 2006, an internal review was undertaken of the integration of early childhood and parenting services at opioid treatment clinics in a large Area Health Service of New South Wales, Australia. Methods. A qualitative study design, using semi-structured interview questions was used. Data were collected via six focus groups (4-15 participants in each group) and individual interview of child and family health nurses, nurse unit managers and clinical staff ( n = 58). Results. Three key components of a model for providing early childhood support in collaboration with opioid treatment services were identified. First, the importance of building a trusting relationship between the woman and the child and family health nurses, second, maintaining continuity of care and a multidisciplinary/multiagency approach, and finally the importance of staff education, support and professional development. Conclusion. The provision of early childhood and parenting services on site, as part of a multidisciplinary 'one stop shop' approach to service delivery was a clear recommendation of the review. Relevance to clinical practice. Reduction of access difficulties to specialised early childhood support is of benefit to clients, community health services attempting to provide a service to this difficult to reach population and to drug and alcohol services seeking to provide a high level of holistic care for clients. [ABSTRACT FROM AUTHOR]

Aim. To describe the experiences of women who have had an emergency hysterectomy following a severe postpartum haemorrhage and the impact on their early mothering experiences. Background. Postpartum haemorrhage and subsequent hysterectomy is a traumatic birth event. Traumatic birth experiences have the potential to impact on a woman's experience of motherhood and her initial relationship with her baby. The relative rarity of this event makes it easy to dismiss the experiences of women having a hysterectomy following childbirth. Little is known about a woman's early mothering experience in the context of having an emergency hysterectomy. Design. Qualitative naturalistic inquiry approach. Method. Data were collected through semi-structured qualitative interviews from 21 Australian women who had an emergency hysterectomy following a severe postpartum haemorrhage. Results. Findings revealed three themes in relation to early mothering experiences in the context of having a hysterectomy following a severe postpartum haemorrhage. They were 'initial separation: lost bonding time', 'feelings of failure' and 'relinquishing care of the infant'. Conclusions. This paper highlights the ways undergoing emergency hysterectomy following childbirth can impact on the experience of early mothering in the postnatal period. Relevance to clinical practice. Greater recognition and attention to the specific needs of women who have an emergency hysterectomy following childbirth is required. Providing women with an opportunity to talk, debrief and ask questions related to their birthing experiences, will help women to reconcile their feelings. Giving women the opportunity to have their infants with them in intensive care unit, together with ongoing emotional support and anticipatory guidance, may also be useful approaches in assisting women during this difficult and traumatic time. [ABSTRACT FROM AUTHOR]

Nurses and midwives play a key role in providing universal maternal, child and family health services in Australia. However, the Australian federation of states and territories has resulted in policy frameworks that differ across jurisdictions and services that are fragmented across disciplines and sectors. This paper reports the findings of a study that reviewed and synthesised current Australian service policy or frameworks for maternity and child health services in order to identify the degree of commonality across jurisdictions and the compatibility with international research on child development. Key maternity and child health service policy documents in each jurisdiction were sourced. The findings indicate that current policies were in line with international research and policy directions, emphasising prevention and early intervention, continuity of care, collaboration and integrated services. The congruence of policies suggests the time is right to consider the introduction of a national approach to universal maternal, child health services. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to generate insight into younger women’s experiences of recovery from breast cancer-related breast surgery and to contribute to the knowledge base for clinicians practising in this field. Background. Despite the abundance of literature concerning the impact of breast cancer and breast loss on older women over 50 years of age, fewer studies have been conducted specifically with women younger than 50 years focusing on the recovery from breast cancer and related breast surgery. The effects of breast cancer on younger women differ to those of older women; younger women may have difficulty coming to terms with loss of fertility, perceived loss of femininity, sexuality and may experience body image disfigurement. Younger women may face these issues as a result of the treatment and surgery they have received to confine the breast cancer and attempt to improve their chances of survival. Design. A phenomenological qualitative methodology was used to capture the true essence and lived experience of four Australian women under the age of 50, who had undergone surgery as a result of being diagnosed with breast cancer. Methods. Tape-recorded semi-structured face-to-face interviews. Results. Thematic analysis revealed four major themes. These were ‘It absolutely encompassed me,’‘Being overwhelmed,’‘Living with fear and uncertainty’ and ‘Finding strength within.’ Conclusions. Findings of this study shed light on the experiences of recovery from breast cancer-related surgery in women under 50. Relevance to clinical practice. This research study will assist clinicians in understanding the needs of younger women undergoing breast cancer-related breast surgery, who may require counselling in relation to fertility and relationship issues and assistance in coping with the demands of work and home life. [ABSTRACT FROM AUTHOR]

Background: Gastro-oesophageal reflux (GOR) is common in infants. When the condition causes pathological symptoms and/or complications it is considered gastro-oesophageal reflux disease (GORD). It appears to be increasingly diagnosed and causes great distress in the first year of infancy. In New South Wales (NSW), residential parenting services support families with early parenting difficulties. These services report a large number of babies admitted with a label of GOR/GORD. The aim of this study was to explore the maternal and infant characteristics, obstetric interventions, and reasons for clinical reporting of GOR/GORD in NSW in the first 12 months following birth (2000-2011).Methods: A three phase, mixed method sequential design was used. Phase 1 included a linked data population based study (n = 869,188 admitted babies). Phase 2 included a random audit of 326 medical records from admissions to residential parenting centres in NSW (2013). Phase 3 included eight focus groups undertaken with 45 nurses and doctors working in residential parenting centres in NSW.Results: There were a total of 1,156,020 admissions recorded of babies in the first year following birth, with 11,513 containing a diagnostic code for GOR/GORD (1% of infants admitted to hospitals in the first 12 months following birth). Babies with GOR/GORD were also more likely to be admitted with other disorders such as feeding difficulties, sleep problems, and excessive crying. The mothers of babies admitted with a diagnostic code of GOR/GORD were more likely to be primiparous, Australian born, give birth in a private hospital and have: a psychiatric condition; a preterm or early term infant (37-or-38 weeks); a caesarean section; an admission of the baby to SCN/NICU; and a male infant. Thirty six percent of infants admitted to residential parenting centres in NSW had been given a diagnosis of GOR/GORD. Focus group data revealed two themes: "It is over diagnosed" and "A medical label is a quick fix, but what else could be going on?"Conclusions: Mothers with a mental health disorder are nearly five times as likely to have a baby admitted with GOR/GORD in the first year after birth. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular). [ABSTRACT FROM AUTHOR]

Aims: To identify young parents' perceptions and experiences of a parenting support programme, run by a non-government organisation, which provided both community group-based, and one-on-one home visiting, support. Study Design: A qualitative descriptive study was conducted in one of the most socio-economically disadvantaged areas of Sydney, NSW; this is also an area with one of the highest percentage of births among young parents. Young parents were eligible to participate whether they attended one of the parenting groups and/or received professional home visiting through the young parents programme. Eighteen young women were interviewed, and a further ten participated in a focus group. Thematic analysis of the focus groups and interviews was undertaken. Findings: Four themes were identified in the analysis: 'someone I know and trust', 'we just talk about anything and everything', 'doing the personal' and 'getting out and relaxing'. These themes were linked through the common thread of relationships; the relationships between themselves and other young mothers, and with the workers on the programme. The characteristics of the person with whom they had a relationship, the type of relationship, the content of their interactions and the benefits of these relationships were all important. Conclusions: This study is limited by the small sample size and the 'low risk' status of the young parents who engaged in the programme. This study demonstrated not only the importance for young parents of all forms of interaction, whether it is one-on-one, in a group or social networking; but most importantly, the benefits of having someone to talk to. [ABSTRACT FROM AUTHOR]