Help or hindrance? Single,unsupported mothers’ perceptions of health visiting

Although there have been studies of clients' perceptions of health visiting, the views of single, unsupported mothers about the health visiting service have been under-researched. Therefore, this study investigated their views using semi-structured interviews with 12 single, unsupported mothers identified by health visitors within one National Health Service Community Trust. The data were analysed using Burnard's (1991) thematic content analysis, which enabled a number of identifiable themes to emerge. Findings showed that the participants perceived the health visiting service as being concerned almost exclusively with babies and there was a general lack of understanding about the broader role of the health visitor. Clinics were seen as places to visit to weigh the baby but not as a contact point with a health visitor. Some health visitors were perceived as being judgemental in attitude and not necessarily interested in the clients as individuals. Participants considered that health visitors should be friendly, interested, able to promote their confidence and offer individualized advice. Overall the study suggests that health visitors may not be utilizing all dimensions of their role with single, unsupported mothers and may not be communicating effectively with them about this. The study also shows that single, unsupported mothers wish to be treated in the same way as other mothers but at present some feel that they are stigmatized and treated differently. The paper concludes with an outline of the implications of the findings and recommendations for practice and future research.     

新疆艾滋病高发地区经母婴传播的HIV感染儿童及其母亲保健服务利用情况分析

目的了解新疆维吾尔自治区（新疆）艾滋病高发地区经母婴传播的HIV感染儿童及其母亲接受孕产期保健和预防艾滋病母婴传播（PMTCT）服务情况,为制定新疆消除儿童艾滋病感染方案提供依据。方法从“新疆维吾尔自治区艾滋病综合防治信息系统”和“预防艾滋病、梅毒和乙肝母婴传播管理信息系统”中获得2011 — 2017年出生的调查对象基本信息,使用自行设计的问卷通过一对一、面对面的询问方式,回顾性调查HIV感染儿童和母亲孕产期接受保健服务和PMTCT服务的有关信息。结果144例HIV感染儿童的母亲初中及以下文化程度者占81.25%（117/144）,81.25%（117/144）是农民和家庭妇女;孕期产前检查比例为61.81%,住院分娩比例为79.17%,孕产期HIV抗体检测比例为72.22%,HIV抗体阳性检出比例为75.96%;母亲在孕产期纳入PMTCT服务体系比例为44.44%;南疆地区HIV感染儿童母亲纳入PMTCT服务体系比例为38.18%,北疆地区为64.71%,二者差异有统计学意义。结论新疆南部和北部地区HIV感染儿童母亲接受孕产期保健和PMTCT服务利用方面存在较大差距。 HIV感染儿童的母亲文化程度偏低,缺乏孕产期保健意识,PMTCT服务利用不足,应持续加强育龄妇女和孕产妇PMTCT健康教育。     

An exploratory study of demand for the health visiting service within a marketing framework

A small exploratory study was carried out to consider the concept of demand for the health visiting service from the clients' perspective. Because of the internal market introduced to the British health system under the National Health Service and Community Care Act, the idea of 'marketing' was used as a conceptual framework to underpin the study. Guided interviews were carried out with a sample of nine mothers of pre-school children to elicit the reasons why clients access the service, what they value about it and how they think it could be improved. A detailed qualitative analysis of these data indicates that demand for health visiting relates, in the first instance, to clients' knowledge of the service. This knowledge, and the extent to which the service meets their expectations, appear to influence the value the women place on health visiting and their subsequent use of it. A cycle is described, which illustrates critical points at which health visiting responses affect demand and use of service. The implications of the study for health visiting and for marketing the service are discussed.     

A theory of maternal engagement with public health nurses and family visitors

BACKGROUND: Home visiting by public health nurses and family visitors is promoted as an important intervention for enhancing parent and child development. Mothers of children at-risk for developmental delays tend to be the most difficult to access and engage, and commonly drop out of home visiting programmes prematurely. PURPOSE: This paper reports a study developing a theory that describes the process by which mothers of children at-risk engage with public health nurses and family visitors in a blended home visiting programme. METHODS: Grounded theory was used to guide the collection, recording, organization and analysis of the data. A purposeful sample of 20 mothers receiving public health nurse and family visitor home visits were recruited from a public health unit in Canada. Data were collected through client record reviews and 29 in-depth interviews that explored participants' experiences, beliefs and expectations about engagement. Data collection and analysis continued until all categories were saturated. FINDINGS: Mothers felt vulnerable and frequently powerless when they allowed the service providers into their home. Mothers with children at-risk engage with public health nurses and family visitors through a basic social process of limiting family vulnerability, which has three phases: (1) overcoming fear; (2) building trust; and (3) seeking mutuality. The personal characteristics, values, experiences and actions of the public health nurse, family visitor and mother influence the speed at which each phase is successfully negotiated and the ability to develop a connected relationship. CONCLUSION: Public health nurses working with families at risk need to identify client fears and perceptions related to home visiting, and to explain the role of public health nurses and family visitors to all family members. Given the importance that mothers place on the development of an interpersonal relationship, it is important for home visitors continually to assess the quality of their relationships with clients.     

Education and role conflict in the health visitor profession, 1918–39

BROOKS J and RAFFERTY AM. Nursing Inquiry 2010; 17 : 142–150
Education and role conflict in the health visitor profession, 1918–39 Health visiting was the public health profession in the UK, which arose during the Victorian period to support and supervise the mothers of the nation. The health visitor was expected to teach the new mothers hygiene, infant feeding and diet, help them in the home when necessary and then report back to the Medical Officer for Health. Her role therefore was multifaceted and required education and training from a number of differing bodies. She needed nursing skills to help with the practicalities of observation and home care, sanitary knowledge to ensure that the buildings were safe and training in law and epidemiology. In order to fulfil these professional requirements, by the middle of the twentieth century the health visitor was expected to be a nurse by background, be educated for health visiting in a university and understand community medicine. These differing and sometimes opposing requirements meant that the health visitor was often caught in‐between conflicting ideologies. It is this idea of ‘in‐betweenness’ from the work of the anthropologist Marilyn Strathern and its relation to the work and education of the health visitor that this article will focus.     

How the health visitor can help when problems between parents add to postnatal stress

BACKGROUND: Caring for a baby can provoke or intensify discord between parents, with adverse effects on their own well-being and their parenting. AIM: The aim of this study was to appraise evidence obtained from 450 mothers on the quality of the parents' relationship during the postnatal period and the value of support provided by health visitors in cases of discord. DESIGN: The health visitors were based at nine clinics in an outer London borough, and had been trained on a four-day course (the Brief Encounters course) to screen mothers for relationship problems at the 6-8-week check and to offer support (supportive listening, practical advice, referral) if problems were revealed. Data on relationship quality were obtained by a self-report screening scale completed at the 6-8-week check and again at the 12-week visit for immunizations, when the scale was included in a self-report questionnaire on help received from the health visitor. Intervention records kept by the health visitor showed what form any support had taken. Some 6 weeks later, 25 of the 82 mothers offered support, and their health visitors, were interviewed about their experience of the intervention. RESULTS: One in five mothers were identified as having a relationship problem at the 6-8-week check. Most were offered support. One in five of the 351 mothers who completed a questionnaire at the 12-week visit reported receiving support in improving their relationship. The follow-up interviews showed that most mothers valued this support. Responses to a questionnaire completed by health visitors showed that most were enthusiastic about its benefits. CONCLUSIONS: A four-day training course for health visitors enabled them to screen for relationship problems during the postnatal period and to provide support when required in a way that was valued by mothers. Most health visitors were enthusiastic about the value of the intervention in improving their contribution to family welfare.     

门诊护理服务满意度调查分析

目的了解门诊病人就诊的满意度情况,找出门诊服务的缺陷,分析原因,寻找对策,提高门诊服务的质量,提高病人满意度。方法采用自制的门诊服务调查表,调查我院门诊病人离开时的满意度。结果共229例病人接受了调查,绝大多数病人对我院的门诊服务质量是满意的,不同文化程度的人群满意度不同。结论可根据门诊病人满意度的各种影响因素,加强管理,提高门诊的医疗服务质量。     

门诊服务满意度调查分析

[目的]了解门诊病人就诊的满意度情况,找出门诊服务的缺陷,分析原因,寻找对策,提高门诊服务的质量,提高病人满意度。[方法]采用自制的门诊服务调查表,调查我院门诊病人离开时的满意度。[结果]共129例病人接受了调查,绝大多数病人对我院的门诊服务质量是满意的,不同文化程度的人群满意度不同。[结论]可根据门诊病人满意度的各种影响因素,加强管理,提高门诊的医疗服务质量。     

Child-rearing anxiety and its correlates among Japanese mothers screened at 18-month infant health checkups

OBJECTIVE: To examine the level of child-rearing anxiety and to explore the variables correlated with child-rearing anxiety in a city in Japan. DESIGN: Cross-sectional study. SAMPLE: From July to September 2003, 371 mothers who visited community health centers in a city in Tokyo Metropolis for their child's 18-month health checkups. MEASUREMENTS: Child-rearing anxiety was measured by the child-rearing anxiety scale. Questions in a self-reported questionnaire were on maternal variables, including maternal background information, child variables, and family system variables such as the presence of social support, and utilization of parenting support services. Also included within the questionnaire was the General Health Questionnaire-12. RESULTS: Hierarchical multiple linear regression analysis revealed that mothers with higher child-rearing anxiety had less childcare satisfaction, more depressive symptoms, more worries about the child, less support from the husband, and less social support. CONCLUSION: To identify mothers with high child-rearing anxiety in Japan, the infant health checkups should be utilized as an opportunity for screening, focusing on variables regarding mothers. Public health nurses can provide the necessary support after gaining an understanding of issues confronting mothers to prevent child-rearing anxiety and child abuse.     

Health visitors'' perceptions of domestic violence: the private nature of the problem

This study investigates health visitors' perceptions of domestic violence with a focus on the abuse of women by their male partners. Criticism has been levied at health visitors for responding inappropriately to women who seek help. There has been limited research into the process of health visiting practice in dealing with this emotive health need. The extent of the problem is difficult to ascertain, but estimates would suggest that it is a major public health issue. The abuse frequently commences or intensifies during pregnancy, and many of the women who experience domestic violence have children of pre-school age. It is during this time that they are most likely to come into contact with the health visiting service. The research was carried out in two National Health Service (NHS) trusts, one in the London region and the other in the south-east of England. A brief questionnaire was sent to all health visitors within the NHS trusts to ascertain the numbers of abused women known to the health visiting service. The findings suggest that the majority of health visitors in both NHS trusts were involved with families where domestic violence occurs. One of the key themes which emerged from interviews with 12 health visitors from each NHS trust (n = 24) was the very private nature of domestic violence in terms of identifying the issue. Implications for practice are that health visitors need to be more proactive in their questioning techniques and in influencing public policy, but they also require support through the provision of appropriate training.     

Postpartum Taiwanese women: their postpartum depression, social support and health-promoting lifestyle profiles

Background. To reach the Millennium Development Goals, maternal health‐promoting behaviours need to be encouraged after childbirth; little is known about the health‐promoting behaviour among first‐time mothers during their postpartum period. Aim. To examine levels of engagement in health‐promoting behaviours and related factors among postpartum women in Taiwan. Methods. This cross‐sectional study was conducted through a convenience sample of 122 qualified women. Participants self‐completed a questionnaire and mailed it back using a stamped, self‐addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert‐type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self‐developed social support scale. Results. The average overall Health Promotion Lifestyle Profile score was low (mean, 2·83 SD 1·35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers‐in‐law, mothers and husbands. An astonishing 42·6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health‐promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self‐actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model. Conclusions. This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles. Relevance to clinical practice. This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.     

Patient satisfaction with psychiatric inpatient care

AIM: This paper reports a study of psychiatric inpatient satisfaction with care in one Finnish psychiatric hospital, and explores the factors associated with satisfaction. BACKGROUND: Patient satisfaction is a central indicator for healthcare quality. Previous literature has shown that psychiatric inpatients are quite satisfied with their care in general, but have reported dissatisfaction in the areas of information access and compulsory care. Changes in the structure of Finnish mental health services due to dehospitalization have increased interest in exploring psychiatric patients' treatment experiences and general satisfaction. METHOD: Data were collected in inpatient settings using a self-rating patient satisfaction questionnaire. A total of 316 patients leaving the study units during a 1-year period (May 2000-April 2001) was recruited. The response rate was 61% (n = 313). FINDINGS: In general, patients were quite satisfied with their care. Of seven different satisfaction areas, they were most satisfied with staff-patient relationships, and reported most dissatisfaction in the areas of information, restrictions, compulsory care and ward atmosphere/physical milieu. Younger and female patients were less satisfied with staff-patient relationships than older patients and men. manova (five factors, main effects and two-way interactions in the model) showed that male patients with occasional symptoms or symptoms persisting for less than a month were more satisfied with staff than were women. Further, when symptoms persisted for a month or up to 1 year or more, women were more satisfied with staff than men. CONCLUSION: General patient satisfaction in psychiatric hospital care was good. However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be paid to collaboration with young adults (18-24 years) and female patients with mental health problems of short duration.     

Impact of the role of nurse, midwife and health visitor consultant

AIM: This paper describes the findings from one aspect of an evaluation study of the role of the nurse, midwife and health visitor consultant and the consultants' perceived impact of their role on services and patient care. BACKGROUND: The nurse, midwife and health visitor consultant role was established in 2000 in England to improve patient care, strengthen leadership and provide a clinical career opportunity for nurses, midwives and health visitors. An evaluative study was commissioned to report on the role 4 years after the new consultant posts were first established. METHOD: A multimethod evaluation was undertaken in 2002-2003 combining focus groups, telephone interviews and a comprehensive questionnaire survey of all the consultants in England. Four hundred and nineteen consultants responded to the questionnaire, 22 volunteered for the focus groups and 32 participated in the interviews. RESULTS: Nearly half (44%) the consultants who responded to the survey reported having a substantial impact on their service and 55% reported having some positive impact. High reported impact increased to 71% for those who had been in post for 2 years or longer. Consultants felt that they had been most successful in providing better support to staff, but only 10% said that they had a major impact on reducing unnecessary expenditure within the service. Factors associated with high levels of reported impact included engagement in a wide range of activities, perceived competence in the role and strong medical support. Those reporting most impact also reported the greatest dissatisfaction with salary. CONCLUSION: As consultants become more established in their posts, they are able to identify improvements in practice, service reconfiguration and educational advantages for staff. Our findings suggest that the true influence of these posts will become clearer over time as the impact of consultants on long-term organizational change becomes more apparent.     

Guiding mothers' management of health problems of very low birth-weight infants

OBJECTIVE: Explore the feasibility, usefulness, and outcomes of a pilot program to support mothers in developing competencies for managing health problems of their very low birth-weight (VLBW) infants in partnership with the primary care clinician (PCC). DESIGN: In a randomized study, mothers who received guided participation (GP) and printed guidelines for managing VLBW infant health problems were compared with mothers who received only the guidelines and standard care (GL group). SAMPLE: All mothers (GP = 20; GL = 11) were at least 18 years old and English speaking. Infants were all VLBW (< or =1,500 g). INTERVENTION: GP began during the infant's neonatal intensive care unit stay and continued with public health nurses (PHNs) and a family service clinician through the infant's first 4 postterm months. Measurements: Intervention feasibility and usefulness were assessed with maternal and clinician feedback. Outcomes included maternal and clinician appraisal of mothers' use of clinical resources and mothers' perceptions of primary-care quality and the family-PCC relationship. RESULTS: Intervention feasibility and usefulness were supported. GP and GL groups did not differ significantly on outcomes. CONCLUSIONS: Findings indicate a longer intervention period, GP organized by infant problem episodes, and enhancement of the PHN role in the context of interdisciplinary and interagency collaboration.     

Evaluation of a public health nurse visiting program for pregnant and parenting teens

A visiting nurse agency created the Pregnant and Parenting Team Program, an innovative program for serving pregnant and parenting teen mothers to promote family and child health and family self‐sufficiency. Public health nurses (PHNs) provide home visits that offer social, emotional, educational, and health care support to pregnant and parenting teen mothers 19 years of age and younger and their children. Foundational program pillars include: (1) a trusting relationship between teen mothers and a PHN through home visits; (2) outreach and coordination with schools, hospital, clinics, and human service agencies; (3) a comprehensive and intensive maternal mental health curriculum; and (4) community support and caring through provision of essential items needed for success in parenting. Measures of program effectiveness included identification of pregnant and parenting adolescent mothers, birth outcomes, active enrollment in school, delay of repeat pregnancy, maternal‐infant bonding and attachment, use of community resources, and infant growth and development. Participants in the program were more likely to be enrolled in school and had better birth outcomes in comparison with nonparticipants. Outcome data collected from January 1, 2008 to July 23, 2010 demonstrated progress toward stated goals.     

Support for teenage mothers: a qualitative study into the views of women about the support they received as teenage mothers

AIM OF THE STUDY: To gain insight into the support teenage mothers received during pregnancy, birth and their child's pre-school years and young women's perceptions of the usefulness of a support group for teenage mothers. BACKGROUND: Most qualitative studies have focused on teenage mothers around the time of the birth of their first child. For this study, women were recruited several years after the birth (median 8.5 years), so that they would have had time to reflect on the support they had received. DESIGN: The qualitative method of semi-structured interviews was chosen to obtain in-depth information and to allow teenage mothers' own views to be heard. Ten individual interviews and one paired interview were undertaken. FINDINGS: Recruitment was difficult because taking part in research was not a priority for many of the women. The study confirmed the strong link between deprivation and teenage pregnancy found in other studies, and suggested that mental health problems in teenage mothers may be more difficult to detect. Teenage women need more information on mental health and on services available to them. The fear, expressed by some of the women in this study, of becoming different from other women in their social network should be considered by health workers when establishing intervention programmes. CONCLUSIONS: Professional bodies of health workers should lobby government to provide a minimum standard of living and sufficient child-care to combat deprivation. Former teenage mothers should be involved in the recruitment, planning and implementation stages of research and interventions. Health professionals should be aware that mental health problems in teenage mothers may be particularly difficult to detect. Key community health workers or a support group may provide information on services, mental health and education facilities available that would benefit teenage mothers. A support group may also give emotional support.     

Patients' and their parents' satisfaction levels about the treatment in a child and adolescent mental health inpatient unit

The aim of this study is to demonstrate the feedback and the satisfaction levels of the adolescents and their parents who received treatment in the newly opened inpatient unit. The results of the questionnaire evaluating the quality of the mental health service provided by the inpatient unit were examined retrospectively. The participants were the adolescents and their parents who received treatment and were discharged between January 2006 and May 2007. They were asked to give feedback on their observations and perceptions about the treatment they received, starting from the admission assessment until the time they were discharged. The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. Information about the adolescents' and their parents' experience of the treatment they received is essential and valuable in terms of promoting the quality of service and better treatment outcomes of an inpatient unit.     

Health literacy and the information needs and dilemmas of first-time mothers over 35 years

Aim and objectives. This paper aims to highlight the information‐based dilemmas of a particular group of healthcare patients, first‐time mothers over 35 years. Background. In recent years, there has been a proliferation of health‐related information and a move towards greater public access to health information as an important step towards patient education and empowerment. Information technologies, such as the Internet, have added considerable momentum to this trend. Many health professionals now consider the provision of detailed health information to patients as requisite for informed decision making. Within the literature there is some emphasis on the importance of patient understanding of information received; however, to date, few studies have considered information over‐consumption as problematic. Methods. Using in‐depth interviews, a sample of 22 first‐time mothers over 35 years was interviewed over three junctures: 35 weeks gestation, 10–14 days postpartum and six to eight months postpartum. Three focus group interviews of midwives and maternal and child health nurses were also conducted. This paper was undertaken as part of a larger project to evaluate the experience of first mothering over 35 years. Results. Mothers in this study were found to have access to large volumes of health information. This tendency was driven by both the women and the health professionals who cared for them. Midwives and maternal and child health nurses revealed a tendency to provide older first‐time mothers with considerable health information of a medical orientation, understanding that this is what the women required. However, despite common perceptions of empowerment, the consumption of medical‐type information proved frightening and many mothers described feeling overwhelmed by ‘knowing too much’. Conclusion. This study contributes to the limited understanding of the information needs of a growing group of childbearing women, first‐time mothers over 35 years. By providing an insight into the ‘downside’ of extensive health information, nursing staff, in particular, may consider the amount and type of information they distribute. Some suggestions are offered to health professionals to ameliorate the information‐based dilemmas of these women. Relevance to clinical practice. As the number of childbearing women over 35 years continues to grow, it is important for health professionals to understand the particular needs of this group. In doing so, doctors, midwives and maternal and child health nurses may be in a position to provide more meaningful maternal support.