School of Nursing and Midwifery, University of Western Sydney, Sydney, NSW, Australia.
BMC Health Serv Res. 2013 Apr 8;13:133. doi: 10.1186/1472-6963-13-133.
There 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.
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.
CFHNs 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.
Overall, 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.
国际上越来越认识到需要在怀孕和产后识别出有不良围产期心理健康风险因素的女性。在澳大利亚新南威尔士州，“支持家庭早期”政策为妇女和家庭提供了评估和支持框架，包括常规的社会心理评估和抑郁筛查。本研究调查了在该州政策建议下，儿童和家庭健康护士（CFHNs）在产后评估和筛查方面采取的方法。这是一项定性民族志研究，包括 83 名 CFHN 和 20 名女性。观察发生在 13 名护士身上；在家庭或诊所环境中，对 20 名妇女进行了观察。另外 70 名护士参加了讨论小组。使用观察工具（4D&4R）和现场记录来记录观察结果，并使用频率进行描述性分析。使用现场记录、访谈数据和讨论组记录进行主题分析。
这是一项定性民族志研究，包括 83 名 CFHN 和 20 名女性。观察发生在 13 名护士身上；在家庭或诊所环境中，对 20 名妇女进行了观察。另外 70 名护士参加了讨论小组。使用观察工具（4D&4R）和现场记录来记录观察结果，并使用频率进行描述性分析。使用现场记录、访谈数据和讨论组记录进行主题分析。
CFHNs 表现出多种评估和筛查方法。在观察到的 20 次互动中的 50%（10 次）进行了社会心理评估；然而，所有妇女都使用爱丁堡抑郁量表进行了筛查。确定了代表评估过程方法的四个主要主题：“参与：首先做好那一点”、“做一些文书工作”、“创造舒适”和“社会心理评估：以另一种方式进行”。护士还利用了其他技能，例如观察妇女与婴儿的互动、注意非言语交流以及运用直觉来做出临床决策。
总的来说，护士对评估和筛查采取了敏感和关爱的方法，但是，在两个地点之间对政策建议的解释存在差异。护士采用灵活的、基于关系的评估方法；然而，当需要纳入结构化的社会心理评估过程时，他们会感到紧张。为了有效地进行评估和筛查，CFHNs 需要持续的支持、培训和监督，以维持这项敏感和情感挑战的工作。
