Joint action between child health care nurses and midwives leads to continuity of care for expectant and new mothers

Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden
International Journal of Qualitative Studies on Health and Well-Being (Impact Factor: 0.93). 07/2012; 7. DOI: 10.3402/qhw.v7i0.18183
Source: PubMed


Reduction of the duration of postpartum hospital stay in western countries highlights the need for better support and continuity of care for expectant and new mothers. The aim of this study was to investigate strategies to improve continuity of care for expectant and new mothers. The study also aimed to elaborate on a preliminary substantive grounded theory model of "linkage in the chain of care" that had been developed earlier. Grounded theory methodology, which involved multiple data sources comprising structured interviews with midwives and child healthcare nurses (n=20), as well as mothers (n=21), participant observation, and written material, was used. Comparative analysis was used to analyse the data. To achieve continuity, three main strategies, transfer, establishing and maintaining a relation, and adjustment, were identified. These strategies for continuity formed the basis of the core category, joint action. In all the strategies for continuity, midwives and child healthcare nurses worked together. In addition, mothers benefited from the joint action and recognized continuity of care when strategies for continuity were implemented. The results are discussed in relation to the established concepts of continuity.

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    • "Internationally, parent education is typically offered up until 2 months post-birth, that is, antenatal and perinatal education (Renkert and Nutbeam, 2001; Bryanton et al., 2013). In Sweden, where the current study was carried out, parent education groups are held during pregnancy and throughout the first year of the newly born child (Fabian et al., 2005, 2006; Barimani and Hylander, 2012). "
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    ABSTRACT: The aim of the study was to describe and to understand midwives' and child healthcare nurses' experiences of working with parent education groups through their descriptions of the role and what they find rewarding and challenging in that work. Data were collected through three open-ended questions from a web survey: 'How do you refer to your role when working in parent education?', 'What is the biggest challenge or difficulty for you when working in parent education?' and 'What is most rewarding when working in parent education?' The answers were analysed by using qualitative content analysis and correlation analysis. The results show that the midwives and child healthcare nurses either included or excluded the group when describing their role as leaders and their influence on parents. The same applies to what they found rewarding and what was difficult and challenging for them in working with the groups. Primarily, the leaders who excluded the group expressed a lack of competence on a professional level in managing groups and using the right teaching methods to process the knowledge content. One important question to deal with is how to best support midwives and nurses in child healthcare to be prepared for working with parent education groups. One obvious thing is to provide specialized training in an educational sense. An important aspect could also be providing supervision, individually or in groups. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email:
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    • "Barimani and Hylander [44] highlighted the importance of individualised communication transfer processes for children and families with identified risk. In phase one CFH nurses complained that ‘poor’ communication resulted in them being left unsure of the medical histories, existing plans and further management required for families with risk factors. "
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    • "CFH nurses are directed via policy and professional competency statements to collaborate with other health professions to provide continuity of service [8,36,37]. Yet, very little literature addresses the nature of continuity in CFH nursing practice; what does exist reports gaps in continuity of care between CFH nurses and other maternity and CFH professionals [29,38]. "
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    ABSTRACT: Continuity in the context of healthcare refers to the perception of the client that care has been connected and coherent over time. For over a decade professionals providing maternity and child and family health (CFH) services in Australia and internationally have emphasised the importance of continuity of care for women, families and children. However, continuity across maternity and CFH services remains elusive. Continuity is defined and implemented in different ways, resulting in fragmentation of care particularly at points of transition from one service or professional to another.This paper examines the concept of continuity across the maternity and CFH service continuum from the perspectives of midwifery, CFH nursing, general practitioner (GP) and practice nurse (PN) professional leaders. Data were collected as part of a three phase mixed methods study investigating the feasibility of implementing a national approach to CFH services in Australia (CHoRUS study). Representatives from the four participating professional groups were consulted via discussion groups, focus groups and e-conversations, which were recorded and transcribed. In total, 132 professionals participated, including 45 midwives, 60 CFH nurses, 15 general practitioners and 12 practice nurses. Transcripts were analysed using a thematic approach. 'Continuity' was used and applied differently within and across groups. Aspects of care most valued by professionals included continuity preferably characterised by the development of a relationship with the family (relational continuity) and good communication (informational continuity). When considering managerial continuity we found professionals' were most concerned with co-ordination of care within their own service, rather than focusing on the co-ordination between services. These findings add new perspectives to understanding continuity within the maternity and CFH services continuum of care. All health professionals consulted were committed to a smooth journey for families along the continuum. Commitment to collaboration is required if service gaps are to be addressed particularly at the point of transition of care between services which was found to be particularly problematic.
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