Factors Associated with Maternal Engagement in Infant Care When Mothers Use Substances.

Introduction: Mothers who use substances can play a key role in the treatment and care of their infants. However, challenges exist to engaging these mothers in the care of their infant. The purpose of this study was to identify factors associated with maternal engagement in infant care when mothers are experiencing substance use disorders. Materials and Methods: A systematic search was conducted using the databases of CINAHL, APA PsycINFO, and PubMed along with a manual search of Google Scholar between the years of 2012 and 2022. Studies were included if they were (1) original qualitative research; (2) published in English; (3) peer reviewed; (4) from the perspective of mothers who use substances or nurses; (5) included descriptions of interactions between mothers who use substances and their infants during postpartum care, and/or in the nursery or neonatal intensive care unit; and (6) conducted in the United States. The studies were assessed for quality and validity using 10 criteria from the Joanne Briggs Institute critical appraisal checklist for qualitative research. Results: Findings from 22 qualitative studies were synthesized using a thematic synthesis approach and revealed 3 overarching themes that included 7 descriptive subthemes that identified factors to maternal engagement. The seven descriptive subthemes included: (1) Attitudes Toward Mothers Who Use Substances; (2) Knowledge on Addiction; (3) Complicated Backgrounds; (4) Emotional Experiences; (5) Managing Infant Symptoms; (6) Model of Postpartum Care; and (7) Hospital Routines. Discussion: Participants described stigma from nurses, complex backgrounds of mothers who use substances, and postpartum models that influenced mothers' engagement in infants' care. The findings suggest several clinical implications for nurses. Nurses should manage their biases and approach mothers who use substances in a respectful manner, increase their knowledge of issues and care related to addiction in the perinatal period, and promote family-centered approaches to care. Conclusion: The findings of 22 qualitative studies described factors associated with maternal engagement in mothers who use substances that were integrated using a thematic synthesis method. Mothers who use substances have complex backgrounds and experience stigma which can negatively impact their engagement with their infants.

Provider Characteristics That Hinder Relationships with Black Women in the Perinatal Period.

Black women have often reported challenges in their relationships with health care providers during the perinatal period. This study synthesized the findings of qualitative studies to describe health care providers' characteristics that hinder therapeutic relationships with Black women in the perinatal period. A systematic search was conducted and findings from 12 qualitative studies were synthesized using a thematic synthesis approach. Two overarching themes that included seven descriptive themes were discovered. The seven descriptive themes include the following: (1) provides differential treatment; (2) expresses biased attitudes; (3) lacks empathy; (4) limits choices; (5) communicates inadequate health information; (6) provides deficient care; and (7) dismisses concerns. Participants experienced challenged relationships with health care providers who held implicit biases and discouraged them from participating in their care. The findings suggest the importance of confronting implicit biases, promoting a bias-free health care system, and providing quality care that is respectful to Black women in the perinatal period.

Descriptions of Maternal Mortality From Nurses Who Practice in Perinatal Settings.

OBJECTIVE: To explore nurses' descriptions of maternal mortality when caring for women in the perinatal period in Indiana. DESIGN: A qualitative descriptive approach was used to produce nurses' descriptions of maternal mortality. SETTING/PARTICIPANTS: Convenience sample of 16 nurses recruited from the Indiana Section of the Association of Women's Health, Obstetric and Neonatal Nurses. MEASUREMENTS: Semistructured phone interviews were conducted, and participants were asked to explain their experiences related to maternal mortality. This information, which was summarized using content analysis, provided data related to nurses' descriptions of maternal mortality when caring for women in the perinatal period. RESULTS: Analysis revealed three main themes that explain nurses' descriptions of maternal mortality: When It Comes to Maternal Mortality: Out of Sight Is Out of Mind, Nurses Express Detachment From Their Role in Preventing Maternal Mortality, and Experience With Maternal Mortality or a Near-Miss Event Is a Turning Point for Nurses. CONCLUSION: Nurses who have limited experience with maternal mortality and who approach the issue in a detached manner may miss opportunities to provide health education to women in the perinatal period. Nurses need education on substance use disorders in the perinatal period, guidance on how to support women in the postpartum period, and support for coping with death and dying in the perinatal period.

Provider Characteristics Associated with Trust When Caring for Women Experiencing Substance Use Disorders in the Perinatal Period.

INTRODUCTION: Women experiencing substance use disorders (SUD) have often reported challenges in their relationships with health care providers during the perinatal period that served as a barrier to care. Establishing trust is an important aspect in forming positive relationships. The purpose of this study was to identify provider characteristics associated with the development of trust when caring for women experiencing SUD during the perinatal period. METHODS: A systematic search was conducted using the databases of CINAHL, APA PsychINFO, and PubMed along with a manual search of Google Scholar between the years of 2000-2021. Studies were included if they were (1) original qualitative research; (2) published in English; (3) peer reviewed; (4) from the perspective of women experiencing SUD; (5) included descriptions of positive health care interactions between women experiencing SUD in the perinatal period and their health care providers; and (6) conducted in the United States or Canada. The studies were assessed for quality and validity using 10 criteria from the Joanne Briggs Institute critical appraisal checklist for qualitative research. RESULTS: Findings from 21 qualitative studies were synthesized using a thematic synthesis approach and revealed 3 overarching themes that included 7 descriptive subthemes which identified provider characteristics associated with trust. The 7 descriptive subthemes included: developing rapport with women, demonstrating caring behaviors, including women in care, understanding women's SUD treatment efforts, reassuring women, delivering competent care, and educating women. DISCUSSION: Participants' accounts of trusting interactions with health care providers occurred when providers viewed women approvingly, affirmed their treatment efforts and maternal abilities, and delivered competent care that was knowledgeable of issues associated with SUD. The findings suggest the importance of confronting implicit biases, integrated care, and fostering a stigma-free and trauma-informed working environment.

Nurses' Descriptions of Interactions When Caring for Women With Perinatal Substance Use Disorders and Their Infants.

The purpose of this review is to describe health care interactions between nurses and women with perinatal substance use disorders, including interactions with their infants from the perspective of the nurses. Findings from 11 qualitative inclusion articles were synthesized using a metasummary approach. The majority of articles showed that nurses experience problematic interactions when providing care to women with perinatal substance use disorders and their infants, although some results indicated that some nurses engage in interactions that are assuring. Six types of conflictual interactions were identified: inadequate care, distressing, condemning, deficient knowledge, rejecting, and dissatisfying. Two types of therapeutic interactions were identified: compassionate and supportive. The findings underscore the importance of managing stigma, enhancing knowledge of the science of addiction processes, and promoting best practices when caring for this population.