Protocol for evaluation of the continuum of primary care in the case of a miscarriage in the emergency room: a mixed-method study.

BACKGROUND: In Quebec (Canada), nearly 20,000 pregnancies end in miscarriage, and the majority of the miscarriages are dealt with in an emergency unit. Although there are studies documenting the effects of this type of grief on mental health, men's experiences are much less discussed than those of women. Similarly, no study has evaluated best practices in terms of service continuity, from emergency care to community resources. The aim of this study is to better understand the relationships that exist between the organization of emergency room and primary care health services for women presenting with miscarriage, on the one hand, and the positions and experiences of women and men within these services, on the other. METHODS: The general objective of this mixed-method study can be broken down into three methodological sections. Focus 1. Institutional discourses and practices. This section is structured as a multiple case study of the mandates of five participant institutions. The study will involve (a) a documentary analysis; (b) a quantitative survey (N: 200) and (c) group interviews (N: 75) with caregivers and emergency unit managers. Focus 2. Women's and men's experiences of miscarriages and the institutional response. This section includes (a) a survey (N: 232) and (b) individual interviews (N: 80) designed to identify best practices in emergency involving women and their partners in each area. Focus 3. This section will integrate the information furnished by the first two sections in order to create an ethnographic overview of the situation. DISCUSSION: This innovative project will provide answers to critical questions on how to improve the effectiveness and quality of interdisciplinary and multisectoral interventions to promote the mental health and psychosocial well-being of couples having experienced a miscarriage. It will have a material effect on the organization of emergency services and of the primary care pathway for women experiencing a miscarriage and for their partners. TRIAL REGISTRATION: Not applicable. This study involves a retrospective view of usual health care interventions. This study is not a clinical trial that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes.

Using implementation evaluation to uncover a child neglect prevention program.

UNLABELLED: Child neglect is an ecosystemic problem with a great variety of risk factors to consider and, therefore, it requires a multimodal and individualized intervention. Although such an intervention is better for the families, it represents a great challenge for the evaluation process. OBJECTIVES: The purpose of this study is to document, using Dane and Schneider's model (1998), the differences between the services received by parents participating in a parental group designed to prevent the presence or the recurrence of child neglect. METHODS: Quantitative program implementation data was collected from 50 families who took part in a four-module program over a two-year period. RESULTS: The results demonstrate uniformity with regard to the program's central elements despite the differences in the services each family received. Adherence to the program was mainly respected despite slight variations in the number of sessions offered and in the group sizes. On the other hand, dosage varied greatly, with families attending from one to four offered modules. For each module, attendance varied from participation in one group session to participation in all ten group sessions. Moreover, for families who participated in at least two modules, attendance significantly increased between the first and second module. The families' level of participation also differed, with families being rated from low to highly engaged at the end of each group session. CONCLUSIONS: Interventions must be adjusted to the specific needs of the clientele and to the characteristics of the environment in which they will be implemented. These variations could have important impacts on the effects of the intervention on the families. Therefore, evaluating these programs requires the consideration of these variations and of their repercussions on the program's effects.

Psychosocial factors associated with paternal postnatal depression.

BACKGROUND: While maternal postpartum depression is a well-known phenomenon, paternal postnatal depression has been less studied. It is known that paternal postnatal depression impacts on children's and families' development, affects marital satisfaction and affects the economic health of industrialized countries. The aim of this study was to identify the psychosocial factors associated with paternal postnatal depression. METHODS: A descriptive-correlational study was conducted with a sample of fathers of infants (average age: 11 months) who were breastfed exclusively or predominantly for at least 6 months, comparing psychosocial factors in fathers with (n: 17, 8.2%) and without a positive score for depression on the EPDS scale (n: 188). Psychosocial factors were assessed through questionnaires. RESULTS: Depression in fathers of breastfed infants is associated with the experience of perinatal loss in a previous pregnancy, parenting distress, infant temperament (difficult child), dysfunctional interactions with the child, decreased marital adjustment and perceived low parenting efficacy. Multivariate analysis suggests an independent effect of psychosocial factors such as parenting distress, quality of the marital relationship and perceived parenting efficacy on paternal depression. LIMITATIONS: The sample focused on fathers of breastfed infant, since breastfeeding has become the feeding norm, and this should be taken into account when considering the generalization of findings. CONCLUSION: These findings emphasize the need to consider a set of psychosocial factors when examining fathers' mental health in the first year of a child's birth. Health professionals can enhance parenting efficacy and alleviate parenting distress by supporting fathers' unique experiences and addressing their needs.

Transition to fatherhood: modeling the experience of fathers of breastfed infants.

Transition to parenthood has long been examined from the angle of mothers' experience. When looked at this transition through fathers' lens, fathers' involvement and perceived parental efficacy appear to be landmarks of this experience. This article examines a model of the relationships among father involvement, perceived parental efficacy, events related to breastfeeding, support, stress, and income with a sample of 164 fathers of breastfed infants. This model highlights the direct and indirect contributions of support and stress to fathers' perceived parenting efficacy and involvement. Possible directions for nursing practice, education, and research are proposed to ease men's transition to fatherhood.

Nursing students' perceptions of their experiences with fathers during their family nursing clinical practicum / Percepções de estudantes de enfermagem sobre suas experiências com pais durante a prática clínica em enfermagem familiar / Percepciones de alumnos de enfermería sobre sus experiencias con padres durante su pasantía clínica en el área de enfermería familiar

There is consensus that supporting fathers' involvement in their children's care is essential and that nurses can play an important role, facilitating this process. There is little evidence about how nurses' education as family nurses enable them to work with fathers. This study aimed to explore undergraduate nursing students' perceptions of their experience with fathers during family nursing clinical practicum. An exploratory descriptive qualitative study allowed twelve nursing students to participate in a one-hour interview, at a university of Central Canada. The critical incident technique was used for data collection and analysis was done with N Vivo7. Four themes reflected students' experiences: Experiencing critical events with fathers; Perceiving fathers and father involvement as important; Building a relationship with fathers and Reflecting upon formal education and clinical practicum. Family nurses need to revisit their attitudes towards fathers and make space for this important member of the family in health care situations.

Existe consenso de que apoiar o envolvimento dos pais no cuidado de seus filhos é essencial e que os enfermeiros desempenham um importante papel, facilitando esse processo. Há poucas evidências sobre como o ensino de enfermagem familiar capacita enfermeiros para trabalhar com pais. O estudo objetivou explorar a percepção de estudantes de enfermagem sobre suas experiências com pais durante a prática clínica de enfermagem familiar. Estudo qualitativo, descritivo-exploratório, com doze estudantes de enfermagem que participaram de uma entrevista de uma hora, em universidade canadense. Utilizou-se a técnica do incidente crítico para guiar a coleta dos dados e o N Vivo7 para análise. Quatro temas refletiram as experiências: Vivenciando eventos críticos com pais; Percebendo a importância dos pais; e seu envolvimento com eles; Construindo uma relação com os pais e Refletindo sobre a formação e a prática clínica. Enfermeiros da família necessitam rever suas atitudes e abrir espaço para este importante membro familiar nas situações de cuidado em saúde.

Existe consenso que apoyar la participación de los padres en el cuidado de sus niños es fundamental y que los enfermeros pueden ser facilitadores de este proceso. Hay pocas evidencias sobre como la educación de enfermeros de la familia les capacita para trabajar con padres. El estudio tuvo como objetivo explorar las percepciones de alumnos de pregrado en enfermería sobre sus experiencias con padres durante su pasantía clínica en enfermería familiar. Investigación cualitativa exploratoria y descriptiva con doce alumnos que participaron en una entrevista de una hora, en una universidad canadiense. Para el análisis se utilizó N Vivo7. Cuatro temas reflejaron las experiencias: Vivenciando eventos críticos con padres; Percibiendo padres y su involucramiento con ellos como importantes; Construyendo un relacionamiento con padres y Reflexionando sobre educación formal y pasantía clínica. Los enfermeros de la familia necesitan revisitar sus actitudes y abrir espacio para ese miembro importante de la familia en situaciones de atención a la salud.

A survey and description of projects that support and promote fathering in Canada: still work to do to reach fathers in their real-life settings.

This study aimed to identify the characteristics of current Canadian intervention programs designed to support father involvement. Sixty-one projects in the 10 provinces constituted the sample. Results show that most of the projects operate on limited budgets. The activities they offer mostly target fathers themselves to the exclusion of key people in their social environment. The discussion underscores the strenghts and weaknesses of father support programs, and guidelines for future intervention in this area are proposed.