Clinician Engagement in Quality: A Literature Review.

BACKGROUND AND OBJECTIVES: Defining quality in the health care context has proven difficult, with many organizations not able to clearly articulate their use of this term in a manner that is easily understood by their clinical staff. This review seeks to investigate the literature to explore clinician engagement in quality including where engagement has been problematic, and if the reasons for this have been identified. METHODS: An integrative review of the literature was undertaken to determine whether evidence within the literature supports a hypothesis that there is a lack of understanding of and engagement in quality at an organizational level by health professionals. A search of the literature was conducted using EBSCO Academic Complete, CINAHL, and MEDLINE databases. RESULTS: This article identified 18 studies where the understanding of quality by clinicians and their level of engagement with the process are investigated. We found that there has been no comprehensive study that explores the development of an agreed-upon definition and measurement of quality or clinician understanding and engagement in quality. The studies conducted have been small and discipline-specific. CONCLUSION: There is a growing body of evidence indicating that clinical and nonclinical staff interpret the meaning of quality and quality improvement differently. Quality and quality improvement are interpreted in relation to the clinician's individual work, professional, and learning and development experience. The literature suggests that clinician interpretation is influenced in part by their own personal beliefs and values, in addition to their interpretation of their individual work/professional responsibilities.

Mothers' experiences while admitted to a residential parenting unit: a qualitative study.

Background: In Australia, most states have residential parenting units that provide parenting support to parents (usually mothers) who are experiencing significant parenting difficulties with their infants or toddlers. The three most common reasons for admission to a residential service are: sleep and settling issues, adjustment to parenting, and feeding issues. Aim: The overall study aim was to explore mothers' experience of a residential admission, as one tool to increase the "patient (mother) voice" within the residential parenting service and provide a mechanism for staff to understand the impact of their interactions with mothers on the care delivery process. Design: A qualitative descriptive approach and thematic analysis were used. One hundred mothers provided responses to a routinely collected questionnaire that asked about their experience while admitted to one of three residential parenting units. All mothers were eligible to participate. Results: Three major themes were identified: not knowing what to expect; working collaboratively with parents; and facilitating maternal learning. Mothers identified that they had increased parenting confidence levels, and gained new parenting knowledge and skills as an outcome of the residential stay. Conclusions: The value of a residential stay is clearly articulated by the mothers in the stories collected. These themes have affirmed that the residential units are parent-focused. Some mothers were surprised by the nurses' willingness to listen to their preferences about their child's care and to work with them adapting interventions to their cultural and home context.

Characteristics and service needs of women and babies admitted to residential parenting units in New South Wales: A mixed-methods study.

AIMS AND OBJECTIVES: To examine the characteristics and service needs of women and babies admitted to residential parenting services (RPS) in the first year following birth in New South Wales, Australia. BACKGROUND: In Australia, there is a tiered system to support maternal, child and family health, which includes RPS. DESIGN: Sequential explanatory mixed-methods design. METHODS: Individual patient data were obtained from a random review of 10% of all medical records (n = 300 of 3,011 admissions) of women with an infant of <12 months of age who were admitted to RPS in 2013. Following review of the medical records, qualitative data were collected via interviews with eight women who accessed RPS. Chi-square analysis and Student's t test were used to analyse quantitative data. Qualitative data were analysed using a descriptive interpretive approach. An integrative approach was taken in reporting the findings. RESULTS: Women admitted to the RPS were on average 32 years of age, were Australian born (72%) and had a university qualification (40%), and most were employed. The majority of women were primiparous (60%) and had a vaginal birth (61%). Women with male infants were much more likely to be admitted to the RPS (58%) compared to the NSW male-to-female ratio (51.3% vs. 48.7%). Over 50% of women reported mental health issues with 27% having an Edinburgh Postnatal Depression Scale score ≥13 on admission. The primary reason women sought parenting support was for sleep and settling (83%). During their stay, services used by women included social workers (44%), psychologists (52%) and psychiatrists (4.5%). CONCLUSION: Women who access RPS report psychosocial and mental health issues. Services provided by RPS support women during this challenging early parenting period by providing multidisciplinary, holistic and peer support. RELEVANCE TO CLINICAL PRACTICE: A high prevalence of mental health issues identified in this study indicated a need for ongoing training and support for RPS staff. Ensuring clinicians have the appropriate skill sets to best support their clientele will maximise the outcomes for women and families who access RPS during the early parenting period.

Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia.

AIM AND OBJECTIVES: To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015. BACKGROUND: For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care. DESIGN: A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups. RESULTS: Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity. CONCLUSIONS: There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers. RELEVANCE TO CLINICAL PRACTICE: Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families.