Seeing Red: A Grounded Theory Study of Women's Anger after Childbirth.

Persistent intense anger is indicative of postpartum distress, yet maternal anger has been little explored after childbirth. Using grounded theory, we explained how and why mothers develop intense anger after childbirth and the actions they take to manage their anger. Twenty mothers of healthy singleton infants described their experiences of anger during the first two postpartum years. Mothers indicated they became angry when they had violated expectations, compromised needs, and felt on edge (e.g., exhausted, stressed, and resentful), particularly around infants' sleep. Mothers described suppressing and/or expressing anger with outcomes such as conflict and recruiting support. Receiving support from partners, family, and others helped mothers manage their anger, with more positive outcomes. Women should be screened for intense anger, maternal-infant sleep problems, and adequacy of social supports after childbirth. Maternal anger can be reduced by changing expectations and helping mothers meet their needs through social and structural supports.

Anger in the context of postnatal depression: An integrative review.

BACKGROUND: Contrary to social constructions of new motherhood as a joyous time, mothers may experience postnatal depression and anger. Although postnatal depression has been thoroughly studied, the expression of maternal anger in the context of postnatal depression is conceptually unclear. This integrative review investigated the framing of anger in the context of postnatal depression. METHODS: After undertaking a search of CINAHL, Ovid-Medline, PsycInfo, and Web of Science, we identified qualitative (n = 7) and quantitative (n = 17) papers that addressed maternal anger and postnatal depression. We analyzed the data by developing themes. RESULTS: Our review indicated that anger was a salient mood disturbance for some postnatally depressed women with themes integrated as: (i) anger accompanying depression, (ii) powerlessness as a component of depression and anger, and (iii) anger occurring as a result of expectations being violated. CONCLUSIONS: Our findings indicate that anger can coexist with women's postnatal depression. Anger can be expressed toward the self and toward children and family members with negative relationship effects. We recommend that health care providers and researchers consider anger in the context of postnatal mood disturbances.

Can nursing epistemology embrace p-values?

The use of correlational probability values (p-values) as a means of evaluating evidence in nursing and health care has largely been accepted uncritically. There are reasons to be concerned about an uncritical adherence to the use of significance testing, which has been located in the natural science paradigm. p-values have served in hypothesis and statistical testing, such as in randomized controlled trials and meta-analyses to support what has been portrayed as the highest levels of evidence in the framework of evidence-based practice. Nursing has been minimally involved in the rich debate about the controversies of treating significance testing as evidentiary in the health and social sciences. In this paper, we join the dialogue by examining how and why this statistical mechanism has become entrenched as the gold standard for determining what constitutes legitimate scientific knowledge in the postpositivistic paradigm. We argue that nursing needs to critically reflect on the limitations associated with this tool of the evidence-based movement, given the complexities and contextual factors that are inherent to nursing epistemology. Such reflection will inform our thinking about what constitutes substantive knowledge for the nursing discipline.

Healthcare needs and access in a sample of Chinese young adults in Vancouver, British Columbia: A qualitative analysis.

OBJECTIVES: Immigrants of Chinese ethnicity and young people (between 18 and 30 years of age) are known to access health services less frequently and may be at greater risk for experiencing unmet health needs. The purpose of this study was to examine the health beliefs, health behaviors, primary care access, and perceived unmet healthcare needs of Chinese young adults. METHODS: Semi-structured in-depth interviews were carried out with eight Chinese young adults in Vancouver, Canada. RESULTS: A content analysis revealed that these Chinese young adults experienced unmet healthcare needs, did not have a primary care provider, and did not access preventive services. Cultural factors such as strong family ties, filial piety, and the practice of Traditional Chinese Medicine influenced their health behaviors and healthcare access patterns. CONCLUSION: Chinese young adults share similar issues with other young adults in relation to not having a primary care provider and accessing preventive care but their health beliefs and practices make their needs for care unique from other young adults.

Morphine infusions after pediatric cranial surgery: a retrospective analysis of safety and efficacy.

INTRODUCTION: Morphine infusions are avoided after cranial surgery in children due to concerns of masking neurological deterioration and because cranial surgery is considered less painful than other surgical procedures. Studies indicate that up to 60% of patients experience moderate to severe pain after craniotomies. Morphine has demonstrated efficacy in the treatment of acute postoperative pain, yet codeine phosphate is commonly preferred as the standard treatment. We assessed the efficacy and safety of intravenous morphine use outside the intensive care unit (ICU) following cranial surgery in children. METHODS: A retrospective case series analysis was conducted of medical records for 71 children. The patients underwent either cranial reconstruction (2002-2007) or supratentorial/infratentorial craniotomies (2005-2007) at British Columbia Children's Hospital. Comparison was made between patients receiving a continuous morphine infusion (CMI) and patients receiving acetaminophen and codeine. Patients were assessed for pain control and adverse events. RESULTS: Thirty-seven children received CMI on the unit (30 cranial reconstruction and seven craniotomy), while 34 (10 cranial reconstruction and 24 craniotomy) received acetaminophen and codeine. There was no statistical difference in pain control. There was a statistically significant difference in nausea on postoperative day one (p = 0.002). CONCLUSIONS: These findings suggest that CMI is as safe a treatment option as acetaminophen and codeine. Careful observation enables nurses to safely administer a CMI for children following cranial surgery on a surgical unit setting.