Maternal and Child Health Nursing education before and during COVID-19: An exploratory descriptive study.

BACKGROUND: Major disruptions to higher education during COVID-19 resulted in a rapid shift to online learning and associated adaptations to teaching and assessment practices, including for postgraduate programs requiring practical skill development such as nursing and midwifery. Educator perspectives of this transition have not been widely studied. PURPOSE: This qualitative descriptive study aimed to describe Australian postgraduate Maternal, Child and Family Health nurse educators' perceptions of COVID-19 impacts on student knowledge of theory and practice, and lessons learned through their responses. METHOD: Semi-structured interviews were reflexively thematically analyzed. RESULTS: All participants recognized struggles, opportunities and innovations within three key themes: "We've learned how to be flexible": Grappling with COVID-safe teaching and assessment; "Chat rooms and Zoomland": Learning in a virtual community; and "We've had a few struggles": Clinical placement tensions. Educators described a sense of uncertainty, increased flexibility, opportunities for change and new ways of connecting. They adapted by developing new online resources and broadening clinical practicum and assessment requirements to address new practice approaches including telehealth. CONCLUSIONS: Rapidly changing practice requirements and concerns about risk of disease transfer between workplace and placement venues restricted placement opportunities. Educators learned and incorporated new skills and strategies into their teaching, while aiming to meet professional expectations and maintain quality of education. Some strategies are likely to be maintained for future education programs.

Consultation to review clinical placement processes: A quality assurance project.

AIM: Working in partnership is a key goal for nursing and community health practice. This case study reports the quality assurance process employed to enhance the process of allocating clinical places for postgraduate Maternal and Child Health nurses in Victoria, Australia. BACKGROUND: The review of the clinical placement process occurred because councils (placement providers) reported being overwhelmed with inquiries and applications for places, time-line issues and some confusion about processes. This situation was further compounded as these clinical placements were provided by Councils at no cost to universities or students. DESIGN: The Quality Assurance consultation process was guided by an action research approach and systematically explored the experience of municipalities hosting students. METHOD: This involved five discrete phases: Online survey 1, Focus group, Draft consultation report, Online survey 2 and Distribution of Maternal and Child Health clinical placement process packages. Feedback was reported regarding what was working well, challenges with existing student placements and suggested strategies to improve the student placement process. RESULTS: Collaboration led to improvements in the clinical placement process and produced key resources for stakeholders. An unexpected outcome of the process was the development of a List of Expectations and Responsibilities for all stakeholders. CONCLUSION: The councils providing MCH clinical experience are highly valued by the universities and their students as clinical placement is provided voluntarily as a contribution to the MCH profession. All parties indicated it was very beneficial to collaborate to optimise this process.

Diagnostic Accuracy of the Social Attention and Communication Surveillance-Revised With Preschool Tool for Early Autism Detection in Very Young Children.

Importance: Early identification of children on the autism spectrum is crucial to facilitate access to early supports and services for children and families. The need for improved early autism identification tools is highlighted by the lack of sufficient diagnostic accuracy in current tools. Objectives: To examine the diagnostic accuracy of the Social Attention and Communication Surveillance-Revised (SACS-R) and SACS-Preschool (SACS-PR) tools when used with a large, community-based, convenience sample and identify the prevalence of autism in this sample. Design, Setting, and Participants: This diagnostic accuracy study was conducted in Melbourne, Australia, training maternal and child health nurses who monitored 13 511 children aged 11 to 42 months using the SACS-R and SACS-PR during their routine consultations (June 1, 2013, to July 31, 2018). Children identified as being at high likelihood for autism (12-24 months of age: n = 327; 42 months of age: n = 168) and at low likelihood for autism plus concerns (42 months of age: n = 28) were referred by their maternal and child health nurse for diagnostic assessment by the study team. Data analysis was performed from April 13, 2020, to November 29, 2021. Exposures: Children were monitored with SACS-R and SACS-PR at 12, 18, 24, and 42 months of age. Main Outcomes and Measures: Diagnostic accuracy of the SACS-R and SACS-PR was determined by comparing children's likelihood for autism with their diagnostic outcome using clinical judgment based on standard autism assessments (Autism Diagnostic Observation Schedule-Second Edition and Autism Diagnostic Interview-Revised). Results: A total of 13 511 children (female: 6494 [48.1%]; male: 7017 [51.9%]) were monitored at least once with the SACS-R at their 12-, 18-, and 24-month-old routine maternal and child health consultations (mean [SD] age, 12.3 [0.59] months at 12 months; 18.3 [0.74] months at 18 months; 24.6 [1.12] months at 24 months) and followed up at their 42-month maternal and child health consultation (mean [SD] age, 44.0 [2.74] months) with SACS-PR (8419 [62.3%]). At 12 to 24 months, SACS-R showed high diagnostic accuracy, with 83% positive predictive value (95% CI, 0.77-0.87) and 99% estimated negative predictive value (95% CI, 0.01-0.02). Specificity (99.6% [95% CI, 0.99-1.00]) was high, with modest sensitivity (62% [95% CI, 0.57-0.66]). When the SACS-PR 42-month assessment was added, estimated sensitivity increased to 96% (95% CI, 0.94-0.98). Autism prevalence was 2.0% (1 in 50) between 11 and 30 months of age and 3.3% (1 in 31) between 11 and 42 months of age. Conclusions and Relevance: The SACS-R with SACS-PR (SACS-R+PR) had high diagnostic accuracy for the identification of autism in a community-based sample of infants, toddlers, and preschoolers, indicating the utility of early autism developmental surveillance from infancy to the preschool period rather than 1-time screening. Its greater accuracy compared with psychometrics of commonly used autism screening tools when used in community-based samples suggests that the SACS-R+PR can be used universally for the early identification of autism.

Victorian maternal and child health nurses' family violence practices and training needs: a cross-sectional analysis of routine data.

This study investigated maternal and child health (MCH) nurse family violence clinical practices, practice gaps and future family violence training needs. Descriptive analysis was conducted of routine data collected as part of a larger MCH nurse family violence training project conducted in 2018. A purposive sample of routine data (2017-18) was analysed from six Victorian metropolitan and four regional and rural areas that were experiencing high rates of violence, as indicated by police reports. Descriptive statistics and regression analyses were used to identify rates of nurse family violence screening, safety planning and referral, with practice differences analysed across locations. MCH nurses ask only one in two clients about family violence at the mandated 4-week postnatal clinic visit. Overall, metropolitan nurses screen for family violence at higher rates than rural nurses. Safety planning rates were low (1.3%), suggesting that screening is not translating to disclosure rates equivalent to state-wide prevalence (~14-17%) or police data. Nurse referrals are even lower (<1%), with practice differences noted across reporting systems. Despite data collection limitations, analysis of routine data shows significant gaps in nurse family violence screening and response practices. This evidence reinforces the need for systems changes to address family violence and other maternal health and social issues.

Working with families: A systematic scoping review of family-centred care in universal, community-based maternal, child, and family health services.

Children's long- and short-term health and developmental outcomes can be improved when families are engaged and supported, and inform care planning. Family-centred care (FCC) underpins policy directions for universal, community-based, child and family health services in the early years, although its implementation in this context is poorly understood. This systematic scoping review of the current literature aimed to improve understanding of FCC implementation in maternal, child, and family health universal services. Key databases and grey literature were searched using descriptors of maternal, child, and family health population and context, and FCC concept. Reference checking identified further literature for analysis. Thirteen included papers reported on nine studies from Australia, New Zealand, and the United Kingdom. Limited participant representation of fathers and diverse community members was evident. Deductive thematic analysis identified four areas of FCC demonstrated in this literature: respectful relationships, effective communication to foster shared understanding, flexible and contextualized care, and support for autonomy and agency. The literature demonstrated the interplay between organizational, professional, and recipient factors and their impact on the implementation of FCC. For successful FCC implementation, all these elements should be considered.

Maternal and Child Health nurse's preparedness to respond to women and children experiencing intimate partner violence: A cross sectional study.

BACKGROUND: Intimate partner violence victims regularly seek health care and support. Health care providers need to understand the complexities of partner violence and how to safely respond to clients. Policy guiding nurse identification and responses exist, yet practices and education are lagging. Maternal and Child Health nurses are required to address intimate partner violence, yet their knowledge and preparedness to undertake this work is under-explored. The most effective methods of provider training are unknown. OBJECTIVES: 1) To assess the level of Maternal and Child Health nurse intimate partner violence training and nurse preparedness to address partner violence and 2) compare group differences in preparedness by nurse location, role and level of training. DESIGN: A cross sectional research design. PARTICIPANTS: Australian community based Maternal and Child Health nursing workforce. METHODS: Online survey conducted in June 2018. Survey questions explored nurse characteristics, knowledge and 'preparedness' to complete intimate partner violence work and previous violence training. Descriptive analysis involved reporting proportions within categories. Proportional group differences were analysed using Chi square test of independence. Statistical significance was set at p < 0.05. RESULTS: Survey response rate was 65% (735/1125). Nurses feel well prepared to complete intimate partner violence practices, although differences were seen across groups. Rural nurses feel less prepared than metropolitan colleagues, especially conducting safety assessments and documentation. Nurse co-ordinators are the most prepared. A dose response relationship is seen between training and preparedness: nurses with greater (>10 h) and more recent training (within 5 years) report being more prepared for intimate partner violence work. CONCLUSIONS: Greater systems supports are needed for sustainable nurse intimate partner violence work. In particular, opportunities are needed for rural nurse training, delivered locally and tailored to rural needs and context. Nurse co-ordinators are key leaders to achieving sustained nurse intimate partner violence practices.

Australian parents' experiences when discussing their child's overweight and obesity with the Maternal and Child Health nurse: A qualitative study.

AIMS AND OBJECTIVES: To explore parents' experiences when discussing child overweight issues with the Maternal and Child Health nurse. BACKGROUND: Community-based child and family health nurses are in a unique position to discuss child overweight and obesity with parents. However, studies of parents' experiences in this context are lacking. METHOD: Ten mothers of children identified as overweight or obese from regional Victoria, Australia, were interviewed in 2017. Data were analysed using an inductive qualitative thematic approach. The COREQ guidelines were used to ensure study rigour. RESULTS: In summary, the analysis revealed experiences of Maternal and Child Health nurses "brushing over" the topic, with a lack of information provided about how to tackle the problem at home. The interpersonal relationship aspect of continuity of care was described as facilitating awareness of the child's overweight, although mothers expressed confusion about what constituted a "healthy weight range." While some mothers perceived the nurse's role was to offer evidence-based information and support, others saw the family doctor as the appropriate health professional to address the problem. CONCLUSION: The findings of this study indicate that parents are often left unsure how to manage their child's weight despite the child being identified as overweight or obese by their Maternal and Child Health nurse. RELEVANCE TO CLINICAL PRACTICE: Discussions about overweight and obesity may be facilitated by continuity of care where established relationships serve as a facilitator for effective communication. The findings further indicate a need for more structured support of Maternal and Child Health nurses working with parents of young children identified as overweight or obese, including ongoing education, skill development and improved understanding of parental health literacy and its links to childhood obesity.

Preceptor Education for Specialty Community-Based Nurses: A Pre- and Postevaluation.

BACKGROUND: Quality preceptorship is an integral aspect of nursing education. Evidence suggests that preceptor education programs can be designed to support RNs in their capacity as preceptors. Little has been reported on the effectiveness of preceptor programs for community-based nurses who provide primary health care for preschool children and their families. METHOD: The project evaluated the effectiveness of a 4-hour face-to-face tailored preceptor education program undertaken by 59 nurses in Victoria, Australia. Pre- and postsurveys were undertaken to evaluate the program. RESULTS: Participants had improved understanding of the role of preceptor after the education program. They had increased confidence in their ability to give feedback, assess clinical skills, and use the clinical assessment tool. They were also surer of the standard of performance expected of students. CONCLUSION: A strategically designed preceptor program was effective in improving some preceptorship skills of community-based nurses who supervise postgraduate nursing students. J Contin Educ Nurs. 2018;49(3):111-118.

Breastfeeding Support in the Early Postpartum: Content of Home Visits in the SILC Trial.

BACKGROUND: The Supporting breastfeeding In Local Communities (SILC) cluster randomized controlled trial evaluated whether a home visit focussed on infant feeding early in the postpartum period increased the percentage of infants breastfeeding at 4 months in low socioeconomic areas of Victoria, Australia. The visits were offered to women identified as at risk of early breastfeeding cessation after discharge home with a new baby. This paper describes the content of the home visits. METHODS: SILC visited 1,043 women from September 2012 to March 2013, and completed a data sheet for each visit documenting topics discussed, as well as what support and resources were offered. Frequencies and percentages are presented. RESULTS: Home visits most commonly included the provision of reassurance to women (91%). Topics discussed included general breastfeeding information (83%), supply and demand (83%), positioning (79%), and feeding frequency (78%). Newborn feeding/behavior (57%), expression of breastmilk (54%), nipple pain (41%), low breastmilk supply (41%), and the use of nipple shields (18%) were also prominent topics. The issues and support needs of women were similar across locations (rural, regional or metropolitan) and regardless of maternal parity or age. There was some variation in the resources suggested in different localities. CONCLUSIONS: New mothers require help and reassurance independent of whether this is their first or subsequent child, reinforcing the need for support, breastfeeding information, and education about normal neonatal behavior. Key aspects of support are reassurance, normalization of infant behavior, and education.

Attachment icebergs: Maternal and child health nurses' evaluation of infant-caregiver attachment.

Secure attachment of infants to their caregiver is important when promoting the emotional wellbeing and mental health of infants. Maternal and child health (MCH) nurses are well positioned to observe the quality of interactions between infants and caregivers and to assess and intervene. However, as yet there are no approved methods to assess the emotional and mental health of infants in community settings. A qualitative descriptive study of 12 MCH nurses in Victoria, Australia, using semi-structured interviews, was thematically analysed. The data revealed that nurses used many skills to identify and manage attachment difficulties. Key among these were observations of interactions, collaboration with caregivers and reflective practice. Assessments and interventions are also influenced by nurses' emotions, attitudes and workplace factors. An unexpected finding was that attachment markers can be likened to an 'iceberg': warning indicators at the tip can be easily observed by the nurse, while the less obvious underlying factors need to be explored in order to support attachment and improve infant mental health outcomes. Education for nurses should include concepts of attachment and link behaviours with emotional wellbeing.

Supporting breastfeeding In Local Communities (SILC) in Victoria, Australia: a cluster randomised controlled trial.

OBJECTIVES: Breastfeeding has significant health benefits for mothers and infants. Despite recommendations from the WHO, by 6 months of age 40% of Australian infants are receiving no breast milk. Increased early postpartum breastfeeding support may improve breastfeeding maintenance. 2 community-based interventions to increase breastfeeding duration in local government areas (LGAs) in Victoria, Australia, were implemented and evaluated. DESIGN: 3-arm cluster randomised trial. SETTING: LGAs in Victoria, Australia. PARTICIPANTS: LGAs across Victoria with breastfeeding initiation rates below the state average and > 450 births/year were eligible for inclusion. The LGA was the unit of randomisation, and maternal and child health centres in the LGAs comprised the clusters. INTERVENTIONS: Early home-based breastfeeding support by a maternal and child health nurse (home visit, HV) with or without access to a community-based breastfeeding drop-in centre (HV+drop-in). MAIN OUTCOME MEASURES: The proportion of infants receiving 'any' breast milk at 3, 4 and 6 months (women's self-report). FINDINGS: 4 LGAs were randomised to the comparison arm and provided usual care (n=41 clusters; n=2414 women); 3 to HV (n=32 clusters; n=2281 women); and 3 to HV+drop-in (n=26 clusters; 2344 women). There was no difference in breastfeeding at 4 months in either HV (adjusted OR 1.04; 95% CI 0.84 to 1.29) or HV+drop-in (adjusted OR 0.92; 95% CI 0.78 to 1.08) compared with the comparison arm, no difference at 3 or 6 months, nor in any LGA in breastfeeding before and after the intervention. Some issues were experienced with intervention protocol fidelity. CONCLUSIONS: Early home-based and community-based support proved difficult to implement. Interventions to increase breastfeeding in complex community settings require sufficient time and partnership building for successful implementation. We cannot conclude that additional community-based support is ineffective in improving breastfeeding maintenance given the level of adherence to the planned protocol. TRIAL REGISTRATION NUMBER: ACTRN12611000898954; Results.

Developmental surveillance of infants and toddlers by maternal and child health nurses in an Australian community-based setting: promoting the early identification of autism spectrum disorders.

Although signs of autism spectrum disorders (ASDs) are evident during the first year of life, few children are diagnosed prior to 3 years. The objective in this article is to highlight the role that primary health care professionals can play in the early identification of ASDs by briefly outlining the successful implementation of The Social Attention and Communication Study. Maternal and child health nurses were trained on the early signs of ASDs, which enabled them to identify these children prior to 2 years. The training procedure used will be outlined, and the early signs that were monitored will be explained in detail. It is recommended that routine monitoring for ASDs in infancy and toddlerhood become standard practice among all primary health care professionals.

Information and communication technology (ICT) use in child and family nursing: what do we know and where to now?

Whilst the use of information and communication technology (ICT) in acute care services has been well documented, less is known about the impact of computerising community-based primary care such as child and family health nursing services. This self-complete survey of 606 nurses working in the Victorian Maternal and Child Health (MCH) service (response rate 60%) found that the predominantly older workforce were confident with the use of ICT. This contrasts with findings from the acute sector where older nurses had lower ICT confidence. The survey revealed a variation in ICT support and a lack of data collection system compatibility. Professional education resources were not able to be effectively used in all locally supplied computers. Although MCH nurses have adapted well to computerisation, there is room for improvement. Appropriate resourcing, education and infrastructure support are areas that need to be addressed and would benefit from an overarching body responsible for development and quality assurance.