Nurses' and Midwives' Awareness of the Recommended Breastfeeding Practices During the Pandemic of COVID-19 and the Associated Factors in Jordan.

Introduction: The COVID-19-related restrictions imposed to reduce viral transmission have highlighted the need to support the importance of maternal breastfeeding. Clear guidelines for consistent practices across settings have been drawn up on the basis of the best available data. Emerging recommendations call to increase nurses' and midwives' awareness of these guidelines. Objective: This study aimed to explore nurses' and midwives' awareness of the recommended breastfeeding practices and associated factors in Jordan during the COVID-19 pandemic. Methods: An online descriptive cross-sectional design was adopted. This study was conducted in clinical settings representing Jordan's North, Middle, and Southern regions. One hundred seventy nurses and midwives were selected through a convenient sampling technique. Results: The mean total score of the awareness was 7.78 (SD = 1.60); 62.9% of participants were highly aware of the recommended breastfeeding practices. Nurses and midwives who were aware of the recommended breastfeeding practices during the pandemic of COVID-19 (90.7%) were more likely to perceive COVID-19 preventive measures as effective than those who were not aware of breastfeeding practices (74.6%) (χ2 = 7.886, p = .005), while work experience in years (χ2 = 8.966, p < .01) was significantly associated with awareness of the breastfeeding recommended practices. Conclusion: Most Jordanain nurses and midwives were highly aware of the recommended breastfeeding practices during COVID-19 pandemic. This awareness was positively associated with working experience and perceiving that the preventive measures of COVID-19 are effective. Educational programs for nurses and midwives about breastfeeding practice recommendations are necessary to help mothers obtain appropriate care and education.

Telehealth Care for Perinatal Depression in Immigrant and Refugee Women: A Scoping Review.

Immigrant and refugee women have higher rates of perinatal depression compared to native-born women. Innovative telehealth interventions provide opportunities for prevention and treatment of perinatal depression. However, little is known about telehealth for perinatal immigrant and refugee women with depression. The aims of this scoping review were to identify available literature addressing the use of telehealth care for perinatal depression in immigrant and refugee women, and to determine the content, mode of delivery, and outcomes of telehealth care when provided for this population. A systematic literature search from 2000 to July 2023 was conducted in six databases and grey literature. The initial search resulted in 988 articles which were screened for their titles and abstracts. Eighty-one full-text articles were reviewed, yielding five articles included in this review. One quantitative study (a feasibility descriptive study), three qualitative studies, and a commentary supported the user satisfaction and potential effectiveness of telehealth care, delivered via telephone and text messaging, in improving perinatal depression symptoms. This review revealed a dearth of data-based studies on the outcomes of telehealth care for perinatal depression among immigrant and refugee women. Collaboration among researchers, healthcare providers, and technology engineers is required to improve telehealth care for this population.

Quality of Life of Caregivers of Women Receiving Cancer Treatment in Turkey.

AIM: The study aims to explore the predictors of the quality of life of caregivers of women receiving cancer treatment in Turkey. METHOD: This study was conducted in a Medical-Oncology inpatient clinic of a University Hospital in Istanbul, Turkey, between February and June 2020. Descriptive data were collected from 128 family caregivers using caregiver and patient identification forms and the quality of life scale- family version. Bivariate analyses and multiple regression were used to analyze the data. RESULTS: The mean score of the quality of life was 4.41 (standard deviation=0.63). A backward multiple regression revealed that being female caregivers, increased time spent for care per day, and caring for women with metastatic cancer were factors associated with poor quality of life. CONCLUSION: Although caregiving responsibilities bring challenges to every caregiver, those who are at high risk for impaired quality of life during caregiving need further support in their caregiving to maintain quality of life. Further research should focus on finding solutions to better support caregivers who are experiencing impairment in their quality of life.

Trauma-informed care for perinatal women during the COVID-19 pandemic: A survey of nurses and midwives in Turkey.

OBJECTIVES: There is a paucity of evidence on the provision of trauma-informed care among nurses and midwives during the pandemic.Therefore, this online survey of Turkish nurses and midwives aimed to: describe reported maternal concerns and anxieties during the COVID-19 pandemic; and explore aspects of trauma-informed care for perinatal women during the COVID-19 pandemic (i.e., nurses' and midwives' knowledge, opinions, perceived competence, current practices, and implementation barriers). DESIGN: A cross-sectional descriptive survey design. SETTING AND PARTICIPANTS: A web-based survey conducted between June 2021 to December 2021. A total of 102 nurses and midwives comprised the final sample of this study. FINDINGS: The safety of COVID-19 vaccine was both the most common maternal concern (73%) and the most frequently noted maternal source of anxiety (79%) reported to nurses and midwives by perinatal women. Most nurses and midwives were knowledgeable of, held favorable opinion about, and perceived moderate competence in trauma-informed care. The most frequently provided practice was encouraging mothers to make use of their own social support system (82%). Time constrains and lack of resources were perceived as somewhat to significant barriers to providing trauma-informed care during the pandemic. CONCLUSIONS: Access to correct information related to COVID-19 vaccination is necessary to reduce maternal anxiety. Since perinatal nurses and midwives had favorable opinions concerning implementing trauma-informed care, successful strategies for mitigating the implementation barriers are essential to facilitate the provision of trauma-informed care during the pandemic.

Cigarette Smoking Cessation Counselling in Pregnant Smokers with Mental Illness/Substance Use Disorders.

Our objective was to determine if past-year mental illness and substance use disorders (SUD) among pregnant smokers predicted the probability of receipt of counselling for cigarette smoking cessation. A secondary analysis of data from the National Survey on Drug Use and Health 2016-2019 was conducted. We found that approximately 83% of pregnant smokers (N = 373) received screening for cigarette smoking, and 65% received cessation counselling. Having mental illness predicted the probability of receipt of counselling for smoking cessation in pregnant smokers (adjusted odds ratio [AOR]: 3.75; 95% confidence interval [CI]: 1.25-11.27). However, having SUD (alcohol [AOR: 2.30; 95%CI: 0.57-9.26] or illicit drug use [AOR: 1.32; 95%CI: 0.26-6.82]) or comorbid mental illness and SUD (AOR: 0.23; 95%CI: 0.03-2.03) was not associated with receipt of counselling for smoking cessation. Practice guidelines and policy initiatives are needed to reduce cigarette use and its related adverse health outcomes in pregnant smokers with SUD.

Predictors of cigarette smoking in pregnant women with substance use disorders.

BACKGROUND: Cigarette smoking is common among pregnant women with substance use disorders (SUD) and may contribute to more adverse health consequences for the infant than alcohol and illicit drug use. However, most studies focused on stopping illicit drug use and paid little attention to cigarette smoking in pregnant women with SUD. PURPOSE: To identify predictors of current smoking among pregnant women with SUD, given past-month psychological distress, alcohol use and illicit drug use, the receipt of past-year mental health and substance use treatment controlling for potential confounders. METHODS: Secondary analysis of cross-sectional data from the National Survey on Drug Use and Health (NSDUH) 2015-2019 was conducted. The NSDUH included 3,540 pregnant women aged 18-44 years; among them were 195 lifetime smokers with SUD. Multiple logistic regression modeling was used to examine the probability of prenatal smoking. RESULTS: Sixty-one percent of pregnant women with SUD reported current cigarette smoking. The likelihood of prenatal smoking increased with a higher level of past-month psychological distress (Adjusted Odds Ratio [AOR] 1.14; 95% Confidence Interval [CI]: 1.02-1.28), past-month illicit drug use (AOR: 5.68; 95% CI: 1.59-20.21), and past-year substance use treatment receipt (AOR: 5.73; 95% CI: 1.88-17.45). CONCLUSION: The receipt of substance use treatment markedly increased the probability of smoking in pregnant women with SUD. Treatment and policy initiatives are required to address and integrate cigarette smoking within other substance use treatment modalities for pregnant women with SUD.

Cigarette smoking cessation and mental health treatment receipt in a U.S national sample of pregnant women with mental illness.

OBJECTIVES: To (1) compare the probability of cigarette smoking cessation for pregnant women with and without past-year mental illness by the trimester of pregnancy; and (2) examine the association between the receipt of past-year mental health treatment and prenatal cigarette smoking cessation among pregnant lifetime-smokers with mental illness. METHODS: We conducted secondary analysis of data from the National Survey on Drug Use and Health (NSDUH) 2008-2014. The NSDUH included 2019 pregnant lifetime smokers aged 18-44 years, 528 of whom had a mental illness. We used multiple logistic regression to model the probability of prenatal cigarette smoking cessation. RESULTS: Pregnant lifetime-smokers with mental illness had a lower rate of cigarette smoking cessation than women without mental illness (47.9% vs. 61.7%, p = 0.001). Compared to pregnant women without mental illness, pregnant women with mental illness had a significantly lower odds of smoking cessation in the first trimester (Adjusted Odds Ratio [AOR]: 0.34, 95% Confidence Interval [CI]: 0.18-0.66), but not in the second (AOR: 0.87, 95% CI: 0.46-1.63) and third trimesters (AOR: 0.94, 95% CI: 0.51-1.72). The likelihood of quitting smoking did not differ significantly for pregnant lifetime-smokers with mental illness who received and did not receive mental health treatment (AOR: 1.69, 95% CI: 0.87-3.28). CONCLUSION: Pregnant lifetime-smokers with mental illness are less likely to quit smoking than those without mental illness; overall, pregnant women tended to quit smoking as they progressed in their pregnancy. The receipt of mental health treatment was not associated with quitting smoking. Mental health care providers need to screen for cigarette use among pregnant women and strengthen smoking cessation efforts. CLINICAL RELEVANCE: Pregnancy presents a unique opportunity for mental health care providers to screen for cigarette use in women with mental illness and support their smoking cessation efforts.

Perceived barriers to mental health and substance use treatment among US childbearing-aged women: NSDUH 2008-2014.

This study compared and contrasted perceived barriers to mental health and substance use treatment among pregnant and non-pregnant women from 2008-2010 to 2011-2014. A trend study was conducted using secondary data from the National Survey on Drug Use and Health 2008-2014 from a propensity score-matched sample of pregnant (n = 5,520) and nonpregnant women (n = 11,040) aged 18 to 44 years. The most frequently perceived barriers to mental health treatment among all women ranked similarly in 2008-2010 compared to 2011-2014: cost (45.2% vs. 50.6%), opposition to treatment (41.9% vs. 41.4%), and stigma (28.2% vs. 24.7%). The rank order of barriers to substance use treatment in 2008-2010 among all women was cost (38.7%), stigma (18.2%), and time/transportation limitations (17%), whereas in 2011-2014, stigma ranked first (35.5%), followed by cost (25.9%) and time/transportation limitations (22.2%). In 2011-2014, the women were significantly more likely than women in 2008-2010 to report not knowing where to go (8.2% vs. .9%, p = .003) and a lack of substance use treatment programs (17.7% vs. 3.0%, p = .014). Perceived barriers to mental health treatment did not change overtime; however, there was a decrease in reported availability of substance use treatment programs between 2008-2010 and 2011-2014.

Knowledge of and Perceived Competence in Trauma-Informed Care and Attitudes of NICU Nurses Toward Mothers of Newborns With Neonatal Abstinence Syndrome.

OBJECTIVE: To explore how knowledge of and perceived competence in trauma-informed care inform the attitudes of NICU nurses toward mothers of newborns with neonatal abstinence syndrome (NAS). DESIGN: A cross-sectional survey study. SETTING: A southern U.S. metropolitan children's hospital with 145 NICU beds. PARTICIPANTS: Convenience sample of 150 NICU nurses. METHODS: Participants completed an online survey questionnaire adapted from the Attitudes About Drug Abuse in Pregnancy questionnaire and the Trauma-Informed Pediatric Care survey. Participants also responded to one open-ended question about their experiences in working with mothers of newborns with NAS. We used descriptive and inferential statistics and content analysis to analyze the survey data. RESULTS: Participants demonstrated low to moderate knowledge about and perceived competence in trauma-informed care and showed more judgmental attitudes toward mothers of newborns with NAS. Level of knowledge about mothers with substance use disorder and perceived competence in trauma-informed care were associated with participants' attitudes toward mothers of newborns with NAS. Emergent themes from qualitative data included the following: Mother-Newborn Dyads Shape Nurses' Judgmental Attitudes, Caring for Mothers of Newborns With NAS Is a Challenging Experience, and Need to Refine Care for Mothers Through Intra- and Interdisciplinary Collaboration. CONCLUSION: NICU nurses need further education about mothers of newborns with NAS. Improved knowledge about these women and adaptation of the principles of trauma-informed care may influence NICU nurses' judgmental attitudes toward mothers of newborns with NAS.

Depression, Anxiety, and Substance Use Disorders and Treatment Receipt Among Pregnant Women in the United States: A Systematic Review of Trend and Population-Based Studies.

The objective of this systematic review was to synthesize findings of trend and population-based studies on depression, anxiety, and substance use disorders and treatment receipt among pregnant women in the United States. Twenty-eight articles (nine trend studies and 19 population-based studies) were included for review. Two trend studies showed that illicit drug use disorder increased in pregnant women over the past decade, particularly opioid and marijuana use disorders. Three studies reported an increase in treatment admissions for these disorders from 1992 to 2012; however, the overall treatment admission rate for pregnant women remained relatively stable at 4%. Three studies identified an increase in antidepressant use from 1995 to 2010 in pregnant women. Nine of 19 population-based studies revealed that White ethnicity, older reproductive age, college education, and health insurance coverage were associated with mental health and substance use treatment receipt among pregnant women. Further studies are warranted among a nationally representative sample of pregnant women.

Trends in mental health and substance use disorders and treatment receipt among pregnant and nonpregnant women in the United States, 2008-2014.

PURPOSE: To compare trends in mental health and substance use disorders and treatment receipt of pregnant and nonpregnant women from 2008 to 2014. METHODS: Using data from the 2008-2014 National Survey on Drug Use and Health, logistic regression was used to compare trends in mental health and substance use disorders and treatment receipt for mental health and substance use disorders among propensity score-matched groups of pregnant (n = 5520) and nonpregnant women (n = 11,040). Among women in the matched sample who met criteria for at least one mental illness, trends in mental health treatment receipt of pregnant (n = 1003) and nonpregnant women (n = 2634) were compared. RESULTS: There were no differences in the trends by pregnancy status from 2008 to 2014. Past-year anxiety disorder, past-month psychological distress and illicit drug use disorder increased in the total sample from 2008 to 2014, yet trends in mental health treatment and unmet need for substance use treatment did not change over time. Pregnant women had lower odds of mental illness, but those who had mental illness were less likely to receive mental health treatment than their nonpregnant counterparts. CONCLUSIONS: There is a need for preventive strategies addressing anxiety disorder, psychological distress and illicit drug use among women of childbearing age as well as initiatives to increase access to mental health treatment among pregnant women.

Racial/ethnic differences in mental health treatment among a national sample of pregnant women with mental health and/or substance use disorders in the United States.

OBJECTIVE: To examine racial/ethnic differences in the receipt of mental health treatment among pregnant women with mental health (i.e., depression and serious psychological distress) and/or substance use disorders. METHOD: Secondary analysis of data from the National Survey on Drug Use and Health was conducted. The sample consisted of 1232 pregnant women with mental health/substance use disorders. RESULTS: Black/African American (Adjusted Odds Ratio [AOR]: 0.36, 95% Confidence Interval [CI]: 0.17-0.75), other non-Hispanic (AOR: 0.24, 95% CI: 0.11-0.52), and Hispanic (AOR: 0.42, 95% CI: 0.22-0.81) pregnant women had significantly lower odds of mental health treatment receipt compared to Whites, even when controlling for age, education, marital status, number of children, employment status, income, health insurance, county urbanicity, self-rated health status, type of mental health condition, and time. There were no racial/ethnic differences by mental health and/or substance use disorders. Among pregnant women who perceived unmet mental health treatment need (N = 299), a greater proportion of White compared to Non-White pregnant women perceived cost as an obstacle to access treatment (62.1% vs. 35.6%, p = .001); however, the two groups did not differ in other perceived barriers to mental health treatment (i.e., opposition to treatment, stigma, time/transportation limitation, and not knowing where to go). CONCLUSIONS: Strategies are needed to increase access to mental health treatment among racial/ethnic minority women who are pregnant and have mental health/substance use disorders. Further studies are required to understand racial/ethnic differences in the perceived barriers to mental health treatment.

The Lived Experience of Jordanian Parents in a Neonatal Intensive Care Unit: A Phenomenological Study.

BACKGROUND: Many international studies in the field of neonatal nursing have identified parental stress, coping difficulties, support issues, and various other experiences that are related to the birth of a preterm infant. However, no studies have assessed the interrelated issues of parental stress, social support, satisfaction, and nursing support in neonatal intensive care units (NICUs) in Jordan. PURPOSE: This study describes the lived experiences, needs in relation to care, and support systems of parents whose neonates were admitted to the NICU. METHODS: A qualitative design using a phenomenological approach was used to explore the experiences of Jordanian parents who gave birth to neonates in the NICU setting. Participants were recruited from the NICUs of government, teaching, and private hospitals. Data were collected using semistructured interviews that were conducted with parents in a suitable place. Ten participants were interviewed: eight mothers and two fathers. After interviews were transcribed, the methodology suggested by van Manen (1990) was used to analyze the data. RESULTS: The shock, worry, and anxiety experienced by parents; the influences of NICU admission on the experiences of parents and families; the information and assistance required and received by parents from healthcare professionals; and the emotions and satisfaction of parents were the main themes that emerged from the study to reflect the lived experience of parents of neonates in the NICU. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The parents in this study were satisfied with the healthcare process in the NICUs, even when this care did not fulfill their expectations or needs for their infants. Nurses in the NICUs must develop interventions and strategies that minimize the stress experienced by parents and that support the emotional capacity of parents to deal with this stressful situation.

Impact of psychosocial status and disease knowledge on deferoxamine adherence among thalassaemia major adolescents.

This cross-sectional study aimed to explore the relationship between psychosocial status, disease knowledge and adherence to deferoxamine treatment in adolescents with thalassaemia major. A purposive sample of 36 adolescents with transfusion dependence, ages 12-19 years, was recruited. A semi-structured interview and two structured questionnaires were used. In this sample, 56% were low adherence and 36% were psychologically impaired. Statistically significant factors associated with psychological impairment were: adolescents more than 16 years; low deferoxamine adherence; mean ferritin more than 2500 µg/L; family size more than six; family income equal or less than 350 Jordanian dinar and having sibling with thalassaemia. Additionally, adolescents with high level of knowledge had significantly lower scores on Pediatric Symptom Checklist.

Nursing students evaluation of problem based learning and the impact of culture on the learning process and outcomes: a pilot project.

PURPOSES: This study evaluates students' learning experiences in a clinical pediatric nursing course adopting Problem Based Learning (PBL) and investigates how students' cultural background impacts on self directed learning. METHODS: A mixed-methods approach combining quantitative and qualitative methods was utilized to answer the research objectives. An observational technique for the PBL teaching sessions was employed; and 226 third-year students were asked to complete PBL evaluation questionnaire. RESULTS: Fifty seven percent (n = 130) responses to the questionnaire were analyzed. Overall, students considered PBL to be moderately effective in their learning experience, with a mean of 3.64 (S.D = 1.18). Students qualitative responses fell within four thematic categories including: developing cognitive abilities, independent learning, motivation to learn, and group learning. Difficulties encountered by students were: it is time-consuming, it has unclear objectives, it is a stressful process, and it results in an increased workload. A small number of students indicated that PBL tutorials were boring and complained about lack of contribution from instructors and limited recourses. Learning is intertwined with culture; students' previous educational experiences, uncertainty, English language proficiency, computer resources, gender, and achievement were identified as the most important cultural issues that impact the learning process and outcomes. CONCLUSION: Successful implementation of PBL does not come easily; teachers should be alert to the issues of culture in designing curriculum.