Midwives' experience of telehealth and remote care: a systematic mixed methods review.

INTRODUCTION: Increasing the midwifery workforce has been identified as an evidence-based approach to decrease maternal mortality and reproductive health disparities worldwide. Concurrently, the profession of midwifery, as with all healthcare professions, has undergone a significant shift in practice with acceleration of telehealth use to expand access. We conducted a systematic literature review to identify and synthesize the existing evidence regarding how midwives experience, perceive and accept providing sexual and reproductive healthcare services at a distance with telehealth. METHODS: Five databases were searched, PubMed, CINHAL, PsychInfo, Embase and the Web of Science, using search terms related to 'midwives', 'telehealth' and 'experience'. Peer-reviewed studies with quantitative, qualitative or mixed methods designs published in English were retrieved and screened. Studies meeting the inclusion criteria were subjected to full-text data extraction and appraisal of quality. Using a convergent approach, the findings were synthesized into major themes and subthemes. RESULTS: After applying the inclusion/exclusion criteria, 10 articles on midwives' experience of telehealth were reviewed. The major themes that emerged were summarized as integrating telehealth into clinical practice; balancing increased connectivity; challenges with building relationships via telehealth; centring some patients while distancing others; and experiences of telehealth by age and professional experience. CONCLUSIONS: Most current studies suggest that midwives' experience of telehealth is deeply intertwined with midwives' experience of the response to COVID-19 pandemic in general. More research is needed to understand how sustained use of telehealth or newer hybrid models of telehealth and in-person care are perceived by midwives.

Adverse Childhood Experiences and Depression: The Mediating Role of Resilience and Emotional Regulation.

The current study examined the mediating roles of resilience and emotional regulation in the association between childhood trauma and depressive symptoms among individuals who experienced adverse childhood experiences (ACEs). Data from 200 women aged 17 to 77 years who were psychiatric outpatients were collected using self-reported questionnaires assessing child adversity, depressive symptoms, resilience, and emotional regulation. A positive correlation was found between a subscale of the ACE-IQ and depression. Childhood trauma was associated with higher risk of depressive symptoms among participants with lower resilience (an association that was partly explained by resilience level [mediation]). Emotional regulation was not a significant mediator in the childhood trauma-depression association. Our findings indicate that resilience is a key mediator between childhood trauma and depression. Individuals who experienced childhood trauma may benefit from evidence-based interventions focused on strengthening resilience and improving coping strategies. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 45-54.].

Cortisol Regulation among Women Who Experience Suicidal Ideation during Pregnancy.

Background: Suicidal thoughts occur in up to one third of pregnant women. Suicidal ideation (SI) has been linked to hypothalamic-pituitary-adrenal (HPA) axis dysregulation in other populations and could underlie SI during pregnancy when the HPA axis undergoes gestational transformation. However, no studies have evaluated the HPA axis in prenatal suicide risk, including regulation of cortisol. We examined whether SI is associated with distinct features of cortisol regulation among women during the 3rd trimester of pregnancy. Methods: Sixty-four women completed measures of SI and provided 8 saliva samples across 2 consecutive days for cortisol assay. Three cortisol metrics were assessed in separate linear regression models (awakening response, diurnal slope, and area under the curve), along with selected covariates. Results: Women with SI (n=10) had a dampened diurnal cortisol slope in contrast to other women (ß = -.32, p =.005; ηp2 =.094). Cortisol levels decreased from waking to 45 minutes after waking (.33ug/dL to .27ug/dL) rather than increasing as found for women without SI (.38ug/dL to .51ug/dL). Their cortisol also rose from 4pm to sleep (.09ug/dL to .31ug/dL) in contrast to a decrease among women without SI (.12ug/dL to .09ug/dL; F = 6.26 (4,59), p=.015). Limitations: The small number of women with SI may have reduced the power to detect significant effects. Conclusions: Findings for women with SI differ from the expected pattern of cortisol secretion across the day and indicate circadian rhythm dysfunction. Further research can build on these results to clarify mechanisms underlying perinatal suicidality, with improved assessment and intervention targets as the goal.

Suicide Prevention Education for Psychiatric Inpatient Nurses in Egypt.

The completed suicide of a patient represents a critical event for any nurse who was in charge of or had some contact with the individual or their family. Nurses may blame themselves and experience feelings of worthlessness associated with their inability to prevent the patient's death. One way to prevent an attempted or completed suicide on the inpatient unit is to educate psychiatric nursing personnel in suicide prevention. The focus of the current article is to present and discuss the unique issues faced by nursing educators in Egypt and whether the education and training of nurses employed at a rural hospital in Egypt would be a useful step toward mitigating these high-risk behaviors and lethal actions. [Journal of Psychosocial Nursing and Mental Health Services, 58(5), 32-38.].