Remote provision of breastfeeding support and education: Systematic review and meta-analysis.

The Covid-19 pandemic has led to a substantial increase in remotely provided maternity care services, including breastfeeding support. It is, therefore, important to understand whether breastfeeding support provided remotely is an effective method of support. To determine if breastfeeding support provided remotely is an effective method of support. A systematic review and meta-analysis were conducted. Twenty-nine studies were included in the review and 26 contributed data to the meta-analysis. Remotely provided breastfeeding support significantly reduced the risk of women stopping exclusive breastfeeding at 3 months by 25% (risk ratio [RR]: 0.75, 95% confidence interval [CI]: 0.63, 0.90). There was no significant difference in the number of women stopping any breastfeeding at 4-8 weeks (RR: 1.10, 95% CI: 0.74, 1.64), 3 months (RR: 0.89, 95% CI: 0.71, 1.11), or 6 months (RR: 0.91, 95% CI: 0.81, 1.03) or the number of women stopping exclusive breastfeeding at 4-8 weeks (RR: 0.86, 95% CI: 0.70, 1.07) or 6 months (RR: 0.93, 95% CI: 0.85, 1.0). There was substantial heterogeneity of interventions in terms of mode of delivery, intensity, and providers. This demonstrates that remote interventions can be effective for improving exclusive breastfeeding at 3 months but the certainty of the evidence is low. Improvements in exclusive breastfeeding at 4-8 weeks and 6 months were only found when studies at high risk of bias were excluded. They are also less likely to be effective for improving any breastfeeding. Remote provision of breastfeeding support and education could be provided when it is not possible to provide face-to-face care.

Entering forbidden territory - Value conflicts of female Muslim student nurses providing personal care to male patients: A qualitative study.

BACKGROUND: Saudi Arabia is now facing a critical nursing shortage and is under considerable pressure to recruit more local nurses. However, attracting Saudi Arabian women into the nursing profession has traditionally been difficult due to religious and cultural barriers. OBJECTIVES: The study was designed to provide insights into the research participants' experiences or awareness of conflicts between professional nursing values and the dominant religious and cultural values of Saudi Arabia. DESIGN: The research took the form of a qualitative case study. SETTING: The study was conducted at a leading university in Saudi Arabia. PARTICIPANTS: The participants consisted of 24 female Muslim student nurses from the second and fourth years of study of the BSc Nursing degree and six female Muslim College of Nursing faculty members from the same university. METHODS: Data collection methods consisted of individual interviews and focus groups, and thematic analysis was used to analyse the data. The study used a theoretical framework based on Rokeach's (1973, 1979) theories of values and value change. RESULTS: All student participants were found to be experiencing conflicts between the nursing requirement to provide personal care to male patients, and their religious and cultural values relating to personal modesty. Faculty participants were aware of the presence of this value conflict, but it was not being formally acknowledged or addressed at the case study institution. The lack of official practice or policy guidance was found to be reinforcing the potential for the value conflict. Participants regarded religious values as fixed and mandatory, but cultural values as subject to change. CONCLUSIONS: It was concluded that awareness-raising initiatives and open discussion of value conflicts should be conducted by the university to help realign the participants' culturally influenced values with the requirements of nursing. The available Islamic guidance should also be used to clarify the institution's official position on the provision of personal care to male patients by Muslim female nurses and improve understanding of the nursing tasks acceptable within Islam.

An integrative literature review of student retention in programmes of nursing and midwifery education: why do students stay?

AIMS AND OBJECTIVES: The purpose of the review was to identify student characteristics and strategies in research studies investigating retention (why students stay) as opposed to attrition (why students leave) nursing and midwifery preregistration programmes. BACKGROUND: Retention in nursing and midwifery programmes is a serious international problem. Many governments are committed to diversifying both the student population and the health care workforce. This has led to higher education institutes in some countries offering places on nursing and midwifery programmes to students with non-traditional entry qualifications. There are suggestions that the policy of widening access has contributed to the challenges of retention in nursing and midwifery programmes. DESIGN: Integrative literature review. METHOD: Undertaken using electronic databases and specific search terms, 15 articles were identified and reviewed. The critical appraisal tools produced by CASP (2009) were used to evaluate the quality of the data. Findings from the identified research literature were analysed using qualitative content analysis. RESULTS: Two broad themes emerged from the analysis: Programme and Personal. Subthemes were identified in these that give clues as to why students stay: profession, support, student characteristics and family. CONCLUSIONS: Personal commitment and good support seem to be essential for students to remain on undergraduate programmes of nursing and midwifery. The term 'support' is rarely explicit and requires to be more clearly defined. Furthermore, studies reviewed fail to indicate clearly how to identify when students are most vulnerable and which interventions are most appropriate in different situations in supporting retaining students on programmes. RELEVANCE TO CLINICAL PRACTICE: Nursing and midwifery student retention is a political and professional problem. Collaboration between clinical placement providers, academic institutions, students and their families is required to address the issue. Illumination of factors that help students stay may help us devise interventions that prevent future students leaving.

Why students leave in the UK: an integrative review of the international research literature.

AIMS AND OBJECTIVES: The purpose of this integrative review of the literature was to find and review international research studies that explored student attrition to determine what is known about the topic and to identify gaps in the research with a view to addressing the situation in the UK. BACKGROUND: Attrition from nursing programmes is a serious problem in the UK. It is recognised as a complex phenomenon, not attributable to a single cause. Regardless of actual attrition rates and trends, departments of nursing are challenged to perform in a business-like manner. Consequently, every student lost to a programme of study equates to a financial penalty for the department and to the future workforce and community. DESIGN: Integrative review of the literature. METHOD: Using electronic databases and specific search terms, 18 articles were identified and reviewed. Findings from the identified international research literature were analysed using qualitative content analysis. RESULTS: Four broad themes that accounted for factors of relevance to attrition were identified: Social, Prediction, Programme and Personal. CONCLUSIONS: Retention studies are fraught with methodological problems. These include incomplete or inaccurate data and low response rates. Attrition early in programmes may be attributed to a failure to understand the roles of nurses in contemporary societies. This has led to dissatisfaction with programmes and academic failure, as students may underestimate the intellectual demands of their programmes. Attrition later in the programme may be attributed to a combination of personal factors that culminate in a personal crisis. RELEVANCE TO CLINICAL PRACTICE: The research literature suggests that stereotyping of nurses is a major factor in attrition. Both professions need to find ways of communicating contemporary roles to wider society.

Representations of rituals and care in perinatal death in British midwifery textbooks 1937-2004.

OBJECTIVE: to assess the evolution of attitudes and practices relating to perinatal loss through an analysis of British midwifery textbooks. DESIGN: a literature review of midwifery textbooks, written or edited by midwives, published in the UK after 1902, and a critical analysis of textbooks to determine the ideological and professional standpoints presented to readers. FINDINGS: the rhetoric and ritual relating to perinatal loss as portrayed in British midwifery textbooks has changed, with the most dramatic changes taking place in the past 30 years. Evidence to support the changes is largely anecdotal, and little reference is made to research relating to perinatal death. The 'dirty' elements of perinatal death relating to the decay that takes place in the baby's body after death are not addressed. The critique of psychological theory relating to loss is absent, as are alternatives to the model proposed by Kübler Ross. Cultural aspects of loss and bereavement are rarely addressed. KEY CONCLUSIONS: the review of midwifery textbooks suggests that an ideological shift has taken place in relation to perinatal loss. The changing demographic trends, and the shift of birth and death from home to hospital, have altered the expectations and experiences of parents and professionals. Midwifery textbooks provide readers with a prescribed and formulaic approach to perinatal loss. IMPLICATIONS FOR PRACTICE: the absence of information relating to the appearance of the dead baby, together with the lack of clinical exposure, may mean that midwives are unable to provide parents with appropriate information. The lack of reference to an evidence base that may conflict with the ideology presented in the midwifery textbooks leaves readers with an incomplete understanding of the professional issues relating to perinatal loss.