Using action research to develop midwives' skills to support women with perinatal mental health needs.

AIMS AND OBJECTIVES: The aim of the research was to identify and develop midwives' skills to support women with mental health needs during pregnancy, using an action research approach. BACKGROUND: A review of perinatal mental health services in a large Dublin maternity unit revealed a high number of referred women who 'did not attend' the perinatal mental health service with few guidelines in place to support midwives in identifying and referring women for specialist help. DESIGN: Action research using cooperative inquiry involved a mental health nurse specialist and a team of midwives, who were drawn to each other in mutual concern about an area of practice. METHODS: Data were gathered from three Cooperative Inquiry meetings, which incorporated one main Action Research Cycle of constructing, planning, taking and evaluating action. Data were analysed using a thematic content analysis framework. RESULTS: Participants experienced varying levels of uncertainty about how to support women with perinatal mental health needs. Cooperative inquiry supported participants in making sense of how they understood perinatal mental health and how they managed challenges experienced when caring for women with perinatal mental health issues. Participants developed a referral pathway, highlighted the significance of education to support women with perinatal mental health issues and identified the value of using open questions to promote conversation with pregnant women about mental health. CONCLUSIONS: Midwives value education and support to identify and refer women at risk of perinatal mental health issues. Cooperative inquiry, with a focus on action and shared reflection, facilitated the drawing together of two professional groups with diverse knowledge bases to work together to develop practice in an area of mutual concern. RELEVANCE TO CLINICAL PRACTICE: Perinatal mental health is a significant public health issue and midwives need support to make psychosocial assessments and to negotiate access to specialist services where available and when required.

Human resources: a common-sense discipline.

Being able to hire the right team members, keeping them engaged ina professional and productive environment, and avoiding litigation help keep the team functioning and meeting the everyday goals of providing quality patient care. Although these topics may seem complex, medical providers and professionals have resources available to them, such as the Human Resources department, the Medical Director, senior management,and legal counsel. Hiring the right people, creating a positive work environment, and avoiding litigation are all common sense principals that are relevant regardless of profession, industry, or company. Understanding how to apply the principles and concepts of Human Resources and personnel management can seem overwhelming: however, asking for help from the resources mentioned previously and applying the common sense information found in this article will help one to be a successful leader and practitioner.

Integrating observational and experimental approaches to demonstrate causation in stream biomonitoring studies.

Routine biomonitoring of aquatic ecosystems generally is performed with the intent of demonstrating a causal relationship between stressors and responses. However, because it is impossible to eliminate other potential explanations for observed spatiotemporal correlation between stressors and responses, demonstrating causal relationships is highly tenuous in descriptive studies. In this research we show how results of descriptive and experimental approaches can be integrated to demonstrate a causal relationship between heavy metals and benthic community responses in a Rocky Mountain stream (CO, USA). By using a stressor identification process, we show that effects and exposure data collected from a contaminated site (Arkansas River, CO, USA) can be integrated with experimental data to support causal arguments. Analysis of the spatial co-occurrence of metals and benthic community responses in the Arkansas River provided support for the hypothesis that metals caused alterations in benthic community structure. Exposure pathways were quantified by measuring metal bioaccumulation in caddisflies (Trichoptera) collected upstream and downstream from metal inputs. A long-term (10-year) monitoring study showed that reductions in metal concentrations corresponded with improvements in benthic communities. These results were supported by microcosm and field experiments that quantified concentration-response relationships between heavy metals and benthic community composition. Consistency of these responses was demonstrated by comparing results to a spatially extensive survey of metal-polluted streams in Colorado. Our study demonstrates the power of integrating descriptive and experimental approaches for developing causal arguments in ecological assessments.