Perceptions of service providers and parents regarding improving outcomes of young children living in circumstances of disadvantage

Many children live in circumstances which make it difficult for them to develop the capacities needed to succeed later in life. Previous research has focused on determining the risk factors for impaired outcomes and on evaluating the impact of specific programs. There has been a lack of research exploring the wisdom of people at the grassroots level and across programs. This research asked service providers and parents to describe the challenges that are faced by families with young children living in circumstances of disadvantage, the barriers preventing participation in programs, and the strategies that would address these challenges and barriers. Three research approaches were incorporated into the design of this project; qualitative policy research, community-based participatory research, and knowledge transfer methodology. These approaches were applied in order to encourage the participation of community organizations, to produce information that would provide guidance to policy-makers, and to promote implementation of the strategies recommended by research participants. In Phase One, 28 service providers from 24 Regina programs were interviewed. In Phase Two, the results from the service provider interviews were presented to focus groups of target parents to obtain their feedback. This process served to acknowledge the expertise of the parents as those with firsthand experience of their own reality. The categories of challenges, barriers and strategies that were identified by participants were psychosocial (related to personal connections and mental well-being) and/or structural (concrete and tangible issues). Four themes emerged from these findings. First, interrelatedness and synergistic interaction among the social conditions faced by these families was evident. Second, instability was present at both familial and program delivery levels. Third, target families faced power imbalances from multiple sources. Finally, a lack of belonging or connectedness was experienced by families as a result of their circumstances of social exclusion. The results point to the need for policies to address the following areas: adequate household income, childcare, funding of non-government organizations, housing, and mental health and addictions. By presenting the views of people at the grassroots level, it is hoped that these research results will provide direction to policy-makers

Maternal, Newborn and Child Health Needs, Opportunities and Preferred Futures in Arusha and Ngorongoro: Hearing women's Voices.

With the approaching sunset on the Millennium Development Goals (MDGs), Tanzania continues with its final national push towards achievement of MDG #4 and MDG #5. The Mama Kwanza Socio-economic Health Initiative (MKSHI) was introduced in the hope of contributing to improving maternal, newborn, and child health in Arusha and Ngorongoro. The MKSHI project is a holistic, inter-sectoral approach to maternal, newborn, and child health which aligns with the Government of Tanzania's Vision 2025. At the project onset, a baseline assessment was conducted to launch ongoing benchmarking, monitoring, and evaluation of the project's impacts and implications. The aim of this baseline assessment was twofold. First it was to determine the state of maternal, newborn, and child health in the two project sites. Second it was to ensure that a baseline of key indicators was established as well as identification of unique indicators relevant to the populations of interest. The baseline study was a mixed methods approach to identify maternal, newborn, and child risk factors and indicators in the two target sites. This paper focuses on the qualitative methods and findings. The qualitative component included a series of five community dialogue meetings and thirty-seven individual/dyad interviews with women, providers, and stakeholders. Initially, community meetings were held as open dialogues on maternal, newborn, and child health issues, opportunities, and preferred futures. Individual/dyad interviews were held with women, providers, and stakeholders who held unique information or experiences. Both community dialogue and interview data was analysed for themes and guiding or critical comments. Three over-arching findings emerged: What took you so long to come? How do we know what you know? and How will it change for our daughters? Participant voices are vital in ensuring the achievement of local and global efforts and preferred futures for maternal, newborn, and child health services. This study contributes to the inclusion of women in all aspects of the planning, implementation, and delivery of maternal, newborn, and child health services in the target areas and beyond

Reflections on Study Abroad: Insights from Registered Nurses

Globalization has resulted in the increased internationalization of higher education with most universities hosting international students and sending domestic students on international learning experiences. As part of this trend, many undergraduate nursing programs offer study abroad clinical placements to promote cultural sensitivity and global citizenship. While there is an abundance of research evaluating student perceptions of specific international study abroad experiences soon upon their return, there is little research exploring longer-term perspectives of participants across a range of diverse international placement sites. To provide guidance for their study abroad program, a nursing school in western Canada gathered the perspectives of participants from the previous one to eight years. These currently practicing registered nurses had clinical placements in one of six countries across four continents between 2008 and 2015 as part of their undergraduate nursing education. In total 35 participants completed an online survey with 13 agreeing to an individual, semi-structured follow-up interview to elicit more detailed responses. The study was guided by Thorne’s interpretive description qualitative approach. The key beneficial features of their experience identified by the participants included cross-cultural learning, relationship building, and exposure to diverse health contexts. Narratives also captured challenges including cultural adjustment, financial burden, meeting placement and academic expectations, and issues of social injustice/inequality. The participants provided advice for the planning and delivery of international nursing clinical placements and recommended close curricular alignment between the course and placement site, faculty presence, and thorough student pre-departure preparation as essential components of study abroad nursing programs. The narratives highlighted the importance of faculty guidance to help participants move toward critical global citizenship by assessing their own beliefs and assumptions while considering the historical, sociocultural, economic, and political factors as well as other perspectives evident in the host placement context. Such transformational learning should be reinforced by the integration of social responsibility and global citizenship within undergraduate nursing curricula to ensure all nursing graduates are exposed to these critical worldviews. The findings provide guidance for the delivery of future international placements at this school of nursing and may help inform the design and implementation of similar programs. These registered nurses reinforced the value of study abroad as rich experiential learning opportunities that facilitate long-term cultural competence and a critical global nursing perspective. Résumé La mondialisation a entraîné une internationalisation accrue de l’enseignement supérieur, la plupart des universités accueillant des étudiants internationaux et soutenant la mobilité de ses propres étudiants pour une partie de leur formation à l’international. Suivant cette tendance, de nombreux programmes de premier cycle en sciences infirmières offrent des stages cliniques à l’international pour soutenir le développement de leur sensibilité culturelle et citoyenneté mondiale. Bien que plusieurs recherches portent sur les perceptions d’étudiantes peu après leur retour d’expériences spécifiques d’études à l’international, peu de recherches ont examiné la perspective à plus long terme des participantes à des stages dans divers contextes internationaux. Afin d’orienter son programme de stages à l’international, une école de sciences infirmières de l’Ouest canadien a recueilli le point de vue de participantes des dernières huit années. Celles-ci, désormais infirmières en exercice, avaient fait un stage clinique dans un de six pays répartis sur quatre continents, au cours de leurs études de premier cycle en sciences infirmières, entre 2008 et 2015. Au total, 35 participantes ont répondu à un sondage en ligne et 13 d’entre elles ont accepté de prendre part à un entretien individuel subséquent semi-dirigé afin d’approfondir leurs réponses. La recherche était guidée par l’approche qualitative de description interprétative proposée par Thorne. Parmi les plus grands avantages de l’expérience, identifiés par les participantes, notons l’apprentissage interculturel, la création de relations et l’exposition à divers contextes de santé. Les récits décrivaient aussi certains défis, dont l’adaptation culturelle, le fardeau financier, le respect des exigences à la fois du milieu de stage et du milieu de formation, ainsi que les questions d’injustice/ inégalité sociale. Les participantes ont formulé des recommandations pour la planification et la réalisation de stages cliniques internationaux en sciences infirmières, et ont jugé essentiels ces éléments pour tout programme de mobilité : un lien pédagogique étroit entre le cours et le milieu de stage, la présence d’un membre du corps professoral et la préparation minutieuse des étudiantes avant leur départ. Les récits soulignaient l’importance de l’encadrement professoral pour soutenir le développement des participantes vers une citoyenneté mondiale critique en analysant leurs propres croyances et idées préconçues, tout en tenant compte des facteurs historiques, socioculturels, économiques et politiques, ainsi que d’autres perspectives observées dans le milieu d’accueil du stage. Une telle expérience d’apprentissage transformationnelle devrait être consolidée par l’intégration des notions de responsabilité sociale et de citoyenneté mondiale dans le programme d’études de premier cycle en sciences infirmières, de sorte que toutes les diplômées soient exposées à ces visions du monde essentielles. Les résultats ont servi à orienter le format des prochains stages internationaux dans cette école de sciences infirmières et pourraient contribuer à la conception et à la mise en œuvre de programmes similaires. Ces infirmières en exercice ont réaffirmé l’importance des études à l’international comme étant de riches occasions d’apprentissage expérientiel, qui favorisent une intégration durable de la compétence culturelle et une perspective globale critique en sciences infirmières

Learning about population-health through a community practice learning project: An evaluation study.

Increasing student nurse numbers requiring community placement learning opportunities has led to insufficient numbers of community nurses being available to support student nurses in the community. Although the study presented in the article is based in the UK this issue is reported widely in the literature across the globe. Universities in many countries have had to find innovative ways of providing community health learning opportunities for student nurses. This article reports on how one university in the UK has approached this challenge through students engaging in a population-based study in the community through group work. A research study was undertaken into this innovation which found that the student nurses engaged well with the project and with their groups and undertaking the project had positive value and impact on them and their understanding of population-health. Issues that arose for them largely focused on unequal participation in the group work by some with many participants perceiving that they had done more work on the group project and presentation than others in their group. However, working in this way was perceived to be a good learning experience for the majority of participants

The experiences of student nurses on placements with practice nurses : a pilot study

To prepare the registered nurse of tomorrow in the United Kingdom (UK) to care for patients in general practice (GP)-led services, today's student nurses need to have the opportunity to experience placements with practice nurses to enable them to make positive career choices to become practice nurses in the future. The role of the practice nurse is described in the article. As a pilot project, seventeen students undertook placements with practice nurses in one of seven GP practices selected by the London GP Deanery and the university as having fulfilled the criteria to support student nurses in placements. A mentorship preparation programme was provided to prepare practice nurses for mentoring these students. An evaluation study was undertaken of this pilot project. Findings showed that students were highly positive about the experience; the majority rated this placement as being as good as or better than previous placement experiences. The evaluation also explored the impact on student learning and the value that the placement had. There was a positive impact on students' knowledge and skills in certain clinical areas especially related to health promotion. Students also indicated that they would like to have additional placements with practice nurses and would consider a career as a practice nurse in the future

The Psychosocial and Emotional Experience of Breastfeeding

Breastfeeding is acknowledged as optimal infant nutrition, yet despite high initiation rates, early cessation remains common. To understand why, we asked mothers in Western Canada how they felt about their breastfeeding experience. A total of 191 women (response rate 35%) responded to a survey distributed by public health nurses. While many women felt positive about their overall breastfeeding experience, others shared mixed or negative emotions. Several themes were evident: (a) Most women reported a variety of positive aspects beyond the health benefits, (b) lactation difficulties were commonly reported, and (c) diversity among the reflections highlights the uniqueness of each breastfeeding journey. The findings reaffirm the need for breastfeeding programs to holistically promote the range of positive aspects while providing realistic information on common challenges and strategies to overcome these. Mothers require individualized support that assesses psychosocial and emotional needs and offers encouragement, reassurance, and acknowledgment of the range of experiences

Maternal perceptions of breastfeeding and infant nutrition among a select group of Maasai women

Abstract Background Adverse health outcomes are higher among Maasai children in the Ngorongoro Conservation Area compared to other co-located ethnic groups and regions of Tanzania. The Mama Kwanza Socioeconomic Health Initiative, a Canadian-Tanzanian partnership delivering healthcare at clinics in this region, gathered perceptions of mothers regarding breastfeeding and infant nutrition in order to inform culturally sensitive, realistic, and effective health promotion efforts. Methods A qualitative description approach was used in interviewing 30 Maasai mothers of infants zero to six months of age to explore their infant feeding practices, beliefs, knowledge, and recommendations to support breastfeeding. A local research team was trained to conduct and transcribe the interviews and assist with data interpretation. Qualitative content analysis was used in analyzing the interview transcripts. Results Lactation is universal in this culture with all the mothers planning to breastfeed for at least one year and most having initiated breastfeeding within one hour of birth. Lactation skills and knowledge are passed down intergenerationally from the elder women. None of the infants less than six months were exclusively breastfed, with a variety of liquid and semi-solid supplements given. Mothers perceived their milk alone was nutritionally insufficient with maternal dietary deficiencies cited as a factor. Conclusions While there is a strong breastfeeding culture among the Maasai in Ngorongoro, intersectoral efforts are required to provide culturally respectful health education on the benefits of exclusive breastfeeding and to ensure the maternal dietary adequacy required to achieve this goal. The findings reinforce the importance of international health projects adapting health promotion initiatives to local realities and beliefs in efforts to improve maternal child health

Predictors and impact of trust on vaccine decisions in parents of 2-year-old children in Canada: findings from the 2017 Childhood National Immunization Coverage Survey (cNICS)

Abstract Trust is known to be an important factor in vaccine decisions for parents of young children, but there has been a lack of Canadian data measuring the determinants and impact of trust. Using data from the 2017 Canadian Childhood National Immunization Coverage Survey (cNICS), this study analyzed the relationships between sources that parents trust for vaccine information and demographics, parental knowledge, attitudes, and beliefs (KAB) and vaccine decisions (refusal, delay or reluctance) in parents of 2-year-old children who had accepted at least one vaccine for their child (n = 6125). The findings show that 83% of parents trust doctors for vaccine information; 70–80% trust pharmacists, PMH, nurses and HC/PHAC; 34% trust family and 23% trust friends and CAM HCPs. However, parents found to have poor or moderate KAB were less likely to trust doctors, nurses, pharmacists, PMH and HC/PHAC. Parents were also less likely to trust the PMH or HC/PHAC if they had high school education or less or trade/college education, or were widowed, separated, or divorced. Parents who had never been reluctant to vaccinate their 2-year-old child were over 2 times more likely to trust doctors, nurses, pharmacists, PMH and HC/PHAC while parents who trusted family and friends were less likely to delay or refuse vaccines. There was also significant regional variation within Canada, with parents from Quebec most likely to trust doctors, nurses, pharmacists, friends, PMH and HC/PHAC. Parents from the Territories were less likely to trust doctors, nurses and pharmacists, but more likely to trust family. Parents were less likely to trust doctors if they were from the Prairies, and pharmacists if they were from BC, and parents from the Prairies and BC were less likely to trust HC/PHAC. Parents from Ontario were less likely to trust family or friends, but more likely to trust the PMH. Tailored vaccine campaigns are needed to account for educational, marital, and regional differences across Canada to improve vaccine uptake