Examining the impact of trauma-informed cognitive behavioral therapy on perinatal mental health outcomes among survivors of intimate partner violence (the PATH study): Protocol for a feasibility study

Background: Intimate partner violence (IPV) is a pervasive public health problem, impacting the health and quality of life of survivors worldwide. The trauma of IPV is associated with a high incidence of mental illness, namely depressive and anxiety disorders, and posttraumatic stress disorder (PTSD). Moreover, literature endorses cognitive behavioral therapy (CBT) interventions as a gold standard for those with symptomatology consistent with anxiety disorders, mood disorders, and PTSD. However, efficacy has not been evaluated among a population of pregnant survivors of IPV. Objective: We present the protocol that will be used to explore the efficacy of trauma-informed cognitive behavioral therapy on maternal and child health outcomes for pregnant women with PTSD, depression, or anxiety symptomatology resulting from IPV. A secondary aim will be to test the validity and feasibility of study methodology to support the successful implementation of a full-scale randomized controlled trial. Methods: The Promoting Attachment Through Healing (PATH) study will use a mixed-methods approach grounded in an intersectional feminist framework to explore the effectiveness of trauma-informed CBT for pregnant survivors of IPV. Study participants will be recruited through the hospital-based Perinatal Mental Health Clinic (London, Ontario, Canada). A feasibility sample of 20 pregnant women (cohort 1) will be selected to engage in an eight-session antenatal CBT intervention facilitated by the program\u27s perinatal clinical nurse specialist, with evaluation at baseline, at two months postpartum (intervention and online questionnaire), and at six and twelve months postpartum (online questionnaire only). Concurrently, we will conduct a retrospective audit of 100 medical charts (cohort 2; 50 charts of perinatal women who received CBT and 50 charts of women who did not receive perinatal CBT) from the past five years. The efficacy of the intervention will be based on a reduction of mental illness symptomatology, improved maternal-infant attachment, maternal coping, and maternal quality of life. Additionally, the feasibility of the protocol and acceptability of the intervention from the women\u27s perspective will be examined. Inductive content analysis of all qualitative data will be used to determine common themes. Additionally, descriptive statistics, including measures of central tendency and dispersion, will be computed for all continuous variables. Alternatively, frequency tables will be constructed for all categorical variables. Results: The work reported here is in the proposal phase. Once the protocol is implemented, we will report the results in a follow-up paper. Participant recruitment for cohort 1 has started and we have finished data collection for cohort 2. It is anticipated that the results will be available by the end of 2018. Conclusions: Findings will assess the acceptability of the study methodology and protocol for a full-scale randomized controlled trial. Furthermore, if CBT is proven effective for pregnant survivors of IPV, this intervention could be readily adopted by health care and social support services, thereby contributing to an improved standard of care for this unique population

Exploring the characteristics and behaviors of nurses who have attained microcelebrity status on instagram: Content analysis

Background: Instagram is a social media platform that enables users to share images and videos worldwide. Some nurses have used Instagram to document their experiences as a nurse and have subsequently gained microcelebrity status-that is, a user who purposefully seeks to amass a substantive Web-based following and has become recognized as a niche area of interest. Objective: This study aimed to identify the characteristics and behaviors of microcelebrity nurses who act as influencers on Instagram and use their nursing profile to gain attention and presence on the Web. Methods: A qualitative, exploratory, nonparticipatory content analysis of media and text generated by a purposeful sample of 10 registered nurses who use Instagram and sustain a definable microcelebrity status was conducted. In this study, manifest and latent data were examined to gain an understanding of the characteristics and behaviors of nurses who have attained microcelebrity status on Instagram. Results: Data analysis revealed 5 themes of Instagram posts: (1) engaging Instagram users, (2) educational opportunities and insights, (3) nursing-related humor, (4) emotions experienced by nurses, and (5) media and narratives including patient details or work context. Messages were primarily positive in nature; however, multiple potential privacy, ethical, and professional issues were noted throughout the posted content. Conclusions: The findings of this study help to expand the current knowledge related to the use of social media platforms such as Instagram, especially in regard to the emergence of nurses who use this form of technology to achieve or maintain a microcelebrity status. This study calls for additional research on nurses\u27 attainment of microcelebrity status on social media as well as further policy development to adequately prepare nurses to navigate social media

Perceptions and Nursing Demands and Experiences in the Midst of an International Crisis (PANDEMIC): A Qualitative Study of Nurse Educators’ Experiences

The COVID-19 pandemic caused widespread disruption to nurse educators’ work, both within higher educational institutions and in clinical practice learning environments. In this study, we explored the experiences of nurse educators in academic and clinical settings during COVID-19 and the impact the pandemic has had on their work. We conducted semi-structured interviews with 15 nurse educators from six different countries and used thematic analysis to gain a comprehensive understanding of nurse educators experiences during the pandemic. The participants’ experiences were classified into stages that reflected the intensity of the pandemic and resulted in four themes: (a) the calm before the storm, (b) battening down the hatches, (c) weathering the storm, and (d) silver linings. Understanding challenges and supporting nurse educators throughout the pandemic is essential to maintaining appropriate nursing education in both academic and clinical settings. Résumé La pandémie de COVID-19 a perturbé le travail des infirmières enseignantes à tous les niveaux, à la fois dans les établissements d’enseignement supérieur et dans les environnements d’apprentissage de la pratique clinique. Dans le cadre de ce projet, nous nous sommes attardés aux expériences des infirmières enseignantes en milieux universitaire et clinique pendant la COVID-19 ainsi que l’impact de la pandémie sur leur travail. Nous avons mené des entrevues semi-structurées avec 15 infirmières enseignantes de 6 pays différents et utilisé une analyse thématique pour dégager une compréhension globale des expériences des infirmières enseignantes pendant la pandémie. Les expériences des participantes, déclinées en étapes qui reflétaient l’intensité de la pandémie, ont abouti à quatre thèmes : (a) le calme avant la tempête, (b) la fermeture des écoutilles, (c) la résistance à la tempête, et (d) les bons côtés. Comprendre les défis et soutenir les infirmières enseignantes tout au long de la pandémie furent essentiels au maintien de la formation en sciences infirmières à la fois en milieu universitaire et en milieu clinique

Criticai discourse analysis of policies impacting the intersection of health and experiences of intimate partner violence for rural women in Ontario, Canada

Introduction: Intimate partner violence (IPV) impacts approximately one quarter of Canadian women, and services provided to support women are heavily influenced by policy. Policy sets the stage and tone for action in all sectors. To date, there have been no critical discourse analyses examining how provincial, hospital, and women\u27s shelter policies intersect and impact women in rural communities. Methods: A critical discourse analysis using a case study of one rural community in south-western Ontario was undertaken by a multisectoral team of researchers using a critical, feminist, intersectional lens. The selected policies were (1) Domestic Violence Action Plan for Ontario (ODVAP), (2) the rural women\u27s shelter policy, and (3) the hospital policy. Results: The internal analysis of the policies revealed that ODVAP Rural and Remote Health rrh. org. au focused on societal solutions to violence requiring cross-sectoral cooperation with a focus on marginalized populations, whereas the rural shelter policy focused on creating a philosophical orientation to underpin their work with clients. There was no formal hospital policy related to the provision of services for women who have experienced violence. The policies revealed a disconnect between the stated goals and the specifics concerning how the policies would come together to achieve these goals. Obstacles such as having no clear link for how ODVAP and the shelter policy would work together, idealization of training but a lack of specificity on what training would be useful, and the requirement of affirmative action on the part of women to engage with services functioned as a means to maintain the status quo, that is, working in a siloed approach to care. Conclusions: Integrative systems are important for women who have experienced IPV given the wide range of health, social, and economic consequences of violence. Policy alignment is important for women who have experienced or are experiencing IPV, particularly in rural contexts where services are fraught with additional barriers

An agent based approach to the automation of risk management in IT projects

The failure of projects in the field of Information Technology (IT) is a common problem. The aim of this work was to analyse and suggest a programmatic solution to improving the success of project outcomes. This was achieved through analysis of project variables to identify and quantitatively evaluate the risks surrounding a project and suggest possible mitigations to the project manager. The solution makes use of agent-based systems to monitor project risks and recommend mitigations in response to changing project variables. A knowledge base of common risks and related mitigations was collected through research and a selection of industry professionals in the field of IT with a wide range of experience in various areas of IT. This was used to provide a set of real world test data of risk/mitigation mappings to allow the suggestion and ranking of project risks based on a set of quantitative measures of risk likelihood. An impact for the risk is set by the project manager which, when combined with the calculated likelihood, can allow the calculation of a risk priority. The solution implementation takes two forms; a management tool for the project manager and a monitoring tool, which makes the project statuses visible to all in the project to aid in communication among the project team and stakeholder management, which are two common factors of failure. The research results were positive and showed that the use of real world data in combination with an identified set of measures can identify risks and propose mitigations as well as facilitating communication improvement among project team members through the use of the website monitoring system. This encourages a clear and open approach to project, stakeholder and team management thereby increasing the likelihood of project success

A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety

Patients in intensive care units (ICUs) often receive sedation for prolonged periods. In order to better understand the impact of sub-optimal sedation practice on outcomes, we performed a systematic review, including observational studies and controlled trials which were conducted in sedated patients in the ICU and which compared the impact of changes in or different protocols for sedation management on economic and patient safety outcomes

The incidence of sub-optimal sedation in the ICU: a systematic review

Patients in intensive care units (ICUs) are generally sedated for prolonged periods. Over-sedation and under-sedation both have negative effects on patient safety and resource use. We conducted a systematic review of the literature in order to establish the incidence of sub-optimal sedation (both over- and under-sedation) in ICUs

Investigation of digital technology use in the transition to parenting: Qualitative study

Background: The transition to parenting—that is, the journey from preconception through pregnancy and postpartum periods—is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied. Objective: The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices. Methods: A qualitative descriptive study was conducted to understand new parents’ experiences with and uses of digital technology during 4 stages—prenatal, pregnancy, labor, and postpartum—of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents’ type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed. Results: A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: “Is this normal; is this happening to you?!”, “Am I having a heart attack; what is this?”, and “Anyone can put anything on Wikipedia”: Managing the Negative Impacts of Digital Information. Conclusions: Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers’ perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents

Experiences of At-Risk Women in Accessing Breastfeeding Social Support During the Covid-19 Pandemic

Background: With strict public health measures implemented in March 2020 due to the COVID-19 pandemic, many breastfeeding parents, who are within an at-risk population, have experienced limited formal and/or informal breastfeeding social support. In the Canadian context, the experiences of these women is unknown. Research Aim: To explore the experiences of at-risk postpartum breastfeeding women in accessing formal and informal breastfeeding social support during the COVID-19 pandemic. Methods: This was a prospective, longitudinal interpretive description study using mixed methods. Data were gathered using an online survey and one 52–112-min semi-structured interview at 12-weeks postpartum. At-risk breastfeeding participants were those who lack social support and had at least one of the following: age \u3c 25 years; experiencing or had experienced intimate partner violence; or of low income. We sought participants’ experiences of accessing breastfeeding social support during the first few months of the COVID-19 pandemic/lockdown. Seven participants completed the survey and the interview. Results: Participants identified that the COVID-19 pandemic created barriers to accessing formal and informal breastfeeding social support, which stemmed from public health restrictions and difficulties communicating online with families and healthcare providers. Additionally, participants identified that the COVID-19 pandemic/lockdowns facilitated feelings of connectedness, protection, and resiliency. Conclusion: We provide preliminary insight into the experiences of trying to access breastfeeding social support during the COVID-19 pandemic. Future researchers should seek to prioritize improved communication and resources in supporting breastfeeding during COVID-19 and future pandemics/lockdowns

Changes in care-a systematic scoping review of transitions for children with medical complexities

Background: Children with medical complexity (CMC) and their parents are affected physically and mentally during transitions in care. Coordinated models of care show promise in improving health outcomes. Objective: The purpose of this scoping review was to examine research related to CMC and their parents and transitions in care. The aim was 3-fold: (1) to examine the extent, range, and nature of research activity related to the impact of transitions on physical and mental health for CMC and their parents; (2) to summarize and disseminate research findings for key knowledge users; and (3) to identify research gaps in the existing literature to inform future studies. Methods: Twenty-three sources were identified through database searches and five articles met the inclusion criteria of CMC (multi-organ involvement or technology-dependent) (or parents of CMC) transitioning from hospital to alternate levels of care where outcome measures were physical or mental health-related. Results: Numerical analysis revealed substantial variation in methodological approaches and outcome measures. Content analysis revealed two themes for parents of CMC during this transition: (1) emotional distress, and (2) high expectations; and three themes for CMC: (1) improved health, (2) changes in emotion, and (3) disrupted relationships. Conclusion: The findings from this scoping review reveal for parents, transitions in care are fraught with emotional distress and high expectations; and for CMC there are improvements in quality of life and emotional health post-hospital to home transitions when collaborative models of care are available. This review serves as an early attempt to summarize the literature and demonstrate a need for further research