Biomedical subjects

Debra Creedy

Publications and source records attributed to Debra Creedy.

16 recordsLinked to original sources

PubMed2005

Effectiveness of a counseling intervention after a traumatic childbirth: a randomized controlled trial.

UNLABELLED: Adverse childbirth experiences can evoke fear and overwhelming anxiety for some women and precipitate posttraumatic stress disorder. The objective of this study was to assess a midwife-led brief counseling intervention for postpartum women at risk of developing psychological trauma symptoms. METHOD: Of 348 women screened for trauma symptoms, 103 met inclusion criteria and were randomized into an intervention (n = 50) or a control (n = 53) group. The intervention group received face-to-face counseling within 72 hours of birth and again via telephone at 4 to 6 weeks postpartum. Main outcome measures were posttraumatic stress symptoms, depression, self-blame, and confidence about a future pregnancy. RESULTS: At 3-month follow-up, intervention group women reported decreased trauma symptoms, low relative risk of depression, low relative risk of stress, and low feelings of self-blame. Confidence about a future pregnancy was higher for these women than for control group women. Three intervention group women compared with 9 control group women met the diagnostic criteria for posttraumatic stress disorder at 3 months postpartum, but this result was not statistically significant. DISCUSSION: A high prevalence of postpartum depression and trauma symptoms occurred after childbirth. Although most women improved over time, the intervention markedly affected participants' trajectory toward recovery compared with women who did not receive counseling. CONCLUSIONS: A brief, midwife-led counseling intervention for women who report a distressing birth experience was effective in reducing symptoms of trauma, depression, stress, and feelings of self-blame. The intervention is within the scope of midwifery practice, caused no harm to participants, was perceived as helpful, and enhanced women's confidence about a future pregnancy.

Adult↗

PubMed2005

Read, Think, Do!: a method for fitting research evidence into practice.

AIM: This paper discusses a process for research utilization that overcomes well-known barriers in order to influence clinical decision-making and practice change. Read, Think, Do! is a problem-solving approach to research utilization and practice development which has the potential to overcome barriers to research utilization. BACKGROUND: Any process for research utilization at the practice level needs to overcome numerous barriers in order to influence clinical decision-making and practice change. Access to research-based knowledge is an obvious first step in the evidence-based approach to care delivery, but is clearly inadequate alone in influencing the improvement of practice. DISCUSSION: Read, Think, Do! acknowledges the complexity of problem-solving processes from the outset by looking for (1) the evidence, (2) assessing the value to practice, and (3) addressing the social and cultural milieu of the practice setting to ascertain the best strategies for initiating and sustaining practice change. This approach draws distal forms of empirical knowledge that have the capacity to improve patient outcomes into the proximal knowledge base of the clinical nurse. This is achieved by collaboration, planning and evaluation involving all levels of staff and a specialist facilitator, the Clinical Nurse Consultant in evidence-based practice. CONCLUSION: Read, Think, Do! is a method of research utilization and practice development that has the potential to overcome barriers to research utilization and avoid the "misplaced concreteness" that can occur when trying to fit empiricism into practice. By addressing the breadth and diversity of issues surrounding research utilization in a systematic manner it presents a sustainable method for practice change informed by evidence.

Decision Making↗

PubMed2005

An investigation of aged care mental health knowledge of Queensland aged care nurses.

Older people are at risk for developing psychiatric disorders and require highly skilled and knowledgeable nurse practitioners to provide early recognition and intervention of psychiatric problems. This study sought to identify the aged care mental health knowledge of registered nurses (RNs) employed in long-term aged care and test the validity and reliability of a North American tool for use in an Australian context. The Mary Starke Harper Ageing Knowledge Exam (MSHAKE) was sent to RNs (n = 350) in 70 long-term care facilities (LTCF) in Queensland, Australia, and 107 surveys were returned (30.5% response). Participants were found to be unprepared for the reality of caring for the mental health needs of an older population and to have knowledge deficits related to suicide, prevalence of mental illness, mental health and ethnicity, and a number of issues regarding dementia.

Adult↗

PubMed2004

Violence towards emergency department nurses by patients.

Emergency department (ED) violence is a significant problem in many hospitals. This study identified the incidence of violence by patients towards nurses in two EDs. Patient factors related to violence were identified and the circumstances surrounding the violent incident were described. Of the 71 ED nurses who participated, 50 (70%) reported 110 episodes of violence in a five-months period. That is approximately five violent incidents per week. Violence was reported most often on evening shifts (n=41, 37%). The nurses' perceived that the perpetrators of violence were under the influence of alcohol (n=30, 27%) and drugs (n=27, 25%) and displayed behaviours associated with mental illness (n=42, 38%). Nurses in this study were sworn at (n=67, 61%), pushed (n=11, 10%), hit (n=3, 3%), and kicked (n=3, 3%). Identification of trends and patterns of violence is necessary so that better health care planning and service provision as well as effective preventative and safe strategies for nurses in the workplace can be implemented.

Adult↗

PubMed2004

Content and processes of postpartum counseling after a distressing birth experience: a review.

BACKGROUND: A distressing birth experience can produce debilitating symptoms of psychological trauma; however, little is known about the content and processes of counseling interventions to relieve trauma symptoms. This review identifies and examines common content and processes of postpartum counseling interventions to address trauma symptoms following childbirth. METHOD: A search of major databases (Cinahl 1982-2003; Cochrane 2003; Embase; Proquest; Psychlit; Pubmed/Medline 1966-2003; Sociofile) was conducted, using combinations of the key words of "childbirth,""postpartum,""posttraumatic stress disorder,""anxiety,""trauma,""stress,""debriefing," and "counselling" or "counseling." Identified content and processes were clustered through a thematic analysis. RESULTS: Nineteen publications were retrieved. Counseling strategies provided women with opportunities to talk about their birth experience, express feelings about what happened, have questions answered, address gaps in knowledge or understanding of events, connect the event with emotions and behavior, talk about future pregnancies, and explore existential issues. CONCLUSIONS: Descriptions of postpartum counseling and debriefing are generalized and nonspecific; they provide minimal direction for postpartum counseling models, lack necessary detail for replication, may require psychotherapeutic training and therefore be unsuitable for use by caregivers, and are often based on opinion with little empirical evaluation. Few studies have tested specific counseling interventions on a range of maternal outcomes. Further research is needed to develop counseling models for use by health professionals with women who report a distressing birth experience.

Counseling↗

PubMed2004

Mental health knowledge in residential aged care: a descriptive review of the literature.

Health care staff knowledge of mental health is vital in the provision of quality care for older people in residential aged care settings. This paper aims to describe mental health knowledge competence of health care staff in residential aged care through a review of existing literature and to explore the link between knowledge, attitudes and education about older people and mental health. A literature review was conducted using electronic databases and library catalogues to identify articles published in English during the period 1982-2002. There is insufficient evidence within the literature to draw conclusions about staff knowledge levels in relation to mental health, however, the literature identified a link between continuing education, knowledge levels and staff attitudes to older people with mental health disorders. Future studies are needed to investigate existing levels of mental health knowledge among health care staff in residential aged care and to identify and evaluate strategies to enhance their ability to provide care for this population.

Aged↗

PubMed2004

Midwives' knowledge of newborn feeding ability and reported practice managing the first breastfeed.

Continuous uninterrupted skin-to-skin contact is known to facilitate newborn transition to extrauterine life, the ability to actively find the nipple and establishment of effective breastfeeding but is not promoted consistently in practice. The Newborn Feeding Ability Questionnaire (NFAQ) was developed to measure midwives' knowledge and practice in supporting the first breastfeed. The NFAQ was administered to 3 500 midwives in Australia through a mailed survey. A response rate of 31.6% (n=1 105) was achieved and the sample was representative of the national midwifery population for age sex, education and experience. Mean total score for knowledge was 85.94 (range 40-110 out of 110), SD=10.55) and mean practice score was 95.89 (range 57-117 out of 120), SD=9.19). Knowledge of newborn feeding ability was consistently associated with best practice in managing the first breastfeed. Almost all midwives reported that skin-to-skin contact for newborn infants immediately after birth was important, but few understood the significance of 'continuous uninterrupted' skin-to-skin contact to facilitate correct attachment and effective suckling. One-third reported separting mother and baby for routine interventions before allowing the opportunity to demonstrate pre-feeding behaviour or actually breastfeed. Although midwives attempt to ensure the first breastfeed is facilitated soon after birth, the practice of continuous uninterrupted skin-to-skin contact seems poorly understood and not uniformly practised. Further research is needed to investigate how midwives teach mothers' positioning and attachment for the first breastfeed. Education of midwives so they can optimally facilitate the first breastfeed is required to improve breastfeeding initiation rates.

Australia↗

PubMed2003

Traditional postpartum practices among Thai women.

BACKGROUND: Culture is often related to notions of well-being, illness, healing and health that inform individuals in their day-to-day activities. The postpartum period is noted for traditional practices related to rest, healing and the consumption of food and drinks, but a contemporary view of these practices is needed. AIMS: To gain an understanding of the traditional practices that Thai women follow in relation to postpartum care and the rationales underpinning such practices. METHODS: This descriptive study surveyed 500 Thai women living in Ubon Ratchathani, Thailand and attending their first postpartum hospital clinic appointment. A self-completion questionnaire was specially developed and pilot tested, and then administered to women attending the clinic. DATA ANALYSIS: Descriptive statistics were used in relation to the incidence of particular behaviours. Chi-square analyses were conducted to determine relationships between demographic characteristics and traditional practices. RESULTS: The majority of Thai women adhered to traditional postpartum practices related to the notion of regaining 'heat'. These included 'lying by fire', food restrictions, taking hot baths and consuming hot drinks. Other activities involved not exposing the body to heat loss by keeping covered, not shampooing the hair, avoiding the wind and sexual abstinence. Younger, less educated, primiparous women were more likely to report traditional practices. Mothers and mothers-in-law were most influential in recommending these behaviours. CONCLUSIONS: Traditional postpartum practices are still dominant in contemporary Thai culture and are perpetuated by close female family relatives. Health professionals need to be aware of clients' culture and consider the extent to which professional care complements the mothers' traditional beliefs. Nurses need to educate women about the benefits of contemporary postpartum care and to provide strategies to help them to integrate their beliefs and the practices recommended in contemporary health care practice.

Adolescent↗

PubMed2003

Thai nurses' beliefs about breastfeeding and postpartum practices.

Cultural beliefs are important determinants of health care behaviours. Nurses have an important influence on infant feeding decisions and maternal postpartum care, but little is known about the extent to which their practice is influenced by traditional beliefs and/or recent innovations driven by evidence-based research. The aim of this study was to investigate Thai nurses' traditional beliefs about breastfeeding and related postpartum care, and their impact on nursing practice. A survey of 372 nurses working in hospitals and health services in Ubon Ratchathani, Thailand was undertaken. Questionnaire items were developed from a review of the literature and exploratory interviews with Thai women. Descriptive statistics were used to represent the incidence of particular beliefs and behaviours. Chi-square analyses were conducted to determine relationships between demographic characteristics and traditional beliefs and practices. There were discrepancies between nurses' beliefs and contemporary evidence-based practices. Many nurses supported traditional Thai postpartum practices such as food restrictions and encouraging hot baths. Some traditional beliefs supported by nurses may be detrimental to women and babies such as "lying by fire", discarding of colostrum, and giving boiled water to neonates. Only half the nurses reported that they encouraged mothers to breastfeed immediately following birth. The study was undertaken in the North-East of Thailand, where the population is known to have strong belief systems. Reliability and content validity of the tool would be enhanced through replication studies and qualitative investigations of other breastfeeding issues. There is a need for professional development strategies such as peer review and mentoring to address inadequate knowledge and outdated practices of some health professionals, as well as continuity of care models to assess quality care outcomes that are culturally appropriate.

Adult↗

PubMed2003

A simplified predictive index for the detection of women at risk for postnatal depression.

BACKGROUND: Many women who suffer from postnatal depression are never diagnosed or treated. The objective of this study was to develop an index for use in maternity settings that identifies women who may be at risk for postnatal depression. METHODS: Women (n = 1762) attending the "booking-in" clinic were screened for antenatal risk factors for postnatal depression. On the third postnatal day eligible women were screened for postnatal risk factors. The Edinburgh Postnatal Depression Scale was mailed to participants 16 weeks after the birth. A predictive index was developed, based on the mean Edinburgh Postnatal Depression Scale scores for each risk factor. The sensitivity, specificity, positive predictive value, and negative predictive value were used to assess the diagnostic value of the index. RESULTS: Seven hundred and twenty-three (50.1%) of the eligible women completed all phases of the study. Of this group, 93 (12.2%) women scored higher than 12 on the Edinburgh Postnatal Depression Scale. At a cutoff of 6, the index had positive predictive value of 39.8 percent for postnatal depression, a threefold improvement over the base rate. CONCLUSION: The Brisbane Postnatal Depression Index provides a clinically useful method for identifying women at risk for developing postnatal depression. It has applications for early intervention or to identify high-risk groups for research purposes.

Depression, Postpartum↗

PubMed2003

The first breastfeed: a content analysis of midwifery textbooks.

This paper reviews content related to the first breastfeed in textbooks commonly used in midwifery education programs in Australia. Few scholars have critically examined the adequacy of such information for evidence-based midwifery practice. Five midwifery textbooks were chosen for content analysis specifically related to: skin-to-skin contact for newborn adaptation; orientation and coordination; suckling for effective breastfeeding; instructions to facilitate breastfeeding initiation; breast structure and function; and breastfeeding promotion. A score was calculated with the maximum possible total of 105. The content analysis scores ranged from 35 to 54, with two texts (Lowdermilk, Perry & Bobak 2000; Sweet 1997) scoring 54. Skin-to-skin contact to facilitate breastfeeding initiation is not well promoted in popular midwifery textbooks. Further research to promote midwives access to evidence-based research for effective midwifery practice in relation to breastfeeding initiation is required.

Adult↗

PubMed2002

Nurses' attitudes towards clients who self-harm.

BACKGROUND: Deliberate self-harm is frequently encountered by emergency department (ED) nurses. However, clients are often dissatisfied with the care provided and clinicians feel ambivalent, helpless or frustrated when working with clients who self-harm. AIM: The aim of the study was to develop and test a scale to identify relevant dimensions of ED nurses' attitudes to clients who present with self-injury. METHODS: Items on Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) were drawn from a literature review and focus group discussions with ED nurses. The tool was piloted with 20 ED nurses not working in the target agencies. A survey of nurses working within 23 major public and 14 major private EDs in Queensland, Australia (n = 1008) was then undertaken. RESULTS: A total of 352 questionnaires were returned (35% response). Analysis revealed four factors that reflected nurses' attitudes toward these clients. The factors related to nurses' perceived confidence in their assessment and referral skills; ability to deal effectively with clients, empathic approach; and ability to cope effectively with legal and hospital regulations that guide practice. There was a generally negative attitude towards clients who self-harm. Correlations were found between years of ED experience and total score on the ADSHQ, and years of ED experience and an empathic approach towards clients who deliberately self-harm. CONCLUSION: There is a need for continuing professional development activities to address negative attitudes and provide practical strategies to inform practice and clinical protocols.

Attitude of Health Personnel↗

PubMed2002

Study of Queensland emergency department nurses' actions and formal and informal procedures for clients who self-harm.

Emergency department nurses are often required to assess and manage the needs of people who self-harm. A survey of 352 nurses working within 23 major public and 14 major private emergency departments in Queensland, Australia, investigated the extent to which formal and informal procedures are available and the extent to which these procedures guide how nurses respond to clients who present with deliberate self-harm. The Risk Assessment Questionnaire was developed and found that nurses are frequently called to respond to clients presenting because of deliberate self-harm, but most have no formal training in this area. In some services there is a lack of formal and comprehensive procedures for assessment and treatment. Where procedures do exist, significant therapeutic areas related to assessment are not explored with clients. These findings have implications for continuing professional development activities, nursing education programs and clinical practice procedures.

Emergency Nursing↗

PubMed2002

Governing nursing conduct: the rise of evidence-based practice.

Drawing on the Foucauldian concept of 'governmentality' to analyse the evidence-based movement in nursing, we argue that it is possible to identify the governance of nursing practice and hence nurses across two distinct axes; that of the political (governance through political and economic means) and the personal (governance of the self through the cultivation of the practices required by nurses to put evidence into practice). The evaluation of nursing work through evidence-based reviews provides detailed information that may enable governments to target and instruct nurses regarding their work in the interest of preserving the health of the population as a whole. Political governance of the nursing population becomes possible through centralised discursive mechanisms, such as evidence-based reviews that present nursing practice as an intelligible field whose elements are connected in a more or less systematic manner. The identity of the evidence-based nurse requires the modern nurse to develop new skills and attitudes. Evidence-based nursing is an emerging technology of government that judges nursing research and knowledge and has the capacity to direct nursing practice at both the political and personal level.

Australia↗

PubMed2002

Postdischarge surveillance of surgical site infections: a multi-method approach to data collection.

BACKGROUND: Surveillance of surgical site infections (SSIs) is an important clinical indicator of quality patient care, yet an increasing number of SSIs manifest after discharge and are not detected through standard surveillance methods. AIM: This study evaluated a multimethod approach to postdischarge surveillance of SSIs with use of a cesarean section procedure as a case study. METHOD: A postdischarge questionnaire was sent on day 30 to women (n = 277) who had undergone cesarean section. A follow-up telephone interview was conducted if the questionnaire had not been returned within 2 weeks, a diagnosis of infection could not be clearly determined from the responses given, or to confirm the diagnosis of infection. If follow-up could not be made, a chart audit was undertaken. RESULTS: A total response rate of 89% (247/277) was obtained. Twenty-one women with SSI were identified through questionnaire responses. Additional strategies of telephone follow-up and chart review of patients with possible infection and of nonresponders identified more postdischarge infections (33%, 14/42). The overall infection rate was 17% (42/247) compared with 2.8% (7/247) at discharge. CONCLUSION: Postdischarge surveillance approaches need to achieve the best possible response rate, reflect follow-up health care delivery patterns, be cost-effective, gather data from both patients and treating physicians, and use standard definitions to facilitate benchmarking with other health care facilities and surveillance systems. The inclusion of contacting nonresponders in any method of postdischarge surveillance is recommended to determine the most accurate infection rate.

Adolescent↗

PubMedDate not supplied

Development and evaluation of an intensive intervention program for children with a chronic health condition: a pilot study.

A range of developmental risk factors threatens the psychosocial well-being of children with a chronic health condition (CCHC). Early intervention and prevention programs are emerging as an effective response to improving individual and family coping mechanisms. In particular, efforts to address individual and family coping throughout the important pre-teen transitional ages for CCHC have gained popularity although their effectiveness has not been adequately demonstrated. We conducted a pre-post intervention study to evaluate an intensive intervention program for CCHC aged 10-14 years that aimed to enhance well-being. Twelve CCHC participated in a pilot 8-week intensive intervention program. At three month follow-up there was a significant increase in children's self esteem (t = 3.39, p < .01). There was a decrease in mean scores for anxiety and depression symptoms. Parental perceptions of the impact of the condition on the child reduced significantly (t = 2.37, p < .05). It was beyond the scope of the present study to conclusively evaluate the effectiveness of the intensive intervention program, however results show that it was a promising strategy to improve a range of outcomes for CCHC. Further research using a larger sample is needed to determine the ways in which this program influences psychosocial well-being of CCHC and their families.

Adaptation, Psychological↗