Caring for families experiencing stillbirth: Evidence-based guidance for maternity care providers

BackgroundEvidence-based guidance is needed to inform care provided to mothers and families who experience stillbirth. This paper focuses upon how meaningful and culturally appropriate care can be provided to mothers and families from when they are informed that their baby will be stillborn to many years after the experience. Avoidable suffering may be occurring in the clinical setting.AimsTo promote and inform meaningful and culturally appropriate evidence-informed practice amongst maternity care providers caring for mothers and families who experience stillbirth.MethodsA comprehensive systematic review was conducted which primarily synthesised relevant qualitative research studies. An expert advisory group comprised of stillbirth researchers, clinicians, and parents who have experienced stillbirth provided guidance for the review and the development of implications for practice.FindingsGrieving parents want staff to demonstrate sensitivity and empathy, validate their emotions, provide clear, information, and be aware that the timing of information may be distressing. Parents want support and guidance when making decisions about seeing and holding their baby. Sensitivity, respect, collaboration, and information are essential throughout the experience of stillbirth. Culturally appropriate care is important and may require staff to accommodate different cultural practices.ConclusionThe findings of the review and expert consensus inform the provision of meaningful and culturally appropriate care for mothers and families that have experienced stillbirth. Evidence informed implications for practice are provided to guide the actions, communication, and behaviours of maternity care providers.     

Early Pregnancy Assessment Services in Australia: What psychosocial support is available? A qualitative study

ProblemWomen commonly experience emotional distress following miscarriage but do not receive the support they need from healthcare providers.BackgroundMiscarriage can result in psychological morbidity; however, appropriate support at the time of a miscarriage can lead to better psychological outcomes. Early Pregnancy Assessment Services (EPASs) are dedicated outpatient services considered the “gold standard” for miscarriage care. Little is known about the psychosocial support EPASs provide in Australia.AimsThe aim of this study was to explore the provision of psychosocial support in Australian EPASs.MethodsSemi-structured interviews were conducted with 29 purposively sampled key-informants from 13 EPASs. Interviews were audio-recorded, transcribed, and thematically analysed.FindingsConsiderable variation was found in how EPASs functioned and their provision of psychosocial support. Many services were co-located with antenatal services, run by doctors with limited experience and most did not offer any psychosocial training to staff specific to EPAS. Referrals for additional support were generally not offered for first trimester miscarriages, and follow-up typically focused on physical management rather than emotional wellbeing. All EPAS staff demonstrated a strong commitment to providing best possible care to women within their own clinical setting and acknowledged the need for improved psychosocial support.ConclusionThis study provides the first exploration of Australian EPASs’ provision of psychosocial support. It has shown that while health care professionals working in EPASs are dedicated to providing the best possible care to women within their clinical setting, psychosocial support is very limited and could be improved.     

零售业企业员工的积极应激因素探索——基于哥本哈根社会心理问卷的分析

积极心理学的兴起和哥本哈根社会心理问卷的出现,为积极应激这一较少得到实证研究的应激现象提供了理论视角和分析工具.通过对该问卷的重新分析,选取10家零售商业企业的383名员工为被试,验证了应激项目与健康状况因子、工作满意度因子之间的正相关关系,并归纳了积极应激的工作意义感、团队精神感、与领导关系、工作控制度、工作认可度、工作自由度这七个因子及其具体内容.这些积极应激条件的存在与甄别,为企业激发员工的积极应激状态、提高工作满意度提供了可操作化的途径.     

Psychosocial Correlates of Interpersonal Sensitivity: A Meta-Analysis

This meta-analysis examines how interpersonal sensitivity (IS), defined as accurate judgment or recall of others’ behavior or appearance, is related to psychosocial characteristics of the perceiver, defined as personality traits, social and emotional functioning, life experiences, values, attitudes, and self-concept. For 215 independent studies reported in 96 published sources, higher IS was generally associated with favorable or adaptive psychosocial functioning. Significant mean correlations were found for 27 of the 40 categories of psychosocial variables; these categories covered many different personality traits, indicators of mental health, and social and work-related competencies. Moreover, many additional studies that fell outside these conceptual categories also showed significant positive relations between IS and numerous other psychosocial variables. Taken together, the results support the construct validity of IS tests and demonstrate that IS is associated with many important aspects of personal and social functioning.

The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study

ProblemAlthough perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain.AimTo compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA).MethodsWomen attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an ‘at-risk’ flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the ‘at-risk’ flag for PIPA than for Usual-Care. Each model’s performance was evaluated using the midwife’s agreement with the ‘at-risk’ flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach.FindingsBoth models performed well at identifying ‘at-risk’ women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying ‘at-risk’ women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted.DiscussionOverall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as ‘at-risk’ and ‘not at-risk’ of perinatal psychosocial morbidity.     

A bio-psycho-social model of successful aging as shown through the variable “physical activity”

In this article, we present and explain a bio-psycho-social model of successful aging with subjective well-being as a criterion of a successful aging process. We focus on physical activity because it is a crucial behavior. Physical activity can support successful aging in two different ways: first, due to its physiological and cognitive effects, and Second, an older person can enhance subjective well-being (SWB) while being physically active. The model points out that an older person can regulate SWB. To do this, an older person should set and pursue personally and culturally valued goals. The strength of the association between setting a goal and goal pursuance, respectively, and SWB depends on the extent a person is able to satisfy psychological needs (autonomy, competence, relatedness). But, the decision as to which goal will be set and pursued does not belong to the older person exclusively. The bio-psycho-social model explains that the chance to enhance SWB is restricted by personal dispositions (e.g., physiological constitution, psychological factors) and social–structural constraints (e.g., predominant stereotype of aging, facilities especially for target groups). Funding credit: Landesstiftung Baden Württemberg gGmbH [Landesstiftung Foundation]     

Relationships between bullying, psychosocial work environment and individual stress reactions

It is frequently assumed that a poor psychosocial working environment will create conditions that encourage bullying. However, few studies have examined this assumption while comparing work environment ratings of bullied and non-bullied employees who work in the same organization and/or department. The objectives of this study were therefore, first, to investigate relationships between bullying and other psychosocial work environment factors within a particular organizational setting and, second, to investigate if bullied employees reported higher levels of stress than non-bullied employees. A total of 186 blue-collar employees from a Danish manufacturing company participated in the study (response rate of 93%). Results showed significant differences in bullied and non-bullied employees' ratings of psychosocial factors such as job control, management style, role clarity, social climate, social contact and work centrality. In order to investigate assumptions that a poor psychosocial work environment creates conditions that encourage bullying, a number of analyses compared the company's manufacturing departments with either high, medium or low levels of bullying. Results showed significant departmental differences. Yet, when bullied employees were removed from the statistical analyses, with regard to the perceived psychosocial environment these same departments could be differentiated only on the basis of rated job demands and management style. The results therefore bring into question the assumption that a generally poor work environment contributes to bullying. None the less, they do suggest that management style may directly or indirectly have contributed to a higher level of bullying. Also, bullied employees reported significantly more symptoms of psychological stress and mental fatigue than non-bullied employees.     

Do you think that your health or safety are at risk because of your work? A large European study on psychological and physical work demands

Throughout Europe there are relatively few statistics, gathered a national level, which deal specifically with the problem of violence at work. In the UK, the revised Reporting of Injuries. Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995 now require that certain violent incidents are reported on a national basis. The criteria for reporting, which are entirely dependent on the physical outcome of incidents, are discussed. It is recommended that employing organizations should establish their own internal systems for reportmg and recording a wider range of violent, and potentially violent, incidents. These should then be used to inform risk assessment and risk management.     

Psychosocial risk factors for excessive gestational weight gain: A systematic review

BackgroundExcessive weight gain during pregnancy can have adverse health outcomes for mother and infant throughout pregnancy. However, few studies have identified the psychosocial factors that contribute to women gaining excessive weight during pregnancy.AimTo review the existing literature that explores the impact of psychosocial risk factors (psychological distress, body image dissatisfaction, social support, self-efficacy and self-esteem) on excessive gestational weight gain.MethodsA systematic review of peer-reviewed English articles using Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO, Informit, Web of Science, and Scopus was conducted. Quantitative studies that investigated psychosocial factors of excessive GWG, published between 2000 and 2014 were included. Studies investigating mothers with a low risk of mental health issues and normally-developing foetuses were eligible for inclusion. From the total of 474 articles located, 12 articles were identified as relevant and were subsequently reviewed in full.FindingsSignificant associations were found between depression, body image dissatisfaction, and social support with excessive gestational weight gain. No significant relationships were reported between anxiety, stress, self-efficacy, or self-esteem and excessive gestational weight gain.ConclusionThe relationship between psychosocial factors and weight gain in pregnancy is complex; however depression, body dissatisfaction and social support appear to have a direct relationship with excessive gestational weight gain. Further research is needed to identify how screening for, and responding to, psychosocial risk factors for excessive gestational weight gain can be successfully incorporated into current antenatal care.     

The need for improved emotional support: A pilot online survey of Australian women’s access to healthcare services and support at the time of miscarriage

ProblemWomen need improved emotional support from healthcare professionals following miscarriage.BackgroundSignificant psychological morbidity can result following miscarriage and may be exacerbated by poor support experiences. Women frequently report high levels of dissatisfaction with healthcare support at this time.AimThis study was developed to pilot a survey aimed at exploring women’s access to healthcare services and support at the time of miscarriage.MethodsWomen over 18 years, residing in Australia, who had experienced a miscarriage in the past two years completed a 29-item online survey.FindingsA total of 399 women completed the survey. Two key findings arose: 1) More than half of women (59%) were not offered any information about miscarriage or pregnancy loss support organisations or referral/access to counselling services at the time of miscarriage, despite almost all reporting they would have liked various forms of support from items listed 2) More than half (57%) did not receive follow up care, or emotional support at this time, beyond being asked how they were coping emotionally. Other findings showed 3) Women accessed various healthcare services at the time of miscarriage and 4) Women often saw a general practitioner at the time of miscarriage despite having a private obstetrician.ConclusionThere is clear mismatch between the support women want at the time of miscarriage and the care they receive from healthcare professionals. Despite considerable structural barriers, it seems likely there is scope within healthcare professionals’ usual practice for improved support care through simple measures such as increased acknowledgement, information provision and referral to existing support services.