Anne-Lyse de Guio
Core knowledge, skills and attitudes of registered nurses working with families identified with psychosocial vulnerabilities during the perinatal period under the NSW Safe Start framework
Extensive evidence (Ferguson, 1998; Gunnar, Morison, Chilsholm, & Schuder, 2001; Schore, 2001) demonstrates the importance of high quality parenting during an infant’s first three years of life to promote optimal bio-psycho-neurological brain development. NSW Safe Start is a Government response to the recognition that many families will experience extra stress and unexpected challenges during the perinatal period. It identifies a framework for the provision of universal assessment and coordinated care delivered by maternity, child and family health services for all parents expecting or caring for a baby (NSW Health, 2009). Through the provision of universal health services Safe Start aims to ensure the health and wellbeing of all infants, promote the social functioning of their families, provide services that are relevant and family led and improve the continuity of care from pregnancy to the postnatal period.
The research study will investigate the core skills, knowledge and attitudes of registered nurses to undertake the various activities required by the Safe Start policy and to meet the expectations outlined in the policy.
The exploration of the research question will be conducted from three different perspectives – leading professionals, mothers with positive experience of the service, and experienced registered nurses involved in the service.
The first study uses a Delphi survey to seek the opinion of leading professionals from various disciplines and backgrounds (e.g. health and social sciences, policy making, education and service management), who have contributed or are contributing to the development of effective early childhood services, about the knowledge, qualities and skills that they expect the nurses to possess. It is anticipated that a consensus will be reached about the broad parameters of advanced nursing abilities.
The Delphi method has been highlighted as beneficial to consensus building (Aichholzer, 2009) and the development of collective human intelligence. The Delphi allows for the anonymous inclusion of participants with expertise or advanced knowledge in specific topics relevant to the research question and for the sharing and/or modification of their opinions through a series of iterative data collections commonly called rounds. Each round generates a new set of information based on the responses from the last round and reporting of the summary of the group responses. The process is completed when a consensus is reached or when no new responses are returned (Power, 2003). Up to 17 ‘experts’ have been invited to participate in the study. The study outcomes are expected to bring more clarity and consensus about the core knowledge, skills and attitudes required for nurses to implement the Safe Start initiative competently.
In order to increase the validity of the Delphi a second study gains the perspective of mothers who experienced pregnancy and postnatal care delivered by services that followed the Safe Start policy and who consider that they had a satisfactory experience. I will seek the perceptions and satisfaction of up to 15 parents who during pregnancy or the postnatal period (up to 2 years) received specific perinatal interventions guided by the Safe Start principles using semi-structured interviewing.
The purpose of the second study is to determine what nursing activities and attitudes were most helpful in supporting mothers to minimise difficulties encountered when becoming a mother and to enhance their parenting skills. An Appreciative Inquiry (AI) (Cooperrider & Whitney, 2005) framework was selected to underpin the collection of data obtained through one to one semi-structured interviews. Mothers are invited to participate in the study through advertisements placed on local playgroups notice boards.
Finally, experienced registered nurses who are currently implementing Safe Start are invited to share their experiences about meeting the needs of families with identified vulnerabilities. This third study focuses on the perception of advanced practice nurses. The nurses must have a minimum of 5 years community experience in the field of child and family health and at least 2 years delivering targeted interventions in response to psychosocial needs of families. The AI framework is used in order to focus on the multiple stories of achievement, success, strength and innovation that are currently demonstrating the existing skills and qualities of nurses in NSW.
Findings from this three-pronged research will inform the development of national nursing education programs that will support the development of a competent early childhood nursing workforce responsible for the delivery of early interventions to families highly vulnerable and sometimes difficult to engage. The research also has the potential to inform midwifery education, as midwives have a significant role in the implementation of Safe Start during the antenatal period.