Negotiating policy in practice: child and family health nurses' approach to the process of postnatal psychosocial assessment.

摘要: There is growing recognition internationally of the need to identify women with risk factors for poor perinatal mental health in pregnancy and following birth. In state New South Wales, Australia Supporting Families Early policy provides a framework assessment support families includes routine psychosocial depression screening. This study investigated approach taken by Child Family Health Nurses (CFHNs) birth screening as recommended policy. was qualitative ethnographic that included 83 CFHN 20 women. Observations occurred thirteen nurses; women, home or clinic environment. An additional 70 nurses participated discussion groups. observational tool (4D&4R) field notes were used record observations analysed descriptively using frequencies. Field notes, interview data group transcripts thematically. CFHNs demonstrated range approaches Psychosocial conducted 50% (10 out 20) interactions observed; however, all screened Edinburgh Depression Scale. Four major themes represent process identified: ‘Engagement: getting first bit right’, ‘Doing some paperwork’, ‘Creating comfort’ ‘Psychosocial assessment: doing it another way’. utilised other skills such observing interacting their baby, taking note non verbal communication intuition develop clinical decision. Overall, nurses’ took sensitive caring screening, there differences interpretations recommendations across two sites. adopt flexible, relationship-based process; they experience tension when required incorporate structured processes. To undertake effectively, require ongoing support, training supervision maintain this emotionally challenging work.