Browsing by Author "Premji, Shahirose"

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    Exploring protective factors for pregnancy-related anxiety in Tanzanian women
    (2017) Wall, Vanessa; Premji, Shahirose; Letourneau, Nicole; McCaffrey, Graham; Dimitropoulos, Gina
    Pregnancy-related anxiety is highly correlated with pre-term birth which can be fatal in low-and-middle-income countries. Modifiable protective factors for pregnancy-related anxiety need to be identified to prevent this condition. This study aimed to identify factors associated with low or no pregnancy-related anxiety among women attending two antenatal clinics in districts of Mwanza, Tanzania. A cross-sectional secondary data analysis was completed using data from a longitudinal study that examined biomarkers of stress, anxiety, depression, and birth outcomes. Data were analyzed using bivariate analysis and multiple linear regression. Findings did not reveal any modifiable protective factors. Perceived stress, active depression, and number of people living in the home were the only statistically significant predictors of pregnancy-related anxiety in our sample. Findings indicated that pregnancy-related anxiety may be associated with cultural factors such as family dynamics, and stigmatization of fear or anxiety. Before protective factors can be identified, more qualitative research may be needed in these countries to better understand the cultural nuances of pregnancy-related anxiety in low-and-middle income countries.
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    Pregnancy-Related Anxiety in Mwanza, Tanzania: a Qualitative Approach
    (2016) King Rosario, Melanie; Premji, Shahirose; Raffin Bouchal, Shelley; Este, David
    Pregnancy-related anxiety is defined as fears and worries related to the health of the woman, the baby, the pregnancy, and delivery; it is a strong determinant of preterm birth and other maternal and infant outcomes. There is limited research on the mental health of pregnant women residing in low- and middle-income countries (LMIC) and little exploration into women’s experiences of pregnancy-related anxiety. In this descriptive phenomenological study, ten pregnant and postpartum women participated in semi-structured interviews. Following Colaizzi’s method of analysis, the essence of the women’s experience was described. The findings revealed a state of worry and concern, often causing physical symptoms, and disrupting personal sense of peace. Major themes included: fear for survival of self and child; lack of knowledge about pregnancy, symptoms, and side effects; spirituality and acceptance. Personal relationships, interactions with the healthcare system, and peer support also played an important role in the participants’ experiences.
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    Prenatal Maternal Anxiety as a Risk Factor for Preterm Birth and the Effects of Heterogeneity on This Relationship: A Systematic Review and Meta-Analysis
    (2016-05-19) Rose, M. Sarah; Pana, Gianella; Premji, Shahirose
    Background. Systematic reviews (SR) and meta-analyses (MA) that previously explored the relationship between prenatal maternal anxiety (PMA) and preterm birth (PTB) have not been comprehensive in study inclusion, failing to account for effects of heterogeneity and disagree in their conclusions. Objectives. This SRMA provides a summary of the published evidence of the relationship between PMA and PTB while examining methodological and statistical sources of heterogeneity. Methods. Published studies from MEDLINE, CINAHL, PsycINFO, and EMBASE, until June 2015, were extracted and reviewed. Results. Of the 37 eligible studies, 31 were used in this MA; six more were subsequently excluded due to statistical issues, substantially reducing the heterogeneity. The odds ratio for PMA was 1.70 (95% CI 1.33, 2.18) for PTB and 1.67 (95% CI 1.35, 2.07) for spontaneous PTB comparing higher levels of anxiety to lower levels. Conclusions. Consistent findings indicate a significant association between PMA and PTB. Due to the statistical problem of including collinear variables in a single regression model, it is hard to distinguish the effect of the various types of psychosocial distress on PTB. However, a prenatal program aimed at addressing mental health issues could be designed and evaluated using a randomised controlled trial to assess the causal nature of different aspects of mental health on PTB.
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    Preterm Birth: Understanding Temporal Changes in Anxiety and Depression Measures
    (2017) Doktorchik, Chelsea; Premji, Shahirose; Patten, Scott; Slater, Donna; Williamson, Tyler
    Background: This study aimed to understand whether there is a pattern of change in levels of anxiety and depression between the second and third trimesters of pregnancy that are associated with a risk of PTB. Chronic stress was assessed as a potential modifier of the relationship. Methods: This study conducted a secondary data analysis on the All Our Babies prospective cohort. Logistic regression modeling was used to analyze the data. Results: A worsening of anxiety during pregnancy increased the odds of preterm delivery (OR 2.70, 95% CI 1.28, 5.69; p=0.009). An improvement in anxiety reduced the odds of PTB (OR 0.96, 95% CI 0.94, 0.98; p=<0.001). Consistently low depression decreased the odds of PTB (OR 0.65, 95% CI 0.45, 0.96; p=0.029). Chronic stress did not modify any of these relationships. Conclusions: Efforts should be made to replicate these results in a cohort with a larger sample size.
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    A qualitative study: Mothers of late preterm infants relate their experiences of community-based care
    (PloS ONE, 2017-03) Premji, Shahirose; Currie, Genevieve; Reilly, Sandra; Dosani, Aliyah; May Oliver, Lynette; Lodha, Abhay K; Young, Marilyn
    Purpose In Alberta, the high occurrence of late preterm infants and early hospital discharge of mother-infant dyads has implications for postpartum care in the community. Shortened hospital stay and complexities surrounding the care of biologically and developmentally immature late preterm infants heighten anxiety and fears. Our descriptive phenomenological study explores mothers’ experience of caring for their late preterm infants in the community. Methods Eleven mothers were interviewed using a semi-structured interview guide. Interview transcripts were analysed using an interpretive thematic approach. Findings The mothers’ hospital experience informed their perspective that being a late preterm infant was not a “big deal,” and they tended to treat their infant as normal. “Feeding was really problem,” especially the variability in feeding effectiveness, which was not anticipated. Failing to recognize late preterm infants’ feeding distress exemplified lack of knowledge of feeding cues and tendencies to either rationalize or minimize feeding concerns. Public health nurses represent a source of informational support for managing neonatal morbidities associated with being late preterm; however, maternal experiences with public health nurses varied. Some nurses used a directive style that overwhelmed certain mothers. Seeing multiple public health nurses and care providers was not always effective, given inconsistent and contradictory guidance to care. These new and changing situations increased maternal anxiety and stress and influenced maternal confidence in care. Fathers, family, and friends were important sources of emotional support. Conclusion After discharge, mothers report their lack of preparation to meet the special needs of their late preterm infants. Current approaches to community-based care can threaten maternal confidence in care. New models and pathways of care for late preterm infants and their families need to be responsive to the spectrum of feeding issues encountered, limit duplication of services, and ensure consistent and effective care that parents will accept.
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    Tracking the Social Organization of Nurses’ Practices in Level 2 Neonatal Intensive Care Units: An Institutional Ethnography of Feeding Work
    (2017) Ringham, Catherine; Rankin, Janet; Ewashen, Carol; Premji, Shahirose; Marcellus, Lenora; Venturato, Lorraine; Carryer, Jenny
    The character of neonatal nurses’ work is episodic and discontinuous. While nurses play an integral role in mediating the ebb and flow of constantly changing priorities, in the Level 2 Neonatal Intensive Care Units (NICU) their work is also complicated by new technologies, safety work, and institutionally driven quality improvement (QI) projects. As the numbers and types of QI, safety, and standardizing strategies proliferate, they can overwhelm nurses’ responses to infant’s needs, particularly late preterm infants (LPIs) who require less technological interventions during their care in the NICU. An institutional ethnographic approach was used to examine the social organization of nurses’ work with LPIs in Level 2 NICU. Feeding work, a central organizer of nurses’ work, emerged as the main thread of analysis. The data showed that feeding work does not unfold as an orderly, stepwise procedure. Observations revealed how feeding episodes for all infants were broken up by the need for a nurse to attend to technologies developed for ‘safety’ and to meet standardized protocols. The work relies on nurses’ capacity to notice, to respond, to flex, and to adapt. However, nursing tasks are being broken into disparate pieces as nurses become subject to ideological practices that rely on a form of logical/rational thinking about how work can be planned and organized to unfold safely. Often in the milieu of nursing activity, LPIs were viewed ‘out of the corner of nurses’ eyes,’ socially organized to be rendered peripheral to nurses’ full attention. The research findings explicate serious tensions in nurses’ work, particularly with feeding LPIs. The findings call into question the foundations on which standardized protocols and practices are built and offers an opportunity for policy makers, health care leaders, and nurses themselves to understand how neonatal nurses’ work is organized and to begin creative discussions to resolve tensions and to direct further research in Level 2 NICUs.
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    Understanding Pre-Registration Employment and Transition to Practice for the Newly Graduated Nurse
    (2017) Reimche, Ruthanne; Hirst, Sandra; Seneviratne, Cydnee; Walsh, Christine; Premji, Shahirose
    Background Transition from nursing student to a registered nurse is fraught with difficulties such as gaining acceptance and knowledge on the unit, and obtaining comfort and confidence. Approximately 20% of newly graduated nurses (NGNs) leave the profession in the first year often due to difficulties in the transition phase. The focus of this research was understanding direct paid pre-registration employment and transition to practice for the NGN. Methods A study with a descriptive qualitative design was conducted. Nine participants, between three months and one year after completing their nursing program, were interviewed. Thematic analysis was conducted on the data. Findings The main themes emerging from the data were support, vulnerability, de-stress, becoming comfortable, and gaining confidence. Contribution to Nursing Practice Interviewing NGNs with paid pre-registration employment will assist employees’ understanding of the transition experience of new graduates, which may assist with retention of new hires.