‘So, the circle has grown’ – Child Health Services nurses’ experiences of giving parental interviews with nonbirthing parents

Abstract

Background Lately, greater focus has been given to the mental health of nonbirthing parents postpartum. However, mothers, but not nonbirthing parents, are routinely screened for postpartum depression, and until recently, nonbirthing parents have not been given the same opportunity as mothers to discuss their parental role without the other parent present. To strengthen the parental role, a separate parental interview with the nonbirthing parent began to be offered as part of the Swedish Child Health Service's (CHS) general programme. Aim This study aimed to explore CHS nurses’ experiences of performing parental interviews with nonbirthing parents. Methods Content analysis was used when analysing data from six research interviews, of which half were focus group interviews. In total, 11 CHS nurses were interviewed. Results Child Health Service nurses reported that although the interview with the nonbirthing parent was a positive experience and that a more family‐oriented perspective was something many of them had been longing for, they could also feel that it demanded a lot from them, including things they had perhaps not previously considered. CHS nurses reported difficulties with having such close contact with both parents, and they also described feeling worried about the information that could come up in a standardised conversation and the knowledge provided. Conclusion There are both possibilities and challenges in widening the responsibilities of the CHS nurse to include the nonbirthing parent by offering a postpartum interview. Implications This study provides information to healthcare professionals about the importance of providing proper guidance and education when broadening the duties and responsibilities for CHS nurses to include nonbirthing parents in mental health screening. CHS nurses must be given the resources needed to deal with the challenges they encounter and sufficient time for the interviews to be possible and meaningful.

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“…Practice-focused studies included studies where assessment was already part of current practice (88) or recently introduced (92), and studies where assessment was introduced into practice in the context of a research study that examined its acceptability and feasibility (78,81,(93)(94)(95). Mental health assessment tools used in practice included the EPDS (88,(92)(93)(94), the Whooley questions (28,92), the Depression Anxiety Stress Scales (DASS) (88,96), the Center for Epidemiologic Studies-Depression scale (CES-D) (95,97), the Impact of Event Scale-Revised (IES-R) (95,98), and the Post-traumatic Adjustment Screen (81,99). In some services, these were completed as part of a more comprehensive psychosocial assessment (88,92).…”

“…Mental health assessment tools used in practice included the EPDS (88,(92)(93)(94), the Whooley questions (28,92), the Depression Anxiety Stress Scales (DASS) (88,96), the Center for Epidemiologic Studies-Depression scale (CES-D) (95,97), the Impact of Event Scale-Revised (IES-R) (95,98), and the Post-traumatic Adjustment Screen (81,99). In some services, these were completed as part of a more comprehensive psychosocial assessment (88,92). In the practice-based studies, acceptability was predominantly examined by completion rates and health professional perspectives (gathered by interview and focus groups) and with little detail reported concerning specific measures.…”

“…A preference was expressed to speak with a general practitioner rather than someone in maternity or health visiting (34,49); perceiving maternity to be focused on the woman and pregnancy, and physical rather than emotional health (49), with men's emotional well-being not a priority in current models of care (80). Notably, where parental interviews had been introduced with non-birthing parents in child health services, nurses felt their inclusion indicated to society and parents the importance of non-birthing parents, helping them to feel included (92). Within specialist early parenting services, staff reported that a focus on maternal mental health could be a barrier to screening fathers and that the service's function and the father's involvement (e.g., primary caregivers, admitted to the service, actively participating) determined who was screened (88).…”

“…Connected to the culture and remit of services (service-level), and to the gaps in knowledge, skills and confidence (practitionerlevel), professionals in universal services (maternity, health visiting and child health) identified a fundamental need for training in theory and practice for working with fathers (87) and specifically in relation to paternal mental health (34,87,89,90) and addressing potentially difficult situations when working with couples (92). Professionals with experience of supporting fathers in relation to their mental health identified the importance of access to clinical supervision (84,92).…”

“…With no process or guidance in place, some health visitors viewed screening men as problematic (87,89). Child health nurses reported a range of approaches and lack of structured methods (84), commending the introduction of a planned approach (92). Within specialist services, there was similarly no uniform approach (88) and both professionals and parents expressed that routine screening would help to "normalize" paternal perinatal mental health difficulties (80,83,88).…”