Postnatal psychosocial assessment and clinical decision-making, a descriptive study

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Journal Article
Journal of Clinical Nursing, 2018, 27 (19-20), pp. 3739 - 3749
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© 2018 John Wiley & Sons Ltd Aims and objectives: To describe experienced child and family health nurses’ clinical decision-making during a postnatal psychosocial assessment. Background: Maternal emotional well-being in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy and the interventions used are determined by the standard of nursing decision-making. Design: A qualitative methodology was employed to explore decision-making behaviour when conducting a postnatal psychosocial assessment. Methods: This study was conducted in an Australian early parenting organisation. Twelve experienced child and family health nurses were interviewed. A detailed description of a postnatal psychosocial assessment process was obtained using a critical incident technique. Template analysis was used to determine the information domains the nurses accessed, and content analysis was used to determine the nurses’ thinking strategies, to make clinical decisions from this assessment. Results: The nurses described 24 domains of information and used 17 thinking strategies, in a variety of combinations. The four information domains most commonly used were parenting, assessment tools, women-determined issues and sleep. The seven thinking strategies most commonly used were searching for information, forming relationships between the information, recognising a pattern, drawing a conclusion, setting priorities, providing explanations for the information and judging the value of the information. Conclusion: The variety and complexity of the clinical decision-making involved in postnatal psychosocial assessment confirm that the nurses use information appropriately and within their scope of nursing practice. The standard of clinical decision-making determines the results of the assessment and the optimal access to care. Relevance to clinical practice: Knowledge of the information domains and the decision-making strategies that experienced nurses use for psychosocial assessment potentially improves practice by providing a framework for education and mentoring.
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