title: Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia.
abstract: OBJECTIVE
  To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015.
  
  
  BACKGROUND
  For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care.
  
  
  METHODS
  A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups.
  
  
  RESULTS
  Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity.
  
  
  CONCLUSIONS
  There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers.
  
  
  CONCLUSIONS
  Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families.
authors.affiliation: Centre for Midwifery, Child & Family Health, University of Technology Sydney, Broadway, NSW, Australia.
authors.forename: Cathrine
authors.initials: C
authors.lastname: Fowler
authors.affiliation: School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.
authors.forename: Virginia
authors.initials: V
authors.lastname: Schmied
authors.affiliation: Tresillian Family Care Centres, Campsie, NSW, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Dickinson
authors.affiliation: School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.|Ingham Institute, Liverpool, NSW, Australia.
authors.forename: Hannah Grace
authors.initials: HG
authors.lastname: Dahlen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002648:Child; D002668:Child Rearing / Q000523:psychology*; D002669:Child Welfare / Q000523:psychology*; D005260:Female; D006801:Humans; D007223:Infant; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D024802:Nurse's Role; D016487:Parenting / Q000523:psychology
keywords: family nursing; family nursing interventions; nursing assessment; parenting psychosocial adjustment