Maintaining quality in a school of nursing [abstract]

Three years ago, the School of Nursing (Victoria) obtained ISO 9001 accreditation. This has resulted in a number of initiatives and benefits for the School as well as changes in the workload and administrative responsibilities of the author. The latter changes include responsibility for the `quality management system' that has been established. The ISO series of quality management originated in the industrial sector in Britain. In order for the system to be acceptable and applicable in a human service industry, it was modified to meet the specific needs. These modifications had to be consistent with the ISO framework as well as addressing the needs of the School. The system requires that official and documented policies be in place and performance standards set and maintained. It also requires that customer complaints be heard and addressed. Other features of the system include the monitoring of preferred suppliers of service, documentation of professional education, staff development and the regular audtiting of procedures. Accreditation has brought to the faculty, students and the university quality accreditation to a standard recognized internationally, particularly throughout Europe and Asia. Students and staff benefit because procedures are clearly outlined, recognized and adhered to.(AU)

Traditional birth attendants, their training, and maternal health in Belize

A prospective case-series design and methodological approach which combined emic perspectives of ethnomedicine with etic measures of biomedicine were used to describe the obstetric concepts and practices of traditionally and biomedically trained traditional birth attendants (TBAs) and to determine if, and how, these TBAs differentially affect maternal health during parturition. Participants included one traditionally trained and one biomedically trained TBA (Case-Series TBAs) and 30 women living in Cayo and Orange Walk districts in Belize. Health histories and physical examinations of each woman were performed before and after parturition; timed observation of each TBA and woman was conducted after parturition. Lastly, a survey of concepts and practices of 26 TBAs (Survey TBAs) from these districts was conducted. Results show the Case-Series TBAs made significant contributions to maternal health during parturition through evaluation, support, and referral; however, certain interventions probably contributed to some impairment e.g., instructing women to bear down at apparent onset of active labor and exhaustion; assisted placental birth prior to signs of spontaneous separation and hemorrhage, with consequent anemia. The Case-Series TBAs shared most concepts and practices and had no differential effect on maternal health. Concepts appeared to be empirically derived but differed substantively from biomedical understandings; practices were viewed efficacious in terms of concepts and assessments of maternal health; both were generally widespread among the Survey TBAs. From this one can infer that TBAs in Cayo and Orange Walk districts make significant contributions to maternal health, yet may contribute to the impairments described; that exposure to biomedical obstetrics has had limited influence. Results suggest this is due to stability of the existing ethno-obstetric system. Traditional theory and therapy are reinforced because they are internally consistent, empirically derived, and perceived as efficacious by TBAs and women they attend. These findings are relevant to midwifery education and maternal health in Belize. The design and methodological approach were particularly useful for cross-cultural study of parturition and provided a framework for exploring interaction of biology and culture in the context of health.(AU)