Sonographers' level of autonomy in communication in Australian obstetric settings: Does it affect their professional identity?

INTRODUCTION: Unlike the United Kingdom, policies in Australia prevent sonographers from exercising autonomy in their level of communication with pregnant patients in the event of adverse findings. The organisational structure makes the sonographer dependent on the sonologist because sonographers do not have the authority to provide the official report. The emotional labour on sonographers is increased as they struggle to provide patient-centred care, given the limits put on their communication during the ultrasound examination. The aim of this study was to explore Australian sonographers' views on communicating adverse findings, including their level of autonomy in communicating with patients and how this influences their sense of professional identity. METHODS: Following a national survey, seven purposively selected participants, who were qualified to perform obstetric ultrasound examinations, completed follow-up interviews. The interviews were thematically analysed with iterative comparison to the survey results. Three case studies show sonographers differed in their 'communicator type' due to geographical location and workplace setting. RESULTS: The case studies illustrate a sonographer's communication role, and level of autonomy is negotiated/renegotiated depending on the needs and expectations of each workplace. Their communication practices varied due to the sonologist (radiologist/obstetrician) policy on sonographer/patient communication, presence and support in the clinical setting. A strong professional identity and level of autonomy came from the construction of attributes that were built over time based on multiple factors, including previous experience, geographical location, critical incidents, training and supportive work environments. CONCLUSION: The sonography profession demands autonomy and a strong professional identity free of hierarchical barriers within a collaborative model of care.

The Effect of Ethnicity on 2D and 3D Frontomaxillary Facial Angle Measurement in the First Trimester.

Objectives. To determine the existence and extent of ethnic differences in 2D or 3D fetal frontomaxillary facial angle (FMFA) measurements. Methods. During routine 11-14 weeks nuchal translucency screening undertaken in a private ultrasound practice in Sydney, Australia, 2D images and 3D volumes of the fetal profile were collected from consenting patients. FMFA was measured on a frozen 2D ultrasound image in the appropriate plane and, after a delay of at least 48 hours, was also measured on the reconstructed 3D ultrasound volume offline. Results. Overall 416 patients were included in the study; 220 Caucasian, 108 north Asian, 36 east Asian and 52 south Asian patients. Caucasians had significantly lower median FMFA measurements than Asians in both 2D (2.2°; P < 0.001) and 3D (3.4°; P < 0.001) images. Median 2D measurements were significantly higher than 3D measurements in the Caucasian and south Asian groups (P < 0.001 and P = 0.04), but not in north and east Asian groups (P = 0.08 and P = 0.41). Conclusions. Significant ethnic variations in both 2D and 3D FMFA measurements exist. These differences may indicate the need to establish ethnic-specific reference ranges for both 2D and 3D imaging.

Comparison of frontomaxillary facial angles using both 2D and 3D ultrasound at 11+0 to 13+6 weeks of gestation.

INTRODUCTION: The aim of this study is to (i) directly compare both two-dimensional (2D) and three-dimensional (3D) frontomaxillary facial angle (FMFA) in first trimester, and (ii) to assess the ease with which both may be performed. MATERIALS AND METHODS: Both 3D volumes of the fetal head and 2D fetal profiles were collected from 251 consenting patients during routine first-trimester nuchal translucency (NT) screening. The FMFA in 2D was measured at the time of the NT screening. The 3D FMFA was measured offline. RESULTS: The 2D FMFA was systematically higher than the 3D FMFA. The difference in 3D-2D FMFA was statistically significant from 11+0 to 12+3 weeks. From 12+4 to 13+6 weeks the difference was no longer significant with p = 0.06. Performing the measurement did not unduly increase the time of the study. Even for the experienced sonographer the technique is technically difficult, relying on many factors for accurate caliper placement. DISCUSSION: The 2D FMFA is greater than the 3D angle. This was found in previous studies, but not thought to be statistically significant. The difference decreased with increasing gestational age. There is a learning curve associated with performing this measurement. Normative data for both 2D and 3D, incorporating ethnicity, may be necessary before inclusion in the first-trimester algorithm.

Collecting sensitive data: the impact on researchers.

The authors undertook an exploratory study to identify issues that arose for researchers while conducting fieldwork. Ten researchers engaged in "sensitive" inquiry were purposefully sampled and encouraged to talk about their experiences during the data collection process. Interviews were transcribed and common themes identified. The findings indicate that these researchers experienced a number of difficulties that centered around issues of lack of training, confidentiality, role conflict, costs to the participants, the desire for reciprocity, and feelings of isolation. The authors discuss the implications of the findings, including the need for support for researchers for further research.