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Pregnant people and parents engage with social media networking sites seeking support and information that is shared in a relatable way. Engaging with social media influencers (SMIs) and their followers, however, may have both affirming and harmful effects. SMIs can facilitate information-sharing, discussion, and supportive behaviors, but engaging with SMIs can lead to negative experiences and exposure to misinformation. To date, little is known about the impacts of following influencers during pregnancy and early parenthood. The aim of this study was to explore how engaging with SMIs impacts pregnant people and parents of children aged 5 or under in Australia. A qualitative descriptive approach was taken. Qualitative data from 85 anonymously completed online written surveys were thematically analyzed using Braun & Clarke's six-step process. Five overarching themes and two subthemes were identified. The first theme, "Comparisons of self," held two subthemes: "Unfavorable comparisons of self to SMIs" and "Favorable comparisons of self to SMIs." Additional themes were "A virtual community of inspiration and togetherness," "Sharing of information, opinions & experiences," "Gatekeeping self-efficacy," and "Credibility." The findings of the study indicated that discordance between influencer-mediated expectations of parenthood and a person's actual experience may affect well-being and perceptions of parental self-efficacy. Information sought from influencers may substitute for face-to-face education by clinicians. Health professionals who are also influencers may possess the ability to provide evidence-based information. This content, however, is not without risk for bias or incompleteness.
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Responsabilidad Parental , Medios de Comunicación Sociales , Femenino , Embarazo , Niño , Humanos , Investigación Cualitativa , Padres , ComunicaciónRESUMEN
Mental health disorders are responsible for 125.3 million disability-adjusted life years (DALYs) lost globally, with depression in adolescents rising faster than in adults. In total, more than 90% of the 1.2 billion adolescents in the world live in low- and middle-income countries (LMICs). Despite the rise in teenage marriage and pregnancy in LMICs, there is a paucity of research on the role of pregnancy as a risk factor for adolescent mental health, and the role of spousal connectedness as a potential protective factor. This study aims to address this gap. A total of 2408 currently married adolescent (aged 15-19 years) women from the Bangladesh Adolescent Health and Wellbeing Survey 2019-2020 were analysed. Multivariable models were used to assess the factors associated with depression symptoms and major depressive disorder (MDD). The prevalence of moderate/severe depressive symptoms or MDD among adolescents was 14.6%, well ahead of south Asian levels. The odds of having moderate/severe depressive symptoms (adjusted odds ratio [AOR]=1.94, 95% confidence interval [CI] 1.37-2.76) or MDD (AOR=1.63, 95%CI 1.18-2.25) were higher in pregnant adolescent women than in non-pregnant adolescent women. A closer relationship with one's husband reduced the risk of developing moderate/severe depressive symptoms (AOR=0.90, 95% CI 0.84-0.96) or MDD (AOR=0.91, 95% CI 0.86-0.97). Pregnancy and connectedness had no statistically significant interaction effect on depression. There is an urgent need for affordable and scalable interventions to reduce the risk of mental health morbidity in pregnant adolescent women especially in low- and middle-income countries.
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Trastorno Depresivo Mayor , Adulto , Embarazo , Femenino , Humanos , Adolescente , Trastorno Depresivo Mayor/epidemiología , Matrimonio , Salud Mental , Bangladesh/epidemiología , Salud del AdolescenteRESUMEN
BACKGROUND: Bangladesh outperforms its Least Developed Country (LDC) status on a range of health measures including life expectancy. Its frontline medical practitioners, however, are not formally trained medical professionals, but instead lightly-trained 'village doctors' able to prescribe modern pharmaceuticals. This current study represents the most complete national survey of these practitioners and their informal 'clinics'. METHODS: The study is based on a national Computer Assisted Telephone Interviewing (CATI) of 1,000 informal practitioners. Participants were sampled from all eight divisions and all 64 districts of Bangladesh, including 682 participants chosen from the purposively recruited Refresher Training program conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), supplemented with 318 additional participants recruited through snowball sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: In addition to demographics, village doctors were asked about the characteristics of their 'clinics' including their equipment, their training, income and referral practices. RESULTS: Three quarters of the wholly male sample had not completed an undergraduate program, and none of the sample had received any bachelor-level university training in medicine. Medical training was confined to a range of short-course offerings. Village doctor 'clinics' are highly dependent on the sale of pharmaceuticals, with few charging a consultation fee. Income was not related to degree of short-course uptake but was related positively to degree of formal education. Finally, practitioners showed a strong tendency to refer patients to the professional medical care system. CONCLUSIONS: Bangladesh's village doctor sector provides an important pathway to professional, trained medical care, and provides some level of care to those who cannot afford or otherwise access the nation's established healthcare system. However, the degree to which relatively untrained paramedical practitioners are prescribing conventional medicines has concerning health implications.
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Personal de Salud , Médicos , Humanos , Masculino , Bangladesh , Comercio , Preparaciones FarmacéuticasRESUMEN
BACKGROUND: Evidence suggests that fluctuations of cortisol and physiological parameters can emerge during the course of mild Traumatic Brain Injury (mTBI). OBJECTIVE: To investigate fluctuations of cortisol and physiological parametersduring the acute phase of mTBI in hospitalized patients. METHODS: 30 participants (19 patients with mTBI and 11 controls) were examined for saliva cortisol dynamics, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and body temperature (BT) fluctuations for four consecutive days. Also, the participants completed the Athens Insomnia Scale and Epworth Sleepiness Scales, in order to check for sleep problems. RESULTS: Patients showed elevated levels of cortisol relative to controls (peak at 8 am and lowest levels at 12 am), as well as for most physiological parameters. MAP was significantly higher for patients throughout the measurement period, and BT was elevated for patients relative to controls at almost all measurements of the first and second day. Mean HR tended to track at non-significantly higher levels for the mTBI group. Patients' sleepiness and insomnia values (ESS and AIS) were initially significantly higher relative to controls but the difference dissipated by day 4. CONCLUSION: The increase in absolute values of cortisol and physiological parameters measurements, indicates that in the acute phase of mTBI, a stressful process is activated which may affect sleep quality as well.Supplemental data for this article is available online at at doi: 10.1080/00207454.2021.1951264.
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Conmoción Encefálica , Lesiones Encefálicas , Trastornos del Inicio y del Mantenimiento del Sueño , Humanos , Hidrocortisona , Saliva , SomnolenciaRESUMEN
AIM: The aim of the study is to identify and map what is known about workplace violence involving midwives in Australia and New Zealand. BACKGROUND: Research from the United Kingdom demonstrates that workplace violence within maternity services is a pervasive issue with significant and wide-ranging clinical, individual and organisational consequences. To date, little is known about this issue within Australian and New Zealand maternity services. EVALUATION: A scoping review, guided by Arksey and O'Malley's framework, was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Just one identified study aimed to explore midwives' experiences of workplace violence. A further nine arrived at related results or themes. KEY ISSUES: Workplace violence is present in a variety of forms across maternity services in Australia and New Zealand. Its prevalence is, however, yet to be understood. Workplace violence causes physical and mental health issues for midwives, premature workforce attrition, and jeopardizes the quality and safety of maternity care. CONCLUSIONS: Workplace violence has been acknowledged as one of the key contributing factors towards premature attrition from the midwifery profession, with new graduate midwives most likely to leave. With the midwifery workforce ageing and evidence of serious clinical implications emerging, workplace violence needs urgent research and organisational attention. IMPLICATIONS FOR NURSING MANAGEMENT: Workplace violence is a key contributing factor towards recruitment and retention challenges for managers. To help tackle this, managers have a key role to play in identifying and effectively addressing workplace violence by acting as positive role models, taking a zero-tolerance approach and fostering collegial relationships. Managers, holding key clinical leadership positions, are pivotal to ensuring all complaints raised are handled with transparency and consistency regardless of one's position within the clinical hierarchy and organisational structure.
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Partería , Violencia Laboral , Australia , Femenino , Fuerza Laboral en Salud , Humanos , Servicios de Salud Materna , Nueva Zelanda , Enfermeras Obstetrices/psicología , EmbarazoRESUMEN
AIM: COVID-19 rapidly transformed how Australians access health care services. This paper considers how the inability for urban patients to access in-person care expediated the introduction of virtual solutions in health service delivery thus creating a new access paradigm for rural and remote Australians. CONTEXT: 'Physical distancing' is a phrase synonymous with public health responses to COVID-19 in Australia, but distance is a decades-long problem for rural health access. Counterintuitively, the pandemic and associated restrictions on mobility have reduced in real terms the distance from, and therefore the time taken to access, critical public services. 'Lockdowns' have unlocked health access for rural and remote Australians in ways that had been rejected prior to 2020. The pandemic has disrupted traditional delivery models and allowed the piloting of novel solutions, at the same time as stress-testing current delivery systems. In the process, it has laid bare a myopia we term 'urban paternalism' in understanding and delivering rural health. APPROACH: This commentary outlines how the COVID-19 operating environment has challenged traditional urban-dominated policy thinking about virtual health care delivery and how greater availability of telehealth appointments goes some way to reducing the health access gap for rural and remote Australians. CONCLUSION: Australian Commonwealth Government policy changes to expand the Medical Benefit Scheme (MBS) to include telephone or online health consultations are a positive initiative towards supporting Australians through the ongoing public health crisis and have also created access parity for some rural and remote patients. Although initially announced as a temporary COVID-19 measure in March 2020, telehealth has now become a permanent feature of the Medicare landscape. This significant public health reform has paved the way for a more flexible and inclusive universal health care system but, more importantly, taken much needed steps towards improving access to primary health care for patients in rural and remote areas. Now the question is: Can the health care system integrate this virtual model of delivery into 'business as usual' to ensure the long-term sustainability of telehealth services to rural and remote Australia?
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COVID-19 , Telemedicina , Anciano , Australia , Control de Enfermedades Transmisibles , Reforma de la Atención de Salud , Humanos , Programas Nacionales de Salud , PandemiasRESUMEN
OBJECTIVE: This systematic review explores changes in perinatal empathy and influence on maternal behaviours and child development. BACKGROUND: The well-being and development of infants are commonly linked to their mothers' capacity for empathy. However, characteristic changes during pregnancy and childbirth including sleep deprivation, mood and cognitive difficulties may disrupt empathic processing. METHODS: Original research papers (n = 7413) published in English language peer-reviewed academic journals were obtained by searching four electronic databases PsycINFO, PubMed, Scopus and CINAHL. Inclusion criteria were studies reporting empathy of women in the period from pregnancy to 12 months postpartum. Empathy was operationalised as a general tendency of empathic emotional responding and cognitive perspective taking. Thirteen studies were systematically assessed using the Critical Appraisal Skills Programme criteria. RESULTS: Impaired empathy in mothers, due most notably to high personal distress, was associated with risk of neglect or maltreatment of children and was partially explained by mothers' aversive response to infant crying. CONCLUSION: Few studies present empathy as a central theme. There is a paucity of definitional parameters and theoretical linkages and over-reliance on brief self-report indices of empathy. Future studies need to be theory based, incorporate experimental approaches, and provide greater sampling diversity toadvance our understanding of empathy in perinatal women.
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Empatía , Relaciones Madre-Hijo , Madres/psicología , Mujeres Embarazadas/psicología , Desarrollo Infantil , Crianza del Niño , Femenino , Humanos , Lactante , Conducta Materna/psicología , EmbarazoRESUMEN
BACKGROUND: Intensive care unit (ICU) patients experience two affronts to normal 24-h rhythms: largely internal events such as medication and external factors such as light, noise and nursing interventions. AIMS AND OBJECTIVES: We investigated the impact of light variance within an ICU on 24-h rhythmicity of three key physiological parameters: heart rate (HR), mean arterial blood pressure (MAP) and body temperature (BT) in this patient population. DESIGN: Patients were assigned to beds either in the 'light' or 'dark' side within a single ICU. An actigraph continuously recorded light intensity for a 24-72-h period. METHODS: Measurements of HR, MAP and BT were recorded every 30 min. RESULTS: HR, MAP and BT did not follow 24-h rhythmicity in all patients. Higher light exposure in the Light Side of the ICU (122·3 versus 50·6 lx) was related to higher HR (89·4 versus 79·8 bpm), which may translate to clinically relevant outcomes in a larger sample. Duration of stay, the one clinical outcome measured in this study, showed no significant variation between the groups (p = 0·147). CONCLUSIONS: ICU patients are exposed to varying light intensities depending on bed positioning relative to natural sunlight, affecting the 24-h rhythm of HR. Larger, well-controlled studies also investigating the effect of relevant light intensity are indicated. RELEVANCE TO CLINICAL PRACTICE: Light is a variable that can be manipulated in the constrained environment of an ICU, thus offering an avenue for relatively unobtrusive interventions.
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Presión Arterial/fisiología , Temperatura Corporal/fisiología , Ritmo Circadiano/fisiología , Enfermería de Cuidados Críticos/métodos , Frecuencia Cardíaca/fisiología , Luz , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Low birth weight (LBW) remains a leading global cause of childhood morbidity and mortality. This study leverages a large national survey to determine current prevalence and socioeconomic, demographic and heath related factors associated with LBW in Bangladesh. METHODS: Data from the Multiple Indicator Cluster Survey (MICS) 2012-13 of Bangladesh were analyzed. A total of 2319 women for whom contemporaneous birth weight data was available and who had a live birth in the two years preceding the survey were sampled for this study. However, this analysis only was able to take advantage of 29% of the total sample with 71% missing birth weight for newborns. The indicator, LBW (< 2500 g) of infants, was examined as the outcome variable in association with different socioeconomic, demographic and health-related covariates. Mixed-effects logistic regression was performed to identify possible factors related to LBW. RESULTS: In the selected sub-sample, about 20% of infants were born with LBW, with lowest rates observed in Rajshahi (11%) and highest rates in Rangpur (28%). Education of mothers (adjusted odds ratio [AOR] 0.52, 95% confidence interval [CI] 0.39-0.68 for secondary or higher educated mother) and poor antenatal care (ANC) (AOR 1.40, 95% CI 1.04-1.90) were associated with LBW after adjusting for mother's age, parity and cluster effects. Mothers from wealthier families were less likely to give birth to an LBW infant. Further indicators that wealth continues to play a role in LBW were that place of delivery, ANC and delivery assistance by quality health workers were significantly associated with LBW. However there has been a notable fall in LBW prevalence in Bangladesh since the last comparable survey (prevalence 36%), and an evidence of possible elimination of rural/urban disparities. CONCLUSIONS: Low birth weight remains associated with key indicators not just of maternal poverty (notably adequate maternal education) but also markers of structural poverty in health care (notably quality ANC). Results based on this sub-sample indicate LBW is still a public health concern in Bangladesh and an integrated effort from all stakeholders should be continued and interventions based on the study findings should be devised to further reduce the risk of LBW.
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Recién Nacido de Bajo Peso , Adolescente , Adulto , Bangladesh , Femenino , Política de Salud , Encuestas Epidemiológicas , Humanos , Salud del Lactante , Recién Nacido , Modelos Logísticos , Masculino , Salud Materna , Persona de Mediana Edad , Factores de Riesgo , Factores Socioeconómicos , Adulto JovenRESUMEN
PROBLEM: Whistleblowing, which involves raising concerns about wrongdoing, carries risks yet can be crucial to ensuring the safety of health service users in maternal and newborn healthcare settings. Understanding of the experiences of health care professionals that enact whistleblowing in this context is currently limited. BACKGROUND: Notable inquiries involving maternity services such as those reported upon by Ockenden and Kirkup and the Lucy Letby case in the United Kingdom have shone an international spotlight on whistleblowing failures. AIM: To identify and synthesise available literature addressing the experiences of healthcare professionals enacting whistleblowing in maternal and newborn care settings. METHODS: This scoping review followed Arksey and O'Malley's framework. Five academic databases were systematically searched for documents published between January 2013 and October 2023 with additional searches of Google Scholar and related reference lists. FINDINGS: Whilst 35 papers from international sources were identified, the majority originated from the United Kingdom, where recent high-profile incidents have occurred. Thematic analysis identified three main themes: 'Structural Power', 'Perfectionism' and 'Bravery, Hope and Disappointment', each with sub-themes. DISCUSSION: Whistleblowing is frequently an altruistic act in a hierarchical system. It exposes poor practices and disrupts power dynamics, especially in challenging workplace cultures. Open disclosure, however, requires psychological safety. Obstacles persist, emphasising the need for a culture of trust and transparency led by individuals who embody the desired values. CONCLUSION: Primary research on whistleblowing in maternal and newborn healthcare settings is limited. This study sheds light on power dynamics and factors that affect whistleblowing.
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Personal de Salud , Denuncia de Irregularidades , Humanos , Femenino , Personal de Salud/psicología , Recién Nacido , Embarazo , Servicios de Salud Materna , Actitud del Personal de Salud , Servicios de Salud Materno-InfantilRESUMEN
BACKGROUND: Malnutrition in children with neurodevelopmental disorders (NDDs) is a significant global public health issue. Nutritional assessment combined with management or advice are essential to produce optimal outcomes. OBJECTIVES: The objective of this study was to assess nutritional status and the sociodemographic profile of children with neurodevelopmental disorders in Bangladesh. METHODS: A cross-sectional study was conducted from December to April 2020 among the population of children with NDDs who presented to the pediatric department of the TMSS Medical College and Rafatullah Community Hospital in Bogura during this period. Socio-demographic data along with anthropometric measurements of the children were taken. Assessment of nutritional status were made using metrics such as z-scores for weight-for-age (WAZ), height-for-age (HAZ), and body mass index-for-age (BAZ). Descriptive statistics (number and percentage) and analytical statistics (chi-square and logistic regression) were included. RESULTS: 58.6% of children displayed malnutrition, with 47.8% showing undernutrition (WHZ / BAZ - 1 SD-≤-3 SD), and 10.8% overnutrition (BAZ > 2SD). Significant negative associations were found between malnutrition and parental education level, urban residency, and monthly family income. Children diagnosed with cerebral palsy exhibited twice the likelihood to be malnourished (AOR 2.39, 95% CI 0.83-6.87). Furthermore, residing in rural regions was associated with an increased risk of experiencing malnutrition, as indicated by an adjusted odds ratio of 1.60 (95% CI 0.12-3.09). CONCLUSIONS: While the results are cross-sectional, over half of children with NDDs were found to be malnourished, suggesting that children with NDD in Bangladesh are vulnerable to developing any form of malnutrition. Therefore, regular assessments and timely nutritional support may improve their situation.
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Interpreters occupy a complex position in police interviews involving domestic violence cases-neutral but necessary parties to traumatic content. The following systematic review explores the relatively sparse scholarly literature on interpreters' psychological responses to being a party to domestic violence interviews in a policing context. This article aims to explore themes of relevant studies targeting interpreters' mental health in such cases, with nine articles emerging from a comprehensive search of eight databases supplemented with a Google Scholar search. Various themes involving interpreters emerged from the ensuing analysis, including intrinsic difficulties, misguided expectations, role requirements, psychological impacts, posttraumatic growth, coping strategies, and recommendations for future research and practice, with findings holding implications for interpreting in other traumatic domains.
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BACKGROUND: Pregnant and new parents are increasingly engaging with social media. The impacts of engaging with social media 'influencers' and 'bloggers' during a time of heightened vulnerability to influence, in particular, merits exploration. AIM: To systematically review the literature to identify what is known about how following social media 'influencers' and 'bloggers' impacts pregnant and new parents' experiences and decision-making. METHODS: A search of CINAHL, World of Science, Medline, EMBASE and Google Scholar databases was undertaken in January 2023 to identify the literature focusing on the impacts of engaging with influencers or bloggers as pregnant or new parents. The reference lists of the included papers were hand-searched. Data were extracted from each paper, tabulated, and thematically analysed. The review was reported using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS: Seventeen papers met the inclusion criteria and were included in the final synthesis. Thematic analysis revealed four overarching themes, which were 'sharing information', 'support', 'identity', and 'monetisation'. DISCUSSION: Social media influencers provide a network of peers amongst whom discussions, supportive behaviours, and information sharing take place. However, concern arises around the potential for combative interactions, the risk for transmission of misinformation, and the potential impacts of following influencers who are also qualified health professionals. CONCLUSION: Existing research suggests that engaging with social media influencers can be both beneficial and harmful for pregnant and new parents. At the current time, it is unclear how exposure to the benefits or harm impacts personal experiences and decision-making.
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Responsabilidad Parental , Medios de Comunicación Sociales , Embarazo , Femenino , Humanos , Parto , Padres , Personal de SaludRESUMEN
This study examines health regulation under conditions of geographical constraint in two strikingly different settings, one on a remote island in Bangladesh and the other in an impoverished rural region in Australia. Both suffer from an absence of medically qualified professionals, which means that in the resultant vacuum, patients access alternative healthcare. The concept of regulation (or lack of regulation) is explored in terms of unconventional new responses to rural health deficits. The two cases show unexpected commonality, with policymakers facing shared challenges beyond physical remoteness. The difference in the degree of enforcement of regulation offers the greatest point of difference. This comparative study revealed a weak health regulatory system in the remote Bangladesh area of Bhola Island where 'alternatives' to formal clinical approaches have become the default choice. Brazen stop-gap servicing is commonplace on Bhola Island, but in The Gemfields such practices only occur in the shadows or as a last resort. Each isolated location, one in a developing country and the other in a developed setting, exemplifies how geographical remoteness can present an opportunity for innovations in supply to emerge. Surprisingly, it is the developing world case that better leverages a regulatory void to respond to local healthcare needs.
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Radar , Servicios de Salud Rural , Bangladesh , Atención a la Salud , Instituciones de Salud , Humanos , Población RuralRESUMEN
OBJECTIVES: Despite a significant decline over time, maternal mortality remains high in Bangladesh. Institutional delivery during childbirth is crucial to reducing maternal mortality, but uptake of institutional delivery services (IDS) remains suboptimal in Bangladesh. Though women's education plays a crucial role in the use of IDS, the educational status of the household head and area-level literacy rate also appear to act as predictors of IDS uptake. This study aims to assess the effect of the educational status of women and household heads as well as district-level adult literacy rates on the use of IDS during childbirth among women in Bangladesh. DESIGN: This study analyzed nationally representative cross-sectional survey data from the 2019 Bangladesh Multiple Indicator Cluster Survey. SETTING: Bangladesh. PARTICIPANTS: 9,207 currently married women aged 15-49 years who had at least one live birth in the two years preceding the survey were included in the study. The outcome measure was women's use of IDS during their last childbirth. A multilevel logistic regression model was used to explore the association between education status of women and household heads, and district (i.e., area unit) adult literacy rates and uptake of IDS among women in Bangladesh by controlling for other sociodemographic covariates and clustering. RESULTS: About 53% of women used IDS during childbirth. Adjusting for other factors and clustering, women with higher educational status, those living in households with higher-educated heads, and those in districts with greater adult literacy rates are more likely to use IDS, after controlling for key sociodemographic variables including wealth. CONCLUSIONS: Uptake of IDS in Bangladesh remains low, with education playing an important independent role in determining rates. The findings of the study provide empirical evidence for policymakers to design multi-modal educational programs targeted not only at literate women but also at household head (especially male) and communities where literacy (and equally importantly health literacy) may be variable or absent.
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Mortalidad Materna , Adulto , Bangladesh , Estudios Transversales , Escolaridad , Femenino , Humanos , Masculino , Factores SocioeconómicosRESUMEN
The context within which midwifery students are professionally socialised is thought to impact upon the development of their sense of belongingness, their attitudes and values, and their commitment to the midwifery profession. Negative forms of socialisation are known to lead to undesirable outcomes including desensitisation about humanistic needs. This has potential to extend to an acceptance of workplace bullying and unfair treatment of others, including midwifery students whilst on clinical placement. This study aimed to explore how the social culture of the maternity setting influences midwifery students' experiences of being bullied whilst on clinical placement. One hundred and twenty midwifery students from Australia and the United Kingdom completed a qualitative online survey and the data was thematically analysed. One main overarching theme and four sub themes were identified. These were: 'the organisational culture of acceptance: "in front of"', 'brazen expression', 'group buy-in', 'suppression of dissent', and 'collateral damage'. Each of these factors enabled replication of the problem and led to perpetuation of the bullying cycle. This study illuminated that an entrenched culture of acceptance exists which impacts the students educational experience, the care received by mothers and babies, and the reputation of the midwifery profession.
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Acoso Escolar , Partería , Estudiantes de Enfermería , Australia , Femenino , Humanos , Embarazo , Reino UnidoRESUMEN
PROBLEM: Bullying in the midwifery profession has been documented and the problem is now known to extend to the poor treatment of midwifery students. In nursing, research has shown that bullying in the clinical workplace can adversely impact on quality of care. To date, no research has explored whether the bullying of midwifery students has secondary impacts on the experiences and care of mothers, babies, and their support persons. AIM: To examine how midwifery students, who self-identify as having been bullied, perceive the repercussions on women and their families. METHODS: This qualitative descriptive study explored 120 Australian and United Kingdom (UK) based midwifery students. Data were collected using an anonymous online qualitative survey and were thematically analysed. FINDINGS: The findings suggest that the bullying of midwifery students impacts women and their families in a number of ways. Midwifery students perceive that mothers and babies are frequently implicated either directly or indirectly in the enactment of bullying. This can impact their safety, fractures relationships, and impairs the women's confidence in the student and the profession. Students additionally reported that women and/or their support persons can feel compelled to step in to defend and protect the student. CONCLUSIONS: The bullying of midwifery students is perceived to place women at risk, in uncomfortable situations, damage rapport and undermines their confidence in students and the profession. This also impacts adversely on the student's ability to provide women centred care as they lose confidence in front of the woman and her family when they are bullied by registered midwives.
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Acoso Escolar , Partería , Estudiantes de Enfermería , Australia , Femenino , Humanos , Madres , Percepción , Embarazo , Investigación CualitativaRESUMEN
PROBLEM: An increasing body of research suggests midwifery students experience bullying and harassment whilst on clinical placement. Little is known, however, about factors that foster bullying within this context and how they may be addressed. AIM: To explore and describe midwifery students' perceptions of what modifiable organisational factors foster bullying behaviours and to map the identified factors against the students' perceptions of a solution. METHODS: A qualitative descriptive design was used. A total of 120 midwifery students from the United Kingdom and Australia participated in this study. Participants completed an online qualitative survey and data was thematically analysed. FINDINGS: The midwifery students in this study perceive that several organisational factors exist that help foster bullying behaviours towards them whilst undertaking clinical placement. Three overarching themes were identified relating to ineffective midwifery mentorship, the high stress environment of the maternity unit, and challenges faced with transparency and whistleblowing. Students identified a range of potential structural responses to bullying. CONCLUSIONS: Recommendations are made that midwifery managers and academics acknowledge how students perceive several potentially modifiable organisational factors which either lead to or exacerbate the likelihood of them being the target of bullying whilst on clinical placement. Consideration should be given to solutions that from the student's perspective may help tackle bullying and subsequently lead to fewer students leaving midwifery education and further depleting the future workforce.
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Acoso Escolar , Partería , Estudiantes de Enfermería , Femenino , Humanos , Percepción , Embarazo , Investigación Cualitativa , Encuestas y CuestionariosRESUMEN
BACKGROUND: Dengue virus, an Aedes mosquito-borne flavivirus, is associated with close to 400 million reported infections per annum worldwide. Reduction of dengue virus transmission depends entirely on limiting Aedes breeding or preventing adult female contact with humans. Currently, the World Health Organization promotes the strategic approach of integrated vector management in order to optimise resources for mosquito control. MAIN TEXT: Neglected tropical disease researchers focus on geographical zones where the incidence of clinical cases, and prevalence of vectors, are high. In combatting those infectious diseases such as dengue that affect mainly low-income populations in developing regions, a mosquito-centric approach is frequently adopted. This prioritises environmental factors that facilitate or impede the lifecycle progression of the vector. Climatic variables (such as rainfall and wind speed) that impact the vector's lifecycle either causally or by happenstance also affect the human host's 'lifecycle', but in very different ways. The socioeconomic impacts of the same variables that influence vector control impact host vulnerability but at different points in the human lifecycle to those of the vector. Here, we argue that the vulnerability of the vector and that of the host interact in complex and unpredictable ways that are characteristic of (complex and intransigent) 'wicked problems'. Moreover, they are treated by public health programs in ways that may ignore this complexity. This opinion draws on recent evidence showing that the best climate predictors of the scale of dengue outbreaks in Bangladesh cannot be explained through a simple vector-to-host causal model. CONCLUSIONS: In mapping causal pathways for vector-borne diseases this article makes a case to elevate the lifecycle of the human host to a level closer in equivalence to that of the vector. Here, we suggest value may be gained from transferring Rittel and Webber's concept of a wicked (social) problem to dengue, malaria and other mosquito-transmitted public health concerns. This would take a 'problem definition' rather than a 'solution-finding' approach, particularly when considering problems in which climate impacts simultaneously on human and vector vulnerability.