Perspectives about the baby friendly hospital/health initiative in Australia: an online survey.

BACKGROUND: Evidence supports the health and economic benefits of breastfeeding, and the positive impact of the Baby Friendly Health Initiative (BFHI) on increasing breastfeeding rates and improving breastfeeding outcomes. The BFHI is a World Health Organization and United Nations International Children's Emergency Fund initiative to promote, support and maintain breastfeeding. The BFHI was updated in 2018 and includes the Ten Steps to Successful Breastfeeding (the Ten Steps 2018) and the International Code of Marketing of Breast-milk Substitutes (the WHO Code). Despite policy and guideline support for breastfeeding and the BFHI, there are currently only 70 accredited hospitals, healthcare centres and regional clusters in Australia, accounting for 23% of maternity facilities. This research aimed to explore health professionals and other stakeholders' perspectives on the uptake and implementation of the BFHI in Australia from an organisational change perspective. METHODS: An online survey administered via relevant Australian-based professional associations was fully or partially completed by 332 participants who support mothers and newborns in their roles. Descriptive statistics and content analysis were used to analyse quantitative and qualitative data. RESULTS: The majority of participants supported legislating the WHO Code, closely monitoring BFHI compliance, ensuring sufficient knowledge about breastfeeding and the BFHI among staff, improving care within maternity facilities, continuous support of mothers' post-discharge, and improving social media support of breastfeeding. It was also perceived that an interdisciplinary team approach and multidisciplinary involvement were important requirements for successfully implementing the BFHI. There was no consensus among participants that Australian health policies support breastfeeding and the implementation of the BFHI. CONCLUSIONS: This study emphasised the significance of legislation around the Code, executive and leadership support and culture, and providing adequate resources concerning uptake and implementation of the BFHI. Considering that uptake of the BFHI has been limited and no formal government support has been provided to further develop the BFHI and support the Code in Australia, findings of this research may help with potential future actions to facilitate the BFHI uptake and Code implementation.

The uptake and implementation of the Baby Friendly Health Initiative in Australia.

PROBLEM: Despite evidence that implementation of the Initiative has been effective in increasing breastfeeding rates and duration of breastfeeding worldwide; the uptake is low with only 70 Baby Friendly accredited maternity facilities across Australia (approximately 23% of facilities). BACKGROUND: The Ten Steps to Successful Breastfeeding and International Code of Marketing of Breastmilk Substitutes shaped the foundation for the Initiative to implement practices that protect, promote and support breastfeeding. There is evidence that implementation of the Initiative is impacted by individual and organisational culture, organisational support, and education. Organisational change is also identified as playing an important role in the successful implementation of the Initiative. Despite policy and guideline support for the Initiative at national and state levels in Australia the uptake of the Initiative is low. AIM: The aim of this research was to explore health practitioners' perspectives about the uptake and implementation of the Initiative in Australia. METHODS: Semi-structured, face-to-face, telephone and Skype interviews were conducted with 12 health practitioners. Thematic analysis was used to analyse data. RESULTS: Participants identified that the uptake and implementation of the Initiative in Australia is complex. This complexity was related to six themes: (1) policy and guideline support for the Initiative, (2) leadership support to implement the Initiative, (3) improving breastfeeding and Initiative-related knowledge, (4) improving communication between stakeholders regarding the Initiative, (5) accreditation and reaccreditation processes, and (6) implementation complexity. CONCLUSION: Using organisational change theories as a guide to implementation of the Initiative may be useful for facilities intending to become accredited.

Legislation, policies and guidelines related to breastfeeding and the Baby Friendly Health Initiative in Australia: a document analysis.

Objectives The aim of the present study was to assess the extent to which publicly available legislation, policy and guidelines related to breastfeeding and the Baby Friendly Health Initiative (BFHI) underpin and support the uptake and implementation of the BFHI in Australia. Methods Altheide's document analysis model (sample, data collection, data organisation, data analysis and report) was used to source and analyse publicly available legislation, policies and guidelines in Australia that were related to breastfeeding and the BFHI at national, state and professional organisational levels. Results Legislation documents contained no direct references to the BFHI or Code of Marketing of Breast-milk Substitutes, despite the documents being supportive of breastfeeding. There is little reference to the Code of Marketing of Breast-milk Substitutes or to monitoring of the Marketing in Australia of Infant Formulae (MAIF) Agreement at national and state levels. A gap exists in documents that provide up-to-date records regarding monitoring of breastfeeding rates at the national level. Conclusions National and state guidelines are supportive of breastfeeding and the BFHI. However, the BFHI and Code of Marketing of Breast-milk Substitutes are not legislated in Australia and information related to breastfeeding rates is not up to date. A legislative establishment supporting the Code and establishing plans to monitor the MAIF Agreement and breastfeeding outcomes may influence uptake and implementation of the BFHI. What is known about the topic? Extensive evidence supports the health and economic benefits of breastfeeding. Despite a high initiation rate of breastfeeding in Australia (96%) most recently reported in 2010, the rate of breastfed infants dropped considerably over time: approximately 15% of infants were breastfed for the recommended 6 months. Research supports the positive effect of the BFHI on increasing breastfeeding rates and improving breastfeeding outcomes. In 2016, there are 69 Baby-friendly-accredited maternity facilities across Australia, compared with 77 accredited facilities in 2011 (~23% of all maternity facilities). What does this paper add? This is the first document analysis of publicly available legislation, policy and guidelines related to breastfeeding and the BFHI at Australian national, state and professional organisational levels to assess the extent to which these documents support breastfeeding, as well as the uptake and implementation of the BFHI. This study identifies strengths and weaknesses at legislative, policy and guideline levels that could potentially influence the uptake and implementation of the BFHI. What are the implications for practitioners? The uptake and implementation of the BFHI is potentially influenced by legislation, policy and guidelines at national and state levels. Given the low uptake of the BFHI in Australia, this analysis outlines the extent to which these documents support breastfeeding and the BFHI, and indicates what these documents lack with regard to supporting the uptake and implementation of the BFHI.

Impact of Service-Learning on Leadership and an Interest in Social Justice.

BACKGROUND: Many articles describe how service-learning has been implemented, but few studies have demonstrated its effectiveness. METHOD: A service-learning component was added to a course in a registered nurse-to-baccalaureate degree (RN-to-BSN) completion program. The service-learning component included a 5-hour service requirement and class discussions. The purpose of this study was to evaluate service-learning's impact on postlicensure RN-to-BSN students' self-evaluation of their leadership skills and their interest in social justice. This study used a quantitative, pretest-posttest control group design and a Likert scale survey. RESULTS: Variations in precourse and postcourse responses of the control group did not demonstrate a measurable effect; responses of the service-learning group revealed a small effect size for both the leadership construct and the social justice construct. CONCLUSION: This study was unique in that it addressed nontraditional RN-to-BSN students in an accelerated program, 70% of whom were taking the course in an online format.

What constitutes 'support' for the role of the Aboriginal and Torres Strait Islander child health workforce?

As well as providing primary health care services, Aboriginal and Torres Strait Islander health workers are known to significantly contribute to the overall acceptability, access and use of health services through their role of cultural brokerage in the communities within which they work. As such they are uniquely positioned to positively influence health improvements for this vulnerable population. This study sought to identify key areas that both Aboriginal and Torres Strait Islander and non-Indigenous health professionals working within Indigenous communities felt were important in providing support for their roles. This group of workers require support within their roles particularly in relation to cultural awareness and capability, resource provision, educational opportunities, collaboration with colleagues and peers, and professional mentorship.

Investigating the use of social media to help women from going back to smoking post-partum.

OBJECTIVE: To investigate the social factors that would help women who had quit smoking due to pregnancy from returning to smoking after delivery of their baby. METHODS: Women who attended their first antenatal check-up at a general public hospital were invited to participate in pre- and postpartum interviews. RESULTS: A total of 24 women were interviewed pre- and postpartum. They reported isolation as a factor that influenced how they dealt with stress. This stress was linked to relapse. The use of electronic media through the Internet was a way women could interact with the outside community without having to leave home. CONCLUSIONS: Women who had strong family relationships in geographic proximity were not as likely to use the computer to interact with relatives and friends. Women who did not have strong local and family ties that support their desire to not go back to smoking, reported using Facebook and other Internet activities to keep in touch while they stayed at home with their new infant. IMPLICATIONS: The use of electronic media may help facilitate interaction between new mothers, which could prevent isolation and relapse back to smoking after delivery. This mechanism might also be used to enhance skill-development and problem-solving by these women.

The impact of surgical ward nurses practising respiratory assessment on positive patient outcomes.

OBJECTIVE: A literature review to examine the incorporation of respiratory assessment into everyday surgical nursing practice; possible barriers to this; and the relationship to patient outcomes. PRIMARY ARGUMENT: Escalating demands on intensive care beds have led to highly dependent patients being cared for in general surgical ward areas. This change in patient demographics has meant the knowledge and skills required of registered nurses in these areas has expanded exponentially. The literature supported the notion that postoperative monitoring of vital signs should include the fundamental assessment of respiratory rate; depth and rhythm; work of breathing; use of accessory muscles and symmetrical chest movement; as well as auscultation of lung fields using a stethoscope. Early intervention in response to changes in a patient's respiratory health status impacts positively on patient health outcomes. Substantial support exists for the contention that technologically adept nurses who also possess competent respiratory assessment skills make a difference to respiratory care. CONCLUSIONS: Sub-clinical respiratory problems have been demonstrated to contribute to adverse events. There is a paucity of research knowledge as to whether respiratory education programs and associated inservice make a difference to nursing clinical practice. Similarly, the implications for associated respiratory educational needs are not well documented, nor has a research base been sufficiently developed to guide nursing practice. Further research has the potential to influence the future role and function of the registered nurse by determining the importance of respiratory education programs on post-operative patient outcomes.

The relationship between exercise, Body Mass Index and menopausal symptoms in midlife Australian women.

The main objective of the study was to examine the relationship between physical activity and Body Mass Index (BMI) on menopausal symptoms in Australian midlife women. This study is a secondary data analysis of the Queensland Midlife Women Health Study (2001), which included a randomized, population-based postal survey with a questionnaire. Selected women completed a questionnaire, which included measurement of sociodemographic factors (age, employment and education attainment), general health, use of hormone replacement therapy, smoking, exercise pattern and BMI. The measures that are reported in this paper include menopausal symptoms, BMI and exercise. After adjusting for confounding variables, significant multivariate difference was still found for most menopausal symptoms, including a significant relationship between somatic symptoms, psychological symptoms, depression and anxiety. No significant relationship was seen, however, between vasomotor symptoms, sexual function and exercise. In conclusion, the study showed that exercise was effective in relieving somatic and psychological symptoms, including depression and anxiety. These findings are promising news for women who are interested in using non-pharmacological interventions for relieving menopausal symptoms.

The role of child health nurses in enhancing mothering know-how.

Supporting early parenting and promoting family health is an important aspect of contemporary child health nursing in Australia. Recent studies suggest that within a service climate that increasingly funds targeted, population-based needs rather than universal needs, child health nurses are concerned about maintaining individual nurse-client relationships, particularly with individual families. There is however, limited evidence available to use in response to these concerns. In this paper the way a group of middle-class mothers of infants, who, in today's health service climate, may not be a target group for health services, develop their caregiving know-how, is discussed. The findings presented suggest that both expert and lay knowledge have a part to play in supporting women in their early mothering. Women such as these, in essence, need a clearing-house to help them sift through the overwhelming information they access, respond to, and turn into everyday practices that work. Well placed child health nursing services may achieve this. While there is significant support for this claim in the literature, mechanisms for effective support remains the challenge. A key may be found in nurses focusing on the promotion of communicative or interactive health literacy as an outcome of their programs.

School-based youth health nurses: roles, responsibilities, challenges, and rewards.

A case study and focus-group discussions were conducted with 10 youth health nurses (nurses) employed in the recently introduced School-Based Youth Health Nurse Program (SBYHNP) to identify their roles, responsibilities, and professional development needs. Major roles are support, referral, health promotion, and marketing. Clients include high school students, teachers, and parents; the majority of whom are female and aged 13-16 years. Health issues addressed during individual consultations are predominantly psychosocial but also include medical, sexual health and sexuality issues, health surveillance, and risk-taking behaviors. Nurses also provide clients with health information and promote enhanced personal skill development during these consultations. Health promotion strategies undertaken by nurses were predominantly health education and health information displays. Nurses reported marketing their role and function within the school to be an essential and often difficult aspect of their role. Professional development through the SBYHNP was excellent; however, there was concern relating to the availability of future educational opportunities. The SBYHNP provides nurses with a new, challenging, autonomous role within the school environment and the opportunity to expand their role to incorporate all aspects of the health-promoting schools' framework.