Public health service board members' understanding of care quality in residential aged care services.

Objective The objective of this study was to explore how health service boards understand care quality for older people living in public sector residential aged care services. Methods Semi-structured interviews were undertaken with board members from six Victorian public health services responsible for the governance of 15 residential aged care services comprising over 850 beds. Transcripts were thematically analysed. Results Eleven board members were interviewed. While committed to their governance and monitoring role, analysis suggests board members have a limited understanding of the residential aged care environment. They rarely visit and the information they receive about residential aged care is primarily clinical data (quality indicators) as well as sub-committee and staff reports. In addition to quality indicator data and reports, accreditation and complaints are used to measure care quality. Conclusion Board members vary in their understanding of care quality in residential aged care settings. The exclusive focus on clinical indicators and accreditation as measures of quality reinforces this understanding. Visiting residential aged care services would provide understanding of the care environment and context for the information they receive. The provision of other metrics, such as consumer advocacy reports and residents' and families' experiences of care, would further assist board members to monitor care quality in these settings.

Research priorities in residential aged care services: A statewide survey.

OBJECTIVES: To ascertain the research priorities of staff working in Victorian residential aged care services (RACS). METHOD: In October 2016, all 754 Victorian RACS were asked to list three most important research priorities in a confidential postal survey. Descriptive statistics and content analysis were used to analyse the data. RESULTS: One hundred and sixty-two (21.5%) RACS participated. Research priorities, in order of importance, were grouped thematically as workforce issues, strategies to manage residents with dementia and funding to the sector. Staffing numbers and mix, particularly nurse-to-resident ratios, dominated workforce issues. The management of responsive behaviours was highlighted as a pressing clinical issue, and insufficient funding to the sector impacted on most issues reported. CONCLUSIONS: The research priorities identified were inter-related. Some were already well researched, suggesting RACS staff have little time and/or limited access to research evidence to inform the care and management of residents, possibly because of inadequate staffing and funding.

Barriers and facilitators for health professionals referring Aboriginal and Torres Strait Islander tobacco smokers to the Quitline.

OBJECTIVE: To examine the barriers and facilitators among health professionals to providing referrals to Quitline for Aboriginal and Torres Strait Islander clients who smoke. METHODS: A brief online survey, based on the Theoretical Domains Framework, was completed by 34 health professionals who work with Aboriginal and Torres Strait Islander people in South Australia and the Northern Territory. RESULTS: Respondents who frequently made referrals had higher domain scores than less frequent referrers for 'Skills and knowledge' (M=4.44 SD=0.39 vs. M=4.09 SD=0.47, p<0.05) and 'beliefs about capabilities' (M=4.33 SD=0.44 vs. M=3.88 SD=0.42, p<0.01). Barriers to providing referrals to Quitline were lack of client access to a phone, cost of a phone call, preference for face-to-face interventions, and low client motivation to quit. CONCLUSIONS: Health professionals working with Aboriginal and Torres Strait Islander clients should be supported to build their skills and confidence to provide referrals to Quitline and other brief cessation interventions. Building capacity for face-to-face support locally would be beneficial where phone support is not preferable. Implications for public health: Engaging with health professionals who work with Aboriginal and Torres Strait Islander people to increase referrals to Quitline is strategic as it builds on their existing capacity to provide cessation support.

Identifying risk factors for very preterm birth: a reference for clinicians.

OBJECTIVE: to provide an accessible list of individual and population-based risk factors associated with very preterm birth to assist care providers in planning appropriate pregnancy care. DESIGN: a population-based case-control study. SETTING: Victoria, Australia. PARTICIPANTS: women were recruited from April 2002 to 2004. Cases had a singleton birth between 20 and 31+6 weeks gestation and controls were a random selection of women having a birth of at least 37 weeks gestation in the same time period as the cases. MEASUREMENTS AND FINDINGS: structured interviews were conducted within a few weeks postpartum with 603 cases and 796 controls. Data were collected on sociodemographic factors; obstetric and gynaecological history; and maternal health problems, both pre-existing and occurring during the index pregnancy. Risk factors were calculated. KEY CONCLUSIONS: when correlated, risk factors were grouped as either lifestyle or maternal health factors. The majority of the risks were obstetric or gynaecological factors. Risks occurring in pregnancy may precipitate preterm birth. IMPLICATIONS FOR PRACTICE: knowing the risk factors for very preterm birth is likely to be helpful for pregnancy care providers. The development of a risk factor checklist based on the findings presented here may enable more informed planning of care and timely intervention.

Care providers' views and experiences of postnatal care in private hospitals in Victoria, Australia.

OBJECTIVE: in Australia, as in other developed countries, women have consistently reported lower levels of satisfaction with postnatal care compared with antenatal and intrapartum care. However, in Victoria Australia, women who receive private hospital postnatal care have rated their care more favourably than women who received public hospital care. This study aimed to gain a further understanding of this by exploring care providers' views and experiences of postnatal care in private hospitals. DESIGN: qualitative design using semi-structured interviews and thematic analysis. SETTING: private maternity hospitals in Victoria, Australia. PARTICIPANTS: eleven health-care providers from three metropolitan and one regional private hospital including eight midwives (two maternity unit managers and six clinical midwives) and three obstetricians. FINDINGS: two global themes were identified: 'Constrained Care' and 'Consumer Care'. 'Constrained care' demonstrates the complexity of the provision of postnatal care and encompasses midwives' feelings of frustration with the provision of postnatal care in a busy environment complicated by staffing difficulties, a lack of continuity and the impact of key players in postnatal care (including visitors, management and obstetricians). 'Consumer care' describes care providers' views that women often approach private postnatal care as a consumer, which can impact on their expectations and satisfaction with postnatal care. Despite these challenges, care providers, particularly midwives, highly valued (and generally enjoyed working in) postnatal care. KEY CONCLUSIONS: this study, along with other Australian and international studies, has identified that hospital postnatal care is complex and characterised by multiple barriers which impact on the provision of quality postnatal care. Further research is needed to evaluate routine postnatal practices and continuity of care within the postnatal period. In-depth qualitative studies investigating women's expectations and experiences of postnatal care in both the public and private sector are also needed.

The relationship between sun protection policy and associated practices in a national sample of early childhood services in Australia.

Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a self-administered survey about the sun protection policies and practices in their early childhood service (response rate of 59%). Most (95%) had a written sun protection policy. The most common policy inclusions were hat wearing (91%), sunscreen use (87%) and enforcement of policy (97%). Less frequently reported inclusions were protective clothing (69%), information for parents/caregivers (58%) and regular reviews/updates of policies (65%). Basic sun protection practices (e.g. required any type of hat and sunscreen use) were more commonly reported than extensive practices (required protective clothing or regularly applied sunscreen). Higher sun protection policy scores, being a formal childcare service as opposed to a kindergarten/pre-school and having SunSmart status as opposed to not, were associated with higher sun protection practice scores (P < 0.001). Sun protection policies may be improved through encouraging services to have more specific policy inclusions and to model their policies on the SunSmart Early Childhood Program.

Research interviewers' experience in the Early Births study of very preterm birth: qualitative assessment of data collection processes in a case-control study.

This paper describes an evaluation study that aimed to assess data collection processes in a population-based case-control study of very preterm birth. Semi-structured interviews were conducted with the 10 research interviewers to determine their perceptions of the hypotheses, the differences between interviewing cases and controls and between modes of interview, their reactions to questions which they had to ask in interviews and their training. Time and cost of the collection of data were also considered. None of the research interviewers identified which of the questions in the interview constituted the primary hypothesis. All interviewers interviewed cases and controls (including mothers of twins and singletons), and collected data face-to-face and by telephone. Whilst half of the interviewers had no issue with asking sensitive questions, hearing of intimate partner violence, risk-taking behaviour and inappropriate medical care were confronting for others. Training was judged as adequate, as was the continuing support of the project co-ordinator. On average, interviewing took 40% of research interviewers' time, and 25 interviews were completed per effective full-time month of interviewer time. Each interview cost approximately $170AU to complete. In relation to this case-control study, interviewer bias may be lessened since research interviewers had been unable to infer the hypothesis of the study. All interviewers had interviewed both cases and controls and any systematic differences can be adjusted for in the analysis.

How is maternal psychosocial health assessed and promoted in the early postnatal period? Findings from a review of hospital postnatal care in Victoria, Australia.

OBJECTIVE: to describe how women's maternal health, particularly at a psychosocial level, is assessed and promoted during the postnatal hospital stay. DESIGN: postal survey of public hospitals providing postnatal care and interviews with care providers. SETTING: all publicly funded maternity units and selected health professionals in Victoria, Australia. PARTICIPANTS: hospital postal survey: sixty six hospital respondents; interviews: 38 maternity unit managers, clinical midwives and medical practitioners. FINDINGS: there was little consistency across the State in relation to routine observations of the mother. Physical checks were much more common than enquiring about how women felt physically. Practice in psychosocial assessment was also diverse, with care plans/maps (clinical pathways) being the main tool to guide assessment. Most participants reported that psychosocial assessment was undertaken during pregnancy. Follow-up after birth also varied. Hospital respondents reported that emotional well-being is assessed postnatally by observation and conversation with women. Participants who were interviewed reported that midwives had mixed skills in assessing and dealing with complex psychosocial issues. Three hospitals administer the Edinburgh Postnatal Depression Scale to women in the days after birth, and three hospitals provide routine sessions of structured debriefing. Survey participants reported that the busy and, at times, chaotic nature of postnatal wards affected the provision of care and the level of psychosocial support offered to women. KEY CONCLUSIONS: although one of the stated aims of early postnatal care is the promotion of maternal well-being, the diversity of practices and the routine nature of many of these practices suggest that care is often not individualised or woman-centred. The reliance of detecting and managing women with particular psychosocial issues during pregnancy results in this aspect of care being given less priority postnatally than may be ideal. IMPLICATIONS FOR PRACTICE: strategies are required to provide health professionals with guidelines and skills to enhance the detection of women who have, or have the potential to develop, health problems after birth. This requires a reorganisation of the way early postnatal care is provided in relation to the use of routine practices; the ability of caregivers to spend time with women in an environment that offers privacy and confidentiality; the structuring of care around individual needs; and opportunities for women to be cared for by caregiver/s with whom they have met before.