Breastfeeding in the context of the COVID-19 pandemic: A discussion paper.

Breastfeeding offers one of the most fundamental global health benefits for babies. Breastmilk is lifesaving, providing not only nutrition but immunologic benefits and as such is strongly supported by the World Health Organization and leading healthcare associations worldwide. When the COVID-19 pandemic started in 2020, the impact of the restrictions to prevent the spread of the disease created challenges and questions about provision of safe, quality care, including breastfeeding practices, in a new 'normal' environment. Mothers were temporarily separated from their babies where infection was present or suspected, parents were prevented from being present on neonatal units and vital breastfeeding support was prevented. This discussion paper provides an overview of essential areas of knowledge related to practice for neonatal nurses and midwives who care for breastfeeding mothers and babies, in the context of the COVID-19 pandemic and the latest global guidance. Three areas will be discussed; the protective benefits of breastfeeding, keeping breastfeeding mothers and babies together and supporting mothers to breastfeed their babies. Finally, care recommendations are presented to serve as a summary of key points for application to practice for neonatal nurses and midwives.

Women's experiences of learning to breastfeed.

AIM: This research explores women's experiences of learning to breastfeed. DESIGN: A purposive cohort of healthy mothers participated in individual audio recorded interviews late pregnancy and then 2 and 8 weeks after birth. All interviews were transcribed verbatim and analysed using van Manen's approach. SETTING AND PARTICIPANTS: Participants were 13 first time mothers based in a rural municipality in Victoria, Australia. KEY FINDINGS: Women's voices gave rich descriptions of their experience of learning to breastfeed. Women shared the physicality of having 'great big engorged breasts' or 'sore nipples', and 'learning to latch' while 'having so very many things happening'. CONCLUSION: Many participants felt overwhelmed with learning to breastfeed at the same time as coping with caesarean wounds, perineal trauma, uterine bleeding and extreme fatigue. FUTURE IMPLICATIONS: Parenting education needs to be offered early in pregnancy so couples can explore birthing and its potential outcomes and to introduce infant cues and behaviours as a base for understanding how these impact on breastfeeding and problem solving.

Barriers to Couplet Care of the Infant Requiring Additional Care: Integrative Review.

BACKGROUND: Historically, once the baby was born, the mother and baby were separated shortly after birth into a postnatal ward and a baby nursery. Overtime, with advances in neonatology led to an increasing number of neonates being separated from their mothers at birth for specialised neonatal care if they required additional needs. As more research has been undertaken there is an increasing focus that mothers and babies should be kept together from birth, termed couplet care. Couplet care refers to keeping the mother and baby together. Despite this evidence, in practice, this is not happening. AIM: to examine the barriers to nurses and midwives providing couplet care of the infant requiring additional needs in postnatal and nursery. METHODS: A thorough literature review relies on a well-developed search strategy. This resulted in a total of 20 papers that were included in this review. RESULTS: This review revealed five main themes or barriers to nurses and midwives providing couplet care: models of care, systems and other barriers, safety, resistance, and education. DISCUSSION: Resistance to couplet care was discussed as being caused by feelings of lack of confidence and competence, concerns around maternal and infant safety and an under-recognition of the benefits of couplet care. CONCLUSION: The conclusion is that there is still a paucity of research in relation to nursing and midwifery barriers to couplet care. Although this review discusses barriers to couplet care, more specific original research on what nurses and midwives themselves perceive to be the barriers to couplet care in Australia is needed. The recommendation is therefore to undertake research into this area and interview nurses and midwives to ascertain their perspectives.

An Exploration of Nurses' Experience Following a Face-to-Face or Web-Based Intervention on Patient Deterioration.

A web-based clinical simulation program, known as FIRST2ACT (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends), was designed to increase the efficacy of clinicians' actions in the recognition and immediate response to a patient's deterioration. This study, which was nested in a larger mixed method project, used ten focus groups (n = 65) of graduate, enrolled, registered nurses, associate nurse unit managers, and general managers/educators/coordinators from four different institutions to investigate whether nurses felt their practice was influenced by participating in either a face-to-face or web-based simulation educational programme about patient deterioration. The results indicate that individuals who were less "tech-savvy" appreciated the flexibility of web-based learning, which increased their confidence. Face-to-face students appreciated self-reflection through performance evaluation. While face-to-face simulations were unable to completely duplicate symptoms, they showed nurses' adaptability. Both interventions enhanced clinical practice by improving documentation and replies while also boosting confidence and competence. Web learners initially experienced tech-related anxiety, which gradually subsided, demonstrating healthcare professionals' resilience to new learning approaches. Overall, the study highlighted the advantages and challenges of web-based and face-to-face education in clinical practice, emphasising the importance of adaptability and reflective learning for healthcare professionals. Further exploration of specific topics is required to improve practice, encourage knowledge sharing among colleagues, and improve early detection of patient deterioration.

Managing projected midwifery workforce deficits through collaborative partnerships.

To address workforce shortages, the Australian Government funded additional nursing and midwifery places in 2009 pre-registration courses. An existing deficit in midwifery clinical placements, combined with the need to secure additional clinical placements, contributed to a serious shortfall. In response, a unique collaboration between Midwifery Academics of Victoria (MIDAC), rural and metropolitan maternity managers (RMM and MMM) groups and Department of Health (DOH) Victoria was generated, in order to overcome difficulties experienced by maternity services in meeting the increased need. This group identified the large number of different clinical assessment tools required to be being completed by midwives supervising students as problematic. It was agreed that the development of a Common Assessment Tool (CAT) for use in clinical assessment across all pre-registration midwifery courses in Victoria had the potential to reduce workload associated with student assessments and, in doing so, release additional placements within each service. The CAT was developed in 2009 and implemented in 2010. The unique collaboration involved in the development of the CAT is a blueprint for future projects. The collaboration on this project provided a range of benefits and challenges, as well as unique opportunities for further collaborations involving industry, government, regulators and the tertiary sector.

Challenges Facing the Nursing Profession in Saudi Arabia: An Integrative Review.

There is a paucity of recent literature identifying the issues facing the nursing profession in Saudi Arabia. The aim of this integrative review is to highlight the ongoing challenges facing the nursing profession in Saudi Arabia despite attempts to make a difference and suggests recommendations for the future. Literature published from 2000 to 2020, inclusive, relevant for nursing challenges in Saudi Arabia was accessed and reviewed from multiple sources. In Saudi Arabia, inadequate numbers of Saudi nurses have prompted an increase in recruitment of expatriate nurses. This has created its own issues including, retention, lack of competency in English and Arabic, as well as Arabic cultural aspects, insufficient experience, and a high workload. The result is job dissatisfaction and increased attrition as these nurses prefer to move to more developed countries. For national nurses, the issues are the need to recruit more and retain these nurses. There are a range of cultural factors that contribute to these issues with national nurses. There is a need to improve the image of nursing to recruit more Saudi nurses as well as addressing issues in education and work environment. For expatriate nurses there is a need for a better recruitment processes, a thorough program of education to improve knowledge and skills to equip them to work and stay in Saudi. There is also a need for organizational changes to be made to increase the job satisfaction and retention of nurses generally. Healthcare in Saudi Arabia also needs leaders to efficiently manage the various issues associated with the nursing workforce challenges.

Sexuality, pregnancy and midwifery care for women with intellectual disabilities: a pilot study on attitudes of university students.

Women with intellectual disability have historically not been provided the opportunity to become mothers. Attitudes held by future professionals will determine the level and quality of support these women are provided. This study was designed to evaluate and compare the attitudes of students from Education, Disability and Midwifery towards the sexuality and parenting of people with an intellectual disability, and to further examine the attitudes held by Midwifery students following a lecture strategy. A questionnaire assessing attitudes towards the sexuality and parenting of people with intellectual disability was implemented and contained the themes of marriage, parenting, sexual intercourse and sterilization. Significant differences were found between student groups on the themes of sterilization and parenting, with further analysis indicating that Disability students held significantly more positive attitudes than the other two groups. Students reported less positive attitudes towards parenting than marriage, sterilization and sexual intercourse. Respondents' age was significantly associated with their attitudes on parenting, indicating that older students held more conservative attitudes towards the ability of people with an intellectual disability to parent. In addition, this research indicated that the attitudes of Midwifery students became more positive following a lecture delivered after the questionnaire.

Graduate nurses experiences of developing trust in the nurse-patient relationship.

This paper presents the findings of a qualitative exploratory descriptive study that aimed to explore and describe graduate nurses' perceptions and experiences of establishing trust in the nurse-patient relationship. Trust has been identified in the literature to be a crucial element in establishing an effective nurse- patient relationship. There is little in the literature, however, about the development of trust in the new graduate nurse-patient relationship. This research attempts to address this deficit. With this in mind, in depth interviews were conducted with seven first year registered nurses participating in graduate year programs. These first year nurses were asked to describe what their knowledge, understanding and experience of trust was in the nurse-patient relationship. From the data the themes that emerged were building a rapport, communication, being professional and confidence. The results of this study indicate that before a graduate nurse can achieve a trusting relationship with a patient, they first have to develop a rapport with them. More emphasis, therefore, on teaching communication skills in undergraduate and graduate programs may help to increase the knowledge and skills of new graduate nurses. In addition, including discussions on the factors that are important to building rapport and trust, what being a professional entails and strategies for caring for patients in situations where rapport has not been achieved. This research was undertaken as part of a Bachelor of Nursing Honors program.

Student and new graduate perception of hospital versus institutional clinic for clinical educational experience.

OBJECTIVE: To explore final-year students and new graduates from 2 North American chiropractic colleges regarding perceptions of the clinical educational experience in a hospital vs the institutional clinical setting. METHODS: A qualitative exploratory descriptive design was used for this research. Students and new graduates were invited to participate from a United States and Canadian chiropractic college. Semistructured interviews were conducted with 49 students and 14 new graduates lasting 60 minutes. Content analysis of the transcribed interviews was undertaken. RESULTS: The data identified that there were advantages and disadvantages to having clinical education in both settings. For instance, the hospital setting had a more varied patient case mix (making it more complex and challenging for their clinical skills development), the pace was faster, and there was more evidence-based practice. This compared to the college clinics, which tended to be slower paced and had less variation, students were required to build a patient base, and patient demographics resembled that expected in private practice. Each environment was considered a unique clinical learning experience. CONCLUSION: Access and opportunity in both clinical environments is considered optimal in regards to providing a broad and varied student clinical experience. Exclusivity to one may not provide the best preparation for the professional context. As most graduate opportunities are private practice, the institutional clinical environment will provide a sufficient clinical teaching and learning environment to support the professional needs. A combination of these environments is considered ideal for the graduate.

Health belief dualism in the postnatal practices of rural Swazi women: an ethnographic account.

OBJECTIVE: This study explores and describes the values, beliefs, and practices of rural Swazi women regarding childbearing in the postpartum period. METHOD: A retrospective ethnographic research design was used. A snowballing sampling method was used to recruit fifteen participants. Face-to-face unstructured audio-taped interviews and field notes were utilised to gather data. FINDINGS: Results showed that rural Swazi women held a dual health belief system of modern and traditional medicinal use; practiced lengthy periods of postpartum confinement; customarily gave regular enemas and traditional medicines to their babies; undertook the specific cultural practice of taking the baby to enyonini [a tree struck by lightening] to perform specific rituals; used self-prescribed pharmacy medicines; used both traditional and modern contraception; as well as practiced breastfeeding. CONCLUSION: Rural Swazi women observe modern health practices alongside traditional customary practices that are inherent to their health belief and value systems in the postnatal period. These customary beliefs and values underpin their birth practices postpartum. Recommendations include the need to consider including formal knowledge on cultural aspects of childbirth and postpartum care into midwifery education; a review of maternal care practices and policies to incorporate widely practised traditional elements including redressing the use of self-prescribed pharmacy medicines to ensure a higher level of safety.