Support during pregnancy for women at increased risk of low birthweight babies.

BACKGROUND: Studies consistently show a relationship between social disadvantage and low birthweight. Many countries have programmes offering special assistance to women thought to be at risk for giving birth to a low birthweight infant. These programmes, collectively referred to in this review as additional social support, may include emotional support, which gives a person a feeling of being loved and cared for, tangible/instrumental support, in the form of direct assistance/home visits, and informational support, through the provision of advice, guidance and counselling. The programmes may be delivered by multidisciplinary teams of health professionals, specially trained lay workers, or a combination of lay and professional workers. This is an update of a review first published in 2003 and updated in 2010. OBJECTIVES: The primary objective was to assess the effects of programmes offering additional social support (emotional, instrumental/tangible and informational) compared with routine care, for pregnant women believed to be at high risk for giving birth to babies that are either preterm (less than 37 weeks' gestation) or weigh less than 2500 g, or both, at birth. Secondary objectives were to determine whether the effectiveness of support was mediated by timing of onset (early versus later in pregnancy) or type of provider (healthcare professional or lay person). SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) on 5 February 2018, and reference lists of retrieved studies. SELECTION CRITERIA: Randomised trials of additional social support during at-risk pregnancy by either a professional (social worker, midwife, or nurse) or specially trained lay person, compared to routine care. We defined additional social support as some form of emotional support (e.g. caring, empathy, trust), tangible/instrumental support (e.g. transportation to clinic appointments, home visits complemented with phone calls, help with household responsibilities) or informational support (advice and counselling about nutrition, rest, stress management, use of alcohol/recreational drugs). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: This updated review includes a total of 25 studies, with outcome data for 11,246 mothers and babies enrolled in 21 studies. We assessed the overall risk of bias of included studies to be low or unclear, mainly because of limited reporting or uncertainty in how randomisation was generated or concealed (which led us to downgrade the quality of most outcomes to moderate), and the impracticability of blinding participants.When compared with routine care, programmes offering additional social support for at-risk pregnant women may slightly reduce the number of babies born with a birthweight less than 2500 g from 127 per 1000 to 120 per 1000 (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.86 to 1.04; 16 studies, n = 11,770; moderate-quality evidence), and the number of babies born with a gestational age less than 37 weeks at birth from 128 per 1000 to 117 per 1000 (RR 0.92, 95% CI 0.84 to 1.01, 14 studies, n = 12,282; moderate-quality evidence), though the confidence intervals for the pooled effect for both of these outcomes just crossed the line of no effect, suggesting any effect is not large. There may be little or no difference between interventions for stillbirth/neonatal death (RR 1.11, 95% CI 0.88 to 1.41; 15 studies, n = 12,091; low-quality evidence). Secondary outcomes of moderate quality suggested that there is probably a reduction in caesarean section (from 215 per 1000 to 194 per 1000; RR 0.90, 95% CI 0.83 to 0.97; 15 studies, n = 9550), a reduction in the number of antenatal hospital admissions per participant (RR 0.78, 95% CI 0.68 to 0.91; 4 studies; n = 787), and a reduction in the mean number of hospitalisation episodes (mean difference -0.05, 95% CI -0.06 to -0.04; 1 study, n = 1525) in the social support group, compared to the controls.Postnatal depression and women's satisfaction were reported in different ways in the studies that considered these outcomes and so we could not include data in a meta-analysis. In one study postnatal depression appeared to be slightly lower in the support group in women who screened positively on the Edinbugh Postnatal Depression Scale at eight to 12 weeks postnatally (RR 0.74, 95% CI 0.55 to 1.01; 1 study, n = 1008; moderate-quality evidence). In another study, again postnatal depression appeared to be slightly lower in the support group and this was a self-report measure assessed at six weeks postnatally (RR 0.85, 95% CI 0.69 to 1.05; 1 study, n = 458; low-quality evidence). A higher proportion of women in one study reported that their prenatal care was very helpful in the supported group (RR 1.17, 95% CI 1.05 to 1.30; 1 study, n = 223; moderate-quality evidence), although in another study results were similar. Another study assessed satisfaction with prenatal care as being "not good" in 51 of 945 in the additional support group, compared with 45 of 942 in the usual care group.No studies considered long-term morbidity for the infant. No single outcome was reported in all studies. Subgroup analysis demonstrated consistency of effect when the support was provided by a healthcare professional or a trained lay worker.The descriptions of the additional social support were generally consistent across all studies and included emotional support, tangible support such as home visits, and informational support. AUTHORS' CONCLUSIONS: Pregnant women need the support of caring family members, friends, and health professionals. While programmes that offer additional social support during pregnancy are unlikely to have a large impact on the proportion of low birthweight babies or birth before 37 weeks' gestation and no impact on stillbirth or neonatal death, they may be helpful in reducing the likelihood of caesarean birth and antenatal hospital admission.

A conceptual model: Redesigning how we provide palliative care for patients with chronic obstructive pulmonary disease.

ABSTRACTBackground:Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns. OBJECTIVE: Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers. METHOD: Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia. RESULTS: A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as "usual" care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death. SIGNIFICANCE OF RESULTS: Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with other nonmalignant conditions.

Establishing a nurse practitioner model to enhance continuity between palliative care settings.

BACKGROUND: Nurse practitioners (NP) are relatively new in Australia with national registration achieved in 2010. Most NP-related literature is about establishing models and scope of practice. This paper reports on the establishment and 12-month evaluation of an NP model of care, between inpatient and community palliative care services, developed to coordinate client care between hospital and home. AIM: To enhance patient outcomes, in hospital or home; to enhance professional relationships between services and facilitate effective discharges and admissions between services. DESIGN AND SETTING: Both services worked together to develop an evaluation framework, based on agreed key performance indicators. RESULTS: The NP model contributed to earlier discharges from hospital and fewer hospital admissions for those being cared for at home. There are developing opportunities to strengthen professional relationships through clinical and educational collaboration. CONCLUSION: The model has benefited both patient care and clinical cooperation between services.

Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace.

BACKGROUND: Fetal scalp blood sampling for lactate estimation may be considered following identification of an abnormal or non-reassuring fetal heart rate pattern. The smaller volume of blood required for this test, compared with the more traditional pH estimation, may improve sampling rates. The appropriate use of this practice mandates systematic review of its safety and clinical effectiveness prior to widespread introduction. OBJECTIVES: To evaluate the effectiveness and risks of fetal scalp lactate sampling in the assessment of fetal well-being during labour, compared with no testing or alternative testing. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2015). SELECTION CRITERIA: All published and unpublished randomised and quasi-randomised trials that compared fetal scalp lactate testing with no testing or alternative testing to evaluate fetal status in the presence of a non-reassuring cardiotocograph during labour. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures of the Cochrane Pregnancy and Childbirth Group. Two review authors independently assessed the studies. MAIN RESULTS: The search identified two completed randomised controlled trials (RCTs) and two ongoing trials. The two published RCTs considered outcomes for 3348 mother-baby pairs allocated to either lactate or pH estimation of fetal blood samples when clinically indicated in labour. Overall, the published RCTs were of low or unclear risk of bias. There was a high risk of performance bias, because it would not have been feasible to blind clinicians or participants.No statistically significant between-group differences were found for neonatal encephalopathy (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.32 to 3.09, one study, 2992 infants) or death. No studies reported neonatal seizures. We had planned to report death with other morbidities, for example, neonatal encephalopathy; however, the data were not available in a format suitable for this, therefore death due to congenital abnormality was considered alone. The three reported neonatal deaths occurred in babies with diaphragmatic hernias (n = 2) or congenital cardiac fibrosis (n = 1). All three babies had been randomised to the pH group and were not acidaemic at birth.There were no statistically significant differences for any of the pre-specified secondary fetal/neonatal/infant outcomes for which data were available. This included low Apgar score at five minutes (RR 1.13, 95% CI 0.76 to 1.68, two studies, 3319 infants) and admission to neonatal intensive care units (RR 1.02, 95% CI 0.83 to 1.25, one study, 2992 infants), or metabolic acidaemia (RR 0.91, 95% CI 0.60 to 1.36, one study, 2675 infants) considered within the studies, either overall or where data were available for those where fetal blood sampling had occurred within 60 minutes of delivery.Similar proportions of fetuses underwent additional tests to further evaluate well-being during labour, including scalp pH if in the lactate group or scalp lactate if in the pH group (RR 0.22, 95% CI 0.04 to 1.30, two studies, 3333 infants;Tau² 1.00, I² = 58%). Fetal blood sampling attempts for lactate and pH estimation were successful in 98.7% and 79.4% of procedures respectively in the one study that reported this outcome.There were no significant between-group differences in mode of birth or operative birth for non-reassuring fetal status, either for all women, or within the group where the fetal blood sample had been taken within 60 minutes of delivery (for example, caesarean section for all enrolled, RR 1.09, 95% CI 0.97 to 1.22, two studies, 3319 women; operative delivery for non-reassuring fetal status for all enrolled RR 1.02, 95% CI 0.93 to 1.11, one study, 2992 women).Neither study reported on adverse effects of fetal scalp lacerations or maternal anxiety. AUTHORS' CONCLUSIONS: When further testing to assess fetal well-being in labour is indicated, fetal scalp blood lactate estimation is more likely to be successfully undertaken than pH estimation. Further studies may consider subgroup analysis by gestational age, the stage of labour and sampling within a prolonged second stage of labour. Additionally, we await the findings from the ongoing studies that compare allocation to no fetal blood sample with sampling for lactate and address longer-term neonatal outcomes, maternal satisfaction with intrapartum fetal monitoring and an economic analysis.

Fetal pulse oximetry for fetal assessment in labour.

BACKGROUND: The use of conventional cardiotocographic (CTG) monitoring of fetal well-being during labour is associated with an increased caesarean section rate, compared with intermittent auscultation of the fetal heart rate, resulting in a reduction in neonatal seizures, although no differences in other neonatal outcomes. To improve the sensitivity of this test and therefore reduce the number of caesarean sections performed for nonreassuring fetal status, several additional measures of evaluating fetal well-being have been considered. These have demonstrated some effect on reducing caesarean section rates, for example, fetal scalp blood sampling for pH estimation/lactate measurement. The adaptation of pulse oximetry for use in the unborn fetus could potentially contribute to improved evaluation during labour and therefore lead to a reduction in caesarean sections for nonreassuring fetal status, without any change in neonatal outcomes. OBJECTIVES: To compare the effectiveness and safety of fetal intrapartum pulse oximetry with other surveillance techniques. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2014), contacted experts in the field and searched reference lists of retrieved studies. In previous versions of this review, we performed additional searches of MEDLINE, Embase and Current Contents. These searches were discontinued for this review update, as they consistently failed to identify any trials that were not shown in the Cochrane Pregnancy and Childbirth Group's Trials Register. SELECTION CRITERIA: All published and unpublished randomised controlled trials that compared maternal and fetal outcomes when fetal pulse oximetry was used in labour, (i) with or without concurrent use of conventional fetal surveillance, that is, cardiotocography (CTG), compared with using CTG alone or (ii) with or without concurrent use of both CTG and other method(s) of fetal surveillance, such as fetal electrocardiography (ECG) plus CTG. DATA COLLECTION AND ANALYSIS: At least two independent review authors performed data extraction. We sought additional information from the investigators of three of the reported trials. MAIN RESULTS: We included seven published trials: six comparing fetal pulse oximetry and CTG with CTG alone (or when fetal pulse oximetry values were blinded) and one comparing fetal pulse oximetry plus CTG with fetal ECG plus CTG. The published trials, with some unpublished data, were at high risk of bias in terms of the impractical nature of blinding participants and clinicians, as well as high risk or unclear risk of bias for outcome assessor for all but one report. Selection bias, attrition bias, reporting bias and other sources of bias were of low or unclear risk. The trials reported on a total of 8013 pregnancies. Differing entry criteria necessitated separate analyses, rather than meta-analysis of all trials.Systematic review of four trials from 34 weeks not requiring fetal blood sampling (FBS) prior to study entry showed no evidence of differences in the overall caesarean section rate between those monitored with fetal oximetry and those not monitored with fetal pulse oximetry or for whom the fetal pulse oximetry results were masked (average risk ratio (RR) 0.99 using random-effects, 95% confidence intervals (CI) 0.86 to 1.13, n = 4008, I² = 45%). There was evidence of a higher risk of caesarean section in the group with fetal oximetry plus CTG than in the group with fetal ECG plus CTG (one study, n = 180, RR 1.56, 95% CI 1.06 to 2.29). Neonatal seizures and neonatal encephalopathy were rare in both groups. No studies reported details of long-term disability.There was evidence of a decrease in caesarean section for nonreassuring fetal status in the fetal pulse oximetry plus CTG group compared to the CTG group, gestation from 34 weeks (average RR (random-effects) 0.65, 95% CI 0.46 to 0.90, n = 4008, I² = 63%). There was no evidence of differences between groups in caesarean section for dystocia, although the overall incidence rates varied between the trials. AUTHORS' CONCLUSIONS: The addition of fetal pulse oximetry does not reduce overall caesarean section rates. One study found a higher caesarean section rate in the group monitored with fetal pulse oximetry plus CTG, compared with fetal ECG plus CTG. The data provide limited support for the use of fetal pulse oximetry when used in the presence of a nonreassuring CTG, to reduce caesarean section for nonreassuring fetal status. A better method than pulse oximetry is required to enhance the overall evaluation of fetal well-being in labour.

Malaysian nurses' skin care practices of preterm infants: experience vs. knowledge.

This study sought to explore the impact of Malaysian nurses' perceptions, knowledge and experiences in preterm infant skin care practices using a descriptive approach. Questionnaires were distributed to Neonatal Intensive Care Unit (NICU) nurses in one teaching hospital in Malaysia. A knowledge gap was revealed among nurses in both theoretical and practical knowledge of preterm infant skin. Nurses working for more than 5 years in NICU or having a Neonatal Nursing Certificate (NNC) were not predictors of having adequate knowledge of preterm infants' skin care. The results highlight the complex issue of providing effective skin care to preterm infants. However, a specific finding related to nurses' confidence provides some direction for future practice and research initiatives. Clear clinical evidence-based guidelines and Continuing Nursing Education on relevant topics of preterm infants' care may provide the required knowledge for the nurses.

Leadership and management skills of general practice nurses: experience or education?

A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace.

BACKGROUND: Fetal vibroacoustic stimulation (VAS) is a simple, non-invasive technique where a device is placed on the maternal abdomen over the region of the fetal head and sound is emitted at a predetermined level for several seconds. It is hypothesised that the resultant startle reflex in the fetus and subsequent fetal heart rate (FHR) acceleration or transient tachycardia following VAS provide reassurance of fetal well-being. This technique has been proposed as a tool to assess fetal well-being in the presence of a nonreassuring cardiotocographic (CTG) trace during the first and second stages of labour. OBJECTIVES: To evaluate the clinical effectiveness and safety of VAS in the assessment of fetal well-being during labour, compared with mock or no stimulation for women with a singleton pregnancy exhibiting a nonreassuring FHR pattern. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 September 2012) and reference lists of all retrieved articles. We sought unpublished trials and abstracts submitted to major international congresses and contacted expert informants. SELECTION CRITERIA: All published and unpublished randomised trials that compared maternal and fetal/neonatal/infant outcomes when VAS was used to evaluate fetal status in the presence of a nonreassuring CTG trace during labour, compared with mock or no stimulation. DATA COLLECTION AND ANALYSIS: Two review authors independently sought to assess for inclusion all the potential studies we identified as a result of the search strategy. We planned to resolve any disagreement through discussion or, if required, to consult a third person. Where there was uncertainty about a particular study, we attempted to contact study authors for additional information. However, these attempts were unsuccessful. MAIN RESULTS: The search strategies yielded six studies for consideration of inclusion. However, none of these studies fulfilled the requirements for inclusion in this review. AUTHORS' CONCLUSIONS: There are currently no randomised controlled trials that address the safety and efficacy of VAS used to assess fetal well-being in labour in the presence of a nonreassuring CTG trace. Although VAS has been proposed as a simple, non-invasive tool for assessment of fetal well-being, there is insufficient evidence from randomised trials on which to base recommendations for use of VAS in the evaluation of fetal well-being in labour in the presence of a nonreassuring CTG trace.

Behind the rhetoric: is palliative care equitably available for all?

Disparities in access to health care also extend to the end-of-life care. Despite the general principle that palliative care is equitably available for all in need, it remains underutilised by certain groups in the community. Ethnic minorities, older people and patients with non-cancer diseases are found to be at a greatest risk for underutilisation of palliative care. Barriers to access palliative care by these groups in the community are complex and often overlapping. To overcome these barriers, there is a need to take action on many fronts. This paper discusses these barriers and provides an overview of the strategies that have been implemented to address these issues.

Postnatal Cytomegalovirus Infection of Preterm and Very-low-birth-weight Infants Through Maternal Breast Milk: Does It Matter?

BACKGROUND: Postnatal infection with cytomegalovirus (CMV) in very-preterm and very-low-birth-weight infants, transmitted through breast milk (BM), is potentially associated with adverse outcomes. This study aimed to investigate the incidence and clinical significance of postnatal CMV infection in a tertiary neonatal intensive care unit. METHODS: Infants of CMV-seropositive mothers born in a neonatal intensive care unit in Melbourne, Australia, were observed for 14 weeks from birth in a prospective cohort study. Maternal BM and infant urine were tested weekly for CMV by culture and polymerase chain reaction, respectively. Clinical and laboratory data were collected and analyzed in relation to the infants' CMV infection status. RESULTS: Data from 65 infants of 56 CMV-seropositive mothers were available for analysis. Of these mothers, 88% (49/56) shed CMV in their BM. Of the 58 infants exposed to CMV-positive BM, 27 (47%) became urine polymerase chain reaction CMV-positive. There was no significant difference in gestational age, birth weight, incidence of bronchopulmonary dysplasia, or necrotizing enterocolitis between the CMV-positive and CMV-negative groups. However, CMV-positive infants had a longer length of hospital stay and more episodes of prolonged neutropenia. Of the CMV-positive infants, 30% (8/27) remained asymptomatic, 48% (13/27) had symptoms categorized as mild and 22% (6/27) as severe. CONCLUSIONS: About half of preterm and very-low-birth-weight infants exposed to CMV-positive BM become infected, and a fifth develop significant clinical symptoms. Future studies should address the maternal and neonatal factors that determine the risk of mother-to-infant CMV transmission, as well as those leading to clinical deterioration and long-term sequelae.

Developing acute care-based mental health nurses' knowledge and skills in providing recovery-orientated care: A mixed methods study.

Recovery-oriented principles have progressively been accepted as a standard of mental health practice in many countries, including Australia. A private mental health Clinic in Melbourne, Australia, is dedicated to embedding the principles of recovery-oriented practice into care by (i) providing recovery education and training for their staff and (ii) co-designing resources with consumers to promote active consumer engagement and participation. The purpose of this study was to evaluate the impact of these initiatives on staff knowledge and provision of recovery-oriented care in acute care. Two groups of study participants were recruited: the first group completed the staff training programme introducing the concept of recovery-oriented practice, and the second group was a convenience sample of nurses recruited 12 months later working on the acute inpatient wards at the study site. Nurses completed Recovery Knowledge Inventory (RKI) and Recovery Self-Assessment (RSA-Provider) surveys and participated in a focus group discussion. The three major themes identified from the focus group discussion were as follows: (i) nurses' understanding of personal recovery-orientated practice, (ii) how to embed personal recovery-oriented care into practice, and (iii) barriers to consumer participation in recovery-oriented activities in acute care. There were significant differences between the two groups on the RKI subscale scores of 'Expectations regarding recovery' and the 'Roles of self-definition and peers in recovery' and 'Life goals' and 'Choice' factors on the RSA subscale scores. There were some gaps in the nurses' knowledge and implementation of personal recovery-oriented concepts, highlighting the need for further training and cultural change.

Effect of a multidisciplinary rehabilitation program for patients receiving weight management interventions on eating behaviours and health-related quality of life.

The rapid rise in obesity prevalence is life-style related and tackling this problem requires a pro-active multi-faceted approach to management. A private health care provider in Melbourne, Australia, developed a multidisciplinary rehabilitation program for patients who had undergone bariatric surgery or receiving pharmacological weight loss treatments. The study aim was to assess the programs' effect on patients' quality of life, mental well-being, and eating behaviours. METHODS: A prospective, observational, before and after study design was used. A total of 54 patients, 27 who had bariatric surgery and 27 receiving pharmacotherapy participated. Outcome measures were: change in weight and BMI, intuitive eating scale, impact of weight on quality of life scale and the depression, anxiety and stress scale. RESULTS: Both medical and surgical patients reported improvements in their health-related quality of life and eating behaviours. Despite this, at program completion 71.4% of patients who had bariatric surgery reported severe anxiety and 52.4% severe stress levels. CONCLUSION: Participation in a rehabilitation program that provided patients with peer support and access to expert advice supported patients to make healthy eating choices and improved their quality of life. The high prevalence of stress and anxiety related symptoms highlights the need to provide individuals who have undergone bariatric surgery with ongoing mental health support.

Evaluation of a blended learning approach to developing specialty-nursing practice. An exploratory descriptive qualitative study.

BACKGROUND: An ageing population and a transitioning workforce is creating demands on healthcare workforces. Clinical and procedural knowledge deficits cause anxieties in new and experienced nurses alike when integrating into new teams. Overcoming these boundaries can be achieved with Introductory programs. These develop knowledge, technical skills and non-technical skills. Investigating nurses drive to undertake such programs, and the benefits they perceive for themselves, will help to tailor future programs. OBJECTIVES: To explore post-registration nurses' motivations for undertaking an introductory program that utilised a blended learning methodology. Identifying changes in participants understanding and clinical behaviours. METHODS: An exploratory descriptive qualitative study design was used to evaluate the Introduction to Specialty Practice (ISP) program that is run by a large private healthcare provider in Melbourne, Australia. The health service includes eight campuses and four intensive care units across the group. Twelve participants from a mixture of critical care and acute care clinical areas were consented. They were interviewed using a semi-structured questionnaire. Responses were transcribed verbatim and thematic analysis of the transcripts then occurred. RESULTS: The study demonstrated intrinsic and extrinsic factors influenced participant's desires to undertake this program. Three major themes were evident: 1) that caring without knowledge was daunting, 2) that participants needed to create a clinical and professional identity and 3) that participant's perspective on their delivery of care improved, along with their professional aptitude. CONCLUSION: Maintaining currency with knowledge, skills, and technological developments is crucial for nurses to consistently deliver high-level care. The demands that nurses' face within their clinical areas affects their intention to stay within the workforce and their ability to deliver care. Introductory programs that utilise blended learning strategies have a role to play in enabling nurses to create their professional identity, find their position in clinical teams, and meet the requirements of organisations.

Evaluation of the effectiveness of an eLearning program in the nursing observation and assessment of acute surgical patients: A naturalistic observational study.

AIM/OBJECTIVE: The aim of this study was to evaluate the effectiveness of an eLearn program in changing surgical nurses' approach to clinical assessment. BACKGROUND: Nurses need to have the knowledge and skills to recognise and respond to changes in patients' physiological condition in a timely manner. A private health service in Melbourne, Australia developed an online (eLearn) program highlighting the importance of clinical assessment and provided nurses with an overview of the Airway,Breathing, Circulation, Disability, Exposures ('ABCDE') approach. DESIGN: A before and after study design that involved naturalistic observation of nurse-patient interactions and nurses' performing patient clinical assessments was undertaken on two surgical wards. METHODS: The intervention ward nurses received standard education and exposure to the eLearning program. The comparison ward nurses received standard workplace education on patient assessment. The nurses were observed from May to August 2018. RESULTS: Following completion of the eLearn, intervention ward nurses were observed to spend more time with their patients conducting clinical assessment. On both wards, not all nurses performed comprehensive ABCDE assessment and there was variability associated with the sequencing of ABCDE assessment. CONCLUSIONS: This study provides some evidence that completion of an eLearn can change clinical practice, however the intensity of the intervention was insufficient to achieve optimal practice in the conduct of clinical assessments.

Evaluation of a community pharmacy-based intervention for improving patient adherence to antihypertensives: a randomised controlled trial.

BACKGROUND: The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications--Hypertension Adherence Program in Pharmacy (HAPPY). METHODS/DESIGN: The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data. DISCUSSION: To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12609000705280.

Psychological factors among elderly women with suicidal intentions or attempts to suicide: a controlled comparison.

The aim of this study was to measure a range of psychological factors identified as important in the literature (resilience, psychological distress, feelings of hopelessness, personal and interpersonal control) among community-dwelling elderly women (N = 31) who had suicidal intentions or attempted suicide. The target group was matched to a control group on age within 5 years. The target group reported lower resilience, personal and interpersonal control but higher psychological distress and feelings of hopelessness compared to the control group. Women who had suicidal ideation or attempts in the last 12 months reported higher personal and interpersonal control. This suggests that although suicide among older women is strongly linked to psychological factors, it warrants further investigation.

A narrative review of parental education in preparing expectant and new fathers for early parental skills.

OBJECTIVE: To explore expectant and new fathers' views of antenatal education classes in preparing them for early parenting skills. DESIGN: This review used a narrative review approach. Search strategy of electronic databases includes Medline, CINAHL, ProQuest, Scopus and PubMed. Studies from 2000 to 2018 reporting parental education in preparing early parenting skills for fathers only or if the studies were on both parents, and the results reported on the fathers were available were included in the review. FINDINGS: There were two quantitative and four qualitative studies. Studies were from Sweden (n = 4), United Kingdom (n = 1), and Australia (n = 1). There were three phenomenographical studies and three exploratory descriptive studies. The three key themes that emerged for expectant and new fathers were experiencing feelings of exclusion, lack of postnatal education, and need for support services. CONCLUSIONS: The evidence suggests that the current parental education classes do not meet the needs of expectant and new fathers in early parenting skills. In order to provide expectant and new fathers with early parental skills, it is necessary to adapt the current education classes to include the needs of these men. Alternatively, to have men only classes. It is important for midwives to actively include and engage expectant and new fathers in parental education. This review has identified the need for further research and to develop strategies to involve more men in parental education.

Empathic and listening styles of first year undergraduate nursing students: A cross-sectional study.

BACKGROUND: Effective communication and empathy are fundamental to nurse-patient relationships and good nursing practice. Although the importance of listening is widely accepted in the nursing practice, little research exists regarding the empathic and listening styles of undergraduate nursing students. PURPOSE: This study investigated empathic and listening styles of first year nursing students. METHOD: A cross-sectional study of 135 first year Bachelor of Nursing (BN) students from one Australian university completed paper-based versions of the revised Listening Styles Profile (LSP) and Active-Empathic Listening Scale (AELS). RESULTS: Participants reported strong preference for 'people' listening style and 'responding' empathic listening process. No statistically significant differences were found between male and female students. People-oriented LSP was strongly correlated with the three stages of AELS, Content-oriented LSP was strongly correlated with Processing and with Responding AELS and Action-oriented LSP was strongly correlated with Processing AELS. CONCLUSION: It is not only important that communication skills training exists in the nursing curriculum but ensuring that knowledge learnt in the classroom is transferred to the clinical setting. Nurses must consistently implement active listening techniques and effective communication skills with all patients.

Scope of Practice, Role Legitimacy, and Role Potential for Cancer Care Coordinators.

OBJECTIVE: The cancer care coordinator (CCC) role has become a priority in providing coordinated, patient-centered, supported care for patients, and their families experiencing cancer. The CCC role exists with heterogeneity across tumor streams, clinical disciplines, and institutions. This study explored CCCs perceptions and experiences of their role, scope of practice, and potential for future role development. METHODS: This research used a mixed methods design. Focus groups and individual interviews were conducted with a purposive sample of 16 CCCs from two tertiary public teaching hospitals in Melbourne, Australia. A thematic analysis approach was used. A quantitative record of relative time spent on tasks was also collected. RESULTS: Three major themes were identified: (1) Perceptions of role legitimacy, (2) Structure and funding of the role determines scope of practice, and (3) Reflections on the potential for the role. Variability was evident in predominant tasks undertaken, integration into the unit, level of patient contact, and regard from other professional colleagues. Variability appears to relate to employment time assigned to the role, and history and structure of the role. CONCLUSIONS: The findings underline the need when establishing and reviewing CCC roles for explicit attention to be given to the reporting, integration, structural, and collegiate support for the role as this will profoundly influence its success.

Learning style preferences of Australian accelerated postgraduate pre-registration nursing students: A cross-sectional survey.

Graduate entry programs leading to registration are gaining momentum in nursing. These programs attract student cohorts with professional, cultural, gender and age diversity. As a consequence of this diversity, such accelerated programs challenge traditional pedagogical methods used in nursing and require different approaches. To date, however, there has been limited research on the learning styles of students undertaking these programs to inform academics involved in their delivery. Kolb's Experiential Learning model has been used widely in a variety of educational settings because it is based on the theory of experiential learning. More recently VARK (Visual, Aural, Read/write and Kinaesthetic) model has become popular. The aim of this study was to investigate the learning styles of two cohorts of graduate entry nursing students undertaking an accelerated masters-level program. This was a cross-sectional survey of two cohorts of Master of Nursing Practice students enrolled at a large Australian university. The students were more inclined toward converging (practical) and least toward concrete experience (experiencing) learning styles. The majority of students were more inclined toward kinaesthetic and least toward aural learning style. Findings have implications for academics engaged in teaching graduate entry nursing students.