Attitudes Toward People With Intellectual Disability Associated With Integrated Sport Participation.

Direct, meaningful contact with people with intellectual disability, such as through integrated sport, may be related to positive attitudes. The current study aimed to compare implicit (unconscious) and explicit (conscious) attitudes between adults involved in integrated sport events and those in a comparison group who were not and examine the association between attitudes and degree of integrated sport involvement. An online survey measuring attitudes was completed by 295 adults without intellectual disability who participated in integrated sport activities and 450 adults who did not. Individuals involved in integrated sport reported less negative behavioral and affective attitudes relative to the comparison group, with mixed results for cognitive attitudes. Groups did not differ on implicit attitudes. Greater integrated sport involvement was related to some aspects of explicit attitudes. Involvement in integrated sport may be linked to how participants view intellectual disability, which has important implications for enhancing social inclusion and informing positive attitudes.

Pressure Injury Prevention for Complex Cardiovascular Patients in the Operating Room and Intensive Care Unit: A Quality Improvement Project.

PURPOSE: The purpose of our project was to examine the effect of an alternating pressure (AP) overlay on hospital-acquired pressure injury (HAPI) in high-risk cardiovascular surgical patients. PARTICIPANTS AND SETTING: This quality improvement (QI) initiative was conducted in a core group of 8 cardiovascular operating room (OR) suites and 1 cardiovascular surgical critical intensive care unit (ICU) in a large Indiana-based academic hospital. The sample comprised adult patients who underwent complex cardiovascular surgical procedures and those in the cardiovascular surgical ICU with extracorporeal membrane oxygenation (ECMO), ventricular assistive device (VAD), and undergoing heart and/or lung transplant, or open chest procedures. APPROACH: The AP overlay was placed on OR cardiovascular foam surfaces and on selected ICU support surfaces for patients who met inclusion criteria. We used a pre/postcomparative QI design to assess outcomes including OR-related HAPI rates, ICU aggregate unit HAPI data, related costs, and staff satisfaction during the 3-month project period. OUTCOMES: Operating room-related HAPIs were reduced from 8/71 (11%) preintervention to 0/147 (0%) postintervention (P = .008), resulting in a cost avoidance of $323,048 and positive staff satisfaction (mean = 3.85; 1- to 4-point Likert scale). No adverse outcomes occurred. Although not significant, ICU HAPI rates decreased from 10 to 7 pre/postintervention (P = .29), demonstrating a 14% HAPI reduction with a cost avoidance of $121,143. The ICU incidence density decreased from 3.57 to 3.24; however, there was no decrease in ICU monthly unit prevalence. Critical care staff satisfaction was positive (mean = 2.95; 1- to 4-point Likert scale) with most staff members preferring the AP overlay to a fluid immersion surface. A cost savings of 48% (AP overlay vs fluid immersion rental) was identified in the ICU. IMPLICATIONS FOR PRACTICE: We achieved fewer HAPIs and reduced costs and observed positive staff satisfaction, along with no adverse events with the use of the AP overlay. Further research is needed to determine the safety and efficacy of this device for this pressure injury prevention option for immobile patients in both the OR and the ICU.

Maternal mental health in Australia and New Zealand: a review of longitudinal studies.

AIM: The aim of this paper is to describe the factors that impact on the mental health of Australian and New Zealand (NZ) women in the perinatal period (pregnancy and the year following birth), and to determine the impact of perinatal mental health on women's subsequent health by summarising findings from prospective longitudinal studies conducted in Australia and NZ. METHODS: A systematic search was conducted using the databases, Scopus, Medline, PsychInfo and Health Source to identify prospective longitudinal studies focused on women's social and emotional health in the perinatal period. Forty-eight papers from eight longitudinal studies were included. RESULTS: The proportion of women reporting depressive symptoms in the first year after birth was between 10 and 20% and this has remained stable over 25 years. The two strongest predictors for depression and anxiety were previous history of depression and poor partner relationship. Importantly, women's mood appears to be better in the first year after birth, when compared to pregnancy and five years later. Becoming a mother at a young age is by itself not a risk factor unless coupled with social disadvantage. Women report a high number of stressors in pregnancy and following birth and the rate of intimate partner violence reported is worryingly high. CONCLUSION: Midwives have an important role in the identification, support and referral of women experiencing mental health problems. As many women do not seek help from mental health services, the potential for a known midwife to impact on women's mental health warrants further examination.

Someone to talk to: young mothers' experiences of participating in a young parents support programme.

AIMS: To identify young parents' perceptions and experiences of a parenting support programme, run by a non-government organisation, which provided both community group-based, and one-on-one home visiting, support. STUDY DESIGN: A qualitative descriptive study was conducted in one of the most socio-economically disadvantaged areas of Sydney, NSW; this is also an area with one of the highest percentage of births among young parents. Young parents were eligible to participate whether they attended one of the parenting groups and/or received professional home visiting through the young parents programme. Eighteen young women were interviewed, and a further ten participated in a focus group. Thematic analysis of the focus groups and interviews was undertaken. FINDINGS: Four themes were identified in the analysis: 'someone I know and trust', 'we just talk about anything and everything', 'doing the personal' and 'getting out and relaxing'. These themes were linked through the common thread of relationships; the relationships between themselves and other young mothers, and with the workers on the programme. The characteristics of the person with whom they had a relationship, the type of relationship, the content of their interactions and the benefits of these relationships were all important. CONCLUSIONS: This study is limited by the small sample size and the 'low risk' status of the young parents who engaged in the programme. This study demonstrated not only the importance for young parents of all forms of interaction, whether it is one-on-one, in a group or social networking; but most importantly, the benefits of having someone to talk to.

'Get alongside us', women's experiences of being overweight and pregnant in Sydney, Australia.

Studies of women's experiences of being overweight and pregnant are limited in the literature. Given the increasing rates of obesity in pregnant women, and the impact of being overweight on the health of the mother and the child, this qualitative descriptive study aimed to explore the perceptions and experiences of overweight pregnant women attending two maternity units in Sydney, Australia. Fourteen women aged between 25 and 42 years with a body mass index greater than 30 kg/m(2) participated in a face-to-face interview in their third trimester of pregnancy or in the early post-natal period. All interviews were recorded and transcribed. Field notes were also recorded following each interview. Data were analysed using thematic analysis. Four themes were identified in the data: 'being overweight and pregnant', 'being on a continuum of change', 'get alongside us' and finally 'wanting the same treatment as everyone else'. Most women recognised their weight as an issue both for their own health and well-being and for its impact on the baby. Women believed health professionals should address the issue of obesity with them but do so in a supportive and positive way that recognised their individual needs and expectations. Health professionals need to consider new approaches or models of care for overweight women that give them support and enable individual needs and expectations to be met. Culturally specific programs may also need to be developed.

What works to engage young parents into services? Findings from an appreciative inquiry workshop.

AIM: Lack of engagement in parenting support programs by young parents has been identified previously in the literature. This paper reports an innovative strategy utilizing appreciative inquiry (AI) to involve service providers and young parents in identifying strategies to engage young parents in services and programs. METHODS: A one-day workshop was held involving service/program staff and young mothers in three phases of AI: discovery, dreaming, and delivery. A variety of activities were used to gather data from participants: Small group discussion, creative 'art work' development, and notes. RESULTS: Results identified strategies that would promote and sustain young parents' engagement in services/programs, such as supportive non-judgmental attitude of staff, having a 'one stop shop' for services, and meeting childcare and educational needs of parents. CONCLUSION: Through AI, factors were identified that promote and sustain engagement of young parents into parenting support programs, and the need to engage fathers was also recognized.

Connecting, learning, leaving: supporting young parents in the community.

Providing support and parenting education through home visiting is a key early intervention strategy with young parents. Less is known about what home visitors do that makes a difference. The purpose of this paper is to describe the role and experiences of professional staff working with young parents participating in a multicomponent parent support programme (home visiting and supported parenting groups) provided by a non-government organisation in a socially disadvantaged area of Sydney, Australia. This was a qualitative descriptive study. Data were collected through three focus groups conducted with the same six staff over an 18-month period. Participant descriptions of their role and experiences working with young mothers were analysed thematically. Additional data from 20 anonymised client records were analysed through content analysis. Analysis of the focus group data revealed two themes, 'Connecting' and 'Facilitating Learning'. The theme 'Connecting' reflected the development of a relationship with the young mother commencing with 'how do we engage them?', 'building trust' through to formation of a relationship described as 'they know we're not friends, they know we're workers'. The second theme, 'Facilitating Learning' was informed by the analysis of both group and client record data and comprised a number of themes around what and how mothers learnt, through to 'ending the relationship' as the mothers left the programme. The quality of a mothers' learning was dependent on the quality of the connection between herself and the staff, similarly their capacity and, or confidence to leave the programme was dependent on the relationship, 'connecting' and the learning undertaken. Role modelling through interactions with children as well as with each other was seen as the most effective way to facilitate social and parenting skill development, while formal education sessions were evaluated by the workers to be less successful than informal ones.

'Not waving but drowning': a study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women.

OBJECTIVE: to explore the experiences and concerns of health professionals who care for childbearing women who are obese. BACKGROUND: obesity is increasing nationally and internationally and has been described as an epidemic. A number of studies have highlighted the risks associated with obesity during childbirth, yet few studies have investigated the experiences and concerns of midwives and other health professionals in providing care to these women. DESIGN: a descriptive qualitative study using focus groups and face-to-face interviews to collect data. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. SETTING: three maternity units in New South Wales, Australia. PARTICIPANTS: participants included 34 midwives and three other health professionals. FINDINGS: three major themes emerged from the data analysis: 'a creeping normality', 'feeling in the dark' and 'the runaway train'. The findings highlight a number of tensions or contradictions experienced by health professionals when caring for childbearing women who are obese. These include, on the one hand, an increasing acceptance of obesity ('a creeping normality'), and on the other, the continuing stigma associated with obesity; the challenges of how to communicate effectively with pregnant women about their weight and the lack of resources, equipment and facilities ('feeling in the dark') to adequately care for obese childbearing women. Participants expressed concerns about how quickly the obesity epidemic appears to have impacted on maternity services ('the runaway train') and how services to meet the needs of these women are limited or generally not available. CONCLUSION AND IMPLICATIONS FOR PRACTICE: it was clear in this study that participants felt that they were 'not waving but drowning'. There was concern over the fact that the issue of obesity had moved faster than the health response to it. There were also concerns about how to communicate with obese women without altering the relationship. Continuity of care, training and skills development for health professionals, and expansion of limited services and facilities for these women are urgently needed.

The nature and impact of collaboration and integrated service delivery for pregnant women, children and families.

AIM: This paper explores the impact of models of integrated services for pregnant women, children and families and the nature of collaboration between midwives, child and family health nurses and general practitioners. BACKGROUND: Increasingly, maternity and child health services are establishing integrated service models to meet the needs of pregnant women, children and families particularly those vulnerable to poor outcomes. Little is known about the nature of collaboration between professionals or the impact of service integration across universal health services. DESIGN: Discursive paper. METHODS: A literature search was conducted using a range of databases and combinations of relevant keywords to identify papers reporting the process, and/or outcomes of collaboration and integrated models of care. RESULTS: There is limited literature describing models of collaboration or reporting outcomes. Several whole-of-government and community-based integrated service models have been trialled with varying success. Effective communication mechanisms and professional relationships and boundaries are key concerns. Liaison positions, multidisciplinary teams and service co-location have been adopted to communicate information, facilitate transition of care from one service or professional to another and to build working relationships. CONCLUSIONS: Currently, collaboration between universal health services predominantly reflects initiatives to move services from the level of coexistence to models of cooperation and coordination. RELEVANCE TO CLINICAL PRACTICE: Integrated service models are changing the way professionals are working. Collaboration requires knowledge of the roles and responsibilities of colleagues and skill in communicating effectively with a diverse range of professionals to establish care pathways with referral and feedback mechanisms that generate collegial respect and trust.

Physical activity in pregnancy: women's perceptions, practices, and influencing factors.

INTRODUCTION: Evidence shows that physical activity during and after pregnancy results in health gains for women. There is no clear understanding apparent in the literature of women's experiences with physical activity during their pregnancy. The aim of this study was to describe women's perceptions and participation in physical activity during pregnancy and identify factors influencing participation. METHODS: In this qualitative descriptive study, face-to-face interviews were conducted with 19 women, all at different stages of pregnancy, who were asked about their experiences with physical activity. RESULTS: Data analysis resulted in four categories describing "meaning of physical activity," "perceived benefits of physical activity in pregnancy," "barriers to and motives for participation in physical activity," and "process of engagement in physical activity." The process of engagement in physical activity by women was shown to have three marked phases: "uncertainty," "engaging," and "compromise." DISCUSSION: To facilitate women's self-management across these phases, support is needed that focuses on providing strategies to strengthen individual approaches by women. Such support might promote activities of daily living as a specific entity of physical activity, expose myths about activity during pregnancy, and endorse the benefits of weight management arising from physical activity, not just during pregnancy, but across the lifespan.

None of them were satisfactory: women's experiences with contraception.

Seventy-two women, aged between 18 and 50 years, participated in focus groups to talk about their experiences with using contraception. There were both continuities and differences between women in each of the age groups. Younger women appeared to be more accepting of medical opinion, while many older women rejected medical interference in contraceptive decisions. Patterns of use were similar with the pill having been the contraceptive of first choice for the majority of women. The most persistent feature through the groups was a strong sense of dissatisfaction with contraception, in terms of both side effects and range of available methods.

Evaluation of the extended role of the midwife: the voices of midwives.

It is not uncommon for midwives in Australian hospitals to order and interpret tests and initiate medications. The National Health and Medical Research Council only formally acknowledged these practices through recommendations in 1998. Successful extension of the midwife's role is assumed to be advantageous to the health-care system in its ability to satisfy consumer demand for a less medicalized experience and to be cost effective. This paper presents the results of the first phase of a three-phase fourth generation evaluation of the extended role of the midwife in two acute care settings in the Northern Territory, Australia. The results suggest that recognition of the extended role of the midwife has the potential to deliver high level continuous midwifery care to women, to increase work satisfaction for the midwives and to enhance professional autonomy and responsibility in the workplace. However, when compared with their counterparts in the United Kingdom and New Zealand, midwives in Australia continue to practice with considerable limitations placed on their autonomy.