Women's experiences of ceasing to breastfeed: Australian qualitative study.

OBJECTIVE: To investigate mothers' infant feeding experiences (breastfeeding/formula milk feeding) with the aim of understanding how women experience cessation of exclusive breastfeeding. DESIGN: Multimethod, qualitative study; questionnaire, focus groups and interviews. SETTING: Northern and Southern Tasmania, Australia. PARTICIPANTS: 127 mothers of childbearing age from a broad sociodemographic context completed a questionnaire and participated in 22 focus groups or 19 interviews across Tasmania, 2011-2013. RESULTS: Mothers view breastfeeding as 'natural' and 'best' and formula milk as 'wrong' and 'unnatural'. In an effort to avoid formula and prolong exclusive breastfeeding, mothers will endure multiple issues (eg, pain, low milk supply, mastitis, public shaming) and make use of various forms of social and physical capital; resources such as father/partner support, expressing breast milk, bottles and dummies. The cessation of exclusive breastfeeding was frequently experienced as unexpected and 'devastating', leaving mothers with 'breastfeeding grief' (a prolonged sense of loss and failure). CONCLUSIONS AND IMPLICATIONS: For many mothers, the cessation of exclusive breastfeeding results in lingering feelings of grief and failure making it harmful to women's emotional well-being. Reframing breastfeeding as a family practice where fathers/partners are incorporated as breastfeeding partners has the potential to help women negotiate and prolong breastfeeding. Proactive counselling and debriefing are needed to assist women who are managing feelings of 'breastfeeding grief'.

'They're born to get breastfed'- how fathers view breastfeeding: a mixed method study.

BACKGROUND: Fathers' attitudes and actions can positively or negatively affect mothers' intentions to breastfeed, breastfeeding duration and exclusivity. In-depth information about fathers' perspectives on breastfeeding are largely absent in the literature about infant feeding. The objective of this research was to investigate how fathers view breastfeeding. METHODS: This mixed method study recruited Tasmanian fathers with children < 24 months of age. Fathers completed a questionnaire and participated in either semi structured one-on-one or group interviews. Transcripts were analysed using a process of iterative thematic analysis. RESULTS: Twenty-six fathers participated in the study. They had a mean age of 34 years and just over half were first time fathers. A total of 13 fathers lived in areas classified by SEIFA as disadvantaged. Twenty-one reported they had decided as a couple to breastfeed their current child. Fathers' views on breastfeeding are complex, multi-layered and change over time: as babies get older, as fathers get more familiar with feeding babies, when feeding practices change and when family circumstances change. Four thematic categories related to how fathers view breastfeeding were identified; Breastfeeding as healthy and natural, the value of breast feeding and breastmilk, a pragmatic approach to breastfeeding and Breastfeeding as something achieved or imposed. CONCLUSION: Fathers in our study valued breastfeeding and saw it as healthy and natural for babies. However, many of the fathers in our study had seen their partners struggle with breastfeeding. As a result some also viewed breastfeeding as a potentially harmful practice for mothers. Their accounts demonstrated that breastfeeding problems affect families, not just mothers and infants. There is scope for improvement in the care of women during and after birth to reduce breastfeeding problems and for fathers to learn more about breastfeeding prior to the birth of their child.

Art, music, story: The evaluation of a person-centred arts in health programme in an acute care older persons' unit.

AIMS AND OBJECTIVES: To evaluate the impact of an arts in health programme delivered by a specialised artist within an acute older person's unit. BACKGROUND: Acute hospitals must meet the increasingly complex needs of older people who experience multiple comorbidities, often including cognitive impairment, either directly related to their admission or longer term conditions, including dementia. A focus on physical illness, efficiency and tasks within an acute care environment can all divert attention from the psychosocial well-being of patients. This focus also decreases capacity for person-centred approaches that acknowledge and value the older person, their life story, relationships and the care context. The importance of arts for health and wellness, including responsiveness to individual need, is well established: however, there is little evidence about its effectiveness for older people in acute hospital settings. We report on a collaborative arts in health programme on an acute medical ward for older people. DESIGN: The qualitative study used collaborative enquiry underpinned by a constructivist approach to evaluate an arts programme that involved participatory art-making activities, customised music, song and illustration work, and enlivening the unit environment. METHODS: Data sources included observation of art activities, semi-structured interviews with patients and family members, and focus groups with staff. Data were transcribed and thematically analysed using a line by line approach. RESULTS: The programme had positive impacts for the environment, patients, families and staff. The environment exhibited changes as a result of programme outputs; patients and families were engaged and enjoyed activities that aided recovery from illness; and staff also enjoyed activities and importantly learnt new ways of working with patients. CONCLUSIONS: An acute care arts in health programme is a carefully nuanced programme where the skills of the arts health worker are critical to success. Utilising such skill, continued focus on person-centeredness and openness to creativity demonstrated positive impacts for patients, families, staff and the ward environment. IMPLICATIONS FOR PRACTICE: This study affirms the contribution of an arts in health program for older persons in an acute care setting in challenging the dominance of a task based medical model and emphasising person-centred care and outcomes.

More than just clowns--Clown doctor rounds and their impact for children, families and staff.

Admission to hospital is recognised as a difficult time for children and families. This study explored clown doctor activities in an acute paediatric setting and the impact their activities have on children, their families, other health professionals and clown doctors themselves. We used observation, semi-structured interviews and focus groups with children and parents and staff and clown doctors and results provide a rich description of the work of clown doctors. The major themes were 'the encounter - in the moment' of the interaction of the child and the clown doctor and 'beyond the encounter'. The findings show that the impact of clown doctor visits is experienced beyond the immediate interaction, and this has not been clearly articulated in previous studies. This study highlights the multifaceted and complex nature of the work of the clown doctors and the high level of skill required as they modify and interpret play, activities and environment based on individual need and response.