Empowering our First Nations workforce: evaluation of a First Nations COVID-19 vaccination training program.

BACKGROUND: A COVID-19 vaccination training program was designed for Aboriginal and Torres Strait Islander (First Nations) health workers and practitioners in Queensland to expand their scope of practice to include COVID-19 immunisation. In the setting of a global pandemic, the project aimed to improve vaccination levels and show how First Nations staff are central to community-led responses to effectively address their community's health needs. METHODS: The program, consisting of an online module and face to face workshop, is described and then evaluated with the RE-AIM framework via mixed methods of participant training surveys and qualitative feedback. RESULTS: The program reached 738 online and 329 workshop participants with the majority identifying as First Nations. The 52 workshops were attended by participants from 12 different hospital and health services in Queensland and 13 Aboriginal Community Controlled Health Organisations (ACCHOs). Feedback was positive, with participants rating the training highly. Of the First Nations Health Workers and Practitioners who responded to the workshop follow up survey, the majority (34/40) implemented their new skills in practice helping minimise the impact of COVID-19 outbreaks in their community. Most respondents (38/40) considered vaccination should be permanently in their scope of practice. CONCLUSIONS: The successful implementation of the vaccination training project was an example of First Nations led health care. Improving scope of practice for First Nations health staff can improve not just career retention and progression but also the delivery of primary care to a community that continues to bear the inequity of poorer health outcomes.

Value of clinical engagement in the NSW Health response to COVID-19.

Clinical engagement has been critical to the NSW Health response to COVID-19, with clinicians across the state working together at a scale and pace not seen before. Since mid-March 2020, 30 COVID-19 Communities of Practice (COPs) have been established, bringing together over 3500 clinicians and other members across 30 different clinical specialties to inform and support a consistent statewide response to the pandemic. COPs share issues, escalate priorities and develop evidence-based guidance on a range of topics. This article provides practical insights into the value of clinical leadership and engagement in a time of crisis. It describes the role of COVID-19 COPs, what they have achieved and their importance in supporting the ongoing pandemic response in New South Wales.

Piloting a Telephone Based Health Coaching Program for Pregnant Women: A Mixed Methods Study.

Objectives Get Healthy in Pregnancy (GHiP) is a telephone based lifestyle coaching service for pregnant women, in New South Wales, Australia. GHiP had two service options; a telephone-based health coaching program consisting of up to 10 calls and information only (including one call). This study sought to compare the outcomes of the two GHiP options, to determine the characteristics of women likely to use the service and to explore the feedback from women and health professionals. Methods A pragmatic stratified clustered randomised controlled trial was conducted. Two metro and three rural hospitals were randomised into health coaching or information only arms. Self-reported measures of height and weight and health behaviours (dietary and physical activity) were collected at baseline and 36 weeks gestation. Process evaluation included descriptive analysis of routine program data, and semi-structured interviews with participants and health professionals. Results Of 3736 women screened, 1589 (42.5%) were eligible to participate, and of those eligible, 923 (58.1%) were recruited. More women in the health coaching arm gained weight within the target range for their BMI at 36 weeks gestation (42.9%) compared with information only (31.9%). Women found GHiP to be useful and supportive and midwives and doctors said that it facilitated conversations about weight with pregnant women. Conclusions for Practice Telephone-based lifestyle programs integrated with routine clinical care show promise in helping pregnant women achieve healthy gestational weight gain, but in this case was not significantly different from one information telephone call. Strong positive feedback suggests that scaled-up service delivery would be well received. TRIAL REGISTRATION: ACTRN12615000397516 (retrospectively registered).

Pragmatic cluster randomised trial of a free telephone-based health coaching program to support women in managing weight gain during pregnancy: the Get Healthy in Pregnancy Trial.

BACKGROUND: Excessive gestational weight gain can result in poor maternal and child health outcomes. Estimates from single studies indicate the prevalence of excessive gestational weight gain in Australia could lie between 38 and 67 %. The risk of excessive weight gain can be reduced through healthy eating and exercise. We describe the rationale and methods of the Get Healthy in Pregnancy Service, a trial service which aims to support women in achieving appropriate gestational weight gain through an existing telephone-based health coaching service. METHODS/DESIGN: This study aims to compare the effectiveness of a telephone-based health coaching program versus provision of information only in supporting pregnant women to achieve appropriate gestational weight gain. A pragmatic stratified clustered randomised controlled trial will be conducted with 710 women who present to 5 hospitals for their first antenatal appointment during the recruitment period (6-8 months), have a pre-pregnancy body mass index (BMI) ≥ 18.50 (healthy weight or above), are 18 years and over, singleton gestation, English speaking, have no pre-existing medical conditions that may limit their ability to exercise or require a restricted diet and are 18 weeks or less gestation. Hospitals will be randomised into one of two intervention models: a) information only; or b) information plus 10 telephone-based health coaching sessions with a university qualified coach. Both interventions will set a weight-range target with pregnant women. The women attending antenatal clinics at participating hospitals will be screened at their initial hospital appointment to assess their eligibility. Women recruited to the trial will have a number of measures recorded including anthropometrics (self-reported height and weight) and dietary and physical activity scores during and following pregnancy. These measurements will be collected at baseline (prior to 18 weeks gestation), 36 weeks gestation and 12 months post-birth. DISCUSSION: This study responds to a need for an effective intervention that targets excessive gestational weight gain at a population level. This study investigates the potential for an innovative intervention combining two existing services; a free state-wide telephone-based health coaching service and hospital-based antenatal care to support pregnant women to achieve healthy weight gain during pregnancy. The use of existing services provides the potential for immediate post-study implementation. While the impacts of telephone-based lifestyle programmes have been tested in a number of settings, there are few studies which evaluate the effectiveness and acceptability of telephone support in achieving healthy gestational weight gain in association with routine antenatal care. TRIAL REGISTRATION: ACTRN12615000397516 (Registration date: 26 June 2014, retrospectively registered).

Core elements of transition support programs: the experiences of newly qualified Australian midwives.

AIM: This article reports on newly qualified midwives' experiences of the core elements of their transition support program; clinical rotations, supernumerary time, study days and midwife-to-midwife support. BACKGROUND: There is limited knowledge and understanding of how midwives transition from student to registered midwife and how best to support them during this time. METHOD: A qualitative descriptive approach. Thirty-eight newly qualified midwives from 14 hospitals in the state of New South Wales, Australia participated. Telephone interviews and focus groups were used to collect the data. Content analysis was used to analyse the data set. FINDINGS: Despite being employed by different hospitals, most participants were offered transition support programs that shared common core elements: rotations to a variety of clinical areas, additional study days, supernumerary time and support from colleagues. Participants stressed the importance of planned clinical rotations and supernumerary time that allowed them to ease into the new clinical area. Study days provided an opportunity for graduates to focus on new skills and to connect with their peers. Support from colleagues, managers and educators was essential, though workloads often impacted on its availability. CONCLUSION: The evidence from the project contributes to our understanding of newly graduated midwives' support needs. As such the findings can be used to inform the development, implementation and evaluation of future transition support programs that better meet the needs of graduates, the women they care for and the facilities in which they work.

The self reported confidence of newly graduated midwives before and after their first year of practice in Sydney, Australia.

BACKGROUND: Graduates from a new, 3-year Bachelor of Midwifery program joined those educated through the 1 year, postgraduate route (for those already qualified as nurses) for the first time in New South Wales (NSW) Australia in 2007. Many hospitals offer transition support programs for new graduates during their first year of practice though there is little evidence available to inform these programs. OBJECTIVES: To establish the new midwife's confidence in working to the 14 "National Competency Standards for the Midwife"(1) and the International Confederation of Midwives (ICM) Definition of a Midwife and to explore whether the new midwife's confidence changed over the new graduate year. In particular the study set out to determine whether there were any differences in the confidence of new graduates from undergraduate or postgraduate programs. DESIGN: Pre and post survey with comparisons longitudinally and within undergraduate and postgraduate cohorts. SETTINGS: Three Area Health Services in Sydney and surrounding areas, Australia. PARTICIPANTS: A convenience sample of all new graduate midwives employed in the three Area Health Services in the early months of 2008. METHODS: New graduate midwives rated their level of confidence (1-10) in working to the 14 National Competency Standards for the Midwife and the ICM Definition of a Midwife during their first weeks of employment and after the completion of their first year of practice. RESULTS: Midwives prepared through the undergraduate and postgraduate routes commenced their first year of practice with similar levels of confidence. The confidence of these midwives increased modestly over the first year of practice. Those from postgraduate programs were significantly more confident than those from undergraduate programs on four competencies after the first year of practice. Participant's self reported confidence in working to the ICM Definition of a Midwife was low. CONCLUSIONS: Our profession and community need strong, confident midwives and it is in all our interests to look to ways we can best achieve this. While the findings of this study should be treated with caution, this study suggests that there is room for improvement in the way we support newly graduated midwives to build their confidence over their first year of practice. Further research is needed to identify the needs of newly graduated midwives and how best we can support them to develop as strong and confident practitioners through their first year of practice.

Addressing obesity in pregnancy: the design and feasibility of an innovative intervention in NSW, Australia.

OBJECTIVE: Obesity amongst women of child bearing age is increasing at an unprecedented, rate throughout the Western world. This paper describes the design of an innovative, collaborative, antenatal intervention that aims to assist women to manage their weight during pregnancy and, presents aspects of the programme evaluation. DATA SOURCES/STUDY SETTING: The programme was introduced at two sites, one in South East Sydney and, the other on the Central North Coast of NSW. Data were drawn from both sites and pooled for analysis. STUDY DESIGN: This evaluation used mixed methods drawing on qualitative and quantitative data. DATA COLLECTION METHODS: Focus groups were held with staff in the antenatal clinic, who were, responsible for recruiting to the new service. Members of staff were also asked to record BMI for all women offered the service and using a simple questionnaire, record the reasons women gave for declining the new service. PRINCIPLE FINDINGS: The recruitment rate to the new service was 35% though this result should be treated with caution. Those women with a BMI of >35 were twice as likely to elect to participate in the new service as women with a BMI of less than 35. Focus groups with midwives in the antenatal clinic responsible for recruitment identified three themes impacting on recruitment to the service; 'finding the words', 'acknowledging challenges' and 'midwives' knowledge'. CONCLUSIONS: Antenatal clinic midwives were unprepared for talking to women about their weight. Increasing the confidence and skills of staff in offering service innovations to eligible women is a major challenge to be met if new models of care are to be successful in addressing overweight and obesity in pregnancy.

Making sense of dementia: understanding amongst indigenous Australians.

INTRODUCTION: Dementia is a growing health and social concern for all Australians. Whilst the prevalence of dementia amongst Australia's indigenous people is unclear, there is some evidence that dementia rates are five times that of the general Australian population. To date no studies have examined dementia knowledge levels in indigenous communities. PURPOSE OF THE STUDY: This paper aims to explore indigenous Australians' understanding, knowledge and misconceptions of dementia. DESIGN AND METHODS: Hundered and seventy-four indigenous adults participated in a cross-sectional survey using a modified version of the Alzheimer's Disease Knowledge Test (ADK). The survey included demographic information, two open-ended questions and 20 multiple choice questions. Each ADK item was examined to identify responses that revealed commonly held correct beliefs, knowledge gaps and misconceptions. RESULTS: The overall level of understanding of dementia was poor. Younger participants were significantly more likely to have no knowledge of Alzheimer's Disease, whereas the other age groups were most likely to have at least some knowledge. It was also revealed that there are common misconceptions about Alzheimer's Disease held by both indigenous and non-indigenous communities. IMPLICATIONS: Culturally appropriate awareness campaigns and targeted educational interventions need to be implemented to improve the general level of understanding of dementia in indigenous communities.

Maternal mortality: what can we learn from stories of postpartum haemorrhage?

Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality. Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring. This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994-2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.