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1.
BMC Psychol ; 7(1): 39, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234948

RESUMO

BACKGROUND: Significant gaps exist in education for prospective and new parents, especially for some of the most vulnerable families. Prospective parents would like more information during pregnancy to prepare them for parenting, and need access to trusted and quality information. The Royal Women's Hospital (the Women's) in Melbourne, Australia, a large tertiary referral maternity hospital, developed a parenting education kit known as 'Growing Together'. The kit, designed to guide prospective and new parents from conception until 1 year after birth, includes three components: an A4 sized book, a specifically designed 'App' and a children's story book. We aim to evaluate the impact of the kit on a range of outcomes. METHODS: A two-arm cluster randomised controlled trial will be used. Antenatal clinic days will be randomised to either the intervention or standard care arms. Women in the intervention arm receive the kit at their antenatal booking visit. Women in the standard care arm receive the standard information resources at the Women's. Analyses will be by intention to treat. INCLUSION CRITERIA: primiparous women with adequate English-speaking ability and ≤ 30 weeks' gestation at first pregnancy booking appointment. The primary outcome of the study is the 'experience of motherhood questionnaire' (EMQ), a 20 item validated self-report measure, ranging from 0 to 80, with lower scores indicating better maternal health and wellbeing. To detect a 10% difference in new mothers scoring ≤40 between women who have received the kit (60%) and those who have not (50%), would require 408 per group (total of 816 women) with 95% confidence and 80% power. Allowing for loss to follow up, we aim to recruit 1000 mothers. Secondary outcomes include parents' views and experiences of their care and of the kit during pregnancy and after the birth, parental attachment, knowledge, confidence, wellbeing and health-seeking behaviour; and emotional, developmental and physical health of the infant. Survey data will be collected from mothers at 2, 6 and 12 months postpartum and partners at 6 months. DISCUSSION: This study will provide much needed high-level evidence on the impact of a comprehensive education resource for new parents. TRIAL REGISTRATION: ANZCTRN12615000270516 - Retrospectively registered (23/03/2015); trial started on 16 March 2015.


Assuntos
Educação não Profissionalizante , Mães/psicologia , Poder Familiar , Adulto , Austrália , Protocolos Clínicos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Avaliação de Resultados (Cuidados de Saúde) , Gravidez , Inquéritos e Questionários
2.
Postgrad Med J ; 95(1122): 205-209, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31097576

RESUMO

PURPOSE: Implantable cardioverter defibrillator (ICD) implantation rates remain variable despite established guideline recommendations. This study aims to assess whether being managed by a cardiologist has an impact on whether patients are considered for an ICD for primary prevention of sudden cardiac death. DESIGN/METHODS: Single-centre, retrospective, observational study of patients identified to have severe left ventricular systolic dysfunction (LVSD) on echocardiography (n = 129) between 1 and 30 June 2016 with cross-sectional assessment at 1 year. An assessment of ICD consideration at 1 year following the echocardiogram was documented, in addition to the specialty of the managing physician (group 1-electrophysiologist/heart failure specialist; group 2-all other cardiologists; group 3-non-cardiologist). RESULTS: 129/1173 (11%) transthoracic echocardiographies (s) were identified to have severe LVSD. 52 (40%), 37 (29%) and 40 (31%) were managed by group 1, group 2 and group 3, respectively. Mean age was 74.7 (±12.6) years with a predominance of male gender (70.5%). An ICD was not considered in 47.3%. Those managed by a cardiologist were more likely to be considered for an ICD than a non-cardiologist (63.9% vs 30.0%; OR 4.0, 95% CI 1.8 to 8.8, p = 0.001) with a greater survival at 1 year (89.9% vs 52.5%, OR 8.1 95% CI 3.2 to 20.4, p < 0.001). Group 1 were more likely to consider ICD than group 2 cardiologists (75.0% vs 45.9%; OR 3.5; 95% CI 1.4 to 8.7, p = 0.005). CONCLUSION: There is significant variation between cardiologists and non-cardiologists, as well as within different cardiology subspecialists, when considering the option of ICD therapy for primary prevention.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Padrões de Prática Médica/estatística & dados numéricos , Prevenção Primária , Especialização/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Women Birth ; 2018 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-30104172

RESUMO

BACKGROUND: It is critical women's voices are heard if there is to be more widespread implementation of midwifery-led continuity models. Publicly-funded homebirth is one such model, yet there has been limited systematic evaluation from the women's perspective. AIM: Examine women's experiences of and views about the two publicly-funded homebirth programs in Victoria, Australia. METHODS: A cross-sectional design was used. All eligible women enrolled in the two pilot homebirth programs in metropolitan Melbourne whose infants were eight weeks of age or more during the evaluation period were invited to participate in a postal survey. A structured questionnaire was used, with some open-ended questions to enable extra comments. We explored women's reasons for choosing homebirth; views of care; experience of labour and birth; views on transfer; and overall experience of the homebirth program. Data were analysed using descriptive statistics. Simple thematic analysis was used for open-ended questions. FINDINGS: The survey response rate was 71% (96/136). A high percentage of women rated their care as 'Very good': pregnancy 81%; labour and birth 90%; and the early postpartum period 83%. Women reported low levels of anxiety during labour and birth, were able to express their feelings, felt in control, and coped physically and emotionally better than they had expected. They felt well supported by midwives and overall reported very positive experiences of the homebirth programs. CONCLUSIONS: These two publicly-funded homebirth pilot programs demonstrated very positive care ratings by women. These findings, along with the clinical outcomes (reported separately), support the continuation and expansion of the program.

4.
Midwifery ; 63: 60-67, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29803988

RESUMO

BACKGROUND: Caseload midwifery has many benefits for women and their babies, however only around 8% of women receive caseload care in the public maternity system in Australia. Midwives working within caseload models are required to provide activity-based care (working on-call, responsively to the needs of their caseload of women) rather than undertaking shift work. There has been debate regarding the impact of caseload work on midwives, but recently caseload work has been associated with higher professional satisfaction and lower burnout when compared to midwives working in traditional models. However, there continues to be debate about the impact of caseload on midwives, so further investigation is needed. DESIGN AND SETTING: A national cross-sectional survey of midwives working in Australian public hospitals that have birthing services was undertaken. We explored burnout and midwives' attitudes to their professional role using the Copenhagen Burnout Inventory and the Midwifery Process Questionnaire, respectively. Comparisons were made across three groups of midwives: those who worked in the caseload model, midwives who did not work in this model but worked in a hospital with a caseload model, and midwives who worked in a hospital without a caseload model. PARTICIPANTS AND FINDINGS: We received 542 responses from midwives from 111 hospitals from all Australian states and one of the territories. Of respondents, 107 midwives worked in a caseload model, 212 worked in a hospital with a caseload model but did not work in caseload, and 220 midwives worked in a hospital without a caseload model. Midwives working in caseload had significantly lower burnout scores in the personal and work-related burnout subscales, and a trend toward lower scores in the client-related burnout subscale. They also had higher scores across all four subscales of the midwifery process questionnaire, demonstrating more positive attitudes to their professional role. KEY CONCLUSIONS: Although concerns have been raised regarding the impact of caseload midwifery on midwives, this national study found that midwives working within caseload had a more positive attitude to their work and lower burnout scores than those not working in the model, compared with both midwives working in a hospital with a caseload model and midwives working in a hospital without caseload. This large national study does not support earlier suggestions that caseload midwifery causes increased burnout. IMPLICATIONS FOR PRACTICE: Given the benefits of caseload for women and their infants, and the benefits for midwives found in this study, policy-makers and health care providers should focus on how the caseload model can be expanded to provide increased access for both women and midwives.

5.
Int J Epidemiol ; 47(6): 1745-1756, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29534192

RESUMO

Background: Occupational and environmental airborne asbestos concentrations are too low and variable for lifetime exposures to be estimated reliably, and building workers and occupants may suffer higher exposure when asbestos in older buildings is disturbed or removed. Mesothelioma risks from current asbestos exposures are therefore not known. Methods: We interviewed and measured asbestos levels in lung samples from 257 patients treated for pneumothorax and 262 with resected lung cancer, recruited in England and Wales. Average lung burdens in British birth cohorts from 1940 to 1992 were estimated for asbestos-exposed workers and the general population. Results: Regression analysis of British mesothelioma death rates and average lung burdens in birth cohorts born before 1965 suggests a lifetime mesothelioma risk of approximately 0.01% per fibre/mg of amphiboles in the lung. In those born since 1965, the average lung burden is ∼1 fibre/mg among those with no occupational exposure. Conclusions: The average lifetime mesothelioma risk caused by recent environmental asbestos exposure in Britain will be about 1 in 10 000. The risk is an order of magnitude higher in a subgroup of exposed workers and probably in occupants in the most contaminated buildings. Further data are needed to discover whether asbestos still present in buildings, particularly schools, is a persistent or decreasing hazard to workers who disturb it and to the general population, and whether environmental exposure occurs predominantly in childhood or after beginning work. Similar studies are needed in other countries to estimate continuing environmental and occupational mesothelioma hazards worldwide, including the contribution from chrysotile.

6.
Women Birth ; 31(4): 269-277, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29126796

RESUMO

BACKGROUND: Dietary intake of pregnant women do not appear to meet the dietary recommendations. Nutrition knowledge and practices of pregnant women and their antenatal care clinicians are factors that may be influential on dietary intakes of pregnant women. AIM: To assess and compare pregnancy nutrition recommendation knowledge and to explore how nutrition knowledge impacts on food choices in pregnant women and nutrition education practices of antenatal care providers. METHODS: An explanatory sequential research mixed methods study design was applied. All participants were recruited from a metropolitan maternity hospital in Melbourne, Australia. The first phase assessed pregnancy nutrition knowledge and sources of nutrition information using a questionnaire (n=202) then followed semi-structured interviews with women and clinicians (n=31). FINDINGS: The clinicians obtained significantly higher nutrition scores than compared to women, however, nutrition knowledge gaps were highlighted for both women and clinicians. Women reported receiving limited nutrition advice, a reflection of the clinicians reporting they provided limited nutrition advice. CONCLUSION: A key challenge for women adhering to dietary recommendations was having inadequate knowledge of the dietary recommendations and receiving limited information from their care providers. Similarly, as well as time constraints, limited nutrition knowledge and a lack of nutrition training impacted on the capacity of clinicians to provide adequate nutrition education.


Assuntos
Dieta , Conhecimentos, Atitudes e Prática em Saúde , Gestantes/psicologia , Cuidado Pré-Natal , Adulto , Austrália , Aconselhamento , Feminino , Humanos , Política Nutricional , Estado Nutricional , Gravidez , Fenômenos Fisiológicos da Nutrição Pré-Natal , Inquéritos e Questionários , Adulto Jovem
7.
Women Birth ; 31(3): 194-201, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28964707

RESUMO

BACKGROUND: Despite high-level evidence of the benefits of caseload midwifery for women and babies, little is known about specific practice arrangements, organisational barriers and facilitators, nor about workforce requirements of caseload. This paper explores how caseload models across Australia operate. METHODS: A national cross-sectional, online survey of maternity managers in public maternity hospitals with birthing services was undertaken. Only services with a caseload model are included in the analysis. FINDINGS: Of 253 eligible hospitals, 149 (63%) responded, of whom 44 (31%) had a caseload model. Operationalisation of caseload varied across the country. Most commonly, caseload midwives were required to work more than 0.5 EFT, have more than one year of experience and have the skills across the whole scope of practice. On average, midwives took a caseload of 35-40 women when full time, with reduced caseloads if caring for women at higher risk. Leave coverage was complex and often ad-hoc. Duration of home-based postnatal care varied and most commonly provided to six weeks. Women's access to caseload care was impacted by many factors with geographical location and obstetric risk being most common. CONCLUSION: Introducing, managing and operationalising caseload midwifery care is complex. Factors which may affect the expansion and availability of the model are multi-faceted and include staffing and model inclusion guidelines. Coverage of leave is a factor which appears particularly challenging and needs more focus.


Assuntos
Administração de Caso/organização & administração , Hospitais Públicos/organização & administração , Tocologia/organização & administração , Modelos Organizacionais , Austrália , Estudos Transversais , Feminino , Humanos , Gravidez , Inquéritos e Questionários
8.
Matern Child Health J ; 20(10): 2179-88, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27395383

RESUMO

Objectives This study explored nutrition knowledge of pregnant women, and how it correlated with participant characteristics, their main sources of information and changes to their diet since becoming pregnant. Methods Pregnant women residing in Australia accessing pregnancy forums on the internet were invited to complete a web-based questionnaire on general nutrition and pregnancy-specific nutrition guidelines. Results Of the 165 eligible questionnaire responses, 114 were complete and included in the analysis. Pregnancy nutrition knowledge was associated with education (r s = 0.21, p < 0.05) and income (r s = 0.21, p < 0.05). Only 2 % of pregnant women achieved nutrition knowledge scores over 80 %. Few women received nutrition advice during their pregnancy, of which most were advised by their doctor. Dietary changes adopted since becoming pregnant included consuming more fruit, vegetables, dairy and high fibre foods. Conclusions for Practice Pregnant women in this study had limited knowledge of the dietary guidelines for healthy eating during pregnancy. Furthermore, nutrition counselling in maternity care appears to be infrequent. One approach to optimising maternal diets and subsequently preventing adverse health outcomes is to enhance their knowledge of the pregnancy nutrition guidelines through the provision of nutritional counselling. Furthermore, research exploring the access and use of nutrition resources, and nutrition advice provided to pregnant women is recommended to understand how knowledge impacts on dietary behaviour.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Dieta Saudável , Política Nutricional , Gestantes/psicologia , Fenômenos Fisiológicos da Nutrição Pré-Natal , Adulto , Austrália , Estudos Transversais , Feminino , Humanos , Internet , Mães , Inquéritos Nutricionais , Gravidez , Inquéritos e Questionários , Adulto Jovem
9.
Midwifery ; 35: 24-30, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27060397

RESUMO

OBJECTIVE: to explore midwives' and doctors' views and experiences of publicly-funded homebirthing models. DESIGN: cross-sectional survey implemented two years after the introduction of publicly-funded homebirthing models. SETTING: two public hospitals in Victoria, Australia. PARTICIPANTS: midwives and doctors (obstetric medical staff). MAIN OUTCOME MEASURES: midwives' and doctors' views regarding reasons women choose home birth; and views and experiences of a publicly-funded home birth program, including intrapartum transfers. FINDINGS: of the 44% (74/167) of midwives who responded to the survey, the majority (86%) supported the introduction of a publicly-funded home birth model, and most considered that there was consumer demand for the model (83%). Most thought the model was safe for women (77%) and infants (78%). These views were stronger amongst midwives who had experience working in the program (compared with those who had not). Of the 25% (12/48) of doctors who responded, views were mixed; just under half-supported the introduction of a publicly-funded home birth model, and one was unsure. Doctors also had mixed views about the safety of the model. One third agreed it was safe for women, one third were neutral and one third disagreed. Half did not believe the home birth model was safe for infants. The majority of midwives (93%) and doctors (75%) believed that intrapartum transfers from home to hospital were easier when the homebirthing midwife was a member of the hospital staff (as is the case with these models). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: responding midwives were supportive of the introduction of publicly-funded home birth, whereas doctors had divergent views and some were concerned about safety. To ensure the success of such programs it is critical that all key stakeholders are engaged at the development and implementation stages as well as in the ongoing governance.


Assuntos
Parto Obstétrico , Parto Domiciliar , Enfermeiras Obstétricas , Assistência Perinatal , Médicos , Atitude do Pessoal de Saúde , Parto Obstétrico/economia , Parto Obstétrico/métodos , Feminino , Financiamento Governamental/métodos , Programas Governamentais , Parto Domiciliar/economia , Parto Domiciliar/psicologia , Parto Domiciliar/estatística & dados numéricos , Humanos , Recém-Nascido , Modelos Organizacionais , Segurança do Paciente , Assistência Perinatal/economia , Assistência Perinatal/organização & administração , Gravidez , Avaliação de Programas e Projetos de Saúde , Vitória
10.
J Am Pharm Assoc (2003) ; 56(3): 274-279.e3, 2016 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27053278

RESUMO

OBJECTIVES: This study sought to: (1) determine the percentage of community pharmacists in Indiana with advanced diabetes credentials; (2) identify the perceived benefits and barriers that pharmacists have toward obtaining advanced diabetes credentials; and (3) assess the intent and interest in pursuing advanced diabetes credentials in the future. METHODS: A cross-sectional statewide telephone survey of community pharmacists in Indiana was conducted from November 2014 to March 2015. Survey items were derived from a compilation of structured and unstructured questions that were of interest to the research team. Questions regarding demographics, current credentials held, and common diabetes-related counseling topics were asked to all respondents. The research team also sought to determine pharmacists' perceptions of the benefits and barriers to obtaining advanced diabetes credentials. The survey was divided into 3 sections: personal and professional demographics, current credentials, and perceptions of diabetes credentials. Respondents answered dichotomous, Likert-scale response, and open-ended questions. Six research assistants administered the survey. RESULTS: A total of 1024 community pharmacies were contacted, and 907 pharmacists responded, for an 88.5% response rate. Of the 907 participants, 9 pharmacists (<1%) held advanced diabetes credentials, and 6 others held advanced diabetes credentials that had expired. One-half (50%) of pharmacists agreed that advanced diabetes credentials were important for all community pharmacists, although 45% of all pharmacists surveyed did not think that advanced diabetes credentials were necessary for delivering patient care services. CONCLUSION: Despite the opportunity for community pharmacists to expand their role in advanced diabetes care, few have obtained advanced diabetes credentials, and available research has yet to articulate the barriers inhibiting the process. Results from this pilot survey will provide insight into the future dissemination of a nationwide survey to community pharmacists.


Assuntos
Serviços Comunitários de Farmácia/normas , Credenciamento , Diabetes Mellitus/terapia , Farmacêuticos/normas , Adulto , Aconselhamento , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Projetos Piloto , Papel Profissional
11.
Women Birth ; 29(3): 223-33, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26631349

RESUMO

BACKGROUND: Caseload midwifery models are becoming more common in Australian maternity care. Little is known about how caseload midwifery compares with mainstream models of midwifery care in terms of both the organisation of the work and the meaning of the work for caseload midwives. AIM: To explore caseload and standard care midwives' views and experiences of midwifery work in two new caseload models in Victoria, Australia. METHODS: A mixed-methods approach was used. Quantitative data were collected using two cross-sectional surveys of midwives at the two study sites at the commencement of the caseload model and after two years. Qualitative data were collected using in-depth interviews with caseload midwives six months and two years after commencing in the role. Content analysis was used to analyse open-ended survey questions, and interview data were analysed thematically. Themes arising from these data sources were then considered using Normalization Process Theory. FINDINGS: Two themes emerged from the data. Caseload midwifery was a 'different' way of working, involving activity-based work, working on-call, fluid navigation between work and personal time and avoiding burnout. Working in caseload was also perceived by caseload midwives to be 'real' midwifery, facilitating relationships with women, and requiring responsibility, accountability, autonomy and legitimacy in their practice. Perceptions of caseload work were influenced by understanding these differences in caseload work compared to mainstream maternity care. CONCLUSION: Increased understanding of the differences between caseload work and mainstream maternity models, and introducing opportunities to be exposed to caseload work may contribute to sustainability of caseload models.


Assuntos
Tocologia/métodos , Obstetrícia/organização & administração , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Inquéritos e Questionários , Vitória , Adulto Jovem
13.
Women Birth ; 29(3): 214-22, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26603016

RESUMO

BACKGROUND: The benefits of caseload midwifery care are clearly documented, and many policy documents in Australia support its expansion. Despite this, little is known about the availability of caseload across Australia, nor about what proportion of women have access to a caseload model. This paper describes caseload midwifery in the public maternity system in Australia; its prevalence, and factors associated with implementation and sustainability. METHODS: A cross-sectional online survey of maternity managers of public hospitals that provide birthing services throughout Australia. FINDINGS: Sixty-three percent (149/235) of eligible participants responded. Respondents were from all states and territories, metropolitan, regional and remote areas, and from hospitals with very small to very large birth numbers. Only 31% reported that their hospital offers caseload midwifery, and an estimated eight percent of women received caseload care at the time of the survey, most of whom were considered to be of 'low obstetric risk'. Many respondents were planning to implement or expand caseload. Key factors associated with the implementation of caseload were funding to establish the model, the interest and availability of staff to work in the model, organisational support and perceived consumer demand. CONCLUSION: This is the first study to explore caseload implementation at a national level. Although the number of services offering caseload midwifery care has increased nationally, access remains relatively limited. Women who live in metropolitan areas and who are considered at 'low obstetric risk' are most likely to be able to access this model. Funding and support for establishing new models are the main barriers to implementation.


Assuntos
Hospitais Públicos , Tocologia/organização & administração , Austrália , Estudos Transversais , Feminino , Humanos , Gravidez , Inquéritos e Questionários
14.
Midwifery ; 31(2): e7-e15, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25451548

RESUMO

OBJECTIVES: in Australia, models of maternity care that offer women continuity of care with a known midwife have been promoted. Little is known about the intentions of the future midwifery workforce to work in such models. This study aimed to explore midwifery students' views and experiences of caseload midwifery and their work intentions in relation to the caseload model following graduation. DESIGN: cross-sectional survey. SETTING: Victoria, Australia. PARTICIPANTS: 129 midwifery students representing all midwifery course pathways (Post Graduate Diploma, Bachelor of Midwifery, Bachelor of Nursing/Bachelor of Midwifery) in Victoria. FINDINGS: midwifery students from all course pathways considered that continuity of care is important to women and indicated that exposure to continuity models during their course was very positive. Two-thirds of the students (67%) considered that the continuity experiences made them want to work in a caseload model; only 5% reported that their experiences had discouraged them from continuity of care work in the future. Most wanted a period of consolidation to gain experience as a midwife prior to commencing in the caseload model. Perceived barriers to caseload work were being on-call, and challenges in regard to work/life balance and family commitments. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwifery students in this study were very positive about caseload midwifery and most would consider working in caseload after a period of consolidation. Continuity of care experiences during students' midwifery education programmes appeared to provide students with insight and understanding of continuity of care for both women and midwives. Further research should explore what factors influence students' future midwifery work, whether or not their plans are fulfilled, and whether or not the caseload midwifery workforce can be sustained.


Assuntos
Estudantes de Enfermagem/psicologia , Carga de Trabalho/normas , Adulto , Continuidade da Assistência ao Paciente , Estudos Transversais , Feminino , Humanos , Tocologia/educação , Inquéritos e Questionários , Vitória
15.
BMC Pregnancy Childbirth ; 14: 426, 2014 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-25539601

RESUMO

BACKGROUND: Caseload midwifery reduces childbirth interventions and increases women's satisfaction with care. It is therefore important to understand the impact of caseload midwifery on midwives working in and alongside the model. While some studies have reported higher satisfaction for caseload compared with standard care midwives, others have suggested a need to explore midwives' work-life balance as well as potential for stress and burnout. This study explored midwives' attitudes to their professional role, and also measured burnout in caseload midwives compared to standard care midwives at two sites in Victoria, Australia with newly introduced caseload midwifery models. METHODS: All midwives providing maternity care at the study sites were sent questionnaires at the commencement of the caseload midwifery model and two years later. Data items included the Midwifery Process Questionnaire (MPQ) to examine midwives' attitude to their professional role, the Copenhagen Burnout Inventory (CBI) to measure burnout, and questions about midwives' views of caseload work. Data were pooled for the two sites and comparisons made between caseload and standard care midwives. The MPQ and CBI data were summarised as individual and group means. RESULTS: Twenty caseload midwives (88%) and 130 standard care midwives (41%) responded at baseline and 22 caseload midwives (95%) and 133 standard care midwives (45%) at two years. Caseload and standard care midwives were initially similar across all measures except client-related burnout, which was lower for caseload midwives (12.3 vs 22.4, p = 0.02). After two years, compared to midwives in standard care, caseload midwives had higher mean scores in professional satisfaction (1.08 vs 0.76, p = 0.01), professional support (1.06 vs 0.11, p <0.01) and client interaction (1.4 vs 0.09, p <0.01) and lower scores for personal burnout (35.7 vs 47.7, p < 0.01), work-related burnout (27.3 vs 42.7, p <0.01), and client-related burnout (11.3 vs 21.4, p < 0.01). CONCLUSION: Caseload midwifery was associated with lower burnout scores and higher professional satisfaction. Further research should focus on understanding the key features of the caseload model that are related to these outcomes to help build a picture of what is required to ensure the long-term sustainability of the model.


Assuntos
Esgotamento Profissional/psicologia , Satisfação no Emprego , Tocologia/organização & administração , Doenças Profissionais/psicologia , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Relações Interprofissionais , Pessoa de Meia-Idade , Modelos Organizacionais , Papel Profissional/psicologia , Relações Profissional-Paciente , Inquéritos e Questionários , Vitória , Adulto Jovem
16.
Midwifery ; 30(1): e26-33, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24246969

RESUMO

AIM OF THE STUDY: to explore the information sources used by women during pregnancy to meet their information needs regarding pregnancy, birth and the postpartum period. DESIGN: a cross-sectional postal survey of all eligible women who birthed at the Royal Women's Hospital, Melbourne, Australia between November 2010 and January 2011. Surveys were sent at four months post partum. FINDINGS: forty-seven per cent (350/752) of eligible women returned the surveys, of whom 62% were primiparous. 'Discussion with a midwife' was the source of information used by the greatest number of women during pregnancy (246/350, 70%). Less than half of the women used the internet to access information (154/350, 44%), and group information sessions were the least preferred information format (8/330, 2.4%). Women from non-English speaking backgrounds (NESB) were less likely to use written and online resources. One-third of the women had unmet learning needs, particularly in relation to breast feeding and postnatal recovery. Overall, women rated books as the most useful source of information (57/332, 17.2%). The model of pregnancy care influenced the source women rated as most useful. Women who received most of their pregnancy care from a midwife described discussion with a midwife as their most useful source of information (42/150, 28%). In contrast, of the group who received most of their care from a doctor in antenatal clinic, the largest proportion reported that the internet was their most useful source of information (10/57, 28%). CONCLUSION AND RECOMMENDATIONS: discussion with midwives is an important source of information for women. The internet did not play a significant role in information seeking for more than half of the women in the study. Existing sources of information may not meet the needs of women from NESB, either because women do not access the multilingual resources currently available or because resources may only be provided in English or a few other common languages.


Assuntos
Tocologia , Educação de Pacientes como Assunto , Assistência Perinatal , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Disseminação de Informação , Comportamento de Busca de Informação , Internet , Gravidez , Inquéritos e Questionários , Vitória
17.
Midwifery ; 29(9): 1064-72, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23427854

RESUMO

OBJECTIVE: Follow-through experiences (which enable midwifery students to experience continuity of care with individual women through pregnancy, labour and birth and the postnatal period) are a component of midwifery education programmes in Australia and the United Kingdom. Current accreditation standards in Australia require midwifery students to have a total of 20 continuity of care experiences with an average of 20 hours per woman over the duration of their course. There has been limited research regarding students' and academics' experiences of follow-through experiences; and there has been debate regarding the appropriate number of follow-through experiences in midwifery curricula. This study aimed to explore the follow-through experience from the perspective of midwifery students and academics in Victoria, Australia. DESIGN: cross-sectional design using a web-based survey. SETTING: Victoria, Australia. PARTICIPANTS: Students (n=401) and academics (n=35) from all seven universities in Victoria that offer accredited midwifery programmes including the Bachelor of Midwifery, Bachelor of Nursing/Bachelor of Midwifery double degree, Postgraduate Diploma of Midwifery and Masters of Midwifery (entry to practice). FINDINGS: Students and academics were in agreement that continuity of care is important to women. They considered the follow-through experience to be a unique and valuable learning opportunity and agreed that follow-through experiences should be included in midwifery education programmes. However, students and academics raised major concerns about the impact of follow-through experiences on students' capacity to meet university course requirements (such as missing lectures/tutorials and clinical placements), and spending extensive periods of time on-call both within and outside the university semester. Students and academics also reported concerns about the impact of follow-through experiences on students' personal lives, including paid employment and family responsibilities (such as childcare or caring for family members). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: In settings where continuity of care options for women are relatively limited, prescriptive requirements regarding the number and hours of follow-through experiences can present significant challenges for midwifery students. Midwifery regulatory bodies should consider these findings when developing or revising standards for midwifery education.


Assuntos
Docentes de Enfermagem , Enfermagem Materno-Infantil , Tocologia/educação , Enfermeiras Obstétricas/psicologia , Aprendizagem Baseada em Problemas/métodos , Estudantes de Enfermagem/psicologia , Adulto , Austrália , Continuidade da Assistência ao Paciente , Estudos Transversais , Currículo/normas , Feminino , Humanos , Enfermagem Materno-Infantil/educação , Enfermagem Materno-Infantil/métodos , Modelos Educacionais , Relações Enfermeiro-Paciente , Pesquisa em Educação de Enfermagem , Assistência Perinatal/métodos , Gravidez
18.
Midwifery ; 29(2): 159-66, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22342229

RESUMO

OBJECTIVE: women have consistently rated postnatal care less favourably than other episodes of maternity care. Midwives have also reported concerns with postnatal care, with challenges related to workloads, busy environments and lack of staff. Given these concerns, a regional hospital in Victoria, Australia redesigned its postnatal care provision. The changes included cessation of routine postnatal observations and the use of clinical pathways for women who gave birth vaginally; promotion of rest through minimal disturbances before 9 am; discouraging the use of the call bell system except in emergency situations; introduction of 'one-to-one' time with women; and promotion of normalcy and independence. This paper examines midwives' views of the changes and their impressions of the effects of the changes on women and their infants. DESIGN: cross-sectional surveys of midwives were conducted six months after the changes to postnatal care were introduced then again, two years later. Midwives' views and experiences of the changes; the impact of the changes on confidence and autonomy of practice; views regarding the effect on women's satisfaction with care; and the perceived safety of the changes were explored. SETTING: a regional hospital in Victoria, Australia where approximately 2,000 births occur each year. PARTICIPANTS: permanent part-time and full-time midwives. FINDINGS: response rates were 64% (50/78) at baseline and 60% (50/84) two years later. Overall, midwives were supportive of, and complied with, the changes to postnatal care. They agreed that change was needed and believed that the new way of providing care would be better for women and increase individualised care. Midwives also agreed that the changes would facilitate rest for women, believed that removal of routine observations for women after a vaginal birth was safe and that it would allow more time with women. Over time, midwives were more likely to feel autonomous when providing postnatal care. However, some concerns were raised, mostly in relation to the challenges around postnatal documentation, care provision without the guidance of a care/clinical pathway, and about limiting the use of the call bell to only emergency situations. Midwives were not confident that the changes would necessarily translate to a measurable increase in women's satisfaction with care, and were not confident that the changes translated into more time to spend listening and providing support to women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: overall, midwives were supportive of the changes and agreed that change to postnatal care was needed. Challenges remain around the most effective method of communication and documentation of postnatal care. It is important that when major changes to care provision are implemented that care providers' views and experiences are explored given their crucial role in the introduction and maintenance of changes and the potential impact on them as care providers.


Assuntos
Enfermeiras Obstétricas/psicologia , Unidade Hospitalar de Ginecologia e Obstetrícia , Cuidado Pós-Natal/métodos , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/tendências , Inovação Organizacional , Preferência do Paciente , Gravidez , Melhoria de Qualidade , Vitória
19.
Aust Health Rev ; 36(1): 75-8, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22513024

RESUMO

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.


Assuntos
Mão de Obra em Saúde/organização & administração , Tocologia , Parcerias Público-Privadas , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Serviços de Saúde Materna , Tocologia/educação , Gravidez , Universidades , Vitória
20.
BMC Public Health ; 11 Suppl 5: S8, 2011 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-22168585

RESUMO

OBJECTIVE: Research on new models of care in health service provision is complex, as is the introduction and embedding of such models, and positive research findings are only one factor in whether a new model of care will be implemented. In order to understand why this is the case, research design must not only take account of proposed changes in the clinical encounter, but the organisational context that must sustain and normalise any changed practices. We use two case studies where new models of maternity care were implemented and evaluated via randomised controlled trials (RCTs) to discuss how (or whether) the use of theory might inform implementation and sustainability strategies. The Normalisation Process Model is proposed as a suitable theoretical framework, and a comparison made using the two case studies - one where a theoretical framework was used, the other where it was not. CONTEXT AND APPROACH: In the maternity sector there is considerable debate about which model of care provides the best outcomes for women, while being sustainable in the organisational setting. We explore why a model of maternity care--team midwifery (where women have a small group of midwives providing their care)-- that was implemented and tested in an RCT was not continued after the RCT's conclusion, despite showing the same or better outcomes for women in the intervention group compared with women allocated to usual care. We then discuss the conceptualisation and rationale leading to the use of the 'Normalisation Process Model' as an aid to exploring aspects of implementation of a caseload midwifery model (where women are allocated a primary midwife for their care) that has recently been evaluated by RCT. DISCUSSION: We demonstrate how the Normalisation Process Model was applied in planning of the evaluation phases of the RCT as a means of exploring the implementation of the caseload model of care. We argue that a theoretical understanding of issues related to implementation and sustainability can make a valuable contribution when researching complex interventions in complex settings such as hospitals. CONCLUSION AND IMPLICATIONS: Application of a theoretical model in the research of a complex intervention enables a greater understanding of the organisational context into which new models of care are introduced and identification of factors that promote or challenge implementation of these models of care.


Assuntos
Continuidade da Assistência ao Paciente/normas , Implementação de Plano de Saúde/normas , Comportamento Materno , Serviços de Saúde Materna/normas , Avaliação de Processos e Resultados (Cuidados de Saúde)/métodos , Adulto , Austrália , Feminino , Pesquisa sobre Serviços de Saúde , Maternidades , Humanos , Tocologia , Modelos Teóricos , Obstetrícia/organização & administração , Estudos de Casos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/organização & administração , Avaliação de Programas e Projetos de Saúde , Saúde Pública , Pesquisa Qualitativa
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