The Expanding Role of the Canadian Nurse Practitioner in Medical Aesthetics.

Advanced practice in nursing is well established and has been active since the 1800s. In most cases, the role was developed because of a specific need or gap in patient care. Advanced practice nurses (APNs) have been experts in medical aesthetic injections for more than 30 years. The APNs' independence became increasingly common as a mechanism of continuity of care for the non-surgical-medical aesthetic patients. The APN role has evolved, and nurse practitioners (NPs) are now collaborating with nurses safely and effectively in nurse-led clinics in medical aesthetics. There are specific education and college regulations that are required to ensure patient safety in this collaborative care model. The role of the NP in a nurse-led medical aesthetic clinic is an accepted and recognized independent practice role that creates an innovative and well-regulated approach to patient care.

Factors that Promote a Positive Childbearing Experience: A Qualitative Study.

INTRODUCTION: Experiences of pregnancy and birth are important and have long-term impacts on the well-being of women and their families. Perinatal services should aim for care that promotes a positive childbearing experience, as well as optimizing health outcomes for the woman and newborn. This study aimed to understand the health system factors that promote a positive childbearing experience. METHODS: Women who had a positive experience and had given birth in Australia in the previous 12 months were recruited for individual semistructured interviews. The interview guide focused on health system factors that participants credited with contributing to their positive experience of perinatal care. Interviews were conducted until data saturation was reached. Qualitative data were transcribed verbatim and analyzed using inductive thematic analysis. RESULTS: Data from 36 interviews were thematically analyzed, and 4 major themes were generated: health care provider attributes, health system attributes, communication and decision-making, and experience of care. The salient factors that promoted positive experiences included care that was respectful and individualized with effective communication, access to midwifery continuity of care models, and good integration between services. Competent and professional health care providers who facilitated shared decision-making were also essential. DISCUSSION: Although women often sought out care that promoted physiologic birth, they emphasized that the way they were cared for was more important than fulfilling specific birth aspirations. Quality maternity care has the capacity to support a woman's confidence in her own abilities and promote a positive, and sometimes transformative, childbearing experience.

Where do low risk women live relative to maternity services across Victoria? Expanding access to public homebirth models across Victoria.

PROBLEM: Currently <1% of Australian women give birth at home. BACKGROUND: In Australia there are very few options for women to access public funded homebirth. AIM: We aimed to use geo-mapping to identify the number of women eligible for homebirth in Victoria, based on the criteria of uncomplicated pregnancies and residing within 15-25kms of suitable maternity services, to plan future maternity care options. METHODS: Retrospective study of births between 2015 and 2017 in Victoria, Australia. All women who were identified as having a low risk pregnancy at the beginning of pregnancy were included. The number of women within 15 and 25km of a suitable Victorian public maternity hospital and catchment boundaries around each hospital were determined. FINDINGS: Between 2015 and 2017, 126,830 low risk women gave birth in Victoria, of whom half live within 25km of seven Victorian hospitals. Currently, 2% of suitable women who live close to the current public homebirth models accessed them. DISCUSSION: We present a method to inform the expansion of maternity service options using Victoria as an example. On the basis of the maximum number of low risk women living close by, we have also identified the Victorian maternity services that would be most suitable for creation of public homebirth or low risk continuity of midwifery models. CONCLUSION: This approach could can be used to plan other maternity care services.

Women's experiences of birth trauma: A scoping review.

BACKGROUND: A high number of Australian women report experiencing traumatic birth events. Despite high incidence and potential wide spread and long-lasting effects, birth trauma is poorly recognised and insufficiently treated. Birth trauma can trigger ongoing psychosocial symptoms for women, including anxiety, tokophobia, bonding difficulties, relationship issues and PTSD. Additionally, women's future fertility choices can be inhibited by birth trauma. AIM: To summarize the existing literature to provide insight into women's experiences of birth trauma unrelated to a specific pre-existing obstetric or contextual factor. METHODS: The review follows 5 stages of Arksey and O'Malley's framework. 7 databases were searched using indexed terms and boolen operators. Data searching identified 1354 records, 5 studies met inclusion criteria. FINDINGS: Three key themes emerged; (1) health care providers and the maternity care system. (2) Women's sense of knowing and control. (3) Support. DISCUSSION: Continuity of carer creates the foundations for facilitative interactions between care provider and woman which increases the likelihood of a positive birth experience. Women are able to gain a sense of feeling informed and being in control when empowering and individualized care is offered. Functional social supports and forms of debriefing promotes psychological processing and can enable post traumatic growth. CONCLUSION: Existing literature highlights how birth trauma is strongly influenced by negative health care provider interactions and dysfunctional operation of the maternity care system. A lack of education and support limited informed decision-making, resulting in feelings of losing control and powerlessness which contributes to women's trauma. Insufficient support further compounds women's experiences.

A pathway to establish a publicly funded home birth program in Australia.

BACKGROUND: Home births provide women a birth choice where they may feel more comfortable and confident in their ability to give birth. PROBLEM: Most women in Victoria do not have publicly funded access to appropriately trained health professionals if they choose to give birth at home. METHODS: This paper describes the process of setting up a publicly funded home birth service and provide details of description of the set up and governance. We also report outcomes over 9 years with respect to parity, transfer to hospital, adverse maternal and neonatal outcomes. RESULTS: Of the 191 women who were still booked into the home birth program at 36 weeks gestation, 148 (77.5%) women gave birth at home and 43 (22.5%) women were transferred into the hospital. The overall rate of vaginal birth was also high among the women in the home birth program, 185 (96.9%) with no added complications ascribed to home births. Such as severe perineal trauma [n=1] 0.6% PPH [n=4] 2.7%, Apgar score less than 7 at 5min [n=0] admissions post home birth to special care nursery [n=2] 1.35%. DISCUSSION: This unique study provides a detailed road map of setting up a home birth practice to facilitate other institutions keen to build a publicly funded home birth service. The birth outcome data was found to be consistent with other Australian studies on low risk home births. CONCLUSION: Well-designed home birth programs following best clinical practices and procedures can provide a safe birthing option for low risk women.

Simulation based training in a publicly funded home birth programme in Australia: A qualitative study.

BACKGROUND: Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. However there is a small risk of emergencies requiring immediate, skilled management to optimise maternal and neonatal outcomes. We developed and implemented a simulation workshop designed to run in a home based setting to assist with emergency training for midwives and paramedical staff. The workshop was evaluated by assessing participants' satisfaction and response to key learning issues. METHODS: Midwifery and emergency paramedical staff attending home births participated in a simulation workshop where they were required to manage birth emergencies in real time with limited availability of resources to suit the setting. They completed a pre-test and post-test evaluation form exploring the content and utility of the workshops. Content analysis was performed on qualitative data regarding the most important learning from the simulation activity. RESULTS: A total of 73 participants attended the workshop (midwifery=46, and paramedical=27). There were 110 comments, made by 49 participants. The most frequently identified key learning elements were related to communication (among midwives, paramedical and hospital staff and with the woman's partner), followed by recognising the role of other health care professionals, developing an understanding of the process and the importance of planning ahead. CONCLUSION: Home birth simulation workshop was found to be a useful tool by staff that provide care to women who are having a planned home birth. Developing clear communication and teamwork were found to be the key learning principles guiding their practice.

Herpes simplex virus type 1 portal protein UL6 interacts with the putative terminase subunits UL15 and UL28.

The herpes simplex virus type 1 (HSV-1) UL6, UL15, and UL28 proteins are essential for cleavage of replicated concatemeric viral DNA into unit length genomes and their packaging into a preformed icosahedral capsid known as the procapsid. The capsid-associated UL6 DNA-packaging protein is located at a single vertex and is thought to form the portal through which the genome enters the procapsid. The UL15 protein interacts with the UL28 protein, and both are strong candidates for subunits of the viral terminase, a key component of the molecular motor that drives the DNA into the capsid. To investigate the association of the UL6 protein with the UL15 and UL28 proteins, the three proteins were produced in large amounts in insect cells with the baculovirus expression system. Interactions between UL6 and UL28 and between UL6 and UL15 were identified by an immunoprecipitation assay. These results were confirmed by transiently expressing wild-type and mutant proteins in mammalian cells and monitoring their distribution by immunofluorescence. In cells expressing the single proteins, UL6 and UL15 were concentrated in the nuclei whereas UL28 was found in the cytoplasm. When the UL6 and UL28 proteins were coexpressed, UL28 was redistributed to the nuclei, where it colocalized with UL6. In cells producing either of two cytoplasmic UL6 mutant proteins and a functional epitope-tagged form of UL15, the UL15 protein was concentrated with the mutant UL6 protein in the cytoplasm. These observed interactions of UL6 with UL15 and UL28 are likely to be of major importance in establishing a functional DNA-packaging complex at the portal vertex of the HSV-1 capsid.