ORCID Profile
0000-0003-0605-1186
Current Organisations
Deakin University
,
Linda Sweet and Associates
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Publisher: CSIRO Publishing
Date: 04-08-2022
DOI: 10.1071/AH22059
Abstract: Objective Healthcare delivery in Australia is managed at state and territory levels. This paper aims to compare the content and structure of publicly accessible Australian maternity service state and territory frameworks which guide the delivery of maternity care. Methods A scoping review was conducted to identify publicly accessible Australian state and territory maternity service frameworks. A comparative content analysis was undertaken. Results Six of the potential eight states and territories had locatable frameworks. Differences in both structure and content were found between frameworks. Variation exists between standalone maternity service frameworks and comprehensive clinical frameworks. Several jurisdictions align policy and ministerial directives in their frameworks outlining service delivery and guidance relating to maternal and/or neonatal transfer. Language referring to the assessment of maternity services and service risk varied. Conclusion Consistency in structure, language, and a clear communication strategy embedded into each maternity service framework may improve the functioning and consistency of Australian maternity services at each level of the healthcare system.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.WOMBI.2019.11.004
Abstract: Restriction of food and fluids during labour increases women's discomfort, anxiety and stress which are associated with obstruction of the normal process of labour. Whilst research evidence and clinical guidelines recommend that normal uncomplicated labouring women should not be limited in their oral intake during labour, some midwives continue to restrict or discourage women's oral intake. To promote best practice, it is important to understand the influencing factors which affect midwives' decision-making processes. This study aimed to investigate the influences that affect midwifery practice regarding oral food and fluid intake for low-risk labouring women. An interpretive descriptive approach employed 12 semi-structured interviews with registered midwives with current labour and birthing experience in Australia. Data was analysed using thematic analysis. Three themes were identified: midwives' knowledge and beliefs work environment and women's expectations of care. Midwives' practice was affected by their knowledge and values developed from professional and personal experiences of labour, their context of practice and work environment, the clinical guidelines, policies and obstetric control, and women's choice and comfort. This study indicates that midwives' decision-making in relation to women's oral nutrition during labour is multifaceted and influenced by complicated environments, models of care, and power relations between doctors and midwives, more so than clinical guidelines. It is important for midwives to be aware of factors negatively influencing their decision-making processes to enable autonomy and empowerment in the provision of evidence-based care of labouring women.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.WOMBI.2018.11.006
Abstract: There are currently 429 midwives in Australia who hold the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines for midwives. Little is known about how midwives are using the endorsement and what factors impact on its use. To critically examine the literature to discover what the barriers and enablers are for midwives to use the endorsement. A search was undertaken examining literature published since 2004. Due to a lack of articles specific to midwifery, the search was widened to include literature related to similar non-medical health professions. The search was ided into two streams: accessing the Medicare Benefits Schedule and accessing the Pharmaceutical Benefits Scheme and prescribing. Twenty-six primary articles from 2009 onward met the review criteria. Although singular barriers and enablers to both streams were identified, many of the themes act as both enabler and barrier. Themes common to both the Medicare Benefits Schedule focus and the Pharmaceutical Benefits Scheme and prescribing focus are that of medical support, scope of practice, ongoing support from health care consumers and management, and endorsement processes. Barriers occur approximately three times more frequently than enablers. Barriers and enablers occur for various reasons including legislative, regulatory, organisational, and the in idual's support for and attitude towards these roles. To overcome barriers and facilitate the success of emerging non-medical extended practice roles, significant buy-in and investment is needed across all levels of the health system. The review highlights a significant gap in knowledge about the endorsement's use in midwifery.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.NEPR.2012.08.015
Abstract: Midwifery students, clinicians and educators in Australia identified the need for improved feedback for midwifery students whilst they are on clinical placement in particular formative assessment. The miniCEX or mini-clinical evaluation exercise is one approach to assessment that has been proven valid and reliable in medical education. The aim of this research was to develop, implement and evaluate a miniCEX tool for midwifery education. Using an action research approach, this project engaged midwifery clinicians and midwifery students to adapt and implement the miniCEX in a postnatal ward environment. Focus groups were held to establish the clinical expectations and develop performance guidelines of students across the domains of midwifery practice, as well as evaluate their use in practice. Evaluation of the midwifery miniCEX, including its applicability from the perspective of staff and students was positive. The miniCEX was found to be easy to use, time efficient and valuable for learning. The miniCEX is an innovative approach to assessment and feedback in midwifery education, and there is currently no identified evidence of its use in midwifery education despite broad use globally in medical education. The implementation of the midwifery miniCEX offers broad benefit to both midwifery students and midwifery clinicians and educators globally.
Publisher: Springer Science and Business Media LLC
Date: 24-03-2022
DOI: 10.1186/S13006-022-00466-9
Abstract: Common approaches to manage breastfeeding problems such as pain, blocked ducts, and milk production issues include breast compression, breast massage, application of warmth or cold, medications, and breastmilk expression. Several devices are available to apply heat or cold to the breast, however, none promote breast compression and/or massage simultaneously. A new device ‘Lactamo’ has been developed to address this. This study was a pre-market evaluation of the Lactamo device. The aims were to determine user safety, and satisfaction of Lactamo. The study was conducted in an Australian tertiary maternity hospital in 2019–2020. Women who were less than 3 months post-partum and were currently breastfeeding participated in the study. We conducted structured telephone surveys at 1 and 4 weeks post supply of Lactamo. Questions included demographic information, feedback on safety, usage, and perceived benefits of Lactamo. The cohort ( n = 30) consisted of equal number of primiparous and multiparous women, 50% were born in Australia and the remainder from 11 other countries. A total of 41 telephone surveys were conducted with 27 women. Of these, 26 (96%) had used Lactamo, and the one that did not, felt she did not have a lactation concern to warrant using it. All women indicated that the device was safe to use and had no concerns, apart from one woman who experienced itching because of the device but continued to use it over clothing as she found it beneficial. Most women used it at room temperature or warmed. The frequency of use varied from once per week (17%) to daily (33%), and use was often prompted by a lactation concern such as engorgement, pain, blocked ducts, and low supply. Lactamo was found to be safe, and a valuable aid for breastfeeding women. More research is needed to understand the efficacy of the device in treating breastfeeding problems such as pain, blocked ducts, and milk production issues.
Publisher: Wiley
Date: 11-05-2016
DOI: 10.1002/AJUM.12011
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.MIDW.2022.103408
Abstract: Assessment of women's risk status influences the operationalisation of maternity. Decisions are made at a health service executive level, related to the ongoing level of maternity care provided, and/or sustainability of the maternity service. The aim of this scoping review was to explore how health service executives considered maternity risk when operationalising safe maternity services in Australia. Scoping review methodology was used to examine the breadth and extent of evidence, and to identify potential gaps in the research evidence. Overall, there was little literature on how health service executives understand and interpret risk to providing and operationalising maternity services. Evidence indicated a reduced tolerance for risk in the provision of maternity services. Executive consistency and midwifery leadership were important in operationalisation of maternity service provision. With rising rates of maternity service closure and reduction of service capability in Australia, women are most impacted, having reduced access to timely and quality care. More needs to be done to understand the health service executive perspective regarding drivers for these decisions and the barriers and enablers for maternity service sustainability. How health service executives perceive maternity care and experience operationalising maternity services, particularly in rural areas is a gap identified. Further research is warranted in this area to address this significant lack of knowledge. Understanding how health service executive consider maternity care is crucial for ongoing operational safety and maternity care sustainability.
Publisher: Elsevier BV
Date: 12-2008
Publisher: Informa UK Limited
Date: 06-2009
Publisher: Springer Science and Business Media LLC
Date: 14-05-2019
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.WOMBI.2021.08.007
Abstract: There are 15 publicly-funded homebirth programs in Australia. Women's access to these programs is determined by program specific inclusion and exclusion criteria. To examine women's perception of inclusion and exclusion criteria for publicly-funded homebirth programs in Australia and how these perceptions may influence women's choices and access to these programs. A national online survey was conducted and promoted through social media networks to women interested in homebirth in Australia. Quantitative data were analysed to generate descriptive statistics and a content analysis was performed on qualitative data. A total of 830 surveys were collected. Most women were supportive of inclusion and exclusion criteria related to social and environmental factors, although there was ambivalence about requiring ambulance cover, not having a history of domestic violence in the current relationship and requiring the woman to speak basic English. With regards to obstetric factors, only a requirement for labour to commence spontaneously at term was supported by over half of participants. All other obstetric related criteria had over half of participants disagreeing or strongly disagreeing that they should be used to prevent a woman from birthing at home. A desire for choice and access was frequently mentioned in the qualitative data. There is a need to address the lack of choice many women experience when pregnant and the lack of equitable access to affordable homebirth services in Australia.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.WOMBI.2021.01.009
Abstract: There are fifteen publicly-funded homebirth programs currently operating in Australia. Suitability for these programs is determined by a series of inclusion and exclusion criteria. The aim of this scoping review is to identify common inclusion and exclusion criteria for publicly-funded homebirth programs and other related factors that affect access to these programs. A Google search was conducted for publicly-funded homebirth programs listed on the National Publicly-funded Homebirth Consortium website. Public websites, documents, and policies were analysed to identify inclusion and exclusion criteria for these programs. Eleven of the 15 publicly-funded homebirth programs mention the availability of homebirth on their health service website, with varying levels of information about the inclusion and exclusion criteria available. Two of the programs with no information on their health service website are covered by a state-wide guideline. Additional details were sought directly from programs and obtaining further information from some in idual homebirth programs was challenging. Variation in inclusion and exclusion criteria exists between programs. Common areas of variation include restrictions relating to Body Mass Index, parity, age, English language ability, tests required during pregnancy, and gestation at booking to the homebirth program. The inclusion and exclusion criteria for a publicly-funded homebirth program determines women's access to the program. Limited publicly available information regarding inclusion and exclusion criteria for many publicly-funded homebirth programs is likely to limit women's awareness of and access to these programs.
Publisher: Springer International Publishing
Date: 2019
Publisher: Elsevier BV
Date: 07-2023
Publisher: SAGE Publications
Date: 14-09-2010
Abstract: In 2006, the Australian Government introduced the Family Law Amendment (Shared Parental Responsibility) Act 2006 (Cth), which put in place a legal presumption of shared parental responsibility for children after separation and which emphasizes “equal-time” parenting arrangements regardless of the child’s age. A qualitative approach was taken to investigate breastfeeding women’s experiences of the implementation of the act and its impact on their ability to maintain breastfeeding. Fifteen women responded to questions related to their breastfeeding and their engagement with the family law system. Interviews were audio recorded and transcribed, and data were then analyzed thematically. These women experienced inconsistent advice from all facets of legal services, including opinions about the inappropriateness of breastfeeding for infants over 6 months of age. Breastfeeding was considered only as nutrition, without recognition of its immunological and cognitive benefits and the security and comfort it provides. Many participant women felt that they had been persuaded against discussing breastfeeding in the legal system, resulting in a sense of disempowerment.
Publisher: Wiley
Date: 27-06-2022
DOI: 10.1111/BIRT.12569
Abstract: The COVID‐19 pandemic has led to multiple changes in maternity services worldwide. Systems rapidly adapted to meet public health requirements aimed at preventing transmission of SARS‐CoV‐2, including quarantine procedures, travel restrictions, border closures, physical distancing and “stay‐at‐home” orders. Although these changes have impacted all stakeholders in maternity services, arguably the women at the center of this care have been most affected. This study aimed to explore women's experiences of receiving maternity care during the COVID‐19 pandemic in Australia. A national cross‐sectional online survey, including fixed choice and open‐ended questions, was conducted during the first wave of the COVID‐19 pandemic in Australia pregnant and postnatal women were recruited through social media networks. The survey was completed by 3364 women. Women felt distressed and alone due to rapid changes to their maternity care. Limited face‐to‐face contact with health practitioners and altered models of care often required women to accommodate significant changes and to coordinate their own care. Women felt that they were often “doing it alone,” due to public health restrictions on support people and visitors, both within and outside health services. Women described some benefits of visitor restrictions, such as, more time for rest, breastfeeding establishment, and bonding with their baby. This large nationwide Australian study provides unique data on women's experiences of receiving maternity care during the COVID‐19 pandemic. Lessons learned provide an opportunity to rebuild and reshape the maternity sector to best meet the needs of women and their families during current and future public health crises.
Publisher: Elsevier BV
Date: 02-2017
Publisher: Public Library of Science (PLoS)
Date: 15-10-2020
Publisher: Wiley
Date: 08-2014
Abstract: Sonographers use psychomotor skills to perform medical ultrasound examinations. Psychomotor skills describe voluntary movements of the limb, joints, and muscles in response to sensory stimuli and are regulated by the motor neural cortex in the brain. We define a psychomotor skill in relation to medical ultrasound imaging as "the unique mental and motor activities required to execute a manual task safely and efficiently for each clinical situation." Skills in clinical ultrasound practice may be open or closed most skills used in medical ultrasound imaging are open. Open skills are both complex and multidimensional. Visuomotor and visuospatial psychomotor skills are central components of medical ultrasound imaging. Both types of skills rely on learners having a visual exemplar or standard of performance with which to reference their skill performance and evaluate anatomic structures. These are imperative instructional design principles when teaching psychomotor skills.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Informa UK Limited
Date: 20-08-2019
DOI: 10.1080/13561820.2019.1645648
Abstract: This article explores how work-based interprofessional education (IPE) influences collaborative practice in rural health services in Australia. Using a qualitative case study design, three rural hospitals were the focal point of the project. Marginal participant observations (98 hours) and semistructured interviews (
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/PY13087
Abstract: Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.WOMBI.2016.11.011
Abstract: Increasing global migration is resulting in a culturally erse population in the receiving countries. In Australia, it is estimated that at least four thousand Sub-Saharan African women give birth each year. To respond appropriately to the needs of these women, it is important to understand their experiences of maternity care. The study aimed to examine the maternity experiences of Sub-Saharan African women who had given birth in both Sub-Saharan Africa and in Australia. Using a qualitative approach, 14 semi-structured interviews with Sub-Saharan African women now living in Australia were conducted. Data was analysed using Braun and Clark's approach to thematic analysis. Four themes were identified access to services including health education birth environment and support pain management and perceptions of care. The participants experienced issues with access to maternity care whether they were located in Sub-Saharan Africa or Australia. The study draws on an existing conceptual framework on access to care to discuss the findings on how these women experienced maternity care. The study provides an understanding of Sub-Saharan African women's experiences of maternity care across countries. The findings indicate that these women have maternity health needs shaped by their sociocultural norms and beliefs related to pregnancy and childbirth. It is therefore arguable that enhancing maternity care can be achieved by improving women's health literacy through health education, having an affordable health care system, providing respectful and high quality midwifery care, using effective communication, and showing cultural sensitivity including family support for labouring women.
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12884-019-2667-Y
Abstract: The World Health Organization recommends that infants be exclusively breastfed until the age of six months. Breastfeeding is generally understood to mean the provision of human breastmilk to the infant by direct feeding at the breast, and interventions aimed at supporting exclusive breastfeeding are therefore targeted at this activity. However, breastfeeding is actually an umbrella term covering the provision of breastmilk to an infant by any means. Our population of interest is mothers who exclusively feed their infants indirectly using expressed breastmilk. Some research suggests that any expressing, and exclusively expressing in particular, can be a risk factor for early cessation of exclusive breastmilk provision, so we were interested to identify whether any specific support existed for exclusively expressing mothers outside of the context of premature infants and the Neonatal Intensive Care Unit setting. A scoping review following the Joanna Briggs Institute approach was used to explore the phenomenon of formal and informal supports in the community for exclusively expressing mothers. Searches were run across academic databases and of government websites and infant feeding support organisations. Finally, an informal internet search was run using a simple search string. On analysis of results, there were no studies or articles that met the search criteria. An informal internet search linked us directly with websites and blogs that could be considered a form of support intervention. These informal results suggest that support material or programs could possibly exist in other modalities but we cannot find them in the context of this type of scoping review. The results of the search corroborated what we had suspected – that exclusively expressing mothers are not specifically supported by usual channels for new parents and that it is also difficult to find acknowledgement that exclusive expression exists. The absence of results demonstrates the relevance of this study: exclusively expressing mothers are an under-served population. If we wish to strive towards achievement of World Health Organization breastfeeding goals, exclusively expressing mothers require targeted support to assist in their infant feeding experience, and there is little formal evidence of it currently being provided.
Publisher: Elsevier BV
Date: 10-2013
Publisher: Elsevier BV
Date: 10-2013
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.NEDT.2011.11.020
Abstract: This discussion paper analyses a midwifery Continuity of Care program at an Australian University with the symbiotic clinical education model, to identify strengths and weakness, and identify ways in which this new pedagogical approach can be improved. In 2002 a major change in Australian midwifery curricula was the introduction of a pedagogical innovation known as the Continuity of Care experience. This innovation contributes a significant portion of clinical experience for midwifery students. It is intended as a way to give midwifery students the opportunity to provide continuity of care in partnership with women, through their pregnancy and childbirth, thus imitating a model of continuity of care and continuity of carer. A qualitative study was conducted in 2008/9 as part of an Australian Learning and Teaching Council Associate Fellowship. Evidence and findings from this project (reported elsewhere) are used in this paper to illustrate the evaluation of midwifery Continuity of Care experience program at an Australian university with the symbiotic clinical education model. Strengths of the current Continuity of Care experience are the strong focus on relationships between midwifery students and women, and early clinical exposure to professional practice. Improved facilitation through the development of stronger relationships with clinicians will improve learning, and result in improved access to authentic supported learning and increased provision of formative feedback. This paper presents a timely review of the Continuity of Care experience for midwifery student learning and highlights the potential of applying the symbiotic clinical education model to enhance learning. Applying the symbiotic clinical education framework to evidence gathered about the Continuity of Care experience in Australian midwifery education highlights strengths and weaknesses which may be used to guide curricula and pedagogical improvements.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.MIDW.2007.09.001
Abstract: to explore fathers' experiences of the breast feeding of their very-low-birthweight preterm babies from birth to 12 months of age. a qualitative study using interpretive phenomenology. Data were collected via longitudinal in-depth in idual interviews. publicly funded tertiary level hospital, Australia. a purposive s le of 17 Australian parents took part in the broader study. This paper reports on data from the seven participant fathers. this paper explores the discursive changes in fathers' accounts of their perspectives on and support of the breast feeding of their preterm baby. The fathers' accounts highlight their marked influence on breast feeding, their ambivalent experiences related to breast feeding and their struggle in negotiating a parenting role related to baby feeding. this study highlights the role and influence that fathers of preterm babies have on breast feeding, and explores the tensions and paradoxes inherent in promoting the ideology of breast feeding while valuing the practice of bottle feeding. this study highlights the need to encourage and involve fathers in breast-feeding education including the impact of bottle feeding on breast-feeding outcomes. The active and positive contribution that fathers make towards preterm breast feeding should be acknowledged and encouraged.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Elsevier BV
Date: 07-2021
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.NEDT.2017.09.004
Abstract: Many health professionals use psychomotor or task-based skills in clinical practice that require concomitant communication with a conscious patient. Verbally engaging with the patient requires highly developed verbal communication skills, enabling the delivery of patient-centred care. Historically, priority has been given to learning the psychomotor skills essential to clinical practice. However, there has been a shift towards also ensuring competent communication with the patient during skill performance. While there is literature outlining the steps to teach and learn verbal communication skills, little is known about the most appropriate instructional approach to teach how to verbally engage with the patient when also learning to perform a task. A literature review was performed and it identified that there was no model or proven approach which could be used to integrate the learning of both psychomotor and communication skills. This paper reviews the steps to teach a communication skill and provides a suggested model to guide the acquisition and development of the concomitant -communication skills required with a patient at the time a psychomotor skill is performed.
Publisher: Ubiquity Press, Ltd.
Date: 04-04-2023
DOI: 10.5334/PME.903
Abstract: Background: Technology is increasingly present in the clinical environment. There is a dearth of investigation of the relationship between technology and touch concerning student learning of physical examination practices. Method: Integrative review methods were used to synthesise empirical literature to provide a comprehensive understanding of the relationship between physical examination, learning and technology in the context of health professional student clerkships. Results: Three databases including MEDLINE, CINAHL and Eric were searched for all articles published from 2014 to 2021 using terms relating to (i) physical examination, (ii) technology, and (iii) student clerkships. Thirty-three studies met the inclusion criteria. From the analysis, it is evident that technologies that intersect with learning of physical examination may broadly be apportioned into two categories: 1) technologies that mediate physical examination practices and 2) technologies that mediate the learning of physical examination. Conclusions: This review indicates that technologies may have multiple roles in the student learning of physical examination, including technology mediating increased diagnostic accuracy and access to supplementary learning material relating to physical examination that is integrated for the clinical clerkship environment. It highlights a need to further understand the touch versus technology relationship and explore the dynamic intersection.
Publisher: Wiley
Date: 15-03-2023
DOI: 10.1111/AJR.12978
Abstract: Continued rural maternity closure across Australia has seen impacts on women and families such as financial pressures, quality and safety concerns, and emotional pressure. This review aimed at understanding how media coverage of rural maternity and closure are presented and what impact this may have on maternity service sustainability. This research seeks to examine media discourse and characteristics of online newspaper articles related to rural maternity services. A narrative review was conducted using thematic discourse analysis to examine online newspaper content published in Victoria, Australia from 2010 to June 2021. Local maternity services were a source of community interest for rural people. Coverage of negative outcomes for mothers and babies was highlighted by rural newspapers however, increased content over the last 12‐month period focused on community support for the sustainability of rural maternity services. Recent community support in newspaper articles coincided with maternity services reviews and retaining some of these rural services. Community support in media may provide a protective social pressure, leading rural health services to consider this when reviewing the sustainability or closure of rural maternity services. Media attention about sustaining local maternity services by highlighting issues and representing community voices may influence health executive to consider opportunities to remodel and sustain high‐quality and safe maternity care in rural settings. Knowing how rural health executives consider media, community pressure, and how it impacts expediency of maternity service closure decisions is unknown and an important gap in knowledge to explore and understand.
Publisher: Springer Science and Business Media LLC
Date: 23-11-2020
DOI: 10.1186/S13006-020-00337-1
Abstract: Ensuring women receive optimal breastfeeding support is of key importance to the health of mothers and their infants. Early discharge within 24 h of birth is increasingly common across Australia, and the practice of postnatal home visiting varies between settings. The reduction in length of stay without expansion of home visits reduces midwives’ ability to support breastfeeding. The impact of early discharge on first-time mothers establishing breastfeeding was unknown. The study aim was to understand the experiences of first-time Australian mothers establishing breastfeeding when discharged from the hospital within 24 h of a normal vaginal birth. A qualitative interpretive method was used. Semi-structured interviews with 12 women following early discharge were conducted. Data were audio recorded, professionally transcribed, and subjected to a thematic analysis. Three interconnected themes of ‘self-efficacy’, ‘support’ and ‘sustainability’ were identified. Self-efficacy influenced the women’s readiness and motivation to be discharged home early and played a role in how some of the mothers overcame breastfeeding challenges. Social, semi-professional and professional breastfeeding supports were key in women’s experiences. Sustainability referred to and describes what women valued in relation to continuation of their breastfeeding journey. This study found accessible people-based breastfeeding services in the community are valued following early discharge. Furthermore, there is demand for more evidence-based breastfeeding educational resources, potentially in the form of interactive applications or websites. Additionally, a focus on holistic and in idualised breastfeeding assessment and care plans prior to discharge that link women with ongoing breastfeeding services is paramount.
Publisher: Elsevier BV
Date: 03-2008
DOI: 10.1016/J.WOMBI.2007.11.001
Abstract: An interpretive phenomenological study involving 17 Australian parents was undertaken to explore parents' experiences of breastfeeding very low birth weight (VLBW) preterm infants from birth to 12 months of age. Data were collected from 45 in idual interviews held with both mothers and fathers, which were then transcribed verbatim and analysed using thematic analysis. From this study, the analysis identified the following themes: the intention to breastfeed naturally breast milk as connection the maternal role of breast milk producer breastmilk as the object of attention breastfeeding and parenting the hospitalised baby and the demise of breastfeeding. The discussion presented here presents the theme of the intention to breastfeed 'naturally'. This study found that all of the participant women decided to breastfeed well before the preterm birth, and despite the birth of a VLBW preterm infant continued to expect the breastfeeding experience to be normal regardless of the difference of the postpartum experience. It is without doubt that for these parents the pro-breastfeeding rhetoric is powerfully influential and thus successful in promoting breastfeeding. Furthermore, all participants expected breastfeeding to be 'natural' and satisfying. There is disparity between parents' expectations of breastfeeding 'naturally' and the commonplace reality of long-term breast expression and uncertain at-breast feeding outcomes. How the parents came to make the decision to breastfeed their unborn child -- including the situations and experiences that have influenced their decision making -- and how the preterm birth and the dominant cultures subsequently affected that decision will be discussed. The findings have implications for midwifery education and maternity care professionals who support parents making feeding decisions early in pregnancy and those striving to breastfeed preterm infants.
Publisher: Wiley
Date: 23-03-2022
DOI: 10.1111/AJO.13518
Abstract: Rates of homebirth in Australia remain low, at less than 0.3% of all births. To report maternal and neonatal outcomes of ten years of a publicly funded homebirth service, 2009–2019. Retrospective analysis of clinical outcome data including neonatal outcomes of women who requested a homebirth at a large metropolitan health service in Victoria, Australia. The primary outcomes included: maternal outcomes (mortality, transfer to hospital, place and mode of birth, perineal status, type of third stage of labour, postpartum haemorrhage), and neonatal outcomes (mortality, Apgar score at five minutes, birthweight, breastfeeding initiation, significant morbidity, transfer to hospital). Referrals for 827 women were reviewed 633 remained eligible at 36 weeks gestation, and 473 (57%) birthed at home. Compared to women who did not, women who had a homebirth were significantly more likely to be multiparous, have a normal vaginal birth and an intact perineum, less likely to require suturing and less likely to have blood loss of more than 500 mL. Compared to infants not born at home, infants born at home were significantly less likely to require resuscitation, more likely to be of normal birthweight and exclusively receive breastmilk on discharge. There were no maternal deaths and one neonatal death of a baby born at home before the arrival of a midwife. The outcomes for women accepted into the publicly funded homebirth program suggest appropriate triaging and case selection. A publicly funded homebirth program, with appropriate governance and clinical guidelines, appears to be a safe option for women experiencing low‐risk pregnancies.
Publisher: Informa UK Limited
Date: 06-05-2014
Publisher: Elsevier BV
Date: 12-1997
DOI: 10.1016/S1031-170X(97)80028-1
Abstract: Childbirth is essentially women's business, a natural female act being performed since the beginning of mankind. However, as Western society has evolved, so too has the management of childbirth. It is the medical profession that has gained control of providing care for childbearing women, to the detriment of many women's experiences. The societal expectations on childbearing women, the iatrogenic effects of pregnancy being treated as an illness under the medical model, and the implications for the profession of midwifery will be discussed.
Publisher: Wiley
Date: 12-2015
DOI: 10.1111/AJR.12214
Abstract: To map trends in the maternity service availability for rural women in South Australia and identify the frequency of women birthing outside of their region of residence. A retrospective review of birth location for rural South Australian women from 1991 to 2010. Rural maternity units in South Australia. Birthing statistics from the Pregnancy Outcomes Statistics Unit in South Australia Rural birth statistics, including place of birth in relation to place of residence and location of maternity units. Over 60% of maternity units across rural South Australia have closed since 1991. There has been a rise in the percentage of women birthing away from their usual region of residence, rising from 18% in 1991-1995 to 24% in 2006-2010. This study has revealed that almost one quarter of all women residing in rural South Australia relocate to another area to give birth. This is a significant concern for rural women and their families through the expectation of separation, and for the local health services who might now not have the facilities and skills to manage an unplanned maternity presentation. These concerns need to be considered and addressed in order to provide safe and effective care for child-bearing women regardless of location.
Publisher: Springer Science and Business Media LLC
Date: 29-12-2013
Publisher: Springer Science and Business Media LLC
Date: 2008
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.NEPR.2015.03.002
Abstract: The experience of midwifery students in receiving the newborn at birth, before and after structured training in neonatal resuscitation: A pilot study. The practice of receiving the newborn, including neonatal resuscitation is an essential component of midwifery. Anecdotal evidence suggests preparation for the task is ad hoc within midwifery curricula, leading to student's anxiety. This paper reports impacts of neonatal resuscitation training upon levels of knowledge, preparedness, and anxiety for midwifery students receiving the newborn. Midwifery students participated in an online questionnaire before and after neonatal resuscitation training. The responses collected were subjected to descriptive analysis. Of 10 students invited, 6 completed the pre and post course questionnaires. Knowledge of the responsibility in receiving the newborn and instigation of resuscitation increased after attending the course. Steps to prepare to receive the newborn and clinical signs for initial assessment remained static. Students felt more prepared to receive the newborn after the course but did not improve in their preparation to initiate resuscitation. Anxiety levels remained static. Structured neonatal resuscitation training and strategies to ensure application of skills learnt should be embedded into midwifery curricula. Midwifery students' experience in receiving the newborn and neonatal resuscitation is worthy of further study.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Springer Science and Business Media LLC
Date: 30-01-2014
Publisher: Springer Netherlands
Date: 2011
Publisher: Informa UK Limited
Date: 28-12-2022
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.NEPR.2016.11.007
Abstract: There is a wealth of research investigating the role of the clinical facilitator and the student experience of clinical education. However, there is a paucity of recent research reviewing the students' perspectives of facilitators' qualities that influence their learning. This paper explores undergraduate nursing students' perceptions of the qualities of a clinical facilitator that enhanced their learning. The study was designed as a cross-sectional survey. A total of 452 third year nursing students at one Australian University were invited to participate. A total of 43 students completed the survey and were analysed thus, the response rate was 9.7%. Results of the study indicate that nursing students perceive availability, approachability and feedback from the clinical facilitator to be highly influential to their learning in the clinical setting. The relational interdependence of these is discussed. Clinical facilitators have an important role in student learning. The findings of this study can be used in the development of clinical facilitator models, guidelines and in continuing education.
Publisher: Elsevier BV
Date: 05-2022
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier BV
Date: 03-2023
Publisher: Informa UK Limited
Date: 29-03-2016
Publisher: Informa UK Limited
Date: 2012
DOI: 10.3109/13561820.2011.636157
Abstract: Interprofessional practice implies that health professionals are able to contribute patient care in a collaborative environment. In this paper, it is argued that in a hospital the nurses' station is a form of symbolic power. The term could be reframed as a "health team hub," which fosters a place for communication and interprofessional working. Studies have found that design of the Nurses' Station can impact on the walking distance of hospital staff, privacy for patients and staff, jeopardize patient confidentiality and access to resources. However, no studies have explored the implications of nurses' station design on interprofessional practice. A multi-site collective case study of three rural hospitals in South Australia explored the collaborative working culture of each hospital. Of the cultural concepts being studied, the physical design of nurses' stations and the general physical environment were found to have a major influence on an effective collaborative practice. Communication barriers were related to poor design, lack of space, frequent interruptions and a lack of privacy the name "nurses' station" denotes the space as the primary domain of nurses rather than a workspace for the healthcare team. Immersive work spaces could encourage all members of the healthcare team to communicate more readily with one another to promote interprofessional collaboration.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.WOMBI.2016.09.013
Abstract: Early discharge following birth has become an emerging phenomenon in many countries. It is likely early discharge has an impact on the establishment of breastfeeding. To critically appraise the evidence on what women value in relation to breastfeeding initiation and support, and investigate the impact early discharge can have on these values. A literature search was conducted for publications since 2005 using the following databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Scopus and PsycINFO 21 primary articles were selected and included in the review. There is no standard definition for 'early discharge' worldwide. Due to inconsistent definitions worldwide and minimal literature using a 24h definition, research defining early discharge as up to 72h postpartum is included. Seven key factors in relation to breastfeeding initiation and support following early discharge were identified, namely trust and security, consistent advice, practical breastfeeding support, breastfeeding education, comfortable environment, positive attitudes and emotional support, and in idualised care. The findings suggest in idualised postnatal lengths of stay may be beneficial for the initiation of breastfeeding. Five values were not impacted by early discharge, but rather in idual midwives' practice. There is consensus in the literature that early discharge promoted a comfortable environment to support breastfeeding initiation. Wide variations in the definition of early postnatal discharge made it difficult to draw influential conclusions. Therefore, further research is required.
Publisher: Elsevier BV
Date: 05-2023
DOI: 10.1016/J.WOMBI.2022.11.003
Abstract: To manage the COVID-19 pandemic, public health restrictions and a rapid pivot to telehealth occurred. Peripartum services were significantly affected by a strained infrastructure. Decreased face to face access to health services and support affected maternal experiences and confidence internationally, yet little was reported with the Australian and Aotearoa New Zealand context. To explore the early parenting and infant feeding experiences of new mothers from Australia and Aotearoa New Zealand in the context of a pandemic. An interpretive qualitative approach and thematic analysis obtained an in-depth understanding of the experiences of 27 mothers who gave birth during the first wave of the COVID-19 pandemic in 2020. Australian and Aotearoa New Zealand women reported similar experiences, which varied contextually. Restrictions and requirements impacted favourably and unfavourably. Many women found the peace and space of social distancing an unexpected benefit and were proud of their achievements, whilst others shared feelings of isolation and distress. Some women felt they instinctively did what they needed to do. Experiences correlated with differing levels of self-efficacy. While many women relished the freedom from social obligations when faced with feeding challenges, there was general dissatisfaction with the level of support available. Care was fragmented, and health care needs were unmet, impacting feeding and parenting decisions and mental health. Access to timely and appropriate professional support is an important factor in establishing breastfeeding and developing parenting confidence, particularly in the context of a pandemic and should be a health policy priority.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.WOMBI.2017.06.017
Abstract: There is no current validated clinical assessment tool to measure the attainment of midwifery student competence in the midwifery practice setting. The lack of a valid assessment tool has led to a proliferation of tools and inconsistency in assessment of, and feedback on student learning. This research aimed to develop and validate a tool to assess competence of midwifery students in practice-based settings. A mixed-methods approach was used and the study implemented in two phases. Phase one involved the development of the AMSAT tool with qualitative feedback from midwifery academics, midwife assessors of students, and midwifery students. In phase two the newly developed AMSAT tool was piloted across a range of midwifery practice settings and ANOVA was used to compare scores across year levels, with feedback being obtained from assessors. Analysis of 150 AMSAT forms indicate the AMSAT as: reliable (Cronbach alpha greater than 0.9) valid-data extraction loaded predominantly onto one factor and sensitivity scores indicating level of proficiency increased across the three years. Feedback evaluation forms (n=83) suggest acceptance of this tool for the purpose of both assessing and providing feedback on midwifery student's practice performance and competence. The AMSAT is a valid, reliable and acceptable midwifery assessment tool enables consistent assessment of midwifery student competence. This assists benchmarking across midwifery education programs.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Wiley
Date: 25-11-2021
DOI: 10.1002/JTR.2505
Abstract: Political relations between countries can potentially affect and be affected by bilateral visitor flows. Applying various modified Granger causality tests, this article uses Japan and China as a case study of the possible bi‐directional linkages between tourism demand and political relations. Findings suggest that country relations do influence visitor flows, but not vice versa. The influence is statistically strong regarding visitor flows from China to Japan, but is weak and insignificant in the opposite direction, although this relationship appears to be time‐varying and strengthening recently. This article concludes with a discussion of policy implications and some suggestions for further research.
Publisher: Wiley
Date: 18-09-2022
DOI: 10.1111/AJO.13612
Abstract: The DIAMOND antenatal clinic was established to provide multidisciplinary continuity of care to pregnant women living with morbid (body mass index (BMI) ≥40 kg/m The aim was to describe clinic processes, demographics, clinical outcomes and women's perceptions of the clinic. Women who received antenatal care in the clinic between 2016 and 2019 (n = 257) had routine data collected for retrospective analysis. A patient satisfaction survey was conducted for women who received care in 2019 (n = 89). The median BMI was 49 kg/m Establishing a dedicated clinic for women living with high BMI provides a well-liked environment for a high-risk cohort of women. Our review identified opportunities for improvement in clinic processes. We plan to assess overall impact on perinatal outcomes.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.WOMBI.2015.02.001
Abstract: To report on a study measuring midwifery students' self-reported abilities in teaching and supervising breastfeeding mothers. Abilities were assessed at two time intervals, before and after completing a maternal and infant nutrition topic with simultaneous clinical opportunities to consolidate their skills. A convenience s le of midwifery students in an Australian university completed a pre- and post-intervention survey to assess their self-rated ability to teach and supervise breastfeeding mothers. Rasch analysis was used to gain conjoint estimates of students' self-reported abilities to teach and supervise breastfeeding mothers across 37 items with varying complexity of care needs. Rasch analysis was used to determine validity and reliability of the 37-item tool, to develop a hierarchical linear scale reflecting difficulty of breastfeeding supportive activities, and to determine student learning between the two time points. From 95 responses, 34 of the 37 items met the requirement for unidimensionality. Outcomes identified that midwifery students' self-efficacy measures for breastfeeding support abilities can be reliably estimated. A hierarchical scale for learning these clinical skills has been generated to inform curricula development and learning processes. While there was an overall increase in the ease of difficulty of 21 items in the survey at time point two, eight items were identified as becoming more difficult. The findings of this study challenge midwifery educators to reconsider the educational activities provided for midwifery students' that aim to develop the requisite skills to provide effective breastfeeding support, including the provision of specific clinical opportunities to learn from breastfeeding women.
Publisher: Springer Science and Business Media LLC
Date: 25-09-2012
DOI: 10.1007/S10995-011-0887-5
Abstract: Breastfeeding policies and practices were analysed in childcare settings in the metropolitan area of Adelaide, South Australia. Childcare centres were purposively selected based on their geographical location, type and socioeconomic score of the area. Qualitative inquiry approach was employed by undertaking interviews with childcare centres' director or baby house coordinator to explore their perception towards breastfeeding practice and support within their centre. Breastfeeding related policy documents, where available, were also collected during the interviews to triangulate data. A total of 15 face-to-face interviews were conducted. Six childcare centres had a written policy specifically on breastfeeding support, although the technical issues of handling breastmilk were included in most centres' food and nutrition guidelines. Most participants believed that decision to breastfeed is the personal choice of parents, and hence saw the childcare centre's role as supporting parental choice whether it is breastfeeding or not. The provision of physical space to breastfeed and facilities to store the expressed breast milk were the most common practices in support of parents who had chosen to continue breastfeeding. Participants perceived mothers' work-related issues such as distance from the centre, time, and unsupportive workplace the most important barriers that led to early introduction of bottle feeding or breastfeeding cessation. Most childcare centres support breastfeeding in a more passive than active way. Breastfeeding promotion needs to be an integral part of childcare centres training, policy and practice if an increased rate of breastfeeding is to be achieved particularly amongst working mothers.
Publisher: Medknow
Date: 06-2017
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.NEPR.2019.03.001
Abstract: Precepting is a common and expected role of nurses in clinical settings worldwide. This research explored novice nurse's experiences of precepting undergraduate nursing students in high-acuity hospital environments. An interpretive study was undertaken with 12 novice nurses (<3-years of post-registration clinical experience), who were precepting nursing students. Data was collected through focus groups and thematically analysed. The zone of proximal development theory was applied to understand the relationship of learning that occurs between students and nurses. Three themes were identified. Firstly, participants established that precepting students enhanced their own self-development, and was a rewarding role, that not only developed the student into a nurse, but provided opportunities for the novice nurse to learn. Second, precepting was both challenging and rewarding. The challenges involved the student, the context, and the preceptors' own teaching and learning skills, resulting in feelings of frustration and conflict between nursing care and preceptor roles. Third, precepting was an expectation of both the nursing role and from senior nurses. At times, the participants felt overwhelmed and drained, particularly when having students that challenged them on multiple consecutive shifts. Participants identified the need for guidance and support from more capable peers to develop confidence while precepting nursing students.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.WOMBI.2021.09.006
Abstract: Australian midwives are considering leaving the profession. Moral distress may be a contributing factor, yet there is limited research regarding the influence of moral distress on midwifery practice. Moral distress was first used to describe the psychological harm incurred following actions or inactions that oppose an in iduals' moral values. Current research concerning moral distress in midwifery is varied and often focuses only on one aspect of practice. To explore Australian midwives experience and consequences of moral distress. Semi-structured interviews were used to understand the experiences of moral distress of 14 Australian midwives. Interviews were recorded and transcribed verbatim. Data were analysed using thematic analysis and NVIVO12©. Three key themes were identified: experiencing moral compromise experiencing moral constraints, dilemmas and uncertainties and professional and personal consequences. Describing hierarchical and oppressive health services, midwives indicated they were unable to adequately advocate for themselves, their profession, and the women in their care. It is evident that some midwives experience significant and often ongoing moral compromise as a catalyst to moral distress. A difference in outcomes between early career midwives and those with more than five years experiences suggests the cumulative nature of moral distress is a significant concern. A possible trajectory across moral frustration, moral distress, and moral injury with repeated exposure to morally compromising situations could explain this finding. This study affirms the presence of moral distress in Australian midwives and identified the cumulative effect of moral compromise on the degree of moral distress experienced.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 09-2022
Publisher: Wiley
Date: 10-09-2013
DOI: 10.1111/TCT.12024
Abstract: With vertical integration, registrars and medical students attend the same educational workshops. It is not known whether these learners have similar or different learning styles related to their level of education within the medical training schema. This study aims to collect information about learning styles with a view to changing teaching strategies. If a significant difference is demonstrated this will impact on required approaches to teaching. The VARK learning inventory questionnaire was administered to 36 general practice registrars and 20 medical students. The learning styles were compared as in iduals and then related to their level of education within the medical training schema. Students had a greater preference for multimodal learning compared with registrars (62.5 per cent versus 33.3 per cent, respectively). More than half of the registrars preferred uni or bimodal learning modalities, compared with one-third of the medical students. The present workshop format based on visual and aural material will not match the learning needs of most learners. This small study has shown that the majority of medical students and registrars could have their learning preferences better met by the addition of written material to the workshop series. Surprisingly, a significantly larger number of medical students than registrars appeared to be broadly multimodal in their learning style, and this warrants further research.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.WOMBI.2021.10.001
Abstract: Holistic reflection encompasses reflection as a continuum, incorporating critical reflection, reflexivity, critical thinking and a whole-of-person approach. The development of holistic reflection in midwifery students and midwives is rarely measured in a standardised way. To develop and test a tool to measure holistic reflection in midwifery students and midwives, for use in pre-registration and post-graduate education, and research. The eight-step approach to tool development by DeVellis was followed with psychometric testing of data from a cross-sectional survey. Midwifery students (pre-registration and postgraduate), and midwifery alumni of an Australian university. Draft items (n = 84) were generated from review of the literature, qualitative research, and a theoretical model. An expert panel (n = 19) reviewed draft items resulting in 39 items. The survey included demographic details, the draft Holistic Reflection Assessment Tool, emotional intelligence subscale, and a social desirability scale. Participants repeated the online survey at two weeks to confirm test-retest reliability. The 187 responses were received. Exploratory factor analysis with varimax rotation revealed three factors accounting for 49% of variance. Internal consistency of the tool was high (α = .91) and test-retest reliability at two weeks (α = .93) demonstrated stability. There were low correlations between social desirability (r = .22, p < .001) and emotional intelligence (r = .21, p < .001) with the new holistic reflection scale. The Holistic Reflection Assessment Tool is the first for midwifery. The tool was reliable, stable, and valid. Further research is warranted for criterion validity.
Publisher: Wiley
Date: 03-07-2014
DOI: 10.1111/JAN.12203
Abstract: To examine health worker-client interactions during care planning to understand processes that foster client empowerment and disempowerment. It is unclear how health worker-client exchanges and information sharing through chronic condition care planning currently operate in primary health care. Moreover, it is unclear how control in these exchanges either enhances collaborative decision-making, partnership and client empowerment, or works to create client disempowerment and dependency on workers and health services. Critical discourse analysis of qualitative data from ethnographic observations and audio-taped worker-client consultations. Multidisciplinary teams in two Australian community-based primary healthcare sites participated. This included nurses, general practitioners and allied health workers and their clients who had a chronic condition care plan. Nineteen worker-client consultations were observed/recorded in 2011. Control was expressed through multiple processes inherent in the worker role and in their interactions with clients. When workers exercised disproportionate control and clients relinquished their own control, client disempowerment and dependency were evident. Clients' attempts to gain control and workers' attempts to relinquish control alleviated clients' disempowerment and dependency. However, structural features of information sharing systems and workers' care planning behaviours diminished such efforts. Worker awareness of their communication style and the power of their role must improve for client chronic condition self-care management to be achieved. Training on the impacts of control in worker communication and systems where they work must be provided if unbeneficial forms of client dependency are to be overcome and true self-care management is to be realized.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.WOMBI.2016.10.006
Abstract: The Continuity of Care Experience is a mandated workplace based component of midwifery education in Australia. Since its inclusion in midwifery clinical education, the pedagogical approaches used across Australia have varied. The purpose of this integrative review is to determine the outcomes of the Continuity of Care Experience as an educational model. A search for relevant research literature was undertaken in 2015 using a range of databases and by examining relevant bibliographies. Articles published in English, which provided information about the outcomes of Continuity of Care Experiences for midwifery education were included. A total of 20 studies were selected. The included studies were primarily exploratory and descriptive. Studies reported the value that both students and women place on the relationship they developed. This relationship resulted in opportunities that enhanced student learning by providing a context in which clinical practice learning was optimized. Challenges identified included managing time and workload pressures for students in relation to the CCE, inconsistencies in academic use of the experience, and variations in how the healthcare system influences the continuity experience. No research was found that reports on the educational model in terms of defining learning objectives and assessment of outcomes. This represents an important omission in mandating this clinical practice model in midwifery curricula without sufficient guidance to unify and maximize learning for students. Research is required to explore the educational intent and assessment methods of the Continuity of Care Experience as an educational model.
Publisher: Wiley
Date: 14-08-2020
DOI: 10.1002/AJUM.12222
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.WOMBI.2018.06.004
Abstract: Practice-based or clinical placements are highly valued for linking theory to practice and enabling students to meet graduate outcomes and industry standards. Post-practicum, the period immediately following clinical experiences, is a time when students have an opportunity to share, compare and engage critically in considering how these experiences impact on their learning. Reflective practice has merit in facilitating this process. This project aimed to optimise the learning potential of practice-based experiences by enhancing midwifery students' capacity for reflective practice through writing. Design-based research was used to implement an educational intervention aimed at developing reflective practice skills and enhance reflective writing. The Bass Model of Holistic Reflection was introduced to promote the development of reflective capacity in midwifery students. Academics and midwifery students were provided with guidance and resources on how to apply the model to guide reflective writing. Students' written reflections completed before (n=130) and after the introduction of the intervention (n=96) were evaluated using a scoring framework designed to assess sequential development of reflective capacity. The pre-intervention scores ranked poorly as evidence of reflective capacity. All scores improved post-intervention. The introduction of a holistic structured model of reflection resulted in improved scores across all five components of reflective writing self-awareness, sources of knowledge, reflection and critical reflection, evidence informed practice and critical thinking. While further work is required the results show that the implementation process and use of the Bass Model enables students to demonstrate their capacity to reflect-on-practice through their writing.
Publisher: Elsevier BV
Date: 05-2022
Publisher: Wiley
Date: 18-08-2020
DOI: 10.1002/AJUM.12223
Publisher: SAGE Publications
Date: 15-03-2013
Abstract: Australia has high rates of breastfeeding initiation, with a consistent decline over the first year. Furthermore, there is a growing trend of maternal employment and rising numbers of children enrolled in different types of child care services, both of which can have a negative impact on breastfeeding. To provide evidence to better inform implementation of breastfeeding-friendly strategies in child care settings, this study examined breastfeeding policy and practice in child care centers in metropolitan Adelaide. The paper reports on a survey sent to 292 child care centers in metropolitan Adelaide in 2010. The survey collected information on center location and type, number of enrolled children under age 2, and number of breastfed babies. The survey also included questions about breastfeeding facilities and support, breastfeeding policies, staff training, and barriers to and recommendations to enhance breastfeeding support in child care centers. Of the 62 completed returned surveys (21% response rate), 43 centers (69.4%) reported that they currently have children who receive breast milk at the center however, in most centers, the total number of breastfed children was reported to be between 1 and 4 76% reported that the center was supportive of exclusive breastfeeding for 6 months and 80.6% had statements on breastfeeding as part of their food and nutrition policies or guidelines. Furthermore, 64.5% reported there was no formal or informal training for staff on breastfeeding support, but 50% reported that staff members do provide breastfeeding advice to mothers of children in their center. Despite some strategies in place to support breastfeeding, there are no standards on breastfeeding policies, practices, and training in child care settings. Therefore, the extent and scope of such support depend on parental request and the perceptions and attitudes of child care center staff toward breastfeeding.
Publisher: SAGE Publications
Date: 31-10-2022
DOI: 10.1177/13674935221136229
Abstract: This grounded theory study aimed to explore the subjective experiences of children living with Human Immunodeficiency Virus (HIV) from the perspective of children and their families in Indonesia. Twenty participants were interviewed, consisting of 12 children aged 9–18 years and eight family members. Using grounded theory analysis, this study identified three categories: ‘coping with diagnosis’, ‘disclosing their status’ and ‘living with the stigma of HIV’. Participants responded with shock, denial, sadness, secrecy and often had misconceptions about the virus to the diagnosis of themselves or their children. After diagnosis, children with HIV and their families continuously lived with stigma stemming from in idual and societal beliefs about the virus. This stigma manifested in actions such as isolation, disclosure avoidance, secrecy, deception and social rejection. Because of these stigmatisations, many of the participants decided not to disclose the child’s HIV status and used status strategies such as telling lies, keeping secrets and keeping their distance. The participants offered insight into the need for comprehensive programs to address care gaps. This study highlights that health professionals need to develop practical guidelines to support families during the disclosure process, provide psychosocial care for children, and create stigma reduction interventions for children with HIV.
Publisher: Wiley
Date: 20-08-2023
DOI: 10.1111/JAN.15422
Abstract: The aim was to examine the social determinants of health on human immunodeficiency virus care quality for children in Indonesia. A qualitative design using constructivist grounded theory methods was utilized. Data were collected between 2019 and 2020 using in‐depth‐ interviews and memo writing. In total, 23 semi‐structured in idual interviews with healthcare professionals, 12 with children with human immunodeficiency virus, and eight family members were conducted. Data were analysed with the two‐step initial coding and focused coding, along with the constant comparative method, theoretical sensitivity and memo writing. Five themes were constructed from participants' perspectives on human immunodeficiency virus care for children: (1) living with a low‐socioeconomic status, (2) lacking instrumental support, (3) experiencing complicated procedures for public health insurance, (4) limited Human Immunodeficiency Virus care services for children and (5) lacking care coordination, policies and practices. Children living with human immunodeficiency virus had poor health outcomes, due to having a low‐socioeconomic status, reduced access to healthcare, coupled with a lack of social support services. This study demonstrated how the social determinants of health negatively impact the quality of care for Indonesian children with human immunodeficiency virus and their families. Understanding these determinants would benefit health professionals, in particular nurses, to consider these factors in their assessment to create a holistic care plan for children living with human immunodeficiency virus and their families. Addressing the social determinants of health would beneficially enhance outcomes and well‐being of children living with human immunodeficiency virus health in Indonesia.
Publisher: Wiley
Date: 23-07-2023
DOI: 10.1111/JAN.15789
Abstract: Healthcare waste production is a significant contributor to carbon emissions, negatively impacting the environment. Ineffective healthcare waste disposal results in greater measures to manage it which is costly to both the environment and healthcare organizations. This study aimed to improve waste management in a tertiary maternity hospital. Specifically, the impact of a midwife‐led intervention to improve waste segregation, staff knowledge and attitudes and waste management‐related costs was investigated. A multi‐method study including pre‐ and post‐intervention staff waste management knowledge and attitude surveys and waste audits of bins located on the postnatal ward. The intervention included education sessions, posters and signage by waste bins and monthly newsletters distributed throughout 2021 to raise staff awareness of correct waste segregation processes. Pre‐ and post‐intervention surveys were distributed in early 2021 and early 2022, respectively. The waste audits occurred on three occasions, January, July and December of 2021. The waste audit included total waste in kilograms (kg), waste in kg by segregation and identification of correct and incorrect segregation. Waste audit and quantitative staff survey data were analysed using descriptive statistics and chi square. Qualitative data from the staff surveys were analysed using content analysis. Knowledge and attitudes to waste management were similar across pre‐ and post‐intervention staff surveys. Knowledge of accurate allocation of specific items to waste streams was variable with errors identified in both the pre‐ and post‐surveys. Waste audit data showed reductions in clinical waste at each measurement, with a 71.2% decrease in clinical waste from baseline to the final audit. Accuracy of waste segregation also improved from the baseline to final audit, resulting in a 48% reduction in waste management costs. The midwife‐led initiative improved waste segregation and achieved the associated waste management cost reduction. A midwifery‐led initiative to address waste production and segregation on a maternity ward had a positive impact on waste segregation practices and associated waste management costs. The existence of change ch ions along with in‐service sessions, posters and newsletters to raise awareness of correct waste segregation resulted in a 71% reduction of incorrect items being placed in clinical waste bins. Challenges such as COVID‐19 pressures and workload made it difficult for midwives to engage in waste management education and effective waste segregation. No patient or public contribution. Implementing clinician‐led waste management interventions across hospital wards while addressing workload issues are likely to have significant cost benefits for organisations and minimise the environmental impacts of healthcare settings.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.WOMBI.2021.04.007
Abstract: High infant mortality remains a global health problem, particularly in less developed countries. Indonesia has one of the highest infant mortality rates in Southeast Asia. Known factors relate to documented medical conditions and do not necessarily explain their origin. To identify and explore factors that contribute to infant mortality in Papua, Indonesia, through the lens of health workers' perceptions. A qualitative descriptive approach using semi-structured interviews was used. Twelve Indonesian health workers participated. Interviews were audio-recorded and transcribed, and then analysed thematically. Five main themes were generated: beliefs and practices related to pregnancy, birth, and infants infant health factors maternal health factors barriers to seeking, receiving and providing infant health care and enablers and strategies for improving infant health. Cultural factors were perceived as contributing to poor health outcomes by shaping decisions, help seeking behaviour and health care access. Poverty, health literacy, road access and transport, shortage of health staffing, and health equipment and medicines exacerbate poor health outcomes. Cultural knowledge and sensitivity are central to the provision and acceptance of health care by local families in Papua, Indonesia. Recommendations include: improving cultural sensitivity and cultural safety of service implementing community health promotion to enhance maternal and infant health improving community participation in health care planning and delivery and enhancing collaboration between national, provincial, regency and local governments.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.WOMBI.2021.04.009
Abstract: Excessive gestational weight gain in women who are overweight or obese puts them at risk of poor short- and long-term outcomes for maternal and neonatal health. Several interventions have been trialled to encourage women who are overweight or obese to limit gestational weight gain during pregnancy. The aim of this review was to analyse the evidence on interventions to limit gestational weight gain in pregnant women who are overweight or obese. An integrative review guided by the Joanna Briggs Institute approach was conducted. An unlabeled search query of pregnancy, weight, and obesity was conducted in Medline, Scopus and CINAHL, limited to English language, 2010-2020 publications, and primary research on humans. Unlabeled search query of "((pregnancy outcome) OR (prenatal care) OR (pregnancy complications)) AND ((weight loss) OR (weight gain) OR (weight management)) AND (obesity) was used. Additional 9 records were identified through reference lists. Following a critical appraisal, 21 primary research articles were included in this review. A thematic synthesis was undertaken. Four major themes were identified. These are (1) mixed findings of lifestyle interventions for weight management, (2) ineffectiveness of probiotics or metformin for weight management, (3) psycho-behavioural interventions for weight management, and (4) midwifery role as an integral component in multidisciplinary intervention for weight management. The literature suggests a need for longer duration of behavioural lifestyle intervention sessions led by the same midwife trained in motivational interviewing to limit weight gain in pregnant women who are overweight or obese.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Public Library of Science (PLoS)
Date: 15-11-2021
DOI: 10.1371/JOURNAL.PONE.0260049
Abstract: Vaccination against COVID-19 is a key global public health strategy. Health professionals including midwives and doctors support and influence vaccination uptake by childbearing women. There is currently no evidence regarding the COVID-19 vaccination perceptions and intentions of those who receive or provide maternity care in Australia. The aim of this study was to address this gap in knowledge and explore the perceptions and intentions regarding COVID-19 vaccination from consumers and providers of maternity care in Australia. A national cross-sectional online study conducted in early 2021 in Australia, a country that has had a very low number of COVID-19 cases and deaths. Recruitment was undertaken through parenting and health professional social media sites and professional college distribution lists. A total of 853 completed responses, from women (n = 326), maternity care providers including doctors (n = 58), midwives (n = 391) and midwifery students (n = 78). Personal intention to be vaccinated ranged from 48–89% with doctors most likely and women least likely. Doctors and midwifery students were significantly more likely to recommend the vaccine to pregnant women in their care than midwives (p .001). Fewer doctors (2%) felt that women should wait until breastfeeding had concluded before being vaccinated compared with 24% of midwives and 21% of midwifery students (p .001). More than half of the midwives (53%) had concerns about the COVID-19 vaccine for the women in their care compared with 35% of doctors and 46% of midwifery students. Despite national guidelines recommending vaccination of breastfeeding women, 54% of practitioners were unlikely to recommend vaccination for this group. This is the first study to explore the perceptions and intentions regarding COVID-19 vaccination from the perspective of those who receive and provide maternity care in Australia. Findings have utility to support targeted public health messaging for these and other cohorts.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.NEPR.2019.03.001
Abstract: Precepting is a common and expected role of nurses in clinical settings worldwide. This research explored novice nurse's experiences of precepting undergraduate nursing students in high-acuity hospital environments. An interpretive study was undertaken with 12 novice nurses (<3-years of post-registration clinical experience), who were precepting nursing students. Data was collected through focus groups and thematically analysed. The zone of proximal development theory was applied to understand the relationship of learning that occurs between students and nurses. Three themes were identified. Firstly, participants established that precepting students enhanced their own self-development, and was a rewarding role, that not only developed the student into a nurse, but provided opportunities for the novice nurse to learn. Second, precepting was both challenging and rewarding. The challenges involved the student, the context, and the preceptors' own teaching and learning skills, resulting in feelings of frustration and conflict between nursing care and preceptor roles. Third, precepting was an expectation of both the nursing role and from senior nurses. At times, the participants felt overwhelmed and drained, particularly when having students that challenged them on multiple consecutive shifts. Participants identified the need for guidance and support from more capable peers to develop confidence while precepting nursing students.
Publisher: Elsevier BV
Date: 10-2018
Publisher: Rural and Remote Health
Date: 30-08-2018
DOI: 10.22605/RRH4306
Publisher: Wiley
Date: 08-2014
DOI: 10.1111/AJR.12097
Abstract: Studies have investigated the impact of medical students undertaking longitudinal clerkships in General Practices however, little is known about the impact of students' longitudinal clerkships on clinical supervisors in the hospital environment. This research aimed to explore the educational impacts and benefits gained from supervisory responsibilities in a rural hospital context. We assessed the impact of longitudinal clerkships using in idual and group-structured interviews. The responses were thematically analysed by the researchers. Two rural hospitals in Victoria, Australia. Fifteen senior medical and nursing staff at two rural hospitals who supervised year four medical students in a longitudinal clinical program. Thematic analysis identified three major themes: changes to the supervisor, change in the hospital learning culture and student usefulness. Doctors and nurses who undertook student supervisory responsibilities reported a sense of personal change, including increased reflective practice, improved value of professional identity and increased enthusiasm for interprofessional learning. Supervisors updated their clinical skills and became proactive in seeking out learning opportunities for students. Hospitals became more vibrant learning environments and interprofessional education enhanced teamwork. Patient care increased, knowledge gaps filled and hospital governance, policy and procedures challenged. The benefits of longitudinal clerkship in the rural hospital setting provided symbiotic relationships between hospitals, students, patients and educations provider. The interprofessional approach towards clinical supervision enhanced supervisor learning and generated an understanding among professional groups of each other's clinical skills, roles and values, and raised an awareness of the importance of working collaboratively for better patient outcomes and addressing future workforce shortages.
Publisher: BRILL
Date: 2016
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.WOMBI.2017.09.009
Abstract: Midwifery programs leading to registration as a midwife in Australia have undergone significant change over the last 20 years. During this time accreditation and governance around midwifery education has been reviewed and refined, moving from state to national jurisdiction. A major change has been the mandated inclusion of Continuity of Care Experiences as a clinical practice-based learning component. The purpose of this discussion is to present the history of the governance and accreditation of Australian midwifery programs. With a particular focus on the evolution of the Continuity of Care Experience as a now mandated clinical practice based experience. Historical and contemporary documents, research and grey literature, are drawn together to provide a historical account of midwifery programs in Australia. This will form the background to the inclusion of the Continuity of Care Experience and discuss research requirements to enhance the model to ensure it is educationally sound. The structure and processes for the Continuity of Care Experience vary between universities and there is currently no standard format across Australia. As such, how it is interpreted and conducted varies amongst students, childbearing women, academics and midwives. The Continuity of Care Experience has always been strongly advocated for however there is scant evidence available in terms of its educational theory underpinnings. Research concerned with the intended learning objectives and outcomes for the Continuity of Care Experience will support the learning model and ensure it continues into the future as an educationally sound learning experience for midwifery students.
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.MIDW.2022.103462
Abstract: To investigate predictors of breastfeeding self-efficacy, postnatal care experiences, and there subsequent impact on breastfeeding outcomes in Australia and Aotearoa New Zealand in the context of the COVID-19 pandemic. A cross-sectional online survey collected data between August and October 2020 with recruitment via social media. Quantitative data were analyzed using descriptive analyses, and linear and logistic regression analysis related to the Breastfeeding Self-Efficacy Scale-Short Form findings. Open text responses were analyzed using content analysis. There were 1001 complete responses. Visitor restrictions impacted the woman's early parenting experience in both positive and negative ways. One third of participants stated their postnatal needs were not met with 82 stating that they had no postnatal care at all. During the first six weeks postnatal, 48.1% felt not very or not at all confident caring for their baby. Despite 94.3% of participants initiating breastfeeding, only 70% were exclusively breastfeeding at six weeks. The mean self-efficacy score was 49.98 suggesting the need for additional help, with first time mothers having a statistically significant lower score. Sub-optimal postnatal care and support negatively influence breastfeeding self-efficacy. Women desired additional help during the COVID-19 pandemic inclusive of support and education to meet their postnatal needs and exclusively breastfeed. Women require appropriate and timely postnatal care and support to promote confidence in caring for baby and achieve their breastfeeding goals. Preferably this care should be provided face-to-face.
Publisher: Elsevier BV
Date: 05-2022
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.MIDW.2022.103338
Abstract: Obesity is a global public health problem, and in high income countries such as Australia, approximately 60 percent of women are overweight, and half of these women are classed in the obese range. A large proportion of women who are obese are of childbearing age and many are undergoing surgical weight loss procedures (bariatric surgery) before becoming pregnant. To collate and synthesize available literature regarding women's experiences of pregnancy and/or lactation following bariatric surgery. A scoping review was undertaken of published research between 1990 and 2021, written in English, involving human participants, which described experiences of pregnancy and/or lactation after bariatric surgery. From a total of 4673 abstracts identified using search terms and strings, only 5 items (4 published conference abstracts and one full paper) were identified. Women had little knowledge of how the bariatric surgery might impact pregnancy and only a minority received additional medical/nutrition care during pregnancy. Women wanted more information and support managing their pregnancies, and often received inconsistent advice. For some women experiences of conflict between eating well for the developing fetus and eating little to minimize weight gain or undo the weight loss they had achieved was reported. Ensuring that both health care providers and women are informed about promoting a healthy pregnancy and lactation after bariatric surgery is paramount. More research is required to understand women's experiences and information needs to ensure advice and care is tailored to their specific needs.
Publisher: Elsevier BV
Date: 2015
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.5688/AJPE6545
Publisher: Elsevier BV
Date: 11-2021
Publisher: Wiley
Date: 06-02-2021
DOI: 10.1111/AJO.13307
Abstract: The COVID‐19 pandemic meant rapid changes to Australian maternity services. All maternity services have undertaken significant changes in relation to policies, service delivery and practices and increased use of personal protective equipment. The aim of this study was to explore and describe doctors’ experiences of providing maternity care during the COVID‐19 pandemic in Australia. A national online survey followed by semi‐structured interviews with a cohort of participants was conducted during the first wave of the COVID‐19 pandemic in Australia (May–June 2020). Participants were recruited through social media networks. Eighty‐six doctors completed the survey, and eight were interviewed. Almost all doctors reported rapid development of new guidelines and major changes to health service delivery. Professional colleges were the main source of new information about COVID‐19. Most (89%) doctors felt sufficiently informed to care for women with COVID‐19. Less than half of doctors felt changes would be temporary. Doctors described workforce disruptions with associated personal and professional impacts. The ability to access and process up‐to‐date, evidence‐based information was perceived as important. Doctors acknowledged that altered models of care had increased pregnant women’s anxiety and uncertainty. All doctors described silver linings from sector changes. This study provides unique insights into doctors’ experiences of providing maternity care during the COVID‐19 pandemic in Australia. Findings have immediate relevance to the maternity sector now and into the future. Lessons learnt provide an opportunity to reshape the maternity sector to better prepare for future public health crises.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 23-09-2023
Publisher: Wiley
Date: 27-07-2023
DOI: 10.1111/JAN.15806
Abstract: To explore the satisfaction and experiences of women and staff with the BSOTS in an Australian hospital. Cross‐sectional descriptive survey. Surveys were distributed to women and staff between February and May 2022. Survey questions reflected satisfaction with triage and provision of care under the BSOTS system (for women) and confidence in using the BSOTS system and its impact on triage‐related care (for staff). Survey data were summarized using descriptive statistics, and qualitative responses were analysed using content analysis. There were 50 women and 40 staff (midwives and doctors) survey respondents. Most women were satisfied with triage wait times, the verbal information they received and the time it took for them to receive care. Nearly all midwife participants indicated they had high knowledge and confidence in using the BSOTS. Most staff indicated that the BSOTS supported the accurate assessment of women and had benefits for women, staff and the hospital. The findings showed that women and staff were satisfied with receiving and providing care in a maternity triage setting under the BSOTS system. Implementing standardized maternity triage approaches such as the BSOTS in health settings delivering care to pregnant women is recommended for improving flow of care and perceptions of care quality by women. Quality of maternity triage processes is likely to impact the satisfaction of women attending services and the staff providing care. The BSOTS was shown to improve maternity triage processes and was associated with satisfaction of women and staff. Maternity settings can benefit from implementing triage approaches such as the BSOTS as it standardizes and justifies the care provided to women. This is likely to result in satisfaction of women and staff engaged in maternity triage and improve the birth outcomes of women and babies. The reporting of this paper has followed SQUIRE guidelines. Women engaged with maternity services were participants in the study but did not contribute to the design, conduct or publication of the study.
Publisher: Cold Spring Harbor Laboratory
Date: 22-09-2020
DOI: 10.1101/2020.09.22.20199331
Abstract: The global COVID-19 pandemic has radically changed the way health care is delivered in many countries around the world. Evidence on the experience of those receiving or providing maternity care is important to guide practice through this challenging time. A cross-sectional study was conducted in Australia. Five key stakeholder cohorts were included to explore and compare the experiences of those receiving or providing care during the COVID-19 pandemic. Women, their partners, midwives, medical practitioners and midwifery students who had received or provided maternity care from March 2020 onwards in Australia were invited to participate in an online survey. which was released between 13 th May and 24 th June 2020 a total of 3701 completed responses were received. While anxiety related to COVID-19 was high among all five cohorts, there were statistically significant differences between the responses from each cohort for most survey items. Women were more likely to indicate concern about their own and family’s health and safety in relation to COVID-19 whereas midwives, doctors and midwifery students were more likely to be concerned about occupational exposure to COVID-19 through working in a health setting than those receiving care through attending these environments. Midwifery students and women’s partners were more likely to respond that they felt isolated because of the changes to the way care was provided. Despite concerns about care received or provided not meeting expectations, most respondents were satisfied with the quality of care provided, although midwives and midwifery students were less likely to agree. This paper provides a unique exploration and comparison of experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia. Findings are useful to support further service changes and future service redesign. New evidence provided offers unique insight into key stakeholders’ experiences of the rapid changes to health services.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.WOMBI.2015.12.002
Abstract: Competency Standards in Australia articulate that the midwife must be able to contribute to the professional development of themselves and others. Few undergraduate health professional curricula currently incorporate content for the development of specific knowledge and skills required for clinical teaching. This project aimed to understand and enhance midwifery students' preparedness to assume their future clinical teaching responsibilities. Design-based research was used to implement an educational intervention aimed at developing clinical teaching skills through a peer education session between 1st and 3rd year students. The perspectives of 30 undergraduate midwifery students about their preparedness for their teaching role and the intervention were obtained through 3 focus groups. A thematic analysis of the data was undertaken. Three themes were identified encompassing the research aims and objectives 'Co-creating a culture for learning', 'reciprocal teaching and learning' and 'developing clinical teaching capacities'. The findings indicate that the midwifery students had a holistic understanding of their responsibilities in clinical teaching in the workplace. They were able to identify ways in which their teaching capacities were being developed through their clinical experiences and the curriculum, both intended and hidden. Despite limited educational activities for clinical teaching, the midwifery students made explicit connections of the relational interdependence of workplace-based experiences and their learning. Students were clearly able to identify ways in which their own learning experiences and the culture in which this learning is embedded, assists them to develop clinical teaching skills, ready to support the next generation of midwifery students.
No related grants have been discovered for Linda Sweet.