ORCID Profile
0000-0002-7011-8923
Current Organisations
Flinders University
,
Griffith University Logan Campus
,
Griffith University Griffith Health
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Publisher: CSIRO Publishing
Date: 2021
DOI: 10.1071/AH19264
Abstract: ObjectiveTo determine maternal access to continuity of midwifery care in public maternity hospitals across the state of Queensland, Australia. MethodsMaternal access to continuity of midwifery care in Queensland was modelled by considering the proportion of midwives publicly employed to provide continuity of midwifery care alongside 2017 birth data for Queensland Hospital and Health Services. The model assumed an average caseload per full-time equivalent midwife working in continuity of care with 35 women per annum, based on state Nursing and Midwifery Award conditions. Hospitals were grouped into five clusters using standard Australian hospital classifications. ResultsTwenty-seven facilities (out of 39, 69%) across all 15 hospital and health services in Queensland providing a maternity service offered continuity of midwifery care in 2017 (birthing onsite). Modelling applying the assumed caseload of 35 women per full-time equivalent midwife found wide variations in the percentage of women able to access continuity of midwifery care, with access available for an estimated 18% of childbearing women across the state. Hospital classifications with higher clinical services capability and birth volume did not equate with higher access to continuity of midwifery care in metropolitan areas. Regional health services with level 3 district hospitals assisting with & births showed higher levels of access, potentially due to additional challenges to meet local population needs to those of a metropolitan service. Access to full continuity of midwifery care in level 3 remote hospitals (& births) was artificially inflated due to planned pre-labour transfers for women requiring specialised intrapartum care and women who planned to birth at other hospitals. ConclusionsDespite strong evidence that continuity of midwifery care offers optimal care for women and their babies, there was significant variation in implementation and scale-up of these models across hospital jurisdictions. What is known about the topic?Access to continuity of midwifery care for pregnant women within the public health system varies widely however, access variation among different hospital classification groups in Australian states and territories has not been systematically mapped. What does this paper add?This paper identified differential access to continuity of midwifery care among hospital classifications grouped for clinical services capability and birth volume in one state, Queensland. It shows that higher clinical services capability and birth volume did not equate with higher access to continuity of midwifery care in metropolitan areas. What are the implications for practitionersScaling up continuity of midwifery care among all hospital classification groups in Queensland remains an important public health strategy to address equitable service access.
Publisher: E.U. European Publishing
Date: 13-10-2023
DOI: 10.18332/EJM/171359
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: 08-2023
Publisher: Informa UK Limited
Date: 11-2013
DOI: 10.1057/HS.2013.7
Publisher: Springer International Publishing
Date: 2022
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: 07-2022
DOI: 10.1016/J.NEPR.2022.103349
Abstract: Evaluate interventions to prepare preceptors for their role in undergraduate health student clinical education. Preceptor training and development are crucial to quality clinical learning experiences for undergraduate health students. The efficacy of education interventions designed for preceptors and use of reliable, valid outcome measures are unclear. A systematic literature review informed by PRISMA Guidelines. Major databases CINAHL, Medline and Google Scholar were searched between January 2010 and November 2021. 1253 articles were initially retrieved. Removal of duplicates and screening by title, abstract and keywords yielded 156 papers. Twenty-one papers fulfilled the inclusion criteria and were assessed using an adapted 'Critical Appraisal Checklist for Reports of Educational Interventions' and the New World Kirkpatrick Model. Most interventions were developed for the nursing profession and evaluated using pre-post-test (86%) or post-test only (5%). Two studies were considered high quality. Most studies (81%) reported positive short-term impact on preceptor knowledge, skills, attitudes and confidence. Two thirds (62%) of included studies measured preceptor behaviour change. No study measured impact related to quality of health care. Small s le sizes limited inferential analyses. Psychometric testing of tools to measure preceptor outcomes was inconsistent and validity and reliability were not reported in most studies. Structure and content of interventions were erse and lacked rigour in outcome measurement. Most interventions demonstrated some positive impact on preceptor development. Objective measures determining longer term impact or how enhanced preceptor development translated into quality clinical student learning support was lacking. Future research should consider how best to measure the impact of educational interventions on broader outcomes such as quality of client care.
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: 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: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.WOMBI.2008.10.001
Abstract: Midwifery Group Practice (MGP) is a continuity of midwifery care model for women in all risk groups (Low, Moderate and High) available at a tertiary metropolitan hospital in Australia. This demonstration study aimed to compare the clinical effectiveness of MGP with other models of care at the hospital. Comparisons of clinical outcomes were made between women who received care under MGP (n=618) and those receiving 'Other' modes of care at the hospital (n=3548) between three risk categories over a 15-month period. There were more Low (MGP n=218, 35.3%, 'Other' n=773, 21.8%) and fewer High Risk (MGP n=46, 7.4%, 'Other' n=564, 15.9%) women in MGP, with similar proportions of Moderate Risk women (MGP n=354, 57.3%, 'Other' n=2211, 62.3%). Significant differences include: fewer assisted deliveries for Moderate Risk women in MGP (27.7% MGP, 46.1% 'Other') fewer labour inductions (Low Risk: 12.8% MGP, 25.1% 'Other' Moderate Risk: 21.8% MGP, 29.5% 'Other' High Risk: 19.6% MGP, 34.9% 'Other') less epidural analgesia (Low Risk: 22.5% MGP, 49.0% 'Other' Moderate Risk: 20.3% MGP, 38.4% 'Other' High Risk: 17.4% MGP, 32.6% 'Other') and differences in the overall pattern of perineal trauma. No significant differences were found in the incidence of post-partum haemorrhage, antenatal hospital admissions, or neonatal admission to Special or Intensive Care. MGP is clinically effective when practiced in a routine setting.
Publisher: Elsevier BV
Date: 10-2011
Publisher: CSIRO Publishing
Date: 15-07-2019
DOI: 10.1071/AH18209
Abstract: Objective This study sought to compare costs for women giving birth in different public hospital services across Queensland and their babies. Methods A whole-of-population linked administrative dataset was used containing all health service use in a public hospital in Queensland for women who gave birth between 1 July 2012 and 30 June 2015 and their babies. Generalised linear models were used to compare costs over the first 1000 days between hospital and health services. Results The mean unadjusted cost for each woman and her baby (n = 134 910) was A$17406 in the first 1000 days. After adjusting for clinical and demographic factors and birth type, women and their babies who birthed in the Cairns Hospital and Health Service (HHS) had costs 19% lower than those who birthed in Gold Coast HHS (95% confidence interval (CI) –32%, –4%) women and their babies who birthed at the Mater public hospitals had costs 28% higher than those who birthed at Gold Coast HHS (95% CI 8, 51). Conclusions There was considerable variation in costs between hospital and health services in Queensland for the costs of delivering maternity care. Cost needs to be considered as an important additional element of monitoring programs. What is known about the topic? The Australian maternal care system delivers high-quality, safe care to Australian mothers. However, this comes at a considerable financial cost to the Australian public health system. It is known that there are variations in the cost of care depending upon the model of care a woman receives, and the type of delivery she has, with higher-cost treatment not necessarily being safer or producing better outcomes. What does this paper add? This paper compares the cost of delivering a full cycle of maternity care to a woman at different HHSs across Queensland. It demonstrates that there is considerable variation in cost across HHSs, even after adjusting for clinical and demographic factors. What are the implications for practitioners? Reporting of cost should be an ongoing part of performance monitoring in public hospital maternity care alongside clinical outcomes to ensure the sustainability of the high-quality maternal health care Australian public hospitals deliver.
Location: Australia
No related grants have been discovered for Roslyn Donnellan-Fernandez.