Objective to explore the views of midwives and maternal–child health nurses regarding factors tha... more Objective to explore the views of midwives and maternal–child health nurses regarding factors that influence breast feeding initiation and continuation, focusing on how support for women could be improved to increase breast feeding duration. Design a focus group study. Setting hospital or domiciliary (home-visiting) midwives and community-based maternal and child health (MCH) nurses in one region of Victoria, Australia. Methods twelve MCH nurses and five midwives who provided supportive services to women in the immediate postnatal period attended one of three audio-recorded focus groups. Thematic findings were identified. Findings four key themes were: ‘Guiding women over breast-feeding hurdles’, ‘Timing, and time to care’; ‘Continuity of women’s care’ and ‘Imparting professional knowledge’. Given the a pattern of hospital discharge of mother and infant on day one or day two after birth, participants thought the timing of immediate postnatal breast-feeding support was critical to en...
Objective To examine factors that influence the establishment and continuation of breastfeeding a... more Objective To examine factors that influence the establishment and continuation of breastfeeding among women living in a southern region of Victoria. Method Sequential mixed methods design including paper-based survey and focus group enquiry. Finding Women who had breastfed their infants (n = 170) reported reliance on midwives, lactation consultants and maternal and child health nurses for breastfeeding advice and support in the immediate and medium postnatal periods. Women who chose a private hospital appeared to receive less immediate postnatal support than those in a public hospital. Access to individual guidance from midwives and MCH nurses was regarded as critical to overcoming breastfeeding difficulties, in the face of the alternative suggested by people to ‘give up’. They described themes of: ‘Women's experience of nurses/midwives’, ‘Expectations versus reality’, ‘Not giving up despite difficulties’, and ‘Breastfeeding support’. Sources of lay support were not universal. C...
The Australian & New Zealand journal of obstetrics & gynaecology, 2014
Core clinical skills acquisition is an essential component of undergraduate medical and midwifery... more Core clinical skills acquisition is an essential component of undergraduate medical and midwifery education. Although interprofessional education is an increasingly common format for learning efficient teamwork in clinical medicine, its value in undergraduate education is less clear. We present a collaborative effort from the medical and midwifery schools of Monash University, Melbourne, towards the development of an educational package centred around a core skills-based workshop using low fidelity simulation models in an interprofessional setting. Detailed feedback on the package was positive with respect to the relevance of the teaching content, whether the topic was well taught by task trainers and simulation models used, pitch of level of teaching and perception of confidence gained in performing the skill on a real patient after attending the workshop. Overall, interprofessional core skills training using low fidelity simulation models introduced at an undergraduate level in me...
Breastfeeding review : professional publication of the Nursing Mothers' Association of Australia, 2013
Working women need to juggle work, child care and family to continue to breastfeed. This qualitat... more Working women need to juggle work, child care and family to continue to breastfeed. This qualitative study's aim was to explore women's experiences of returning to work following the birth of their baby. Focus groups were held with women within one multi-campus university, who had commenced breastfeeding at birth and had returned to work or study within 12 months. In addition, educators working with babies in childcare centres on two of the campuses were interviewed. Thematic analysis was employed used Rogoff's (2003) three planes of analysis, the individual, the interpersonal and the cultural-institutional. Three themes, proximity, flexibility, and communication, were identified relating to the factors impacting on women and their choices to breastfeed or wean on returning to work. From a socio-cultural perspective these themes can be understood as situated within the interrelated contexts of workplace, child care and family. Limitations of the study include the small n...
To examine factors that influence the establishment and continuation of breastfeeding among women... more To examine factors that influence the establishment and continuation of breastfeeding among women living in a southern region of Victoria. Sequential mixed methods design including paper-based survey and focus group enquiry. Women who had breastfed their infants (n=170) reported reliance on midwives, lactation consultants and maternal and child health nurses for breastfeeding advice and support in the immediate and medium postnatal periods. Women who chose a private hospital appeared to receive less immediate postnatal support than those in a public hospital. Access to individual guidance from midwives and MCH nurses was regarded as critical to overcoming breastfeeding difficulties, in the face of the alternative suggested by people to 'give up'. They described themes of: 'Women's experience of nurses/midwives', 'Expectations versus reality', 'Not giving up despite difficulties', and 'Breastfeeding support'. Sources of lay support were not universal. The duration of breastfeeding might be extended by early problem resolution. To enhance breastfeeding participation, further examination of the extent and timeliness of service provision by health service providers is necessary.
to explore the views of midwives and maternal-child health nurses regarding factors that influenc... more to explore the views of midwives and maternal-child health nurses regarding factors that influence breast feeding initiation and continuation, focusing on how support for women could be improved to increase breast feeding duration. a focus group study. hospital or domiciliary (home-visiting) midwives and community-based maternal and child health (MCH) nurses in one region of Victoria, Australia. twelve MCH nurses and five midwives who provided supportive services to women in the immediate postnatal period attended one of three audio-recorded focus groups. Thematic findings were identified. four key themes were: 'Guiding women over breast-feeding hurdles', 'Timing, and time to care'; 'Continuity of women's care' and 'Imparting professional knowledge'. Given the a pattern of hospital discharge of mother and infant on day one or day two after birth, participants thought the timing of immediate postnatal breast-feeding support was critical to enable women to initiate and continue breast feeding. Community-based MCH nurses reported time gaps in uptake of new mother referrals and time-pressured face-to-face consultations. Both groups perceived barriers to continuity of women's care. health services subscribe to the Baby Friendly Health Initiative and government policies which support breast feeding, however providers described time pressures and a lack of continuity of women's care, including during transition from hospital to community services. there is a need to examine administration of service delivery and how domiciliary and community nurses can collaborate to establish and maintain supportive relationships with breast feeding women.
International journal of nursing education scholarship, 2010
Application of evidence is accepted as an important component of clinical practice. Teaching rese... more Application of evidence is accepted as an important component of clinical practice. Teaching research to undergraduate students has been reported internationally as a challenge, particularly for nurse educators. In this paper, reported is a strategy designed to enhance research learning for undergraduate midwifery students at one university, which formed part of a larger, international investigation into women's responses to caesarean birth. Following theory classes and briefings, students worked with their clinical educators in practice to interview women using existing tools, and were engaged in qualitative data analysis. A number of challenges were encountered throughout the process, both for the educators and students. However, the teaching approach provided benefits for students in learning about midwifery research. Recommended as essential is for continued development of pedagogical approaches that make research tangible for students. Furthermore, provision of support for clinical staff working with students is important for success of such approaches.
Midwives&... more Midwives' ability to manage maternal deterioration and 'failure to rescue' are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives' ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance. An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a 'birthing suit' simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data. The mean total knowledge score was 75% (range 46-91%) with low skill performance, means for both scenarios 54% (range 39-70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32)=2.247, p=0.032), in the second and more difficult APH scenario. Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation.
Learning undertaken through clinical placements provides up to 50% of the educational experience ... more Learning undertaken through clinical placements provides up to 50% of the educational experience for students in pre-registration midwifery courses. However little is known about of the impact various models of clinical placement have on the learning experiences of undergraduate midwifery students. Two clinical placement models have been employed for undergraduate midwifery students at Monash University, including the block placement model and the continuous two days per week model. This project sought to explore the learning experiences of students in these two models of placement. Focus groups were held on two campuses with a total of 17 students from different cohorts and programs. No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model. No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model.
Breastfeeding review: professional publication of the Australian Breastfeeding Association
Current exclusive breastfeeding rates in Victoria do not meet World Health Organization (WHO) rec... more Current exclusive breastfeeding rates in Victoria do not meet World Health Organization (WHO) recommended standards. This study describes the reasons for early cessation of breastfeeding from the perspectives of the mothers, midwives and maternal and child health (M&CH) nurses in Frankston, Victoria. Interviews were conducted with women who had ceased to breastfeed within three weeks of birth. Midwives who regularly worked in the home visiting program and M&CH nurses participated in focus groups. The main aim was to describe local factors associated with early breastfeeding cessation. Themes identified included: midwifery assistance; knowledge, expectations and reality; social influences; influence of health professionals. These findings support previous evidence of factors that inhibit establishment of breastfeeding and suggest that failure to successfully establish breastfeeding is complex. Collaboration between health and social services, health professionals and community is req...
Objective to explore the views of midwives and maternal–child health nurses regarding factors tha... more Objective to explore the views of midwives and maternal–child health nurses regarding factors that influence breast feeding initiation and continuation, focusing on how support for women could be improved to increase breast feeding duration. Design a focus group study. Setting hospital or domiciliary (home-visiting) midwives and community-based maternal and child health (MCH) nurses in one region of Victoria, Australia. Methods twelve MCH nurses and five midwives who provided supportive services to women in the immediate postnatal period attended one of three audio-recorded focus groups. Thematic findings were identified. Findings four key themes were: ‘Guiding women over breast-feeding hurdles’, ‘Timing, and time to care’; ‘Continuity of women’s care’ and ‘Imparting professional knowledge’. Given the a pattern of hospital discharge of mother and infant on day one or day two after birth, participants thought the timing of immediate postnatal breast-feeding support was critical to en...
Objective To examine factors that influence the establishment and continuation of breastfeeding a... more Objective To examine factors that influence the establishment and continuation of breastfeeding among women living in a southern region of Victoria. Method Sequential mixed methods design including paper-based survey and focus group enquiry. Finding Women who had breastfed their infants (n = 170) reported reliance on midwives, lactation consultants and maternal and child health nurses for breastfeeding advice and support in the immediate and medium postnatal periods. Women who chose a private hospital appeared to receive less immediate postnatal support than those in a public hospital. Access to individual guidance from midwives and MCH nurses was regarded as critical to overcoming breastfeeding difficulties, in the face of the alternative suggested by people to ‘give up’. They described themes of: ‘Women's experience of nurses/midwives’, ‘Expectations versus reality’, ‘Not giving up despite difficulties’, and ‘Breastfeeding support’. Sources of lay support were not universal. C...
The Australian & New Zealand journal of obstetrics & gynaecology, 2014
Core clinical skills acquisition is an essential component of undergraduate medical and midwifery... more Core clinical skills acquisition is an essential component of undergraduate medical and midwifery education. Although interprofessional education is an increasingly common format for learning efficient teamwork in clinical medicine, its value in undergraduate education is less clear. We present a collaborative effort from the medical and midwifery schools of Monash University, Melbourne, towards the development of an educational package centred around a core skills-based workshop using low fidelity simulation models in an interprofessional setting. Detailed feedback on the package was positive with respect to the relevance of the teaching content, whether the topic was well taught by task trainers and simulation models used, pitch of level of teaching and perception of confidence gained in performing the skill on a real patient after attending the workshop. Overall, interprofessional core skills training using low fidelity simulation models introduced at an undergraduate level in me...
Breastfeeding review : professional publication of the Nursing Mothers' Association of Australia, 2013
Working women need to juggle work, child care and family to continue to breastfeed. This qualitat... more Working women need to juggle work, child care and family to continue to breastfeed. This qualitative study's aim was to explore women's experiences of returning to work following the birth of their baby. Focus groups were held with women within one multi-campus university, who had commenced breastfeeding at birth and had returned to work or study within 12 months. In addition, educators working with babies in childcare centres on two of the campuses were interviewed. Thematic analysis was employed used Rogoff's (2003) three planes of analysis, the individual, the interpersonal and the cultural-institutional. Three themes, proximity, flexibility, and communication, were identified relating to the factors impacting on women and their choices to breastfeed or wean on returning to work. From a socio-cultural perspective these themes can be understood as situated within the interrelated contexts of workplace, child care and family. Limitations of the study include the small n...
To examine factors that influence the establishment and continuation of breastfeeding among women... more To examine factors that influence the establishment and continuation of breastfeeding among women living in a southern region of Victoria. Sequential mixed methods design including paper-based survey and focus group enquiry. Women who had breastfed their infants (n=170) reported reliance on midwives, lactation consultants and maternal and child health nurses for breastfeeding advice and support in the immediate and medium postnatal periods. Women who chose a private hospital appeared to receive less immediate postnatal support than those in a public hospital. Access to individual guidance from midwives and MCH nurses was regarded as critical to overcoming breastfeeding difficulties, in the face of the alternative suggested by people to 'give up'. They described themes of: 'Women's experience of nurses/midwives', 'Expectations versus reality', 'Not giving up despite difficulties', and 'Breastfeeding support'. Sources of lay support were not universal. The duration of breastfeeding might be extended by early problem resolution. To enhance breastfeeding participation, further examination of the extent and timeliness of service provision by health service providers is necessary.
to explore the views of midwives and maternal-child health nurses regarding factors that influenc... more to explore the views of midwives and maternal-child health nurses regarding factors that influence breast feeding initiation and continuation, focusing on how support for women could be improved to increase breast feeding duration. a focus group study. hospital or domiciliary (home-visiting) midwives and community-based maternal and child health (MCH) nurses in one region of Victoria, Australia. twelve MCH nurses and five midwives who provided supportive services to women in the immediate postnatal period attended one of three audio-recorded focus groups. Thematic findings were identified. four key themes were: 'Guiding women over breast-feeding hurdles', 'Timing, and time to care'; 'Continuity of women's care' and 'Imparting professional knowledge'. Given the a pattern of hospital discharge of mother and infant on day one or day two after birth, participants thought the timing of immediate postnatal breast-feeding support was critical to enable women to initiate and continue breast feeding. Community-based MCH nurses reported time gaps in uptake of new mother referrals and time-pressured face-to-face consultations. Both groups perceived barriers to continuity of women's care. health services subscribe to the Baby Friendly Health Initiative and government policies which support breast feeding, however providers described time pressures and a lack of continuity of women's care, including during transition from hospital to community services. there is a need to examine administration of service delivery and how domiciliary and community nurses can collaborate to establish and maintain supportive relationships with breast feeding women.
International journal of nursing education scholarship, 2010
Application of evidence is accepted as an important component of clinical practice. Teaching rese... more Application of evidence is accepted as an important component of clinical practice. Teaching research to undergraduate students has been reported internationally as a challenge, particularly for nurse educators. In this paper, reported is a strategy designed to enhance research learning for undergraduate midwifery students at one university, which formed part of a larger, international investigation into women's responses to caesarean birth. Following theory classes and briefings, students worked with their clinical educators in practice to interview women using existing tools, and were engaged in qualitative data analysis. A number of challenges were encountered throughout the process, both for the educators and students. However, the teaching approach provided benefits for students in learning about midwifery research. Recommended as essential is for continued development of pedagogical approaches that make research tangible for students. Furthermore, provision of support for clinical staff working with students is important for success of such approaches.
Midwives&... more Midwives' ability to manage maternal deterioration and 'failure to rescue' are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives' ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance. An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a 'birthing suit' simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data. The mean total knowledge score was 75% (range 46-91%) with low skill performance, means for both scenarios 54% (range 39-70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32)=2.247, p=0.032), in the second and more difficult APH scenario. Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation.
Learning undertaken through clinical placements provides up to 50% of the educational experience ... more Learning undertaken through clinical placements provides up to 50% of the educational experience for students in pre-registration midwifery courses. However little is known about of the impact various models of clinical placement have on the learning experiences of undergraduate midwifery students. Two clinical placement models have been employed for undergraduate midwifery students at Monash University, including the block placement model and the continuous two days per week model. This project sought to explore the learning experiences of students in these two models of placement. Focus groups were held on two campuses with a total of 17 students from different cohorts and programs. No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model. No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model.
Breastfeeding review: professional publication of the Australian Breastfeeding Association
Current exclusive breastfeeding rates in Victoria do not meet World Health Organization (WHO) rec... more Current exclusive breastfeeding rates in Victoria do not meet World Health Organization (WHO) recommended standards. This study describes the reasons for early cessation of breastfeeding from the perspectives of the mothers, midwives and maternal and child health (M&CH) nurses in Frankston, Victoria. Interviews were conducted with women who had ceased to breastfeed within three weeks of birth. Midwives who regularly worked in the home visiting program and M&CH nurses participated in focus groups. The main aim was to describe local factors associated with early breastfeeding cessation. Themes identified included: midwifery assistance; knowledge, expectations and reality; social influences; influence of health professionals. These findings support previous evidence of factors that inhibit establishment of breastfeeding and suggest that failure to successfully establish breastfeeding is complex. Collaboration between health and social services, health professionals and community is req...
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