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Objective: The Samoan community has a disproportionately higher incidence of gestational diabetes mellitus (GDM). We explored consumer and healthcare providers' insight into perceptions of risk, attitudes to lifestyle behaviour change and experiences of GDM among Australian Samoan women in South Western Sydney. Methods: Semi-structured interviews and a focus group with Samoan women recruited through three churches, a diabetes and pregnancy clinic in South Western Sydney and via social media were conducted. Semi-structured interviews with healthcare providers' were also conducted. Main themes were thematically analysed to identify recurring patterns using Quirkos software. Identified themes were framed against the constructs of the Health Belief Model. Results: One focus group (n=4) and 12 one-to-one interviews were conducted among Samoan women. Eighteen semi-structured interviews with healthcare providers' were also conducted. There was a high concordance between Samoan women and healthcare providers' regarding perception of risk and barriers to maintaining a healthy lifestyle. However, Samoan women reported negative interactions with healthcare providers' that hindered their behaviour change, while healthcare providers' reported that normalisation of diabetes, confusion of GDM with type 2 diabetes and spiritual health beliefs were deterrents to behaviour change among Samoan women. Conclusion: Cross-cultural factors can influence the uptake of a healthy lifestyle. Future research should consider use of culturally tailored strategies when developing educational resources targeting Samoan women. Implications for research, policy and practice: The participants' viewpoints expressed in this study suggest a critical need for the development of culturally-tailored health promotion strategies for Samoan women and cultural training for healthcare providers', to improve GDM care and subsequent pregnancy outcomes. What is already known about the topic? * There is limited data and research on GDM particularly among the Australian-Samoan community though the available data highlight the significant morbidity and mortality due to diabetes in this population. * Samoan women are at an increased risk of gestational diabetes mellitus. What this paper adds: * This paper provides knowledge and understanding on ways to prevent and manage GDM by investigating the perception of risk and experiences of GDM among Australian Samoan women and healthcare professionals in Sydney. * It provides current evidence base for policy makers and researchers to develop health promotion strategies and interventions that are relevant to the Samoan and other culturally and linguistically diverse (CALD) communities in Australia. [ABSTRACT FROM AUTHOR]

Objectives: The study investigated how senior residential aged care staff perceived the purpose, function, impact and challenges of implementing a new role in their organisation for an unregistered care worker with a Bachelor of Dementia Care: the Dementia Care Support Worker. The role was piloted over two years in an Australian organisation with three aged care facilities to examine its potential to address gaps in service provision for people with dementia. Background: The residential aged care workforce is under pressure to care for residents with increasingly complex health conditions and where most care is provided by care workers. Presently no formal leadership role exists for care workers with specialised dementia knowledge in the aged care setting. Study design and methods: A qualitative descriptive approach was taken to explore senior staff members' perceptions of the role at two time points. Twenty-three semi-structured interviews held in July-August 2017 (n = 12), soon after role commencement, and in February-March 2019 (n = 11) were thematically analysed. Results: Three themes reflected senior staff members' expectations of the role: enhancing staff and management knowledge about dementia and dementia care practices; facilitating changes to improve care for residents living with dementia; and educating and supporting residents' families. Eighteen months later, participants felt the role was helping meet the need for improved care of residents with dementia, and staff understanding of dementia. They suggested communication and support structures to improve role effectiveness. Discussion: Staff were receptive to the establishment of the Dementia Care Support Worker role and felt it resulted in improvement in dementia care. Success was contingent on strong organisational support and resourcing. Conclusion: Improving dementia knowledge of care staff is an essential first step in driving care quality improvements. The Dementia Care Support Worker role for care workers has the potential to address knowledge needs and support improved care practices. Implications for research, policy, and practice: This research models how a new role might be configured for unregistered care workers with specialist dementia knowledge. Further research is needed to explore the establishment of such a role more widely in other organisations, to investigate whether it could provide a new career development pathway for care workers and improve the skills and capacity of the aged care workforce. Substantial policy changes would also be required to support role viability, such as around increased salary. Research which examines the impact of such roles on care outcomes would complement the findings. What is already known about the topic? • While dementia is common in residential aged care, knowledge of dementia is typically low among the care staff. • Consequently, care staff are not equipped to meet the complex needs of residents with dementia and their families. • New roles for unregistered care workers with specialised dementia knowledge have been proposed, but not tested. What this paper adds • This research models how a new role might be configured for care workers with specialist dementia knowledge. • Aged care facility leaders support a role for care workers with formal specialist dementia knowledge and skills, and perceive the role helps improve the quality of resident care and develop stakeholders' dementia knowledge. • Appropriate communication and support structures are required for the effective establishment of the role. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had widespread impacts on the community and has demanded a rapid response from the aged care sector. System changes for infection control have been required including the use of personal protective equipment, lockdowns, visitor restrictions and changes to activities within aged care facilities. Even prior to COVID-19, the high physical and emotional demands of aged care work were recognised. Objective: This study sought to understand aged care workers' experiences of the COVID-19 pandemic. Methods: Using a pragmatic paradigm qualitative data about work experiences during COVID-19 was collected from people employed in different aged care organisations in a range of aged care roles and settings from multiple Australian states. Data was collected using focus groups and interviews conducted online between August-October 2020. Inductive thematic analysis was used to identify key themes in the data. results: Participants included 15 people working across a range of aged care roles including clinical, care and management staff and across both residential and community settings. Five themes were identified which characterised aged care workers thoughts about their jobs during the pandemic. These included intensified procedures and emotional demands, feeling undervalued and detached from the frontline, exposure of existing system deficiencies, recognising teamwork and increased confidence in technology. conclusion: Reflecting on aged care workers' experiences of COVID-19 highlights the need to better support workers and acknowledge their important role in caring for older Australians. This includes at an organisational level by providing supportive environments and access to online resources as well as at the community and policy level by recognising aged care workers as frontline workers. The COVID-19 pandemic has also highlighted existing systemic issues in the aged care sector that need to be addressed for the provision of quality aged care in Australia during the COVID-19 pandemic and into the future. What is already known about the topic? * While the COVID-19 pandemic is affecting the global community, it is disproportionately impacting the aged care sector with higher rates of severe illness and death and wide-ranging system changes to prevent and control the spread of the virus. * Prior to COVID-19, aged care work was associated with high job demands and lack of access to resources to support aged care workers in their role. * Survey data on the Australian RACF workforce found workers felt prepared for the pandemic with a wide range of measures to control the spread of COVID-19 but they faced several challenges associated with their additional roles and restrictions. What this paper adds * This paper provides qualitative and descriptive insights into the challenges experienced by the Australian aged care workforce during COVID-19 including increased workloads and intensified emotional demands of their roles while at the same time feeling undervalued by the wider community. * This study has highlighted the need to better support and acknowledge aged care workers in the community through their portrayal in the media and within their organisations by facilitating supportive team environments and providing access to online resources and training. * This paper discusses existing systemic issues that have been highlighted by COVID-19 and the Royal Commission into Aged Care Quality and Safety and need to be addressed for the wellbeing of workers and the provision of quality aged care. [ABSTRACT FROM AUTHOR]

Background: Midwifery vacancies persist in small maternity units in Australian rural and private settings where midwives are expected to also care for general (non-maternity) patients when midwifery activity is low. Recruiting dual registered nurse/midwives over single registered midwives is preferred, as single registered midwives are seen as inflexible to assist with nursing work. Little is known about single registered midwives’ contribution to care of general patients in small maternity units. Objective: This scoping study aimed to consult single registered midwives and managers of single registered midwives to determine perspectives on single registered midwives’ contribution in small maternity units where the workload encompasses both midwifery and care of general patients, to inform further research. Study design and methods: This study used a qualitative description design. Two online focus groups were held, one containing three single registered midwives, the other three managers of single registered midwives. Similar questions were posed to each group about single registered midwives’ contribution to care in small maternity units. Data analysis was conducted collaboratively through coding and thematic categorisation processes. Results: Four major categories were found. Single registered midwives’ scope of practice concerning general patients is undefined; single registered midwives possess transferrable clinical skills applicable to general patients; practical, professional, and emotional barriers exist for single-registered midwives in small maternity units; and future research recommendations include scope of practice and workplace experiences. Discussion: Persistent midwifery vacancies are implicated in the closure of small maternity units to the detriment of childbearing families. Understanding the contribution of single registered midwives in small maternity units will inform future research and midwifery recruitment strategies to improve access to services. Conclusion: The experiences of single registered midwives working in small maternity units warrants further investigation. This scoping study contributes to the literature about single registered midwives’ experiences in small maternity units and suggests considerations for future research. Implications for research, policy and practice: Findings from this study provide information about the contribution of single registered midwives to small maternity units where there is an expectation to contribute to care of general patients in addition to midwifery. Future research into the experiences of single registered midwives working in these settings will generate information to inform recruitment strategies, potentially improving access to maternity care in small maternity units and may be used in the review of midwifery regulation and educational standards. What is already known about the topic? • Midwifery vacancies persist in small maternity units in rural and regional areas where the workload comprises both midwifery and nursing practice, despite strategies to recruit dual registered nurse/ midwives. • Dual registrants face challenges in maintaining both nursing and midwifery professional obligations in small maternity units. • There are increasing numbers of single registered midwives registering each year in Australia and educational opportunities to become a single registered midwife exist in rural settings. What this paper adds: • Single registered midwives make a useful contribution to care in small maternity units, and they assist with the care of general patients. • The scope of practice for single registered midwives in assisting with general patients is not defined. • Recommendations for future research include scope of practice for assisting with general patients and workplace challenges faced by single registered midwives because of their midwife-only qualification. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the training and implementation of the gravimetric method for estimating postpartum blood loss in clinical practice in Indonesian midwife-led birth centres. Background: Postpartum haemorrhage remains a leading cause of maternal death, particularly in low-resource settings. There is no gold standard for assessing blood loss volume during labour and childbirth. Studies recommended using a gravimetric method to measure blood loss in low-resource settings due to its relative accuracy and simplicity. Study design and methods: An online training module for the use of the gravimetric method was developed. All participants undertook the training and were asked to implement the method in clinical practice. A pre/post-test study design was used to examine midwives' understanding of the gravimetric method; their implementation experience was explored using a structured questionnaire. Knowledge was assessed pre-training. The training consisted of both theoretical and practical elements and the opportunity for participants to ask questions. Post-training tests were administered, followed by a one-month period of implementation and an evaluation of their experience of using the method in practice. Results: Two hundred and eighty-five midwives from 17 health facilities were recruited to the study, and a total of 101 midwives from 12 health facilities completed all elements. The participants' understanding of the gravimetric method improved significantly following the training. Although a number of challenges were identified regarding the implementation of the gravimetric method in practice, the participants were generally positive about its use, and 89% said that they would recommend this method to colleagues. Conclusion: A three-hour online training effectively improved participants' understanding of the gravimetric method for assessing blood loss volume. This study identified midwives' positive experiences with the gravimetric method and identified areas to improve practitioner experience of implementation in practice. Implications for research, policy, and practice: A three-hour online training followed by a onemonth implementation period could be an effective and efficient approach to developing midwives' understanding and use of the gravimetric method of blood loss estimation postpartum. What is already known about the topic? * The gravimetric method estimates the blood loss volume by weighing sanitary materials used during the labour process (i.e., gauze, sheets, swabs, pads, etc.) before and after being contaminated by the blood. * In clinical practice, the weight difference (in grams) is considered as 'blood loss volume' for ease of measurement and reported in millilitres without any formal conversion of units of weight to volume. * The benefits of the gravimetric method have been reported previously. However, there is limited evidence on the evaluation of this method to train midwives regarding implementation of the gravimetric method in clinical practice. What this paper adds * An online training programme is effective in increasing midwives' knowledge and awareness of the gravimetric method for postpartum blood loss assessment. * The midwives found the gravimetric method simple to adopt in clinical practice, which increased their confidence in detecting postpartum haemorrhage. * The midwives encountered some barriers while implementing the gravimetric method and provided strategies to mitigate the issues raised. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to understand the challenges that nurses and midwives face when seeking to practice social distancing within the various clinical settings in a hospital work environment during COVID-19. Background: COVID-19 has had a significant impact on nurses and midwives internationally. With the ease of transmission of COVID-19 and the limitations in pharmaceutical interventions, other measures had to be implemented across communities and in healthcare settings. These public health measures were enacted in various ways throughout the world. A key measure employed globally was social distancing. Australia was no different, initiating community wide interventions to apply social distancing principles and action, in an effort to reduce transmission. Whilst at their places of work, nurses and midwives were also encouraged to practice social distancing. Design and methods: Using convenience sampling, 579 nurses and midwives employed within one local health district in NSW, Australia completed an online questionnaire during the COVID-19 pandemic. Subsequently, a thematic analysis was undertaken as a way of categorising data from the 216 (37%) qualitative responses with regards to social distancing. This study adhered to The Standards for Reporting Qualitative Research (SRQR) guidelines. Results: Overwhelmingly, responses indicated that participants found it challenging to practice social distancing in their workplaces across various clinical settings within the hospital. The two major themes identified were: 1) challenges relating to social distancing with patients and 2) challenges related to social distancing with colleagues. Several sub themes were also identified. Conclusion: The COVID-19 pandemic has highlighted a number of challenges for healthcare professionals, social distancing being a key challenge. Social distancing is argued to be almost impossible in various clinical settings within a hospital where patient contact and provision of care in a team environment occurs. What is already known about the topic? * Social distancing has been demonstrated as an effective public health intervention to prevent the spread of infectious diseases, such as MERS, SARS and Ebola. What this paper adds: * During COVID-19, social distancing practices in acute healthcare environments have been enforced. However, this creates difficulties for health professionals such as nurses and midwives when providing quality care. * The results showed that social distancing has been more difficult than anticipated to adhere to in the work environment.* The built environment of hospitals (physical layout) and working in multidisciplinary teams made social distancing particularly challenging for nurses and midwives. [ABSTRACT FROM AUTHOR]

Objective: This study explored healthcare workers' experiences of transitioning infusions of natalizumab from hospital to a patient-centred model of home care. Background: Hospital in the home is one of the fastest growing healthcare delivery models. In Australia, intravenous infusions are rarely available at home for chronic disease patients, such as those with multiple sclerosis. A recent trial of natalizumab infusions at home for patients with multiple sclerosis required both the hospital and hospital in the home staff to consider the logistics of how this transition could be achieved safely. Study design and methods: This was a qualitative study using an exploratory-descriptive approach. Twelve participants from two main groups of healthcare workers participated in delivering natalizumab infusions during the six-month trial period and were subsequently interviewed about their experience. Participants were recruited from a hospital ambulatory care day unit and a Home Infusion Team from a private provider of home nursing care located in South Australia. The data was analysed thematically. Results: Three main themes were identified from the interviews: 'preparing for change', 'focussing on the patient', and 'enhancing professional support and relationships'. These findings demonstrated the importance of understanding healthcare workers' experiences of transitioning to a patient-centred model of care, from hospital to home infusion of natalizumab. Discussion: Flexibility and good management of logistics is necessary to maintain the standards of the health services, which highlights the need for training and professional support to facilitate quality home care. This may enhance workers' sense of professional confidence and trust and reduce stress when delivering the home model of care. Conclusion: Healthcare workers and patients worked to support one another, not only therapeutically but also logistically within collegial relationship and interdependent communications. Being flexible, communicating clearly and being willing to work together within the team, especially between the hospital in the home staff and the hospital staff, was demonstrated to be an important factor for the safe delivery of infusions at home. Managing the logistics of delivering a flexible and safe home therapy service was an important part of this model of care. Implications for research, policy, and practice: The results of this study will be used to inform healthcare teams about the key logistical components that are important for healthcare services, when considering transitioning to a home-based model of care for treating people with relapsing-remitting multiple sclerosis. What is already known about the topic? * Although outpatient infusion programs are often hospital based, they may be run by regional health authorities or private organisations, such as a hospital in the home service. * Healthcare workers delivering a hospital in the home service require advanced knowledge and skill in order to deliver quality care. What this paper adds: * The development of a comprehensive logistical process, which has the patient at the centre of the model of care, enabled natalizumab to be delivered safely in the community by healthcare workers. * Being flexible, communicating clearly and being willing to work together within the team, especially between the hospital in the home staff and the hospital staff, was demonstrated to be an important factor for the safe delivery of infusions at home [ABSTRACT FROM AUTHOR]