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Background. Exclusive breastfeeding provides complete nutrition for a baby's first six months of life. However, the majority of Australian infants are not exclusively breastfed for this length of time. Although numerous strategies have been implemented to increase rates of exclusive breastfeeding, Australian statistics remain low. Furthermore, most breastfeeding research has focused on why women cease breastfeeding in the early postnatal period (from birth to two months), yet limited research focuses on the experience of exclusive breastfeeding between two and six months, where the greatest decline occurs. Aim. To provide an in-depth, idiographic interpretation of the experiences of first-time Australian mothers who intended to exclusively breastfeed for six months, but ceased between two and six months. Methods. The study utilised interpretative phenomenological analysis (IPA) to understand how five new mothers understood their breastfeeding journeys. Data were collected through face-to-face semi-structured interviews. Data were transcribed in full and analysed using IPA's flexible seven-step approach. This research was approved by the women's and children's health network human research ethics committee (HREC) (HREC/MWCHN/008) and the University of South Australia HREC (0000031997) in early 2014. Findings. Three higher-order themes were identified: 1) the exclusive breastfeeding journey, 2) the challenge of breastfeeding exclusively, 3) breastfeeding in the 21st century. The mothers intended to exclusively breastfeed for six months. While they overcame many physical difficulties associated with breastfeeding, it was ultimately social complexities that provided the greatest challenges and influenced their decisions to cease exclusive breastfeeding. These included the introduction of solid foods before the recommended time of six months, and the perceived disapproval of breastfeeding in public. Noticing many differences in opinions and recommendations regarding breastfeeding, the mothers began to desire autonomy in their mothering, describing public comments and opinions as unwanted and judgemental. Conclusion. This qualitative reflection contributes a nuanced understanding of the breastfeeding journey between two and six months, deepening our understanding and enabling the development of appropriate strategies and support for increasing the duration of exclusive breastfeeding, as well as direction for continued research. [ABSTRACT FROM AUTHOR]

Background: Interest in the influence of culture on birth practices is on the rise, and with it comes a sense of urgency to implement practices that aid the normalisation and humanisation of birth. This groundswell is occurring despite a broader cultural milieu of escalating technology-use and medicalisation of birth across the globe. Against this background, rates of epidural analgesia use by women in labour are increasing, despite the risk of side effects. Socio-cultural norms and beliefs are likely to influence pain relief choices but there is currently scant research on this topic.Methods: This study was undertaken to gain insight into the personal, social, cultural and institutional influences on women in deciding whether or not to use epidural analgesia in labour. The study had an ethnographic approach within a theoretical framework of Critical Medical Anthropology (CMA), Foucauldian and feminist theory. Given the nature of ethnographic research, it was assumed that using the subject of epidural analgesia to gain insight into Western birth practices could illuminate broader cultural ideals and that the epidural itself may not remain the focus of the research.Results: Findings from the study showed how institutional surveillance, symbolised by the Journey Board led to an institutional momentum that in its attempt to keep women safe actually introduced new areas of risk, a situation which we named the Paradox of the institution.Conclusions: These findings, showing a risk/safety paradox at the centre of institutionalised birth, add a qualitative dimension to the growing number of quantitative studies asserting that acute medical settings can be detrimental to normal birth practices and outcomes. [ABSTRACT FROM AUTHOR]

Selecting the most appropriate methodology for research as a doctoral student is one of the most important yet difficult decisions. Not only should the methodology suit the research question, it is important that it resonates with the philosophy of one's discipline and produces needed results that will contribute to knowledge. Interpretative phenomenological analysis (IPA) is an approach to qualitative enquiry. IPA seeks to explore how individuals make sense of their major life experiences and is committed to the detailed study of each particular case before moving to broader claims. In the field of midwifery, midwives work with women throughout pregnancy, childbirth and the early postnatal period, offering individualized care based on the unique needs of each woman. IPA aligns with this women-centered philosophy as it offers a methodological approach that considers the individual in a local context. By capturing context specific situations, IPA allows broad-based knowledge to be contextualized within a social and cultural context, producing relevant findings. Thus the access to IPA studies will enable midwives to better care for women and their families through understanding the experiences and perceptions of those in their scope of practice. This paper presents the theoretical framework leading to practical guidelines on how to conduct a doctoral-level IPA study, as experienced by the first author. It also addresses the advantages and challenges around utilizing IPA, illustrated through examples from the doctoral student's study on the journey of exclusive breastfeeding in Australia. [ABSTRACT FROM AUTHOR]

In this article, we discuss the principal difficulties in gaining ethics approval for an ethnographic midwifery doctoral research project in a hospital setting in South Australia. The research focus is on the various personal, social, institutional and cultural influences on women making a choice about whether or not to use epidural analgesia in labour. The obstacles encountered in gaining human research ethics committee (HREC) approval are discussed within the wider context of the benefits of ethnography as a research methodology, as well as the potential consequences to ethnography when assessed by quantitative research standards. By sharing our experience, we add to the current literature debating the “ethics” of ethics committee review in qualitative research approval. Engaging with the academic debate surrounding “ethics creep” – the increasing jurisdiction of ethics committees over research design – we consider the possibility of moving beyond principle-based ethics towards an ethical theory that more fully addresses the complexities of ethnographic research. [ABSTRACT FROM AUTHOR]

Background The Baby Friendly Hospital Initiative (BFHI) influences health care practices and increases the initiation and duration of exclusive breastfeeding. Consistent definitions enable the accurate monitoring of breastfeeding rates and behaviour. This information refines policy and helps reach national breastfeeding targets. Only 21% (66/317) of Australian hospitals are BFHI accredited. Objective To examine the factors perceived to promote or hinder BFHI accreditation. Method Focus group interviews explored opinions of 31 participants, in differing roles and levels of employment, across midwifery, medical, nursing and ancillary staff at six South Australian maternity hospitals. Results The results suggest that staffs' understanding and personal views are often discordant with BFHI aims. Perceived difficulties include the accreditation process, hospital dynamics, and the Ten Steps implementation plus a bottle feeding culture and maternal employment that impact upon continued breastfeeding. Conclusions Upper management support, specific funding, a dedicated co-ordinator with 'area leaders', development of a specific breastfeeding policy incorporating various disciplines and staff, containing detailed protocols that comply with the International Code of Marketing of Breast Milk Substitutes and subsequent World Health Assembly (WHA) resolutions, are all required. Staff and mothers require multiple modes of education to understand the BFHI, including sponsorship for training of lactation consultants. Full implementation of BFHI across Australia will assist the development of nationally accepted breastfeeding definitions, improve monitoring and evaluation of rates and practices, and improve breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

The objective of this study was to discuss ideas for improving child health services on the basis of findings of an observational study that was designed to explore the role of child health nurses in supporting parents during the first 6 months following the birth of an infant. As part of a larger study in a child health service in urban Australia, surveys were used to collect data from two independent samples of both parents and nurses at an 8-month interval. Data were condensed using factor analysis; regression analyses were used to determine which aspects of care were most important for the parents, and importance-performance analysis was used to determine which aspects of care needed improvement. While the majority of parents valued support from child health nurses, a need for improvement was identified in empowering parents to make their own decisions, discussing emotional issues with parents, providing continuity of care and giving consistent advice. Organisations should value and provide support for child health nurses in their invisible, non-quantifiable work of supporting families. The structure of child health services should also provide child health nurses continuity of care with the families they support. [ABSTRACT FROM AUTHOR]

The article discusses a study that examines the relationship between mood change and workload of midwives in Australia. The researchers investigate 20 midwives in a metropolitan hospital regarding their daily fluctuations in subjective mood and workload. Study reveals that mood change influenced the safety, performance and psychological wellbeing of the midwives.

The history of the relationship between complementary medicine (CM) and mainstream health care has shifted from the early days of pluralism, through hostility and exclusion, to one of grudging acceptance. The current situation is one of a tacit acknowledgement and in some cases open endorsement by biomedicine for a number of forms of CM practice, largely driven by the popularity of CM to consumers in our increasingly market driven health care system. How this relationship is ultimately worked out will impact both on the practice of CM and biomedicine, and on the health care choices available to consumers. In this article we review the research and commentary literature on the current and emerging relationship between biomedicine and CM. In particular we explore the ways in which mainstream inclusion of CM is discussed in the literature, and the biomedical and CM perspectives of mainstream CM inclusion. Finally we discuss the implications of the emerging relationship for CM, and CM practitioners and consumers. [ABSTRACT FROM AUTHOR]

The transition to parenthood is a major life event and may be one of the most acute changes experienced during a person's life. Nevertheless, many parents find themselves unprepared for their parenting role. It has been found that a positive experience throughout the period of transition to parenthood contributes to the parent's confidence and ability to master new roles, highlighting the need to develop innovative strategies which support parents through the transitional period. This article introduces one such strategy, a postnatal planner entitled 'Coming ready or not!' developed from an action research study designed to develop, implement, and evaluate strategies to improve postnatal education for parents. Using the antenatal period to address postnatal concerns must be considered. [ABSTRACT FROM AUTHOR]

Since the 1970s, men have been encouraged to actively participate in the childbirth process, resulting in a shared experience for couples. Nevertheless, after the baby is born, many fathers find themselves displaced, unsure of how to embrace the transition to parenthood. The shift in cultural practice and evolving needs of families calls for the recognition of fathers as well as mothers in the provision of midwifery services. Innovative strategies must be considered to enhance postnatal education that is father-inclusive and responsive to the needs of families in the 21st century. This article introduces one strategy created from an action research study conducted to develop, implement, and evaluate strategies to improve postnatal education for parents. [ABSTRACT FROM AUTHOR]

Midwifery education in Australia has embraced competency-based learning models where assessment of clinical competency is fundamental to educational programmes. Both clinical and theoretical components of the programme need to be fulfilled and passed in order to register as a midwife. Concerns have been raised regarding competency-based approaches to midwifery education which may not incorporate national competency standards and, in particular, minimum clinical requirements for registration. It is the purpose of this paper to present the findings from a delphi study which aimed to gain consensus from experts regarding the appropriateness of using minimum requirements of birth and follow-through experiences for registration purposes in Australia. The delphi is stage two of a research project. Stage one involved a systematic review of literature to establish the evidence for measuring competency in midwifery practice using minimal requirements of stated clinical experience for registration purposes. The findings from this review concluded that no specific evidence exists for measuring competency in midwifery practice using minimum requirements of stated clinical experience for registration purposes. The results of the delphi indicate that there is consensus that prescriptive criteria should be incorporated to measure competence in midwifery students for registration purposes. Nevertheless, a number of significant issues were raised with regards to achieving minimum requirements in practice. [ABSTRACT FROM AUTHOR]

Over several decades, national competency standards have been developed In Australia to define competence for midwives. Furthermore, national standards for the accreditation of the three year, Bachelor of Midwifery programme have been developed. Each standard has associated evaluative criteria such as minimum clinical requirements to determine if the standard has been met. Concerns have been raised regarding competency based approaches to midwifery education which may not incorporate national competency standards and, in particular, minimum clinical requirements for registration. Philosophically there has been a move by many of the registering bodies In Australia from competency based standards to a more prescriptive approach. For example, midwifery graduates seeking to register as a midwife are now required to demonstrate substantial birthing experience as a pre-requisite for registration. However, the current number of births required for registration purposes Is unsupported by evidence and appears to be based on custom and tradition. It is essential that any midwifery practice requirements are based on evidence based research in order for the profession to be guided by evidence based outcomes. It is the purpose of this paper to present a systematic review of the evidence for incorporating minimum clinical requirements as an appropriate assessment criterion for registration. [ABSTRACT FROM AUTHOR]

The frequency and severity of adverse events in Australian healthcare is under increasing scrutiny. A recent state government report identified 31 events involving “death or serious [patient] harm” and 452 “very high risk” incidents. Australia‐wide, a previous study identified 2,324 adverse medical events (AME) in a single year, with more than half considered preventable. Despite the recognized link between fatigue and error in other industries, to date, few studies of medical errors have assessed the fatigue of the healthcare professionals involved. Nurses work extended and unpredictable hours with a lack of regular breaks and are therefore likely to experience elevated fatigue. Currently, there is very little available information on Australian nurses' sleep or fatigue levels, nor is there any information about whether this affects their performance. This study therefore aims to examine work hours, sleep, fatigue and error occurrence in Australian nurses. Using logbooks, 23 full‐time nurses in a metropolitan hospital completed daily recordings for one month (644 days, 377 shifts) of their scheduled and actual work hours, sleep length and quality, sleepiness, and fatigue levels. Frequency and type of nursing errors, near errors, and observed errors (made by others) were recorded. Nurses reported struggling to remain awake during 36% of shifts. Moderate to high levels of stress, physical exhaustion, and mental exhaustion were reported on 23%, 40%, and 36% of shifts, respectively. Extreme drowsiness while driving or cycling home was reported on 45 occasions (11.5%), with three reports of near accidents. Overall, 20 errors, 13 near errors, and 22 observed errors were reported. The perceived potential consequences for the majority of errors were minor; however, 11 errors were associated with moderate and four with potentially severe consequences. Nurses reported that they had trouble falling asleep on 26.8% of days, had frequent arousals on 34.0% of days, and that work‐related concerns were either partially or fully responsible for their sleep disruption on 12.5% of occasions. Fourteen out of the 23 nurses reported using a sleep aid. The most commonly reported sleep aids were prescription medications (62.7%), followed by alcohol (26.9%). Total sleep duration was significantly shorter on workdays than days off (p<0.01). In comparison to other workdays, sleep was significantly shorter on days when an error (p<0.05) or a near error (p<0.01) was recorded. In contrast, sleep was higher on workdays when someone else's error was recorded (p=0.08). Logistic regression analysis indicated that sleep duration was a significant predictor of error occurrence (χ2=6.739, p=0.009, eβ=0.727). The findings of this pilot study suggest that Australian nurses experience sleepiness and related physical symptoms at work and during their trip home. Further, a measurable number of errors occur of various types and severity. Less sleep may lead to the increased likelihood of making an error, and importantly, the decreased likelihood of catching someone else's error. These pilot results suggest that further investigation into the effects of sleep loss in nursing may be necessary for patient safety from an individual nurse perspective and from a healthcare team perspective. [ABSTRACT FROM AUTHOR]

Focuses on an academic's experience of gaining midwifery clinical teaching privileges at a major maternity hospital in South Australia. Requirements for midwifery practice; Duty of care and legal responsibilities.

Background: Although lactation experts suggest that a correct positioning and attachment technique reduces breastfeeding problems and enhances long-term breastfeeding, evidence from randomized trials is lacking. The objective of this study was to evaluate the effect of postpartum positioning and attachment education on breastfeeding outcomes in first-time mothers. Method: A randomized trial was performed in a public hospital in Adelaide, South Australia, where 160 first-time mothers were randomly allocated to receive either structured one-to-one education (experimental group) or usual postpartum care (control group) within 24 hours of birth. The primary outcome was breastfeeding at 6 weeks and 3 and 6 months postpartum; other outcomes were nipple pain and trauma in hospital and at 6 weeks and 3 and 6 months, and satisfaction with breastfeeding. Results: No significant differences occurred in breastfeeding rates between the groups at each endpoint, although a trend in the direction of lower rates was seen at each endpoint in the experimental group. This group reported less nipple pain on days 2 (p = 0.004) and 3 (p = 0.04), but this was not sustained on follow-up. No differences were observed in nipple trauma in hospital or in self-reported nipple pain and/or trauma at the three endpoints. Experimental group women were less satisfied with breastfeeding at 3 and 6 months postpartum when using a one-item measure; however, a multiple-item measure showed no significant differences at the three endpoints. Conclusions: The intervention did not increase breastfeeding duration at any assessment time or demonstrate any differences between the groups on secondary outcomes. The trend toward lower breastfeeding rates in the experimental group suggests a need for a larger trial to evaluate whether or nor postpartum positioning and attachment education may negatively affect breastfeeding. [ABSTRACT FROM AUTHOR]

This paper reports on the results of an Australian community-based palliative care research project which investigated and compared the effectiveness of existing support systems for paid (community nurses) and unpaid (primary carers) care givers in a regional health care center in New South Wales, Australia. In particular it looked at the needs, concerns, effects, and perceived adequacy of support system on carers.Methodology employed in the study relied on both qualitative and quantitative methods. Qualitative data was obtained by using a questionnaire which obtained demographic data about the carers. In addition, a series of taped open-ended questions were posed to the carers on the impact and experience of caring for the terminally ill. Taped interviews were analyzed using content analysis and elicitation of themes.Qualitative techniques utilized the Inventory of Socially Supportive Behaviors (ISSB). Examination of data collected using simple frequencies and percentages allowed cross examination of paid care givers and the questionnaire was used to assess perceived support of both sets of participants. A Wilcoxan Signed Rank non- [ABSTRACT FROM PUBLISHER]

Explores the evaluation of the clinical performance of nursing students at the University of Wollongong in New South Wales. Existence of problems inherent in the development of a valid, objective and time-efficient method; Expectation on the demonstration of competency by the students; Enhancement of student learning.