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The primary cause of maternal and fetal mortality due to hypertensive disorders in pregnancy is delays in accessing healthcare services. These delays are often attributed to insufficient knowledge, attitudes at the time of diagnosis, and a lack of awareness regarding the condition, including its critical warning signs and symptoms. To evaluate pregnant women's initial knowledge and attitudes upon receiving their first diagnosis of hypertensive disorders of pregnancy. A cross-sectional quantitative design was used to assess the knowledge and views of 216 expectant mothers on hypertensive disorders of pregnancy (HDP) across three high-risk clinics in Brunei Darussalam. Participants were selected through convenience sampling. Data were collected using a bilingual self-administered questionnaire, adapted from a validated instrument. Descriptive statistics and inferential analyses, including t -tests, One-Way ANOVA, and multiple regression, were conducted using SPSS (Version 23). Among 216 participants, 69 % demonstrated good knowledge of hypertensive disorders during pregnancy (p < 0.001). Despite positive attitudes towards seeking medical help (p < 0.001), 69 % initially opted for home remedies, and 50 % avoided hospitals unless necessary, leading to delays in healthcare-seeking behaviour. The findings highlight the need for targeted health campaigns to bridge the gap between knowledge and practice, ensuring timely medical intervention for hypertensive disorders during pregnancy. The study reveals significant knowledge gaps and attitudes contributing to delayed healthcare-seeking behaviours. Targeted health campaigns and culturally sensitive educational programs are essential to improve timely medical interventions and maternal outcomes in Brunei Darussalam. [ABSTRACT FROM AUTHOR]

Background: Workplace violence (WPV) remains an international problem. This raises challenges for staff in meeting their duty of care to consumers while enforcing zero tolerance for violence directed toward them. Purpose: The aim of the study was to expose the values and beliefs underpinning practice and reveal any flawed assumptions or evidence, upon which decisions related to WPV are made. By increasing staff awareness, the secondary aim is to decrease staff stress when confronted with conflicting policies and duty of care responsibilities. Methodology: Explanatory research as part of a larger descriptive study was used. Semistructured interviews with a sample of managers and staff (n = 99) in Victorian Health Services (Australia) were performed. Initial descriptive analysis identified a tension between duty of care, worker safety, and zero tolerance. This article reports the secondary analysis to examine these relationships in depth. Findings: Feeling obligated and providing care for aggressive patients was difficult while maintaining own safety: "You cannot do both." Although there were contrasting views about the merits of zero tolerance, policies were rarely enacted: "We cannot refuse to treat." In congruency between legislative requirements creates confusion for decision-making: "Which Act trumps what?" Conclusion: Despite policies supporting zero tolerance, staff do not enact these because they prioritize duty of care to consumers before duty of care to self. Zero tolerance, with incongruent legislation, compounds this tension and impairs decision-making. [ABSTRACT FROM AUTHOR]

Abstract Aims To examine the neurobiological response experienced by healthcare workers when exposed to workplace violence perpetrated by consumers, with a view to informing future training and self-care strategies for staff well-being. Background Considerable work has been undertaken internationally to identify the causes of workplace violence and to develop legislation and guidance for reducing the risk in healthcare. However, there is a gap in understanding workers' innate neurobiological response to workplace violence, and how to prepare staff to recognise the professional and self-care implications of such a response. Design This explanatory study was part of a larger descriptive study. Methods Individual and group interviews were conducted with managers, directors, health/safety staff, nurses and educators (n = 99) from rural and metropolitan health services in Australia. Inductive thematic analysis was conducted, followed by in depth analysis to answer the question: what neurobiological response could be occurring when healthcare workers experience workplace violence? The analytical framework was informed by polyvagal theory. Results With the increased risk of threat to physical and personal safety in the workplace, healthcare workers may experience activation of the fight, flight or freeze response, affecting their wellbeing and performance at work and at home. Participants recognised a need to care for themselves and understand their own reactions, so that they could better address the needs of consumers. Conclusions Education for health care workers should include knowledge of the neurobiological responses to threat, and techniques to increase their capacity to identify, and manage their responses. An understanding of trauma-informed care for staff, will enable them to recognise the cumulative effects of workplace violence, and identify strategies to manage their well-being. Relevance to clinical practice Information about the body's neurobiological response to stressors that threaten physiological and psychological safety can assist healthcare providers to better understand how to respond to workplace violence and aggression. Highlights • Workplace violence against healthcare staff continues to increase. • Threat to safety may result in activation of fight/flight/freeze responses in staff. • Cumulative fight/flight/freeze responses affect wellbeing and performance. • Understanding neurobiological responses assists staff managing workplace violence. • Healthcare staff need to implement self-care strategies daily. [ABSTRACT FROM AUTHOR]

Setting: The study setting is a tertiary referral hospital of over 980 beds, in Victoria, Australia. The hospital is a long established major academic public health service providing healthcare, health professional education and health research. The hospital has 103,756 in-patient admissions, 190,756 outpatient attendances and over 82,000 presentations to the Emergency Department annually.Participants: 22 clinicians completed an in-depth, audio-recorded interview: 12 medical and 10 nursing staff, with a variety of clinical experience.Intervention(s): Each audio recorded interview was transcribed verbatim for thematic analysis. The semi structured questions were designed to explore the clinician's understanding of deaths that meet the criteria to be reported to Coroners Court of Victoria (CCOV), and why such reporting was required. There was also the opportunity to identify any barriers or enablers to the reporting process, whether internal or external to the organisation.Results: Two main themes emerged from the interviews: 1. lack of awareness of which deaths are reportable to the coroner and 2. the need for educational support. Several subthemes were also identified such as accountability, the need for feedback and blame.Discussion: The understanding of clinicians as to which deaths meet the reportable criteria in healthcare is quite variable and this indicates that there might be a level of under reporting. Apart from the potential of not meeting legal obligations, there may also be the loss of a valuable opportunity for lessons to inform clinical practice and enhance the delivery of safe patient care. [ABSTRACT FROM AUTHOR]

Background Integrating evidence-based practice (EBP) into undergraduate education and preparing future nurses to embrace EBP in clinical practice becomes paramount in today's complex and evolving healthcare environment. The role that EBP plays in the practical lives of nursing students will depend on the degree to which it is promoted by academics, how it is incorporated into courses and its application to clinical setting. Hence, nursing academics play a crucial role in influencing its integration into curricula. Drawn from a larger doctoral study, this paper presents findings discussing how nurse academics value and engage with EBP. Methods Grounded theory was employed to explore processes used by nursing academics while incorporating EBP into teaching and learning practices. Twenty-three academics across Australian universities were interviewed. Nine were also observed while teaching undergraduate students. Data were collected from semi-structured interviews and non-participant observation. In keeping with the tenets of grounded theory, data collection and analysis continued until theoretical saturation was reached. In total, four categories emerged. This paper focuses on the category conceptualised as Valuing and Engaging with EBP . Results How nursing academics valued and engaged with EBP was closely associated with meanings they constructed around understanding it, attitudes and commitment to implementation while teaching and working clinically. Different opinions also existed in regard to what actually constituted EBP. However, they engaged with and valued EBP by keeping themselves up-to-date, being involved in research activities, using evidence in teaching, therefore leading by example. Participants identified a number of barriers influencing their engagement with EBP including heavy workloads, limited time, lack of commitment within their schools, lack of confidence with teaching EBP, and complexity of EBP application. Faculty clinical practice, committed academics, workload management and continuing education were highlighted as facilitators. Conclusion A number of barriers prevented academics from fully engaging with EBP at academic or practice levels. Academic institutions and practice settings need to employ strategic planning to overcome such barriers. [ABSTRACT FROM AUTHOR]

Background Many pregnant women use complementary and alternative medicine. Although midwives are often supportive, how they communicate with women about the safe use of these therapies has received limited research attention. Aim The aim of this study was to explore how midwives interact with women regarding use of complementary and alternative medicine during pregnancy. Methods We utilised grounded theory methodology to collect and analyse data. Twenty-five midwives who worked in metropolitan hospitals situated in Melbourne, Australia, participated in the study. Data were collected from semi structured interviews and non-participant observations, over an 18-month period. Findings How midwives communicate about complementary and alternative medicine is closely associated with the meaning they construct around the woman's role in decisionmaking. Most aim to work in a manner consistent with the midwifery partnership model and share the responsibility for decisions regarding complementary and alternative medicine. However, although various therapies were commonly discussed, usually the pregnant woman initiated the dialogue. A number of contextual conditions such as the biomedical discourse, lack of knowledge, language barriers and workplace constraints, limited communication in some situations. Conclusion Midwives often interact with women interested in using CAM. Most value the woman's autonomy and aim to work in partnership. However, various contextual conditions restrain overt CAM communication in clinical practice. [ABSTRACT FROM AUTHOR]

Background Increasing numbers of residents are transferred from aged care facilities to emergency departments. Frequently, residents arrive with inadequate documentation regarding their presenting complaint or medical history, making it difficult for emergency department staff to make decisions about care. Methods A retrospective review of emergency department records was undertaken for residents transferred from residential aged care facilities to two emergency departments in Melbourne, Victoria in 2012. Results 2880 resident transfers were included in the sample, of which 408 transfers were randomly selected for documentation review. Clinically important documentation was frequently absent including: the reason for transfer to the ED (n = 197, 48.2%); baseline cognitive function (n = 244, 59.7%); and vital signs at time of complaint (n = 285, 69.9%). When the reason for transfer was absent, residents with an altered conscious state had more investigations and spent longer in the emergency department than when the reason for transfer was recorded. Conclusion Inadequate documentation negatively impacted the resident's journey through the emergency department. There is evidence that inadequate documentation contributes to poor patient outcomes. To minimise the gaps in the transfer documentation regular staff development and quality assurance programs may be required in residential aged care facilities. [ABSTRACT FROM AUTHOR]

Objective: this paper presents the findings from a qualitative study that aimed to explain the processes midwives engaged in when considering the use of complementary and alternative medicine by pregnant women. Design: grounded theory methodology was employed for the study. Data was generated from in-depth interviews and non-participant observation of midwives interacting with expectant mothers. Twenty-five midwives who worked in four hospitals and associated community clinics in Victoria, Australia, participated. Findings: the theory 'Navigating a safe path together' offers a possible explanation of how midwives are responding. When working with women interested in the use of complementary and alternative medicine, midwives move through an iterative process of individualising pregnancy care, encountering diverse perspectives and minimising the risks associated with childbearing. Key conclusion: at the heart of the theory is the meaning midwives' construct around safe childbirth and their professional roles. Despite widespread support for the therapies, midwives' actions in clinical practice are mediated by a number of factors including the context of their professional work, their beliefs and knowledge, and the woman's expectation and health. Implications for practice: the research highlights the need for improved education and greater professional guidance to equip midwives to respond with greater understanding, and confidence to the increasing prevalence of CAM in the maternity setting. [ABSTRACT FROM AUTHOR]

The article focuses on the denial of medical care or treatment by patients in a clinical environment and how medical practitioners and nurses respond to the refusal of active treatment. Topics include the limits of patient autonomy, the right to self-determination in relation to medical care, and the patient's knowledge of consent laws.

Background Increasing numbers of residents are transferred from aged care facilities to emergency departments. Frequently, residents arrive with inadequate documentation regarding their presenting complaint or medical history, making it difficult for emergency department staff to make decisions about care. Methods A retrospective review of emergency department records was undertaken for residents transferred from residential aged care facilities to two emergency departments in Melbourne, Victoria in 2012. Results 2880 resident transfers were included in the sample, of which 408 transfers were randomly selected for documentation review. Clinically important documentation was frequently absent including: the reason for transfer to the ED (n = 197, 48.2%); baseline cognitive function (n = 244, 59.7%); and vital signs at time of complaint (n = 285, 69.9%). When the reason for transfer was absent, residents with an altered conscious state had more investigations and spent longer in the emergency department than when the reason for transfer was recorded. Conclusion Inadequate documentation negatively impacted the resident's journey through the emergency department. There is evidence that inadequate documentation contributes to poor patient outcomes. To minimise the gaps in the transfer documentation regular staff development and quality assurance programs may be required in residential aged care facilities. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Research indicates that many midwives support the use of complementary and alternative medicine to manage the normal challenges of pregnancy and birth. However, midwives’ responses involve highly complex processes and assuming that their positive views will translate into advocacy of the therapies in practice fails to appreciate the impact of contextual conditions. Methodology: Grounded theory was employed to explore the personal, social and structural factors that influence midwives’ behaviour and attitudes towards the use of complementary and alternative medicine. Twenty-five midwives who were employed in metropolitan hospitals situated in Victoria, Australia, participated in the study. Data was collected from semi structured interviews and non participant observation of a subgroup, over an 18-month period in 2010–2011. Results: Contextual conditions exert a powerful influence on midwives’ behaviour towards complementary and alternative medicine. The most significant factors identified in our study include the context of professional work, the midwife''s beliefs and knowledge, and the woman''s expectations and health. Conclusions: Midwives’ professional behaviour regarding complementary and alternative medicine is the result of the complex interface of opposing factors. While many assert that the use of complementary therapies is congruent with their professional philosophy and there is a strong demand from women, integration into clinical practice remains limited in the Australian maternity setting. [Copyright &y& Elsevier]

Abstract: Background: Midwives commonly endorse the use of complementary medicine. However many work in hospitals where there can be significant opposition to use of these therapies. This paper describes how one group of midwives negotiated the conflicting perspectives. Method: Grounded theory was employed. Twenty five participants were recruited from metropolitan hospitals in Australia. Data was collected from interviews and observations. Results: Midwives'' behaviour was influenced by the meaning they constructed around their professional role and authority. Some emphasised ideological congruence, historical ties, and the ability of certain complementary therapies to reduce medical interventions, in order to legitimise their use. However, many were aware of biomedical opposition and undertook various strategies to protect themselves from conflict. Conclusions: Conflict regarding the use of complementary and alternative medicine is context specific. In some situations midwives can successfully negotiate the competing perspectives and expectations, while at other times they struggle to reconcile the disparities. [Copyright &y& Elsevier]

Summary: Background: Induction of labour is a common obstetric procedure. Some women are likely to turn to complementary and alternative medicine in order to avoid medical intervention. Aim: The aim of this paper is to examine the scientific evidence for the use of complementary and alternative medicine to stimulate labour. Method: An initial search for relevant literature published from 2000 was undertaken using a range of databases. Articles were also identified by examining bibliographies. Results: Most complementary and alternative medicines used for induction of labour are recommended on the basis of traditional knowledge, rather than scientific research. Currently, the clinical evidence is sparse and it is not possible to make firm conclusions regarding the effectiveness of these therapies. There is however some data to support the use of breast stimulation for induction of labour. Acupuncture and raspberry leaf may also be beneficial. Castor oil and evening primrose oil might not be effective and possibly increase the incidence of complications. There is no evidence from clinical trails to support homeopathy however, some women have found these remedies helpful. Blue cohosh may be harmful during pregnancy and should not be recommended for induction. Other complementary and alternative medicine (CAM) therapies may be useful but further investigation is needed. Conclusions: More research is needed to establish the safety and efficacy of CAM modalities. Midwives should develop a good understanding of these therapies, including both the benefits and risks, so they can assist women to make appropriate decisions. [Copyright &y& Elsevier]

Summary: Objective: There is evidence that the use of Complementary and Alternative Medicine by childbearing women is becoming increasingly popular in industrialised countries. The aim of this is paper is to review the research literature investigating the midwives’ support for the use of these therapies. Method: A search for relevant research published from 2000 to 2009 was undertaken using a range of databases and by examining relevant bibliographies. A total of thirteen studies were selected for inclusion in this review. Results: The findings indicate that the use of Complementary and Alternative Medicine is widespread in midwifery practice. Common indications for use include; labour induction and augmentation, nausea and vomiting, relaxation, back pain, anaemia, mal-presentation, perineal discomfort, postnatal depression and lactation problems. The most popular therapies recommended by midwives are massage therapy, herbal medicines, relaxation techniques, nutritional supplements, aromatherapy, homeopathy and acupuncture. Midwives support the use Complementary and Alternative Medicine because they believe it is philosophically congruent; it provides safe alternatives to medical interventions; it supports the woman''s autonomy, and; incorporating Complementary and Alternative Medicine can enhance their own professional autonomy. Conclusions: There is considerable support by midwives for the use of Complementary and Alternative Medicine by expectant women. Despite this enthusiasm, currently there are few educational opportunities and only limited research evidence regarding CAM use in midwifery practice. These shortfalls need to be addressed by the profession. Midwives are encouraged to have an open dialogue with childbearing women, to document use and to base any advice on the best available evidence. [ABSTRACT FROM AUTHOR]

Summary: Objective: There is evidence that the use of Complementary and Alternative Medicine by childbearing women is becoming increasingly popular in industrialised countries. The aim of this is paper is to review the research literature investigating the midwives’ support for the use of these therapies. Method: A search for relevant research published from 2000 to 2009 was undertaken using a range of databases and by examining relevant bibliographies. A total of thirteen studies were selected for inclusion in this review. Results: The findings indicate that the use of Complementary and Alternative Medicine is widespread in midwifery practice. Common indications for use include; labour induction and augmentation, nausea and vomiting, relaxation, back pain, anaemia, mal-presentation, perineal discomfort, postnatal depression and lactation problems. The most popular therapies recommended by midwives are massage therapy, herbal medicines, relaxation techniques, nutritional supplements, aromatherapy, homeopathy and acupuncture. Midwives support the use Complementary and Alternative Medicine because they believe it is philosophically congruent; it provides safe alternatives to medical interventions; it supports the woman''s autonomy, and; incorporating Complementary and Alternative Medicine can enhance their own professional autonomy. Conclusions: There is considerable support by midwives for the use of Complementary and Alternative Medicine by expectant women. Despite this enthusiasm, currently there are few educational opportunities and only limited research evidence regarding CAM use in midwifery practice. These shortfalls need to be addressed by the profession. Midwives are encouraged to have an open dialogue with childbearing women, to document use and to base any advice on the best available evidence. [Copyright &y& Elsevier]

Abstract: Background: the use of complementary and alternative medicine (CAM) has become increasingly prevalent in industrialised countries, with women being the most prolific users. Some women continue to consume these therapies when they become pregnant. Aim: to review the literature exploring prevalence and motivation for use of complementary and alternative medicine by pregnant women. Method: a search for relevant literature published from 2001 was undertaken using a range of databases and by examining relevant bibliographies. Results: although the estimates vary widely from 1% to 87%, the general trend indicates that a significant number of pregnant women use complementary and alternative medicine. Common modalities used include massage, vitamin and mineral supplements, herbal medicine, relaxation therapies and aromatherapy. Reasons for use are varied and include the belief that these therapies offer safe alternatives to pharmaceuticals, they allow greater choice and control over the childbearing experiences, and they are congruent with their holistic health beliefs. The influence of traditional cultural practices on the use of these therapies is unclear. Most expectant women rely on advice from family and friends, and many do not disclose their use to their pregnancy care providers. Conclusions: many women use complementary and alternative medicine when they are pregnant. Further research is needed to gain a greater understanding of the true prevalence and expectant women’s motivation for the use of complementary and alternative medicine. Health-care professionals are encouraged to ask women about their use of these treatments and seek out relevant information. [Copyright &y& Elsevier]

Abstract: Background: The use of complementary and alternative medicine during pregnancy has become increasingly popular over the past decade in Australia. Aim: The purpose of this discussion paper to make recommendations and foster a constructive debate regarding the appropriate response by the midwifery profession. Discussion: Midwives should receive basic education regarding the use of complementary and alternative medicine. All women should be routinely question women about their use and this should be documented. While a few therapies could be safely integrated, in most situations interested women should be referred to a qualified practitioner. Referral frameworks and flexible clinical guidelines should be investigated. Conclusion: With the appropriate education and support, midwives are in an excellent position to engage women in open dialogue and raise awareness of the benefits and risks of CAM practices. The way forwards for midwifery profession is to focus on self-governance, education and flexible clinical guidelines. [Copyright &y& Elsevier]