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Refereed/Peer-reviewed Background: Integral to quality midwifery practice is the education of midwives. Like other countries, Australia faces ongoing challenges in delivering midwifery education programs. Reasons include escalating program costs, challenges in securing meaningful clinical experiences, subsumption of midwifery with nursing, and associated loss of identity in some institutions. Aim: To critically examine the literature exploring the historical and current drivers, supports and impediments for entry-to-practice midwifery programs to identify strategies to strengthen midwifery education in Australia. Methods: A structured integrative literature review using Whittemore and Knafl’s five-stage framework was undertaken; 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation of results. Findings: The literature search identified 50 articles for inclusion. The thematic analysis identified four key themes: i. a commitment to educational reform, ii. building a midwifery workforce, iii. quality maternity care through midwifery education, and iv. progressing excellence in midwifery education. Discussion: Extensive literature describes the evolution of midwifery education in Australia over the last 30 years. Through collaboration and amidst opposition, quality midwifery education has been established in Australia. Identification of midwifery as a distinct profession and transformative leadership have been integral to this evolution and must be grown and sustained to prevent a decline in standards or quality. Conclusion: There is a need to address priorities in midwifery education and for the evaluation of midwifery programs and pedagogy. The provision and maintenance of quality education and practice require shared responsibility between education providers and health care services.

BACKGROUND: The COVID-19 pandemic has caused isolation, fear, and impacted on maternal healthcare provision. AIM: To explore midwives' experiences about how COVID-19 impacted their ability to provide woman-centred care, and what lessons they have learnt as a result of the mandated government and hospital restrictions (such as social distancing) during the care of the woman and her family. METHODS: A qualitative interpretive descriptive study was conducted. Twenty-six midwives working in all models of care in all states and territories of Australia were recruited through social media, and selected using a maximum variation sampling approach. Data were collected through in-depth interviews between May to August, 2020. The interviews were recorded, transcribed verbatim, and thematically analysed. FINDINGS: Two overarching themes were identified: 'COVID-19 causing chaos' and 'keeping the woman at the centre of care'. The 'COVID-19 causing chaos' theme included three sub-themes: 'quickly evolving situation', 'challenging to provide care', and 'affecting women and families'. The 'Keeping the woman at the centre of care' theme included three sub-themes: 'trying to keep it normal', 'bending the rules and pushing the boundaries', and 'quality time for the woman, baby, and family unit'. CONCLUSION: Findings of this study offer important evidence regarding the impact of the pandemic on the provision of woman-centred care which is key to midwifery philosophy. Recommendations are made for ways to preserve and further enhance woman-centred care during periods of uncertainty such as during a pandemic or other health crises.

Rates of homebirth in Australia remain low, at less than 0.3% of all births.To report maternal and neonatal outcomes of ten years of a publicly funded homebirth service, 2009-2019.Retrospective analysis of clinical outcome data including neonatal outcomes of women who requested a homebirth at a large metropolitan health service in Victoria, Australia. The primary outcomes included: maternal outcomes (mortality, transfer to hospital, place and mode of birth, perineal status, type of third stage of labour, postpartum haemorrhage), and neonatal outcomes (mortality, Apgar score at five minutes, birthweight, breastfeeding initiation, significant morbidity, transfer to hospital).Referrals for 827 women were reviewed; 633 remained eligible at 36 weeks gestation, and 473 (57%) birthed at home. Compared to women who did not, women who had a homebirth were significantly more likely to be multiparous, have a normal vaginal birth and an intact perineum, less likely to require suturing and less likely to have blood loss of more than 500 mL. Compared to infants not born at home, infants born at home were significantly less likely to require resuscitation, more likely to be of normal birthweight and exclusively receive breastmilk on discharge. There were no maternal deaths and one neonatal death of a baby born at home before the arrival of a midwife.The outcomes for women accepted into the publicly funded homebirth program suggest appropriate triaging and case selection. A publicly funded homebirth program, with appropriate governance and clinical guidelines, appears to be a safe option for women experiencing low-risk pregnancies.

Background The COVID‐19 pandemic has led to multiple changes in maternity services worldwide. Systems rapidly adapted to meet public health requirements aimed at preventing transmission of SARS‐CoV‐2, including quarantine procedures, travel restrictions, border closures, physical distancing and “stay‐at‐home” orders. Although these changes have impacted all stakeholders in maternity services, arguably the women at the center of this care have been most affected. This study aimed to explore women's experiences of receiving maternity care during the COVID‐19 pandemic in Australia. Methods A national cross‐sectional online survey, including fixed choice and open‐ended questions, was conducted during the first wave of the COVID‐19 pandemic in Australia; pregnant and postnatal women were recruited through social media networks. Results The survey was completed by 3364 women. Women felt distressed and alone due to rapid changes to their maternity care. Limited face‐to‐face contact with health practitioners and altered models of care often required women to accommodate significant changes and to coordinate their own care. Women felt that they were often “doing it alone,” due to public health restrictions on support people and visitors, both within and outside health services. Women described some benefits of visitor restrictions, such as, more time for rest, breastfeeding establishment, and bonding with their baby. Conclusions This large nationwide Australian study provides unique data on women's experiences of receiving maternity care during the COVID‐19 pandemic. Lessons learned provide an opportunity to rebuild and reshape the maternity sector to best meet the needs of women and their families during current and future public health crises.

This is an Accepted Manuscript of an article published by Taylor & Francis in Reflective Practice on 28.12.21, available online: https://doi.org/10.1080/14623943.2021.2013191. Arts-based learning in the context of clinical placement is rarely discussed in the literature, yet storytelling is potentially a valuable tool for students to reflect on the multi-dimensional experience. Clandinin and Connolly’s approach to narrative inquiry provided the methodology to explore students’ experiences of storytelling as a learning strategy. Narrative inquiry is a relationship-based methodology, used to study the nature of people’s experience. The approach is like that of clinical facilitators who work collaboratively with students to understand and provide mentorship through placement experiences. Creative writing and storytelling sessions with students were conducted throughout placement. Data included creative writing, oral stories, and researcher journal entries, collected over six placement blocks with 26 nursing students. Analysis identified that students engaged enthusiastically with storytelling; stories highlighted moments of student-patient interactions; the value of a positive clinical facilitator-student relationship; the complexity of registered nursestudent relationships; and students from cultural and linguistic diverse backgrounds experienced feelings of isolation from staff. The simple tools of pen and paper were a powerful medium for students to reflect on their interactions with patients. Facilitating the process of storytelling provided the researcher with insight into intrinsic and extrinsic obstacles and opportunities which may impact students’ engagement with patients.

BackgroundThe World Health Organization recommends that infants be exclusively breastfed until the age of six months. Breastfeeding is generally understood to mean the provision of human breastmilk to the infant by direct feeding at the breast, and interventions aimed at supporting exclusive breastfeeding are therefore targeted at this activity. However, breastfeeding is actually an umbrella term covering the provision of breastmilk to an infant by any means. Our population of interest is mothers who exclusively feed their infants indirectly using expressed breastmilk. Some research suggests that any expressing, and exclusively expressing in particular, can be a risk factor for early cessation of exclusive breastmilk provision, so we were interested to identify whether any specific support existed for exclusively expressing mothers outside of the context of premature infants and the Neonatal Intensive Care Unit setting.MethodsA scoping review following the Joanna Briggs Institute approach was used to explore the phenomenon of formal and informal supports in the community for exclusively expressing mothers. Searches were run across academic databases and of government websites and infant feeding support organisations. Finally, an informal internet search was run using a simple search string.ResultsOn analysis of results, there were no studies or articles that met the search criteria. An informal internet search linked us directly with websites and blogs that could be considered a form of support intervention. These informal results suggest that support material or programs could possibly exist in other modalities but we cannot find them in the context of this type of scoping review.ConclusionsThe results of the search corroborated what we had suspected – that exclusively expressing mothers are not specifically supported by usual channels for new parents and that it is also difficult to find acknowledgement that exclusive expression exists.The absence of results demonstrates the relevance of this study: exclusively expressing mothers are an under-served population. If we wish to strive towards achievement of World Health Organization breastfeeding goals, exclusively expressing mothers require targeted support to assist in their infant feeding experience, and there is little formal evidence of it currently being provided.

Background Common approaches to manage breastfeeding problems such as pain, blocked ducts, and milk production issues include breast compression, breast massage, application of warmth or cold, medications, and breastmilk expression. Several devices are available to apply heat or cold to the breast, however, none promote breast compression and/or massage simultaneously. A new device ‘Lactamo’ has been developed to address this. Methods This study was a pre-market evaluation of the Lactamo device. The aims were to determine user safety, and satisfaction of Lactamo. The study was conducted in an Australian tertiary maternity hospital in 2019–2020. Women who were less than 3 months post-partum and were currently breastfeeding participated in the study. We conducted structured telephone surveys at 1 and 4 weeks post supply of Lactamo. Questions included demographic information, feedback on safety, usage, and perceived benefits of Lactamo. Results The cohort (n = 30) consisted of equal number of primiparous and multiparous women, 50% were born in Australia and the remainder from 11 other countries. A total of 41 telephone surveys were conducted with 27 women. Of these, 26 (96%) had used Lactamo, and the one that did not, felt she did not have a lactation concern to warrant using it. All women indicated that the device was safe to use and had no concerns, apart from one woman who experienced itching because of the device but continued to use it over clothing as she found it beneficial. Most women used it at room temperature or warmed. The frequency of use varied from once per week (17%) to daily (33%), and use was often prompted by a lactation concern such as engorgement, pain, blocked ducts, and low supply. Conclusion Lactamo was found to be safe, and a valuable aid for breastfeeding women. More research is needed to understand the efficacy of the device in treating breastfeeding problems such as pain, blocked ducts, and milk production issues.

Background Substantial changes occurred in Australian healthcare provision during the COVID-19 pandemic to reduce the risk of infection transmission. Little is known about the impact of these changes on childbearing women. Aim To explore and describe childbearing women’s experiences of receiving maternity care during the COVID-19 pandemic in Australia. Methods A qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. Twenty-seven interviews were conducted with women from across Australia. Data was analysed thematically. Findings Three primary themes and nine sub-themes emerged: ‘navigating a changing health system’ (coping with constant change, altered access to care, dealing with physical distancing restrictions, and missing care), ‘desiring choice and control’ (experiencing poor communication, making hard decisions, and considering alternate models of care), and ‘experiencing infection prevention measures’ (minimising the risk of exposure and changing care plans to minimise infection risk). Discussion The substantial changes in care delivery for pregnant and postpartum women during the pandemic appear to have reduced woman-centred care. In most cases, care was perceived as impersonal and incomplete, resulting in a very different experience than expected; consequences included missing care. The presence of a known care provider improved women’s sense of communication, choice, and control. Conclusion This study provides unique insight into the experiences of childbearing women across Australia. The importance of respectful woman-centred care cannot be forgotten during a pandemic. The findings may inform future service planning during pandemics and disaster situations.

BackgroundWoman-centred care is recognised as a fundamental construct of midwifery practice yet to date, there has been no validated tool available to measure it. This study aims to develop and test a self-report tool to measure woman-centred care in midwives.MethodsA staged approach was used for tool development including deductive methods to generate items, testing content validity with a group of experts, and psychometrically testing the instrument with a sample drawn from the target audience. The draft 58 item tool was distributed in an online survey using professional networks in Australia and New Zealand. Testing included item analysis, principal components analysis with direct oblimin rotation and subscale analysis, and internal consistency reliability.ResultsIn total, 319 surveys were returned. Analysis revealed five factors explaining 47.6% of variance. Items were reduced to 40. Internal consistency (.92) was high but varied across factors. Factors reflected the extent to which a midwife meets the woman’s unique needs; balances the woman’s needs within the context of the maternity service; ensures midwifery philosophy underpins practice; uses evidence to inform collaborative practice; and works in partnership with the woman.ConclusionThe Woman-Centred Care Scale-Midwife Self Report is the first step in developing a valid and reliable tool to enable midwives to self-assess their woman-centredness. Further research in alternate populations and refinement is warranted.

A neonatal early discharge (NED) program is a supported process where preterm infants leave hospital before they have established full sucking feeds and are gavage fed by their parents while they transition to breast- and/or bottle-feeds. While there is some evidence in the literature describing the outcomes of this process for preterm infants, there is even more limited evidence of the effects and outcomes of these NED programs on parents. The objective of this study was to summarize and critically appraise the literature regarding the effects of NED on parents. A literature search was conducted for English language publications since 2007 using MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar. A total of 20 primary articles met the inclusion criteria for the review. An integrative thematic synthesis identified 4 themes: establishing parenting skills/confidence; bonding with the newborn; psychological distress; and the need for support and resources. Findings suggest that parents have various concerns regarding discharge from the neonatal unit and therefore support from healthcare professionals and family plays a crucial role during the experience. There were also various external factors such as socioeconomic status and cultural differences that impact on parents differently, and it is therefore challenging to draw definite conclusions. This warrants further research in the area.

Introduction If a paramedic moves interstate in Australia, they are often required to undertake a local state-specific internship in the state or territory they are moving to. The small differences in roles undertaken between the states and territories are not sufficient to explain this requirement. In order to better understand this expectation, the authors explored the national and organisational cultural factors that could explain its purpose. Methods Semi-structured interviews were conducted with six major stakeholders of an internship, and interpreted using organisational and national-cultural dimensions derived from the work of Hofstede, Waisfisz and Minkov. Results Seven core themes were identified, layered according to the stakeholders that have the greatest influence over the theme, and discussed using the study's interpretive framework (cultural dimensions). These core themes describe the concerns the respondents had about elements of the paramedic internship, including the culture of the internship, attitudes, education, communication, the profession, the organisation, and recruitment and selection. Conclusion The insights gained into the cultural characteristics of the ambulance organisation help us to better understand the need for the internship. From a cultural perspective, paramedics need to be able to balance risk aversion (policy/procedure) with risk taking (unpredictable work demands); structure (militaristic) with independence (autonomy); a hierarchy-based power relationship and a competency-based power relationship and, finally, indulgence (socialisation for organisational acceptance) with restraint (becoming a professional). This balancing of judgement and actions is extremely complex, delicate and organisation-specific, thus explaining the importance for the individual organisation of having a prolonged observation period during which ‘a feel’ for these ‘balances’ can be obtained to ensure that the paramedic ‘fits’ into the specific organisation to become ‘one of us’.

The impact of COVID-19 on midwifery students is anticipated to be multi-faceted. Our aim was to explore Australian midwifery students’ experiences of providing maternity care during the COVID-19 pandemic. In a cross-sectional study 147 students were recruited through social media. Data were collected through an online survey and semi-structured interviews. Surveys were analysed using descriptive statistics; interviews and open text responses were interpreted through qualitative analysis. Findings revealed students found communication from hospitals and universities to be confusing, inconsistent and they relied on mass media and each other to remain updated. Moving to online learning and being isolated from peers made learning difficult. During clinical placements, students felt expendable in terms of their value and contribution, reflected in essential equipment such as personal protective equipment not always being available to them. Witnessing perceived compromised midwifery care increased students’ emotional burden, while personal household responsibilities and financial concerns were problematic. One silver lining witnessed was women’s appreciation of an improved ‘babymoon’, with fewer visitors, allowing uninterrupted time to establish breastfeeding and connection with their baby. Findings may guide management of midwifery education during future pandemics or health crises for universities and hospitals..

Introduction Vaccination against COVID-19 is a key global public health strategy. Health professionals including midwives and doctors support and influence vaccination uptake by childbearing women. There is currently no evidence regarding the COVID-19 vaccination perceptions and intentions of those who receive or provide maternity care in Australia. The aim of this study was to address this gap in knowledge and explore the perceptions and intentions regarding COVID-19 vaccination from consumers and providers of maternity care in Australia. Methods A national cross-sectional online study conducted in early 2021 in Australia, a country that has had a very low number of COVID-19 cases and deaths. Recruitment was undertaken through parenting and health professional social media sites and professional college distribution lists. A total of 853 completed responses, from women (n = 326), maternity care providers including doctors (n = 58), midwives (n = 391) and midwifery students (n = 78). Findings Personal intention to be vaccinated ranged from 48–89% with doctors most likely and women least likely. Doctors and midwifery students were significantly more likely to recommend the vaccine to pregnant women in their care than midwives (p Conclusion This is the first study to explore the perceptions and intentions regarding COVID-19 vaccination from the perspective of those who receive and provide maternity care in Australia. Findings have utility to support targeted public health messaging for these and other cohorts.

Background Ensuring women receive optimal breastfeeding support is of key importance to the health of mothers and their infants. Early discharge within 24 h of birth is increasingly common across Australia, and the practice of postnatal home visiting varies between settings. The reduction in length of stay without expansion of home visits reduces midwives’ ability to support breastfeeding. The impact of early discharge on first-time mothers establishing breastfeeding was unknown. The study aim was to understand the experiences of first-time Australian mothers establishing breastfeeding when discharged from the hospital within 24 h of a normal vaginal birth. Methods A qualitative interpretive method was used. Semi-structured interviews with 12 women following early discharge were conducted. Data were audio recorded, professionally transcribed, and subjected to a thematic analysis. Results Three interconnected themes of ‘self-efficacy’, ‘support’ and ‘sustainability’ were identified. Self-efficacy influenced the women’s readiness and motivation to be discharged home early and played a role in how some of the mothers overcame breastfeeding challenges. Social, semi-professional and professional breastfeeding supports were key in women’s experiences. Sustainability referred to and describes what women valued in relation to continuation of their breastfeeding journey. Conclusion This study found accessible people-based breastfeeding services in the community are valued following early discharge. Furthermore, there is demand for more evidence-based breastfeeding educational resources, potentially in the form of interactive applications or websites. Additionally, a focus on holistic and individualised breastfeeding assessment and care plans prior to discharge that link women with ongoing breastfeeding services is paramount.

BackgroundIn Australia, the provision of maternity care during the COVID-19 pandemic was significantly altered to limit transmission of the virus. Many hospitals limited face-to-face appointments to only the pregnant woman and restricted the number of support people present during labour, birth, and postnatal visits to one person. How these restrictions were experienced by partners and support persons of childbearing women are unknown.AimTo explore the experiences of partners and support persons of women receiving maternity care during the COVID-19 pandemic.MethodsA two-phased qualitative study including an online survey and interviews. Analysis was undertaken using content analysis.FindingsPartners and support persons experienced a sense of 'missing out' from the pregnancy and maternity care experience because of changes in the provision of care during the pandemic. They reported feelings of isolation, psychological distress, and reduced bonding time with babies. Conflicting information and processes within and across maternity services contributed to feelings of uncertainty and a perceived reduction in the quality of care. Partners and support persons were negatively impacted by restrictions on maternity wards, however they also perceived these to be of benefit to women.DiscussionMany partners and support persons were negatively impacted by restrictions in maternity services during the pandemic; strategies to ensure their active involvement in maternity care are needed.ConclusionThis study offers insights from the unique perspective of partners and support people of women receiving maternity care during the pandemic. Policies and processes that exclude partners and support persons need to be reconsidered.

Problem The COVID-19 pandemic has required rapid and radical changes to the way maternity care is provided in many nations across the world. Background Midwives provide care to childbearing women across the continuum and are key members of the maternity workforce in Australia. Aim To explore and describe midwives’ experiences of providing maternity care during the COVID-19 pandemic in Australia. Methods A two-phased cross-sectional descriptive study was conducted. Data were collected through an online survey and semi-structured interviews between May-June 2020. Findings Six hundred and twenty midwives responded to the online survey. Many reported a move to telehealth appointments. For labour care, 70% of midwives reported women had limited support; 77% indicated postnatal visiting was impacted. Five main themes were derived from the qualitative data including: coping with rapid and radical changes, challenges to woman-centred care, managing professional resilience, addressing personal and professional challenges, and looking ahead. Discussion Restrictions applied to women’s choices, impacted midwives’ ability to provide woman-centred care, which resulted in stress and anxiety for midwives. Professional resilience was supported through collaborative relationships and working in continuity models. Midwives revealed ‘silver linings’ experienced in providing care during the pandemic. Conclusion Findings provide valuable evidence to understand the impact on midwives who have provided care during the COVID-19 pandemic. Knowledge will be useful for health leaders and policy makers as they consider ways to continue care during the pandemic and support the essential midwifery workforce. Recommendations are presented to improve preparedness for future pandemics.

Introduction The global COVID-19 pandemic has radically changed the way health care is delivered in many countries around the world. Evidence on the experience of those receiving or providing maternity care is important to guide practice through this challenging time. Methods A cross-sectional study was conducted in Australia. Five key stakeholder cohorts were included to explore and compare the experiences of those receiving or providing care during the COVID-19 pandemic. Women, their partners, midwives, medical practitioners and midwifery students who had received or provided maternity care from March 2020 onwards in Australia were recruited via social media and invited to participate in an online survey released between 13th May and 24th June 2020; a total of 3701 completed responses were received. Findings While anxiety related to COVID-19 was high among all five cohorts, there were statistically significant differences between the responses from each cohort for most survey items. Women were more likely to indicate concern about their own and family’s health and safety in relation to COVID-19 whereas midwives, doctors and midwifery students were more likely to be concerned about occupational exposure to COVID-19 through working in a health setting than those receiving care through attending these environments. Midwifery students and women’s partners were more likely to respond that they felt isolated because of the changes to the way care was provided. Despite concerns about care received or provided not meeting expectations, most respondents were satisfied with the quality of care provided, although midwives and midwifery students were less likely to agree. Conclusion This paper provides a unique exploration and comparison of experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia. Findings are useful to support further service changes and future service redesign. New evidence provided offers unique insight into key stakeholders’ experiences of the rapid changes to health services.

OBJECTIVE: To report on the findings of a survey of sonographer skill‐teaching practices in Australia using the SonoSTePs tool. METHOD: A cross‐sectional survey of all qualified sonographers registered with the Australian Sonographer Accreditation Registry. RESULTS: The 528 responses showed the use of a two‐step skill‐teaching approach to teach scanning skills and the incorporation of additional instructional practices to support a learner's initial acquisition of scanning skills, which include: providing coaching and guidance as the skill is practised; performing physical guidance; providing immediate error correction; and providing end‐task feedback. Based on our findings, sonographer skill‐teaching practices fall short of best pedagogical approaches. CONCLUSION: There is a pressing need to identify the optimal pedagogical approaches to teach complex psychomotor scanning skills. Research is required to ensure that the scanning skills are taught efficiently and that the pedagogical approaches to teach scanning skills foster the learner's long‐term retention of the skill. There is also an accompanying need for sonographers involved in teaching scanning skills to have knowledge of the motor‐learning theories and principles related to teaching a complex psychomotor skill.

Objective To report the qualitative findings of the inaugural survey of sonographer skill-teaching practices in Australia using the SonoSTePs tool. Method A national cross-sectional survey of all qualified sonographers registered with the Australian Sonographer Accreditation Registry. A mix of quantitative and qualitative data was collected. This paper reports on a content analysis of the qualitative data relating to factors that impact on teaching. Results A total of 528 respondents provided a range of qualitative data in five extended text questions. Five key themes emerged from the analysis: limited protected teaching time; perceived skill complexity; learner skill level and credentials; avoiding overwhelming the learner; and patient well-being and their willingness to be scanned. Novel teaching interactions between the educator and the student sonographer were identified. Information was provided to learners at four time-points across the continuum of clinical practice performance. The type, quantity and purpose of the information provided by the educator to the learner differed at each of these four time-points and included the following: (i) pre-task clarification, guidance and practice norms; (ii) in-task verbal information and scanning support; (iii) post-task support and information; and (iv) end-task or terminal feedback. Conclusion This is the first published study which reports the push and pull factors affecting pedagogical approaches to teach and learn complex scanning skills. These results provide a corpus of new knowledge, and the first analysis and review, about the pedagogical findings related to teaching scanning skills for clinical practice. This study provides a basis for further research and practice improvements.

This article was migrated. The article was marked as recommended. Background: Developing critical thinking in health care education is pivotal in student development and patient outcomes. Gamification and learning through play within health care education is rising in popularity and may assist to develop problem-solving and critical thinking skills. Aim: To develop and enhance students' capacity to rapidly recall and communicate critical links in practice through a modified 'snap' game. Method: Students are provided decks of cards depicting clinical pictures (syringe, bath, blood, medications etc). Turning over two cards at a time, the students race to link the two concepts together. Findings: Linking Out Loud was well received by students and worked to develop knowledge, critical thinking, communication and problem-solving. Linking Out Loud could be easily replicated for all health disciplines.

BackgroundChildhood Human Immunodeficiency Virus (HIV) infection occurs almost exclusively via mother to child transmission (MTCT) during pregnancy, birth, or through breastfeeding. Recent studies have shown that male involvement (MI) in antenatal care (ANC) and HIV testing, including couples voluntary counselling and testing (CVCT), increases the likelihood that women will adhere to prevention advice and comply with HIV treatment if required during their pregnancy; hence reducing the rates of MTCT of HIV. This realist review investigates how, why, when, and for whom MI in ANC works best to provide contextual advice on how MI in ANC can be best used for prevention of mother to child transmission (PMTCT) of HIV.MethodsA realist review of existing evidence was conducted. Realist review seeks to explain how and why an intervention works, or does not work, in a given context. This was completed through the five stages of realist synthesis; Eliciting the program theory, search strategy, study selection criteria, data extraction, and data analysis and synthesis. Findings are presented as context-mechanism-outcome (CMO) configurations outlining the mechanisms that work in given contexts to give an outcome.ResultsThree CMO configurations were developed. These describe that 1) Couples in monogamous relationships have higher levels of trust, commitment and security leading to increased uptake of PMTCT programs together; 2) ANC spaces that make 'male friendly' adaptions promote normalisation of MI in PMTCT and are more welcoming, leading to increased willingness of male partners to participate in ANC; and 3) couples and communities with higher health literacy encourage increased informed decision making, ownership, and responsibility and thus increased participation in PMTCT of HIV.ConclusionsThe CMOs developed in this review give contextual advice on how one might improve ANC services to increase MI and help reduce MTCT of HIV. We propose that MI in ANC works best where couples are monogamous and trusting, where ANC spaces actively promote being a 'male friendly space' and where there are high levels of community education programs around MTCT.

Problem Early discharge following birth has become an emerging phenomenon in many countries. It is likely early discharge has an impact on the establishment of breastfeeding. Objective To critically appraise the evidence on what women value in relation to breastfeeding initiation and support, and investigate the impact early discharge can have on these values. Method A literature search was conducted for publications since 2005 using the following databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Scopus and PsycINFO; 21 primary articles were selected and included in the review. Findings There is no standard definition for ‘early discharge’ worldwide. Due to inconsistent definitions worldwide and minimal literature using a 24 h definition, research defining early discharge as up to 72 h postpartum is included. Seven key factors in relation to breastfeeding initiation and support following early discharge were identified, namely trust and security, consistent advice, practical breastfeeding support, breastfeeding education, comfortable environment, positive attitudes and emotional support, and individualised care. Conclusion The findings suggest individualised postnatal lengths of stay may be beneficial for the initiation of breastfeeding. Five values were not impacted by early discharge, but rather individual midwives’ practice. There is consensus in the literature that early discharge promoted a comfortable environment to support breastfeeding initiation. Wide variations in the definition of early postnatal discharge made it difficult to draw influential conclusions. Therefore, further research is required.

Background The Australian Midwifery Standards Assessment Tool (AMSAT) was developed against the Competency Standards for the Midwife in 2017 to enable consistent assessment of midwifery student performance in practice-based settings. The AMSAT requires revision and re-validation as the competency standards have now been superseded by the Midwife Standards for Practice 2018. Objective This research revised and validated the AMSAT to assess performance of midwifery students against the Midwife Standards for Practice 2018 and assessed its sensitivity. Design A mixed-methods approach was used in a two-phase process. Phase one involved the re-wording of the AMSAT and behavioural cue statements in an iterative participatory process with midwifery academics, assessors and students. The tool was field-tested in different assessment environments in phase two. Completed assessment forms were statistically analyzed, whilst assessor surveys were analysed using descriptive statistics and qualitative content analysis. Findings Analysis of AMSAT (n = 255) indicates the tool as: internally reliable (Cronbach alpha > .9); valid (eigenvalue of 16.6 explaining 67% of variance); and sensitive (score analysis indicating increased levels of proficiency with progressive student experience). Analysis of surveys (n = 108) found acceptance of the tool for the purpose of summative and formative assessment, and in the provision of feedback to midwifery students on their performance. Conclusion This study demonstrates that the re-developed AMSAT is a valid, reliable and acceptable tool to assess midwifery students’ performance against the Australian Midwife Standards for Practice This user-friendly tool can be used to standardize midwifery student assessment in Australia and enable continued benchmarking across education programs.

Objective. To determine the level of alignment between course and topic outcomes of a third- and fourth-year pharmacotherapy curriculum. Methods. Each topic taught in each course was categorized into subtopics and each subtopic had a set of learning outcomes. The learning outcomes for the courses and subtopics were matched to examine alignment. Cognitive levels were categorized using the Structure of the Observed Learning Outcome (SOLO) taxonomy of prestructural, unistructural, multistructural, relational, or extended abstract. The types of knowledge that the curriculum was intended to instill also were categorized as declarative or functioning. Results. There were eight explicit course outcomes for each course and 140 subtopic outcomes for course 1 and 136 for course 2. Wide variations in alignment between the courses and subtopic outcomes were found. Issues identified included the use of redundant verbs and insufficient alignment and balance of cognitive levels and types of knowledge embedded in each outcome. Conclusion. Alignment between the course and subtopic outcomes was not optimal. Using a constructive alignment analysis, learning outcome issues that need improvement for course alignment were identified. The methodology used here can be applied to other courses to promote effective curriculum design.

Objective To report on the initial content development of the sonographer skill teaching practices survey (SonoSTePs) tool to measure skill teaching perceptions. Method The nine-step model by Sarantakos [Social Research, 3rd edn. London: Palgrave Macmillan; 2005. 1-464], was used to guide the initial development of the instrument, content domains, and the generated questions. The face and content validity of the instrument was established after progressing through two expert panel reviews (experts in the fields of education, statistics, and ultrasound) and two pilot tests. Results Results of the pilot testing identified differing discriminant variability (variation ratios) between the use of a five-point and a seven-point Likert-type frequency scale. In particular, the pilot two (P2) 30-item instrument, using a frequency seven-point Likert-type scale, resulted in good variation ratios (0.68 across 24 items; SD=0.11), demonstrating discriminatory ability between individual participant's teaching practices. Conclusions The content and face validity of the SonoSTePs instrument has been established using principles of questionnaire construction and development.

In the past 5 years there has been a rapid rise in numbers of foreign-trained medical graduates returning to their countries to work as interns across the Western Pacific. These graduates were found to have a varied and different level of clinical knowledge and skill from that previously experienced in the region. This change in workforce profile led to an urgent need for upskilling clinicians as educators and supervisors. A team of clinical education facilitators were invited to design and deliver context-specific professional education workshops to address this need. These workshops were designed to equip clinical staff with education and supervision skills to optimise teaching and learning opportunities in clinical settings for these new graduates of foreign medical programs. Embracing a collaborative approach and addressing learning needs in local contexts has enabled the team to enhance medical education capacity in the Western Pacific region. This article presents the context of the need for and development of clinical education workshops for intern supervisors in the Western Pacific.

Background Practice-based or clinical placements are highly valued for linking theory to practice and enabling students to meet graduate outcomes and industry standards. Post-practicum, the period immediately following clinical experiences, is a time when students have an opportunity to share, compare and engage critically in considering how these experiences impact on their learning. Reflective practice has merit in facilitating this process. Aim This project aimed to optimise the learning potential of practice-based experiences by enhancing midwifery students’ capacity for reflective practice through writing. Methods Design-based research was used to implement an educational intervention aimed at developing reflective practice skills and enhance reflective writing. The Bass Model of Holistic Reflection was introduced to promote the development of reflective capacity in midwifery students. Academics and midwifery students were provided with guidance and resources on how to apply the model to guide reflective writing. Students’ written reflections completed before (n = 130) and after the introduction of the intervention (n = 96) were evaluated using a scoring framework designed to assess sequential development of reflective capacity. Findings The pre-intervention scores ranked poorly as evidence of reflective capacity. All scores improved post-intervention. Conclusions The introduction of a holistic structured model of reflection resulted in improved scores across all five components of reflective writing; self-awareness, sources of knowledge, reflection and critical reflection, evidence informed practice and critical thinking. While further work is required the results show that the implementation process and use of the Bass Model enables students to demonstrate their capacity to reflect-on-practice through their writing.

Orientation and role modelling are two specific teaching strategies, that when implemented effectively, can have a profound positive impact on learning. Orientating the student to the healthcare facility, the healthcare team and the creation of shared expectations, establishes a positive and supportive environment for learning and socialises the student to the workplace. Indeed, a well-planned orientation can be both effective and inspirational for students. Clinical orientation provides an opportunity to get to know students individually as well as an opportunity to establish the future working climate within the work group. Taking time to orient the learner enables the development of partnerships in learning and can save significant time and angst, particularly when compared to cases where partnerships and shared understandings are not established. It is essential that the clinical teacher take every opportunity during this critical time to establish a positive climate for learning. Ways in which to conduct orientation and establishing effective interpersonal relationships with students will be presented. Similarly, role modelling is a powerful teaching tool for passing on the knowledge, skills, and values of a profession. Student learning from role models occurs through observation and reflection, and is a complex mix of conscious and unconscious activities. Role modelling is said to have three categories; clinical competence, teaching skills and personal qualities. Clinical competence encompasses knowledge and skills, communication with patients, staff and students, and sound clinical reasoning and decision making. A student-centred approach to teaching and learning incorporating effective communication, feedback, and opportunities for reflection is essential to effective role modelling. Personal qualities such as compassion, honesty, and integrity, and effective interpersonal relationships and professionalism are equally important. There is substantial evidence that health professional students are exposed to both good and bad role models. Ways in which to provide positive role modelling will be presented.

Health professionals are required to perform a range of skills to undertake their clinical practice roles. The clinical, technical, procedural, or psychomotor skills required for each discipline are unique. To be able to perform these skills they must first be taught and then learned. Most educators still use a two-step or master-apprentice model to teach simple and complex psychomotor skills. However, when the skill is complex, there is an emergent body of literature which suggests that an alternative pedagogical approach should be used. This is because using a two-step skill teaching approach may not use a range of instructional approaches that are suited to learning large and multi-dimensional skills. Therefore, the skill should be classified as either simple or complex prior to teaching it. When it is complex, an alternative skill teaching approach should be used. Yet, there is currently a lack of contemporary literature which outlines a strategy to identify and classify those skills which are complex. Consequently, it is currently a challenge for educators to be able to perform this instructional approach. This presentation will outline the steps to classify and identify those psychomotor skills which are complex. An 11-step model will be presented and reviewed to teach complex psychomotor skills (Nicholls, Sweet, Muller, & Hyett, 2016).