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Problem: Postnatal follow-up screening is recommended for all women diagnosed with gestational diabetes mellitus (GDM). However follow-up rates are poor and highly variable in Australia and internationally. The reasons that mothers are not completing recommended postnatal screening after GDM diagnosis are not well understood or studied. The quality of communication may be an important influence on the completion of postnatal GDM follow-up., Aim: To explore and assess women's communication experiences of postnatal GDM follow-up., Methods: Theoretical, purposeful sampling was used to identify women diagnosed with GDM. Convergent interviews explored participants' communication experiences with GDM and postnatal follow-up. Transcripts were provided to and updated by participants. Data was analysed with Leximancer(®) (V4, 2011) automated content analysis software., Setting and Participants: This research was conducted at a major tertiary referral hospital in Queensland, Australia, between December 2012 and July 2013. Women participating in maternity shared care and diagnosed with GDM were interviewed (n=13)., Findings: Five themes, all concerned with obtaining information, were identified: diagnosis of GDM; seeking GDM information; accessing specialist services; need for postnatal GDM follow-up; and completing GDM follow-up. Results were interpreted using Communication Accommodation Theory (CAT) to explore whether and how the information needs of women were accommodated. Women's interpretations of communication events influenced their knowledge, perceptions and motivation to complete recommended postnatal follow-up., Conclusion: Accommodation of the communication and information needs of women with GDM may be an effective strategy for clinicians to encourage completion of recommended postnatal GDM follow-up., (Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students., Objectives: To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance., Design and Setting: Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses., Participants: A population of 489 final-year nursing students in programs of study leading to license to practice., Methods: Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis., Results: Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R(2)=0.090, F(7, 352)=4.962, p<0.001., Discussion: The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning., Conclusion: The web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Aims. To develop a program to support behaviour changes for women with a history of Gestational Diabetes Mellitus (GDM) and a Body Mass Index (BMI) > 25 kg/m(2) to delay or prevent Type 2 Diabetes Mellitus. Methods. Women diagnosed with GDM in the previous 6 to 24 months and BMI > 25 kg/m(2) were randomized to an intervention (I) (n = 16) or a control (C) (n = 15) group. The intervention was a pedometer program combined with nutrition coaching, with the primary outcome increased weight loss in the intervention group. Secondary outcomes included decreased waist and hip measurements, improved insulin sensitivity and body composition, increased physical activity, and improved self-efficacy in eating behaviours. Results. Median (IQR) results were as follows: weight: I -2.5 (2.3) kg versus C +0.2 (1.6) kg (P = 0.009), waist: I -3.6 (4.5) cm versus C -0.1 (3.6) cm (P = 0.07), and hip: I -5.0 (3.3) cm versus C -0.2 (2.6) cm (P = 0.002). There was clinical improvement in physical activity and eating behaviours and no significant changes in glucose metabolism or body composition. Conclusion. A pedometer program and nutrition coaching proved effective in supporting weight loss, waist circumference, physical activity, and eating behaviours in women with previous GDM.

Aims and Objectives: To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients., Background: Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience., Design: Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia., Methods: Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken., Results: Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support., Conclusions: There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills., Relevance to Clinical Practice: There is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies., (© 2014 John Wiley & Sons Ltd.)

Background: Gestational diabetes mellitus (GDM) affects almost 5% of pregnancies in Australia, and within 15 years, 25% of affected women will go on to develop Type 2 Diabetes Mellitus (T2DM). The adoption of preventive health behaviours may be influenced by women's experiences of GDM., Question: This review sought to understand women's beliefs, values, perceptions and experiences following diagnosis of GDM., Methods: Peer reviewed and professional journals were searched for primary research, published between January 1991 and December 2011 that explored the beliefs, values, perceptions and experiences of peripartum or postpartum women with a diagnosis or history of GDM., Findings: Nineteen studies met the inclusion criteria and the majority of these studies were qualitative (n=15). Each study was reviewed and synthesis revealed three emergent themes and core concepts related to each theme: Responses (initial reaction to GDM diagnosis, negative thoughts following diagnosis, struggle to manage GDM, feelings of 'loss of control', changes to identity and adapting to change), Focus of Concern (concern for baby's health, mother's concern for her own health, perceived seriousness of GDM, perceived fear of T2DM) and Influencing Factors (cultural roles and beliefs, social stigmas, social support, professional support, adequate and appropriate information, social roles and barriers to self-care)., Conclusion: The experiences of women with GDM are unique and personal however this review highlights common experiences evident in the existing research. The proposed framework may be used by midwives in clinical assessment and care of women diagnosed with GDM., (Copyright © 2012 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

With the global shortage of health care workers predicted to worsen, attrition from the work force must be minimized. This review examined the incidence or prevalence of neck, shoulder, and upper back musculoskeletal disorders, a possible source of attrition, among midwives, nurses, and physicians. Four electronic databases were systematically searched for publications meeting inclusion criteria. Reference lists of retrieved articles were hand searched for additional articles. After eliminating articles that did not meet inclusion criteria, the remaining articles were assessed for quality and prevalence or incidence data were extracted. Twenty-nine articles published between 1990 and 2012 were included and assessed for quality. Median annual prevalence rates were 45% (neck), 40% (shoulder), and 35% (upper back). Methodological concerns included small sample size, inconsistency of outcome measures, likelihood of non-response bias, and low response rates. Midwives, who have not been well studied, demonstrated prevalence somewhat lower than that of nurses and physicians., (Copyright 2013, SLACK Incorporated.)

Objective: To determine the prevalence of neck and upper back musculoskeletal symptoms in a group of Australian midwives and explore individual characteristics and workplace exposures associated with these symptoms., Design: cross-sectional, using data from the Nurses and Midwives e-Cohort Study, a longitudinal, electronic survey of midwives and nurses in Australia, New Zealand and the United Kingdom., Setting: data were collected via an online survey in 2006-2008., Participants: qualified Australian midwives aged 23-70 years., Measurements and Findings: We undertook descriptive analysis of the sample, calculated prevalence and examined associations between individual and workplace variables and neck and upper back musculoskeletal symptoms. Variables achieving p<0.1 in bivariate analysis were entered simultaneously into logistic regression models. Overall prevalence rates were 48.8% for neck and 28.2% for upper back musculoskeletal symptoms; work-related prevalence was 40.8% (neck) and 24.5% (upper back), comparable to reported rates among nurses and physicians. Presence of symptoms in the adjacent area was associated with greater than a fourfold increased risk for neck and upper back symptoms. Participants with care responsibility for an adult dependent were 36% more likely to report neck symptoms. Current shift work and total physical activity were associated with decreased likelihood of neck and upper back symptoms, respectively. Psychological job demands were only weakly associated with upper back symptoms, possibly because the survey tool could not capture a sufficiently broad range of psychosocial exposures to present a complete picture. A striking finding was that work in awkward postures conferred an increased risk of 35% for neck and nearly 50% for upper back symptoms., Key Conclusions: neck and upper back musculoskeletal symptoms were prevalent in this sample. Both individual and workplace factors were significantly associated with neck and/or upper back symptoms. Psychological job demands and work in awkward postures are potentially modifiable exposures that deserve further examination., Implications for Practice: midwives who are or may become carers for adult dependents should be aware of a possible increased risk for neck symptoms. It may be prudent for midwives and those who employ/supervise them to monitor and, where possible, jointly develop strategies to mitigate psychological job demands. The potential hazard posed by work in awkward postures warrants consideration of how midwives may minimize time spent working in these postures., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Early evidence suggests spinal musculoskeletal symptoms are as prevalent in Australian midwives as in samples of nurses. Functional consequences of these symptoms include sick leave and functional incapacity, which are costly at both individual and workplace levels. To date there have been no studies of these consequences in midwives., Question: What risk factors are associated with sick leave and functional incapacity among midwives with spinal musculoskeletal symptoms?, Methods: We undertook a cross-sectional study of qualified Australian midwives who completed the baseline survey of the Nurses and Midwives e-Cohort Study. A comprehensive set of independent variables were examined for bivariate associations with the main outcomes of sick leave and functional incapacity due to work-related musculoskeletal symptoms in the neck, upper or lower back. Associations that achieved a p value<.1 were entered into multiple logistic regression models., Findings: 729 midwives with a mean age of 46 years were eligible for inclusion. Functional incapacity was more than twice as common as sick leave. Severity of worst pain was the explanatory variable most strongly associated with each main outcome and the only one significant for both. Psychological job demands showed a significant association with sick leave, while several individual factors were associated with both outcomes. Only the association of poorer general health with functional incapacity remained significant in all three spinal regions., Conclusion: Our sample reported considerable work-related musculoskeletal pain and functional incapacity. Factors associated with sick leave and functional incapacity in midwives should be confirmed by longitudinal studies with the aim of developing tertiary prevention strategies., (Copyright © 2012 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to examine the prevalence of overweight and obesity and the association with demographic, reproductive work variables in a representative cohort of working nurses and midwives., Design: A cross sectional study of self reported survey data., Settings: Australia, New Zealand and the United Kingdom., Methods: Measurement outcomes included BMI categories, demographic (age, gender, marital status, ethnicity), reproductive (parity, number of births, mother's age at first birth, birth type and menopausal status) and workforce (registration council, employment type and principal specialty) variables., Participants: 4996 respondents to the Nurses and Midwives e-Cohort study who were currently registered and working in nursing or midwifery in Australia (n=3144), New Zealand (n=778) or the United Kingdom (n=1074)., Results: Amongst the sample 61.87% were outside the healthy weight range and across all three jurisdictions the prevalence of obesity in nurses and midwives exceeded rates in the source populations by 1.73% up to 3.74%. Being overweight or obese was significantly associated with increasing age (35-44 yrs aOR 1.71, 95% CI 1.41-2.08; 45-55 yrs aOR 1.90, 95%CI 1.56-2.31; 55-64 aOR 2.22, 95% CI 1.71-2.88), and male gender (aOR 1.46, 95% CI 1.15-1.87). Primiparous nurses and midwives were more likely to be overweight or obese (aOR 1.37, 95% CI 1.06-1.76) as were those who had reached menopause (aOR 1.37, 95% CI 1.11-1.69). Nurses and midwives in part-time or casual employment had significantly reduced risk of being overweight or obese, (aOR 0.81, 95% CI 0.70-0.94 and aOR 0.75, 95% CI 0.59-0.96 respectively), whilst working in aged carried increased risk (aOR 1.37, 95% CI 1.04-1.80)., Conclusion: Nurses and midwives in this study have higher prevalence of obesity and overweight than the general population and those who are older, male, or female primiparous and menopausal have significantly higher risk of overweight or obesity as do those working fulltime, or in aged care. The consequences of overweight and obesity in this occupational group may impact on their workforce participation, their management of overweight and obese patients in their care as well as influencing their individual health behaviours and risks of occupational injury and chronic disease., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Existing workforce data, as an estimate of the current capability of the midwifery workforce to provide midwifery care, is confounded by systematic reporting issues that may overestimate the potential of the existing midwifery workforce. This paper reports the characteristics of qualified Australian midwives who responded to the baseline data collection in the Midwives and Nurses e-Cohort Study and compares those who are currently practising in midwifery with those who are not. Currently practising midwives represented only 52% of those respondents who identified as midwives and the profile of the typical midwife is female, aged over 40 years, Australian, married or in a de facto relationship. She has been registered for over 10 years, educated to postgraduate diploma level and currently works in a clinical midwifery role in a hospital for less than 35 hours per week. Specific deficits in the Australian midwifery workforce namely low numbers of indigenous midwives, independent practitioners and midwives suitably qualified to teach and undertake research in academia are identified. Drawing on the nationally representative e-cohort data, this cross-sectional analysis identifies for the first time the real face of the Australian midwifery workforce and provides an evidence-based foundation for future workforce planning and a methodology for other countries interested in accurately monitoring their actual and potential midwifery workforce., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)

Background: The University of Queensland has developed the Clinical Practice Performance electronic Portfolio (CPPeP) as a learning and assessment tool for third year nursing students. To promote effective use of the CPPeP in the clinical setting, barriers must be identified and strategies developed to overcome them., Methods: A 24-question survey exploring the use and perceptions of the CPPeP was administered to 42 third year nursing students. Questions explored actual barriers encountered while eight open-ended questions were thematically analysed for perceived barriers., Results: A 100% response rate was achieved. Students were comfortable with working with computers. Twenty nine students (69%) encountered specific barriers. Of the 152 written comments to the open-ended questions, perceived barriers were evident in 72 of them. Barriers experienced related to gaining access, finding time and staff attitude. The majority of students made their portfolio entries at home., Conclusion: Students enjoyed using the CPPeP but competed with staff for the limited numbers of computers available. Heavy workloads and 'busyness' of the wards also prohibited access along with negative staff attitudes and reluctance of registered nurses to engage as student preceptors. The issue of overcoming barriers is more complex than simply providing more computers or overcoming staff prejudices. Finding time is a barrier not easily overcome given the current and projected nursing shortage., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: In 2006, a digitalised clinical portfolio was introduced into an undergraduate nursing program. The use of a tablet personal computer (PC) with wireless broadband access could overcome issues around computer access in the clinical setting enhancing authenticity and timeliness of assessment., Methods: In July 2007, a Hewlett-Packard TC 4400 tablet PC was issued to three participating students. A focus group utilising a semi-structured interview and a survey collected data from the students at the end of the trial to determine the effectiveness of the strategy., Results: Participants used tablet PCs to access their portfolios. However, lack of space, busy wards and concerns about the security of the PCs limited their use in the clinical setting. The majority of their journal entries were made at home and within similar time frames to those prior to access to tablet PCs. Participants also used the PCs to provide education to other students and staff but were reluctant to use them in front of patients., Conclusion: Barriers limiting the use of tablet PCs in the clinical setting may be overcome with greater proficiency in their utility and increased portability of the technology. Tablet PCs offer advantages related to and beyond portfolio use in the clinical setting.

The notion of social support is one which midwives often intuit rather than clearly articulate or conceptualise. Increasingly social support is being touted as an area of midwifery assessment and potential intervention which may improve birthing outcomes for mothers and their infants. This paper is the first of three to address social support within the discipline of midwifery. It aims to review the fundamental theoretical constructs relating to social support and proposes a conceptual model to assist midwives in applying social support theory to their practice. Further papers will address social support-related research assumptions and the validation of measurement instruments in midwifery research.