Search

Introduction: Evidence-based teaching and learning strategies should underpin any educational activity. This is particularly important for interprofessional education (IPE) activities, where there is an expectation that healthcare professions are taught using best available evidence. There is a research–practice gap that this review aims to address by using the current evidence to develop recommendations regarding optimal design components to better inform faculty who design IPE. Methods: A five-stage scoping review was conducted. Methodological characteristics and IPE design components of primary and review studies were extracted. Three important components of design—participants (level and stage of progression, discipline type and number, group size and ratios), learning constructs (theories, frameworks, learning objectives) and learning approaches (exchange, observation, action, simulation and practice)—were reviewed to develop recommendations regarding effective design. Results: A total of 41 papers were eligible for inclusion, 24 primary and 17 review studies. The primary studies were predominantly descriptive case studies with 31 disciplines involved in IPE activities across the studies. There was inconsistent reporting of learning constructs utilised in design, and the most reported learning approach was exchange. There was significant variability in the aims and design of the 17 review studies, ranging from systematic reviews to realist reviews, with the number of included studies ranging from six to 104. Conclusions: There was a lack of detailed reporting regarding design components, which limits the evidence base to inform IPE design. Reported components from the primary studies were augmented by findings from the review studies and the wider literature, which enabled the development of recommendations to assist faculty in the design of IPE programs and activities.

OBJECTIVE To describe the placental characteristics and neonatal outcomes of Central Australian Aboriginal women based on maternal self-report of tobacco use. METHODS Placental and neonatal variables were collected from a prospective maternal cohort of 19 smokeless tobacco chewers, 23 smokers and 31 no-tobacco users. RESULTS Chewers had the lowest placental weight (460 g) while the no-tobacco group had the heaviest placental weight (565 g). Chewers and the no-tobacco group had placental areas of similar size (285 cm2 and 288 cm2 , respectively) while the placentas of smokers were at least 13 cm2 smaller (272 cm2 ). There were two stillbirths in the study and more than one-third (36%) of neonates (newborns) were admitted to the Special Care Nursery, with the chewers' neonates having a higher admission rate compared with smokers' neonates (44% vs. 23%). The cohort mean birthweight (3348 g) was not significantly different between the groups. When stratified for elevated maternal glucose, the chewers' neonates had the lowest mean birthweight (2906 g) compared to the neonates of the no-tobacco group (3242 g) and smokers (3398 g). CONCLUSIONS This research is the first to demonstrate that the maternal use of Australian Nicotiana spp. (pituri) as smokeless tobacco may negatively impact placental and neonatal outcomes. Implications for public health: Maternal smokeless tobacco use is a potential source of placental and foetal nicotine exposure. Maternal antenatal screening should be expanded to capture a broader range of tobacco and nicotine products, and appropriate cessation support is required.

Background: Hand hygiene is fundamental approach to prevent and control spread of infection. Many measures available to enhance compliance to hand hygiene, yet little is known of ‘speaking up for hand hygiene’ initiative among parents and nurses especially in paediatric intensive care unit (PICU). Aim: To assess parents’ and nurses’ perceptions on ‘speaking up for hand hygiene’ in the prevention of ventilator-associated pneumonia (VAP) in a PICU. Methods: We revised evidence-based information related to VAP preventative strategies for a PICU population and updated education materials for staff and families using the ‘Speaking up for Hand Hygiene’ initiative. Parents of children receiving mechanical ventilation were provided with education on hand hygiene. Parents and staff groups were invited to participate in a survey exploring their confidence with this initiative. Results: Parents (78.9%) and nurses (91.2%) agreed the initiative would increase hand hygiene practice. Parents (94.5%) would welcome being reminded about hand hygiene but only 68.4% of parents were willing to remind nurses and 78.9% to remind other PICU staff. Nurses (88.2%) reported being willing to remind parents and other PICU staff and 88.2% indicated that they would welcome being reminded about hand hygiene from parents and 94.1% from other PICU staff. Conclusion: Parents of children receiving mechanical ventilation and PICU nursing staff perceived ‘Speaking up for hand hygiene’ as an important initiative. There are, however factors that contribute to a reluctance to prompt hand hygiene that require further research.

Aim To measure sound exposure in an Australian single-room configured, neonatal unit and compare findings to current sound level recommendations. Methods Sound meters were placed inside 51 internal environments (incubators or open cots), and within the surrounding environment of each occupied single room between September 15 and October 28, 2015. One-second incremental monitoring of decibels on an A-weighted scale (dBA), occurred over a minimum of 48 h. Results All equivalent continuous sound pressure levels (Leq) were significantly higher than the recommended 45 dBA for both incubators and open cots. Maximum sound levels (Lmax) were significantly higher than the recommended 65 dBA, peaking at 126.7 dBA inside the incubator and 124.7 dBA inside the open cot. Incubators were observed to have a higher total percentage of time above 45 dBA than open cots for both day (99.84% vs. 75.59%) and night (98.66% vs. 59.56%). Conclusion Sound levels exceeded the recommended maximum exposure levels outlined by the American Academy of Pediatrics (AAP). The long-term sequelae of adverse sensory exposure on preterm neurodevelopment remains unclear. Renewed attention on factors contributing to increased sound levels in neonatal units needs to be a clinical priority.

Introduction Implementation of interprofessional education (IPE) is recognised as challenging, and well-designed programs can have differing levels of success depending on implementation quality. The aim of this review was to summarise the evidence for implementation of IPE, and identify challenges and key lessons to guide faculty in IPE implementation. Methods Five stage scoping review of methodological characteristics, implementation components, challenges and key lessons in primary studies in IPE. Thematic analysis using a framework of micro (teaching), meso (institutional), and macro (systemic) level education factors was used to synthesise challenges and key lessons. Results Twenty-seven primary studies were included in this review. Studies were predominantly descriptive in design and implementation components inconsistently reported. IPE was mostly integrated into curricula, optional, involved group learning, and used combinations of interactive and didactic approaches. Micro level implementation factors (socialisation issues, learning context, and faculty development), meso level implementation factors (leadership and resources, administrative processes), and macro level implementation factors (education system, government policies, social and cultural values) were extrapolated. Sustainability was identified as an additional factor in IPE implementation. Conclusion Lack of complete detailed reporting limits evidence of IPE implementation, however, this review highlighted challenges and yielded key lessons to guide faculty in the implementation of IPE.

Background Newborns have their vital signs measured as part of routine care. However, there is inconsistency in accepted physiological ranges for well newborns beyond the post-delivery stabilisation period which has implications for the identification of illness. Objective To explore differences in physiological vital signs between three gestational age groups: late preterm (34+0 - 36+6), early term (37+0–38+6) and term (≥39+0) weeks gestation. Design A single site prospective observational study. Setting A postnatal ward and special care baby unit in a major tertiary hospital in Australia. Participants Newborns from 34 weeks gestation admitted to either the postnatal ward or special care baby unit. Methods Heart rate, respiratory rate and oxygen saturation were continuously monitored for up to 6 h. Newborn temperature and blood pressure were measured twice during the monitoring period. Results Continuous monitoring resulted in 284,542 heart rate, 275,826 respiratory rate, 287,572 SpO2 values, and 60 temperature and 60 blood pressure data points. Heart rate was significantly different between gestational age groups with late preterm heart rates 13.4 bpm (95% CI 6.5–20.4) higher than term newborns. Early term heart rates were 2.3 bpm (95% CI -4.6 – 9.3) higher than term newborns, although not statistically significantly different. Heart rate was significantly different based on sex with females on average 7.7 beats per minute (bpm) (95% CI 1.9–13.5) higher than males. Respiratory rate was not significantly different between gestational age groups however, on average, was −2.0 respiration rate per minute (rpm) (95% CI -6.8 – 2.7) lower for late preterm babies and −1.3 rpm (95% CI -6.0 – 3.4) lower for early term babies compared to term newborns. SpO2 was not significantly different between gestational age groups, however, on average was −1.17 log units (95% CI -2.32 to −0.01) lower for late preterm newborns and −1.00 log units (95% CI -2.16 – 0.15) lower for early term newborns compared to term newborns. Respiratory rate and SpO2 were neither clinically nor statistically significantly different by sex. There were no significant differences between gestational age groups for temperature (p = 0.38) or blood pressure (systolic p = 0.93, diastolic p = 0.54). No significant mean differences were observed based on sex for temperature (p = 0.57) or blood pressure (systolic p = 0.98, diastolic p = 0.40). Conclusions This study demonstrated a clinically significant higher heart rate in those born late preterm. This may have implications for current “one-size fits all” newborn early warning tools, as well as care of well late preterm infants in maternity units.

STATEMENT: This review explores the effectiveness of simulation-based team training in obstetric emergencies for improving technical skills. A literature search was conducted that included all articles to January 2018. A total of 21 articles were included from a potential 1327 articles. Each included study was assessed for impact of the training program using Kirkpatrick's 4-level model. Only the performance of technical skills was evaluated.Five studies reported on acceptance of simulation as an education tool at a level 1. Level 2 outcomes were reported in 7 studies where staff demonstrated improved skills in an educational setting. Three studies reported improved performance in a clinical setting at a level 3. Ten studies were categorized as level 4 and found that simulation learning was translated into improved techniques or maneuvers in reduced time frames in emergency situations of shoulder dystocia and postpartum hemorrhage. There was evidence that neonatal outcomes were improved.

No description supplied

Aims and objectives: To extract, examine and report the highest available levels of evidence from healthcare disciplines in the use of simulation-based education as substitution for clinical placement in prelicensure programmes. Background: Simulation is widely employed across prelicensure health professional education to create safe, realistic clinical learning experiences for students. Whether simulation can be employed to substitute for actual clinical placement, and if so, in what proportion, replacement ratio and duration, is unclear. Methods: A systematic review and quality appraisal of primary studies related to prelicensure students in all health disciplines, guided by the PRISMA checklist. Results: Ten primary studies were included, representing 2,370 students from three health disciplines in four countries. Eight studies were experimental and quasi-experimental and methodological quality was assessed as moderate to high with good to very good inter-rater agreement. Direct substitution of simulation for clinical practice ranged from 5% to 50%. With one exception, replacement ratios were 1:1 and duration of replacement ranged from 21 hr–2 years. Levels of evaluation included measures of reaction, knowledge and behaviour transfer; no negative outcomes were reported. We appraised practicalities for design of substitution, design limitations and knowledge transfer to accreditation standards for prelicensure programmes. Conclusions: This review synthesised highest levels and quality of available evidence for substitution of simulation for clinical placement in health professional education. Included studies were heterogenous in simulation interventions (proportion, ratio and duration) and in the evaluation of outcomes. Future studies should incorporate standardised simulation curricula, widen the health professions represented and strengthen experimental designs. Relevance to clinical practice: Current evidence for clinical educational preparation does not appear to be translated into programme accreditation standards governing clinical practice experience for prelicensure programmes in relevant jurisdictions. Overall, a stronger evidence base is necessary to inform future curricula and policy development, to strengthen clinical practice in health.

Clinical simulation is an essential component of health professional education. Digital technologies can provide students with near-reality, interactive virtual simulation learning experiences on static and mobile appliances. Clarification is needed, however, regarding the various types of virtual simulation and the different program components. We drew on published literature to define virtual simulation modalities and to offer definitive terminology to clarify the nomenclature and composition of virtual simulation. Reporting should include description of ‘Fidelity’, ‘Immersion’, and ‘Patient’ to add clarity and utility to research in the field.

Refereed/Peer-reviewed Background: There is unprecedented increase in use of simulation-based education in healthcare settings. The key driver is improving quality and safety in healthcare. To date, there is limited understanding of the degree to which this goal has been achieved. Aim: This scoping review aimed to explore the extent to which simulation-based education in healthcare has addressed and impacted contemporary patient safety priorities. Methods: Systematic searches of literature (2007-2016) were based on each of 10 patient safety priorities articulated in Australia's National Safety and Quality Health Service Standards and New Zealand's Health, Quality and Safety Indicators and markers. Included primary studies evaluated transferability to practice and/or behavioural change and improved patient outcomes, based on Kirkpatrick's training evaluation model Level 3 and Level 4. Findings: Fifteen papers met inclusion criteria. Studies aligned with four of ten National Safety and Quality Health Service Standards: (3). Preventing and controlling healthcare associated infections; (4). Medication safety; (6). Clinical handover; (9). Recognising and responding to clinical deterioration. The studies were indicative of potential for simulation-based education to have a significant impact on patient safety. Discussion: Studies that qualify as translational science, demonstrating changes in clinician behaviours and improved patient outcomes, are emerging. Little evidence from Australian and New Zealand contexts suggests that outcomes of simulation-based education in this region are not commensurate with the significant government investments. Conclusion: Translational studies, despite being difficult to design and conduct, should form part of a thematic, sustained and cumulative program of simulation-based research to identify translational science.

Problem Postnatal screening rates to detect type two diabetes following gestational diabetes are low. The quality of communication is an important element to consider in developing targeted strategies that support women in completing recommended follow-up care. Aims To explore the communication perspectives, practices and preferences of women, hospital clinicians and general practitioners, to determine strategies that may promote completion of recommended postnatal GDM follow-up, in Queensland Australia. Method We used an exploratory, three-phase, mixed-methods approach, interpreted through intergroup communication theory. Phase one: convergent interviews explored perspectives of the communication experience in GDM care among new mothers (n = 13), hospital clinicians (n = 13) and general practitioners (n = 16). Phase two: a retrospective chart audit assessed current practice in postnatal discharge summaries of women (n = 86). Phase three: an online survey identified the preferences of general practitioners and hospital clinicians who provide maternity care in Queensland. Triangulation of the findings from the interviews, audit and surveys was used to clarify results and increase the robustness of the findings. Results Three themes: Seeking information, Written hospital discharge summary (discharge summary) and Clarity of follow-up requirements, provide direction for pragmatic strategies to promote follow-up. Practical recommendations include continued discussion about care with women from the point of GDM diagnosis into the postnatal period; discharge summaries that give primacy to diagnosis and ongoing treatment; and provision of explicit directions for recommended testing and timing. Implications This research informs seven practical recommendations to help promote completion of recommended postnatal GDM follow-up.

Problem The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up. Aim Describe and analyse communication processes between hospital clinicians (midwives, medical, allied staff) and general practitioners who provide postnatal gestational diabetes mellitus care. Methods Purposive sampling and convergent interviews explored participants’ communication experiences providing gestational diabetes mellitus postnatal follow-up. Data were analysed with Leximancer automated content analysis software; interpretation was undertaken using Communication Accommodation Theory. Setting and participants Clinicians who provided maternity care at a tertiary referral hospital (n = 13) in Queensland, Australia, and general practitioners (n = 16) who provided maternity shared care with that hospital between December 2012 and July 2013. Findings Thematic analysis identified very different perspectives between the experiences of General Practitioners and hospital clinicians; six themes emerged. General practitioners were concerned about themes relating to discharge summaries and follow-up guidelines. In contrast, hospital clinicians were more concerned about themes relating to gestational diabetes mellitus antenatal care and specialist clinics. Two themes, gestational diabetes mellitus women and postnatal checks were shared. Conclusion Gestational diabetes mellitus follow-up is characterised by communication where general practitioners appear to be information seekers whose communication needs are not met by hospital clinicians. Midwives are ideally placed to assist in improving communication and postnatal gestational diabetes mellitus follow-up.

Objectives To calculate 95% reference ranges for heart rate, respiratory rate, oxygen saturation, temperature and blood pressure for well late preterm newborns between 34+0/7 and 36+6/7 weeks of gestation during typical neonatal behaviour. Approach A single site, prospective cohort study in a major Australian quaternary hospital between February and September 2019. A total of 120 late preterm newborns had their heart rate, respiratory rate and oxygen saturation measurements recorded every two seconds for up to two hours with unconditional 95% reference ranges determined using a linear mixed model with random intercept for total standard deviation calculation including repeated measures. Temperature and blood pressure measurements were collected twice - at the start and conclusion of the data recording period, with weighted 2.5th and 97.5th percentiles calculated using the mean value. Main results A total of 364,577 heart rate, 365,208 respiratory rate, 360,494 peripheral oxygen saturation, and 240 temperature and blood pressure values were obtained. The 95% reference ranges were: heart rate 102 - 164 bpm; respiratory rate 15 - 67 rpm; oxygen saturation 94 - 100%; temperature 36.4 - 37.6°C; systolic blood pressure 51 - 86 mmHg; diastolic blood pressure 28 - 61 mmHg; mean arterial pressure 35 - 68 mmHg. Significance Seven vital sign references ranges were reported for the late preterm population during a typical newborn period (such as crying, sleeping, feeding, awake and alert, and during nappy hygiene cares); internal and external validation should be completed prior to clinical use. Cut off points for escalation of care have previously been generalised to all newborns irrespective of gestational age which may result in over-treatment or a delay in recognising subtle signs of deterioration.

Background Preterm infants and neonates with respiratory conditions commonly require intubation and conventional mechanical ventilation (CMV) to maintain airway patency and support their respiration. Whilst this therapy is often lifesaving, it simultaneously carries the risk of lung injury. The use of lung recruitment manoeuvres (LRMs) has been found to reduce the incidence of lung injury, and improve oxygenation and lung compliance in ventilated adults. However, evidence pertaining to their use in neonates is limited, and there is no consensus of opinion as to whether LRMs are appropriate or effective in this population. Objectives To determine the effects of LRMs on mortality and respiratory outcomes in mechanically ventilated neonates, when compared to no recruitment (routine care). Search methods We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 4) in the Cochrane Library, MEDLINE via Ovid (1946 to 13 April 2020), and CINAHL via EBSCOhost (1989 to 13 April 2020). We also handsearched the reference lists of retrieved studies to source additional articles. Selection criteria We included randomised controlled trials (RCTs), quasi‐RCTs and randomised cross‐over studies that compared the effect of LRMs to no recruitment (routine care) in mechanically ventilated neonates. Data collection and analysis Two review authors independently assessed trial eligibility, extracted data and evaluated risk of bias in the included studies. When studies were sufficiently similar, we performed a meta‐analysis using mean difference (MD) for continuous data and risk ratio (RR) for dichotomous data, with their respective 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of the evidence for key (clinically important) outcomes. Main results We included four studies (152 participants in total) in this review. Three of these studies, enrolling 56 participants, contributed data to our prespecified outcomes. Two studies enrolling 44 participants on CMV for respiratory distress syndrome compared a stepwise LRM with positive end‐expiratory pressure (PEEP) to routine care. Meta‐analysis demonstrated no evidence of a difference between the LRM and routine care on mortality by hospital discharge (RR 1.00, 95% CI 0.17 to 5.77; low‐certainty evidence), incidence of bronchopulmonary dysplasia (RR 0.25, 95% CI 0.03 to 2.07; low‐certainty evidence), duration of supplemental oxygen (MD ‐7.52 days, 95% CI ‐20.83 to 5.78; very low‐certainty evidence), and duration of ventilatory support (MD ‐3.59 days, 95% CI ‐12.97 to 5.79; very low‐certainty evidence). The certainty of the evidence for these outcomes was downgraded due to risk of bias, imprecision, and inconsistency. Whilst these studies contributed data to four of our primary outcomes, we were unable to identify any studies that reported our other primary outcomes: duration of continuous positive airway pressure therapy, duration of neonatal intensive care unit stay, and duration of hospital stay. The third study that contributed data to the review enrolled 12 participants on CMV for respiratory and non‐respiratory causes, and compared two different LRMs applied after endotracheal tube suctioning to routine care. It was determined that both LRMs may slightly improve end‐expiratory lung volume at 120 minutes' post‐suctioning, when compared to routine care (incremental PEEP LRM versus routine care: MD ‐0.21, 95% CI ‐0.37 to ‐0.06; double PEEP LRM versus routine care: MD ‐0.18, 95% CI ‐0.35 to ‐0.02). It was also demonstrated that a double PEEP LRM may slightly reduce mean arterial pressure at 30 minutes' post‐suctioning, when compared with routine care (MD ‐16.00, 95% CI ‐29.35 to ‐2.65). Authors' conclusions There is insufficient evidence to guide the use of LRMs in mechanically ventilated neonates. Well‐designed randomised trials with larger sample sizes are needed to further evaluate the potential benefits and risks of LRM application in this population.

As of the 31st July 2020, more than 17 million confirmed COVID-19 cases with over 668k deaths have been reported worldwide (World Health Organisation (WHO), 2020). The COVID-19 virus is genetically similar to the Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS) (Schmidt, Davids, & Malinga., 2020; Zhao et al., 2020). However, initial investigations of the basic reproduction number (Ro) of COVID-19 shows higher transmissibility than SARS and MERS (Zhao et al.,2020). The mode of transmission of COVID-19 is mainly through close contacts via droplets from human to human (World Health Organisation (WHO), 2020). Whilst researchers around the world are focused on developing a vaccine for COVID-19, transmission preventative measures become the most effective means of response.

In Australia, a national approach to accreditation of programs and regulation of health professions was adopted a decade ago. Accreditation standards and regulatory frameworks can drive change and provide support for interprofessional education and collaborative practice. There is a commonly held belief among Australian academics involved in health professional education, that accreditation and practice standards provide system-level support for interprofessional education and interprofessional collaborative practice. Using a purpose-designed analysis framework and scoring scheme, we analyzed standards of accreditation and practice for 29 regulated, self-regulated and member health professions in Australia to determine the extent and accountability of statements related to interprofessional education and interprofessional collaborative practice. Currently, in Australia, there is a fragmented and inconsistent approach to interprofessional education and interprofessional collaboration evident in accreditation and practice standards and, in general, there are more explicit requirements in standards of the regulated health professions. However, overall the concepts of interprofessional education and interprofessional practice are ill-defined and statements lack accountability and/or outcome measures. Our analysis provides a foundation for reform of Australian standards and an approach for analysis of accreditation and practice standards which may be useful in other jurisdictions.

Background: Simulation is potentially a means of increasing clinical education capacity. Significant investments have been made in simulation but the extent to which this has improved uptake, quality and diversity of simulation use is unclear. Aim: To describe the current use of simulation in tertiary nursing education programs leading to nurse registration Australia and New Zealand, and determine whether investments in simulation have improved uptake, quality and diversity of simulation experiences. Methods: A cross sectional electronic survey distributed to lead nursing academics in programs leading to nurse registration in Australia and New Zealand. Findings: 51.6% of institutions responded and reported wide variation in allocation of program hours to clinical and simulation learning. Simulation was embedded in curricula and positively valued as an adjunct or substitute for clinical placement. While simulation environments were adequate, staff time, training and resource development were barriers to increasing the quality, amount and range of simulation experiences. Quality assurance and robust evaluation were weak. Discussion: Simulation program hours are inconsistently reported and underutilized in terms of potential contribution to clinical learning. Benefits of capital investment in simulation physical resources have been realised, but barriers persist for increasing high quality simulation in nursing programs. Conclusion: Transitioning components of clinical education from the clinical to tertiary sectors has resource implications. Establishment of sustainable, high quality simulation experiences requires staff training, shared resources, best practice and robust evaluation of simulation experiences in nursing curricula. Refereed/Peer-reviewed

Background: Elevated sound levels and low language exposures of preterm infants (< 37 weeks) cared for in the neonatal unit contribute to poorer growth, cognition, language and motor outcomes. These delays can have lasting effects on childhood development and continue throughout adult life. Whilst recommendations have been established for appropriate sound exposure levels in neonatal units, very little is known about the optimal level of language exposure. Objectives: To examine the evidence regarding language exposure, both measured (observational) and prescribed (interventional), in preterm infants (< 37 weeks) cared for in neonatal units and to identify optimal exposure levels to promote neurodevelopment. Search Methods: An electronic search of English-language articles with an open date range was conducted in the PubMed, MEDLINE, Joanna Briggs, CINAHL and Cochrane databases and in Google Scholar. The criteria were limited to original research studies of preterm infants (< 37 weeks) in which language was either measured as it naturally occurred in the neonatal unit environment or through a language intervention. Results: The search produced a total of 2,367 articles, 49 of which were related to language. A full-text review of these articles identified 10 eligible studies and 6 studies from reference searches. Conclusions: Preterm infants experience low levels of language exposure and high sound exposures in neonatal units. There is a lack of conclusive evidence to recommend an optimal level of language exposure to support improved neurodevelopmental outcomes in preterm infants. Further research from large, good-quality clinical trials is required before clear direction can be provided to inform clinical practice.

Context The birth process and the moments thereafter are a crucial time for newborns as they adapt to extra uterine life. The adaptive process begins immediately and can take a number of days to complete. The process involves initiating and maintaining respirations, thermoregulation, and the change from foetal circulation to newborn circulation. The majority of newborns successfully adapt to extra uterine life, some experience difficulty. Early warning tools may assist clinicians identify early signs of failure to adapt and/or deterioration but these are dependent on ‘ Normal' vital sign reference ranges for triggering an escalation of care. Age-matched early warning tools may improve the sensitivity of tools. Objective To identify physiological vital sign reference ranges for newborns ≥34 weeks gestation from two hours of age. Design Systematic Review. Data sources Between August 2016 and January 2017, PubMed, CINAHL, Embase, The Cochrane Library databases, and conference abstracts were searched for primary studies published between 1946 and 2017. Reference lists of retrieved articles were reviewed for potential studies. Review methods Primary studies published in English that reported physiological vital sign reference ranges pertaining to well newborns born from 34 weeks gestation were selected. Two authors independently assessed eligibility of studies for inclusion. Titles and abstracts were matched with the inclusion criteria: studies investigating heart or respiratory rate, temperature, blood pressure and oxygen saturations in well newborns greater than 34 weeks gestational age. Assessment of quality and grading of level of evidence were assessed using National Health and Medical Research Council level of Evidence Hierarchy Table and the Quality Assessment Tool for Quantitative Studies. Any disagreements were resolved by consensus. Data were extracted by two reviewers. Results A total of 1497 primary studies were retrieved. Following screening and removal of duplicates and screening, 10 primary studies investigating heart rate (n=1), respiratory rate (n=1), temperature (n=1), blood pressure (n=4) and oxygen saturations (n=3) were eligible for inclusion in this review. The populations studied included term (n=6) or both preterm and term newborns (n=4). No reference ranges for any vital sign measurements could be identified from the included literature. In addition, inconsistencies between vital sign parameters of newborns were identified between the studies. Conclusion There is paucity of normal vital sign data in the late preterm >34 weeks and post term gestational age cohorts despite literature suggesting differences in physiological maturity between these cohorts.

Objective Respectful maternity care is a pervasive human rights issue, but little is known about its realisation in Australia. Two scales, developed in North America, measure key aspects of respectful maternity care: the Mothers on Respect Index and Mothers Autonomy in Decision Making scale. This study aimed to validate these two scales in Queensland, Australia, and to determine the extent to which women currently experience respectful maternity care and autonomy in decision making. Design A sequential two-phase study. A focus group reviewed the scales, made adaptations to scale items and completed a Content Validation Survey. The Respectful Maternity Care in Queensland survey, comprising the validated Australian scales and demographic questions was distributed online in early 2020. Setting Queensland, Australia. Participants Focus group involved women (n=10) who were aged over 18, English-speaking, and had given birth during the preceding two years. All women who had birthed in Queensland between September 2019 and February 2020, were eligible to participate in the cross-sectional survey. 161 women participated in the survey. Measurements and findings Item content validity (>0.78) was established for all but one item. Scale content validity was established for both scales (0.92 and 0.99 respectively). Survey participants (n= 161) were mostly married/partnered (95%), heterosexual (93%), tertiary educated (47%), Caucasian (88%), and had experienced a range of maternity models of care. Median scores on each scale (74 and 26 respectively) indicated that participants felt well respected and highly autonomous. Free-text comments highlighted the importance of relationship-based care. Key conclusions Both scales appear valid for use in Australia. Although most participants reported high levels of respect and autonomy, the proportion of participants who had experienced continuity of midwifery care was also high. Implications for practice Both scales could be routinely deployed as patient reported experience measures in Australia, broadening the data that informs maternity service planning and delivery.

Background E-simulation may enable a feasible education solution to the management of deteriorating patients. Method The study involves a pre–post quasi-experimental evaluation of global data on educational outcomes from an e-simulation program. Results Qualified nurses (n = 1,229) and final year nursing students (n = 1,742) were among 5,511 participants from 20 countries who completed the program. Both groups' knowledge and performance improved significantly (p = Conclusion E-simulation may enhance students' preparation for practice and improve qualified nurses' management of deteriorating patients.

Background Standardised pain assessment i.e. the McGill Pain Questionnaire provide an elicited pain language. Midwives observe spontaneous non-elicited pain language to guide their assessment of how a woman is coping with labour. This paper examined the labour pain experience using the questions: What type of pain language do women use? Do any of the words match the descriptors of standardised pain assessments? What type of information doverbal and non-verbal cues provide to the midwife? Methods A literature search was conducted in 2013. Studies were included if they had pain as the primary outcome and examined non-elicited pain language from the maternal perspective. A total of 12 articles were included. Findings: The analysis revealed six categories in which labour pain can be viewed: ‘positive’, ‘negative’, ‘physical’, ‘emotional’, ‘transcendent’ and ‘natural’. Women’s language comprised i.e. prefixes and suffixes, which indicate the qualities of pain, and figurative language. Language indicated location of pain, gave insight into other life phenomena i.e. death, and shared similarities with standardised pain assessmentdescriptors. Labour cues were ‘functional’, ‘dysfunctional,’ or ‘neutral’ (part of the physiological childbirth process), and were verbal, non-verbal, emotional, psychological, physical behaviour or reactions, or tactile. Conclusion Labour can bring about a spectrum of sensations and therefore emotions from happiness and pleasure to suffering and grief. Spontaneous pain language comprises verbal language and non-verbal behaviour. Narratives are an effective form of pain communication in that they provide details regarding the quality, nature and dimensions of pain, and details notcaptured in quantitative data.

ObjectivesTo measure the internal and external light exposure of incubators and open cots in an Australian single-room configured neonatal unit and compare findings to current recommendations.MethodsLight meters were placed in the internal and external environment of incubators and open cots within occupied single rooms in a tertiary-level neonatal unit between 15 September and 28 October 2015. Data were recorded in one-second increments over a minimum of 48 hours per room.ResultsInternal median light in incubators and open cots predominantly fell below 50 lux, with low amplitude diurnal cycling. Incubator covers substantially reduced external light exposure, contributing to very low light conditions (ConclusionsOverall, light levels fell predominantly below 50 lux with peak periods of extreme light exposure. Low amplitude cyclic light was evident, but it remains unknown if this is sufficient to produce an effect on circadian entrainment, especially in preterm neonates. Current guidelines do not stipulate optimal cyclic light levels in neonatal units to promote circadian rhythms in the newborn population. Further research to determine well-defined lighting parameters for neonates of different gestations is paramount.

In midwifery we espouse a woman centred care approach to practice, yet in midwifery education no valid instrument exists with which to measure the performance of these behaviours in midwifery students.To develop and validate an instrument to measure woman centred care behaviours in midwifery students.We identified four core concepts; woman's sphere, holism, self-determination and the shared power relationship. We mapped 18 individual descriptive care behaviours (from the Australian National Competency Standards for the Midwife) to these concepts to create an instrument to articulate and measure care behaviours that are specifically woman centred. Review by expert midwifery clinicians ensured face, content and construct validity of the scale and predictive validity and reliability were tested in a simulated learning environment. Midwifery students were video recorded performing a clinical skill and the videos were reviewed and rated by two expert clinicians who assessed the woman centred care behaviours demonstrated by the students (n=69).Test and re-test reliability of the instrument was high for each of the individual raters (Kappa 0.946 and 0.849 respectively p0.001). However, when raters were compared there were differences between their scores suggesting variation in their expectations of woman centred care behaviours (Kappa 0.470, p0.001). Midwifery students who had repeated exposures to higher levels of simulation fidelity demonstrated higher levels of woman centred care behaviours.The WCCS has implications for education and the wider midwifery profession in recognising and maintaining practice consistent with the underlying philosophy of woman centred care.

Postnatal care is best provided in primary health care settings, yet Practice Nurses (PNs) lack relevant training and report difficulty in providing postnatal care.To evaluate the feasibility of a pilot educational intervention in improving PN competence and confidence to care for mothers and infants in the first postnatal year.A feasibility study.PNs were recruited from selected general practices Queensland, Australia to undertake the pilot educational intervention that included a pre-intervention survey, two-day education program, program evaluation and completion of a practice journal.Thirteen PNs from three general practices participated, with 31% completing all study components. Evaluation of the intervention was positive and all participants reported increased confidence and competence in providing postnatal care. Following detailed consideration of feasibility (process, resource, management and scientific assessment) we propose that changes to intervention delivery and data collection should be incorporated into a larger trial.

Mujeres que dan a luz pueden transmitir una reaccion cultural al dolor. Cuanto mas distancia cultural hay entre una mujer y su matrona mayor es la posibilidad de una interpretacion erronea de su experiencia del dolor de parto. Este articulo examina las creencias, influencias y practicas del parto que contribuyen al entendimiento transcultural del dolor. Se realizo una busqueda de la literatura en abril de 2013. Fueron incluidos doce estudios lo cuales tuvieron el dolor como un resultado principal y examinaron el idioma del dolor no provocado (es decir, el idioma natural que no esta obtenido por la evaluacion estandarizada del dolor) de la perspectiva materna. Los resultados linguisticos fueron presentados en otro articulo anterior. En cambio, este articulo presenta los resultados culturales usando un marco de ciencia social aplicada para reflexionar sobre el nexo del dolor y la cultura dentro de la comunicacion del dolor y el desarrollo de una practica culturalmente sensible. Los estudios representaron creencias y practicas del parto compartidos por la cultura africana, asiatica, europea, norteamericana y sudamericana que esta atribuido – en parte – a los factores fisiologicos comunes del parto. El parto puede estar impactado por los factores ‘internos’: las reacciones y actitudes del dolor, la religion y espiritualidad, las definiciones y significaciones del dolor, la ansiedad, la aceptacion y tolerancia del dolor, la conceptualizacion de la maternidad, la psicologia, y las creencias sociales; los factores externos pueden incluir el ambiente (entorno fisico u contexto del parto) y el modelo de atencion. La interpretacion de estas creencias puede estar influenciada por el desarrollo de competencia cultural de la matrona. Observar los patrones culturales ofrece a las matronas unos lentes culturales, a traves, de los modelos de atencion (ej. tecnocratico, humanista, holistico) para entender mejor la experiencia del dolor de la mujer, para reflexionar sobre la interpretacion transcultural del dolor y para desarrollar la competencia transcultural.

Background The purpose of regulation of health professionals is public protection. Concerns regarding professional conduct or midwifery care can lead to clinical investigation. Midwifery literature reveals midwives feel ill-equipped and unprepared for clinical investigation and experience stress and abreaction. Aim To explore the lived experience of clinical investigation and identify the personal and professional impact on Australian midwives. Method Semi-structured interviews of a purposive sample of Australian midwives. Data analysis was informed by a phenomenological conceptual framework derived from Husserl, Heidegger and Merleau-Ponty. Findings Twelve midwives were interviewed, with seven under current investigation. Discussion involved personal and professional experiences of three or more investigations each, over a period of three to five years. Most investigations were instigated by hospitals with two complaints from women. Seven participants were alleged negligent following adverse neonatal outcomes and five had misconduct allegations. Midwives were employed or in private practice and half provided homebirth services. Themes included being safe, being connected, time and being, perception and well-being. Discussion The investigative process involves different health services, state and national bodies using varying powers and processes over protracted time periods. Participants discussed aspects such as disrespect, inequity, powerlessness, silence and ostracization. Midwives who successfully navigated clinical investigation developed resilience through reflection on clinical practice in a culture of safety. Conclusion The process of regulating midwives, designed to protect the Australian public, may be harming investigated midwives. Understanding the personal and professional impact of clinical investigation needs to underpin midwifery education, clinical practice, inform policy and regulatory reform.

Background Knowledge provides a foundation for safe and effective nursing practice. However, most previous studies have focused on exploring nursing students' self-reported perceptions of, or confidence in, their level of patient safety knowledge, rather than examining their actual levels of knowledge. Objective The overarching objective of this study was to examine final year nursing students' levels of knowledge about key patient safety concepts. Design A cross-sectional design was used for this study. Data collection was undertaken during 2018 using a web-based patient safety quiz with 45 multiple choice questions informed by the Patient Safety Competency Framework for Nursing Students. A Modified Angoff approach was used to establish a pass mark or ‘cut score’ for the quiz. Setting and participants Nursing students enrolled in the final year of a pre-registration nursing program in Australia or New Zealand were invited to participate in the study. Results In total, 2011 final year nursing students from 23 educational institutions completed the quiz. Mean quiz scores were 29.35/45 or 65.23% (SD 5.63). Participants achieved highest scores in the domains of person-centred care and therapeutic communication, and lowest scores for infection prevention and control and medication safety. Based on the pass mark of 67.3% determined by the Modified Angoff procedure, 44.7% of students (n = 899) demonstrated passing performance on the quiz. For eight of the institutions, less than half of their students achieved a passing mark. Conclusions Given the pivotal role that nurses play in maintaining patient safety, the results from this quiz raise important questions about the preparation of nursing students for safe and effective clinical practice. The institutional results also suggest the need for increased curricula attention to patient safety.

Maternal tobacco smoking is a recognized risk behavior that has adverse impacts on maternal and fetal health. However, in some populations, the use of smokeless tobacco exceeds the use of smoked tobacco. In central Australia, Aboriginal populations utilize wild tobacco plants (Nicotiana spp.) as a smokeless product. These plants are known by a variety of names, one of which is pituri. The plants are masticated and retained in the oral cavity for extended periods of time and their use continues throughout pregnancy, birth, and lactation. In contrast to the evidence related to combusted tobacco use, there is no evidence as to the effects of pituri use in pregnancy. Central Australian Aboriginal women who were at least 28 weeks pregnant were stratified into three tobacco exposure groups: (a) Pituri chewers, (b) smokers, and (c) non-tobacco users. Routine antenatal and birth information, pre-existing and pregnancy-related maternal characteristics, fetal characteristics, and biological samples were collected and compared. The biological samples were analysed for tobacco and nicotine metabolite concentrations. Samples from the mother included venous blood, urine, hair and colostrum and/or breast milk. From the neonate, this included Day 1 and Day 3 urine and meconium, and from the placenta, arterial and venous cord blood following delivery. This is the first study to correlate the pregnancy outcomes of central Australian Aboriginal women with different tobacco exposures. The findings will provide the foundation for epidemiological data collection in related studies. Note to readers: In this article, the term “Aboriginal” was chosen by central Australian women to refer to both themselves and the Aboriginal people in their communities. “Indigenous” was chosen to refer to the wider Australian Aboriginal and Torres Strait Islander people.

A scoping review aims to systematically explore and map the research available from a wide range of sources. The objective of this study was to produce a scoping review checklist to guide future scoping studies to enable rigorous review and critique of phenomena of interest. The methods used included a review of literature, expert consensus group meetings, a modified Delphi survey and, finally, verification against recent scoping study examples. Results showed that the checklist was able to identify key elements of scoping reviews. The 22-item Scoping Review Checklist (SRC), which includes two optional stakeholder consultation items, has been developed using rigorous recommended approaches. The checklist can be used to guide the conduct and critique of scoping studies. Refereed/Peer-reviewed

Objective The objective of this review is to explore, review and synthesize the empirical literature that reports on the concept of woman centred care. Design Integrative review of the empirical literature on the concept of woman centred care. Data sources A comprehensive search strategy was conducted using the phrase ‘woman-centred care’ ‘women-centred care’ (and all associated spelling variants) in the relevant databases including PubMed, Cumulative Index to Nursing and Allied Health, Intermid, Scopus, Informit and Web of Science. A concurrent search using the phrase ‘patient-centred care’ (and associated spelling variants) was also conducted, to ensure all studies about care of a woman in pregnancy, labour and postpartum were captured. Review method A comprehensive five stage integrative review methodology was used to review primary studies which addressed woman-centred care as either an intervention or an outcome. The quality of included studies was assessed using the appropriate Critical Appraisal Skills Programme tool. Results Initial searching located 1205 papers. Seventeen studies met the inclusion criteria (qualitative n=12 and quantitative n=5). The studies were conducted in Australia (n=5), Ireland (n=1), Japan (n=2), Netherlands (n=2), New Zealand (n=1), South Africa (n=1), Sweden (n=1), Switzerland (n=1), United Kingdom (n=1), and the United States of America (n=2). The quality of the studies varied. NVivo software was employed to abstract and synthesize the data. Analysis revealed 10 subthemes synthesized under three pre-determined main themes of clinical practice (choice and control, empowerment, protecting normal birth, relationships and the individual midwife), maternity service (model of care, continuity of care and maternity care systems) and education (registered practitioners and student midwives). Conclusions This review integrates the empirical literature to illuminate the concept of woman-centred care as it currently applies to clinical practice, maternity service, and education. The concept of woman- centred care is intertwined in the themes and subthemes identified in the studies. There is wide variation in how woman-centred care is interpreted and this contributes to the confusion and tokenism with which it is discussed in health policy documents and frameworks. Further research is also warranted in the development of a universal definition of woman-centred care and in how woman-centred care behaviours are developed in practitioners.

To explore the potential of mobile eye-tracking to identify healthcare students' area of visual interest and its relationship to performance ratings.Eye-tracking identifies an individual's visual attention focus, and has been used as a training technique in medicine and in nursing. In this study participants wore a point of view (PoV) camera within a spectacle frame during simulation education experiences.Thirty-nine final year nursing and paramedicine students individually participated in three 8 minute clinical simulations with debriefing using videoed eye-tracking recordings. Coloured dots on the video depicted the participant's pupil fixation on five targeted areas. Data extracted from the video camera were collated to report time spent on each target (their 'gaze').The mean total gaze of expert designated targets in the environment for three 8 minute scenarios was 40-77%. Of 35 participants' focus on three main areas of interest, their priority was the patient's head (34%), the patient's trunk (24%) and their clinical assistant (5%), with significant differences between nursing and paramedic disciplines (P 0.05). Objectively rated clinical performance improved significantly by the third scenario (P ≤ 0.001). Participants were positive regarding use of eye tracking during debriefing.Eye tracking has the potential to enhance debriefing and educational outcomes, although there are limitations to gaze capture in high fidelity environments and resource cost is high. Further study is warranted to enable better understanding of how expert clinicians achieve high levels of performance.

OBJECTIVE:To provide a critical and interpretive review of the literature to investigate examples of pain assessment tools used in a childbirth context. Through these examples of pain assessment, the concept of elicited verbal pain language is introduced and explored.METHODS:Electronic search strategies were used to identify primary research regarding maternal reports of pain (during labor, postpartum and retrospectively), which were captured by standardized pain assessment tools.FINDINGS:The review revealed the physiological (the sensory and affective dimensions of pain, the intensity of pain, and the influence of parity on pain perception), psychological (the influence of maternal attitude, mood, and memory on pain perception), and ethnocultural (the impact of the ethnocultural context on pain perception) components of the pain experience. The strengths and limitations of pain assessment tools are highlighted. There were similarities in the reviewed studies’ approaches to pain assessment despite the cross-cultural representation of birth. Possible implications for cross-cultural pain assessment and communication are outlined.CONCLUSION:The question remains regarding the appropriateness of implementing standardized pain assessment tools across birth context. An ongoing critique of pain assessment may inform the provision of better care overall for birthing women in multicultural societies.

OBJECTIVE: The purpose of this article was to examine childbirth (labor) pain language through an analysis of the McGill Pain Questionnaire (MPQ) descriptors.METHOD: Language was extracted from 6 studies which used MPQ descriptors (and originally formed part of a larger interpretive review of pain assessment). MPQ descriptors are considered rich language data because they provide insight into the different qualities and dimensions of pain. An applied linguistic approach, which examines language in its real world context (in this instance, childbirth and midwifery) was used to analyze maternal language.FINDINGS: The MPQ descriptors conveyed sensory, affective, evaluative, and miscellaneous dimensions of the labor pain experience. Words were classified according to the semantic category of the descriptors (the associated meanings of pain words), parity, stage of labor, and the location of pain. Generalizations cannot be made from this small sample of maternal language; however, this analysis provides an introduction to maternal MPQ descriptors and gives insight into a possible association between maternal MPQ descriptors and words which may be used to represent other female pain events.CONCLUSION: The descriptors analyzed in this article revealed a rather homogeneous language; yet, they provided insight into the qualities and intensity of labor pain across women of different parity. Pain can be quantified in a numeric-verbal language, but the use of a pain measurement tool alone may lead to assumptions or underestimations of the individual nature of a woman’s labor, which may impact on her pain management. An acknowledgment of a woman’s labor as intimate and emotive is also needed, which is captured in the spontaneous language of her own account of labor.

Maternal mental health during pregnancy has been identified as a key factor in the future physiological, emotional and social development of both the mother and her baby. Yet little is known about the factors that contribute to increased levels of pregnancy-specific distress. The present study investigated the role of two psychosocial and personality-based constructs, namely women's sense of coherence (SoC) and their mothering orientations, on their pregnancy-specific distress.During their second trimester of pregnancy, 293 Australian and New Zealand women participated in an online study. Hierarchical multiple regression analysis was used to determine the unique contribution of women's SoC (Sense of Coherence Scale, SoC 13) and their antenatal mothering orientation (Antenatal Mothering Orientation Measure-Revised, AMOM-R) to pregnancy-specific distress (Revised Prenatal Distress Questionnaire, NuPDQ).Low SoC was the best determinant of women's pregnancy-specific distress, accounting for over 45% of the variance (β = -0.33, p 0.001, 95% CI [-0.43, -0.23]). A Regulator mothering orientation was correlated with distress but did not have a unique contribution in the final model.This study further highlights the importance of better understanding women's perceptions of emotional health and their mothering role while taking into consideration their wider social context.

Professors of nursing and midwifery are recognized as discipline leaders and thus have a key role to play in the development of disciplinary knowledge, especially through their research activity. Watson and Thompson (2008) paraphrased the research and scholarship roles of the professoriate, from the UK National Conference of University Professors, as a requirement to “maintain individual authoritative industry in scholarship and research” (p 981). This article is protected by copyright. All rights reserved.

Clinical simulation has changed significantly over the last three decades. The introduction of virtual simulation programs enables safe repetition of practice in standardized scenarios that, if rigorously developed, can support validity and reliability. This chapter focuses on enhancing rigor across the five stages of development of virtual simulation programs, drawing on our experience of developing a patient deterioration management program known as Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends. The program includes background educational materials, precourse and postcourse knowledge tests, and three interactive management scenarios (acute myocardial infarction [AMI], hypovolemic shock, and chronic obstructive pulmonary disease). The chapter helps the reader to assess approaches to enhancing rigor in the development, implementation, and evaluation of virtual simulation and appreciate the importance of and steps necessary to trialling a virtual simulation prior to full integration with an established curriculum.

Background The complexity and variation in ventilator associated pneumonia (VAP) definitions in paediatrics may pose threats to the reliable identification of VAP. The revision of the surveillance definition to ventilator-associated event (VAE) has been mandated in adult populations, to overcome these issues. However, the evidence for application of the definition is unknown in children. Objectives To review the evidence on the application of the new VAE surveillance definition in paediatric population and examine the potential challenges in clinical practice. Review methods A systematic approach was used to locate and synthesise the relevant paediatric literature. Studies were appraised according to epidemiological appraisal instrument (EAI) and the grades of evidence in the National Health Medical Research Council (NHMRC) guidelines. Results Seven studies met the inclusion criteria. Quality of study methods was above 50% on the EAI. The overall grade of evidence was assessed as C (satisfactory). The incidence of VAE in children ranged from 1.1 to 20.9 per 1000 ventilator days as a result of variations in surveillance criteria across included studies. There is little agreement between the new VAE and PNU/VAP surveillance definition in the identification of VAP. Challenges in the application of VAE surveillance were related to; the difference in modes of ventilation used in children versus adults, inconclusive criteria tailored to paediatric samples and a lack of data that support for automatic data extraction applied in paediatric studies. Conclusion This review demonstrated promising evidence using the new VAE surveillance definition to define the VAE in children, but the level of the evidence is low. Before the possibility of real implementation in clinical settings, challenges related to VAE paediatric specific criteria’ and the value of automated data collection need to be considered.