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To manage the COVID-19 pandemic, public health restrictions and a rapid pivot to telehealth occurred. Peripartum services were significantly affected by a strained infrastructure. Decreased face to face access to health services and support affected maternal experiences and confidence internationally, yet little was reported with the Australian and Aotearoa New Zealand context.To explore the early parenting and infant feeding experiences of new mothers from Australia and Aotearoa New Zealand in the context of a pandemic.An interpretive qualitative approach and thematic analysis obtained an in-depth understanding of the experiences of 27 mothers who gave birth during the first wave of the COVID-19 pandemic in 2020.Australian and Aotearoa New Zealand women reported similar experiences, which varied contextually. Restrictions and requirements impacted favourably and unfavourably. Many women found the peace and space of social distancing an unexpected benefit and were proud of their achievements, whilst others shared feelings of isolation and distress. Some women felt they instinctively did what they needed to do. Experiences correlated with differing levels of self-efficacy.While many women relished the freedom from social obligations when faced with feeding challenges, there was general dissatisfaction with the level of support available. Care was fragmented, and health care needs were unmet, impacting feeding and parenting decisions and mental health.Access to timely and appropriate professional support is an important factor in establishing breastfeeding and developing parenting confidence, particularly in the context of a pandemic and should be a health policy priority.

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.

Intimate partner violence (IPV) is a prolific and growing issue that can have long-lasting negative consequences for the health and safety of those involved. Bystander intervention is one method for helping to combat incidents of IPV, as research suggests that bystanders are frequently present at the scene of assaults and incidents of IPV. This study explored individual differences of bystanders that may influence whether they decide to intervene in an unfolding incident of IPV, as well as how the likelihood of intervening may vary as a function of the apparent gender or sexual orientation of the individuals involved in an incident of IPV. Participants were recruited from an online survey platform to obtain a balanced sample of heterosexual and sexual minority individuals. Participants completed a bystander task where they listened to an audio vignette of an unfolding IPV incident and were instructed to stop the audio if/when they would intervene in a real-life context. Participants were randomly assigned to listen to one of four versions of the vignette in which the apparent gender of the aggressor and victim were manipulated. Results revealed participants were more likely to intervene if they identified as a sexual minority (vs. as a heterosexual), reported less rape myth acceptance, or had greater endorsement of gender equality. Results also revealed that associations between bystander characteristics and intervening behavior largely did not differ across vignette conditions, suggesting that they may influence the likelihood of intervening consistently across incidents of IPV regardless of the apparent gender and sexual orientation of the aggressor and victim. However, participants in general were most likely to intervene in the male aggressor/female victim vignette. Implications for IPV prevention programming—including the need to include more diverse and less heteronormative depictions of IPV—are discussed.

Background Restriction of food and fluids during labour increases women’s discomfort, anxiety and stress which are associated with obstruction of the normal process of labour. Whilst research evidence and clinical guidelines recommend that normal uncomplicated labouring women should not be limited in their oral intake during labour, some midwives continue to restrict or discourage women’s oral intake. To promote best practice, it is important to understand the influencing factors which affect midwives’ decision-making processes. Objective This study aimed to investigate the influences that affect midwifery practice regarding oral food and fluid intake for low-risk labouring women. Design An interpretive descriptive approach employed 12 semi-structured interviews with registered midwives with current labour and birthing experience in Australia. Data was analysed using thematic analysis. Findings Three themes were identified: midwives’ knowledge and beliefs; work environment and women’s expectations of care. Midwives’ practice was affected by their knowledge and values developed from professional and personal experiences of labour, their context of practice and work environment, the clinical guidelines, policies and obstetric control, and women’s choice and comfort. Conclusion This study indicates that midwives’ decision-making in relation to women’s oral nutrition during labour is multifaceted and influenced by complicated environments, models of care, and power relations between doctors and midwives, more so than clinical guidelines. It is important for midwives to be aware of factors negatively influencing their decision-making processes to enable autonomy and empowerment in the provision of evidence-based care of labouring women.

Background Acupuncture during pregnancy and the perinatal period aims to increase normal birth and enhance a woman’s birth experience by decreasing intervention and adverse birth outcomes. Acupuncture in Australian maternity services has not been well accepted, and there is limited research evidence as to whether women are supportive of acupuncture treatment. Objective The aims of this study were to understand childbearing aged women’s attitudes, beliefs and practices to using acupuncture during pregnancy and the perinatal period, and possible acceptance of a midwife providing acupuncture treatments. Design A descriptive/explorative quantitative methodology was used to gather data from childbearing aged women using an online survey. Statistical analysis was used for quantitative data and content analysis for the free-text responses. Recruitment of respondents took place in 2017 via Facebook birth and parenting groups and pages. Findings Of 304 respondents, 68% (n = 206) had used acupuncture, and of these, 68% (n = 140) used acupuncture for concerns during pregnancy and the perinatal period. The majority of respondents indicated they would consider acupuncture during pregnancy and the perinatal period (89%) and 62% indicated they would have a midwife provide a treatment. The free-text responses provided mostly positive comments on the outcomes and satisfaction of acupuncture treatments (84% n = 199). Conclusion The majority of respondents would consider acupuncture during pregnancy and the perinatal period, were positive to trying acupuncture for various concerns, and were positive towards a midwife providing treatments. These findings raise awareness of women’s desire for the choice of an acupuncture treatment during pregnancy and the perinatal period.

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.

Background High infant mortality remains a global health problem, particularly in less developed countries. Indonesia has one of the highest infant mortality rates in Southeast Asia. Known factors relate to documented medical conditions and do not necessarily explain their origin. Aim To identify and explore factors that contribute to infant mortality in Papua, Indonesia, through the lens of health workers’ perceptions. Methods A qualitative descriptive approach using semi-structured interviews was used. Twelve Indonesian health workers participated. Interviews were audio-recorded and transcribed, and then analysed thematically. Findings Five main themes were generated: beliefs and practices related to pregnancy, birth, and infants; infant health factors; maternal health factors; barriers to seeking, receiving and providing infant health care; and enablers and strategies for improving infant health. Discussion Cultural factors were perceived as contributing to poor health outcomes by shaping decisions, help seeking behaviour and health care access. Poverty, health literacy, road access and transport, shortage of health staffing, and health equipment and medicines exacerbate poor health outcomes. Conclusion Cultural knowledge and sensitivity are central to the provision and acceptance of health care by local families in Papua, Indonesia. Recommendations include: improving cultural sensitivity and cultural safety of service; implementing community health promotion to enhance maternal and infant health; improving community participation in health care planning and delivery; and enhancing collaboration between national, provincial, regency and local governments.

Clinical placement is a core feature of Australian midwifery education programs, with clinical supervision acknowledged as a key component for student success. The aim of this study was to evaluate the clinical facilitation models in South Australia, specifically the quality of clinical supervision to facilitate learning, and key stakeholder satisfaction. A mixed method evaluation research design was used to compare three models of clinical facilitation for midwifery students undertaking clinical placement across five venues. Midwifery students (n = 174), across two universities completed an anonymous e-survey utilising the validated Clinical Placement Experience Questionnaire. Midwives (n = 149) across five venues completed an anonymous purpose-designed questionnaire on their experience providing clinical supervision to midwifery students and Clinical Facilitators (n = 8) representing three facilitation models completed a self-report e-diary for two weeks and engaged in a focus group. Few differences were identified between the quality of student support and learning opportunities. Students in all models were well orientated and prepared for the clinical environment. Clinical Facilitators were supportive, educative and valuable for the students to achieve their learning objectives. One significant difference was that facilitators employed in the ‘Shared’ model were more able to provide support to midwives supervising students and maintain good liaison with the universities. Refereed/Peer-reviewed

s Background Continuity of Care Experiences are a mandated component of Australian midwifery programs leading to registration. Despite research evidence of the benefits of Continuity of Care Experiences for student learning and for women, there is limited evidence on the personal impact of this experience to students. Additionally, there is limited guidance on how to best support students to successfully complete this valuable component of their program. Objective To identify the emotional, psychological, social and financial costs of undertaking the Continuity of Care Experience component of a midwifery program and to provide information which may lead to educational strategies within CoCE aimed to improve student support and alleviate challenges. Design Using surveys and diary entries, a convergent parallel mixed methods approach was used to collect qualitative and quantitative data concurrently. Descriptive statistics were used to analyse financial cost, and clinical, travel and wait times. A constant comparative analysis was used for qualitative data about student's Continuity of Care Experiences. Integrative analysis was used to reconstruct the two forms of data. Setting Two Australian universities offering Bachelor of Midwifery programs. Participants Seventy students completed the demographic survey and 12 students submitted 74 diaries describing 518 episodes of care. There was a response rate of 18% recorded. Findings Analysis identified four themes: perception of Continuity of Care Experiences; personal safety; impact on self and family; and professional relationships. The mean time spent per completed experience was 22.20 hours and the mean cost was $367.19. Although students found Continuity of Care Experiences to be a valuable learning experience, they identified numerous factors including time, money, and personal circumstances that impacted on their ability to successfully meet the requirements. Implications for practice Continuity of Care Experiences are a highly valuable, but often challenging component of midwifery education in Australia. Using a model of social interdependence, students, educators and maternity care providers may engage better with the process and philosophies of CoCE.

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.

Background Immersive virtual reality is an advancing technology that has the potential to change the traditional pedagogical approaches to teaching tertiary nursing and midwifery students. The application of immersive virtual reality in nursing and midwifery education may be a novel, accessible method for information provision and skill acquisition, however little is known of the extent of immersive virtual reality technology integration into tertiary nursing and midwifery programs. Objectives The purpose of this review is to identify the application and integration of immersive virtual reality within nursing and midwifery tertiary education programs. Design A scoping review based on the Joanna Briggs Institute methodology for scoping reviews was undertaken. An a priori review protocol and eligibility criterion was developed with the protocol subject to review a posteriori following first round screening. An electronic search of ten databases was conducted in January 2018. Results A total of n = 506 non-duplicate records were identified and subjected to level one and level two screening. The search strategy and screening process identified n = 2 articles that were quality checked and included for review. Conclusions There is currently a paucity of quality published literature on the application and/or integration of immersive virtual reality into nursing and midwifery tertiary education. Immersive virtual reality has the potential to increase competence and confidence for students providing accessible and repeatable learning opportunities in a fail-safe environment. There is a need for educators to be involved in the conceptualisation, design, integration and research of immersive virtual reality technology into undergraduate nursing and midwifery programs.

Post-practicum is a time when students have an opportunity to share, compare and engage critically in considering how their clinical experiences impact on their learning and future roles as professionals. Reflective practice has merit in facilitating this process. This project aimed to enhance student’s capacity for reflective practice through reflective writing to optimise the learning potential of longitudinal practice-based midwifery experiences. A design-based approach was used to implement an educational intervention to enhance students’ reflective writing. Midwifery students at Griffith University were familiar with and had been using the Bass Model of Holistic Reflection for the previous 3 years. Students at Flinders University were unfamiliar with the model and through the project were provided with guidance and resources on its use to guide their post-practicum reflection. Students’ written reflections completed before and after the introduction of the model at Flinders University were evaluated and compared with the writing from students at Griffith University. Results show that Flinders University students’ scores pre-intervention ranked poorly as evidence of reflective capacity and were lower than the scores of their counterparts at Griffith University at the same time. Post-intervention, all Flinders University scores improved, whilst students from Griffith University, who had been using the Bass Model throughout their entire programme, demonstrated developmental improvement in their reflective capacity across time. Use of the Bass Model improved all components of reflective writing including self-awareness, awareness of sources of knowledge, reflection and critical reflection, evidence-informed practice and critical thinking. This project has demonstrated that use of the Bass Model improved student’s capacity to reflect on practice as evidenced through their writing and is a post-practicum pedagogy with the potential to enhance learning.

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.

Background Increasing global migration is resulting in a culturally diverse population in the receiving countries. In Australia, it is estimated that at least four thousand Sub-Saharan African women give birth each year. To respond appropriately to the needs of these women, it is important to understand their experiences of maternity care. Objective The study aimed to examine the maternity experiences of Sub-Saharan African women who had given birth in both Sub-Saharan Africa and in Australia. Design Using a qualitative approach, 14 semi-structured interviews with Sub-Saharan African women now living in Australia were conducted. Data was analysed using Braun and Clark’s approach to thematic analysis. Findings Four themes were identified; access to services including health education; birth environment and support; pain management; and perceptions of care. The participants experienced issues with access to maternity care whether they were located in Sub-Saharan Africa or Australia. The study draws on an existing conceptual framework on access to care to discuss the findings on how these women experienced maternity care. Conclusion The study provides an understanding of Sub-Saharan African women’s experiences of maternity care across countries. The findings indicate that these women have maternity health needs shaped by their sociocultural norms and beliefs related to pregnancy and childbirth. It is therefore arguable that enhancing maternity care can be achieved by improving women’s health literacy through health education, having an affordable health care system, providing respectful and high quality midwifery care, using effective communication, and showing cultural sensitivity including family support for labouring women.

Effective clinical supervision in midwifery programs leading to registration is essential to ensure that students can provide safe and competent woman centred care by the completion of their program. A number of different clinical supervision models exist in Australia and internationally, with varying levels of support and facilitation of student learning opportunities. In Australia, midwifery students must achieve specified learning outcomes and midwifery practice requirements to be eligible to register as a midwife. Identifying a best practice clinical supervision model for Australian midwifery students is therefore a priority for all key stakeholders, particularly education and maternity care providers. The aim of this literature review was to explore different types of clinical supervision models in order to develop and implement a best practice model in midwifery education programs. Refereed/Peer-reviewed

183 Background: Pediatric oncology (PO) patients with central lines (CLs) are at high risk for CL associated bloodstream infections (CLABSI), which increase morbidity, mortality, and costs. A large portion of ambulatory CL care in the home is provided by families who often have limited opportunities to develop the needed skills and adhere to best practice line care. Methods: A pilot quality improvement initiative was undertaken from 5/2015-6/2016 to develop a coaching program for families to demonstrate external CL care with a nurse during a routine clinic visit (teach-back), either on a simulation model or the patient. Tests of change were implemented to add teach-backs during routine clinic visits and ensure teach-back documentation in the medical record. Initial steps included assessing family interest in teach-backs by conducting surveys about CL care at home and unstructured incorporation into routine care by existing clinic nursing staff. After assessment of the pilot phase, targeted interventions started April 2016 including dedicated staff for scheduling, tracking, and performing teach-backs during routine clinic visits; culture change including an expectation that all families would participate and on-going staff education about the program; language change to increase participation by avoiding family perception of being tested; and incentives (gift-card raffle) for nurses to provide coaching. Results: Before April 2016, less than 25% of families participated due to a combination of family refusal; lack of nursing availability, space, or time; and inability to approach prior to line removal. In April 2016, 52% of families participated, reaching 90% by June 2016. Informal feedback from both staff and patient/family participants suggested increased job satisfaction by nurses and wide acceptance by all. In addition, many families participated in multiple teach-back sessions to improve line care skills. Conclusions: A CL teach-back program in a busy ambulatory PO clinic is feasible, but requires dedicated resources and culture change. Ongoing improvements are in place to ensure sustainability of the program and measure the impact on ambulatory CLABSI rate and family distress and line care skills.

Introduction: Midwifery education standards in Australia require students to undertake Continuity of Care Experiences (COCE). The COCE afford an ongoing relationship between a midwifery student and a woman for student learning, from initial contact in the early antenatal period, through pregnancy, birth and postnatal period.When exploring student learning in the COCE, we found incidental findings of significant personal cost to students undertaking COCE. Aim: To identify andmeasure these personals costs involved for students participating in the COCE. Methods: A mixed method study was undertaken over a 12 month period. A total of 72 midwifery students across all three years of Bachelor of Midwifery programs at two universities participated through an online survey, and diary records of their time, costs and personal concerns for each individual COCE they participated in across one year. Two focus groups were held at the conclusion of the 12 months of diary collection to discuss the findings and gain a deeper insight into the student experience. Results: Of particular interest is the personal time taken to complete the COCE and the financial costs including travelling and parking to health services, and childcare. Significant non-clinical time of travelling and being with women for extended periods in clinic waiting to see the healthcare practitioners will be detailed. Furthermore, personal safety issues, concerns about their professional relationships with staff and the impact of the COCE on their personal/private relationships will be presented. Conclusion: When developing educational interventions it is important to consider the impact on all stakeholders, including the student experience. These findings of the true costs of the COCE for students may influence the expectations placed on students and the support provided by both education and health service providers.