Employer-based support for registered nurses undertaking postgraduate study via distance education

Previous literature has focused on the need for support of undergraduate nursing students during clinical placements. Little is known about the support provided by employers for registered nurses (RNs) who pursue further education. This study sought to identify and describe the types, levels and perceived need for support in the workplace for RNs as they undertake further postgraduate nursing study by distance education (DE).Using an exploratory descriptive design a self-report questionnaire was distributed to a convenient sample of 270 RNs working in one acute care public hospital in Tasmania, Australia.92 questionnaires (response rate 34%) were returned with 26 (28%) reporting being currently enrolled in further study by DE and a further 50 (54)% of RNs planning future study. Results revealed that 100% of participants with a Masters degree completed this by DE. There were differences between the support sought by RNs to that offered by employers, and 16 (34%) who had done or were currently doing DE study, received no support to undertake DE. There was an overwhelming desire by RNs for support; 87 (94%), with a majority believing some support should be mandatory 76 (83%).This study may encourage employers to introduce structured support systems that will actively assist nurses to pursue further study. © 2010

Using a validated instrument to assess pregnancy planning and preconception care at antenatal booking visits: a retrospective cohort study

Objective: To determine the completion rate for the London Measure of Unplanned Pregnancy (LMUP), a psychometrically validated measure of a woman's intention with regard to a current or recent pregnancy, during booking visits at two metropolitan antenatal care clinics; to identify socio-demographic characteristics associated with unplanned pregnancy. // Design, setting, participants: Retrospective cohort study; analysis of LMUP data for women attending antenatal care booking consultations as public patients in the Sydney Local Health District, 31 December 2019 – 30 November 2020. // Main outcome measures: Proportions of women with LMUP scores indicating unplanned (0–9) or planned pregnancies (10–12); associations between planned pregnancy and socio-demographic characteristics, crude and adjusted for age, parity, and socio-economic status (Index of Relative Socioeconomic Disadvantage). // Results: Of 4993 women with antenatal care bookings, the LMUP was completed by 2385 (47.8%; 1142 of 3564 women at the tertiary referral hospital [32.0%], 1118 of 1160 at the secondary hospital [96.3%]). Planned pregnancies were indicated by the total LMUP scores of 1684 women (70.6%); 1290 women (59.1%) reported no health actions in preparation for pregnancy. In multivariable analyses, planned pregnancies were more likely in all age groups than for women aged 24 years or younger (30–34 years: adjusted odds ratio [aOR], 2.54; 95% confidence interval [CI], 1.76–3.66; 35–39 years: aOR, 2.91; 95% CI, 1.95–4.33). The likelihood of planned pregnancy declined with increasing parity (v no previous births: three previous births: aOR, 0.25; 95% CI, 0.16–0.40; four or more previous births: aOR, 0.10; 95% CI, 0.05–0.19). // Conclusion: Seven in ten women who completed the LMUP had planned their pregnancies, but fewer than half had undertaken health-related actions prior to conceiving. Higher parity was associated with unplanned pregnancy, indicating the importance of postpartum contraception advice. Overcoming barriers to implementing the LMUP more widely would enhance preconception health monitoring

Enhancing use of emergency contraceptive pills: A systematic review of women’s attitudes, beliefs, knowledge and experiences in Australia

Over a decade after emergency contraceptive pills (ECPs) became available without a prescription, the rate of unintended pregnancies remains high in many settings. Understanding women’s experiences and perceptions of ECPs may provide insights into this underutilisation. We systematically searched databases to identify qualitative and quantitative primary studies about women’s beliefs, knowledge and experiences of ECPs in Australia. Findings demonstrate persistent misunderstandings around access, how ECPs work, and a moral discourse around acceptable versus unacceptable use. Addressing knowledge and the stigma around ECPs use is fundamental to increasing the use of this medically safe and effective strategy

Prevalence and predictors of iron deficiency anemia in children under five years of age in Pakistan, a secondary analysis of national nutrition survey data 2011–2012

Background: Iron deficiency Anemia (IDA) in children is a recognized public health problem that impacts adversely on child morbidity, mortality and impairs cognitive development. In Pakistan information on the true prevalence and predictors of IDA is limited. This study sought to investigate IDA in children under five years of age using data from a nationally representative stratified cross-sectional survey. Methods: Secondary analysis was performed on the National Nutrition Survey in Pakistan 2011–2012. We used a pre-structured instrument to collect socio demographic and nutritional data on mothers and children. We also collected Anthropometric measurements and blood samples for micronutrient deficiencies. IDA was defined as having both haemoglobin levels of \u3c110 g/L and ferritin levels of \u3c 12 μg/L. Data analysis was performed by applying univariate and multivariate techniques using logistic regression through SPSS. Findings: A total of 7138 children aged between 6–59 months were included in the analysis. The prevalence of IDA was 33.2%. In multivariate regression analysis adjusted odds ratios (AOR) were calculated. Age \u3c 24 months (AOR 1.40, 95% CI 1.18–1.55 p \u3c0.05), stunting (AOR 1.42 CI 1.23–1.63 p\u3c0.05), presence of clinical anemia (AOR 5.69 CI 4.93–6.56 p\u3c0.05), having a mother with IDA (AOR 1.72 CI 1.47–2.01 p\u3c0.05) and household food insecurity (AOR 1.20 CI 1.10–1.40 P\u3c0.05) were associated with IDA. Living in a rural area (AOR 0.77 CI 0.65–0.90 p\u3c0.05) and being a female child (AOR 0.87 CI 0.76–0.98 p\u3c0.05) were associated with reduced odds of IDA. Conclusion: The prevalence of IDA amongst Pakistani children represents a moderate burden that disproportionately affects the youngest, growth retarded children, affected children are more likely to have mothers with IDA and live in areas where food security is lacking. National efforts to alleviate the burden of IDA should involve both short term vertical programs such as iron supplementation and long term horizontal programs including wheat flour fortification

What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales

Background: Under the generalist model of health care in rural Australia, general practitioners (GPs) are often the first point of contact for women seeking health services for unintended pregnancy, including pregnancy decision-making support and options advice, antenatal or abortion care. Rural women are more likely to experience unintended pregnancy in Australia, yet little is known about how well local rural primary healthcare services currently meet their needs. Methods: To address this gap, this qualitative study explores through in-depth semi-structured interviews, the experiences of 20 rural women managing an unintended pregnancy, and their expectations of, and satisfaction with, the quality of care they received. The Framework Method was used to organise data and conduct an inductive thematic analysis. Results: Three themes related to management of unintended pregnancy in a rural primary care setting were identified: (1) women expect informed and efficient care once services are reached; (2) women desire greater choice and aftercare; and (3) comprehensive reproductive health should be part of rural primary care. Participants indicated an awareness of the limitations of the rural health system, yet a firm expectation that despite access delays, all of their reproductive health needs would be met. Choice, time efficiency, and aftercare were identified as gaps in the current primary care service experience. A desire for greater attention to rural reproductive health, including improved contraception, was also emphasised. Conclusions: Rural women with unintended pregnancy experienced gaps in service quality and described a lack of woman-centred care in their local rural health setting. This study offers insight into how rural primary care providers can better support women to make decisions about and reach their preferred services for unintended pregnancy

Evaluation of a maternal, neonatal and child health intervention package in a rural district of Pakistan: A quasi-experimental study

Background: Pakistan is among the countries which have the highest maternal, neonatal and child mortality rates. Immediate efforts are required to enable Pakistan to achieve the health related sustainable development goals. The continuum of care interventions can substantially reduce the mortality burden, however local evidence to implement them is lacking in Pakistan. We implemented the maternal, neonatal and child health intervention package comprised of health facility strengthening, capacity building, continuum of care interventions and community mobilization and evaluated its effectiveness on maternal, neonatal and child health care practices and neonatal mortality.Methods: The intervention package was delivered through existing public health system in a rural district of Pakistan. We used a quasi-experimental design to assess the impact of interventions. Baseline and end line surveys were conducted and neonatal mortality was considered as the primary outcome measure. Data were analysed using bivariate and difference and difference analysis techniques.Results: We found a reduced risk of neonatal mortality (RR 0.704; 95% CI 0.557-0.889; p=0.0033), in intervention areas compared to control area. For secondary outcomes; including mortality for infants and under five children, antenatal care, skilled birth attendance, institutional deliveries, postnatal care, delayed bathing, inappropriate cord care practices, birth asphyxia, exclusive breastfeeding and immunization a significant difference (p\u3c0.001) was observed in the intervention area compared to control area.Conclusions: This study provides local evidence from Pakistan that effective methods for delivering MNCH interventions within the existing health infrastructure can improve the MNCH outcomes especially in the rural areas

Evidence-based policy responses to strengthen health, community and legislative systems that care for women in Australia with female genital mutilation / cutting

Evidence-based policy responses to strengthen health, community and legislative systems that care for women in Australia with female genital mutilation / cutting Background: The physical and psychological impact of female genital mutilation / cutting (FGM/C) can be substantial, long term, and irreversible. Parts of the health sector in Australia have developed guidelines in the management of FGM/C, but large gaps exist in community and professional knowledge of the consequences and treatment of FGM/C. The prevalence of FGM/C amongst Australian women is unknown. Our article reviews the literature on research on FGM/C in Australia, which focuses on health system response to women and girls with FGM/C. Recommendations are made for policy reform in health, legislation, and community programs to provide the best healthcare, protect children, and help communities abandon this harmful practice. Main body: Midwives and doctors in Australia acknowledged a lack of knowledge on FGM/C, clinical guidelines and consequences for maternity care. In a metropolitan Australian hospital with specialised FGM/C care, women with FGM/C had similar obstetric outcomes as women without FGM/C, underlining the importance of holistic FGM/C clinics. Greater focus on integration of refugee and migrant populations into their new cultures may be an important way of facilitating the abandonment of this practice, as is education of communities that practise FGM/C, and experts involved in the care and protection of children. Men could be important advocates for protecting women and girls from violence and FGM/C through a man-to-man strategy with programs focussing on men's health and other personal issues, education, and communication. The Australian Government has identified gender-based violence as an area of priority and has been implementing a National plan to reduce violence against women and their children 2010-2022. A multidisciplinary network of experts on FGM/C could be established within this taskforce to develop well-defined and rapid referral pathways to care for and protect these children, as well as coordinate education and prevention programs to help communities abandon this harmful practice. Conclusion: Countries of migration can be part of the solution for abandonment of FGM/C through community interventions and implementation of national and coordinated training in FGM/C of experts involved in the care and protection of children and women. The global focus on collaboration on research, training and prevention programs should be fostered between countries of FGM/C prevalence and migration

Community attitudes and gendered influences on decision making around contraceptive implant use in rural Papua New Guinea.

BACKGROUND: Despite targeted interventions to improve contraceptive implant acceptability and uptake in rural Papua New Guinea (PNG), ongoing use of this method remains limited. Previous literature has suggested community attitudes and intrinsic factors within the decision-making process may be negatively impacting on implant uptake, however these elements have not previously been studied in detail in this context. We set out to explore community attitudes towards the contraceptive implant and the pathways to decision making around implant use in a rural community on Karkar Island, PNG. METHODS: We conducted 10 focus-group (FGD) and 23 in-depth interviews (IDI) using semi-structured topic guides. Key sampling characteristics included age, exposure or non-exposure to implants, marital status, education and willingness to participate in discussion. Four FGDs were held with women, four with men and two with mixed gender. IDIs were carried out with five women (current implant users, former implant users, implant never users), five men, five religious leaders (Catholic and non-Catholic), four village leaders and four health workers. Two in-depth interviews (four participants) were analysed as dyads and the remaining participant responses were analysed individually. RESULTS: Men were supportive of their wives using family planning but there was a community-wide lack of familiarity about the contraceptive implant which influenced its low uptake. Men perceived family planning to be 'women's business' but remained strongly influential in the decision making processes around method use. Young men were more receptive to biomedical information than older men and had a greater tendency towards wanting to use implants. Older men preferred to be guided by prominent community members for decisions concerning implants whilst young men were more likely to engage with health services directly. CONCLUSIONS: In communities where a couple's decision to use the contraceptive implant is strongly coloured by gendered roles and social perceptions, having a detailed understanding of the relational dynamics affecting the decision-making unit is useful in targeting future healthcare interventions. Engaging groups who are reluctant to connect with health information, as well as those who are most influential in the decision making process, will have the greatest impact on increasing implant acceptability and uptake

Tourette syndrome research highlights from 2022

This is the ninth yearly article in the Tourette Syndrome Research Highlights series, summarizing selected research reports from 2022 relevant to Tourette syndrome. The authors briefly summarize reports they consider most important or interesting