Leadership In Learning And Teaching In Higher Education: Perspectives Of Academics In Non-Formal Leadership Roles

Developing leaders and leadership are key factors to improve learning and teaching in higher education. Despite the abundance of literature concerning developing formal leadership, fewer studies have been conducted with academics in non-formal leadership roles that focus on how they develop their leadership in learning and teaching. Publication and funding metrics are evidence of leadership and success in research. Metrics in learning and teaching exist, but are less well accepted and valued. We undertook a qualitative descriptive study to examine how academics in non-formal leadership roles at an Australian university understood leadership and described their leadership in teaching. Following ethical approval, eight participants were interviewed using a semi-structured format. Thematic analysis revealed four themes: leadership is the ability to influence direction; all about the culture; becoming visible and speaking up; and learning leadership together. Participants said leading teaching teams effectively and influencing quality learning experiences for students and colleagues is ‘evidence’ of leadership in learning and teaching. Some said a few research colleagues and formal leaders did not accept such ‘evidence’ and continued to favour leadership of research teams. This paper contributes new strategies as possible ways forward to facilitate cultural change in higher education institutions that include: a need for formal leaders and academics to reach agreement about evidence of effective leadership in learning and teaching; academics sharing innovations to effectively lead teaching teams and to promote quality teaching experiences for students; and mentoring colleagues in learning and teaching

Leadership In Learning And Teaching In Higher Education: Perspectives Of Academics In Non-Formal Leadership Roles

Developing leaders and leadership are key factors to improve learning and teaching in higher education. Despite the abundance of literature concerning developing formal leadership, fewer studies have been conducted with academics in non-formal leadership roles that focus on how they develop their leadership in learning and teaching. Publication and funding metrics are evidence of leadership and success in research. Metrics in learning and teaching exist, but are less well accepted and valued. We undertook a qualitative descriptive study to examine how academics in non-formal leadership roles at an Australian university understood leadership and described their leadership in teaching. Following ethical approval, eight participants were interviewed using a semi-structured format. Thematic analysis revealed four themes: leadership is the ability to influence direction; all about the culture; becoming visible and speaking up; and learning leadership together. Participants said leading teaching teams effectively and influencing quality learning experiences for students and colleagues is ‘evidence’ of leadership in learning and teaching. Some said a few research colleagues and formal leaders did not accept such ‘evidence’ and continued to favour leadership of research teams. This paper contributes new strategies as possible ways forward to facilitate cultural change in higher education institutions that include: a need for formal leaders and academics to reach agreement about evidence of effective leadership in learning and teaching; academics sharing innovations to effectively lead teaching teams and to promote quality teaching experiences for students; and mentoring colleagues in learning and teachin

Stillbirth is associated with perceived alterations in fetal activity - findings from an international case control study

Background Stillbirth after 28 weeks gestation affects between 1.3–8.8 per 1000 births in high-income countries. The majority of stillbirths in this setting occur in women without established risk factors. Identification of risk factors which could be identified and managed in pregnancy is a priority in stillbirth prevention research. This study aimed to evaluate women’s experiences of fetal movements and how these relate to stillbirth. Methods An international internet-based case–control study of women who had a stillbirth ≥28 weeks’ gestation within 30 days prior to completing the survey (n = 153) and women with an ongoing pregnancy or a live born child (n = 480). The online questionnaire was developed with parent stakeholder organizations using a mixture of categorical and open–ended responses and Likert scales. Univariate and multiple logistic regression was used to determine crude (unadjusted) and adjusted odds ratios (aOR) with 95% confidence intervals (CI). Summative content analysis was used to analyse free text responses. Results Women whose pregnancy ended in stillbirth were less likely to check fetal movements (aOR 0.54, 95% CI 0.35–0.83) and were less likely to be told to do so by a health professional (aOR 0.55, 95% CI 0.36–0.86). Pregnancies ending in stillbirth were more frequently associated with significant abnormalities in fetal movements in the preceding two weeks; this included a significant reduction in fetal activity (aOR 14.1, 95% CI 7.27–27.45) or sudden single episode of excessive fetal activity (aOR 4.30, 95% CI 2.25–8.24). Cases described their perception of changes in fetal activity differently to healthy controls e.g. vigorous activity was described as “frantic”, “wild” or “crazy” compared to “powerful” or “strong”. Conclusions Alterations in fetal activity are associated with increased risk of stillbirth. Pregnant women should be educated about awareness of fetal activity and reporting abnormal activity to health professionals

Is maternal hypotension during pregnancy and/or posterior located placenta associated with increased risk of stillbirth? A case-control study

Title: Is maternal hypotension during pregnancy and/or posterior located placenta associated with increased risk of stillbirth? Design: A retrospective case-controlled study comparing a group of stillbirths with a live born control group matched for maternal age, baby gender, gestational age and year of birth. The purpose of this study was to ascertain whether hypotensive women or women with a posterior located placenta are at increased risk of stillbirth. Two Australian tertiary referral obstetric hospitals were chosen as participating hospitals for this study. All cases with a discharge diagnosis of stillbirth over a five year period at these hospitals were identified and considered as cases for inclusion in the study. An attempt was made to match each case with two controls. After exclusions there were 124 cases and 243 controls. Blood pressure (BP) readings throughout pregnancy were extracted from the medical record of each subject, and summary 'exposure' measures were created. These included: diastolic and systolic readings as well as mean arterial pressure taken at the initial (booking BP), minimum, calculated average, and final reading prior to the birth. Placental position, as determined by midtrimester ultrasound, was also collected. Results: This study found that low Diastolic Blood Pressure (DBP) readings (between 60-70mmHg) throughout pregnancy were associated with a statistically significant increased risk of stillbirth. This trend was seen from the initial reading at booking (OR 1.83 95% CI 1.0-3.2, p=0.03) through to the last taken before the birth (OR 1.53 95% CI 0.9-2.5, p=0.09) including the calculated average over the course of the pregnancy (OR 1.61 95% CI 1.0-2.6, p=0.05) and minimum observed during the pregnancy (OR 2.94 95% CI 0.98-8.8, p=0.05). In addition, this study found a minimum diastolic reading of less than 60mmHg carries a significant risk of stillbirth with a crude odds ratio of 3.5 (95% CI 1.18-10.41, p=0.02). This study did not show a statistically ignificant association of systolic hypotension with stillbirth. However, after combining both systolic and diastolic blood pressures to calculate the mean arterial blood pressure (MAP) the analysis did suggest that women with a minimum MAP between 73-83mmHg were at increased risk of stillbirth (OR 1.69 CI 1.02-2.81, p=0.04). Furthermore, this study found that three MAP readings of less than 83.3 during the course of the pregnancy carries almost twice the risk of stillbirth (adjusted OR 1.99) even after adjusting for race, gravidity, parity, BMI and SGA (and matching for maternal age, gestational age, gender and year of birth.) Women who have a posterior located placenta were statistically more likely to suffer a stillbirth than women who had a placenta in any other position (crude OR 1.64) and this estimate was largely unaffected by adjustment for blood pressure and other putative risk factors (adjusted OR 1.67) Conclusion: In conclusion, this is the first study which specifically examined a stillborn population in order to explore whether maternal hypotension and posterior located placenta impact negatively on stillbirth incidence and the results of this study suggest that both maternal hypotension and posterior located placenta are probably independent contributory risk factors for stillbirth. This means that maternity care providers should closely manage and monitor progress of women who are hypotensive during pregnancy or those whose placenta is posterior; and that effective management strategies need to be developed to care for these women.Thesis (Ph.D.)--School of Population Health and Clinical Practice, 2007

Accuracy of self-reported sleep position in late pregnancy.

BACKGROUND:There is emerging research to suggest that supine maternal sleep position in late pregnancy may adversely affect fetal wellbeing. However, these studies have all been based on maternal report of sleeping position. Before recommendations to change sleep position can be made it is important to determine the validity of these studies by investigating how accurate pregnant women are in reporting their sleep position. If avoiding the supine sleeping position reduces risk of poor pregnancy outcome, it is also important to know how well women can comply with the instruction to avoid this position and sleep on their left. METHOD:Thirty women in late pregnancy participated in a three-night observational study and were asked to report their sleeping position. This was compared to sleep position as recorded by a night capable video recording. The participants were instructed to settle to sleep on their left side and if they woke overnight to settle back to sleep on their left. RESULTS:There was a moderate correlation between reported and video-determined left-side sleep time (r = 0.48), mean difference = 3 min (SD = 3.5 h). Participants spent an average of 59.60% (SD = 16.73%) of time in bed on their left side (ICC across multiple nights = 0.67). Those who included left side among their typical sleep positions reported significantly longer sleep during the study (p<0.01). CONCLUSIONS:On average participant reports of sleep position were relatively accurate but there were large individual differences in reporting accuracy and in objectively-determined time on left side. Night-to-night consistency was substantial. For those who do not ordinarily sleep on that side, asking participants to sleep on their left may result in reduced sleep duration. This is an important consideration during a sleep-critical time such as late pregnancy

A triple risk model for unexplained late stillbirth

BACKGROUND: The triple risk model for sudden infant death syndrome (SIDS) has been useful in understanding its pathogenesis. Risk factors for late stillbirth are well established, especially relating to maternal and fetal wellbeing. DISCUSSION: We propose a similar triple risk model for unexplained late stillbirth. The model proposed by us results from the interplay of three groups of factors: (1) maternal factors (such as maternal age, obesity, smoking), (2) fetal and placental factors (such as intrauterine growth retardation, placental insufficiency), and (3) a stressor (such as venocaval compression from maternal supine sleep position, sleep disordered breathing). We argue that the risk factors within each group in themselves may be insufficient to cause the death, but when they interrelate may produce a lethal combination. SUMMARY: Unexplained late stillbirth occurs when a fetus who is somehow vulnerable dies as a result of encountering a stressor and/or maternal condition in a combination which is lethal for them

Bearing witness : midwives experiences of witnessing traumatic birth

Conclusions: as far as we can determine this is the first study to explicitly examine the phenomenon of midwives witnessing traumatic birth from the midwives point of view. While it was anticipated that midwives might describe being emotionally distressed by their experiences, the extent of their empathy and feelings of being stuck between two philosophies provide new knowledge into what affects midwives when working with birthing women. Further research into these areas is warranted. Better understanding of how witnessing traumatic birth impacts on midwives and what kind of support after these experiences is required to ensure midwives are equipped to cope when witnessing traumatic birth.

Water immersion policies and guidelines: how are they informed?

Water immersion for labour and birth is consistently challenged as a practice lacking support from high quality evidence. Despite this, the option is available to Australian women. Practitioners are guided by policies and guidelines however, given the research paucity, questions surround the way in which water immersion policies and guidelines are informed.The aims of the study were to determine how water immersion policies and/or guidelines are informed and to what extent the policy/guideline facilitates the option of water immersion for labour and birth with respect to women's choice and autonomy.Phase two of a three phase mixed methods study used critical, post structural interpretive interactionism to examine the process of development and implementation of water immersion policies and guidelines from informant's experience. Semi-structured interviews were conducted with 12 Australian participants.Participants highlighted that the lack of randomised controlled trials had resulted in other forms of evidence being drawn upon to inform water immersion policies and guidelines. This was influenced in part by individual interpretations of evidence with medical views taking precedence. This sometimes resulted in policy and guideline documents that were restrictive with this impacting on women's ability to access the option.Perceived limitations of research and the subsequent translation of this perceived paucity of evidence into policies and guidelines, has impacted on women's ability to exercise choice and autonomy with respect to water immersion and indeed, on the professional autonomy of practitioners who wish to facilitate it

Practitioner accreditation for the practice of water immersion during labour and birth: results from a mixed methods study

Water immersion for labour and birth is an option that is increasingly favoured by women. Australian water immersion policies and guidelines commonly specify that practitioners, such as midwives, must undertake further education and training to become accredited.A three-phase mixed methods approach was used. Phase one used critical discourse analysis to determine who or what informs policies and guidelines related to water immersion for labour and/or birth. Phase two examined policy and guideline informants' experiences of the development of policies/guidelines, whilst phase three surveyed Australian midwives' views and experiences of water immersion and their use of and/or involvement in the development of policies and guidelines.Practitioner accreditation for the facilitation of water immersion was a common finding across all phases of the study. An examination of policies and guidelines found that practitioners, namely midwives, were required to meet additional training requirements to facilitate water immersion. Participants of phases two and three identified and discussed accreditation as a significant challenge to the option of water immersion, particularly where there were inconsistencies across documents and in the interpretation of their content.The need for practitioners to be accredited to facilitate water immersion was identified as a major barrier to availability and therefore, women's ability to access the option. Given these findings, the need for accreditation should be challenged