A nurse-led model of care to improve access to contraception and abortion in rural general practice: Co-design with consumers and providers.

AIM: To describe key features of a co-designed nurse-led model of care intended to improve access to early medication abortion and long-acting reversible contraception in rural Australian general practice. DESIGN: Co-design methodology informed by the Experience-Based Co-Design Framework. METHODS: Consumers, nurses, physicians and key women's health stakeholders participated in a co-design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six-step process for thematic analysis. RESULTS: Fifty-two participants took part in the co-design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient-approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications. CONCLUSION: Our approach to experience-based co-design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse-led model of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The co-designed nurse-led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice. IMPACT: Nurse-led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse-led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025. REPORTING METHOD: Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist. PATIENT OR PUBLIC CONTRIBUTION: Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee

Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice

INTRODUCTION: Women living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas. METHODS AND ANALYSIS: ORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women's health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases; secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has the potential to increase LARC and medical abortion access in rural and regional Australia. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Monash University Human Research Ethics Committee (Project ID: 29476). Findings will be disseminated via multiple avenues including a knowledge exchange workshop, policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763)

Co-design of a nurse-led model of care to increase access to medical abortion and contraception in rural and regional general practice: A protocol.

PROBLEM: Women in rural and regional Australia experience a number of barriers to accessing sexual and reproductive health care including lack of local services, high costs and misinformation. SETTING: Nurse-led task-sharing models of care for provision of long-acting reversible contraception (LARC) and early medical abortion (EMA) are one strategy to reduce barriers and improve access to services but have yet to be developed in general practice. KEY MEASURES FOR IMPROVEMENT: Through a co-design process, we will develop a nurse-led model of care for LARC and EMA provision that can be delivered through face-to-face consultations or via telehealth in rural general practice in Australia. STRATEGIES FOR CHANGE: A co-design workshop, involving consumers, health professionals (particularly General Practitioners (GPs) and Practice Nurses (PNs)), GP managers and key stakeholders will be conducted to design nurse-led models of care for LARC and EMA including implant insertion by nurses. The workshop will be informed by the 'Experience-Based Co-Design' toolkit and involves participants mapping the patient journey for service provision to inform a new model of care. EFFECTS OF CHANGE: Recommendations from the workshop will inform a nurse-led model of care for LARC and EMA provision in rural general practice. The model will provide practical guidance for the set-up and delivery of services. LESSONS LEARNT: Nurses will work to their full scope of practice to increase accessibility of EMA and LARC in rural Australia

Effects of analgesic intervention on behavioural responses to Low Atmospheric Pressure Stunning

Worldwide, more than 50 billion chickens are killed annually for food production so their welfare at slaughter is an important concern. Low Atmospheric Pressure Stunning (LAPS) is a novel approach to pre-slaughter stunning of poultry in which birds are rendered unconscious by gradually reducing oxygen tension in the atmosphere to achieve a progressive anoxia (hypobaric hypoxia). Advantages of this approach over electrical stunning are that birds are not shackled while conscious and all birds are reliably and irreversibly stunned. However, concerns remain that birds undergoing LAPS could experience discomfort or pain. Here we investigated whether subjecting birds to LAPS with and without administration of an opioid analgesic (butorphanol) affected behavioural responses. A blocking design was used in which pairs of birds receiving either analgesic or sham treatment were allocated to three types (analgesic/analgesic, analgesic/sham, or sham/sham). In line with previous studies, birds showed a consistent sequence of behaviours during LAPS: ataxia, loss of posture, clonic/tonic convulsions, leg paddling and motionless. Overall, administration of butorphanol had no effect on the range and patterning of behavioural responses during LAPS, but there were some differences in behaviour latencies, counts and durations. For example, latencies to ataxia, mandibulation and deep inhalation were delayed by analgesic treatment, however the duration of ataxia and other behaviours related to loss of consciousness were unaffected. Fewer birds receiving analgesia showed jumping and slow wing flapping behaviour compared to controls, which suggests these may be pain related. These behaviours after the onset of ataxia and the results may reflect a smoother induction to unconsciousness in analgised birds. Collectively, the results do not provide convincing evidence that birds undergoing LAPS are experiencing pain. While there were effects of analgesia on some aspects of behaviour, these could be explained by potential sedative, dysphoric and physiological side effects of butorphanol. The behavioural responses to LAPS appear to be primarily related to exposure to anoxia rather than hypobaric conditions, and thus in terms of welfare, this stunning method may be equivalent to controlled atmosphere stunning with inert gases

Views and experiences of the female condom in Australia: An exploratory cross-sectional survey of cisgender women.

BackgroundThe female condom is the only female-initiated form of protection against unintended pregnancy and sexually transmissible infections (STIs). However, use of this method in Australia is low. To better understand women's views and experiences of the female condom, we conducted an interventional cross-sectional study.MethodsCisgender women ≥16 years, heterosexually active and living in New South Wales were recruited through social media advertisements and email invitations to clients of a family planning service. Eligible participants were provided with three female condoms and invited to complete a follow-up survey. Survey responses for women who attempted to use at least one female condom were summarised using counts and proportions.ResultsWe recruited 556 women; few (30/556) had used the female condom before the study. There were 284 women who used, or attempted to use, a female condom during the study and completed the follow-up survey. Fifty-one percent (104/205) reported experiencing some difficulty in insertion, although only 46% (130/284) had seen an instructional demonstration. Approximately half (105/204) of women rated the sensation and comfort of the female condom as the same or better than the male condom, and 66% (137/204) reported that it provided the same or better lubrication. Approximately half of women said they would consider using the female condom again for STI prevention (51% (133/260)) or contraception (40% (103/260)), or would recommend to others (43% (112/260)).ConclusionFindings highlight the need for increased health promotion and education regarding use of the female condom. To increase access it will be important to address method cost and availability in Australia. Future research should explore other perspectives of this method, including among the LGBTIQ+ community

Do images of 'watching eyes' induce behaviour that is more pro-social or more normative? A field experiment on littering.

Displaying images of eyes causes people to behave more pro-socially in a variety of contexts. However, it is unclear whether eyes work by making people universally more pro-social, or by making them more likely to conform to local norms. If the latter, images of eyes could sometimes make people less pro-social if pro-social behaviour is not the local norm. To separate these hypotheses we conducted a field experiment in which we explored whether manipulating a local descriptive norm altered the eyes effect. We recorded litter dropping decisions on a university campus in a 2 x 2 design, comparing situations with and without litter already on the ground (a manipulation of the local descriptive norm) and with and without large signs displaying images of watching eyes. We additionally recorded the number of potential human observers in the vicinity at the time of each littering decision. We observed a norm effect: the presence of litter on the ground increased littering, replicating previous findings. We also found that images of watching eyes reduced littering, although contrary to previous findings this was only when there were larger numbers of people around. With regard to our central aim, we found no evidence that litter on the ground interacted non-additively with images of eyes to induce increased littering behaviour. Our data therefore support the hypothesis that images of eyes induce more pro-social behaviour, independent of local norms. This finding has positive implications for the application of eye images in combating anti-social behaviour

The perception and production of phones and tones: The role of rigid and non-rigid face and head motion

There is evidence, mostly with phones (consonants & vowels), that visual concomitants of articulation facilitate speech perception. Here the visual concomitants of lexical tone are considered. In tone languages fundamental frequency variations signal lexical meaning. In a word identification experiment with auditory-visual words differing only in tone, Cantonese perceivers performed above chance in a Visual Only condition. A subsequent study showed augmentation of word pair discrimination in noise in an Auditory-Visual compared to an Auditory Only condition for Cantonese, tonal Thai speakers, and even non-tone Australian speakers). The source of this perceptual information was sought in an OPTOTRAK production study of a Cantonese speaker. Functional Data Analysis (FDA) and Principal Component (PC) extraction suggests that the salient PCs to distinguish tones involve rigid motion of the head rather than non-rigid face motion. Results of a final perception study using OPTOTRAK output in which rigid or non-rigid motion could be presented independently in tone differing or phone differing conditions, suggests that non-rigid motion is most useful for the discrimination of phones, whereas rigid motion is most useful for the discrimination of tones

Men and masculinities in qualitative research on vasectomy : perpetuation or progress?

Although vasectomy is a safe and highly effective method of contraception, uptake is variable globally, with scope for increased engagement in high income nations. Very little qualitative research has been published in recent years to explore men’s perspectives on vasectomy, which represents a key opportunity to better understand and strengthen men’s contribution to reproductive and contraception equality. This paper takes a scoping review approach to identify key findings from the small but important body of qualitative literature. Recent masculinities research argues that, despite some expansion in ways of being masculine, an underpinning ethos of masculinist dominance remains. Extant research on men’s attitudes to vasectomy supports this ambivalent picture, indicating that while there are extending repertoires of masculinity for men to draw on in making sense of vasectomy, many remain underpinned by masculinist narratives. There remains scope for education and health promotion ensuring vasectomy is viewed as a suitable and safe option by more men of reproductive age. Increased uptake of vasectomy may also help shift the longstanding social expectation that women take primary responsibility for contraceptive practices, challenging gender discourses on contraception

Inclusion of intrauterine device insertion to registered nurses’ scope of clinical practice

Background: Intrauterine devices are highly effective in preventing pregnancy; however uptake remains low in Australia. Extending provision to registered nurses with the required knowledge and skills to undertake IUD insertions may increase utilisation. Aim: This qualitative study explored the attitudes of nurses and medical officers in regards to extending nurses scope of practice to include intrauterine device insertion in the context of reproductive and sexual health care. Methods: Semi-structured interviews were conducted with ten nurses prior to, and four following, intrauterine device insertion training, and post-training surveys were completed by the six medical officers who provided mentoring and supervision during training. Thematic analysis was undertaken for interview and survey responses. Findings: Three key themes were identified: 1) perceived benefits and value, 2) perceived barriers and challenges, and 3) factors contributing to successful implementation. Nurses reported the addition of intrauterine device insertions was a positive expansion of their scope of practice, and that it would improve clients’ access to this contraceptive method. All interviewees identified the usefulness of ongoing support for nurses through mentoring relationships. Medical officers were positive and supportive of the expansion of scope. Discussion and conclusion: Inclusion of intrauterine device insertions in registered nurses scope of practice appears feasible and well-received by registered nurses and medical officers, suggesting nurses are well-placed to provide intrauterine device insertions in Australia. Research into service delivery models will be useful to support national credentialing standards and promote inclusion of intrauterine device insertion to nurse scope of practice