The role of focus groups in a randomised controlled trial : the ADEPT study

In a recent study we developed a decision aid for prenatal testing of fetal abnormalities. The effectiveness of the decision aid compared with a pamphlet in increasing women\u27s informed choice and decreasing conflict was evaluated using a cluster randomised controlled trial, A DEcision aid for Prenatal Testing for fetal abnormalities (ADEPT) [ISRCTN22532458]. Challenged with the need to ensure that the decision aid best suited the needs of women and health professionals involved General Practitioners (GPs), we explored the potential of both quantitative and qualitative methodologies to inform the development phase. In this article we discuss our rationale for, and provide some insights regarding our experience of, using qualitative methods during the development phase of the decision aid.<br /

Midwife standards for practice: one size does fit all

Background: The development of the Nursing and Midwifery Board of Australia (NMBA) Midwife standards for practice (Standards) will set out the expectations of all midwives regardless of the area of practice, model of care, years of experience or practice setting. The Standards will guide consumers, employers and other stakeholders on what to reasonably expect from a midwife and inform midwifery education accreditation standards, the regulation of midwives and determination of the midwife's capability for practice. Aim: This presentation will describe the phases of development of the Standards, the final Standards and the implementation of the Standards to midwives. Discussion: The project for the development of the Standards included literature and evidence reviews, interviews, consultations, surveys and observations of midwives in practice. The relevant evidence has been integrated with the knowledge, experiences and views of midwives across Australia who practice in various jurisdictions and sectors, as well as in clinical and non-clinical roles. Consumers and individuals who represent professional, government and regulatory authorities have also played critical roles in the development of the Standards. Midwifery practice in this project is apparent as the promotion of health and wellbeing in relation to childbearing, with inherent responsibilities and accountabilities for safety and quality that occurs in the context of culturally safe and respectful partnerships and professional relationships. The Standards acknowledge the involvement of others while clearly positioning midwifery practice as focused on the needs of the woman. Implications for practice: The Standards reflect the practice of midwives in clinical and non-clinical settings, reflect contemporary evidence-based midwifery practice, align with the other NMBA standards for practice and meet legislative requirements

Evaluation of an innovative approach to enhancing midwives' understanding of breastfeeding physiology through the use of animation

Background: Supporting women to breastfeed requires knowledge of the physiology, including the complex interplay of both endocrine and autocrine systems. The use of e-learning provides an alternative platform for customising and diversifying content to appeal to a variety of learning styles. While the evidence addressing the effectiveness of instructional animation is equivocal, an innovative approach utilising the application of animation in enhancing midwives' knowledge regarding lactation is warranted. Drawing on expertise in lactation, midwifery education and video design and production, a seven-minute animated video was produced. In this presentation we will showcase the video and present the results of the evaluation. Methods: The aim of this study was to evaluate registered midwives' understanding of breastfeeding physiology and the acceptability and usability of the animated resource. In February/March 2018, registered midwives across Australia were offered the opportunity to review and evaluate the video by completing a cross-sectional anonymous online survey consisting of 29 items containing 4-point Likert scales and free-text responses. Invitation was via the Australian College of Midwives national newsletter. Ethics approval from Deakin University was obtained. Descriptive statistics were used to analyse quantitative data and free-text was coded. Results: Results of the registered midwife evaluation will be presented that will demonstrate midwives' opinions of the animation as a teaching modality. The presentation will include midwives' views on how the resource impacted on their breastfeeding knowledge and understanding and their views of the animation as a learning resource. Comparison will be made to the students' evaluation where 85-95% of respondents reported that the resource enhanced their learning. Discussion and Conclusion: Evidence to inform the use of innovative approaches to support traditional teaching methods will be provided. These results will provide valuable data to inform further innovation in the area of professional development education in breastfeeding and other complex midwifery concepts

Nurturing yourself and each other: the value of emotional intelligence

Background: Emotional intelligence refers to the individual's capacity to identify, use, understand and respond appropriately to emotions in themselves and others. The nursing and midwifery literature recommends emotional intelligence as an important construct for enhancing well-being amongst nurses and midwives. Despite this, how nursing and midwifery students perceive emotional intelligence is not well understood. Emotional intelligence capabilities are seen as fundamental to the student nurse or midwifes ability to negotiate the emotional complexities of clinical practice as well as support their own emotional well-being. Objective: The study aimed to explore final year undergraduate nursing and midwifery students' perceptions of emotional intelligence. Method: Qualitative data were collected via face to face semi-structured interviews with final year Bachelor of Nursing and Bachelor of Nursing and Bachelor of Midwifery enrolled at Deakin University, Victoria. Interviews were digitally recorded with participants' written and informed consent and professionally transcribed. Data was analysed using thematic analysis. Key Findings: Emotional intelligence was valued as an important concept, yet the application of emotional intelligence to their undergraduate curriculum was not well-defined. Participants appeared to be caught between competing paradigms; their perceptions of emotional intelligence and the reality of the clinical environment. Participants acknowledged the emotional aspects of their classroom and clinical learning, but were ill equipped and/or were not supported in linking their coping strategies to emotional intelligence. Suppression or denial of emotions, or distancing themselves behind tasks and policies were some of the strategies employed by participants in their attempt to impose emotional control within the clinical environment. Conclusion: Explicitly nurturing emotional intelligence in their undergraduate years would convey to nursing and midwifery students the importance of emotional well-being and may better equip them to manage the emotional complexities of their professional life

Exploring midwives' practice and experience of episiotomy

Aim: This study explored Australian midwives' experience and practice of performing an episiotomy. Background: Evidence underpins the recommended angle and length of episiotomy to avoid morbidity for the woman, yet there is limited research regarding midwives' episiotomy knowledge, skill and attitudes. Methods: A cross-sectional anonymous survey of Australian midwives with current birthing experience was employed. The survey contained items modified from validated instruments with Likert scales, a diagram, categorical responses and open ended responses. Data was analysed using descriptive statistics and thematic analysis. Results: A total of 360 surveys responses were analysed. Approximately half (46%) midwives were in senior clinical positions. Experience varied considerably, with approximately half of the midwives (55.6%) having undertaken <4 episiotomies independently and 20% 'very confident' in the procedure. Only 28% midwives identified the episiotomy length correctly while 73% midwives identified the angle correctly. Two thirds of participants (n=236) identified the correct angle on the pictorial representation. Overall, only 15% of midwives identified the three characteristics of a correctly performed episiotomy. The three most common clinical reasons for performing an episiotomy were fetal distress, perineal 'buttonhole' and previous severe perineal trauma. Analysis of attitudes revealed themes such as lack of confidence and experience, fear, and limited evidence supporting episiotomy explaining midwives' use/non-use of episiotomy. There was significant variation in health service requirements to establish a midwife's competence to perform episiotomy. Most midwives (75%, n=270) wanted further education regarding episiotomy, with face-to-face workshops as the preferred format for education. Conclusion: Knowledge and practice gaps demonstrated the need for continuing professional development to translate evidence to practice and promote optimal outcomes for women. Many midwives are inexperienced with the procedure and simulation in workshops may assist midwives feel more confident to perform an episiotomy when is clinically indicated

Using animation to teach breastfeeding physiology: a proof of concept study

Background: Breastfeeding provides the optimal nourishment for infant and child health and supporting mothers to breastfeed is a global health priority. Midwives are uniquely placed to provide breastfeeding education and support to the woman and it is imperative that they have a sound understanding of the physiological underpinnings of breastfeeding. However, midwifery students and some midwives continue to struggle with the complex physiology of lactation. The purpose of this study was to evaluate an instructional animation resource to teach breastfeeding physiology to student and practicing midwives. Further, this study also offers insights into how student and practicing midwives accept novel approaches to learning. Methods: A cross-sectional survey design using both quantitative and qualitative approaches was employed in this proof of concept study. The setting was online with midwifery students recruited from Deakin University and registered midwives recruited from the Australian College of Midwives membership. Snowball sampling was also employed to recruit midwives through professional networks of the research team. The quantitative part of this study included a structured online questionnaire for midwives and midwifery students and descriptive statistics were used to present the quantitative data. The qualitative data were collected from open-ended questions on the questionnaire and a deductive approach was used for analysing the data. Results: This proof of concept study collected data from 110 participants and provides evidence for the use of animation as an effective pedagogical tool to explain complex concepts. The animated instructional resource was viewed favorably by both the midwifery students and practicing midwives. Conclusions: The findings from this study, support the pedagogical advantages of animated instructional resources for teaching complex physiology. Further, educators should be encouraged and feel confident to develop and use animation technology as both an engaging and effective teaching resource especially for complex concepts

Mind the gap: reporting and analysis of sex and gender in clinical trials in Australia, a cross-sectional study

Introduction: Historically, medical studies have underrepresented female participants and most research data have been collected from males and generalized to other genders. This article aims to determine if there is a sex and/or gender gap in recent Australian health research. Methods: This descriptive cross-sectional study of the published literature examines recent Australian-based clinical trials for inclusion of sex and gender. Medians and interquartile ranges (IQRs) were calculated for study sample sizes and female:male representation. Proportion of sex and/or gender was analyzed by the clinical specialty of the trials. t-Tests were used to ascertain significance of any difference in recruitment of female and males. Results: A total of 88 articles were included in the analysis. Most studies (n = 63) were randomized clinical controlled trials. Overall women constituted 55% (IQR 30% of all participants). Of the 71 mixed-sex studies, only 8.9% (n = 7) analyzed the data by sex. Women were significantly underrepresented in cardiology and nephrology studies and overrepresented in psychiatry, care of the elderly, and orthopedic studies. Conclusions: When analyzed by specialty, women are overrepresented in specialties considered to be female patient dominated, such as psychiatry and care of the elderly, and underrepresented in specialties such as cardiology and nephrology. The overrepresentation of women in some specialties can reinforce gender stereotypes, potentially harming women. In addition, exclusion of males from these areas of research may be of disservice to men’s health

Women’s experiences of gestational breast cancer and their interactions with the health care system: a scoping review

Aim: To report the evidence of women's experiences following a diagnosis of gestational breast cancer (GBC) and their interactions with the healthcare system. Design: A systematic scoping review. Data Sources: This scoping review systematically searched Medline, CINAHL, Psych INFO, EMBASE and SCOPUS, in addition to six grey literature databases in October 2021. A 2020 PRISMA flow diagram depicting the flow of information. Review Methods: Guided by six steps in Arksey and OMalley's Framework (2005). One researcher completed the literature review, and four independently screened the titles and abstracts related to the eligibility criteria. Results: Totalling 25 articles, these studies comprise 2 quantitative, 20 qualitative, 1 mixed-method and 2 other documents, a book and debate. Thematic analysis was guided by Braun and Clarke (2006) to identify an overarching theme of adjustment that underpinned women's narratives and was reinforced by four major and several minor themes. The four major themes were: psychological impact, motherhood, treatment and communication. The relationship between the themes contextualizes the enormous complexity concerning women's experiences with GBC. Conclusion: Cancer management for GBC is complex and multifaceted. At a time of conflicting emotions for women, Multidisciplinary teams are well placed to provide support, normalize the woman's experience of motherhood, demonstrate an understanding of treatment effects, and communicate in a considerate and empathetic manner with information that is timely and relevant. GBC management involves doctors, nurses, midwives and many other healthcare professionals, which can add to the impost of diagnosis. Impact: This scoping review contributes to a better understanding of women's experience of GBC. The results may inform improvements in the support and communication for these women with GBC and their families