Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia

BACKGROUND: State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding) and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. METHODS: A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73), exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning). Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives) and a medical practitioner from eachselected hospital. RESULTS: Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives) providing postnatal care. Staffing issues impact on hospitals' ability to provide continuity of care. Recruitment and retention of midwives are significant issues, particularly in rural areas. CONCLUSION: Staffing in postnatal wards is a challenging issue, and varies with hospital locality and model of care. Staff/patient ratios and recruitment of midwives in rural areas are the two areas that appear to have the greatest negative impact on staffing adequacy and provision of quality care. Future research on postnatal care provision should include consideration of any impact on staff and staffing

Community planning and urban design in contested places. Some insights from Belfast

Although social conflict due to the presence of different groups divided by cultural, religious or ethnic issues plagues many contemporary cities, community and participatory planning methods still pay little attention to segregation in contested spaces as a specific matter of concern. This paper aims to contribute to filling this gap through the development of a novel tool to be implemented during community planning processes in contested cities, particularly in (visual) mapping processes. The pilot area for developing the lexicon has been selected within the city of Belfast, which has been struggling for years with problems related to inter-religious sectarian conflicts. The material effects on the urban structure of the long process of defensive planning during the socalled Troubles and within the post-conflicts peace programmes have been investigated by analysing urban artefacts including edges, borders, barriers, doors, visual control points. The paper suggests that a simple, recognizable lexicon may contribute to honing community planning methods in contested places by integrating the traditional methodology of visual mapping with a tailored taxonomy of elements of urban conflict, which may be used at many stages of the planning process, including developing a visual map, design and planning, and developing and implementing an action plan

Kerr Visits Son

Photograph used for a story in the Daily Oklahoman newspaper. Caption: "Without his bucket of sorghum, Governor Kerr was in San Mateo, Calif., over the weekend to visit his son, Robert, cadet midshipman, who is studying to become an officer in the merchant marine. (they are surrounded by other Oklahomans at the school)