Night-time behaviour and interactions between mothers and their infants of low risk for SIDS : a longitudinal study of room-sharing and bed-sharing.

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Measuring success: Program fidelity of Queensland\u27s child health home visiting services. a document analysis

Background: The Family CA.R.E. (Community-based Assistance Resourcing and Education) program was introduced in Queensland two decades ago. It aimed to redress health inequalities for infants from families experiencing specific social stressors. The program has been locally adapted over time and has not been evaluated against the original program. This study assessed the extent to which selected hospital and health services in Queensland, Australia have modified the original Family C.A.R.E. program. Methods: Altheide\u27s model was used to facilitate a critical document analysis of policies and guidelines for adapted Family C.A.R.E. home visiting programs in use by hospital and health services (target n = 7). Results: Five of seven eligible services provided service model documentation. There was low alignment with the original Family C.A.R.E. program across four of the five participating services. While the program delivered within Service 4 was highly aligned to the structure and intent of the original model, variation to the program was still evident. Importantly, four of the five participating programs were not collecting evaluation measures. Conclusions: Health services have adapted the original Family C.A.R.E program format to \u27fit\u27 the local service environment but have largely failed to collect data to facilitate evaluation. Inability to evaluate the program leads to uncertainty about program success and benefits as well as any unintended consequences for families engaging in unevaluated home visiting programs. This study highlights the importance of monitoring program fidelity and evaluating success given the potential ramifications for this vulnerable cohort and for health service delivery

Child health nurses’ perceptions of the family community-based assistance resourcing and education program in contemporary practice: A qualitative study

Background. The Family Community-based Assistance Resourcing and Education Program (FCP) is a nurse home visiting program that was introduced in Queensland two decades ago to redress health inequalities for infants from families experiencing specific social stressors. Locally adapted versions of this home visiting program are still in use, but have not been evaluated. This study examined child health nurse perceptions of the adapted FCP in one regional Queensland health service. Methods. A qualitative descriptive exploratory study using two focus groups (conducted May 2019) with Child Health Nurses who delivered the FCP was conducted. Transcripts of digital recordings were analysed using Braun and Clarke’s (2006) six-step framework for guided thematic analysis. Results. A total of 16 Child Health Nurses participated in the study, with a mean of 10 years’ experience with the program. Data analysis generated 12 themes organised under three domains: ‘Establishing the relationship with families’, ‘What works in practice’ and ‘We could do it better’. Participants cited flexibility, expert input and in-home delivery as key program benefits. However, narrow eligibility criteria, poor screening for perinatal anxiety and resourcing constraints were identified as limitations. Conclusions. This study is the first to measure Child Health Nurses’ perceptions of an adapted FCP. It sheds light on their ‘practice wisdom’, including the program’s ability to meet the needs of families with social vulnerabilities. The study supports prior calls for home visiting programs to be evaluated against clearly stated program intentions. Participant insights have been shared to inform practice and program implementation both locally and as part of Queensland’s First 2000 Days health service delivery reform agenda

Paediatric palliative care by video consultation at home: a cost minimisation analysis

Background: In the vast state of Queensland, Australia, access to specialist paediatric services are only available in the capital city of Brisbane, and are limited in regional and remote locations. During home-based palliative care, it is not always desirable or practical to move a patient to attend appointments, and so access to care may be even further limited. To address these problems, at the Royal Children's Hospital (RCH) in Brisbane, a Home Telehealth Program (HTP) has been successfully established to provide palliative care consultations to families throughout Queensland

Components and principles of a pediatric palliative care consultation: results of a Delphi study

Background: Pediatric palliative care is a distinct specialty that requires input from pediatric and palliative medicine specialists to provide comprehensive high-quality care. Consultations undertaken early in a child's illness trajectory, when end-of-life care is not anticipated to be required, enables relationships to be established and may enhance the quality of care provided

Identifying the risk : A prospective cohort study examining postpartum haemorrhage in a regional Australian health service

Acknowledgements The authors would like to acknowledge the midwifery and medical staff who assisted in the data collection for this study and the women who consented to participate. Funding The research study was generously funded through an early career grant awarded by Wishlist: Sunshine Coast Health Foundation. The grant funded a research midwife to undertake study co-ordination, data collection and entry.Peer reviewedPublisher PD

Home telehealth and paediatric palliative care: clinician perceptions of what is stopping us?

Background: Advances in technology have made the use of telehealth in the home setting a feasible option for palliative care clinicians to provide clinical care and support. However, despite being widely available and accessible, telehealth has still not been widely adopted either in Australia or internationally. The study aim was to investigate the barriers, enablers and perceived usefulness for an established home telehealth program in paediatric palliative care from the perspective of clinicians

Promoting Evidence-Based Childhood Fever Management Through a Peer Education Programme Based on the Theory of Planned Behaviour

ABSTRACT Aims and Objectives This study examined effectiveness of a theoretically based education programme in reducing inappropriate antipyretic use in fever management. Background Paediatric nurses’ inconsistent, ritualistic antipyretic use in fever management is influenced by many factors including inconsistent beliefs and parental requests. Determinants of antipyretic administration, identified by the Theory of Planned Behavior (TPB), were belief-based attitudes and subjective norms. Design A quasi-experiment explored group effects of a Peer Education Program, based on the TPB, on factors influencing paediatric nurses’ antipyretic administration. Surveys and chart audits collected data from medical wards at experimental and control hospitals one month pre and one and four months post Peer Education Program. Methods All nurses employed in targeted wards were eligible to participate in surveys and all eligible charts were audited. The Peer Education Program (PEP) consisted of four one-hour sessions targeting evidence-based knowledge, myths and misconceptions, normative, attitudinal and control influences over and rehearsal of evidence-based fever management. All nurses in experimental hospital targeted wards were eligible to attend. Peer education and support facilitated session information reaching those unable to attend sessions. Results Two-way univariate ANOVAs explored between subject, experimental and control group and within subject factors, pre, post and latency data. Significant interactions in normative influence (p=0.01) and intentions (p=0.01), a significant main group effect in control influence (p=0.01) and a significant main effect between audit data across time points (p=0.03) highlight PEP effectiveness in behaviour change. Normative, control and intention changes post PEP were maintained in latency data; mean temperature was not. Conclusion The PEP, based on a behaviour change theory, initiated and maintained evidence-based intentions for antipyretics use in fever management. Relevance to Clinical Practice The promotion of evidence-based change in organisational unit intentions and behaviour highlights the crucial role peer support and education can play in continuing educational programmes

Attitudes to lesbian, gay, bisexual and transgender parents seeking health care for their children in two early parenting services in Australia

Aim: to examine the attitudes to and knowledge and beliefs about homosexuality, of nurses and allied professionals in two early parenting services in Australia. Background: Early parenting services employ nurses and allied professionals. Access and inclusion policies are important in community health and early childhood service settings. However, little is known about the perceptions of professionals who work within early parenting services in relation to lesbian, gay, bisexual and transgender families. Design: This is the final in a series of studies and was undertaken in two early parenting services in two states in Australia using a cross-sectional design with quantitative and qualitative approaches. Methods: Validated questionnaires were completed by 51 nurses and allied professionals and tested with Chi-squared test of independence (or Fisher’s exact test), Mann–Whitney U-test, Kruskal–Wallis one-way analysis of variance, or Spearman’s rank correlation. Thematic analysis examined qualitative data collected in a box for free comments. Results: Of the constructs measured by the questionnaires, no significant relationships were found in knowledge, attitude and gay affirmative practice scores by sociodemographic variables or professional group. However, attitude to lesbians and to gay men scores were significantly negatively affected by conservative political affiliation (p=0.038), held religious beliefs (p=0.011), and frequency of praying (p=0.018). Six overall themes were found: respect, parenting role, implications for the child, management, disclosure, resources and training. Conclusions: The study provided an in-depth analysis of the attitudes, knowledge and beliefs of professionals in two early parenting services, showing that work is needed to promote acceptance of diversity and the inclusion of LGBT families in planning, developing, evaluating and accessing early parenting services. Relevance to clinical practice: Access and inclusion plans for lesbian, gay, bisexual and transgender families are crucial in early parenting services in Australia and should be included in professional development programs

Expansion of Electronic Health Record-Based Screening, Prevention, and Management of Diabetes in New York City

To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community–clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre–post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care