Exploring the influence of psychological factors on breastfeeding duration, phase 1: Perceptions of mothers and clinicians

Breastfeeding duration rates in Australia are low, prompting a search for modifiable factors capable of increasing the duration of breastfeeding. In this study, participants were asked which psychological factors they believed influence breastfeeding duration. Participants included 3 groups of mothers who had breastfed for varied lengths of time (n = 17), and 1 group of breastfeeding clinicians (n = 4). The nominal group technique was employed, involving a structured group meeting progressing through several steps. Analyses included collation of individual and group responses, group comparisons, and a thematic analysis of group discussions. Forty-five psychological factors thought to influence the duration of breastfeeding were identified. Factors considered most important included the mother's priorities and mothering self-efficacy, faith in breast milk, adaptability, stress, and breastfeeding self-efficacy. In addition to informing the design of phase 2 of this study, these results add to our knowledge of this emerging research area. © Copyright 2009 International Lactation Consultant Association

Strategies for success: A toolbox of coping strategies used by breastfeeding women

Aims. The purpose of this paper is to present the findings of two qualitative studies which identified strategies used by breastfeeding women to assist them to continue breastfeeding. Background. While breastfeeding initiation rates are high in Australia, the majority of women wean before the recommended time. The identification of interventions which may increase breastfeeding duration is therefore a research priority. Design. The Against All Odds study used a case-controlled design to investigate the characteristics of women who continued to breastfeed in the face of extraordinary difficulties. Phase One of the I Think I Can study employed the Nominal Group Technique to investigate the views of subject matter experts regarding which psychological factors may influence the duration of breastfeeding. Method. Against All Odds study participants (n = 40) undertook a one- to two-hour interview and the transcribed data were analysed using thematic analysis. Stratified purposeful sampling was employed in the I Think I Can study (n = 21), with participants assigned group membership according to their most recent breastfeeding experience. A fourth group was composed of experienced breastfeeding clinicians. The nominal group technique was used to generate group data and segments of the discussion were audiotaped and transcribed for thematic analysis. Results. Participants in both the studies raised strategies used to assist them in their efforts to cope with the challenges of breastfeeding and early motherhood. These strategies included increasing breastfeeding knowledge, staying relaxed and 'looking after yourself', the use of positive self-talk, challenging unhelpful beliefs, problem solving, goal setting and the practice of mindfulness. Conclusions. Employment of these simple behavioural and cognitive strategies may assist women to cope with the pressures inherent in the experience of early mothering, thereby increasing the duration of breastfeeding. Relevance to clinical practice. These results may represent a 'tool box' of coping strategies which can be provided to women for use in the postnatal period. © 2009 Blackwell Publishing Ltd

Barriers to use of information and computer technology by Australia's nurses: A national survey

Aims and objectives. To support policy planning for health, the barriers to the use of health information and computer technology (ICT) by nurses in Australia were determined. Background. Australia, in line with many countries, aims to achieve a better quality of care and health outcomes through effective and innovative use of health information. Nurses form the largest component of the health workforce. Successful adoption of ICT by nurses will be a requirement for success. No national study has been undertaken to determine the barriers to adoption. Design. A self-administered postal survey was conducted. Method. A questionnaire was distributed to 10,000 members of the Australian Nursing Federation. Twenty possible barriers to the use of health ICT uptake were offered and responses were given on a five point Likert scale. Results. Work demands, access to computers and lack of support were the principal barriers faced by nurses to their adoption of the technology in the workplace. Factors that were considered to present few barriers included age and lack of interest. While age was not considered by the respondents to be a barrier, their age was positively correlated with several barriers, including knowledge and confidence in the use of computers. Conclusions. Results indicate that to use the information and computer technologies being brought into health care fully, barriers that prevent the principal users from embracing those technologies must be addressed. Factors such as the age of the nurse and their level of job must be considered when developing strategies to overcome barriers. Relevance to clinical practice. The findings of the present study provide essential information not only for national government and state health departments but also for local administrators and managers to enable clinical nurses to meet present and future job requirements. © 2008 Blackwell Publishing Ltd

Attitudes of Australian nurses to information technology in the workplace: A national survey

This article reports on the views of Australian nurses as to their use of computers in the workplace. Data were collected by questionnaires mailed to 10 000 members of the 150 000-member Australian Nursing Federation, which represents 60% of the Australian nursing workforce. The response rate was 43.3%. Computer use was 20% by assistants in nursing, rising to 75% by enrolled nurses and to more than 95% by RNs. Principal uses for the computers by the nurses were for access to patients' records and for internal communication. Most respondents (79%) agreed that the use of computers had improved information access. Only 9.4% considered that adoption of a national electronic health record would not be useful to healthcare. Fewer than 5% stated that they have no interest in computers, and 87% considered that their age was never or rarely a barrier to their use of the technology. However, not all aspects of computer introduction to nursing were positive. The proportions of respondents who considered that the use of computers had made their work easier, reduced duplication of data entry, and reduced errors in handing patient data were only 42%, 32%, and 31%, respectively. Results demonstrate a positive attitude toward information technology by Australian nurses but identify issues that must be addressed to support continued interest and engagement. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

The components of resilience: Perceptions of an Australian rural community

Resilience, of individuals, is a well-established concept in the psychology/ mental health literatures, but has been little explored in relation to communities. Related theory in the community development and social impact assessment literature provides insight into qualities and assets of communities that enable them to develop effectively or to adapt to major changes. This article reports the components of community and individual resilience identified through a participatory action research study within a rural Australian community. These are social networks and support; positive outlook; learning; early experiences; environment and lifestyle; infrastructure and support services; sense of purpose; diverse and innovative economy; embracing differences; beliefs; and leadership. These components entail interactions between individuals, the community, infrastructure, the environment and the economy in the process of building resilience. The findings extend from previous research by recognizing environmental and economic factors, infrastructure and support services, as enhancing resilience, and expand the limited evidence base for those wishing to promote resilience at the community scale. © 2010 Wiley Periodicals, Inc

Ego-resilience and psychological wellness in rural communities

Resilience in the context of rural communities is defined as the capacity to move through and beyond adversity. The literature recognises that rural people suffer particular stressors: high exposure to global economic pressures and government policy changes; droughts, floods and other extreme weather conditions; and the challenges of keeping a farm financially viable and family intact. Owing to the necessities of survival in "the bush", rural people tend to be stoic and self-reliant and therefore reluctant to seek help except in dire emergencies. Rural men have been shown to draw on inner strengths to regain control after difficult experiences, along with using formal and social supports, and strategies such as taking breaks. Individual and community resilience are mutually supportive and researchers argue that balanced social and economic development is needed to enhance resilience and wellbeing in rural areas, in addition to improved access to mental health and other health services. © 2011 by Nova Science Publishers, Inc. All rights reserved

Implementation of oral health recommendations into two residential aged care facilities in a regional Australian city

Background  Residents of aged care facilities usually have a large number of oral health problems. Residents who suffer from dementia are at particular risk. A systematic review of the best available evidence with regard to maintaining the oral health of older people with dementia in residential aged care facilities provided a number of recommendations. Objectives  The aim of the implementation project was to introduce evidence-based oral hygiene practices for patients with dementia in two publicly funded residential aged care facilities and monitor for changes in nursing awareness, knowledge, documentation and practice to improve patient outcomes and ensure appropriate accreditation standards were met. An additional aim was to identify barriers and strategies to overcome barriers to implementation of evidence-based recommendations. Methods  Two facilities, a 40-bed facility and a 71-bed facility in the health service district of the regional Australian city of Toowoomba, provided the setting. A quality improvement approach was taken, using a number of strategies from the National Health and Medical Research Council guidelines for implementation studies. The implementation involved a number of stages, including project development, interactive oral health education, oral audits of residents, changes to oral hygiene practice via care plans and critical reflection. Results  The multidisciplinary approach to improving oral healthcare appeared to improve knowledge and awareness and move oral health practices in facilities closer to best practice. Specialised training in oral health was provided to a Clinical Nurse Consultant. Regular oral audits were introduced and facility staff were trained in the use of the oral audit tool. Care plans at one facility were of better quality and more comprehensive than before the intervention. Comments made during critical reflection suggested improvements in the oral health of residents, increased use of oral swabs and saliva substitutes, improved care of dentures and mention of the use of mouth props in resident care plans. There was also some evidence that changes brought about by the implementation are sustainable. Conclusion  The majority of recommendations provided in the systematic review of oral healthcare for dementia patients were applicable to the applied context. The importance of day-to-day leaders was highlighted by the apparently varied outcomes across target facilities. The quality improvement approach would appear to have considerable advantages when applied to improving practice in residential aged care