Birth of a very low birth weight preterm infant and the intention to breastfeed 'naturally'.

Author version made available in accordance with the publisher's policy for non-mandated open access submission. Under Elsevier's copyright, non-mandated authors are permitted to make work available in an institutional repository.Summary An interpretive phenomenological study involving 17 Australian parents was under- taken to explore parents’ experiences of breastfeeding very low birth weight (VLBW) preterm infants from birth to 12 months of age. Data were collected from 45 individual interviews held with both mothers and fathers, which were then transcribed verbatim and analysed using thematic analysis. From this study, the analysis identified the following themes: the intention to breastfeed naturally; breast milk as connection; the maternal role of breast milk producer; breastmilk as the object of attention; breastfeeding and parenting the hospitalised baby and the demise of breastfeeding. The discussion presented here presents the theme of the intention to breastfeed ‘naturally’. This study found that all of the participant women decided to breastfeed well before the preterm birth, and despite the birth of a VLBW preterm infant continued to expect the breastfeeding experience to be normal despite the difference of the postpartum experience. It is without doubt that for these parents the pro-breastfeeding rhetoric is powerfully influential and thus successful in promoting breastfeeding. Furthermore, all participants expected breast- feeding to be ‘natural’ and satisfying. There is disparity between parents’ expectations of breastfeeding ‘naturally’ and the commonplace reality of long-term breast expression and uncertain at-breast feeding outcomes. How the parents came to make the decision to breastfeed their unborn child — including the situations and experiences that have influenced their decision making — and how the preterm birth and the dominant cultures subsequently affected that decision will be discussed. The findings have implications for midwifery education and maternity care professionals who support parents making feeding decisions early in pregnancy and those striving to breastfeed preterm infants

Family Law as a determinant of child health and welfare: Shared parenting, breastfeeding and the best interests of the child

Author version made available in accordance with the publisher's policy.In July 2006 the Australian Government introduced the Family Law Amendment (Shared Parental Responsibility) Act 2006 (Cth) (the Shared Parental Responsibility Act 2006) which puts in place a legal presumption of shared parental responsibility for children after separation and which emphasises ‘equal time’ parenting arrangements. Equal time places expectations on both parents to participate—equally—in child care regardless of the child’s age. Breastfeeding is optimal for infants and requires the infant and mother to spend significant time together. The expectation of equal time or substantial and significant parenting arrangements becomes problematic when considering breastfed children. This article begins a discussion about the decisions regarding shared parenting of breastfed children made as a consequence of the 2006 amendments that do not always appear to be in the best interests of children’s health and wellbeing. The paper argues that the Shared Parental Responsibility Act 2006, and the decisions made, can work at a macro-level to produce social and health disparities for these children. Decisions about parenting of children under the Family Law Act 1975 (Cth) are required to be made with the ‘best interests of the child’ as the paramount consideration; a central tenet of the Act which remains in place following the Shared Parental Responsibility Act 2006. The application of this requirement has particular implications when the child is very young and pre-verbal and is being breastfed by the mother. There appears to be a tension in determining the best interests of the child in cases where children are breastfed and their father is seeking equal or substantial shared care arrangements. Breastfeeding has significant physical, psychological, financial benefits to individuals, families and society, and is an important public health practice. Shared parenting orders, made since the Shared Parental Responsibility Act 2006, have the potential to separate breastfeeding mothers and their child which would impact on women’s ability to breastfeed, influencing their perseverance and ultimately breastfeeding duration (Brodribb 2004). This outcome is arguably not in the best interests of the child. Two cases from an on-going study to investigate breastfeeding women’s experiences of the implementation of the Act will be presented. These examples will illustrate that the court made decisions for 2 breastfeeding mothers are not consistent and compromise the ability of women to continue breast feeding. From the women’s perspective this is viewed as not in the best interests of their infants. Further questions are raised about the best interests of children when domestic violence and/or abuse are present. The impact of this new law on the continued breastfeeding of very young children is an unacknowledged consequence and a public health concern

An exploration of the midwifery continuity of care program at one Australian University as a symbiotic clinical education model.

Author version made available in accordance with the publisher's policy for non-mandated open access submission. Under Elsevier's copyright, non-mandated authors are permitted to make work available in an institutional repository.Objective This discussion paper analyses a midwifery Continuity of Care program at an Australian University with the symbiotic clinical education model, to identify strengths and weakness, and identify ways in which this new pedagogical approach can be improved. Background In 2002 a major change in Australian midwifery curricula was the introduction of a pedagogical innovation known as the Continuity of Care experience. This innovation contributes a significant portion of clinical experience for midwifery students. It is intended as a way to give midwifery students the opportunity to provide continuity of care in partnership with women, through their pregnancy and childbirth, thus imitating a model of continuity of care and continuity of carer. Methods A qualitative study was conducted in 2008/9 as part of an Australian Learning and Teaching Council Associate Fellowship. Evidence and findings from this project (reported elsewhere) are used in this paper to illustrate the evaluation of midwifery Continuity of Care experience program at an Australian university with the symbiotic clinical education model. Findings Strengths of the current Continuity of Care experience are the strong focus on relationships between midwifery students and women, and early clinical exposure to professional practice. Improved facilitation through the development of stronger relationships with clinicians will improve learning, and result in improved access to authentic supported learning and increased provision of formative feedback. This paper presents a timely review of the Continuity of Care experience for midwifery student learning and highlights the potential of applying the symbiotic clinical education model to enhance learning. Conclusion Applying the symbiotic clinical education framework to evidence gathered about the Continuity of Care experience in Australian midwifery education highlights strengths and weaknesses which may be used to guide curricula and pedagogical improvements

Identification of parental stressors in an Australian neonatal intensive care unit

Author version made available in accordance with the publisher's policy.Aims: This study explored the types and levels of stress in parents with infants in a South Australian NICU, and identifies the psychometric properties of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) in this Australian setting. Background: It is well recognised that many parents experience stress following a preterm birth and subsequent hospitalisation and separation from their baby or from the admission of a newborn infant to intensive care. Methods: This mixed method study used a parental stress assessment tool, a maternal needs inventory, and a measure of the degree of required therapeutic interventions for the neonate to assess types and levels of parental stress. Quantitative and qualitative data was collected and analysed using descriptive statistics and thematic analysis respectively. Results: Moderate stress levels in parents (n=40), predominantly related to alteration of their parental role, and the appearance and behaviours of their infant was demonstrated. These findings are further supported by a qualitative analysis and maternal needs inventory assessment which suggests the need for good communication, information sharing and consistent and empathetic staff practices. Conclusion: These findings suggest the need to develop local interventions to reduce stress and enhance parents’ abilities and understanding of their infant. Furthermore, despite the low number of participants, the PSS:NICU subscales were found to be reliable. Implications for Practice: Neonatal nurses working in a NICU environment need to be aware of the common situations which cause stress in parents, and develop skills in communicating with and supporting parents through this traumatic period

Preparing medical students as agentic learners through enhancing student engagement in clinical education.

Publisher version made available in accordance with Publisher's copyright policy.Preparing medical students to be agentic learners is held to be increasingly important. This is because beyond sequencing, enhancing and varying of experiences across university and health care settings, medical students require epistemological agency to optimize their learning. The positioning of students in these settings, and their engagement with these is central to effective medical education. Consequently, when considering both the processes and outcomes of individuals’ learning to become a doctor, it is helpful to account for the interrelated pedagogical factors of affordance, guidance, and engagement. This paper focuses on the last set of concerns - the student’s engagement - with particular consideration to how they shape the relations between what experiences are afforded through the medical program and how they elect to engage with them. Evidence from a qualitative study is used to present five salient factors that are central to assist medical students prepare as agentic learners

Learning styles in vertically integrated teaching.

This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.Background: With vertical integration, registrars and medical students attend the same educational workshops. It is not known whether these learners have similar or different learning styles related to their level of education within the medical training schema. This study aims to collect information about learning styles with a view to changing teaching strategies. If a significant difference is demonstrated this will impact on required approaches to teaching. Methods: The VARK learning inventory questionnaire was administered to 36 general practice registrars and 20 medical students. The learning styles were compared as individuals and then related to their level of education within the medical training schema. Results: Students had a greater preference for multimodal learning compared with registrars (62.5 per cent versus 33.3 per cent, respectively). More than half of the registrars preferred uni or bimodal learning modalities, compared with one-third of the medical students. Discussion: The present work- shop format based on visual and aural material will not match the learning needs of most learners. This small study has shown that the majority of medical students and registrars could have their learning preferences better met by the addition of written material to the workshop series. Surprisingly, a significantly larger number of medical students than registrars appeared to be broadly multi- modal in their learning style, and this warrants further research

The midwifery miniCEX--a valuable clinical assessment tool for midwifery education

Author version made available in accordance with the publisher's policy for non-mandated open access submission. Under Elsevier's copyright, non-mandated authors are permitted to make work available in an institutional repository.Background Midwifery students, clinicians and educators in Australia identified the need for improved feedback for midwifery students whilst they are on clinical placement; in particular formative assessment. The miniCEX or mini-clinical evaluation exercise is one approach to assessment that has been proven valid and reliable in medical education. The aim of this research was to develop, implement and evaluate a miniCEX tool for midwifery education. Methods Using an action research approach, this project engaged midwifery clinicians and midwifery students to adapt and implement the miniCEX in a postnatal ward environment. Focus groups were held to establish the clinical expectations and develop performance guidelines of students across the domains of midwifery practice, as well as evaluate their use in practice. Findings Evaluation of the midwifery miniCEX, including its applicability from the perspective of staff and students was positive. The miniCEX was found to be easy to use, time efficient and valuable for learning. Discussion The miniCEX is an innovative approach to assessment and feedback in midwifery education, and there is currently no identified evidence of it use in midwifery despite broad use globally in medical education. Conclusion The implementation of the midwifery miniCEX offers broad benefit to both midwifery students and midwifery clinicians and educators globally

The Curriculum and Pedagogic Properties of Practice-based Experiences: The Case of Midwifery Students

Author version made available in accordance with Publisher's copyright policy.This paper outlines curriculum considerations for the ordering, enactment and experiencing of practice-based experiences (e.g. practicums) in tertiary education programs developing occupational specific capacities. Increasingly, these programs are engaging students in practicum experiences (i.e. those in the circumstances of practice). These practice-based experiences require considerable investment on the part of all involved and so need to be used in ways that do justice to those invest- ments. However, such experiences are often provided and engaged in by students without consideration being given to their educational purposes; their likely contri- butions and how they can be sequenced and utilised to achieve those purposes. Here, the specific concern is to identify bases for considering these purposes and how these might be realised through the selection and sequencing of student experiences. A case study of two practicum experiences comprising midwifery students’ ‘follow-through’ experiences with birthing women and clinical placements is used to identify the kinds of learning that can arise through different kinds of practice-based experiences and how they might be most effectively organised. The concern, therefore, is to identify how the midwifery curriculum (i.e. pathways of experiences) can be ordered and augmented by particular pedagogic practices that assist realise the program’s intended learning outcomes. The two different practice-based experiences are found to gener- ate distinct learning outcomes for the students. The follow-throughs generate under- standings about the birthing process from the birthing mothers’ perspectives and provide goal states for midwifery work and understandings about midwifery practice, whereas the development of clinical capacities that arise through clinical placements. Consequently, the formers kinds of experiences might be best provides before, or in conjunction with second. Importantly, rather than viewing these experiences as being supplementary to what is provided within tertiary education institutions, they need to be consider as particular kinds of experiences on their own terms and engage with and utilise their contributions accordingly

Work-integrated learning (WIL) supervisors and non-supervisors of allied health professional students.

Published version made in accordance with Publisher policy. Authors retain copyright for articles published in Rural and Remote Health, published version may be used with author permission. ‘First published in the journal, Rural and Remote Health [http://www.rrh.org.au]’Introduction: This study sought to characterise the allied health professional (AHP) workforce of the Northern Territory (NT), Australia, in order to understand the influence of student supervision on workload, job satisfaction, and recruitment and retention. Methods: The national Rural Allied Health Workforce Study survey was adapted for the NT context and distributed through local AHP networks. Valid responses (n=179) representing 16 professions were collated and categorised into ‘supervisor’ and ‘non- supervisor’ groups for further analysis. Results: The NT AHP workforce is predominantly female, non-Indigenous, raised in an urban environment, trained outside the NT, now concentrated in the capital city, and principally engaged in individual patient care. Allied health professionals cited income and type of work or clientele as the most frequent factors for attraction to their current positions. While 62% provided student supervision, only half reported having training in mentoring or supervision. Supervising students accounted for an estimated 9% of workload. Almost 20% of existing supervisors and 33% of non-supervising survey respondents expressed an interest in greater supervisory responsibilities. Despite indicating high satisfaction with their current positions, 67% of respondents reported an intention to leave their jobs in less than 5 years. Student supervision was not linked to perceived job satisfaction; however, this study found that professionals who were engaged in student supervision were significantly more likely to report intention to stay in their current jobs (>5 years; p<0.05)

A survey of child care centers about breastfeeding support in Adelaide, South Australia.

Author's version made available in accordance with Publisher's copyright policy.Background: Australia has high rates of breastfeeding initiation, with a consistent decline over the first year. Furthermore, there is a growing trend of maternal employment and rising numbers of children enrolled in different types of child care services, both of which can have a negative impact on breastfeeding. Objectives: To provide evidence to better inform implementation of breastfeeding-friendly strategies in child care settings, this study examined breastfeeding policy and practice in child care centers in metropolitan Adelaide. Methods: The paper reports on a survey sent to 292 child care centers in metropolitan Adelaide in 2010. The survey collected information on center location and type, number of enrolled children under age 2, and number of breastfed babies. The survey also included questions about breastfeeding facilities and support, breastfeeding policies, staff training, and barriers to and recommendations to enhance breastfeeding support in child care centers. Results: Of the 62 completed returned surveys (21% response rate), 43 centers (69.4%) reported that they currently have children who receive breast milk at the center; however, in most centers, the total number of breastfed children was reported to be between 1 and 4; 76% reported that the center was supportive of exclusive breastfeeding for 6 months; and 80.6% had statements on breastfeeding as part of their food and nutrition policies or guidelines. Furthermore, 64.5% reported there was no formal or informal training for staff on breastfeeding support, but 50% reported that staff members do provide breastfeeding advice to mothers of children in their center. Conclusions: Despite some strategies in place to support breastfeeding, there are no standards on breastfeeding policies, practices, and training in child care settings.Therefore, the extent and scope of such support depend on parental request and the perceptions and attitudes of child care center staff toward breastfeeding