Perspectives about the baby friendly hospital/health initiative in Australia: an online survey.

BACKGROUND: Evidence supports the health and economic benefits of breastfeeding, and the positive impact of the Baby Friendly Health Initiative (BFHI) on increasing breastfeeding rates and improving breastfeeding outcomes. The BFHI is a World Health Organization and United Nations International Children's Emergency Fund initiative to promote, support and maintain breastfeeding. The BFHI was updated in 2018 and includes the Ten Steps to Successful Breastfeeding (the Ten Steps 2018) and the International Code of Marketing of Breast-milk Substitutes (the WHO Code). Despite policy and guideline support for breastfeeding and the BFHI, there are currently only 70 accredited hospitals, healthcare centres and regional clusters in Australia, accounting for 23% of maternity facilities. This research aimed to explore health professionals and other stakeholders' perspectives on the uptake and implementation of the BFHI in Australia from an organisational change perspective. METHODS: An online survey administered via relevant Australian-based professional associations was fully or partially completed by 332 participants who support mothers and newborns in their roles. Descriptive statistics and content analysis were used to analyse quantitative and qualitative data. RESULTS: The majority of participants supported legislating the WHO Code, closely monitoring BFHI compliance, ensuring sufficient knowledge about breastfeeding and the BFHI among staff, improving care within maternity facilities, continuous support of mothers' post-discharge, and improving social media support of breastfeeding. It was also perceived that an interdisciplinary team approach and multidisciplinary involvement were important requirements for successfully implementing the BFHI. There was no consensus among participants that Australian health policies support breastfeeding and the implementation of the BFHI. CONCLUSIONS: This study emphasised the significance of legislation around the Code, executive and leadership support and culture, and providing adequate resources concerning uptake and implementation of the BFHI. Considering that uptake of the BFHI has been limited and no formal government support has been provided to further develop the BFHI and support the Code in Australia, findings of this research may help with potential future actions to facilitate the BFHI uptake and Code implementation.

The uptake and implementation of the Baby Friendly Health Initiative in Australia.

PROBLEM: Despite evidence that implementation of the Initiative has been effective in increasing breastfeeding rates and duration of breastfeeding worldwide; the uptake is low with only 70 Baby Friendly accredited maternity facilities across Australia (approximately 23% of facilities). BACKGROUND: The Ten Steps to Successful Breastfeeding and International Code of Marketing of Breastmilk Substitutes shaped the foundation for the Initiative to implement practices that protect, promote and support breastfeeding. There is evidence that implementation of the Initiative is impacted by individual and organisational culture, organisational support, and education. Organisational change is also identified as playing an important role in the successful implementation of the Initiative. Despite policy and guideline support for the Initiative at national and state levels in Australia the uptake of the Initiative is low. AIM: The aim of this research was to explore health practitioners' perspectives about the uptake and implementation of the Initiative in Australia. METHODS: Semi-structured, face-to-face, telephone and Skype interviews were conducted with 12 health practitioners. Thematic analysis was used to analyse data. RESULTS: Participants identified that the uptake and implementation of the Initiative in Australia is complex. This complexity was related to six themes: (1) policy and guideline support for the Initiative, (2) leadership support to implement the Initiative, (3) improving breastfeeding and Initiative-related knowledge, (4) improving communication between stakeholders regarding the Initiative, (5) accreditation and reaccreditation processes, and (6) implementation complexity. CONCLUSION: Using organisational change theories as a guide to implementation of the Initiative may be useful for facilities intending to become accredited.

Students take the lead for learning in practice: A process for building self-efficacy into undergraduate nursing education.

To prepare graduate nurses for practice, the curriculum and pedagogy need to facilitate student engagement, active learning and the development of self-efficacy. This pilot project describes and explores an initiative, the Check-in and Check-out process, that aims to engage students as active partners in their learning and teaching in their clinical preparation for practice. Three interdependent elements make up the process: a check-in (briefing) part; a clinical practice part, which supports students as they engage in their learning and practise clinical skills; and a check-out (debriefing) part. A student evaluation of this initiative confirmed the value of the process, which has subsequently been embedded in the preparation for practice and work-integrated learning courses in the undergraduate nursing programs at the participating university. The introduction of a singular learning process provides consistency in the learning approach used across clinical learning spaces, irrespective of their location or focus. A consistent learning process-including a common language that easily transfers across all clinical courses and clinical settings-arguably enhances the students' learning experience, helps them to actively manage their preparation for clinical practice and to develop self-efficacy.

Legislation, policies and guidelines related to breastfeeding and the Baby Friendly Health Initiative in Australia: a document analysis.

Objectives The aim of the present study was to assess the extent to which publicly available legislation, policy and guidelines related to breastfeeding and the Baby Friendly Health Initiative (BFHI) underpin and support the uptake and implementation of the BFHI in Australia. Methods Altheide's document analysis model (sample, data collection, data organisation, data analysis and report) was used to source and analyse publicly available legislation, policies and guidelines in Australia that were related to breastfeeding and the BFHI at national, state and professional organisational levels. Results Legislation documents contained no direct references to the BFHI or Code of Marketing of Breast-milk Substitutes, despite the documents being supportive of breastfeeding. There is little reference to the Code of Marketing of Breast-milk Substitutes or to monitoring of the Marketing in Australia of Infant Formulae (MAIF) Agreement at national and state levels. A gap exists in documents that provide up-to-date records regarding monitoring of breastfeeding rates at the national level. Conclusions National and state guidelines are supportive of breastfeeding and the BFHI. However, the BFHI and Code of Marketing of Breast-milk Substitutes are not legislated in Australia and information related to breastfeeding rates is not up to date. A legislative establishment supporting the Code and establishing plans to monitor the MAIF Agreement and breastfeeding outcomes may influence uptake and implementation of the BFHI. What is known about the topic? Extensive evidence supports the health and economic benefits of breastfeeding. Despite a high initiation rate of breastfeeding in Australia (96%) most recently reported in 2010, the rate of breastfed infants dropped considerably over time: approximately 15% of infants were breastfed for the recommended 6 months. Research supports the positive effect of the BFHI on increasing breastfeeding rates and improving breastfeeding outcomes. In 2016, there are 69 Baby-friendly-accredited maternity facilities across Australia, compared with 77 accredited facilities in 2011 (~23% of all maternity facilities). What does this paper add? This is the first document analysis of publicly available legislation, policy and guidelines related to breastfeeding and the BFHI at Australian national, state and professional organisational levels to assess the extent to which these documents support breastfeeding, as well as the uptake and implementation of the BFHI. This study identifies strengths and weaknesses at legislative, policy and guideline levels that could potentially influence the uptake and implementation of the BFHI. What are the implications for practitioners? The uptake and implementation of the BFHI is potentially influenced by legislation, policy and guidelines at national and state levels. Given the low uptake of the BFHI in Australia, this analysis outlines the extent to which these documents support breastfeeding and the BFHI, and indicates what these documents lack with regard to supporting the uptake and implementation of the BFHI.

The invisibilization of health promotion in Australian public health initiatives.

The field of health promotion has arguably shifted over the past thirty years from being socially proactive to biomedically defensive. In many countries this has been accompanied by a gradual decline, or in some cases the almost complete removal of health promotion designated positions within Government health departments. The language or discourse used to describe the practice and discipline of health promotion is reflective of such changes. In this study, critical discourse analysis was used to determine the representation of health promotion as a practice and a discipline within 10 Australian Government weight-related public health initiatives. The analysis revealed the invisibilization of critical health promotion in favour of an agenda described as 'preventive health'. This was achieved primarily through the textual practices of overlexicalization and lexical suppression. Excluding document titles, there were 437 uses of the terms health promotion, illness prevention, disease prevention, preventive health, preventative health in the documents analysed. The term 'health promotion' was used sparingly (16% of total terms), and in many instances was coupled with the term 'illness prevention'. Conversely, the terms 'preventive health' and 'preventative health' were used extensively, and primarily used alone. The progressive invisibilization of critical health promotion has implications for the perceptions and practice of those identifying as health promotion professionals and for people with whom we work to address the social and structural determinants of health and wellbeing. Language matters, and the language and intent of critical health promotion will struggle to survive if its speakers are professionally unidentifiable or invisible.

I had no other option: Women, electroconvulsive therapy, and informed consent.

Electroconvulsive therapy (ECT) is a controversial procedure used in the management of depression. Whilst it may be administered under mental health legislation, it is usually given to people who voluntarily consent. At the practice level, the consent process for ECT requires a detailed explanation of the procedure. The person consenting must have capacity to make this decision, and consent must be given freely and without coercion. Research using a feminist narrative approach unexpectedly highlighted the issue of potential coercion in the context of explaining the procedure. In-depth interviews were used to understand seven women's accounts of deciding to receive ECT. A thematic analysis of their narratives uncovered a shared concern with how they consented to the treatment. Four subthemes were identified that related to the way in which they provided their consent: (i) 'Not enough information'; (ii) 'I had no other choice'; (iii) 'Just go along with it'; and (iv) 'Lacking capacity'. A consent process that includes elements of passive coercion and a lack of timely and appropriate information influences the way some women make decisions. These factors can disempower women at the point of decision-making. A practice shift is needed where women are enabled to have control over decisions. Further, there is a need to adhere more rigorously to noncoercive practice when obtaining consent.

Is unplanned out-of-hospital birth managed by paramedics 'infrequent', 'normal' and 'uncomplicated'?

BACKGROUND: Unplanned out-of-hospital birth is often perceived as precipitate in nature, 'infrequent', 'normal' and 'uncomplicated'. However, international studies report unplanned out-of-hospital birth is associated with increased rates of maternal and neonatal morbidity and mortality. This research describes intrapartum, immediate postpartum and neonatal care provided by paramedics in Queensland, Australia. The objectives were to (1) determine the number of cases where the paramedic documented birth or imminent birth during the study period (2) to describe the incidence of births prior to or during paramedic care (3) to detail any risk factors and/or complications recorded by paramedics during these cases, (4) identify paramedic pain management practices for intrapartum care, and (5) to examine the maternal and neonatal outcomes as documented by paramedics. METHOD: A retrospective analysis of Queensland Ambulance Service (QAS) de-identified patient care records, generated from clinical case data between the 1st of Jan 2010 and 31st of Dec 2011, was undertaken. Descriptive analysis and x 2 tests were used to test associations between categorical variables, and the Wilcoxon rank-sum for associates between continuous variables which were not normally distributed. Content analysis was utilised to code free text fields. RESULTS: Six thousand one hundred thirty-five records were identified as intrapartum cases. This represented approximately 0.5% of the annual QAS caseload; 5722 were classified as maternal records and 413 were neonatal records. Paramedics recorded antenatal and/or intrapartum complications in 27.3% (n = 1563) of cases. Abnormal maternal vital signs were recorded in 30.1% (n = 1725) of cases. Of the 5722 women attended by paramedics during their labour, a birth occured in 10.8% (n = 618) of cases. Parity was documented in 41.4% (n = 256) of mothers who birthed. Neonatal records were available for 66.8% (n = 413) of actual births, 60.0% (n = 248) recorded a full set of neonatal vital signs and an Apgar score. When an Apgar score was recorded, 21.8% (n = 91) scored ≤7 out of 10. CONCLUSIONS: The research described intrapartum, immediate postpartum and neonatal care provided by paramedics and identified factors that may complicate paramedic clinical management of labouring and birthing women. Further research is required to determine if there are opportunities to improve the paramedic management of such cases.

Accelerated RN-to-BSN Service-Learning Program Serves the Vulnerable.

The definition, implementation, and benefits support the value of service-learning for nursing education. However, accelerated RN-to-BSN programs may have difficulty requiring service-learning experiences. This article offers a biblical rationale for service with vulnerable populations and an example of how service-learning is implemented into the curriculum of an accelerated, nontraditional, online/onsite RN-BSN completion program at a Christian university.

Impact of Service-Learning on Leadership and an Interest in Social Justice.

BACKGROUND: Many articles describe how service-learning has been implemented, but few studies have demonstrated its effectiveness. METHOD: A service-learning component was added to a course in a registered nurse-to-baccalaureate degree (RN-to-BSN) completion program. The service-learning component included a 5-hour service requirement and class discussions. The purpose of this study was to evaluate service-learning's impact on postlicensure RN-to-BSN students' self-evaluation of their leadership skills and their interest in social justice. This study used a quantitative, pretest-posttest control group design and a Likert scale survey. RESULTS: Variations in precourse and postcourse responses of the control group did not demonstrate a measurable effect; responses of the service-learning group revealed a small effect size for both the leadership construct and the social justice construct. CONCLUSION: This study was unique in that it addressed nontraditional RN-to-BSN students in an accelerated program, 70% of whom were taking the course in an online format.

Midwifery practice during birth: Ritual companionship.

BACKGROUND: There is an expectation that midwifery practice is woman centred and promotes physiology. In addition, midwives must assess the wellbeing of mother and baby, and monitor the progress of labour. It is important to understand how midwifery actions and interactions influence the birth experience for women. AIM: The aim of this study was to explore midwifery practice during physiological birth from the perspective of both midwives and mothers. METHOD: A narrative inquiry involving face-to-face in-depth interviews was used to gather data. The participants were 10 midwives and 10 women who had recently attended or experienced an uncomplicated physiological birth. Data was analysed to identify themes occurring across the narratives. FINDINGS: Two types of midwifery practice were identified from the data: rites of passage and rites of protection. Rites of passage were synergistic with women's needs during birth and involved managing distractions and reflecting internal wisdom. Rites of protection involved performing clinical assessments to determine wellbeing and labour progress. These practices could contradict the rites of passage by disrupting aloneness and reinforcing external wisdom. CONCLUSION: Midwives performed two types of practices which intersected with women's experience of birth in differing and contested ways. Conceptualising the role of the midwife as a 'ritual companion' and actions and words as rituals enables a deeper exploration of the values transmitted and reflected by midwifery practice. This study contributes to a discourse about midwifery practice during birth, women's experience of birth, and the influence of the institution on the nature of mother-midwife relationship.

Midwifery professionalisation and practice: Influences of the changed registration standards in Australia.

BACKGROUND: In June 2010 the Australian Health Practitioner Agency unified the national registration of health professionals in Australia and introduced a separate register for midwives. Standard registration renewal requirements aimed to provide safe, competent practitioners. These new conditions created the impetus for practitioners to consider how they meet the re-registration standards for either their nurse or midwifery register/s. QUESTION: How are midwives responding to the changed re-registration conditions for registration renewal? METHODS: Longitudinal case study design. A purposive sample of 24 midwives from five states was recruited. 20 took part in individual interviews over two re-registration periods. 4 midwives were interviewed in a focus group to verify the findings. FINDINGS: Three themes captured issues and tensions about registration and midwifery practice. They are Rotation, Restriction and Extension. CONCLUSION: This paper has shown how the re-registration conditions and standards post 2010 have generated discourse around registration renewal. The simultaneous introduction of regulatory and legislative changes has resulted in the construction of categories within contemporary midwifery practice that do not necessarily align with the Nursing and Midwifery Board of Australia (NMBA) requirements for re-registration. Further research is recommended to examine the continuing influence and impact of the changes on the Australian midwifery workforce.

The extent to which the public health 'war on obesity' reflects the ethical values and principles of critical health promotion: a multimedia critical discourse analysis.

ISSUE ADDRESSED: The discipline of health promotion is responsible for implementing strategies within weight-related public health initiatives (WR-PHI). It is imperative that such initiatives be subjected to critical analysis through a health promotion ethics lens to help ensure ethical health promotion practice. METHODS: Multimedia critical discourse analysis was used to examine the claims, values, assumptions, power relationships and ideologies within Australian WR-PHI. The Health Promotion Values and Principles Continuum was used as a heuristic to evaluate the extent to which the WR-PHI reflected the ethical values of critical health promotion: active participation of people in the initiative; respect for personal autonomy; beneficence; non-maleficence; and strong evidential and theoretical basis for practice. RESULTS: Ten initiatives were analysed. There was some discourse about the need for participation of people in the WR-PHI, but people were routinely labelled as 'target groups' requiring 'intervention'. Strong evidence of a coercive and paternalistic discourse about choice was identified, with minimal attention to respect for personal autonomy. There was significant emphasis on the beneficiaries of the WR-PHI but minimal attention to the health benefits, and nothing about the potential for harm. Discourse about the evidence of need was objectivist, and there was no discussion about the theoretical foundations of the WR-PHI. CONCLUSION: The WR-PHI were not reflective of the ethical values and principles of critical health promotion. So what? Health promotion researchers and practitioners engaged in WR-PHI should critically reflect on the extent to which they are consistent with the ethical aspects of critical health promotion practice.

Nursing care of children in general practice settings: roles and responsibilities.

AIMS: To examine roles and responsibilities of Practice Nurses in the area of child health and development and in advising parents about child health issues. BACKGROUND: As the focus of Australia's health care system shifts further towards the primary health care sector, governmental initiatives require that Practice Nurses are knowledgeable, confident and competent in providing care in the area of child health and development. Little is known about roles and responsibilities of Practice Nurses in this area. DESIGN: Cross-sectional survey design. METHODS: Practice Nurses completed a national online survey examining the roles and responsibilities in child health and development, professional development needs and role satisfaction. Data were collected from June 2010-April 2011. RESULTS: Respondents (N = 159) reported having a significant role in well and sick child care and were interested in extending their role. Frequent activities included immunization, phone triage/advice, child health/development advice, wound care and Healthy Kids Checks. However, few had paediatric/child nursing backgrounds or postgraduate qualifications in paediatric nursing and they reported limited preparation for the role. Practice Nurses reported difficulties with keeping up-to-date with child health information and advising parents confidently. Satisfaction was relatively low regarding opportunities and encouragement to undertake professional development and expand scope of practice. CONCLUSION: Practice Nurses are largely unprepared to meet the demands of their child health role and need support to develop and maintain the skills and knowledge base necessary for high-quality, evidence-based practice. Both financial and time support is needed to enable Practice Nurses to access child health professional development.

Australian midwives' interpretation of the re-registration, recency of practice standard.

OBJECTIVE: The aim ofthe present study was to investigate how midwives are responding to the changed re-registration requirements; specifically the Recency of Practice (RoP) Standard. METHODS: A qualitative longitudinal case study used conversational interviews conducted annually at two time phases after the introduction of national registration. RESULTS: Findings reveal that confusion has created challenges in demonstration of the RoP standard. This confusion was evident at individual and organisational levels. CONCLUSIONS: Professional bodies need to support staff in this transition by providing clearer guidance that exemplifies the Nursing and Midwifery Board of Australia expectations.

Continuing professional development and changed re-registration requirements: midwives' reflections.

BACKGROUND: In 2010 new legislation in Australia led to the establishment of the Australian Health Practitioner Regulatory Authority standards, now used to manage nursing and midwifery registration and the annual re-registration requirements for midwives and nurses. These clearly articulate the continuing professional development (CPD) requirements together with a guiding framework. Individuals need to engage in adult pedagogy which makes explicit the need for self-examination to identify and prioritise their learning needs. OBJECTIVES: This study aimed to investigate how existing registered midwives approach and are challenged by these changed statutory requirements in Australia, particularly completion of CPD activity. DESIGN: This paper reports the findings from phase one of a two phase, longitudinal, case study in which midwives describe their experience during in-depth qualitative interviews. SETTING: Australia PARTICIPANTS: A sample of 20 female participants was recruited nationally from four states using a purposive sampling approach to provide maximum variation to explore the issue. METHODS: Each participant took part in an in-depth interview. In order to facilitate reflection on experiences each participant was asked to discuss an object that held professional value or meaning to them. RESULTS: A key theme in the findings is the relationship between motivation which influences the decisions that midwives are making about CPD, their ongoing registration and practice context. The findings reveal implicit values and beliefs about practice relationships and how these function as motivational factors that influence midwives' decisions about CPD and practice options. CONCLUSIONS: The findings provide insight into the need for system wide dialogue to devise ways to support midwives to maintain as well as to continue to develop their practice, through CPD and to acknowledge the challenges faced by those midwives who currently hold dual registration as a registered nurse in the context of the changed requirements.

Experiences of birth and breastfeeding following assisted conception.

The short and long-term benefits that breastfeeding has for both infant and mother are well recognised. With births increasingly occurring as a result of assisted conception (AC) technologies, the impact that these treatments have on a woman's experience of breastfeeding is an important issue to explore. This paper reports findings from a qualitative study exploring this association. Women who had undergone AC and planned to give birth at one private institution in regional Queensland, Australia, were approached to participate in this study (n = 12). Utilising narrative enquiry in the form of pre and post-birth interviews, participants' accounts of their experiences of breastfeeding were analysed as a means of understanding and representing their journeys. Findings demonstrated that during pregnancy the women were focused on healthy outcomes, showing ambivalence towards the mode of birth. There was a determination to breastfeed that was seen as one way to counteract the intervention and medicalisation they had undergone to conceive. Postnatally, for a number of women in the study breastfeeding difficulties were experienced--a finding that supports recent research. Further mixed method investigation into the impact that assisted conception has on breastfeeding intention, initiation and ability is indicated.

What constitutes 'support' for the role of the Aboriginal and Torres Strait Islander child health workforce?

As well as providing primary health care services, Aboriginal and Torres Strait Islander health workers are known to significantly contribute to the overall acceptability, access and use of health services through their role of cultural brokerage in the communities within which they work. As such they are uniquely positioned to positively influence health improvements for this vulnerable population. This study sought to identify key areas that both Aboriginal and Torres Strait Islander and non-Indigenous health professionals working within Indigenous communities felt were important in providing support for their roles. This group of workers require support within their roles particularly in relation to cultural awareness and capability, resource provision, educational opportunities, collaboration with colleagues and peers, and professional mentorship.

Supporting maternal transition: continuity, coaching, and control.

The transition from maternity services to community child health services on discharge from hospital occurs at a potentially vulnerable time for women in their transition through the childbearing/early parenting continuum. Their experiences contribute to their developing maternal efficacy and parenting skill. The ideal attributes of services that aim to support women and their families during this time include continuity of care, service integration, and birth in accessible, community-based contexts. The purpose of this study was to investigate aspects of maternal experience of mothers attending with their infants a publicly funded drop-in postnatal health-care service, as well as their reasons for attending and their perceptions of its usefulness to them as a mechanism of continuity and a source of support.

Investigating the use of social media to help women from going back to smoking post-partum.

OBJECTIVE: To investigate the social factors that would help women who had quit smoking due to pregnancy from returning to smoking after delivery of their baby. METHODS: Women who attended their first antenatal check-up at a general public hospital were invited to participate in pre- and postpartum interviews. RESULTS: A total of 24 women were interviewed pre- and postpartum. They reported isolation as a factor that influenced how they dealt with stress. This stress was linked to relapse. The use of electronic media through the Internet was a way women could interact with the outside community without having to leave home. CONCLUSIONS: Women who had strong family relationships in geographic proximity were not as likely to use the computer to interact with relatives and friends. Women who did not have strong local and family ties that support their desire to not go back to smoking, reported using Facebook and other Internet activities to keep in touch while they stayed at home with their new infant. IMPLICATIONS: The use of electronic media may help facilitate interaction between new mothers, which could prevent isolation and relapse back to smoking after delivery. This mechanism might also be used to enhance skill-development and problem-solving by these women.

Outcomes for women and infants following assisted conception: implications for perinatal education, care, and support.

Assisted conception is becoming an increasingly more common treatment option for women and couples who experience fertility problems. Links have been made in the literature between assisted conception and a greater incidence of pregnancy or birth complications, low birth weight or premature babies, and babies with congenital abnormalities. In addition, evidence suggests that the experience of assisted conception may influence the development of early mothering relationships and impact parenting adjustment. Although this commentary article does not strategically review all available literature, it provides an overview of the health issues that women and families undergoing assisted conception have experienced or may experience. Through raising awareness and promoting discussion of these issues, practitioners will be better equipped to provide informed education and support.