Communication technology practices used by midwives with pregnant women/people in Aotearoa New Zealand to ensure quality maternal and newborn care.

INTRODUCTION: Communication technology such as texting is commonly used for sending appointment reminders and reinforcing health messages. Midwives have identified concerns with privacy of information or information taken out of context within an online format. How this technology is used to ensure quality maternal care within a continuity model of midwifery care is unknown. AIM: To describe midwives' experiences of using communication technology with pregnant women/people in Aotearoa New Zealand. METHODS: A mixed methods design was used to collect online survey data from Lead Maternity Carer midwives. Recruitment was through closed midwifery Facebook groups in Aotearoa New Zealand. Survey questions were informed by the Quality Maternal & Newborn Care framework & findings and an integrative literature review. Quantitative data was analysed using descriptive statistics, and qualitative comments analysed using thematic analysis. FINDINGS: 104 midwives responded to the online survey. Phone calls, texting and emails were commonly used by midwives to reinforce health messages and decision making. Communication technology supported, and enhanced relationships midwives develop with their pregnant clients. Texting enhanced documentation of care and enabled midwives to work efficiently. Midwives, however identified concerns when managing expectations around urgent and non-urgent communication. DISCUSSION: Midwives are bound by regulations to ensure they provide safe care to pregnant women/people. Negotiating and understanding expectations around use of communication technology is vitally important to ensure that communications and connections are undertaken in a safe manner.

Translating Cultural Safety to the UK.

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be 'culturally safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.

The influence of yarning circles: A cultural safety professional development program for midwives.

BACKGROUND: A university educated, First Peoples health workforce is paramount to improving health outcomes for Australia's First Peoples. However, a significant gap exists between the academic success of First Peoples and non-Indigenous students. The facilitation of culturally safe learning and teaching environments by academics is essential to closing this gap. There is little research on midwifery academics' understanding of Cultural Safety and the translation of this understanding in learning and teaching. OBJECTIVES: To explore the influence of yarning circles within a professional development program to enhance midwifery academics' awareness of Cultural Safety. METHODS: A six-month staff development program which consisted of two workshops and a series of yarning circles was offered to all midwifery academics. Eight participants agreed to be interviewed after completion of the program. Interviews were transcribed verbatim, read and re-read, and analysed using a six staged thematic analysis process. RESULTS: Six key themes centred on participants' Sense of Belonging, Sense of Safety, Sense Knowing, Sense of Support, Sense of Difference, and Sense of Challenge were identified. These concepts were supportive of participants' developing awareness of Cultural Safety. CONCLUSION: Yarning circles can encourage midwifery academics' awareness of Cultural Safety. Awareness is the first step towards becoming culturally safe. Yarning provided a safe and supportive space for challenging discussions and reflective learning about racism, white privilege, and difference. Midwifery academics described steps they could take to promote Cultural Safety in the classroom.

Cultural safety continuing professional development for midwifery academics: An integrative literature review.

BACKGROUND: Awareness of cultural safety by midwifery academics is integral to the provision of a safe learning and teaching environments, use of effective pedagogies, and academic success of Indigenous midwifery students. However, little is known about the scope and efficacy of continuing professional development activities that aim to develop awareness of cultural safety by midwifery academics. AIMS: To conduct an integrative review of the literature with respect to the scope and efficacy of professional development interventions that aim to increase awareness of cultural safety by midwifery academics. METHODS: An integrative review of peer-reviewed literature from 2005 -2017 was undertaken. Documents were assessed using the Critical Appraisals Skills Program (CASP) guidelines. Concepts were mapped thematically. RESULTS: Results are reported and discussed using key themes identified in the analysis. Five broad themes emerged from the analysis of studies. The themes were named: Cultural Terms, Knowledge of Culture, Cultural Education, Cultural Aspirations and Culture in Curricula. CONCLUSIONS: Midwifery academics requireprofessional development to raise their awareness of cultural safety in order to adopt effective learning and teaching practices. There is currently no agreed best practice framework to support awareness of cultural safety for midwifery academics. The philosophy of midwifery practice has many synergies with the principles of cultural safety. Cultural safety needs to be embedded into professional development plans for midwifery academics.

Evaluating awareness of Cultural Safety in the Australian midwifery workforce: A snapshot.

PROBLEM: There are no validated tools to measure midwives' awareness of Cultural Safety. BACKGROUND: Cultural Safety is an important component of midwifery practice. Measurement can inform practice and evaluate professional development strategies. AIM: To adapt and evaluate the Awareness of Cultural Safety Scale with the midwifery workforce. METHODS: An online survey was distributed to members of Australian College of Midwives and Congress of Aboriginal and Torres Strait Islander Nurses and Midwives. Measures included the Awareness of Cultural Safety Scale - Revised, Self-assessment of Cultural Knowledge and Perceptions of Racism scales. FINDINGS: The revised Awareness scale had a Cronbach's alpha of 0.87. Principal Component Analysis with varimax rotation produced a three-factor structure accounting for 67% of variance. Awareness scores correlated with Self-assessment of Cultural Knowledge (r=0.22 p<0.03) and Perceptions of Racism (r=0.62 p<0.001) scales. Educators scored significantly higher on awareness compared to clinicians (t (1,80)=-3.09, p=0.003). Perceptions of Racism predicted Awareness of Cultural Safety scores (F (2,87) 29.25, adjusted r square=0.39 p<0.001 95% Confidence Interval=1.09, 1.93). DISCUSSION: The revised scale was a reliable and valid measure of Cultural Safety across a diverse sample of midwives. Midwives working in education settings have a higher awareness of Cultural Safety than clinical peers. CONCLUSION: The Awareness of Cultural Safety Scale can be used with midwives across practice settings. Professional organisations and education providers need to promote the professional responsibilities of midwives towards Cultural Safety in clinical practice and education.

Impact of a continuing professional development intervention on midwifery academics' awareness of cultural safety.

BACKGROUND: Cultural safety in higher education learning and teaching environments is paramount to positive educational outcomes for Aboriginal and/or Torres Strait Islander (hereafter called First Peoples) students. There is a lack of research evaluating the impact of continuing professional development on midwifery academics' awareness of cultural safety. AIM: To implement and evaluate a continuing professional development intervention to improve midwifery academics' awareness of cultural safety in supporting First Peoples midwifery students success. METHODS: A pre-post intervention mixed methods design was used. Academics (n=13) teaching into a Bachelor of Midwifery program agreed to participate. The intervention consisted of two workshops and five yarning circles across a semester. Data included the Awareness of Cultural Safety Scale, self-assessment on cultural safety and perceptions of racism, evaluation of the intervention, participants' journal entries, and researcher's reflections. FINDINGS: Responses on the Awareness of Cultural Safety Scale revealed significant improvement in participants' awareness of cultural safety. There was an upward trend in self-assessment ratings. Participants reported high levels of satisfaction with the intervention or workshops and yarning circles. Participants' journal entries revealed themes willingness to participate and learn, confidence as well as anger and distress. CONCLUSION: Increased awareness of cultural safety can be transformative for midwifery academics. Workshops and yarning circles can support academics in moving beyond a 'sense of paralysis' and engage in challenging conversations to transform their learning and teaching and in turn foster a culturally safe learning and teaching environment for First Peoples midwifery students towards success.

Marcadores tumorais: revisão de literatura / Tumor markers: a literature review

Os marcadores tumorais são macromoléculas presentes no tumor, no sangue ou em outros líquidos biológicos,cujo aparecimento e/ou alterações em suas concentrações estão relacionados com a gênese e o crescimento de células neoplásicas. Este trabalho apresenta uma revisão da literatura nacional e internacional sobre o papel dos marcadores tumorais no manejo clínico de pacientes com câncer, desde o auxílio no diagnóstico e estadiamento até a avaliação da resposta terapêutica, detecção de recidivas e prognóstico, além de auxiliar na decisão da terapia a ser utilizada, bem como terapias adjuvantes. De todo o levantamento bibliográfico realizado, pode-se dizer que pacientes que inicialmente apresentam um marcador tumoral em nível elevado, e que se normaliza com a intervenção terapêutica invariavelmente têm uma resposta favorável; já aqueles que apresentam um marcador tumoral persistentemente elevado ou em ascensão apresentam alta probabilidade de doença recorrente ou progressiva e devem ser vistos como suspeitos de doença metastática.