The evolving challenges of specialist gynaecological cancer nurse roles - A qualitative study.

AIMS: To determine how specialist gynaecological cancer nurses experience and perceive their role. DESIGN: An Interpretive Description qualitative study employing semi-structured interview methods was conducted. METHODS: Specialist nurses working in Australia or New Zealand were recruited via the Australia and New Zealand Gynaecological Oncology Group and the Cancer Nurses Society of Australia to contribute to focus group, dyadic and/or individual interviews. Audio-recordings of the interviews were transcribed, de-identified, and subjected to a thematic analysis. RESULTS: Specialist cancer nurses participated in the study via one focus group interview (N = 6), one dyadic interview (N = 2) and 13 individual interviews between April - August 2016. Three major themes were inductively derived from 19 minor themes: 'Working between worlds' locates the role of the specialist nurse in the provision of gynaecological cancer care; 'The patient's 'go-to' person' highlights participants' relationships with patients; and 'When so much depends on one person' explores the personal and professional impact of working in a specialist nursing role. CONCLUSION: Specialist nurses identified themselves as an accessible source of support and expertise for both women with gynaecological cancers throughout their disease trajectory and multidisciplinary team members. The main challenges they faced were the evolving and expanding nature of their bespoke roles and the dependence on them as individuals in these roles. Clearer role boundaries, guidelines for practice, effective professional support, and active succession planning are recommended. IMPACT: This study explored the experiences and perceptions of gynaecological oncology specialist nurses. Despite similar roles being in place across many countries for several years, the roles continue to evolve and lack clear definition which is burdensome to their incumbents. This research indicates that it is now time for nursing leaders and the broader nursing profession to delineate scope of practice, standardise nomenclature and practice and embed these roles in nursing career and education pathways.

"Our nurse is the glue for our team" - Multidisciplinary team members' experiences and perceptions of the gynaecological oncology specialist nurse role.

PURPOSE: To determine how members of gynaecological oncology multidisciplinary teams experience and perceive the specialist nurse role. METHODS: Members of gynaecological oncology multidisciplinary teams were recruited via two professional organisations to participate in an online qualitative survey. Survey responses were subjected to an inductive content analysis and categorised according to meaning. RESULTS: Sixty-six (n = 66) multidisciplinary team members participated in the online survey. Most participants worked in metropolitan areas and within the public health care system. 71% (n = 47) of participants had a specialist nurse working in their team. Participants without a specialist nurse in their team (n = 19) believed that this was a disadvantage to the women in their care except where other experienced nurses were able to fill this void. Key aspects of the specialist nurse role identified by multidisciplinary team members included: Contact, communication, and coordination; Support and advocacy; Knowledge and education; Assessment, referral and management. Concerns and disadvantages relating to the role identified by team members included the development of dependence on the specialist nurse, the impact of large workloads, and the oversight of what other nurses can offer the patients. CONCLUSIONS: This study has contributed the perspective of a key stakeholder, the multidisciplinary team, to our understanding of the gynaecological oncology specialist nurse role. Clearer definition of specialist nurse roles is required. Standardised nomenclature and guidelines for practice are recommended to ensure that the specialist nurse role and their scope of practice are clear to key stakeholders and over-dependence on the individual in the role is mitigated.

Differences in meconium stained amniotic fluid in an Australian population: A retrospective study.

BACKGROUND: Meconium stained amniotic fluid commonly occurs postdates ( >40 weeks gestation) indicating fetal maturity. Previous literature indicates that different ethnicities mature at different rates. AIM: To compare the rate of meconium stained amniotic fluid of Australian-born and non-Australian born women. METHODS: A retrospective correlation study design was implemented, using data collected in the birth outcomes system at one tertiary hospital. Data was collected from all women who gave birth to a term (>/=37 weeks gestation), singleton, liveborn baby between January 1st to December 31st, 2014. Maternal country of birth was used for comparison. Categorical data was analyzed using Chi-Square test for Independence. Continuous variables were assessed for normality, and differences were compared using an Independent t-test or a Mann-Whitney U test. All tests were two-tailed and p<0.05 was considered statistically significant. RESULTS: 3,041 women were included; 1131 Australian-born and 1910 non-Australian born. Meconium stained amniotic fluid occurred more frequently in non-Australian born women compared to Australian-born women (23.5% vs. 19.8 p=0.02). Their babies were significantly smaller (Mean=3265g, Standard Deviation 463.8 vs Mean=3442g, Standard Deviation 499.2, p<0.001), with no difference in gestational length (Mean=39.4, Standard Deviation 1.28 vs Mean=39.5, Standard Deviation 1.18, p=0.06). Increasing gestational age had the strongest association with meconium stained amniotic fluid; >/=42 weeks gestation occurring 3.52 (95% Confidence Interval: 2.00, 6.22, p=<0.001) more than <40 weeks gestation. CONCLUSION: Maternity health services should record ethnicity and region of birth to provide individualised care as women born overseas often have poorer perinatal outcomes when compared to Australian-born women.

Core competencies for diabetes educators: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The purpose of the proposed review is, firstly, to map the core competencies for diabetes educators, as reported in the literature, and secondly, to review currently used criteria for core competencies in the assessment of diabetes educators.

Maternal and child health nurses work with refugee families: Perspectives from regional Victoria, Australia.

AIMS AND OBJECTIVES: To explore service provision for Victorian regional refugee families from the perspective of maternal and child health nurses. BACKGROUND: Increasingly, more families from a refugee background are resettling in regional Victoria. The refugee journey has significant effect on families. Refugee families with infants and young children can be provided with support by maternal and child health services; however, many families experience barriers to ongoing engagement with this service. DESIGN: This descriptive study used focus group and questionnaire. A purposive sample of 26 maternal and child health nurses was drawn from six municipalities throughout regional Victoria, where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio-recorded narratives were transcribed, prior to inductive thematic analysis. METHODS: This descriptive study used focus group and questionnaire. A purposive sample of 26 Maternal and Child Health nurses was drawn from six municipalities throughout regional Victoria where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio-recorded narratives were transcribed verbatim, prior to inductive thematic analysis. RESULTS: Participating nurses were experienced nurses, averaging 12 years in the service. Four major themes emerged from thematic analysis: "How to identify women from a refugee background"; "The Maternal and Child Health nurse role when working with families from a refugee background"; "Interpreting issues"; and "Access to other referral agencies." Nurses worked to develop a relationship with families, attending to a complex mix of issues which were complicated by language barriers. Nurses found their role in supporting refugee families required additional time and more home visits. CONCLUSIONS: To provide best practice, maternal and child health nurses need (i) ongoing professional development; (ii) time, flexibility and creativity to build relationships with refugee families and (iii) better access to services that enhance communication, such as interpreting services and translated resources. RELEVANCE TO CLINICAL PRACTICE: Nurses require ongoing professional development to help them address the multifaceted needs of families of refugee background. With limited resources available in regional areas, accessing further education can be challenging. Distance education models and organisational support could provide nurses with educational opportunities aimed at improving service provision and clinical practice.

Experiences of gynecological cancer patients receiving care from specialist nurses: a qualitative systematic review.

BACKGROUND: The care needs of women with gynecological cancer are complex and change over the course of their cancer journey. Specialist nurses are well positioned to play a role in meeting the needs of women with gynecological cancer although their role and scope of practice have not been well defined. As patients are a key stakeholder, understanding their experience of care is an important step in better defining the role and scope of practice of specialist nurses in gynecological oncology in Australia and New Zealand. OBJECTIVES: This review sought to consider gynecological cancer patients' experiences of specialist nursing care. Exploring the patient's experience of care by a specialist nurse is one step in the process of better defining the role and scope of practice of specialist gynecological-oncology nurses in Australia and New Zealand. INCLUSION CRITERIA TYPES OF PARTICIPANTS: This review included studies with a focus on women with gynecological cancer who had been cared for by a specialist nurse. Studies of women with gynecological cancer at any point on the continuum of care from pre-diagnosis to survivorship or end of life, including those with a recurrence of the disease, were included, with no limit to the duration of care received for inclusion in the review. PHENOMENA OF INTEREST: Studies that explored how women with gynecological cancer experience the care and interventions of specialist nurses were included. TYPES OF STUDIES: Qualitative studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered for review. This review also considered the qualitative components of mixed method studies. CONTEXT: Research conducted in any country was considered for inclusion in this review providing that the study was reported in English. Studies conducted in any setting including, but not limited to, acute hospitals, outpatient/ambulatory clinics, chemotherapy or radiotherapy units, support groups, palliative care units or the patient's home were included. SEARCH STRATEGY: A three-step search strategy was utilized in this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by a comprehensive search using all identified keywords and index terms across all included databases. The reference lists of all identified reports and articles were hand searched for additional studies. METHODOLOGICAL QUALITY: Each paper was independently assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute the Qualitative Assessment and Review Instrument. When disagreement arose between the reviewers, the given paper was independently appraised by a third reviewer. DATA EXTRACTION: Data were extracted from papers included in the review using the standardized data extraction tool from Joanna Briggs Institute the Qualitative Assessment and Review Instrument. Data extraction was completed independently by two reviewers. DATA SYNTHESIS: Extracted findings from seven included papers were grouped according to similarity in meaning from which 11 categories were developed. These categories were then subjected to a meta-synthesis that produced a set of three synthesized findings. RESULTS: Key findings were extracted from six included papers and classified as unequivocal (U) or credible (C). A total of 30 findings were extracted and aggregated into 11 categories based on similarity in meaning. From the 11 categories, three synthesized findings were developed: i) Tailored care: specialist nurses play a role in understanding and meeting the individual needs of women with gynecological cancer; ii) Accessible care: specialist nurses guide women with gynecological cancer along the continuum of care and are an easily accessed source of knowledge and support; iii) Dependable expertise: women with gynecological cancer express trust and reassurance in the experience and expertise of the specialist nurse. CONCLUSIONS: This systematic review synthesized the findings of seven studies that captured the experiences of women with gynecological cancer who received care from a specialist nurse. The specialist nurse offers tailored, accessible and expert care to women with gynecological cancer. From the synthesis it is recommended that women with gynecological cancer have access to the services of a specialist nurse at key points on the continuum of care, that specialist nurses provide information to patients on their disease and treatment in the form preferred by the patient and ensure that this information has been understood, and that specialist nurses are afforded time to spend with patients to enable greater exploration and identification of patient needs and the provision of personalized care. Further study that considers other key stakeholders in the specialist nurse role in gynecological oncology is recommended in order to gain a full understanding of specialist nurses' contribution to the care of women with gynecological cancer. Additionally, it is recommended that further studies be conducted to seek the perspectives of women with gynecological cancer from culturally and linguistically diverse backgrounds and Indigenous populations on specialist nursing care as they appear to be under-represented in current research.

New midwives' experiences of transition support during their first year of practice: a qualitative systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The current review aims to investigate new midwives' experiences of transition support during their first year of practice as registered midwives. A further objective is to identify the social support experiences of new midwives during their first year of practice as registered midwives.Specifically, the review question is: How do new graduate midwives experience transition and social support during their first year of practice?

Nurses' experiences of supervising nursing students who demonstrate unsafe practices in clinical placements: a systematic review protocol.

REVIEW QUESTION/OBJECTIVES: This review explores the experiences of nurses who have supervised nursing students on clinical placement who demonstrate unsafe practices. The primary objective is to identify and synthesize the best available evidence on the experiences of nurses supervising students who demonstrate unsafe practices in clinical placements. The secondary objective is to explore why nurses award pass grades to students who demonstrate unsafe performance in clinical placements. The review question is "what is the experience of nurses supervising nursing students who demonstrate unsafe practices in clinical placements?"

Exploration of the role of specialist nurses in the care of women with gynaecological cancer: a systematic review.

AIM AND OBJECTIVE: To evaluate the role and interventions used by specialist nurses in caring for women with gynaecological cancer. BACKGROUND: Evidence evaluating the efficacy of specialist nurses in the gynaecological-oncology setting is limited and fragmented. DESIGN: Systematic review including both randomised controlled trials and nonrandomised studies. METHODS: Nine major databases were accessed from their date of inception to April 2013 with search results limited to publications from 1993-2013. Inclusion criteria were applied to select studies for review. Studies were critically appraised and assessment of the risk of bias performed. Data were extracted and compiled, with a narrative analysis undertaken. RESULTS: Nine studies (six randomised controlled trials and three nonrandomised studies) testing interventions by specialist nurses in the gynaecological-oncology setting were included in the systematic review. Results for the randomised controlled trials and nonrandomised studies were reported separately to enable distinction between evidence levels. Risk of bias assessment revealed that the quality of the randomised controlled trials was mixed and highlighted the inherent flaws of nonrandomised study designs. Studies varied greatly in the type of intervention provided and the tools used to measure outcomes, contributing to mixed results. The review demonstrated some positive effects of interventions by specialist nurses for women with gynaecological cancer, although these must viewed in conjunction with the assessment of evidence quality. CONCLUSIONS: This systematic review has contributed to our understanding of the patient-centred aspects of the specialist nurse role in the gynaecological-oncology setting and further research is required to evaluate the role overall. RELEVANCE TO CLINICAL PRACTICE: The review indicates that interventions that either encompassed all domains of care, involved telephone contact or were executed between diagnosis and the completion of treatment were the most successful.

Japanese men's success in altered fatherhood role in a foreign country.

This study explores the meaning of the lived experience of childbirth and parenting of Japanese men who became fathers in a foreign country. Japanese men have been raised to maintain very strict gender roles, excluding them from sharing with their wives the experience of childbirth and the day-to-day parenting of young children. The study employed a descriptive phenomenological approach with in-depth interviews. Participants included nine Japanese men born and raised in Japan who were living in Honolulu. Three theme categories emerged from the data: "making active efforts in preparation for childbirth in a foreign country"; "challenges in pregnancy, childbirth, child care, and as husbands or partners"; and "challenges in transition to parenthood." Japanese men successfully altered their transitional and authoritarian gender role to a family orientated social structure, under the influence of Western values, when living in foreign country. By spending more time with their new family, they acknowledged the processes of becoming a father. The ability to adapt their expectations of fatherhood in line with Western values was enhanced by the support of coworkers, their mature age, rich educational background, and the personal financial resources of the male participants in the study.

Exploring the impact of clinical placement models on undergraduate midwifery students.

BACKGROUND: Learning undertaken through clinical placements provides up to 50% of the educational experience for students in pre-registration midwifery courses. However little is known about of the impact various models of clinical placement have on the learning experiences of undergraduate midwifery students. Two clinical placement models have been employed for undergraduate midwifery students at Monash University, including the block placement model and the continuous two days per week model. OBJECTIVE: This project sought to explore the learning experiences of students in these two models of placement. METHOD: Focus groups were held on two campuses with a total of 17 students from different cohorts and programs. DISCUSSION: No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model. CONCLUSION: No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model.

Undergraduate midwifery students' sense of belongingness in clinical practice.

BACKGROUND: Clinical placements form a large and integral part of midwifery education. While much has been written about nursing students' clinical placements, less is known about clinical experiences of undergraduate midwifery students. In nursing, belongingness has been demonstrated to be a key factor in clinical learning but little is known about this in midwifery education. OBJECTIVES: This study sought to examine undergraduate midwifery students' sense of belongingness in their clinical practice. DESIGN: A quantitative design using an online questionnaire was employed. A tool adapted by Levett-Jones (2009a), and previously used with nursing students, was utilised to examine sense of belonging in undergraduate midwifery students. PARTICIPANTS: Sixty undergraduate midwifery students from two campuses at one Australian university participated in the study. Students were drawn from a single Bachelor of Midwifery degree and a double Bachelor of Nursing/Bachelor of Midwifery degree. METHODS: On completion of a scheduled lecture, students were invited by one of the researchers to participate in the study by completing the online questionnaire and the link provided. Data were analysed using descriptive statistics. RESULTS: Midwifery students generally reported similar perceptions of belongingness with previous studies on nursing students. However, a few differences were noted that require further exploration to fully understand. CONCLUSIONS: Midwifery students experienced a sense of belonging in their clinical placements. The findings contribute to understandings of the experiences for midwifery students and provide a foundation on which to develop future clinical placement experiences.

Safety of non-medically led primary maternity care models: a critical review of the international literature.

The Australian government has announced major reforms with the move to a primary maternity care model. The direction of the reforms remains contentious; with the Australian Medical Association warning that the introduction of non-medically led services will compromise current high standards in maternity services and threaten the safety of mothers and babies. The purpose of this paper is to conduct a critical review of the literature to determine whether there is convincing evidence to support the safety of non-medically led models of primary maternity care. Twenty-two non-randomised international studies were included representing midwifery-led care, birth centre care and home birth. Comparative outcome measurements included: perinatal mortality; perinatal morbidity; rates of medical intervention in labour; and antenatal and intrapartum referral and transfer rates. Findings support those of the three Cochrane reviews, that there is sufficient international evidence to support the conclusion of no difference in outcomes associated with low risk women in midwifery-led, birth centre and home birth models compared with standard hospital or obstetric care. These findings are limited to services involving qualified midwives working within rigorous exclusion, assessment and referral guidelines, limiting the number of urgent intrapartum transfers that come with increased risk of perinatal mortality.

Managing projected midwifery workforce deficits through collaborative partnerships.

To address workforce shortages, the Australian Government funded additional nursing and midwifery places in 2009 pre-registration courses. An existing deficit in midwifery clinical placements, combined with the need to secure additional clinical placements, contributed to a serious shortfall. In response, a unique collaboration between Midwifery Academics of Victoria (MIDAC), rural and metropolitan maternity managers (RMM and MMM) groups and Department of Health (DOH) Victoria was generated, in order to overcome difficulties experienced by maternity services in meeting the increased need. This group identified the large number of different clinical assessment tools required to be being completed by midwives supervising students as problematic. It was agreed that the development of a Common Assessment Tool (CAT) for use in clinical assessment across all pre-registration midwifery courses in Victoria had the potential to reduce workload associated with student assessments and, in doing so, release additional placements within each service. The CAT was developed in 2009 and implemented in 2010. The unique collaboration involved in the development of the CAT is a blueprint for future projects. The collaboration on this project provided a range of benefits and challenges, as well as unique opportunities for further collaborations involving industry, government, regulators and the tertiary sector.

Critical discourse analysis: understanding change in maternity services.

This paper provides an example of the use of critical discourse analysis (CDA) in the area of maternity care policy and describes the process of CDA as an effective research method for understanding the influences of change in the context of Australian maternity services. CDA is a methodological approach that examines how discourse is formed and given power, as a result of how power is used, who uses it and the context within which this usage takes place. The application of CDA is described in this study for the purpose of examining key-stakeholder use of knowledge and power for the purpose of influencing the direction of the maternity services reform. The CDA theoretical framework guided discourse identification and analysis of the purpose behind the discourse through examination of power relationships between key stakeholders. The use of a theoretical lens in the form of neoliberalism to supplement the theoretical framework facilitated the exposure of forces intrinsic to the maternity care context driving change.

Primary maternity care reform: whose influence is driving the change?

BACKGROUND: in 2009 the Australian government announced a programme of reform that will change the way maternity services have traditionally been delivered. A shift to a primary maternity care model has occurred despite strong challenges from medicine and a general public that has embraced high technology in all aspects of life including childbirth. AIM: a critical analysis was undertaken for the purpose of identifying discourses that have influenced the direction of the Australian maternity care reform agenda. METHOD: within a critical discourse analysis framework data were collected from state, territory and commonwealth government policy documents, and selected written submissions from national key stakeholder organisations to the National Review of Maternity Services 2008. FINDINGS: three discourses influencing the direction of the reform are described, these include the following: 'Australia is one of the safest place to give birth or to be born, but not for everyone'; 'maternity care is primarily about mothers and babies, not about the service or the health professionals' and 'government must ensure provision of safe and sustainable maternity services'. CONCLUSION: the Australian government has strong support for the primary maternity care reform backed by a strong key stakeholder alliance involving consumers, midwives and rural doctors. On the contrary to the position of the key stakeholder alliance, the obstetric position has been unable to provide government with solutions to escalating costs and workforce deficits in the delivery of safe and sustainable maternity services. Consumers, rural doctors, midwives and government all agree on the need to safeguard excellent safety and quality standards whilst at the same time reducing high levels of medical intervention and providing options for care in a reformed maternity service designed to meet the needs of all Australian women.

The struggle for contested boundaries in the move to collaborative care teams in Australian maternity care.

BACKGROUND: the maternity services reforms announced by the Australian government herald a process of major change. The primary maternity care reforms requires maternity care professionals to work collaboratively as equals in contrast to the current system which is characterised by unequal relationships. AIM: critical discourse analysis (CDA) using neoliberalism as an interpretive lens was employed to determine the positions of the respective maternity care professionals on the proposed reform and what purpose was served by their representations to the national review of maternity services. METHOD: a CDA framework informed by Fairclough, linking textual and sociological analysis in a way that foregrounds issues of power and resistance, was undertaken. Data were collected from selected written submissions to the 2008 national review of maternity services representing the position of midwifery, obstetrics, general practitioners including rural doctors and maternity service managers. FINDINGS: maternity care professionals yielded several discourses that were specific to the discipline with a number that were shared across disciplines. The rise in consumerism has changed historical positions of influence in maternity services policy. The once powerful obstetric position in determining the direction of policy has come under siege, isolated in the presence of a powerful alliance involving consumers, midwives, sympathetic maternity service managers and some medical professions. The midwifery voice has been heard, a historical first, supported by its presence as a member of the alliance. CONCLUSION: the struggle for contested boundaries is entering a new phase as maternity care professionals struggle with different perceptions of what multidisciplinary collaboration means in the delivery of primary maternity care.

National review of maternity services 2008: women influencing change.

BACKGROUND: In 2009 the Australian government announced a major program of reform with the move to primary maternity care. The reform agenda represents a dramatic change to maternity care provision in a society that has embraced technology across all aspects of life including childbirth. METHODS: A critical discourse analysis of selected submissions in the consultation process to the national review of maternity services 2008 was undertaken to identify the contributions of individual women, consumer groups and organisations representing the interests of women. RESULTS: Findings from this critical discourse analysis revealed extensive similarities between the discourses identified in the submissions with the direction of the 2009 proposed primary maternity care reform agenda. The rise of consumer influence in maternity care policy reflects a changing of the guard as doctors' traditional authority is questioned by strong consumer organisations and informed consumers. CONCLUSIONS: Unified consumer influence advocating a move away from obstetric -led maternity care for all pregnant women appears to be synergistic with the ethos of corporate governance and a neoliberal approach to maternity service policy. The silent voice of one consumer group (women happy with their obstetric-led care) in the consultation process has inadvertently contributed to a consensus of opinion in support of the reforms in the absence of the counter viewpoint.