What do Australian medical programs teach medical students about breastfeeding?

Objectives To investigate what breastfeeding information is included in Australian medical program curricula and how and by whom it is taught. Method The ten Australian medical schools who have graduated students from their current programs were asked to nominate a person to complete an 11-item questionnaire. Data collected from the questionnaire included: if and where breastfeeding is located within the medical program; who teaches medical students about breastfeeding; and other opportunities medical students have to learn about breastfeeding. Results The questionnaire was completed and returned by nine of the ten nominated people, giving a response rate of 90 percent. One respondent did not know whether breastfeeding was included in the curriculum. The advantages of breastfeeding, normal breastfeeding management and breastfeeding problems were taught within the curriculum in the remaining eight programs. All medical programs encouraged contact with breastfeeding mothers and infants although it was not clear whether this included clinical teaching. Teaching about breastfeeding was undertaken by people from a number of different professional areas (e.g. midwives, doctors, lactation consultants) with all schools utilizing a minimum of three professions. Conclusions While most Australian medical students received some instruction about breastfeeding, the subject areas taught and the method of teaching varied widely between medical programs. Some students received little formal teaching, with patient contact being the main avenue for gaining breastfeeding knowledge and experience. Others had minimal clinical contact. Ideally breastfeeding should be incorporated into the broader curriculum whenever it is applicable and include both formal teaching and clinical instruction

Rural men and mental health: their experiences and how they managed

There is a growing awareness that a primary source of information about mental health lies with the consumers. This article reports on a study that interviewed rural men with the aim of exploring their mental health experiences within a rural environment. The results of the interviews are a number of stories of resilience and survival that highlight not only the importance of exploring the individuals' perspective of their issues, but also of acknowledging and drawing on their inner strengths. Rural men face a number of challenges that not only increase the risk of mental illness but also decrease the likelihood of them seeking and/or finding professional support. These men's stories, while different from each other, have a common thread of coping. Despite some support from family and friends participants also acknowledged that seeking out professional support could have made the recovery phase easier. Mental health nurses need to be aware, not only of the barrier to professional support but also of the significant resilience that individuals have and how it can be utilised

A review of the educational needs of nurses administering cancer chemotherapy in rural and remote areas of Queensland

This paper describes current issues in chemotherapy nursing practice in rural and remote Australia. There is a trend to refer chemotherapy clients back to their rural and remote health facility for treatment from major oncology centres in Australia. However, it is increasingly apparent that the majority of nurses administering chemotherapy in smaller centres lack the theoretical and clinical knowledge to ensure optimum client outcomes and nurse/client safety. There are also issues unique to rural and remote life which will influence optimum chemotherapy service delivery. The research program described in the paper will ascertain the education requirements of rural and remote nurses administering chemotherapy and the design and delivery of a chemotherapy education package specific to the rural and remote context. Similar programs will ensure the best standards of chemotherapy practice in non-metropolitan areas by enhancing the practical and theoretical knowledge base of rural and remote nurses

Callers’ attitudes and experiences of UK breastfeeding helpline support

Background: Breastfeeding peer support, is considered to be a key intervention for increasing breastfeeding duration rates. Whilst a number of national organisations provide telephone based breastfeeding peer support, to date there have been no published evaluations into callers’ experiences and attitudes of this support. In this study we report on the descriptive and qualitative insights provided by 908 callers as part of an evaluation of UK-based breastfeeding helpline(s). Methods: A structured telephone interview, incorporating Likert scale responses and open-ended questions was undertaken with 908 callers over May to August, 2011 to explore callers’ experiences of the help and support received via the breastfeeding helpline(s). Results: Overall satisfaction with the helpline was high, with the vast majority of callers’ recalling positive experiences of the help and support received. Thematic analysis was undertaken on all qualitative and descriptive data recorded during the evaluation, contextualised within the main areas addressed within the interview schedule in terms of ‘contact with the helplines’; ‘experiences of the helpline service’, ‘perceived effectiveness of support provision’ and ‘impact on caller wellbeing’. Conclusion: Callers valued the opportunity for accessible, targeted, non-judgmental and convenient support. Whilst the telephone support did not necessarily influence women’s breastfeeding decisions, the support they received left them feeling reassured, confident and more determined to continue breastfeeding. We recommend extending the helpline service to ensure support can be accessed when needed, and ongoing training and support for volunteers. Further advertising and promotion of the service within wider demographic groups is warranted

Tenure, mobility and retention of nurses in Queensland, Australia: 2001 and 2004

[Abstract]: Aim: Data were collected on tenure, mobility and retention of the nursing workforce in Queensland to aid strategic planning by the Queensland Nurses’ Union. Background: Shortages of nurses negatively affect the health outcomes of patients. Population rise is increasing the demand for nurses in Queensland. The supply of nurses is affected by recruitment of new and returning nurses, retention of the existing workforce and mobility within institutions. Methods: A self-reporting, postal survey was undertaken of Queensland Nurses Union members from the major employment sectors of aged care, public acute and community health and private acute and community health. Results: Only 60% of nurses had been with their current employer more than five years. In contrast 90% had been nursing for five years or more and most (80%) expected to remain in nursing for at least another five years. Breaks from nursing were common and part-time positions in the private and aged care sectors offered flexibility. Conclusion: The study demonstrated a mobile nursing workforce in Queensland although data on tenure and future time in nursing suggested that retention in the industry was high. Concern is expressed for replacement of an aging nursing population

The proqol-21: A revised version of the professional quality of life (ProQOL) scale based on Rasch analysis

The Professional Quality of Life scale is a measure intended to provide practitioners and researchers with an indication of a caring professional’s compassion satisfaction, burnout, and secondary traumatic stress. While this measure has been used extensively in nursing research, owing to the relevancy of patient-care associated satisfaction and fatigue within this profession, information regarding the construct validity of this measure is less well represented in the literature. We examined the construct validity of the Professional Quality of Life scale using a Rasch analysis procedure on each of its three scales, as a means of substantiating their measurement adequacy. Responses on the Professional Quality of Life scale from 1615 registered nurses (age x̅ = 46.48 years, SD = 11.78) were analysed. While support for the measurement adequacy (invariance, person/item fit, and unidimensionality) of the compassion satisfaction scale was found, the burnout and secondary traumatic stress scales did not demonstrate adequate measurement properties. We instead present an alternative measurement model of these subscales, involving items from each, to form a robust measure of compassion fatigue, and provide recoding, scoring, and normed scores for both measures. Our findings indicate that use of the Professional Quality of Life scale’s burnout and secondary traumatic stress scales may require caution, while our revised compassion satisfaction and fatigue scales provide robust measurement options for practitioners and researchers

Differentiated legitimacy, differentiated resilience: beyond the natural in ‘natural disasters’

This paper starts with a flood in southern Malawi. Although apparently a ‘natural’ event, those most affected argued that it was made much worse by the rehabilitation of a nearby irrigation scheme. We use this example to interrogate the current interest in resilience from a perspective informed by political ecology and political economy, arguing that a focus on resilience should not be at the expense of understanding the conditions that shape vulnerability, including the ways in which ‘communities’ are differentiated. Complex factors are at play – and the ways in which these combine can result in a ‘perfect storm’ for some individuals and households. These factors include the effects of history combining with ethnicity, of legitimacy influencing voice, and of the interplay of political dynamics at different levels. In particular, processes of commodification have played an important role in shaping how some may benefit at the cost of catastrophic harm to others

From incomer to insider: The development of the TRANSPEC model - A systematic review of the factors influencing the effective rapid and early career TRANsition to a nursing SPECiality in differing contexts of practice

(c) The Author/sObjective Shortages in the speciality nursing workforce, both nationally and internationally are driving the need for the development of an evidence-based model to inform recruitment and retention into speciality nursing practice. This study aimed to identify the factors influencing rapid and early career transition into speciality nursing practice. Methods A comprehensive systematic review of the literature was undertaken using a convergent qualitative synthesis design where results from qualitative, quantitative and mixed methods studies were transformed into qualitative findings. Databases included CINAHL, Medline, Scopus and PsycINFO. Search terms were: nurse, early career, rapid career, transition, specialty, and Medical Subject Heading terms included: professional development and educational, nursing, and continuing. Using validated tools, papers were independently assessed by a minimum of two reviewers. Results Twenty-three research articles were included. There were no randomized control trials. Through thematic analysis and matrix mapping of the results, the TRANSPEC model was developed. The model outlines three phases of transition: pre-entry, incomer and insider. There has been little focus on pre-entry with programs being designed at the incomer and insider phases. Impacting on these phases are three concepts: the self (professional and personal), the transition processes (informal and formal) and a sense of belonging. The overarching theme influencing the phases and concepts is the context of practice. Enablers and inhibitors influence successful transition and therefore impact on recruitment and retention. Each nurse’s transition is influenced by time. Conclusions For successful transition, the enablers and inhibitors impacting on the three concepts, phases and the context of practice need to be considered when developing any program. It is apparent that while previous studies have focused on the transition processes, such as curricula, the development of the self and a sense of belonging are also essential to successful transition. Further studies should include the pre-entry phase

Gender and personal breastfeeding experience of rural GP registrars in Australia - a qualitative study of their effect on breastfeeding attitudes and knowledge

Introduction: While most doctors believe they have a major role to play in breastfeeding promotion, and consider it worthwhile taking time to assist women to continue to breastfeed, it appears that gender and personal breastfeeding experience affect their attitude and confidence concerning breastfeeding issues. As doctors practicing in rural and regional areas may be expected to provide a greater degree of assistance and support for breastfeeding women, their views on these topics are of particular interest. This article reports the results of qualitative interviews with eight GP registrars from rural and regional Australia, and their views about the influence gender and personal experience have on their ability to assist breastfeeding women. The study is part of a larger project investigating the breastfeeding skills and knowledge of GP registrars as a basis for designing a tailored educational breastfeeding resource. This project uses mixed methods and triangulation of data. Method: Semi-structured, one-on-one interviews were conducted with eight GP registrars from southern Queensland, Australia. The participants were chosen so that there were eight unique combinations of age (<34 or ≥34), gender (male or female) and breastfeeding experience (self or spouse had breastfed/had not breastfed) to ensure diversity of responses and increase the transferability of results. Demographics were collected from each participant, as well as information about: their attitudes to breastfeeding and to counselling breastfeeding women; their perception of breastfeeding knowledge needs and their confidence assisting breastfeeding women; and prior training about breastfeeding. Transcripts of the recorded interviews were returned to the participants for verification before analysis. Emergent themes were identified both within and between interviews following content analysis. Results: Four male and four female registrars with a mean age of 35 years (range 28-43 years) were recruited. Two participants of each gender were parents and their children had been breastfed for more than 6 months. Half the participants practised in small or other rural communities (RRMA 4 or 5), with three of the remainder practising in regional areas. Participants perceived that women thought female doctors were more knowledgeable and skilful concerning breastfeeding issues, regardless of their training or experience. They also assumed that women with breastfeeding problems would attend a female GP in preference to a male GP. These assumptions led male participants’ to question the need for them to know any more than basic breastfeeding information. Being female, however, did not automatically confer special breastfeeding knowledge, with nulliparous female participants also mentioning a lack of knowledge and skills. In contrast, having personal breastfeeding experience (of self or spouse) was an important source of breastfeeding information and skill development, and increased the participants’ confidence to assist breastfeeding women. Those without personal breastfeeding experience questioned the validity of the information they provided and felt that they would not be competent to assist mothers until they had had personal breastfeeding experience. Conclusion: This subset of rural Australian GP registrars acknowledged that both gender and personal experience with breastfeeding influenced their attitudes, perceived knowledge and confidence with breastfeeding issues. Female doctors were thought to be more knowledgeable and skilful in assisting breastfeeding women. Additionally, personal breastfeeding experience was thought to be important for gaining competence in the area. While GPs do not work with breastfeeding women in isolation, they appear to be an important resource for breastfeeding women, particularly when living in rural and remote areas. These results have implications for those training GP registrars. Both men and women should be encouraged to learn practical breastfeeding information and skills to assist breastfeeding women, rather than relying on personal or spousal breastfeeding experience. By having some expertise in the area, they can work in partnership with others in the community to provide the services mothers need

The Rise of the Resilient Local Authority?

The term resilience is increasingly being utilised within the study of public policy to depict how individuals, communities and organisations can adapt, cope, and ‘bounce back’ when faced with external shocks such as climate change, economic recession and cuts in public expenditure. In focussing on the local dimensions of the resilience debate, this article argues that the term can provide useful insights into how the challenges facing local authorities in the UK can be reformulated and reinterpreted. The article also distinguishes between resilience as ‘recovery’ and resilience as ‘transformation’, with the latter's focus on ‘bouncing forward’ from external shocks seen as offering a more radical framework within which the opportunities for local innovation and creativity can be assessed and explained. While also acknowledging some of the weaknesses of the resilience debate, the dangers of conceptual ‘stretching’, and the extent of local vulnerabilities, the article highlights a range of examples where local authorities – and crucially, local communities – have enhanced their adaptive capacity, within existing powers and responsibilities. From this viewpoint, some of the barriers to the development of resilient local government are not insurmountable, and can be overcome by ‘digging deep’ to draw upon existing resources and capabilities, promoting a strategic approach to risk, exhibiting greater ambition and imagination, and creating space for local communities to develop their own resilience