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Background: Traumatic births are considered as challenging events in the professional life of midwives. Negative emotional and psychological consequences of these births on midwives are well-established. However, evidence suggests that in the aftermath of challenging events, such as birth traumas, positive outcomes may emerge as well. Based on the literature, shoulder dystocia (SD) is known as one of the most traumatic birth experiences for midwives. In this study we aimed to explore the impact of experiencing SD complicated births on clinical practice of midwives. Methods: A qualitative descriptive study was undertaken. Midwives who had an experience of at least one case of SD were invited to the study through the Australian College of Midwives. In-depth interviews were conducted with 25 midwives. Data were analysed using an inductive thematic approach. Results: Three themes were identified 1) Putting on a brave face 2) Towards the growth zone 3) I am resilient enough to recover, because of …. Experience of SD was described as a dreadful event in midwives’ career. However, on reflection, this experience was considered as a benefit which developed midwives’ clinical expertise and contributed to their professional empowerment. Having faith in birth normality, support from workplace, seniority/ years of experience and self-confidence were among the factors which helped midwives in overcoming the stress after SD. Conclusion: There needs to be greater awareness about the consequences of traumatic births such as SD for midwives. Collegial support has a critical role in helping midwives to have a positive outlook on their traumatic experience and to ease their pathway of professional growth.

Like any new technology, rapid integration of genomic sequencing (GS) into the clinical setting can pose challenges for genetic health professionals (GHPs) using it to diagnose patients. We conducted semi-structured interviews with 31 clinical geneticists and genetic counsellors across Europe, Australia and Canada to gain a better understanding of the issues they were experiencing when requesting GS and receiving reports from laboratories. There was a spectrum of interactions between genetic health professionals and laboratories. This ranged from those that almost exclusively request sequencing from the laboratory that is affiliated with their genetic service, to those who do not have access to exome sequencing 'in-house' and instead send patient samples to a selection of different external laboratories. In general, a closer interaction between the clinicians and the laboratory scientists increased the involvement of the clinicians in the analysis/interpretation process. This appeared to lead to fewer, but more clinically relevant variants being reported, and greater GHP satisfaction in what is reported. Our findings suggest that GHPs consider integration of clinical expertise into the analysis/interpretation process is critical to ensure that the variants reported are of high clinical significance to patients. They also highlight the importance of providing GHPs with training in report interpretation. ispartof: EUROPEAN JOURNAL OF MEDICAL GENETICS vol:63 issue:3 ispartof: location:Netherlands status: published

This chapter aims to describe how clients view ownership of equines and how clinicians can bring this topic into psychotherapy sessions. More specifically, the focus of this chapter will outline how inquiring about client's relationships with their equines can give assessment information, can inform treatment goals and interventions as well as teach clients to use their relationships with their equines as a resource in their healing. Clients come to therapy in various states of dis-ease and their relationships with their equines can contribute to their healing, help build a sense of mastery and competence, and can sometimes be a reason to get up and moving each day. Through clinical expertise, client self-reports, and interviews with other clinicians, this chapter will be a dynamic tool and resource which will help inform students and professionals as they navigate relationships with clients, families, and systems to offer best practices in psychotherapy and healing.

Introduction Many organisations struggle to clearly differentiate the radiographer consultant role from advanced or specialist practice, with newly appointed consultant practitioners often ill-prepared for working at this level. This article discusses the design, implementation and validation of an outcomes framework for benchmarking competencies for trainee or new-in-post consultant radiographers. Methods Five experienced radiographers from different clinical specialisms were seconded to a twelve month consultant trainee post, guided by a locally-devised outcomes framework. A longitudinal qualitative study explored, from the radiographers' perspective, the impact of the outcomes framework on the transition to consultant practice and beyond. Data collection included semi-structured interviews (months 1, 6 and 12), validation via a focus group (month 18) and a group interview (5 years). Results Early interactions with framework objectives were mechanistic, but as participants better understood the role more creative approaches emerged. Despite diverse clinical expertise, the framework facilitated parity between participants, promoting transparency and credibility which was important in how the consultant role was perceived. All participants achieved all framework outcomes and were subsequently appointed to substantive consultant radiographer positions. Conclusion This outcomes framework facilitates experienced radiographers to successfully transition into consultant radiographers, enabling them to meet multiple non-clinical targets while continuing to work effectively within a changing clinical environment. It is the first validated benchmarking tool designed to support the transition to radiographer consultant practice. Adoption of the tool will provide a standardised measure of consultant radiographer outcomes that will promote inter-organisational transferability hitherto unseen in the UK.

Clinical decisions should be informed by the best available research evidence. But finding, appraising, and applying evidence in making clinical decisions for individual patients is a complex process, and clinicians need help accomplishing it in their limited time. Evidence-based medicine (EBM) resources try to assist busy clinicians by screening, preappraising, extracting, and digesting the evidence into plain clinical language. The 5S model (systems, summaries, synopses, syntheses, and studies) provides a framework for the hierarchy of evidence and its readiness to be used at the bedside. Systematic reviews (syntheses) are studies aiming to systematically locate, appraise, and summarize the research findings related to a specific clinical decision. Clinical practice guidelines are documents produced through a comprehensive synthesis of literature, elicitation of values and perspectives from all stakeholders, and systematic development of practice recommendations, which are easily transferable to clinical practice. But even the high-quality guideline recommendations should be adapted to local contexts of care, by considering local resources, costs, and culture. Evidence is only one component of clinical decisions and should be accompanied by clinical expertise and involvement of patient values and needs.

The chapter provides several avenues to reach out into a demographic community, nation, and the world at large. The chapter outlines opportunities for professionals to shape and heal communities with their clinical expertise. The avenues one chooses depend upon timing, luck, clinical specialties, and comfort zone. The chapter explains how to work with radio, newspapers, and television, and how to participate in health screenings, such as National Depression Awareness Day. It provides six goals of a public education idea. These include (1) making psychological appeal to the masses, (2) shaping policy so that large groups use the services, (3) impacting movies and television story lines, (4) helping corporations, (5) helping companies help people, and (6) organizing screenings. Some parallel ideas about how to reach the consumer with the value of what these psychological services do for people are also discussed in the chapter.