Search

Background: Graduate Diploma in Midwifery students at an Australian university poorly evaluated a compulsory theoretical subject (unit of study) titled Becoming a Reflective Practitioner over several years. Method: Authentic practice-based simulated scenarios were introduced to improve student learning and as an innovative approach to teaching reflective practice. The introduction was evaluated using student feedback surveys, pre- and post simulation knowledge questionnaires, and 6-week retention-of-knowledge questionnaires. Results: Students reported improved levels of satisfaction, greater learning, and increasing knowledge in the simulated practice area. The students rated the scenarios as useful in increasing reflective practice, but this was secondary to skill acquisition. Conclusion: Simulated activities may prove useful in developing reflective practice, but further investigation is required to examine how to shift the focus from clinical skill acquisition to reflective practice. © 2012 International Nursing Association for Clinical Simulation and Learning.

Objective. To determine, from the evidence, what is the optimum decision to delivery (DDI) intervals in emergency Caesarean sections (CS). The aim of the study was to help guide policy in maternity services and identify issues relating to DDI and safe practice in maternity care. Method. A systematic review of the literature was undertaken. Assessment of the quality of eligible papers was undertaken using the Critical Appraisal Skills Program (CASP) rating. Results. There is no strong evidence that a DDI of 30min or less is associated with improved outcomes for babies or mothers. Some evidence suggests that a DDI of greater than 30min but less than 75min confers benefit, but these findings were confounded by the indications for the emergency CS. Conclusion. Urgent CS should occur as soon as possible, but there is insufficient evidence to support a definite time frame, such as 30min. A consistency of approach and nomenclature in describing the urgency of CS is necessary, which would enable criteria for further audit regarding DDI. Staff training should be addressed to improve transfer systems for CS. Antenatal risk assessment and congruence with role delineation and service delivery capacity is important. What is known about the topic? The 30-min rule has been cited and used globally as best practice, despite the low level of supporting evidence. What does this paper add? There is no strong evidence that DDIs of less than 30min are associated with improved neonatal or maternal outcomes. A DDI of greater than 30min but less than 75min confers some benefit, but this is tempered by the urgency of the CS. What are the implications for practitioners? Urgent CS should occur as soon as possible, but there is insufficient evidence to support a definite time frame, such as 30min. A consistency of approach and nomenclature in describing the urgency of CS is necessary, which would enable criteria for further audit regarding DDI. Staff training should be addressed regarding effic

Background: Publicly-funded homebirth programs in Australia have been developed in the past decade mostly in isolation from each other and with limited published evaluations. There is also distinct lack of publicly available information about the development and characteristics of these programs. We instigated the National Publicly-funded Homebirth Consortium and conducted a preliminary survey of publicly-funded homebirth providers. Aim: To outline the development of publicly-funded homebirth models in Australia. Methods: Providers of publicly-funded homebirth programs in Australia were surveyed using an on-line survey in December 2010. Questions were about their development, use of policy and general operational issues. A descriptive analysis of the quantitative data and content analysis of the qualitative data was undertaken. Findings: In total, 12 programs were identified and 10 contributed data to this paper. The service providers reported extensive multidisciplinary consultation and careful planning during development. There was a lack of consistency in data collection throughout the publicly-funded homebirth programs due to different databases, definitions and the use of different guidelines. Discussion: Publicly-funded homebirth services followed different routes during their development, but essentially had safety and collaboration with stakeholders, including women and obstetricians, as central to their process. Conclusion: The National Publicly-funded Homebirth Consortium has facilitated a sharing of resources, processes of development and a linkage of homebirth services around the country. This analysis has provided information to assist future planning and developments in models of midwifery care. It is important that births of women booked to these programs are clearly identified when their data is incorporated into existing perinatal datasets. © 2011 Australian College of Midwives.

Background: Hospital birth is commonly thought to be a safer option than homebirth, despite many studies showing similar rates of safety for low risk mothers and babies when cared for by qualified midwives with systems of back-up in place. Recently in Australia, demand has led to the introduction of a small number of publicly-funded homebirth programs. Women's confidence in having a homebirth through a publicly-funded homebirth program in Australia has not yet been explored. Aim: The aim of the study was to explore the reasons why multiparous women feel confident to have a homebirth within a publicly-funded model of care in Australia. Methods: Ten multiparous English-speaking women who chose to have a homebirth with the St George Hospital Homebirth Program were interviewed in the postnatal period using semi-structured, open-ended questions. Interviews were transcribed, then a thematic analysis was undertaken. Results: Women, having already experienced a normal birth, demonstrated a strong confidence in their ability to give birth at home and described a confidence in their bodies, their midwives, and the health system. Women weighed up the risks of homebirth through information they gathered and integration with their previous experience of birth, their family support and self-confidence. Discussion: Women choosing publicly-funded homebirth display strong confidence in both themselves to give birth at home, and their belief in the health system's ability to cope with any complications that may arise. Implications for practice: Many women may benefit from access to publicly-funded homebirth models of care. This should be further investigated. © 2010 Australian College of Midwives.

Aim. The aim of this study was to review clinical interventions that increase the uptake and/or the success rates of vaginal birth after caesarean section. Background. Repeat caesarean section is the main reason for the increase in surgical births. The risk of uterine rupture in women who have prior caesarean sections prevents many clinicians from recommending vaginal birth after caesarean. Despite this, support for vaginal birth after caesarean continues. Data sources. A search of five databases and a number of relevant professional websites was undertaken up to December 2008. Review methods. A systematic review of quantitative studies that involved a comparison group and examined a clinical intervention for increasing the uptake and/or the success of vaginal birth after caesarean section was undertaken. An assessment of quality was made using the Critical Skills Appraisal Programme. Results. Induction of labour using artificial rupture of membranes, prostaglandins, oxytocin infusion or a combination, was associated with lower vaginal birth rates. Cervical ripening agents such as prostaglandins and transcervical catheters may result in lower vaginal birth rates compared with spontaneous labour. The impact of epidural anaesthesia in labour on vaginal birth after caesarean success is inconclusive. X-ray pelvimetry is associated with reduced uptake of vaginal birth after caesarean and higher caesarean section rates. Scoring systems to predict likelihood of vaginal birth are largely unhelpful. There is insufficient data in relation to vaginal birth after caesarean section between different closure methods for the primary caesarean section. Conclusion. Clinical factors can affect vaginal birth after caesarean uptake and success. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Introduction: The environment for birth influences women in labor. Optimal birthing environments have the potential to facilitate normal labor and birth. The measurement of optimal birth units is currently not possible because there are no tools. An audit tool, the Birth Unit Design Spatial Evaluation Tool (BUDSET), was developed to assess the optimality of birthing environments. The BUDSET is based on 4 domains (fear cascade, facility, aesthetics, support), each comprising design principles that are further differentiated into specific assessable design items. In the process of developing measurement tools, content validity must be established. The aim of this study was to establish the content validity of the BUDSET from the perspective of women and midwives. Methods: This was a mixed-methods study with a survey assessing agreement with BUDSET items and in-depth interviews. Survey results were analyzed using an item-level content validity index and a survey-level validity index. Interview data were analyzed using a directed content analysis approach. The study was conducted in 2 locations-a major maternity hospital and a midwifery research center, both in Australia. Study participants were 10 women and 2 midwifery academics. Results: The survey revealed that content-related validity varied according to the BUDSET domain, with the domains of facility and support established as content valid by most participants. The domains of the fear cascade and aesthetic were less strong, particularly among pregnant women. Interview data analysis provided content validity evidence of both the fear cascade and aesthetic domains. A further 4 subthemes of fear cascade also were identified: foreign space, medical-hospital-emergency, being sterile/clinical, and protecting the woman from the environment. Content validity evidence for facility and support domains also was established. Discussion: This study has established that the BUDSET is content valid for assessing the optimality o

Purpose: To relate nurses' self-rated perceptions of violence (emotional abuse, threat, or actual violence) on medical-surgical units to the nursing working environment and to patient outcomes.Design: Cross-sectional collection of data by surveys and primary data collection for 1-week periods on 94 nursing wards in 21 hospitals in two states of Australia.Methods: Nursing Work Index-Revised (NWI-R); Environmental Complexity Scale (ECS) PRN-80 (a measure of patient acuity); and a nursing survey with three questions on workplace violence; combined with primary data collection for staffing, skill mix, and patient outcomes (falls, medication errors).Findings: About one third of nurses participating (N=2,487, 80.3% response rate) perceived emotional abuse during the last five shifts worked. Reports of threats (14%) or actual violence (20%) were lower, but there was great variation among nursing units with some unit rates as high as 65%. Reported violence was associated with increased ward instability (lack of leadership; difficult MD and RN relationships). Violence was associated with unit operations: unanticipated changes in patient mix; proportion of patients awaiting placement; the discrepancy between nursing resources required from acuity measurement and those supplied; more tasks delayed; and increases in medication errors. Higher skill mix (percentage of registered nurses) and percentage of nurses with a bachelor of science in nursing degrees were associated with fewer reported perceptions of violence at the ward level. Intent to leave the present position was associated with perceptions of emotional violence but not with threat or actual assault.Conclusions: Violence is a fact of working life for nurses. Perceptions of violence were related to adverse patient outcomes through unstable or negative qualities of the working environment. Perceptions of violence affect job satisfaction.Clinical Relevance: In order to manage effectively the delivery of nursing care in ho

Aims and objectives: The study aimed to explore whether nurse staffing, experience and skill mix influenced the model of nursing care in medical-surgical wards. Background: Methods of allocating nurses to patients are typically divided into four types: primary nursing, patient allocation, task assignment and team nursing. Research findings are varied in regard to the relationship between these models of care and outcomes such as satisfaction and quality. Skill mix has been associated with various models, with implications for collegial support, teamwork and patient outcomes. Design: Secondary analysis of data collected on 80 randomly selected medical-surgical wards in 19 public hospitals in New South Wales, Australia during 2004-2005. Methods: Nurses (n = 2278, 80·9% response rate) were surveyed using The Nursing Care Delivery System and the Nursing Work Index-Revised. Staffing and skill mix was obtained from the ward roster and other data from the patient record. Models of care were examined in relation to these practice environment and organisational variables. Results: The models of nursing care most frequently reported by nurses in medical-surgical wards in this study were patient allocation (91%) and team nursing (80%). Primary nursing and task based models were unlikely to be practised. Skill mix, nurse experience, nursing workload and factors in the ward environment significantly influenced the model of care in use. Wards with a higher ratio of degree qualified, experienced registered nurses, working on their 'usual' ward were more likely to practice patient allocation while wards with greater variability in staffing levels and skill mix were more likely to practice team nursing. Conclusions: Models of care are not prescriptive but are varied according to ward circumstances and staffing levels based on complex clinical decision making skills. Relevance to clinical practice: Variability in the models of care reported by ward nurses indicates that nurses adapt

The oceans play a key role in climate regulation especially in part buffering (neutralising) the effects of increasing levels of greenhouse gases in the atmosphere and rising global temperatures. This chapter examines how the regulatory processes performed by the oceans alter as a response to climate change and assesses the extent to which positive feedbacks from the ocean may exacerbate climate change. There is clear evidence for rapid change in the oceans. As the main heat store for the world there has been an accelerating change in sea temperatures over the last few decades, which has contributed to rising sea-level. The oceans are also the main store of carbon dioxide (CO2), and are estimated to have taken up 40% of anthropogenic-sourced CO2 from the atmosphere since the beginning of the industrial revolution. A proportion of the carbon uptake is exported via the four ocean ‘carbon pumps’ (Solubility, Biological, Continental Shelf and Carbonate Counter) to the deep ocean reservoir. Increases in sea temperature and changing planktonic systems and ocean currents may lead to a reduction in the uptake of CO2 by the ocean; some evidence suggests a suppression of parts of the marine carbon sink is already underway. While the oceans have buffered climate change through the uptake of CO2 produced by fossil fuel burning this has already had an impact on ocean chemistry through ocean acidification and will continue to do so. Feedbacks to climate change from acidification may result from expected impacts on marine organisms (especially corals and calcareous plankton), ecosystems and biogeochemical cycles. The polar regions of the world are showing the most rapid responses to climate change. As a result of a strong ice–ocean influence, small changes in temperature, salinity and ice cover may trigger large and sudden changes in regional climate with potential downstream feedbacks to the climate of the rest of the world. A warming Arctic Ocean may lead to further releases of

Aim: To review the titles, roles and scope of practice of Advanced Practice Nurses internationally. Background: There is a worldwide shortage of nurses but there is also an increased demand for nurses with enhanced skills who can manage a more diverse, complex and acutely ill patient population than ever before. As a result, a variety of nurses in advanced practice positions has evolved around the world. The differences in nomenclature have led to confusion over the roles, scope of practice and professional boundaries of nurses in an international context. Method: CINAHL, Medline, and the Cochrane database of Systematic Reviews were searched from 1987 to 2008. Information was also obtained through government health and professional organisation websites. All information in the literature regarding current and past status, and nomenclature of advanced practice nursing was considered relevant. Findings: There are many names for Advanced Practice Nurses, and although many of these roles are similar in their function, they can often have different titles. Conclusion: Advanced Practice Nurses are critical for the future, provide cost-effective care and are highly regarded by patients/clients. They will be a constant and permanent feature of future health care provision. However, clarification regarding their classification and regulation is necessary in some countries. Crown Copyright © 2009.

Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated. Crown Copyright © 2009.

Aim. To find that changes in models of service delivery together with the dynamic nature of the contemporary health care context have changed the direction and focus of nurses' work. The aim of this paper is to explore some of the drivers for change and their impact and recommend a way forward to optimising nurses' work in the hospital environment. Background. The healthcare workplace has been transformed over the past 20 years in response to economic and service pressures. However, some of these reforms have had undesirable consequences for nurses' work in hospitals and the use of their time and skills. Results. As the pace and complexity of hospital care increases, nursing work is expanding at both ends of the complexity continuum. Nurses often undertake tasks which less qualified staff could do while at the other end of the continuum, are unable to use their high level skills and expertise. This inefficiency in the use of nursing time may also impact negatively on patient outcomes. Conclusions. Nurses' work that does not directly contribute to patient care, engage higher order cognitive skills or provide opportunity for role expansion may decrease retention of well-qualified and highly skilled nurses in the health workforce. Relevance to clinical practice. In this climate of nursing shortages, we need to use nurses in a cost-effective but also, intellectually satisfying manner, to achieve a sustainable nursing workforce. © 2008 Blackwell Publishing Ltd.

The Monterey Bay Aquarium Research Institute (MBARI) has developed an autonomous seafloor mapping capability for high resolution mapping of the deep ocean seafloor. The MBARI Mapping AUV is a 21" diameter, Dorado class autonomous underwater vehicle (AUV) equipped with a 200 kHz multibeam sonar, 110 kHz and 410 kHz sidescan sonars, and a 2-16 kHz subbottom profiler. All components of the vehicle are rated to 6000 m depth. Using precise navigation and attitude data from an laser-ring-gyro-based inertial navigation system (INS) integrated with a Doppler velocity log sonar (DVL), the Mapping AUV can image the deep-ocean seafloor and shallow subsurface structure with much greater resolution than is possible with hull-mounted sonars. The system can also be operated in an ROV-mounted configuration, allowing near-bottom surveys in very restricted terrain. The Mapping AUV has conducted several autonomous surveys of Monterey Canyon and Smooth Ridge in Monterey Bay, and ROV-mounted surveys of five sites along the Monterey Canyon axis during 2005 and 2006. During June 2006, the Mapping AUV surveyed mounds and channel deposits in the Santa Monica Basin. The bathymetric surveys have achieved a vertical precision of 0.3 m; surveys from a 20 m altitude achieve sub-meter lateral resolution and surveys from 50-100 m altitudes achieve lateral resolutions less than 2 m. The subbottom profile data provides resolution of ~0.1 m with penetrations up to 50 m in soft sediments. The combination of high-resolution bathymetry with closely spaced subbottom profiles allow us to Additional Mapping AUV expeditions are planned for 2006, including surveys of Barclay submarine canyon and the summits of Davidson and Axial seamounts.

The scientific community is engaged in a lively debate over whether and how venting from the gas-hydrate reservoir and the Earth’s climate is connected. The various scenarios which have been proposed are based on the following assumptions: the inventory of methane gas-hydrate deposits is locally enormous, the stability of marine gas-hydrate deposits can easily be perturbed by temperature and pressure changes, enough methane can be released from these deposits to contribute adequate volumes of this isotopically distinct greenhouse gas to alter the composition of oceanic or atmospheric methane reservoirs, and the mechanisms exist for the transfer of methane from deeper geologic reservoirs to the ocean and/or atmosphere. However, some potential transfer mechanisms have been difficult to evaluate. Here, we consider the possibility of marine slumping as a mechanism to transfer methane carbon from gas hydrates within the seafloor into the ocean and atmosphere. Our analyses and field experiments indicate that large slumps could release volumetrically significant quantities of solid gas hydrates which would float upwards in the water column. Large pieces of gas hydrate would reach the upper layers of the ocean before decomposing, and some of the methane would be directly injected into the atmosphere.

We report on controlled experiments to document the fate of naturally occurring methane hydrate released from the sea floor (780 m, 4.3°C) by remotely operated vehicle (ROV) disturbance. Images of buoyant sediment-coated solids rising (∼0.24 m/s) from the debris cloud, soon revealed clear crystals of methane hydrate as surficial material sloughed off. Decomposition and visible degassing began close to the predicted phase boundary, yet pieces initially of ∼0.10 m size easily survived transit to the surface ocean. Smaller pieces dissolved or dissociated before reaching the surface ocean, yet effectively transferred gas to depths where atmospheric ventilation times are short relative to methane oxidation rates.

The Intranet Pencil and Paper Checklist (Murgolo-Poore et al., 2002) is a new measure developed to gauge the perceptions of organization members as to the effectiveness of the firms Intranet, from an Internal Marketing and Human Resource perspective. Three dimensions of the construct "Intranet Effectiveness " have been distilled from initial scale development research and testing, they are Operations, Facilitation and Culture.The instrument is now applied to a financial services organization with approximately 3000 staff to test its robustness across all layers of a hierarchy. It performed well, particularly in plumbing the perceptions of management towards their Intranet.Several theoretical perspectives were investigated to understand how OC and Intranet effectiveness may be associated, including Transaction Cost Theory, Communication Theory and Social Identity Theory. With this theoretical underpinning the instrument was administered to discern if an effective Intranet, through its power to communicate and involve multiple stakeholders had any correlation with Organizational Commitment.Intranet effectiveness was found to have a significant correlation, which varied in its effect across user groups. It was suggested as a focus for future research that peripheral groups might have benefited from the Intranet in a way that increased OC amongst those cohorts disproportionately. Should such a theory be borne out by empirical investigation, it has potential application for strategic decision making in Intranet design and management.

Hydrate Ridge is part of the accretionary complex at the Cascadia margin and is an area of widespread carbonate precipitation induced by the expulsion of methane-rich fluids. All carbonates on Hydrate Ridge are related to the methanecarbon pool either through anaerobic methanotrophy or through methanogenesis. Several petrographically distinct lithologies occur in boulder fields or in massive autochtonous chemoherm complexes which include methane-associated diagenetic mudstones and venting-induced breccias. The mudstones result from methane diagenesis in different sediment horizons and geochemical environments related to very slow methane venting. Cemented bioturbation casts occur as fragments, complex framework or as clasts together with bivalve shells as part of intraformational breccias, which are restricted to chemoherm complexes. Here, fluids ascend from the sub-seafloor and support aragonite-dominated carbonate precipitation near or at the sediment surface. Voids within mudclast breccias are either aragonite-rich indicating a formation near the surface at vent sites or are cemented by dolomite, which indicates formation in deeper parts of the sediment column. Brecciation is caused by tectonic or slump processes. In addition, we recognized a direct relationship between gas hydrates and sediment fracturing as well as the oxygen isotope composition of carbonate lithologies. Such gas hydrate-associated carbonates either show layered megapores and veins as relics of the original gas hydrate fabric or consist of aragonite-cemented intraclast breccias formed by growing and decomposing gas hydrate near the sediment surface. Both rock fabrics and the enrichment of 180 in high Mg-calcite demonstrate carbonate-forming mechanisms of gas hydrate.

The oxidation of methane in anoxic marine sediments is thought to be mediated by a consortium of methane-consuming archaea and sulfate-reducing bacteria. In this study, we compared results of rRNA gene (rDNA) surveys and lipid analyses of archaea and bacteria associated with methane seep sediments from several different sites on the Californian continental margin. Two distinct archaeal lineages (ANME-1 and ANME-2), peripherally related to the order Methanosarcinales, were consistently associated with methane seep marine sediments. The same sediments contained abundant 13C-depleted archaeal lipids, indicating that one or both of these archaeal groups are members of anaerobic methane-oxidizing consortia. 13C-depleted lipids and the signature 16S rDNAs for these archaeal groups were absent in nearby control sediments. Concurrent surveys of bacterial rDNAs revealed a predominance of delta -proteobacteria, in particular, close relatives of Desulfosarcina variabilis. Biomarker analyses of the same sediments showed bacterial fatty acids with strong 13C depletion that are likely products of these sulfate-reducing bacteria. Consistent with these observations, whole-cell fluorescent in situ hybridization revealed aggregations of ANME-2 archaea and sulfate-reducing Desulfosarcina and Desulfococcus species. Additionally, the presence of abundant 13C-depleted ether lipids, presumed to be of bacterial origin but unrelated to ether lipids of members of the order Desulfosarcinales, suggests the participation of additional bacterial groups in the methane-oxidizing process. Although the Desulfosarcinales and ANME-2 consortia appear to participate in the anaerobic oxidation of methane in marine sediments, our data suggest that other bacteria and archaea are also involved in methane oxidation in these environments.