Women's views and outcomes of an educational intervention designed to enhance psychosocial support for women during pregnancy

Background: Identification of psychosocial issues in pregnant women by screening is difficult because of the lack of accuracy of screening tools, women's reluctance to disclose sensitive issues, and health care practitioner's reluctance to ask. This paper evaluates if a health professional education program, a new (ANEW) approach, improves pregnant women's ratings of care and practitioner's listening skills and comfort to disclose psychosocial issues.

Methods: Midwives and doctors from Mercy Hospital for Women, Melbourne, Australia, were trained from August to December 2002. English-speaking women (< 20 wks' gestation) were recruited at their first visit and mailed a survey at 30 weeks (early 2002) before and after (2003) the ANEW educational intervention. Follow-up was by postal reminder at 2 weeks and telephone reminder 2 weeks later.

Results: Twenty-one midwives and 5 doctors were trained. Of the eligible women, 78.2 percent (584/747) participated in a pre-ANEW survey and 73.3 percent (481/657) in a post-ANEW survey. After ANEW, women were more likely to report that midwives asked questions that helped them to talk about psychosocial problems (OR 1.45, CI 1.09–1.98) and that they would feel comfortable to discuss a range of psychosocial issues if they were experiencing them (coping after birth for midwives [OR 1.51, CI 1.10–2.08] and feeling depressed [OR 1.49, 1.16–1.93]; and concerns relating to sex [OR 1.35, CI 1.03–1.77] or their relationships [OR 1.36, CI 1.00–1.85] for doctors).

Conclusions: The ANEW program evaluation suggests trends of better communication by health professionals for pregnant women and should be evaluated using rigorous methods in other settings.

Putting woman-centered care into practice : a new (ANEW) approach to psychosocial risk assessment during pregnancy

Background: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy.

Methods: ANEW used a before‐and‐after survey design to evaluate the effects of a 6‐month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self‐rated communication skills, and open‐ended questions about participants' experience of the educational program.

Results: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program.

Conclusions:The program increased the self‐reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

It takes more than breadcrumbs to learn generic skills : collaborating to improve information literacy

The effective teaching and learning of generic skills is becoming an important component of undergraduate education with the introduction of graduate attribute programmes in some Australian universities. Research shows that contextualised learning of these skills is important, but is a discipline-specific context sufficient to ensure student success in acquiring these skills? This paper studies the effectiveness of information skills
learning by a group of undergraduates using Brookfield’s concept of critical reflection and Critical Incident Questionnaire (CIQ). Most students reported positive experiences where the learning environment encouraged a deep approach to learning and negative experiences where that environment encouraged a surface approach. To ensure that students’ approach to
learning is appropriate for achieving the level of information literacy required of graduates, the study recommends the integration of information skills learning into course curricula through the close collaboration of academic and library staff.

Granulocyte colony-stimulating factor receptor: stimulating granulopoiesis and much more

The granulocyte colony-stimulating factor receptor (G-CSFR) plays an important role in the production, survival and activation of neutrophilic granulocytes during both normal and emergency hematopoiesis. The G-CSFR also participates in the development of other myeloid lineages, the mobilization of hematopoietic stem cells and myeloid cell migration. This has lead to several important clinical applications for its ligand, G-CSF. More recently, additional important roles for G-CSFR have emerged outside the hematopoietic system, such as in the protection and repair of a diverse range of tissues, including muscle, liver and neural tissue, providing further scope for developing G-CSF as a therapeutic agent. The G-CSFR has also been implicated in the etiology of disease, with mutations/variants of G-CSFR implicated in neutropenia, myelodysplasia and leukemia. Additionally, autocrine/paracrine stimulation of G-CSFR may be important in the biology of solid tumors, including metastasis.

Extending the Workers' Compensation Act 1987 (N.S.W.) to include independent contractors and to allow more highly paid workers to insure fully their income, with particular reference to engineers

In mid-1987, the existing workers’ compensation system in New South Wales was replaced by a new Scheme, called ‘WorkCover’. While WorkCover solved a number of the financial problems that had plagued its predecessor, its enactment created other issues. Furthermore, WorkCover has failed to deal with a number of gaps in providing compensation for occupational injuries, most notably those suffered by independent contractors. By combining a study of aspects of industrial law and industrial relations, this thesis will examine some of those problems and gaps, in particular: (a) Should WorkCover be amended to enable independent contractors to come within its ambit? (b) Should there be additional insurance cover available (known as ‘top-up’ insurance) to insure those parts of workers’ wages presently left unprotected by WorkCover? (c) Should workers be permitted to take out another form of ‘top-up’ insurance to increase the quantum of death cover presently provided by the Scheme? (d) Should independent contractors who arc permitted to enter WorkCover also be permitted to obtain the extended cover set out in (b) and (c) above? Where appropriate, the thesis compares WorkCover to the workers’ compensation schemes in other Australian jurisdictions. It develops each of the matters referred to above by referring to the results of the writer’s survey of members of the Institution of Engineers (NSW Branch) which was conducted in May and June 1991.

Death and late-stage dementia in institutions : a cultural analysis

The first purpose of this study was to describe the deaths of fifteen nursing home residents with late-stage dementia. The devastating effect of dementia on a person has been called a ‘living death’ (Woods, 1989). The caring which occurs when someone is going through this process in a nursing home was recorded and analysed. In analysing this act of caring, the second purpose was to look for the origins of the structures and the sources of pressure that shaped the context and therefore helped determine the behaviour of the various groups under observation. These groups were residents and their relatives, the staff of the nursing home and the treating doctors. Before commencing observations and carrying out this study, an understanding needed to be developed of: the condition of dementia as it is perceived by health professionals and presented in the media; the institutions in which the majority of people with dementia end their days; the background and conditions of the staff who nurse in them; the models of care that guide and determine policies; and the conceptions of life and death which underpin relevant laws and moral standpoints. Accordingly, in part 1. chapter 1 the history, causes, pathology and effects of dementing conditions are examined. Relevant medical and lay literature including media influences are examined which pertain to the subject of death and dementia and nursing home care. The history of this institutional care is briefly examined together with the growth of the discipline of gerontological nursing. Chapter 2 discusses some of the effects of this history on present day care and the concept of emotional work being carried out within the present day aged care public policy regulations. The moral arguments surrounding illness and dying in Australian society today are briefly discussed. Chapter 3 describes the conceptual framework for the study, the ethnographic method that has been employed and an outline of critical theory as the basis for analysis. The chapter concludes by recounting the practical steps taken to arrange the field work, secure the consent of participants, record data and gather documents, and outlines the ethical considerations given to the undertaking of the study. Chapter 4 describes the context in which the study took place and the first tentative exploration of the culture from an etic perspective. Part 2 describes the death trajectories observed and raises some questions about alternative strategies that may have been considered within a different paradigm of caring. In chapter 5 the death trajectories of each of the fifteen residents in the study are described, each written with a particular emphasis to illustrate aspects of the culture of care that emerged through thematic analysis. Observations, comments and feelings from staff and family are wound in and around these case studies. Chapter 6 looks more closely at the impact of policy and institutional pressure on the milieu in which these deaths took place. Part 3 draws conclusions from the observations and makes suggestions for emancipatory change as viewed from the author's standpoint of critical ethnographic analysis. In the final chapter an argument is presented for policy change that leads a movement towards palliative care practices for people with late-stage dementia. Approaches to implementation of palliative care will need to take account of any expression by the resident such as an advanced directive, indicating a preferred approach to treatment in the period prior to death; a need for a better understanding of such issues as the significance of body breakdown, the manifestations of pain and electrolyte imbalances; the surrounding ethical complexities and shift in public opinion, and perhaps, most of ail, the culture of the institutions in which this dying will take place. A definition of late-stage dementia which might be used in determining patterns of care is set out. A discussion about changes in practice which relate lo communication with treating doctors, the administering of antibiotics, the relief of pain, the mobilisation of residents and the provision of food and water takes place in light of the evidence found. The discussion of these issues is raised in the form of debate. Each aspect needs more rigorous analysis and information so that evidence-based practice, rather than care which is value-laden and emotional, can be used when treatment decisions are made for people with late-stage dementia.

More than a mere story : social and political markers in Australian short fiction of the 1980's

This thesis is a literary history which argues that much of the short fiction published in Australia during the 1980s was deeply influenced by the rapid social and political changes during that decade. My argument concentrates on links between the short stones of the period and the socio/political environment into which they were written. The decade was marked by massive changes in technology, the workplace, and in all other areas of social life. In general terms, the ideology of the 'market' predominated over notions of small 'l' liberalism and the last vestiges of state intervention in the economy. The Australian short story benefited from the social 'experiments' of the 1970s in that its concerns became broader - encompassing the onslaught of feminism, the foregrounding of 'multicultural' concerns, and a move away from the bush into the city as a primary site for narratives. The decade was a rich period for the genre. Why was there a tolerance for a new diversity, in literary terms, when the social and political environment was turning to the right? This is a central question of the thesis. I argue that instead of the 'base' determining the 'superstructure' (i.e. culture) the superstructural changes were essential to the deconstruction of the social and political landscape. This thesis contends that a relationship always exists between the 'literary' and 'the social'. I argue, among other things, that many of the short fictions were influenced by 'postmodern' theory to the extent that they became a form of traumatic note-taking, which masked a late romanticism beneath a fear of the sovereign subject. The fear of 'closure' which insinuated itself into many of the texts, besides being a form of academic corrective, was also a flight from emotional candor. I argue that storytelling was, in many cases, the loser.

Are employees entitled to more?

George Lopez, chair of CPA Australia's insolvency and reconstruction committee reported in Australian CPA (November 2001) on the replacement of the Commonwealth Government Employee Entitlements Support Scheme (EESS) with a new scheme, the General Employee Entitlements Redundancy Scheme (GEERS). Both schemes provide a safety net by which government pays employees their service entitlements and then takes the employees' place in claims against the insolvent employer organisation. Such schemes are fundamentally inequitable as ultimately they require taxpayers and shareholders to foot the bill for the mistakes, excesses, misdemeanours or incompetence of employers. Similar arrangements have been proposed in the past. For instance, the Australian Law Reform Commission's Harmer Report (1988) contained a recommendation that a wage earner (fidelity-type) protection fund be established. In the state of Victoria, local government legislation already exists to ensure that long service leave entitlements are funded.

Working together : collaboration between midwives and doctors in public hospitals

While collaborative, multidisciplinary teamwork is widely espoused as the goal of contemporary hospitals, it is hard to achieve. In maternity care especially, professional rivalries and deep-seated philosophical differences over childbirth generate significant tensions. This article draws on qualitative research in several Victorian public maternity units to consider the challenges to inter-professional collaboration. It reports what doctors and midwives looked for in colleagues they liked to work with — the attributes of a “good doctor” or a “good midwife”. Although their ideals did not entirely match, both groups respected skill and hard work and sought mutual trust, respect and accountability. Yet effective working together is limited both by tensions over role boundaries and power and by incivility that is intensified by increasing workloads and a fragmented labour force. The skills and qualities that form the basis of “professional courtesy” need to be recognised as Aust Health Rev 2009: 33(2): 315–324 essential to good collaborative practice.