Key milestones in the operationalisation of professional nursing ethics in Australia: a brief historical overview

Objective To provide a brief historical overview of the achievement of key milestones in the development of mechanisms for operationalising professional nursing ethics in Australia; examples of such milestones include: the publication of the first Australian text on nursing ethics (1989), the provision of the first Australian national distance education course on nursing ethics for registered nurses (1990), the adoption of the first code of ethics for Australian nurses (1993), and the commissioning of the first regular column on nursing ethics by the Australian Nurses Journal (2008).

Setting Australian nursing ethics.

Primary argument An historical perspective on the achievement of key milestones in the development of mechanisms for operationalising professional nursing ethics in Australia has been poorly documented. As a consequence an authentic ‘Australian voice’ is missing in global discourses on the history and development of nursing ethics as a field of inquiry. Compared with other countries, the achievement of key milestones pertinent to the operationalisation of nursing ethics in Australia has been relatively slow. Even so, over the past three decades an Australian perspective on nursing ethics has gained a notable voice in the international arena with Australian nursing scholars now making a significant contribution to the field.

Conclusion Nursing ethics in Australia remains a ‘work in progress’. Although significant achievements have been made in the last three decades, the ongoing development of mechanisms for advancing nursing ethics in Australia would benefit from the development and implementation of a strategic agenda of collaborative, internationally comparative, cross disciplinary scholarship, research and critique.

Empoderamento dos enfermeiros : estudo de alguns fatores intervenientes

Enquadramento O empoderamento é um processo que resulta no fortalecimento pessoal e profissional, na forma de aquisição de competências, motivação, satisfação e tomada de decisão. Está vinculado á autonomia profissional e concretiza-se na tomada de decisão autónoma do enfermeiro. Objetivos:; Identificar as variáveis sociodemográficas, socioprofissionais e de contexto formativo que influenciam o Empoderamento dos enfermeiros. Método:Realizamos um estudo de natureza quantitativa, descritiva-analítico e correlacional com amostra não probabilística de 240 enfermeiros que responderam ao questionário sociodemográfico, á escala “ Perceptions of Empowerment in Midwifery Scale” (Mathews, Scott e Gallagher (2009)1 e á escala da motivação para o exercício profissional. Os enfermeiros possuíam idades entre os 26 e os 66 anos, maioritariamente com vinculo por tempo indeterminado á instituição onde trabalham. Revelaram uma boa perceção sobre o Empoderamento com percentuais a oscilar entre os 50,0% no reconhecimento organizacional e os 100% no reconhecimento por pares. Os mais jovens possuem melhor perceção sobre o Empoderamento no reconhecimento por pares, organizacional e empoderamento global, e os mais velhos maior empoderamento na dimensão pessoal. São os Enfermeiros com mestrado e doutoramento que possuem uma menor perceção na dimensão multidimensional, reconhecimento por pares e reconhecimento organizacional. Quanto à motivação 40,0%dos participantes do estudo encontram-se muito motivados, Conclusão. Pelos resultados obtidos podemos concluir que são os enfermeiros com maior motivação e com mais formação que revelam melhor perceção sobre o Empoderamento. e consequentemente maior capacidade de decisão.

Nurses', midwives' and key stakeholders' experiences and perceptions on requirements to demonstrate the maintenance of professional competence.

Aim: To present the qualitative findings from a study on the development of scheme(s) to give evidence of maintenance of professional competence for nurses and midwives. Background: Key issues in maintenance of professional competence include notions of self- assessment, verification of engagement and practice hours, provision of an evidential record, the role of the employer and articulation of possible consequences for non-adherence with the requirements. Schemes to demonstrate the maintenance of professional competence have application to nurses, midwives and regulatory bodies and healthcare employers worldwide. Design: A mixed methods approach was used. This included an online survey of nurses and midwives and focus groups with nurses and midwives and other key stakeholders. The qualitative data are reported in this study. Methods: Focus groups were conducted among a purposive sample of nurses, midwives and key stakeholders from January–May 2015. A total of 13 focus groups with 91 participants contributed to the study. Findings: Four major themes were identified: Definitions and Characteristics of Competence; Continuing Professional Development and Demonstrating Competence; Assessment of Competence; The Nursing and Midwifery Board of Ireland and employers as regulators and enablers of maintaining professional competence. Conclusion: Competence incorporates knowledge, skills, attitudes, professionalism, application of evidence and translating learning into practice. It is specific to the nurse's/midwife's role, organizational needs, patient's needs and the individual nurse's/midwife's learning needs. Competencies develop over time and change as nurses and midwives work in different practice areas. Thus, role-specific competence is linked to recent engagement in practice.

Patient safety issues and concerns in Bhutan’s healthcare system: a qualitative study.

This study identified medication errors, healthcare associated infections, diagnostic errors, surgical errors, laboratory errors and a lack of infrastructure to progress patient safety in hospital contexts as major concerns in the resource poor nation of Bhutan. A culturally adaptive Bhutanised approach to redress these concerns and improve patient safety is proposed.

A public health intervention to change knowledge, attitudes and behaviour regarding alcohol consumption in pregnancy

Aim. To evaluate the effectiveness of a public health intervention aimed at changing knowledge, attitudes and behaviour. Methods. A non-blinded parallel group randomised controlled trial of pregnant women over 18 years of age. Women were recruited in the second trimester and assigned to one of two treatment groups. Both groups completed an initial questionnaire assessing knowledge, attitudes, and practices relating to alcohol consumption during pregnancy. The intervention group then received a mocktail recipe booklet and participants were asked to share the information with their partner. The control group received standard antenatal care. A follow-up questionnaire was conducted four weeks post birth. Primary outcome measures were a knowledge score of the health risks associated with alcohol consumption during pregnancy and an attitude score toward drinking during pregnancy. Secondary outcome measures included whether or not the woman and her partner abstained from drinking. Ethical approval was granted by the Women’s and Children’s Health Network and the University of South Australia. Results. A total of 161 participants were recruited at baseline (intervention = 82, control = 79) and 96 participants completed the trial (intervention = 49, control = 47). The findings suggest that the mocktail booklet was effective at improving knowledge (p<0.001; effect size 0.80) and improving attitudes towards drinking during pregnancy (p=0.017; effect size 0.43) in the intervention group compared to the control group. Although women in the intervention group were 30% more likely to abstain from drinking than in the control group (RR=1.3, 95% CI 0.97 – 1.75), this result was not statistically significant (p=0.077). Conclusions. Knowledge regarding the effects of alcohol consumption as well as attitudes towards drinking significantly improved as a result of a mocktail recipe booklet. Improving knowledge and changing attitudes has the potential to change health behaviour. Therefore, this intervention may reduce the percentage of women who continue to drink alcohol while they are pregnant and improve outcomes for infants and children.

'How can we go on caring when nobody here cares about us?' Australian public maternity units as contested care sites

BACKGROUND: Provision of personalised, continuous care focused on 'well women' is now central to midwifery identity and work ideals, but it remains difficult in hospital contexts shaped by increased demand and by neoliberal policies. Previous accounts of occupational and work-family conflicts in midwifery and nursing have pointed to the 'moral distress' associated with managing conflicting expectations in health workplaces. QUESTION: This paper examines these issues in the Australian context and considers further the ethical implications of midwives not feeling 'cared for' themselves in health care organisations. METHODS: Qualitative research in several Victorian maternity units included use of interviews and observational methods to explore staff experiences of organisational and professional change. Data were coded and analysed using NVivo. FINDINGS: Midwives reported frequent contestation as they sought to practice their ideal of themselves as caregivers in what they reported as often 'uncaring' workplaces. To interpret this data, we argue for seeing midwifery caring as embodied social practice taking place within 'organisation carescapes'. CONCLUSION: Theoretical analysis of the moral and ethical dimensions of the contemporary organisational structure of maternity care suggests that a practice-based and dialogical ethic should form the core principle of care both for women in childbirth and for their carers.

Does the poor quality of Australian health education documentation undermine the message? A review of documents informing pregnant women about alcohol

Background. The advice given to pregnant women about alcohol consumption during pregnancy is variable across countries and within countries.Aim. The aim of this study was to review the content and design of existing Australian health education documentation regarding alcohol consumption in pregnancy that is available to pregnant women. Methods. A documentary analysis was conducted. This involved the identification and collection of a range of health education documents, which were then systematically analysed. The thematic and symbolic elements of each document were compared and contrasted using a modified version of the DISCERN instrument. Findings. A total of 32 documents were retrieved via general and targeted internet searching. Documents varied considerably in their purpose, language levels, accessibility, and quality. The majority of documents scored as low to moderate quality. Implications. Although there are many and varied existing documents relating to alcohol consumption during pregnancy in Australia, these are not of high quality and could be substantially improved by including publication dates, using simple language, and providing sources of information. This may result in a more effective public health message and so help to reduce the number of pregnant women who continue to drink during pregnancy.

Perinatal mental health education for midwives in Victoria

Perinatal mental health issues affect women and their families world-wide. Midwives can make a difference to women and families lives with early and prompt detection of perinatal mental health issues.

A Experiência de dor no doente oncológico com doença avançada

Introdução: O pós-parto abrange o processo de transição para a parentalidade, considerado um dos principais momentos de transição ao longo da vida, responsável por mudanças a vários níveis, nomeadamente individual, conjugal, familiar e social, implicando gestão de novos sentimentos, comportamentos e preocupações com o(a) próprio(a) e com o(s), filho(s) (Kaitz, 2007; Mendes, 2009). Esta revisão integrativa da literatura foca-se nas preocupações da figura materna da díade parental no período pós-parto. Objetivos: Analisar os estudos de investigação acerca da temática das preocupações maternas no pós-parto nas sociedades contemporâneas. Metodologia: Revisão integrativa da literatura centrada na temática “preocupações maternas no pós-parto”. Utilizouse o motor de busca EBSCOhost, com acesso às bases de dados científicos: CINAHL® Complete; MEDLINE Complete; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; e ainda a base de dados SCIELO ”. Obtiveramse 17 publicações científicas com a utilização do Boolean search operators “AND”, para os descritores MeSH pósparto/“ postpartum” e nascimento/“childbirth” e como tema principal “preocupações maternas”/“maternal concerns”, com disponibilidade para aceder ao texto completo, com data de publicação entre o período de Janeiro 2000 e Dezembro 2015. Resultados: Os resultados da revisão integrativa da literatura acerca da temática das preocupações maternas que pretendeu responder à questão - Quais as preocupações maternas durante o pós-parto nas sociedades contemporâneas? - agruparam-se em 5 áreas: preocupações maternas e o cuidar do recém-nascido; preocupações maternas e recuperação funcional; preocupações maternas e transição para a parentalidade; preocupações maternas e relacionamento conjugal; e preocupações maternas intergeracionais. Conclusões: Da revisão dos artigos selecionados verificou-se que as preocupações maternas refletem as necessidades das mães, no período de transição de pós-parto, assim como, as assinaladas alterações no assumir de novos papéis e da redefinição/reorganização nas responsabilidades, no seio da díade parental/família e deste modo, espelham uma área de interesse no âmbito dos cuidados à mulher/casal e família após o nascimento de um filho, de onde as intervenções de enfermagem especializada em saúde materna e obstetrícia são relevantes na avaliação da transição saudável no contexto do pós-parto, quer na vertente materna, quer na díade parental e no cuidar do recém-nascido. Palavras-chave: pós-parto; preocupações maternas; recém-nascido; nascimento Referências bibliográficas: Kaitz, M. (2007). Maternal concerns during early parenthood. Child: Care, Health and Development, 33(6), 720-727. Lugina, H., Christensson, K., Massawe, S., Nystrom, L., & Lindmark, G. (2001). Change in maternal concerns during the 6 weeks postpartum period: A study of primiparous mothers in Dar es Salaam, Tanzania. Journal of Midwifery & Women’s Health, 46(4), 248-257. doi: 10.1016/S1526-9523(01)00133-7 Lugina, H., Nyström, L., Christensson, K., & Lindmark, G. (2004). Assessing mothers’ concerns in the postpartum period: Methodological issues. Journal of Advanced Nursing, 48(3), 279-290. doi: 10.1111/j.1365-2648.2004.03197.x Mendes, I. M. (2009). Ajustamento materno e paterno: Experiências vivenciadas pelos pais no pós-parto. Coimbra, Portugal: Mar da Palavra. * Escola Superior de Enfermagem de Coimbra, Unidade Científico-Pedagógica de Enfermagem de Saúde Materna e Obstetrícia [ana@esenfc.pt] ** Escola Superior de Enfermagem de Coimbra, Enfermagem de Saúde Materna, Obstetrícia e Ginecologia, Professora C