The spiritual and professional impact of stillbirth

Stillbirth is without question one of the most devastating experiences of grief for parents and families. The death of a baby is also a distressing experience for healthcare professionals who share hopes of a live healthy baby at the end of pregnancy. It is a sad reality however, that in Ireland one in 238 babies will die before birth. The creation and nurture of new life in pregnancy is a spiritual experience as a new baby is at the same time experienced and anticipated. There is little in the published literature concerning the spiritual impact of stillbirth on healthcare chaplains who are the main providers of spiritual care for parents and staff colleagues in Irish maternity units. In addition there are few qualitative studies that explore the impact of stillbirth on consultant obstetricians and no published studies on the spiritual impact of stillbirth on bereaved parents. This study explored the spiritual and professional impact of stillbirth on Irish maternity healthcare chaplains, consultant obstetricians and bereaved parents. Following an overall review of spiritual care provision following stillbirth in the Irish maternity services, thematic analysis was used in the first phase of the study following in-depth interviews with maternity healthcare chaplains. Interpretative Phenomenological Analysis was used in the second and third phases with consultant obstetricians and bereaved parents respectively. The data from both maternity healthcare chaplains and consultant obstetricians revealed that stillbirth posed immense personal, spiritual and professional challenges. Chaplains expressed the spiritual and professional impact of stillbirth in terms of perception of their role, suffering, doubt and presence as they provided care for bereaved parents. A review of spiritual care provision in the Irish maternity services revealed a diversity of practice. The data from consultant obstetricians identified considerable personal, professional and spiritual impact following stillbirth that was identified in superordinate themes of human response to stillbirth, weight of professional responsibility, conflict of personal faith and incongruence between personal faith and professional practice. Data from bereaved parents revealed that stillbirth was spiritually challenging and all parents expressed that stillbirth posed considerable challenge to their faith/ belief structure. The parents of only three babies felt that their spiritual needs were adequately addressed while in hospital. The data had six superordinate themes of searching for meaning, maintaining hope, importance of personhood, protective care, questioning core beliefs and relationships. Other findings from the data from bereaved parents outlined the importance of environment of care and communication. This study has revealed the immense impact of stillbirth on healthcare chaplains, consultant obstetricians and most especially the spiritual impact for bereaved parents. Recommendations are made for improvements in clinical and spiritual care for bereaved parents following stillbirth and for staff wellbeing and support initiatives. Further research areas are recommended in the areas of spiritual care, theological reflection, bereavement care, post-mortem consent procedures and staff wellbeing.

Improving the outcomes of foot and ankle surgery. Professional impact of the Australasian College of Podiatric Surgeons' audit tool

Background Surgery is an example of expanded practice scope that enhances podiatry and incorporates inter-professional collaboration. By 2050 demand for foot and ankle procedures is predicted to rise nationally by 61.9%. Performance management of this increase motivated the development of an online audit tool. Developed in collaboration with the Australasian College of Podiatric Surgeons (ACPS), the ACPS audit tool provides real-time data capture and reporting. It is the first audit tool designed in Australia to support and improve the outcomes of foot and ankle surgery. Methods Audit activity in general, orthopaedic, plastic and podiatric surgery was examined using a case study design. Audit participation enablers and barriers were explored. Case study results guided a Delphi survey of international experts experienced or associated with foot and ankle surgery. Delphi survey-derived consensus informed modification of a generic data set from the Royal Australasian College of Surgeons (RACS). Based on the Delphi survey findings the ACPS online audit tool was developed and piloted. Reliability and validity of data entry and usability of this new tool was then assessed with an online survey. Results The case study found surgeon attitudes and behaviours positively impacted audit participation, and also indicated that audit data should be: (1) available in real time, (2) identify practice change, (3) applicable for safety and quality management, and; (4) useful for peer review discussion. The Delphi process established consensus on audit variables to be captured, including the modified RACS generic data set. 382 cases of foot and ankle surgery were captured across 3 months using the new tool. Data entry was found to be valid and reliable. Real-time outcome reporting and practice change identification impacted positively on safety and quality management and assisted peer review discussion. An online survey showed high levels of usability. Conclusions Surgeon contribution to audit tool development resulted in 100% audit participation. The data from the ACPS audit tool supported the ACPS submission to the Medical Services Advisory Committee to list podiatric surgery under Medicare, an outcome noted by the Federal Minister of Health.

The impact of outcomes-driven curriculum reform on teacher perspectives of professional practice

This thesis is the result of an investigation of a Queensland example of curriculum reform based on outcomes, a type of reform common to many parts of the world during the last decade. The purpose of the investigation was to determine the impact of outcomes on teacher perspectives of professional practice. The focus was chosen to permit investigation not only of changes in behaviour resulting from the reform but also of teachers' attitudes and beliefs developed during implementation. The study is based on qualitative methodology, chosen because of its suitability for the investigation of attitudes and perspectives. The study exploits the researcher's opportunities for prolonged, direct contact with groups of teachers through the selection of an over-arching ethnography approach, an approach designed to capture the holistic nature of the reform and to contextualise the data within a broad perspective. The selection of grounded theory as a basis for data analysis reflects the open nature of this inquiry and demonstrates the study's constructivist assumptions about the production of knowledge. The study also constitutes a multi-site case study by virtue of the choice of three individual school sites as objects to be studied and to form the basis of the report. Three primary school sites administered by Brisbane Catholic Education were chosen as the focus of data collection. Data were collected from three school sites as teachers engaged in the first year of implementation of Student Performance Standards, the Queensland version of English outcomes based on the current English syllabus. Teachers' experience of outcomes-driven curriculum reform was studied by means of group interviews conducted at individual school sites over a period of fourteen months, researcher observations and the collection of artefacts such as report cards. Analysis of data followed grounded theory guidelines based on a system of coding. Though classification systems were not generated prior to data analysis, the labelling of categories called on standard, non-idiosyncratic terminology and analytic frames and concepts from existing literature wherever practicable in order to permit possible comparisons with other related research. Data from school sites were examined individually and then combined to determine teacher understandings of the reform, changes that have been made to practice and teacher responses to these changes in terms of their perspectives of professionalism. Teachers in the study understood the reform as primarily an accountability mechanism. Though teachers demonstrated some acceptance of the intentions of the reform, their responses to its conceptualisation, supporting documentation and implications for changing work practices were generally characterised by reduced confidence, anger and frustration. Though the impact of outcomes-based curriculum reform must be interpreted through the inter-relationships of a broad range of elements which comprise teachers' work and their attitudes towards their work, it is proposed that the substantive findings of the study can be understood in terms of four broad themes. First, when the conceptual design of outcomes did not serve teachers' accountability requirements and outcomes were perceived to be expressed in unfamiliar technical language, most teachers in the study lost faith in the value of the reform and lost confidence in their own abilities to understand or implement it. Second, this reduction of confidence was intensified when the scope of outcomes was outside the scope of the teachers' existing curriculum and assessment planning and teachers were confronted with the necessity to include aspects of syllabuses or school programs which they had previously omitted because of a lack of understanding or appreciation. The corollary was that outcomes promoted greater syllabus fidelity when frameworks were closely aligned. Third, other benefits the teachers associated with outcomes included the development of whole school curriculum resources and greater opportunity for teacher collaboration, particularly among schools. The teachers, however, considered a wide range of factors when determining the overall impact of the reform, and perceived a number of them in terms of the costs of implementation. These included the emergence of ethical dilemmas concerning relationships with students, colleagues and parents, reduced individual autonomy, particularly with regard to the selection of valued curriculum content and intensification of workload with the capacity to erode the relationships with students which teachers strongly associated with the rewards of their profession. Finally, in banding together at the school level to resist aspects of implementation, some teachers showed growing awareness of a collective authority capable of being exercised in response to top-down reform. These findings imply that Student Performance Standards require review and, additional implementation resourcing to support teachers through times of reduced confidence in their own abilities. Outcomes prove an effective means of high-fidelity syllabus implementation, and, provided they are expressed in an accessible way and aligned with syllabus frameworks and terminology, should be considered for inclusion in future syllabuses across a range of learning areas. The study also identifies a range of unintended consequences of outcomes-based curriculum and acknowledges the complexity of relationships among all the aspects of teachers' work. It also notes that the impact of reform on teacher perspectives of professional practice may alter teacher-teacher and school-system relationships in ways that have the potential to influence the effectiveness of future curriculum reform.

The impact of professional development on early childhood educators’ confidence, understanding and knowledge of education for sustainability

In recent times, Australia has recognised and enacted a range of initiatives at service, system and community levels that seek to embed sustainability into the early childhood sector. This paper explores the impact of a professional development (PD) session that provided opportunities for early childhood educators to learn and share ideas about the theory and practice of sustainability generally and early childhood education for sustainability (ECEfS) specifically. The PD was entitled ‘Living and Learning about Sustainability in the Early Years’ and was offered on three occasions across Tasmania. A total of 99 participants attended the three PD sessions (one 5 hour; two 2 hour). The participants had varying levels of experience and included early childhood teachers, centre based educators and preservice teachers. At the start and end of the PD, participants were invited to complete a questionnaire that contained a series of likert scale questions that explored their content knowledge, level of understanding and confidence in regards to ECEfS. Participants were also asked at the start and end of the PD to ‘list five words you think of when you consider the word sustainability.’ A model of teacher professional growth was used to conceptualise the results related to the changes in knowledge, understanding and confidence (personal domain) as a result of the PD related to ECEfS (external domain). The likert-scale questions on the questionnaire revealed significant positive changes in levels of knowledge, understanding and confidence from the start to the end of the PD. Differences as a function of length of PD, level of experience and role are presented and discussed. The ‘5 words’ question showed that participants widened their understandings of ECEfS from a narrow environmental focus to a broader understanding of the social, political and economic dimensions. The early childhood education and care (ECEC) sector has been characterised as having a pedagogical advantage for EfS suggesting that early childhood educators are well placed to engage with EfS more readily than might educators in other education sectors. This article argues that PD is necessary to develop capability in educators in order to meet the imperatives around sustainability outlined in educational policy and curriculum documents in ECEC.

The impact of community health professional contact postpartum on breastfeeding at 3 months : a cross-sectional retrospective study

This study investigated the effect of any health professional contact and the types of contact new mothers received in the first 10 days post-discharge on breastfeeding rates at 3 months. This cross-sectional retrospective self-report survey was distributed to women who birthed in Queensland, Australia between 1st February and 31st May 2010 at 4–5 months postpartum. Data were collected on pregnancy, birth, postpartum care and infant feeding. Logistic regression was used to assess the relationship between health professional contact and breastfeeding at 3 months. Data were analysed by birthing facility sector because of significant differences between sectors in health professional contact. The study cohort consisted of 6,852 women. Women in the public sector were more likely to be visited at home than women birthing in the private sector. Any health professional contact (AOR 1.65 99 % CI 0.98–2.76 public sector, AOR 0.78 99 % CI 0.59–1.03 private sector) and home visits (AOR 1.50 99 % CI 0.89–2.54 public sector, AOR 0.80 99 % CI 0.46–1.39 private sector) were not associated with breastfeeding at 3 months in either sector. A telephone call (AOR 2.07 99 % CI 1.06–4.03) or visit to a general practitioner (GP) (AOR 1.83 99 % CI 1.04–3.21) increased the odds of breastfeeding in public sector women. Health professional contact or home visiting in the first 10 days post-discharge did not have a significant impact on breastfeeding rates at 3 months. Post-discharge telephone contact for all women and opportunities for self-initiated clinic visits for women assessed to be at higher risk of ceasing breastfeeding may be the most effective care.

Cultural forces in journalism : the impact of cultural values on Māori journalists’ professional views

Social system-level analyses of journalism have tended to focus on political and economic influences, at the expense of other factors, such as the role that culture and cultural values play in shaping journalists' professional views and practices. This paper identifies cultural values as a particularly fruitful area for providing a more nuanced analysis of journalism culture. It examines this issue in the context of in-depth interviews with 20 M?ori journalists from Aotearoa New Zealand. The study finds that Indigenous journalism in that country is strongly influenced by M?ori cultural values, such as showing respect to others, following cultural protocols, and making use of culturally-specific language. Cultural limitations are also identified in the form of the social structures of M?ori society, and journalists' strategies in working around these are discussed. The paper highlights the implications a renewed focus on cultural values can have for the study of journalism culture more broadly.

Professional indemnity insurance, performance and pre-emptive negligence: The impact of ‘non-claims’

As part of Australian licensing requirements professional valuers are required to maintain a level of professional indemnity insurance. A core feature of any insurance cover is that the insured has an obligation to notify their insurer of both actual and potential claims. An actual claim clearly will impact upon future policies and premiums paid. Notification of a potential claim, whether or not the notification crystallises into an actual claim, also can have an impact upon the insured’s claims history and premiums. The Global Financial Crisis continues to impact upon business practices and land transactions both directly and indirectly. The Australian valuation profession is not exempt from this impact. One example of this ongoing impact is reflected in a worrying practice engaged in by some financial institutions in respect of their loan portfolios. That is, even though the mortgagor is not in default, some institutions are pre-emptively issuing notices of demand regarding potential losses. Further, in some instances such demands are based only on mass appraisal valuations without specific consideration being given to the individual lot in question. The author examines the impact of this practice for the valuation profession and seeks to provide guidance for the appropriate handling of such demands.

The impact of personality and workplace belongingness on mental health workers’ professional quality of life

Objectives Mental health workers are constantly exposed to their clients’ stories of distress and trauma. While listening to these stories can be emotionally draining, professionals in this field still derive pleasure from their work. This study examined the role of personality and workplace belongingness in predicting compassion satisfaction, secondary traumatic stress, and burnout in mental health professionals. Methods Mental health staff (N = 156) working in a counselling service completed a questionnaire that included measures relating to professional quality of life, the Five-Factor Model of personality, workplace belongingness, as well as questions relating to the participants’ demographic profile, work roles and trauma history. Results The results indicated that, high levels of emotional stability (low neuroticism), extraversion, agreeableness, conscientiousness, and being connected at work, are essential factors that promote the professional quality of life of mental health workers. Specifically, workplace belongingness was the strongest predictor of compassion satisfaction and low levels of burnout, while neuroticism was the strongest predictor of secondary traumatic stress. Conclusions Important implications from this study include: (1) encouraging mental health staff to increase self-awareness of their dispositional characteristics and how their personalities affect their wellbeing at work, and; (2) encouraging management to facilitate practices where mental health workers feel connected, respected, and supported in their organisation.

Shaping the Future of Mental Health Policy and Legislation in Northern Ireland: The Impact of Service User and Professional Social Work Discourses

This paper explores the complex interrelationship between service user and professional social work discourses and provides a critical commentary on their respective contributions to the recent review of mental health policy and legislation in Northern Ireland. The analysis indicates that dominant trends in mental health care, as mediated through service structures and institutional identities, have tended to prioritize the more coercive aspects of the social work role and reinforce existing power inequalities with service users. It is argued that such developments underline the need for a ‘refocusing’ debate in mental health social work to consider how a more appropriate balance can be achieved between its participatory/empowering and regulatory/coercive functions. Whilst highlighting both congruence and dissonance between respective discourses, the paper concludes that opportunities exist within the current change process for service users and social workers to build closer alliances in working together to reconstruct practice, safeguard human rights and develop innovative alternatives to a traditional bio-medical model of treatment.

The level playing field: the impact of assessment practice on professional development

Context: The effects of assessment practice on students’ learning are unclear, particularly regarding professional development. Corralling in objective structured clinical examinations (OSCEs) is designed to reduce illicit passing of examination information. Candidates completing an examination are kept secluded until the next cohort of examinees has begun. We used the introduction of corralling as a context in which to explore social influences on examination misconduct, with the aims of improving understanding of the hidden effects of assessment, and evaluating the acceptability of corralling from the student perspective.

Methods: A questionnaire was administered to students corralled post-OSCE for the first time. Eleven semi-structured interviews were subsequently conducted. Questionnaire data were analysed for descriptive statistics and thematic analysis of interview transcripts was carried out.

Results: The questionnaire response rate was 95.4% (251/263). Before corralling, 80.9% (203/251) of students were aware of the sharing of information among peers and 78.5% (197/251) agreed that such misconduct was unprofessional. The majority were in favour of corralling (90.8%, 228/251). Four themes emerged from the semi-structured interviews: the student network versus the individual; assessment-driven culture; the deferring of professionalism, and the ‘level playing field’. Students saw interaction within the student network, on a background of assessment-driven culture, as the key driver in examination misconduct. Conforming to the rules of the social network was prioritised over individual agency, although the mismatch between the rules of the network and the dominant professional discourse caused some conflict for individuals. Deferred professionalism (described as the practice of taking on the norms of professional behaviour only when qualified) was a rationalisation used to minimise this conflict. Corralling provided a ‘level playing field’ in which the influences of the network were minimised.

Conclusions: Examination misconduct is thus a complex social construction with implications for individual learners in terms of professional development. Corralling is one mechanism for addressing misconduct that is acceptable to students, but assessment processes have important hidden effects which educators should acknowledge.

Changing roles of nurse educators employed in acute and chronic care settings : the impact of professional and statutory mandates in Ontario at four sites of one hospital corporation /

The role of the hospital-employed nurse educator is evolving. Factors influencing this change include the introduction of standards for nurse educators by the College of Nurses of Ontario (CNO), a change in the way nurses are educated, the emergence of nursing as a profession, and hospital restructuring as a result of budgetary constraints. Two of these influencing factors: the introduction of the updated Standards of Practice for Registered Nurses and Registered Practical Nurses (1996) and hospital restructuring occurred over the last 7 years at several hospitals in southern Ontario. Current literature as well as the Standards of Practice (1996) were utilized to examine the current roles and responsibilities of nurse educators and subsequently develop a questionnaire to study the impact of these influencing factors on the role of the nurse educator. This questionnaire was piloted and revised before its distribution at 4 hospitals in southern Ontario. Twenty-five of the 41 surveys (61%) distributed were returned for analysis. The data reflected that the Standards of Practice had a positive influence on the role of the nurse educator, while hospital restructuring had a negative impact. In addition, many of the roles and responsibilities identified in the literature were indeed part of the current role of nurse educators, as well as several responsibilities not captured in the literature. The predictions for the future of this role in its current state were not positive given the financial status of the health care system as well as the lack of clarity for the role and the current level ofjob satisfaction among practicing nurse educators. However, a list of recommendations were generated which, if implemented, could add clarity to the role and improve job satisfaction. This could enhance the retention of current nurse educators and the possibility of recruiting competent nurse educators to the role in the future.

An exploration of the impact of a mandatory quality assurance program on the staff nurse's commitment to professional development /

This study explored experiences in relation to the impact of the College of Nurses of Ontario's (CNO's) mandatory Quality Assurance (QA) program on registered nurses (RNs) working in a clinical setting of an acute care hospital. A qualitative descriptive research design was used and data collection was done in 2 stages. First, a survey with open-ended questions was given to 45 nurses. Second, 8 respondents from the survey were interviewed using a semistructured format. Data were obtained from 2 groups-diploma-prepared and post diploma-prepared RNs. Findings demonstrated that the CNO's QA program had varying influences on the RNs' learning paths, and these differences appeared to be related to the educational background of the individual. The diploma-prepared nurses reported that their commitment to professional development was influenced by their level of internal motivation, the pressures associated with time, and the need for a strong external motivator, namely the obligation of management to conduct formal performance appraisals. They further reported that the QA program played a part in positively altering their commitment to continuing education. The post-diploma baccalaureate nurses reported that the QA program played a positive role in influencing their ongoing learning, along with their level of internal motivation, the work and health care environment, and the element of professionalism. Several implications for nursing practice, theory, and fiirther research also became evident.