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To examine the concept of midwifery agency when using Maternity Early Warning Tools.
Concept analysis using Rogers' evolutionary method.
Data were collected from interviews with midwives working in various Australian maternity settings. A subset of the dataset was collected and analysed (2021–2022) to examine how agency functions when midwives use Maternity Early Warning Tools.
Three conceptual attributes fundamental to agency were identified: considered judgement, reasoned clinical decision-making, and collaborative action. These attributes reveal how midwives navigate the interface between structured risk management tools and relational, woman-centred care.
Maternity Early Warning Tools can either limit or enhance professional agency. When used reflexively, they become artefacts that support learning, communication, and sound clinical judgement. Viewing these tools as enablers rather than enforcers sustains midwifery expertise and strengthens interdisciplinary collaboration.
Sustaining midwifery agency protects both professional integrity and the quality of woman-centred care.
What problem did the study address? How the use of Maternity Early Warning Tools influences midwives' agency.
To report how person-centred care principles are applied to care planning and to explore the contextual factors affecting their implementation in older adult care homes in England.
A combined framework analysis and quantitative content analysis study.
Using a semi-structured questionnaire, we interviewed 22 care home managers in England, exploring topics around care planning processes. Audio recordings were transcribed verbatim. Transcripts were analysed through a combined framework approach and content analysis.
Most care home managers discussed person-centred care planning in terms of understanding residents' values and preferences and their engagement in decision-making. Factors facilitating person-centred planning implementation included accessible planning tools, supportive care home leadership, effective communication and collaborative partnerships. Inhibiting factors included regulatory and care practice misalignment, time constraints and adverse staffing conditions.
Differences between care home practitioners' understanding and practice of person-centred care planning require further examination to improve understanding of the sector's complexity and to develop suitable care planning instruments.
Findings demonstrate a need for improved staff access to specialised person-centred care training and an opportunity for care home nursing practitioners to lead the co-development of digital person-centred care planning tools that reflect the reality of long-term care settings.
Identifying factors influencing the implementation of holistic approaches to care planning makes clear the need for modernising long-term care policy and practice to adapt to the contemporary challenges of the care home sector.
Study reporting was guided by the Standards for Reporting Qualitative Research.
Two public involvement advisors with lived experience of caring for a relative living in a care home contributed to the development of the interview guide, advised on care home engagement, guided the interpretation of the findings and commented on the drafted manuscript.
Commentary on: Kearns, RJ, Kyzayeva, A, Halliday, LO, et al. Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ 2024;385.
Implications for practice and research Health research, policy and information should emphasise the advantages of intrapartum epidurals beyond pain relief, especially for women with pre-existing conditions and preterm labour. Health services must provide access to a 24-hour epidural service within their maternity care.
The use of intrapartum epidurals to manage pain during labour and birth has been globally accepted for decades.
Addressing physical inactivity is a promising dementia risk reduction strategy due to its direct benefits for brain health, and indirect benefits for other modifiable dementia risk factors. A potential limitation of previous interventions is that they often overlook how increasing physical activity affects other behaviours throughout the 24-hour day, such as sleep and sedentary behaviour, which are also important for brain health. Further, interventions are rarely tailored to the individual, considering their needs, preferences and constraints that may serve as barriers or facilitators to behaviour change. The current phase I randomised controlled trial, Small Steps, aims to investigate feasibility, acceptability and preliminary effectiveness of a personalised 24-hour time-use intervention to improve lifestyle and cognitive health in older adults.
Participants aged ≥65 years from Adelaide, South Australia will be recruited and randomised to either the Extended or Condensed programme. During the first 12 weeks, participants in the Extended programme will use a tailored website to set personalised weekly goals to move towards their ‘optimal’ 24-hour day for brain health, facilitated by weekly website ‘check-ins’ and weekly phone calls with a research staff member. Participants randomised to the Condensed programme will have access to the website educational resources only but will not undergo personalised goal setting or telephone calls. Following the introductory phase (first 12 weeks), phone calls will be gradually withdrawn for the Extended programme. Primary (feasibility and acceptability) and secondary outcomes (changes in time use, cognitive function and behaviour change metrics) will be assessed 12, 24 and 36 weeks after the beginning of the intervention.
Ethics approval has been obtained from the University of South Australia’s Human Research Ethics Committee (205989). Study findings will be disseminated through peer-reviewed journal articles, conference presentations, media releases and community engagement.
To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic.
In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses.
Discursive paper.
Nursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures.
COVID-19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under-resourced changes to workload, and this has been brought into stark visibility with the current COVID-19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive.
Objective measures commonly fail to capture the complexity of the critical care nurses’ role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.
To investigate clinicians' perspectives on the transition from hospital to home and identify gaps in care for older adults living with frailty during the transfer of care.
Qualitative reflexive thematic analysis of focus groups
Focus groups were conducted with clinicians using purposive sampling. Participants were eligible if they had provided or overseen the clinical care of a patient transferring from hospital to home. Verbatim transcripts were analysed, and themes were identified using NVivo through the development of codes and exploration of core commonalities.
A total of 28 clinicians participated in five focus groups. Participants included nurses (n = 14), allied health (n = 8), medical officers (n = 2), managers and hospital executives (n = 4). Themes were categorised into four domains: (1) system fragmentation and finite resources challenge healthcare navigation for everyone; (2) the interplay of cultural and societal considerations in the context of ageing; (3) fragile cycle of care for older patients who frequent hospitalisation; and (4) effective communication and expertise being critical for quality care.
Despite decades of research, the transition from hospital to home for older adults living with frailty remains a persistent challenge. This study identified significant and continued unmet needs in navigating a complex health system, underscoring the evidence-practice gap in transitional care services. Results have informed the development and implementation of a feasibility study (TRANSFER-II), currently underway, that tests the feasibility of a nurse-coordinated model of transitional care support for older adults.
Transfers from hospital to home, frequent readmissions and transitions in care are common for older adults living with frailty. Understanding the enablers and barriers in transitional care for this vulnerable population can enhance the quality of care, improve communication and inform the development of more effective transitional care models. The findings underline the critical role nurses play in addressing systemic gaps and improving continuity of care for older adults across diverse health systems.
Transitional care is complex, and older populations are more at risk of returning to hospital. Findings highlight the significant unmet needs in navigating a complex health system and revealed the fragile cycle of care for older adults who frequent hospital. Reiterating the importance of effective communication and clinical expertise in delivering safe patient-centred nursing care.
This qualitative study was reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist.
Patients and carers contributed to the design of this qualitative study through consultation with a consumer advisory group, where potential transitional care interventions were discussed. These discussions highlighted a need to further explore transitional care unmet needs, informing the development of this focus group study.
Hearing loss is highly prevalent and impacts many aspects of a person’s life, including communication, social engagement, employment, general health and well-being. Yet, many people do not access hearing healthcare and are unaware of the range of hearing healthcare options available. Barriers to hearing healthcare include poor understanding of hearing loss and its impact; poor knowledge of help-seeking for hearing healthcare options; minimal support to help decide which option is best; and stigma related to hearing loss. These barriers lead to many people not receiving the hearing healthcare they need. Guided by theories of behaviour change and implementation science, HearChoice, an online tailored decision support intervention, has been co-developed to empower adults with hearing difficulties by offering them choice and control over their own hearing healthcare. HearChoice aims to facilitate informed decisions, accessibility and uptake of hearing healthcare, including a wide range of interventions, for adults with hearing difficulties. The objectives of the trial are to evaluate the effectiveness, health economics and feasibility of HearChoice.
This online randomised controlled trial will recruit participants with hearing difficulties across Australia, with an anticipated sample size of 640. Participants will be randomised to either HearChoice (treatment) or an Australia-specific Hearing Option Grid (active control), both delivered online. Outcomes will be assessed at baseline when the interventions will be offered, at 7 days post-intervention (primary endpoint) and at 3 months post-intervention. An email reminder will be sent at 1-month post-intervention. The primary outcome is decisional conflict. Secondary outcomes include measures of readiness and self-efficacy to take action, hearing-related quality of life and empowerment, assessment of the value and impact of HearChoice, work performance and health, and feasibility measures. Primary analysis will compare outcomes between HearChoice and the active control at the primary endpoint.
The study was approved by the Curtin University Human Ethics Committee (HRE2023-0024). All participants will provide written informed consent prior to participation. A broad dissemination plan of the study findings includes peer-reviewed publications, scientific conference presentations, articles and presentations for the wider community and public written in lay and accessible language, and social media.
Australian New Zealand Clinical Trials Registry (ACTRN12624001139561).
To investigate discrepancies in perceptions regarding the accessibility and availability of rest and relaxation (R&R) spaces between hospital doctors in Scotland and NHS Scotland regional health boards (HBs), with the intention of informing best practices for organisational policy on the provision of R&R spaces both now and in the future.
A qualitative study, through an inhabited institutionalism (II) lens, of semi-structured interviews of hospital doctors across the career continuum in Scotland and all NHS regional HBs in Scotland providing written information relating to R&R space provision.
NHS Scotland during the COVID-19 pandemic and beyond.
Hospital doctors (n=30) who had participated in a larger qualitative study and provided specific insights on R&R spaces. All NHS Scotland regional HBs (n=14).
Although HBs reported the provision of R&R spaces, numerous doctors reported R&R spaces had been removed, relocated or were inaccessible. Furthermore, limited awareness of their availability attributed to inadequate communication, compounded the issue. This divergence between institutional reporting and front-line experience can be interpreted through the lens of II, which posits that institutional polices are often interpreted and implemented differently.
This study emphasises how crucial R&R spaces are to promoting doctors’ well-being especially during the time of high stress. HBs must not only guarantee the accessibility and physical availability of R&R spaces but also enhance their communication regarding the provision.
FreshRSS 