Desley Hegney

The influence of psychological factors on breastfeeding duration

AIM This paper reports on a study examining the relationship between womens psychological characteristics and breastfeeding duration, after controlling for socio-demographic factors. BACKGROUND The literature suggests that psychological factors may influence breastfeeding behaviour, but studies are few. Existing evidence and the results of phase 1 of our study were used to construct a list of psychological factors, which were tested for their association with breastfeeding duration in the current design. METHOD Participants were postnatal inpatients in one of two regional hospitals between October and December 2005 and they completed the initial questionnaire within 14 days of giving birth (n = 375). Infant feeding method at 6 months and the timing of introduction of other food(s), where relevant, were ascertained by telephone interview. FINDINGS Forty-four per cent of the sample showed signs of postnatal distress in the 14 days following the birth. Breastfeeding duration was statistically significantly associated with psychological factors including dispositional optimism, breastfeeding self-efficacy, faith in breastmilk, breastfeeding expectations, anxiety, planned duration of breastfeeding and the time of the infant feeding decision. As a set, these psychological factors were more predictive of breastfeeding duration than was the set of socio-demographic characteristics. The duration of any breastfeeding was uniquely predicted by faith in breastmilk, planned breastfeeding duration and breastfeeding self-efficacy. CONCLUSION This increased knowledge of the factors influencing breastfeeding will assist in identifying women at risk of early weaning and in constructing programmes capable of increasing the length of time for which women breastfeed.

Systematic Review of Interventions to Improve Prescribing

Objective: To update 2 comprehensive reviews of systematic reviews on prescribing interventions and identify the latest evidence about the effectiveness of the interventions. Data Sources: Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed(1951–May 2007). EMBASE (1974–March 2008), International Pharmaceutical Abstracts (1970–March 2008), and 11 other bibliographic databases of medical, social science, and business research. Following an initial title screening process and after selecting 6 specific intervention categories (identified from the previous reviews) in community settings, 2 reviewers independently assessed abstracts and then full studies for relevance and quality and extracted relevant data using formal assessment and data extraction tools. Results were then methodically incorporated into the findings of the 2 earlier reviews of systematic reviews. Data Selection And Synthesis: Twenty-nine of 26,314 articles reviewed were assessed to be of relevant, high-quality research. Audit and feedback, together with educational outreach visits, were the focus of the majority of recent, high-quality research into prescribing interventions. These interventions were also the most effective in improving prescribing practice. A smaller number of studies included a patient-mediated intervention; this intervention was not consistently effective. There is insufficient recent research into manual reminders to confidently update earlier reviews and there remains insufficient evidence to draw conclusions regarding the effectiveness of local consensus processes or multidisciplinary teams. Conclusions: Educational outreach as well as audit and feedback continue to dominate research into prescribing interventions. These 2 prescribing interventions also most consistently show positive results. Much less research is conducted into other types of interventions and there is still very little effort to systematically test why interventions do or do not work.

Barriers to use of information and computer technology by Australia's nurses: a national survey

AIMS AND OBJECTIVES To support policy planning for health, the barriers to the use of health information and computer technology (ICT) by nurses in Australia were determined. BACKGROUND Australia, in line with many countries, aims to achieve a better quality of care and health outcomes through effective and innovative use of health information. Nurses form the largest component of the health workforce. Successful adoption of ICT by nurses will be a requirement for success. No national study has been undertaken to determine the barriers to adoption. DESIGN A self-administered postal survey was conducted. METHOD A questionnaire was distributed to 10,000 members of the Australian Nursing Federation. Twenty possible barriers to the use of health ICT uptake were offered and responses were given on a five point Likert scale. RESULTS Work demands, access to computers and lack of support were the principal barriers faced by nurses to their adoption of the technology in the workplace. Factors that were considered to present few barriers included age and lack of interest. While age was not considered by the respondents to be a barrier, their age was positively correlated with several barriers, including knowledge and confidence in the use of computers. CONCLUSIONS Results indicate that to use the information and computer technologies being brought into health care fully, barriers that prevent the principal users from embracing those technologies must be addressed. Factors such as the age of the nurse and their level of job must be considered when developing strategies to overcome barriers. RELEVANCE TO CLINICAL PRACTICE The findings of the present study provide essential information not only for national government and state health departments but also for local administrators and managers to enable clinical nurses to meet present and future job requirements.

Can We Predict Burnout among Student Nurses? An Exploration of the ICWR-1 Model of Individual Psychological Resilience.

The nature of nursing work is demanding and can be stressful. Previous studies have shown a high rate of burnout among employed nurses. Recently, efforts have been made to understand the role of resilience in determining the psychological adjustment of employed nurses. A theoretical model of resilience was proposed recently that includes several constructs identified in the literature related to resilience and to psychological functioning. As nursing students are the future of the nursing workforce it is important to advance our understanding of the determinants of resilience in this population. Student nurses who had completed their final practicum were invited to participate in an online survey measuring the key constructs of the ICWR-1 model. 422 students from across Australia and Canada completed the survey between July 2014 and July 2015. As well as several key demographics, trait negative affect, mindfulness, self-efficacy, coping, resilience, and burnout were measured. We used structural equation modeling and found support for the major pathways of the model; namely that resilience had a significant influence on the relationship between mindfulness, self-efficacy and coping, and psychological adjustment (burnout scores). Furthermore, as predicted, Neuroticism moderated the relationship between coping and burnout. Results are discussed in terms of potential approaches to supporting nursing students who may be at risk of burnout.

Workplace violence: differences in perceptions of nursing work between those exposed and those not exposed: a cross-sector analysis

Nurses are at high risk of incurring workplace violence during their working life. This paper reports the findings on a cross-sectional, descriptive, self-report, postal survey in 2007. A stratified random sample of 3000 of the 29 789 members of the Queensland Nurses Union employed in the public, private and aged care sectors resulted in 1192 responses (39.7%). This paper reports the differences: between those nurses who experienced workplace violence and those who did not; across employment sectors. The incidence of workplace violence is highest in public sector nursing. Patients/clients/residents were the major perpetrators of workplace violence and the existence of a workplace policy did not decrease levels of workplace violence. Nurses providing clinical care in the private and aged care sectors experienced more workplace violence than more senior nurses. Although workplace violence was associated with high work stress, teamwork and a supportive workplace mitigated workplace violence. The perception of workplace safety was inversely related to workplace violence. With the exception of public sector nursing, nurses reported an inverse relationship with workplace violence and morale.

Retaining rural and remote area nurses - The Queensland, Australia experience

Because higher-than-average turnover rates for nurses who work in remote and rural areas are the norm, the authors conducted a study to identify professional and personal factors that influenced rural nurses’ decisions to resign. Using a mail survey, the authors gathered qualitative and quantitative data from nurses who had resigned from rural and remote areas in Queensland, Australia. Their findings, categorized into professional and rural influences, highlight the importance of work force planning strategies that capitalize on the positive aspects of rural and remote area practice, to retain nurses in nonmetropolitan areas.

Job Satisfaction and Nurses in Rural Australia

As with many other countries, Australia is experiencing problems in recruitment and retention of registered nurses. The shortage of nurses and midwives is particularly evident in many rural and remote areas. Because of this shortage, at least two state governments have undertaken studies related to them. Using data derived from a national study of rural nurses, we discuss how job satisfaction may affect the recruitment and retention of rural nurses in Australia. Understanding what influences on-the-job satisfaction in rural and urban areas will assist health service managers to attract and retain nurses in rural and remote areas.

The effect of shift rotation on employee cortisol profile, sleep quality, fatigue, and attention level: A systematic review

Background: Disrupted circadian rhythm, especially working night duty together with irregular sleep patterns, sleep deprivation, and fatigue, creates an occupational health risk associated with diminished vigilance and work performance. Purpose: This study reviewed the effect of shift rotations on employee cortisol profile, sleep quality, fatigue, and attention level. Methods: Researchers conducted a systematic review of relevant articles published between 1996 and 2008 that were listed on the following databases: SCOPUS, OVID, Blackwell Science, EBSCO Host, PsycINFO, Cochrane Controlled Trials Register, and CEPS. A total of 28 articles were included in the review. Results: Previous research into the effects of shift work on cortisol profiles, sleep quality, fatigue, and attention used data assessed at evidence Levels II to IV. Our systematic review confirmed a conflict between sleep-wake cycle and light-dark cycle in night work. Consequences of circadian rhythm disturbance include disruption of sleep, decreased vigilance, general feeling of malaise, and decreased mental efficiency. Shift workers who sleep during the day (day sleepers) experience cortisol secretion increases, which diminish the healing power of sleep and enjoy 1 to 4 hours less sleep on average than night sleepers. Sleep debt accumulation results in chronic fatigue. Prolonged fatigue and inadequate recovery result in decreased work performance and more incidents. Rotation from day shift to night shift and its effect on shift workers was a special focus of the articles retained for review. Conclusions: Disturbed circadian rhythm in humans has been associated with a variety of mental and physical disorders and may negatively impact on work safety, performance, and productivity.

Against all odds: a retrospective case-controlled study of women who experienced extraordinary breastfeeding problems

AIMS The study investigated factors empowering women to continue breastfeeding despite experiencing extraordinary difficulties. The study documented the experiences and characteristics of women who continued to breastfeed (continuing cohort) and those who weaned (non-continuing cohort) despite extraordinary difficulties. DESIGN Retrospective case control. METHODS The study was undertaken in south-east Queensland, Australia in 2004. Forty women (20 in each cohort) were recruited over six months. Both quantitative (breastfeeding knowledge questionnaire) and qualitative (semi-structured interviews) data were collected. This paper describes the qualitative data. RESULTS Women from both cohorts expressed idealistic expectations about breastfeeding and experienced psychological distress due to their breastfeeding problems. Those who continued breastfeeding used coping strategies and exhibited personal qualities that assisted them to overcome the difficulties experienced. Women who continued to breastfeed were more likely to report relying on a health professional they could trust for support. This latter cohort were also more likely to report having peers with which they shared their experiences. Non-continuing women expressed feelings of guilt and inadequacy following weaning and were more likely to feel isolated. CONCLUSIONS This study has highlighted the methods women use to deal with breastfeeding problems. It has also revealed modificable factors that can improve breastfeeding duration. RELEVANCE TO CLINICAL PRACTICE The findings indicate that clinicians should: *Provide information which accurately reflects the breastfeeding experience; *Ensure systems are in place so that effective postnatal support for breastfeeding difficulties is available; *Consider screening to ascertain levels of psychological distress, sadness and disillusionment among breastfeeding women; *Design educational interventions with elements of cognitive skills, problem-solving and self-efficacy training to equip women with the skills to overcome any experienced difficulties.

Exploring the Influence of Psychological Factors on Breastfeeding Duration, Phase 1: Perceptions of Mothers and Clinicians

Breastfeeding duration rates in Australia are low, prompting a search for modifiable factors capable of increasing the duration of breastfeeding. In this study, participants were asked which psychological factors they believed influence breastfeeding duration. Participants included 3 groups of mothers who had breastfed for varied lengths of time (n = 17), and 1 group of breastfeeding clinicians (n = 4). The nominal group technique was employed, involving a structured group meeting progressing through several steps. Analyses included collation of individual and group responses, group comparisons, and a thematic analysis of group discussions. Forty-five psychological factors thought to influence the duration of breastfeeding were identified. Factors considered most important included the mothers priorities and mothering self-efficacy, faith in breast milk, adaptability, stress, and breastfeeding self-efficacy. In addition to informing the design of phase 2 of this study, these results add to our knowledge of this emerging research area. J Hum Lact. 25(1):55-63.