Lesley E. Halliday

Home alone: Patient and carer uncertainty surrounding discharge with continuing clinical care needs

Abstract As a result of advances in anaesthesia and surgical procedures, increasing numbers of patients in Australia are being discharged ‘early’ into the home environment with residual care requirements. As many of these patients have undergone surgery that in the past would have required a period of hospitalisation and care from qualified staff lasting several days, this situation has the potential to create problems for both patients and their carers. A total of fourteen interviews were conducted with seven patient/carer dyads. Analysis identified three themes related to the uncertainty both patients and carers experienced attributed to a lack of sufficient discharge preparation and information, pointing to gaps in continuity of care and also in discharge planning and home-health care. It is suggested that the identified issues have applicability for the development of patient education in a day surgery/acute context and that the use of evidenced-based and innovative interventions among health professionals might improve both patient and caregiver outcomes.

Exploring the concept of uncertain fertility, reproduction and motherhood after cancer in young adult women

Exploring the concept of uncertain fertility, reproduction and motherhood after cancer in young adult women The topics of uncertainty in illness and infertility--as separate entities--are well covered and critiqued in the literature. Conversely, no research has been identified that specifically relates to the uncertain fertility, reproduction and motherhood challenges faced by young women after cancer. Therefore, there has been no opportunity to extend understanding, adequately acknowledge or effectively manage the needs of young women who may face unique reproductive uncertainties after cancer. The objective of this article is to provide a descriptive review of the literature and present what is currently known about uncertainty in the context of cancer and in relation to fertility, reproduction and motherhood. This article sets out the need for an increased research focus into this aspect of cancer survivorship to minimise the unique psychosocial challenges these women often face. Raising awareness and acknowledging the significance and impact of uncertain reproductive capacity on younger womens psychosocial health will aid cancer co-ordinators, nurses and other health professionals to formulate and deliver timely and appropriate education, management and support.

Mothering and self-othering: the impact of uncertain reproductive capability in young women after hematological malignancy.

We explored the experiences of uncertain fertility, pregnancy, and motherhood in 12 young women treated for hematological malignancy during their reproductive years. It is demonstrated how, through interpretations of the womens own words, these women lived and coped with a sense of “otherness” in relation to their peers. The concept of otherness is described and discussed in relation to relevant existing literature and it is concluded that, regardless of their cancer history, young womens uncertainty in this context has a broad impact on their psychosocial health and requires sensitive and empathic information, discussion, and support.

Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia.

OBJECTIVE To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes. METHODS A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth. RESULTS Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7-2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8-10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight. CONCLUSION The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.

Undertaking ethical qualitative research in public health: are current ethical processes sufficient?

uman research ethics committees ensure that aspects of ethical research (informed consent, minimising harm, privacy and confidentiality) are clearly stated in research proposals to ameliorate risks to participants. However, ethical issues that arise in qualitative health research that may affect both the researcher and those being researched are not as easy to identify prospectively and can be overlooked in ethics application processes.

The Australasian Maternity Outcomes Surveillance System: An evaluation of stakeholder engagement, usefulness, simplicity, acceptability, data quality and stability

The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts active, prospective surveillance of severe maternal conditions in Australia and New Zealand (ANZ). AMOSS captures greater than 96% of all births, and utilises an online, active case‐based negative reporting system.

Vasa Praevia: a descriptive review of existing literature and the evolving role of ultrasound in prenatal screening

Introduction: Literature addressing the feasibility of prenatal detection of vasa praevia during the mid‐trimester morphology ultrasound scan is scarce, as is a lack of consensus about the appropriate management of pregnancies once it is detected.

Liminal Reproductive Experiences After Therapies for Hematological Malignancy

In this article, we discuss the psychosocial health of young women related to fertility, pregnancy, and motherhood after therapies for hematological malignancies. We utilized a hermeneutical phenomenological approach to conduct in-depth interviews with 12 women who had previously received treatment for a hematological malignancy and had experienced uncertainty surrounding their ability to start or extend their biological family. Our presented findings are interpretations of the women’s own words as they articulated how they inhabited a liminal space. We concluded that although fertility and motherhood possibly might not be immediate concerns when they received a diagnosis of hematological malignancy, young women could subsequently experience ongoing issues and concerns related to reproductive uncertainty and motherhood capabilities, which have the potential to affect emotionally and psychosocially on their lives. These issues might possibly require longer-term support, counseling, and informational resources. We also discuss the strengths, limitations, and implications of the study.

Wrapping myself in cotton wool: Australian women's experience of being diagnosed with vasa praevia

BackgroundVasa praevia (VP) is an obstetric condition that is associated with significant perinatal mortality and morbidity. Although the incidence of VP is low, it is one of the few causes of perinatal death that can be potentially prevented through detection and appropriate care. The experience of women diagnosed with or suspected to have VP is largely unknown. The aim of this study was to explore the experiences and impact that a diagnosis or suspected diagnosis of VP had on a group of Australian women.MethodA qualitative study using a descriptive exploratory design was conducted and Australian women diagnosed with VP were recruited via online methods in 2012. An inductive approach was undertaken and interviews were analysed using the stages of thematic analysis.ResultsOf the 14 women interviewed, 11 were diagnosed with VP during pregnancy with 5 subsequently found not to have VP (non-confirmed diagnosis). Three women were diagnosed during childbirth with one neonatal death. Five major themes were identified: feeling like a ticking time bomb; getting diagnosis right; being taken seriously; coping with inconsistent information; and, just a massive relief when it was all over.ConclusionsThis is the first study to describe women’s experience of being diagnosed with or suspected to have VP. The findings from this research reveal the dilemmas these women face even if their baby is ultimately born healthy. Their need for clear and consistent information, sensitive care, support and continuity is evident. Clinicians can use these findings in developing information, counselling and models of care for these women.