Conjoint Professor Michael Hazelton

Background: Supporting women to achieve healthy gestational weight gain is a global health challenge. Inadequate and excessive gestational weight gains are associated with short and long-term adverse maternal and infant health outcomes. Qualitative studies suggest that symptoms of pregnancy, health professional attitudes, lack of guidance, personal knowledge and beliefs, lack of support, weight stigma, and lack of time and money, are barriers to achieving healthy weight gain. Less is known about women's perceptions and experience of gestational weight gain within normal body mass index categories with even less known about the experience of women motivated to participate in pregnancy weight management intervention trials. Aim: To describe the experience and perspectives of women participating in an Australian weight management pilot randomised controlled trial. Methods: Five women from regional New South Wales enrolled in the Eating 4 Two trial, participated in semi - structured interviews during the post-natal period. A qualitative descriptive methodology and inductive thematic analysis was applied. Findings: Two main themes emerged: 1) Addressing weight gain in pregnancy; and 2) Pregnancy weight the balancing act. Women identified weight gain as an important topic, the need for improvements within maternity services, responsive feedback and realistic support strategies. Women identified pregnancy symptoms, occurring during early and late pregnancy as barriers to achieving healthy weight gain. Conclusion: Further investigation into the effects of pregnancy symptoms on eating and physical activity patterns across pregnancy is warranted. Both qualitative and quantitative research is needed to monitor the translation of guideline recommendations into clinical practice.

Problem: Studies investigating the direct and indirect relationships between psychosocial factors (i.e. attitudes, beliefs and values), health related behaviour (diet and physical activity) and gestational weight gain are increasing. To date heterogeneity of psychosocial measurement tools has limited research progress in this area, preventing measurement of effects by meta-analysis techniques. Aim: To conduct a revalidation analysis of a Weight Related Behaviours Questionnaire, originally developed by Kendall, Olson and Frangelico within the United States of America and assess its performance for use within the Australian context. Methods: A revalidation study using Exploratory Factor Analysis was undertaken to assess the factor structure and internal consistency of the six psychosocial scales of the Weight Related Behaviours Questionnaire, within the Woman and Their Children's Health (WATCH), pregnancy cohort. The questionnaire was self-completed between 18 ¿ 20 weeks gestation. Psychosocial factors included; Weight locus of control; Self-efficacy; Attitudes towards weight gain; Body image, Feelings about the motherhood role; and Career orientation. Findings: Weight locus of control, Self-efficacy and Body image, retained the same factor structure as the original analysis. The remaining psychosocial factors observed a different factor structure in terms of loadings or number of factors. Deleted items modelling suggests the questionnaire could be strengthened and shortened. Conclusion: Weight Locus of control, Self-efficacy and Body image were observed as consistent, valid and reliable psychosocial measures for use within the Australian context. Further research is needed to confirm the model and investigate the potential for combining these scales into a shorter psychosocial measurement tool.

Background: Inadequate or excessive gestational weight gain is associated with both short and long-term adverse maternal and infant health outcomes. The practice of routine maternal weight monitoring has been suggested as an effective health promotion intervention, both as a screening tool for adverse maternal and infant outcomes and as a weight management strategy for addressing gestational weight gain. Discussion: The effectiveness of routine maternal weighing as part of maternity care has been debated for more than 30 years. The National Health and Medical Research Council of Australia have recently revised their pregnancy care clinical practice guidelines recommending maternal weight monitoring (clinician and/or self-weighing) be reintroduced into clinical practice. This paper presents a timely discussion of the topic that will contribute new insights to the debate. Conclusion: Weight gain in pregnancy is complex. Evaluation of the translation, implementation, acceptability and uptake of the newly revised guidelines is warranted, given that evidence on the practice remains inconclusive. Future research exploring social ecological interventions to assist pregnant women achieve optimal gestational weight gains are suggested to expand the evidence base.

Seclusion is a restrictive practice used to protect the person or others from harm, however can result in trauma-related harm. While interventions to reduce seclusion have been successful, use in forensic mental health remains high. This integrative review aims to explore factors associated with the duration and frequency of seclusion in forensic mental health settings and determine sex differences in seclusion use. Results indicate that common factors associated with the use of seclusion in forensic mental health settings are younger age, diagnosis of psychotic disorder or personality disorder, and previous seclusion. Sex differences are inconsistent. Common reasons for initiating seclusion relate to actual violence and threats of violence. There is a lack of contemporary literature and current research has not considered how sex may affect seclusion use. Further research is required to identify specific risk factors for males and females and test timely and appropriate interventions to help reduce seclusion use in forensic mental health settings.

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a ¿now window¿ of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

The prevalence of health risk behaviours and associated poor physical health is high in people with severe mental illness. Mental health service guidelines and policies stipulate that mental health services should address physical health of people who access services. This study reports results from a large, interdisciplinary, cross-sectional study exploring mental health clinicians¿ (n¿=¿385) views of role legitimacy in physical health service provision. All disciplines reported that mental health clinicians have a role to play in addressing the physical health of consumers. Among mental health clinicians, psychiatrists and mental health nurses received higher endorsement than allied health clinicians in relation to the provision of physical health care, with primary care providers including general practitioners also ranking highly. As community mental health services routinely appoint allied health staff to case management roles, a challenge for services and a challenge for clinicians are to ensure that physical health and the effects of medication are monitored appropriately and systematically. Online and telephone support services received relatively lower endorsement. As the availability of nonface to face services increases, there is a need to explore their utility in this population and where appropriate promote their uptake.

Background: Cardiac and pulmonary rehabilitation have been shown to reduce the symptoms of disease, as well as reducing health care utilization. To ensure the continuation of these programs, patient outcome measures (POMs) are essential to map treatment effectiveness. This review is a comparative effectiveness literature review of studies with a pre- to post-POM assessment of responsiveness (ie, change in health status over time). Methods: A quality review of the literature included not only randomized controlled trials but also parallel studies, as well as all observational and retrospective trials. This review included a list of articles and their characteristics; a quality assessment of the literature and a list of POMs utilized in this setting were assessed for responsiveness. Results: There was inconsistency in the literature with the measurement of responsiveness or effect size. The most commonly used POM was the SF-36; however, it was found to be less responsive to change in health status pre- to post-rehabilitation, particularly in the mental domain of this instrument. The most responsive POM in this setting was the Global Mood Scale. Conclusion: The surveyed literature found no "gold standard" POM for either cardiac rehabilitation or pulmonary rehabilitation but there was some preference for the disease-specific POMs; however, some of these instruments lose their discriminatory power at the end of the rehabilitation period. This literature review found that a Likert scale is more responsive than a dichotomous scale and that a simple questionnaire is more responsive in a pre- to post-setting than a complex questionnaire.

Background: Immersive virtual reality is an advancing technology that has the potential to change the traditional pedagogical approaches to teaching tertiary nursing and midwifery students. The application of immersive virtual reality in nursing and midwifery education may be a novel, accessible method for information provision and skill acquisition, however little is known of the extent of immersive virtual reality technology integration into tertiary nursing and midwifery programs. Objectives: The purpose of this review is to identify the application and integration of immersive virtual reality within nursing and midwifery tertiary education programs. Design: A scoping review based on the Joanna Briggs Institute methodology for scoping reviews was undertaken. An a priori review protocol and eligibility criterion was developed with the protocol subject to review a posteriori following first round screening. An electronic search of ten databases was conducted in January 2018. Results: A total of n = 506 non-duplicate records were identified and subjected to level one and level two screening. The search strategy and screening process identified n = 2 articles that were quality checked and included for review. Conclusions: There is currently a paucity of quality published literature on the application and/or integration of immersive virtual reality into nursing and midwifery tertiary education. Immersive virtual reality has the potential to increase competence and confidence for students providing accessible and repeatable learning opportunities in a fail-safe environment. There is a need for educators to be involved in the conceptualisation, design, integration and research of immersive virtual reality technology into undergraduate nursing and midwifery programs.

The aim of this integrative literature review was to identify high quality empirical research and theoretical literature on the sources of meaning in life and people's beliefs regarding the meaning of life. This will inform current mental health clinical practice and research by providing a synthesis of empirical and theoretical literature. Failure to address meaninglessness or the existential crisis can lead to psychopathologies such as depression, anxiety, addiction, aggression, hopelessness, apathy, lower levels of well-being, physical illness, and suicide. Integrative literature reviews incorporate empirical research and theoretical literature. The inclusion criteria were primary research and theoretical papers and books by prominent theorists. Thirty-nine items underwent the critical appraisal process. Thirty-two papers or books were included. Overwhelmingly the results revealed that relationships, particularly relationships with family, are cited as the most important source of meaning in people's lives in all cultures and age groups. There was no consensus identified to answer the meaning of life question. These results and future research will allow mental health clinicians to help patients deepen their understanding of themselves, identify where they find meaning and understand their beliefs about meaning of life, contributing to a reduction in symptomatology and meaninglessness, and an increase in happiness, life satisfaction, positive affect, better coping, psychosocial health and well-being, and more meaningfulness in life.

Background Both men and women can experience depressive or anxious episodes when transitioning to parenthood. Mindfulness interventions are one way to teach men coping strategies to manage these feelings. Aim This integrative review examined original research, evaluating mindfulness as an intervention for men during the perinatal period. Methods A comprehensive search resulted in 157 articles. After applying defined inclusion and exclusion criteria, 2 original research papers remained. Thematic analysis identified five themes, the first three of which were discussed in Part I of this article. Findings Mindfulness based stress reduction strategies for men have been shown to be effective across a range of health issues, although there is little research during the perinatal period. Research suggests that men engaged in mindfulness based stress reduction in the perinatal period experienced better regulation of emotions and stress, and felt more present for their pregnant partners. Conclusions To improve men¿s wellbeing, innovative ways of providing perinatal mindfulness based stress reduction are needed. New or adapted mindfulness based stress reduction programmes are needed to improve men¿s awareness, empathy, self-esteem and psychological wellbeing to better support their pregnant partners.

Background Men are as likely to suffer stressors associated with pregnancy as their pregnant partners, but are less likely to receive support. Mindfulness interventions are a possible way to enable men to manage and reduce stress that may provoke anger and depression. Aim This integrative review examined original research into using mindfulness as an intervention for men during the perinatal period. Methods Using the question, 'Can mindfulness based stress reduction reduce stress in men with pregnant partners during the perinatal period?', a comprehensive search retrieved 157 articles. Following defined inclusion and exclusion criteria, 2 original research papers were included in the review. Thematic analysis identified five themes, the first three of which will be discussed here. Findings Research suggests that men engaged in mindfulnessbased stress reduction during the perinatal period experienced improvements in regulating emotions and handling stress, as well a deeper sense of connection with their pregnant partner. Conclusion To improve the wellbeing of men with pregnant partners, mindfulness-based stress reduction techniques are needed to help men to improve psychological wellbeing and better support their pregnant partners.

Introduction Workplace violence is one of the most significant and hazardous issues faced by nurses globally. It is a potentially life-threatening and life-affecting workplace hazard often downplayed as just ¿part of the job¿ for nurses. Methods A cross-sectional design was used and data were collected using a purpose developed survey tool. Surveys were distributed to all members of the College of Emergency Nurses¿ Australasia (CENA) in 2010 and 537 eligible responses were received (RR¿=¿51%). Results Patient-related violence was reported by 87% of nurses in the last six months. Precipitants and antecedents for episodes of violence were reported in three categories: nurse-related; patient-related and emergency-department specific factors. Triaging was identified as the highest risk nursing activity, and the triage area identified as the highest risk location in the department. Patients who presented with alcohol intoxication, substance misuse or mental health issues were identified as the groups at greatest risk for potential violence. Discussion Patient-related violence was reported by the majority of emergency nurses surveyed. A number of precipitants and antecedents perceived to be risk factors by participants were found to be significant and are unavoidable in the working lives of emergency department nurses.

The purpose of this paper is to review the literature on swearing in English with particular emphasis on healthcare contexts, a previously neglected area of research. The review commences with a discussion of the nature of swearing, definitional considerations, and its prevalence. This is followed by an outline of the uses and functions of swearwords, and discussion of those aspects of swearing linked to illness, aggression, gender, and mental health problems. The final section focuses on the importance of appropriate responses to swearing to the practice of health professionals, in particular, those within the nursing profession.

Violence in healthcare is a significant issue and one that is increasing in prevalence globally. Nurses have been identified as the professional group at most risk, with patients the main source of this violence. The aim of this study was to describe the experiences of Australian ED nurses with episodes of patient-related violence from young adults (16-25. years of age) and the parents of paediatric patients. Data analysis of semi-structured interviews led to the identification of antecedents to episodes of violence and behaviours specific to these two groups of interest. These behaviours included: "performing" and attention-seeking behaviours and violent behaviours including both verbal and physical abuse. Antecedents discussed by participants included: parental emotions and alcohol and substance abuse. Overall the results speak to a working environment where participants regularly feel unsafe. Violence in the ED is perceived to occur frequently and to such an extent that participants have become resigned to expect and accept it as part of their job. The role played by distinct groups such as young adults and the parents of paediatric patients must be acknowledged and this knowledge used along with other known risk factors to help identify patients at risk of potential violence. © 2012 Elsevier Ltd.