A qualitative study of innovations implemented to improve transition of care from maternity to child and family health (CFH) services in Australia

BackgroundThe transition of care (ToC) from maternity services, particularly from midwifery care to child and family health (CFH) nursing services, is a critical time in the support of women as they transition into early parenting. However significant issues in service provision exist, particularly meeting the needs of women with social and emotional health risk factors. These include insufficient resources, poor communication and information transfer, limited interface between private and public health systems and tension around role boundaries. In response some services are implementing strategies to improve the transition of care from maternity to CFH services.AimThis paper describes a range of innovations developed to improve transition of care between maternity and child and family health services and identifies the characteristics common to all innovations.MethodsData reported were collected in phase three of a mixed methods study investigating the feasibility of implementing a national approach to child and family health services in Australia (CHoRUS study). Data were collected from 33 professionals including midwives, child and family health nurses, allied health staff and managers, at seven sites across four Australian states. Data were analysed thematically, guided by Braun and Clarke's six-step process of thematic analysis.FindingsThe range of innovations implemented included those which addressed; information sharing, the efficient use of funding and resources, development of new roles to improve co-ordination of care, the co-location of services and working together. Four of the seven sites implemented innovations that specifically targeted families with additional needs. Successful implementation was dependent on the preliminary work undertaken which required professionals and/or organisations to work collaboratively.ConclusionImproving the transition of care requires co-ordination and collaboration to ensure families are adequately supported. Collaboration between professionals and services facilitated innovative practice and was core to successful change.     

The board advisory tasks in small firms and the event of crises

In this article we examine what affects the board of directors’ involvement in the advice to management, with emphasis on the influence of crises on the board advisory tasks performance. Based on a survey of 881 small Norwegian firms, we analyse responses from CEOs in order to determine whether and to what extent the board is actively involved in the governance process during crises through providing advice. The study has two major contributions to board research in general and research of into small firms in particular. The first is the go beyond the “usual suspects” of board size, CEO duality, and board independence when looking for determinants of board involvement in advice. The second contribution is a clearer understanding of board involvement during crises. Our results show that board member diversity becomes particularly important during crises, since this provides the CEO and firm access to a more diverse pool of competences and experiences. We also find that crises moderate the effects of incentive on the board’s involvement in advice. This evidence sheds new light on the determinants of directors’ involvement in board tasks, suggesting that directors’ incentive to perform certain board tasks vary according to the contingent situation the firm is experiencing.     

In the steps of Joan Acker: A journey in researching inequality regimes and intersectional inequalities

Inspired by two of Acker's interconnected concepts, inequality regimes and intersectionality, the authors revisit their intersectional research. By exploring their various studies on inequality regimes and intersectionality, the authors propose some novel insights that have emerged from an aggregate appraisal of some 17 empirically researched papers, all shaped by Joan Acker's sociology. While Acker's work on gender and organizations has provided crucial insights into much of this work, this article concentrates on the overarching concept of inequality regimes and then focuses in on less‐developed aspects of intersectionality in Acker's work. In doing so, it reconsiders the value of inequality regimes in pushing the boundaries of intersectional insights.     

Floods and maternal healthcare utilisation in Bangladesh

Population and Environment - Floods are a common natural hazard in Bangladesh, and climate change is expected to further increase flooding frequency, magnitude and extent. Pregnant women...     

Personal reflections on cautions and considerations for navigating the path of grounded theory doctoral theses and dissertations: a long walk through a dark forest

Grounded theory (GT) has been a popularly used qualitative research methodology in the social sciences and has become increasingly popular for doctoral theses and dissertations. Yet, issues such as the changing nature of grounded theory, time constraints, theses advisors, doctoral committee procedures and Institutional Review Board regulations create challenges for doctoral candidates (researchers) who choose to use GT for their dissertations. In this paper, we present the general and specific challenges of using GT for doctoral theses and dissertations by sharing our personal experiences from our Ph.D. programmes in the USA. We conclude by providing practical suggestions for doctoral researchers who are considering using GT for their theses and dissertations.     

Recognition and gendered identity constructions in labour activation

Few studies have considered how labour activation programmes affect participants’ identity construction, particularly from a gender comparison perspective. Using qualitative data and recognition theories, this exploratory study of the Norwegian Qualification Program examined how gender may affect labour activation recipients’ identity construction and sense of social value. The findings suggest that women experience labour activation as an enabling process, facilitating an enhanced sense of social value and status. In contrast, men experience either no such change or a diminution of their sense of worth and status. The study shows how cultural values regarding gender, work and employment are embedded in social work practice and activation policy implementation. Underscoring how activation may be intertwined in such cultural values and norms, the study calls for further research to understand these processes, as they may affect outcomes in labour activation policy.     

Reconciling transnational mobility and national social security: what say the welfare state bureaucrats?

The welfare state was constructed to ensure the well-being of a sedentary population, consisting of citizens living within the territorial boundaries of the nation. However, mobility patterns change, and more people lead lives that criss-cross national borders while drawing on different sources of transnational social protection – the welfare state included. Now, the daily work of bureaucrats involves delivering national social security benefits to transnationally mobile recipients. Through encounters and casework processes, these welfare state bureaucrats observe how ‘transnationals’ deal with complex regulations and make use of the social security system. This article explores bureaucrats’ perceptions of individuals’ agency and behaviour as they reconcile their transnational mobility with national social security. It builds on data collected during ethnographic fieldwork in the Norwegian welfare administration, including 36 interviews, participant observation and informal conversations. The analysis identifies an institutional perspective of transnationals’ agency as shaped by their level of regulatory awareness and compliance. The bureaucrats observe some types of transnational behaviour to be more prevalent than others. As the article concludes, these bureaucratic perspectives have major implications for transnational social security delivery and how the welfare state accommodates transnational mobility.     

Assessment of recovery in older patients hospitalized with different diagnoses and functional levels,evaluated with and without geriatric assessment

Background

The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. Furthermore, to compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests.

Methods

Prospective, observational cohort study, including 961community dwelling patients aged?≥?70 years, transferred from medical, cardiac, pulmonary and orthopedic acute hospital departments to intermediate care in nursing home. Functional assessment with Barthel index (BI) was performed at admission to the nursing home and further geriatric assessment tests was performed during the first week. Logistic regression models with and without geriatric assessment were compared concerning the patients having 1) slow recovery (nursing home stay up to 2 months before return home) or, 2) poor recovery (dead or still in nursing home at 2 months).

Results

Slow recovery was independently associated with a diagnosis of non-vertebral fracture, BI subgroups 50–79 and <50, and, in the model including geriatric assessment, also with cognitive impairment. Poor recovery was more complex, and independently associated both with BI?<?50, receiving home care before admission, higher age, admission with a non-vertebral fracture, and in the geriatric assessment model, cognitive impairment.

Conclusions

Geriatric assessment is optimal for determining the recovery potential of older patients after acute hospitalization. As some hospitals lack geriatric services and ability to perform geriatric screening tests, a simpler assessment based on admission diagnoses and ADL function (BI), gives good information regarding the possible rehabilitation time and possibility to return home.