General Practice and Primary Care - Theses
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ItemWitnessing loss during Lockdown: Nurses and Midwives experience caring for women who suffered miscarriage during the Covid-19 lockdown in Melbourne Australia( 2023-08)This qualitative study explored psychosocial care for women who experienced miscarriage in a public hospital during the Covid-19 pandemic in Melbourne, Australia, and the effects of this on the nurses and midwives who cared for them. Findings showed a movement further away from family-focused care increasing the risk of women feeling isolated, alone and psychologically traumatised. This study also showed the increased distress nurses and midwives felt caring for women experiencing miscarriage during the pandemic on both their own wellbeing and for their patients.
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ItemReproductive genetic carrier screening for cystic fibrosis, fragile X syndrome and spinal muscular atrophy in general practice( 2022)The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and The Royal Australian College of General Practice recommend that information on reproductive genetic carrier screening (RGCS) for at least the most common inherited genetic conditions in our population, that is thalassaemia, cystic fibrosis (CF), spinal muscular atrophy (SMA), and fragile X syndrome (FXS), should be offered to all women planning pregnancy or in early pregnancy regardless of family history or ethnicity. While it is recognized that general practice is an appropriate place to undertake RGCS, little is known about when and how general practitioners are offering RGCS in Australia and what their attitude to screening is. This study, using qualitative and quantitative methods, has investigated when, where, how and why general practitioners (GPs) have participated in a 3-condition RGCS testing for FXS, CF, and SMA, and has measured carrier frequencies for these conditions in the community. GP participation was generally low, with much greater participation among obstetricians. Marked inequity of access to RGCS was identified, with very low rates of screening among socioeconomically disadvantaged women and women from rural and regional areas. GPs offering screening had a positive attitude to the role of general practice in RGCS. They were confident in their counselling skills and reported that the offer of screening was acceptable to their patients. Offering screening as part of preconception care was seen as preferable to antenatal screening. Barriers to offering screening in general practice were low levels of GP education in carrier screening, out of pocket cost of screening, regional or rural locations, and low frequency of preconception care consultations. Addressing the causes of inequity of access to screening in general practice, particularly the out-of-pocket cost of screening, and poor provision of preconception care, will allow more women and couples the opportunity to make informed choices about participation in screening.