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Christine Catling

Biography

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Dr Christine Catling, a midwife for over 20 years, is a senior midwifery lecturer at UTS. She believes research, innovation and good quality midwifery are pivotal to the well-being of mothers and young families.

Christine has extensive experience in antenatal education, policy development and research, and has published on workforce issues, home birth, vaginal birth after caesarean section, maternal mortality, vaginal breech birth, maternal and child health in Papua New Guinea, simulation-based learning and vitamin D levels in mothers and neonates. 

In 2015 she was the inaugural research fellow for the World Health Organisation Collaborating Centre at UTS. Her PhD explored the influences on women who chose a publicly-funded home birth in Australia.

Professional

Australian College of Midwives
Maternity Choices Australia

Image of Christine Catling
Senior Lecturer, Faculty of Health
Core Member, CHSP - Health Services and Practice
Member, Centre for Midwifery, Child and Family Health (CMCFH)
MSc (Midwifery), PhD (UTS)
Member, Australian College of Midwives
 
Phone
+61 2 9514 4912

Research Interests

Research expertise

  • Vaginal breech birth
  • Maternal and neonatal mortality in Papua New Guinea
  • Home birth
  • Respectful maternity care
  • Maternity workplace culture
Can supervise: Yes

Areas of research supervision

  • Home birth
  • Antenatal education
  • Intuition in midwifery
  • Psychological birth trauma

Apply for a research degree

Books

Catling, C., Cummins, A. & Hogan, R. 2016, Stories in Midwifery: Reflection, Inquiry, Action, 1, Elsevier.
Includes 18 chapters, each presenting a variety of stories from women, midwives and family members around a range of topics related to birthing and midwifery Includes 24 video stories presenting personal accounts from a range of lived ...

Conferences

Catling, C. 2015, 'Regulation, Association and Education of midwives', International Seminar, Akademi Kebidanan Kartini, Bali.
Catling, C., Hogan, R., Fox, D., Cummins, A., Kelly, M. & Sheehan, A. 2015, 'Improving confidence in first year midwifery students', WOMEN AND BIRTH, pp. S43-S43.
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Catling, C., Coddington, R., Foureur, M. & Homer, C.S.E. 2014, 'Publicly-funded homebirth in Australia: outcomes over 6 years', International Confederation of Midwives 30th Triennial Conference, Prague, Czech Republic.
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Catling, C., Coddington, R., Foureur, M. & Homer, C.S.E. 2013, 'Publicly-funded homebirth in Australia: A review of maternal and neonatal outcomes for the last six years', New Horizons, Royal North Shore Hospital, Sydney.
Catling, C., Coddington, R., Foureur, M. & Homer, C.S.E. 2013, 'Publicly-funded homebirth in Australia: outcomes over 6 years', Perinatal Society of Australia and New Zealand 17th Annual Congress 'Controversies in perinatal care, Adelaide.
Catling, C., Coddington, R., Foureur, M. & Homer, C.S.E. 2013, 'Maternal and neonatal outcomes from publicly-funded homebirth models in Australia', . Australian College of Midwives 18th Biennial Conference, 'Life, Art and Science in Midwifery, Hobart.
Catling, C. 2011, 'Why women choose a publicly-funded homebirth', A Midwifery Odyssey, Australian College of Midwives 17th National Conference, Sydney.
Catling, C. 2011, 'Publicly-funded homebirth panel member', Homebirth Australia Conference, Newcastle.
Catling, C. 2010, 'What are the influences on women who choose a homebirth? Preliminary results from PhD study', Midwives & Women: A Brilliant Blend: Australia College of Midwives 16th National Conference, Adelaide.
Catling, C. 2005, 'Vitamin D levels in pregnant women and their babies in Sydney', 27th Triennial Congress of the International Confederation of Midwives, Brisbane.
Catling, C. 2003, 'Consulting with the community', Australian College of Midwives Incorporated 13th Biennial National Conference, Darwin.

Journal articles

Petrovska, K., Watts, N.P., Catling, C., Bisits, A. & Homer, C.S. 2017, ''Stress, anger, fear and injustice': An international qualitative survey of women's experiences planning a vaginal breech birth.', Midwifery, vol. 44, pp. 41-47.
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OBJECTIVE: the outcomes of the Term Breech Trial had a profound impact on women's options for breech birth, with caesarean section now seen as the default method for managing breech birth by many clinicians. Despite this, the demand for planned vaginal breech birth from women does exist. This study aimed to examine the experiences of women who sought a vaginal breech birth to increase understanding as to how to care for women seeking this birth option. DESIGN: an electronic survey was distributed to women online via social media. The survey consisted of qualitative and quantitative questions, with the qualitative data being the focus of this paper. Open ended questions sought information on the ways in which woman sourced a clinician skilled in vaginal breech birth and the level of support and quality of information provided from clinicians regarding vaginal breech birth. Thematic analysis was used to analyse and code the qualitative data into major themes. FINDINGS: in total, 204 women from over seven countries responded to the survey. Written responses to the open ended questions were categorised into seven themes: Seeking the chance to try for a VBB; Encountering coercion and fear; Putting the birth before the baby?; Dealing with emotional wounds; Searching for information and support; Traveling across boundaries; Overcoming obstacles in the system. KEY CONCLUSIONS: for women seeking vaginal breech birth, limited system and clinical support can impede access to balanced information and options for care. Recognition of existing evidence on the safety of vaginal breech birth, as well as the presence of clinical guidelines that support it, may assist in promoting vaginal breech birth as a legitimate option that should be available to women.
Catling, C., Petrovska, K., Watts, N., Bisits, A. & Homer, C.S. 2016, 'Barriers and facilitators for vaginal breech births in Australia: Clinician's experiences.', Women and Birth, vol. 29, no. 2, pp. 138-143.
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Since the Term Breech Trial in 2000, few Australian clinicians have been able to maintain their skills to facilitate vaginal breech births. The overwhelming majority of women with a breech presentation have been given one birth option, that is, caesarean section. The aim of this study was to explore clinician's experiences of caring for women when facilitating a vaginal breech birth.A descriptive exploratory design was undertaken. Nine clinicians (obstetricians and midwives) from two tertiary hospitals in Australia who regularly facilitate vaginal breech birth were interviewed. The interviews were analysed thematically.Participants were five obstetricians and four midwives. There were two overarching themes that arose from the data: Facilitation of and Barriers to vaginal breech birth. A number of sub-themes are described in the paper.In order to facilitate vaginal breech birth and ensure it is given as an option to women, it is necessary to educate, upskill and support colleagues to increase their confidence and abilities, carefully counsel and select suitable women, and approach the option in a calm, collaborative way.
Simpson, M. & Catling, C. 2016, 'Understanding psychological traumatic birth experiences: A literature review.', Women and Birth, vol. 29, no. 3, pp. 203-207.
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Traumatic birth experiences can cause postnatal mental health disturbance, fear of childbirth in subsequent pregnancies and disruption to mother-infant bonding, leading to impaired child development. Some women may develop postnatal Post Traumatic Stress Disorder, which is a particularly undesirable outcome. This paper aimed to gain a better understanding of factors contributing to birth trauma, and the efficacy of interventions that exist in the literature.A literature search was undertaken in April 2015. Articles were limited to systematic reviews or original research of either high to moderate scientific quality. A total of 21 articles were included in this literature review.Women with previous mental health disorders were more prone to experiencing birth as a traumatic event. Other risk factors included obstetric emergencies and neonatal complications. Poor Quality of Provider Interactions was identified as a major risk factor for experiencing birth trauma. Evidence is inconclusive on the best treatment for Post Traumatic Stress Disorder; however midwifery-led antenatal and postnatal interventions, such as early identification of risk factors for birth trauma and postnatal counselling showed benefit.Risk factors for birth trauma need to be addressed prior to birth. Consideration needs to be taken regarding quality provider interactions and education for maternity care providers on the value of positive interactions with women. Further research is required into the benefits of early identification of risk factors for birth trauma, improving Quality of Provider Interactions and how midwifery-led interventions and continuity of midwifery carer models could help reduce the number of women experiencing birth trauma.
Catling, C.J. & Homer, C.S. 2016, 'Twenty-five years since the Shearman Report: How far have we come? Are we there yet?', Women and Birth, vol. 29, no. 1, pp. 93-99.
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In 1989, the first major state-wide report into maternity services, known as the Shearman Report after its author, was released in New South Wales, the most populous state in Australia.This paper reflects upon the report and tracks the progress of five of its key recommendations. The recommendations are still some of the major issues facing maternity services across the country. These are: community-based maternity care, rural maternity services, hospital visiting rights for privately practising midwives, obstetric intervention, and midwifery continuity of maternity care.In some ways, much has changed in 25 years including the terminology used in the report, the importance of midwifery continuity of care and the woman-centred nature of many services. However, in other ways, there is still a long way to go to address these major issues. Despite more than a quarter of a century, many recommendations have not been fulfilled, especially access to care in rural areas, rates of obstetric intervention, and the issue of visiting rights for privately practising midwives which has gone backwards.A continued and renewed effort is needed to ensure that the forward thinking recommendations of the Shearman Report are ultimately realised for all women and their families.
Catling, C., Hogan, R., Fox, D., Cummins, A., Kelly, M. & Sheehan, A. 2016, 'Simulation workshops with first year midwifery students.', Nurse Education in Practice, vol. 17, pp. 109-115.
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Simulated teaching methods enable a safe learning environment that are structured, constructive and reflective. We prepared a 2-day simulation project to help prepare students for their first clinical practice. A quasi-experimental pre-test - post-test design was conducted. Qualitative data from the open-ended survey questions were analysed using content analysis. Confidence intervals and p-values were calculated to demonstrate the changes in participants' levels of understanding/ability or confidence in clinical midwifery skills included in the simulation. 71 midwifery students participated. Students rated their understanding, confidence, and abilities as higher after the simulation workshop, and higher still after their clinical experience. There were five main themes arising from the qualitative data: having a learning experience, building confidence, identifying learning needs, developing communication skills and putting skills into practise. First year midwifery students felt well prepared for the clinical workplace following the simulation workshops. Self-rated understanding, confidence and abilities in clinical midwifery skills were significantly higher following consolidation during clinical placement. Longitudinal studies on the relationship between simulation activities and student's overall clinical experience, their intentions to remain in midwifery, and facility feedback, would be desirable.
Catling, C., Petrovska, K., Watts, N.P., Bisits, A. & Homer, C.S. 2016, 'Care during the decision-making phase for women who want a vaginal breech birth: Experiences from the field.', Midwifery, vol. 34, pp. 111-116.
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few women are given the option of a vaginal breech birth in Australia, unless the clinicians feel confident and have the skills to facilitate this mode of birth. Few studies describe how clinicians provide care during the decision-making phase for women who choose a vaginal breech birth. The aim of this study was to explore how experienced clinicians facilitated decisions about external cephalic version and mode of birth for women who have a breech presentation.a descriptive exploratory design was undertaken with nine experienced clinicians (obstetricians and midwives) from two tertiary hospitals in Australia. Data were collected through face to face interviews and analysed thematically.five obstetricians and four midwives participated in this study. All were experienced in caring for women having a vaginal breech birth and were currently involved in providing such a service. The themes that arose from the data were: Pitching the discussion, Discussing safety and risk, Being calm and Providing continuity of care.caring for women who seek a vaginal breech birth includes careful selection of appropriate women, full discussions outlining the risks involved, and undertaking care with a calm manner, ensuring continuity of care. Health services considering establishing a vaginal breech service should consider that these elements are included in the establishment and implementation processes.
Scarf, V., Catling, C., Viney, R. & Homer, C.S. 2016, 'Costing alternative birth settings for women at low risk of complications: A systematic review', PLoS One, vol. 11, no. 2, pp. 1-17.
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Background There is demand from women for alternatives to giving birth in a standard hospital setting however access to these services is limited. This systematic review examines the literature relating to the economic evaluations of birth setting for women at low risk of complications. Methods Searches of the literature to identify economic evaluations of different birth settings of the following electronic databases: MEDLINE, CINAHL, EconLit, Business Source Complete and Maternity and Infant care. Relevant English language publications were chosen using keywords and MeSH terms between 1995 and 2015. Inclusion criteria included studies focussing on the comparison of birth setting. Data were extracted with respect to study design, perspective, PICO principles, and resource use and cost data. Results Eleven studies were included from Australia, Canada, the Netherlands, Norway, the USA, and the UK. Four studies compared costs between homebirth and the hospital setting and the remaining seven focussed on the cost of birth centre care and the hospital setting. Six studies used a cost-effectiveness analysis and the remaining five studies used cost analysis and cost comparison methods. Eight of the 11 studies found a cost saving in the alternative settings. Two found no difference in the cost of the alternative settings and one found an increase in birth centre care. Conclusions There are few studies that compare the cost of birth setting. The variation in the results may be attributable to the cost data collection processes, difference in health systems and differences in which costs were included. A better understanding of the cost of birth setting is needed to inform policy makers and service providers.
Rumsey, M., Catling, C., Thiessen, J. & Neill, A. 2016, 'Building nursing and midwifery leadership capacity in the Pacific.', International nursing review.
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The Australian Award Fellowship Program aimed to strengthen nursing and midwifery leadership and capacity in developing countries in the Pacific.It is necessary to build an optimal global health workforce, and leadership and mentorship are central to this need. This is especially important in small island states such as the Pacific who have limited capacity and resources.This health system strengthening program addressed quality improvement in education, through the mentorship of potential nursing and midwifery leaders in the South Pacific Region.Program participants between 2013 and 2015 were interviewed. Data were audio-taped, transcribed and analysed thematically using an inductive process.Thirty-four nurses and midwives from 12 countries participated. There were four main themes arising from the data which were: having a country-wide objective, learning how to be a leader, negotiating barriers and having effective mentorship.Our study showed that participants deemed their mentorship from country leaders highly valuable in relation to completing their projects, networking and role modelling. Similar projects are described.The limitation of this study was its small size. There is a need to continue to build the momentum of the program and Fellows in each country in order to build regional networks.The Program has provided beneficial leadership education and mentorship for nurses and midwives from Pacific countries. It has provided a platform to develop quality improvement projects in line with national priorities.Global aid programs and the recipients of the program would benefit from comparable health strengthening approaches to nursing and midwifery in similar developing countries.
Watts, N.P., Petrovska, K., Bisits, A., Catling, C. & Homer, C.S.E. 2016, 'This baby is not for turning: Women's experiences of attempted external cephalic version', BMC PREGNANCY AND CHILDBIRTH, vol. 16.
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Petrovska, K., Watts, N.P., Catling, C., Bisits, A. & Homer, C.S.E. 2016, 'Supporting Women Planning a Vaginal Breech Birth: An International Survey', BIRTH-ISSUES IN PERINATAL CARE, vol. 43, no. 4, pp. 353-357.
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Corcoran, P.M., Catling, C. & Homer, C.S.E. 2016, 'Models of midwifery care for Indigenous women and babies: A meta-synthesis.', Women and birth : journal of the Australian College of Midwives.
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Indigenous women in many countries experience a lack of access to culturally appropriate midwifery services. A number of models of care have been established to provide services to women. Research has examined some services, but there has not been a synthesis of qualitative studies of the models of care to help guide practice development and innovations.To undertake a review of qualitative studies of midwifery models of care for Indigenous women and babies evaluating the different types of services available and the experiences of women and midwives.A meta-synthesis was undertaken to examine all relevant qualitative studies. The literature search was limited to English-language published literature from 2000-2014. Nine qualitative studies met the inclusion criteria and literature appraisal - six from Australia and three from Canada. These articles were analysed for coding and theme development.The major themes were valuing continuity of care, managing structural issues, having negative experiences with mainstream services and recognising success.The most positive experiences for women were found with the services that provided continuity of care, had strong community links and were controlled by Indigenous communities. Overall, the experience of the midwifery services for Indigenous women was valuable. Despite this, there were still barriers preventing the provision of intrapartum midwifery care in remote areas.The expansion of midwifery models of care for Indigenous women and babies could be beneficial in order to improve cultural safety, experiences and outcomes in relation to pregnancy and birth.
Coddington, R., Catling, C. & Homer, C.S.E. 2016, 'From hospital to home: Australian midwives' experiences of transitioning into publicly-funded homebirth programs.', Women and birth : journal of the Australian College of Midwives.
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Over the past two decades, 14 publicly-funded homebirth models have been established in Australian hospitals. Midwives working in these hospitals now have the opportunity to provide homebirth care, despite many having never been exposed to homebirth before. The transition to providing homebirth care can be daunting for midwives who are accustomed to practising in the hospital environment.To explore midwives' experiences of transitioning from providing hospital to homebirth care in Australian public health systems.A descriptive, exploratory study was undertaken. Data were collected through in-depth interviews with 13 midwives and midwifery managers who had recent experience transitioning into and working in publicly-funded homebirth programs. Thematic analysis was conducted on interview transcripts.Six themes were identified. These were: skilling up for homebirth; feeling apprehensive; seeing birth in a new light; managing a shift in practice; homebirth-the same but different; and the importance of mentoring and support.Midwives providing homebirth work differently to those working in hospital settings. More experienced homebirth midwives may provide high quality care in a relaxed environment (compared to a hospital setting). Midwives acceptance of homebirth is influenced by their previous exposure to homebirth.The transition from hospital to homebirth care required midwives to work to the full scope of their practice. When well supported by colleagues and managers, midwives transitioning into publicly-funded homebirth programs can have a positive experience that allows for a greater understanding of and appreciation for normal birth.
Catling, C., Reid, F. & Hunter, B. 2016, 'Australian midwives' experiences of their workplace culture', Women and Birth.
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Catling, C., Medley, N., Foureur, M., Ryan, C., Leap, N., Teate, A. & Homer, C.S.E. 2015, 'Group versus conventional antenatal care for women', Cochrane Database of Systematic Reviews.
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Moores, A., Catling, C., West, F., Neill, A., Rumsey, M., Kilio Samor, M. & Homer, C.S.E. 2015, 'What motivates midwifery students to study midwifery in Papua New Guinea?', Pacific Journal of Reproductive Health, vol. 1, no. 2, pp. 60-67.
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Introduction: Midwives in Papua New Guinea have a vital role to play in addressing the high maternal and neonatal mortality rate. Attracting applicants in sufficient numbers and quality to study midwifery has been challenging in some countries. Aim: The aim of this study was to explore the motivation of students to study midwifery in Papua New Guinea. Findings from this study will assist in midwifery workforce recruitment and retention. Methods: Between 2012-2014, midwifery students (n=298) from the four midwifery schools in Papua New Guinea were surveyed and interviewed on their perceptions regarding their midwifery studies. One part of the data collection process asked the students to describe their motivation to become a midwife with the question: Why did you choose to study midwifery? A content and thematic analysis was undertaken. Results: 194 (65% response rate) students provided between 1-3 different responses to the question, making a total of 246 responses. Three main themes emerged which were recognising a public need; recognising professional needs; and, building upon experience. Discussion: Forty-one percent (n=101) of midwifery students in Papua New Guinea studied midwifery because they wanted to help lower the high maternal mortality in the country. This is a unique finding reflecting the reality of maternal and child health in Papua New Guinea and is of great contrast to the motivations of midwifery students in similarly low to middle income countries in the region and globally.
Catling, C., Watts, N., Petrovska, K., Sjostedt, C., Bisits, A. & Homer, C.S.E. 2015, ''Normal' vaginal breech birth: The clinicians' perspective', WOMEN AND BIRTH, vol. 28, no. 1, pp. S43-S43.
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Cummins, A.M., Catling, C., Hogan, R. & Homer, C.S. 2014, 'Addressing culture shock in 1st year midwifery students: maximising the initial clinical experience', Women and Birth, vol. 27, no. 4, pp. 271-275.
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Background Many Bachelor of Midwifery students have not had any exposure to the hospital setting prior to their clinical placement. Students have reported their placements are foreign to them, with a specialised confusing `language. It is important to provide support to students to prevent culture shock that may lead to them leaving the course.
Homer, C.S., Scarf, V.L., Catling, C. & Davis, D. 2014, 'Culture-based versus risk-based screening for the prevention of group B streptococcal disease in newborns: A review of national guidelines', Women and Birth, vol. 27, no. 1, pp. 46-51.
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Background: Maternal colonisation with group B streptococcus (GBS) is recognised as the most frequent cause of severe early onset infection in newborns. National and international guidelines outline two approaches to the prevention of early onset disease in the neonate: risk based management and antenatal culture-based screening. We undertook an analysis of existing national and international guidelines in relation to GBS in pregnancy using a standardised and validated instrument to highlight the different recommended approaches to care.
Catling, C., Dahlen, H. & Homer, C.S. 2014, 'The influences on women who chose publicly-funded homebirth in Australia', Midwifery, vol. 30, no. 7, pp. 892-898.
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Sibbritt, D., Catling, C., Adams, J., Shaw, A. & Homer, C.S. 2014, 'The self-prescibed use of aromatherapy oils by pregnant women', Women and Birth, vol. 27, no. 1, pp. 41-45.
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Catling, C., White, H., Cummins, A.M. & Hogan, R. 2014, 'The Virtual Tutor Project: a student-friendly guide to clinical skills', Clinical Simulation in Nursing, vol. 10, no. 5, pp. e277-e280.
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Using a variety of different teaching methods is an important educational strategy to facilitate learning. There was a need to provide effective education to nursing and midwifery students that used current technology, and was user-friendly. The aim of the Virtual Tutor project was to enhance nursing and midwifery students' learning of key clinical skills: inserting a female urinary catheter, adult resuscitation and priming an intravenous therapy line, using step by step videos for students' self-directed use. Three `how to videos of the clinical skills were made and embedded into the undergraduate nursing and midwifery clinical subjects. Evaluative feedback was gained from students and the project team. Surveys were completed by students after they had used one or more of the videos. The results showed that the use of the Virtual Tutor videos was helpful in enhancing the student's experience of learning clinical skills, and most students stated that they would access the videos again for self-directed study. The conclusion was that practical, accessible videos of how to perform common clinical skills are a useful learning tool for nursing and midwifery students.
Catling, C., Coddington, B., Foureur, M. & Homer, C.S. 2013, 'Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years', Medical Journal of Australia, vol. 198, no. 11, pp. 616-620.
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Objective: To report maternal and neonatal outcomes for Australian women planning a publicly funded homebirth from 2005 to 2010.
Sibbritt, D., Catling, C., Scarf, V.L. & Homer, C.S. 2013, 'The profile of women who consult midwives in Australia', Women and Birth, vol. 26, no. 4, pp. 240-245.
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Background: There is no Australian data on the characteristics of women who consult with midwives. Aim: To determine the profile of women who consult midwives in Australia. Methods: This cross-sectional research was conducted as part of the Australian Longitudinal Study on Womens Health (ALSWH). Participants were the younger (3136 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n = 801). The main outcome measure was consultation with a midwife.
Catling-Paull, C., Coddington, R.L., Foureur, M.J. & Homer, C.S.E. 2013, 'Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years REPLY', MEDICAL JOURNAL OF AUSTRALIA, vol. 199, no. 11, pp. 743-743.
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Homer, C.S., Ryan, C.L., Leap, N., Foureur, M., Teate, A. & Catling, C. 2012, 'Group versus conventional antenatal care for women (Review)', The Cochrane Database of Systematic Reviews.
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The primary and secondary outcomes were pre-determined as described. The included trials measured a number of outcomes that were non-pre-speci?ed. As these were important for the populations studied in the trials, these were included post hoc. For example, the Ickovics 2007a trial targeted young women and the outcomes included sexual and behavioural outcomes including HIV risk behaviour and STDs. The Kennedy 2011 trial included family healthcare readiness. In addition, inadequate antenatal care was included as a non-pre-speci?ed outcome as it was used as a measure of quality of care
Smith, R.M., Gray, J.E., Raymond, J.E., Catling, C. & Homer, C.S. 2012, 'Simulated Learning Activities: Improving Midwifery Students' Understanding of Reflective Practice', Clinical Simulation in Nursing, vol. 8, no. 9, pp. 451-457.
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Graduate Diploma in Midwifery students at an Australian university poorly evaluated a compulsory theoretical subject (unit of study) titled Becoming a Reflective Practitioner over several years. Method: Authentic practice-based simulated scenarios were introduced to improve student learning and as an innovative approach to teaching reflective practice. The introduction was evaluated using student feedback surveys, pre- and post simulation knowledge questionnaires, and 6-week retention-of-knowledge questionnaires. Students reported improved levels of satisfaction, greater earning, and increasing knowledge in the simulated practice area. The students rated the scenarios as useful in increasing reflective practice, but this was secondary to skill acquisition. Simulated activities may prove useful in developing reflective practice, but further investigation is required to examine how to shift the focus from clinical skill acquisition to reflective practice.
Catling, C., Foureur, M. & Homer, C.S. 2012, 'Publicly-funded homebirth models in Australia', Women and Birth, vol. 25, no. 4, pp. 152-158.
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Background: Publicly-funded homebirth programs in Australia have been developed in the past decade mostly in isolation from each other and with limited published evaluations. There is also distinct lack of publicly available information about the development and characteristics of these programs. We instigated the National Publicly-funded Homebirth Consortium and conducted a preliminary survey of publicly-funded homebirth providers. Aim: To outline the development of publicly-funded homebirth models in Australia. Methods: Providers of publicly-funded homebirth programs in Australia were surveyed using an on-line survey in December 2010. Questions were about their development, use of policy and general operational issues. A descriptive analysis of the quantitative data and content analysis of the qualitative data was undertaken. Findings: In total, 12 programs were identified and 10 contributed data to this paper. The service providers reported extensive multidisciplinary consultation and careful planning during development. There was a lack of consistency in data collection throughout the publicly-funded homebirth programs due to different databases, definitions and the use of different guidelines. Discussion: Publicly-funded homebirth services followed different routes during their development, but essentially had safety and collaboration with stakeholders, including women and obstetricians, as central to their process. Conclusion: The National Publicly-funded Homebirth Consortium has facilitated a sharing of resources, processes of development and a linkage of homebirth services around the country. This analysis has provided information to assist future planning and developments in models of midwifery care. It is important that births of women booked to these programs are clearly identified when their data is incorporated into existing perinatal datasets.
Homer, C.S. & Catling, C. 2012, 'Safe timing for an urgent Caesarean section: what is the evidence to guide policy?', Australian Health Review, vol. 36, no. 3, pp. 277-281.
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To determine, from the evidence, what is the optimum decision to delivery (DDI) intervals in emergency Caesarean sections (CS). The aim of the study was to help guide policy in maternity services and identify issues relating to DDI and safe practice in maternity care. A systematic review of the literature was undertaken. Assessment of the quality of eligible papers was undertaken using the Critical Appraisal Skills Program (CASP) rating. There is no strong evidence that a DDI of 30 min or less is associated with improved outcomes for babies or mothers. Some evidence suggests that a DDI of greater than 30 min but less than 75 min confers benefit, but these findings were confounded by the indications for the emergency CS. Urgent CS should occur as soon as possible, but there is insufficient evidence to support a definite time frame, such as 30 min. A consistency of approach and nomenclature in describing the urgency of CS is necessary, which would enable criteria for further audit regarding DDI. Staff training should be addressed to improve transfer systems for CS. Antenatal risk assessment and congruence with role delineation and service delivery capacity is important.
Homer, C.S.E., Foureur, M.J., Allende, T., Pekin, F., Caplice, S. & Catling-Paull, C. 2012, ''It's more than just having a baby' women's experiences of a maternity service for Australian Aboriginal and Torres Strait Islander families', Midwifery, vol. 28, no. 4, pp. e509-e515.
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Catling, C., Johnston, R.A., Ryan, C.L., Foureur, M. & Homer, C.S. 2011, 'Clinical Interventions that increase the uptake and success of vaginal birth after caesarean section: a systematic review', Journal of Advanced Nursing, vol. 67, no. 8, pp. 1646-1661.
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Aim. The aim of this study was to review clinical interventions that increase the uptake and/or the success rates of vaginal birth after caesarean section. Background. Repeat caesarean section is the main reason for the increase in surgical births. The risk of uterine rupture in women who have prior caesarean sections prevents many clinicians from recommending vaginal birth after caesarean. Despite this, support for vaginal birth after caesarean continues. Data sources. A search of five databases and a number of relevant professional websites was undertaken up to December 2008. Review methods. A systematic review of quantitative studies that involved a comparison group and examined a clinical intervention for increasing the uptake and/or the success of vaginal birth after caesarean section was undertaken. An assessment of quality was made using the Critical Skills Appraisal Programme. Results. Induction of labour using artificial rupture of membranes, prostaglandins, oxytocin infusion or a combination, was associated with lower vaginal birth rates. Cervical ripening agents such as prostaglandins and transcervical catheters may result in lower vaginal birth rates compared with spontaneous labour. The impact of epidural anaesthesia in labour on vaginal birth after caesarean success is inconclusive. X-ray pelvimetry is associated with reduced uptake of vaginal birth after caesarean and higher caesarean section rates. Scoring systems to predict likelihood of vaginal birth are largely unhelpful. There is insufficient data in relation to vaginal birth after caesarean section between different closure methods for the primary caesarean section. Conclusion. Clinical factors can affect vaginal birth after caesarean uptake and success.
Catling, C., Dahlen, H. & Homer, C.S. 2011, 'Multiparous women's confidence to have a publicly-funded homebirth: A qualitative study', Women and Birth, vol. 24, no. 3, pp. 122-128.
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Background: Hospital birth is commonly thought to be a safer option than homebirth, despite many studies showing similar rates of safety for low risk mothers and babies when cared for by qualified midwives with systems of back-up in place. Recently in Australia, demand has led to the introduction of a small number of publicly-funded homebirth programs. Womens confidence in having a homebirth through a publicly-funded homebirth program in Australia has not yet been explored. Aim: The aim of the study was to explore the reasons why multiparous women feel confident to have a homebirth within a publicly-funded model of care in Australia. Methods: Ten multiparous English-speaking women who chose to have a homebirth with the St George Hospital Homebirth Program were interviewed in the postnatal period using semistructured, open-ended questions. Interviews were transcribed, then a thematic analysis was undertaken. Results: Women, having already experienced a normal birth, demonstrated a strong confidence in their ability to give birth at home and described a confidence in their bodies, their midwives, and the health system. Women weighed up the risks of homebirth through information they gathered and integration with their previous experience of birth, their family support and self-confidence. Discussion: Women choosing publicly-funded homebirth display strong confidence in both themselves to give birth at home, and their belief in the health systems ability to cope with any complications that may arise.
Catling, C., Johnston, R.A., Ryan, C.L., Foureur, M. & Homer, C.S. 2011, 'Non-Clinical Interventions that increase the uptake or success of vaginal birth after caesarean section: a systematic review', Journal of Advanced Nursing, vol. 67, no. 8, pp. 1662-1676.
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Aim. The aim of this study was to review non-clinical interventions that increase the uptake and/or the success rates of vaginal birth after caesarean section. Background. Increases in rates of caesarean section are largely due to repeat caesarean section in a subsequent pregnancy. Concerns about vaginal birth after caesarean section have centred on the risk of uterine rupture. Nonetheless, efforts to increase the vaginal birth rate in these women have been made. This study reviews these in relation to non-clinical interventions. Data sources. Literature was searched up until December 2008 from five databases and a number of relevant professional websites. Review methods. A systematic review of quantitative studies that evaluated a nonclinical intervention for increasing the uptake and/or the success of vaginal birth after caesarean section was undertaken. Only study designs that involved a comparison group were included. Further exclusions were imposed for quality using the Critical Skills Appraisal Programme. Results. National guidelines influence vaginal birth after caesarean section rates, but a greater effect is seen when institutions develop local guidelines, adopt a conservative approach to caesarean section, use opinion leaders, give individualized information to women, and give feedback to obstetricians about mode of birth rates. Individual clinician characteristics may impact on the number of women choosing and succeeding in vaginal birth after caesarean section. There is inconsistent evidence that having private health insurance may be a barrier to the uptake and success of vaginal birth after caesarean section. Conclusion. Non-clinical factors can have a significant impact on vaginal birth after caesarean section uptake and success.
Sheehy, A.D., Foureur, M., Catling, C. & Homer, C.S. 2011, 'Examining the Content Validity of the Birthing Unit Design Spatial Evaluation Tool Within a Woman-Centered Framework', Journal Of Midwifery & Womens Health, vol. 56, no. 5, pp. 494-502.
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Introduction: The environment for birth influences women in labor. Optimal birthing environments have the potential to facilitate normal labor and birth. The measurement of optimal birth units is currently not possible because there are no tools. An audi
Catling, C., McDonnell, N., Moores, A. & Homer, C.S. 2011, 'Maternal mortality in Australia: Learning from Maternal Cardiac Arrest', Nursing and Health Sciences, vol. 13, no. 1, pp. 10-15.
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Cardiac arrest in pregnancy is fortunately a rare event that few midwives will see during their career. The increase in maternal age, the Body Mass Index, cesarean sections, multiple pregnancies, and comorbidities over recent years have increased the probability of cardiac arrest. The early warning signs of impending maternal cardiac arrest are either absent or go unrecognized. Maternal mortality reviews highlight the deficiencies that maternity care providers have in managing cardiac arrest in pregnancy.The aim of this article is to address the knowledge deficiencies of health professionals by reviewing the physiological changes in pregnant women that complicate the management of cardiopulmonary resuscitation, using a case scenario. There are key differences in the management of pregnant women, when compared to standard adult resuscitation. The outcome is dependent on the speed of the response and the consideration of a number of crucial pregnancy-specific interventions. Staff members need to be adequately trained in order to deal with maternal cardiac arrest and have access to training packages and in-service education programs. As cardiac arrest in pregnancy is a rare event, emergency drill simulations are an important component of ongoing education.
Catling-Paull, C., Dahlen, H. & Homer, C.S.E. 2011, 'Multiparous women's confidence to have a publicly-funded homebirth: A qualitative study', WOMEN AND BIRTH, vol. 24, no. 4, pp. 180-180.
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Duffield, C.M., Conlon, L.S., Kelly, M.A., Catling, C. & Stasa, H. 2010, 'The Emergency Department Nursing Workforce: Local Solutions for Local Issues', International Emergency Nursing, vol. 18, no. 4, pp. 181-187.
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Demand for health services especially emergency services has increased substantially in recent years. As a consequence, Emergency Departments and hospitals have focused greater attention on the way they provide care using the workforce differently to meet efficiency targets. A strategy frequently implemented is either the initiation or restructuring of Emergency Nurse Practitioner roles. The future role of the emergency nurse is likely to be different from that of today, as health services adapt and evolve to meet demand. However, the authors caution against the notion of implementing new positions or restructuring existing positions without first analysing patient throughput, case-mix, staff competency levels, cross-professional boundaries and relevant local issues.
Roche, M.A., Diers, D., Duffield, C.M. & Catling, C. 2010, 'Violence toward nurses, the work environment, and patient outcomes', Journal of Nursing Scholarship, vol. 42, no. 1, pp. 13-22.
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This study's purpose was to relate nurses' self-rated perceptions of violence (emotional abuse, threat or actual violence) on medical/surgical units to the nursing working environment and to patient outcomes. Cross sectional collection of data by surveys and primary data collection for one week periods on 94 nursing wards in 21 hospitals in two states of Australia.
Catling, C., Johnston, R.A., Ryan, C., Foureur, M. & Homer, C.S. 2010, 'Interventions for increasing the uptake or success of vaginal birth after caesarean section: A Technical Report', pp. 1-94.
Duffield, C.M., Roche, M.A., Diers, D., Catling, C. & Blay, N. 2010, 'Staffing, skill mix and the model of care', Journal of Clinical Nursing, vol. 19, no. 15-16, pp. 2242-2251.
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The study explored whether nurse staffing, experience and skill mix influenced the model of nursing care in medical-surgical wards. Nurses (n=2278, 80.9% response rate) were surveyed using The Nursing Care Delivery System and the Nursing Work Index-Revised. Staffing and skill mix was obtained from the ward roster and other data from the patient record. Models of care were examined in relation to these practice environment and organisational variables.
Homer, C.S., Catling, C., Sinclair, D., Faizah, N., Balasubramanian Appiah, V., Foureur, M., Hoang, D.B. & Lawrence, E.M. 2010, 'Developing an interactive electronic maternity record', Birtish Journal of Midwifery, vol. 18, no. 6, pp. 384-389.
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Women have a strong need to be involved in their own maternity care. Pregnancy hand-held records encourage women's participation in their maternity care; gives them an increased sense of control and improves communication among care providers. They have been successfully used in the UK and New Zealand for almost 20 years. Despite evidence that supports the use of hand-held records, widespread introduction has not occurred in Australia. The need for an electronic version of pregnancy hand-held records has become apparent, especially after the introduction of the Electronic Medical Record in Australia. A personal digital assistant (PDA) was developed as an interactive antenatal electronic maternity record that health-care providers could use in any setting and women could access using the internet. This article will describe the testing of the antenatal electronic maternity record.
McMurtrie, J., Catling-Paull, C., Teate, A., Caplice, S., Chapman, M. & Homer, C. 2010, 'The St. George Homebirth Program: an evaluation of the first 100 booked women (vol 49, pg 631, 2009)', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 50, no. 1, pp. 100-100.
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Duffield, C.M., Roche, M.A., O'Brien-Pallas, L. & Catling, C. 2009, 'The Implications of Staff 'Churn' for Nurse Managers, Staff, and Patients', Nursing Economic, vol. 27, no. 2, pp. 103-110.
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The article discusses a study of 40 hospital wards that analyzed staff skills and patient outcomes. The author explores factors that influence staff turnover, the consequences and their effect on the quality of patient care, and the costs. The study found that the changes that occur during staff turnover have an impact on the continuity of patient care and present challenges to the nurse manager in areas such as scheduling, supervision, and leadership.
Duffield, C.M., Roche, M.A., O'Brien-Pallas, L., Catling, C. & King, M.T. 2009, 'Staff satisfaction and retention and the role of the Nursing Unit Manager', Collegian, vol. 16, no. 1, pp. 11-17.
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Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated
McMurtrie, J.E., Catling, C., Teate, A., Caplice, S.L., Chapman, M. & Homer, C.S. 2009, 'The St. George Homebirth Program: An evaluation of the first 100 booked women', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 49, no. 6, pp. 631-636.
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Background: The St. George Homebirth Program was the first publicly funded homebirth model of care set up in New South Wales. This program provides access to selected women at low obstetric risk the option of having their babies at home. There are only four other publicly funded homebirth programs operating in Australia. Aims: To report the outcomes of the first 100 women booked at the St. George Homebirth Program. Methods: A prospective descriptive study was undertaken. Data were collected on the first 100 women who gave birth between November 2005 and March 2009. Two databases were accessed and missing data were followed up by review of the relevant charts. Results: Of the first 100 booked women, 63 achieved a homebirth, 30 were transferred to hospital or independent midwifery care in the antenatal period and seven were transferred intrapartum. Two women were transferred to hospital in the early postnatal period, one for a postpartum haemorrhage and one for hypotension. One baby suffered mild respiratory distress, was treated in the emergency department and was discharged home within four hours. Conclusion: The St. George Hospital homebirth program has provided reassuring outcomes for the first 100 women it has cared for over the past four years. Wider availability of this service could be achieved provided there is the appropriate close collaboration between providers and effective processes for consultation, referral and transfer. The outcomes of women and babies in publicly funded homebirth programs deserve further study, and the development of a national prospective database of all planned homebirths would contribute to this knowledge.
Bowyer, L., Catling, C., Diamond, T., Homer, C.S., Davis, G.K. & Craig, M.S. 2009, 'Vitamin D, PTH and calcium levels in pregnant women and their neonates', Clinical Endocrinology, vol. 70, no. 3, pp. 372-377.
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To determine the prevalence of vitamin D deficiency in pregnant women and their neonates and to examine factors associated with vitamin D deficiency. Population-based study of pregnant women and their neonates from South-eastern Sydney, Australia. Serum 25 hydroxy-vitamin D (25-OHD), PTH, calcium, albumin, phosphate and alkaline phosphatase were measured in women at 23-32 weeks gestation and on cord blood at delivery. Maternal skin phototype was recorded using the Fitzpatrick scale. Vitamin D deficiency (defined as 25-OHD <= 25 nmol/l) was found in 144 of 971 (15%) women and 98 of 901 (11%) neonates. Median 25-OHD was 52 nmol/l (range 17-174) in mothers and 60 nmol/l (17-245) in neonates. Maternal 25-OHD levels varied by season, with lowest levels in late winter/early spring (P < 0.001). Factors associated with maternal vitamin D deficiency in multiple logistic regression were (OR, 95% CI): maternal birthplace outside Australia: 2.2 (1.4-3.5, P = 0.001), dark skin phototype: 2.7 (1.6-4.5, P < 0.001), wearing a veil: 21.7 (11.7-40.3, P < 0.001) and younger maternal age: 0.93 (0.89-0.97, P = 0.001). Maternal vitamin D deficiency increased the risk of neonatal vitamin D deficiency (OR 17.2, 95% CI 8.8-34.3) and birth weight was lower among infants of deficient vs. sufficient mothers: mean (SD) 3245 g (545) vs. 3453 g (555), P < 0.001. Vitamin D deficiency is common among pregnant women; immigrant, veiled and dark skinned women are at greatest risk. Maternal vitamin D deficiency increases the risk of neonatal vitamin D deficiency and lower birth weight.
Duffield, C.M., Gardner, G., Chang, A.M. & Catling, C. 2009, 'Advanced nursing practice: A global perspective', Collegian - Journal of Royal College of Nursing, Aust..., vol. 16, no. 2, pp. 55-62.
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To review the titles, roles and scope of practice of Advanced Practice Nurses internationally. Background: There is a worldwide shortage of nurses but there is also an increased demand for nurses with enhanced skills who can manage a more diverse, complex and acutely ill patient population than ever before. As a result, a variety of nurses in advanced practice positions has evolved around the world. The differences in nomenclature have led to confusion over the roles, scope of practice and professional boundaries of nurses in an international context. Method: CINAHL, MEDLINE, and the Cochrane database of Systematic Reviews were searched from 1987 to 2008. Information was also obtained through government health and professional organisation websites. All information in the literature regarding current and past status, and nomenclature of advanced practice nursing was considered relevant. Findings: There are many names for Advanced Practice Nurses, and although many of these roles are similar in their function, they can often have different titles. Conclusion: Advanced Practice Nurses are critical for the future, provide cost effective care and are highly regarded by patients/clients. They will be a constant and permanent feature of future health care provision. However, clarification regarding their classification and regulation is necessary in some countries.
Duffield, C.M., Gardner, G. & Catling, C. 2008, 'Nursing work and the use of nursing time', Journal Of Clinical Nursing, vol. 17, no. 24, pp. 3269-3274.
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Aim: To find that changes in models of service delivery together with the dynamic nature of the contemporary health care context have changed the direction and focus of nurses' work. The aim of this paper is to explore some of the drivers for change and their impact and recommend a way forward to optimising nurses' work in the hospital environment. Background: The healthcare workplace has been transformed over the past 20 years in response to economic and service pressures. However, some of these reforms have had undesirable consequences for nurses' work in hospitals and the use of their time and skills. Results: As the pace and complexity of hospital care increases, nursing work is expanding at both ends of the complexity continuum. Nurses often undertake tasks which less qualified staff could do while at the other end of the continuum, are unable to use their high level skills and expertise. This inefficiency in the use of nursing time may also impact negatively on patient outcomes. Conclusions: Nurses' work that does not directly contribute to patient care, engage higher order cognitive skills or provide opportunity for role expansion may decrease retention of well-qualified and highly skilled nurses in the health workforce. Relevance to clinical practice: In this climate of nursing shortages, we need to use nurses in a cost-effective but also, intellectually satisfying manner, to achieve a sustainable nursing workforce.
Catling, C. & Homer, C.S. 2003, 'Ensuring Consumer Consultation in the Provision of Maternity Care at St. George Hospital', Achievements in Nursing, vol. 5, pp. 11-15.
Catling, C. 1994, 'Mothers in Prison', Modern Midwife, vol. 4, no. 6, pp. 26-28.
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Reports

Rumsey, M., Catling, C. & Homer, C. WHO Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2015, Health System Strengthening in PNG: Past, Present and Future Challenges.
Moores, A., Catling, C., West, F., Neill, A., Rumsey, M. & Homer, C. WHO Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2015, What Motivates Midwifery Students to Study Midwifery in Papua New Guinea?.
Catling, C., Johnston, R., Ryan, C., foureur & Homer Interventions for increasing the rates of uptake or success of vaginal birth after caesarean section A Technical Report.