BackgroundSince 2000, the United Nations’ Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa.MethodsThis review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms ‘obstetric care’, ‘access’, ‘barriers’, ‘developing countries’ and ‘sub-Saharan Africa’ were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies.ResultsOne hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women’s self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users’ residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships.ConclusionDespite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women.Systematic review registrationPROSPERO 2014 CRD42014015549 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0503-x) contains supplementary material, which is available to authorized users.

There is a need for mental health literacy interventions targeted at students, particularly those who are younger, male, born outside Australia and of a lower level of education. As rates of specific help-seeking intentions for students were relatively low, there is a need for further exploration of the barriers to help seeking from professional sources.

The epistemological underpinnings of grounded theory make it valuable in the study of nursing, which is premised on an interpersonal process between nurses and clients. Further, it is a useful style of research when there is little prior information about a topic. In this article (Part 1), Terence McCann and Eileen Clark outline the key features of this methodology. In the follow-up article (Part 2, McCann and Clark 2003a), a critique is provided of grounded theory and the two main approaches to this methodology. In the final article in the series (Part 3, McCann and Clark 2003b), the authors illustrate how grounded theory can be applied to nursing research with examples from McCann's Australian study (McCann and Baker 2001) of how community mental health nurses promote wellness with clients who are experiencing an early episode of psychotic illness key words grounded theory epistemology constant comparative analysis coding core category ▲ ▲ ▲ ▲

Becoming a carer is associated with physical, emotional, and financial hardship, with caregivers often experiencing a maelstrom of emotions as they struggle to understand what has happened to their loved one. While the burden of caring for young people with first-episode psychosis (FEP) has been well documented, much less is known about how carers develop the strength and resilience to continue caring. This qualitative study aimed to understand the experience of 20 first-time primary caregivers of young adults with FEP. Most caregivers were female (85%, n 5 17) and parents (85%, n 5 17). The average length of involvement as a caregiver at an FEP service was 14.5 months. Six main themes were identified in the data, highlighting the carers' experience in supporting young adults with FEP. Caregiving is a burdensome responsibility and is characterized as a roller coaster and unpredictable experience. Caregivers often feel responsible for the young person's illness; however, eventually most come to terms with the changes that have occurred in the young person with FEP. As a consequence of the illness, the relationship between caregiver and care recipient frequently becomes closer and deeper, although it is important that they both maintain hope for the future. These findings provide important insights into the experiences of first-time caregivers of young people with FEP, with direct implications for improving the information and support given to caregivers by FEP services, as well as the development of interventions that effectively address the unique challenges caregivers face following the onset of FEP.Key words: experience/first-episode psychosis/hope/ interpretative phenomenological analysis/primary caregivers/qualitative Background

s u m m a r yThis paper presents the findings of a survey which explored the career preferences of Australian Bachelor of Nursing students for certain clinical specialities. A convenience sample was recruited, with data collected three times between 2005 and 2007. With first-year students, acute care nursing of the adult and child and midwifery were the most popular career choices, whereas considerably less were interested in mental health or aged care nursing, and nearly two-fifths were undecided. By third-year, there was a shift in career preferences, with acute care of the adult and mental health being the most popular choices. In contrast, midwifery and aged care were the least preferred careers. The study provides some evidence students commence their course with a predominantly lay-informed image of nursing, but this may be tempered by favourable curricular influences towards the mental health field. However, the curriculum discourages students from pursuing a career in aged care and midwifery.