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Biomedical subjects

Bernie Carter

Publications and source records attributed to Bernie Carter.

At least 19 recordsLinked to original sources
PubMed2006

Feeding by numbers: an ethnographic study of how breastfeeding women understand their babies' weight charts.

BACKGROUND: Weighing breastfed babies has been the subject of some controversy as the previous international growth chart was largely based on data from infants fed infant formula. The concern that professionals may be misled by the charts into suggesting to mothers that they supplement unnecessarily was a major impetus for the World Health Organization's investment in a new growth chart. Evidence of interpretation in practice has been scant. METHODS: An ethnographic study was conducted in a town in the Northwest of England to investigate this issue. In the first phase, women and health visitors were observed in the well-child clinic during clinic sessions and breastfeeding group meetings. In the second phase, longitudinal interviews with 14 women were conducted. Each woman was interviewed up to three times in the first six months after the birth of her baby, with a total of 35 interviews. RESULTS: Mothers and health visitors focussed on weight gain with frequent weighing and attention to even minor fluctuations of the plotted line being evident. Women felt it important to ensure their baby's weight followed a centile, and preferred for this to be the fiftieth centile. Interventions included giving infant formula and solids as well as changing what the mother ate and drank. Women also described how they worried about their baby's weight. Little effective support by health professionals with breastfeeding technique was observed. CONCLUSION: Babies were weighed more often than officially recommended, with weighing and plotting being at the core of each clinic visit. The plotted weight chart exerted a powerful influence on both women's and health visitors' understanding of the adequacy of breastfeeding. They appeared to rate the regular progression of weight gains along the chart centiles more highly than continued or exclusive breastfeeding. Thus weighing and visual charting of weight constituted a form of surveillance under the medical gaze, with mothers actively participating in self monitoring of their babies. Interventions, by mothers and health visitors, were targeted towards increasing weight gain rather than improving breastfeeding effectiveness. Improvements in training are needed for health visitors in weighing techniques, assessing growth patterns--particularly of breastfed babies--and in giving information to women, if the practice of routine weight monitoring is to support rather than undermine breastfeeding.

Journal Article↗
PubMed2006

Appreciating what works: discovering and dreaming alongside people developing resilient services for young people requiring mental health services.

Within this paper we report on a study undertaken to identify resilient services for young people requiring mental health services in the United Kingdom. Whilst undertaking the study we faced issues related to determining what constitutes mental health services, and issues related to different disciplinary perspectives and discourses. These were set within an environment that was changing rapidly as new ways of working were being implemented. Data were collected via interviews and surveys. Nearly every participant felt that young people were not served well. However, the study focused on things that were working well and were being achieved.

Adolescent↗
PubMed2006

Weight monitoring of breastfed babies in the United Kingdom--interpreting, explaining and intervening.

Weighing infants in their first 6 months is an important aspect of growth monitoring and a common activity of child health care services worldwide. During the same 6 months, support for establishing breastfeeding and the promotion of continued exclusive breastfeeding are important activities of health professionals. Parents and health professionals may perceive conflicts between achieving both robust growth and continuing breastfeeding. In this narrative review, the literature on weighing breastfed babies in the United Kingdom is examined. A companion paper examined issues of growth charts, scales and weighing frequency and accuracy. This paper considers issues of interpretation of the plotted weight values for individual breastfed babies, noting the complexities of growth patterns, which may lead to difficulties of accurate identification of those individuals whose growth merits further investigation. Little attention has been given to issues of explaining the interpreted growth curves to parents and this issue is explored and noted as of importance for further study. Research evidence on choosing appropriate interventions to improve the growth of breastfed babies is reviewed. The paucity of such evidence leads to suggestions for future study. This review gathers together a wide range of literature from many different perspectives, with the hope of informing weight monitoring practice so that this can both identify infants whose weight may be of concern, and who may need appropriate intervention, and support continued breastfeeding.

Body Weight↗
PubMed2006

Chronic pain in children and adolescents.

Chronic pain is a widespread and significant clinical problem. It can result in major negative short- and long-term physical and emotional effects in multiple domains of children's and their families' lives as Pain Associated Disability Syndrome. Assessment of chronic pain is challenging but it is an essential clinical task. Management requires a multidimensional response focussing on the whole patient. Specialist pain management units and programmes use cognitive behavioural methods and promote adaptive coping and focus on the child re-engaging with normal activities. While chronic pain is not well understood, there is emerging evidence that young people and their parents can recover from chronic disability, dependency and distress, and return to a normal life.

Adaptation, Psychological↗
PubMed2005

Weight monitoring of breastfed babies in the UK - centile charts, scales and weighing frequency.

Weighing infants during their first 6 months is an important focus of growth monitoring and a common activity of child health care services worldwide. In these same months, health workers provide support for breastfeeding and promote continued exclusive breastfeeding. The literature on the practice of weighing breastfed babies is reviewed, as it applies to the United Kingdom. The shape of the growth curves for breastfed babies differs from that of formula-fed infants and also from centile charts previously in use. The World Health Organization commitment to the production of a new growth reference has generated discussion of the implications of charts in use. The country-specific charts in use in the UK are examined and the data used to construct them discussed with reference to clinical use for breastfed infants. Recent UK discussions on charts, as well as on the frequency of routine weighing for babies in the community are considered, and the available evidence on the accuracy of weighing in practice is noted. The choices made in constructing different charts; the physical condition of scales and their use in practice have implications for plotted growth. This paper aims to present a wide range of evidence available in this area in order to encourage debate on practice. A companion paper will discuss issues of interpretation, conveying information to parents, and interventions.

Anthropometry↗
PubMed2004

Pain narratives and narrative practitioners: a way of working 'in-relation' with children experiencing pain.

Children's narratives about their pain are often drowned out by the more pervasive, scientific, dominant, academic and professional discourses. The ideas I propose in this paper are drawn from narrative inquiry and from the narrative medicine movement to illustrate how a narrative approach can positively influence nursing (and other) practice. Sharing children's narratives of pain allows to be 'in-relation' with children and their experiences of pain, requiring practitioners to be less distanced and passive. In order to start and to understand their pain we need to be prepared to be hurt by it. Attending to children's stories helps them to articulate their experiences and gives them voice and agency. A narrative approach to practice can help us to be more the sort of professionals we wanted to be, i.e. more generous, more affective, more remembered and more effective. By helping to 'fix' children's broken stories we can help them move towards stories of healing.

Adaptation, Psychological↗
PubMed2004

Evaluating student paediatric advanced nurse practitioners' experiences of a paediatric pharmacology module: in the context of reflective learning.

An evaluation of the first paediatric pharmacology module at Master's level was undertaken. The broad aims were: to ascertain whether the participants had achieved the modular learning outcomes; how their pharmacological knowledge base had altered as a result of the module; and whether their professional practice had been influenced subsequent to undertaking the module. The findings of the 12 participants who registered on the module are reported. Three tools were utilized to generate the data for this broadly qualitative study. The findings indicated that reflective thinking at the evaluative level enabled the participants to monitor their professional and personal performance and that their critical thinking skills and confidence had increased. The questionnaire survey had some limitations, but was seen as the only feasible method of achieving a representation as to whether the module had subsequently influenced the professional practice of the participants. The data presented convincing evidence of the relevance of study of a paediatric pharmacology module at Master's level for the professional and personal development of practitioners.

Child↗
PubMed2003

Methodological issues and complementary therapies: researching intangibles?

The increasing drive to adopt evidence-based practice within the mainstream health service creates a sense of urgency for high quality, rigorous research to support CAM. The RCT is seen as the gold standard for allopathic research. However, the tenets of the RCT cannot simply be just picked up and applied to CAM research. Critics of the RCT propose that it fractures and fragments the essence of many complementary therapies. Challenges including standardisation, blinding, randomisation, practitioner influence, placebos, and controls are explored and some possible solutions are presented. CAM researchers need to be creative so that they capture some of the intangibles that currently slip through the reductionist net of the RCT.

Complementary Therapies↗