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Denis Walsh

Publications and source records attributed to Denis Walsh.

6 recordsLinked to original sources
PubMed2005

Appraising the quality of qualitative research.

In the process of undertaking a meta-synthesis of qualitative studies of free-standing midwife-led units, the authors of this paper encountered a number of methodologically and epistemologically unresolved issues. One of these related to the assessment of the quality of qualitative research. In an iterative approach to scoping this issue, we identified eight existing checklists and summary frameworks. Some of these publications were opinion based, and some involved a synthesis of pre-existing frameworks. None of them provide a clear map of the criteria used in all their reviewed papers, and of the commonalities and differences between them. We critically review these frameworks and conclude that, although they are epistemologically and theoretically dense, they are excessively detailed for most uses. In order to reach a workable solution to the problem of the quality assessment of qualitative research, the findings from these frameworks and checklists were mapped together. Using a technique we have termed a 'redundancy approach' to eliminate non-essential criteria, we developed our own summary framework. The final synthesis was achieved through reflexive debate and discussion. Aspects of this discussion are detailed here. The synthesis is clearly rooted in a subjectivist epistemology, which views knowledge as constructed and hermeneutic in intent, encompassing individual, cultural and structural representations of reality.

Humans↗
PubMed2005

Subverting the assembly-line: childbirth in a free-standing birth centre.

Across the world, concern is being expressed about the rising rates of birth interventions. As a result, there is growing interest in alternative organisational models of maternity care. Most of the research to date on these models has examined clinical outcomes. This paper, discussing key findings from an ethnographic study of a free-standing birth centre in the UK, explores organisational dimensions to care. It suggests that the advantages of scale have been under-recognised by policy makers to date. The birth centre displays organisational characteristics that contrast with the dominant Fordist/Taylorist model of large maternity units. These characteristics allow for greater temporal flexibility in labour care and tend to privilege relational, 'being' care over task-orientated, 'doing' care. In addition, features of a bureaucracy are much less in evidence, enabling entrepreneurial activity to flourish. There may be lessons here for other heath services as well as maternity services in optimising the advantages of small-scale provision.

Anthropology, Cultural↗
PubMed2005

Meta-synthesis method for qualitative research: a literature review.

AIM: This paper discusses the purpose and stages of meta-synthesis and the epistemological status of knowledge generated from the technique. Particular attention is paid to exploring the contested areas of the method that remain. BACKGROUND: There is a growing interest in meta-synthesis as a technique for generating new insights and understanding from qualitative health care research. An increasing number of meta-synthesis papers are appearing in the nursing and midwifery literature. METHODS: Literature on the technique of meta-synthesis and examples of meta-synthesis papers were searched and reviewed. A meta-synthesis exercise was undertaken, and this informed reflection and critique of the method. FINDINGS: Meta-synthesis attempts to integrate results from a number of different but inter-related qualitative studies. The technique has an interpretive, rather than aggregating, intent, in contrast to meta-analysis of quantitative studies. Examples from the literature indicate that some aspects of the technique are not yet fully established. CONCLUSION: Despite the contingent nature of evidence gleaned from meta-synthesis and current lack of consensus about some of its aspects, meta-synthesis is an important technique for qualitative researchers and can deepen understanding of the contextual dimensions of health care.

Data Interpretation, Statistical↗
PubMed2004

Outcomes of free-standing, midwife-led birth centers: a structured review.

BACKGROUND: Over the last two decades, childbirth worldwide has been increasingly concentrated in large centralized hospitals, with a parallel trend toward more birth interventions. At the same time in several countries, interest in midwife-led care and free-standing birth centers has steadily increased. The objective of this review is to establish the current evidence base for free-standing, midwife-led birth centers. METHODS: A structured review, based on Cochrane guidelines, was conducted that included nonrandomized studies. The comparative outcomes measured were rates of normal vaginal birth; cesarean section; intact perineum; episiotomy; transfers; and babies remaining with their mothers. RESULTS: Of the 5 controlled studies that met the review criteria, all except one was a single site study. Since no study was randomized, meta-analysis was not performed. The included studies all raised quality concerns, and significant heterogeneity was observed among them. For the outcomes measured, every study reported a benefit for women intending to give birth in the free-standing, midwife-led unit. CONCLUSIONS: The benefits shown for women recruited into the included studies who intended to give birth in a free-standing, midwife-led unit suggest a question about the efficacy of consultant unit care for low-risk women. However, the findings cannot be generalized beyond the individual studies. Good quality controlled studies are needed to investigate these issues in the future.

Birthing Centers↗