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Biomedical subjects

Holly Powell Kennedy

Publications and source records attributed to Holly Powell Kennedy.

15 recordsLinked to original sources
PubMed2005

A study of midlife women's reasons for changing healthcare providers.

PURPOSE: The purpose of this study was to examine the reasons midlife women report for changing healthcare providers and to determine if there were any differences in reasons given for the change based on gender or ethnicity. DATA SOURCES: This was an analysis of data collected from a healthy community-based sample of midlife women as part of a longitudinal 5-year study of changes in health outcomes during transition to menopause. Women were queried about their experience in changing healthcare providers. CONCLUSIONS: Over 42% indicated that they had changed health providers because of dissatisfaction with care. The component accounting for the majority of the variance was related to communication issues. There were no significant differences across ethnic groups in decision to change providers or in reasons for their dissatisfaction with care. However, their reports of experiencing racism in the healthcare system were troubling. IMPLICATIONS FOR PRACTICE: The ability of the provider to communicate with women may have implications in women's choices in health care later in life.

Adult↗
PubMed2004

Enhancing Delphi research: methods and results.

BACKGROUND: The Delphi method provides an opportunity for experts (panelists) to communicate their opinions and knowledge anonymously about a complex problem, to see how their evaluation of the issue aligns with others, and to change their opinions, if desired, after reconsideration of the findings of the group's work. Delphi studies have the potential to provide valuable information, yet few researchers have taken further steps to support or refine their findings. Without this step there is a potential threat to the applicability, or external validity, of the results. AIMS: The purpose of this article is to present an argument for further inquiry to enhance and support Delphi findings, and specific approaches to this will be considered. METHODS: Methods to enhance, expand, or refine Delphi study findings are described. Mixed method design within a Delphi study on midwifery practice is described, and a follow-up narrative study to examine the findings is presented. FINDINGS: Selected results from the follow up narrative study are presented to convey how the narrative data clarified the Delphi findings. Together, the studies provide a more robust depiction of midwifery practice, process, and outcomes. Although there were similarities to the dimensions identified previously, there was a more dynamic focus and explanation of the interaction between the midwife, the woman who had received midwifery care, and the health care system. STUDY LIMITATIONS: Lack of diversity in the sample and the midwives' familiarity with the author's past research represent a potential threat to the findings. Prolonged interviews and multiple narratives were gathered in an effort to control for this. CONCLUSION: Delphi studies are research exercises conducted by a panel of experts. Designing studies to further enhance, clarify, or refine their findings from the context of practice holds promise for their ability to influence clinical care.

Data Collection↗
PubMedDate not supplied

The landscape of caring for women: a narrative study of midwifery practice.

Our purpose was to expand knowledge on the process and outcomes of midwifery care. Narrative analysis was used to interpret stories provided by midwives to illustrate their practice and recipients of midwifery care about their experience. A purposive sample of 14 midwives and four recipients of midwifery care was recruited as a subsample from a prior Delphi study on midwifery practice. Three broad themes were identified: 1) the midwife in relationship with the woman, 2) orchestration of an environment of care, and 3) the outcomes of care, called "life journeys" for the woman and the midwife. The findings are discussed from the perspectives of therapeutic landscapes described in cultural geography and prior research on midwifery practice. The challenge is to confirm the associations between the processes of care identified in these narratives with both short- and long-term outcomes in the health of women and their families. These appear to go well beyond the usual perinatal measures currently used in health care research and hold implications for how care is delivered, measured, and evaluated.

Anecdotes as Topic↗
PubMedDate not supplied

Redesigning prenatal care through CenteringPregnancy.

CenteringPregnancy is a model of group prenatal care that provides more than 20 hours of contact time between the childbearing care provider and a cohort of pregnant women with similar due dates. During this time, each woman has the opportunity to build community with other pregnant women, learn self-care skills, get assurance about the progression of her pregnancy, and gain knowledge about pregnancy, birth, and parenting. Ten essential elements have been defined, which contribute to the success of this model of prenatal care delivery. These elements correspond with the Institute of Medicine's 2001 challenge to improve the quality of health care in the United States. Foundational perspectives provide potential explanations for the model's growing influence and success. Implications for clinical practice and further research to link it with perinatal health outcomes are suggested.

Anecdotes as Topic↗
PubMedDate not supplied

Voices of diversity in midwifery: a qualitative research study.

The practice of midwifery reflects the spectrum of diversity among midwives and the women they serve, yet the composition of midwives in ACNM does not reflect the diversity of the women for whom they provide care. Providing culturally appropriate care for women requires our best understanding of their beliefs, needs, and desires; it also requires a wide range of diverse clinicians. This study proposed to learn more about the practice of midwifery from a diverse sample of midwives. A qualitative research design, which included small group interviews, videotape collection of data, and content analysis, was used. Four major themes were identified: 1) the worldview of midwifery through the lens of diversity, 2) the experience of diversity, 3) midwifery strategies rooted in diversity, and 4) the legacy for the profession of midwifery. There must be purposeful action by every individual in the profession, as well as the collective voice of midwifery, to identify barriers to inclusiveness and to foster a culture of diversity through respect, recruitment, and mentoring.

Adult↗
PubMedDate not supplied

Student perceptions of ideal and actual midwifery practice.

This research was conducted to document midwifery students' observations of ideal midwifery care in different educational and clinical midwifery settings. A survey questionnaire using the 39 processes of exemplary midwifery process identified by Kennedy in 2000 was sent to a group of newly graduated certified nurse-midwives, all members of the American College of Nurse-Midwives. The questionnaire was constructed to permit the respondent to evaluate "ideal" and "actual" midwifery practices. Significant differences between actual observations and ideal perceptions of midwifery practice were found in two of the four clinical settings (birth centers and homebirth) and one type of education program (BA to BSN to CNM). No difference was found between traditional versus distance learning programs. Of most concern was that half of the respondents perceived a lack of congruity on ideal and actual midwifery practices that supported normal birth. The results of this study represent a "theory-practice" gap and should be considered by educators and preceptors in the development of curriculum and clinical experiences.

Attitude of Health Personnel↗
PubMedDate not supplied

A light in the fog: caring for women with postpartum depression.

It is estimated that at least 1 in 10 women will experience postpartum depression, yet systematic screening for it in clinical practice is too often neglected. The foggy unreality of this affective disorder leads women to believe they are losing their minds, and their efforts to find help can be elusive. Women with postpartum depression who go undetected and untreated are at risk for immediate harm and potential lifelong sequelae for themselves and their families, and especially for their children. This article provides 1) an understanding of the woman's experience of postpartum depression, 2) a review of two instruments, developed through a focused program of research to screen for the disorder, 3) triage in clinical practice, and 4) an overview of the three dimensions of treatment: psychopharmacology, psychotherapy, and psychosocial care. Practical guidance and client information are provided to assist midwives and primary care providers to incorporate systematic screening into clinical practice, to identify effective interdisciplinary treatment teams, and to muster family and community resources to help with this commonly hidden childbearing crisis.

Child↗
PubMedDate not supplied

Conducting international research in midwifery: a workshop held at the ICM Congress, Vienna, April 2002.

A workshop on international research in midwifery was held at the International Confederation of Midwives (ICM) Triennial Congress in Vienna, April 2002. Thirty-five participants from 12 countries took part. The participants themselves defined the agenda, and subsequent discussion addressed the following issues: international research relationships and collaboration; ethical conduct in international research in midwifery; the role of the International Confederation of Midwives in international research; and identifying topics for an international midwifery research agenda. Recommendations arising from this workshop were as follows: develop guidelines and a code of ethics for the conduct of international research in midwifery; continue to actively support research and further develop that support; support education and capacity building for research at basic and continuing education levels; and update on a regular basis the priorities identified for collaborative international studies.

Austria↗
PubMedDate not supplied

A concept analysis of optimality in perinatal health.

This analysis was conducted to describe the concept of optimality and its appropriateness for perinatal health care. The concept was identified in 24 scientific disciplines. Across all disciplines, the universal definition of optimality is the robust, efficient, and cost-effective achievement of best possible outcomes within a rule-governed framework. Optimality, specifically defined for perinatal health care, is the maximal perinatal outcome with minimal intervention placed against the context of the woman's social, medical, and obstetric history.

Benchmarking↗
PubMedDate not supplied

Linking obstetric and midwifery practice with optimal outcomes.

OBJECTIVE: To compare midwifery and medical care practices and measure optimal perinatal outcomes using a new clinimetric instrument. DESIGN: Prospective descriptive cohort design. SETTING: A large, inner city obstetric service with medical and midwifery services. PARTICIPANTS: Three hundred seventy-five of 400 consecutively enrolled patients were participated (25 excluded due to extreme risk status or missing data); 92% were of minority race/ethnicity and 54% had less than a high school education. Of the 375 patients, 179 received physician care and 196 received nurse-midwife care. MAIN OUTCOME MEASURES: The Optimality Index-US was measured. Health record data were extracted and scored using the Optimality Index-US to summarize the optimality of processes and outcomes of care as well as the woman's preexisting health status. RESULTS: Midwifery patients had more optimal care processes (less use of technology and intervention) with no difference in neonatal outcomes, even when preexisting risk was taken into account. CONCLUSION: Even among moderate-risk patients, the midwifery model of care with its limited use of interventions can produce outcomes equivalent to or better than those of the biomedical model.

Adolescent↗
PubMedDate not supplied

Keeping birth normal: research findings on midwifery care during childbirth.

OBJECTIVE: This study describes processes and outcomes of midwifery care through narratives told by exemplary midwives. DESIGN: Narrative analysis. SETTING: Midwifery practices in hospital, birth center, and home settings. PARTICIPANTS: Purposive sample of 14 midwives drawn from a large national Delphi panel on exemplary midwifery practice. DATA ANALYSIS: Systematic analysis of interview data was conducted until interpretive consensus was achieved across all text and codes. Results were compared with two prior qualitative studies conducted by the first author on midwifery practice for congruence and emergence of new findings. RESULTS: The support of normalcy was identified as a significant process of midwifery care during labor and birth. CONCLUSIONS: The midwives believed that birth is normal, and many of their actions were specifically aimed toward the support of it as a physiologic, rather than pathologic, process. Through their words, we see subtle care processes focused on meeting a woman's individual needs and tapping into her personal strength. Implications for practice and further research to link their approach to caring for women with perinatal outcomes are reviewed.

Adult↗
PubMedDate not supplied

Sleep-wake cycles, social rhythms, and sleeping arrangement during Japanese childbearing family transition.

OBJECTIVE: To examine how sleep-wake cycles and social rhythms of Japanese parents are related to their sleeping arrangements before and after the birth of their first child. DESIGN: Prospective longitudinal, time-series methods. SETTING: Participants' homes in four geographical areas of Japan. PARTICIPANTS: Convenience sample of 101 Japanese first-time parent couples who completed antepartum and postpartum questionnaires. MAIN OUTCOME MEASURES: 24-hr sleep-wake rhythm from 7-day logs at 32 to 36 weeks gestation and 4 to 5 weeks postpartum and daily social rhythm from Monk's Social Rhythm Metric. RESULTS: Mothers' total sleep time and activity level decreased after birth. Social rhythms became less regular for mothers and more consistent and regular for fathers. Although sleeping arrangement had no effect on parents' daily social rhythms, it had a significant effect on the 24-hr sleep-wake rhythm. Regularity of sleep-wake rhythms was more prominent for fathers sleeping with mother and baby than for fathers sleeping alone. CONCLUSIONS: Couples having their first child face great changes in their sleep-wake cycles and social rhythms. Nurses can counsel expectant parents to think about their sleeping habits and social activities and assist them in making informed decisions about the best sleeping arrangement during transition to parenthood.

Adaptation, Psychological↗