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Biomedical subjects

R Mander

Publications and source records attributed to R Mander.

At least 19 recordsLinked to original sources
PubMed2001

The midwife's ultimate paradox: a UK-based study of the death of a mother.

OBJECTIVE: to identify the meaning of the death of a mother to the midwife providing care for her. DESIGN: a qualitative study in which the fieldwork comprised mainly semistructured telephone interviews. Data were also collected by letters and e-mail correspondence. SETTING: the midwife informants are based in the UK. PARTICIPANTS: because of the sensitive nature of the topic, a volunteer sample of midwives who had 'experienced' the death of a mother was appropriate. Further 'non-experienced' midwives were recruited using a snowball technique. FINDINGS: the midwife's experience of the death of a mother is comparable with that of emergency personnel attending large-scale disasters. It features images intruding, identifying with those involved, encountering death and being unprepared. KEY CONCLUSIONS: the midwife faces a number of psychological challenges following the death of a mother, which justify this event being considered as a disaster. The findings of implications for practice: this study suggests that there may be a need for cultural change among midwives. It is possible that changes in midwifery education and in the midwife's continuing education may facilitate this.

Adaptation, Psychological↗
PubMed1999

The significance of 'hierarchy' in a research project on adoption and adaptation.

In the course of phenomenological research project focusing on the midwife's care of the mother who relinquishes her baby for adoption, hierarchy emerged repeatedly as a significant theme. This concept manifested itself both methodologically as well as thematically. In methodological terms, hierarchy first became apparent during the planning phase in the selection of the research design: at this point it took the form of the distinction between quantitative and qualitative research design. In the course of applying for research access the same attitudes re-emerged in the gatekeepers' responses to the research design which had been chose. Later, during the field work, hierarchy appeared in the course of the interviews, in the form of the unequal balance of power between the interviewer and the informant. Specific tactics were required to overcome the likelihood of hierarchy affecting the data at this stage. Eventually this concept was raised by the informants, who included both relinquishing mothers an midwives, and became a major theme. The informants' use of hierarchy to explain the unselfishness of relinquishment proved to be one of a number of strategies which facilitated coping either with the experience of relinquishment or with caring for a women going through that experience. The conclusion which emerges is that hierarchy features in many aspects of life. While it may be beneficial when applied to certain situations to facilitate coping, in other circumstances it may be less than positive.

Adaptation, Psychological↗
PubMed1998

A reappraisal of Simpson's introduction of chloroform.

OBJECTIVE: To examine the introduction of the use of chloroform in childbirth, assessing the role of Sir James Young Simpson, the various motives for the innovation, and the health and sociological consequences for those involved in childbirth. DESIGN: A review of the attitudes of mothers, midwives, obstetricians and family practitioners, based on contemporary publications and subsequent historical analyses. FINDINGS: The context in which chloroform was introduced was fundamentally important to its widespread acceptance in the UK. The use of this drug carried serious implications for the childbearing woman, as well as the practice and status of those who provided her care. KEY CONCLUSIONS: The implications of the introduction of chloroform in childbirth were short, medium and long term. The changes associated with the acceptance of this drug may bear comparison with those relating to certain, current, pain-control methods.

Analgesia, Obstetrical↗
PubMed1998

Analgesia and anaesthesia in childbirth: obscurantism and obfuscation.

The terms 'analgesia' and 'anaesthesia' have been defined by emphasizing differing aspects of their effects. The distinction between these interventions has not been clarified by their definitions. The historical remedies for pain were similarly unclear. This lack of clarity is apparent in the introduction of chloroform in childbirth, which has much in common with the introduction and effects of epidural analgesia. The reasons for and benefits of this lack of clarity are examined.

Analgesia, Epidural↗
PubMed1997

Choosing the choices in the USA: examples in the maternity area.

The concept of choice has featured prominently in both the recent United Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modelled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.

Analgesia, Epidural↗
PubMed1996

The grieving mother: care in the community?

The assumption is sometimes made that the mother's own home is the most appropriate place for the grieving mother to begin to mourn her loss. For this reason she may be transferred with undue haste. We must ask why this assumption is made and whether the mother participates in the decision to return home. Other's research suggests that the community may not be able to provide the support which the mother needs and may even make excessive demands of her. The midwife's visits to the mother's home provide an important opportunity to care for the mother, although this opportunity may not always be well utilised. Coping strategies, including self-help groups have been recommended.

Female↗
PubMed1995

The relevance of the Dutch system of maternity care to the United Kingdom.

The Dutch system of maternity care is occasionally held up as an example to be emulated by health care providers in the United Kingdom. There are, however, certain differences between maternity care in the two countries which prevent the direct transfer of a system of maternity care from the Netherlands to the UK. The countries are different in terms of their geography and social class distribution. The organizational frameworks within which maternity care is provided demonstrate important differences. The midwives are from a different background, undergo a different preparation and face crucially different working arrangements. There are also certain, largely cultural, differences between mothers in the two countries. Despite these discrepancies, much may be learned by those involved in maternity care in the UK from their Dutch counterparts and the Dutch system of care.

Attitude to Health↗
PubMed1995

Personal computers and process writing: a written language intervention for deaf children.

This study was concerned with the effectiveness of word processing as a written language intervention for primary-age deaf children. Subjects were 14 children in two primary school deaf-unit classes matched in terms of age, gender, and degree of hearing loss. A quasi-experimental design incorporating multiple-group baselines with pre- and post-tests enable all subjects to receive the intervention while maintaining experimental control. Samples of children's written language were collected at the end of each phase in the study. Experienced teachers of deaf children rated five dimensions of the quality of the written language samples, while a speech and language therapist judged other linguistic qualities of the writing. Significant improvements in quality ratings over the course of the study indicated that the word processing intervention had led to improvements in the children's written language skills. These results confirm the effectiveness of word processing as an adjunct to the process writing approach to written language instruction for deaf children.

Child↗
PubMed1992

See how they learn: experience as the basis of practice.

Personal accounts of nurses' and midwives' experiences of health problems feature not infrequently in the nursing press, with different points being made. The contribution of experience to learning is examined in relation to data collected during a study of midwives' care of relinquishing mothers. The extent to which there is a conflict between experiential learning, valued as a component of andragogy, and aspirations to being a research-based profession is examined.

Education, Nursing↗
PubMed1992

The value of clinical experience to a non-clinician: combining midwifery practice with teaching.

This paper explores the value of clinical experience to midwives and other health care providers who work in other than clinical situations. The value of this experience may relate to personal or educational goals. Due to the lack of attention to this topic in the midwifery literature, the author recounts her own experience and compares it with the nursing and health visiting literature. Differing expectations feature as an issue. The value of this arrangement, for teaching, research and personal development more than compensate for the difficulties identified.

Clinical Competence↗
PubMed1992

Seeking approval for research access: the gatekeeper's role in facilitating a study of the care of the relinquishing mother.

While undertaking a study of midwives' care of mothers relinquishing a baby for adoption, the search for permission for access provided valuable insights into the role and functioning of the 'gatekeepers', who included a range of nursing/midwifery personnel and others. The benefits and positive aspects of this process are discussed. The variability of the response to the request for permission for research access gives insight into the gatekeepers' decision-making process. The functioning of research ethics committees is shown to be unpredictable. The gatekeepers' comments are related to the comments made by mothers in an early stage of the study. The way in which the gatekeepers utilize their own individual experience is crucial to their decisions regarding permitting research access. This experience may take the form of personal experience, occupational experience or experience of research.

Adoption↗
PubMed1991

The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease.

The accuracy of clinical diagnosis for pelvic inflammatory disease was determined in 95 women who presented with pelvic pain to primary care physicians and then were referred to gynecologists. Laparoscopy or laparotomy with endometrial biopsy and fimbrial minibiopsy revealed that prevalence of pelvic inflammatory was 46% (44/95) and positive and negative predictive values of gynecologists were 74% (23/31) and 67% (43/64) (p = 0.0002). If histopathologic diagnosis was the standard, clinical accuracies of the gynecologists were no better than chance (p = 0.43), suggesting an expectation bias for visual diagnosis. Laparoscopy had a sensitivity of 50% (12/24) and a specificity of 80% (40/50) for salpingitis if the standard was fimbrial histopathologic diagnosis (p = 0.01). These results support the routine use of laparoscopy, supplemented when negative by endometrial and fimbrial minibiopsy, to accurately diagnose pelvic inflammatory disease.

Cervix Uteri↗