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Soo Downe

Publications and source records attributed to Soo Downe.

11 recordsLinked to original sources
PubMed2007

Expert intrapartum maternity care: a meta-synthesis.

AIM: This paper reports a meta-synthesis exploring the accounts of intrapartum midwifery skills, practices, beliefs and philosophies given by practitioners working in the field of intrapartum maternity care who are termed expert, exemplary, excellent or experienced. BACKGROUND: Expertise in nursing and medicine has been widely debated and researched. However, there appear to be few studies of practitioners' accounts of expertise in the context of maternity care. Given current international debates on the need to promote safe motherhood, and, simultaneously, on the need to reverse rising rates of routine intrapartum intervention, an examination of the nature of maternity care expertise is timely. METHOD: A systematic review and meta-synthesis were undertaken. Twelve databases and 50 relevant health and social science journals were searched by hand or electronically for papers published in English between 1970 and June 2006, using predefined search terms, inclusion, exclusion and quality criteria. FINDINGS: Seven papers met the criteria for this review. Five of these included qualified and licensed midwives, and two included labour ward nurses. Five studies were undertaken in the USA and two in Sweden. The quality of the included studies was good. Ten themes were identified by consensus. After discussion, three intersecting concepts were identified. These were: wisdom, skilled practice and enacted vocation. CONCLUSION: The derived concepts provide a possible first step in developing a theory of expert intrapartum non-physician maternity care. They may also offer more general insights into aspects of clinical expertise across healthcare groups. Maternity systems that limit the capacity of expert practitioners to perform within the domains identified may not deliver optimal care. If further empirical studies verify that the identified domains maximize effective intrapartum maternity care, education and maternity care systems will need to be designed to accommodate them.

Adult↗
PubMed2006

A systematic review of the nature of support for breast-feeding adolescent mothers.

OBJECTIVE: to review the evidence on the nature of support for breast-feeding adolescent mothers. METHODS: a systematic review of relevant English-language papers was conducted using an a-priori search strategy. Agreement on final inclusion was reached by consensus across the team. The findings were tabulated and described narratively and thematically. FINDINGS: of 209 studies identified, seven fitted the inclusion criteria. The papers included in this review varied in design, quality and focus. Five types of support were identified: emotional, esteem, instrumental, informational and network. The participants in the included studies seemed to find the emotional, esteem and network components of support most helpful. Support from the participants' mothers seemed to be particularly powerful. The provision of continuity of support from an expert individual who is skilled in both lactation support and working with adolescents was also highly valued by breast-feeding adolescents. There was also evidence to suggest that targeted breast-feeding educational programmes, specifically designed for the adolescent learner, may be successful in improving breast-feeding initiation and continuation rates in this population. However, a question still arises about which elements of the complex package on offer were most effective. CONCLUSION: the studies included in the review are diverse. Although the support provided by known and trusted individuals emerges as important to the adolescents, further research is required on the specific nature of that support and the person best placed to provide it. The acceptability and feasibility of other aspects of support and modes of provision also requires additional exploration. Further qualitative and feasibility studies are therefore warranted in order to inform future randomised-controlled interventions trials.

Adolescent↗
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

'She would help me from the heart': an ethnography of Egyptian women in labour.

This article reports an ethnographic study of the intrapartum care of women who were expecting normal births in an Egyptian hospital. The study involved observations of labouring women, and interviews with them shortly after they had given birth. The data were synthesised into three themes: the epistemology of hospital care, characterised by 'technical touch'; women's experience of hospital childbirth, which was contrasted unfavourably with home birth experiences; and women's epistemology of birth, which was characterised by 'helping from the heart'. This latter concept expresses the participants' preferred way of doing birth. We describe the impact of the paradigm clash experienced by these women, and propose an approach to the provision of childbirth care in Egypt and beyond which combines the clinical safety of evidence based and experientially developed technical skills with the emotional safety of trusting, respectful, loving relationships. We have termed this 'skilled help from the heart'.

Adult↗
PubMed2005

Skin care in the well term newborn: two systematic reviews.

BACKGROUND: Awareness is increasing that the use of some commercial products on the premature neonatal skin may be beneficial, whereas the use of others may be harmful. The World Health Organization developed general postnatal care guidelines and the Association of Women's Health, Obstetric and Neonatal Nurses published specific evidence-based guidance relating to neonatal skin care. No systematic reviews on the topic have focused on the term newborn. The objective of this review was to determine, for the well term baby, if the use of soaps or detergents in bath water is associated with the development of dry, cracked, or flaking skin in the perinatal period, and short- and long-term consequences of the use of emollients, lotions, or moisturizers for dry skin. METHODS: We conducted a structured systematic review of prospective studies involving term newborns. RESULTS: No relevant studies were located. CONCLUSIONS: No prospective studies of research in skin care involving the term newborn were found. Some recommendations for skin care may balance risk and benefit for the compromised infant, but this balance may be different for the healthy term newborn. Clinical practitioners should be aware that outcomes related to the use of soaps, detergents, emollients, and lotions on the term neonatal skin have not been formally investigated. Systematic reviews that yield no formal results provide insights into unresearched areas of practice, and should be reported to highlight these deficits, and to avoid duplication of effort by future investigators.

Baths↗
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

A prospective randomised trial on the effect of position in the passive second stage of labour on birth outcome in nulliparous women using epidural analgesia.

OBJECTIVE: To determine whether the rate of instrumental birth in nulliparous women using epidural analgesia is affected by maternal position in the passive second stage of labour. DESIGN: A pragmatic prospective randomised trial. SETTING: Consultant maternity unit in the Midlands. PARTICIPANTS: One hundred and seven nulliparous women using epidural analgesia and reaching the second stage of labour with no contraindications to spontaneous birth. INTERVENTIONS: The lateral versus the supported sitting position during the passive second stage of labour. MEASUREMENTS: Mode of birth, incidence of episiotomy, and perineal suturing. FINDINGS: Recruitment was lower than anticipated (107 vs. 220 planned). Lateral position was associated with lower rates of instrumental birth rate (lateral group 33%; sitting group 52%; p=0.05, RR 0.64, CI for RR: 0.40-1.01; Number-needed-to-treat (NNT)=5), of episiotomy (45% vs. 64%; p=0.05, RR 0.66, CI for RR: 0.44-1.00, NNT=5), and of perineal suturing (78% vs. 86%; p=0.243, RR 0.75, CI for RR 0.47-1.17). The odds ratio for instrumental birth in the sitting group was 2.2 (CI 1.00-4.6). Logistic regression of potential confounder variables was undertaken, due to a large variation in maternal weight between the randomised groups. Of the nine possible confounders tested, only position of the baby's head at full dilation affected the risk of instrumental birth significantly (p=0.4, OR 2.7 where the fetal head was in the lateral or posterior position). Maternal weight did not appear to have any effect. The odds ratio for instrumental delivery for women randomised to the sitting position was slightly higher within the logistic regression model (adjusted OR 2.3). KEY CONCLUSIONS: Women randomised to the lateral position had a better chance of a spontaneous vaginal birth than those randomised to the supported sitting position. Position of the babies head at full dilation had an additional effect on mode of birth. These effects are not conclusively generalizable. RECOMMENDATIONS FOR PRACTICE: The lateral position is likely to be at best beneficial, and at the worst no less harmful than the sitting position for most women and their babies who meet the criteria set for this study. Conclusive evidence for or against the technique should be established using larger trials.

Adult↗
PubMedDate not supplied

Midwives and the fetal nuchal cord: a survey of practices and perceptions.

A systematic search of studies of intrapartum management of the nuchal umbilical cord at term found no published controlled studies in this area. A postal survey containing both structured and open questions and a request for local protocols and guidelines was sent to all 637 midwives in 7 maternity units in England. There were 401 (63%) responses. There appeared to be no unit guidelines for this area of practice. Midwife approaches to nuchal cord during birth varied, and included clamping and cutting of loose nuchal cords and a hands-off approach to tight nuchal cords. Reasons for specific actions included doing what had been taught during midwifery training and learning from previous personal experiences. Theories of diffusion of innovation and of planned behaviour may provide a conceptual basis for understanding the adoption of specific practices. Future qualitative and controlled studies are needed to explore the nature and consequences of varying approaches to intrapartum nuchal cord management.

Clinical Competence↗