My friend Steve.
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Adaptation, Psychological↗
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Eventually all of us must die.
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Anecdotes as Topic↗
The evaluation of a clinical development unit leadership preparation program by focus group interviews - part 2: negative aspects.
In Western Sydney, Australia, in 1996, the Area Health Service and the University of Western Sydney entered a strategic alliance to develop a nursing research culture in the health services. One of the strategies implemented to achieve this was the establishment of a network of research-receptive environments known as Clinical Development Units (CDUs). In terms of research receptivity, evidence at the time suggested that it could only be developed in units where the leadership style is democratic and participatory. In terms of CDUs, evidence suggested that their successful development depended critically on the effective management of CDU leadership stressors. In light of this, it was agreed to conduct a CDU leadership preparation program in Western Sydney. The program aimed to furnish CDU leaders with the participatory leadership skills required to develop and manage their units. It was expected that the acquisition of such leadership skills would serve to minimize the leadership stessors they could expect to experience. This is the second of two papers which report course evaluation data. The first focused on the more positive evaluation data; this paper focuses on the negative evaluation data and outlines how the current program has been modified in light of these data. In addition, it discusses two themes which emerged during data analysis. These were nurses' apparent mutual lack of trust and their pressing needs to be recognized as valuable and merit-worthy.
Anecdotes as Topic↗
Integrating on campus problem based learning and practice based learning: issues and challenges in using computer mediated communication.
The Faculty of Nursing, University of Newcastle, Australia, has been keen to initiate strategies that enhance student learning and nursing practice. Two strategies are problem based learning (PBL) and clinical practice. The Faculty has maintained a comparatively high proportion of the undergraduate hours in the clinical setting in times when financial constraints suggest that simulations and on campus laboratory experiences may be less expensive.Increasingly, computer based technologies are becoming sufficiently refined to support the exploration of nursing practice in a non-traditional lecture/tutorial environment. In 1998, a group of faculty members proposed that computer mediated instruction would provide an opportunity for partnership between students, academics and clinicians that would promote more positive outcomes for all and maintain the integrity of the PBL approach. This paper discusses the similarities between problem based and practice based learning and presents the findings of an evaluative study of the implementation of a practice based learning model that uses computer mediated communication to promote integration of practice experiences with the broader goals of the undergraduate curriculum.
Anecdotes as Topic↗
Newly qualified Project 2000 staff nurses in Scottish nursing homes: issues for education.
The contribution of nursing homes to nurse education in the UK is growing. This article presents educational issues raised by nine senior Nurse Managers from nursing homes in one Scottish health board. The Managers were interviewed as part of a larger Scottish study of employers' views of the skills of newly qualified Project 2000 staff nurses. Perceptions of the adequacy of the skills of newly qualified diplomates in first staff nurse posts in nursing homes following registration were explored. Impressions were mixed but generally favourable. The perceived strengths - confidence, knowledge and a questioning approach, and perceived limitations - in practical and organisational skills, matched closely those of senior Nurse Managers in the NHS sector. Managers noted the significance for learning of the business and customer care ethos of nursing home care and of the exacting skill requirements of specialist and increasingly acute care demands within this sector. There was uncertainty about and concern to strengthen preceptorship support. Matters for debate include the adequacy of telephone support versus in person on-site support for newly qualified nurses, whether expectations of initial performance are realistic and whether skill requirements differ between independent and NHS sectors. The potential value of NHS and independent health care inter-sectoral dialogue and networking is suggested.
Anecdotes as Topic↗
Postpartum care should provide alternatives to meet parents' need for safety, active participation, and 'bonding'.
OBJECTIVE: To describe new parents' choice of the type of maternity care they wanted to receive, the family suite (FS) or an early discharge (ED), and to gain a better understanding of parents' experiences of different postnatal care alternatives. DESIGN: A qualitative study using semi-structured interviews. The interviews were analysed by content analysis. SETTING AND PARTICIPANTS: Eleven couples and one mother, including both first-time and experienced parents. Six families received care at a FS while the others chose an ED within 24 hours after birth. MEASUREMENTS AND FINDINGS: The postpartum period was experienced as an unpredictable time for new parents, when the need for safety, participation in decision-making, and 'bonding' was felt to be central and decisive to their choice of care. The type of care that the parents felt best met their needs varied according to the mother's assessment of her own and the baby's health status, the parents' requirements and experience and the way in which they, as parents, handled the opportunities and demands of different environments. However, the opportunities for the parents to choose the form of care they considered best for their family were limited. PRACTICAL IMPLICATIONS: To best fulfil parents' wishes and needs in postnatal care alternative care forms are needed. Also, a way to treat the family as a whole on an individual family basis must be found and parents of newborn babies should be allowed to choose the form of care they consider best.
Adult↗
An exploratory metasynthesis of midwifery practice in the United States.
OBJECTIVES: To conduct a metasynthesis of six qualitative studies of midwifery care and process; identify common themes and metaphors among the six studies for further exploration and theory development; and create a framework for further metasynthesis of qualitative studies of midwifery practice in the USA. DESIGN: A qualitative metasynthesis to analyse, synthesise, and interpret six qualitative studies on the process and practice of midwifery care. SAMPLE AND SETTING: Hospital, birth centre, and home birth settings were represented across all of the studies. Participants included nurse- and direct-entry midwives who provided both childbearing and gynaecological care. Recipients of midwifery care also received both childbearing and gynaecological care. FINDINGS: Four overarching themes were identified: the midwife as an 'instrument' of care; the woman as a 'partner' in care; an 'alliance' between the woman and midwife; and the 'environment' of care. These were interpretively and conceptually arrayed into a helix model of midwifery care. KEY CONCLUSIONS: The findings from this exploratory metasynthesis clearly indicate that the practice of midwifery is a dynamic partnership between the midwife and the woman, and reflects an environmental perspective. In a country that has a standard of highly technical childbirth care, perhaps the most outstanding concept of this model is that of the midwife as an 'instrument' of care. The significance of the findings will be determined by their ability to guide further research efforts to support a standard of midwifery care for all women in the USA. IMPLICATIONS FOR PRACTICE: This model offers a benchmark and a structure for considering the dynamic elements of midwifery practice and key roles that the midwife plays in the health care of women and babies.
Anecdotes as Topic↗
Australian women's stories of their baby-feeding decisions in pregnancy.
OBJECTIVE: To describe the baby-feeding decisions of a group of Australian women prior to birth. DESIGN, SETTING AND PARTICIPANTS: A qualitative study using face-to-face in depth interviews was undertaken with 29 women. All interviews were audio-tape recorded and transcribed verbatim. Data were analysed using thematic analysis. FINDINGS: The women observed and sought information from a variety of sources as well as exploring their own understandings of themselves and their breasts. Based on this knowledge the women made their antenatal baby-feeding decisions. These baby-feeding decisions grouped into four thematic groups, 'assuming I'll breast feed'; 'definitely going to breast feed'; 'playing it by ear' and 'definitely going to bottle feed'. Each of these standpoints was associated with, and precipitated a number of behaviours and strategies. IMPLICATIONS: The findings of this research highlight the need for antenatal educators and midwives who provide care in pregnancy to acknowledge a range of experiences and expectations of women and to provide diverse educational opportunities to meet a range of needs. There is a need for further research to identify how midwives can encourage and assist women to explore and challenge their assumptions about breast feeding as they relate to other aspects of their lives.
Adult↗
Partnership in midwifery care in New Zealand.
OBJECTIVE: to examine whether equal power is essential to the perceptions of partnership in midwifery practice and to propose an alternative model of how power might best be shared. DESIGN: a cross-sectional design was employed using the predominant methods of interview, questionnaires and thinking aloud tape recordings as triangulation of data. SETTING: two large metropolitan hospitals in Auckland, New Zealand and home birth settings. SAMPLE: Forty one independent and hospital-based midwives and 37 nulliparous women at low obstetric risk for whom labour care was provided. FINDINGS: the majority of the midwives and the women in the two studies presented believed they had achieved a midwifery partnership with little emphasis placed on the need for equality in decision making. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the model proposed provides a framework that identifies how power can be shared without the need for equality. The integration of this model into practice may assist midwives and women to recognise and utilise differences in their experience and knowledge to achieve their aims of achieving a partnership and a successful birth.
Adult↗
A national survey in England of the routine examination of the newborn baby.
OBJECTIVE: To identify current practices for the initial routine examination of healthy newborn babies, and determine the extent to which midwives are carrying out this examination. DESIGN AND PARTICIPANTS: Postal questionnaires were sent to consultant paediatricians and midwifery managers in all maternity units in England. Questionnaires were also sent to the 12 universities in England which run the N96 post-registration course in the examination of the newborn baby. FINDINGS: Questionnaires were returned from 197 (86%) maternity units. Senior house officers examined in 83% (160/193) a median of 92% of babies; 44% (74/167) had at least one midwife (median of two) with qualifications to carry out the examination and in 31% (51/167) some examinations were conducted by a midwife. However, a third of midwives with this qualification carried out no examinations, and nationally only about 2% of babies were examined by a midwife. Rates of referral by midwives and senior house officers were similar. Examinations were carried out between four and 48 hours from birth; most units considered six hours an acceptable minimum. An estimated 1% of babies were transferred home without routine examination; the GP was responsible for most (83-93%) of these babies' examinations; midwives for 10-23%; and senior house officers in hospital for 4-7%. Twelve per cent (23/194) of units carried out a second examination prior to discharge. Most respondents were in favour of midwives carrying out the examinations provided they were adequately trained. CONCLUSIONS: Many of the consultant paediatricians and midwifery managers stated that suitably trained midwives could routinely examine the healthy newborn baby; however, many currently N96 trained midwives were examining few or no babies. An extension of training would be needed were midwife examination to become general policy.
Anecdotes as Topic↗
Young single women's experiences of pregnancy, adjustment, decision-making and ongoing identity construction.
OBJECTIVE: To explore young pregnant women's experiences of embodiment, ongoing identity construction, decision-making processes and the way in which these are influenced by contemporary discourse, information sources and interaction with health professionals and others. DESIGN: An exploratory descriptive pilot study. Data were collected via diaries kept during pregnancy, two face-to-face, open-ended interviews, one in the second trimester of pregnancy and one six to eight weeks after the birth of the baby, and a brief telephone interview conducted six months post birth. SETTING: A major metropolitan hospital for women in Melbourne, Victoria, Australia, and the community. PARTICIPANTS: Five English speaking participants, aged between 17 and 23 years. FINDINGS: All the young women accepted, even welcomed, the physical changes of pregnancy. Acceptance of pregnancy and an evolving positive sense of identity was assisted by support from families, particularly mothers, access to sympathetic and expert health professionals, exposure to a range of opinions through classes, books and the media, general acceptance from society at large, support from friends, and choices and opportunities in relation to ongoing education and employment.
Adaptation, Psychological↗
Hang on and don't look down!
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Anecdotes as Topic↗
Doing things with illness. The micro politics of the CFS clinic.
This paper focuses on lay and professional ideas about the nature of chronic fatigue syndrome (CFS), and in particular, the ways in which understandings of the disorder are developed in a clinical setting. Our data are drawn from observations of consultations between sufferers and physicians in a UK medical out-patients clinic. We treat the clinic as a political field. That is to say, as an arena in which 'problems' (about the management of illness) are constituted, and alternative approaches and solutions to such problems are pressed. We note that in the realms of symptoms, aetiology and treatment evaluation, lay people in the CFS clinic have quite distinct ideas about what their problems are and how they might be analysed and managed--ideas that are often in conflict with those of medical professionals. Thus, lay sufferers, for example, operate within a different conceptual terrain from that of many professional experts. They are more likely to refer to a disease (myalgic encephalomyelitis or ME), rather than a syndrome. They call upon different kinds of hypotheses to explain their symptoms. They hold to conflicting ideas about the order of causal sequences, and they give emphasis to different kinds of phenomena in their accounts of illness. As a consequence, clinical consultations can often take on the form of a political contest between physician and patient to define the true and real nature of the patient's disorder--a micro political struggle in which neurological symptoms can be re-framed as psychiatric symptoms, and psychiatric symptoms as neurological. In short, a contest in which the demarcation lines between mind and body are continually assessed and re-defined, and the tenets of 'biomedicine' are constantly challenged.
Anecdotes as Topic↗
Can I afford free treatment?: Perceived consequences of health care provider choices among people with tuberculosis in Ho Chi Minh City, Vietnam.
Vietnam has a well-organised National TB Control Programme (NTP) with outstanding treatment results. Excellent prospect of cure is provided free of charge. Still, some people prefer to pay for their TB treatment themselves in private clinics. This is a potential threat to TB control since no notification of cases treated in the private sector occurs, and there is no control of the effectiveness of treatment provided in private clinics. Using a qualitative approach within a grounded theory framework, this study explores health-seeking behaviour among people with TB, applying a specific focus on reasons for choices of private versus pubic health care providers. The study identifies a number of characteristics of private TB care, which both seem attractive to patients and at the same time contrast sharply with the structure of the NTP strategy. These include flexible diagnostic procedures, no administrative procedures to establish eligibility for treatment, flexible choices of drug regimens, non-supervised treatment (no DOT), no tracing of defaulters in the household, no official registration of TB cases and thus less threat to personal integrity. A possibility to demand individualised service through the use of fee-for-service payments directly to physicians also seems attractive to many patients. A number of the components of the NTP strategy that have been put in place in order to secure optimal public health outcomes are lacking in the private sector. A dilemma for TB control is that this seems to be an important reason for why many people with TB opt for private providers where quality of care is virtually uncontrolled. The global threat of TB has led to calls for forceful measures to control TB. However, based on the findings in this study it is argued that the use of rigid approaches to TB control that do not encompass a strong component of responsiveness towards the needs of individuals may be counterproductive for public health.
Anecdotes as Topic↗
Negotiating control and meaning: home birth as a self-constructed choice in Finland.
Each society has its own consensual understanding of birth and its determinants: caregivers, location, participants and loci of decision-making, which in the Western world are based on biomedical knowledge. However, two competing cultural models of childbirth, the biomedical/technocratic model and natural/holistic model, mediate women's choices and preferences for the place and caregiver in childbirth. This article explores the way in which these cultural models of birth and the existing practical possibilities for choices shape women's and men's understanding of home birth. Based on interviews with 21 Finnish women and 12 Finnish men, the reasons for and experiences of planning and building toward a home birth are examined through an analysis of birth narratives. The analysis focuses especially on the women's definitions of what is 'natural' and their relationship with health services where biomedical practices and knowledge are the norm. The analysis shows that the notion of 'natural birth' holds various meanings in Finnish women's narratives namely self-determination, control, and trust in one's intuition. I seek to demonstrate that just as the biomedical management of childbirth exhibits distinct cross-cultural variation, so also does resistance to biomedical hegemony, as such resistance is strongly embedded in the local socio-cultural situation.
Anecdotes as Topic↗
Doctors drifting: autonomy and career uncertainty in young physicians' stories.
In the early 1990s unemployment among physicians was experienced, though transiently, in Finland for the first time. The situation was new both for the entire profession and for professionals, especially for young doctors and medical students who were given pessimistic prospects for the future. In this paper I analyze the life stories told by these young doctors and ask how this period of unemployment and insecurity can be explained and experienced in a way that is compatible with the professional identity of a good, valuable young physician. First, however, I look back to the context of unemployment and the public debate among the medical profession. I point to the collision between what seemed to be the best way for the profession to react and what it could mean for a young doctor actually threatened by unemployment. The results show that it was a question of retaining autonomy and drifting but these words gain different meanings depending on who is defining them.
Anecdotes as Topic↗