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The private adolescent: privacy needs of adolescents in hospitals.
This report is based on an interpretative study that explored the meaning of space to adolescents in the hospital environment. Through designing their own adolescent ward and discussing their designs in an interview, participants articulated their spatial needs in the ward environment. This paper addresses the private space issues of the adolescent patient in the ward environment. Issues that are discussed include the use of the telephone, the bathroom, and the bedroom, and additional facilities needed to enhance privacy in the ward.
Epilepsy, the mother and the child: a personal perspective.
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Seizure--into the new millennium.
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Informed consent in complementary and alternative medicine: current status and future needs.
"Informed consent" is an action. It is a process that fulfills the pretreatment ethical obligations of provider to patient. Through the process, the provider discloses meaningful and realistic facts about positive and negative expectations concerning the proposed intervention and addresses concerns that are pertinent to the patient. Disclosure is of facts that are known or realistically expected to be known by a qualified provider regardless of background or product genus. The disclosure obligation does not vary with the background of the provider or the label given to the therapy. MD, nurse, naturapath, chiropractor, and licensed and unlicensed practitioner have the responsibility to provide quality information about the therapeutic worth of the intervention based on reliable data. This obligation pertains whether the intervention is standard, experimental, investigational, natural, alternative, complementary, or unproven. Misrepresentation of material facts voids consent and triggers legal liability. Today, the oncology community meets the informed consent obligation through a stepwise process that produces standards of care and builds studies and data collection to produce reliable outcome information on patient benefit. These data enrich the ability of a patient to consider and provide informed consent to treatment. In contrast, although there are some ongoing studies of complementary and alternative (CAM) therapies, there does not appear to be a groundswell of support for these activities within the CAM community. The development of standards of care and reliable information about CAM therapies appears to be seriously lagging and a disservice to obligations toward informed participation and consent by the patients seeking CAM interventions.
Clients' experiences of frozen shoulder and its treatment with Bowen technique.
Bowen technique (BT) is a therapy that uses a light, non-invasive pressure applied to specific and prescribed locations throughout the body to trigger the body's own self-healing powers. Frozen shoulder is a painful condition associated with a reduced range of motion in the affected shoulder that is often resistant to conventional treatment. Within this paper, the qualitative findings from a larger study are presented and 20 participants' experiences of BT, their comparisons with other interventions, and their satisfaction with the therapy are explored. Overwhelmingly, BT was experienced as being gentle, relaxing and noninvasive and of help with significantly eliminating and improving the symptoms associated with frozen shoulder.
Midwife-led maternity services and consumer 'choice' in an Australian metropolitan region.
OBJECTIVE: Identify the factors determining women's support for midwife-led maternity care in an Australian metropolitan region, and identify the implications for the role of midwives and for the expansion of options for childbearing women. DESIGN: A two-stage research design was utilised. In the first stage a sample of women were surveyed regarding their choice of maternity service provider and site of provision of maternity services. In the second stage, in-depth interviews were used to collect the birthing narratives of a sample of 50 women involved in the first stage of the research. SETTING: A metropolitan region of Adelaide, South Australia. PARTICIPANTS: Women who had given birth to a live baby in the 1991 calendar year, who lived within a designated region and who gave birth at one of four hospitals in or near the region. In the first stage of the study, 519 women returned surveys, giving a response rate of 61.7%. Sixty-four per cent of these women expressed an interest in being involved in further research, and fifty of these were randomly selected for interview. FINDINGS: Despite recent calls in Australia to increase the choices available to childbearing women, these choices are limited by, amongst other things, insufficient information about midwife-led maternity services. The work of midwives remains silenced and invisible to many women pregnant for the first time, who have little idea about what midwives can do. This research shows that women's main source of information about midwife care is developed through the actual experience of it, particularly in giving birth. This experience leads to an extremely positive recognition and appraisal of the work of midwives, such that the majority of women indicate that they would be happy with midwife care for subsequent births. First-time mothers are significantly disadvantaged in terms of choices available to them because of this lack of information about midwife-led maternity care. IMPLICATIONS: In the interests of providing childbearing women with real choices for maternity care, strategic interventions to better publicise the role of midwives and of midwife-led services are needed.
Why some women do not breast feed: bottle feeding and fathers' role.
OBJECTIVE: To explore women's experiences and perceptions of baby feeding and to explore the explanations offered by women who choose to either breast or bottle feed. DESIGN: A qualitative study, which was prospective in design. Participants were interviewed three times: the first stage was between six and 14 weeks of pregnancy; the second stage was between 34 and 39 weeks; and the third stage was between six and 14 weeks after childbirth. PARTICIPANTS: 19 participants were recruited to the study group via 12 antenatal clinics in Coventry, UK. FINDINGS AND DISCUSSION: The data indicate that participants make baby-feeding decisions either prior to conception or early in the pregnancy. Findings also indicate that both breast and bottle feeders possessed knowledge of the benefits of breast feeding, but this did not seem to influence decision making. One of the most significant factors influencing the decision to bottle feed appears to be a desire for paternal involvement. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: To increase the incidence of breast feeding, health-care professionals should consider the need for preconceptual health promotion. The role of paternal involvement in baby-feeding decisions also needs to be acknowledged and men need to be included in breast-feeding promotion campaigns.
'Giving midwifery care: student midwives' views of their working role.
OBJECTIVE: to explore the opinions, feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences. DESIGN: using quantitative and qualitative methods. A phenomenological approach was used to guide the qualitative section of the study reported here. SETTING: all seven midwifery schools in Southern Ireland. PARTICIPANTS: all students in the first intake of 1995 in every midwifery school in Ireland (n = 125). DATA COLLECTION: individual and group interviews, diary-keeping and questionnaires. KEY CONCLUSIONS: the findings presented here illustrate the students' views of their working role. The environment appeared to be one of work, rather than learning, and the students' status that of junior employee rather than 'learner' They perceived themselves as 'thrown in the deep end' without much support or guidance from qualified staff. They were frightened, unsure of themselves and suffered from role conflict and loss of status. There appeared to be an acute shortage of staff and the care given was seen to be the basic minimum, fulfilling women's physical needs but ignoring their emotional ones. The care given appeared to be planned according to routine and economic necessity rather than for sound midwifery, medical or social reasons. IMPLICATIONS FOR PRACTICE: the education of students needs to focus on the development of autonomous practice and the use of routines and non-research based care should be phased out. Students need to be assisted, with support from educated mentors, to plan care in a holistic way that will enable them to develop their midwifery skills in the future.
Exploring factors influencing Chinese women's decision to have elective caesarean surgery.
OBJECTIVES: to identify the factors that influence Hong Kong Chinese women's decision to have an elective caesarean section. To explore Chinese women's perceptions of their autonomous involvement in childbirth decision-making. DESIGN: a qualitative exploratory design. SETTING: a postnatal ward of a private hospital in Hong Kong. PARTICIPANTS: a purposive sample of six postnatal women who had undergone an elective caesarean section. FINDINGS: four thematic categories were identified including: avoiding fetal and maternal risks, exercising autonomy to make an independent choice, Chinese belief systems, and rejoicing and regretting. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: we propose the provision of a 'named' midwife and continuity of care. Improving the availability of information on caesarean sections, accommodating a Chinese belief system in the planning of midwifery services at the international level and establishing post caesarean section peer support groups are recommended.
Swedish midwives' care of women who are at high obstetric risk or who have obstetric complications.
OBJECTIVE: to describe how midwives experience the care of women who are at high obstetric risk or who have an obstetric complication during pregnancy, childbirth and early parenthood. DESIGN: a qualitative approach using a phenomenological method. PARTICIPANTS: 10 Swedish midwives, recognised as highly skilled clinicians with at least five years of clinical experience in the studied context, from four different hospitals. FINDINGS: the essence of midwifery when caring for women at high obstetric risk or with a manifested complication was defined as 'a struggle for the natural process'. Women's transition, physically as well as emotionally, during pregnancy, childbirth and early parenthood, was described as a genuinely natural process. The midwives' struggle consisted of encouraging and preserving this process within each woman. It was based on embodied knowledge and included a balancing between the medical and natural perspectives. Prerequisites, and therefore part of the struggle for the natural process, were sensitivity to the spontaneous, mutual interaction with the woman and enduring presence. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: the midwives' responsibility is to promote the natural process during pregnancy, childbirth and puerperium within every woman at high obstetric risk or with obstetric complications. The findings could serve as a basis for reflection on the professional role of midwives, and on the organisation of modern maternity care.
Tanzanian midwives' views on becoming a good resource and support person for postpartum women.
OBJECTIVES: to explore midwives' views in relation to the provision of systematic postpartum care. DESIGN: qualitative focus group study using grounded theory approach. SETTING: Dar es Salaam, Tanzania. PARTICIPANTS: 49 nurse/midwives in five focus group discussions, each having 9-11 participants. FINDINGS: eight categories were identified: 'reflecting', 'getting ready', 'defining abilities', 'networking', 'integrating', 'balancing', 'dealing with reality', and 'caring'. The identified core category that integrated and encapsulated all other categories was 'becoming a good resource and support person for postpartum woman'. The mediating factors found to have potential for influencing how a midwife can function in order to become a good resource and support person were: a) the structure and approach in maternal and child health services, b) midwives' knowledge, attitude and skills, c) informal sources of knowledge to parents, and d) cultural beliefs and practices. CONCLUSION: the findings of this study provide an understanding of the way midwives feel and think about the provision of postpartum care. The findings demonstrate that midwives need support in their efforts to achieve what they consider necessary for postpartum care. Interventions for educating and supporting midwives should be targeted at enabling them to deal with all the factors that influence their role and help them to identify and use better strategies to provide quality care.
Whose evidence counts? An exploration of health professionals' perceptions of evidence-based practice, focusing on the maternity services.
OBJECTIVES: to gain an insight into how health professionals in the maternity services define evidence and how they perceive different types of evidence are valued in maternity care. DESIGN: using a qualitative approach data were collected by semi-structured interviews: the content of each was analysed thematically. SETTING: England. PARTICIPANTS: a purposeful sample of ten midwives, two obstetricians and one research nurse. FINDINGS: definitions of evidence vary widely among health practitioners. These definitions are affected by individuals' own beliefs and give rise to a hierarchy in which some types of evidence are valued above others. All the participants made direct or indirect reference to cultural beliefs inherent within the health service, and indicated that these beliefs determine the extent to which different types of evidence are seen as legitimate. IMPLICATIONS FOR PRACTICE: the concept of evidence-based practice is not value-free. Evidence that reinforces notions of authoritative knowledge may be transposed into clinical practice quickly and easily. Conversely, health practitioners may have difficulty putting evidence into practice that challenges the cultural norms of the profession. There is a need for further work to make explicit the values that underpin different sources of knowledge and expose the hierarchies of evidence that exist.
Parents' experience of early discharge from hospital after birth in Sweden.
OBJECTIVE: to investigate the factors that influence the experience of mothers and fathers when they have chosen to return home, earlier than is the normal routine, following the birth of their baby. DESIGN: a qualitative study, using open interviews, was undertaken. The text of the transcripts was coded and categorised according to the grounded theory method using constant comparative analysis. SETTING: interviews were carried out with 12 parents, six mothers and six fathers, individually in their own homes. They had all left a maternity/family ward at the Helsingborg Hospital in southern Sweden within 26 hours of birth whereas the normal discharge time is 72 hours. MEASUREMENTS AND FINDINGS: 'a sense of security' was the core category. Achieving a sense of security linked to informed choice for early discharge appeared to be dependent on the following categories: (l) the midwives' empowering behaviour; (2) affinity within the family; (3) the parents' right to autonomy/control; (4) physical well-being. There appears to be an inner connection between each of these categories. KEY CONCLUSIONS: the midwife's empowering behaviour supports the parents' sense of security and encourages their informed choice of earlier discharge after birth. When the mothers' and babies return home it strengthens the affinity within the family and the father's sense of participation.
A critical ethnographic approach to facilitating cultural shift in midwifery.
OBJECTIVE: to improve understanding of local midwifery morale, inform development and reorganisation of a maternity unit, and enhance midwifery involvement in strategic planning. PARTICIPANTS: a randomised stratified sample of 20 midwives working in a UK National Health Service (NHS) hospital and its surrounding community area. METHOD: within a critical ethnographic framework, focus groups were tape-recorded and transcribed, and analysed using a thematic content analysis approach. FINDINGS: key areas affecting midwifery morale were identified, in particular staffing levels, working relationships and organisational issues. One year later, despite many changes having taken place, midwifery morale was still low but participants were more politically analytical of, and actively involved in changing their situation. The findings of the study indicate that there are complex and long-standing cultural inhibitions to the effective development of midwifery care but, if these are made explicit through a planned collaborative process, such as in this study, a process of cultural shift can be seen to begin. IMPLICATIONS FOR PRACTICE: focus groups can be a useful tool in moving midwifery culture forward within a local context.
Finnish women's experiences of antenatal care.
OBJECTIVE: to explore and describe women's experiences of antenatal care. DESIGN: semi-structured interviews, dialogical interviews and non-participant observation in two phases both during and after pregnancy were analysed according to Colaizzi's phenomenological method. SETTING: four maternity clinics in one rural and one urban primary health care centre and one outpatient maternity clinic at a central hospital in Finland. PARTICIPANTS: in the first phase a purposive sample of nine women were interviewed at 36 weeks gestation, three weeks, three months and two and a half years after birth. In the second phase, data were collected for further breadth and depth and 31 women, who were going through different stages of pregnancy, delivery and the puerperium participated. Data were collected by means of interviews supplemented by non-participatory observation. In the total sample of 40 Finnish women, one half was primigravidae and the other half multigravidae. FINDINGS: a main thread running through the women's experiences of antenatal care were their needs and wishes that concerned the health of the unborn baby, but also the health and dignity of themselves and their family. The pregnant women wanted to share their pregnancy and childbirth story in a confident relationship based on humaneness and interest in a peaceful atmosphere. They needed protection safeguarded through scientifically based and humane surveillance, and professional competence was expected. They wanted to continuously participate in the new situations through knowledge in dialogues and they wanted to involve their family in the care on their own terms. The childbirth preparation groups had an important multidimensional role in the care. IMPLICATIONS FOR PRACTICE: the findings challenge the antenatal care that so far has been focused on the physical health, the needs of the primigravida and a blurred family perspective. The family perspective implies knowing both the pregnant woman and her partner in terms of the pregnancy, the birth and a new parenthood. Humane, scientifically based perinatal care can be developed by innovations from these findings, especially considering the multidimensional role of the parent groups.
What women from an Islamic background in Australia say about care in pregnancy and prenatal testing.
OBJECTIVE: to examine satisfaction with care and services in relation to antenatal care and prenatal testing and to present what women say about what can be done better to improve antenatal care for women from an Islamic background. DESIGN: in-depth interviews of women's perceptions and experiences of care received relating to prenatal testing and antenatal care. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 15 women of Islamic background who are now living in Melbourne. FINDINGS: in general, women had positive experiences with care relating to antenatal care and prenatal testing in Australia. This is particularly so when they compared care in Australia with that of their own country. However, women indicated several issues of concern where they were dissatisfied and they believed need to be improved for pregnant women from an Islamic background. Firstly, there was a lack of sufficient communication between health care providers and the women. This was not only due to a language problem, but also a lack of cultural appreciation among health care providers. Secondly, women identified the issue of gender of health care providers as important; women stated clearly their need to have female doctors for their care. CONCLUSIONS: the findings of this study have implications for antenatal care and prenatal testing services in Australia and elsewhere. Women provided several suggestions for the improvement of care including the need for sufficient information of prenatal testing and antenatal care and the need for culturally sensitive services. In providing services for women of an Islamic background, it is imperative that health care providers take into account individual women's preferences and personal circumstances and go beyond an assumption based on women's religion and ethnicity.
An evaluation by focus group and survey of a course for Midwifery Ventouse Practitioners.
OBJECTIVE: to evaluate the Midwifery Ventouse Practitioners' (MVPs) Course and the MVPs' perception of its effect on their practice. DESIGN: qualitative and quantitative. PARTICIPANTS: 18 midwives who had completed the MVP course at Bournemouth University 1998-2000. DATA COLLECTION: focus group (n=8) and postal questionnaire (n=18). FINDINGS: important issues were identified by the focus group and informed the development of the questionnaire which achieved a 100% response rate. The mean length of full-time experience as a midwife was 18.6 years (SD 6.8; range 9-33); 11 midwives were based in community maternity units and seven in consultant units. Seventeen of the MVPs had been called to assist 505 women in this capacity; 366 (72%) had an MVP ventouse-assisted birth, 129 (26%) a normal birth and 10 women (2%) needed obstetric assistance. In this regard, there were considerable differences between individual MVPs. The midwives gave high priority to woman-centred values and to the very judicious use of intervention. They felt that the course had increased their confidence in relation to their midwifery practice, in general, and their ability to define fetal position and station, in particular. They reported a high level of confidence when undertaking their first ventouse birth after completing the course. KEY CONCLUSIONS AND IMPLICATIONS: midwives who have undertaken this course do not appear to expand their role to the detriment of normal midwifery, as had been feared. Even highly experienced midwives value increasing their confidence in relation to vaginal and abdominal examination. Ambulance transfer in the second stage of labour was prevented for at least 109 women. A long-term clinical evaluation of the births to which an MVP has been called is needed.