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PubMed2004

Sharing the spirit of the policy agenda? Private complementary therapists' attitudes towards practising in the British NHS.

During recent years, complementary medicine (CM) has grown as a significant provider of health care in the UK, the majority of this provision being allocated through the small private business sector to privately paying clients. Given the substantial demand for CM, the government acknowledges its structural integration with orthodox medicine (OM) to be a logical progression. However, although the time frame, evidence bases and regulatory structures are as yet undetermined, key to the current emphasis on integration is an underlying assumption that private sector providers would be willing participants, potentially alongside nurses. In this context, using a combined questionnaire (n=426) and interview (n=49) survey, this paper makes an initial exploration and considers the current connections that private therapists have with OM and their attitudes towards collaborating with and working within the NHS. The majority of therapists claimed not to have existing business connections with NHS providers, though many stated that they had established some form of informal arrangements. In general, therapists were happy that they had experienced increasingly positive reactions from orthodox clinicians towards their therapies. The overwhelming majority of therapists were positive about the proposition of working within OM but did have certain reservations. Given the range and intensity of opinion found in this initial investigation, the paper concludes by signposting some substantive avenues of focused research inquiry on the structural integration of CM and OM.

Adult↗
PubMed2004

Paediatric nurses' attitudes to massage and aromatherapy massage.

Complementary therapies have continued to increase in popularity in healthcare and it is widely accepted that they can be incorporated into the nursing role. However, this acceptance does not necessarily mean that the introduction of therapies into the nursing arena has been without confusion and without professional and legal implications. Consequently, this small-scale, qualitative study aimed to explore the perceptions and lived experiences of paediatric nurses of two therapies, namely massage and aromatherapy massage. There is a dearth of literature exploring nurses' perceptions to the incorporation of these therapies, especially in the arena of paediatric nursing where massage and aromatherapy massage are common practice. Semi-structured interviews were undertaken with qualified nurses and revealed the themes of 'benefit', 'family centred care', 'nursing care' and 'being held back'. It was found that at some stage during their professional career each nurse had performed massage and/or aromatherapy massage. All nurses were able to recall certain benefits of the therapies for the children that they had observed and many discussed the importance of involving the family as a way of including them in to the care of their child. However, for the nurses in this study, it was evident that the incorporation of complementary therapies into the nursing role was determined by the context in which they practised. Due to the dominance of the medical model, nurses faced pressures and conflicts in the realities of their nursing work, which meant they were often unable to carry out these therapies.

Anecdotes as Topic↗
PubMed2006

"Not getting tanked": definitions of moderate drinking and their health implications.

BACKGROUND: People encounter large amounts of sometimes-inconsistent information about risks and benefits of alcohol consumption, and about what constitutes "low-risk" or "moderate" drinking. METHODS: We used 150 in-depth interviews linked to questionnaire data to learn how people define moderate drinking and to describe the relationships between definitions, attitudes, and beliefs about moderate drinking and individuals' drinking patterns. RESULTS: People adhere to definitions of moderate alcohol consumption that could put them, or others, at risk for short- or long-term negative consequences of drinking. Definitions that confused increased tolerance of alcohol with moderate drinking, and those that defined moderate drinking by the absence of short-term negative consequences or ability to maintain control over drinking, ignore long-term risks of heavy consumption. Individuals with risky attitudes were also more likely to report at-risk drinking practices. CONCLUSIONS: Americans have complex beliefs about benefits and risks of alcohol consumption, and public health officials have not succeeded in conveying strong or clear messages about what constitutes low-risk drinking or about dose-response effects. Different (but more consistent) approaches to public education may be needed to increase knowledge about drinking-related risks. The prevalence of diverse norm-based definitions suggests that alternative normative information could help people reassess their own consumption.

Adult↗
PubMed2006

Liver failure, life support, family support, and palliation: an inside story.

My sister was admitted to the intensive-care-unit (ICU) five months before she died. At the time of admission her life-support wishes were not discussed with her. During her time in the ICU, we, the family, were given hope that she may survive. As with most families, we wanted my sister to live. During her progression from ICU to step-down unit to ward unit, the plan of care was not discussed, and goals were not set. Many medical teams were involved in my sister's care, and many looked at individual body parts instead of the whole person. I am a Registered Nurse at the same hospital where my sister was being cared for. Through many family meetings I was regarded as a medical professional, not as a sister. Knowing the medical system yet going through this as a family member has given me the opportunity to gain insight into what should have happened. If code status had been discussed we would have known my sisters wishes. If relevant literature pertaining to her disease and her slim chance of recovery had been brought to our attention, my sister could have died at home as she wished, and perhaps could have lived her final days in comfort.

Anecdotes as Topic↗
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

Caring for women from culturally diverse backgrounds: midwives' experiences.

The aim of this study was to show how midwives cared for women from culturally diverse backgrounds. In-depth interviews were used to collect data from 12 experienced midwives who volunteered to participate in the study from a midwifery unit with a culturally diverse population. Study findings revealed that midwives preserved and accommodated the cultural preferences of women from a Chinese background by incorporating the forces of yin-yang into care, heeding the maternal hierarchy and women's stoicism; and for women from an Islamic background by heeding modesty and gender preferences (Hejab), the place of prayer in daily life (Salat), and the imperative of visiting by others (Hadith). Hence, midwives negotiated care that was culturally comfortable for women and their families. Furthermore, triangulated studies addressing the partnership between the midwife and the diverse client are needed, as well as the development of aspects of the health service that are more culturally sensitive.

Adult↗
PubMedDate not supplied

Somali refugee women speak out about their needs for care during pregnancy and delivery.

More than half of all Somali refugees in the United States live in Minnesota. To obtain information to develop culturally sensitive health education materials, we conducted two focus groups with 14 Somali women who had each given birth to one child in Minnesota. Overall, women thought that their childbirth experience was positive. They also reported racial stereotyping, apprehension of cesarean births, and concern about the competence of medical interpreters. Women wanted more information about events in the delivery room, pain medications, prenatal visits, interpreters, and roles of hospital staff. The most desirable educational formats were a videotape, audiotapes, printed materials, and birth center tours. To increase their attendance at prenatal appointments, participants said they needed reminder telephone calls, transportation, and childcare.

Adult↗
PubMedDate not supplied

First birth stories of student midwives: keys to professional affective socialization.

The purpose of this article was to examine the professional affective socialization of midwifery students. Students from the Community-Based Nurse-Midwifery Education Program (CNEP) tell about their first births in their Lost My Hat stories posted on the electronic bulletin board of the Frontier School of Midwifery and Family Nursing. Qualitative analysis of 38 of these stories showed internalization of the values and beliefs of the midwifery model of care by students. Themes of the Lost My Hat stories were congruent with some of the aspects of the Model of Exemplary Midwifery Practice developed by Kennedy. Major themes included the circle of safety provided by the preceptor and a woman-centered approach to care. These findings can help midwifery educators promote socialization of students in the profession.

Adult↗
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↗
PubMed2004

Women's satisfaction with decision-making related to augmentation of labour.

OBJECTIVE: to describe women's experiences of participating in decision-making related to augmentation of labour. DESIGN: a qualitative approach using modified grounded theory technique. Open-ended interviews were conducted 1-3 days after childbirth. SETTING: the interviews were performed in the postnatal wards in five hospitals (tertiary level) in Stockholm, Sweden. PARTICIPANTS: 20 newly delivered women who had received oxytocin infusion for augmentation of labour during childbirth. FINDINGS AND KEY CONCLUSIONS: support and guidance from midwives in combination with knowledge and expectations about the intervention seemed to be important for women's satisfaction with decision-making concerning augmentation of labour. Four patterns of decision-making were found. One group of women participated in the decision-making regarding augmentation of labour while a second group was invited, but refrained from participation. These women were satisfied with the decisions made. A third group of women did not participate, but wanted to and they were dissatisfied with the decisions made. The fourth group did not participate in the decision-making-and did not want to. These women accepted the decisions made. The desire for information exceeded the desire for involvement in decision-making and the majority of women had confidence in the midwives' assessment.

Adult↗
PubMed2004

Women's behaviour, beliefs and information sources about physical exercise in pregnancy.

OBJECTIVE: To examine the potential effect of low-risk pregnancy on women's recreational activity patterns and to explore pregnant women's beliefs and information sources regarding physical exercise participation. DESIGN: Preliminary, prospective survey SETTING: Participants' homes in the East Midlands, UK. PARTICIPANTS: Fifty-seven nulliparous, pregnant women. MEASUREMENTS: Levels of maternal physical activity participation were assessed by semi-structured interview at 16, 25, 34 and 38 weeks gestation. The modified Baecke questionnaire provided a measure of women's habitual sport and leisure activities in the 12 months prior to pregnancy. A 10-item scale assessed maternal beliefs regarding the importance of physical activity in pregnancy. The fetal health locus of control scale measured the extent to which women believed their own behaviour, the behaviour of others and/or chance would influence fetal health. Open-ended questions assessed women's information sources. FINDINGS: Fourteen of the 36 (39%) women who reported participating in some form of weekly exercise before pregnancy did not report pursuing any similar activities during pregnancy. Rest and relaxation were perceived as being significantly more important during pregnancy than was regular exercise or the maintenance of an active lifestyle. Fifty-five respondents (96%) indicated that they had received advice about physical activity at least once during pregnancy. At 16 weeks gestation, women obtained most of their information from books and magazines. Between 25 and 38 weeks gestation, most advice came from family and friends. Participants who reported receiving this advice were significantly older, more educated and of a higher activity level pre-pregnancy. KEY CONCLUSIONS: Levels of maternal exercise may decline during pregnancy both as a result of the physical changes of pregnancy and from a combination of social and psychological factors. Present health education may be failing to correct inaccurate perceptions of the risks associated with physical exercise in pregnancy. IMPLICATIONS FOR PRACTICE: Improving the quantity and quality of information related to physical exercise has the potential to correct inaccurate perceptions and confer several benefits on maternal and fetal health. Effective intervention strategies should focus not only on the pregnant woman but also extend to her family, friends and exercise provider.

Adaptation, Psychological↗
PubMed2004

A qualitative study of mothers' and fathers' experiences of routine ultrasound examination in Sweden.

OBJECTIVE: to conceptualise mothers' and fathers' thoughts and feelings before, during and after the routine ultrasound examination during the second trimester of pregnancy. DESIGN, SETTING AND PARTICIPANTS: a grounded theory study. Two to four weeks after their ultrasound examination, 22 Swedish mothers and 22 fathers were interviewed in their homes. FINDINGS: the basic social process was confirmation of a new life. The four categories, visualising-the evident option, overwhelming to see life; becoming a family and reassuring, all represent a time span in the parents' process towards confirmation of a new life. The caregivers' way of assisting and supporting the process by information and treatment was very important to parents. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: as the ultrasound examination is perceived as a confirmation of a new life it is an extremely important milestone for both parents so the father should be encouraged to participate. It is an important and unique event for both women and men in their process towards becoming parents. This process was largely dependent on the treatment the parents had received during the examination and the information given. The findings of this study are of interest to midwives and others who perform ultrasound examinations as it explains why adequate time must be allowed for the examination and the importance of the information given before hand. When introducing new forms of fetal diagnosis in the future it should be kept in mind that this might irrevocably be accepted by parents who long for confirmation of a new life.

Adult↗