Liberating qualitative research findings from the dusty shelf of academia: developing a translational methodology illustrated by a case study of the experience of living with dementia. The exponential growth of qualitative health and social care reports in recent years has generated a dialogue about the utility of qualitative research findings. The traditional methods of dissemination often result in the findings remaining on 'the shelf' with the result that they have little impact on practice, policy, or members of the public. In this study I develop a generic framework for synthesizing and communicating qualitative research findings that are already in the public arena. The framework is comprised of four stages: - Stage 1 is a strategy for identifying relevant and useful studies in the area; Stage 2 develops relevant and useful criteria for selecting studies: the quality of a study is assessed by its; substantive contribution, aesthetic merit, reflexivity, impact and expression of reality; Stage 3 draws upon the philosophy of phenomenology and hermeneutics as a way of synthesising the selected studies, providing an experiential description of the phenomenon of interest (called a structural textual synthesis). Stage 4 offers principles by which the structural textural synthesis can be transformed and communicated to lay audiences in more aesthetic and understandable ways. The above framework is applied to the phenomenon of living with dementia from the perspective of the partner with dementia and their care partner. The structural-textural synthesis is transformed into a script, which has been performed, and recorded on DVD. The transferable implications of this framework are considered for their potential to communicate qualitative research findings already in the public arena to the public in ways that facilitate understanding and empathy

Women's experiences of their perineum following childbirth: expectations, reality and returning to normality The aim of the study was to explore the feelings, perceptions and experiences of women in relation to their perineum following childbirth in the early postnatal period. A grounded theory approach was used for collecting and analysing data from eleven diaries and seven interviews with broad questions about how the perineum, following a vaginal birth, affected the way daily living activities were carried out. Initially purposeful sampling was utilised to recruit women but as important issues emerged recruitment continued through theoretical sampling. Following childbirth women expressed a strong desire to get back to normal reflecting the core theme `striving for normality'. Normality in this context meant doing normal things and feeling like their normal selves. Much of what the women described doing during the early postnatal period was related to achieving that goal and linked to the following categories: `preparing for the unknown', `experiencing the unexpected', `adjusting to reality', `getting back to normal' and `recovery of self'. The main theoretical idea that emerged from this study and derived directly from the data is that: If women are able to successfully adjust to their new and often unexpected reality after the birth of their baby, and begin to reclaim their selves and their world, then they experience a return to their normality. The data demonstrates and clarifies three distinct but related aspects. Firstly, coping with the unexpected consequences of childbirth meant that the women frequently made adjustments to how they carried out essential activities such as walking, sitting and passing urine, in order to try and carry on as normal. The second aspect related to daily activities that were not essential but which women felt necessary to undertake because of social expectations. These included housework and shopping. The third aspect related to how the women felt about their body as a result of the perineal trauma they sustained, and what helped them to feel like their `normal selves' again. These interrelated stages form a framework that reflects Maslow's lower order, hierarchy of needs, within the humanistic psychology paradigm. Implications for practice include the need to improve care in areas of preparing women having their first baby, listening to women as part of the assessment of perineal pain following birth and the need for continuity of care from the same midwife in order for women to appropriately manage their perineal experience.

A small percentage of mentally ill patients, sometimes referred to as 'revolving door' patients, are frequently readmitted to psychiatric hospitals. This study explores how these patients construct meaning and reality and how this enacted reality provides a context for shaping their identities. The study draws on mental health policy, political ideologies and the history of deinstitutionalisation in order to illuminate this problematic phenomenon. The study is framed within the social sciences, but more specifically within the fields of mental health and social work practice. The methodology is qualitative, placing emphasis on a hermeneutic phenomenological approach. The foundation of the study is underpinned by a social construction and social psychology framework. A unique minimalist interview technique based on the Biographic Narrative Interpretive Method is used for data collection and analysis. Data from seven interviews with participants are presented followed by the researcher's reflections on the interviews and post-interview process. The life stories of four of the seven participants are analysed by using reflective teams. The lived life, or chronological chain of events as narrated, is analysed sequentially and separately. The told story, or thematic ordering of the narration, is then analysed using thematic field analysis; this involved reconstructing the participants' system of knowledge, their interpretations of their lives and their classification of experiences into thematic fields. An integrated procedure of abductive and inductive analysis of the stories elicited from participants offered immense potential for constructing meaning. Perspectives on 'revolving door' patients have often regarded them as having a one-dimensional life. This study revealed that these existential lives are complex and diverse and exist within a cultural matrix of social and psychological constructs. Interpretations of these patients' experiences illuminate the complexities arising from multiple admissions to psychiatric hospitals and highlight the problematic aspects which impact their socially constructed identities. These case studies of 'revolving door' patients' personally narrated lives extend the social psychological study of self/identity and contribute to the field of mental health research.

Pre-eclampsia is an enigmatic multisystem disorder of the second half of pregnancy. Placental hypoxia and generalised endothelial dysfunction are features of this syndrome and the clinical manifestations of this disease are suggestive of reduced maternal tissue perfusion. There is convincing evidence that the hypoxic placenta released as yet unknown circulating factor(s), which rsult in the generalised endothelial dysfunction. The hypothesis of this study is that, altered expression of hypoxia regulated genes occurs in the placenta and vascular endothelium in pregnancies complicated by pre-eclampsia which accounts for the clinical manifestations of the syndrome including the reduced blood flow. There is an ongoing debate regarding the shared and disparate components of the pathophysiology of pre-eclampsia and Intra uterine growth restriction (IUGR) hence women with IUGR pregnancy were also included in this study. The primary aim of this research was to identify, through bioinformatics a set of hypoxia regulated genes in pre-eclamptic placenta and then to validate the results through RT-qPCR from the placenta and also in edothelial cells exposed to the plasma from three groups of women (pre-eclampsia, IUGR and normal pregnancy) recruited for the study. First, Strain gauge plethysmography was used to measure maternal tissue blood flow in the claf, which was compared to tissue oxygen saturation measured using pulse oximetry in the three groups of women. Second, using bioinformatics, a set of novel potential hypoxia regulated genes namely angiogenein inhibitor, apolipoprotein E, growth differentiating factor (GDF15), HS19, KISS1, NAD-Ubiquinone oxidoreductase 1 (NDUFAB1) and ROBO$ were identified and RT-qPCR was used to study their expression in the placenta and also in the two endothelial cell lines, (Human umbilical vein endothelial cells and Myometrial uterine microvascular endothelial cells) exposed to hypoxic conditions and plasma from the threee groups of women. Calf blood flow was significantly decreased in women with pre-eclampsia however the difference was not statistically significant in women with IUGR pregnancy compared to normal pregnancy. Notably, tissue oxygen saturation was not significantly different between the three groups of women and there was no correlation between tissue blood flow and oxygen saturation in all the three groups. Overall, the expression of the novel hypoxia regulated genes was increased in pre-eclamptic placenta compared to placenta from normal pregnancy. There was an overall reduction in the expression of the hypoxia regulated genes by HUVEC exposed to plasma from women with pathological pregnancies. However there was no change in expression of the hypoxia regulated genes by UtMVEC when exposed to similar conditions. The study findings suggest that in pre-eclampsia there is compensatory up-regulation of hypoxia regulated genes in the placenta probably in response to uteroplacental ischemia. In both pre-eclampsia and IUGR, there is a failure of up- regulation of hypoxia regulated genes in maternal endothelial cells cultured in vivo in response to circulating factor(s) released by the hypoxic placenta and this may explain the clinical manifestation of impaired tissue perfusion.

Serious questions need to be asked about the current status of midwifery in Australia. This doctorate examines the lack of recognition of midwifery as an autonomous profession and its consequential invisibility in Australian maternity care.Despite the significant amount of evidence that continues to accumulate to support the expansion of midwifery models of care, such changes have not been widespread in Australia. An examination of international, national and local health policy and strategic direction in maternity services, together with a critique of contemporary Australian midwifery and the role of the midwife within the public health system, provide the rationale and context for the study. The 'case' for introducing improved systems and models of maternity care is developed with regard to the evidence for increasing the utilisation of midwifery. The doctorate argues for greater visibility and recognition of midwifery in Australia with a focus on the role of midwifery leadership and its potential to improve collaboration. A number of case studies report experiences and insights of leadership and collaboration across different contexts: clinical practice, organisation of health services and health policy leadership in maternity services. The result is a comprehensive understanding of the reasons for the lack of visibility of midwifery and the potential costs of such a situation continuing. The exploration of this situation highlights the barriers to recognising and acknowledging midwifery itself. Attention is drawn to the continuing lack of voice and visible leadership in Australian midwifery, with midwives being absent from decision-making in situations whereothers, predominantly nurses and doctors, speak 'for' them. This work examines the barriers to midwives forming alliances and working to influence government agendas at the social, organisational and political level. Exploration of the power structures and hierarchical constraints that exist reveals particular barriers and highlights what is needed to address the impending decline of the profession in Australia. The enhanced capacity that midwives would experience if their work were to be understood, recognised and valued in the provision of maternity services in Australia, is postulated through the development of a construct called 'professional capital'. Drawing on several theoretical perspectives, it is argued that the notion of 'professional capital' is dependent on a strategy of focused and deliberate leadership and collaboration within maternity services and the creation of positive social networks and affiliations amongst midwives. Professional capital would enable greater visibility and recognition of midwifery and a more effective midwifery contribution to maternity services. It is suggested that improved professional and societal recognition will ultimately enhance the professional performance and self image of midwives. Such developments will enable new and effective ways of supporting and strengthening inter-professional relationships and systems of care that will, in the long term, improve the outcomes and experiences of women who access maternity services.

The partograph, developed over 50 years ago and based on research conducted by Friedman (1954, 1955 & 1956), has been promoted by the World Health Organisation as the “gold” standard for assessing progress in labour. The basic premise of the partograph is that regular vaginal examinations throughout labour that calculate the extent and rate of cervical dilation will be the most reliable indicator of labour progress. A review of the medical and midwifery literature suggested that the progress of labour can also be assessed by observing women’s behavioural responses to labour. This study set out to describe and test the reliability and consistency of these behavioural cues. These cues were derived from published literature and used to construct a “Labour Assessment Tool” (LAT). The LAT was tested and modified using an expert reference group and results of a pilot test. Inter-rater reliability was established during the pilot study and verified with other experienced midwives as data collectors. The LAT recorded partograph observations as well as labour behaviours. The study was undertaken in two Australian hospitals between 1999 and 2002. Women were given information on the study during regular antenatal visits to the hospitals from 30 weeks gestation and invited to participate during one of their antenatal visits between 37 weeks and 42 weeks of pregnancy. There were 21 women of the 225 women approached who declined to participate. The LAT observations were recorded on 203 participants however only 179 participants (94 nulliparous and 85 multiparous women) who generated 47,768 individual observations were suitable for analysis. There were 59 participants (31 nulliparous and 28 multiparous women) who were induced into labour or had their labours augmented. Women excluded from the study included those with complications of pregnancy and labour. Women were also withdrawn from the study at the time an epidural was commenced but their data to that point were retained for analysis. The data were examined from three perspectives. The first was from a ‘phases of labour’ perspective based on the work of Friedman (1954; 1955). Data obtained at the time the women had an internal cervical assessment were allocated to early labour, active labour, transition or full dilation, based on the results of the cervical measurements. The second perspective examined all the descriptors over the course of labour from admission to hospital or the beginning of an induction of labour, to second stage of labour. Frequencies were again generated for each behaviour from admission to hospital until full dilation. They were compared to the mean dilation generated for both parity groups based on the 279 cervical examinations that were performed on the participants. The third perspective examined behavioural patterns observed within each woman’s labour unrelated to the time to full dilation or Friedman’s phases of labour model. Results indicate that specific behavioural descriptors associated with progress were observed before cervical dilation increased. Descriptors indicating cervical dilation was occurring, or had occurred, and descriptors indicating impending second stage as well as second stage itself, were identified. Differences were observed between the labours of multiparous and nulliparous women and induced labours and non induced labours.

This study examines participants' perceptions of the significant messages and meanings communicated to them through the ceremony of the Blessingway (a ritual titled after the Navajo Blessingway), a contemporary women's birth ritual performed by midwives. A narrative approach was used for data gathering based on Fisher's rationale that meaning emerges through narrative. Fifteen women participated in open-ended interviews. Thirteen of the women identified themselves as midwifes. Four major themes emerged from the data: (1) interconnectivity, (2) care, (3) change, and (4) power. The results of the study show the Blessingway's role in communicating a group's care during a time of transformation, usually birth. Adoption, marriage, and entry into midwifery were also mentioned in the study as occasions for a Blessingway ritual. During a Blessingway, many levels of relationship intersect and emphasize the "web of connectedness" the women consider part of their lives. The continuous, multidimensional, and overlapping nature of interconnectivity defines the places of connection highlighted during the Blessingway ceremony. The sense of connectedness generates bonds of care--cohesion, nurturance and safety--and provides a "cocoon-like" environment. Once nurtured and protected, the women feel the support of their community. The women then resolve and transform the contradictions and ambiguities of their liminal state, acknowledge their value of self, recognize their own power, the power of their community, the power of the circle of women and the power of the archetypal woman. / Graduation date: 1997

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

The purpose of this study was to develop a theory in order to explain the meaning and process of learning the role of the midwife from midwives in the clinical setting. To achieve the depth and detail required in the absence of literature on this topic, the grounded theory approach was adopted. The sample consisted of twenty student midwives and seventeen midwives. Data were collected by means of unstructured interviews which were tape-recorded. Each participant was interviewed on a minimum of two separate occasions. The constant comparative method was used to analyse the data. The findings of the research contribute to knowledge by making explicit how the role of the midwife is interpreted and enacted, the effect this has on what role students learn, how it is learned and hence how the role is transmitted from one generation of midwives to the next. The `emic' perspective facilitated the emergence of a number of theoretical ideas. Central to these are the rules of practice. When midwives rigidly follow written and unwritten rules they prescribe midwifery care which corresponds to the medical model. In doing so they act as obstetric nurses or handmaidens to the doctor. When everything is interpreted as rules to be followed prescriptive midwives appear to be uncaring and detached from the experience of childbirth. The individual needs of women are not met and the relationship between midwife and client is superficial. Midwives who rigidly follow the rules inhibit the growth and development of students providing them with few opportunities to achieve beyond the level of their role model. Midwives are flexible when they interpret the rules for the benefit of women and provide a woman-centred model of care. These midwives therefore act as autonomous practitioners. When rules are interpreted and adapted to meet the needs of women, flexible midwives demonstrate involvement in women's experiences and are empathic, supportive and caring. Midwives who use professional judgement to interpret the rules provide an environment in which senior students can become autonomous practitioners. When midwives demonstrate the role of autonomous practitioner, practise a woman-centred model of care and meet the learning needs of students, they are appropriate role models and teachers. There is conflict in the clinical setting when practitioners who hold opposing attitudes, values and beliefs practice together. Conflict can be avoided when flexible midwives adopt strategies that involve becoming prescriptive or practising by subterfuge. In accordance with Bandura's social learning theory students learn by observing and emulating the example of their role models. Learning is vicarious when students observe the consequences of their role models' actions. When learning the role from a role model is interpreted as a passive process, a behaviourist and pedagogical approach to learning and teaching ensures perpetuation of the obstetric nurse role that is no longer considered acceptable. Role modelling serves as a vehicle for transmitting new behaviour when learning is perceived to be an active process. In this case a humanistic, andragogical and cognitive approach to learning and teaching is adopted giving students the freedom to determine their own role. Practice from a number of role models is emulated. In this way each midwife acquires a unique identity which is derived from an abstract role model rather than a particular person. Students are prepared for the autonomous role of the midwife, and it is this role they wish to emulate.

Thesis (MNursing (Advanced Practice))--University of South Australia, 1996