No description available.

This thesis explores what ‘woman centred care’ means to both women and midwives and how this care is offered by midwives and perceived by women. It is set within the context of current health care policy and the way in which this impacts on both the organisation and implementation of maternity care. A flexible qualitative design was used to explore both women’s and midwives’ experiences of current maternity care over the full trajectory of maternity provision. A modified grounded theory approach was used framed within a feminist perspective. The fieldwork was undertaken in two phases. In phase one and interviews were undertaken with twelve women in early pregnancy, later pregnancy and after the birth; a total of twenty-five interviews with women were completed. Nine midwives were also interviewed in phase one. Preliminary and tentative categories were identified from both sets of interviews and were used to inform phase two of the study. Five women participated in the second phase of data collection. This included both informal, telephone contact and in-depth interviews spanning from early pregnancy until after the birth and included observation of their care in labour. The community midwives and delivery suite midwives specifically involved in their care were also interviewed. The data demonstrated a continued mismatch between the women’s and the midwives’ perspectives and it was evident that despite the policy drivers and consumerist rhetoric of ‘woman centred care’ and its original underpinning principles of continuity, choice and control, that this was not the overriding experience for the women who participated in the study. Data analysis highlighted some opportunities for negotiation but these were not explicitly recognised or realised by the women or midwives and there was little time or flexibility in the system to accommodate such opportunities. The increasing bureaucracy of the maternity care system also constrains continuity of carer over the full spectrum of the childbearing trajectory and reduces the potential for women to know the midwife who provided care. Thus for many midwives being ‘with the institution’ was more likely than ‘being ‘with woman’.

The aim of this study is to explore Saudi women’s experience of being healthy during the postpartum period (also called Nifas in Arabic). Little attention has been given to women’s experience of health during the postpartum period; however, it is essential to understand their experiences and understandings of health during this time if we are to develop healthcare programmes that meet their needs and improve outcomes during postpartum period healthcare. Little attention is given to postpartum women’s health in Saudi Arabia, and a postpartum woman with a normal vaginal childbirth is usually discharged from a maternity hospital 24-48 hours after the childbirth. Then, for the next 40 days, she is secluded within the home, cared for by others (usually her mother) and will only be seen by healthcare services (the obstetrician) a month after childbirth to receive their postpartum check-up. This sole consultation is limited to examining her episiotomy, a routine procedure for the majority of Saudi women. The aim of this study is to find out about women’s health practices during this hidden but important time for women’s health- the 40 days following child birth that are spent in the home. This is an interpretive phenomenological study that examines online forum discussions of Saudi Arabian women sharing experiences and seeking advice on their health during the postpartum period (28 threads), as well as a total of 12 in-depth, semi-structured interviews with women (n=7) and their carers (n=5) within their 40 days postpartum. Thematic analysis was used. The women described their experience of being healthy during the postpartum period. They believed that, during this time, women become vulnerable and open to certain illness, but they also perceived this period as an opportunity to achieve their optimal health and attractiveness. Some of the common themes that emerged were the challenges of confinement, achieving health, everyday threats and constraints, warnings and consequences, striving for normality, and becoming better than normal. However, key themes identified during interviews with postpartum women also included trust in various sources of knowledge, which included their carers, female relatives, friends, and online postpartum health discussions. The study also uncovered several strategies women used to follow health advice that were often hidden from their healthcare practitioners. In contrast, the findings from the online community discussions demonstrate that this was a forum where women could discuss issues which they did not feel able to discuss during interviews and in front of carers. These issues included the difficulties of judging expertise and advice, emotional and psychological health, husbands, and sexual activity. The study’s findings can be used to explain the postpartum women’s perception of health to healthcare providers, and the study can assist in understanding some of these women’s strategies to be healthy, including commonly followed traditional health practices. It highlights their difficulties in making sense of the large amount of traditional advice they are faced with, which covers every aspect of daily life during this period, from hygiene and food to preventing and healing episiotomies, but which also ignores key issues for these women (mental and sexual health). Finally, this study highlights Saudi women’s need for support and improved communication between these women and clinical services during the postpartum period; the frankness of the online discussions indicates that a reliable and confidential online health education forum might offer an effective way of providing this information and support.

Since the late 1990s there has been an increasing focus on parenting ability, support and education which is reflected in policy, practice and research in the UK. This research analyses how nurses might intervene to provide this support, specifically in relation to crying baby and the role of nurses at NHS direct. It involves collection and analysis of data from NHS Direct call data in 2002, and solo focus group data in 2006. Within the wider tradition of grounded theory, the methodology includes use of discourse and thematic analytical approaches. The research analyses the means by which NHS Direct nurses make different use of the algorithms and organisational protocols to make decisions and give advice to parents with crying babies, how their clinical knowledge and experience influences these decisions, and how nurses explore parents’ ability to cope. This is seen within the organisational context of NHS Direct, a 24 hour government funded telephone service described as both a triage service and an advice/helpline service. Findings from the study indicate a degree of tension between the essentially humanistic nursing culture and the highly scripted, protocol driven rules based system that underpins NHS Direct. Despite this tension, nurses will sometimes combine their knowledge with that of the algorithm where the call is involved with eliminating emergencies. The same synthesis of knowledge is not apparent with the knowledge contained in the algorithm regarding non-medical, nonemergency, value-sensitive issues relating to parental coping with excessive infant crying. Findings suggest that NHS Direct nurses use the ‘crying baby’ algorithm differently and this variance is influenced by experience and familiarity with the algorithm. Adherence to the algorithm is perceived by nurses as safe in relation to the medical questions which exclude emergencies. The non-medical elements of the algorithm, which include prompting the nurse to ask about parent coping ability and the possibility of shaking their child, are treated differently and it is considered safe to not ask, or ask around the question and to not offer the advice prompted by the decision aid software. The algorithm prompt to assess parental coping ability is rarely successful in encouraging the nurse to do so overtly. From these findings, consideration might be given to enhancing nurses’ knowledge, skills and confidence, supported with appropriate supervision, to provide effective intervention in relation to value sensitive, non-medical issues such as parental coping ability and in handling the uncertainty such issues may yield. Allied to this would be establishing clarity and recognition of the inherently different, but not opposing functions of providing a triage service and an advice/ helpline service.

No description available.

The effects of undertaking a regular exercise programme during and following pregnancy were investigated with healthy primigravid women within Ayrshire Central Hospital, Irvine. A randomised control trial was used with subjects being randomly assigned to either a control group who continued with the existing antenatal education programme or an exercise group who had the addition of participating in an aerobic exercise programme. In early pregnancy, no significant differences were found between the groups in relation to activity levels or mean scores of psychological variables with the exception of the control group having significantly more positive scores for perceptions of body image. During and following pregnancy, the exercise group maintained their scores on all psychological variables i.e. perceptions of coping assets (positive psychological well-being), coping deficits (negative psychological well-being), physical well-being, body image, somatic symptoms experienced, attitudes to marital relationships, sex and pregnancy. In contrast, the control group tended to have significant reductions in perceptions of the ability to cope (positive psychological well-being), physical well-being, body image, somatic symptoms experienced, attitudes to marital relationships, pregnancy and sex during pregnancy in addition to an increase in perceived coping deficits (negative psychological well-being).The exercise group participated in a significantly higher number of episodes of physical activity sessions than the control group. No significant relationship was noted between frequency of physical activity and responses to psychological indictors in post pregnancy. In conclusion, women who participated in regular physical activity tended to have a protection against a reduction of psychological well-being as measured by a variety of psychological constructs. The maintenance in psychological well-being was experienced both during and following pregnancy and there was no indication of any risk to the pregnancy or the baby. This was in contrast to the significant reduction in psychological well-being experienced by the women in the control group during the same period.

Objective: This research discovers patients’ experiences of the new and traditional routes of care and reveals the advantages and disadvantages of each within a chosen locality. It informs how a community service is delivering the new health agenda and most importantly how the patients feel and perceive their journeys through community-based care and hospital-based care. Therefore, its findings are crucial as feedback on how successful health plans have been to move more care to the community. It will reveal the Early Response team’s processes to ensure the service is fully utilised in intermediate care and give a better understanding about which patients are suitable for the home service. DESIGN – This qualitative research takes the form of multiple case studies encompassing semi-structured interviews to encourage discussion on the topic of care journeys. Participant information sheets and consent forms were used. The anonymity of the participant was upheld by using a pseudonym to refer to their contribution. All patients gave consent for the staff member who assessed them to be interviewed giving a total of three case study sources of the home patient, the hospital patient and the staff member as the units of measurement. Themes were searched for in the coding process derived from Kolcaba’s (2010) comfort theory and the bio-psycho-social model (Engel, 1977). These were physical, psychological, social and environmental along with two themes derived from the literature review of age discrimination and loneliness. Data generated helped ascertain the success of an alternative type of care service and formulated recommendations for practice. Setting: The patient interviews took place at the patients’ home so that they had time to experience their care pathway. Staff interviews took place in a quiet room at their place of work. Flexibility was offered regarding location, time of day and if the patients wished relatives to be present. Participants: 10 patients and 10 staff were interviewed totalling 20 participant interviews. The patient group was split into 5 patients who attended A & E and received their subsequent care in hospital and 5 patients who attended A & E and 4 were able to receive their subsequent care at home with the Early Response Service. The patients from each group were matched on the basis of same/similar injury. Each staff member who assessed the patients was matched to their patient, giving a multiple case study of the home and hospital patient and two staff members. The age range of patient participants was 72-89 years old and the staff participants 39-58 years old. There were 8 females and 2 males in the patient group and 9 females and 1 male in the staff group. Results: Data were analysed using the six theme headings and by searching through data for specific reference to answering the research questions. Key words found were burden, coping, independence or dependence, recovery, pain, equipment, finance, frailty and disorientation. Comfort took the form of pain relief, carer assistance and reassurance, not feeling a burden and having needs met in a timely fashion. Discomfort took the form of pain, cold, hunger, loneliness, finances, disorientation and needing more flexibility in carer calls. Tabular analysis revealed all hospital admissions were necessary and the reasons for admission were more serious or required medical/surgical intervention compared to the home care group. Positive home patient comments included being able to have care at home with less disruption to patients’ social networks and positive hospital patient comments included being able to receive maximum assistance over a 24 hour period as they felt they could not have coped at home. Results in relation to ageing theory, age discrimination and loneliness are discussed and interestingly care at home can be interpreted as positive discrimination of the older person by offering an alternative care option. Both hospital and home patients were satisfied with the care they received on the whole. Conclusion: The Early Response Service are correctly identifying the most suitable patients to receive care at home. An improvement in staff resources or skills such as intravenous drug administration would widen their referral criteria to be able to offer their service to more patients. There is still work to be done in respect of pulling patients out of hospital who are deemed medically stable, but are waiting for social care packages.

Different patterns of care and a range of lead professionals have influenced care provision in relation to childbirth. The role of a midwife has been influenced by historical factors, research and service changes within the National Health Service. Little is known about how the role of the midwife is perceived. This study explored the views of women and midwives relating to the role of the midwife. Mixed methods of data collection were utilised. In the first phase of the study 4 focus groups (a total of 9 women) were performed. In the second phase of the study longitudinal interviews were conducted. A total of 10 women participated in this phase. The interviews were performed at 4 different time points of their childbearing experience. A total of 40 interviews were conducted. Additionally diaries from the 10 women were completed, to capture information between the interview time points. Following the initial exploratory phase , a postmodern feminist technoscience theoretical stance underpins the second phase of this study; in particular it draws on the work of Donna Haraway. Haraway’s notion of ‘situated knowledges’ provides the opportunity to locate the views of women and midwives. This provided the opportunity to utilise her notions of ‘modest witness’, ‘cyborg’, ‘goddess’, ‘material-semiotic’ and connect to their perceptions. One facet of the study’s originality lies in matching the women’s and midwives’ ‘situated knowledges’, by interviewing the 10 midwives who were present at each of the 10 women’s birth experiences. Analysis using thematic networks was used to construct basic, organising and global themes. The findings indicate that the use of technology has a powerful influence on women’s perceptions in relation to the role of the midwife. Women and midwives connected with technology through material-semiotic connections, which has led to cyborgification within a consultant led model of care and birth environment. Women overwhelmingly perceived that birth was safer in hospital, due to the presence of technology and doctors; doctors were perceived as the decision maker and the midwife as a ‘handmaiden’. ‘Being’ and ‘doing’ midwives were recognised. The midwives were all situated in a different place within these categories, depending on their values and experiences. Generally the ‘doing’ midwives were free to ‘do’, as they supported the biomedical culture of the environment they were working in. ‘Being’ midwives supported the natural elements of the birth process, they adapted to the role of a ‘hybrid’ midwife within a consultant led environment, interchanging their technological skills for normality skills when they were secluded from interferences of the medicalised culture. This study provides evidence to inform practice developments within midwifery and makes a contribution to feminist theorising. It asserts that the culture of childbirth in contemporary society is technological, medically led and the normal birth process is not valued. This has contributed to cyborgification of women and midwives within a consultant led setting. An advancement of Haraway’s theory has been made from the emergence of the way in which the ‘being’ midwife morphs into a ‘doing’ midwife when she feels that she has to conform to the medicalised culture of the environment or from women’s expectations of their birth experience.

Midwifery practice in Ireland has emerged from a system of care dominated by the biomedical model of childbirth. The aim of this study was to explore the experiences of labour ward midwives who are potentially complicit with this approach. This study reveals how midwives’ environment impacts on their construction of childbirth. The opening of a large new maternity hospital afforded the opportunity to see if the move to this setting would influence midwifery practice. A hermeneutic phenomenological approach was used based on the work of Heidegger and Gadamer. The study was undertaken in two phases, the first involved interviewing six labour ward midwives working in a busy obstetric led labour ward which was due to close. The findings revealed that midwives complied with the norms for the unit and did not take responsibility for the biomedical approach to care. The second phase was undertaken twelve months after the opening of the hospital which was an amalgamation of three maternity units. Seventeen midwives were interviewed for this phase of the study. The move to the larger unit revealed a paradox for midwifery autonomy and enabled midwives to practice in new ways. The maternity service was delivered through a system that values detachment and an attempt at equal (not individualised) care under conditions of limited resources and constraints. This had resonance with Lipsky’s and Foucault’s work. A contrasting situation occurred within the individual labour rooms as the midwives worked in relative isolation, away from the general activity of the unit. This phase of data was framed in terms of Merleau-Ponty’s four existentials. Midwives had opportunities to enact ‘real midwifery’ and normalise birth for women using a range of strategies rather than resorting to interventionist therapies. Midwives shared in the joy of achievement when positive births occurred. The paradox of this mega maternity unit enabled authentic midwifery to emerge. The study provides an insight into the experience of labour ward midwives and how midwifery identities are revealed by the narratives they relate. It also highlights the complexity of contemporary maternity care in large centralised maternity units.

Background: Literature indicates underutilization of Palliative Care Services in the UK, with possible inequalities of access. These trends in underutilization are seen in Adult-Palliative Day-Care (APDC), a Specialist Palliative Care Service delivered in the outpatient setting. However, gaps in knowledge remain regarding if underutilization in APDC is real, and the identity and nature of the factors which determine access. Aim: The overall research question was “What are the factors which act to determine access to APDC?”. Five sub-questions for exploration in the context of access were formulated relating to the: perceived health care needs of users; the benefits of using APDC, and understandings of the role of APDC as a palliative care service. Methods: The study site was a cancer network in the Midlands of England which covered rural and urban areas. It contained 5 APDC units, 3 Primary Care Trusts, and 3 Acute Care Trusts. Fifty semistructured in-depth interviews were conducted with: 19 providers of APDC; 13 health professional referrers; 11 palliative care patients who had used the service; and 7 of their carers. The reasons for non-attendance for 149 patients who were referred to day-care but did not attend were also analysed. Thematic analysis with constant comparison and content analysis were used to analyse transcripts and document data respectively. Results: Eighteen determinants of access were identified arising out of the characteristics of the: potential service user (2), the health service or organization (9), and from interactions between potential service users, the family, the wider society, and the health service (7). The study found that utilization measures in APDC may not be accurately representing service use, as APDC units maybe functioning at their maximum capacity while current calculation methods report underutilization. Conclusion: New insights into accessing APDC are presented which and may have applications for future policy and research.