Thesis (M.S.)--University of Michigan, 1964.

Thesis (M.Sc.)--Memorial University of Newfoundland, 1987. / Typescript. Restricted until May 1988. Bibliography : leaves 145-155. Also available online.

Thesis (M.S.)--University of Michigan, 1995.

Thesis (M.S.)--University of Michigan, 1986.

No description available.

D.Cur. / Health care professionals, in all settings, have become increasingly aware of the consumers' legitimate right to participate in decision-making regarding care to be received. Health professionals have also being criticised for planning and delivering care that does not take into consideration the client's perceived needs, wishes and expectations of such care. This study is undertaken primarily to explore and describe the expectations of both the care-givers (midwives, student-midwives and doctors) and the health care consumers (mothers and fathers). The focus of the study is the care to be provided to mothers by midwives during labour. It is the aim of the researcher to ameliorate lapses in the provision of comprehensive health care. The study design is exploratory, descriptive, qualitative and contextual in nature. The main purpose of this study is to formulate guidelines for implementation by the midwife during labour. In order to accomplish this purpose, the research study followed six (6) distinct phases in which different objectives were addressed. In Phase 1, the expectations of mothers and partners/fathers concerning the care to be provided by the midwives during labour were explored. These were described after conducting in-depth qualitative interviews with both the mothers and partners/fathers. In Phase 2, focus group discussions were conducted with the midwives and studentmidwives, to explore and describe their expectations concerning the care to be provided by the midwives during labour. In Phase 3, narratives were gathered from selected doctors, in which they explored and described their expectations concerning the care to be provided to the mothers by midwives during labour. The results of the interviews, focus group discussions and narratives were subsequently analysed based on categories of "Theory for Health Promotion in Nursing (Department of Nursing Science, RAU, 1998)". The results were also contextualised. A concept analysis was conducted in Phase 4 in order to identify the characteristics of the concept "Caring" using different situations where caring takes place, from literature sources (uses of the concept) as well as the two main themes which emerged from the research results. Thereafter, the identified characteristics of Caring were placed in comparison with the research results obtained from Phase 1, 2 and 3 and were reduced under the following headings: Prerequisites, Process and Consequences. From this process the concept "Caring" was defined. In Phase 5 of the study, a conceptual framework was developed out of all the characteristics determined from the concept analysis and was discussed in three phases namely, the initial, integration and termination. In the final phase, that is Phase 6, the guidelines for operationalising caring during labour were formulated from all the characteristics determined from the concept analysis and the following headings were maintained that is, Prerequisites, Process and Consequences. These guidelines were evaluated and refined by the midwives and student-midwives from the specific hospital where data was collected. The conclusions and trustworthiness of this study were discussed. Recommendations were made in terms of highlighting the possibilities of application of the guidelines for operationalising caring during labour in nursing education, nursing practise and nursing research.

M.Cur. / The objective of this study explores and describes the experiences of first-time mothers regarding pain management during the first stage of labour. A qualitative approach involving phenomenology was used. Midwives were also interviewed to determine their assessment and management strategies in this regard in order to get a broader perspective on the focus of interest. The data collected from the mothers revealed three themes and they are: the care rendered, needs/wishes and beliefs/feelings of the mothers regarding the care given. These themes were further subdivided into small headings/categories as specified in the data and elaborated on. Eight categories of care strategies emerged from the data gathered from the midwives. Information from both the mothers and midwives were then extensively discussed and compared to the existing literature. Conclusions were drawn and recommendations formulated, in the form of guidelines, to assist midwives and other health-care professionals to improve their caring modalities in the management of patients with pain during the first stage of labour.

M.Cur. / Midwives are responsible to assess pain before treating it; then they should reassess the pain to evaluate the effectiveness of the interventions and plan future therapy. Accurate and objective measures of labour pain continue to be scarce and the discrepancy in labour pain perceptions between parturients and health-care providers remains challenging. Various pain measurement tools are currently in use measuring chronic and acute pain, but many problems were encountered applying these methods to the woman in labour. The charts were detailed and required too much time to complete. The aim of the study was to develop a multidimensional labour pain assessment instrument to assist clinicians and midwives with labour pain control. Objectives for developing a valid and reliable instrument to accurately measure labour pain included refinement of the labour pain assessment instrument developed from literature, testing of the refined instrument on patients during labour, compilation of a final instrument and development of guidelines on how to implement the labour pain assessment instrument in nursing practice. A descriptive and exploratory approach was used to describe, evaluate, observe, explore and assemble new knowledge on assessment and measurement of pain during the first stage of labour. Development of the instrument was addressed in the literature chapter. The research was conducted in three phases, combining qualitative and quantitative research. During phase one, the instrument was refined in two stages. Focus group interviews were conducted with members regarded as knowledgeable in the field of normal labour who evaluated the face and content validity of the instrument. The most senior people teaching Midwifery at all South African universities evaluated the face and content validity of the instrument with an open-ended questionnaire thereafter, using the Delphi technique. The analysis of the first Delphi round was compared to the focus group analysis. The instrument was altered and submitted to the Delphi experts in a second open-ended questionnaire to confirm the alterations. During phase two, the altered instrument was tested in private and provincial hospitals. Testing of the altered labour pain assessment instrument on patients in active labour yielded quantitative data. A statistician at the University of Johannesburg was consulted to assist with tabulation, frequencies and statistical tests needed. The midwives from the private and provincial hospitals also completed the second Delphi open-ended questionnaire. A Likert scale was included in the second Delphi instrument as midwives have less time available to complete questionnaires. The qualitative analysis of their responses was compared to those of the second Delphi round experts to avoid an inflated estimate of validity that might have been brought forth by the very small second Delphi round sample. The instrument was finally altered and, during phase three, guidelines were developed on how to implement the labour pain assessment instrument in nursing practice.The experts concluded the instrument as a simple tool that can measure and assist with labour pain control, assess the progress of labour and the patient’s condition, assist with training, guide inexperienced midwives in pain assessment and serve as a research tool. The labour pain assessment instrument can be a valuable tool in assisting clinicians and midwives with labour pain control during the first stage of labour and initiate standards for pain measurement. The challenge remains to convince institutions to improve pain control during labour and protect themselves from potential pain maltreatment litigation by using a valid and reliable pain measurement instrument.

Epidural analgesia has increased in usage dramatically in the United States as a means of comfort for labor pain. Prior studies have connected epidural analgesia to an increase in cesarean birth rate, an increase in use of instrumentation, an increase in length of labor, episiotomy rate, and maternal fever. Epidural analgesia has produced additional costs to the patient and society. The purpose of this study is to examine the relationship between epidural analgesia during childbirth and childbirth outcomes. The data for this study were obtained from a retrospective patient record review of 200 systematically selected labor patients who delivered in 2002 at a midwestern hospital. The epidural analgesia rate was 72% at this facility in 2002, a significant increase from the previous 5 years. Using the Chi-square test of independence, 3 relationship was established between epidural analgesia and four of the variables examined. A statistically significant relationship was found to exist between epidural analgesia and cesarean birth rate, pitocin augmentation, and the first and second stages of labor with the total sample. The results of the study are important for healthcare providers who are relaying influential wellness information to childbearing women and their partners. The results indicate a need for further education for healthcare providers on alternative methods of pain relief for their patients during childbirth.

Orientador: José Carlos Peraçoli / Resumo: Avaliar o grau de satisfação das parturientes na assistência ao parto prestada no serviço da Maternidade do Hospital das Clinicas da Faculdade de Medicina de Botucatu. Material e métodos: Realizou-se estudo observacional transverso com puérperas que receberam assistência ao parto. Foram aplicados dois questionários, sendo um referente a expectativa e o outro com relação a experiência das parturientes, ambos aplicados no puerpério, 48h após o parto, para avaliar a satisfação das pacientes em relação ao tratamento realizado e a expectativa prévia. Foi realizada ainda a análise quantitativa dos resultados apresentados em porcentagem, média e desvio padrão. Resultados: Das puérperas selecionadas, observamos uma população com idade média de 26 anos, uma porcentagem relevante tanto de nulíparas 33%, como de multíparas (um a cinco partos prévios) 58%. As pacientes apresentaram baixo grau de escolaridade, 53,49% encontravam-se no grupo que abrangia alfabetizada até o ensino fundamental completo, e 72,09% consideraram estar em um relacionamento estável. Ao realizarmos a analise das questões, estas foram subdivididas em três áreas abrangentes. Observamos na área abrangente um, relacionada ao estresse, uma ansiedade bem acentuada nas parturientes, bem como o relato destas terem se sentido angustiadas durante o parto, fatores que contribuem para piora no grau de satisfação das pacientes, o que pode estar relacionado a diversos fatores, tais como falta de informação e dor durant... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The purpose of this study was to evaluate the degree of satisfaction of parturients in childbirth care provided by the Maternity Service of the Hospital das Clinicas, Faculdade de Medicina de Botucatu. Material and methods: A prospective, cross-sectional study was carried out on parturients who received childbirth care. Two questionnaires were applied, one referring to expectation and the other regarding the experience of the parturients, both applied in the puerperium, 48 hours after the birth, in order to evaluate the patients' satisfaction regarding the treatment performed and the previous expectation. A quantitative analysis of the results was performed, presented as percentage, mean and standard deviation. Results: Of the pos partum selected, we observed a population with a mean age of 26 years, a relevant percentage of nulliparous 33%, and multiparous (one to five previous births) 58%. The patients had a low level of schooling, 53.49% were in the group that had literate until full elementary education, and 72.09% considered themselves to be in a stable relationship. When we analyzed the questioning, they were subdivided into three broad areas. We observed in the comprehensive area one, related to stress, a very accentuated anxiety in the parturient, as well as the report of these that they felt distressed during the birth, factors that contributes to bring down the level of satisfaction of the patients which can be related to several factors such as lack of i... (Complete abstract click electronic access below) / Mestre