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Ouers se belewenis van die dood van 'n baba met kongenitale afwykingsDe Kock, Joanita 16 April 2014 (has links)
M.Cur. (Midwifery and Neonatal Nursing) / The purpose of this study is to determine the experiences of the parents after the death of a congenital abnormal baby. Parents who have lost a baby go through a process of grief. This also applies to parents of a baby with congenital abnormalities. Parents whose congenital abnormal baby dies, not only grieve because of the abnormality of their baby, but also because it died Unstructured in-depth interviews were held with six couples within a year after the death of their babies. The experiences of the six couples were afterwards compared. A literature study was undertaken in order to determine what the conclusions of other researchers field were. The result of the literature study was compared with that of the present study. Recommendations are made at the end of this study on the practical applications, education and further research that can be undertaken on this subject.
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The hardest moment: How nurses adapt to neonatal deathNichols, Lee Anne, 1957- January 1987 (has links)
Thirteen nurses were interviewed over an eight week period to explore their adaptive responses to neonatal death. A process of adaptation was identified that included several phases through which these nurses proceeded before they finalized the death experience for themselves. These phases included responses to the resuscitation of the infant; the measures taken to console the bereaved parents; feelings associated with difficult moments during the dying process; the behaviors utilized to strengthen themselves before and after the death; reactions to the silence in the unit that occurred afterwards; the values they discovered when reflecting on how the death was handled; and the development of a philosophical meaning from their experiences. Data were collected and analyzed using grounded theory methodology.
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On the Mechanical Experiments and Modeling of Human CervixShi, Lei January 2021 (has links)
The mechanical function of the uterine cervix is critical for a healthy pregnancy. During pregnancy, the cervix undergoes a significant remodeling from a mechanical barrier into a compliant structure to allow for a successful delivery. A too early or too late cervical softening will lead to spontaneous preterm births (sPTB) or dystocia. PTB is a leading cause of neonatal death, affecting 15 million newly born babies each year around the world. According to CDC, the rate of PTB increases in recent years. Dystocia increases the risk to both mother and newborn babies, leading to neonatal asphyxia, neonatal infection, uterine rupture, or other dangerous sequelae. Therefore, it is significant to have a better correlation of the mechanical properties change and the biological remodeling process of the cervix during pregnancy. This thesis will focus on (1) mechanical experiments of the human cervix, and (2) the development of a material constitutive model for cervix to characterize the complex microstructure-related mechanical property of the cervix.
In this thesis, a spherical indentation test was designed and conducted on human cervical samples sliced perpendicular to the axial direction, to characterize the compressive mechanical behavior of the human cervix. A uniaxial tensile was designed and conducted on the strip samples cut along and perpendicular to the preferential fiber direction from the indentation samples, to characterize the tensile mechanical behavior of the cervix. Based on the detailed experimental investigation, a nonlinear time-dependent anisotropic microstructure-inspired constitutive model has been developed. The basic idea of the model is that the mechanical behavior of the human cervix can be decomposed into an equilibrium and a time-dependent part, and the tension and compression mechanical behaviors are caused by disparate mechanisms. Specifically, the collagen fibrous network plays a major role in the tensile mechanical response, while proteoglycans (PGs), glycosaminoglycans (PGs),, and liquid cause the compressive mechanical response. The tensile time-dependent mechanical behavior of the human cervix is mostly attributed to the interactions between the collagen fiber and other components, while the compressive time-dependent mechanical behavior is mainly attributed to the porous effect. The equilibrium and time-dependent mechanical responses have been well captured using the model, and the results reveal the connection between the ECM microstructure remodeling and mechanical properties change during pregnancy.
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Medical futility as an action guide in neonatal end-of-life decisionsSidler, Daniel 03 1900 (has links)
Thesis (MPhil)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: This thesis discusses the value of medical futility as an action guide for neonatal endof-
life decisions. The concept is contextualized within the narrative of medical
progress, the uncertainty of medical prognostication and the difficulty of just resource
allocation, within the unique African situation where children are worse off today
than they were at the beginning of the last century. parties actively engage in an interactive deliberation for a plan of action. Both parties
ought to accept moral responsibility. Such a model of deliberation has the added
advantage of transcending the limitations of the participants to arrive at a higher-level
solution, which is considered more than just a consensus.
It has been argued that medical progress has obscured the basic need for human
compassion for the dying and for their loved ones. The literature furthermore reports
that the quality of end-of-life care is unsatisfactory for both patients and their
families. It is within this context that the concept of medical futility is positioned as a
useful action guide.
As we do not have the luxury of withdrawing from the responsibility to engage in the
deliberation of end-of-life decisions, such responsibility demands an increasing
awareness of ethical dilemmas and a model of medical training where
communication, conflict-resolution, inclusive history taking, with assessment of
patient values and preferences, is focussed on. The capacity for empathetic care has to
be emphasized as an integral part of such approach. Finally, in this thesis, the concept
of medical futility is tested and applied to clinical case scenarios.
It is argued that the traditional medical paradigm, with its justification of an 'all out
war' against disease and death, in order to achieve utopia for all, is outdated. Death in
the neonatal intensive care unit is increasingly attributed to end-of-life decisions.
Futile treatment could be considered a waste of scarce resources, contradicting the
principle of nonmaleficence and justice, particularly in an African context.
The ongoing confidence in, and uncritical submission to the technological progress in
medicine is understood as a defence and coping mechanism against the backdrop of
the experience of life's fragility, suffering and the inevitability of death.
Such uncritical acceptance of the technological imperative could lead to a harmful
fallacy that cure is effected by prolonging life at all cost. What actually occurs,
instead, is the prolongation of the dying process, increasing suffering for all parties
involved.
The historical development of the concept of medical futility is discussed,
highlighting its applicability to the paradigmatic scenario of cardio-pulmonary
resuscitation. Particular attention is given to ways in which the concept could
endanger patient-autonomy by allowing physicians to make unilateral, paternalistic
decisions.
It is argued that the informative model of the patient-physician relationship, where the
physician's role is to disclose information in order for the patient to indicate her
preferences, ought to be replaced by a more adequate deliberative model, where both / AFRIKAANSE OPSOMMING: Hierdie tesis bespreek die waarde van mediese futiliteit as 'n maatstaf vir aksie in
gevalle van neonatale 'einde-van-lewe' besluite. Die konsep word gekontekstualiseer
binne die wêreldbeskouing van mediese vooruitgang, die onsekerheid van mediese
prognostikering en die probleme wat geassosieer IS met regverdige
hulpbrontoekenning; spesifiek binne die unieke Afrika-situasie.
Dit word aangevoer dat die tradisionele mediese paradigma, met regverdiging vir
voorkoming van siekte en dood ten alle koste, verouderd is. Sterftes in neonatale
intensiewe sorgeenhede word toenemend toegeskryf aan 'einde-van-lewe' besluite
Futiele behandeling sou dus beskou kon word as 'n vermorsing van skaars
hulpbronne, wat teenstrydig sou wees met die beginsels nie-skadelikheid ('nonmaleficence')
en regverdigheid.
Die volgehoue vertroue in en onkritiese aanvaarding van aansprake op tegnologiese
vooruitgang lil geneeskunde, kan beskou word as verdediging- en
hanteringsmeganisme in die belewenis van lewenskwesbaarheid, lyding en die
onafwendbaarheid van die dood.
Sodanige onkritiese aanvaarding van die tegnologiese imperatief kan tot 'n
onverantwoordbare denkfout, naamlik dat genesing plaasvind deur verlenging van
lewe ten alle koste, lei. Wat hierteenoor eerder mag plaasvind, is 'n verlenging die
sterwensproses en, gepaard daarmee, toenemende lyding van all betrokke partye.
Die historiese ontwikkeling van die konsep van mediese futiliteit word bespreek met
klem op die toepaslikheid daarvan op die paradigmatiese situasie van kardiopulmonêre
resussitasie. Spesifieke aandag word gegee aan maniere waarop die
konsep pasiënte se outonomie in gevaar stel, deur die betrokke medici die reg te gee
tot eensydige, paternalistiese besluitneming. Die argument is dan dat die informatiewe model, waar die verhouding tussen die
dokter en pasiënt gebasseer is op die beginsel dat die dokter inligting moet verskaf
aan die pasiënt sodat die pasiënt 'n ingeligte besluit kan neem, vervang moet word
met 'n meer toepaslike beraadslagende model, waar sowel die dokter as die pasiënt
aktief deelneem aan interaktiewe beraadslaging oor 'n aksieplan. Albei partye word
dan moreel verantwoordbaar. So 'n model van beraadslaging het die bykomende
voordeel dat dit die beperkings van die deelnemers kan transendeer. Sodoende word
'n hoër-vlak oplossing - iets meer as 'n blote consensus - te weeg gebring.
Die argument word ontwikkel dat mediese vooruitgang meelewing met die
sterwendes en hul geliefdes mag verberg. Verder dui die literatuur daarop dat die
kwaliteit van einde-van-lewe-sorg vir sowel die pasiënte as hul familie onaanvaarbaar
is. Dit is binne hierdie konteks dat die konsep van mediese futiliteit kan dien as 'n
maatstaf vir aksie.
Medici kan nie verantwoordelikheid vir deelname aan beraadslaging rondom eindevan-
lewe beluitneming vermy nie, en as sodanig vereis die situasie toenemende
bewustheid van sowel die etiese dilemmas as 'n mediese opleidingsmodel waann
kommunikasie, konflikhantering, omvattende geskiedenis-neming, met insluiting van
die pasient se waardes en voorkeure, beklemtoon word. Die kapasiteit vir empatiese
sorg moet weer eens beklemtoon word as 'n integrale deel van hierdie benadering.
Ten slotte, hierdie tesis poog om die konsep van mediese futiliteit te toets en toe te
pas op kliniese situasies.
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Birth pains : changing understandings of miscarriage, stillbirth and neonatal death in Australia in the Twentieth CenturyThompson, Susannah Ruth January 2008 (has links)
Feminist and social historians have long been interested in that particularly female ability to become pregnant and bear children. A significant body of historiography has challenged the notion that pregnancy and childbirth considered to be the acceptable and 'appropriate' roles for women for most of the twentieth century in Australia - have always been welcomed, rewarding and always fulfilling events in women's lives. Several historians have also begun the process of enlarging our knowledge of the changing cultural attitudes towards bereavement in Australia and the eschewing of the public expression of sorrow following the two World Wars; a significant contribution to scholarship which underscores the changing attitudes towards perinatal loss. It is estimated that one in four women lose a pregnancy to miscarriage, and two in one hundred late pregnancies result in stillbirth in contemporary Australia. Miscarriage, stillbirth and neonatal death are today considered by psychologists and social workers, amongst others, as potentially significant events in many women's lives, yet have received little or passing attention in historical scholarship concerned with pregnancy and motherhood. As such, this study focuses on pregnancy loss: the meaning it has been given by various groups at different times in Australia's past, and how some Australian women have made sense of their own experience of miscarriage, stillbirth or neonatal death within particular social and historical contexts. Pregnancy loss has been understood in a range of ways by different groups over the past 100 years. At the beginning of the twentieth century, when alarm was mounting over the declining birth rate, pregnancy loss was termed 'foetal wastage' by eugenicists and medical practitioners, and was seen in abstract terms as the loss of necessary future Australian citizens. By the 1970s, however, with the advent of support groups such as SANDS (Stillbirth and Neonatal Death Support) miscarriage and stillbirth were increasingly seen as the devastating loss of an individual baby, while the mother was seen as someone in need of emotional and other support. With the advent of new prenatal screening technologies in the late twentieth century, there has been a return of the idea of maternal responsibility for producing a 'successful' outcome. This project seeks to critically examines the wide range of socially constructed meanings of pregnancy loss and interrogate the arguments of those groups, such as the medical profession, religious and support groups, participating in these constructions. It will build on existing histories of motherhood, childbirth and pregnancy in Australia and, therefore, also the history of Australian women.
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The factors contributing to high neonatal morbidity and mortality in Limpopo ProvinceRamaboea, Moyahabo Joyce 11 1900 (has links)
A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M.A. (Health Studies)
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The factors contributing to high neonatal morbidity and mortality in Limpopo ProvinceRamaboea, Moyahabo Joyce 11 1900 (has links)
A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M. A. (Health Studies)
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Factors contributing to the increased perinatal mortality rate in Limpopo provinceMaesela, Phogole Crawford 10 1900 (has links)
The purpose of the study was to determine the causes, of the increased perinatal
mortality, identify and describe other factors contributing to the increased perinatal
mortality rate in a rural healthcare facility situated in Sekhukhune district in Limpopo
province, and to formulate the recommendations that will reduce the perinatal mortality
rate based on the results. A quantitative, descriptive, cross-sectional and retrospective
design was conducted. The study population was one hundred and sixty two (162)
records of babies who died in the perinatal facility from the 1st January 2015 to the 31st
December 2015 with a gestational age of about 28 weeks or more. No sampling was
done, but a census was used. The sample comprised of one hundred and sixty two (162)
of all the records related to perinatal mortality. Data were collected from patients’ records
by using a checklist. Analysis of the data was performed by the IBM Statistical Package
for Social Sciences (SPSS) version 14 computer software. Frequency tables and pie
graphs were used to present the data.
The results indicated that 75.3% (n=122) of the records were associated with health
personnel as a factor contributing to perinatal mortality. Furthermore, preterm cases
accounted for 45.1% (n=73) and prematurity accounted for 37.0% (n=60) of the cases of
perinatal mortality. Therefore, preterm births and prematurity are risk factors that should
be managed immediately after birth, and all babies should be managed prior to being
transferred to the other healthcare institutions.
The recommendations are that the education of patients about early antenatal visit, signs
of labour and danger signs during pregnancy and training of healthcare workers on
record-keeping have to be done on a continuous basis. Managers should conduct quality
improvement programmes, benchmarking and implement maternal and neonatal
guidelines in the clinical area throughout pregnancy. / Health Studies / M. P. H. (Health Studies)
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