bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal medicines use and lifestyle in migraine management and prevention
Authors: Manning Karen , Jansenn Paul , Dowson Andrew
Published: May 2014

The management of migraine yields the best results when lifestyle adjustments are made in conjunction with the use of acute and/or preventive treatments. Migraine remains a disabling condition. In a survey of 1614 migraineurs conducted by the Migraine Action Association in 2007, about 80% reported an attack at least once a month, and more than half of them reported having an attack every week.

A range of options is available to migraineurs: diet and lifestyle adjustments, acute and preventive medication, as well as complementary therapies and other recent developments. The results of the Migraine Action Association's survey highlight how respondents experience current treatment methods, and to what extent they are aware of alternatives. The authors argue that through improved understanding about migraine and other headache types, and a better knowledge of the help and support available, migraine sufferers will be better equipped to manage this chronic and disabling lifelong condition.
The RESCUEicp study of decompressive craniectomy: Implications for practice
Authors: Corteen Elizabeth , Timofeev Ivan , Kirkpatrick Peter , Hutchinson Peter
Published: May 2014

The Randomized Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of intracranial pressure (RESCUEicp) study was undertaken to determine whether decompressive craniectomy has a role in the management of patients with traumatic brain injury and raised intracranial pressure. The study compares maximal medical management and decompressive craniectomy, the two approaches used when all other interventions have failed to control intracranial hypertension. Neither of these therapies has grade one evidence to support its use, but both are regularly used as a final escalation of treatment in this vulnerable client group. The pilot phase of the study has been completed and the main study is now underway, having recruited over 100 patients to date.

Nurses caring for patients enrolled in research studies have a duty to be involved in the research process, as well as to understand the evidence obtained and apply it to practice. In this article, the authors draw on their experience of involvement in the RESCUEicp study to highlight possible areas where nurses can become more involved in the process of research so that research findings can be used to improve the care that their patients receive when they are at their most vulnerable. Such an approach has great potential to shape the development of nursing as a profession.
Exploring the lived experience of palliative care for people with MS 1: A literature review
Authors: Embrey Nikki
Published: May 2014

This article is the first in a series which explores patients′ experiences of palliative care services for moderate-to-advanced multiple sclerosis (MS). This first article comprises a review of the literature on palliative care services for non-cancer patients. Subsequent articles will present research evidence of patients′ experiences of palliative care services for MS.

A phenomenological approach is adopted, a method especially suited to studying and understanding people′s experiences of illness andthe care they receive. Such an approach entails a rational and intuitive process, rather than a rigid and restrictive method.

The findings of this literature review highlight that people in the advanced stages of MS have a number of unmet needs. Variations were noted in the care received, and palliative care appears to enhance the patient′s experience. A supportive care pathway may reduce variations, by identifying appropriate patients for high quality holistic care. It is recommended that imaginative and innovative solutions are sought to meet the needs of those with advanced disease.
Nursing management of extradural haematoma
Authors: Osborne Ann Christine
Published: May 2014

Informed nursing management can improve outcomes for head-injured patients with extradural haematoma. Ann Christine Osborne explains
From cryptic talk to crosswords
Authors: McDonald Sheena
Published: May 2014

In her third column, Sheena McDonald describes how she regained her verbal IQ through word-games, following an acquired brain injury
The impact of spontaneous subarachnoid haemorrhage on patients' families and friends
Authors: Noble Adam , Schenk Thomas
Published: May 2014

Poor outcomes experienced by some patients who have experienced a subarachnoid haemorrhage (SAH), such as cognitive and emotional disorders, combined with the comparatively young age of many patients, have a substantial impact on patients' families and carers. How a carer adjusts to the situation can be critical to how well the patient recovers. This review highlights how carers of patients who have had a SAH can provide long-term support; this, however, is often at a cost to their own wellbeing. Research suggests that there is a relationship between carer wellbeing and patient disability. Recent evidence suggests that carers are at an abnormal risk of developing post-traumatic stress disorder as a result of their loved-one's SAH. This article will show that better support for carers, in the form of treatment for their stress disorders, could improve not only their own health but also, the outcome of the SAH patient they care for. An effective way to provide improved support for carers and relatives of patients who have had a SAH would be through specialized liaison nurses.
The impact of national policy on palliative care on patients with neurodegenerative disease
Authors: Clarkson Christopher J
Published: May 2014

The National Service Framework for Long-Term Conditions states that people with long-term neurological conditions are to receive a comprehensive range of palliative care services when they need them. It has been estimated that around 300?000 people with neurological conditions in the UK have unmet palliative care needs. Parkinson's disease is one of the most prevalent neurodegenerative diseases and patients could benefit from palliative care to help control symptoms at an early stage in the disease. For this to happen a more effective interface must be developed between specialist neurological, palliative care and primary healthcare teams. More research is needed to determine trigger points when palliative care input is needed for patients with neurodegenerative disease, as well as better coordination of health and social care services. None of this will be achievable unless there is significant additional investment in specialist palliative care and primary care services.
New hope for people affected by dementia
Authors: Woodward Sue
Published: May 2014

I am sure that the announcement at the end of July of a new potential drug that may halt the progression of Alzheimer's disease will not have escaped your attention, having featured heavily in the BBC evening news on 29 July. The News potentially useful drug, Rember, was discovered by accident over 20 years ago by Professor Claude Wischik (BBC News, 2008). This is not the first breakthrough scientific discovery to be made by accident. Penicillin was identified in a similar way, for example. The events that led to the discovery of Rember occurred in the professor's laboratory, when a drop of methylthioninium chloride (a blue dye), was accidentally dropped into a test tube (BBC News, 2008). The test tube contained tau protein, the basis for the characteristic neurofibrillary tangles seen at postmortem in the brains of patients suffering from Alzheimer's disease. When the blue dye came into contact with the tau protein, the protein was destroyed.
Rehabilitation of people with cognitive problems: Findings from a field study
Authors: Sørensen Birgitte , Nielsen Catherine Sand , Hounsgaard Lise
Published: May 2014

The aim of this study was to focus on the nursing rehabilitation of patients with cognitive problems following acquired brain damage. The objective of the study was to explore how actions of highly experienced nurses promoted and strengthened the complex content of the nursing rehabilitation. This article discusses a field study which used participant observations as well as ongoing solicited and unsolicited conversations with nurses. The work of five experienced nurses was followed for three months during the day in a specialized ward for patients with medium severe acquired brain damage at a Danish hospital. The nursing intervention in the rehabilitative process is a complex interaction between ‘what to do’ and ‘how to do’. The specific focus on the ‘patient's current cognitive capacity’ primarily emerged through field observations as nurses were reluctant to express their precise scientific knowledge. It is worth considering if an increase in nurses' use of scientific knowledge in the rehabilitation process of people with cognitive problems could strengthen nurses' position in a multi-disciplinary rehabilitation approach.
The developing role of the neuro-oncology nurse: A Dutch perspective
Authors: Zwinkels Hanneke
Published: May 2014

This article describes the role of specialist nurses in care, cure and research for patients with brain tumours in the Netherlands. The responsibility of the specialist nurse is management of care during the disease process and its treatment and includes patient education, symptom management and follow-up. Re-allocation of tasks and responsibilities has led to the function of the nurse practitioner, who is responsible for medical treatment with oral chemotherapy. Nursing research in neuro-oncology is focused on specialist nurse functions, which conclude that most patients and relatives value specialist nurse support highly. This article discusses nursing research in relation to symptom clustering which is defined as symptoms that occur simultaneously, cluster together and, as a result, influence outcome such as quality of life, health status and functional status, important outcomes in neuro-oncology clinical trials. Finally, the development and validation of self-report measure instruments for these symptoms resulted in use in randomized controlled trials is explored.
Breaking the rules of acquired brain injury
Authors: McDonald Sheena
Published: May 2014

Sheena McDonald shares some of her experience of recovering from a traumatic brain injury, and reflects on the meaning of being given a prognosis that did not accord with that experience
The responsibility of professional leadership
Authors: Parker Michael
Published: May 2014

Excellence is beyond the reach of a mere mortal, but as a group, individuals can compensate for each other's weaknesses and strive for greater things. However, the amalgamation of many is not sufficient to yield progress. Each person must strive to improve him/her self so as to have the capacity to improve others. The future will belong to those who have the knowledge to handle it.
It's how you live that matters
Authors: McDonald Sheena
Published: May 2014

I have just enjoyed watching Olympic triple champion Sir Chris Hoy interviewing award-winning sports writer Richard Moore, at the most recent Turn the Tables fund-raising lunch organized by Cancer Research UK. Between courses, those people normally interviewed by forensic inquisitors—George Osborne, Charles Kennedy and gang—are given the chance to interrogate their sometime tormentors—Jeremy Paxman, Nick Robinson et al, for the amusement of the lunchers. The event always kicks off with the latest good news from the charity's spokesman about the treatment of cancer and increased recoveryrates, while a lot of money is raised and a good time is had by all.
A review of the literature on nursing in Huntington's disease: A need for specialist knowledge
Authors: Baker Mark , McLaren Susan , Crichton Nicola
Published: May 2014

The paper summarizes the findings of a literature review examining the nursing management of people with Huntington's disease. The importance of reviewing nursing management practice with this patient population reflects the growing interest in the speciality area of complex neurological conditions. A range of major electronic databases were used to inform this review to identify original relevant research papers and grey literature sources from 1997–2008. Very few nursing-related research papers were found that directly address the nursing management of people who suffer from Huntington's disease. The literature highlights the need for specialist knowledge and education for nurses working in this area and identified that there are future research opportunities for nurses working in this speciality area.
Spasticity management, part 2: Choosing the right medication to suit the individual
Authors: Keenan Elizabeth
Published: May 2014

Spasticity is considered to be either of cerebral origin, such as cerebral palsy or stroke, or of spinal origin, such as traumatic injury or spinal ischaemia. While the initial approach to managing spasticity should include detailed assessment and reduction of aggravating factors, if necessary an antispasmodic treatment should be started. Nurses, doctors, physiotherapists and occupational therapists need to work together while educating the person, carers and family on a variety of treatment options tailored uniquely to the individual's needs. While baclofen is the most commonly used antispasmodic agent and often the first choice of clinicians, each of the available antispasmodic treatments needs to be considered examined, with particular regard to their half-life, side effects and the route of absorption, along with practical applications in clinical settings.
Causes and rehabilitation of urinary incontinence after stroke: A literature review
Authors: Matthews Maureen , Mitchell Elizabeth A
Published: May 2014

Urinary incontinence is a common symptom after stroke and affects between 32% and 79% of patients. The National Sentinel Audit report by the Intercollegiate Stroke Working Party (2008a) indicates that urinary incontinence is better managed in designated stroke units, rather than in general medical wards. This literature review explores the causes of urinary incontinence after stroke and examines pertinent issues for rehabilitation practice. The literature showed that nursing staff attribute their negative attitudes towards patients with incontinence to a lack of education specific to continence assessment and management. Although education often focuses on containment of incontinence, rather than continence promotion, continence assessment is key to the development of the individual's continence promotion plan.
Understanding mental capacity and the power of attorney
Authors: Potter Ian
Published: May 2014

Understanding and acting on the intentions of people who are unable to communicate their wishes for future care is a complicated issue. Ian Potter provides guidance on the different powers of attorney.
Where has the end-of-life care money gone?
Authors: Thomas Sue
Published: May 2014

Several years ago I was involved in a study to explore whether continence policy was being translated into action by primary care trusts (PCTs) (Thomas et al, 2004). Since much of the health policy today is discretionary for PCTs to implement, it was not surprising to me that not a lot had happened in ‘Cinderella’ continence services. Without a stick to beat PCTs or mandatory targets, it seems that services that are not priority areas will never get the attention they should.
Managing primary pituitary tumours: Assessments and complications
Authors: Mestecky Ann-Marie
Published: May 2014

Specific treatment for primary pituitary tumours and the diseases they cause will depend on the tumour type, but most patients require surgery which is most commonly performed via a transnasal transsphenoidal approach. Postoperative complications include impairment of visual acuity, visual field defects, diabetes insipidus, epistaxis, and cerebrospinal fluid leak. The nursing assessments and management of each of the complications will be discussed in this article.
Deprivation of liberty safeguards: Assessment and authorization
Authors: Culverhouse Mathieu , Amin Yogi
Published: May 2014

The DoLS scheme provides a procedure for deprivation of liberty to be authorized and contains safeguards for people in hospitals and residential care homes.
NHS reform: Out with the old and in with the new
Authors: Thomas Sue
Published: May 2014

The changes to the NHS outlined by the new government will require difficult local decisions and neuroscience nurses need to help ensure that money is spent wisely.
Meet the BANN board: Roles and interests
Authors: Preece Anne
Published: May 2014

Ann Preece introduces two additional members of the BANN board, Neal Cook and Ruth Trout.
Government’s listening exercise closes
Authors: Thomas Sue
Published: May 2014

The government’s listening exercise for the controversial Health and Social Care Bill is over. In this policy article, Sue Thomas reports the proposed changes to the Bill, and how these will impact on neuroscience nurses.
Protect Parkinson’s nurses in England
Authors: Moonan Clare
Published: May 2014

Parkinson’s UK has launched ‘Protect Parkinson’s nurses’, a new campaign to raise awareness of the vital services that Parkinson’s disease nurse specialists provide to both those with the condition and their carers.
Assessment of an autoinjection device commonly used by patients with multiple sclerosis
Authors: D’Arcy Caroline , Parkes Laura , Shepherd Gillian
Published: May 2014

Aim: To determine the level of correct use of an autoinjection device for administering interferon beta-1a subcutaneously among patients with relapsing–remitting multiple sclerosis (MS), and to identify training needs to improve technique.

Methods: In this Phase IV observational study at 11 UK sites, patients were assessed on device use via a 10-point checklist. The percentage of patients performing all 10 steps correctly, the three most common incorrect steps, and the association between correct device use and recent training or disease history were evaluated.

Results: Of 100 patients, 38% (95% confidence interval: 28.5%, 48.3%) used the autoinjector correctly. The three most common incorrect steps involved device maintenance, identification of injection completion and device priming. There were no associations between correct device use and recent training, relapse rate, injection-site reactions, cognitive impairment and time on treatment (all P>0.05).

Conclusions: There is a need for ongoing training of patients regarding correct autoinjection device use.
Predictors of post-concussion syndrome after mild traumatic brain injury
Authors: Brunker Chris
Published: May 2014

Chris Brunker provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail.
Health-care workers' perceptions of contributors to quality of life for people with Huntington's disease
Authors: Harding Vincent , Stewart Inga , Knight Caroline
Published: May 2014

Background:

Huntington's disease (HD) is a long-term neurological condition. Owing to its degenerative nature, quality of life (QoL) considerations are important regardless of whether individuals are in the early, middle, or end-of-life stages. Currently there is a shortage of person-centred research looking at non-pharmacological interventions to improve QoL for those with an HD diagnosis.

Objective:

To assess perceptions of QoL among health-care workers at a specialist HD unit in a UK hospital, as well as their perceptions of how they and others contribute to the QoL of service users.

Methodology:

Eight participants were recruited using opportunity sampling. They included dietetics, occupational therapy, nursing, physiotherapy, psychology, and speech and language therapy staff. One-to-one, face-to-face, semi-structured interviews were conducted with each participant. The data was analysed using the qualitative methodology grounded theory.

Results:

Eight main themes arose: QoL; the unit; staff; communication; hopes, fears and behaviour; family involvement; ongoing support; and future directions for enhancement of QoL.

Conclusions:

It is hoped that the paper will act as a foundation for further exploration of QoL issues and a focus on how individuals with HD and other neurological conditions can be best supported to live with optimal QoL. The paper should raise awareness of HD and be of assistance to health-care workers by highlighting the challenges faced in providing appropriate support, while also making recommendations for future practice.
Steps toward change: foot care in the stroke patient with diabetes
Authors: De Sousa Ismalia
Published: May 2014

Foot care in patients with diabetes has been acknowledged as crucial in preventing amputations, reducing the costs for the NHS and improving patients' quality of life. Diabetes is a condition in crescendo and a major risk factor for stroke. Comprehensive changes in stroke care have taken place in the UK in the last few years, and acute stroke settings are expected to provide excellence and high-quality care that can reduce patients' morbidity and disability. Impairment caused by stroke can be a barrier to the management of diabetes, resulting in increased risk of secondary stroke and complications of diabetes. Specially trained ward-based stroke nurses have the required knowledge and expertise and are in the best position to improve patients' quality of life and prevent long-term complications from diabetes, through assessment, care, awareness and education. The purpose of this paper is to analyse the impact of foot care management in stroke patients with diabetes and raise awareness among health professionals. The paper acknowledges the need for change in clinical practice.
Spiritual experiences in temporal lobe epilepsy: a literature review
Authors: McCrae Niall , Elliott Samantha
Published: May 2014

Profound spiritual experiences have been observed as a trait of temporal lobe epilepsy (TLE), as described in the Geschwind syndrome. This systematic review considers the evidence for ictal and interictal religiosity, and the neurological, psychiatric and cultural factors. Research in this area is at an early stage of development, with indications that a temporal focus is an important factor in spiritual experiences of epilepsy, albeit as a relatively rare and nebulous trait. The literature indicates that spiritual feelings may arise from a reciprocity of biological and psychosocial factors, but nurseq should afford the possibility of a genuinely transcendent experience. Further research may help to explain whether the complex, partial seizures of TLE are a cause of abnormal religiosity or an accessory to spiritual enlightenment.
Focus on: transient ischaemic attack
Authors: Haunton Victoria J , Robinson Thompson G
Published: May 2014

Transient ischaemic attack (TIA) is a common and important condition affecting 46 000 new patients each year in the UK. It is strongly predictive of future stroke, with the risk being greatest in the first few days after the event. Prompt recognition, early specialist assessment and robust treatment of TIA are therefore vital. However, there is frequent confusion regarding the symptoms of TIA among both patients and health professionals. Additionally, patients often delay seeking help following a TIA and fail to use emergency access routes to care. Further public health initiatives are urgently required to address these issues and to ensure that TIA is recognised as a medical emergency.
Influencing the development of evidence-based practice
Authors: Renfrew Mary J
Published: May 2014

The first article in this series examined the development of evidence-based practice in midwifery, and looked at some of the challenges to evidence-based practice. This is a continuation of that article. It starts with a describption of systematic reviews and meta-analyses, and includes a discussion of some of the opportunities for midwives to become involved in and to influence the development of evldence-based practice.
Changing Childbirth: Changing clinical decisions
Authors: Page Lesley , Phillips Jane , Drife James
Published: May 2014

Enabling women and their families to be in control of their pregnancies and the birth of their babiesis a fundamental principle of care. This requires that decisions be made, together with the woman, which are informed by an understanding of the values of the family, their wishes, the clinical examination, and information from evidence. This article describes the process of balancing such factors and the difficulties involved, from the point of view of the woman, her midwife, and an obstetrician, with a focus on the probable risks of postpartum haemorrhagein grande multiparity.
Part 2. Deciding on a homebirth: help and hindrance
Authors: Ogden Jane , Shaw Adrienne , Zander Luke
Published: May 2014

The second part of this supplement explored the factors involved in deciding to have a homebirth. Although some women stated that they were determined from the beginning to have a homebirth, others provided clear and rich accounts of the factors which involved their decision. These included wanting to be in their own home, simply not wanting to be in hospital, listening to (and often disregarding) other peoples' professional and lay views and beliefs about risk and safety.
Reflection in midwifery: professional narcissism or seeing with women?
Authors: Kirkham Mavis
Published: May 2014

Midwives are exhorted to reflect on practice but reflection has received tittle critical examination within midwifery. Personal and professional defence mechanisms make it difficult to see our work as clients or colleagues see it Techniques for achieving this change in viewpoint are suggested: debriefing clients and work with stories can be particularly useful. Whatever technique we use support is essential if we are safely to experience the degree of openness needed to develop midwifery knowledge.
Recollections of patients: versions of the truth
Authors: Symon Andrew
Published: May 2014

The recollection of events may be affected by several factors. Including pain and exhaustion, the effects of inhalational or opiate analgesia, and particularly by the distorting effects of time. Patients frequently do not have contemporaneous records to help the focusing of memories, and this can mean that allegation of negligence are sometimes made on the basis of a misunderstanding or misperception.
After the Labour landslide, where next for midwives and women?
Authors: Hunt Sheila
Published: May 2014

On May 1 1997, the British electorate chose a new Labour Government with an impressive mandate. The Conservative Party could not have anticipated the extent or depth of the decimation of their support.
Waterbirth: updating the evidence
Authors: Garland Dianne , Jones Keith
Published: May 2014

This article reviews the ideological, controversial and professional positions taken up in recent literature on waterbirth and considers three overviews of the practice. It examines five reports of the initial outcomes of waterbirth, icluding the author's most recent study. There are similarities in regard to the avoidance of injected analgesics, the incidence of perineal trauma and the incidence of low Apgar scores. The ‘outcomes’ evidence does not strongly support women's expressed beliefs about the efficacy of waterbirth. This may be due to inadequate understanding of the beliefs and/or to the relative crudeness of the ‘outcomes’ studies.
Research with women not on women: a consumer charter
Authors: Robinson Jean
Published: May 2014

‘I can see you are in pain Mrs Jones, and the midwife tells me you have asked for an epidural. I wonder if you would like to take part in our research comparing two different drugs to see which is best?’ The doctor then repeats the ethical mantra: ‘Of course you are quite free to refuse.’
What are we called? Words that colleagues use
Authors: Mander Rosemary
Published: May 2014

As a midwife I am accustomed to being called by a number of different names. Because the Trust provides me with a white dress, I have difficulty persuading the families with whom I work not to call me ‘nurse’. This struggle is being resolved gradually by the use of first names.
Midwifery education: Part 8 Scotland
Authors: Grant Beatrice
Published: May 2014

In 1976, Scotland saw the formation of twelve Colleges of Nursing and Midwifery from an amalgam of groups of Schools of Midwifery and Schools of Nursing. This removed midwifery education from the remit of the head of a maternity hospital to a Director of Nursing Education. This was a major change to which the professions adapted reasonably well and for midwives there were gains and losses.
Acupuncture: an alternative option in pregnancy
Authors: Hawkey Mary
Published: May 2014

The last 5 years have witnessed a sea change in our approach to the practice of conventional medicine — a change fuelled by the semantic shift from ‘patient’ to ‘client’ or ‘consumer’ and consolidated by the realization that despite the armoury of technological wares at its disposal, ortho-dox Western medicine fails to completely satisfy. While complementary therapies are mostly used as an adjuvant to rather than replacing orthodox treatments, according to Which Magazine 1995, £60 million was spent in that year alone on over-the-counter ‘alternative medicines’.
Reduced fetal movements: a research-based project
Authors: Fisher Margaret Louise
Published: May 2014

Variable and overmedicalized policies regarding the identification, assessment and monitoring of reduced fetal movements were recently questioned. Evidence was acquired through an extensive literature search, information from other units and a 3-month local audit. Audit findings indicated great variances in maternal perception, with links to changing gestation and fetal and placental positions. Greatest fetal activity occurred at night. Women reported concerns over a wide range of times, and appeared to be receiving inconsistent advice, resulting in increased anxieties. Technological tests were being over-relied upon and inappropriately used. The vast majority of women were noted to have normal movements and pregnancies following assessment. It was concluded that improved education of mothers and professionals was required to more appropriately identify a reduction in movements. An information leaflet was designed, and the Cardiff chart updated and modified. A low-key, individualized protocol for assessment and monitoring was devised and implemented.
40 years of Bounty support for mothers and babies
Authors: Hope Alexandra
Published: May 2014

Just eleven years younger than the NHS itself, Bounty is now in its 40th year of operations. Today, Bounty packs and guides are virtually a national institution, reaching as many as 95% of expectant women and a remarkable 96% of new mothers. What does the company do to earn the broad support it seems to enjoy from midwives, hospitals and the Government?
Improving relationships through clinical supervision: 2
Authors: Deery Ruth
Published: May 2014

The first part of this article focused on the way the midwife–client relationship has evolved, and how this has affected the way midwives relate to each other and the women for whom they care. Recent policy initiatives (Department of Health, 1993; Department of Health, 1997) have, to a certain extent, made midwifery practice more daunting, challenging and complex, and some midwives have stated that they do not get the support they require within the current model of statutory supervision (Association of Radical Midwives, 1995; M Kirkham, 1998; personal communication). Therefore supporting midwives and equipping them with the skills to take innovative and truly woman-centred care forward must become a priority. This article addresses the therapeutic relationship that exists between midwives and their clients, and encourages supervisors of midwives and midwifery managers to consider alternative ways that they and their organizational structures could offer support to midwives. The concept of clinical supervision is introduced and offered as one possible alternative to supporting midwives, as well as to help them build on the positive aspects of their practice.
Unwitting racism and midwifery
Authors: Hunt Sheila C , Richens Yana
Published: May 2014

Changing Childbirth (1993), although now nearly six years old, remains the main thrust of the government policy for the maternity services. Central to its philosophy is that the woman should be at the centre of care. She must be part of the planning of care and should have the information that she needs in order to make informed choices. But is it possible for the midwife who fails to see the woman as an equal, or who treats a woman with indifference, based on the hue of her skin, to see the woman as central to her care, or act as the advocate of one whose skin colour, culture and traditions are dissimilar to her own? Can she act as an advocate for a woman whose lifestyle differs from her own, or whose choices appear somewhat unconventional?
How it feels to be a midwife ventouse practitioner
Authors: Charles Cathy
Published: May 2014

This article is a personal account of some of the thoughts and feelings of a midwife ventouse practitioner. I consciously employ the first person singular, as the article is not intended to be an objective account, on the contrary it is intended to complement the ‘harder’ factual ventouse articles recently published, by taking a more qualitative and reflective approach. The article gives an overview of my experience of training. It describes some of my personal philosophy and how I relate this to my practice. I touch on issues such as the temptation to intervene inappropriately, coping with failure, and minimizing disempowerment of the labouring woman.
Midwifery birthing practice - change through audit
Authors: Walsh Denis , Harris Mark , Shuttlewood Sarah
Published: May 2014

Midwifery-led audit is rare in published literature. This project addressed key areas of midwifery birthing practice at the author's unit that were at variance with evidence. The process of doing audit is described and strengths/weaknesses are assessed.
Midwives, obstetricians and prenatal screening
Authors: Wray Julie , Maresh Michael
Published: May 2014

Prenatal screening is a routine procedure within contemporary maternity care and most women opt for prenatal testing and become involved in various aspects of such tests. Evidence to date suggests that the level of the practitioner's knowledge can impinge upon their communication skills and create barriers to information giving. A number of studies have identified that evaluations and monitoring of this aspect of antenatal care around information giving, staff training and guideline awareness, is minimal. Therefore, this study aimed to explore midwives’ and obstetricians’ perceptions of their roles, training needs, guideline awareness and their views of the local prenatal service. The study was undertaken between 1996 and 1997 across seven maternity units and involved 245 midwives and obstetricians. In developing the method, published standards and guidelines for practice were used to underpin the approach chosen. The findings suggest that a lack of guideline awareness exists, as well as dissatisfaction with local prenatal screening services and an identified need for further training among midwives and obstetricians.
The bottom line: Care of the perineum must be improved
Authors: Jackson Karen B
Published: May 2014

In the UK, around 750000 women will give birth each year. Of these, 525000 (approximately 70%) will sustain perineal trauma and will require stitches (Kettle and Johanson, 2000a). It is generally accepted that most of these women will experience perineal pain immediately after delivery and in the short term. What is not generally known is that long-term perineal pain and dyspareunia can affect around 20% or 120750 women who have sustained perineal trauma a year (Kettle and Johanson, 2000a). This may impact on a woman's self-image, her sexuality, her relationship with her baby and can ultimately adversely affect the couple's relationship. This article will focus on this ill-researched but highly pertinent issue of women's health. It includes possible methods of preventing perineal trauma, the continuing debate concerning episiotomy versus spontaneous tearing and issues surrounding repair of the perineum. A future article will discuss the treatment of perineal pain and discomfort and practical help for women suffering dyspareunia.
Perceptions of routine nuchal translucency screening
Authors: French Sophie
Published: May 2014

To date, the provision of nuchal translucency (NT) screening for pregnant women has been regionally selective and, although medical research has continued to explore methods of improving specificity and sensitivity of such programmes, relatively little work has focused on women's experiences of first trimester nuchal translucency screening. The aim of this qualitative study was to investigate pregnant women's experiences of routinely offered NT scans. Semi-structured interviews were undertaken with 10 women, the descriptive data of which was analysed using content analysis. Data revealed women's understanding of NT screening varied considerably. Women's experiences of the service indicated differences in access to resources that impacted on opportunities to discuss NT screening options and levels of satisfaction. Moreover, perceptions of choice revealed differences in opinion as to whether consent had been obtained. In view of current debate surrounding evidence-based practice, clinical governance and health improvement initiatives, it is concluded that the midwifery profession needs to critically examine routine NT screening programmes in relation to issues of choice, control, information exchange and multidisciplinary coordination of maternity care.
Primary care groups: how are they shaping up?
Authors: Smith Judith
Published: May 2014

In this paper, the author sets out the policy context for the development of the new national network of primary care groups (PCGs) and identifies those features which distinguish them from predecessor primary care based commissioning organisations. The progress of PCGs over the first six months of operation are then assessed, drawing on the findings of a national evaluation study of PCGs and other early commentaries. The paper concludes with an analysis of what the development of PCGs entails for midwives, and sets out a checklist concerning the means by which they can be sure that they have an appropriate influence within PCGs, and in time, primary care trusts.
Expectant fathers attitudes towards pregnancy
Authors: Thomas S Grace , Upton Dominic
Published: May 2014

The majority of midwifery practice and literature focuses on mothers with little research on fathers-to-be. This study was undertaken in order to gain a better understanding of men's psychological response to pregnancy in their partners. Data from a questionnaire and attitude scale survey were collected from 141 expectant fathers. Anxiety was not reported in a significant proportion of expectant fathers and this was not associated with age, social class or number of previous pregnancies. However, a significant proportion of fathers reported symptoms of couvade and an indication that psychological and emotional state altered during pregnancy. The study suggests that it would be beneficial for health-care professionals to recognize the needs of the father-to-be in a more holistic manner.
Informed consent to intrapartum procedures
Authors: Marshall Jayne E
Published: May 2014

This paper discusses the complex issue of obtaining informed consent for intrapartum procedures, highlighting both the moral and legal obligations of every practising midwife and obstetrician as accountable practitioners. It challenges the health professional to examine their own practice of obtaining informed consent for procedures they undertake in labour, bearing in mind they have a duty to inform the client of risks as well as benefits. Furthermore, for consent to be legally valid, the client has to demonstrate understanding (a concept that is both subjective and difficult to assess), and it must be voluntary. The author suggests that informed consent to intrapartum procedures should be obtained during the antenatal period rather than during labour itself, when the woman may be deeply distressed by pain and unable to fully make an informed decision.
Evidence-based care series 1: Birth environment
Authors: Walsh Dennis
Published: May 2014

Birth environment plays a pivotal role in the experience and outcome of childbirth and therefore the decision regarding place of birth is crucial. Choosing a home birth not only affirms the normality of childbirth but also endorses midwife-led care and continuity as important ingredients of care provision. It is also, in some senses, a political decision as the historical struggle over who controls maternity care illustrates. Yet, despite good evidence as to its efficacy for women at low obstetric risk, it remains a marginalized choice within current maternity care.
Midwives should learn to delegate to support staff
Authors: Dimond Bridgit
Published: May 2014

This article explores the possibility of the midwife expanding her role and the legal implications of this on UKCC guidance. It also asks what activities, if any, could the midwife delegate to others and considers the legal principles which apply to delegation and supervision.
Postnatal care needs are not being met
Authors: Singh Debbie
Published: May 2014

A survey of 960 women who gave birth in 1999 or 2000 showed that women's needs for postnatal care, information and support are not being fully met. Although half of the women said they got all the physical care that they needed in the first month after giving birth, around 60% did not think their emotional support needs had been met. First time mothers and women who had instrumental deliveries or emergency caesareans were less likely to feel positive about their postnatal care. These findings support the extension of midwife care past the first 10 days after birth. The aims of postnatal care need to be made more explicit, with a focus on providing information and emotional support as well as physical care.
Termination for fetal defects? The debate must go on
Authors: Devane Declan , Devane Marcella
Published: May 2014

Few would argue that advances in medical technology are not beneficial, yet the development of prenatal diagnostic techniques is occurring at such a rate that it exceeds our abilities to deal with the consequent ethical, moral and psychological issue of abortion for fetal abnormality (Bewley, 1993). In a relatively stable society, few continually question the prevailing moral consensus. It can be argued, however, that unless these reproductive issues remain the subject of continual ethical debate, there is little hope of achieving agreement between an individual's personal moral philosophy and what they may be required to do in practice. This article is not intended as a solution to the ethical dilemmas surrounding abortion for fetal abnormality, nor is it intended to address all the emerging issues, but as a means of encouraging debate on an issue which impinges on the ethics of midwifery practice. The authors will, therefore, explore some of the ethical issues raised by the implementation of abortion for fetal abnormality and address the moral and ethical factors offered as justification and condemnation for this action.
Home births in British Columbia
Authors: Page Lesley
Published: May 2014

A belief that hospital birth is safer than home birth persists in most parts of the world despite good evidence to the contrary. In many developed countries, the view of birth is changing to such an extent that caesarean birth is being promoted as safer than vaginal birth for healthy mothers and babies.
Where have all the midwives gone?
Authors: Charlton Doug
Published: May 2014

Just before I sat down to write this commentary I heard the words midwife shortage on the television. Yes even Watchdog Health Check has woken up to the fact that there seems to be a lack of practising midwives.
How is the government going to raise breast-feeding rates?
Authors: Carson Christine
Published: May 2014

The government is fully committed to the promotion of breast-feeding as the best nutrition for infants and supports breast-feeding as being nutritionally adequate for the first 6months of life.
One-to-one midwifery practice part 2: the transition period
Authors: Stevens Trudy , McCourt Christine
Published: May 2014

Drawing from the ethnographic part of the evaluation of case load midwifery (McCourt and Page, 1996), this paper explores the adaptations and changes that were demanded from the responding midwives when they first held an individual case load. The participants reported that they needed time and experience to develop appropriate skills and approaches to the work. Some of the adaptations were obvious and expected, for example the movement away from an institutional setting and the requirement to develop skills in all areas of midwifery. Others, such as the importance of handling relationships with women (including ‘educating women’ as to reasonable expectations, and ‘defining boundaries’), and of developing a flexible attitude to time and time management skills, became apparent over time.
Exploring inconsistent breastfeeding advice: 2
Authors: Simmons Valerie
Published: May 2014

Inconsistent breastfeeding advice and support has been linked to the early cessation of breastfeeding (Rajan 1993, Department of Health, 1988). The available literature fails to explain why inconsistent advice exists, or why this problem has developed and persists. The ability to understand why healthcare professionals (HCPs) give the advice they do is central to understanding the perpetuation of variations in breastfeeding advice. This article is drawn from a qualitative study that involved interviewing midwives, health visitors and mothers who were or had breastfed within a trust in the north of England. Data were analysed and three main themes emerged. Conflicting advice is shown to have a detrimental effect on mothers who choose to breastfeed, inconsistency is mostly evident as inaccurate information and the authoritarian way that HCPs communicate to women appears to worsen the inconsistencies that exist.
High-risk patients — should midwives opt out?
Authors: Robinson Jean
Published: May 2014

It’s no fun reading maternal death reports, and I have to admit I was in no hurry to tackle the latest Confidential Enquiry when it came out last December (RCOG, 2001). One problem is that the last two editions have been huge and cumbersome, whereas the reports used to come in neat, handy-sized paperbacks, which could easily be packed for train journeys. Now I feel guilty, of course, because AIMS should have sent in a much quicker response. There is an explosive consumer booby trap tucked into the chapter on midwifery practice, and it could increase rather than decrease maternal deaths.
Language use in antenatal consultations
Authors: Stapleton Helen , Kirkham Mavis , Thomas Gwenan , Curtis Penny
Published: May 2014

The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). The focus of this paper is on midwives’ use of language and the ‘packaging’ of verbal and non-verbal information during antenatal consultations. Midwives were observed making very little effort to explore and accommodate women’s individual information needs and hence they often disseminated information that was irrelevant to the woman concerned or that duplicated information offered on a previous occasion. Women rarely sought clarification about information they did not understand because the powerful, non-verbal messages midwives conveyed suggested that they had little time for elaboration or explanation. As women rarely saw the same midwife at their antenatal visits, there were few opportunities to establish the relationships based on mutual trust, respect and reciprocity that support information exchange. The language used by midwives tended to emphasise the risks, rather than the benefits, of non-interventionist approaches and to downplay the limitations of technological interventions.