bluuebunny/crossref_metadata_2025 huggingface dataset:
Exudate assessment and management
Authors: Davies Patricia
Published: May 2014

Good wound management must involve an holistic approach to care; without considering the whole person, appropriate management might not be as good as it could be. In a time of austerity, it is important that money is spent appropriately on the correct wound-management technologies. Exudate assessment and management are a vital part of wound management. In this article, the focus will be on exploring the nature of exudate and tools available to evaluate exudate. Finally, suggestions will be made on the management of exudate.
Traffic light system for healed venous leg ulcer monitoring
Authors: Hindley Jenny
Published: May 2014

The purpose of this paper is to introduce the conceptualisation and evolution of a trialed Doppler traffic light system for healed venous leg ulceration. This tool aims to facilitate clinical decision-making and provides a systematic approach to the ongoing assessment of arterial disease in patients with healed venous leg ulcers when used in conjunction with other purposely-designed assessment documentation to ensure the novice registered and unregistered nurse contributes safely and effectively to the care of patients. The validation and trial of this clinical decision tool is discussed in terms of the use of a recognised methodology determining its fitness for purpose and robustness.
A decision model for community nurses providing bereavement care
Authors: Brownhill Suzanne , Chang Esther , Bidewell John , Johnson Amanda
Published: May 2014

Community (district) nurses play a significant role in assisting and supporting bereaved informal carers (family members and friends) of recently deceased clients of palliative care. Bereavement care demands a wide range of competencies including clinical decision-making. To date, little has been known about the decision-making role of community nurses in Australia. The aim of this study was to conduct in-depth examination of an existing data set generated from semi-structured interviews of 10 community nurses providing follow-up bereavement care home visits within an area health service of a metropolitan region of Sydney, Australia. A grounded theory approach to data analysis generated a model, which highlights an interaction between ‘the relationship’, ‘the circumstances’ (surrounding the bereavement), ‘the psychosocial variant’, ‘the mix of nurses’, ‘the workload’, and ‘the support’ available for the bereaved and for community nurses, and elements of ‘the visit’ (central to bereavement care).

The role of community nurses in bereavement care is complex, particularly where decision-making is discretionary and contingent on multiple variables that effect the course of the family's grief. The decision model has the potential to inform community nurses in their support of informal carers, to promote reflective practice and professional accountability, ensuring continuing competence in bereavement care.
Measuring safe staff levels in the community: the ‘DominiC’ workforce management tool
Authors: Bowers Ben , Durrant Kay
Published: May 2014

There is significant need to establish and predict what numbers of district nursing staff are needed to provide quality patient care. This is the first in a series of articles sharing the evidence-based and tested solutions being used in clinical practice across the UK to inform caseload and workforce planning. Stockport NHS Foundation Trust's electronic workload management tool ‘DominiC’ is explored in this article. The tool promotes continuity of patient care, efficient resource allocation and the benchmarking of care. It predicts future service demands and measures these against the staff resources available. Lessons learned from the process of developing and implementing DominiC are shared to help inform clinicians and managers looking for similar workforce planning solutions.
Developing cultural competence in palliative care
Authors: McGee Paula , Johnson Mark RD
Published: May 2014

Increasing ethnic or cultural diversity in the population served by healthcare services requires improved competence and updated provision. Both individual staff and institutions need to reflect on and prepare to meet new challenges. Three key elements—reflective self-awareness, knowledge of others, and skills in managing difference—must be developed. Recognition of diversity and a database of appropriate information are essential for both workers and management of organisations. Above all, some preparedness for continual change and learning is essential. This article provides some suggestions and examples to assist with this.
Striking a professional balance: interactions between nurses and their older rural patients
Authors: Corbett Sophie , Williams Fiona
Published: May 2014

Close relationships between older adults and their health-care professionals in community settings can enhance wellbeing and support positive health in older age. In rural areas, health-care workers may know their patients socially as well as professionally, and roles are mediated. This article reports the findings from 16 qualitative interviews with older adults and health and social care professionals in rural areas of Wales. The study found that the sharing of non-clinical information in rural home-care situations is both likely and desirable, supporting the sense of social connectedness experienced by the older adult, contributing towards the development of the nurse/carer–client relationship and improving older adult wellbeing. However, it is recognised that there is potential for boundaries to become blurred and, in some situations, nurses and carers may need support to negotiate the divide between appropriate and inappropriate disclosure while maintaining a close relationship with the older adult.
Book Reviews
Authors: Neville Lillian
Published: May 2014

This is an exciting new book which is practical and easy to understand. It is of value to anyone working in health or social care who requires a guide to relevant and contemporary ethical issues.
Considering the psychological effects of stroke
Authors: Welch Rachel
Published: May 2014

With an ageing population and stroke disability on the increase, the psychological care of the stroke survivor is as important as the physical care. The Healthcare assistant needs to be aware of the psychological and emotional changes that occur when stroke happens. This article will look at the importance of providing information to and involving a stroke patient in their own care.
Evaluation of assistant and associate practitioner roles across NHS South Central
Authors: Leach Camilla , Wilton Emma
Published: May 2014

An evaluation of assistant/associate practitioner (AP) roles across NHS South Central has illustrated some of the perceived benefits that APs can bring to service delivery and patient care. This article outlines some of these key benefits, as considered by APs and their managers, and explores the continuing professional development needs of new and existing APs.
Simulation-based education in support of HCA development
Authors: McKenzie Smith Michelle , Turkhud Kelly
Published: May 2014

In the wake of the Francis Report and its 290 recommendations, the role and training of the healthcare assistant (HCA) have once again come under the spotlight. Francis asks for HCAs to be regulated and national standards for their education and training to be agreed ( Francis, 2013 ). The HCA Crisis Avoidance and Resource Management (CARMA) course has run at the Montagu Clinical Simulation Centre (MCSC), South Yorkshire for 5 years now.

This article evaluates the impact that this course, which uses simulation-based education as a teaching methodology, has had on the attitudes of HCAs and on their role in clinical practice.

Simulation is an ideal educational method for addressing nontechnical skills, such as communicating with patients and members of the multidisciplinary team ( Gaba, 2004 ). Allowing participants to prepare for emergency situations, simulation-based education gives individuals and teams the opportunity to practise within a safe environment, making behaviours more or less permanent ( Beaubien and Baker, 2004 ).
Addressing cancer fear and fatalism—how you can help
Authors: Kaplan Gwen , Kilgour Gill
Published: May 2014

Every year in the UK, around 300 000 people are diagnosed with cancer, about the same as the population of Coventry.

More people are surviving the disease nowadays—in fact, survival rates have doubled in the past 40 years. Yet through our seven years of experience of talking to the public, we know many believe cancer is still a death sentence and don't want to know if they have it. We also hear echoes of this belief from some working in the health profession, who have a remit to encourage people to adopt healthier lifestyles and seek help early if they are worried about a symptom.

Fear and the sense of fatalism about the disease can be major barriers to accessing help earlier and everyone—including healthcare assistants and assistant practitioners—can play a role in addressing this.
Consequences of infant maltreatment on child wellbeing
Authors: Lazenbatt Anne , Bunting Lisa , Taylor Julie
Published: May 2014

Child maltreatment is a major public health and social welfare problem. Evidence consistently shows that infants under one are more at risk of fatal injury, physical abuse and neglect than any other age group, mainly because they are almost completely dependent on others for their overall wellbeing and development. This article discusses the impact of infant maltreatment on children’s health and wellbeing. It highlights the sizeable body of literature on the relationship between types of infant maltreatment and a variety of negative developmental, health and mental health consequences.
A holistic approach to multiple sclerosis
Authors: Carolan Alison , Gournay Kevin
Published: May 2014

The aim of this article is to provide mental health nurses with an overview of multiple sclerosis and the very common mental health consequences of this devastating illness. In turn, this article will set out to demonstrate how mental health nurses can provide interventions for this population and how they might also work alongside other professionals in the spirit of the teamwork that is so important to provide sufferers with holistic care.
Informing patients about sudden unexpected death in epilepsy: A survey of specialist nurses
Authors: Lewis Sheila , Higgins Sue , Goodwin Mel
Published: May 2014

The National Institute for Health and Clinical Excellence (NICE) recommends that people with epilepsy and their families and carers should be ‘given and have access to’ information about sudden unexpected death in epilepsy (SUDEP). The aim of this survey was to examine what, when and how information about SUDEP is disseminated to patients by clinical nurse specialists in epilepsy (CNSEs).

Method

: A total of 250 postal questionnaires were sent to members of the Epilepsy Nurses Association (ESNA) in July 2006. Responses were received from 146 nurses (58%). CNSEs accounted for 103 (71%) of the respondents. The remaining responses were excluded as not being CNSEs.

Results

: CNSEs discussed SUDEP with most patients (50%). They tended to raise SUDEP when discussing specific risks (48%) and general risk (71%). Forty-five CNSEs would discuss the issue at diagnosis and 17 when therapy was started. Risk factors mentioned included non-compliance (84%), safety risks (78%), nocturnal seizures (68%), alcohol/drugs use (67%) and history of status epilepticus (65%). The main behavioural responses noted were, improved adherence (62%), avoidance of risk (59%) and anxiety(49%). Only 57% of CNSEs were aware that guidelines regarding SUDEP exist.

Conclusions

: As SUDEP appears to be related to seizures, management should include optimal drug treatment and seizure control. This may present a challenge as patients generally want to lead as normal a life as possible.
Nontraumatic spinal cord injury, part 3: Care for spinal cord compression
Authors: Collis Pellatt Glynis
Published: May 2014

Spinal cord compression leading to temporary or permanent neurological damage may be caused by a range of conditions that include spinal tumours, spinal infections and parasites. Tumours may be primary or metastatic, epidural abscesses may be caused by a range of organisms but in recent years due to the increase in susceptible patients tuberculosis has become more common. Parasitic cord compression may be caused by hydatid cysts, a parasitic condition that is endemic in parts of the world popular with British holiday makers. Patients need both physical and emotional care from nurses as they often have both neurological impairments caused by the cord compression plus an underlying condition or disease to cope with.
Cutaneous side effects of infused apomorphine: The patient and carer experience
Authors: Poltawski Leon , Edwards Hazel , Todd Amy , Watson Tim , James Cherry-Ann , Lees Andrew
Published: May 2014

Subcutaneously infused apomorphine, used in the treatment of Parkinson's disease, is associated with the development of hard nodules at the infusion site. They may interfere with drug absorption and make it difficult to find a suitable infusion site. Relatively little is known about aetiological factors for nodule development, or which treatments are most effective. A case series assessment was used to investigate nodule formation, effects and management in 24 individuals receiving apomorphine by infusion. Demographics and clinical information, opinions of patients and carers, and physical and sonographic assessment data were obtained. Difficulty finding infusion sites was the most commonly reported problem caused by nodules. Tissue changes varied considerably, and included nodule formation, dermal thickening and diffuse oedema. No single factor was found to substantially influence severity, but poor hygiene and needle-changing technique appeared to exacerbate the problem. A variety of treatments were employed and therapeutic ultrasound was reported to be particularly beneficial. Tissue evaluation by visual inspection, palpation and sonography may be feasible tools for the assessment of condition severity and treatment effectiveness.
Evaluating a fast-track service for diagnosing MND/ALS against traditional pathways
Authors: Callagher Pauline , Mitchell Douglas , Bennett Wendy , Addison-Jones Robert
Published: May 2014

The fast-track diagnostic service for people suspected of having MND/ALS was introduced at the Royal Preston Hospital in January 2005. This service aims to shorten waiting times, decrease requirements for inpatient admission and enable the final diagnosis to be presented in a clinic-based environment in a planned, controlled manner.

In this article, the diagnostic process for people suspected of having MND in Lancashire and South Cumbria is described. Comparisons are made between the fast-track diagnostic services and traditional diagnostic pathways (i.e. outpatient clinic, hospital transfer, private referral), outlining the timelines from referral to diagnosis. Secondly, patients' perceptions of their experience of the diagnostic services will be described.
Assessing multiple sclerosis patients’ and carers’ views of respite care
Authors: Mullan Fiona , Acheson Karen , Coates Vivien
Published: May 2014

Background: People with multiple sclerosis (MS) often require full-time care, which may be provided by informal carers. Respite becomes a vital part of carers’ lives allowing temporary relief. Little attention in the literature is given to the people who experience respite care.

Aim: The aim of this study was to assess the views of respite care by MS patients and their carers.

Method: A cross sectional survey was conducted in Northern Ireland, one questionnaire for patients and another for carers. The lists of two long stay respite units provided the sample for the study, from these 96 patients and 96 carers were approached. A total of 70 patients (73%) and 28 carers (29%) responded.

Results: Seventy-one percent of patients used respite care to give their carers a break; 64% of carers used respite to relieve stress. More than half, 64% of patients, enjoyed respite; 6% were angry about requiring respite; 57% of carers felt guilty about using respite. Overall, 81% of patients were satisfied with respite. Almost all carers (96%) stated that respite allowed them to continue caring.

Conclusions: Both patients and carers felt respite was a positive and necessary form of care. The study did highlight that activities or outings for patients in respite would be welcomed.
Part eight: Perineal care should be a feminist issue
Authors: Walsh Denis
Published: May 2014

A significant body of robust research exists to inform perineal care but it is almost all about process and outcome variables reflecting practitioner's interests. It is scandalous that women's concerns and priorities have been largely sidelined apart from a few notable exceptions discussed in this article. This reflects the largely patriarchal culture that exists within hospital-based maternity services. We can learn much from feminist research principles that can assist us in redefining the research agenda so that what we study and how we study it is more woman-centred.
Licking the problem of tongue-tie
Authors: O’Shea Mary
Published: May 2014

Much of the literature up to the 1990s makes little, if any, reference to tongue-tie and its impact on breastfeeding. For a baby to successfully breastfeed it must latch on to the mother’s areola with his or her upper gum ridge, buccal fatty pads and tongue. A consultant paediatric surgeon at Southampton General Hospital, has been ‘snipping’ tongue-tie for many years and will shortly be publishing his research. The author spent a day at the clinic in Southampton and observed three cases.
One-to-one midwifery practice part 4: sustaining the model
Authors: Stevens Trudy , McCourt Christine
Published: May 2014

This article, the last in a series of four looking at the implementation of a case load (CL) midwifery scheme, examines issues around the sustainability of the model. It is based on a data collection period of 46 months, from the inception of the scheme following Changing Childbirth (Department of Health, 1993). The CL scheme now operates as part of the mainstream local service, and has recently been extended across the local community service. This article focuses mainly on problems and an analysis of the motivations of midwives who left, as the previous article looked at the meaning of CL midwifery and discussed the considerable rewards and satisfaction the midwives’ experienced. Here we discuss the main factors in midwives’ decisions to leave and how far these might be linked to the context of their work, the features of a pilot scheme or more enduring features of working with a personal CL.
Caring for pregnant women with diabetes
Authors: Morrison Julie , Neale Lee , Taylor Rennae , McCowan Lesley
Published: May 2014

Continuity of midwifery care (CMC) has been associated with favourable outcomes for ‘low-risk’ mothers and babies. It was hypothesised that CMC in pregnant women with diabetes would reduce the postnatal length of stay and improve maternal satisfaction with intrapartum and total pregnancy care. Women with gestational, type 1 and type 2 diabetes (n=284) were randomised, to CMC, provided by one of three midwives, or to standard care provided by a variety of midwives. Eighty eight percent of women were very satisfied with overall care and rates of satisfaction did not differ between groups. There was a trend to increased satisfaction with labour care in the continuity group. Women randomised to CMC had a shorter mean duration of labour and the postnatal readmission rate was less. There was no difference in the rate of neonatal hypoglycaemia, however, there was a significant reduction in newborn admission to the neonatal unit for hypoglycaemia in the continuity group. CMC did not reduce postnatal length of stay, or improve maternal satisfaction in this setting, where satisfaction with overall care was already high.
Specialist care for drug using pregnant women
Authors: Mitchell Elaine , Hall Jennifer , Campbell Doris , van Teijlingen Edwin
Published: May 2014

The Golden Square Special Clinic for drug using pregnant women is a multidisciplinary clinic offering integrated, holistic care and advice to pregnant and pre-pregnant drug users in and around Aberdeen. It provides antenatal, specialist obstetric, drug and social services to clients as well as acting as a resource centre for midwifery staff throughout Grampian. The clinic first opened in 1997. Attendance has risen, perhaps because of increasing numbers of this client group, but certainly because of increasing acceptance of this service and increasing understanding of the benefits to the mother and to the baby. Initial feedback from clients suggests that the high level of support offered is not only appreciated but is successful in producing positive outcomes in terms of stabilization and reduction of drug use.
Addressing inequalities in health: the Breasts Benefits project
Authors: Lockey Rachael , Hart Angie
Published: May 2014

It is well known that people from low socioeconomic backgrounds are less likely to breastfeed than others, thus potentially increasing health inequalities. Breast Benefits is a project working in secondary schools, reaching a target audience of young men and women aged 13–15 years living in areas of relative socioeconomic deprivation. This article gives a detailed description of the research process undertaken in order to develop a user-friendly education pack for use with young people aged 13–15 years. The project team included young people, educationalists, researchers, midwives and community workers. The findings from the pilot sessions show that young people were responsive to classroom sessions about breasts and breastfeeding, finding them interesting and informative. A key outcome of this work is an educational pack designed to assist teachers to stimulate cultural change by tackling the subject of both breasts and breastfeeding with young people. This research suggests that the devised teaching session will be effective in most state secondary schools, all of which will have a diverse student body.
Breastfeeding: different ethnic background, different perceptions?
Authors: Simmie Elizabeth
Published: May 2014

The objective of this quantitative study was to compare attitudes to breastfeeding of Asian and Caucasian mothers using a quantitative questionnaire including the 17 item Iowa Infant Feeding Attitude Scale (IIFAS). It is important in health promotion initiatives to emphasise the benefits of breastfeeding and to identify and address misconceptions within individual ethnic backgrounds as well as promoting breastfeeding to the population as a whole in order to increase rates of breastfeeding.
Stories as evidence: Why do midwives still use directed pushing?
Authors: Perez-Botella Mercedes , Downe Soo
Published: May 2014

This article uses story-telling techniques to describe and then reflectively analyse the practice of directed pushing in the second stage of labour. The practice is endemic despite evidence from formal research that it does not benefit women and babies, and, indeed, that it may be harmful. The lessons from the narrative account are discussed alongside the formal evidence base. The article is based on a student midwife's story of observing a midwife who used directed pushing to ‘manage’ the expulsive phase of labour in one case. Three specific aspects are discussed, namely the paradox of research-based evidence, trust policies, and professional skills and beliefs; technocratic monitoring and mechanical theories of childbirth; and issues of power and resistance. The intention is to highlight the potentially dramatic impact that story telling could have in the shaping of maternity services when constructively used as a tool to inform practice.

This is the first of a two-part series of articles that explore the issues around normality and the expulsive phase of labour. The second article will address the phenomenon of so-called ‘premature’, or ‘early’ pushing.
A public health role in perinatal mental health: Are midwives ready?
Authors: Ross-Davie Mary , Elliott Sandra , Sarkar Anindita , Green Lucinda
Published: May 2014

There is increasing awareness of perinatal mental health as a public health issue. The Government is keen for midwives to further develop their role in public health. Midwives need to be adequately prepared to take on a more developed role in perinatal mental health if practice improvements are to be made. The aim of this study was to identify any barriers to successful implementation by midwives of the recommendations from the Confidential Enquiries into Maternal Deaths aimed at reducing maternal deaths from suicide. This article describes a survey of midwives’ attitudes, knowledge and confidence in relation to perinatal mental health. The study used a quantitative survey method. A 29 item questionnaire was completed by 187 midwives working with one inner London Trust prior to attending a one day study day on perinatal mental health. Statistical analysis of the data was carried out using the SPSS (Statistical Package for the Social Sciences) software package. The study found that midwives are willing to take on a more developed role in relation to mental health but that they often lack training, knowledge and confidence in this area.
Pre-registration midwifery training: including learning disabilities
Authors: Gibson Tim
Published: May 2014

Government policy and legislation now oblige mainstream services, including midwifery, to consider the needs of people with learning disabilities in planning and care delivery. However evidence indicates that professionals are not always afforded the training required to enable them to provide effective care for this group. This article describes the development and initial delivery of two half study days on the BSc in Midwifery Studies. The aims of the half study days are to equip student midwives with the basic knowledge and skills to facilitate their care delivery to people with learning disabilities in general but in particular to parents with learning disabilities. The content of the half study days are set out along with a consideration of student evaluations and strategies to improve future delivery. It is hoped that this will stimulate debate regarding the best way forward in the provision of learning disabilities material within undergraduate midwifery education.
Why don't midwives ask about domestic abuse?
Authors: Buck Lisa , Collins Sally
Published: May 2014

Routine screening for domestic abuse in pregnancy is recommended and midwives are in an ideal position for this role. However due to an apparent reluctance to enquire about domestic abuse it often remains a hidden problem with detrimental consequences for women and their unborn children. The aim of this systematic review was to identify the most commonly reported factors that prevent healthcare professionals from routinely screening women for domestic abuse.

Six electronic databases were searched for all articles published in the English language up to January 2006. Data, including all the reported reasons for not screening for domestic abuse, were extracted from all the studies which met the inclusion criteria. A simple ‘vote-counting’ analysis was performed with graphical representation and calculation of weighted means. Thirteen papers met the inclusion criteria. The perceived barriers to screening appeared similar across a range of specialities and clinical settings. The most commonly cited factors were: lack of time, lack of training, and inadequate resources.

Domestic abuse remains a serious public health issue and is frequently exacerbated by pregnancy. Our results suggest that raising awareness of the issue should help midwives understand the need to prioritise screening and find the time required to do so. Encouragingly it also suggests that improving basic education and increasing access to simple resources, such as leaflets giving details of where to get support, may provide practitioners with the confidence required to ask women about domestic abuse.
Exploring autonomy in education: preparing student midwives
Authors: Baird Kathleen
Published: May 2014

The following article aims to describe the findings from a piece of research which examined whether a sample of senior midwifery students, close to registration, believed that their preregistration midwifery education had prepared, empowered and enabled them to be autonomous practitioners upon qualification. Most of the participants believed that their midwifery education had in the most part prepared them to be qualified midwives, but it had failed to equip them for professional autonomy. They believed that the concept and realization of midwifery autonomy had not been explicit enough in their educational programme. Any perceived barriers which the students felt inhibited qualified midwives from practising with professional autonomy will also be discussed, as many of the participants interviewed considered that they had only witnessed midwifery autonomy in midwiferyled birthing units and that it was almost invisible in obstetric led units. They considered that the medicalization of childbirth had prevented most of their midwifery mentors practising autonomous midwifery.
Beliefs and practices of postpartum infant care: review of different cultures
Authors: Abuidhail Jamila , Fleming Valerie
Published: May 2014

Cultural values and beliefs play an important role in the medical attention-seeking behaviour of postpartum mothers during the postnatal period. Infant care, similar to other human behaviours, is influenced by cultural beliefs so exploration of cultural beliefs and practices of infant care is essential (Mennella et al, 2005). This article reviews the literature surrounding postnatal infant care with particular focus on the beliefs and practices among different cultures. The purpose is to highlight the variety of cultural beliefs and discuss how these can influence practices (excluding breastfeeding) during the postnatal period. It should help midwives understand the basis for some women's cultural beliefs and practices regarding postnatal infant care.
Make or break: the importance of good mentorship
Authors: Miles Sarah
Published: May 2014

Student midwives not only have an enormous workload to contend with in order to obtain their degree, but they also have to tackle the hierarchical demands of the wards in which they train. Positive mentorship is essential in order that student midwives learn self-confidence, assertiveness and autonomy while providing woman-centred care. The rationale for writing this article came not only from the negative experiences of labour ward, but also from the many positive experiences that enable students to feel secure and welcome on their placement. However the subtle, or in some cases blatant, power games that are played on the wards serve to confuse, humiliate and belittle those who are in a vulnerable position. Mentors require valuable training and support from management and the universities in order that they do not take out their own frustrations on their students.
Should midwives wear uniforms? Let's ask the women
Authors: Baxter Jackie , Pride Jilly
Published: May 2014

This study was designed to ascertain the views of women during their experiences of childbirth in regard to the wearing of uniform by midwives at a central London teaching hospital. One hundred and fifteen women leaving the hospital following their postnatal stay were invited to complete a short questionnaire. A 91% response rate was achieved. The findings were evenly distributed. About half of the respondents were in favour of midwives wearing uniform. However, the other half of women considered uniform to be unimportant. Three main themes emerged from the written comments provided by the respondents: ‘professional identity', ‘as long as midwives are caring it does not matter what they wear' and ‘safety'. These findings will be useful to support policy making as the maternity unit moves into a new building in October 2008 when midwives will be expected to return to wearing nurse-type uniform.
Midwives' attitudes to smoking and smoking cessation in pregnancy
Authors: Randall Sue
Published: May 2014

This qualitative study used a phenomenological approach to explore seven midwives' attitudes towards smoking and smoking cessation in pregnant women. Purposeful sampling was used. Semi-structured interviews were undertaken for data collection, and a thematic analysis was used, based on Colaizzi's approach. Four themes emerged from the data: relationships; context of smoking; competing issues; and competence in smoking cessation. The themes of relationships, context of smoking and competence in smoking cessation correlate with existing literature. However, the theme of competing issues shows an aspect of the phenomenon not previously seen in midwifery or nursing literature. Further research on this may be beneficial.
Effectivness of cooling gel pads and ice packs on perineal pain
Authors: Navvabi Shahin , Abedian Zahra , Steen-Greaves Mary
Published: May 2014

This article reports the findings of a randomized controlled trial undertaken at the Hazrat Ommolbanin University Maternity Hospital in Mashhad, Iran, which investigated the effectiveness of localized cooling treatments to alleviate perineal trauma. From October 2005 to February 2006, 121 primiparous women who were at term and had an episiotomy were randomly recruited to one of three treatment groups (Group 1 – no localized cooling; Group 2 – Ice pack; Group 3 – cooling gel pad). The intensity of pain, wound healing and women's satisfaction levels were the main outcomes measured. The intensity of pain was measured by a Numeric Rating Scale (NRS) (1–10) and wound healing was evaluated by the REEDA scale within 4 hours of episiotomy repair; at days 1, 2, 5 and 10. The use of oral analgesia was measured at day 10. Women's satisfaction levels with oral analgesia and localized cooling treatments were also assessed at day 10 by a NRS.

There was evidence that localized cooling treatments are effective in alleviating perineal pain, which was in favour of the cooling gel pad group. A statistical significant difference was reported at 4 hours (P=0.003); day 2 (P=0.004); and at day 10 (P=0.044). At days 1 and 5 there was evidence of a reduction in the intensity of pain but this did not reach a statistical significant difference. A reduction in the use of oral analgesia was reported in favour of the cooling gel pad group (P<0.001). Women's satisfaction levels with oral analgesia were similar within the three treatment groups but a higher level of satisfaction when assessing localized treatment was reported by the cooling gel pad group (P‹0.001). Wound healing rates were also reported to be better in the cooling gel pad group when compared to the other two groups (P<0.001).

Women's views and treatments to alleviate perineal pain without any adverse affects on wound healing are important aspects of midwifery care. This trial has demonstrated evidence that localized cooling of the perineum reduces the intensity of pain. Women were more satisfied when applying cooling gel pads and this treatment appeared to assist in wound healing.
Nuchal cords: sharing the evidence with parents
Authors: Reed Rachel , Barnes Margaret , Allan Jan
Published: May 2014

The presence of a nuchal cord, where the umbilical cord is around the neck at the point of birth is a common occurrence, and checking for, and managing a nuchal cord has become part of routine midwifery practice. Whilst a tight nuchal cord is associated with some short-term morbidity, it is unclear whether such outcomes are actually a result of the presence of the nuchal cord itself, or as a result of clamping and cutting the cord. The action of looping a loose nuchal cord over the baby's head before the emergence of the body may also interfere with the normal physiology of birth. In addition women's experience of birthing a baby with a nuchal cord has not been explored. The association of nuchal cords with danger is embedded within our culture and influences parent's perceptions. Therefore, childbirth education needs to address the issues surrounding this commonly occurring situation.
Failure to void in labour: postnatal urinary and anal incontinence
Authors: Birch Linda , Doyle Patrick M , Ellis Roger , Hogard Elaine
Published: May 2014

The objectives was to identify the impact of intrapartum voiding on postnatal urinary and anal incontinence. A longitudinal, prospective, repeated measures, cohort study design was used. The study was set in one of the biggest and busiest acute NHS university teaching hospitals in the North West of England, which provides maternity care to over 4000 women each year. Primiparous women with no pre-existing disease (n=516) participated and were recruited after a normal 20-week gestation obstetric ultrasound scan.

Data was collected using validated questionnaires during the last trimester of pregnancy and postnatally at six weeks, six months and finally at one year. Obstetric and demographic data was extracted from case notes. This included age, body mass index, gestation, duration of labour, analgesia, birth weight, mode of delivery and perineal trauma. Statistical analysis was undertaken using Statistics Package for Social Sciences (SPSS version 13.0).

The main outcome measures were urinary incontinence symptoms and anal incontinence symptoms. Prolonged periods of time in labour without emptying the bladder was associated with increased rates of postnatal urinary incontinence (OR 2.36) and may also contribute to anal incontinence.

Postnatal urinary incontinence may be reduced if intrapartum bladder care policies reflect frequent emptying. This preliminary data supports large-scale exploration of the association between postnatal anal incontinence and bladder emptying in labour.
Kurdish women's experiences and perceptions of their first pregnancy
Authors: Shaho Ronak
Published: May 2014

There is limited information in current literature on the experiences of pregnant Kurdish women in Iran. The purpose of this study was to describe how these women experienced and perceived their first pregnancy and the meanings they attached to those experiences.

A qualitative study was carried out. Data were obtained from 15 women whose interviews were tape-recorded and transcribed. The women's experiences were varied and diverse. Most had difficulty coping with the physical and emotional symptoms of pregnancy. Physical effects, psychological effects, interaction with their husbands, babies, and relatives were the essential domains related to the experience of pregnancy.

Pregnancy is a difficult time for most women and midwives are in a position to make the experience more comfortable and satisfying for these women. Midwives should focus on preparing women for the often dramatic changes in pregnancy at their antenatal visits.
Vaginal birth as a rite of passage
Authors: Clift-Matthews Victoria
Published: May 2014

I watched with great interest a recent episode of Channel 4's One Born Every Minute. If you haven't seen it yet I recommend it because I found it compelling viewing. The particular episode I saw involved a young couple having their second baby and choosing a vaginal birth after having an emergency caesarean the first time around. The woman is post dates so an elective caesarean is booked but it is clear she is desperate to go into labour before this appointment because, she says, she felt she had ‘failed’ by not giving birth vaginally with her first child. She wants to be able to do ‘the one thing a woman's supposed to do’.
Reflexivity: a review of the literature in the context of midwifery research
Authors: Lambert Carol , Jomeen Julie , McSherry Wilfred
Published: May 2014

This article critically examines the existing midwifery literature associated with reflexivity. Reflexivity is a widely accepted concept central to qualitative research methodology. The importance of this process is highlighted demonstrating how it remains an integral part of ensuring the transparency and quality of research inquiry. This article sets out to review the literature; expand the concept of reflexivity from a midwifery perspective and reinforces the need for practitioner researchers to gain understanding and acknowledge reflexivity. This will ensure strong and trustworthy inquiry and allow the researcher to explore and make sense of the relationship between themselves, the research and the object of research.
Developing an interactive electronic maternity record
Authors: Homer Caroline SE , Catling-Paull Christine J , Sinclair Dee , Faizah Nor , Balasubramanian Venki , Foureur Maralyn J , Hoang Doan B , Lawrence Elaine
Published: May 2014

Women have a strong need to be involved in their own maternity care. Pregnancy hand-held records encourage women's participation in their maternity care; gives them an increased sense of control and improves communication among care providers. They have been successfully used in the UK and New Zealand for almost 20 years. Despite evidence that supports the use of hand-held records, widespread introduction has not occurred in Australia.

The need for an electronic version of pregnancy hand-held records has become apparent, especially after the introduction of the Electronic Medical Record in Australia. A personal digital assistant (PDA) was developed as an interactive antenatal electronic maternity record that health-care providers could use in any setting and women could access using the internet. This article will describe the testing of the antenatal electronic maternity record.
Childbirth practitioners' attitudes to third stage management
Authors: Downey Candice , Bewley Susan
Published: May 2014

Although the effects of delayed cord clamping are well documented and numerous health-care organizations recommend it as part of the management of the third stage of labour, there is little evidence that the practice occurs in the hospital setting. The aims of this project were to ascertain both the level of knowledge and the common third stage practices of obstetricians, midwives and neonatologists using a questionnaire at a London foundation trust. The results show that, despite the recommendation of delayed cord clamping in the local guideline, early cord clamping is still routine practice among maternity staff practising active management. In order to optimize neonatal care, guidelines need to include objective definitions of early and delayed cord clamping, and the rationale behind recommendations.
Using service-users' views to design a maternal obesity intervention
Authors: Khazaezadeh Nina , Pheasant Hannah , Bewley Susan , Mohiddin Abdu , Oteng-Ntim Eugene
Published: May 2014

Obesity is increasingly a matter of concern in the general population, but maternal obesity has received limited emphasis compared to adult and childhood obesity. In addition there is a lack of evidence regarding service users' views.

A qualitative study was conducted to identify and understand the health-care needs of service users in Lambeth in south-east London. Semi-structured interviews were conducted with six obese pregnant women and three obese women trying to conceive.

The lack of awareness of obesity as well as the lack of existing services was acknowledged. The need to develop and implement evidence-based care pathways which focus on improving the identification and management of obesity and include a community-based multi-component, and culturally sensitive intervention was recommended.

This feasibility study has highlighted key issues raised by women given the limited evidence of effectiveness around interventions for this target group.
Midwifery students' significant birth stories: Telling the drama, Part 1
Authors: Weston Rosalind
Published: May 2014

This article presents the first part of a narrative inquiry which aimed to explore the value students place on storytelling, and the significant birth stories they hear and tell during their midwifery programme. Here the findings of the analysis of the significant ‘birth stories’ are explored. Participants consisted of five final-year midwifery students, on a 3-year BSc (Hons) midwifery programme in 2007, from one university in the south east of England. Data were collected through two focus groups, and analyzed narratively. Four types of ‘story-telling’ themes emerged, each with a different learning purpose: dramatic stories helped to affirm students' decision-making in practice; humorous stories, embedded in memories, are deliberately retold to help other students ‘not to take anything for granted’ in practice; emotional and traumatic stories facilitate reflection on practice; and lecturers' well-told stories influence students' practice beyond the original telling. The findings suggest that stories do assist students to link theory to practice and facilitate deeper learning. They have implications for students, midwifery mentors and lecturers.
Ideals, expectations and reality: Challenges for student midwives
Authors: Barkley Angela
Published: May 2014

This article looks at the way in which student midwives begin their training with certain expectations and ideals about the normality of the birth process. It considers how these expectations can be challenged by the reality of the hospital/medical environment, and considers whether students adapt their expectations accordingly. This article considers the challenges of promoting and practising normal birth against an increasingly medical backdrop, and examines culture within midwifery and in particular how this can affect student midwives.
Relational continuity as a model of care in practical midwifery studies
Authors: Aune Ingvild , Dahlberg Unn , Ingebrigtsen Oddbjørn
Published: May 2014

Objective: To gain insight into how continuity of care can increase student midwives’ understanding of midwifery, with emphasis on the promotion of normal pregnancy, childbirth and postnatal period. Design/setting: A pilot project at Sør-Trøndelag University College. Six student midwives provided continuity of care to 58 women throughout their pregnancy, childbirth and postnatal period. The students, under the supervision of a clinical midwife, worked in pairs during the antenatal care, in groups during antenatal classes and individually during childbirth and the home visit. A group interview with the six student midwives, based on a focus group technique, was conducted at the end of the project. Qualitative data were analysed through systematic text condensation. Findings: The findings include three main themes: relational continuity, personal development and health-promoting perspective. By offering relational continuity, the students experienced interdependent trust and partnership. This resulted in personal development based on mastering skills and relational learning. The students became aware of the importance of individual care, holistic care and empowerment and understood midwifery through a health-promoting perspective. Conclusions: To achieve high quality midwifery skills, student midwives would benefit from experiencing relational continuity in their practical studies. This continuity promotes interdependent trust and partnership with the women in their care. Follow up through continuity of care gives the students more meaningful practice and results in personal development for the students and health promotion in midwifery.