bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventing readmissions: are we doing enough?
Authors: Naumann David N , Quinn Morgan , Sivanesan Sarrumathy , Farooq Umar , Hendrickse Charles W , Bowley Douglas M
Published: May 2014

Readmission to hospital within 30 days of discharge impacts adversely on patients’ wellbeing, and increases treatment burdens in terms of human resources, logistics and cost. This is a retrospective review of consecutive surgical admissions to a single NHS unit readmitted to the same facility within 30 days of index admission between April and July 2012. Admission diagnosis was evaluated to determine whether readmission was for pathology related to initial presentation. Readmissions were categorised as unavoidable or potentially avoidable. Of 2036 general surgery admissions, 181 out of 2036 (8.9%) were coded as readmissions. 104 out of 181 (57%) were for the same pathology, or complication of the initial index presentation (potentially avoidable readmission); 77 out of 181 (43%) readmissions were planned or were for pathology unrelated to index diagnosis. Overall, the potentially avoidable admission rate was 104 out of 2036 (5.1%). Potentially avoidable readmissions were more likely if the index presentation was an emergency (p < 0.001). Most surgical readmissions within 30 days are potentially preventable without additional resources. A minority of readmissions are due to inaccurately coding. The identification of patients at high risk for readmission, focus on coding, improved patient information, adequate initial treatment, adequate symptomatic relief on discharge, and comprehensive follow up is required to reduce readmission rates, especially following emergency admissions.
Administering long-acting antipsychotic injections
Authors: Hemingway Steve , Covill Carl , Holliday Lindsay
Published: May 2014

This is the first of two articles. It introduces the background to a workshop to update mental health nurses toward competently administering long-acting intramuscular injections. The art and science of administering intramuscular injections is a complex activity for the nurse to perform, thus key issues in doing so are discussed.
A guide to intermittent self-catheterisation
Authors: Nazarko Linda
Published: May 2014

The mental health nurse often provides care and support to people who have conditions that affect psychological and physiological wellbeing. People who have neurological and long-term conditions may have bladder voiding problems. NICE (2012a) recommends that intermittent self-catheterisation (ISC) should be used in preference to an indwelling catheter if it is clinically appropriate and a practical option for the patient. Individuals who have reasonable bladder capacity and sufficient dexterity and motivation can regain control of their bladder using ISC. However, the prospect of introducing a urinary catheter into the bladder several times a day can pose physical and emotional challenges ( Logan et al, 2008 ). The mental health nurse who has a good knowledge of ISC can help the person with voiding problems to overcome these challenges and promote wellbeing.
The management of challenging behaviour and cognitive impairment
Authors: Braine Mary E
Published: May 2014

The area of management of challenging behaviour is under-researched and often inadequately addressed in the holistic care of the neuroscience patient. This paper outlines a framework by which to manage such patients, offering practical suggestions about how to manage these patients to improve outcomes and quality of life. The proposed framework emphasizes the importance of a comprehensive clinical assessment when formulating a management plan of environmental and behavioural strategies, before any pharmacological intervention should be considered. Continual assessment is crucial to the framework, along with multidisciplinary working and appropriate staff training and education.
The minimal and appropriate use of physical restraint in neuroscience nursing
Authors: Braine Mary E
Published: May 2014

This paper's aim is to address some of the issues concerning the use of physical restraint in the neurosciences setting. Although it is recognized that the evidence base for deploying physical restraint is sketchy, with little evidence to support the efficiency or safety of restraint, it is recognized that other specialties such as learning disability and rehabilitation have much to offer neuroscience in this area of practice. Some of the key issues concerning the use of physical restraint will be explored. These include consent to treatment, human rights, incapacity common law and treatment of necessity. The common types of restraint devices are also discussed along with some issues to consider in practice. Other factors associated with the use of physical devices such as risk assessments and education of staff are also discussed. Finally, areas for future research in this complex, increasingly legislative-led area of practice are suggested.
Considering the physiological and psychological consequences of spinal cord injury
Authors: Chen Hsiao-Yu , Boore Jennifer RP
Published: May 2014

Spinal cord injury has a wide variety of severe physiological and psychological consequences for those affected and changes a person′s accustomed life style significantly. Nurses involved in the rehabilitation of such patients need to consider a variety of issues, including the physical, psychological, social, sexual, and spiritual needs of clients. Relationships with family members and intimate partners are also critical to the success of rehabilitation. This article considers the physiological and psychological effects of a spinal cord injury. A discussion of approaches to care delivery that can maximize a client′s ability to adapt his/her life style to the injury is set in the context of nursing as practised in the authors′ respective countries, Taiwan and the UK.
An investigation of patients and providers′ views of services for motor neurone disease
Authors: Brown Janice B , Lattimer Valerie , Tudball Tracey
Published: May 2014

The aims of this study were to investigate whether health and social care services met the needs of patients with motor neurone disease (MND) and their carers, to explore their preferences for service delivery and to compare these preferences with the services provided locally.

Design

: Structured interviews were conducted with 11 patients and 9 family carers living in three counties in southern England. A questionnaire survey of 17 commissioners from primary care trusts and social care was undertaken to collect detailed information about the scale and scope of local services.

Results

: Patients and carers consistently praised professionals′ efforts but identified deficiencies in professionals′ knowledge of MND and the organization of health and social care services, including the availability of key workers, respite care and specialized equipment, the speed of services, counselling and emotional support, and patients and families′ limited involvement in service evaluation.

Conclusions

: The three most important ways of improving services for patients with MND and other life-limiting neurodegenerative diseases would be the introduction of knowledgeable, specialist primary neurological care teams; a requirement for interprofessional and multi-agency cooperation; and active involvement of patients and carers in service development.
BOOK REVIEWS
Authors: Fitzpatrick Maria
Published: May 2014

I read Andy McCann's book on a brief break on the south coast. As a June 2004 stroke survivor, I wondered at the outset whether it was really the right kind of holiday reading. However, I swiftly found the account of a sudden, unexpected life change compelling, informative, enjoyable and, perhaps, above all, a positive experience.
The nursing management of children with severe traumatic brain injury and raised ICP
Authors: N Tume Lyvonne
Published: May 2014

Traumatic brain injury remains the greatest cause of death and disability in children worldwide. The children's intensive care nurse plays a key role in the prevention of secondary injury in these children, which can ultimately affect patient outcome. This article discusses the pathophysiology of paediatric brain injury and provides a framework for the intensive care nursing of these children. The pragmatic approach taken highlights the neurophysiological rationale and evidence base (where available) for key nursing interventions. A clear understanding of the neurophysiology is crucial for nurses working with children with traumatic brain injuries so that effective care can be given.
An introduction to neuroethics: Part 1. The values of ethics and the neurosciences
Authors: Stanley Robert , Gallagher Ann , Eberhardie Christine , Wainwright Paul
Published: May 2014

This is the first in a series of seven articles that comprise an introduction to the understanding and application of ethics in the neurosciences. Neuroethics encompasses the ways in which developments in neuroscience intersect with social and ethical issues. There is no universal definition of neuroethics, although two broad categories of issues can be discerned: those emerging from what we can do and those emerging from what we know. Ethical problems follow from advances in neuroimaging, psychopharmacology, brain implants and brain-machine interfaces, but are also raised by growing understanding of the neural basis of behaviour, personality, consciousness, and transcendent states.

This series of articles is intended to help practitioners explore neuroethics in their own practice. In this first article, advances in neuroscience are described and the need for ethical inquiry in the subject is discussed. Definitions of neuroethics are considered, as are implications for nursing practice. Several questions are raised, including: Should we limit the degree to which we can use neurological information in evaluating individuals in regulatory, legal, medical or commercial contexts? Should we undertake certain kinds of neuroscience experiments in view of the possible misuse of the results? How should we discriminate between treatment (medication to treat depression) and enhancement (medication to improve cognition in a person of normal intelligence) What does it mean to have a brain?
The perioperative management of thymectomy in myasthenia gravis: an overview
Authors: Jacob Saiju , Viegas Stuart , Hilton-Jones David , Willcox Nick
Published: May 2014

Myasthenia gravis is an autoimmune disease affecting the neuromuscular junction, which produces fatiguable weakness. Treatment of this condition includes cholinesterase inhibitors, immunosuppressive therapy and/or thymectomy. Optimal perioperative management of thymectomy is crucial in achieving favourable outcomes postoperatively and in the control of myasthenia. This article reviews the basic principles of thymectomy and its perioperative care with respect to myasthenia.
Prospective evaluation of a nurse-led headache service in a sub-regional neurology unit
Authors: Clarke Carl E , Edwards Julie , Nicholl David , Sivaguru Arul , Furmston Alexandra , Davies Paul
Published: May 2014

A sub-regional neurology unit hired a nurse trained in headache management to diagnose migraine, tension-type headache and medication-overuse headache, as well as advise general practitioners on treatment and collaborate with consultant neurologists in managing other headache disorders. Over 2 years, the nurse saw 1347 new referrals. Most patients had migraine (47%) or tension-type headache (41%) and could be managed by the nurse according to protocols from the British Association for the Study of Headache (BASH). The proportion of patients requiring neuroimaging fell from 29% to 13%. Of those patients with migraine returning for a first follow-up appointment with the nurse, signifi cantly more reported some degree of improvement (n=140, 50.4%) than deterioration (n=43, 15.5%) (P<0.001, binomial test). Similarly, signifi cantly more patients with tension type headache reported some improvement (n=56, 47.5%) compared to deterioration (n=5, 4.2%) (P<0.001). The nurse-led service abolished waiting times exceeding 13 weeks and reduced waiting times for all neurology patients. This work shows that a nurse-led headache service can safely and effectively treat migraine and tension-type headache leading to reduced waiting times for all neurology patients.
Reviewing the application of the Glasgow Coma Scale: Does it have interrater reliability?
Authors: Baker Mark
Published: May 2014

This article explores if the Glasgow Coma Scale (GCS) has interrater reliability. The GCS was proposed as a tool that could be used with confidence by a range of healthcare practitioners. For this to be true the agreement between persons using the GCS should be consistent. This study investigates the evidence to assess if this is the case. This was undertaken with a systematic literature review of mainly electronic journals and healthcare databases. It remains unclear if the GCS has interrater reliability: the evidence base does not show agreement between researchers. Recent research is inconsistent not only in its conclusions but also its research methodologies. The uncertain research relating to interrater reliability contradicts the fundamental principle of the assessment tool (that it could be used with confidence by a range of healthcare professionals). The use of the GCS in adult nursing should be done with the knowledge that the evidence base supports the practitioner. As a result authoritative research is required to assess if the GCS has IR reliability. This is overdue, especially in the UK where the GCS has been part of formal guidance for several years.
The importance of nutrition support in the head-injured patient
Authors: Whitehurst Emma
Published: May 2014

The nutritional requirements of head-injured patients are significantly increased. This is related to the hypermetabolic and hypercatabolic response to head injury, and is multifactorial. Head-injured patients are at high risk of malnutrition, due to raised nutritional requirements and the likelihood of neurological deficit affecting the ability to take in sufficient nutrients orally. Early and often prolonged nutrition support is needed to improve clinical outcomes in the head-injured population. Nutrition support may be oral, or via artificial means depending on the needs of the individual. Adequate nutrition support relies heavily on appropriate screening and monitoring. The commitment of the entire multidisciplinary team is needed to ensure that nutrition support measures in the head-injured patient are successful. Nursing staff play a key role in nutritional care; nutrition link-nurses are particularly valuable in ensuring that good nutritional care is given.
Advances in brain tissue oxygen monitoring: Using the Licox system in neurointensive care
Authors: Helliwell Roni
Published: May 2014

The care and management of a traumatic brain-injured patient continues to present many challenges to the bedside practitioner. As technology is integrated into intensive care management it has become clear that maintaining conventional intracranial pressure and cerebral perfusion pressure levels will not always prevent cerebral ischaemia.

The Licox Brain Tissue Oxygen Monitoring System offers a direct, accurate, real-time, regional partial pressure measurement of oxygen levels in brain tissue. The information gained from this monitoring system will provide an early warning of oxygenation problems that can contribute to secondary injury. When Licox is used in combination with other neurointensive care monitoring parameters it can help inform the bedside practitioner in making decisions about the choice of interventions and in assessing their effectiveness.
Developing care pathways for hospice and neurological care: Evaluating a pilot
Authors: Day Rebecca
Published: May 2014

A project was undertaken to develop and pilot care pathways for Sue Ryder Care at Leckhampton Court Hospice, Cheltenham. The project's aims were to produce service user-centred, evidence-based, multidisciplinary health care records which would support and inform the development of palliative care pathways and be subject to evaluation. Following the collaboration of a multidisciplinary focus group and service user involvement, a total of five care pathways were developed. Four of these have been piloted over a 6-month period. This article describes the development process for developing and evaluating the care pathways, identifies their potential benefits and makes recommendations for the future use of care pathways for patients in hospice and neurological care settings.
Spasticity management, part 1: An educational approach to person-centred care
Authors: Keenan Elizabeth
Published: May 2014

Spasticity is a common symptom of neurological diseases in cerebral palsy, multiple sclerosis, traumatic brain injury, stroke and spinal cord injury. Spasticity is only one component of upper motor neurone syndrome and often coexists with weakness, spasms, stiffness, fatigue and reduced dexterity. Spasticity occurs when there is an imbalance between inhibitory and excitatory signals from the spinal cord and brain. The combination of these positive and negative features makes the assessment and management of each patient unique. Spasticity is complex and requires careful evaluation within a multidisciplinary team. Nurses, doctors, physiotherapists and occupational therapists work together through educating the person, carers and family on a variety of treatment options tailored uniquely to the individual person's needs.
Support for people with tremor and movement disorders
Authors: Salmon Geoff
Published: May 2014

As the longest running charity offering help for people with neurological movement disorders, the National Tremor Foundation helps many people with essential tremor, their families and carers
High-profile case highlights issues surrounding assisted suicide
Authors: Shepherd Charles
Published: May 2014

Dr Charles Shepherd considers the current law on assisted suicide in light of the case of Kay Gilderdale, the mother of Lynn Gilderdale, an ME sufferer who died in 2008.
Supporting people who have a changed appearance
Authors: Borwick Gemma
Published: May 2014

People who have been disfigured as the result of a neurological injury need support to address the psychosocial impact of a changed appearance. Gemma Borwick explains
Excessive daytime sleepiness in a prevalent population of people with Parkinson’s disease
Authors: W Walker Richard , Hand Annette , L Cookey Ibifuro , K Gray William
Published: May 2014

Background: The aim of this study was to evaluate the extent and nature of sleep problems in a community-dwelling cohort of people with Parkinson’s disease (PD).

Methods: Cases were identified from a prevalence study. Participants were assessed for excessive daytime sleepiness using the Epworth sleepiness scale and were also asked a series of questions related to their nocturnal sleep pattern. They were also assessed using a number of standard rating scales. These included the Unified Parkinson’s Disease Rating Scale, the 39-item Parkinson’s Disease Questionnaire, the Mini-Mental State Examination and the Hospital Anxiety and Depression scale.

Results: Of 75 participants, 31 reported the quality of their sleep to have deteriorated since being diagnosed with PD (41.3%), 20 participants had excessive daytime sleepiness (26.7%). Excessive daytime sleepiness was significantly associated with greater disease progression, reduced cognitive function, lower quality of life and greater depression. Excessive daytime sleepiness was only weakly associated with a report of a deterioration in the quality of sleep.

Conclusions: Excessive daytime sleepiness is a common problem in people with PD and is associated with a range of other motor and non-motor symptoms.
Measuring behavioural outcome in neurodisability
Authors: Alderman Nick , Knight Caroline , Stewart Inga , Gayton Anita
Published: May 2014

Development of performance indicators to demonstrate clinical efficacy of neuropsychiatry services are in their infancy. Lack of homogeneity within clinical populations necessitates services to compile a basket of appropriate outcome measures, including provision for serious challenging behaviour where appropriate. At present, service level indicators for aggression are lacking. In this paper, the validity of compiling a performance indicator using an observational rating scale for aggression already employed in everyday clinical work is examined. Routine data collected using the ‘Overt Aggression Scale—Modified for Neurorehabilitation’ for 79 patients with acquired brain injury or dementia over a six month period were examined. Two performance indicators were created, one based on frequency of aggression, the other an aggregate score which combined frequency and severity. An indicator reflecting frequency did not demonstrate compelling evidence that aggression was well managed and suggested this behaviour worsened in the case of patients with progressive neurological conditions. However, one that incorporated the multivariate characteristics of aggression succeeded in reflecting convincing change at service level. It was possible to develop an appropriate service level performance indicator from an existing measure with proven psychometric properties. Additional advantages in savings in financial costs and diverting staff from clinical activities are highlighted.
The role of the multiple sclerosis specialist nurse in counselling patients at diagnosis
Authors: White Bradley
Published: May 2014

Multiple sclerosis (MS) is a chronic, progressive, immune-mediated disorder of the central nervous system ( Compston and Coles, 2002 ; Fitzner and Simons, 2010 ) that affects an estimated 100 000 people in the UK ( Multiple Sclerosis Society, 2012 ). With an unknown aetiology, unpredictable course and debilitating effects, MS has a significant impact on patients’ lives, affecting many areas of functioning. MS specialist nurses play an integral part in helping patients and their families come to terms with their diagnosis as well as in facilitating their adjustment to the disease. This article describes the role of the MS specialist nurse in providing support to patients and their families from the moment of diagnosis and throughout treatment.
Research Roundup
Authors: Storey Stacey
Published: May 2014

Stacey Storey 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.
Digital removal of faeces in the bowel management of patients with spinal cord injury: a review
Authors: Solomons Jon , Woodward Sue
Published: May 2014

Bowel dysfunction is frequently reported to be a leading cause of reduced quality of life following a spinal cord injury (SCI). There are numerous interventions for neurogenic bowel dysfunction, of which digital removal of faeces is one of the most commonly performed. It is imperative that nurses in the community and acute settings are trained and able to carry out digital removal of faeces when indicated. Failure to provide this care can have serious consequences for the patient, including faecal incontinence, bowel obstruction and autonomic dysreflexia. This literature review assesses the quality of evidence available on digital removal of faeces for people with SCI. It concludes that digital rectal removal of faeces remains a necessary intervention for many patients. More research and training are needed on this and other interventions for neurogenic bowel management. The low status of bowel care in nursing and wider society needs to be challenged so that people with SCI can benefit from high quality bowel care and associated improvements in quality of life.
Developing an integrated care pathway: the process and its application to neurological conditions
Authors: Peel Charlotte , Thomas Sue , Worth Paul
Published: May 2014

There is increasing recognition that integrated services provide improved quality and cost-effective care ( Ham, 2011 ; Ham and Curry, 2011 ; Goodwin et al, 2012 ). This article outlines the steps taken to create an integrated care pathway for people living with Parkinson's, a process that could be transferred to benefit those living with other neurological conditions. The impetus for this work followed increasing national interest in how services delivered by multiple service providers and professionals could be improved, and financial efficiency gained, while also optimising quality of care for those living with Parkinson's. The project sought both to create an effective integrated care pathway benefiting those living with a given condition within a specific area and then to understand how this process could be replicated for other areas and conditions.
Managing urinary incontinence after stroke
Authors: Woodward Sue
Published: May 2014

Urinary incontinence affects 40–60% of people following stroke and can cause distress for patients and their families, affecting quality of life, skin integrity and carer burden. There is evidence that professional input through structured assessment and management of care, together with the involvement of specialist continence nursing services, may reduce urinary incontinence and related symptoms after stroke. This paper discusses the normal physiology of micturition, the effect of stroke on bladder control, and assessment and management of urinary incontinence following stroke.
Evaluating Qualitative research
Authors: Bluff Rosalind
Published: May 2014

This article is designed to provide guidelines to assist midwives in evaluating the qualitative research studies. Criteria for evaluating quantitative are frequently applied to qualitative methodolgies and this is inappropriate. To provide effective care for mothers and babies midwives need to be able to critically evaluate qualitative as well as quantitative research.
Breastfeeding and sexuality: societal conflicts and expectations
Authors: Hall Jennifer
Published: May 2014

It is assumed that breastfeeding failure is due to practical difficulties. This article explores some of the issues relating to culture and female sexuality that influence the woman in her choices and ability to feed.
Oral intake in labour: Nottingham's policy formulated and audited
Authors: Newton Carol , Champion Penny
Published: May 2014

After critically examining the literature and finding a lack of evidence to support starving all laboring women, a policy was written supporting women's choice to eat and drink in normal labour. Standards were set and audited. This article described the process.
Of mice and men: effects of drugs in the womb
Authors: Robinson Jean
Published: May 2014

Some mice are smarter than others, and it was the brighter ones — types CD-1 — That they used for the tests in Oklahoma (Rayburn et at, 1997). Readers who cannot bear the thought of research on animals can switch off here. Not that anything too awful happened to the mice.
Just how bad is midwifery training? The lessons of CESDI
Authors: Robinson Jean
Published: May 2014

‘There were gross CTG abnormalities, worsening in the hour leading up to full dilatation. The midwife seemed concerned, sought the senior house officer (SHO), but took it no further.’
The Danger of Sponsorship in Midwifery
Authors: Broadfoot Mary , Rampersad K Nadia
Published: May 2014

Why do commercial companies want to sponsor charities? The answer is that they can see a benefit for the company — that is, their profits will increase. Commercial companies must make money for their shareholders. The Inland Revenue does not view sponsorship as a gift. And the Charity Commission, who oversee the activities of charities in England and Wales, cautions charities to take great care before entering into a sponsorship agreement, especially where the charity's name or logo is to be used by the commercial company.
The birth plan game
Authors: Robinson Jean
Published: May 2014

Sometimes I read an article that niggles away at the back of my mind and won't go away. I push it to one side because there are more urgent things to do, but it keeps buzzing around because the issues it raised are still there and I haven't digested them. Maybe I'm prevaricating because I found the research results uncomfortable. Perhaps midwives found one report as challenging as I did, because despite its importance, there has been remarkably little discussion.
Education for change, change for midwifery education
Authors: UKCC The
Published: May 2014

The UKCCs report Fitness for Practice contains 33 recommendations based on the mass of evidence collected by the UKCC Commission for Nursing and Midwifery Education. Most of them can realistically be implemented within 2-3years.
Nutrition in pregnancy: knowing the facts
Authors: Allen Rose , Burke Margaret
Published: May 2014

A woman's nutritional status can influence maternal, fetal and neonatal wellbeing (Liljestrand, 1999; Wynn and Wynn, 1994). Therefore it is important that midwives have current evidence to convey to women about appropriate nutritional requirements which contribute to a successful outcome of pregnancy.
The effect of selective visiting on maternal anxiety
Authors: Poole Michelle
Published: May 2014

This study considered the effect of selective visiting on anxiety levels of mothers during the first seven days of the postnatal period. Seventy-eight mothers discharged into the locality before the seventh postnatal day were invited onto the study. Both the mothers and the midwives were asked to complete separate questionnaires. The data from 46 responses show that there does not appear to be an effect on mean anxiety levels of mothers who are selectively visited in this initial early period.
The benefits of breastfeeding for the infant
Authors: Bick Debra
Published: May 2014

There is some evidence that ingestion of breast milk protects the infant against certain infectious and non-infectious conditions. Evidence of protection against other conditions and conferred intellectual advantage is inconclusive. It is important that midwives are aware of current evidence to inform the advice they give to women on infant feeding. A narrative review of the evidence was carried out following a critical assessment of the literature. Studies published within the last 10years were selected and included if they fulfilled specified checklist criteria. Following critical assessment of the literature, study results were categorized as either ‘established benefit’ or ‘possible benefit’. Established benefits of ingestion of breast milk include protection against gastrointestinal infection, otitis media and necrotising enterocolitis. Further evidence is required of a protective benefit against urinary tract and lower respiratory tract infection, childhood diabetes, Sudden Infant Death Syndrome and conferred intellectual advantage. Assessing the advantages of breast milk ingestion for infant health and development is complex due to the many potential confounding factors which could bias results. Large, longitudinal cohort studies, which take account of all potential confounding factors are required. There is currently, however, sufficient evidence of a protective benefit to recommend that infants should be breast-fed for a minimum of four months.
Complimentary medicine and pregnancy
Authors: Dover Clare
Published: May 2014

Complementary therapies are playing an increasing role in pregnancy and childbirth. Herbal and homeopathic remedies are seen as less harsh than traditional medicines; osteopathy has an important role in relieving backache; hypnosis can dull pain and calm fears; acupuncture can be used in pain relief by stimulating the production of endorphins which act as natural painkillers, and aromatherapy and reflexology provide stress relief. All branches stress the importance of not triggering premature contractions.
Involving the user in midwifery research
Authors: Mitchell Mary , Salmon Debra
Published: May 2014

More than ever before, policy decisions in relation to maternity services are shaped by the views of the women who use them. A central part of this process has been to use research as a way of eliciting a user perspective. This article argues that a more creative and inclusive approach to research could be taken, in which women users themselves shape the research process through active involvement. This would be particularly beneficial to those groups often shown to be marginalized by maternity care.
Postnatal perineal care and the effects on sexuality
Authors: Jackson Karen B
Published: May 2014

Long term perineal pain and dyspareunia can affect 20% of women who have sustained perineal trauma (Kettle and Johanson 2000). This can have a profound effect on a woman's self esteem, her body image and ultimately on her most intimate relationships. In the last article, discussion centred around prevention of trauma, perineal care during labour and delivery and issues surrounding repair of the perineum. This article will focus on care of the perineum in the postnatal period, including reducing perineal pain, use of analgesia, and effects on sexuality.
Critical incident analysis of the third stage of labour
Authors: Clements Cathy
Published: May 2014

Critical incident analysis is a method of reflective practice that enables a particular topic to be studied in great detail. Under the headings and guidance of Gibbs’ reflective cycle (Gibbs, 1988), the management of the third stage of labour has been carefully analysed, criticised and discussed. Active management of third stage has become almost routine practice in many maternity units, with professionals justifying their actions by acknowledging the potential risk of postpartum haemorrhage. It is interesting to discover that women can perhaps tolerate a greater blood loss than previously thought and it must be accepted that the entire birthing process involves normal physiological events that have evolved for a good reason. While it is imperative that safety of mother and baby remain the priority, woman-centered care and informed choice should form the basis of all midwifery practice.
Part five: Why we should reject the bed birth myth
Authors: Walsh Denis
Published: May 2014

The ‘bed birth myth’ has been propagated by the professionals for their own convenience and has disenfranchised generations of women whose ancestors knew well the advantages of mobility and upright postures for parturition. A revolution is needed in delivery suites across the country to restore a facilitatory birth environment and the adaptation and/or removal of all beds would be a simple but symbolic first step.
Using over the counter medication in pregnancy
Authors: Young Felicity
Published: May 2014

Many medications, especially those used for the common ailments experienced by maternity clients, are freely available to buy without a doctor's prescription or the supervision of a pharmacist. Pregnant women may choose to use drugs without being aware of the relevant safety concerns, and without having immediate access to pertinent advice regarding the suitability of the drug. This article aims to highlight the professional responsibility that midwives have for ensuring the safe and appropriate use of medication in pregnancy and when breast-feeding. Examples of drugs used to treat minor pregnancy-related health problems will be used to illustrate the midwife's role in assisting women to make safe choices.
Intimate examinations: the complexities of consent
Authors: Robinson Jean
Published: May 2014

The Royal College of Obstetricians and Gynaecologists (RCOG) is preparing a report on intimate examinations. I wish them luck. Many doctors who think women are being ‘difficult’ or ‘uncooperative’ don't seem to realise that the patient was fine until she had a nasty experience with one of their colleagues, maybe years before.
One-to-one midwifery practice part 1: setting the scene
Authors: Stevens Trudy , McCourt Christine
Published: May 2014

Although proposing attractive women-centred services, the recommendations of Changing Childbirth (Department of Health, 1993) have been criticised for ignoring the needs of midwives who would staff them. Continuity of carer schemes place higher demands on midwives to be available for women; many doubted if they would be prepared or able to work this way. This is the first in a series of four articles reporting on a study of individual case load midwifery practice within an urban maternity service. The findings suggest that this model attracted midwives who, frustrated and disillusioned with conventional styles of practice, might otherwise have left the profession. After having mastered an initial ‘steep learning curve’, the midwives relaxed and reported immense satisfaction from working this way. They considered they were finally working as ‘real midwives’. In this paper we define the model of practice and study details, ‘setting the scene’ for the subsequent papers which examine the nature and implications of individual case load midwifery for practitioners.
Community midwifery support workers
Authors: Crowther Sue , Spiby Helen , Morrell C Jane
Published: May 2014

The role of community midwifery support worker was developed to provide the new social support intervention evaluated in a large randomised controlled trial. This new role had a specific training programme developed using an National Vocational Qualification framework. The role had a woman-centred approach to assist mothers in the early postnatal days. Considerations of the organisation of the work, management, support and safety for these workers are described.
Postnatal depression:can midwives help?
Authors: Bott Jane
Published: May 2014

Postnatal depression (PD) is probably the most common complication of the puerperium. According to all the available evidence, the prevalence is at least 10% (Lawrie et al, 2000). While the postnatal period appears to be a particularly significant time, the whole childbearing period is in fact associated with a sharp increase in the prevalence of both psychotic and non-psychotic affective disorders (Department of Health, 1998). The effects of PD may be devastating for the woman and her family. This article will update midwives in relation to the effects of PD, highlighting the need to develop practice to ensure as far as possible that these effects are minimised. Ways in which midwives can make a difference will be explored. By developing their understanding of PD, midwives will be in a better position to provide individualised, women-centred care.
Are midwives losing the art of keeping birth normal?
Authors: Walsh Denis
Published: May 2014

Why do some women have days of early labour and others give birth within four hours? Why do some women want to push early in labour? Why do some women's contractions stop in second stage? Does it matter if all or none of the above occur?
Practice recommendations for managing shoulder dystocia
Authors: McGeown Pat
Published: May 2014

Although a relatively rare event, shoulder dystocia was directly responsible for up to 8% of intrapartum deaths (CESDI 1997; 1998) and two thirds had avoidable factors in their management. These findings and the epidemic of litigation cases associated with shoulder dystocia highlights the urgent need to review our practice and practice guidelines. This article considers some of the discussions arising from the multidisciplinary perinatal forum held by the West Midlands Perinatal Institute focusing on obstetric emergencies.
Interactive multimedia in midwifery education
Authors: Furber Christine
Published: May 2014

This article describes how collaboration in a European project has initiated the development of interactive learning using information technology in pre-registration midwifery education. Participation in the project has enabled new teaching methods to be initiated and evaluated, and facilitated communication with peers from other countries.
Promoting the transition to first-time parenthood
Authors: Ross Michael Killoran
Published: May 2014

The transition to first-time parenthood is associated with various difficulties, including deteriorating relationships. The Promoting Parenthood Project in Ayrshire and Arran aims to promote the psychological wellbeing of new parents. One hundred and twenty three couples took part in an evaluation of four different models of antenatal classes. Psychological, relationship and pregnancy wellbeing were assessed, as were social support and coping. Both men and women reported growing dissatisfaction with their partner's role performance, although women experienced a higher level of anxiety than men throughout the transition to parenthood. Maximal relationship dissatisfaction appears to occur within the first three postnatal months.
Fatherhood: the changes and challenges
Authors: Baafi Mercy , McVeigh Carol , Williamson Moira
Published: May 2014

A quantitative survey was conducted to investigate the functional status of men following becoming a father (not necessarily for the first time). By 6weeks postpartum a majority of new fathers were maintaining the same level of activities, the increase in the level of household activities was slight. The usual working hours remained the same for most fathers, however, it was difficult to maintain educational activities including keeping up with studies and assignments. Sexual activities declined sharply and about half of the fathers were not engaging in sexual activity as often as before.
Neonatal alloimmune thrombocytopenia
Authors: Harkness Mairi
Published: May 2014

Neonatal alloimmune thrombocytopenia (NAIT) affects one in every 1000–2000 live births. Intracranial haemorrhage is the most serious complication of this condition, but the severity of thrombocytopenia in affected pregnancies varies widely. Effective treatment depends upon prompt and accurate diagnosis, however, diagnosis is difficult and at present is most commonly made after a baby develops evidence of abnormal bleeding. There is general concern that lack of awareness of the condition contributes to delay in diagnosis and an increase in potentially avoidable morbidity and mortality. This article aims to provide midwives with information about the incidence, diagnosis and clinical management of NAIT.
Framing information in antenatal care
Authors: Stapleton Helen , Kirkham Mavis , Curtis Penny , Thomas Gwenan
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 these papers is on the role of the midwife in disseminating information to, and facilitating informed decision-making with, women in her care. Although health professionals generally expressed positive sentiments out the MIDIRS leaflets and their potential to assist women in making informed choices, competing demands within the clinical environment limited their effective use. This paper illustrates behavioural and organisational impediments, such as midwives’ conversational styles and pressures on their time, which reduced the opportunities for pregnant women to access the evidenced-based information they needed to participate more effectively in decision-making processes.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 these papers is on the role of the midwife in disseminating information to, and facilitating informed decision-making with, women in her care. Although health professionals generally expressed positive sentiments out the MIDIRS leaflets and their potential to assist women in making informed choices, competing demands within the clinical environment limited their effective use. This paper illustrates behavioural and organisational impediments, such as midwives’ conversational styles and pressures on their time, which reduced the opportunities for pregnant women to access the evidenced-based information they needed to participate more effectively in decision-making processes.
The public health role of the midwife
Authors: Henderson Christine
Published: May 2014

Ask most midwives about their ‘public health’ activities and they will say that it is an integral part of their role. So integral that it is difficult to quantify. The extent of involvement in public health activities by midwives currently is variable and largely unknown. In the next few months we will be including articles with a public health focus and would like to include your experiences, projects or thoughts about this area of the midwife’s role. The short report that follows focuses on a study undertaken in the 19 maternity units of the West Midlands between December 2000 and March 2001 that attempted to determine a baseline of the public health role of midwives (Henderson, 2001).
Routine anti-D prophylaxis for RhD-negative pregnant women
Authors: Jarvis Sarah
Published: May 2014

Haemolytic disease of the newborn affects about 500 fetuses in England and Wales annually, and kills 25-30. In 1999, the Royal College of Obstetricians and Gynaecologists published guidelines recommending routine antenatal anti-D prophylaxis of at least 500 IU at 28 and 34 weeks’ gestation for all Rhesus D (RhD)-negative women. This recommendation has been confirmed by the National Institute for Clinical Excellence, which outlines the rationale behind its decision, and the issues that should be discussed with each eligible woman. Midwives are the primary providers of antenatal care for most pregnant women. As such, they are likely to be the most important source of information for women eligible to receive antenatal anti-D prophylaxis. By setting out the scientific basis of alloimmunization with RhD antigen, this article will put midwives in a position to reassure women who are not at risk. This article also aims to summarize the issues concerned and their relative importance, and to provide the midwife with the information she needs to offer every women the opportunity to make a fully informed decision about routine antenatal anti-D prophylaxis.
Talking about the birth with a midwife
Authors: Dennett Sue
Published: May 2014

Evidence suggests that some women are psychologically traumatized by their birth experience and that talking to an appropriate professional may be therapeutic. This study explores the provision for talking about the birth as a postnatal routine and its perceived benefits. A postal questionnaire was sent to a cohort sample of 100 women who had given birth 8–10weeks earlier. The women who talked about the birth regarded it positively. The discussion generally took place within the first 3days with the community midwife. Most women felt that this was right although some would have liked to talk to the midwife present at the birth. The main findings suggested that women found talking about the birth useful. Perhaps more significant is that all the women who did not talk about the birth expressed the wish to do so.
Baby friendly: a way to accreditation. Part 2
Authors: Rogers Marilyn
Published: May 2014

In March 2002 the maternity unit at the Calderdale Royal Hospital in Yorkshire became accredited as a Baby Friendly Hospital. At assessment the hospital was the only hospital in the Yorkshire region to hold the award, and accreditation generated a groundswell of interest from other hospitals, eager to gather information on the implementation of the UNICEF Ten Steps to Successful Breastfeeding. This article is an account of how the Calderdale Royal Hospital improved standards of care for breastfeeding mothers and documents one approach to success. It follows the collaborative process leading to accreditation and includes information regarding the guidelines and literature developed to support and implement the initiative. A previous article (Vol 11(9): 556–64) focused on steps 1 and 2 of the Ten Steps to Successful Breastfeeding. This second article documents the implementation of Steps 3–10.