bluuebunny/crossref_metadata_2025 huggingface dataset:
Inequalities in dementia care and the impact of the draft NICE guidelines on diagnosis
Authors: Nazarko Linda
Published: May 2014

The UK lags behind the rest of Europe in diagnosis and treatment of dementia. Acetylcholinesterase inhibitors are currently available to treat mild-to‑moderate Alzheimer's disease, and memantine is used to treat moderate-to‑severe dementia. These drugs do not offer a miracle cure but can help some people enjoy an improved quality of life for a time. The intention of draft guidance from the National Institute for Health and Clinical Excellence (NICE) is to reduce access to acetylcholinesterase inhibitors to the treatment of moderate dementia only and the guidance will not recommend the use of memantine. It is argued that this decision, made on the grounds of cost, will make the recommended management of people with Alzheimer's disease in the UK inequitable by comparison with the treatment offered to other groups with long-term conditions.
Assessment of sedated head-injured patients using the Glasgow Coma Scale: An audit
Authors: Brunker Chris
Published: May 2014

The Glasgow Coma Scale (GCS) is widely used to assess head-injured patients. However, patients with acute severe head injury are typically managed with varying doses of sedative drugs which may interfere with GCS assessments. There is a question as to whether GCS assessments are useful and justified when the patient is sedated. The limited literature available is briefly reviewed. The aim of the audit described in this paper was to gain an overview of current practice among the neuroscience intensive care units in the UK, in search of any consensus. Thirty questionnaires were distributed and 23 returned (a 77% response). The results show considerable variations in practice and, in particular, differences between those units that treat only neuroscience patients and those that manage general intensive care patients as well. This audit demonstrates a lack of clear consensus and highlights the need for more research.
The management of medication for Parkinson's disease in hospitals and care homes
Authors: Carter Lesley
Published: May 2014

Earlier in 2006 the Parkinson's Disease Society launched its ‘Get it on time’ campaign to ensure that people with Parkinson's disease in hospitals and care homes receive their medication on time, every time. This article explains why timely administration of medication is so important to improving the care for people living with Parkinson's disease.
Incontinence after stroke:Guidance to overcome shortcomings in management
Authors: Ayers Tim , Wells Mandy
Published: May 2014

Urinary and fecal incontinence are highly prevalent following acute stroke, and yet a recent national audit revealed shortcomings in how they are assessed and managed. In this article the authors outline the aetiology of post-stroke incontinence, and explore policy and guidance to support good practice. The authors conclude that more research is needed to support the development of practices and interventions to address post stroke incontinence specifically but that adherence to structured assessment and management approaches based on generic continence expertise is essential in the meantime.
The role of patient education in the rehabilitation of people with spinal cord injuries
Authors: Williams Sue
Published: May 2014

Individuals with newly acquired spinal cord injuries need to be educated to manage the consequences of their neurological impairment and disability. However, to enable individuals with long-term conditions to manage their own care, they need to be provided with more than simply information about their condition. Critical to independence and self-management are empowerment and self-efficacy. As part of the process of rehabilitation, patient education programmes need to incorporate teaching strategies that develop these key skills to facilitate a successful outcome of rehabilitation for the patient
Understanding the monitoring of intracranial pressure: a benchmark for better practice
Authors: Mestecky Ann-Marie , Brunker Chris , Connor Jane , Hanley Claire
Published: May 2014

This article provides an overview of the different devices used to measure intracranial pressure (ICP) and discusses their advantages and disadvantages. The ICP waveform is analysed and the clinical significance of changes in the waveform are explored. Advice is given on how to troubleshoot distortions in the waveforms and on the general care of an ICP device. This article concludes with a benchmark for practice on ICP monitoring.
The provision of culturally appropriate care for individuals with spinal cord injuries
Authors: Collis Pellatt Glynis
Published: May 2014

Britain is one of the most ethnically diverse countries in Europe, and most spinal cord injury units admit patients from other countries for rehabilitation. Nurses in spinal cord injury care will, therefore, encounter patients from a range of cultural backgrounds. This article defines and discusses the concepts of culture, race and ethnicity in relation to the care of those with spinal cord injuries. The impact of these concepts on quality and equality in nursing care is identified. The article suggests how to provide culturally appropriate care for people with spinal cord injury from diverse cultural backgrounds, by avoiding cultural stereotypes and taking an individualized approach to care.
Can an all-graduate profession work?
Authors: Woodward Sue
Published: May 2014

In September the Nursing and Midwifery Council (NMC) approved plans to change pre-registration nursing education to an all graduate qualification in 2015. This decision follows an extensive consultation as part of the Government's ‘Modernising nursing careers’ initiative and has not been universally welcomed. Many nurses hold the view that a degree doesn't necessarily make a good nurse and that academic achievement cannot replace clinical experience. Others are concerned that the degree entry requirements will prevent sufficient numbers of nurses entering the profession, which will put a further strain on the existing workforce.
The physics of identifying with others: Implications for autism
Authors: Power Richenda
Published: May 2014

The relationship between thought and motion in child development and what it might reveal about autism was the focus of a conference on 5-6 September. Richenda Power reports
Care for the person with dementia, 3: Psychological and emotional effects
Authors: Beart Kirsty
Published: May 2014

The aim of this series of articles is to question the traditional view that the devastation of dementia is all that is left of a person and offer readers a resource for helping individuals and their carers live with dementia. Kirsty Beart conducted a series of interviews with ten pairs of people with dementia and their carers (Beart, 2006). This article is an extract focusing on themes identified as affecting a person′s emotional and psychological wellbeing, in particular, the fear of dementia and the effect of personality changes. Some guidance is offered on how people can deal with these issues based on current knowledge of the interview respondents themselves and that of the theory offered at present.
Dying must become a part of living
Authors: Thomas Sue
Published: May 2014

Sue Thomas considers the aims of the new end-of-life care strategy and an NMC announcement on nurse prescribing of mixed drugs
Revisiting anatomy and physiology
Authors: Woodward Sue
Published: May 2014

Over the last few months I have been working extremely hard with Ann-Marie Mestecky to edit together a new comprehensive neuroscience nursing textbook to be published by Blackwell Publishing next year: a British ‘Hickey’, so to speak, only better. This experience can only be described as a labour of love that has taken over our lives, but it has also been a salutary experience and has brought home to me once again how difficult it is for us all to keep up to date with recent developments in the field of neurosciences. While many neuroscience nurses specialize in one particular disease entity, the majority of us have to keep up to date with a whole range of sub-specialities as we work in either neurology, neurosurgery, neurocritical care or even neuroscience nursing education.
Magic mushrooms
Authors: Winter George
Published: May 2014

George Winter reflects on the mind-altering power of certain types of fungi
Causes, characteristics and management of dystonia
Authors: Pountney David
Published: May 2014

Dystonia is the third most common neurological movement syndrome, affecting an estimated 40 000 people in the UK and more than 3 million people worldwide (Jinnah and Hess, 2008). The disorder is characterized by excessive involuntary muscle contractions that lead to twisting movements and unnatural postures, with or without tremor (Fahn et al, 1998). Although dystonia is a neurological disorder, it does not usually lead to problems with other functions of the brain such as cognition. The German neurologist Hermann Oppenheim first used the term ‘dystonia musculorum deformans’ in 1911; however, only one third of people affected by dystonia are known to be receiving medical treatment due to difficulties in recognizing and diagnosing the condition (Grant and Meager, 2005).
Supporting families in the context of adult traumatic brain injury
Authors: Clark Charlotte , Brown Janice , Bailey Chris , Hutchinson Peter
Published: May 2014

Families are fundamental to the wellbeing, quality of life and functional and social outcomes of individuals who sustain traumatic brain injury (TBI). However, the family is often vulnerable and at risk from the challenge of supporting an individual who has been left with long-term neurological disability. Considering the young population often affected, the resulting conditions can have significant emotional and financial burden for families and service providing for their long-term needs. The National Service Framework for Long-term Conditions acknowledges that the whole family is affected by neurological disability and it suggests that a ‘whole-family’ approach to managing TBI may be useful. This paper will argue that both family systems theory and family-centred care are frameworks that may be helpful in achieving the ‘whole-family’ approach in practice. However, future research is needed that will assess the efficacy of these and other approaches so that health-care services know the true value of any such intervention.
Mental health in Parkinson's disease: Supporting patients and carers
Authors: Savory Lorraine
Published: May 2014

The primary objective of this article is to describe mental health conditions that may be encountered in Parkinson's disease (PD), with the main emphasis on Parkinson's disease dementia. Carers and partners of people with PD can find the stress of caring for these additional disorders as well as the PD overwhelming. Assessment and support for both the carer and the person with PD are vital to good management for this condition. Drug therapy can help alleviate some of the symptoms of dementia, depression and psychosis. Individual care is best achieved by coordinated care by both the mental health teams and the Parkinson's disease specialist nurse, to improve the quality of life for the person with PD and his/her carers.
The 4th National Neuroscience Nursing Conference, Regent's College, London, 12 May 2009: Poster presentations
Authors: Woodward Sue
Published: May 2014

Huntington's disease (HD) is a hereditary progressive neurodegenerative genetic condition that affects the basal ganglia. There is currently no cure. Disease onset is usually between 30–50 years of age and treatment is palliative over 15 years or so.
When brain injury meets tabloid news
Authors: McDonald Sheena
Published: May 2014

Brain injury is one of society's final frontiers. The so-called ‘silent epidemic’ is simply not talked about, despite the fact that an estimated one million people—in Britain alone—attend hospital every year as a result of having a head injury. Add to that number those who have had some form of neurological dysfunction since birth and the aggregate of those who know something about brain injury, directly or indirectly, exceeds the number of Britons who are, say, members of a political party! And yet it does not form part of the public debate—or certainly has not in recent years. But all that has suddenly changed! Thanks to Susan Boyle (a.k.a. SuBo, according to the popular press) there is a general awareness that brain injury does not necessarily reduce the sufferer's world.
Innovations in the assessment and management of stroke: The use of telemedicine
Authors: Birns Jonathan , Roots Angela
Published: May 2014

Although stroke units and thrombolysis are effective in acute stroke management, use of these treatment methods is limited because of a lack of expertise. Telemedicine allows a distant stroke clinician to provide remote specialist assessment of patients with real-time clinical evaluation and interpretation of brain imaging. This interaction can take place within minutes of arrival of a patient to hospital helping to meet the demands of ‘time is brain’ in acute stroke care. Telemedicine is feasible, acceptable, technically and diagnostically reliable and is associated with improved delivery of thrombolysis. Different models for providing audiovisual interaction between patient and stroke clinician have been developed to meet the local needs of a variety of populations. Telemedicine facilitates effective networking between different stroke providers, having potential for education and training in addition to ensuring that patients have a greater opportunity to receive the full range of therapeutic options now and in the future.
Subarachnoid haemorrhage has long-term effects on social life
Authors: Berggren Elisabeth , Sidenvall Birgitta , Larsson Dennis
Published: May 2014

Aim: The aim of this study was to describe activities of living after a subarachnoid haemorrhage (SAH) from the perspective of relatives and patients in two cohorts and to evaluate the application of relatives’ statements, as a tool in nursing care, in order to support the patient.

Background: Memory problems after SAH are common according to patients’ and relatives’ statements and memory test results. This may influence the adjustment to daily life. Supporting patients and relatives requires knowledge concerning the activities of daily living from the perspective of both patients and relatives.

Method: Eleven relatives and 11 patients (cohort 1), 11 years after the onset of an SAH and 15 relatives and 15 patients (cohort 2) 6 years after the onset of an SAH participated in the study. Interview questions and memory tests were used to collect data.

Findings: Problems with activities of daily living were common and patients had more problems with social life than with personal and instrumental activites. The change in social company habits were due to emotional problems. Patients’ statements about problems with activities of living corresponded to results from patients’ memory tests and patients’ statements.

Conclusions: Relatives’ and patients’ statements are useful as tools in nursing care. Introducing fromalized dialogues and memory tests would improve the after care for this group of patients and improve their future family relationships.
Exercise intervention soon after stroke onset to prevent muscle atrophy
Authors: Tamura Ayako , Ichihara Takako , Minagawa Takako , Kuwamura Yumi , Kondo Hiroko , Takata Shinjiro , Yasui Natuo , Nagahirois Shinji
Published: May 2014

Objective: To investigate the effects of nurse-led exercise interventions, in addition to standard rehabilitation, on patients suffering from hemiplegia soon after stroke onset.

Methods: Interventions involved a series of hip bridges. Efficacy was evaluated by monitoring leg muscle mass. Participants were divided into control, intervention and terminated intervention groups. In addition to standard rehabilitation, the intervention group performed a series of hip bridges once a day. Leg muscle mass was evaluated using dual-energy X-ray absorptiometry (DXA). Measurements were taken 3–5 days after stroke onset, then again 7 days after initial measurement.

Results: During the first week, the mean decrease in leg muscle mass on the paralyzed side was 417 g (7%) for the control group, 304 g (6%) for the terminated intervention group and 108 g (2%) for the intervention group. Only the difference between control and intervention groups was significant (P=0.008).

Conclusions: Exercise interventions comprising a series of hip bridges soon after stroke onset, in addition to standard rehabilitation, can reduce leg muscle atrophy on the paralyzed side in stroke patients.
A qualitative study relating to the experiences of people with MS: differences by disease severity
Authors: Moriya Rika , Suzuki Sumie
Published: May 2014

A significant characteristic of multiple sclerosis (MS) is the spatial and temporal variation of lesions ( McDonald et al, 2001 ), i.e. variation in the location and time at which lesions manifest, while the manner in which the disease progresses, the symptoms and severity all differ. This complexity and diversity means that MS patients have varying needs. Using qualitative and exploratory design, this study aimed to highlight the experiences of MS patients depending on disease severity. Mildly impaired participants had difficulty recognizing symptoms of MS prior to diagnosis, and were able to live a normal life following diagnosis if they made adjustments. Moderately impaired participants’ self-identities fluctuated with their symptoms. Severely impaired participants’ experiences included developing new coping strategies, accepting their situation and undergoing a shift in mentality in order to live a new life as a disabled person. At the same time, they felt dejection and instability about their life in association with changes in their symptoms. As this shows, MS patients have diverse experiences due to the disease’s inherent spatial and temporal variation in lesions.
Stroke policy and secondary prevention: how well are we adhering to these guidelines?
Authors: Malewezi Emmie
Published: May 2014

Stroke recurs in up to 20% of patients. From the moment a person has an acute cerebrovascular event of any sort, he/she is at an increased risk of further events. Unfortunately for those who suffer a recurrent stroke, the outcomes are poorer than after a first stroke and the patient is likely to have increased disabilities which incur additional hospitalization costs over the longer term. Results from the recent national sentinel stroke audit reveal that there is still more to be done in order to optimize secondary stroke prevention in survivors. All nurses working in stroke and those who come in contact with stroke patients, both in primary and secondary settings have an important role to play in secondary stroke prevention.
Empowering decision-making in cannabis use in multiple sclerosis
Authors: Fitzpatrick Ben , Cook Neal F
Published: May 2014

A diagnosis of multiple sclerosis (MS) introduces a challenging period in a person’s life whereby decisions regarding treatment and management are made in the context of significant new information that needs to be processed. This reoccurs as the condition progresses and health status is affected. Empowering people to make informed decisions often requires individualized approaches in order to understand the health belief and motivation behind the decision and also to develop a trusting, therapeutic rapport with the person. This case documents one such approach taken with a person diagnosed nine years ago with MS. An educational intervention was adopted to empower him to make an informed decision regarding his current use of cannabis for symptom control.
Development and evaluation of an interdisciplinary training programme for stroke
Authors: Catangui Elmer Javier , Slark Julia
Published: May 2014

Introduction: The coordinated, specialized care given in stroke units has been shown repeatedly to improve outcomes for patients ( Royal College of Physicians, 2010 ). Collaborative working within the multidisciplinary team is integral to the good results achieved by such units. Healthcare for London has reorganized stroke care in London to include 8 fully functioning hyperacute units and 24 subacute units providing care for stroke patients. Imperial College Healthcare NHS Trust has been designated a hyperacute unit for northwest London and the staff received specialist training to provide the highest possible care for this patient population.

Methods: A team of professionals with expertize in stroke care developed a training programme aimed at all health professionals. The goal is for specialists from all members of the stroke team to teach each professional involved in stroke patient care using a framework of interprofessional education (IPE). The 3-day course includes all aspects of stroke patient care from acute physiological monitoring to continence, physical rehabilitation and end-of-life care.

Results: To date, seven courses have been run with excellent feedback from all multi-professional members attending. The teaching team meet after each course to evaluate the feedback forms and amend the course as appropriate. The evaluation allows the attendee to rate the session as excellent, good, fair or poor.

Conclusions: Collaborative interdisciplinary working is essential to excellent stroke care provision. The stroke training course at Imperial College Healthcare Trust is attempting to ensure collaborative working starts with collaborative training and hope that those who learn together can grow together and become the best possible team, to ensure the best outcomes for stroke patients.
Quality of life among carers of people with Huntington’s disease
Authors: Cox Marie
Published: May 2014

Background: Long-term care of people with Huntington’s disease (HD) rests mainly with family or partner carers, and HD care presents burdens not seen in other disorders. Identifying factors that affect HD carer QoL may provide insights into easing carer burden.

Aim: To describe the quality of life (QoL) of carers of people with HD.

Methods: Thirty one HD carers completed the 34-item Huntington’s Disease Quality of Life Battery for Carers (HDQOL-C) questionnaire.

Results: Fifty five per cent of the participants indicated a mid-level QoL. The number of hours spent caring inversely correlated with QoL. The number of times a carer socialised per month was positively related to QoL. Participants reported that access to affordable care programmes for the HD-affected person, more time for themselves, and social support would improve their QoL.

Conclusions: Providing respite may improve HD carer QoL. Research on interventions to improve HD carer QoL is warranted.
Providing informational support to the families of TBI patients: a survey of nursing staff in Finland
Authors: Coco Kirsi , Tossavainen Kerttu , Jääskeläinen Juha , Turunen Hannele
Published: May 2014

Background: People with a traumatic brain injury (TBI) constitute a significant patient care population: every year almost 8 million brain injuries are diagnosed worldwide. Social support (informational, emotional and practical) has been identified as one of the essential factors that help TBI patients' families to cope with the severe situation.

Aims: This paper reports on a study of how often nursing staff provide interventions of informational support and the level of competence needed by nursing staff working in all neurosurgical wards to support the families of TBI patients.

Methods: The target group included all nursing staff (n=172) in all neurosurgical wards in Finland. Data was collected via a self-completion questionnaire in 2010. The participants were nurses (n=115; response rate 67%) working in the neurosurgical wards of all five Finnish university hospitals. The data were statistically analysed using SPSS version 19. Descriptive statistics, the Kolmogorov-Smirnov test, one-way ANOVA, two-way ANOVA, MANOVA and linear regression were used.

Results: Overall, the nurses often provided informational support to TBI patients' families. They often told them about treatment and about their own responsibilities to family members; by contrast, they seldom informed family members about prevention of secondary injuries. There was a connection between the age and work experience of the nursing staff and the provision of information about secondary injuries.

Conclusions: Nurses with less work experience may have limited competence in delivering information to family members. This should be taken into consideration when planning the staffing of shifts, ensuring that there are always enough experienced nurses on duty.
Knowledge and understanding of CT imaging in stroke: a case study approach
Authors: Catangui Elmer J
Published: May 2014

Every year an estimated 150 000 people have a stroke in the UK. The gold standard for stroke diagnosis mainly relies not on patient history and clinical symptoms but on the results of imaging. This article explains the role of imaging in stroke and uses a case study approach to help the multidisciplinary team understand and gain confidence in interpreting basic imaging in suspected stroke.
Omega 3 fatty acids and the brain: implications for nursing practice
Authors: Helvig Ashley , Decker Michael
Published: May 2014

This article synthesises the current literature regarding the effects of omega 3 polyunsaturated fatty acids (omega 3 PUFAs) in various neurological disorders and suggests implications for nursing practice. Omega 3 PUFAs are essential fatty acids and are crucial in cell functioning. Docosahexaenoic acid is a particularly important omega 3 PUFA that modulates the lipid bilayer of neuronal cell membranes, reduces inflammation and synthesises neuroprotectin D1, which has anti-apoptotic properties (preventing cell death). Omega 3 PUFAs are reported to have neuroprotective properties in Alzheimer's disease, ischaemia, epilepsy and attention-deficit hyperactivity disorder. Because humans are not able to synthesise omega 3 PUFAs, the body's supply comes from consumption. Nursing practice should include assessment for risks of neurological disorders as well as education regarding omega 3 PUFA intake. Knowledge of omega 3 PUFAs allows the nurse to educate patients thoroughly and accurately regarding the importance of these supplements.
Midwifery education: Part 1 The West Midlands region
Authors: Henderson Christine
Published: May 2014

In 1987, within the West Midlands region there were 18 schools of nursing and 17 schools of midwifery. There were 376 student midwives undertaking the 18-month postregistration midwifery course. All preregistration courses (long) for midwives ceased in the 1970s until 1990. Midwifery schools provided post-basic courses for continuing professional education and maternity care for student nurses.
Midwives and litigation: supervision
Authors: Symon Andrew
Published: May 2014

Inadequate levels of supervision have been cited as an influence in suboptimal outcomes, and in the origin of legal actions against midwives and obstetricians. All staff have a duty to ensure that supervision, both of patients and of their junior colleagues, is of a satisfactory standard. Thorough documentation in the case notes help an investigator to establish the level of supervision a patient has received.
Midwifery values: part two
Authors: Siddiqui Jeanne
Published: May 2014

In times of organizational and professional change, professional values must be clearly identified, believed in and acted upon. Some values will be shared by all professionals, while others may present the opportunity for interprofessional conflict. Supremacy of values may be claimed when values are said to be based upon objective, scientific and authoritative knowledge. Whatever their perceived status, professional values must be respected as valid evidence of an important professional obligation that raises levels of awareness and allow the public to recognize good practice.
Tomorrow's fetal monitoring? A midwife reflects
Authors: Lawrence Sally
Published: May 2014

Near infrared spectroscopy can be used to measure fetal brain oxygenation during labour. The purpose of this article is to inform midwives of this latest development of intrapartum monitoring. It will describe the principles and clinical application of this technique and will discuss the role of the midwife in its future use and evaluation.
Midwifery education: part 3 The Northern and Yorkshire region
Authors: Allen Rose
Published: May 2014

The Northern and Yorkshire region brought together the former Northern region and the former Yorkshire region in April 1995. Before this time there had been a period of rationalization and amalgamation which greatly reduced the number of institutions offering programmes of midwifery education.
Exploring midwifery knowledge
Authors: Kelly Mary E
Published: May 2014

This article explores carper's fundemental patterns of knowing in nursing from a midwifery perspective. This approach is utilised in an attempt to identify an epistemology of midwifery practice. Emphasis is placed on the need to explore what midwifery is so that midwives critically reflect on practice and in turn provide high quality care.
Being with women in pain — do midwives need to rethink their role?
Authors: Leap Nicky
Published: May 2014

I was half listening to Australian radio the other day when a main news item captured my attention: ‘Research has shown that it is no longer fashionable for women in labour to strive for “natural” childbirth: Australian women in the 1990s expect to be offered a choice of pain relief methods and they no longer labour without using drugs to control pain.’
Cocaine and its effects on pregnancy
Authors: Bunford Debra
Published: May 2014

Cocaine use in the UK is increasing and is found across all socioeconomic groups. Maternal complications linked to cocaine include: spontaneous abortion, preterm labour, placental abruption and pregnancy-induced hypertension in the mother and also intrauterine growth retardation, fetal distress, gastric, skeletal and cardiac abnormalities in the fetus. This article examines the complex physiological effects of cocaine on both mother and fetus, demonstrating that the complications highlighted occur irrespective of poverty.
From clinical credibility to academic elitism
Authors: Hindley Carol
Published: May 2014

This article discusses the perceived clinical credibility of midwifery lectures. Are midwife teachers practical teachers with academic expertise or pure theorists? Research findings will highlight the opinions of clinicians, student midwives and lecturers with respect to the nature of clinical credibility.
Who's afraid of the graduate midwife?
Authors: Hunt Sheila C
Published: May 2014

Midwifery has almost come of age. It is showing all the signs of being a profession, and in keeping with that maturity it is time for all midwifery education to be at degree level. Diploma level qualifications should be phased out and in the future all student and qualified midwives should have the benefit of a university education.
The case for bilingual workers within the maternity services
Authors: Baxter Carol
Published: May 2014

Ensuring access to the population they serve is central to the role of health authorities and trusts. Language and communication difficulties are among the most common barriers to access for black and minority ethnic people. The employment of bilingual workers in the health service has been one response to improving access for this section of the population. This review examines some of the available evidence of the effectiveness of such services and puts forward the case for their development within maternity services.
How other people see us
Authors: Henderson Christine
Published: May 2014

I wonder what the passing of 1998 has meant for you. For me it was a mixture of things including spending time experiencing first hand what the new NHS has to offer to performing as ‘Ginger Spice’ at the golf dinner! Fortunately, with the wig, recognition was difficult. Some experiences were good and some were bad, but I would like to think that I have changed for the better and am more sensitive to how others may feel when they are in receipt of care in the NHS. First impressions matter, the environment and the way we are can make or mar an experience.
Can childbirth be changed? — offering women a choice
Authors: McClean Jan , Turnbull Deborah A , McGinley Mary C , Lunan C Burnett
Published: May 2014

This article discusses the implementation and evaluation of an initiative to routinely provide healthy women with five choices for the type of maternity care they receive (community- and hospital-based shared care, named midwife care, DOMINO and home birth). A cohort study of 345 women was carried out at the Glasgow Royal Maternity Hospital. The study aimed to: determine the proportion of women offered choice for their type of maternity care after the introduction of the initiative; determine the proportion of women choosing the different types of care and to examine the socio-demographic predictors of the choice of care; and examine women's attitudes to being offered a choice in the type of maternity care they receive and reasons for making particular choices. The study was carried out using a retrospective review of case records and self-report questionnaires from a consecutive sub-sample of 170 women. Of those eligible, 90% (95% CI: 86% to 93%) were offered choice of care type. Half of the eligible women chose community-based shared care, 36% chose named midwife care, 10% chose hospital-based shared care, 4% requested DOMINO care and less than 1% selected home birth. Women's choice of the type of care they received was unrelated to their socio-demographic characteristics. Women were satisfied with the way that choices were offered and valued being able to choose their type of care. The response rate of the questionnaire was 84%. This article concludes that it may be realistic to routinely offer women a variety of choices of the care type they receive given the support of the professional groups involved.
The third way: A realistic plan to reinvent the profession
Authors: Page Lesley , Sandall Jane
Published: May 2014

The aims of all those involved in maternity care are the same. They are to ensure that women and their babies leave care as healthy as possible, having had the most positive experience of care possible. Each group contributes in a different way, bringing unique skills related to their own specialty.
Women, men, breast-feeding and sexuality
Authors: Jackson Karen B
Published: May 2014

Articles concerning the influences on breast-feeding rates are prolific in the midwifery journals, with heavy emphasis on technical, biological and psychosocial difficulties. However, it is only recently that sexuality and men's attitudes to breast-feeding has been discussed in any depth. This article will explore this important issue.
Audit and risk management in neonatal encephalopathy
Authors: Evans K , Rigby AS , Williams TS , Hall DMB
Published: May 2014

Litigation on behalf of children with cerebral palsy is a major issue. The best indicator of hypoxic ischaemic injury during birth is neonatal encephalopathy. In a study on neonatal encephalopathy we identified 164 babies with possible encephalopathy. A checklist was devised to assess the quality of the records kept by the midwife, obstetrician, neonatal nurse, and paediatricians. The checklist consisted of seven identical items for each professional group; each item was scored from 1 to 10. It gave useful information about the quality of records and could distinguish between different hospitals and professional groups, and detect changes over time. The records were particularly poor in describing what parents had been told and in determining the status or profession of individuals signing entries in the notes. The checklist is a useful approach to audit, a valuable aide memoire when reviewing the notes after an adverse event, such as severe neonatal encephalopathy, and a way of improving the standard of notes.
Evaluating the WHO/UNICEF breast-feeding course
Authors: Wissett Lynn , Dykes Fiona , Bramwell Ros
Published: May 2014

Many maternity care facilities within the UK are now participating in the global WHO/UNICEF Baby Friendly Initiative (BFI). To assist with one of the key requirements, to educate relevant health care staff, UNICEF UK offer a 20-hour evidence-based breast-feeding management course (UNICEF/WHO 1997). This paper describes an empirical evaluation of the impact of this course on health professionals’ attitudes and knowledge in relation to breast-feeding. The results demonstrated a statistically significant change in knowledge. A qualitative approach highlighted a marked difference in self-reported attitudes. The extent of attitude change related to the strength of evidence underpinning each of the ten steps to successful breast-feeding. Organizational and cultural changes taking place concurrently within the hospital facilitated staff in implementing the BFI.
The baby friendly breast-feeding management course
Authors: Dinwoodie Kate , Bramwell Ros , Dykes Fiona , Lang Sandra , Runcieman Annie
Published: May 2014

In 1997 the WHO/UNICEF 18-hour lactation course, known as the Baby Friendly Initiative (BFI), was launched in the United Kingdom (UK). This course was designed to meet the training needs of National Health Service (NHS) trusts wishing to achieve the WHO/UNICEF baby friendly award. The first six of these courses, run by the University of Central Lancashire in conjunction with UNICEF UK BFI, were evaluated by questionnaire 6months following completion of the course, with both qualitative and quantitative data being collected. The findings showed that course members reported a sustained increase in knowledge, skills and positive attitudes concerning breast-feeding and that the course had increased confidence to actively support breast-feeding mothers and their infants.
Deaf women: Informed choice, policy and legislation
Authors: Bramwell Ros , Harrington Frank , Harris Jennifer
Published: May 2014

The maternity care of deaf women is a subject which has received little attention, either within midwifery research, or within the arena of disability studies. Previous research has highlighted basic difficulties of access and information for such women. Midwives need to be aware of the challenges which can exist in ensuring deaf women can give informed consent, and that their rights and expectations under the Patient's Charter and Disability Discrimination Act are met. Failure of communication could potentially lead to a civil action for negligence. The use of relatives and friends for translation is still a common practice, but a case study illustrates the way in which this can distort even a relatively straightforward communication. Increasingly, the threat of litigation will probably lead to a growth in the availability of professional sign language interpreters, but maternity services may wish to consider the relative merits of different models for accessing these services.
Evidence into practice for midwifery-led care: part 2
Authors: Munro Jane , Spiby Helen
Published: May 2014

This paper is the second in our series following the development of evidence-based guidelines for midwifery-led care in the labour ward of an inner-city university teaching hospital. The first part of the evaluation of the initiative is presented here. It sought midwives' views through group discussions using the SWOT analysis technique and semi-structured interviews with a random and purposive sample and it measured the guidelines against an external appraisal instrument. The midwives were positive about being involved in the process of development and found the guidelines useful in defining and supporting autonomous midwifery practice. They also perceived significant changes in practice. The guidelines complied well with the majority of the criteria in the appraisal tool.
Stress in midwifery practice: an empirical study
Authors: Birch Linda
Published: May 2014

This research was undertaken in a maternity unit in spring 2000. Team midwifery had been fully implemented, and midwifery-led care was expanding. The sickness levels attributed to stress had risen sharply in the unit since implementation of the changes in working practices resulting from the Cumberlege recommendations. The staff believed that ‘change’ had led to stress, and thus to sickness. The aim of the study was to identify the contribution that change and other external and internal factors have had on the stress levels of the midwives working within the unit. Questionnaires were issued to assess life changes and stress levels. The results indicate that the perception of stress is far greater than the reality. Only 6% of midwives scored high on their stress analysis questionnaire. Stress perception was increased by having children at home, working part-time and working in a team. Recurring life events were also present in the stressed group. Occupational stress can often be linked to the personality of the individual. Home related stress often resulted as a consequence of trying to juggle work and home commitments. Interpersonal coping mechanisms and individual personality had the greatest affect on perception of, and ability to cope with potentially stressful situations. The amount of change needed to produce a stress response will vary from person to person and is related to their personality rather than the amount of change per se. The appropriateness of organisational initiatives such as worker support schemes, stress counsellors, and stress awareness schemes are questioned. These measures have not been beneficial to this group. Greater input into personality awareness and self awareness, linked to coping strategies may provide a more constructive approach.
How cost-effective is it to leave perineal skin unsutured?
Authors: Petrou Stavros , Gordon Beverley , Mackrodt Carolyn , Fern Elizabeth , Ayers Sarah , Grant Adrian , Truesdale Ann , McCandlish Rona
Published: May 2014

This paper describes a cost-effectiveness evaluation based on a randomized controlled trial comparing two policies for surgical repair of perineal trauma. Data were collected for 1780 women who were randomly allocated to either a two-stage postpartum perineal repair policy leaving the skin unsutured (n=890) or a three-stage postpartum perineal repair policy that required suturing of the skin (n=890). The two-stage postpartum perineal repair policy was found to reduce the risk of adverse outcomes at 10days and at 3months, without leading to a significant increase in health-care costs. A widespread adoption of a two-stage postpartum perineal repair policy leaving the skin unsutured following perineal trauma is likely to represent a cost-effective use of health-care resources.
Antenatal information wanted by first-time fathers
Authors: McElligott Mary
Published: May 2014

Fathers wish to attend parenthood education sessions but may have no real input into the educational content. This small study asked first-time fathers to indicate topics for discussion at midwife-led courses. The results indicate that new fathers wish to gain knowledge about their unique role in pregnancy, birth and early parenthood. The least favoured topics included both breast and bottle-feeding. If sessions remain exclusively woman-focused then these interested new fathers will not gain the knowledge they seek.
Are midwives using research evidence in practice?
Authors: Richens Yana
Published: May 2014

Improving clinical effectiveness has been a government priority for the past decade. It has been proposed that a way to achieving clinical effectiveness is through using evidence in practice. This study uses ethnography to explore the question: ‘Are midwives using research evidence in practice?’ The study was conducted over a 6-month period in a maternity hospital in the UK which has 4500 births each year. Key issues emerged which restricted midwives' use of evidence in practice and these were organised into the themes; doctors and monitors, policies and procedure, theory-practice gap, lack of support, knowledge and time, the all singing-dancing midwife, practice dictated by staffing levels. The study highlights that the issues which impact on the integration of evidence into practice, are complex.
Women, midwives and screening tests
Authors: Bennett Vivienne
Published: May 2014

Midwives are often the main source of information when describing screening tests that are available to women. This article aims to demonstrate how people resolve the conflicts that arise when faced with uncertain choices and how midwives need to respect and respond to those decisions. Midwives must be aware of their ethical and legal responsibilities when offering screening tests and when supporting women in their decisions.
Midwifery debriefing — in whose best interest?
Authors: Madden Isobelle
Published: May 2014

Within midwifery, there have been moves to explore the value of debriefing or listening services for women following childbirth. However, the nature or philosophy of listening in this context is unclear, and some (Alexander, 1998; Robinson, 1998) have warned of the possible dangers of an uncritical application of this concept to midwifery practice. Drawing on reflections from personal practice, the author proposes a model for the intervention that acknowledges its political aspects, and throws critical light on the possible agendas inherent in this aspect of caring work. She concludes that listening is a complex, multilayered activity with pitfalls and possibilities not only for the empowerment of childbearing women, but also for the personal and professional development of midwives.
A personal philosophy of midwifery
Authors: Clarke Hilary
Published: May 2014

Midwifery can appear confusing and disjointed to the experienced and uninitiated alike. As a response to this, the author has formulated a personal philosophy of midwifery (PPOM) framework to use as a tool for global reflection. The PPOM is defined as a personal approach to an institutional goal. The framework is a reflection tool, designed to aid the user in formalising their own PPOM. Within the article, the PPOM will be examined and its use demonstrated. The fundamental benefit of the PPOM framework use is by making sense of the complexity of midwifery care and embracing the individuality of the midwife.
Safeguarding the welfare of children: 1
Authors: Chapman Therese
Published: May 2014

Department of Health policy requires all health professionals to contribute to the child protection process. Midwives are anticipated to recognise predictors of risk, by identifying adult behaviours or attitudes that might indicate possible future difficulties in parenting. This paper, presented in two parts, examines the contradictions arising from the social constructs of motherhood, childhood and abuse and describes how these intrinsic tensions, coupled with the lack of any objective tools to predict possible abuse, gives rise to conflict in the midwife-mother relationship. It summarises the sociopolitical culture that sustained this social control approach to addressing parenting difficulties. Discussion explores how the governmental Framework for the Assessment of Children in Need and their Families (Department of Health, 2000) could be adapted for utilisation by midwives, to assist them in making objective social assessments and identifying the needs of individual women and their families, supporting a welfare-based approach to the provision of care and services.
Step 45: Research 5: children
Authors: Dimond Bridgit
Published: May 2014

In previous Steps articles we have considered the principles applying to undertaking research. This article considers the legal issues arising in research that involves children. Further information on the rights of the child to consent is provided by the British Medical Association (BMA) (BMA, 2001).
Delivering the future: taking midwifery forward in Wales
Authors: Phillips Robyn
Published: May 2014

Midwives in Wales can feel justifiably proud when reflecting on their achievements in the delivery of maternity services in Wales since 1993. What is particularly remarkable, is that the last 10 years have culminated in a collective strength, positive energy and momentum for change discernable to others (Gould, 2003).