bluuebunny/crossref_metadata_2025 huggingface dataset:
Woman-centred or women-centred care: does it matter?
Authors: Leap Nicky
Published: May 2014

The concept of woman-centred care is fundamental to midwifery and underpins the philosophy statements of midwifery professional organizations. It has also been used as a framework in a range of policy documents and standards related to midwifery and maternity service provision, notably in the UK and Australia.

This discussion article questions the conceptual and practical implications of substituting ‘women-centred care’ for ‘womancentred care’ in terms of addressing women's individual needs and shifting the locus of control away from the institution and professionals towards the woman herself. Contested meanings of woman-centred care and empowerment are explored in relation to conceptual interpretations and the development of projects involving midwifery continuity of care.
Midwives' interactions with women who smoke in pregnancy
Authors: Ebert Lyn Maxine , Freeman Lesa , Fahy Kathleen , Riet Pamela van der
Published: May 2014

This article presents the findings from a study examining midwives' interactions with women who smoke in pregnancy. The aim of this study was to find out how midwives currently interact with women who smoke in pregnancy, in relation to the women's health and wellbeing. The study used an interpretive interactionism design.

There were two major findings: there is incongruity between midwives' internal discourses and expressed discourses when working with women who smoke in pregnancy and smoking cessation advice interactions typically do not involve a dialogue. Smoking cessation advice interactions are predictable, monotonous and non-productive. This type of interaction is best understood as a game with set rules and roles. Midwives need a woman-centred discourse from which to engage in an effective dialogue with women who smoke in pregnancy. Recommendations for practice and education are discussed.
Effects of valsalva manoeuvre on maternal and fetal wellbeing
Authors: Hollins Martin Caroline J
Published: May 2014

The aim of this article is to relate basic findings from research papers to identify the effects that valsalva manoeuvre (‘purple pushing’) has upon maternal and fetal wellbeing. Analysis of 16 papers revealed four main consequences from purple pushing. These include: an increase in fetal distress; maternal distress; and perineal trauma, when compared with spontaneous pushing. Valsalva manoeuvre also makes little difference to length of second stage. Key conclusions from this literature review are that women should be encouraged to push instinctively, which often embraces natural vocalization. Restrictions of time should not be imposed when mother and fetus are well. Awaiting instinctive behaviour reduces the incidence of urinary system, pelvic floor and perineal trauma. These findings should facilitate midwives to critically understand research that underpins the Royal College of Midwives (2007) second stage of labour guidelines.
Midwives' illness perceptions of antenatal depression
Authors: Jomeen Julie , Glover Lesley F , Davies Sally-Anne
Published: May 2014

Antenatal depression (AND) is recognized as a significant issue for many pregnant women. Despite prevalence equal to that of postnatal depression, AND often goes undetected. Current National Institute for Health and Clinical Excellence (NICE) antenatal and postnatal mental health guidance provides a clear remit for midwives with regard to the prediction and detection of deleterious perinatal mental health. Midwives need to be adequately prepared to take on such a role, yet evidence highlights that midwives lack the knowledge and the confidence to detect mental health problems. This article describes a survey of midwives' knowledge of AND. Fifty-two midwives completed a questionnaire about training, experience and illness perceptions of AND. Findings demonstrated generally poor levels of training and confidence among midwives but good levels of knowledge and appropriate illness perceptions of AND. The findings of this study are reassuring for the successful implementation of the NICE antenatal and postnatal mental health guidelines within maternity services.
Difficulties in recruiting pregnant women with eating or weight issues
Authors: Tierney S , Butterfield C , Stringer E , Fox JRE , McGowan L , Furber L
Published: May 2014

During pregnancy, the eating behaviour and body of childbearing women can become open to public scrutiny. It is important to gather the views of those who are pregnant and have an eating/weight issue to ensure that maternity services meet their needs and to reduce any stress and discomfort they may endure. However, prompting women to engage in research that would explore these issues in depth can prove difficult. This article outlines the experiences of a team of investigators who have tried to examine the phenomena of pregnancy among women who have an eating disorder or who are classed as obese. It focuses on the obstacles encountered while undertaking two qualitative projects and outlines lessons learnt from this work, which may prove helpful to others wishing to study these areas.
Birthrate Plus: using ratios for maternity workforce planning
Authors: Ball Jean A , Washbrook Marie
Published: May 2014

This is the second in a series of three articles exploring the staffing needs in the maternity services. Undertaking Birthrate Plus studies in hundreds of maternity units in the UK revealed a number of issues which affect any assessment of midwifery staffing needs in both hospital and community services.

Using a simplistic approach of the annual births in a hospital as the sole basis for assessing staffing needs ignores the movement of women between different health trusts. Many hospitals provide care to women from outside their catchment area and this ‘cross border’ flow significantly affects the numbers of community midwives required.

The patterns and policies of intrapartum care have a large impact upon hospital staffing needs, and these patterns vary across different services. Stand alone midwife-led units provide care for women in the community as well as for those who give birth within the unit. If required standards of midwifery care are to be maintained then more focused methods of calculating staffing needs must be used.

This article will explore these issues and explain how ratios have been produced and which can be used to assess staffing needs based upon local information.
Planning for success: setting SMART goals for study
Authors: Werle Lee Karen P
Published: May 2014

This article is aimed at new undergraduate students of midwifery. Health-care programmes are a mix of theory and practice and therefore have unique challenges. Juggling study and practice requirements, as well as your personal life can be daunting. This article provides ideas on how to plan for success through goal setting and time management.
Development of maternity support worker roles in the UK
Authors: Griffin Richard , Dunkley-Bent Jacqueline , Skewes Jon , Linay Denise
Published: May 2014

Support workers have long been a feature of the maternity services. Recent years have seen a substantial development of the role to the point that there are now two distinct support roles, one traditional (undertaking housekeeping duties for example) the other a new higher-level role providing more direct support to midwives. This article seeks to explain this development. The authors present a model that describes the evolution and development of the role. It is proposed that there are four stages maternity support worker posts need to progress to become an enduring part of the NHS workforce: Initial, Developmental, Consolidation and Establishment. The model the role is now at a critical stage requiring a move from Consolidation to Establishment ensuring, for instance, that Maternity Support Workers are included in annual commissioning cycles.
Exploring pregnancy following a pre-term birth or pregnancy loss
Authors: Wood Lorna , Quenby Shiobhan
Published: May 2014

This is the first of two papers. The first paper outlines the literature review that informed the pilot study; the second describes the qualitative pilot study: stress, immunity and preterm birth pilot study (SIPP). The review examined qualitative research to understand the area of investigation and determine whether this corresponded with the findings of the pilot study. The SIPP study used semi-structured interviews exploring women's answers to a life events questionnaire as part of a larger quantitative prospective observational study, the stress, immunity and preterm birth (SIP) study. The SIP study examined the association between maternal stress, maternal immune response and pregnancy outcome in women with a history of recurrent idiopathic preterm labour.

The review evolved into three broad themes: the impact of perinatal loss on a subsequent pregnancy; the preterm labour experience; and disenfranchised grief.
Why midwives fail to stay in practice following a return to practice course
Authors: Payne Sheena
Published: May 2014

Over the last 10 years the government has been committed to a return to practice initiative to increase the number of practising midwives (Department of Health, 1999). In 2003, an audit undertaken locally found that only a third of those midwives remained in practice following a return to midwifery practice programme. It therefore seemed imperative to find out why, having completed the programme, midwives did not stay in practice. The sample group were those returnees who had completed the programme at the university since 2000. The research methodology included all returnees being sent questionnaires, of which 36% were returned, completed. The 21% who were not currently in practice were then interviewed. The results were similar to the findings of Ball et al (2002) and Kirkham and Morgan (2006), that dissatisfaction with midwifery practice and family commitments were the main reasons for not staying in practice. The findings also suggest that the longer the midwife has been out of practice the more difficult the return to present day contemporary midwifery practice. Return to practice programmes need to be tailored to reflect these findings.
Undocumented migrants and maternity care
Authors: Wiseman Octavia
Published: May 2014

At present undocumented migrants in the UK who fall pregnant must, by law, be charged for all maternity care. This article outlines how this legislation works in practice: what charges are made, how debts are managed and how much money is recovered. It explores how this policy may impact on the health-seeking behaviour of pregnant undocumented migrants, looked at in the context of the Confidential Enquiries into Maternal and Perinatal Health and research into immigration and charging for maternity care. The author draws on national and international public health policy to explore the midwife's obligation to advocate for vulnerable clients and explores how undocumented migrants' access to healthcare and their ability to make informed choices about maternity care could be improved.
Postnatal depression and infant feeding: A review of the evidence
Authors: Donaldson-Myles Fiona
Published: May 2014

The evidence supporting the widely-accepted benefits of breastfeeding regularly comes under scrutiny and parents and midwives often receive conflicting information on the subject. However, one of the likely advantages of breastfeeding seems to have been largely overlooked—breastfeeding may help protect against postnatal depression (PND). This review explores the evidence of the link between breastfeeding and postnatal depression. Although research in the early 1980s suggested that breastfeeding increases the risk of PND, more recent research is almost unanimous in suggesting that breastfeeding actually improves postnatal mood, with some evidence suggesting that it makes no difference. While the evidence for maternal psychoprotection conferred by breastfeeding is strong, many studies are confounded by inconsistent definitions of breastfeeding and the variety of clinical tools used to assess depression, many of which are not specific for PND symptoms. This review demonstrates that, not withstanding these research challenges, there is clear evidence that breastfeeding helps to protect against PND. An evidence-based understanding of the risk factors for PND will assist midwives in encouraging breastfeeding and helping women combat this devastating condition.
The Midwives Save Lives petition is delivered on behalf of 5000 midwives
Authors: Bainbridge Jane
Published: May 2014

Launched at the International Confederation of Midwives earlier this year, the Midwives Save Lives petition calls on global leaders to invest more in midwives and health workers.
Pregnancy and heart disease: An introduction
Authors: Brooks Ruth
Published: May 2014

Heart disease has been the overall leading cause of maternal death in the UK for the last 6 years of reporting. It is particularly concerning that half of those who died in the last 3-year period had received substandard care ( Cantwell et al. 2011 ). This article aims to provide readers with a broad overview of the haemodynamic changes of pregnancy and the issues women with various cardiac conditions face in pregnancy. Midwives are at the forefront of antenatal and perinatal care, and in a unique position to facilitate the early identification of high-risk pregnancies. Follow-up during pregnancy should be tailored according to the degree of assessed risk. Management of women with pre-existing or acquired heart disease should therefore have input from a consultant with an interest in maternal cardiology and an expert high-risk multi-professional team.
Short-term international midwifery consultancy: Evaluating practice
Authors: Maclean Gaynor D.
Published: May 2014

Knowing whether or not one has succeeded in an assignment can be advantageous, although the evidence to substantiate this may not be apparent. Awareness is an important attribute for any consultant or technical adviser working in the field of international development and must be encapsulated within cultural sensitivity. This third and final article in this short series explores some of the issues relating to evaluating one's practice and aspiring to enhance it. Reflective practice is advocated and some suggestions and checklists are offered to assist the consultant in reassessing her/his approach and activities and in drawing conclusions which will culminate in the report recommendations. Both care and caution are counselled with regard to the latter and in the use of English. Undoubtedly, every aspect of international consultancy demands regular and repeated re-evaluation and constant effort if one is to offer best practice.
Direct maternal deaths due to puerperal fever: Back to the future?
Authors: McIntosh Tania
Published: May 2014

The triennial review of maternal deaths 2006–2008 has just been published by the Centre for Maternal and Child Enquiries (CMACE) (2011) , and demonstrates that genital tract infection is now the leading cause of direct maternal deaths. This article looks back to the period before the discovery of antibiotics in the late 1930s when infection—or puerperal fever as it was known—was the leading cause of maternal death. The article explores how the problem of puerperal fever was perceived and dealt with, and suggests that knowledge of the past may help us to deal with future challenges.
Deafness and antenatal care: Understanding issues with access
Authors: Jackson Meghan
Published: May 2014

Deaf pregnant women are often neglected within midwifery services, mostly due to a lack of understanding of how best to care for women with different communication needs. Midwives have a key role in exchanging information and taking the time to understand deaf women's needs in order to act as an advocate and helping to overcome the barriers that can be created by deafness. In order to fulfil this role, midwives need to have an understanding of the problems faced by deaf women and their partners when accessing maternity services.
Advising on postnatal contraceptive methods, services and support
Authors: Smith Debbie , Taylor Wendy
Published: May 2014

Midwives are ideally placed to advise women about contraception during pregnancy and in the postnatal stage, and the National Institute for Health and Clinical Excellence (NICE) (2006) has outlined the ‘core care’ in relation to contraception that each woman and baby should receive. In some cases, midwives have the opportunity to counsel and advise women who have not accessed advice on contraception prior to their current pregnancy. It is important for midwives to be aware of the available methods of contraception and current advice as to the suitability and efficacy of the methods, as well as when they should be commenced. This article considers the guidelines regarding contraceptive advice in the postnatal period, and provides details of where midwives can access expert contraceptive services and the latest evidence supporting the use of various contraceptive methods.
Managing perinatal mental health: A survey of practitioners’ views
Authors: Rothera Ian , Oates Margaret
Published: May 2014

Perinatal psychiatric illnesses are a leading cause of maternal morbidity and mortality but difficulties still exist with the correct identification and management of these disorders. This study surveyed health professionals involved in the care of women with maternal mental health disorders and identified where improvements are required. Midwives, obstetricians and health visitors were asked for their views on the identification, treatment and management of a range of perinatal mental health disorders. The results showed that participants lacked the required knowledge/skills to identify and manage these disorders effectively and most had not received any specific pre-qualification or postgraduate training in perinatal mental health. Most requested additional support, including specialist advice, training and guidelines and agreed that all women with perinatal mental health disorders should have the support of specialized perinatal psychiatric services. Systems are needed to develop and maintain practitioners’ knowledge and skills and to ensure improved access to specialist advice and support when required.
Home births gaining popularity in the United States after a 15-year decline
Authors: Bainbridge Jane
Published: May 2014

A recent study has found a 28% increase in home births among non-Hispanic white women in the USA, taking the proportion giving birth at home in 2008 to more than 1%.
Substance-misusing women: Stigma in the maternity setting
Authors: Radcliffe Polly
Published: May 2014

This article examines the reproduction of stigma in maternity services by exploring the workplace discourse of antenatal staff in three hospital trusts. Interviews with antenatal staff, field notes and observation of antenatal practice carried out as part of a larger study into the experiences of substance‐misusing women of antenatal services in three hospital trusts are referred to. It is argued that since stigma and judgmental attitudes have been found to be a barrier for substance‐misusing women’s access to antenatal care, discourse concerning drug‐using pregnant women and how it is deployed by staff must be taken seriously. The article concludes that these findings emphasize the continued need—set out in recent guidelines from the National Institute for Health and Clinical Excellence (NICE) (2010) —for regular training for antenatal staff about substance misuse, opiate substitution therapy and the social and emotional experiences of a substance‐misusing lifestyle. There is also a need for funding of specialist substance‐misuse midwifery posts and centres of expertise in order for guidance and policy to be properly implemented.
Incorrect sexing after pregnancy loss: A note of caution
Authors: Hills Alison , Fox Robert , Gardner Mary , Siassakos Dimitrios
Published: May 2014

This article provides a report of a 22-week gestation intrauterine fetal death, incorrectly sexed as male on examination at time of delivery. The fetus was later found to have a normal female genitalia and karyotype. The authors discuss when errors in sexing are likely and recommend routine use of quantitative-fluorescent PCR (QF-PCR) for assessment of fetal sex in cases of extreme prematurity, maceration and fetal hydrops.
Using hair sample analysis in self-reported and observed drug use in pregnant women
Authors: Thajam Deirdre , Sibley Colin , Lavender Tina , Atkinson Diane
Published: May 2014

As part of a larger study, maternal hair samples from 56 drug using women were collected within 24 hours of parturition and assayed using gas chromatography and/or mass spectrometry for cannabis, heroin, methadone, cocaine, amphetamine, methamphetamineand benzodiazepines. Reported and observed drug use was compared: a Cohens Kappa coefficient of 0.732 was obtained indicating substantial agreement between reported and observed use. Interesting practice issues emerged. These included the wish to please health practitioners and to avoid negative judgements or removal from services. Also, concerns that confidentiality would be breached or that children would be removed from their care and dissatisfaction with information provided by healthcare practitioners when prescribing medication was communicated.
Is it time to blend student learning?
Authors: Moore Susie
Published: May 2014

Antenatal screening has traditionally been taught to student midwives in the classroom setting using standard lectures. There is little evidence that this approach is supportive of active learning.

This article presents a case study of a blended learning approach and evaluates its outcomes. Students worked in groups and developed a presentation and handout for their peers. The activity was evaluated by means of student feedback and the findings were implemented some weeks later when the activity was repeated for a different topic.

The findings suggest that group work and presentations promote active learning and are suitable teaching methods for use across the midwifery curriculum. However, when employed as blended learning interventions, the teaching input may be increased unless feedback and assessment are undertaken by peers.
Exploring the midwife's role in health promotion practice
Authors: Lee Deborah Jane , Haynes Charlotte L , Garrod Deborah
Published: May 2014

Despite an increasing policy focus in the UK on midwives' role in health promotion, there is a paucity of research in this area. This article aims to address this by exploring midwives' opinions and working practice on health promotion through semi-structured interviews with 15 midwives across 3 NHS sites within Northwest England. Transcribed data were analyzed following the interpretivist tradition and adhered to grounded theory principles. Themes that were identified include delivery of health promotion and barriers to health promotion. While midwives acknowledged the importance of their role in improving health, practice was predominantly ‘health education’. Barriers to delivering health promotion included concerns about the midwife-client relationship and inadequate training. The authors recommend midwifery services re-evaluate current post-registration health promotion training programmes and focus on skills such as motivational interviewing.
Breastfeeding patterns in infants with Down's syndrome: A literature review
Authors: Sooben Roja D.
Published: May 2014

This article reports on the findings of a literature review undertaken to examine factors that influenced breastfeeding among mothers of babies with Down's syndrome. Seven studies were identified, with the earliest published in 1983. The review indicates that higher rates of breastfeeding initiation were associated with professional breastfeeding support, whereas barriers to breastfeeding initiation were linked to the infants' inability to feed or to issues with the medical condition. The review underlines that despite the clearly identified health benefits of breastfeeding there is limited evidence on how new mothers of infants with Down's syndrome are supported to take advantage of such health benefits. More focussed research is urgently needed to seek a deeper understanding of the support needs of both mother and infant to enhance the breastfeeding experience. Such a concerted effort would provide a more up-to-date evidence base to health professionals directly involved in the maternity care of these women.
Enquiry-based learning in midwifery: the lecturer's experience
Authors: Peace M
Published: May 2014

In September 2008, an enquiry-based learning (EBL) approach was implemented for the first time into the University of Hertfordshire's (UH) pre-registration midwifery programme. An evaluation of this approach was therefore required. This study explored the lecturers' experiences of using EBL within the first year of its implementation. A qualitative methodological approach using a phenomenological design were used and two of the main themes that emerged are presented in this paper: ‘facilitation of EBL’ and ‘EBL and the midwifery curriculum.’ Conclusions drawn from this study found that overall, EBL is a useful approach within the midwifery curriculum but it should be supported by key lectures that address foundational knowledge in midwifery. The method of facilitation is a key factor in the effectiveness of this approach and staff reflection is deemed to be an important aspect in supporting facilitators to develop in their role. Recommendations are made for the future development of this approach.
Critical refective entry: postnatal depression
Authors: Ritchie Mary
Published: May 2014

For this reflective account, I have drawn upon a particular experience I found difficult to deal with emotionally. I expect to gain a greater understanding of the issue and how I can deal with it better in the future by reflecting upon my experience and researching the subject in more detail. For this particular reflective account, I will be using Gibbs reflective cycle ( Gibbs, 1988 ).
Midwifery education: making sense of the current challenges
Authors: Ball Linda
Published: May 2014

Higher education institutions and the NHS both face a number of major challenges. This paper provides an overview of some of the key contemporary publications that will have an impact on the UK university system in the coming months, and attempts to clarify their potential and real effect on the future of midwifery education and the ongoing development of midwifery curriculum.

There is a very real risk that recent government proposals for future higher education funding in conjunction with their major reconfiguration of the NHS will both fragment and destabilise existing university education systems. Money is tight, and will become tighter, making the task of meeting the demands of midwifery stakeholders, while not compromising on the quality of the midwifery student experience, even harder for educators. Women and their partners deserve a safe transition to parenthood and a positive and life-enhancing experience of UK maternity services—in the coming months midwifery curricula will be judged on their ability to facilitate this.
Drinking coffee can reduce women's chances of conceiving through IVF
Authors: Bainbridge Jane
Published: May 2014

A Danish study has shown that drinking more than five cups of coffee a day may reduce chances of conception by IVF by up to 50%.
Supervision of midwives: Reacting to the future?
Authors: Perkins Danielle
Published: May 2014

This article explores how supervision can be viewed as either reactionary or proactive. Historically, midwifery supervision was seen as a punitive measure. This article looks at how the current premise of supervision leads to a cycle which may prevent supervisors of midwives (soMs) promoting the role and how demonstrating more proactive activities and communicating these to midwives will ensure that the full benefits of supervision are utilised.
Maternal mortality rates in Mexico linked to violence during pregnancy
Authors: Bainbridge Jane
Published: May 2014

A study into maternal mortality and abortion rates in Mexico suggest concerns that induced abortion may be related to violence against women during pregnancy.
Antenatal care in pregnancy following a stillbirth
Authors: Hannah Katherine
Published: May 2014

In 2010, approximately 4110 (1 in 200) babies in the UK were stillborn (Stillbirth and Neonatal Death (SANDS), 2012). Although stillbirth accounts for around 50% of child deaths ( SANDS, 2012 ), it remains an underemphasised aspect of clinical practice ( Kohner and Henley, 2001 ; Mottram, 2004 ; SANDS, 2012 ). Although many women who have a stillbirth will become pregnant again, there appears to be relatively little research into pregnancy following stillbirth, its management, and women and their families' experiences. As previous stillbirth is a risk factor for complications and stillbirth in subsequent pregnancies, as well as having psychological implications, it is vital that care is tailored to meet the holistic requirements of families and to detect deviations from the norm so that appropriate interventions are not delayed.
Are HIV-infected pregnant women at a higher risk of developing depression?
Authors: Crompton Louise
Published: May 2014

Aim: To determine whether pregnant women with HIV are at a greater risk of developing perinatal depression (PND). Method: a literature review identified relevant evidence surrounding the prevalence of depression in HIV-infected pregnant women. Inclusion and exclusion criteria were applied to 52 articles, of which five quantitative studies were applicable. Findings: social and psychological factors secondary to HIV infection were noted to be the main reason for an increase in the prevalence of PND. conclusion: Women with a complex psychosocial background are at a significantly higher risk of developing PND. suggestions have been made by the author to incorporate the findings into a care Pathway that allows for the routine screening of all women to help highlight those at a greater risk of developing PND. There is a need for further research to support the findings of the literature review as well as to broaden the current research available in high-income countries.

This article focuses on the HIV-infected and HIV at-risk pregnant population of the USA. The prevalence of PND in this population is explored and risk factors acknowledged. Trending risk factors for PND in this population include HIV status, psychiatric history, stress and substance use. These findings are incorporated into a draft tool that could be integrated into current practice.
Literature review: Eating and drinking in labour
Authors: Hunt Lauren
Published: May 2014

The aim of this literature review is to investigate whether women of low-risk status should be denied oral fluids and food intake during labour. Objective: To improve outcome of mothers and neonates by looking at appropriate studies to discern whether withholding oral fluids and food during labour decreases the risk of maternal morbidity from Mendelson's syndrome (1946). The review also aims to determine the benefits and harm of oral fluid or food for women in labour compared with women free to eat and drink. Method: Randomised controlled clinical trials. Data collection methods: Quarterly searches of the Cochrane Database of Systematic Reviews and weekly searches of MEDLINE. Findings: This review discovered that there is no clear statement of findings restricting oral fluids and foods in labour, and that the validity of this practice needs to be questioned and further research carried out. Conclusion: When undertaking this literature review, the author found limited studies looking at eating and drinking in labour. The issue of whether women should eat and drink in labour is controversial. This diet restriction is a precaution for women who are at high risk of requiring a caesarean section (general anaesthesia); however, for pregnant women who are low risk, the research indicated there was little risk and midwives should review policies within their own Trusts.
Risk perception in women with high-risk pregnancies
Authors: Lee Suzanne
Published: May 2014

Risk perception in women with high-risk pregnancies affects the decisions they make about antenatal care and therefore may influence the wellbeing of mother and baby. This paper considers the factors which influence women when making risk assessments of their pregnancies and how these assessments may differ from those of health-care professionals. Women use multiple sources of information to determine their risk status, including advice from professionals and other trusted sources, and their own intuitive knowledge. They recognise the risks posed by their pregnancies and will take steps to ensure the health of themselves and their babies. However, these may not include following all medical recommendations. Women's perceptions of risks and the care they will accept are weighed up in the context of their individual circumstances. Midwives need to be aware of these factors to ensure the care they give is individually appropriate, respectful and realistic.
Women's experiences of induction of labour for post-date pregnancy
Authors: Murtagh Martha , Folan Margaret
Published: May 2014

This qualitative study used a descriptive phenomenological approach to investigate women's experiences of induction of labour (IOL) and how it impacts on their experience of childbirth. Semi-structured interviews were carried out with nine nulliparous women who underwent IOL for post-date pregnancies in a maternity unit in Ireland. Interviews were transcribed verbatim and analysed for emergent themes using Giorgi's method of analysis (1985). Findings revealed negative descriptive accounts of IOL owed to a number of reasons; however, birthing a healthy baby transformed this negativity to an overall satisfactory experience. This suggests that satisfaction appeared to have been more related to the fact that they had successfully birthed a healthy baby than their actual experience of IOL. The study highlights the need for greater provision of quality information on IOL, encouragement to partake in the decision-making process and continued support from midwives in the pre-labour phase of IOL.
Using antimicrobial Surgihoney to prevent caesarean wound infection
Authors: Dryden Matthew , Goddard Clare , Madadi Aznvik , Heard Michael , Saeed Kordo , Cooke Jonathan
Published: May 2014

Caesarean section (CS) wound infection rates are unacceptably high; around 10% according to figures from the Health Protection Agency (2012) . This service evaluation assessed the effects of Surgihoney on surgical site infection rates in women undergoing caesarean section. All women presenting for CS were offered Surgihoney as a single application wound dressing at the end of the procedure. All women were followed up and examined for surgical site infection for 30 days after CS. A single application of Surgihoney dressing reduced surgical site infection (SSI) by 60.33% from a rate of 5.42% (n=590) to 2.15% (n=186) (p-value=0.042). The potential saving to the NHS of using Surgihoney as a single application achieving this level of wound infection reduction is considerable. Surgihoney offers a simple, cost-effective intervention to reduce SSI in women undergoing CS. It is applicable to practice in all health economies and could potentially save considerable surgical infective morbidity in patients undergoing surgical delivery.
Transcultural therapy 1: mental health and learning disabilities
Authors: Jukes Mark , O'Shea Kate
Published: May 2014

In this article, the first of two parts, the issues surrounding healthcare provision are discussed in the context of the UK as a multicultural society. Concerns relating to nurse education and training are identified in regard to the implications for practice surrounding diagnosis across cultures, classification of illness, and the status and influence of psychological assessments within the field of mental health and learning disability. Finally, the concept of empowerment is critically reviewed, emphasizing that service providers need to collaborate with communities. Community mental health and learning disability nurses are required to make dynamic alliances with communities, through the individual, and so redirect the power relationship to the community and subsequently respond to the demands for cultural diversity sensitively from within healthcare provision and services.
Can electric beds aid pressure sore prevention in hospitals?
Authors: Hampton Sylvia
Published: May 2014

The purchase, cleaning and maintenance of air mattresses can be an expensive part of pressure sore prevention and repositioning of patients can be time consuming and costly in terms of possible nursing injuries. The King's Fund bed has been a friend to the health service for many years but the time has come to look for an alternative system that will support patient comfort and independence, will assist nurses in implementation of a no-lifting policy and aid pressure sore prevention policies. This article describes a study that was undertaken in two medical wards to assess the value of electrically controlled beds in relation to the prevention of pressure sores, implementation of a no-lifting policy and quality of patient care. A total of 782 patients took part in the study over a 6-month period and 726 replies were obtained from nurses. The ward had similar profiles of patients' medical conditions and age; they were being medically managed by the same consultants. Results showed that patients experienced greater comfort on beds with the electric facility, produced less pressure sores, mobilized easily and pressure sore prevention costs could be reduced. There is a need to be proactive in prevention of pressure sores and not reactive to a pressure sore that is already developing.
The benefits and application of the Lyofoam product range
Authors: Williams Clare
Published: May 2014

Foam dressings are used widely by many healthcare professionals. They provide an excellent healing environment for exuding wounds. Lyofoam is a polyurethane foam dressing that has been developed over the last few years and is available in a variety of presentations for light, moderately, and heavily exuding wounds. A new addition to complement the Lyofoam range is Lyofoam Extra Adhesive. Lyofoam is a well established and clinically proven wound dressing.
Indications for and principles of intermittent self-catheterization
Authors: Doherty Willie
Published: May 2014

Intermittent self-catheterization (ISC) or carer/nurse assisted intermittent catheterization has developed over the past few years as a means of treating patients with bladder emptying problems. Initially the process was designed for patients with the dexterity to carry out the procedure; today, however, more nurses are trained in the technique and are therefore able to support people with coordination problems in carrying out the procedure. Education programmes on catheterization are becoming increasingly popular and many district nurses have become skilled in its practice. This article describes some of the conditions that may be associated with bladder dysfunction and which warrant ISC. The support required from nurses in the planning, implementing, intervention and evaluation of a package of care are discussed. Simple advice such as avoiding constipation, monitoring urine to identify infection and general measures to improve hygiene all play a role in maintaining good health.
A normal lifestyle: parental stress and coping in childhood diabetes
Authors: Lowes Lesley , Lyne Patricia
Published: May 2014

This article forms part of an extensive literature review informing a study exploring the parental experience of home management of children with newly diagnosed diabetes. As a diagnosis of childhood diabetes may represent a major stressor event for parents, selected theories and models of stress and coping are discussed. These suggest that, influenced by a variety of interpersonal and environmental factors, parents may approach the process of coping in different ways. Coping strategies employed by parents of children with diabetes elicited from the literature are categorized according to a psychological theory of stress and coping. Normalization, a coping strategy used by parents of chronically ill children, is discussed in relation to childhood diabetes. To conclude, implications for nursing practice are outlined and suggestions made about how parents may be assisted to cope with the demands of having a child with diabetes.
Therapeutic massage in older persons: research issues
Authors: Weinrich Sally P , Haddock Sue , Robinson Karen
Published: May 2014

Growing recognition of the importance of holistic nursing interventions is resulting in a revival in the use of therapeutic massage. Massage contributes to health and healing through enhancement of relaxation, and is a safe, caring, and inexpensive intervention. Therapeutic massage research using older populations is reviewed for identification of its theoretical framework, design, outcome variables, sample, procedures, instruments, analyses and results. To establish a scientific basis for therapeutic massage in the future, it is critical that nurses include the following key elements in their research studies: clear definitions; procedures for massage that include type(s) of massage performed, part of body massaged, and length of time of massage; and analyses that control for the pre-massage level of the variable of interest. Research variables need to focus on concepts that have major health consequences such as agitation, immune status, and pain.
The patient-centred care model: holistic/multiprofessional/reflective
Authors: Ellis Susan
Published: May 2014

Holistic patient-centred care (PCC) is often regarded as the quintessence of nursing practice. However, closer examination reveals that provision of care for patients with a physical illness or disability is centred around their compromised physical condition rather than their individual needs. Often, little attention is given to ‘total care’ and negotiation with the patient is largely excluded. This is evident in the continued use of medical models of care and the assumption that physical needs are the priority for practice. This article presents an alternative — the PCC model. This is a multiprofessional, reflective model which facilitates an unbiased and non-presumptuous approach, thereby overriding the tendency of healthcare professionals to rely on paternalistic and habitual practice. It empowers patients, allowing them to determine their own needs, and encourages reflection, self-awareness and personal and professional growth in the healthcare professionals who adopt it. Although the model was devised and piloted within a hospice it has the potential to be adapted for use in any healthcare setting.
We must all press to protect the title ‘nurse’
Authors: Castledine George
Published: May 2014

A crucial point to emerge from the review of the regulation of nurses, midwives and health visitors (JM Consulting Ltd, 1998) was the proposal to protect the title ‘nurse’. This was one of only four points which the Government deemed appropriate to go out for consultation. The report points out that the common title and functions of a midwife are, in effect, protected, but that this is not the case for the title and functions of nurses. There are penalties for someone who inappropriately represents him/herself as a registered nurse but these have rarely been enacted.
Development of a meaningful learning environment in theatres
Authors: Radford Mark , Hunt Louise
Published: May 2014

During the 1990s, geographical distancing of clinical areas and nurse education establishments led to breakdowns in communication. This article focuses on how Good Hope Hospital NHS Trust and the University of Central England in Birmingham created a meaningful learning environment for student nurses in the operating theatre using a revised version of Crofts and Taylor's (1996) perioperative placement model. The student evaluation has demonstrated that the quality of placement, teaching and supervision were of a high standard and students felt that their nursing skills had been enriched as a direct result of the placement. This article will also examine the background to student placements in the operating theatre.
Quality and marketing issues in nursing education
Authors: Hughes Karen
Published: May 2014

Two important issues in nursing education are quality and marketing. These issues both complement and support each other. The aim of this article is to highlight the concepts of quality and marketing as a valuable partnership in nursing education, a partnership that is capable of improving the quality of education provision and potentially of increasing student numbers. Major themes include an analysis of the reluctance by institutions to implement marketing strategies, the image of the institution, and customer satisfaction. The article concludes by suggesting that nurse educators need to know who their customers are, who they could be, and what those customers want and need, in order to run successful and valued courses.
Observation and documentation of bedside blood transfusion
Authors: Rowe Rachael , Doughty Heidi
Published: May 2014

Correct administration of blood and the management of the transfused patient are a fundamental element of transfusion safety. Recently published guidelines from the British Committee for Standards in Haematology highlight that most serious transfusion complications occur within the first 15 minutes. They recommend baseline observations before and 15 minutes after commencement of each unit of blood. Using a Royal College of Physicians (RCP) proforma, 100 clinical case notes were examined retrospectively for standards of transfusion documentation and bedside observation. The audit identified that bedside practice was variable and that only 16% of cases met this standard. Most wards continued with hourly observations in uncomplicated cases. Trust guidelines and a staff education programme have been implemented to address the audit results.
The prison healthcare service: a workforce committed to change
Authors: Norman Ann , Parrish Alan A
Published: May 2014

This article discusses the changes that are needed in the prison healthcare service, outlining the move to a multidisciplinary team approach, away from the outdated, medically dominated service which prevails today. This article supports the partnership arrangements put forward in ‘The Future Organization of Prison Health Care’ (Department of Health (DoH), 1999) and suggests how this can be achieved locally, calling on nurses working in the prison environment to be proactive and forge links with colleagues in local NHS services. The need for clinical governance to be firmly established and regular reports to be submitted to prison governors on the quality and provision of services is highlighted.
Central venous catheter removal: procedures and rationale
Authors: Drewett Sarah R
Published: May 2014

The use of central venous catheters (CVCs) has become fairly commonplace within both the hospital and community setting. The removal of these devices is often a task performed without much teaching and the procedure to follow is passed on from one nurse to another with little or no research on which to base actions. This article describes the potential complications associated with CVC removal and methods to prevent them. It will also give the nurse research-based procedures to follow when removing the various types of CVC. These written procedures should be used as a training guideline only. Practical training and supervision until competent is still required.
The amputation of healthy limbs is not an option
Authors: Beckford-Ball Jason
Published: May 2014

The latest ‘Horizon’ programme on BBC 2 (Horizon, 2000) investigated Body Dysmorphic Disorder (BDD) and featured the surgeon Robert Smith who recently amputated the healthy limbs of two sufferers at Falkirk and District Royal Infirmary. BDD is a condition in which the sufferer believes that part of his/her body is ‘ugly’ or defective and in its worst form the disorder can lead to sufferers attempting to amputate their own limbs, sometimes with fatal results. Sufferers experience depression, self-loathing and may attempt suicide.