1,720,972 research outputs found
“What a difference a day makes” - Second trimester termination of pregnancy in the gynaecology ward: A case study
No full textThe focus of this study are the nurses who care for women undergoing termination of pregnancy in the second trimester. Termination of pregnancy (abortion) is the deliberate ending of a pregnancy. In New Zealand for the year ending December 2015, 13,155 abortions were performed and of these, 553 abortions were performed after the 12th week of pregnancy (second trimester). Changes to how abortions are undertaken has resulted in increased participation by nurses and midwives in the process, where the resulting products of conception often resemble a fully formed foetus. Despite abortion being so widely accessed, little is known about the attitudes, opinions or feelings of the nurses who deliver the care.
The purpose of this study was to explore issues for nurses who provide care for women undergoing second trimester termination of pregnancy in the gynaecology inpatient setting. Case study methodology was used. This study used face to face semi structured interviews and retrospective clinical note review as data collection methods. Themes which were identified in the interviews included: staff experiences and attitudes, strategies for managing demands and challenges, and training and support. The study found that whilst the stance of the nurses who participated in second trimester termination of pregnancy care was largely pro-choice they were not necessarily immune to the stressors associated with the processes of termination of pregnancy, particularly as the gestational age of the pregnancy advances. Support for nurses who work in abortion services is at best haphazard and when compared to the disciplines of palliative care and mental health was found woefully lacking. In addition, education for nurses specific to abortion care was ad-hoc, fragmented and relied mostly on informal peer teaching from other nurses.
The key recommendations emanating from the study were that consideration should be given to developing structures, processes and training to support nurses in their practice with a view to maintaining high quality patient care. Training for staff should be evidence-based, patient centric, planned and a priority and not rely primarily on the good will of colleagues. It is envisaged that the findings of the study will provide a framework with which to build robust support structures for nurses working in this unique area of healthcare
Maternal perception of fetal movements: A qualitative description
No full textBackground: Maternal perception of decreased fetal movements is a specific indicator of fetal compromise, notably in the context of poor fetal growth. There is currently no agreed numerical definition of decreased fetal movements, with subjective perception of a decrease on the part of the mother being the most significant definition clinically. Both qualitative and quantitative aspects of fetal activity may be important in identifying the compromised fetus.Yet, how pregnant women perceive and describe fetal activity is under-investigated by qualitative means. The aim of this study was to explore normal fetal activity, through first-hand descriptive accounts by pregnant women.
Methods: Using qualitative descriptive methodology, interviews were conducted with 19 low-risk women experiencing their first pregnancy, at two timepoints in their third trimester. Interview transcripts were later analysed using qualitative content analysis and patterns of fetal activity identified were then considered along-side the characteristics of the women and their birth outcomes.
Results: Fetal activity as described by pregnant women demonstrated a sustained increase in strength, frequency and variation from quickening until 28-32 weeks. Strength of movements continued to increase at term, but variation in movement types reduced. Kicking and jolting movements decreased at term with pushing or stretching movements dominating. In this study increased strength and frequency of movements at term as determined qualitatively by the mother was associated with higher mean customised birthweight of newborns, whilst decreased frequency was in all cases associated with either maternal obesity, customised birthweight under the 20th centile or operative delivery for non-reassuring fetal status.
A novel finding of a complex pattern of fetal movements in relation to mealtimes is reported here. More than a third of participants (37%) described marked increases in fetal movements in response to hunger, in many cases subsiding postprandially. The women who described this pattern in response to hunger and eating, subsequently gave birth to infants significantly smaller (mean difference 364gm) than those who did not describe a fetal response to hunger. Patterns of fetal movements were reported to be influenced by time of day, maternal position and activity, with an inverse relationship between maternal activity and fetal activity described by all participants.
Conclusions: Maternal descriptions of fetal movements with advancing gestation and in relation to time of day are consistent with fetal activity as described in ultrasound studies, lending reliability to the maternal account. Maternal perception of fetal movements in response to environmental stimuli such as maternal meals and maternal position-changes may constitute a maternal-fetal communication in the interests of maintaining the pregnancy. Pregnant women are reassured by fetal movements occurring at a usual time or situation, suggesting that maternal monitoring of fetal movements is a dynamic process taking into account a broad range of fetal functions
The Good, the Bad and the Ugly. The experiences of midwives who transition work settings: A qualitative descriptive study
No full textThis research explores the experiences of midwives as they transition work settings. It has been found that these experiences are both positive and negative. Midwives relish working with women in a capacity that brings them joy and sustains them within the profession. They achieve this with the valued support of their families, practice partners and colleagues. However, there are numerous stressors on midwives including financial, emotional, physical, family commitments, bullying and work demands, which impact on the ability of the midwife to fulfil these obligations. This dissonance leads to increased levels of stress and fatigue and in order to manage this, the midwives who participated in this research appear to transition work settings.
By analysing the lived experiences of nine midwives in Aotearoa/New Zealand who have transitioned work settings between core and LMC (or vice versa) in the previous two years, I have explored the research question ‘What are the experiences of midwives who transition work settings?’ using a qualitative descriptive research framework. Face to face interviews were conducted with midwives around the South Island of Aotearoa/New Zealand using semi-structures interview questions, followed by transcription and thematic analysis. Four main themes emerged, ideal midwife, movement happens, support and obstruction and things have changed. The themes and subthemes are discussed in depth through this work and literature used to support the discourse.
The main finding was that transitioning work-settings is a way of remaining professionally and personally sustained in the current system of maternity care in Aotearoa/New Zealand. Other findings were that support from family, colleagues and managers, as well as the relationships with the women, are imperative for midwives in either work setting to remain sustainable. That the lack of support, bullying, harassment, poor remuneration and family commitments, are stressors that impact on the working lives of midwives and contribute to their decisions to transition work settings. There are implications from this research for midwives, DHB, workforce planning, educators and the wider profession
Becoming a Homebirther, Smooth Sailing or Rocky Road? An Exploration of Pakeha Women's Experience on the Path to Homebirth
No full textThis study explores the experiences of primiparous women on the
path to planning the homebirth of their first child. There are many
challenges along the way and although there are many supports,
society does not generally view homebirth as a safe option. This
study highlights the themes emerging about the relative ease or disease
of the journey. Was the experience smooth sailing on an
undulating ocean or a testing trek along a rocky road?
There is a vast body of evidence about homebirth, with much of the
quantitative literature being outcome focussed and most of the
qualitative literature exploring women's experience of the
homebirth-day. Birthing at home has been linked with increased
maternal satisfaction compared with other birth venues and
correlates with a feeling of maintaining power and control during
the birth process. Homebirth has also been shown to have similar
rates of intrapartum and neonatal mortality, as well as lower
maternal intervention rates, in low risk populations.
This study principally investigates the experience of Pakeha New
Zealand women on their way to planning a homebirth for their first
baby. The findings of this narrative inquiry include that women
make the journey to becoming a homebirther both before
pregnancy and during pregnancy, and that they need good support
and information. Hearing positive homebirth stories, having a
midwife who professes a preference for homebirth, and having
access to homebirth resources play integral roles in becoming a
homebirther
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Kangaroo Mother Care: Participatory Action Research within a Neonatal Intensive Care Unit in Aotearoa New Zealand
No full textHuman infants share common biological and developmental needs in the postnatal period that are optimally met during intimate contact with their mother or primary caregiver. In the case of infants hospitalised in tertiary-level neonatal intensive care units (NICUs), there is a departure from instinctual caregiving and nurturing found in the mother-infant pair, due in part, to a model of care which supports maternal-infant separation. This can lead to suboptimal physiological responses, altered neurobiology and life-long negative health effects. The social construction of neonatal care currently positions it within the paradigm of biomedical science. Where family-centred, developmental care frameworks have been integrated, and Kangaroo Mother Care (KMC) has been embedded into caregiving routines, enhanced patient, whānau/family, staff and organisational outcomes have been found.
This study is underpinned by the importance of KMC for the enhancement of infant and whānau/families’ health and developmental outcomes. Despite its classification as an evidence-based practice, and recommendations by the World Health Organisation for its use in all healthcare settings, KMC is inconsistently applied. The highly complex and contextual nature of the environments where medically-dependent babies are cared for is acknowledged. There is a need for health services to explore innovative research approaches, through a social science lens, to assist in the implementation of KMC. This thesis illustrates one such approach.
The purpose of this study was to explore and activate improvement of the KMC programme within one NICU in Aotearoa New Zealand using Participatory Action Research (PAR). The research was theoretically informed by Als’ developmental biology and care theories, D’Agata’s Infant Medical Trauma model, and the Foucauldian concept of power/knowledge through a critical feminist lens. A participatory approach was chosen in the hope that transformation of KMC practice would be achieved and embedded within this NICU. In addition, I intended to contribute to the emerging body of evidence calling for the collaboration of all community members toward enhanced quality of KMC. Multiple methods were used to capture data relating to the NICU’s KMC programme through audit, observation and interview of key stakeholders.
Project planning included the conventions of PAR generally applied to research using this methodology. Three iterative cycles of exploration, implementation and evaluation of the KMC programme were envisaged within this setting. Active participation with multiple NICU stakeholders was planned for, forming the basis of action-based change and improvement of KMC. However, the three-cycle process was not achieved within the time limitations of my research, with field work finishing at the conclusion of the first exploratory cycle. This thesis describes the unfolding processes of PAR, as well as the inclusion of a secondary discourse analysis and parental perspectives from local and global literature.
Key findings showed inconsistently documented KMC and the near-absence of KMC practice for a significant group of babies. Whilst the benefit of KMC was embedded in the understanding of participants, this knowledge did not translate to practice. There was an unrealistic optimism about the functioning of KMC by most of the stakeholders. In addition, participants expressed ambiguity about their programme, contributing to and influenced by suboptimal KMC education and training. A pathway to improvement of their KMC programme was lacking, and the lines of responsibility for it were unclear. This factor undoubtedly contributed to the difficulties of implementing a full PAR project. Whilst parental, staff and organisational factors were found to influence KMC implementation, arguably the greatest effect on the intervention were the power relations inherent within the normative technocratic, biomedical paradigm. Power relations constituting what was considered authoritative knowledge, and who was authorised to speak, impacted on the participatory nature of the research itself. This resulted in the research not proceeding past the first PAR exploratory cycle through to rounds of implementation and evaluation.
This thesis describes participatory inquiry into one KMC programme in the high-income NICU setting, through the lenses of multiple participants within the context of Aotearoa New Zealand. These were not previously known. It also provides an example of how Foucauldian- and feminist-informed PAR methodology may be used within the NICU setting for inquiry into KMC, an intervention positioned outside of the normative biomedical framework
New Zealand midwives' management of perineal trauma during childbirth: A survey of practice
No full textBackground: Perineal trauma is the most common complication of vaginal birth and how this is treated has an impact on the incidence and duration of pain and dysfunction. Responsibility for the management of women’s perinea after uncomplicated births in New Zealand ordinarily rests with midwives although this is a little known aspect of practice. This study aimed to identify how midwives assess and manage second degree perineal trauma, the level to which their practice reflects best evidence, and what influences midwives’ decision-making.
Methods: A descriptive approach using an online survey of 75 questions was used to access the population of 2910 New Zealand midwives. Inclusion criterion was current perineal management. Quantitative data were collected and associations examined using chi-square and Fisher’s exact test. Interval data were analysed with a two-sample t-test.
Results: 818 midwives returned a questionnaire, 744 (25% of the midwifery population) met the inclusion criteria. Evidence-based suturing material for repair of the last second degree tear was used by 96%. Correct suturing technique throughout all layers of repair was 42%. Rectal examination during assessment was performed by 45% increasing to 86% after repair. Confidence to repair was directly related to years since midwifery qualification (p<.001) and self-employment (p<.001). The tear was left unsutured by 7% and associated with reduced confidence with repair (p<.001), lack of recent experience with repair (p<.001), and home birth (p=.002). Unsutured tears were shorter than sutured tears (vaginal/perineal length, p<.001; depth, p=.004) and associated with delayed healing (p=.034). Care to six weeks postpartum was provided by 377 midwives. Perineal analgesia included oral medication (76%), pelvic floor exercises (44%), cooling (38%), and suppositories (31%). Visual assessments of healing were performed by 84% of midwives, 49% of women, and 7% of support people. Complications of infection (2%), pain (2%), and healing delay (3%) were uncommon.
Conclusions: This research has added a New Zealand midwifery practice perspective to the existing literature on second degree perineal care. Potential for reductions in perineal morbidity were identified, even though New Zealand midwifery care already has a low rate of complications compared to international studies
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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