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Midwifery Practice (midwifery + practice)
Selected AbstractsNursing and midwifery research in Scotland: from partnership to collaborationINTERNATIONAL NURSING REVIEW, Issue 2 2006T. Fyffe mmed ed Nurses and midwives form the workforce that provides the greatest proportion of direct care to service users. They have the ability to make a significant impact not only on the quality and outcomes of patient care, but also on service users' and carers' perceptions of the care experience. It is therefore vital that nursing and midwifery practice has a robust knowledge and evidence base. The Scottish Executive Health Department, in partnership with other key stakeholders, launched in 2004 an £8 million funding package for research and development capacity and capability initiatives for nursing, midwifery and the allied health professions. This article seeks to describe the process of engagement and partnership building that enabled this scheme to be developed. It will attempt to illustrate how the convergence of political, policy and professional agendas has provided the opportunity for nurses and midwives to set a direction of travel for research and development that will enable them to become key players within multidisciplinary research at United Kingdom and international levels. [source] Maternal distress: a concept analysisJOURNAL OF ADVANCED NURSING, Issue 9 2010Elizabeth Emmanuel emmanuel e. & st john w. (2010) Maternal distress: concept analysis. Journal of Advanced Nursing,66(9), 2104,2115. Abstract Aim., This paper is a report of an analysis of the concept of maternal distress. Background., Although not well-developed, the concept of maternal distress has offered an important viewpoint in nursing and midwifery practice since the mid-1990s. Traditionally, understanding of maternal distress has been based on the medical model and dysfunction. The concept of maternal distress needs development so that it describes responses ranging from normal stress responses to those indicating mental health problem/s. Data sources., The SCOPUS, CINAHL and Medline databases were searched for the period from 1995 to 2009 using the keywords ,psychological distress', ,emotional distress' and ,maternal distress'. Review methods., Steps from Rodgers' evolutionary concept analysis guided the conduct of this concept analysis. Results., Four attributes of maternal distress were identified as responses to the transition to motherhood, with the level of each response occurring along a continuum: stress, adapting, functioning and control, and connecting. Antecedents to maternal distress include becoming a mother, role changes, body changes and functioning, increased demands and challenges, losses and gains, birth experiences, and changes to relationships and social context. The consequences of maternal distress are compromised mental health status, maternal role development, quality of life, ability to function, quality of relationships and social engagement. The extent of the impact depends on the level of maternal distress. Conclusion., Clearer interpretation of maternal distress offers a comprehensive approach to understanding maternal emotional health during the transition to motherhood. Acknowledging women's experiences and providing more appropriate support could alleviate some of the struggles and hardships experienced by mothers. [source] Enhancing Delphi research: methods and resultsJOURNAL OF ADVANCED NURSING, Issue 5 2004Holly Powell Kennedy PhD CNM FACNM Background., The Delphi method provides an opportunity for experts (panelists) to communicate their opinions and knowledge anonymously about a complex problem, to see how their evaluation of the issue aligns with others, and to change their opinions, if desired, after reconsideration of the findings of the group's work. Delphi studies have the potential to provide valuable information, yet few researchers have taken further steps to support or refine their findings. Without this step there is a potential threat to the applicability, or external validity, of the results. Aims., The purpose of this article is to present an argument for further inquiry to enhance and support Delphi findings, and specific approaches to this will be considered. Methods., Methods to enhance, expand, or refine Delphi study findings are described. Mixed method design within a Delphi study on midwifery practice is described, and a follow-up narrative study to examine the findings is presented. Findings., Selected results from the follow up narrative study are presented to convey how the narrative data clarified the Delphi findings. Together, the studies provide a more robust depiction of midwifery practice, process, and outcomes. Although there were similarities to the dimensions identified previously, there was a more dynamic focus and explanation of the interaction between the midwife, the woman who had received midwifery care, and the health care system. Study limitations., Lack of diversity in the sample and the midwives' familiarity with the author's past research represent a potential threat to the findings. Prolonged interviews and multiple narratives were gathered in an effort to control for this. Conclusion., Delphi studies are research exercises conducted by a panel of experts. Designing studies to further enhance, clarify, or refine their findings from the context of practice holds promise for their ability to influence clinical care. [source] Peer review in Nursing and Midwifery: a literature reviewJOURNAL OF CLINICAL NURSING, Issue 4 2008Amelia Rout MSc, BSc (Hons) Aims and objectives., The Clinical Education Project investigated clinical education in nursing and midwifery settings. The aim of this phase was to investigate and evaluate the processes and outcomes of clinical assessment of preregistration nurses and midwives, focusing on the assessment interview, and to evaluate the feasibility of introducing peer review of the clinical assessment interview in acute clinical settings. Background., Peer review is common in many professional areas. The literature describes various applications of peer review and makes recommendations for its use. However, there is a shortage of studies investigating the use of peer review in nursing and midwifery education and practice. Design., The project involved a systematic literature review and a qualitative exploratory study. This article describes the first part of the study: a systematic literature review of peer review. The second part of the study is reported elsewhere. Methods., The systematic literature review investigated international articles written since 1994 that contained information on peer review in pre/post registration nursing and midwifery within higher education or practice. Results., From the available literature, 52 specific initiatives were analysed. The majority of articles originated in America and involved nursing staff working in secondary care settings. Fifty-one articles had missing information varying from not stating the sample size to not including information about evaluations. Conclusions., The literature review found that whilst peer review is commonplace in nursing and midwifery practice, there is a lack of robust literature about its use. Relevance to clinical practice., Peer review in clinical settings such as nursing and midwifery can facilitate the sharing of good practice and personal and professional growth. It allows participants to learn from each other and gain insight into their development. [source] Increasing research evidence in practice: a possible role for the consultant nurseJOURNAL OF NURSING MANAGEMENT, Issue 3 2008HARRY CHUMMUN BSc (Hons) Aims, To determine the extent to which clinical nursing practice has adopted research evidence. To identify barriers to the application of research findings in practice and to propose ways of overcoming these barriers. Background, Way back in 1976, nursing and midwifery practice started adopting research evidence. By 1990s, there was some transparency of research evidence in practice, but more could have been done to widen its adoption. Many barriers were identified which could hinder implementation of the evidence in practice, and the effort to remove these remains weak. Evaluation, 25 research articles from across Europe and America were selected, and scrutinized, and recommendations analysed. Findings, Many clinical practitioners report a lack of time, ability and motivation to appraise research reports and adopt findings in practice. The clinical environment was not seen as research friendly as there were a general lack of research activities and facilities locally. There was a clear lack of research leadership in practice. Implication for nursing management, This paper reviewed the research evidence from several published research papers and provides consultant nurses with practical suggestions on how to enhance research evidence application in their practice. It recommends how consultant nurses can make their practice more research transparent by providing the required leadership, creating a research-friendly organization, developing a clear research agenda and facilitating staff develop a local research framework for reading research and implementing research evidence in their practice. [source] Performance assessment in health care providers: a critical review of evidence and current practiceJOURNAL OF NURSING MANAGEMENT, Issue 8 2007KAREN E. STC. Aim, To evaluate methods of performance assessment through an international literature review and a survey of current practice. Background, Over the past two decades health care organizations have focussed on promoting high quality care in conjunction with retaining motivated staff. Cognisant of such initiatives, we sought to evaluate assessment methods for qualified staff according to their utility in the working environment. Methods, A systematic literature search was completed and each paper independently reviewed. All health care organizations in Northern Ireland submitted details of their performance assessments. Each was critically appraised using a utility index. Results, Performance was not universally defined. A broad range of assessments were identified, each method had advantages and disadvantages. Although many lacked rigorous testing, areas of good practice were also noted. Conclusions, No single method is appropriate for assessing clinical performance. Rather, this study endorses proposals for a multi-method strategy to ensure that performance assessment demonstrates all attributes required for effective nursing and midwifery practice. [source] Maternal Position at Midwife-Attended Birth and Perineal Trauma: Is There an Association?BIRTH, Issue 3 2005Barbara Soong RM, IBCLC ABSTRACT:,Background: Most women will sustain some degree of trauma to the genital tract after vaginal birth. This study aimed to examine the association between maternal position at birth and perineal outcome in women who had a midwife-attended, spontaneous vaginal birth and an uncomplicated pregnancy at term. Methods: Data from 3,756 births in a major public tertiary teaching hospital were eligible for analysis. The need for sutures in perineal trauma was evaluated and compared for each major factor studied (maternal age, first vaginal delivery, induction of labor, not occipitoanterior, use of regional anesthesia, deflexed head and newborn birthweight >3,500 g). Birth positions were compared against each other. Subgroup analysis determined whether birth positions mattered more or less in each of the major factors studied. The chi-square test was used to compare categorical variables. Results: Most women (65.9%) gave birth in the semi-recumbent position. Of the 1,679 women (44.5%) who required perineal suturing, semi-recumbent position was associated with the need for perineal sutures, whereas all-fours was associated with reduced need for sutures; these associations were more marked in first vaginal births and newborn birth weight over 3,500 g. When regional anesthesia was used, semi-recumbent position was associated with a need for suturing, and lateral position associated with a reduced need for suturing. The four major factors significantly related to perineal trauma included first vaginal birth, use of regional anesthesia, deflexed head, and newborn weight more than 3,500 g. Conclusions: Women should be given the choice to give birth in whatever position they find comfortable. Maternity practitioners have a responsibility to inform women of the likelihood of perineal trauma in the preferred birth position. Ongoing audit of all clinicians attending births is encouraged to further determine effects of maternal birth position and perineal trauma, to investigate women's perception of comfortable positioning at birth, and to measure changes to midwifery practice resulting from this study. [source] Risk of perineal damage is not a reason to discourage a sitting birthing position: a secondary analysisINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2010A. De Jonge Summary Aim:, To examine the association between semi-sitting and sitting position at the time of birth and perineal damage amongst low-risk women in primary care. Background:, Evidence on the association between birthing positions and perineal trauma is not conclusive. Most studies did not distinguish between positions during the second stage of labour and position at the time of birth. Therefore, although birthing positions do not seem to affect the overall perineal trauma rate, an increase in trauma with upright position for birthing cannot be ruled out. Methods:, Secondary analysis was performed on data from a large trial. This trial was conducted amongst primary care midwifery practices in the Netherlands. A total of 1646 women were included who had a spontaneous, vaginal delivery. Perineal outcomes were compared between women in recumbent, semi-sitting and sitting position. Logistic regression analysis was used to examine the effects of these positions after controlling for other factors. Findings:, No significant differences were found in intact perineum rates between the position groups. Women in sitting position were less likely to have an episiotomy and more likely to have a perineal tear than women in recumbent position. After controlling for other factors, the odds ratios (OR) were 0.29 [95% confidence interval (CI): 0.16,0.54] and 1.83 (95% CI: 1.22,2.73) respectively. Women in semi-sitting position were more likely to have a labial tear than women in recumbent position (OR: 1.43, 95% CI: 1.00,2.04). Conclusion:, A semi-sitting or sitting birthing position does not need to be discouraged to prevent perineal damage. Women should be encouraged to use positions that are most comfortable to them. [source] Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008MP Amelink-Verburg Objective, To assess the nature and outcome of intrapartum referrals from primary to secondary care within the Dutch obstetric system. Design, Descriptive study. Setting, Dutch midwifery database (LVR1), covering 95% of all midwifery care and 80% of all Dutch pregnancies (2001,03). Population, Low-risk women (280 097) under exclusive care of a primary level midwife at the start of labour either with intention to deliver at home or with a personal preference to deliver in hospital under care of a primary level midwife. Methods, Women were classified into three categories (no referral, urgent referral and referral without urgency) and were related to maternal characteristics and to neonatal outcomes. Main outcome measures, Distribution of referral categories, main reasons for urgent referral, Apgar score at 5 minutes, perinatal death within 24 hours and referral to a paediatrician within 24 hours. Results, In our study, 68.1% of the women completed childbirth under exclusive care of a midwife, 3.6% were referred on an urgency basis and 28.3% were referred without urgency. Of all referrals, 11.2% were on an urgency basis. The main reasons for urgent referrals were fetal distress and postpartum haemorrhage. The nonurgent referrals predominantly took place during the first stage of labour (73.6% of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2%, respectively (P < 0.001). On average, the mean Apgar score at 5 minutes was high (9.72%) and the peripartum neonatal mortality was low (0.05%) in the total study group. No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group, followed by the group of referrals without urgency and the nonreferred group. Conclusions, Risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives. [source] Increased blood loss in upright birthing positions originates from perineal damageBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2007A De Jonge Objective, To assess whether the risk of severe blood loss is increased in semi-sitting and sitting position, and if so, to which extent blood loss from perineal damage is responsible for this finding. Design, Secondary analysis of data from a large trial. Setting, Primary care midwifery practices in the Netherlands. Population, About 1646 low-risk women who had a spontaneous vaginal delivery. Methods, Blood loss was measured using a weighing scale and measuring jug. Logistic regression analysis was used to examine the net effects of birthing position and perineal damage on blood loss greater than 500 ml. Main outcome measures, Mean total blood loss and incidence of blood loss greater than 500 ml and 1000 ml. Results, Mean total blood loss and the incidence of blood loss greater than 500 ml and 1000 ml were increased in semi-sitting and sitting position. In logistic regression analysis, the interaction between birthing position and perineal damage was almost significantly associated with an increased risk of blood loss greater than 500 ml. Semi-sitting and sitting position were only significant risk factors among women with perineal damage (OR 1.30, 95% CI 1.00,1.69 and OR 2.25, 95% CI 1.37,3.71, respectively). Among women with intact perineum, no association was found. Conclusions, Semi-sitting and sitting birthing positions only lead to increased blood loss among women with perineal damage. [source] | ||||||||||