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Aune I.,The College of Nursing and Midwifery | Amundsen H.H.,Innlandet Hospital HF | Skaget Aas L.C.,Norwegian University of Science and Technology
Midwifery | Year: 2014

Objective: to gain an understanding about midwives' experiences of providing a continuous supportive presence in the delivery room during childbirth, and to learn about factors that may affect this continuous support. Design/setting: qualitative study at a maternity unit in Norway, where about 4000 births take place each year. In-depth interviews were conducted with ten midwives working in two different maternity wards. The qualitative data were analysed using systematic text condensation. Findings: the analysis generated three main themes: relational competence, the midwife's ideology, the culture and philosophy of the maternity unit. The midwives identified being mentally present and actively developing mutual trust with the woman in labour as two very important factors for building a relationship with her. They suggested that the midwife's first encounter with the woman is a key opportunity for establishing rapport during labour. Successfully providing a continuous presence during labour fostered the midwives' perception of themselves as a 'good midwife'; this was considered a feature of holistic care and health promotion. The workload in the unit sometimes made it difficult for them to provide a continuous presence in the delivery room. The midwives experienced feelings of inadequacy when they felt that they had too little time available for the woman in labour. Key conclusions: midwives' skill in building a relationship with the woman in labour combined with their values and understanding of the midwifery profession are important factors influencing their decision to provide a continuous presence during childbirth. If it is policy that maternity units should provide continuous support to women in labour, managers should ensure that it is actually provided. © 2013 Elsevier Ltd.


Clarke M.,National Health Research Institute | Clarke M.,The College of Nursing and Midwifery | Loudon K.,National Health Research Institute
Trials | Year: 2011

Background: Systematic reviews have shown uncertainty about the size or direction of any 'trial effect' for patients in trials compared to those treated outside trials. We are not aware of any systematic review of whether there is a 'trial effect' related to being treated by healthcare practitioners or institutions that take part in research.Methods: We searched the Cochrane Methodology Register and MEDLINE (most recently in January 2009) for studies in which patients were allocated to treatment in one or other setting, and cohort studies reporting the outcomes of patients from different settings. We independently assessed study quality, including the control of bias in the generation of the comparison groups, and extracted data.Results: We retrieved and checked more than 15,000 records. Thirteen articles were eligible: five practitioner studies and eight institution studies. Meta-analyses were not possible because of heterogeneity. Two practitioner studies were judged to be 'controlled' or better. A Canadian study among nurses found that use of research evidence was higher for those who took part in research working groups and a Danish study on general practitioners found that trial doctors were more likely to prescribe in accordance with research evidence and guidelines. Five institution studies were 'controlled' but provided mixed results. A study of North American patients at hospitals that had taken part in trials for myocardial infarction found no statistically significant difference in treatment for patients in trial and non-trial hospitals. A Canadian study of myocardial infarction patients found that trial participants had better survival than patients in the same hospitals who were not in trials or those in non-trial hospitals. A study of general practices in Denmark did not detect differences in guideline adherence between trial and non-trial practices but found that trial practices were more likely to prescribe the trial sponsor's drugs. The other two 'controlled' studies of institutions found lower mortality in trial than non-trial hospitals.Conclusions: The available findings from existing research suggest that there might be a 'trial effect' of better outcomes, greater adherence to guidelines and more use of evidence by practitioners and institutions that take part in trials. However, the consequences for patient health are uncertain and the most robust conclusion may be that there is no apparent evidence that patients treated by practitioners or in institutions that take part in trials do worse than those treated elsewhere. © 2011 Clarke and Loudon; licensee BioMed Central Ltd.


Dahlberg U.,Norwegian University of Science and Technology | Aune I.,The College of Nursing and Midwifery
Midwifery | Year: 2013

Objective: the aim of the present study was to gain a deeper understanding of how relational continuity in the childbearing process may influence the woman's birth experience. Research design/setting: a Q-methodological approach was chosen, as it allows the researcher to systematically assess subjectivity. 23 women were invited to sort a sample of 48 statements regarding their subjective view of birth experience after having participated in a pilot project in Norway, where six midwifery students provided continuity of care to 58 women throughout the childbearing process. The sorting patterns were subsequently factor-analysed, using the statistical software 'PQ' which reveals one strong and one weaker factor. The consensus statements and the defining statements for the two factors were later interpreted. Findings: both factors seemed to represent experiences of psychological trust and a feeling of team work along with the midwifery student. Both factors indicated the importance of quality in the relation. Factor one represented experiences of presence and emotional support in the relationship. It also represented a feeling of personal growth for the women. Factor two was defined by experiences of predictability in the relation and process, as well as the feeling of interdependency in the relation. According to quality in the relation, women defining factor two experienced that the content, not only the continuity in the relation, was important for the birth experience. Key conclusions: relational continuity is a key concept in the context of a positive birth experience. Quality in the relation gives the woman a possibility to experience positivity during the childbearing process. Continuity in care and personal growth related to birth promote empowerment for both the woman and her partner. Relational continuity gives an opportunity for midwives to provide care in a more holistic manner. © 2012 Elsevier Ltd.


Mccann E.,The College of Nursing and Midwifery | Sharek D.,The College of Nursing and Midwifery
International Journal of Mental Health Nursing | Year: 2014

Very little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) people in relation to mental health services. Therefore, the overall aim of the current research was to explore LGBT people's experiences of mental health service provision in Ireland. The objectives were to identify barriers and opportunities, to highlight service gaps, and to identify good practice in addressing the mental health and well-being of LGBT people. A mixed methods research design using quantitative and qualitative approaches was deployed. A multipronged sampling strategy was used and 125 respondents responded to the questionnaire. A subset of phase 1 (n=20) were interviewed in the qualitative phase. Quantitative data was analyzed using descriptive statistics. Qualitative data were analyzed thematically. The sample consisted of LGBT people (n=125) over 18 years of age living in Ireland. Over three-quarters (77%) had received a psychiatric diagnosis. Findings include that whilst 63% of respondents were able to be 'out' to practitioners, 64% felt that mental health professionals lacked knowledge about LGBT issues and 43% felt practitioners were unresponsive to their needs. Finally, respondent recommendations about how mental health services may be more responsive to LGBT people's needs are presented. © 2013 Australian College of Mental Health Nurses Inc.


Doyle C.,The College of Nursing and Midwifery
Nursing children and young people | Year: 2012

A children's nurse in the Republic of Ireland describes her experience working with children with complex needs in their homes, the preferred setting for their care. The varied duties involved in meeting essential, often complicated, requirements and gradually improving the quality of life of child and family are explored using Peplau's model of care. Career pathways for children's nurses in Ireland now include the development of community posts and planned support in the home for children with long-term illnesses and their caregivers.


O'Shea M.,The College of Nursing and Midwifery
Journal of perioperative practice | Year: 2011

The purpose of this paper is to present the findings of an evaluation study which examines the perceived effectiveness of a pre-admission visit for children (and their parents) undergoing day surgery procedures in the Republic of Ireland. This follow on paper provides the findings of an evaluation study subsequent to the pre-admission, practice development initiative published in the Journal of Perioperative Practice, June 2010, 20 (6) 203-206.


Nicholl H.,The College of Nursing and Midwifery
Paediatric nursing | Year: 2010

Diary records in healthcare research are becoming more common. This article describes the use of a diary as a method in which mothers' experiences of caring for children were explored in a hermeneutic phenomenological study or similar. Data for the original study were collected using three interviews and a diary recorded on three separate occasions. The challenges and issues that can arise when using diaries are discussed here.


Leahy-Warren P.,The College of Nursing and Midwifery | McCarthy G.,The College of Nursing and Midwifery
Midwifery | Year: 2011

Objective: to present an integrated literature review on maternal parental self-efficacy (MPSE) in the postpartum period. Data sources: a literature search of CINAHL with full text and MEDLINE and PsycINFO from their start dates to February 2010. Study selection: inclusion criteria were English written research articles which reported the measurement of MPSE in the postpartum period. Data extraction: articles were reviewed based on purpose, theoretical framework, data collection method, sample, main findings and nursing implications for maternal parenting. In addition, data related to the instruments that were used to measure MPSE were included. Data synthesis: data revealed is a statistically significant increase in MPSE over time from baseline; a positive relationship between MPSE and number of children, social support, maternal parenting satisfaction and marital satisfaction; and a negative relationship between MPSE and maternal stress, anxiety and postpartum depression. A variety of instruments to measure MPSE were used but the majority were based on Bandura's framework. Conclusions: findings from this review may assist women's health researchers and clinical nurses/midwives in assessing and developing appropriate interventions for increasing risk awareness, enhancing MPSE and subsequent satisfaction with parenting and emotional well-being. Further research is necessary underpinned by theoretical frameworks using domain-specific instruments to identify predictors of MPSE. © 2010 Elsevier Ltd.


Timmins F.,The College of Nursing and Midwifery
Nursing Management | Year: 2011

Communication is a fundamental element of care at every level of nursing practice. It is important, therefore, for nurse managers to create environments that promote and encourage good communication, and help nurses to develop their communication skills formally and informally. This article discusses the effects of communication on the quality of care. It examines nurses' professional duty to maintain good communication skills and how managers can help them do this. It also discusses nurse managers' communication skills in the context of leadership style, conflict resolution and self-awareness. Finally, it considers the notion of shared governance as good practice.


Diwan V.,University of Queensland | Gobe G.,University of Queensland | Brown L.,The College of Nursing and Midwifery
Pharmacological Research | Year: 2014

The development of chronic kidney disease (CKD) and associated cardiovascular disease involves free radical damage and inflammation. Addition of adenine to the diet induces inflammation followed by CKD and cardiovascular disease. NOD-like receptor protein-3 (NLRP-3) is pro-inflammatory in the kidney; glibenclamide inhibits production of NLRP-3. Male Wistar rats were fed either control rat food or adenine (0.25%) in this food for 16 weeks. Glibenclamide (10 mg/kg/day) was administered to two groups with and without adenine for the final 8 weeks. Kidney function (blood urea nitrogen/BUN, plasma creatinine/PCr, plasma uric acid, proteinuria), kidney structure (fibrosis, inflammation), cardiovascular parameters (blood pressure, left ventricular stiffness, vascular responses and echocardiography) and protein expression of markers for oxidative stress (HO-1), and inflammation (TNF-α, NLRP-3) were assessed. In adenine-fed rats, glibenclamide decreased BUN (controls: 6 ± 0.6; adenine: 56.6 ± 5.4; adenine + glibenclamide: 19.4 ± 2.7 mmol/L), PCr (controls: 42 ± 2.8; adenine: 268 ± 23; adenine + glibenclamide: 81 ± 10 μmol/L), proteinuria (controls: 150 ± 7.4; adenine: 303 ± 19; adenine + glibenclamide: 220 ± 13 μmol/L) (all p < 0.05). Glibenclamide decreased infiltration of chronic inflammatory cells, fibrosis, tubular damage and expression of HO-1, TNF-α and NLRP-3 in the kidney. Glibenclamide did not alter plasma uric acid concentrations (controls: 38 ± 1; adenine: 63 ± 4; adenine + glibenclamide: 69 ± 14 μmol/L). Cardiovascular changes included decreased systolic blood pressure and improved vascular responses although cardiac fibrosis, left ventricular stiffness and hypertrophy were not reduced. Glibenclamide improved kidney structure and function in CKD and decreased some cardiovascular parameters. Inflammatory markers and cell populations were attenuated by glibenclamide in kidneys. © 2013 Elsevier Ltd. All rights reserved.

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