Julie Wray | University of Salford (original) (raw)
Papers by Julie Wray
British Journal of Midwifery, 14 (5) , pp. 246-254., 2006
MIDIRS Digest, Dec 2012
As we consider the future of universal postnatal care provision by midwives within the UK Nationa... more As we consider the future of universal postnatal care provision by midwives within the UK National Health Service (NHS) and how women's needs following childbirth could best be met, we need to have a clear picture of the 'state' of current postnatal care services. By 'state' of postnatal care we refer to care provision including content of care, models of care, the main care providers and duration of care provision. While recent evaluations of revisions to the routine provision of community and hospital-based postnatal care have demonstrated the potential benefits for women, their infants and use of NHS resources (MacArthur et al 2002, Bick et al 2011), surveys with women who have received postnatal care within the NHS suggest a decline in the standard of care received (Wray 2006, NCT 2010, Wray 2011). Despite evidence from a range of sources, including large clinical trials (MacArthur et al 2002), the content of postnatal midwifery care has changed little since statutory provision was introduced in 1902, mainly as women's health needs were not considered.
MIDIRS Midwifery Digest 22:3 , Sep 2012
As midwives we know from our practice that postnatal care can receive less attention and can be a... more As midwives we know from our practice that postnatal care can receive less attention and can be a low priority in terms of resources"
The Practising Midwife, Feb 2011
It is well known that recovering from childbirth can be a real challenge for many women. New moth... more It is well known that recovering from childbirth can be a real challenge for many women. New mothers are, mostly, left to self care and manage their own recovery process. In seeking to feel like their old selves again mothers in this ethnographic study took longer than the traditional six weeks and needed to manage their feelings around being cooped up after childbirth. This article highlights an aspect of self care such as getting out and about, with or without the baby -a process that is pivotal to good recuperation and a sense of wellbeing after childbirth.
Nurse Education in Practice
It is already known that for many women hospital postnatal care is the least satisfying and value... more It is already known that for many women hospital postnatal care is the least satisfying and valued part of their maternity care provision (Audit Commission 1997). Indeed the term ‘the Cinderella of the maternity services’ is bandied about in everyday discourse within midwifery in relation to postnatal care. There are major issues in relation to the content and organisation of postnatal care, yet there has been limited revision to service delivery, which is struggling to cope when faced with a shortage of midwives. This study sought to involve service users, notably newly delivered mothers and established users groups in a participatory manner to explore mother’s experiences of postnatal care. What unfolded was a number of important factors that provide further insights into what matters to women after birth. In common with previous research, postnatal care at home was highly regarded by mothers in this study. Concerns continued to be raised about hospital care, as the postnatal ward proved to be challenging for some women and their partners. Fundamental components of service delivery regarding cleanliness and hygiene, noise, rest and support for infant feeding and baby care were key findings. A further aspect was the challenge of undertaking research area as a collaboration with user groups and other stakeholders, particularly in handling findings not predicted at the outset.
Co-authored with Barbara Hastings-Asatourian This evaluation considers the implementation of t... more Co-authored with Barbara Hastings-Asatourian
This evaluation considers the implementation of the Sure Start Plus Pilot (SSPP) programme at the two pilot sites of Manchester and Salford and was commissioned by the teenage pregnancy teams in these cities. It is a local evaluation considering how the programme has been implemented in the context of the national objectives and targets for the two cities.
The principal investigators were Julie Wray and Barbara Hastings-Asatourian, supported by an expert project team. The team recognised that the impact of such an evaluation would not be absolutely evident in the short term and the impact of a service aimed at tackling the effects of poverty and levelling out inequality would only be successfully monitored over the longer term.
However, short term objectives were set and the evaluation aimed to collect, examine and analyse data that reflected the extent to which SSPP had been implemented and monitored. This was achieved by both quantitative and qualitative methods examining statistics and capturing the experiences and opinions of the SSPP team. Findings identified marked diversity between Manchester and Salford in the way that SSPP was structured, organised and services provided. Variations existed in the staffing arrangements, partnerships, monitoring approaches and leadership styles.
Findings show that where quantitative data required nationally were rigorously collected by the teenage pregnancy teams at the sites, there was clear evidence of movement towards the targets and several examples of unique services and innovative practice. For example the uptake of support packages did increase over the 3 years, new roles with partnership agencies were established and the introduction of posts like the young fathers worker began to have an impact. There were some areas of incomplete data, and some areas where progress towards targets appeared to be less successful.
Following thematic analysis, focus group and face to face interview data have suggested why this is the case.
Key Messages
It became apparent throughout the course of this evaluation that many of the issues and lessons learned locally emerged as a consequence of issues which required addressing nationally. Several issues originating at the national level created problems in implementation and evaluation. Some
of the issues could be avoided by:
• Involving local teams in target setting.
• Involvement of young people in the planning stage.
• Setting realistic targets.
• Designing realistic monitoring data collection instrument and piloting it prior to
commencement of programmes.
The evaluators recommend the following:
• Many and varied channels of communication, and reinforcement of SSPP goals. This might
include using newsletters, websites and discussion groups, as well as more traditional means
of cascading information in formal meetings and briefings.
• That agencies identified in The Teenage Pregnancy Directory of Agencies be included in this communication process in both cities.
• That any changes taking place in the management and operation of the SSPP (e.g. monitoring, funding) also be communicated effectively. This should also include communication about the rationale behind the strategy, enabling open discussion and agreement before any future work begins.
• Recognition, publicity and joint writing up of innovative projects and good practice (especially for example those exemplified at national level the young mums group, the work of the young fathers worker and work with BME groups).
• An increase in prominence given to the prevention of conceptions and repeat conceptions.
• Closer working and apparent sharing between the two teenage pregnancy teams, so that services highlighted as examples of innovative practice in the National Evaluation can be piloted in both cities.
2006 Royal College of Nurisng Sexual Health Conference London
European Journal of Oncology Nursing, 2009
British Journal of Midwifery, 14 (5) , pp. 246-254., 2006
MIDIRS Digest, Dec 2012
As we consider the future of universal postnatal care provision by midwives within the UK Nationa... more As we consider the future of universal postnatal care provision by midwives within the UK National Health Service (NHS) and how women's needs following childbirth could best be met, we need to have a clear picture of the 'state' of current postnatal care services. By 'state' of postnatal care we refer to care provision including content of care, models of care, the main care providers and duration of care provision. While recent evaluations of revisions to the routine provision of community and hospital-based postnatal care have demonstrated the potential benefits for women, their infants and use of NHS resources (MacArthur et al 2002, Bick et al 2011), surveys with women who have received postnatal care within the NHS suggest a decline in the standard of care received (Wray 2006, NCT 2010, Wray 2011). Despite evidence from a range of sources, including large clinical trials (MacArthur et al 2002), the content of postnatal midwifery care has changed little since statutory provision was introduced in 1902, mainly as women's health needs were not considered.
MIDIRS Midwifery Digest 22:3 , Sep 2012
As midwives we know from our practice that postnatal care can receive less attention and can be a... more As midwives we know from our practice that postnatal care can receive less attention and can be a low priority in terms of resources"
The Practising Midwife, Feb 2011
It is well known that recovering from childbirth can be a real challenge for many women. New moth... more It is well known that recovering from childbirth can be a real challenge for many women. New mothers are, mostly, left to self care and manage their own recovery process. In seeking to feel like their old selves again mothers in this ethnographic study took longer than the traditional six weeks and needed to manage their feelings around being cooped up after childbirth. This article highlights an aspect of self care such as getting out and about, with or without the baby -a process that is pivotal to good recuperation and a sense of wellbeing after childbirth.
Nurse Education in Practice
It is already known that for many women hospital postnatal care is the least satisfying and value... more It is already known that for many women hospital postnatal care is the least satisfying and valued part of their maternity care provision (Audit Commission 1997). Indeed the term ‘the Cinderella of the maternity services’ is bandied about in everyday discourse within midwifery in relation to postnatal care. There are major issues in relation to the content and organisation of postnatal care, yet there has been limited revision to service delivery, which is struggling to cope when faced with a shortage of midwives. This study sought to involve service users, notably newly delivered mothers and established users groups in a participatory manner to explore mother’s experiences of postnatal care. What unfolded was a number of important factors that provide further insights into what matters to women after birth. In common with previous research, postnatal care at home was highly regarded by mothers in this study. Concerns continued to be raised about hospital care, as the postnatal ward proved to be challenging for some women and their partners. Fundamental components of service delivery regarding cleanliness and hygiene, noise, rest and support for infant feeding and baby care were key findings. A further aspect was the challenge of undertaking research area as a collaboration with user groups and other stakeholders, particularly in handling findings not predicted at the outset.
Co-authored with Barbara Hastings-Asatourian This evaluation considers the implementation of t... more Co-authored with Barbara Hastings-Asatourian
This evaluation considers the implementation of the Sure Start Plus Pilot (SSPP) programme at the two pilot sites of Manchester and Salford and was commissioned by the teenage pregnancy teams in these cities. It is a local evaluation considering how the programme has been implemented in the context of the national objectives and targets for the two cities.
The principal investigators were Julie Wray and Barbara Hastings-Asatourian, supported by an expert project team. The team recognised that the impact of such an evaluation would not be absolutely evident in the short term and the impact of a service aimed at tackling the effects of poverty and levelling out inequality would only be successfully monitored over the longer term.
However, short term objectives were set and the evaluation aimed to collect, examine and analyse data that reflected the extent to which SSPP had been implemented and monitored. This was achieved by both quantitative and qualitative methods examining statistics and capturing the experiences and opinions of the SSPP team. Findings identified marked diversity between Manchester and Salford in the way that SSPP was structured, organised and services provided. Variations existed in the staffing arrangements, partnerships, monitoring approaches and leadership styles.
Findings show that where quantitative data required nationally were rigorously collected by the teenage pregnancy teams at the sites, there was clear evidence of movement towards the targets and several examples of unique services and innovative practice. For example the uptake of support packages did increase over the 3 years, new roles with partnership agencies were established and the introduction of posts like the young fathers worker began to have an impact. There were some areas of incomplete data, and some areas where progress towards targets appeared to be less successful.
Following thematic analysis, focus group and face to face interview data have suggested why this is the case.
Key Messages
It became apparent throughout the course of this evaluation that many of the issues and lessons learned locally emerged as a consequence of issues which required addressing nationally. Several issues originating at the national level created problems in implementation and evaluation. Some
of the issues could be avoided by:
• Involving local teams in target setting.
• Involvement of young people in the planning stage.
• Setting realistic targets.
• Designing realistic monitoring data collection instrument and piloting it prior to
commencement of programmes.
The evaluators recommend the following:
• Many and varied channels of communication, and reinforcement of SSPP goals. This might
include using newsletters, websites and discussion groups, as well as more traditional means
of cascading information in formal meetings and briefings.
• That agencies identified in The Teenage Pregnancy Directory of Agencies be included in this communication process in both cities.
• That any changes taking place in the management and operation of the SSPP (e.g. monitoring, funding) also be communicated effectively. This should also include communication about the rationale behind the strategy, enabling open discussion and agreement before any future work begins.
• Recognition, publicity and joint writing up of innovative projects and good practice (especially for example those exemplified at national level the young mums group, the work of the young fathers worker and work with BME groups).
• An increase in prominence given to the prevention of conceptions and repeat conceptions.
• Closer working and apparent sharing between the two teenage pregnancy teams, so that services highlighted as examples of innovative practice in the National Evaluation can be piloted in both cities.
2006 Royal College of Nurisng Sexual Health Conference London
European Journal of Oncology Nursing, 2009
Abstract Julie Wray, Senior Lecturer, Joint Editor The Practising Midwife Journal, University ... more Abstract
Julie Wray, Senior Lecturer, Joint Editor The Practising Midwife Journal, University of Salford, UK Reclaiming Postnatal Care Giving birth and the aftercare within the hospital or home setting is one of the most emotive areas of healthcare and one that midwives strive to ensure adheres to the patients requests as much as is possible. However growing evidence shows that for too long postnatal care has been a marginalised topic within research and has become the Cinderella of the childbirth continuum. In fact many women feel abandoned postnatal and are ‘left to get on with it’ alone. Using data from Julie’s most recent study, an ethnography of women’s experiences of care and recovery after birth, which included periods of observations on two postnatal wards in the North West of England and a series of three in-depth interviews of 17 women after birth; once at 2/3 weeks after birth, then again at 3 months and finally at 6/7 months – a lively debate will unfold. Julie will be arguing that midwifery needs to reclaim postnatal care for the benefit of women’s health and wellbeing
TITLE: Finding our way together: the story of a carer and service user forum CONTEXT: In 201... more TITLE: Finding our way together: the story of a carer and service user forum
CONTEXT:
In 2010 the carer and service user forum in the School of Nursing and Midwifery at Salford University celebrated its 5th Birthday. In addition to carers and service users the panel comprises academics, students and representatives from external organisations. There is a strong commitment both within the School to ensure that the voice of people (carers and service users) is heard so they can effectively contribute to finding ways in which their lives and their wellbeing can be improved. Working collaboratively with those that have the same strong commitment has been the bedrock of the forums success to date and together the forum has established a range of innovative approaches to service user and carer involvement in nurse education.