Bringing together the ‘Threads of Care’ in possible miscarriage for women, their partners and nurses in non-metropolitan EDs (original) (raw)
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Midwifery
Objective: To explore experiences of care during labour and birth from the perspectives of both the healthcare provider and women receiving care, to inform recommendations for how the quality of care can be improved and monitored, and, to identify the main aspects of care that are important to women. Design: A descriptive phenomenological approach. 53 interviews and 10KII as per table 1 took place including indepth interviews (IDI), focus group discussions (FGD) and key informant interviews (KII) conducted with women, healthcare providers, managers and policy makers. Following verbatim transcription thematic framework analysis was used to describe the lived experience of those interviewed. Setting: 11 public healthcare facilities providing maternity care in urban Tshwane District, Gauteng Province (n = 4) and rural Waterberg District, Limpopo Province (n = 7), South Africa. Participants: Women who had given birth in the preceding 12 weeks (49 women, 7 FGD and 23 IDI); healthcare providers working in the labour wards (33 healthcare providers; nurses, midwives, medical staff, 5 FGD, 18 IDI; managers and policy makers (10 KII). Findings: Both women and healthcare providers largely feel alone and unsupported. There is mutual distrust between women and healthcare providers exacerbated by word of mouth and the media. A lack of belief in women's ability to make appropriate choices negates principles of choice and consent. Procedure-rather than patient-centred care is prioritised by healthcare providers. Although healthcare providers know the principles of good quality care, this was not reflected in the care women described as having received. Beliefs and attitudes as well as structural and organisational problems make it difficult to provide good quality care. Caring behaviour and environment as well as companionship are the most important needs highlighted by women. Professional hierarchy is rarely seen as supportive by healthcare providers but when present, good leadership changes the culture and experience of women and care providers. The use of mobile phones to provide feedback regarding care was positively viewed by women. Conclusion: Clarity regarding what a healthcare facility can (or cannot provide) is important in order to separate practice issues from structural and organisational constraints. Improvements in quality that focus on caring as well as competence should be prioritised. Increased dialogue between healthcare providers and users should be encouraged and prioritised. Implications for practice: A renewed focus is needed to ensure companionship during labour and birth is facilitated. Training in respectful maternity care needs to prioritise caring behaviour and supportive leadership.
Caring for women through early pregnancy loss: Exploring nurses’ experiences of care
Collegian, 2020
Background: Early pregnancy loss is a common experience globally yet little is known about nurses' experiences of providing early pregnancy loss care to women. Aims: Study aims were to explore the experiences of nurses providing this care, what assists and challenges them and their perceptions of how they could be better supported. Methods: A qualitative descriptive design was employed. Findings: Twenty-five registered nurses completed in-depth interviews. Thematic analysis revealed four themes and nine subthemes: (1) Caring for all needs (Prioritising physical needs, Acknowledging emotional needs, Offering explanations and information, Respecting individuality); (2) Caring through the journey; (3) Working with challenges (Managing the environment, Tendering time); and (4) Reflecting on the role (Recognising their good work, Valuing experience and knowledge, Facing the impact of care). Discussion: Valuable insight revealed the complexity of the nurses' work and the emphasis they place on emotional care. Comparisons can be made to Hochschild's concepts of emotional labour and emotion work. It is suggested that the nurses' gift emotion work to care for the women. However, in an outcomesbased hospital environment, nurses can also be at risk of burnout. Conclusion: Nurses must be supported by health organisations to continue their emotion work. Further research into interventions to support nurses providing early pregnancy loss care, including trialling Balint groups, are recommended.
Midwifery, 2009
to gain a deeper understanding of how women who seek care at an early stage experience the latent phase of labour. a qualitative interview study using the grounded theory approach. the study was conducted at a hospital in the southwestern part of Sweden with a range of 1600-1700 deliveries per year. The interviews took place in the women's homes two to six weeks after birth. eighteen Swedish women, aged 22-36, who were admitted to the labour ward while they were still in the latent phase of labour. 'Handing over responsibility' to professional caregivers emerged as the core category or the central theme in the data. The core category and five additional categories formed a conceptual model explaining what it meant to women being admitted in the early stage of labour and their experiences of the latent phase of labour. The categories, which all related to the core category, were labelled: (1) 'longing to complete the pregnancy,' (2) 'having difficulty managing...
Woman centred care? An exploration of professional care in midwifery practice
2008
This thesis explores what 'woman centred care' means to both women and midwives and how this care is offered by midwives and perceived by women. It is set within the context of current health care policy and the way in which this impacts on both the organisation and implementation of maternity care. A flexible qualitative design was used to explore both women's and midwives' experiences of current maternity care over the full trajectory of maternity provision. A modified grounded theory approach was used framed within a feminist perspective. The fieldwork was undertaken in two phases. In phase one and interviews were undertaken with twelve women in early pregnancy, later pregnancy and after the birth; a total of twenty-five interviews with women were completed. Nine midwives were also interviewed in phase one. Preliminary and tentative categories were identified from both sets of interviews and were used to inform phase two of the study.
Woman-centred care in childbirth: A concept analysis (Part 1)
Curationis, 2013
Woman-centred care' in childbirth is a process in which a woman makes choices and is involved in and has control over her care and relationship with her midwife. The aim of this paper is to study the concept of woman-centred care through analysis in the context of childbirth. The attributes, antecedents and consequences of this concept are identified, and a model case, a borderline case and a contrary case constructed to achieve conceptual clarity. A concept analysis was undertaken as described by Walker and Avant (2011), with an extensive exploration of domain-specific literature and evidence from various disciplines. It was established from the concept analysis that 'woman-centred care' was complex and experienced individualistically. The analysis indicated that mothers' participation is supposed to be based on a more collaborative relationship and partnership. Participation is exhibited by open communication and the mother's involvement in decision-making, consultation and collaboration with the attending midwife, further characterised by mutual respect and the midwife listening to the mother's views. There is also an exchange of complete and unbiased information, recognition and honouring of cultural diversity and making of informed choices. Through an inductive discovery approach and drawing on inferences, attributes were clustered in an attempt to identify the apparent essence of the concept. From the results of the concept analysis described in this study, the researchers recommend the formulation of criteria that could facilitate implementation and evaluation of womancentred care and its empirical referents in the context of the Batho Pele principles (Part 2).
Scandinavian Journal of Caring Sciences, 2019
Objective: To explore women’s traumatic childbirth expe- riences in order to make maternity care professionals more aware of women’s intrapartum care needs. Method: A qualitative exploratory study with a constant comparison/grounded theory design was performed. Thirty-six interviews were conducted with women who had given birth in a Dutch birth setting. Findings: Three themes, playing a profound role in the occurrence of traumatic birth experiences, emerged: (i) lack of information and consent – maternity care professionals’ unilateral decision making during intrapartum care, lacking informed-consent. (ii) feeling excluded – women’s maladaptive response to the healthcare professionals’s one-sided decision making, leaving women feeling distant and estranged from the childbirth event and the experience. (iii) discrepancies – inconsistency between women’s expectations and the reality of labour and birth – on an intrapersonal level. Conclusion: Women’s intrapartum care needs cohere with the concept of woman-centred care, including person- alised care and reflecting humanising values. Care should include informed consent and shared decision-making. Maternity care professionals need to continuously evalu- ate whether the woman is consistently part of her own childbearing process. Maternity care professionals should maintain an ongoing dialogue with the woman, includ- ing women’s internalised ideas of birth.