Therapeutic Actions Midwifery Care

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Challenges faced in rural hospitals: the experiences of nurse managers in Uganda.

Related Articles Challenges faced in rural hospitals: the experiences of nurse managers in Uganda. Int Nurs Rev. 2018 Apr 19;: Authors: Kakyo TA, Xiao LD Abstract AIM: The aim of this study was to understand nurse ward managers perceived challenges in the rural healthcare setting in Uganda. BACKGROUND: The health workforce, essential medicines and equipment and political unrest are the main factors affecting the international community in addressing the hefty disease burden in World Health Organization African regions. Nurse ward managers have an important role to play to mitigate these factors in health facilities in these regions through leadership, supervision and support for staff. METHODS: This study utilized interpretive phenomenology based on Gadamer's hermeneutical principles. Eleven nurse managers from two rural public hospitals in Uganda were interviewed. Those with more than a 2-year experience in their management role were invited to participate in the study. RESULTS: Nurse managers pointed out four major challenges with staffing, while they worked in the rural healthcare settings. These are summarized into themes: 'Numbers do matter'; 'I cannot access them when I need them at work'; 'Challenges in dealing with negative attitudes'; and 'Questioning own ability to manage health services'. DISCUSSION: Health facilities in rural areas face extremely low staff-to-patient ratio, a high level of workload, lack of essential medicines and equipment, low salaries and delayed payment for staff. CONCLUSION: Nurse managers demonstrated situation-based performance to minimize the impact of these challenges on the quality and safety of patient care, but they had less influence on policy and resource development. IMPLICATIONS FOR NURSING POLICY: It is imperative to mobilize education for nurse ward managers to enable them to improve leadership, management skills and to have a greater impact on policy and resource development. PMID: 29672843 [PubMed - as supplied by publisher]

The Effect of Tai Chi Exercise on the Risk and Fear of Falling in Older Adults: a Randomized Clinical Trial.

Related Articles The Effect of Tai Chi Exercise on the Risk and Fear of Falling in Older Adults: a Randomized Clinical Trial. Mater Sociomed. 2018 Mar;30(1):38-42 Authors: Mortazavi H, Tabatabaeichehr M, Golestani A, Armat MR, Yousefi MR Abstract Background: Falling and fear of falling are among the most common problems of the elderly, which can cause illness, isolation, dependency and reduced quality of life in elderly. Exercise is recommended to prevent falling injuries in the elderly. Aim: This study aimed to examine the effect of Tai Chi exercise on the risk and fear of falling in older adults. Materials and Methods: In this randomized clinical trial, a total of 60 male and female elderly were randomly divided into two groups: Tai Chi exercise and control (daily activities) groups. Tai Chi exercise protocol in the intervention group consisted of 3 sessions per week for 10 weeks. The risk and fear of falling were assessed in subjects by using standardized questionnaires, including Berg's Balance Scale and Fall Efficacy Scale-International (FES-I) before initiating the protocol, at the end of 4th, 8th weeks and at the end of exercise period. Results: Two groups were matched in terms of age, gender, education, and body mass index. Baseline values of risk of falling and fear of falling were not significantly different between the two groups (P>0.05). The score of fear of falling at the end of 4th, 8th weeks and at the end of exercise period was significantly different between the two groups (P<0.05) and it decreased in the intervention group, but the risk of falling reduced after 8 and 10 weeks in the intervention group (P<0.001). Conclusion: Performing Tai Chi exercises for at least four weeks could reduce fear of falling and reduce the risk of falls in older adults after 8 weeks. PMID: 29670476 [PubMed]

Exploring the meaning and practice of self-care among palliative care nurses and doctors: a qualitative study.

Related Articles Exploring the meaning and practice of self-care among palliative care nurses and doctors: a qualitative study. BMC Palliat Care. 2018 Apr 18;17(1):63 Authors: Mills J, Wand T, Fraser JA Abstract BACKGROUND: Self-care practice within the palliative care workforce is often discussed, yet seemingly under-researched. While palliative care professionals are required to implement and maintain effective self-care strategies, there appears little evidence to guide them. Moreover, there is an apparent need to clarify the meaning of self-care in palliative care practice. This paper reports qualitative findings within the context of a broader mixed-methods study. The aim of the present study was to explore the meaning and practice of self-care as described by palliative care nurses and doctors. METHODS: A purposive sample of 24 palliative care nurses and doctors across Australia participated in semi-structured, in-depth interviews. Interviews were digitally recorded and transcribed prior to inductive qualitative content analysis, supported by QSR NVivo data management software. RESULTS: Three overarching themes emerged from the analysis: (1) A proactive and holistic approach to promoting personal health and wellbeing to support professional care of others; (2) Personalised self-care strategies within professional and non-professional contexts; and (3) Barriers and enablers to self-care practice. CONCLUSIONS: The findings of this study provide a detailed account of the context and complexity of effective self-care practice previously lacking in the literature. Self-care is a proactive, holistic, and personalised approach to the promotion of health and wellbeing through a variety of strategies, in both personal and professional settings, to enhance capacity for compassionate care of patients and their families. This research adds an important qualitative perspective and serves to advance knowledge of both the context and effective practice of self-care in the palliative care workforce. PMID: 29669559 [PubMed - in process]

'I didn't think you were allowed that, they didn't mention that.' A qualitative study exploring women's perceptions of home birth.

Related Articles 'I didn't think you were allowed that, they didn't mention that.' A qualitative study exploring women's perceptions of home birth. BMC Pregnancy Childbirth. 2018 Apr 18;18(1):105 Authors: Naylor Smith J, Taylor B, Shaw K, Hewison A, Kenyon S Abstract BACKGROUND: Evidence suggests that home birth is as safe as hospital birth for low risk multiparous women, and is associated with reduced intervention rates and increased rates of normal birth. However the home birth rate in the UK is low, and few women choose this option. The aims of this study were to identify what influences multiparous women's choice of birth place, and to explore their views of home birth. METHODS: Five focus groups were conducted with multiparous women (n = 28) attending mother and baby groups in a city in the UK with a diverse multi-ethnic population. Data were analysed thematically using the Framework Method, combining deductive and inductive approaches to the data. RESULTS: Several themes were developed from the data, these were: the expectation that birth would take place in an Obstetric Unit; perceptions of birth as a 'natural' event; lack of knowledge of what home birth looked like; and a lack of confidence in the reliability of the maternity service. Two themes emerged regarding the influences on women's choices: clear information provision, particularly for those from ethnic minority groups, and the role of health care professionals. A final theme concerned women's responses to the offer of choice. CONCLUSIONS: There are gaps in women's knowledge about the reality and practicalities of giving birth at home that have not been previously identified. Other findings are consistent with existing evidence, suggesting that many women still do not receive consistent, comprehensive information about home birth. The findings from this research can be used to develop approaches to meet women's information and support needs, and facilitate genuine choice of place of birth. PMID: 29669527 [PubMed - in process]

Third-year nursing students' lived experience of caring for the dying: a hermeneutic phenomenological approach.

Related Articles Third-year nursing students' lived experience of caring for the dying: a hermeneutic phenomenological approach. Contemp Nurse. 2018 Apr 18;:1-11 Authors: Ranse K, Ranse J, Pelkowitz M Abstract BACKGROUND: In preparation for practice as a Registered Nurse, it is essential that students are equipped to care for the dying patient and their family. AIM: To explore nursing students' lived experience of caring for a dying patient and their family. DESIGN: Hermeneutic phenomenology. METHODS: Students who had cared for a dying patient in their final year of study were invited to participate in an interview. Participants' narratives (n = 6) were thematically analysed. FINDINGS: Analysis revealed three themes: being caring, unexpectedness in witnessing an expected death and experiencing loss. Students demonstrated family-centred care but recounted unexpectedness in both the dying trajectory and physical changes in the dying patient. When reflecting on experiencing loss, students questioned their own actions, acknowledged the value of relationships and identified ways to cope. CONCLUSIONS: Engaging students in the care of dying patients and providing appropriate preparation/support can influence their experience and the care they provide in the future. PMID: 29669455 [PubMed - as supplied by publisher]

Person-centred discharge education following coronary artery bypass graft: A critical review.

Related Articles Person-centred discharge education following coronary artery bypass graft: A critical review. J Clin Nurs. 2017 Dec;26(23-24):5206-5215 Authors: Rushton M, Howarth M, Grant MJ, Astin F Abstract AIMS AND OBJECTIVES: To examine the extent that individualised education helps reduce depression and anxiety and improves self-care for people who have undergone coronary artery bypass graft surgery. BACKGROUND: Individualised discharge planning is increasingly important following cardiac surgery due to recurrent admissions as well as the issue of anxiety and depression, often due to lack of preparation. The hospital to home transition is fundamental in the recovery process. Individualised education and person-centred care ensure that patients' educational needs are met. This empowers patients, increasing self-efficacy or confidence, resulting in autonomy, a smoother discharge process and avoiding postdischarge problems and rehospitalisation. DESIGN: A critical review of published peer-reviewed literature was conducted. METHODS: Electronic databases searched included MEDLINE, CINAHL, the Cochrane Library and PsychInfo 2009-2015. RESULTS: Eight articles were identified for review, and a Critical Appraisal Skills Programme framework was used to determine the quality of the papers, all of the papers focussed on coronary artery bypass graft. The designs were typically experimental or quasi-experimental with two reviews. CONCLUSION: A greater understanding of the patients' needs allows tailored education to be provided, which promotes self-care management. This level of patient empowerment increases confidence and ultimately minimise anxiety and depression. Despite the varying teaching and learning methods associated with individualised education, patient-centred education has the potential to assist cardiac nurses in adequately preparing patients for discharge following their coronary artery bypass graft. RELEVANCE TO CLINICAL PRACTICE: Development of individualised education programmes is crucial in preparing patients for discharge. The reduction in readmission to hospital has a significant effect on already stretched resources, and the reduction in postoperative complications during the recovery period linked with depression and anxiety will have a positive effect on the individuals' ability to self-care, health and well-being. PMID: 28881069 [PubMed - indexed for MEDLINE]

Home delivery among antenatal care booked women in their last pregnancy and associated factors: community-based cross sectional study in Debremarkos town, North West Ethiopia, January 2016.

Related Articles Home delivery among antenatal care booked women in their last pregnancy and associated factors: community-based cross sectional study in Debremarkos town, North West Ethiopia, January 2016. BMC Pregnancy Childbirth. 2017 Jul 14;17(1):225 Authors: Kasaye HK, Endale ZM, Gudayu TW, Desta MS Abstract BACKGROUND: In Ethiopia, nearly half of the mothers who were booked for antenatal care, who supposed to have institutional delivery, gave home delivery nationally. Home delivery accounts majority while few of childbirth were attended by the skilled provider in Amhara regional state. This study aimed to determine the proportion of home delivery and associated factors among antenatal care booked women who gave childbirth in the past 1 year in Debremarkos Town, Northwest Ethiopia. METHODS: A community-based Cross sectional study was conducted from January 1st- 25th 2016. Epi Info version 7 was used to determine a total sample size of 518 and simple random sampling procedure was employed. Data was collected through an interview by using pretested structured questionnaire. Data were entered into Epi Info version 7, cleaned and exported to SPSS version 21 for analysis. A p-value less than or equals to 0.05 at 95% Confidence Intervals of odds ratio were taken as significance level in the multivariable model. RESULTS: A total of 127 (25.3%) women gave childbirth at home. Un-attending formal education (Adjusted Odds Ratio = 7.56, 95% CI: [3.28, 17.44]), absence of health facility within 30 min distance (AOR = 3.41, 95% CI: [1.42, 8.20]), not exposed to media (AOR = 4.46, 95% CI: [2.09, 9.49]), Unplanned pregnancy (AOR = 3.47, 95% CI [1.82, 6.61]), attending ANC at health post (AOR = 5.45, 95% CI: (1.21, 24.49) and health center (AOR = 2.74, 95% CI [1.29, 5.82]), perceived privacy during ANC (AOR = 3.69[1.25, 10.91]) and less than four times ANC visit (AOR = 5.04, 95% CI (2.30, 11.04]) were significantly associated with home delivery. CONCLUSIONS: Home delivery in this study was found to be low. Educational level, media exposure, geographic access to a health facility, Unplanned pregnancy, an institution where ANC was booked, perceived privacy during ANC and number of ANC visit were found to be determinants of home delivery. Health institutions, health professionals, policy makers, community leaders and all concerned with the planning and implementation of maternity care in Ethiopia need to consider these associations in implementing services and providing care, for pregnant women. PMID: 28705188 [PubMed - indexed for MEDLINE]

Cost-effectiveness of an ambulance-based referral system for emergency obstetrical and neonatal care in rural Ethiopia.

Related Articles Cost-effectiveness of an ambulance-based referral system for emergency obstetrical and neonatal care in rural Ethiopia. BMC Pregnancy Childbirth. 2017 Jul 12;17(1):220 Authors: Accorsi S, Somigliana E, Solomon H, Ademe T, Woldegebriel J, Almaz B, Zemedu M, Manenti F, Tibebe A, Farese P, Seifu A, Menozzi S, Putoto G Abstract BACKGROUND: To estimate the cost-effectiveness of an ambulance-based referral system an dedicated to emergency obstetrics and neonatal care (EmONC) in remote sub-Saharan settings. METHODS: In this prospective study performed in Oromiya Region (Ethiopia), all obstetrical cases referred to the hospital with the ambulance were consecutively evaluated during a three-months period. The health professionals who managed the referred cases were requested to identify those that could be considered as undoubtedly effective. Pre and post-referral costs included those required to run the ambulance service and the additional costs necessary for the assistance in the hospital. Local life expectancy tables were used to calculate the number of year saved. RESULTS: A total of 111 ambulance referrals were recorded. The ambulance was undoubtedly effective for 9 women and 4 newborns, corresponding to 336 years saved. The total cost of the intervention was 8299 US dollars. The cost per year life saved was 24.7 US dollars which is below the benchmarks of 150 and 30 US dollars that define attractive and very attractive interventions. Sensitivity analyses on the rate of effective referrals, on the costs of the ambulance and on the discount rate confirmed the robustness of the result. CONCLUSIONS: An ambulance-based referral system for EmONC in remote sub-Saharan areas appears highly cost-effective. PMID: 28701153 [PubMed - indexed for MEDLINE]

A cost effectiveness analysis of midwife psycho-education for fearful pregnant women - a health system perspective for the antenatal period.

Related Articles A cost effectiveness analysis of midwife psycho-education for fearful pregnant women - a health system perspective for the antenatal period. BMC Pregnancy Childbirth. 2017 Jul 11;17(1):217 Authors: Toohill J, Callander E, Gamble J, Creedy DK, Fenwick J Abstract BACKGROUND: Psycho-education can reduce childbirth fear and caesarean section numbers. This study determines the cost-effectiveness of a midwife-led psycho-education intervention for women fearful of birth. METHOD: One thousand four hundred ten pregnant women in south-east Queensland, Australia were screened for childbirth fear (W-DEQ A ≥ 66). Women with high scores (n = 339) were randomised to the BELIEF Study (Birth Emotions and Looking to Improve Expectant Fear) to receive psycho-education (n = 170) at 24 and 34 weeks of pregnancy or to the control group (n = 169). Women in both groups were surveyed 6 weeks postpartum with total cost for health service use during pregnancy calculated. Logistic regression models assessed the odds ratio of having vaginal birth or caesarean section in the study groups. RESULT: Of 339 women randomised, 184 (54%) women returned data at 6 weeks postpartum (Intervention Group n = 91; Control Group n = 93). Women receiving psycho-education had a higher likelihood of vaginal birth compared to controls (n = 60, 66% vs. n = 54, 58%; OR 2.34). Mean 'treatment' cost for women receiving psycho-education was AUS$72. Mean cost for health services excluding the cost of psycho-education, was less in the intervention group (AUS$1193 vs. AUS$1236), but not significant (p = 0.78). For every five women who received midwife counselling, one caesarean section was averted. The incremental healthcare cost to prevent one caesarean section using this intervention was AUS$145. CONCLUSION: Costs of delivering midwife psycho-education to women with childbirth fear during pregnancy are offset by improved vaginal birth rates and reduction in caesarean section numbers. TRIAL REGISTRATION: Australian New Zealand Controlled Trials Registry ACTRN12612000526875 , 17th May 2012 (retrospectively registered one week after enrolment of first participant). PMID: 28693447 [PubMed - indexed for MEDLINE]

Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

Related Articles Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit. Am J Crit Care. 2017 Jul;26(4):336-341 Authors: Brooks LA, Manias E, Nicholson P Abstract BACKGROUND: Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. OBJECTIVES: To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. METHODS: The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. RESULTS: Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. CONCLUSIONS: Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. PMID: 28668920 [PubMed - indexed for MEDLINE]

Culture matters: indigenizing patient safety in Bhutan.

Related Articles Culture matters: indigenizing patient safety in Bhutan. Health Policy Plan. 2017 Sep 01;32(7):1042-1048 Authors: Pelzang R, Johnstone MJ, Hutchinson AM Abstract Studies show that if quality of healthcare in a country is to be achieved, due consideration must be given to the importance of the core cultural values as a critical factor in improving patient safety outcomes. The influence of Bhutan's traditional (core) cultural values on the attitudes and behaviours of healthcare professionals regarding patient care are not known. This study aimed to explore the possible influence of Bhutan's traditional cultural values on staff attitudes towards patient safety and quality care. Undertaken as a qualitative exploratory descriptive inquiry, a purposeful sample of 94 healthcare professionals and managers were recruited from three levels of hospitals, a training institute and the Ministry of Health. Interviews were transcribed verbatim and analysed using thematic analysis strategies. The findings of the study suggest that Bhutanese traditional cultural values have both productive and counterproductive influences on staff attitudes towards healthcare delivery and the processes that need to be in place to ensure patient safety. Productive influences encompassed: karmic incentives to avoid preventable harm and promote safe patient care; and the prospective adoption of the 'four harmonious friends' as a culturally meaningful frame for improving understanding of the role and importance of teamwork in enhancing patient safety. Counterproductive influences included: the adoption of hierarchical and authoritative styles of management; unilateral decision-making; the legitimization of karmic beliefs; differential treatment of patients; and preferences for traditional healing practices and rituals. Although problematic in some areas, Bhutan's traditional cultural values could be used positively to inform and frame an effective model for improving patient safety in Bhutan's hospitals. Such a model must entail the institution of an 'indigenized' patient safety program, with patient safety research and reporting systems framed around local patient safety concerns and solutions, including religious and cultural concepts, values and perspectives. PMID: 28430978 [PubMed - indexed for MEDLINE]

The Invisibility of Disadvantage: Why Do We Not Notice?

Related Articles The Invisibility of Disadvantage: Why Do We Not Notice? Stud Health Technol Inform. 2017;235:388-392 Authors: Showell C, Cummings E, Turner P Abstract Personal health records (PHRs) offer tantalising benefits for patients and healthcare providers, including improvements in patient-provider communication, patient empowerment, and access to data and information. A suspicion that disadvantaged patients are less likely to use or benefit from PHRs stimulated a research agenda that included: (a) a literature review; and (b) empirical analysis of eight years' hospital admission and discharge data linked to measures of patient social disadvantage. The results demonstrated an association between disadvantage, increased use of public hospital services and barriers to PHR use. These findings may appear self-evident, but dramatically highlight how disadvantaged patients continue to be overlooked in many e-health design processes, and are rarely a focus of user centred design. The paper concludes by briefly considering the implications of this invisibility. PMID: 28423820 [PubMed - indexed for MEDLINE]

Self-guided interventions for managing psychological distress in people with cancer - A systematic review.

Related Articles Self-guided interventions for managing psychological distress in people with cancer - A systematic review. Patient Educ Couns. 2017 May;100(5):846-857 Authors: Ugalde A, Haynes K, Boltong A, White V, Krishnasamy M, Schofield P, Aranda S, Livingston P Abstract OBJECTIVE: People with cancer can experience psychological distress but do not always desire, or engage with, professional support to assist with managing distress. Interventions that are self-directed or guided by patients may hold promise as they allow patients to engage with interventions as they need. The objective of this review is to describe and appraise the evidence for effectiveness of self-guided interventions that aim to manage psychological distress in people with cancer. METHODS: A systematic search of Medline, PsychInfo and CINAHL identified 15 relevant papers, reporting on 14 studies. RESULTS: Of the interventions, three studies comprised hard-copy workbooks, six studies used resource packs, four were online resources and one was a brief multimedia resource. One study was adequately powered and demonstrated a positive effect. Almost all interventions required some level of facilitation. Distressed participants may benefit more from interventions. CONCLUSION: Self-guided interventions represent a potentially efficient way of delivering support for people affected by cancer, however evidence supporting them is lacking. PRACTICE IMPLICATIONS: There is a need to generate evidence to understand the impact of self-guided interventions for: i) the ideal delivery point in the disease trajectory, ii) patient groups, iii) intervention content and iv) type and mode of delivery. PMID: 28081937 [PubMed - indexed for MEDLINE]

Effectiveness of an internet-based education on maternal satisfaction in NICUs.

Related Articles Effectiveness of an internet-based education on maternal satisfaction in NICUs. Patient Educ Couns. 2017 May;100(5):943-949 Authors: Kadivar M, Seyedfatemi N, Mokhlesabadi Farahani T, Mehran A, Pridham KF Abstract OBJECTIVE: This study was conducted to evaluate the effect of internet-based education on the satisfaction of the mothers of the preterm neonates in the NICUs. METHODS: This quasi-experimental study was conducted on 80 mothers of preterm neonates hospitalized in the NICUs of two hospitals in Iran during 9 months. The mothers were assigned in two groups as cases and controls. The satisfaction level of the mothers was evaluated by using WBPL-Revised1 in both groups on the first and tenth day of the study. Mothers in the case group received the educational program available at www.iranlms.ir/myinfant for 10days. After 10days, the satisfaction level of the mothers in both groups was measured by questionnaire again. RESULT: the satisfaction of the mothers increased in both groups after this intervention. However, comparison of the mean scores revealed that the satisfaction of the mothers in the case group increased significantly following the intervention (P<0.001). CONCLUSION: Considering the benefits of internet-based education, its utilization in mothers education programs in NICUs is recommended. PRACTICE IMPLICATIONS: The results of this study show nurses in the NICU is a way to improve communication and education to parents of infants hospitalized in NICU. PMID: 27876221 [PubMed - indexed for MEDLINE]