Anna Nolte

Reconceptualising failure to rescue in midwifery: A concept analysis

AIM to reconceptualise the concept of failure to rescue, distinguishing it from its current scientific usage as a surveillance strategy to recognise physiologic decline. BACKGROUND failure to rescue has been consistently defined as a failure to save a patient׳s life after development of complications. The term, however, carries a richer connotation when viewed within a midwifery context. Midwives have historically believed themselves to be the vanguards of normal, physiologic processes, including birth. This philosophy mandates careful consideration of what it means to promote normal birth and the consequences of failure to rescue women from processes which challenge that outcome. DATA SOURCES the Medline, CINAHL, PsycINFO, PubMED, Web of Science and Google Scholar databases were searched from the period of 1992-2014 using the key terms of concept analysis, failure-to-rescue, childbirth, midwifery outcomes, obstetrical outcomes, suboptimal care, and patient outcomes. English language reports were used exclusively. The search yielded 45 articles which were reviewed in this paper. REVIEW METHOD a critical analysis of the published literature was undertaken as a means of determining the adequacy of the concept for midwifery practice and to detail how it relates to other concepts important in development of a conceptual framework promoting normal birth processes. FINDINGS failure to rescue within the context of the midwifery model of care requires robust attention to a midwifery managed setting and surveillance based on a caring presence, patient protection, and midwifery partnership with patient. CONCLUSION clarifying the definition of failure to rescue in childbirth and defining its attributes can help inform midwifery providers throughout the world of the ethical importance of considering failure to rescue in clinical practice. Relevance to midwifery care mandates use of failure to rescue as both a process and outcome measure.

Guidelines for value‐sensitive clinical accompaniment in community health nursing

Aim  The goal of the first part of the study was to explore and describe the experiences of students with regard to value-sensitive clinical accompaniment in community nursing. The purpose of phase two of the research and of this article was to develop guidelines for value-sensitive clinical accompaniment of student nurses by professional nurses in community nursing Background  Undergraduate students have reported that owing to different cultures and values, value conflicts are experienced during clinical accompaniment, which affects clinical learning in community nursing negatively. Method  A qualitative, exploratory and descriptive research design was done in a specific context; guidelines were formulated as a result of the findings in phase 1. Once the guidelines were formulated the guidelines were validated and refined by presenting them to a panel of experts for validation. The accessible population was experts in the field of community health nursing and the participants that were conveniently selected were asked to validate the guidelines. Results  Three main categories were identified, namely, respect during clinical accompaniment, value-sensitive communication and sensitivity to quality of clinical accompaniment. The validated and refined guidelines were described. Conclusion and implications for nurse managers  Guidelines for value-sensitive clinical accompaniment of student nurses by professional nurses as experts in community nursing should be implemented by nurse managers as they are important in any relationship to set the climate for both personal and professional wellbeing.AIM The goal of the first part of the study was to explore and describe the experiences of students with regard to value-sensitive clinical accompaniment in community nursing. The purpose of phase two of the research and of this article was to develop guidelines for value-sensitive clinical accompaniment of student nurses by professional nurses in community nursing BACKGROUND Undergraduate students have reported that owing to different cultures and values, value conflicts are experienced during clinical accompaniment, which affects clinical learning in community nursing negatively. METHOD A qualitative, exploratory and descriptive research design was done in a specific context; guidelines were formulated as a result of the findings in phase 1. Once the guidelines were formulated the guidelines were validated and refined by presenting them to a panel of experts for validation. The accessible population was experts in the field of community health nursing and the participants that were conveniently selected were asked to validate the guidelines. RESULTS Three main categories were identified, namely, respect during clinical accompaniment, value-sensitive communication and sensitivity to quality of clinical accompaniment. The validated and refined guidelines were described. CONCLUSION AND IMPLICATIONS FOR NURSE MANAGERS: Guidelines for value-sensitive clinical accompaniment of student nurses by professional nurses as experts in community nursing should be implemented by nurse managers as they are important in any relationship to set the climate for both personal and professional wellbeing.

Ethics in Nursing – A South African Perspective

Ethics and health care in South Africa is largely influenced by biomedical ethical principles and Western values, concepts and theories. The history and highlights in nursing ethics in South Africa has not been well documented. Colonising thinking and actions are spread throughout the nursing profession with the indigenous worldview under-examined in ethics in nursing. There is minimal incorporation of postcolonial concepts, specifically about ethics and indigenous knowledge in health care. For nursing to remain relevant in South Africa decolonisation is critical. The decolonisation process involves, among others asserting and stimulating discussions about indigenous knowledge to reveal the abundance and richness of indigenous languages, worldviews, teachings and experiences. Decolonising of nursing, health care and nursing ethics within the context of the nursing profession is critical to address the current health challenges faced by the population of South Africa.

Birth stories from South Africa: Voices unheard

BACKGROUND The manner that birth events unfold can have a lasting impact on women. Giving voice to womens experiences is key in the creation of care that embodies humanistic, family-centred service. AIM The aim of this research was to describe the experiences of women receiving care during childbirth. METHODS The design was qualitative and descriptive using thematic analysis to analyse womens birth stories. A purposive sample of women (N=12) who had recently given birth in South Africa was selected. Participants were recruited who had delivered across a variety of settings: public, private, and maternity hospital, as well as at home. Data were collected using in-depth interviews and field notes. FINDINGS Four themes were noted: cocoon of compassionate care, personal regard for shared decision-making, beliefs about birth, and protection. Themes demonstrated both caring and non-caring behaviours including feelings of sadness, loneliness and being unwanted, being scared and uncertain, and overall dissatisfaction with the birth experience. Irrespective of setting, patients felt the absence of shared decision-making; the exception was where care was with midwives in an independent maternity hospital or at home. DISCUSSION A period of high vulnerability, birth is often met with care perceived as non-caring and lacking in compassion. Many women reported failure to be included as a partner in decision-making where birth occurred in private or public hospital settings. Where a midwifery model of care was in place, experiences were uniformly positive. CONCLUSIONS Fundamental change is needed in midwifery education and scope of practice, with overhaul of health system resourcing.

A Critical Evaluation on a Fulbright Experience

Problem Although many Fulbright awardees have detailed experiences in varied countries, there is less discussion on the impact on the host institution and efforts to sustain the change between both participants. Methods The critical evaluation examines professional and personal impact of a Fulbright U.S. Scholar Award at the University of Johannesburg in South Africa. Findings This work details the influence of the host faculty in the experience for both the host faculty in the Department of Nursing and the scholar receiving the awarded. Challenges to achieve a successful exchange are described, and activities to sustain connections and maximize impact are presented, with particular emphasis on midwifery. Conclusions Collaborative research and teaching activities strengthened through administrative endorsement support ongoing exchange.PROBLEM Although many Fulbright awardees have detailed experiences in varied countries, there is less discussion on the impact on the host institution and efforts to sustain the change between both participants. METHODS The critical evaluation examines professional and personal impact of a Fulbright U.S. Scholar Award at the University of Johannesburg in South Africa. FINDINGS This work details the influence of the host faculty in the experience for both the host faculty in the Department of Nursing and the scholar receiving the awarded. Challenges to achieve a successful exchange are described, and activities to sustain connections and maximize impact are presented, with particular emphasis on midwifery. CONCLUSIONS Collaborative research and teaching activities strengthened through administrative endorsement support ongoing exchange.