Helen Bellchambers

Socially disadvantaged women's views of barriers to feeling safe to engage in decision-making in maternity care

BACKGROUND Although midwifery literature suggests that woman-centred care can improve the birthing experiences of women and birth outcomes for women and babies, recent research has identified challenges in supporting socially disadvantaged women to engage in decision-making regarding care options in order to attain a sense of control within their maternity care encounters. OBJECTIVE The objective of this paper is to provide an understanding of the issues that affect the socially disadvantaged womans ability to actively engage in decision-making processes relevant to her care. RESEARCH DESIGN The qualitative approach known as Interpretative Phenomenological Analysis was used to gain an understanding of maternity care encounters as experienced by each of the following cohorts: socially disadvantaged women, registered midwives and student midwives. This paper focuses specifically on data from participating socially disadvantaged women that relate to the elements of woman-centred care-choice and control and their understandings of capacity to engage in their maternity care encounters. FINDINGS Socially disadvantaged women participants did not feel safe to engage in discussions regarding choice or to seek control within their maternity care encounters. Situations such as inadequate contextualised information, perceived risks in not conforming to routine procedures, and the actions and reactions of midwives when these women did seek choice or control resulted in a silent compliance. This response was interpreted as a consequence of womens decisions to accept responsibility for their babys wellbeing by delegating health care decision-making to the health care professional. CONCLUSION This research found that socially disadvantaged women want to engage in their care. However without adequate information and facilitation of choice by midwives, they believe they are outsiders to the maternity care culture and decision-making processes. Consequently, they delegate responsibility for maternity care choices to those who do belong; midwives. These findings suggest that midwives need to better communicate a valuing of the womans participation in decision-making processes and to work with women so they do have a sense of belonging within the maternity care environment. Midwives need to ensure that socially disadvantaged women do feel safe about having a voice regarding their choices and find ways to give them a sense of control within their maternity care encounters.

Efficacy of the use of evidence‐based algorithmic guidelines in the acute care setting for pain assessment and management in older people: a critical review of the literature

AIM The aim of the literature review was to identify all examples of primary research using an algorithmic approach for the implementation of a clinical practice guideline relating to pain assessment and/or management within acute care, with a specific focus on older people. DESIGN Critical literature review. DATA SOURCES Inclusion criteria were; English language publications within the past 13 years; peer reviewed; research conducted within a hospital; about adult inpatients. Exclusion criteria; research located outside of a hospital context; quality improvement studies; rehabilitation studies and literature reviews. REVIEW METHODS Critical appraisal of the literature by using a qualitative interpretation of a translational approach. The literature was thematically mapped according to the criteria of credibility, transferability, plausibility and applicability. RESULTS No clinical practice guideline was found that directly related to both assessment and management of pain using an algorithm in acute care for older people. Five studies were found to have relevance and were critically evaluated. CONCLUSION A critique of the literature shows that an algorithmic approach is feasible for translation into a clinical practice guideline for assessment and management of pain in older people within the acute care setting. IMPLICATIONS FOR PRACTICE Implementation of any algorithmic approach requires consideration of the environment, culture and availability of resources.

Experiences of older people following the introduction of consumer-directed care to home care packages: A qualitative descriptive study

To explore the experiences of older people receiving home care package (HCP) support following the introduction of consumer‐directed care (CDC) by the Australian government on 1 July 2015.