Joy Merrell

Negotiating the transition: caring for women through the experience of early miscarriage

AIM To explore womens experiences of having an early miscarriage in a hospital gynaecological unit. BACKGROUND Miscarriage is a global health issue affecting significant numbers of women and is usually considered a distressing experience. This distress is often interpreted as being characteristic of grief. Nurses and other health professionals in hospital and community settings are therefore expected to provide appropriate care to meet the physical and emotional needs of the woman. DESIGN A qualitative, ethnographic study of a hospital gynaecological unit in the UK. METHODS The primary method was 20 months of part-time participant observation. Data were also collected through documentary analysis of key documents in the setting and formal interviews. These were with eight women who had an early miscarriage and 16 health professionals (nurses, doctors, ultrasonographers) working in the unit. RESULTS Three clear phases emerged in the womens experience of miscarriage and hospital admission; first signs and confirmation, losing the baby and the aftermath. These were interpreted as being components of a process of transition. The hospital admission emerged as vital in these early phases in which the importance of nurses and other health professionals providing sensitive, engaged care to meet the emotional and physical needs of the woman was identified. CONCLUSIONS The hospital setting emerged as highly influential in shaping the care that was given to women and influencing their experiences. Transition models were felt to be more appropriate than grief and bereavement models in guiding the psychological care given to women. RELEVANCE TO CLINICAL PRACTICE The experience of hospital admission and the actions of nurses and other health professionals is influential in how women negotiate the transition through miscarriage.

Addressing the nutritional needs of older people in residential care homes.

In the UK and Europe, malnutrition in older people is a significant and continuing problem. Malnutrition predisposes to disease, impedes recovery from illness, increases mortality and is costly to society. Despite the high number of older people potentially at risk, malnutrition in care homes has been under explored. There is concern that national guidelines regarding the nutritional care of older people in residential care homes are not always implemented. This qualitative study explored the factors that influence the nutritional care provided to residents in two different types of local authority residential care homes (providing personal care) in Wales. One home had communal dining rooms; the other had eight bedded units with their own kitchen and dining facilities. The sample of 45 participants, comprised 19 staff (managers, care and catering staff), 16 residents and 10 residents’ relatives. Data were collected using semi-structured interviews, focus groups, observation and documentary review between August 2009 and January 2010. This paper focuses on how staff assessed and addressed residents’ nutritional needs. In both care homes, staff strove to be responsive to residents’ dietary preferences, provided person-centred care and worked in partnership with residents and their families to provide nutritious food in a homely environment. Neither home conducted nutritional screening to identify those at risk of malnutrition, contrary to national guidelines, but relied on ad hoc observation and monitoring. The staff’s knowledge of special dietary needs was limited. A need for further training for care home staff regarding the importance of nutrition in maintaining health in older people, use of nutritional screening and special dietary needs was identified. Shared nutrition training between health and social care staff needs expansion and policy implications in terms of an enhanced regulatory focus on maintaining nutritional needs in care homes are proposed.

Food or medicine? The food-medicine interface in households in Sylhet

ETHNOPHARMACOLOGICAL RELEVANCE Bangladesh has a rich traditional plant-medicine use, drawing on Ayurveda and Unami medicine. How these practices translate into people׳s homes and lives vary. Furthermore, the overlap between food and medicine is blurred and context-specific. This paper explores the food-medicine interface as experienced by Bengali women in their homes, in the context of transnational and generational changes. AIM AND OBJECTIVES The aim is to explore the overlap of food and medicines in homes of Bengali women in Sylhet. The objectives are to explore the influences on medicinal plant practice and to scrutinise how catagories of food and medicine are decided. MATERIAL AND METHODS The paper draws on in-depth ethnographic research conducted in Sylhet, North-east Bangladesh as part of a wider project looking at food and medicine use among Bengali women in both the UK and Bangladesh. Methods included participant observation, unstructured interviews and semi-structured interviews with a total of thirty women. RESULTS The study indicates that the use of plants as food and medicine is common among Bengali women in Sylhet. What is consumed as a food and/or a medicine varies between individuals, generations and families. The use and perceptions of food-medicines is also dependent on multiple factors such as age, education and availability of both plants and biomedicine. Where a plant may fall on the food-medicine spectrum depends on a range of factors including its purpose, consistency and taste. CONCLUSIONS Previous academic research has concentrated on the nutritional and pharmacological properties of culturally constructed food-medicines (Etkin and Ross, 1982; Owen and Johns, 2002, Pieroni and Quave, 2006). However, our findings indicate a contextualisation of the food-plant spectrum based on both local beliefs and wider structural factors, and thus not necessarily characteristics intrinsic to the products׳ pharmacological or nutritional properties. The implications of this research are of both academic relevance and practical importance to informing health services.

Beneficence, respect for autonomy, and justice: principles in practice.

The principles of beneficence, respect for autonomy, and justice have been debated in various ways in a number of disciplines including philosophy ( 1 , 2 ) and medical ethics ( 3 - 7 ). The scope of debate is broad and encompasses critiques of orthodox perspectives on ethical theories, for example, McIntyre ( 8 , 9 ), and Nunner-Winkler ( 10 ); critiques of the ethics of scientific research, for example, Faulder ( 11 ); and social scientific interest in examining the moral component of research processes ( 12 , 13 ).

Womenʼs Experience of Decision-Making With Medication Abortion

Background:Medication abortion received regulatory approval in 2001 in the United States with healthcare providers increasingly offering this method. However, most studies in the United States have only explored acceptability and decision-making with women who participated in clinical trials. Overall, the literature on womens experience with a method that it is now widely available is under research in the United States. Objective:To describe and analyze the womens experience as they choose the option of and experienced the process of medication abortion. Design:A constructivist grounded theory study. Setting:Outpatient clinical offices in a three-state area in the northeast region of the United States. Participants:A purposive sample of 22 women aged 16 to 45 who experienced a medication abortion. Methods:Data were collected by in-depth, open-ended, face-to-face interviews. The constant comparative method was used for analysis. Results:Five interwoven categories emerged regarding womens initial decision to have a medication abortion: choosing a natural process, avoiding “surgery,” respecting the “baby,” scheduling to meet needs, and appreciating the home setting. The enhanced sense of personal control associated with the medication abortion option was the overriding reason given for choosing this method. Conclusion:This study contributes to the paucity of literature on the reasons why women choose medication abortion. It is important for nurses to understand the complexity of medication abortion decision-making so that they can effectively support women through this process.

Influence of Adult Knee Height, Age at First Birth, Migration, and Current Age on Adult Physical Function of Bangladeshi Mothers and Daughters in the United Kingdom and Bangladesh

In the United Kingdom, Bangladeshi women have the lowest self-reported levels of physical activity and some of the highest levels of metabolic disease of all ethnic groups. To better understand these risks for poor health we employed life course and intergenerational hypotheses to predict lower body physical function in a sample of 121 Bangladeshi mothers (40–70 years old) and one of their adult daughters (17–36 years old) living in Bangladesh or in the UK. For the mothers, older age and shorter knee height predicted reduced lower body physical function. Knee height is a biomarker of nutrition and health status between birth and puberty. Age at first birth did not have a significant effect. For daughters, older age and migration to the UK predicted reduced lower body physical function. We controlled for total stature and fatness in all analyses. UK-born daughters were taller than BD-born daughters living in the UK, mostly due to differences in knee height. These new findings support previous research indicating that early life health and adequate nutritional status, along with appropriate adult physical activity and diet, may decrease risks for poor physical function, morbidity, and premature mortality.

Triple whammy: women's perceptions of midlife mothering.

PurposeTo understand womens experiences as older first-time mothers during the transition to menopause. Study Design and MethodsA hermeneutic, phenomenological study exploring the lived experiences of 13 women aged 39 to 47 when they achieved first-time motherhood. Women were mothering one or more children aged 12 or younger and experiencing symptoms of perimenopause. Data were generated through two in-depth interviews with each woman. Meaning was mutually negotiated through dialogue with the women and simultaneously with the text, as well as through ongoing data analysis. ResultsFour themes emerged: Achieving First-Time Motherhood at Midlife, Intensive Mothering, Out of Sync, and Perimenopause as a State of Uncertainty. Clinical ImplicationsIncreasingly, nurses and nurse midwives will be caring for women aged 40 and older as they navigate motherhood during the transition to menopause. Through their stories, women can share concerns they have about mothering at an older age, and the effect of perimenopausal symptoms on their mothering experiences. Nurses should offer anticipatory guidance to women who delay motherhood until midlife, provide information about the transition to menopause, and assess the older mothers level of social support. Nurses can help build capacity for support within community and professional resources, such as hospital supported mother/baby and breastfeeding support groups.

A Qualitative Study of Women's Decision to View or Not View an Ultrasound Image Before Early Medication Abortion

BACKGROUND Transvaginal ultrasounds are commonly performed for gestational dating of pregnancy before a medication abortion. This paper presents findings regarding womens perspectives on viewing the gestational dating ultrasound image, which arose from a study exploring womens medication abortion experience. By providing women the opportunity to talk about their medication abortion experience through open-ended interviews, women reported their experience of viewing or not viewing the ultrasound in detail, which to date has been underexplored. METHODS A constructivist, grounded theory approach was used. The purposive sample consisted of 18 women in the United States who experienced a medication abortion in the preceding 4 months. FINDINGS Not all women wanted to view the ultrasound; however, they all wanted a choice. Women wanted to view the image to confirm health and fertility, satisfy curiosity, and process their decision regarding the pregnancy. None of the women stated that they wanted to view the image as a prerequisite to making their decision to terminate the pregnancy; rather, viewing was a way to process their decision. CONCLUSIONS Women wanted a choice of whether to view the ultrasound image because they felt it was their right to decide whether to access this aspect of their personal health information. They wanted providers to engage in a dialogue about viewing the image or not and to respect their decision. Providers need to be appropriately prepared to offer women the choice to view and to support women in their decision.

Home fire safety intervention pilot with urban older adults living in Wales

The purpose of this pilot study was to evaluate the effects of a home fire safety (HFS) education program developed in the US, on improved HFS knowledge and practice in a purposive sample of 12 urban older adults living in Swansea, Wales. Knowledge was tested at baseline (T1), immediately after watching a Video on HFS (T2), and at 2-week follow-up (T3). A majority of the participants were Caucasian (n=9, 81.8%), and female (n=11, 91.7%); their mean age was 78years old (SD=12.7years). They had two chronic illnesses (n=1.8, SD=1.3), walked without help (n=7, 58.3%), and lived in a flat (n=10, 90.9%). Knowledge scores (percent correct) changed over time and were significantly different from T1 (46.7%) to T2 (59.2%, p=0.04) and from T1 (46.7%) to T3 (58.9%, p=0.04), but T2 and T3 (p=0.94) scores showed no difference. There is a need for educational HFS intervention programs aimed at this age group. This pilot successfully targeted active older adults living independently in sheltered housing complexes. Further fire safety research is needed with community dwelling older adults living in other types of housing.