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- Heys, S., et al.
(författare)
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‘I know my place’; a meta-ethnographic synthesis of disadvantaged and vulnerable women's negative experiences of maternity care in high-income countries
- 2021
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Ingår i: Midwifery. - : Churchill Livingstone. - 0266-6138 .- 1532-3099. ; 103
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Tidskriftsartikel (refereegranskat)abstract
- Objective: During pregnancy and childbirth, vulnerable and disadvantaged women have poorer outcomes, have less opportunities,face barriers in accessing care,and are at a greater risk of experiencing a traumatic birth. A recent synthesis of women's negative experiences of maternity care gathered data from predominantly low-income countries. However, these studies did not focus on vulnerable groups, and are not easily transferable into high-income settings due to differences in maternity care provision. The aim of this study was to synthesise existing qualitative literature focused on disadvantaged and vulnerable women's experience of maternity care in high-income countries. Methods: A systematic literature search and meta-ethnographic methods were used. Search methods included searches on four databases, author run, and backward and forward chaining. Searches were conducted in March 2016 and updated in May 2020. Findings: A total of 13,330 articles were identified and following checks against inclusion / exclusion criteria and quality appraisal 20 studies were included. Meta-ethnographic translation analytical methods were used to identify reciprocal and refutational findings, and to undertake a line of argument synthesis. Three third order reciprocal constructs were identified, ‘Prejudiced and deindividualized care’, ‘Interpersonal relationships and interactions’ and ‘Creating and enhancing insecurities.’ A line of argument synthesis entitled ‘I know my place’ encapsulates the experiences of disadvantaged and vulnerable women across the studies, acknowledging differential care practices, stigma and judgmental attitudes. A refutational translation was conceptualised as ‘Being seen, being heard’ acknowledging positive aspects of maternity care reported by women. Conclusion: Insights highlight how women's vulnerability was compounded by complex life factors, judgmental and stigmatizing attitudes by health professionals, and differential care provision. Further research is needed to identify suitable care pathways for disadvantaged and vulnerable women and the development of suitable training to highlight negative attitudes towards these women in maternity care settings. © 2021
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- Nyman, Viola, 1961, et al.
(författare)
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Do I need to change? Midwives´experiences of action research and the first encounter on labour ward in Sweden
- 2014
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Ingår i: The Nordic Conference on Advances in Health Care Sciences Research.
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Konferensbidrag (refereegranskat)abstract
- AIMS: To describe an Insider Action Research study undertaken with midwives based on one Swedish labour ward in order to improve the quality of care starting in the first encounter with women and their partners. To describe midwives' responses to a changed approach in the initial labour ward encounter. METHOD: The insider action researcher kept a research journal documenting thoughts, reactions, reflections and the development of the AR process. Thirty seven out of 57 midwives working on the labour ward were interviewed about their experiences. Interviews were tape recorded, transcribed and analyzed using interpretive description. RESULTS: The AR started 2010. Initially, midwives found it most difficult to change their routine of starting the fetal heart monitoring when women first arrived in labour, and then leaving to read the woman's medical record and notes. Through the debates more midwives moved towards spending time in the room with the woman and partner, talking with them, thereby creating meaningful relationships from the outset. The midwives' reflexive responses in the interviews illuminate their initial reluctance to respond to the AR process, but also, the value of reflecting beyond routines to build a lingering presence in the first labour encounter. CONCLUSIONS: Examination of the three years of insider AR through qualitatively analyze clinical documents, the researcher's journal including notes of observations and interviews revealed the complexity and the difficulty of providing time to manage reflection in a large organization. To a greater or lesser extent, midwives had integrated relatively impersonal system-wide technocratic norms of childbirth into their belief systems and behaviors. The AR study design enabled the midwives reflect on routines and start the transformation of tacit use-in-action to reflection-in-action, and reflection-on-action.
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- Nyman, Viola, 1961, et al.
(författare)
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Glancing beyond or being confined to routines: Labour ward midwives' responses to change as a result of action research
- 2013
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 29:6, s. 573-578
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Tidskriftsartikel (refereegranskat)abstract
- Objective to examine midwives' responses to a changed approach in the initial encounters with women and their partners in the labour ward. Design as part of a local project to improve hospital based childbirth care, Action Research (AR) was undertaken with midwives. To establish their beliefs, practices, and responses to change during the first cycle, 37 out of 57 midwives were interviewed. Data analysis was guided by interpretative description. Setting a labour ward in western Sweden. Findings two themes emerged: ‘Glancing beyond routines’ describes how the changed care approach enabled ‘valuing the idea’ and ‘acquiring extended space to create a lingering presence’. The theme ‘being confined to inherent routines’ expresses ‘resistance to the need for change’ and a ‘feeling of pressure to change’. Key conclusions the AR study design enabled the midwives to reflect on their routines and to transform tacit use-in-action to reflection-in-action. Midwives who persisted in being confined to inherent routines felt pressured by the change process. Others felt that the AR process granted them official licence to create chronological and emotional space in which they could ‘be’ and not just ‘do’. Implications for practice to a greater or lesser extent, midwives in this setting had integrated relatively impersonal system-wide technocratic norms of childbirth into their belief systems and behaviours. The data suggest that a whole-system shift is necessary to enable caring, behaviours based on the formation of positive relationships to become the key driver of the first encounter on the labour ward.
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- Perez-Botella, M., et al.
(författare)
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The use of salutogenesis theory in maternity care contexts
- 2014
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Ingår i: The International Confederation of Midwives. ICM 30th Triennial Congress. 1-5 June 2014 Prague, Czech Republic.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To gain an understanding of the use of the salutogenesis theory in maternity care contexts. Background: Current models of maternity care provision centre heavily on the application of technology and risk prevention based on pathogenic constructs of health, interested in studying pathology and its cure. In contrast, new ways of approaching health advocate for the study of what contributes to creating it, highlighting the importance of understanding all contributing factors, including individual abilities to maintain health. The salutogenesis theory (Antonovsky 1979) proposes such an approach: understanding how people stay healthy and how to make the best use of their own resources. Methods: A systematic review and simple thematic analysis were undertaken. Social and health care electronic databases were searched using predefined terms, inclusion, exclusion and quality criteria. Review of reference lists of included papers and consultation with experts were conducted. Results: Eight papers met the inclusion criteria: six research studies and two theory papers. Findings: A great proportion of the excluded papers used salutogenesis concepts within pathogenic frameworks. From the included research papers, only one employed a true salutogenic approach. The remaining research papers only used aspects of the theory. The two theory papers showed great insight into the theory, providing examples on how it could improve maternity care delivery as well as positively influencing systems and working environments where care is delivered. Conclusions: The use of salutogenesis in maternity care is relatively new and scarce compared to other disciplines. This might explain the low quality of the use of the theory: most studies utilised aspects of the theory but not always embracing a holistic salutogenic approach. It would be useful to devise guidance to aid researchers apply the theory more holistically as well as a tool which would help identify studies which make adequate use of the theory.
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