Category / Nursing & Midwifery

Breastfeeding poster presentation at Royal College of Midwives conference

Publishing

Dr. Catherine Angell, Senior Lecturer in Midwifery attended the annual RCM conference on November 13-14 in Telford.  Catherine presented an academic poster to highlight some of BU’s key research in the Centre for Midwifery, Maternal & Perinatal Health.  The poster (Fig. 1) reported findings of a survey of users of the Healthtalkonline webpages on breastfeeding.  These webpages are based on breastfeeding research conducted at BU can be found here.  BU research has fed into research-based training modules for midwives, lactation consultants and other professionals.  Currently the breastfeeding webpages receive around 37,000 hits each month, representing around 1,500 individuals.

The problem with clicks on webpages is that it suggests interest but it does not constitute evidence of changing knowledge or behaviour.  Dr. Angell teamed up with BU colleagues Prof. Vanora Hundley, Prof. Edwin van Teijlingen, and Senior Lecturer Alison Taylor as well as Prof. Kath Ryan from La Trobe University Australia to study the effect of the webpages.

To ascertain the impact of the webpages the team developed and conducted an online questionnaire survey of users of the breastfeeding webpages between Nov.2012- Feb. 2013.  A questionnaire study was administered after ethical approval had been granted. The survey was completed by 159 people, mainly from the UK, but also from other parts of the world such as Australia and New Zealand (12.6%) and the USA/Canada (2.5%).

BU was also represented at the RCM conference through BU Visiting Faculty Jillian Ireland.  Jillian is a community midwife working for NHS Poole, who presented a poster on the benefits to mothers and staff of the RCM Bournemouth & Poole Community choir.

 

Prof. Edwin van Teijlingen

Centre for Midwifery, Maternal & Perinatal Health

 

 

IVF failure is hard to accept!

 

On today’s BBC webpage is a very interesting article under the title ‘I wish IVF had never been invented’ (www.bbc.co.uk/news/magazine-24725655).  The article lists comments, experiences and/or feelings from readers of Magazine about the frequency with which In Vitro Fertilisation (IVF) fails.

The article reminded me that some years ago colleagues at the University of Aberdeen and I published a series of articles on the often difficult decision for couples to end IVF treatment after having tried for a long time (1-3).  We noted that couples embarking on their IVF  programme are full of optimism with unrealistically high expectations. Then we noted that IVF yield only a 20-25 percent pregnancy rate per cycle, today the success rate is still less than one in three for women under 35 according to the Human Fertilisation and Embryology Authority (HFEA), in short many couples leave the IVF clinic childless. We also noted that IVF treatment can also be a source of tension for couples.

We concluded at the time that the decision to end IVF treatment is a complex interaction between (a) the experience of diagnosis of infertility; investigations and IVF treatment; and (b) the emotions around involuntary childlessness. Our results indicated the need for improved psychological preparation of couples who decide to end IVF treatment.

 

We commented that IVF clinics should adapt their systems to facilitate the needs of this client group and consider a policy, which would help couples ‘plan for the end’ in the beginning. Finally, our study suggested that health care staff involved in IVF care need to examine their roles in providing an environment, which (1) encourages realistic expectations to ensure realistic decisions; (2) offers accurate and consistent information; and (3) deliver an efficient support system, which encompasses listening skills and recognises grief for which at present, there appears to be little validation. Only then, can reflective practice improve service provision for those who decide to end IVF treatment. Reading the various comments on the BBC webpages today suggests to me that many of our original recommendations still have currency!

 

Prof. Edwin van Teijlingen

Centre for Midwifery, Maternal & Perinatal Health

 

References

  1. Peddie, V., van Teijlingen, E., Bhattacharya, S (2004) Decision making in in-vitro fertilisation: How women view the end of treatment Human Fertility, 7: 31-37.
  2. Peddie, V.L., van Teijlingen E., Bhattacharya, S. (2005) A qualitative study of women’s decision-making at the end of IVF treatment, Human Reproduction, 20 (7): 1944-1951.
  3. Peddie, V.L., Porter, M., van Teijlingen E., Bhattacharya, S. (2006) Research as a therapeutic experience? An investigation of women’s participation in research on ending IVF treatment, Human Fertility, 9(4): 231-238.

CMMPH PhD students steal the show at the GLOW maternal health conference

PG research

The second Global Women’s Health Conference, held in Birmingham on November 1st, highlighted the work that still needs to be done to reduce maternal mortality. Prof Wendy Graham from the University of Aberdeen opened the conference outlining the progress to date but reminding us that there was much still to do. Her hard hitting presentation showed the unacceptable conditions of birthing rooms in many countries. She urged the audience to remember that “we do not want universal health care of poor quality.”

Rachel Arnold

This was followed by a short film produced by BU Visiting Professor Gwyneth Lewis, which tells the story of Mrs X and why she died in childbirth.

A number of presenters highlighted hospital conditions and disrespectful staff as a disincentive for women in seeking facility birth. However, Rachel Arnold, PhD student in CMMPH,  reminded the audience that the carers were women too. She noted that it is all too easy to blame health care professionals, forgetting the challenging conditions that they have to work in. In her excellent and moving presentation Rachel presented quotes from midwives and doctors in Afghanistan that brought a number of audience members to tears.

BU Prof Vanora Hundley presented work from Pakistan evaluating a decision tool to support policy makers and programme managers who are considering the potential role of clean birth kits in their strategy for care at birth.

Sheeta;

Sheetal Sharma

While PhD student Sheetal Sharma’s poster presentation Getting women to care in Nepal: A Difference in Difference analysis of a health promotion intervention stole the day winning best poster prize.   Sheetal has a unique international supervisory team led by BU and her PhD is supported by Bournemouth University with a studentship and a Santander grant.

The event was also an opportunity to publicise next year’s international conference on Midwifery and the post-MDG agenda, which will be held at Bournemouth University.

BU well represented at Global Women’s (GLOW) Research Conference

PG research

 

At tomorrow’s Global Women’s (GLOW) Research Conference at the University of Birmingham BU’s Centre for Midwifery, Maternal & Perinatal Health is very well presented.  Prof. Vanora Hundley presents her poster Clean Birth Kits to promote safe childbirth, which reports the views of policy makers and district health officers in Pakistan regarding the potential for CBKs to facilitate clean birth practices.

 

PhD student Sheetal Sharma also presents a poster on her thesis under the title: Getting women to care in Nepal: A Difference in Difference analysis of a health promotion intervention.  Sheetal’s work is supervised by BU Professors Edwin van Teijlingen and Vanora Hundley, BU Senior Lecturer in Midwifery Catherine Angell, BU Visiting Fellow Dr. Padam Simkhada (ScHARR, University of Sheffield) and Dr. Elisa Sicuri from CRESIB (Barcelona Centre for International Health Research) in Spain and Prof. José M. Belizán from IECS (Institute for Clinical Effectiveness and Health Policy) in Argentina.  Sheetal’s PhD evaluates a community-based health promotion intervention in Nepal which aims to improve the uptake of maternity care.  The intervention is sponsored by the London-based Buddhist charity Green Tara Trust (see: http://www.greentaratrust.com/ ).

 

Whilst PhD student Rachel Arnold will give an oral presentation of her PhD research under the title:  Afghan women: a qualitative study of the culture of care in an Afghan maternity hospital.   This PhD, supervised by BU Professors Immy Holloway and Edwin van Teijlingen and BU Visiting Professor Kath Ryan (La Trobe University, Australia), analyses the culture of care within a maternity hospital in the Afghan capital Kabul and examines the perspectives of midwives, doctors and cleaners on their role and care within that hospital. In a country striving to reduce the high rate of maternal mortality the provision of quality intrapartum care for women in Kabul’s maternity hospitals is vital.

 

BU Professors Vanora Hundley and Edwin van Teijlingen will also take the opportunity at the GLOW conference to promote the forthcoming BU conference on what will happen after the Millennium Development Goals in 2015 ‘Midwifery and the post MDG agenda’ (http://postmdgagenda-eorg.eventbrite.co.uk/ ).

 

Vanora Hundley is Professor of Midwifery

Edwin van Teijlingen is Professor of Reproductive Health Research

 

Twenty years after the publication of Changing Childbirth, where are we now?

Twenty years after the publication of Changing Childbirth, an eminent panel of clinicians, politicians and consumer representatives assembled to review the legacy of this key Changing CHildbirthmaternity report. The session, funded by the Wellcome Trust, was held at the Royal College of Obstetricians and Gynaecologists in London – an appropriate place given the balance of power at the time of the report.  BU Professors Vanora Hundley and Edwin van Teijlingen were invited to attend as part of the selected audience at the session.

The session started with the panel reminding the audience that maternity services prior to the publication of Changing Childbirth in the early 1990s were anything but women focused. Several speakers noted that this report was the first to put women at the centre of maternity care, and many of the recommendations regarding patient-centred care across the NHS followed on from it. As the president of the Royal College of Midwives (RCM) Lesley Page commented: “It was common sense, but hugely radical.”

Changing Childbirth was the government’s response to Sir Nicholas Winterton’s ground-breaking review of the maternity services (Health Select Committee report 1992). The review was unique in seeking views from women – as Nicholas Winterton noted, his Parliamentary committee also made history by letting women who came to give evidence breastfeed during the hearing.

Baroness Julia Cumberlege reflected on how she had been determined that the Health Select Committee report would not simply be another filed document but would have an impact. Twenty years on has the report had an impact? 

The discussions covered a wide-ranging number of maternity care issues at the time of Changing Childbirth’s conception, many of which are still issues today in the UK.  We’d like to highlight two of these issues where BU has made an academic contribution.  First, the observation that we need to be cautious in making assumptions about choices that women perceive they have in childbirth. Profs van Teijlingen and Hundley’s research has demonstrated that women often cannot envisage or value potential choices if these options don’t exist in their current environment.1,2   

The second BU contribution to the debate is around the closure of small maternity units. One of the panel members compared the centralisation of maternity services to that of banks and supermarkets.  A comparative study was published in 2010 by Prof. van Teijlingen and BU Visiting Fellow Dr. Emma Pitchforth under the title ‘Rural maternity care: Can we learn from Wal-Mart?’.

Overall the panel was positive about the legacy of Changing Childbirth – that is, a more humanised maternity services. However, all present expressed disappointment at the failure of the NHS to introduce continuity of carer, something that women who gave evidence stated they valued highly. As Nicholas Winterton said: “We have made progress but we should be making further progress – It is unfinished business.”

Vanora Hundley is Professor of Midwifery

Edwin van Teijlingen is Professor of Reproductive Health Research

 References:

  1. Hundley V, Ryan M and Graham W (2001) Assessing women’s preferences for intrapartum care. Birth 28 (4): 254-263.
  2. van Teijlingen E, Hundley V, Rennie AM, Graham W, Fitzmaurice A. (2003) Maternity satisfaction studies and their limitations: “What is, must still be best”, Birth 30: 75-82.  
  3. van Teijlingen ER and Pitchforth E. (2010) Rural maternity care: Can we learn from Wal-Mart? Health & Place 16: 359-364.

 

 

 

Fresher’s, midwifery students and photographs!

Fresher’s week for midwifery students started with a hard copy photograph. The image had to depict themselves and what midwifery meant to them.  This was used as an ice-breaker for the very first session and students had five minutes to share their photo with the person next to them, before that person fed back to the group the student’s name, and how the photo depicted their commitment to midwifery.  The students were wonderfully creative and inventive. Many had accessed the 6 C’s and based their image around the values of care, compassion,  commitment and communication, all important attributes that midwives bring to the profession. Some photographs depicted the students with midwifery related objects such as stethoscopes, pinards, and fob watches, whilst others were shown working with children/adults and one even washing an elephant on an international placement! All shared a common theme, enabling and facilitating others.  

As an ice-breaker it worked particularly well as the room hummed with animated conversation, but there was a secondary purpose to the activity. It was also a  ‘dummy’ run to see if it would work as an interview activity for the forthcoming 2013-2014 selection days for under-graduate pre-registration midwifery students. The interview process to select new students consists of a number of activities, one of which was a team activity. In previous years students were asked to participate in fictionalized scenarios, which consisted of survival on a lifeboat with limited provisions, being stranded in a forest in the snow after a plane crash and latterly a ‘real life dilemma’ based around prioritizing staff requests for holidays in August or having Xmas and New Year off.  Students had to work as a team and after a twenty minute discussion agree on priorities relating to the particular scenario. These activities enabled the interviewers to see which prospective students were team players, which students actively contributed and whether anybody in particular dominated proceedings. During the 1:1 interview which followed, students were asked about how they felt they had contributed. It was interesting to compare interviewer gradings with the student’s own insight into their participation.

This year the current admissions tutors were keen to try something new – hence the photograph activity.  Prospective candidates will be asked to bring along a photograph to their interview and will have been directed to draw links to one of the identified 6 C’s and to articulate it during their presentation. Each candidate will be partnered with one other during the activity and then asked to feedback each others’ thoughts to the whole group. Interviewers will score the candidates on the following: Communication (verbal & non verbal), how the particular ‘C ‘ was verbalized, creativity of the photograph, listening skills and how the role of the midwife is identified. Ultimately as the activity will be time restricted it is hoped that the candidates will be able, through their photographs to summarize, with reference to the 6 C’s, the values and attributes of a midwife. 

If anybody is interested to know more about the process, please contact Midwifery Admission tutors on the West campus: Susan Mant on smant@bournemouth.ac.uk, and Sarah Emberley on semberley@bournemouth.ac.uk and on the East Campus: Jan Stosiek on jstosiek@bournemouth.ac.uk and Jane Fry on jfry@bournemouth.ac.uk. 

 

 

Beijing and Hong Kong with the Fusion Investment Fund Study Leave Strand. Dr. Rick Fisher, HSC/BUDI

Fusion, Research themes

I applied to be seconded to the BU Dementia Institute, with the objective of raising the profile of the Institute on an international stage. This activity builds on  my current role as chair of the HSC International Strategy Group. The Fusion Fund award was granted to enable me to be released from some of my work commitment within HSC to spend two days per week with BUDI over a period of six months. Contributing to the Fusion Strand ‘Mental health and wellbeing across the lifespan’ the intention was to proactively seek academic and research collaboration with colleagues overseas.

Serendipity?

The intended strategy for this undertaking was to identify overseas areas where there was an opportunity for such collaboration to take place. This would be achieved by undertaking a targeted literature review of existing research centres. An initial reading of primary literature identified that dementia is a growing concern in China. At this time, through my role as a member of BU’s International Task Force, I was aware of a delegation visiting Beijing. A leading light in gerontology, Professor Du Peng, who I had identified through my reading, is Professor of Psychology at Renmin University in Beijing. A small flurry of email exchanges resulted in Dr Biao Zeng from BU’s Psychology department being able to meet with Professor Du, paving the way for a visit to take place later in the year.

I also, with the aid of Professor Anthea Innes, identified Professor Timothy Kwok, of the Jockey Club Centre for Positive Ageing (JCCPA) as a potential collaborator. Timothy and Anthea have previously explored comparative research opportunities. The JCCPA is located in Hong Kong; I could have a ‘free’ stop over with my chosen airline, thereby maximizing the funding. Initial email exchanges with Prof Kwok resulted in an agreement to meet during my trip.The meetings were scheduled for the week beginning September 9th. In the meantime I was introduced to Prof Junqi Yan, who was able to arrange for me to visit a neuro-rehabilitation centre in Beijing, thus adding another opportunity to the visit.

 Visit to Renmin University, Beijing.

Situated in the North of Beijing, Renmin University, (formerly the People’s University of China) is a high-ranking educational establishment and is branded as China’s flagship for Social Sciences and Humanities education.

 

 

 

 

 

 

 

 

 Students relax on campus

 

 

                      Views of Freshers’ Week

 

 


 

 

 

 

 

 

 

 

  

 

 

On a bright, warm Monday morning Biao Zeng and I met with Prof Du,  Prof James Sun, Chair of the Department of Psychology and Associate Dean of the School of Sciences and also Pro Hu Ping who is Associate Dean in the Department of Psychology. Besides his role as head of Population Studies focusing on Gerontology,  Professor Du is also  Director of Academic research for the entire university.

 

     L-R  Prof Sun, Prof Du, Prof Hu, Dr. Rick Fisher, Dr. Biao Zeng

 We had a very positive meeting in which we discussed a number of opportunities. Prof Du and I discussed possibilities of a bid to a recently announced ESRC call for collaborative research between China and the EU.  He is also in the process of setting up a multidisciplinary centre for the study of ageing and has a sociology/social policy background. Prof Du also demonstrated a project, funded by Samsung, in which it is possible to simulate the difficulties older people and those with a physical disability experience as a result of poor building design. This project appears to have some parallels with research being conducted at BUDI.

Prof Sun, who is also Deputy Director of Leadership Studies, is very positive about collaborative ventures. He is keen to foster PhD studentships and a variety of models of faculty exchange. Our meeting was followed by what Prof Sun described as a ‘simple’ lunch, served in the university private dining room, with exquisite presentation.

In all, this was a very positive visit and I am developing a proposal to maintain the keen interest shown in the ESRC bid.

 Visit to Beijing United Family Rehabilitation Hospital

 On the following day I met with Prof Yan and three of his PhD students. We discussed some of their research projects, which included a study into the pressures and health risks being experienced by the fledgling middle management in China’s burgeoning industrial landscape. We travelled through (very slow) Beijing traffic to visit the newly-established Beijing United Family Rehabilitation Hospital. Privately funded and catering for Beijing’s upper strata, this is dedicated to the rehabilitation of those who have neurological impairment. We were met by Dr Jason Zhou, Assistant Chief Medical Officer and Director of Neuro-rehabilitation. Dr Zhou was enthusiastic about the excellent facilities in the hospital which include hydrotherapy and hyperbaric oxygen therapy and he is keen to explore collaborative opportunities for both research and education.

 

                                       Beijing United Family Rehabilitation Hospital.

  Dr Jason Zhu (left) and Prof Junqi Yan next to the hydrotherapy pool.

The Hong Kong Jockey Club Centre for Positive Ageing

 The following day was spent travelling to Hong Kong. Here I was to meet Professor Timothy Kwok. Besides his work as Director of the Jockey Club Centre for Positive Ageing  he is Professor in Medicine and Therapeutics at the Chinese University of Hong Kong. His primary research interests centre around the prevention of cognitive decline in elderly people. On arrival I was shown around the Centre by Research Officer, Bel Wong Pui Sze . The centre is arranged  over three floors with good access for wheelchair users throughout. It comprises two levels of day centres; people attend according to the degree of their dementia. There is also a residential facility offering respite care. A major feature of the Centre is in the ways in which it seeks to support those with dementia and those who care for them at home. These include a variety of literature, short courses and a telephone support line. It also aims to raise awareness of dementia within the general public of Hong Kong.

 

 With Prof Timothy Kwok, at the Jockey Club Centre for Positive Ageing

 

   Respite room at the Jockey Club Centre for Positive Ageing

Prof Kwok has numerous interests focused on elderly care and dementia. We had positive discussions regarding a number of ventures and he expressed considerable interest in collaborating on a Chinese language version of the Dementia Educational Game being developed with Fusion Investment Fund monies, by myself, Dr Christos Gatzidis (DEC) and Jonathan Ferraris.

 

                     Goodnight to Hong Kong

In all, this was a positive experience  that has the potential to deliver collaboration across both China and Hong Kong. The next step is to translate some of this bonhomie into measurable outputs.

I would like to thank the BU Fusion Investment Fund for giving me the opportunity to undertake this venture.

rfisher@bournemouth.ac.uk


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The portrayal of childbirth in the mass media

Fusion

Marilyn Cash from HSC’s Centre for Midwifery, Maternal and Perinatal Health recently delivered a paper on the Portrayal of Childbirth in the Mass Media, at the Reimagining Birth International Research Symposium held at the Humanities Institute University College Dublin, Ireland.  The research symposium brought together academics, medics and artists from around the world to explore how childbirth has been portrayed/represented/imagined in the worlds of art and medicine. 

The symposium provided an opportunity for contemporary critical debates into the visual culture of childbirth.  This was a unique opportunity for researchers and practitioners to explore/discuss the visual and sensorial culture of birth, and to contribute to our reimagining of this fundamental personal life experience for mother and child.  Central to the vision of the symposium is the ambition to build connections between interested parties, providing a forum for transcending current knowledge silos and contributing to innovative change in this important personal/cultural domain of human experience.

The paper is part of an ongoing collaboration between academics in the Centre for Midwifery, Maternal and Perinatal Health and the Media School and the University of Stirling, exploring the medicalisation of childbirth.  As a direct result of the symposium academics from the group have been invited to present at the Perinatal Care Online Conference to be held in November 2013. For further information please contact a member of the Media and Childbirth research team (which includes: Prof Vanora Hundley: vhundley@bournemouth.ac.uk, Prof Edwin van Teijlingen: evteijlingen@bournemouth.ac.uk, Dr Ann Luce: aluce@bournemouth.ac.uk, Dr Marilyn Cash: mcash@bournemouth.ac.uk , Prof Helen Cheyne: h.l.cheyne@stir.ac.uk, Dr Catherine Angell: cangell@bournemouth.ac.uk .

HSC student wins Santander Travel Grant to go to Yale

PG research, Post-award, Training

Mrs. Anita Immanuel has just been awarded a travel award from Santander to visit the Yale Cancer Centre in the USA. Anita studies the quality of lives of adults in Dorset who have survived cancer of the blood or immune system. Cancer is a devastating disease and with the advances in treatment patients are living longer, however left with debilitating side effects which can negatively affect their quality of life.

Anita’s research will identify any unmet needs in this group of patients and will give a better understanding into comprehensive survivorship care thereby maximising quality of life. This study uses a mixed methods approach in examining the quality of lives of these patients who have been treated for a haematological cancer. Data will be collected across three Dorset hospitals: The Royal Bournemouth Hospital, Poole Hospital and Dorset County Hospital.

Dr. Helen McCarthy, Consultant Haematologist at The Royal Bournemouth Hospital and Anita’s clinical supervisor, highlighted: “At Yale Cancer Centre Survivorship Clinic, Anita will be introduced to their comprehensive survivorship care programme which can help improve the quality of lives of adults treated with cancer in Dorset.

Dr. Jane Hunt, the lead supervisor and senior lecturer at Bournemouth University’s School of Health & Social Care added: “The survivorship programme at the Yale Cancer Centre Survivorship Clinic integrates a multidisciplinary approach for following up patients treated for cancer by leading experts, which differs significantly from our own. I am convinced Anita’s PhD study will benefit from collaborating with the Yale experts.

BU Prof. Edwin van Teijlingen, Anita’s third supervisor, commented “We are grateful to Santander for this funding. We know Anita’s research will significantly contribute to the underdeveloped area of research on adult haematological cancer survivors”.

For more about Santander Awards see: http://microsites.bournemouth.ac.uk/graduate-school/pgt-santander-mobility-awards/

Burdett Trust for Nursing Grant

‘Delivering Excellence in Nutrition and Dignity in Dementia Care – Empowering Nurses and Care Home Staff to Enhance the Care Environment’.

Dr Jane Murphy and Joanne Holmes from the School of Health & Social Care, working in collaboration with representatives from local council (Partners in Care), the Local Enterprise Partnership, local and national care home organisations have won significant grant income from the Burdett Trust for Nursing to tackle the increasing and yet unresolved problems of nutrition and delivering dignity in dementia. Over a two year period, the project will identify best practice guidelines for delivering nutrition in dementia care by providing a new nutrition education programme based on fundamental principles of self-leadership and nutrition to empower nurses and care home staff. The programme will be easily translated and adopted widely to induce a long-lasting culture change towards excellence in dementia care that is person-centred and upholds dignity.

 

For further details, contact either Jane (jmurphy@bournemouth.ac.uk) or Joanne (holmesj@bournemouth.ac.uk).

 

Burdett Trust for Nursing Grant: Humanising Services: A new transferable leadership strategy for improving ‘what matters to older people’ to enhance dignity in care

Awarded & submitted bids

In collaboration with Bournemouth University, Professor Kathleen Galvin of the Faculty of Health and Social Care, University of Hull has been successful in attracting a grant from the Burdett Trust for Nursing to apply a new theoretical framework for the purpose of ‘humanising services’ in two clinical settings. The experience of dignity is linked to what makes people ‘feel human’. Conversely, what leads to dehumanisation and therefore loss of dignity needs to be understood and acted upon in meaningful service improvement. (Patients Association, 2009; 2012). Using a lifeworld orientation and grounded in phenomenological philosophy eight key considerations that are relevant to the challenge to improve peoples’ experiences of the human dimensions of services have been defined (Todres et al., 2009; Galvin & Todres, 2012). These are not detailed lists of ‘do’s’ and ‘don’ts’ or abstract generalities such as the need for more ‘user /customer focus’ or ‘choice’. Rather, they are eight dimensions about what makes a person feel human, which could help nurses, with service providers, to effectively focus their leadership when improving services to enhance dignity in care.  The team from University of Hull, Professor Steven Ersser, Dr Fiona Cowdell, Professor Roger Watson, Jane Wray, Kathleen Galvin and the team from Bournemouth University, Professor Les Todres and Dr Caroline Ellis-Hill are interested in what older people with long term skin conditions (being treated at a dermatology outpatient clinic) and people who have had a stroke (being cared for in a stroke rehabilitation unit with outreach service) point to that would make human perspectives more central in treatment. Our key practice partners include: Dr. Shernaz Walton, Consultant Dermatologist, Hull and East Yorkshire, NHS Trust and Dr Damien Jenkinson, National Stroke Lead, Royal Bournemouth Hospital Trust. Within these two settings, dermatology clinic and a stroke rehabilitation unit, a tripartite humanising improvement team group comprising older service users, nurses, and academics will engage in a robust ‘humanising improvement’ process that will be evaluated.

Galvin, K.T. &  Todres, L (2012) Caring and Well-being: A lifeworld approach. London: Routledge

The Patients’ Association (2009) Patients…not numbers, People…not statistics.

 The Patients’ Association (2012) Stories from the present, lessons for the future.

Todres, L., Galvin, K. and Holloway, I. (2009) The humanisation of healthcare: a value framework for qualitative research.  International Journal of Qualitative Studies on Health and Well-being, 4, 68-77.

A royal birth? Lucky Kate

PG research

With the Queen’s Jubilee, the Olympics and Andy Murray winning at SW1 Wimbledon (again) it seems Britain is still riding a wave of optimism with the birth of a male heir to the throne; the Prince of Cambridge. The baby was delivered on 22 July 2013 at St Mary’s Hospital in Paddington, west London, weighing 8lb 6oz. The document said: “Her Royal Highness, the Duchess of Cambridge was safely delivered of a son at 4.24pm today. He and the duchess will remain in the hospital overnight. A bulletin signed by the Queen’s gynaecologist Marcus Setchell, who led the medical team that delivered the baby – was taken by a royal aide from St Mary’s to the palace under police escort.

The implications are wide -reaching, in multi-cultural Britain the royal baby is unusual for London in having a mother originally from the UK and most babies delivered in the capital these days (57%) are to mothers born overseas and nearly half of all babies (48%) are born outwith marriage. With midwifery cuts and the further medicalisation of birth where the “cascade of interventions” often occurs when birth is induced.  For instance, in the USA which spends more money on healthcare than any country in the world and yet the maternal mortality rate is among the highest of any industrialised country.

And on July 19, 2013, the USA the House State-Foreign Operations Appropriations Subcommittee today approved a steep cutback in international family planning assistance for fiscal year 2014. Rejecting President’s Obama’s 2014 budget request of $635.4 million, the Subcommittee capped appropriations for international family planning and reproductive health programs at $461 million, $174 million less than the President’s request, and $137 million (23% below the current funding level).  The cuts, if approved by the full Congress, would have a devastating impact: Several million women in the developing world would lose access to contraceptives services, resulting in more unplanned pregnancies and deaths from unsafe abortions. Each pregnancy multiplies a woman’s chance of dying from complications of pregnancy or childbirth. Maternal mortality rates are particularly high for young and poor women, those who have least access to contraceptive services. It is estimated that one in three deaths related to pregnancy and childbirth could be avoided if all women had access to contraceptive services.

Not so lucky, therefore, are Kate’s counterparts in the South – Frightening statistics include that daily, approximately 800 women die from preventable causes related to pregnancy and childbirth. In our study site, Nepal every year, 4,500 Nepali women die in childbirth due to lack of medical care. In low-income countries, most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. All women need is access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth.

To make every birth worldwide as joyful an event as the royal birth in London we need is: a) more and better midwifery services; and b) improved access to care for pregnant women globally.

Sheetal Sharma is a HSC PhD student and currently a visiting researcher in Barcelona, supervised by Dr. Elisa Sicuri at CRESIB on an evaluation of a health promotion programme in rural Nepal aiming to improve access to care; in which socio-economic and cultural barriers exist.

Thanks to Edwin & Elisa for their input in this piece.

References:

http://www.populationinstitute.org/newsroom/press/view/57/

http://midwifeinternational.org/how-to-become-midwife/business-of-baby/

http://www.bbc.co.uk/news/uk-23408377

http://www.unfpa.org/public/home/mothers/pid/4382

http://www.bbc.co.uk/news/uk-23403391

Joint PhD studentships: an example of FUSION in practice.

Fusion, PG research

For many clinicians undertaking a PhD means choosing to either give up clinical practice for a period of time or studying on top of an already demanding full-time job. Now a partnership between the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) and Portsmouth Hospitals NHS Trust (PHT) is making it easier for midwives to undertake a doctorate while still maintaining their clinical skills. The team has developed a novel joint studentship that will allow midwives to combine clinical practice with a research role, working across BU and PHT. The studentships will run for four years and PhD students will spend two days per week working as a midwife in clinical practice and three days per week working on their thesis. This set up facilitates the co-creation of knowledge.

In addition to providing the individual midwives with excellent education, these studentships are designed to examine an area of clinical practice identified by PHT where the evidence is lacking and research is needed. As a consequence the research studies will be directly relevant to practice and will have a demonstrable impact in the future. Hence BU will be able to show that its research and education have a direct benefit to the wider society. Finally, the studentships benefit midwifery practice by building a critical mass of researchers, which will help translate research findings into practice and so create a culture of evidence-based practice.

The result is a studentship that truly fuses research, education and practice.

The CMMPH/PHT partnership has developed three matched-funded PhD studentships for midwives, which will begin in September 2013. These joint PhD studentships will be supervised by both BU academics (Sue Way, Catherine Angell, Carol Wilkins, Maggie Hutchings, Edwin van Teijlingen & Vanora Hundley) and supervisors from PHT based in practice.  We are excited about this novel approach to PhD studentships and hope that we will have many more studentships with other NHS Trusts in the future.

For further information please contact Prof. Vanora Hundley or Prof. Edwin van Teijlingen.

Research Ethics: Insights from the Centre for Midwifery, Maternal & Perinatal Health and the Centre for Social Work, Sociology & Social Policy

PG research, Publishing, Research Ethics, Research Integritiy

Ethics contributions

Collage of research ethics contributions

Academics based in HSC have experience in a wide-range of research.  In the process of reflecting on all aspects of the research process several members of HSC have published about ethical issues that they have had to address in their own research.    This BU Blog highlights some of these key HCS papers which may help fellow academics and students across the globe address similar ethical questions.  HSC has a history of publishing on research ethics, Professor Emerita Immy Holloway wrote about the researcher who may have a dual role, or even conflicting role, as researcher and health care professional (1).  More recently, several midwifery researchers in the Centre for Midwifery, Maternal & Perinatal Health wrote about the issues facing practitioners doing research in the field where they work, especially concerning the similarities and differences between professional ethics and research ethics (2-3).  Negotiating ethical paths cleaved by competing concerns between protecting research participants and over-managing the ethical process is tricky.

In her book Rainforest Asylum: The enduring legacy of colonial psychiatric care in Malaysia Dr. Ashencaen Crabtree in the Centre for Social Work, Sociology & Social Policy, addresses the problematic issue of gate-keepers in research together with the ethics of critical observation of abuse (potential or actual), as well as the ethics of advocating on behalf of research participants (4).

The fear that the ethical application process in the UK is becoming more and more cumbersome and bureaucratic has been widely recognised as highlighted by Prof. van Teijlingen and colleagues (5-6).

Research ethics review processes are also considered in terms of access to participants regarded as ‘vulnerable’ in a recently published paper by Dr. Ashencaen Crabtree (7) of ethnographers working in health settings who are seeking to understand the context of care and patient/service user experiences.  She concludes that paternalistic control of participation on the grounds of ethical protection of vulnerable people seriously disenfranchises potential participants in preventing them from being able to share their relevant, lived experiences as recipients of service provision.

Prof. van Teijlingen and BU Visiting Fellow Dr. Padam Simkhada highlighted that the social, cultural and economic contexts in which research is conducted often differ between developing and developed countries.  However they stress that researchers need to apply for research ethics approval to the relevant local authority, if national legislation requires one to do so (8).

A new and challenging area of research is the use of discussion boards as a source of research data.  In their paper Dr. Bond and BU colleagues discuss both practical and ethical dilemmas that arise in using such data (9). In earlier research, Prof. Parker of the Centre for Social Work, Sociology & Social Policy, highlighted some of the benefits and dangers of using email and the Internet for research as the potential for electronic media continues its rapid growth (10).

Obtaining informed consent is something that all researchers need to consider. However, in some research situations obtaining consent can be particularly challenging.  Prof. Hundley and colleagues discuss the ethical challenges involved in conducting a cluster randomised controlled trial, where consent needs to be considered at a number of levels (11).  In a second paper issues of consent during pregnancy, where there is the potential for harm to two participants, are considered (12).

In research into the implications of the Mental Capacity Act 2005 for social research, Prof. Parker explored the contested meanings and difficulties associated with informed consent in social research, highlighting some of the challenges raised by an almost unquestioned acceptance of biomedical research ethics in social research and questioning whether potential ‘harm’ is different in this context (13, 14). This research has led to further explorations of the potential for ethical covert research by Prof. Parker and Dr. Ashencaen Crabtree.

 

The way forward

There a plenty of challenges to research ethics in both the health and social care sectors.  Ethical considerations relate to technological developments such conducting research over the Internet or the analysis of tweets.  HSC staff will continue to publish on a range of moral dilemma as well as practical issues related to research ethics.  Moreover, academic from the two centres are planning a Masterclass on research ethics to be held in early 2014.

 

 

References

  1. Holloway, I., Wheeler, S. (1995) Ethical Issues in Qualitative Nursing Research, Nursing Ethics 2: 223-232.   Web address:  http://nej.sagepub.com/content/2/3/223.full.pdf+html
  2. Ryan, K., Brown, B., Wilkins, C., Taylor, A., Arnold, R., Angell, C., van Teijlingen, E. (2011) Which hat am I wearing today? Practicing midwives doing research, Evidence-Based Midwifery 9(1): 4-8.
  3. van Teijlingen, E.R., Cheyne, H.L. (2004) Ethics in midwifery research, RCM Midwives Journal 7 (5): 208-10.
  4. Ashencaen Crabtree, S. (2012) Rainforest Asylum: The enduring legacy of colonial psychiatric care in Malaysia, London: Whiting & Birch.
  5. van Teijlingen, E., Douglas, F., Torrance, N. (2008) Clinical governance and research ethics as barriers to UK low-risk population-based health research? BMC Public Health 8(396)                            Web address: www.biomedcentral.com/content/pdf/1471-2458-8-396.pdf
  6. van Teijlingen, E. (2006) Reply to Robert Dingwall’s Plenary ‘Confronting the Anti-Democrats: The unethical Nature of Ethical Regulation in Social Science, MSo (Medical Sociology online) 1: 59-60  Web address:  www.medicalsociologyonline.org/archives/issue1/pdf/reply_rob.pdf
  7. Ashencaen Crabtree, S. (2013) Research ethics approval processes and the moral enterprise of ethnography. Ethics & Social Welfare. Advance Access: DOI:10.1080/17496535.2012.703683
  8. van Teijlingen E.R., Simkhada, P.P. (2012) Ethical approval in developing countries is not optional, Journal of Medical Ethics 38 :428-430.
  9. Bond, C.S,  Ahmed, O.H., Hind, M, Thomas, B., Hewitt-Taylor, J. (2013) The Conceptual and Practical Ethical Dilemmas of Using Health Discussion Board Posts as Research Data, Journal of Medical Internet Research 15(6):e112)  Web address: http://www.jmir.org/2013/6/e112/
  10. Parker, J.  (2008) Email, ethics and data collection in social work research: some reflections from a research project, Evidence & Policy: A Journal of Research, Debate & Practice, 4 (1): 75-83.
  11. Hundley, V, Cheyne, HC, Bland, JM, Styles, M, Barnett, CA.. (2010) So you want to conduct a cluster randomised controlled trial? Lessons from a national cluster trial of early labour, Journal of Evaluation in Clinical Practice 16: 632-638
  12. Helmreich, R.J., Hundley, V., Norman, A., Ighedosa, J., Chow, E. (2007) Research in pregnant women: the challenges of informed consent, Nursing for Women’s Health 11(6):  576-585.
  13. Parker, J., Penhale, B., Stanley, D., 2010. Problem or safeguard? Research ethics review in social care research and the Mental Capacity Act 2005. Social Care & Neurodisability, 1 (2): 22-32.
  14. Parker, J., Penhale, B., Stanley, D. (2011) Research ethics review: social care and social science research and the Mental Capacity Act 2005, Ethics & Social Welfare, 5(4): 380-400.

 

Vanora Hundley, Sara Ashencaen Crabtree, Jonathan Parker & Edwin van Teijlingen

 

 

PechaKucha – presenting research in a fast and furious manner!

The Normal Labour and Birth Conference allowed me to experience a novel way of showcasing research and exchanging ideas – the PechaKucha. Pronounced “peh-chak-cha”, the PechaKucha session is made up of a series of short presentations. Presenters must use 20 slides, each of which must be displayed for exactly 20 seconds – no more, no less. The concept, conceived by two young architects (Astrid Klein and Mark Dytham) in Japan in 2003, is to enable individuals to exchange their ideas in a fast moving, concise and exciting format. Not one to ignore the call to try something new, I decided to undertake this challenge as a double act with my colleague Professor Helen Cheyne from the University of Stirling. We presented our team’s work on the media’s portrayal of labour and birth, which was also being displayed as a poster.

Poster
Research team includes Ann Luce, Marilyn Cash, Vanora Hundley, Helen Cheyne, Edwin van Teijlingen and Catherine Angell

The PechaKucha was quite an undertaking, as the slides move automatically and you cannot stop them moving on! However, it really focused the mind and helped us identify the key messages from our work. The session was very lively and the energy generated a lot of discussion that continued into the coffee break afterwards. As for the PechaKucha method, I’d say that it is definitely a useful tool for our community research meetings, and perhaps also for our doctoral students to use as they prepare for their vivas.

The conference was also an opportunity to catch up with colleagues from the International Early Labour Research Group. The group have been involved in producing a series of research papers featured in a special issue of Midwifery. We also discussed future research and opportunities for research collaboration.

Dizzy the dog attends midwives forum

Fusion

 

Left to Right: Mandy Williams - Community Midwife, Gay Rogers - Breakfast Host and Hospital Midwife and Luisa Cescutti-Butler, Senior Lecturer (Midwifery)

Every three months hospital and community midwives at Salisbury NHS Trust Hospital attend a forum dedicated to matters relating to Examination of the Newborn (EXON).  The aims of the forum are to support healthcare professional undertaking newborn examinations, sharing of experiences/case studies, interprofessional working, maintenance of competence, formulate and review internal  processes and peer support for professionals in training. Members consist of midwives, nurses, a consultant Paediatrician and Children’s physiotherapists. BU student midwives are welcome to attend when working with their community midwives and on this occasion two students were present. As unit leader for EXON at BU and one of the link lecturers at the hospital, I chair, coordinate and facilitate the forums, with venues alternating between hospital and community.  This month we met for breakfast at a colleague’s home, where midwives were greeted with the smells of freshly brewed coffee and a newly prepared home cooked frittata. Further offerings included fresh strawberries, raspberries, warm croissants, cocktail sausages and quails eggs.  

Minutes and agendas are sent out in advance. A standing item is a report from senior children’s physiotherapist Karen Robinson, whose department leads the service for Developmental Dysplasia of the Hips (DDH) in newborns.  A recent case was brought to our attention, where a baby had been examined by midwives and doctors and found to have an unstable right hip. The baby was appropriately referred for an ultrasound scan which subsequently found the right hip normal, but considered the left hip abnormal.  The Barlow’s and Ortolani manoeuvres used by both professions at the time of the examination had not detected any left hip abnormality. A robust discussion ensured as to the complexities of examining babies for DDH and the difficulties in detecting unstable hips when the manoeuvres used by all professionals were themselves unreliable. However Karen was able to reassure us by indicating that in the seven years of the Children’s Physiotherapy Department leading the DDH service, very few babies had been ‘missed’. Karen also emphasized the significance of caring for babies’ hips in general and the importance of educating parents around their baby’s ‘hip health’. The 3rd year midwifery students are currently taught theory around DDH with opportunities to practice manoeuvres on ‘Baby Hippy’. As facilitator for these sessions I realized that our midwifery curriculum had to include general baby hip health in the first year of the student’s programme. Rachael, a 3rd year student midwife, was in agreement: “the discussion around hip care for newborns was great to listen to. I agree that it would be really beneficial to have a lecture on hip care for students”. 

Left to Right: Rachael Callan - 3rd year student midwife, Carol Bremner - Community Midwife, Beccy Seaton-Harris - 1st year student midwife and Fiona White - Community Midwife

On other matters Karen highlighted a number of babies diagnosed with Erb’s Palsy following birth had recently been treated by the department. Various options were offered as to why these babies had sustained these birth injuries, resulting in the forum unanimously agreeing that education around Erb’s Palsy and Brachial Plexus Injuries would benefit all professionals involved with childbirth.  Terri Coates, an expert on Brachial Plexus Injuries and a midwife at Salisbury, agreed to arrange a study day with the national Erb’s Palsy Support Group, to be held at either Salisbury Hospital or BU for midwives and students.

There are many advantages in having a regular forum to discuss issues relating to newborn examination.  Case studies are presented and debated and education around various topics are provided at regular intervals. The forum also supports midwives from other trusts who are having difficulties with undertaking the examination in their areas. Beccy, the 1st year student midwife had the following to say: “It was very informative. It was good to see community and hospital midwives coming together as a team. I am also interested in learning more about Erb’s Palsy and attending a study day. Learning about general hip care would also be beneficial. The breakfast was lovely too”.

Dizzy

The last bark, I mean word, goes to Dizzy. He gets terribly excited when breakfast is served and runs from one midwife to another hoping for a dropped sausage or at least a titbit from a kind soul. After not having much luck, he eventually settles down and gently snores in the corner of the room.