ANTENATAL CARE EQUITY & SOCIAL EQUALITY FOR WOMEN WITH FEMALE GENITAL MUTILATION (FGM) IN SCOTLAND: A MULTI-STAKEHOLDER VIEW

This thesis describes a case study of an NHS Scotland antenatal care pathway for women with female genital mutilation (FGM), and includes recommendations for the field of antenatal FGM management. Over the last decade, reports of substandard antenatal FGM management from a rapidly growing population of affected women have increased demands for just and equitable healthcare. Consequently, in 2015, a health board in the central belt of Scotland established a multidisciplinary FGM management programme. To determine the impact of this programme on antenatal care equity and social equality for women with FGM its guidelines, interviews with community midwives (CMWs), FGM specialists, and women with FGM were conducted. The findings were analysed using critical communicative methodology (CCM). The findings on the development, organisation, and delivery of the pathway demonstrate the transformative impact of multidisciplinary resources for FGM management and support on equitable antenatal care access when embedded into routine antenatal policies and practices. The findings also show how the absence of robust monitoring and evaluation processes enables contested practices and limits care equity for non-pregnant women with FGM. Novel contributions of this study link social and emotional FGM training to reciprocal improvements in confidence, trust, and communication between CMWs and women with FGM. FGM specialists who empower women to advocate for themselves and their relationship with the practice of FGM are also found to be central to the delivery of sensitive, relevant, and person-led antenatal care. Furthermore, the interdisciplinary implications of this study offer relevant insight for research, development, and service provision beyond Insight. Most notably, until unjust educational and financial health system policies are challenged, experiences of unresolved intersectional discrimination will continue to disproportionately disadvantage migrant women with FGM

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

What do critical care nurses require from a clinical information system : is it possible for a system to meet these needs?

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The Nature of evidence to inform critical care nursing practice.

This thesis presents a body of publications, in the area of critical care nursing, for consideration for the award of Doctor of Philosophy by Publication. The thesis is presented in three chapters: Introduction; Body of Work; and Research, Knowledge, Evidence and Practice. In the first chapter the emergence of evidence-based practice is described, in general. Initially, an overview of the origins and trends of nursing research methodology is provided; the purpose of which is to set in context the body of work. Utilising a narrative approach (Boje, 2001; McCance et aL, 2001; Sandelowski, 199 1; Vezeau, 1994) as a 'personal journal of discovery' I then reflexively describe my own development as a nurse researcher practitioner, drawing on my own publications to illustrate my progress, the development of my thinking, my research practice and the development of my understanding of pragmatice pistemology. The second chapter is comprised of my publications relevant to critical care nursing. Spanning a period of eleven years, they represent my contribution to critical care nursing knowledge. In the concluding chapter I have summarised initially my own contribution to critical care nursing knowledge, before moving on to a more detailed critique of evidence-based practice. Finally I have made recommendations for the way forward. In addition to presenting my body of work, the aim of this PhD is to challenget he current concept of evidence-based practice, arguing that its definition is too narrow to encompass the rage of different types of knowledge that nurses use when caring for critically ill patients. I have utilised my own publications, to demonstrate how a variety of approaches are necessary to provide the best evidence for developing practice. I have positioned my argument within a theoretical understanding of pragmatic epistemology. In this way, I am working towards the development of a science of practice. Simultaneously I am also, to some extent, challenging conventional concepts of what constitutes doctoral level knowledge and how a PhD looks. My conclusion is that critical care nursing knowledge is drawn from many sources, and should be applied in an integrated way that enables practitioners to make a positive difference to the life of patients.Knowledge that is not or cannot be applied to practice is therefore of no value. The valuing of practice knowledge brings with it the requirement that all forms of knowledge (and their relevant methodologies) are considered as equal,in terms of their potential to impact on practice and that nothing should be rejected on paradigmatic grounds. In contemporary healthcare evidence is hierarchically valued and this raises many questions of equity. Where the value of knowledge becomes unequal is when its application to practice is limited. The corollary of a pragmatice pistemology is that it requires a pragmatic process to make it work. For me, at this point in time, the best available is practice development. In summary,this thesis represents a construction of work that makes an original contribution to knowledge. The product of my thesis is a theory of pragmatic epistemology as the basis for a science of practice

Developing appropriate Fetal Alchohol Spectrum Disorder (FASD) prevention initiatives within a rural community in South Africa

Includes bibliographical references.This study focused on women who consumed alcohol during pregnancy. The study population was situated in the West Coast/Winelands, a rural area in the Western Cape Province of South Africa. The study was done in a community which is classified as one of the many previously disadvantaged groups in South Africa. This study was done as part of a larger three-year project on Fetal Alcohol Syndrome Prevention in the Western Cape and Gauteng Provinces of South Africa. The phenomenon of drinking during pregnancy was used as a case example of health compromising occupations in the South African context. Prenatal alcohol exposure may result in brain damage that affects behaviors of those affected. The beliefs, norms, values and perceptions of mothers regarding alcohol consumption are also an important aspect in maintaining healthy pregnancies

The shape of general hospital nursing: the division of labour at work

This thesis is about nursing work and the ways in which nurses in a general hospital accomplished occupational jurisdiction. It is based on ethnographic data generated on a surgical ward and a medical ward in a single NHS trust hospital. The study is set in the context of recent developments in nursing and medical education (DHSS, 1987; GMC, 1993; UKCC, 1987) and health policy (DH, 1989) which have created the impetus for shifts in the division of labour in health care, reviving deep-rooted historical tensions between professional and service versions of nursing. Drawing on the work of Hughes (1984), Abbott (1988) and Strauss and colleagues (Strauss et al, 1963; Strauss et al, 1964; Strauss, 1978) the aim of this project was to move on from the policy debates and develop a less essentialist account of the nursing role through an exploration of the ways in which nurses managed the parameters of their work in the course of their everyday activities. Hughes concept of 'dirty work' is employed as a sensitising device. The work of hospital-based general nurses is explored through the analysis of five key nursing boundaries: nurse-doctor, nurse-support worker, nurse-patient/relative, nurse-nurse, and nurse-management. The professional and sociological literature suggested that as a result of recent policy developments, there would be an increased need for negotiation of nurses' inter-occupational boundaries with medicine and support workers and that this was likely to be subject to some tension. But field observations revealed that nurses accomplished these inter-occupational boundaries with minimal negotiation and little explicit conflict. Conversely, there were policy-related tensions at the three other key nursing boundaries - at nurses' infra-occupational boundary, at the boundary between nurses and patients and their relatives, and at the boundary between ward-based nurses and nursing and general management - which were largely unanticipated