Lesbian women choosing motherhood: the journey to conception

Increasingly, lesbian women are choosing to have children in the context of a same-sex relationship, and their journey to conception and on to motherhood involves a range of decisions that are unique to lesbian couples. While creating a de novo family is burdened with decisions, choosing to be parents was a deliberate and conscious decision made by lesbian women participating in our study. The findings presented in this article focus on choosing which partner would be pregnant, donor decisions, as well as methods of conception used by lesbian women participating in a qualitative study that examined the experiences of lesbian mothers in Australia. This article is not intended to be interpretive, but rather a description of the processes engaged by participants

Journey to motherhood : experiences of lesbian de novo families in Australia

Lesbian mothering is becoming more visible in societies around the world, however to date, little research has explored the experiences of coupled, lesbian women creating de novo families in Australia. The aim of this qualitative study, underpinned by feminist philosophy, was to explore the experiences of lesbian mothers in Australia. To achieve this aim, in-depth, semi-structured, story sharing interviews, journaling and a demographic data collection sheet were used to collect data from the fifteen couples participating in the study. The data were analysed and three main themes were identified: becoming mothers, constructing motherhood and legitimising our families. De novo refers to a family constellation where two lesbian women who are partnered, plan, conceive, birth and are raising their children in the context of their same-sex relationship. While the literature demonstrates growing acceptance of lesbian mothering, they remain marginalised and subsequently vulnerable. The findings of this study identified that participants deliberately and consciously approached decisions associated with creating their families, they laboured to legitimise the position of the non-birth mother in their families and that, despite growing acceptance, continue to experience homophobia when interfacing with healthcare providers and services. Complex decisions about which woman in the couple would conceive, their preferred method of conception and the known or unknown status of the sperm donor were encountered with determined commitment by the participants. They spent many hours, days, months and sometimes years, researching their options about how to create a family. The factors that often determined which woman would try to conceive were age, health and personal preference. Choosing a known or unknown sperm donor was sometimes dependent on the method of conception used to achieve a pregnancy. For example, some couples preferred to use alternate insemination at home and this limited them to a known sperm donor. Aside from the preferred method of conception, the known or unknown status of the sperm donor was considered carefully in relation to his intentions about future contact with the child or parenting expectations, his physical and intellectual characteristics, his availability and his health. After a pregnancy had been achieved and a baby born, the participants endeavoured to construct their roles and position in their family and their community. The lack of visibility of de novo families in society meant that essentially, there were few role models for constructing motherhood. In addition, lesbian mothers were sometimes excluded from the usual familial support that heterosexual mothers might experience, due to rejection by their biological family because of their lesbian identity. One of the major challenges the couples experienced was legitimising their family, and in particular, the position of the non-birth mother. The couples laboured to implement specific strategies to justify the non-birth mother’s position as a legitimate parent in their family. During their interactions with healthcare providers and services, participants experienced various forms and levels of homophobia and heteronormativity. They often anticipated homophobia and implemented strategies to avoid interacting with healthcare services and providers that they perceived as homophobic. Other participants met homophobia head-on and regarded it as a unique opportunity to teach others about themselves and their family and subsequently promote acceptance of diversity. Participants were challenged by heteronormativity and expressed frustration at heterosexual assumption and experiences of being excluded. To counter these sometimes stressful and devaluing interactions, participants implemented specific strategies to maintain their safety. The findings of this study have revealed some interesting and significant aspects of lesbian mothering in the Australian context, some of which resonate with the literature while others represent new knowledge. In elucidating the experiences of lesbian mothers, a deeper understanding of the decisions made on their journey to motherhood, how they constructed motherhood and family, and strategies that promote inclusive healthcare have been identified

Redesign of a model of nursing practice : a case study

Models of nursing practice create a context, boundary, direction and expectations for nurses, patients and other members of the health care team. The literature is scanty in regard the experience of Australian nurses faced with the process of redesign in their workplace. This study presents a case study of the process of designing a new model for a surgical ward in a large hospital in Western Sydney and explored the nurses’ experiences of this redesign process. The participants were the nurses working in the ward and the nurse managers associated with the ward management and included the nurse unit manager and directors of nursing. Data for the case study were accessed from a number of sources for different purposes. The case study of the redesign of the model of nursing practice showed that change is a difficult process, which needs to involve all stakeholders. There are a number of implications for clinicians, managers and educators from this case study. Managers and clinicians must share an effective communication process during redesign and identify common outcomes. Clinicians need to be encouraged to work towards a vision of nursing practice through debate and education. Educators must be used to support the redesign process by preparing nurses to undertake change, provide information on models of nursing practice and change theory. Recommendations for future research include evaluations of the role of education in redesign and the effect of redesign from patient perspective. Other studies could include descriptive studies of nurse managers’ experiences of redesign in a clinical setting and reasons why nurses are resistant to change

Older lesbian women's health and healthcare : a narrative review of the literature

Aims and objectives: The purpose of this narrative review is to locate, evaluate and synthesise the evidence presented in contemporary literature, related to the experiences of older lesbian women. Background: Lesbian women have been identified as having unique health needs. In conjunction with the usual challenges associated with ageing, lesbian women are burdened with additional complications because of their lesbian orientation. To promote optimal health, the distinct needs of older lesbian women need to be identified and considered by those responsible for planning and delivering culturally competent services/care and allocating resources to support healthy ageing. Design: Narrative review is typically used to evaluate and synthesise health-related literature and involves the critical evaluation of included, empirical studies to form innovative conclusions and perspectives. Method: Database searches using relevant keywords and applying specific limits yielded 55 articles for initial review. Eventually, 45 articles were excluded and 10 qualitative, empirical articles were then appraised using the Critical Appraisal Skills Program tool. Subsequently, seven articles were identified as meeting the inclusion criteria and formed the basis of this narrative review. Results: Data were extrapolated from the included articles and three themes emerged: support, resilience and disclosure. These themes formulate the findings of this article. Conclusions: Remarkably, very little contemporary literature exists that addresses the health and well-being of older lesbian women, and this cohort remain positioned on the peripheries of research and society. Older lesbian women continue to be marginalised because of their lesbian identity and actively cultivate support systems, negotiate disclosure and develop resilience to minimise the effects of their marginal position. Relevance to practice: Recognition that older lesbian women often create, and draw on, a family of choice for support is imperative. In addition, the clinical environment should be safe for older lesbian women to disclose their sexual orientation and other sensitive information

De novo families : lesbian motherhood

The aim of this recent Australian study was to explore the experiences of lesbian women choosing motherhood. Participants included 30 self-identifying lesbian mothers. Data were collected via interviews, data collection sheets, and online journaling. The interview and journaling data were analyzed using constant comparative analysis and subsequently illuminated three main themes: becoming mothers, constructing motherhood, and legitimizing our family. These papers described the journey to motherhood and specifically explored the various methods of conception and other decisions that participants made when planning their family, the challenge of heteronormativity in health care, and legitimizing the role of the non-birth mother in de novo families. This article aims to present the participants’ experiences of motherhood that was a constant topic found woven throughout all three of the identified themes. Participants identified that they had a unique opportunity to create their own mothering roles in the absence of significant “lesbian mother” role models and that they were able to adjust and to adapt their roles depending on fluctuating circumstances

Redesign of the model of nursing practice in an acute care ward : nurses' experiences

Objective: To describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases. Design: Descriptive case study. Setting: A surgical ward in an acute care hospital in Greater Western Sydney. Subjects: Fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase. Main outcome measure: Descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model. Results: Many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases. Conclusions: The struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change

De novo lesbian families: legitimizing the other mother

This study aimed to explore the experiences of other mothers in de novo or planned lesbian-led families in Australia to elaborate on one theme: legitimizing our families. Little is known or understood about how lesbians construct mothering within their families. Even less is understood about the experiences of the often marginalized and invisible other mother; that is, the non-birth mother in lesbian families. Fifteen self-identified lesbian couples participated in semistructured, in-depth interviews (as couples) using a story-sharing approach, undertook journaling, and completed a demographic data collection sheet. To be included in the study, participants had to have planned, conceived, birthed, and be raising their children together. A process of constant comparative analysis was used to analyse the data and generate themes and subthemes. Legitimizing our families was described by participants in terms of several subthemes, including the following: the role of the other mother in planning, conception, pregnancy, and birth; symbols of family connection; and negotiating health care. Other mothers participating in the study were acutely aware that people in society generally did not perceive them as genuine parents. This finding was consistent with the concepts of Others and Othering. To this end, other mothers sought to legitimize their role within their families by establishing symbols and using ceremonies, names, and other methods of formal recognition to justify their role as an authentic mother and signify legitimate de novo family connections

Story-sharing as a method of data collection in qualitative research

The aim of this article is to demonstrate the use of storysharing as a practical and valuable method of data collection in qualitative research interviews. The benefits and limitations of the method will be evaluated and discussed

Autofagia silmänpohjan ikärappeuman eläinmallissa

Mental illness presents a growing disease burden, with worldwide prevalence estimates between 18 and 36% (1). In the USA, the prevalence of affective disorders including unipolar depression and bipolar disorder (BD) is around 20% (2, 3). While psychotropic medications remain at the front line of treatment for affective disorders, a growing body of research evidence strongly supports the role of exercise in the treatment of these affective disorders. Although remaining to be elucidated, there are a number of potential mechanisms by which exercise may be beneficial including neurobiological (4, 5) and pharmacological-like mechanisms (6). In the present paper, we shall discuss recent findings fromsystematic reviews and make recommendations for structured exercise, as distinct from unstructured or incidental physical activity, in the treatment of both depression and BD. This review also examines the role of exercise in the treatment of post-natal depression (PND) since this often transient but prevalent condition is rarely examined

Change process during redesign of a model of nursing practice in a surgical ward

Aim This paper reports a case study of nursing practice model redesign in a surgical ward at a large metropolitan acute care hospital in Sydney, Australia. Background Literature suggests that factors such as financial restraints and shortage of nurses necessitate redesign of nursing care. Method A descriptive case study design was used. The nursing practice model was changed from a patient allocation model to a team-nursing model and a new role of Clinical Activities Coordinator was introduced. Results This study has confirmed that people need to be able to empower themselves to ensure an effective change process. It was also apparent in the case study that the staff were resistant to the redesign. Conclusions Change is a difficult process, which needs to involve all stakeholders. The planning process needs to consider the characteristics of the context such as workload and skill required, and the measures such as patient and staff satisfaction and health outcomes