Balancing it out: the process by which midwifery students provide care to women following stillbirth in Papua New Guinea

Stillbirth is a paradox of life and death. Each year, 3 million women worldwide experience stillbirth. As frontline providers of maternal health care, midwifery students and midwives are often with the woman when stillbirth occurs. The support midwifery staff provide during and after the birth contributes to how a woman recovers from her loss. Stillbirth significantly affects the wellbeing of midwifery staff, particularly midwifery students who may have little experience of stillbirth. Papua New Guinea (PNG) has one of the highest stillbirth rates in the Pacific, yet midwifery students' experiences as regards stillbirth in PNG have not been documented. This thesis helps address this gap, to inform strategies to help midwifery students cope with this often-challenging aspect of their work, thereby helping improve the provision of maternal health care in PNG. PNG is a Pacific Island nation of 8 million people. Most of the population live a subsistence lifestyle in rural and remote village communities. With an unevenly resourced health care system, a shortage of registered midwives and inadequate infrastructure, women have limited access to maternal health care facilities and skilled care during delivery. Women typically have lower social status than men and thus have limited abilities to make individual decisions, notably in relation to their reproductive health. This qualitative study employed constructivist grounded theory and decolonising methodologies consistent with the PNG context in which the research was conducted. Purposive sampling was used to recruit participants from a cohort of midwifery students enrolled at a PNG university. A three-phase approach was utilised over a 12-month period. Focus group discussions (n = 3) with midwifery students explored socially shared knowledge and beliefs about pregnancy, birth and stillbirth to generate initial concepts. Next, rich, semi-structured interviews (n = 11) with nine female and two male students expanded on key issues and concepts raised in the focus group discussions. A workshop with eight female students was then conducted to discuss the 'big ideas' from data analysis and conceive how ideas fit together. Transcribed audio files and workshop diagrams were analysed using constructivist grounded theory methods of initial and focused coding and categorisation to inform a developing grounded theory. The theory was presented at the study site in PNG and authenticated by people involved in the research and its outcomes. Students' narratives show how social, cultural and religious elements of PNG life influenced the creation of meaning and determined individual and community behaviour. Students described transitioning to midwifery and their philosophical approach to care for women following stillbirth. Male students explained the challenges they faced working as student midwives when pregnancy and birth are considered women's business. In a country with diverse customs and beliefs, stillbirth is attributed to various causes. Students revealed the personal and professional consequences of caring that affected their own health and wellbeing. 'Balancing It Out' is the core category emerging from the contextual environment in which the study participants live and work. The theory describes the processes the students used in (i) 'Becoming a midwife', (ii) 'Traversing different belief systems' and (iii) 'Dealing with feelings' to achieve their aim of providing the best possible care to women following stillbirth. Providing quality midwifery care means students taking into account difficult conversations about religion, culture and social issues. Students need communication skills to have layered discussions to improve health outcomes for the women and their families. This is the first study of midwifery students' experiences of providing care to women following stillbirth in PNG. Every midwifery student at the study site had experienced providing care to women following stillbirth prior to becoming a midwifery student. This ubiquitous experience exemplifies the need for ongoing research into interconnected social, cultural, spiritual and systemic factors that influence concepts of stillbirth and the provision of care in the PNG context. This study is unique and there are no comparable studies from other Pacific countries, despite the high stillbirth rates across the region. However, many of the elements identified within this study correspond with findings from research investigating the provision of care to women after stillbirth by nursing students internationally. These include the psychological effects of stillbirth on students and the challenges of supporting the woman following a stillbirth delivery with holistic care that meets her social and cultural needs. The emergent themes from this study emphasise the importance of social and emotional aspects of health, and not just the biophysical. The concepts emphasise the importance of holistic care that reflects the founding principles of the World Health Organization (WHO) definition of health as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' (2014, p.1). The major findings of this study offer practical insights into WHO frameworks, such as the Declaration of Alma-Ata (1978) and the Ottawa Charter for Health Promotion (1986), which highlight that attaining good health requires addressing the social determinants of health. This study also offers insights into the realities of providing holistic care to women following stillbirth and the importance of advocating, enabling and mediating across health, social and economic sectors to attain the best outcomes for women following stillbirth and the midwifery staff who provide them with maternity care. Findings from this study exemplify the operational reality of these broad international documents and the importance of this unrecognised issue of care. The experiences of the midwifery students at this university demonstrate the reality for health staff, not only in PNG but also in other similar settings. The findings have practical implications for informing midwifery education and practice in PNG and provide a platform for maternal and child health research in PNG and the wider Pacific region. As a recommendation for action, students requested specific modules in midwifery education for providing care to women experiencing stillbirth, which incorporate not only biomedical but social, cultural and spiritual aspects. Teaching of bereavement care skills would assist midwifery students in their practice and provide a balance between clinical management and social and emotional support for women. This action has begun. Recommendations from this study have informed midwifery educators who now discuss psychosocial care for women experiencing stillbirth in course content. The new postgraduate midwifery curriculum under development will include a discrete unit on stillbirth and appropriate care for women. Self-care modules for midwifery students to build coping mechanisms to deal with the emotions they experience are also needed. Professional support and supervision for midwifery students following a critical event have the potential to reduce the effects of negative emotions on their health and wellbeing. Ongoing research is needed to assess the suitability and sustainability of these modules in the care of these women

Human culture and science fiction: a review of the literature, 1980-2016

This article aimed to uncover the foci, themes, and findings of research literature that utilized science fiction content or concepts to describe and illustrate human culture. To capture a representative range of research, the PRISMA process was applied to database searches across a range of disciplines, not restricted to science fiction journals. Findings revealed that science fiction literature has been used in research across disciplines including theology, semantics, natural sciences, and education. Two characteristics of the use of science fiction in research became evident in the review: its role as a tool for advocacy and cultural insight and its effectiveness as an aid to learning and teaching. An unclear boundary between real science and science in the public imagination is problematic for research success, but the purposeful integration of fictional representations of science (both natural and social) into the research story has demonstrable benefits. To address the limited application of objective methodologies, adoption of increasingly robust quantitative analysis into research in the fields of literature and culture is recommended. This would assist in bridging the two cultures divide between the humanities and natural sciences

Irish Maritime Trade in the Eighteenth Century: a Study in Patterns of Trade, Market Structures, and Merchant Communities

Ireland has a centuries-long history of maritime and economic interaction with Great Britain and other more distant communities on the Atlantic rim. In the last forty years of academic writing on the main themes of Ireland's economic history, very few historians have examined the late-eighteenth century maritime trade data. The original Customs logs or port books are lost but other sources of information remain. This thesis uses a new source of information, Richard Eaton's A Daily and Alphabetical Arrangement of all Imports and Exports at the Port of Dublin, in the Quarter ending the 25th March, 1785, as well as the shipping reports contained in the daily newspapers of the time to create a micro-history of the maritime and mercantile interaction between Ireland and her trading partners. Eaton's "List" not only gives us a complete tally of the goods exported from, and imported into Dublin in the first three months of 1785 but the customs official also recorded the names of each merchant or firm operating in Dublin at that time. This is the first time that such detailed information has been available to scholars and it is unavailable from any other source. The focus is on Dublin in 1785 and a comparison is made with another Irish port city -- Belfast. Change over time is measured by using data for the same focal cities in 1770. Ireland's key market is England and Liverpool is the increasingly popular destination for goods leaving Dublin and the port of lading for goods arriving in Dublin. Using the databases created for the purpose, this thesis analyses the relationship between Dublin/Belfast and Liverpool and discusses the patterns of trade and market structures. Although every export/import sector had a group of leading merchants, no single merchant or small group of merchants were able to wield sufficient market power to exclude competitors. All sectors of the merchant communities of Dublin, Belfast and Liverpool -- regardless of whether they dealt in primary produce, linen products or merchants' goods -- were general merchants, with little evidence of specialisation

“A safe haven to support me”: an evaluation report on the Central Coast Family Wellbeing Program

A significant proportion of young people in Australia including the NSW Central Coast region are not engaged in school, work and other social systems. The consequences of disengagement can be profound and are linked to higher rates of social and mental health problems, including suicide, alcohol and drug use. Being male and Indigenous are amongst the key factors identified as being risks for youth disengagement. This report presents an analysis of the Family Wellbeing (FWB) program on the NSW Central Coast. FWB implementation is designed to enhance the social and emotional wellbeing of young Aboriginal men and improve engagement in education, employment and other social and cultural participation. The report draws attention to the need for more sustainable funding for promising programs such as the Central Coast FWB including properly resourced long-term evaluation. Insecurity and loss of funding means a loss of opportunity for future participants to be supported, mentored and engaged in learning and employment. It will also impact on those who have completed FWB and who rely on the FWB network for ongoing support

Sexual health and wellbeing training with women in Pacific Island Countries and Territories: a scoping review

Background: Women who are spouses of students at a faith-based university in Papua New Guinea (PNG) are afforded proximal power. These women are perceived as leaders and regularly approached by members in their communities to provide advice on sexual and reproductive health matters. Women leaders therefore need access to sexual health information and training to provide appropriate advice. Objective: The aim of this paper is to review the characteristics of community-based sexual health training in Pacific Island Countries and Territories (PICTs), as reported in published literature. This is evidence to inform the development of sexual health training programs for women in PNG. Methods: A systematic search of databases, repositories and websites identified peer-reviewed studies. Grey literature was also sourced from government and non-government organisations and PNG health professionals. Six published papers, one report, one health worker practice manual and one health worker training package were identified for inclusion. Selected papers were assessed against the Canadian Hierarchy of Evidence to determine quality of evidence for practice. Themes were identified using a thematic analysis approach. Results: Three themes became apparent from the literature synthesis: i) program development; ii) mode of delivery, and iii) evaluation. Social and cultural context influenced all elements of sexual health training in PICTs. Few studies reported evidence of comprehensive evaluation. Conclusions: Successful sexual health training programs in PICT communities are designed and delivered accounting for local contexts. Programs that engage participants with diverse abilities inspire change to achieve desired outcomes. Key findings from this study can be used to assist women leaders to contextualise and operationalise sexual health training to promote the wellbeing of members in their communities

Asia-Pacific women's experiences of stillbirth: a metasynthesis of qualitative literature

Literature related to Asia–Pacific women's lived experiences of stillbirth was reviewed through metasynthesis of selected empirical studies. An overarching construct of "interconnectedness" between complex experiences influenced by cultural and systemic factors became apparent. Four experiential themes emerged: "acts of accusation," "rocky relationships," "entangled emotions," and "routines of reconciliation." These were influenced by two systemic factors: "contexts of culture" and "health care matters." Women's sociocultural experiences and their engagement with health care systems influenced how they managed and reconciled their loss. This study contributes to the literature on women's experiences of stillbirth, furthering theory creation and generating future research agendas

Irish Maritime Trade in the Eighteenth Century: a Study in Patterns of Trade, Market Structures, and Merchant Communities

Ireland has a centuries-long history of maritime and economic interaction with Great Britain and other more distant communities on the Atlantic rim. In the last forty years of academic writing on the main themes of Ireland's economic history, very few historians have examined the late-eighteenth century maritime trade data. The original Customs logs or port books are lost but other sources of information remain. This thesis uses a new source of information, Richard Eaton's A Daily and Alphabetical Arrangement of all Imports and Exports at the Port of Dublin, in the Quarter ending the 25th March, 1785, as well as the shipping reports contained in the daily newspapers of the time to create a micro-history of the maritime and mercantile interaction between Ireland and her trading partners. Eaton's "List" not only gives us a complete tally of the goods exported from, and imported into Dublin in the first three months of 1785 but the customs official also recorded the names of each merchant or firm operating in Dublin at that time. This is the first time that such detailed information has been available to scholars and it is unavailable from any other source. The focus is on Dublin in 1785 and a comparison is made with another Irish port city -- Belfast. Change over time is measured by using data for the same focal cities in 1770. Ireland's key market is England and Liverpool is the increasingly popular destination for goods leaving Dublin and the port of lading for goods arriving in Dublin. Using the databases created for the purpose, this thesis analyses the relationship between Dublin/Belfast and Liverpool and discusses the patterns of trade and market structures. Although every export/import sector had a group of leading merchants, no single merchant or small group of merchants were able to wield sufficient market power to exclude competitors. All sectors of the merchant communities of Dublin, Belfast and Liverpool -- regardless of whether they dealt in primary produce, linen products or merchants' goods -- were general merchants, with little evidence of specialisation

Irish Maritime Trade in the Eighteenth Century: a Study in Patterns of Trade, Market Structures, and Merchant Communities

Ireland has a centuries-long history of maritime and economic interaction with Great Britain and other more distant communities on the Atlantic rim. In the last forty years of academic writing on the main themes of Ireland's economic history, very few historians have examined the  late-eighteenth century maritime trade data. The original Customs logs or port books are lost but other sources of information remain. This thesis uses a new source of information, Richard Eaton's A Daily and Alphabetical Arrangement of all Imports and Exports at the Port of Dublin, in the Quarter ending the 25th March, 1785, as well as the shipping reports contained in the daily newspapers of the time to create a micro-history of the maritime and mercantile interaction between Ireland and her trading partners. Eaton's "List" not only gives us a complete tally of the goods exported from, and imported into Dublin in the first three months of 1785 but the customs official also recorded the names of each merchant or firm operating in Dublin at that time. This is the first time that such detailed information has been available to scholars and it is unavailable from any other source. The focus is on Dublin in 1785 and a comparison is made with another Irish port city -- Belfast. Change over time is measured by using data for the same focal cities in 1770. Ireland's key market is England and Liverpool is the increasingly popular destination for goods leaving Dublin and the port of lading for goods arriving in Dublin. Using the databases created for the purpose, this thesis analyses the relationship between Dublin/Belfast and Liverpool and discusses the patterns of trade and market structures. Although every export/import sector had a group of leading merchants, no single merchant or small group of merchants were able to wield sufficient market power to exclude competitors. All sectors of the merchant communities of Dublin, Belfast and Liverpool -- regardless of whether they dealt in primary produce, linen products or merchants' goods -- were general merchants, with little evidence of specialisation.</p

The use of grounded theory in studies of nurses and midwives' coping processes: A systematic literature search

Background: Researchers are increasingly using grounded theory methodologies to study the professional experience of nurses and midwives.\ud \ud Aim: To review common grounded theory characteristics and research design quality as described in grounded theory studies of coping strategies used by nurses and midwives\ud Methods: A systematic database search for 2005–2015 identified and assessed grounded theory characteristics from 16 studies. Study quality was assessed using a modified Critical Appraisal Skills Programme (CASP) tool.\ud \ud Findings: Grounded theory was considered a methodology or a set of methods, able to be used within different nursing and midwifery contexts. Specific research requirements determined the common grounded theory characteristics used in different studies. Most researchers did not clarify their epistemological and theoretical perspectives.\ud \ud Conclusion: To improve research design and trustworthiness of grounded theory studies in nursing and midwifery, researchers need to state their theoretical stance and clearly articulate their use of grounded theory methodology and characteristics in research reporting