Being in a dilemma: Experiencing birth in Zambia

Numerous publications investigating childbirth in sub-Saharan Africa have overlooked the psychological and emotional elements that women experience, in favour of physical dimensions, such as maternal mortality. The aim of this study was to explore childbirth experiences, in order to better understand how women in Zambia experience and give meaning to the phenomenon. An interpretive phenomenological approach was utilised. Through purposive sampling methods, fifty birthing women, aged between 16 and 38 years, from all the nine provinces of the country were recruited. Unstructured in-depth interviews were conducted. Analysis uncovered six structures. The main focus of this paper is 'Being in a dilemma'. The selection of this structure reflects its general interest and predominance in data analysis. It entailed experiencing the phenomenon without knowledge of whom or what one was going to encounter. The key themes were: 1) choosing where to birth, and 2) choosing the advice to adhere to. The findings illuminated a need for an attitudinal change in maternity care professionals, and a parallel need to build agency and autonomy in women. It is this intrinsic level that is undermining attempts to reduce high maternal mortality in Zambia.Department of HE and Training approved lis

Wound assessment tools and nurses’ needs: an evaluation study

The purpose of this study was to ascertain how well different wound assessment tools meet the needs of nurses in carrying out general wound assessment and whether current tools are fit for purpose. The methodology employed was evaluation research. In order to conduct the evaluation, a literature review was undertaken to identify the criteria of an optimal wound assessment tool which would meet nurses’ needs. Several freely available wound assessment tools were selected based on predetermined inclusion and exclusion criteria and an audit tool was developed to evaluate the selected tools based on how well they met the criteria of the optimal wound assessment tool. The results provide a measure of how well the selected wound assessment tools meet the criteria of the optimal wound assessment tool. No tool was identified which fulfilled all the criteria, but two (the Applied Wound Management tool and the National Wound Assessment Form) met the most criteria of the optimal tool and were therefore considered to best meet nurses’ needs in wound assessment. The study provides a mechanism for the appraisal of wound assessment tools using a set of optimal criteria which could aid practitioners in their search for the best wound assessment tool

”I was meant to be able to do this”: women’s experiences of breastfeeding. A phenomenological study

Introduction. There is strong evidence demonstrating that human breastmilk provides complete nutrition for human infants. While the rate of initiation of breastfeeding in the UK has increased steadily over the last 25 years, rates of exclusive breastfeeding in the early weeks and months over the same time period have shown only marginal increases. Method. An interpretive phenomenological approach informed by the philosophy of Martin Heidegger was adopted. The aim was to understand women’s experience of breastfeeding. Women were recruited from one city in the East Midlands in the UK, where the prevalence of breastfeeding is decreasing. Potential participants were recruited via health visitors at the primary birth visit. Ethical approval was received from the university and NHS research ethics committees. Data were collected between three and six months after the birth of their youngest child and analysis was guided by interpretive phenomenological principles. Findings. The women were found to be ill-prepared for the realities of breastfeeding and, for most women, the shock of this experience was overwhelming. In particular there was a lack of understanding and preparation for common problems and a lack of awareness of newborn behaviour. Misunderstandings of newborn behaviour resulted in the women blaming infantfeeding behaviours, such as crying, wakeful states and cluster feeding, on the specific method of infant-feeding. Frequent feeding cues were overwhelming and the women felt overawed by the sense of responsibility. It also led them to question their ability to provide an adequate milk supply. Discussion. The extent to which inadequate preparation for breastfeeding had a negative impact on the breastfeeding experiences of women in this study was a surprise. Antenatal education should focus more on preparing women for the realities. Education and support for breastfeeding women need to encompass infant-feeding cues and infant behaviours

Perspectives of Women Giving Birth in Zambia

Background & aim: Women experience childbirth in a variety of contexts with different aspirations. However, the experience has far-reaching implications for women’s health and that of their neonates. To explore the childbirth experiences of women giving birth in Zambia in order to better understand how they give meaning to the experience this study was conducted. Methods: This study was carried out using an interpretive phenomenological approach. Purposive sampling was utilized to recruit 50 participants from all the 10 provinces of Zambia. The ages of the subjects ranged from 16 to 38 years. The deliveries, both home and institutional, occurred between 2005 and 2011. The data were collected through tape-recorded in-depth unstructured interviews. Data analysis was performed using van Manen’s six steps of analysis. Results: The major theme of “being there” constituted two subthemes, namely “feeling safe” and “sense of achievement” emerged from the obtained data. The major theme elucidated the physical presence of the provider, as well as feelings of safety, comfort, trust, being recognized, and respected. The subtheme of “feeling safe” explicated women’s feelings of being at ease and at peace with their care providers, while the subtheme of “sense of achievement” clarified the participants’ expressions of pride that came through experiencing childbirth perceived by the woman giving birth to be satisfactory.  Conclusion: By being physically and psychologically present for the woman who is giving birth, birth attendants, particularly midwives assisted in raising their confidence levels. Caring behaviours, such as showing kindness and respect, giving privacy, as well as making the cases feel comfortable made a qualitative difference of the childbirth experience

Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease

Background: Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this. Objectives: To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids. Search methods: We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors. Selection criteria: We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake. Data collection and analysis: Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression. Main results: We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet. Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses - LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted. Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and it may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence), and probably reduces risk of CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs), and arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear. Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression. There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, although LCn3 slightly reduced triglycerides and increased HDL. ALA probably reduces HDL (high- or moderate-quality evidence). Authors' conclusions: This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event risk, CHD mortality and arrhythmia

A way of seeing study abroad in the context of nurse education

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Traumatic grief in young people in Sub-Saharan Africa: a scoping review

Holly Taggart,1 Sheila Greatrex-White,2 1Mental Health Commission, CentreForum, Westminster, UK; 2School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK Aim: To identify relevant and pertinent themes and interventions within the literature relating to childhood traumatic grief, in order to provide a sound background of evidence for further research and service development. Background: Childhood traumatic grief is caused when a significant person in a child's life dies under circumstances that they perceive to be traumatic. This can leave a child unable to return to the same level of physical and emotional functioning that he or she had prior to the death occurring. In Sub-Saharan Africa, there is an increased risk for childhood traumatic grief due to a high prevalence of orphanhood, environmental stressors, stigma, and abuse. This can have detrimental effects upon mental health. Methods: The review followed the York methodology: identifying the purpose and agreeing on the strategy beforehand; identifying relevant sources/studies; selecting the studies; charting the data; and collating, summarizing, and reporting results. Results and discussion: Interventions identified to prevent and/or manage traumatic grief included narrative exposure therapy, psychotherapy, mentoring, peer-group support, psychosocial support, a grief and loss therapy session, and memory boxes. Mental health remains neglected within service and policy development as well as in global health spending. The average amount expended on mental health services per person per year in low-income countries is less than $0.25. Only 36% of people in low income countries are covered by a mental health policy, compared with 92% in high income countries. Limitations: The sixth stage of the York methodology was omitted. Only papers written in English were included in the review. Conclusion: Childhood traumatic grief in young people is an important issue within Sub-Saharan Africa and has relevance to the global mental health agenda. Implications for nursing and health policy: With the HIV/AIDS pandemic continuing to threaten and the number of orphans estimated to rise, a number of recommendations developed from the literature are suggested. Keywords: childhood traumatic grief, HIV/AIDS, interventions, mental health, orphans, scoping review, Sub-Saharan Africa, young peopl

Practice improvement, breastfeeding duration and health visitors

The primary purpose of practice improvement is to improve clinical practice through changing the behaviour of healthcare professionals. Breastfeeding is a key public health issue, conferring benefits associated with both infant and maternal health, yet breastfeeding rates in the UK and Ireland are among the lowest in Western Europe. In this paper, the ways in which practice improvement can be utilised to enhance both efficiency and effectiveness are described, using a case study of the potential contribution of health visitors to increasing breastfeeding duration in primary care in order to illustrate this in clinical practice