Research and theory for nursing and midwifery: Rethinking the nature of evidence

Background and Rationale: The rise in the principles of evidence-based medicine in the 1990s heralded a re-emerging orthodoxy in research methodologies. The view of the randomised controlled trial (RCT) as a “gold standard” for evaluation of medical interventions has extended recently to evaluation of organisational forms and reforms and of change in complex systems—within health care and in other human services. Relatively little attention has been given to the epistemological assumptions underlying such a hierarchy of research evidence. Aims and Methods: Case studies from research in maternity care are used in this article to describe problems and limitations encountered in using RCTs to evaluate some recent policy-driven and consumer-oriented developments. These are discussed in relation to theory of knowledge and the epistemological assumptions, or paradigms, underpinning health services research. The aim in this discussion is not to advocate, or to reject, particular approaches to research but to advocate a more open and critical engagement with questions about the nature of evidence. Findings and Discussion: Experimental approaches are of considerable value in investigating deterministic and probabilistic cause and effect relationships, and in testing often well-established but unevaluated technologies. However, little attention has been paid to contextual and cultural factors in the effects of interventions, in the culturally constructed nature of research questions themselves, or of the data on which much research is based. More complex, and less linear, approaches to methodology are needed to address these issues. A simple hierarchical approach does not represent the complexity of evidence well and should move toward a more cyclical view of knowledge development

The process of establishing implementing and maintaining a social support infant feeding programme

Objective To describe the process of establishing and implementing a social support infant feeding intervention. Design This paper outlines the initial stages of a randomised controlled trial which assessed the effectiveness of a social support intervention on a range of infant feeding outcomes. Details are presented of the processes involved in recruiting, training and supporting a group of volunteers who provided support to the study sample. Setting Camden and Islington, London, UK. Results Initial networking with local agencies and organisations provided invaluable information and contacts. Employing a dedicated volunteer co-ordinator is vitally important in the recruitment, training and support of volunteers. Providing child care and travel expenses is an essential incentive for volunteers with young children. Advertisements placed in local newspapers were the most successful means of recruiting volunteers. Appropriate training is needed to equip volunteers with the necessary knowledge and skills to provide effective support. Particular emphasis in the training focused upon developing the necessary interpersonal skills and self-confidence. The evaluation of the training programme demonstrated that it improved volunteers’ knowledge and reported confidence. The provision of ongoing support is also essential to maintain volunteers’ interest and enthusiasm. The retention of volunteers is, however, a key challenge. Conclusions The processes outlined in this paper have demonstrated the feasibility of successfully establishing, implementing and maintaining a community-based social support infant feeding programme. The experiences described provide useful insights into the practical issues that need to be addressed in setting up a social support intervention

Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial

Objective To evaluate the effectiveness of telephone based peer support in the prevention of postnatal depression

Communicating choice: an exploration of mothers' experiences of birth

YesObjective: This article gives an in-depth insight into the ways in which communication between midwives and the birthing woman shape the birth experience. Background: Birth is a significant life event for many women that can have profound, long-lasting effects on how they see themselves as women and mothers. Within the literature the importance of control over the birth experience and the support that the birthing woman receives from midwives is stressed. Methods: Six women who had recently given birth participated in one-to-one semi-structured interviews designed to explore the kinds of support they received before, during and after their birth. An inductive thematic analysis was employed in order to identify and explore key issues which ran throughout the interviews. Results: Within the interviews the importance of being an active mother, someone who made decisions in relation to her labour, was stressed. The analysis explores the ways in which communication style and compassionate care either enabled or prevented women from adopting the position of ‘active’ mother. Conclusion: It is argued that a personal connection with midwives and clear and open communication which places the birthing woman in a position of control are key to positive birth experiences

High-resolution hydraulic parameter maps for surface soils in tropical South America

Modern land surface model simulations capture soil profile water movement through the use of soil hydraulics sub-models, but good hydraulic parameterisations are often lacking, especially in the tropics. We present much-improved gridded data sets of hydraulic parameters for surface soil for the critical area of tropical South America, describing soil profile water movement across the region to 30 cm depth. Optimal hydraulic parameter values are given for the Brooks and Corey, Campbell, van Genuchten–Mualem and van Genuchten–Burdine soil hydraulic models, which are widely used hydraulic sub-models in land surface models. This has been possible through interpolating soil measurements from several sources through the <i>SOTERLAC</i> soil and terrain data base and using the most recent pedotransfer functions (PTFs) derived for South American soils. All soil parameter data layers are provided at 15 arcsec resolution and available for download, this being 20x higher resolution than the best comparable parameter maps available to date. Specific examples are given of the use of PTFs and the importance highlighted of using PTFs that have been locally parameterised and that are not just based on soil texture. We discuss current developments in soil hydraulic modelling and how high-resolution parameter maps such as these can improve the simulation of vegetation development and productivity in land surface models

Support to woman by a companion of her choice during childbirth: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>To evaluate the effectiveness and safety of the support given to women by a companion of their choice during labor and delivery.</p> <p>Methods</p> <p>A total of 212 primiparous women were enrolled in a randomized controlled clinical trial carried out between February 2004 and March 2005. One hundred and five women were allocated to the group in which support was permitted and 107 to the group in which there was no support. Variables regarding patient satisfaction and events related to obstetrical care, neonatal results and breastfeeding were evaluated. Student's t-test or Wilcoxon's test, chi-square or Fisher's exact test, risk ratios, and their respective 95% confidence intervals were used in the statistical analysis.</p> <p>Results</p> <p>Overall, the women in the support group were more satisfied with labor (median 88.0 versus 76.0, p < 0.0001) and delivery (median 91.4 versus 77.1, p < 0.0001). During labor, patient satisfaction was associated with the presence of a companion (RR 8.06; 95%CI: 4.84 – 13.43), with care received (RR 1.11; 95%CI: 1.01 – 1.22) and with medical guidance (RR 1.14 95%CI: 1.01 – 1.28). During delivery, satisfaction was associated with having a companion (RR 5.57, 95%CI: 3.70 – 8.38), with care received (RR 1.11 95%CI: 1.01 – 1.22) and with vaginal delivery (RR 1.33 95%CI:1.02 – 1.74). The only factor that was significantly lower in the support group was the occurrence of meconium-stained amniotic fluid (RR 0.51; 95%CI: 0.28 – 0.94). There was no statistically significant difference between the two groups with respect to any of the other variables.</p> <p>Conclusion</p> <p>The presence of a companion of the woman's choice had a positive influence on her satisfaction with the birth process and did not interfere with other events and interventions, with neonatal outcome or breastfeeding.</p