„NORMAL IS NOT JUST ONE SPECIFIC EXPERIENCE“ WOMEN´S EXPERIENCES AND VIEW OF NORMAL BIRTH: A QUALITATIVE RESEARCH

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadVerndun eðlilegra fæðinga hefur verið mikilvægt viðfangsefni innan ljósmóðurfræða síðustu áratugi. Þar er iðulega stillt upp mismunandi sýn læknisfræðinnar og ljósmóðurfræðinnar en sjónum sjaldnar beint að upplifun kvenna sjálfra og hvað fyrir þeim eðlileg fæðing er. Í þessari rannsókn var markmiðið að fá fram reynslu kvenna og sýn á eðlilega fæðingu. Aðferðafræði rannsóknarinnar er eigindleg og byggist á viðtölum við tíu konur, fjölbyrjur og frumbyrjur, sem eiga samtals nítján fæðingar að baki. Viðtölin eru greind með fyrirbærafræðilegri aðferð Vancouver-skólans. Við heildargreiningu á fyrirbærinu eðlileg fæðing er unnið úr reynslu allra kvennanna og spunninn sameiginlegur vefur. Undirstöðuþemað við úrvinnslu á sögum kvennanna er Að gera fæðingarreynsluna að sinni eðlilegu fæðingu. Í þeirri ferð er fólgin óvissa, þar sem eðlilegt er að fá hjálp og ef vel tekst til eru þar tækifæri til valdeflingar. Sjö meginþemu með undirþemum eru greind sem öll hafa áhrif innbyrðis á heildarupplifun og lýsingu á fyrirbærinu eðlileg fæðing. Þessi þemu eru eftirfarandi: að hafa stjórn, stuðningur ljósmóður, sameiginlegt verkefni, öryggi og umhverfi, reynsla af sársauka, að taka á móti eigin barni, ekki eðlileg fæðing. Í skilgreiningum fagfólks á eðlilegri fæðingu hafa jafnan andstæðurnar „inngrip“ og „ekki inngrip“ legið til grundvallar. Í hugum þeirra kvenna sem rætt var við í rannsókninni er þessi tvískipting ekki útgangspunktur eðlilegrar fæðingar. Allar konurnar líta svo á að þær eigi eðlilega fæðingu að baki – jafnvel náttúrulega fæðingu – þrátt fyrir fjölbreytt inngrip og ólíkar fæðingarsögur. Sýn þessara kvenna brýtur á vissan hátt upp hugtakið eðlileg fæðing eins og það hefur hingað til verið skilgreint innan ljósmóðurfræðinnar. Niðurstöður rannsóknarinnar styðja ljósmæður í að leggja einstaklingsbundnari skilning á mörk hins eðlilega, treysta á innsæisþekkingu og mæta konum á þeirra eigin forsendum í fæðingu. Rannsaka mætti hvernig tæknilegt, félagslegt og menningarlegt umhverfi barneignarþjónustu hefur áhrif á persónubundnar skilgreiningar á eðlilegri fæðingu.Protecting normal birth has for a number of years been an important and significant topic in midwifery. The contrasting visions of the medico-technical approach and the physio-social midwifery approach are regularly juxtaposed, but less space has been given to what women´views are and how they experience normal birth. This research explores women´s own perceptions of what normal birth is. The methodology of the research is qualitative and based on interviews with ten women, both multiparous and primiparous, who have given a total of nineteen births. Anlalysis of data was based on the Vancouver School of doing phenomenology. Through making a comprehensive analysis of the phenomenon of normal birth from the point of view of women, a collective multi- -voice construction of their normal birth was designed. The overriding theme which emerged was “Making birth your own normal birth experience.” This journey of birth is full of uncertainty, where it is normal to get help, but the experience can also be an empowering self-discovery. Seven central themes with sub themes emerged which are all inter-related. Together they make up the holistic experience of „ÞAÐ ER EKKI EITTHVAÐ EITT EÐLILEGT“ Reynsla og sýn kvenna á eðlilega fæðingu: Eigindleg rannsókn „NORMAL IS NOT JUST ONE SPECIFIC EXPERIENCE“ WOMEN´S EXPERIENCES AND VIEW OF NORMAL BIRTH: A QUALITATIVE RESEARCH LJÓSMÆÐRABLAÐIÐ - JÚLÍ 2018 39 normal birth. These themes are: to be in control, midwife´s support, a joint venture, safety and surroundings, experience of pain, to receive your child, not a normal birth. “Intervention” or “non- intervention” into the birth process, which is the critical dichotomy many birth professionals use to define normal birth, is not a central concern in the women´s experiences. All the women interviewed describe their births as normal – even natural – despite there having been varied interventions and birth stories at work. Their views critically challenge traditional definitions of normal birth. This may encourage us to consider more subjective and contextual approaches to defining normalcy. It vitalizes our reliance on our intuitive knowledge and prioritizes meeting women on their own terms in every birth experience. For future studies it would be interesting to explore techno - social and cultural aspects of maternity services on personal definitions of normal birth

„Okkar viðkvæmustu konur“ - Veruleiki barnshafandi kvenna sem eru umsækjendur um alþjóðlega vernd

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Downloa

„Normalcy is so relative. Normal is not just one specific experience.“ Women´s Experiences of Normal Birth: A Qualitative Phenomenological Research

Verndun eðlilegra fæðinga hefur verið fyrirferðarmikið viðfangsefni innan ljósmóðurfræða síðustu áratugi. Þar er iðulega stillt upp mismunandi sýn læknisfræðinnar og ljósmóðurfræðinnar en sjónum sjaldnar beint að upplifun kvenna sjálfra af eðlilegum fæðingum. Í þessari rannsókn eru konur spurðar um þeirra eigin sýn. Rannsóknarspurningin sem lögð er til grundvallar er: Hver er reynsla kvenna af eðlilegum fæðingum? Aðferðarfræði rannsóknarinnar er eigindleg og byggist á viðtölum við tíu konur, fjölbyrjur og frumbyrjur, sem eiga samtals nítján fæðingar að baki. Viðtölin eru greind með fyrirbærafræðilegri aðferð Vancouver-skólans í fyrirbærafræði. Við heildargreiningu á fyrirbærinu eðlileg fæðing er unnið úr reynslu allra kvennanna og spunninn sameiginlegur vefur. Undirstöðuþemað við úrvinnslu á sögum kvennanna er Að gera fæðingarreynsluna að sinni eðlilegu fæðingu. Í þeirri ferð er fólgin óvissa, þar sem eðlilegt er að fá hjálp, en ef vel tekst til felast í reynslunni tækifæri til valdeflingar. Auk þess koma í ljós sjö yfirþemu sem áfram eru sameiginlega rakin í undirþemu. Öll hafa þau áhrif innbyrðis á heildarupplifun og lýsingu á fyrirbærinu eðlileg fæðing. Þessi þemu eru eftirfarandi: að hafa stjórn, stuðningur ljósmóður, sameiginlegt verkefni, öryggi og umhverfi, reynsla af sársauka, að taka á móti eigin barni, ekki eðlileg fæðing – þegar fæðingin er ekki lengur í eigin höndum. Í skilgreiningum fagfólks á eðlilegri fæðingu hafa andstæðurnar „inngrip“ og „ekki inngrip“ jafnan legið til grundvallar. Í hugum þeirra kvenna sem hér er rætt við er þessi tvískipting hins vegar ekki útgangspunktur eðlilegrar fæðingar. Allar konurnar líta svo á að þær eigi eðlilega fæðingu að baki – jafnvel náttúrulega fæðingu – þrátt fyrir fjölbreytt inngrip og ólíkar fæðingarsögur. Sýn þessara kvenna brýtur á vissan hátt upp hugtakið eðlileg fæðing eins og það hefur hingað til verið skilgreint. Sjónarhorn þeirra styður okkur ljósmæður í að leggja einstaklingsbundnari skilning á mörk hins eðlilega, treysta á innsæisþekkingu og mæta konum á þeirra eigin forsendum í fæðingu. Lykilorð: Eðlileg/náttúruleg fæðing, fæðingarreynsla kvenna, umönnun ljósmæðra, fyrirbærafræðileg nálgun.Protecting normal birth has for a number of decades been a significant preoccupation within midwifery. The contrasting visions of the medico-technical approach and the physio-social midwifery are regularly juxtaposed, but much less space given to what women themselves experience as normal birth. In this research women are asked about their own perceptions. The critical question posed is: What are women´s experiences of normal birth? The methodology of the research is qualitative and based on interviews with ten women, both multiparous and primiparous, who have given a total of nineteen births. The interviews are analyzed using the Vancouver School of doing phenomenology. When making a comprehensive analysis of the phenomenon of normal birth the women´s experiences are worked through and a collective multi-voice construction of their normal birth designed. The overriding theme which emerges is “Making birth your own normal birth experience.” This journey is laden with uncertainty, where it is normal to get help, but the experience can also be an empowering self-discovery. In addition, seven central themes emerge which are all inter-related, making up a holistic experience of normal birth. These themes are: to be in control, midwife´s support, a joint venture, safety and surroundings, experience of pain, to receive your child, not a normal birth - the birth is out of your hands. “Intervention” or “no intervention” into the birth process, which is the critical dichotomy many birth professionals use to define normal birth, is not a central concern in the women´s experiences. All the women interviewed describe their births as normal – even natural – despite there having been varied interventions and different kinds of birth processes at work. Their views critically challenge traditional definitions of normal birth. This supports us midwives in lending more subjective and context specific ingredients to what constitutes normalcy, encourages us to rely on our intuitive knowledge, and to meet women on their own terms in every birth experience. Keywords: Normal/natural birth, women´s birth experience, midwifery care, phenomenological approach

“There was no panic”—Nurse managers’ organising work for COVID-19 patients in an outpatient clinic : A qualitative study

Funding information: University of Iceland Research Fund. Publisher Copyright: © 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.Aim: To provide insight into the contribution of nursing to the establishment and running of a hospital-based outpatient clinic for COVID-19 infected patients, and thereby to inform the development of similar nursing care and healthcare more generally. Design: Qualitative descriptive study centred on collaboration between nurse managers and researchers. Methods: Drawing on Donabedian’s model of quality health services and the work of Allen on “Nurses’ organising work”, data were collected using four semi-structured, audio-recorded, focus group interviews with five nurse managers. The interviews were conducted in May and June 2020, transcribed, and subsequently analysed using deductive and inductive content analysis into an overarching category, main categories, and sub-categories. Results: “There was no panic – challenged by the unprecedented” was a strong thread, which was reflected in two categories: (a) Everyone walked in step, containing the sub-categories: Public officials set the tone, Creating order in disorder, and Mutual respect and teamwork, and (b) Inspired by extraordinary accomplishments, encompassing the sub-categories: Realising one's potential and Unexpectedly rewarding. In exceptional circumstances the nurse managers’ decision-making authority grew, material and manpower resources were sufficient, promptly constructed work procedures were in place, and tasks were completed instantly in trusting and respectful interdisciplinary collaboration. With sound support and trust from hospital directors, the nurse managers utilised their expertise to the fullest and they were proud of their work. Conclusion: The findings portray the almost invisible work of nurse managers in organising complex care. Although the circumstances were exceptional the findings speak to the accomplishments that can be gained when nurse managers have autonomy and the opportunity to utilise their professional capacity to the fullest. Impact: The findings reveal the almost invisible work of nurses in organising complex care and can inform the establishment of outpatient clinics for patients infected with COVID-19 and of healthcare development more generally.Peer reviewe

Sequence variants at the TERT-CLPTM1L locus associate with many cancer types

The common sequence variants that have recently been associated with cancer risk are particular to a single cancer type or at most two. Following up on our genome-wide scan of basal cell carcinoma, we found that rs401681[C] on chromosome 5p15.33 satisfied our threshold for genome-wide significance (OR = 1.25, P = 3.7 x 10(-12)). We tested rs401681 for association with 16 additional cancer types in over 30,000 cancer cases and 45,000 controls and found association with lung cancer (OR = 1.15, P = 7.2 x 10(-8)) and urinary bladder, prostate and cervix cancer (ORs = 1.07-1.31, all P < 4 x 10(-4)). However, rs401681[C] seems to confer protection against cutaneous melanoma (OR = 0.88, P = 8.0 x 10(-4)). Notably, most of these cancer types have a strong environmental component to their risk. Investigation of the region led us to rs2736098[A], which showed stronger association with some cancer types. However, neither variant could fully account for the association of the other. rs2736098 corresponds to A305A in the telomerase reverse transcriptase (TERT) protein and rs401681 is in an intron of the CLPTM1L gene