32 research outputs found

    Twinning in Nepal: the Royal College of Midwives UK and the Midwifery Society of Nepal working in partnership

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    The midwifery association of the United Kingdom, the Royal College of Midwives (RCM), has twinned with the Midwifery Society of Nepal (MIDSON) to help strengthen the latter association, through its Global Midwifery Twinning Project (GMTP). The GMTP aims to strengthen midwifery and develop leadership, advocacy, and campaigning skills both at the level of the association and at the individual midwife level. Reciprocity is an important aspect of twinning as the RCM also hopes to strengthen midwifery in the UK through greater engagement of its members and a raised profile of global maternal and new-born health. This paper describes the importance of collaboration between established national midwifery organisations and newly established ones. It includes a case study outlining the experience of a UK midwifery volunteer in Nepal. The paper ends with some thoughts on the effects of the GMTP project on midwifery in Nepal

    M-Sequences Related to the Multifocal Electroretinogram: Identification of Appropriate Primitive Polynomials to Avoid Cross-Contamination in Multifocal Electroretinogram Responses

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    The basis of multifocal ERG is the use of a decimated m-sequence for simultaneous and independent stimulation of many areas of the visual pathway. The purpose of this thesis is to investigate the effects of cross contamination from higher orders of the response. To examine the effects of cross contamination a series of primitive polynomials were found by constructing finite fields. The first order ERG response is formed by cross correlating the m-sequence with the physiological response. A second order response is formed by investigating particular flash sequences of the stimulation sequence and is formed by cross correlation of a second order m-sequence with the physiological response. Zech Logarithms were used to identify cross contamination between the various first and second order sequences. Tables of good and bad primitive polynomials were constructed for degree 12 to degree 16 and the effects of window length and decimation length examined. If we decimate the sequence into 128 areas, and look at a window of length 16, cross-contamination occurs in all sequences generated from primitive polynomials of degree less than or equal 12, but only 26% in the case of degree 14, and 5.6% for degree 16. Finally, selected good and bad primitive polynomials were used to generate decimated m-sequences for a multifocal electrophysiological experiment to demonstrate the practical effects of cross-contamination. Trace arrays showing uncontaminated discreet physiological responses from 61 individual elements were recorded using the example good primitive polynomial whereas additional waveforms were present on the trace array when the same experiment was repeated with a bad primitive polynomial. The use of finite field theory to generate primitive polynomials and zech logorithm analysis enables us to predict which primitive polynomials are suitable for m- sequence generation for multifocal electroretinography. Practical investigations support the theoretical analysis. This has important implications for developers of multifocal electrophysiology systems

    Facilitating learning for auxiliary nurse midwives around maternal mental health in Southern Nepal.

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    Mental health, in particular maternal mental health, has been low on the global agenda until relatively recently. Consequently, it has not featured much in Nepal on the curriculum for maternity care workers. Auxiliary Nurse Midwives are key maternity care providers in rural Nepal. They are sources of information and potential agents for change in their communities. To increase awareness of maternal mental health, training was designed by Nepali and UK experts. Training was run by UK-based volunteers (some ex-pat Nepalis) with Nepali interpreters - all health care and/or education professionals. This paper describes the planning and a reflexive and responsive approach to workshops based on the needs of participants

    The Impact on Parent Training on Marital Functioning: A Comparison of Two Group Versions of the Triple P – Positive Parenting Program for Parents of Children with Early-Onset Conduct Problems

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    Thirty-seven (37) couples experiencing child behavior problems and concurrent marital conflict were randomly assigned to one of two variants of a group parent training program, either Standard Group Triple P (SGTP; n = 19) or Enhanced Group Triple P (EGTP; n = 18). SGTP incorporated 8 sessions (4 group sessions and 4 telephone consultations) and taught parents to identify the causes of child behaviour problems, promote children’s development, manage misbehavior and plan ahead to prevent child behavior problems in ‘‘high risk’’ parenting situations. Families in the EGTP condition received SGTP plus 2 additional group sessions of partner support training that taught partners to support one another to parent as a team. These additional sessions included information and active skills training in communication skills; giving and receiving constructive feedback; holding casual conversations; supporting each other when problems occur; holding problem solving discussions; and improving relationship happiness. There were significant improvements from pre- to post-intervention for both conditions, on measures of disruptive child behavior, dysfunctional parenting style, conflict over parenting, relationship satisfaction and communication. No differences, however, were found between the two conditions, with both the EGTP and the SGTP programs resulting in similar outcomes. In the main, initial treatment effects for both mothers and fathers were maintained at 3-month follow-up

    Gender Inequalities and Childbearing: A Qualitative study of Two Maternity Units in Nepal

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    The role and status of women in South Asian countries like Nepal are widely recognised to be lower than that of men. This gender inequality can be found throughout all levels of society. Our study is about the influence of gender on pregnancy and childbirth, which are very much in the female domain in South Asia, both at home and in health facilities. A mixed-method, qualitative research study was undertaken in two birthing facilities in Kathmandu Valley to examine barriers to women accessing these services from the perspective of hospital staff. Thematic analysis identified seven subthemes related to gender, namely: (1) support from family, autonomy & decision making; (2) women’s workload; (3) finances; (4) women wanting female doctor; (5) consent; (6) delivery room; and (7) preference for male offspring. Overall, gender-based roles negatively impacted many stages of the mother’s childbirth journey. Some staff recognised gender roles as a barrier to women accessing services but did not recognize themselves or their practices as a potential barrier. Gender issues identified at both birthing facilities generally reflect those of Nepali society as a whole. Raising awareness among maternity-care workers about gender issues and what they can do about it in personal interaction and how they reflect can on it would be the first step to improving the experiences of women of childbearing age

    Midwives' competence : is it affected by working in a rural location?

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    Introduction: Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to ‘competencies’ identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. Method: This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. Results: The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p = 0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p <0.001) and initial and discharge examination of the newborn (p <0.001). Both groups reported facing barriers to continuing professional development; however, more of the rural group had attended an educational event within the last month (p <0.001). Lack of time was a greater barrier for urban midwives (p = 0.02), whereas distance to training was greater for rural midwives (p = 0.009). Lack of motivation or interest was significantly higher in urban units (p = 0.006). Conclusion: It is often assumed that midwives in rural areas where there are fewer deliveries, will be less competent and confident in their practice. Our exploratory study suggests that the issue of competence is far more complex and deserves further attention.NHS Education Scotlan

    Experience of fathers with babies admitted to neonatal care units: A review of the literature

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    There is a growing understanding of the role and place of men in maternity care generally and for fathers of babies in neonatal care in particular. This review offers a systematic narrative review on issues affecting fathers, whose babies are admitted to neonatal units. Twenty-seven papers in the review highlighted four key themes: stress & anxiety; information; gender roles and emotions

    Nepal needs midwifery

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    This paper is published as a Commentary. It has no abstract, but the paper links the Millennium Development Goals to the maternity workforce in Nepal and highlights to need for recognition of the midwifery profession in that country

    Needs assessment of mental health training for Auxiliary Nurse Midwives: a cross-sectional survey

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    Mental health in pregnant women and new mothers is increasing recognised on the global health agenda. In Nepal mental health is generally a difficult to topic to discuss. THET, a London-based organisation, funded Bournemouth University, and Liverpool John Moores University in the UK and Tribhuvan University in Nepal to train community-based maternity workers on issues around mental health. This paper reports on a quantitative survey with nearly all Auxiliary Nurse Midwives in Nawalparasi (southern part of Nepal). The findings illustrate the lack of training on mental health issues related to pregnancy and childbirth in this group of health workers. Thus the paper’s conclusions stress the need for dedicated training in this field
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