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41.

Background

Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth.

Aim

To increase understanding of decision-making in complex home-like birth settings by exploring midwives’ and women’s perspectives and to develop a dynamic model integrating participatory processes for making shared decisions.

Methods

The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births.

Findings

The central phenomenon that arose from the data was “defining/redefining decision as a joint commitment to healthy childbirth”. The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife’s decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman’s decision, making an informed decision or taking the necessary decision.

Discussion and conclusion

To respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice.  相似文献   
42.
43.
This longitudinal study examined the associations between relationship abuse, coping variables, and mental health outcomes among a sample of battered women obtained from shelter and nonresidential community agencies (N = 61). Sexual aggression was a stronger predictor of poorer mental health than was physical assault. Engagement coping strategies were generally predictive of positive mental health, and disengagement coping strategies were generally predictive of poorer mental health. Results highlight the complexity of the associations between different forms of relationship abuse, coping strategies, and mental health among this population.  相似文献   
44.
Brand alliances represent a popular business strategy in many industries, because firms hope to evoke positive consumer evaluations of both the alliance’s product and the partner brands. However, extant research offers mixed findings regarding the effects of a brand alliance on its partner brands (i.e., spillover effects). In response, this study separates spillover effects into the effects of the alliance product on the partner brands (brand alliance effects) and the effects between partner brands (brand contrast effects), while also noting the potential moderating impact of perceived attitude- and product-based fit between partner brands on resulting spillover effects. Two experimental studies consistently reveal the existence of brand contrast effects; furthermore, the partner brand’s attitude-based fit reduces undesired brand contrast effects and positively moderates spillover effects in brand alliances, whereas product-based fit does not. Therefore, a third study identifies relevant drivers of partner brand’s attitude-based fit for different brand alliances (i.e., co-branding, ingredient branding, and joint advertising). The findings have notable implications for the design and management of brand alliances.  相似文献   
45.

Problem and background

Despite a generally affluent society, the caesarean section rate in Switzerland has steadily climbed in recent years from 22.9% in 1998 to 33.7% in 2014. Speculation by the media has prompted political questions as to the reasons. However, there is no clear evidence as to why the Swiss rate should be so high especially in comparison with neighbouring countries.

Aim

To describe the emerging expectations of giving birth of healthy primigravid women in the early second semester of pregnancy in four Swiss cantons.

Methods

Qualitative individual interviews with 58 healthy primigravid women, were audio recorded, transcribed and subjected to thematic analysis. Recruitment took place through public and private hospitals, birth centres, obstetricians and independent midwives. The main ethical issues were informed consent, autonomy, confidentiality and anonymity.

Findings

The three main themes identified were taking or avoiding decisions, experiencing a continuum of emotions and planning the care.

Discussion

Being pregnant was part of a project women had mapped out for their lives. Only three women in our sample expressed a wish for a caesarean section. One of the strongest emotions was that of fear but in contrast some participants expressed faith that their bodies would cope with the experience.

Conclusion

Bringing together the three languages and cultures produced a truly “Swiss” study showing contrasts between a matter of fact approach to pregnancy and the concept of fear. Such a contrast is worthy of further and deeper exploration by a multi-disciplinary research team.  相似文献   
46.
Starting from the axiom system for price indices given by Eichhorn, this paper intends t o suggest some new axioms. They seem useful from a theoretical of practical point of view. The reversal tests, introduced by Fisher i n 1922, are investigated systematically. This procedure leads to new reversal properties and to a group theoretical representation of these properties.  相似文献   
47.
As recent events have shown, simultaneous crop losses in different parts of the world can cause serious risks to global food security. However, to date, little is known about the spatial dependency of lower than expected crop yields from global breadbaskets. This especially applies in the case of extreme events, i.e., where one or more breadbaskets are experiencing far below average yields. Without such information, risk management approaches cannot be applied and vulnerability to extremes may remain high or even increase in the future around the world. We tackle both issues from an empirical perspective focusing on wheat yield. Interdependencies between historically observed wheat yield deviations in five breadbaskets (United States, Argentina, India, China, and Australia) are estimated via copula approaches that can incorporate increasing tail dependencies. In doing so, we are able to attach probabilities to interregional as well as global yield losses. To address the robustness of our results, we apply three different methods for constructing multivariate copulas: vine copulas, ordered coupling using a minimax approach, and hierarchical structuring. We found interdependencies between states within breadbaskets that led us to the conclusion that risk pooling for extremes is less favorable on the regional level. However, notwithstanding evidence of global climatic teleconnections that may influence crop production, we also demonstrate empirically that wheat production losses are independent between global breadbaskets, which strengthens the case for interregional risk pooling strategies. We argue that through interregional risk pooling, postdisaster liabilities of governments and international donors could be decreased.  相似文献   
48.
A decline in urban forest structure and function in the United States jeopardizes the current focus on developing sustainable cities. A number of social dilemmas—for example, free-rider problems—restrict the sustainable production of ecosystem services and the stock of urban trees from which they flow. However, institutions, or the rules, norms, and strategies that affect human decision-making, resolve many such social dilemmas, and thus, institutional analysis is imperative for understanding urban forest management outcomes. Unfortunately, we find that the definition of institutions varies greatly across and within disciplines, and conceptual frameworks in urban forest management and urban ecosystems research often embed institutions as minor variables. Given the significance of institutional analysis to understanding sustainable rural resource management, this paper attempts to bring clarity to defining, conceptually framing, and operationally analyzing institutions in urban settings with a specific focus on sustainable urban forest management. We conclude that urban ecologists and urban forest management researchers could benefit from applying a working definition of institutions that uniquely defines rules, norms, and strategies, by recognizing the nested nature of operational, collective choice, and constitutional institutions, and by applying the Institutional Analysis and Development framework for analysis of urban social-ecological systems (SESs). Such work promises to spur the desired policy-based research agenda of urban forestry and urban ecology and provide cross-disciplinary fertilization of institutional analysis between rural SESs and urban ecosystems.  相似文献   
49.
Regarding the requirements and conditions of professional??s work, their particular needs for reflection and continuing education are revealed. Continuing professional development (CPD) is an appropriate approach for this type of reflection. On the background of a rather small body of empirical research, we argue that the method of mutual visitation can fulfil the requirements of CPD. We report a case study about three mutual visitations of dental practitioners in Germany to describe and evaluate their experiences. The data reveal conditions helping to achieve a successful mutual visitation: their embedding in a professional learning program, the right combination of participants, a proper preparation and competencies to give and to take feedback.  相似文献   
50.
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