Including the nonrational is sensible midwifery

Since the subordination of midwifery by medicine and nursing in the 19th and 20th centuries the standard approach to childbirth has been dominated by rationality. This approach proceeds by creating dichotomies and then prioritising one half of the dichotomy whilst rejecting the opposite term. Rationality itself is prioritised, for example, by contrasting it with the rejected opposite: irrationality. Expert clinical practice is, however, increasingly identified as being inclusive of more than merely rational ways of knowing and behaving. This paper is based on a post-structural study concerning changes to women's embodied sense of self during childbearing. We expose the limitations of pure rationality in the context of childbirth and use the concept of safety to exemplify the limitations that pure rationality imposes. The paper draws on philosophical and spiritual theory to present an analysis of ideas about mind, body, soul and spirit. The standard rational/irrational dichotomy is critiqued and contrasted with the embodied reality of nonrational experiences that are individual, contextual and 'in-the-moment'. Nonrational experiences are identified to be inclusive of power and knowledge that are both rational and nonrational. This revised conceptualisation provides a theoretical basis that allows for and promotes more possibilities and thus more holistic ways of knowing in midwifery. Our thesis is that midwives and women need to take conscious account of nonrational knowledge and power during the childbearing year. We argue that pure rational thinking limits possibilities by excluding the midwife's embodied ways of knowing along with the ways of knowing embodied by the woman. The inclusion of women's and midwives'nonrational ways of knowing in childbearing situations opens us up to knowledge and power that provides for a more complete, and therefore a more optimal, decision-making process.     

Risky Sexual Behavior among Arrested Adolescent Males: The Role of Future Expectations and Impulse Control

The current study evaluates two predictors of adolescent sexual risk‐taking, specifically whether impulse control or future expectations predict condom use and casual sex. We examine whether risky sex occurs among youth who tend to act without thinking about the future, or instead, youth who report low future expectations. We consider these relations longitudinally among a sample of sexually active justice‐involved adolescent males (N = 752, M age = 15.58) a group at heightened risk for sexual risk‐taking. We found that optimistic expectations for the future predict a higher likelihood of engaging in consistent condom use, whereas high impulse control is related to a lower likelihood of casual sex. Implications for intervention and research on positive sexual health are discussed.     

Complexity of domestic violence in a South Asian context in Hong Kong: cultural and structural impact

With the dearth of empirical research related to the experiences of domestic violence among South Asian communities in Hong Kong, this study engages with migrant South Asian women’s subjective understanding and experience of domestic violence. Presenting women’s narratives of their experiences with domestic violence allow for a better understanding of the complexities that inform and shape women’s experiences and decision-making in the face of partner violence. This empirical study investigated South Asian women’s experience of domestic violence in the context of Hong Kong through in-depth interviews with 14 South Asian women who had experienced abuse and 6 helping professionals from 4 social service agencies. Analysis of the data revealed that the nature and context of abuse posed as a barrier in their help seeking. The findings highlight the importance of understanding the influence of cultural and structural conditions and the difficulties and complexities women face that increases women’s vulnerability to abuse. This paper offers an analysis of how structures thereby come to impact on women’s distress and vulnerability. The study also highlights the need for inclusive service provision for minority ethnic women experiencing domestic violence.     

Assessment of recovery in older patients hospitalized with different diagnoses and functional levels,evaluated with and without geriatric assessment

Background

The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. Furthermore, to compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests.

Methods

Prospective, observational cohort study, including 961community dwelling patients aged?≥?70 years, transferred from medical, cardiac, pulmonary and orthopedic acute hospital departments to intermediate care in nursing home. Functional assessment with Barthel index (BI) was performed at admission to the nursing home and further geriatric assessment tests was performed during the first week. Logistic regression models with and without geriatric assessment were compared concerning the patients having 1) slow recovery (nursing home stay up to 2 months before return home) or, 2) poor recovery (dead or still in nursing home at 2 months).

Results

Slow recovery was independently associated with a diagnosis of non-vertebral fracture, BI subgroups 50–79 and <50, and, in the model including geriatric assessment, also with cognitive impairment. Poor recovery was more complex, and independently associated both with BI?<?50, receiving home care before admission, higher age, admission with a non-vertebral fracture, and in the geriatric assessment model, cognitive impairment.

Conclusions

Geriatric assessment is optimal for determining the recovery potential of older patients after acute hospitalization. As some hospitals lack geriatric services and ability to perform geriatric screening tests, a simpler assessment based on admission diagnoses and ADL function (BI), gives good information regarding the possible rehabilitation time and possibility to return home.

     

Experience with research paradigms relates to infants’ direction of preference

Interpreting and predicting direction of preference in infant research has been a thorny issue for decades. Several factors have been proposed to account for familiarity versus novelty preferences, including age, length of exposure, and task complexity. The current study explores an additional dimension: experience with the experimental paradigm. We reanalyzed the data from 4 experiments on artificial grammar learning in 12-month-old infants run using the head-turn preference procedure (HPP). Participants in these studies varied substantially in their number of laboratory visits. Results show that the number of HPP studies is related to direction of preference: Infants with limited experience with the HPP setting were more likely to show familiarity preferences than infants who had amassed more experience with this paradigm. This evidence has important implications for the interpretation of experimental results: Experience with a given method or, more broadly, with the laboratory environment may affect infants’ patterns of preferences.