Salutogenic qualities of midwifery care: A best-fit framework synthesis

BackgroundAlthough midwifery care is wellness-based and promotes normal physiology, it exists within a medical model that focuses on risk aversion and disease prevention. Salutogenic theory could provide an alternative approach to midwifery care, supporting health-promoting factors, rather than solely avoiding adverse events.AimsThe aim of this study was to explore women’s experiences of their midwifery care and identify salutogenic aspects of midwifery care.MethodsBest-fit framework synthesis was used to analyse 349 quotes about women’s experiences of midwifery care from 31 qualitative studies in ten high-income countries. Key salutogenic concepts of comprehensibility, manageability and meaningfulness were used as the basis for coding, and thematic analysis was used to expand and clarify the framework to best fit the data.FindingsDefinitions for the salutogenic aspects of midwifery care were developed. Comprehensibility (cognitive aspects of health): ways that midwives help women increase predictability and preparation during childbearing through apredictable caregiver, a predictable system and preparation for an unpredictable experience. Manageability (behavioural aspects of health): ways that midwives enhance and support a woman’s internal resilience, adding extra support when needed, and strengthen women’s external resources through connections to family, community and specialist care. Meaningfulness (emotional/spiritual aspects of health): ways that midwives encourage the commitment and engagement of childbearing women by providing care through a personalised relationship, by cultivating a woman’s autonomy.ConclusionFindings of this study may be used to further research into ways that salutogenic theory can bring a health and wellness-focused agenda to midwifery policy and practice.     

Perceptions of paternal involvement and labour pain management in Chinese couples during childbirth: A qualitative study

BackgroundLabour pain is an individual experience embedded in a socio-cultural context. In childbirth, the father’s involvement provides important support to the mother during labour. However, few published studies have evaluated couples’ experiences of paternal involvement and labour pain management in the Chinese context.AimThis study aimed to understand the experience of labour pain management and the father’s involvement in childbirth from the perspectives of women and their partners in Hong Kong.MethodsAn exploratory qualitative design was adopted. A purposive sample of 45 Chinese parents was recruited at the postnatal unit of a regional hospital. Data were collected through semi-structured face-to-face interviews within 1 month after birth. The data were subjected to content analysis.FindingsThe findings revealed six major themes: the mothers’ experience of labour pain, effectiveness of pain relief measures, mothers’ perceptions of support from their partners, mothers’ perceptions of support from healthcare professionals, fathers’ experience of involvement in childbirth and suggested improvements to maternity services.DiscussionChinese mothers experienced intense labour pain and used various pain relief measures. Both parents considered the involvement of fathers and support from healthcare professionals to be highly significant during childbirth.ConclusionsThis study highlights the need for a family-centred model of care during childbirth that involves both parents in the decision-making process. Chinese maternity services should implement individualised birth plans that acknowledge both parents’ expectations and preferences, thus promoting a positive childbirth experience for the parents.     

Women’s reports of satisfaction and respect with continuity of care experiences by students: Findings from a routine,online survey

BackgroundPre-registration midwifery students in Australia undertake a minimum of ten continuity of care experiences with childbearing women. However, women are rarely asked to formally evaluate this care by students.AimTo evaluate data from a routine, web-based survey of women about having a midwifery student provide a continuity of care experience.MethodsAll women (n = 886) recruited by a midwifery student for a continuity of care experience during a 12 month period received an email inviting them to complete an online survey. The survey included personal details, experiences of care, and two scales on Respect and Satisfaction.ResultsA response rate of 57% (n = 501) was achieved. On average students attended six antenatal visits (mean = 5.83) and had six postnatal contacts with women. Most students attended labour and birth (92.6% n = 464). Most women rated overall satisfaction with care by their student as ‘better than they had hoped’. Positive correlations were found between number of antenatal visits and postnatal contact with students on both levels of satisfaction and respect felt by women. Women felt more satisfied when their midwifery student attended labour and birth.ConclusionsThe online survey was feasible and provided valid and reliable feedback from women about their student during a continuity of care experience. Women valued having an ongoing relationship with a student during pregnancy, labour and birth, and postpartum. Pre-registration midwifery education programs should continue to privilege relationship-based care and national standards should support the effective integration of continuity of care experiences.     

The experiences of privately practising midwives in Australia who have been reported to the Australian Health Practitioner Regulation Agency: A qualitative study

BackgroundIn Australia the majority of homebirths are attended by privately practising midwives (PPMs). In recent years PPMs have been increasingly reported to the Australian Health Practitioner Regulation Agency (AHPRA) mostly by other health professionals.Purposeto explore the experiences of PPMs in Australia who have been reported to the AHPRA.MethodsA qualitative interpretive approach, employing in-depth interviews with eight PPMs was undertaken and analysed using thematic analysis. A feminist theoretical framework was used to underpin the research.ResultsThe majority of reports made to AHPRA occurred when midwives supported women who chose care considered outside the recommended Australian College of Midwives (ACM) Consultation and Referral Guidelines. During data analysis an overarching theme emerged, “Caught between women and the system”, which described the participants’ feelings of working as a PPM in Australia. There were six themes and several sub-themes: The suppression of midwifery, A flawed system, Lack of support, Devastation on so many levels, Making changes in the aftermath and Walking a tight rope forever. The findings from this study reveal that midwives who are under investigation suffer from emotional and psychological distress. Understanding the effects of the process of investigation is important to improve the quality of professional and personal support available to PPMs who are reported to AHPRA and to streamline processes.ConclusionIt is becoming increasingly difficult for PPMs to support the wishes and needs of individual women and also meet the requirements of the regulators, as well as the increasingly risk averse health service.     

论高校教师的职业倦怠

不同个体、不同类型的职业倦怠其产生原因各不相同,归结起来,高校教师产生职业倦怠的主要原因有四个:学术权利和行政权利的不均衡;高校教师职称评聘、业绩考核制度存在弊端;高校教师录用和选聘过程缺乏有力的人才测评以及社会对高校教师报赏的失衡。因此,缓解和克服高校教师的职业倦怠也要从这几个方面考虑。     

目前遗传资源和传统知识法律保护机制国际探索的成就与不足——评CBD事先知情同意机制和FAO农民权机制

传统知识是长期以来传统部族在长期的生产生活实践中创造出来的知识、技术、经验的总称,是一种知识形态和知识产品。CBD等国际组织对遗传资源及有关传统知识的保护进行了多年的探索,在保护机制上取得了一定的创新。CBD开创的事先知情同意机制和FAO开创的农民权机制为其代表。两种机制均在物权层面设计了遗传资源及有关传统知识的保护规则,但前者具有较强的保障力,后者基本上还是一种道义意义上的权利。但只有提供知识产权保护方能充分实现传统部族在传统知识上的利益。     

Double and group acceptance sampling plan for truncated life test based on inverse log-logistic distribution

This paper introduces a double and group acceptance sampling plans based on time truncated lifetimes when the lifetime of an item follows the inverse log-logistic (ILL) distribution with known shape parameter. The operating characteristic function and average sample number (ASN) values of the double acceptance sampling inspection plan are provided. The values of the minimum number of groups and operating characteristic function for various quality levels are obtained for a group acceptance sampling inspection plan. A comparative study between single acceptance sampling inspection plan and double acceptance sampling inspection plan is carried out in terms of sample size. One simulated example and four real-life examples are discussed to show the applicability of the proposed double and group acceptance sampling inspection plans for ILL distributed quality parameters.     

Modified maximum likelihood estimator under the Jones and Faddy's skew t-error distribution for censored regression model

It is well-known that classical Tobit estimator of the parameters of the censored regression (CR) model is inefficient in case of non-normal error terms. In this paper, we propose to use the modified maximum likelihood (MML) estimator under the Jones and Faddy''s skew t-error distribution, which covers a wide range of skew and symmetric distributions, for the CR model. The MML estimators, providing an alternative to the Tobit estimator, are explicitly expressed and they are asymptotically equivalent to the maximum likelihood estimator. A simulation study is conducted to compare the efficiencies of the MML estimators with the classical estimators such as the ordinary least squares, Tobit, censored least absolute deviations and symmetrically trimmed least squares estimators. The results of the simulation study show that the MML estimators work well among the others with respect to the root mean square error criterion for the CR model. A real life example is also provided to show the suitability of the MML methodology.