Practice developments supporting change implementation in Wellington,New Zealand (NZ) for ‘continuity of care when transitioning complex preterm infants from NICU to home’

The discussion paper will focus on continuity of care relating to previous NZ research, specifically to transitioning complex preterm infants from NICU to home based on parent experiences, and on the practice developments that have occurred, to ensure optimal health outcomes. Previous NZ research discovered parent desire a consistent service delivery for the entire transition journey from NICU and at home.An informative and comprehensive opportunity has occurred for reflective professional practice, evaluation, development and implementation which have transpired in positive change through innovative practice developments and support change implementation in Wellington, NZ. This has resulted in the articulation of a model of care that has both embraced and integrated parental desires for a continuity of care process for complex preterm infants. This has been achieved by having the same Discharge Facilitator/Key Case Manager present within the NICU and external to the NICU for Home-based infants for the entire transition journey.The paper will focus and emphasis additional practice development changes and furthermore, will present a real purpose, for other countries to learn of such practice developments that have exemplified a celebratory success for families of Wellington, NZ.     

Adapting Sexual Configurations Theory to Nursing

Lesbian, gay, bisexual, transgender, and queer/questioning people in the United States experience multiple health disparities related to sexual and reproductive health. Attempts to address these disparities have focused on sexual orientation and gender identity rather than on the specific aspects of sexuality that may be more relevant to an individual’s health outcomes. This focus is also incongruent with a holistic approach to health and wellness interventions. We propose an adaptation of sexual configurations theory, a psychological theory with which to accurately describe different aspects of sexuality, to better position nurses to address these important disparity issues. We position sexual configurations theory within a contextual framework that incorporates aspects of trauma theory as a new way to evaluate individual sexuality in a holistic nursing context.     

Narrative Study of the Significance of Infertility and Its Treatment for Maternal Identity

ObjectiveTo explore how women who experienced infertility and underwent fertility treatments constructed maternal identities after they successfully gave birth.DesignNarrative qualitative study.SettingFinland, Scandinavia.ParticipantsTwenty-six previously infertile Finnish women who later conceived were recruited via social media, health clinics, and relevant informal support organizations.MethodsNarrative analysis was used to process written accounts and individual episodic interviews with each of the 26 women.ResultsFour different identity stories emerged from the data: Fractured Maternity, Pursuing Maternity, Learning Maternity, and Discovering Maternity. Infertility, its treatment, and childbirth were narrated as turning points in the participants’ life courses, but the significance of these turning points for maternal identity varied across the four stories.ConclusionThese findings have important implications for nursing practice. Health care professionals should be aware of the effects of previous long-standing infertility on the subsequent experience of motherhood so they can provide women with understanding, sufficient support, and appropriate interventions throughout the transition to motherhood.     

La place du désir dans la dysphorie de genre : une étude qualitative auprès de personnes transgenres sous traitement de réassignation sexuelle

ObjectivesThe DSM-5 defines gender dysphoria as a significant distress caused by the experience of an incongruence with regard to the person's biological sex. The diagnosis of gender dysphoria, not determined by biological, psychological and cultural elements, relies primarily on the anamnesis and the narrative of the transgender persons.MethodIndividual interviews were conducted with a sample of nine patients consulting a gender dysphoria consultation, who benefited from sexual reassignment treatments. The interviews were analyzed with the Interpretative Phenomenological Analysis (IPA).ResultsParticipants describe the development of their transgender identity as a desire to live in a body, which is culturally assigned to the opposite gender, and to be recognized by society as such. This desire – related to affects and not cognitions – is triggered by events, such as the experience of being attracted to persons with the same sex, but without feeling homosexual, or by differences experienced with same-sex peers during socialization. The desire is experienced at various stages of the development and expressed in various ways, depending on the person's biography and his way of being in and relating to the world. When the desire emerges, it is more or less easily welcomed, and at times also repressed; a consequence of this repression may be, that the body as place of this desire may be attacked. In this last situation, the dysphoric state may be caused by the impossibility to accept and to realize the emerging desire. Contextual elements, such as being forced for professional reasons to clarify the transgender issue or the encounter with a key person, move the evolution of this desire. On the contrary, negative attitudes of family members or significant others may impede gender identity formation.DiscussionThe analysis of these narratives allowed to consider the condition of transgender persons not only as dysphoria, and thus situate it in a traditional medical perspective which distinguishes between normal and pathological, but also to conceive it as a “career” towards the possible and desirable. While, the term dysphoria relates to a problematic side of the transgender condition, we consider that the perspective of a desire provide a more constructive way to conceive transgender identity.ConclusionThe challenge for the expert-psychiatrist is to grasp the different expression of this desire and to allow it to freely emerge and evolve, and to express and realize itself. The role of the psychiatrist is thus not limited to be a “gatekeeper” in the treatments of sexual reassignment, but to accompany transgender persons in their career of gender transition. As such, the psychiatrist adopts a therapeutic stance, which aims–as in other conditions–to help that desires can circulate more freely.     

Constructing robust selves after brain injury: positive identity work among members of a female self-help group

Despite common experiences of identity damage, decline, and deterioration, many brain injury survivors succeed in reconstructing robust identities in the wake of injury. Yet, while this accomplishment greatly benefits survivors’ quality of life, little is known about how positive identity work might be facilitated or enhanced in therapeutic institutions. Drawing on data from a women’s self-help group, we argue that an egalitarian, reflective, strength-focused, and gender-segregated environment can provide female ABI (acquired brain injury) survivors with a fertile scene for identity enhancement and offer unique opportunities for collective identity development. Sociolinguistic interactional analysis revealed four types of positive identity work undertaken within the group: constructing competent selves; tempering the threat of loss and impairment; resisting infantilisation and delegitimisation; and asserting a collective gender identity. This identity work was facilitated by specific programme attributes and activities and contributed to the global project of decentring disability and destigmatising impairments and losses. We call for increased attention to identity issues in brain injury rehabilitation and argue that gender-segregated programming can provide a unique space for female survivors to construct empowering individual and collective identities after injury.     

Debate: What if it’s not just a phase?

In order to support children and young people who are exploring their gender, we need to develop a shared understanding of gender identities and enhance the evidence base relating to long-term outcomes. All professionals working with children and young people should be trained in gender diversity. Health-care systems must be adapted to enable us to record gender identity; outcome measures should be developed that accommodate different gender identities. In doing so, we will develop clearer information about the number of children and young people who are exploring their gender and the way that gender identities develop throughout childhood. We will also start to demystify gender and work to enhance understanding and acceptance of diversity.