An evaluation of strategies to improve the quality and content of hospital‐based postnatal care in a metropolitan Australian hospital

Aim and objective. This study aimed to design, implement and evaluate strategies to improve the quality and content of hospital‐based postnatal care. Background. Following birth, women report physical health problems, difficulties with breastfeeding, a lack of parenting self‐efficacy and there is high occurrence of postnatal distress and depression. Despite these significant needs, women are frequently dissatisfied with the advice and support they receive from hospital‐based postnatal care. Design. A pre/post test design compared the effect of multifaceted strategies on perceptions of quality and content of postnatal care, knowledge and experience of postnatal problems, parenting self‐efficacy and breastfeeding outcomes. The key strategy, ‘one‐to‐one time’, focused on providing women an uninterrupted period of time each day when a midwife would be available to discuss women’s concerns about their health and that of their baby. Method. A convenience sample of 146 women at baseline and 148 women postintervention completed a postal self‐report questionnaire between 2–4 weeks postpartum. Results. There were no significant differences between baseline and postintervention groups in perceived quality of care, breastfeeding outcomes and maternal self‐efficacy. Women experiencing health issues, including insufficient milk supply, backache, abnormal bleeding and urinary incontinence, were more likely to report that they received good or excellent care and advice in the postintervention group. Strategies to increase rest appeared effective with women less likely to report excessive tiredness postintervention. The key strategy, ‘one‐to‐one time’ was not consistently implemented, 57% of women reported they received 10 minutes or less of uninterrupted time with a midwife and only 11% reported that they were provided with 20 minutes or more. Conclusion. There is the potential for individualised care to impact on outcomes for women but established routines and institutional priorities are difficult to change. Relevance to clinical practice. Midwives require both skill development and time to be able to sensitively listen to women’s needs in the hospital postnatal setting.     

Deep and almost unbearable suffering: consequences of childhood sexual abuse for men’s health and well‐being

Previous studies indicate that childhood sexual abuse can have extensive and serious consequences. The aim of this research was to do a qualitative study of the consequences of childhood sexual abuse for Icelandic men’s health and well‐being. Phenomenology was the methodological approach of the study. Totally 14 interviews were conducted, two per individual, and analysed based on the Vancouver School of Phenomenology. The main results of the study showed that the men describe deep and almost unbearable suffering, affecting their entire life, of which there is no alleviation in sight. The men have lived in repressed silence most of their lives and have come close to taking their own lives. What stopped them from committing suicide was revealing to others what happened to them which set them free in a way. The men experienced fear‐ or rage‐based shock at the time of the trauma and most of them endured the attack by dissociation, disconnecting psyche and body and have difficulties reconnecting. They had extremely difficult childhoods, living with indisposition, bullying, learning difficulties and behavioural problems. Some have, from a young age, numbed themselves with alcohol and elicit drugs. They have suffered psychologically and physically and have had relational and sexual intimacy problems. The consequences of the abuse surfaced either immediately after the shock or many years later and developed into complex post‐traumatic stress disorder. Because of perceived societal prejudice, it was hard for the men to seek help. This shows the great need for professionals to be alert to the possible consequences of childhood sexual abuse in their practice to reverse the damaging consequences on their health and well‐being. We conclude that living in repressed silence after a trauma, like childhood sexual abuse, can be dangerous for the health, well‐being and indeed the very life of the survivor.     

Critique of Falloon and the Optimal Treatment Project

The Optimal Treatment Project advocated by Falloon has been demonstrated through the scientific research literature to be efficient and effective treatment strategies for people experiencing severe mental illness. For this reason, there is little critique of this approach. While the potential value of the project is acknowledged, it is important to identify the appropriateness of the model for specific services and to understand comprehensively the resources necessary for successful implementation. The aim of this paper is to review the literature in relation to the Optimal Treatment Project with a view to exploring the complexities associated with the model. It is concluded that the involvement of multiple stakeholders, including consumers of mental health services, should become an essential element of any implementation strategy.