Our first child was incompatible with life: understanding miscarriage as a lived experience

Miscarriage as a medical experience is removed several times from the lived experience of a mother, partner and family. Often there is no space to grieve and mourn to facilitate that. In this article it will be shown that the lived experience of a miscarriage challenges the notion of care and loss forever. Ask a woman the memory is always there and very often the pain. It's important to let the wisdom of sadness speak and emotions to flow unhurried. Emotions need to be set free. What is less appreciated is that professional carers often feel at a loss themselves and they too need love and support. Staff and relatives are sometimes in different contexts of awareness and information about diagnosis and all aspects of care often need to be translated The experience of loss is not only related to death but to loss of hope, dreams, function and handing over care to another carer. Dealing with loss is a feature of being human, but dealing with multiple losses is sadly often a part of being a practicing nurse and midwife. It is time to really appreciate what it means to live through a miscarriage. What we need now to do is move beyond a medical experience into creating a space where a woman can feel safe and loved to grieve for all that is lost and all that could have been.     

Adapting management by objectives to nursing

MBO--what is it? It is a philosophy, a process, a system, a strategy, a procedure, a technique, and a method for and of managers who seek ways to challenge themselves and their staff to see and contribute to the overall mission of the organization. MBO is energizing and demanding. It is work. It is accountability made real. MBO is adaptable to the nursing service setting. Managers responsible for nursing service units can take from the strategies of the MBO system the elements of formulation of goals and objectives, development of action plans, and implementation necessary to increase the accountability; and the output of the work rendered. MBO is a system of results and proven value. For this nurse, it is a logical way to manage the business of nursing.     

Usage of a defibrillator

Guideline 2010 for cardiopulmonary resuscitation was released the other day. There is no big change in the use of a defibrillator. Asynchronous defibrillation is used as a therapy for VF and pulseless VT. When you find a patient, start CPR immediately and prepare a defibrillator. About the value of energy, comply a recommended value of defibrillator's manufacturer with biphasic waveform, on the other hand, deliver 360J shock with monophasic waveform. Cardioversion is used as a therapy for supraventricular arrhythmia like atrial fibrillation. It is important to synchronize with QRS complex on ECG surely and deliver a shock. If it is not synchronized surely, there is a possibility to occur VF. Transcutaneous pacing is used as a therapy for bradycardia. It produces a depolarization of myocardium by giving current stimulus from a surface of a body, and force a heart to contract. It is usually carried out at demand mode, and confirmed that a heart contracts certainly. Defibrillator is an only device to terminate VF and pulseless VT and it is important to test defibrillator usually so that it can be used any time it is necessary.     

A new statistical test based on the wavelet cross-spectrum to detect time-frequency dependence between non-stationary signals: application to the analysis of cortico-muscular interactions

The study of the correlations that may exist between neurophysiological signals is at the heart of modern techniques for data analysis in neuroscience. Wavelet coherence is a popular method to construct a time-frequency map that can be used to analyze the time-frequency correlations between two time series. Coherence is a normalized measure of dependence, for which it is possible to construct confidence intervals, and that is commonly considered as being more interpretable than the wavelet cross-spectrum (WCS). In this paper, we provide empirical and theoretical arguments to show that a significant level of wavelet coherence does not necessarily correspond to a significant level of dependence between random signals, especially when the number of trials is small. In such cases, we demonstrate that the WCS is a much better measure of statistical dependence, and a new statistical test to detect significant values of the cross-spectrum is proposed. This test clearly outperforms the limitations of coherence analysis while still allowing a consistent estimation of the time-frequency correlations between two non-stationary stochastic processes. Simulated data are used to investigate the advantages of this new approach over coherence analysis. The method is also applied to experimental data sets to analyze the time-frequency correlations that may exist between electroencephalogram (EEG) and surface electromyogram (EMG).     

Diseases Commonly Confused with Acute Coronary Occlusion

Gastric and duodenal ulcers in the majority of cases are believed to be due to an increase in the corrosive properties of the gastric content and not to a local decrease in the resistance of the gastric wall. The increase in the corrosive properties of the gastric content is due to a hypersecretion of gastric juice. In duodenal ulcer patients this hypersecretion is predominantly of nervous origin and is due to the tensions and strain of modern life. It is abolished by a complete vagotomy. The hypersecretion of gastric juice in patients with gastric ulcer is of hormonal origin and is due to a hyperfunction of the gastric antrum in the presence of food in the stomach. This hypersecretion is abolished by excision of the antrum.     

Relationship between sample size and the definition of equivalence in non-inferiority drug studies

Statistical testing of clinical trial data leads to acceptance of a hypothesis if a test of the opposite (null) hypothesis (H0) fails to reach a critical probability value. The usual aim is to demonstrate that a new treatment is superior to a comparator, whence H0 is that the two treatments are the same. By contrast, in studies designed to show that a new treatment is equivalent to an existing therapy, the same principle is satisfied by an amended null hypothesis, that the treatments differ by more than a defined amount. This reversal entails subtle but important logical and practical problems which affect particularly the calculation of sample size. The choice of the limits used to define equivalence is critical to the calculation of sample size in a manner not previously discussed, and in the interpretation of data in relation to the probability of Type I and Type II errors. Investigators, regulatory bodies and institutional ethics committees must ensure that the range of values chosen to indicate equivalence is clinically appropriate and be aware of the effect of this decision on possible errors in accepting or rejecting H0.     

Community-based Service Delivery in Rehabilitation: The Promise and the Paradox

Purpose : According to many researchers, rehabilitation is being prevented from developing as a distinct profession due to two major problems. First, it has been claimed that rehabilitation is in need of a professional identity and a sense of cohesion if it is to emerge as a discipline. Second, it has been recognized that there is a need for a rehabilitation framework to challenge the restorative approach that continues to dominate rehabilitation, linking it back to the medical model from which it has attempted to escape. The model of community-based rehabilitation (CBR) is offered as a model that can provide the impetus for an attitudinal shift from the restorative tradition and unite rehabilitation workers through a cohesive framework. Method : Unfortunately, the implementation of community-based rehabilitation in urban societies has been disappointing. The current paper is a conceptual discussion of communitybased rehabilitation that explores some potential causes of this poor implementation. Results : To some extent, the implementation failure of community-based rehabilitation can be attributed to the paradoxes that are inherent in its fundamental construct sempowerment and community inclusion. These paradoxes occur at a conceptual level, a practical level and a contextual level. Conclusions : Some solutions are offered to enable the paradigm to be implemented more fully. In particular, it is suggested that there is a need to develop useful working definitions of these constructs, favourable attitudes among rehabilitation workers and a focus on community development.     

Evidence-based management of constipation in the oncology patient.

Constipation is suffered by over 50% of cancer patients and is regarded as one of the most distressing symptoms causing both physical and emotional distress. A need to treat constipation is often due to a failure to prevent it. There is little literature in this area and research based on clinical trials as to best treatment is virtually non-existent. It is suggested that many health-care professionals dismiss constipation as a relatively trivial problem, resulting in a lack of attention to the subject. There is a lack of consensus on the definition of constipation and confusion regarding effective methods for prevention and treatment. It could be argued that health-care professionals are more intent on monitoring the direct effects rather than the secondary effects of treatment. Since constipation is largely preventable, there is a need to highlight the importance of prevention in addition to establishing effective treatment guidelines. Oncology nurses are in an ideal position to identify cancer patients in a high-risk category and utilize preventive strategies. The study described has led to the development of evidence-based drug guidelines to be used in the prevention of constipation and acute/chronic constipation to ensure that patients receive the best treatment possible.     

Already in the 21st century ... a new leadership in health sciences

It is a fact to state that health care has never succeeded in covering such a wide series of sectors of the population in our country. The health care network created both by public as well as private efforts, and occasionally due to the collaboration by both fields, offers a framework of health care services which ensures there is a satisfactory coverage for the general population. It is difficult to provide a rebuttal to this statement; all one needs to do is recall what the status of our health care system was a few years ago. We have not achieved a perfect system. The development of our health care network has been produced by expansion. As we have come to believe that health is an unalienable right, we have to expand health care services to cover everyone. This effort leads to a second phase which brings to bear upon us new problems. One is the quality of health care services and the second is cost.     

Developing the sociology of health in nurse education: towards a more critical curriculum — Part 2: linking methodology and epistemology

In Part Two of the paper a model forcurriculum development is proposed which derives from the teaching experience of the authors. This is intended to provide a methodological and conceptual framework for studying the problem of human consciousness and action in relation to health in a way that is consistent with both the values and purposes of student-centred learning and the claims of critical theory. It is suggested that such a critical curriculum of health is needed in order to ensure that the ‘knowledgeable doer’ Project 2000 aims to produce is indeed a qualitatively different kind of professional nurse practitioner.     

Alcoholism and other drug dependencies

The disease of addiction is upon us and it is obvious that the elderly are not immune. There is every reason to believe from early reports that the elderly respond favorably to treatment, perhaps more so than their younger counterparts. It is believed that treating chemical dependency as a primary disease rather than as a symptom of something else has been a great boon in terms of improving recovery rates. Furthermore, group therapy is the main component of treatment in rehabilitation, as it affords the greatest opportunity to shift the dependence on chemical to a dependence on human beings. The physician is in a key position to help the elderly, because so many elderly need and use medical care. Intervention is highly recommended if the doctor is knowledgeable and skilled in this area and is willing to kindly confront the patient with a somewhat undesirable diagnosis. Rehabilitation regimens are becoming more plentiful throughout the country. If services are unavailable, however, there is always AA to fall back on or to recommend initially. Remember, fully one third of all AA members are older than 50 and that it is a source of acceptance, support, and an opportunity to depend on human beings instead of psychoactive chemicals. Remember too that few patients with addiction recover by themselves. It is worth remembering that this is an incurable disease in that once addicted, it is unlikely that anyone can ever use socially psychoactive chemical substances again. Use of psychoactive chemicals is fraught with danger for the physician and the patient and indeed may place the physician at risk for malpractice. There is great satisfaction to be gained from helping those afflicted with alcoholism and other drug dependencies. The gratitude displayed by those receiving help for this affliction is truly remarkable and one that will leave the clinician with a sense of "a job well done."     

The nurse manager in transition

With the current, widespread, highly visible, non-fault dismissals brought about by massive hospital downsizing and restructuring, there has been a layoff of many capable, responsible, and respectable managers. In some localities it will not be possible to obtain a similar position to the one that is lost. Adjusting to this significant life transition event, moving from one job to another involves a process that is initiated when the manager's current reality is disrupted and ends when a bridge is built from the disrupted reality to one of the possible realities that can be created. During this process there are many emotional ups and downs and confusion as to identity. While what is happening may be clear to an observer, for the person in transition reality may be fractured in such a devastating way that it is like being frozen in time. Finally, a new reality is built as the old one is relinquished, and the excitement of new beginnings is experienced with a new and perhaps different role. Eventually, the pain and disappointment of losing a job is replaced with the challenges of the present. Meanwhile, while the present job seems secure it is good planning for the future to be aware and ready for the job hunt process. Getting laid off or fired is a real possibility in today's tightening economic conditions and the astute nurse manager should be ready for it.     

ANNUAL REPORT OF COUNCIL FOR THE YEAR ENDING 30th JUNE, 1949

The thinning guide presented with this paper is a graph of stocking per acre on predominant height, and it indicates what is considered to be the optimum range of stocking within which thinning should maintain P. radiata stands in South Australia, if an optimum compromise between certain factors is to be achieved.

These factors include a commercial first thinning as a pre-requisite, full site use, reasonable rates of diameter growth, and stability to wind.

It is suggested that representation of a thinning guide in terms of stand height and in graphical form gives it a flexibility to individual stand characteristics which is not possible in tabular form, and that such flexibility is necessary if a thinning guide is to be a ready practicable guide to logging officers. A special value of the graphical form is that past and proposed thinning of a stand can be represented diagrammatically, against a background of growth and stability criteria. By indicating long-term possibilities, this should assist with short-term decisions.     

Mothers' experiences of having their newborn child in a neonatal intensive care unit

BACKGROUND: From birth the child has an ability to respond to the environment, which influences the interaction between mother and child. If this attachment is interrupted, the child's emotional development is negatively influenced. When the child needs care in a neonatal intensive care unit (NICU) it is difficult to establish contacts between mother and child. Separation from the child is found to be the most difficult aspect for mothers when their newborn child is hospitalized in a NICU. AIM: The aim of this study was to describe mothers' experiences when their full-term newborn child was cared for in a NICU during the postpartum maternity care period. METHOD: A phenomenological hermeneutic interview study was performed. Ten mothers were interviewed once, 6 months to 6 years after the experience. RESULTS: The essence of the experience is understood as an alternation between two opposite concepts, exclusion and participation, with emphasis on exclusion. A feeling of exclusion dominates when the new mother feels a lack of interaction and a sense of not belonging to either the maternity care unit or the NICU. This has a negative effect on her maternal feelings. On the contrary, when a feeling of participation dominates, a continuous dialogue exists and the mother is cared for as a unique person with unique needs. This supports her maternal feelings in a positive direction. The implication of the result for nurses is that it is important to decrease mothers' experience of exclusion and to increase their feeling of participation when their child is cared for in a NICU. A return visit to the responsible nurse to go through the treatment and experiences should be offered to all parents whose child has been cared for in a NICU.     

Evidence-based uncertainty in mental health nursing

The drive towards evidence-based practice is part of a modern reflective and caring service. However there is a paradox at the heart of the notion of evidence-based care. In order to perform any systemized examination of treatment there has to be a conscious acknowledgement of uncertainty about that treatment. This is uncomfortable and when research does find evidence in favour of a treatment, there is a relief and a return to conviction about what is the best. The paradox is that it seems the most valued research practices are predicated on generalizations about patient treatments and categories. However, nursing care is based on the notion of the uniqueness of the patient and the nurse-patient relationship. Sometimes it is necessary to address the particular and not to rush to generalizations and certainty. The psychoanalytic framework promotes a capacity to tolerate uncertainty and provides a model for understanding conflicting feelings, which can occur within the nurse-patient relationship. The author proposes the psychoanalytic observational method as an adjunct to other research methods. This method places certain kinds of evidence within the rubric of evidence-based nursing practice. The evidence collected in this method is the evidence of the conscious and unconscious experience within the nurse-patient relationship. The author will describe and argue for the place of this research method within the canon of other more widely practised methods within mental health practice. She will propose that for safe practice it is necessary to value and examine the veracity of the feelings and tacit understanding of the nurse. She contends that the current climate of excessive bureaucracy and persecutory risk management is having a damaging effect on both the research process and effective nursing care.     

Towards practice development — a vision in reality or a reality without vision?

This paper describes the development of a conceptual framework for practice development. Drawing on the authors' combined experiences of facilitating developments in practice, a conceptual framework is proposed. It is argued that much practice development in health care today lacks a systematic approach and is often undertaken by individual practitioners who are poorly prepared for their roles. A short history of practice development is outlined to contextualize current development activities. The proposed framework is located in a critical social science philosophy and it is suggested that such a philosophy enables individual growth and development, empowerment of practitioners and the generation of cultural change that sustains continuous growth and innovation in practice. An example of the framework in use is described and recommendations proposed to enable organizations to embrace a systematic approach to practice development.     

A multidisciplinary approach to self care in chronic pelvic pain

Chronic pelvic pain is one of the most difficult conditions encountered by health professionals working with women both in primary and secondary care. The cause is variable, and for some women a diagnosis is never determined. While it is acknowledged that it is a symptom and not a condition, many women and professionals continue to seek a cause and cure. It is contended that this client group is best supported by a multidisciplinary approach to symptom control that incorporates the skills of the gynaecologist, physiotherapist, nurse, psychologist and pain management specialist. This is often difficult to achieve within a resource-limited environment. An alternative approach is suggested using current resources, which provides patient education and support, thus empowering women to influence their health behaviours and situations.     

Negotiating skills.

The Collins English Dictionary defines negotiation as "a discussion set up or intended to produce a "settlement or agreement." It is a skill everyone uses on a regular basis in daily life; often without realising. A plan to meet friends fo an evening meal for example involves agreeing a time and venue--this is negotiation. As it is the the process of coming to terms with the "other side" and trying to get the best deal possible it is necessary to accept the fact that a conflict of interest does exist. There is an atmosphere of uncertainty until the deal is completed and one side may gain and one may lose relative to their opening position. For this skill to be successfully applied when working with clinical management colleagues, a formal set of guidelines is necessary. In this article I highlight some of the problems which can arise and offer a systematic approach to this difficult but rewarding management activity.     

Narrative inquiry as a research methodology exploring person centred care in nursing

Background

Although, person centred care has for a long time been an important approach to nursing care, it is often not a reality in the clinical environment. The focus of health research has, until recently, been on the physical aspects of a persons’ illness and this has influenced how care is delivered. There is a need to broaden the focus from the illness to the person who is ill. A holistic approach to the persons’ social and cultural experience of their illness will aid health care professions to provide person centred care.This paper will make the argument that narrative inquiry is a well suited to health care research in general and nursing research in particular as it focuses its inquiry on the individual person's experience of their illness – ‘what matters’ from the person's point of view. Narrative inquiry explores the narrative from a temporal, social and spatial view.

Proxy consent to medical treatment: implications for rehabilitation

When a patient is unable to give an informed consent to a proposed therapeutic intervention, the principal health care provider is legally bound to secure a consent to treatment from the patient's legally authorized guardian or proxy. The appointment of a proxy decision-maker is a legal rather than a medical process, and health care providers risk a law suit if it is circumvented. Furthermore, the nature of the proxy appointment, which varies from state to state, is complicated by an absence of well-defined guidelines relating to the conditions under which a proxy is needed, who may serve as a proxy, how the proxy should be selected, and the scope of the proxy's authority. Because rehabilitation serves many incompetent patients, its providers should be intimately acquainted with the laws on appointing proxies so as to protect patient rights and to avoid personal liability.