Newly qualified midwives' transition to qualified status and role: assimilating the 'habitus' or reshaping it?

AIM: to ascribe meaning to the everyday experiences of midwives during their first year of practice as they interact with their social environment. DESIGN: a qualitative, ethnographic study. SETTING: a major maternity department located in the West Country, UK. PARTICIPANTS: seven newly qualified midwives working in the chosen setting. MEASUREMENTS: as befits an ethnographic approach, observant participation and interviews in the field were the selected data collection tools. Reflexivity was at the hub of the research process. A field diary was kept in order to ensure that the researcher took into account both her own perceptions and the interactions with participants and significant others. This paper draws on data that illustrates some of the predispositions that may constitute the midwifery habitus. FINDINGS: the main themes that emerged from the data were in relation to the culture of midwifery, fitting into the culture and determining what type of midwife the neophytes wanted to be ('what is a midwife?'). To enhance transparency, the latter theme is focused upon in this paper using a model that is a synthesis of some of the findings and Bourdieu's notion of habitus. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this research provides insight into the professional and cultural experiences of newly qualified midwives, especially how cultural interactions, education and expectations may shape the midwifery habitus. It would seem that midwives who take a critical and reflective approach to practice are key players in the cultural re-creation of midwifery. Accordingly, to enable the aforementioned approach to practice, it is important that reflective and reflexive practices are an integral part of midwifery education. Nevertheless, the implications for practice are not merely one-dimensional. Observations in the field suggest the importance of making the quality of midwives' working lives a priority by facilitating a more supportive working environment. Moreover, midwives should not be marginalised for preferring to work in the community, the birth centre or the high-risk environment. Future planning of the maternity services needs to consider how a 'being with the woman' approach can be facilitated for all women, balancing the virtues of both the medical and midwifery models of care.

Development of a unique triage system for acute care physical therapy and occupational therapy services: an administrative case report.

BACKGROUND AND PURPOSE: This administrative case report documents the development of a mechanism by which systematic triage was used to assign patients to therapists in acute care settings. The primary objective was to develop a triage tool to improve patient access to medically necessary therapy services. CASE DESCRIPTION: A unique triage tool and a decision tree were developed to determine which patients referred to therapists for acute care therapy required skilled services. The triage tool was used to examine therapy referrals for patients from 2 large academic hospitals; 6 criteria were used to determine which evaluations should be cancelled. During the trial period, the predictive ability of individual triage criterion items was analyzed, the tool was modified and validated, and a decision tree was established. Descriptive and chi-square analyses were performed on all variables of interest. OUTCOMES: The systematic triage system reduced the number of therapy evaluations that were not appropriate by 29%, resulting in an improvement in the availability of therapy services for patients who required skilled care. The average number of patients per therapist per workday decreased from 18.9 to 12.1 and from 15.1 to 12.8 in the 2 hospitals. An improvement in a newly developed "workload index" related to missed patient visits also indicated the success of this project. DISCUSSION: A novel systematic triage system reduced the number of therapy evaluations that were not appropriate, resulting in an improvement in the availability of therapy services for patients who require skilled intervention.

Expedited wound healing with noncontact, low-frequency ultrasound therapy in chronic wounds: a retrospective analysis.

OBJECTIVE: To evaluate the clinical role of noncontact, low-frequency ultrasound therapy (MIST Therapy System; Celleration, Eden Prairie, Minnesota) in the treatment of chronic lower-extremity wounds. DESIGN: A retrospective observational study. SETTING: A multidisciplinary, vascular wound-healing clinic. PATIENTS: One hundred sixty-three patients who received MIST Therapy plus standard of care (treatment group) and 47 patients who received the standard of care alone (control group). INTERVENTIONS: All wounds in the control and treatment groups received the standard of wound care and were followed for 6 months. In the treatment group, MIST Therapy was administered to wounds 3 times per week for 90 days or until healed. MAIN OUTCOME MEASURES: Proportion of wounds healed and wound volume reduction. Rate of healing was also quantified using 1-way analysis of variance to determine the slope of the regression line from starting volume to ending volume, where a steeper slope indicates a faster healing rate. Outcomes were evaluated in all wounds and etiology-specific subgroups. MAIN RESULTS: A significantly greater percentage of wounds treated with MIST Therapy and standard of care healed as compared with those treated with the standard of care alone (53% vs 32%; P = 0.009). The slope of the regression line in the MIST arm (1.4) was steeper than the slope in the control arm (0.22; P = .002), indicating a faster rate of healing in the MIST-treated wounds. CONCLUSION: The rate of healing and complete closure of chronic wounds in patients improved significantly when MIST Therapy was combined with standard wound care.

Use of a modified tilt table for preambulation strength training as an adjunct to burn rehabilitation: a case series.

Because of the system-wide complications that arise with prolonged bed rest, early mobilization plays a critical role in the recovery process, especially in the patient with significant burn injury. Unfortunately, early mobilization of patients with severe burns can be a difficult and uncontrolled task and often requires several people to lift a patient to a standing position. This article describes the use of a modified tilt table that allows patients to perform a weight-bearing exercise, such as an inclined squat, in a gravity-reduced environment. Use of the modified tilt table may offer a more suitable therapeutic option when treating critically ill patients by providing a safe and controlled transition from bed rest to ambulation. Perhaps most importantly, the table appears to provide psychological benefits by empowering the patient to take more of an active role during the early stage of recovery.