'After last time, would you trust them?' - Rebuilding trust in midwives after a traumatic birth.

AIM: To explore the processes pregnant women used to rebuild their trust in midwives and obstetricians, after a previous traumatic birth. DESIGN: A longitudinal feminist constructivist Grounded Theory methods study, using semi-structured interviews to investigate how women made sense of their journeys through pregnancy and maternity care, when they had previously experienced a traumatic birth. SETTING: Nine UK women were recruited in early pregnancy via the internet and social media, and were interviewed three times during the perinatal period. FINDINGS: During pregnancy, participants re-analysed their previous birth experience(s) in order to plan for this pregnancy and birth. Once they had conceptualised their plans, they sought out healthcare professionals who could offer support, and used naturally occurring or engineered trust diagnostic situations to establish whether trust could be rebuilt. CONCLUSION: Without a trusting relationship, midwives and obstetricians cannot deliver appropriate and efficient healthcare to pregnant people. Understanding the processes that pregnant women utilise to rebuild trust may help healthcare professionals to better understand their role in re-establishing these relationships.

Women's experiences of using the Alexander Technique in the postpartum: ' in a way, it's just as beneficial as sleep'.

BACKGROUND: The postpartum is a transitional period and potentially challenging time of heightened vulnerability for women where self-care is compromised. Mothers can ignore their needs while prioritising baby care. The Alexander Technique (AT) is a holistic self-management technique shown to be effective in managing some psycho-physical tension issues and heightening self-efficacy and self-care. The AT has potential to help compromised aspects of maternal well-being in the postpartum. OBJECTIVE: To explore how women familiar with the AT use it for the key postpartum issues of Sleep and rest, one of three superordinate themes identified in a qualitative interview study. DESIGN: Semi-structured interviews via Skype. RESEARCH APPROACH: Interpretative Phenomenological Analysis. PARTICIPANTS: Seven women, with varying levels of AT experience, 4-13 months postpartum. FINDINGS: Participants used a variety of self-care strategies through modifying their self-management with respect to Sleep and rest. Identified sub-themes were the 'knitting' of maternal and infant sleep, how participants rested using the AT and recognising maladaptive habits. KEY CONCLUSIONS: Further research into the AT as an approach to supporting perinatal well-being is warranted. IMPLICATIONS FOR PRACTICE: The AT has significance for self-management, self-care, addressing maternal needs for rest, restorative sleep as well as tension issues in the postpartum.

A systematic exploration of a perinatal wellbeing framework through women's experiences of lumbo-pelvic pain.

BACKGROUND: Women's wellbeing during the perinatal period has received increasing attention in research, policy and practice, but is often poorly defined and conceptualised. We have developed a framework of perinatal wellbeing (PWB) which we will refine further in this review, using the example of lumbo-pelvic pain (LPP). Perinatal LPP, which includes lower back pain (LBP) and pelvic girdle pain (PGP), is common and can significantly affect women's wellbeing. AIM: The aims of this review are (1) to synthesise research into women's experiences of LPP and (2) to use these findings to contribute further to developing our framework of PWB. DESIGNS AND METHODS: A systematic search of online databases was conducted for qualitative studies exploring women's experiences of LPP linked to the perinatal period; 15 papers describing 11 studies were identified. A framework synthesis approach (Carroll et al., 2011; Carroll et al., 2013) was used to synthesise studies, using the PWB framework as the a priori framework. FINDINGS: The review highlights the impact of LPP on all areas of women's lives and their functioning at every level, as well as the impact of a range of factors on women's experiences. Only one study explored women's experiences of LBP, all others focused on PGP. Findings illustrate how multi-faceted women's wellbeing is in the context of LPP, particularly the importance of relationships and support, but also the role played by wider socio-cultural discourses of pregnancy and motherhood and by women's individual circumstances and characteristics. Findings underline the interconnectedness of physical, emotional and psychological experiences. The review largely confirmed, and further elaborated, the domains of the original framework, but also led to some changes, notably the inclusion of an 'individual factors' domain describing women's individual circumstances and characteristics. The limited discussion of LPP during labour and birth was notable. CONCLUSIONS AND IMPLICATIONS: Findings support the framework, but also provide evidence for some changes, thus further refining the framework. Women's wellbeing in the perinatal period (with regards to LPP, other issues, or generally) should not be considered in isolation, but needs to take account of women's life context. The perinatal period should be considered a continuum, rather than seeing each part in isolation. For clinical practice, the review underlines the importance of distinguishing between PGP and LBP and offering appropriate, individualised support.

Healthy ageing in a deprived northern UK city: A co-creation study.

With ageing comes an increased risk of poor health and social isolation, particularly in poorer populations. Older people are under-represented in research and as a result interventions may not take account of their context or barriers to participation. In co-creative work, future service users work with professionals on an equal basis to design, develop and produce a service or intervention. Our objectives were to (a) undertake a co-creation study with older people living in a northern city in the United Kingdom, (b) explore maintenance of health and well-being in older age, (c) explore the application of co-creation with an older community population and (d) evaluate the process and inform future work. The study was conducted during 2017 by a project team of 10 lay community dwelling older people and four university researchers. Findings demonstrate that state of mind and of health were key to well-being in older age. Feeling safe, comfortable and pain free were important along with being able to adapt to change, have choice and a sense of personal freedom. Social connectedness was seen as the keystone to support healthy behaviours. Rather than developing new interventions, there was a perceived need to connect people with existing resources and provide a human 'bridge' to address barriers to accessing these. In conclusion, the co-creation process proved productive, even when undertaken on a small scale. The scope of the project needs to be realistic, to use diverse methods of recruitment and skilled facilitators, and to prepare well in terms of accessibility, simple systems and appropriate information provision.

Conceptualising women's perinatal well-being: A systematic review of theoretical discussions.

BACKGROUND: Perinatal well-being has increasingly become the focus of research, clinical practice and policy. However, attention has mostly been on a reductionist understanding of well-being based on a mind-body duality. Conceptual clarity around what constitutes well-being beyond this is lacking. AIM: To systematically review theoretical discussions of perinatal well-being in the academic literature. DESIGN AND METHODS: A search of online databases identified papers which discussed perinatal well-being theoretically, taking a multi-dimensional approach to well-being. Thematic synthesis was used to identify and synthesize relevant elements within the included papers. FINDINGS: Eight papers were identified for inclusion in this review. All contributed a number of elements towards a theoretical discussion of perinatal well-being. Three themes were developed: (1) the importance of a number of general domains of women's lives and domains specific to the perinatal period, (2) well-being as a subjective and individual experience with physical/embodied, affective, and psychological/cognitive aspects, and (3) the dynamic nature of well-being. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Perinatal well-being is a complex, multi-dimensional construct. Current theoretical discussions in the academic literature do not provide a comprehensive model or conceptualisation covering all aspects of well-being during the perinatal period. Further theoretical work is required, particularly with regards to theorising well-being during labour and birth, the perinatal period as a continuum, and the role played by women's expectations. The themes identified in this review contribute to a tentative model of perinatal well-being, taking note particularly of the dynamic nature of well-being. This model should be refined and validated through empirical work and can then be used to underpin further research and the development of a multi-dimensional measure of perinatal well-being.

"It Can't Be Like Last Time" - Choices Made in Early Pregnancy by Women Who Have Previously Experienced a Traumatic Birth.

Background: A significant number of women experience childbirth as traumatic. These experiences are often characterized by a loss of control coupled with a perceived lack of support and inadequate communication with health care providers. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them. Methods: A longitudinal grounded theory methods study involving nine women was conducted. Over half of the participants had a formal diagnosis of post-traumatic stress disorder (PTSD) and/or PND related to the previous birth. Interviews were carried out at three timepoints perinatally. These findings are from the first interviews at 12-20 weeks. Results: From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analyzing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective cesareans to freebirth. Some women felt well supported by those around them, including care providers, partners, friends, and family. Others did not feel supported and were anticipating conflict in trying to assert their birth choices. Many early relationships with healthcare professionals were characterized by fear and mistrust. Discussion: If women who have previously experienced a traumatic birth become pregnant again, they have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with care providers at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control.

Hospital staff experiences of their relationships with adults who self-harm: A meta-synthesis.

PURPOSE: This review aimed to synthesize qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self-harm. METHODS: Nine studies were identified from a systematic search of five research databases. Papers included the experiences of physical health and mental health staff working in inpatient settings. The studies employed various qualitative research methods and were appraised using an adapted quality assessment tool (Tong, Sainsbury, & Craig, 2007). A meta-synthesis was conducted using traditional qualitative analysis methods including coding and categorizing data into themes. RESULTS: Three main themes derived from the data. 'The impact of the system' influenced the extent to which staff were 'Fearing the harm from self-harm', or were 'Working alongside the whole person'. A fear-based relationship occurred across mental health and physical health settings despite differences in training; however, 'Working alongside the whole person' primarily emerged from mental health staff experiences. Systemic factors provided either an inhibitory or facilitative influence on the relational process. CONCLUSIONS: Staff experiences of their relationship with people who self-harm were highlighted to have an important impact on the delivery and outcome of care. Increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self-awareness within the relationship may lead to a more mutually beneficial experience of care. Equally, structure, clarity, and support within inpatient systems may empower staff to feel more confident in utilizing their existing skills. PRACTITIONER POINTS: Working with people who self-harm can be emotionally challenging and how staff cope with this can significantly impact on the engagement of staff and patients. Increasing the skills of staff in managing relational issues and tolerating distress, as well as providing support and reflective practice groups may be useful in managing emotional responses to working with people who self-harm. Refining the supportive, procedural, and environmental structures surrounding the caregiving relationship may help enable better integration of physical and mental health care.

A qualitative exploration of responses to self-compassion in a non-clinical sample.

Research suggests that being self-compassionate can have myriad benefits, including life satisfaction, health-promoting behaviours and improved mental health. Given the possible advantages of being self-compassionate, it seems critical to explore how to promote this in the general population. This qualitative study aimed to understand responses to the idea of being compassionate to oneself within the general population. Semi-structured interviews were conducted in the North East of England between October 2014 and February 2015, they were analysed using thematic analysis. As part of an intervention study, non-clinical volunteers watched a psychoeducation video about the concept of self-compassion and then participated in one of four meditation exercises. Following this, participants were interviewed about their responses to the idea of being self-compassionate. Three themes were identified: Benefits of Self-Compassion; Being Self-Compassionate and Barriers to Self-Compassion. Participants believed that being self-compassionate would be beneficial, for both themselves and the world, but they believed that self-compassion would make them vulnerable and that others would judge them. Thus, participants were afraid to be the first ones to be self-compassionate and stated that, in order for self-compassion to be acceptable, we need to change the perspective of western culture. These findings underscore the importance of understanding society's role in a person's ability to be self-compassionate. In order to reap the benefits of self-compassion, we need to create a culture that accepts and encourages this. As practitioners, we are in a position to lead in self-compassion and to encourage other leaders to promote this as a preventative mental health strategy.

The psychological impact of overactive bladder: A systematic review.

This review aimed to provide an overview of the current research on the psychological impact of overactive bladder. A systematic search yielded 32 papers. It was found that people with overactive bladder tended to have greater levels of depression, anxiety and embarrassment/shame; difficulties with social life; impact on sleep and sexual relationships; and a lower quality of life than people without overactive bladder. A psychological impact on family members was also found. Psychological health should be considered an important aspect of managing overactive bladder and further research is required to determine how best to provide psychological care and support in this area.

Food choice by people with intellectual disabilities at day centres: A qualitative study.

People with intellectual disabilities experience a range of health inequalities. It is important to investigate possible contributory factors that may lead to these inequalities. This qualitative study identified some difficulties for healthy eating in day centres. (1) Service users and their family carers were aware of healthy food choices but framed these as diets for weight loss rather than as everyday eating. (2) Paid carers and managers regarded the principle of service user autonomy and choice as paramount, which meant that they felt limited in their capacity to influence food choices, which they attributed to the home environment. (3) Carers used food as a treat, a reward and for social bonding with service users. (4) Service users' food choices modelled other service users' and carers' choices at the time. It is suggested that healthy eating should be made more of a priority in day care, with a view to promoting exemplarily behaviour that might influence food choice at home.

An exploration of pregnant teenagers' views of the future and their decisions to continue or terminate their pregnancy: implications for nursing care.

AIMS AND OBJECTIVES: To explore teenagers' views of the future in relation to their choices to continue or terminate pregnancy. BACKGROUND: Despite recent decreases in the numbers of teenage pregnancies, across the world, the teenage pregnancy rate remains high. Consideration of views of the future (future orientation) appears to play an important part in teenage girls' decisions to continue with pregnancy. To date, no study has explored this in teenage pregnant girls at the time they make their decision to continue with or terminate their pregnancy. DESIGN: Cross-sectional mixed methods design. METHODS: Three groups were included: termination of pregnancy (n = 19), antenatal (n = 9) and never pregnant (n = 23). Participants were 13-18 years old. The termination of pregnancy and antenatal groups were interviewed, and the never pregnant group completed postal questionnaires. RESULTS: Groups differed in individual aspects of future orientation, that is, education, career and family, and reasons for pregnancy resolution choice. The termination group had more clearly developed and longer-term plans for the future with a focus on career. The never pregnant group shared aspects of their future orientation with both the antenatal and termination of pregnancy groups. The impact of negative discourses about teenage pregnancy from others was identified as a significant issue. CONCLUSIONS: How pregnant teenage girls view the future has a relationship with their decision to terminate or continue with their pregnancy. RELEVANCE TO CLINICAL PRACTICE: The findings suggest that working with teenage girls to clarify their views of the future may be useful both in preventing future unwanted pregnancy and in supporting teenagers in making pregnancy decisions. Supporting pregnant teenagers in distancing themselves from negative stereotypes of teenage mothers may also be beneficial.

Targeted group-based interventions in schools to promote emotional well-being: a systematic review.

The school environment offers significant opportunities to deliver psychological interventions to groups of young people in the UK. However, the nature and effectiveness of programmes are not consistently documented. This systematic review aimed to identify and examine group-based interventions delivered in UK schools. Sixteen papers describing eight interventions were included. It was found that nurture groups have an immediate positive impact on the social and emotional well-being of young people. Results from follow-up studies are less clear, and limited by a high level of sample attrition. The findings reported in relation to social and emotional aspects of learning, cognitive, behavioural and social skills based interventions were limited as each intervention is only evaluated by one paper. The review highlighted a need to implement well-designed, longitudinal studies with larger samples in order to evaluate which interventions are effective in UK schools.

The impact of pre-treatment weight-loss expectations on weight loss, weight regain, and attrition in people who are overweight and obese: a systematic review of the literature.

PURPOSE: Research exploring the relationships between initial weight-loss expectations with actual outcome in terms of weight loss, weight regain, and attrition/attendance suggests contradictory findings. The purpose of this review was to collate research exploring the impact of weight-loss expectations on weight loss, weight regain, and attendance/attrition. It was hoped this would further the current understanding of the relationship between expectations and outcome. METHODS: PsychInfo, Medline, and Web of Science were systematically searched and 13 relevant papers were identified. To be included for review, studies had to assess and analyse weight-related expectations; distinguish between higher and lower expectations; include participants who were aged over 18 and attempting to lose weight; be published within a peer-reviewed journal between 1990 and 2010. Findings were analysed qualitatively. RESULTS: Findings were largely unclear. The relationship between expectations and weight loss appears to change with time, whilst the findings from studies looking at weight regain suggest that there is no association. The relationship between expectations with attendance/attrition is also unclear. CONCLUSIONS: Through reviewing literature regarding the relationships between expectations with various outcomes, a number of discrepancies emerged. Exploration of these discrepancies enabled an understanding to be developed of the complex relationship between expectations and weight-loss treatment outcome. The importance of the terminology used and the ways in which expectations are assessed is discussed and future areas of research are suggested.

Lower urinary tract symptoms in men: self-perceptions and the concept of bother.

OBJECTIVE: To explore the meaning that men attach to their experiences of having lower urinary tract symptoms (LUTS) and to understand 'bother' in the context of those meanings. PATIENTS AND METHODS: Sixteen men with symptoms suggestive of LUTS and/or an enlarged prostate were recruited from the outpatient urology clinic of a London teaching hospital. They were assessed before or shortly after their first appointment, during which demographic information, including age, occupation, marital status and ethnicity, was obtained and an individualized repertory grid was completed. Each man also completed the International Prostate Symptom Score, which included an item measuring overall bother, and the Hospital Anxiety and Depression Scale. RESULTS: Most participants held very negative views about what it meant to have prostate problems and viewed them as being associated with old age. Nevertheless, they also had reasonably high levels of self-esteem. However, there was evidence that these had been higher before they had prostate problems, and that self-esteem might decline over time. Bother was related to symptom scores and to anxiety. Also, a perception that other people, particularly their partner, saw them in a more negative light because of their symptoms was associated with higher levels of bother. CONCLUSIONS: The findings suggest that men attempt to preserve a sense of a relatively youthful and intact 'self' in the face of advancing years and a progressive disease that was viewed as being associated with old age. Overall, these men had a reasonably secure self-image and they deployed a range of cognitive strategies to maintain this. Bother appears to be a combination of symptom severity, psychological distress, negative evaluations of the condition and beliefs about the reactions of others. Reducing anxiety and challenging negative stereotypes and expectations that others would view them negatively if their problems were known might reduce bother. Attending to these factors could enable watchful waiting to be optimized by reducing bother. Trials to evaluate interventions drawing on these principles would be valuable.

Returning home after intensive care: a comparison of symptoms of anxiety and depression in ICU and elective cardiac surgery patients and their relatives.

OBJECTIVE: This study gathered data on symptoms of anxiety and depression in patients and relatives after discharge from intensive care and examined whether the intensive care population differ from an elective cardiac surgery group with regards to their anxiety and depression symptom reporting. DESIGN AND SETTING: A single measurement point matched group comparison study in an ICU follow-up programme. PATIENTS AND PARTICIPANTS: Twenty ICU patients and their relatives and a matched comparison group of 15 elective cardiac surgery patients and their relatives. MEASUREMENTS AND RESULTS: Patients and relatives completed the Hospital Anxiety and Depression Scale. Relatives answered an open question to explore the perceived impact of Intensive care/cardiac surgery on their lives. ICU patients' relatives reported significantly higher number of symptoms of anxiety than did ICU patients, higher number of symptoms of depression than cardiac surgery patients' relatives, and more troubling and life-altering experiences than the relatives of cardiac surgery patients. CONCLUSIONS: Relatives of ICU patients also suffer anxiety and depression, and services should address this need. Group differences suggest that ICU patients' relatives have "unique" characteristics of depression symptom reporting.

Men's experiences of having lower urinary tract symptoms: factors relating to bother.

OBJECTIVE: To gain an understanding of men's experiences of having lower urinary tract symptoms (LUTS) and of bother, a principle determinant of whether a patient has an intervention for LUTS. PATIENTS AND METHODS: Data were collected on 75 patients with LUTS presenting to a urology outpatient clinic. Men completed a questionnaire asking about their symptoms, bother, mood and perceptions about LUTS. RESULTS: Most participants scored within the normal range for anxiety and depression, and expressed a moderate level of distress. They were to some extent bothered by their symptoms. Most men perceived LUTS as a long-term problem but felt unable to control their symptoms. The results suggest that bother reflects men's overall distress with having LUTS. Bother appears to be related to symptom severity, self perception, social limitation and the impact of LUTS. Embarrassment and social anxiety relate strongly to bother. CONCLUSION: Several psychological factors relate to bother; it may be possible to reduce bother using a brief psychological intervention.

Masculinity, infertility, stigma and media reports.

There is growing concern about the health of men in the developed West. Compared with women they have higher rates of morbidity and mortality and are less likely to seek out and employ medical services. Several authors have drawn on social constructionist models, such as the concept of hegemonic masculinity, to account for these gender differences in risk and behaviour. One might anticipate that certain conditions, such as male infertility, would be perceived as posing a particular threat to conventional views of masculinity. There is some support for this, although there is little research into the social construction of male infertility. In this study Discourse Analysis was employed to analyse newspaper accounts of a reported decline in sperm counts in order to study the way in which infertility and masculinity were represented and constructed in the media. The results indicate a construction of fertility as being in crisis and of male infertility as conflated with impotence. Men were positioned as vulnerable and threatened by forces outside their control. The accounts drew on a range of stereotypically masculine reference points, such as warfare and mechanical analogies. These results are consistent with concepts of hegemonic masculinity and suggest that men are offered a highly restricted set of options in terms of perceiving and representing their bodies and their health.

Men and chronic illness: a qualitative study of LUTS.

In order to determine how men react to and manage chronic conditions 16 men with Lower Urinary Tract Symptoms (LUTS) were interviewed to examine the relationship between detecting symptoms and seeking medical help, perceptions of symptoms and the impact of symptoms on daily life. Transcripts were analysed employing IPA and four major themes identified: Uncertainty/Trying to understand, Implications, Ways of coping and Self-concept/Identity. Uncertainty about the nature and origins of their condition and its gradual onset contributed to the delay in seeking medical advice. Men adopted a range of coping strategies to manage their symptoms. Implications for primary health care consultations are considered.