Midwives' lived experience of caring during childbirth--a phenomenological study.

OBJECTIVE: The aim of this study was to obtain a deeper understanding of midwives' lived experience of caring during childbirth in a Swedish context. METHODS: Ten midwives were recruited from one university hospital with two separate delivery units in western Sweden. Data were collected by both written narratives and interviews. With an inductive approach using a descriptive phenomenological method, the answers to the question: "Can you describe a situation in which you felt that your caring was of importance for the woman and her partner?" were analysed. RESULTS: A general structure of the phenomenon of caring in midwifery during childbirth, including five key constituents: sharing the responsibility, being intentionally and authentically present, creating an atmosphere of calm serenity in a mutual relationship, possessing the embodied knowledge, and balancing on the borders in transition to parenthood. CONCLUSIONS: This study emphasises how the midwives shared the responsibility and their possessed embodied knowledge of childbirth and how new unique knowledge was constructed together with the woman, child and her partner. The study has the potential to increase knowledge and understanding of midwives' lived experience of caring during childbirth and therefore has implications for practice, education, and research.

Patients' experiences of supportive conversation as long-term treatment in a Swedish psychiatric outpatient care context: a phenomenological study.

This study aims to describe patients' experiences of supportive conversation as long-term treatment in a psychiatric outpatient context. A focus group interview was conducted with six female patients (aged 40-60 years). Five key constituents captured the essence of the general structure of supportive conversation: being treated as a responsible person, sensing intimate contact and togetherness, perceiving stability in the relationship, learning to manage daily living, and growing as a person. Supportive conversations have a positive influence on the patient's state of mind and enhance self-confidence, thereby giving the inner strength to grow as a person.

The evolution of midwifery education at the master's level: a study of Swedish midwifery education programmes after the implementation of the Bologna process.

In Europe, midwifery education has undergone a number of reforms in the past few decades. In several countries, it has shifted from vocational training to academic education. The higher education reform, known as the "Bologna process" aimed to create convergence in higher education among a number of European countries and enhance opportunities for mobility, employment and collaborative research. It also indicated a transparent and easily compared system of academic degrees, generating a new educational system in three cycles. This study explores the implementation of the process in Sweden when the midwifery education was transferred from diploma to postgraduate or master's level. The aim of this study was to analyse how the implementation of the Bologna process in the Swedish higher education system has impacted midwifery education programmes in the country. Descriptive statistics and content analysis were employed to analyse 32 questionnaire responses from teachers and the 2009-2010 curricula and syllabi of 11 postgraduate midwifery education programmes at Swedish universities and university colleges. The results revealed variations among the universities at the major subject into the three disciplines; midwifery, nursing and caring with different conceptualisations, even when the content was identical in the curricula to that of the midwifery professional knowledge base. Implementation of the new reform not only has accelerated the academisation process, but also puts higher demand on the students and requires higher competencies among teachers to involve more evidence-based knowledge, seminars, independent studies and a postgraduate degree project in the major subject. Thus the students earn not only a diploma in midwifery, but also a master's degree in the major subject, which affords the opportunity for an academic career. But still there is a tension between professional and academic education.

Nurses' experiences of participation in a research and development programme.

AIMS AND OBJECTIVES: To describe clinical nurses' experience of participating in a Research and Development (R&D) programme and its influence on their research interest and ability to conduct and apply nursing research. BACKGROUND: To stimulate nurses' research interest and to overcome barriers for building research capacity in nursing, there is a need for sustainable research programmes. A two-year programme was designed for nurses, to take part in both an academic education for master and research seminars and workshops to conduct a research project from idea to publication. DESIGN: A qualitative approach using using focus group interviews. METHODS: Registered nurses (n=12) with a bachelor's degree in nursing, participated. Data were collected in focus group interviews, after one year and when the programme ended. Content analysis was used to analyse the data. RESULTS: The findings consist of two themes: being a traveller in the world of nursing research, which included three categories, and experiencing professional growth as a result of nursing research training, in both cases focusing on the experience of students involved in a cohesive programme which included four categories: discovering new dimensions of clinical nursing practice; selected and confirmed; supported by professional others; development of professional self-concept. CONCLUSIONS: To support early career researchers, there is a need for strong leadership, an organisational and supportive infrastructure underpinning research capability building in nurses. In this context, research strategies, programmes and collaboration between leaders of academia and clinical institutions appear to be essential. RELEVANCE TO CLINICAL PRACTICE: The R&D programme illustrates an effective way of stimulating nurses' lifelong learning by building the capacity to conduct and apply nursing research in clinical practice. The structure of the programme can be used as a model in other contexts.

National survey of how acupuncture education is organised for Swedish midwives.

OBJECTIVE: in Sweden, acupuncture education is required before midwives can use the method in clinical practice. Courses in acupuncture are usually organised by private individuals or companies, and each health facility decides on the adequacy of the educational package. Therefore, there is no overall standard or quality control for free-standing courses of acupuncture education for midwives. The aim of this study was to survey the education given to Swedish midwives in the use of acupuncture treatment in the obstetric area. DESIGN: a postal survey using a structured questionnaire. SETTING: organisers of acupuncture education. PARTICIPANTS: 18 acupuncture instructors. MEASUREMENTS AND FINDINGS: acupuncture courses were usually organised outside universities and colleges. The courses were similar in terms of extent and content, and were mainly based on a Western medical approach. The recommended indications were extensive despite a lack of scientific evidence. The most common instructor profile was a midwife without any academic degree. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: courses differed considerably in the extent to which they were research based. Continuing professional education for midwives should be given at the same academic level, at least, as basic midwifery education.

Empowerment in the midwifery context--a concept analysis.

OBJECTIVE: The concept empowerment is difficult to understand, define and translate into different contexts. Therefore, the purpose of this paper was to analyze the empowerment concept in the midwifery context, focused on the childbearing period, aimed at clarifying its meaning in order to enable comprehension and use in clinical practice, education and research. DESIGN: Semi structured interviews and written text. SETTING: Prenatal clinics, delivery and maternity wards in western Sweden. PARTICIPANTS: Nine midwives and 12 couples. MEASUREMENTS AND FINDINGS: A concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review, the concept was empirically elucidated in the fieldwork phase. The final step was to describe criteria and attributes, illustrative cases, antecedents and consequences of the concept. The following tentative criteria and attributes of empowerment in the midwifery context are described: developing a trustful relationship; starting an awareness process, making it possible to reflect on the changing situation; acting based on the parents' situation on their own terms, getting them involved and able to make informed choices; confirming the personal significance of becoming parents. Finally, empowerment in the midwifery context was redefined. KEY CONCLUSION: Midwives use empowerment in education and research as well as strategies on both the micro and macro levels in practice. IMPLICATIONS FOR PRACTICE: Empirical findings from the concept analysis confirm the concept's relevance in the midwifery context.

A national survey of how acupuncture is currently used in midwifery care at Swedish maternity units.

OBJECTIVE: it is not known how acupuncture is used in midwifery care in Sweden and what kind of requirements health-care providers have for midwives and acupuncture training programmes. The aims of this study were to survey indications for the use of acupuncture in midwifery care in Sweden, and to examine the criteria and requirements used for purchase of acupuncture education programmes. DESIGN: a postal survey using a structured questionnaire. SETTING: 45 maternity units in Sweden. PARTICIPANTS: the midwife-in-charge of the units. MEASUREMENTS AND FINDINGS: the most common indications for the use of acupuncture were relaxation, pain relief, retained placenta, after pains, milk stasis during lactation, hyperemesis and pelvic instability. Specific requirement for acupuncture education were provision of a short course during weekdays including a follow-up course. KEY CONCLUSION: acupuncture is widely used for many indications in Swedish maternity units despite weak or no evidence to support effectiveness in midwifery care. Requirements for acupuncture education did not seem to be in accordance with what might be expected for this type of qualified intervention. IMPLICATIONS FOR PRACTICE: the use of acupuncture in midwifery care should not persist until systematic evaluation of the effect of this method is carried through.

Impact of the Bologna process in Bachelor nursing programmes: The Swedish case.

The higher education reform in Europe known as the "Bologna Process" implies further harmonisation and integration of nursing programmes into the higher education system. This study explores this process in Sweden, where the development of nursing education into an undergraduate programme started in 1977. The aim of this study was to analyse characteristics of the major subject and its relationship to other subject areas, such as medical sciences and social sciences, in Bachelor level nursing programmes in Sweden following initial implementation of the Bologna process. A constructivist approach and descriptive content analysis were employed to analyse the 2008 nursing curricula and syllabi of 27 undergraduate programmes at 26 Swedish universities and university colleges. The results revealed variation in terms and concepts used for the major subject as well as its scientific foundation, demarcation between the major subject and other subjects included in the study programmes and its relationship to the profession. These variations are linked to the variety of research orientations under debate in the Scandinavian countries: Nursing Science and Caring Science; representing different knowledge domains, focus, challenges and visions for the discipline. Potential implications of basing curricula on a major subject other than Nursing Science in a Bachelor level nursing programme are highlighted.

Transition to puberty as experienced by 12-year-old Swedish girls.

The purpose of this study was to describe 12-year-old girls' experiences of entering puberty. A qualitative approach was used to gather data from focus group interviews, and content analysis was used to identify common themes from the responses of 18 girls. Findings revealed four main themes: (a) growing up--awareness, bodily changes, longing; (b) mother--a close and important relationship; (c) menarche--a personal and important occurrence; and (d) sex and relationships. Girls sought understanding for their feelings and thoughts during this transition period. Mothers were important to be close at hand and provide understanding. When entering menarche, the girls felt a greater need for integrity. They strongly experienced their sexuality physically and had many questions about sex and their physical changes. They longed to discuss these issues and learn more about sex but stated adults had failed them in this regard because the adults believed the girls were too young for this information. School nurses have opportunities to meet the needs of girls during the transition to puberty.

Research priorities in nursing--a Delphi study among Swedish nurses.

AIMS AND OBJECTIVES: The main aim was to illuminate essential areas for future patient-related nursing research. The secondary aim was to stimulate nurses to explore important research areas based on clinical practice. BACKGROUND: Priority-setting is regarded as one of the main strategies to ensure excellence in nursing science, to direct nursing research and develop healthcare practice accordingly as well as strengthening the nursing profession's research commitment. DESIGN AND METHOD: A three-round Delphi survey was conducted. A panel of 118 clinicians, in various nursing, teaching and administrative positions participated. Ninety-five panel members completed all three rounds (81%). The majority were female, aged 25-67 (mean 49) years, with an average of 23 (range 1-40) years in nursing, working in hospitals (42%), primary healthcare centres, community care (44%) and administration/education (14%). Sixty-six per cent had graduate diplomas and 34% had an academic education, ranging from bachelors' to doctoral degrees. RESULTS: Three hundred and eighty nursing research areas were identified, evaluated and ranked using content analysis and descriptive statistics. The participants' prioritized research aimed at preserving humanistic values and developing cross-organisational collaboration in the healthcare system. Nursing research aimed at preserving human dignity in geriatric care, respectful transfers, continuity of care and exploring the characteristics of a caring encounter were ranked high relative to the patient welfare, to the healthcare organisation and to the nursing profession. CONCLUSIONS: Nurses prioritize research that will improve clinical practice, assure patients' wellbeing and a caring environment. Nurses can reach consensus on the objectives of patient-related nursing research despite differences in age, workplace, educational period and level of academic degree. Relevance to clinical practice. When prioritizing important areas for patient-related nursing research, informed nursing practitioners' commitment initiates knowledge development within clinical practice from a nursing science perspective as well as expanding cross-professional and cross-organisational collaboration.