Personal control in pain relief during labour.

Personal control is a central feature of women's involvement in their childbirth experiences. To achieve this control tacit rules and guidelines are applied to define how women and the professionals who care for them should behave. This study investigated the extent to which women exercised control in pain relief during the first stage of labour by comparing (a) the rules which they held prior to childbirth (2-3 cm cervical dilatation) with those which they afterwards felt applied to their labour and (b) the rules held by the women before and after childbirth with those held by the midwives. In a quantitative study using a repeated measures design, a questionnaire was administered to 35 midwives and to 100 women prior to and within 24 hours following their delivery. Consistency of the women's scores before and after childbirth, indicated by few statistically significant differences, tended to confirm their rules on control of pain relief. Some of the rules were held even more strongly following childbirth. A surprising finding was the even stronger agreement by midwives with some of the rules. There was a definite trend for many of the rules held by the women prior to childbirth to increase following birth towards those of the midwives. This could be the result of the experience of childbirth per se but the possibility that it was contributed to by the influence of the midwives cannot be ruled out and warrants further research. An interesting hierarchy in the rules for compliance with professional care has been highlighted.

Psychosocial factors influencing personal control in pain relief.

A questionnaire was administered to 100 women (50 primigravidae, 50 multigravidae) to investigate the influence of psychosocial factors on personal control in pain relief. Personal control was measured using a 36-item scale based on the concept of 'Rule'. The women were asked to rate each rule on a 7-point Likert scale. Measures of psychosocial factors included assessment of the women's expectations of labour pain, maternal confidence, pain intensity, antenatal training and partner support. Demographic variables including parity were also recorded. The questionnaires were completed prior to and within 48 h following the women's delivery (whilst they were inpatients on the postnatal ward).Two variables, antenatal training and pain intensity, emerged as predictors of personal control in pain relief following stepwise multiple regression analysis. These findings have implications for clinical practice particularly in the area of antenatal care and planning care during labour.

Student midwives' learning experience on the wards.

This paper is based on an investigation into the learning experiences of student midwives in the clinical setting in one maternity unit in the Republic of Ireland. A questionnaire approach was adopted for the data collection and 42 student midwives participated in the study. A number of factors were identified which appear to influence students' experiences of 'learning on the job'. The quality of their clinical teaching and their observations of the way in which trained staff practise midwifery may influence their decision to continue practising midwifery following registration. These findings clearly point to the importance for midwives to reassert their true role as 'independent practitioners' of normal maternity care.

Midwife/client relationship: midwives' perspectives.

This study set out to explore midwives' understanding of the factors which affected the development of a therapeutic relationship with clients. A qualitative approach was adopted for the study to avoid placing predetermined categories upon midwives' perceptions. Because of the qualitative nature of the study in-depth interviews were conducted to allow midwives to explore in depth their perceptions of the research topic. Themes identified within the interview data indicated conflicting needs/interests which in turn seemed to cause dilemmas for the midwives interviewed. It seemed appropriate therefore to take the data analysis one step further by utilising dilemma analysis. Consideration of the situations in which the midwives experienced 'good' or 'poor' relationships revealed a complex picture of the factors affecting relationships with clients. Four main issues were identified: the nature and value of the midwives' role; recognition of authority/autonomy in practising this role; emotional involvement with clients; and maintaining personal integrity. From dilemma analysis of the data it appears that when midwives were successful in managing these issues then the relationship became 'special' and therapeutic for clients. Mismanagement of these issues in contrast led to dilemmas which then inhibited development of meaningful relationships between the midwives and clients. In view of the fact that clients and midwives value this 'special' relationship a case is made for midwives to be prepared educationally to manage effectively issues which are raised in their everyday practice. Only then will the midwife/client relationship become therapeutic.

Stoma care: the patient's perspective.

This was a qualitative study, the design of which was based on ideas from the grounded theory approach to data collection and analysis. The study examined the concept of human needs from the perspectives of individuals who have an ileostomy or a colostomy and attempted to ascertain their evaluation of the way in which their needs were fulfilled during the time they spent in hospital. Respondents consisted of a convenience sample of six individuals who had recent experience of surgery involving the formation of a stoma. Data were collected through unstructured, non-directive interviews. Analysis of data involved identification of themes and categories that emerged from the transcripts of the interviews. Findings indicated that while individuals' physical needs were met, their psychological and sociocultural needs were not identified. This seems to imply that nurses may not be aware of the relevance of these needs to individuals who have an ileostomy or a colostomy. Since respondents identified the existence of a good relationship with nurses as being conducive to the fulfillment of these needs, it could be inferred that nurses may lack the skills that are necessary to develop a good relationship with those who are in their care.

Motivation for continuing education in midwifery.

Continuing education is increasingly recognised as vital for the improvement of health care. This paper discusses the findings of a study carried out to investigate whether practising midwives working in selected hospitals in Northern Ireland are motivated to participate in continuing education. A questionnaire approach was used to investigate 60 midwives of ward sister/staff midwife grades. Quantitative data were enhanced with information from semi-structured interviews. Midwives in this study conceptualised continuing education as both formal and informal learning experiences. Despite variations in the views they held of the value of continuing education to themselves, all respondents identified continuing education as being important for professional reasons. The findings suggest that midwives lack motivation to participate in informal and formal continuing education. However, the findings also indicate that encouragement and support from managers, adequate provisions of educational facilities, social responsibility and having to work night duty/part-time may influence midwives' ability to participate in available continuing education programmes. In conclusion the findings highlight the need for an effective staff appraisal system and the provision of a range of opportunities (formal and informal) for continuing education to motivate midwives to continue their education.