No second chance: junior neonatal nurses' experiences of caring for babies at the end-of-life and their families

Death of an infant is acutely stressful for parents and professionals. Little is known about junior nurses' experiences providing end-of-life care in Neonatal units (NNU). This study aimed to better understand junior nurses' experiences providing end-of-life care in NNU. Neonatal nurses (n = 12) with less than 3 years experience participated in a focus group. Nominal Group Technique (NGT) was used to build consensus around the challenges faced, alongside suggested developments in improving future care provision. Primary analysis involved successive rounds of ranking and decision-making whilst secondary analysis involved thematic analysis. All issues, whether environmental, professional or social appeared driven by an awareness on the part of nurses, that there was no ‘second chance’ which created a huge pressure to ‘get if right’ for the infants and families. Regarding future care 2 areas of improvement identified were ‘Education and Training’ and Support. This paper unpacks these findings making recommendations for practice.

No second chance: the experiences of junior neonatal nurses in providing end-of-life care for babies and families in the NNU

Background

An infant’s death is acutely stressful for parents and professionals. Little is known about junior nurses’ experiences providing end-of-life care in Neonatal Units (NNU).

Objectives

To better understand junior nurses’ experiences providing end-of-life care in NNU, the study explored the challenges and opportunities inherent in their practice relating to providing such care to babies and their families.

Methods

Neonatal nurses (n=12) with less than 3 years’ experience who were undergoing a neonatal education programme participated. Two focus groups were convened each with 6 nurses. The Ethics Committee at the relevant University approved the study. Nominal Group Technique (NGT) was used in the focus groups to build consensus around the challenges faced by junior nurses, alongside suggested developments in improving future care provision. Primary analysis involved successive rounds of ranking and decision making whilst secondary analysis involved thematic analysis.

Results

The study identified the pressures these nurses felt in having only one chance to ‘get it right’ for the infants and their families. They perceived the need for further ‘education and training’ highlighting that improved education provision would include both additional courses and internal training sessions. Greater ‘support’ from mentors themselves more experienced in this aspect of care within the NNU was identified as important in addressing issues around confidence building and skill development.

Conclusions

The results highlight junior nurses’ need for specific education and mentorship around end-of-life care for babies. This presentation will outline the implications for practice, education and further research.

Effects of time-controlled and continuous grazing on total herbage mass and ground cover

Grazing practices in rangelands are increasingly recognized as a management tool for environmental protection in addition to livestock production. Long term continuous grazing has been largely documented to reduce pasture productivity and decline the protective layer of soil surface affecting environmental protection. Time-controlled rotational grazing (TC grazing) as an alternative to continuous grazing is considered to reduce such negative effects and provides pasture with a higher amount of vegetation securing food for animals and conserving environment. To research on how the grazing system affects herbage and above ground organic materials compared with continuous grazing, the study was conducted in a sub-tropical region of Australia from 2001 to 2006. The overall results showed that herbage mass under TC grazing increased to 140% in 2006 compared with the first records taken in 2001. The outcomes were even higher (150%) when the soil is deeper and the slope is gentle. In line with the results of herbage mass, ground cover under TC grazing achieved significant higher percentages than continuous grazing in all the years of the study. Ground cover under TC grazing increased from 54% in 2003 to 73%, 82%, and 89% in 2004, 2005, and 2006, respectively, despite the fact that after the high yielding year of 2004 herbage mass declined to around 2.5 ton ha^(−1) in 2005 and 2006. Under continuous grazing however there was no significant increase over time comparable to TC grazing neither in herbage mass nor in ground cover. The successful outcome is largely attributed to the flexible nature of the management in which grazing frequency, durations and the rest periods were efficiently controlled. Such flexibility of animal presence on pastures could result in higher water retention and soil moisture condition promoting above ground organic material.

Memory Bias for Anxiety Prior to Academic Achievement Situations: Influences of Time, Mood, Personality and Post-Event-Processing

The current thesis examines memory bias for state anxiety prior to academic achievement situations like writing an exam and giving a speech. The thesis relies on the reconstruction principle, which assumes that memories for past emotions are reconstructed rather than stored permanently and accurately. This makes them prone to memory bias, which is af-fected by several influencing factors. A major aim is to include four important influencing factors simultaneously. Early research on mood and emotional autobiographical memory found evidence for the existence of a propositional associative network (Bower, 1981; Col-lins & Loftus, 1975), leading to mood congruent recall. But empirical findings gave also strong evidence for the existence of mood incongruent recall for one’s own emotions, which was for example linked to mood regulation via mood repair (e.g. Clark & Isen, 1982), which seems to be associated to the personality traits extraversion and neuroticism (Lischetzke & Eid, 2006; Ng & Diener, 2009). Moreover, neuroticism and trait anxiety are related to rumination, which is seen as negative post-event-processing (e.g. Wells & Clark, 1997). Overall, the elapsed time since the emotional event happened should have an impact on recall of emotions. Following the affect infusion model by Robinson and Clore (2002a), the influence of personality on memory bias should increase over time. Therefore, three longitudinal studies were realized, using naturally occurring as well as laboratory settings. The used paradigm was equivalent in all studies. Subjects were asked about their actual state anxiety prior to an academic achievement situation. Directly after the situation, cur-rent mood and recall of former anxiety were assessed. The same procedure was repeated a few weeks later. Personality traits and post-event-processing were also assessed. The results suggest a need to have a differentiated view on predicting memory bias. Study 1 (N = 131) as well as study 3 (N = 53) found evidence for mood incongruent memory in the sense of mood repair and downward regulation as a function of personality. Rumination was found to cause stable overestimation of pre-event anxiety in study 2 (N = 141) as well as in study 3. Although the relevance of the influencing factors changed over time, an increasing relevance of personality could not consistently be observed. The tremendously different effects of the laboratory study 2 indicated that such settings are not appropriate to study current issues. Theoretical and psychotherapeutically relevant conclusions are drawn and several limitations are discussed.

What is health and what is important for its achievement? : A qualitative study on adolescent boys’ perceptions and experiences of health

Few qualitative studies have explored adolescent boys’ perceptions of health. Aim: The aim of this study was therefore to explore how adolescent boys understand the concept of health and what they find important for its achievement Methods: Grounded theory was used as a method to analyse interviews with 33 adolescent boys aged 16 to 17 years attending three upper secondary schools in a relatively small town in Sweden. Results: There was a complexity in how health was perceived, experienced, dealt with, and valued. Although health on a conceptual level was described as ‘holistic’, health was experienced and dealt with in a more dualistic manner, one in which the boys were prone to differentiate between mind and body. Health was experienced as mainly emotional and relational, whereas the body had a subordinate value. The presence of positive emotions, experiencing self-esteem, balance in life, trustful relationships, and having a sense of belonging were important factors for health while the body was experienced as a tool to achieve health, as energy, and as a condition. Conclusion: Our findings indicate that young, masculine health is largely experienced through emotions and relationships and thus support theories on health as a social construction of interconnected processes. 

Students' views on the learning of kanji : A study the views and experiences of students at the Swedish universities concerning the teaching and learning of Chinese characters as used in Japanese

Kanji, the Chinese characters adopted to write the Japanese language, is often mentioned as one of the most difficult aspects of mastering said language. This is especially said about people from outside the Sinosphere i.e. PRC, Taiwan, North and South Korea, Japan and Vietnam. In the following thesis 12 students studying the Japanese language at Swedish universities were interviewed about their experiences when it comes to learning and being taught about kanji. A chapter summarizing some of the research that is relevant to this thesis is also included. Topics touched upon in this and the result chapter include the desire for more structured approach to kanji learning based on breaking down the characters into elemental components, spaced repetition (SRS), mnemonics.

Patients' experiences of support for learning to live with diabetes to promote health and well-being : A lifeworld phenomenological study

Learning to live with diabetes in such a way that the new conditions will be a normal and natural part of life imposes requirements on the person living with diabetes. Previous studies have shown that there is no clear picture of what and how the learning that would allow persons to incorporate the illness into their everyday life will be supported. The aim of this study is to describe the phenomenon of support for learning to live with diabetes to promote health and well-being, from the patient's perspective. Data were collected by interviews with patients living with type 1 or type 2 diabetes. The interviews were analysed using a reflective lifeworld approach. The results show that reflection plays a central role for patients with diabetes in achieving a new understanding of the health process, and awareness of their own responsibility was found to be the key factor for such a reflection. The constituents are responsibility creating curiosity and willpower, openness enabling support, technology verifying bodily feelings, a permissive climate providing for participation and exchanging experiences with others. The study concludes that the challenge for caregivers is to create interactions in an open learning climate that initiates and supports reflection to promote health and well-being.

The Broader Impact of Disability Research: Aligning Public Policy with the Experiences of People with Disabilities and Healthcare Providers

Thesis (Ph.D.)--University of Washington, 2016-07

Beyond the numbers of maternal near-miss in Rwanda - a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy.

BACKGROUND: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting. METHODS: A framework of Naturalistic Inquiry guided the study design and analysis, and the 'three delays' model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014. RESULTS: The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities. CONCLUSION: Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.

"It's Equal but It's not Fair": The experiences of Teacher Candidates of Color in a Predominantly White Institution

Thesis (Ph.D.)--University of Washington, 2016-06