Background-Changing Childbirth (1993), a report on the future of maternity services in the United Kingdom, endorsed the development of a primarily community based midwifery led service for normal pregnancy, with priority given to the provision of "woman centred care". This has led to the development of local schemes emphasising continuity of midwifery care and increased choice and control for women.
Aims-To
Women with intellectual disability have historically not been provided the opportunity to become mothers. Attitudes held by future professionals will determine the level and quality of support these women are provided. This study was designed to evaluate and compare the attitudes of students from Education, Disability and Midwifery towards the sexuality and parenting of people with an intellectual disability, and to further examine the attitudes held by Midwifery students following a lecture strategy. A questionnaire assessing attitudes towards the sexuality and parenting of people with intellectual disability was implemented and contained the themes of marriage, parenting, sexual intercourse and sterilization. Significant differences were found between student groups on the themes of sterilization and parenting, with further analysis indicating that Disability students held significantly more positive attitudes than the other two groups. Students reported less positive attitudes towards parenting than marriage, sterilization and sexual intercourse. Respondents' age was significantly associated with their attitudes on parenting, indicating that older students held more conservative attitudes towards the ability of people with an intellectual disability to parent. In addition, this research indicated that the attitudes of Midwifery students became more positive following a lecture delivered after the questionnaire.
This is the final article in a nine-part series describing the Principles of Nursing Practice developed by the Royal College of Nursing (RCN) in collaboration with patient and service organisations, the Department of Health, the Nursing and Midwifery Council, nurses and other healthcare professionals. This article discusses Principle H, the need for leadership among staff and the provision of care that is responsive to individuals' needs.
OBJECTIVE: To quantify the extent to which a standardized pain management order set reduced racial/ethnic inequities in post-Cesarean pain evaluation and treatment. STUDY DESIGN: A follow-up retrospective cohort study comparing previously reported racial/ethnic inequities in post-Cesarean pain management (baseline period: 07/01/14e06/30/16) to data after implementation of a standardized pain management order set (03/ 01/17e02/28/18). Medical records were queried for number of pain assessments; pain scores> 7; scheduled non-opiate doses, and as needed opiate doses (converted to 5mg oxycodone tablet equivalents, OTE). Outcomes were grouped into 0-< 24 and 24-48 hours postpartum, and stratified by race/ethnicity (Hispanic, non-Hispanic Black (NHB), non-Hispanic White (NHW), Asian, and other). Analyses included logistic regression for the categorical outcome of pain score> 7 (severe pain), and linear regression. Main effect and interaction terms were used to calculate the difference-in-difference from baseline to follow-up. RESULTS: Before order set implementation (N¼1701), we demonstrated NHW women had lower pain scores, more frequent pain assessments, and received more opiates than NHB women (% pain scores> 7 NHW/NHB 0-< 24h: 20%/28%; 24-48h: 25%/37%). After implementation (N¼888), severe pain remained more common among NHB women (% pain scores> 7 NHW/NHB 0-< 24h: 23%/31%; 24-48h: 26%/38%). Pain management processes changed after implementation (Table ), with overall fewer assessments, less opiates and more non-opiate analgesics. However, racial/ethnic inequities in number of assessments and treatment were unchanged (Table, all p for interaction > 0.05), with the exception of an increase in NSAID doses 24-48 hours postpartum for Hispanic women. CONCLUSION: A standardized pain management order set reduced overall postpartum opiate use, but did not reduce racial/ethnic inequities in pain evaluation and treatment. Future work should investigate racial equity-focused education and interventions designed to eliminate inequities in pain management.
The Mary Seacole awards provide an opportunity for individuals to be recognised for their outstanding work in black and minority ethnic (BME) communities. Set up in 2004, the awards are funded by Health Education England and made in association with the Royal College of Nursing, Royal College of Midwives, Unison and Unite, with the support of NHS Employers. They are open to nurses, midwives and health visitors in England, and recipients need not come from a BME background.
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