People with advanced liver disease have complex end-of-life needs. Palliative care provision for these patients is often poor, with no clear national guidance for end-stage liver disease. This article describes a pilot project (n=20) conducted to assess the impact of early hospice intervention on patients' wellbeing and experience. Patients remained under acute hospital management and were seen by the hospice's specialist nurse practitioner on a monthly basis and referred into hospice services as needed. Monthly measurements of symptoms and wellbeing were taken using the Palliative care Outcome Scale (POS) and Palliative care Outcome Scale-symptoms (POS-s). Findings showed that this model of care addressed previously unmet holistic care needs, with timely interventions appearing to improve overall outcome despite deteriorating health. Indications that a shared care pathway could reduce the length of stay and cost of paracentesis, as well as the number and length of hospital admissions, led to the implementation of a more formal, larger-scale study, which is currently in progress.

Objective: To explore women's experience of attending yoga for pregnancy classes in order to generate a theory about which aspects, if any, are effective in enhancing self-efficacy for labour and birth. Design: A longitudinal grounded theory study. Methods: Semi-structured interviews were undertaken with women before they started yoga for pregnancy classes, after they had attended at least six classes, and finally, postnatally. Interview transcripts were analysed using constructive grounded theory and a self-efficacy framework. Setting: Three yoga for pregnancy teachers' classes in England. Participants: Twenty two women attending yoga for pregnancy classes. Findings: Analysis of interviews with women at three time points led to a propositional theory that yoga for pregnancy enhances women's self-efficacy for labour by building their confidence and competence through a combination of techniques. These include repeated practice of a variety of pain management strategies, use of affirming language and the telling of positive labour stories, underpinned by yoga practice to lower somatic response to stress.

1 Background 2As women's anxiety and the rate of medical intervention in labour and birth continue to 3 increase, it is important to identify how antenatal education can increase women's 4 confidence and their ability to manage the intense sensations of labour. 5 Aim 6To report a Grounded Theory study of how the aims, language and actions of Yoga for 7Pregnancy teachers may impact upon women's self-efficacy for labour and birth. 8 Methods 9Yoga for pregnancy classes in three locations were filmed. Semi-structured interviews were 10 undertaken with the teachers to explore what they were trying to achieve in their classes, 11 and how. Interviews and classes were transcribed and analysed using grounded theory. 12 Findings 13There was considerable consistency in the teachers' aims, the language they used in 14 classes and in their thinking about class structure. Four main themes emerged: creating a 15 sisterhood, modelling labour, building confidence and enhancing learning. Teachers see 16 yoga for pregnancy as a multi-faceted, non-prescriptive intervention that enhances women's 17 physical, emotional and social readiness for labour and birth, and supports women to make 18 their own decisions across the transition to parenthood. 19 Conclusion 20Women's self-efficacy for labour is complex and multi-factorial. This study offers insights into 21 the factors which may be involved in increasing it. These include not only traditional 22 elements of yoga such as postures, breathing and meditation, but also the creation of safe, 23 women-only groups where anxieties, experiences and stories can be shared, and pain-24 coping techniques for labour learned and practised. 25 2.

No abstract

No abstract