Medically high-risk pregnancy: Women's perceptions of their relationships with health care providers.

The purpose of this article is to examine women's perceptions of the patient-provider relationship in the context of medically high-risk pregnancy (MHRP). Sixteen in-depth interviews were conducted with women hospitalized for MHRP on a maternal-fetal medical unit in the US. Tenets of phenomenology guided the data analysis. We found that beyond normative stress related to managing physical aspects of MHRP, women reported added emotional stressors associated with navigating the fragmented health care environment. This study suggests that improved care coordination and systematic integration of psychosocial professionals within the perinatal interdisciplinary health care team are vital to reduce care-related stressors on this vulnerable patient group.

ON BEING MOTHER AND PATIENT: DIALECTICAL STRUGGLES DURING MEDICALLY HIGH-RISK PREGNANCY.

Medically high-risk pregnancy (MHRP) affects 3 to 10% (diagnosis-dependent) of pregnant women in the United States (National Institute of Child Health Development, 2015), threatening maternal and fetal well-being. Although mothers' prenatal distress and mother-infant attachment after birth have been quantitatively researched, little research has examined women's lived experiences of MHRP in the United States. We examined 16 women's experiences of MHRP during hospitalization at an urban, Northeastern U.S. hospital using an interpretive phenomenological approach. Our qualitative findings provide new understanding of how women expend tremendous energy simultaneously navigating new roles of mother and patient. While negotiating these roles, they experienced dialectical struggles and uncertainty relating to emotion management, locus of control, appraisals of self/others, and relational self. Women managed these conflicts within the contexts of their emerging maternal identity, patient-provider relationships, and social relationships. Women struggled as they managed emotion, determined their level of responsibility for fetal outcomes, appraised others and themselves, and worried about how they were perceived. This amplified distress and contributed to women's emotional exhaustion, sense of being overwhelmed, and stress burden. New explication of these energy-depleting dynamic processes underlying women's experiences of MHRP and their impact on the future mother-infant relationship is considered, and strategies for psychosocial support are identified.

Helping, mediating, and gaining recognition: The everyday identity work of Romanian health social workers.

Health social work is a field with challenges, opportunities, and ways of professing social work that may vary between different national contexts. In this article, we look at how Romanian health social workers construct their professional identity through their everyday identity work. Drawing on a qualitative study based on interviews with 21 health social workers working in various organizational contexts, we analyze what health social workers say they do and how this shapes their self-conception as professionals. Four main themes emerged from participants' descriptions: being a helping professional, being a mediator, gaining recognition, and contending with limits. Through these themes, participants articulated the everyday struggles and satisfactions specific to working as recently recognized professionals in Romanian health and welfare systems not always supportive of their work.

NICU Bereavement Care and Follow-up Support for Families and Staff.

BACKGROUND: Experiencing the death of an infant in the neonatal intensive care unit (NICU) affects both families and staff, creating challenges and opportunities for best practices. PURPOSE: This practice-based article describes a comprehensive approach to delivering bereavement services to NICU families, as well as education and support to NICU staff. METHODS: Bereaved NICU parent and staff survey feedback, including quotes describing individual experiences and suggestions for improved service delivery. RESULTS: Bereaved NICU families and caregivers find meaning and purpose in the act of creating keepsake memories at the time of the infant's death. Mutual healing takes place with subsequent, individualized follow-up contacts by staff familiar to the bereaved parents over the course of a year. IMPLICATIONS FOR PRACTICE: Those staff involved in the care of a NICU infant and family, during and after the infant's death, attest to the value in providing tangible keepsakes as well as continuing their relationship with the bereaved parents. An effective administrative infrastructure is key to efficient program operations and follow-through. IMPLICATIONS FOR RESEARCH: Studying different methods of in-hospital and follow-up emotional support for NICU bereaved families. Identifying strategies for staff support during and after NICU infant loss, and the impact a formal program may have on staff satisfaction and retention.

Practicing maternal virtues prematurely: The phenomenology of maternal identity in medically high-risk pregnancy.

In this study, we examine the phenomenology of maternal identity development among U.S. women hospitalized with medically high-risk pregnancies (MHRP). We conducted 16 in-depth interviews with women and found that they drew on culturally normative notions of maternal nurture, worry, and sacrifice to construct maternal identity in the context of MHRP. Based on our findings, we suggest that MHRP shape women's sense of connection to and distinctive cognitive representations of their fetus. We conclude that hospitalization simultaneously promotes and challenges women's early maternal identifications.

The Writing Series Project: a model for supporting social work clinicians in health settings to disseminate practice knowledge.

Social work clinicians across health care settings are uniquely positioned to disseminate valuable practice experience, thereby contributing to knowledge development within their field of practice and across disciplines. Unfortunately, practitioners tend to shy away from writing and research, and are often reluctant to publicly disseminate their expertise through peer-reviewed journals and conference presentations. To better support health social workers in scholarly endeavors, we developed and implemented The Writing Series Project in southeast Queensland, Australia. This article reports on the development, programmatic challenges and practitioner feedback that offer insight into the benefits and pitfalls that we encountered.

Predictors of maternal depression in the first year postpartum: marital status and mediating role of relationship quality.

Existing literature has documented the associations between marital status and maternal depression within the first year postpartum. Using data that is representative of urban non-marital births in the United States with a large over-sample of non-marital births, we investigate the association of maternal depression with not only marital status but also relationship quality with the father of the baby. Quality is independently associated with maternal depression after controlling for marital status and other variables that have been documented as risk factors for maternal depression. In addition, relationship quality explains away the associations between marital status and maternal depression. After controlling for relationship quality, single women were no more likely to be depressed compared to married or cohabiting women.

Support for siblings of NICU patients: an interdisciplinary approach.

Siblings of hospitalized newborns in neonatal intensive care units (NICU) experience unique thoughts and feelings in response to this situational crisis. Providing an opportunity for siblings and their parents to address both of their concerns can improve sibling adjustment to the NICU, and is also consistent with a family-centered care philosophy. This article traces the development and evolution of sibling policy and program changes at Helen DeVos Children's Hospital (HDVCH) NICU, and describes the current comprehensive model for inclusion of siblings. Particular emphasis will be given to the cornerstone program "Celebrating Siblings Pizza Party." Infection control considerations and the importance of an interdisciplinary team approach to enhance an array of sibling services are also highlighted.

The Hyperemesis Beliefs Scale (HBS): a new instrument for assessing beliefs about severe nausea and vomiting in pregnancy.

OBJECTIVE: The purpose of this research was to validate the Hyperemesis Beliefs Scale (HBS), a new instrument for assessing patient perception factors of hyperemesis gravidarum (HG) that influence reported patient satisfaction with medical care. METHODS: Patients' beliefs and their perception of their physicians' beliefs about the causal explanations of HG, seriousness of the illness, and the impact of the illness upon patients' daily lives were determined using a newly developed hyperemesis beliefs scale (HBS) in a sample of 96 women. Exploratory factor analyses of the patient and physician versions of the HBS were performed separately using principal factor analysis extraction and oblique rotation in SPSS. RESULTS: Exploratory factor analyses of patient and physician versions of the HBS demonstrated broad support for the hypothesized factor structure. However, two key differences appeared in the two versions of the HBS. First, the patient items exhibited two causal factors (general and personal), whereas the physician items showed only a single causal factor. Second, in the patient version, items assessing the impact of HG on the babies' health loaded separately from the rest of the items in the HBS, whereas the analyses of the corresponding physician items indicated that the baby items loaded well on the degree of seriousness factor. CONCLUSION: This scale may be of value in facilitating further research on HG illness representations, patient-physician relationship and patient satisfaction. Specifically, the HBS design provides data to show whether patient-physician agreement on particular measures is associated with better patient satisfaction outcomes.

Hyperemesis gravidarum and patient satisfaction: a path model of patients' perceptions of the patient-physician relationship.

OBJECTIVE: To examine the relationship between patients' perceptions of the patient-physician relationship and patients' satisfaction with the overall medical care received from their physicians in the treatment of hyperemesis gravidarum (HG). METHODS: This study investigated patients' beliefs and their views of their physicians' beliefs about the causal explanation of HG, the seriousness of the illness, and the impact of the illness upon patients' daily lives. Also examined were the extent to which patients' beliefs were congruent with their perception of their physicians' beliefs, and patients' ratings of the humanistic characteristics of physicians they deemed important. Ninety-six respondents who had experienced at least one hospitalization from January 1993 through April 1997 responded to interview questions focusing on their HG illness experience. Using both quantitative and qualitative methodological approaches, a path model of patient perception factors associated with patient satisfaction was tested. RESULTS: Perceived shared beliefs about the etiology of HG for a particular patient's illness were more important direct contributing factors of satisfaction than were the specific causal explanations. The length of the patient-physician relationship provided important indirect effects on patient satisfaction; three key mediating variables were patients' perceptions about physician humanism and perceived agreement about the cause and impact of HG. Pertinent qualitative findings are provided as additional sources of information to supplement the quantitative results. CONCLUSION: Knowledge of the patient-physician relationship factors that influence HG women's satisfaction can be used to enhance service delivery and may ultimately improve perinatal outcomes.

Chicken or the egg? The biological-psychological controversy surrounding hyperemesis gravidarum.

Women's somatic complaints are more likely to be labeled by physicians and other health care professionals as psychologically based when the condition has an obscure etiology. Perhaps because of this, there are a number of medical conditions which have been under investigated and where erroneous assumptions about them exist. Hyperemesis gravidarum (HG)--severe nausea and vomiting during pregnancy--is an example of such an illness. HG remains a puzzling condition for both physicians and patients because there is no known cause or cure. By its very nature, HG has a clearly established biological cause--pregnancy. Yet, because the exact causal pathophysiological mechanism is unknown, the organicity of the pregnant state is either minimized or ignored. This paper examines how HG is characterized in the literature and the empirical basis for psychogenesis. Analysis of the literature reveals a tension in the discourse such that both biologic and psychologic approaches to HG have existed in parallel tracks throughout history. Still, results support that sociocultural factors rather than scientific evidence have shaped the overarching and predominant illness paradigm of psychogenesis. Implications for women's health care and HG, in particular, are presented.

Fundamental contradictions in cultural competence.

Cultural competence (CC) is considered highly relevant to social work practice with clients belonging to ethnic and racial minority groups, as the burgeoning literature and creation of practice standards on CC attest. However, examination of the conceptual underpinnings of CC reveals several major anomalies. The authors argue that several aspects of CC contradict central social work concepts or are at odds with current, standard social work practice. These contradictions extend to the epistemological foundations of CC and the rights and dignity of the individual. To further stress the conceptual tensions at the heart of CC, the authors incorporate recent philosophical work addressing collective identities and group rights. The question of whether culturally competent practice is achievable is also addressed. The authors urge academicians and practitioners to thoroughly examine the theoretical and ethical bases of CC because of their highly important ramifications for social work practice.

Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum.

OBJECTIVE: To report the weight loss and associated symptoms experienced by a large cohort of women with hyperemesis gravidarum (HG). METHODS: Data were obtained from an HG website registry, where women with HG were recruited on-line. Respondents were included if they experienced at least 1 live birth>27 weeks' gestation. Extreme weight loss was defined as a loss of >15% of prepregnancy weight. RESULTS: Of the 819 women surveyed, 214 (26.1%) met criteria for extreme weight loss. These women were twice as likely to be Hispanic or nonwhite. Extreme weight loss (p<0.001) was associated with indicators of the severity of HG, such as hospitalization and use of parenteral nutrition, and with multiple symptoms during pregnancy, such as gallbladder and liver dysfunction, renal failure, and retinal hemorrhage. Among all women surveyed, 22.0% reported that symptoms lasted throughout pregnancy; this finding was nearly twice as likely among women with extreme weight Loss: 63 of 214 (29.4%) vs. 117 of 605 (19.3%) (OR=1.73, 95% CI 1.2-2.5, p=0.003). For some women, symptoms continued postpartum and included food aversions, muscle pain, nausea, and posttraumatic stress. Approximately 16% of babies were born prematurely, and 8% reportedly weighed <2500 g. Among women with extreme weight loss, 9.3% reported having a child with a behavioral disorder. CONCLUSIONS: Extreme weight loss is common among women with HG, suggesting that HG is a form of prolonged starvation in pregnancy and that the long-term effects of this condition on women and their offspring warrant further investigation.

The women's health movement: making policy, 1970-1995.

With the advent of second-wave feminism during the 1970s, a significant body of literature emerged describing sexist practices in women's health care. Gender-bias and gender disparities found in women's health care became concerns that garnered considerable attention in the United States because of the increased health risks posed for women. This article describes key historical challenges and accomplishments made in U.S. women's health care policy during the quarter century spanning 1970-1995 that influence contemporary health care social work practice and social work education.

The silent thief: osteoporosis and women's health care across the life span.

Osteoporosis is a skeletal disease characterized by loss of bone mass and density, which results in an increased risk of fractures. The disease is referred to as the "silent thief," because it is often not until a person falls and breaks a bone that patients and their physicians become aware of weakening bones. An estimated 1.5 million bone fractures occur each year in the United States and cost nearly dollar 17 billion in health care costs and lost productivity. The perception that osteoporosis is an older person's disease is an erroneous one. Osteoporosis does not discriminate by age; in fact, it is a geriatric disease with an adolescent onset. Social workers in health care and other practice settings working with female clients across the life span are in prime positions to influence patient outcomes and reduce health care costs by raising awareness of the risk factors and complex biopsychosocial aspects of this debilitating disease. This article presents social work interventions within the conceptual framework of primary, secondary, and tertiary disease prevention.

Women's experiences with a pregnancy complication: causal explanations of hyperemesis gravidarum.

There is a multiplicity of proposed causes, yet a scarcity of research regarding the pregnancy complication, hyperemesis gravidarum (HG), severe nausea and vomiting. This is not unlike other female medical conditions that have been underinvestigated, and perhaps as a result, erroneous assumptions about them persist. This is a report of qualitative findings from a larger study that investigated, in part, illness perspectives of 96 women with HG. Results reveal women view HG as biologically determined and that it has substantial impact on their daily functioning. The study challenges commonly held notions that HG is a psychosomatic disorder.

Gender-biased diagnosing of women's medical complaints:contributions of feminist thought, 1970-1995.

With the advent of second-wave feminism during the 1970s, a significant body of literature emerged describing sexist practices in women's health care. Gender-biased diagnosing-the notion that somatic complaints by female medical patients are more likely to be labeled by physicians as psychosomatic-became a concern that garnered considerable attention in Europe and the United States because of the increased health risks it posed for women. This article examines the impact of feminist knowledge on this topic during the quarter century spanning 1970-1995. Analysis of the literature reveals feminist perspectives played a critical role in uncovering and problematizing gender bias in women's health care.

Client violence toward social workers: the role of management in community mental health programs.

With the shift in mental health treatment from psychiatric hospitals to community agencies, mental health workers provide outreach interventions to clientele with increasingly acute psychiatric disorders in their neighborhoods and residences. This article examines job-related, client-perpetrated threats or physical violence against social workers in general, and community outreach mental health professionals in particular. The article highlights the critical role of supervisors and administrators in community mental health programs in developing proactive prevention and postincident response policies and procedures that create an organizational climate of safety awareness, training, and psychological support to traumatized worker-victims. Recommendations for macro-level intervention are proposed, and implications for social work education and the profession are addressed.