Existential aspects of parenthood transition seen from the health professionals' perspective - an interview and theatre workshop study.

OBJECTIVES: A sense of existential vulnerability is embedded in parenthood transition. It is linked to meaning in life, relationship changes, awareness of death, and sometimes a transcendent belief. Nevertheless, in most maternity service guidelines, the existential aspects of life are not an explicit focus. Therefore, this study aimed to explore how health professionals in maternity services experience and understand existential aspects of parenthood transition among new parents. STUDY DESIGN: Data were generated through a user-involving two-phase process inspired by action research consisting of three focus group interviews with health professionals (n = 10) and, subsequently, a theatre workshop for parents, health professionals, and researchers (n = 40). Between the two phases, case narratives were constructed using information from the interviews and, in collaboration with a dramatist, dramatized and then played out at a workshop by professional actors. We used thematic analysis for all data. RESULTS: We identified five themes in the data material: 1. Death and fragility in maternity care, 2. Existential aspects in camouflage, 3. Existential and spiritual aspects of being professional in maternity care, 4. Talking about existential aspects of care, 5. Equipped for providing existential care? CONCLUSIONS: Existential aspects were often recognized during birth, specially in traumatic situations or discerned in the physical and non-verbal relational energy between the birthing woman and midwife or partner. Less often, existential aspects were recognized during pregnancy and the post-partum period.

Existential aspects in the transition to parenthood based on interviews and a theatre workshop.

OBJECTIVES: There are multitudes of existential feelings and considerations around childbirth, with both positive and negative sources of existential meaning; often they are mixed up, but they impact parents' ideas of meaning and purpose in life. The aim of this study was to explore existential aspects of parenthood transition among new fathers and mothers in view of a potential training programme for professionals in maternity services. STUDY DESIGN: Data were generated through a user-involving two-phase process inspired by action research consisting of first, four focus group-interviews (n = 10); and second, a theatre workshop for parents, health professionals, and researchers (n = 40). Between the two phases, case-narratives were constructed based on the interviews and, in collaboration with a dramatist, dramatized and then played at the workshop by professional actors. Data from interviews and the workshop were thematised for further analysis. RESULTS: We identified five themes: 1. A turning point of what to hold sacred; 2. Changed relationships - guilt and overwhelming love; 3. Awareness of death; 4. Religiousness embodied; 5. What we talk about. CONCLUSIONS: Existential aspects of parenthood transition were closely related to meaning in life, changes in relationships, awareness of death and relation to a transcendent belief. Existential aspects were explicated and discussed in nuanced ways expressing existential vulnerability. It is therefore important to both acknowledge and address existential aspects in maternity care, for the simple reason (among others) that they matter to parents. Moreover, this might enhance a coherent and authentic parenthood transition embedding the paradoxicalities.

How participatory action research changed our view of the challenges of shared decision-making training.

OBJECTIVE: This paper aims to demonstrate how the use of participatory action research (PAR) helped us identify ways to respond to communication challenges associated with shared decision-making (SDM) training. METHODS: Patients, relatives, researchers, and health professionals were involved in a PAR process that included: (1) two theatre workshops, (2) a pilot study of an SDM training module involving questionnaires and evaluation meetings, and (3) three reflection workshops. RESULTS: The PAR process revealed that health professionals often struggled with addressing existential issues such as concerns about life, relationships, meaning, and ability to lead responsive dialogue. Following the PAR process, a communication programme that included communication on existential issues and coaching was drafted. CONCLUSION: By involving multiple stakeholders in a comprehensive PAR process, valuable communication skills addressing a broader understanding of SDM were identified. A communication programme aimed to enhance skills in a mindful and responsive clinical dialogue on the expectations, values, and hopes of patients and their relatives was drafted. PRACTICAL IMPLICATIONS: Before integrating new communication concepts such as SDM in communication training, research methods such as PAR can be used to improve understanding and identify the needs and priorities of both patients and health professionals.