To participate or not to participate: The troublesome question of nurses' conscientious objection to abortion: A qualitative study.

AIM: To report a study investigating the implementation of the "conscience clause" by practising nurses in two National Health Service Hospital Trusts in the UK. DESIGN: A qualitative study. METHODS: Data were collected from 2018 to 2020 through qualitative face-to-face interviews with 20 nurses, transcribed verbatim and analyzed by thematic analysis. RESULTS: Major themes were developing conscience, negotiating conscience and parameters of participation. CONCLUSION: Participants had varied views on conscientious objection, reflecting a continuum from unwillingness to be near anything related to abortion to being willing to participate in the whole process. Most participants framed involvement as fulfilling their "duty of care" to their patient. Direct experience of witnessing abortion overrode faith-based foundations to shape participants' beliefs as objectors or non-objectors. Non-objectors were supportive of objecting colleagues. IMPLICATIONS FOR THE PROFESSION: The complex nature of conscience as a fundamental human right is inherently related to the cultural and social context of nursing. "Employability" raised important questions over the real world of a nurse's legal right to invoke conscientious objection without consequences. IMPACT: Problem addressed Conscientious objection to abortion continues to affect nursing. Main findings There was little knowledge of the law and a reluctance to make formal objections. Where and on whom will the research have an impact It highlights the need for delineated and implemented guidelines on conscientious objection in practice for nurses. Its findings, while local, may be applicable to other abortion services. PATIENT AND PUBLIC CONTRIBUTION: Representatives of each were key in our advisory group. REPORTING METHOD: COREQ checklist for qualitative research.

When New Life Meets Death: Three Hermeneutic Case Studies From Switzerland.

Pregnant women in Switzerland expect safe and healthy birth outcomes for themselves and their babies. However, in 2018, 691 died in infancy with gaps identified in the provision of services to parents in such circumstances. Our study aims to illustrate these gaps and how, from participants' perspectives, they were addressed. A hermeneutic method was employed to analyze three cases: one from each major language region was via primary health-care providers. A thematic analysis was carried out with individual participants followed by a cross-case comparison which showed a hermeneutic of rupture, the juxtaposition of time and reshaping the family. This article shows the unique journeys experienced by parents whose baby dies before or shortly after birth in one country where neither the language nor experience is shared. The derivation of three hermeneutic themes may resonate with other parents or health professionals.

A critical analysis of articles using a Gadamerian based research method.

It is over 20 years since Michael Crotty's groundbreaking critique of phenomenological research in nursing. However, rather than entering into the acrimonious discussions that followed, we developed a research method that we believed translated Gadamer's philosophy into the world of empirical research. Fundamental to that work was our differentiation of hermeneutics from phenomenology. The aim of the present paper was to provide a critical analysis of the citations from publication in 2003 until the end of 2017. We identified 402 citations of which 362 were included. One hundred and sixty-three articles mentioned the article in passing, usually in a list of authors who had discussed hermeneutics. Sixteen citations misrepresented the method mainly claiming that we discussed a method for hermeneutic phenomenology (or phenomenological hermeneutics). Of the 117 citations that partially used the method, the main focus was the four steps of data analysis. Sixty studies used our method in totality although they derive from varying philosophical standpoints. Disappointingly, there has been little critique of our Gadamerian research method. For health disciplines to truly make progress in the academic stage, it is vital that we engage in with critique, some of which will come through open and honest reflexive engagement with our topics.

Potential conflicts in midwifery practice regarding conscientious objection to abortions in Scotland.

BACKGROUND:: This study was developed as a result of a court case involving conflicts between midwives' professional practice and their faith when caring for women undergoing abortions in Scotland. RESEARCH QUESTIONS:: What are practising Roman Catholics' perspectives of potential conflicts between midwives' professional practice in Scotland with regard to involvement in abortions and their faith? How relevant is the 'conscience clause' to midwifery practice today? and What are participants' understandings of Canon 1398 in relation to midwifery practice? RESEARCH DESIGN:: The theoretical underpinning of this study was Gadamer's hermeneutic out of which the method developed by Fleming et al. involving a five-stage approach was utilised. PARTICIPANTS AND RESEARCH CONTEXT:: The research was conducted in the south of Scotland. A purposive sampling method was used. Eight participants who were practising Roman Catholics familiar with the subject of conscientious objection who were either midwives, lawyers (civil, canon or both) or priests contributed. ETHICAL CONSIDERATIONS:: The major ethical issues related to respect for autonomy, maintaining confidentiality and obtaining voluntary informed consent. Parish priests agreed to act as gatekeepers to prospective participants. All legal requirements were addressed regarding data collection and storage. Approval was given by the ethics committee of the university with which one of the researchers were associated. FINDINGS:: Three key themes provide an understanding of the situation in which midwives find themselves when considering the care for a woman admitted for an abortion: competing legal systems, competing views of conscience and limits of participation. CONCLUSION:: Clear guidelines for practice should be developed by a multi-professional and consumer group based on an update of the abortion law to reflect the change from a surgical to medical procedure. Clarification of Canon 1398 in relation to what is and is not participation in the procurement of abortion would be of benefit to midwives with a conscientious objection.

A multicentre postal survey investigating the contribution of illness perceptions, coping and optimism to quality of life and mood in adults with muscle disease.

OBJECTIVE: To replicate the finding that illness perceptions influence quality of life in adults with muscle disease and to explore the additional influence of coping and optimism on quality of life and mood. DESIGN: A postal survey including questionnaires recording quality of life, mood, illness perceptions, optimism, coping and functional impairment. SETTING: National Health Service muscle clinics in the United Kingdom. PARTICIPANTS: A convenience sample of adults with muscle disease. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Individualised Neuromuscular Quality of Life Questionnaire, Hospital Anxiety and Depression Scale. RESULTS: A total of 226 completed questionnaires were returned. Although functional impairment explained most of the variance in three out of eight quality of life domains, psychological factors explained greater amounts of variance (between 19% and 52% of variance) in all other quality of life domains and in both mood domains (between 45% and 48% of variance). Overall, illness perceptions explained much of the variance in quality of life and mood score (between 5% and 37% of variance), while coping (up to 8% of variance) and optimism (up to 15% of variance) explained smaller amounts of variance. CONCLUSION: The results confirm that illness perceptions are associated with quality of life in muscle disease and suggest that they also influence mood. The addition of optimism and coping variables into the analysis yielded small increases in the proportions of variance in quality of life and mood which were explained. These results have implications for the composition of future psychological interventions.

De novo repeat interruptions are associated with reduced somatic instability and mild or absent clinical features in myotonic dystrophy type 1.

Myotonic dystrophy type 1 (DM1) is a multisystem disorder, caused by expansion of a CTG trinucleotide repeat in the 3'-untranslated region of the DMPK gene. The repeat expansion is somatically unstable and tends to increase in length with time, contributing to disease progression. In some individuals, the repeat array is interrupted by variant repeats such as CCG and CGG, stabilising the expansion and often leading to milder symptoms. We have characterised three families, each including one person with variant repeats that had arisen de novo on paternal transmission of the repeat expansion. Two individuals were identified for screening due to an unusual result in the laboratory diagnostic test, and the third due to exceptionally mild symptoms. The presence of variant repeats in all three expanded alleles was confirmed by restriction digestion of small pool PCR products, and allele structures were determined by PacBio sequencing. Each was different, but all contained CCG repeats close to the 3'-end of the repeat expansion. All other family members had inherited pure CTG repeats. The variant repeat-containing alleles were more stable in the blood than pure alleles of similar length, which may in part account for the mild symptoms observed in all three individuals. This emphasises the importance of somatic instability as a disease mechanism in DM1. Further, since patients with variant repeats may have unusually mild symptoms, identification of these individuals has important implications for genetic counselling and for patient stratification in DM1 clinical trials.

Elevated plasma levels of cardiac troponin-I predict left ventricular systolic dysfunction in patients with myotonic dystrophy type 1: A multicentre cohort follow-up study.

OBJECTIVE: High sensitivity plasma cardiac troponin-I (cTnI) is emerging as a strong predictor of cardiac events in a variety of settings. We have explored its utility in patients with myotonic dystrophy type 1 (DM1). METHODS: 117 patients with DM1 were recruited from routine outpatient clinics across three health boards. A single measurement of cTnI was made using the ARCHITECT STAT Troponin I assay. Demographic, ECG, echocardiographic and other clinical data were obtained from electronic medical records. Follow up was for a mean of 23 months. RESULTS: Fifty five females and 62 males (mean age 47.7 years) were included. Complete data were available for ECG in 107, echocardiography in 53. Muscle Impairment Rating Scale score was recorded for all patients. A highly significant excess (p = 0.0007) of DM1 patients presented with cTnI levels greater than the 99th centile of the range usually observed in the general population (9 patients; 7.6%). Three patients with elevated troponin were found to have left ventricular systolic dysfunction (LVSD), compared with four of those with normal range cTnI (33.3% versus 3.7%; p = 0.001). Sixty two patients had a cTnI level < 5ng/L, of whom only one had documented evidence of LVSD. Elevated cTnI was not predictive of severe conduction abnormalities on ECG, or presence of a cardiac device, nor did cTnI level correlate with muscle strength expressed by Muscle Impairment Rating Scale score. CONCLUSIONS: Plasma cTnI is highly elevated in some ambulatory patients with DM1 and shows promise as a tool to aid cardiac risk stratification, possibly by detecting myocardial involvement. Further studies with larger patient numbers are warranted to assess its utility in this setting.

Correction: Elevated plasma levels of cardiac troponin-I predict left ventricular systolic dysfunction in patients with myotonic dystrophy type 1: A multicentre cohort follow-up study.

[This corrects the article DOI: 10.1371/journal.pone.0174166.].

An exploratory qualitative analysis of student midwives views of teaching methods that could build their confidence to deliver perinatal bereavement care.

BACKGROUND: Equipping student midwives with confidence to deliver bereavement care to childbearing women is a challenge for midwifery lecturers. OBJECTIVE: To explore qualitative data provided by student midwives who evaluated the workbook Bereavement care for childbearing women and their families (Hollins Martin & Forrest, 2013) to explore their views of potential teaching strategies that could build their confidence to deliver real bereavement care. METHOD: An exploratory qualitative thematic analysis was used to provide, analyse and report themes identified within data collected in a prior study. PARTICIPANTS: Participants were student midwives (n=179) in their second/third year of a midwifery degree program at 1 of 3 universities in the UK were included in the study. DATA COLLECTION/ANALYSIS: Data to evaluate effectiveness of the bereavement workbook as a teaching method was collected using a survey instrument. It was the comments written under questions by participants that were analysed in the present study. FINDINGS: Three themes emerged: (1) increasing classroom interaction, (2) the importance of reflecting on emotions, and (3) need for experience. DISCUSSION: Although this study has addressed delivery of education that relates to midwives, the findings are cross transferable to other healthcare educators, practitioners, and students. Several solutions are proposed that could potentially build student confidence to deliver bereavement care: lecturers should (1) encourage group discussion in the classroom to help build student confidence to emotionally cope during real bereavement events; (2) ensure students gain exposure by encouraging qualified midwives to include them in real bereavement events early on in their training, and (3) develop packages of perinatal bereavement scenarios for simulation and rehearsal in the clinical skills laboratory. Post-implementation, it is recommended that these teaching strategies be evaluated.

Measurement of clinical performance of nurses: a literature review.

Despite a 40-year history of researching and developing an instrument for measurement of clinical competence in nursing, there are none that are universally accepted for this purpose. This article presents a critical review of the research, which has been carried out to explore the measurement of nurses' clinical performance. To search the literature in a systematic manner, the criteria stipulated by the Cochrane Research Database were applied. The review showed that assessment tools have been developed using a variety of different methods and several instruments were found to have been developed but nothing that is universally accepted. However, the authors found that the pathway for instrument generation suggested by Smith and Kendall (1963) offers a robust approach to the generation of such a tool regardless of the practice setting. Other methods identified in this literature review also offer interested researchers an opportunity to explore the current role of the nurse, as well as the possibility of developing tools for assessing the performance of students at various stages in their education and nurses at various times after qualification.

Women's views about the importance of education in preparation for childbirth.

BACKGROUND: This paper reports original research that embraces childbearing women's views about the importance of education in preparation for childbirth. A survey was carried out using the Birth Satisfaction Scale developed by Hollins Martin and Fleming (2011). All of the items in the questionnaire include a space where the women can add their own comments to allow them to document what is important to them. This paper reports the analysis of this qualitative data. METHODS: The qualitative data collected in the survey was analysed using Braun and Clarke's (2006) method for undertaking a thematic analysis. PARTICIPANTS: Participants were a convenience sample of postnatal women from a maternity unit in the West of Scotland (UK) (n = 228) who had an uncomplicated pregnancy at term (37-42 weeks). Those with a medical diagnosis, poor obstetric history, prematurity (<37 weeks), postmaturity (>42 weeks), younger than (<16) and over (>50) of age, had a history of stillbirth, perinatal or neonatal death were excluded from participating in the study. RESULTS: Three themes emerged from the data: 'Better to be prepared', 'Prepared through previous experience' and 'In labour nothing goes to plan'. CONCLUSION: The participants in this study were variable in their reports about the importance of education in preparation for childbirth, with some clearly presenting a perception of no need. For the midwife, importance lies in providing women with educational opportunities and choice and control in relation to uptake. RECOMMENDATIONS: Women may perceive more value in education when they evaluate it as critical to their outcomes. For example, providing information about: (a) how to identify risk factors before and after birth, (b) strategies that can work towards improving maternal and fetal health, (c) how to improve fetal growth and wellbeing, (d) how to improve nutritional and dietary status, (e) optimising pregnancy outcomes. In relation to delivery of education, midwives require to make purpose and links clear.

The duality of professional practice in nursing: academics for the 21st century.

Although pre-registration nursing in the United Kingdom (UK) is moving towards a graduate exit, the vocational/professional debate is still live and continues to be played out in both popular and professional literature. This study considers the nature of contemporary academic communities and the challenge of duality in professional nursing life. More than a decade after the move into higher education (HE) however the role of the academic is still controversial, with much of the debate focussed on the nature of clinical credibility. This article considers the dimensions of academic nursing, reports the views of academics and clinicians and introduces a model of working that could potentially harness and blend the skills of academics and clinicians, nurturing a culture of applied scholarship throughout the professional/academic journey.

'Show us you know us': using the Senses Framework to support the professional development of undergraduate nursing students.

As students, fledgling nurses need to feel they belong to a community of academics, peers and mentors who value their contribution to learning and knowledge. Creating a sense of community allows students to experience academic and practice integration at the beginning of their professional journey, recognising that positive learning experiences at an early stage of professional maturation can shape lifelong attitudes to learning and discovery. The Senses Framework has been used to develop supportive working in relation to older adults; it also has resonance for the development of undergraduate nurses. This article focuses on the student experience, exploring the potential for the Senses Framework to underpin a learning community, promoting collaboration and acknowledging the emotional, academic and professional work that is now essential for the preparation of registered nurse in the 21st Century.

The effectiveness of interventions to reduce undernutrition and promote eating in older adults with dementia: A systematic review.

EXECUTIVE SUMMARY: Background Older adults with dementia may have feeding difficulties for several reasons: they may experience deterioration in motor and cognitive skills making eating difficult, they may forget to eat, fail to recognise food or they may suffer from dysphagia. Food intake is often poor and malnutrition is common, leading to adverse health outcomes.This review specifically focussed on how best to promote and achieve 'normal' eating and feeding in older adults with dementia, in order that undernutrition and its consequences could be avoided.Review Objectives The aim was to identify and assess the effectiveness of interventions that encouraged eating and minimised risk of undernutrition in older adults with dementia.Types of Participants Adults over the age of sixty with dementia in any care setting (who were not living independently). People receiving enteral tube feeding were excluded.Types of Interventions Any intervention that promoted dietary intake e.g. changes in practice of health care workers, family or volunteers, educational interventions, changes in food service.Types of Outcomes The primary outcomes were improvement in dietary intake and/or nutritional status. Measurements included: dietary intake, anthropometry, clinical outcomes, functional indicators.Types of Studies Randomised controlled trials, controlled trials and quasi-experimental studies with a 'before and after' design.Search Strategy The search strategy aimed to find both published and unpublished studies using a three-step approach. Papers were limited to the English language and a date restriction of 1999 to 2009 was set.Critical appraisal Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review. Disagreements that arose between the reviewers were resolved through discussion.Data Extraction For quantitative studies, data was extracted using a data extraction form developed to include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. This was based on the JBI data extraction tool from MAStARI and 2 reviewers extracted data independently.Data synthesis Heterogeneity in study designs, interventions and outcomes meant meta-analysis was not possible. Findings were discussed in a narrative summary.Results The review included 11 studies. This included one RCT, 1 randomised crossover study, 3 controlled non-randomised trials, 6 quasi-experimental studies. None of the studies provided robust evidence, however there was moderate evidence (Level 3) to support a Grade B recommendation for improvements in dietary intake and/or nutritional status with the following interventions: education of healthcare staff, simple environmental manipulations such as the use of high contrast tableware or small dining rooms, the introduction of something of interest such as an aquarium or background music, or the provision of feeding assistance, provision of enhanced menus, use of a decentralised food service, enhanced nutritional screening combined with increased dietetic time.Conclusion There is moderate (Level 3) evidence to support each of the interventions appraised in this review.Implications for Practice There is moderate support that warrants consideration of the interventions listed above. Careful monitoring of weight of individual residents would help to determine the effectiveness of any such change in delivery of care.Implications for Research Future research into interventions to improve eating and minimise undernutrition in older people with dementia should feature the following: inclusion of reliable outcome measures, full details of interventions, randomisation of participants, inclusion of control groups, adequate sample sizes, longitudinal follow up, consideration of baseline demographics of intervention groups, and experimental design that allows the determination of the effectiveness of individual definable changes in delivery of care.

Hermeneutic research in nursing: developing a Gadamerian-based research method.

This paper takes the stance that although there are many different approaches to phenomenological and hermeneutic research, some of these have become blurred due to multiple interpretations of translated materials. Working from original texts by the German philosophers, this paper reconsiders the relevance of phenomenology and hermeneutics to nursing research. We trace the development of Gadamer's philosophy in order to propose a research method based in this tradition. Five steps have been identified as a guide for nurse researchers. These are deciding upon a question, identification of preunderstandings, gaining understanding through dialogue with participants, gaining understanding through dialogue with text and establishing trustworthiness.