Nurses' experiences when conducting the mental state examination (MSE): A scoping review.

The Mental State Examination (MSE) is an assessment framework used to facilitate the collection of subjective and objective data about a person's current mental state. There is a lack of understanding of nurses' experiences when conducting the MSE. The aim of this scoping review is to identify, examine and summarize the available literature relating to nurses' experiences when conducting the MSE. A scoping review was conducted using Arksey and O'Malley (2005) framework to review, examine and synthesize the available literature on nurses' experiences with the MSE. A PRISMA flow diagram was used to describe the systematic literature search. Six databases (APA PsycInfo, CINAHL, MEDLINE, PubMed, ProQuest, and Scopus) were searched including reference lists of eligible sources. Google Scholar, Trove and Proquest Dissertation and Thesis were searched for grey literature. Twelve articles included in this scoping review considered nurses experiences when conducting the MSE. The principles of thematic analysis were used to synthesize the studies. Three distinct themes were identified from the literature: (i) Nurses' role and the MSE, (ii) Nurses' competence and knowledge when conducting the MSE, and (iii) Nurses' confidence when conducting the MSE. The results of this scoping review identified the MSE as a component of the mental health nursing role and a core competency of mental health telephone triage services. The MSE was used by nurses in the Emergency department (ED), acute in-patient and community mental health settings, including mental health telephone triage services. Nurses working in EDs and acute in-patient mental health settings experienced a lack of confidence and competence, including a knowledge deficit in conducting the MSE in comparison to nurses working in community mental health settings. Community mental health nurses identified the importance of conducting an MSE higher than acute in-patient mental health nurses. This review identified the need for evidence-based research related to the MSE and its application in nursing practice. Evidence-based research will inform the development of MSE guidelines and policies, thus, enhance mental health nursing practice related to the MSE, including improving and strengthening consumer-nurse therapeutic alliance in acute in-patient mental health settings.

Fathers' perceptions and experiences of support to be a parenting partner during the perinatal period: A scoping review.

AIMS AND OBJECTIVES: The aim of this study was to explore fathers' perceptions and experiences of support in the perinatal period. Change in society has seen the increased visibility of fathers being involved during pregnancy and engaging in their infants' lives and the expectation and benefits of men playing an equal and direct role in caring for their children. However, less is known about the nature of support that fathers require to facilitate this role transition. DESIGN: A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. METHODS: A systematic search of CINAHL Plus, MEDLINE, the Cochrane Library, PsycARTICLES, PsycINFO, Psychology, Soc INDEX and Behavioural Sciences Collections databases for qualitative or mixed methods studies with qualitative data was undertaken. Qualitative data were extracted from original studies for coding and theme generation. Thematic synthesis was employed for the final stages of analysis. RESULTS: Overall, 23 papers were included. Men desired to fulfil their rite of passage to be an involved father to their child. This transitional process commenced with men articulating their commitment to creating a role as an involved father and to be a role model for their children. Becoming a father is seen as having a significant status in society which contributes to their self-efficacy as fathers. CONCLUSION: Fathers require support from all levels of the 'ecosystem' including policy, socio-cultural and workplace changes as well as recognition and support from partners, family, peers and in particular from health service providers. Developing the parenting partnership requires a co-production approach and commitment at macro, meso and micro levels. RELEVANCE TO CLINICAL PRACTICE: Supporting men to be engaged fathers requires policy, socio-cultural and workplace changes; however, maternity services and particularly midwives have an important role in this change.

A pilot study: Transitioning into a new graduate midwife - perspectives about a unique student-led practice.

OBJECTIVE: To explore midwifery students' (and as new graduates') experiences and level of satisfaction about a student-led midwifery model of care. METHODS: This was a qualitative study to elicit rich descriptive data from the participants. Thematic analysis was used. The students were interviewed at the end of their final year of study and they were subsequently interviewed at the end of their graduate year. RESULTS: Two overarching themes were identified from the qualitative findings from the first and second interviews including the students building and sustaining important relationships and transitioning from a student to new graduate. CONCLUSIONS: The midwifery students valued the opportunity to spend one year in a student-led model of care so that they could build and sustain important relationships with women and their team including the mentor midwife as new graduates. The students developed confidence by being respected by midwives and enabled them to advocate for women.

Health literacy and self-management in people with coronary heart disease: a systematic review protocol.

OBJECTIVE: The objective of the review is to assess the association between health literacy levels and self-management behaviors in people with coronary heart disease. INTRODUCTION: Initiating and maintaining self-management behaviors following a coronary event can be challenging. The capacity to initiate behavioral changes requires adequate health literacy, which is the ability to understand and use health care information to make appropriate health decisions. INCLUSION CRITERIA: This review will consider studies including individuals at any age who have been diagnosed with coronary heart disease. Studies that used a standardized measure of health literacy with the primary outcome of self-management behaviors or an element of self-management (eg, medication adherence) will be considered for inclusion. METHODS: The review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases to be searched include CINAHL, Embase, PubMed, APA PsycINFO, Cochrane, Scopus, ScienceDirect, ProQuest Dissertations and Theses, Google Scholar, and OpenGrey. This will be followed by a forward and backward search of relevant articles. Cross-sectional, case-control, cohort, and mixed methods studies (quantitative component only) will be included. Studies will be screened by 2 independent reviewers and undergo a critical appraisal process. Included studies will be assessed for methodological quality, and data will be extracted using a JBI data extraction tool in the JBI System for the Unified Management, Assessment and Review of Information. The results will be presented as a narrative synthesis and, where possible, a meta-analysis will be conducted. The Grading of Recommendations, Assessment, Development, and Evaluation approach will be used to assess the certainty of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021257407.

Hospital-based assistant in Midwifery role for undergraduate midwifery students: A survey exploration.

PROBLEM: Little is known about the experiences of undergraduate midwifery students employed as Assistants in Midwifery (AIM) in Australia. BACKGROUND: Assistants in Nursing have been embedded in the Australian health system for many years, but the AIM role is relatively new. Undergraduate Bachelor of Midwifery students, in second or third year, can gain employment as an AIM at hospital maternity units. Little is known about the scope of practice for these roles and the experiences of AIM. AIM: This study aimed to explore the experiences and scope of practice of AIM in New South Wales (NSW), Australia, over the last five years. METHODS: A Qualtrics online survey enabled collection of quantitative and qualitative data from 128 respondents in late 2019. This was accompanied with the analysis of position descriptions for all AIM jobs advertised between September 2019 and February 2020. FINDINGS: Analysis of AIM position descriptions reflected nursing language rather than midwifery. Survey responses demonstrated ambiguity about the AIM scope of practice and the appropriate level of supervision required to perform the role. Qualitative data revealed the many benefits of the role for midwifery students. DISCUSSION: Opportunities to participate in midwifery assistant work enhances student confidence and improves job readiness. However, a clearly defined scope of practice is one of the most important components of any employment model for undergraduate students. Clarification of the role and scope of practice of the AIM role is long overdue. There is ongoing need for advocacy to ensure that students working as AIM are employed to carry out midwifery activities and are supervised by midwives. CONCLUSION: This project provides insight into the advantages and disadvantages of working as an AIM whilst studying for a Bachelor of Midwifery degree. While the AIM position reaps many rewards for students, appropriate supervision in the workplace requires availability of adequate numbers of employed registered midwives.

Educational programs and teaching strategies for health professionals responding to women with complex perinatal mental health and psychosocial concerns: A scoping review.

BACKGROUND: Mental health and psychosocial concerns such as domestic violence in pregnancy and after birth are significant issues. Maternal health, social and environmental contexts have a direct influence on child development and long-term health. However, midwives, nurses and other health professionals lack confidence and skills in assessing, supporting and referring women with perinatal psychosocial concerns. AIM AND OBJECTIVES: The aim of the scoping review is to review educational innovations and teaching strategies used to build skills and knowledge in health professionals and students to address psychosocial concerns including perinatal mental health, domestic violence and drug and alcohol misuse. DESIGN: A scoping review was undertaken to help identify the breadth of papers reporting educational innovations and strategies particularly to address psychosocial concerns. METHOD: Four databases CINAHL, PsychoInfo, PubMed, OvidMedline and the grey literature were searched using a diverse range of terms for papers published in English between January 2009 and December 2020. This yielded 2509 papers and after review, 34 papers were included in the scoping review. RESULTS: The 34 papers in this review found a diversity of educational initiatives and strategies delivered either face-to-face, online or in a blended mode addressing the learning needs of health professionals working with women with complex psychosocial concerns. The following characteristics in the papers were examined; focus of education, design and development, length, target audience including interprofessional focus, self-care, sensitive topics, debriefing, involving lived experience consumers and evaluation measures. PARTICIPANTS: In the studies indicated that they benefited from hearing about the individuals' lived experiences, opportunities for simulated practice and valued interprofessional learning experiences for both content and teamwork. The emergence of virtual modes offered some innovative and engaging ways to create a safe space for psychosocial education. However, the research does not provide guidance as to the best mode of delivery or length of program CONCLUSION: This scoping review provides a broad overview of innovative and diverse educational methods and strategies being used in the nursing, midwifery and health disciplines to engage students and practitioners in learning in the areas of perinatal mental health and psychosocial care. Involvement of lived experience consumers in the design and delivery of education programs can positively impact learners' knowledge and understandings of sensitive psychosocial topics. These diverse approaches could be used to shape the development and evaluation of future education programs.

Development and Validation of a Scale to Measure Self-efficacy and Self-management in People With Coronary Heart Disease.

BACKGROUND: Self-management is important in reducing coronary risk factors and in preventing recurrent cardiac events. An enabling factor that promotes self-management among patients with coronary heart disease (CHD) is self-efficacy. However, there is no standardized measure that captures self-efficacy and self-management concurrently in this population. AIM: The authors of this study report on the development and validation of a brief scale to measure self-efficacy and self-management in patients with CHD. METHODS: Scale development and testing comprised (1) item generation, (2) content validity, and (3) pilot testing. The Heart Health Self-Efficacy and Self-Management (HH-SESM) scale includes 2 constructs: self-efficacy and self-management, measured concurrently. Components of the HH-SESM scale consisted of items related to behavioral and coronary risk factor modification. Survey data from 143 participants were used in exploratory factor analyses to test the factorial validity and internal consistency of the scale. RESULTS: Twelve items with the same response format were included in the exploratory factor analysis. The factor analysis revealed a single-factor solution accounting for 36.7% and 36.5% of the variance in scores of the self-efficacy and self-management scales, respectively. The correlation ( r = 0.72, P < .001) between the self-efficacy and self-management constructs indicates moderate convergent validity. Cronbach α of self-efficacy (0.83) and self-management (0.81) constructs showed good internal consistency. CONCLUSION: The HH-SESM is a brief, easy-to-administer, and reliable measure of self-efficacy and self-management in patients with CHD.

A qualitative study of the impact of adverse birth experiences on fathers.

BACKGROUND: Being present during labour and birth can, for some fathers, result in feelings of fear, uncertainty, anxiety, and helplessness. Witnessing birth complications or adverse events may cause immediate and long-term anxiety and stress. In turn, this experience can impact on men's sense of self and identity as a man and father and can affect his relationship with his infant and partner. The aim of this study was to explore the immediate and longer-term impact of witnessing a complicated or adverse birth experiences on men in heterosexual relationships and their role as a father. METHODS: An interpretive qualitative approach informed the design of this study. A total of 17 fathers, one from New Zealand and sixteen from Australia participated through face to face, telephone and email interviews. The ages of the men were between 24 to 48 years, and the time since the adverse birth experience ranged from 4.5 months to 20.5 years. FINDINGS: Thematic analysis revealed three major themes representing men's experiences of witnessing a complicated birth or adverse event; 'Worst experience of my life', 'Negotiating my place: communicating with health professionals' and 'Growing stronger or falling apart'. Men were unprepared and feared for the lives of their infants and partners, they expected and wanted to be involved in the birth and the maternity care journey, instead they were pushed to the side and excluded from the labour and birth during times of emergency. Being excluded from part or all of the birth perpetuated worry and vulnerability as, at times, men were left not knowing anything about what was happening to their partners. Midwives and other health professionals' support was important to the way fathers adjusted and processed the complications of the labour and birth event. This experience impacted on their own mental health and their relationship with their baby and partner. CONCLUSION: Findings demonstrate that following a complicated or adverse birth experience, men questioned their role as a father, their place in the family and their role at the birth. There is a need to include and inform the expectant father that help is available if they experience negative feelings of hopelessness or despair. Maternity services and care providers need to involve fathers so that they feel part of the maternity care system and journey which may mitigate feelings of helplessness.

The experience of workplace gender discrimination for women registered nurses: A qualitative study.

AIM: To explore the experiences of female registered nurses (RNs), who encounter workplace gender discrimination in nursing. DESIGN: This study used a qualitative exploratory design informed by feminist perspectives and was underpinned by social constructionism. METHODS: Women who were RNs (N = 10) and employed in New South Wales (NSW) were purposively selected to convey their experiences of workplace gender discrimination. Data were collected through semi-structured interviews, between April and July 2020. Analysis was guided by the work of Anderson and Jack (Women's words; 1991) who recommend three ways of listening. Interviews were transcribed verbatim and Braun and Clarke's (Qualitative Research in Psychology, 3, 77-101; 2006) six-step guide was used to develop themes. RESULTS: Thematic analysis revealed five overarching themes: It's a man's world; Gender stereotypes; Being a woman and nurse; Reluctance to call out gender discrimination and The status quo. Findings from this study highlighted that participants believed men's career progression in nursing were favoured over women. CONCLUSION: Findings from this research highlight that socially constructed gendered norms continue to form the basis of inequality for women in the workplace. Fostering and sustaining workplace cultures that support family and work life balance, and that do not discriminate against women, is fundamental to ensuring equality for women. IMPACT: There is limited qualitative research into women's experiences of workplace gender discrimination in nursing. This research highlights the need for workplace strategies to be implemented to ensure women are better supported and equally represented in leadership positions and advanced practice roles in nursing. All nurses should be given equal consideration based on experience and qualifications. Career development and progression opportunities should be fair, equitable and transparent with clearly documented criteria.

Nursing students' experiences of repeating units in an undergraduate program: A qualitative study.

BACKGROUND: Academic failure in undergraduate nursing education programs is a growing concern globally. While some students choose to continue with their nursing course by repeating units of study, others discontinue from their respective nursing programs contributing to a marked increase in nursing attrition rates. This academic failure can be attributed to competing demands of paid employment and family commitments. AIM: The aim of this study was to explore first year students' experiences of repeating a unit of study in the undergraduate nursing program. METHODS: A descriptive qualitative design informed this study which involved undergraduate nursing students enrolled at a large metropolitan multi-campus nursing school in Australia. Data were collected from nine nursing students who had repeated one or more units of study using face-to-face and telephone interviews and data were analysed used thematic analysis. FINDINGS: Four themes emerged from the data 'struggling to meet workload expectations', 'making the adjustment', 'utilising academic supports and resources' and 'the strength to carry on'. The struggles faced by nursing students repeating units of study included the university's academic environment, heavy workload and issues encountered to meet academic writing standards, juggling to balance the demands of paid employment and personal commitments. Participants demonstrated strength and resilience in their quest to fulfil their dreams and goals of becoming a Registered Nurse, and some reassessed their financial situations to make changes to paid employment hours or reduce study workload to part-time. While peer support was valued, participants expressed their desire for further tutor support to consolidate learning. CONCLUSIONS: Support strategies tailored for students repeating nursing units are needed to ensure students continue successfully with their nursing programs.

Refugee women's experiences negotiating motherhood and maternity care in a new country: A meta-ethnographic review.

OBJECTIVES: The aim of this meta-ethnographic review was to examine refugee women's experiences negotiating motherhood and maternity services in a new country with a view to identifying the specific needs of refugee women accessing maternity care in high income countries. DESIGN: A meta-ethnographic synthesis of qualitative research. DATA SOURCES: Five databases were searched for papers published in English between January 2000 and January 2017. REVIEW METHODS: The synthesis process was guided by the seven steps of meta-ethnography. The quality of included studies was assessed using the COREQ tool. RESULTS: One overarching theme and three major themes emerged from the synthesis. The overarching theme "Living between two cultures" conveyed women's experience of feeling "in between" cultures and described refugee women's experience of striving to maintain a strong cultural identity from their country of origin while simultaneously adapting to their new context and country. This theme permeated the following three major themes: 1) "Constructing maternal identity across cultures" which discusses the cultural conflict experienced by refugees accessing maternity services in their host country; 2) "Understanding in practice" which describes reciprocal issues in communication between women and health professionals; and 3) "Negotiating care" which illustrates a mix of coping mechanisms which refugee women utilise to navigate health services in the context of high income countries. CONCLUSION: Liminality is a ubiquitous experience for refugee women seeking maternity care in high income countries. It impacts feelings of belonging and connection to services and society. It is often a challenging experience for many women and a time in which they reformulate their identity as a citizen and a mother. This review found that the experience of liminality could be perpetuated by social factors, and inequality of healthcare provision, where communication and cultural barriers prevented women accessing care that was equal, accessible, and meaningful. Findings revealed both positive and negative experiences with maternity care. Continuity, culturally appropriate care, and healthcare relationships played an important role in the positive experiences of women. The review also revealed the damaging effects of disparities in care experienced by refugee women.

The experience of women with an eating disorder in the perinatal period: a meta-ethnographic study.

BACKGROUND: Pregnancy is a time of enormous body transformation. For those with an eating disorder during pregnancy this time of transformation can be distressing and damaging to both the mother and the child. In this meta-ethnographic study, we aimed to examine the experiences of women with an Eating Disorder in the perinatal period; that is during pregnancy and two years following birth. METHOD: A meta-ethnographic framework was used in this review. After a systematic online search of the literature using the keywords such as pregnancy, eating disorders, anorexia, bulimia, binge eating disorder, perinatal, postnatal and post-partum, 11 papers, involving 94 women, were included in the review. RESULTS: A qualitative synthesis of the papers identified 2 key themes. The key theme that emerged during pregnancy was: navigating a 'new' eating disorder. The key that emerged in the perinatal period was return to the 'old' eating disorder. CONCLUSION: Following a tumultuous pregnancy experience, many described returning to their pre-pregnancy eating behaviors and thoughts. These experiences highlight the emotional difficulty experienced having an eating disorder whilst pregnant but they also point to opportunities for intervention and a continued acceptance of body image changes. More research is needed on the experiences of targeted treatment interventions specific for pregnant and postpartum women with an eating disorder and the effectiveness of putative treatment interventions during this period.

A meta-ethnographic synthesis of midwives' and nurses' experiences of adverse labour and birth events.

INTRODUCTION: Health professionals are frequently exposed to traumatic events due to the nature of their work. While traumatic and adverse labour and birth events experienced by women are well researched, less attention has been given to midwives' and nurses' experiences of these events and the impact it has on their lives. AIMS AND OBJECTIVES: To undertake a meta-ethnographic study of midwives' and nurses' experiences of adverse labour and birth events. METHODS: Scopus, CINHAL PLUS, MEDLINE and PUBMED databases were searched using subject headings and keywords. The search was limited to papers published in peer-reviewed journals from 2004-October 2016. Quality appraisal was undertaken using the Critical Appraisal Skills Programme tool. INCLUSION CRITERIA: Papers had to be qualitative or have a substantial qualitative component. Studies were included if they primarily focused on midwives' or nurses' perspectives or experiences of complicated, traumatic or adverse labour and birth events. ANALYTIC STRATEGY: A meta-ethnographic approach was used incorporating methods of reciprocal translation guided by the work of Noblit and Hare (1988, Meta-Ethnography: Synthesizing qualitative studies (Vol. 11). Newbury Park: Sage publications). FINDINGS: Eleven qualitative studies were included in the final sample. Four major themes were (i) feeling the chaos; (ii) powerless, responsible and a failure; (iii) "It adds another scar to my soul"; and (iv) finding a way to deal with it. CONCLUSION: Midwives and nurses feel relatively unprepared when faced with a real-life labour and birth emergency event. While many of the midwives and nurses were traumatised by the experience, some were able to view their encounter as an opportunity to develop their emergency response skills. RELEVANCE TO CLINICAL PRACTICE: Witnessing and being involved in a complicated or adverse labour and birth event can be traumatic for nurses and midwives. Organisational and collegial support needs to be available to enable these health professionals to talk about their feelings and concerns.

A meta-ethnographic synthesis of fathers' experiences of complicated births that are potentially traumatic.

INTRODUCTION: birth is a natural and for many, life enhancing phenomenon. In rare circumstances however birth can be accompanied with complications that may place the mother and infant at risk of severe trauma or death. Witnessing birth complications or obstetric emergencies can be distressing and potentially traumatic for the father. AIM: the aim of this paper is to report on the findings of a meta-ethnographic synthesis of father's experiences of complicated births that are potentially traumatic. METHODS: databases searched included CINAHL, Scopus, PubMed and PsycINFO with Full Text. The search was conducted in February and March 2013 and revised in February 2015 for any new papers, and the search was limited to papers published in English, full text and peer-reviewed journals published between January 2000 to December 2013. INCLUSION CRITERIA: studies were included if they focused on fathers/men's experiences of witnessing a birth with complications including a caesarean section or an adverse obstetric event. Studies included needed to use qualitative or mixed methods research designs with a substantial qualitative component. ANALYTIC STRATEGY: a meta-ethnographic approach was used using methods of reciprocal translation guided by the work of Noblit and Hare (1988) on meta-ethnographic techniques. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool. FINDINGS: eight qualitative studies with a total of 100 participants were included in the final sample. The men ranged in age from 19 to 50 years. SYNTHESIS: Four major themes were identified: 'the unfolding crisis', 'stripped of my role: powerless and helpless', 'craving information' and 'scarring the relationship'. Participants described the fear and anxiety they felt as well as having a sense of worthlessness and inadequacy. Men did not receive sufficient information about the unfolding events and subsequently this birth experience impacted on some men's interactions and relationships with their partners. CONCLUSIONS: witnessing a complicated or unexpected adverse birth experience can be distressing for men and some may report symptoms of birth trauma. Being informed by and receiving support from midwives and other health professionals appears to help mitigate the negative impact of birth complications. Effective support may help address men's confusion about their role, however genuinely including men as recipients of care or service in pregnancy, labour and birth raises important questions about whether the father is also a recipient of maternity care and if the transition to fatherhood is itself becoming a medical event?

Finding Meaning in Life Following Emergency Postpartum Hysterectomy: What Doesn't Kill Us Makes Us Stronger.

INTRODUCTION: Childbirth is generally perceived to be a triumphant and joyous moment in a woman's life. However, current research indicates that it can also be a time of fear, dread, and apprehension, particularly when the birth experience is traumatic. Some women attempt to seek the positives of their traumatic or unexpected childbirth experience to be able to cope with their experience. However, little attention is directed toward how women rebuild their lives and grow following traumatic birth experiences such as severe postpartum hemorrhage and emergency hysterectomy. METHODS: Twenty-one Australian women, aged 24 to 57 years, who had experienced severe postpartum hemorrhage and emergency hysterectomy were interviewed in an in-depth qualitative study about their experiences. RESULTS: Thematic analysis revealed the major theme of moving forward and 4 subthemes: appreciating life and what you have; what really counts: learning and growing; accepting it: it's just the way it is; and reframing the experience: seeking the positives All of the women found meaning following their hysterectomy, which produced a positive perspective on their lives. DISCUSSION: The way that women find meaning and cope with the trauma of having a severe postpartum hemorrhage and emergency hysterectomy is significant to their ability to move forward and live life to the fullest. Midwives and other health care providers may be in a position to provide support for women in the aftermath of severe postpartum hemorrhage and emergency hysterectomy.

Separation, failure and temporary relinquishment: women's experiences of early mothering in the context of emergency hysterectomy.

AIM: To describe the experiences of women who have had an emergency hysterectomy following a severe postpartum haemorrhage and the impact on their early mothering experiences. BACKGROUND: Postpartum haemorrhage and subsequent hysterectomy is a traumatic birth event. Traumatic birth experiences have the potential to impact on a woman's experience of motherhood and her initial relationship with her baby. The relative rarity of this event makes it easy to dismiss the experiences of women having a hysterectomy following childbirth. Little is known about a woman's early mothering experience in the context of having an emergency hysterectomy. DESIGN: Qualitative naturalistic inquiry approach. METHOD: Data were collected through semi-structured qualitative interviews from 21 Australian women who had an emergency hysterectomy following a severe postpartum haemorrhage. RESULTS: Findings revealed three themes in relation to early mothering experiences in the context of having a hysterectomy following a severe postpartum haemorrhage. They were 'initial separation: lost bonding time', 'feelings of failure' and 'relinquishing care of the infant'. CONCLUSIONS: This paper highlights the ways undergoing emergency hysterectomy following childbirth can impact on the experience of early mothering in the postnatal period. RELEVANCE TO CLINICAL PRACTICE: Greater recognition and attention to the specific needs of women who have an emergency hysterectomy following childbirth is required. Providing women with an opportunity to talk, debrief and ask questions related to their birthing experiences, will help women to reconcile their feelings. Giving women the opportunity to have their infants with them in intensive care unit, together with ongoing emotional support and anticipatory guidance, may also be useful approaches in assisting women during this difficult and traumatic time.

Between life and death: women's experiences of coming close to death, and surviving a severe postpartum haemorrhage and emergency hysterectomy.

OBJECTIVE: to describe women's experiences of having an emergency hysterectomy following a severe postpartum haemorrhage. DESIGN: a qualitative research approach was used to guide this study. Data were collected through semi-structured, tape recorded face to face, email internet and telephone interviews. SETTING: three States in Australia: New South Wales, Victoria and Western Australia. PARTICIPANTS: twenty-one Australian women who experienced a severe post partum followed by an emergency hysterectomy participated in the study. The median age of participants at time of interview was 42 years and the median time since having the hysterectomy was four years. FINDINGS: a process of inductive analysis revealed the major theme, 'between life and death' and three sub-themes, 'being close to death: bleeding and fear', 'having a hysterectomy: devastation and realisation' and 'reliving the trauma: flashbacks and memories'. CONCLUSION: formulating a plan of care for women identifiably at risk of PPH and ensuring appropriate follow-up counselling is made, is key to help reduce the emotional and psychological symptoms experienced by these women in the aftermath of severe postpartum haemorrhage and hysterectomy.

Interviewing people about potentially sensitive topics.

AIM: This paper explores the challenges of interviewing people about sensitive topics. It uses existing literature and the first author's experience of interviewing women traumatised by having an emergency hysterectomy following a severe postpartum haemorrhage. It also highlights the strategies that can assist interviews. BACKGROUND: Interviewing participants about sensitive topics requires skill and special techniques. Certain research topics have the potential to cause participants and researchers distress and discomfort. Identifying ways to prevent vicarious traumatisation and researcher burnout is imperative to the integrity of the research. DATA SOURCES: Twenty one Australian women took part in in-depth, tape-recorded, face-to-face, email, internet and telephone interviews. REVIEW METHODS: This is a methodology paper on the first author's experience of interviewing women on potentially sensitive topics. CONCLUSION: Some participants may find telling their stories to be cathartic, providing them with a sense of relief. Implementing techniques that may be helpful in initiating the interview process can be challenging.

Women's perceptions and experiences of a traumatic birth: a meta-ethnography.

AIM: This study presents the findings a meta-ethnographic study reporting women's perceptions and experiences of traumatic birth. BACKGROUND: Childbirth is viewed by many as a life transition that can bring a sense of accomplishment. However, for some women, birth is experienced as a traumatic event with a minority experiencing post-traumatic stress. A traumatic birth experience can have a significant impact on the physical and emotional well-being of a woman, her infant and family. DATA SOURCE: The CINAHL, MEDLINE, Scopus and PubMed databases were searched for the period January 1994 to October 2009 using the keywords birth trauma, traumatic birth, qualitative research, birth narrative and birth stories. REVIEW METHODS: A meta-ethnographic approach was used. Quality appraisal was carried out. An index paper served as a guide in identifying particular findings and comparing them with other findings. This 'reciprocal translation' process started with a search for common themes, phrases and metaphors. RESULTS: Ten qualitative studies were included in the final sample. Six major themes were identified: 'feeling invisible and out of control', 'to be treated humanely', 'feeling trapped: the reoccurring nightmare of my childbirth experience', 'a rollercoaster of emotions', 'disrupted relationships' and 'strength of purpose: a way to succeed as a mother'. CONCLUSIONS: It is evident that a small percentage of women experience a traumatic birth. Although some women who experience a traumatic birth do not necessarily have physical or psychological adverse outcomes, others identify a significant personal impact. Healthcare professionals must recognize women's need to be involved in decision-making and to be fully informed about all aspects of their labour and birth to increase their sense of control.