Regional special care nursery environments : Navigating the role of mother
- Authors: Knox, Kate , Wellard, Sally , King, Rosemary
- Date: 2007
- Type: Text , Conference paper
- Relation: Paper presented at 9th National Rural Health Conference, Albury, New South Wales : 7th-10th March 2007
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- Description: Premature birth presents challenges for most mothers assuming a parenting role with their infant. Living in rural and regional areas provides additional hardship due to isolation, distances and limited support services. The predominant focus of research in the area of premature birth has been on the survival of infants. There has been limited investigation of the experiences of women with infants in special care nurseries (SCNs), in regional Australia. The ways in which mothers ‘navigate their way’, physically and emotionally, in SCN environments was the focus of this study. Using a qualitative interpretive design data were collected through in-depth interviews with mothers and analysed thematically. Women related a dislocation in their lives as a result of their infant’s hospitalisation. The nursery space and the various ways space was used to marginalise or sanction mothers was revealed and resulted in women adopting conflicting roles throughout this time. These findings provide direction for developing more supportive environments for parents relying on SCNs for the care of their infant. This study provides new insight into the experiences of women and their environmental sensitivity within SCN settings. Findings will increase regional midwives’ understanding of mothers’ interpretations of the neonatal nursery environment. Insights into maternal perspectives will assist in the provision of better family-centred care and improved outcomes for the vulnerable families of premature infants.
- Description: 2003005864
Juggling type 1 diabetes and pregnancy in rural Australia
- Authors: King, Rosemary , Wellard, Sally
- Date: 2009
- Type: Text , Journal article
- Relation: Midwifery Vol. 25, no. 2 (2009), p. 126-133
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- Description: Objective: to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps. Design: qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically. Setting: The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals. Participants: seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months. Findings: rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants' experiences were coloured by their limited access and interactions with expert health professionals. Conclusion: women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals. Implications for practice: national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes. © 2007 Elsevier Ltd. All rights reserved.
Barriers and enablers to women's access to services during childbearing in Timor-Leste
- Authors: King, Rosemary
- Date: 2019
- Type: Text , Thesis , PhD
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- Description: Background: In Timor-Leste the maternal mortality ratio (MMR) is one of the highest in Southeast Asia, in some districts only 15-25% of women birth in a facility with a skilled birth attendant (SBA). Care from SBA is the international benchmark for quality maternity care. Purpose: Determine the barriers and enablers to women's access to services during childbearing in Timor-Leste, including women’s expectations and needs. Methodology: Qualitative research using focused ethnography, data collection methods included semi-structured interviews, focus groups and participant observation. Seventeen stakeholders and thirty women from three districts in Timor-Leste participated. Thematic analysis and coding of data with triangulation of the findings between separate participant groups. Results: Barriers to woman’s access to SBA include poor roads, lack of transport, costs associated with accessing SBA, lack of availability and poor quality services. Lack of privacy, multiple care-givers and poor interpersonal communication from SBA were also noted. Stakeholders emphasise health promotion and antenatal care to counteract the influence of traditional beliefs and promote demand for SBA. Many women demonstrate their agency in health seeking behaviours and choices for care during pregnancy and childbirth. Discussion: Women understand that pregnancy and childbirth poses potential risks to their health. Rural women, women from low socio-economic and other marginalised groups have less access to services. Perceptions of poor quality services also reduce women’s demand. Conclusion: Barriers and enablers to woman’s access to services are identified using an amended AAAQ framework introducing the domain of Antecedents in addition to domains of Access, Availability, Acceptability and Quality (AAAQA). Further expenditure on health service infrastructure, staff training and community outreach will improve access and quality SBA. Culturally safe SBA services may also improve the uptake of SBA service in Timor-Leste. Key words: Timor-Leste, Skilled birth attendance, cultural safety, women’s agency, quality maternity care.
- Description: Doctor of Philosophy
Key factors deterring women's engagement with skilled birth attendants in three districts of Timor-Leste. A qualitative descriptive study
- Authors: King, Rosemary , Jones, Linda
- Date: 2019
- Type: Text , Journal article
- Relation: Midwifery Vol. 79, no. (Dec 2019), p. 8
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- Description: Objective: To describe the barriers to women's access to maternity services in three districts of Timor-Leste. Research design/setting: Focused ethnography with data collection methods commensurate with a qualitative research design. Setting and participants: Data was collected in three districts in Timor-Leste. Participants included seventeen stakeholders, health professionals and managers providing skilled birth attendance (SBA) in Timor-Leste and thirty women who have given birth and are competent to give consent. Findings: Access to SBA services is seriously impeded by poor roads and lack of transportation, the poor condition and amenity of services, restricted hours of opening, the lack of availability of skilled SBA professionals and medical resources. Participants also commented upon the lack of privacy and multiple caregivers. Timorese patriarchal family structures, intergenerational decision-making and cultural attitudes towards reproductive health information and services potentially reduce women's access to reproductive health services. Conclusion: This data provides a comprehensive record of the multiple structural barriers to women's access to SBA services. The modified AAAQA framework provides categories and an organisational structure to these barriers to SBA services. Implications for practice: Maternity care in Timor-Leste is extremely poorly resourced. Midwives and other SBA will need to provide innovative low cost solutions if they are to consistently provide respectful culturally safe midwifery care. This includes the provision of privacy and a one to one midwifery relationship 'with woman'. In addition, many women are unable to access SBA, where possible the MoH can consider strategies to improve the provision of SBA services to women birthing in community. Crown Copyright (C) 2019 Published by Elsevier Ltd. All rights reserved.
Perceptions of people with Type 2 diabetes about self-management and the efficacy of community based services
- Authors: Wellard, Sally , Rennie, Sheree , King, Rosemary
- Date: 2008
- Type: Text , Journal article
- Relation: Contemporary nurse : a journal for the Australian nursing profession Vol. 29, no. 2 (2008), p. 218-226
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- Description: Self-management has become a key strategy for managing the health care of people with diabetes. This study explored issues people with type 2 diabetes experienced in their self-management practices and access to regional community based services. Using a qualitative interpretative design data was collected from four participants who were interviews about their perceptions of facilitators, barriers and issues they encountered in their diabetes care in a regional setting. The findings indicate difficulties participants experienced in gaining access to quality services in regional areas, including long waiting times, difficulties making appointments, and their perception that healthcare professionals fail to acknowledge patients self-management knowledge and practices. Additionally, participants reported food choices affected their family relationships and experience of social stigma. These issues compromised their self-management decisions. The findings support other studies that show a need for health professionals to develop strategies to improve community based services for people with type 2 diabetes and to increase public awareness of the scope of diabetes management.