scholarly journals An exploration of how women in the UK perceive the provision of care received in an early pregnancy assessment unit: an interpretive phenomenological analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e023579 ◽  
Author(s):  
Wendy Norton ◽  
Lynn Furber
Keyword(s):  
Early Pregnancy ◽  
Clinical Information ◽  
First Trimester ◽  
Phenomenological Analysis ◽  
Interpretive Phenomenological Analysis ◽  
Large Teaching Hospital ◽  
Assessment Unit ◽  
Small Set ◽  
Individualised Care ◽  
The Uk

ObjectiveThe objective of the study was to explore how women experience care within an early pregnancy assessment unit (EPAU) and how they are helped to understand, reconcile and make sense of their loss and make informed decisions about how their care will be managed following a first trimester miscarriage.DesignThis was a single centre, prospective qualitative study. An interpretive phenomenological analysis approach was used to interpret the participants’ meanings of their experiences. It is an ideographic approach that focuses in depth on a small set of cases to explore how individuals make sense of a similar experience.SettingAn EPAU in a large teaching hospital in the Midlands that provides care to women in their early pregnancy, including those experiencing pregnancy loss.ParticipantsA purposive sample of 10 women were recruited to this study. All of the women were either miscarrying at the time of this study or had miscarried within the previous few weeks.ResultsSix superordinate themes in relation to women’s experiences of miscarriage were identified: (1) the waiting game, (2) searching for information, (3) management of miscarriage: no real choice, (4) the EPAU environment, (5) communication: some room for improvement and (6) moving on.ConclusionsThis study found that improvements are required to ensure women and their partners receive a streamlined, informative, supportive and continuous package of care from the point they first see their general practitioner or midwife for support to being discharged from the EPAU. The provision of individualised care, respect for women’s opinions and appropriate clinical information is imperative to those experiencing miscarriage to help them gain a degree of agency within an unfamiliar situation and one in which they feel is out of their control.

scholarly journals Interpretive Phenomenological Analysis of Experiences of Four Individuals Reporting Exposure to Workplace Bullying in the UK

2018 ◽  
Vol 9 (1) ◽  
pp. 23-42
Author(s):  
Mary O'Neill ◽  
Denise Borland
Keyword(s):  
Workplace Bullying ◽  
Qualitative Data ◽  
Phenomenological Analysis ◽  
Interpretive Phenomenological Analysis ◽  
Transactional Analysis ◽  
Being Bullied ◽  
The Individual ◽  
The Uk ◽  
Modern Workplace

Workplace bullying is a toxic dynamic that is widespread in the modern workplace. While there is a wealth of qualitative data about the process of bullying, very little is documented about the emotional and cognitive experiences of those exposed to workplace bullying. What do they feel about themselves? What do they feel towards the perpetrators of the abuse and their organisation? This is an Interpretive Phenomenological Analysis (IPA) of the experiences of four individuals who self-identified and were also operationally identified as being bullied by a manager within their organisation. Common themes were identified across the four individuals and are discussed using TA concepts, specifically those from the cathexis and classical schools of TA. The results suggest that the bullying dynamic is predicated on discounting by the participants, their managers and the organisations. The participants were discounted by their managers through a negative and withholding stroke pattern of criticism and blame. This resulted in a loss of trust in their employer and lack of support by the organisation, both of which were seen as a discount of the individual. The participants react to their situation by moving into script which could be seen through the Miniscript process.   Citation - APA format:O'Neill, M. & Borland, D. (2018). Interpretive Phenomenological Analysis of Experiences of Four Individuals Reporting Exposure to Workplace Bullying in the UK. International Journal of Transactional Analysis Research & Practice, 9(1), 23-42. https://doi.org/10.29044/v9i1p23  

scholarly journals Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: Findings from the VESPA Study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260534
Author(s):  
Maria Memtsa ◽  
Venetia Goodhart ◽  
Gareth Ambler ◽  
Peter Brocklehurst ◽  
Edna Keeney ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Unit Volume ◽  
Hospital Admissions ◽  
First Trimester ◽  
Pregnancy Care ◽  
Emergency Hospital ◽  
Admission Rates ◽  
Senior Clinician ◽  
The Uk

Objective To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions. Design Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the “Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes”. Setting 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata. Participants 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017. Exposures Planned and actual senior clinician presence, unit size, and weekend opening. Main outcome measures Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs. Results 205/6397 (3.2%; 95% CI 2.8–3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED. Conclusions Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.

scholarly journals Variations in the organisation of and outcomes from Early Pregnancy Assessment Units: the VESPA mixed-methods study

2020 ◽  
Vol 8 (46) ◽  
pp. 1-138
Author(s):  
Maria Memtsa ◽  
Venetia Goodhart ◽  
Gareth Ambler ◽  
Peter Brocklehurst ◽  
Edna Keeney ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Clinical Data ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Hospital Admissions ◽  
Qualitative Interviews ◽  
Assessment Unit ◽  
The Uk

Background Early pregnancy complications are common and account for the largest proportion of emergency work in gynaecology. Although early pregnancy assessment units operate in most UK acute hospitals, recent National Institute of Health and Care Excellence guidance emphasised the need for more research to identify configurations that provide the optimal balance between cost-effectiveness, clinical effectiveness and service- and patient-centred outcomes [National Institute for Health and Care Excellence (NICE). Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management. URL: http://guidance.nice.org.uk/CG154 (accessed 23 March 2016)]. Objectives The primary aim was to test the hypothesis that the rate of hospital admissions for early pregnancy complications is lower in early pregnancy assessment units with high consultant presence than in units with low consultant presence. The key secondary objectives were to assess the effect of increased consultant presence on other clinical outcomes, to explore patient satisfaction with the quality of care and to make evidence-based recommendations about the future configuration of UK early pregnancy assessment units. Design The Variations in the organisations of Early Pregnancy Assessment Units in the UK and their effects on clinical, Service and PAtient-centred outcomes (VESPA) study employed a multimethods approach and included a prospective cohort study of women attending early pregnancy assessment units to measure clinical outcomes, an economic evaluation, a patient satisfaction survey, qualitative interviews with service users, an early pregnancy assessment unit staff survey and a hospital emergency care audit. Setting The study was conducted in 44 early pregnancy assessment units across the UK. Participants Participants were pregnant women (aged ≥ 16 years) attending the early pregnancy assessment units or other hospital emergency services because of suspected early pregnancy complications. Staff members directly involved in providing early pregnancy care completed the staff survey. Main outcome measure Emergency hospital admissions as a proportion of women attending the participating early pregnancy assessment units. Methods Data sources – demographic and routine clinical data were collected from all women attending the early pregnancy assessment units. For women who provided consent to complete the questionnaires, clinical data and questionnaires were linked using the women’s study number. Data analysis and results reporting – the relationships between clinical outcomes and consultant presence, unit volume and weekend opening hours were investigated using appropriate regression models. Qualitative interviews with women, and patient and staff satisfaction, health economic and workforce analyses were also undertaken, accounting for consultant presence, unit volume and weekend opening hours. Results We collected clinical data from 6606 women. There was no evidence of an association between admission rate and consultant presence (p = 0.497). Health economic evaluation and workforce analysis data strands indicated that lower-volume units with no consultant presence were associated with lower costs than their alternatives. Limitations The relatively low level of direct consultant involvement could explain the lack of significant impact on quality of care. We were also unable to estimate the potential impact of factors such as scanning practices, level of supervision, quality of ultrasound equipment and clinical care pathway protocols. Conclusions We have shown that consultant presence in the early pregnancy assessment unit has no significant impact on key outcomes, such as the proportion of women admitted to hospital as an emergency, pregnancy of unknown location rates, ratio of new to follow-up visits, negative laparoscopy rate and patient satisfaction. All data strands indicate that low-volume units run by senior or specialist nurses and supported by sonographers and consultants may represent the optimal early pregnancy assessment unit configuration. Future work Our results show that further research is needed to assess the potential impact of enhanced clinical and ultrasound training on the performance of all disciplines working in early pregnancy assessment units. Trial registration Current Controlled Trials ISRCTN10728897. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 46. See the NIHR Journals Library website for further project information.

Evaluation of Normal Heart Rate in Early Pregnancy Corresponding to Gestational Age between Six to Eight Weeks

Med Phoenix ◽  
2017 ◽  
Vol 2 (1) ◽  
pp. 34-37
Author(s):  
Akhilesh Kumar Jha ◽  
Bikranta Rimal ◽  
Tarannum Khatun
Keyword(s):  
Heart Rate ◽  
Early Pregnancy ◽  
Well Being ◽  
Clinical Decision ◽  
First Trimester ◽  
Normal Heart ◽  
Normal Heart Rate ◽  
First Trimester Of Pregnancy ◽  
Singleton Pregnancies

Background: Ultrasonography is the reliable and safe way for the evaluation of pregnancy. Heart rate can be detected more confidently from the Ultrasonography. Heart rate is an important parameter for the evaluation of early pregnancy. The purpose of this study was to evaluate the normal heart rate in embryos/fetuses between 6 and 8 weeks of gestation.Method: In our region people are poor and most of them do not know the benefit of regular follow up examination during pregnancy. So most of pregnant women come to our centre at late stage of pregnancy. The number of pregnancy cases is good in our centre but the number of early pregnancy cases coming to regular follow up examination is low. Thus the study was conducted in 51 normal singleton pregnancies undergoing routine ultrasound examination during the first trimester of pregnancy. The duration of study was 6 weeks.Result: Out of 51 singleton pregnancies, 20 cases (39.2%) heart rate were between 131-150 beat per minute and 25 cases (49.0 %) heart rate were between 151-170 beat per minute. However 4 cases (7.8%) were between 110-120 beat per minute and 2 cases (3.9%) were more than 171 beat per minute. There were zero cases above the 180 beat per minute.Conclusion: The result of this study will help to evaluate abnormal and normal fetal heart rate so that early clinical decision whether to continue the pregnancy or terminate it can be taken, as Ultrasonography is only the method used in screening fetal well being in most of the region of our country.Med Phoenix Vol.2(1) July 2017, 34-37

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

scholarly journals Identity in transition: an interpretative phenomenological analysis of international humanitarian workers’ experiences of returning home

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Emilia Marie Wersig ◽  
Kevin Wilson-Smith
Keyword(s):  
Interpretative Phenomenological Analysis ◽  
Phenomenological Analysis ◽  
Moral Values ◽  
Future Research ◽  
Aid Workers ◽  
Structured Interviews ◽  
Work Settings ◽  
Returning Home ◽  
The Uk ◽  
Humanitarian Work

AbstractThis interpretative phenomenological analysis explores aid workers’ understanding of identity and belonging through the transition from working in humanitarian aid to returning home. Semi-structured interviews were conducted with 10 participants who had returned to the UK after working in recently founded non-governmental organisations in Northern France between 2016 and 2019. Analysis of interview data identified four superordinate themes: (1) shared humanitarian identity, (2) limits and borders, (3) holding on to humanitarian identity and (4) redefining belonging and identity. Aid workers’ belonging in humanitarian work settings is rooted in shared moral values and being able to fulfil a clearly defined role. Upon returning, aid workers struggled to reintegrate, manifesting as denial of having left humanitarian work, re-creation of the social setting and moral demarcation. Participants formed a new sense of belonging through redefining their social in-group. The study sheds light on a previously unexplored area of research, specifically characterised through the closeness of the international humanitarian setting and participants’ homes. Findings suggest organisations can assist aid workers’ re-entry by supporting professional distance in the field, and through opportunities that allow to sustain moral values post-mission. Future research should focus on the role of peer support in the re-entry process and the re-entry experiences of aid workers returning from comparable settings further afield (e.g. Greece).

scholarly journals ‘A sense of purpose’: Older prisoners’ experiences of successful ageing behind bars

2021 ◽  
pp. 147737082199514
Author(s):  
Hila Avieli
Keyword(s):  
Old Age ◽  
Environmental Conditions ◽  
Older Men ◽  
Phenomenological Analysis ◽  
Interpretive Phenomenological Analysis ◽  
Successful Ageing ◽  
Older Prisoners ◽  
Unified Process ◽  
Self Discovery ◽  
Better Than

There is growing interest in ageing offenders and their lives in prison. However, this subject is often studied from a deprivation perspective, focusing on issues such as lack of medical care and proper environmental conditions. This article highlights experiences of wellbeing while ageing in confinement, using the conceptual framework of successful ageing. An interpretive phenomenological analysis perspective was used to analyse the narratives of 18 older prisoners. The narratives revealed four themes: ‘Like all other older men’: comparing ageing in prison with ageing within the community; ‘Better than what I have outside’: prison as an escape from a life of loneliness, poverty and delinquency; ‘Here I get some respect’: the older prisoner as a mentor; and ‘I feel accomplished’: experiences of growth and self-discovery as a means for successful ageing in prison. The findings suggest that ageing in prison may not be perceived as a single, unified process, but as a personal and individual phenomenon, and that old age may facilitate positive changes in the lives of ageing offenders in prison.

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