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Biomedical subjects

Christine McCourt

Publications and source records attributed to Christine McCourt.

6 recordsLinked to original sources
PubMed2006

Problem based learning in midwifery - the teachers perspective.

BACKGROUND: Problem- or evidence-based learning (PBL or EBL) has become more widely used in the education of health professionals. Although there has been research exploring its effectiveness and the student's perspective, there has been little research exploring the perceptions of the teacher. The objective of this study was to investigate the experiences of teachers facilitating a problem based learning curriculum in midwifery. The study took place at Thames Valley University, which has implemented this approach across the entire curriculum. METHODS: Semi-structured interviews were undertaken following random selection from two groups of teachers; those more experienced as teachers and those who had entered teaching more recently. FINDINGS AND DISCUSSION: Aspects of the teacher's role identified included questioning students to draw out their knowledge and understanding and to help students challenge each other, discuss and evaluate their learning. Strategies used varied depending on the stage of the programme. Difficulties encountered were mostly in relation to facilitating groups of differing backgrounds and ability and seeking to enable the students to work well together. Key challenges for teachers were in relation to developing facilitation skills, balancing input or guidance with facilitating independent learning. CONCLUSIONS: Problem based learning was perceived to be beneficial in helping students relate theory to practice and in encouraging an active and enquiring approach to evidence, but teachers raised important questions about its practice. Tensions were identified between the constructivist theories on which the model of PBL rests and the formal requirements of an externally regulated professional curriculum.

Attitude of Health Personnel↗
PubMed2006

Does regular massage from late pregnancy to birth decrease maternal pain perception during labour and birth?--A feasibility study to investigate a programme of massage, controlled breathing and visualization, from 36 weeks of pregnancy until birth.

The present study was undertaken to produce a detailed specification of a programme of massage, controlled breathing and visualization performed regularly by birth partners, from 36 weeks gestation and assisted by a trained professional, following hospital admission during labour and birth. As current research on massage interventions for pain relief in labour is poorly characterized, we began by undertaking a feasibility study on an established massage programme [Goldstone LA. Massage as an orthodox medical treatment past and future. Complementary Therapies in Nursing & Midwifery. 2000;6:169-75]. The intervention was designed in light of experimental findings that repeated massage sessions over 14 days increases pain threshold, by an interaction between oxytocin and opioid neurons [Lund I, Yu L-C, Uvnas-Moberg K, Wang J, Yu C, Kurosawa M, et al. Repeated massage-like stimulation induces long-term effects on nociception: contribution of oxytocinergic mechanisms. European Journal of Neuroscience 2002;16:330-8]. A 4 week time-frame was selected to coincide with a physiological increase in maternal pain threshold [Cogan R, Spinnato JA. Pain and Discomfort Thresholds in Late Pregnancy. Pain 1986;27:63-8, Whipple B, Josimovich JB, Komisaruk BR. Sensory thresholds during the antepartum, intrapartum, and postpartum periods. International Journal of Nursing Studies 1990;27(3):213-21, Gintzler AR, Komisaruk BR. Analgesia is produced by uterocervical mechano-stimulation in rats: roles of afferent nerves and implications for analgesia of pregnancy and parturition. Brain Research 1991;566:299-302, Gintzler AR, Liu N-J. The maternal spinal cord: biochemical and physiological correlates of steroid-activated antinociceptive processes. In: Russell JA, Douglas AJ, Windle RJ, Ingram CD, editors., Progress in Brain Research. Volume 133. The Maternal Brain. Neurobiological and Neuroendocrine adaptation and disorders in pregnancy and postpartum. Amsterdam: Elsevier Science, 2001. p. 83-97]. The main objective was to measure the effects of the programme on maternal pain perception during labour and birth. To detect any effect of massage during labour, on maternal cortisol and catecholamines, cord venous blood was taken to measure plasma concentrations following birth. Twenty-five nulliparous (N) and 10 multiparous (M) women participated in the study. Cortisol values were similar to published studies following labour without massage but pain scores on a Visual Analogue Scale (VAS), at 90min following birth were significantly lower than scores recorded 2 days postpartum [Capogna G, Alahuhta S, Celleno D, De Vlieger H, Moreira J, Morgan B, et al. Maternal expectations and experiences of labour pain and analgesia: a multi-centre study of nulliparous women. International Journal of Obstetric Anaesthesia 1996;5:229-35]. The mean score was 6.6. Previous studies suggest that a reduction from 8.5 to 7.5 would significantly reduce pharmacological analgesia in labour [Capogna G, Alahuhta S, Celleno D, De Vlieger H, Moreira J, Morgan B, et al. Maternal expectations and experiences of labour pain and analgesia: a multi-centre study of nulliparous women. International Journal of Obstetric Anaesthesia 1996;5:229-35].

Adult↗
PubMed2005

Supporting choice and control? Communication and interaction between midwives and women at the antenatal booking visit.

This study focused on patterns of communication between midwives and pregnant women and their implications for information, choice and control as now advocated in UK government policy. An earlier casenote audit evaluation of a new organisation of maternity care where midwives carry a personal caseload indicated no difference in quality standards of midwifery care from conventional care, yet women using the service gave a different view. In order to understand whether this difference might be an artefact of the research, responses to change, or a reflection of the limitations of using casenotes for research, an observation-based study was conducted. Forty interviews were observed in three UK settings: hospital clinic, GP clinic and women's homes. Interviews were tape-recorded and notes and drawings of interaction made. The transcripts were analysed using structured and qualitative approaches. The interactional patterns differed according to model of care i.e. conventional or caseload, and setting of care. Several key 'tasks' in the visits were noted, with risk screening and health education information being dominant in conventional care. A continuum of styles of communication was identified, with the prevalent styles also differing according to location and organisation of care. The hierarchical and formal styles discussed in earlier sociological work were the most common in conventional care, despite the focus of midwifery on being 'with-woman' and the recent policy emphasis on consumer choice. The caseload visits showed a less hierarchical and more conversational form and supported women's reports that this model of care offered them greater information, choice and control. The variation in patterns suggests that context is an important consideration in research of this type, with environment (both micro- and macro-level) and organisation of care influencing the ways in which the concepts of choice or consumerism operate in practice.

Communication↗
PubMed2005

Evaluation of the use of health care assistants to support disadvantaged women breastfeeding in the community.

There is little experience of the use of health care assistants in the community to support breastfeeding in the UK. The aim of this project was to evaluate the implementation of a small-scale pilot project using health care assistants in the community to support disadvantaged women breastfeeding. The evaluation was funded as part of the Department of Health's Infant Feeding Initiative. A longitudinal observational and quasi-experimental design was used. The project involved women, who had recently given birth, living in an area of London identified by the government's Sure Start scheme as socio-economically disadvantaged. This paper focuses mainly on the findings drawn from the qualitative data focusing on the process of implementation, the role of the Support Worker and women's perceptions of the support. The findings suggest that the use of health care assistants in the community may offer a practical and encouraging approach in supporting breastfeeding which is acceptable to both breastfeeding women and health care professionals. More research is needed to establish whether the intervention significantly increases breastfeeding rates.

Adult↗
PubMed2005

Research and theory for Nursing and Midwifery: Rethinking the Nature of Evidence.

BACKGROUND AND RATIONALE: The rise in the principles of evidence-based medicine in the 1990s heralded a re-emerging orthodoxy in research methodologies. The view of the randomised controlled trial (RCT) as a "gold standard" for evaluation of medical interventions has extended recently to evaluation of organisational forms and reforms and of change in complex systems-within health care and in other human services. Relatively little attention has been given to the epistemological assumptions underlying such a hierarchy of research evidence. AIMS AND METHODS: Case studies from research in maternity care are used in this article to describe problems and limitations encountered in using RCTs to evaluate some recent policy-driven and consumer-oriented developments. These are discussed in relation to theory of knowledge and the epistemological assumptions, or paradigms, underpinning health services research. The aim in this discussion is not to advocate, or to reject, particular approaches to research but to advocate a more open and critical engagement with questions about the nature of evidence. FINDINGS AND DISCUSSION: Experimental approaches are of considerable value in investigating deterministic and probabilistic cause and effect relationships, and in testing often well-established but unevaluated technologies. However, little attention has been paid to contextual and cultural factors in the effects of interventions, in the culturally constructed nature of research questions themselves, or of the data on which much research is based. More complex, and less linear, approaches to methodology are needed to address these issues. A simple hierarchical approach does not represent the complexity of evidence well and should move toward a more cyclical view of knowledge development.

Delivery, Obstetric↗