Care Pathway For Women Research Articles

Potential improvements to women’s care pathways after gestational diabetes: a qualitative study

Women with prior gestational diabetes face a highly increased risk of type 2 diabetes and are difficult to recruit for follow-up care, possibly due to a loss of professional support in the care pathway. This study aimed to explore Danish health professionals’ experiences of the challenges in the care pathway for women with prior gestational diabetes, the obstacles to continuity of care, and the possibility of better preventing type 2 diabetes. Qualitative semi-structured interviews with 12 healthcare professionals were conducted. The interviews were analyzed using inductive content analysis. The study adheres to the COREQ checklist. The findings are organized into five main categories. The conclusions indicate that gestational diabetes is easily overlooked due to a lack of information sharing and continuity across health care delivery systems. Creating a management plan and engaging general practice nurses as designated health professionals may improve the care pathway and better prevent type 2 diabetes.

Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study.

BackgroundThe development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section.ObjectiveThis paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women’s experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback.MethodsA mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals’ knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time.ResultsData collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete.ConclusionsThe results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature.International Registered Report Identifier (IRRID)DERR1-10.2196/23514

Rapid quality improvement in a preterm birth clinic care pathway during the COVID-19 pandemic

BackgroundPreterm birth (PTB) occurs in 8% of births in the UK. At Imperial College Healthcare NHS Trust, our PTB prevention clinic manages the care of approximately 1000 women/year. Women referred...

287 A new UK reproductive care pathway for women with serious MTDNA disease

In March 2015, the UK government passed into law, an amendment to the Human Fertilisation and Embryology Act 1990 to permit ‘Mitochondrial Donation’. This provided a unique legal framework for techniques that make it possible to ‘replace’ mutated mitochondrial DNA (mtDNA) in human oocytes or zygotes. As a group, primary mtDNA diseases are the most prevalent of the inherited neurometabolic disorders, affecting up to 1 in 5000 live births and can often have devastating clinical consequences. To date, treatments focus on palliation of symptoms, while the emergence of reproductive techniques, such as Mitochondrial Donation, offers the first real opportunity to prevent the maternal transmission of some serious forms of mtDNA disease. The Human Fertilization and Embryo Authority (HFEA), the statutory regulatory authority charged with regulating human embryo research in the UK, has devised, a detailed regulatory process for Mitochondrial Donation. To ensure compliance with the HFEA regulations we describe how we have established a high quality, integrated care pathway that provides care that is available to anyone in the UK, and comprehensively involves pathways for couples seeking reproductive advice, IVF pathway for potential mothers with pathogenic mtDNA mutations, a pathway for donors and long-term follow up of children born.

Protocol for evaluation of the continuum of primary care in the case of a miscarriage in the emergency room: a mixed-method study

BackgroundIn Quebec (Canada), nearly 20,000 pregnancies end in miscarriage, and the majority of the miscarriages are dealt with in an emergency unit. Although there are studies documenting the effects of this type of grief on mental health, men’s experiences are much less discussed than those of women. Similarly, no study has evaluated best practices in terms of service continuity, from emergency care to community resources. The aim of this study is to better understand the relationships that exist between the organization of emergency room and primary care health services for women presenting with miscarriage, on the one hand, and the positions and experiences of women and men within these services, on the other.MethodsThe general objective of this mixed-method study can be broken down into three methodological sections. Focus 1. Institutional discourses and practices. This section is structured as a multiple case study of the mandates of five participant institutions. The study will involve (a) a documentary analysis; (b) a quantitative survey (N: 200) and (c) group interviews (N: 75) with caregivers and emergency unit managers. Focus 2. Women’s and men’s experiences of miscarriages and the institutional response. This section includes (a) a survey (N: 232) and (b) individual interviews (N: 80) designed to identify best practices in emergency involving women and their partners in each area. Focus 3. This section will integrate the information furnished by the first two sections in order to create an ethnographic overview of the situation.DiscussionThis innovative project will provide answers to critical questions on how to improve the effectiveness and quality of interdisciplinary and multisectoral interventions to promote the mental health and psychosocial well-being of couples having experienced a miscarriage. It will have a material effect on the organization of emergency services and of the primary care pathway for women experiencing a miscarriage and for their partners.Trial registrationNot applicable. This study involves a retrospective view of usual health care interventions. This study is not a clinical trial that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes.

A midwifery-led care pathway for women requesting caesarean sections

The caesarean section rate in the UK has increased dramatically in the last 20 years. Subsequently, there has been a rise in caesarean sections for maternal request (CSMR) without medical indications. In 2011, the National Institute for Health and Care Excellence (NICE) added to their guidance, that if after discussion and support, a vaginal birth is not acceptable, elective caesarean should be offered. This article proposes the implementation of a midwifery-led care pathway for women requesting caesarean section without medical indication. The care pathway includes group psychoeducational therapy which has been found to reduce CSMR, emergency caesarean sections and negative birth experiences. The challenges and barriers that may be faced when leading developments in maternity services are discussed, with reference to political, economic, social and technological factors.

Maternal request for caesarean section: Audit of a care pathway

This report is based on an audit of the delivery outcome of a specific care pathway for women who had made a maternal request for caesarean section (MRCS). The study took place in a UK inner city National Health Service maternity unit with 6,000 births per year. All 31 multiparous and 16 nulliparous women on the pathway were included. All of the former group had delivered vaginally, all reported having experienced their previous birth as traumatic, and all subsequently delivered vaginally. Of the 16 nulliparous women, six delivered by planned caesarean section; four delivered vaginally; four had an instrumental delivery and two had an emergency caesarean section. A designated multidisciplinary care pathway that incorporates education and support may have the potential to help more women to achieve a normal delivery. More research is needed to assess its potential for reducing unnecessary caesarean deliveries and for improving user experience.

Care Gaps and Opportunities to Improve Risk Reduction Strategies of Women Diagnosed with Gestational Diabetes in Centre Wellington

To identify care gaps and opportunities to optimize T2 diabetes prevention and develop a Gestational Diabetes (GDM) care pathway for women in Centre Wellington.

News

Research focus: Itai Nyamatore (left), Barbara Featherstone (centre) and Denise Henry each received a research bursary worth £6,250 last month as winners of the RCN's Mary Seacole leadership development award. Ms Nyamatore, strategic nurse manager at Northampton Primary Care Trust will look at supporting named nurses and care co-ordinators; Ms Featherstone, a modern matron at Northamptonshire Healthcare NHS Trust, will try to improve mental health promotion among people from black and minority ethnic backgrounds with chronic physical conditions; and Ms Henry, a practice development midwife at Queen Charlotte's and Chelsea Hospital, London, will look at setting up and co-ordinating an integrated care pathway for women with female genital mutilation.