Experiences Of Different Models Research Articles

A content analysis of women’s experiences of different models of maternity care: the Birth Experience Study (BESt)

BackgroundPregnancy, birth, and early parenthood are significant life experiences impacting women and their families. Growing evidence suggests models of maternity care impact clinical outcomes and birth experiences. The aim of this study was to explore the strengths and limitations of different maternity models of care accessed by women in Australia who had given birth in the past 5 years.MethodsThe data analysed and presented in this paper is from the Australian Birth Experience Study (BESt), an online national survey of 133 questions that received 8,804 completed responses. There were 2,909 open-ended comments in response to the question on health care provider/s. The data was analysed using content analysis and descriptive statistics.ResultsIn models of fragmented care, including standard public hospital care (SC), high-risk care (HRC), and GP Shared care (GPS), women reported feelings of frustration in being unknown and unheard by their health care providers (HCP) that included themes of exhaustion in having to repeat personal history and the difficulty in navigating conflicting medical advice. Women in continuity of care (CoC) models, including Midwifery Group Practice (MGP), Private Obstetric (POB), and Privately Practising Midwifery (PPM), reported positive experiences of healing past birth trauma and care extending for multiple births. Compared across models of care in private and public settings, comments in HRC contained the lowest percentage of strengths (11.94%) and the highest percentage of limitations (88.06%) while comments in PPM revealed the highest percentage of strengths (95.93%) and the lowest percentage of limitations (4.07%).ConclusionsWomen across models of care in public and private settings desire relational maternity care founded on their unique needs, wishes, and values. The strengths of continuity of care, specifically private midwifery, should be recognised and the limitations for women in high risk maternity care investigated and prioritised by policy makers and managers in health services.Trial registrationThe study is part of a larger project that has been retrospectively registered with OSF Registries Registration DOI https://doi.org/10.17605/OSF.IO/4KQXP.

The passion and politics behind a new midwifery continuity of care model: MAPS

There is evidence that continuity of care - increasingly a focus of maternity care policy in the UK - contributes to improved outcomes. However, uncertainty remains about which models of care are most effective in which circumstances, and why this is. A plausible explanation is grounded in the idea that the continuity elements of care contribute to and reinforce best quality care. The Quality Maternal and Newborn Care Framework describes the components and characteristics of quality care. As a first step in developing a maternity care evaluation toolkit, we adapted this Framework to see if it could be used to evaluate perceptions and experiences of different models of care.A qualitative comparative enquiry using focus groups. From a six-phase thematic analysis, we first derived then compared the principal sub-themes from the focus groups and mapped these to the original Framework.Two health boards in Scotland.Pregnant women, new mothers, midwives and obstetricians who had experience of various models of maternity care. This paper reports findings from the pregnant women and new mothers.These are presented in two parts: the seven focus groups with pregnant women and new mothers are reported in this paper; the five focus groups with midwives and obstetricians in our accompanying paper. Those using the maternity services had experience of caseloading midwifery, ‘modified universal provision’ and ‘high risk’ models of maternity care. While women from all groups shared certain perspectives, those with experience of caseloading midwifery were consistently positive, reporting positive relationships, tailored care and effective communication. Women experiencing other models of care, especially the modified universal provision model, tended to report more negative relational experiences: lack of information, lack of tailored care, and anxiety and confusion. Timing of the focus group (i.e. during pregnancy or after the birth) appeared to make little difference to responses. Mapping responses to the Framework's characteristics of care was straightforward; mapping also showed how the Framework's components of care are interlinked.Our adaptation of the Quality Maternal and Newborn Care Framework as a data collection tool allowed us to compare women with experience of different models of care, and relational factors were identifiable in many responses. Positive responses were found in all models but were most emphasised in the caseloading midwifery model, suggesting that the experience of caseloading continuity and its relational elements is highly valued. While further work is required to identify if this can be linked to improved clinical outcomes, we have established that the Quality Maternal and Newborn Care Framework can be adapted as an exploratory tool for assessing perceptions and experiences of maternity care.

Using the Quality Maternal and Newborn Care Framework to evaluate women's experiences of different models of care: A qualitative study

ObjectiveThere is evidence that continuity of care - increasingly a focus of maternity care policy in the UK - contributes to improved outcomes. However, uncertainty remains about which models of care are most effective in which circumstances, and why this is. A plausible explanation is grounded in the idea that the continuity elements of care contribute to and reinforce best quality care. The Quality Maternal and Newborn Care Framework describes the components and characteristics of quality care. As a first step in developing a maternity care evaluation toolkit, we adapted this Framework to see if it could be used to evaluate perceptions and experiences of different models of care. DesignA qualitative comparative enquiry using focus groups. From a six-phase thematic analysis, we first derived then compared the principal sub-themes from the focus groups and mapped these to the original Framework. SettingTwo health boards in Scotland. ParticipantsPregnant women, new mothers, midwives and obstetricians who had experience of various models of maternity care. This paper reports findings from the pregnant women and new mothers. ResultsThese are presented in two parts: the seven focus groups with pregnant women and new mothers are reported in this paper; the five focus groups with midwives and obstetricians in our accompanying paper. Those using the maternity services had experience of caseloading midwifery, ‘modified universal provision’ and ‘high risk’ models of maternity care. While women from all groups shared certain perspectives, those with experience of caseloading midwifery were consistently positive, reporting positive relationships, tailored care and effective communication. Women experiencing other models of care, especially the modified universal provision model, tended to report more negative relational experiences: lack of information, lack of tailored care, and anxiety and confusion. Timing of the focus group (i.e. during pregnancy or after the birth) appeared to make little difference to responses. Mapping responses to the Framework's characteristics of care was straightforward; mapping also showed how the Framework's components of care are interlinked. Key conclusionsOur adaptation of the Quality Maternal and Newborn Care Framework as a data collection tool allowed us to compare women with experience of different models of care, and relational factors were identifiable in many responses. Positive responses were found in all models but were most emphasised in the caseloading midwifery model, suggesting that the experience of caseloading continuity and its relational elements is highly valued. While further work is required to identify if this can be linked to improved clinical outcomes, we have established that the Quality Maternal and Newborn Care Framework can be adapted as an exploratory tool for assessing perceptions and experiences of maternity care.

An exploration of physiotherapy students’ experiences of different models of clinical supervision

Purpose: Evidence within the United Kingdom practice setting has shown that there is a shortage of placements and there have been calls for higher education institutions (HEI) to adopt different models of supervision with their practice placement partners. A free market now operates in the healthcare education sector and competition between HEI will potentially compound placement issues. Different models of placement supervision exist, and revisiting these approaches is timely and an important strategy to address some of these key political and economic issues that placement and education providers face.

International experiments with different models of allocating funds to facilitate integrated care: a scoping review protocol

IntroductionIntegrated care is viewed widely as a potential solution to some of the major challenges faced by health and social care systems, such as those posed by service duplication, fragmentation...

European Federation of Psychiatric Trainees Exchange: Benefits to trainees and organisations

IntroductionDuring my time in Gothenburg, I have spent my first week with the team on the emergency inpatient ward. During my second week in Sweden, I have visited inpatient assessment unit where in depth psychological and psychiatric evaluations can be conducted. My final day was spend in a secure state institution providing accommodation and care to young people at risk of absconding or presenting with challenging behaviours.What did I learnThrough the participation in the program I was able to gain first-hand experience of different models of healthcare delivery and I intend to implement some of the positive ideas into the services in the UK. Similarly, I hope that the host organisation may benefit from hearing how care is provided in the UK.During my trip to Sweden, it was the first time I had an opportunity to deliver a presentation to an international audience. This highlighted new challenges such as language barrier and lack of familiarity with jargon, systems and practices that we take for granted within the NHS. I have learnt from the experience and I have now a better idea how to improve my presentations in the future. I have gained a lot of confidence in my presentation skills by speaking in front of a large audience of clinicians that I have not met before.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Challenges and achievements in integrated care: different health and social care providers working together. Successful projects that show that this is the way

Background : The Catalan health system is a public healthcare system, funded by taxes, with universal coverage and public healthcare services portfolio. There’s a mixed healthcare providers network. On the other hand, there’s a public network of social services also focused to chronically ill patients social needs. Delivery of integrated health and social care with a shift to a patient-centered model is one of the main challenges of our public system. We will share three experiences of different models developed to improve integration of social and healthcare services, to guarantee the continuum of care and to achieve quality health and social care outcomes. Projects : 1.- Chronicity and the role of nursing expertise: care and cure network. N Borrell, Clinical Nurse Complex Surgical Patient, Moises Broggi Hospital. Chronic patients care is one of the challenges of the health system due to increasing incidence and morbidity of population involved. To meet the complex chronic patients (PCC) needs or advanced chronic illness (MACA) we have developed Integrated Care Units (AAI) led by nurses as responsible for ensuring a comprehensive and integrated nursing care, ensuring quality of care and continuum between health and social services. Results show that people needs are better identified and care resources better used. 2.- Integrated care model: a framework for collaboration between Social and Healthcare for home care of dependent people. JL Argudo, Director of Healthcare Programs, Parc Sanitari Sant Joan de Deu. A Perez, director Fundacio d'Atencio a la Dependencia Sant Joan de Deu. This initiative was launched to assist people at home, both to solve social issues as dependency or autonomy improvement as well as healthcare needs, and is based on public-private co-operation between different health and social care institutions. Among its strengths includes cooperative work to detect user's needs before discharge from hospital, professionalized care and coordination between health and social teams. 3.- PRINCEP program: clinical program for specialized and integrated care of pediatric patients with complex chronic conditions. N Ricart. PRINCEP program. Pediatrics Department. Hospital Sant Joan de Deu, Esplugues, Barcelona (Spain) With the development of the science and technology applied to health, infant mortality has drastically dropped in the last half century. This longer survival has led to a new phenomenon: the increase in pediatric complex chronic conditions (CCC). PRINCEP program is aimed to offer integrated care for patients who are dependent of technology assistance, need specific case management or regular use of hospital facilities. The program is efficient in the care of CCC children with social vulnerability. Results shown that its implementation to other areas would allow better care coordination and savings in health and social costs. It also obtains long-term benefits for the health system: a greater number of CCC children will reach the adulthood in better conditions, being well integrated in its community and well known for the professionals, allowing the optimization of resources and the patients well-being.

Educating the chartered surveyor: looking back to look forward

Purpose – The purpose of this paper is to consider perennial issues in the education of chartered surveyors and to use the debates and experiences of the past to inform the present and future, particularly the question of the balance between academic and practical training. Design/methodology/approach – Primary and secondary sources were used to establish a history of the growth of the profession and the development of formal education and assessment from the 19th century and to consider current issues with reference to wider theories of education. Findings – The profession grew from vocational roots and did not enjoy the centuries of status of, say, the law. The 19th century saw an increasing technicalisation and professionalisation of surveying, with developments in various strands of the discipline, from the rural land agents to construction and public housing specialists. The muted reception from the universities in recognising the discipline is instructive. Looking at the relationship between classroom education and apprenticeship and what is needed in the preliminary education and assessment of surveyors holds contemporary lessons as increasing university fees has prompted renewed review of the most economical ways of training, while maintaining rigour. Originality/value – There have been histories of surveying and of the Royal Institution of Chartered Surveyors, but this paper relates the past to the present. Its value is in highlighting the tension between the practical and academic, allowing current debates to benefit from earlier discussions and longitudinal experience of different models of education. This paves the way for a wider consideration of experiential learning theory to be applied to a fundamental review of surveying education.

Learning to Change Together: The Social Context of Architectural Learning

In architectural education, learning is often structured to inform and support change to sustainable design and behaviour. The built and natural contexts in which this learning takes place are considered an important element in informing the new ways of seeing and knowing our environments, which are necessary for change. Yet the social context of learning also affects the opportunities for such transformative learning experiences. This paper discusses how this social context can influence the way in which the learner interacts with the built and natural environment and how this , in turn, can support transformation. Recent experiences of different models of learning in the US, New Zealand, and Australia are used to demonstrate the contexts-social, natural, and built-in which learning about the environment in general, and architecture specifically, takes place. An ethno-methodological approach has been taken to develop an understanding of how meaning is made through learning experiences, and how this influences behaviour. Through observations and documentation, the nature of social interchange, the role of the natural and built environments, and the effect of the learning experiences, both formal and informal, on behaviour are explored. Findings from this investigation will inform the development of a framework for architectural education.

Reflections on Practice Learning in Northern Ireland and the Republic of Ireland: Lessons from Student Experiences

Practice learning is viewed as one of the most important components of social work education wherever in the world social work is practised. Northern Ireland and the Republic of Ireland provide an interesting case example of the educational impact on students resulting from their experience of different models of practice learning. Although sharing a common historical legacy, recent developments in policy in both jurisdictions have tended to engender greater divergences in how programmes organise and deliver social work education and practice learning. Drawing on findings from a joint-research project with students in Queen's University, Belfast and Trinity College, Dublin, the authors highlight significant cross-border similarities as well as differences in the way practice learning is conceptualised, organised and delivered. Through comparing and contrasting student experiences, the authors reflect on how the findings might help to inform the future development of practice learning standards in both jurisdictions.

The presidential party and the fifth republic

Until 1986 the prevailing interpretation of the French Fifth Republic was one of encroaching presidential domination; notwithstanding some welcome revisionism occasioned by ‘cohabitation’, presidentialism continues to permeate analysis of contemporary French politics. This article attempts a comparative assessment of the presidential party as it has functioned under the first four presidents of the French Fifth Republic: de Gaulle, Pompidou, Giscard d'Estaing and Mitterrand. It is contended that each presidential party has shared certain attributes, resulting from systemic influences in France's semi‐presidential system; while retaining distinct characteristics derived from its identity as a particular type of party, and from the experience of a varying political context. The opportunities and constraints faced by successful presidential parties outweigh in importance their dissimilarites, inherited from their experience of different models of party organisation and ideology. No presidential party that ha...