Good Emotional Support Research Articles

The Effect of Academic Model Supervision on the Workload and Stress of Nurses in Hospitals: A Literature Review

Nurses often face high workloads and significant levels of stress due to the demands of complex work and high pressure. The academic supervision model is important because it can help nurses manage workload, improve skills and knowledge, and reduce stress levels. Effective supervision is expected to improve the quality of health services, job satisfaction, and have a positive impact on patients and the health system as a whole. This study aims to determine the influence of academic model supervision on the workload and stress of nurses in hospitals. This study uses a literature review method from research articles in the Scopus and Google Scholar databases published in 2014-2023 with the keywords "Supervision", "Academic Model", "Nurse Workload", and "Nurse Stress". Based on the analysis of 22 research articles, it was found that the supervision of the academic model had a positive impact on nurse performance, job satisfaction, work motivation, quality of nursing care, reduction of stress levels, and improvement of overall health service quality. Academic model supervision can help nurses improve skills and knowledge, improve services provided, develop professionalism, increase independence, improve nursing care, reduce workload, improve nurse performance, provide good emotional support, and continuous learning, and reduce the level of stress experienced by nurses. The implications of this research suggest that implementing academic model supervision in hospitals can lead to better nurse outcomes, including enhanced job satisfaction, reduced stress, and improved quality of care. Consequently, this can result in higher patient satisfaction and a more efficient and effective health care system overall.

The elderly's experiences: family support and participation in the integration of health services

Background: Higher life expectancy in Indonesia alarms the government to become more serious in enhancing the implementation of community programs for elderlies. The programs are intended to improve the life quality of the elderlies. Integration of health services for the elderly program that is well-implemented will make it easier for elderlies to Purpose: To determine the relationship between family support and the active participation of elderlies in attending integration of health servicesMethod: This correlational study was performed using a cross-sectional approach on 30 elderlies as respondents who were purposively sampled. Data of this study were collected using questionnaires which were then analyzed in a univariate analysis using frequency data. Bivariate analysis was also carried out using the chi-square test. Results: Most of the respondents actively participated in the program (76.67 percent). They are aware that they are vulnerable to health problems because respondents have good family support (53.33 percent). In particular, they rated good emotional support (66.67 percent), good facility support (73.33 percent), good knowledge and information support (46.67 percent), and good appraisal support (46.67 percent).Conclusion: The data analysis indicated the presence of a correlation between family support and the active participation of elderlies in the integration of health services for the elderly program in Ende Regency.Suggestion: Public Health Center needs to raise awareness of the reluctance of elderlies in attending the integration of health services for the elderly. It is necessary that health workers visit and approach the family of elderlies in order to improve the elderly's health and quality of life.

Description of Social Support for Postpartum Mothers in The Working Area of The Dukuh Kupang Community Health Center of Surabaya City

Introduction: Postpartum is a physical and psychological adjustment to the birth process. Social support is one of the factors that can influence the occurrence of psychological disorders. The role of social support provided can improve mental health and psychological well-being. Objective: The purpose of this study describes the picture of social support for postpartum mothers in the work area of the Dukuh Kupang Health Center, Surabaya City. Method: In this study, the research used quantitative descriptive methods. Data retrieved in January – June 2022. The data used is primary data using a questionnaire. The population in this study was all postpartum mothers with a total of 36 postpartum mothers. The sampling technique uses total sampling. Data analysis uses univariate single data analysis. Result and Discussion: The results of this study showed that postpartum mothers in the work area of puskesmas Dukuh Kupang Kota Surabaya almost all (88.9%) had good emotional support, almost all (97.2%) had good award support, almost all (91.7%) had good instrumental support, almost all (94.4%) had good information support. Conclusion: The conclusion of the results of this study is that the identification of postpartum mothers in the work area of the Dukuh Kupang Health Center, Surabaya City, almost entirely received good social support. Advice for puskesmas to provide preventive efforts to postpartum mothers, for the community to increase emotional support in postpartum mothers again.

HUBUNGAN EMOTIONAL SUPPORT DENGAN TINGKAT KECEMASAN IBU HAMIL PRIMIGRAVIDA TRIMESTER III DALAM MENGHADAPI PERSALINAN DI PUSKESMAS KUTA SELATAN

Pregnancy is an important experience that brings about many changes. Changes that occur in pregnancy can have. an impact on the psychological aspects of pregnant women, in addition to hormonal changes during pregnancy. These hormonal changes can cause the mother to experience some emotional changes that can cause anxiety. The fulfillment of emotional needs can be provided by providing emotional support to pregnant women. Emotional support is the support that is manifested in the form of affection, trust, attention, listening, and being listened to. With emotional support, it is hoped. that it will be able to control the emotional level of the mother so that it can. reduce the. level of anxiety of pregnant women in facing the delivery process. The purpose of this study was to determine the relationship between emotional support and the level of anxiety of primigravida pregnant women in the third trimester in facing the delivery process at the South Kuta Health Center. The design of this research is correlative analytic with a cross-sectional approach. The samples used in this study. were all primigravida pregnant women in the third trimester, totaling 106 respondents. Collecting data using a questionnaire and data analysis using spearman rho. The results of this study indicate that most respondents have good emotional support (92,5%) and most mothers experience mild anxiety (36,8%). The results of the bivariate test showed that there. is. a significant negative relationship between emotional support and anxiety levels of pregnant. women, r = - 0.420, p- value = 0,001 < 0,05. This study concludes that there is a relationship between emotional support and the level of anxiety of primigravida pregnant women in the third trimester in facing childbirth at the South Kuta Health.Center.

Knowledge, Attitude, and Practice of Cervical Cancer Screening among Women Infected with HIV in Kasenengwa District of Eastern Province, Zambia

Women living with Human Immunodeficiency Virus (WLHIV) have a higher risk of developing cervical cancer due to their immune-compromised state. Cervical cancer screening leads to early detection and treatment. The aim of the study was to determine the knowledge, attitude, and practices of cervical cancer screening among women infected with HIV in Kasenengwa District, Eastern Province, Zambia. A descriptive cross-sectional study design using a semi-structured questionnaire was used to collect data from 266 WLHIV. Basic descriptive statistics were done using SPSS version 23.0. Almost two-thirds (62.7%) of the 266 WLHIV in the study had adequate knowledge about cervical cancer screening. Almost three-fifths of the respondents (57.1%) had a negative attitude toward cervical cancer screening. The majority (78.2%) had been counselled by healthcare workers on cervical cancer screening with good emotional support from family members (72.9%). About two-thirds (68.4%) of the respondents had been screened for cervical cancer. Most women indicated that they didn’t have access to cervical cancer screening services because they did not know where to go (61.5%) and distant screening sites (56.3%) WLHIV in the study had adequate knowledge, but unfavorable attitude towards cervical cancer screening, while two-thirds had been screened for cervical cancer. Accessibility to screening sites was poor. More education and sensitization are needed in the district to eliminate misconceptions about cervical cancer screening, which may influence uptake. Keywords: Cervical Cancer; Screening; Knowledge; Practice.

Service evaluation: orthoptic-led teaching of soft contact lens handling for parents in the management of pediatric aphakia

ABSTRACT To gauge parental satisfaction of an orthoptic-led specialist service for teaching soft contact lens (CL) handling in the management of children with pediatric aphakia. 20 families attending the contact lens clinic completed a satisfaction questionnaire to enquire about their experience of learning how to insert and remove their child’s CL. Families were questioned on their experiences with preoperative counseling, practical teaching, additional support and the patient literature that was provided by the orthoptists in the CL clinic. Qualitative data and free comments were analyzed. 18/20 (90%) said they had received good practical insertion and removal teaching. 19/20 (95%) felt they received good emotional support. Only 6/20 (30%) families agreed with the statement that they found learning insertion and removal difficult. 15/20 (75%) families did not feel rushed, and 18/20 (90%) said they could learn at their own pace. All except one family (95%) achieved daily CL handling within a few months, with ongoing support from a multi-disciplinary team. One family surveyed was much earlier in their postoperative journey, but was on track to achieve this imminently. All families (100%) felt they were appropriately counselled preoperatively regarding the need for training and daily CL handling. 95% found the provided written information useful. 8/20 (40%) reported they found insertion harder than removal, 4/20(20%) reported they found removal harder. Teaching insertion and removal skills is an important aspect of managing paediatric aphakia and presents many challenges. Most parents eventually cope well and achieve daily CL handling within a few months, with support from a multi-disciplinary team. Families surveyed were all competent and were satisfied with their experience. The parental satisfaction survey gave our team confidence that our orthoptic-led service works well, orthoptists have the knowledge and skills to provide technical training to parents alongside vital emotional support, and contact lens handling is a rewarding extended role for orthoptists in a multi-disciplinary team.

DOZ047.05: The flip side of the coin

Abstract Background Being two medical doctors (family practitioner and pediatric surgeon) with a son born with a rare type of esophageal atresia we felt the need to explore the nonmedical side of this disease. Aim The aim of this study was to emphasize the role of emotional support for parents with children born with all types of esophageal atresia and to realize the importance of the nonsurgical side—the flip side of the coin, to explore the need for support not only for the patient but also the family. Literature Review and Personal Experience The epidemiology, surgical management, and biological outcome of esophageal atresia with/without trachea-esophageal fistula are well known. The softer, more humane side of this condition, the flipside of the coin, being the cause of PTSD children with OA (mothers > fathers).2 Severe anxiety also seems to be present in some of these parents. A meta-analysis done in 2013 concluded that psychological morbidity associated with esophageal atresia has important implications for clinical practise3; namely, if psychological support is being offered to parents during the neonatal period and continues as part of the long-term follow-up for both parents and the patients, the overall outcome is improved and the biopsychosocial morbidity of the parents decreases. Personal experience has taught us that a good support system is a critical part of a child's clinical treatment plan. Parents need good emotional support in order to be there for their child when he or she needs them. Conclusion Surgeons look at diseases from a technical point of view. They ask how they can surgically fix the problem and improve the patient's quality of life. They often forget the other side that parents need emotional support, someone to be there for them and to listen to their experience in hospital and at home. The family as another patient needs to be treated and included in the overall treatment plan if the intention is to improve the quality of life for both the patients and their families. There is a need to develop a multidisciplinary support system in South Africa to aid patients born with OA and their caring families. This includes the entire family and is not limited to the mothers but also includes fathers and other siblings often overlooked.

Enabling good emotional support for and with people with learning disabilities

PurposePicking up from Cotter et al.’s article on the transferential process, the purpose of this paper is to set out some arguments about the ways of meeting the emotional needs of people with learning disabilities.Design/methodology/approachThe commentary draws on two studies: one is about understanding and changing disabling practices, and the other is about bereavement support for people with learning disabilities. Both use qualitative approaches, and in both studies, people with learning disabilities are active agents or co-researchers, who have assisted in shaping the ideas and values of the research.FindingsProfessional practices, including those within the therapeutic context, can act as institutional barriers which create people with learning disabilities as passive or incompetent. However, this paper sets out some preliminary findings showing that not only can people with learning disabilities support each other, but also that face-to-face support workers can support people with learning disabilities to understand and cope with their emotions.Practical implicationsFrontline support workers should be seen as professionals, with their own range of resources to provide good emotional support. Further, people with learning disabilities can come together in groups to develop peer support about difficult and sensitive topics.Originality/valueTalking about therapies for people with learning disabilities has long been overlooked. As their value is now recognised, it is important that the views and wishes of people with learning disabilities themselves are heard, so that they can contribute to the processes which support them.

Pre-transplant emotional support is associated with longer survival after allogeneic hematopoietic stem cell transplantation.

Emerging evidence suggests that psychosocial factors pre-transplant predict survival in cancer patients undergoing hematopoietic stem cell transplantation (HSCT). These studies, however, typically have small sample sizes, short-term follow ups or a limited panel of medical covariates. We extend this research in a large, well-characterized sample of transplant patients, asking whether patients' perceived emotional support and psychological distress predict mortality over 2 years. Prior to transplant, 400 cancer patients (55.5% males; 82.8% White; Mage=50.0 years; 67.0% leukemia, 20.0% lymphoma) were interviewed by a social caseworker, who documented the patients' perceived emotional support and psychological distress. Subsequently, patients received an allogeneic HSCT (51.0% matched-related donor, 42.0% matched-unrelated donor and 7.0% cord blood). HSCT outcomes were obtained from medical records. Controlling for demographic characteristics (age, sex, race/ethnicity and marital status) and medical confounders (disease type, conditioning regimen, remission status, cell dosage, donor and recipient CMV seropositivity, donor sex, comorbidities and disease risk), ratings of good emotional support pre-transplant predicted longer overall survival (hazard ratio (HR)=0.61, 95% confidence interval (CI), 0.42-0.91; P=0.013). Pre-transplant psychological distress was unrelated to survival, however (Ps>0.58). Emotional support was marginally associated with lower rates of treatment-related mortality (HR=0.58, CI, 0.32-1.05; P=0.073). These findings are consistent with the hypothesis that emotional support contributes to better outcomes following HSCT. Future studies should examine whether intervention efforts to optimize emotional resources can improve survival in cancer patients.

SATISFACTION OF THE FAMILY MEMBERS OF PATIENTS ADMITTED IN THE INTENSIVE EMERGENCY CARE UNIT

The appreciation of care by families is of great importance in the evaluation of the quality of care in an intensive care unit (ICU). This study used the adaptation of the Family Satisfaction with Care in the Intensive Care Unit questionnaire: FS-ICU (24). Our objective was to know the degree of satisfaction of family members for the care received from the patient admitted to the Emergency Intensive Care Unit (UCIE) as well as with the decision-making process for patient care. This is a cross-sectional, observational, descriptive and prospective study for 5 months. A sample of 69 main relatives of patients admitted to the unit with more than 24 hours of stay was studied, applying the FS-ICU (24) questionnaire. The following results were obtained: In relation to the care of the patient in the ICUE, 68.12% of relatives perceived an excellent or very good concern for the patient, a very good pain management in 49.28%, very good management of dyspnea in 40%, regarding family care, 43.48% considered it very good, with good emotional support in 46.38%. 47.83% considered the coordination of care as good, as well as the concern of the staff. When assessing professional care, the nurse's skills and competencies were considered very good at 43.48%, and communication as good at 43.48%; The doctor's skills and competencies were also very good at 43.48%. Regarding the environment of the UCIE, it was considered good in 44,935, the waiting room as sufficient in 47.83%, and the amount of care as very good in 43.48%. We conclude that most family members have a high degree of satisfaction, result that is similar to international studies; it also gives us aspects to improve such as the waiting room and the privacy of the patients. keywords: Satisfaction; Care; Quality; Intensive Care Unit; Emergency; FS-ICU.

The development and evaluation of an emotional support algorithm for carers

Carers - people who provide regular support for a friend or relative who could not manage without them - frequently report high levels of stress. Good emotional support could help relieve this stress. This study uses seven scenarios that depict different types of stress and acquires emotional support messages for them. We then categorize and evaluate the emotional support for different types of stress. We found that telling the carer they are appreciated and offering support are the best types of emotional support. Additionally, we found that how well a supporter sympathises with a situation affects the type of support they consider suitable. We describe and evaluate an algorithm that selects different categories of support to be used by an intelligent virtual agent to provide emotional support to carers experiencing different types of stress.

QUALITY OF LIFE IN BRAZILIAN WOMEN WITH BREAST CANCER – ASSOCIATION WITH THE SOCIAL ENVIRONMENT

Background and Aims: The incidence of breast cancer is increasing in Brazil, constituting a major cause of morbidity and mortality with major social and epidemiological impact. The aim of this study is to evaluate the association between social support before the treatment of breast cancer and quality of life (QOL) six months after starting treatment. Methods: Eligible participants were women with no history of cancer and who were treated for breast cancer in National Cancer Institute of June/2009-March/2010. The evaluation of the social support was performed before the oncology treatment. EORTC QLQ-C30 was used to measure quality of life. Medical Outcomes Survey-Social Support Survey was used to assess social support. The bivariate analysis of dichotomous variables and odds ratio with confidence interval 95% were analyzed. Results: 195 women were evaluated and it was observed that good emotional support is a protective factor for overall health (OR=0.42 95% CI 0.23-0.79) and scale functionality (OR=0.36 95% 0, 18-0.71). The information support was associated with better global health (OR=0.41 95% CI 0.22-0.76), functionality (OR=0.35 95% CI 0.18-0.70) and symptoms scale (OR=0.38 95% CI 0.18-0.77). Women who reported good emotional support showed reduced of 70% to have general health problems after six months of treatment (95% CI 0.13-0.65). Conclusions: The results of this study suggest that a good social environment in which these women are inserted prior to treatment showed a positive association with the better quality of life six months after surgery in women with breast cancer, underscoring the importance of environmental assessment of the social in these patients.

Instrumental and emotional social support at work and leisure time: association with self-rated health and sickness absence in a longitudinal context

ObjectivesPotential associations between sickness absence, self rated health and social support are highly relevant for the current public health research and our aim is to investigate how different aspects of...

P2-79 The impact of social environment on quality of life in elderly women with breast cancer in Brazil

IntroductionStudies suggest that social support is associated with improved health outcomes in cancer patients. The relationship between social environmental and health outcomes in elderly Brazilian women with breast cancer has...

Experts weigh in on BRCA1/2 mutations and prophylactic surgeries

Gail Tomlinson, MD, PhD, interim director of the Greehey Children's Cancer Research Institute at the University of Texas Health Science Center, San Antonio, and coauthor of the prospective BRCA1/2 mutation study.2 “For women and families at risk of developing these cancers, this study shows a very real benefit to these prophylactic surgeries, allowing women to concentrate on other aspects of their lives, such as their families, children, and jobs.” “Women with BRCA1mutations have a higher percentage of triple-negative tumors that don't respond to tamoxifen or aromatase inhibitors and can be very aggressive, so some of these women may be less willing to run the risk of waiting [rather than undergo one or both surgeries].” “We need to see if, after 20 to 30 years, women still feel good about having had these surgeries.” Martha Thomas, MS, certified genetic counselor at the University of Texas Health Science Center at San Antonio “No genetic testing is perfect. BRCA analysis will detect up to 90% to 92% of all mutations. The BRCA rearrangement test came out in 2007, and it looks for large deletions and duplications in the gene. A lot of women have had to come back to have this new test.” “The Genetic Information Nondiscrimination Act of 2008 prevents people from discrimination by Insurers and employers based on genetic test results, but it doesn't include life insurance. But, I think because these tests are relatively new, unless you're getting a multimillion-dollar policy, rarely does it come up.” “I had one woman who, when she gother positive results back, wanted to go to the operating room immediately. But the doctor I work with says, ‘Prevention is never an emergency.’” “A lot of people's concerns are for their children. Except under extreme circumstances, we don't recommend testing under age 18. The earliest is about 25.” “Even after a prophylactic mastectomy, there is still a 5% to 10%residual risk of developing breast cancer. And if women decide to keep their nipple, there's a slight additional residual risk.” Kelly Hunt, MD, chief of the surgical breast section at The University of Texas MD Anderson Cancer Center in Houston, Texas “Recommendations are re-evaluated every year, and these study Results certainly will make those recommendations stronger. In the past, there was less data showing that these surgeries reduce mortality. There have been ads encouraging women to get genetic testing, and that brings in women who may not need to be tested. Also, just because a woman tests negative for BRCA1or 2doesn't mean she still isn't high risk. That's why women considering the test should get counseling.” “The mutation location, a patient's family history, and her age at diagnosis will all affect relative risk. Older women won't benefit as much from oophorectomy after menopause. Also, breast cancer patients who have been treated with chemotherapy that leads to menopause may not receive much benefit from oophorectomy.” “It's always important to consider how many quality years you're gaining with this surgery. Individuals need to know what life changes will occur, especially with young women who have oophorectomies now that it is less clear whether they should take hormone replacement therapy.” Christina Finlayson, MD, professor of surgery and director of the Diane O'Connor Thompson Breast Center at the University of Colorado Cancer Center in Aurora “As we're testing more people, we're finding more mutations. The initial families we tested were at very high risk. Now, if a patient is diagnosed with breast cancer under age 45, it's an indication to test even if there's no family history. So, we're picking up family members with the mutation that may or may not have as high a risk as the original group we studied.” “Locally, I see many more women choosing prophylactic mastectomies Than high-risk screening. But there also has been a pendulum shift in the general population away from breast conservation toward mastectomy. Prevention is becoming amore accepted way to manage your health.” “Women with the mutations who have cancer in 1 breast will choose bilateral mastectomies because they have a 40–50% chance of getting cancer in the other breast in the next 10 years.” “It's important that women realize that reconstruction after mastectomy is not the same as breast augmentation. We can do a lot to make the breasts look better, but they will never feel the same—the breast area is numb and the nipple, ifwe save it, is still numb.” “It's important for women undergoing prophylactic mastectomy to do a little grief therapy, because it is a loss. I think they under estimate the scope of the operation—it takes a lot out of you, and there are life long changes you have to cope with. Having good emotional support is very important.”

Empowering patients with diabetes: a qualitative primary care study focusing on South Asians in Leicester, UK

We aimed to explore the experience and attitudes of primary care patients with diabetes living in a UK community with a high proportion of South Asian patients of Indian origin, with particular reference to patient empowerment. Semi-structured interviews were conducted with patients with diabetes attending two general practices in Leicester, UK. Patients were interviewed in English, Gujarati or Punjabi and interviews were transcribed with translation into English where necessary. Broad themes were identified and Framework charting was used to organise data for analysis. Interviews were conducted with 15 South Asian and 5 white patients. We identified both similar and culturally specific elements within the experience, attitudes and barriers in the two ethnic groups. High regard for education, particularly in South Asians, was associated with a positive attitude to empowerment through knowledge, but also sometimes led to low motivation to become partners in diabetes management. High prevalence of diabetes and strong family networks meant that families were an important source of knowledge for South Asians and that these patients generally had good emotional support. Practical considerations such as the need for a convenient venue for educational initiatives were common to both ethnic groups, but some cultural preferences were also identified, for example for appropriate language provision and separate gender sessions. Educational initiatives aimed at promoting self-management in chronic diseases such as diabetes need to be designed with an awareness of the complexity of social and cultural experiences and attitudes in target communities.

Expectant or Surgical Management of Miscarriage: A Qualitative Study

Thirteen women who presented to the Early Pregnancy and Gynaecology Assessment Unit of the authors’ institution with an incomplete miscarriage were offered the choice of surgical treatment or expectant management. The options were explained to the patients after ultrasound diagnosis. Five women each chose surgery and expectant management, and 3 tried expectant management but eventually underwent surgical treatment. An average of 5 weeks after the initial contact, the women were interviewed in depth about their experience. Women who chose expectant management expressed a desire to have a “natural” experience with natural healing, or they preferred to avoid surgery. Surgical treatment was chosen by women who were anxious to have the experience over with and who wanted to return to a normal life as quickly as possible. In both groups, some patients felt that they could have used more time and more information to make the treatment decision. Women in each group had similar experiences with bleeding and pain before coming to the early pregnancy unit, but women who opted for surgical management reported quick resolution of their symptoms (Table 1). Women who had expectant management reported continued heavy bleeding with severe pain. Some did not feel prepared for the experience. Three patients who chose expectant management decided to undergo surgery when the pain and bleeding continued. Both groups reported strong emotional support from family and friends, but some in the expectant management group said that support diminished after several days. Most patients who underwent surgery reported good emotional support from the hospital personnel.TABLE 1: Themes and categories

Apoyo Social y Estado de Salud Percibido en Población no Institucionalizada de Más de 60 años

The purpose of this study is to describe the degree of social support in a sample of non-institutionalized population aged 60 and over and to explore possible relations between social support and perceived health. We analyse data coming from Barcelona 1992 Health Survey. Sociodemographic and perceived health variables are analysed together with several social support variables based on the presence and number of available people for instrumental and emotional support necessity and perceived aid need for personal care and daily needs. In the study period, 1156 subjects aged 60 and over were interviewed at home. 20% of the sample (28.9% were women) lived alone and 28.2% (41.7% were women) were widowed. 43% had an extensive social support and 51% had a good emotional support. The men with less emotional support had a worse perceived health (OR = 2.7, IC 95% = 1.3-5.5). Only aid need for daily works in women was associated with worse perceived health (OR = 6.3, IC 95% = 3.2-12.4). Instrumental and emotional support availability weren't associated with perceived health in women in spite of they lived alone in a greatest proportion. In men, only emotional support absence was associated with worse perceived health.

Psychosocial study on Hong Kong Chinese with gynecological cancer.

Psychosocial support and adjustment to cancer in 115 Chinese patients with gynecological malignancies were studied by interviews using semi-structured and structured questionnaires before commencement of treatment. Ninety per cent of patients had emotional support with 72% coming from family members, while 77% of the patients said that they were clearly informed of their diagnosis. The majority of our patients (63%) did not wish to see a counsellor. Psychological outcome of the patients was good, with less than 21% having expression of anxiety or depression. Social adjustment was less favorable; 42% of women had a reduction in leisure activity. The majority of married couples maintained a good marital relationship even though 78% had reduction or cessation of their sexual activity. Good emotional support was associated with fewer neurotic symptoms. Though there was no statistical significance demonstrated, the good psychosocial support and the favorable psychological outcome in this group of patients indicated the likelihood of a positive relationship between the two.

Doulas and the quality of maternity services.

Critical comment is provided on a recent study by Klaus and Kennell on the beneficial effects of the use of doulas in providing support for women in labor. It is commonly agreed that a womens role in the decision making about her care and good emotional support from a companion result in a more satisfying delivery with better outcomes than neither of these. The study referred to was one conducted among a Hispanic population in a Texas hospital and the results are similar to the Klaus and Kennells prior work in Guatemala where labor was shortened and interventions such as cesarean section were reduced. The author finds that the Texas womens hospital care began with substandard care and should not have been described as modern obstetric practice e.g. 33% of the women received minimal (<4 visits or 1st visit after 27 weeks) or no prenatal care. The ward of 12 beds afforded no privacy and hospital staff did not speak their language. Women had no voice in the delivery process i.e. patients were confined to bed immediately after admission and artificial rupture of membranes was done routinely after 5 cm dilatation. It would be reasonable to expect that a doula with experience of labor who could speak the language would improve the delivery experience. The question is raised as to whether the doula really provided emotional support or whether her presence improved the quality and appropriateness of hospital staff actions toward the laboring woman. The author suggests that the presence was important because even an observer improved circumstances compared with the control group. Removing the institutionalization of treatment is the goal of a satisfactory delivery context. Women need social support during labor. Hospitals need to make accessible to women the option to have whomever she chooses to help to her during labor and birth whether it be a trained midwife friends family member or partner. The emotional support from hospital staff and others helps to make the mother feel in control of what is going on thereby improving outcomes for her and her baby. The doula may have been a help but the first level of concern is that the mothers babies and their families need a higher standard than this Texas hospital provided.