(1) The study explored the knowledge, beliefs, and practices of midwives and gynecologists in Flanders, Belgium regarding smoking cessation counseling for pregnant women.
(2) Semi-structured interviews were conducted with 9 midwives and 8 gynecologists. The interviews found that while the health risks of smoking during pregnancy were known, knowledge of smoking cessation policies and guidelines was insufficient.
(3) Participants reported barriers like fear of provoking resistance, and lack of time and communication skills for smoking cessation counseling. Training in motivational interviewing was suggested to help address barriers.
This was a discussion on healthcare reform between various medical professionals, students, patients, and insurers.
1. Dr. Donna Beck, a naturopathic physician, shared her experience being unable to get credentialed by an HMO despite being a qualified doctor, showing the system prioritizes insurance companies over patients.
2. A patient described the high costs and difficulties navigating their health plan, showing the system is complex and lacks transparency.
3. The group agreed the system needs reform to focus on prevention, wellness, nutrition education, and making care accessible, patient-centered, and driven by consumer needs rather than insurance profits.
This document provides guidance for doctors on managing the interface between NHS and private treatment in England, Wales and Northern Ireland. It outlines several key principles:
1) Patients can choose to receive private treatment instead of or in addition to NHS care. Private and NHS care should be kept separate.
2) Patients who receive private consultations or investigations can transfer to the NHS waiting list in the same position as if the care was received through the NHS.
3) Consultants should not pressure patients to receive private care instead of NHS care, but can discuss private options if clinically appropriate NHS treatment is unavailable.
4) Issues around "top up payments" where patients receive some private care in addition to NHS care are
This document discusses a research study examining the impact of nurse-led outpatient follow-up care on reducing heart failure readmission rates. It begins by introducing heart failure as an increasing health problem, especially in those over 65. The population of focus is recently discharged heart failure patients at high risk of readmission. The intervention studied is additional nurse-led outpatient follow-up care including follow-up calls and educational sessions. Current practice involves discharge teaching but readmissions continue. The significance of the nursing role in education to reduce readmissions and costs is discussed.
This study examined the impact of a text messaging intervention on quality of life in 396 diabetes patients in eastern Nepal. The intervention provided health education via mobile phone over 6 months. Patients received SMS with diabetes management information and strategies to improve adherence and prevent complications. Knowledge about diabetes increased significantly after the education program. The study found that mobile health services can help increase treatment adherence and quality of life for people with diabetes.
Jacquelyn Favours conducted a capstone project assessing the primary care needs of women in Middle Tennessee and making recommendations for Planned Parenthood of Middle & East Tennessee (PPMET) to expand its services. She analyzed 450 patient records from PPMET clinics, finding high rates of chronic conditions. She recommended that PPMET expand primary care services, seek partnerships with medical schools, and launch a "Primary Care Safety Net" program to provide initial primary care to uninsured women. The project provided evidence of need to support PPMET expanding its role in improving women's healthcare access in the region.
This study assessed antenatal coverage and health seeking behavior among pregnant women in rural areas of Etawah, India. The study found that antenatal coverage was 46.61%, which is lower than other studies in India. Coverage was highest among women aged 25-29 years and more educated women. While 40% of women self-reported for antenatal care, counseling was the most neglected aspect of services provided. The study concludes that antenatal coverage needs to be increased and that greater awareness programs are required on pregnancy-related issues.
This study assessed the health attitudes, perceptions, and knowledge of school teachers in Bahrain. It found that while teachers had average knowledge of some health issues like asthma and diabetes, their knowledge of other issues like hypertension was poor. The study recommends providing teachers with continuous health training to improve their knowledge and ability to act as good health models for students and provide health education.
This document summarizes a counselling toolkit developed to support adherence to treatment for drug-resistant tuberculosis (DR-TB) patients in Khayelitsha, South Africa. The toolkit provides guidance for structured counselling sessions delivered by lay counselors. It includes detailed plans for 14 sessions at different stages of treatment, addressing topics like treatment literacy, adherence strategies, and support for interruptions or treatment failure. The goal is to encourage treatment completion through education and addressing barriers to adherence. Implementation requires training counselors and supervisors, along with session guides, patient adherence plans, educational flipcharts, and a phased approach. The toolkit was presented at a tuberculosis conference in South Africa in 2014.
This was a discussion on healthcare reform between various medical professionals, students, patients, and insurers.
1. Dr. Donna Beck, a naturopathic physician, shared her experience being unable to get credentialed by an HMO despite being a qualified doctor, showing the system prioritizes insurance companies over patients.
2. A patient described the high costs and difficulties navigating their health plan, showing the system is complex and lacks transparency.
3. The group agreed the system needs reform to focus on prevention, wellness, nutrition education, and making care accessible, patient-centered, and driven by consumer needs rather than insurance profits.
This document provides guidance for doctors on managing the interface between NHS and private treatment in England, Wales and Northern Ireland. It outlines several key principles:
1) Patients can choose to receive private treatment instead of or in addition to NHS care. Private and NHS care should be kept separate.
2) Patients who receive private consultations or investigations can transfer to the NHS waiting list in the same position as if the care was received through the NHS.
3) Consultants should not pressure patients to receive private care instead of NHS care, but can discuss private options if clinically appropriate NHS treatment is unavailable.
4) Issues around "top up payments" where patients receive some private care in addition to NHS care are
This document discusses a research study examining the impact of nurse-led outpatient follow-up care on reducing heart failure readmission rates. It begins by introducing heart failure as an increasing health problem, especially in those over 65. The population of focus is recently discharged heart failure patients at high risk of readmission. The intervention studied is additional nurse-led outpatient follow-up care including follow-up calls and educational sessions. Current practice involves discharge teaching but readmissions continue. The significance of the nursing role in education to reduce readmissions and costs is discussed.
This study examined the impact of a text messaging intervention on quality of life in 396 diabetes patients in eastern Nepal. The intervention provided health education via mobile phone over 6 months. Patients received SMS with diabetes management information and strategies to improve adherence and prevent complications. Knowledge about diabetes increased significantly after the education program. The study found that mobile health services can help increase treatment adherence and quality of life for people with diabetes.
Jacquelyn Favours conducted a capstone project assessing the primary care needs of women in Middle Tennessee and making recommendations for Planned Parenthood of Middle & East Tennessee (PPMET) to expand its services. She analyzed 450 patient records from PPMET clinics, finding high rates of chronic conditions. She recommended that PPMET expand primary care services, seek partnerships with medical schools, and launch a "Primary Care Safety Net" program to provide initial primary care to uninsured women. The project provided evidence of need to support PPMET expanding its role in improving women's healthcare access in the region.
This study assessed antenatal coverage and health seeking behavior among pregnant women in rural areas of Etawah, India. The study found that antenatal coverage was 46.61%, which is lower than other studies in India. Coverage was highest among women aged 25-29 years and more educated women. While 40% of women self-reported for antenatal care, counseling was the most neglected aspect of services provided. The study concludes that antenatal coverage needs to be increased and that greater awareness programs are required on pregnancy-related issues.
This study assessed the health attitudes, perceptions, and knowledge of school teachers in Bahrain. It found that while teachers had average knowledge of some health issues like asthma and diabetes, their knowledge of other issues like hypertension was poor. The study recommends providing teachers with continuous health training to improve their knowledge and ability to act as good health models for students and provide health education.
This document summarizes a counselling toolkit developed to support adherence to treatment for drug-resistant tuberculosis (DR-TB) patients in Khayelitsha, South Africa. The toolkit provides guidance for structured counselling sessions delivered by lay counselors. It includes detailed plans for 14 sessions at different stages of treatment, addressing topics like treatment literacy, adherence strategies, and support for interruptions or treatment failure. The goal is to encourage treatment completion through education and addressing barriers to adherence. Implementation requires training counselors and supervisors, along with session guides, patient adherence plans, educational flipcharts, and a phased approach. The toolkit was presented at a tuberculosis conference in South Africa in 2014.
The document discusses several topics relating to ethics and standards in critical care environments. It outlines the goals of maintaining high practice standards in intensive care medicine. A multidisciplinary team approach is emphasized. Standards of care include assessment, diagnosis, planning, implementation, and evaluation. Maintaining current knowledge, quality of care, research, and resource utilization are among the standards of professional practice. Legal and ethical issues pertaining to scope of practice, standard of care, negligence, consent, and confidentiality are also reviewed. The relationship between intensivists and patients must respect patient autonomy, beneficence, non-maleficence, and social justice.
Seminar on ethics committee, cultural concernsPriyanka Tambe
This document discusses ethics committees, cultural concerns, and truth telling in medical research and patient care. It provides details on the roles and responsibilities of ethics committees in ensuring ethical and lawful experimentation. It describes how cultural barriers like language and religion can impact patient care, and the importance of understanding different cultures. The document also discusses the ethics of truth telling patients their diagnosis and errors, exceptions for patients who don't want information or those who may harm themselves, and allowing patients to plan for receiving bad news.
This document discusses a 2013 California court case that allowed unlicensed school personnel to administer insulin injections to diabetic students. Nurses argued this was unsafe as school staff have no medical training. The document outlines diabetes management, the court arguments, and impact on nursing. It recommends only licensed nurses administer insulin, as unlicensed staff lack needed education and could put children at risk.
Impact of thalassemia major on patients' families in south punjab, pakistanDr.Kamran Ishfaq
ABSTRACT… Objectives: The objectives of this study were to examine the level of awareness
of the parents regarding Thalassemia Major; the cost of treatment of Thalassemia Major Patients
and the sufferings it brings to the families; the social problems faced by patients’ families; to
identify the barriers patients’ families face in the treatment of Thalassemia child. Study Design:
Descriptive study. Setting: Four Thalassemic Centers (i) Thalassemia / Hemophilia Centre, The
Children’s Hospital & the Institute of Child Health Multan (ii) Fatimid Foundation Multan (iii) Amna
Blood Foundation (iv) Minhajul Quran Multan. Period: January-2013 to June-2013. Methods:
A sample of 500 respondents was drawn from the total population and structured interview
schedule was administrated. Data were analyzed and interpreted by using SPSS (Statistical
Package for Social Sciences) 19.0 version software. The structured interview was discussed
with two experts of the Sociology Department and two Senior Doctors (>8 years’ experiences)
working in the Thalassemia centers and Government Health Institutions. It was revised to
incorporate recommended improvements. Descriptive and inferential statistics were applied to
analyze the data that includes: frequency, percent, mean, standard deviations. Results: Data
indicated that 100(20.0%) respondents were patients’ father while 329(65.8%) were mothers
and 71(14.2%) were close relatives. Of the 500 respondents, 306(61.2%) were married to their
first cousins, 91(18.2%) of the respondents were married to their second cousins, 34(6.8%) of
the respondents married in distance relatives and 69(13.8%) of the respondents married out of
family. Conclusion: The study summarized that the health care providers should be encouraged
to talk about Thalassemia as a public health problem in Pakistan and should enhance the public
awareness to eliminate the Thalassemia in Pakistan.
Criticisms of orthodox medical ethics, importance ofsupriyawable1
ethics is a very large and complex field of study with many branches .medical ethics is the branch of ethics that deals moral issues in medical practice. principles of medical ethics - autonomy ,beneficence ,confidentiality,do not harm,equity .importance of communication .
Complementary medical health services: a cross sectional descriptive analysis...home
This summary analyzes a research article describing a cross-sectional study of patient data from the largest naturopathic teaching clinic in Canada. The study aimed to describe the patient demographics, health conditions, and services provided at the clinic over three years. Key findings include:
- Over 13,000 unique patients received care in over 76,000 visits. The median patient age was 37 and most patients were female.
- Common health concerns included those consistent with primary care like chronic health conditions. Obtaining health education and help with chronic issues were top reasons for visits.
- Services provided included herbal medicines, homeopathy, acupuncture, and nutrition counseling.
- The clinic attracts patients from a
The document discusses evidence based healthcare and the process of evidence based medicine. It describes the 5 step process as asking questions, acquiring information, appraising the quality of evidence, applying the results, and assessing performance. Simple skills can help focus questions and basic rules can improve ability to critique literature. Simple math, not complex statistics, can help clearly describe study results.
This document summarizes a presentation on whether incidental findings from prenatal testing should always be reported to patients. It discusses the case for reporting all incidental findings by defining what incidental findings are and outlining the purpose and goals of prenatal diagnosis. It then applies principles of medical ethics including autonomy, beneficence, non-maleficence, and justice to argue that incidental findings of known clinical significance that are actionable should be reported. It acknowledges the difficulty of incidental findings of unknown significance but still argues they should be shared with parents so they can make informed decisions. Finally, it addresses concerns about discovering late-onset untreatable diseases and risks of anxiety, but concludes that an ethical approach is to
"'I am proud that MaineCare has been working in partnership with other payers to advance payment reform through greater investment in primary care to both improve outcomes for patients and reduce preventable high cost spending in emergency departments and avoidable inpatient admissions.
– Mary C. Mayhew, Commissioner, Maine Department of Health & Human Services
This webinar discussed the business case for self-management support. It outlined evidence that self-management programs can deliver savings to the NHS through reduced GP, nurse, outpatient, A&E and medication usage. A ROI model was presented that calculates potential savings for commissioners based on their population. Case studies showed programs achieving a £2.24 return for every £1 spent. Challenges like an aging population and rising long-term conditions were discussed. The webinar argued for an experienced provider and defined outcomes to make an evidence-based case for self-management.
EVIDENCE-BASED PSYCHIATRIC NURSING PRACTICE, Components of EPBBASES FOR NURSING PRACTICE, DEVELOPING EVIDENCE-BASED CARE, HIERARCHY OF RESEARCH EVIDENCE, TAXONOMY FOR INFORMED DECISION-MAKING, CHARACTERISTICS OF GOOD BEHAVIORAL HEALTH PRACTICE GUIDELINES, CLINICAL ALGORITHMS
The document discusses the importance of a team approach in treating chronic conditions like chronic kidney disease. It notes that chronic diseases now represent a major health issue and require input from multiple medical specialists. A team approach can improve patient outcomes and quality of life while reducing costs and mortality rates. Effective team strategies include regular multidisciplinary treatment planning meetings, appointing a care coordinator, developing treatment protocols, and ensuring good communication between specialists, primary care physicians, and patients.
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
This document discusses opportunities to empower patients and reduce demand on the UK National Health Service (NHS) through patient education. It identifies four key areas along the patient journey that could be improved: 1) healthcare education; 2) healthcare information; 3) healthcare provision; and 4) healthcare involvement. It then provides seven recommendations to better empower patients in these areas, such as providing compulsory health education in schools, regulating health information online through an NHS accreditation system, training non-traditional community healthcare experts, and creating mobile apps and tools to help patients manage their conditions. The overall aim is to improve health literacy and help patients better navigate the healthcare system, with the goal of reducing unnecessary demand on NHS services.
Independent practitioner, independent midwifery practitioner issues and chall...Arifa T N
The document discusses issues related to independent nursing practice, specifically for nurse practitioners and midwives. It defines nursing and the roles of nurse practitioners who can manage medical conditions, order tests, treatments, and medications. It also defines independent nurse practitioners and midwives. Key issues for independent practice include scope of services, conflict of interest, endorsement, advertising, fees, informed consent, documentation, confidentiality, and liability protection. Areas of independent nursing practice are also outlined, along with standards and challenges for independent midwifery practice in India.
The document discusses the career of a physician assistant. It provides a brief history of the profession starting in the 1960s to address a shortage of primary care physicians. The duties of a PA are described, including examining patients, diagnosing illnesses, prescribing medication, and assisting in surgery. Strong projected job growth of 38% by 2022 is explained by an increasing and aging population demanding more healthcare services. The salary range for PAs is outlined, with a median of $90,930 annually. Education requirements including a master's degree from an accredited program are also summarized.
El documento presenta un análisis técnico realizado por Oscar Germade sobre varios índices bursátiles europeos como el EuroStoxx50, DAX, IBEX35 y CAC40, recomendando posiciones cortas en todos ellos con niveles de entrada, stop y objetivos definidos. También recomienda una posición larga en el Bund alemán, indicando los mismos parámetros. El análisis se basa en líneas de soporte y resistencia calculadas.
Este documento define multimedia como la combinación de diferentes formas de contenido como texto, sonido, imágenes, animación y video. Explica que el contenido multimedia puede ser lineal o no lineal e interactivo, y que se usa en aplicaciones como educación, entretenimiento y comunicaciones.
Este documento resume la historia de la computación desde las primeras máquinas mecánicas y electromecánicas hasta el desarrollo del microprocesador. También describe los componentes básicos de una computadora, tanto externos como internos, y las unidades de medida para el almacenamiento y procesamiento de información digital.
The document discusses several topics relating to ethics and standards in critical care environments. It outlines the goals of maintaining high practice standards in intensive care medicine. A multidisciplinary team approach is emphasized. Standards of care include assessment, diagnosis, planning, implementation, and evaluation. Maintaining current knowledge, quality of care, research, and resource utilization are among the standards of professional practice. Legal and ethical issues pertaining to scope of practice, standard of care, negligence, consent, and confidentiality are also reviewed. The relationship between intensivists and patients must respect patient autonomy, beneficence, non-maleficence, and social justice.
Seminar on ethics committee, cultural concernsPriyanka Tambe
This document discusses ethics committees, cultural concerns, and truth telling in medical research and patient care. It provides details on the roles and responsibilities of ethics committees in ensuring ethical and lawful experimentation. It describes how cultural barriers like language and religion can impact patient care, and the importance of understanding different cultures. The document also discusses the ethics of truth telling patients their diagnosis and errors, exceptions for patients who don't want information or those who may harm themselves, and allowing patients to plan for receiving bad news.
This document discusses a 2013 California court case that allowed unlicensed school personnel to administer insulin injections to diabetic students. Nurses argued this was unsafe as school staff have no medical training. The document outlines diabetes management, the court arguments, and impact on nursing. It recommends only licensed nurses administer insulin, as unlicensed staff lack needed education and could put children at risk.
Impact of thalassemia major on patients' families in south punjab, pakistanDr.Kamran Ishfaq
ABSTRACT… Objectives: The objectives of this study were to examine the level of awareness
of the parents regarding Thalassemia Major; the cost of treatment of Thalassemia Major Patients
and the sufferings it brings to the families; the social problems faced by patients’ families; to
identify the barriers patients’ families face in the treatment of Thalassemia child. Study Design:
Descriptive study. Setting: Four Thalassemic Centers (i) Thalassemia / Hemophilia Centre, The
Children’s Hospital & the Institute of Child Health Multan (ii) Fatimid Foundation Multan (iii) Amna
Blood Foundation (iv) Minhajul Quran Multan. Period: January-2013 to June-2013. Methods:
A sample of 500 respondents was drawn from the total population and structured interview
schedule was administrated. Data were analyzed and interpreted by using SPSS (Statistical
Package for Social Sciences) 19.0 version software. The structured interview was discussed
with two experts of the Sociology Department and two Senior Doctors (>8 years’ experiences)
working in the Thalassemia centers and Government Health Institutions. It was revised to
incorporate recommended improvements. Descriptive and inferential statistics were applied to
analyze the data that includes: frequency, percent, mean, standard deviations. Results: Data
indicated that 100(20.0%) respondents were patients’ father while 329(65.8%) were mothers
and 71(14.2%) were close relatives. Of the 500 respondents, 306(61.2%) were married to their
first cousins, 91(18.2%) of the respondents were married to their second cousins, 34(6.8%) of
the respondents married in distance relatives and 69(13.8%) of the respondents married out of
family. Conclusion: The study summarized that the health care providers should be encouraged
to talk about Thalassemia as a public health problem in Pakistan and should enhance the public
awareness to eliminate the Thalassemia in Pakistan.
Criticisms of orthodox medical ethics, importance ofsupriyawable1
ethics is a very large and complex field of study with many branches .medical ethics is the branch of ethics that deals moral issues in medical practice. principles of medical ethics - autonomy ,beneficence ,confidentiality,do not harm,equity .importance of communication .
Complementary medical health services: a cross sectional descriptive analysis...home
This summary analyzes a research article describing a cross-sectional study of patient data from the largest naturopathic teaching clinic in Canada. The study aimed to describe the patient demographics, health conditions, and services provided at the clinic over three years. Key findings include:
- Over 13,000 unique patients received care in over 76,000 visits. The median patient age was 37 and most patients were female.
- Common health concerns included those consistent with primary care like chronic health conditions. Obtaining health education and help with chronic issues were top reasons for visits.
- Services provided included herbal medicines, homeopathy, acupuncture, and nutrition counseling.
- The clinic attracts patients from a
The document discusses evidence based healthcare and the process of evidence based medicine. It describes the 5 step process as asking questions, acquiring information, appraising the quality of evidence, applying the results, and assessing performance. Simple skills can help focus questions and basic rules can improve ability to critique literature. Simple math, not complex statistics, can help clearly describe study results.
This document summarizes a presentation on whether incidental findings from prenatal testing should always be reported to patients. It discusses the case for reporting all incidental findings by defining what incidental findings are and outlining the purpose and goals of prenatal diagnosis. It then applies principles of medical ethics including autonomy, beneficence, non-maleficence, and justice to argue that incidental findings of known clinical significance that are actionable should be reported. It acknowledges the difficulty of incidental findings of unknown significance but still argues they should be shared with parents so they can make informed decisions. Finally, it addresses concerns about discovering late-onset untreatable diseases and risks of anxiety, but concludes that an ethical approach is to
"'I am proud that MaineCare has been working in partnership with other payers to advance payment reform through greater investment in primary care to both improve outcomes for patients and reduce preventable high cost spending in emergency departments and avoidable inpatient admissions.
– Mary C. Mayhew, Commissioner, Maine Department of Health & Human Services
This webinar discussed the business case for self-management support. It outlined evidence that self-management programs can deliver savings to the NHS through reduced GP, nurse, outpatient, A&E and medication usage. A ROI model was presented that calculates potential savings for commissioners based on their population. Case studies showed programs achieving a £2.24 return for every £1 spent. Challenges like an aging population and rising long-term conditions were discussed. The webinar argued for an experienced provider and defined outcomes to make an evidence-based case for self-management.
EVIDENCE-BASED PSYCHIATRIC NURSING PRACTICE, Components of EPBBASES FOR NURSING PRACTICE, DEVELOPING EVIDENCE-BASED CARE, HIERARCHY OF RESEARCH EVIDENCE, TAXONOMY FOR INFORMED DECISION-MAKING, CHARACTERISTICS OF GOOD BEHAVIORAL HEALTH PRACTICE GUIDELINES, CLINICAL ALGORITHMS
The document discusses the importance of a team approach in treating chronic conditions like chronic kidney disease. It notes that chronic diseases now represent a major health issue and require input from multiple medical specialists. A team approach can improve patient outcomes and quality of life while reducing costs and mortality rates. Effective team strategies include regular multidisciplinary treatment planning meetings, appointing a care coordinator, developing treatment protocols, and ensuring good communication between specialists, primary care physicians, and patients.
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
This document discusses opportunities to empower patients and reduce demand on the UK National Health Service (NHS) through patient education. It identifies four key areas along the patient journey that could be improved: 1) healthcare education; 2) healthcare information; 3) healthcare provision; and 4) healthcare involvement. It then provides seven recommendations to better empower patients in these areas, such as providing compulsory health education in schools, regulating health information online through an NHS accreditation system, training non-traditional community healthcare experts, and creating mobile apps and tools to help patients manage their conditions. The overall aim is to improve health literacy and help patients better navigate the healthcare system, with the goal of reducing unnecessary demand on NHS services.
Independent practitioner, independent midwifery practitioner issues and chall...Arifa T N
The document discusses issues related to independent nursing practice, specifically for nurse practitioners and midwives. It defines nursing and the roles of nurse practitioners who can manage medical conditions, order tests, treatments, and medications. It also defines independent nurse practitioners and midwives. Key issues for independent practice include scope of services, conflict of interest, endorsement, advertising, fees, informed consent, documentation, confidentiality, and liability protection. Areas of independent nursing practice are also outlined, along with standards and challenges for independent midwifery practice in India.
The document discusses the career of a physician assistant. It provides a brief history of the profession starting in the 1960s to address a shortage of primary care physicians. The duties of a PA are described, including examining patients, diagnosing illnesses, prescribing medication, and assisting in surgery. Strong projected job growth of 38% by 2022 is explained by an increasing and aging population demanding more healthcare services. The salary range for PAs is outlined, with a median of $90,930 annually. Education requirements including a master's degree from an accredited program are also summarized.
El documento presenta un análisis técnico realizado por Oscar Germade sobre varios índices bursátiles europeos como el EuroStoxx50, DAX, IBEX35 y CAC40, recomendando posiciones cortas en todos ellos con niveles de entrada, stop y objetivos definidos. También recomienda una posición larga en el Bund alemán, indicando los mismos parámetros. El análisis se basa en líneas de soporte y resistencia calculadas.
Este documento define multimedia como la combinación de diferentes formas de contenido como texto, sonido, imágenes, animación y video. Explica que el contenido multimedia puede ser lineal o no lineal e interactivo, y que se usa en aplicaciones como educación, entretenimiento y comunicaciones.
Este documento resume la historia de la computación desde las primeras máquinas mecánicas y electromecánicas hasta el desarrollo del microprocesador. También describe los componentes básicos de una computadora, tanto externos como internos, y las unidades de medida para el almacenamiento y procesamiento de información digital.
Este documento trata sobre informática educativa. Explica que la informática educativa investiga, teoriza y aplica los avances tecnológicos en procesos educativos. Se vale principalmente de computadoras, internet y la web para mejorar la administración, investigación, enseñanza, aprendizaje y evaluación educativas. También discute problemas y controversias como quién debe desarrollar material computarizado y la necesidad de coordinar esfuerzos entre grupos de investigación.
This policy brief discusses strategies to increase patient engagement in their own healthcare. It outlines three key areas: improving health literacy, promoting shared decision-making, and supporting self-management of chronic conditions. Effective interventions include providing tailored written and online health information, training healthcare professionals in communication skills, using decision aids and question prompts, and delivering self-management education programs. Governments need a coherent strategy targeting multiple levels to inform and empower patients in their care.
The document discusses strategies to increase patient engagement in their own healthcare. It outlines three key areas: improving health literacy, promoting shared decision-making, and supporting self-management of chronic conditions. Effective interventions include providing tailored written and online health information, training healthcare professionals in communication skills, using decision aids and question prompts, and delivering self-management education programs. Governments need a coherent strategy targeting multiple levels to inform and empower patients in their care.
Applying A Maori-Centred Consultation Approach For Engaging With Maori Patien...Jennifer Holmes
This document describes an undergraduate medical student's application of a Māori-centered consultation approach when interviewing a Māori patient. The student used the Hui Process, a 4-step Māori communication model, and the Meihana Model, a holistic Māori health model. The student followed the steps of mihimihi (greeting), whakawhanaungatanga (building relationship), and kaupapa (main purpose). Through sharing stories and maintaining cultural connections, the student was able to have an in-depth 2.5 hour interview and gain a holistic understanding of the patient's physical, family, mental, spiritual, environmental, and cultural health. The student demonstrated learning how
Do Maternity Policies in the UK in practice enable and empower women to make ...Claire Carey
This chapter provides a historical overview of maternity policy development in the UK from the 1940s onwards. Key policies and reports are discussed, including the introduction of the NHS in 1948, the Cranbrook Report in 1959, and the influential Peel Report in 1970 which recommended all births take place in hospitals. Criticism of medicalization of birth and lack of women's voices in policy led to advocacy groups campaigning for informed choice. Later reports in the 1980s reinforced hospital birth recommendations but alternative views calling for less intervention and empowering women were also emerging. The analysis sets the context for understanding women's experiences within the system.
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
Physiotherapists in primary care in the Republic of Ireland were surveyed about their assessment and management of lifestyle risk factors. The survey found that physiotherapists most commonly assessed physical activity levels, followed by dietary status. Few assessed smoking status or alcohol consumption. The main barriers to assessing these factors were lack of time, limited knowledge and expertise, and a perception that it was not part of their role. The study highlights opportunities for physiotherapists to play a greater role in addressing lifestyle risk factors through more systematic assessment and management. Training is needed to help overcome barriers identified in the survey.
· For this assignment you will use the Quantitative and the QualitLesleyWhitesidefv
· For this assignment you will use the Quantitative and the Qualitative article that you submitted for week 4 assignment that were related to your week 2 picot question.
· Only articles you uploaded and used in week 4 (Quantitative or Qualitative) are to be submitted. Articles must be current (within the last 5 years). All articles must be related to the field of nursing and related to the topic list from week 2.
· Write a summary (one to two pages)
· In the summary identify differences in article designs and research methods. Describe the differences in your articles designs and methods. Carefully review the rubric before you submit. This summary is using your own words to examine the differences specifically between the articles.
· Use current APA style for your summary paper and to cite your sources.
· Submit the Articles and the summary, APA Format
Week 4 assignment articles used are attached separately
Week 2 Assignment PICOT Questions:
Question 1: In nurses with acute stress, how does mindfulness plan compared to relaxing to music reduce an individual's stress symptoms?
Question 2: how do first-time mothers of premature babies in NICU overcome postnatal stress during the first two months after birth?
Question 3: How does the use of exercises compare to medication in reducing stress among elderly people?
RESEARCH ARTICLE Open Access
Mixed feelings: general practitioners’
attitudes towards eHealth for stress urinary
incontinence - a qualitative study
Lotte Firet* , Chrissy de Bree, Carmen M. Verhoeks, Doreth A. M. Teunissen and Antoine L. M. Lagro-Janssen
Abstract
Background: Stress urinary incontinence (SUI) is the most prevalent subtype of urinary incontinence and is a bothering
condition in women. Only a minority of those with SUI consult a general practitioner (GP). EHealth with pelvic
floor muscle training (PFMT) is effective in reducing incontinence symptoms and might increase access to care.
The role of the GP regarding such an eHealth intervention is unknown. The aim of the study is to gain insight
into the attitudes towards a PFMT internet-based, eHealth, intervention for SUI.
Methods: A qualitative study was conducted. Data were collected through semi-structured interviews among
purposively sampled GPs. Audio records were fully transcribed, and analysed thematically.
Results: Thirteen GPs were interviewed, nine females and four males. Three themes emerged: appraisal of eHealth as a
welcome new tool, mixed feelings about a supportive role, and eHealth is no cure-all. GPs welcomed eHealth for SUI
as matching their preferences for PFMT and having advantages for patients. With eHealth as stand-alone therapy GPs
were concerned about the lack of feedback, and the loss of motivation to adhere to the intervention. Therefore, GPs
considered personal support important. The GP’s decision to recommend eHealth was strongly influenced by
a woman’s motivation and her age. GPs’ treatment preferences for elderly are d ...
The document summarizes key recommendations from a guideline on providing routine psychosocial support to patients undergoing fertility treatment. It outlines that patients should expect: staff to understand the emotional impact of infertility; both partners to be involved in treatment; and to receive personalized care tailored to their needs at different treatment stages. It also provides 10 tips for patients on getting support from clinics and having a healthy experience of diagnosis and treatment.
Impact of health education on tuberculosis drug adherenceSkillet Tony
Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.
RESEARCH ARTICLE Open AccessWoman-centred care during preg.docxrgladys1
RESEARCH ARTICLE Open Access
Woman-centred care during pregnancy and
birth in Ireland: thematic analysis of
women’s and clinicians’ experiences
Andrew Hunter1*, Declan Devane1, Catherine Houghton1, Annmarie Grealish2, Agnes Tully1 and Valerie Smith1
Abstract
Background: Recent policy and service provision recommends a woman-centred approach to maternity care. Midwife-
led models of care are seen as one important strategy for enhancing women’s choice; a core element of woman-centred
care. In the Republic of Ireland, an obstetric consultant-led, midwife-managed service model currently predominates and
there is limited exploration of the concept of women centred care from the perspectives of those directly involved; that
is, women, midwives, general practitioners and obstetricians.
This study considers women’s and clinicians’ views, experiences and perspectives of woman-centred maternity
care in Ireland.
Methods: A descriptive qualitative design. Participants (n = 31) were purposively sampled from two
geographically distinct maternity units. Interviews were face-to-face or over the telephone, one-to-one or
focus groups. A thematic analysis of the interview data was performed.
Results: Five major themes representing women’s and clinicians’ views, experiences and perspectives of
women-centred care emerged from the data. These were Protecting Normality, Education and Decision
Making, Continuity, Empowerment for Women-Centred Care and Building Capacity for Women-Centred Care.
Within these major themes, sub-themes emerged that reflect key elements of women-centred care. These
were respect, partnership in decision making, information sharing, educational impact, continuity of service,
staff continuity and availability, genuine choice, promoting women’s autonomy, individualized care, staff
competency and practice organization.
Conclusion: Women centred-care, as perceived by participants in this study, is not routinely provided in
Ireland and women subscribe to the dominant culture that views safety as paramount. Women-centred care
can best be facilitated through continuity of carer and in particular through midwife led models of care;
however, there is potential to provide women-centred care within existing labour wards in terms of
consistency of care, education of women, common approaches to care across professions and women’s
choice. To achieve this, however, future research is required to better understand the role of midwife-led care
within existing labour ward settings. While a positive view of women-centred care was found; there is still a
difference in approach and imbalance of power between the professions. More research is required to
consider how these differences impact care provision and how they might be overcome.
Keywords: Women-centred care, Choice in childbirth, Qualitative enquiry, Framework analysis, Thematic analysis
* Correspondence: [email protected]
1School of Nursing and Midwifery, National University of Ireland, Galway,
.
Family-Planning-lecture that will help you ace your examJudahPauloEspero
There are many different types of contraception, but not all types are appropriate for all situations. The most appropriate method of birth control depends on an individual’s overall health, age, frequency of sexual activity, number of sexual partners, desire to have children in the future, and family history of certain diseases. Ensuring access for all people to their preferred contraceptive methods advances several human rights including the right to life and liberty, freedom of opinion, expression and choice and the right to work and education, as well as bringing significant health and other benefits.
The document is the proceedings from the Australian Smoking Cessation Conference in 2013. It includes:
- An introduction welcoming attendees and emphasizing the theme of translating science into clinical practice.
- An overview by the Scientific Committee of the diverse and innovative abstracts presented on topics like tailored smoking cessation methods, novel uses of nicotine replacement therapy, and programs for vulnerable groups.
- Invited speaker abstracts on topics such as integrated treatment for substance users, a smoking cessation project for pregnant smokers, smoking rates and interventions for Aboriginal people, adolescent tobacco dependence and cessation approaches.
Outcome research examines the end results of health services on individuals in order to provide scientific evidence to inform healthcare decisions. It helps people make informed healthcare choices and improves delivery and outcomes by producing evidence-guided research. While outcome research groups like AHRQ and PCORI improve patient care and outcomes, outcome research relies on funding, so less common illnesses or those in developing countries may be understudied. Overall, outcome research can significantly impact healthcare policies by using evidence to guide decisions.
The truth between the lines – Community pharmacists in improving the health o...inemet
Community pharmacists can play an important role in improving public health by providing evidence-based advice and services. This includes promoting healthy behaviors, preventing disease, identifying health issues, and supporting those with long-term conditions. The evidence shows pharmacists are well-positioned for this work given their accessibility and the frequent contact the public has with pharmacies. However, pharmacists need more support to take a holistic, proactive approach to public health rather than just reacting to issues related to medicines. Priority areas for pharmacists to provide brief lifestyle advice include physical activity, weight management, diet, nutrition, smoking, and alcohol.
NICE Guidance Prevention of STIs and Under 18 Conceptionsbpilmer
A quick reference guide presenting recommendations on 'one to one interentions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups.'
The document summarizes the Winterbourne Medicines Programme, which was established to investigate concerns about the overuse of antipsychotic and antidepressant medications for people with learning disabilities. Six NHS foundation trusts partnered with NHS Improving Quality to better understand current medication practices and test improvements over six months. The program aimed to ensure medications are used safely and appropriately for this patient population.
Medical research involves developing new medicines, medical procedures, or improving existing ones, ranging from basic scientific principles to clinical trials involving human subjects. The history of medical research shows increasing rigor, from early recorded trials to the first randomized controlled trial in 1946. Medical ethics principles that guide research include respecting patient autonomy, doing no harm, providing benefit, and justice.
1) Smoking rates are significantly higher among people living with HIV (PLHIV) compared to the general population, and smoking is associated with increased health risks for PLHIV such as lung and other infections.
2) Effective smoking cessation interventions for PLHIV include brief advice from healthcare providers combined with pharmacotherapy and behavioral support. Tailoring interventions to specific groups can improve effectiveness.
3) Interventions targeting social networks and contexts, such as the LGBTQ community, show promise for supporting smoking cessation among HIV-positive individuals.
Nursing please I need two answer two peesr with 100.docx4934bk
Nursing research aims to provide evidence to enhance nursing practices. There are two primary types of nursing research: quantitative and qualitative. Quantitative research focuses on measurable client outcomes, while qualitative examines the experiences of patients and nurses. When conducting research, nurses face challenges like selection bias that could influence the accuracy of the sample. It is important to have a sound selection strategy to overcome these issues and ensure validity.
Researching patients with congestive heart failure (CHF) also presents obstacles. Educating CHF patients to prevent re-admissions is one challenge. Researchers must also avoid HIPAA violations when accessing medical records and get authorization from patients for interviews. The factors contributing to CHF, like lifestyle and genetics, must
Similar to De Wilde Tency Steckel Temmerman Boudrez Maes (20)
2. promoting smoking cessation, compared to standard care or brief
interventions [14]. Motivation may fluctuate over time or from one
situation to another, and can be influenced to change in a partic-
ular direction. Lack of motivation or resistance to change is seen
as something that is open to change. The main focus of MI is fa-
cilitating behavior change by helping people to explore and resolve
their ambivalence about behavior change. Adopting a victim-
blaming, aggressive and/or confrontational style as in traditional
approaches, is likely to produce negative responses like arguing,
which may be interpreted by the health care provider as denial or
resistance [14].
In Flanders (Northern Belgium), prenatal care is mostly provid-
ed by a gynecologist or a midwife and sometimes by a general
practitioner. As such, these health care providers are well-placed
to deliver smoking cessation advice during pregnancy. In 2011 the
prevalence of smoking during pregnancy in Flanders was 12.3% [15].
Since 2004 the Belgian government implements a national smoking
cessation policy. Smoking pregnant women attending at least eight
consultations with a tobaccologist receive a reimbursement of €30
for every consult with a maximum of €240. Smoking partners of
pregnant women receive €30 for the first and €20 for the follow-
ing seven consultations. Folders and flyers promoting this
reimbursement were distributed among midwives and gynecolo-
gists by mail. From January 2006 to June 2009 the government only
received 133 requests for reimbursement [16]. The lack of success
of this policy might be explained partly by a lack of awareness among
health care providers, resulting in few referrals to tobaccologists.
Furthermore, women continuing smoking during pregnancy might
be a low motivated group, not yet prepared to invest in smoking
cessation consultations and who are hard to reach with smoking
cessation information and support. The national policy, originally
restricted to pregnant women and their partner, was extended in
October of 2009: smoking cessation reimbursement has been avail-
able since then for each counseling session (individually or in group)
by a tobaccologist or a physician.
Since gynecologists perform most prenatal consultations and since
there is an increasing percentage of women consulting a midwife
[17–19], our study population was limited to gynecologists and mid-
wives. The objectives of our study were (1) to explore knowledge,
beliefs and practice among midwives and gynecologists concern-
ing smoking cessation several years after the implementation of a
smoking cessation policy for pregnant women and their partners
and (2) to examine if midwives and gynecologists in Flanders do
have a role in smoking cessation in pregnant women.
Methods
Design
A qualitative study using semi-structured interviews was con-
ducted in order to describe and analyze midwives’ and gynecologists’
experiences with giving smoking cessation advice during pregnan-
cy. Areas of interest included in the interview guide were based on
the authors’ clinical expertise regarding prenatal consultations and
the 5A’s framework.
Participants
Purposive sampling was used to select eligible participants, rep-
resenting both occupational groups (midwives and gynecologists).
In order to be included participants had to perform prenatal con-
sultations. Years of experience in prenatal care were taken into
account (≤10 years and >10 years). We expected to reach data sat-
uration by recruiting three to five participants in each cell of the
sampling matrix, with a minimum of twelve and a maximum of
twenty participants. When data saturation was not reached extra
interviews would be performed.
In Flanders there were 467 registered gynecologists and 198 reg-
istered independent midwives at the time of sampling (2008). First,
a list of gynecologists was obtained from the Flemish Organisation
for Obstetrics and Gynaecology. All 467 registered Flemish gyne-
cologists received an invitation to participate in the interview (April
2008). Two weeks later a reminder was sent to the non-responders.
Five letters returned address unknown. Seventeen gynecologists
replied: two had no prenatal consultations, four planned to retire
within the following months and eleven agreed to participate. Fol-
lowing further explanation by telephone, three gynecologists refused
participation. Finally, in total eight gynecologists were inter-
viewed, four with less than 10 years of experience in prenatal care,
four with more than 10 years of experience.
Second, a list of registered independent midwives was ob-
tained from the Flemish Organisation of Midwives. In total 198
midwives were invited to participate in the interview (June 2008).
Two weeks later a reminder was sent. Eleven midwives replied and
finally nine midwives agreed to be interviewed. Five midwives had
less than 10 years of experience, four had more than 10 years of
experience.
Recruitment was not continued, as data saturation and the ob-
jectives of the sampling matrix had been reached.
Data collection
Seventeen interviews were conducted by the first author between
June 2008 and January 2010 and lasted between 23 and 61 minutes.
One researcher performed all of the interviews, thus ensuring con-
sistency throughout the data collection. All interviews, except one,
took place at the midwife’s or doctor’s office.
Semi-structured face-to-face interviews were conducted using
an interview guide with open-ended questions. The topics for the
interview guide were partially inspired by the English question-
naire of Bull and Whitehead [12]. The questionnaire was translated
into Dutch and two questions concerning knowledge about smoking
cessation programmes for pregnant women were adapted to the
Belgian situation. A gynecologist, a sociologist, two midwives, a
psychologist–tobaccologist and an ethicist reviewed the interview
guide in order to establish content validity. No additional items were
added.
The final interview guide consisted of three main topics, with
corresponding questions, regarding:
• Knowledge about risks of smoking during pregnancy, smoking
cessation guidelines and interventions and the use of nicotine
replacement therapy (NRT):
○ Tell me what you know about the risks of smoking during
pregnancy
○ To which extent are you familiar with the national policy re-
garding “stoppen met roken (smoking cessation)”? What is
the content of this policy?
○ To which extent are you familiar with other interventions,
campaigns, guidelines and their contents?
○ Tell me what you know about the use of NRT during
pregnancy.
• Beliefs about smoking and smoking pregnant women:
○ To which extent do you agree with the following statement:
“a pregnant woman is able to quit smoking”?
○ What are the main reasons why women continue to smoke
during pregnancy?
○ Under which circumstances would it be better for a preg-
nant smoker to continue smoking rather than attempt to stop?
○ In your opinion, what are effective interventions to promote
smoking cessation for pregnant women?
ARTICLE IN PRESS
Please cite this article in press as: Katrien De Wilde, et al., Which role do midwives and gynecologists have in smoking cessation in pregnant women? – A study in Flanders, Belgium,
Sexual & Reproductive Healthcare (2015), doi: 10.1016/j.srhc.2014.12.002
2 De Wilde et al./Sexual & Reproductive Healthcare ■■ (2015) ■■–■■
3. ○ What is your opinion on influencing the decision of a preg-
nant woman to continue or to quit smoking?
○ To which extent do you agree with the following statement:
“I am the right person to offer smoking cessation advice to
pregnant women.”
• Dealing with smoking and smoking cessation during prenatal con-
sultation:
○ Tell me how you conduct a conversation with a pregnant
smoker [note to interviewer: keep in mind: Ask, Advice, Assess,
Assist and Arrange follow-up]
○ If interested, what kind of smoking cessation training would
you need or prefer?
Finally we asked participants about their work experience, train-
ing in smoking cessation counseling and their own smoking status.
Ethical considerations
The study was approved by the Ethical Committee of Ghent Uni-
versity Hospital. All interviews were audiotaped with permission
from the participant. Written informed consent was obtained prior
to the interview and confidentiality was assured. After comple-
tion of the study the tapes will be destroyed.
Data analysis
Data analysis was based on deductive content analysis. This
method is used when the structure of analysis is operationalized
on the basis of previous knowledge [20]. Analysis of the way par-
ticipants handled smoking and smoking cessation during prenatal
consultation was based on the 5 A’s framework [3].
Members of the research team (KDW, KT) transcribed the re-
cordings of each interview verbatim. The researchers checked the
transcriptions with the recordings in order to gain accuracy. Tran-
scripts were read several times to obtain a sense of the whole. A
thorough reading of the transcripts was followed by the develop-
ment of a categorization matrix based on the interview guide and
the 5 A’s framework (Table 1). Next, data were coded according to
the categories [20]. Findings were discussed with all authors and
consensus with regard to the reflections was reached.
Results
Participant characteristics
All participants were non-smokers at the time of the inter-
view, two were ex-smokers. All participants, except two, were female.
Three midwives attended a training in smoking cessation skills
(Table 2). Participants came from different Flemish provinces.
Themes
All data could be categorized in the five themes of the catego-
rization matrix. The last interviews confirmed the validity of these
theme, no new themes emerged. Each theme includes quotes from
the participants.
Theme 1: Basic knowledge regarding fetal and maternal risks
associated with smoking during pregnancy
Basic knowledge is defined as the readily available knowledge
participants have at the moment of the interview without having
to do research about the topic. The most common risks of smoking
reported by both occupational groups were intrauterine growth re-
striction, low birth weight, placental problems and sudden infant
death syndrome.
Midwives spontaneously mentioned fetal or neonatal risk factors
and were more uncertain about some risks, such as preeclampsia,
hypertension and malformations. Midwives–teachers also knew the
risk of stillbirth and fertility problems.
Gynecologists immediately made a distinction between neona-
tal and maternal risks. They mentioned such additional risks as
fertility problems, early menopause, lung diseases, different forms
of cancer, premature aging of the skin, an irritable or lazy baby and
long term risks for the child such as negative influence on school
results, addictive behavior and allergies. In their opinion, the risks
of premature skin aging and fertility problems have a stronger effect
on smoking cessation compared to a list of neonatal risks.
All participants were convinced that prevention is required
because of the risks for mother and child. Smoking prevention as
well as smoking cessation in general are considered to be impor-
tant health issues. They believed that smoking cessation advice
should start before pregnancy, preferably in high school, since
smoking cessation can take several attempts and requires time, even
more than the duration of a pregnancy. Sensitizing society by pro-
moting non-smoking is important as well, according to the
participants.
Theme 2: Specific knowledge regarding national smoking cessation
guidelines and the use of nicotine replacement therapy (NRT)
In most cases, the specific knowledge regarding smoking ces-
sation guidelines or interventions was limited. The precise
requirements of the programme for reimbursement, such as the
number of consultations or the amount of the repayment, were
largely unknown. Half of the participants thought that the nation-
al policy provided free smoking cessation counseling.
The interviewed midwives had insufficient knowledge regard-
ing the use of NRT in pregnancy; therefore they avoided this topic
during prenatal consultation. Gynecologists were aware of the fact
that bupropion and varenicline are contra-indicated during preg-
nancy and although they knew that NRT could be used safely during
pregnancy, they did not recommend it.
Theme 3: The image of “the smoking pregnant woman”
Participants had a negative image of “the smoking pregnant
woman”: a low educated woman living with a smoking partner and
“bad examples” in their history, such as smoking during a previ-
ous pregnancy without visible or immediate problems for the baby
or the mother, which makes them minimalize their smoking habit.
She told me that her neighbour smoked twenty-five cigarettes every
day and that she had a baby weighing over four kilograms. Yes, that
is what she told me! And what can I do, how can I convince her,
she was right. (Midwife 5)
This image does not fit with perceptions of the participants of
a “pregnant woman”: a woman who follows life style advice im-
mediately, in order to give birth to a healthy baby. Hence, a minority
of the participants believed that smoking related pregnancy com-
plications have to be attributed to the responsibility of the woman
herself. Some gynecologists even believed that these women should
not be rewarded with additional attention or consultation time. Other
participants believed that they need extra ultrasounds in order to
examine the fetal growth, which implies extra costs for the couple
and the society.
Participants believed that addiction, ignorance, stress, (complex)
social problems and a lack of support of the partner and peers are
barriers to attempts to cease smoking.
Most midwives and gynecologists did not believe that there are
acceptable situations in which it is better for pregnant women to
continue smoking, even in stressful situations. Others had a differ-
ent opinion and advised to reduce daily consumption of cigarettes
instead of quitting.
ARTICLE IN PRESS
Please cite this article in press as: Katrien De Wilde, et al., Which role do midwives and gynecologists have in smoking cessation in pregnant women? – A study in Flanders, Belgium,
Sexual & Reproductive Healthcare (2015), doi: 10.1016/j.srhc.2014.12.002
3De Wilde et al./Sexual & Reproductive Healthcare ■■ (2015) ■■–■■
4. Table 1
Categorization matrix based on the interview guide and the 5 A’s framework in smoking cessation counseling and perceived barriers.
Theme 1: Basic knowledge regarding fetal and maternal
risks associated with smoking during pregnancy
Focus Risks
Fetus/child (M) List of risks:IUGR, LBW, placental problems, SIDS
Woman and fetus/child (G) Fertility problems, stillbirth (M-teachers, G)
Early menopause, lung diseases, cancer, premature aging of the skin, irritable or lazy baby,
long term risks for the child (G)
Uncertainty about some risks, such as preeclampsia, hypertension and malformations (M)
Importance of smoking prevention, not only during pregnancy (society issue)
Theme 2: Specific knowledge regarding national
smoking cessation guidelines and the use of NRT
Existence of
national policy
Content of national policy Guidelines NRT
Awareness of
national policy
Number of consultations or amount of
repayment was largely unknown
No knowledge of
other guidelines
Insufficient knowledge: not discussed with client or avoiding the topic (M)
Sufficient knowledge, but not recommended: is it really safe? (G)
Bupropion and varenicline: not prescribed, not safe during pregnancy (G)
Theme 3: The image of “the smoking
pregnant woman”
Image Barriers for smoking cessation in pregnant women
Negative image:low educated woman, smoking
partner, “bad examples” in their history
In contrast with perception of “pregnant woman”:
follows life style advice immediately
Addiction, ignorance, stress, (complex) social
problems, lack of support of the partner and peers
“Extra ultrasounds” vs “no extra consultation time”
Theme 4: The 5 A’s framework Ask Advise Assess Assist Arrange follow-up
Subtheme 1: Dealing with smoking
(cessation) during prenatal
consultation
Asking questions about the
smoking behavior
Advising smoking cessation Information by leaflets
or websites
Referral to tobaccologist or other
professional in smoking cessation
counseling, but client has to book
own appointment
Frequency: Asking once or at every
consult
Way of asking questions
Discussing health risks for mother
and child
Information regarding smoking
cessation counseling
No questions asked about the
smoking behavior of the partner
No advice: avoiding the topic
Negative example: Advice to
reduce daily consumption
No examples, this step is skipped No use of NRT
Subtheme 2: Barriers regarding the
execution of 5 A’s framework
Lack of time (G) Lack of time (G) Lack of time (G) Lack of time (G)
Lack of communication skills: how
do I give advice? (M)
Lack of communication skills: how
do I assess the readiness to quit
smoking? (M)
Fear of provoking resistance (M) Fear of provoking resistance (M)
Disappointment: no effect of
advice, no influence on the woman
More urgent priorities in prenatal
care
Giving advice is not my job (G)
Theme 5: Perceived need
for smoking cessation training
Training in smoking cessation
counseling
Content of training Need for training, suggestions for content
3 midwives with training (Table 2)
No training due to lack of time (G)
Training did not meet needs:
too theoretical, too short (M)
No need for training, prefer to refer their clients (G)
Suggestions for content: Communication about sensitive topics (i.e.
smoking cessation), dealing with resistance during conversation (role
play?), dealing with own disappointment if advice is not followed (M)
The answers are provided by both occupational groups, unless otherwise specified: midwives (M) or gynecologists (G).
ARTICLEINPRESS
Pleasecitethisarticleinpressas:KatrienDeWilde,etal.,Whichroledomidwivesandgynecologistshaveinsmokingcessationinpregnantwomen?–AstudyinFlanders,Belgium,
Sexual&ReproductiveHealthcare(2015),doi:10.1016/j.srhc.2014.12.002
4DeWildeetal./Sexual&ReproductiveHealthcare■■(2015)■■–■■
5. When she can’t stop smoking, I tell her to reduce the number of ciga-
rettes to an absolute minimum. (. . .) Less than three cigarettes a
day, in which case she is not considered to be a smoker any longer.
(Gynaecologist 4)
Theme 4: The 5A’s framework in smoking cessation counseling and
perceived barriers
Subtheme 4.1: Dealing with smoking (cessation) during prenatal
consultation The 5A’s method of smoking cessation [3] was used
as a framework to analyze the practice of the participants:
• Ask: All participants asked questions about the smoking status
and daily consumption of their clients during the first visit and
documented it in the medical record. Most midwives and some
gynecologists asked the questions again during the following
visits. The smoking status of the partner was not questioned.
I ask: “Do you smoke?”. When she answers “Yes”, then I want to
know how much she smokes. I try to get insight in her reality, on
the condition that she tells the truth of course. (. . .) I write the
answers down in the medical record. (. . .) During the next
consultation I ask if she has cut down her daily consumption.
(Midwife 7)
• Advise: Most participants felt it was their duty to provide smoking
cessation advice, but admitted that there are often other more
urgent priorities in prenatal care, such as giving information about
different ways of giving birth, pain relief and breastfeeding. Es-
pecially gynecologists expressed lack of time. One gynecologist
thought that she was overqualified and that giving life style
advice, including smoking cessation advice, belonged to the tasks
of a tobaccologist or general practitioner.
I don’t have the time. I am not the kind of person who wants to
spend half an hour to motivate smoking cessation. I think that I
am too highly qualified. That’s not my job, I have too many other
things to do. I want to refer them [smokers] to a specialist.
(Gynaecologist 4)
Most participants advised smoking cessation, some advised to
reduce the daily consumption, especially in stressful situations.
I think that if the woman gets too much stressed about the fact that
it is forbidden to smoke, then the only thing you can say, is: “Alright,
you can smoke a few cigarettes a day.” I try to motivate her to smoke
less than ten cigarettes, if possible less than five cigarettes a day.
(Gynaecologist 3)
Risk factors associated with smoking during pregnancy were dis-
cussed with the woman in order to convince her to quit. Midwives
admitted that they lack communication skills to talk about a sen-
sitive topic like smoking and smoking cessation during pregnancy;
they feared provoking resistance or not having any influence on the
woman’s behavior.
Lack of self-confidence and knowledge is visible, so my me-
ssage about smoking cessation is not strong enough, the client doesn’t
listen and then I feel like I can do nothing to influence her deci-
sion. (Midwife 5)
I try to start a conversation about smoking behaviour, but when I
feel that it [the conversation] is blocked and I get the opposite effect,
then I will be very careful. I know that they will not stop
smoking and that I am not able to do something about it. I don’t
want to chase them away so that they drop out of prenatal care.
(Midwife 14)
• Assess: Participants skipped this step during prenatal consul-
tation. After asking questions about the smoking behavior they
immediately gave cessation advice without assessing if the
woman was ready to quit smoking.
• Assist: Several participants used leaflets to support or replace
their advice or referred to websites that discuss smoking ces-
sation and different ways of counseling. NRT is not recommended.
• Arrange follow up visits: Three independent midwives re-
ferred to a general practitioner or a tobaccologist. Most
gynecologists referred to a general practitioner, a tobaccologist
or a psychologist working in the same hospital. All referring
participants were not sure that the referral had any effect since
the woman herself had to make the appointment(s) with the
tobaccologist. For most women this barrier would be too high,
participants thought.
Table 2
Characteristics of the participants.
Number Midwife (M) or
gynecologist (G)
Years of work
experience
Training in smoking cessation skills Additional information
1 G 5
2 G 7 Stopped smoking more than 10 years ago, smoked for
two years
3 G 18
4 G 6
5 M 18 Attended a theoretical training in smoking cessation
skills of 4 hours
6 M 2
7 M 25 Attended training in smoking cessation skills of several
days. Scientific interest in the topic
Stopped smoking more than 20 years ago, smoked for
6 months
Teacher
8 M 23 Work experience in developing countries
9 M 5
10 M 7 Training in and experience with the use of the Minimal
Intervention Strategy (MIS) for smoking cessation in
prenatal care
Worked for 4 years in the Netherlands
11 G 3 Teacher
12 M 7 Teacher, worked for 2 years in the Netherlands
13 G* 33 Teacher
14 M 30
15 M 4
16 G* 16
17 G 15
* Male participant.
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5De Wilde et al./Sexual & Reproductive Healthcare ■■ (2015) ■■–■■
6. The results as a whole demonstrate that the participants have
insufficient knowledge of effective health education methods, in par-
ticular regarding smoking cessation.
Subtheme 4.2: Barriers regarding the execution of 5 A’s
framework Participants were aware of the fact that asking ques-
tions about smoking behavior should lead them to an action, but
immediately they mentioned different barriers that hindered them
from taking action. Because of a lack of time, a lack of communi-
cation skills and fear of resistance they sometimes barely discuss
or avoid the topic. Some participants expressed their disa-
ppointment regarding the poor effect of their smoking cessation
advice. Therefore, they were reluctant to assess the smoking be-
havior because they felt that it was a “waste of their pre-
cious consultation time, because the smoker didn’t quit anyway
(gynaecologist 16)”.
Theme 5: Perceived need for smoking cessation training
None of the gynecologists attended smoking cessation training
due to their busy schedule. Most of them believed that it was
better to refer the client to e.g. a tobaccologist than to attend a
training session.
Three midwives attended some kind of training and two of them
even expressed a need for more extensive training to provide them
with a theoretical background about the risks of smoking during
pregnancy as well as the skills to communicate about sensitive topics
like smoking cessation, to deal with resistance and to conduct mo-
tivational interviewing, if possible by using role play. Some
participants would like a testimony of an ex-smoker and some sug-
gestions on how to deal with their own disappointment if the woman
refuses to follow their advice.
Discussion
The objectives of our study were (1) to explore knowledge, beliefs
and practice among midwives and gynecologists concerning smoking
cessation several years after the implementation of a smoking ces-
sation policy for pregnant women and their partners and (2) to
examine if midwives and gynecologists in Flanders do have a role
in smoking cessation in pregnant women.
All participants knew that smoking during pregnancy can cause
severe health problems in (pregnant) women and babies. Despite
this general opinion, there was a difference in the focus of mid-
wives and gynecologists regarding these risks. Midwives were
focused on fetal and neonatal risks since contacts are limited to
pregnancy and postpartum. Risks for the pregnant woman herself
were less known, thought of and rarely discussed with their clients.
Gynecologists also have contact with women during non-
pregnancy related consultations. Therefore, they focused on risks
for both woman and fetus.
Most participants believed that knowledge of the health risks
is the most important motivation for smoking cessation. There-
fore, risks were listed during the first consultation and with this
information participants expected women to quit. However, it has
been shown that information alone is not sufficient for behavioral
change; the health risks of smoking are well known and yet 30%
of the population continues to smoke [21].
The number of consultations and the amount of reimburse-
ment of the national policy was largely unknown. For example, half
of the participants thought that the national policy provided in free
smoking cessation counseling. Hence, they gave the wrong infor-
mation to their clients. Gynecologists and midwives should be better
informed about the content of the national smoking cessation policy
for pregnant women, or the pregnant women themselves should
be reached with relevant information on smoking cessation in an
effective way. This includes also promoting referral to a tobaccologist.
The knowledge regarding NRT, especially of midwives, was
insufficient and thus NRT was not recommended. In Flanders NRT
is over-the-counter medication. If the woman does not inform the
pharmacist about her pregnancy, she can buy the pro-
duct without specific information regarding the use and the dose
of NRT during pregnancy. NRT is the only pharmacotherapy for
smoking cessation that has been tested in RCTs conducted in
pregnancy.
There were no statistically significant differences in rates of
miscarriage, stillbirth, premature birth, low birth weight, admis-
sions to neonatal intensive care or neonatal death between NRT
or control groups, but further research regarding efficacy and safety
is needed [22].
Participants had a negative image of “the smoking pregnant
woman”: a low educated woman living with a smoking partner
and “bad examples” in their history. This image does not fit with
the ideal image of the participants of a “pregnant woman”: a
woman who follows life style advice immediately, in order to give
birth to a healthy baby. It could be possible that these prejudices
hinder a conversation about smoking cessation. At the time of the
interview none of the participants smoked, this also could make it
more difficult to understand why a pregnant woman cannot or
would not stop smoking.
All participants asked questions about the smoking status and
the daily consumption. Midwife 7, who attended a more extensive
training in smoking cessation, and midwife 10, with experience in
MIS in prenatal care, also asked how long the client smoked, what
brand and on which occasion she smoked, which led to a more
profound insight in her smoking behavior. By asking the right
questions it is possible to gather extra information, hence the
right arguments for that specific woman that can be used to mo-
tivate her smoking cessation.
The smoking status of the partner was not questioned and passive
smoking was not a topic of conversation. Given the health prob-
lems related to passive smoking [23], this topic needs special
attention as well.
Several participants offered an information leaflet or referred to
a website to support the oral information or as a replacement of
the information in case of lack of time. Leaflets are useful as sup-
plementary communication to inform, educate and advise people
about health issues. However, when leaflets are given without oral
smoking cessation advice, they have less effect [21].
In line with previous observations [6], the most important bar-
riers for giving smoking cessation advice were lack of time, lack of
communication skills in sensitive topics such as smoking cessa-
tion, and dealing with resistance. Most gynecologists believed that
a conversation about the smoking behavior would take too much
time, time they do not have in their opinion during a standard
prenatal consultation of 10–15 minutes. Midwives mentioned several
times that they did not know how to start a conversation without
provoking resistance or without “chasing the woman away”. Their
experiences with these conversations were negative, so they dis-
cussed the topic superficially, hoping that the woman would get
the message. Even midwife 5, who attended a short theoretical
training about smoking cessation during pregnancy, still felt she
lacked the appropriate skills.
None of the gynecologists attended a training in smoking ces-
sation and most of them were not willing to do so. They pre-
ferred to refer the woman. Three midwives attended a training and
even wanted to be trained more. However in this study there were
no important differences in dealing with smoking cessa-
tion between trained and non-trained midwives. This may suggest
that the duration and content of the training did not meet the needs.
Midwives reported that most were too short, too theoretical and
did not provide participants with the right skills to communicate
about a sensitive topic such as smoking.
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6 De Wilde et al./Sexual & Reproductive Healthcare ■■ (2015) ■■–■■
7. “Ask”, “Advice” and to a lesser extent “Assist” of the 5 A’s frame-
work were implemented in smoking cessation communication,
which is similar to previous studies [3]. Although gynecologists pre-
ferred to refer their clients, referral to a tobaccologist is rare and
when a woman is referred, she seldom makes an appointment, ac-
cording to the participants. This might be explained by the fact that
the gynecologist or the midwife is someone the woman knows and
trusts, a tobaccologist is in almost all cases a stranger to them. Also
the fact that they did not assess the woman’s readiness to quit may
hinder making the appointment.
There are two possible suggestions to help smoking pregnant
women. A first strategy would be that there is someone within the
obstetric team trained in giving smoking cessation advice and is seen
as a confidant by the pregnant woman [24]. Since gynecologists ex-
pressed mostly time pressure as a barrier during their prenatal
consultation, it could be considered to organize more shared con-
sultations with a trained midwife. The midwife can provide prenatal
care combined with life style advice, such as smoking cessation
advice, and build a partnership with the woman [24,25]. A second
and possibly more effective strategy in Flanders is to use an abbre-
viated version of the 5 A’s framework, more specifically the AAR-
method: (1) Ask questions about the smoking behavior; (2) deliver
brief Advice to quit smoking and determine the readiness and mo-
tivation to quit; and (3) Refer to specialized smoking cessation
counseling, i.e. by a tobaccologist or a trained midwife [26]. Moti-
vation may fluctuate over time or from one situation to another,
which means that motivation can be influenced by searching for
the right arguments for each particular client. The technique of mo-
tivational interviewing (MI) can be used to initiate a conversation
about smoking, to explore and resolve uncertainties about smoking
cessation and to motivate them to make a quit attempt. By using
this technique an aggressive or confrontational approach is avoided
and self-belief of the client is encouraged [14,27]. It would be rec-
ommendable that health care providers are trained in using MI in
order to avoid resistance in clients and to enhance their own self-
confidence in discussing sensitive topics. When they assess an
increased motivation of the woman to quit smoking, she can be re-
ferred to a tobaccologist. This also ensures a separation between
prenatal care and smoking cessation counseling so that fear of clients
dropping out of prenatal care is avoided.
Limitations
A possible limitation is the number of participants involved in
the study. Only eight gynecologists and nine midwives agreed to
participate, despite the fact that all registered gynecologists and in-
dependent midwives in Flanders received an invitation and a
reminder. This may indicate that only health care providers with
special interest in the topic agreed to participate.
A second limitation is the fact that qualitative studies are con-
textual, which means that the results should be related to the context
of the study. This study focused on gynecologists and midwives per-
forming prenatal consultations in Flanders. This does not imply that
these findings have no meaning in other contexts, but that they must
be interpreted in relation to the other context.
Conclusions
Participants had a negative image of “the smoking pregnant
woman”: a low educated woman living with a smoking partner and
“bad examples” in their history. It could be possible that these preju-
dices hinder a conversation about smoking cessation.
The most important barriers reported to providing smoking ces-
sation counseling are lack of time, restricted communication skills
and fear of provoking resistance. Even trained midwives experi-
ence these barriers and have doubts about their competencies in
giving smoking cessation advice. Gynecologists seem not inter-
ested in training regarding smoking cessation and prefer to refer
their clients.
The following two possible suggestions to help smoking preg-
nant women should be explored:
1 Training in smoking cessation counseling of a team member who
is seen as a confidant by the pregnant woman. This could be a
trained midwife, who can provide prenatal care combined
smoking cessation advice.
2 A possibly more effective strategy in Flanders is to use an ab-
breviated version of the 5 A’s framework, more specifically the
AAR-method. The role of the midwife and gynecologist is then
limited to asking questions about smoking behavior, providing
brief advise, determining the readiness to quit and referring
clients to specialized smoking cessation counseling.
Further research should focus on the implementation of the AAR-
method in order to increase the number of pregnant women who
stop smoking.
Conflict of interest
The authors do not have any financial and personal relation-
ships with other people or organizations that could inappropriately
influence or bias their work.
Acknowledgements
The authors would like to thank all midwives and gynecolo-
gists who participated in this study for their time and open
communication and Kathleen Temmerman, RM, MSC, for transcrib-
ing several interviews.
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8 De Wilde et al./Sexual & Reproductive Healthcare ■■ (2015) ■■–■■