Thèses sur le sujet « Labour wards »

Monitoring of women in labour is an important aspect of the practice of the health care professionals working in the labour ward. The pregnancy of a woman mightappear to be normal but it is not possible to predict the positive outcome of labour until the baby is born because foetal distress can occur suddenly or other problems can arise during the course of labour. Doctors need to closely monitor the progress of labour of all the women regardless of whether he pregnancy is rated low risk or not. The use of Cardiotocography (CTG) during labour thus becomes critical. In the current study the perceptions of the doctors working in labour ward units will be explored and described in order to recommend activities that could optimize the use of CTG by doctors as an intrapartum monitoring tool. A qualitative research design will be used and the data collection method will be by means of semi-structured audio-taped one-on-one interviews.

Introduction: Clinical Leadership is a way of facilitating change and increasing the quality of care at the front line of practice. However, the failure of midwifery leadership and being designated an oppressed group questions the ability of midwives to practice as clinical leaders in the labour ward environment. Whilst there is some research relating to clinical leadership in nursing, no research exists that investigates the clinical leadership of midwives who are directly involved in giving care to women. Aim: The aim of this research was to explore clinical leadership on the labour ward and to develop an understanding of the associated characteristics of clinical leadership. The attributes that delineated effective clinical leadership were examined in addition to associated professional discourses and relationships of power that existed on the labour ward. Methods: A critical ethnographic approach was undertaken on the labour ward of a district general hospital and a teaching hospital in the North of England, using participant observation and semi-structured interviews. A total of sixty-nine hours of participant observation was undertaken. A purposive sample of 30 midwives were interviewed in the first instance and further interviews were undertaken with 18 midwives who were nominated as effective clinical leaders by the midwives in the initial interviews. Data were examined through the lens of Bourdieu’s Theory of Practice. Findings: Clinical leadership existed at different levels on the labour ward, however, midwives mostly identified LWCs in this role. LWCs’ clinical leadership was necessary, contradictory, gendered, socialised and unsupported within the hierarchical, high-risk and fearful labour ward. A combination of heroic and values-based clinical leadership was required to maintain safety and facilitate productivity. Heroic leadership, the high level of accountability and symbolic capital invested in the LWC led to a loss of autonomy for other midwives, a lack of dissent and difficulty initiating changes in practice. The contradictory nature of the LWCs’ work and a lack of support led to them experiencing both emotional and physical stress. Within an increasingly highrisk labour ward environment the LWC clinical leaders experienced professional misrecognition and discrimination that resulted in dysfunctional inter-professional relationships and keeping the obstetricians away from women. Conclusion: A high level of responsibility invested in the LWC combined with socialisation led to heroic leadership which fostered dependency prevented change and innovation. Inequalities of power and dysfunctional relationships were symptoms of a system failure that does not support midwifery practice or woman-centred care. Recommendations are made for policy, education, practice and future research.

This study examines labour ward culture on two British labour wards, in terms of mother-baby contact and breastfeeding, which has not been empirically researched since 1985 (Garforth & Garcia 1989). ‘Aims’: to investigate the organisational culture; examine mothers' beliefs and experiences; and midwives' knowledge, beliefs and practices. ‘Objectives’: To compare organisational cultures; identify if midwifery practice is evidence based and factors which facilitate or detract from it; identify mothers' preferences, beliefs and levels of satisfaction. ‘Study Design’: Ethnography with case study and diagnostic analysis also utilised. Methods: observation and interviews: purposive sample of mothers (n = 50) and midwives (n = 51); interviews with Heads of Midwifery (n = 2); focus groups with midwives (n = 3); and documentary analysis. ‘Results’: Despite Trust strategies and Heads of Midwifery support for evidence-based practice, clinical guidelines and midwifery beliefs about mother-baby contact and early breastfeed were not usually congruent. Mother-baby contact after birth is usually interrupted for completion of tasks and some babies have multiple contact episodes, which has not been previously described in the literature. Completion of routine tasks for transfer of mothers and babies to postnatal ward takes precedence, because of organisational demands and insufficient resources. However, most mothers expressed feeling satisfied with contact achieved and support for breastfeeding. ‘Conclusion’: Findings of the study have contributed new insights and knowledge of labour ward culture. It is not conducive to uninterrupted mother-baby contact and is not evidence-based. ‘Recommendations’: The development of a learning culture and clinical leadership to promote evidence-based practice and woman-centred care is recommended. The unique period after birth should not be disturbed, to prioritise routine tasks.

Over recent years much research has been conducted which examines the consequences of economic and social restructuring on different localities. Arguably, few places have experienced these processes to such detrimental affect as the Vauxhall ward in north Liverpool, which possesses one of the highest levels of unemployment in the country. During 1990 I was employed by the Eldonian Development Trust to conduct a skills survey of the population of Vauxhall, as a community led attempt to redress this situation. This thesis combines detailed analysis of the skills audit, entitled the Vauxhall Job Link Survey, with the results of a complementary, qualitative research approach, in an attempt to understand why such a large proportion of the area's population are excluded from paid employment. To develop its arguments the research also draws extensively on a variety of secondary data sources. The findings of the research are related to existing labour market and social polarisation theories. The thesis reveals that the dual processes of deindustrialisation and counterurbanisation have led to a small, residual population remaining in Vauxhall, which is poorly placed to compete for the limited number of job opportunities arising in the city. Detailed analysis by gender reveals that the position of many women is particularly poor. It is propounded that one reason for this is the particular patriarchal relationship that has developed in the area over the last two centuries, with very clearly defined roles of male and female economic activity.

Aims: This study explored how midwives access and use information whilst caring for women with high risk needs in the labour ward. The study focussed on identification of information needs, sources and types of information, use of information and what facilitates and inhibits information access. Background: Social trends and advancing healthcare mean that the complexity of care for the minority of women who are recommended to birth in the labour ward is increasing. The immediacy and unpredictability of this suggests that midwives need to access information whilst with women in order to deliver excellent care. Method and analysis: As midwives are a social group, the principles of ethnography were used. Between October 2011 and March 2012 twenty-one purposively sampled midwife participants were observed providing care to women with high risk needs on the labour ward. Ten of these observed midwives were purposively sampled for interview. The data were analysed with thematic analysis using open and focussed coding. Findings: Midwives identify their information needs through their professional knowledge. Information sources used by midwives include maternity notes, guidelines, equipment, computers and the environment. Verbal information is transmitted through a network of women and colleagues via midwives. Midwives seek different types of information: woman specific, practice based, objective and organisational. Factors that facilitate and inhibit information access are related to the search time, usability, versatility and approachability of the source or channel rather than reliability. There are information proficient characteristics shown by some midwives. Implications for practice and research: The verbal information network could be enhanced to include women in care collaborations. Information proficiency as a potentially learnable skill may be taught to midwives to improve information access. If reliable sources and channels are accessible, usable and approachable it may increase their use. Passive information, information need and information types as areas that may influence practice require further research.

Waterbirth practice has the potential to support a midwifery model of care and yet little is known about how the organisation of care can be changed to improve the use of birthing pools. This action research study focused on a group of midwives working on a labour ward in an English obstetric led maternity unit with 3,800 births and 25 recorded waterbirths per year. Interviews and focus groups with labour ward midwives and managers were employed to identify barriers to birthing pool use and inform the change process. Three problem-solving workshops with labour ward coordinators were organised with the aim of influencing other midwives’ use of birthing pools. Data from a newly developed waterbirth questionnaire and maternity records were used to evaluate change in levels of personal knowledge, waterbirth self-efficacy and social support. Foucauldian discourse analysis and One-Way ANOVA with Tukey post hoc tests were used to analyse qualitative and quantitative data. Fourteen midwives took part in focus groups and seventeen in interviews over four research phases. Interventions, developed by workshop attendees, included improvements to the recording and dissemination of waterbirth and water immersion data, target setting and the appointment of a waterbirth champion. By the end of the study the numbers of waterbirth practitioners, recorded waterbirths and social support increased significantly. Discourse analysis revealed the presence of dominant biomedical and subjugated ‘being with woman’ midwifery discourses. The study is the first to describe midwives’ attitudes to waterbirth practice and attempt to improve the use of hospital birthing pools. The findings illustrate that, by co-opting rather than replacing dominant discourses, it is possible to support the delivery of a midwifery model of care in a medicalised environment. As such this study offers a pragmatic approach to organisational change.

This study examines the severe conditions under which local media workers produce reports for global media outlets in conditions of war and the ways in which they cope with and respond to these challenges. I take as my case study, the diminution of the Pashtun journalist into a “fixer” for global media in the U.S.-led, so-called War on Terror (WoT). Based on my experience as a journalist as well as interviews with local Pashtun journalists, I disclose a situation in which the local journalist is compelled to risk his very life to gather news; news, which further exposes him to threats to life from the two warring sides. Precarity, in this scenario, is a fact of life, which carried serious consequences, not just for the journalist and his community, but also for what is passed off as news in global media.

The thesis begins with an exploration of my experiences of caring for dying babies which considers the way in which the care given to dying babies differs according to the care environment. This sets the scene for an exploration of rituals surrounding their care. Critical Interpretive Synthesis was selected as a research design for the study because it offered the opportunity to take an interpretive approach to a range of data and allowed the creation of new arguments. Documentary data including professional literature, professional textbooks and professional guidelines were analysed and interpreted using methods which guideline analysis, critical appraisal and rhetorical analysis. The diverse range of analyses facilitated both the rigour and meaning of the data to interrogated. Performance Theory was used as the theoretical framework in the thesis to allow the rituals to be revealed and explored as dramatic performances. The thesis demonstrated that the origin of the rituals was rooted in the need for the baby to be treated with compassion and dignity and to provide parents with the opportunity to form meaningful attachments in the brief period between the previable baby’s birth and death. The rituals were devised by parents who had been bereaved and were incorporated into guidelines. The guidelines practised the rhetoric of choice but the data demonstrated that the rituals appear to have been adopted as routines which were then used indiscriminately, robbing them of their meaning.The findings reveal how care to meet the physical needs of the dying previable baby requires to be made more explicit to enable the ideology and of ‘comfort care’ to be realised in practice. The thesis also demonstrated a need for inclusiveness to represent the spectrum of parents affected by the death of a previable baby when researching perinatal loss and formulating policy.

Patient monitoring is a complex task, particularly during childbirth, where assessment of the baby's condition is inferred from the continuous electronic recording of the baby's heart rate pattern and maternal uterine contractions (CTG). Computerised decision support has long been advocated, as difficulties in the interpretation of the CTG have led to failure to intervene and unnecessary intervention. The problem is large, for obstetric litigation now accounts for 80% of the UK National Health Service litigation bill. The Plymouth Perinatal Research Group has developed a computerised decision support system for patient monitoring during childbirth and the UK Medical Research Council has agreed to fund a multicentre randomised trial. The work of this thesis was an investigation of the labour ward care system to inform the human-centred design of the decision support system for patient monitoring in childbirth, prior to the clinical trial. It was recognised that many decision support systems have failed to gain clinical acceptance, as conventional design models were inadequate. Lack of attention to the organisational context of the care system and the process of the direct patient care led to the design of inflexible 'expert' systems, which constrained working practices. A pilot ethnographic study of an existing decision support system, used for the analysis of umbilical cord blood samples, was undertaken to clarify the research approach required for the main study. It was found that barriers to effective use within the wider work system included inadequate implementation and lack of organisational support. A case study approach produced a more comprehensive account of the context and process of the use of the computer system. The main study combined qualitative with quantitative techniques to investigate the system of care in childbirth, both outside and within the delivery room, to provide a unique, holistic perspective. The organisational context of the labour ward was investigated by direct observation of clinicians over the course of their work for 220 hours. Observations were documented and transcribed to computer text files. Patterns of actions and events were coded using ATLAS(ti) data analysis software. The codes were counted and tabulated to model the main features of this labour ward care system, which was expressed in the form of a rich picture diagram. These findings were confirmed by a limited study of five other UK labour wards. The core qualitative categories, derived from the observation data, found a complex and problematic relationship between communication, decision making and accountability. Decisions were often made outside the delivery room and were subject to misinterpretation and bias. The organisational hierarchy made it difficult for junior staff to question clinical management decisions. A system of tacit practice, external demands upon clinicians and transient allocation of junior midwives to labour ward militated against teamwork. This increased the vulnerability of the care of mothers to error. The process of direct patient care, within the individual delivery room, of 20 mothers in labour was captured in a novel audio-video observation study. The 111 hours of first stage labour and 12 hours of second stage labour were recorded and digitised to computer files. Recurrent actions and patterns of behaviour were coded both quantitatively and qualitatively using ATLAS(ti) data analysis software. Midwives left the room on average every 15 minutes to be absent for 27% of the first stage of labour. Record keeping occurred on average every 10 minutes and accounted for 19% of midwives' time. Midwives had little time to talk with mothers and only sat down at the bedside for 15% of the time. Psychosocial support was not given priority. Parents were generally excluded from communication between clinicians yet 108 clinicians took part in the care of the 20 women. Pressures from medicolegal directives and task-orientated imperatives overshadowed meaningful interaction with parents and caused spurious care priorities. This work has revealed the need for a critical reassessment of the type of support that is required for monitoring situations in all areas of medicine. A range of functions, such as shared information displays and models, have been suggested to augment roles and relationships between clinicians and parents to support patient-centred care. The present work has revealed that a combination of computer-based technology and changes to working practice can support the parents, their individual carers and their various roles. In this way the system of care can be more aligned to the objective of a safe and emotionally satisfying birth experience for parents and staff. A further programme of research is required to follow-up the existing studies, develop these new forms of interaction between technology and clinicians, and evaluate their effectiveness. The research methods employed in the present work will provide a more comprehensive evaluation of the decision support system in the forthcoming multicentre trial. The methods of investigation have also been shown to be of relevance to patient safety research, service delivery and training.

Conflict entails numerous sacrifices in human resources in addition to loss of life, while it is difficult to appraise the real cost of conflict, one can determine the number of fatalities. It is the primary goal of this thesis to develop an accounting technique by which the human capital cost of fatalities due to the Northern Ireland Conflict may be measured in an accepted unit of account. While the development of a model for measuring human capital loss is in itself an important part of the study, the ultimate objective is to arrive at an estimate of the human capital cost of subversive deaths in Northern Ireland. In this analysis a representative individual is used to estimate human capital loss. The expected earnings stream over the relevant number of earnings period, discounted at the appropriate rate of interest and accounting for the probability of death and unemployment within these periods is the definition given to the value of the human capital stock of an individual. The primary data used in this study is that which recorded fatalities due to the conflict. Considering that human capital is an important input in the production function and that conflict tends to destroy the more productive portion of the human capital stock, the long-run effect of losses due to continuing strife and conflict are as yet unknown. In the short-run, however, the conflict is known to exert a heavy toll on the Northern Ireland economy. As of April 1990, the total human capital loss estimate of subversive deaths resulting from the Northern Ireland conflict were £186,993,266 for security forces and £400,493,890 for civilians, resulting in a total estimated loss of £587,487,156.

Bakgrund: Barnmorskans yrkesområde är inom sexuell, reproduktiv och perinatal hälsa. Detövergripande målet i barnmorskeutbildningen är att utveckla självständiga och kompetenta barnmorskor. Den verksamhetsförlagda utbildningen (VFU) motsvarar ungefär halva studietiden och är en viktig del i barnmorskeutbildningen. Förlossningsavdelningen är en viktig miljö för barnmorskestudenter att inhämta kunskaper om graviditet och förlossning. Motiv: VFU på förlossningsavdelning är en känslomässig och intensiv period för barnmorskestudenter. Barnmorskestudenters uppfattningar om vad som främjar utveckling behöver studeras vidare för att kunna optimera framtida verksamhetsförlagda utbildningar. Syfte: Det övergripande syftet var att belysa barnmorskestudenters upplevelser av verksamhetsförlagd utbildning på förlossningsavdelning.  Metod: En kvalitativ design med induktiv ansats har använts. Semistrukturerade intervjuer med sju barnmorskestudenter i Sverige genomfördes. Intervjuerna har analyserats genom en kvalitativ innehållsanalys. Resultat: Genom analysprocessen framkom ett tema, VFU på förlossningsavdelning – en känslomässig berg- och dalbana samt tre kategorier; Att både ge och ta emot stöd där en mängd faktorer som kan påverka mötet med kvinnan och stödpersonen beskrevs. Andra kategorin Att hålla ihop hela vägen beskrev hur barnmorskestudenternas hälsa varierade samt svårigheter i att gå från en trygg yrkesroll till en studentroll. Tredje kategorin Hinder i utvecklingsprocessen visade hur Covid-19-pandemin påverkade barnmorskestudenternas VFU, optimeringar inför framtida VFU samt tankar om den framtida yrkesrollen. Åtta subkategorier bildades. Konklusion: Barnmorskestudenterna upplevde sin VFU på förlossningsavdelning som en känslomässig berg- och dalbana. Flertalet faktorer som tidigare erfarenheter, relationen till handledaren och reflektionsmöjligheter påverkade barnmorskestudenters möte med kvinnan och stödpersonen. Att belysa dessa faktorer och inkludera barnmorskestudenter i den kvinnocentrerade vården kan leda till ökat självförtroende och kompetens hos barnmorskestudenter vilket i sin tur kan leda till optimeringar av den kvinnocentrerade vården.
Background: The midwife's profession is within the sexual, reproductive and perinatalhealth. The overall purpose of midwifery education is to develop independent and competent midwives. The clinical internship is an important part of the education. The labour ward is an important environment for midwifery students to acquire knowledge about pregnancy and childbirth. Motive: Clinical internship in the labour ward is an emotional and intense period for midwifery students. Midwifery student’s perceptions of what promotes development needs to be studied further, in order to optimise future clinical internships. Aim: The aim was to investigate midwifery students experiences of clinical internship at labour wards.  Methods: A qualitative design with an inductive approach was used. Semi-structured interviews with seven midwifery students in Sweden participated. The interviews were analysed with qualitative content analysis. Result: A theme emerged, Clinical internship at the labour ward - an emotional roller coaster and three categories; To both give and receive support where a number of factors that can affect the meeting with the woman and the support person were described. Second category Holding together all the way described how the midwifery student’s health varies as well as difficulties in the student role. The third category Obstacles in the development process showed how the Covid-19-pandemic affected midwifery student’s clinical internship, optimisations and thoughts about the future professional role.  Conclusion: The clinical internship at the labour ward was described as an emotional roller coaster. Previous experiences, the relationship with the supervisor and opportunities for reflection influenced the midwifery student's encounter with the woman and the support person. Elucidating these factors and including midwifery students in women-centered care can lead to increased self-confidence and competence among midwifery students, this couldlead to optimisations of the women-centered care.

An international maritime labour market study, the thesis focuses on the Dutch naval labour market, analysing wartime Zeeland admiralty crews. The research is based primarily on unique naval pay sources. Analysis of crew compositions has not been made on this scale in the period before. The 1667 Dutch Medway Raid is the starting point, where a few British played a leading role – amongst many others reported on the Dutch side. Pepys and Marvell primarily blamed their joining the enemy on the lure of superior Dutch payment. The thesis asks how many British there were really, how they came to be in Dutch service, and whether this involvement occurred, as indicated, at other times too. Part One is thematic and explores the background mechanisms of the maritime environment in detail, determining causation. First, the two naval recruitment systems are compared and completely reassessed in the light of state intervention in the trade sphere. Two new sets of ‘control’ data – naval wages and foreign shipping – are amongst the incentives and routes determined. British expatriate communities are examined as conduits for the supply of naval labour and civilian support. British personnel are compared and contrasted with other foreigners, against the background of Anglo-Dutch interlinkage and political transition from neutrality through conflict to alliance. Part Two is chronological, covering four major wars in three chapters. Micro-case studies assembled from the scattered record streams enable analysis of the crews of particular officers and ships. Seamen were an occupation that made them a very little known group: the thesis examines the different career types of British personnel of many different ranks, shedding light on their everyday lives. The thesis shows that British personnel were an integral part of Dutch crews throughout the period, even when the two nations were fighting each other. The basic need of subsistence labour for employment took precedence over allegiance to nation/ideology, demonstrating limitations in state power and the continual interdependence forced on the maritime powers through the realities of the labour market.

El trabajo se centra en analizar la vigencia y afectación de la relación laboral por parte del derecho fundamental de la libertad religiosa. Por tal razón se examina la evolución histórica de tal derecho hasta su generalización en la Contemporaneidad en los países occidentales, con especial tratamiento del caso español. Asimismo se examina la legislación internacional y comunitaria en la materia. Posteriormente la obra analiza la pluralidad cultural y religiosa que caracteriza España en la actualidad, una riqueza que es trasladable a sus centros de trabajo. Por tal razón, y dado el carácter limitado del fenómeno secularizador, se desarrolla una argumentación encaminada a explicar las características del Derecho del Trabajo del siglo XXI, que tiene como reto la de transformarse en un Derecho inclusivo. La inclusión se produciría por tratarse de un Derecho religiosamente neutro desde el punto de vista formal en cuanto a sus preceptos, pero materialmente garantista de las convicciones de cada cual, que evitara así discriminaciones. A partir de aquí la obra se centra esencialmente en tres figuras y sus manifestaciones en la relación laboral: el derecho a la libertad religiosa, el derecho a la objeción de conciencia por razones religiosas y la tutela antidiscriminatoria del trabajador creyente. El derecho a la libertad religiosa ha de reconocerse al trabajador por cuenta ajena aunque, como los otros derechos fundamentales, podrá ser limitado a través de la oportuna ponderación con otros derechos y bienes en juego. Así, la vigencia del derecho a la libertad religiosa en el puesto de trabajo se garantiza de varios modos: 1) en los supuestos más extremos y cuando no concurre ninguna medida legal o recurso material más al alcance del trabajador, dicho trabajador puede defender sus convicciones mediante el ejercicio del derecho a la objeción de conciencia, que le permite desobedecer puntualmente respecto al cumplimiento de una obligación jurídica apta para lesionar sus convicciones (ius resistentiae); 2) el trabajador que es objeto de discriminación por razón de sus convicciones religiosas, puede utilizar las medidas antidiscriminación previstas legalmente; 3) y, finalmente, el trabajador puede ejercer el derecho a la libertad religiosa directamente, tanto para defender dicho derecho en su sentido negativo, cuando sufre algún tipo de injerencia en sus convicciones; como desde un punto de vista positivo, de forma activa, cuando es necesario remover obstáculos jurídicos y alterar las condiciones de trabajo para la óptima expansión del derecho. Y precisamente, tal es el aspecto más discutible, pero menos discutido en España, de la eficacia jurídica del derecho a la libertad religiosa; pues es el que determinaría históricamente que el Derecho del Trabajo conciba dicho derecho desde un punto de vista meramente liberal, o, por el contrario desde una visión acorde con el Estado de Derecho. Como manifestaciones de dichas figuras en el puesto de trabajo se analizan, entre otras, las festividades y descansos, el uso de indumentaria y simbología religiosa, o las actividades proselitistas. Asimismo, se examina el concepto de empresa de tendencia religiosa.
The paper focuses on analysing the validity and application of the fundamental right of religious freedom within labour relations. For this reason, it examines the historical evolution of this right until it became the norm in modern Western countries, looking in particular at the case of Spain. In addition, it examines international and community legislation in this area. The work subsequently analyses the plurality of cultures and religions that characterise Spain today, a richness that can be transferred to the countrys workplaces. Because of this, and given the limited secularist phenomenon, it provides reasoning with which it aims to explain the nature of Labour Law in the 21st century, which faces the challenge of making itself an inclusive area of law. lt is supposedly inclusive since it is a religiously neutral area of law from a formal point of view judging by its precepts, though in practice it protects the convictions of everyone, thus preventing discrimination. From here, the paper goes on to focus on essentially three aspects and their manifestations in labour relations: the right to religious freedom, the right to conscientious objection on religious grounds, and the legal protection of religious workers from discrimination. The right to religious freedom must be granted to employed workers although, as with other fundamental rights, it may be restricted when properly weighed up against other legal rights at stake. Thus, the validity of the right to religious freedom in the workplace is safeguarded in several ways: 1) in the most extreme cases and where there is no other legal measure or practical recourse available to them, workers may defend their convictions by exercising the right to conscientious objection, which allows them occasionally to breach a legal obligation that would go against their convictions (ius resistentiae); 2) workers who are subject to discrimination for their religious convictions may make use of the anti-discrimination measures provided by law; 3) and finally, workers may exercise the right to religious freedom directly, to defend the aforementioned right in its negative sense where their convictions are infringed upon, as well as actively from a positive point of view, where it is necessary to remove legal obstacles and change the working conditions in respect of the right as far as possible. And this is precisely the most debatable aspect, though less so in Spain, of the legal effectiveness of the right to religious freedom, since it is this aspect that would historically determine whether Labour Law will see this right from a merely liberal point of view or, on the other hand, from a Rule of Law standpoint. The manifestations of these aspects analysed in the workplace include, among others, holidays and breaks, the use of religious symbols and attire, and proselytising activities. Furthermore, the concept of a company with religious leanings is also examined.
El treball es centra en analitzar la vigència i l'afectació de la relació laboral per part del dret fonamental de la llibertat religiosa. Per aquesta raó s'examina l'evolució històrica d'aquest dret fins a la seva generalització a la contemporaneïtat en els països occidentals, amb especial tractament en el cas espanyol. Així mateix s'examina la legislació internacional i comunitària en la matèria. Posteriorment, l'obra analitza la pluralitat cultural i religiosa per la qual es caracteritza Espanya a l'actualitat, una riquesa que és traslladable en els seus centres de treball. Per aquesta raó, i donat el caràcter limitat del fenomen secularitzador, es desenvolupa una argumentació encaminada a explicar les característiques del Dret del Treball del segle XXI, que té com a repte el transformar-se en un Dret inclusiu. La inclusió es produiria pel fet de tractar-se d'un Dret religiosament neutre des del punt de vista formal en quant als seus preceptes, però materialment garantista de les conviccions de cadascú, que evitarà així discriminacions. A partir d'aquí ('obra es centra essencialment en tres figures i les seves manifestacions en la relació laboral: el dret a la llibertat religiosa, el dret a l'objecció de consciència per raons religioses i la tutela antidiscriminatòria del treballador creient. El dret a la llibertat religiosa s'ha de reconèixer al treballador per compte aliè tot i que com amb els altres drets fonamentals, podrà ser limitat a través de l'apropiada ponderació amb altres drets i béns en joc. Així, la vigència del dret a la llibertat religiosa en el lloc de treball es garanteix mitjançant diferents maneres: 1) En els supòsits més extrems i quan no concorri a l'abast del treballador cap mesura legal o recurs material addicional a l'abast del treballador, dit treballador pot defensar les seves conviccions mitjançant l'exercici del dret a l'objecció de consciència, el qual li permet desobeir puntualment respecte al compliment d'una obligació jurídica apta per lesionar les seves conviccions (ius resistentiae) ; 2) el treballador que és objecte de discriminació per raó de les seves conviccions religioses, pot utilitzar les mesures antidiscriminació previstes legalment; 3) i, finalment, el treballador pot exercir el dret a la llibertat religiosa directament, tant per defensar aquest dret en el seu sentit negatiu, com quan pateix algun tipus d'ingerència en les seves conviccions, com des del punt de vista positiu, de forma activa, quan és necessari remoure obstacles jurídics i alterar les condicions de treball per l'òptima expansió del dret. l precisament, el darrer és l'aspecte més discutible, però menys discutit a Espanya, el de l'eficàcia jurídica del dret a la llibertat religiosa, ja que és el que determinaria històricament que el Dret del Treball concebi esmentat dret des d'un punt de vista merament liberal, o, pel contrari des d'una visió acord amb l'Estat de Dret. Com a manifestacions de dites figures en el lloc de treball s'analitzen entre altres, les festivitats i descansos, l'ús de la indumentària i simbologia religiosa, o les activitats proselitistes. Tanmateix, s'examina el concepte d'empresa de tendència religiosa.

Thesis (M.Tech.: Nursing)-Durban Institute of Technology, 2005 1 v. : ill. ; 30 cm
An exploratory descriptive research design was used for this study which investigated the underutilisation of a rural clinic’s labour ward by low risk pregnant women (LRPW). The study took place in Maputaland, Northern KwaZulu-Natal. Rosenstock’s health belief model (HBM) modified by Becker et al, in 1977 was adapted as a framework for this study.

碩士
高雄醫學大學
性別研究所碩士班
94
Teacher couples are common in campus. In contrast with married male teachers, who do not need to go home in a hurry after school, married female teachers often rush home dealing with the domestic affairs. Since both of the couples are teachers, how they divide their domestic labor after school would be full of gender implications. In the past, the analyzing theories of the researches in the division of domestic labor drew largely from the West; however, these theories have come into conflict with local realities. By applying qualitative research method and interviewing eight couples in this study, I acquired there are a variety of division in domestic affairs, the results are as follows: 1.The quasi-traditional type: wives are engaged in nearly all the housework. The ideology of “judging a woman by how she keeps the house” has a great effect, even though women have her careers as teachers. The working structure of teaching ( work time is identical with children’s school time, etc) also leads to strengthen the connection of female teachers and housework. The agents develop various ways to make a balance between their inner ideal and current condition of division, such as “outdoor-indoor philosophy”, or husband buying a good broom in exchange for his wife’s sweeping. That means the mental feeling can replace real condition to soothe the inequality in division and make the current division continue. 2.The transitional type: wives still do more in housework than husbands, however husbands do some portion voluntarily. In this type, wives actively endeavor to make husbands do some housework by taking the structure of “both are equally working as teachers” as a negotiation counter. However, husbands do not totally agreed with their wives, and sometimes they resist this division by using subtle strategies such as doing housework sloppily or delaying to do it. When this behavior causes their wives’ dissatisfaction, husbands will ‘communicate’ with their wives by using some seemingly logic reason and make women feel more powerless. 3.The egalitarian type: husbands and wives share the housework almost equally. In this type we can detect the traditional ideology still comes into play. However, wives use the ideology and structure as negotiation counter, such as asking husbands to help baby bath by the ideology of “men have more strength than women”, or asking husbands to pick up children by the structural reason of “they should go to school earlier”. The wives not only directly challenge but also subtly resist the traditional gender division. As for the husbands, they do not passively participate in this division, but they actively change their identity—men can do everything women do, except pregnancy. They are even very proud of themselves as a “new good man” 4.The Helper type: helpers, such as mother, mother-in-law, or migrant workers instead of the couples themselves do most of the housework, which reduce the burden of domestic labor. The wives, as well as their husbands can have their own regular leisure after work, which is not usually available to couples in other types. The wives use much more subtle strategies to resist the traditional gender division such as ‘do not do the housework voluntarily’ than egalitarian types or close the door to avoid the pressure of public opinions. In conclusion, the four types above make a good example of the current balance among ‘ideology’, ‘structures’ and ‘agents’. “Ideology” means the influence of the pressure from traditional norms or the rising notion of gender equality. “Structures” are factors which are difficult to change, such as work schedule or distance. Through the interactive negotiations, resistance or even quarrels between the couples, “agents” can change the status quo. In other words, division types described above are not stable. Once any of the three aspects changes, the temporary division in domestic labor will readjust. A new analyzing framework for researches on domestic work-- culture, structure and agents – is introduced in the study.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesia Johannesburg, 2015
Epidural analgesia has become the gold-standard for providing labour analgesia. Internationally 40-60% of labouring women receive epidural analgesia. At Chris Hani Baragwanath Academic Hospital (CHBAH) currently less than 10% of parturients receive epidural analgesia. Greater involvement of nursing staff is needed for this service to expand. Nurses should have the necessary knowledge if they are to be involved in the provision of labour epidurals. All 50 nurses working in the CHBAH labour ward at the time of the study were invited to complete a previously validated, self-administered questionnaire. The questionnaire included demographic data and a knowledge test. The demographic section assessed personal and professional details and identified sources of knowledge related to epidural analgesia. The knowledge test was comprised of 22 questions divided into five knowledge subsections relating to epidural analgesia: spinal cord anatomy and physiology, epidural pharmacology, assessment of sensory and motor blockade, complications of epidural analgesia, and the general management of a patient receiving epidural analgesia. The data was collected during working hours. Of the 50 questionnaires handed out, 45 were returned resulting in a 90% response rate. Of these, 43 questionnaires were usable. The majority of the participants were in the 30-39 years age range. The median number of years worked in labour ward was 11 (range 0.5 - 30 years). Forty four percent of the nurses had a three year diploma in nursing and 33% had a four year diploma in nursing. Sixty five percent of nurses cared for less than five patients with epidurals per month. Eighty four percent of nurses had received no specific education regarding labour epidurals. The overall knowledge of nurses working in the CHBAH labour ward, labour ward high care and labour ward admissions was poor with a median score of 4 out of a total score of 22. The results for the subsections were as follows: anatomy and physiology of the spinal cord with a median score of 1 (range 0-4), epidural pharmacology with a median score of 1 (range 0-4), assessment of sensory and motor blockade with a median score of 0 (range 0-5), complications arising from epidural analgesia with a median score of 0 (range 0-3) and general management of epidural analgesia with a median score of 2 (range 0-3). Urgent educational programs and teaching need to be instituted in order to improve the nurses’ knowledge.
MT2017

Determination of staffing needs is a priority for an organization seeking to provide safe patient care in an environment which is cost conscious. Registered nurses and midwives spend more time with patients than any other single category of health professionals and also provide 24 hour direct patient care. Activity based norms are recognized by the World Health Organization to be the most suitable way of determining staffing needs; establishing of time spent on activities is one of the key factors in determining activity based staffing norms. This study focuses on ascertaining the timing of activities of midwives during labour in maternity obstetrics units with the possibility of using the information at a later date to determine activity based staffing norms for midwives in the maternity obstetrics units. An adaptation of Hodnett’s (1996) five categories of labour support was used as a framework for measuring activities performed by midwives and nurses while supporting women in labour. This model was adapted from the previous work sampling study conducted in Toronto (McNiven and Hodnett, 1992:1). Purpose of the study The purpose of the study was to determine the time taken to perform nursing activities during labour in South African Midwife Obstetrics Units (MOUs) to inform the future process of developing nursing norms for labour wards in MOUs in the public sector. Research design This was an exploratory observational study using a mixed method design that included both qualitative and quantitative methods. Spot observations studies were conducted during patients’ first stage of labour, which constituted the quantitative part of the design, i.e. activities observed and measured during the observation period. Naive sketches were used in the qualitative part of the study. The study was conducted in the six Midwife Obstetrics Units in Ekurhuleni Metropolitan Health District of Gauteng. v Main findings Activities carried out by midwives in the MOUs were mainly reactive to the physiological processes of labour as they occur. Midwives in MOUs did not display the “soft skills” referred to in Hodnett’s categories of labour support. On the other hand, those skills that they managed to display were not easy to capture because they happen simultaneously with other activities e.g. touching and holding. Most of the categories of labour support were difficult to measure because they occurred very quickly and in “groups/batches.” The activities of midwives when caring for patients in labour were timed, and the calculation of the frequency at which nursing activities was carried out was particularly successful, but the researcher concluded that while the study was useful to provide insights into the quality of care, these results could not be used as a basis for determining activity based norms. This is due to the fact that the midwives did not practice quality care and the observation method was difficult to implement. The tool would need to be simplified and the possible use of technology such as videos should be considered if the study were to be replicated. Factors that influenced the time spent and the duration of activities relate to communication, relationships, resources and systems failures. Conclusion The categories of labour support can be used for improving patient care and, if adapted to the South African setting, could be fit for the purpose of developing activity based norms, but only once midwives are taught and encouraged to implement the “soft skills” in labour which are necessary but seldom practiced. Key concepts: Maternity obstetrics unit, workload, activity based norms, categories of labour support.
LG2018

"December 2004"
Includes ammendments in front pocket.
Bibliography: leaves 503-515.
515 leaves : ill. (chiefly col.) ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, School of Humanities, Discipline of Linguistics, 2006?

This study aimed at assessing factors related to male participation in PMTCT in three public hospitals in Addis Ababa, Ethiopia. A quantitative, descriptive correlational design was used to assess correlation between male participation and socio-demographics, knowledge and awareness in HIV/PMTCT, socio-cultural belief, programmatic factors and reported risk. Male partners (n=216) were interviewed and reviews of HIV counselling and testing (HCT) acceptance formats were made. The major findings were 54.5% (n=156) males reported receiving HCT during their visit to partner’s antenatal care. Some 71.5 % (n=677) of women were accompanied to labour wards by male partners; 86.5% (n=208) of males accepted intra-partum HCT; 55.1% (n=216) scored above the mean score (10) on a 15-point scale for male participation. Male participation in PMTCT was found to have a statistically significant but weak correlation with educational level (r=0.193), income (r=0.167), PMTCT knowledge and awareness (r=0.172), socio-cultural belief (r=-0.164) and reported risk (r=-0.23).
Health Studies
M.A. (Public Health)

This dissertation is an ethnographic work describing how foodways have become central to identity negotiation in a Maya village that has recently been impacted by evangelical conversion and tourism. This village is in the region of Quintana Roo, Mexico best known for its involvement in the Caste Wars of Yucatán and historic resistance to assimilation to Mexican identity. However, in recent years, the demand for inexpensive labor in the hotel zone of the Caribbean coast of Quintana Roo has led to improved infrastructure and transportation to these villages. With this improved infrastructure has come increased outside interaction including the establishment of evangelical churches and day labor buses. These combined influences of religion and labor changes have led to new ways of negotiating identity that had not previously existed in village life here. Because life in this village had always centered on subsistence farming and its associated food getting and food making tasks, the option for wage labor and evangelical religion have provided a support system for those unable or unwilling to participate in traditional forms of subsistence. The new social structures are often negotiated using food and foodways as a declaration of belonging or resistance. My work provides vignettes describing these processes of identity negotiation at the national, regional and familial levels.
text