• Alleviating postnatal perineal trauma: To cool or not to cool?

      Steen, Mary; Briggs, Michelle; King, David; UCLan/University of Leeds/Royal College of Midwives (Mark Allen Publishing, 2006-05-01)
      This article discusses the evidence reported from quasi randomised trials and randomised controlled trials on the efficacy and acceptability of localised cooling methods in alleviating perineal trauma. Two types of cooling methods were identified: iced sitz baths and cooling devices. The review suggests that cooling may lower the levels of reported perineal pain after childbirth and reduce the inflammatory response associated with perineal trauma. However, women's preferences as well as the efficacy of the cooling method should be taken into consideration. Women's natural reluctance to sit in iced sitz baths suggests that this cooling method is unpleasant and may explain why there has been a decline in this method being used in clinical practice over the last two decades. The use of localised cooling devices appear to be a more acceptable method for women.
    • Anxiety, bonding and attachment during pregnancy, the transition to parenthood and psychotherapy

      Steen, Mary; Jones, Alun; Woodworth, Barabara; University of Chester ; University of Chester ; Chester and Wirral Partnership NHS Trust (Mark Allen Publishing, 2013-12-01)
      Although becoming and being a parent are considered happy life events, parents can suffer from varying degrees of anxiety and variable mood. Anxiety and mood changes can be missed and this can lead to mental health problems if not recognised at an early stage. An insecure attachment in a parent's early infanthood can contribute to increased levels of anxiety and emotional problems when becoming and being a parent themselves, which can influence mother and child bonding as well as wider difficulties within family relationships. In many instances, attachment styles can be passed on to the infant causing a range of emotional and intellectual difficulties. In certain circumstances, these parents may benefit from psychotherapy. Psychotherapy is a method of addressing troubling emotions along with life difficulties and relationship struggles. Using psychological methods, a psychotherapist can help a person change his or her life for the better by becoming more effective in work or personal relationships. Local community support and befriending approaches have been shown to be beneficial in alleviating anxiety and depression. This article briefly describes what psychotherapy is and demonstrates ways in which interpersonal attachment styles established early on in life can bring difficulties to adult relationships. Two disguised scenarios referring to actual psychotherapy consultations are included to illustrate how plans can be put in place to address interpersonal difficulties related to attachment styles.
    • Daniel's story: Self-injury and the case study as method

      Lovell, Andy; University of Chester (Mark Allen Publishing, 2006-02-01)
      This journal article explores the value of case study methodology as a means of investigating the relationship between people with learning disabilities and self-injury. One life story might appear to be of limited value in this regard; however, it is argued that it might not only be of use in demonstrating the development of an isolated self-injuring career, but there may also be insights into its entrenchment in the lives of others. The telling of one story might serve as a filter, through which the interventions of medication, mechanical restraint and behaviourism can be observed over time. Furthermore, studying one life in some detail might be used to illustrate broader concerns about the context of the transition from institutional to community care. The restrictions of such an approach are acknowledged, particularly in the telling of a story where the main character's words cannot be heard, but maybe that is also the point of undertaking research about those at the margins of society.
    • Drug action: The therapeutic effect

      Robertson, Deborah A. F.; University of Chester (Mark Allen Publishing, 2017-05-13)
      Abstract In this article in the series of ‘bite sized’ pharmacology, we will look at the concept of drug action- the therapeutic effect of the medications we give. It is important that prescribers are aware of factors that can affect drug action and the time to onset of and subsequent duration of the desired therapeutic effect. We will look at factors that affect these two important areas of drug action. Knowledge of these factors can assist the prescriber when deciding on doses and dose schedules to ensure that patients receive their medications at the correct dosing, by the correct route and in the right formulation to ensure optimum therapeutic effect. It also helps the prescriber understand why dose adjustments are made or some drugs are avoided in patients with hepatic or renal impairment.
    • Feme pad: Out of the ice age and into the new millennium

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (Mark Allen Publishing, 2000-05-03)
      Explains the principles behind and use of the Feme Pad, a new cooling gel pad designed to alleviate perineal pain and reduce swelling following delivery.
    • Homeopathic remedies for self-adminstration during childbirth

      Calvert, Jan; Steen, Mary; Leeds Complementary Therapy Centre; Royal College of Midwives/University of Central Lancashire (Mark Allen Publishing, 2007-03)
      The first of two articles. This article discusses a study that assessed the usage and impact of providing a self-administered kit of homeopathic remedies at the end of pregnancy, childbirth, and post-childbirth. The study was undertaken at the hospital and at home. Nineteen women in south Leeds participated in this study between September 2005 and February 2006.
    • People with learning disabilities who engage in self-injury

      Lovell, Andy; University College Chester (Mark Allen Publishing, 2004-07-01)
      This journal article represents some of the findings of the author's research into the relationship between self-injury and learning disability. It identifies the key theoretical discourses associated with the phenomenon, before elaborating on the main principles of each and identifying resultant intervention strategies. These interventions, psychotropic medication, mechanical restraint, and the behavioural approach are subsequently described. Case-study methodology was employed since this enabled the examination over time of these intervention strategies in the lives of individuals fulfilling the necessary criteria of persistent self-injury and significant communication difficulties. The findings of the research suggest a frequently piecemeal approach to self-injury, with arbitrary selection of behavioural intervention approaches, a continued reliance on powerful medication, and ambivalence concerning the use of mechanical restraint. Nurses were often skilled in working from a behavioural perspective, but were hindered by complex family circumstances and a failure to gain the confidence of direct care staff. There was also a lack of appreciation about the relationship between the individual and his/her self-injury, and recognition of the nature of the intransigence.
    • Perineal tears and episiotomy: How do wounds heal?

      Steen, Mary; UCLan/Royal College of Midwives (Mark Allen Publishing, 2007-05-01)
      The care of perineal wounds is an important aspect of postnatal care. This article focuses on the healing of perineal wounds, describes tissue trauma, different types of wounds and classification of perineal wounds. Wound healing, factors that can prevent healing and the need to provide adequate pain relief that will have no adverse effect on healing are discussed in detail.
    • Risk, recognition and repair of perineal trauma

      Steen, Mary; University of Chester (Mark Allen Publishing, 2012-11-01)
      The risk of perineal injury during childbirth continues to affect the majority of women. Morbidity associated with perineal injury and repair is a major health problem for women. Therefore, it is vitally important that midwives are educated and trained to recognise risk factors and the extent of perineal injury. Education and training has been shown to assist midwives to gain confidence and clinical skills to suture competently and keep themselves up-to-date with the best available evidence on which to base their care. This article provides an overview of the literature relating to risk, recognition and repair of the perineum during the childbirth continuum.
    • Self-administered Homeopathy part 2: A follow up study

      Steen, Mary; Calvert, Jan; Leeds Teaching Hospitals NHS Trust (Mark Allen Publishing, 2007-06-01)
      This paper discusses a follow up study that used a semi-structured interview technique to further explore the experiences of women and their partners following the use of a specifically chosen homeopathic kit that included ten remedies that were self-administered.The interview data demonstrated that women and several birth partners experienced positive emotional, psychological and physical benefits from using the kit of homeopathic remedies. Implications: Self administered homeopathic remedies have the potential to promote a women-led approach to childbirth and an active supportive role for the birth partner. The findings will form the foundations to undertake further research in this field.
    • Understanding perineal pain: Women's descriptions

      Steen, Mary; Royal College of Midwives/University of Central Lancashire (Mark Allen Publishing, 2008-06-01)
      Women perceive, describe and react to pain differently; it cannot be easily quantified. Pain is a private and personal experience to the individual. It is, therefore, impossible for another person to know exactly what someone else’s pain feels like. When measuring pain there is a need to assess both the intensity and the quality of the pain to gain an insight into a person’s experience of pain. Therefore during a PhD Study which involved the investigation of the effectiveness of localised cooling treatments to alleviate perineal pain, women were asked to describe the pain as well as the intensity (Steen & Marchant, 2007). The quality of pain was measured by asking the woman to describe the pain in her own words. These words were analysed as pain descriptors under the themes of sensory, affective, evaluative and miscellaneous as described by the McGill Pain Scale. In addition, intensity, discomfort, physical symptoms, metaphors used and links to the expectations of the woman were considered. (Melzack & Wall, 1996). This article will give an overview of the pain syndrome, discuss measurement of pain methods and the use of word descriptors to assess the quality of pain. The assessment of perineal pain and women’s descriptions will be further explored. This insight will give an understanding of the pain experience of women who have perineal trauma following childbirth and this may lead to further research and the development of a specific evaluating tool.