Gestational Diabetes Nursing Case Study

Gestational Diabetes Nursing Case Study-27
Previous studies have shown that GDM can result in an emotionally distressing pregnancy, but there is little research on the patient experience of GDM care, especially of a demographically diverse UK population.

Previous studies have shown that GDM can result in an emotionally distressing pregnancy, but there is little research on the patient experience of GDM care, especially of a demographically diverse UK population.

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The unit currently sees around 200 women with GDM per year and has good biomedical pregnancy outcomes, with rates of macrosomia and preeclampsia lower than in the intervention arm of the ACHOIS trial [9] (a large study exploring whether treatment of GDM would reduce perinatal complications) and similar low rates of shoulder dystocia and emergency Caesarean section.

To achieve these outcomes the women are intensively managed by a multidisciplinary team of diabetes specialist nurses, doctors, dietitians, obstetricians and specialist midwives with weekly or fortnightly clinic visits.

In this paper we present a study that aimed to describe the experiences of women from a demographically diverse population of their GDM and GDM care, to help inform healthcare delivery for women both during and after pregnancy.

The study used in-depth personal interviews and focus groups to elicit women’s experiences of GDM and GDM care.

We obtained approval from the National Research Ethics Service (reference 13/SW/0141).

We chose to use both interviews and focus groups in order to achieve a more comprehensive understanding of the data [25].However, most qualitative studies exploring women’s experiences of GDM have not considered women’s relationships with their healthcare providers, women’s views on how to enhance care provision, and their experience of postpartum and preventive care in relation to their future diabetes risks.Of the three previous studies conducted in the UK, two included participants with mainly White ethnicity [20, 22].Gestational diabetes mellitus (GDM) affects up to 5% of all pregnancies in the UK [1], between 1% and 25% of pregnancies globally, [2] and its incidence is increasing [3].GDM is associated with an increased risk of adverse fetal, infant and maternal pregnancy outcomes including preeclampsia, primary caesarean section, excessive fetal growth (large for gestational age or macrosomia), shoulder dystocia or birth injury, neonatal hypoglycaemia, and admission to neonatal intensive care [4].In order to cater for different preferences and to widen our participation we offered participants the choice of either a focus group or an interview, and whether the interview took place on the phone, in a non-clinical building on the hospital site, or at the participant’s home.The study was conducted in a diabetes pregnancy unit at a large teaching hospital in London, UK.We identified seven themes: the disrupted pregnancy, projected anxiety, reproductive asceticism, women as baby machines, perceived stigma, lack of shared understanding and postpartum abandonment.These themes highlight the often distressing experience of GDM.Focus groups have the potential advantage of utilising the group effect [26, 27] to explore areas of consensus and diversity in the experiences within the group [28].Interviews have the advantage of allowing the interviewer to build trust with the interviewee as well as provide the interviewee the opportunity to analyse their own motivations, therefore improving the quality of the data [29].

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