Critical reflection in midwifery practice: the protection motivation theory

Background: The aim of this paper is to shed light on the notion of fear and inter-personal working relationships, and to promote safe midwifery practice, by critically reflecting on our practice and being aware of fear appeals and the protection motivation theory (PMT).

Theory: PMT provides a general account of the impact of persuasive communication, emphasising the cognitive processes that mediate behaviour change and questions whether ‘fear appeals’ could influence behaviour. Discussion: It is possible that when a midwife decides on a particular care pathway, she determines the degree and perception of the four elements of the PMT; severity, vulnerability, response-efficacy and self-efficacy. If the midwife decides that both the degree of severity and her perception of vulnerability are high, whereas response and self-efficacy perceptions are low, she will probably decide against her original care pathway. For the PMT to be used safely, an appropriate judgement call is required and is based on full understanding of the situation, effective communication with the multidisciplinary team, full knowledge of the proposed care, and competence and confidence in the proposed care. Conclusion: By critically reflecting on their practice and using the PMT, the author believes that midwives will be able to work in partnership with obstetricians to provide safe and effective care within their sphere of practice and in the absence of fear.     

Health behaviour change theory meets falls prevention: Feasibility of a habit-based balance and strength exercise intervention for older adults

ObjectivesHabit formation is a proposed mechanism for behaviour maintenance. Very few falls prevention studies have adopted this as an intervention framework and outcome. Therefore, we tested feasibility of a theory-based behaviour change intervention that encouraged women to embed balance and strength exercises into daily life routines (e.g., eating, self-care routines).DesignThe EASY LiFE study was a mixed-methods, 4-month feasibility intervention that included seven group-based sessions and two telephone calls.Main outcome measuresWe obtained performance-based (i.e., Short-Physical-Performance-Battery) and psychological self-report measures (i.e., intention, self-efficacy, planning, action control, habit strength, quality of life) from 13 women at baseline (T1) and 4-month follow-up (T2). We applied the Framework-Method to post-intervention, semi-structured interviews to evaluate program content and delivery.ResultsIn total, 10 of 13 women completed the program (M_age = 66.23, SD = 3.98) and showed changes in their level of action control [mean difference_T1−T2 = 1.7, 95% CI (−2.2 to −0.8)], action planning [mean difference_T1−T2 = 0.8, 95% CI (−1.1 to −0.2)], automaticity [mean difference_T1−T2 = 2.5, 95% CI (−3.7 to −1.2)], and exercise identity [mean difference_T1−T2 = 2.0, 95% CI (−3.2 to −0.8)]. Based on the Theoretical Domains Framework we identified knowledge, behavioural regulation, and social factors as important themes. For program delivery, dominant themes were engagement, session facilitators and group format.ConclusionThe theory-based framework showed feasibility for promoting lifestyle integrated balance and strength exercise habits. Using activity and object-based cues may be particularly effective in generating action and automaticity.     

Communicating power and resistance: exploring interactions between aboriginal youth and non-aboriginal staff members in a residential child welfare facility

Aboriginal youth are highly overrepresented within the child welfare system. High-risk youth are often placed in out-of-community residential placements. Such residential placements have been described by some as a continuation of colonial practices. Using communication theory as a conceptual model, we propose a qualitative analysis of micro-interactions that take place between Aboriginal youth and non-Aboriginal workers during the management of high-risk behaviors within a residential program. Three broad categories of interaction emerge from the data: complementary, symmetrical/complementary (where youth show a form of submission despite resistance), and symmetrical (characterized by a power struggle). Despite the diversity of interactions along this symmetrical to complementary continuum, interventions always start and finish in the same fashion. Moreover, the nature of interactions depended mostly on how quickly youth accepted the consequences of their behaviors. We also extracted five categories related to culture, race or context that are perceived as influencing the interactions that take place between staff and youth. The analysis of micro-interactions within clinical, organizational, social and historical contexts points to mechanisms by which asymmetrical power relations may be replicated on a day-to-day basis despite the best intentions of residential workers.     

The War Between Faith and Fact

Is there a war going on between science and religion or not? The Center for Theology and the Natural Sciences and many other bridge-building advocates deny that a war must be fought between genuine science and authentic faith. Yet, a new book, Faith vs. Fact, by Jerry Coyne, launches a new attack against those with faith in God. This essay asks whether such an attack comes from genuine science or from scientism—a materialist ideology that claims rational science as its ally.     

Aboriginal Health Care and Bioethics: A Reflection on the Teaching of the Seven Grandfathers

Contemporary bioethics recognizes the importance of the culture in shaping ethical issues, yet in practice, a process for ethical analysis and decision making is rarely adjusted to the culture and ethnicity of involved parties. This is of a particular concern in a health care system that is caring for a growing Aboriginal population. We raise the possibility of constructing a bioethics grounded in traditional Aboriginal knowledge. As an example of an element of traditional knowledge that contains strong ethical guidance, we present the story of the Gifts of the Seven Grandfathers. We note a resemblance of this Ojibway teaching to virtue ethics in European traditions, but we suggest that there are also important differences in how these two traditions are currently presented. We hope that further engagement with a variety of indigenous moral teachings and traditions could improve health care involving Aboriginal patients and communities, and enrich the discipline of bioethics.     

The “Jewish Knight” of Slobodka honor culture and the image of the body in an Ultra-Orthodox Jewish context

Scholarship on Ultra-Orthodox Jewish thought has traditionally assumed that the views of these communities derive from a struggle against the Jewish Enlightenment and Zionism, as well as against any values they identify as “modern.” This article challenges that assumption. Beginning with an examination of Ultra-Orthodox sources that present an image of the religious leader as the “ideal Jew,” the author then focuses on sources concerning the founder of the Slobodka Yeshiva in Lithuania. This rabbi intended his students to internalize “modern” norms found in the European honor culture of his time, while translating them into the language of Jewish Ultra-Orthodoxy. The author chooses to present his argument by tracing the image of the body in the Slobodka method, since it is precisely through the nexus of the body that Ultra-Orthodox Judaism was segregated from general European society and culture.     

Past and present,day by day: Communication with former romantic partners,relationship-contingent self-esteem,and current relationship outcomes

In an effort to illuminate factors delineating when communication with former romantic partners can be beneficial versus detrimental, this work examines how communication affects both the current and former relationships, and whether these associations vary as a function of one’s self-worth being tied to the relationship (i.e., relationship-contingent self-esteem, RCSE). Over three weeks, undergraduates in relationships who regularly communicated with a former partner (N = 46) completed nightly measures of former partner communication and satisfaction with current and former relationships. Results indicated that among those higher in RCSE, communication with former partners undermined current relationship satisfaction and bolstered former relationship satisfaction, patterns not evident among those lower in RCSE. For some, communication with former partners can be problematic for the current relationship.     

Drugs,Sex, and Condoms: Identification and Interpretation of Race‐Specific Cultural Messages Influencing Black Gay and Bisexual Young Men Living with HIV

Black gay and bisexual young men carry a disproportionate burden of HIV in the United States. This study explored Black gay and bisexual young men living with HIV's identification and interpretation of race‐specific cultural messages regarding substance use, sexual activity, and condom use. A total of 36 Black gay and bisexual young men living with HIV (ages 16–24, mean = 20.6 years) from four geographically diverse regions of the United States participated in qualitative in‐depth interviews. Results from this study elucidate the ways in which these young men interpret various forms of race‐specific cultural messages and experiences regarding substance use, sexual activity, and condom use. Participants discussed cultural messages and experiences promoting and discouraging condoms and substance use. Regarding sexual activity, only messages and experiences promoting sex were reported. Across all three categories, messages and experiences promoting risk were predominant. Data further revealed that socially transmitted cultural messages received by young men emanated from multiple sources, such as family, peers, sexual partners, community/neighborhood, and the broader society. Race‐specific cultural messages and experiences should be addressed in interventions for this population, and programs should assist young men in developing a critical consciousness regarding these messages and experiences in order to promote health and well‐being.