Journal articles
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Hunter L, Burns E, Baker K, 'Developing an initiative to involve service-users in the recruitment of student midwives'
Practising Midwife (2019)
ISSN: 1461-3123
Abstract In this fourth article of our Advancing practice education series, a novel initiative regarding the engagement of service-users to student midwife recruitment is outlined. Whilst the NMC mandates service user involvement, it can be challenging to implement. We at Oxford Brookes University introduced an initiative involving group discussions between candidates and service users. Feedback was sought via an evaluation form which 68 candidates and six service users completed. Candidates enjoyed the opportunity to question mothers in an informal group setting, and women felt valued through sharing their stories and making a meaningful contribution to the recruitment process.
Website
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Harcourt K, Hunter L, Appleton JV, Clegg M, 'The influence of social relationships on men's weight'
Journal of Nutrition Education and Behavior 52 (2) (2019) pp.106-113
ISSN: 1499-4046
Abstract There is a clear link between the development of obesity with poor diet and exercise behaviours. In the UK, excess weight is more prevalent among men than women: 41% of men and 31% of women are classed as overweight (BMI 25.0 -29.9 kg/m2); 68% and 58% of men and women respectively are overweight or obese (BMI≥ 25 kg/m2). An increase in BMI is also associated with a greater risk of mortality in men than in women however men are under-represented in lifestyle interventions for weight loss: In 2016, 7% of Slimming World members were men. It has been argued that men may perceive larger bodies to be more masculine and more desirable to women. Furthermore, factors contributing to male obesity such as eating large portions and consuming large volumes of alcohol, can be viewed as quintessentially masculine behaviours.
To promote weight loss and reduce obesity among men, it is useful to understand which social interactions influence male weight loss behaviours. It is known that men in heterosexual relationships often gain weight after getting married, however the extent of women’s influence on men’s food intake and weight is unclear. Research studies investigating the influence that women and female partners have on male dietary and weight loss have been mixed; while some suggests they have a positive impact, other research suggests the impact is mixed or negative. Friends, peers and colleagues are also referenced regarding men’s diet and physical activity behaviours and behavioural intentions. The qualitative literature in the UK which explores how social relationships influence men’s weight and weight-related behaviours is, however, limited, therefore this research study sought to address this literature gap. The primary research question was to explore men’s perceptions and attitudes of dietary and physical activity behaviours in relation to weight and weight management.
Website
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Varley M, Hunter L, 'How does pelvic girdle pain impact on a woman's experience of her pregnancy and the puerperium?'
Evidence Based Midwifery 17 (2) (2019) pp.60-70
ISSN: 1479-4489
Abstract Background. Pelvic girdle pain is a prevalent condition during pregnancy. The associated pain can be constant and extremely distressing for women; however, the pathogenesis is still unclear. It is important to gain insight into women’s experiences of pelvic girdle pain in order to improve these with a view to impacting positively on their physical symptoms, while also improving overall wellbeing and mental health throughout pregnancy and the puerperium. Aims and Objectives. To use published literature to gain an insight into how pelvic girdle pain can impact on a woman’s experience of pregnancy and the puerperium, to provide meaningful, evidence-based, recommendations for midwifery practice. Method. A systematic literature review of qualitative research was undertaken. Database searches using Cumulative Index to Nursing and Allied Health, British Nursing Index, PsycINFO, and PubMed identified seven studies published between 2005 and 2014 in Sweden and England. Each paper was quality appraised in order to inform assessment of the credibility of findings. Following Noblit and Hare’s (1988) seven-step process for metaethnography, findings from each paper were synthesised into key themes which were then developed into a new conceptual model. Results. A conceptual model, consisting of five key themes, was identified. The central theme is ‘loss of identity and control’, the themes leading on from this are: ‘adapting to pain’, ‘inadequacy and independence’, ‘expectations and perceptions of others’, and ‘psychological strain’. The model highlights the link between mental wellbeing and perceived intensity of pain. Conclusions. Pelvic girdle pain has a debilitating impact on the lives of pregnant women and further research is necessary to identify effective treatment methods.
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Burns E, Hunter L, Rodd Z, MacLeod M, Smith L, 'Developing and evaluating an online learning tool to improve midwives' accuracy of visual estimation of blood loss during waterbirth: an experimental study'
Midwifery 68 (2018) pp.65-73
ISSN: 0266-6138 eISSN: 1532-3099
Abstract Objective. The principal objective was to test the effectiveness of an online learning tool to improve midwives’ accuracy of blood loss estimations in a birthing pool environment. The secondary objective was to assess the acceptability of the online learning tool to the midwives using it. Design. A one group pre-test post-test experiment with immediate and six weeks follow-up to test ability together with an online questionnaire to assess perceived usefulness of an online learning tool. Setting. A large NHS maternity hospital comprising an acute care obstetric unit, a small district unit labour ward, one alongside midwifery-led unit and three freestanding midwifery-led units. Participants. Volunteer NHS employed midwives who had experience in caring for women labouring and giving birth in water (n=24). Intervention. An online learning tool comprising six randomly ordered short video simulations of blood loss in a birthing pool in real time, and a tutorial giving verbal and pictorial guidance on making accurate blood loss estimations in water was developed then piloted. Midwives’ accuracy scores for estimating blood loss in each of the videos were calculated at three timepoints; pre and immediately post the learning component, and six weeks later. The estimated blood loss volume was subtracted from the actual blood loss volume, to give the difference between estimated and real blood loss in millilitres(ml) which was then converted to percentage difference to standardise comparison across the six volumes. The differences between pre- and post-learning for each of the six blood volumes was analysed using a repeated measures ANOVA. Statistical significance was set at p<0.05. An online questionnaire incorporated questions using Likert scales to gauge confidence and competence and free text. Free text responses were analysed using a modified form of inductive content analysis. Findings. 22 midwives completed the online learning and immediate post-test, 14 completed a post-test after six weeks, and 15 responded to the online questionnaire. Pre-test results showed under-estimation of all blood loss volumes and particularly for the two largest volumes (1,000 and 1,100 ml). Across all volumes, accuracy of estimation was significantly improved at posttest 1. Accuracy diminished slightly, but overall improvement remained, at post-test 2. Participants rated the online tool positively and made suggestions for refining it. Key conclusions and implications for practice. This is the first study measuring the accuracy of midwives’ blood loss estimations in a birthing pool using real-time simulations and testing the effectiveness of an online learning tool to improve this important skill. Our findings indicate a need to develop interventions to improve midwives’ accuracy at visually estimating blood loss in water, and the potential of an online approach. Most women who labour and/or give birth in water do so in midwifery-led settings without immediate access to medical support. Accuracy in blood loss estimations is an essential core skill.
Website
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Hunter L, Da Motta G, McCourt C, Wiseman O, Haora P, Rayment J, Wiggins M, Harden A, 'Better together: a qualitative exploration of women’s perceptions and experiences of group antenatal care using focus groups and interviews'
Women and Birth 32 (4) (2018) pp.336-345
ISSN: 1871-5192 eISSN: 1878-1799
Abstract Problem. Childbearing women from socio-economically disadvantaged communities and minority ethnic groups are less likely to access antenatal care and experience more adverse pregnancy outcomes. Background. Group antenatal care aims to facilitate information sharing and social support. It is associated with higher rates of attendance and improved health outcomes. Aims. To assess the acceptability of a bespoke model of group antenatal care (Pregnancy Circles) in an inner city community in England, understand how the model affects women’s experiences of pregnancy and antenatal care, and inform further development and testing of the model. Methods. A two-stage qualitative study comprising focus groups with twenty six local women, followed by the implementation of four Pregnancy Circles attended by twenty four women, which were evaluated using observations, focus groups and semi-structured interviews with participants. Data were analysed thematically. Findings. Pregnancy Circles offered an appealing alternative to standard antenatal care and functioned as an instrument of empowerment, mediated through increased learning and knowledge sharing, active participation in care and peer and professional relationship building. Multiparous women and women from diverse cultures sharing their experiences during Circle sessions was particularly valued. Participants had mixed views about including partners in the sessions. Conclusions. Group antenatal care, in the form of Pregnancy Circles, is acceptable to women and appears to enhance their experiences of pregnancy. Further work needs to be done both to test the findings in larger, quantitative studies and to find a model of care that is acceptable to women and their partners.
Website
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Hunter L, Da Motta G, McCourt C, Wiseman O, Rayment J, Haora P, Wiggins M, Harden A, '"It makes sense and it works": maternity care providers' perspectives on the feasibility of a group antenatal care model (Pregnancy Circles)'
Midwifery 66 (2018) pp.56-63
ISSN: 0266-6138 eISSN: 1532-3099
Abstract Aim. To test the feasibility of introducing a group antenatal care initiative (Pregnancy Circles) in an area with high levels of social deprivation and cultural diversity by exploring the views and experiences of midwives and other maternity care providers in the locality before and after the implementation of a test run of the group model. Design. (i) Pre-implementation semi-structured interviews with local stakeholders. (ii) Post-implementation informal and semi-structured interviews and a reflective workshop with facilitating midwives, and semi-structured interviews with maternity managers and commissioners. Data were organised around three core themes of organisational readiness, the acceptability of the model and its impact on midwifery practice, and analyzed thematically. Setting. A large inner-city National Health Service Trust in the United Kingdom. Participants. Sixteen stakeholders were interviewed prior to, and ten after, the group model was implemented. Feedback was also obtained from a further nine midwives and one student midwife who facilitated the Pregnancy Circles. Intervention. Four Pregnancy Circles in community settings. Women with pregnancies of similar gestation were brought together for antenatal care incorporating information sharing and peer support. Women undertook their own blood pressure and urine checks, and had brief individual midwifery checks in the group space. Findings. Dissatisfaction with current practice fuelled organisational readiness and the intervention was both possible and acceptable in the host setting. A perceived lack of privacy in a group setting, the ramifications of devolving blood pressure and urine checks to women, and the involvement of partners in sessions were identified as sticking points. Facilitating midwives need to be adequately supported and trained in group facilitation. Midwives derived accomplishment and job satisfaction from working in this way, and considered that it empowered women and enhanced care. Key conclusions. Participants reported widespread dissatisfaction with current care provision. Pregnancy Circles were experienced as a safe environment in which to provide care, and one that enabled midwives to build meaningful relationships with women. Implications for practice. Pre-registration education inadequately prepared midwives for group care. Addressing sticking points and securing management support for Pregnancy Circles is vital to sustain participation in this model of care.Website
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Hunter L, Snow S, Warriner S, 'Being there and reconnecting: midwives’ perceptions of the impact of mindfulness training on their practice'
Journal of Clinical Nursing 27 (5/6) (2018) pp.1227-1238
ISSN: 0962-1067 eISSN: 1365-2702
Abstract Objective: To ascertain how midwives perceived attending a mindfulness course impacted on their professional practice, particularly in regard to any stress they experienced at work.
Design: A qualitative study using Interpretive Phenomenological Analysis. Semi-structured interviews were conducted with nine midwives.
Setting: A large maternity Trust in the United Kingdom.
Intervention: An eight-week Mindfulness course, adapted from Mindfulness-based Cognitive Therapy.
Findings: Four superordinate themes were identified: ‘being challenged and committing’, ‘containing the self’, ‘reconnecting’, and ‘moving forward with confidence’. Focusing on the present moment enabled participants better to identify the boundary between self and other. This led to an increased sense of control and a reconnection with and reframing of relationships with colleagues and the women in their care.
Key conclusions: Mindfulness may provide an effective way to address the high levels of stress, role dissatisfaction and workplace bullying found in Midwifery, by improving both the working environment and patient care. The pivotal role of positive workplace relationships in this process resonates with other nursing research and with contemporary philosophical thought.
Relevance to clinical practice: This study adds to a body of evidence which suggests investing in the wellbeing of midwifery staff improves both job satisfaction and women’s experiences of care. Website
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Wiseman O, Hunter L, Leap N, Robinson H, Mackeith N, 'Facilitating group antenatal care: a new way of working'
The Practising Midwife 20 (9) (2017)
ISSN: 1461-3123
Abstract This article outlines the principles and evidence behind group antenatal care and explores how developing group facilitation skills can enhance midwifery practice. The authors discuss the impact of different training models developed by the REACH Pregnancy Programme to support the implementation of ‘Pregnancy Circles’ as part of a randomised controlled trial of group antenatal care within an NHS context. Website
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Hunter L, 'Mindfulness training can reduce depression and anxiety among nurses'
Evidence-Based Nursing (2017)
ISSN: 1367-6539
Abstract Commentary on "Guillaumie L, Boiral O, Champagne J. A mixed-methods systematic review of the effects of mindfulness on nurses. J Adv Nurs. 2016 Oct 5. doi: 10.1111/jan.13176Website
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Einion A, Hunter L, 'Conference Review of: Research Seminar: Childbearing in Europe – the qualitative research network research – BfiN and Network for Women’s Health in Childbearing, with the focus on migrants and minorities – WoMBH-net Helsinki, 14-15 September 2017'
Practising Midwife (2017)
ISSN: 1461-3123
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Warriner S, Hunter L, Dymond, M, 'Mindfulness in maternity: evaluation of a course for midwives'
British Journal of Midwifery 24 (3) (2016)
ISSN: 0969-4900
Abstract
Stress and burnout are endemic within the NHS and midwifery profession and have a negative impact on the health and well-being of individual midwives and on retention and recruitment for the profession as a whole. Furthermore, stress can have a negative impact on the care of childbearing women as midwives seek to manage their stress levels by employing strategies such as task orientation. As part of a larger project to engage staff in personal and workplace wellbeing, The Oxford University Hospitals NHS Foundation Trust (OUHFT) maternity services provided staff with the opportunity to learn the practice of mindfulness meditation. An eight week course was made available with the intention of supporting staff to manage stress and anxiety, increase resilience and self-compassion and improve the culture of the organisation as a whole. Evaluations carried out immediately post course and after 4-6 weeks indicated a positive impact in both personal and organisational domains.
Website
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Hunter LJ, 'Making time and space: the impact of mindfulness training on nursing and midwifery practice. A Critical Interpretative Synthesis'
Journal of Clinical Nursing 25 (7-8) (2016) pp.918-929
ISSN: 0962-1067
Abstract
Aims and Objectives: to explore qualitative literature to ascertain whether and how nurses and midwives perceive that mindfulness impacts on their practice, particularly their interactions with patients.
Background: Stress and burnout, which negatively impact patient care, are widely reported among nurses and midwives, who face unique stressors as professionals who often hold little organisational power but are expected to shoulder the burden of resource cuts and an increasingly complex workload. Mindfulness is increasingly used as a tool to decrease stress and burnout in health professionals, and may also increase practitioner compassion and improve patient interactions.
Design: a critical interpretative synthesis.
Methods: a systematic search was undertaken to identify qualitative studies where the majority of participants were qualified nurses and/or midwives who had attended mindfulness training. Retrieved literature was read and re-read to identify relevant material, which was then coded into themes. Related themes were grouped into synthetic constructs, and a synthetic argument was produced to illustrate the relationships between these.
Results: five relevant papers were identified. Findings indicate that mindfulness training enables nurses and midwives to gain some control over their thoughts and stress levels. This then creates a quiet mental space giving them agency and perspective and leading to improved caring, including a more patient-centred focus and increased presence and listening. Mindfulness appears to alter the way nurses and midwives operate within a stressful work environment, thereby changing the way the environment is experienced by themselves and, potentially, the people in their care.
Conclusions: Further research is needed, but current qualitative research suggests mindfulness may enable nurses and midwives to work with compassion in stressful and demanding work environments.
Relevance to clinical practice: Mindfulness may offer an enabling way of coping with stress, in contrast to longstanding strategies such as task-orientation and depersonalisation.
Website
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Hunter L, Magill-Cuerden J, McCourt C, '"Oh no, no, no, we haven’t got time to be doing that": Challenges encountered introducing a breastfeeding support intervention on a postnatal ward'
Midwifery 31 (8) (2015) pp.798-804
ISSN: 0266-6138 eISSN: 1532-3099
Abstract
Objective: To identify elements in the environment of a postnatal ward which impacted on the introduction of a breastfeeding support intervention.
Design: A concurrent, realist evaluation including practice observations and semi-structured interviews.
Setting: A typical British maternity ward.
Participants: Five midwives and two maternity support workers were observed. Seven midwives and three maternity support workers were interviewed. Informed consent was obtained from all participants. Ethical approval was granted by the relevant authorities.
Findings: A high level of non-compliance with the intervention was driven by a lack of time and staff, and the ward staffs’ lack of control of the organisation of their time and space. This was compounded by a propensity towards task orientation, workload reduction and resistance to change – all of which supported the existing medical approach to care. Limited support for the intervention was underpinned by staff willingness to reconsider their views and a widespread frustration with current ways of working.
Key conclusions: This small, local study suggests that the environment and working conditions on a typical British postnatal ward present significant barriers to the introduction of breastfeeding support interventions requiring a relational approach to care.
Implications for practice: Midwives and maternity support workers need to be able to control their time and space, and feel able to provide the relational care they perceive that women need, before breastfeeding support interventions can be successfully implemented in practice. Frustration with current ways of working, and a willingness to consider other approaches, could be harnessed to initiate change that would benefit health professionals and the women and families in their care. However, without appropriate leadership or facilitation for change, this could alternatively encourage learned helplessness and passive resistance.
Website
Book chapters
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Hunter L, 'Teenage motherhood' in Squire C (ed.), The Social Context of Birth, CRC Press (2017)
ISBN: 978-1-78523-125-4 eISBN: 978-1-315-37807-7
Abstract Chapter 16Website
Selected Publications
Chapters in books
Hunter, L. (2015). Spirituality in Midwifery Care. Chapter 6 in Lindsay, P. and Peate, I. (Eds), “Introducing the Social Sciences for Midwifery Practice: Birthing in A Contemporary Society” Routledge, Abingdon p87-102.
Peer Reviewed Papers
Hunter, L. (2015) Making time and space: the impact of mindfulness training on nursing and midwifery practice. A Critical Interpretative Synthesis. Journal of Clinical Nursing, in press.
Hunter, L. Magill-Cuerden, J. and McCourt, C (2015). ‘Oh no, no, no, we haven’t got time to be doing that’. Challenges encountered introducing a breastfeeding support intervention on a postnatal ward. Midwifery 31:8, 798-804.
Hunter, L. Magill-Cuerden, J. and McCourt, C. (2015). Disempowered, passive and isolated: how teenage mothers' postnatal inpatient experiences in the UK impact on the initiation and continuation of breastfeeding. Journal of Maternal and Child Nutrition 11:1, 47-58.
Hunter, L. and Magill-Cuerden, J. (2014). Young mothers' decisions to initiate and continue breastfeeding in the UK: tensions inherent in the paradox between being, but not being able to be seen to be, a good mother. Evidence Based Midwifery 12:2, 46-51.
Hunter, L. Magill-Cuerden, J. and McCourt, C. (2013). Addressing the institutional barriers to teenage mothers initiating breastfeeding on the postnatal ward (conference abstract). Maternal and Child Nutrition Supplement 3, 14-15.
Hunter, L. (2012). Challenging the reported disadvantages of e-questionnaires and addressing methodological issues of online data collection. Nurse Researcher 20:1, 11-20.
Other Papers
Hunter, L. (2015). Being with woman: claiming midwifery space. The Practising Midwife 18:3, 20-22.
Swift, J. and Hunter, L. (2014). Exploring abuse. Midwives 3, 42-3.
Hunter, L. (2013). Discourses of teenage motherhood: finding a framework that enables the provision of appropriate support. Part 1: Risk discourses and the shortcomings of the Teenage Pregnancy Strategy. Essentially MIDIRS 4:3, 32-7.
Hunter, L. (2013). Discourses of teenage motherhood: finding a framework that enables the provision of appropriate support. Part 2: situational and developmental perspectives. Essentially MIDIRS 4:4, 32-7.
Conference Presentations
Hunter, L. (2014). Compassionate Care: an oxymoron on the postnatal ward? University of Worcester Normal Birth Conference, Worcester.
Hunter, L. (2013). Addressing the institutional barriers to teenage mothers initiating breastfeeding on the postnatal ward. Maternal Infant Nutrition and Nurture conference, University of Central Lancashire
Hunter, L. (2012). Teenage mothers' early postnatal experiences establishing breastfeeding: identifying barriers to develop tools to improve in-hospital support. Royal College of Midwives' Annual Conference, Brighton.
Publications from RADAR
- Hunter, L (2016) Making time and space: the impact of mindfulness training on nursing and midwifery practice. A Critical Interpretative Synthesis. Journal of Clinical Nursing, 25 (7). pp. 918-929. [summary page]
- Warriner, S, Hunter, L, Dymond, M (2016) Mindfulness in maternity: evaluation of a course for midwives. British Journal of Midwifery, 24 (3). [summary page]
- Hunter, L (0) Mindfulness training can reduce depression and anxiety among nurses. Evidence-Based Nursing [summary page]