AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
TRANSCULTURAL APPROACHES MIDWIFERY CARE
TO
J a n Pincombe, RAT, RM, RIN, BA, Post Grad Dip Ed, M.App. SC Ph.D. This p a p e r is an exploratory investigation into Leininger's transcultural theory a n d its applicability to three groups of p r e g n a n t women. A small sample comprising of I9 Islamic Lebanese-born women, 18 Islamic Turkish-born w o m e n a n d 2 0 Australian-born w o m e n were included in the study. The Prenatal Needs I n s t r u m e n t (PNI) revealed a rich source of needs a n d beliefs o f the w o m e n in this stud), during theirprenatal period. Both qualitative a n d quantitative methods were included in the P N I a n d interpreters were used to interview the women. There w a s some limited support f o r the efficacy o f Leininger's theory, although due to the small sample size, caution should be exercised with generalising to other populations. Introduction Many of the consumers of Australian midwifery services c o m e from different cultural backgrounds. An understanding of transcultural concepts will e m p o w e r midwives to provide care that is culturally appropriate. Herberg's definition of transcultural nursing states it is about "the provision of nursing care in a m a n n e r that is sensitive to the needs of individuals, families and groups w h o represent diverse cultural populations within a society ''1 Herberg suggests a way of overcoming cultural barriers is to apply transcultural principles which she believes can lead to m o r e sensitive and effective communications. Nurses are asked to carry out a thorough assessment of the cultural aspects of a clients lifestyle, health beliefs and health practice and in carrying out this approach, stress and conflict will be reduced - b o t h for the client and midwife. Leininger 2 is a central nursing transcultural theorist and her caring constructs have b e e n applied to explore her theory in a study about Islamic w o m e n and Australian-born w o m e n and their ideas about prenatal and birthing experiences. She developed an integrated approach adopted by anthropologists w h o believe that health and illness are strongly affected by the cultural background of the individual. Leininger used concepts from other disciplines and c o m b i n e d them with nursing ideas (caring, JUNE 1992
nursing process and interpersonal communications) in her theory. Transcultural nursing concepts, according to Leininger, consist of cultural beliefs and values, health and illness systems, nurse-client interactions and culture-specific nursing care. The Transcultural nursing framework Leininger defines transcultural nursing as "comparative study and analysis of different cultures and subcultures in the world with respect to their caring behaviour, nursing care and health-illness values and patterns o f behaviour with the goal of developing a scientific and humanistic b o d y of knowledge in order to provide culture-specific and culture universal nursing care practices". 3 The term culture has as its central premise that family is the central e x p e r i e n c e base. Ethnocaring constructs are central to Leiningers' theory and consists of three phases. These phases are n o w considered. 4 P h a s e I: This phase consists of the major sources which derive ethnonursing constructs. These four subsystems inter-relate with each other and feed into Phase II. These four sub-systems are: A. "The general ethnography of the lifeways of a designated culture or subculture. B. Major social structure features. C. Cultural values D. Health/illness caring system (including beliefs, values, n o r m s and role caring practices)".5 Phase II: The second phase includes the major classifications of ethnonursing care constructs and consists of 19 major taxonomic caring constructs (see Figure 1). Phase III: This phase consists of five constructs taken from Leininger, which include: A. Analysis of major ethnonursing care constructs B. Theoretical formulations C. Research-testing of the theory D. Analysis of ethnocaring research data
ACMIJOURNAL
PAGE 11
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
Phase I. Major Sources to Derive Ethnonursing A. General ethnography of the lifeways of a designated culture or subculture
lB. Major social structure features
I C. Cultural values
I
D. Health-illnesscaring system ] (including beliefs, values, norms, and role caring practices)
Phase II. Classification of Ethnonursing Care Constructs Major taxonomic caring constructs and segregates (subsets not listed) 1. Comfort measures 2. Support measures 3, Compassion 4. Empathy 5. Helping behaviours 6. Cooling behaviours 7. Stress alleviation measures 8. Touching (hand-body contacts) 9. Nurturance 10, Succorance 11. Surveillance 12. Protective behaviours 13. Restorative behaviours 14. Stimulative behaviours 15. Health maintenance acts 16, Health instruction 17. Health consultation 18. Special ethnocare techniques 19. Other constructs
FIGURE 1
I A' Analysis I constructs c ~ maj~ a ethn~ r e
l B. Theoretical formulations
]
I C. Research-testingof the theory
1
I D. Analysis of ethnocaring research data
I E. Determining nursing interventions based upon research findings
Feedback process to recheck findings for reliability and validity.
E. Determining nursing interventions based u p o n research findings. 6 These constructs feedback into Phase I to "recheck" findings for reliability and validity. Bruni provides a critical analysis of Leininger's transcultural theory, and examines the nature of the underlying theoretical framework of transcultural theory.7 Bruni suggests that the structural variables class and gender are omitted from Leininger's analysis, while the focus of culture constitutes the "formative force in determining patterns of behaviour ( c o m p o u n d e d perhaps by ethnicityrelated problems)."* Bruni argues that Leininger's culturalist explanation is superficial and suggests that an examination of the Australian Aboriginal people supports this notion. She cites Nathan's research as providing an ideal m o d e l for a health care delivery system for Aboriginal people.9 In c o m p a r i s o n to the limiting culturalist theory put forth by Leininger, this model, based on self-determination has b e e n found to be the m o r e successful for planning service provision,m
PAGE 12
Phase III. Analysis and Testing of Constructs and Use of Findings
Kanitsaki, however encourages m e m b e r s of the nursing profession to support the d e v e l o p m e n t of transcultural nursing. II She does not address Leininger's trancultural theory but puts forward what she sees as a conflict b e t w e e n the patients' world views and the traditionalist approach carried out by health professionals caring for this client. Kanitsaki defines the client in her example as having a non-English speaking background, w h o views her treatment in terms of maintaining a n o n traditional approach to her nursing care and treatment. The health professionals caring for this client provided nursing diagnosis in m o r e "concrete, objective and e x p l a i n a b l e by scientific a n a l y s i s " t e r m s I2 completely negating the clients' needs for a "multicultural, holistic and humanistic approach" to nursing care.13In pursuing this particular theoretical framework, Kanitsaki argued health professionals were denying this client individualised mad holistic nursing care and were responsible for inflicting their o w n world views on their clients. Although Leininger has based her studies o n 30 different cultures including the Gadsup people
ACMIJOURNAL
JUNE 1992
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
living in the Eastern Highlands of New Guinea, her constructs have not been tested with Australian born, Lebanese-born, or Turkish-born w o m e n resident in Australia. I4 The study by Facci, Seniuk and Vella found that 39.5% of migrant w o m e n from the ten language groups they studied had some knowledge about prenatal and postnatal services provided by the Illawarra Area Health Service.15 These groups included Turkish and Arabic speaking w o m e n from rural backgrounds (87. 5 % and 47. 5 % respectively). However, the study did not differentiate between prenatal and postnatal services. The study highlighted that only 15.2 % of these w o m e n had sought advice from these services, with most w o m e n consulting their general practitioner. The researchers concluded that inaccessibility and the inappropriateness of these services provided by the Illawarra Area Health Service deterred migrant w o m e n from seeking assistance.
The Prenatal Needs Instrument (PNI) was administered to 57 pregnant w o m e n in o n e public hospital prenatal clinic. The instrument was filled out by the w o m e n with assistance from the interpreter and research assistant. The PNI contained b o t h qualitative and quantitative methodologies. The researcher believed it was important to include qualitative methods to ensure u n k n o w n aspects of the w o m e n s ' cultures would be elicited. W o m e n were contacted during their 28th to 30th gestational week of pregnancy, firstly to request consent, and secondly to explain their questionnaire if consent was given. The PNI consisted of a section designed by elicit demographic information and questions that investigated prenatal, birthing and postnatal aspects o f pregnancy. Because many o f the w o m e n from Turkey and Lebanon were neither literate in their o w n language nor familiar with English, the interpreter recorded the responses for the woman.
Characteristics o f the Sample P o p u l a t i o n Haertsch suggested that prenatal educational for Islamic w o m e n was traditionally provided by their mothers and/or other female members of their family during the pregnancy.'6 For Muslim w o m e n in Australia this is not always possible as geographic separation may exclude this. Because most prenatal classes in Australia are conducted in English, many Muslim w o m e n are excluded. These women, particularly those with small children, are relatively isolated in their h o m e s and do not have opportunities to learn English: Also, the attendance of m e n at prenatal classes in Australia is the normal sequence of events, and for Muslim w o m e n this is not acceptable particularly if the viewing o f a birthing film is part of the education session.
Of the 57 w o m e n in the sample population there was a wider distribution in age range for the Lebanese-born and for the Turkish-born w o m e n compared to that of the Australian-born w o m e n . The largest proportion o f Australian-born w o m e n were from the 21 to 25 age range (40%) and the 26 to 30 year age range (45%). The age ranges of the Lebanese w o m e n showed 22 % were in the 21-25 year group, 26% were in the 26-30 and the 31-35 year groups, 16% in 36-40 year groups, and 5% over 40. The Turkish w o m e n showed a similar distribution in age range with 28% in the 21-25 and the 26-30 year group, 22 % in the 31-35 year group, and 11% in the 36 to 40 and the over 40 year groups.
In this research some aspects of Leininger's transcultural theoretical constructs will be tested for their legitimacy in the Australian context.
Conclusion
Limitations o f the study As the sample size was small, statistical analysis was n o t applied to t h o s e questions, as critical assumptions of chi-square could not be met and simple percentages were used. However the sample was representative of the Lebanese-born and Turkish-born w o m e n attending the pre-natal clinic.
JUNE 1992
It can be argued that there are differences between Islamic groups of w o m e n from their c o u n t r y of origin, that is Lebanese-born and Turkish-born as well as the Australian-born w o m e n for some of the variables investigated in this research. It is apparent there are different cultural customs and rites eviclenced between the three different groups. These is some support for the notion of Leiningers' cultural belief construct being generalisable to the Lebanese-born w o m e n and to a lesser extent the Turkish-born women.
ACMIJOURNAL
PAGE 13
AUSTRALIANCOLLEGEOF MIDWIVESINCORPORATED
This research demonstrates the importance of including opportunities for the use of qualitative methods to be used in gathering information. The later allows for the expression of culturally rich information that may be obscured by quantitative methods alone.
References 1 2 3 4
Boyle, J., a n d Andrews, M. (1989) Transcultural Concepts in Nursing Care. Boston, Scott, Foresman a n d C o m p a n y ; 3. Leininger, M. (1978) Transcultural Nursing: Theories a n d Practices, U t a h , J o h n Wiley and Sons. Marriner, A. (1986) Nursing Theorists a n d Their Work. St Louis, T h e CV Mosby Company, 147. Leininger, M. (1978) Transcultural Nursing: Concepts, Theories a n d Practices. Utah, J o h n Wiley a n d Sons.
5 6 7 8 9
Ibid., 39. Ibid. Bruni, N. (1988)A criticalanalysis of Transcultural theory. The Australian Journal of Advanced Nursing, 5 (3). Ibid. Nathan, E (1980) A Home A w a y f r o m Home. Bundoora,
Victoria, PIT Press. 10 Ibid. 11 Kanitsaki, O. (1988) Transcultural nursing: challenge to change. The australian Journal of ddvanced Nursing, 5 (3), 4-11. 12 Ibid. 13 Ibid. 14 Marriner, A. Op. Cit. 15 Facci, E, Seniuk, S. a n d Vella, A. (1985) Migrant w o m e n s ' health in the Illawarra: Service or Dis-service? Paper p r e s e n t e d a t the National Conference on Women's Health in a Changing Society, Adelaide, 5 September. 16 Haertsch, M. (1989) Towards an understanding of Muslim w o m e n a n d midwives a n d their relationship in childbirth in Australia. Midwifery Back to the Future, 6th Biennial Conference of the Australian College o f Midwives Incorporated, 21-23 June.
Are you interested informing RESEARCH NETWORK?
a
Dear Colleague Maggie Haertsch and I have met a couple of times discussing the "Research Network" proposed and tentatively begun in Perth 1991. We have written to everyone w h o expressed interest and circulated to members of this group the names, addresses and research interests of those in the "network". If you were not in Perth but are interested in establishing contact with midwives interested in research, please contact us and have your names added to the mailing list. We are exploring ways of getting together and organising our activities. This may involve a two day meeting in Melbourne o n November 27-28, 1992, to share research interests and ideas and learn from colleagues. At this meeting we will plan for regular meetings and/or conferences, agree of "terms of reference" and decide h o w we want the network to function. Yours sincerely Lesley M. Barclay Professor of Nursing in Family Health University of Technology, Sydney P.O. Box 123 BROADWAY NSW 2007
PAGE14
ACMIJOURNAL
JUNE 1992
TRANSCULTURAL APPROACHES MIDWIFERY CARE
TO
J a n Pincombe, RAT, RM, RIN, BA, Post Grad Dip Ed, M.App. SC Ph.D. This p a p e r is an exploratory investigation into Leininger's transcultural theory a n d its applicability to three groups of p r e g n a n t women. A small sample comprising of I9 Islamic Lebanese-born women, 18 Islamic Turkish-born w o m e n a n d 2 0 Australian-born w o m e n were included in the study. The Prenatal Needs I n s t r u m e n t (PNI) revealed a rich source of needs a n d beliefs o f the w o m e n in this stud), during theirprenatal period. Both qualitative a n d quantitative methods were included in the P N I a n d interpreters were used to interview the women. There w a s some limited support f o r the efficacy o f Leininger's theory, although due to the small sample size, caution should be exercised with generalising to other populations. Introduction Many of the consumers of Australian midwifery services c o m e from different cultural backgrounds. An understanding of transcultural concepts will e m p o w e r midwives to provide care that is culturally appropriate. Herberg's definition of transcultural nursing states it is about "the provision of nursing care in a m a n n e r that is sensitive to the needs of individuals, families and groups w h o represent diverse cultural populations within a society ''1 Herberg suggests a way of overcoming cultural barriers is to apply transcultural principles which she believes can lead to m o r e sensitive and effective communications. Nurses are asked to carry out a thorough assessment of the cultural aspects of a clients lifestyle, health beliefs and health practice and in carrying out this approach, stress and conflict will be reduced - b o t h for the client and midwife. Leininger 2 is a central nursing transcultural theorist and her caring constructs have b e e n applied to explore her theory in a study about Islamic w o m e n and Australian-born w o m e n and their ideas about prenatal and birthing experiences. She developed an integrated approach adopted by anthropologists w h o believe that health and illness are strongly affected by the cultural background of the individual. Leininger used concepts from other disciplines and c o m b i n e d them with nursing ideas (caring, JUNE 1992
nursing process and interpersonal communications) in her theory. Transcultural nursing concepts, according to Leininger, consist of cultural beliefs and values, health and illness systems, nurse-client interactions and culture-specific nursing care. The Transcultural nursing framework Leininger defines transcultural nursing as "comparative study and analysis of different cultures and subcultures in the world with respect to their caring behaviour, nursing care and health-illness values and patterns o f behaviour with the goal of developing a scientific and humanistic b o d y of knowledge in order to provide culture-specific and culture universal nursing care practices". 3 The term culture has as its central premise that family is the central e x p e r i e n c e base. Ethnocaring constructs are central to Leiningers' theory and consists of three phases. These phases are n o w considered. 4 P h a s e I: This phase consists of the major sources which derive ethnonursing constructs. These four subsystems inter-relate with each other and feed into Phase II. These four sub-systems are: A. "The general ethnography of the lifeways of a designated culture or subculture. B. Major social structure features. C. Cultural values D. Health/illness caring system (including beliefs, values, n o r m s and role caring practices)".5 Phase II: The second phase includes the major classifications of ethnonursing care constructs and consists of 19 major taxonomic caring constructs (see Figure 1). Phase III: This phase consists of five constructs taken from Leininger, which include: A. Analysis of major ethnonursing care constructs B. Theoretical formulations C. Research-testing of the theory D. Analysis of ethnocaring research data
ACMIJOURNAL
PAGE 11
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
Phase I. Major Sources to Derive Ethnonursing A. General ethnography of the lifeways of a designated culture or subculture
lB. Major social structure features
I C. Cultural values
I
D. Health-illnesscaring system ] (including beliefs, values, norms, and role caring practices)
Phase II. Classification of Ethnonursing Care Constructs Major taxonomic caring constructs and segregates (subsets not listed) 1. Comfort measures 2. Support measures 3, Compassion 4. Empathy 5. Helping behaviours 6. Cooling behaviours 7. Stress alleviation measures 8. Touching (hand-body contacts) 9. Nurturance 10, Succorance 11. Surveillance 12. Protective behaviours 13. Restorative behaviours 14. Stimulative behaviours 15. Health maintenance acts 16, Health instruction 17. Health consultation 18. Special ethnocare techniques 19. Other constructs
FIGURE 1
I A' Analysis I constructs c ~ maj~ a ethn~ r e
l B. Theoretical formulations
]
I C. Research-testingof the theory
1
I D. Analysis of ethnocaring research data
I E. Determining nursing interventions based upon research findings
Feedback process to recheck findings for reliability and validity.
E. Determining nursing interventions based u p o n research findings. 6 These constructs feedback into Phase I to "recheck" findings for reliability and validity. Bruni provides a critical analysis of Leininger's transcultural theory, and examines the nature of the underlying theoretical framework of transcultural theory.7 Bruni suggests that the structural variables class and gender are omitted from Leininger's analysis, while the focus of culture constitutes the "formative force in determining patterns of behaviour ( c o m p o u n d e d perhaps by ethnicityrelated problems)."* Bruni argues that Leininger's culturalist explanation is superficial and suggests that an examination of the Australian Aboriginal people supports this notion. She cites Nathan's research as providing an ideal m o d e l for a health care delivery system for Aboriginal people.9 In c o m p a r i s o n to the limiting culturalist theory put forth by Leininger, this model, based on self-determination has b e e n found to be the m o r e successful for planning service provision,m
PAGE 12
Phase III. Analysis and Testing of Constructs and Use of Findings
Kanitsaki, however encourages m e m b e r s of the nursing profession to support the d e v e l o p m e n t of transcultural nursing. II She does not address Leininger's trancultural theory but puts forward what she sees as a conflict b e t w e e n the patients' world views and the traditionalist approach carried out by health professionals caring for this client. Kanitsaki defines the client in her example as having a non-English speaking background, w h o views her treatment in terms of maintaining a n o n traditional approach to her nursing care and treatment. The health professionals caring for this client provided nursing diagnosis in m o r e "concrete, objective and e x p l a i n a b l e by scientific a n a l y s i s " t e r m s I2 completely negating the clients' needs for a "multicultural, holistic and humanistic approach" to nursing care.13In pursuing this particular theoretical framework, Kanitsaki argued health professionals were denying this client individualised mad holistic nursing care and were responsible for inflicting their o w n world views on their clients. Although Leininger has based her studies o n 30 different cultures including the Gadsup people
ACMIJOURNAL
JUNE 1992
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
living in the Eastern Highlands of New Guinea, her constructs have not been tested with Australian born, Lebanese-born, or Turkish-born w o m e n resident in Australia. I4 The study by Facci, Seniuk and Vella found that 39.5% of migrant w o m e n from the ten language groups they studied had some knowledge about prenatal and postnatal services provided by the Illawarra Area Health Service.15 These groups included Turkish and Arabic speaking w o m e n from rural backgrounds (87. 5 % and 47. 5 % respectively). However, the study did not differentiate between prenatal and postnatal services. The study highlighted that only 15.2 % of these w o m e n had sought advice from these services, with most w o m e n consulting their general practitioner. The researchers concluded that inaccessibility and the inappropriateness of these services provided by the Illawarra Area Health Service deterred migrant w o m e n from seeking assistance.
The Prenatal Needs Instrument (PNI) was administered to 57 pregnant w o m e n in o n e public hospital prenatal clinic. The instrument was filled out by the w o m e n with assistance from the interpreter and research assistant. The PNI contained b o t h qualitative and quantitative methodologies. The researcher believed it was important to include qualitative methods to ensure u n k n o w n aspects of the w o m e n s ' cultures would be elicited. W o m e n were contacted during their 28th to 30th gestational week of pregnancy, firstly to request consent, and secondly to explain their questionnaire if consent was given. The PNI consisted of a section designed by elicit demographic information and questions that investigated prenatal, birthing and postnatal aspects o f pregnancy. Because many o f the w o m e n from Turkey and Lebanon were neither literate in their o w n language nor familiar with English, the interpreter recorded the responses for the woman.
Characteristics o f the Sample P o p u l a t i o n Haertsch suggested that prenatal educational for Islamic w o m e n was traditionally provided by their mothers and/or other female members of their family during the pregnancy.'6 For Muslim w o m e n in Australia this is not always possible as geographic separation may exclude this. Because most prenatal classes in Australia are conducted in English, many Muslim w o m e n are excluded. These women, particularly those with small children, are relatively isolated in their h o m e s and do not have opportunities to learn English: Also, the attendance of m e n at prenatal classes in Australia is the normal sequence of events, and for Muslim w o m e n this is not acceptable particularly if the viewing o f a birthing film is part of the education session.
Of the 57 w o m e n in the sample population there was a wider distribution in age range for the Lebanese-born and for the Turkish-born w o m e n compared to that of the Australian-born w o m e n . The largest proportion o f Australian-born w o m e n were from the 21 to 25 age range (40%) and the 26 to 30 year age range (45%). The age ranges of the Lebanese w o m e n showed 22 % were in the 21-25 year group, 26% were in the 26-30 and the 31-35 year groups, 16% in 36-40 year groups, and 5% over 40. The Turkish w o m e n showed a similar distribution in age range with 28% in the 21-25 and the 26-30 year group, 22 % in the 31-35 year group, and 11% in the 36 to 40 and the over 40 year groups.
In this research some aspects of Leininger's transcultural theoretical constructs will be tested for their legitimacy in the Australian context.
Conclusion
Limitations o f the study As the sample size was small, statistical analysis was n o t applied to t h o s e questions, as critical assumptions of chi-square could not be met and simple percentages were used. However the sample was representative of the Lebanese-born and Turkish-born w o m e n attending the pre-natal clinic.
JUNE 1992
It can be argued that there are differences between Islamic groups of w o m e n from their c o u n t r y of origin, that is Lebanese-born and Turkish-born as well as the Australian-born w o m e n for some of the variables investigated in this research. It is apparent there are different cultural customs and rites eviclenced between the three different groups. These is some support for the notion of Leiningers' cultural belief construct being generalisable to the Lebanese-born w o m e n and to a lesser extent the Turkish-born women.
ACMIJOURNAL
PAGE 13
AUSTRALIANCOLLEGEOF MIDWIVESINCORPORATED
This research demonstrates the importance of including opportunities for the use of qualitative methods to be used in gathering information. The later allows for the expression of culturally rich information that may be obscured by quantitative methods alone.
References 1 2 3 4
Boyle, J., a n d Andrews, M. (1989) Transcultural Concepts in Nursing Care. Boston, Scott, Foresman a n d C o m p a n y ; 3. Leininger, M. (1978) Transcultural Nursing: Theories a n d Practices, U t a h , J o h n Wiley and Sons. Marriner, A. (1986) Nursing Theorists a n d Their Work. St Louis, T h e CV Mosby Company, 147. Leininger, M. (1978) Transcultural Nursing: Concepts, Theories a n d Practices. Utah, J o h n Wiley a n d Sons.
5 6 7 8 9
Ibid., 39. Ibid. Bruni, N. (1988)A criticalanalysis of Transcultural theory. The Australian Journal of Advanced Nursing, 5 (3). Ibid. Nathan, E (1980) A Home A w a y f r o m Home. Bundoora,
Victoria, PIT Press. 10 Ibid. 11 Kanitsaki, O. (1988) Transcultural nursing: challenge to change. The australian Journal of ddvanced Nursing, 5 (3), 4-11. 12 Ibid. 13 Ibid. 14 Marriner, A. Op. Cit. 15 Facci, E, Seniuk, S. a n d Vella, A. (1985) Migrant w o m e n s ' health in the Illawarra: Service or Dis-service? Paper p r e s e n t e d a t the National Conference on Women's Health in a Changing Society, Adelaide, 5 September. 16 Haertsch, M. (1989) Towards an understanding of Muslim w o m e n a n d midwives a n d their relationship in childbirth in Australia. Midwifery Back to the Future, 6th Biennial Conference of the Australian College o f Midwives Incorporated, 21-23 June.
Are you interested informing RESEARCH NETWORK?
a
Dear Colleague Maggie Haertsch and I have met a couple of times discussing the "Research Network" proposed and tentatively begun in Perth 1991. We have written to everyone w h o expressed interest and circulated to members of this group the names, addresses and research interests of those in the "network". If you were not in Perth but are interested in establishing contact with midwives interested in research, please contact us and have your names added to the mailing list. We are exploring ways of getting together and organising our activities. This may involve a two day meeting in Melbourne o n November 27-28, 1992, to share research interests and ideas and learn from colleagues. At this meeting we will plan for regular meetings and/or conferences, agree of "terms of reference" and decide h o w we want the network to function. Yours sincerely Lesley M. Barclay Professor of Nursing in Family Health University of Technology, Sydney P.O. Box 123 BROADWAY NSW 2007
PAGE14
ACMIJOURNAL
JUNE 1992
