Kind, honest and open communication is at the heart of midwifery care and maternity practice, and is vital in providing safe, person-centred care. This new book explores communication in midwifery from a range of perspectives and across different settings. It considers the theoretical and practical dimensions of communication, including how and why we communicate and who we communicate with. It uses case studies and practical examples to put ideas into real-world context and to explore topic areas in ways which are thought-provoking, accessible and useful to practitioners. Above all, Communication in Midwifery supports midwives in developing their theoretical understanding around communication and building a practical toolkit of ideas and strategies for use in a range of settings and with diverse groups of people. It helps midwives and other caregivers in navigating the nuanced and complex situations they encounter every day where clear, honest and collaborative communication is vital. Covers communication in pregnancy, birth and the postnatal period; the use of written, verbal and non-verbal approaches; and complex scenarios where communication may be challenging, such as diverse groups, trauma and loss Explores new methods of communicating, including the use of the internet and social media, and their benefits and challenges Highlights the importance of communication between professions and ways this can be enhanced Covers contemporary issues of consent, risk and safety in maternity care Useful at all stages of a midwife's career from undergraduate to qualified midwife

The Objective Structured Clinical Examination (OSCE) was developed for all undergraduate nursing programmes, with the aim of emphasising the need for nursing students to be competent in clinical skills, to assess clinical reasoning skills and as a means of standardizing the assessment process. This practical, easy to read and interactive study guide helps nursing and midwifery students at all levels to maximise their chances of success with OSCEs. It features case studies, quick quizzes, recap and recall summaries and an OSCE preparation plan; all of which help to prepare the student for the examination. Hints and tips on what to expect during the examination and pointers on what the examiner will be looking for, together with a comprehensive chapter on personal learning will help to guide the student through the process and maximise their chances of success! "Very readable with useful tips and information for students" Cath Hill, Keele University "I found the book extremely relevant from the students' perspective, reader friendly and well structured. Quizzes and activities excellent." - Liz Day, Senior Lecturer, Nursing and Health Care Practice, University of Derby "A useful and easily digested text on this important assessment strategy", Ms. Karen Lumsden, Faculty of Nursing and Applied Clinical Studies, Canterbury Christchurch University "Useful for students as they prepare... Easy to read and understand." Kirsty Wedgbury, Faculty of Health and Community Care, Birmingham City University

Legal and ethical competence is a cornerstone of professional midwifery practice and an essential part of midwifery training. Law and Ethics for Midwifery is a unique and practical resource for student midwives. Written by an experienced midwifery lecturer, this text draws on a wide variety of real life case studies and focuses particularly on the core areas of accountability, autonomy and advocacy. Opening with two chapters providing overviews respectively of ethical theories and legislation, the book is then arranged thematically. These chapters have a common structure which includes case studies, relevant legislation, reflective activities and a summary, and they run across areas of concern from negligence through safeguarding to record-keeping. Grounded in midwifery practice, the text enables student midwives to consider and prepare for ethical and legal dilemmas they may face as midwives in clinical practice.

Care for Children Born Small for Gestational Age is a comprehensive handbook that serves to synthesize the extensive recent literature in the area to provide a practical resource aimed at a wide range of healthcare professionals, including obstetricians, midwives, neonatologists, and primary care physicians. This comprehensive handbook includes an in-depth survey of the prevention, diagnosis, treatment and long-term monitoring of children born small for gestational age, as well as related conditions such as intrauterine growth restriction, metabolic syndrome and type 2 diabetes. Additionally, the short and long-term psychiatric and social consequences of this condition are addressed.

How to be a Nurse or Midwife Leader is an indispensable guide for all nurses and midwives who wish to develop and improve their practice as leaders. Written in collaboration with the NHS Leadership Academy, this practical book draws on the real experience of over 10,000 nurses and midwives to bring leadership dilemmas to life in specific situations. Key learning features include: * How to develop your self-awareness * How to develop your personal impact and presence * How to survive and thrive * How to get your message across * How to get the best out of others * How to work with and lead other professionals and patients * How to have courageous conversations * How to balance conflicting demands and needs Containing exercises and reflective questions to help apply theory to leadership practice, How to be a Nurse or Midwife Leader is an ideal companion for all nurses and midwives, whether you are newly qualified, or stepping into a team leader role.

The second edition of this successful text is an essential and accessible guide to legal aspects of midwifery for all midwife supervisors, midwives, and midwifery students. Midwives will find this book provides them with the knowledge and understanding they require to make sense of the legal principles that affect their day-to-day work and allay their anxieties, encouraging them to extend and develop their practice safely and with confidence.
This new edition includes new and revised case studies throughout. It also contains new sections on NHS accountability, the Human Rights Act, the Data Protection Act, reproductive technologies and disciplinary pathways.
? Relates legal issues to everyday midwifery practice
? Written by an experienced midwife for midwives
? Accessible, relevant and up-to-date

Making good nutritional choices can mean women optimise the outcomes of their birthing experience and offer their babies the best possible start in life. To support this, all health professionals who work with women during pregnancy, birth and the postnatal period need to have an appropriate knowledge of nutrition, healthy eating and other food related issues. This evidence-based text provides an informative and accessible introduction to nutrition in pregnancy and childbirth. As well as allowing readers to recognise when nutritional deficiency may be creating challenges, it explores the psychosocial and cultural context of food and considers their relevance for women's eating behaviour. Finally, important emerging issues, such as eating during labour, food supplements and maternal obesity, are discussed. An important reference for health professionals working in midwifery or public health contexts especially, this book is also the ideal companion for a course on nutrition in pregnancy and childbirth.

This fully revised, new edition of Innovations in Hospice Architecture responds to the need for an up-to-date, theoretically based reference book summarizing key historical and recent developments with respect to this rapidly evolving building type. This Second Edition presents: an overview of the historical origins of the contemporary hospice the diverse variations on the basic premise of hospice care a review of the scant architectural literature published on this subject to date a broad series of case studies of exemplary hospices around the world planning and design concepts for palliative care environments. Case study projects are from Japan, Canada, Europe, Africa, Australia, Indonesia, China, the United States and South America. Thirty-six case studies are individually presented and comparatively analysed, and prognostications for the future of hospice architecture are examined. Each case includes floor plans, technical drawings and beautiful, full colour illustrations. Through an in-depth discussion of the inner profundities of hospice architecture, the book presents this type as a humane, genuine expression of the spiritual, physical and psychosocial dimensions of the contemporary death and dying movement. Written with a broad audience in mind, the book provides both technical and conceptual information, blending narrative, images and diagrammation so that the audience may understand and articulate the complexities of this specialized building type in professional practice contexts.

Most aged in India are experiencing a highly protracted death in hospitals, entangled in tubes and machines. Such 'medicalised death' entails huge psychological, social and financial costs for both patients and their caregivers. There are also many who are dying in abject neglect. However, Government response to end-of-life care has been almost negligible and there is an acute information deficit on dying matters. This book examines different settings where elderly die, including hospitals, family homes and palliative set-ups. The discourse is set in the backdrop of international attempts to restructure and reconfigure the health delivery system for ageing population. It makes critical commentaries on global developments, offers state-of-art reviews of recent advances, substantiates and corroborates facts by personal narratives and case histories. The book overcomes a segmental understanding of the field by weaving various sociological, medical, legal and cultural issues together. Finally, the authors critically examine biomedicine's potential to meet the complex needs of the dying elderly. In an attempt to bring cultural sensitivity in end-of-life care, they explore the lost Indic 'art of dying' which has the potential to de- medicalise death. Increasing public sensitivity to poor dying conditions of the elderly in India and facilitating changes to improve care systems, this book also demonstrates the limitations of the western specialization of death. It will be of interest to academics in the field of Medical Sociology/Anthropology, Medicine, Palliative care, Public Health and Social Work, Social Policy and Asian Studies.

In How to Run Reflective Practice Groups: A Guide for Healthcare Professionals, Arabella Kurtz explores the use of reflective practice in the modern healthcare context. Responding to the rapidly increasing demand for reflective practice groups in healthcare and drawing on her extensive experience as a facilitator and trainer, Kurtz presents a fully developed, eight-stage model: The Intersubjective Model of Reflective Practice Groups. The book offers a guide to the organisation, structure and delivery of group sessions, with useful suggestions for overcoming commonly-encountered problems and promoting empathic relationships with clients and colleagues. Clearly and accessibly written, using full situational examples for each stage of the presented model, How to Run Reflective Practice Groups offers a comprehensive guide to facilitating reflective practice in healthcare.

Now in its 3rd edition, Lecture Notes: Obstetrics and Gynaecology has been extensively revised and updated to provide a concise and practical introduction to obstetrics and gynaecology for medical students and junior doctors. Starting with a section on basic science, the text is divided into six sections that explain female health needs and their management from the early years to old age. The self-assessment section is now a separate chapter, and includes Extended Matching Questions (EMQs), scenarios for practical history taking for the Objective Structured Clinical Examination (OSCE) and Multiple Choice Questions (MCQs). Part 1 looks at female reproductive anatomy and physiology. Part 2 covers the puberty and menstrual problems of young women, sub-fertility, pregnancy prevention, and sexual problems. Part 3 examines the reproductive years including pregnancy and childbirth. Part 4 covers the mature woman including menstrual problems of the older woman and pelvic pain. Part 5 discusses the older woman including the menopause, incontinence and malignancy including breast cancer. Part 6 demonstrates the importance of public health statistics on the provision of services in obstetrics and gynaecology. Now in two-colour throughout, with a new colour plate section, Lecture Notes: Obstetrics and Gynaecology covers the core material needed for O&G courses, written specifically for medical students, nursing students, junior doctors on the Foundation Programme and the first two years of specialist training, midwives, and GPs.

This fully updated new edition of From Birth to Five Years: Practical Developmental Examination is a step-by-step 'how to' guide to the developmental examination of pre-school children. Based on up-to-date research into current child development philosophies and practices, this text supports the wider group of professionals who are required to assess children's developmental progress as part of their day-to-day working practices. It begins with a practical framework for developmental examination, then progresses through each of the key developmental domains, offering guidance on enquiry and observation, and on how to chart typical and atypical patterns, with red flags for recognising significant delay or disordered development. Advice is also given on how to make sense of the findings and how best to communicate this information to parents. To consolidate and expand on the practical and theoretical information across this book and its companion, Mary Sheridan's From Birth to Five Years, an updated companion website is available at www.routledge.com/cw/sharma, which includes the following additional learning material: An interactive timeline of the key developmental domains; Introductions to theory with links to further reading; Research summaries; Video clips demonstrating practical assessment skills; Downloadable resources including pictures to support examination of verbal and non-verbal development, and tips to facilitate and promote development. Developed alongside the original Mary Sheridan's From Birth to Five Years: Children's Developmental Progress, this unique guide expands on its normative developmental stages by offering practical guidance for health, education and social care professionals, or anyone concerned with monitoring children's developmental progress.

Supporting Women to Give Birth at Home describes and discusses the main challenges and issues that midwives and maternity services encounter when preparing for and attending a home birth. To ensure that a home birth is a real option for women, midwives need to be able to believe in a woman's ability to give birth at home and to promote this birth option, providing evidence-based information about benefits and risks. This practical guide will help midwives to have the necessary skills, resources and confidence to support homebirth. The book includes: the present birth choices a woman has the implications homebirth has upon midwifery practice how midwives can prepare and support women and their families the midwife's role and responsibilities national and local policies, guidelines and available resources pain management options With a range of recent home birth case studies brought together in the final chapter, this accessible text provides a valuable insight into those considering homebirth. Supporting Women to Give Birth at Home will be of interest to students studying issues around normal birth and will be an important resource for clinically based midwives, in particular community based midwives, home birth midwifery teams, independent midwives, and all who are interested in homebirth as a genuine choice.

Nurses typically go in to the profession of nursing because they want to "care" for patients, not knowing that the inherent stresses of the work environment put them at risk for developing psychological disorders such as burnout syndrome, posttraumatic stress disorder (PTSD), anxiety and depression. Symptoms of these disorders are often debilitating and affect the nurse's functioning on both a personal and professional level. While environmental and/or organizational strategies are important to help combat stress, oftentimes the triggers experienced by nurses are non-modifiable including patient deaths, prolonging life in futile conditions, delivering post-mortem care and the feeling of contributing to a patient's pain and suffering. It is paramount that nurses enhance their ability to adapt to their work environment. Resilience is a multidimensional psychological characteristic that enables one to thrive in the face of adversity and bounce back from hardships and trauma. Importantly, resilience can be learned. Factors that promote resilience include attention to physical well-being and development of adaptive coping skills. This book provides the nurse, and the administrators who manage them, with an overview of the psychological disorders that are prevalent in their profession, first-person narratives from nurses who share traumatic and/or stressful situations that have impacted their career and provide detailed descriptions of promising coping strategies that can be used to mitigate symptoms of distress.

Qualitative research, particularly phenomenology, is increasingly popular as a method for midwifery and health-related research. These approaches enable rich and detailed explanations to be uncovered and bring experience to life. Important recommendations and practice- based implications may then be raised and debated for future use. This book brings together a range of phenomenological methods and insights into one accessible text.

Illustrated with plenty of examples of successful phenomenological research, Qualitative Research in Midwifery and Childbirth keeps the focus applied to midwifery and childbirth and makes clear the links to practice throughout. The book introduces three key phenomenological approaches - descriptive, interpretive and the life world - and includes a comparative chapter which discusses the differences between these varied perspectives and methods. Each chapter focuses on how these approaches are used within midwifery research. The remaining chapters present a number of different research projects. These demonstrate how different phenomenological approaches have been used to explore and uncover experiences of childbirth and maternity as well as offering important insights into how women experience different facets of the birth experience during the antenatal, intra-partum and postnatal period.

Designed for researchers and students undertaking research projects on midwifery and childbirth, this text includes contributions from a range of international and highly regarded phenomenological authors and researchers.

Global and national confidential inquiry reports show that 60 to 80% of maternal and neonatal morbidity and mortality are due to avoidable errors. This comprehensive and illustrated second edition offers a practical guide to the management of obstetric, medical, surgical, anaesthetic and newborn emergencies in addition to organisational and training issues. The book is divided conveniently into nine sections and updated throughout in line with modern research and practice. Several new chapters cover setting up skills and drills training in maternity services to reduce avoidable harm, managing obstetric emergencies during 'home births' and in low-risk midwifery units, and minimizing maternal and fetal morbidity in failed operative vaginal delivery. Each chapter includes a practical algorithm for quick reference, the scientific basis for proposed actions, a case-based practical exercise and useful learning tools such as 'Key Pearls' and 'Key Pitfalls'. An invaluable resource for obstetricians, neonatologists, midwives, medical students, anesthesiologists and the wider perinatal team.

Few experiences can compare to the trauma and pain of losing a baby; and the wall of silence that often surrounds that loss can make grieving even harder. Loving You From Here explores the traumatic impact of losing a baby through stillbirth and neonatal death. It features the moving stories of multiple families; some affected recently, some decades ago, but still living with the loss. This book is a practical guide for grieving parents in the grips of tragedy, and those around them who want to be able to offer support. From managing those initial feelings of shock, grief, guilt and anger, this book will also show families how it is possible to grow around that grief and eventually form an enduring bond with their baby. This profound and insightful book will help everyone impacted by the loss of a baby - before, during or after birth - including those who have suffered an early or a late miscarriage and those who have had an ectopic pregnancy, and provides sensitive and reassuring advice on all aspects of loss and bereavement, as well as practical advice on how to find a new normal. This groundbreaking book breaks through the suffocating silence that surrounds the death of a baby and gives a voice to all those affected by baby loss.

The Objective Structured Clinical Examination (OSCE) was developed for all undergraduate nursing programmes, with the aim of emphasising the need for nursing students to be competent in clinical skills, to assess clinical reasoning skills and as a means of standardizing the assessment process. This practical, easy to read and interactive study guide helps nursing and midwifery students at all levels to maximise their chances of success with OSCEs. It features case studies, quick quizzes, recap and recall summaries and an OSCE preparation plan; all of which help to prepare the student for the examination. Hints and tips on what to expect during the examination and pointers on what the examiner will be looking for, together with a comprehensive chapter on personal learning will help to guide the student through the process and maximise their chances of success! "Very readable with useful tips and information for students" Cath Hill, Keele University "I found the book extremely relevant from the students' perspective, reader friendly and well structured. Quizzes and activities excellent." - Liz Day, Senior Lecturer, Nursing and Health Care Practice, University of Derby "A useful and easily digested text on this important assessment strategy", Ms. Karen Lumsden, Faculty of Nursing and Applied Clinical Studies, Canterbury Christchurch University"Useful for students as they prepare... Easy to read and understand." Kirsty Wedgbury, Faculty of Health and Community Care, Birmingham City University

Safe Maternity & Pediatric Nursing Care, 2nd Edition. Online Resources, and Davis Edge work together to create an interactive learning experience that teaches students to think critically and make the best patient care decisions. The text, written specifically for LPNs/LVNs, provides the comprehensive nursing knowledge they need to understand in this key course. Online Resources equip instructors with the lesson plans, teaching resources, and activities to create an active classroom environment where students can apply what they're learning. Davis Edge online quizzing tracks student progress; assesses their knowledge; prepares students for classroom exams and the NCLEX®; and provides real time analytics to identify their weak concepts and topic areas. Text This is the maternity/peds textbook that focuses on what LPNs must know with just the right depth and breadth of coverage of the knowledge and skills to practice safely. A student-friendly approach helps LPN/LVNs to master safe and effective nursing care by developing the critical-thinking and problem-solving skills they need to excel in clinical practice. Clear, concise, readable, well organized, and easy to follow, it's the text that prepares new nurses to make the connections. Davis Edge Davis Edge is the online quizzing program that integrates seamlessly into the classroom to give students the additional practice questions they need to perform well on course exams and the NCLEX®. Handpicked preset assignments save instructors time, while actionable analytics let them take the pulse of how their students are performing. Instructors have the real-time data they need to monitor, track, and assess their class's mastery of the content. They are able to easily identify the areas in which students are struggling, intervene quickly, and provide remediation to ensure that students succeed and improve within following areas: Comprehension and Retention: How well do students understand the content? Participation and Engagement: Are students keeping-up with their reading and assignments? Test-Taking Skills: Are students prepared for NCLEX®-style questions and improving their test-taking skills? An access code inside new printed texts unlocks Davis Edge as well as a wealth of online learning tools and resources, including an ebook powered by VitalSource. Our new approach to LPN/LVN education LPN/LVN Connections responds to the pressures and challenges faced in nursing education with a new approach that highlights key themes across our core textbooks, maintains a consistent reading level, common terminology and lab values to improve student outcomes in class and prepares them for professional practice. Educators: Contact your F.A. Davis Consultant to learn more about LPN/LVN Connections. Make the connections every step of the way. Also Available… Study Guide for Safe Maternity & Pediatric Nursing Care. 2nd Edition Davis's Nursing Skills Videos for LPN/LVN, 3rd Edition

The second book from Sunday Times bestselling author Linda Fairley. 'No matter how many babies I deliver, each and every one is a miracle, connecting me to the world like nothing else, reminding me that we are all equal in the beginning, and in the end. It's a great leveller, childbirth.' It's January 1972 and times have changed since Linda first stepped onto a maternity ward four years earlier. Gone are the starched skirts and steaming milk kitchens of the 1960s; these are the exhilarating days of disposable equipment and new technology. The Pill will soon be free to all women, and more and more fathers are daring to brave the delivery room. At the newly-opened Ashton maternity unit the midwives' spirits are high, and, in spite of the dark cloud of laundry strikes on the horizon, there's the scent of a new era on the cold winter wind. But one thing has stayed the same - the babies keep coming. Year after year, Linda faithfully helps the women of Greater Manchester through their most vulnerable and emotional hours, whether it is by giving calm instructions over the phone to a panicking husband, delivering a baby unexpectedly in a hospital lift, or by dashing headlong to the rescue of a snowed-in mum-to-be. As 25-year-old Linda becomes a mother herself she understands, more than ever, what a precious gift it is to bring children into the world, and she holds each new baby just that little bit tighter. As the years roll by Linda finds herself delivering the babies of mothers and fathers she helped to bring into the world decades earlier - making her something of a local celebrity. Through the highs and lows, through the modernisations that transform the hospital and the world outside, Linda's passion for midwifery burns as bright as ever. With 42 years of experience Linda is one of Britain's longest-serving midwives, and reaching the retirement age in 2008 didn't stop her doing the job she loves. Although she has seen generations of women give birth and delivered more than 2,000 babies, she treats every new arrival like the new miracle it is.

The Sunday Times bestseller 'Delivering my first baby is a memory that will stay with me forever. Just feeling the warmth of a newborn head in your hands, that new life, there's honestly nothing like it... I've since brought more than 2,200 babies into the world, and I still tingle with excitement every time.' It's the summer of 1968 and St Mary's Maternity Hospital in Manchester is a place from a bygone age. It is filled with starched white hats and full skirts, steaming laundries and milk kitchens, strict curfews and bellowed commands. It is a time of homebirths, swaddling and dangerous anaesthetics. It was this world that Linda Fairley entered as a trainee midwife aged just 19 years old. From the moment Linda delivered her first baby - racing across rain-splattered Manchester street on her trusty moped in the dead of night - Linda knew she'd found her vocation. 'The midwife's here!' they always exclaimed, joined in their joyful chorus by relieved husbands, mothers, grandmothers and whoever else had found themselves in close proximity to a woman about to give birth. Under the strict supervision of community midwife Mrs Tattershall, Linda's gruellingly long days were spent on overcrowded wards pinning Terry nappies, making up bottles and sterilizing bedpans - and above all helping women in need. Her life was a succession of emergencies, successes and tragedies: a never-ending chain of actions which made all the difference between life and death. There was Mrs Petty who gave birth in heartbreaking poverty; Mrs Drew who confided to Linda that the triplets she was carrying were not in fact her husband's; and Muriel Turner, whose dangerously premature baby boy survived - against all the odds. Forty years later Linda's passion for midwifery burns as bright as ever as she is now celebrated as one of Britain's longest-serving midwives, still holding the lives of mothers and children in her own two hands. Rich in period detail and told with a good dose of Manchester humour, The Midwife's Here! is the extraordinary, heartwarming tale of a truly inspiring woman.

As rates of multiple births increase, birth professionals are discovering a distinct lack of resources to support parents who wish to breastfeed. Written in an accessible format, Breastfeeding Twins and Triplets is a source of information for parents, lactation consultants, birthing professionals and healthcare workers wishing to support multiple birth families. Stagg's evidence-based guide discusses the discovery of a multiple pregnancy, how families can prepare for breastfeeding, premature birth, hand expressing and pumping as well as transitioning premature babies onto the breast and moving away from tube feeds. Stagg's own experience of breastfeeding her twins and career as a breastfeeding counsellor and lactation consultant with the IBCLC (International Board-Certified Lactation Consultants) ensures this guide is filled with practical knowledge to support multiple birth families in their journey.

By the mid-twentieth century, two things appeared destined for extinction in the United States: the practice of home birth and the profession of midwifery. In 1940, close to half of all U.S. births took place in the hospital, and the trend was increasing. By 1970, the percentage of hospital births reached an all-time high of 99.4%, and the obstetrician, rather than the midwife, assumed nearly complete control over what had become an entirely medicalized procedure. Then, seemingly out of nowhere, an explosion of new alternative organizations, publications, and conferences cropped up, documenting a very different demographic trend; by 1977, the percentage of out-of-hospital births had more than doubled. Home birth was making a comeback, but why? The executive director of the American College of Obstetricians and Gynecologists publicly noted in 1977 the "rising tide of demand for home delivery," describing it as an "anti-intellectual-anti-science revolt." A quiet revolution spread across cities and suburbs, towns and farms, as individuals challenged legal, institutional and medical protocols by choosing unlicensed midwives to catch their babies at home. Coming Home analyzes the ideas, values, and experiences that led to this quiet revolution and its long-term consequences for our understanding of birth, medicine, and culture. Who were these self-proclaimed midwives and how did they learn their trade? Because the United States had virtually eliminated midwifery in most areas by the mid-twentieth century, most of them had little knowledge of or exposure to the historic practice, drawing primarily on obstetrical texts, trial and error, and sometimes instruction from aging home birth physicians to learn their craft. While their constituents were primarily drawn from the educated white middle class, their model of care (which ultimately drew on the wisdom and practice of a more diverse, global pool of midwives) had the potential to transform birth practices for all women, both in and out of the hospital.

Beyond Self-Care for Helping Professionals is an innovative guide to professional self-care focused not just on avoiding the consequences of failing to take care of oneself, but on optimal health and positive psychology. This new volume builds upon the Expressive Therapies Continuum to introduce the Life Enrichment Model, a strengths-based model that encourages mindful participation in a broad array of enriching experiences. By enabling therapists and other Helping Professionals to develop a rich emotional, intellectual, and creative foundation to their lives and clinical practices, this guide sets a new standard for self-care in the helping professions.