A Guide to Effective Care in Pregnancy and Childbirth

Author: Murray Enkin,Eleanor Enkin

Publisher: Oxford University Press, USA

ISBN: 9780192623249

Category: Medical

Page: 429

View: 8037

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All the main findings and conclusions of these publications are available here in an easily readable, inexpensive, and updated form. The new edition is extensively revised and rewritten, incorporating the results of the important evidence about the effects of care during pregnancy and childbirth that has accumulated since the first edition was published. The first edition received critical acclaim because its conclusions were based on sound evidence and has become a unique reference source for evaluating care policies and practices.

Guide to Effective Care in Pregnancy and Childbirth

Author: Murray Enkin,Marc Keirse,James Neilson,Caroline Crowther,Lelia Duley,Ellen Hodnett,Justus Hofmeyr

Publisher: OUP Oxford

ISBN: 9780192631732

Category: Medical

Page: 544

View: 2379

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A Guide to effective care in pregnancy and childbirth is a clearly written review of the important research evidence on the effects of the various care practices carried out during pregnancy, childbirth, and the early days after birth. In addition to the details provided in the text, the book concludes with valuable tables that list the practices which are beneficial, those of unknown effectiveness, and those likely to be ineffective or harmful.

Mothering Magazine's Having a Baby, Naturally

The Mothering Magazine Guide to Pregnancy and Childbirth

Author: Peggy O'Mara

Publisher: Simon and Schuster

ISBN: 9781416595748

Category: Family & Relationships

Page: 368

View: 8400

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For more than twenty-five years, Mothering magazine has captured an audience of educated women who appreciate its "we'll inform, you choose" approach to parenting. Having a Baby, Naturally reflects this spirit with straightforward, uncensored information about pregnancy and childbirth, addressing common concerns and questions in a compassionate, nonjudgmental style. Written by Peggy O'Mara, the longtime publisher, editor, and owner of Mothering magazine, it synthesizes the best theories and safest practices used in natural childbirth, including recommendations from the World Health Organization, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists. Throughout, O'Mara reinforces her belief that each woman's pregnancy and birth experience is a one-of-a-kind event. She covers such topics as: Nutrition, diet, and exercise Emotional self-awareness during and after pregnancy A trimester-by-trimester guide to what is happening in your body and your child's Birth choices -- offering suggestions, not "rules" Pain medication alternatives Birth locations, from hospitals to home birth Relieving morning sickness with natural remedies Prenatal testing Breastfeeding Prematurity and multiple births Balancing work and family The father's role during pregnancy and beyond Difficult subjects, such as birth defects, miscarriages, and postpartum depression, are also treated with sensitivity and candor. Finally, a book for the thinking woman who believes in her own inherent capacity to make smart, informed decisions about her pregnancy and birth, just as she makes in other areas of her life. Having a Baby, Naturally is a celebration of childbirth and an accurate and objective guide to helping women fortify their spirits, develop trust in their bodies, and make the best possible choices to protect their new baby's health.

Therapiehandbuch Gynäkologie und Geburtshilfe

Author: Jürgen Wacker,Martin Sillem,Gunther Bastert,Matthias W. Beckmann

Publisher: Springer-Verlag

ISBN: 3642301894

Category: Medical

Page: 469

View: 2566

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Das erfahrene Herausgeber- und Autorenteam stellt in dem Handbuch alle üblichen Diagnose- und Therapieschritte praxisorientiert und alltagstauglich dar: von den Grundlagen der Evidenz und den Leitlinien über die Versorgung und Früherkennung in Geburtshilfe und gynäkologischer Onkologie bis hin zu Therapiestrategien und Notfallmanagement. Dabei ist der neueste Stand der Forschung berücksichtigt. Die 2. Auflage wurde umfassend bearbeitet, aktualisiert und um Kapitel u. a. zum Vulvakarzinom und zur komplementärenTherapie in der Onkologie erweitert.

The Thinking Woman's Guide to a Better Birth

Author: Henci Goer

Publisher: Penguin

ISBN: 1440674302

Category: Health & Fitness

Page: 384

View: 2498

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As an intelligent woman, you are probably used to learning as much as you can before making major decisions. But when it comes to one of the most important decisions of your life--how you will give birth—it is hard to gather accurate, unbiased information. Surprisingly, much of the research does not support common medical opinion and practice. Birth activist Henci Goer gives clear, concise information based on the latest medical studies. The Thinking Woman's Guide to a Better Birth helps you compare and contrast your various options and shows you how to avoid unnecessary procedures, drugs, restrictions, and tests. The book covers: Cesareans Breech babies Inducing labor Electronic Fetal Monitoring Rupturing Membranes Coping with slow labor Pain medication Epistiotomy Vaginal birth after a Ceasarean Doulas Deciding on a doctor or midwife Choosing where to have your baby and much more . . .

Fanaroff and Martin's Neonatal-Perinatal Medicine

Diseases of the Fetus and Infant

Author: Richard J. Martin,Avroy A. Fanaroff,Michele C. Walsh

Publisher: Elsevier Health Sciences

ISBN: 0323295371

Category: Medical

Page: 1936

View: 8690

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Tackle your toughest challenges and improve the quality of life and long-term outcomes of your patients with authoritative guidance from Fanaroff and Martin s Neonatal-Perinatal Medicine. Drs. Richard J. Martin, Avroy A. Fanaroff, and Michele C. Walsh and a contributing team of leading experts in the field deliver a multi-disciplinary approach to the management and evidence-based treatment of problems in the mother, fetus and neonate. New chapters, expanded and updated coverage, increased worldwide perspectives, and many new contributors keep you current on the late preterm infant, the fetal origins of adult disease, neonatal anemia, genetic disorders, and more. "...a valuable reference book and a pleasure to read." Reviewed by BACCH Newsletter, Mar 2015 Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Be certain with expert, dependable, accurate answers for every stage of your career from the most comprehensive, multi-disciplinary text in the field! See nuance and detail in full-color illustrations that depict disorders in the clinical setting and explain complex information. Obtain more global perspectives and best practices with contributions from international leaders in the field of neonatal-perinatal medicine. Get comprehensive guidance on treating patients through a dual focus on neonatology and perinatology. Spot genetic problems early and advise parents of concerns, with a completely new section on this topic. Make informed clinical choices for each patient, from diagnosis and treatment selection through post-treatment strategies and management of complications, with new evidence-based criteria throughout. Stay at the forefront of your field thanks to new and completely revised chapters covering topics such as: Principles and Practice l Immune and Non-immune Hydrops Fetalis l Amniotic Fluid Volume l Enhancing Safe Prescribing in the Neonatal Intensive Care Unit l Role of Imaging in Neurodevelopmental Outcomes of High-Risk Neonates l Patent Ductus Arteriosus l Gastroesophageal Reflux and Gastroesophageal Reflux Diseases in the Neonate. Find and grasp the information you need easily and rapidly with indexing that provides quick access to specific guidance.

Physiology in Childbearing

With Anatomy and Related Biosciences

Author: Dorothy Stables,Jean Rankin

Publisher: Elsevier Health Sciences

ISBN: 0702044113

Category: Medical

Page: 800

View: 7821

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This ISBN is now out of print. A new edition with e-book is available under ISBN 9780702044762. The third edition of this popular textbook gives a clear, easy-to-read account of anatomy and physiology at all stages of pregnancy and childbirth. Each chapter covers normal physiology, changes to the physiology in pregnancy, and application to practice. The physiology of childbearing is placed within a total biological context, drawing on evolution, ecology, biochemistry and cell biology. Follows childbearing from preconception to postnatal care and the neonate Logical progression through the body systems Highly illustrated, with simple diagrams Emphasises links between knowledge and practice to promote clinical skills Main points summarised to aid study. Website: 10 multiple-choice questions per chapter for self-testing Downloadable illustrations, with and without labels Fully searchable.

Pregnancy and Childbirth E-Book

A holistic approach to massage and bodywork

Author: Suzanne Yates

Publisher: Elsevier Health Sciences

ISBN: 0702047848

Category: Medical

Page: 440

View: 3093

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Pregnancy and childbirth brings together, for the first time, western and eastern approaches providing a sound amalgamation of theoretical and practical information for bodywork practitioners world-wide. It describes in detail the application of massage and shiatsu from early pregnancy, including work during labour and for the first year postnatally for the mother. This is a useful source of information for massage therapists, shiatsu practitioners, osteopaths, physical therapists, chiropractors, reflexologists, aromatherapists, acupuncturists, yoga and Pilates instructors. For Students and practitioners to use as a learning manual and reference tool, the text provides: Clarity of information Full text referencing Clear diagrams, photographs, and summary boxes Clinical accuracy: reviewed by, and with contributions from, international specialists including midwives, obstetricians, osteopaths, chiropractors, acupuncturists, aromatherapists and massage therapists.

Prenatal Massage - E-Book

A Textbook of Pregnancy, Labor, and Postpartum Bodywork

Author: Elaine Stillerman

Publisher: Elsevier Health Sciences

ISBN: 0323075460

Category: Medical

Page: 480

View: 9635

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Authored by a well-known expert on prenatal massage, this comprehensive text helps you understand the intricate physiology of pregnancy so you can confidently apply appropriate massage techniques for each trimester, and throughout labor and postpartum. You'll find clear, colorfully illustrated explanations of a wide range of techniques and procedures, including Swedish massage, acupuncture points, myofascial release, trigger point therapy, lymphatic drainage, and reflexology. Contraindications and precautions are also provided where necessary to help you provide safe and effective care for every client. Comprehensive coverage guides you through all aspects of prenatal massage in a single book, addressing fundamentals, techniques, preparation, and prevention of potential problems. Many useful techniques are described in detail for prenatal through postpartum massage with step-by-step instructions so you can begin using these techniques with your clients immediately. Numerous boxes throughout the text highlight key information and provide clinical tips. Touch Points and In My Experience boxes share the author's personal observations about the chapter material with real-life examples from her years in practice. Over 350 detailed, full-color illustrations and photographs illuminate procedures, concepts, and techniques. Clear writing and organization addresses content in four main units: pregnancy massage, labor massage, postpartum massage, and marketing strategies. A companion DVD packaged with the book contains 45 minutes of video demonstrating different massage techniques presented in the book. DVD icons within the text encourage you to watch relevant video footage at appropriate points. Learning objectives and key terms at the beginning of each chapter clearly identify the concepts you should focus on in the chapter. Review questions at the end of each chapter enable you to assess your understanding and review important information presented in the book. A glossary of all key terms and definitions makes it easy to quickly look up a new term or to refresh your memory.

Meta-Analysis for Explanation

A Casebook

Author: Heidi Hartmann,Larry V. Hedges,Richard J. Light

Publisher: Russell Sage Foundation

ISBN: 1610441338

Category: Social Science

Page: 392

View: 2799

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Social science research often yields conflicting results: Does juvenile delinquent rehabilitation work? Is teenage pregnancy prevention effective? In an effort to improve the value of research for shaping social policy, social scientists are increasingly employing a powerful technique called meta-analysis. By systematically pulling together findings of a particular research problem, meta-analysis allows researchers to synthesize the results of multiple studies and detect statistically significant patterns among them. Meta-Analysis for Explanation brings exemplary illustrations of research synthesis together with expert discussion of the use of meta-analytic techniques. The emphasis throughout is on the explanatory applications of meta-analysis, a quality that makes this casebook distinct from other treatments of this methodology. The book features four detailed case studies by Betsy Jane Becker, Elizabeth C. Devine, Mark W. Lipsey, and William R. Shadish, Jr. These are offered as meta-analyses that seek both to answer the descriptive questions to which research synthesis is traditionally directed in the health and social sciences, and also to explore how a more systematic method of explanation might enhance the policy yield of research reviews. To accompany these cases, a group of the field's leading scholars has written several more general chapters that discuss the history of research synthesis, the use of meta-analysis and its value for scientific explanation, and the practical issues and challenges facing researchers who want to try this new technique. As a practical resource, Meta-Analysis for Explanation guides social scientists to greater levels of sophistication in their efforts to synthesize the results of social research. "This is an important book...[it is] another step in the continuing exploration of the wider implications and powers of meta-analytic methods." —Contemporary Psychology

Mayes' Midwifery E-Book

A Textbook for Midwives

Author: Sue Macdonald

Publisher: Elsevier Health Sciences

ISBN: 0702045969

Category: Medical

Page: 1084

View: 7775

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Mayes’ Midwifery, an established key textbook for students and qualified midwives, contains essential knowledge for professional practice. For this 14th edition, each section and chapter has been fully updated and enhanced by leading authors to ensure the text complies with contemporary practice and current guidelines. Added benefits are the availability of a variety of additional online resources for each chapter, including case studies, video and website links, and a bank of multiple-choice questions to test knowledge. With a strong emphasis on normal birth, the book covers the spectrum of midwifery-related topics applied to practice, providing a foundation of knowledge, and encouraging independent thought through the use of reflective exercises in each chapter and online. The book provides midwives with material that meets individual ways of learning and supports current modes of midwifery education. Mayes’ Midwifery is the text for initial preparation and for ongoing midwifery practice. New chapters on essential contemporary issues: Vulnerable women Perspectives on the future of midwifery, in a global context Evidence-based information to guide best practice Learning outcomes and Key Points in all chapters Reflective activities Now with an integrated website offering additional resources and material including: Multiple-choice questions for self-testing Case studies Reflective activities to consolidate your professional development Useful additional reading, resources and weblinks Expanded topics Downloadable materials including illustrations

The Midwife's Labour and Birth Handbook

Author: Vicky Chapman,Cathy Charles

Publisher: John Wiley & Sons

ISBN: 1118480104

Category: Medical

Page: 416

View: 6160

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Praise for previous editions: “An excellent resource for both student midwives andqualified staff alike.” (Alison James, MidwiferyLecturer, Plymouth University) "A lovely book with a lot of practical advice and easy tonavigate. (Jayne Samples, Midwifery Lecturer, University ofHuddersfield) This fully revised and updated third edition of TheMidwife’s Labour and Birth Handbook is a practical andaccessible guide to midwifery care. It addresses important questions such as: Why are women being pressured into caesarean section for breechpresentation when the evidence is equivocal? If a baby needs assisted ventilation breaths at birth, why notbring the ambubag to the baby and leave the cord intact so the babycan benefit from the extra maternal oxygen supply? Why is skin-to-skin contact at birth so rarely offered topreterm babies when there is evidence of benefit? This well-regarded text promotes normality and woman-centredcare, using research, evidence-based guidelines and anecdotalaccounts from women. It challenges practice and guidelines whichare biased or based on poor evidence. Guidance is offered on how todeal with difficult, sometimes controversial, situations. The Midwife's Labour and Birth Handbook 3rdedition is an essential guide for both student midwives andexperienced practising midwives. New to this edition: Full colour photographs including a kneeling breech birth Suturing diagrams to assist left-handed midwives. Expanded chapters on slow progress in labour andmalposition/malpresentations, including a rare photograph of a facepresentation birth.

Schwangerenvorsorge durch Hebammen

Author: Hebammengemeinschaftshilfe e.V

Publisher: Georg Thieme Verlag

ISBN: 3830455879

Category: Medical

Page: 368

View: 2185

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Das Konzept des Berufsverbandes für die Schwangerenvorsorge durch Hebammen. Der sichere Weg für alle Hebammen, die eine echte Alternative zu der Schwangerenvorsorge durch Frauenärzte anbieten wollen. Um mit der ärztlichen Schwangerenvorsorge konkurrieren zu können, ist ein umfassendes Fachwissen die unabdingbare Voraussetzung. Dieses Fachbuch liefert die verlässliche Basis: + Erkenntnisse der evidenzbasierten Medizin + plus praktisch bewährtes Erfahrungswissen + plus Berücksichtigung der psychosozialen Situation der Frau Alle Autorinnen sind Expertinnen auf dem Gebiet der Schwangerenvorsorge. Der Inhalt entspricht nicht einer Einzelmeinung, sondern einem Konsens innerhalb des Berufsverbandes. Was ist neu? - Einbeziehung neuer Studienergebnisse und Gesetzesänderungen - Zusätzliches Kapitel: Qualitätsmanagement - Vollständig überarbeitete Kapitel über Pränataldiagnostik und Förderung der Kontaktaufnahme zwischen Mutter und Kind.

Spiritual Midwifery

Author: Ina May Gaskin

Publisher: Book Publishing Company

ISBN: 1570671044

Category: Medical

Page: 480

View: 6643

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Shares the birthing stories of women who chose to have their babies at home with the help of a midwife, provides information about the safety of techniques used in the hospital before and after birth,discusses postpartum depression and maternal death, and includes resources for doulas, birth centers, and other organizations.

Joints and Connective Tissues

General Practice: The Integrative Approach Series

Author: Kerryn Phelps,Craig Hassed

Publisher: Elsevier Health Sciences

ISBN: 0729582175

Category: Medical

Page: 1280

View: 763

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Joints and Connective Tissues - General Practice: The Integrative Approach Series. In order to diagnose and manage the patient presenting with musculoskeletal symptoms, it is important to distinguish whether the pathology is arising primarily in the so-called hard tissues (such as bone) or the soft tissues (such as cartilage, disc, synovium, capsule, muscle, tendon, tendon sheath). It is also important to distinguish between the two most common causes of musculoskeletal symptoms, namely inflammatory and degenerative.

Advanced Practice Nursing E-Book

An Integrative Approach

Author: Ann B. Hamric,Judith A. Spross,Charlene M. Hanson

Publisher: Elsevier Health Sciences

ISBN: 1437720080

Category: Medical

Page: 848

View: 3686

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Covering all advanced practice competencies and roles, this book offers strategies for enhancing patient care and legitimizing your role within today’s health care system. It covers the history of advanced practice nursing, the theory behind the practice, and emerging issues. Offering a comprehensive exploration of advanced practice nursing, this edition also adds a focus on topics including the APN scope of practice, certification, and the ethical and legal issues that occur in clinical practice. The development of all major competencies of advanced practice nursing is discussed: direct clinical practice, consultation, coaching/guidance, research, leadership, collaboration, and ethical decision-making. Advanced practice competencies are discussed in relation to all advanced practice nursing and blended CNS-NP roles (case manager, acute care nurse practitioner), highlighting the shared aims and distinctions of each role. In-depth discussions on educational strategies explain how competencies develop as the nurses’ practice progresses. A chapter on research competencies demonstrates how to use evidence-based research in practice, and how to promote these research competencies to other APNs. A conceptual framework shows the clear relationship between the competencies, roles, and challenges in today’s health care environment. Practical strategies are provided for business management, contracting, and marketing. Comprehensive information covers the essential competencies of the new Doctor of Nursing Practice degree. More exemplars (case studies) provide real-life scenarios showing APN competencies in action. A new chapter shows how to provide reliable and valid data to substantiate your impact and justify equitable reimbursement for APN services, also enhancing your skills in quality improvement strategies, informatics, and systems thinking. Information on telehealth considerations covers the new sources of electronic healthcare information available to patients and describes how to counsel them on using reliable resources.

Midwifery Essentials: Labour E-Book

Author: Helen Baston,Jenny Hall

Publisher: Elsevier Health Sciences

ISBN: 0702042552

Category: Medical

Page: 200

View: 1077

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Labour is the third title in the Midwifery Essentials series and is about the provision of safe and effective care during labour and birth. This book prepares the reader to provide safe, evidence-based, woman-centred intrapartum care. Assessment and the role of the midwife in early labour The first stage of labour, monitoring maternal and fetal wellbeing Coping with contractions, without pharmacological pain relief Advantages and disadvantages of pharmacological analgesia Indications for induction or augmentation of labour The second stage of labour and the procedure for episiotomy The third stage of labour and the impact of different approaches Different methods of anaesthesia and preparation for caesarean birth The procedure for evidence-based perineal suturing. Assessment and the role of the midwife in early labour The first stage of labour, monitoring maternal and fetal wellbeing Coping with contractions, without pharmacological pain relief Advantages and disadvantages of pharmacological analgesia Indications for induction or augmentation of labour The second stage of labour and the procedure for episiotomy The third stage of labour and the impact of different approaches Different methods of anaesthesia and preparation for caesarean birth The procedure for evidence-based perineal suturing. Midwifery Essentials consists of a series of four pocketbooks, based on the popular and successful ‘Midwifery Basics’ articles published in ‘The Practising Midwife’ journal. They have been written in response to many requests from students, midwives and supervisors to combine these articles into a handy text. The books remain true to the style of the articles and have been updated and expanded to create a user-friendly source of information on different aspects of midwifery care. They will stimulate debate and require the reader both to reflect on their current practice, local policies and procedures and to challenge care that is not woman centred. There are many dimensions to the provision of woman-centred care that practitioners need to consider and understand so the series is based on the principles of holistic care, using a ‘jigsaw’ model as a framework. Each aspect of the jigsaw should be considered during the assessment, planning, implementation and evaluation of woman-centred maternity care, for example: how does a midwife obtain consent from a woman for a procedure, maintain a safe environment during the delivery of care and make the most of the opportunity to promote health? what are the professional and legal issues in relation to the procedure and is this practice based on the best available evidence? which members of the multi-professional team contribute to this aspect of care and how is it influenced by the way in which care is organised? Series features: Provides information essential for best practice at all stages of pregnancy and birth ‘Jigsaw’ model promotes holistic care Scenarios help readers understand the context of maternity care Activities encourage further exploration and debate.

Midwifery Essentials: Antenatal E-Book

Author: Helen Baston,Jenny Hall

Publisher: Elsevier Health Sciences

ISBN: 0702042536

Category: Medical

Page: 176

View: 4008

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Antenatal is the second title in the Midwifery Essentials series and looks at the provision of safe and effective antenatal care, exploring the role of the midwife in the context of professional and national guidance. This book prepares the reader to provide safe, evidence-based, woman-centred maternity care. Models of care and the range of professionals involved The booking history and involving the woman in decisions Optimising and monitoring maternal health throughout pregnancy Blood tests and antenatal screening for fetal abnormality Monitoring the growing fetus Facilitating women to prepare for birth. Models of care and the range of professionals involved The booking history and involving the woman in decisions Optimising and monitoring maternal health throughout pregnancy Blood tests and antenatal screening for fetal abnormality Monitoring the growing fetus Facilitating women to prepare for birth. Midwifery Essentials consists of a series of four pocketbooks, based on the popular and successful ‘Midwifery Basics’ articles published in ‘The Practising Midwife’ journal. They have been written in response to many requests from students, midwives and supervisors to combine these articles into a handy text. The books remain true to the style of the articles and have been updated and expanded to create a user-friendly source of information on different aspects of midwifery care. They will stimulate debate and require the reader both to reflect on their current practice, local policies and procedures and to challenge care that is not woman centred. There are many dimensions to the provision of woman-centred care that practitioners need to consider and understand so the series is based on the principles of holistic care, using a ‘jigsaw’ model as a framework. Each aspect of the jigsaw should be considered during the assessment, planning, implementation and evaluation of woman-centred maternity care, for example: how does a midwife obtain consent from a woman for a procedure, maintain a safe environment during the delivery of care and make the most of the opportunity to promote health? what are the professional and legal issues in relation to the procedure and is this practice based on the best available evidence? which members of the multi-professional team contribute to this aspect of care and how is it influenced by the way in which care is organised? Series features: Provides information essential for best practice at all stages of pregnancy and birth ‘Jigsaw’ model promotes holistic care Scenarios help readers understand the context of maternity care Activities encourage further exploration and debate.

Vaginal Birth After Caesarean

The VBAC Handbook

Author: Helen Churchill,Wendy Savage

Publisher: Pinter & Martin Publishers

ISBN: 1905177240

Category: Health & Fitness

Page: 104

View: 1379

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Women are over four times more likely to have a caesarean birth than they were some years ago. Intended for women who have had a caesarean or repeat caesareans, this title provides suggestions for constructive ways to achieve vaginal birth when it is the right option for mother and baby.

Emotions in Midwifery and Reproduction

Author: Billie Hunter,Ruth Deery

Publisher: Macmillan International Higher Education

ISBN: 1137086416

Category: Medical

Page: 272

View: 1162

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With contributions from a range of leading international authors, this 'stop and make you think' book explores the many contemporary issues surrounding emotion work in reproductive healthcare. The editors, forerunners in their field, have brought together both theoretical and clinical aspects to challenge readers to consider the significance of this important topic in their day-to-day work. Using examples of maternity care and infertility settings from the UK and beyond, and with an emphasis on personal reflection throughout, the book explores the subjects of: • Emotional well-being • Client-practitioner relationships • Infertility • Loss • Breast feeding • Motherhood Emotions in Midwifery and Reproduction underlines the importance of emotions and how they are managed, experienced and negotiated in clinical settings, addressing issues that are frequently overlooked in the drive for efficiency and effectiveness in the health service. It is stimulating reading for all midwifery and nursing students and practitioners looking to understand their patients' and their own emotional needs.