Slovenian midwifery professionalization: Perception of midwives and related health professions.

INTRODUCTION: This article presents research into the professionalization of midwifery in Slovenia. Since recognition by related occupations is important for professions, this comparative study asked doctors and nurses in Slovenia about their perceptions of the status of midwifery. METHODS: A questionnaire survey was conducted with 300 Slovenian midwives, 666 nurses and 416 obstetricians. The questionnaire included statements covering traditional sociological notions of the profession (ethics, theory, power), and three notions based on new elements of professionalism (reflective practice, interdisciplinary working, and partnership with clients). RESULTS: Findings suggest that nurses perceived themselves to be less autonomous than midwives, and this partly explains why most nurses thought that midwifery should be a specialized course of study, after the general nursing diploma. Obstetricians claimed to support midwives, however, they did not give midwives credit for basic midwifery competencies and did not feel midwifery to be equal to their profession. Midwives revealed not to feel autonomous; they felt that nursing and obstetrics is jeopardizing independent midwifery practice. CONCLUSIONS: Slovenian midwifery was poorly evaluated in some attributes of professionalism, especially knowledge and autonomy. Even midwives themselves consider midwifery more occupation than profession. The autonomy of midwifery will be hard to achieve in the institutions of medical dominance. The study revealed that participants of all three groups are in a competitive relation and are poorly aware of the roles and competencies of the other two professions. Therefore, partially joined education might be beneficial in order to promote interprofessional collaboration in the future.

Focus Group in Community Mental Health Research: Need for Adaption.

The article presents an analysis of the use of focus groups in researching community mental health users, starting with the reasons for using them, their implementation in mental health service users' research, and the adaptations of focus group use when researching the experiences of users. Based on personal research experience and a review of scientific publications in the Google Scholar, Web of Science, ProQuest, EBSCOhost, and Scopus databases, 20 articles published between 2010 and 2016 were selected for targeted content analysis. A checklist for reporting on the use of focus groups with community mental health service users, aiming to improve the comparability, verifiability and validity was developed. Adaptations of the implementation of focus groups in relation to participants' characteristics were suggested. Focus groups are not only useful as a scientific research technique, but also for ensuring service users' participation in decision-making in community mental health and evaluating the quality of the mental health system and services .

The role of non-governmental organizations in the mental health area: differences in understanding.

INTRODUCTION: The contribution's aim is highlighting the differences in understanding non-governmental organizations' (NGOs) role in the mental health area within the public support network for patients with mental health problems from various viewpoints, in order to achieve progress in supporting patients with mental health problems in local communities. METHODS: Qualitative data gathered as a part of a cross-sectional study of NGOs in the support network for patients with mental health problems in two Slovenian health regions (56 local communities), carried out in 2013 and 2014, were used. Qualitative analysis of interviews, focus groups and answers to an open survey question was performed. RESULTS: There are differences in understanding NGOs' role in the support network for patients with mental health problems, which stem from the roles of stakeholders (local community officials, experts, care providers, and patients) within this system and their experience. DISCUSSION AND CONCLUSION: The actual differences need to be addressed and overcome in order to provide integrated community care. The importance of knowing the current state of NGOs in their life cycle and the socio-chronological context of the local community support network is evident.

How do midwives in Slovenia view their professional status?

OBJECTIVE: The aim of the study was to explore Slovenian midwives' views of their professional status. The influence of participants' educational background on their views was also examined, since higher education is related to professionalism. DESIGN: This was a quantitative descriptive survey, using postal data collection. The questionnaire comprised of six elements crucial for professionalism--three elements distinctive of 'old' professionalism (power, ethics, specific knowledge) and three characteristics of 'new' professionalism (reflective practice, inter-professional collaboration and partnership with users). PARTICIPANTS: A total of 300 midwives who were registered in a national register of nurses and midwives at the time of the study. The response rate was 50.7% (152 returned the questionnaire). Participants that were on a probationary period were excluded, leaving 128 questionnaires for analysis (43%). Some 40.9% participants had secondary midwifery education, 56.7% had higher midwifery education and only few (2.4%) finished postgraduate education. FINDINGS: The majority of participants did not consider midwifery to be a specific profession. Midwives with secondary education were more likely to consider practical skills to be important than theoretical midwifery knowledge. In general midwives did not feel enabled to practice autonomously; and this caused them to face ethical dilemmas when aiming to fulfil women's wishes. All participants with midwifery secondary school education thought that obstetrics jeopardises midwifery scope of practice, but only half of the BSc participants thought this. One-fifth of all participants estimated that midwifery is also threatened by nursing. The respondents reported feeling a lack of control over their professional activity and policy making; however the majority of midwives claimed that they were willing to take on more responsibility for independent practice. KEY CONCLUSIONS: Slovenian midwifery cannot be considered to be a profession yet. It faces several hindrances, due to its historical development. IMPLICATIONS FOR PRACTICE: In order to develop a specific professional identity for midwives, the content and structure of education should be analysed and changed in order to improve socialisation and professionalism. In clinical settings, the scope of midwifery practice and responsibilities, as defined by EU directives, should be agreed by all professional groups.

Patient involvement in Europe--a comparative framework.

PURPOSE: The purpose of this paper is to provide and explain the model that underlies most of the research reported within this special issue on "Patient involvement in health care across Europe". DESIGN/METHODOLOGY/APPROACH: This introduction provides a literature review and a conceptual framework for the understanding of patient involvement and its potential development within health care across Europe. FINDINGS: Patient involvement can be characterised in terms of three ideal types: voice, choice and co-production. Policies for developing user involvement in healthcare can have disempowering as well as empowering consequences. The pattern of dissemination of user involvement across Europe varies in form and content largely due to path dependency. RESEARCH LIMITATIONS/IMPLICATIONS: The paper provides a template for future comparative research on user involvement in health care and one that could be extended to social care as well as other varieties of human services. This introduction and the special issue highlights the need for further comparative research in this area. ORIGINALITY/VALUE: The paper presents a robust model for comparative research. The findings may well be useful not only to researchers but also to policy makers and analysts.

User involvement in Slovenian healthcare.

PURPOSE: The purpose of this paper is to report on current developments in user involvement in healthcare in Slovenia and to explore the issue from the macro-, mezzo- and micro-levels. DESIGN/METHODOLOGY/APPROACH: User involvement is first contextualised within history of the organisation of healthcare system, from its socialist past through to its post-transitional developments. Second, user involvement is tracked through an analysis of healthcare policies and legislation as well as at its institutional and organisational levels. Finally, user involvement practices are illustrated from the perspective of individual patients. A descriptive and exploratory case study design was employed, including a literature review, document analysis and qualitative thematic analysis of nine in-depth and four semi-structured interviews. FINDINGS: The findings reveal a complex and at times ambivalent picture in which user involvement is still not firmly embedded into the healthcare system, despite being generally accepted. ORIGINALITY/VALUE: No systematic qualitative research of patient involvement in Slovenia has previously been published. This research will establish a basis for further investigations of the topic.

Rhetorical skills as a component of midwifery care.

OBJECTIVE: this article argues that rhetorical skills are an important quality factor of midwifery care. In particular, it aims to identify and discuss the relevance of three classical means of persuasion: ethos, pathos and logos. DESIGN: secondary analysis, rhetorical analysis of semi-structured interviews. SETTING: Slovenia. Interviews were carried out predominantly in 2006. Data refer to childbirths in 2005 and 2006. PARTICIPANTS: four women with recent experience of childbirth. FINDINGS: analysis identified the presence of all three means of persuasion in the interaction between midwives and women. Focusing on midwives, the quality of their awareness and command of rhetorical skills remains questionable. In particular, women experienced lack of a rational account of the situation and decisions made by health-care professionals involved in maternity care. KEY CONCLUSIONS: acknowledging professional ethics, awareness and good command of all three means of persuasion [but above all, argumentative persuasion (logos)] is an integral component of midwifery care. It can contribute to collaborative relations between midwives and women, and thus promote women-centred midwifery care. IMPLICATIONS FOR PRACTICE: knowledge of the three classical rhetorical means of persuasion should be integrated into professional midwifery curricula.

Self-rated health in different social classes of Slovenian adult population: nationwide cross-sectional study.

OBJECTIVES: Self-rated health can be influenced by several characteristics of the social environment. The aim of this study was to evaluate the relationship between self-rated health and self-assessed social class in Slovenian adult population. METHODS: The study was based on the Countrywide Integrated Non-communicable Diseases Intervention Health Monitor database. During 2004, 8,741/15,297 (57.1%) participants aged 25-64 years returned posted self-administered questionnaire. Logistic regression was used to determine unadjusted and adjusted estimates of association between poor self-rated health and self-assessed social class. RESULTS: Poor self-rated health was reported by 9.6% of participants with a decrease from lower to upper-middle/upper self-assessed social class (35.9 vs. 3.7%). Logistic regression showed significant association between self-rated health and all self-assessed social classes. In an adjusted model, poor self-rated health remained associated with self-assessed social class (odds ratio for lower vs. upper-middle/upper self-assessed social class 4.23, 95% confidence interval 2.46-7.25; P < 0.001). CONCLUSIONS: Our study confirmed differences in the prevalence of poor self-rated health across self-assessed social classes. Participants from lower self-assessed social class reported poor self-rated health most often and should comprise the focus of multisectoral interventions.

How does culture show? A case study of an international and interprofessional course in palliative care.

Research shows slow improvement of the care of dying persons and their significant others. One of the reasons for that is the lack of palliative care education as an integral part of health professionals' undergraduate education. The paper discusses an attempt to develop innovative forms of palliative care education: an international, interprofessional and IT-supported undergraduate course for Swedish and Slovenian students of nursing, medicine, occupational therapy, physiotherapy, psychology and social work, which has been developed jointly by the two authors. One of the aims of the course has been to address differences in professional and national cultures relevant to quality in palliative care. The development and pilot implementation phases of the course were analysed qualitatively, using evaluation materials from students and teachers and from an external evaluation study. The results show that the interprofessional approach in the course enabled students to get to know other professions, as well as enabling them to work together as a team and resolve conflicts. Cultural differences between Sweden and Slovenia were not very pronounced, yet they came to the fore regarding teamwork and relationships between professions, as well as in respect of the "right thing" to do in relation to patient' problems.

Identification of population groups at very high risk for frequent perception of stress in slovenia.

AIM: To identify population groups at very high risk for frequent perception of stress and thus enable more focused planning of prevention actions in Slovenia. METHODS: Data originate from the national survey carried out in 2001 on health behavior of 15,379 adults aged 25-64. The overall response rate of the mailed questionnaire was 64%, with 9,043 questionnaires eligible for analysis. Binary multiple logistic regression was used to determine the impact of gender, age, education, employment, self-assessed social class, type of residence community, and geographical region on the prevalence of frequent stress perception. RESULTS: The highest odds for stress were registered in women (OR(women vs men)=1.39, P<0.001), aged 40-49 years (OR(40-49 vs 30-39)=1.18, p=0.017; OR(50-59 vs 40-49)=0.73, P<0.001), participants with the lowest (OR(primary vs uncompleted primary education)=0.72, P=0.008) and the highest education levels (OR(college or higher vs secondary education)=1.26, P=0.022), unemployed participants (OR(unemployed vs housekeepers/students)=1.80, P=0.001), and administrative/intellectual employees (OR(administrative/intellectual employees vs housekeepers/students)=1.75, P=0.001), participants self-classified in the lowest social class (OR(labor vs lower)=0.50, P<0.001); residents from urban and suburban communities (OR(rural vs suburban/urban residence community)=0.86, P=0.037), and participants from the Eastern geographical region of Slovenia (OR(Eastern vs Western)=1.12, P=0.097). CONCLUSION: In Slovenia, employed women, aged 40-49, with at least college education level were identified as the largest population sub-group at very high risk for frequent stress perception with at least minor difficulties in coping with these feelings, requiring specific public health measures to be introduced in this group.