Relationships Among Individual and Hospital Characteristics and Self-Efficacy in Labor Support Among Intrapartum Nurses in Texas.

OBJECTIVE: To explore the relationships among individual and workplace characteristics and self-efficacy in labor support among intrapartum nurses. DESIGN: Cross-sectional survey. SETTING: Online distribution from April to August 2020. PARTICIPANTS: Members of the Texas section of the Association for Women's Health, Obstetric, and Neonatal Nurses (N = 106). METHODS: I conducted descriptive analysis on individual and workplace characteristics, including scores on the Self-Efficacy Labor Support Scale. I conducted backward stepwise multivariate linear regression to assess the factors associated with self-efficacy in providing labor support. RESULTS: Years as an intrapartum nurse had a positive association with self-efficacy in labor support. Experience with open-glottis pushing, the overall cesarean birth rate, and the use of upright positioning during labor and birth were also positively associated with self-efficacy in labor support. Conversely, lack of recognition by providers was negatively associated with self-efficacy in labor support. CONCLUSION: Findings suggest that modifiable factors at the individual and hospital levels are associated with nurses' self-efficacy in labor support. Hospitals must work to engage in obstetric practices that are congruent with providing labor support, including the use of experienced nurses to mentor new nurses and the creation of a unit culture to reinforce the intent of individual nurses to provide labor support.

Violência obstétrica: fatores desencadeantes e medidas preventivas de enfermagem / Obstetric violence: unleashing factors and preventive nursing measures

OBJETIVO: Caracterizar os fatores que ocasionam a violência obstétrica e a importância da enfermagem no desenvolvimento de medidas preventivas. MÉTODOS: Trata-se de uma revisão sistemática da literatura com metassíntese, com utilização do protocolo PRISMA. Realizou-se a pesquisa referida na fonte de busca: Biblioteca Virtual em Saúde (BVS) e nas bases de dados: SCIELO e LILACS, apresentando uma totalidade de 61 documentos. Após estabelecimento e aplicação dos critérios de inclusão: artigos disponíveis gratuitos, publicados entre 2015 a 2020, em língua portuguesa, inglesa e espanhola e exclusão: não apresentassem à temática, repetitivos, dissertações e resumos, resultando em um total de 10 artigos. RESULTADOS: O processo do parto é um acontecimento repleto de possíveis equívocos, condutas dolorosas e negligências, que podem gerar a violência obstétrica causando traumas físicos e psicológicos irreversíveis. CONCLUSÃO: Por meio desse estudo buscou destacar a importância de minimizar as praticas abusiva, com o uso de estratégias que efetivem programas e políticas voltadas ao binômio mãe-filho.(AU)

OBJECTIVE: To characterize the factors that cause obstetric violence and the importance of nursing in the development of preventive measures. METHODS: This is a systematic review of the literature with metasynthesis, using the PRISMA protocol. The research was reported in the search source: Virtual Health Library (VHL) and in the databases: SCIELO and LILACS, presenting a total of 61 documents. After establishment and application of inclusion criteria: free available articles, published between 2015 and 2020, in Portuguese, English and Spanish and exclusion: do not present to the theme, repetitive, dissertations and abstracts, resulting in a total of 10 articles. RESULTS: The delivery process is an event full of possible misunderstandings, painful behaviors and negligence, which can generate obstetric violence causing irreversible physical and psychological trauma. CONCLUSION: Through this study, we sought to highlight the importance of minimizing abusive practices, with the use of strategies that effectively implement programs and policies aimed at the mother-child binomial.(AU)

OBJETIVO: Caracterizar los factores que causan la violencia obstétrica y la importancia de la enfermería en el desarrollo de medidas preventivas. METODOS: Se trata de una revisión sistemática de la literatura con metasíntesis, utilizando el protocolo PRISMA. La investigación fue reportada en la fuente de búsqueda: Virtual Health Library (VHL) y en las bases de datos: SCIELO y LILACS, presentando un total de 61 documentos. Tras el establecimiento y aplicación de criterios de inclusión: artículos gratuitos, publicados entre 2015 y 2020, en portugués, inglés y español y exclusión: no se presentan al tema, repetitivos, disertaciones y resúmenes, dando como resultado un total de 10 artículos. RESULTADOS: El proceso de entrega es un evento lleno de posibles malentendidos, comportamientos dolorosos y negligencia, que puede generar violencia obstétrica causando traumas físicos y psicológicos irreversibles. CONCLUSION: A través de este estudio, buscamos destacar la importancia de minimizar las prácticas abusivas, con el uso de estrategias que implementen eficazmente programas y políticas dirigidas al binomio materna-infantil.(AU)

Percepción de mujeres sobre el cuidado humanizado de enfermería durante la atención en el parto / Women's Perception about Humanized Nursing Care during Childbirth Care

Introducción: El alto grado de utilidad de un instrumento diseñado para medir cuidados humanizados en enfermería, unido a las carencias de estudios en el contexto cubano sobre su aplicación, exigen desde esta perspectiva, su implementación en el proceso del parto, pues aportaría elementos que permiten evaluar la humanización del cuidado de la enfermería obstétrica en Cuba. Objetivo: Describir la percepción de mujeres sobre el cuidado humanizado de enfermería durante la atención en el parto el parto. Métodos: Estudio no experimental, descriptivo, de corte transversal, entre enero y diciembre del 2019. Participaron 121 mujeres hospitalizadas en el servicio de puerperio del Hospital Ciro Redondo de Artemisa, Cuba. Se aplicó la 3ra versión del instrumento "Percepción de los Comportamientos de Cuidado Humanizado en Enfermería" y se empleó distribución de frecuencia absolutas, relativas y acumuladas, la media aritmética y la escala evaluativa tipo Likert. Resultados: En las 121 mujeres encuestadas, se obtuvo que 96,69 por ciento percibió solo algunas veces una relación de cuidado humanizado en el personal de enfermería de la institución que la atendió durante su trabajo de parto y parto seguido de 88,42 por ciento que lo percibió casi siempre y de las tres dimensiones del instrumento: cualidades del hacer de enfermería obtuvo el mayor porcentaje en la categoría de siempre con 75,20 por ciento. Conclusiones: La mayor cantidad de la muestra percibió que solo algunas veces el profesional de enfermería le brindó cuidados humanizados durante la atención al parto(AU)

Introduction: The high degree of usefulness of an instrument designed to measure humanized nursing cares, together with the lack of studies in the Cuban context about its application, demand from this perspective, its implementation in the delivery process, since it would provide elements that allow to assess humanization of obstetric nursing care in Cuba. Objective: To describe women's perception about humanized nursing care during childbirth care. Methods: Nonexperimental, descriptive and cross-sectional study, carried our between January and December 2019. One hundred and twenty-one women participated who had been hospitalized in the puerperium service of Ciro Redondo Hospital in Artemisa, Cuba. The third version of the instrument "Perception of Humanized Care Behaviors in Nursing" was applied and absolute, relative and cumulative frequency distribution were used, together with arithmetic mean and the Likert-type assessment scale. Results: In the 121 women surveyed, it was obtained that 96.69 percent perceived only "sometimes" a relationship of humanized care from the nursing personnel of the institution where they were attended during labor and delivery, followed by 88.42 percent, which perceived such relationship "almost always." Of the three instrument dimension, qualities of nursing work obtained the highest percentage in the category "always," accounting for 75.20 percent. Conclusions: Most of the sample perceived that only "a few times" did the nursing professional provide humanized cares during delivery care(AU)

Cultivating Resilience Among Perinatal Care Providers During the Covid-19 Pandemic.

The Covid-19 pandemic has further illuminated the already existing need for methods of building resilience in perinatal caregivers. Using a scoping review approach, literature was examined to identify evidence-based models of resilience building in a cohort of perinatal clinicians. Research published between January 2015 and 2020 was evaluated using PubMed, CINAHL, EMBASE, and PsycINFO databases. Of the initial 3399 records reviewed, 2 qualitative studies met the inclusion criteria. Given the deleterious effects of Covid-19 on perinatal care providers, and in light of the paucity of available studies, personnel, time, and funding should be allocated for research to address these issues.

Identifying optimal labor and delivery nurse staffing: The case of cesarean births and nursing hours.

BACKGROUND: Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. PURPOSE: We examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing. METHODS: This retrospective descriptive study used hours of productive nursing time per delivery as the treatment variable to determine direct nursing time per delivery and its impact on the likelihood of a C-section. For comparisons, we also assessed the likelihood of augmentations and of inductions, as well as the number of neonatal intensive care unit (NICU) hours per birth. We limited our sample to those births between 37 and 42 weeks of gestation. Two complimentary models (the quadratic and piecewise regressions) distinguishing optimal staffing patterns from ineffective staffing patterns were developed. The study was implemented in eleven hospitals that are part of a large, integrated healthcare system in the Southwest. DISCUSSION: While a simple linear regression of the likelihood of a C-section on nursing hours per delivery indicated no statistically distinguishable effect, our 'optimal staffing' model indicated that nurse staffing hours employed by using a large sample of hospitals were actually minimizing C-sections (robustness checks are provided using similar model comparisons for the likelihood of augmentation and induction, and NICU hours). Where the optimal staffing models did not appear to be effective for augmentations, inductions, and NICU hours, we found significant differences between facilities (i.e., significant fixed effects for hospitals). In all specifications, we also controlled for weeks of gestation, race, sex of the child, and mother's age.

Meaningful learning actualized through a perinatal continuity of care experience.

Leaders in nursing education embrace innovative, real-world learning environments that transform today's generation of nursing students into critical thinkers. Scheduling exclusive child-bearing practicums are challenging due to staffing, time, and maternal client presentation. Utilizing transformative learning theory a perinatal continuum of care clinical learning experience evolved. This paper will discuss the qualitative, descriptive study of Bachelor of Science in Nursing students in rural, Midwestern United States who completed maternal/infant didactic, high-fidelity simulation, and real-world experiences relative to women during the perinatal period. Participants (n = 50) consisted of third-semester baccalaureate nursing students enrolled in the maternal/infant course. Data were collected from students' reflective journal blogs at the end of the semester. The aim of this study was to identify the outcomes of students learning through this perinatal experience. Three themes emerged from this study: self-analysis, critical thinking, and self-efficacy. Students' reflection indicated that through this comprehensive clinical experience, they developed a new self-awareness. Students noted that the experience was unique to any they had encountered. The perinatal assignment provided an opportunity for professional growth in this specialty area due to the interface of theory, simulation, and clinical applications expounded in the reflective clinical blog throughout the experience.

Possibilidades para a mudança do modelo obstétrico hegemônico pelas enfermeiras obstétricas / Opportunities for nurse midwives to bring change to the hegemonic model of obstetrics / Posibilidades para el cambio del modelo obstétrico hegemónico por las enfermeras obstétricas

Objetivo: descrever o uso das tecnologias de cuidado da enfermeira obstétrica qualificada na modalidade de residência e sua relação com a práxis profissional. Método: estudo qualitativo com 13 enfermeiras obstétricas atuantes em duas maternidades públicas do Rio de Janeiro, Brasil. Dados coletados por entrevista individual, semiestruturada e análise hermenêutica-dialética. Resultados: a transição do modelo intervencionista estrutura-se no cuidado humanizado com a incorporação de um modelo centrado nas boas práticas e nas tecnologias não invasivas de cuidado da enfermeira obstétrica. A práxis da enfermeira obstétrica contribui para a transformação qualitativa deste cenário, com resgate sobre a fisiologia, o fortalecimento de vínculo e empoderamento da mulher, ressignificando o momento do parto. Conclusão: a prática da enfermeira e o uso das tecnologias não invasivas constituem possibilidades para ruptura do modelo hegemônico culturalmente instituído no Brasil, sendo necessária ainda a constituição de um consenso que supere o senso comum(AU)

Objective: to describe the use of care technologies by residency-qualified nurse midwives and their relationship with professional praxis. Method: in this qualitative study with 13 nurse midwives at two public maternity hospitals in Rio de Janeiro, Brazil, data were collected by individual, semi-structured interview and hermeneutic-dialectic analysis. Results: the transition from the interventionist model builds on humanized care by incorporating a model centered on nurse midwives' use of best practices and noninvasive care technologies. Their praxis contributes to qualitative change in this scenario by reinstating physiology, fostering stronger bonding, and empowering women, so as to re-signify the moment of childbirth. Conclusion: nurse midwives' praxis and use of noninvasive technologies constitute opportunities to break with the culturally established model hegemonic in Brazil, while a consensus still needs to be built to surmount common sense(AU)

Objetivo: describir el uso de tecnologías asistenciales por parte de enfermeras parteras tituladas en residencia y su relación con la praxis profesional. Método: en este estudio cualitativo con 13 enfermeras parteras de dos maternidades públicas de Río de Janeiro, Brasil, los datos fueron recolectados mediante entrevista individual, semiestructurada y análisis hermenéuticodialéctico. Resultados: la transición del modelo intervencionista se basa en la atención humanizada al incorporar un modelo centrado en el uso de las mejores prácticas y tecnologías de atención no invasiva por parte de las enfermeras parteras. Su praxis contribuye al cambio cualitativo en este escenario al reinstaurar la fisiología, fomentar vínculos más fuertes y empoderar a las mujeres, para resignificar el momento del parto. Conclusión: la praxis de las enfermeras parteras y el uso de tecnologías no invasivas constituyen oportunidades para romper con el modelo hegemónico culturalmente establecido en Brasil, mientras que aún debe construirse un consenso para superar el sentido común(AU)

Interprofessional Simulation to Improve the Understanding of Obstetric Sepsis.

Sepsis parameters are not well defined for the obstetric population, which can result in delayed recognition. The escape room-based simulation sought to improve obstetric providers' and nurses' understanding, identification, and timely treatment of maternal sepsis. Participants expressed interest and enthusiasm in using this learning style to improve care of the sepsis patient. This intervention proved beneficial to staff development educators as an innovative and effective way to improve interprofessional engagement and promote knowledge of maternal sepsis.

Cervical Ripening and Labor Induction and Augmentation, 5th Edition.

Cervical ripening and induction and augmentation of labor are common procedures in labor and birth units. The potential risks and benefits for the procedure should be explained to women so that they can make informed decisions. Clinicians should be knowledgeable about the methods and medications used and be skilled in maternal-fetal assessment. Adequate nurse staffing is required to monitor the mother and fetus to promote the best possible outcomes. This practice monograph includes information on mechanical and pharmacologic methods for cervical ripening; labor induction and augmentation with oxytocin, a high alert drug; and nurse staffing levels and skills needed to provide safe and effective care during cervical ripening and labor induction and augmentation.

Verbal communication of the parturient nurse's dyad in the active phase of labor.

OBJECTIVES: to analyze verbal communication between the nurse and the parturient during the active phase of labor in two Lusophone countries. METHODS: quantitative analytical study. Sample of 709 interactions between nurses and parturients using verbal communication during the active phase of labor in Brazil and Cape Verde. The following variables were analyzed: companion, conative vocative, conative imperative, emotive/expressive and referential/context functions, contact/channel and code. RESULTS: the absence of interaction predominated in most of the variables analyzed during the active phase of labor in both countries. In Cape Verde all interactions occurred during the absence of the companion. CONCLUSIONS: considering the social and cultural aspects of each country, nurses need to develop skills to communicate verbally with the parturient, offering a better interaction during the parturition process.

Nursing Support During Latent Phase Labor: A Scoping Review.

PURPOSE: The purpose of this scoping review was to synthesize the literature on nursing support during the latent phase of the first stage of labor. In 2014, the definition of the beginning of active labor changed from 4 centimeters (cm) to 6 cm cervical dilation. More women may have an induction of labor based on results of recent research showing no causal increase in risk of cesarean birth with elective induction of labor for low-risk nulliparous women. Therefore, in-hospital latent phase labor may be longer, increasing the need for nursing support. DESIGN: Scoping review of the literature from 2009 to present. METHODS: We conducted the review using key words in PubMed, CINAHL, and Scopus. Search terms included different combinations of "latent or early labor," "birth," "support," "nursing support," "obstetrics," and "onset of labor." Peer-reviewed research and quality improvement articles from 2009 to present were included if they had specific implications for nursing care during the latent phase of labor. Articles were excluded if they were not specific to nursing, focused exclusively on tool development, or were from the perspective of pregnant women or providers only. RESULTS: Ten articles were included. Results were synthesized into six categories; support of physiologic labor and birth, the nurse's own personal view of labor, birth environment, techniques and tools, decision-making, and importance of latent labor discussion during the prenatal period. CLINICAL IMPLICATIONS: Support for physiologic labor and birth is an important consideration for use of nonpharmacological methods during latent labor. The nurse's own personal view on labor support can influence the support that laboring women receive. Nurses may need additional education on labor support methods.

'InUTERO': The effectiveness of an educational half day stillbirth awareness workshop for maternity care providers.

BACKGROUND: There is a disconnect between what maternity care providers consider should be done and what they actually do with respect to talking with their pregnant clients about reducing their risk of stillbirth. This suggests that they would benefit from receiving up-to-date knowledge about stillbirth, alongside education that provides them with strategies for talking about stillbirth with pregnant women. OBJECTIVES: To gain an understanding of maternity care provider (obstetricians and midwives) knowledge of stillbirth and determine whether delivering a half day workshop improves knowledge and results in intention to change practice. DESIGN: A pre-post intervention study. SETTING: Maternity care providers (Obstetricians, Midwives) working in the northern areas of Tasmania, Australia were asked, via questionnaire, about their knowledge of stillbirth both before and after attending a half-day workshop. PARTICIPANTS: Maternity care providers (n = 51) attended the workshop and 30 (59%) completed both the pre-workshop and post-workshop surveys. METHODS: A four hour interactive workshop grounded in understanding the stillbirth experience. Participants were given up-to-date information about stillbirth risks and current prevention research as well as provided with an actionable step wise approach to talking about stillbirth prevention in pregnancy. RESULTS: Stillbirth knowledge scores (total of 8-points) significantly increased following the workshop (pre: mean = 2.9 ± 1.5; post: mean = 4.7 ± 1.4 points, t 29 = 7.9, <0.001). Before the workshop, only 20% of participants responded that they "always" or usually" discussed the possibility stillbirth occurring with pregnant women in their care whereas, after the workshop, nearly all (88%) indicated that they planned to "always" discuss stillbirth with their pregnant clients. CONCLUSIONS: Attending a stillbirth awareness for prevention education workshop resulted in significant knowledge improvement and self-reported intention to change practice in a group of Australian maternity care providers. While these results are promising, further study is needed to determine the presence and extent of actual practice change following such education.

The effect on pregnant women's prenatal attachment of a nursing practice using the first and second Leopold's maneuvers.

OBJECTIVE: This study aimed to determine the effect on pregnant women's prenatal attachment of a nursing practice using the first and second Leopold's maneuvers. METHOD: This experimental, randomized and controlled study was conducted in a pregnancy class of a training and research hospital in Kocaeli, Turkey from September 2016 to September 2017. Its sample included 100 pregnant women, 50 in the experimental group and 50 in the control group (https://www.random.org, accessed: 09.20.2016). Data were collected using a personal information form, the Prenatal Attachment Inventory (PAI) and the Fetal Position Awareness Scale (FPAS). The study offered education that included fetal development, the first and second Leopold's maneuvers, and Leopold's maneuvers were administered in the 28th week of the women's pregnancy and re-administered in the 32nd and 36th weeks of pregnancy. No intervention was administered to the control group in these weeks, but the scales were administered. RESULTS: The sociodemographic, obstetric, social support and baby-related characteristics of the groups were similar (p > .05). There were no statically significant differences between their mean PAI and FPAS scores in the 28th week of pregnancy (p > .05). The experimental group's mean PAI and the FPAS scores in the 32nd and 36th weeks of pregnancy were significantly higher than those of the control group (p < .01). CONCLUSION: The study concluded that Leopold's maneuvers affected the pregnant women's prenatal attachment levels.

Verbal communication of the parturient nurse's dyad in the active phase of labor / Comunicación verbal de la diade enfermera parturienta en la fase activa del trabajo de parto / Comunicação verbal da díade enfermeiro-parturiente na fase ativa do trabalho de parto

ABSTRACT Objectives: to analyze verbal communication between the nurse and the parturient during the active phase of labor in two Lusophone countries. Methods: quantitative analytical study. Sample of 709 interactions between nurses and parturients using verbal communication during the active phase of labor in Brazil and Cape Verde. The following variables were analyzed: companion, conative vocative, conative imperative, emotive/expressive and referential/context functions, contact/channel and code. Results: the absence of interaction predominated in most of the variables analyzed during the active phase of labor in both countries. In Cape Verde all interactions occurred during the absence of the companion. Conclusions: considering the social and cultural aspects of each country, nurses need to develop skills to communicate verbally with the parturient, offering a better interaction during the parturition process.

RESUMEN Objetivos: analizar la comunicación verbal entre enfermero y parturienta durante la fase activa del trabajo de parto en dos países lusófonos. Métodos: estudio analítico cuantitativo. Muestra con 709 interacciones utilizando comunicación verbal de enfermeros y parturientas en la fase activa del trabajo de parto en Brasil y Cabo Verde. Se analizaron las variables: acompañante, funciones conativa/ vocativo e imperativo, emotiva/expresiva, referencial/contexto, contacto/canal y código. Resultados: predominó ausencia de interacciones en la mayoría de las variables analizadas en la fase activa del trabajo de parto en los dos países. En Cabo Verde, todas las interacciones han sido establecidas con la ausencia del acompañante. Conclusiones: considerando los aspectos sociales y culturales de cada país, los enfermeros necesitan desarrollar habilidades para se comunicaren verbalmente con las parturientas, ofreciéndoles mejor interacción en el proceso de parturición.

RESUMO Objetivos analisar a comunicação verbal entre enfermeiro e parturiente durante a fase ativa do trabalho de parto em dois países lusófonos. Métodos: estudo analítico quantitativo. Amostra com 709 interações utilizando comunicação verbal de enfermeiros e parturientes na fase ativa do trabalho de parto no Brasil e Cabo Verde. Analisaram-se as variáveis: acompanhante, funções conativa vocativa, conativa imperativa, emotiva/expressiva, referencial/contexto, contato/canal e código. Resultados: predominou ausência de interações na maioria das variáveis analisadas na fase ativa do trabalho de parto nos dois países. Em Cabo Verde, todas as interações foram estabelecidas com a ausência do acompanhante. Conclusões: considerando os aspectos sociais e culturais de cada país, os enfermeiros precisam desenvolver habilidades para comunicarem-se verbalmente com as parturientes, oferecendo a elas melhor interação no processo de parturição.