An exploration of patient-provider dynamics and childbirth experiences in rural and urban Peru: a qualitative study.

BACKGROUND: Between 2006 and 2013, Peru implemented national programs which drastically decreased rates of maternal and neonatal mortality. However, since 2013, maternal and neonatal mortality in Peru have increased. Additionally, discrimination, abuse, and violence against women persists globally and impacts birthing experiences and mental health. This qualitative study sought to better understand the attitudes and beliefs regarding childbirth among women and providers in Southern Peru. This study also explores how these beliefs influence utilization of skilled care, patient-provider dynamics, and childbirth experiences and identifies factors that impact providers' provision of care. METHODS: Thirty semi-structured interviews were conducted with 15 participants from rural Colca Canyon and 15 participants from urban Arequipa between April and May 2018. In each region, 10 women who had experienced recent births and five providers were interviewed. Provider participants predominantly identified as female and were mostly midwives. All interviews were conducted, transcribed, and coded in Spanish. A framework analysis was followed, and data were charted into two separate thematic frameworks using contextual and evaluative categories of conceptualization of childbirth. RESULTS: All recent births discussed were facility-based births. Four domains emerged: women's current birth experiences, provision of childbirth care, beliefs about childbirth among women and providers, and future health-seeking behavior. Findings suggest that women's feelings of helplessness and frustration were exacerbated by their unmet desire for respectful maternity care and patient advocacy or companionship. Providers attributed strain to perceived patient characteristics and insufficient support, including resources and staff. CONCLUSIONS: Our findings suggest current childbirth experiences placed strain on the patient-provider dynamic and influenced women's attitudes and beliefs about future experiences. Currently, the technical quality of safe childbirth is the main driver of skilled birth attendance and facility-based births for women regardless of negative experiences. However, lack of respectful maternity care has been shown to have major long-term implications for women and subsequently, their children. This is one of the first studies to describe the nuances of patient-provider relationships and women's childbirth experiences in rural and urban Peru.

A Qualitative Assessment of Mothers' Experience With Pediatric Anemia Care in Arequipa, Peru.

Background: Despite national efforts to control pediatric anemia in Peru, each year, 67.4% of all newborns are diagnosed with anemia during their first year of life. The literature on Peruvian mothers' understanding and beliefs of pediatric anemia is limited. In the present study, we aimed to understand mother's perspective of pediatric anemia and explore their perceptions on how to prevent and treat anemia in Peru. Methods: During May-June 2018, we administered a short demographic questionnaire and conducted language-sensitive interviews with mothers of children clinically diagnosed with anemia in three different governmental health centers in Arequipa, Peru. Interviews were audio-recorded and transcribed verbatim. We used the Framework Analysis approach to analyze qualitative data. Results: A total of 14 Peruvian mothers were interviewed. Across interviews, three main themes emerged: (I) Mothers' Understanding of Pediatric Anemia; (II) Attitudes about Provider Recommendations for Pediatric Anemia Control; and (III) Barriers to Effective Pediatric Anemia Control. Peruvian mothers expressed skepticism toward national pediatric anemia guidelines as they believe recommendations received at health clinics jeopardized their children's overall health. Participants identified several barriers to effective anemia control: limited and confusing health information received during pediatric healthcare appointments, lack of systematic protocols in health clinics, and inconsistent referral processes. Conclusion: We identified factors that limit the acceptance of current pediatric anemia control guidelines followed at governmental health centers in Arequipa, Peru. Understanding maternal beliefs concerning pediatric anemia can guide future anemia control guidelines at the primary care level for pediatric patients in Peru.

Desenvolvimento de ferramenta de dimensionamento das equipes de enfermagem para unidades de terapia intensiva / Development of nursing team sizing tool for intensive care units

Objetivo: desenvolver ferramenta de gestão para o dimensionamento das equipes de enfermagem de unidades de terapia intensiva adulto brasileiras, com base na legislação do Ministério da Saúde para equipe mínima, complementando-a com o escore do Nursing Activities Score e parâmetros consensualizados por especialistas. Método: estudo metodológico, composto por revisão documental, revisão integrativa, aplicação do método Delphi e desenvolvimento da ferramenta, realizado no período de janeiro a dezembro de 2018. Resultados: Na revisão documental foram identificadas quatro normas do Ministério da Saúde contendo parâmetros de dimensionamento e uma do Conselho Federal de Enfermagem. Na revisão integrativa foram selecionados 11 artigos, relativos a aplicação do Nursing Activities Score, nas bases de dados PUBMED/MEDLINE, LILACS, CINAHL, SciELO e SCOPUS, sendo os dados analisados em planilha eletrônica do Microsoft Excel, que resultaram, em conjunto com a revisão documental e a experiência da autora, em nove questões/parâmetros que foram utilizadas para validação por 15 enfermeiros intensivistas das regiões sul e sudeste, utilizando o Método Delphi, sendo aplicados questionários semiestruturados, contendo a escala de Likert de 5 pontos, onde considerou-se consenso a marcação igual ou superior a quatro pontos. Foram necessárias três rodadas Delphi até que se atingisse o consenso. Em seguida foi desenvolvida a ferramenta de dimensionamento em Microsoft Excel, se valendo das funções do Excel para a elaboração das fórmulas de cálculo, que tiveram como base os parâmetros da legislação do Ministério da Saúde, o escore NAS e os nove parâmetros consensualizados pelos especialistas. Identificou-se a existência de duas normas do Ministério da Saúde para UTIs Públicas, optando-se por utilizar os parâmetros da mais benéfica. Conclusão, aplicabilidade e impacto: A ferramenta desenvolvida tem importância ímpar no dimensionamento das equipes de enfermagem de unidades de terapia intensiva, uma vez que supre a lacuna da legislação do Ministério da Saúde no tocante ao perfil assistencial e demanda da unidade, possibilitando a geração do quantitativo de pessoal de forma rápida, dando subsídios técnicos para tomadas de decisão

Objective: to develop a management tool for the dimensioning of the nursing teams of Brazilian adult intensive care units, based on the legislation of the Ministry of Health for minimum staff, complementing it with the Nursing Activities Score and parameters agreed by specialists. Method: methodological study, consisting of documentary review, integrative review, application of the Delphi method and development of the tool, carried out from January to December 2018. Results: in the documentary review, four Ministry of Health standards were identified, containing parameters for design and one from the Federal Council of Nursing. In the integrative review, 11 articles were selected for the application of the Nursing Activities Score in the PUBMED / MEDLINE, LILACS, CINAHL, SciELO and SCOPUS databases. Data were analyzed in a Microsoft Excel spreadsheet, which resulted, together with the documentary review and the experience of the author of nine years of staffing in public hospitals, in nine questions / parameters that were used for validation by 15 intensive nurses from the southern and southeastern states, using the Delphi Method, with semi-structured questionnaires and 5-point Likert scale, where it was considered as a consensus marking equal to or greater than four points. It took three Delphi rounds until consensus was reached. Next, the tool was developed in Microsoft Excel, using the Excel functions to compile the calculation formulas, which were based on the parameters of the Ministry of Health legislation, the NAS score and the nine parameters agreed upon by the specialists. It was identified the existence of two norms of the Ministry of Health for Public ICUs, opting to use the parameters of the most beneficial. Conclusion, applicability and impact: the tool developed has unique importance in the dimensioning of the nursing teams of intensive care units, since it fills the gap of the Ministry of Health legislation regarding the care profile and demand of the unit and enables the generation of personnel quantitative in a fast way, giving technical support for decision making

Desenvolvimento de ferramenta de dimensionamento das equipes de enfermagem para unidades de terapia intensiva / Development of nursing team sizing tool for intensive care units

Objetivo: desenvolver ferramenta de gestão para o dimensionamento das equipes de enfermagem de unidades de terapia intensiva adulto brasileiras, com base na legislação do Ministério da Saúde para equipe mínima, complementando-a com o escore do Nursing Activities Score e parâmetros consensualizados por especialistas. Método: estudo metodológico, composto por revisão documental, revisão integrativa, aplicação do método Delphi e desenvolvimento da ferramenta, realizado no período de janeiro a dezembro de 2018. Resultados: Na revisão documental foram identificadas quatro normas do Ministério da Saúde contendo parâmetros de dimensionamento e uma do Conselho Federal de Enfermagem. Na revisão integrativa foram selecionados 11 artigos, relativos a aplicação do Nursing Activities Score, nas bases de dados PUBMED/MEDLINE, LILACS, CINAHL, SciELO e SCOPUS, sendo os dados analisados em planilha eletrônica do Microsoft Excel, que resultaram, em conjunto com a revisão documental e a experiência da autora, em nove questões/parâmetros que foram utilizadas para validação por 15 enfermeiros intensivistas das regiões sul e sudeste, utilizando o Método Delphi, sendo aplicados questionários semiestruturados, contendo a escala de Likert de 5 pontos, onde considerou-se concenso a marcação igual ou superior a quatro pontos. Foram necessárias três rodadas Delphi até que se atingisse o consenso. Em seguida foi desenvolvida a ferramenta de dimensionamento em Microsoft Excel, se valendo das funções do Excel para a elaboração das fórmulas de cálculo, que tiveram como base os parâmetros da legislação do Ministério da Saúde, o escore NAS e os nove parâmetros consensualizados pelos especialistas. Identificou-se a existência de duas normas do Ministério da Saúde para UTIs Públicas, optando-se por utilizar os parâmetros da mais benéfica. Conclusão, aplicabilidade e impacto: A ferramenta desenvolvida tem importância ímpar no dimensionamento das equipes de enfermagem de unidades de terapia intensiva, uma vez que supre a lacuna da legislação do Ministério da Saúde no tocante ao perfil assistencial e demanda da unidade, possibilitando a geração do quantitativo de pessoal de forma rápida, dando subsídios técnicos para tomadas de decisão

Objective: to develop a management tool for the dimensioning of the nursing teams of Brazilian adult intensive care units, based on the legislation of the Ministry of Health for minimum staff, complementing it with the Nursing Activities Score and parameters agreed by specialists. Method: methodological study, consisting of documentary review, integrative review, application of the Delphi method and development of the tool, carried out from January to December 2018. Results: in the documentary review, four Ministry of Health standards were identified, containing parameters for design and one from the Federal Council of Nursing. In the integrative review, 11 articles were selected for the application of the Nursing Activities Score in the PUBMED / MEDLINE, LILACS, CINAHL, SciELO and SCOPUS databases. Data were analyzed in a Microsoft Excel spreadsheet, which resulted, together with the documentary review and the experience of the author of nine years of staffing in public hospitals, in nine questions / parameters that were used for validation by 15 intensive nurses from the southern and southeastern states, using the Delphi Method, with semi-structured questionnaires and 5-point Likert scale, where it was considered as a consensus marking equal to or greater than four points. It took three Delphi rounds until consensus was reached. Next, the tool was developed in Microsoft Excel, using the Excel functions to compile the calculation formulas, which were based on the parameters of the Ministry of Health legislation, the NAS score and the nine parameters agreed upon by the specialists. It was identified the existence of two norms of the Ministry of Health for Public ICUs, opting to use the parameters of the most beneficial. Conclusion, applicability and impact: the tool developed has unique importance in the dimensioning of the nursing teams of intensive care units, since it fills the gap of the Ministry of Health legislation regarding the care profile and demand of the unit and enables the generation of personnel quantitative in a fast way, giving technical support for decision making