Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study.

BACKGROUND: Risk perception is fundamental to decision-making; therefore its exploration is essential to gaining a comprehensive understanding of the decision-making process for peripartum interventions. The aim of this study was to investigate associations between personal and systemic factors of the work setting and the risk perception of obstetric healthcare professionals, and in turn how this might influence decisions regarding obstetric interventions. METHODS: Case vignettes were used to measure risk perception. A quantitative cross-sectional online survey was performed within an exploratory sequential mixed-methods design, and an intervention readiness score created. Associations were calculated using location and dispersion measures, t-tests and correlations in addition to multiple linear regression. RESULTS: Risk perception, as measured by the risk assessment score, was significantly lower (average 0.8 points) for midwives than for obstetricians (95%-CI [-0.673; -0.317], p < .001). Statistically significant correlations were found for: years of experience and annual number of births in the current workplace, but this was not clinically relevant; hours worked, with the groups of participants working ≥ 30,5 h showing a statistically significant higher risk perception than participants working 20,5-30 h (p = .005); and level of care of the current workplace, with the groups of participants working in a birth clinic (Level IV) showing a statistically significant lower risk perception than participants working in Level I hospital (highly specialised obstetric and neonatal care; p = .016). The option of midwife-led birthing care showed no correlation with risk perception. The survey identified that risk perception, occupation, years in the profession and number of hours worked (i.e. full or part time) represent significant influences on obstetric healthcare professionals' willingness to intervene. CONCLUSIONS: The results of the survey give rise to the hypothesis that the personal and systemic factors of professional qualification, occupation, number of hours worked and level of acuity of the workplace are related to the risk perception of obstetric healthcare professionals. In turn, risk perception itself made a significant contribution to explaining differences in willingness to intervene, suggesting that it influences obstetricians' and midwives' decision-making. Overall, however, the correlations were weak and should be interpreted cautiously. The significant variations in the use of interventions must be addressed in order to provide the highest quality and best possible care for childbearing women and their families. To this end, developing strategies to improve interdisciplinary relationships and collaboration is of great importance. TRIAL REGISTRATION: German Clinical Trials Register DRKS00017172 (18.06.2019).

Intrapartum risk perception-A qualitative exploration of factors affecting the risk perception of midwives and obstetricians in the clinical setting.

OBJECTIVE: to gain an in-depth view of the specific risk perception of midwives and obstetricians, in order to achieve a deeper understanding of the situations which midwives and obstetricians perceive as risky and of the factors affecting their risk perception. DESIGN: a qualitative approach using focus group discussions was used as part of the first strand within a sequential explorative mixed methods project. PARTICIPANTS: 24 midwives and obstetricians providing labour care in the clinical setting ANALYSIS: according to qualitative content analysis. FINDINGS: both external and internal factors were identified which potentially influence the risk perception of midwives and obstetricians: (i) the individual perception of the obstetric health professional, (ii) the dyad of obstetric health professional & woman, (iii) being part of a team and (iv) being part of an institution. While risk definitions/classifications and obstetric risk factors were less common topics, structural and organisational factors, such as lack of staff and excessive workload, dominated the discussions about risky situations in the delivery room. KEY CONCLUSION: Obstetric health professionals' risk perception is multifactorial and risky situations in the delivery room can be described as a complex construct of various factors. The results suggest that there are different forms of risk perception and different factors which are perceived as risky. IMPLICATIONS FOR PRACTICE: Reflection on one's own role and actions should be included in the training of obstetric professionals and also be maintained in everyday professional life.

The effects of dementia care mapping on nursing home residents' quality of life and staff attitudes: design of the quasi-experimental study Leben-QD II.

BACKGROUND: The main objective of care for people with dementia is the maintenance and promotion of quality of life (Qol). Most of the residents in nursing homes have challenging behaviors that strongly affect their Qol. Person-centered care (PCC) is an approach that aims to achieve the best possible Qol and to reduce challenging behaviors. Dementia Care Mapping (DCM) is a method of implementing PCC that has been used in Germany for several years. However, there are no data on the effectiveness of DCM or the challenges of implementation of DCM in German nursing homes. METHODS/DESIGN: In this quasi-experimental non-randomized cluster-controlled study, the effects of DCM will be compared to 2 comparison groups. 9 nursing homes will take part: 3 will implement DCM, 3 will implement a comparison intervention using an alternative Qol assessment, and 3 have already implemented DCM. The main effect outcomes are Qol, challenging behaviors, staff attitudes toward dementia, job satisfaction and burnout of caregivers. These outcomes will be measured on 3 data points. Different quantitative and qualitative data sources will be collected through the course of the study to investigate the degree of implementation as well as facilitators of and barriers to the implementation process. DISCUSSION: This study will provide new information about the effectiveness of DCM and the implementation process of DCM in German nursing homes. The study results will provide important information to guide the national discussion about the improvement of dementia-specific Qol, quality of care in nursing homes and allocation of resources. In addition, the study results will provide information for decision-making and implementation of complex psychosocial interventions such as DCM. The findings will also be important for the design of a subsequent randomized controlled trial (e.g. appropriateness of outcomes and measurements, inclusion criteria for participating nursing homes) and the development of a successful implementation strategy. TRIAL REGISTRATION: Current Controlled Trials ISRCTN43916381.

[Comment about the policy statement of the MDS. A position statement of the assessment group of the University Witten/Herdecke with regard to nursing documentation]. / Kommentar zur Grundsatzstellungnahme "Pflegeprozess und Dokumentation" des MDS. Positionspapier der Assessmentgruppe, Universität Witten/Herdecke, zur Pflegedokumentation.

In 2005 the Medical Advisory Service of Social Health Insurance (MDS) in Germany published a policy statement with regard to the nursing process and documentation. According to the intention of the association, this statement should be considered as recommendations which are able to improve nursing practice and to contribute to streamlining of bureaucracy in nursing care. Recognising the broad impact of this publication on nursing institutions, a working group on nursing assessment of the University Witten/Herdecke conducted a critical review of the statement. Significant criteria for evaluation were the primary role of nursing documentation, quality requirements for the documentation as well as recent scientific results concerning the implementation of nursing process and assessment-based nursing diagnoses. The review revealed that the statement lacks of a clear rationale and its content appears to be merely research-based. Therefore it has to be questioned if the publication will accomplish the claimed effects. In fact, future quality criteria for health care are to be developed independently on the basis of scientific results and in consideration of the experiences of all concerned social groups.