Silent voices of the midwives: factors that influence midwives' achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry.

BACKGROUND: In Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery). METHODS: This was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes. RESULTS: Thematic analysis of the midwives' responses revealed three factors that influence successful resuscitation: 1. Hands-on training ("HOT") with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills; 2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and. 3. Strategies that reduce barriers. Immediately after birth, live resuscitation can commence at the mother's bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation. The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research. CONCLUSIONS: Training in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of "HOT" real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife's beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.

Air, Air, Air: a champion midwife programme in Tanzania using HOT neonatal resuscitation-lessons learned.

BACKGROUND: Tanzania has approximately 40 000 newborn deaths per year, with >25% of these linked to intrapartum-related hypoxia. The Helping Babies Breathe© and Golden minute© (HBB©) programme was developed to teach skilled intervention for non-breathing neonates at birth. While Helping Babies Breathe© and Golden minute©, providing training in simulated bag and mask ventilation, is theoretically successful in the classroom, it often fails to transfer to clinical practice without further support. Furthermore, the proclivity of midwives to suction excessively as a first-line intervention is an ingrained behaviour that delays ventilation, contributing to very early neonatal deaths. METHODS: The 'champion' programme provided guided instruction during a real-life resuscitation. The site was Amana Hospital, Tanzania. The labour ward conducts 13 500 deliveries annually, most of which are managed by midwives. Brief mannikin simulation practice was held two to three times a week followed by bedside hands-on training (HOT) of bag and mask skills and problem solving while reinforcing the mantra of 'air, air, air' as the first-line intervention during a real-life emergency. RESULTS: Champion midwives (trainers) guided instructions given during a real emergency at the bedside caused learners beliefs to change. Trainees observed changes in baby skin colour and the onset of spontaneous breathing after effective ventilation. CONCLUSIONS: Visible success during an actual real-life emergency created confidence, mastery and collective self-efficacy.

Effect of a mindfulness programme for long-term care residents with type 2 diabetes: A cluster randomised controlled trial measuring outcomes of glycaemic control, relocation stress and depression.

AIMS: The aim of this study was to determine physical, behavioural and psychosocial effects of a newly developed mindfulness programme for older adults with type 2 diabetes relocating to long-term care facility. BACKGROUND: Taiwan is viewed as an "aged society" with significant proportion of the population living in a long-term care facility. Approximately one third of residents living in long-term care facilities have been diagnosed with type 2 diabetes, and disruption to management of their glycaemic levels is at risk for up to one year after relocating to a long-term care facility. DESIGN: A cluster randomised controlled trial was used to examine the effects of a newly developed mindfulness programme on outcomes of glycaemic levels, relocation stress and depression. METHODS: A total of 140 participants were recruited from six long-term care facilities in Southern Taiwan. A mindfulness programme was delivered over 9 weeks and consisted of meditations, education and exercise techniques that were delivered by a Registered Nurse trained in mindfulness strategies. Participants in the control group received routine care as provided in the facilities, including routine check-ups at diabetes clinics as necessary. Data were analysed by Johnson-Neyman technique and generalised estimating equations. RESULTS: In total, 120 residents completed the study. The majority of patients were female (64.8%), and 83.5% of the sample were financially supported by their children. The results showed significant improvements in glycated haemoglobin (HbA1c), relocation stress (Wald χ2  = 78.91) and depression (Wald χ2  = 45.70) between groups. In the intervention group, the mean of HbA1c levels showed 16.4% reduction (Mean differences = 1.3; SD = 0.3). However, there were no significant differences in relocation stress and depression within groups. CONCLUSION: The results provided positive effects of the mindfulness programme for older people with diabetes moving into long-term care facilities. The programme will assist in future planning for diabetes care in long-term care facilities. IMPLICATIONS FOR PRACTICE: To incorporate the mindfulness program into existing diabetes education programs for older people living in LTCFs. Further investigation on the sustainability of the mindfulness program is warranted.

Reconsidering the transfer of patients from the intensive care unit to the ward: a case study approach.

Evidence indicates that the poorly managed transfer of a patient from the intensive care unit (ICU) to the ward can lead to physical and psychological complications for the patient, and often require ICU readmission and rehospitalization. Reviewing this patient transfer process to improve the quality of care would be a positive step towards enhancing patients' recovery and providing skills to staff. The aim of this paper is to review case studies of transferring ICU patients to general wards in order to identify the shortcomings of this process. A literature review was conducted to evaluate current practices in the ICU transfer process. The results of this paper have clinical implications, suggest approaches to improve support for patients and their carers, and provide strategies to improve the transfer procedure.