Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives in Jordan.

INTRODUCTION: Episiotomy is still performed routinely by clinicians in many countries. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy practice among clinicians working in public hospitals in Jordan. METHODS: A cross-sectional study, using a self-administered survey questionnaire, was conducted among midwives and obstetricians in three public hospitals in Jordan. RESULTS: 112 (87.5%) clinicians responded to the questionnaire. Low knowledge level of evidence about overuse and risk of episiotomy was identified among participants with a significant difference among obstetricians and midwives (P<0.05). Results revealed that both obstetricians and midwives have limited access to evidence which is not emphasised in their learning, practice, or hospital policy. The majority of obstetricians (80%) and midwives (79%) thought an episiotomy rate of 81% is about right. The most common reason for performing episiotomy identified by both obstetricians (83.1%) and midwives (75.5%) was to reduce the risk of 3rd and 4th degree perineal laceration. The most common obstacle to reducing episiotomy rate reported by obstetricians (78.0%) was lack of training on preventing perineal tears, while the most common obstacles reported by midwives were insufficient time to wait for the perineum to stretch (56.6%) and difficulty changing the conventional practices in the labour ward (52.8%). CONCLUSION: This study identifies that obstetricians and midwives in Jordan rely on non evidence-based beliefs to guide their practice on performing an episiotomy. Training, continuing education, and developing evidence based clinical policies and guidelines for surgical procedures, such as in an episiotomy, are needed.

Caring behaviours by midwives: Jordanian women's perceptions during childbirth.

BACKGROUND: It is agreed internationally that caring is a central part of nursing and midwifery. There is a growing concern about the lack of caring in childbirth settings in developing countries including Jordan. The aim of this study was to explore women's perceptions of midwives' caring behaviours during childbirth to assist develop strategies for improvement. METHODS: An exploratory and qualitative design utilizing semi-structured interviews was used to explore women's perceptions of midwives' caring behaviours during childbirth. Interviews were digitally recorded and transcribed verbatim. Data were analysed by using thematic coding. Repetitive themes that described commonalties between the women's perceptions were identified and described. FINDINGS: Twenty-one women participated in the interviews. Three main themes were identified: (1) Women's feelings during childbirth: they felt frightened, humiliated, ignored, and disrespected. Negative actions in term of tangible or physical non-caring behaviours and emotional behaviours were reported. (2) Women's perceptions of the caring behaviours of midwives during childbirth: women had negative experiences during childbirth, they reported disrespectful manners and physical and empathetic abandonment by midwives during childbirth. (3) Women's preferred caring behaviours: women wanted the midwives to listen to what they say, to demonstrate respect for them, and be truly 'present' for women when they needed them. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The absence of caring behaviours from a group of Jordanian midwives' elicited negative responses from women in labour, who found this distressing. Devising strategies, informed by the study, focused on the preferred caring behaviours identified by women, could improve the standard of care provided by midwives currently working in labour wards in public hospitals in Jordan. These strategies should recognise that core competencies for midwifery care must go beyond skills training alone and highlight the importance of the psychosocial and emotional components of caring as well as routine procedural activities.

Nursing Documentation of Postoperative Pain Management: A Documentary Analysis.

BACKGROUND: Although proper documentation of pain for postoperative patients is essential to promote patient health outcomes, there is limited examination of nurses' documentation of pain management. PURPOSE: The purpose of this study was to qualitatively analyze nursing documentation of pain management among postoperative patients in Jordan. METHOD: A documentary analysis method was used. A purposive sample of 80 medical records were reviewed, and a total of 720 nursing records were analyzed. RESULTS: The analysis revealed that nurses' documentation of pain management was limited, vague, incomplete, and largely dependent on their subjective evaluation. Many of the documented goals were broad, not specific, not measurable, and with no time frame. CONCLUSIONS: Documentation patterns revealed a lack of proactive and systematic approach to pain assessment and management. Furthermore, there was little documented evidence of efforts to evaluate the effectiveness of pain management interventions. Findings have important implications for standardizing documentation of pain assessment, intervention, and evaluation.

Evaluate the Effect of Education Interventions in the Prevention of Diabetic Foot Ulcers through Knowledge of the Disease and Self-Care Practices in Saudi Arabia.

BACKGROUND: Diabetes mellitus places a substantial burden on society worldwide. Diabetic foot ulcers are a challenging problem for clinicians. Six generally accepted detriments to the healing of diabetic foot ulcers were identified: infection, glycaemic control, vascular supply, smoking, nutrition and deformity. AIM: To evaluate the effect of educational interventions in the prevention of diabetic foot ulcers through knowledge of the disease and self-care practices. METHODS AND DESIGN: A quasi-experimental, design was used. The study was conducted in the Internal Medicine Department and Outpatient clinic at Umulj general hospital - 2016. The study sample consists of 60 adult patients with diabetes mellitus. Approval to conduct the study obtained from the Ministry of Health and the University of Tabuk Research Ethics Committee. RESULTS: This study shows that, a significant relationship between levels of patient's knowledge, practice and level of education. CONCLUSION: The result of the present study concluded that implementation of the developed educational program showed significant improvement in the patients level of knowledge, patients ability to perform self-foot care and level of patient awareness after program implementation.

Breastfeeding self efficacy among pregnant women in Saudi Arabia.

OBJECTIVES: To examine the association between prenatal breastfeeding self-efficacy among Saudi pregnant women and type of feeding at 4 weeks post partum, and also to examine the association of maternal socio-demographic variables with the breastfeeding self-efficacy levels of Saudi pregnant women. Methods: A cross-sectional design has been applied in the study by recruiting 101 pregnant women from the General Hospital, Umluj, Kingdom of Saudi Arabia. The prenatal breastfeeding self-efficacy scale was used to measure self-efficacy for breastfeeding during pregnancy. Descriptive statistics, Chi-square, Pearson correlation coefficient were used for statistical purposes. A p-value ≤0.05 was considered significant. Results: The average breastfeeding self-efficacy score was 70±11.9. No significant relationship was existed between breastfeeding self-efficacy and the maternal sociodemographic variables. A significant relationship was found between type of feeding at 4 weeks postpartum and prenatal breastfeeding self-efficacy (r=0.061, p less than 0.05). Women who exclusively breastfeed their babies had high scores on prenatal breastfeeding self-efficacy scale than those who mixed feed or bottle feed their infants. Conclusion: Levels of prenatal breastfeeding self-efficacy among Saudi pregnant women were high and can be predictive of breastfeeding exclusivity at 4 weeks postpartum. The prenatal breastfeeding self-efficacy could be used to measure whether the woman could organize and execute the causes of action needed to perform breastfeeding behavior.

Implementation of a childbirth preparation program in the maternal and child health centres in Jordan.

OBJECTIVE: To investigate the feasibility and outcomes of introducing childbirth preparation programs in a sample of Maternal and Child Health centres in Jordan. DESIGN: An exploratory, descriptive design, and practice- research engagement was used to implement and evaluate the proposed childbirth preparation program. Face to face interviews and field notes were used to collect data. Outcomes of pregnancy and birth were collected from interviews with women using a structured format. SETTING AND PARTICIPANTS: Three Maternal and Child Health centres were randomly selected from the three main regions of Jordan. A convenience sample of 107 primigravid women was recruited for the implementation process. Six health staff (3 doctors and 3 midwives) also participated. FINDINGS: The practice- research engagement approach assisted the researchers and care providers in dealing with problems that arose during the implementation of the program. Out of the 107 women initially recruited, only 36 women completed the implementation program, with attrition rate of 65%. The main reasons for poor attendance included: difficulty in keeping contact with participants, transportation difficulties, duration of the program, health problems, antenatal follow up at a private clinic, and not having permission from husbands to attend. The effectiveness of the program was noticed through some improved pregnancy outcomes for the participants and the high satisfaction of the health professionals and women who participated. The program was effective in increasing knowledge and understanding of women regarding the different aspects of pregnancy, birth, and postnatal periods. It helped promote a trusting relationship between health professionals and women; and increased staff self confidence in providing specific and essential information to women. Women seemed to have an increased sense of control over the childbirth process, and it reinforced benefits and duration of breastfeeding and knowledge of family planning. Challenges identified by health professionals and women included: women's commitment and capacity to attend the scheduled sessions and shortage of qualified staff. KEY CONCLUSIONS: Implementing a childbirth preparation program in a developing country appears possible, successful, and effective if logistical and cultural requirements can be better addressed. This was evidenced with a high rate of participants' satisfaction (women and health care providers), and suggestions of improved pregnancy outcomes. IMPLICATIONS FOR PRACTICE: It is necessary to address some logistical issues of delivery and recognise the importance and limitations of current human resources. Policy makers in the Ministry of Health should consider implementation of a childbirth preparation program, as there are no existing programs. Clinical leaders, supported by researchers, should jointly consider reframing the program into a shorter more logistically acceptable delivery mode. This could be tested and evaluated.

The effect of a postnatal education and support program on breastfeeding among primiparous women: a randomized controlled trial.

INTRODUCTION: Women's traditional way of breastfeeding has altered in Jordan with rates declining in recent years. OBJECTIVE: The objectives of this study were to test whether the introduction of an educational program supporting breastfeeding would increase the proportion of women who breastfed fully to six months, improve the women's level of breastfeeding knowledge, and decrease the proportion of infants admitted to hospitals due to gastrointestinal illnesses. METHODS: A randomized controlled trial was conducted in 90 primiparous women who had given birth to a healthy, full term, singleton baby at two hospitals in the southern region of Jordan. Women were randomly allocated to either the intervention group (n=45), in which they were offered a one-to-one postnatal educational session and follow-up phone calls at two months and four months postpartum, or the control group (n=45), in which they received routine postnatal care. The primary outcomes were the proportion of women fully breastfeeding their babies at six months and the women's level of breastfeeding knowledge at six months postpartum. RESULTS: The postnatal education and support program significantly improved breastfeeding knowledge measured by differences between mean pre- and post-test scores. This was statistically significant for the intervention group (p<0.001) but was not significant for the control (p=0.23). The proportion of women fully breastfeeding their babies at 6 months was not found to be statistically significantly different between the intervention group (39%) and the control group (27%), percentage difference=12% (95% confidence interval [-9% to 30%], Chi squared: χ(2)=3.54, p>0.05). CONCLUSIONS: Although the postnatal education and support program improved breastfeeding knowledge among women in the study, this increase in knowledge did not translate to an increase in the duration of full breastfeeding to six months.

Childbirth practices in Jordanian public hospitals: consistency with evidence-based maternity care?

BACKGROUND: In 1996, the World Health Organization stated that 'childbirth is a natural process and in normal birth, there should be a valid reason to interfere with this natural process' and encouraged practices that are evidence-based. The practices encouraged included avoiding unnecessary augmentation of labour, facilitating upright position for birth and restricting the use of routine episiotomy. Many countries have been slow to fully implement evidence-based practice in maternity care. The aim of this study was to examine maternity hospital practices in Jordan and assess their consistency with evidence-based maternity care. METHODS: An explorative research design with non-participant observation was used. Data were collected from low-risk women during labour and birth using a questionnaire for maternal characteristics and an observational checklist. A proportional stratified sample was selected to recruit from three major public hospitals in Jordan. Data were analysed using descriptive statistics. RESULTS: A total of 460 women were observed during labour and birth. The majority were multiparous (80%). A range of interventions were observed in women having a normal labour including augmentation (95%), continuous external fetal monitoring (77%), lithotomy position for birth (100%), and more than one third (37%) had an episiotomy with varying degrees of laceration (58%). CONCLUSIONS: Childbirth practices were largely not in accordance with the World Health Organization evidence-based practices for normal birth. High levels of interventions were observed, many of which may not have been necessary in this low-risk population. Further work needs to occur to explore the reasons why evidence-based practice is not implemented in these hospitals.

Strategies used by Jordanian women to alleviate heartburn during pregnancy.

OBJECTIVE: to explore the strategies used by Jordanian women to manage heartburn during pregnancy. DESIGN: an exploratory descriptive study. PARTICIPANTS AND SETTING: 235 Jordanian women from the three regions of Jordan, aged between 18 and 54 years, who were pregnant at the time of the study or had previously had at least one full-term pregnancy. FINDINGS: a number of strategies were used by Jordanian women in the sample for the alleviation of heartburn of pregnancy, including non-pharmacological strategies such as diet and lifestyle changes, pharmacological treatments such as antacids, and the use of home remedies such as drinking cold milk, 'baking powder' in liquid form or herbs, eating cucumber, lintel seeds, or dry tea leaves. Women aged 40 years and older, who had lower income, and were not employed were more likely to use home remedies to manage heartburn in pregnancy than the other groups. Overall, women rated their chosen strategy as useful. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: heartburn can be very uncomfortable and can affect food intake and appetite, daily routine and even sleep. Heartburn during pregnancy is at risk for being poorly managed given that birth is the cure. As a health-care provider, it is important to prepare women and their families to manage heartburn during pregnancy effectively. Midwives should encourage women to seek help from care providers when they need it, and continue to assess heartburn and the strategies used to manage symptoms during pregnancy.

How women manage nausea and vomiting during pregnancy: a Jordanian study.

OBJECTIVE: to explore the strategies used by Jordanian women to manage nausea and vomiting during pregnancy. DESIGN: cross sectional descriptive study. SETTING: the three regions of Jordan. PARTICIPANTS: 235 women aged 18-54 years who had been pregnant. FINDINGS: there a number of strategies were used by Jordanian women in the sample for the alleviation of nausea and vomiting of pregnancy, varying from non-pharmacological strategies such as diet and lifestyle changes to the use of complementary alternative medicine and pharmacological treatments. IMPLICATIONS FOR PRACTICE: preparing women and their families to manage nausea and vomiting during pregnancy effectively is important; midwives should encourage women to seek help from care providers when they need it, and continue to assess nausea and vomiting and management strategies during the first weeks of pregnancy.

The lived experience of Jordanian women who received family support during labor.

PURPOSE: Policies regarding childbirth in Jordan currently exclude attendance by a female relative to provide support. This study was done in order to describe the experience of a group of Jordanian women who had been afforded support from a female relative during a nursing research project. DESIGN AND METHODS: Semistructured interviews were conducted with 25 women at 6 weeks postpartum. All of the women had given birth at the main hospital in the southern region of Jordan. FINDINGS: Women had positive experiences with their female relative support. Four themes were identified as common to the women involved: (1) increased sense of security, (2) provision of physical help, (3) communicating the woman's needs/wishes to her professional caregivers, and (4) emotional support and encouragement. CLINICAL IMPLICATIONS: The results show that the support of a female relative was helpful for this small group of Jordanian women experiencing their first labor and birth. Since the literature clearly shows that support in labor is appropriate and produces improved outcomes, public health practitioners in maternal and child health, along with hospitals, should emphasize this as a valuable resource for pregnant women. Non-Western or developing countries could benefit from more fully using evidence currently in the literature on a range of practices, including that of emotional and social support in labor.

A comparison of labour and birth outcomes in Jordan with WHO guidelines: a descriptive study using a new birth record.

AIM: to examine data collected during the testing of a new birth record in Jordan from 1 July to 31 August 2004, and to compare these practices with guidelines from the World Health Organization (WHO) and evidence-based recommendations. This was part of a larger study that used an action research approach to engage practitioners in implementation of the new record. DESIGN: descriptive, comparative design. SETTING: three Ministry of Health hospitals in Jordan. PARTICIPANTS: the birth records of 1254 mothers and babies were used. MEASUREMENTS: data on selected labour and birth practices were collected from the records. Comparisons were made using recognised evidence-based guidelines. FINDINGS: the rates of a number of labour and birth practices were inappropriately high, and differed from WHO guidelines and evidence-based recommendations. The rates of augmentation of labour (46%) and episiotomy (53%) were particularly high, and seem to be in excess of the WHO recommendations, which state that neither of these practices should be undertaken routinely. IMPLICATIONS FOR PRACTICE: information on labour and birth practices can assist clinicians working in these three hospitals to reflect upon their care and outcomes. Clinicians may be able to use this information to change practice to improve care for women and babies. Organisational support and clinical leadership are necessary in order to provide health professionals with time and resources to access research data and undertake comparisons that can lead to health service and system-level improvement.

Implementation of a new birth record in three hospitals in Jordan: a study of health system improvement.

This study tested the introduction of a new integrated clinical record in Jordan where currently no clinical report links antenatal, birth and postnatal care for women. As a result, no continuity of information is provided to clinicians nor are there national statistics on trends, or performance of hospitals around birth. Our study was conducted in the Jordanian Ministry of Health, the maternity wards and registration departments of three hospitals in Jordan and in the Maternal and Child Health Centres located near these hospitals. We used an exploratory, descriptive design and practice-research engagement to investigate and report on the process of change to improve and implement the new birth record. Through engaging practitioners in research, care improved, the quality of reporting changed, managers developed more effective measures of hospital performance and policy makers were provided with information that could form the basis of a national maternity data monitoring system. Quantitative and qualitative audit data demonstrated improved clinical reporting, organizational development and sustained commitment to the new record from clinicians, managers and policy leaders.