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1.
Int Nurs Rev ; 67(1): 7-10, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32083727

RESUMEN

Global healthcare expenditure is increasing, along with the numbers of older patients with multiple comorbidities, while the numbers of health workers are hugely decreasing, and many nursing and midwifery vacancies remain unfilled. With the World Health Organization declaring 2020 the Year of the Nurse and Midwife, and commencing the Nursing Now campaign with partners including the International Council of Nurses and the International Confederation of Midwives, has allowed these professions to unite, encourage advocacy and the call for global investment in nursing and midwifery. These actions will permit these professions to address universal health coverage, global inconsistencies of professional practice, and recruitment and retention. The Nightingale Challenge seeks to place early career nurses and midwives at the forefront of transformation, calling on employers worldwide to invest and provide nursing leadership development, and to become a key part of the solution to address the issues of providing universal health coverage, promoting gender equality and supporting economic growth. This will help place them at the heart of tackling 21st century health challenges.


Asunto(s)
Liderazgo , Partería , Organización Mundial de la Salud , Femenino , Humanos , Consejo Internacional de Enfermeras , Partería/organización & administración , Enfermeras Obstetrices , Rol de la Enfermera , Embarazo
2.
BMC Health Serv Res ; 19(1): 719, 2019 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-31639001

RESUMEN

BACKGROUND: Despite improvements in recent years, Ethiopia faces a high burden of maternal morbidity and mortality. Antenatal care (ANC) may reduce maternal morbidity and mortality through the detection of pregnancy-related complications, and increased health facility-based deliveries. Midwives and community-based Health Extension Workers (HEWs) collaborate to promote and deliver ANC to women in these communities, but little research has been conducted on the professional working relationships between these two health providers. This study aims to generate a better understanding of the strength and quality of professional interaction between these two key actors, which is instrumental in improving healthcare performance, and thereby community health outcomes. METHODS: We conducted eleven in-depth interviews with midwives from three rural districts within Jimma Zone, Ethiopia (Gomma, Kersa, and Seka Chekorsa) as a part of the larger Safe Motherhood Project. Interviews explored midwives' perceptions of strengths and weaknesses in ANC provision, with a focus as well on their engagement with HEWs. Thematic content analysis using Atlas.ti software was used to analyse the data using an inductive approach. RESULTS: Midwives interacted with HEWs throughout three key aspects of ANC promotion and delivery: health promotion, community outreach, and provision of ANC services to women at the health centre and health posts. While HEWs had a larger role in promoting ANC services in the community, midwives functioned in a supervisory capacity and provided more clinical aspects of care. Midwives' ability to work with HEWs was hindered by shortages in human, material and financial resources, as well as infrastructure and training deficits. Nevertheless, midwives felt that closer collaboration with HEWs was worthwhile to enhance service provision. Improved communication channels, more professional training opportunities and better-defined roles and responsibilities were identified as ways to strengthen midwives' working relationships with HEWs. CONCLUSION: Enhancing the collaborative interactions between midwives and HEWs is important to increase the reach and impact of ANC services and improve maternal, newborn and child health outcomes more broadly. Steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening.


Asunto(s)
Promoción de la Salud/organización & administración , Partería/organización & administración , Atención Prenatal , Adulto , Actitud del Personal de Salud , Etiopía/epidemiología , Estudios de Evaluación como Asunto , Femenino , Humanos , Recién Nacido , Embarazo , Atención Prenatal/organización & administración , Población Rural
4.
BMC Pregnancy Childbirth ; 19(1): 331, 2019 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-31500580

RESUMEN

BACKGROUND: In the United Kingdom, midwives will engage in discussions with the multidisciplinary team as to whether they can provide Obstetric High Dependency Care (OHDC) on the Delivery Suite or whether a woman's care should be escalated to the critical care team. This study aimed to explore the question: What factors influence midwives to provide OHDC or request care be escalated away from the obstetric unit in hospitals remote from tertiary referral centres? METHODS: Focus groups were undertaken with midwives (n = 34) across three obstetric units in England, with annual birth rates ranging from 1500 to 5000 per annum, in District General Hospitals. Three scenarios in the form of video vignettes of handover were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission of woman with chest pain receiving facial oxygen and requiring continuous electrocardiogram (ECG) monitoring. Two focus groups were conducted in each of the obstetric units with experienced midwives. Data were analysed using a qualitative framework approach. RESULTS: Factors influencing midwives' care escalation decisions included the care environment, a woman's diagnosis and fetal or neonatal factors. The overall plan of care including the need for ECG and invasive monitoring were also influential factors. Midwives in the smallest obstetric unit did not have access to the facilities for OHDC provision. Midwives in the larger obstetric units provided OHDC but identified varying degrees of skill and sometimes used 'workarounds' to facilitate care provision. Midwifery staffing levels, skill mix and workload were also influential. Some differences of opinion were evident between midwives working in the same obstetric units as to whether OHDC could be provided and the support they would enlist to help them provide it. Reliance on clinical guidelines appeared variable. CONCLUSIONS: Findings indicate that there may be inequitable OHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable OHDC care including skills development for midwives and precise escalation guidelines to minimise workarounds. Training for midwives must include strategies that prevent skills fade.


Asunto(s)
Competencia Clínica , Parto Obstétrico , Servicios de Salud Materna/organización & administración , Partería , Complicaciones del Trabajo de Parto , Carga de Trabajo/psicología , Adulto , Actitud del Personal de Salud , Salas de Parto/normas , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Parto Obstétrico/psicología , Femenino , Grupos Focales , Humanos , Partería/métodos , Partería/organización & administración , Partería/normas , Evaluación de Necesidades , Complicaciones del Trabajo de Parto/clasificación , Complicaciones del Trabajo de Parto/terapia , Transferencia de Pacientes/métodos , Embarazo , Derivación y Consulta , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/normas , Reino Unido
5.
BMC Pregnancy Childbirth ; 19(1): 332, 2019 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-31500582

RESUMEN

BACKGROUND: The North Eastern region in Kenya experiences challenges in the utilization of maternal and newborn health services. In this region, culture and religion play a major role in influencing healthcare seeking behaviour of the community. This study was conducted to (i) understand key inherent barriers to health facility delivery in the Somali community of North Eastern Kenya and (ii) inform interventions on specific needs of this community. METHODS: The study was conducted among community members of Garissa sub-County as part of a baseline assessment before the implementation of an intervention package aimed at creating demand and increasing utilization of maternal and newborn services. Focus group discussions and key informant interviews were conducted with clan leaders, Imams, health managers, member of the county assembly, and service users (women and men) in three locations of Garissa sub-County. Data were analysed through content analysis, by coding recurrent themes and pre-established themes. RESULTS: Using health facility for delivery was widely acceptable and most respondents acknowledged the advantages and benefits of skilled birth delivery. However, a commonly cited barrier in using health facility delivery was the issue of male nurses and doctors attending to women in labour. According to participants, it is against their culture and thus a key disincentive to using maternity services. Living far from the health facility and lack of a proper and reliable means of transportation was also highlighted as a reason for home delivery. At the health facility level, respondents complained about the poor attitude of health care providers, especially female nurses being disrespectful; and the limited availability of healthcare workers, equipment and supplies. Lack of awareness and information on the importance of skilled birth attendance was also noted. CONCLUSION: To increase health facility delivery, interventions need to offer services that take into consideration the sociocultural aspect of the recipients. Culturally acceptable and sensitive services, and awareness on the benefits of skilled birth attendance among the community members are likely to attract more women to use maternity services and thus reduce adverse maternal and newborn health outcomes.


Asunto(s)
Cultura , Parto Obstétrico , Servicios de Salud Materna , Enfermeros/psicología , Aceptación de la Atención de Salud , Mujeres Embarazadas/psicología , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/psicología , Parto Obstétrico/estadística & datos numéricos , Femenino , Grupos Focales , Humanos , Kenia , Masculino , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/estadística & datos numéricos , Partería/organización & administración , Partería/normas , Evaluación de Necesidades , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Embarazo , Investigación Cualitativa , Factores Sexuales , Percepción Social , Negativa del Paciente al Tratamiento/psicología , Negativa del Paciente al Tratamiento/estadística & datos numéricos
6.
BMC Health Serv Res ; 19(1): 655, 2019 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-31500636

RESUMEN

BACKGROUND: Uganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda's skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care. METHODS: This is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis. RESULTS: The skilled birth attendance policy was an important priority on Uganda's maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional. CONCLUSION: Uganda's skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.


Asunto(s)
Política de Salud , Accesibilidad a los Servicios de Salud/normas , Servicios de Salud Materna/organización & administración , Partería/organización & administración , Enfermeras Obstetrices/provisión & distribución , Parto Obstétrico/normas , Parto Obstétrico/estadística & datos numéricos , Femenino , Instituciones de Salud/normas , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Servicios de Salud Materna/normas , Mortalidad Materna , Partería/normas , Partería/estadística & datos numéricos , Enfermeras Obstetrices/organización & administración , Enfermeras Obstetrices/normas , Obstetricia/normas , Formulación de Políticas , Embarazo , Calidad de la Atención de Salud , Uganda
7.
Nurs Outlook ; 67(6): 642-648, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31376985

RESUMEN

To meet the United Nations Sustainable Development Goals (SDGs) in the United States, research by nurses and midwives has a real opportunity to make a significant impact. This paper identifies opportunities to strengthen research capacity in the United States amongst nurses and midwives in ways that will help meet the SDGs and ensure its sustainability. Research capacity means that in a country, there are individuals and teams capable of defining problems, setting priorities, establishing objectives for the goals of the research study, and following rigorous scientific procedures. By strengthening U.S. research capacity by addressing critical weaknesses in content expertise, nursing and midwifery's voices in policy dialogues, and global research initiatives will be have greater assurance of being included.


Asunto(s)
Salud Global , Partería/organización & administración , Atención de Enfermería/organización & administración , Desarrollo Sostenible , Creación de Capacidad , Femenino , Humanos , Objetivos Organizacionales , Embarazo , Naciones Unidas , Estados Unidos
8.
J Clin Nurs ; 28(23-24): 4225-4235, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31410929

RESUMEN

AIMS AND OBJECTIVES: To synthesise international research that relates to midwives' use of best available evidence in practice settings and identify key issues relating to the translation of latest evidence into everyday maternity care. BACKGROUND: Midwifery is a research-informed profession. However, a gap persists in the translation of best available evidence into practice settings, compromising gold standard maternity care and delaying the translation of new knowledge into everyday practice. DESIGN: A five-step integrative review approach, based on a series of articles published by the Joanna Briggs Institute (JBI) for conducting systematic reviews, was used to facilitate development of a search strategy, selection criteria and quality appraisal process, and the extraction and synthesis of data to inform an integrative review. METHODS: The databases CINAHL, MEDLINE, Web of Science, Implementation Science Journal and Scopus were searched for relevant articles. The screening and quality appraisal process complied with the PRISMA 2009 checklist. Narrative analysis was used to develop sub-categories and dimensions from the data, which were then synthesised to form two major categories that together answer the review question. RESULTS: The six articles reviewed report on midwives' use of best available evidence in Australia, the UK and Asia. Two major categories emerged that confirm that although midwifery values evidence-based practice (EBP), evidence-informed maternity care is not always employed in clinical settings. Additionally, closure of the evidence-to-practice gap in maternity care requires a multidimensional approach. CONCLUSION: Collaborative partnerships between midwives and researchers are necessary to initiate strategies that support midwives' efforts to facilitate the timely movement of best available evidence into practice. RELEVANCE TO CLINICAL PRACTICE: Understanding midwives' use of best available evidence in practice will direct future efforts towards the development of mechanisms that facilitate the timely uptake of latest evidence by all maternity care providers working in clinical settings.


Asunto(s)
Partería/organización & administración , Enfermeras Obstetrices/organización & administración , Conducta Cooperativa , Enfermería Basada en la Evidencia/métodos , Femenino , Humanos , Embarazo
9.
Nurs Outlook ; 67(6): 628-641, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31420180

RESUMEN

The United Nations 2030 Agenda for Sustainable Development was implemented on January 1, 2016 and is composed of 17 Sustainable Development Goals (SDGs) and further delineated by 169 targets. This article offers background information on the 2030 Agenda as it relates to nursing and midwifery, professional organizational initiatives currently advancing the SDGs, the ethos of global citizenship, the urgency to respond to dwindling planetary health, the salience of nursing and midwifery advocacy in SDG attainment, and the myriad opportunities for nurses to lead and collaborate toward realizing these Global Goals. A US-based perspective is employed to underscore the Agenda's relevance to the US nursing workforce and healthcare system. The SDGs, with their holistic bio-psycho-social-environmental approach to health, present enormous opportunities for nurses and midwives. The SDG framework is naturally aligned with the foundational philosophy and purpose of our professions.


Asunto(s)
Defensa del Consumidor , Salud Global , Partería/organización & administración , Atención de Enfermería/organización & administración , Desarrollo Sostenible , Femenino , Humanos , Objetivos Organizacionales , Embarazo , Naciones Unidas
10.
Women Birth ; 32(5): 427-436, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31326382

RESUMEN

BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.


Asunto(s)
Continuidad de la Atención al Paciente , Servicios de Salud del Indígena , Servicios de Salud Materna/organización & administración , Bienestar Materno/etnología , Partería/organización & administración , Grupo de Ascendencia Oceánica/psicología , Parto/etnología , Adulto , Australia , Características Culturales , Femenino , Humanos , Obstetricia , Embarazo , Fumar
11.
Midwifery ; 77: 144-154, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31330402

RESUMEN

OBJECTIVES: To compare neonatal and maternal outcomes, and the relative risk of interventions between mothers attended to by midwives, general practitioners, and obstetricians, and to assess the cost-effectiveness of the employee-model of midwifery-led care in Nova Scotia, Canada, when compared with general practitioners. DESIGN, SETTING, AND PARTICIPANTS: The study was a retrospective cohort study involving routinely collected clinical and administrative data from all low-risk births from January 1st, 2013 to December 31st, 2017. There were 24,662 observations. MEASUREMENTS: Descriptive statistics were used to summarise the mother's socio-demographic characteristics. We used a nearest-neighbour matching estimator in assessing differences in outcomes, and generalized linear models in the estimation of the risks of interventions, adjusting for potential confounders. An analytic decision tree served as the vehicle for the cost-effectiveness analysis, assessed using the net monetary benefit approach. All health care resources utilized were measured and valued. Neonatal intensive care admissions avoided was the measure of outcome. We performed probabilistic sensitivity and subgroup analyses. FINDINGS: Mothers attended to by midwives spent less time at the hospital during birth admissions, were less likely to have interventions, instrumental births, and more likely to have exclusive breastfeeding at discharge from birth admission. There were no differences in Apgar scores and neonatal intensive care unit admissions. The employee-model of midwifery-led care was found to be cost-effective. KEY CONCLUSIONS: The midwifery program is both effective and cost-effective for low-risk pregnancies IMPLICATIONS FOR PRACTICE: Increasing the number of midwives will increase access and represents value for money.


Asunto(s)
Análisis Costo-Beneficio/normas , Partería/métodos , Pautas de la Práctica en Enfermería/normas , Calidad de la Atención de Salud/normas , Adulto , Estudios de Cohortes , Análisis Costo-Beneficio/estadística & datos numéricos , Femenino , Humanos , Recién Nacido , Partería/organización & administración , Partería/estadística & datos numéricos , Nueva Escocia , Pautas de la Práctica en Enfermería/organización & administración , Pautas de la Práctica en Enfermería/estadística & datos numéricos , Embarazo , Calidad de la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos
12.
BMC Pregnancy Childbirth ; 19(1): 206, 2019 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-31286892

RESUMEN

BACKGROUND: Caesarean sections (CSs) are associated with increased maternal and perinatal morbidity, yet rates continue to increase within most countries. Effective interventions are required to reduce the number of non-medically indicated CSs and improve outcomes for women and infants. This paper reports findings of a systematic review of literature related to maternity service organisational interventions that have a primary intention of improving CS rates. METHOD: A three-phase search strategy was implemented to identify studies utilising organisational interventions to improve CS rates in maternity services. The database search (including Cochrane CENTRAL, CINAHL, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS) was restricted to peer-reviewed journal articles published from 1 January 1980 to 31 December 2017. Reference lists of relevant reviews and included studies were also searched. Primary outcomes were overall, planned, and unplanned CS rates. Secondary outcomes included a suite of birth outcomes. A series of meta-analyses were performed in RevMan, separated by type of organisational intervention and outcome of interest. Summary risk ratios with 95% confidence intervals were presented as the effect measure. Effect sizes were pooled using a random-effects model. RESULTS: Fifteen articles were included in the systematic review, nine of which were included in at least one meta-analysis. Results indicated that, compared with women allocated to usual care, women allocated to midwife-led models of care implemented across pregnancy, labour and birth, and the postnatal period were, on average, less likely to experience CS (overall) (average RR 0.83, 95% CI 0.73 to 0.96), planned CS (average RR 0.75, 95% CI 0.61 to 0.93), and episiotomy (average RR 0.84, 95% CI 0.74 to 0.95). Narratively, audit and feedback, and a hospital policy of mandatory second opinion for CS, were identified as interventions that have potential to reduce CS rates. CONCLUSION: Maternity service leaders should consider the adoption of midwife-led models of care across the maternity episode within their organisations, particularly for women classified as low-risk. Additional studies are required that utilise either audit and feedback, or a hospital policy of mandatory second opinion for CS, to facilitate the quantification of intervention effects within future reviews. PROSPERO REGISTRATION: CRD42016039458 ; prospectively registered.


Asunto(s)
Cesárea/estadística & datos numéricos , Prestación de Atención de Salud/organización & administración , Partería/organización & administración , Atención Perinatal/organización & administración , Mejoramiento de la Calidad/organización & administración , Cesárea/normas , Prestación de Atención de Salud/métodos , Femenino , Humanos , Partería/métodos , Modelos Estadísticos , Atención Perinatal/métodos , Embarazo
13.
Midwifery ; 77: 78-85, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31271963

RESUMEN

BACKGROUND: Alongside midwifery units (AMUs) are managed by midwives and proximate to obstetric units (OUs), offering a home-like birth environment for women with straightforward pregnancies. They support physiological birth, with fast access to medical care if needed. AMUs have good perinatal outcomes and lower rates of interventions than OUs. In England, uptake remains lower than potential use, despite recent changes in policy to support their use. This article reports on experiences of access from a broader study that investigated AMU organisation and care. METHODS: Organisational case studies in four National Health Service (NHS) Trusts in England, selected for variation geographically and in features of their midwifery units. Fieldwork (December 2011 to October 2012) included observations (>100 h); semi-structured interviews with staff, managers and stakeholders (n = 89) and with postnatal women and partners (n = 47), on which this paper reports. Data were analysed thematically using NVivo10 software. RESULTS: Women, partners and families felt welcome and valued in the AMU. They were drawn to the AMUs' environment, philosophy and approach to technology, including pain management. Access for some was hindered by inconsistent information about the existence, environment and safety of AMUs, and barriers to admission in early labour. CONCLUSIONS: Key barriers to AMUs arise through inequitable information and challenges with admission in early labour. Most women still give birth in obstetric units and despite increases in the numbers of women birthing on AMUs since 2010, addressing these barriers will be essential to future scale-up.


Asunto(s)
Accesibilidad a los Servicios de Salud/normas , Partería/normas , Adulto , Centros de Asistencia al Embarazo y al Parto/organización & administración , Centros de Asistencia al Embarazo y al Parto/normas , Centros de Asistencia al Embarazo y al Parto/estadística & datos numéricos , Inglaterra , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Partería/organización & administración , Servicio de Ginecología y Obstetricia en Hospital , Prioridad del Paciente/psicología , Prioridad del Paciente/estadística & datos numéricos , Investigación Cualitativa , Medicina Estatal/organización & administración
14.
Rev Lat Am Enfermagem ; 27: e3139, 2019 Apr 29.
Artículo en Portugués, Inglés, Español | MEDLINE | ID: mdl-31038633

RESUMEN

OBJECTIVE: to compare, after four years of the implementation of the Stork Network, the obstetric practices developed in a university hospital according to the classification of the World Health Organization. METHOD: cross-sectional study carried out in the year of adherence to the Stork Network (377 women) and replicated four years later (586 women). Data were obtained through medical records and a structured questionnaire. The Chi-square test was used in the analysis. RESULTS: four years after the implementation of the Stork Network, in Category A practices (demonstrably useful practices/good practices), there was increased frequency of companions, non-pharmacological methods, skin-to-skin contact and breastfeeding stimulation, and decreased freedom of position/movement. In Category B (harmful practices), there was reduction of trichotomy and increased venoclysis. In Category C (practices with no sufficient evidence), there was increase of Kristeller's maneuver. In Category D (improperly used practices), the percentage of digital examinations above the recommended level increased, as well as of analgesics and analgesia, and there was decrease of episiotomy. CONCLUSION: these findings indicate the maintenance of a technocratic and interventionist assistance and address the need for changes in the obstetric care model. A globally consolidated path is the incorporation of midwife nurses into childbirth for the appropriate use of technologies and the reduction of unnecessary interventions.


Asunto(s)
Parto Obstétrico/enfermería , Promoción de la Salud/organización & administración , Partería/organización & administración , Parto , Adulto , Brasil , Lactancia Materna , Estudios Transversales , Parto Obstétrico/normas , Práctica Clínica Basada en la Evidencia , Femenino , Promoción de la Salud/normas , Hospitales Universitarios , Humanos , Trabajo de Parto , Servicios de Salud Materna , Partería/métodos , Partería/normas , Embarazo , Desarrollo de Programa , Factores Socioeconómicos , Adulto Joven
15.
Int J Gynaecol Obstet ; 146(1): 126-131, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31058318

RESUMEN

After the declaration of the Millennium Development Goals in 2000 by the United Nations, many stakeholders allocated financial resources to "global maternal health." Research to expand care and improve delivery of maternal health services has exponentially increased. The present article highlights an overview, namely 10 of the health system, clinical, and technology-based advancements that have occurred in the past three decades in the field of global maternal health. The list of topics has been selected through the cumulative clinical and public health expertise of the authors and is certainly not exhaustive. Rather, the list is intended to provide a mapping of key topics arranged from broad to specific that span from the global policy level to the level of individual care. The list of health system, clinical, and technology-based advancements include: (10) Millennium Development Goals and Sustainable Development Goals; (9) Development of clinical training programs, including the potential for subspecialty development; (8) Prenatal care expansion and potential; (7) Decentralized health systems, including the use of skilled birth attendants; (6) Antiretroviral therapy for HIV; (5) Essential medicines; (4) Vaccines; (3) mHealth/eHealth; (2) Ultrasonography; and (1) Obstetric hemorrhage management. With the Sustainable Development Goals now underway, the field must build upon past successes to sustain maternal and neonatal well-being in the future global health agenda.


Asunto(s)
Salud Global/normas , Salud Materna/normas , Atención Prenatal/organización & administración , Femenino , Humanos , Mortalidad Materna , Partería/organización & administración , Mortalidad Perinatal , Embarazo , Desarrollo Sostenible , Naciones Unidas
16.
Sex Reprod Healthc ; 20: 87-92, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31084826

RESUMEN

BACKGROUND: Midwifery practice is in the process of continuing developments and contemporary working conditions asking for proactive behaviour, which could increase work-efficiency, job satisfaction, commitment and coping attitudes towards stress resistance. This study aims to provide an in depth exploration of midwives' perceptions of facilitators and/or barriers of proactive behaviour in midwifery practice. METHODS: A qualitative descriptive study, using individual semi-structured interviews, was undertaken within a sample of 102 Flemish and Dutch midwives who were interviewed from September to December 2017 using a four-item topic-list. RESULTS: Six influencing factors emerged from the data consisted of the causal, contextual and conditional factors faced by the midwives in order to show proactive behaviour in midwifery practice. Midwives elaborated the need for team consultations, a safe organizational culture, an appreciative midwifery leader and an attitude of lifelong learning. Furthermore, midwives are looking for a way to deal with both challenges in healthcare and the competitive societal system. CONCLUSION: This inductive study confirmed, supported and expanded previous deductive research and provided additional insights of proactive behaviour in midwifery. Providing midwives with knowledge of the influencing factors, required to successfully effecting proactive behaviour in midwifery, this study has subsequently merit for future research in the transfer of recommendation in daily midwifery practice, education and policymaking.


Asunto(s)
Actitud del Personal de Salud , Conducta , Partería/métodos , Adulto , Femenino , Procesos de Grupo , Humanos , Liderazgo , Masculino , Persona de Mediana Edad , Partería/educación , Partería/organización & administración , Cultura Organizacional , Grupo de Atención al Paciente/organización & administración , Investigación Cualitativa , Adulto Joven
17.
Int J Health Plann Manage ; 34(2): e987-e994, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30945362

RESUMEN

Following the World Health Organization's recommendation for developing countries to discontinue the use of Traditional Birth Attendants (TBAs) in rural areas, the government of Ghana banned TBAs from offering maternal health care services. Since this ban, community-level conflicts have intensified between TBAs, (who still see themselves as legitimate culturally mandated traditional midwives) and nurses. In this articles, we propose a partnership model for a sustainable resolution of these conflicts. This article emanates from the apparent ideological discontent between people from mainstream medical practice who advocate for the complete elimination of TBAs in the maternal health service space and individuals who argue for the inclusion of TBAs in the health sector given the shortage of skilled birth attendants and continued patronage of their services by rural women even in context where nurses are available. In the context of the longstanding manpower deficit in the health sector in Ghana, improving maternal healthcare in rural communities will require harnessing all locally available human resources. This cannot be achieved by "throwing out" a critical group of actors who have been involved in health-care provision for many decades. We propose a win-win approach that involve retraining of TBAs, partnership with health practitioners, and task shifting.


Asunto(s)
Servicios de Salud Materna/normas , Partería/organización & administración , Mejoramiento de la Calidad , Servicios de Salud Rural , Femenino , Ghana , Humanos , Embarazo
18.
PLoS One ; 14(4): e0214577, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30947314

RESUMEN

BACKGROUND: While Nepal's maternal mortality ratio (MMR) has improved overall, the proportion of maternal deaths occurring in health facilities and attended to by skilled birth attendants (SBAs), has nearly doubled over 12 years. Although there are numerous socioeconomic, environmental and other factors at play, one possible explanation for this discrepancy between utilization of skilled maternal care services and birth outcomes lies in the quality of care being provided by SBAs. The objective of this study is to determine how competent SBAs are after training, across multiple settings and facility types in Nepal. METHODS: We used a quantitative cross-sectional analysis to evaluate a sample of 511 SBAs, all female, from 276 sub-health posts (SHP), health posts (HP), primary healthcare centers (PHC), and district and regional hospitals in the mountain, hill, and terai districts of Nepal. Any SBA actively employed by one of these health facilities was included. SBAs who had received less than three months of training were excluded. Outcomes were measured using SBAs' scores on a standardized knowledge assessment, clinical skills assessment, and monthly delivery volume, particularly as it compared with the WHO's recommendation for minimum monthly volume to maintain competence. RESULTS: SBAs on average exhibit a deficiency of both knowledge and clinical skills, failing to meet even the 80-percent standard that is required to pass training (knowledge: 75%, standard deviation 12%; clinical skills: 48%, standard deviation 15%). Moreover, SBAs are conducting very few deliveries, with only 7 percent (38/511) meeting the minimal volume recommended to maintain competence by the WHO, and a substantial fraction (70/511, 14%) performing an average of no monthly deliveries at all. CONCLUSIONS: Taken together, our findings suggest that while countries like Nepal have made important investments in SBA programs, these healthcare workers are failing to receive either effective training or sufficient practice to stay clinically competent and knowledgeable in the field. This could in part explain why institutional deliveries have generally failed to deliver better outcomes for pregnant women and their babies.


Asunto(s)
Personal de Salud , Servicios de Salud Materna/organización & administración , Partería/organización & administración , Partería/normas , Parto , Calidad de la Atención de Salud , Adulto , Competencia Clínica , Estudios Transversales , Parto Obstétrico , Femenino , Instituciones de Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Recién Nacido , Persona de Mediana Edad , Nepal , Enfermeras y Enfermeros , Embarazo , Estudios Retrospectivos , Servicios de Salud Rural , Población Rural
19.
PLoS One ; 14(4): e0215098, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30973919

RESUMEN

OBJECTIVE: To explore pregnant women's preferences for birth setting in England. DESIGN: Labelled discrete choice experiment (DCE). SETTING: Online survey. SAMPLE: Pregnant women recruited through social media and an online panel. METHODS: We developed a DCE to assess women's preferences for four hypothetical birth settings based on seven attributes: reputation, continuity of care, distance from home, time to see a doctor, partner able to stay overnight, chance of straightforward birth and safety for baby. We used a mixed logit model, with setting modelled as an alternative-specific constant, and conducted a scenario analysis to evaluate the impact of changes in attribute levels on uptake of birth settings. MAIN OUTCOME MEASURES: Women's preferences for birth setting. RESULTS: 257 pregnant women completed the DCE. All birth setting attributes, except 'time to see doctor', were significant in women's choice (p<0.05). There was significant heterogeneity in preferences for some attributes. Changes to levels for 'safety for the baby' and 'partner able to stay overnight' were associated with larger changes from baseline uptake of birth setting. If the preferences identified were translated into the real-world context up to a third of those who reported planning birth in an obstetric unit might choose a midwifery unit assuming universal access to all settings, and knowledge of the differences between settings. CONCLUSIONS: We found that 'safety for the baby', 'chance of a straightforward birth' and 'can the woman's partner stay overnight following birth' were particularly important in women's preferences for hypothetical birth setting. If all birth settings were available to women and they were aware of the differences between them, it is likely that more low risk women who currently plan birth in OUs might choose a midwifery unit.


Asunto(s)
Entorno del Parto/estadística & datos numéricos , Conducta de Elección , Toma de Decisiones , Conocimientos, Actitudes y Práctica en Salud , Partería/organización & administración , Prioridad del Paciente , Mujeres Embarazadas/psicología , Adulto , Inglaterra , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Embarazo , Atención Prenatal , Encuestas y Cuestionarios , Adulto Joven
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