Breastfeeding Women's Attitudes About the SARS-COV-2 Vaccine in Spain.

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus 2 has spread globally, causing the coronavirus disease 2019 (COVID-19) pandemic. To control the pandemic and to achieve herd immunity, four vaccines have obtained market authorization in Europe. Researchers have reported that the sequence of administration of the vaccines depends on the risk of exposure to COVID-19 and age, recommending the vaccine to pregnant and breastfeeding women. RESEARCH AIM: To examine the knowledge, willingness and attitudes of breastfeeding women in Spain regarding the possibility of receiving the COVID-19 vaccine. METHODS: An observational descriptive cross-sectional study in two tertiary-level hospitals from Valencia was conducted. Breastfeeding women (N = 301) were recruited by non-probability sampling of consecutive cases. Questionnaires were collected in June 2021. RESULTS: More than one in every two participants would accept a COVID-19 vaccine, and the percentage rose in participants who were older, more educated, or worked in high-risk jobs. Their main source of information was the Internet, and midwives were the professionals who most recommended vaccination. Participants who would not accept vaccination during lactation reported reasons linked to lack of information regarding vaccination in their condition and how it might affect newborns. CONCLUSION: It is of primary concern for healthcare professionals to foster a greater understanding by providing updated information regarding the need, safety, and efficacy of the vaccine for both lactating mothers and their newborns.

Experiences and attitudes of midwives during the birth of a pregnant woman with COVID-19 infection: A qualitative study.

BACKGROUND: The COVID-19 pandemic has become one of the most important threats to global health. Midwives are at the core of the response to the pandemic. Women still need midwifery support and care. The work of midwives is acknowledged as emotionally demanding, and their welfare may be compromised by a range of workplace and personal stress factors. AIM: To investigate the experiences and attitudes of midwives who have provided pregnancy and childbirth care to women with a confirmed or suspected COVID-19 infection. METHODS: A qualitative phenomenological study was carried out in two Spanish tertiary hospitals. Fourteen midwives were recruited by purposive sampling technique. Data were collected through individual in-depth interviews and analysed using Giorgi's descriptive method. FINDINGS: Three themes emerged: "challenges and differences when working in a pandemic", "emotional and mental health and wellbeing" and "women's emotional impact perceived by midwives". Midwives pointed to several factors tied to a safe, supportive and empowering work place: support from staff and managers, access to adequate personal protective equipment, and reliable guidelines. They also dealt with professional and personal challenges during the pandemic, showing feelings of fear, anxiety, uncertainty, discomfort, lack of support, and knowledge. Finally, midwives expressed their concerns about the feelings of pregnant women with COVID-19, such as fear, anxiety, and loneliness. CONCLUSION: The results of this study show some of the challenges for midwives during the course of the COVID-19 pandemic, emphasizing the value of a good communication, emotional support, and stress management, to provide woman-centred care.

Intervenciones de enfermería en el abordaje de la pérdida perinatal y su afrontamiento por las enfermeras: revisión bibliográfica / Perinatal loss: literature review of nursing interventions and nurse coping mechanisms

FUNDAMENTOS: La muerte perinatal es un suceso traumático que requiere de una atención humanizada con cuidados enfermeros de calidad para ayudar a padres y madres al afrontamiento saludable del duelo. OBJETIVOS: Analizar la importancia de los cuidados enfermeros y su repercusión en el duelo, explorando prácticas enfermeras adecuadas, así comovalorar el afrontamiento que hacen las enfermeras de ese proceso de atención al duelo perinatal. MÉTODOS: Revisión bibliográfica de la literatura en inglés, portugués y español de los últimos 5 años, en las bases de datos: Pubmed, Cuiden, Dialnet, IBECS, Scielo, Lilacs, MEDES. Los términos DeCS y MeSH utilizados fueron: muerte perinatal, mortinato, duelo, cuidados de enfermería, adaptación psicológica y enfermería. Se identificaron 375 documentos. Se utilizaron guías de calidad CASPe apropiadas a cada diseño. RESULTADOS: Se seleccionaron 17 documentos, sobre el abordaje enfermero en la pérdida perinatal y el afrontamiento de los profesionales. La creación de "caja de recuerdos" del bebé y el contacto con el mortinato se mostraron beneficiosos para la prevención del duelo complicado. Los profesionales tienden a evitar el contacto con los progenitores por la alta carga emocional y desgaste que supone. CONCLUSIONES: La atención enfermera en el abordaje de la pérdida perinatal debe basarse en cuidados rigurosos, procedimentados con guías e individualizados. Es importante la creación de recuerdos y la formación específica de los profesionales en este ámbito de actuación, así como la protección emocional de los profesionales que prestan cuidados en la muerte perinatal

BACKGROUND: Perinatal death is a highly traumatic event that requires a humanized care with quality nursing care to help parents to a healthy coping of grief. OBJECTIVS: To analyze the importance of quality nursing care and its impact on grief, exploring appropriate nursing practices, as well as assessing the nurses' coping with this process of attention to perinatal grief. METHODOLOGY: Bibliographic review of the literature in English, Portuguese and Spanish in the last 5 years, in data-bases: Pubmed, Cuiden, Dialnet, IBECS, Scielo, Lilacs, MEDES. DeCS-MeSH terms used: perinatal death, stillbirth, grief, nursing care, psychological adaptation and nursing. 375 documents were identified. CASPe quality guides appropriate to each design were used. RESULTS: 17 articles were selected, focusing on the nursing approach in perinatal loss and the coping of professionals. The creation of the baby's "memory box" and contact with the stillborn becomes beneficial for the prevention of complicated grief. Professionals tend to avoid contact with the parents because of the high emotional burden and wear it entails. CONCLUSIONS: Nursing care in the approach to perinatal loss should be based on rigorous care, proceduralized with guidelines and individualized. It is important to create memories and the specific training of professionals in this field of action, as well as the emotional protection of professionals

Women's satisfaction with maternity care during preterm birth.

BACKGROUND: Women's satisfaction with maternity care is strongly influenced by their sociodemographic characteristics, values, and attitudes. The arrival of a preterm baby is often a traumatic time, with unique factors involved. The Spanish Preterm Birth Experience and Satisfaction Scale (P-BESS) is a robust instrument capable of assessing women's satisfaction during preterm birth. The purpose of this study was to assess women's satisfaction with maternity care during labor and birth with preterm babies in a Spanish-speaking population. METHODS: This is a cross-sectional study. Participants were 182 women who gave birth within 37 weeks' gestation. Factors associated with satisfaction were studied through univariate and bivariate analyses and through multiple linear regression using the backward elimination method. RESULTS: Women reported high satisfaction with maternity care overall (average score of 84 out of 95). Women with a university education were generally less satisfied. Women were more satisfied if they were pregnant for the first time. Women who reported a previous premature birth or neonatal death were more satisfied, and women who had prior miscarriages were less satisfied compared with women without these experiences. CONCLUSIONS: The analysis confirmed that the majority of women surveyed were very satisfied with their childbirth experience. The Spanish P-BESS can be a useful way of prioritizing intervention measures, focusing on those aspects lowest scored by women, such as "information and explanations" and "confidence in staff," to improve maternity services for families experiencing preterm birth.

Development of a short questionnaire based on the Practice Environment Scale-Nursing Work Index in primary health care.

BACKGROUND: Professional nursing environments determine the quality of care and patient outcomes. Assessing the quality of environments is essential to improve and obtain better health outcomes. Simplifying and shortening the way to evaluate environments reliably is also important to help nurses better understand the strengths and weaknesses of their environments. In that sense, identifying essential elements of nursing environments would allow the construction of short assessment tools to improve such environments. OBJECTIVE: To construct a short tool to assess primary health care (PHC) nursing environments based on the Practice Environment Scale-Nursing Work Index (PES-NWI) questionnaire. METHODS: Observational, cross-sectional, analytical study (data collection February-April 2015). Tool: PES-NWI (31 items). Population: PHC nurses (three health districts in Valencia, Spain) with more than 3 months in the organization. The nurses were asked to select the 10 elements of the questionnaire (items) that they considered key to facilitate and improve professional care, establishing as a final selection criterion that they obtain a global election >40%. Variables: sociodemographic and 31 questionnaire items. Analysis: descriptive statistics, reliability, multidimensional scaling (ALSCAL), factor analysis, multiple linear regression. Finally, we have analyzed the concordance between both measurements (TOP10 score on the full scale score) using the Bland-Altman method. RESULTS: Study sample = 269 (Response rate = 80.29%). A total of 10 elements were identified based on selection frequency of the questionnaire PES-NWI. A factorial analysis explained 62.1% of variance, internal structure of three dimensions: (1) Participation in leadership and management, (2) Nursing foundations for quality of care, (3) Adequacy of resources, with Accumulate Variance explained: Component (1): 24%; Component (2): 43.1%; Component (3): 62.1%. Reliability (Cronbach's Alpha) was 0.816 for short questionnaire, and >0.8 for all measurements. Stress = 0.184 and RSQ = 0.793. Bland-Altman method: the scaling tends to be 1.92 points higher (equivalent to a maximum deviation of 1.54%) than the full-scale PES-NWI score (max score on PES-NWI = 124 points). CONCLUSIONS: It is possible to identify essential elements of environments to construct a short tool that simplifies the study of PHC environments. Conducting rapid studies of environments will provide managers with information about specific elements that require prioritization to enhance quality of care and safety.

Translation, adaptation and psychometric validation of the preterm birth experience and satisfaction scale (P-BESS) into Spanish.

BACKGROUND: Preterm labour and birth are two of the most important issues in perinatal care. The birth of a preterm baby is often a stressful and traumatic time for parents. Assessment of satisfaction with maternity services is crucial and questionnaires are the most common method as long as they are well-constructed. Only one, The Preterm Birth Experience and Satisfaction Scale (P-BESS), developed in United Kingdom, has been designed for this specific birth type. OBJECTIVES: To translate, transculturally adapt and assess the psychometric properties of the P-BESS into Spanish. DESIGN: Cross-sectional study. SETTING: Maternity unit of a tertiary level hospital in Spain. PARTICIPANTS: A total of 182 woman who gave birth before 37 weeks of gestation. METHODS: The instrument was translated and back translated. The P-BESS was tested for face validity and construct validity by carrying out an exploratory/confirmatory factor analysis. Reliability was estimated from the internal consistency, with the Cronbach's alpha (α), and the test-retest, with the  intraclass correlation coefficient (ICC). FINDINGS: The principal component analysis revealed the presence of three factors with eigenvalues greater than 1, explaining a total variance of 66.6%. A subsequent varimax rotation revealed the presence of strong loadings on each of the three components. Confirmatory factor analysis was performed, offering the model a very good fit to the data: chi-square was χ2(df=149)=362.727 (p = 0.000); the root mean square error of approximation (RMSEA)=0.089; the normed fix index (NFI )= 0.852 and the comparative fit index (CFI)=0.905. The total scale and subscales had good reliability with all Cronbach´s alpha above the acceptable level of 0.7. The total ICC was 0.994 (CI 95%, 0.988-0.997). CONCLUSIONS: The Spanish version of P-BESS appears to be a robust, valid and reliable instrument for assessing satisfaction with care during preterm birth. IMPLICATIONS FOR PRACTICE: the instrument provides a more comprehensive understanding of this complex experience. It allows the detection of areas of intervention in order to empower strategies to cope with preterm births and to maximise feelings of self-confidence and control.

La importancia del desarrollo académico de postgrado en la mejora profesional enfermera: Másteres y doctorados / The importance of academic development for nurses' professional advancement: masters and phd

Los aspectos formativos son esenciales para el desarrollo de cualquier disciplina. La ciencia enfermera ha vivido cambios profundos y positivos en su historia más reciente, que han culminado con su conversión académica en título de grado y la posibilidad de acceder a estudios superiores de segundo y tercer ciclos (másteres y doctorados). Analizamos en nuestro estudio la situación actual de la formación superior en Enfermería reflexionando sobre los antecedentes. El nivel académico y formativo de las enfermeras se ha mostrado como un elemento clave en aspectos básicos para los servicios sanitarios, como son la mejora de la seguridad del paciente y los resultados en salud (disminución de la mortalidad hospitalaria, menos eventos no deseados como errores de medicación, caídas, úlceras por presión...), y una mejora global de la calidad del cuidado. Además, ello está repercutiendo en el protagonismo social que las enfermeras están adquiriendo. Por ello, el acceso al desarrollo académico superior de las enfermeras a través de másteres (profesionalizantes o investigadores) o programas de doctorado, además de contribuir a desarrollar la disciplina, mejora el cuidado y permite la asunción de nuevas responsabilidades y roles avanzados, que son no solo de mayor calidad, sino también más eficientes para el sistema, que debe fomentar y facilitar la formación de sus enfermeras

Training aspects are essential for the development of any discipline. The nursing science has undergone profound and positive changes in its most recent history, which have culminated with its academic development into a Bachelor's degree, with the possibility of accessing Nursing Master's and PhD's. In our study, we analyzed the real situation of higher Nursing education, reflecting on its background. It's proven that the academic and training level of nurses is key for the success of Health Services, including: the improvement of patient safety and health outcomes (decrease in hospital mortality, less unwanted events such as medication errors, falls, pressure ulcers), and a global improvement in the quality of care. This has a double-pronged impact, reflected on nurses' acquired social role and recognition. Access to higher academic development through Masters (focused both on specialization or research) and/or PhD programs, in addition to contributing to the discipline's development, improves care and allows for the unfolding of new responsibilities and advanced roles. Highly trained nurses don't only display a higher professional quality, but are also more efficient for the system, which should in return encourage and facilitate the training of its nurses

Validity of instruments for measuring the satisfaction of a woman and her partner with care received during labour and childbirth: Systematic review.

BACKGROUND: patient satisfaction as an indicator of quality of care is becoming more and more important. The use of questionnaires is the most common method to evaluate satisfaction with maternity care. Despite the extensive variety of instruments available for this purpose, they vary widely in terms of their content and quality. OBJECTIVES: to identify, assess and summarize the most recent and robust instruments available to measure woman and partner satisfaction with the overall package of care during the labour and birth of their baby within a hospital setting. DESIGN: systematic review. METHODS: sixteen electronic databases were consulted. The research also included hand searching references of identified articles. Studies were assessed by two independent reviewers. Inclusion criteria were that participants were mothers and their respective partners and that the questionnaire was a multidimensional instrument used for measuring satisfaction with care during the labour and birth of a baby. Furthermore, the psychometric properties related to construction, reliability and validity of the questionnaire had to be reported. FINDINGS: seventeen studies were included. The majority of the questionnaires was developed within Europe and was disparate in terms of sample, items, dimensions and collection time. Most of them were limited to healthy women with low obstetric risk pregnancies. Only one instrument included partners as the subject of study. All questionnaires reported at least one aspect of reliability, content and construct validity. CONCLUSIONS: there are a moderate number of instruments capable of measuring maternal satisfaction with the care received during labour and birth within a hospital setting. Our study provides an overview of the most up-to-date, valid and reliable tools available. Further investigations are needed in order to improve existing instruments by performing additional psychometric tests, considering more specific populations and assessing the satisfaction of the partner and mother jointly. IMPLICATIONS FOR PRACTICE: assessments of satisfaction with care during labour and birth are relevant to healthcare professionals, administrators and policy makers. Therefore, these instruments are able to assist them according to their specific needs.