Video Review of Simulated Pediatric Cardiac Arrest to Identify Errors/Latent Safety Threats: A Mixed Methods Study.

INTRODUCTION: Outcomes from pediatric in-hospital cardiac arrest depend on the treatment provided as well as resuscitation team performance. Our study aimed to identify errors occurring in this clinical context and develop an analytical framework to classify them. This analytical framework provided a better understanding of team performance, leading to improved patient outcomes. METHODS: We analyzed 25 video recordings of pediatric cardiac arrest simulations from the pediatric intensive care unit at the Alberta Children's Hospital. We conducted a qualitative-dominant crossover mixed method analysis to produce a broad understanding of the etiology of errors. Using qualitative framework analysis, we identified and qualitatively described errors and transformed the data coded into quantitative data to determine the frequency of errors. RESULTS: We identified 546 errors/error-related actions and behaviors and 25 near misses. The errors were coded into 21 codes that were organized into 5 main themes. Clinical task-related errors accounted for most errors (41.9%), followed by planning, and executing task-related errors (22.3%), distraction-related errors (18.7%), communication-related errors (10.1%), and knowledge/training-related errors (7%). CONCLUSIONS: This novel analytical framework can robustly identify, classify, and describe the root causes of errors within this complex clinical context. Future validation of this classification of errors and error-related actions and behaviors on larger samples of resuscitations from various contexts will allow for a better understanding of how errors can be mitigated to improve patient outcomes.

The impact of clinical result acquisition and interpretation on task performance during a simulated pediatric cardiac arrest: a multicentre observational study.

PURPOSE: The acquisition and interpretation of clinical results during resuscitations is common; however, this can delay critical clinical tasks, resulting in increased morbidity and mortality. This study aims to determine the impact of clinical result acquisition and interpretation by the team leader on critical task completion during simulated pediatric cardiac arrest before and after team training. METHODS: This is a secondary data analysis of video-recorded simulated resuscitation scenarios conducted during Teams4Kids (T4K) study (June 2011-January 2015); scenarios included cardiac arrest before and after team training. The scenario included either a scripted paper or a phone call delivery of results concurrently with a clinical transition to pulseless ventricular tachycardia. Descriptive statistics and non-parametric tests were used to compare team performance before and after training. RESULTS: Performance from 40 teams was analyzed. Although the time taken to initiate CPR and defibrillation varied depending on the type of interruption and whether the scenario was before or after team training, these findings were not significantly associated with the leader's behaviour [Kruskal-Wallis test (p > 0.05)]. An exact McNemar's test determined no statistically significant difference in the proportion of leaders involved or not in interpreting results between and after the training (exact p value = 0.096). CONCLUSIONS: Team training was successful in reducing time to perform key clinical tasks. Although team training modified the way leaders behaved toward the results, this behaviour change did not impact the time taken to start CPR or defibrillate. Further understanding the elements that influence time to critical clinical tasks provides guidance in designing future simulated educational activities, subsequently improving clinical team performance and patient outcomes.

RéSUMé: BUT: L'acquisition et l'interprétation des résultats cliniques pendant les réanimations sont courantes; toutefois, cela peut retarder les tâches cliniques critiques, ce qui entraîne une augmentation de la morbidité et de la mortalité. Cette étude vise à déterminer l'impact de l'acquisition et de l'interprétation des résultats cliniques par le chef d'équipe sur la réalisation des tâches critiques lors d'un arrêt cardiaque pédiatrique simulé, avant et après la formation de l'équipe. MéTHODES: Il s'agit d'une analyse de données secondaires de scénarios de réanimation simulés enregistrés sur vidéo, réalisés au cours de l'étude Teams4Kids (T4K) (juin 2011-janvier 2015); les scénarios comprenaient un arrêt cardiaque avant et après la formation de l'équipe. Le scénario comprenait un document écrit ou un appel téléphonique donnant les résultats en même temps qu'une transition clinique vers la tachycardie ventriculaire sans pouls. Des statistiques descriptives et des tests non paramétriques ont été utilisés pour comparer le rendement de l'équipe avant et après la formation. RéSULTATS: Les performances de 40 équipes ont été analysées. Bien que le temps nécessaire au déclenchement de la RCP et de la défibrillation ait varié selon le type d'interruption et selon que le scénario se déroulait avant ou après la formation de l'équipe, ces résultats n'étaient pas significativement associés au comportement du leader [test de Kruskal-Wallis (p > 0,05)]. Un test exact de McNemar n'a déterminé aucune différence statistiquement significative dans la proportion de dirigeants impliqués ou non dans l'interprétation des résultats entre et après la formation (valeur p exacte = 0,096). CONCLUSIONS: La formation en équipe a permis de réduire le temps nécessaire pour effectuer les tâches cliniques clés. Bien que la formation de l'équipe ait modifié le comportement des dirigeants vis-à-vis des résultats, ce changement de comportement n'a pas eu d'incidence sur le temps nécessaire pour commencer la RCP ou la défibrillation. Une meilleure compréhension des éléments qui influencent le temps consacré aux tâches cliniques critiques fournit une orientation pour la conception des futures activités éducatives simulées, améliorant par la suite le rendement des équipes cliniques et les résultats pour les patients.

Being a member of a novel transitional case management team for patients with unstable housing: an ethnographic study.

BACKGROUND: Homeless and unstably housed individuals face barriers in accessing healthcare despite experiencing greater health needs than the general population. Case management programs are effectively used to provide care for this population. However, little is known about the experiences of providers, their needs, and the ways they can be supported in their roles. Connect 2 Care (C2C) is a mobile outreach team that provides transitional case management for vulnerable individuals in a major Canadian city. Using an ethnographic approach, we aimed to describe the experiences of C2C team members and explore their perceptions and challenges. METHODS: We conducted participant observations and semi-structured interviews with C2C team members. Data analysis consisted of inductive thematic analysis to identify themes that were iteratively discussed. RESULTS: From 36 h of field observations with eight team members and 15 semi-structured interviews with 12 team members, we identified five overarching themes: 1) Hiring the right people & onboarding: becoming part of C2C; 2) Working as a team member: from experience to expertise; 3) Proud but unsupported: adding value but undervalued; 4) Team-initiated coping: satisfaction in the face of emotional strain, and; 5) Likes and dislikes: committed to challenges. CONCLUSIONS: A cohesive team of providers with suitable personal and professional characteristics is essential to care for this complex population. Emotional support and inclusion of frontline workers in operational decisions are important considerations for optimal care and program sustainability.

Connect 2 Care, a Novel Community Outreach Program for Vulnerably Housed Patients With High Acute Care Use: A Mixed-Methods Study Protocol.

Introduction: Vulnerably housed individuals, especially those experiencing homelessness, have higher acute care use compared with the general population. Despite available primary care and social services, many face significant challenges accessing needed services. Connect 2 Care (C2C) is a novel transitional case management program that includes registered nurses and health navigators with complementary expertise in chronic disease management, mental health and addictions, social programs, community health, and housing, financial, transportation and legal resources. C2C bridges acute care and community services to improve care coordination. Methods and Analysis: We will perform a mixed-methods evaluation of the C2C program according to the Donabedian framework of structure, process and outcome, to understand how program structure and process, coupled with contextual factors, influence outcomes in a novel intervention. Eligible patients are homeless or unstably housed adults with complex health conditions and high acute care use. Change in emergency department visit rate 12-months after program enrolment is the primary outcome. Secondary outcomes include 12-month post-enrolment hospital admissions, cumulative hospital days, health-related quality of life, housing status, primary care attachment and substance use. Qualitative methods will explore experiences with the C2C program from multiple perspectives and an economic evaluation will assess cost-effectiveness. Discussion: Academic researchers partnered with community service providers to evaluate a novel transitional case management intervention for vulnerably housed patients with high acute-care use. The study uses mixed-methods to evaluate the Connect 2 Care program according to the Donabedian framework of structure, process and outcome, including an assessment of contextual factors that influence program success. Insights gained through this comprehensive evaluation will help refine the C2C program and inform decisions about sustainability and transferability to other settings in Canada.

Quality of clinical care provided during simulated pediatric cardiac arrest: a simulation-based study.

PURPOSE: We sought to assess compliance to resuscitation guidelines during pediatric simulated cardiac arrests in a pediatric intensive care unit (PICU) and to identify performance gaps to target with future training. METHODS: In a prospective observational study in a PICU, ten cardiac arrest scenarios were developed for resuscitation training and video recorded. The video recordings were examined for times to start cardiopulmonary resuscitation (CPR), delivery of first shock, CPR quality (rate, depth), length of pauses, chest compression fraction (CCF), ventilation, pulse/rhythm assessment, compressors' rotation, and leader's behaviours. The primary outcome was percentage of events compliant to Pediatric Advance Life Support guidelines. RESULTS: Compliance to guidelines was poor in the 23 simulation events studied. The median [interquartile range] time to start CPR was 29 [16-76] sec and 320 [245-421] sec to deliver the first shock. A total of 306 30-sec epochs of CPR were analyzed; excellent CPR (≥ 90% compressions in target for rate and depth) was achieved in 22 (7%) epochs. More than a quarter of the CPR pauses lasted > 10 seconds (33/127, 26%) with just one task performed in most of them; CCF was ≥ 80% in 19/23 (82.6%) events. Ventilation rate for intubated patients was greater than 10 breaths·min-1 in 15/27 (56%) of one-minute epochs observed. CONCLUSIONS: Review of simulated resuscitation events found suboptimal compliance with resuscitation guidelines, particularly the times to starting CPR and delivering the first shock, as well as compression rate and depth.

RéSUMé: OBJECTIF: Nous avons tenté d'évaluer l'observance des directives de réanimation pendant les arrêts cardiaques pédiatriques simulés dans une unité de soins intensifs pédiatriques (USIP) et d'identifier les écarts de performance afin d'aiguiller la formation future. MéTHODE: Dans une étude observationnelle prospective réalisée au sein d'une USIP, dix scénarios d'arrêt cardiaque ont été élaborés à des fins de formation en réanimation et enregistrés sur vidéo. Les enregistrements vidéo ont été étudiés pour évaluer le délai d'initiation de la réanimation cardiorespiratoire (RCR) et d'administration du premier choc, ainsi que la qualité de la RCR (fréquence, profondeur), la durée des pauses, la fraction des compressions thoraciques (FCT), la ventilation, l'évaluation du pouls/rythme, la rotation des compresseurs et les comportements du leader. Le critère d'évaluation principal était le pourcentage d'événements conformes aux directives de Soins avancés en réanimation pédiatrique (SARP). RéSULTATS: L'observance des directives était faible dans les 23 sessions étudiées. Le temps médian [écart interquartile] était de 29 [16­76] sec avant d'amorcer la RCR et de 320 [245­421] sec avant d'administrer le premier choc. Au total, 306 séquences de 30 sec de RCR ont été analysées; une RCR excellente (≥ 90 % des compressions situées dans la cible de fréquence et de profondeur) a été réalisée dans 22 (7 %) séquences. Plus d'un quart des pauses de RCR ont duré > dix secondes (33/127, 26 %), avec une seule tâche réalisée dans la plupart; la FCT était de ≥ 80 % dans 19/23 (82,6 %) sessions. Chez les patients intubés, la fréquence de ventilation était supérieure à 10 respirations·min-1 dans 15/27 (56 %) des séquences d'une minute observées. CONCLUSION: Le passage en revue des événements de réanimation simulés a décelé une observance sous-optimale des directives de réanimation, particulièrement en ce qui touche au délai de l'initiation de la RCR et du premier choc, ainsi qu'à la fréquence et à la profondeur des compressions.

Bedside chest compression skills: Performance and skills retention in in-hospital trained pediatric providers. A simulation study.

PURPOSE: To assess the effects of a real-time feedback device and refresher sessions in acquiring and retaining chest compression skills. METHODS: Healthcare providers participated in refresher sessions at 3-time points (blocks) over 1-year. At each block, chest compression (CC) skills were assessed on an infant and adult task trainer, in one 2-min trial without feedback (blinded), and up to three 2-min trials with feedback (unblinded). Skills retention over time was explored at three time lags: 1-3, 3-6, >6 months. Data collected included chest compression rate (100-120/min), depth (4 cm for infants and 5 cm for adults), and recoil between compressions. RESULTS: Among 194 participants, achievement of excellent CC (≥90% of adequate compressions for all parameters) increased with feedback. Linear mixed models found significant (p < 0.05) improvement in rate, depth, and recoil. Performance between last unblinded trial in block 1 with the following blinded trial in block 2 significantly decayed in rate on both task trainers irrespective of time passed, while depth and recoil performance were maintained only for infants. CONCLUSIONS: A real-time visual feedback device improved CC skills with better results in infants. Skills decayed over time despite two refresher sessions with feedback.

Isotopic reconstruction of the weaning process in the archaeological population of Canímar Abajo, Cuba: A Bayesian probability mixing model approach.

The general lack of well-preserved juvenile skeletal remains from Caribbean archaeological sites has, in the past, prevented evaluations of juvenile dietary changes. Canímar Abajo (Cuba), with a large number of well-preserved juvenile and adult skeletal remains, provided a unique opportunity to fully assess juvenile paleodiets from an ancient Caribbean population. Ages for the start and the end of weaning and possible food sources used for weaning were inferred by combining the results of two Bayesian probability models that help to reduce some of the uncertainties inherent to bone collagen isotope based paleodiet reconstructions. Bone collagen (31 juveniles, 18 adult females) was used for carbon and nitrogen isotope analyses. The isotope results were assessed using two Bayesian probability models: Weaning Ages Reconstruction with Nitrogen isotopes and Stable Isotope Analyses in R. Breast milk seems to have been the most important protein source until two years of age with some supplementary food such as tropical fruits and root cultigens likely introduced earlier. After two, juvenile diets were likely continuously supplemented by starch rich foods such as root cultigens and legumes. By the age of three, the model results suggest that the weaning process was completed. Additional indications suggest that animal marine/riverine protein and maize, while part of the Canímar Abajo female diets, were likely not used to supplement juvenile diets. The combined use of both models here provided a more complete assessment of the weaning process for an ancient Caribbean population, indicating not only the start and end ages of weaning but also the relative importance of different food sources for different age juveniles.

El nacimiento en Cuba: análisis de la experiencia del parto medicalizado desde una perspectiva antropológica / Childbirth in Cuba: analysis of the experience of medically supervised delivery from an anthropological perspective

En Cuba, el conocimiento sobre el embarazo, el parto y el puerperio es deficiente actualmente, ya que el nacimiento ha sido abordado fundamentalmente como un evento médico, desde sus aristas clínicas. Su análisis desde las perspectivas teóricas de la Antropología Médica, puede contribuir a incrementar la calidez en los servicios de atención, así como al empoderamiento de las mujeres y los hombres como los principales responsables de sus procesos reproductivos. El presente estudio investigó la experiencia y percepción sobre el nacimiento en tres hospitales de La Habana. Su propósito fue comprender las representaciones y prácticas relacionadas con el parto y describir la experiencia de las mujeres. Se utilizaron técnicas cualitativas de investigación: entrevistas y observación participante a 36 mujeres en parto, diez familiares y nueve obstetras. Los discursos fueron analizados según la Teoría Fundamentada. Todos los nacimientos tuvieron lugar con numerosas intervenciones médicas. La experiencia de la maternidad fue muy intensa. La participación de los hombres fue limitada. Desde la perspectiva antropológica el uso rutinario de las intervenciones médicas y las regulaciones institucionales descritas se consideran manifestaciones de violencia física y de género(AU)

Knowledge about pregnancy, childbirth, and postpartum in Cuba is currently poor. Childbirth has been fundamentally studied as a medical event from its clinical aspects. The analysis of the reproductive process from the Medical Anthropology perspective could contribute to healthcare services providing more humane treatment and to empowerment for women and men as the people primarily responsible for their reproductive processes. This study researched on the experience and the perception of childbirth in three hospitals located in Havana, with the objective of understanding the representations and practices associated to childbirth and of describing female experiences during this event. Qualitative research techniques were used such as interviews and participant observation of 36 women in labor, ten family members and nine obstetricians. The qualitative data was analyzed using Grounded Theory methodology. All the childbirths occurred with a number of medical interventions and the maternity experience was very intense. Male participation was restricted. From the anthropological perspective, the routine use of some medical interventions and the institutional regulations described herein are considered expressions of physical and gender violence(AU)

El nacimiento en Cuba: análisis de la experiencia del parto medicalizado desde una perspectiva antropológica / Childbirth in Cuba: analysis of the experience of medically supervised delivery from an anthropological perspective

En Cuba, el conocimiento sobre el embarazo, el parto y el puerperio es deficiente actualmente, ya que el nacimiento ha sido abordado fundamentalmente como un evento médico, desde sus aristas clínicas. Su análisis desde las perspectivas teóricas de la Antropología Médica, puede contribuir a incrementar la calidez en los servicios de atención, así como al empoderamiento de las mujeres y los hombres como los principales responsables de sus procesos reproductivos. El presente estudio investigó la experiencia y percepción sobre el nacimiento en tres hospitales de La Habana. Su propósito fue comprender las representaciones y prácticas relacionadas con el parto y describir la experiencia de las mujeres. Se utilizaron técnicas cualitativas de investigación: entrevistas y observación participante a 36 mujeres en parto, diez familiares y nueve obstetras. Los discursos fueron analizados según la Teoría Fundamentada. Todos los nacimientos tuvieron lugar con numerosas intervenciones médicas. La experiencia de la maternidad fue muy intensa. La participación de los hombres fue limitada. Desde la perspectiva antropológica el uso rutinario de las intervenciones médicas y las regulaciones institucionales descritas se consideran manifestaciones de violencia física y de género

Knowledge about pregnancy, childbirth, and postpartum in Cuba is currently poor. Childbirth has been fundamentally studied as a medical event from its clinical aspects. The analysis of the reproductive process from the Medical Anthropology perspective could contribute to healthcare services providing more humane treatment and to empowerment for women and men as the people primarily responsible for their reproductive processes. This study researched on the experience and the perception of childbirth in three hospitals located in Havana, with the objective of understanding the representations and practices associated to childbirth and of describing female experiences during this event. Qualitative research techniques were used such as interviews and participant observation of 36 women in labor, ten family members and nine obstetricians. The qualitative data was analyzed using Grounded Theory methodology. All the childbirths occurred with a number of medical interventions and the maternity experience was very intense. Male participation was restricted. From the anthropological perspective, the routine use of some medical interventions and the institutional regulations described herein are considered expressions of physical and gender violence

Percepción sobre la prestación de servicios de atención a la infertilidad desde una mirada antropológica / Perception on the rendering of service to care for infertility from an anthropological viewpoint

Introducción: algunas investigaciones han dado cuenta de una especie de frialdad médica vista en la atención a la infertilidad por parte de los prestadores de salud y percibida por parte de los usuarios de estos servicios. Objetivo: conocer la percepción de usuarios y prestadores de salud, sobre la gestión y prestación de atención a la infertilidad en tres servicios en La Habana. Métodos: estudio descriptivo realizado entre abril de 2007 y marzo de 2010. Se empleó un abordaje de tipo cualitativo que responde al diseño de Teoría Fundamentada. La población objeto de estudio se estructuró en dos grupos: las parejas infértiles atendidas en servicios seleccionados y sus prestadores de salud. Resultados: se describieron cuatro categorías inductivas: la atención a la infertilidad por el sistema de salud; la organización, funcionamiento y satisfacción con los servicios de atención; la relación usuarios(as) prestadores, y el tránsito de los usuarios/as por los servicios de atención a la infertilidad. Se corroboraron debilidades para la atención a la infertilidad: insuficiente capacidad resolutiva y necesidad de establecer funciones, normas y algoritmos en cada nivel de atención, para la mejora de sus procesos e insuficiente pensamiento médico-social, que parte de la ideología médico-hegemónica. Conclusiones: existen limitaciones en recursos materiales y profesionales, es insuficiente la organización e integración de los servicios, lo que provoca fallas en la gestión y continuidad de la atención; se produce descentralización ejecutiva de la normativa y resulta insuficiente el tratamiento a las personas y a las parejas desde sus condicionamientos socioculturales(AU)

Introduction: some research works have reported a sort of medical coldness observed in the care for infertility by health care providers and perceived by medical service users. Objective: to find out the perception of users and of health care providers on the management and provision of care for infertility in three medical services of Havana. Methods: descriptive study conducted from April 2007 to March 2010. A qualitative-type approach was used to respond to the design of founded theory. The target population was divided into two groups: fertile couples assisted in selected services and their health care providers. Results: four inductive categories were described: care for infertility by the health care system; the organization and functioning of and satisfaction with the infertility care services, relationships of users and service providers, and the transit of users through the services of care for infertility. Some weaknesses in infertility care services were confirmed such as the poor resolution capacity and the need of establishing functions, standards and algorithms in each level of care in order to improve their processes, and lack of adequate social and medical thinking resulting from the hegemonic medical ideology. Conclusions: there are some constraints in material and professional resources; the organization and integration of services are poor leading to failures in management and continuity of care; executive decentralization of standards and the treatment given to persons and couples, taking their sociocultural conditions into account, is not enough(AU)

Percepción sobre la prestación de servicios de atención a la infertilidad desde una mirada antropológica / Perception on the rendering of service to care for infertility from an anthropological viewpoint

Introducción: algunas investigaciones han dado cuenta de una especie de «frialdad médica¼ vista en la atención a la infertilidad por parte de los prestadores de salud y percibida por parte de los usuarios de estos servicios. Objetivo: conocer la percepción de usuarios y prestadores de salud, sobre la gestión y prestación de atención a la infertilidad en tres servicios en La Habana. Métodos: estudio descriptivo realizado entre abril de 2007 y marzo de 2010. Se empleó un abordaje de tipo cualitativo que responde al diseño de Teoría Fundamentada. La población objeto de estudio se estructuró en dos grupos: las parejas infértiles atendidas en servicios seleccionados y sus prestadores de salud. Resultados: se describieron cuatro categorías inductivas: la atención a la infertilidad por el sistema de salud; la organización, funcionamiento y satisfacción con los servicios de atención; la relación usuarios(as) prestadores, y el tránsito de los usuarios/as por los servicios de atención a la infertilidad. Se corroboraron debilidades para la atención a la infertilidad: insuficiente capacidad resolutiva y necesidad de establecer funciones, normas y algoritmos en cada nivel de atención, para la mejora de sus procesos e insuficiente pensamiento médico-social, que parte de la ideología médico-hegemónica. Conclusiones: existen limitaciones en recursos materiales y profesionales, es insuficiente la organización e integración de los servicios, lo que provoca fallas en la gestión y continuidad de la atención; se produce descentralización ejecutiva de la normativa y resulta insuficiente el tratamiento a las personas y a las parejas desde sus condicionamientos socioculturales.

Introduction: some research works have reported a sort of "medical coldness" observed in the care for infertility by health care providers and perceived by medical service users. Objective: to find out the perception of users and of health care providers on the management and provision of care for infertility in three medical services of Havana. Methods: descriptive study conducted from April 2007 to March 2010. A qualitative-type approach was used to respond to the design of founded theory. The target population was divided into two groups: fertile couples assisted in selected services and their health care providers. Results: four inductive categories were described: care for infertility by the health care system; the organization and functioning of and satisfaction with the infertility care services, relationships of users and service providers, and the transit of users through the services of care for infertility. Some weaknesses in infertility care services were confirmed such as the poor resolution capacity and the need of establishing functions, standards and algorithms in each level of care in order to improve their processes, and lack of adequate social and medical thinking resulting from the hegemonic medical ideology. Conclusions: there are some constraints in material and professional resources; the organization and integration of services are poor leading to failures in management and continuity of care; executive decentralization of standards and the treatment given to persons and couples, taking their sociocultural conditions into account, is not enough.

[Childbirth in Cuba: analysis of the experience of medically supervised delivery from an anthropological perspective]. / El nacimiento en Cuba: análisis de la experiencia del parto medicalizado desde una perspectiva antropológica.

Knowledge about pregnancy, childbirth, and postpartum in Cuba is currently deficient. Childbirth has been fundamentally studied as a medical event from its clinical aspects. Analysis of the reproductive process from the Medical Anthropology perspective could contribute to healthcare services providing more humane treatment and empowerment for women and men as the persons primarily responsible for their reproductive processes. This study investigated the experience and perception of childbirth in three hospitals in Havana. The scope of this research was to understand the representation and practice of childbirth and to describe the experiences of women during this event. Qualitative investigation techniques were used, together with interviews and participant observation of 36 women in labor, ten family members and nine obstetricians. The qualitative data was analyzed using Grounded Theory methodology. All the childbirths occurred with numerous medical interventions and the maternity experience was very intense. The participation of men was limited. From the anthropological perspective the routine use of some medical interventions and the institutional regulations described are considered manifestations of physical and gender violence.

Legislación y atención medicalizada al nacimiento en el ejercicio de la maternidad y la paternidad en Cuba / Legislation and nursing care at birth time and motherhood/fatherhood in Cuba / Legislação e atenção medicalizada ao nascimento no exercício da maternidade e a paternidade em Cuba

El nacimiento de un hijo o una hija constituye un momento transcendental en la vida personal y familiar, en el que se desarticulan o consolidan aspectos de la feminidad y la masculinidad. Objetivo: desde esta perspectiva se realizó una investigación con el fin de comprender la forma como influyen la representación de la maternidad, el sistema médico en el que se inserta la atención al parto y las legislaciones relacionadas con la maternidad en la concepción y en el ejercicio de la maternidad y la paternidad durante el embarazo, el parto y el puerperio. Metodología: se utilizaron varias técnicas cualitativas de investigación (entrevistas y observación participante) a mujeres atendidas en tres hospitales de maternidad de La Habana y sus compañeros (esposos legales o consensuales). Resultados: los hallazgos develan roles de género en los cuales la mujer es la cuidadora por excelencia y la responsable de la reproducción y los hombres son relegados de ella; se refuerzan y consolidan institucionalmente desde lo legislado y desde la atención médica al proceso. Paralelo a esto, deja al descubierto la emergencia de una nueva masculinidad mediante la mayor implicación de los hombres en este proceso, de su mayor inserción en el espacio privado y de la exteriorización de sentimientos asociados con el nacimiento de su bebé. Conclusión: surge la necesidad de generar políticas orientadas a desmontar la cultura patriarcal en aras de construir relaciones de pareja más igualitarias y democráticas en la sociedad cubana.

The childbirth is a transcendental moment in personal and family life. During this event, some aspects are revised related with femininity and masculinity. Objective: from this perspective, was carried out this research with the purpose of understand how the maternity representation, the medical system that attend childbirth and the laws influence in the conception and practice of maternity and paternity during the pregnant, labour, and puerperium. Methodology: some qualitative techniques were used, as interviews and open observation to women and their partners (spouses or common laws) who were attended in three hospitals of Havana. Results: the results show as the traditional gender roles are reinforced by the laws, institutional regulations and the medical practice in hospitals. This traditional view has been that women take on most child care responsibilities and men are relegated of this. Parallel with this, a new form of masculinity emerges as a result of the increasing of participation of men in the event and in household activities and the externalization of feelings when they know their children. Conclusion: New gender policies are needed in order to deconstruct the patriarchal culture and develop egalitarian and democratic relationships in Cuban society.

O nascimento de um filho ou uma filha constitui um momento transcendental na vida pessoal e familiar, no qual se desarticulam ou consolidam aspectos da feminidade e a masculinidade. Objetivo: desde esta perspectiva, realizou-se uma pesquisa com o fim de compreender a forma como influem a representação da maternidade, o sistema médico no qual se concentra a atenção ao parto e as legislações relacionadas com a maternidade na concepção e no exercício da maternidade e a paternidade durante a gravidez, o parto e o puerpério. Metodologia: se utilizaram diversas técnicas qualitativas de pesquisa (entrevistas e observação participante) a mulheres atendidas em três hospitais de maternidade de La Habana e seus companheiros (esposos legais e consensuais). Resultados: os achados revelam roles de gênero nos quais a mulher é a cuidadora por excelência e a responsável da reprodução e os homens são relegadas dela; se reforçam e consolidam institucionalmente desde o legislado e desde a atenção médica ao processo. Paralelo a isto, deixa ao descoberto a emergência de uma nova masculinidade mediante a maior implicação dos homens neste processo, de sua maior inserção no aspecto privado e da exteriorização de sentimentos associados com o nascimento de seu bebê. Conclusão: surge a necessidade de gerar políticas orientadas a desmontar a cultura patriarcal em favor de construir relacionamentos mais igualitários e democráticos na sociedade cubana.

El nacimiento en Cuba: análisis de la experiencia del parto medicalizado desde una perspectiva antropológica / Childbirth in Cuba: analysis of the experience of medically supervised delivery from an anthropological perspective

En Cuba, el conocimiento sobre el embarazo, el parto y el puerperio es deficiente actualmente, ya que el nacimiento ha sido abordado fundamentalmente como un evento médico, desde sus aristas clínicas. Su análisis desde las perspectivas teóricas de la Antropología Médica puede contribuir a incrementar la calidez en los servicios de atención, así como al empoderamiento de las mujeres y los hombres como los principales responsables de sus procesos reproductivos. El presente estudio investigó la experiencia y percepción sobre el nacimiento en tres hospitales de La Habana. Su propósito fue comprender las representaciones y prácticas relacionadas con el parto y describir la experiencia de las mujeres. Se utilizaron técnicas cualitativas de investigación: entrevistas y observación participante a 36 mujeres en parto, diez familiares y nueve obstetras. Los discursos fueron analizados según la Teoría Fundamentada. Todos los nacimientos tuvieron lugar con numerosas intervenciones médicas. La experiencia de la maternidad fue muy intensa. La participación de los hombres fue limitada. Desde la perspectiva antropológica el uso rutinario de las intervenciones médicas y las regulaciones institucionales descritas se consideran manifestaciones de violencia física y de género.

Knowledge about pregnancy, childbirth, and postpartum in Cuba is currently deficient. Childbirth has been fundamentally studied as a medical event from its clinical aspects. Analysis of the reproductive process from the Medical Anthropology perspective could contribute to healthcare services providing more humane treatment and empowerment for women and men as the persons primarily responsible for their reproductive processes. This study investigated the experience and perception of childbirth in three hospitals in Havana. The scope of this research was to understand the representation and practice of childbirth and to describe the experiences of women during this event. Qualitative investigation techniques were used, together with interviews and participant observation of 36 women in labor, ten family members and nine obstetricians. The qualitative data was analyzed using Grounded Theory methodology. All the childbirths occurred with numerous medical interventions and the maternity experience was very intense. The participation of men was limited. From the anthropological perspective the routine use of some medical interventions and the institutional regulations described are considered manifestations of physical and gender violence.

La perspectiva de género y la relación médico-paciente para el problema de la infertilidad / Gender perspective and the physician-patient relationship in treating infertility

Se hace una reflexión acerca de la necesidad de incluir la categoría género en la evaluación de la calidad de la atención a la infertilidad. El punto de partida que se plantea es la identificación de modelos explicativos personales para la infertilidad de hombres y mujeres, y prestadores(as) de salud, para lograr establecer diferencias y similitudes entre sus valoraciones. Se propone volver a pensar en la calidad de la atención desde una perspectiva de género, a partir de la identificación de zonas de encuentros y desencuentros entre los mundos valorativos de pacientes y prestadores de salud

This paper made a reflection on the need of including the category gender in the evaluation of the quality of care to infertility. The starting point is the identification of personal explanatory models for infertility in men and women, and health providers, with a view to seeing the differences and similarities among their assessments. It made the proposal of re-thinking the quality of care of infertility from a gender perspective, based on the identification of areas of agreement and disagreement between the evaluating worlds of patients and of health providers

La perspectiva de género y la relación médico-paciente para el problema de la infertilidad / Gender perspective and the physician-patient relationship in treating infertility

Se hace una reflexión acerca de la necesidad de incluir la categoría género en la evaluación de la calidad de la atención a la infertilidad. El punto de partida que se plantea es la identificación de modelos explicativos personales para la infertilidad de hombres y mujeres, y prestadores(as) de salud, para lograr establecer diferencias y similitudes entre sus valoraciones. Se propone volver a pensar en la calidad de la atención desde una perspectiva de género, a partir de la identificación de zonas de encuentros y desencuentros entre los mundos valorativos de pacientes y prestadores de salud(AU)

This paper made a reflection on the need of including the category gender in the evaluation of the quality of care to infertility. The starting point is the identification of personal explanatory models for infertility in men and women, and health providers, with a view to seeing the differences and similarities among their assessments. It made the proposal of re-thinking the quality of care of infertility from a gender perspective, based on the identification of areas of agreement and disagreement between the evaluating worlds of patients and of health providers(AU)

Perspectiva antropológica y de género en el análisis de la atención al embarazo, parto y puerperio / Anthropological and gender perspective in the analysis of care provided to pregnancy, delivery and puerperium

Se presenta un análisis teórico de la atención al embarazo, parto y puerperio, desde la perspectiva antropológica y aplicando la categoría "género", con el objetivo de hacer visible la manera en que a través de la atención a estos procesos se organizan y mantienen las diferencias e inequidades históricas entre hombres y mujeres. Son considerados como elementos relevantes, el tránsito del proceso de atención del espacio privado, con la participación casi exclusiva de mujeres, al espacio público donde se incluyen los varones; la medicalización de estos procesos y el papel de las tecnologías. Los aspectos citados implican falta de protagonismo y poca autoridad de las mujeres y sus familias ante el nacimiento de un hijo/a. Las formas diversas de asumir la maternidad por mujeres y hombres, son aspectos que deben ser analizados en la sociedad cubana actual desde la perspectiva antropológica, para contribuir, a través del modelo de atención al proceso reproductivo, a crear las bases para el desarrollo de una maternidad y una paternidad responsable, mediante una mayor incorporación de las mujeres y sus familias en la planificación, ejecución y evaluación de la atención

A theoretical analysis of the care of pregnancy, delivery and puerperium, from an anthropological perspective and using the category "gender", was made in this paper in order to show the way in which historical differences and inequalities between men and women are organized and sustained through the care of these processes. Relevant elements of this analysis were the transition of the process of care from the private setting -with the almost exclusive involvement of women- to the public setting where men are included; the medicalization of these processes and the role of technology. All these aspects imply lack of prominent role and low authoritative level on the part of women and their families with respect to childbirth. The various ways of assuming maternity by women and men should be analyzed from the anthropological perspective in the context of the present Cuban society. This analysis may contribute, through the pattern of care to the reproduction process, to lay the foundations for responsible motherhood and fatherhood and greater involvement of women and their families in the planning, implementation and evaluation of the care to these processes

Perspectiva antropológica y de género en el análisis de la atención al embarazo, parto y puerperio / Anthropological and gender perspective in the analysis of care provided to pregnancy, delivery and puerperium

Se presenta un análisis teórico de la atención al embarazo, parto y puerperio, desde la perspectiva antropológica y aplicando la categoría "género", con el objetivo de hacer visible la manera en que a través de la atención a estos procesos se organizan y mantienen las diferencias e inequidades históricas entre hombres y mujeres. Son considerados como elementos relevantes, el tránsito del proceso de atención del espacio privado, con la participación casi exclusiva de mujeres, al espacio público donde se incluyen los varones; la medicalización de estos procesos y el papel de las tecnologías. Los aspectos citados implican falta de protagonismo y poca autoridad de las mujeres y sus familias ante el nacimiento de un hijo/a. Las formas diversas de asumir la maternidad por mujeres y hombres, son aspectos que deben ser analizados en la sociedad cubana actual desde la perspectiva antropológica, para contribuir, a través del modelo de atención al proceso reproductivo, a crear las bases para el desarrollo de una maternidad y una paternidad responsable, mediante una mayor incorporación de las mujeres y sus familias en la planificación, ejecución y evaluación de la atención(AU)

A theoretical analysis of the care of pregnancy, delivery and puerperium, from an anthropological perspective and using the category "gender", was made in this paper in order to show the way in which historical differences and inequalities between men and women are organized and sustained through the care of these processes. Relevant elements of this analysis were the transition of the process of care from the private setting -with the almost exclusive involvement of women- to the public setting where men are included; the medicalization of these processes and the role of technology. All these aspects imply lack of prominent role and low authoritative level on the part of women and their families with respect to childbirth. The various ways of assuming maternity by women and men should be analyzed from the anthropological perspective in the context of the present Cuban society. This analysis may contribute, through the pattern of care to the reproduction process, to lay the foundations for responsible motherhood and fatherhood and greater involvement of women and their families in the planning, implementation and evaluation of the care to these processes(AU)

Cultura sobre maternidad y paternidad y su repercusión en la concepción de la infertilidad / Culture on motherhood and fatherhood and its impact on the concept of infertility

Introducción La infertilidad es el hecho que una vez vivenciado provoca la reformulación de las expectativas en relación con la maternidad y la paternidad. Objetivos Explorar la cultura existente en Cuba en relación con la maternidad y la paternidad, su repercusión en la concepción de la infertilidad y la manera en que esta es percibida por el individuo y la colectividad. Métodos Se realizaron entrevistas en profundidad a nueve expertos en reproducción humana y salud pública, seleccionados por un muestreo en cascada a partir de un informante clave. El número de entrevistas se definió según el criterio de saturación de la información. Resultados Se identificaron tres etapas: Cuba pre-revolucionaria, década del 60 y los últimos 20 años. Todos los entrevistados coincidieron en que en la actualidad el binomio mujer-madre persiste, solo ha cambiado lo culturalmente añadido que hace que la mujer razone cuándo es más conveniente ser madre y si desea tener un hijo o dos a lo sumo, lo que está tornando crítica la situación en cuanto al reemplazo poblacional. En relación con los hombres infértiles, dos expertos plantearon la descalificación y el cuestionamiento que sobre su virilidad hace la sociedad cubana. Se obtuvo escasa información referida a la percepción de la infertilidad por la pareja infértil y por la colectividad. Conclusiones Dentro del patrón sociocultural cubano, se reconoce a la mujer como principal responsable de la decisión de tener o no descendencia y de su cantidad. Lo anterior repercute en la concepción de la infertilidad, desde su atención médica regulada con exclusión de las vivencias de las parejas y la prácticamente ausencia del varón a los servicios de atención, hasta la poca información que se tiene sobre lo que experimentan los hombres, la pareja infértil y la familia cubana ante la infecundidad

Introduction Infertility is an event that whenever it occurs, it causes the re-shaping of the expectations about motherhood and fatherhood. Objectives To explore the existing culture in Cuba about motherhood and fatherhood and its impact on the concept of infertility, as well as to know how this is perceived by the individual and the community. Methods In-depth interviews were administered to 9 experts in human reproduction and public health, who were selected through a cascade-sampling from a key informant. The number of interviews was defined according to the saturation criterion of the information received. Results The first result was the identification of three stages: Cuba before the revolution, the 60ïs and the last 20 years up to the present. All the interviewed experts agreed that the woman-mother binomial persisted, it was just that the level of culture had increased, which made the woman decide the most suitable time for her to become a mother and the number of children -one child or two at most- leading to a critical situation in terms of the natural replacement of the Cuban population. Regarding infertile men, two experts pointed out that their virility is generally questioned by the Cuban society. Limited information on the perception of infertility by the infertile couple and the community as well was obtained. Conclusions Within the social-cultural pattern of the Cuban society, it is recognized that the woman is the responsible for making a decision of having offspring or not and of the number of children. The above-mentioned has an impact on the concept of infertility, starting from the controlled medical care with the coupleïs experience being excluded and the man being practically absent to the medical care appointments, to the limited information available regarding what the men, the infertile couple and the Cuban family feel in case of infertility

Cultura sobre maternidad y paternidad y su repercusión en la concepción de la infertilidad / Culture on motherhood and fatherhood and its impact on the concept of infertility

Introducción La infertilidad es el hecho que una vez vivenciado provoca la reformulación de las expectativas en relación con la maternidad y la paternidad. Objetivos Explorar la cultura existente en Cuba en relación con la maternidad y la paternidad, su repercusión en la concepción de la infertilidad y la manera en que esta es percibida por el individuo y la colectividad. Métodos Se realizaron entrevistas en profundidad a nueve expertos en reproducción humana y salud pública, seleccionados por un muestreo en cascada a partir de un informante clave. El número de entrevistas se definió según el criterio de saturación de la información. Resultados Se identificaron tres etapas: Cuba pre-revolucionaria, década del 60 y los últimos 20 años. Todos los entrevistados coincidieron en que en la actualidad el binomio mujer-madre persiste, solo ha cambiado lo culturalmente añadido que hace que la mujer razone cuándo es más conveniente ser madre y si desea tener un hijo o dos a lo sumo, lo que está tornando crítica la situación en cuanto al reemplazo poblacional. En relación con los hombres infértiles, dos expertos plantearon la descalificación y el cuestionamiento que sobre su virilidad hace la sociedad cubana. Se obtuvo escasa información referida a la percepción de la infertilidad por la pareja infértil y por la colectividad. Conclusiones Dentro del patrón sociocultural cubano, se reconoce a la mujer como principal responsable de la decisión de tener o no descendencia y de su cantidad. Lo anterior repercute en la concepción de la infertilidad, desde su atención médica regulada con exclusión de las vivencias de las parejas y la prácticamente ausencia del varón a los servicios de atención, hasta la poca información que se tiene sobre lo que experimentan los hombres, la pareja infértil y la familia cubana ante la infecundidad(AU)

Introduction Infertility is an event that whenever it occurs, it causes the re-shaping of the expectations about motherhood and fatherhood. Objectives To explore the existing culture in Cuba about motherhood and fatherhood and its impact on the concept of infertility, as well as to know how this is perceived by the individual and the community. Methods In-depth interviews were administered to 9 experts in human reproduction and public health, who were selected through a cascade-sampling from a key informant. The number of interviews was defined according to the saturation criterion of the information received. Results The first result was the identification of three stages: Cuba before the revolution, the 60ïs and the last 20 years up to the present. All the interviewed experts agreed that the woman-mother binomial persisted, it was just that the level of culture had increased, which made the woman decide the most suitable time for her to become a mother and the number of children -one child or two at most- leading to a critical situation in terms of the natural replacement of the Cuban population. Regarding infertile men, two experts pointed out that their virility is generally questioned by the Cuban society. Limited information on the perception of infertility by the infertile couple and the community as well was obtained. Conclusions Within the social-cultural pattern of the Cuban society, it is recognized that the woman is the responsible for making a decision of having offspring or not and of the number of children. The above-mentioned has an impact on the concept of infertility, starting from the controlled medical care with the coupleïs experience being excluded and the man being practically absent to the medical care appointments, to the limited information available regarding what the men, the infertile couple and the Cuban family feel in case of infertility(AU)