Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia.

BACKGROUND: Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units. METHODS: A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar < 7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed. RESULTS: Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% - 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p < 0.001 for both). Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p < 0.001). Request for regional anesthesia was the most common cause for transfer (47.1%). CONCLUSION: Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.

Safety Performance in Acute Medical Care: A Qualitative, Explorative Study on the Perspectives of Healthcare Professionals.

Healthcare professionals need specific safety performance skills in order to maintain and improve patient safety. The purpose of this study is to get a deeper understanding of healthcare professionals' perspective in acute care on the topic of safety performance. This study was conducted using a qualitative approach. Healthcare professionals working in nursing were interviewed using semi-structured interviews. Using content analyzing, categories were identified which present aspects of safety performance; subcategories were developed deductively. A total of 23 healthcare professionals were interviewed, of which 15 were registered nurses, five were nursing students and three were pedagogical personnel. Nine (39.1%) were <30 years old, 17 (73.9%) were female, and 9 (39.1%) had a leadership function. Results highlight the importance of safety performance as a construct of occupational health rather than of patient safety, and the role of the organization, as well as the self-responsibility of healthcare professionals. Healthcare professionals should be more conscious of their role, have a deeper understanding of the interaction of individual, team, patient, organization and work environment factors.

[Integrating academic nurses in German university hospitals: a follow-up survey]. / Einbindung von Pflegefachpersonen mit Hochschulabschlüssen an deutschen Universitätskliniken: ein Follow-up-Survey.

INTRODUCTION: The effective integration of professional nursing staff with university training into care processes is associated internationally with better patient outcomes. In Germany, there is a current lack of reliable figures on graduates and their areas of responsibility. Therefore, the aim of this follow-up survey, designed as a repetition of a previous one, was to ascertain the number of nurses with a Bachelor's or Master's degree involved in direct patient care at university medical centers. METHOD: In a cross-sectional study, chief nursing officers in university medical centers were asked to quote the number of professional nurses with a university degree (Bachelor, Master, Doctorate). Additional questions focused on their tasks and responsibilities and the measures undertaken to facilitate their integration into the organization. The data were analyzed using descriptive statistics. RESULTS: In total, n=29 valid questionnaires from 35 university medical centers were included in the analysis, resulting in a response rate of 82.85%. For a total of 18 centers, the number of university-qualified nurses had increased by n=786 between 2015 (n=593) and 2018 (n=1,379). The overall percentage of nurses with a university degree working at a university medical center in the study was 3.16% (SD=1.66; min - max=1.09 - 6.69; Q1 - Q3=1.49 - 4.04; 95% CI 2.30 to 3.95). In direct patient care, the quota was 2.11% (SD=1.40; min - max=0.47 - 5.42; Q1 - Q3=0.87 - 3.16; 95% CI 1.36 to 2.76). The main focus of their duties was on standard care and patient education (graduates with a Bachelor's degree), evidence-based nursing practice development (Master's degree) and research activities (doctoral degree). DISCUSSION: Compared to 2015, the proportion of professional nursing staff with university training has increased but remains at a very low level. These nurses perform relevant clinical tasks and are involved in the development of good practice. However, there is a need for better competence-based differentiation.

Survey of alongside midwifery-led care in North Rhine-Westfalia, Germany.

Background Alongside midwifery-led care (AMC) was introduced in Germany in 2003. The aim of our study was to collect data about the utilization of AMC within North Rhine-Westfalia (NRW), Germany's most populous state, and to collect information regarding the approach used for implementation of AMC and providers' experiences in day-to-day work. Methods Quantitative data were collected by questionnaire, telephone interview and comparative analysis of documents created for use in AMC. Qualitative data were compiled by questionnaire and workshop. Results Seven obstetric departments offer AMC in NRW. On average, 3.4% of women gave birth in these AMC units, corresponding to 0.3% of all births in NRW. For the establishment of AMC, institutional, organizational, professional and formal arrangements were undertaken. An eligibility and transfer checklist was agreed upon between midwives and obstetricians. Both professions were faced with skepticism. Daily work in AMC resulted in improved teamwork between the two professions and increased job satisfaction for midwives. Acquisition of manual skills and time constraints were the major challenges. Conclusion The low utilization of AMC is not due to the concept of care itself or difficulties with its implementation, nor to a lack of eligible women. Reasons may be insufficient awareness about AMC or a lack of interest in this type of care.

[State of development of the role of academic nursing staff at German university hospitals in 2015]. / Survey zur Einbindung von Pflegefachpersonen mit Hochschulabschlüssen an deutschen Universitätskliniken - Stand 2015.

INTRODUCTION: In order to meet the requirements of the increasing complexity of patient care it is recommended to promote more differentiated nursing staff structures and to integrate academic nurses, which is international standard and recommended by the German Science Council. The implementation level is unclear. What is the percentage of nurses with an academic degree at German university hospitals, and what are their task profiles? METHOD: Standardised written survey by nursing directors of all 32 German university hospitals and medical universities in 2015. RESULTS: The response rate was 75 %. The ratio of nurses with an academic degree amounted to 1.7 % overall, and to 1.0 % in direct patient care. The activities of nurses with an academic degree correspond to international Advanced Nursing Practice approaches including conceptual development (76 %), support of evidence-based care (72 %), practice projects (64 %) and patient counselling (56 %). There were significant variations among hospitals nationwide concerning pay rates with a current lack of reliable pay structures. DISCUSSION: This is the first national survey to determine the quota of nurses with an academic degree in direct patient care. The ratio of 1 % is well below the 10 to 20 % recommended by the German Science Council - hence the need for immediate action and comprehensive reforms. A follow-up survey is planned for 2017.

[Nursing, patient safety and the acquisition of nursing-sensitive outcomes in German hospitals]. / Pflege, Patientensicherheit und die Erfassung pflegesensitiver Ergebnisse in deutschen Krankenhäusern.

As the largest occupational group in healthcare, nurses continuously work in very close contact to patients and nursing home residents. No other professionals in the healthcare sector are involved in or responsible for so many different processes. They play a key role in, on the one hand, identifying and potentially avoiding errors and, on the other hand, in causing them. Traditionally, error handling in Germany is still strongly influenced by pointing a finger to and tabooing problematic behaviour. Structured systems for detecting errors and error reports can help to improve risk management in nursing. There is a need to develop fundamental structures like national indicators of nursing quality for systematic and valid error measurements and the structured collection of nursing-sensitive outcomes at a national level.