Desafios no cotidiano de cuidados domiciliares às crianças com necessidades es-peciais de saúde na voz de cuidadoras familiares / Desafíos en la atención domiciliaria diaria para niños con necesidades especiales de salud en la voz de los cuidadores familiares / Challenges in everyday home care to children with special health needs in the voice of caregivers family

This study aims to describe the daily challenges of caring for children with special healthneeds by family caregivers in the home. Research with a qualitative, descriptive and exploratoryapproach, mediated by the semi-structured interview conducted at home with 15 family caregiversof children. Saturation sampling was used, the statements were double transcribed, and submittedto content analysis. The results reveal that the care provided to children with special health needsis carried out exclusively by women in the family, mothers and grandparents, children between 0and 10 years of age, who need medication care for their survival. From the statements, two thematiccategories emerged: "Challenges faced by family caregivers of CRIANES" and "Care and strategiesfor medication administration". It is noteworthy that the challenges of daily care involve food, bodyhygiene, constant surveillance and the administration of medications. It is suggested that the familyof these children, be supported by health services and oriented, in order to minimize the challengesof daily care in the home space. (AU)

Este estudio tiene como objetivo describir los desafíos del cuidado diario de los niñoscon necesidades especiales de salud por parte de los cuidadores familiares en el hogar. Investigacióncon enfoque cualitativo, descriptivo y exploratorio, mediada por la entrevista semiestructurada realizada en el hogar a 15 familiares cuidadores de niños. Se utilizó muestreo de saturación, lasdeclaraciones se transcribieron doblemente y se sometieron a análisis de contenido. Los resultadosrevelan que la atención que se brinda a los niños con necesidades especiales de salud es realizadaexclusivamente por mujeres de la familia, madres y abuelos, de niños entre 0 y 10 años, quienesnecesitan atención con medicamentos para su supervivencia. De las declaraciones surgieron doscategorías temáticas: “Retos que enfrentan los cuidadores familiares de CRIANES” y “Cuidados yestrategias para la administración de medicamentos”. Es de destacar que los desafíos del cuidadodiario involucran la alimentación, la higiene corporal, la vigilancia constante y la administración demedicamentos. Se sugiere que la familia de estos niños, sea apoyada por los servicios de salud yorientada, con el fin de minimizar los desafíos del cuidado diario en el espacio del hogar. (AU)

Este estudo objetiva descrever os desafios do cotidiano de cuidados às criançascom necessidades especiais de saúde por cuidadores familiares no espaço domiciliar. Pesquisa de abordagem qualitativa, descritiva e exploratória, mediada pela entrevista semiestruturada realizada no espaço domiciliar com 15 cuidadoras familiares de crianças. Utilizou-se amostragem por saturação, as enunciações foram duplamente transcritas, e submetidas à análise de conteúdo. Os resultados revelam que o cuidado exercido às criançascom necessidades especiais de saúde é realizado exclusivamente por mulheres da família,mães e avós, de crianças entre 0 a 10 anos de idade, que necessitam de cuidados medicamentosos para sua sobrevivência. Das enunciações emergiram duas categorias temáticas“Desafios enfrentados por cuidadoras familiares de CRIANES” e “Cuidados e estratégiaspara administração de medicamentos”. Ressalta-se que os desafios do cotidiano de cuidados envolvem a alimentação, higiene corporal, vigilância constante e a administração demedicamentos. Sugere-se a que a família dessas crianças, sejam amparadas pelos serviçosde saúde e orientadas, a fim de minimizar os desafios do cuidado cotidiano no espaço domiciliar. (AU)

Experiences of maternity care among women at increased risk of preterm birth receiving midwifery continuity of care compared to women receiving standard care: Results from the POPPIE pilot trial.

BACKGROUND: Midwifery continuity of care models for women at low and mixed risk of complications have been shown to improve women's experiences of care. However, there is limited research on care experiences among women at increased risk of preterm birth. We aimed to explore the experiences of care among women with risk factors for preterm birth participating in a pilot trial (POPPIE) of a midwifery continuity of care model which included a specialist obstetric clinic. METHODS: A total of 334 pregnant women identified at increased risk of preterm birth were randomly allocated to either midwifery continuity of care (POPPIE group) or standard maternity care. Women in both groups were followed up at six-to-eight weeks postpartum and were invited to complete a postnatal survey either online or by post. An equal status exploratory sequential mixed method design was chosen to collect and analyse the quantitative postnatal survey data and qualitative interviews data. The postnatal survey included measures of social support, trust, perceptions of safety, quality of care, control during childbirth, bonding and quality of life. Categorical data were analysed with chi-squared tests and continuous data were analysed with t-tests and/or Mann-Whitney U test to measure differences in measures scores among groups. The qualitative interview data were subjected to a thematic framework analysis. Data triangulation brought quantitative and qualitative data together at the interpretation stage. FINDINGS: A total of 166 women completed the survey and 30 women were interviewed (90 and 16 in POPPIE group; 76 and 14 in standard group). We found survey respondents in the POPPIE group, compared to respondents in the standard group, were significantly more likely to report greater trust in midwives (Mann-Whitney U, p<0.0001), greater perceptions of safety during the antenatal care (t-test, p = 0.0138), have a particular midwife to contact when they needed during their pregnancy (t-test, p<0.0001) and the postnatal period (chi-squared, p<0.0001). They reported increased involvement in decisions regarding antenatal, intrapartum and postnatal care (t-test, p = 0.002; p = 0.008; p = 0.006 respectively); and greater postnatal support and advice about: feeding the baby (chi-squared, p<0.0001), handling, settling and looking after the baby (chi-squared, p<0.0001), baby's health and progress (chi-squared, p = 0.039), their own health and recovery (chi-squared, p = 0.006) and who to contact about any emotional changes (chi-squared, p = 0.005). There were no significant differences between groups in the reporting of perceptions of safety during birth and the postnatal period, concerns raised during labour and birth taken seriously, being left alone during childbirth at a time of worries, control during labour, bonding, social support, and physical and mental health related quality of life after birth. Results from qualitative interviews provided insight and depth into many of these findings, with women in the POPPIE group reporting more positive experiences of bonding towards their babies and more positive physical health postnatally. CONCLUSIONS: Compared with standard maternity care, women at increased risk of PTB who received midwifery continuity of care were more likely to report increased perceptions of trust, safety and quality of care. TRIAL REGISTRATION: ISRCTN (Number: 37733900); UK CRN (ID: 31951).

Behind the Scenes: Publishing in the Maternal and Child Health Journal.

The Editors of the Maternal and Child Health Journal offer an inside look at publishing in the journal, including advice for potential authors and reviewers.

Unexpected Influences-A Maternity Nursing Career and the Next Generation.

A nurse reflects on what her daughters have picked up from her career in maternity nursing, education, and research.

Calidad de la asistencia enfermera en una unidad de cuidados intensivos maternos / Qualidade da assistência de enfermagem em uma unidade de terapia intensiva materna / Quality of nursing care in a maternal intensive care unit

Objetivo: evaluar la calidad de la asistencia en una Unidad de Cuidados Intensivos maternos, ha tenido por base indicadores de estructura proceso y resultados. Material y método: estudio descriptivo, de análisis documental con abordaje cuantitativo. La colecta de datos ocurrió entre enero y febrero de 2017 en la Unidad de Cuidados Intensivos maternos de una maternidad de referencia en Piauí. Fue utilizado un guion observacional con muestra censal de 72 pacientes. Resultados: el eje higiene, confort y seguridad mostró una asistencia global deseable, excepto para los indicadores de nutrición e hidratación que presentaron asistencia tolerable o limíte. El eje que presentó mejores resultados fue las anotaciones de enfermería con asistencia deseable en gran parte de los artículos analizados. Conclusión: el estudio evidenció resultados satisfactorios de forma general, sin embargo, es importante que ocurran mejoras en la asistencia de enfermería a las pacientes ingresadas en la unidad de cuidados intensivos maternosl, sobre todo para los indicadores de nutrición e hidratación

Objetivo: avaliar a qualidade da assistência em uma Unidade de Terapia Intensiva Materna, tendo por base indicadores de estrutura, processo e resultados. Material e método: estudo descritivo, de análise documental com abordagem quantitativa. A coleta de dados ocorreu entre os meses de janeiro e fevereiro de 2017 na Unidade de Terapia Intensiva materna de uma maternidade de referência do Piauí. Utilizou-se roteiro observacional com amostra censitária de 72 pacientes. Resultados: o eixo higiene, conforto e segurança demonstraram uma assistência global desejável, exceto para os indicadores nutrição e hidratação que apresentaram assistência sofrível ou limítrofe. O eixo que apresentou melhores resultados foi anotações de enfermagem com assistência desejável em grande parte dos itens analisados. Conclusão: o estudo evidenciou resultados satisfatórios de forma geral, entretanto, chama-se atenção para melhoras na assistência de enfermagem às pacientes internadas na Unidade de Terapia Intensiva Materna, sobretudo para os indicadores nutrição e hidratação

Objective: to evaluate the quality of care provided in a maternal intensive care unit, based on indicators of structure, process and results. Material and methods: descriptive study of documentary analysis with a quantitative approach. Data collection happened between January and February 2017 at the Maternal Intensive Care Unit of a reference maternity hospital in Piauí. An observational script with a census sample of 72 patients was used. Results: the hygiene, comfort and safety axis showed adequate care. However, the nutrition and hydration indicators presented with risky and undesirable care. The axis that presented the best results was nursing records with adequate care in most of the analyzed items. Conclusion: the study showed satisfactory results in general; however, attention should be given to improvements in nursing care for patients hospitalized in the Maternal Intensive Care Unit, especially for the nutrition and hydration indicators

Experienced job autonomy among maternity care professionals in The Netherlands.

OBJECTIVE: High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care system and whether they expect a new system of integrated maternity care to affect their experienced job autonomy. DESIGN: A cross-sectional survey. The Leiden Quality of Work Life Questionnaire was used to assess experienced job autonomy among maternity care professionals. SETTING: Data were collected in the Netherlands in 2015. PARTICIPANTS: 799 professionals participated of whom 362 were primary care midwives, 240 obstetricians, 93 clinical midwives and 104 obstetric nurses. FINDINGS: The mean score for experienced job autonomy was highest for primary care midwives, followed by obstetricians, clinical midwives and obstetric nurses. Primary care midwives scored highest in expecting to lose their job autonomy in an integrated care system. KEY CONCLUSIONS: There are significant differences in experienced job autonomy between maternity care professionals. IMPLICATIONS FOR PRACTICE: When changing the maternity care system it will be a challenge to maintain a high level of experienced job autonomy for professionals. A decrease in job autonomy could lead to a reduction in job related wellbeing and in satisfaction with care among pregnant women.

How have the lives of pregnant women changed in the last 30 years?

BACKGROUND: To what extent have the characteristics and needs of pregnant women changed over time? This cross-sectional, comparative study describes some socio-demographic, mental health and lifestyle characteristics of two samples of pregnant women assessed 30 years apart. METHODS: We recruited two samples of pregnant women who were attending their first clinic visit at the same large Queensland maternity hospital 30 years apart between 1981 to 1984 (Sample A, N=6753) and 2011-2012 (Sample B, N=2156). The women were compared using the same survey tool. Descriptive statistics are presented. Pearson's chi-square tests were undertaken (significance at <0.05) to determine how the characteristics and needs of pregnant women may be changing over time. FINDINGS: Women, recently sampled, were older, more highly-educated and were more likely to be living with, but not married to, their partners, as well as having their first baby, than were women 30 years ago. As well, recently sampled, pregnant women were more likely to be non-smokers, to have higher body mass indexes and more symptoms of anxiety, but were less likely to be having an unplanned pregnancy. CONCLUSION: This study found a number of differences between the socio-demographic characteristics, lifestyles and mental health of two samples of pregnant women assessed 30 years apart. Our findings suggest the need for ongoing monitoring of pregnant women to determine changing health priorities. Being more educated, today's women may be more amenable to health education interventions. Higher body mass indexes for recently sampled women, highlights an emerging problem that needs to be addressed.

La importancia de la estimulación intrauterina: nuevos contenidos y retos en los programas de educación maternal / The importance of intrauterine stimulation: New content and challenges in maternal education programmes

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Challenges and Creative Strategies in Undergraduate Nursing Education in Maternal-Child Health.

Maternal-child health (MCH) is an integral part of most nursing undergraduate curricula. However, there are variations in implementation related to classroom and clinical experiences. The purpose of this article is to describe recent trends in MCH education, explore potential challenges, and highlight creative solutions for MCH nursing education. Perinatal nursing requires a solid skill base and sound knowledge base in many subjects, including health promotion and behavior change theory. Educators need to provide students with a firm educational foundation to meet both workforce demands and the needs of childbearing women, infants, and families.

Trends in Baby-Friendly® Care in the United States: Historical Influences on Contemporary Care.

The protection that breast-feeding affords both mother and infant against acute and chronic illness is well documented. The grassroots, public health, and governmental supports for breast-feeding have influenced changes in maternal and newborn care. History indicates that the additional influence has come in the form of governmental workshops and initiatives, professional organizations, as well as The Joint Commission. This includes the influence that the Baby-Friendly® Hospital Initiative and the Ten Steps to Successful Breastfeeding have had on infant care throughout the years. The requirements that hospitals must follow to implement all, or some, of the Ten Steps lead to change in care that not only increases breast-feeding rates but also leads to health improvements. This article reviews how an upward trend in the adoption of Baby-Friendly practices to support breast-feeding impacts infant care.

Infermeria pediàtrica / No disponible

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Las nodrizas y su importancia en los cuidados / As amas de leite e sua importância no cuidado / Wet nurses and their importance in care

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Lean in to our profession.

Nurses play a critical role in the delivery of high-quality, evidence-based health care. Nurses can "lean in" to our professional by voicing our opinions, contributing to decisions affecting health care practice and policy, and assuming leadership roles.

El papel de la matrona en la «estrategia de nido» como prevención de la tos ferina / The role of the midwife in the "cocoon strategy" for prevention of pertussis

La tos ferina es un importante problema de salud pública que afecta especialmente a la mujer gestante y a los recién nacidos, y que es susceptible de prevención y control mediante la vacunación. El aumento en los últimos años del número de casos hace necesario poner en práctica la «estrategia de nido» (vacunación de las personas del entorno del lactante que puedan actuar como fuente de infección), que ha demostrado ampliamente su eficacia. La matrona, como personal directamente implicado en la salud de la mujer y del recién nacido, es el profesional de elección para liderar esta estrategia, actuando en cuatro momentos claves: 1. Consulta preconcepcional: vacunación de la mujer y su pareja; 2. Primera consulta de control de embarazo: revisión del estado de vacunación de la mujer y la pareja. Planificación de la administración de la vacuna. Información; 3. Preparación al parto: información de la estrategia de nido; 4. Visita puerperal: vacunación de la mujer y la pareja

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Satisfacción en la provisión de redes de apoyo social en grupos de acompañamiento a la maternidad / Satisfaction in providing social support networks in assistance groups for mothers

Objetivos: Conocer la percepción del grado de satisfacción que tienen las madres, con hijos menores de un año y que participan en las dinámicas grupales que los CAP ofrecen, en relación al contenido y redes de provisión del Apoyo Social (AS) así como las causas que disminuyen la satisfacción en el receptor de este apoyo. Material y métodos: Estudio con diseño cualitativo y enfoque fenomenológico. La población objeto de estudio estaba constituida por madres participantes en dinámicas grupales de cinco CAP de la provincia de Barcelona. Como instrumento de recogida de datos se empleó la entrevista semiestructurada, entre julio de 2011 y julio de 2012; todas fueron grabadas, transcritas y analizadas. Resultados: AS informal: la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional y evaluativo procedente de las enfermeras; identificándose 4 categorías que contribuyen en esta percepción: contacto profesional/accesibilidad, disparidad y/o actualización, confianza y no procede. AS formal, la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional, evaluativo y técnico procedente de la pareja y madre (abuela materna); identificándose 8 categorías en esta percepción: disparidad y/o actualización en los consejos, exigencia, empatía, confianza, inseguridades, tiempo, distancia y no procede. Conclusiones: Los factores identificados deberían considerarse en los planes de mejora de la satisfacción y acompañamiento de las madres en este momento de profundos cambios en su vida; dado que aportar un AS satisfactorio repercute en la promoción de la salud y prevención de la enfermedad (AU)

Objectives: To determine the level of satisfaction of mothers of under one year-old babies who participate in group activities provided by the CAP regarding the content and Social Support (AS), support network as well as the causes that lead to a lower satisfaction level for people receiving this support. Methods: This study includes a qualitative design and phenomenological approach. The study population consisted of mothers participating in group activities in five different CAP in the province of Barcelona. Semi-structured interviews were used as a data collection instrument between July 2011 and July 2012. They were all recorded, transcribed and analyzed. Results: informal AS: most mothers are very or completely satisfied with the information, emotional and evaluative AS from nurses; four categories were identified, that contributed to this perception: professional contact / access, discrepancy and / or update, confidence and not applicable. Formal AS: most mothers are very or completely satisfied with the information, emotional, and technical evaluation from the couple and mother (maternal grandmother) AS; eight categories were identified in this item: discrepancy and / or update on advice, requests, empathy, trust, lack of confidence, time, distance and not appropriate. Conclusions: The factors identified should be considered in plans to improve the satisfaction and support of mothers in this time of profound change in their life since AS provides a satisfactory impact on health promotion and disease prevention (AU)