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1.
Enferm. clín. (Ed. impr.) ; 30(6): 411-418, nov.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197671

RESUMO

OBJETIVO: Describir las percepciones y deseos sobre el parto en un grupo de gestantes a término de Zamora. MÉTODO: Estudio cualitativo de carácter fenomenológico. Participantes y ámbito de estudio: embarazadas de 37-38 semanas, centros de salud Zamora Sur y Santa Elena (Zamora). Recogida de datos: entrevistas semiestructuradas, hasta llegar a saturación de datos (16 entrevistas). Análisis de datos: análisis de contenido temático. RESULTADOS: Los sentimientos maternos variaron desde la alegría hasta el miedo o el estrés. Las entrevistadas manifestaron no sentirse capaces de soportar el dolor del parto. Las necesidades que sintieron como más importantes fueron contar con apoyo y acompañamiento en el parto (sobre todo de su pareja) y recibir buen trato de los sanitarios. CONCLUSIONES: La importancia y la repercusión del parto para la mujer no solo atiende al ámbito biológico, sino en gran medida también al mental, al emocional y al social. En él intervienen múltiples factores que lo condicionan: los sentimientos maternos, su capacidad de afrontar el dolor del parto, sus necesidades, sus cambios realizados, el apoyo con el que cuentan y los profesionales sanitarios que atienden a la mujer


OBJECTIVE: To describe perceptions and wishes regarding childbirth in a group of full-term pregnant women in Zamora. METHOD: Qualitative study of phenomenological character. Participants and scope of study: pregnant women (37-38 weeks), Zamora Sur and Santa Elena health centres (Zamora, Spain). Data collection: semi-structured interviews, until data saturation (16 interviews). Data analysis: analysis of thematic content. RESULTS: The maternal feelings varied from joy to fear or stress. The interviewees said they did not feel capable of enduring the pain of childbirth. The needs that they felt most important were having support and accompaniment during delivery (especially of their partner) and receiving good treatment from the healthcare workers. CONCLUSIONS: The importance and repercussion of childbirth for women are not only biological, but also largely mental, emotional and social. It is conditioned by multiple factors: maternal feelings, their ability to deal with the pain of childbirth, their needs, the changes they have made, the support they have and the health professionals who care for them


Assuntos
Humanos , Feminino , Gravidez , Nascimento a Termo , Percepção , Trabalho de Parto/psicologia , Serviço de Acompanhamento de Pacientes/psicologia , Enfermeiras Obstétricas/estatística & dados numéricos , Enfermeiras Obstétricas/psicologia , Parto Obstétrico/métodos , Parto Obstétrico/enfermagem , Amostragem , Dor do Parto/enfermagem , Dor do Parto/psicologia
2.
Nursing ; 50(9): 64-68, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32826681

RESUMO

PURPOSE: To examine the effect of Benson's relaxation technique on occupational stress in midwives working in a Labor and Delivery (L&D) unit. METHODS: This pre- and post-quasi-experimental study involved 65 midwives with a minimum 1 year of experience using convenience sampling. After training, the participants performed Benson's relaxation technique twice a day for 4 weeks. RESULTS: Occupational stress was measured using standard questionnaires of occupational stress. Data were analyzed using the Statistical Package for Social Sciences software. Statistical analysis was performed using the Kolmogorov-Smirnov goodness-of-fit test, Student's t-test, and Wilcoxon signed rank test. CONCLUSION: This study demonstrated that Benson's relaxation technique may be effective in reducing occupational stress among midwives in L&D units.


Assuntos
Enfermeiras Obstétricas/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Estresse Ocupacional/prevenção & controle , Terapia de Relaxamento/métodos , Adulto , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia , Estresse Ocupacional/epidemiologia , Gravidez , Inquéritos e Questionários , Adulto Jovem
3.
Enferm. clín. (Ed. impr.) ; 30(supl.5): 179-182, jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196664

RESUMO

Problems that exist in health segment is the number of medical graduates that is not comparable with the amount of job vacancy and that makes health worker need to have another skill or ability. The program that is held by Yogyakarta Husada Health Polytechnic to equipt the graduate is to provide entrepreneurship training, which is in accordance with their competence in order to open up opportunities of business either independently or collaborated. The method of this research is using descriptive method. The data collection is done by observation, documentation study of business growth done by all the tenant (student or alumni) after getting training doing visits and internship. The sample of the research was student and alumni of nurses and midwives in Karya Husada Health Polytechnic who has participated in entrepreneurship training. The results were obtained by this program is carried out during 3 years since 2015 until 2017 first year of this study followed as many as 20 participants, second year do allowed by 21 participants, third years of this study followed by 34 participants and that mean there was 75 participant of the sample. After further training has been given then do an evaluation and monitoring, in first year there were 6 (30%) of entrepreneur is independent, second year there was 9 people (42.86%) of entrepreneurs are independent, in third years there was 12 people (35.29%) are independent entrepreneurs. Meanwhile the participants who still need mentoring and guidance form first year till third year as many as 48 people. Type of business that they do in the form of goods or services. Conclusion of the entrepreneurship training activities is the activity that can create new entrepreneur who was independent in health segment or non- medical segment both in form of goods or services


No disponible


Assuntos
Humanos , Planos para Motivação de Pessoal/organização & administração , Pessoal de Saúde/estatística & dados numéricos , Contrato de Risco , Estudantes de Enfermagem/estatística & dados numéricos , Motivação , Enfermeiras Obstétricas/estatística & dados numéricos
4.
Am J Obstet Gynecol ; 223(2): 254.e1-254.e8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32044310

RESUMO

BACKGROUND: Planned home births have leveled off in the United States in recent years after a significant rise starting in the mid-2000s. Planned home births in the United States are associated with increased patient-risk profiles. Multiple studies concluded that, compared with hospital births, absolute and relative risks of perinatal mortality and morbidity in US planned home births are significantly increased. OBJECTIVE: To explore the safety of birth in the United States by comparing the neonatal mortality outcomes of 2 locations, hospital birth and home birth, by 4 types of attendants: hospital midwife; certified nurse-midwife at home; direct-entry ("other") midwife at home; and attendant at home not identified, using the most recent US Centers for Disease Control and Prevention natality data on neonatal mortality for planned home births in the United States. Outcomes are presented as absolute risks (neonatal mortality per 10,000 live births) and as relative risks of neonatal mortality (hospital-certified nurse-midwife odds ratio, 1) overall, and for recognized risk factors. STUDY DESIGN: We used the most current US Centers for Disease and Prevention Control Linked Birth and Infant Death Records for 2010-2017 to assess neonatal mortality (neonatal death days 0-27 after birth) for single, term (37+ weeks), normal-weight ( >2499 g) infants for planned home births and hospital births by birth attendants: hospital-certified nurse-midwives, home-certified nurse-midwives, home other midwives (eg, lay or direct-entry midwives), and other home birth attendant not identified. RESULTS: The neonatal mortality for US hospital midwife-attended births was 3.27 per 10,000 live births, 13.66 per 10,000 live births for all planned home births, and 27.98 per 10,000 live births for unintended/unplanned home births. Planned home births attended by direct-entry midwives and by certified nurse-midwives had a significantly elevated absolute and relative neonatal mortality risk compared with certified nurse-midwife-attended hospital births (hospital-certified nurse-midwife: 3.27/10,000 live births odds ratio, 1; home birth direct-entry midwives: neonatal mortality 12.44/10,000 live births, odds ratio, 3.81, 95% confidence interval, 3.12-4.65, P<.0001; home birth-certified nurse-midwife: neonatal mortality 9.48/10,000 live births, odds ratio, 2.90, 95% confidence interval, 2.90; P<.0001). These differences increased further when patients were stratified for recognized risk factors. CONCLUSION: The safety of birth in the United States varies by location and attendant. Compared with US hospital births attended by a certified nurse-midwife, planned US home births for all types of attendants are a less safe setting of birth, especially when recognized risk factors are taken into account. The type of midwife attending US planned home birth appears to have no differential effect on decreasing the absolute and relative risk of neonatal mortality of planned home birth, because the difference in outcomes of US planned home births attended by direct-entry midwives or by certified nurse-midwives is not statistically significant.


Assuntos
Parto Domiciliar/estatística & dados numéricos , Mortalidade Infantil , Tocologia/estatística & dados numéricos , Enfermeiras Obstétricas/estatística & dados numéricos , Adulto , Entorno do Parto/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Intenção , Gravidez , Estados Unidos
5.
Midwifery ; 83: 102648, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32035343

RESUMO

In the Netherlands, a percentage of newly qualified midwives start work in maternity care as a hospital-based midwife, although prepared particularly for working autonomously in the community. AIM: This study aimed to explore newly qualified Dutch midwives' perceptions of their job demands and resources during their initiation to hospital-based practice. DESIGN: We conducted a qualitative study with semi structured interviews using the Job Demands-Resources model as theoretical framework. METHODS: Twenty-one newly qualified midwives working as hospital-based midwives in the Netherlands were interviewed individually between January and July 2018. Transcripts were analyzed using thematic content analysis. FINDINGS: High workload, becoming a team member, learning additional medical procedures and job insecurity were perceived demands. Participants experienced the variety of the work, the teamwork, social support, working with women, and employment conditions as job resources. Openness for new experiences, sociability, calmness and accuracy were experienced as personal resources, and perfectionism, self-criticism, and fear of failure as personal demands. CONCLUSION: Initiation to hospital-based practice requires from newly qualified midwives adaptation to new tasks: working with women in medium and high-risk care, managing tasks, as well as often receiving training in additional medical skills. Sociability helps newly qualified midwives in becoming a member of a multidisciplinary team; neuroticism and perfectionism hinders them in their work. Clear expectations and a settling-in period may help newly qualified midwives to adapt to practice. The initiation phase could be better supported by preparing student midwives for working in a hospital setting and helping manage expectations about the settling-in period.


Assuntos
Enfermeiras Obstétricas/educação , Enfermeiras Obstétricas/psicologia , Percepção , Fatores de Tempo , Adulto , Feminino , Humanos , Relações Interprofissionais , Satisfação no Emprego , Países Baixos , Enfermeiras Obstétricas/estatística & dados numéricos , Pesquisa Qualitativa , Carga de Trabalho/psicologia , Carga de Trabalho/normas
7.
Midwifery ; 82: 102618, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887470

RESUMO

OBJECTIVE: The purpose of this study was to examine the ways in the decision to access a planned epidural in labour was topicalised and negotiated between pregnant women and midwives. DESIGN: This article uses conversation analysis to examine how decision-making unfolds in antenatal consultations in a large metropolitan hospital in South Australia. Data were sampled from naturally-occurring interactions between women and midwives in routine antenatal consultations. Analysis focused on talk about planning to access (or, avoid) an epidural during an upcoming labour. FINDINGS: This paper illustrates that in the context of woman-centred care, women are held unilaterally responsible for the decision to accept or reject a planned epidural in labour with little or no input from the midwife. Midwives take a step back from involvement in the discussion beyond the solicitation of a decision from the woman. Women wanting a planned epidural took a strong, assertive stance in the interaction and drew on their previous birthing experience, limiting opportunity for the midwife to engage in meaningful discussion about the risks and benefits. On the other hand, women rejecting a planned epidural were less assertive and engaged in more complex interactional work to account for their decision. KEY CONCLUSIONS: The lack of involvement by midwives may be linked to the non-directive ethos that prevails in maternity care. It is argued that, in this dataset, the institutional imperative for women to know and decide on pain relief while pregnant in order to allocate to a model of care is prioritised over women's aspirations and expectations of childbirth. IMPLICATIONS FOR PRACTICE: By analysing the ways in which midwives and women interact at the point in time at which decisions were made to plan access to an epidural we can continue to reveal underlying forces that drive the rising rates of medical interventions in childbirth. This paper also contributes to research evidence on how midwives manage the potentially contradictory dialect between supporting women's childbirth preferences while also managing institutional requirements and evidence-based practice.


Assuntos
Anestesia Epidural/métodos , Tomada de Decisões , Relações Enfermeiro-Paciente , Encaminhamento e Consulta/normas , Adulto , Anestesia Epidural/normas , Feminino , Humanos , Enfermeiras Obstétricas/psicologia , Enfermeiras Obstétricas/normas , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Gestantes/psicologia , Encaminhamento e Consulta/estatística & dados numéricos , Austrália do Sul
8.
Midwifery ; 82: 102596, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887471

RESUMO

OBJECTIVE: to investigate how recent graduates from a combined work/study midwifery degree programme in Uganda viewed its effects on their wellbeing and work prospects. DESIGN: Using an adapted version of the Qualitative Impact Protocol (QuIP), a phenomenological approach was applied to thematic analysis to examine semi-structured interviews and WhatsApp group discussion. SETTING: Introduction of enhanced midwifery training (from Diploma to Degree level) combining study with professional practice within a low income country health system facing extreme capacity constraints. PARTICIPANTS: 14 members of the first cohort of graduates from the degree programme. FINDINGS: The graduates were overwhelmingly positive about improved professional knowledge, clinical skills, confidence, career commitment and prospects. They also had to contend with resentment from colleagues, increased workload and debt. Counselling training, peer support, and experience of managing stress during the training helped them to cope with these challenges. CONCLUSIONS: Qualitative feedback from those receiving advanced midwifery training highlights the importance of addressing social as well as technical skills, including leadership capacity and resilience in handling working relationships.


Assuntos
Enfermeiras Obstétricas/psicologia , Autoeficácia , Fatores de Tempo , Adaptação Psicológica , Adulto , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Enfermeiras Obstétricas/educação , Enfermeiras Obstétricas/estatística & dados numéricos , Pesquisa Qualitativa , Inquéritos e Questionários , Uganda
9.
J Clin Nurs ; 29(1-2): 152-162, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31610060

RESUMO

AIMS AND OBJECTIVES: To describe the prescribing behaviours and practices of registered nurse and midwife prescribers and to explore experiences of enablers and barriers to prescribing practices. BACKGROUND: The extension of prescriptive authority to nurses and midwives internationally has created new opportunities for them to expand their scope of practice and is of significant benefit to effective and efficient health service provision. DESIGN: Cross-sectional national survey of registered nurse and midwife prescribers. METHODS: Data were collected through an online survey between April-July 2018. A total of 84 nurse and midwife prescribers participated. The STROBE checklist was applied as the reporting guideline for this study. RESULTS: Respondents estimated that two-fifths of their consultations involved an episode of prescribing. Nurse and midwife prescribers engaged in similar prescribing behaviours spanning the range of activities from initiating new medications to ceasing medicines. The most frequently selected criterion for prescribing was clinical effectiveness. Prescribing was viewed as essential to respondents' clinical practice, allowing them to provide a complete episode of care and leading to a reduction in medication errors and reduced delays and waiting times for patients. Enablers of prescribing included knowledge, experience, education and access to continuous professional development, as well as support from colleagues and organisations. CONCLUSION: Little is known about the prescribing behaviours and practices of registered nurse and midwife prescribers. While prescribing authority enables nurse and midwife practitioners to deliver holistic care, there remain significant barriers and challenges including increased workloads, lack of continuous professional development, lack of support and overly restrictive rules and policies governing prescribing. RELEVANCE TO CLINICAL PRACTICE: Addressing the barriers identified in this study could enable more nurse and midwife prescribers to work to their full scope of practice, enabling populations to fully capitalise on the contributions of registered nurse and midwife prescribing services.


Assuntos
Prescrições de Medicamentos/enfermagem , Padrões de Prática em Enfermagem , Estudos Transversais , Prescrições de Medicamentos/estatística & dados numéricos , Cuidado Periódico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Gravidez , Inquéritos e Questionários
11.
Matronas prof ; 20/21(4/1): 28-34, 2019-2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192425

RESUMO

OBJETIVO: Analizar la información que proporcionan los incidentes de seguridad reportados mediante el sistema de notificación de incidentes en el Servicio de Medicina Maternofetal del Hospital Clínic de Barcelona en el primer año tras su implantación. METODOLOGÍA: Se ha realizado un estudio transversal observacional descriptivo incluyendo todos los incidentes de seguridad reportados al Servicio de Medicina Maternofetal del Hospital Clínic de Barcelona en 2016. Las variables estudiadas fueron las siguientes: tipo de incidente, riesgo, turno y notificador. Para su análisis se utilizó el programa Microsoft Excel de Windows. RESULTADOS: Los incidentes de seguridad más frecuentes corresponden a los relacionados con la gestión clínica y los procedimientos, seguidos de los de medicación. La mayoría de los incidentes que se reportan son de riesgo bajo y se observaron en el turno de día; sin embargo, los de riesgo alto se produjeron durante el turno de noche. Destaca también que el colectivo que más notifica es el de enfermeras y matronas. CONCLUSIONES: El personal de enfermería, y concretamente las matronas, son una pieza fundamental en la seguridad obstétrica. Es básico seguir las estrategias y prácticas seguras recomendadas y continuar trabajando para crear una cultura de seguridad


OBJECTIVE: Analyze the information provided by the security incidents reported through the incident reporting system in the Materno-Fetal Medicine Service of the Hospital Clínic of Barcelona in the first year after its implementation. METHODOLOGY: A descriptive observational cross-sectional study was conducted, including all safety incidents reported to the Maternal-Fetal Medicine Service of the Hospital Clínic de Barcelona in 2016. The variables studied were: type of incident, risk, shift and notifier. For its analysis, the Microsoft Excel Windows program was used. RESULTS: The most frequent safety incidents correspond to those related to clinical management and procedures, followed by those of medication. The majority of incidents that are reported are of low risk and were observed in the day shift, however, those of high risk occurred during the night shift. It also highlights that the group that most notifies is that of nurses and midwives. CONCLUSIONS: Nursing and specifically midwives are a fundamental part of obstetric safety. It is essential to follow the recommended safe strategies and practices and continue working to create a safety culture


Assuntos
Humanos , Feminino , Segurança do Paciente , Centros de Saúde Materno-Infantil/estatística & dados numéricos , Enfermeiras Obstétricas/normas , Gestão de Riscos/normas , Estudos Transversais , Enfermeiras Obstétricas/estatística & dados numéricos , Obstetrícia/normas , Gestão de Riscos/estatística & dados numéricos
12.
Curationis ; 42(1): e1-e7, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31793307

RESUMO

BACKGROUND: The primary purpose of cardiotocography is to detect early signs of intrapartum hypoxia and improve foetal outcomes. Intrapartum hypoxia remains the major cause of perinatal deaths during monitored labours. This is attributed to the midwives' lack of knowledge and skills in the foetal implementation and interpretation of cardiotocographs. OBJECTIVES: This study aimed to establish midwives' knowledge and interpretive skills of cardiotocography. METHOD: The study employed a quantitative research approach with an explorative, descriptive, cross-sectional design. A total of 226 purposively selected participants were asked to complete a self-administered, structured questionnaire, of which 125 responded by completing the questionnaire. The study was conducted in labour wards in KwaZulu-Natal public hospitals in 2014. Data analysis was performed by means of descriptive and inferential statistics using analysis of variance. RESULTS: The findings revealed that the midwives in KwaZulu-Natal public hospitals were found to be clinically lacking in knowledge of cardiotocography. CONCLUSION: The limited cardiotocographic knowledge of the midwives in KwaZulu-Natal public hospitals was possibly because of a lack of in-service training, as more than half of the participants (70%) indicated a need for this.


Assuntos
Cardiotocografia/métodos , Competência Clínica/normas , Enfermeiras Obstétricas/normas , Adulto , Cardiotocografia/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Avaliação Educacional/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Enfermeiras Obstétricas/estatística & dados numéricos , África do Sul , Inquéritos e Questionários
13.
BMJ Open ; 9(10): e030797, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666266

RESUMO

OBJECTIVE: To assess Chilean medical and midwifery students' attitudes and willingness to become trained to provide abortion care, shortly after abortion was decriminalised in 2017. DESIGN: We fielded a cross-sectional, web-based survey of medical and midwifery students. We used generalised estimating equations to assess differences by type of university and degree sought. SETTING: We recruited students from a combination of seven secular, religiously-affiliated, public and private universities that offer midwifery or medical degrees with a specialisation in obstetrics and gynaecology, located in Santiago, Chile. PARTICIPANTS: Students seeking medical or midwifery degrees at one of seven universities were eligible to participate. We distributed the survey link to medical and midwifery students at these seven universities; 459 eligible students opened the survey link and 377 students completed the survey. PRIMARY AND SECONDARY OUTCOMES: Intentions to become trained to provide abortion services was our primary outcome of interest. Secondary outcomes included moral views and concerns about abortion provision. RESULTS: Most students intend to become trained to provide abortion services (69%), 20% reported that they will not provide an abortion under any circumstance, half (50%) had one or more concern about abortion provision and 16% agreed/strongly agreed that providing abortions is morally wrong. Most believed that their university should train medical and midwifery students to provide abortion services (70%-79%). Secular university students reported higher intentions to provide abortion services (beta 0.47, 95% CI: 0.31 to 0.63), more favourable views (beta 0.52, CI: 0.32 to 0.72) and were less likley to report concerns about abortion provision (adjusted OR 0.47, CI: 0.23 to 0.95) than students from religious universities. CONCLUSION: Medical and midwifery students are interested in becoming trained to provide abortion services and believe their university should provide this training. Integrating high-quality training in abortion care into medical and midwifery programmes will be critical to ensuring that women receive timely, non-judgemental and quality abortion care.


Assuntos
Aborto Legal/psicologia , Atitude do Pessoal de Saúde , Enfermeiras Obstétricas/psicologia , Estudantes de Medicina/psicologia , Adolescente , Adulto , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Religião , Estudantes de Medicina/estatística & dados numéricos , Adulto Jovem
15.
Midwifery ; 78: 97-103, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31419782

RESUMO

OBJECTIVE: To increase understanding of integrative power in decision-making in home-like childbirth from midwives' and women's perspectives. DESIGN: A qualitative multiple case study. SETTING: Two regions of Switzerland, a French and a German-speaking. PARTICIPANTS: Twenty interviews with midwives and 20 with women and some partners who had experienced complications in home-like births. METHODS: Data were collected from in-depth interviews relevant for casestudy. Four cases during second stage of labour were carefully selected using literal replication logic. Interview transcripts were analysed in developing case descriptions and in interpreting mechanisms related to perception of power in making decision. FINDINGS: The analysis of each case and a cross-case comparison showed that mechanisms for building integrative power, such as creation of relationships, cooperation, loyalty, legitimacy and respect, were highly visible in midwifery decision-making activities. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The study highlighted the visibility of integrative power mechanisms in decision-making in homelike settings. Until now, mechanisms of positive power in midwifery have been poorly described in literature. Integrative power could be a promising strategy to reinforce decision-making strategies. Therefore, clinical and policy measures explicitly addressing the positive aspects of power should be developed and evaluated.


Assuntos
Tomada de Decisão Compartilhada , Parto Domiciliar/métodos , Mães/psicologia , Enfermeiras Obstétricas/psicologia , Parto/psicologia , Adulto , Feminino , Parto Domiciliar/normas , Parto Domiciliar/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Mães/estatística & dados numéricos , Enfermeiras Obstétricas/estatística & dados numéricos , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Suíça
16.
Cancer Prev Res (Phila) ; 12(10): 701-710, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31427275

RESUMO

Self-sampling for human papillomavirus (HPV) testing is an alternative to physician sampling particularly for cervical cancer screening nonattenders. The GRECOSELF study is a nationwide observational cross-sectional study aiming to suggest a way to implement HPV-DNA testing in conjunction with self-sampling for cervical cancer screening in Greece, utilizing a midwifery network. Women residing in remote areas of Greece were approached by midwives, of a nationwide network, and were provided with a self-collection kit (dry swab) for cervicovaginal sampling and asked to answer a questionnaire about their cervical cancer screening history. Each sample was tested for high-risk (hr) HPV with the Cobas HPV test. HrHPV-Positive women were referred to undergo colposcopy and, if needed, treatment according to colposcopy/biopsy results. Between May 2016 and November 2018, 13,111 women were recruited. Of these, 12,787 women gave valid answers in the study questionnaire and had valid HPV-DNA results; hrHPV prevalence was 8.3%; high-grade cervical/vaginal disease or cancer prevalence was 0.6%. HrHPV positivity rate decreased with age from 20.7% for women aged 25-29 years to 5.1% for women aged 50-60 years. Positive predictive value for hrHPV testing and for HPV16/18 genotyping ranged from 5.0% to 11.6% and from 11.8% to 27.0%, respectively, in different age groups. Compliance to colposcopy referral rate ranged from 68.6% (for women 25-29) to 76.3% (for women 40-49). For women residing in remote areas of Greece, the detection of hrHPV DNA with the Cobas HPV test, on self-collected cervicovaginal samples using dry cotton swabs, which are provided by visiting midwives, is a promising method for cervical cancer secondary prevention.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Testes de DNA para Papilomavírus Humano , Programas de Rastreamento/organização & administração , Tocologia/organização & administração , Infecções por Papillomavirus/diagnóstico , Manejo de Espécimes/métodos , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Idoso , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/etiologia , Colposcopia/estatística & dados numéricos , Redes Comunitárias/organização & administração , Redes Comunitárias/normas , Estudos Transversais , DNA Viral/análise , DNA Viral/genética , Autoavaliação Diagnóstica , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Grécia/epidemiologia , Testes de DNA para Papilomavírus Humano/métodos , Testes de DNA para Papilomavírus Humano/normas , Testes de DNA para Papilomavírus Humano/estatística & dados numéricos , Humanos , Ciência da Implementação , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Tocologia/métodos , Enfermeiras Obstétricas/organização & administração , Enfermeiras Obstétricas/normas , Enfermeiras Obstétricas/estatística & dados numéricos , Papel do Profissional de Enfermagem , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , População Rural/estatística & dados numéricos , Manejo de Espécimes/normas , Manejo de Espécimes/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/etiologia , Esfregaço Vaginal/métodos , Esfregaço Vaginal/estatística & dados numéricos , Adulto Jovem
17.
Midwifery ; 78: 8-15, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31326664

RESUMO

OBJECTIVE: To explore midwives' experiences of the management of the second stage of labour in women with epidural analgesia. DESIGN: Descriptive qualitative study using semi-structured face-to-face interviews. PARTICIPANTS: Purposive sample of twelve midwives working in three Obstetric Units. Among them six were senior midwives with more than five years' experience on labour ward and six were junior midwives with less than five years' experience on labour ward. FINDINGS: The findings included four themes: a) timing of second stage of labour and maternal pushing; b) maternal positions and mobility; c) perspectives on epidural boluses; d) midwifery presence and support. The time 'allowed' by midwives for the passive phase of the second stage of labour ranged from zero to two hours, with some of them avoiding vaginal examinations to delay the recorded starting time of active pushing. The semi-sitting and the lithotomy positions were the most used respectively in labour and at birth. Some midwives encouraged the kneeling position or the lateral position. Regarding the management of the epidural bolus during the second stage of labour, the interviewees' opinions were divided between favourable and unfavourable to the administration of analgesic boluses after the full cervical dilatation. Midwives reported their experiences of providing different care to women with epidural analgesia when compared to women without epidural, mainly due to a more medicalised approach and the midwives' sense of 'usefulness' when caring for women not experiencing labour pain. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: To our knowledge, this was the first study on this topic conducted in an Italian setting. Despite the consistent body of evidence on the effects of epidural analgesia in the second stage on birth outcomes, the lack of clear guidelines, the presence of different hospital protocols and Obstetricians' opinion, introduce uncertainty in midwifery practice and lead midwives with feelings of 'uselessness'. Across the four themes, midwives frequently had to negotiate a space for their professional autonomy with other healthcare professionals, whilst adhering to the Obstetric Units' protocols. An influencing factor on the care provided to women with epidural was the years of midwife's experience on labour ward. Further research and the development of comprehensive midwifery care guidelines on the management of the second stage of labour in women with an epidural analgesia appears essential.


Assuntos
Analgesia Epidural/métodos , Segunda Fase do Trabalho de Parto/fisiologia , Enfermeiras Obstétricas/psicologia , Adulto , Analgesia Epidural/psicologia , Analgesia Epidural/normas , Feminino , Humanos , Entrevistas como Assunto/métodos , Itália , Segunda Fase do Trabalho de Parto/psicologia , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa
18.
Midwifery ; 78: 50-57, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31357116

RESUMO

INTRODUCTION: In Flanders, Belgium, 78.2% of the women exclusively breastfeed their babies following birth. However, after three months just one third of those babies is breastfed exclusively. This is in contrast with the WHO recommendations of a minimum of six months. Studies reveal that women are not always satisfied with the breastfeeding support they receive from their midwives, which can lead to early cessation of breastfeeding. The general aim of this study is to gain an in-depth understanding of the supporting role of midwives in breastfeeding support during the first two weeks after birth and compare it to the needs of the breastfeeding women. METHODS: A qualitative approach was used with an observational design and a focus group study. Two researchers performed non-participative observations in both hospital and primary healthcare settings. Midwife-mother interactions during breastfeeding support (midwives, n = 21; mothers, n = 59) were observed. Analysis of the data gathered from two focus groups with midwives (n = 10) and two focus groups with mothers (n = 9) provides an in-depth understanding of the supporting role of midwives during breastfeeding and helps to investigate whether that role corresponds to the mothers' needs both from the mothers' and the midwives' perspective. Observations and focus groups were analyzed using thematic analysis. FINDINGS: The analysis showed that both midwives and mothers want the breastfeeding to be a success. Generally, the production of breastmilk is a priority, for both the midwives and the mothers. Overall a hands-on approach regarding breastfeeding support was observed, mainly in the hospital settings when compared with the findings from the primary healthcare settings. A hands-on approach often occurs without asking the mother's consent. During the breastfeeding support, a professional relationship between the midwife and the mother is fostered. In primary healthcare there is one - to - one support which is contrary to hospital care, resulting in a personalized relationship. Breastfeeding support is influenced by personal (e.g. negative belief in breastfeeding policies) and external context factors (e.g. time restraints). CONCLUSION: The research data revealed three topics on breastfeeding support by the midwife which were the focus, the approach and the relationship between the midwife and the mothers. The way the midwife provides this support varies due to the setting (hospital or primary health care) and due to personal convictions of midwives and mothers. The study shows the importance of providing breastfeeding support which is tailored to individual needs of the mother.


Assuntos
Aleitamento Materno/métodos , Enfermeiras Obstétricas/psicologia , Adulto , Bélgica , Feminino , Grupos Focais/métodos , Maternidades/organização & administração , Maternidades/estatística & dados numéricos , Humanos , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Atenção Primária à Saúde/métodos , Pesquisa Qualitativa , Apoio Social
19.
Cad Saude Publica ; 35(7): e00223018, 2019 07 22.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31340337

RESUMO

This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Adulto , Brasil , Cesárea/estatística & dados numéricos , Cesárea/tendências , Criança , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Estudos de Avaliação como Assunto , Feminino , Idade Gestacional , Maternidades , Humanos , Trabalho de Parto , Saúde Materna/tendências , Enfermeiras Obstétricas/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Assistência Perinatal/tendências , Gravidez , Dados Preliminares , Apoio Social , Adulto Jovem
20.
Midwifery ; 77: 71-77, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31255911

RESUMO

OBJECTIVE: We aimed to explore midwives' perspectives on post-abortion care (PAC) in Uganda. Specifically, we sought to improve understanding of the quality of care. DESIGN: This was a qualitative study using individual in-depth interviews and an inductive thematic analysis. SETTING AND PARTICIPANTS: Interviews were conducted with 22 midwives (the 'informants') providing PAC in a public hospital in Kampala, Uganda. The narratives were based on experiences in current and previous workplaces, in rural and urban settings. FINDINGS: The findings comprise one main theme - morality versus duty to provide quality post-abortion care - and three sub-themes. Our findings confirm that the midwives were committed to saving women's lives but had conflicting personal morality in relation to abortion and sense of professional duty, which seemed to influence their quality of care. Midwives were proud to provide PAC, which was described as a natural part of midwifery. However, structural challenges, such as lack of supplies and equipment and high patient loads, hampered provision of good quality care and left informants feeling frustrated. Although abortion was often implied to be immoral, the experience of PAC provision appeared to shape views on legality, leading to an ambiguous, yet more liberal, stance. Abortion stigma was reported to exist within communities and the health workforce, extending to both providers and care-seeking women. Informants had witnessed mistreatment of women seeking care due to abortion complications, through deliberate care delays and denial of pain medication. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwives in PAC were dedicated to saving women's lives; however, conflicting morality and duty and poor working conditions seemed to impede good-quality care. Enabling midwives to provide good quality care includes increasing the patient-midwife ratio and ensuring essential resources are available. Additionally, efforts that de-stigmatise abortion and promote accountability are needed. Implementation of policies on respectful post-abortion care could aid in ensuring all women are treated with respect.


Assuntos
Aborto Induzido/enfermagem , Obrigações Morais , Princípios Morais , Enfermeiras Obstétricas/psicologia , Cuidado Pós-Natal/métodos , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Cuidado Pós-Natal/psicologia , Cuidado Pós-Natal/estatística & dados numéricos , Pesquisa Qualitativa , Uganda
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