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1.
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
3.
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
4.
J Forensic Leg Med ; 66: 44-49, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31220788

RESUMO

BACKGROUND: Today even low incidence of complications for mothers or neonates during pregnancy, delivery or postpartum is unacceptable to the public and can result in claims because of greater expectation from patients and an increase in media coverage. The present study was conducted to investigate the reasons for medical malpractice claims on maternal and neonatal impairment, which are achieved in Iranian Legal Medicine Organization councils. MATERIALS AND METHODS: The present cross-sectional and retrospective study used convenience sampling to collect data of total claims from 31 provinces archived in the supreme council of the ILMO in 2 years. In this article, the medical malpractice claims on maternal and neonatal impairment during pregnancy, labour, delivery and early postpartum were reported. The data were collected through a validated researcher-made checklist and were analyzed in SPSS 16. RESULTS: Among total of 299 cases of impairment, cerebral palsy (33.34%), Erb's palsy due to shoulder dystocia (24.24%) and Down Syndrome (24.24%) were the main confirmed causes of malpractice for neonatal impairment and Retained Surgical Mass (20.5%), Salpingectomy and/or Oophorectomy Related to EP (17.2%), Hysterectomy (17.2%) and Episiotomy Related complication (17.2%) were the main confirmed causes of malpractice for maternal impairment. CONCLUSION: Considering this fact that medical malpractice was confirmed in a large proportion of some preventable and important complications, therefore, results of this study can be used for developing educational programs for related healthcare providers to prevent those complications.


Assuntos
Parto Obstétrico/efeitos adversos , Imperícia/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Adulto , Neuropatias do Plexo Braquial/epidemiologia , Paralisia Cerebral/epidemiologia , Estudos Transversais , Síndrome de Down/epidemiologia , Distocia/epidemiologia , Feminino , Corpos Estranhos/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Enfermeiras Obstétricas/estatística & dados numéricos , Obstetrícia , Gravidez , Estudos Retrospectivos , Amostragem
5.
Midwifery ; 75: 117-126, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100483

RESUMO

OBJECTIVE: The objective of this study was to compare midwife-led and consultant-led obstetrical care for women with uncomplicated low-risk pregnancies. We estimated costs and maternal outcomes in both units to achieve a cost-effectiveness ratio. DESIGN: The cost-analysis was made according to the "intention to treat" concept in order to minimize bias associated with the non-randomization of participants. At the obstetric-led unit, women received care from both midwives and medical staff while those in the alternative structure called 'Le Cocon' only received care from midwives. SETTING: The obstetric-led unit of the Erasme University-Hospital in Brussels and its alongside midwife-led unit. PARTICIPANTS: The study population included all low-risk pregnant women from 1 March 2014 until 31 October 2015 who were affiliated to the MLOZ (Mutualités Libres-Onafhankelijke Ziekenfondsen; third Belgian statutory health care insurer). INTERVENTIONS: The cost calculation involved a bottom-up approach. The health care consumption of each participant was obtained from MLOZ's data. The study included costs occurred the beginning of pregnancy until 3 months post-partum. Clinical data were extracted from the patient medical records. FINDINGS: Compared to the traditional obstetric-led unit, the alternative midwife-led unit was associated with a cost reduction for the national payer (∆ = -€397.39, p = 0.046) and for the patient (∆ = - €44.19, p = 0.016). There were no significant differences in rates of caesarean, instrumental birth and epidural analgesia between MLU and OLU. A sensitivity analysis was performed (Appendix C) but does not change the overall results and conclusions. KEY CONCLUSIONS: Due to the small size of the samples, no statistical differences were found. More analysis is needed to evaluate the cost-effectiveness regarding the use of epidural analgesia, caesarean and instrumental birth rates in the midwife-led unit. IMPLICATIONS FOR PRACTICE: Given the economical findings, this could contribute to reduce health expenditures for both women (out of pocket) and state (public payer via health care insurers).


Assuntos
Enfermeiras Obstétricas/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Padrões de Prática em Enfermagem/economia , Adulto , Bélgica , Análise Custo-Benefício , Feminino , Humanos , Enfermeiras Obstétricas/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Assistência Perinatal/economia , Assistência Perinatal/métodos , Assistência Perinatal/estatística & dados numéricos , Padrões de Prática em Enfermagem/organização & administração , Padrões de Prática em Enfermagem/estatística & dados numéricos , Gravidez , Estudos Retrospectivos
7.
Midwifery ; 73: 69-77, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30903921

RESUMO

OBJECTIVE: This study assesses the genesis of stress among midwifery students in Ghana and its impact on their academic performance. DESIGN: A contextual cross-sectional design was used, and data were drawn from a 17-modified-item response from the College Undergraduate Stress Scale (CUSS), a rating of students' academic performance and stress management techniques. SETTING: The study took place at the Saint Michael's Midwifery Training School located at Pramso, within the Bosomtwe District, Ashanti Region, Ghana. MEASUREMENTS: The data was analysed using descriptive statistics, factor analysis, χ2 test and ordinal logistic regression models. FINDINGS: Result indicates that academic stressors (schoolwork and less vacation), interpersonal stressors (extracurricular groups, family obligations), intrapersonal stressor (bills/overspending) and environmental stressor (mistakes with expecting mothers) are direct stressors among midwifery students. The study discovered a statistically significant difference in stress management techniques among the study participants (p < 0.05). The multivariate analysis found that respondents' reactions when stressed had a significant effect on their academic performance. However, after adjusting for the stressors, having less vacation had significant effect on respondents' academic performance. Meanwhile, the interaction term significantly strengthens for respondents who had sufficient resting time during vacation. CONCLUSIONS: Considering the extensive and intense nature of midwifery training per the prescribed curriculum, there is the need for orientation of students on the effect of stress on their academic performance and effective coping mechanisms. IMPLICATIONS FOR PRACTICE: Regulation and planning of midwifery curricula in the future should incorporate adequate vacation periods to facilitate synthesis of knowledge among students.


Assuntos
Desempenho Acadêmico/normas , Enfermeiras Obstétricas/psicologia , Estresse Psicológico/etiologia , Desempenho Acadêmico/psicologia , Adolescente , Adulto , Distribuição de Qui-Quadrado , Educação em Enfermagem/métodos , Educação em Enfermagem/normas , Feminino , Gana , Humanos , Masculino , Enfermeiras Obstétricas/educação , Enfermeiras Obstétricas/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , Estresse Psicológico/psicologia , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Universidades/organização & administração , Universidades/estatística & dados numéricos
8.
J Adv Nurs ; 75(10): 2099-2109, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30791113

RESUMO

AIMS: To determine the prevalence and predictors of victimization and perpetration of dating violence among nursing and midwifery students. DESIGN: A cross-sectional study design. METHODS: The sample consisted of nursing and midwifery students (N = 603) at the largest state university in southeastern Turkey. Data were collected with a validated, investigator-designed survey instrument between September 2015 and January 2016. FINDINGS: Most participants had been exposed to dating violence. Jealousy, controlling behaviour, and restrictions on another's social life were not perceived as violent behaviour in dating relationships. There was no significant relationship of dating violence with gender, smoking, place of residence, or marijuana use. Exposure to parental violence and alcohol use were found to be the strongest predictors of being a perpetrator of violence in the dating violence perpetration model. CONCLUSION: The findings highlight the lack of recognition of dating violence among nursing and midwifery students. The perceptions of students should be enriched by adding content on violent behaviours in the curriculum of nursing and midwifery programmes. IMPACT: Efforts to reduce and stop dating violence have a crucial role in preventing future violence in established relationships. We acknowledge that the prevalence of dating violence among nursing and midwifery students is high. Psychological and verbal violence are extremely common and most are not recognized as violent behaviours by the students. This study contributes to the understanding of violent behaviours related to dating violence among nursing and midwifery students for establishing healthy relationship.


Assuntos
Agressão/psicologia , Corte/psicologia , Violência por Parceiro Íntimo/psicologia , Violência por Parceiro Íntimo/tendências , Enfermeiras Obstétricas/psicologia , Estudantes de Enfermagem/psicologia , Adulto , Estudos Transversais , Feminino , Previsões , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Enfermeiras Obstétricas/estatística & dados numéricos , Prevalência , Fatores de Risco , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários , Turquia , Adulto Jovem
9.
JMIR Mhealth Uhealth ; 7(2): e11644, 2019 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-30758298

RESUMO

BACKGROUND: Over the past decade, mobile health has steadily increased in low-income and middle-income countries. However, few platforms have been able to sustainably scale up like the MomConnect program in South Africa. NurseConnect was created as a capacity building component of MomConnect, aimed at supporting nurses and midwives in maternal and child health. The National Department of Health has committed to expanding NurseConnect to all nurses across the country, and an evaluation of the current user experience was conducted to inform a successful scale up. OBJECTIVE: This study aims to evaluate the perception and use of NurseConnect by nurses and midwives to produce feedback that can be used to optimize the user experience as the platform continues to scale up. METHODS: We conducted focus group discussions and in-depth interviews with 110 nurses and midwives from 18 randomly selected health care facilities across South Africa. Questions focused on mobile phone use, access to medical information and their experience with NurseConnect registration, as well as the content and different platforms. RESULTS: All participants had mobile phones and communication through calls and messaging was the main use in both personal and work settings. Of 110 participants, 108 (98.2%) had data-enabled phones, and the internet, Google, and apps (South African National Department of Health Guidelines, iTriage, Drugs.com) were commonly used, especially to find information in the work setting. Of 110 participants, 62 (56.4%) were registered NurseConnect users and liked the message content, especially listeriosis and motivational messages, which created behavioral change in some instances. The mobisite and helpdesk, however, were underutilized because of a lack of information surrounding these platforms. Some participants did not trust medical information from websites and had more confidence in apps, while others associated a "helpdesk" with a call-in service, not a messaging one. Many of the unregistered participants had not heard of NurseConnect, and some cited data and time constraints as barriers to both registration and uptake. CONCLUSIONS: Mobile and smartphone penetration was very high, and participants often used their phone to find medical information. The NurseConnect messages were well-liked by all registered participants; however, the mobisite and helpdesk were underutilized owing to a lack of information and training around these platforms. Enhanced marketing and training initiatives that optimize existing social networks, as well as the provision of data and Wi-Fi, should be explored to ensure that registration improves, and that users are active across all platforms.


Assuntos
Mães/psicologia , Enfermeiras Obstétricas/psicologia , Relações Enfermeiro-Paciente , Adulto , Feminino , Grupos Focais/métodos , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , África do Sul
10.
Int J Gynaecol Obstet ; 145(2): 187-192, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30763454

RESUMO

OBJECTIVE: To test the hypothesis that modified perinatal mortality, early neonatal mortality, and other measures of perinatal mortality are lower with facility births than with home births among deliveries conducted by traditional birth attendants (TBAs) or nurse-midwives. METHOD: This population-based observational study used data collected prospectively for home and facility deliveries conducted by TBAs and nurse-midwives in 13 rural communities in Zambia between September 1, 2009, and December 31, 2015. RESULTS: We enrolled 48 956 pregnant women. In adjusted analysis, modified perinatal mortality (adjusted odds ratio [aOR] 0.63, 95% confidence interval [CI] 0.45-0.88), early neonatal mortality (0.48, 0.33-0.69), and fresh stillbirth/day-1 neonatal mortality (0.55, 0.38-0.80) were lower among home deliveries than among facility deliveries conducted by TBAs, but did not differ among deliveries conducted by nurse-midwives. Rates of fresh stillbirth did not differ between home and facility delivery by either TBAs (aOR 1.03, 95% CI 0.64-1.66) or nurse-midwives (1.19, 0.67-2.10). CONCLUSION: Our findings show significant reductions in modified perinatal mortality, early neonatal mortality, and fresh stillbirth/day-1 neonatal mortality among home deliveries done by TBAs. This may be explained by robust community structures built by our program and referral bias of complicated cases.


Assuntos
Tocologia/estatística & dados numéricos , Enfermeiras Obstétricas/estatística & dados numéricos , Mortalidade Perinatal , Natimorto/epidemiologia , Adulto , Feminino , Instalações de Saúde/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Vigilância da População , Gravidez , Sistema de Registros , População Rural , Adulto Jovem , Zâmbia/epidemiologia
11.
Midwifery ; 69: 10-16, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30390462

RESUMO

BACKGROUND: The effectiveness of continuity of care during the perinatal period is well documented, but implementing continuity of care model to practice requires evaluation. AIM: To evaluate the effect of a caseload midwifery program (CMP) on birth outcomes and rates of perinatal interventions at a metropolitan tertiary hospital in Australia, compared with standard midwifery-led care (SMC). METHODS: This was a retrospective, matched-cohort study. We extracted the data of 1000 nulliparous women from records of 19,001 women who gave birth at the hospital from 2011 to 2014. We used basic statistical tests to compare baseline demographic data, and logistic regression to calculate odds ratios, to evaluate maternal and neonatal outcomes. RESULTS: Adjusted regression analysis for the primary outcome showed that compared with women who received SMC, women who received care through CMP had an increased rate of normal vaginal birth (69% vs. 50%, OR = 1.79, 95%, CI = 1.38-2.32). Assessment of secondary outcomes showed that the women in CMP group had decreased rates of instrumental birth (15% vs. 26%, OR = 0.48, 95% CI = 0.35-0.66), episiotomy (23% vs. 40%, OR = 0.43, 95% CI = 0.33-0.57), epidural analgesia (33% vs. 43%, OR = 0.64, 95% CI = 0.50-0.83) and amniotomy (35% vs. 50%, OR = 0.56, 95% CI = 0.43-0.72). The CMP group also had greater rates of water immersion (54% vs. 22%, OR = 4.18, 95% CI = 3.17-5.5), physiological 3rd stage (7% vs. 1%, OR = 11.71, 95% CI = 3.56-38.43) and 2nd degree tear (34% vs. 24%, OR = 1.60, 95% CI = 1.21-2.11). There were no significant differences between the two groups for rates of other secondary outcomes including Caesarean section, cervical ripening procedures, third- and fourth-degree tears, postpartum haemorrhage and neonatal outcomes. CONCLUSION: CMP care is associated with increased rate of normal vaginal birth which supports wider implementation of the model. In addition, using routinely collected data and a cohort matching design can be an effective approach to evaluate maternal and neonatal outcomes.


Assuntos
Educação de Pós-Graduação em Enfermagem/estatística & dados numéricos , Enfermeiras Obstétricas/educação , Resultado da Gravidez/epidemiologia , Carga de Trabalho/normas , Adolescente , Adulto , Austrália , Estudos de Coortes , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Educação de Pós-Graduação em Enfermagem/métodos , Feminino , Humanos , Modelos Logísticos , Enfermeiras Obstétricas/estatística & dados numéricos , Paridade , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
12.
Midwifery ; 69: 76-83, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30415104

RESUMO

OBJECTIVE: To assess if and how primary care midwives adhere to the guideline by addressing transition to motherhood at the first prenatal booking visit and to what extent there was a difference in addressing transition to motherhood between nulliparous and multiparous women. DESIGN: Cross-sectional observational study of video-recorded prenatal booking visits. SETTING AND PARTICIPANTS: 126 video recordings of prenatal booking visits with 18 primary care midwives in the Netherlands taking place between August 2010 and April 2011. MEASUREMENTS: Five observers assessed dichotomously if midwives addressed seven topics of transition to motherhood according to the Dutch guideline prenatal midwifery care from the Royal Dutch Organization of Midwives and used six communication techniques. Frequencies and percentages of addressing each topic and communication technique were calculated. Differences between nulliparous and multiparous women were examined with Chi-Square tests or Fischer Exact tests, were appropriate. The agreement between the five observers was quantified using Fleiss' Kappa. FINDINGS: During all visits at least one of the seven topics of transition to motherhood was addressed. The topics mother-to-infant bonding and support were addressed respectively in 2% and 16% of the visits. In almost all visits the topics desirability of the pregnancy, experience with the ultrasound examination or abdominal palpation or hearing the foetal heartbeat and practical preparation were addressed. Open questions for addressing transition to motherhood were used in 6% of the prenatal booking visits. Dutch midwives addressed transition to motherhood mostly by giving information (100%) and by using closed-ended questions (94%) and following woman's initiative (90%). Nulliparous women brought up transition to motherhood on their own initiative more often than multiparous women (97% versus 84%). For the topics 'desirability of the pregnancy 'and' practical preparations' and for conversation techniques 'giving information' and 'closed-ended questions', 100% agreement was achieved. However, the topic 'Support' had poor agreement (kappa = 0.19). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although during every visit the transition of motherhood was addressed, the topics mother-to-infant bonding and support should get more attention. Midwives should improve adherence to the guideline by addressing transition to motherhood and by using more open questions. Furthermore, they should focus on taking the initiative to address the transition to motherhood in multiparous women themselves.


Assuntos
Fidelidade a Diretrizes/normas , Enfermeiras Obstétricas/normas , Cuidado Pré-Natal/normas , Adulto , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Mães/estatística & dados numéricos , Países Baixos , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Gravação em Vídeo/métodos
13.
Midwifery ; 69: 92-101, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30453122

RESUMO

BACKGROUND: Labor and birth companionship is a key aspect of respectful maternity care. Lack of companionship deters women from accessing facility-based delivery care, though formal and informal policies against companionship are common in sub-Saharan African countries. AIM: To identify client and provider factors associated with labor and birth companionship DESIGN: Cross-sectional evaluation among delivery clients and providers in 61 health facilities in Kigoma Region, Tanzania, April-July 2016. METHODS: Multilevel, mixed effects logistic regression analyses were conducted on linked data from providers (n = 249) and delivery clients (n = 935). Outcome variables were Companion in labor and Companion at the time of birth. FINDINGS: Less than half of women reported having a labor companion (44.7%) and 12% reported having a birth companion. Among providers, 26.1% and 10.0% reported allowing a labor and birth companion, respectively. Clients had significantly greater odds of having a labor companion if their provider reported the following traits: working more than 55 hours/week (aOR 2.46, 95% CI 1.23-4.97), feeling very satisfied with their job (aOR 3.66, 95% CI 1.36-9.85), and allowing women to have a labor companion (aOR 3.73, 95% CI 1.58-8.81). Clients had significantly lower odds of having a labor companion if their provider reported having an on-site supervisor (aOR 0.48, 95% CI 0.24-0.95). Clients had significantly greater odds of having a birth companion if they self-reported labor complications (aOR 2.82, 95% CI 1.02-7.81) and had a labor companion (aOR 44.74, 95% CI 11.99-166.91). Clients had significantly greater odds of having a birth companion if their provider attended more than 10 deliveries in the last month (aOR 3.43, 95% CI 1.08-10.96) compared to fewer deliveries. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These results suggest that health providers are the gatekeepers of companionship, and the work environment influences providers' allowance of companionship. Facilities where providers experience staff shortages and high workload may be particularly responsive to programmatic interventions that aim to increase staff acceptance of birth companionship.


Assuntos
Parto Obstétrico/normas , Amigos/psicologia , Relações Interpessoais , Enfermeiras Obstétricas/psicologia , Gestantes/psicologia , Adolescente , Adulto , Estudos Transversais , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Doulas/estatística & dados numéricos , Feminino , Política de Saúde/tendências , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Tanzânia , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos
14.
Holist Nurs Pract ; 33(1): 52-59, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30422925

RESUMO

The objective of this article is to present the results from a cross-sectional survey carried out to assess and compare knowledge, attitudes, and beliefs of the obstetrician-gynecologists and midwives, regarding a set of complementary and alternative therapies in the area of the Corredor del Henares in Spain. The results show a high percentage of acceptance regarding complementary and alternative therapies in the field of obstetrics and gynecology, and more than half of the Spanish professionals of reproductive health would like to learn more about these therapies.


Assuntos
Terapias Complementares/métodos , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras Obstétricas/normas , Obstetrícia/normas , Adulto , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Espanha , Inquéritos e Questionários
15.
Women Birth ; 32(2): e182-e188, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30042066

RESUMO

BACKGROUND: Midwives in Australia are educated through a range of routes providing flexible ways to become a midwife. Little is known about whether the route to registration impacts on mid-career experiences, in particular, whether the pathway (post-nursing pathway compared with 'direct-entry') makes any difference. AIM: The aim of this study was to explore the midwifery workforce experiences and participation in graduates six to seven years after completing either a post-nursing Graduate Diploma in Midwifery (GradDip) or an undergraduate degree, the Bachelor of Midwifery (BMid), from one university in New South Wales, Australia. METHODS: Data were collected from mid-career midwives having graduated from one NSW university from 2007-2008 using a survey. The survey included validated workforce participation instruments - the Maslach Burnout Inventory (MBI), the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Perceptions of Empowerment in Midwifery Scale (PEMS). RESULTS: There were 75 respondents: 40% (n=30) Bachelor of Midwifery and 60% (n=45) GradDip graduates. The age range was 27-56 years old (mean age=36 years) Bachelor of Midwifery graduates being on average 7.6 years older than Graduate Diploma in Midwifery graduates (40 vs 33 years; p<0.01). Almost 80% (59), were currently working in midwifery. Nine of the 12 not working in midwifery (75%) planned to return. There were no differences in workforce participation measures between the two educational pathways. Working in a continuity of care model was protective in regards to remaining in the profession. CONCLUSION: Most mid-career graduates were still working in midwifery. There were no differences between graduates from the two pathways in relation to burnout, practice experiences or perceptions of empowerment.


Assuntos
Tocologia , Enfermeiras Obstétricas , Adulto , Atitude do Pessoal de Saúde , Austrália , Feminino , Humanos , Pessoa de Meia-Idade , Tocologia/educação , Tocologia/organização & administração , Tocologia/estatística & dados numéricos , Enfermeiras Obstétricas/educação , Enfermeiras Obstétricas/organização & administração , Enfermeiras Obstétricas/psicologia , Enfermeiras Obstétricas/estatística & dados numéricos , Inquéritos e Questionários , Recursos Humanos
16.
Int J Gynaecol Obstet ; 143(2): 211-216, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29992555

RESUMO

OBJECTIVE: To examine whether auxiliary nurse-midwife provision of medical abortion in pharmacies was associated with reduced post-abortion contraceptive use in Nepal. METHODS: The present prospective observational study compared contraceptive use among women aged 16-45 years and up to 63 days of pregnancy, who presented at one of six privately-owned pharmacies or six public health facilities in the Chitwan and Jhapa districts of Nepal for medical abortion between October 16, 2014, and September 1, 2015. Participants obtained medical abortions per Nepali protocol and completed a follow-up visit and interview at 14-21 days. Effective contraceptive use was compared between abortion care settings using multivariable mixed effects logistic regression. RESULTS: Of 605 participants, 600 completed follow-up at 14-21 days; 474 (79.0%) were using a contraceptive method, most commonly pills (180 [30.0%]) and injectables (175 [29.2%]), followed by condoms (82 [13.7%]), long-acting reversible methods (33 [5.5%]), and sterilization (4 [0.7%]). Receipt of care from a private pharmacy was not associated with a difference in the use of hormonal or long-acting methods (adjusted odd ratio 0.89, 95% confidence interval 0.60-1.33). CONCLUSION: Medical abortion provision from pharmacies by qualified providers can provide women with necessary induced-abortion care while not compromising longer-term pregnancy prevention.


Assuntos
Aborto Induzido/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Nepal , Enfermeiras Obstétricas/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Gravidez , Estudos Prospectivos , Adulto Jovem
17.
Midwifery ; 62: 264-272, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29734121

RESUMO

INTRODUCTION: Obstetric anal sphincter injurie (OASI) in vaginal births are a serious complication, and are associated with maternal morbidity. Focus on modifiable factors in midwives clinical skills and competences contributing to prevent the occurrence of OASI are essential. The objective of this study was to investigate the association between OASI and factors related to midwife-led birth such as manual support of perineum, active delivery of baby's shoulders, maternal birth position, and pushing and breathing techniques in second stage of labour. METHODS: A prospective cross sectional study including primiparous (n = 129) and multiparous (n = 628) women in midwife-led non-instrumental deliveries with OASI (n = 96) or intact perineum (n = 661). Data were collected in a university hospital in Norway with two different birth settings: an alongside midwife-led unit with approximately 1500 births per year and an obstetrical unit with approximately 3500 births per year. In midwife-led births, there were a total of 2.6% OASI and 18.9% intact perineum. RESULTS: The sample consisted of 757 women, 12.7% suffered OASI and 87.3% of participating women had an intact perineum. This selected sample compares the most serious outcome (OASI), and the optimal outcome (intact perineum).In primiparous women, 61 women suffered OASI and 68 women had intact perineum, while for multipara women, 35 women suffered OASI and 593 women had intact perineum. There was an increased risk of OASI if women actively pushed when the head was crowning compared to breathing the head out (adjusted OR: 3.10; 95% CI: 1.75 to 5.47). The maternal birth position associated with the lowest risk of OASI was kneeling position (adjusted OR: 0.15; 95% CI: 0.03 to 0.70), supine maternal birth position (adjusted OR: 2.52; 95% CI: 1.04 to 4.90) and oxytocin augmentation more than 30 min in second stage (OR: 1.93; 95% CI: 1.68 to 15.63) were associated with an increased risk of OASI, when adjusting for maternal, foetal, and obstetric factors. CONCLUSION: Our study suggests that actively pushing when the baby's head is crowning, a supine maternal birth position and oxytocin augmentation more than 30 min in second stage, were associated with increased risk of OASI when compared to intact perineum. A kneeling maternal birth position was associated with a decreased risk of OASI.


Assuntos
Canal Anal/lesões , Enfermeiras Obstétricas/estatística & dados numéricos , Adulto , Canal Anal/cirurgia , Estudos Transversais , Episiotomia/efeitos adversos , Feminino , Humanos , Trabalho de Parto , Lacerações/etiologia , Lacerações/cirurgia , Noruega/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/cirurgia , Gravidez , Estudos Prospectivos , Fatores de Risco
18.
J Obstet Gynaecol Can ; 40(5): 579-587, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29731205

RESUMO

OBJECTIVE: To examine maternity providers' recommendations for pregnant women with vulvodynia regarding management of vulvar pain and postpartum care, and to examine if, and how, a woman's chronic vulvar pain affects providers' examination and management during labour. METHODS: This research was part of a larger study that invited physicians and midwives to answer a questionnaire regarding pregnancy and childbirth care in women with vulvodynia. To achieve the current objectives, the questionnaire included both dichotomous (yes or no) and open-ended items. The current sample (n = 116) consisted of 75 physicians and 41 midwives. RESULTS: Over 60% of the sample reported making recommendations for vulvar pain management during pregnancy, and 32.8% of providers reported making special postpartum care recommendations for women with vulvodynia. Differences between physicians and midwives were noted for some of these recommendations. For example, to manage vulvar pain, only physicians recommended the use of/change in medications (P <0.001) and only midwives recommended complementary medicines (P = 0.02) and the use of lubricants (P = 0.006) and made recommendations for sexual well-being (P = 0.02). The majority of the sample (75%) reported that a woman having vulvodynia affected labour examination and management; providers most frequently reported minimizing exams and early use of epidural. Over 80% of midwives and 54% of physicians minimized exams during labour for women with vulvodynia (P= 0.01). CONCLUSION: Further research is needed to understand the optimal provision of care for pregnant and postpartum women with vulvodynia. We advocate for increased education of vulvodynia aimed at providers of antenatal, labour, and postnatal care.


Assuntos
Manejo da Dor , Cuidado Pós-Natal , Padrões de Prática em Enfermagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Vulvodinia/terapia , Adulto , Feminino , Humanos , Trabalho de Parto , Masculino , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Médicos/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Inquéritos e Questionários
19.
J Pregnancy ; 2018: 7198513, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29686904

RESUMO

Introduction: Healthcare providers play an integral role in breastfeeding education and subsequent practices; however, the education and support provided to patients may differ by type of provider. The current study aims to evaluate the association between type of birth attendant and breastfeeding duration. Methods: Data from the prospective longitudinal study, Infant Feeding Practices Survey II, was analyzed. Breastfeeding duration and exclusive breastfeeding duration were defined using the American Academy of Pediatrics' national recommendations. Type of birth attendant was categorized into obstetricians, other physicians, and midwife or nurse midwife. If mothers received prenatal care from a different type of provider than the birth attendant, they were excluded from the analysis. Multinomial logistic regression was conducted to obtain crude and adjusted odds ratios and 95% confidence intervals. Results: Compared to mothers whose births were attended by an obstetrician, mothers with a family doctor or midwife were twice as likely to breastfeed at least six months. Similarly, mothers with a midwife birth attendant were three times as likely to exclusively breastfeed less than six months and six times more likely to exclusively breastfeed at least six months compared to those who had an obstetrician birth attendant. Conclusions: Findings from the current study highlight the importance of birth attendants in breastfeeding decisions. Interventions are needed to overcome barriers physicians encounter while providing breastfeeding support and education. However, this study is limited by several confounding factors that have not been controlled for as well as by the self-selection of the population.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Enfermeiras Obstétricas/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Relações Profissional-Paciente , Adulto , Atitude do Pessoal de Saúde , Comportamento de Escolha , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Tocologia/métodos , Mães/psicologia , Gravidez , Estudos Prospectivos , Autorrelato , Fatores de Tempo , Adulto Jovem
20.
J Clin Nurs ; 27(21-22): 4000-4017, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29679403

RESUMO

AIMS AND OBJECTIVES: To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. BACKGROUND: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. DESIGN: Mixed methods research utilising prospective descriptive survey and interview. METHODS: An online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed. RESULTS: The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years. CONCLUSIONS: An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice. RELEVANCE TO CLINICAL PRACTICE: Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.


Assuntos
Enfermeiras Obstétricas , Papel do Profissional de Enfermagem , Prática Profissional , Adulto , Idoso , Emprego/economia , Emprego/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Enfermeiras Obstétricas/legislação & jurisprudência , Enfermeiras Obstétricas/organização & administração , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Estudos Prospectivos , Pesquisa Qualitativa , Inquéritos e Questionários , Texas , Saúde da Mulher
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