A comprehensive investigation of biopsychosocial determinants influencing primary dysmenorrhea among university students.

Dysmenorrhea, characterized by pain and related symptoms, significantly impacts women's quality of life in work and education, prompting a comprehensive evaluation of associated factors. The objective of this study was to utilize structural equation modeling (SEM) to analyze and assess the biopsychosocial factors influencing dysmenorrhea among university students. Three hundred and thirty-nine university students were included in this cross-sectional descriptive study. Data were collected using the Participant Information Form, the Beck Anxiety Scale (BAS), the Beck Depression Scale (BDS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Adverse Childhood Experiences Scale (ACES), the Pain Catastrophizing Scale (PCS) and the Visual Analogue Scale (VAS). It was determined that the variables of pain onset (t = 3.24, p < .05) and age at menarche (t = -2.16, p < .05) showed a significant relationship with the model. The variables of the PCS (t = 16.87, p < .001), BDS (t = 3.06, p < .05), and BAS (t = 5.13, p < .001) showed a significant relationship with the model. Social factors in the model were examined, and a family history of dysmenorrhea and the ACES variables did not contribute significantly to the model (p > .05). The study indicates primary dysmenorrhea influenced by biological and psychological factors. Nurses should conduct holistic assessments and provide comprehensive care for affected women.

Health professionals' perceptions of planned home birth care within the Brazilian health system.

BACKGROUND: The American College of Obstetricians and Gynecologists, in its opinion of the Committee on Midwifery Practice, points out that planned home birth is a woman's and family's right to experience, but also to choose and be informed about, their baby's place of birth. The aim of this study was to understand obstetric nurses' perceptions of planned home childbirth care within the framework of the Brazilian obstetric model. METHOD: A qualitative study, with Snowball Sampling recruitment, totaling 20 obstetric nurses through semi-structured interviews between September 2022 and January 2023, remotely, using the Google Meet application and the recording feature. After the data had been collected, the material was transcribed in full and subjected to content analysis in the thematic modality with the support of ATLAS.ti 8.0 software. RESULTS: Obstetric care at home emerged as a counterpoint to hospital care and the biomedical model, providing care at home based on scientific evidence and humanization, bringing qualified information as a facilitator of access and financial costs as an obstacle to effective home birth. CONCLUSION: Understanding obstetric nurses' perceptions of planned home birth care in the context of the Brazilian obstetric model shows the need for progress as a public policy and for strategies to ensure quality and regulation.

Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.

BACKGROUND: Evidence is limited on nurse staffing in maternity units. PURPOSE: To estimate the relationship between hospital characteristics and adherence with Association of Women's Health, Obstetric and Neonatal Nurses nurse staffing guidelines. METHODS: We enrolled 3,471 registered nurses in a cross-sectional survey and obtained hospital characteristics from the 2018 American Hospital Association Annual Survey. We used mixed-effects linear regression models to estimate associations between hospital characteristics and staffing guideline adherence. FINDINGS: Overall, nurses reported strong adherence to AWHONN staffing guidelines (rated frequently or always met by ≥80% of respondents) in their hospitals. Higher birth volume, having a neonatal intensive care unit, teaching status, and higher percentage of births paid by Medicaid were all associated with lower mean guideline adherence scores. DISCUSSION AND CONCLUSIONS: Important gaps in staffing were reported more frequently at hospitals serving patients more likely to have medical or obstetric complications, leaving the most vulnerable patients at risk.

Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership.

BACKGROUND: Obstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it. METHODS: Observational study, based on a cross-sectional design, carried out with data deriving from the study "Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento" (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of-delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients' profile. RESULTS: Results have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2. CONCLUSION(S): Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

[Action Research on the Use of the Flipped Teaching Model in Obstetric Nursing Laboratory Classes].

BACKGROUND: Obstetric nursing laboratory courses typically involve both time and credit limitations. Using traditional teaching methods such as "teacher demonstrate, students imitate" in these courses provides insufficient opportunities for students to develop the ideal level of maternity nursing expertise. Lack of sufficient familiarity with the relevant techniques, procedures, and clinical scenarios prior to participation in internships reduces the level of safety in clinical care environments. PURPOSES: (1) To explore the effectiveness as perceived by baccalaureate nursing students of an obstetric nursing laboratory classes based on a flipped teaching model; (2) To examine the application of a flipped teaching model in obstetric nursing laboratory classes as well as the problems encountered and the actions necessary to resolve these problems. The findings may be used as a reference for future teaching and guidance. METHODS: This study used an action research framework as a guide and employed focus groups and questionnaires to collect student perceptions of the flipped teaching model. RESULTS: The feedback of students was highly positive because the classes involved repeated practice, were integrated into the clinical context, and allowed active learning independent of time and space restrictions. These attributes affected learning efficiency positively. The following four themes emerged from the focus group analysis: helps improve self-directed learning, helps integrate into the clinical context, helps peers learn from each other, and helps bring teachers and students closer. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study demonstrated an actual implementation of the flipped teaching model in obstetric nursing laboratory classes as well as assessed the learning perceptions of students. This teaching method provides opportunities for teachers and students to discuss and practice nursing skills, strengthen students' self-directed learning capabilities, and improve students' learning motivation. The author recommends that this innovative teaching strategy may be used to teach various subjects and different disciplines in nursing.

Prevention of Failure to Rescue in Obstetric Patients: A Realist Review.

BACKGROUND: At least 40% of maternal deaths are attributable to failure to rescue (FTR) events. Nurses are positioned to prevent FTR events, but there is minimal understanding of systems-level factors affecting obstetric nurses when patients require rescue. AIMS: To identify the nurse-specific contexts, mechanisms, and outcomes underlying obstetric FTR and the interventions designed to prevent these events. METHODS: A realist review was conducted to meet the aims. This review included literature from 1999 to 2020 to understand the systems-level factors affecting obstetric nurses during FTR events using a human factors framework designed by the Systems Engineering Initiative for Patient Safety. RESULTS: Existing interventions addressed the prevention of maternal death through education of clinicians, improved protocols for care and maternal transfer, and an emphasis on communication and teamwork. LINKING EVIDENCE TO ACTION: Few researchers addressed task overload or connected employee and organizational outcomes with patient outcomes, and the physical environment was minimally considered. Future research is needed to understand how systems-level factors affect nurses during FTR events.

MEDICAL STAFF IN THE CARE OF A PREGNANT PATIENT DIAGNOSED WITH FETAL DEFECT.

OBJECTIVE: The aim: The research conducted aims at evaluating the way the medical staff functions in the care of the pregnant patient diagnosed with fetal defects. PATIENTS AND METHODS: Material and methods: 158 midwives took part in the study. The MINI-COPE standardized questionnaire and author's questions were used. RESULTS: Results: During the period when the care was provided for the pregnant patients diagnosed with fetal defects, nearly 50% of the midwives under examination complained about the decline of their wellbeing. 75,3% of the respondents seek help and advice on how to deal with a stressful situation. Ideal for providing a systemic support, the midwives most often chose a psychologist and a psychotherapist. The surveyed who reported no need for a systemic support for the medical staff at the workplace, as the causes of their attitude pointed to their diminished trust in the ward nurse and no place for honest conversations. Most of the midwives surveyed during the care of the patient with the fetal defects experienced stress and bigger mental exhaustion. Over half of the surveyed reported lack of systemic psychological support provided for the medical staff at the workplace. CONCLUSION: Conclusions: The research indicates the need to introduce courses and training on topics related to how to deal with stressful situations into the education system of medical staff.

Waterbirth in low-risk pregnancy: An exploration of women's experiences.

AIMS: To explore retrospective descriptions about benefits, negative experiences and preparatory information related to waterbirths. DESIGN: A qualitative study. METHODS: Women who gave birth in water with healthy pregnancies and low-risk births were consecutively recruited between December 2015-October 2018 from two birthing units in Sweden. All who gave birth in water during the recruitment period were included (N = 155) and 111 responded to the survey. Women were emailed a web-based survey six weeks postpartum. Open-ended questions were analysed with qualitative content analysis. RESULTS: Two themes were identified related to benefits: (a) physical benefits: the water eases labour progression while offering buoyancy and pain relief; and (b) psychological benefits: improved relaxation and control in a demedicalized and safe setting. Two themes were identified related to negative experiences: (a) equipment-related issues due to the construction of the tub and issues related to being immersed in water; and (b) fears and worries related to waterbirth. In regard to preparatory information, respondents reported a lack of general and specific information related to waterbirths, even after they contacted birthing units to ask questions. Supplemental web-based information was sought, but the trustworthiness of these sources was questioned and a need for trustworthy web-based information was articulated. CONCLUSION: Women who give birth in water experience physical and psychological benefits, but need better equipment and sufficient information. There is room for improvement with regard to prenatal and intrapartum care of women who give birth in water. IMPACT: Judging from women's recounts, midwives and nurses should continue advocating waterbirth in low-risk pregnancies. The lack of adequate equipment in Swedish birthing units articulated by women challenge current routines and resources. The findings illustrate unfulfilled needs for preparatory information about waterbirth, further strengthening that midwives should discuss the possibility of waterbirth when meeting expectant parents in the antenatal setting.

The satisfaction of the normal delivery: finding oneself. / Satisfação no parto normal: encontro consigo.

OBJECTIVE: To understand the satisfaction women experience during the normal delivery. METHODOLOGY: Qualitative, exploratory and descriptive study, developed during January and February of 2017, from interviewing twenty women that were satisfied with their natural delivery, residing on the countryside of Sao Paulo. The Symbolic Interactionism and the Thematic Content Analysis support this study. RESULTS: The main theme "Normal delivery as a means to find oneself" developed through three thematic units that report the satisfaction in the normal delivery: "Decision for normal delivery", "Childbirth with welcoming support", "Violence: it is not all roses". The satisfaction has been correlated to the accomplishment of the dream of giving birth, welcoming support of Doulas/health professionals and the presence of a companion/family members during the process, but it also reveals labors marked by invasive, imposing and unwelcoming experiences. CONCLUSIONS: The empowerment granted and felt by the woman during the normal delivery experience reinforces the urgency of investments to promote sociocultural transformations that concern childbirth in Brazil.