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Midwifery Aug 2023The purpose of this qualitative study was to explore how health care professionals, managers and community members experienced the implementation of a training program...
AIM
The purpose of this qualitative study was to explore how health care professionals, managers and community members experienced the implementation of a training program in comprehensive emergency obstetric and neonatal care training in rural Tanzania.
BACKGROUND
Given the high rates of maternal and newborn mortality in Tanzania, the government committed to improving maternal health by increasing access to health care; improving reproductive, maternal, newborn health; reducing maternal and neonate mortality; and increasing the number of public health centers with emergency obstetric and neonatal care. To address the gap in emergency obstetric and neonatal care amongst the health workforce, five health care facilities in rural Tanzania participated in a 3-month specialized training program. The training was geared to increase access to skilled deliveries, prevent maternal and neonate deaths, and reduce referrals to district hospitals.
METHODS
Twenty-four focus group discussions were held with members of Council Health Management Team, Health Facility Management Team, staff who received training, and community members. Data collection and analysis was guided by content analysis and the World Health Organization's availability, accessibility, acceptability, and quality framework.
FINDINGS
Participants reported acquiring necessary skills that enabled them to provide quality and safe obstetric and newborn care. Five themes emerged from the analysis 1) competent and confident health care teams, 2) renewed commitment to teamwork, 3) community confidence and trust in the health team, 4) mentorship as a critical element of success, and 5) enhancing training and practice. These five emerging themes demonstrate enhanced confidence and trust by the community and increased competency of health care teams to support mothers through pregnancy and birth at the health centre.
CONCLUSION
The competencies acquired by health care providers demonstrate an increase in staff commitment and teamwork. There is an increased number of deliveries in health centres, a declining trend of maternal and neonate deaths and referrals to other health centres because the health care providers are capable of competently and confidently providing emergency obstetric and neonatal care services.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Tanzania; Parturition; Qualitative Research; Maternal Health Services; Mothers; Delivery, Obstetric; Health Services Accessibility
PubMed: 37187099
DOI: 10.1016/j.midw.2023.103698 -
BMC Pregnancy and Childbirth Aug 2023Birth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed...
BACKGROUND
Birth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia.
METHODS
A case-control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software.
RESULTS
The odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal-fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia.
CONCLUSION
Birth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.
Topics: Child, Preschool; Female; Humans; Infant, Newborn; Pregnancy; Apgar Score; Asphyxia; Asphyxia Neonatorum; Birth Weight; Case-Control Studies; Fetal Macrosomia; Hospitals, University; Risk Factors; Thailand
PubMed: 37582743
DOI: 10.1186/s12884-023-05885-y -
Journal of Obstetric, Gynecologic, and... Sep 2023To modify an existing instrument used to measure the attitudes of perinatal nursing caregivers about pregnant women with substance use disorder (SUD) and to...
OBJECTIVE
To modify an existing instrument used to measure the attitudes of perinatal nursing caregivers about pregnant women with substance use disorder (SUD) and to psychometrically test the new instrument: Caregiver Attitudes on Substance Use in Pregnancy (CASUD-OB).
DESIGN
Instrument modification and psychometric testing of results from a modified instrument.
SETTING
Multi-hospital health care system in the midwestern United States.
PARTICIPANTS
A total of 147 perinatal nursing caregivers (perinatal nurses: n = 131; unlicensed assistive personnel: n = 16) who worked on obstetric and neonatal nursing units.
METHODS
We modified the existing instrument, and 12 experts in perinatal nursing (1 who also had expertise in SUD in the perinatal period) evaluated the items for content validity. We administered the CASUD-OB via online survey between November 2019 and December 2019. We used item reduction, calculated item-total correlations, and conducted exploratory factor analysis to modify the instrument and assessed its internal consistency.
RESULTS
After psychometric testing, we reduced the number of items from 26 to 16. Through item reduction and exploratory factor analysis, we identified three subscales (Caregiver Bias, Caregiver Self-Awareness, and Caregiver Perception of Parental Fitness). The Cronbach's alpha for the overall instrument was .92.
CONCLUSION
This study provides preliminary evidence to suggest that the CASUD-OB may be a valid and reliable instrument for measuring nurses' attitudes toward pregnant women with SUD. Through additional testing, this instrument has the potential to become a valuable resource to evaluate quality improvement initiatives, staff education programs, and other interventions designed to transform the attitudes of nursing caregivers toward pregnant women with SUD.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Caregivers; Psychometrics; Reproducibility of Results; Surveys and Questionnaires; Substance-Related Disorders; Attitude
PubMed: 37393066
DOI: 10.1016/j.jogn.2023.05.115 -
BMC Nursing Sep 2023The perinatal period is a crucial time for women, as they experience various biological, psychological, and social stressors. Due to the complexity of this vulnerable...
BACKGROUND
The perinatal period is a crucial time for women, as they experience various biological, psychological, and social stressors. Due to the complexity of this vulnerable time, there is a high prevalence of depressive and anxiety disorders among pregnant women. In 2019, the Health Commission of Shenzhen initiated perinatal mental health screening programme in China. However, attitudes and perceptions of medical staff towards implementing mental health screening programme during pregnancy remain unclear. The aim of this study was to explore the perceptions and attitudes of obstetric staff and midwives towards screening for perinatal mental disorders in pregnant women, and identify their perceived needs and motivations for undertaking this task.
METHODS
This is a qualitative exploratory study. Data were collected through in-depth, semi-structured, face-to-face interviews. The dataset was analysed using inductive content analysis. Purposive sampling method was used to recruit 13 participants at a tertiary maternal hospital in Shenzhen from September to November, 2019.
RESULTS
A total of 13 obstetric staff was interviewed, including two obstetricians, three midwives, and eight nurses. Four themes were identified from this study: views on perinatal mental health disorders screening, competency in identifying and supporting high-risk groups, barriers to dealing with psychological problems during pregnancy, and the support needs of medical staff in undertaking the tasks of mental health disorders screening.
CONCLUSION
Medical staff lacked sufficient knowledge and skills in perinatal psychological health and were not well prepared for the task of screening pregnant women for mental health disorders. To address this issue, medical organisations and relevant government sectors should provide training to medical staff on perinatal mental health disorders, enhance public awareness of perinatal mental health disorders, establish a model of multidisciplinary collaboration for the screening of women's perinatal mental disorders, and provide continuous and holistic care for pregnant women.
PubMed: 37705010
DOI: 10.1186/s12912-023-01475-7 -
The Journal of Maternal-fetal &... Dec 2023With the development of precision medicine and artificial intelligence, the infusion of many drugs has been intelligently controlled according to patients' conditions.... (Review)
Review
With the development of precision medicine and artificial intelligence, the infusion of many drugs has been intelligently controlled according to patients' conditions. However, the infusion of oxytocin (OT) still relies on medical staff responsible for implementing artificial regulation based on observation of fetal electronic monitoring and other maternal and fetal conditions. In this review, we discussed recent trends in intelligent infusion systems, the development status and dilemma of intelligent control of OT infusion, the drug intelligent feedback control system principle, and current risks and challenges to further promote obstetric informatization.
Topics: Pregnancy; Female; Humans; Oxytocin; Artificial Intelligence; Fetal Monitoring; Fetus; Fetal Diseases
PubMed: 37403363
DOI: 10.1080/14767058.2023.2230512 -
Nursing ResearchDisrespect and abuse of laboring and child-birthing women in healthcare is a global problem that violates a woman's right to respectful care. The abuse can be...
BACKGROUND
Disrespect and abuse of laboring and child-birthing women in healthcare is a global problem that violates a woman's right to respectful care. The abuse can be life-threatening and jeopardizes their rights to health, bodily integrity, and freedom from discrimination. This study aimed to understand the factors influencing nurse and midwife disrespect and abuse of child-birthing women in healthcare settings.
METHODS
An exploratory, nonexperimental, cross-sectional design was used to identify correlates and predictors of disrespect and abuse of child-birthing women by nurses/midwives. Pearson product-moment correlation and hierarchical multiple regression analyses were used to explore the relationships between nurse intrapersonal, interpersonal (Nursing Incivility Scale), organizational/structural factors (Professional Practice Work Environment Inventory), and disrespect and abuse (Disrespect and Abuse Scale) toward women during labor and childbirth.An online electronic survey was used to collect data from an international nursing and midwifery population from May 2021 to September 2021. Data were collected from 231 nurses and midwives.
RESULTS
The standardized regression coefficients showed that gender, number of hours worked per week, and organizational/structural factors were all predictors of disrespect and abuse. Organizational/structural factors were the strongest predictor of disrespect and abuse, accounting for 20% of the variance in the regression model.
DISCUSSION
These findings support the patient abuse in healthcare model, where researchers hypothesized that nurse/midwife intrapersonal, interpersonal, and organizational/structural factors contribute to patient abuse in healthcare settings. Work environment, gender, and number of hours worked per week were significant predictors of disrespect and abuse. The results of this study support future research that addresses unhealthy work environments and develops policies to transform the values and norms of labor and delivery.
Topics: Pregnancy; Female; Humans; Child; Delivery, Obstetric; Cross-Sectional Studies; Attitude of Health Personnel; Parturition; Women's Rights; Professional-Patient Relations; Maternal Health Services
PubMed: 37625176
DOI: 10.1097/NNR.0000000000000674 -
MCN. the American Journal of Maternal...To identify gaps in postnatal depression screening and support services for intended parents (parents who are intended to receive the baby from a gestational surrogacy...
PURPOSE
To identify gaps in postnatal depression screening and support services for intended parents (parents who are intended to receive the baby from a gestational surrogacy pregnancy), also known as commissioned parents.
STUDY DESIGN AND METHODS
This descriptive study used quantitative and free-text survey questions designed to assess postnatal depression screening and postnatal services available for all parents and, more specifically, for intended parents.
SAMPLE
The survey was sent to 2,000 randomly selected postpartum nurses in the United States who are members of the Association of Women's Health, Obstetric and Neonatal Nurses.
RESULTS
Completion of the survey was offered to the 125 nurses who responded that they provided care for intended parents. Thirty-seven percent of respondents indicated that postpartum support services are available for both parents. Free-text responses describe a gap in postnatal services for intended parents. Although 85% of survey respondents reported that postpartum depression screening occurs in their setting, nurses reported neither fathers nor intended parents are screened for postnatal depression.
CLINICAL IMPLICATIONS
This study expands the known gap in postnatal support services for intended parents, including postnatal depression screening. Recommendations for nurses working in the perinatal setting include providing consistent support for all parents as they transition to parenthood. Creating standardized policies and practices reflecting the diverse needs and cultures of intended parents can help direct all clinicians toward providing more significant support. Adapting current postnatal screening and support systems could provide a continuum of support for all families.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Depression, Postpartum; Mothers; Parents; Postnatal Care; Postpartum Period; Women's Health; Male
PubMed: 37335549
DOI: 10.1097/NMC.0000000000000919 -
Medicine Oct 2023The aim of this study is to investigate the core competencies of midwives in China. Combination of qualitative research and quantitative research. A total of 100...
The aim of this study is to investigate the core competencies of midwives in China. Combination of qualitative research and quantitative research. A total of 100 midwives in 3 tertiary (Grade 3) hospitals in Shijiazhuang were investigated by using the Midwife Core Competency Scale, and simultaneously followed by semi-structured interviews with 12 midwives. The questionnaire survey showed that the average score of core competencies of midwives was 4.17 ± 0.17. The scores of midwives' competency for labor and delivery care (4.31 ± 0.09), new-born care (4.29 ± 0.04), and postpartum care (4.25 ± 0.13) were relatively high, while the prepregnancy care had the lowest score (3.88 ± 0.07). The interview results showed that the self-perception of core midwifery competencies was not bad, the limitations of midwives' work scope affect the core competencies, and midwifery education needs to strengthen the humanistic care and the training of obstetric knowledge and technology.
Topics: Pregnancy; Female; Humans; Midwifery; Labor, Obstetric; Qualitative Research; Hospitals; China
PubMed: 37904464
DOI: 10.1097/MD.0000000000034246 -
International Journal of Disaster Risk... Jul 2023COVID-19 has become a global pandemic, which necessitates that health workers be capable of protecting themselves and their patients. This article aimed to describe...
Exploring the knowledge, attitudes, behaviors and training needs of obstetric and gynecological nurses regarding COVID-19 during the peak period of the pandemic in middle-risk areas of China: A cross-sectional study.
BACKGROUND
COVID-19 has become a global pandemic, which necessitates that health workers be capable of protecting themselves and their patients. This article aimed to describe knowledge levels, attitudes, behaviors and training needs regarding COVID-19 among obstetric and gynecological nurses in medium-risk areas during the pandemic.
METHOD
A cross-sectional survey of obstetric and gynecological nurses in medium-risk areas was performed during the peak period of the pandemic in China. The main survey tool was the self-designed COVID-19 Knowledge, Attitude, Behavior and Training Needs Questionnaire. Pearson correlation analysis was conducted to analyze the relationships among knowledge, attitudes, behaviors and training needs.
RESULTS
A total of 599 nurses were recruited, of whom 27.7% failed the knowledge part of the questionnaire. Positive correlations were found between knowledge and attitudes (r = 0.100, P = 0.015) and between attitudes and behaviors (r = 0.352, P = 0.000) regarding occupational protection against COVID-19. A total of 88.5% of nurses preferred online training to traditional training, and more than 70% believed that demonstration of and training in operations by their own department were effective ways to learn about how to protect themselves against COVID-19.
CONCLUSION
The higher the level of knowledge about the disease was, the more positive the attitude toward occupational protection, and consequently, the more actively protective behaviors were adopted. Training affected nurses' knowledge of COVID-19 occupational protection and promoted positive attitudes, which further facilitated the effective prevention and control of the disease. Online training with demonstrations are recommended for COVID-19 training of nurses.
PubMed: 37216169
DOI: 10.1016/j.ijdrr.2023.103746 -
Medicine Oct 2023To compare the effect of different noninvasive external therapies of traditional Chinese medicine (TCM) on the prevention of postpartum urinary retention (PUR) using a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To compare the effect of different noninvasive external therapies of traditional Chinese medicine (TCM) on the prevention of postpartum urinary retention (PUR) using a network meta-analysis (NMA).
METHODS
A search of the China National Knowledge Infrastructure, WanFangDate, VIP, China Biomedical Literature Database, PubMed, The Cochrane Library, Embase, and Web of Science databases were reviewed for related randomized controlled trials dated between database inception and December 31, 2022, on the prevention of PUR by noninvasive TCM. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies; then, a NMA was performed using Revman5.3 software, State13.1 software, and frequency methodology.
RESULTS
In total, 16 studies involving 3637 cases of parturients and 9 types of noninvasive TCM external treatments were incorporated into the NMA. The NMA results show that based on routine nursing, in terms of reducing the incidence of urinary retention, acupoint compressing combined with auricular acupressure is ranked first, followed by acupoint hot compress, acupoint massage combined with auricular acupressure, Yin-Yang therapy, acupoint massage, auricular acupressure, acupoint compressing, and routine nursing. In terms of urination time, acupoint compressing combined with auricular acupressure ranked first, followed by acupoint massage combined with auricular acupressure, acupoint electrical stimulation, acupoint compressing, TCM heating therapy, acupoint massage, auricular acupressure, and routine nursing. In terms of reducing residual urine volume after the first urination, acupoint compressing combined with auricular acupressure was ranked first, followed by auricular acupressure, acupoint compressing, acupoint massage, TCM heating therapy, and routine nursing.
CONCLUSION
Current evidence shows that acupoint compressing combined with auricular acupressure may be the best noninvasive TCM treatment for preventing PUR based on routine nursing; however, further high-quality clinical randomized controlled trials are needed for validation and support.
Topics: Humans; Female; Pregnancy; Medicine, Chinese Traditional; Network Meta-Analysis; Urinary Retention; Acupuncture Therapy; Acupressure; Delivery, Obstetric
PubMed: 37832117
DOI: 10.1097/MD.0000000000035399