Midwifery最新文献_第4页

Novel solutions to the midwifery retention crisis in England: an organisational case study of midwives’ intentions to leave the profession and the role of retention midwives 英格兰助产士留任危机的新解决方案：助产士离职意向及留任助产士作用的组织案例研究

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-20 DOI: 10.1016/j.midw.2024.104152

Problem/Background

: Midwifery retention is a global issue, but less is known regarding what motivates midwives’ intention to stay or leave within individual organisations. In 2021, NHS England funded maternity organisations to employ retention midwives. To date, the impact of these roles has not been evaluated.

Aim

: To explore the views of midwives regarding their intentions to leave or stay within one English organisation and to provide insights into the perceived impact of the role of retention midwives.

Methods

: An instrumental case study was carried out in one organisation. Data a mixed methods survey (n=67/91) and interview data (n=7). Quantitative data was analysed using descriptive and inferential statistics; qualitative data using thematic analysis. All data was synthesised together.

Findings

: The three themes included ‘Values-based tensions: The eroding role of the midwife’; ‘Discerning differences: Intentions to leave or stay’; ‘Retention midwives: Activities and impact’.

Discussion

: We found that there was a clear link between midwives’ intention to leave or stay and their workplace roles; specialist midwives were more likely to stay, report satisfaction, autonomy, and feel a sense of contribution or effectiveness in their role compared to those in other roles. The retention midwives were making a positive difference to midwives’ experience of the workplace.

Conclusion

: Midwives working within the same organisation have different experiences of their role and job satisfaction. Future work should consider applying the positive elements of the specialist roles to the wider midwifery workforce to enhance retention. The retention midwife role shows promise, but further evaluation is required.

问题/背景：助产士留任是一个全球性问题，但人们对助产士在个别机构内留任或离职的动机却知之甚少。2021 年，英国国家医疗服务体系资助产科机构聘用留用助产士。目的：探讨助产士对其在一家英国机构内去留意向的看法，并深入了解留任助产士角色的感知影响：方法：在一家机构内开展工具性案例研究。数据采用混合方法调查（n=67/91）和访谈数据（n=7）。定量数据采用描述性和推论性统计进行分析；定性数据采用主题分析进行分析。对所有数据进行了综合：三个主题包括 "基于价值观的紧张关系：结果：三个主题包括 "基于价值观的紧张关系：助产士角色的侵蚀"、"辨别差异：去留意向"；"留住助产士：活动和影响"：活动和影响"：我们发现，助产士的去留意向与她们在工作场所的角色之间存在着明显的联系；与其他角色的助产士相比，专业助产士更有可能留下来，她们对自己的角色表示满意、拥有自主权，并感觉到自己的贡献或效率。留任助产士对助产士的工作场所体验产生了积极的影响：结论：在同一机构工作的助产士对其角色和工作满意度有不同的体验。未来的工作应考虑将专业角色的积极因素应用到更广泛的助产士队伍中，以提高留任率。留任助产士角色显示了前景，但还需要进一步评估。

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引用次数: 0

Birthing consciousness and the flow experience during physiological childbirth 分娩意识和生理分娩过程中的流动体验

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-20 DOI: 10.1016/j.midw.2024.104151

Problem

It has been demonstrated that birth without medical intervention conveys significant physical and psychological benefits to the mother and her newborn baby. However, there is a need to include women's subjective experience of physiological birth to understand and promote it.

Background

The theoretical concept of “birthing consciousness” hypothesizes that women during natural childbirth sometimes experience a specific altered state of consciousness, which is a positive peak experience that resembles “flow” in many aspects.

Aim

To investigate the underexplored connection between the physiological mode of childbirth and altered states of consciousness during childbirth.

Methods

Israeli women with childbirth experience were recruited through social media (Facebook groups with a focus on childbirth and motherhood). Participants (n = 766) completed an online survey: the Flow State Scale (FSS) and a demographic questionnaire.

Findings

Differences were found between modes of birth as to flow state, as women who experienced physiological childbirth (i.e., with no epidural anesthesia or instrumental interventions) had a higher flow state during birth.

Discussion

This link empirically confirms the phenomenon of birthing consciousness. All nine dimensions of the mental state of flow apply to childbirth: challenge-skill balance, action-awareness merging, clear goals, unambiguous feedback, concentration on the task, sense of control, loss of self-consciousness, transformation of time, and autotelic experience.

Conclusion

Understanding a women's subjective experience during physiological birth can enhance clinical understanding of physiological birth thus promoting positive physiological birth experiences – which has crucial health benefits. We propose that more studies need to be done to promote experiencing flow during physiological birth.

问题事实证明，在没有医疗干预的情况下分娩，对母亲和新生儿的生理和心理都有很大好处。背景 "分娩意识 "这一理论概念假设，自然分娩过程中妇女有时会经历一种特定的意识改变状态，这是一种积极的高峰体验，在许多方面类似于 "流动"。方法通过社交媒体（以分娩和母性为主题的 Facebook 群组）招募有分娩经验的以色列女性。参与者（n = 766）完成了一项在线调查："流动状态量表"（FSS）和一份人口统计学问卷。研究结果发现不同分娩方式的流动状态存在差异，经历过生理性分娩（即没有硬膜外麻醉或器械干预）的妇女在分娩时的流动状态更高。流动心理状态的九个维度均适用于分娩：挑战-技能平衡、行动-意识融合、目标明确、反馈清晰、专注于任务、控制感、失去自我意识、时间转换和自发体验。我们建议需要开展更多研究，以促进生理分娩过程中的流动体验。

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引用次数: 0

International News October 2024 2024 年 10 月国际新闻

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-20 DOI: 10.1016/j.midw.2024.104135

引用次数: 0

Barriers and facilitators of screening postpartum depression by primary maternal health workers: A mixed methods study based on the normalization process theory 基层孕产妇保健工作者筛查产后抑郁症的障碍和促进因素：基于正常化过程理论的混合方法研究。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-18 DOI: 10.1016/j.midw.2024.104148

Background

Postpartum depression (PPD) significantly impacts mothers and children's health. China aims to incorporate PPD screening in postpartum home visits, but research on implementation barriers and facilitators is scarce. We designed and implemented a new PPD screening program in Changsha, China, requiring maternal health workers to integrate PPD screening into their postpartum home visits.

Aims

To identify real-world barriers and facilitators associated with integrating PPD screening into routine home visits from the perspective of maternal health workers.

Methods

We employed a mixed-methods approach. Maternal health workers involved in the newly introduced PPD screening program were included. Guided by Normalization Process Theory (NPT), quantitative data were collected using the NoMAD instrument, and qualitative data were obtained through semi-structured interviews. Data were analyzed using descriptive statistics for the survey and thematic analysis for the interviews.

Results

All 42 maternal health workers involved in the new PPD program completed the quantitative survey, and nine participated in qualitative interviews. The NoMAD survey revealed high scores for Coherence and Cognitive Participation, but lower scores for Collective Action, particularly regarding insufficient skills and resource adequacy. Thematic analysis identified several barriers, including workload concerns, the need for enhanced psychological healthcare capacity, and lack of economic incentives. Facilitators included the integration of structured feedback and clear referral pathways.

Conclusion

Addressing identified barriers through targeted skill training, well-defined referral pathways, and formal recognition of the screening program in performance evaluations could help achieve successful normalization.

背景：产后抑郁症（PPD）严重影响母亲和儿童的健康。中国的目标是在产后家访中纳入 PPD 筛查，但有关实施障碍和促进因素的研究却很少。我们在中国长沙设计并实施了一项新的PPD筛查项目，要求孕产妇保健工作者将PPD筛查纳入其产后家访中。目的：从孕产妇保健工作者的角度出发，找出将PPD筛查纳入常规家访的现实障碍和促进因素：我们采用了混合方法。方法：我们采用了混合方法，将参与新引入的 PPD 筛查项目的孕产妇保健工作者纳入其中。在规范化过程理论（NPT）的指导下，我们使用 NoMAD 工具收集定量数据，并通过半结构化访谈获得定性数据。调查数据采用描述性统计，访谈数据采用主题分析：所有参与新 PPD 计划的 42 名孕产妇保健工作者都完成了定量调查，9 人参加了定性访谈。NoMAD 调查显示，一致性和认知参与得分较高，但集体行动得分较低，尤其是在技能不足和资源充足方面。专题分析发现了一些障碍，包括工作量问题、加强心理保健能力的需要以及缺乏经济激励。促进因素包括整合结构化反馈和明确的转诊途径：通过有针对性的技能培训、明确的转诊途径以及在绩效评估中对筛查计划的正式认可来解决已发现的障碍，有助于成功实现正常化。

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引用次数: 0

Development and early implementation of telemonitoring of complicated pregnancies – A qualitative study with the perspectives of health professionals 复杂妊娠远程监护的开发和早期实施--从医疗专业人员的角度进行的定性研究。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-18 DOI: 10.1016/j.midw.2024.104149

Background

Telemonitoring may offer promising opportunities in health care. In obstetric health care, there is a need to expand and improve digitalization. Nevertheless, there is limited knowledge based on healthcare professionals' perspectives regarding the use of telemedicine and remote cardiotocography during pregnancy, as well as its implementation.

Aim

To explore the perspectives of health-care professionals who manage telemonitoring of complicated pregnancies.

Design and setting

A qualitative interview study undertaken in a hospital with a tertiary obstetric unit in Northen Denmark.

Methods

Based on a purposive sample strategy, 11 semi-structured interviews of health-care professionals involved in the management of telemonitoring in women with complicated pregnancies were conducted and analyzed using a reflexive thematic analytical approach.

Findings

The findings are assembled into two main themes. The experience of relevance to own practice: included the embedded potentials in telemonitoring providing women-centred care, but also challenges related to the implementation of a new technology. Experience of challenges and potential in day-to-day operation: included frustrations regarding the technological devices and software, working experiences increasing confidence in telemonitoring, and perspectives on the required interdependence across departments.

Conclusion

This study adds important knowledge to support awareness and reflection on how challenges impact the successful implementation of telemonitoring in obstetric and midwifery care. This includes knowledge of important processes and resources to ensure ongoing implementation and evaluation. Implementation strategies and collaborations to support a multiple-level system change, such as an interdisciplinary team, seem crucial to minimize challenges, build shared visions, and engage staff.

背景：远程监控可为医疗保健提供大有可为的机会。在产科医疗保健中，有必要扩大和改进数字化。然而，从医护人员的角度来看，他们对孕期远程医疗和远程心动图的使用及其实施的了解还很有限。目的：探讨管理复杂妊娠远程监护的医护人员的观点：在丹麦北部一家设有三级产科的医院进行的定性访谈研究：根据目的性抽样策略，对参与复杂妊娠妇女远程监护管理的专业医护人员进行了 11 次半结构化访谈，并采用反思性主题分析方法对访谈结果进行了分析：研究结果分为两大主题。与自身实践相关的经验：包括远程监护在提供以妇女为中心的护理方面所蕴含的潜力，但也包括与实施新技术相关的挑战。日常操作中的挑战和潜力：包括技术设备和软件方面的挫折、增强对远程监控信心的工作经验，以及对跨部门相互依存所需的观点：这项研究增加了重要的知识，有助于认识和思考在产科和助产护理中成功实施远程监护所面临的挑战。这包括了解确保持续实施和评估的重要流程和资源。支持多层次系统变革的实施策略和合作（如跨学科团队）对于最大限度地减少挑战、建立共同愿景和吸引员工参与似乎至关重要。

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引用次数: 0

Shared decision-making in maternity care in Saudi Arabia: A cross-sectional study 沙特阿拉伯孕产妇护理中的共同决策：横断面研究

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-14 DOI: 10.1016/j.midw.2024.104147

Background

Shared decision-making (SDM) in maternity care involves women actively in decisions, thereby reducing decisional conflicts and enhancing satisfaction with care.

Aim

To investigate SDM and the factors associated with it, and its correlation with respect in maternity care in Saudi Arabia.

Methods

A comprehensive, nationwide online questionnaire-based study was conducted between January to May 2023, involving women aged 18 years and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. The Mothers’ Autonomy in Decision-Making (MADM) scale and the Mothers of Respect Index (MORi) were used. Low to very low SDM was defined as a score of ≤ 24 on the MADM and low to very low respected was defined as a score of ≤ 49 on the MORi.

Results

A total of 505 women completed the survey. Low to very low SDM was reported by 137 (34.1 %, 95 confidence interval (CI), 29.6 % - 38.9 %) women. Factors significantly associated with low to very low SDM included seeing different obstetricians of different gender at each visit (adjusted odds ratio (AOR) 2.0, 95 % CI, 1.0 – 3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95 % CI, 1.2 – 5.6) and having an instrumental vaginal birth (AOR 6.67, 95 % CI, 1.6 - 28.1). There was a positive association between low to very SDM and feeling of low to very low respect ((χ2 = 83.8173, p < 0.001).

Conclusion

More than one-third of women experienced low to very low SDM in maternity care. This should alert healthcare providers to the importance of continuity of care in Saudi Arabia.

背景产科护理中的共同决策（SDM）让女性积极参与决策，从而减少决策冲突并提高护理满意度。目的调查沙特阿拉伯产科护理中的 SDM 及其相关因素，以及其与尊重的相关性。方法在 2023 年 1 月至 5 月期间开展了一项基于在线问卷的全国性综合研究，研究对象为 18 岁及以上、怀孕或在过去 12 个月中经历过怀孕/分娩的女性。研究采用了母亲自主决策量表（MADM）和母亲尊重指数（MORi）。MADM评分≤24分为 "低度至极度低度SDM"，MORi评分≤49分为 "低度至极度低度受尊重"。137名（34.1%，95 置信区间 (CI)，29.6% - 38.9%）女性表示 SDM 低至很低。与低至极低 SDM 显著相关的因素包括：每次就诊时都见到不同性别的产科医生（调整后的几率比（AOR）为 2.0，95 % CI，1.0 - 3.9）；整个孕期没有见到同一位产科医生（AOR 2.6，95 % CI，1.2 - 5.6）；以及阴道助产（AOR 6.67，95 % CI，1.6 - 28.1）。低度至极度 SDM 与低度至极度受尊重感之间存在正相关（χ2 = 83.8173，p < 0.001）。在沙特阿拉伯，医疗服务提供者应警惕连续性护理的重要性。

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引用次数: 0

Caregiver perceptions of complementary feeding in rural and urban Indonesia: A qualitative comparative study 印度尼西亚农村和城市的护理人员对辅食喂养的看法：定性比较研究

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-14 DOI: 10.1016/j.midw.2024.104146

Objective

To explore caregivers’ perspectives on complementary feeding in rural and urban areas of Central Java, Indonesia.

Design

A qualitative comparative study using in-depth interviews. We applied thematic analysis to identify themes and subthemes and presented representative quotes.

Setting

Rural and urban villages in Central Java Province, Indonesia.

Participants

46 mothers and grandmothers of 6- to 23-month-old children.

Findings

We identified five themes: 1) timing of food introduction, 2) types of complementary foods, 3) meal preparations, 4) complementary food benefits, and 5) expectations toward complementary foods. While caregivers in urban areas had more favourable perceptions of complementary feeding, some misperceptions existed regarding complementary feeding in both areas. These misconceptions included the age of complementary food introduction, the delay in introducing animal-source foods, and the emphasis on any food the child preferred as long as they ate rather than on healthy food choices.

Key conclusions

There were similarities and differences in complementary feeding perspectives between caregivers in rural and urban areas. Therefore, policymakers and public health workers should design interventions to enhance complementary feeding practices by addressing the contextual issues in specific settings.

目标探讨印度尼西亚中爪哇省农村和城市地区护理人员对辅食喂养的看法。研究结果我们确定了五个主题：1）添加食物的时间；2）辅食的种类；3）膳食的准备；4）辅食的益处；5）对辅食的期望。虽然城市地区的照顾者对辅食喂养有更多的好感，但两个地区的照顾者对辅食喂养都存在一些误解。这些误解包括添加辅食的年龄、推迟添加动物源性食物，以及强调只要孩子喜欢吃任何食物就可以，而不是选择健康的食物。因此，政策制定者和公共卫生工作者应针对具体情况设计干预措施，以加强辅食喂养实践。

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引用次数: 0

Embodiment and the technologies of induction of labour 体现与引产技术

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-14 DOI: 10.1016/j.midw.2024.104144

Objective

To critically engage with the body project of induction of labour.

Design

A nested, qualitative study that formed part of a feasibility Random Controlled Trial investigating different methods of outpatient induction of labour. The data reported in this article were gathered via interview with women and midwives involved in the trial. All the participants who took part in the trial presented as cisgender women.

Findings

Analysis of 27 interview transcripts suggested that the expansion in choice of when, how and where to start labour can change the way decisions about labour onset is understood. The space needed for a new body project is emerging where distinctions between medicalised labour and spontaneous labour are less clear.

Conclusion

The embodiment of the new technologies of induction for those involved in this study was both a facet of increased freedom and autonomy and a gendered discourse where the normative function of routine intervention appeared more complete.

设计这是一项嵌套的定性研究，是一项可行性随机对照试验的一部分，该试验调查了门诊引产的不同方法。本文报告的数据是通过采访参与试验的妇女和助产士收集的。对 27 份访谈记录的分析表明，对分娩开始的时间、方式和地点的选择范围的扩大可能会改变人们对分娩开始的决定的理解。在医疗化分娩和自然分娩的区别不那么明显的情况下，新的身体项目所需的空间正在出现。结论对于参与本研究的人来说，引产新技术的体现既是自由和自主权增加的一个方面，也是常规干预的规范功能显得更加完整的性别话语。

引用次数: 0

Barriers and facilitators to self-management among women with gestational diabetes: A systematic review using the COM-B model 妊娠糖尿病妇女自我管理的障碍和促进因素：使用 COM-B 模型进行系统回顾。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-13 DOI: 10.1016/j.midw.2024.104141

Background

Gestational diabetes mellitus is a common complication during pregnancy, and its prevalence rates have increased dramatically in recent years. Treatment of gestational diabetes requires the active self-management, however, this can be challenging. Understanding the barriers and facilitators of adherence to self-management recommendations is essential for designing effective interventions.

Aim

To identify and synthesize barriers and facilitators to self-management of gestational diabetes reported by pregnant women.

Methods

This was a mixed-methods systematic review, including qualitative, quantitative, and mixed-methods studies. A literature search was conducted in four databases (PubMed, Embase, CINAHL, and the Web of Science). Eligible studies explored the barriers and/or facilitators, experiences and/or perceptions to engage in self-management in women with gestational diabetes. The Capability, Opportunity, Motivation, Behaviour model was used to classify barriers and facilitators affecting self-management.

Results

Thirty-six studies (23 qualitative, 11 quantitative, and 2 mixed-methods) met the inclusion criteria. We identified barriers and facilitators relating to capability (e.g., physical discomforts and constraints; lack of knowledge of GDM and self-management behaviours; forgetfulness), opportunity (e.g., limited education and resources; social support from family, friends, and peer groups; conflict with existing lifestyles or cultural norms), and motivation (e.g., perceived negative consequence of self-management behaviours or not perceived benefits; negative emotion; concern the health of the baby).

Conclusion

In this study, we identified the barriers and facilitators of self-management in women with gestational diabetes, which were explained by relevant theoretical models. Interventions should be developed with full consideration of these findings to ensure that pregnant women have the correct knowledge and confidence to self-manage their complications.

背景：妊娠糖尿病是孕期常见的并发症，近年来发病率急剧上升。妊娠糖尿病的治疗需要积极的自我管理，但这可能具有挑战性。了解坚持自我管理建议的障碍和促进因素对于设计有效的干预措施至关重要。目的：确定并综合孕妇报告的妊娠糖尿病自我管理的障碍和促进因素：这是一项混合方法的系统性综述，包括定性、定量和混合方法研究。我们在四个数据库（PubMed、Embase、CINAHL 和 Web of Science）中进行了文献检索。符合条件的研究探讨了妊娠糖尿病妇女参与自我管理的障碍和/或促进因素、经验和/或认知。研究采用能力、机会、动机、行为模型对影响自我管理的障碍和促进因素进行分类：36项研究（23项定性研究、11项定量研究和2项混合方法研究）符合纳入标准。我们确定了与能力（如身体不适和制约因素；缺乏对 GDM 和自我管理行为的了解；健忘）、机会（如教育和资源有限；来自家庭、朋友和同龄群体的社会支持；与现有生活方式或文化规范的冲突）和动机（如认为自我管理行为会带来负面影响或没有感觉到好处；负面情绪；对婴儿健康的担忧）有关的障碍和促进因素：在这项研究中，我们确定了妊娠糖尿病妇女自我管理的障碍和促进因素，并通过相关理论模型对其进行了解释。在制定干预措施时，应充分考虑到这些发现，以确保孕妇拥有正确的知识和信心来自我管理并发症。

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引用次数: 0

Registered nurse lactation consultants' experiences supporting maternal mental health: A qualitative descriptive study 注册护士哺乳顾问支持产妇心理健康的经验：定性描述研究

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-12 DOI: 10.1016/j.midw.2024.104145

Background

The province of Nova Scotia has the highest rates of perinatal mental health disorders in Canada, and rates of exclusive breastfeeding fall below the Canadian national average. Exclusive breastfeeding is identified as a protective factor against the development of perinatal mental health disorders. Lactation consultant support is associated with increased rates of exclusive breastfeeding and decreased rates of perinatal mental health disorders. Despite this, little is known regarding the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health.

Objective

To understand the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health.

Design

A qualitative descriptive design using online semi-structured interviews.

Setting & Participants

Ten Registered Nurse Lactation Consultants employed in the publicly funded healthcare system in Nova Scotia, Canada, were recruited via purposive sampling.

Findings

Three themes emerged regarding the relational experiences of Registered Nurse Lactation Consultants while supporting maternal mental health; these included (1) Experiences supporting maternal mental health, (2) Providing maternal mental health care, and (3) Mothers need support.

Key conclusions and implications for practice

Registered Nurse Lactation Consultants described positive experiences supporting maternal mental health and indicated that lactation consultant appointments were an opportune time to provide screening and support for maternal mental health. Enhancing support for maternal mental health requires collaborative and integrated approaches throughout the perinatal period. Healthcare providers, including Registered Nurse Lactation Consultants, must be provided with the support and resources to provide timely and appropriate support for maternal mental health throughout the perinatal period.

背景新斯科舍省是加拿大围产期精神疾病发病率最高的省份，纯母乳喂养率低于加拿大全国平均水平。纯母乳喂养被认为是围产期精神疾病的一个保护因素。哺乳顾问的支持与纯母乳喂养率的提高和围产期精神疾病发病率的降低有关。尽管如此，人们对注册护士哺乳顾问在支持产妇心理健康方面的经验却知之甚少。目的了解注册护士哺乳顾问在支持产妇心理健康方面的经验。主要结论和对实践的启示注册护士哺乳顾问描述了支持孕产妇心理健康的积极经验，并表示哺乳顾问预约是提供孕产妇心理健康筛查和支持的好时机。加强对孕产妇心理健康的支持需要在整个围产期采取协作和综合的方法。必须为包括注册护士哺乳顾问在内的医疗保健提供者提供支持和资源，以便在整个围产期为孕产妇的心理健康提供及时、适当的支持。

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引用次数: 0