Birth-Issues in Perinatal Care最新文献_第10页

A History of Cesarean Birth as a Risk Factor for Postpartum Hemorrhage Even After Successful Planned Vaginal Birth 剖腹产史是产后出血的风险因素之一，即使是在成功的阴道分娩计划之后。

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-11-11 DOI: 10.1111/birt.12892

J. Boujenah, M. Belabbas, A. Tigaizin, A. Benbara, I. Hensienne, M. Fermaut, L. Carbillon

Background

It is unclear if a history of cesarean birth (CB) is a risk factor for postpartum hemorrhage (PPH) even after a successful planned vaginal birth.

Methods

A historical retrospective cohort study from all deliveries (42,456) between 2004 and 2019. Inclusion criteria were as follows: (i) women with only one previous CB; (ii) liveborn cephalic singleton pregnancy and term spontaneous labor; (iii) successful planned vaginal birth; (iv) no operative vaginal delivery; and (v) no history of PPH. Women who experienced intrapartum uterine rupture leading to CB were excluded. Those who experienced uterine rupture diagnosed after vaginal birth were not excluded. The labor after cesarean (LAC) group (109 women with previous CB and current vaginal birth) were compared with 2 control groups to consider the parity: control group 1 (1633 nulliparous women) and control group 2 (4197 parous women). The main outcome was the rate of PPH (> 500 mL). Multivariate analysis was performed to investigate whether previous CB was an independent risk factor for PPH. Bivariate analysis and causal framework was used to determine the relation between variables of clinical interest.

Results

The PPH rates in the LAC group, control group 1, and control group 2 were 12.8%, 5.3%, and 6.4%, respectively. Irrespective of the group control (1 or 2), a history of CB was associated with an increased risk of PPH: adjusted odds ratio (aOR) 2.38 [95% confidence interval (CI) 1.28–4.44] (adjusted with maternal age, overweight, hyperthermia, and use of oxytocin) and aOR 2.16 [95% CI 1.20–3.87] (adjusted with maternal age and overweight) for Groups 1 (parous) and 2 (nulliparous), respectively.

Conclusion

A history of cesarean birth could be a risk factor for PPH even after successful planned vaginal delivery.

背景：目前尚不清楚剖宫产史（CB）是否是产后出血（PPH）的风险因素，即使是在成功的计划阴道分娩后：方法：对 2004 年至 2019 年期间的所有分娩（42456 例）进行历史回顾性队列研究。纳入标准如下(i) 仅有过一次 CB 的产妇；(ii) 活产头位单胎妊娠和足月自然分娩；(iii) 顺利经阴道分娩；(iv) 未进行阴道分娩手术；(v) 无 PPH 病史。排除了产中子宫破裂导致 CB 的产妇。不排除阴道分娩后诊断为子宫破裂的产妇。剖宫产后分娩（LAC）组（109 名曾有过剖宫产经历且目前经阴道分娩的产妇）与两组对照组进行了比较，以考虑其奇偶性：对照组 1（1633 名无阴道分娩的产妇）和对照组 2（4197 名有阴道分娩经历的产妇）。主要结果是 PPH（> 500 毫升）发生率。进行了多变量分析以研究既往 CB 是否是 PPH 的独立风险因素。双变量分析和因果框架用于确定临床相关变量之间的关系：LAC组、对照组1和对照组2的PPH发生率分别为12.8%、5.3%和6.4%。无论对照组是第 1 组还是第 2 组，剖宫产史都与 PPH 风险的增加有关：第 1 组（顺产）和第 2 组（非顺产）的调整赔率（aOR）分别为 2.38 [95% 置信区间（CI）1.28-4.44]（与产妇年龄、超重、高热和催产素的使用进行调整）和 2.16 [95% CI 1.20-3.87]（与产妇年龄和超重进行调整）：结论：剖宫产史可能是PPH的一个风险因素，即使是在顺利通过阴道分娩的情况下。

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引用次数: 0

Pregnant Women's Care Needs During Early Labor–A Scoping Review 孕妇早产期间的护理需求--范围审查。

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-11-11 DOI: 10.1111/birt.12891

Antonia N. Mueller, Susanne Grylka-Baeschlin

Introduction

Pregnant women face the challenge of managing early labor on their own until they feel the need to seek professional support. However, professional support during such a vulnerable stage of labor may sometimes be insufficient. This study aims to understand pregnant women's care needs during early labor in order to improve the quality of care provided at the onset of labor.

Methods

A scoping review was conducted following a systematic search strategy in May 2021 and in August 2022 concentrating on pregnant women in early labor with spontaneous onset of labor. A sensitive search strategy was used with five different databases. The articles were screened by two independent researchers. Data were extracted and mapped to answer the research question.

Results

52 articles were included. Major reasons for seeking professional help are to receive reassurance and get advice and information on how to cope with early labor. Furthermore, many women express the need for professional guidance. Several articles demonstrated women's preferences for hospital admission or a continuous care model. While some women want empowerment and empathy from a midwife, others require clear instructions on helpful measures or even clinical interventions within the process.

Conclusions

Managing early labor without professional support creates a major challenge for pregnant women and nurtures insecurities and anxiety. Protecting women from unnecessary interventions is a well-intentioned plan, yet a lack of support in early labor may sometimes jeopardize a positive birth experience. New ways need to be elaborated to support women-centred and individualized approaches to providing early labor care.

引言在感到需要寻求专业支持之前，孕妇面临着自行处理早产的挑战。然而，在如此脆弱的分娩阶段，专业人员的支持有时可能并不充分。本研究旨在了解孕妇在早产期间的护理需求，从而提高临产护理的质量：方法：我们于 2021 年 5 月和 2022 年 8 月采用系统检索策略进行了一次范围界定审查，重点关注自然临产的早产孕妇。采用了敏感的检索策略，使用了五个不同的数据库。文章由两名独立研究人员进行筛选。对数据进行提取和映射，以回答研究问题：结果：共收录了 52 篇文章。寻求专业帮助的主要原因是为了得到安慰，并获得如何应对早产的建议和信息。此外，许多妇女表示需要专业指导。有几篇文章表明，产妇更倾向于住院或持续护理模式。有些产妇希望助产士能给予她们力量和同情，而另一些产妇则需要助产措施的明确指导，甚至需要在分娩过程中进行临床干预：结论：在没有专业支持的情况下处理早产对孕妇来说是一项重大挑战，并会滋生不安全感和焦虑。保护妇女免受不必要的干预是一项用心良苦的计划，但早产时缺乏支持有时可能会危及积极的分娩体验。需要制定新的方法来支持以妇女为中心和个性化的早产护理方法。

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引用次数: 0

Enhancing Perinatal Cannabis Use Counseling: Insights From Taiwan's Addiction Treatment Practice 加强围产期大麻使用咨询：台湾戒毒实践的启示。

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-11-11 DOI: 10.1111/birt.12898

Ya-Yun Tsai, Lien-Chung Wei

This letter responds to Cernat et al.'s study on counseling about cannabis use during pregnancy and lactation, drawing parallels with addiction treatment practices in Taiwan. We highlight the importance of open, non-judgmental approaches and harm reduction strategies in counseling pregnant women with substance use disorders. Our experience at a psychiatric center in Taiwan emphasizes the need for continuous counseling throughout pregnancy and postpartum, particularly given the observed increase in cannabis use among new mothers. We support the study's emphasis on exploring patients' perceived benefits from cannabis use and addressing underlying reasons for use. By integrating insights from qualitative studies on patient perspectives, we have improved patient engagement and outcomes in our practice. This commentary underscores the global relevance of the study's findings and calls for continued research to bridge the gap between clinician and patient experiences in perinatal cannabis use counseling.

这封信回应了 Cernat 等人关于孕期和哺乳期大麻使用咨询的研究，并将其与台湾的成瘾治疗实践相提并论。我们强调，在为患有药物使用障碍的孕妇提供咨询时，开放、不做评判的方法和减少伤害的策略非常重要。我们在台湾一家精神病治疗中心的经验强调了在整个孕期和产后持续提供咨询的必要性，尤其是考虑到已观察到新妈妈使用大麻的情况有所增加。我们支持该研究强调探索患者从使用大麻中感知到的益处，并解决使用大麻的根本原因。通过整合定性研究中关于患者观点的见解，我们在实践中提高了患者的参与度和治疗效果。这篇评论强调了研究结果的全球相关性，并呼吁继续开展研究，以弥合围产期大麻使用咨询中临床医生和患者经验之间的差距。

引用次数: 0

Translating Priorities Into Practice: Midwifery Care for Uninsured Migrant Populations Across Canada 将优先事项转化为实践：加拿大各地无保险移民的助产护理。

IF 2.5 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-11-07 DOI: 10.1111/birt.12893

Heidi Elias, Lindsay Larios

Background

Immigrants and newcomers are identified by many provincial midwifery associations as “priority populations.” Recently, newcomer populations have shifted considerably, with more people coming to Canada with precarious immigration status who are increasingly ineligible for public healthcare insurance and facing barriers to accessing care. Our aims were to: (1) gain an understanding of the policies related to equitable access to midwifery care and how they may apply to migrant groups without public healthcare insurance and (2) identify existing policy themes, gaps, and regulatory barriers that limit access for this vulnerable population in Canada.

Methods

We conducted a high-level document content analysis using a health equity framework. We aimed to identify language related to equitable access in midwifery services, with particular emphasis on uninsured populations. A total of 64 documents were analyzed, including legislation and publicly available statements from midwifery regulatory bodies and associations.

Results

Midwifery regulatory authorities and associations across Canada are consistent in establishing an expectation that midwives will provide accessible care to diverse clientele. However, how these commitments are put into practice varies considerably between jurisdictions. We compared the cases of Manitoba and Ontario to illustrate the disconnect between commitments to priority populations and implementation.

Discussion

While there is a clearly demonstrated intention to provide equitable access to midwifery care to all people, including “priority populations” like migrants and newcomers, in practice, these commitments have not been fully realized. Equity is encumbered by broader structural issues, such as the growth in the number of newcomers without access to public health insurance. Moves toward equity within midwifery and healthcare more broadly need to meaningfully engage with other policy sectors, such as immigration, to be able to adapt to emerging issues affecting reproductive care, such as the growing precarity of newcomer populations in Canada.

背景：移民和新移民被许多省级助产士协会确定为 "优先人群"。最近，新移民人口发生了很大变化，越来越多的人以不稳定的移民身份来到加拿大，他们越来越没有资格享受公共医疗保险，并在获得护理方面面临障碍。我们的目标是(1）了解与公平获得助产护理相关的政策，以及这些政策如何适用于没有公共医疗保险的移民群体；（2）确定现有的政策主题、差距以及限制加拿大这一弱势群体获得护理的监管障碍：我们采用健康公平框架对文件内容进行了高级分析。我们的目标是识别与助产服务的公平获取相关的语言，尤其侧重于未参保人群。共分析了 64 份文件，包括助产士监管机构和协会的立法和公开声明：加拿大各地的助产士监管机构和协会都一致期望助产士能为不同的客户提供方便的护理服务。然而，如何将这些承诺付诸实践，各辖区之间存在很大差异。我们比较了马尼托巴省和安大略省的情况，以说明对重点人群的承诺与实施之间的脱节：虽然有明确的意图为所有人，包括移民和新移民等 "优先人群 "提供公平的助产护理机会，但在实践中，这些承诺并未完全实现。公平性受到更广泛的结构性问题的制约，例如无法获得公共医疗保险的新移民人数不断增加。在助产和更广泛的医疗保健领域实现公平需要与移民等其他政策部门进行有意义的合作，以便能够适应影响生殖保健的新问题，如加拿大新移民人口日益不稳定的问题。

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引用次数: 0

The Incidence of Postpartum Post-Traumatic Stress Disorder in Women Exposed to Adverse Childhood Experiences: A Systematic Review and Meta-Analysis 曾有不良童年经历的妇女产后创伤后应激障碍的发病率：系统回顾与元分析》。

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-11-04 DOI: 10.1111/birt.12871

Linli Zou, Shu Wang, Jingfen Chen, Daniel Krewski, Shi Wu Wen, Xiaolu Lai, Ri-hua Xie

Background

Adverse childhood experiences (ACEs) are known contributors to lifelong mental health challenges. Despite studies linking ACEs to increased risk of adverse postpartum mental health outcomes, a systematic review on the occurrence of postpartum post-traumatic stress disorder (PTSD) in women with ACEs is lacking.

Methods

A systematic search was conducted in seven databases to retrieve studies from inception to January 31, 2024. A random-effects model was used to quantify weighted estimates of postpartum PTSD incidence. Statistical analysis was conducted using R software.

Results

Seven studies were included in the system review. One study was identified as an outlier and excluded from the meta-analysis. Among the six remaining studies, 1186 women exposed to ACEs were identified, with 249 of them experiencing postpartum PTSD. The estimated incidence of postpartum PTSD among women exposed to ACEs was 22.6% (95% confidence interval [CI] 16.1%–29.8%). Subgroup analysis revealed significant variations in incidence depending on study settings (p < 0.01) and PTSD assessment methods (p < 0.01). Due to multicollinearity among the primary variables, a meta-regression to identify factors influencing study heterogeneity was not conducted.

Conclusion

The incidence of postpartum PTSD was 22.6% in women with ACEs, higher than that observed in the general obstetric population. This finding suggests the need to provide comprehensive postpartum care for these women.

背景：众所周知，童年的不良经历（ACEs）是导致终生心理健康挑战的因素。尽管有研究表明 ACE 与产后心理健康不良后果的风险增加有关，但目前还缺乏对有 ACE 妇女产后创伤后应激障碍（PTSD）发生情况的系统性综述：方法：在七个数据库中进行了系统性检索，以检索从开始到 2024 年 1 月 31 日的研究。采用随机效应模型对产后创伤后应激障碍发病率的加权估计值进行量化。统计分析使用 R 软件进行：七项研究被纳入系统回顾。其中一项研究被确定为离群值，并被排除在荟萃分析之外。在剩余的六项研究中，共发现了 1186 名暴露于 ACEs 的妇女，其中 249 人出现了产后创伤后应激障碍。据估计，接触过ACE的妇女中产后创伤后应激障碍的发生率为22.6%（95%置信区间[CI] 16.1%-29.8%）。分组分析显示，不同研究环境下的发病率存在显著差异（p 结论：产后创伤后应激障碍的发病率与研究环境有关：在患有 ACE 的妇女中，产后创伤后应激障碍的发生率为 22.6%，高于普通产科人群。这一发现表明，有必要为这些妇女提供全面的产后护理。

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引用次数: 0

Reduction of Noise Levels During Caesarean Births Through Audiovisual Feedback is Associated With Lower Stress Levels for Patients 通过视听反馈降低剖腹产过程中的噪音水平可降低患者的压力水平。

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-11-01 DOI: 10.1111/birt.12878

Caroline Helena Gabrysch, Sophie-Isabelle Anders, Iris Dressler-Steinbach, Thorsten Braun, Ilhamiyya Efe, Wolfgang Henrich

Objective

Noise reduction during surgical procedures leads to improved surgical performance and results. The caesarean birth (CB) is an exceptional operation and a life changing experience. Through the introduction of staff education and implementation of audiovisual feedback, we intended to reduce noise, and subsequently reduce surgical complications and increase the well-being of patients and staff.

Methods

During Phase I, blinded baseline measurements of noise were conducted. Phase II started after staff education and structured questionnaires on subjective noise and stress were added, and in Phase III audiovisual feedback was introduced. Mean and peak noise levels over the time of the procedure were obtained in A-weighted decibels (dB(A)). Kruskal–Wallis H tests were performed to evaluate the impact of interventions on noise levels. Questionnaires were evaluated using descriptive statistics; stress-scores were compared using independent sample t-tests.

Results

Ninety planned CBs were included. Median noise levels were 62.85 dB(A) at baseline. They decreased significantly to 60.60 dB(A) (Phase II) and 59.25 dB(A) (Phase III), respectively. This reduction of 3.6 dB(A) leads to a subjective noise reduction of around 20%. Significant differences for A-weighted and peak noise levels during actual surgery were found after combining staff education with audiovisual feedback. In Phase III, staff reported less stressful noise. Stress also decreased significantly in the patient group. Beeping machines and telephones were identified as the most stressful sources of noise.

Conclusion

We show that noise reduction during CB is both necessary and possible. Diminished subjective perception of noise and stress are positive impacts of this intervention. Staff education and audiovisual feedback can help to provide a calm and lower stress environment for patients and staff during caesarean births.

目的：降低手术过程中的噪音可提高手术性能和效果。剖腹产（CB）是一项特殊的手术，也是一次改变人生的经历。我们希望通过开展员工教育和实施视听反馈来降低噪音，从而减少手术并发症，提高患者和员工的健康水平：方法：在第一阶段，我们对噪音进行了盲法基线测量。第二阶段在对员工进行教育后开始，并增加了关于主观噪音和压力的结构化问卷调查，第三阶段引入了视听反馈。测量过程中的平均噪音水平和峰值噪音水平均以 A 加权分贝（dB(A)）为单位。采用 Kruskal-Wallis H 检验来评估干预措施对噪音水平的影响。使用描述性统计对问卷进行评估；使用独立样本 t 检验对压力分数进行比较：结果：共纳入了 90 个计划中的 CB。基线噪音水平中位数为 62.85 dB(A)。在第二阶段和第三阶段，噪声中值分别为 60.60 dB(A)和 59.25 dB(A)。降低 3.6 dB(A)后，主观噪音降低了约 20%。在将员工教育与视听反馈相结合后，发现实际手术过程中的 A 加权噪音和峰值噪音水平存在显著差异。在第三阶段，工作人员报告噪音压力降低。病人组的压力也明显降低。嘟嘟声的机器和电话被认为是最令人紧张的噪声源：我们的研究表明，在 CB 期间减少噪音是必要的，也是可行的。结论：我们的研究表明，在 CB 过程中减少噪音是必要的，也是可行的，减少对噪音和压力的主观感受是这一干预措施的积极影响。员工教育和视听反馈有助于在剖腹产过程中为患者和员工提供一个平静和低压力的环境。

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引用次数: 0

Parity Moderates the Socioeconomic Predictors of Birth Setting Choice 均等调节生育环境选择的社会经济预测因素。

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-10-28 DOI: 10.1111/birt.12882

Ahoua Dembélé, Bethlehem Peters, Dmitry Tumin

Background

The increase in the number of people choosing community birth has raised interest in understanding the factors that influence birth setting choices. This study investigates how parity influences the association between maternal socioeconomic factors and choice of community versus hospital birth.

Methods

We used 2009–2021 US birth certificate data to identify community births (planned home or birth center births), parity, and maternal characteristics, including Women, Infants, and Children (WIC) program participation, race, ethnicity, educational attainment, marital status, body mass index (BMI), and age. Parity was interacted with each covariate in a multivariable logistic regression model of birth setting.

Results

Among 26,526,010 eligible births, 58% were to multiparous mothers, with 1.9% occurring in a birth center or at home. For most maternal characteristics, associations with community birth were stronger in the multiparous group compared to the nulliparous group. For example, being married was associated with greater odds of community birth in both groups, but the strength of this association was greater within the multiparous group (odds ratio 4.00 vs. 1.94, interaction p < 0.001). The same pattern (stronger association with community birth in the multiparous group than in the primiparous group) was observed for race/ethnicity, educational attainment, and WIC participation, all of which were associated with lower odds of community birth.

Conclusion

This study shows that parity significantly moderates associations between maternal socioeconomic characteristics and birth setting, implying studies of decision-making in this context should purposively stratify samples and analyses by parity.

背景：随着选择社区分娩的人数增加，人们开始关注影响分娩环境选择的因素。本研究调查了准妈妈的社会经济因素与选择社区分娩还是医院分娩之间的关系：我们使用 2009-2021 年美国出生证明数据来识别社区分娩（计划内家庭分娩或分娩中心分娩）、奇偶性和产妇特征，包括妇女、婴儿和儿童 (WIC) 计划参与情况、种族、民族、教育程度、婚姻状况、体重指数 (BMI) 和年龄。在出生环境的多变量逻辑回归模型中，胎次与每个协变量相互影响：在 26,526,010 名符合条件的新生儿中，58% 的新生儿为多产妇，1.9% 的新生儿在分娩中心或家中分娩。就大多数产妇特征而言，多产妇组与社区分娩的相关性比无产妇组更强。例如，在两组中，已婚与社区分娩的几率都更大，但在多产妇组中，这种关联的强度更大（几率比 4.00 vs. 1.94，交互作用 p）：本研究表明，准妈妈的社会经济特征与分娩环境之间的关联有明显的调节作用，这意味着在这种情况下进行的决策研究应根据准妈妈的情况有目的地对样本进行分层和分析。

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引用次数: 0

Midwifery Continuity of Care During Pregnancy, Birth, and the Postpartum Period: A Matched Cohort Study 助产士在妊娠、分娩和产后期间的持续护理：匹配队列研究。

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-10-28 DOI: 10.1111/birt.12875

L. Lundborg, K. Åberg, X. Liu, M. Norman, O. Stephansson, K. Pettersson, M. Ekborn, S. Cnattingius, M. Ahlberg

Objective

To compare pregnancy outcomes in a midwifery continuity of care (MCoC) model to standard midwifery care in Sweden.

Design

Matched cohort study.

Setting

Public healthcare during pregnancy and childbirth, Stockholm, Sweden.

Population

Women giving birth at Karolinska University Hospital site Huddinge in Stockholm between January 1, 2019, and August 31, 2021.

Methods

Data on all births including MCoC and standard care, during the time period, were retrieved from the national Swedish Pregnancy Register. Propensity score matching was applied to obtain a matched set from the standard care group for every woman in the MCoC model. Based on the matched cohort, we estimated risk ratios (RR) for binary outcomes with 95% confidence intervals (CI).

Main Outcome Measures

Interventions during labor, mode of birth, and preterm birth (< 37 gestational weeks).

Results

Compared with standard care, women in the MCoC model were more likely to give birth spontaneously (RR 1.06 95% CI 1.02–1.10) and less likely to have an elective cesarean on maternal request (RR 0.24 95% CI 0.11–0.51). The risk of preterm birth was also reduced in the MCoC group (RR 0.51 95% CI 0.32–0.82).

Conclusion

The MCoC model was associated with fewer medical interventions and improved pregnancy outcomes.

目的：比较瑞典助产士持续护理（MCoC）模式与标准助产士护理的妊娠结局：比较瑞典助产士持续护理（MCoC）模式与标准助产护理的妊娠结局：设计：匹配队列研究：研究地点：瑞典斯德哥尔摩妊娠和分娩期间的公共医疗保健：人群：2019 年 1 月 1 日至 2021 年 8 月 31 日期间在斯德哥尔摩卡罗林斯卡大学医院 Huddinge 院区分娩的妇女：方法：从瑞典全国妊娠登记册中检索这一时期内包括 MCoC 和标准护理在内的所有分娩数据。采用倾向得分匹配法为 MCoC 模型中的每位妇女从标准护理组中获得匹配组。根据匹配队列，我们估算了二元结果的风险比（RR）及 95% 的置信区间（CI）：主要结果测量指标：产程干预、分娩方式和早产（结果：与标准护理相比，MCoC 模型中的产妇分娩方式更安全、更有效率：与标准护理相比，MCoC 模型中的产妇更有可能自然分娩（RR 1.06 95% CI 1.02-1.10），更不可能应产妇要求进行选择性剖宫产（RR 0.24 95% CI 0.11-0.51）。MCoC 组的早产风险也有所降低（RR 0.51 95% CI 0.32-0.82）：MCoC模式减少了医疗干预，改善了妊娠结局。

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引用次数: 0

Status of Horizontal Violence, Level of Psychological Empowerment, and Their Correlation Among Obstetric Nurses: A Cross-Sectional Survey 产科护士的横向暴力状况、心理授权水平及其相关性：一项横断面调查。

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-10-27 DOI: 10.1111/birt.12879

Shan Huang, Ganxia Kong, Qiumei Li, Hamza Saidi Lilenga, Jinguo Zhai

Background

China's maternity policy has led to an increase in work pressure, which has prompted horizontal violence among obstetric nurses. To understand this phenomenon better, we attempted to identify the factors that influence horizontal violence as well as the level of psychological empowerment among obstetric nurses.

Methods

This cross-sectional survey was conducted among 522 obstetric nurses from December 2022 to February 2023.

Results

The findings revealed that 40.42% (211) of the obstetric nurses had experienced horizontal violence in the past 3 months. The overall level of psychological empowerment of obstetric nurses was relatively low. Regression analysis indicated that being a formal worker, being from the area where one serves, the meaning attributed to work, and perceptions of autonomy, self-efficacy, and work impact acted as protective factors against the risk of horizontal violence among obstetric nurses. When compared with the 20–29-year-old age group, those in the 30–39-year-old age group showed a lower risk of experiencing horizontal violence (odds ratio [OR] = 0.369, p < 0.01). Compared with nurses who had worked in obstetrics for < 3 years, those who had worked for 3–5, 6–10, 11–20, and > 20 years showed lower risks of experiencing horizontal violence than the reference level (OR = 0.234, p < 0.05; OR = 0.182, p < 0.05; OR = 0.105, p < 0.05; and OR = 0.056, p < 0.05, respectively).

Discussion

The incidence of horizontal violence among obstetric nurses is high, and the overall level of psychological empowerment is low. Nursing managers can alleviate the occurrence of horizontal violence by augmenting the psychological empowerment level of obstetric nurses.

背景：中国的生育政策导致了工作压力的增加，从而引发了产科护士中的横向暴力。为了更好地了解这一现象，我们试图找出影响横向暴力的因素以及产科护士的心理赋权水平：方法：我们于 2022 年 12 月至 2023 年 2 月对 522 名产科护士进行了横断面调查：调查结果显示，40.42%（211人）的产科护士在过去3个月中经历过横向暴力。产科护士的整体心理赋权水平相对较低。回归分析表明，正规工作者、来自服务地区、工作的意义以及对自主性、自我效能感和工作影响的看法是产科护士遭遇横向暴力风险的保护因素。与 20-29 岁年龄组相比，30-39 岁年龄组发生横向暴力的风险较低（比值比 [OR] = 0.369，p 20 岁年龄组发生横向暴力的风险低于参考水平（比值比 = 0.234，p 讨论）：产科护士的横向暴力发生率较高，总体心理授权水平较低。护理管理者可以通过提高产科护士的心理授权水平来减少横向暴力的发生。

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引用次数: 0

Wait, What? What's Going On?— Pregnancy Experiences of Deaf and Hard of Hearing Mothers Who Do Not Sign 等等，什么？不会手语的聋人和重听母亲的怀孕经历。

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care

Pub Date : 2024-10-27 DOI: 10.1111/birt.12881

Sanjana Ratakonda, Tiffany L. Panko, Sasha Albert, Lauren D. Smith, Margarita M. Cooley, Monika Mitra, Michael McKee

Objective

Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care.

Design

Qualitative study using thematic analysis.

Setting

Semi-structured, individual remote, or in-person interviews in the United States.

Sample

Twenty-two DHH English speakers (non-signers) who gave birth in the United States within the past 5 years.

Methods

Semi-structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted.

Main Outcome Measures

The barriers and facilitators related to a positive perinatal care experience among DHH women.

Results

Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self-advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences.

Conclusions

Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.

目的：与听力正常的妇女相比，聋人和听力障碍（DHH）妇女在生殖保健方面遇到的障碍和不良生育结果的发生率更高。本研究探讨了不会手语的聋哑妇女的怀孕经历，以更好地了解她们获得最佳围产期保健的障碍和促进因素：设计：采用主题分析法进行定性研究：在美国进行的半结构化远程个人访谈或面对面访谈：22 名在过去 5 年中在美国分娩的讲英语的 DHH（非签署者）：半结构式访谈探讨了 DHH 妇女如何经历怀孕和分娩，包括获得围产期信息和资源、与医疗保健提供者的关系、沟通途径以及她们在整个怀孕期间与医疗保健系统的关系。我们进行了专题分析：主要结果测量：与 DHH 女性积极的围产期护理体验相关的障碍和促进因素：结果：出现了五个关键主题。在障碍方面，医疗保健沟通障碍和患者自主权的丧失突出了 DHH 女性在围产期医疗保健方面的挣扎。与此相反，DHH 参与者强调了无障碍医疗沟通实践和便利措施、使用患者权益或自我倡导以及辅助技术对 DHH 父母获得更积极的围产期保健体验的重要性：结论：围产期医疗服务提供者和工作人员应定期询问如何确保为 DHH 患者提供包容性和无障碍的医疗保健体验，并提供沟通便利，以获得最佳护理。此外，医疗服务提供者应更多地了解 DHH 患者独特的育儿需求和资源。

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引用次数: 0