1
|
Carvajal B, Hancock A, Lewney K, Hagan K, Jamieson S, Cooke A. A global overview of midwives' working conditions: A rapid review of literature on positive practice environment. Women Birth 2024; 37:15-50. [PMID: 37648619 DOI: 10.1016/j.wombi.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND In the United Kingdom (UK), a critical shortage of midwives puts pressure on the already overworked midwives working in maternity services. Considering the challenges that midwives in the UK face, this rapid review was conducted to inform a larger-scale initiative to improve the working conditions of midwives in an acute NHS Trust in the Midlands area of the UK. OBJECTIVE To describe midwives' perceptions and experiences of positive practice environments. METHODS A search strategy to identify literature about midwives' perceptions and experiences of positive practice environments was conducted in Medline, CINAHL Plus and Embase databases. Literature screening was conducted independently in two steps using an eligibility tool. The articles' quality assessment was conducted using the Mixed Method Appraisal Tool. Data were extracted using the Job Quality framework and managed using NVivo12. RESULTS Seventy articles were included in this review. Midwives' working conditions can be improved in all seven areas of the Job Quality framework. Most articles in the review reported the negative aspects of midwives' working environments, making it challenging for the team to define a positive practice environment for midwives. Despite this, authors discuss that a positive practice environment is at least sustained by ensuring midwives' ability to provide care; providing good employment conditions; developing respectful organisations; and increasing team resources, such as those that improve team resilience. CONCLUSIONS Midwives' working conditions are universally challenging. Failure to address the situation will compromise recruitment and retention, increasing the shortage of midwives. Provision of safe and respectful care appears to be directly linked to midwives' safe and respectful working conditions.
Collapse
Affiliation(s)
- Bielka Carvajal
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; Departamento de Promocion de la Salud de la Mujer y el Recien Nacido, Universidad de Chile, Chile.
| | - Angela Hancock
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; School of Nursing and Midwifery, Keele University, UK
| | - Katharine Lewney
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
| | - Karen Hagan
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
| | - Sarah Jamieson
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
| | - Alison Cooke
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; School of Nursing and Midwifery, Keele University, UK
| |
Collapse
|
2
|
Asaye MM, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Experience and perceptions of healthcare providers on clinical management and care of near-miss infants: a qualitative content analysis. BMC Health Serv Res 2023; 23:1403. [PMID: 38093259 PMCID: PMC10720054 DOI: 10.1186/s12913-023-10097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/30/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Neonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale. However, understanding the experiences and perceptions of healthcare providers in the clinical management and care of NNM infants remains unexplored. The aim was to investigate the determinants contributing to the survival of neonatal near-miss babies and to identify any barriers encountered, as reported by the experiences of healthcare providers in public hospitals of Amhara Regional State, northwest Ethiopia. METHODS Semi structured interviews were used to collect data from 25 midwives, nurses, and pediatricians with at least six months of prior experience in one of the labor wards or neonatal intensive care units at one of the four public health hospitals in the Amhara Regional state of northwest Ethiopia included in a large intervention study assessing a NNM scale. Purposeful sampling was used, selecting participants based on their experiences related to the aim of this study. The participants had a varying level of education and years of experience to care for NNM infants. The average age of the healthcare providers was 31 years, with 7 years of work experience. The transcripts of the interviews with the healthcare providers were analyzed using qualitative content analysis. RESULTS The experience and perceptions of healthcare providers was described in the main category "A sense of hopelessness when caring for the baby" capturing a broader emotional and professional aspect, while the subcategories "Unclear responsibilities discharging one's mission", "Provision of kangaroo mother care" and "Quick action required at birth" are more specific and practical. Healthcare providers perceived a sense of hopelessness when caring for the NNM infant, particularly providing Kangaroo Mother Care (KMC) and quick actions when required at birth to save the life of the infant. CONCLUSION Unclear responsibilities and a sense of hopelessness could have acted as barriers, hindering the ability of healthcare providers to fulfill their mission of taking swift actions and providing KMC to NNM infants, thus impacting their ability to save the lives of these infants. Healthcare providers' and parents' attitudes must be changed towards hope rather than hopelessness when caring for NNM infants.
Collapse
Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
- Sofiahemmet University, Stockholm, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Solna, Sweden.
- School of Health and Welfare, Karolinska Institute, Dalarna University, Falun, Sweden.
| |
Collapse
|
3
|
Kc A, Ramaswamy R, Ehret D, Worku B, Kamath-Rayne BD. Recent Progress in Neonatal Global Health Quality Improvement. Clin Perinatol 2023; 50:507-529. [PMID: 37201994 DOI: 10.1016/j.clp.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Quality improvement methodologies, coupled with basic neonatal resuscitation and essential newborn care training, have been shown to be critical ingredients in improving neonatal mortality. Innovative methodologies, such as virtual training and telementoring, can enable the mentorship and supportive supervision that are essential to the continued work of improvement and health systems strengthening that must be done after a single training event. Empowering local champions, building effective data collection systems, and developing frameworks for audits and debriefs are among the strategies that will create effective and high-quality health care systems.
Collapse
Affiliation(s)
- Ashish Kc
- Global Health, Institute of Medicine, Sahlgrenska Academy, School of Public Health and Community Medicine, Gothenburg University, Gothenburg, Sweden; Department of Women's and Children Health, Uppsala University, Dag Hammarskjölds Väg 14B, Uppsala 751 85, Sweden
| | - Rohit Ramaswamy
- Cincinnati Children's Medical Center Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Danielle Ehret
- Global Health, University of Vermont Larner College of Medicine, 111 Colchester Avenue, Burlington, VT 05401, USA; Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Bogale Worku
- Addis Ababa University, Addis Ababa, Ethiopia; Ethiopian Pediatric Society, Addis Ababa Chapter Office, Family Building 5th Floor, Room 501, Addis Ababa, Ethiopia
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, 345 Park Boulevard, Itasca, IL 60143, USA.
| |
Collapse
|
4
|
KC A, Kong SYJ, Basnet O, Haaland SH, Bhattarai P, Gomo Ø, Gurung R, Ahlsson F, Meinich-Bache Ø, Axelin A, Malla H, Basula YN, Pathak OK, Pokharel SM, Subedi H, Myklebust H. Usability, acceptability and feasibility of a novel technology with visual guidance with video and audio recording during newborn resuscitation: a pilot study. BMJ Health Care Inform 2022; 29:bmjhci-2022-100667. [PMID: 36455992 PMCID: PMC9717377 DOI: 10.1136/bmjhci-2022-100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/21/2022] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Inadequate adherence to resuscitation for non-crying infants will have poor outcome and thus rationalise a need for real-time guidance and quality improvement technology. This study assessed the usability, feasibility and acceptability of a novel technology of real-time visual guidance, with sound and video recording during resuscitation. SETTING A public hospital in Nepal. DESIGN A cross-sectional design. INTERVENTION The technology has an infant warmer with light, equipped with a tablet monitor, NeoBeat and upright bag and mask. The tablet records resuscitation activities, ventilation sound, heart rate and display time since birth. Healthcare providers (HCPs) were trained on the technology before piloting. DATA COLLECTION AND ANALYSIS HCPs who had at least 8 weeks of experience using the technology completed a questionnaire on usability, feasibility and acceptability (ranged 1-5 scale). Overall usability score was calculated (ranged 1-100 scale). RESULTS Among the 30 HCPs, 25 consented to the study. The usability score was good with the mean score (SD) of 68.4% (10.4). In terms of feasibility, the participants perceived that they did not receive adequate support from the hospital administration for use of the technology, mean score (SD) of 2.44 (1.56). In terms of acceptability, the information provided in the monitor, that is, time elapsed from birth was easy to understand with mean score (SD) of 4.60 (0.76). CONCLUSION The study demonstrates reasonable usability, feasibility and acceptability of a technological solution that records audio visual events during resuscitation and provides visual guidance to improve care.
Collapse
Affiliation(s)
- Ashish KC
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - So Yeon Joyce Kong
- Department of Women’s and Children’s Health, Laerdal Medical AS, Stavanger, Norway
| | | | | | | | | | - Rejina Gurung
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Golden Community, Lalitpur, Nepal
| | - Fredrik Ahlsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Ljungblad LW, Skovdahl K, McCormack B, Dahl B. "Keep It Simple"-Co-Creation of a Tailored Newborn Resuscitation Course for Midwifery Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:81-93. [PMID: 35082549 PMCID: PMC8785135 DOI: 10.2147/amep.s346991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To develop a tailored newborn resuscitation course for midwifery students. PATIENTS AND METHODS A qualitative study using an explorative, abductive approach was applied. Co-creation through workshops was facilitated to develop a tailored newborn resuscitation course for midwifery students. Four workshops with midwifery students and midwives were conducted from May to October 2020. Twenty participants attended one workshop of their choice. Five out of Norway's six midwifery education programmes participated, and included midwives from across Norway. All workshops were held digitally via the Zoom platform. A seven-step framework analysis method was applied to analyse the workshop data. RESULTS We identified four themes: 1) practice guidance, 2) technical skills 3) non-technical skills 4) innovative methods. CONCLUSION Findings emphasize the importance of practice guidance, technical skills, non-technical skills and innovative methods to facilitate the learning process. However, these skills cannot be acquired without the context to facilitate them, and thus a supportive culture is essential to sustain newborn resuscitation expertise as a midwife/midwifery student. We found that midwives expressed the same need to learn, train and prepare themselves for newborn resuscitation as midwifery students. The importance of facilitating the learning of newborn resuscitation with low-dose, high-frequency training in a supportive culture thus matters to both midwifery students and expert midwives.
Collapse
Affiliation(s)
- Linda Wike Ljungblad
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Kirsti Skovdahl
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Brendan McCormack
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
- Centre for Person-Centred Practice Research, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| |
Collapse
|
6
|
Brogaard L, Hvidman L, Esberg G, Finer N, Hjorth-Hansen KR, Manser T, Kierkegaard O, Uldbjerg N, Henriksen TB. Teamwork and Adherence to Guideline on Newborn Resuscitation-Video Review of Neonatal Interdisciplinary Teams. Front Pediatr 2022; 10:828297. [PMID: 35265565 PMCID: PMC8900704 DOI: 10.3389/fped.2022.828297] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Little is known about the importance of non-technical skills for the adherence to guidelines, when teams of midwives, obstetricians, anesthesiologists, and pediatricians resuscitate and support the transition of newborns. Non-technical skills are competences underpinning successful teamwork in healthcare. These are usually referred to as leadership, situational awareness, communication, teamwork, decision making, and coping with stress and fatigue. OBJECTIVE By review of videos of teams managing newborns with difficult transition, we aimed to investigate whether the level of the teams' non-technical skills was associated with the degree of adherence to guidelines for newborn resuscitation and transitional support at birth. METHODS Four expert raters independently assessed 43 real-life videos of teams managing newborns with transitional difficulties, two assessed the non-technical score and two assessed the clinical performance. Exposure was the non-technical score, obtained by the Global Assessment Of Team Performance checklist (GAOTP). GAOTP was rated on a Likert Scale 1-5 (1 = poor, 3 = average and 5 = excellent). The outcome was the clinical performance score of the team assessed according to adherence of the European Resuscitation Counsel (ERC) guideline for neonatal resuscitation and transitional support. The ERC guideline was adapted into the checklist TeamOBS-Newborn to facilitate a structured and simple performance assessment (low score 0-60, average 60-84, high 85-100). Interrater agreement was analyzed by intraclass correlation (ICC), Bland-Altman analysis, and Cohen's kappa weighted. The risk of high and low clinical performance was analyzed on the logit scale to meet the assumptions of normality and constant standard deviation. RESULTS Teams with an excellent non-technical score had a relative risk 5.5 [95% confidence interval (CI) 2.4-22.5] of high clinical performance score compared to teams with average non-technical score. In addition, we found a dose response like association. The specific non-technical skills associated with the highest degree of adherence to guidelines were leadership and teamwork, coping with stress and fatigue, and communication with parents. Inter-rater agreement was high; raters assessing non-technical skills had an interclass coefficient (ICC) 0.88 (95% CI 0.79-0.94); the neonatologists assessing clinical performance had an ICC of 0.81 (95% CI 0.66-0.89). CONCLUSION Teams with an excellent non-technical score had five times the chance of high clinical performance compared to teams with average non-technical skills. High performance teams were characterized by good leadership and teamwork, coping with stress, and fatigue and communication with parents.
Collapse
Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte Esberg
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Neil Finer
- Department of Neonatology, University of California, San Diego, San Diego, CA, United States
| | | | - Tanja Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Ole Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
7
|
Ediger K, Rashid M, Law BHY. What Is Teamwork? A Mixed Methods Study on the Perception of Teamwork in a Specialized Neonatal Resuscitation Team. Front Pediatr 2022; 10:845671. [PMID: 35498772 PMCID: PMC9046838 DOI: 10.3389/fped.2022.845671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/11/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Neonatal resuscitation is a team-based activity involving many decisions and tasks. Non-technical factors, such as teamwork, are increasingly recognized as impacting how well-neonatal resuscitation is performed, and therefore influencing infant outcomes. Prior studies on teamwork in neonatal resuscitation have focused on quantification of teamwork behaviors, or the effects of team training. This study aimed to explore healthcare providers' own perception of teamwork in this specialized environment to identify perceived barriers and facilitators to effective team functioning. METHODS This single-center exploratory sequential mixed methods study used two phases. First, semi-structured interviews were conducted, and thematic analysis used to identify themes. Subsequently, interview data informed the development of quantitative surveys to explore selected themes in the wider team. RESULTS From ten semi-structured interviews, seven themes were identified including: (1) Team Composition, (2) Effective Communication, (3) Team leadership, (4) Hierarchy, (5) Team Training, (6) Debriefing, and (7) Physical Environment. Perceived teamwork facilitators include role assignment, familiarity, team composition, talking out loud to maintain shared mental models, leadership, and team training. Perceived barriers included time pressures, ad hoc team, ineffective leadership, and space limitations. Selected themes (Communication, Speaking up, Hierarchy, and Leadership) were further explored via electronic surveys distributed via email to all members of the resuscitation team. There were 105 responses; a response rate of ~53%. All respondents agreed or strongly agreed that speaking up is important; however, not all felt comfortable doing so. Neonatal fellows (14%) and nurses (12%) were most likely to report not feeling comfortable speaking up. All respondents agreed that team communication is important to an effective resuscitation. Most respondents (91.5%) agreed that a hierarchy exists within the team; 54.3% believed that hierarchy positively contributes to effective resuscitation. All respondents agreed or strongly agreed that having a clearly defined leader is important in delivery room resuscitations. Ineffective leadership was the most cited reason for poor team communication. CONCLUSIONS In this mixed methods study of perceptions of teamwork within a specialized, multi-disciplinary neonatal resuscitation team, communication, hierarchy, and leadership were positively perceived and facilitates teamwork. However, even in this environment, some nurses and trainees expressed discomfort with speaking up.
Collapse
Affiliation(s)
- Krystyna Ediger
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Marghalara Rashid
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | |
Collapse
|
8
|
Bettinger K, Mafuta E, Mackay A, Bose C, Myklebust H, Haug I, Ishoso D, Patterson J. Improving Newborn Resuscitation by Making Every Birth a Learning Event. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121194. [PMID: 34943390 PMCID: PMC8700033 DOI: 10.3390/children8121194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
One third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression (i.e., failure to breathe at birth). Evidence-based resuscitation with stimulation, airway clearance, and positive pressure ventilation reduces mortality from respiratory depression. Improving adherence to evidence-based resuscitation is vital to preventing neonatal deaths caused by respiratory depression. Standard resuscitation training programs, combined with frequent simulation practice, have not reached their life-saving potential due to ongoing gaps in bedside performance. Complex neonatal resuscitations, such as those involving positive pressure ventilation, are relatively uncommon for any given resuscitation provider, making consistent clinical practice an unrealistic solution for improving performance. This review discusses strategies to allow every birth to act as a learning event within the context of both high- and low-resource settings. We review strategies that involve clinical-decision support during newborn resuscitation, including the visual display of a resuscitation algorithm, peer-to-peer support, expert coaching, and automated guidance. We also review strategies that involve post-event reflection after newborn resuscitation, including delivery room checklists, audits, and debriefing. Strategies that make every birth a learning event have the potential to close performance gaps in newborn resuscitation that remain after training and frequent simulation practice, and they should be prioritized for further development and evaluation.
Collapse
Affiliation(s)
- Kourtney Bettinger
- Department of Pediatrics, University of Kansas School of Medicine, 3901 Rainbow Blvd, MS 4004, Kansas City, KS 66103, USA
| | - Eric Mafuta
- School of Public Health, University of Kinshasa, Kinshasa 11850, Democratic Republic of the Congo; (E.M.); (D.I.)
| | - Amy Mackay
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
| | - Carl Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
| | - Helge Myklebust
- Laerdal Medical Strategic Research Department, Tanke Svilandsgate 30, N-4002 Stavanger, Norway; (H.M.); (I.H.)
| | - Ingunn Haug
- Laerdal Medical Strategic Research Department, Tanke Svilandsgate 30, N-4002 Stavanger, Norway; (H.M.); (I.H.)
| | - Daniel Ishoso
- School of Public Health, University of Kinshasa, Kinshasa 11850, Democratic Republic of the Congo; (E.M.); (D.I.)
| | - Jackie Patterson
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
| |
Collapse
|
9
|
Ljungblad LW, Skovdahl K, McCormack B, Dahl B. Balancing Life and Death During the Golden Minute - Midwives' Experiences of Performing Newborn Resuscitation. J Multidiscip Healthc 2020; 13:943-952. [PMID: 32982271 PMCID: PMC7505716 DOI: 10.2147/jmdh.s268959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/13/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To explore midwives' experiences in performing newborn resuscitation on maternity wards. PATIENTS AND METHODS It was a qualitative study, using a phenomenological hermeneutic approach. Individual interviews with 16 clinical midwives working in Norwegian maternity wards were conducted from August 2018 to January 2019. RESULTS The complexity underlying how midwives balance responsibility and vulnerability when performing newborn resuscitation during the Golden Minute was revealed. Midwives described the stress they experienced during resuscitation events and their need for support and confirmation after performing newborn resuscitation. CONCLUSION The vulnerability and responsibility that midwives bear for mothers and newborns simultaneously affected midwives in several ways. We saw that midwives need support and confirmation to be prepared for newborn resuscitation. We also found that a lack of knowledge, skills and experience were barriers to midwives feeling prepared. Simulation training, including tailored programs, are suggested to improve midwives' skills and help them feel prepared for real-life resuscitations. The importance of midwives' assessment during the Golden Minute and further investigation from other perspectives are needed to understand fully this clinical complexity.
Collapse
Affiliation(s)
- Linda Wike Ljungblad
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, KongsbergN-3603, Norway
| | - Kirsti Skovdahl
- Faculty of Health and Social Sciences, University of South-Eastern Norway, KongsbergN-3603, Norway
| | - Brendan McCormack
- Faculty of Health and Social Sciences, University of South-Eastern Norway, KongsbergN-3603, Norway
- Divisions of Nursing, Occupational Therapy & Arts Therapies, Centre for Person-Centred Practice Research, School of Health Sciences, Queen Margaret University, Musselburgh, East LothianEH21 6UU, UK
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, KongsbergN-3603, Norway
| |
Collapse
|
10
|
Michel-Schuldt M, McFadden A, Renfrew M, Homer C. The provision of midwife-led care in low-and middle-income countries: An integrative review. Midwifery 2020; 84:102659. [DOI: 10.1016/j.midw.2020.102659] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 01/03/2020] [Accepted: 02/01/2020] [Indexed: 11/25/2022]
|
11
|
Beyond basic resuscitation: What are the next steps to improve the outcomes of resuscitation at birth when resources are limited? Semin Fetal Neonatal Med 2018; 23:361-368. [PMID: 30001818 DOI: 10.1016/j.siny.2018.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Implementation of basic neonatal resuscitation in low- and middle-income settings consistently saves lives on the day of birth. What can be done to extend these gains and further improve the outcomes of infants who require resuscitation at birth when resources are limited? This review considers how resuscitation and post-resuscitation care can advance to help meet the survival goals of the Every Newborn Action Plan for 2030. A brief summary of the evidence for benefit from basic neonatal resuscitation training in low- and middle-income countries highlights key aspects of training, low-dose high-frequency practice, and implementation with single providers or teams. Reorganization of processes of care, as well as new equipment for training and selected clinical interventions can support further quality improvement in resuscitation. Consideration of the resuscitation algorithm itself focuses on important actions for all babies and special considerations for small babies and those not crying after thorough drying. Finally, an examination of the vital elements of assessment and continued stabilization/care in the health facility draws attention to the opportunities for prevention of intrapartum-related events and the gaps that still exist in postnatal care. Extending and improving implementation of basic resuscitation to make it available to all newborns will assure continued benefit to the largest numbers; once high coverage and quality of basic resuscitation are achieved, health systems with maturing capacity can extend survival gains with improved prevention, more advanced resuscitative interventions, and strengthened postnatal care.
Collapse
|
12
|
Kc A, Bergström A, Chaulagain D, Brunell O, Ewald U, Gurung A, Eriksson L, Litorp H, Wrammert J, Grönqvist E, Edin PA, Le Grange C, Lamichhane B, Shrestha P, Pokharel A, Pun A, Singh C, Målqvist M. Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial. BMJ Glob Health 2017; 2:e000497. [PMID: 29071130 PMCID: PMC5640082 DOI: 10.1136/bmjgh-2017-000497] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Nepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes. Methods/design Cluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker’s performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed. Discussion In contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality. Trial registration number ISRCTN30829654.
Collapse
Affiliation(s)
- Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Health Section, UNICEF, UN House, Lalitpur, Nepal
| | - Anna Bergström
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Institute for Global Health, University College London, London, UK
| | - Dipak Chaulagain
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Lifeline Nepal, Kathmandu, Nepal
| | - Olivia Brunell
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Uwe Ewald
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Leif Eriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Litorp
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johan Wrammert
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Erik Grönqvist
- Health Economic Forum, Uppsala University, Uppsala, Sweden
| | - Per-Anders Edin
- Department of Economics, Uppsala University, Uppsala, Sweden
| | - Claire Le Grange
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Amrit Pokharel
- Department of Health Services, Ministry of Health, Nepal
| | - Asha Pun
- Health Section, UNICEF, UN House, Lalitpur, Nepal
| | | | - Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|