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Kabir MR, Chan K. “Do we even have a voice?” Health providers’ perspective on the patient accommodation strategies in Bangladesh. PLoS One 2022; 17:e0271827. [PMID: 35913915 PMCID: PMC9342766 DOI: 10.1371/journal.pone.0271827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/08/2022] [Indexed: 11/21/2022] Open
Abstract
Objective In a resource-constrained setting like Bangladesh, effective patient-provider communication is critical to the delivery of maternal healthcare services. Using communication accommodation theory, this study tried to understand how providers perceive, engage, and accommodate patients’ needs in maternity wards. Methods This qualitative exploratory study used a semi-structured interview guide to conduct in-depth face-to-face interviews of ten healthcare providers in two government-funded public health facilities in Bangladesh. The interview data were analyzed using MAXQDA 2020 software. Results The thematic analyses revealed that nurses and midwives faced conceivable neglect from patients and their attendees due to possible service and facility constraints, indicating their low status and control within the service operation. Despite efforts to address patients’ emotional and psychological concerns, providers appear to avoid (divergence strategy) confronting patients and their irate visitors. Unimodal convergence emerged when providers accepted patients’ arguments about the systematic inadequacy of service facilities. Providers have employed interpretability tactics to communicate medical opinions and applied nonverbal cues where necessary. Conclusion A lack of open communication between healthcare providers and patients necessitated various forms of accommodation. Integrated strategies addressing service restrictions and initiatives fostering patient understanding and cooperation may improve patient-provider communication.
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Affiliation(s)
- Md. Ruhul Kabir
- School of Communication and Film, Hong Kong Baptist University, Kowloon Tong, Hong Kong
- Department of Food Technology & Nutrition Science, Noakhali Science & Technology University, Noakhali, Bangladesh
- * E-mail: ,
| | - Kara Chan
- School of Communication and Film, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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Abstract
BACKGROUND AND OBJECTIVES Defining quality in the health care context has proven difficult, with many organizations not able to clearly articulate their use of this term in a manner that is easily understood by their clinical staff. This review seeks to investigate the literature to explore clinician engagement in quality including where engagement has been problematic, and if the reasons for this have been identified. METHODS An integrative review of the literature was undertaken to determine whether evidence within the literature supports a hypothesis that there is a lack of understanding of and engagement in quality at an organizational level by health professionals. A search of the literature was conducted using EBSCO Academic Complete, CINAHL, and MEDLINE databases. RESULTS This article identified 18 studies where the understanding of quality by clinicians and their level of engagement with the process are investigated. We found that there has been no comprehensive study that explores the development of an agreed-upon definition and measurement of quality or clinician understanding and engagement in quality. The studies conducted have been small and discipline-specific. CONCLUSION There is a growing body of evidence indicating that clinical and nonclinical staff interpret the meaning of quality and quality improvement differently. Quality and quality improvement are interpreted in relation to the clinician's individual work, professional, and learning and development experience. The literature suggests that clinician interpretation is influenced in part by their own personal beliefs and values, in addition to their interpretation of their individual work/professional responsibilities.
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Brown KL, Pagel C, Ridout D, Wray J, Tsang VT, Anderson D, Banks V, Barron DJ, Cassidy J, Chigaru L, Davis P, Franklin R, Grieco L, Hoskote A, Hudson E, Jones A, Kakat S, Lakhani R, Lakhanpaul M, McLean A, Morris S, Rajagopal V, Rodrigues W, Sheehan K, Stoica S, Tibby S, Utley M, Witter T. Early morbidities following paediatric cardiac surgery: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background
Over 5000 paediatric cardiac surgeries are performed in the UK each year and early survival has improved to > 98%.
Objectives
We aimed to identify the surgical morbidities that present the greatest burden for patients and health services and to develop and pilot routine monitoring and feedback.
Design and setting
Our multidisciplinary mixed-methods study took place over 52 months across five UK paediatric cardiac surgery centres.
Participants
The participants were children aged < 17 years.
Methods
We reviewed existing literature, ran three focus groups and undertook a family online discussion forum moderated by the Children’s Heart Federation. A multidisciplinary group, with patient and carer involvement, then ranked and selected nine key morbidities informed by clinical views on definitions and feasibility of routine monitoring. We validated a new, nurse-administered early warning tool for assessing preoperative and postoperative child development, called the brief developmental assessment, by testing this among 1200 children. We measured morbidity incidence in 3090 consecutive surgical admissions over 21 months and explored risk factors for morbidity. We measured the impact of morbidities on quality of life, clinical burden and costs to the NHS and families over 6 months in 666 children, 340 (51%) of whom had at least one morbidity. We developed and piloted methods suitable for routine monitoring of morbidity by centres and co-developed new patient information about morbidities with parents and user groups.
Results
Families and clinicians prioritised overlapping but also different morbidities, leading to a final list of acute neurological event, unplanned reoperation, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, surgical infection and prolonged pleural effusion. The brief developmental assessment was valid in children aged between 4 months and 5 years, but not in the youngest babies or 5- to 17-year-olds. A total of 2415 (78.2%) procedures had no measured morbidity. There was a higher risk of morbidity in neonates, complex congenital heart disease, increased preoperative severity of illness and with prolonged bypass. Patients with any morbidity had a 6-month survival of 81.5% compared with 99.1% with no morbidity. Patients with any morbidity scored 5.2 points lower on their total quality of life score at 6 weeks, but this difference had narrowed by 6 months. Morbidity led to fewer days at home by 6 months and higher costs. Extracorporeal life support patients had the lowest days at home (median: 43 days out of 183 days) and highest costs (£71,051 higher than no morbidity).
Limitations
Monitoring of morbidity is more complex than mortality, and hence this requires resources and clinician buy-in.
Conclusions
Evaluation of postoperative morbidity provides important information over and above 30-day survival and should become the focus of audit and quality improvement.
Future work
National audit of morbidities has been initiated. Further research is needed to understand the implications of feeding problems and renal failure and to evaluate the brief developmental assessment.
Funding
This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katherine L Brown
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Deborah Ridout
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jo Wray
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Victor T Tsang
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David Anderson
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
| | - Victoria Banks
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David J Barron
- Departments of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
| | - Jane Cassidy
- Departments of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
| | - Linda Chigaru
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Peter Davis
- Departments of Intensive Care and Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Rodney Franklin
- Paediatric Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Luca Grieco
- Clinical Operational Research Unit, University College London, London, UK
| | - Aparna Hoskote
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Emma Hudson
- Department of Applied Health Research, University College London, London, UK
| | - Alison Jones
- Departments of Intensive Care and Paediatric Cardiac Surgery, Birmingham Children’s Hospital, Birmingham, UK
| | - Suzan Kakat
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Rhian Lakhani
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Community Child Health, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Andrew McLean
- Department of Intensive care, Royal Hospital for Children, Glasgow, UK
| | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
| | - Veena Rajagopal
- Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Warren Rodrigues
- Department of Intensive care, Royal Hospital for Children, Glasgow, UK
| | - Karen Sheehan
- Departments of Intensive Care and Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Serban Stoica
- Departments of Intensive Care and Paediatric Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Shane Tibby
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
| | - Martin Utley
- Clinical Operational Research Unit, University College London, London, UK
| | - Thomas Witter
- Departments of Paediatric Intensive Care, Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, UK
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Abstract
BACKGROUND Pressure ulcers are treated by reducing pressure on the areas of damaged skin. Special support surfaces (including beds, mattresses and cushions) designed to redistribute pressure, are widely used as treatments. The relative effects of different support surfaces are unclear. This is an update of an existing review. OBJECTIVES To assess the effects of pressure-relieving support surfaces in the treatment of pressure ulcers. SEARCH METHODS In September 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included published or unpublished randomised controlled trials (RCTs), that assessed the effects of support surfaces for treating pressure ulcers, in any participant group or setting. DATA COLLECTION AND ANALYSIS Data extraction, assessment of 'Risk of bias' and GRADE assessments were performed independently by two review authors. Trials with similar participants, comparisons and outcomes were considered for meta-analysis. Where meta-analysis was inappropriate, we reported the results of the trials narratively. Where possible, we planned to report data as either risk ratio or mean difference as appropriate. MAIN RESULTS For this update we identified one new trial of support surfaces for pressure ulcer treatment, bringing the total to 19 trials involving 3241 participants. Most trials were small, with sample sizes ranging from 20 to 1971, and were generally at high or unclear risk of bias. PRIMARY OUTCOME healing of existing pressure ulcersLow-tech constant pressure support surfacesIt is uncertain whether profiling beds increase the proportion of pressure ulcer which heal compared with standard hospital beds as the evidence is of very low certainty: (RR 3.96, 95% CI 1.28 to 12.24), downgraded for serious risk of bias, serious imprecision and indirectness (1 study; 70 participants).There is currently no clear difference in ulcer healing between water-filled support surfaces and foam replacement mattresses: (RR 0.93, 95% CI 0.63 to 1.37); low-certainty evidence downgraded for serious risk of bias and serious imprecision (1 study; 120 participants).Further analysis could not be performed for polyester overlays versus gel overlays (1 study; 72 participants), non-powered mattresses versus low-air-loss mattresses (1 study; 20 participants) or standard hospital mattresses with sheepskin overlays versus standard hospital mattresses (1 study; 36 participants).High-tech pressure support surfacesIt is currently unclear whether high-tech pressure support surfaces (such as low-air-loss beds, air suspension beds, and alternating pressure surfaces) improve the healing of pressure ulcers (14 studies; 2923 participants) or which intervention may be more effective. The certainty of the evidence is generally low, downgraded mostly for risk of bias, indirectness and imprecision.Secondary outcomesNo analyses were undertaken with respect to secondary outcomes including participant comfort and surface reliability and acceptability as reporting of these within the included trials was very limited.Overall, the evidence is of low to very low certainty and was primarily downgraded due to risk of bias and imprecision with some indirectness. AUTHORS' CONCLUSIONS Based on the current evidence, it is unclear whether any particular type of low- or high-tech support surface is more effective at healing pressure ulcers than standard support surfaces.
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Affiliation(s)
- Elizabeth McInnes
- School of Nursing, Midwifery and Paramedicine, Australian Catholic UniversityNursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (ACU)Executive Suite, Level 5 DeLacy BuildingSt Vincent's Hospital, 390 Victoria RoadDarlinghurstNew South WalesAustralia2010
| | - Asmara Jammali‐Blasi
- School of Nursing, Midwifery and Paramedicine, Australian Catholic UniversityNursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (ACU)Executive Suite, Level 5 DeLacy BuildingSt Vincent's Hospital, 390 Victoria RoadDarlinghurstNew South WalesAustralia2010
| | - Sally EM Bell‐Syer
- CochraneCochrane Editorial UnitSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Vannessa Leung
- Sydney Eye HospitalKensingtonSydneyNSWAustralia2052
- The University of SydneyReserve RoadSydneyNSWAustralia2065
- The University of New South WalesReserve RoadSydneyNSWAustralia2065
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Panagopoulou V, Kalokairinou A, Tzavella F, Tziaferi S. A survey of Greek women's satisfaction of postnatal care. AIMS Public Health 2018; 5:158-172. [PMID: 30094278 PMCID: PMC6079052 DOI: 10.3934/publichealth.2018.2.158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/05/2018] [Indexed: 11/28/2022] Open
Abstract
Background The research described in this paper is a cross-sectional study which surveys women who delivered their babies in a regional hospital in Greece to investigate their satisfaction with their postnatal care. This is the first published study which measures satisfaction of postnatal services in Greece. The aim of this study is to determine which factors most influence postnatal satisfaction, which areas are lacking and therefore identify specific areas which should be targeted to improve the performance of health services. Methods A cross sectional, quantitative study of 300 women who gave birth in a regional Greek hospital between January 2015 and July 2017 were surveyed 40 days after birth using a self-administered questionnaire. The questionnaire contained sociodemographic and clinical characteristic questions and a selection of questions from the WOMen's views of Birth Postnatal Satisfaction Questionnaire (WOMBPNSQ). Results This study found that the dimensions with the higher satisfaction scores were “Professional support” and “Continuity”. The lower satisfaction scores were for the dimensions “Woman's health”, “Contraceptive advice” and “Social support” indicating that these are areas for improvement. The three dimensions most correlated with general satisfaction were “Time with woman”, “Feeding baby” and “Professional support”. Conclusions This study highlights the important role of health professionals showing that they can enhance postnatal satisfaction by spending time with the women, giving guidance on the care of the newborn and baby feeding. Focusing on improving these areas is expected to enhance the quality of postnatal care.
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Affiliation(s)
- Vasiliki Panagopoulou
- Department of Nursing, Laboratory of Integrated Health Care, University of Peloponnese, Sparta, Greece
| | - Athina Kalokairinou
- Faculty of Nursing, National & Kapodistrian University of Athens, Athens, Greece
| | - Foteini Tzavella
- Department of Nursing, Laboratory of Integrated Health Care, University of Peloponnese, Sparta, Greece
| | - Styliani Tziaferi
- Department of Nursing, Laboratory of Integrated Health Care, University of Peloponnese, Sparta, Greece
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Goodwin L, Taylor B, Kokab F, Kenyon S. Postnatal care in the context of decreasing length of stay in hospital after birth: The perspectives of community midwives. Midwifery 2018; 60:36-40. [PMID: 29482175 DOI: 10.1016/j.midw.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/08/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Laura Goodwin
- Institute of Applied Health Research, Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, United Kingdom.
| | - Beck Taylor
- Institute of Applied Health Research, Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, United Kingdom.
| | - Farina Kokab
- Institute of Applied Health Research, Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, United Kingdom.
| | - Sara Kenyon
- Institute of Applied Health Research, Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, United Kingdom.
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7
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Baas C, Wiegers T, de Cock T, Erwich J, Spelten E, Hutton E. Experience with and amount of postpartum maternity care: Comparing women who rated the care they received from the maternity care assistant as ‘good’ or ‘less than good care’. Midwifery 2017; 55:128-136. [DOI: 10.1016/j.midw.2017.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/01/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
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Larkin V, Smith G, Tennant J, Steven A. Student midwives' experiences in relation to assessment of maternal postnatal genital tract health: A case study analysis. Midwifery 2017; 56:61-69. [PMID: 29096281 DOI: 10.1016/j.midw.2017.10.006] [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: 02/27/2017] [Revised: 09/26/2017] [Accepted: 10/14/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE to explore student midwives' experiences of postnatal genital tract assessment within midwifery preregistration curricula. DESIGN a single, instrumental case study design was employed involving final year student midwives. Ethical approval was gained from the Higher Education Institution at the data collection site. Sampling was purposeful and data were collected using a survey (n = 25); narrative style in depth interviews (n = 11), review of programme documentation and a student midwife / researcher data workshop. SETTING one Higher Education Institution in the north of England. FINDINGS three themes were identified from the data analysis, awareness of assessment methods, accessing learning opportunities and actualisation of learning. The awareness theme highlights that most students were aware of potential signs and symptoms associated with genital tract assessment and health however; difficulties were identified concerning assessment of lochia, encountering sequential assessments and recognising potential for deterioration. This awareness was influenced by access to practice based learning opportunities. Access differed due to variation in postnatal provision, service pressures and variety in mentor practices regarding selecting and creating learning opportunities. This study suggests actualisation of learning and confidence in genital tract assessment was achieved when opportunities to integrate theory and practice occurred. Actualisation was hindered by limited allocation of curriculum time specifically for postnatal maternal assessment content and assessment strategies in comparison to other aspects of midwifery knowledge. CONCLUSIONS student midwives' experiences, awareness and learning actualisation varied in relation to the development of knowledge and confidence in maternal postnatal genital tract assessment. While clinical and theoretical learning opportunities were available, access and experience varied and limitations were identified. A number of recommendations are outlined to enhance the students learning experiences in practice and HEI settings, which address placement planning, mentor preparation, the student voice and supporting curricula documentation.
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Affiliation(s)
- Valerie Larkin
- University of Northumbria, Room H210, Coach Lane Campus East, Coach Lane, Benton, Newcastle upon Tyne NE7 7XA, UK.
| | - Gill Smith
- University of Northumbria, Coach Lane Campus East, Coach Lane, Benton, Newcastle upon Tyne NE7 7XA, UK
| | - Julie Tennant
- University of Northumbria, Coach Lane Campus East, Coach Lane, Benton, Newcastle upon Tyne NE7 7XA, UK
| | - Alison Steven
- University of Northumbria, Coach Lane Campus East, Coach Lane, Benton, Newcastle upon Tyne NE7 7XA, UK
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9
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Todd AL, Ampt AJ, Roberts CL. "Very Good" Ratings in a Survey of Maternity Care: Kindness and Understanding Matter to Australian Women. Birth 2017; 44:48-57. [PMID: 27859548 DOI: 10.1111/birt.12264] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Surveys have shown that women are highly satisfied with their maternity care. Their satisfaction has been associated with various demographic, personal, and care factors. Isolating the factors that most matter to women about their care can guide quality improvement efforts. This study aimed to identify the most significant factors associated with high ratings of care by women in the three maternity periods (antenatal, birth, and postnatal). METHODS A survey was sent to 2,048 women who gave birth at seven public hospitals in New South Wales, Australia, exploring their expectations of, and experiences with maternity care. Women's overall ratings of care for the antenatal, birth, and postnatal periods were analyzed, and a number of maternal characteristics and care factors examined as potential predictors of "Very good" ratings of care. RESULTS Among 886 women with a completed survey, 65 percent assigned a "Very good" rating for antenatal care, 74 percent for birth care, 58 percent for postnatal care, and 44 percent for all three periods. One factor was strongly associated with care ratings in all three maternity periods: women who were "always or almost always" treated with kindness and understanding were 1.8-2.8 times more likely to rate their antenatal, birth, and postnatal care as "Very good." A limited number of other factors were significantly associated with high care ratings for one or two of the maternity periods. CONCLUSIONS Women's perceptions about the quality of their interpersonal interactions with health caregivers have a significant bearing on women's views about their maternity care journey.
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Affiliation(s)
- Angela L Todd
- Clinical and Population Perinatal Health Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Amanda J Ampt
- Clinical and Population Perinatal Health Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Christine L Roberts
- Clinical and Population Perinatal Health Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
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Furuta M, Sandall J, Cooper D, Bick D. Severe maternal morbidity and breastfeeding outcomes in the early post-natal period: a prospective cohort study from one English maternity unit. MATERNAL AND CHILD NUTRITION 2015; 12:808-25. [PMID: 25720327 DOI: 10.1111/mcn.12176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Previous research has identified potential issues of establishing and maintaining breastfeeding among women who experience severe maternal morbidity associated with pregnancy and birth, but evidence in the UK maternity population was scarce. We explored the association between severe maternal morbidity and breastfeeding outcomes (uptake and prevalence of partial and exclusive breastfeeding) at 6 to 8 weeks post-partum in a UK sample. Data on breastfeeding outcomes were obtained from a large cohort study of women who gave birth in one maternity unit in England to assess the impact of women's experiences of severe maternal morbidity (defined as major obstetric haemorrhage, severe hypertensive disorder or high dependency unit/intensive care unit admission) on their post-natal health and other important outcomes including infant feeding. Results indicated that among women who responded (n = 1824, response rate = 53%), there were no statistically significant differences in breastfeeding outcomes between women who did or did not experience severe morbidity, except for women with severe hypertensive disorder who were less likely to breastfeed either partially or exclusively at 6 to 8 weeks post-partum. Rather, breastfeeding outcomes were related to multi-dimensional factors including sociodemographic (age, ethnicity, living arrangement), other pregnancy outcomes (neonatal intensive care unit admission, mode of birth, women's perceived control during birth) and post-natal psychological factors (depressive symptoms). Women who experience severe maternal morbidity can be reassured that establishing successful breastfeeding can be achieved. More studies are required to understand what support is best for women who have complex health/social needs to establish breastfeeding.
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Affiliation(s)
- Marie Furuta
- Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Jane Sandall
- School of Medicine, King's College London, Women's Health Academic Centre KHP, St. Thomas' Hospital, London, UK
| | - Derek Cooper
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Debra Bick
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
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East CE, Lau R, Biro MA. Midwives׳ and doctors׳ perceptions of their preparation for and practice in managing the perineum in the second stage of labour: A cross-sectional survey. Midwifery 2015; 31:122-31. [DOI: 10.1016/j.midw.2014.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 05/07/2014] [Accepted: 07/03/2014] [Indexed: 01/07/2023]
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Nabirye RC, Beinempaka F, Okene C, Groves S. Improving Midwifery Care in Ugandan Public Hospitals: The Midwives' Perspective. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2014; 2:7-14. [PMID: 27738665 PMCID: PMC5058424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND A serious shortage of nurses and midwives in public hospitals has been reported in Uganda. In addition, over 80% of the nurses and midwives working in public hospitals have been found to have job stress and only 17% to be satisfied on the job. Stress and lack of job satisfaction affect quality of nursing and midwifery care and puts patients' lives at risk. This is coupled with rampant public outcry about the deteriorating nursing and midwifery care in Ugandan public hospitals. OBJECTIVE To explore factors that result in poor quality of midwifery care and strategies to improve this care from the perspective of the midwives. METHOD It was a qualitative exploratory design. Participants were midwives and their supervisors working in four Regional Referral hospitals in Uganda. Data was collected by FGDs and KIIs. Content analysis was used to analyze the transcribed data from the voice recordings. RESULTS Four major themes emerged from the study. They were organizational (poor work environment and lack of materials/equipment), professional (midwives' attitudes, lack of supervision), public/consumer issues (interference) and policy issues (remuneration, promotion and retirement). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Midwives love their work but they need support to provide quality care. Continuous neglect of midwives' serious concerns will lead to more shortages as more dissatisfied midwives leave service.
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Affiliation(s)
- Rose C Nabirye
- Makerere University School of Health Sciences, Department of Nursing
| | | | | | - Sara Groves
- Mbarara University of Science and Technology
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13
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Aquino MRJV, Edge D, Smith DM. Pregnancy as an ideal time for intervention to address the complex needs of black and minority ethnic women: views of British midwives. Midwifery 2014; 31:373-9. [PMID: 25483209 DOI: 10.1016/j.midw.2014.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION maternal health inequalities exist across the world. In the United Kingdom, whilst there are variations within and between groups, Black and Minority Ethnic (BME) women tend to have worse maternal health outcomes than White British women. However, there is limited information about BME women's experience of maternity services. Midwives are central to the provision of safe maternity care but little is known about their perceptions of ethnically-based inequalities in maternal healthcare. Therefore, this study explored a cohort of midwives' experiences of providing care for BME women, focussing on their views on the relationship between maternal health inequalities and service delivery. METHODS using a specifically-designed topic guide, 20 semi-structured interviews were conducted with qualified midwives in one National Health Service (NHS) Trust in the North West of England over a two-month period. Data were subsequently transcribed and thematically analysed. RESULTS three main and seven sub-themes were identified. Firstly, 'language' summarised difficulties midwives experienced in engaging with women whose English was limited. Secondly, 'expectations of maternity care' outlined the mismatch between midwives and women's expectations of maternity care. Finally, 'complex needs extending beyond maternity care' highlighted the necessity of inter-agency working to address women's care holistically when their needs transcend the scope of maternity services. DISCUSSION Midwives' accounts indicated that they strive to provide equitable care but encountered numerous barriers in doing so. Paradoxically, this might contribute to inequalities in service delivery. In midwives' view, unrestricted access to interpretation and translation services is essential for provision of effective, holistic maternity care. Participants also advocated education for both women and midwives. For the former, this would improve BME women's understanding of health and care systems, potentially leading to more realistic expectations. Improving midwives' cultural competence would better equip them to respond to the needs of an ethnically diverse population. Finally, midwives highlighted that many minority women's complex care needs were identified during pregnancy. Hence, they regarded pregnancy as an ideal time for interventions to improve the health of women and their families and, as such, antenatal care cannot be treated as an isolated event. According to midwives in this study, delivering safe, effective maternity services in the 21st century requires greater collaboration with the women they care for and other health and care agencies (including independent sector providers).
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Affiliation(s)
| | - Dawn Edge
- School of Psychological Sciences, University of Manchester, UK
| | - Debbie M Smith
- Manchester Centre for Health Psychology, The School of Psychological Sciences, Coupland Building, Oxford Road, Manchester, M13 9PL, UK.
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Psaila K, Kruske S, Fowler C, Homer C, Schmied V. Smoothing out the transition of care between maternity and child and family health services: perspectives of child and family health nurses and midwives'. BMC Pregnancy Childbirth 2014; 14:151. [PMID: 24766674 PMCID: PMC4016663 DOI: 10.1186/1471-2393-14-151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 04/14/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In Australia, women who give birth are transitioned from maternity services to child and health services once their baby is born. This horizontal integration of services is known as Transition of Care (ToC). Little is known of the scope and processes of ToC for new mothers and the most effective way to provide continuity of services. The aim of this paper is to explore and describe the ToC between maternity services to CFH services from the perspective of Australian midwives and child and family health (CFH) nurses. METHOD This paper reports findings from phase two of a three phase mixed methods study investigating the feasibility of implementing a national approach to CFH services in Australia (the CHoRUS study). Data were collected through a national survey of midwives (n = 655) and CFH nurses (n = 1098). Issues specifically related to ToC between maternity services and CFH services were examined using descriptive statistics and content analysis of qualitative responses. RESULTS Respondents described the ToC between maternity services and CFH services as problematic. Key problems identified included communication between professionals and services and transfer of client information. Issues related to staff shortages, early maternity discharge, limited interface between private and public health systems and tension around role boundaries were also reported. Midwives and CFH nurses emphasised that these issues were more difficult for families with identified social and emotional health concerns. Strategies identified by respondents to improve ToC included improving electronic transfer of information, regular meetings between maternity and CFH services, and establishment of liaison roles. CONCLUSION Significant problems exist around the ToC for all families but particularly for families with identified risks. Improved ToC will require substantial changes in information transfer processes and in the professional relationships which currently exist between maternity and CFH services.
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Affiliation(s)
- Kim Psaila
- School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia
| | - Sue Kruske
- Director Queensland Centre for Mothers & Babies, The University of Queensland, Brisbane, Queensland, Australia
| | - Cathrine Fowler
- Tresillian Chair for Child & Family Health, Centre for Midwifery, Child & Family Health, Faculty of Nursing, Midwifery & Health, University of Technology Sydney, Australia
| | - Caroline Homer
- Faculty of Nursing, Midwifery & Health, University of Technology Sydney, Sydney, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery & the Family and Community Health Research Group, University of Western Sydney, Sydney, Australia
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Evans AM, Barklam D, Hone K, Ellis G, Whitlock J. Reducing pressure damage: care bundles and collaborative learning. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:S32-S38. [PMID: 24151722 DOI: 10.12968/bjon.2013.22.sup8.s32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Reduction of hospital-acquired pressure ulcers is a patient and nursing priority. Although evidence-based interventions to prevent such ulcers are well known, reducing this healthcare burden has proven consistently difficult. Via case studies, this article describes how a bundle approach to pressure ulcer prevention may be adapted for use within different clinical areas. It illustrates how collaborative learning may facilitate the spread of improvement work across a health board and build improvement skills within nursing.
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Evans AM, Barklam D, Hone K, Ellis G, Whitlock J. Reducing pressure damage: care bundles and collaborative learning. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/bjon.2013.22.sup12.s32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alison M Evans
- Critical Care, seconded to support role-out of SKIN bundle, Cardiff and Vale University Health Board (UHB)/Lecturer Cardiff University
| | | | | | - Gemma Ellis
- Critical Care, Cardiff and Vale UHB/Senior Lecturer, Cardiff University
| | - Joy Whitlock
- Cardiff and Vale UHB, Patient Safety and Quality, University Hospital of Wales, Cardiff
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Larkin V. An exploration of midwives' experiences and practice in relation to their assessment of maternal postnatal genital tract health. Midwifery 2013; 30:72-81. [PMID: 23522663 DOI: 10.1016/j.midw.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/30/2013] [Accepted: 02/02/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE to explore the experiences and practice of midwives in relation to the assessment of maternal postnatal genital tract health. DESIGN a constructionist grounded theory methodology was employed to guide the research design and processes. Ethical approval was gained from the regional research ethics committee and the research and development committee at the data collection site. Sampling was purposeful and data were collected using narrative style in depth interviews involving 14 midwives. Observations of 15 postnatal assessments involving five midwives and 15 postnatal women were also undertaken. SETTING a small maternity unit providing midwifery care to childbearing women in both the hospital and community setting in the North East of England. FINDINGS three themes were identified from the data and form the framework of the constructed grounded theory: Methods, Motivators and Modifiers. Within each theme are a number of categories and focused codes. The Methods theme summarises a range of assessment methods used by the midwives, including risk assessment, questioning and clinical observations. The Motivators theme incorporates factors which motivated how, when and why the midwives undertook genital tract assessment and includes verification, personal preferences and sensitive care. The Modifiers theme consists of factors and contexts, which facilitated or inhibited the midwives' ability to negotiate an appropriate approach to assessment including therapeutic relationship, care in context and evolving midwifery knowledge. CONCLUSIONS the findings of this study suggest midwives are aware of a range of assessment methods; however there was less articulation or demonstration of methods pertaining to assessment of uterine health. The motivating and modifying factors highlight midwife, woman and contextual factors, which may enhance and inhibit the midwives clinical reasoning process. The complexity of contemporary midwifery practice is illuminated as these factors conflict and create practice tensions and contradictions for the midwives. Implications include the need to ensure midwives have the knowledge regarding uterine health and the skills, affective abilities, resources and opportunities to engage women in health assessments within the complexity of contemporary practice.
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Affiliation(s)
- Valerie Larkin
- University of Northumbria, Room H210, Coach Lane Campus East, Coach Lane, Benton, Newcastle upon Tyne, NE7 7XA, UK.
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Bick D, Murrells T, Weavers A, Rose V, Wray J, Beake S. Revising acute care systems and processes to improve breastfeeding and maternal postnatal health: a pre and post intervention study in one English maternity unit. BMC Pregnancy Childbirth 2012; 12:41. [PMID: 22672354 PMCID: PMC3489602 DOI: 10.1186/1471-2393-12-41] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 05/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most women in the UK give birth in a hospital labour ward, following which they are transferred to a postnatal ward and discharged home within 24 to 48 hours of the birth. Despite policy and guideline recommendations to support planned, effective postnatal care, national surveys of women's views of maternity care have consistently found in-patient postnatal care, including support for breastfeeding, is poorly rated. METHODS Using a Continuous Quality Improvement approach, routine antenatal, intrapartum and postnatal care systems and processes were revised to support implementation of evidence based postnatal practice. To identify if implementation of a multi-faceted QI intervention impacted on outcomes, data on breastfeeding initiation and duration, maternal health and women's views of care, were collected in a pre and post intervention longitudinal survey. Primary outcomes included initiation, overall duration and duration of exclusive breastfeeding. Secondary outcomes included maternal morbidity, experiences and satisfaction with care. As most outcomes of interest were measured on a nominal scale, these were compared pre and post intervention using logistic regression. RESULTS Data were obtained on 741/1160 (64%) women at 10 days post-birth and 616 (54%) at 3 months post-birth pre-intervention, and 725/1153 (63%) and 575 (50%) respectively post-intervention. Post intervention there were statistically significant differences in the initiation (p = 0.050), duration of any breastfeeding (p = 0.020) and duration of exclusive breastfeeding to 10 days (p = 0.038) and duration of any breastfeeding to three months (p = 0.016). Post intervention, women were less likely to report physical morbidity within the first 10 days of birth, and were more positive about their in-patient care. CONCLUSIONS It is possible to improve outcomes of routine in-patient care within current resources through continuous quality improvement.
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Affiliation(s)
- Debra Bick
- Kings College, London, Florence Nightingale School of Nursing and Midwifery, London, UK
| | - Trevor Murrells
- Kings College, London, Florence Nightingale School of Nursing and Midwifery, London, UK
| | | | - Val Rose
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Julie Wray
- The University of Salford, School of Nursing and Midwifery, Manchester, UK
| | - Sarah Beake
- Kings College, London, Florence Nightingale School of Nursing and Midwifery, London, UK
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