The impact of effective communication-based care on the childbirth experience and satisfaction among primiparous women: an experimental study

ChatGPT-driven interactive virtual reality communication simulation in obstetric nursing: A mixed-methods study

AIM

(1) Describe the development process for the ChatGPT-based Virtual Reality Obstetric Nursing Communication Simulation System (ChatVR-ONCS), (2) explore its effects on communication competence in nursing students and (3) determine the perceived usability of ChatVR-ONCS and learning experiences in nursing students.

BACKGROUND

Communication is crucial in obstetric nursing, yet traditional teaching methods often fail to enhance students' relevant skills due to their lack of realism. Therefore, developing a training tool that offers high usability, immersive experiences and real-time interactivity is vital.

DESIGN

Mixed research methods were applied involving pre- and post-tests within a single group of 52 nursing students at a Taiwanese science and technology university as well as a focus group.

METHODS

The Visual Analog Scale for Communication Self-Confidence, Maternal and Newborn Care Communication Assessment Form and System Usability Scale were administered before the intervention (T0), immediately after the intervention (T1) and 3 months after the intervention (T2). A focus group was conducted after T2 to explore their learning experience and obtain feedback on the proposed system.

RESULTS

The participants' communication self-confidence, communication skills and ratings on system usability significantly improved after the ChatVR-ONCS intervention, with the effects lasting for 3 months. The qualitative analysis demonstrated a high level of user satisfaction and the positive effects of the system in promoting communication skill development.

CONCLUSION

By integrating artificial intelligence and virtual reality technologies, ChatVR-ONCS not only significantly enhances the effectiveness of nurse-patient communication training but also provides empirical support for digital development in nursing education.

Measurement properties of the German version of the birth satisfaction scale-revised (BSS-R) in women with pre-existing medical conditions and high-risk pregnancy

BACKGROUND

The Birth Satisfaction Scale-Revised (BSS-R) is a validated questionnaire for assessment of childbirth experience which has been translated into many languages. It is the instrument of choice in the International Consortium for Health Outcomes Measurement (ICHOM) standard set for 'Pregnancy and Childbirth'. Translation of the key outcome measures from English into German language was previously performed, but its validation is pending.

AIM AND OBJECTIVES

To analyze the key psychometric properties of the German version of the BSS-R (Ger-BSS-R), and to evaluate its application in women with chronic conditions.

METHODS

248 women with pre-existing medical conditions were provided with the Ger-BSS-R during hospital inpatient stay for childbirth. The 10-item measurement contains three sub-scales for assessing quality of care provision (QC), women's personal attributes (WA), and stress experienced during labor (SE).

RESULTS

Complete data was available in N = 224 cases. After removal of four multivariate outliers, N = 220 were available for psychometric evaluation. The cesarean section rate was 50.5%, prematurity occurred in 14.5% of deliveries and induction of labor was performed in 49.7% of cases with planned vaginal delivery. Mean total BSS-R score was 25.7 (SD 5.94). In the confirmatory factor analysis, the tri-dimensional measurement model was found to offer a good fit to Ger-BSS-R data. For internal consistency, the total, SE and QC sub-scale Cronbach's alphas were significantly lower than those of the founder version.

CONCLUSIONS

The Ger-BSS-R is a robust instrument for assessing birth satisfaction. This is the first study to apply the BSS-R in women with pre-existing medical conditions. Compared to the founder UK version, differences in total BSS-R scores and sub-scales for experience of stress and quality of care are present, requiring further investigations.

How power and knowledge hierarchies affect communication in intrapartum care: findings from public health facilities in two southern Indian districts

BACKGROUND

Effective communication is a key element of medical care; it can foster a warm interpersonal relationship, facilitate the exchange of information, and enable shared decision-making. In the context of obstetric care, it is associated with a range of positive clinical and social outcomes for mother and baby. Extant communication frameworks and respectful maternity care (RMC) guidelines emphasize the importance of effective communication during intrapartum care. Yet, studies conducted in Indian public health settings suggest that there are gaps in the implementation of RMC guidelines.

METHODS

As part of a larger study on disrespect and abuse in Indian public hospitals, we studied the nature of communication in the intrapartum context and the extent to which it is respectful. The study is based on interviews with 29 providers across different levels of public health facilities. Interviews were translated, transcribed, and thematically coded. We examined codes related to communication to understand what kinds of communication occur during intrapartum care and the role played by knowledge and power hierarchies. We then considered their implications for RMC.

RESULTS

We identified four types of communication that occurred in the context of intrapartum care: (a) compassionate, to comfort and support the laboring woman, (b) factual, to obtain or provide information or updates, (c) prescriptive, to obtain consent and cooperation from the woman and her family members, and (d) defensive, to protect against accusations of poor care. Knowledge and power hierarchies operated differently in each type of communication, with prescriptive and defensive communication more likely to be disrespectful than others.

CONCLUSIONS

Our findings suggest that successful implementation of RMC guidelines requires greater attention to knowledge and power hierarchies, and an understanding of the ways in which they operate in a clinical setting. Integrating this understanding into guidelines, medical education, training programmes, and interventions will facilitate effective and respectful communication during maternity care.

Translation and validation of the Hungarian version of the Birth Satisfaction Scale-Revised (BSS-R)

BACKGROUND

Evidence relating maternal birth experience to a range of maternal and neonatal outcomes is increasingly compelling. Consequently valid and reliable self-report of birth experience from the mothers perspective is critical.

AIM

The current study sought to translate and validate a Hungarian-language version of the Birth Satisfaction Scale-Revised (BSS-R).

METHOD

Following forward and backwards translation into Hungarian, the Hungarian BSS-R (HU-BSS-R) was administered to women in a major Transylvanian hospital maternity unit within 72 h postpartum. Key psychometric characteristics were then examined in relation to factor structure, divergent and convergent validity, internal consistency, and known-groups discriminant validity.

RESULTS

Two-hundred and thirty-two women completed the HU-BSS-R. Confirmatory factor analysis revealed the HU-BSS-R to offer an excellent fit to data for the established tri-dimensional measurement model. The HU-BSS-R was also found to offer excellent convergent and divergent validity and known-groups discriminant validity. No significant differences were observed between internal consistency observations between the current study and the original UK validation study.

CONCLUSIONS

The HU-BSS-R is a valid and reliable translation of the original BSS-R, it has proved itself to have excellent psychometric properties and is suitable for use in the Hungarian maternity context.

Implementation and evaluation of the WHO maternity care model: a convergent parallel mixed-methods study protocol

Background

According to the World Health Organization (WHO), intrapartum care is considered a platform for providing respectful, personalized, and women-centered services to women. This study aims to investigate the intrapartum care model proposed by WHO.

Methods

This convergent parallel mixed-methods study will be carried out in qualitative and quantitative phases. In the quantitative phase (a quasi-experimental study), 108 pregnant women admitted to the maternity ward will be randomized to intervention (receiving intrapartum care based on the WHO model) and control group (receiving routine hospital care) before the beginning of the active stage of labor (cervix dilatation equal to 5 cm) and Wijma's delivery fear scale (DFS) will be completed for them and again at 7-8 cm dilatation. The participants of both groups will be followed up for 6 weeks after labor and then they will be invited to a relatively quiet place to complete the Childbirth Experience Questionnaire (CEQ 2.0), the Edinburgh Postpartum Depression Scale (EPDS), the Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS-I), the Pregnancy and Childbirth Questionnaire (PCQ), exclusive breastfeeding and a checklist on willingness to give birth to another child. The qualitative phase will employ content analysis to explain mothers' views about the effects of this model especially subjective components of this model on their labor process after 4-6 weeks. The two phase's results will be discussed in combination.

Discussion

The implementation of such care models is expected to prevent mental disorders caused by negative experiences of childbirth, and also, prevent uncontrolled increases in cesarean sections.

Clinical Trial Registration

https://fa.irct.ir/user/trial/68313/view, identifier (IRCT20120718010324N69).

The comparison of the effect of non-pharmacological pain relief and pharmacological analgesia with remifentanil on fear of childbirth and postpartum depression: a randomized controlled clinical trial

INTRODUCTION

Childbirth may be associated with psychological, social, and emotional effects and provide the background for women's health or illness throughout their life. This research aimed at comparing the impact of non-pharmacological pain relief and pharmacological analgesia with remifentanil on childbirth fear and postpartum depression.

MATERIALS AND METHOD

This randomized clinical trial with two parallel arms was conducted on 66 women with term pregnancy referred to Taleghani Hospital in Tabriz for vaginal delivery during September 2022 to September 2023. First, all of the eligible participants were selected through Convenience Sampling. Then, they were randomly assigned into two groups of pharmacological analgesia with remifentanil and non-pharmacological analgesia with a ratio of 1:1 using stratified block randomization based on the number of births. Before the intervention, fear of childbirth (FOC) was measured using Delivery Fear Scale (DFS) between 4 and 6 cm cervical dilatation. Pain and fear during labor in dilatation of 8 cm were measured in both groups using VAS and DFS. After delivery, FOC was assessed using Delivery Fear Scale (W DEQ Version B) and postpartum depression using the Edinburgh's postpartum depression scale (EPDS). Significance level was considered 0.05. Mean difference (MD) was compared with Independent T-test and ANCOVA pre and post intervention.

RESULTS

The mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after the intervention by controlling the effect of the baseline score (MD: -6.33, 95%, Confidence Interval (CI): -12.79 to -0.12, p = 0.04). In the postpartum period, the mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after controlling the effect of the baseline score (MD: -21.89; 95% CI: -35.12 to -8.66; p = 0.002). The mean score of postpartum depression in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group (MD: -1.93, 95% CI: -3.48 to -0.37, p = 0.01).

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N10. Date of registration: 05/07/2022 Date of first registration: 05/07/2022. URL: https://www.irct.ir/trial/61030; Date of recruitment start date05/07/2022.

CONCLUSION

The study results indicated a reduction in FOC and postpartum depression among parturient women receiving non-pharmacological strategies with active participation in childbirth compared to women receiving pharmacological analgesia. Owing to the possible side effects of pharmacological methods for mother and fetus, non-pharmacological strategies with active participation of the mother in childbirth are recommended to reduce the FOC and postpartum depression.