A Qualitative and Quantitative Assessment of the Risk of Human Errors in Midwifery Tasks in Child Delivery Ward Using Engineering Approach (EA) and Predictive Human Errors Analysis (PHEA)

@#Introduction: Maternity wards are of the highly sensitive wards in hospital. Errors in midwifery tasks can lead to life threatening risks for the mother and infant and higher medical costs. The present study is an attempt to qualitatively and quantitatively assess human errors in midwife staff using preventive human error analysis and engineering approach. Methods: The study was carried out as a case study in the maternity ward of Shoushtar Women Hospital. The participants were selected through convenient sampling and seven midwifery experts took part in the study. The work process in maternity ward was categorized into four categories of admittance, pre-labor, labor, and post-labor and the tasks and sub-tasks were determined based on hierarchical task analysis (HTA). Afterwards, human errors were quantified using EA technique and then, using PHEA technique a description of error in each tasks and error control solutions were provided. Results: The results clarified that the highest risks of human errors were in the tasks like cervix check, serum therapy, infant’s body check, preparing delivery equipment, and wearing personal protective equipment. Conclusion: Since, midwifery tasks are rule base and regulations and they are performed at a higher level of awareness and cognition, preventing errors entails continuous presence of a midwife next to patient’s bed along with an assistant midwife and codification of an infant examination checklist. Programming empowerment education including safety education to midwives is also recommended.

Undang-Undang Jagaan Kesihatan Ibu Di Malaysia: Hak Pesakit Wanita di Hospital Kerajaan

@#Introduction Women as patients is a normal situation. However, women patients of the obstetric and gynaecology category are of a different category. This is because obstetric and gynaecology patients will be warded in the maternity ward and labour room according to the needs of their care and treatment. The care and treatments in the maternity ward and labour room involving the care and treatments by a special team of trained medical doctors, midwives and nurses in obstetrics and gynaecology areas of expertise. Hence, the importance of scutinising the relevant laws and legislations pertaining to the protection of female patients’ rights when they are utilising the maternity ward and labour room are fundamental in determining whether such rights existing in our healthcare services pertaining to pregnant women. Healthcare laws relating to women’s healthcare and government health policy on pregnant women are scrutinised to ascertained whether the laws and policy give impact or effect to the healthcare services rendered, including scrutinising the qualification, capability and the quantity of obstetric and gynaecology doctors on whether it fulfils the requirement of the government hospitals’ maternity ward and labour room. Methods Doctrinal research method is adopted with applying the empirical approach whereby interviews and a focus group discussion were held with the O&G specialist doctors and selected medical officer and staff nurses of Maternity Hospital Kuala Lumpur. Results The finding shows that there are already in placed a policy of the Ministry of Health Malaysia outlining the women patients’ rights in maternity ward and labour room. However, there are deficiencies from the aspect of law and government policy wherein there is no specific laws in relation to pregnant patient rights nor is there a clear policy on women health. Conclusions The writing concludes that there is a need for a new policy to re-establish governance in maternity ward and to further enhance health care quality for women patients hence, to appropriately define the position of women patients’ rights in the government hospital’s maternity ward.

The maternity ward of a teaching hospital: reconfiguration of maternal-child nursing care / Maternidad de un hospital-escuela: reconfiguración de la asistencia de enfermería materno-infantil / Maternidade de um hospital-escola: reconfiguração da assistência de enfermagem materno infantil

ABSTRACT Objective: to analyze the strategies used by nurses and nurse professors for a better position in the maternity ward of the teaching hospital of the Universidade Federal do Espírito Santo. Method: this is a social-historical study with a qualitative approach. The primary sources were written documents, such as official letters, memos, ordinances, standards and routines of the hospital; photographic material; and oral testimonies from seven participants. The interviews were performed using a semi-structured questionnaire, with questions regarding the adaptation from a sanatorium to a teaching hospital, the challenges faced, and the strategies adopted by the nursing department. Results: the results allowed us to understand the close link between the maternity ward and the nursing course of the Universidade Federal do Espírito Santo, which created a differentiated nursing care that integrated training and care with a broader and humanized look. Final considerations: the actions of the nurses were recognized and gave them professional visibility, influencing a new form of care in the maternity ward.

RESUMEN Objetivo: analizar las estrategias usadas por las enfermeras asistenciales y enfermeras docentes por una mejor posición en la maternidad del hospital-escuela de la Universidad Federal de Espírito Santo. Método: estudio de naturaleza histórico-social con abordaje cualitativo. Las fuentes primarias se constituyeron de documentos escritos, como los oficios, los memorandos, los decretos, las normas y las rutinas hospitalarias; el material fotográfico; y las declaraciones orales de siete participantes. La encuesta fue orientada por la ruta semiestructurada con cuestiones sobre la adaptación del sanatorio para hospital-escuela, los retos enfrentados y las estrategias adoptadas por la enfermería. Resultados: permitieron entender la estrecha vinculación de la maternidad con el curso de enfermería de la Universidad Federal de Espírito Santo, el que determinaba una asistencia de enfermería diferenciada, la cual integraba enseñanza y asistencia con una mirada más amplia y humanizada. Consideraciones finales: las acciones de las enfermeras fueron reconocidas y generaron visibilidad profesional, influenciando una nueva manera de cuidar en la maternidad.

RESUMO Objetivo: analisar as estratégias usadas pelas enfermeiras assistenciais e enfermeiras docentes por uma melhor posição na maternidade do hospital-escola da Universidade Federal do Espírito Santo. Método: estudo de natureza histórico-social com abordagem qualitativa. As fontes primárias constituíram-se de documentos escritos, como ofícios, memorandos, portarias, normas e rotinas hospitalares; material fotográfico; e depoimentos orais de sete participantes. A entrevista foi orientada por roteiro semiestruturado com questões sobre a adaptação do sanatório para hospital-escola, os desafios enfrentados e as estratégias adotadas pela enfermagem. Resultados: permitiram entender a estreita vinculação da maternidade com o curso de enfermagem da Universidade Federal do Espírito Santo, o que determinava uma assistência de enfermagem diferenciada, a qual integrava ensino e assistência com um olhar mais amplo e humanizado. Considerações finais: as ações das enfermeiras foram reconhecidas e geraram visibilidade profissional, influenciando uma nova forma de cuidar na maternidade.

Avaliação da presença do acompanhante no parto e puerpério em maternidade pública / Evaluation of the presence of the companion during birth and the puerperium in a public maternity unit / Evaluación de la presencia del acompañante en el parto y puerpério en maternidad pública

Estudo descritivo quantitativo com o objetivo de avaliar a opinião de puérperas sobre a experiência da presença do acompanhante, no processo do parto e puerpério, em uma maternidade pública, referência para gestação de alto risco, do Estado do Paraná-Brasil. A coleta de dados ocorreu entre agosto e setembro de 2012 com 105 puérperas, a partir de questionário semiestruturado. A presença do acompanhante foi considerada positiva e as tarefas por ele realizadas proporcionaram à puérpera segurança, especialmente pelo cuidado com ela e o bebê. Destacou-se que as usuárias querem ter acompanhante, independentemente das condições estruturais da instituição.

This descriptive quantitative study aimed to evaluate puerperas' opinions regarding experiencing the presence of the companion in the process of birth and puerperium, in a public maternity unit, a center of excellence for high risk pregnancies, in the State of Paraná. Data collection occurred between August and September 2012 with 105 puerperas, using a semi-structured questionnaire. The presence of the companion was considered positive, and the tasks he undertook provided the puerpera with security, especially for care for her and the baby. It stood out that the service users wish to have a companion, regardless of the institution's structural conditions.

Estudio descriptivo cuantitativo cuyo objetivo fue evaluar la opinión de puérperas sobre la experiencia de la presencia del acompañante, en el proceso del parto y puerpério, en una maternidad pública, referencia para gravidez de alto riesgo, del Estado de Paraná. Los datos fueron obtenidos entre agosto y septiembre de 2012 con 105 puérperas, con base en un cuestionario semiestructurado. La presencia del acompañante fue considerada positiva y las tareas por él realizadas proporcionaron a la puérpera seguridad, especialmente en razón del cuidado con ella y el bebé. Se destaca que las usuarias quieren un acompañante, independientemente de las condiciones estructurales de la institución.

Analysis of a humanization proposal to the childbirth / Análise de uma proposta de humanização ao parto

The objective of this research study was to analyze the continuity of activities implemented in a maternity ward in the city of Londrina to improve humanized childbirth assistance. This is an observational study, with a qualitative approach, featuring a study sample of 30 parturient women diagnosed with impending labor, as well as staff, faculty and students, totaling 28 health professionals. The instrument for data collection was based on categories of obstetrical practices of the practical guide for normal delivery assistance from the OMS (1996), which were checked through the observation technique during labor, delivery and postpartum, consisting of variables related to patient obstetric history transcribed from medical records. We observed some positive point; for instance, all women had the company of another person during moments of assistance, privacy in the form of screens and curtains, relaxation techniques, among others. We observed some negative points when the parturient was not given the right to decide on a preferred position for labor, as well as frequent vaginal tests, performed by more than one person. It can be assumed that all implemented measures have discouraged medical-assisted childbirth, and encouraged biomechanical practices and interventions during labor, which are considered more appropriate to the physiology of the procedure.

O objetivo desta pesquisa foi analisar a continuidade das atividades que foram implementadas numa maternidade do município de Londrina, Estado do Paraná, para melhorar o atendimento humanizado ao parto. Estudo observacional, com abordagem qualitativa, cuja população foi composta por 30 parturientes com diagnóstico de trabalho de parto efetivo e funcionários, docentes e alunos totalizando 28 profissionais da saúde. O instrumento de coleta de dados foi embasado nas categorias das práticas obstétricas do guia prático da assistência ao parto normal da OMS (1996) que foram checadas por meio da técnica de observação durante trabalho de parto, parto e puerpério imediato e foi composto por variáveis referentes à história obstétrica. Como pontos positivos, observou-se que em todas as mulheres foram realizados cuidados como, presença de acompanhante; privacidade com uso de biombos e cortinas; técnicas de relaxamento entre outros. Os pontos negativos observados foram a impossibilidade do direito de escolha da posição preferida para o parto e a realização de exames vaginais frequentes, especialmente, por mais de um prestador do cuidado. Pode-se considerar que o conjunto de medidas humanizadoras implementadas tem desestimulado o parto medicalizado, e incentivado as práticas e intervenções biomecânicas no trabalho de parto, consideradas como mais adequadas à fisiologia do mesmo.