Formación profesional de la matrona/matrón en Chile: años de historia / Professional formation of midwives in Chile: years of history

INTRODUCCIÓN: El estudio demuestra la evolución de la formación de Matronas/Matrones en Chile para proporcionar atención de salud humanizada y de calidad a la mujer en todo su curso de vida, en el ámbito de la salud sexual, reproductiva y recién nacido. OBJETIVO: Examinar los principales hitos en la formación de Matronas/Matrones, avances y sistematicidad del proceso evolutivo en Chile. Método: Se revisaron textos, publicaciones en revistas, reglamentos y normas de los últimos quince años de la historia y desarrollo de la profesión de Matrona/Matrón en Chile. La búsqueda bibliográfica se realizó entre marzo 2018 y mayo 2019. Se consultaron las bases de datos Dialnet, PubMed/Medline, Scielo, Medwave. RESULTADOS: La formación profesional de la Matrona/Matrón constituye el desarrollo académico y continuo necesario para enfrentar diversos desempeños. Transita de una formación empírica como partera a una formación profesional con la creación de la primera Escuela de Matronas de la Universidad de Chile en 1834. Desde el siglo XVIII comienza a cambiar la disciplina obstétrica con tendencia a la fundamentación científica: planes de estudio rediseñados, modificación de requisitos de ingreso, nuevas escuelas en universidades públicas y privadas. Actualmente la carrera dura cinco años, otorgándose el grado de Licenciatura y título profesional de Matrona/Matrón. CONCLUSIÓN: La Matrona chilena debe ser una profesional con talento humano y compromiso con la sociedad para otorgar cuidados de salud seguros, respetuosos y de calidad en la salud sexual y reproductiva, al recién nacido y familia.

INTRODUCTION: The study demonstrates the evolution of the training of Midwives in Chile to provide quality humanized health care to women throughout their life course in the area of sexual, reproductive and newborn health. OBJECTIVE: To examine the main milestones in the formation of Midwives, advances and systematicity of the evolutionary process in Chile. METHOD: Publications in journals, regulations and norms from the last fifteen years of the history and development of the profession of Midwives in Chile were reviewed. The bibliographic search was conducted between March 2018 and March 2019. The databases Dialnet, PubMed/Medline, Scielo, Medwave were consulted. RESULTS: The professional training of the Midwife constitutes the academic and continuous development necessary to face various performances. Transition was from an empirical formation as a midwife to a professional formation with the creation of the first School of Midwives of the University of Chile in 1834. Since the 18th century, the obstetric discipline began to change with a tendency towards scientific foundations: redesigned curricula, modification of entrance requirements, new schools in public and private universities. Currently, the course lasts five years, with a Bachelor's degree and professional title of Midwife/Matron. CONCLUSION: The Chilean midwife must be a professional with human talent and commitment to society to provide safe, respectful and quality sexual and reproductive health care to the newborn and family.

Effectiveness of solution-focused group counseling on the mental health of midwifery students

Abstract Objective The present study was conducted with the objective of investigating the effectiveness of solution-focused group counseling (SFGC) on promoting the mental health of midwifery students. Methods The present study is an intervention-based study with a pretest, a post-test, and a control group. The statistical population included all of the midwifery students studying in the midwifery department of the Bam University of Medical Sciences, Kerman, Iran, who filled out the General Health Questionnaire (GHQ) in the screening phase. In the second phase, 40 individuals, having a low level of mental health based on the cutoff score of 23, were selected and randomly divided into 2 groups (intervention and control), each group with 20 participants. The intervention group participated in 5 sessions of 75 minutes for SFGC. Then, the post-test was held in both groups and the data analysis was conducted using the Mann-Whitney and the Kruskal-Wallis test with IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp, Armonk, NY, USA). The significance level was considered as p < 0.05. Results The findings showed that the mean of the post-test mental health scores of the intervention group (14.5 ± 50.35) and of the control group (23.6 ± 35.83) showed a statistically significant difference (p < 0.0001). Moreover, the comparison between the mean scores of the mental health subscales (physical symptoms, stress, social performance, and depression) showed a statistically significant difference in these groups, and SFGC improved physical symptoms, stress, social performance, and depression in the members of the intervention group. Conclusion Solution-focused group counseling may improve all levels of mental health. This type of counseling is recommended to be used to solve the psychological problemsand to improve the mental health of students, as well as of the staff of the health system.

Paradoxos do programa de parteiras tradicionais no contexto das mulheres Krahô / Paradoxes of the traditional midwives program in the context of Krahô women

Resumo Este artigo analisa o impacto do Programa Trabalhando com Parteiras Tradicionais no cotidiano de um grupo de mulheres indígenas Krahô. Trata-se de um estudo etnográfico que utilizou a observação e o diário de campo como suportes principais, além de entrevistas pontuais e dados secundários. O trabalho de campo ocorreu entre agosto de 2015 e dezembro de 2016 e envolveu dez mulheres de oito aldeias diferentes. Os resultados apontam uma desconexão entre o objetivo principal do Programa, centrado na valorização e no resgate do saber da parteira, e a realidade no cotidiano das aldeias. Muito embora o programa tenha como público-alvo mulheres que já atuam empiricamente no cenário do parto, houve o entendimento de que as mulheres "tornaram-se parteiras" após o curso. Por consequência, a falta de pagamento e a expectativa frustrada de contratação por parte do "governo", embora não previstas, foram interpretadas como descaso. Os resultados indicam um viés etnocentrado do Programa, focado na difusão do saber científico e na entrega de materiais fora da lógica de cuidado do grupo em análise. Estudos que avaliem o impacto das ações do Programa em outros contextos, inclusive não indígenas, podem contribuir para os ajustes necessários e a efetiva valorização do trabalho dessas mulheres.

Abstract This paper analyses the impact of the Working with Traditional Midwives Program on the daily routine of a Krahô indigenous women group. This is an ethnographic study that mainly used observation and field diary as supporting tools. Other tools were timely interviews and secondary data. Fieldwork occurred between August 2015 and December 2016 and involved ten women of eight different villages. Results point to a disassociation between the Program's main objective, which is focused on appreciating and reviving midwives' knowledge and the daily village reality. Although the Program has targeted women who already work empirically on the birth setting, there was a generalized acknowledgement in villages that women "became midwives" after taking the course. Consequently, the lack of payment and the frustrated expectation that "government" would hire them, though never assumed, were interpreted as neglect. Results reveal an ethnocentric bias of the Program, focused on disseminating scientific knowledge and delivering materials that deviate from the logic of the group under analysis. Studies that evaluate the impact of the Programs' actions in other contexts, including non-indigenous ones, may contribute to the necessary adjustments and the effective appreciation of these women's work.

The Signs of alert and Labor: knowledge among pregnant women / Sinais de alerta e de trabalho de parto: conhecimento entre gestantes

Abstract Objectives: ididentify the scores on the pregnant women's knowledge on the signs of alert and labor and correlate the scores with the maternal age, number of children and the guidance they received during pregnancy. Methods: this is a descriptive, cross-sectional study with a quantitative approach on pregnant women's previous knowledge of the signs of alert and labor performed with 100 pregnant women on their 30th week of gestation at the Hospital de Clínicas da UFTM (Clinical Hospital). The data collection was carried out from April to June 2016, using a semi-structured instrument tested as a pilot study. Results: only 21% of the pregnant women reported taking part in the pregnant women's group; 61% of them referred to not receiving any information on the signs of alert and labor. A statistically significant association was verified between the number of correct answers and the guidance they received during prenatal consultations. However, there was no correlation between the correct scores on maternal age and the number of children. Conclusions: the pregnant women who did not receive any kind of guidance, they had lower scores on the correct answers, which shows the importance of guiding them about Health Education during their prenatal consultations.

Resumo Objetivos: identificar escores de conhecimento de gestantes sobre os sinais de alerta e de trabalho de parto e correlacionar escores de acerto com a idade materna, o número de filhos e o recebimento de orientações durante a gestação. Métodos: trata-se de um estudo de abordagem quantitativa, transversal, sobre o conhecimento prévio acerca dos sinais de alerta e de trabalho de parto realizado com 100 gestantes, a partir da 30ª semana gestacional, no Hospital de Clínicas da UFTM. A coleta de dados foi realizada no período de abril a junho de 2016 por meio de instrumento semiestruturado, testado mediante estudo piloto. Resultados: apenas 21% das gestantes relataram a participação em grupo de gestantes e 61% referiram não ter recebido nenhum tipo de informação sobre os sinais de alerta e de trabalho de parto. Verificou-se uma associação estatisticamente significante entre o número de acertos e as orientações recebidas durante o pré-natal. Entretanto, não houve correlação entre escores de acerto e a idade materna e o número de filhos. Conclusões: gestantes que não receberam orientações tiveram escores de acertos mais baixos o que demonstra a importância da Educação em Saúde durante o pré-natal.

Trabajo, miserias y recompensas: Asistentes sociales, enfermeras y matronas en la construcción de la política sanitaria chilena a mediados del siglo XX / Work, miseries and rewards: Social workers, nurses and midwives in the construction of Chilean health policy in the mid-twentieth century

RESUMEN El artículo busca mostrar el aporte realizado por asistentes sociales, enfermeras y matronas a la exitosa política de salud pública de mediados del siglo XX en Chile, llevada a cabo por el Servicio Nacional de Salud en el marco de un modelo de desarrollo estatista y benefactor. Se han utilizado fuentes documentales de diverso tipo y testimonios de asistentes, enfermeras y matronas entrevistadas para la investigación. Las profesionales, encargadas fundamentalmente de tareas operativas y en contacto directo con la población usuaria del Servicio Nacional de Salud, fueron artífices de la instalación de una verdadera pedagogía sanitaria que cambió el patrón epidemiológico y trastocó la cultura de la población chilena, incidiendo en la valoración del autocuidado y la prevención. Como ejecutoras, sortearon las dificultades inherentes al trabajo burocratizado de los programas sociales pero, a la vez, recibieron gratificaciones diversas de tipo afectivo y altruista, que las hizo sentirse protagonistas de una construcción histórica.

ABSTRACT The article seeks to show the contribution made by social workers, nurses and midwives to the successful public health policy implemented in the mid-twentieth century in Chile by the National Health Service in the context of a statist and welfare development model. Documentary sources of different types and testimonies of social workers, nurses and midwives who were interviewed for this research were used. These professionals, mainly responsible for operational tasks and in close contact with the users of the National Health Service, were responsible for the establishment of a true health pedagogy that changed the epidemiological pattern and touched the culture of the Chilean population, influencing its estimation of self-care and prevention. As executors of the policy, they avoided the difficulties inherent to the bureaucratized work of social programs, gaining, at the same time, satisfaction at the affective and altruistic level, which made them feel like the protagonists of a historical process.

A concorrência na arte de partejar na cidade do Rio de Janeiro entre 1835 e 1900 / Competition in the arts of midwifery in the city of Rio de Janeiro from 1835 to 1900

Resumo Este artigo discute a concorrência entre parteiras e médicos na oferta dos serviços de partos na cidade do Rio de Janeiro entre 1835 e 1900. Foram analisadas as atas da congregação, os livros do curso de partos e de termos de exames de verificação de médicos, cirurgiões, boticários e parteiras da Faculdade de Medicina do Rio de Janeiro, além de anúncios e propagandas de médicos e parteiras nas colunas "Anúncios" e "Indicações Úteis" do Jornal do Commercio . Observa-se como o aumento do número de médicos-parteiros e seus discursos científicos contribuíram para que as parteiras se vissem obrigadas a diversificar a clientela, instalando-se e atendendo em áreas populares e inóspitas.

Abstract The article discusses competition between midwives and doctors offering birth-related services in the city of Rio de Janeiro from 1835 to 1900. The research analyzed minutes from meetings, textbooks on births, and terms from qualification examinations for physicians, surgeons, apothecaries, and midwives at the Rio de Janeiro Medical School (Faculdade de Medicina do Rio de Janeiro), as well as announcements by and advertisements for doctors and midwives in columns featuring advertisements and useful recommendations in the Jornal do Commercio newspaper. An increase in the number of delivery physicians, and their scientific discourses led midwives to feel an obligation to diversify their clientele, consequently establishing themselves and working in lower-class and inhospitable areas.

Protagonismo de enfermeiras obstétricas nas transformações das situações reais de trabalho após um curso de aprimoramento / The role of obstetrical nurses in the transformation of real work situations after an improvement course

A presente dissertação teve como objeto de pesquisa o protagonismo de enfermeiras obstétricas nas situações reais de trabalho após um Curso de Aprimoramento. Objetivo: Apreender as transformações das situações reais de trabalho, vivenciadas por enfermeiros obstétricos após um Curso de Aprimoramento. Método: Trata-se de uma pesquisa com abordagem qualitativa, do tipo estudos de casos múltiplos, com abordagem qualitativa, a partir dos pressupostos teóricos e metodológicos da avaliação de quarta geração. Realizou-se entrevistas para a coleta de dados. Os sujeitos do estudo foram oito enfermeiras(os) obstétricas(os) que participaram de um Curso de Aprimoramento ofertado pela Universidade Federal de Minas Gerais e financiado pelo Ministério da Saúde. A pesquisa compreendeu o período de abril de 2017 a fevereiro de 2018. A análise de casos baseou-se em proposições teóricas desenvolvidas por meio do referencial teórico "Clínica da Atividade" descrito por Yves Clot (2011) e na proposta metodológica de "Modelos Lógicos" de Robert K. Yin (2015), além de componentes adaptados da matriz de Ziel-Orientierte Projekt Planung "ZOOP". Resultados: A análise revelou que as enfermeiras(os) obstétricas(os) enfrentaram desafios, como: i) dificuldade de comunicação entre as equipes multiprofissionais e gestão institucional; ii) necessidade de reforço da identidade das(os) enfermeiras(os) obstétricas(os); iii) atuação limitada na atenção ao parto e ao nascimento; iv) a falta de acesso das mulheres e suas famílias aos serviços com atuação autônoma das(os) enfermeiras(os) obstétricas(os). Além disso, o Curso de Aprimoramento favoreceu as enfermeiras obstétricas à aquisição e desenvolvimento de protagonismo para a ação e intervenção em seus serviços de atuação. Um movimento no coletivo, proporcionou maior centralidade do cuidado à mulher e família, melhor comunicação entre os profissionais, maior número de partos assistidos pela Enfermagem Obstétrica, estímulo à equipe em relação à atuação da Enfermagem Obstétrica, maior segurança e autonomia das enfermeiras(os) obstétricas(os) em relação ao cuidado no parto e nascimento, melhor estabelecimento de vínculo com as mulheres em situação de vulnerabilidade e apropriação das tecnologias não invasivas de cuidado. Considerações Finais: a teoria da "Clínica da Atividade" e seus conceitos se mostraram condizentes para a análise do poder de agir permitindo a co-construção do protagonismo de enfermeiras obstétricas nas situações reais de trabalho.(AU)

The present dissertation had as object of research the protagonism of obstetrical nurses in the real working situations after an Enhancement Course. Objective: To understand the transformations of real work situations, experienced by obstetrical nurses after an Enhancement Course. Method: This is a research with a qualitative approach, like multiple case studies, with a qualitative approach, based on the theoretical and methodological assumptions of the fourth generation evaluation. Interviews were conducted to collect data. The subjects of the study were eight obstetric nurses who participated in an Improvement Course offered by the Federal University of Minas Gerais and funded by the Ministry of Health. The research comprised the period from April 2017 to February 2018. A Case analysis was based on theoretical propositions developed through the theoretical reference "Clinic of the Activity" described by Yves Clot (2011) and in the methodological proposal of "Logical Models" of Robert K. Yin (2015), besides adapted components of the matrix of Ziel-Orientierte Projekt Planung "ZOOP". Results: The analysis revealed that obstetric nurses faced challenges, such as: i) difficulty in communication between multiprofessional teams and institutional management; (ii) the need to strengthen the identity of obstetric nurses; iii) limited performance in delivery and birth care; iv) the lack of access of women and their families to the autonomous services of the obstetric nurses. In addition, the Enhancement Course favored obstetrical nurses to acquire and develop protagonism for action and intervention in their services. A movement in the collective, provided a greater centrality of the care to the woman and family, better communication among the professionals, greater number of deliveries assisted by Obstetric Nursing, encouragement to the team in relation to Obstetrical Nursing, greater security and autonomy of the nurses, obstetric care in relation to care in childbirth and birth, better bonding with vulnerable women, and appropriation of noninvasive care technologies. Final Thoughts: The "Activity Clinic" theory and its concepts proved to be adequate for the analysis of the power to act, allowing the co-construction of the role of obstetrical nurses in real work situations.(AU)

O curso de aprimoramento para enfermeiras obstétricas: desenvolvendo e ampliando o poder de agir de um coletivo profissional no seu meio de trabalho / The course of improvement for obstetrical nurses: developing and expanding the power to act of a professional collective in their work environment

Para a mudança de modelo na atenção obstétrica o Ministério da Saúde tem investido na formação e capacitação de enfermeiras (os) obstétricas (os) e uma das modalidades trata-se de um curso de capacitação de curto prazo intitulado de Curso de Aprimoramento para Enfermeiros Obstétricos. Este estudo teve como objetivo analisar o Curso de Aprimoramento para Enfermeiras (os) Obstétricas (os) como articulador da transformação das situações reais de trabalho no âmbito da assistência ao parto. Trata-se de um recorte de uma pesquisa avaliativa com abordagem qualitativa em que se utilizou o referencial conceitual da "Clínica da Atividade" de Yves Clot (2010). Os sujeitos do estudo foram enfermeiras (os) obstétricas (os) de quatro regiões do Brasil inseridos em maternidades e que se enquadraram nos critérios de inclusão do estudo, totalizando 64 participantes. Para a coleta de dados utilizou-se uma ficha de identificação e foram realizados oito grupos focais. A análise de dados foi realizada pela análise de conteúdo direta, utilizando-se o software MAXQDA© versão 2018. O material gravado dos grupos focais foi transcrito e analisado por meio do software, sistematizado e categorizado para compor o banco de dados, considerando opiniões recorrentes, dissensos e consensos das participantes. Foram construídas quatro categorias de análise guiadas pelo refencial teórico: a) sentimentos e expectativas do curso em relação ao poder de agir do enfermeiro; b) a autonomia do enfermeiro obstétrico para o fortalecimento do gênero profissional; c) o cuidado como chave propulsora para a mudança; d) o curso como articulador do coletivo no trabalho. A primeira foi construída a partir dos sentimentos referidos pelas (os) aprimorandas (os) relativos ao Curso e vivência no campo de prática, bem como suas expectativas. A segunda categoria refere-se a autonomia da (o) enfermeira (o) obstétrica (o) e foi definida devido às inúmeras vezes que o termo "autonomia do enfermeiro" foi utilizado pelas (os) aprimorandas (os) durante a discussão nos grupos focais. A terceira categoria demostra a retomada do significado do cuidar em enfermagem pelas (os) aprimorandas (os) a partir da vivência no campo de prática do Curso servindo de inspiração para a mudança pessoal e profissional. A quarta e última categoria dá ênfase aos planos de ação/intervenção nos processos de assistência ao parto e nascimento, elaborado no final da primeira etapa do curso pelas (os) aprimorandas (os), juntamente com os pesquisadores, refletindo os enfrentamentos necessários para mudanças de atitude e práticas no âmbito do cuidado, formação e gestão. Por meio deste estudo, pode-se inferir que o Curso de Aprimoramento para enfermeiras (os) obstétricas (os) foi importante para a reafirmação do gênero profissional e um articulador da transformação das situações reais de trabalho no âmbito da assistência ao parto. Espera-se, assim, que este trabalho contribua para a criação de outros cursos para profissionais de enfermagem, utilizando esta modelagem metodológica de modo que suas repercussões possam potencializar a prática da (o) enfermeira (o) obstétrica (o) de forma autônoma, fortalecendo assim, o protagonismo dessas profissionais nas transformações das situações reais de trabalho.(AU)

In order to change the model in obstetric care, the Ministry of Health has invested in the training and qualification of obstetrical nurses and one of the modalities is a short-term training course, titled an Improvement Course for Obstetric Nurses. This study aimed to analyze the Course of Improvement for Obstetric Nurses as an articulator of the transformation of real work situations in the field of childbirth care. It is a cut of an evaluative research with a qualitative approach in which the conceptual reference of the "Clinic of the Activity" of Yves Clot (2010) was used. Participants were professional obstetrician nurses from four regions of Brazil inserted in maternity hospitals and who met the inclusion criteria of the study, totaling 64 participants. For data gathering, an identification card was used and eight focal groups were performed. The analysis of the data was performed through the direct content analysis using the software MAXQDA © version 2018. The recorded material of the focus groups was transcribed and analyzed through the software, systematized and categorized to compose the database, considering recurrent opinions, dissent and consensus of the participants. Four categories of analysis were constructed guided by the theoretical reference: a) feelings and expectations of the course in relation to the nurse's power to act; b) the autonomy of the obstetric nurse to strengthen the professional gender; c) care as the driving force for change; d) the course as articulator of the collective at work. The first category reveals the feelings, expectations and meanings that the experience in other daily work that has served as a model for childbirth and childbirth care has for the obstetric nurses in training. The first one was built based on the participants's feelings about the course and their experiences in the field of practice, as well as their expectations. The second category refers to the autonomy of the obstetric nurse and was defined because of the several times that the term "nurse´s autonomy" was used by the obstetrics nurses in training during the discussion in the focus groups. The third category shows the resumption of the meaning of care in nursing by obstetrician nurses in training, from the experience of practice of the Course serving as inspiration for personal and professional change. The fourth and last category emphasizes action / intervention plans in childbirth and childbirth care processes, elaborated at the end of the first stage of the course by the learners, together with the researchers, reflecting the confrontations that will be necessary for changes in attitudes and practices in care, training and management. Through this study, it can be inferred that the course of improvement for obstetrical nurses was important for the reaffirmation of the professional gender and an articulator of the transformation of the real work situations in delivery assistance. Therefore, it is hoped that this work will contribute to the creation of other courses for nursing professionals, using this methodology so that its repercussions can potentialize the practice of the obstetric nurse in an autonomous way, thus strengthening the role of these professionals in the transformation of real work situations.(AU)

Atención del parto y del puerperio inmediato con pertinencia intercultural / Care of childbirth and immediate puerperium

PROPÓSITO: Explorar los factores que influyen en la aplicación de la interculturalidad con respecto a la atención del parto y puerperio inmediato en personal médico y paramédico, comadronas y usuarias del Centro de Urgencias Médicas (CUM) de Tecpán, Chimaltenango, abril-mayo 2017. MATERIAL Y MÉTODOS: Estudio cualitativo con diseño etnográfico. Se realizaron entrevistas en profundidad al personal de salud y usuarias del CUM y grupos focales con comadronas. Se evaluó la infraestructura de las salas de parto y posparto. RESULTADOS: En el personal médico y paramédico se evidenciaron saberes limitados acerca de la pertinencia cultural, descrita en las Normas de Atención con Pertinencia Cultural. Se contó con el 65% de los elementos de infraestructura y equipo de la sala de partos culturalmente adecuada. Las comadronas percibieron una atención deficiente y refirieron poco interés y capacitación del personal del servicio de salud. Las usuarias opinaron que existe una buena relación con el personal de salud, sin embargo no se les brindó una atención con adecuación cultural. CONCLUSIONES: Los factores que influyen en la implementación de las prácticas interculturales son de índole económica principalmente, además de aspectos estructurales, organizaciones y socioculturales.

PURPOSE: To explore the factors that influence the implementation of interculturality in regards to care during childbirth and the immediate postpartum period, in medical and paramedical staff, traditional midwives and patients of the Center of Medical Urgencies (CUM), Tecpán, Chimaltenango, April-May 2017. MATERIALS AND METHODS: Qualitative study with an ethnographic design. In-depth interviews with medical staff and patients of the CUM were carried out in addition to focal groups with traditional midwives. The infrastructure of the birthing room and postpartum ward were evaluated. RESULTS: CONCLUSIONS: The medical and paramedical staff showed limited awareness of cultural pertinence, as described in the Norms of Attention with Cultural Pertinence. The birthing room satisfies 65% of the criteria of infrastructure and equipment of a culturally pertinent birthing room. The traditional midwives perceived deficient patient care and identified a lack of interest and training of the health staff. The patients experienced a good relationship with the health staff, but declared a lack of cultural adequacy in the attention. The factors that influence in the implementation of intercultural practices are principally of economic nature, in addition to structural, organizational and sociocultural aspects.

Midwives' educational needs and knowledge about sexually transmittable infections in the Islamic Republic of Iran

This study aimed to evaluate the educational needs and knowledge about sexually transmittable infections [STIs] demonstrated by midwives. In a cross-sectional study in 2014, 144 midwives in Rasht, Islamic Republic of Iran, were surveyed. The Persian version of the Sexually Transmitted Disease Knowledge Questionnaire [STD-KQ] and a researcher-made questionnaire to evaluate educational needs and profile were used. The participants obtained 74% of the total score of STD-KQ. Thirty-one percent of participants were categorized in high or very high need of education. Seventy percent of midwives mentioned they were trained on all STIs at university. However, only 6.3% of midwives were aware of existing STIs guidelines. Participants reported that in the last two years they were only educated about HIV/AIDS and hepatitis B at their workplace. Thus, a comprehensive educational programme to empower midwives for complete STIs control is recommended

Design and Evaluation of Reform Plan for Local Academic Nursing Challenges Using Action Research

PURPOSE: This study identifies challenges to the first nurse training program for undergraduate nursing students at a nursing and midwifery school in Iran using a collaborative approach in order to improve the program. METHODS: Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. The participants were 148 individuals from nursing academic and clinical settings, including administrators, faculty members, students, and staff nurses. We obtained approval from the research deputy and ethics committee of Shahid Beheshti University of Medical Sciences in Tehran, Iran for this study. RESULTS: Lack of coherence in the educational program and implementation of the program, inadequate communication between management inside and outside the organization, insufficient understanding of situations by students, and improper control of inhibitors and use of facilitators in teaching and in practice were among the major challenges in the first training process in the context of this study. After classification of problems, the educational decision-making authorities of the school developed an operational program with stakeholder cooperation to plan initial reforms, implementation of reforms, reflection about the actions, and evaluation. Comparison of student satisfaction with the collaborative learning process versus the traditional method showed that except for the atmosphere in the clinical learning environment (p > .05), the mean differences for all dimensions were statistically significant. CONCLUSIONS: The results confirm the overall success of the revised partnership program, but stressed the need for further modification of some details for its implementation in future rounds.

Barreras de acceso a tratamiento de la depresión posparto en Centros de Atención Primaria de la Región Metropolitana: un estudio cualitativo / Barriers restricting postpartum depression treatment in Chile

Background: In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers. Aim: To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile. Material and Methods: Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used. Results: There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions. Conclusions: Patient and provider related barriers restricting treatment of postpartum depression were identified.

[Frequency of academic failure and its associated factors from the viewpoint of students with and without academic failure in the Faculty of Nursing and Midwifery, Khoramabad, Iran]

Main task of universities is training efficient and effective human resources. Students annually experience academic failure due to different reasons. Because academic failure of medical students has negative impacts on the community, patients, profession and university, the present study aimed to determine the frequency of academic failure, and to compare its associated factors from the viewpoint of the students with and without academic failure. This descriptive cross sectional study was conducted during the second semester of 2011-2012 academic years on 148 nursing and midwifery students in Khorramabad Nursing and Midwifery Faculty using convenience sampling method. Academic failure was considered 0.2 and more decline in standard score [Z score] of the grade point average of the prior semester compare to the two previous semesters. The instrument was a researcher made questionnaire which included demographic information and 52 questions about influential factors on academic failure. Five point likert scale questions from very high to very low applied to examine the students' agreement with the factors affecting academic failure. The Questionnaires were self-reporting. Descriptive statistics, Chi square test, and independent T test were used for data analysis. 36.5% of the students had academic failure. The most important reported factors of academic failure from the viewpoint of the students with academic failure were death of a close one [4.13 +/- 1.25], faculty members' teaching method [4.11 +/- 1.7], high number of courses per semester [3.89 +/- 0.95], and delivery of theoretical and clinical courses at the same term [3.76 +/- 1.09]. Those of the students without academic failure were faculty members' evaluation methods [4.03 +/- 1.36], faculty members' teaching method [3.81 +/- 1.1], high number of courses in each semester [3.76 +/- 1.09], and educational planning [3.76 +/- 1.14]. There was no significant difference between the viewpoints of students with and without academic failure in the associated factors of academic failure. More than one third of the students had academic failure. Applying some strategies are necessary such as identifying and supporting students at risk of academic failure by consultant faculty members, encourage and support faculty members to apply more effective teaching and evaluation methods, teach correct studying and learning methods to students, and revision in the nursing educational planning

Una mirada histórica: recordando la desaparición de una Escuela (comparación entre Bs. As. y Córdoba) / Remembering the disappearance of a school (comparison between Buenos Aires and Cordoba)

El parto es un hecho fisiológico, sin embargo rara vez enla historia, se ha dejado librado a la obra de la Naturaleza.La parturienta encontró generalmente siempre, solidaridady asistencia por parte de los que la rodeaban.El proceso invariable del parto, con sus molestias ydolores, despertó desde lejanos tiempos, el instinto deasistencia en las mujeres familiarizadas con dicha práctica,dando lugar a las “comadronas”; parteras u obstetras.El trabajo pretende, sin ánimo de comparación, recordarla creación universitaria de la Escuela de Parteras, en Córdobay en Buenos Aires.

Childbirth is a physiological fact, though rarely inhistory, has been left to the work of Nature.The mother usually found always solidarityand assistance from those around her.The process invariably birth with their discomfort andpain, woke from distant times, the instinct of women assistance familiar with this practice,giving rise to the "midwives"; midwives or obstetricians.This paper attempts nonprofit comparison, rememberuniversity building Midwifery School in Cordobaand Buenos Aires.

Parto e nascimento domiciliar assistidos por parteiras tradicionais: o programa trabalhando com parteiras tradicionais e experiências exemplares / Labor and birth at home assisted by traditional midwives: the program working with TBAs and exemplary experiences

O Ministério da Saúde tem como uma de suas prioridades a atenção integral à saúde da mulher e da criança. No que se relaciona particularmente à melhoria da assistência obstétrica – com vistas à redução da morbimortalidade materna e neonatal e à ampliação do acesso, da qualificação e da humanização da atenção pré-natal, ao parto, ao nascimento, ao puerpério, ao recém-nascido e à situação de abortamento – o Ministério vem desenvolvendo um conjunto de estratégias, incluindo-se entre elas a melhoria da atençãoao parto e nascimento domiciliar assistidos por parteiras tradicionais.

[Priorities of clinical education evaluation from nursing and midwifery students' perspective]

Evaluation of clinical education is a fundamental part of educational planning. Students' perspective is one of the most important factors in educational evaluation. This study aims to determine the priorities of clinical education evaluation from the view points of nursing and midwifery students in Azad University of Semnan. It was a descriptive cross- sectional study. One hundred and sixty nursing and midwifery students of Islamic Azad University of Semnan were recruited by census. Data was collected by a researcher made questionnaire [alpha=0.9] and analyzed using descriptive and inferential statistics by SPSS-PC [v.13]. The findings revealed that the students' knowledge of evaluation aims and its methods [3/71 +/- ./59] was the most important factor and receiving feedback [3/46 +/- ./71]was the least important factor in clinical evaluation from the students' perspective. There were no relationship between the students' perspective about clinical evaluation and their age, marital status, discipline, and also the semester of education. Giving information about the process and purposes of clinical education evaluation and considering the students' viewpoints in this regard from the beginning of clinical placement is recommended. Students' understanding of evaluation goals and processes would facilitate accepting the results and promote their motivation for effective learning