'To be Informed and Involved': Women's insights on optimising childbirth care in Lithuania.

INTRODUCTION: The user expectations and experiences of healthcare services are acknowledged as components of the quality of healthcare evaluations. The aim of the study is to analyse women's experiences and views on childbirth care in Lithuania. METHODS: The study used the Babies Born Better (B3) online survey as the data collection instrument. The B3 is an ongoing longitudinal international project, examining the experiences of intrapartum care and developed as part of EU-funded COST Actions (IS0907 and IS1405). Responses to open-ended questions about (1) the best things about the care and (2) things in childbirth care worth changing are included in the current analysis. The participants are 373 women who had given birth within 5 years in Lithuania. A deductive coding framework established by the literature review was used to analyse the qualitative data. The framework involves three main categories: (1) the service, (2) the emotional experience and (3) the individually experienced care, each further divided into subcategories. RESULTS: Reflecting the experience and views regarding the service at birthplace women wished empowerment, support for their autonomy and to be actively involved in decisions, the need for privacy, information and counselling, especially about breastfeeding. In terms of emotional experience, women highlighted the importance of comprehensibility/feeling of safety, positive manageability of various situations and possibilities for bonding with the newborn. Individually experienced care was described by feedback on specific characteristics of care providers, such as competence, personality traits, time/availability and encouragement of esteem in women in childbirth. The possibilities of homebirth were also discussed. The findings reflected salutogenic principles. KEY CONCLUSIONS: The findings suggest that the Lithuanian healthcare system is in a transition from paternalistic attitude-based practices to a shift towards patient-oriented care. Implementation of the improvements suggested for women in childbirth care in Lithuania would require some additional services, improved emotional and intrapersonal aspects of care and a more active role for women. PATIENT/PUBLIC CONTRIBUTION: Patients and the public contributed to this study by spreading information about surveys and research findings through their involvement in service user groups that have an interest in maternity care. Members of the patients' groups and the public were involved in the discussion of the results.

Significance of organizational health features during the COVID-19 pandemic for the well-being of Lithuanian healthcare workers.

Summary: During various emergencies, especially pandemics, there is a heavy burden on healthcare workers and pharmacists. Organizational support plays a significant role in protecting their mental health. Though the study aimed analyze the subjectively perceived difficulties and challenges of healthcare workers related to organizing work in the context of a pandemic. Methods: Twenty seven subjects (20 women, 7 men) participated in the qualitative research 30-45 min. Duration semi-structured interviews were performed, and thematic data analysis was applied. Results: During the first wave of the COVD-19 pandemic, research participants experienced an avalanche of change in all significant areas of life: experienced general overall uncertainty, confusion in working order, and intense changes in work functions, responsibilities, and workload. These changes reduced the scope for control and predictability, there was a lack of structure and clarity. The avalanche of change caused by the COVID-19 pandemic provoked a strong and controversial emotional response. The contradiction was revealed between helplessness, disruption, loss of control experienced by staff and the internal and external pressure to adapt as quickly as possible to the functions of caregivers. The threats posed by the pandemic reinforced the need for active and engaged leadership and highlighted the key features of an employee supporting organization. Conclusion: Surviving the avalanche of change caused by the pandemic, healthcare workers and pharmacists emphasized the importance of management decisions about managing patient and employee health threats, clear work organization, active and inclusive leadership, change planning, and organizational concern for employee sustainability and emotional well-being. Regular, systematic, clear and understandable, timely, open and sincere, uncontroversial, and consistent communication of administration provides security for employees and can contribute to better physical and psychological well-being of employees.

Postnatal Depression and Post-Traumatic Stress Risk Following Miscarriage.

The experience of miscarriage is an important population-level problem that affects approximately 10-25% of pregnancies. The physical consequences of miscarriage have been researched extensively, but psychological sequelae less so. First-person accounts show that women who have experienced miscarriage feel pressured to stay silent, to grieve, and to fight intense physical and psychological challenges alone. There is ample scientific evidence on the links between miscarriage and physical and mental health disorders, such as complicated grief, anxiety, depression, post-traumatic stress, suicidal risk, psychosomatic disorders, sexual health disorders, etc. However, there is a lack of deeper understanding of the specifics of psychological morbidity after miscarriage, as well as of the information on vulnerability and resilience factors. This study aims to assess the risk of postnatal depression and post-traumatic stress following miscarriage. A total of 839 Lithuanian women who had one or more miscarriages were asked to complete an online questionnaire, including the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R). Of the women, 59.1% were found to be at increased risk of postnatal depression and 48.9% at high risk of postnatal depression; 44.7% of the women were considered to be at increased risk of post-traumatic stress. An impaired relationship with one's body and childlessness has been the strongest predictors of psychological morbidity risk.

Experience of Late Miscarriage and Practical Implications for Post-Natal Health Care: Qualitative Study.

Miscarriage is the most common reason for pregnancy loss, affecting around one in four pregnancies. It is classified as a traumatic event, associated with an increased risk for depression, anxiety, post-traumatic stress, alcohol dependence, somatic symptoms, sexual dysfunction, suicide, and complicated grief. This study aimed to analyse experiences of late miscarriage and to describe practical implications for post-natal health care based on characteristics of pregnancy loss revealed in a qualitative study. Seven women who had late miscarriages participated in in-depth biographical interviews. A phenomenological thematic analysis was applied. Experiential characteristics of late miscarriage were described by four themes and 13 subthemes: the initial splitting state (Dissociation, An Opened Void, An impaired Symbiosis, and The Body is Still Pregnant while the Psyche is Mourning); Betrayal of the body (Symbolic Experience of Internalised Death, Shocking Materiality of the Ongoing Miscarriage, Lost control of the Body, and Confusing Body Signals); Disconnecting (Depersonalising Medical Environment, Guilt Falsifies perception, and Retreat as a means of Self-Preservation); and Reconnecting (Collecting Shatters and Reinterpretation of Maternal Identity). Based on the results of the experiential analysis, another four themes represent practical recommendations for post-natal health care: Informing, Opportunity for Goodbye, Attention to Emotional Wellbeing, and Respectful Hospital Environment.

Psychological Aspects of Media Communication during the COVID-19 Pandemic: Insights from Healthcare and Pharmacy Specialists in Lithuania.

In the setting of disasters, people seek information as they hope that knowledge will provide security. This makes the media a critical source of crisis exposure. The aim of the study described in this article was to analyze COVID-19 pandemic-related psychological aspects of media use by healthcare and pharmacy workers in Lithuania and to reveal the subjective effects of media consumption on their psychological well-being. 967 healthcare workers and pharmacists in Lithuania completed an electronic survey, which consisted of questions about the changes in well-being experienced since the beginning of the lockdown and media use in the search for information on COVID-19. It was found that communication might have ambiguous effects on psychological well-being. Excessive, unreliable, misleading, contradictory information and "catastrophizing" were subjectively related to impaired psychological well-being. Objective and reliable, relevant, clear, timely, hopeful and supportive information had a subjective positive effect. Seeking COVID-19-related information many times a day was associated with increased fear of becoming infected with COVID-19, feeling unable to control the risk of contracting COVID-19, fear of infecting relatives with COVID-19 and feeling that other people would avoid interaction with healthcare workers and pharmacists because of their job. General browsing was not consistently associated with COVID-19-related fears.

How Does the Assessment of Work Organization during the COVID-19 Pandemic Relate to Changes in the Well-Being of Health System Workers?

In the case of various emergencies, especially pandemics, healthcare workers are faced with disproportionate pressures. Organizational support plays a significant role in protecting the psychological and physical health of healthcare workers. This interdisciplinary research aims to determine how changes in the physical and psychological well-being of healthcare and pharmacy workers during the first wave of the COVID-19 lockdown are related to work organization factors that support safety and stability. A quantitative research strategy was applied in the research. Data from an electronic survey assessed the changes in the physical and psychological well-being of healthcare and pharmacy workers during the lockdown period and the organizational factors supporting safety and stability. The sample of the quantitative research consisted of 967 employees of healthcare institutions and pharmacies in Lithuania. This research broadens the concept of organizational factors and provides data on their interaction with the changes of employee well-being indicators in a pandemic situation. It was found that positive changes in the evaluation of physical as well as psychological well-being during the COVID-19 lockdown could be consistently predicted by all the analyzed safety and stability supporting organizational factors that were found to be associated with subjective physical well-being and psychological well-being even when adjusting for the effect of socio-demographic factors (gender, age, work field, and specialty). The identification and proper management of organizational factors was significant for the psychological and physical well-being of healthcare workers during the lockdown period. It was found that all estimates of safety and stability supporting organizational factors during the first wave of the COVID-19 pandemic lockdown were positively related and could act as protective factors to the subjective physical and psychological well-being of healthcare and pharmacy workers.