Housing instability: Exploring socioecological influences on the health of birthing people.

STUDY AIM: To describe how socioecological influences of housing instability affect pregnancy health among birthing and postpartum people. DESIGN: We used the socioecological framework to guide this exploratory descriptive study using semi-structured, in-depth interviews. METHODS: We purposively recruited birthing people in the southern mid-Atlantic region. Seventeen one-time, semi-structured interviews were conducted between February 2020 and December 2021 with English-speaking unstably housed participants ≥18 years old, currently pregnant, or recently postpartum. Qualitative and quantitative content approaches were used to analyse transcribed interviews. Dedoose software was used to identify code patterns and refine the codebook until group consensus. The team examined code patterns, explored meaning in text and codified code-generated categories to describe experiences. RESULTS: Majority (82.4%) of participants were African Americans between 22 and 41 years, and most were postpartum (76.5%). Participants described multiple forms of housing instability, reasons for losing housing, challenges with finding housing and strategies for finding housing. Participants did not describe housing instability as a barrier to receiving prenatal care. Building and sustaining individual relationships and social support were prominent factors affecting their housing challenges. Participants also reported a lack of obstetric provider inquiry about housing status during pregnancy. Many reported that challenges with housing triggered mental health issues, especially depression. CONCLUSION: Nurses and other obstetric providers are key points of contact in the prenatal care setting for assessing housing stability. Additionally, refining social structures and funding support services within communities and prenatal health systems should be a strategy for future programme and policy planning improvement. IMPACT: This study highlights critical areas for consideration when addressing social determinants for birthing people and reinforces the need for more comprehensive assessment in the prenatal setting. PATIENT OR PUBLIC CONTRIBUTION: Members of the public participated in this study as key informants for study interviews.

The effectiveness of telemedicine interventions on women with postpartum depression: A systematic review and meta-analysis.

BACKGROUND: Postpartum depression (PPD) is a public health problem that has significant adverse effects on mothers, couple's relationships, newborn neurodevelopment, and child emotional and cognitive development. This study reviewed the effectiveness of telemedicine interventions in postparturient women with postpartum depression. AIMS: To evaluate the effectiveness of telemedicine intervention in women with postpartum depression. METHODS: Cochrane Library, PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO were searched for relevant articles published between 2003 and March 2021. We also manually reviewed the reference lists of the retrieved articles. The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias for individual studies was evaluated according to the Cochrane Handbook. RevMan 5.4 software was used to carry out the meta-analysis. RESULTS: The meta-analysis included 20 randomized controlled trials with a total of 3252 patients. The results demonstrated that telemedicine was an effective intervention for treating PPD and anxiety and for improving functional impairment in women during their postpartum period. LINKING EVIDENCE TO ACTION: This meta-analysis provided evidence that telemedicine was an effective intervention for treating PPD in women. Telemedicine also has significant effects on anxiety and improved functional impairment in women during their postpartum period. Our findings may provide accurate evidence-based guidance for postpartum women's mental health management. In the future, more high-quality studies are required for verifying these results.

Community- based maternal and newborn interventions in Africa: Systematic review.

AIM AND OBJECTIVES: This review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths. BACKGROUND: Most neonatal deaths (99%) occur in low- and middle-income countries, with approximately half happening at home. In resource-constrained settings, community-based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub-Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015. METHODS: The review includes quantitative, qualitative and mixed-method studies, with a data-based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist. RESULTS: The results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health. CONCLUSION: The systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services. RELEVANT TO THE CLINICAL PRACTICE: Conceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers.

Embedding skin tone diversity into undergraduate nurse education: Through the lens of pressure injury.

OBJECTIVE: To explore health disparity in on-campus undergraduate nurse education through the analysis of teaching and teaching material exploring pressure injuries. BACKGROUND: As a discipline, nursing espouses ideologies of inclusion, equity and valuing diversity. However, little is known about how these ideologies translate into clinical care. Pressure injury prevention is a routine aspect of nursing care; yet, there is evidence of inequity in relation to clinical care and patient assessment, as people with darker skin tones have a higher prevalence of severe pressure injuries before detection of damage occurs. Despite limited literature being available surrounding the topic of pressure injuries and skin tone diversity, it remains the responsibility of nurse educators to address contemporary issues and health disparity within the nursing curriculum. DESIGN: A multiple method collective case study. The STROBE checklist was followed in reporting this study. METHODS: Documentary and observational data of lectures regarding pressure injuries were collected during 2017 and 2018 from five Higher Education Institutes in England delivering approved nursing undergraduate programmes. RESULTS: Documentary analysis confirmed all Higher Education Institutes overwhelmingly directed teaching and learning activities about pressure injury towards people with Caucasian skin tones. Observation of teaching indicated all teaching sessions only contained brief, separate and superficial information on people with pressure injuries and darker skin tones. There was no discursive language or awareness of colour or colour blindness. CONCLUSION: Radical critique of all teaching and learning activities needs to occur, to help explore, improve and meaningfully and authentically include diversity and inclusivity in nurse education, and in particular, how people across the skin tone spectrum are included and represented in teaching and learning activities. RELEVANCE TO CLINICAL PRACTICE: Critical examination of current teaching practice is crucial to address disparity and ensure care for people with darker skin tones is optimised. Nurse educators have a responsibility to educate for the care needs of all, as the quality of nurse education has a direct impact on care delivery and health disparity. This paper highlights the importance of addressing skin tone diversity and offers the opportunity for reflective practice, not just in formal education, but in clinical settings by preceptors and senior staff.

Non-invasive care technologies: nurses' contributions to the demedicalization of health care in a high-risk maternity hospital / Tecnologías no invasivas de cuidado: contribuciones de las enfermeras para la desmedicalización del cuidado en la maternidad de alto riesgo / Tecnologias não invasivas de cuidado: contribuições das enfermeiras para a desmedicalização do cuidado na maternidade de alto risco

ABSTRACT Objective: to discuss the use of non-invasive care technologies by nurse-midwives in a high-risk maternity hospital. Method: a descriptive and qualitative study with ten nurse-midwives who work at the obstetric center of a high-risk maternity at a university hospital in Rio de Janeiro City. Data collection took place in June and July 2017, through a semi-structured interview. The material was submitted to content analysis. Results: The participants use non-invasive care technologies from the perspective of health work technologies and demedicalization, setting up a care process centered on sensitive work and soft technologies. Thus, they shift the focus away from interventionist procedures and develop a care based on human relationships, integrality and female protagonism. Conclusion: with these technologies, nurse-midwives perform a new way of caring in high-risk maternity hospitals, contributing to the humanization of care and rearrangement of these fields. Implications for the practice: the use of these technologies drives the change of the care model by focusing on sensitive work and soft technologies instead of rough work and procedural hegemony.

RESUMEN Objetivo: discutir el uso de las tecnologías no invasivas de cuidado por enfermeras obstétricas en una maternidad de alto riesgo. Método: estudio descriptivo y cualitativo, con diez enfermeras obstétricas que actúan en el centro obstétrico de una maternidad de alto riesgo de un hospital universitario de Rio de Janeiro. La recolección de los datos ocurrió en junio y julio de 2017, a través de una entrevista semiestructurada. El material fue sometido al análisis de contenido. Resultados: las participantes comprenden las tecnologías no invasivas de cuidado bajo la óptica de las tecnologías del trabajo en salud y las utilizan en la perspectiva de la desmedicalización, conformando un proceso de cuidar con énfasis en el trabajo vivo y en las tecnologías blandas. Así, desplazan el foco de la intervención y desarrollan un cuidado pautado en la relación humana, en la integralidad y en el protagonismo femenino. Conclusión: con estas tecnologías, las enfermeras obstétricas introducen un nuevo modo de producir el cuidado en las maternidades de alto riesgo, contribuyendo para la humanización de la asistencia y reconfiguración de esos campos. Implicaciones para la práctica: el uso de estas tecnologías impulsa el cambio del modelo de asistencial a partir del enfoque en el trabajo vivo y en las tecnologías blandas en detrimento del trabajo muerto y la hegemonía centrada en procedimientos.

RESUMO Objetivo: Discutir o uso das tecnologias não invasivas de cuidado por enfermeiras obstétricas em uma maternidade de alto risco. Método: Estudo descritivo e qualitativo, com dez enfermeiras obstétricas que atuam no centro obstétrico de uma maternidade de alto risco de um hospital universitário do Rio de Janeiro. A coleta dos dados aconteceu em junho e julho de 2017, através de entrevista semiestruturada. O material foi submetido à análise de conteúdo. Resultados: As participantes utilizam as tecnologias não invasivas de cuidado sob a ótica das tecnologias do trabalho em saúde e na perspectiva da desmedicalização, configurando um processo de cuidar centrado no trabalho vivo e nas tecnologias leves. Desse modo, retiram do foco os procedimentos intervencionistas e desenvolvem um cuidado pautado na relação humana, na integralidade e no protagonismo feminino. Conclusão: Com essas tecnologias, as enfermeiras obstétricas introduzem um novo modo de produzir o cuidado nas maternidades de alto risco, contribuindo para a humanização da assistência e reconfiguração desses campos. Implicações para a prática: O uso dessas tecnologias impulsiona a mudança do modelo assistencial, a partir do enfoque no trabalho vivo e nas tecnologias leves em detrimento ao trabalho morto e à hegemonia centrada em procedimentos.

The Second Triennial Systematic Literature Review of European Nursing Research: Impact on Patient Outcomes and Implications for Evidence-Based Practice.

BACKGROUND: European research in nursing has been criticized as overwhelmingly descriptive, wasteful and with little relevance to clinical practice. This second triennial review follows our previous review of articles published in 2010, to determine whether the situation has changed. OBJECTIVE: To identify, appraise, and synthesize reports of European nursing research published during 2013 in the top 20 nursing research journals. METHODS: Systematic review with descriptive results synthesis. RESULTS: We identified 2,220 reports, of which 254, from 19 European countries, were eligible for analysis; 215 (84.7%) were primary research, 36 (14.2%) secondary research, and three (1.2%) mixed primary and secondary. Forty-eight (18.9%) of studies were experimental: 24 (9.4%) randomized controlled trials, 11 (4.3%) experiments without randomization, and 13 (5.1%) experiments without control group. A total of 106 (41.7%) articles were observational: 85 (33.5%) qualitative research. The majority (158; 62.2%) were from outpatient and secondary care hospital settings. One hundred and sixty-five (65.0%) articles reported nursing intervention studies: 77 (30.3%) independent interventions, 77 (30.3%) interdependent, and 11 (4.3%) dependent. This represents a slight increase in experimental studies compared with our previous review (18.9% vs. 11.7%). The quality of reporting remained very poor. LINKING EVIDENCE TO ACTION: European research in nursing remains overwhelmingly descriptive. We call on nursing researchers globally to raise the level of evidence and, therefore, the quality of care and patient outcomes. We urge them to replicate our study in their regions, diagnose reasons for the lack of appropriate research, identify solutions, and implement a deliberate, targeted, and systematic global effort to increase the number of experimental, high quality, and relevant studies into nursing interventions. We also call on journal editors to mandate an improvement in the standards of research reporting in nursing journals.

A promoção da integridade do períneo no cuidado à mulher no parto / The promotion of perineal integrity in the care to women at childbirth

As enfermeiras obstétricas nos partos utilizam cuidados para preservação perineal e optam pelas técnicas hands on e hands off, em que, segundo evidências científicas atuais, não há diferença nas taxas de lacerações perineais. Como objeto de pesquisa: A promoção da integridade perineal no cuidado à mulher utilizada pelas enfermeiras obstétricas no parto; e objetivos: Verificar a prevalência e os fatores associados ao cuidado de promoção da integridade do períneo feminino no parto; Identificar as estratégias adotadas para a promoção da integridade perineal da mulher na assistência ao parto; Descrever a promoção da integridade perineal realizada pelas enfermeiras obstétricas. Estudo misto, quan  QUAL, sendo a fase quantitativa um estudo transversal, retrospectivo, baseado nos registros do livro de partos assistidos pelas enfermeiras obstétricas de uma maternidade pública do Rio de Janeiro em 2015. Os dados foram armazenados no Microsoft Excel® e o processamento das variáveis foi realizado por meio do software Stata SE 13®, no qual foram avaliadas as prevalências, realizada análise bivariada das variáveis dependentes e independentes e foram procedidos os cálculos de seus respectivos intervalos de confiança a 95% e Razões de Chances (OR) bruta. Na fase qualitativa, tipo descritiva, realizaram-se entrevistas semiestruturadas com todas as enfermeiras obstétricas atuantes no centro obstétrico desta unidade e analisadas pela técnica da análise de conteúdo temática. Resultados: Realizada análise de 555 registros de partos normais assistidos por essas profissionais e a técnica de cuidado perineal mais utilizada foi a hands off (92,4%). A ocitocina foi utilizada em 21,6% das mulheres e apresentou 6,6 (RP) mais probabilidade do cuidado de proteção perineal com as mãos (hands on) ser empregado. A posição materna não supina no parto predominou (94,6%). Quando essa posição é supina, há 1,4 (OR) mais chances de ser utilizado o cuidado protetor hands on. A episiotomia foi praticada em apenas uma mulher (0,2%). As lacerações de 1º grau foram mais prevalentes (65%). As de 3º grau ocorreram em apenas duas mulheres (0,4%). A maioria (87,2%) dos RNs teve peso adequado ao nascer. Na análise qualitativa, as participantes eram jovens, com inserção recente na especialidade, na assistência ao parto normal e preferem o hands off. Relatam uso eventualmente do hands on e do óleo vegetal. Adotam como princípios do cuidado de promoção da integridade perineal: o respeito à fisiologia do parto e ao protagonismo feminino e a não intervenção no corpo feminino. Também almejam alcançar as seguintes metas de cuidado: promover o retorno sexual e atividades de vida cotidiana no pós-parto e estimular o conhecimento sobre as repercussões fisiológicas do parto sobre o períneo. Portanto, essas profissionais optam pela conduta expectante e o cuidado hands off, procedendo à prevenção quaternária no parto normal. Estas profissionais priorizam o respeito à fisiologia do parto, promovem a autonomia e protagonismo da mulher no parto. Para tal, utilizam essas estratégias de cuidados perineais com metas para uma melhor qualidade e segurança no parto e pós-parto, prestando um cuidado baseado nas evidências científicas atuais e na humanização do parto e nascimento.

Nurse midwives in childbirth take care procedures for perineal preservation and opt for hands-on and hands-off techniques, which according to current scientific evidence present no difference in rates of perineal lacerations. As research object: the promotion of perineal integrity in the care of women performed by nurse midwives in childbirth; and research objectives: to verify the prevalence and factors associated with care to promote the integrity of the female perineum at birth; to identify the strategies adopted to promote the perineal integrity of women in childbirth care; to describe the promotion of perineal integrity performed by nurse midwives. A mixed study, quan  QUAL, being the quantitative phase a cross-sectional, retrospective study based on the records, on the birth record book, of births assisted by nurse midwives at a public maternity hospital in Rio de Janeiro in 2015. The data were stored in Microsoft Excel® and the variables were processed using Stata SE 13® software, in which the prevalences have been analyzed, bivariate analysis of dependent and independent variables has been applied and their respective gross Chances Ratios (OR) and confidence intervals were calculated at 95%. In the descriptive, qualitative phase, semi-structured interviews were conducted with all the nurse midwives working at the Obstetric Center of this health unit and analyzed by the thematic content analysis technique. Results: Analysis of 555 records of normal childbirth assisted by these professionals was performed, and the most used perineal care technique was hands off (92.4%). Oxytocin was used in 21.6% of the women and presented 6.6 (RP) more probability of the perineal protection with hands (hands on) being employed. Maternal non-supine position at birth predominated (94.6%). When this position is supine, there are 1.4 (OR) more chances of using the hands-on protective care. Episiotomy was performed in only one woman (0.2%). First-degree lacerations were more prevalent (65%). Third-degree lacerations occurred only in two women (0.4%). The majority (87.2%) of the newborns had adequate birth weight. In the qualitative analysis, the participants were young, with recent entry in the specialty, in normal childbirth assistance and prefer the hands off technique. They report some use of hands-on and vegetable oil. They adopt as principles of care the promotion of the perineal integrity: the respect for the physiology of childbirth and the female protagonism and the non-intervention in the female body. They also aim to achieve the following care goals: to promote the return to sexual and daily life activities in the postpartum period and to stimulate knowledge about the physiological repercussions of childbirth on the perineum. Therefore, these professionals opt for the expectant conduct and the hands-off care, proceeding the quaternary prevention in normal childbirth. These professionals prioritize the respect for the physiology of childbirth, promote the autonomy and protagonism of the woman in childbirth. For this purpose, they use these strategies of perineal care with goals for a better quality and safety in childbirth and postpartum period, providing a care based on current scientific evidence and on the humanization of childbirth and birth.

Planetary Health and the Role of Nursing: A Call to Action.

PURPOSE: To discuss the drivers of planetary health, responses, and the role of nursing in making health systems more resilient in an era of increasing stresses. As health providers, scientists, educators, and leaders, nurses have an obligation to prepare for climate change and other impacts of ecosystem strain on human health. DESIGN AND METHODS: Review of literature relevant to a planetary health framework. FINDINGS: Population displacement, new disease patterns and health needs, stresses on air quality, food production and water systems, and equity concerns, as well as the generation of sustainable energy, are all intimately related to health. CONCLUSIONS: Nurses are key to achieving the sustainable development goals that, like the planetary health framework, focus on environmental sustainability and human well-being. Nurses contribute to resilient health systems, as trusted leaders and providers of health care, and as advocates and change makers impacting the world. CLINICAL RELEVANCE: It is critical that nurses and other health professionals consider the multiple effects of ecosystem strain on human health, and anticipate population health and health system planning and response.

Women's expectations and experiences of rupture of membranes and views of the potential use of reagent pads for detecting amniotic fluid.

AIMS: To explore first-time mothers' expectations and experiences regarding rupture of membranes at term and their views on the potential use of reagent pads that detect amniotic fluid. BACKGROUND: There is little information available on women's experiences of spontaneous rupture of membranes, or interest in using methods to confirm rupture of membranes (e.g. reagent pads). DESIGN: Descriptive qualitative study, using focus groups and telephone interviews with women during pregnancy and after the birth of their first baby. Thematic analysis was undertaken to analyse women's responses. METHODS: Ethics committee approval was obtained. Twenty-five women participated in the study of whom 13 contributed both during pregnancy and postpartum between October 2015-March 2016. FINDINGS: Three overarching themes were identified from the data from women's expectations and experiences: uncertainty in how, when and where membranes may rupture; information which was felt to be limited and confirmation of rupture of membranes. The potential use of reagent pads met with varied responses. CONCLUSION: Women were interested in having facts and figures regarding rupture of membranes, such as characteristics of liquor; volume and probability of membranes rupturing spontaneously at term. Use of a pad as a means of confirmation was viewed as helpful, although the potential for increasing anxiety was raised.

Delphi Survey of Clinical Nursing and Midwifery Research Priorities in the Eastern Mediterranean Region.

PURPOSE: As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region. DESIGN: A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016. METHODS: Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau. FINDINGS: Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections. CONCLUSIONS: Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives. CLINICAL RELEVANCE: Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally.

Issues and challenges of curriculum reform to competency-based curricula in Africa: A meta-synthesis.

Although in recent decades reforms to undergraduate nursing and midwifery education have increasingly been guided by the concept of competency-based curriculum in a drive to produce competent graduates in the African context, the topic remains poorly researched in-depth. The related issues and challenges need to be explored in the interest of evidence-based practice. This article stems from a systematic review of qualitative literature on the design and implementation of competency-based curriculum. Data was inductively analyzed using constant comparison. The two categories that emerged were: (i) the need for a paradigm shift to competency-based curriculum; and (ii) the associated issues and challenges, such as a shift from informative to transformative learning, lack or limited of involvement of key stakeholders in curriculum development, focus on hospital-oriented education, lack of preparation of educators, and inappropriate resources. While ongoing reform of nursing and midwifery education continues, much still needs to be done - in particular, extensive financial investment to increase the capacity of educators, mentors and infrastructure, and the development of collaborative frameworks between nursing and midwifery and higher educational councils.

Ensino em serviço de enfermeiras obstétricas na modalidade de residência: o papel da preceptoria / Residency in-service education for nurse-midwives: the role of preceptorship

O objeto da pesquisa é o papel da preceptoria no ensino em serviço de enfermeiras obstétricas na modalidade de residência. No ensino de enfermagem obstétrica, pode se aplicar os conceitos pedagógicos de Paulo Freire, visto que o ensino deve capacitar enfermeiras com competências técnico-profissionais e conscientes do contexto sanitário, sociopolítico, organizacional, econômico, do trabalho em saúde da mulher e da própria profissão, para que sejam capazes de participar ativamente na mudança do modelo hegemônico e de implementar as práticas humanizadas e voltadas para as necessidades da mulher. Os objetivos da pesquisa foram: analisar como ocorre o ensino em serviço da preceptoria da residência em enfermagem obstétrica nos cenários da prática hospitalar; identificar as estratégias pedagógicas adotadas pela preceptoria durante esta formação; discutir as potencialidades e os limites do ensino em serviço para a formação de enfermeiras obstétricas capazes de atuar na mudança do modelo assistencial medicalizado. Para alcançá-los, optou-se pela pesquisa de abordagem qualitativa e do tipo descritiva. Os cenários foram quatro maternidades públicas municipais onde são desenvolvidas as atividades práticas dos programas de residência de enfermagem obstétrica, com coordenação pedagógica da Faculdade de Enfermagem da Universidade do Estado do Rio Janeiro (UERJ), onde foram entrevistadas dezesseis enfermeiras obstétricas preceptoras, por atuarem diretamente na formação das residentes de enfermagem obstétrica. A análise foi guiada pela hermenêutica-dialética. Foram construídas duas categorias: a) O ensino em serviço da preceptoria ocorre segundo a rotina assistencial e apresenta contradições entre a teoria e a prática; b) O papel da preceptora no ensino em serviço: ênfase nas práticas humanizadas, mas limitado pela organização do ensino e do trabalho da enfermeira obstétrica no hospital. Os resultados demonstram que o ensino em serviço ocorre segundo a rotina assistencial com valorização da unidade teórico-prática, possibilitando a integração de teoria, vivência e trabalho, defendida por Paulo Freire. Visa ao modelo humanizado, baseado nas individualidades de cada mulher, porém sua efetivação é prejudicada por fatores relacionados à organização do processo formativo, que exige a constituição de um elo de comunicação entre universidade e serviço. As preceptoras utilizam estratégias de ensino, como a discussão de casos, leitura de artigos científicos e questionamentos acerca da prática. Contudo, não estimulam o pensamento crítico sobre os conflitos e as resistências do contexto assistencial em que a residência se efetiva. Elas dão ênfase para a realização de procedimentos técnicos, almejando o aprendizado de habilidades e destrezas. Espera-se que este estudo contribua para a melhora desta formação. Recomenda-se que seja estimulada a comunicação entre academia e os campos de prática, e que esta aproximação também seja próspera para as preceptoras, promovendo a expansão de seu conhecimento didático-pedagógico e, consequentemente, favorecendo sua prática como preceptoras.

The object of this research is the role of preceptorship in the in-service training of nurse-midwives in residency programs. Paulo Freire's pedagogical concepts can be applied to the teaching of nurse-midwifery, since education should capacitate nurses with technical and professional competencies and make them aware of the healthcare, sociopolitical, organizational and economic contexts, as well as the work in the area of women's healthcare and their own profession, so they will be able to actively participate in changing the hegemonic model and to implement humanized practices focused on women's needs. The objectives of the research were: to analyze how the nurse-midwifery residency preceptorship in-service teaching occurs in the scenarios of hospital practice; to identify the pedagogical strategies adopted by the preceptorship during this training process; to discuss the potentialities and limits of in-service education for the training of nurse-midwives capable of contributing to the change of the medicalized health care model. A qualitative and descriptive approach was chosen in order to achieve these objectives. The scenarios were four public maternity hospitals, where the practical activities of nurse-midwifery residency programs are carried out under the pedagogical coordination of the School of Nursing of the State University of Rio de Janeiro (UERJ), where sixteen preceptors of nurse-midwifery were interviewed, since they directly participate in the training process of the residents of the nurse- midwifery program. The analysis was conducted based on the dialectical hermeneutics method. Two categories were built: a) The preceptorship in-service teaching occurs according to the care routine and presents contradictions between theory and practice; b) The preceptor's role in the in-service training: oriented to humanized practices, but constrained by the organization of the nurse-midwives' training and work load dynamics in the hospital. The results showed that the in-service training takes place according to the care routine with and that it values the unity of theory and practice, which enables the integration of theory, work and experience, as advocated by Paulo Freire. It aims for the humanized model, based on the individuality of each woman, but its effectiveness is hampered by factors related to the organization of the training process, which requires the establishment of a communication link between the university and the scenarios for practice. The preceptors use teaching strategies such as case discussions, reading of scientific papers and questions regarding the practice. However, they do not stimulate critical thinking about the conflicts and the resistance in the care context in which the residency program occurs. They emphasize the performance of technical procedures, aiming at the learning of abilities and skills. It is expected that this study will further contribute to the improvement of residency training. It is recommended that the communication between the academy and practice fields be stimulated, and that this proximity may also be thriving for preceptors, promoting the expansion of their pedagogical and didactic knowledge, consequently favoring their practice as preceptors.

Conformidade da assistência de enfermeiras obstétricas às recomendações para o parto normal: estudo em duas maternidades / Compliance of nurse-midwives' care with the recommendations for normal birth: a study in two hospitals

Esta dissertação objetivou avaliar a conformidade das práticas assistenciais nos partos normais atendidos pela enfermeira obstétrica com as recomendações e normas técnicas vigentes; e comparar a conformidade dessas práticas entre as equipes de enfermeiras obstétricas de duas maternidades públicas. Estudo transversal, retrospectivo, comparativo e baseado em dados secundários de duas maternidades públicas, com equipes de enfermeiras obstétricas com predominância de modalidades de formação diferentes. Foram incluídos na pesquisa os registros dos atendimentos realizados por enfermeiras obstétricas durante o período do trabalho de parto e parto normal de mulheres com gestações normais ou classificadas de risco habitual, de feto único, com apresentação cefálica fletida e idade gestacional entre 37 semanas e 41 semanas e 6 dias. Foram analisados 266 atendimentos das enfermeiras obstétricas aos partos normais na maternidade A e 254 atendimentos na maternidade B. A coleta de dados ocorreu por meio de instrumento elaborado a partir das recomendações da OMS para a assistência ao parto normal. Adotaram-se as seguintes categorias de avaliação: de 100 a 75% ­ conformidade adequada; de 74 a 50% ­ conformidade parcial; e abaixo de 50% ­ sem conformidade. Foi aplicado o teste Z bicaudal, com intervalo de confiança de 95%, = 0,05 e p-valor0,025 para verificar a diferença estatística significante entre as proporções de conformidade das práticas recomendadas nas amostras investigadas. As enfermeiras obstétricas atendem predominantemente as mulheres primíparas e que realizaram sete ou mais consultas de pré-natal. Quanto às práticas assistenciais da Categoria A da OMS, todas as variáveis testadas na maternidade A apresentam conformidade adequada. Na maternidade B, a única prática que obteve conformidade parcial foi o clampeamento oportuno do cordão umbilical e as demais também apresentaram conformidade adequada. A maternidade A apresentou maior proporção de registros em três parâmetros assistenciais recomendados em comparação com a maternidade B: a presença do acompanhante antes do parto, presença do acompanhante no parto e clampeamento oportuno do cordão umbilical, enquanto na maternidade B houve maior percentual em relação aos registros do uso do partograma e da ausculta dos batimentos cardiofetais. Foi reduzido o quantitativo de mulheres atendidas pelas enfermeiras obstétricas que teve complicações após o parto, 7,1% na maternidade A e 5,1% na maternidade B. Quanto aos neonatos, em 0,8% dos bebês na maternidade A e em 6,3% na maternidade B foram utilizadas manobras de reanimação. Os recém-nascidos encaminhados à unidade neonatal representaram 0,8% na maternidade A e 4,3% na maternidade B. Não houve registro de natimortalidade, óbito neonatal ou materno em ambas as instituições. Os resultados encontrados parecem favorecer a maternidade A, onde a equipe de enfermeiras obstétricas tem maior quantitativo de egressas da formação na modalidade de residência. Contudo, ainda há práticas utilizadas de forma inadequada, como a prescrição de dieta zero e ocitocina para acelerar o trabalho de parto em boa parte das parturientes, o que denota a necessidade de aprimorar a conformidade de alguns parâmetros assistenciais para a clientela de baixo risco obstétrico em ambas as maternidades.

This work aimed to evaluate the compliance of care practices in normal births attended by nurse-midwives with existing recommendations and technical standards; and compare the compliance of such practices between two teams of nurse-midwives from two public hospitals. Cross-sectional, retrospective, comparative study, based on secondary data from two public maternity hospitals, with teams of nurse-midwives with a predominance of different educational and training backgrounds. The study included the record of the assistance provided by nurse- midwives during labor and normal birth of women with normal or low-risk pregnancies, with a single fetus in vertex presentation, and gestational age between 37 weeks and 41 weeks and 6 days. In Maternity A, 266 attendances of nurse-midwives during normal birth were analyzed versus 254 attendances in Maternity B. Data collection occurred through a questionnaire elaborated following the WHO recommendations for normal birth care. The following assessment categories were adopted: 100-75% - adequate compliance; 74-50% - partial compliance; and below 50% - no compliance. The two-tailed Z-test was applied, with a 95% confidence interval, = 0.05 and p-value0.025, to check the statistically significant difference between the proportions of compliance with recommended practices in the investigated samples. Nurse- midwives assist predominantly primiparas who had seven or more prenatal consultations. In relation to the WHO Category A care practices, all variables tested in Maternity A presented adequate compliance. In Maternity B, the only practice that obtained partial compliance was timely cord clamping and the others showed adequate compliance as well. Maternity A showed a higher proportion of records regarding three recommended care parameters compared with Maternity B: the partner's presence before labor, the partner's presence during childbirth and timely cord clamping, while in Maternity B there was a higher percentage of records regarding the use of partograph and auscultation of fetal heart rate. The number of women attended by nurse- midwives who had complications after birth was low, 7.1% in Maternity A and 5.1% in Maternity B. With regard to newborns, resuscitation maneuvers were used in 0.8% of the babies in the Maternity A and 6.3% in Maternity B. Newborns referred to the neonatal unit accounted for 0.8% in Maternity A and 4.3% in Maternity B. There were no reports of stillbirth, neonatal or maternal death at both institutions. The results seem to favor Maternity A, where the team of nurse- midwives has a higher quantity of graduates from residency training programs. However, there are still inappropriate practices, such as zero diet prescription and oxytocin to accelerate labor for most of the parturients, which shows the need to improve the compliance of some assistance parameters for low-obstetric-risk parturients in both hospitals.

Incorporating Nurse-Midwifery Students into Graduate Medical Education: Lessons Learned in Interprofessional Education.

There is a current emphasis on interprofessional education in health care with the aim to improve teamwork and ultimately the quality and safety of care. As part of a Health Resources and Services Administration Advanced Nursing Education project, an interprofessional faculty and student team planned and implemented the first didactic coursework for nurse-midwifery and medical students at the University of California, San Francisco and responded to formative feedback in order to create a more meaningful educational experience for future combined cohorts. This article describes the process of including advanced nurse-midwifery students into 2 classes previously offered solely to medical students: 1) an elective in which students are matched with a pregnant woman to observe care that she receives before, during, and after giving birth; and 2) a required course on basic clinical care across the human lifespan. The development of these interprofessional courses, obstacles to success, feedback from students, and responses to course evaluations are reviewed. Themes identified in student course evaluations included uncertainty about interprofessional roles, disparity in clinical knowledge among learners, scheduling difficulties, and desire for more interprofessional education opportunities and additional time for facilitated interprofessional discussion. As a result of this feedback, more class time was designated for interprofessional exchange; less experienced rather than advanced midwifery students were included in both classes; and more interdisciplinary panel presentations were provided, along with clearer communication about student and clinician roles. Early project activities indicated nurse-midwifery students can be effectively included in existing medical student courses with revised curriculum and highlighted challenges that should be considered in the planning phase of similar projects in the future. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

The Effect of Uterine and Nipple Stimulation on Induction With Oxytocin and the Labor Process.

AIMS: The present research study was conducted with the objective of determining the effect of uterine and nipple stimulation on induction with oxytocin and the birth process. METHODS: A randomized controlled experiment was conducted at the maternity ward of a state hospital located in the province of Sivas in Turkey. Three hundred ninety pregnant women who were giving birth via vaginal delivery were randomly assigned to three groups (nipple stimulation, uterine stimulation, control). After the birth, the groups were assessed in terms of the birth duration and synthetic induction with oxytocin. Statistical analyses were performed through the use of SPSS 14.0 software and included analysis of variance, Tukey's test, Dunnett's test, Tamhane's T2 test, and chi-square test. RESULTS: The study established statistically significant differences (p < .05) among the groups in terms of the average durations of the first, second and third phases of the action of birth, the status concerning delivery by C-section and the application of labor induction. The phases of birth were shorter for the nipple stimulation group (first phase: 3.8 hours, second phase: 16 minutes, third phase: 5 minutes) and the uterine stimulation group (first phase: 4.0 hours, second phase: 21 minutes, third phase: 6 minutes) when compared to the control group (first phase: 6.8 hours, second phase: 27 minutes, third phase: 6 minutes). In the control group, 89.2% of the pregnant women were subject to labor induction and 8.5% to cesarean section. No women in the nipple stimulation group or uterine stimulation group had a cesarean section. LINKING EVIDENCE TO ACTION: Nipple and uterine stimulation reduce the frequency of elective labor induction, the rate of relevant complications, and support normal vaginal birth by providing endogenous labor induction. Therefore, these interventions should be considered for pregnant women in labor.

Establishing a volunteer doula program within a nurse-midwifery education program: a winning situation for both clients and students.

The use of labor doulas is beneficial for mothers and newborns, but availability and cost can be barriers. The Nashville Volunteer Doula Program was formed to provide labor support to clients of a faculty nurse-midwifery practice. The volunteer doula pool is comprised of both nurse-midwifery students who have trained as doulas and community doulas. Training and coordination of volunteers are managed by nurse-midwifery students with faculty support. Students gain valuable exposure to providing supportive care during labor and birth, which augments their nurse-midwifery education. This novel program operates at a low cost and offers benefits to students as well as women who use the doula service. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

How clinical nurse and midwifery consultants optimise patient care in a tertiary referral hospital.

AIMS AND OBJECTIVES: To develop new insights into the phenomenon of clinical nurse/midwifery consultant clinical effectiveness in a tertiary referral hospital. BACKGROUND: International studies identify the pivotal role clinical nurse/midwifery consultants play in patient outcomes. There remains, however, a significant deficit in our knowledge of how these, or other advanced practice nurses and midwives, apply their extensive experience, ontological understandings and tacit knowledge to the enhancement of patient outcomes in complex healthcare environments. DESIGN: This study was underpinned by the principles of Heideggerian hermeneutic phenomenology. METHODS: Recruitment involved expressions of interest distributed hospital-wide to clinical nurse/midwifery consultants. Inclusion criteria specified a minimum of three years' experience. Fifteen clinical nurse/midwifery consultants, representing a broad range of specialties, were interviewed. Preliminary descriptive analysis of transcribed data was followed by in-depth hermeneutic analysis. RESULTS: The findings comprise four themes: walking beside the patient, anticipating the unexpected, pushing through barriers and leading within a complex system. These themes highlight how clinical nurse/midwifery consultants significantly influence pre-existing trajectories of patient care delivery through context-appropriate strategies. CONCLUSION: This study introduces new insights into the meanings advanced practice nurses and midwives develop from their engagements with patients and how these meanings inform clinical decisions. The paper accomplishes this by drawing on Heideggerian philosophical concepts such as ontological understandings, authenticity and care. It also casts light on the participants' shared understandings of how to synergise expectations within the team. RELEVANCE TO CLINICAL PRACTICE: The significance of this paper lies in the uncovering of ontological understandings and tacit knowledge of how consultant nurses and midwives optimise patient care delivery in challenging situations. The findings indicate, however, that the value of these internationally established roles is yet to be fully realised. The paper concludes by recommending strategies to assist newly appointed clinical nurse/midwifery consultants transition into these demanding autonomous roles.

Localização das lacerações perineais no parto normal em mulheres primíparas / Locus of perineal lacerations in vaginal birth among primiparous women / Localización de las laceraciones perineales en el parto normal en mujeres primíparas

Estudo de tipo transversal, cujo objetivo foi analisar a distribuição das lacerações vulvo-perineais e os fatores relacionados à sua localização nas regiões anterior e posterior do períneo no parto normal. A amostra foi constituída por 317 primíparas que tiveram parto normal sem episiotomia e apresentaram laceração perineal. Os dados foram coletados em dois centros de parto normal, nas cidades de São Paulo e Itapecerica da Serra, Estado de São Paulo, no período de 2001 a 2012, e integram o banco de dados de cinco subprojetos vinculados ao projeto Trauma perineal no parto normal: prevenção, morbidade e cuidados. Houve predomínio de lacerações na região posterior do períneo. Não houve diferença estatística significante em relação ao local da laceração perineal e a posição materna no parto, variedade de posição no desprendimento cefálico, circular de cordão umbilical e peso do recém-nascido, porém houve diferença significante em relação ao tipo de puxo.

Cross-sectional study, aiming at analyzing the distribution of vulvo-perineal lacerations and factors related to its location in anterior and posterior region of perineum in spontaneous birth. Sample was comprised of 317 women who had vaginal delivery without episiotomy and with perineal laceration. Data were collected in two centers of normal birth, in the cities of São Paulo and Itapecerica da Serra, in the state of São Paulo, Brazil, from 2001 to 2012. It integrates the database of five subprojects under the Perineal trauma in normal birth: prevention, morbidity and care project. There was predominance of lacerations in the posterior perineum region. There was no statistically significant difference in relation to the location of the perineal laceration and the maternal position during delivery, variety of fetal head position in the detachment, umbilical cord circular, and weight of the new-born, but there was significant difference concerning the kind of pushing.

Estudio transversal, cuyo objetivo fue analizar la distribución vulvo-perineal de las laceraciones y los factores relacionados con su localización en el parto normal. La muestra consistió de 317 mujeres primíparas que tuvieron parto normal sin episiotomía y presentaron laceración perineal. Los datos fueron recolectados en dos centros de parto normal, en las ciudades de São Paulo e Itapecerica da Serra, Estado de São Paulo – Brasil, de 2001 a 2012, y forman parte de la base de datos de cinco subproyectos relacionados al proyecto Trauma perineal en el parto normal: prevención, morbilidad y cuidados. Hubo predominio de laceraciones en la región posterior del perineo. No hubo diferencia estadísticamente significativa en relación a la localización de la laceración perineal y la posición materna durante el parto, variedad de posición en la cabeza fetal en el desprendimiento, circular de cordón umbilical y peso del recién nacido, pero hubo diferencia significativa en relación al tipo de pujo.

Methods and Estimates of the Reimbursement for the Nurse Midwifery Center in the National Health Insurance.

PURPOSE: The purpose of this study is to develop the optimal nursing fee for nurse-midwifery center (MC) in the national health insurance system. METHODS: The three methodologies used to calculate the conversion factors for the MCs in the national health insurance include cost accounting method, sustainable growth rate (SGR) model, and index model. In this study, the macro-economic indicators and the national statistics were used to estimate the conversion factors for the MCs. RESULTS: The optimal nursing fee for the MCs in 2011 was estimated to be an increase of 57.7% by cost accounting analysis, a decrease of 17.1% by SGR model, and a decrease of 16.1% by index model. The results from SGR model and index model could had been biased due to the upswing of medical spendings in the short-term period (2008~2009). A sensitivity analysis of pre-delivery subsidy program for OB & GYN hospitals and clinics showed that the program has substantially diminished the demand for the MC services. CONCLUSION: More reliable methodologies to estimate nursing fees precisely are required to prove the value of nurses' services and a government subsidy program for the MC services should be followed from a social perspective.

Methods and Estimates of the Reimbursement for the Nurse Midwifery Center in the National Health Insurance / 여성건강간호학회지

PURPOSE: The purpose of this study is to develop the optimal nursing fee for nurse-midwifery center (MC) in the national health insurance system. METHODS: The three methodologies used to calculate the conversion factors for the MCs in the national health insurance include cost accounting method, sustainable growth rate (SGR) model, and index model. In this study, the macro-economic indicators and the national statistics were used to estimate the conversion factors for the MCs. RESULTS: The optimal nursing fee for the MCs in 2011 was estimated to be an increase of 57.7% by cost accounting analysis, a decrease of 17.1% by SGR model, and a decrease of 16.1% by index model. The results from SGR model and index model could had been biased due to the upswing of medical spendings in the short-term period (2008~2009). A sensitivity analysis of pre-delivery subsidy program for OB & GYN hospitals and clinics showed that the program has substantially diminished the demand for the MC services. CONCLUSION: More reliable methodologies to estimate nursing fees precisely are required to prove the value of nurses' services and a government subsidy program for the MC services should be followed from a social perspective.