Perinatal Nurses' Experiences With and Knowledge of the Care of Incarcerated Women During Pregnancy and the Postpartum Period.

OBJECTIVE: To describe perinatal nurses' experiences of caring for incarcerated women during pregnancy and the postpartum period; to assess their knowledge of the 2011 position statement Shackling Incarcerated Pregnant Women published by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN); and to assess their knowledge of their states' laws regulating nonmedical restraint use, or shackling, of incarcerated women. DESIGN: Cross-sectional survey. SETTING: Online across the United States. PARTICIPANTS: AWHONN members who self-identified as antepartum, intrapartum, postpartum, or mother-baby nurses (N = 923, 8.2% response rate). METHODS: A link to an investigator-developed survey was e-mailed to eligible AWHONN members (N = 11,274) between July and September 2017. RESULTS: A total of 74% (n = 690) of participants reported that they cared for incarcerated women during pregnancy or the postpartum period in hospital perinatal units. Of these, most (82.9%, n = 566) reported that their incarcerated patients were shackled sometimes to all of the time; only 9.7% reported ever feeling unsafe with incarcerated women who were pregnant. "Rule or protocol" was the most commonly endorsed reason for shackling. Only 17.0% (n = 157) of all participants knew about the AWHONN position statement, and 3% (n = 28) correctly identified the conditions under which shackling may ethically take place (risk of flight, harm to self, or harm to others). Only 7.4% (n = 68) of participants correctly identified whether their states had shackling laws. CONCLUSION: Our results suggest critical gaps in nurses' knowledge of professional standards and protective laws regarding the care of incarcerated women during pregnancy. Our findings underscore an urgent need for primary and continuing nursing education in this area.

Humanized Care: insertion of obstetric nurses in a teaching hospital. / Cuidados humanizados: a inserção de enfermeiras obstétricas em um hospital de ensino.

OBJECTIVE:: to evaluate the care provided at an Antepartum, Intrapartum, Postpartum (AIP) unit at a teaching hospital following the inclusion of obstetric nurses. METHOD:: transversal study, performed at a AIP unit at a teaching hospital in the capital of the Brazilian state of Mato Grosso. The sample comprised data regarding the 701 childbirths that took place between 2014 and 2016. The data were organized using Excel and analyzed using version 7 of Epi Info software. RESULTS:: the results suggest that including obstetric nurses contributed towards qualifying the care provided during labor and childbirth, followed by a reduction in the number of interventions, such as episiotomy caesareans sections, and resulting in encouragement to employ practices that do not interfere in the physiology of the parturition process, which in turn generate good perinatal results. CONCLUSION:: inserting these nurses collaborated towards humanizing obstetric and neonatal care.

Cuidados humanizados: a inserção de enfermeiras obstétricas em um hospital de ensino / Cuidados humanizados: inserción de enfermeras obstétricas en un hospital de enseñanza / Humanized Care: insertion of obstetric nurses in a teaching hospital

RESUMO Objetivo: analisar a assistência prestada em uma unidade de Pré-parto/Parto/Pós-parto (PPP) de um hospital de ensino após a inserção de enfermeiras obstétricas. Método: estudo transversal, realizado em uma unidade de PPP de um hospital de ensino da capital do estado de Mato Grosso. A amostra foi composta por dados relativos a 701 partos normais ocorridos entre os anos de 2014 e 2016. Os dados foram organizados com uso do software Excel e analisados no Epi Info versão 7. Resultados: os resultados sugerem que a inserção das enfermeiras obstétricas contribuiu para a qualificação do cuidado prestado ao parto e ao nascimento, uma vez que ocorreu a redução de intervenções, tais como a episiotomia e as cesarianas, havendo o incentivo ao uso de práticas que não interferem na fisiologia do processo parturitivo, gerando bons resultados perinatais. Conclusão: a inserção dessas enfermeiras colaborou com a humanização do cuidado obstétrico e neonatal.

RESUMEN Objetivo: analizar la atención brindada en unidad de Preparto/Parto/Posparto (PPP) de hospital de enseñanza luego de inserción de enfermeras obstétricas. Método: estudio transversal, realizado en unidad de PPP de hospital de enseñanza de la capital del Estado de Mato Grosso. Muestra compuesta por datos relativos a 701 partos normales sucedidos entre 2014 y 2016. Datos organizados utilizando software Excel y analizados con Epi Info versión 7. Resultados: los resultados sugieren que la inserción de enfermeras obstétricas contribuyó a la calificación del cuidado brindado al parto y al nacimiento, habiéndose constatado que existió reducción de intervenciones tales como la episiotomía y la cesárea, existiendo un incentivo para la elección de prácticas que no interfieran con la fisiología del proceso de parición, generándose buenos resultados perinatales. Conclusión: la inserción de las enfermeras colaboró con la humanización del cuidado obstétrico y neonatal.

ABSTRACT Objective: to evaluate the care provided at an Antepartum, Intrapartum, Postpartum (AIP) unit at a teaching hospital following the inclusion of obstetric nurses. Method: transversal study, performed at a AIP unit at a teaching hospital in the capital of the Brazilian state of Mato Grosso. The sample comprised data regarding the 701 childbirths that took place between 2014 and 2016. The data were organized using Excel and analyzed using version 7 of Epi Info software. Results: the results suggest that including obstetric nurses contributed towards qualifying the care provided during labor and childbirth, followed by a reduction in the number of interventions, such as episiotomy caesareans sections, and resulting in encouragement to employ practices that do not interfere in the physiology of the parturition process, which in turn generate good perinatal results. Conclusion: inserting these nurses collaborated towards humanizing obstetric and neonatal care.

Understanding the moral nature of intrapartum nursing.

OBJECTIVE: To explore how intrapartum nurses understand and negotiate their moral responsibilities toward women during childbirth. DESIGN: Qualitative critical narrative. SETTING: Labor and birth unit in an urban Canadian hospital. PARTICIPANTS: Fourteen intrapartum registered nurses. METHODS: Critical narrative analysis using a feminist ethics perspective. RESULTS: Nurses understood their moral responsibilities to laboring women in a variety of ways depending on the nurses' personal and professional experiences, the people involved, and the context of care. Four themes were identified: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. A key factor influencing responses to women was the degree to which expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women, and their families. Although nurses were able to identify contextual influences that constrained their ability to maintain effective relationships with women, the influence of their own values on the care they provided was less apparent. Nurses also described limits of their responsibilities for others, which departed from the idealized expectations often reflected in professional guidelines CONCLUSION: These findings suggest a need to challenge assumptions related to the provision of choice and family centered care to create environments that can support and sustain understanding and trust between nurses and women giving birth. In addition, given the lack of shared understandings of what constitutes best care, there is a need to develop collaborative models of care that include the voices of women as a central component.

Professional quality of life of Japanese nurses/midwives providing abortion/childbirth care.

This study explored the relationship between professional quality of life and emotion work and the major stress factors related to abortion care in Japanese obstetric and gynecological nurses and midwives. Between October 2011 and January 2012, questionnaires that included questions concerning eight stress factors, the Professional Quality of Life Scale, and the Japanese version of the Frankfurt Emotional Work Scale, were answered by 255 nurses and midwives working in abortion and childbirth services. Professional Quality of Life scores (compassion fatigue, compassion satisfaction, burnout) were significantly associated with stress factors and emotion work. Multiple regression analysis revealed that of all the evaluated variables, the Japanese version of the Frankfurt Emotional Work Scale score for negative emotions display was the most significant positive predictor of compassion fatigue and burnout. The stress factors "thinking that the aborted fetus deserved to live" and "difficulty in controlling emotions during abortion care" were associated with compassion fatigue. These findings indicate that providing abortion services is a highly distressing experience for nurses and midwives.

Ethical decision making in intrapartum nursing.

Nurses are confronted daily with making ethical decisions in practice, in which the "right" or best course of action must be determined. However, for intrapartum nurses, the seemingly ordinary nature of ethical issues means that these concerns may be viewed merely as clinical or logistical problems to be solved, leaving the ethical dimensions obscured. This has consequences not only for women and the provision of safe, family-centered maternity care but also for the quality of nurses' work environments and degree of moral distress experienced. This article explores ethical aspects of intrapartum nursing by applying ethical principles and moral reasoning to an "everyday" situation encountered by intrapartum nurses in practice. Implications for practice and the development of healthy moral communities are considered.

Cuidado Humanizado para el ser humano, antes del nacimiento y desde sus primeros minutos de vida / Humanized care for human beings, before birth and from his earliest minutes of life

El cuidado de enfermería es y sigue siendo tema principal de las agendas investigativas y de debate en todas las áreas de especialidad de nuestra profesión, y el cuidado de la paciente obstétrica especialmente durante su etapa de gestación y el parto, no escapa a esta reflexión.Esta preocupación ha provocado con el transcurrir del tiempo, una transformación de esa atención, desde una básica y sencilla en sus orígenes, a una reciente con más instrumentación o intervención durante la labor del parto y el parto, todo con la intención de disminuir los riesgos implícitos en la evolución de esta etapa. Sin embargo, esta tecnocratización si bien ha logrado su cometido en la disminución de complicaciones y riesgos, ha ido poco a poco alejando a la enfermera del cuidado humanístico y afectivo.El artículo reflexiona sobre la susceptibilidad emocional que tiene la gestante en labor y el impacto permanente que la experiencia del parto tiene en ella como mujer, madre, esposa. Incluye aportes de aplicación o prácticos, acerca de la forma de implantar este cuidado en nuestros hospitales, propone una filosofía o creencias que nos permitirán como enfermeras ofrecer cuidado humano al binomio, madre e hijo, es decir al ser humano, antes del nacimiento y desde sus primeros minutos de vida.

Nursing care is and remains the focus of research and discussion agenda in all specialty areas of our profession, and the obstetric patient care especially during her pregnancy and childbirth, is not an exception to this reflection. This concern has led, with the passage of time, to a transformation of that care, from a basic and simple care in its origins, to a recent approach with more instrumentation or intervention during labor and delivery, in order to reduce the risks implicit in the evolution of this stage. However, although this this technocratization has achieved its purpose in reducing complications and risks, it has been slowly distancing nurses form the humanistic and affective care. This article reflects on the emotional susceptibility of mother during labor and, the permanent impact that the birth experience has on her as a woman, mother and wife. It includes contributions and a practical approach about how to implement this type of care in our hospital. It also offers a philosophy or belief that will enable us, as nurses, provide a better and more humane care to both mother and child, i.e. to the human being before birth and from his earliest minutes of life.

Ethics of infant relinquishment, cultural considerations, and obstetric conveniences.

Ethical issues relating to infant relinquishment, caring for culturally diverse women, the importance of shared power between women and their caregivers, and the provision of evidence-based practice versus reliance on obstetric conveniences are addressed in this article. Respectful care of women relinquishing their infants including use of appropriate language demonstrates moral and ethical nursing practice; providing cultural competent care of multilinguistic, multicultural, and multiethnic childbearing women and their families is an ethical imperative. Nurses practicing ethically will foster adoption of best practices on perinatal and neonatal units, and generate a clearly articulated vision of woman and family centered organizational culture. In ethical terms, this demonstrates respect for others as well as beneficence. Promoting the use of ethical nursing practice and evidence-based practice requires that nurses identify change agents, those who are champions and facilitators of evidence-based practice, and then reward such innovators and make sure that clinical guidelines be developed based on best practices.

Applying ethical practice competencies to the prevention and management of unintended pregnancy.

Using a case study that incorporates patient, nurse practitioner, and student perspectives, we address ethical principles of respect for autonomy, beneficence, and fairness; professionals' right of conscience; and a social justice model for the discussion of prevention and management of unintended pregnancy. Through an ongoing process of self-reflection and values clarification, nurses can prepare for the challenge of applying ethical principles to the reproductive health care of women.

A enfermeira obstétrica frente às transformações de sua prática consequente ao movimento de humanização do campo obstétrico hospitalar / The midwife in the face of changes in practice subsequent to the movement of the humanization of obstetric field

Este estudo de perspectiva histórico-social estuda as transformações das práticas das enfermeiras obstétricas consequente ao movimento de humanização do campo obstétrico hospitalar. Tem por objetivos: identificar o capital global das enfermeiras obstétricas; analisar as concepções das enfermeiras sobre a prática profissional no campo obstétrico hospitalar no contexto do movimento de humanização; discutir as transformações percebidas pelas enfermeiras obstétricas sobre sua prática. Utilizei como método a história oral. Os sujeitos foram 25 enfermeiras que vivenciaram no campo obstétrico hospitalar, antes e após a implementação do movimento de humanização. Os cenários foram seis maternidades municipais do Rio de Janeiro. A técnica de coleta de dados foi a entrevista semiestruturada. À luz da perspectiva histórica realizarei a análise dos dados, tendo como base os pressupostos de Pierre Bourdieu. A conjuntura obstétrica do nascimento das entrevistadas era a de transição do parto domiciliar para o ambiente hospitalar. O cenário do parto e nascimento de muitas delas foi uma instituição pública de saúde ou conveniada. As agentes são oriundas de famílias humildes, com pouco capital econômico e cultural. Ressalta-se que as condições de acumulação de capital destas enfermeiras, à época, foram proporcionais às oportunidades que tiveram no campo social em que se encontravam e do processo de socialização. Algumas, após o curso de graduação em enfermagem, buscaram a especialização para adquirir um certificado, que lhes aumentasse o volume de capital e as legitimasse para a realização da assistência ao parto normal. O contexto político onde muitas adquiriram o título de especialista era o de implementação do modelo humanizado no campo obstétrico do município do Rio de Janeiro, favorável para a redução de práticas intervencionistas à parturiente com o incentivo ao parto normal focado na autonomia e no empoderamento feminino...

This historical prospective study of social studies the changing practices of Obstetric Nurses (midwives) to the consequent movement of the humanization of obstetric field hospital. Its goals: to identify the global capital of midwives, to analyze the opinions of nurses on the practice field obstetric hospital in the context of humanization movement, to discuss the changes seen by the midwives on the practice. I used as a method of oral history. The subjects were twenty-five nurses who experienced obstetric hospital in the field before and after the implementation of humanization movement. The scenarios were six maternity hospitals in Rio de Janeiro. The technique of data collection was a semi-structured interview. In the light of historical perspective will perform data analysis, based on the assumptions of Pierre Bourdieu. The situation obstetric birth of the interviewees was the transition from home birth to hospital. The scene of childbirth for many of them was a public health institution or outsourced. The agents are from poor families, with little economic and cultural capital. It is emphasized that the conditions of capital accumulation of these nurses at the time were proportional to the opportunities they had in the social field they were in and the process of socialization. Some, after the undergraduate course in nursing have sought to acquire a specialization certificate, they increase the amount of capital and to legitimize the performance of normal delivery assistance. The political context where many have acquired the specialist title was the implementation of a humanized model in the field of obstetric Rio de Janeiro, favorable for the reduction of interventionist practices for women during childbirth to the promotion of normal birth focus on autonomy and female empowerment...

Buscando autonomia e poder: o processo decisório da adolescente pela gravidez - contribuição para o cuidar em enfermagem / Searching autonomy and power: the power to decide process of the pregnancy for the adolescent - contribution to take care of it in nursing

Pesquisa descritiva com abordagem qualitativa, cujo objeto foi o processo decisório da adolescente pela gravidez. Teve como objetivos descrever o significado para a adolescente grávida da sua decisão pela gravidez e discutir o impacto dessa decisão sobre a sua vida, à luz dos direitos reprodutivos e da bioética. A pesquisa foi realizada com oito adolescentes dos doze aos dezesseis anos, atendidas no ambulatório de pré-natal de uma instituição pública federal na cidade do Rio de Janeiro. A metodologia utilizada para a coleta e análise de dados foi a Grounded Theory. Foram evidenciadas duas categorias que descreveram os significados para as adolescentes dessa sua decisão: 1) Descobrindo-se grávida, cujas subcategorias expressaram o desejo de engravidar, o planejamento da gravidez e a surpresa com a confirmação da gravidez; 2) Optando pela gravidez, cujas subcategorias expressaram a rejeição ao aborto, a descoberta do poder e a experiência de autonomia advindos com a gravidez. Da integração destas categorias emergiu a categoria central representativa do processo social básico: Buscando Autonomia e Poder. Respeitar esta decisão, reconhecendo-a como um direito das adolescentes, representa o ponto de partida para um cuidado de enfermagem sensível, pautado nos princípios da bioética e da humanização. Isto implica a necessidade de profissionais treinados e cientes do que representam os direitos reprodutivos, entendendo que as adolescentes têm o direito de exercer sua sexualidade com segurança e liberdade de escolha e tendo direito à informação sobre meios, possibilidades, estratégias, riscos e vantagens para que possa decidir sobre a sua prole.

Nurses' attitudes toward pregnancy termination in the labor and delivery setting.

OBJECTIVE: To examine nurses' attitudes toward pregnancy termination in the labor and delivery setting and the frequency of nurse refusal to care for patients undergoing pregnancy termination. DESIGN: Nonexperimental, descriptive study. SETTING: Six central and northern California hospitals, including Level 1, 2, and 3 facilities. PARTICIPANTS: Seventy-five labor and delivery registered nurses. METHOD: Anonymous survey with visual analog scales. RESULTS: Ninety-five percent of the nurses indicated they would agree to care for patients terminating a pregnancy because of fetal demise, 77% would care for patients terminating a fetus with anomalies that were incompatible with life, and 37% would care for patients terminating for serious but nonlethal anomalies, with a significant drop in agreement as gestation advanced. Few nurses would agree to care for patients undergoing termination for sex selection, selective reduction, or personal reasons. Nurses both accepting and refusing patient care assignments were criticized by coworkers. CONCLUSION: Clear guidelines should be established on how to handle nurse refusal to care for patients terminating pregnancy in advance. Open discussions should be encouraged between staff and management to minimize criticism.

Should women be given a choice about fetal assessment in labor?

Continuous electronic fetal monitoring (EFM) in labor is one of the most commonly used interventions during intrapartum care. However, randomized controlled trials, observational studies, and meta-analyses about the use of continuous EFM on low-risk intrapartum patients have found no significant differences in infant outcomes between infants whose mothers had EFM or intermittent auscultation (IA) of the fetal heart rate. In addition, research shows a higher incidence of cesarean birth when EFM is used. Although evidence-based practice is supposed to be our goal, the evidence about the lack of efficacy of EFM has not been used in practice. In fact, EFM has become the standard of practice in this country. Considering these facts, should EFM continue to be the standard of practice for low-risk laboring women? Is informed consent indicated, giving women the choice between EFM and IA? Should IA be offered to all low-risk laboring women? Ethical decision-making models are used to examine those questions and to help nurses better delineate their advocacy role.

Tendo que vencer o próprio preconceito: a mulher enfermeira cuidando da mulher que provoca aborto / Having to overcome own prejudice: nurses taking care of woman that provokes abortion

O presente estudo teve como temática os significados atribuídos pelas mulheres enfermeiras que trabalham em maternidades às mulheres que provocam o aborto, e por conseqüência as maneiras pelas quais se estabelecem as relações de interação entre estas mulheres no processo de cuidar em enfermagem. Constituiu-se numa pesquisa descritiva, de abordagem qualitativa, que teve como base os pressupostos da Interação Simbólica e da Grounded Theory. Para obtenção dos dados foi utilizada a estratégia de entrevistas não estruturadas, gravadas em fita cassete, realizadas com enfermeiras atuantes numa maternidade da rede municipal, de referência para realização do aborto terapêutico, na Cidade do Rio de Janeiro. O interesse pelo estudo foi decorrente de anos de trabalho e de ampla experiência da autora no atendimento à clientela feminina, sendo que o tratamento desumano e agressivo oferecido às mulheres, nos casos de aborto provocado nas unidades da rede pública, foi o que despertou o interesse em realizar esta pesquisa. No cotidiano das interações entre mulheres que provocam aborto e enfermeiras que trabalham em maternidade, observou-se estarem fortemente presentes relações de gênero e de poder, determinantes de padrões comportamentais e sexuais rígidos para o sexo feminino na sociedade. Foram abordados dogmas religiosos que defendem a vida intra-uterina a qualquer preço e suas influências no cuidado prestado pelas enfermeiras às mulheres que provocam o aborto. Os resultados demonstraram que a mulher enfermeira vivencia um grande conflito ao cuidar da mulher que provoca aborto. Para estas, assistir as mulheres que provocam aborto é estar sempre "tendo que admitir a existência do próprio preconceito e a discriminação de todos os profissionais de Saúde, nesse tipo de atendimento", é ao mesmo tempo estar "tendo que vencer os próprios preconceitos". Ficou evidente ainda que, embora compreendam que esse comportamento é fruto de uma construção social que aprisiona o corpo feminino à reprodução, as enfermeiras não conseguem deixar de perceber esse ato como crime, e as mulheres que o praticam como criminosas, isto em conformidade com a concepção de ética que lhes é cobrada.