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.

Obstetric triage: a systematic review of the past fifteen years: 1998-2013.

BACKGROUND: Triage concepts have shifted the focus of obstetric care to include obstetric triage units. The purpose of this systematic review is to examine the literature on use of triage concepts in obstetrics during a 15-year time frame. METHODS: A systematic review was completed of the obstetric triage literature from 1998 to 2013 using the electronic online databases from PubMed, CINHAL, Ovid, and Cochrane Library Reviews within the English language. Reference lists of articles were reviewed to identify other pertinent publications. Both peer-reviewed and non-peer-reviewed documents were used. INCLUSION CRITERIA: articles specifically related to obstetric triage or obstetric emergency practices in the hospital setting. Exclusion criteria included: manuscripts that focused on general, nonobstetric emergency and triage units, telephone triage, out-of-hospital practices, other clinical conditions, and references outside the time frame of 1998-2013. RESULTS: Key categories were identified: legal issues and impact of Emergency Medical Treatment and Active Labor Act (EMTALA); liability pitfalls; risk stratification (acuity tools); clinical decision aids; utilization, patient flow, and patient satisfaction; impact on interprofessional education and advanced nursing practice; and management of selected clinical conditions. Components of a best practice model for obstetric triage are introduced. CONCLUSION: Seven key triage categories from the literature were identified and best practices were developed for obstetric triage units from this systematic review. Both can be used to guide future practice and research within obstetric triage.

The implications of professional practice of nurses’ obstetricians graduated from EEAN: the quality of care / As implicações da prática profissional de enfermeiros obstetras egressos da EEAN: a qualidade da assistência / Las consecuencias de la práctica profesional de enfermeros obstetras gradúados de EEAN: la calidad de la atención

Objetivo: Analisar as implicações da prática profissional desses enfermeiros egressos dos CEEO da EEAN/UFRJ para a qualidade da assistência à saúde da mulher. Método: Trata-se de um estudo qualitativo, onde os sujeitos foram vinte (20) enfermeiros obstetras egressos do CEEO/EEAN que atuam no Município do Rio de Janeiro. Resultados: A autonomia e a apropriação da prática dos enfermeiros obstetras são legitimadas e faz valer o direito como enfermeiro obstetra, entretanto, a autonomia da assistência ao parto está limitada por seu desconhecimento sobre o respaldo legal para atuar nesta área do cuidado, por conta do impedimento e preconceito o exercício profissional provenientes de instituições de saúde e da equipe médica por meio de violência verbal e de suas derivações, gerando implicações negativas para a qualidade da atenção e sua prática. Conclusão: Então, o reconhecimento profissional pela aceitação do exercício de enfermagem na sua plenitude deve ser legitimado.

Objective: To analyze the implications of professional practice of these nurses graduated from the CEEO EEAN / UFRJ for quality health care for women. Method: This was a qualitative study, where the subjects were twenty (20) obstetrician nurses graduated at CEEO / EEAN who work in the city of Rio de Janeiro. Results: The autonomy and ownership of the practice of midwives are legitimized and enforces the law as a nurse midwife, however, the autonomy of childbirth care is limited by its lack of knowledge about the legal support to serve in this area of care, due to the impediment professional practice and prejudice from health institutions and medical staff through verbal violence and its derivations, generating negative implications for the quality of care and practice. Conclusion: So, professional recognition by the acceptance of nursing practice in its entirety should be legitimized.

Objetivo: Analizar las implicaciones de esas enfermeras de práctica egresados de la EEAN CEEO / UFRJ para la atención de salud de calidad para las mujeres. Método: Se realizó un estudio cualitativo, donde los sujetos fueron veinte (20) parteras graduados CEEO / EEAN que trabajan en la ciudad de Río de Janeiro. Resultados: La autonomía y la propiedad de la práctica de las parteras son legitimadas y hace cumplir la ley como una partera, sin embargo, la autonomía de la atención del parto se ve limitada por su falta de conocimiento sobre el apoyo legal para servir en esta área de atención, debido al impedimento la práctica profesional y los prejuicios de las instituciones de salud y personal médico a través de la violencia verbal y sus derivaciones, generando consecuencias negativas para la calidad de la atención y la práctica. Conclusión: Por lo tanto, el reconocimiento profesional por la aceptación de la práctica de enfermería en su totalidad debe ser legitimado.

[Legal responsibilities of the nurse in obstetrical nursing]. / Responsabilidade legal do enfermeiro em obstetrícia.

The objective of this literature review is to identify how aspects related to legal responsibilities of the obstetrics nurse and the obstetrics nursing assistant have been approached in Brazilian publications. After researching the following databases for the period of 1980 to 2009; BDENF, CINAHL, LILACS, and SciELO, seven articles which dealt with judicial aspects were selected for this study. It was clear that none of these focused upon legal responsibilities for obstetrical nurses. Error prevention was highlighted among the majority of these publications, as well as civil and ethical responsibilities. However, the majority point out administrative sanctions and penal responsibilities. These aspects need to be researched in greater depth and reported upon, for they may contribute to more qualified formal education for nurses concerning the legal implications of their practice.

The midwives ordinance of Palestine, 1929: historical perspectives and current lessons.

Until 1929, midwifery in Palestine was relatively open to anyone and only partially regulated by the 1918 Public Health Ordinance, legislated shortly after the beginning of British rule. This article describes the factors that guided the shaping of midwifery and suggests possible sources of inspiration for the British legislator in crafting the Midwives Ordinance in 1929, including American, local (Jews and Arabs), and British ones. The Midwives Ordinance reflects the adjustment of midwifery to changes in the society that evolved under the British Mandate. The ordinance shows how the modern midwife's role contracted relative to the traditional one, in the context of social processes in other countries, east and west. This historical research project is based on interviews, archive documents and research literature. It analyzes the British interests in regulating midwifery, including the rationale of preserving public health and reducing infant mortality, against a background of political power struggles as well as cultural, social and professional diversity in Palestine (the tensions between the powers of doctors, nurses, and pharmacists).

Responsabilidade legal do enfermeiro em obstetrícia: [revisão] / Responsabilidad legal del enfermero en enfermería obstétrica: [revision] / Legal responsabilities of the nurse in obstetrical nursing: [review]

Trata-se de uma revisão da literatura, cujo objetivo foi identificar como os aspectos relacionados à responsabilidade legal do enfermeiro e do especialista em enfermagem obstétrica, têm sido abordados nas publicações brasileiras. Após pesquisa nas bases de dados BDENF, CINAHL, LILACS e SciELO, no período de 1980 a 2009, foram incluídos sete artigos que tratavam dos aspectos jurídicos. Constatou-se que nenhum deles enfocou a responsabilidade legal da enfermeira obstétrica. A prevenção do erro foi destacada na maioria das publicações, assim como a responsabilidade civil e ética, entretanto, a minoria salienta as sanções administrativas e a responsabilidade penal. Esses aspectos precisam ser mais pesquisados e divulgados, pois poderão contribuir a instrumentalização dos enfermeiros acerca das implicações legais de seus atos.

The objective of this literature review is to identify how aspects related to legal responsibilities of the obstetrics nurse and the obstetrics nursing assistant have been approached in Brazilian publications. After researching the following databases for the period of 1980 to 2009; BDENF, CINAHL, LILACS, and SciELO, seven articles which dealt with judicial aspects were selected for this study. It was clear that none of these focused upon legal responsibilities for obstetrical nurses. Error prevention was highlighted among the majority of these publications, as well as civil and ethical responsibilities. However, the majority point out administrative sanctions and penal responsibilities. These aspects need to be researched in greater depth and reported upon, for they may contribute to more qualified formal education for nurses concerning the legal implications of their practice.

En el presente artículo se desarrolla una revisión bibliográfica, con el objetivo de identificar de qué forma los aspectos relativos a la responsabilidad jurídica de los enfermeros y de los especialistas en enfermería obstétrica han sido abordados en las publicaciones brasileñas. Después de investigar en las bases de datos BDENF, CINAHL, LILACS y SciELO, en el período de 1980 a 2009, se escogieron siete artículos que tratan sobre aspectos jurídicos. Se constató que ninguno de ellos se centró en la responsabilidad legal de la enfermera obstétrica. La prevención del error es destacada en la mayoría de las publicaciones, así como la responsabilidad civil y ética, sin embargo, sólo en una minoría de los artículos se abordan las sanciones administrativas y la responsabilidad penal. Esos aspectos deben ser más investigados y divulgados, ya que pueden contribuir a la instrumentalización de los enfermeros sobre las consecuencias jurídicas de sus acciones.

The loneliness of the perinatal nurse in litigation.

Perinatal nurses are named in patient lawsuits more than most nurses might imagine, and perinatal nurses are especially vulnerable. In 2005, 15% of all payments in nursing cases involved perinatal nurses. This article describes what some nurses have felt when faced with litigation, and offers consideration for how nursing as a profession, and perinatal nursing as a specialty, should change its approach toward more support of nurses who find themselves in this circumstance.

Consequences of birth policies and practices in post-reform China.

This paper comments on the provision of birthing services in Sichuan and Shanxi Provinces in China within a policy context. The goal was to understand possible unintended and harmful health outcomes for women in the light of international evidence, to better inform practice and policy development. Data were collected from October 2005 to April 2007 in 25 hospitals across 13 counties and one city. Normal and caesarean birth records were audited, observations made of facilities and interviews conducted with officials, administrators, health workers, women who delivered in hospital facilities and women who delivered at home. We argue that in the context of a neo-liberal health economy with poorly developed government regulatory policies, those with the power to pay for maternity care may be vulnerable to a new range of risks to their health from those positioned to make a profit. While poor communities may lack access to basic services, wealthier socio-economic groups may risk an increase in maternal morbidity and mortality through the overuse of avoidable intervention. We recommend a stronger evidence base for hospital maternity services and changes to the role of the State in countering systemic problems.