BACKGROUND: The Tokollo/Mafube District (TMD) Hospital Complex located in the rural area of Fezile Dabi District within the Free State Province has reported a high number of adverse events (AE) from the maternity units. Although the information linked to AE occurring in the hospitals is routinely collected and reported to the hospital management in accordance with the Provincial policy, no study has been done to systematically analyse the available information and to explore the current situation. AIM: To describe the patient-related AE in the maternity units of TMD Hospital Complex, related individual and health system factors, and the functioning of the reporting system used for these AE during the two year study period. METHODOLOGY: A descriptive cross-sectional study design was used, based on a retrospective review of routinely collected hospital data from the health records of patients, the AE Committee meeting minutes, and other relevant hospital documents. The study was conducted at the maternity units of TMD Hospital Complex which consists of two hospitals in the Fezile Dabi District within the Free State Province. Data was collected in the following categories of variables: the types of AE (in terms of levels of seriousness), the profiles of patients who experienced such AE (e.g. age, gravidity, marital status, residence, and socio-economic status), the related health system factors identified during the adverse events committees meetings (such as personnel, transport, equipment, environment and management) and reporting of these AE. RESULTS: This study revealed that a total of 88 patients, comprising 0.8% of the total number of admissions to the maternity units, experienced AE. Maternal AE occurred more commonly than perinatal AE. The majority of women experiencing AE were unemployed (93%), between the ages of 19-34 (81%), unmarried (79%) and resided in towns (88.6%). In addition, most of these women belonged to the groups of primigravida and multigravida (85%), attended between one and three antenatal visits (42%), and delivered via normal vaginal deliveries (76%) with a high number of stillborns (77.2%). Overall, the majority of maternal AE occurred during the intrapartum stage. Another significant finding was that majority of AE reported were classified as the most serious being SAC 1, which accounted for 93% of the maternal AE and 84% of perinatal AE. The early perinatal AE accounted for 100% of the reported perinatal AE. Although majority of AE reported at the institution were within the prescribed period, reporting time to the Complex AE Committee (CAEC) and District AE Committee (DAEC) was exceeded in the majority of cases. In addition, all AE that required investigation complied with the provincial policy but exceeded the required investigation period. The findings regarding health systems related factors as determined by root cause analysis performed by the AE committee revealed that clinical governance issues accounted for 43% of both maternal and perinatal AE, followed by patient transport issues as provided by the Emergency Medical Services (EMS) which also accounted for a significant percentage (33%). CONCLUSION: This study has demonstrated that specific health system related factors played a significant role on the occurrence of AE at the maternity units of TMD Hospital Complex and that the majority of the reported AE were very serious (SAC 1). It is important that these preventable, contributory factors are addressed by management at both the complex and district levels. Furthermore the results suggest that patients’ profiles, to a certain extent, do have an influence on the occurrence of AE in maternity units of TMD hospital Complex and it is important that patients’ profiles be taken into consideration when adverse incidents are analysed.

Thesis (M.S.P.H.)--University of Michigan, 1938.

Thesis (M.S.P.H.)--University of Michigan, 1938.

This hermeneutic study explores the experience of well-being of eight new mothers who live in the Blue Mountains of N.S.W. The experiences were analysed to illuminate definitions, meanings and practices which create their well being. This study transcends existing notions of health and motherhood. The author argues that mothers resist the social expectations created by the 'ideology of motherhood' by; defining their well-being, redefining and resisting the notion of being the 'good mother' by creating practices to achieve their well-being. Social support is integral to this. The study is grounded in hermeneutics incorporating the Heideggerian ideas of being-in-the-world, co-constitution and the hermeneutic circle and also the Gadamerian idea of fusion of horizons. A post-structuralist feminist perspective is adopted, incorporating Foucault's ideas on power, knowledge, truth and resistance. Eight definitions of these new mothers' well-being are presented. Implications for nursing practice, education and research are discussed / Master of Nursing (Hons)

Objetivo. O valor da mortalidade materna como tema relevante para a Saúde Pública mobilizou esforços de governos e organizações, nacionais e internacionais, para a proposição de programas de prevenção e de redução da mortalidade materna. Os Comitês de Estudos de Morte Materna têm sido considerados como um dos instrumentos importantes no combate à mortalidade materna em todo o mundo. O primeiro Comitê de Estudos de Morte Materna criado no Brasil foi o do estado de São Paulo, em 1988. Este estudo teve como objetivo recuperar e caracterizar a trajetória da criação e implantação desse Comitê e os fatores intervenientes no seu percurso evolutivo. Métodos. Os dados que constituíram a base empírica do estudo foram entrevistas com integrantes, ex-integrantes e fundadores do Comitê do Estado de São Paulo e documentos como: atos oficiais, relatórios técnicos, atas de reuniões, normas operacionais, entre outros. Resultados. A análise dos dados mostrou uma trajetória oscilante, marcada por períodos de atividade e de refluxo tendo sido alteradas, ao longo do tempo, a sua composição e estrutura organizacional, mantendo-se, porém, seus objetivos e funções. Considerações finais. Os dados examinados revelaram que a criação do Comitê representou um avanço para a saúde materna. Mostraram também uma expressiva influência, no percurso do Comitê, das injunções político-institucionais, no âmbito da Administração governamental do estado, no período estudado e o reconhecimento de sua posição como instância situada para além de uma estratégia de vigilância epidemiológica. / As a relevant theme for Public Health, maternal mortality has engendered efforts on the part of Governments as well as of national and international organizations in the proposition of programs for prevention and reduction of maternal mortality. All over the world, the Committees for Stu been considered as important tools on fight against maternal mortality. In Brazil, the first Committee for Studies on Maternal Death was the one created in State of São Paulo, in 1988. The target of the present study was to recover and characterize the trajectory of the creation and implantation of this Committee as well as to make a survey on the intervening factors occurring in its course of evolution. Methods. Data on interviews held with members, former members and founders of São Paulo State Committee for Studies on Maternal Death and documents such as official acts, technical reports, minutes of meetings and, operational norms, among others, constituted the empirical basis for this study. Results. Data analysis disclosed an oscillatory course, marked by periods of activity and reflux. Along the years,both its composition and organizational structure were altered, although maintaining its purposes and functions. Final considerations. According to data, the creation of the Committee represented an improvement for the maternal health. They also indicated that in the course of the Committee there happened, in the studied period, an expensive influence of political-institutional injunctions, in the ambit of the state government administration, and the acknowledgement of this status as an instance located beyond the epidemiological surveillance.

Objetivo. O valor da mortalidade materna como tema relevante para a Saúde Pública mobilizou esforços de governos e organizações, nacionais e internacionais, para a proposição de programas de prevenção e de redução da mortalidade materna. Os Comitês de Estudos de Morte Materna têm sido considerados como um dos instrumentos importantes no combate à mortalidade materna em todo o mundo. O primeiro Comitê de Estudos de Morte Materna criado no Brasil foi o do estado de São Paulo, em 1988. Este estudo teve como objetivo recuperar e caracterizar a trajetória da criação e implantação desse Comitê e os fatores intervenientes no seu percurso evolutivo. Métodos. Os dados que constituíram a base empírica do estudo foram entrevistas com integrantes, ex-integrantes e fundadores do Comitê do Estado de São Paulo e documentos como: atos oficiais, relatórios técnicos, atas de reuniões, normas operacionais, entre outros. Resultados. A análise dos dados mostrou uma trajetória oscilante, marcada por períodos de atividade e de refluxo tendo sido alteradas, ao longo do tempo, a sua composição e estrutura organizacional, mantendo-se, porém, seus objetivos e funções. Considerações finais. Os dados examinados revelaram que a criação do Comitê representou um avanço para a saúde materna. Mostraram também uma expressiva influência, no percurso do Comitê, das injunções político-institucionais, no âmbito da Administração governamental do estado, no período estudado e o reconhecimento de sua posição como instância situada para além de uma estratégia de vigilância epidemiológica. / As a relevant theme for Public Health, maternal mortality has engendered efforts on the part of Governments as well as of national and international organizations in the proposition of programs for prevention and reduction of maternal mortality. All over the world, the Committees for Stu been considered as important tools on fight against maternal mortality. In Brazil, the first Committee for Studies on Maternal Death was the one created in State of São Paulo, in 1988. The target of the present study was to recover and characterize the trajectory of the creation and implantation of this Committee as well as to make a survey on the intervening factors occurring in its course of evolution. Methods. Data on interviews held with members, former members and founders of São Paulo State Committee for Studies on Maternal Death and documents such as official acts, technical reports, minutes of meetings and, operational norms, among others, constituted the empirical basis for this study. Results. Data analysis disclosed an oscillatory course, marked by periods of activity and reflux. Along the years,both its composition and organizational structure were altered, although maintaining its purposes and functions. Final considerations. According to data, the creation of the Committee represented an improvement for the maternal health. They also indicated that in the course of the Committee there happened, in the studied period, an expensive influence of political-institutional injunctions, in the ambit of the state government administration, and the acknowledgement of this status as an instance located beyond the epidemiological surveillance.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2003.

Thesis (D.P.H.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Sept. 16, 2008). Includes bibliographical references (p. 89-99).

Thesis (Ph. D.)--University of Wisconsin--Madison, 2003. / Includes bibliographical references (p. 215-234).

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.