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Diss. Linköping : Univ.

Text in English / The aim of the study was to describe the competencies of midwives during the provision of immediate postnatal care (PNC) with the intention of adapting and linking international best practice guidelines as well as a conceptual framework for the implementation of PNC in Swaziland. A quantitative cross-sectional design study was conducted to investigate the competencies of midwives during the provision of immediate postnatal care services to mothers and their infants. A systematic random sampling technique was used to select eighty-eight (88) midwives and six (6) senior midwives to participate in the study. Data collection was done using structured questionnaires. Quantitative data was complemented by data that was generated from open-ended questions at the end of the questionnaires. Data analysis was conducted using IBM SPSS Statistics version 22.0 software. The study highlighted that all the midwives who participated in this study had the relevant qualification. Of the respondents, 70.5% were state-certified midwives with a second registered certificate, 27.3% had bachelor’s degrees, while 2.3% had an advanced midwifery certificate. The study found no difference between the type of qualification of midwives and the knowledge of PNC interventions to be offered to mothers immediately post-delivery across different qualifications held by the midwives (Kruskal-Wallis test: x2=5.498, df=2, p=0.064). Gaps were identified in their knowledge and practices. There were discrepancies in the level of knowledge and practices regarding maternal vital sign assessment immediately after delivery (within 30 minutes). It was noted that these vital signs, i.e. blood pressure (12.5%), temperature (50.0%), pulse (54.5%), respiration (63.6%) were not taken after delivery. It was also noted that 15.0%, 58.0%, 64.8% of the respondents were not aware of the importance of assessing newborns for APGAR, skin-to-skin contact and drying the neonate. The study found that there were no postnatal care guidelines in Swaziland. The findings of the study led to the adaption and linkage of the latest international evidence-based guidelines and a conceptual framework for the implementation of immediate PNC to mothers and their infants in Swaziland. / Health Studies / D. Litt. et Phil. (Health Studies)

MCur / Department of Advanced Nursing Science / See the attached abstract below

No description available.

The aims of intrapartal care are a healthy mother and child and a positive birth experience for the woman. The aims should be achieved using the least possible number of interventions that is compatible with safety. The overall aim of this thesis was to develop an instrument based on the WHO’s recommendations for care in normal birth, to describe documented intrapartal care in a pre- and post-test following a quality improvement program and to elucidate women’s perceptions of received intrapartal care. The Delphi method was used to develop the instrument. Birth records were scrutinized in the pre-test (n=212) as well in the post-test (n=240). Women’s (n=138) perceptions were collected with a questionnaire. An instrument with 69 questions and 24 follow-up questions was developed. The results from the pre-test showed that WHO’s recommendations were only partly followed. Intrapartal care for women at low-risk was similar to care for women at high-risk. Areas for improvement were identified and a quality improvement program was carried out during a two-year period. The post-test showed that the intrapartal care changed towards more adherence to WHO’s recommendations, especially for areas where guidelines were written and for women at low-risk. No statistically significant differences were found for the number of spontaneous vaginal deliveries, mother and child at low-risk after birth, active labour longer than 12 hours or second stage longer than one hour. The result from the women’s questionnaire showed that they to a great extent received care which encompassed practices that are demonstrably useful and should be encouraged. The women’s perceptions were that all received care was of great subjective importance. The instrument developed from WHO’s recommendations can be used to examine intrapartal care. Midwives should carry out a risk assessment on the woman’s arrival at the maternity unit and plan the care together with the woman and significant others. Midwives’ documentation needs to change to incorporate interpersonal aspects. Women’s faith in intrapartal care shows the importance of continuous education for midwives in evidence-based care for normal birth. National evidence-based guidelines for intrapartal care need to be developed. / Målet med förlossningsvården är en frisk mor och ett friskt barn samt en för kvinnan positiv upplevelse av förlossningen. Dessa mål skall eftersträvas med minsta möjliga ingrepp i förlossningens förlopp men med bibehållen säkerhet för mor och barn. Det övergripande syftet med denna avhandling var att, utifrån WHO:s rekommendationer avseende vård vid normal förlossning, utveckla ett instrument för att kartlägga barnmorskors dokumenterade förlossningsvård före och efter ett kvalitetsutvecklingsprogram samt belysa kvinnors uppfattningar av förlossningsvård. Instrumentutvecklingen genomfördes med Delfimetoden. Förlossningsjournaler granskades vid såväl föremätning (n= 212) som eftermätning (n=240). Kvinnors (n=138) uppfattningar insamlades med en enkät. Ett instrument omfattande 69 frågor och 24 uppföljningsfrågor utvecklades. Resultatet av föremätningen visar att WHO:s rekommendationer bara delvis följdes. Vården skilde sig i liten utsträckning för kvinnor med låg- respektive högrisk. Förbättringsområden identifierades och ett kvalitetsutvecklingsprogram genomfördes under en tvåårsperiod. Eftermätningen visar att vården förändrades i riktning mot WHO:s rekommendationer, särskilt för de områden där riktlinjer utvecklats samt för kvinnor i lågriskgruppen. Inga statistiskt signifikanta skillnader noterades beträffande antalet spontana förlossningar, antalet mödrar och barn som var lågrisk efter förlossningen, antalet aktiva förlossningar över 12 timmar och antalet förlossningar med utdrivningsskede över 1 timma. Enkätstudien till kvinnorna visar att de i stor utsträckning erhöll vård enligt den praxis som är bra och bör uppmuntras. Kvinnorna uppfattade genomgående att erhållen vård var av stor subjektiv betydelse. Instrumentet med utgångspunkt från WHO:s rekommendationer kan användas vid kartläggning av förlossningsvård. Barnmorskor bör göra en riskbedömning vid kvinnans ankomst till förlossningen och planera vården tillsammans med kvinnan och anhöriga utifrån denna. Barnmorskors dokumentation behöver förändras för att såväl omfatta medicinsk-tekniska som mellanmänskliga aspekter. Kvinnors tillit till förlossningsvården visar på vikten av att barnmorskor erhåller kontinuerlig fortbildning i evidensbaserad vård avseende normal förlossning. Evidensbaserade nationella riktlinjer för vård vid förlossning behöver utvecklas.

Thesis (MA)--Stellenbosch University, 2010. / ENGLISH ABSTRACT: Hypertensive disorders are one of the leading causes of maternal morbidity and mortality in South Africa. The morbidity and mortality rate can be decreased by early detection and management of hypertensive disorders at primary health care Level. The midwives should therefore be knowledgeable and competent in the assessment and diagnosis of pregnant women who are at risk of developing a hypertensive disorder, and be able to manage the problem. The purpose of the study was to investigate scientifically the knowledge of the registered midwives managing hypertensive disorders in pregnancy working at primary health care level in the Eastern Cape. The objectives set for the study were to investigate the knowledge of the registered midwives in the following areas: • Knowledge about hypertensive disorders • Assessment • Diagnosis • Management A descriptive correlational research design was applied with a quantitative approach to investigate scientifically the knowledge of the registered midwives managing hypertensive disorders in pregnancy. The target population included all the registered midwives working permanently in primary health care clinics in the Buffalo City Local Service Area. A stratified random sample of n=43 (44%) of a population of N=98 clinics both in rural and urban were selected together with a sample of n=101(44%) of N=228 registered midwives working in these clinics. A questionnaire consisting of predominantly closed questions was used for the collection of data, collected personally by the researcher. Ethical approval was obtained from Stellenbosch University, Department of Health and individual informed consent. A pilot study, which did not form part of the study, was conducted to test the questionnaire at the clinics. A 10% (n=10) sample of the registered midwives of 4 clinics participated in the pilot study. The validity and reliability was assured through the pilot study, the use of a statistician, as well as experts in midwifery, nursing and a research methodologist. The data was analysed and presented in tables and histograms. Statistical correlational tests were done to determine any correlations between the variables. Findings obtained show that inadequate knowledge exists among participants with specific reference to knowledge, assessment, diagnosis and management about hypertensive disorders. A statistical correlation was shown between the presence of doctors and the knowledge of the midwives using the Mann-Whitney statistical test (p=0.04). In clinics where there are no doctors’ visits, the knowledge of the staff was higher (0.691), than the total knowledge mean score (0.666). Where doctors are regularly visiting the clinics the mean knowledge score is lower (0.656). These results show that where midwives do not have any additional support as when there are doctors present, individual effort is made to keep up to date as they are practising as independent practitioners. Recommendations are based on the scientific evidence which emphasis further education in advanced midwifery, workshops, conferences, updating their knowledge and weekly in-service training, introduction of a quality assurance and patient education programmes. In conclusion empowering the midwives with the required knowledge about hypertensive disorders will contribute towards decreasing the mortality and morbidity rates. / AFRIKAANSE OPSOMMING: Siektetoestande gekoppel aan hipertensie is een van die vernaamste oorsake van sieklikheid en moedersterftes in Suid-Afrika. Die siektetoestand en sterftekoers kan afneem deur vroeë opsporing en bestuur van hipertensietoestande op primêre gesondheidsorgvlak. Die kraampersoneel behoort dus kundig en bekwaam te wees tydens die assessering en diagnose van swanger vroue wat die risiko loop om ’n toestand van hipertensie te ontwikkel en daartoe in staat te wees om die probleem te kan hanteer. Die doel van die studie is om die kennis van geregistreerde vroedvroue wetenskaplike te ondersoek wat hipertensiewe toestande tydens swangerskap hanteer op Primêre Gesondheidssorgvlak in die Oos-Kaap. Die doelstellings wat uiteengesit is vir die studie, is om die kennis van geregistreerde kraampersoneel in die volgende areas te ondersoek: • Kennis van hipertensiewe toestande • Assessering • Diagnose • Hantering. ’n Beskrywende korrelerende navorsingsontwerp is toegepas met ’n kwantitatiewe benadering om die kennis van die geregistreerde kraampersoneel wat hipertensiewe versteurings in swangerskappe hanteer, wetenskaplik te ondersoek. Die teikengroep het al die geregistreerde kraampersoneel wat permanent in die primêre gesondheidssorgklinieke in die Buffalo City Plaaslike Diensarea werk, ingesluit. ’n Gestratifieerde ewekansige steekproef van n=43 (44%) gekies uit ’n gesamentlike plattelandse en stedelike bevolking van N=98 klinieke met ’n steekproef van n=101 (44%) van N=228 geregistreerde vroedvroue wat in die klinieke werk. ’n Vraelys wat hoofsaaklik uit geslote vrae bestaan, is gebruik vir die insameling van data wat persoonlik deur die navorser ingesamel is. Etiese toestemming is verkry van die Universiteit Stellenbosch, die Departement van Gesondheid asook individuele ingeligte toestemming. ’n Loodsondersoek is uitgevoer om die vraelys te toets by die klinieke wat nie deel van die studie was nie. ’n 10% (n=10), steekproef van die geregistreerde vroedvroue van 4 klinieke het deelgeneem aan die loodsondersoek. Die geldigheid en betroubaarheid is verseker deur die loodsondersoek, die gebruik van ’n statistikus asook kundiges in kraamverpleging en ’n navorsingsmetodoloog. Die data is geanaliseer en weergegee in tabelle en histogramme, statistiese korrelasietoetse is gedoen om korrelasies te bepaal tussen die veranderlikes. Die bevindings, bewys dat ongenoegsame kennis bestaan by deelnemers met spesifieke verwysing na kennis, assessering, diagnose en hantering ten opsigte van aangaande toestande van hipertensiewe toestande. ’n Statistiese korrelasie is getoon tussen die teenwoordigheid van geneeshere en die kennis van vroedvroue deur gebruik te maak van die Mann-Whitney statistiese toets (p=0.04). In klinieke waar daar geen doktersbesoeke is nie, is die personeelkennis beter (0.691) as die totale gemiddelde kennistelling (0.666). Waar geneeshere gereeld die klinieke besoek, is die gemiddelde kennistelling laer (0.656). Hierdie resultate bewys dat waar die vroedvroue geen bykomende ondersteuning deur die teenwoordigheid van geneeshere het nie, het individuele moeite gedoen om op die hoogte te bly, aangesien hulle as onafhanklike praktisyns optree. Aanbevelings is gebaseer op wetenskaplike bewyse wat verdere onderrig beklemtoon in gevorderde kraamverpleging, werkswinkels, konferensies, die bywerk van kennis en weeklikse indiensopleiding, die instel van ’n kwaliteitsversekering en opvoedingsprogramme vir pasiënte. Ten slotte die bemagtiging van vroedvroue wat oor die vereiste kennis beskik van toestande van hipertensiewe toestande, sal bydra tot die afname van sterfte- en siektesyfers.

Syfte:Att undersöka barnmorskors upplevelser och erfarenheter av att ställa frågor om våld enligt nationella riktlinjer. Design: Intervjustudie baserade på nio enskilda semistrukturerade intervjuer som analyserats med kvalitativ innehållsanalys. Omgivning: Fem mödrahälsovårdscentraler i norra Sverige. Deltagare: Nio barnmorskor, som arbetade på landstingsägda och privata hälsocentraler. Barnmorskorna som var i åldrarna 34 – 62 år hade erfarenheter av att arbeta inom mödravården liksom förlossningsvården. (Alla deltagare gav muntligt och skriftligt medgivande på att delta i studien). Resultat: Deltagarnas upplevelser och erfarenheter att arbeta med stöd av riktlinjer och fråga om våldsutsatthet kan sammanfattas i det övergripandet temat: Behöver rätt verktyg för att våga öppna Pandoras ask. Kategorierna: Sakna förutsättningar för att arbeta på ett bra sätt, Övervinna hinder, Hantera egna känslor och Känna trygghet och stöd när arbetet känns svårt beskrev olika aspekter av upplevelser och erfarenheter. Slutsats: Trots att riktlinjerna upplevs som stöd för arbetet visade studien att frågan om våld kan vara svår att ställa på grund av olika omständigheter. Barnmorskan kan då välja att avstå från att fråga eller skjuta upp frågan till ett senare tillfälle i det enskilda fallet trots medvetenhet om att hon ska ställa frågan. Kliniska implikationer: Mer utbildning och fortbildning behövs för barnmorskornas trygghet i att arbeta våldspreventivt. De riktlinjer som finns kan behöva utvecklas och förbättras för att minska osäkerheten vid olika dilemman när barnmorskan ska fråga om våldsutsatthet. / Objective: To explore midwive´s experiences of posing questions about intimate partner violence according to national guidelines.Design: Interview study with individual semi-structured interviews using qualitative content analysis for analysis.Setting: Five antenatal clinics in northern Sweden.Participants: Nine midwives, working in public and private antenatal care clinics. Midwives aged 34 to 62 years with experiences in antenatal health care as well as delivery care participated. All participants gave their verbal and written concent to participate in the study.Results: Participants´ experiences working with support of the guidelines and terms of intimate partner violence can be summed up in the overarching theme: Need to have the right tools to dare open Pandora´s box. The categories: Lack of opportunities to work in a good way, Overcoming barriers, Manage your own emotions and Feel safety and support when work feels difficult described different aspects of experiences.Conclusion: Although the guidelines are perceived as supporting the work study showed that the issue of violence can be difficult to make because of the different circumstances. The midwife can then choose to refrain from asking or defer the matter to a later date in the case despite awareness that she should ask the question.Clinical implications: More education and training is needed to increase midwives security in violence prevention work. The guidelines need to be developed and improved in order to reduce uncertainty at various dilemmas when the midwife to ask about intimate partner violence.

Bakgrund: I det nya yrket som barnmorska i en ny arbetsmiljö med nya kollegor och arbetsuppgifter är behovet av stöd från kollegor en betydande del i upplevelsen av övergången från barnmorskestudent till legitimerad barnmorska. Forskning visar att de nyutexaminerade barnmorskorna är i behov av ett strukturerat stöd men ett utarbetat mentorsprogram finns inte. Syfte: Syftet med studien var att belysa nyutexaminerade barnmorskors upplevelser av stöd från barnmorskekollegor på olika förlossningskliniker i södra Sverige. Metod: Enskilda intervjuer utfördes med åtta nyutexaminerade barnmorskor som arbetade på olika förlossningskliniker. Analysmetoden som användes var en kvalitativ innehållsanalys med induktiv ansats enligt Creswell och Creswell (2018), vilket resulterade i fyra teman. Resultat: Nyutexaminerade barnmorskorna är i behov av stöd och feedback för att känna sig trygga i den nya yrkesrollen, vilket de inte alltid får i den utsträckning de önskar. Tillgången till en mentor under det första året var en positiv aspekt för att kunna reflektera och få feedback. Ett öppet arbetsklimat och att få bekräftelse var viktigt, där mer organisation och feedback behövs. Ett strukturerat mentorskap var önskvärt. Slutsats: Stöd finns men kan förbättras genom mer bekräftelse och feedback, där ett organiserat mentorsprogram skulle kunna vara till hjälp. Det sociala stödet är en del av arbetsmiljön men då det finns brister i stödet finns risk att den nyutexaminerade barnmorskan inte känner trygghet i sitt nya yrke. / Background: In the new profession as a midwife in a new work environment with new colleagues and work tasks, the need of support from colleagues is an important aspect in the transition from a midwife student to a licensed midwife. Research shows that newly graduated midwives need a structured support but there is no such thing as a mentor program. Aim: The aim of the study was to illustrate the newly graduated midwives experience of support from midwives in different delivery wards in south Sweden. Method: Individual interviews were conducted with eight newly graduated midwives working in different delivery wards. The method of choice was a qualitative analysis with an inductive approach (Creswell & Creswell, 2018), which resulted in four themes. Results: The newly graduated midwives are in the need of support and feedback to feel comfortable in the new role as a midwife, which they do not get in the extent they wish for. The access to a mentor during the first year was a positive aspect to reflect and to get feedback from. An open work environment and to be acknowledged was important, were more organization and feedback was needed. A structured mentorship was wished for. Conclusion: Support do exist but can be improved with more acknowledgement and feedback, where a structured mentor program could be an asset. The social support is a part of the work environment but since there are deficiencies in the support there is a risk that the newly graduated midwife does not feel confident in his or her new profession.

Este trabalho é fruto das inquietações da trajetória profissional da pesquisadora que, ao longo de sua carreira profissional, acompanhou as políticas de saúde reprodutiva no país e, como docente, se envolveu com a titulação e qualificação de enfermeiras obstétricas. Diante destas experiências surgiu a necessidade de levantar os fatores facilitadores e dificultadores para formar e inserir enfermeiras obstétricas na prática da assistência ao parto, e como formar profissionais para enfrentar a situação de assistência vigente. Foram entrevistadas profissionais que participam da Associação Brasileira de Obstetrizes e Enfermeiros Obstetras (ABENFO), da elaboração de políticas de saúde no Ministério da Saúde e que atuaram na área como coordenadoras e docentes de cursos de especialização em enfermagem obstétrica. Para subsidiar o trabalho, foi feito uma revisão de literatura sobre as políticas de saúde da mulher, um breve levantamento da história da assistência ao parto e sobre o ensino da enfermagem no Brasil. A seguir, realizou-se 11 entrevistas com profissionais, utilizando-se a História Oral. Este método de investigação possibilita compreender como os indivíduos experimentam e interpretam os acontecimentos, e mostra a percepção do passado como algo que tem continuidade no presente. Após a transcrição, textualização e transcriação dos discursos, foram criadas 4 categorias: Atores e a história, em que as entrevistadas falam da sua trajetória profissional e da história da enfermagem obstétrica; Coadjuvantes das mudanças no contexto do ensino e da prática, onde foram levantados os fatores que contribuíram para a formação e inserção das profissionais na assistência; Barreiras para a formação profissional e para a prática da assistência, em que as entrevistadas mostram alguns dificultadores para a formação e inserção das profissionais e, Desafios na qual foram sintetizados os caminhos que as profissionais devem percorrer para implementar a formação e inserção das profissionais na assistência. Conclui-se que a trajetória percorrida foi importante para a continuidade da formação e da atuação das profissionais e que as políticas ministeriais (portarias e financiamento de cursos) contribuíram para impulsionar a profissão; que tem-se que buscar parcerias com outras categorias profissionais, em especial a médica, com instituições e gestores, e fortalecer os órgãos de classe. Tem-se ainda que titular com qualidade um número maior de profissionais, para que juntas, tenham mais condições de lutar pelas causas da profissão e por mudanças no modelo de assistência. Percebe-se que nos últimos 20 anos a profissão cresceu e foi valorizada, porém, ainda há muito o que conquistar. / This work is a consequence of the uneasiness of the researchers professional path who, throughout her professional career has worked in the country reproductive health policies and, as a teacher, has been involved in the graduation and qualifications of obstetrician nurses. In face of these experiences the need to know the process of graduation and insertion rescue of the obstetrician nurse in the care to women in their reproduction period, within the context of Brazilian reality has emerged. Professionals who have participated in ABENFO (Brazilian Association of Obstetricians and Obstetrician Nurses), in the elaboration of health policies in Ministry of Health and who have acted in the field as coordinators and teachers in graduate specialization in obstetric nursing courses were interviewed. To sustain the study, a review of the literature on women health policies and a brief survey of the history of childbirth care and of Brazilian nursing schools were carried out. Then, 11 interviews with those professionals were done, using Oral History. This investigation method allows the understanding of how individuals feel and interpret the occurrences, and shows the perception of the past as something that extends to the present. After the transcription, textualization and trans-creation of the speeches, 4 categories were defined: Actors and history, in which the interviewed approach their professional path and the obstetric nursing history; Supporters of the changes in context of teaching and practice, in which the factors that contributed to the graduation and insertion of the professionals in care practice are discussed; Obstacles against professional graduation and care practice, in which the interviewed show some difficulties to the graduation and insertion of professionals and, Challenges, in which the ways professionals should go to implement the graduation and insertion of obstetrician nurses in childbirth care are discussed. Finally it is concluded that the path covered was important to the continuation of graduation and actuation of professionals; that the ministry policies (decrees and financing of courses) have contributed to improve the profession; that it is advisable to look for partnership with other professional categories, specially the medical one, with institutions and managers, and that it is necessary to strengthen class organs. It is also necessary to graduate with quality a greater number of professionals, so that together they have more conditions to fight for the profession causes and for changes in the assistance model. It is also observed that in the last 20 years the profession has grown and became more recognized, however, there is still a lot to achieve.