Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Overview: Pregnant women living with obesity are at increased risk of pregnancy complications, with risks rising as Body Mass Index (BMI) increases. Midwives are willing to support women with managing their gestational weight gain but lack confidence and access to supporting resources. In the UK there are no interventions that aim to change the intention and behaviour of midwives, to support women with managing their gestational weight gain. The Theory of Planned Behaviour (TPB) (Ajzen, 1985) was utilised to frame the design of a behaviour change intervention for midwives. This three-phase study conducted a qualitative needs assessment, intervention design, and a quantitative study of, intervention testing. Methods: Phase One: Interview data were thematically analysed and the TPB utilised to elicit participants’ salient beliefs, to inform intervention design. Phase Two: The design of the intervention, and the TPB scale, were informed by Phase One data. Midwives reviewed the intervention and participated in a pilot test of the scale. Phase Three: The intervention was tested in a before-and-after controlled trial, utilising the refined TPB scale. Results: Phase One: 4 key themes emerged: 1)The current state of affairs 2) Perspectives on an intervention: what may work 3) Influences on uptake and successful weight control 4) Taking things forward. Phase Two: An intervention to facilitate the involvement of community midwives in supporting weight management for pregnant women living with obesity; a booklet about weight management in pregnancy; and a TPB scale were designed. Recommendations from midwives were integrated into the final intervention resource, and pilot testing of the scale led to refinement for use in phase 3. Phase Three: Midwives in the intervention group increased their intention to offer weight management support to pregnant women living with obesity. Furthermore, midwives in the intervention group increased actual weight management support for pregnant women living with obesity, after participating in the intervention. Conclusions: This study made a unique contribution to new knowledge by developing and testing a novel intervention that was underpinned by health psychology theory, which increased the intention and behaviour of community midwives to support pregnant women living with obesity, with managing their gestational weight gain.

xiii, 307 p. / The midwifery model and the medical model constitute the two main bodies of knowledge and practice that characterize the way pregnancy and birth are viewed in the United States. The midwifery model emphasizes the normalcy of pregnancy and birth, while the medical model is characterized by a belief in the supremacy of technology over nature and in medical supervision and intervention during pregnancy and delivery. Although both models do espouse important information regarding pregnancy and birth and, at times, there is overlap in the practical application of the models, practitioners of the two models rarely interact with one another. The one situation where practitioners of these two models do come into contact is during home-to-hospital transports for planned home births. Through in-depth interviews with direct-entry midwives, mothers, obstetricians, and nurses, this dissertation explores what happens when practitioners of the two models are forced to interact during home-to-hospital transports in order to provide care for women and their babies. Building on Davis-Floyd's and Johnson and Davis-Floyd's work on home-to-hospital transport, interview data suggest that a series of professional and organizational level factors influence the interactions between obstetricians, direct-entry midwives, and nurses during transports. Findings indicate that care providers engage in emotion work as they navigate the disjuncture between home and hospital, managing their own feelings and the feelings of others during a home-to-hospital transport. Due to the lack of institutionalized protocols governing conduct during transports, practitioners of the two models of care are left to construct their own versions of protocols through micro-level interactions, which at particular times and among certain providers have the effect of transcending the boundaries that divide home and hospital. With the interaction that occurs during a home-to-hospital transport as the central focus, this dissertation provides insight into how the lack of integration between the more marginalized midwifery model and the dominant medical model of care in the U.S. affects care providers and laboring/birthing women during transport situations. / Committee in charge: Jocelyn Hollander, Chairperson; Yvonne Braun, Member; Linda Fuller, Member; Carol Stabile, Outside Member; Melissa Cheyney, Non-UO Member

Thesis submitted in fulfilment of the requirements for the degree Master of Technology in Information Technology in the Faculty of Informatics & Design at the Cape Peninsula University of Technology / Research on health informatics has seen a steady increase during this decade as the role of information technology in the health sector becomes pertinent. Findings of previous research in this domain have uncovered vast information needs of health workers, particularly in developing countries. However, there is a need to continue with multidisciplinary research in priority areas such as midwifery practice and in the environment of marginalised settings. This study explores the significance of the information needs and information-seeking behaviour or practice of midwives during the antenatal and intrapartum care within the environment of a midwifery unit. Additionally, the researcher obtained permission from Faculty of Informatics and Design – CPUT and Health department authority – Western Cape Government in South Africa, to conduct research in the Elsies River Midwifery Obstetric Unit (ERMOU). The research was carried out as case study in a Midwifery Obstetric Unit in the Western Cape, South Africa. The investigator conducted semi-structured interviews and observations to collect qualitative data of the antenatal and intrapartum care environment. The data was transcribed and analysed using thematic analysis and essomenic modelling. The findings comprehensively point to the importance of this research context. The study found that midwives acquired patients’ information from a handwritten Maternity Case Record (MCR) book and midwives’ colleagues, and often during handovers. In addition, midwives also communicate with each other during care activities in the ERMOU. It was apparent that the use of such communication practices is inadequate, and midwives did not always have sufficient information to make appropriate decisions in the ERMOU. All patient information, referral notes, and reporting is paper-based. In addition, essomenic models were used to depict the midwives’ work activities in the antenatal and intrapartum care environment in the Unit. Furthermore, essomenic models defined all the systematic processes that occur in the ERMOU which is described by midwives’ activities and work environment. To improve communication, future research is recommended to consider the importance of the continuity of the education of midwives. Further research will be on the implementation of nursing informatics and the electronic health record system in the Elsies River Midwifery Obstetric Unit.

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.

In nursing education, experiential learning is an important part of the curriculum and accounts for almost half of the requirements for the nursing programmes. A positive relationship with and collaboration between the training institutions and clinical placement facilities are vital for student achievement. Nurse educators are also expected to involve themselves in clinical accompaniment to bridge the theory-practice gap. Student nurses placed in midwifery clinical learning environments experience difficulty in meeting their experiential learning outcomes and programme requirements. Due to the overcrowded clinical facilities, they compete for the limited learning opportunities and resources which make the integration of theory and practice difficult. Therefore, this leads to delay in the commencement of community service by some of the nursing students as they do not graduate because of not achieving midwifery clinical outcomes and programme requirements. The purpose of the study is to assess factors affecting experiential learning for midwifery students at the public college of nursing in the Eastern Cape and the main objectives of the study were to: • Identify the challenges affecting the quality of learning in the clinical learning environment. • Determine the nature of supervision for experiential learning of midwifery students. • Determine the role of a nurse educator in the experiential learning of student nurses in midwifery clinical learning environment. Methods and analysis A quantitative, descriptive survey was conducted by making use of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The CLES+T is a reliable and valid evaluation scale for the gathering of information on the clinical learning environment and supervision of student nurses. The CLES+T evaluation scale was completed by 115 student nurses within the selected sites. The CLES+T evaluation scale is subdivided into three main sections with additional sub-sections: (1) the learning environment (2) the supervisory relationship and (3) the role of the nurse teacher (lecturer).

The main theme of the thesis submitted is the midwifery practice in Pacov parish surroundings in the period of the 2nd half of the 19th century. Based on the studies of professional literature and archival files of diverse nature, the motivation of women to choose a midwife's profession, their education at Charles-Ferdinand University, but also the socioprofessional structure of their clientage, the issues of wages, emergency christenings, godparenthood avd many others, were studied. Using a micro-historical method, a group of 5 midwives, who got involved not only in Pacov, but also in other villages assigned to its parish, was monitored. Inspiration by historical demography is noticeable particularly in the chapters, in which the frequency of assistances at births of each of the midwives, or their filling in the role of godmothers are monitored.

Bakgrund:Barnmorskor som arbetar på barnmorskemottagning [BMM] upplever sig ha bristande kunskap om hur professionellt stöd kan erbjudas till kvinnor med förlossningsrädsla under graviditet. Det är viktigt att gravida kvinnor med förlossningsrädsla erhåller professionellt stöd. Syfte:Syftet med studien är att belysa barnmorskor på barnmorskemottagningens erfarenheter av att erbjuda professionellt stöd till kvinnor med förlossningsrädsla under graviditet. Metod: En kvalitativ intervjustudie med induktiv ansats valdes i denna studie för att få en bredare uppfattning av barnmorskor på BMM erfarenhet. Sju barnmorskor blev intervjuade på två olika BMM i sydvästra Sverige. Resultat: I resultatet framkom det två huvudkategorier "Kvinnans förlossningsrädsla i fokus" och "Barnmorskors behov av resurser och kunskap kring förlossningsrädsla". Det tillkom även två underkategorier "Barnmorskors erfarenheter om kvinnors bristande kunskap kring förlossningsrädsla" och "Vägleda till rätt hjälpinsats för den förlossningsrädda kvinnan". Barnmorskor erbjuder professionellt stöd utifrån sina erfarenheter när kvinnan uttrycker förlossningsrädsla. Detta genom att barnmorskorna är lyhörda vid utredning av orsaker till kvinnans förlossningsrädsla. Slutsats:Barnmorskor på BMM behöver kontinuerlig utbildning om förlossningsrädsla för att kunna erbjuda gravida kvinnor professionellt stöd. Verksamhetschefer på BMM ska erbjuda dessa barnmorskor rätt förutsättningar för att de ska kunna känna sig trygga med att erbjuda professionellt stöd till förlossningsrädda kvinnor. / Background: Midwives working at maternal care center experience insufficient knowledge about how professional support can be offered to pregnant women. It´s important that pregnant women with tocophobia receive professional care from midwives during the entire pregnancy. Purpose: The aim of the study is to highlight maternal care midwives’ experiences providing professional support for pregnant women who fear of giving birth. Method: A qualitative interview study with inductive approach was chosen for this study to gain broader view of the BMM midwives' experiences. Seven midwives were interviewed at two BMM in southwestern Sweden. Results: There were two main categories "Women's fear of childbirth tokophobia". There were two subcategories "Midwife's experiences about women's lack of knowledge about fear of childbirth" and "Guide pregnant women to correct care effort". Midwives offer professional support from their own experience when women express fear of birth. This through midwives being responsive when incuayaring causes to tokophobia women. in focus" and "Midwife's need for resources and knowledge about women`s Conclusion: BMM midwives need continuous education about fear of childbirth in order to offer women prophetic support. BMM occupational managers should offer midwives right prerequisites for midwives to feel safe by providing care to women suffering from tokophobia.

M.Cur. / There is little information about the outcomes and safety of home births, although more and more women are starting to lean towards natural and active births. A home birth provides a more relaxed environment with familiar attendants and less medical intervention. No separation exists between mother and baby as well as other family members. Freedom of movement is promoted and the woman can eat and drink as she pleases. Unnecessary routine preparation for labour doesn't exist and privacy is respected. The purpose of this research was to explore and describe the outcomes of home births in Pretoria, attended by private midwifes, and to provide guidelines in relation with home births.

D.Cur. / Every woman and unborn child has the right to quality antenatal care. Concern is expressed regarding the quality_ of antenatal care currently delivered in South Africa, but due to a lack of formal written standards for antenatal care, this concern cannot be addressed. In view of this, the aim of this study was to generate valid standards for antenatal care. A contextual, exploratory and descriptive research design had been used to complete the research in two phases. An extensive literature exploration was done during the first phase (Development phases 1 and 2) in order to describe a conceptual framework for antenatal care. Concept standards were formulated within this framework and refined with the assistance of a small group of experts. Following changes made to it, it was prepared for validation. The content validity of the standards was tested at national level (validation phase). The concept standards were sent to a group of domain experts in the form of a questionnaire. A purposive, non-randomised and stratified sample had been drawn. The participants were expected to evaluate the content validity of the standards and accompanying criteria and to propose amendments should they deem it to be necessary. A content validity index was calculated for each standard and criterion. A mean of 3,5 and a standard deviation of. 1,0 were regarded as sufficient proof of the content validity of each item. Thereafter, the standards were tested in the clinical practice on the basis of three case studies. Following the necessary adjustment and reformulation, the final standards were formulated. This research does not only make a valuable contribution towards the midwife's practice in the-form of valid standards for antenatal care, but also contributes towards extension of the theoretical basis of the subject discipline by means of the comprehensive description of a conceptual framework for antenatal care by the midwife.