No description available.

Study Setting: Two rural Indonesian districts served by the national midwife-in-the-village programme. Methods: Three critical incident audits of maternal mortality and severe morbidity: confidential enquiry, a verbal autopsy survey, and a participatory community-based review. Results: A range of inter-related factors contributed to poor quality and access. When delivery complications occurred, many women and families were un-informed, un-prepared, found care unavailable, unaffordable, and relied on traditional providers. Social health insurance was poorly promoted, inequitably distributed, complex, bureaucratic, and often led to lower quality care. Public midwives were scarce in remote areas and lacked incentives to provide care to the poor. Emergency transport was often unavailable and private transport incurred further expense. In facilities, there was reluctance to admit poor women, and ill-equipped, under-staffed wards for those accepted. Referrals between hospitals were also common. Examining adverse events from user and provider perspectives yielded multi-level causal explanations. These were used to develop a conceptual model relating structural arrangements (such as decentralisation, commodified care and reductions in public funding) to constrained service provision and adverse health consequences. Conclusions and recommendations: A policy shift towards healthcare as a public good may provide a route to reduce available maternal ill-health. Engaging with those who require and provide critical care in routine assessments can inform more robust health planning, and promote inclusion and participation in health.

A conceptual framework was developed based on Fawcett’s conceptual framework and Stufflebeam’s Decision Making Model. The merging of the concepts of the framework and the model gave rise to the concepts of the research model, viz. environment, registered midwife, curriculum and outcome. These concepts were researched. Donabedian’s Quality Assurance Model and Parlett and Hamilton’s Illuminative Evaluation guided the research methodology. The methodology adopts a triangulated approach, making use of both quantitative and qualitative data collection procedures. In order to study the concept “environment” 250 women were interviewed post-natally in order to determine their perceptions and expectations of care during pregnancy, labour and the puerperium. The findings show that women are not empowered in terms of their expectations of care. Caring appears to be viewed at a very low level and to be taskfocused. Furthermore, caring around the birth process appears to be seen as best when it is hospital-based. Attention needs to be given to health information and health promotion. This concept was also studied through four focus groups held with women in the community. These data were analysed qualitatively. The findings revealed women’s dissatisfaction with the role and function of the nurse. Women’s lack of empowerment was evident in their encounters with health care professionals. Women related more negative than positive experiences of relationships with nurses. Perceptions of lack of trust and lack of concern, inter alia, in and from nurses were highlighted in the interviews. The concept “registered midwife” was studied by requesting registered midwives in a la. e academic hospital’s maternity unit to complete a questionnaire. The questionnaire aimed to obtam the midwives perceptions of the needs of women during pregnancy, labour and the puerperium. It also probed midwives perceptions of their roles and functions. The findings reveal that midwives recognise their teaching responsibility, but appear to have difficulty in meeting this responsibility. Her own education has prepared her for hospitalv based practice. Administration, research and policy-making are not priority roles for the majority of the respondents. “Curriculum” was studied through two questionnaires given to students in the B.Nursing programme. The findings revealed a need to increase curriculum content which relates to primary health care and a need to restructure practical learning opportunities as students do not feel compete,nt to practise in rural hospitals and community settings. The concept “outcome” was studied through two sets of focus groups. One with graduands who were currently in midwifery practice and the other with supervisors of these practitioners. The findings from the graduands’ groups highlighted the need for greater emphasis on culture, health information and promotion and holistic care in their learning experiences. The groups held with the nursing supervisors highlighted their perceptions of student needs and the inadequacy of the hospital as a learning environment. The findings from the four concepts have been used to develop a curriculum for Women’s Health. The curriculum model encapsulates Stufflebeam’s model and the concepts of the conceptual framework. The curriculum process utilizes problem-based learning and community-based education as the means to learning.

The CanMEDS 2015 Framework outlines many key competencies that must be addressed during residency training. The move towards the “Competency by Design” curriculum will require the use of simulation for assessment of these competencies. However, the use of simulation poses many challenges for residency programs including meeting the learning needs of multiple levels of learners, financial constraints, time constraints etc. We performed a program evaluation on an obstetrical emergencies simulation curriculum that involved Obstetrics and Gynecology residency trainees (PGY1-PGY5). Different levels of learners participated in various roles including; first responder (PGY2), second responder (PGY5), confederate roles including patient, nurse or family member (PGY1-3) and assessor (PGY4). This permitted assessment of the following CanMEDS competencies: medical expert and communicator (PGY2); communicator and leader (PGY5); communicator, collaborator and health advocate (PGY1-3) and scholar (PGY4). We were able to determine financial costs, faculty time, and resident time for our existing simulation curriculum and our new simulation curriculum. Residents were surveyed prior to the simulation regarding the learning environment in our pre-existing simulation curriculum and self-efficacy ratings for the competencies mentioned above. Faculty were also surveyed prior to the simulation regarding the residents’ competencies. Station scores were collected for all competencies. Focus groups allowed further exploration of the residents’ and faculty perceptions of the new simulation experience. Lastly, post-simulation surveys of both residents and faculty allowed comparison of pre- and post- learning environment assessment and self- efficacy/performance scores. We had limited station scores from our pre-existing simulation curriculum to allow direct comparison between the specific scenarios The program evaluation determined that this method of incorporating multiple levels of learners provided a feasible and acceptable method of assessing multiple CanMEDS competencies while minimizing financial costs and significantly reducing faculty time requirements. / Thesis / Master of Science (MSc) / This study examined a simulation curriculum for obstetrical emergencies using multiple postgraduate learners in various roles, to provide a learning opportunity and assessment opportunity, for a number of skills required by the Royal College of Physicians & Surgeons of Canada. It was found that involving learners in various roles, including responders; confederates acting as nurses, patients and family members; and assessors, enhanced learning in regards to patient management, communication, collaboration, assessment and health advocacy while reducing financial costs and faculty time requirements.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

AbstractThe aim: The aim of the study was to describe what women are most satisfied with in maternity care and if women´s childbirth experiences can be described by means of the QPP-I, who contains 32 statements related to maternity care. Design: The study is part of a national cross-sectional study which lasted for two weeks in Sweden in 2007. This paper analyzes one of the two questions with open answers, which reads: "What was the best with maternity care?”. Results: The results showed that out of a total of 735 responses 717 could be placed in the existing instrument QPP-I. Responses were analyzed by deductive content analysis and the majority 98% of the women's responses was about commitment, empathy and respect from the midwives. The responses (n = 18) who did not fit in QPP-I were then analyzed inductive and focused on team work and sense of coherence. Conclusion: The instrument QPP-I can be developed with additional statement to measure what it intends to measure, women's perceptions of maternity care.

Thesis--Ed. D. Columbia University, Teachers College, 1974.

Thesis--Ed. D. Columbia University, Teachers College, 1974.

Thesis (Ph. D.)--University of Florida, 1984. / Description based on print version record. Typescript. Vita. Includes bibliographical references (leaves 134-151).

Thesis (M.S.)--University of Wisconsin--Madison, 1983. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 81-94).