| 41. |
- Hellström Muhli, Ulla, et al.
(author)
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Patient-Involvement in Consultation for Atrial-Fibrillation : The Cardiologists’ Perspective
- 2019
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In: International Journal of Health Care Quality Assurance. - : Emerald Group Publishing Limited. - 0952-6862 .- 1758-6542. ; 32:4, s. 765-776
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Journal article (peer-reviewed)abstract
- Purpose: The purpose was to analyse the accounts of Swedish cardiologists concerning patient involvement in consultations for atrial fibrillation (AF). The questions were: (i) how cardiologists handle and provide scope for patient involvement in medical consultations regarding AF treatment and (ii) how cardiologists describe their familiarity with shared decision-making.Design/Methodology/Approach: A descriptive study was designed. Ten (n=10) interviews with cardiologists at four Swedish hospitals were held and a qualitative content analysis was performed on the collected data.Findings: The analysis shows cardiologists´ accounts of (i) persuasive practice, (ii) protective practice, (iii) professional role, and (iv) medical craftsmanship when it comes to patient involvement and shared decision-making.Conclusions: - The term “shared decision-making” implies a concept of not only making one decision but also ensuring that it is finalised with a satisfactory agreement between both parties involved, the patient as well as the cardiologist. - In order for the idea of patient involvement to be fulfilled, the two parties involved must have equal power, which can never actually be guaranteed.Practical implications: Cardiologists should prioritise patient involvement and participation in decision-making regarding AF treatment decisions in consultations when trying to meet the request of patient involvement.Originality/value: Theoretically, we have learned that the patient involvement and shared decision-making requires the ability to see patients as active participants in the medical consultation process.
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| 42. |
- Hellström, Per M., et al.
(author)
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Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture : a pilot study
- 2017
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In: BMC Anesthesiology. - : Springer Science and Business Media LLC. - 1471-2253 .- 1471-2253. ; 17
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Journal article (peer-reviewed)abstract
- Background: Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture. Methods: In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55. Results: The mean gastric half-emptying time in the elderly study group was 53 +/- 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 +/- 4 (41-106) and 59 +/- 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture. Conclusion: This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.
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| 43. |
- Hildingsson, Ingegerd, 1955-, et al.
(author)
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A continuity of care project with two on-call schedules : Findings from a rural area in Sweden
- 2020
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In: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 26
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Journal article (peer-reviewed)abstract
- BackgroundIn many countries, various continuity models of midwifery care arrangements have been developed to benefit women and babies. In Sweden, such models are rare.AimTo evaluate two on-call schedules for enabling continuity of midwifery care during labour and birth, in a rural area of Sweden.MethodA participatory action research project where the project was discussed, planned and implemented in collaboration between researchers, midwives and the project leader, and refined during the project period. Questionnaires were collected from participating women, in mid pregnancy and two months after birth.ResultOne of the models resulted in a higher degree of continuity, especially for women with fear of birth. Having a known midwife was associated with higher satisfaction in the medical (aOR 2.02 (95% CI 1.14–4.22) and the emotional (aOR 2.05; 1.09–3.86) aspects of intrapartum care, regardless of the model.ConclusionThis study presented and evaluated two models of continuity with different on-call schedules and different possibilities for women to have access to a known midwife during labour and birth. Women were satisfied with the intrapartum care, and those who had had a known midwife were the most satisfied. Introducing a new model of care in a rural area where the labour ward recently closed challenged both the midwives’ working conditions and women’s access to evidence-based care.
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| 44. |
- Hildingsson, Ingegerd, 1955-, et al.
(author)
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'A perfect fit' : Swedish midwives' interest in continuity models of midwifery care
- 2023
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In: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 36:1, s. 86-92
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Midwifery continuity models of care are highly recommended yet rare in Sweden, although approximately 50% of pregnant women request them. Before introducing and scaling up continuity models in Sweden, midwives' attitudes about working in continuity models must be investigated.OBJECTIVE: to investigate Swedish midwives' interests in working in midwifery continuity models of care and factors influencing the midwifery workforce's readiness for such models.METHODS: A cross-sectional online survey was utilised and information collected from a national sample of midwives recruited from two unions regarding background and work-related variables. Crude and adjusted odds ratios and logistic regression analysis were used in the analysis.RESULTS: A total of 2084 midwives responded and 56.1% reported an interest. The logistic regression model showed that respondents' ages 24-35 years (OR 1.73) or 35-45 years (OR 1.46); years of work experience 0-3 years (OR 5.81) and 3-10 years (OR 2.04); rotating between wards or between tasks (OR 2.02) and working temporary (OR 1.99) were related to interest in continuity models. In addition, working daytime only (OR 1.59) or on a two-shift schedule (OR 1.93) was associated with such interest.CONCLUSION: A sufficient number of midwives in Sweden appear to be interested in working in continuity models of midwifery care to align with women's interest in having a known midwife throughout pregnancy, birth and postpartum period. Developing strategies and continuity models that will address the preferences of women in various areas of Sweden is important for offering evidence-based maternity services.
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| 45. |
- Hildingsson, Ingegerd, 1955-, et al.
(author)
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Anxiety and depressive symptoms in women with fear of birth : A longitudinal cohort study
- 2021
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In: European Journal of Midwifery. - : European Publishing. - 2585-2906. ; 5:August
-
Journal article (peer-reviewed)abstract
- Introduction: Anxiety and depression during pregnancy could imply difficulties in the attachment to the unborn baby. The objective of this study was to investigate the prevalence and change in anxiety and depressive symptoms in pregnant women with fear of birth. Another aim was to explore associations between symptoms of anxiety and depression on prenatal attachment.Methods: This is a longitudinal cohort study of 77 pregnant women with fear of birth in three hospitals in Sweden. Data were collected by three questionnaires in mid and late pregnancy and two months after birth.Results: Anxiety symptoms were more often reported than depressive symptoms, significantly decreasing over time in both conditions. Anxiety symptoms were associated with low education level, negative feelings towards the upcoming birth, and levels of fear of birth. Depressive symptoms were associated with levels of fear of birth. One in five women presented with fear of birth, anxiety, and depressive symptoms, suggesting that co-morbidity was quite common in this sample. Depressive symptoms and co-morbidity were negatively associated with prenatal attachment.Conclusions: This study shows that symptoms of anxiety and depression in women with fear of birth vary over time and that co-morbidity is quite common. Lack of emotional well-being was related to prenatal attachment. Healthcare professionals must identify and support women with anxiety and depressive symptoms and fear of birth so that difficulties in the relationship between the mother and the newborn baby might be reduced.
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| 46. |
- Hildingsson, Ingegerd, 1955-, et al.
(author)
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Childbirth experience in women participating in a continuity of midwifery care project
- 2021
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In: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 34:3, s. e255-e261
-
Journal article (peer-reviewed)abstract
- Background: Continuity models of care are rare in Sweden, despite the evidence of their benefit to women and babies. Previous studies have shown certain factors are associated with a positive birth experience, including continuity of midwifery care.Aim: The aim was to investigate women's childbirth experiences in relation to background data, birth outcome and continuity with a known midwife, in a rural area of Sweden.Methods: An experimental cohort study. Participating women were offered continuity of midwifery care in pregnancy and birth, during selected time periods. Data were collected in mid-pregnancy and two months after birth. The Childbirth Experience Questionnaire was used to determine women's birth experiences.Result: A total of 226 women responded to the follow-up questionnaire. Not living with a partner, fear of giving birth, and a birth preference other than vaginal were associated with a less positive birth experience. Having had a vaginal birth with no epidural, no augmentation and no birth complication all yield a better birth experience. Women who had had a known midwife were more likely to have had a positive birth experience overall, predominantly in the domain Professional support.Conclusions: The results of this study showed that women who received care from a known midwife in labour were more likely to have a positive birth experience. The results also pointed out the benefits of a less medicalized birth as important for a good birth experience, and that some women may need extra support to avoid a less positive birth experience.
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| 47. |
- Hildingsson, Ingegerd, 1955-, et al.
(author)
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How midwives' perceptions of work empowerment have changed over time : A Swedish comparative study
- 2023
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In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 118
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Journal article (peer-reviewed)abstract
- Objective: The aim of this paper was to compare current perceptions of empowerment in their work with results from a sample of midwives recruited 2012.Design: A comparative cross-sectional cohort study of national samples of midwives in Sweden from 2012 to 2022.Participants: 475 midwives recruited from the Swedish midwifery association in 2012 and 1782 through two midwifery unions in 2022.Methods: Data were collected using a questionnaire with background information and the revised version of the Perception of Empowerment Scale (PEMS). Mean scores and domains of the PEMS were compared between the years.Findings: Midwives' perceptions of empowerment changed over time, in both directions. Their perception of their skills and education, advocating for and empowering women as well as support from the team and manager increased over the years. Midwives in 2022 were less likely to perceive that they were involved in a midwifery-led practice, and the communication with managers was rated lower. Midwives sensed a lack of professional recognition from the medical profession and their contribution to the care of birthing women. Access to resources for birthing women was perceived lower in 2022 compared to 2012. Younger age, shorter work experience and working in labour wards or postnatal wards were associated with lower perceptions of empowerment.Conclusions: Midwives need to have the authority and reality to practice midwife-led care, to receive control over their work. Good communication and recognition from the medical profession is essential to be empowered. This is important in order to maintain a healthy workforce.
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| 48. |
- Hildingsson, Ingegerd, 1955-, et al.
(author)
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Increasing levels of burnout in Swedish midwives : A ten-year comparative study
- 2024
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In: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 37:2, s. 325-331
-
Journal article (peer-reviewed)abstract
- ProblemMidwives’ levels of burnout seem to be increasing worldwide.BackgroundPrevious research show a high prevalence of burnout in midwives.AimTo compare levels of burnout in two national Swedish samples of midwives completing a similar survey.MethodsA comparative study of two cross-sectional national surveys directed at midwives in 2012 and 2022. To measure burnout in midwives, the Copenhagen Burnout Inventory with 19 items was used.FindingsThe sample consisted of 2209 midwives: 466 from 2012 and 1743 from 2022. Personal burnout showed an increase from 39.5 % to 53.6 % over the years; work burnout increased from 15.5 % to 49.2 % and client burnout increased from 15 % to 20.9 %. Personal burnout was associated with working shift. Work burnout was associated with length of work experience and working rotating shifts; and client burnout was associated with shorter work experience.DiscussionThe highest increase in burnout was found in the work domain in 2022 compared to 2012. Notable in the present study is the increase in client burnout, which could be a sign of midwives becoming less caring and more cynical.ConclusionThis study showed that self-reported levels of burnout among Swedish midwives increased over the ten-year period studied. The largest increase was found in the subscale work burnout. Midwives with shorter work experience and those with shift work were the most vulnerable to burnout. Improved organisation of midwifery services needs to be designed to ensure healthy working conditions for midwives.
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| 49. |
- Hildingsson, Ingegerd, 1955-, et al.
(author)
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Quality of intrapartum care assessed by women participating in a midwifery model of continuity of care
- 2021
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In: European Journal of Midwifery. - : E.U. European Publishing. - 2585-2906. ; 5:4, s. 1-10
-
Journal article (peer-reviewed)abstract
- INTRODUCTION Continuity models are rare in Sweden. The aim was to compare the intrapartum care experiences between women who had or not a known midwife attending their birth. METHODS A cohort study was conducted in a rural area with long distance to a labor ward in Sweden. From August 2017 to June 2019, a continuity model with a known midwife was offered between 7 a.m. and 11 p.m. daily. Questions about intrapartum care were assessed in two aspects; the perceived reality and the subjective importance. RESULTS A total of 226 women recruited in early pregnancy were followed up two months after giving birth. Women who had a known midwife providing labor care reported higher overall satisfaction and were more likely to value the subjective importance and the perceived reality significantly higher than women who received intrapartum care without a known midwife assisting. When analyzing the medical aspects of intrapartum care, the most important factors for not being satisfied were deficiencies in the partner’s involvement and insufficient pain relief. For the emotional aspects, deficiencies in participation in decision making was the most important aspect. CONCLUSIONS Having a known midwife assisting at birth reduced discrepancies between women’s subjective importance and perceived reality of intrapartum care, especially regarding support and the involvement of the partner. A known midwife generated higher overall satisfaction with the medical and emotional aspects of intrapartum care. To improve satisfaction and the quality of intrapartum care, continuity midwifery models of care should be implemented.
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| 50. |
- Hildingsson, Ingegerd, 1955-, et al.
(author)
-
Swedish midwives' attitudes towards continuity models - a cross-sectional survey
- 2024
-
In: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 40
-
Journal article (peer-reviewed)abstract
- Background: Midwifery continuity models are growing worldwide, but few such alternatives are available in Sweden. There is sparse knowledge about Swedish midwives' attitudes about midwifery continuity models.Aim: The aim of this study was to explore Swedish midwives' attitudes toward continuity models. An additional aim was to evaluate the psychometric properties of a previously developed instrument measuring attitudes to continuity models.Methods: A cross-sectional survey of a national sample of 2537 midwives in Sweden. The participants completed a questionnaire online. A Principal component Analysis was performed to identify components in the instrument.Results: A fairly similar proportion of midwives worked in antenatal care (30.7%), intrapartum care (30.7%) and in other areas (31.1%). Many midwives (59%) agreed that continuity models should be available to women, but were not certain about if such models should be offered to all women or low risk women only. Two domains of the attitude scale were identified; Relationship-based Midwifery Continuity Models, and Practical and Organisational Aspects of Midwifery Continuity Models. Age, having children, marital status, length of work experience and place of work were associated with high agreement non the two components.Conclusion: Many midwives in general held positive attitudes about continuity models. The relationship aspects were highly valued but midwives were also hesitant about the practical and organisational aspect of continuity models. Unbiased information to midwives about the pros and cons with continuity models should be offered, in order to limit misunderstandings about the model.
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