| 1. |
- Berg, Marie, 1955, et al.
(författare)
-
Evidence-based care and childbearing - A critical approach
- 2008
-
Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; :3, s. 239-247
-
Tidskriftsartikel (refereegranskat)abstract
- Developing the best care for clients and patients is a paramount aim of all health care practices, which therefore, should be based on best evidence. This is also crucial for care during the childbearing period here defined as pregnancy, childbirth, and infancy. However, due to dominance of the evidence-based medicine (EBM) model, health care practice has encountered problems especially regarding its relationship to qualitative research. In this article, we analyze and discuss how research based on a lifeworld perspective fits with evidence-based care (EBC), and how a circular model instead of a hierarchy is suitable when attributing value to knowledge for EBC. The article focuses on the history of EBM and EBC, the power of the evidence concept, and EBC from a narrow to a broad view. Further qualitative research and its use for developing EBC is discussed and examples are presented from the authors’ own lifeworld research in the Nordic childbearing context. Finally, an alternative circular model of knowledge for EBC is presented. In order to develop evidence-based care, there is need for multiple types of scientific knowledge with equal strength of evidence, integrated with clinical experience, setting, circumstances and health care resources, and incorporating the experiences and clinical state of the childbearing woman and her family.
|
|
| 2. |
- Clarke, Mike, et al.
(författare)
-
OptiBIRTH: a cluster randomised trial of acomplex intervention to increase vaginalbirth after caesarean section
- 2020
-
Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393.
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are lowin many countries.Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC ratesthrough an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland andItaly. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education ofclinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review,and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annualhospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940women.Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was nostatistically significant difference in the change in the proportion of women having a VBAC between interventionsites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences betweenintervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI:0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited womenwith birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000.Conclusions: Changing clinical practice takes time. As elective repeat CS is the most common reason for CS inmultiparous women, interventions that are feasible and safe and that have been shown to lead to decreasingrepeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. Thismay best be done using an implementation science approach that can modify evidence-based interventions inresponse to changing clinical circumstances.Trial registration: The OptiBIRTH trial was registered on 3/4/2013. Trial registration number ISRCTN10612254.
|
|
| 3. |
- Degni, Filio, et al.
(författare)
-
Reproductive and maternity health care services in Finland : perceptions and experiences of Somali-born immigrant women
- 2014
-
Ingår i: Ethnicity and Health. - : Informa UK Limited. - 1355-7858 .- 1465-3419. ; 19:3, s. 348-366
-
Tidskriftsartikel (refereegranskat)abstract
- Objective.To explore immigrant Somali women's experiences of reproductive and maternity health care services (RMHCS) and their perceptions about the service providers.Design.Five focus group discussions were conducted from April 1999 to June 2000 using a purposeful sampling strategy in order to reach multiparous female Somali-born Immigrants with experiences from the maternity health care in Finland.Participants.A total of 70 married Somali women aged 18-50 and mother of 2-10 children were studied. Among them, 18 came from Kenya, 32 from Mogadishu and 20 from Hargeysa.Settings.Of the participants, 45 were living in the city of Vantaa, 22 in the city of Helsinki and 13 in the city of Turku.Results.Participants were satisfied with the RMHCS they received in Finland. Despite their satisfaction, the health care providers' social attitudes towards them were perceived as unfriendly, and communication as poor.Conclusions.The women's experiences revealed that they have access to good quality RMHCS in Finland. While their experiences are significant, their perceptions are important for physicians, nurses and midwives in order to achieve culturally competent care.
|
|
| 4. |
- Fägerskiöld, Astrid, 1942-
(författare)
-
Support of mothers and their infants by the child health nurse : expectations and experiences
- 2002
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to describe and analyse the CH nurse's support of mothers and their infants, given in order to form a good relationship md lead to favourable development of the child. In studies I, II and III, grounded theory and constant comparative method were used. The aim of study I was to identify how child health nurses view the mother-infant relationship, and how they can improve this relationship. The nurses (n=10) could, through observation of the interplay between mother and infant, view the relationship between the two of them. Such interplay depends on the mother's ability to interpret the infant's signals and the clarity of these signals. These attributes are influenced by mother and infant body language, vocal language, health status, expectations and life situation, which are also influenced mutually. The nurse could improve this relationship through promoting an understanding of the interplay between mother and infant.The aims of study II were to identify what the child health nurse believed was expected of her by women who had recently become mothers, primipara and multipara; and to investigate which problems the nurse found it most difficult to deal with and to analyse why they were difficult. The nurses (n=15) believed that mothers expected care of the infant and the family from the nurse, comprising support, advice, and child health assessments. The nurses found it most difficult to deal with obstacles to interaction with mothers, such as motherhood problems, hidden, social, and organisational problems.The aims of study III were to identify what first-time mothers expected of the child health nurse; and to investigate the help and support that new mothers receive from nurses, and whether first-time mothers felt that anything was lacking. The mothers (n=20) expected the nurse to be a supporter, characterized by accessibility, approachability, knowledge, advice and support. They had experienced most of these things, accessibility and approachability in particular. However, the nurses showed a lack of continuity in interest in the mothers' bodies and health. In addition, mothers who wished to discontinue breast-feeding felt that they lacked support from the nurse.The aim of study IV was to investigate mothers' experiences of their encounters with the child health nurse. A national random sample of mothers (n=140) reported, based on critical incident technique, support or lack of support from the nurse. Thematic content analysis, including 125 reports and demographic data, was accomplished. Symbolic interactionism was used as a frame of reference. The central factor was that they were able to share the realm of motherhood that the nurse is willing to share all kinds of emotions and experiences related to being a mother. The majority of the mothers had received valuable support during troublesome incidents. Nevertheless, there were several dissatisfied mothers who had expected support but thought that they had received insulting treatment instead.The aims of study V were to describe similarities and differences in expectations of the child health nurse, as they were expressed by recently delivered first-time mothers as compared to an expression of what child health nurses believed mothers of infants expected of them. Data from the intetviews with nurses in study II and mothers in study III (n=35) were analysed by thematic content analysis. The nurse could be someone to approach, who, through her knowledge, could assess the child's development and give immunizations and be a supporter, counsellor, safety provider and a parent group organizer. Similarities between mothers' and nurses' statements occurred more frequently than differences, which are suggested to depend on the Swedish tradition among new mothers of visiting the child health clinic. The mothers expected participation in parent groups to a higher degree than the nurses believed that they did.
|
|
| 5. |
- Jackson, Karin, 1947-
(författare)
-
Att vara förälder till ett för tidigt fött barn : en prospektiv studie om upplevelsen av föräldraskap och möten med vården
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present doctoral thesis focuses mainly on the experiences of 20 women and men of becoming and being parents of a prematurely born child and on their perceptions of their contacts with health and medical care services. An additional aim was to investigate the utilisation of health care during the first year of life and its relation to high-risk diagnoses in the neonatal period.Data were obtained by interviews of the 20 sets of parents to infants born at a gestational age of <34 weeks with no serious congenital defects. These parents were interviewed 1-2 weeks after the infant’s birth and at 2, 6 and 18 months of age. The interview texts were subjected to phenomenological and content analysis. Data was also obtained from the records of 36 infants born at a gestational age of <31 weeks and with a birth weight of <1500 g and 36 full-term infants. The records included information regarding contact with health care services including the child health centres (CHCs) and the outpatient clinics of the paediatric and ophthalmic clinics. Finally data from the other two quantitative studies were obtained from three questionnaires: Quality of Care from The Patient’s Perspective, The Swedish Parenthood Stress Questionnaire and The Toddler Behaviour Questionnaire.The result of the studies showed that the utilisation of health care by the very low birth weight infants was higher than that by the fullterm infants in paediatric and ophthalmic outpatient clinics. High-risk diagnoses in the neonatal period did not correlate with utilisation of care except for visits to the paediatric outpatient clinic, especially planned visits.The internalisation of parenthood was described by the parents as a time-dependent process, with four syntheses of experiences – alienation, responsibility, confidence and familiarity.The development and construction of the mothers’ and fathers’ parental identity followed a pattern that could be summarised into three themes: Unexpected start of parenthood, integration of parenthood into the sense of identity and recognition of parental identity. Important turning points in experiences of parenthood often occurred when the infant could be removed from the incubator, when it was discharged from the ward, and when the infant appeared normal compared to full-term infants.The quality of care was judged, from the parents’ and nurses’ perspective. In general the subjective importance of the given care was rated higher than the care actual given in both neonatal care and care at the CHCs. Higher ratings were given to neonatal care compared with the care at CHSs for medico-technical competence. It was also of importance, of both parents, to receive an optimal identity-oriented approach and socio-cultural atmosphere in the neonatal care and the care at the CHSs. High-risk diagnoses in the newborn did not affect the answers.Parental stress of very preterm children, at 18 months of age, did not differ notably from those parents of children born somewhat less premature, but they assessed their children as being rather later in the development of social behaviours. Parents of children who had had a difficult neonatal period were not more stressed when the child was 18 months old than those who had no problems in the neonatal period.In sum, this research project showed that the parents’ expectations and experiences of becoming mothers and fathers in preterm birth was a process of integrating the unexpected start of parenthood into the parents’ sense of identity and their way of being. When the parents developed a relationship with the infant, actively participated in its care on the basis of their own preferences, and received recognition as parents, this process was strengthened. It is therefore important that the professional caring of the staff should meet and involve the natural caring of the parents.
|
|
