RESUMO
OBJECTIVE: to identify the perception of professional empowerment among midwives in selected Latin American countries (LA). Specifically, this study aimed to compare i) the global level of empowerment among midwives in different LA countries, ii) the scores according to the different dimensions of the scale, and iii) scores according to area the of expertise. DESIGN: A quantitative, observational, analytical, cross-sectional and multisite study using an adaptation of the Perceptions Midwifery Empowerment Scale (PEMS). SETTINGS: Clinical, educational and managerial midwifery positions in 5 LA countries belonging to a Latin American Research Network in Midwifery. All the participating countries reported a similar profile regarding type of education, association and regulation procedures. PARTICIPANTS: A total of 1127 responses from midwives with different professional backgrounds were included in the study. FINDINGS: A total mean score of 73.28 (74.23-72.03) points was reported. Chile reported the lowest score of empowerment compared to the other countries, while Argentina reported the highest. Midwives' perceptions of empowerment within their area of expertise, primary health care (PHC) was the area of reference, and gynaecology reported a significantly lower score. Midwives working in management were significantly more empowered compared with those in other areas. Midwives who had continuous education and postgraduate studies were the most empowered. Regarding the provision of woman-centred Care, Chile and El Salvador differed significantly from Argentina (reference), while Uruguay reported a significantly higher score in this dimension. Midwives working in hospital wards reported significantly lower scores compared to those working in PHC. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study suggests that midwifery programmes in the LA countries would benefit from prioritising professional empowerment, especially in the areas of hospital practice, where midwives' perceptions of empowerment were most limited.
Assuntos
Empoderamento , Enfermeiros Obstétricos , Humanos , Estudos Transversais , Adulto , Feminino , Enfermeiros Obstétricos/psicologia , Enfermeiros Obstétricos/estatística & dados numéricos , Inquéritos e Questionários , Pessoa de Meia-Idade , América Latina , Tocologia/métodos , Tocologia/normas , GravidezRESUMO
OBJECTIVE: To assess Chilean medical and midwifery students' attitudes and willingness to become trained to provide abortion care, shortly after abortion was decriminalised in 2017. DESIGN: We fielded a cross-sectional, web-based survey of medical and midwifery students. We used generalised estimating equations to assess differences by type of university and degree sought. SETTING: We recruited students from a combination of seven secular, religiously-affiliated, public and private universities that offer midwifery or medical degrees with a specialisation in obstetrics and gynaecology, located in Santiago, Chile. PARTICIPANTS: Students seeking medical or midwifery degrees at one of seven universities were eligible to participate. We distributed the survey link to medical and midwifery students at these seven universities; 459 eligible students opened the survey link and 377 students completed the survey. PRIMARY AND SECONDARY OUTCOMES: Intentions to become trained to provide abortion services was our primary outcome of interest. Secondary outcomes included moral views and concerns about abortion provision. RESULTS: Most students intend to become trained to provide abortion services (69%), 20% reported that they will not provide an abortion under any circumstance, half (50%) had one or more concern about abortion provision and 16% agreed/strongly agreed that providing abortions is morally wrong. Most believed that their university should train medical and midwifery students to provide abortion services (70%-79%). Secular university students reported higher intentions to provide abortion services (beta 0.47, 95% CI: 0.31 to 0.63), more favourable views (beta 0.52, CI: 0.32 to 0.72) and were less likley to report concerns about abortion provision (adjusted OR 0.47, CI: 0.23 to 0.95) than students from religious universities. CONCLUSION: Medical and midwifery students are interested in becoming trained to provide abortion services and believe their university should provide this training. Integrating high-quality training in abortion care into medical and midwifery programmes will be critical to ensuring that women receive timely, non-judgemental and quality abortion care.
Assuntos
Aborto Legal/psicologia , Atitude do Pessoal de Saúde , Enfermeiros Obstétricos/psicologia , Estudantes de Medicina/psicologia , Adolescente , Adulto , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Enfermeiros Obstétricos/estatística & dados numéricos , Gravidez , Religião , Estudantes de Medicina/estatística & dados numéricos , Adulto JovemRESUMO
This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.
Este artigo tem como objetivo descrever os primeiros resultados de dois estudos avaliativos, um sobre a Rede Cegonha e outro sobre o projeto Parto Adequado, denominados, respectivamente, de avaliação da Rede Cegonha e Nascer Saudável, e identificar possíveis melhorias em comparação ao estudo Nascer no Brasil. Ambos os estudos têm desenho seccional, realizados em 2017. O estudo avaliação da Rede Cegonha incluiu todas as 606 maternidades públicas e mistas envolvidas na Rede Cegonha e um total de 10.675 puérperas. O estudo Nascer Saudável incluiu uma amostra de conveniência de 12 hospitais da rede privada e um total de 4.798 mulheres. Os indicadores de atenção ao parto e nascimento avaliados foram: presença de acompanhante, atendimento por enfermeira obstétrica, preenchimento de partograma, uso de métodos não farmacológicos, deambulação, alimentação, uso de cateter venoso periférico, analgesia, posição da mulher para o parto, episiotomia e manobra de Kristeler. Esses indicadores foram comparados aos encontrados no Nascer no Brasil, estudo de base nacional realizado em 2011-2012, antes do início dos dois programas de intervenção. Para as comparações utilizamos o teste do qui-quadrado para amostras independentes e nível de 95% de confiança. Houve um aumento significativo do número de mulheres com acesso à tecnologia apropriada ao parto entre os anos de 2011 e 2017 e redução de práticas consideradas prejudiciais. No setor privado, observou-se também redução nas taxas de cesariana e aumento da idade gestacional ao nascer. Os resultados deste estudo mostram que políticas públicas bem conduzidas podem mudar o cenário da atenção ao parto e nascimento, promovendo a redução de desfechos maternos e neonatais negativos.
El objetivo de este artículo es describir los primeros resultados de dos estudios evaluativos, uno sobre la Red Cigüeña y otro sobre el proyecto Parto Adecuado, denominados respectivamente como evaluación de la Red Cigüeña y Nacer Sano, e identificar posibles mejorías en comparación con el estudio Nacer en Brasil. Ambos estudios tienen un diseño transversal, realizados en 2017. El estudio evaluación de la Red Cigüeña incluyó todas las maternidades públicas (606) y mixtas implicadas en la Red Cigüeña y a un total de 10.675 puérperas. El estudio Nacer Sano incluyó una muestra de conveniencia de 12 hospitales privados y a un total de 4.798 mujeres. Los indicadores de atención al parto y nacimiento evaluados fueron: presencia de acompañante, atención por enfermera obstetra, cumplimentación de partograma, uso de métodos no farmacológicos, deambulación, alimentación, uso de catéter venoso periférico, analgesia, posición de la mujer para el parto, episiotomía y maniobra de Kristeler. Estos indicadores se compararon con los encontrados en Nacer en Brasil, un estudio a nivel nacional, realizado en 2011-2012, antes del inicio de los dos programas de intervención. Para las comparaciones utilizamos el test del chi-cuadrado para muestras independientes y nivel de confianza de un 95%. Hubo un aumento significativo del número de mujeres con acceso a la tecnología apropiada para el parto entre los años de 2011 y 2017 y una reducción de las prácticas consideradas perjudiciales. En el sector privado, se observó también una reducción en las tasas de cesárea y aumento de la edad gestacional al nacer. Los resultados de este estudio muestran que las políticas públicas bien dirigidas pueden cambiar el escenario de la atención al parto y nacimiento, promoviendo la reducción de desenlaces maternos y neonatales negativos.
Assuntos
Parto Obstétrico/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Adulto , Brasil , Cesárea/estatística & dados numéricos , Cesárea/tendências , Criança , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Estudos de Avaliação como Assunto , Feminino , Idade Gestacional , Maternidades , Humanos , Trabalho de Parto , Saúde Materna/tendências , Enfermeiros Obstétricos/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Assistência Perinatal/tendências , Gravidez , Dados Preliminares , Apoio Social , Adulto JovemRESUMO
Resumo: Este artigo tem como objetivo descrever os primeiros resultados de dois estudos avaliativos, um sobre a Rede Cegonha e outro sobre o projeto Parto Adequado, denominados, respectivamente, de avaliação da Rede Cegonha e Nascer Saudável, e identificar possíveis melhorias em comparação ao estudo Nascer no Brasil. Ambos os estudos têm desenho seccional, realizados em 2017. O estudo avaliação da Rede Cegonha incluiu todas as 606 maternidades públicas e mistas envolvidas na Rede Cegonha e um total de 10.675 puérperas. O estudo Nascer Saudável incluiu uma amostra de conveniência de 12 hospitais da rede privada e um total de 4.798 mulheres. Os indicadores de atenção ao parto e nascimento avaliados foram: presença de acompanhante, atendimento por enfermeira obstétrica, preenchimento de partograma, uso de métodos não farmacológicos, deambulação, alimentação, uso de cateter venoso periférico, analgesia, posição da mulher para o parto, episiotomia e manobra de Kristeler. Esses indicadores foram comparados aos encontrados no Nascer no Brasil, estudo de base nacional realizado em 2011-2012, antes do início dos dois programas de intervenção. Para as comparações utilizamos o teste do qui-quadrado para amostras independentes e nível de 95% de confiança. Houve um aumento significativo do número de mulheres com acesso à tecnologia apropriada ao parto entre os anos de 2011 e 2017 e redução de práticas consideradas prejudiciais. No setor privado, observou-se também redução nas taxas de cesariana e aumento da idade gestacional ao nascer. Os resultados deste estudo mostram que políticas públicas bem conduzidas podem mudar o cenário da atenção ao parto e nascimento, promovendo a redução de desfechos maternos e neonatais negativos.
Resumen: El objetivo de este artículo es describir los primeros resultados de dos estudios evaluativos, uno sobre la Red Cigüeña y otro sobre el proyecto Parto Adecuado, denominados respectivamente como evaluación de la Red Cigüeña y Nacer Sano, e identificar posibles mejorías en comparación con el estudio Nacer en Brasil. Ambos estudios tienen un diseño transversal, realizados en 2017. El estudio evaluación de la Red Cigüeña incluyó todas las maternidades públicas (606) y mixtas implicadas en la Red Cigüeña y a un total de 10.675 puérperas. El estudio Nacer Sano incluyó una muestra de conveniencia de 12 hospitales privados y a un total de 4.798 mujeres. Los indicadores de atención al parto y nacimiento evaluados fueron: presencia de acompañante, atención por enfermera obstetra, cumplimentación de partograma, uso de métodos no farmacológicos, deambulación, alimentación, uso de catéter venoso periférico, analgesia, posición de la mujer para el parto, episiotomía y maniobra de Kristeler. Estos indicadores se compararon con los encontrados en Nacer en Brasil, un estudio a nivel nacional, realizado en 2011-2012, antes del inicio de los dos programas de intervención. Para las comparaciones utilizamos el test del chi-cuadrado para muestras independientes y nivel de confianza de un 95%. Hubo un aumento significativo del número de mujeres con acceso a la tecnología apropiada para el parto entre los años de 2011 y 2017 y una reducción de las prácticas consideradas perjudiciales. En el sector privado, se observó también una reducción en las tasas de cesárea y aumento de la edad gestacional al nacer. Los resultados de este estudio muestran que las políticas públicas bien dirigidas pueden cambiar el escenario de la atención al parto y nacimiento, promoviendo la reducción de desenlaces maternos y neonatales negativos.
Abstract: This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.
Assuntos
Humanos , Feminino , Gravidez , Criança , Adolescente , Adulto Jovem , Avaliação de Resultados em Cuidados de Saúde , Parto Obstétrico/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Apoio Social , Brasil , Trabalho de Parto , Cesárea/tendências , Cesárea/estatística & dados numéricos , Idade Gestacional , Assistência Perinatal/tendências , Assistência Perinatal/estatística & dados numéricos , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Estudos de Avaliação como Assunto , Saúde Materna/tendências , Dados Preliminares , Maternidades , Enfermeiros Obstétricos/estatística & dados numéricosRESUMO
BACKGROUND: The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections. METHODS: Birth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births. RESULTS: 16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower. CONCLUSIONS: The results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor and birth care. The adoption of good practices in managing labor and birth could be the first step toward more effective obstetric and midwifery care in Brazil. It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.
Assuntos
Trabalho de Parto , Serviços de Saúde Materna/normas , Tocologia/métodos , Enfermeiros Obstétricos/estatística & dados numéricos , Cuidado Pré-Natal/normas , Adolescente , Adulto , Brasil , Criança , Feminino , Parto Domiciliar , Humanos , Recém-Nascido , Padrões de Prática em Enfermagem , Gravidez , Adulto JovemRESUMO
BACKGROUND: community-based midwifery practice has been promoted in the UK maternity policy over the last decade as a means of increasing continuity of care. However, there have been growing concerns to suggest that the community-based continuity model may not be sustainable due to the high levels of occupational burnout in midwives resulted by increased on-call work. AIMS: this paper attempted to identify work factors associated with the levels of burnout in community midwives as compared to hospital midwives, aiming at contributing to the debate of organising sustainable midwifery care. METHODS: a statistical analysis was conducted drawing on data from a survey of all midwives working at one Hospital Trust in England (n=238). Occupational burnout was measured using the Maslach Burnout Inventory (MBI). RESULTS: the sample midwives (n=128, 54%) had significantly higher levels of burnout compared to the reference groups. Multiple regression analysis identified as follows: (1) high levels of occupational autonomy were a key protective factor of burnout, and more prevalent in the community, (2) working hours were positively associated with burnout, and community midwives were more likely to have higher levels of stress recognition, and (3) support for work-life-balance from the Trust had a significant protective effect on the levels of burnout. CONCLUSION: the results should be taken into account in the maternity policy in order to incorporate continuity of care and sustainable organisation of midwifery care.
Assuntos
Esgotamento Profissional/epidemiologia , Tocologia/estatística & dados numéricos , Enfermeiros Obstétricos/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Esgotamento Profissional/etiologia , Inglaterra , Feminino , Inquéritos Epidemiológicos , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Características de Residência , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVES: to examine the present-day knowledge formation and practice of indigenous Kaqchikel-speaking midwives, with special attention to their interactions with the Guatemalan medical community, training models, and allopathic knowledge in general. DESIGN/PARTICIPANTS: a qualitative study consisting of participant-observation in lay midwife training programs; in-depth interviews with 44 practicing indigenous midwives; and three focus groups with midwives of a local non-governmental organization. SETTING: Kaqchikel Maya-speaking communities in the Guatemalan highlands. FINDINGS: the cumulative undermining effects of marginalization, cultural and linguistic barriers, and poorly designed training programs contribute to the failure of lay midwife-focused initiatives in Guatemala to improve maternal-child health outcomes. Furthermore, in contrast to prevailing assumptions, Kaqchikel Maya midwives integrate allopathic obstetrical knowledge into their practice at a high level. CONCLUSIONS AND IMPLICATIONS: as indigenous midwives in Guatemala will continue to provide a large fraction of the obstetrical services among rural populations for many years to come, maternal-child policy initiatives must take into account that: (1)Guatemalan midwife training programs can be significantly improved when instruction occurs in local languages, such as Kaqchikel, and (2)indigenous midwives' increasing allopathic repertoire may serve as a productive ground for synergistic collaborations between lay midwives and the allopathic medical community.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde do Indígena/normas , Serviços de Saúde Materna/normas , Tocologia/educação , Enfermeiros Obstétricos/educação , Papel Profissional , Adulto , Feminino , Guatemala , Humanos , Relações Interprofissionais , Pessoa de Meia-Idade , Enfermeiros Obstétricos/estatística & dados numéricos , Pesquisa QualitativaRESUMO
Despite cervical cancer being one of the leading causes of cancer-related deaths among women in Peru, cervical Pap smear coverage is low. This article uses findings from 185 direct clinician observations in four cities of Peru (representing the capital and each of the three main geographic regions of the country) to assess missed opportunities for health education on Pap smears and other preventive women's health behaviors during women's visits to a health care provider. Various types of health establishments, provider settings, and provider types were observed. Opportunities for patient education on the importance of prevention were rarely exploited. In fact, health education provided was minimal. Policy and programmatic implications are discussed.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Teste de Papanicolaou , Educação de Pacientes como Assunto/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Idoso , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Ginecologia/normas , Ginecologia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiros Obstétricos/normas , Enfermeiros Obstétricos/estatística & dados numéricos , Observação , Educação de Pacientes como Assunto/normas , Peru , Neoplasias do Colo do Útero/diagnóstico , Serviços de Saúde da Mulher/normas , Recursos Humanos , Adulto JovemRESUMO
UNLABELLED: GENERAL OBJECTIVE: to analyse the exercise of essential competencies for midwifery care by nurses and/or midwives in the public health system of São Paulo (eastern zone), Brazil. SPECIFIC OBJECTIVES: to develop a profile of the public health institutions and of the nurses and/or midwives who care for women before, during and following childbirth; to identify the activities performed in providing such care, as well as their frequency; and to specify the possible obstacles or difficulties encountered by them when exercising their competencies. DESIGN: a descriptive and exploratory research design, using a quantitative approach. SETTING: the study was conducted in all public health services of São Paulo (eastern zone), Brazil, namely 59 basic health-care units and six hospitals, during the period of October 2006-December 2007. PARTICIPANTS: the study population consisted of 272 nurses and/or midwives who provide care for pregnant women and newborns at the primary health-care units and maternity hospitals of the public health system. Participants comprised 100% of hospital nurse coordinators (n=6), 61% of hospital maternity nursing and/or midwifery staff (n=62) and 64% (n=204) of nursing and/or midwifery staff working at primary health-care units. METHODS AND FINDINGS: the data collection was based on a single form given to the coordinators and two questionnaires, one handed out to antenatal and postnatal nursing and/or midwifery staff and another handed out to labour and birth nursing and/or midwifery staff. The results showed that nurses and/or midwives providing care for women during pregnancy, labour, birth and the postnatal period did not put the essential competencies for midwifery care into practice, because they encountered institutional barriers and personal resistance, and lacked protocols based on best practice and on the exercise of essential competencies needed for effective midwifery care. KEY CONCLUSIONS: the model of care in the public health services of São Paulo (eastern zone) is based much more on hierarchical positions than on professional competencies or on the recommendations of the scientific community. As a result, health authorities need to review their midwifery policies to improve maternal-infant care by nurses and/or midwives in order to ensure the implementation of best midwifery practice. PRACTICAL IMPLICATIONS: the results of this study support actions to improve the quality of care delivered to women and their families, while integrating nursing and midwifery care in São Paulo, Brazil.
Assuntos
Competência Clínica/estatística & dados numéricos , Tocologia/organização & administração , Enfermeiros Obstétricos/organização & administração , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Cuidado Pré-Natal/organização & administração , Adulto , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido , Bem-Estar Materno/estatística & dados numéricos , Pessoa de Meia-Idade , Tocologia/estatística & dados numéricos , Enfermeiros Obstétricos/estatística & dados numéricos , Pesquisa em Avaliação de Enfermagem , Gravidez , Garantia da Qualidade dos Cuidados de Saúde , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
Presenta el propuesta de ante proyecto sobre el fortalecimiento de la enfermeras/os obstetricas en Nicaragua. Esta propuesta es sobre un Post Grado en Enfermería Obstétrica ha realizarse en el Instituto Politecnico de la Salud (POLISAL) Dr. Luis Felipe Moncada. Esta en dos fases. Con este proyecto pretende especializar en obstetricia a las /los enfermeros con licenciatura para atender a las mujeres durante el embarazo, parto, puerperio, al recién nacido, planifación familiar, la detención precoz del cáncer cervico uterino y mamario, para contribuir a la disminución de la morbimortalidad materna y perinatal. Con este Post Grado se pretende fomentar los valores éticos, morales y humanisticos durante la atención a las usuarias y brindar una atención de enfermería de calidad y con calidez.
Assuntos
Enfermeiros Obstétricos/educação , Enfermeiros Obstétricos/estatística & dados numéricos , Enfermeiros Obstétricos/história , Bem-Estar Materno , Papel Profissional , Saúde PúblicaRESUMO
The results are presented of a field study of the use of high dose Estrogen/Progestin combination drugs in Cusco, Peru, 1987. In Western countries the sale of these products is restricted. In the 1970s the use of high dose Estrogen/Progestin combination drugs as a hormonal pregnancy test was assumed to cause birth defects. Still these drugs have high sales data in Third World countries, where they are marketed for the treatment of menstrual disorders and for pregnancy diagnosis. A widespread misuse as abortifacient is assumed, although the abortive effect has never been proved. In this study 112 gynaecological consultations by doctors and 53 by midwives were observed. Seventeen health professionals and 26 salesmen in pharmacies were interviewed. It turned out that doctors and midwives prescribe high dose Estrogen/Progestin combination drugs to women whose periods are delayed. Of the consults 33% concerned this complaint. Women prefer "hindsight" birth control methods. Abortion is illegal. Under the cover of menstruation regulation or pregnancy diagnosis health professionals meet the wishes of women who search for an abortifacient. The products can easily be obtained without prescription. It is suggested that high dose Estrogen/Progestin combination drugs should be withdrawn from the market.
Assuntos
Abortivos , Atitude do Pessoal de Saúde , Estrogênios , Prática Profissional/estatística & dados numéricos , Progesterona , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Abortivos/provisão & distribuição , Combinação de Medicamentos , Estrogênios/provisão & distribuição , Humanos , Enfermeiros Obstétricos/psicologia , Enfermeiros Obstétricos/estatística & dados numéricos , Peru/epidemiologia , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Médicos/psicologia , Médicos/estatística & dados numéricos , Progesterona/provisão & distribuição , Inquéritos e Questionários , População UrbanaRESUMO
Brain drain, the exodus of highly trained professionals from developing countries to better paying jobs in the developed world, threatens the structure of community health care in those developing countries. In the Caribbean Basin, as in many developing countries, midwives are the primary health care providers for mothers and their children. This paper describes the maternal and child health (MCH) system in the Caribbean island community of St. Vincent and the Grenadines (SVG); compares MCH indicators in SVG with those in developed and developing nations; describes the role of the nurse-midwife in the delivery of MCH services; and examines the growing problem of recruitment and retention (brain drain) of nurse-midwives. Suggestions made by the nurse-midwives of SVG will be used to explore some solutions to this major human resource problem threatening the MCH system and to identify the major obstacles to their implementation.
PIP: The background, history, sociodemographic characteristics, and health services in St. Vincent and the Grenadines are described. In the discussion of the status of maternal and child health (MCH) and the role of nurse-midwife, information is provided on how midwives view their role, the benefits and rewards, drawbacks, and problems of recruitment and retention. 6 strategies for change are presented to address the concerns of nurse-midwives, and the constraints to implementation are noted. Interviews were conducted in August 1990 and validated. Statistical documents and records were consulted and hospital delivery observed. The current health personnel situation is one of shortages of trained physicians and nurses and a burgeoning population creating additional demand for health services. 9 health districts with 36 clinics and 5 rural hospitals and 1 general hospital in Kingston provide services for the 113,570 population. There are 2 privately owned hospitals in Kingston and private practice physicians. The district health center is the primary care facility with a nurse-to-patient ratio of 2/10,000 in 1987 and 4 trained obstetricians for the island. Of these 36 clinics, 16 are without a district nurse. MCH statistics are impressive with no maternal deaths since 1982 and rates comparable to developed countries. Nurse-midwives provide almost all prenatal and postnatal care and delivery. Midwives felt their roles were important and rewarding and are viewed as professional, knowledgeable, compassionate and trustworthy. Benefits were independence, personal satisfaction, career opportunities, and the rewards of contributing to the health of the Islands. Drawbacks were understaffing, lack of modern equipment, inadequate supervision, insufficient orientation to community health principles, lack of career mobility or financial incentives or improvement opportunities, and falling status. To halt the brain drain (exodus of trained professionals from developing countries to higher paying jobs in developed countries) a bond contract making those fiscally liable for their education has been implemented. Recruitment needs to be made from within the community being served. Greater financial incentives are needed. The role and image of the district nurse needs to be upgraded. Decentralized training and greater emphasis on community health must be given during nursing education. The age limit for nursing students needs to be increased and job sharing allowed. The constraints to implementation are lack of funding and resistance to change by those in power.
Assuntos
Enfermeiros Obstétricos/normas , Atenção à Saúde , Indicadores Básicos de Saúde , Humanos , Descrição de Cargo , Enfermeiros Obstétricos/psicologia , Enfermeiros Obstétricos/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Índias OcidentaisRESUMO
Brain drain, the exodus of highly trained professionals from developing countries to better paying jobs in the developed world, threatens the structure of community health care in those developing countries. In the Caribbean Basin, as in many developing countries, midwives are the primary health care providers for mothers and their children. This paper describes the maternal and child health (MCH) system in the Caribbean island community of St. Vincent and the Grenadines (SVG); compares MCH indicators in SVG with those in developed and developing nations; describes the role of the nurse-midwife in the delivery of MCH services; and examines the growing problem of recruitment and retention (brain drain) of nurse-midwives. Suggestions made by the nurse-midwives of SVG will be used to explore some solutions to this major human resource problem threatening the MCH system and to identify the major obstacles to their implementation. (AU)