SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
This article explores the importance of midwifery education and examines the key aspects of the new RCM publication, Valuing practice--a springboard for midwifery education.
BACKGROUND: Medical, dental, nursing and midwifery students are at high risk for occupational exposure to blood-borne pathogens (BBPs) via sharp injuries such as needle stick injuries (NSIs). AIMS: The aim of this study was to determine the frequency of NSIs and the knowledge, attitude and practices of these students regarding their prevention. SETTINGS AND DESIGN: The clinical students at Shiraz University of Medical Sciences, Iran, were eligible to participate in a survey conducted by a self-administered questionnaire in 2004, asking them about NSIs during their clinical training undergraduate years. MATERIALS AND METHODS: A cross-sectional study evaluated NSIs and practices regarding protective strategies against BBPs in medical, dental, nursing and midwifery students at Shiraz University, Iran, in 2004. These students completed a self-administered questionnaire. STATISTICAL ANALYSIS: The data were entered into a personal computer using Epi-Info (version 2000). Chi-square and Fisher's exact tests for categorical variables and student t-test for continuous variables were performed, where appropriate, using SPSS version 10. Alpha was set at the 5% level. RESULTS: The questionnaire was completed by 688 (53%) students. 71.1% (489/688) of the students had NSIs that most commonly (43.6%) occurred in patient rooms. 82% (401/489) of NSIs were not reported. 87.8% (604/688) of the students received information about standard isolation precautions and 86.2% of them had been vaccinated against hepatitis B. CONCLUSION: NSIs and non-reporting of NSIs were highly prevalent in these students. Education about the transmission of blood-borne infections, standard precautions and increasing availability of protection strategies must be provided.
UNLABELLED: Pakistan has a marked discrepancy between reported and unreported maternal mortality, morbidity and reproductive health figures. Pakistan's figures are listed in the "E" category by the World Health Organization meaning there is no official means of data collection and reporting. PURPOSE: The purpose of this study was to develop the standardized "Midwifery Nursing Reproductive Health Data Set (MN-RHDS)" to provide systematic information about Pakistan's maternal mortality, morbidity, reproductive health, midwifery practices, and patient outcomes. METHOD: The descriptive data elements and definitions were generated and validated through Delphi survey and consensus conference of 25 experts. DATA COLLECTION: The experts rated each element on necessity, clarity of definition, and collectability. FINDINGS: Elements were categorized as follows: 1) Antenatal, 2) Labor and Delivery, 3) Postnatal, 4) Demographics, 5) Service Data, 6) Maternal Death, 7) Referral, and 8) Maternal Status. Elements related to task work compared to psychosocial nursing care achieved higher means with lower standard deviation. CONCLUSIONS: The MN-RHDS impacts data collection, storage, retrieval, and linkage of standardized information about reproduction interventions and outcomes in developing nations.
Structural visualization was implemented on nurse-midwife's care during labor and delivery, requiring highly-specialized practice on nursing and midwifery. From discussion about our former researches and literature review, and using an algorithm notion method, we made an algorithm of the monitoring and caring process by the nurse-midwife. It is thought that the visualization of nursing and midwifery practice and the thinking processes of expert nurse-midwives which have not been expressly stated previously can become a foundation for more advanced nursing care throughout the profession.
A random sample of 78 district midwives, representing 24% of all district midwives in the government health service, were interviewed to assess their knowledge and practice of domiciliary midwifery as part of the Jamaican Perinatal Morbidity and Mortality Survey in 1986. A standard questionnaire based on the WHO guidelines on appropriate technology for birth was used. Records of their two preceding home deliveries were examined and their delivery bags inspected for availability of basic supplies and equipment. A mean of 21.5 home deliveries was attended by each rural midwife in 1986 compared with 3.8 in the urban areas. Routine laboratory tests were not done on many mothers, and there were long delays in getting results. Midwives' knowledge was average overall with one-third of them showing poor knowledge of high-risk factors in infants and newborn care. Most midwives routinely shave and give enemas to mothers. Unavailability of equipment and supplies, including vitamin K and eye drops, is common; 24% of midwives made no prenatal home visit in the previous month, and 80% fell short of the set norm of 5 postnatal home visits; 84% of midwives put the baby to the mother's breast within one hour of delivery. Essential supplies and lab investigations need to be provided and measures taken to improve domiciliary midwifery through a programme of continuing education and better supervision of midwives. A strategy to promote home deliveries under specified conditions needs to be considered.
The issue of legalization of midwifery is distinct from that of sanctioning of home births. Ontario should seriously consider establishing midwifery as an independent profession for nondomiciliary care. I hope that such a decision would not be considered in isolation from the rest of the health care system.
The authors provide an overview of quality management in midwifery practice and demonstrate the interaction between peer review, quality improvement, and quality assurance as it relates to midwifery care. Examples of indicators and thresholds are given, as well as how benchmarking fits with other quality management concepts.
Since its inception in 1975, the staff of the Nurse-Midwifery Service at San Francisco General Hospital has attended the deliveries of over 1,000 women. A description of the service and the outcome statistics are presented. The population of women served is a mixed risk group. It includes all women designated as nurse-midwifery patients, including those at risk who were transferred to tertiary care. Outcome statistics are comparable to those of the obstetrics department in general. Use of alternative labor and delivery practices contributes to good perinatal outcome.
Identifying what it is about the way nurse-midwives care for women that might contribute to healthy outcomes for women and infants requires clear definition of that care process. This article describes our efforts to define the theoretical construct of the nurse-midwifery care process. These efforts culminated in the development of a middle range descriptive theory of nurse-midwifery care. We share those efforts with others in the hopes of encouraging dialogue and the testing of this theory in a variety of clinical settings.
Vaginal birth after cesarean (VBAC) is well documented by research studies to be safe and, in many cases, better for women with a previous cesarean birth than a repeat cesarean. The article describes one nurse-midwifery service's policies and procedures for helping women to prepare for and have a trial of labor. During the intrapartal period women with a uterine scar are managed similar to those without a scar except for closer monitoring, lab studies, and intravenous heparin lock. An obstetrician is always in the hospital and available for consultation. Of 53 women attempting VBAC, 83% had a vaginal birth. Those with a previous cesarean for failure to progress had the lowest vaginal birth after cesarean rate of 65%. Maternal and newborn morbidity was low. The authors conclude that nurse-midwifery management of vaginal birth after cesarean candidates is safe and very successful when appropriate physician consultation and hospital services are readily available.
This article describes the experiences of 11 staff CNMs practicing in an inner-city hospital serving low-income women. A history of the conflicts between the OB/GYN Department and the Midwifery Service at Boston City Hospital is presented, as well as an overview of events in 1987-88 that resulted in the unanimous resignation of the staff CNMs and the closing of the service. Discussion of the issues is presented, as well as implications for midwifery practice.
This article presents the findings of a small, descriptive, exploratory study aimed at identifying the content and process components of certified nurse-midwifery care in the postpartum period. The conceptual framework, methods, and analysis were derived from the research of E.J. Lehrman, who identified components of CNM antepartum care. Lehrman's components of prenatal care were all found to be present in the postpartum period, but new data emerged. These data generated three distinctively new categories, ie, therapeutic techniques, lateral relationship, and empowerment. Albeit from a small study, our findings support previous research suggesting aspects of CNM care that might be partially responsible for improved perinatal outcome documented in various populations where CNM care has been established. The article concludes with a discussion of these implications for practice and the need for further definition of the profession of nurse-midwifery.
The purpose of this study was to determine whether antepartum treatment of chlamydia infection resulted in a change in incidence of maternal infection in the intrapartum and postpartum periods as indicated by the incidence of maternal febrile morbidity or antibiotic therapy. In June of 1986, an inner-city tertiary-care center nurse-midwifery service began including diagnosis and treatment of chlamydia infection in routine antepartum care. In this retrospective chart review, the incidence of intrapartum and postpartum infection among women who delivered in this caseload between May 1985 and May 1986 (the last year prior to the routine chlamydia diagnosis and treatment) was compared with that of women who delivered between July 1986 and July 1987 (the first year after initiation of the testing). No significant differences were found. Implications for the development of research projects within nurse-midwifery clinical services are discussed, along with methodologic problems that may ensue when attempting to study changes in outcome in ones' own service.
Nurse-midwives both reinforce and subvert American constructs of gender roles. They do this both within the context of their relationship with the medical establishment and within the context of their relationship with women and families they serve. The authors explore this paradox through an examination of American society's historical and present constructs of gender role, the ways in which the medical profession has absorbed and prescribed these constructs, the effect of these constructs on medical and nurse-midwifery childbirth management of care, and, within the contextual framework thus established, the role of nurse-midwives in reinforcing and subverting traditional gender role constructs. Finally, the impact of this paradox on the provision of nurse-midwifery care to women and families is explored.
Nurse-midwives at the Johns Hopkins Hospital, in conjunction with their colleagues in obstetrics, pediatrics, and infectious disease, are participating in a demonstration project designed to provide continuity of care for women with HIV disease in pregnancy. In the past 19 months, 73 women have been enrolled in the project. This article describes how the midwifery model of care has been integrated into the existing system of routine obstetric care and specialized HIV-related care at the institution. This project could serve as a model for others who are redesigning health care delivery systems to include more nurse-midwives, especially those who are trying to adapt to an ever-increasing number of women experiencing some phase of HIV disease during their pregnancy. A companion article explains the midwifery and medical protocols used in the project and discusses other clinically relevant issues.
The role and functions of nurse-midwifery are currently being studied by the American College of Nurse-Midwives Certification Council. The remarks that were included on the comment sheet and comments included on the margins of the survey forms were subjected to content analysis. These narrative data complement the quantitative data derived from the research. They reflect a capsule view of contemporary role conflict in nurse-midwifery.
Within recent years, the general educational arena has placed a greater emphasis on the incorporation of critical thinking within student curricula. Critical thinking as a learning tool teaches students the art of reason and logic, and encourages the preparation for dynamic situations that occur outside the classroom. The authors believe that critical thinking and nurse-midwifery are inherently intertwined. To utilize the nurse-midwifery management process in the provision of sound and safe practice, the nurse-midwife must also be a critical thinker. The management process of data gathering, assessment, diagnosis, planning, implementation, and evaluation parallels the domains of the critical thinker's process: intellectual standards, modes of reasoning, traits of mind, reasoning abilities, and elements of thought. This article presents similarities between the two models.
Studies of home birth have compared it with hospital birth, with a focus on perinatal outcomes. Although such studies have established the safety of midwife-attended home births, this narrow view does not include all of the concepts represented in a proposed midwifery care framework derived from the philosophy of the American College of Nurse-Midwives. In this essay, the authors recommend the employment of qualitative research with a feminist perspective as a method to elucidate other concepts in the midwifery care framework, and suggest that future home birth research should explore the recognition and validation of the woman and her experiences, appropriate use of technology, and the influences of the birth environment.