scholarly journals Mitigating the mistreatment of childbearing women: evaluation of respectful maternity care intervention in Ethiopian hospitals

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038871
Author(s):  
Anteneh Asefa ◽  
Alison Morgan ◽  
Samson Gebremedhin ◽  
Ephrem Tekle ◽  
Sintayehu Abebe ◽  
...  
Keyword(s):  
Maternity Care ◽  
Intervention Group ◽  
Vaginal Birth ◽  
Outcome Variable ◽  
Respectful Maternity Care ◽  
Post Intervention ◽  
Caesarean Birth ◽  
Care Intervention ◽  
Before And After ◽  
Childbearing Women

ObjectivesThere is a lack of evidence on approaches to mitigating mistreatment during facility-based childbirth. This study compares the experiences of mistreatment reported by childbearing women before and after implementation of a respectful maternity care intervention.DesignA pre–post study design was undertaken to quantify changes in women’s experiences of mistreatment during facility-based childbirth before and after the respectful maternity care intervention.InterventionA respectful maternity care intervention was implemented in three hospitals in southern Ethiopia between December 2017 and September 2018 and it included training of service providers, placement of wall posters in labour rooms and post-training supportive visits for quality improvement.Outcome measuresA 25-item questionnaire asking women about mistreatment experiences was administered to 388 women (198 in the pre-intervention, 190 in the post-intervention). The outcome variable was the number of mistreatment components experienced by women, expressed as a score out of 25. Multilevel mixed-effects Poisson modelling was used to assess the change in mistreatment score from pre-intervention to post-intervention periods.ResultsThe number of mistreatment components experienced by women was reduced by 18% when the post-intervention group was compared with the pre-intervention group (adjusted regression coefficient (Aβ)=0.82, 95% CI 0.74 to 0.91). Women who had a complication during pregnancy (Aβ=1.17, 95% CI 1.01 to 1.34) and childbirth (Aβ=1.16, 95% CI 1.03 to 1.32) experienced a greater number of mistreatment components. On the other hand, women who gave birth by caesarean birth after trial of vaginal birth (Aβ=0.76, 95% CI 0.63 to 0.92) and caesarean birth without trial of vaginal birth (Aβ=0.68, 95% CI 0.47 to 0.98) experienced a lesser number of mistreatment components compared with those who had vaginal birth.ConclusionsWomen reported significantly fewer mistreatment experiences during childbirth following implementation of the intervention. Given the variety of factors that lead to mistreatment in health facilities, interventions designed to mitigate mistreatment need to involve structural changes.

scholarly journals Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

2020 ◽  
Author(s):  
Rodrigo de Jesús Garcia-Cerde ◽  
Maria del Pilar Torres-Pereda ◽  
Marisela Olvera-Garcia ◽  
Jennifer Meghan Hulme
Keyword(s):  
Qualitative Study ◽  
Maternity Care ◽  
Medical Personnel ◽  
Respectful Maternity Care ◽  
Structured Interviews ◽  
Post Intervention ◽  
Care Workers ◽  
Before And After ◽  
Effective Prophylaxis ◽  
The Moment

Abstract Background Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how health personal, at four community hospitals in Mexico, perceive episiotomy, both before and after training in respectful maternity care, obstetric and neonatal emergencies. Methods This is a descriptive and interpretative qualitative study. We conducted Fifty-three pre and post-intervention (PRONTO© Program) semi-structured interviews with generalists, specialists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories. Results Themes fell into six major themes surrounding their perceptions of episiotomy: as a predictable practice, as a prophylactic intervention, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of medical personnel. Conclusions Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this and other harmful obstetrical practices.

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

scholarly journals Midwives’ experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day RMC training

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Veronica Millicent Dzomeku ◽  
Adwoa Bemah Boamah Mensah ◽  
Emmanuel Kweku Nakua ◽  
Pascal Agbadi ◽  
Jody R. Lori ◽  
...  
Keyword(s):  
Maternity Care ◽  
Positive Impact ◽  
Good Practice ◽  
Healthcare Facility ◽  
Positive Influence ◽  
Respectful Maternity Care ◽  
Training Workshop ◽  
Care Practices ◽  
The Impact ◽  
Childbearing Women

Abstract Background In Ghana, studies documenting the effectiveness of evidence-based specialized training programs to promote respectful maternity care (RMC) practices in healthcare facilities are few. Thus, we designed a four-day RMC training workshop and piloted it with selected midwives of a tertiary healthcare facility in Kumasi, Ghana. The present paper evaluated the impact of the training by exploring midwives’ experiences of implementing RMC knowledge in their daily maternity care practices 4 months after the training workshop. Methods Through a descriptive qualitative research design, we followed-up and conducted 14 in-depth interviews with participants of the RMC training, exploring their experiences of applying the acquired RMC knowledge in their daily maternity care practices. Data were managed and analysed using NVivo 12. Codes were collapsed into subthemes and assigned to three major predetermined themes. Results The findings have been broadly categorized into three themes: experiences of practising RMC in daily maternity care, health facility barriers to practising RMC, and recommendations for improving RMC practices. The midwives mentioned that applying the newly acquired RMC knowledge has positively improved their relationship with childbearing women, assisted them to effectively communicate with the women, and position them to recognize the autonomy of childbearing women. Despite the positive influence of the training on clinical practice, the midwives said the policy and the built environment in the hospital does not support the exploration of alternative birthing positions. Also, the hospital lacked the required logistics to ensure privacy for multiple childbearing women in the open labour ward. The midwives recommended that logistics for alternative birthing positions and privacy in the ward should be provided. Also, all midwives and staff of the hospital should be taken through the RMC training program to encourage good practice. Conclusion Despite the report of some RMC implementation challenges, the midwives noted that the 4-day RMC training has had a positive impact on their maternity caregiving practice in the hospital. Policies and programs aimed at addressing the issue of disrespect and abusive practices during maternity care should advocate and include the building of facilities that support alternative birthing positions and privacy of childbearing women during childbirth.

scholarly journals Midwives’ experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day RMC training

2020 ◽  
Author(s):  
Veronica Millicent Dzomeku ◽  
Boamah Mensah Adwoa Bemah ◽  
Nakua Kweku Emmanuel ◽  
Agbadi Pascal ◽  
Lori R. Jody ◽  
...  
Keyword(s):  
Maternity Care ◽  
Positive Impact ◽  
Good Practice ◽  
Healthcare Facility ◽  
Positive Influence ◽  
Respectful Maternity Care ◽  
Training Workshop ◽  
Care Practices ◽  
The Impact ◽  
Childbearing Women

Abstract Background: In Ghana, studies documenting the effectiveness of evidence-based specialized training programs to promote respectful maternity care (RMC) practices in healthcare facilities are few. Thus, we designed a four-day RMC training workshop and piloted it with selected midwives of a tertiary healthcare facility in Kumasi, Ghana. The present paper evaluated the impact of the training by exploring midwives’ experiences of implementing RMC knowledge in their daily maternity care practices four months after the training workshop.Methods: Through a descriptive qualitative research design, we followed-up and conducted 14 in-depth interviews with participants of the RMC training, exploring their experiences of applying the acquired RMC knowledge in their daily maternity care practices. Data were managed and analysed using NVivo 12. Codes were collapsed into subthemes and assigned to three major predetermined themes.Results: The findings have been broadly categorized into three themes: experiences of practising RMC in daily maternity care, health facility barriers to practising RMC, and recommendations for improving RMC practices. The midwives mentioned that applying the newly acquired RMC knowledge has positively improved their relationship with childbearing women, assisted them to effectively communicate with the women, and position them to recognize the autonomy of childbearing women. Despite the positive influence of the training on clinical practice, the midwives said the policy and the built environment in the hospital does not support the exploration of alternative birthing positions. Also, the hospital lacked the required logistics to ensure privacy for multiple childbearing women in the open labour ward. The midwives recommended that logistics for alternative birthing positions and for privacy in the ward should be provided. Also, all midwives and staff of the hospital should be taken through the RMC training program to encourage good practice.Conclusion: Despite the report of some RMC implementation challenges, the midwives noted that the 4-day RMC training has had a positive impact on their maternity caregiving practice in the hospital. Policies and programs aimed at addressing the issue of disrespect and abusive practices during maternity care should advocate and include the building of facilities that support alternative birthing positions and privacy of childbearing women during childbirth.

scholarly journals Analysis of Motor Intervention Program on the Development of Gross Motor Skills in Preschoolers

2020 ◽  
Vol 17 (13) ◽  
pp. 4891
Author(s):  
Cecilia Ruiz-Esteban ◽  
Jaime Terry Andrés ◽  
Inmaculada Méndez ◽  
Ángela Morales
Keyword(s):  
Motor Development ◽  
Intervention Program ◽  
Comparison Group ◽  
Intervention Group ◽  
Free Play ◽  
Post Intervention ◽  
Psychomotor Tests ◽  
Preschool Students ◽  
Leg Coordination ◽  
Before And After

This study aimed to investigate the influence of a structured movement activity program on the motor development of children aged three to five years attending preschool. Participants were 136 preschool students with normative development at three to four years old who lived in the Region of Murcia (Spain). The McCarthy Children’s Psychomotricity and Aptitude Scales (MSCA) battery of psychomotor tests was used to evaluate the motor development profiles of preschoolers before and after the intervention. The sample was divided into two groups: an intervention group (28 students) and a comparison group (108 students). A structured 24 week physical education program was used in the intervention group. An experiential program based on free play was used in the comparison group during the same period. Preschoolers in both groups got a significant improvement in the contrast of pre-intervention with post-intervention in limb coordination. Statistically significant differences in the post-intervention measurements between the comparison group and the intervention group on arm and leg coordination were observed, whereby the intervention group presented higher arm coordination values (F1,134 = 14,389, p = 0.000, η2 = 0.097) and higher leg coordination values (F1,134 = 19,281, p = 0.000, η2 = 0.126) than the comparison group. It was pointed out that structured physical activity education is better educational methodology than free play to achieve adequate motor development in preschool children.

scholarly journals Effectiveness of hamstring stretching using a pressure biofeedback unit for 4 weeks: A randomized controlled trial

2020 ◽  
Vol 40 (02) ◽  
pp. 99-107
Author(s):  
Jin-Oh Ahn ◽  
Jong-Hyuck Weon ◽  
Eun-Kyung Koh ◽  
Do-Young Jung
Keyword(s):  
Controlled Trial ◽  
Intervention Group ◽  
Knee Extension ◽  
Control Group ◽  
Post Intervention ◽  
Lower Back ◽  
Hamstring Muscles ◽  
Before And After ◽  
The Difference ◽  
Pressure Biofeedback

Background: Stretching and length test of hamstring muscles have been performed commonly to manage lower back pain (LBP) in sports rehabilitation. Previous literatures addressed that stretching techniques and length test of hamstring muscles should be performed with the pelvic maintained in an anterior tilt position. However, there is no study to determine the effectiveness of pressure biofeedback unit (PBU) to maintain in anterior pelvic tilting (APT) on length test and stretching of hamstring muscles. Objective: To determine the effectiveness of hamstring muscles stretching using a PBU. Methods: Forty participants with shortness of hamstrings randomized into two groups. Participants performed the active knee extension (AKE) stretching without (control group) or with PBU (intervention group) for four weeks. AKE tests without and with PBU were administered three times before and after hamstrings stretching by each group. Results: The AKE test without PBU showed a significant main effect of time ([Formula: see text]) but not of group ([Formula: see text]) on the AKE angle. The AKE test with PBU showed a significant increase in the AKE angle in the post-intervention compared to the pre-intervention assessments in both groups ([Formula: see text]). The difference of AKE angle between the pre- and post-intervention results was significantly greater in the intervention group than in the control group ([Formula: see text]). Conclusion: We recommend the use of a PBU to maintain the pelvic anterior tilting position when performing the AKE test or AKE stretching.

scholarly journals Effect of emergency severity index implementation on the waiting time for patients to receive health services in the emergency department

2020 ◽  
Vol 37 (4) ◽  
pp. 369-380
Author(s):  
Akbar Sarvari ◽  
Hosein Habibzadeh ◽  
Leyla Alilu ◽  
Naser Sheikhi
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Waiting Time ◽  
Intervention Group ◽  
Simple Random Sampling ◽  
Severity Index ◽  
Emergency Severity Index ◽  
Post Intervention ◽  
Before And After ◽  
To Receive

The waiting time for patients in the emergency department to receive health services influences many processes in this department. This research aimed to determine the effect of implementation and deployment of emergency severity index (ESI) on the waiting time for patients to receive health services in the emergency department. This quasi-experimental study was performed on 736 patients who were referred to the emergency department of Imam Khomeini Hospital of Mahabad. For the ESI triage implementation, 368 patients were assigned to the pre-intervention group and 368 patients were selected for the post-intervention group, using a simple random sampling. Before and after the ESI triage implementation, the waiting time for patients to receive services was measured and recorded using a chronometer. For data analysis, Chi-square, Mann-Whitney and Kruskal-Wallis tests were used. Before and after the intervention, both groups were homogeneous in terms of demographic variables (p > 0.05). The results of Mann-Whitney test indicate that implementation of emergency severity index (ESI) has a positive effect on the decrease of average time intervals to provide health services, as well as on the entire length of stay in the emergency department (p < 0.05). Given the effect of the ESI triage implementation that reduced the waiting time for patients to receive health services, ESI is recommended for training nurses and other emergency staff.

scholarly journals A modified chief complaint-based cardiac triage strategy for reducing delays in the management of patients with ST-elevation myocardial infarction

2021 ◽  
Author(s):  
Hung-Yuan Su ◽  
Jen-Long Tsai ◽  
Yin-Chou Hsu ◽  
Kuo-Hsin Lee ◽  
Chao-Sheng Chang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intervention Group ◽  
Chief Complaint ◽  
St Elevation Myocardial Infarction ◽  
Post Intervention ◽  
Tertiary Referral Center ◽  
Before And After ◽  
St Elevation ◽  
Delays In Diagnosis ◽  
Door To Balloon

Abstract Timely performing electrocardiography (ECG) is crucial for early detection of ST-elevation myocardial infarction (STEMI). For shortening door-to-ECG time, a chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside ECG after focused history-taking was implemented at the emergency department (ED) in a single tertiary referral center. All patients diagnosed with STEMI visiting the ED between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of strategy before and after implantation. Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n = 57; post-intervention group, n = 60) showed significant overall improvements in median door-to-ECG time from 5 to 4 minutes (p = 0.02), achievement rate of door-to-ECG time < 10 minutes from 45–57% (p = 0.01), median door-to-balloon time from 81 to 70 minutes (p < 0.01). Significant trends of increase in achievement rates for door-to-ECG and door-to-balloon times (p = 0.01 and p = 0.006, respectively) was noticed after strategy implementation. The incidence of door-to-ECG time > 10 minutes for those with initially underestimated disease severity was also reduced from 90–10% (p < 0.01). In conclusion, a chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.

scholarly journals “I wouldn’t have hit you, but you would have killed your baby:” Exploring Midwives’ Perspectives on Disrespect and Abusive Care in Ghana.

2019 ◽  
Author(s):  
Millicent Veronica Dzomeku ◽  
Boamah Mensah Adwoa Bemah ◽  
Emmanuel Kweku Nakua ◽  
Pascal Agbadi ◽  
Jody R. Lori ◽  
...  
Keyword(s):  
Maternal Health ◽  
Professional Practice ◽  
Maternity Care ◽  
Study Data ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Related Factors ◽  
Mortality And Morbidity ◽  
Healthcare Facilities ◽  
Childbearing Women

Abstract Background Quality maternal health reduces maternal and neonatal mortality and morbidity. Healthcare professionals, including midwives, are significant agents for the promotion of quality maternal health. Frequents reports of disrespect and abuse of childbearing women by midwives during intrapartum care are becoming common, suggesting that many of these agents are engaging in care practices that compromise quality maternal health. Thus, understanding midwives’ descriptions and experiences of the phenomenon is critical to addressing the threat. This paper, therefore, explored the understanding of midwives on D&AC and their occurrence in professional practice in a tertiary health facility in Kumasi, Ghana.Methods An exploratory descriptive qualitative research design using an interpretative approach was employed in the study. Data were generated through individual in-depth interviews. Data saturation was reached with fifteen interviews. The interviews were audio-recorded and transcribed verbatim. Open Code 4.03 was used to manage and analyse the data.Results The midwives understood D&AC. They also confirmed meting out or witnessing colleagues engage in D&AC in their professional practice. The midwives described D&AC as the provision of inadequate care and the overlooking of patient-centred care, and verbal, physical, and psychological abuse. The themes revealed that socio-economic inequalities, provider perception and victim-blaming, and health system-related factors facilitate D&AC. It emerged that the following marginalized groups were at high risk for D&AC: the non-compliant, mentally ill, HIV/AIDs+, teenagers, poor, and childbearing women on admission at the general labour ward.Conclusion The midwives understood D&AC and revealed that it frequently occurred in their professional practice. Frequent in-service training on respectful maternity care and monitoring of care provision in healthcare facilities are needed to eliminate the incidence of D&AC. Keywords Disrespectful maternity care, childbearing women, midwives, Ghana, qualitative

scholarly journals “I wouldn’t have hit you, but you would have killed your baby:” Exploring Midwives’ Perspectives on Disrespect and Abusive Care in Ghana.

2019 ◽  
Author(s):  
Millicent Veronica Dzomeku ◽  
Boamah Mensah Adwoa Bemah ◽  
Emmanuel Kweku Nakua ◽  
Pascal Agbadi ◽  
Jody R. Lori ◽  
...  
Keyword(s):  
Maternal Health ◽  
Professional Practice ◽  
Maternity Care ◽  
Study Data ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Related Factors ◽  
Mortality And Morbidity ◽  
Healthcare Facilities ◽  
Childbearing Women

Abstract Background Quality maternal health reduces maternal and neonatal mortality and morbidity. Healthcare professionals, including midwives, are significant agents for the promotion of quality maternal health. Frequents reports of disrespect and abuse of childbearing women by midwives during intrapartum care are becoming common, suggesting that many of these agents are engaging in care practices that compromise quality maternal health. Thus, understanding midwives’ descriptions and experiences of the phenomenon is critical to addressing the threat. This paper, therefore, explored the understanding of midwives on D&AC and their occurrence in professional practice in a tertiary health facility in Kumasi, Ghana.Methods An exploratory descriptive qualitative research design using an interpretative approach was employed in the study. Data were generated through individual in-depth interviews. Data saturation was reached with fifteen interviews. The interviews were audio-recorded and transcribed verbatim. Open Code 4.03 was used to manage and analyse the data.Results The midwives understood D&AC. They also confirmed meting out or witnessing colleagues engage in D&AC in their professional practice. The midwives described D&AC as the provision of inadequate care and the overlooking of patient-centred care, and verbal, physical, and psychological abuse. The themes revealed that socio-economic inequalities, provider perception and victim-blaming, and health system-related factors facilitate D&AC. It emerged that the following marginalized groups were at high risk for D&AC: the non-compliant, mentally ill, HIV/AIDs+, teenagers, poor, and childbearing women on admission at the general labour ward.Conclusion The midwives understood D&AC and revealed that it frequently occurred in their professional practice. Frequent in-service training on respectful maternity care and monitoring of care provision in healthcare facilities are needed to eliminate the incidence of D&AC. Keywords Disrespectful maternity care, childbearing women, midwives, Ghana, qualitative

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