Kennedy Holly P, Rousseau Amy L, Low Lisa Kane
Department of Family Health Care Nursing, University of California, San Francisco 94143-0606, USA.
Midwifery. 2003 Sep;19(3):203-14. doi: 10.1016/s0266-6138(03)00034-2.
To conduct a metasynthesis of six qualitative studies of midwifery care and process; identify common themes and metaphors among the six studies for further exploration and theory development; and create a framework for further metasynthesis of qualitative studies of midwifery practice in the USA.
A qualitative metasynthesis to analyse, synthesise, and interpret six qualitative studies on the process and practice of midwifery care.
Hospital, birth centre, and home birth settings were represented across all of the studies. Participants included nurse- and direct-entry midwives who provided both childbearing and gynaecological care. Recipients of midwifery care also received both childbearing and gynaecological care.
Four overarching themes were identified: the midwife as an 'instrument' of care; the woman as a 'partner' in care; an 'alliance' between the woman and midwife; and the 'environment' of care. These were interpretively and conceptually arrayed into a helix model of midwifery care.
The findings from this exploratory metasynthesis clearly indicate that the practice of midwifery is a dynamic partnership between the midwife and the woman, and reflects an environmental perspective. In a country that has a standard of highly technical childbirth care, perhaps the most outstanding concept of this model is that of the midwife as an 'instrument' of care. The significance of the findings will be determined by their ability to guide further research efforts to support a standard of midwifery care for all women in the USA.
This model offers a benchmark and a structure for considering the dynamic elements of midwifery practice and key roles that the midwife plays in the health care of women and babies.
对六项关于助产护理及过程的定性研究进行综合分析；识别这六项研究中的共同主题和隐喻，以便进一步探索和理论发展；并为美国助产实践的定性研究的进一步综合分析创建一个框架。
进行定性综合分析，以分析、综合和解释六项关于助产护理过程和实践的定性研究。
所有研究涵盖了医院、分娩中心和家庭分娩环境。参与者包括提供生育和妇科护理的护士助产士及直接入职的助产士。接受助产护理的对象也同时接受生育和妇科护理。
确定了四个总体主题：助产士作为护理的“工具”；女性作为护理的“伙伴”；女性与助产士之间的“联盟”；以及护理的“环境”。这些主题在解释和概念上被整理成一个助产护理的螺旋模型。
这项探索性综合分析的结果清楚地表明，助产实践是助产士与女性之间的动态伙伴关系，并反映了一种环境视角。在一个拥有高科技分娩护理标准的国家，也许这个模型最突出的概念是助产士作为护理“工具”的概念。这些发现的意义将取决于它们指导进一步研究以支持美国所有女性助产护理标准的能力。
这个模型为考虑助产实践的动态要素以及助产士在妇女和婴儿医疗保健中所扮演的关键角色提供了一个基准和结构。
