Pettersson Karen Odberg, Johansson Eva, Pelembe Maria de Fatima M, Dgedge Clemencia, Christensson Kyllike
Halmstad University, Department of Social and Health Sciences, Halmstad, Sweden.
Health Care Women Int. 2006 Feb;27(2):145-68. doi: 10.1080/07399330500457994.
Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures.
我们开展这项研究的目的是探究莫桑比克马普托一家中央产房的助产士对阻碍或促进其提供优质围产期护理能力的因素的看法。我们对16名助产士进行了深度访谈，并根据扎根理论技术进行了分析。提供优质围产期护理的障碍被确定如下：（i）不支持的环境；（ii）与分娩妇女缺乏赋能且互动有限；（iii）职业上的不足感和自卑感；（iv）未应用最佳护理实践。基于助产士对优质围产期护理障碍及应对措施的反思，我们构建了一个模型。旨在克服这些障碍的行动包括即兴发挥和确定需要变革的领域。已确定的逃避行为包括让他人负责以及屈从于功能失调和结构控制。为了改善围产期护理，助产士需要将自己视为变革推动者，而不是外部和内部因果关系的受害者，因为他们对这些因果关系没有影响力。此外，至关重要的是，助产士应选择旨在克服优质围产期护理障碍的行动，而不是选择可能危及未出生和新生儿健康的逃避行为。我们建议，地方和国家教育项目需要与现有现实相契合，即使它们提供的知识超越了目前实践中的可能性。然而，产时及新生儿即时护理的质量需要一个支持性环境，在本研究的背景下，这一环境存在严重障碍，需要在国家层面加以解决。结构和行政变革难以针对，因为这些取决于国家孕产妇保健（MHC）服务的组织和国家卫生支出。
