Colvin Christopher J, de Heer Jodie, Winterton Laura, Mellenkamp Milagros, Glenton Claire, Noyes Jane, Lewin Simon, Rashidian Arash
University of Cape Town, South Africa.
Midwifery. 2013 Oct;29(10):1211-21. doi: 10.1016/j.midw.2013.05.001. Epub 2013 Jun 12.
to synthesise qualitative research on task-shifting to and from midwives to identify barriers and facilitators to successful implementation.
systematic review of qualitative evidence using a 4-stage narrative synthesis approach. We searched the CINAHL, Medline and the Social Science Citation Index databases. Study quality was assessed and evidence was synthesised using a theory-informed comparative case-study approach.
midwifery services in any setting in low-, middle-, and high-income countries.
midwives, nurses, doctors, patients, community members, policymakers, programme managers, community health workers, doulas, traditional birth attendants and other stakeholders.
task shifting to and from midwives.
thirty-seven studies were included. Findings were organised under three broad themes: (1) challenges in defining and defending the midwifery model of care during task shifting, (2) training, supervision and support challenges in midwifery task shifting, and (3) teamwork and task shifting.
this is the first review to report implementation factors associated with midwifery task shifting and optimisation. Though task shifting may serve as a powerful means to address the crisis in human resources for maternal and newborn health, it is also a complex intervention that generally requires careful planning, implementation and ongoing supervision and support to ensure optimal and safe impact. The unique character and history of the midwifery model of care often makes these challenges even greater.
evidence from the review fed into the World Health Organisation's 'Recommendations for Optimizing Health Worker Roles to Improve Access to Key Maternal and Newborn Health Interventions through Task Shifting' guideline. It is appropriate to consider task shifting interventions to ensure wider access to safe midwifery care globally. Legal protections and liabilities and the regulatory framework for task shifting should be designed to accommodate new task shifted practices.
综合关于助产士工作任务转移的定性研究，以确定成功实施的障碍和促进因素。
采用四阶段叙述性综合方法对定性证据进行系统评价。我们检索了护理学与健康领域数据库、医学在线数据库和社会科学引文索引数据库。评估研究质量，并采用基于理论的比较案例研究方法综合证据。
低收入、中等收入和高收入国家任何环境下的助产服务。
助产士、护士、医生、患者、社区成员、政策制定者、项目管理人员、社区卫生工作者、导乐、传统助产士及其他利益相关者。
助产士工作任务的转入和转出。
纳入37项研究。结果归纳为三大主题：（1）任务转移期间界定和维护助产护理模式面临的挑战；（2）助产士任务转移中的培训、监督和支持挑战；（3）团队合作与任务转移。
这是首次报告与助产士任务转移及优化相关的实施因素的综述。虽然任务转移可能是应对孕产妇和新生儿健康人力资源危机的有力手段，但它也是一项复杂的干预措施，通常需要仔细规划、实施以及持续的监督和支持，以确保产生最佳和安全的影响。助产护理模式的独特性质和历史往往使这些挑战更加严峻。
综述中的证据为世界卫生组织的“通过任务转移优化卫生工作者角色以改善关键孕产妇和新生儿健康干预措施可及性的建议”指南提供了参考。考虑采用任务转移干预措施以确保在全球范围内更广泛地获得安全的助产护理是合适的。应设计任务转移的法律保护、责任和监管框架，以适应新的任务转移实践。
