Wieczorek Christina C, Marent Benjamin, Dorner Thomas E, Dür Wolfgang
Ludwig Boltzmann Institute Health Promotion Research, Ludwig Boltzmann Gesellschaft, Untere Donaustraße 47, 1020, Vienna, Austria.
School of Applied Social Science, University of Brighton, Mayfield House, Falmer, BN1 9PH, UK.
BMC Health Serv Res. 2016 Mar 14;16:91. doi: 10.1186/s12913-016-1336-3.
The health benefits of breastfeeding for mothers and babies are well documented in the scientific literature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an important determinant of breastfeeding initiation and duration. To support and promote breastfeeding on maternity units, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. In Austria, however, less than one fifth of hospitals with a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seem to represent a major challenge to maternity units. This article builds upon previous research that has identified a number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack of intra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcare professionals struggle to work together to successfully integrate the BFHI into practice.
In this study, a qualitative research approach was used. Thirty-six semi-structured interviews with 11 midwives, 11 nurses, 13 physicians, and one quality manager, working across three maternity units, were interviewed on-site. Data analysis followed thematic analysis.
Midwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalization vs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternity units. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguarding vs. circumvention strategies). These differences hindered inter-professional teamwork and collaboration and, therefore, the integration of BFHI into practice.
Differing approaches to childbirth and breastfeeding, deep seated professional jurisdictions, as well as spatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter-professional teamwork and collaboration are widely espoused goals of contemporary healthcare improvement strategies. Yet, critical debate on how these goals can be integrated into practice is needed. To enable collaboration and facilitate the implementation of programs such as BFHI, the different perspectives of health professionals should be brought together and the potential for integrating different forms of knowledge and practices should be considered.
母乳喂养对母婴健康的益处已在科学文献中得到充分记载。研究表明，产前和产后护理期间对母乳喂养的支持是母乳喂养开始和持续时间的重要决定因素。为了在产科病房支持和促进母乳喂养，1991年发起了爱婴医院倡议（BFHI）。然而，在奥地利，目前只有不到五分之一设有产科病房的医院获得了BFHI认证。实施BFHI以及工作实践中的相关变革似乎对产科病房构成了重大挑战。本文基于先前的研究，该研究已确定了奥地利实施BFHI的一些促进因素和障碍。一个主要障碍是缺乏专业内和专业间的协作。因此，本文调查了不同医疗保健专业人员为共同努力将BFHI成功融入实践所面临的困难。
在本研究中，采用了定性研究方法。对三个产科病房的11名助产士、11名护士、13名医生和1名质量经理进行了36次半结构化现场访谈。数据分析采用主题分析法。
助产士、护士和医生对分娩和母乳喂养有不同的方法（医学化与自然化），并且在不同的管辖范围内工作，这在产科病房严格的空间划分中表现出来。在参与BFHI的过程中，助产士、护士和医生采取了不同的策略（保障策略与规避策略）。这些差异阻碍了专业间的团队合作与协作，因此也阻碍了BFHI融入实践。
分娩和母乳喂养的不同方法、根深蒂固的专业管辖范围以及空间限制，对产科病房的专业间团队合作与协作构成了挑战。专业间的团队合作与协作是当代医疗保健改进策略广泛支持的目标。然而，需要对如何将这些目标融入实践进行批判性辩论。为了实现协作并促进BFHI等项目的实施，应整合卫生专业人员的不同观点，并考虑整合不同形式知识和实践的潜力。
