爱尔兰孕期和分娩中的以妇女为中心的护理：对妇女和临床医生经验的主题分析。
Woman-centred care during pregnancy and birth in Ireland: thematic analysis of women's and clinicians' experiences.
机构信息
School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland.
Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, United Kingdom.
出版信息
BMC Pregnancy Childbirth. 2017 Sep 25;17(1):322. doi: 10.1186/s12884-017-1521-3.
BACKGROUND
Recent policy and service provision recommends a woman-centred approach to maternity care. Midwife-led models of care are seen as one important strategy for enhancing women's choice; a core element of woman-centred care. In the Republic of Ireland, an obstetric consultant-led, midwife-managed service model currently predominates and there is limited exploration of the concept of women centred care from the perspectives of those directly involved; that is, women, midwives, general practitioners and obstetricians. This study considers women's and clinicians' views, experiences and perspectives of woman-centred maternity care in Ireland.
METHODS
A descriptive qualitative design. Participants (n = 31) were purposively sampled from two geographically distinct maternity units. Interviews were face-to-face or over the telephone, one-to-one or focus groups. A thematic analysis of the interview data was performed.
RESULTS
Five major themes representing women's and clinicians' views, experiences and perspectives of women-centred care emerged from the data. These were Protecting Normality, Education and Decision Making, Continuity, Empowerment for Women-Centred Care and Building Capacity for Women-Centred Care. Within these major themes, sub-themes emerged that reflect key elements of women-centred care. These were respect, partnership in decision making, information sharing, educational impact, continuity of service, staff continuity and availability, genuine choice, promoting women's autonomy, individualized care, staff competency and practice organization.
CONCLUSION
Women centred-care, as perceived by participants in this study, is not routinely provided in Ireland and women subscribe to the dominant culture that views safety as paramount. Women-centred care can best be facilitated through continuity of carer and in particular through midwife led models of care; however, there is potential to provide women-centred care within existing labour wards in terms of consistency of care, education of women, common approaches to care across professions and women's choice. To achieve this, however, future research is required to better understand the role of midwife-led care within existing labour ward settings. While a positive view of women-centred care was found; there is still a difference in approach and imbalance of power between the professions. More research is required to consider how these differences impact care provision and how they might be overcome.
背景
最近的政策和服务提供建议以妇女为中心的方法来提供产妇保健服务。以助产士为领导的护理模式被视为增强妇女选择权的重要策略之一；这也是以妇女为中心的护理的核心要素。在爱尔兰共和国，目前以产科顾问为主导、助产士管理的服务模式占主导地位，而直接参与其中的人员（即妇女、助产士、全科医生和产科医生）对以妇女为中心的护理概念的探索有限。本研究考虑了爱尔兰妇女和临床医生对以妇女为中心的产妇保健的看法、经验和观点。
方法
描述性定性设计。参与者（n=31）是从两个地理位置不同的产科单位有针对性地抽取的。访谈是面对面或通过电话进行的，一对一或焦点小组进行的。对访谈数据进行了主题分析。
结果
从数据中出现了五个主要主题，代表了妇女和临床医生对以妇女为中心的护理的看法、经验和观点。这些主题是保护正常、教育和决策、连续性、增强以妇女为中心的护理能力和建立以妇女为中心的护理能力。在这些主要主题中，出现了反映以妇女为中心的护理的关键要素的子主题。这些主题包括尊重、决策中的伙伴关系、信息共享、教育影响、服务连续性、人员连续性和可用性、真正的选择、促进妇女的自主性、个性化护理、人员能力和实践组织。
结论
本研究参与者认为，爱尔兰并没有常规提供以妇女为中心的护理，而且妇女也认同以安全为首要的主流文化。通过护理人员的连续性，特别是通过以助产士为主导的护理模式，最能促进以妇女为中心的护理；然而，在现有的产房环境中，通过护理的一致性、妇女的教育、跨专业的共同护理方法和妇女的选择，提供以妇女为中心的护理是有潜力的。然而，为了实现这一目标，需要进行未来的研究，以更好地了解助产士主导的护理在现有产房环境中的作用。虽然对以妇女为中心的护理有积极的看法，但专业之间的方法和权力不平衡仍然存在。需要进行更多的研究，以考虑这些差异如何影响护理服务的提供以及如何克服这些差异。
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