Mercier Rebecca J, Durante Julia C
Rebecca J Mercier is an Assistant Professor, Department Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. The author can be reached via e-mail at
MCN Am J Matern Child Nurs. 2018 Mar/Apr;43(2):97-104. doi: 10.1097/NMC.0000000000000404.
Protocols for neonatal care and mother-baby interaction at cesarean birth frequently differ from those at vaginal birth. There is increasing interest in adopting family-friendly or gentle protocols for women having cesarean birth. Current evidence suggests challenges in achieving interdepartmental cooperation and consensus are potential barriers to implementing gentle cesarean protocols.
To describe how care providers' professional role and characteristics may affect perception about gentle cesarean birth techniques and inform specific concerns about protocol changes.
A cross-sectional survey with mixed-methods analysis incorporating quantitative and qualitative conventional content analysis was used. A structured survey was distributed via email to all care providers on the labor and birth unit, including attending physicians, resident physicians in training, fellows, labor nurses, respiratory therapists, and operating room technicians. Quantitative responses were analyzed with bivariable tests and logistic regression to describe associations between provider attitudes and provider characteristics. Open-ended responses were analyzed with conventional content analysis to develop a model describing influences on overall provider attitudes.
Physicians and nurses generally have positive attitudes on benefits of gentle cesarean techniques. Their perceptions overall are informed by the balance of concerns about patient safety and logistical challenges versus perceived benefits of the techniques. On an individual level, care provider demographic and professional characteristics of gender and prior experience affected attitudes more than their specific role in patient care.
Most labor and birth care providers have positive attitudes about gentle cesarean birth. Implementation of such programs should prioritize patient safety, educate physician and nurses about potential benefits for patients, and use experienced physicians and nurses as ambassadors to increase acceptance.
剖宫产时新生儿护理及母婴互动的方案通常与阴道分娩时不同。越来越多的人倾向于为剖宫产的女性采用家庭友好型或温和型方案。目前的证据表明，实现部门间合作与共识面临的挑战是实施温和剖宫产方案的潜在障碍。
描述医护人员的专业角色和特征如何影响对温和剖宫产技术的认知，并阐明对方案变更的具体担忧。
采用横断面调查，并结合定量和定性的传统内容分析法进行混合方法分析。通过电子邮件向产房的所有医护人员发放结构化调查问卷，包括主治医师、住院医师、研究员、产房护士、呼吸治疗师和手术室技术员。定量回答采用双变量检验和逻辑回归分析，以描述医护人员态度与医护人员特征之间的关联。开放式回答采用传统内容分析法进行分析，以建立一个描述对医护人员总体态度影响的模型。
医生和护士对温和剖宫产技术的益处普遍持积极态度。他们的总体认知受对患者安全和后勤挑战的担忧与该技术感知益处之间平衡的影响。在个体层面上，医护人员的人口统计学特征以及性别和既往经验等专业特征对态度的影响大于他们在患者护理中的具体角色。
大多数产房医护人员对温和剖宫产持积极态度。实施此类方案应优先考虑患者安全，向医生和护士宣传该技术对患者的潜在益处，并让经验丰富的医生和护士担任大使以提高接受度。
