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自然分娩指导计划实施中的挑战与成就:一项定性研究

The Challenges and Achievements in the Implementation of the Natural Childbirth Instruction Program: A Qualitative Study.

作者信息

Dehnavieh Reza, Nia Rahil Ghorbani, Nazeri Zahra

机构信息

Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

出版信息

Iran J Nurs Midwifery Res. 2020 Nov 7;25(6):502-513. doi: 10.4103/ijnmr.IJNMR_295_19. eCollection 2020 Nov-Dec.

Abstract

BACKGROUND

The natural childbirth instruction program, which aims to reduce the cesarean section (C-section) rates in the country and pay attention to demographic policies, has achieved significant accomplishments in the short time span since it was implemented throughout the country. In the present study, the advantages and challenges of the implementation of this program have been analyzed.

MATERIALS AND METHODS

This qualitative study carried out with the participation of 32 knowledgeable individuals who were selected using purposeful sampling and snowball sampling methods among the personnel of Kerman University of Medical Sciences, and it's affiliated educational (university) hospital. The data were collected through semi-structured interviews based on the research objectives, review of texts, and experts' experiences. Data analysis was performed using content analysis method in MaxQDA software.

RESULTS

Data analysis provided the 5 main categories of implementation instructions' strengths, implementation instructions' defects, implementation instructions' achievements, implementation instructions' challenges and threats, and suggestions.

CONCLUSIONS

Accountability in the system that provides health care services for pregnant mothers in public hospitals has been created through the implementation of the natural childbirth promotion package. If managerial barriers and executive and legal inefficiencies are followed up and suitable measures are taken for solving the intra-system conflicts, we can hope that the package, which has been one of the most serious efforts made by the Ministry of Health over the past decades to reduce cesarean delivery, will achieve significant accomplishments.

摘要

背景

旨在降低该国剖宫产率并关注人口政策的自然分娩指导计划,自在全国实施以来的短时间内已取得显著成效。在本研究中,分析了该计划实施的优势和挑战。

材料与方法

本定性研究由克尔曼医科大学及其附属教学(大学)医院的人员中通过目的抽样和滚雪球抽样方法选取的32名知识渊博的个体参与。数据通过基于研究目标的半结构化访谈、文本回顾和专家经验收集。使用MaxQDA软件中的内容分析法进行数据分析。

结果

数据分析得出实施指导的优势、实施指导的缺陷、实施指导的成果、实施指导的挑战与威胁以及建议这5个主要类别。

结论

通过实施自然分娩促进套餐,在为公立医院的孕妇提供医疗服务的系统中建立了问责制。如果跟进管理障碍以及行政和法律效率低下的问题,并采取适当措施解决系统内冲突,我们可以期望该套餐——这是卫生部在过去几十年为降低剖宫产率所做的最重大努力之一——将取得显著成效。

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