Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia.
University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD, 4556, Australia.
BMC Pregnancy Childbirth. 2022 Jan 16;22(1):39. doi: 10.1186/s12884-021-04339-7.
In Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery).
This was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes.
Thematic analysis of the midwives' responses revealed three factors that influence successful resuscitation: 1. Hands-on training ("HOT") with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills; 2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and. 3. Strategies that reduce barriers. Immediately after birth, live resuscitation can commence at the mother's bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation. The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research.
Training in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of "HOT" real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife's beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.
在坦桑尼亚，出生窒息是导致新生儿死亡的主要原因。本研究旨在确定影响新生儿复苏成功的因素，以为临床实践提供信息，并降低极早期新生儿死亡（分娩后 24 小时内死亡）的发生率。
这是一项使用 32 项定性研究报告统一标准（COREQ）的定性叙事研究。对助产士进行了录音、半结构化的个人访谈。应用主题分析来确定主题。
对助产士回答的主题分析揭示了影响复苏成功的三个因素：1. 在现场紧急新生儿复苏事件中进行有实际操作的培训（HOT）并提供临床支持，这可以减少恐惧并使临床技能得以转移；2. 坚定地承诺使用金分钟®和助产士的思维模式；3. 减少障碍的策略。在新生儿出生后，可在母亲床边立即进行现场复苏，并进行积极的临床指导。通过袋和面罩通气，可以立即看到新生儿的生理变化，从而增强对复苏能力的信心和掌握程度。最初进行吸引的倾向会延迟通气，并且很少有临床指征需要进行吸引。让熟练的助产士留在产房很重要，并会影响临床实践。接受采访的助产士表达了对婴儿在金分钟®内的明确承诺。繁重的工作量、频繁的人员轮换和缺乏清洁的工作设备是确定的其他障碍，值得进一步研究。
仅在模拟环境中进行复苏技能培训不足以改变临床实践。在现场紧急复苏事件中进行积极的“HOT”指导可以建立信心，因为成功复苏的可见迹象会影响助产士的信念和行为。此外，助产士共同致力于减少与出生窒息相关的死亡，这可以建立希望和集体效能感。
