评价巴西私立医院助产士的分娩护理：质量改进项目的结果。

Evaluation of labor and childbirth care by nurse-midwives in Brazilian private hospitals: results of a quality improvement project.

机构信息

Programa de pós-graduação em epidemiologia em saúde pública, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil.

Laboratório de Pesquisa Clínica em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.

出版信息

Reprod Health. 2023 Jan 19;20(Suppl 2):17. doi: 10.1186/s12978-022-01537-0.

DOI:10.1186/s12978-022-01537-0

PMID:36658552

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9850504/

Abstract

BACKGROUND

In 2015, a quality improvement project-the "Adequate Childbirth Project" (Projeto Parto Adequado, or PPA)-was implemented in Brazilian private hospitals with the goal of reducing unnecessary cesarean sections. One of the strategies adopted by the PPA was the implementation of labor and childbirth care by nurse-midwives. The objective of this study is to evaluate the results of the PPA in the implementation and adequacy of labor and childbirth care by nurse-midwives in Brazilian private hospitals.

METHODS

Cross-sectional, hospital-based study, carried out in 2017, in 12 hospitals participating in the PPA. We assessed the proportion of women assisted by nurse-midwives during labor and childbirth care and the adequacy of 13 care practices following parameters of the World Health Organization. Women assisted in the PPA model of care and in the standard of care model were compared using the chi-square statistical test.

RESULTS

4798 women were interviewed. Women in the PPA model of care had a higher proportion of labor (53% × 24.2%, p value < 0.001) and vaginal birth (32.7% × 11.3%, p value < 0.001), but no significant differences were observed in the proportion of women assisted by nurse-midwives during labor (54.8% × 50.1%, p value = 0.191) and vaginal birth (2.2% × 0.7%, p value = 0.142). The implementation of recommended practices was adequate, except the use of epidural analgesia for pain relief, which was intermediate. There was a greater use of recommended practices including "oral fluid and food", "maternal mobility and position", "monitoring of labor", "use of non-pharmacological methods for pain relief" and "epidural analgesia for pain relief" in women assisted by nurse-midwives in relation to those assisted only by doctors. Many non-recommended practices were frequently used during labor by nurse-midwives and doctors.

CONCLUSIONS

There was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and an appropriate use of recommended practices in women assisted by nurse-midwives. However, there was no difference in the proportion of women assisted by nurse-midwives in the two models of care. The expansion of nursing participation and the reduction of overused practices remain challenges.

摘要

背景

2015 年，巴西私立医院实施了一项质量改进项目——“适当分娩项目”（Projeto Parto Adequado，简称 PPA），旨在减少不必要的剖宫产。该项目的策略之一是由助产学护士提供分娩和护理服务。本研究旨在评估 PPA 在巴西私立医院实施过程中，助产学护士提供的分娩和护理服务的结果，以及护理实践的充分性。

方法

这是一项 2017 年在参与 PPA 的 12 家医院开展的基于医院的横断面研究。我们评估了由助产学护士在分娩和护理期间协助的妇女比例，以及按照世界卫生组织参数评估的 13 项护理实践的充分性。采用卡方检验比较了接受 PPA 护理模式和标准护理模式的妇女。

结果

共采访了 4798 名妇女。接受 PPA 护理模式的妇女中，分娩（53%×24.2%，p<0.001）和阴道分娩（32.7%×11.3%，p<0.001）的比例较高，但在分娩期间由助产学护士协助的妇女比例（54.8%×50.1%，p=0.191）和阴道分娩（2.2%×0.7%，p=0.142）方面无显著差异。推荐实践的实施是充分的，除了缓解疼痛的硬膜外镇痛，其为中等水平。与仅由医生协助的妇女相比，接受助产学护士协助的妇女更常采用推荐的实践，包括“口服液体和食物”、“产妇的活动和姿势”、“分娩监测”、“使用非药物方法缓解疼痛”和“硬膜外镇痛缓解疼痛”。在分娩期间，助产学护士和医生经常使用许多非推荐的实践。