Persson Margareta, Lindberg Inger, Öhman Ann
Department of Nursing, Umeå University, Sweden.
Department of Nursing, Umeå University, Sweden.
Midwifery. 2023 Apr;119:103608. doi: 10.1016/j.midw.2023.103608. Epub 2023 Jan 31.
Policy documents govern how the prevention and care of obstetric anal sphincter injuries (OASIS) are implemented. Thus, in the absence of Swedish national guidelines on OASIS, differing views may be visible in the regional and local policy documents. Therefore, we aimed to analyse regional and local policies, guidelines, and care programs on the prevention of OASIS and care for OASIS-affected women in a Swedish context by applying a critical frame analysis inspired by Verloo.
A cross-sectional study of existing policy documents from Swedish healthcare regions was performed. The documents were analysed using Verloo's critical frame analysis.
We found that OASIS was framed as a preventable problem addressed by skilled protective manoeuvres of the healthcare staff. Education, communication, and teamwork were three frames of crucial solutions to minimise the prevalence of OASIS. However, complicating power dimensions between professional groups and between professionals and birthing women were identified. Furthermore, several discursive struggles were found, predominantly regarding the scientific evidence for the suggested prevention and care.
The policy documents emphasised that OASIS is preventable, and improved education, communication, and teamwork could diminish the OASIS prevalence. Nevertheless, power dimensions and discursive struggles may challenge the preventive efforts. Furthermore, each Swedish region has the sovereignty to develop its policies, which was reflected in our findings and may imply inequities in care provision. Thus, there is an urgent need to develop comprehensive national high-quality guidelines of high quality for OASIS prevention and care so that all women giving birth have access to equal care and treatment in Sweden.
政策文件规定了产科肛门括约肌损伤（OASIS）的预防和护理如何实施。因此，在瑞典没有关于OASIS的国家指南的情况下，地区和地方政策文件中可能会出现不同的观点。因此，我们旨在通过应用受韦洛启发的批判性框架分析，来分析瑞典背景下关于预防OASIS以及对受OASIS影响的女性进行护理的地区和地方政策、指南及护理计划。
对瑞典医疗保健地区现有的政策文件进行横断面研究。使用韦洛的批判性框架分析对这些文件进行分析。
我们发现，OASIS被视为一个可预防的问题，可通过医护人员熟练的保护性操作来解决。教育、沟通和团队合作是将OASIS患病率降至最低的三个关键解决方案框架。然而，我们发现专业群体之间以及专业人员与产妇之间存在复杂的权力维度问题。此外，还发现了一些话语斗争，主要涉及所建议的预防和护理的科学证据。
政策文件强调OASIS是可预防的，改善教育、沟通和团队合作可以降低OASIS的患病率。然而，权力维度和话语斗争可能会对预防工作构成挑战。此外，瑞典每个地区都有制定自身政策的自主权，这在我们的研究结果中有所体现，可能意味着护理提供方面的不平等。因此，迫切需要制定全面、高质量的国家OASIS预防和护理指南，以便在瑞典所有分娩女性都能获得平等的护理和治疗。
