Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK.
Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK.
BMC Pregnancy Childbirth. 2023 May 20;23(1):368. doi: 10.1186/s12884-023-05641-2.
Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom - a region of high ethnic diversity with varied levels of social complexity.
We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research.
ANALYSIS & FINDINGS: Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service.
Decision-making within maternity care was found to take three forms - where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.
孕妇和产后妇女被认为特别容易受到严重的 SARS-CoV-2 感染症状的影响，因此产科服务大大调整了其护理服务。我们研究了在英国伦敦南部提供护理的产科护理人员在大流行期间的经历和看法，该地区种族多样性高，社会复杂性不同。
我们进行了一项定性访谈研究，作为 2020 年 8 月至 11 月期间服务评估的一部分，对从事产科服务的一系列工作人员（N=29）进行了深入的半结构化访谈。使用适用于跨学科健康研究的扎根理论分析对数据进行分析。
产科医疗保健专业人员提供了他们在大流行期间提供护理的意见、经验和看法。分析得出了关于重新配置产科服务提供期间决策的三个主题，分为以下路径：1）“反思性决策”；2）“务实决策”；3）“反应性决策”。虽然务实决策被发现会破坏护理，但反应性决策被认为会贬低所提供的护理。相反，反思性决策，尽管大流行期间的工作条件困难，仍被认为有利于服务，因为高质量的护理、员工的可持续性以及服务内的创新。
在产科护理中发现决策有三种形式——在最好的情况下，服务的变化可以具有创新性，在最坏的情况下，它们可能会导致所提供的护理贬值，而且这些变化往往具有破坏性。在积极的变化方面，医疗保健提供者确定员工赋权、灵活的工作模式（既适用于他们自己，也适用于作为团队的集体）、个性化的护理交付以及变革管理，是利用当前和正在进行的大流行创新的关键领域。主要经验教训包括关注与护理相关的、有意义的倾听和各级员工的参与，以推动高质量的护理并避免护理中断和贬值。
