Linkage in the chain of care: a grounded theory of professional cooperation between antenatal care, postpartum care and child health care

Purpose: The purpose of this article is to present a Swedish study exploring health care professionals’ cooperation in the chain of care for expectant and new parents between antenatal care (AC), postpartum care (PC) and child health care (CHC). Furthermore, the rationale was to conceptualise barriers and facilitators of cooperation in order to generate a comprehensive theoretical model which may explain variations in the care providers’ experiences. <br><br> Methods: Thirty-two midwives and CHC nurses were interviewed in five focus group – and two individual interviews in a suburb of a large Swedish city. Grounded Theory was applied as the research methodology. <br><br> Results: One core category was discerned: linkage in the chain of care, including six categories with subcategories. Despite the fact that midwives as well as CHC nurses have common visions about linkage, cooperation is not achieved because of interacting barriers that have different influences on the three links in the chain. <br><br> Conclusions: Barriers to linkage are lack of professional gain, link perspective and first or middle position in the chain, while facilitators are chain perspective, professional gain and last position in the chain. As the last link, CHC nurses promote a linkage most strongly and have the greatest gain from such linking

When student midwives are present during labour and childbirth in a peer-learning model : An interview study of parents in Sweden

OBJECTIVE: For peer learning to be useful in clinical practice, we need to know how parents experience peer learning during labour and childbirth. This study explored how parents experienced having two students present during labour and childbirth in a peer-learning model. DESIGN: A qualitative approach using individual interviews followed by thematic inductive analysis. SETTING: Three hospitals and obstetric units in Stockholm, Sweden. PARTICIPANTS: Eleven women and nine partners. FINDINGS: The overarching theme was that of a fruitful model of health care, in which there were gains for both parents and students. Parents described feeling seen and cared for, being made aware of what was going on, and never being left alone (subtheme 1, Trustful relationship). Parents appreciated being able to observe student midwives' attendance to the tasks at hand and that they, the two students, learned from each other (subtheme 2, Advantages for students). CONCLUSIONS: The parent couple was able to build a trustful relationship with both students. Furthermore, could parents only see advantages for students in a peer-learning model. Parents reported generous support and were willing to contribute to student education. Parents took advantage of the learning taking place between the two students. The model deserves to be incorporated in the midwifery-student internships to complement more individually assisted births

Student midwives' perception of peer learning during their clinical practice in an obstetric unit : A qualitative study

BACKGROUND: Evidence supports peer learning in clinical settings, but it has not been studied in obstetric units. In Sweden, obstetric units are a challenging learning area for student midwives because of the lack of attention to student needs and the stress of attaining the final number of 50 assisted births. OBJECTIVES: To explore how student midwives experienced peer learning during clinical placement in an obstetric unit. DESIGN: Qualitative approach. SETTINGS: Three hospitals and obstetric units in Stockholm, Sweden. PARTICIPANTS: Fifteen student midwives in a peer-learning model during clinical placement. METHODS: Individual interviews followed by deductive content analysis using Boud's (2001) theoretical descriptions of peer learning. RESULTS: The students shared skills, experience, and knowledge as equals and took responsibility for their peers' learning while supporting women in labor and childbirth. Students shared ideas, thoughts, and knowledge and gained perspective while learning as peers on an equal level. Students used each other to work independently without much involvement from the preceptor. Feedback was welcomed as encouragement. CONCLUSIONS: Peer learning had positive consequences as an educational model in the clinical context in obstetric units

Föräldragrupper inom mödra- och barnhälsovård : forskning, tillämpning och metoder om ledarskap för välfungerande grupper

Den här texten vänder sig till er som leder eller ska leda föräldragrupper. Med föräldragrupper menar vi de grupper som fungerar som stöd för blivande och nyblivna föräldrar, dvs. det handlar om föräldragrupper på mödrahälsovården (MHV) för blivande föräldrar som leds av barnmorskor och föräldragrupper inom barnhälso­vården (BHV) för nyblivna föräldrar som leds av barnsjuksköterskor eller distrikts­sköterskor. Texten är uppdelad på 7 kapitel. I det första kapitlet tar vi upp de stödjande aktivi­te­ter som riktas till blivande och nya föräldrar. Kapitel ett omfattar också vad övergången till vad föräldraskap innebär, både det som kan vara fysiskt och psykiskt påfrestande men också utvecklande. Vi kommer även in på grupper av nya föräldrar som kan behöva extra stöd, t.ex. ensamstående, samkönade, unga föräldrar och föräldrar som inte pratar svenska. I kapitel två flyttar vi fokus till vad det är som ska stödjas–barnens och föräldrarnas behov. Kapitel tre behandlar föräldrarnas förväntningar och tankar om föräldra­grupper–vad vill föräldrar att för­äldragrupper ska ta upp och hur vill de att de ska genomföras. I kapitel fyra riktas till ledaren och ledarrollen. Vi kommer in på olika förhållningssätt kopplat till att vara ledare, men också att skapa förutsättningar för ett lärande för deltagande föräldrar. Vi granskar hur den profession­ella rollen ser ut, men också svårigheterna med att uppfylla alla de förväntningar som finns på ledare för föräldragrupper. Femte kapitlet tar upp hur gruppen fungerar och vad som kan underlätta, men också försvåra arbetet med en grupp. Det handlar bl.a. om hur man skapar trygghet, om roller, normer och strukturer i en föräldragrupp. Vi avslutar med två kapitel som har fokus på strategier och metoder för att lättare kunna tackla potentiella problem och svårigheter, som man kan uppleva finns i föräldragrupper, och istället vända det till något positivt. I dessa två kapitel beskriver vi kooperativt lärande och kollegial handledning och ger också konkreta idéer på hur dessa två metoder eller strategier kan tillämpas på föräldra­gruppen

Sequence analysis of the genes coding for the molecular chaperones GrpE, DnaK and DnaJ from phytoplasma associated with peanut witches' broom

The aim of this study was to describe and understand parental group (PG) leaders experiences of creating conditions for interaction and communication. The data consisted of 10 interviews with 14 leaders. The transcribed interviews were analysed using thematic analysis. The results showed that the leaders ambition was to create a parent-centred learning environment by establishing conditions for interaction and communication between the parents in the PGs. However, the leaders experience was that their professional competencies were insufficient and that they lacked pedagogical tools to create constructive group discussions. Nevertheless, they found other ways to facilitate interactive processes. Based on their experience in the PG, the leaders constructed informal socio-emotional roles for themselves (e.g. caring role and personal role) and let their more formal task roles (e.g. professional role, group leader and consulting role) recede into the background, so as to remove the imbalance of power between the leaders and the parents. They believed this would make the parents feel more confident and make it easier for them to start communicating and interacting. This personal approach places them in a vulnerable position in the PG, in which it is easy for them to feel offended by parents criticism, questioning or silence

Parents reasons for not attending parental education groups in antenatal and child health care: A qualitative study

Aims and objectives To explore expectant and new parents reasons not to participate in parental education (PE) groups in antenatal care or child health care. Background In Sweden, expectant and new parents are offered PE groups in antenatal care and in child health care. Although many parents feel unprepared for parenthood, an urgent task is to attract parents to attend the PE groups. Design A total of 915 parents with children aged 0 to 21 months answered a web questionnaire with open questions about (a) reasons not to participate; (b) anything that could change their mind; and (c) parenting support instead of PE groups. This was analysed using content analysis. The study follows the SRQR guidelines. Results Parents expressed private reasons for not attending PE groups. Some parents also asked for more heterogeneity regarding content and methods, as well as accommodation of parents different interests. Other parents asked for like-minded individuals who were in similar situation to themselves. Lack of information or invitations from antenatal care or child health care, or that PE groups were unavailable, were additional reasons for not participating in groups. Conclusions Reasons for not attending PE groups were multifaceted from personal, self-interested and norm-critical reasons, to that the groups were not available or that the parents were not aware of their existence. Relevance to clinical practice Parents of today are a diverse group with different interests and needs. Nevertheless, all parents need to feel included in a way that makes participation in PE groups relevant for them. Thus, it is important for leaders to be aware of structures and norms, and to be able to create a group climate and a pedagogy of acceptance where group members value each others differences. However, to attract parents to participate in PE groups, it is necessary for clinical practice to work on individual, group and organisational levels.Funding Agencies|Swedish Research Council [2016-03550]</p

Maternal depression symptoms during the first 21 months after giving birth

Aims: The first year after childbirth involves a major transition for women, which can accentuate inadequacies and feelings of powerlessness, making them vulnerable to depression. The aim of this study was to investigate the prevalence and frequency of maternal postpartum depressive symptoms at different times after giving birth (0-21 months). Methods: Data were collected cross-sectionally using a web questionnaire containing the Edinburgh Postnatal Depression Scale (EPDS). A total of 888 mothers with children in the age range 0-21 months responded. Results: The results showed different levels of depression over the range of months included in the study. The overall prevalence using EPDS &amp;gt; 12 was 27.8%. There were higher levels at 9-12 months and 17-21 months. The highest levels of symptoms of depression were found at nine, 12, and 17 months after birth, and the lowest levels at two and 16 months. Conclusions:Funding Agencies|Swedish Research CouncilSwedish Research CouncilEuropean Commission [2016-03550]</p

Experiences from leading parental education groups : Perceived difficulties and rewards as an indication of skill acquisition

Developing skills in a professional setting is linked to practical experience. The relationship between experience and acquisition of skills can be seen as a transition from novice to expert. In a nursing setting, this has been studied using the Dreyfus model of skill acquisition. The aim was to investigate how experience influences midwives and child healthcare nurses views of difficulties and rewards in working with parental education groups. The study has a cross-sectional design with a mixed methods approach. A total of 437 midwives and child healthcare nurses answered a web-based survey. First, a qualitative analysis was carried out, and then patterns of experience were analysed. The results showed that less experience as a leader corresponds to a greater focus on ones own role and on personal benefits from working with parents, but not on the specific context of the group. With experience, leaders had a greater focus on the group itself and rewards of making it function well. Not being able to take the current group and the specific context into account when working as a leader reduces possibilities of achieving a well-functioning group and the goals of the parental education.Funding Agencies|Swedish Research CouncilSwedish Research CouncilEuropean Commission [721-2012-5473, 2016-03550]</p