Dette får vi til : sluttrapport fra prosjektet "Mørkved sykehjem et utviklingssykehjem"

Mørkved sykehjem i Bodø kommune fikk status som utviklingssykehjem i 2006 og det ble etablert et prosjekt som fikk navnet ”Mørkved sykehjem – et utviklingssykehjem”. Prosjektet definerte kompetanseutvikling og personellrekruttering som sitt hovedmål. Det var også et viktig mål å løfte fram positive sider ved det å arbeide for eldre og igangsette nye forbedrede omsorgsformer. Personalgruppen ble invitert til å fremme forslag til meningsfulle aktiviteter for beboerne og ble deretter inndelt i 11 ulike arbeidsgrupper ut i fra interesse og ønske. På mange måter har personalet vært drivkraften i utviklingsprosjektet gjennom sin motivasjon for å skape et bedre sykehjem gjennom et utvidet aktivitetstilbud for beboerne, noe som utløste mye kreativitet og arbeidsglede. Ledelsens oppgave var å motivere personalet til å gjøre mer eller noe annet enn det de i utgangspunktet hadde tenkt eller trodd de kunne gjøre. I tillegg var det nødvendig å skape møteplasser for den enkelte prosjektgruppe og bidra til å skape innhold og struktur på delprosjektene, samt motivere og støtte ansatte til å gjennomføre de mange nye aktivitetstilbudene. Rapporten bygger på pleiepersonalets egne erfaringer med å delta i utviklingsprosjektet på sykehjemmet. Prosjektet ved Mørkved sykehjem har vist at systemer og rutiner kan endres og at det nytter å utfordre egen arbeidskultur. Det er mye som tyder på at deltagelse i prosjektet har bidratt til økt jobbengasjement og nytenkning hos personalet og dermed medvirket til et mer kvalitetspreget tjenestetilbud til beboerne. Det var mange ansatte som hadde lyst til å utvide og forbedre aktivitetstilbudet til beboerne gjennom å iverksette ulike miljøtiltak. Rapporten inneholder en detaljert beskrivelse av hvordan disse prosjektene ble gjennomført. I tillegg ble det satt søkelys på sykehjemmets rolle i lokalsamfunnet, både gjennom et spennende samarbeid med Mørkvedmarka barneskole og gjennom et mer strukturert samarbeid med Nordlandssykehuset Bodø i form av en gjensidig hospiteringsavtale. Fordi erfaringene fra begge disse prosjektene var så positive, får de også en bred omtale videre i rapporten. Sist, men ikke minst viktig, ble det også iverksatt ulike kompetansehevende tiltak for å bedre kvaliteten på tjenestetilbudet, og de ulike aktivitetene som satte søkelys på kompetanse og fagutvikling har fått en stor plass i rapporten. Mye tyder på at Mørkved sykehjem har lyktes med sine ambisjoner om å bli en attraktiv arbeidsplass gjennom sine bestrebelser om å skape et godt arbeidsmiljø og ved å satse mer bevisst på fagutvikling og kompetanseoppbygging. Personalet gav uttrykk for stor tilfredshet med å jobbe prosjektrettet, som har vært en gunstig arbeidsform for å skape nye tanker og ideer og for å komme bort fra det mer rutinepregede arbeidet. Tydelige og engasjerte ledere som har bidratt til å heve ambisjonsnivået og skape rom for nye arbeidsoppgaver, er kanskje den viktigste årsaken til at dette utviklingsprosjektet har blitt så vellykket. I tillegg til å ha søkelys på ledelse og arbeidsmiljø, er det i imidlertid også nødvendig å gi de ansatte betingelser som kan muliggjøre gode arbeidsdager. Ledelsens mulighet til å inspirere ansatte til økt arbeidsinnsats er begrenset hvis arbeidsvilkårene er for dårlige. God tjenestekvalitet forutsetter kompetent og stabilt personell. For å kunne rekruttere og holde på kompetent personell må omsorgstjenesten tilby gode arbeidsvilkår. Små stillingsbrøker og ufrivillig deltidsjobb er en kilde til frustrasjon for mange og har en uheldig innvirkning både på arbeidsmiljø og tjenestekvalitet. Mye tyder på at redusert bruk av deltidsstillinger og mer fleksible arbeidstidsordninger i omsorgstjenesten er et viktig tiltak for ansattes trivsel og muligheten til å skape en attraktiv arbeidsplass. Kompetanse hos personalet er en forutsetning for å drive fagutvikling på sykehjem, samtidig som den enkelte får mer kompetanse ved å delta i et fagutviklingsprosjekt. Det er fortsatt en relativt høy andel ufaglærte blant ansatte på sykehjem. Mangel på fagutdanning betyr blant annet lite kunnskap om skrøpelige gamles behov og problemer. Lav kompetanse kan også bety liten forståelse for nødvendigheten av å arbeide systematisk og målrettet med faglige spørsmål slik fagutviklingsprosjekt faktisk krever. Derfor er økt satsing på kompetanse en nøkkelfaktor for effektiv og sikker drift av sykehjemstjenesten

Changes in cesarean section rates after introduction of a punitive financial policy in Georgia: A population-based registry study 2017-2019

Background There is little research on how financial incentives and penalties impact national cesarean section rates. In January 2018, Georgia introduced a national cesarean section reduction policy, which imposes a financial penalty on hospitals that do not meet their reduction targets. The aim of this study was to assess the impact of this policy on cesarean section rates, subgroups of women, and selected perinatal outcomes. Methods We included women who gave birth from 2017 to 2019 registered in the Georgian Birth Registry (n = 150 534, nearly 100% of all births in the country during this time). We then divided the time period into pre-policy (January 1, 2017, to December 31, 2017) and post-policy (January 1, 2018, to December 31, 2019). An interrupted time series analysis was used to compare the cesarean section rates (both overall and stratified by parity), neonatal intensive care unit transfer rates, and perinatal mortality rates in the two time periods. Descriptive statistics were used to assess differences in maternal socio-demographic characteristics. Results The mean cesarean section rate in Georgia decreased from 44.7% in the pre-policy period to 40.8% in the post-policy period, mainly among primiparous women. The largest decrease in cesarean section births was found among women <25 years of age and those with higher education. There were no significant differences in the neonatal intensive care unit transfer rate or the perinatal mortality rate between vaginal and cesarean section births in the post-policy period. Conclusion The cesarean section rate in Georgia decreased during the 2-year post-policy period. The reduction mainly took place among primiparous women. The policy had no impact on the neonatal intensive care unit transfer rate or the perinatal mortality rate. The impact of the national cesarean section reduction policy on other outcomes is not known

Factors Associated with Cesarean Section among Primiparous Women in Georgia: A Registry-based Study

Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37–43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome was cesarean section. Descriptive statistics and logistic regression analysis were used to identify factors associated with cesarean section. The proportion of cesarean section was 37.1% with regional variations from 14.2% to 57.4%. Increased maternal age, obesity and having a baby weighing ≥4000 g were all associated with higher odds of cesarean section. Of serious concern for newborn well-being is the high proportion of cesarean section at 37–38 weeks of gestation. Further research should focus on organizational and economical aspects of maternity care to uncover the underlying causes of the high cesarean section rate in Georgia

Births in freestanding midwifery-led units in Norway: What women view as important aspects of care

Objective: To describe what women view as important aspects of care when giving birth in freestanding midwifery-led units in Norway. Methods: Data from four open-ended questions in the Babies Born Better survey, Version 1, 2 and 3 was used. We performed inductive content analysis to explore and describe women's experiences with the care they received. Results: In all, 190 women who had given birth in midwifery-led units in Norway between 2010 and 2020 responded to the B3 survey. The final sample comprised 182 respondents. The analysis yielded three main categories: 1) The immediate birth surroundings, 2) Personal and safe support, and 3) Organisational conditions. Conclusion: This study adds valuable knowledge regarding what women describe as important aspects of care in free-standing midwifery-led units. Women experience maternity services in these units as peaceful, flexible and family-friendly. However, some women perceive the freestanding midwifery-led unit as a vulnerable service, mainly due to lack of midwives on call and uncertainty around temporary closure of the freestanding midwifery-led units. This finding points to the importance of staffing of birth facilities to ensure that all women giving birth have available midwifery care at all times, which is recommended in the National guidelines for care during labour and birth. Predictability around place of birth for the upcoming birth is crucial for every woman and her family. These goals might be achieved by a stable, continuous maternity service in all geographical areas of the country.publishedVersio

Effects of external cephalic Version for breech presentation at or near term in high-resource settings: A systematic review of randomized and non-randomized studies

Introduction: External cephalic version (ECV) for breech presentation involves manual manipulation of the fetus from breech to cephalic presentation at or near term, in an attempt to avoid breech birth. This systematic review summarizes the literature on the effects of ECV at or near term on pregnancy outcomes in high-resource settings. Methods: The MEDLINE, Embase, CINAHL, Cochrane Library, MIDIRS, and SweMED+ databases were searched for relevant articles published through April 2019, with no limitation on publication date. Clinical trials comparing the effects of ECV at ≥36 weeks, with or without tocolysis, with that of no ECV, conducted in northern, western, and central Europe, the USA, Canada, Australia, and New Zealand were eligible for inclusion. Results: Nine articles reporting on 184704 breech pregnancies were included. Pooled data showed that ECV attempts reduced the failure to achieve vaginal cephalic birth (risk ratio, RR=0.56; 95% CI: 0.45–0.71), caesarean section performance (RR=0.57; 95% CI: 0.50–0.64), and non-cephalic presentation at birth (RR=0.45; 95% CI: 0.29–0.68) compared with no ECV. ECV attempts also increased the incidence of Apgar score <7 at 5 minutes (RR=1.29; 95% CI: 1.10–1.52). Conclusions: Women for whom ECV is attempted at or near term are at reduced risk of caesarean section, non-cephalic presentation at term, and failure to achieve vaginal cephalic birth. Compared with no ECV, attempted ECV was also associated with a slightly increased risk of a low Apgar score at 5 minutes. The evidence is limited by the scarcity of high-quality research and the presence of risks of bias.publishedVersio

Expectations related to home-based telemonitoring of high-risk pregnancies: A qualitative study addressing healthcare providers' and users' views in Norway

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Introduction: A pregnancy can be evaluated as high-risk for the woman and/or the fetus based on medical history and on previous or ongoing pregnancy characteristics. Monitoring high-risk pregnancies is crucial for early detection of alarming features, enabling timely intervention to ensure optimal maternal and fetal health outcomes. Home-based telemonitoring (HBTM) is a marginally exploited opportunity in ante-natal care. The aim of this study was to illuminate healthcare providers' and users' expectations and views about HBTM of maternal and fetal health in high-risk preg-nancies before implementation. Material and methods: To address diverse perspectives regarding HBTM of high-risk pregnancies, four different groups of experienced healthcare providers or users were interviewed (n= 21). Focus group interviews were conducted separately with mid-wives, obstetricians, and women who had previously experienced stillbirth. Six indi-vidual interviews were conducted with hospitalized women with ongoing high-risk pregnancies, representing potential candidates for HBTM. None of the participants had any previous experience with HBTM of pregnancies. The study is embedded in a social constructivist research paradigm. Interviews were analyzed using a thematic approach. Results: The participants acknowledged the benefits and potentials of more active roles for both care recipients and providers in HBTM. Concerns were clearly ad-dressed and articulated in the following themes: eligibility and ability of women, avail-ability of midwives and obstetricians, empowerment and patient safety, and shared responsibility. All groups problematized issues crucial to maintaining a sense of safety for care recipients, and healthcare providers also addressed issues related to main-taining a sense of safety also for the care providers. Conditions for HBTM were un-derstood in terms of optimal personalized training, individual assessment of eligibility, and empowerment of an active patient role. These conditions were linked to the im-portance of competent and experienced midwives and obstetricians operating the monitoring, as well as the availability and continuity of care provision. Maintenance of safety in HBTM in high-risk pregnancies was crucial, particularly so in situations involving emerging acute health issues. Conclusions: HBTM requires new, proactive roles among midwives, obstetricians, and monitored women, introducing a fine-tuned balance between personalized and standardized care to provide safe, optimal monitoring of high-risk pregnancies.publishedVersio

What women emphasise as important aspects of care in childbirth - an online survey

Objective To explore and describe what women who have given birth in Norway emphasise as important aspects of care during childbirth. Design The study is based on data from the Babies Born Better survey, version 2, a mixed-method online survey. Setting The maternity care system in Norway. Study population Women who gave birth in Norway between 2013 and 2018. Method Descriptive statistics were used to describe sample characteristics and to compare data from the B3 survey with national data from the MBRN, using SPSS® software (version 20). The open-ended questions were analysed with an inductive thematic analysis, using NVIVO 12® software. Main outcome measures Themes developed from two open-ended questions. Results The final sample included 8,401 women. There were no important differences between the sample population and the national population with respect to maternal age, marital status, parity, mode of birth and place of birth, except for the proportion of planned homebirths. Four themes and one overarching theme were identified; Compassionate and Respectful Care, A Family Focus, Continuity and Consistency, and Sense of Security, and the overarching theme Coherence in Childbearing. Conclusions Socio-cultural and psychological aspects of care are significant for women in childbirth, alongside physical and clinical factors. Caring for the woman implies caring for her partner and having a baby is about ‘becoming a family or expanding the family’. Childbirth is a continuous experience in women’s lives and continuity and consistency are important for women to maintain and promote a coherent experience

Women's negative childbirth experiences and socioeconomic factors: results from The Babies Born Better survey

Introduction/Purpose: To investigate the association between women's socioeconomic status and overall childbirth experience and to explore how women reporting an overall negative birth experience describe their experiences of intrapartum care. Methods: We used both quantitative and qualitative data from the Babies Born Better (B3) survey version 2, including a total of 8317 women. First, we performed regression analyses to explore the association between women's socioeconomic status and labor and birth experience, and then a thematic analysis of three open-ended questions from women reporting a negative childbirth experience (n = 917). Results: In total 11.7% reported an overall negative labor and birth experience. The adjusted odds ratio (OR) of a negative childbirth experience was elevated for women with non-tertiary education, for unemployed, students and those not married or cohabiting. Women with lower subjective living standard had an adjusted OR of 1.70 (95% confidence interval [CI] 1.44–2.00) for a negative birth experience, compared with those with average subjective living standard. The qualitative analysis generated three themes: (1) uncompassionate care – lack of sensitivity and empathy, (2) impersonal care – feeling objectified, and (3) critical situations – feeling unsafe and loss of control. Conclusions: Important socioeconomic disparities in women's childbirth experiences exist even in the Norwegian setting. Women reporting a negative childbirth experience described disrespect and mistreatment as well as experiences of insufficient attention and lack of awareness of individual and emotional needs during childbirth. The study shows that women with lower socioeconomic status are more exposed to these types of experiences during labor and birth

Women’s negative childbirth experiences and socioeconomic factors: results from the Babies Born Better survey

Objective To investigate the association between women's socioeconomic status and overall childbirth experience and to explore how women reporting an overall negative birth experience describe their experiences of intrapartum care. Methods We used both quantitative and qualitative data from the Babies Born Better (B3) survey version 2, including a total of 8,317 women. First, we performed regression analyses to explore the association between women’s socioeconomic status and labour and birth experience, and then a thematic analysis of three open-ended questions from women reporting a negative childbirth experience (n=917). Results In total 11.7% reported an overall negative labour and birth experience. The adjusted odds ratio (OR) of a negative childbirth experience was elevated for women with non-tertiary education, for unemployed, students and not married or cohabiting. Women with lower subjective living standard had an adjusted OR of 1.70 (95% CI 1.44-2.00) for a negative birth experience, compared with those with average subjective living standard. The qualitative analysis generated three themes: 1) Uncompassionate care: lack of sensitivity and empathy, 2) Impersonal care: feeling objectified, and 3) Critical situations: feeling unsafe and loss of control. Conclusion Important socioeconomic disparities in women’s childbirth experiences exist even in the Norwegian setting. Women reporting a negative childbirth experience described disrespect and mistreatment as well as experiences of insufficient attention and lack of awareness of individual and emotional needs during childbirth. The study shows that women with lower socioeconomic status are more exposed to these types of experiences during labour and birth