Analysis of midwifery students' written reflections to evaluate progression in learning during clinical practice at birthing units.

Written daily reflections during clinical practice on birthing units have been used during several years in midwifery education at Lund University, Sweden. However, the usefulness of these reflections for evaluation of progression in learning and professional development of students has to date not been evaluated. In order to analyse written reflections, two taxonomies developed by Bloom and Pettersen have been applied to the texts. Progression in the professional development of midwifery students can be seen through levels of complexity in cognitive and psycho-motor learning areas and also in the description of learning situations. Progression can be seen from a basic description of facts in simple situations at the beginning of the students' practice to a complex description of complicated situations towards the end of the practice. Written daily reflections appear to be a suitable method to help students to reflect in a structured way, thereby helping their professional development. Reflections can help clinical supervisors to understand the needs of the individual student and to support their knowledge accruement. Daily written reflections on clinical practice can be of use in other health education programs

Fathers' sense of security during the first postnatal week-A qualitative interview study in Sweden.

BACKGROUND: father's sense of security in the early postnatal period is important for the whole family. An instrument, which measures Parents' Postnatal Sense of Security (the PPSS instrument), is under development. OBJECTIVE: to explore and describe factors, which influence fathers' sense of security during the first postnatal week. METHODS: an explorative design with a qualitative approach was used. Thirteen fathers from three hospital uptake areas in Southern Sweden were interviewed using focus group discussions and individual interviews. Analysis was carried out using qualitative content analysis. FINDINGS: participation in the processes of pregnancy birth and early parenthood emerged as the main category for fathers' postnatal sense of security. The emergent categories were; 'willingness to participate and take responsibility', 'being given the opportunity to take responsibility', 'being assured about mother's and baby's well-being', 'having someone to turn to-knowing who to ask', 'being met as an individual' and 'being met by competent and supporting staff'. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: new and specific items of importance when investigating fathers' sense of security during the early postnatal period have been pinpointed. Fathers' sense of early postnatal security may be enhanced by giving them a genuine opportunity to participate in the whole process and by giving them the opportunity to stay overnight at the hospital after the birth. Midwives and care organisations need to give clear information about where competent help and advice can be obtained at all hours. Midwives should strengthen the fathering role by acknowledging and listening to the father as an individual person

Limited Spread of Penicillin-Nonsusceptible Pneumococci, Skåne County, Sweden

In response to increasing frequencies of penicillin-nonsusceptible pneumococci (PNSP), for which the MIC of penicillin was >0.12 mg/L, in Skåne County, southern Sweden, national recommendations were initiated in 1995 to limit the spread of pneumococci with high MICs (>0.5 mg/L) of penicillin (PRP), especially among children of preschool age. Traditional communicable disease control measures were combined with actions against inappropriate antimicrobial drug use. During the first 6 years that these recommendations were applied in Skåne County, the average frequency of penicillin-resistant pneumococci has been stable at ≈2.6%, as has the average PNSP frequency (7.4%). However, PNSP have been unevenly distributed in the county, with the highest frequencies in the southwest. Simultaneously, the rate of antimicrobial drug use for children <6 years of age was reduced by 20%. Thus the spread of PNSP between and within the municipalities in the county has been limited

PARENTS’ POSTNATAL SENSE OF SECURITY (PPSS)- developing an instrument and description of important factors based on mothers’ and fathers’ experiences

The overall aim of this thesis was to develop and evaluate a specific instrument, measuring both mothers’ and fathers’ postnatal sense of security during the first postnatal week, and to explore and describe important factors associated with this. Data was collected from 2003 to 2009. The thesis has a methodological (Paper I), an evaluative (Paper II) and an explorative and descriptive design (Paper III and IV). In Papers I and II, 113 mothers and 99 fathers took part. Their infants had been born live at term, at one of the five hospitals in southern Sweden. In Papers III and IV, 14 mothers and 13 fathers from two hospital areas, encompassing five different postnatal wards in Southern Sweden, were interviewed. Statistical analysis of the instrument, testing for construct validity with explorative factor analysis, internal consistency reliability and concurrent validity, using a specific item about experienced sense of security (Paper I) and Mann-Whitney U-test, multiple linear regression analysis as well as multiple logistic regression analysis (Paper II), was carried out. The Parents’ Postnatal Sense of Security (PPSS) instrument developed in Paper I was used for evaluation in Paper II. In Paper III and Paper IV the transcribed texts were analysed using qualitative content text analysis. The PPSS instrument, mother’s version, was reduced to 18 items (explained variance 66.8%, Cronbach’s coefficient alpha 0.88) comprising of the following dimensions; a sense of the midwife’s empowering behaviour, a sense of general wellbeing, a sense of affinity within the family and a sense that breast feeding was manageable. The father’s version was reduced to 13 items (explained variance 69%, Cronbach’s coefficient alpha 0.77) and comprising of the following dimensions; a sense of the midwife’s empowering behaviour, a sense of the mother’s general wellbeing including breast feeding, a sense of general wellbeing and a sense of affinity within the family (Paper I). In Paper II a sense of the midwife’s empowering behaviour, a sense of ones own general wellbeing and a sense of the mother’s wellbeing, as experienced by the father, were significantly associated with a single item about experienced sense of security. Besides general anxiety, measured by the STAI-trait instrument, and parity, a sense of participation during pregnancy was a significantly associated background variable for postnatal sense of security, for both parents. For the mothers, a sense that the father was participating was also significant (Paper II). Paper III showed that postnatal sense of security for mothers included the following on eight categories; Being met as an individual, Being given relevant information, Being prepared for the time after birth, Having someone to turn to – knowing who to ask, Having partner and/or significant others close at hand, Mother’s and the baby’s own resources, Being assured that her one physical health was good and Having planned follow-ups after discharge. For fathers (Paper IV) “Participation in the process of childbirth” emerged as a main category and included the following six categories; Willingness to participate and take responsibility, Being given the opportunity to take responsibility, Mother’s and baby’s wellbeing, Having someone to turn to – knowing who to ask, Being met as an individual and Experiencing competent staff. The newly developed PPSS instrument is a valid and reliable instrument and the only specific postnatal instrument measuring both parents’ postnatal sense of security. However it needs to be tested further when the new items are amalgamated (Paper III and IV). Midwives empowering support during the childbirth process, as well as the father’s participation and involvement are important factors beneficial, for both parents’ postnatal sense of security. An empowering organization must give fathers the opportunity to stay overnight at hospital and offer staff availability as well as planned follow-ups of both mother and child

Fathers matter

Becoming a father, especially for the first time, can present changes in men's identity and in the relationship with their partner. Affinity within the family and participation in the whole process of pregnancy, childbirth and the postnatal period are important for fathers' sense of postnatal security. The fathers want to be already prepared before birth for the early postnatal period. Willingness to participate and take responsibility from the first day of pregnancy is important for his own sake and also for the sake of the mother's and child's wellbeing. Affinity within the family can be strengthened by midwives' empowerment and the father's interaction with the midwife. Midwives should invite fathers to participate in maternity care rather than only 'permit' participation. To enable future development of postnatal care, a specific instrument called Parents'postnatal sense of security (PPSS) has been developed in Sweden. The PPSS can be used to evaluate antenatal and postnatal care and exists in one version for fathers and one for mothers

Parents' postnatal sense of security (PPSS) developing an instrument and description of important factors based on mothers' and fathers' experiences

Background: Postnatal sense of security, for parents, the first week after childbirth is important for their own and their baby’s wellbeing. Variables influencing the mother’s, and particularly the father’s, sense of security during the first postnatal week are not well known. No instrument measuring dimensions which can be influenced and supported by the postnatal health care team has been found and therefore one needed to be developed. Aim: The overall aim of this thesis was to develop a specific instrument and evaluate variables important both for the mother’s and the father’s sense of security the first postnatal week. The aim in paper I was to develop a specific instrument to assess both mothers’ and fathers’ postnatal sense of security concerning the first postnatal week. In paper II the aim was to evaluate dimensions of both parents’ postnatal sense of security the first week after childbirth and to determine associations between the PPSS instrument and different socio-demographical and situational background variables. Design: This thesis had a methodological design (Paper I) and an evaluating design (Paper II). Paper I was carried out in four steps; construction of the items, face validity, data collection and data analysis. Settings and participants: One hundred and thirteen mothers and 99 fathers took part. All had given birth to a live infant at term, in one of five hospitals in southern Sweden (Paper I and II). Data processing and analysis: Statistical analysis of the instrument, testing for construct validity with explorative factor analysis, internal consistency reliability and concurrent validity using a specific item about experienced security (Paper I) and Mann-Whitney U-test, multiple linear regression analysis as well as multiple logistic regression analysis (Paper II) was carried out. The PPSS instrument developed in paper I was used in all analyses in paper II. Findings: The Parents’ Postnatal Sense of Security (PPSS) instrument, mother’s version, was reduced to 18 items (explained variance 66.8 %, Cronbach’s coefficient alpha 0.88) comprising of the following dimensions; a sense of the midwife’s empowering behaviour, a sense of general wellbeing, a sense of affinity within the family and a sense that breast feeding was manageable. The father’s version was reduced to 13 items (explained variance 69 %, Cronbach’s coefficient alpha 0.77) and comprised of the following dimensions; a sense of the midwife’s empowering behaviour, a sense of the mother’s general wellbeing including breast feeding, a sense of general wellbeing and a sense of affinity within the family (Paper I). Of the dimensions in the PPSS instrument, a sense of the midwife’s empowering behaviour, a sense of ones own general wellbeing and a sense of the mother’s wellbeing, as experienced by the father, were significantly associated with a single item about experienced security. Besides general anxiety, measured by the STAI-trait instrument, and parity, a sense of participation during pregnancy was the only significant associated background variable for postnatal sense of security, for both parents. For the mother, a sense that the father was participating was also significant (Paper II). Conclusions: The newly developed PPSS instrument is a valid and reliable instrument and the only specific postnatal instrument measuring both parents’ postnatal sense of security and related dimensions, but needs further evaluation. More focus on the midwife’s empowering behaviour during the postnatal period, as well as sense of participation during pregnancy, are beneficial for both parents’ postnatal sense of security

Important variables for parents' postnatal sense of security: evaluating a new Swedish instrument (the PPSS instrument).

OBJECTIVE: to evaluate dimensions of both parents' postnatal sense of security the first week after childbirth, and to determine associations between the PPSS instrument and different sociodemographic and situational background variables. DESIGN: evaluative, cross-sectional design. PARTICIPANTS AND SETTINGS: 113 mothers and 99 fathers with children live born at term, from five hospitals in southern Sweden. MEASUREMENTS AND FINDINGS: mothers and fathers had similar feelings concerning postnatal sense of security. Of the dimensions in the PPSS instrument, a sense of midwives'/nurses' empowering behaviour, a sense of one's own general well-being and a sense of the mother's well-being as experienced by the father were the most important dimensions for parents' experienced security. A sense of affinity within the family (for both parents) and a sense of manageable breast feeding (for mothers) were not significantly associated with their experienced security. A sense of participation during pregnancy and general anxiety were significantly associated background variables for postnatal sense of security for both parents. For the mothers, parity and a sense that the father was participating during pregnancy were also significantly associated. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: more focus on parents' participation during pregnancy as well as midwives'/nurses' empowering behaviour during the postnatal period will be beneficial for both parents' postnatal sense of security

Parents' experience of early discharge from hospital after birth in Sweden.

OBJECTIVE: to investigate the factors that influence the experience of mothers and fathers when they have chosen to return home, earlier than is the normal routine, following the birth of their baby. DESIGN: a qualitative study, using open interviews, was undertaken. The text of the transcripts was coded and categorised according to the grounded theory method using constant comparative analysis. SETTING: interviews were carried out with 12 parents, six mothers and six fathers, individually in their own homes. They had all left a maternity/family ward at the Helsingborg Hospital in southern Sweden within 26 hours of birth whereas the normal discharge time is 72 hours. MEASUREMENTS AND FINDINGS: 'a sense of security' was the core category. Achieving a sense of security linked to informed choice for early discharge appeared to be dependent on the following categories: (l) the midwives' empowering behaviour; (2) affinity within the family; (3) the parents' right to autonomy/control; (4) physical well-being. There appears to be an inner connection between each of these categories. KEY CONCLUSIONS: the midwife's empowering behaviour supports the parents' sense of security and encourages their informed choice of earlier discharge after birth. When the mothers' and babies return home it strengthens the affinity within the family and the father's sense of participation