Sono, estresse e comportamentos compensatórios por enfermeiras e parteiras australianas

OBJECTIVE: To describe sleep, stress and compensatory behaviors in nurses and midwives. METHODS: The study included 41 midwives and 21 nurses working in Australian hospitals between 2005 and 2009. Participation was voluntary. All participants recorded on a daily basis their work and sleep hours, levels of stress and exhaustion, caffeine intake and use of sleep aids for a month (1,736 days, 1,002 work shifts). RESULTS: Participants reported moderate to high levels of stress and exhaustion on 20-40% of work days; experienced sleep disruption on more than 50% of work days; struggled to remain awake on 27% of work days; and suffered extreme drowsiness or experienced a near accident while travelling home on 9% of workdays. Age, perceived sleep duration and work hours were significant predictors of caffeine intake. About 60% of participants reported using sleep aids (about 20% reported taking prescription medications and 44% of nurses and 9% of midwives reported alcohol use as a sleep aid at least once during the study). Stress and workdays were significant predictors of sedative use. Overall, 22% reported being indifferent or mildly dissatisfied with their job. CONCLUSIONS: Sleep problems, high levels of stress and exhaustion and low job satisfaction are prevalent among nurses and midwives. The use of alcohol and sleeping pills as sleep aids, and the use of caffeine to help maintain alertness is also common. Nurses and midwives may use caffeine to compensate for reduced sleep, especially on workdays, and sleeping pills to cope with their daily work-related stress.OBJETIVO: Describir sueño, estrés y comportamientos compensatorios en enfermeras y parteras. MÉTODOS: El estudio incluyó 41 enfermeras 21 parteras en hospitales australianos de 2005 a 2009. La participación fue voluntaria. Los participantes registraron diariamente las horas de trabajo, sueño, estrés y niveles de agotamiento, cafeína y uso de ayuda para dormir durante un mes (1.736 días, 1.002 turnos). RESULTADOS: Los participantes relataron de moderados a elevados niveles de estrés y de agotamiento en 20%-40% de los días de trabajo; experimentaron disturbios del sueño en más de 50% de los días de trabajo; relataron esfuerzo para permanecer despierto en 27% de los días de trabajo; y sofrieron somnolencia extrema o accidente cerca de casa en 9% de los días de trabajo. Edad, duración del sueño percibido y jornadas fueron predictores significativos de la ingestión de cafeína. Aproximadamente 60% de los participantes relataron utilizar la ayuda para dormir: cerca de 20% usaron de medicación prescripta y 44% de las enfermeras y 9% de las parteras consumirán alcohol como auxilio para dormir al menos una vez durante el estudio. Estrés y días de trabajo fueron predictores significativos del uso de sedativos. En general, 22% relataron ser indiferente, o ligeramente insatisfecho con su trabajo. CONCLUSIONES: Problemas en el sueño, estrés y agotamiento elevados y disminución en la satisfacción en el trabajo son prevalecientes. Uso de alcohol y de medicamentos para dormir, y consumo de cafeína para mantenerse alerta también es común. Enfermeras y parteras pueden usar la cafeína para compensar la reducción del sueño, especialmente en días de trabajo, y usar somníferos para compensar el estrés diario.OBJETIVO: Descrever sono, estresse e comportamentos compensatórios em enfermeiras e parteiras. MÉTODOS: O estudo incluiu 41 enfermeiras 21 parteiras em hospitais australianos de 2005 a 2009. A participação foi voluntária. Os participantes registraram diariamente as horas de trabalho, sono, stress e níveis de exaustão, cafeína e uso de ajuda para dormir durante um mês (1.736 dias, 1.002 turnos). RESULTADOS: Os participantes relataram de moderados a elevados níveis de stress e de exaustão em 20%-40% dos dias de trabalho; experimentaram distúrbios do sono em mais de 50% dos dias de trabalho; relataram esforço para permanecer acordado em 27% dos dias de trabalho; e sofreram sonolência extrema ou acidente perto de casa em 9% dos dias de trabalho. Idade, duração do sono percebida e jornadas foram preditores significativos da ingestão de cafeína. Aproximadamente 60% dos participantes relataram utilizar a ajuda para dormir: cerca de 20% relataram uso de medicação prescrita e 44% das enfermeiras e 9% das parteiras consumiam álcool como auxílio para dormir pelo menos uma vez durante o estudo. Estresse e dias de trabalho foram preditores significativos do uso de sedativos. Em geral, 22% relataram ser indiferente, ou ligeiramente insatisfeito com seu trabalho. CONCLUSÕES: Problemas no sono, estresse e exaustão elevados e diminuição na satisfação no trabalho são prevalentes. São comuns o uso de álcool e de medicamentos para dormir, e consumo de cafeína para se manter alerta. Enfermeiras e parteiras parecem usar a cafeína para compensar a redução do sono, especialmente em dias de trabalho, e usar soníferos para compensar o estresse diário

An occupational health and safety interactive systems model explicating accident/injury causation

This study is concerned with the development of an occupational health and safety model, which provides an explanation for accident/injury causation in nurses. A multiple causation theoretical approach was adopted. The model shows that there are four input determinants, (namely, educational, environmental, management and social) that contribute towards accident/injury causation. Three main processes also contribute, specifically client/patient centred, organisational and nurse centred processes. The model was developed using both qualitative and quantitative methods. The first stage of the study consisted of collecting data from nurses using an open-ended interview (technique). Content analysis was applied to the resultant responses from which a data gathering instrument was developed. A pilot study was conducted to enunciate specific hypotheses, test the content validity of the instrument and to develop a nursing model. The main research instrument, designated as The Occupational Health and Safety Nursing Instrument (OH&SNI) was administered to registered nurses from four hospitals and three groups of nursing students from one tertiary institution. Two hundred and sixty seven registered nurses from a defined area health service, and from hospitals associated with the clinical teaching of the tertiary nursing programme were involved in the study. One hundred and eighty-four nursing students participated in the study. One general research question and seven hypotheses were postulated to investigate the applicability of inputs and processes articulated in the model. Chi-square results revealed attitudinal trends for the four groups of registered nurses and three groups of nursing students in the study. Registered nurses\u27 and nursing students\u27 responses were reduced to a two by two contingency table to check differences in acceptance ( strongly agree/agree ) and rejection ( disagree/sQ-ongly disagree ) levels. The factors in the model were supported when each question from the respondents was tested on an acceptance or rejection level (tested in each case by the chi-squared goodness of fit statistic). Case history data collected from a small number of injured nurses also gave further support to the model. The model showed inputs and processes interacted to explain accident/injury causation and demonstrated support for a multiple causation theory explanation. The model showed that certain preventive measures can be effected to help prevent accident/injury causation

Exploring routine hospital antenatal care consultations — An ethnographic study

BackgroundListening to women as part of their antenatal care has been recognized as valuable in understanding the woman’s needs. Conversations as part of routine antenatal interactions offer ideal opportunities for women to express themselves and for midwives to learn about the woman’s issues and concerns. The antenatal visit and the convention of antenatal consultations for midwives have not been well explored or defined and much of what takes place replicate medical consultative processes. As a consequence, there is little to assist midwives construct woman-centred care consultations for their routine antenatal care practice. This study showed how some practices were better in promoting the woman’s voice and woman-centred care in the hospital setting.MethodContemporary focused ethnography using both interview and observations, explored how midwives from six different public antenatal clinics in South Australia organized their antenatal care consultations with pregnant women.FindingsThematic analysis of the data provided insights into professional interpretation of woman-centred practice. How midwives interacted with women during routine antenatal care events demonstrated that some practices in a hospital setting could either support or undermine a woman-centred philosophy.ConclusionIndividual midwives adopted practices according to their own perceptions of actions and behaviors that were considered to be in accordance with the philosophy of woman-centred care. Information arising from this study has shown ways midwives may arrange antenatal care consultations to maximize women’s participation

‘It's your body, but…’ Mixed messages in childbirth education: Findings from a hospital ethnography

Objectiveto investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth.Designethnography.Settingtertiary hospital in Australian city.Participantssequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork.Findingswomen were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence.Key conclusionsinformed consent is an oft-cited human right in health care, yet in maternity care the micro-politics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices.Implications for practiceas primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned

Antenatal breast expression : a critical review of the literature

Implications for practice: Large, credible RCTs are needed to confirm efficacy and safety of this technique. A survey exploring the prevalence of ABE practices is also indicated and to explore the information currently provided by midwives to women in their care.

Influences on vaginal birth after caesarean section: A qualitative study of Taiwanese women

BackgroundVaginal birth is a safe mode of birth for most women who have had a prior caesarean with a transverse incision. Despite the evidence, most Taiwanese women who have had a previous caesarean are rarely offered the opportunity to consider any possibility other than a repeat caesarean.AimThis study explored factors affecting Taiwanese women’s decisionmaking regarding vaginal birth after cesarean.MethodsAjzen’s Theory of Planned Behaviour provided the theoretical framework to underpin the study, which adopted an interpretive descriptive methodology. Sequential semi-structured interviews were conducted with 29 women who had a previous caesarean and were pregnant between 34 and 38 weeks gestation, ten women who attempted vaginal birth in the third to fifth day postpartum, and 25 women in the fourth week postpartum. Boyatzis’ method of thematic analysis was used to identify themes and codes.FindingsThis paper reports the findings of the prenatal interviews with 29 participants. The major factor influencing women’s decision-making was to avoid negative outcomes for themselves and their babies. Three thematic codes describe influences on the women’s decisions: ‘past experience of childbirth’, ‘anticipating the next experience of normal birth’ and ‘contemplation on the process of childbirth’.ConclusionsWomen who have had a previous caesarean section are prepared to have a vaginal birth but are not always supported to carry out this decision. Changing the models of antenatal care is recommended as a strategy to overcome this difficulty therefore empowering women to make a meaningful choice about VBAC after a CS