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Teamwork among midwives during neonatal resuscitation at a maternity hospital in Nepal
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
Marie Stopes International.
Patan Academy of Health Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).ORCID iD: 0000-0002-0541-4486
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2017 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 3, 262-269 p., S1871-5192(16)30120-2Article in journal (Refereed) Published
Abstract [en]

PROBLEM: The ability of health care providers to work together is essential for favourable outcomes in neonatal resuscitation, but perceptions of such teamwork have rarely been studied in low-income settings.

BACKGROUND: Neonatal resuscitation is a proven intervention for reducing neonatal mortality globally, but the long-term effects of clinical training for this skill need further attention. Having an understanding of barriers to teamwork among nurse midwives can contribute to the sustainability of improved clinical practice.

AIM: To explore nurse midwives' perceptions of teamwork when caring for newborns in need of resuscitation.

METHODS: Nurse midwives from a tertiary-level government hospital in Nepal participated in five focus groups of between 4 and 11 participants each. Qualitative Content Analysis was used for analysis.

FINDINGS: One overarching theme emerged: looking for comprehensive guidelines and shared responsibilities in neonatal resuscitation to avoid personal blame and learn from mistakes. Participants discussed the need for protocols relating to neonatal resuscitation and the importance of shared medical responsibility, and the importance of the presence of a strong and transparent leadership.

DISCUSSION: The call for clear and comprehensive protocols relating to neonatal resuscitation corresponded with previous research from different contexts.

CONCLUSION: Nurse midwives working at a maternity health care facility in Nepal discussed the benefits and challenges of teamwork in neonatal resuscitation. The findings suggest potential benefits can be made from clarifying guidelines and responsibilities in neonatal resuscitation. Furthermore, a structured process to deal with clinical incidents must be considered. Management must be involved in all processes.

Place, publisher, year, edition, pages
2017. Vol. 30, no 3, 262-269 p., S1871-5192(16)30120-2
Keyword [en]
Low-income population, Neonatal resuscitation, Nurse midwives, Practice guidelines, Teamwork
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-316658DOI: 10.1016/j.wombi.2017.02.002ISI: 000405407500015PubMedID: 28254364OAI: oai:DiVA.org:uu-316658DiVA: diva2:1078644
Funder
Swedish Research Council
Available from: 2017-03-06 Created: 2017-03-06 Last updated: 2017-10-24Bibliographically approved
In thesis
1. Surviving birth: Studies of a simplified neonatal resuscitation protocol in a low-income context using a mixed-methods approach
Open this publication in new window or tab >>Surviving birth: Studies of a simplified neonatal resuscitation protocol in a low-income context using a mixed-methods approach
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

United Nations has lately stated ambitious health targets for 2030 in the Sustainable Development Goal agenda, following the already achieved progress between 1990 and 2015 when the number of children dying before the age of five was reduced by more than half. However, the mortality reduction in the first month of life after birth has not kept the same pace. Furthermore, a large number of stillbirths have previously not been accounted for. The aim of this thesis was to evaluate the impact of clinical training in neonatal resuscitation, and to identify strategies for an effective implementation at a maternal health facility in Nepal.

Focus group discussions were used to explore the perceptions of teamwork among staff working closest to the infant at the facility. A prospective cohort study with nested referents was applied to determine effect on birth outcomes after an intervention with Helping Babies Breathe, a simplified protocol for neonatal resuscitation. Sustainability of the acquired skills after training was addressed by employing a quality improvement cycle. Video recordings of health workers performance were collected to analyse adherence to protocol.

Midwives described the need for universal protocols in neonatal resuscitation and management involvement in clinical audit and feedback. There was a reduction of intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and neonatal mortality within 24 hours of life (aOR 0.51, 95% CI 0.31–0.83) after the intervention. Ventilation of infants increased (OR 2.56, 95% CI 1.67–3.93) and potentially harmful suctioning was reduced (OR 0.13, 95% CI 0.09–0.17). Neonatal death from intrapartum-related complications was reduced and preterm infants survived additional days in the neonatal period after the intervention. Low birth weight was not found to be a predictor of deferred resuscitation in the studied context.

This study confirmed the robustness of Helping Babies Breathe as an educational tool for training in neonatal resuscitation. Accompanied with a quality improvement cycle it reduced intrapartum stillbirth and mortality on the day of delivery in a low-income facility setting. Improved postnatal care is needed to maintain the gains in survival through the neonatal period. Increased management involvement in audit and quality of care could improve clinical performance among health workers.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1308
Keyword
cause of death, focus group, guideline adherence, infant, low-income population, low birth weight, Nepal, neonatal resuscitation, nurse midwives, neonatal mortality, newborn, perinatal mortality, preterm, quality improvement cycle, teamwork, postnatal, video recording
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-316728 (URN)978-91-554-9839-9 (ISBN)
Public defence
2017-04-28, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2017-04-07 Created: 2017-03-07 Last updated: 2017-04-21

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Wrammert, JohanKC, AshishMålqvist, MatsLarsson, Margareta

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