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The erratic pathway to regaining a professional self-image after an obstetric work-related trauma: A grounded theory study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Department of Obstetrics and Gynaecology, Ystad Hospital, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.ORCID iD: 0000-0002-2121-7511
Department of Social Medicine and Global Health, Lund University, Sweden.
2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, p. 53-61Article in journal (Refereed) Published
Abstract [en]

Background: It is known that healthcare providers might be affected by severe medical events in which patients are badly hurt. In birth care, escalating situations can result in death or injury to a mother or new-born child.

Objective: To explore the process that Swedish midwives and obstetricians go through after a severe event in the maternity unit.

Design: A modified Constructivist Grounded Theory analysis, based on fourteen in-depth interviews with birth care professionals.

Participants: Seven midwives and seven obstetricians.

Results: A core category, 'regaining of a professional self-image', was constructed and interpreted as being constituted of six main categories illustrating a frequently erratic pathway to the regaining of a professional self-image. The process included a search for external acceptance for the re-establishment of belongingness by obtaining corroboration from the woman, work colleagues and manager, and the medico-legal system.

Media exposure was invariably seen as something negative. Internal processes involved coping with emotions of guilt and shame and the vulnerability that the work entails, as well as contemplating future work. The possibility to fully regain one's professional self-image depended on having a sense of confidence and an urge to support others in similar situations by sharing gained insights. However, the process could also result in reconsidering one's professional self-image by setting up boundaries, creating a better work-life balance, or creating mental back-up plans in case of similar recurrences. For others, the process led to a change of professional identity and a search for roles away from emergency obstetrics or the specialty as such.

Conclusions: Many midwives and obstetricians will experience severe obstetric events that might affect them, sometimes severely. The vulnerability that healthcare professionals are exposed to should not be underestimated and preparedness in terms of collegial support, as well as an awareness in the workplace of how badly affected employees might be, is important. Growth as well as leaving birth care can be the results of the process following a severe event.

Place, publisher, year, edition, pages
2019. Vol. 89, p. 53-61
Keywords [en]
Second victims, Sweden, Midwife, Obstetrician, Severe event, Guilt, Shame, Support
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-344020DOI: 10.1016/j.ijnurstu.2018.07.016ISI: 000454965700009PubMedID: 30342325OAI: oai:DiVA.org:uu-344020DiVA, id: diva2:1187506
Funder
AFA Insurance
Note

Title in thesis list of papers: The erratic pathway to regaining a professional self-image after an obstetric work-related trauma ─ a grounded theory study

Available from: 2018-03-05 Created: 2018-03-05 Last updated: 2019-01-25Bibliographically approved
In thesis
1. Second Victims in Swedish Obstetrics
Open this publication in new window or tab >>Second Victims in Swedish Obstetrics
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The term “second victim” implies that healthcare providers can be pro-foundly affected by severe events in which a patient is badly injured or dies. The patient is the first victim. This thesis investigates the magnitude, riskfactors and consequences of becoming a second victim in Swedish delivery care.

We examined self-reported exposure to severe events in a survey among 1459 midwives and 706 obstetricians. A severe event was defined as severe injury or death to a mother or child or other stressful events, such as threats or violence, during delivery. Of the midwives and obstetricians who responded, 71% and 84%, respectively, had experienced one or several severe events during their career. Post-traumatic stress symptoms following the perceived worst event were measured. Fifteen percent of the midwives and obstetricians reported symptoms equivalent to partial post-traumatic stress disorder (PTSD), and 5% of the midwives and 7% of the obstetricians reported symptoms commensurable with PTSD. Increased risk was correlated with emotions of guilt, and negative experience or support from friends. Professionals with partial PTSD left delivery care significantly more often than their less traumatised colleagues.

Experiences of severe events were, furthermore, investigated, using qualitative content analysis, leading to an overarching theme “acting in an illusory system of control and safety”. This reflected how midwives and obstetricians retrospectively identified factors that had contributed to the course of events leading to such detrimental consequences. The process that the midwives and obstetricians followed in the aftermath of a severe event, were investigated using a Grounded Theory analysis. A core category, “regaining of a professional self-image”, was constructed. Six main categories illustrated an erratic pathway which might lead to full regaining, reconsidering, reconstructing professional self-image or deciding to leave the profession, depending on level of regained professional self-image.

In summary, the majority of midwives and obstetricians will experience severe obstetric events that might affect them, sometimes severely. The vulnerability that healthcare professionals are exposed to should not be underestimated and preparedness in terms of collegial support, as well as an awareness in the workplace of how badly affected employees might be, is important.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 94
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1446
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-344021 (URN)978-91-513-0284-3 (ISBN)
Public defence
2018-05-08, Auditorium minus, Gustavianum, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-04-17 Created: 2018-03-05 Last updated: 2018-10-08

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Wahlberg, ÅsaHögberg, Ulf

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