The experiences of midwives and nurses collaborating to provide birthing care: a systematic review protocol
The experiences of midwives and nurses collaborating to provide birthing care: a systematic review protocol
复制标题
助产士和护士合作提供分娩护理的经验：系统评价方案
DOI：
--
复制
发表时间：
2014
期刊：
影响因子：
--
通讯作者：
K. Baker
中科院分区：
文献类型：
--
作者：
Danielle Macdonald;M. Campbell;E. Snelgrove;M. Aston;M. Helwig;K. Baker
本综述的目的是识别、评价和综合有关助产士和护士合作提供分娩护理经验的定性证据。本定性回顾旨在回答以下问题：助产士和护士合作提供分娩护理的经验是什么？本系统综述的重点是助产士和护士在提供分娩护理方面的合作。协作被定义为：以女性为中心的协作实践，旨在促进各学科在提供高质量护理方面的积极参与。它提高了妇女及其家庭的目标和价值，为护理人员之间的持续沟通提供了机制，优化了护理人员在临床决策中的参与（在学科内部和跨学科），并促进了对所有学科贡献的尊重（临15）临床医生、行政人员、政治家和决策者越来越有兴趣通过合作和提供保健服务来满足病人日益复杂和多样化的需要。具体到产妇护理的提供，北美的几个专业提供者组织发表了联合声明，表明他们致力于合作产妇护理国家提供者团体通过联合声明承诺在产妇保健方面进行合作实践是值得赞扬的。然而，在实施和维持协作实践中涉及的复杂性需要对当前协作经验的理解协作的促进因素和障碍已在文献中普遍确定。协作促进者的例子包括：沟通，5‐12角色清晰度，6‐9、11、12尊重，5‐6、8、10、12信任，5‐7、8、10、12支持性机构/组织/文化，5‐7、10、13、14共同价值观或共同愿景，9、12、13和合作意愿障碍的例子包括：沟通不良，13,15 - 17抵制变革，6,16不同的理念，17,18对专业角色的感知威胁，19,20保险和责任，18,20缺乏尊重，17,20缺乏明确定义的角色，15,19缺乏其他卫生学科的知识促进因素和障碍的相互依赖性是显而易见的，其中一个促进因素的存在，如合作的意愿，往往支持其他促进因素的存在，如沟通和信任。同样，一个障碍的存在，比如沟通不畅，也会成为整体协作的挑战。虽然这些清单并不详尽，但它们确实提供了对产科保健提供者在建立和维持合作实践中可能遇到的各种支持和挑战的见解。世界各地妇女获得产妇保健服务的机会受到地理位置的影响。例如，在新西兰，75%需要围产期护理的妇女选择助产士作为初级保健提供者，21在荷兰，50%的妇女在分娩初期由助产士提供护理然而，在加拿大，2010年助产士接生的新生儿不到5%产妇保健的不同方法反映在获得产妇保健提供者的全球差异上。这些全球产妇护理提供的变化提供了一个机会，探索合作产妇实践的多种模式，并从众多产妇护理提供者的角度了解合作经验。13 .初级保健（分娩保健是其中的一部分）方面的合作已成为提高向全世界个人和家庭提供的保健质量和效率的重点协作护理改善的健康结果包括：剖宫产率降低，硬膜外麻醉用于疼痛管理的使用减少，外阴切开术减少，母乳喂养率增加，23,24和患者满意度提高协作对孕产妇保健的健康结果产生积极影响，因此有必要探索提供护理的专业人员的协作经验。这样的探索可以告知如何最好地支持协作实践，以实现最佳可能的健康结果。文献中一直关注助产士和医生之间的合作关系和态度。24‐32助产士的定义将使用国际助产士联合会对助产士的定义，“助产士是成功完成助产士教育计划的人，该计划在其所在国家得到正式认可，该计划基于ICM基本助产实践基本能力和ICM全球助产教育标准框架；已取得所需的资格，以注册及/或合法持牌从事助产工作，并使用“助产士”的头衔；在助产实践中表现出能力的人。34然而，除了助产士和医生，其他护理提供者也为协作产科护理做出了贡献。例如，护士与助产士和医生一起提供分娩护理。护士将被定义为“…自主工作并与他人合作的自我管理的保健专业人员”。6)国际护士理事会认识到护理的定义更广泛，护理包括所有年龄，家庭，团体和社区，疾病或健康以及所有环境中的个人的自主和协作护理。护理包括促进健康、预防疾病以及照顾病人、残疾人和垂死的人。36 .宣传、促进安全环境、研究、参与制订保健政策、参与病人和保健系统管理以及教育也是护理的关键作用护士和助产士一样，在分娩和分娩期间为妇女和家庭提供直接护理。然而，尽管他们的角色相似，差异也存在例如，在加拿大，护士有在卫生保健系统内提供产科护理的历史，而助产士没有。加拿大于1993年在安大略省首次引入受管制的助产服务37 .保健服务提供者和行政人员继续根据各省将助产士纳入产妇护理队的情况进行不同的调整助产士和护士之间的合作实践的挑战已经确定了几个加拿大研究人员使用定性方法。8、14、39‐42所确定的一个共同主题的例子是，护士与最近整合的助产士一起工作时所经历的角色混淆。8,15,40‐42尽管存在这些相似之处和挑战，但目前还没有对助产士和护士之间合作经验的相关证据进行全面综合。这样的审查将为提供或接受分娩护理的护理提供者和家庭提供宝贵的信息。对现有定性数据的系统回顾将有助于全面了解助产士和护士的合作经验，并有助于为研究人员和政策制定者确定未来的方向。对乔安娜·布里格斯系统评价和实施报告数据库、CINAHL和PubMed的初步搜索显示，目前没有关于该主题的系统评价发表。
Review question/objective The objective of this review is to identify, appraise, and synthesize the qualitative evidence about the experiences of midwives and nurses collaborating to provide birthing care. This qualitative review aims to answer the following question: What are the experiences of midwives and nurses collaborating to provide birthing care? Background The focus of this systematic review is upon collaboration between midwives and nurses for the provision of birthing care. Collaboration is defined as: Collaborative woman‐centered practice designed to promote the active participation of each discipline in providing quality care. It enhances goals and values for women and their families, provides mechanisms for continuous communication among caregivers, optimizes caregiver participation in clinical decision‐making (within and across disciplines), and fosters respect for the contributions of all disciplines.1 (p.15) Interest in collaboration and the provision of health care, as a means to meet the growing complexity and diversity of patient needs is increasing for clinicians, administrators, politicians and decision makers. Specific to the provision of maternity care, several professional provider organizations in North America have released joint statements indicating their commitment to collaborative maternity care.2,3 Commitment to collaborative practice in maternity care, through joint statements, by national provider groups is commendable. However, the complexities involved in implementing and in sustaining collaborative practice require an understanding of current collaborative experiences.4 Facilitators for and barriers to collaboration have been commonly identified in the literature. Examples of facilitators for collaboration include; communication,5‐12 clarity of roles,6‐9,11,12 respect,5,6,8,10,12 trust,5,7,8,10,12 supportive institutions/organizations/culture,5‐7,10,13,14 shared values or shared vision,9,12,13 and a willingness to collaborate.5,6,10 Examples of barriers include: poor communication,13,15‐17 resistance to change,6,16 different philosophies,17,18 perceived threat to professional role,19,20 insurance and liability,18,20 lack of respect,17,20 lack of clearly defined roles,15,19 and lack of knowledge of other health disciplines.13,19 The interdependency of the facilitators and barriers is apparent, where the presence of one facilitator such as a willingness to collaborate often supports the presence of other facilitators such as communication and trust. Similarly, the presence of one barrier, such as poor communication, becomes a challenge to collaboration as a whole. Although these lists are not exhaustive, they do provide insight into the kinds of support and challenges that maternity health care providers may be experiencing in the establishment and maintenance of collaborative practice. Access to maternity care providers is influenced by geography for women around the world. For example, in New Zealand, midwives are chosen as primary care providers by 75% of women requiring perinatal care,21 and in The Netherlands, midwives provide care to 50% of women at the beginning of delivery.9 However, in Canada, midwives in 2010 attended less than 5% of births.22 The different approaches to maternity care are reflected by the global variations in access to maternity care providers. These global variations of maternity care provision provide an opportunity to explore multiple models of collaborative maternity practice and to understand collaborative experiences from the perspective of numerous maternity care providers. Collaboration in primary care, of which birthing care is a part, has become a focus for the improvement of the quality and efficiency of health care provided to individuals and families worldwide.13 Improved health outcomes identified as a result of collaborative care have included: lower caesarean section rates,5,23‐25 reduction in the use of epidural anesthesia for pain management,6,23,24 reduced rates of episiotomies,24,25 increased breastfeeding rates,23,24 and improved patient satisfaction.5,26 The positive impact of collaboration on health outcomes in maternity care supports the need to explore the collaborative experiences of the professionals providing the care. Such an exploration can inform how best to support collaborative practice with the aim of achieving the best possible health outcomes. There has been a focus on the collaborative relationships and attitudes between midwives and physicians in the literature.24‐32 Midwives will be defined using the definition of a midwife from the International Confederation of Midwives, “A midwife is a person who has successfully completed a midwifery education programme that is duly recognized in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.”34 However, apart from midwives and physicians, other care providers also contribute to collaborative maternity care. For example, nurses work with both midwives and physicians in the provision of birthing care. Nurses will be defined as, “…self‐regulated health‐care professionals who work autonomously and in collaboration with others”.35(p.6) The International Council of Nurses recognizes that nursing is more broadly defined, Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.36 Nurses, like midwives, provide direct care to women and families during labour and delivery. However, despite the similarity of their roles, differences exist.2 In Canada, for example, nurses have a history of providing maternity care within the health care system and midwives have not. The first introduction to regulated midwifery occurred in Canada in the province of Ontario in 1993.37 Health care providers and administrators continue to adjust to the integration of midwives into maternity care teams differently in each province.38 Challenges with collaborative practices amongst midwives and nurses have been identified by several Canadian researchers using qualitative methodology.8,14,39‐42 An example of a common theme that was identified was the role confusion experienced by nurses working with recently integrated midwives.8,15,40‐42 Despite these similarities and challenges, no comprehensive synthesis of the current evidence related to the experiences of collaboration among midwives and nurses has been conducted. Such a review would provide invaluable information to care providers and families providing or receiving birthing care. This systematic review of existing qualitative data will contribute to a comprehensive understanding about the collaborative experiences of midwives and nurses, and help to identify future directions for researchers and policy makers. A preliminary search of the Joanna Briggs Database of Systematic Reviews and Implementation Reports, CINAHL and PubMed has revealed that there is currently no systematic review published about this topic.
影响因子：
12.7
作者：
Jackson, DJ;Lang, JM;Nguyen, U
通讯作者：
Nguyen, U