聆听女性的声音:澳大利亚昆士兰州护理人员护理中计划外的外院外生的经历

尽管有些妇女由于快速的劳动而最终出现了计划外的外院诞生,而其他妇女由于先前的出生经验或与医疗保健专业人员的互动而做出决定延迟计划医院护理的决定。作者recent paperinBMC急诊医学have published anew paperinBMC Pregnancy and Childbirth在探索这些决定并在此博客文章中,他们讨论了这些妇女和护理人员的观点,他们关心她们以及他们对研究中叙述的反应。

Paramedics managing out-of-hospital birth

In Australia, approximately1,974 births,代表总出生时间的0.7%,每年到达医院之前。该人群虽然一小部分医护人员案caseload与围产期死亡率和发病率相关,并且具有可能使护理式临床管理复杂化的因素。虽然许多在护理症护理中发生的出生是简单的,但预计护理人员将使用基于证据的准则来识别,管理和转介患有高风险状况或与怀孕有关的患者,识别和管理严重受损的怀孕患者,以及在产前和产后期间提供适当的护理。

Our新文章published inBMC Pregnancy and Childbirth,我们的同伴recent articleinBMC急诊医学,探索妇女在澳大利亚昆士兰州的医护人员参加的妇女计划未计划的外院外生的经历。对22名妇女的访谈表明,参与者以计划外的和出乎意料的方式出生的原因有多种原因,但是她们的原因不一定是通常假定的“沉淀”或“多重性”的出生。

妇女谈判系统

This research identified a relationship between perceived deficits in the current Australian Maternity Care system and the decisions women made when labor began. When paramedics became involved, some women described very positive interactions. However, it was clear that the need for paramedics was sometimes based on the need for medical backup ‘just in case something went wrong.’ These women did not doubt their ability to birth; they were knowledgeable about the birth process and expressed a desire to have components of their birth plan acknowledged. Yet, when these needs conflicted with a paramedic’s care decisions, the women described feeling disempowered. Some women did not understand why paramedics had to make, during what was meant to be a planned natural experience, a series of medical interventions to which they did not consent.

Woman-centered paramedic care

有积极的出生经验的参与者谈到了专业,具有良好沟通技巧并且同情和令人放心的护理人员。他们对医护人员的印象特别深刻,他们全面地提供了照顾,并承认该女人是一个有身体上,情感,社会和精神需求的人。It was amusing during the interviews when women became excited describing an ‘amazing’ and ‘wonderful’ paramedic who put a load of washing on, provided her time for a shower, and thoughtfully left a towel with the baby’s scent on it for the family dog. These were the actions of a paramedic who was not only confident and comfortable with the physical birth process, but also practiced and appeared to appreciate a holistic approach to person-centered care specific to the out-of-hospital environment.

The authors’ perspective

进行这项研究并解释诸如此类主题的妇女故事的经验引发了对作者的个人和高度情绪化的反应。作者认为,尽管婴儿出生于家庭和社会,但出生本身属于女人 - 她生了婴儿。这是一个充满欢乐的时期,应该超越她的期望,以及她应该感觉到最强大和无所畏惧的时刻。但是,在这些访谈中,作者表达了失望,不是因为这些叙述所涉及的各种“专业”,而是朝着女性在叙述中描述的一些个人护理人员,助产士和医生。作者感到安慰的是,当刻画积极的护理经历时,这些经历本质上是例外。

This research motivated the authors to reflect on their own perspective of patient care as a midwife and paramedic. The phrase ‘rest and reassurance’ is one of a few descriptors in the patient care report form that addresses providing psychological support during patient care episodes. It is interesting to reflect on what value paramedics place on this phrase; is it a throwaway line, just a box to be ticked routinely, or do paramedics actually demonstrate it from the patient’s perspective?

研究“人”和身体

We acknowledge that the scope of skills expected of paramedics has increased over the last 20 years, as has the scope of paramedics’ roles and responsibilities. As such, there has been a preoccupation within paramedic education and research that has a purely biophysical approach. However, from this research and others referenced within it, when patients are asked what they value most from paramedic care, they reply ‘professionalism.’ This includes confidence in care, clinical competence, and a high level of clinical knowledge. They also want person-centered care which is respectful and responsive to the preferences, needs, and values of the individual patients themselves. We intend that this research will contribute to making necessary improvements in paramedic education and providing a basis for a paramedical model of care that is patient-centered, embodies respect and empathy for patients, and requires paramedics’ empathy and interpersonal communication skills.

View the latest posts on the BMC Series blog homepage

注释