产科母婴系列服务新模式

随着卫生保健工作的日益完善，母婴保健事业获得了飞速发展，为促进妇女儿童身心健康和学科发展，我院于2005年3月与婴幼儿教育机构合作，将护理项目与婴幼儿早期教育并轨，形成系列服务，使传统的医疗服务范围扩大，采用会员制的方法，从母亲计划怀孕到孩子三岁期间实行跟踪服务，为孕产妇提供完善、人性化的贴心服务，收到了满意效果。现报告如下。     

产科人性化服务新模式的探讨

目的:把人性化服务的理念融入产科服务,探讨人性化服务在产后病房的应用,拓展产科服务范畴,全面有效地提高服务质量。方法:通过对423例观察组产妇和430例对照组产妇及家人对服务满意度的评价,及母婴并发症的观察比较,探讨人性化管理在产后病房应用的可行性。结果:在产后病房应用人性化服务,产妇及家人的满意度为99%,较高于对照组的79%。产妇和婴儿并发症均减少。结论:产后病房实行人性化服务有利于提高产妇及家人的满意度,给产妇提供舒适的服务,促进母婴健康,减少母婴并发症,帮助产妇顺利进入母性角色转变。     

产科开展优质护理服务新模式的探讨

通过探索以人为本的优质护理服务,寻求具有专科特色、能体现产科人性化、规模化、家庭化的优质护理模式。具体可采用加强护理人员培训、完善基础设施、开辟多种护理服务渠道等,建立以完善制度、推出亮点、夯实基础为雏形的产科优质护理服务新模式,满足新时期孕产妇生理、心理和社会等方面的需求,提高了产妇及家属的满意度和护理从业人员的归属感,真正实现了“患者满意、社会满意、政府满意”的目标。     

孕产妇围孕期抑郁的护理干预研究进展

<正>1产前抑郁1. 1概念及发病率产前抑郁是一种发生在妊娠期间的心理健康紊乱和负面情绪状态。由于不能适应妊娠引起的生理和心理变化,而导致孕妇经历不可调节的低落情绪,感到被孤立和隔离,伴随社会活动能力的降低,主要表现为不能控制自己的情绪和行为,并且这些症状持续2周以上~([1])。近年来,孕妇产前     

多种形式的产前服务模式对妊娠结局的影响

目的探讨多种形式的产前服务模式对妊娠结局的影响。方法将2009-01-2009-11来院产前检查的458例孕妇随机分为两组,实验组238例,确定孕妇及家属健康教育需求,有目标地进行讲述和操作演示;对照组220例,按常规进行健康教育。结果实验组相关知识掌握率96.5%,巨大儿发生率6.72%,自然分娩率72.3%,对护理服务满意率100%;对照组相关知识掌握率87.8%,巨大儿发生率15.45%,自然分娩率41.2%,对护理服务满意率94%,两组比较有统计学意义(P<0.005)。结论多种形式的产前服务模式,能提高健康教育效果,适宜临产推广。     

高危妊娠孕妇产前护理需求与护理服务模式

孕产妇死亡率和围产儿死亡率是衡量产科学质量的主要指标,而高危妊娠是引起孕产妇死亡和围产儿死亡的重要原因。因此,加强高危妊娠孕妇的产前管理和产前护理是降低孕产妇死亡率和围产儿死亡率的关键举措,也是提高孕产妇健康水平及人口素质的有效措施。随着医学模式由单纯的生物医学模式发展为生物-心理-社会医学模式。妇产科护理学也随之得到了相应的调整,     

人性化服务在产科门诊的应用

随着医疗体制的不断完善，人们的价值观不断发生变化，在产科门诊，孕期妇女这一特殊群体，她们不仅关注自身的健康，更关注胎儿在宫内的健康和安全。针对这一挑战，从转变护理理念和更新服务模式着手，开展人性化服务。现介绍如下。[第一段]     

孕期产前检查的保健指导

目的：对妊娠妇女进行孕期产前检查的保健指导。方法：通过对孕期产前检查的妊娠妇女在营养，用药，两个方面的阐诉。对妊娠妇女的科学保健进行指导。     

以人为本的导诊服务

以人为本的护理服务已是当今护理的主题，以最大限度满足病人的需要是全体护理共同的目标取向。特诊门诊的导诊工作为就医者提供及时准确的指导、咨询服务，在提高医院服务质量、满足病人需要中起重要作用，目前已成为各医院门诊的一项主要工作内容。     

医院开展产褥期母婴保健延伸服务的研究

目的探索医院开展产褥期母婴保健延伸服务的方式与途经,充分利用医疗资源,为产妇提供连续的多种形式的支持与帮助,促进母婴健康。方法实验组产妇(100例)接受产褥期母婴保健延伸服务,与以往接受常规服务的常规组产妇(100例)做对比研究。在产后复查时,分别对产褥期接受医院延伸服务情况、母婴健康状况及服务需求进行问卷调查,由产妇按5分制评定。结果在反映母乳喂养,母亲生理、心理与新生儿健康诸项目中,两组比较,实验组优于常规组,差异具有统计学意义(P<0.05)。尤其在母乳喂养成功率、乳腺病发生率、自信心、新生儿便秘、脐部感染等项目上,差异有高度显著性意义(P<0.01)。结论多样化的延伸服务能较好地满足产褥期母婴保健的需求,有效地促进母婴健康,为医院开展产褥期母婴保健延伸服务提供了有益的经验。     

Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial

BackgroundOral health care during pregnancy is important for the health of the mother and child. However, pregnant women have limited knowledge about maternal oral health and seldom seek dental care. Further, due to limited training antenatal care providers like midwives rarely discuss oral health with pregnant women. The Midwifery-Initiated Oral Health Dental Service program was developed to address current gaps in oral promotional interventions during pregnancy.ObjectivesTo assess the effectiveness of a Midwifery-Initiated Oral Health Dental Service program in improving uptake of dental services, oral health knowledge, quality of oral health, oral health status and birth outcomes of pregnant women.DesignMulti-centre randomised controlled trial.SettingThree large metropolitan public hospitals in Sydney, Australia.ParticipantsPregnant women attending their first antenatal appointment who were at least 18 years old and had a single low risk pregnancy between 12 and 20 weeks gestation.Methods638 pregnant women were allocated to three groups using block randomisation (n = 211) control group, intervention group 1 (n = 215), intervention group 2 (n = 212) and followed up till birth. Study investigators and data collectors were blinded to group allocation. Intervention group 1 received a midwifery intervention from trained midwives involving oral health education, screening and referrals to existing dental pathways. Intervention group 2 received the midwifery intervention and a dental intervention involving assessment/treatment from cost free local dental services. The control group received oral health information at recruitment. Primary outcome was uptake of dental services. Secondary outcomes included oral health knowledge, quality of oral health, oral health status and birth outcomes.ResultsSubstantial improvements in the use of dental services (20.2% Control Group; 28.3% Intervention group 1; 87.2% Intervention group 2; Odds Ratio Intervention group 2 vs Control Group = 29.72, 95% CI 15.02–58.53, p < 0.001), women’s oral health knowledge (p = 0.03); quality of oral health (p < 0.001) and oral health outcomes (sulcus bleeding, dental plaque, clinical attachment loss, decayed/filled teeth- p < 0.001) were found in Intervention group 2. No difference in the rate of preterm or low-birth weight was found.ConclusionsThe Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported.     

Maintaining oral health during pregnancy: perceptions of midwives in Southwest Sydney

Current evidence highlights the importance of maintaining good oral health during pregnancy, unfortunately, many women in Australia do not access dental services at this time. Compounding the situation is the lack of importance placed on the value of good maternal oral health by prenatal care providers. These constraints highlight the potential value of having preventive oral health advice and referral to an appropriate care pathway during the prenatal period. Midwives are in an excellent position to offer such a service, although the specific aspects of the role have not been clearly defined in Australia. As a preliminary step to the development of an oral health service program, initiated by midwives, this study assesses the midwives' perceptions of such an approach. Data were collected for this qualitative study via a focus group with 15 midwives. Thematic analyses of the data showed that despite the high prevalence of poor oral health in the area, most midwives were unaware of its possible ill-effects on maternal and child health. Midwives were also reluctant to discuss oral health with pregnant women because of a lack of appropriate referral pathways to the Public Dental Services. Midwives were receptive to the idea of establishing this new service but highlighted barriers such as the time involved, the competencies required and the need for referral pathways. The findings suggest that a midwifery-initiated oral health service has potential although issues such as training, time constraints and referral pathways must be addressed.     

A longitudinal comparison of consumer-directed and agency-directed personal assistance service programmes among persons with physical disabilities

Purpose. To compare outcomes for persons who were enrolled in an agency-directed personal assistance services (PAS) programme and then changed to a consumer-directed PAS programme.

Method. A convenience sample was used for this longitudinal study. In-home interviews were conducted by a trained data collector from April 2000 to December 2001.

Results. Participants reported more satisfaction and safety with personal assistance, and fewer unmet needs after receiving consumer-directed services than after receiving agency-directed services. Other variables related to outcomes included race and ethnicity, employment, functional status, unmet needs, and the level of confidence in obtaining help if assistance is unavailable. Participants (74%) also reported high rates of unmet needs in the past month.

Conclusions. Consumer-directed PAS enhances outcomes for many persons with disabilities. Self-reported outcomes are affected by many factors that could be addressed in PAS program development.     

脐带过度扭转产前检查及妊娠结局分析

目的探讨脐带过度扭转对母婴结局的影响。方法对照组（n=215）为正常足月分娩产妇,观察组（n=105）为产后确定为脐带过度扭转的产妇,比较两组的产前胎心监护检查、彩超检查、分娩方式、围产儿结局。结果观察组彩超检查具有特征声像图的发生率、胎心监护异常率高于对照组,观察组脐动脉S／D值高于对照组,差异均有显著性（P〈0．05）;观察组剖宫产率、围产儿并发症发生率显著高于对照组（P〈0．05）。结论产前胎监、彩超检查可为诊断脐带过度扭转提供参考,适时终止妊娠有望改善母婴结局。     

Access to a school health nurse and adolescent health needs in the universal school health service in Finland

Universal school health services are expected to offer similar, needs‐based services to all students across schools, service providers and students’ socio‐economic statuses and health needs. This study investigates access to school health nurses in Finland. The objectives were to study the differences in access to school health nurse between service providers, schools, students’ characteristics and school health nurse resources. Access was examined through a nationwide School Health Promotion study, which is a self‐reporting, voluntary and anonymous survey for 8th and 9th graders (15 to 16‐year old, N = 71865). The ethical committee of the National Institute for Health and Welfare has approved procedure for the School Health Promotion study. Data on school health nurse resources and service providers were obtained from the national database (534 schools; 144 service providers). Multilevel logistic regression was used. Of the pupils, 15% of girls and 11% of boys reported difficult access to a school health nurse. The number of adolescents who reported difficult access ranged between service providers (0%–41%) and schools (0%–75%). Students with lower socio‐economic background, poorer well‐being at school, lack of support for studying and greater health needs reported difficult access more often. School health nurse resources were associated with difficult access only among boys, when resources were under the national recommendations. These findings raise concern about equality and unmet health needs in school health services.     

A qualitative study of mild to moderate psychological distress during pregnancy

Background

Psychological distress is common in the antenatal period. In England, psychological distress is classified as mild, moderate or severe but only those who suffer severe psychological distress are referred to the specialist mental health services. Those who suffer mild to moderate psychological distress are managed by the primary care services. However, little is know about the psychosocial experiences of pregnant women who suffer from mild-moderate psychological distress.

Objective

This study explored the experiences of pregnant women who self-reported mild to moderate psychological distress during antenatal care.

Design

A qualitative study. Data were collected using digitally recorded, face-to-face, semi-structured interviews. Data were analysed using framework analysis.

Setting

A large teaching maternity hospital in North West England.

Participants

Twenty-four pregnant women who self-reported mild to moderate psychological distress to their midwife during routine antenatal care.

Results

Three main themes emerged: the causes of, impact of, and ways of controlling self-reported mild to moderate psychological distress. A range of experiences caused psychological distress including past life and childbearing experiences, and current pregnancy concerns. Mild to moderate psychological distress took over the lives of these pregnant women. The strategies used to control mild to moderate psychological distress included both positive and negative coping elements.

Conclusions

Psychological distress that is categorised as mild to moderate can be extremely debilitating for pregnant women. Identification of these women in clinical practice is crucial so that effective interventions can be targeted appropriately. Screening criteria that has the efficacy to identify depression and anxiety is needed. We recommend that a multidisciplinary approach to the management of care is developed to address the range of experiences that pregnant women who suffer mild to moderate prenatal psychological distress may have.     

Critical pancreatitis management associated with hypertriglyceridemia in pregnancy in emergency service

Because of the variable clinical features of acute pancreatitis, it is difficult to make a differential diagnosis in patients presenting with abdominal pain in emergency departments. Acute pancreatitis due to severe hypertriglyceridemia during pregnancy is rare but due to the increased risk of maternal and fetal mortality, diagnosis and treatment options should be known and should be performed in the emergency department, which is the first admission site.In this case report, we present a 20-year-old woman with 19 weeks pregnant who presented to the emergency department with abdominal pain and whose biochemistry parameters were high enough to give lipemic stimulation was hospitalized in the emergency ıntensıve care unit (EICU) in the emergency department and lipid apheresis treatment was planned successfully. Lipid apheresis treatment in patients with resistant hypertriglyceridemia in the emergency department should become an easy, safe and effective option with the use of an emergency intensive care unit.