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  • 1.
    Akhter, Nargis
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Akhter, Jasmine
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Component that make a midwife grow personally and professionally: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background:

    Midwifery care is an essential component of providing quality maternal and child health care. Mother and new born health outcomes depends on the quality of education, license to practice, the scope of practice, sufficient resources, referral mechanisms and effective teamwork. The aim of this meta-synthesis was to describe components building midwifery professionalism for delivery of quality care. Method: This study was a meta-synthesis focusing to describe the components needed for building midwifery professionalism for delivery of quality care in high, low and middle-income countries. After assessing for relevance and quality in peer-reviewed journals, 30 qualitative studies were included from 2009 to 2018, written in English. This involved an electronic search using the following databases: PubMed, CINAHL, web of Science, Google Scholar, Summon and manually search. Result: After analysis and synthesis, the major findings can be summarized in two components; Clinical experiences make the midwives’ grow personally and professionally and an enabling environment enhances the midwives’ personal and professional development. Subcategories were; Collaboration with other health professionals and with colleges/ colleagues at the workplace, Extensive hands on clinical experience, Professional management of the workplace, Quality pre-service education and quality of the midwifery educators, In-service training, Policies and guidelines regulate the midwifery workforce, Being a member of a midwifery association. Conclusion: To ensure mothers quality midwifery care; midwives play a critical role in strengthening the midwifery workforce in high and low-middle income countries. This study highlights the benefits of building capacity for strengthening midwives and the midwifery profession. Clinical implications: There is a need to improving the educational status, improving policy and practice of health care program and facilitate the necessary resources. There is need for further research to identify how much improvements the newly deployed midwifery cadre service will bring in the field of quality midwifery care personally and professionally especially in rural setting.

  • 2.
    Akter, Rina
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Parvin, Masuda
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Supportive components of care during cesarean section birth: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background

    : Caesarean section is the most common surgery worldwide today. The midwives support is therefore of uttermost important for women undergoing caesarean section. Aim: The aim of the meta-synthesis was to explore the experience related to planned and unplanned cesarean sections among primipara and multipara women in hospital settings worldwide. Method: This study is a meta-synthesis with meta-ethnographic analysis on women’s experiences of caesarean section birth. This is a qualitative research based on scientific literature. The inclusion criterion was peer-review qualitative articles from different original articles about women's experiences. Results: Five categories emerged: Caring attitude and behaviour, pre-existing imagination, relational influence, the need for caring and information. The findings suggest that nurse-midwife enhance their support and increase the women’s knowledge on caesarean section birth in order to improve the experience and also for women to make good choices. Women are influenced by people near to them when choosing to have a cesarean section or not. The mothers face challenges for postoperative recovery and quality of care. Midwives have a duty to assist these mothers. Conclusion: The findings emphasize the importance of person-centered communication skills and relationships in supporting a woman during caesarian section. Organizational systems and services that facilitate continuity of care giver for example, continuity of midwifery care or peer support models, are more likely to facilitate supportive care and a trust-building relationship. Clinical implication: The findings from this study can be used for educational purposes, and to create awareness about the role of midwifery care in relation to CS.

  • 3.
    Akther, Aklima
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Naher, Kalsarun
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Parent’s perceptions experiences and attitudes about kangaroo mother care in neonatal wards: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background:

    The knowledge of facility-based kangaroo mother care (KMC) in Bangladesh is comparatively recent; few facilities have been taking steps towards KMC service. Each year more than a million babies die due to the complication of prematurity. To eliminate the deaths due to prematurity, it is very important to share knowledge about the implementation, experiences, challenges and barriers for KMC practice to promote KMC intervention in the developing countries. Aim: To examine parents’ perceptions, experiences and attitude towards KMC in neonatal wards. Method: This study was a meta-synthesis focusing on parents’ perceptions and experiences of KMC. The included studies used several different qualitative methodologies compiled using Meta ethnography. Result: The results comprised of three categories were identified in this study. The First category was the Barriers towards KMC. This category comprised four preliminary patterns of parent’s perceptions of barriers to have KMC: Separating due to prematurity, Fear of harming, Pain prevented closeness, and Fear prevented closeness. The second category was facilitating factors for KMC, which covered parents’ experiences of the consult support expressed in four preliminary patterns: Own wish for closeness, Having positive experience and Support from the staff. The third category Benefits for KMC included three preliminary patterns of positive perceptions of KMC made by parents: Calming, warming and bonding, connecting with the premature baby and Being able to act as a parent. Conclusion: In this meta-synthesis, the main findings were realized into three categories of KMC- Barriers towards KMC, facilitating factors of KMC, Benefits of KMC. This is a low-cost and effectiveness method of reducing infant mortality. Clinical implications: Health care professionals have opportunities to implement Kangaroo Mother Care in low resource settings. First health care professionals have to be encouraged in all postnatal wards. Secondly, parents need to be aware about KMC so that they can promote their baby’s health and eventually save their baby’s life.

  • 4.
    Banu, Afroza
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Parvin, Shahanaj
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    "There Are Remaining Challenges in Bangladesh" A National Assessment Strategy Supports Reaching International Midwifery Standards Education: A focus group inquiry among midwifery faculty in Bangladesh2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background: Delivery by unskilled birth attendant is causing many maternal and neonatal deaths. Midwives can reduce maternal and neonatal deaths by providing skilled delivery care. To prepare skilled midwives a National Assessment Strategy for Midwifery Education Standards has been introduced.

    Aim: To describe midwifery faculty members’ perceptions of how to affirm quality midwifery education in Bangladesh using a national assessment strategy.

    Methods: A qualitative research design was chosen using a context-specific accreditation assessment tool, guided by the Global Standards for Midwifery Education. The participants were 33 midwifery teachers, and data were analyzed with content analysis.

    Results: The findings indicate that Bangladesh should be prepared to implement the Global Standards for Midwifery Education Accreditation Programmes. The assessment strategy has prepared the faculty for accreditation and paved the way through the development of standards in the tool, overcoming barriers, and using the possible facilitators.

    Conclusion: There are remaining challenges in Bangladesh regarding "moving midwifery". Midwifery teachers demand for separate faculty from nursing. Promotion system for careers development can be initiated. Updating teachers knowledge, having adequate number of teachers with competencies, and maintained collaboration between teaching and clinical practice organizations are important for "moving midwifery" in Bangladesh.

    Clinical application: The present study results can be useful for midwifery education and clinical practice improvement.

  • 5.
    Begum, Momtaj
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Sultana, Nazma
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Women’s and health care provider perceptions and experiences of bottlenecks in midwifery care: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background:

    Women die from preventable causes during pregnancy and childbirth and often in relation to delays in midwifery care. Professional hierarchies might hamper the rights and desires of midwives in provision of normal birth in terms of the provision of quality care to all women and newborns. In health systems where decision making in normal births are influence by doctors this is particularly relevant, with women themselves subordinate to all health care professionals. Aim: The aim of this meta-synthesis was to examine women’s and health care provider’s perceptions and experiences of bottlenecks in midwifery care related to availability, accessibility, acceptability and quality of midwifery care. Method: This study was a qualitative meta-synthesis with a deductive approach, 15 article were selected for this qualitative meta-synthesis. A framework for the evaluation of quality of care and coverage of health services was used for the deductive approach. Results: Four categories emerged based on availability, accessibility, acceptability and quality of care. The delays were due to less awareness of danger signs of severe complications in the community, and delays in decision making by male family members and less empowerment of women, and lack of collaboration between health care professionals. We also identified how to overcome this situation. Conclusion: Midwifes may provide quality maternal care to all women and children and earn trust from community people to promote normal pregnancy and birth and prevent delays when complications arise. Clinical implications: Midwives can provide continuity care and through collaboration with other health care professionals advocate for women empowerment.

  • 6.
    Begum, Mst. Marium
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Nahar., Most. Nargis
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Parents’ and health care providers’ perceptions and experiences of supportive care in neonatal wards: A qualitative metasynthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background:

    Four million infants die with in the first month of life and 27% of these deaths are directly related to low birth weight (LBW) or preterm birth. The main causes of infant death in premature and LBW infants is neonatal infections. It is thus crucial that the infant is taken care of in an appropriate way regarding caring and feeding and that care is provided to improve the child’s chances of survival and to lay the foundation for a healthy life. Aim: The aim of this meta-synthesiswas to examine parent`s and health care providers perceptions and experiences of supportive care in neonatal wards. Method: A qualitative meta-synthesis based on peer-reviewed scientific literature, and meta-ethnographic analysis method. In this meta-synthesis 16 articles were included. Result: The results comprised of two categories, Parents’ perspective of supportive strategies with eight corresponding preliminary patterns and Health care providers’ perspective of supportive strategies with six corresponding preliminary patterns. In the result section, each categories are presented with its corresponding preliminary patterns. The mothers experienced that the baby was unstable and therefore they wanted to be close to the baby at all times if something happened. Important was closeness to the infant is important, parental support according to needs, adequate communication and information with parents, genuine caring and continuous support to get close to the child. It also meant less light and less noise and privacy for the infant and the parent in the NICU ward.

    Conclusion

    Parents wanted to be able to be with his infant as rapidly after birth be reunited in case something happened. The importance of receiving information about their infant’s condition underpinned all communications that the parents undertook with NICU staff both in co-care when together with the child and part-care, when separated. Information for the parents was an important requirement of accepting their situation and immediately affected their anxiety. Clinical implications: The organizers of care must take in account that parents and infants will not be befitted by being cared for apart from each other. When planning for co-care enabling infants to be close to the parents, the mother-baby dyad should be prioritized. Context specific interview studies are suggested on co-care and part-care, parents and care providers perspectives.

  • 7.
    Birath, Camilla
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Edman, Sofia
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Förlossningsrädsla: En begreppsanalys ur barnmorskans perspektiv2018Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Förlossningsrädsla drabbar ungefär en femtedel av alla gravida kvinnor och barnmorskor möter dessa i sitt arbete.

    Syfte: Syftet var att analysera begreppet förlossningsrädsla ur ett barnmorskeperspektiv.

    Metod: En begreppsanalys med en hybridmodell. Först en teoretisk fas med litteratursökning, därefter en fältstudiefas där fem barnmorskor intervjuades följt av en sammanfattandes syntes med resultatet från den teoretiska fasen och fältstudiefasen.

    Resultat: Förlossningsrädsla är något som kan drabba kvinnor innan, under eller efter graviditet och förlossning. Förlossningsrädsla kan vara primär eller sekundär. Vid primär förlossningsrädsla kan kvinnan sakna tilltro till sin förmåga att föda barn och vid sekundär förlossningsrädsla har kvinnan haft en tidigare traumatisk förlossningsupplevelse. Barnmorskorna beskrev förlossningsrädsla som ett komplext begrepp. Kvinnorna använde oftast inte ordet förlossningsrädsla utan barnmorskorna tolkade vad de märkte eller såg hos kvinnan som yttringar av förlossningsrädsla.

    Slutsats: Barnmorskor använder begreppet på olika sätt och efterlyser en tydligare definition och arbetssätt kring förlossningsrädsla. Förlossningsrädsla innebär ett stort lidande för den gravida kvinnan och därför anser författarna till detta examensarbete att det förebyggande arbetet är viktigt och att barnmorskan har en central och betydelsefull roll.

    Kliniks tillämpbarhet: Barnmorskor kan använda sig av studien för att utveckla sin kunskap kring förlossningsrädsla samt se hur andra barnmorskor ser på begreppet förlossningsrädsla.

  • 8.
    Ehrling, Malin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Kvinnans individuella upplevelse av förlossningssmärta: En begreppsanalys2017Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund:

    Förlossningssmärta är ett begrepp som används inom barnmorskeutbildningen och hälso- och sjukvård där kvinnor vårdas under graviditet och på förlossningsavdelningar. Begreppet är odefinierat i litteraturen och hur och vad som innefattas av begreppet är brett. Förlossningssmärta har stor plats inom mödrahälsovården men just som begrepp finns lite information. Syfte: Syftet var att beskriva begreppet förlossningssmärta genom en begreppsanalys. Metod: En begreppsanalys med kvalitativ design. Först utfördes en litteratursökning, den teoretiska fasen, och sedan blev fem barnmorskor identifierade genom ett bekvämlighetsurval och intervjuades i fältstudiefasen. Resultatet från fältstudiefasen sammanställdes med resultatet från den teoretiska fasen. Resultat: Analysen av begreppet förlossningssmärta mynnade ut i ett resultat med flera dimensioner där den unika upplevelsen är konklusionen. De tre huvuddimensionerna är sensorisk, affektiv och kognitiv upplevelse av förlossningssmärta. Där det sensoriska står för fysiologin, det affektiva för det vi bär med oss in i smärtupplevelsen och det kognitiva för hur vi tänker kring smärtupplevelsen. Referens-ramen för begreppet bestäms av dess förutsättningar och konsekvenser. Förlossningssmärtan är en unik upplevelse och endast den födande kvinnan vet hur den känns. Förlossningssmärta är en upplevelse som tolkas olika och uttrycket är individuellt. Slutsats: Förlossningssmärta kan ses som ett komplext begrepp som anpassas till varje gravid utifrån de definierade dimensionerna. Klinisk tillämpbarhet: Begreppet förlossningssmärta är viktigt att klargöra för barnmorskestudenter under utbildning.

  • 9.
    Ekström, Annika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Beskrivning av en kulturellt anpassad kurs för blivande mödrar med familjer i Nepal: En kvalitativ intervjustudie med sjukvårdspersonal2018Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Eftersom fattigdom och brist på transporter gör det svårt för befolkningen i Nepal att få tillgång till sjukhusvård, är det vanligt att gravida kvinnor avstår förebyggande och behandlade vård under graviditet, förlossning och postpartum tid och istället på egen hand eller med hjälp av familjemedlemmar föder sina barn. Graviditet, förlossning och postpartum perioden är den mest utsatta perioden i en kvinnas liv och kunskap om tecken på komplikationer kan vara livräddande för kvinnor som drabbas av komplikationer. Flera studier har föreslagit att Nepal inför antenatal utbildning för familjer som åtgärd för att förbereda inför födande och pospartum period och förebygga komplikationer under graviditet.  Relevanta ämnen och upplägg för en sådan kurs förväntas framträda genom resultaten av denna studie. Syfte: Syftet med denna studie var att beskriva ämnen och utformning av en kulturellt anpassad antanatal utbildning till familjer i Nepal, baserat på erfarenheter från vårdgivare. Metod: En kvalitativ design med semi-strukturerade intervjuer valdes. En intervjuguide utarbetades på förhand med ämnen inspirerade av den svenska föräldrautbildningen. Sammanlagt 26 intervjuer med vårdgivare, inklusive barnmorskor, förlossningsspecialiserade sjuksköterskor, sjuksköterskor eller medicinska läkare, genomfördes i både stads- och landsbygdsområden i Nepal; provinserna 3, 4 och 5. Resultat: Denna studie identifierade vårdgivarnas uppfattningar om vad som ska inkluderas i ett kontextuellt anpassad antenatal kurs till nepalesiska föräldrar och eventuellt till andra familjemedlemmar. Fem huvudteman hittades inklusive; Kursformat och innehåll, Graviditet, Födelseberedskap, Födseln och Postpartum. Slutsats: Mer kunskap och involvering av fäder i graviditet, förlossning och omsorg av barnet kommer att främja jämställdhet mellan kvinnor och män i Nepal. Dessutom kan ökad kunskap hos kvinnor öka deras självförtroende och beslutsfattande makt om sitt egna och deras barns hälsa och välbefinnande. Klinisk tillämpbarhet: Denna studie kan användas som ett underliggande dokument vid utformningen av en antanatal utbildning för blivande föräldrar och eventuellt andra familjemedlemmar i Nepal.

  • 10.
    Envall, Niklas
    et al.
    Karolinska institutet.
    Graflund Lagercrantz, Helena
    Sunesson, Jessica
    Kopp Kallner, Helena
    Intrauterine mepivacaine instillation for pain relief during intrauterine device insertion in nulliparous women: a double-blind, randomized, controlled trial2019Inngår i: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 99, nr 6, s. 335-39Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: 

    To evaluate whether intrauterine mepivacaine instillation before intrauterine device (IUD) insertion decreases pain compared to placebo.

    STUDY DESIGN: 

    We performed a double-blind, randomized, controlled trial comparing mepivacaine 1% 10 mL versus 0.9% NaCl intrauterine instillation using a hydrosonography catheter 5 min before IUD insertion in women 18 years of age or older. Participants completed a series of 10-cm visual analogue scales (VAS) to report pain during the procedure. The primary outcome was the difference in VAS scores with IUD insertion between intervention group and placebo. Secondary outcomes included VAS before and after insertion and analgesia method acceptability.

    RESULTS: 

    We randomized 86 women in a 1:1 ratio; both groups had similar baseline characteristics. In the intention-to-treat analysis, the primary outcome, median VAS with IUD insertion, was 4.8 cm in the intervention group [n=41, interquartile range (IQR) =3.1-5.8] and 5.9 cm in the placebo group (n=40, IQR=3.3-7.5, p=.062). In the per-protocol analysis, the median VAS with IUD insertion was 4.8 cm (IQR=3.1-5.5) and 6.0 cm (IQR=3.4-7.6) for the intervention and placebo groups, respectively (p=.033). More women in the intervention group reported the procedure as easier than expected (n=26, 63.4% vs. n=15, 37.5%), and fewer reported it as worse than expected (n=3, 7.3% vs. n=14, 35%, p=.006).

    CONCLUSION: 

    Intrauterine mepivacaine instillation before IUD insertion modestly reduces pain, but the effect size may be clinically significant.

    IMPLICATIONS STATEMENT: 

    While the reduction in VAS pain scores did not meet our a priori difference of 1.3 points for clinical significance, participants' favorable subjective reaction suggests that this approach merits further study.

    Copyright © 2019 Elsevier Inc. All rights reserved.

    KEYWORDS: 

    Contraception; Intrauterine devices; Mepivacaine; Pain; VAS

  • 11. Envall, Niklas
    et al.
    Kopp Kallner, Helena
    Groes Kofoed, Nina
    Use of effective contraception 6 months after emergency contraception with a copper intrauterine device or ulipristal acetate - a prospective observational cohort study2016Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, nr 8, s. 887-95Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION:

    Emergency contraception must be followed by the use of an effective method of contraception in order to reduce future risk of unintended pregnancies. Provision of long-acting reversible contraception (LARC) is highly effective in this regard. The aim of our study was to compare use of an effective method of contraception 6 months following insertion of a copper intrauterine device (Cu-IUD) or intake of ulipristal acetate (UPA) for emergency contraception (EC).

    MATERIAL AND METHODS:

    Women (n = 79) presenting with need for EC at an outpatient midwifery clinic chose either Cu-IUD or UPA according to preference. Follow up was 3 and 6 months later through telephone interviews. Primary outcome was use of an effective contraceptive method at the 6-month follow up. Secondary outcomes included use of an effective contraceptive method at 3 months follow up and acceptability of Cu-IUD.

    RESULTS:

    A total of 30/36 (83.3%) women who opted for Cu-IUD for EC used an effective contraceptive method 6 months after their first visit compared with 18/31 (58.1%) women who opted for UPA (p = 0.03). In the Cu-IUD group 28/36 (77.8%) were still using Cu-IUD at 6 months and 31/36 (86%) stated that they would recommend the Cu-IUD to others as an EC method.

    CONCLUSION:

    Significantly more women who chose Cu-IUD for EC used an effective method for contraception at the 6-month follow up. The results of this study support increased use of Cu-IUDs for EC.

  • 12.
    Eriksson, Magdalena
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Zetterlund, Jolie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Midwives’ experiences of becoming and being a midwife in the post-conflict setting of Somaliland.: An interview study2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background: Working as a midwife means being an important key to health and counsellor for women, their families and the community. Post conflict refer to the fragile situation occurring after a conflict. The effects of the war in Somalia led to a collapse of the health care system, with consequences for midwives catering for women before, during and after childbirth.

    Purpose: To describe midwives’ experiences of becoming and being a midwife in the post-conflict setting of Somaliland.

    Method: A qualitative and empirical interview study with inductive approach was chosen for this study to gain broader a view of midwives' experiences. Eleven individual interviews with midwives were analysed by thematic analysis.

    Findings: Time as refugees and current social situation were factors that had shaped the midwives, as well as challenges in professional life related to lack of equipment and training, encountering women with low health status, and women in need of additional health education and awareness in general and in reproductive health. Improvement of women's health and rights was also described as a key part of the midwives' jobs.

    Conclusion: Previous life experiences combined with challenges in working life and the desire to change and improve were of great importance for the midwives working in the post conflict setting of Somaliland and gave the them roles as changemakers for Somali women.

    Clinical Applicability: This study can be used to increase the understanding of women’s health and the prerequisites for midwives and women living in, or originating from, a conflict or post conflict setting with experiences of war and displacement.

  • 13.
    Erlandsson, Kerstin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås.
    Lindgren, Helena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Women's premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell2012Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, nr 1, s. 28-33Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To identify whether mothers of stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition.

    Design. A mixed method approach.

    Setting. One thousand and thirty-four women answered a web questionnaire. Sample. Six hundred and fourteen women fulfilled the inclusion criteria of having a stillbirth after the 22nd gestational week and answered questions about premonition. Methods. Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives.

    Main Outcome Measure. The premonition of an unwell unborn baby. Results. In all, 392 of 614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274 of 614 (70%) contacted their clinic and were invited to come in for a check-up, but by then it was too late because the baby was already dead. A further 88 of 614 (22%) decided to wait until their next routine check-up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby.

    Conclusions. Women need to know that a decrease in fetal movements is an important indicator of their unborn baby's health. Healthcare professionals should not delay an examination if a mother-to-be is worried about her unborn baby's wellbeing.

  • 14.
    Gustafsson, Lisa
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Östhaug, Anna Lisa
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Kvinnors upplevelser av barnmorskans stöd vid förlossningsrädsla: En kvalitativ metasyntes2018Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Förlossningsrädsla kan vara påfrestande för kvinnor, förekommer i varierande allvarlighetsgrad och kan leda till negativ förlossningsupplevelse. Förekomsten av förlossningsrädsla varierar mellan olika länder vilket till viss del kan förklaras av olika mätmetoder. Barnmorskan är en betydelsefull person för kvinnor med förlossningsrädsla. Syfte: Syftet med denna studie var att undersöka kvinnors upplevelser och erfarenheter av barnmorskans stöd vid förlossningsrädsla. Metod: Kvalitativ metasyntes med meta-etnografisk analysmetod, där artiklar söktes i databaserna PubMed, CINAHL, Google Scholar, Scopus, Web of Science och PsycINFO. Efter kvalitetsgranskning kom 15 artiklar att analyseras. Resultat: Tre kategorier med tillhörande mönster identifierades; En närvarande barnmorska och En kompetent barnmorska där kvinnornas upplevelser av barnmorskans stöd bidrog till att minska förlossningsrädslan. Kategorin En distanserad barnmorska med tillhörande mönster visar upplevelser som istället ökade förlossningsrädslan. Slutsats: Resultatet påvisar betydelsen av att kvinnor upplever att barnmorskan är närvarande och kompetent för att kvinnan ska känna sig trygg och våga lita på att hon kan föda. Kontinuerligt stöd vid förlossning och fortbildning till personalen som möter förlossningsrädda kvinnor behövs. Caseload kan vara en modell som ytterligare behöver implementeras i barnmorskans arbete.

  • 15.
    Jobs Roos, Kesti
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Roos, Kristin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Gynekologisk undersökning vid eftervårdsbesök -barnmorskans erfarenheter av att bedöma bäckenbottensstrukturer: Kvalitativ intervjustudie med barnmorskor verksamma inommödrahälsovården2018Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund:

    När en kvinna genomgår en graviditet och förlossning innebär det stora

    påfrestningar för hennes kropp. Vid en förlossning kan bristningar uppstå, vilket kan medföra

    besvär för kvinnan i olika utsträckning. Genom eftervårdsbesöket har barnmorskorna en

    möjlighet att identifiera problem som kan ha uppstått och upptäcka odiagnostiserade

    förlossningsskador.

    Syfte:

    Syftet var att beskriva barnmorskans erfarenheter av gynekologisk undersökning och

    att bedöma bäckenbottens strukturer vid eftervårdsbesök inom mödrahälsovården.

    Metod:

    Semistrukturerade intervjuer genomfördes med elva barnmorskor yrkesverksamma

    inom mödrahälsovården. Tematisk analys användes för att analysera materialet.

    Resultat:

    Ett huvudtema, tre organiserande teman samt tio basteman identifierades.

    Huvudtemat var:

    kvinnans behov i centrum. Organiserande teman var: att stödja genom sitt

    förhållningssätt; att verka hälsofrämjande

    och förbättringsområden. Basteman var: att vara

    lyhörd; att bekräfta; att se individuella behov; att motivera till undersökning; att motivera till

    egenvård; utbildning; struktur; dokumentation; tidsaspekten

    och uppföljning.

    Slutsats:

    Barnmorskor inom mödrahälsovården fyller en viktig funktion i att arbeta

    hälsofrämjande och arbetar med kvinnans behov i centrum. De försöker individanpassa varje

    besök och den information som ges ut men upplever att det kan finnas svårigheter att

    motivera kvinnor till gynekologisk undersökning. Mer utbildning, bättre och tydligare struktur

    för bedömning av bäckenbotten samt en förbättrad samtalsmetodik kring besvär som kan

    kvarstå efter förlossningen kan bidra till att kvinnor får den hjälp och vård de behöver.

    Klinisk tillämpbarhet:

    Studiens resultat belyser behov av mer kunskap, utbildning och

    struktur. Att detta uppmärksammas i denna studie kan leda till diskussion om

    vidareutveckling och att ämnet lyfts i den kliniska verksamheten.

  • 16.
    Khatun, Mst Monira
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Akter, Parvin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Save the Children-mentors’ experiences of implementing midwifery model of care in clinical settings in Bangladesh: An interview study with qualitative approach2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background: The Government of Bangladesh recognizes the important role midwives play in preventing maternal and neonatal mortality and morbidity, and their integral link to improving maternal and neonatal health service provision. Thus Save the Children Mentors are created to support and introduce midwives in Bangladesh. The programs clinical mentors will play a critical role to ensuring in-service-training to midwives who provide services in midwife-led care facilities.

    Aim: The aim of this study is to describe Save the Children mentors’ experiences of implementing midwifery model of care in clinical setting in Bangladesh.

    Methods: A qualitative design was chosen. Fourteen interviews were performed with Save the Children Mentors’ in Bangladesh who were currently working in the Strengthening National Midwifery Program. Data was analyzed by inductive content analysis.

    Results: There were all kinds of gaps in the organization of care, in care practices and in community awareness regarding attitudes and knowledge of the midwifery model of care. The Save the Children Mentors learnt how to overcome the hurdles over time while motivating, educating, mentoring, sensitizing and while communicating with manages, health care providers and community members on how to manage implementation of midwifery model of care.

    Conclusion: It is important to contribute the government to improvements and fill the gap of evidence based care to implement midwifery model of care in Bangladesh. Save the Children mentors are making aware people to collaborate and support the midwives as it is a mandate of the government to implement the new cadre and gradually the situation is being changing.

  • 17.
    Olsson, Anna
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Tengvall, Helena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Barnmorskans roll i sex- och samlevnadsundervisningen i grundskolan: En kvalitativ intervjustudie2018Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background:

    Today, most of the sex education takes place in school. Studies shows shortcomings in this education and that students experience shortage of the knowledge wanted regarding this subject. Research has also shown that young people prefer to accomplish sex education with someone who feels comfortable and has good knowledge of the subject. The main subject of midwifery is sexual and reproductive health and rights. However, there is a limited amount of studies conducted regarding midwives involvement in sex education in schools. Purpose: The aim of this study was to highlight the role of the midwife in health-promoting public health work with sex education for adolescents in school. Method: Semi-structured telephone interviews were conducted with four teachers who taught sex education at high school and five midwives with experience of sex education. The collected material was analyzed according to Malterud's systematic text condensation. Result: The result showed that the midwife's health promotion work in school was conducted in a few different ways. Partly through lectures and partly by students visiting the youth health center (ungdomsmottagning). The way in which the work was done was due partly to the school's demand and partly to the availability of the midwife. The average time that the midwife was teaching students were between 30-120 minutes, which were distributed on one and the same occasion. The midwife's role in school was described as being proficient, competent and comfortable talking about sex. The fact that the midwife was unacquainted meant that the students felt comfortable and it was easier to ask questions about sensitive subjects. Conclusion: The conclusion of the study is that there is a need for midwifery skills at school and that, in spite of this, there is no clear and obvious role of the midwife in school education. Clinical applicability: This study can be used to support the midwife's work in sexual education in school. The study can also be used as a basis for establishing cooperation between midwife and school.

  • 18. Pakbaz, Mojgan
    et al.
    Persson, Margareta
    Umeå universitet.
    Löfgren, Mats
    Mogren, Ingrid
    'A hidden disorder until the pieces fall into place': a qualitative study of vaginal prolapse2010Inngår i: BMC women's health, ISSN 1472-6874, Vol. 10, s. 18-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Vaginal prolapse affects quality of life negatively and is associated with urinary, bowel, and sexual symptoms. Few qualitative studies have explored women's experiences of vaginal prolapse. The objective of the study was to elucidate the experiences of living with prolapse and its impact on daily life, prior to surgical intervention.

    METHODS: In-depth interviews were conducted with 14 women with vaginal prolapse, prior to surgical treatment. Recruitment of the informants was according to 'purposive sampling'. An interview guide was developed, including open-ended questions addressing different themes, which was processed and revised during the data collection and constituted part of a study-emergent design. Data were collected until 'saturation' was achieved, that is, when no significant new information was obtained by conducting further interviews. Interviews were audiotaped, transcribed verbatim, and analyzed according to manifest and latent content analysis.

    RESULTS: The theme defining the process of living with prolapse and women's experiences was labelled 'process of comprehension and action'. The findings constitute two categories: obstacles and facilitators to seeking health care. The category obstacles comprises six subcategories that define the factors restraining women from seeking health care: absence of information, blaming oneself, feeling ignored by the doctor, having a covert condition, adapting to successive impairment, and trivializing the symptoms and de-prioritizing own health. The category facilitators include five subcategories that define the factors promoting the seeking of health care: confirmation and support by others, difficulty in accepting an ageing body, feeling sexually unattractive, having an unnatural body, and reaching the point of action.

    CONCLUSION: The main theme identified was the 'process of comprehension and action'. This process consisted of factors functioning as either obstacles or facilitators to seeking health care. The main obstacles described by the participants were lack of information and confirmation. The main facilitators constituted feeling sexually unattractive and impaired physical ability due to prolapse. Information on prolapse should be easily accessible, to improve the possibility for women to gain knowledge about the condition and overcome obstacles to seeking health care. Health care professionals have a significant role in facilitating the process by confirming and informing women about available treatment.

  • 19.
    Parveen, Shahanaz
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Zahan, Mauluda
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Akter, Mst. Noormahal
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Sexual and Gender Based Violence in the Midwifery Education in Bangladesh: A focus group discussion study with midwifery and nursing educators and certified midwives2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background:

    Worldwide, sexual and gender based violence is a significant problem which affects public health and human rights. Since the education for midwives is new in Bangladesh, and there are indications of widespread violence against women in the country, it is central to investigate how the topic is addressed within the midwifery education.

    Aim:

    To examine how sexual and gender based violence is addressed in the midwifery education in Bangladesh and identify potential needs for improvement, from the perspective of midwifery and nursing educators.

    Methods:

    A qualitative inductive design was used in focus group discussions (FGDs) with 29 midwifery and nursing educators. Data was analyzed by qualitative content analysis.

    Results:

    The content related to violence in the curriculum of midwifery education in Bangladesh was not considered sufficient for the students to gain sufficient knowledge or tools for practical work. Future midwives need theoretical and practical knowledge, including a broad base of basic knowledge, communication and trust building skills, skilled educators and varied learning methods. Society and community can act as both a facilitator and barrier for midwifery student's possibilities to be skilled in encountering women exposed to violence.

    Conclusion:

    To improve the midwifery education there is a need to strengthen the midwifery curriculum in line with WHO guidelines within the field of violence. Midwifery students need clinical practice to learn to identify, communicate and support women subjected to violence. Minimization of identified barriers may help to improve the confidence level of future midwives and enable them to give evidence based up-to-date care freely and independently, and to link women with available services. For this, competent midwifery educators and networking are central.

    Clinical application:

    There are needs to review the midwifery curriculum according to the WHO standard guidelines and to provide more practice opportunities to support midwifery students in their process of becoming competent midwives. Providing training for midwifery educators can upgrade their knowledge to make them more ready and skilled in guiding the students in the field of sexual and gender based violence.

  • 20.
    Parvin, Most Nargis
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Moni, Mosammat Ratna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    "Moving" midwifery in Bangladesh: Bangladesh Midwifery Society support to its members and to the country: An interview study with members of the Bangladesh Midwifery Society2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background:

    A midwife association is defined by ICM as a platform for developing strong, supportive, positive relationships among midwives and between the profession of midwifery and other stakeholders such as governments and health care providers. Aim: To describe Bangladesh Midwifery Society members’ perceptions of support provided by BMS, directly to its members and indirectly by ‘moving’ midwifery in the society in Bangladesh. Method: Individual interviews and content analysis. Results: Bangladesh Midwifery Society is directly and indirectly beneficial in supporting individual members and the midwifery profession. Particularly Bangladesh Midwifery Society promotes the establishment of a midwifery profession by providing quality midwifery care to women and newborn, promoting the regulatory body and quality midwifery education in Bangladesh. Conclusion: Bangladesh Midwifery Society is a key player in promoting the establishment of a midwifery profession by providing quality midwifery care to women and newborn, promoting the regulatory body and quality midwifery education in a country where midwifery is being initiated. Clinical application: This study is to be of favor to the upward existing setting of midwives in this country and in countries with the same situation of initiating the midwifery profession.

  • 21.
    Persson, Margareta
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Winkvist, A
    Dahlgren, L
    Mogren, I
    Struggling with daily life and enduring pain: a qualitative study of women's experiences with pelvic girdle pain during pregnancy2013Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, artikkel-id 111Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Few studies have investigated the experiences of living with pelvic girdle pain (PGP) and its impact on pregnant women’s lives. To address this gap in knowledge, this study investigates the experiences of women living with PGP during pregnancy.

    Methods. A purposive sample, of nine pregnant women with diagnosed PGP, were interviewed about their experiences. Interviews were recorded, transcribed to text and analysed using a Grounded Theory approach.

    Results. The core category that evolved from the analysis of experiences of living with PGP in pregnancy was “struggling with daily life and enduring pain”. Three properties addressing the actions caused by PGP were identified: i) grasping the incomprehensible; ii) balancing support and dependence and iii) managing the losses. These experiences expressed by the informants constitute a basis for the consequences of PGP: iv) enduring pain; v) being a burden; vi) calculating the risks and the experiences of the informants as vii) abdicating as a mother. Finally, the informants’ experiences of the consequences regarding the current pregnancy and any potential future pregnancies is presented in viii) paying the price and reconsidering the future. A conceptual model of the actions and consequences experienced by the pregnant informants living with PGP is presented.

    Conclusions. PGP during pregnancy greatly affects the informant’s experiences of her pregnancy, her roles in relationships, and her social context. For informants with young children, PGP negatively affects the role of being a mother, a situation that further strains the experience. As the constant pain disturbs most aspects of the lives of the informants, improvements in the treatment of PGP is of importance as to increase the quality of life. This pregnancy-related condition is prevalent and must be considered a major public health concern during pregnancy.

  • 22.
    Persson, Margareta
    et al.
    Umeå universitet.
    Winkvist, Anna
    Mogren, Ingrid
    'From stun to gradual balance' - women's experiences of living with gestational diabetes mellitus2010Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, nr 3, s. 454-62Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND AIM: In most parts of the western world, screening routines for gestational diabetes mellitus (GDM) are implemented, however, knowledge of the impact GDM has on the experience of pregnancy and life situation is sparse. The aim of this study was to describe pregnant women's experiences of acquiring and living with GDM during pregnancy.

    METHOD: A Grounded Theory approach was used. Ten pregnant women diagnosed with GDM in current pregnancy were interviewed. Data collection was performed in the north of Sweden over two periods; a first set of interviews in 1998-2000 and additional interviews in 2006 to further explore the experience and reach saturation.

    FINDINGS: 'From stun to gradual balance' emerged as the core category, encompassing of the categories 'Struck by lightning', 'Having a personal responsibility', 'Being under surveillance', 'Struggling for protection', 'Feeling socially apart', 'Being sufficiently supported', 'Changing the self-image', 'Adapting to a new situation' and 'Waiting for the 'Moment of truth''. Our findings indicated that the diagnosis of GDM initiated a number of challenges and demands for the pregnant women. Further, being diagnosed with GDM was not only perceived as a medical complication threatening the pregnancy, moreover as an indicator of a future diabetes mellitus.

    CONCLUSION: The experience of being diagnosed with and living with GDM during pregnancy may be understood as a process 'from stun to gradual balance'. The experience comprises positive and negative dimensions. Despite the challenges, the inconveniences and the changes involved, gradually adapting to a lifestyle and balancing the every day life is the prize most of these women are willing to pay in order to secure optimal maternal and foetal health. Knowledge of the experiences of women diagnosed with GDM may enable midwives to provide increased support as well as provide information and preventive measures in order to delay future diabetes mellitus.

  • 23.
    Persson, Margareta
    et al.
    Umeå universitet.
    Winkvist, Anna
    Mogren, Ingrid
    [No unified guidelines concerning gestational diabetes in Sweden. Noticeable differences between screening, diagnostics and management in maternal health services].2007Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, nr 45, s. 3365-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In Sweden, there are noticeable differences between the antenatal health care settings concerning the prevalence of oral glucose tolerance tests (OGTT) to detect gestational diabetes mellitus (GDM). Clinical guidelines for screening, diagnostics and treatment of GDM 2004 were collected from all antenatal health care areas (n=50, 100% of eligible areas) in Sweden. The guidelines were analysed in relation to the available national statistics. The most prominent finding was that there was no consensus on screening, diagnosis and treatment of GDM. In most areas, the well-known risk factors for GDM were used as the criteria for offering OGTT to pregnant women. However, some areas offered OGTT to all pregnant women, resulting in a significantly greater detection of GDM. Hence, it is likely that the reported prevalence of GDM in Sweden is an underestimate. We suggest that national guidelines for screening, diagnosis and treatment of GDM should be developed in order to better fulfil the intentions of the Swedish National Board of Health and Welfare.

  • 24.
    Persson, Margareta
    et al.
    Department of clinical science, Obstetrics and gynecology, Umeå University, Umeå, Sweden.
    Winkvist, Anna
    Mogren, Ingrid
    Surprisingly low compliance to local guidelines for risk factor based screening for gestational diabetes mellitus: A population-based study2009Inngår i: BMC pregnancy and childbirth, ISSN 1471-2393, Vol. 9, s. 53-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Screening for gestational diabetes mellitus (GDM) is routine during pregnancy in many countries in the world. The screening programs are either based on general screening offered to all pregnant women or risk factor based screening stipulated in local clinical guidelines. The aims of this study were to investigate: 1) the compliance with local guidelines of screening for GDM and 2) the outcomes of pregnancy and birth in relation to risk factors of GDM and whether or not exposed to oral glucose tolerance test (OGTT).

    METHODS: This study design was a population-based retrospective cross-sectional study of 822 women. A combination of questionnaire data and data collected from medical records was applied. Compliance to the local guidelines of risk factor based screening for GDM was examined and a comparison of outcomes of pregnancy and delivery in relation to risk factor groups for GDM was performed.

    RESULTS: Of the 822 participants, 257 (31.3%) women fulfilled at least one criterion for being exposed to screening for GDM according to the local clinical guidelines. However, only 79 (30.7%) of these women were actually exposed to OGTT and of those correctly exposed for screening, seven women were diagnosed with GDM. Women developing risk factors for GDM during pregnancy had a substantially increased risk of giving birth to an infant with macrosomia.

    CONCLUSION: Surprisingly low compliance with the local clinical guidelines for screening for GDM during pregnancy was found. Furthermore, the prevalence of the risk factors of GDM in our study was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors of GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. There is a need of actions improving compliance to the local guidelines.

  • 25.
    Rahm, Elin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Heister-Rosvold, Linnea
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Livskvalitet hos mammor till för tidigt födda barn under det första året efter förlossningen: En longitudinell kohortstudie2018Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund

    För tidig födsel innebär ökade risker för barnets liv och hälsa. Att få ett mycket för tidigt fött barn och därmed behöva vårdas på neonatalavdelning kan vara traumatiskt, omvälvande och stressande för mammor och kan ha stor betydelse för deras livskvalitet.

    Syfte

    Att beskriva mammor till för tidigt födda barns livskvalitet och påverkande faktorer upp till 12 månader efter förlossningen.

    Metod

    Studien hade en kvantitativ design och var en longitudinell kohortstudie där mammor (n=493) till barn som vårdats på sex olika neonatalavdelningar i Sverige fick svara på enkäter om livskvalitet (SF-36) vid fyra olika tillfällen under det första året efter förlossningen. Data har analyserats för att se vilka faktorer som kan ha haft betydelse för mammans livskvalitet samt om det fanns några skillnader över tid.

    Resultat

    Lägst livskvalitet skattades vid utskrivning från neonatalavdelning med en signifikant och successiv förbättring de kommande 12 månaderna (p <0,01). Inom grupperna med olika faktorer fanns vissa signifikanta skillnader i livskvalitet med liten eller medelhög effektstorlek i några dimensioner av livskvalitet.

    Slutsats

    Mammorna skattade lägre livskvalitet vid utskrivning än senare under det första året och det fanns skillnader i livskvalitet mellan olika grupper av mammor. Detta är viktig kunskap för hälso- och sjukvårdspersonal i mötet med mammor till för tidigt födda barn.

    Klinisk tillämpbarhet

    Resultatet kan hjälpa barnmorskor och även barnsjuksköterskor och distriktsjuksköterskor att få en bättre förståelse för mammor till för tidigt födda barn och därmed kunna förebygga ohälsa och stötta mammorna för att främja en god anknytning till barnet.

  • 26.
    Rani Biswas, Gita
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Khan, Archana
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Birth giving mothers’ experiences and perceptions about midwifery support during first stage of labour: A qualitative metasynthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background:

    Pregnant women’s expectations regarding midwives’ care during first stage of labour are often positive and when these are not met, they may be dissatisfied and eventually have negative experiences of the labour and birth experiences. The care and treatment and attitudes during this phase can have strong influence both on the birth giving experience as a whole and on the pregnancy outcome. The support provided during the delivery is identified as an important factor in this regard, and midwives are central in providing this support.

    Aim:

    The aim of this is to examine mothers’ perceptions and experiences of first stage of labour in order to illuminate the supportive components of midwifery care.

    Method:

    This study is a meta-synthesis. It is based on qualitative meta-ethnography and includes 13 articles, quality assessed by the Johanna Briggs Institute for Evidence Based Nursing Quality Assessment tool and thereafter synthesized and categorized.

    Results:

    Three important components of supportive midwifery care were found, which represents the three main categories 1) A professional midwife 2) A present midwife 3) Individualized care. A professional midwife should support the woman in coping, be

    knowledgeable about labour and being able to monitor signs and symptoms, support with labour pain, provide a supportive environment, be assertive and communicative and provide emotional support through empowering words. Being supported by a present midwife meant being welcomed, having satisfying interaction and dialogue and to be given prompt attention. Individualized care included that a midwife could adjust the care according to needs and have a clear documentation.

    Conclusion and clinical implications:

    Three categories and its pattern have been discussed in this thesis. Individual care provided by professional and present midwives is central. This will help mothers to get proper services and ensure safe motherhood. It also endorse the midwives to be more benevolent in the services provided. Midwives can be guided through this thesis and the service of mother can thereby be improved. Professional midwives need to enhance their communication skill and the manner of assertiveness. Present midwives need to emphasize on their interpersonal skill. It is also recommended that midwives should have a welcoming manner, and create a friendly environment for welcoming a new born in this world.

  • 27.
    Rani Raha, Pronita
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Basri, Rabeya
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Comprehensive Sexual and Reproductive Health Care in Humanitarian Setting: A qualitative approach among midwives in Cox’sBazar, Bangladesh2018Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background: Inadequate access to Sexual and Reproductive Health (SRH) Care contributes to maternal morbidity and mortality in low resource settings and especially in humanitarian settings such as Cox Bazar in Bangladesh. More than 1.3 million Rohingya refugees are affected an estimated 316,000 women of reproductive age sheltering in Cox-Bazar after they have escaped from Myanmar. They live in spontaneous overcrowded settlements, the humanitarian needs are considerable and women are at high risk of gender-based violence. Around 64.000 women are pregnant and 2500 experience complications and their access to SRH care is limited. There is a lack of data on the quality of care women receive during early and late pregnancy in humanitarian settings and there is a need to provide scientific evidence to evaluate the effectiveness of SRH interventions delivered in humanitarian crises.

    Aim: The aim of this study will explore midwives experiences of providing Comprehensive Sexual and Reproductive Health Care in Humanitarian Settings (Cox-Bazar). More specifically to illuminate the barriers and facilitating factors for women‟s access to safe abortion and family planning in humanitarian crisis

    Methods: An inductive qualitative design was chosen. Data were collected through In-depth interview based on a topic guide and analyses by inductive content analysis. A pre-defined topic guideline was constructed for the IDI allowing the midwives to share their experiences and probe in to issues of significance for the research questions. The interviews were performed on a place and time chosen by the interviewee. Informants are midwives (n= 15) engaged in providing sexual and reproductive health care in Cox Bazar, Bangladesh and were recruited based on the inclusion criteria‟s: three years Diploma in Midwifery completed registered with the Bangladesh Nursing and Midwifery Council and have a at least 2 month working experience in health facilities in Rohingya influx areas at Cox‟s Bazar. The recorded IDIs have been transcribed along with the notes taken during the interviews. The transcripts will be analyzed using inductive Content Analysis where emerging codes will be discussed and re-evaluated to reach consensus and codes divided into categories and furthermore the identification of a theme. 3

    Results: The study findings illuminated the midwives experience to provide care in the humanitarian setting in Cox,s Bazar. Inadequate supplies, space, un-availability of medical doctors in humanitarian context, and inadequate pre-service education and training of informants were identified as structural barriers to provide quality care of comprehensive SRH care. Harmful cultural beliefs, social norms & values about modern contraceptives manipulate the women to choose and use family planning methods and receive care during early and late pregnancy were expressed by the respondent as a cultural barriers to provide quality care. Counseling on sexual and reproductive health issues by the health care providers were identified as a motivating factors of the women for seeking health care were the expressed as an opportunities for improvements in the existing health care system in humanitarian setting were highlighted in this study.

    Conclusion: Comprehensive Sexual and reproductive health is a significant public health need in all communities, including those facing emergencies. It highlights the fact that midwives and paramedics were recognize their fundamental role in detecting cultural norms and ideological opposition to family planning, abortion and other sexual and reproductive health matters often impede access to services, stigma associated with sex, unintended pregnancy, abortion, and concerns about privacy, may inhibit many from using services.

    Clinical application: Study finding will help the policy maker, to identify the professional gaps and equip them to meet the challenge of health care delivery system in humanitarian context. In addition, evaluate the readiness of health care providers to provide comprehensive sexual and reproductive health and rights. Policy expert will be benefited to finally, the finding will explore the areas need to be conduct research in future.

  • 28.
    Wedde Åberg, Maria
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Hillrings, Patricia
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Barnmorskors uppfattningar om hur sexuell och reproduktiv hälsa och rättigheter kan stärkas hos ungdomar: En kvalitativ intervjustudie2018Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund:

    Ungdomars sexuella och reproduktiva hälsa och rättigheter (SRHR) är ett viktigt folkhälsoarbete och barnmorskan har en central roll när det kommer till att nå ungdomarna med kunskap och information. Det förefaller finnas få studier om barnmorskors uppfattningar om vad ungdomar behöver veta mer om när det kommer till deras sexuella och reproduktiva hälsa och rättigheter. Syfte: Syftet med denna studie var att beskriva barnmorskors uppfattningar om vad ungdomar behöver veta mer om inom området sexuell och reproduktiv hälsa och rättigheter. Metod: Kvalitativ intervjustudie med åtta semistrukturerade intervjuer med barnmorskor. Datamaterial analyserades med en kvalitativ innehållsanalys med induktiv ansats. Resultat: Barnmorskorna uppfattade att ungdomarna hade behov av att veta mer om kroppsutveckling. Även mer om sexuellt överförbara infektioner (STI) och preventivmedel samt att killarna behövde veta mer om deras reproduktiva ansvar. Ungdomarna behövde också veta mer om sexuella relationer och rättigheter, innefattande bland annat lagar och homosexualitet. Barnmorskorna ser idag en ökning av sexuella problem bland ungdomarna och barnmorskorna hade en gemensam uppfattning om att det beror på pornografikonsumtion. Slutsats: Barnmorskor har insikt i vad ungdomar behöver veta mer om inom SRHR. Det finns fortfarande brister i undervisning och utbildning till ungdomar inom SRHR och det är angeläget att fokusera och investera i arbeten för att stärka och främja ungdomars SRHR. Klinisk tillämpbarhet: Denna studie lyfter barnmorskors uppfattningar om vad ungdomar behöver veta mer om inom ämnet SRHR. Studien kan användas i klinisk verksamhet till förbättringsarbeten för olika yrkeskategorier som arbetar med ungdomar gällande SRHR.

  • 29.
    Z Ager, Emily
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Helsing, Emma
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Sexualitet, självbild och kropp: En kvalitativ metasyntes om hur kvinnor förhåller sig till det heteronormativa samhällets förväntningar2018Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund:

    Sexualitet är viktigt i en människas liv. I samhället finns normer och förväntningar som vi alla förväntas anpassa oss till, dessa kan påverka sexualiteten och den sexuella hälsan. Genom att beskriva hur kvinnor förhåller sig till sin sexualitet, självbild och kropp utifrån ett heteronormativt samhälle kan barnmorskor få en djupare förståelse för kvinnors livsvillkor. Syfte: Att beskriva hur kvinnor förhåller sig till sin sexualitet, självbild och kropp utifrån samhällsnormer. Metod: Metasyntes baserat på 25 artiklar med kvalitativa data inkluderades i resultatet. Analysen gjordes genom metaetnografi. Resultat: Kvinnorna anpassade sig och var flexibla utifrån rådande samhällsnormer genom att de omfördelar makt i relationen, hanterar bristande utbildning och tabun, anpassar sig efter rådande könsroller samt strävar efter att uppfylla ideal. Dessa presenteras som de fyra huvudkategorierna i resultatet. Slutsats: Kvinnor formar sin sexualitet, självbild och kropp utifrån samhällsnormer och rådande maktstrukturer. De anpassar sig och är flexibla vilket påverkar deras självbild och sexuella hälsa. Självbilden och den sexuella hälsan utmärks av en begränsad makt att forma sitt eget liv. Kvinnor behöver medvetandegöras om denna situation för att få handlingskraft att värna om jämställdhet i sina egna liv och för att kunna verka för jämställdhet i samhället. Klinisk tillämpbarhet: Barnmorskor som yrkesgrupp kan stödja kvinnor i alla åldrar att bejaka sin sexualitet och se det fina i sina kroppar. Att inkludera barnmorskan och hens kompetens i skolans sexualundervisning; i samtal om lust, kroppsacceptans och samtycke, skulle kunna bidra till en förbättrad sexuell hälsa för unga kvinnor. Då barnmorskan i sitt arbete dagligen möter kvinnor som på olika sätt försöker förhålla sig till samhällsnormer och förväntningar kan denna metasyntes vara till hjälp i reflektion över barnmorskans värderingar kring jämställdhet och bemötande av kvinnor i olika livssituationer.

  • 30.
    Zadik, Tove
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Sterner, Kathy
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Vårdvetenskap.
    Exploring midwives’ experiences, attitudes and perceptions in relation to unsafe abortion and post abortion care: - a qualitative study with midwives in Kampala, Uganda.2017Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background: In the East African region abortion complications causes significant morbidity and mortality, impairing women´s and girls’ health and well-being. Health care provider shortages, physicians in particular, non-availability of safe and effective medicines and technology, and the fact that few midwives and nurses are trained in post abortion care (PAC), result in limited health care access. Stigma and legal repercussions further obstruct access to care and contributes to hesitance among health care providers to provide such care. Previous studies concerning women´s access to sexual and reproductive health (SRH) care in Uganda have revealed several barriers to health care access and limited quality of care. Aim: Exploring midwives´ experiences, attitudes and perceptions in relation to unsafe abortion and their experience of providing PAC. Method: In depth interviews were conducted with twelve midwives at Mulago Referall hospital, Uganda by using a semi- structured interview guide. The transcribed material was then developed through qualitative content analysis using a manifest approach. Result: The analysis resulted in two main categories: 1) stigma and social norms related to women´s sexuality and abortion and 2) quality of post abortion care. The result showed that unintended pregnancies, FP and abortions generally are viewed badly in Uganda and are highly stigmatized. The quality of PAC is perceived reduced due to lack of equipment, high work load and stigma surrounding abortions.

    Conclusion: Unsafe abortions are viewed negatively and is seen as a consequence to stigma surrounding FP and unplanned pregnancies, which is mainly affecting young unmarried women. Midwives experienced reduced quality of PAC due to limited resources. The study also shows that new knowledge and education about PAC can help reduce midwives prejudice towards abortion seeking women and broaden their views.

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