hh.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Evaluation of an adapted model of the World Health Organization partograph used by Angolan midwives in a peripheral delivery unit
Halmstad University, School of Social and Health Sciences (HOS).
Halmstad University, School of Social and Health Sciences (HOS).
Karolinska Institutet, Stockholm.
2000 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 16, no 2, p. 82-88Article in journal (Refereed) Published
Abstract [en]

Background:

The addition of laboratory bilirubin readings to an algorithm based on pH alone improves prediction of feeding tube location; although reliable pH-teststrips are available, there is no bedside test to measure bilirubin in feeding tube aspirates.

Objectives:

This study was designed to test the efficacy of a bilirubin teststrip with a newly developed scale in measuring the bilirubin content in feeding tube aspirates, and to determine the effectiveness of a combination of readings from pH and bilirubin teststrips in predicting feeding tube location.

Methods:

A total of 631 gastrointestinal specimens for concurrent pH and bilirubin testing were obtained from adult, acutely ill patients with newly inserted feeding tubes (nasogastric, n = 328; nasointestinal, n = 303) within 5 minutes of radiographs taken to determine tube location. In addition, 225 respiratory specimens were tested. Bilirubin was measured with a teststrip incorporating a newly developed colorimetric visual bilirubin (VBIL) scale, and by a laboratory assay, pH was measured with a teststrip and a pH-meter. Results from the bilirubin and pH tests were read by research assistants and staff nurses and compared with tube location as determined by radiography.

Results:

The correlation between readings made from the 5-point VBIL scale and the trimmed laboratory bilirubin was 0.93, with dichotomized readings correlating 0.87 and kappa equal to 0.86. A pH greater than 5 and a bilirubin less than 5 mg/dL successfully identified 100% of the 225 respiratory cases. In the category of pH 5 or less and bilirubin less than 5 mg/dL, 98% of the cases were gastric cases. In the category of pH greater than 5 and bilirubin 5 or higher mg/dL, nearly 88% of the cases were intestinal cases.

Conclusions:

The newly developed VBIL scale is effective in determining the bilirubin content in feeding tube aspirates. Furthermore, compared with predicting tube location from pHpaper alone, dichotomized readings from the VBIL scale/bilirubin teststrip used in combination with a pH-teststrip improved the ability to differentiate between respiratory and gastrointestinal tube placement, as well as between gastric and intestinal tube placement. Refinement of the VBIL scale is indicated to increase its accuracy.

Place, publisher, year, edition, pages
Edinburgh: Churchill Livingstone , 2000. Vol. 16, no 2, p. 82-88
Keywords [en]
Adolescent, Angola, Education, Nursing, Continuing, Evaluation Studies, Female, Labor, Obstetric, Medically Underserved Area, Midwifery, Pregnancy, Professional Autonomy, Staff Development, World Health Organization
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-3487DOI: 10.1054/midw.1999.0206ISI: 000088086200002PubMedID: 11151554Scopus ID: 2-s2.0-0034207709OAI: oai:DiVA.org:hh-3487DiVA, id: diva2:291583
Available from: 2010-02-02 Created: 2009-12-01 Last updated: 2018-03-23Bibliographically approved
In thesis
1. Challenges and constraints encountered by women and midwives during childbirth in low-income countries: experiences from Angola and Mozambique
Open this publication in new window or tab >>Challenges and constraints encountered by women and midwives during childbirth in low-income countries: experiences from Angola and Mozambique
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aimed to study the actual and perceived quality of midwifery practices during childbirth at peripheral and central health care levels in two low-income countries, Angola (I-III) and Mozambique (IV-V). Theoretical models interpreting women's and midwives' views have been developed.

Objectives: Study I evaluates midwives' use of an adapted model of the World Health Organization's partograph, a tool used to monitor the progress of labour. Study II describes midwives experiences of working without immediate medical assistance. Study III explores women's perceptions of care-seeking behaviour during childbirth. Study IV observes perinatal midwifery care routines and examine partograph documentation. Study V explores and develops a theoretical understanding of factors perceived to obstruct or facilitate midwives ability to provide quality of perinatal care.

Methods: Study I: A one-group pre-and post-test interventional evaluation of 100 partographs from one peripheral delivery unit. Study II: Semi structured interviews with eleven midwives, analysed in a qualitative process comprising six steps. Study III. Ten focus group discussions with pregnant and non-pregnant women, analysed using the grounded theory technique. Study IV. Pre-and post intervention observation of midwifery care of 702 vs. 616 women during delivery and examination of the partographs. Study V: In-depth interviews with 16 midwives, analysed using grounded theory technique. Educational interventions were designed and applied in study II and IV.

Results: Study I. Significant improvement of documenting was found in seven of the ten variables and more partographs were correctly documented in sample II compared to sample I. Missed transfers increased, however, in sample II. Study II: The midwives experiences were sorted under four main areas: (1) Society/culture (2) Significant Others (3) Personal Self (4) Professional Self. Confidence was felt in the role as autonomous midwives but dependency on various factors such as the partograph, a functional referral system, peer support, community trust and continuous supervision was emphasised. Socio-economic hardships were identified as major stress factors for themselves and the women. Study III: Women seemed compelled to "mould" their care seeking behaviour and four patterns, two 'avoiding' and two 'approaching' institutional care were identified. The salient features of each pattern were found to be "personal courage", [B1]"disempowerment", "discarding traditional practices" and "awareness and emancipation". Study IV. No improvements were found in quality of care following the intervention. Common problems proved to be hypothermia and rare initiation of the graphic part of the partograph, which monitors progress of labour. Study V. A process labelled "changing perinatal care management" emerged, which comprised four dimensions addressing aspects related to i) existing environment ii) midwives' interaction with women in labour, iii) midwifery profession and iv) caring technology in order to improve quality of care. Communication and collaboration were identified as change agents.

Conclusions: The findings in this thesis indicate that midwives' ability to provide quality of maternal and perinatal care in lowincome and post-war affected countries is restricted by organizational, structural, educational as well as attitudinal aspects. Women in need of assistance during childbirth are negatively affected as a consequence of midwives reaction to the various constraints, which at times (Luanda) seems to oblige adverse care seeking behaviour. Midwives recognises the need for change, but change is found to be a slow and complex process, which requires engagement by all levels of the care chain. A model suggesting how to achieve quality of maternal and perinatal care in Safe Motherhood context is presented.

Place, publisher, year, edition, pages
Stockholm: Karolinska University Press, 2004. p. 59
Keywords
Women, Midwives, Maternal and perinatal care, Care-seeking behaviour, Moulding and dimensions of change
Identifiers
urn:nbn:se:hh:diva-466 (URN)2082/804 (Local ID)91-7349-822-X (ISBN)2082/804 (Archive number)2082/804 (OAI)
Public defence
2004-03-26, Skandiasalen, Astrid Lindgrens Barnsjukhus. Karolinska Sjukhuset, Stockholm, 00:00 (English)
Available from: 2007-02-05 Created: 2007-02-05 Last updated: 2018-03-23Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMedScopus

Authority records BETA

Odberg Pettersson, Karen

Search in DiVA

By author/editor
Odberg Pettersson, Karen
By organisation
School of Social and Health Sciences (HOS)
In the same journal
Midwifery
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 180 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf