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Background
Lay family caregivers of patients receiving palliative care often confront stressful situations in the care of their loved ones. This is particularly true for families in the home-based palliative care settings, where the family caregivers are responsible for a substantial amount of the patient’s care. Yet, to our knowledge, no study to date has examined the family caregivers’ exposure to critical events and distress with home-based palliative care has been reported from Germany. Therefore, we attempt to assess family caregiver exposure to the dying patient’s critical health events and relate that to the caregiver’s own psychological distress to examine associations with general health within a home-based palliative care situation in Germany.
Methods
A cross-sectional study was conducted among 106 family caregivers with home-based palliative care in the Federal State of North Rhine Westphalia, Germany. We administered the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) Scale. Descriptive statistics and linear regression models relating general health (SF-36) were used to analyze the data.
Results
The frequency of the caregiver’s exposure, or witness of, critical health events of the patient ranged from 95.2% “pain/discomfort” to 20.8% “family caregiver thought patient was dead”. The highest distress scores assessing fear and helpfulness were associated with “family caregiver felt patient had enough’” and “family caregiver thought patient was dead”. Linear regression analyses revealed significant inverse associations between SCARED critical health event exposure frequency (beta = .408, p = .025) and total score (beta = .377, p = .007) with general health in family caregivers.
Conclusions
Family caregivers with home-based palliative care in Germany frequently experience exposure to a large number of critical health events in caring for their family members who are terminally ill. These exposures are associated with the family caregiver’s degree of fear and helplessness and are associated with their worse general health. Thus the SCARED Scale, which is brief and easy to administer, appears able to identify these potentially upsetting critical health events among family caregivers of palliative care patients receiving care at home. Because it identified commonly encountered critical events in these patients and related them to adverse general health of family caregivers, the SCARED may add to clinically useful screens to identify family caregivers who may be struggling.
Introduction
Socioeconomic deprivation in high‐income industrialized countries is a key factor in poor perinatal outcomes. Limited access, utilization, and quality of antenatal care seem to play an important role in poor perinatal outcomes.
Methods
This integrative review aimed to explore experiences of antenatal care among women who are socioeconomically deprived in high‐income industrialized countries. A search was conducted using 5 databases for articles published from 2004 to 2014. Six qualitative and 3 quantitative articles were selected. These were systematically appraised for quality independently by 3 researchers. Relevant themes were identified and organized into categories.
Results
The disadvantages experienced in antenatal care by women who are socioeconomically deprived start before the first contact with health care services and are notable throughout the entire pregnancy. There is disparity in choice of medical or midwifery service provision models. Six categories emerged during review: choice of service provision model, feeling valued, various types of discrimination, structural and interpersonal accessibility, comprehensibility and trustworthiness of information, and engagement and sense of responsibility. Categories underscored the importance of the woman's relationship with the antenatal care provider.
Discussion
Antenatal care models with women‐centered approaches and continuity of care, such as midwifery models, have potential to increase the satisfaction of women with low socioeconomic status with care; this may increase antenatal care utilization and improve perinatal outcomes.
Background
Forced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers’ health.
Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study’s objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers.
Methods
The study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis.
Results
The accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise.
Conclusions
The standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.
The central objective of early prevention in Germany is an improved cooperation between professional groups of the health services and child and youth welfare in interprofessional networks. This objective derives from the realisation that proper care for families with infants can only be achieved if the various groups act in close integration. The ‘Federal Initiative early prevention’ explicitly calls for freelance midwives to be integrated in this context. However, only a few scientific findings on midwives’ cooperation in networks of early prevention have been published to date. This integrative review aims to identify the central themes of interprofessional cooperation of midwives in out-of-hospital obstetrical care from national and international research literature. A systematic search of five research databases for publications between 2005 and 2015 was performed, complemented by a manual search. 25 studies were identified describing various contexts where midwives in out-of-hospital obstetrical care cooperate with other professional groups. Four key themes were analysed: contexts of cooperation, benefits of cooperation, facilitating and restrictive factors of cooperation, and competencies of cooperation. The studies show that there is only limited research coverage of the midwives’ perspective regarding interprofessional cooperation. The existing studies examine the cooperation of midwives primarily with health care professionals, and secondarily with professionals in the social services. In order to expand knowledge on the cooperation of freelance midwives in the networks of early prevention, future research should focus on the perspective of midwives regarding cooperation with other professional groups, both in the health care sector and in the field of social services.
Aim: The aim of this study was to give an overview of family caregiver satisfaction within the home palliative care situation in North Rhine-Westphalia, Germany.
Design: A cross-sectional study.
Methods: An anonymous questionnaire, with seven validated scales, and comprising of 71 items, was used. The items investigated perceived needs and burdens of families within a home-based palliative care situation.
The satisfaction of the family caregivers with the services delivered by palliative care teams was measured by the FAMCARE-2 Scale. Descriptive statistics and analysis of covariance (ANCOVA) were performed.
Results: A convenience sample of 106 family members agreed to participate in the study. Overall, we found high satisfaction within our sample. There was high satisfaction with how the services respected the dignity of families, and how they provided comfort to patients. Satisfaction was lower with regard to information about patients.
Conclusion: High or low satisfaction with palliative care, tells us little about the quality of services. The high satisfaction within this study could be interpreted as a sign that palliative care was important to families at the time of availability. Regular and continuous assessment can serve to inform the continuous quality of care provision for patients and their families.
Background
The continuous rise in caesarean rates across most European countries raises multiple concerns. One factor in this development might be the type of care women receive during childbirth. ‘Supportive care during labour’ by midwives could be an important factor for reducing fear, tension and pain and decreasing caesarean rates. The presence and availability of midwives to support a woman in line with her needs are central aspects for ‘supportive care during labour’.
To date, there is no existing research on the influence of effective ‘supportive care’ by German midwives on the mode of birth. This study examines the association between the attendance and workload of midwives with the mode of birth outcomes in a population of low-risk women in a German multicentre sample.
Methods
The data are based on a prospective controlled multicentre trial (n = 1,238) in which the intervention ‘midwife-led care’ was introduced. Four German hospitals participated between 2007 and 2009.
Secondary analyses included a convenience sample of 999 low-risk women from the primary analyses who met the selection criterion ‘low-risk status’. Participation was voluntary. The association between the mode of birth and the key variables ‘attendance of midwives’ and ‘workload of midwives’ was assessed using backward logistic regression models.
Results
The overall rate of spontaneous delivery was 80.7% (n = 763). The ‘attendance of midwives’ and the ‘workload of midwives’ did not exhibit a significant association with the mode of birth. However, women who were not satisfied with the presence of midwives (OR: 2.45, 95% CI 1.54-3.95) or who did not receive supportive procedures by midwives (OR: 3.01, 95% CI 1.50-6.05) were significantly more likely to experience operative delivery or a caesarean. Further explanatory variables include the type of hospital, participation in childbirth preparation class, length of stay from admission to birth, oxytocin usage and parity.
Conclusion
Satisfaction with the presence of and supportive procedures by midwives are associated with the mode of birth. The presence and behaviour of midwives should suit the woman’s expectations and fulfil her needs. For reasons of causality, we would recommend experimental or quasi-experimental research that would exceed the explorative character of this study.
Background:
Midwifery care in Germany is a legal right for every woman (SGB V). Midwives work employed or freelance in hospitals or in community services, providing maternal care from pregnancy until the end of breastfeeding (Sayn-Wittgenstein 2007). Increasingly, a shortage of midwifery care has been observed, forcing hospitals to understaff or to close their birth units, leaving women and their families without care (Sander et al. 2018). At the same time, birth rates are rising, thus leading to an increasing demand of midwifery care (Destatis 2019). As off today there is no central register for midwives across Germany’s 16 states. Therefor the exact number of registered midwives as well as the scope of services provided by midwives are not known (Niedersächsisches Landesgesundheitsamt 2019). Given the present situation, it seems to be imperative to establish effective midwifery workforce planning.
The aim of this poster is to identify already existing health workforce planning approaches and to determine the extent to which those can be transferred to the German system of midwifery care.
Methods:
Health workforce planning approaches, already being used on a national and international level, have been analysed, focusing their applicability to midwifery services in Germany.
Results:
Particular elements of the workforce planning approaches already being used in Germany for registered physicians seem to be adoptable. However, they need to be adjusted and enhanced to ensure the characteristics of midwifery in the German public health services. Internationally used approaches are not readily transferable due to systemic differences in health care systems.
Conclusions:
The development of new specific workforce and service planning approaches for midwifery care in Germany is crucial to meet present and future needs of women and their families during the childbirth period.