A Correlational Study Of Midwives' Self-Compassion, Psychosocial Health, and Well-Being During the First Wave of COVID-19: What Have We Learned?

INTRODUCTION

During the first wave of the COVID-19 pandemic, midwives worked in a threatening environment and worried about themselves and their families becoming infected. Self-compassion is defined as an attitude of self-kindness that is supported by a balanced attitude toward negative thoughts or feelings and may contribute to the psychosocial health and well-being. The purpose of this study was to describe midwives' self-compassion, psychosocial health, and well-being and the correlation between them.

METHODS

This was a descriptive correlational study using a survey administered online during May, 2020. Participants included midwives who worked in labor and delivery units across Israel during the beginning of the COVID-19 pandemic. Measures included a demographic questionnaire; the Self-Compassion Scale Short Form (SCS-SF), which has 12 items in 6 subscales; and the psychosocial health and well-being questionnaire, a short version of the Copenhagen Psychosocial Questionnaire, which has 24 items in 6 subscales.

RESULTS

Participants (N = 144) reported a moderate-high level of self-compassion with a mean (SD) SCS-SF score of 3.57 (0.69). The mean (SD) psychosocial well-being score was 30.72 (13.57). The burnout subscale score had the highest mean (46.27), representing a high level of burnout. A minority (11.3%) of midwives considered resigning their midwifery positions. A higher level of self-compassion correlated with better psychosocial well-being (r = -0.466; P < .001). The highest correlation was found between the SCS-SF and the psychosocial health and well-being subscale for depressive symptoms (r = -0.574; P < .001).

DISCUSSION

During the first wave of the COVID-19 pandemic, midwives had a moderate-high grade of self-compassion and good psychosocial well-being. Midwives with higher self-compassion had better psychosocial well-being. The findings could inform the development of programs to increase midwives' self-compassion, and psychosocial well-being and the quality of midwifery care, in times of stability and during future pandemics or disasters.

Exploring Midwives Coping and Functioning in the Labor Wards during the Covid-19 Pandemic from the Labour Ward Head Nurses' Perspective: A Qualitative Study

AIM

To explore midwives' coping and functioning in the labor wards during the Covid-19 pandemic from the Labor Ward Head Nurses' perspective.

BACKGROUND

The World Health Organization announced the Covid-19 outbreak to be a pandemic in March 2020. Midwives worldwide were affected by this outbreak, working in risky environments, confronting the anxiety and fear of childbearing women.

METHODS

A qualitative study using thematic analysis was conducted using semi-structured interviews done over the telephone. Thirteen Labor Ward Head Nurses were interviewed, and the texts analyzed. The study took place in April, 2020 during the first Covid-19 lockdown in Israel.

RESULTS

Three main themes were generated in the coding process: (a) stress, fear and anxiety, (b) joint efforts, and (c) frustration.

CONCLUSION

Our study illustrates the difficulties that arose at the beginning of the pandemic, a new and unfamiliar chaotic period. Midwives' managers can use the current research to learn about actions that may assist in improving staff resilience and cohesion during times of crisis.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding the psychological impact of the Covid-19 pandemic among healthcare professionals is crucial for guiding policies and interventions to maintain staff's psychological well-being.

Spiritual Interventions Used by Jewish Women to Facilitate the Family Continuum: A Qualitative Study

Introduction: Spiritual interventions (SI) are used by patients and their families as a means to promote health. The family continuum (FC), which includes finding a partner/spouse, getting married, becoming pregnant, and having a safe pregnancy/birth, is an important concept for the Jewish culture as well as other cultures that have a traditional family-centered approach. There is a dearth of professional literature pertaining to SI to promote the FC. Although patients may use SI, this information is not routinely collected in a health history. The purpose of the study was to describe the experience of Jewish women's use of SI to promote the FC. Methods: This ethnographic study included interviews of Jewish women pertaining to FC, a text review, and field study. Coding of the text, site visits, and interviews were performed and reviewed to identify categories and themes and were refined until saturation was achieved. Results: Fifty-three observant and non-observant Jewish women participated in the study. Women expressed that SI were the means for them playing an active role in fulfilling the FC, and included intermediaries to God, self-improvement, and folk/spiritual remedies. The examples of SI included: visits to holy sites and spiritual leaders for blessings and advice, prayers, psalms, doing good deeds, eating special foods, wearing amulets, and performing certain SI with predesignated repetitions. Women attributed these SI to attaining an FC. Women who achieved each FC milestone without difficulty tended to use less SI, whereas women's SI usage increased the longer a milestone was not achieved. Conclusions: Jewish women are using many SI to promote the FC. Health care should be delivered in a culturally competent manner, which includes the incorporation of safe cultural practices. Obtaining a cultural assessment as part of the medical history could assist the health care professional in integrating safe SI into patient care.

Are Paula method exercises effective for gastrointestinal reactivation post-elective cesarean delivery? Randomized controlled trial

AIM

To examine the effectiveness of the Paula Method exercises in comparison to standard care on resumption of gastrointestinal (GI) activity in women postelective caesarean delivery (CD).

DESIGN

Randomized controlled trial on a postpartum unit of a university medical centre.

METHODS

Sixty-four women following elective CD performed under regional anaesthesia were recruited between 2 February-3 July 2018. Participants were randomized into two groups: The Paula Method exercise group (intervention group) and the control group. Women in the intervention group performed circular muscle exercises according to the Paula Method and received standard care, while those in the control group were treated only with standard care. Time to first bowel sounds, passage of first flatus and first defecation after CD were measured.

RESULTS

A significant difference was found in the time to passage of first flatus, in favour of the intervention group (24.07 [6.85] hours versus 39.07 [10.37] hours; p < .001). No significant differences between the groups were found for other main outcome measures.

CONCLUSION

Paula Method exercises post CD can serve as natural and convenient alternative to the standard, conservative treatment to promote resumption of GI activity.

IMPACT

CD can be associated with postoperative ineffective peristalsis that can lead to a paralytic ileus. Since standard methods are not sufficient for all women, there is a need for alternative modalities to accelerate the resumption of bowel functioning. In the Paula Method exercise group, time to first flatus passage occurred significantly sooner compared with the control group. Time to first defecation was earlier in the Paula Method exercise group but this difference did not reach statistical significance. Along with gum chewing, Paula Method exercises can be part of a simple and inexpensive GI activation strategy post CD. Further research should be performed using these exercises post other operative procedures.

Obstetric anal sphincter injuries and the role of the midwife

Obstetric anal sphincter injuries (OASIS) can have a very negative impact on women's health and quality of life. Literature exists concerning the role of the surgeon and physiotherapist after OASIS, but there is a dearth of literature pertaining to the role of the midwife in the management of women following an obstetric anal sphincter injury. This article examines the midwife's role and describes a new service instituted at Hadassah-Hebrew University medical centre, Jerusalem, utilised in the early postpartum period while the woman is still in hospital, entitled Special Services for Perineal Trauma.

Health Promoting Lifestyle Among Israeli Adult Survivors of Childhood Cancer

Background: Childhood cancer survivors are at risk for recurrence of their primary cancer as well as other secondary site cancers. The survivors are also at increased risk for long-term effects such as chronic illnesses. Health promoting lifestyles are therefore especially important for childhood cancer survivors. The purpose of the study was to describe the health promoting behaviors of childhood cancer survivors and to determine whether these behaviors are associated with demographic and clinical characteristics. This is a descriptive-comparative study that took place in an oncology follow-up clinic in Israel. Sample: Seventy-seven childhood cancer survivors. Tools: Health Promoting Lifestyle Profile 2, questionnaire (interpersonal relationships, spiritual growth, physical activity, nutrition, health responsibility, and stress management), and smoking and alcohol consumption and a demographic–clinical questionnaire. The mean item score was moderate-high. Survivors scored highest on interpersonal relationships and spiritual growth while the lowest scoring activities were physical activity and nutrition. About 30% of the survivors abstained from smoking and alcohol consumption. Women, as opposed to men, were more likely to have higher scores related to nutrition and interpersonal relationships while singles as opposed to those who were married were found to have higher scores related to spiritual growth. Conclusions: Health behaviors associated with interpersonal relationships and spiritual growth were more likely to be performed compared to physical activity, good nutrition, and decreased smoking and alcohol consumption. Special attention should be placed on promoting physical activity and good nutrition among survivors of childhood cancer.

Degree of bother from pelvic floor dysfunction in women one year after first delivery

OBJECTIVE

To investigate rates and range of pelvic floor dysfunction complaints, including anterior and posterior compartments and sexual function, in an unselected population of primiparous women one year from delivery, and examine the degree of bother they cause.

STUDY DESIGN

Cross sectional study. Primiparous women who delivered their first child in our delivery wards 10-14 months previously, were approached by phone and asked to complete the Pelvic Floor Symptom Bother Questionnaire (PFBQ) and provide general demographic information. Details regarding participants' labor and delivery were extracted from electronic medical records. PFBQ score was correlated to demographic and labor and delivery parameters.

RESULTS

198 women completed the questionnaire. Response rate was 94%. Scores ranged from 0 to 44.4 (out of a possible 100). At least one symptom of PFD was reported by 64% of respondents. Various degrees of urinary incontinence were reported by 9.1-12.1% of women. Some degree of fecal or flatus incontinence was reported by 10.1% of women; 11.1% reported some degree of obstructed defecation. Severe degree of bother from one or more PFD symptoms was reported by 40.1-90.9%. Some level of dyspareunia was reported by 37.3%. A "dose response" trend between mode of delivery and rate of dyspareunia was observed.

CONCLUSIONS

Two-thirds of primiparous women one year after delivery suffer PFD symptoms that cause some degree of bother. When asked, women are willing to discuss pelvic floor function; caregivers should initiate discussion and refer women promptly to interventions where necessary.

Gum chewing and gastrointestinal function following caesarean delivery: a systematic review and meta-analysis

AIMS AND OBJECTIVES

The aims of this systematic review and meta-analysis were to summarise current knowledge regarding gum chewing intervention for activation of the gastrointestinal (GI) system following caesarean delivery.

BACKGROUND

GI symptoms such as nausea, vomiting and defecatory difficulties are bothersome for women following a caesarean delivery. There is category A recommendation to not withhold oral intake postoperatively. However, current practice guidelines vary widely on time to initiate oral feeding post caesarean delivery, and additional research is needed. Gum chewing has been shown to stimulate the GI system in other postoperative patient populations.

DESIGN

A systematic review and meta-analysis.

METHODS

An electronic review was undertaken using the following resources: PubMed (Medline), CINAHL, EMBASE and ClinicalTrials.gov databases. Key words used in various combinations included cesarean section; cesarean delivery; postoperative chewing gum; bowel movement; bowel function and complications.

RESULTS

A total of 171 articles were found of which 166 were excluded: 157 were duplicates and the remainder did not meet the inclusion criteria. Five randomised control trials were included in the meta-analysis, focusing on gum chewing as an intervention as compared with a nongum chewing intervention, with a total of 846 participants. Compared with the nongum chewing group, gum chewing showed a beneficial impact on the major outcomes of digestive system activation, including bowel sound, gas passage and defecation.

CONCLUSIONS

This meta-analysis supports the effectiveness of gum chewing post caesarean delivery as a noninvasive/nonpharmacological intervention for reactivation of bowel movement.

RELEVANCE TO CLINICAL PRACTICE

Gum chewing in the immediate postoperative period following caesarean delivery may provide a socially acceptable, low-cost and safe intervention to reduce postcaesarean delivery GI complications and restore GI function.

Knowledge, attitudes and practices of physicians and nurses regarding the link between IVF treatments and breast cancer

PURPOSE

The ovarian stimulating hormones used in In-Vitro Fertilization may increase the incidence of breast cancer. Little research has been conducted to ascertain health professionals' knowledge or practices regarding this possible connection and if they communicate this risk to their patients. This study described the knowledge, attitudes and practices of doctors and nurses regarding the causative link between In-Vitro Fertilization treatments and breast cancer, and to determine if these health professionals were assessing or communicating this possible risk to their patients.

METHOD

Seventy gynecologists and nurses who worked in fertility clinics, had at least one year of experience in fertility and were literate in Hebrew were asked to complete the questionnaires. Ten clinics around the country were contacted and the questionnaires were distributed and collected on the same day.

RESULTS

35 Nurses and 35 gynecologists completed the survey. Although the majority of the physicians (68%) and nurses (69%) thought that there was a possible connection between the hormonal treatment of IVF and breast cancer, physicians were significantly more likely to inform their patients about the connection than were nurses.

CONCLUSIONS

There is a gap between the attitudes and practices of both physicians and nurses in communicating possible cancer risk to IVF clients. It would be beneficial to create a standardized risk communication protocol that would include information and guidelines for practice. More research must be conducted in this area, as there is almost no data on possible maternal risk from IVF treatment.

Paula method of circular muscle exercises for urinary stress incontinence—a clinical trial

The aim of this study was to determine the efficacy of the Paula method of circular muscle training in the management of stress incontinence (SI). The theory behind this method states that activity of distant sphincters affects other muscles. In a pilot study, 59 women, mainly hospital employees, were randomly assigned to participate in exercises according to the Paula method or pelvic floor training. Efficacy was measured by reports of incontinence, quality of life (I-QOL), pad test, and pelvic floor muscle strength (assessed by perineometer and digital examination). Both the Paula exercises and pelvic floor training produced significant changes in urinary leakage compared to baseline as measured by the pad test [mean decrease of 5.4 g (p=0.002) and 9.5 g (p=0.003), respectively]. Women randomized to the Paula method reported improvement in I-QOL scores. The Paula method was found to be efficacious for SI in a population of Israeli women. Larger community-based studies will be required to confirm these results and enable evaluation of between-group differences.