Objective: Presenting methodology for transferring knowledge to improve maternal outcomes in natural delivery based on scientific evidence. Method: An intervention study conducted in the maternity hospital of Itapecerica da Serra, SP, with 50 puerperal women and 102 medical records from July to November 2014. The PACES tool from Joanna Briggs Institute, consisting of pre-clinical audit (phase 1), implementation of best practice (phase 2) and Follow-up Clinical Audit (phase 3) was used. Data were analyzed by comparing results of phases 1 and 3 with Fisher's exact test and a significance level of 5%. Results: The vertical position was adopted by the majority of puerperal women with statistical difference between phases 1 and 3. A significant increase in bathing/showering, walking and massages for pain relief was found from the medical records. No statistical difference was found in other practices and outcomes. Barriers and difficulties in the implementation of evidence-based practices have been identified. Variables were refined, techniques and data collection instruments were verified, and an intervention proposal was made. Conclusion: The study found possibilities for implementing a methodology of practices based on scientific evidence for assistance in natural delivery.
Objective:to evaluate the impact of the implementation of evidence-based practices on normal delivery care. Method:quasi-experimental, before-and-after intervention study conducted in a public maternity hospital, Amapá. Forty-two professionals and 280 puerperal women were interviewed and data from 555 medical records were analyzed. The study was developed in three phases: baseline audit (phase 1), educational intervention (phase 2) and post-intervention audit (phase 3). Results:after the intervention, there was an increase of 5.3 percentage points (p.p.) in the normal delivery rate. Interviews with the women revealed a significant increase of the presence of companions during labor (10.0 p.p.) and of adoption of the upright or squatting position (31.4 p.p.); significant reduction of amniotomy (16.8 p.p.), lithotomy position (24.3 p.p.), and intravenous oxytocin (17.1 p.p.). From the professionals’ perspective, there was a statistical reduction in the prescription/administration of oxytocin (29.6 p.p.). In the analysis of medical records, a significant reduction in the rate of amniotomy (29.5 p.p.) and lithotomy position (1.5 p.p.) was observed; the rate of adoption of the upright or squatting position presented a statistical increase of 2.2 p.p. Conclusions:there was a positive impact of the educational intervention on the improvement of parturition assistance, but the implementation process was not completely successful in the adoption of scientific evidence in normal delivery care in this institution.
How to cite this article:Santos RCS, Riesco MLG. Implementation of care practices to prevent and repair perineal trauma in childbirth. Rev Gaúcha Enferm. 2016;37(spe):e68304. doi: http:// dx.doi. org/10.1590/1983-1447.2016. esp.68304. doi: http://dx.doi. org/10.1590/1983-1447.2016.esp.68304 Implementation of care practices to prevent and repair perineal trauma in childbirth ABSTRACTObjective: To implement care practices for perineal trauma prevention and repairing in normal birth. Method: Quasi-experimental study conducted at Hospital da Mulher Mãe-Luzia, in Macapá, AP, Brazil. Seventy-four (74) nurses and obstetricians and 70 post-partum women were interviewed and the records of 555 patients were analyzed. The study was conducted in three stages: pre-audit and baseline audit (phase 1); educational intervention and implementation of best practices (phase 2); post-implementation audit (phase 3). Data was analyzed by comparison of the results of phases 1 and 3.Results: Following the educational intervention, a lower number of health professionals encouraged directed pushing, performed episiotomies and repaired first-degree lacerations; more women reported lithotomy position; more patient records indicated the use of Vicryl™ to suture the perineal mucosa and skin. Conclusion:The educational intervention improved birth care and perineal outcomes. Nevertheless, gaps were identified in the implementation of evidence, as well as inappropriate perineal care management Keywords: Evidence-based practice. Parturition. Obstetric nursing. RESUMO Objetivos: Implementar práticas assistenciais para prevenção e reparo do trauma perineal no parto normal. Métodos: Estudo quase-experimental, realizado no Hospital da Mulher Mãe-Luzia, Macapá, AP. Realizaram-se 74 entrevistas com enfermeiros e médicos e 70 com puérperas, e analisaram-se dados de prontuários (n=555). O desenvolvimento da pesquisa se deu em três fases: pré-auditoria e auditoria de base (fase 1); intervenção educativa e implementação de boas práticas assistenciais (fase 2); auditoria pós-implementação (fase 3); a análise foi pela comparação das fases 1 e 3.Resultados: Após a intervenção educativa, menos profissionais incentivavam puxos dirigidos, realizavam episiotomia e suturavam lacerações de primeiro grau; mais mulheres informaram que o parto foi em posição litotômica; mais registros nos prontuários indicaram o uso de Vicryl ® na sutura da mucosa e pele. Conclusões:A intervenção educativa melhorou os cuidados e os desfechos perineais, porém há lacunas na implementação das evidências e inadequações no manejo do cuidado perineal. Palavras-chave:Prática clínica baseada em evidências. Parto. Enfermagem obstétrica. RESUMEN Objetivo: Implementar prácticas asistenciales para la prevención y reparación del trauma perineal en el parto. Método: Estudio casi experimental, conducido en el Hospital da Mulher Mãe-Luzia, Macapá, AP. Se realizaron 74 entrevistas con médicos y enfermeras y 70 con puérperas y se analizaron los datos de registros médicos (n=555). La investigaci...
Objetivo: avaliar o impacto de uma intervenção educativa sobre práticas obstétricas e desfechos perineais. Método: estudo longitudinal, segundo a metodologia de implementação de evidências científicas na prática clínica, realizado com enfermeiros e médicos, puérperas e prontuários em uma maternidade pública de referência no estado do Amapá. Resultado: após a intervenção educativa, mais profissionais recomendaram as posições lateral e verticais no período expulsivo do parto; mais puérperas relataram as práticas de puxo dirigido e manobra de Kristeller; menos prontuários indicaram a laceração espontânea e graus de lacerações maiores. Conclusão: a intervenção educativa proporcionou resultados melhores, mas não estatisticamente significativos.Descritores: Auditoria clínica, Períneo, Pesquisa translacional. IMPLEMENTATION OF SCIENTIFIC EVIDENCES IN NORMAL CHILDBIRTH CARE: LONGITUDINAL STUDYObjective: to evaluate the impact of an educational intervention on obstetric practices and perineal outcomes. IMPLEMENTACIÓN DE LA EVIDENCIA CIENTÍFICA EN LA ATENCIÓN DE PARTO NORMAL: UN ESTUDIO LONGITUDINALObjetivo: Evaluar el impacto de una intervención educativa sobre las prácticas obstétricas y resultados perineales. Método: Estudio longitudinal, de acuerdo con la metodología de implementación de la evidencia científica en la práctica clínica, realizada con las enfermeras y los médicos, las madres y los registros en una referencia maternidad pública en el estado de Amapá.Resultado: Después de la intervención educativa, la mayoría de los profesionales recomiendan las posiciones laterales y verticales en la segunda etapa del parto; más madres reportaron las prácticas de extracción y maniobra dirigida Kristeller; a menos que los registros que se indican las laceraciones espontáneas y un mayor grado de laceraciones. Conclusión: La intervención educativa poca mejora de las prácticas y los resultados perineales.
Artigo de revisão de literatura Estação Científica (UNIFAP) https://periodicos.unifap.br/index.php/estacao
<p>A pesquisa translacional é uma metodologia que tem sido proposta para a transferência de conhecimento com a finalidade de melhorar a qualidade do cuidado de saúde. O cuidado no parto inclui a prevenção, classificação e reparo do trauma perineal baseado nas melhores evidências científicas disponíveis. O objetivo foi descrever os aspectos operacionais da metodologia de implementação de evidências utilizada em uma pesquisa translacional para prevenção e reparo do trauma perineal no parto. Trata-se de relato de experiência sobre a utilização da metodologia do Instituto Joanna Briggs, Austrália, aplicada em uma maternidade pública do estado do Amapá. As seguintes atividades foram realizadas: constituição da equipe de auditoria, definição dos critérios e auditoria de base; implementação das melhores práticas; auditoria pós-implementação. Conclui-se que apesar das barreiras percebidas na pesquisa, alguns facilitadores foram observados no local do estudo, após a implementação das práticas baseadas em evidências científicas.</p>
Introduction: Episiotomy rates and spontaneous perineal trauma in normal birth have considerable variation among different health care services. These perineal traumas and related morbidity may be prevented or restricted adopting evidence-based practices during childbirth and perineal repair. Although the well established evidence on perineal trauma prevention and repair, in Brazil there are few studies on the implementation of this evidence in practice. Objectives: Promote the best evidence-based practices for perineal trauma prevention and repair in normal birth; Assess the current practice in perineal trauma prevention and repair in normal birth; Implement the best evidence-based practices on perineal trauma prevention and repair in normal birth; Assess the impact of these implementation on maternal outcomes. Methods: Quasi-experimental intervention study before and after, according to Institute Joanna Briggs methodology implementation of evidence in clinical practice. It was conducted 74 interviews with nurses, obstetricians, residents of both categories and 70 with post-partum women who have had birth at Hospital da Mulher Mãe Luzia, in Macapá, AP, Brazil. It was also analyzed 555 patient data records. The educational intervention was a seminar for professionals, to present and discuss the best evidence-based practice available in relation to perineal care during labour and birth. The study was conducted in three stages: pre-audit and base audit (phase 1); implementation of best practices (phase 2: educational intervention); post-implementation audit (phase 3). Data were analysed comparing the results of phases 1 and 3, with significance level of 5%. The Research Ethics Committee of the School of Nursing of the University of São Paulo approved the study. Results: Concerning professionals, the comparison between phases 1 and 3 showed an increased proportion of professionals who rarely or never encourage direct pushing (55.0% versus 81.2%; p=0.009), perform episiotomy (83.3% versus 96.9%; p=0.021) and leave first-degree lacerations without repairing (61.9% versus 81.3%; p=0.011). Concerning post-partum women, besides the lithotomy position have been most frequent referred by women in the phase 1 (77.1%), it was also the most frequent position in phase 3 (97.1%), with statistical difference (p=0.028). Related to perineal pain 1-2 days, 10-12 days and 30 days after childbirth, the frequency decreased (94.0%, 66.7% and 63.6%, respectively, in each period, in phase 1, and 79.0%, 57.1% and 38.5%, respectively, in each period in phase 3), with statistical difference considering all periods (p=0.019), but no difference between phases 1 and 3. Concerning patient data records, less women had perineal lacerations sutured (92.0%, in phase 1, and 82.1%, in phase 3; p=0.039) and more women had perineal mucosa (4.8%, in phase 1, and 28.1%, in phase 3; p=0.006) and perineal skin (10.2%, in phase 1, and 25.0%, in phase 3; p=0.033) sutured by polyglycolic acid and polyglactin 910. Concerning other analyzed practices and outcom...
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