Maria Rönnerhag

Background: It is projected that the annual number of deaths will increase from 57 to 70 million between 2015 and 2030, placing increased demands on healthcare professionals in end-of-life care. Providing end-of-life care poses significant challenges for healthcare professionals, especially alleviating patients’ suffering. Compassion, which is a foundational concept in caring science, is essential for easing suffering and can transform the caring experience for patients at the end of life and their families. According to the theory of caritative caring, compassion is the source of true caring. Aim: The aim of this integrative review is to explore healthcare professionals’ compassion in end-of-life care. Design: An integrative review design was chosen. The literature searches were conducted in the CINAHL, Scopus and PubMed databases and 12 studies were included. As this was a review of published literature, ethical approval was not required. Quality appraisal: The Critical Skills Appraisal Programme (CASP) for qualitative research was used to evaluate the quality of the included studies. Findings: The analysis revealed one overarching theme; Embracing the patient at the end of life and three categories; Being with the patient in the present moment, Being in a caring communion and Being available and attuned to the patient . Conclusion: A healthcare professional’s compassion can be key to achieving end-of-life care which unites evidence-based practice and the patient’s voice as a human being. It is through compassion that healthcare professionals’ caring can evolve at the end of life. This integrative review shows the importance and significance of a healthcare professional’s compassion in caring for a patient at the end of life.

Background: Intact cord resuscitation in the first three minutes of life improves oxygenation and Apgar scores. The practise of intact cord resuscitation implies the umbilical cord still being connected to the placenta for at least one minute while providing temperature control and equipment for resuscitation. Healthcare professionals described practical challenges in providing intact cord resuscitation. This study aimed to explore neonatal healthcare professionals’ experiences of providing intact cord resuscitation in the mother’s bed. Method: An interview study with an inductive, interpretative approach was chosen and analysed according to reflexive thematic analysis by Braun & Clarke. An open interview guide was used and 20 individual interviews with neonatal healthcare professionals were performed. The study was conducted at five level I-III neonatal care units. In Sweden, resuscitation is performed either in or outside the labour room. Results: The results contributed insight into the participants’ experiences of prerequisites for providing neonatal care in intact cord resuscitation. The sense of the mother’s vulnerability was noticeable, as the participants reported reducing the risk of exposure to protect and preserve the mother’s integrity. The practical challenges in the environment involved working in a limited space. The desire for multi-professional team training comprised education and training as well as debriefing to manage intact cord resuscitation. Conclusion: The result of the present study highlights the fact that neonatal healthcare professionals’ experiences of providing ICR in the mother’s bed were positive and had significant benefits for the neonate, namely zero separation between the neonate and parents and better physical recovery for the neonate. However, the fact that ICR in the mother’s bed can be challenging in several ways, such as emotionally, managing environmental circumstances and ensuring effective team collaboration. Therefore, it is of the utmost importance that healthcare professionals are given the opportunity to reflect and train together as a team. Future recommendations are to summarize evidence-based knowledge to design guidelines for ICR situation.

Aim To evaluate healthcare professionals’ explanations of the prerequisites for safe maternity care and understanding of risk management, including the underlying reasons for decision‐making intended to ensure safe care. Background Risk management focuses on maintaining and promoting safe care by identifying circumstances that place childbearing women at risk of harm, thus reducing risks. Methods A hermeneutic action research approach was chosen. Through a series of focus group sessions we uncovered healthcare professionals’ explanations of risk management. Results One overriding theme emerged; The consequences of what managers do or fail to do constitute the meaning of taking responsibility for team collaboration to provide safe care. Inadequate support, resources and staff shortages have consequences, such as inability to concentrate on team communication and collaboration, leading to the risk of unsafe care. Conclusion Communication constitutes a prerequisite for both team collaboration and risk management. Thus, communication is linked to the ability of managers and healthcare professionals to provide safe care. Implications for Nursing Management In terms of safety management, nurse managers have a significant role in and responsibility for supporting communication training, developing guidelines and providing the prerequisites for interprofessional team reflection.

Aim: The aim of this study was to explore healthcare professionals’ (HCPs) perceptions of adverse events (AE) during childbirth with focus on communication and teamwork.Background: Inadequate communication, a poor teamwork climate and insufficient team training are harmful to women. Reviews of reported AE can be used to develop a safety culture based on preparedness for preventing AE and strengthening patient safety (PS).Design: Action research principles were used to facilitate the implementation and evaluation of this study.Methods: An interprofessional team of HCPs comprising obstetricians, registered midwives and assistant nurses employed at a labour ward agreed to take part. Data were collected from multistage focus group interviews (March 2016–June 2016) and analysed by means of interpretative thematic analysis.Findings: Two analytical themes based on five sub‐themes emerged; promoting interprofessional teamwork and building capabilities by involving HCPs and elucidating relevant strategies. The findings reveal the importance of facilitating relationships based on trust and respectful communication to ensure a safe environment and provide safe maternity care.Conclusion: There is a need for formal and informal support for quality interprofessional teamwork. Research on PS may reduce AE related to miscommunication and poor teamwork. We recommend different forms of communication and teamwork training in interprofessional teams to increase the ability to provide feedback. Accumulated research is required for the evaluation of evidence‐based models in the PS context.

Few studies have focused on women's childbirth experiences in relation to patient safety. The aim of this study was to explore the meaning of safety as a process phenomenon by outlining women's positive and negative experiences of safety in childbirth. A descriptive explorative design was chosen and 16 interviews were conducted. Qualitative content analysis was used. One main theme emerged: safe childbirth through involvement and guidance, based on four subthemes. The characteristics of women's experiences of safe childbirth included the need to be informed and involved by sharing and receiving trustworthy information. Women's experiences of unsafe childbirth included lack of meaningful and trustworthy information that resulted in feelings of being misled or lulled into a false sense of security. Not being involved evoked feelings of being ignored. In conclusion, this study highlights issues of importance for safe maternity care. The perspectives of childbearing women can contribute to an understanding of how to achieve meaningful improvements to provide safer maternity care.