Zusammenfassung
Hintergrund
Die Forschung zu den Arbeitsbedingungen in der stationären Pflege weist auf einen
Zusammenhang mit Qualität und Sicherheit der Versorgung hin. Für die intrapartale
Betreuung ist bekannt, dass eine kontinuierliche 1:1-Betreuung mit besseren perinatalen
Outcomes und weniger Interventionen korreliert. Über die Arbeitsbedingungen angestellter
Hebammen in deutschen Kreißsälen ist bisher wenig bekannt.
Ziel
Analyse der Arbeitssituation aus Sicht der angestellten, im Kreißsaal tätigen Hebammen
in Deutschland.
Methode
Online-Survey von 1599 Hebammen zu ihrer Arbeitssituation mit einem validierten Instrument,
das an die Besonderheiten der Hebammentätigkeit angepasst wurde.
Ergebnisse
Die Rücklaufquote lag bei 44%. Die Zahl der zu betreuenden Frauen ist in den letzten
drei Jahren stark gestiegen, der Personalschlüssel hingegen nicht in gleichem Maße.
Fast zwei Drittel der Hebammen (65%) betreuen in der Regel drei und mehr Frauen gleichzeitig,
35% im Normalfall zwei Frauen parallel. Signifikante Unterschiede zwischen diesen
beiden Gruppen sind in fast allen analysierten Aspekten der Arbeitssituation zu beobachten.
Besonders ausgeprägt waren diese mit Blick auf die Nicht-Bewältigung der Aufgaben
innerhalb der regulären Arbeitszeit (64% vs. 33%; OR 3,7, 95% KI 3,0-4,6; p < 0,001), die Inanspruchnahme von Pausen (5% vs. 19%; OR 4,2, 95% KI 2,9-5,9; p < 0,001), die Häufigkeit der Störungen der eigentlichen Arbeit (96% vs. 88%; OR 3,5,
95% KI 2,3-5,4; p < 0,001), die fehlende Zeit für die individuelle Betreuung der Gebärenden (90% vs. 63%;
OR 5,6, 95% KI 4,2-7,4; p < 0,001), den verbesserungswürdigen Umgang zwischen Hebammen und ÄrztInnen (28% vs.
20%; OR 1,6, 95% KI 1,2-2,0; p = 0,001), das mangelnde Engagement der Krankenhausleitung für die Interessen der geburtshilflichen
Abteilung (92% vs. 83%; OR 2,2, 95% KI 1,6-3,1; p < 0,001) und die Gedanken an einen Arbeitgeberwechsel (60 vs. 40%; OR 2,2, 95% KI 1,8-2,7;
p < 0,001).
Schlussfolgerung
Unter den aktuellen Arbeitsbedingungen ist keine 1:1-Betreuung der Gebärenden zu gewährleisten.
Die notwendige Personalaufstockung muss von einer Verbesserung der Arbeitsbedingungen
flankiert werden, um effektiv zu sein. Weitere Forschung zur Arbeitssituation von
Hebammen, möglichen Einflussfaktoren sowie zum Zusammenhang mit perinatalen Outcomes
ist erforderlich.
Abstract
Background
Nursing research indicates a correlation between work environment and the quality
and safety of nursing care. For intrapartum care there is evidence that continuous
one-to-one support is associated with better perinatal outcomes and fewer interventions.
Little is known about the work environment of midwives working in German labour wards.
Aim
To analyse the work environment in German labour wards from the midwife's perspective.
Methods
Online survey among 1,599 midwives using a validated instrument adapted to the specific
characteristics of midwifery care.
Results
The response rate for the survey was 44 %. The number of women has risen substantially
over the last three years without an equivalent increase in staff numbers. Nearly
two thirds of the midwives (65 %) are responsible for three or more women simultaneously,
most of the time; 35 % are normally providing care for two women at the same time.
There are significant differences between these two groups with regard to nearly all
the work environment aspects analysed. The most pronounced differences were found
with regard to not being able to accomplish tasks during regular working hours (64 %
vs. 33 %; OR 3.7, 95% CI 3.0 to 4.6; p < 0.001), taking legally required breaks (5 % vs. 19 %; OR 4.2, 95% CI 2.9 to 5.9; p < 0.001), frequency of interruptions (96 % vs. 88 %; OR 3.5, 95% CI 2.3 to 5.4; p < 0.001), lack of time for individual care (90 % vs. 63 %; OR 5.6, 95% CI 4.2 to 7.4;
p < 0.001), need for improving the personal interaction between midwives and obstetricians
(28 % vs. 20 %; OR 1.6, 95% CI 1.2 to 2.0; p = 0.001), lack of support from hospital management (92 % vs. 83 %; OR 2.2, 95% CI 1.6
to 3.1; p < 0.001) and the intention to leave the employer (60% vs. 40%; OR 2.2, 95% CI 1.8 to
2.7; p < 0.001).
Conclusion
The current work environment of midwives in German labour wards does not allow one-to-one-care
for women in labour. If the necessary increase in midwifery staff is to be effective,
it needs to be accompanied by an improved work environment. Further research into
the work environment of midwives, likely predictors and associations with perinatal
outcomes is urgently needed.
Schlüsselwörter
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Zeitschrift für Evidenz, Fortbildung und Qualität im GesundheitswesenAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Literatur
- Gutachten zur Situation der Pflege in hessischen Akutkrankenhäusern.Hessisches Sozialministerium, Wiesbaden2014
- Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.BMJ. Mar 20 2012; 344: e1717
- Ärztemangel im Krankenhaus - Ausmaß, Ursachen, Gegenmaßnahmen -.Deutsches Krankenhaus Insitut, Düsseldorf2010
- Nurse staffing and quality of patient care.Evid. Rep. Technol. Assess. 2007; 151: 1-115
- Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments.Med. Care. 2011; 49: 1047-1053
- Patient Mortality Is Associated With Staff Resources and Workload in the ICU: A Multicenter Observational Study.Crit. Care Med. 2015; 43: 1587-1594
- Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: a systematic review of literature.Int. J. Nurs. Stud. 2015; 52: 817-835
- The introduction of DRG funding and hospital nurses’ changing perceptions of their practice environment, quality of care and satisfaction: comparison of cross-sectional surveys over a 10-year period, Int.J. Nurs. Stud. 2013; 50: 219-229
- Pflege-Thermometer 2009. Eine bundesweite Befragung von Pflegekräften zur Situation der Pflege und Patientenversorgung im Krankenhaus.Deutsches Institut für angewandte Pflegeforschung (dip), Köln2010
Braun B, Klinke S, Müller R, et al, Einfluss der DRGs auf Arbeitsbedingungen und Versorgungsqualität von Pflegekräften im Krankenhaus – Ergebnisse einer bundesweiten schriftlichen Befragung repräsentativer Stichproben von Pflegekräften an Akutkrankenhäusern in den Jahren 2003, 2006 und 2008. artec-paper Nr. 173. Bremen, artec - Forschungszentrum Nachhaltigkeit, 2011.
- Auswirkungen von Arbeitsunterbrechungen und Multitasking auf Leistungsfähigkeit und Gesundheit. Eine Tagebuchstudie bei Gesundheits- und KrankenpflegerInnen.Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Dortmund2013
- Gute Pflege braucht gute Bedingungen.Mit Qualifikation, Wertschätzung und Führung gegen Überlastung und Fachkräftemangel. Picker Report 2015. Picker Institut Deutschland gGmbH, Hamburg2015
- Adaptation and psychometric testing of the Practice Environment Scale for use with midwives.Women Birth. 2016; 29: 24-29
- Swedish midwives’ perception of their practice environment - A cross sectional study.Sex. Reprod. Healthc. 2015; 6: 174-181
- Confronting safety gaps across labor and delivery teams.Am. J. Obstet. Gynecol. 2013; 209: 402-408
- Contributions of clinical disconnections and unresolved conflict to failures in intrapartum safety.J. Obstet. Gynecol. Neonatal. Nurs. 2014; 43: 2-12
- Continuous support for women during childbirth.Cochrane Database Syst. Rev. 2013; 7https://doi.org/10.1002/14651858.CD003766.pub5.:CD003766
- Safe midwifery staffing for maternity units.National Institute for Health and Care Excellence (NICE), London2015
Rossi R, Vetter K, Schleußner E, et al. Empfehlungen für die strukturellen Voraussetzungen der perinatologischen Versorgung in Deutschland. S1-Leitlinie 087-001. http://www awmf org/uploads/tx_szleitlinien/087-001l_S1_Perinatologische_Versorgung_2015-05.pdf, 2015. (Letzter Zugriff: 11.05.2016).
- Safe prevention of the primary cesarean delivery.Am. J. Obst. Gyn. 2014; 2013: 179-193
- Safe midwifery staffing for maternity settings. The relationship between staffing at a local level and maternal and neonatal outcomes, and factors affecting these requirements.A report for the National Institute for Health Care and Excellence (NICE). Bazian Ltd, London2015
- Prospective semistructured observational study to identify risk attributable to staff deployment, training, and updating opportunities for midwives.BMJ. 2003; 327: 584
- Is midwife workload associated with quality of process of care (continuous electronic fetal monitoring [CEFM]) and neonatal outcome indicators? A prospective study in consultant-led labour wards in Scotland.Paediatr. Perinat. Epidemiol. 2003; 17: 369-377
- The association between attendance of midwives and workload of midwives with the mode of birth: secondary analyses in the German healthcare system.BMC Pregnancy Childbirth. 2014; 14: 300
- Rationing of nursing care and nurse-patient outcomes: a systematic review of quantitative studies.Int. J. Health Plann. Manage. 2014; 29: 3-25
- Implizite Rationierung von Pflegeleistungen in deutschen Akutkrankenhäusern - Ergebnisse der internationalen Pflegestudie RN4Cast.Gesundheitswesen. 2014; 76: 727-734
- Intrapartum Care: Care of healthy women and their babies during childbirth.National Institute for Health and Care Excellence (NICE), London2014
- Betreuungszufriedenheit von Wöchnerinnen in deutschen Krankenhäusern. Konstituierende Dimensionen.Rolle des Geburtsmodus und Gesamtzufriedenheit. Universität Osnabrück, Fachbereich Humanwissenschaften, Dissertation2012
- The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey.Int. J. Nurs. Stud. 2013; 50: 1667-1677
- Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors.Front. Psychol. 2014; 5: 1261
- Job satisfaction of certified nurse midwives: an examination.Admin. Issues J. 2012; 2: 112-126
- Job satisfaction and leaving intentions of midwives: analysis of a multinational cross-sectional survey.J. Nurs. Manag. 2016; 24: 70-79
- Mitarbeiterzufriedenheit im Krankenhaus - Validierung des Picker-Mitarbeiter-Fragebogens: Eine deutsche Adaption des ”Survey of Employee Perceptions of Health Care Delivery (Picker Institute Boston).Gesundheitswesen. 2013; 75: 34-48
- Staffing in maternity units. Getting the right people in the right place at the right time.The King's Fund, London2011
Picker Institute Europe, NHS Staff Survey 2015. http://www nhsstaffsurveys com/Page/1019/Latest-Results/Staff-Survey-2015-Detailed-Spreadsheets/2015, 2015 (letzter Zugriff:06.05.2016).
- Sociology, systems and (patient) safety: knowledge translations in healthcare policy.Sociol. Health Illn. 2008; 30: 309-324
- Midwife-physician collaboration: a conceptual framework for interprofessional collaborative practice.J. Midwifery Womens Health. 2015; 60: 128-139
- How the past influences interprofessional collaboration between obstetricians and midwives in the Netherlands: Findings from a secondary analysis.J. Interprof. Care. 2016; 30: 71-76
- Nurse-physician communication during labor and birth: implications for patient safety.J. Obstet. Gynecol. Neonatal. Nurs. 2006; 35: 547-556
- Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.J. Midwifery Womens Health. 2015; 60: 237-243
- Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPs project.Qual. Saf. Health Care. 2010; 19: 346-350
The Joint Commission, Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2013, Washington, The Joint Commission, 2013.
- Teamwork and patient safety in dynamic domains of health care: a review of the literature.Acta Anaesth. Scand. 2009; 53: 143-151
- Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: a review of the research literature.Int. J. Nurs. Stud. 2007; 44: 297-314
- Antecedents of hospital nurses’ intention to leave the organization: A cross sectional survey.Int. J. Nurs. Stud. 2015; 52: 1180-1192
- Nursing unit managers, staff retention and the work environment, J.Clin. Nurs. 2011; 20: 23-33
- The association of positive and negative feedback with clinical performance, self-evaluation and practice contribution of nursing students.Nurse Educ. Today. 2013; 33: 1264-1268
- Understanding the role of the professional practice environment on quality of care in Magnet(R) and non-Magnet hospitals.J. Nurs. Adm. 2014; 44: 10-16
- Nurse outcomes in Magnet(R) and non-Magnet hospitals.J. Nurs. Adm. 2012; 42: S44-S49
- Western Australia facing critical losses in its midwifery workforce: a survey of midwives’ intentions.Midwifery. 2013; 29: 497-505
- Personalcontrolling im Krankenhaus.Deutsches Forum für Krankenhausmanagement, Mainz2002
- Nurse turnover: a literature review - an update.Int. J. Nurs. Stud. 2012; 49: 887-905
- Krankenhausbarometer. Umfrage 2014.Deutsches Krankenhausinstitut (DKI), Düsseldorf2014
- Job satisfaction and leaving intentions of Slovak and Czech nurses.Int. Nurs. Rev. 2013; 60: 112-212
Article info
Publication history
Published online: January 08, 2017
Accepted:
July 6,
2016
Received in revised form:
July 1,
2016
Received:
May 11,
2016
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2016 Published by Elsevier Inc.
