| Objectives:To discusses the human resources allocation,psychological status,burnout,core competence,workload,job role positioning and the influencing factors of the midwives in labor room in Fujian Province,that aims to provide evidence-based basis for the health department to formulate relevant policies.Methods:In this study,a cross-sectional survey method was conducted.From May to July 2018,a stratified cluster random sampling method was used to select 732 midwives from 37 midwifery medical institutions in 9 cities of Fujian Province to investigate the core competency levels,the incidence of burnout,the incidence of depression,and the allocation of human resources of midwives.The t-test,analysis of variance and chi-square test were used to analyze the factors affecting the core competency level,the incidence of burnout and the incidence of depression.Statistically significant variables were included in linear regression analysis or logistic regression analysis to screen out independent factors that influence the core competency level,the incidence of burnout and the incidence of depression of midwives.Results:1.The midwives had a long working time in Fujian Province.More than one third of the midwives work for >40 hours per week and 78.58% of the midwives have a maximum working time >40 hours per week.64.21% midwives had greater work pressure,sleep ?7 hours/day accounted for 81.69% and 77.46% did not regularly exercise every week.2.The total score of core competency for midwives in the labor room was(4.11±0.54),and the score of neonatal care was lowest.Midwives' core competency score who were in age?46 years old,master's degree or above,monthly income?9000 yuan,married,maternal and child health care center,nursing age>10 years,labor time>20 years,senior professional title,head nurse,internal staff,working time in 36~40 hours/week,no night shift,very satisfied work,good sleep quality,exercise times in 1~2 times/week,exercise time<1 hour/time,diet and the family-supported were higher than other groups.Multiple linear regression analysis showed that labor time,education,married,traditional Chinese medical hospital,nurses,night shift days,family support and job satisfaction were the factors influencing the core competency of midwives.3.The incidence of job burnout in midwives were 44.67%,of which mild burnout accounted for 25.27%,moderate burnout accounted for 13.80% and severe burnout accounted for 5.46%.Midwives' incidence of burnout who were in 26~35 years old,economically developed areas,college education,monthly income of 3000~5999 yuan,married,general hospital,tertiary hospital,5~10 years of nursing age,1~5 years of labor times,nursing,midwife,contract system,working hours in 36~40 hours/week,the longest working time in 41~50 hours/week,night shift days in 1~8 days / month,work pressure is large and job satisfaction is general,sleep duration in 6~7 hours/day,average sleep quality,non-exercise,irregular diet were higher than other groups.Logistic regression analysis showed that nurses(OR=0.7.824)and midwives(OR=4.563),general job satisfaction(OR=2.2253),dissatisfaction(OR=4.3213)and very dissatisfied(OR=13.4933),poor sleep quality(OR=2.388)and insomnia(OR=3.545),exercise time <1 hour/time(OR=0.301),diet irregularity(OR=2.264)and work stress(OR=0.465)were burnout influencing factors.Job position,low job satisfaction,poor sleep quality and irregular diet were risk factors for midwives' burnout,exercise time and low work stress were protective factors.4.The midwives' depression score was(52.74±12.49),which was significantly higher than the domestic level.The incidence of depression was 51.37%,of which mild depression accounted for 29.37%,moderate depression accounted for 14.89% and severe depression accounted for 7.10%.Midwives' incidence of depression who were in 26~35 years old,southern area of Fujian,college degree,midwifery profession,monthly income of 3000~5999 yuan,married,general hospital,tertiary hospital,nursing age of 5~10 years,1~5 years of labor times,the contract system,working hours in 36~40 hours/week,the longest working hours in 41~50 hours/week,the night shift days in 1~8 days/month,large working pressure,general job satisfaction,the sleep duration in 6~7 hours/day,average sleep quality and non-exercise were higher than other groups.Logistic regression analysis showed that the 26~35 years old(OR=1.848),western area of Fujian(OR=0.310),eastern area of Fujian(OR=0.076)and northern area of Fujian(OR=0.195),contract system(OR=0.620)and large working stress(OR=0.514)were depression influencing factors.Age was a risk factor for depression in midwives,while economically underdeveloped areas,internal staff and low work pressures were protective factors.5.There was a negative correlation between core competency and burnout(r=-0.301,P<0.05),and there was no correlation between depression and core competency,burnout(P>0.05).6.The ratio of obstetric beds to midwives was 1:0.22,which was lower than economically developed cities.The ratio of annual delivery to midwives was 282.93:1,which was significantly higher than other cities in the country.The ratio of annual delivery to midwives were the highest in tertiary hospitals,general hospitals and maternal and child health centers(303.01:1,300.29:1,296.51:1).The number of midwifery per 1000 live births was 3.53,which was lower than WHO standard.The score of midwife core competence in high human resource allocation group(4.16 ±0.52)was slightly higher than the low human resources allocation group(4.07 ±0.55),and the difference was statistically significant(P<0.05).The incidence of job burnout and depression in the low human resource allocation group(28.96%)was significantly higher than that in the high human resource allocation group(P>0.05).From 2015 to 2017,the number of maternal rescue cases in tertiary,secondary and primary hospitals showed an increasing trend and they concentrated in tertiary hospitals.In this survey,the work of the midwife about the three areas of labor observation and care,the electronic fetal heart monitor in the delivery room,the medical record writing,the management of drug and equipment in the delivery room,the newborn rescue work,the treatment of childbirth complications,and participation in the rescue,caesarean section newborn umbilical cord were all involved in the 37 midwifery medical institutions.Conclusions:1.Hospitals should pay attention to training midwives' newborn health knowledge and enhance the core competencies.At the same time,they also should reduce the incidence of burnout and depression and improve the physical and mental health of midwives to ensure maternal and child health.2.Administrators should scientifically and rationally allocate the human resources of midwifery in the delivery room,especially increase the ratio of midwife in tertiary hospitals and maternal and child health centers,reduce the workload,work pressure of midwives and the incidence of job burnout and depression.At the same time,administrators also should pay attention to the activities and rest of midwives and enhance their work efficiency to improve the quality of obstetric services. |
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