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BACKGROUND: Around one-third of women experience childbirth trauma, with 3%--15% developing postpartum posttraumatic stress disorder (PP-PTSD). AIM: Explore birth satisfaction and health perception across two groups of postnatal women with either high or low trauma scores. METHOD: Forty postnatal women were divided into groups dependent upon Posttraumatic Stress Disorder Checklist (PCL-5) scores: high severity (n = 20; range 25-57) or low severity (n = 20; range 0-7). Semi-structured interviews explored women's childbirth experiences related to birth satisfaction and reports of postnatal health. Thematic analysis was performed. FINDINGS: Narrative content differed appreciably between high (A) and low (B) scoring groups. Group A narratives were more negative (A1: Overall, a negative recall), referencing lack of autonomy, support, or being heard (A2: Missing needs) and negative influences (A3: Disrupting my bubble). Group B recalled more birth satisfaction (B1: Mostly positive recall) associated with (B2: Autonomy; B3: Being cared for; B4: Intuition, instinct, and primal force). Group A narratives focused strongly on mental health (A4: Reduced awareness; A6: Experiencing PTSD; A7: Needing help), with some focus on physical health (A5: How I feel physically); Group B spoke less about health (B5: My health). DISCUSSION: High-quality psychological care during labor, with continuity, choice, support, and control, alongside postnatal health follow-up may improve birth satisfaction and reduce the incidence of PP-PTSD. CONCLUSION: To increase birth satisfaction and reduce trauma, maternity care providers must be supported to prioritize high-quality psychological care to women during labor, providing choice, control, and continuity within trusting relationships. Trusting relationships are key to ongoing conversations regarding health and seeking/receiving help. Routine birth satisfaction screening and education for care providers about signs of trauma are important. [ABSTRACT FROM AUTHOR]

Objective: To provide an overview of the challenges of conducting mixed methods research (MMR) in the context of health services research (HSR) and to discuss a case study example of the triangulation procedures used in a MMR study on task-shifting in the Netherlands. Method: A narrative literature review of publications between January 2000 and February 2020 on the use of mixed methods in the context of HSR and a description of the triangulation procedures in an HSR study with a MMR design on task shifting in the Netherlands. Results: The narrative review identified eight challenges. Those related to publishing and appraisal of MMR within HSR were most frequently reported (e.g. 'lack of MMR examples', 'lack of recognition' and 'triangulation issues'). Also, practical problems for conducting MMR within HSR were identified (e.g. 'lack or resources', 'teamwork' and 'lack of quality criteria'). Methodological challenges (e.g. 'sampling' and 'paradigm wars') were less frequently reported as a challenge. Conclusion: While increasing in popularity, there remain a range of challenges for the design, conduct and reporting of MMR designs in HSR. Using a triangulation protocol can potentially help address some of these challenges. [ABSTRACT FROM AUTHOR]

Aim The study protocol is designed to evaluate the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Background Recent (temporarily) enacted legislation in Dutch health care authorizes nurse practitioners and physician assistants to indicate and perform specified medical procedures, i.e. catheterization, cardioversion, defibrillation, endoscopy, injection, puncture, prescribing and simple surgical procedures, independently. Formerly, these procedures were exclusively reserved to physicians, dentists and midwives. Design A triangulation mixed method design is used to collect quantitative (surveys) and qualitative (interviews) data. Methods Outcomes are selected from evidence-based frameworks and models for assessing the impact of advanced nursing on quality of health care. Data are collected in various manners. Surveys are structured around the domains: (i) quality of care; (ii) costs; (iii) healthcare resource use; and (iv) patient centredness. Focus group and expert interviews aim to ascertain facilitators and barriers to the implementation process. Data are collected before the amendment of the law, 1 and 2·5 years thereafter. Groups of patients, nurse practitioners, physician assistants, supervising physicians and policy makers all participate in this national study. The study is supported by a grant from the Dutch Ministry of Health, Welfare and Sport in March 2011. Research Ethics Committee approval was obtained in July 2011. Conclusion This study will provide information about the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Study findings aim to support policy makers and other stakeholders in making related decisions. The study design enables a cross-national comparative analysis. [ABSTRACT FROM AUTHOR]