a1_Cíle. Cílem této studie je prezentovat původní český dotazník KLI-P, který měří psychosociální klima porodnice z perspektivy rodiček. Soubor a procedura. K účelům kvalitativní analýzy byla zpracována data ze 189 porodních příběhů a 44 polostrukturovaných rozhovorů s rodičkami. První verze dotazníku byla administrována u vzorku 760 rodiček. Finální verze dotazníku byla ověřována na reprezentativním vzorku 762 českých rodiček. Statistická analýza. Struktura nástroje byla zkoumána explorační a konfirmační faktorovou analýzou. Vnitřní konzistence jednotlivých škál byla měřena Cronbachovým koeficientem alfa. Při ověřování souběžné validity nástroje byly analyzovány korelace jednotlivých škál i hrubého skóru dotazníku s empirickými kritérii v podobě položek zjišťujících celkovou spokojenost žen s péčí v porodnici Pearsonovým korelačním koeficientem. Výsledky. Explorační faktorová analýza dotazníku poukázala na existenci následujících komponent na porodnickém oddělení (PO) i oddělení šestinedělí (OŠ): vstřícnost a empatie zdravotníků, kontrola rodičky a její podíl na rozhodování, podávání informací a dostupnost zdravotníků, nadřazenost a nedostatek zájmu, fyzické pohodí a služby. Konfirmační analýza ukázala, že tyto faktory neposkytují vyčerpávající charakteristiku faktorové struktury dotazníku, nicméně interpretovatelnost a obsahová validita komponent dostatečně motivují jejich použití. Vnitřní konzistence jednotlivých škál měřená Cronbachovým koeficientem alfa se pohybuje od 0,74 do 0,93 pro PO a od 0,73 do 0,93 pro OŠ. Vysoká obsahová a empirická (souběžná) validita a vysoká reliabilita svědčí pro to, že dotazník KLI-P je užitečným nástrojem v klinické praxi i psychologickém výzkumu., a2_Jeho výhodou je rovněž časová nenáročnost a snadný způsob administrace., Objectives. The aim of the study is to present an original Czech questionnaire KLI-P designed to measure the psychosocial climate in maternity hospitals as reflected by the parturients. Subject and setting. Qualitative data analysis of 189 narratives about the childbirth and 44 semistructured interviews was performed. The first version of the KLI-P was administered to 760 parturients. The final version of the KLI-P was verified on a representative sample of the Czech parturients (N = 762). Statistical analysis. Exploratory and confirmatory factor analyses were used to examine underlying structure of the instrument. Cronbach‘s α was calculated to assess the internal consistency of the component scales. To assess the concurrent validity, correlations between questionnaire scales and four empirical criteria items were examined. Results. Exploratory factor analysis of the KLIP identified the following dimensions of psychosocial climate for both delivery (DU) and after-birth units (ABU): helpfulness and empathy, control and involvement in decision-making, communication of information and availability of caregivers, dismissive attitude and lack of interest, physical comfort and services. Cronbach's alpha of individual scales ranged from 0,74 to 0,93 for DU and from 0,73 to 0,93 for ABU. With high content and concurrent validity and high reliability, as well as short and easy administration, the KLI-P appears to be a useful tool for clinical practice and research., Lea Takács [et al.]., and Obsahuje seznam literatury
a1_This study aims to present the physician Johann Melitsch (1763–1837) as a courageous reformer who presented a specific alternative to the étatist model of healthcare reforms implemented by the Habsburg monarchy in the 18th century. As obstetrics was the focus of Melitsch’s reform activities, the paper also contributes to the broader issue of the professionalisation of obstetrics at the turn of the 18th and 19th centuries. In the 1780s, Joseph II decided to use the assets of the secularised monasteries and hospitals to form a state complex of various health and social care facilities in the capitals of the Habsburg “provinces”. Where conditions and proximity to the university allowed, the first real “clinics”, i.e. hospitals linked to the teaching of medicine (and therefore science), were established: this was the case, for example, in Vienna and Prague. General hospitals formed the core of these complexes; maternity hospitals were also built, primarily for unmarried mothers, to prevent infanticide, but also as a source of female bodies for young medical students, who otherwise generally did not have the opportunity to learn about pregnancy and childbirth. At the same time, a young doctor who had just finished medical school in Prague, the twenty-fouryear- old Johann Melitsch, the son of a cabinet-maker, decided to undertake another project: a Privatentbindungsanstalt, ie. private outpatient maternity clinic. It was designed for married but poor women and also offered the opportunity of midwifery practice to medical students. Thanks to a family inheritance and his wife’s dowry, he was indeed able to found such an institution. And with donations from wealthy patrons from the nobility, he was able to provide small financial rewards or medicines to his patients. His assistants were students. and a2_Melitsch later extended his outpatient care, which was also improved by the “district doctors”, to sick women and children in general and thus offered a counterpart to the “stationary” type of state general hospital. In 1793, he was finally appointed professor at the Prague Faculty of Medicine – but only after the intervention of Emperor Francis I himself, who also granted this institution a “public right”. In 1795 Melitsch drew up a proposal – also probably the first in the Habsburg monarchy – for health insurance for low-income segments of the population. However, this system was never put into practice. In this predominantly Catholic monarchy, where hospitals had hitherto operated mainly on a church or municipal basis and where there was a clear tendency in Melitsch’s time to create a purely state-run health service, this was an exceptional case. The paper is also a contribution to the broader issue of the professionalisation of midwifery at the turn of the 18th and 19th centuries. Besides that, Melitsch is considered to be the first doctor in the Czech lands to perform a successful caesarean section in which both mother and child survived.