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Freeman N, Moroney T, Warland J, Cheney K, Bradfield Z. Midwives' and registered nurses' role and scope of practice in acute early pregnancy care settings in Australia: A qualitative descriptive study. Women Birth 2024; 37:101643. [PMID: 39018604 DOI: 10.1016/j.wombi.2024.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/30/2024] [Accepted: 06/30/2024] [Indexed: 07/19/2024]
Abstract
PROBLEM There is little documented evidence regarding the practice of midwives providing care for women with acute concerns in early pregnancy (< 20 weeks) in Australia. BACKGROUND Women can experience unexpected complications at any gestation of pregnancy and may seek acute care in an emergency or gynaecology service, usually staffed by registered nurses (RNs). They may not receive care from specialised pregnancy clinicians, including midwives. The role and scope of practice of midwives working in acute early pregnancy settings in Australia has not been previously reported. This study provides an opportunity to document practice in an area of pregnancy care not often visible within maternity services in Australia. RESEARCH AIM To describe midwives' and RNs perceptions, perspectives and experiences of role and scope of practice in acute early pregnancy care provision in Australia. METHODS A qualitative descriptive approach was adopted. Midwives and RNs with acute early pregnancy knowledge and experience were recruited. Semi-structured interviews were conducted, and data analysed using inductive thematic analysis. FINDINGS Fifteen participants were interviewed. Three themes were constructed from interview data: Personal and Professional Influences; Being There for Women; The Impact of Setting. DISCUSSION Findings reinforce the lack of clarity around how midwives' scope is enabled in traditional acute early pregnancy care. Setting of care has influenced practice and seen a barrier for midwives who don't hold nursing registration from fulfilling professional scope. Results provide novel benchmarking evidence regarding a largely hidden area of midwifery, signposting areas for reform within education, policy and health service sectors.
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Affiliation(s)
- Nicole Freeman
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, Western Australia, Australia.
| | - Tracey Moroney
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Jane Warland
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kate Cheney
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Zoe Bradfield
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, Western Australia, Australia
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Freeman N, Warland J, Cheney K, Bradfield Z. Midwives' and registered nurses' role and scope of practice in acute early pregnancy care services: a scoping review. JBI Evid Synth 2024; 22:02174543-990000000-00312. [PMID: 38769931 PMCID: PMC11462904 DOI: 10.11124/jbies-23-00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE The objective of this scoping review was to investigate and describe what is reported on the role and scope of practice of midwives and registered nurses providing care for women with pregnancy complications under 20 weeks' gestation in acute clinical settings in Australia. INTRODUCTION In many high-income countries, women experiencing unexpected complications in early pregnancy attend an acute care service, such as an emergency department, rather than a maternity or obstetric unit. This service structure can impact the care women receive, and determine who provides it. Women and their partners, who are often experiencing emotional distress, have reported difficult experiences when accessing acute services, particularly emergency departments, which are not traditionally staffed by midwives. The role and scope of practice of both midwives and registered nurses providing acute early pregnancy care in most high-income countries, including Australia, is poorly reported. Documenting this area of practice is an important first step in facilitating ongoing research in this important aspect of pregnancy care. INCLUSION CRITERIA Published and gray literature that described the role and scope of practice of midwives and/or registered nurses providing care in acute early pregnancy settings in Australia were considered for this review. METHODS A scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A 3-step search strategy was conducted to explore evidence from databases and search engines, gray literature sources, and selected reference lists. After screening, data were extracted from records selected for the final review, mapped, and analyzed using content analysis. RESULTS The evidence reviewed (n=23) included primary research studies, conference abstracts, and gray literature, such as clinical guidance documents, academic theses, and websites from January 2008 to October 2023. The most common setting for care provision was the emergency department. Midwives' and registered nurses' roles and scope of practice in acute early pregnancy care in Australia can be summarized into 4 areas: physical care, psychosocial support, care co-ordination, and communication. Women's access to midwifery care at this time in pregnancy appears to be limited. Registered nurses, usually employed in emergency departments, have the most prominent role and scope in the provision of care for women with acute early pregnancy complications. Descriptions of midwives' practice focuses more on psychosocial support and follow-up care, particularly in early pregnancy assessment service models. CONCLUSIONS This review highlights the inconsistency in midwives' and registered nurses' roles and scope in acute early pregnancy in Australia, a finding which is relevant to other international settings. Both professions could further fulfill role and scope capacity in the provision of supportive, individualized, and timely care for women and families accessing a range of acute early pregnancy services. Emergency departments are the usual practice domain of registered nurses who may be limited in terms of the scope of care they can provide to women with early pregnancy complications. Leaders of the midwifery profession should conduct further research into innovative service models that embed a role for midwives in all settings that provide care for pregnant women, regardless of gestation. REVIEW REGISTRATION Open Science Framework osf.io/7zchu.
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Affiliation(s)
- Nicole Freeman
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- King Edward Memorial Hospital, Women’s and Newborn’s Health Service, Perth, WA, Australia
| | - Jane Warland
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women’s and Newborn’s Health Service, Perth, WA, Australia
| | - Kate Cheney
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Zoe Bradfield
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women’s and Newborn’s Health Service, Perth, WA, Australia
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Trostian B, Curtis K, McCloughen A, Shepherd B, Munroe B, Davis W, Hirst E, Tracy SK. Experiences and outcomes of women with bleeding in early pregnancy presenting to the Emergency Department: An integrative review. Australas Emerg Care 2021; 25:55-83. [PMID: 34083158 DOI: 10.1016/j.auec.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/26/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bleeding in early pregnancy occurs in approximately a quarter of all pregnancies and is a common reason for presentation to the Emergency Department (ED). This review combined current knowledge about experiences, interventions, outcomes and frequency of women presenting to the ED with per vaginal (PV) bleeding in the first 20 weeks of pregnancy. METHODS This integrative literature review was conducted using electronic database and hand searching methods for primary research published from 2000; followed by screening and appraisal. Articles were compared and grouped to identify characteristics and patterns that guided the synthesis of categories. RESULTS Forty-two primary research articles met inclusion criteria. Four main categories related to experiences and outcomes of women with bleeding in early pregnancy presenting to the ED were identified: presentation frequency and characteristics; women and their partners' experiences in the ED; interventions and treatments; patient and health service outcomes. CONCLUSIONS Negative and often frustrating experiences are reported by women experiencing PV bleeding, their partners and ED healthcare providers. While strategies such as early pregnancy assessment services contribute to improved outcomes, the availability of these services vary. Further research is needed to identify specific needs of this group of women and their partners, and the staff providing their care in the ED, to inform strategies for improved quality of care.
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Affiliation(s)
- Baylie Trostian
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia; Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Australia; Department of Obstetrics and Gynaecology, Illawarra Shoalhaven Local Health District, Wollongong, Australia.
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Australia
| | - Andrea McCloughen
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia
| | - Ben Shepherd
- Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Australia
| | - Belinda Munroe
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia; Emergency Services, Critical Care Division, Illawarra Shoalhaven Local Health District, Australia
| | - Warren Davis
- Department of Obstetrics and Gynaecology, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Elizabeth Hirst
- Department of Obstetrics and Gynaecology, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Sally K Tracy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Molly Wardaguga Research Centre, CDU, Darwin, Australia
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Claringbold L, Bilardi J, Temple-Smith M. Early Pregnancy Assessment Services in Australia: What psychosocial support is available? A qualitative study. Women Birth 2020; 34:e575-e583. [PMID: 33279445 DOI: 10.1016/j.wombi.2020.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
PROBLEM Women commonly experience emotional distress following miscarriage but do not receive the support they need from healthcare providers. BACKGROUND Miscarriage can result in psychological morbidity; however, appropriate support at the time of a miscarriage can lead to better psychological outcomes. Early Pregnancy Assessment Services (EPASs) are dedicated outpatient services considered the "gold standard" for miscarriage care. Little is known about the psychosocial support EPASs provide in Australia. AIMS The aim of this study was to explore the provision of psychosocial support in Australian EPASs. METHODS Semi-structured interviews were conducted with 29 purposively sampled key-informants from 13 EPASs. Interviews were audio-recorded, transcribed, and thematically analysed. FINDINGS Considerable variation was found in how EPASs functioned and their provision of psychosocial support. Many services were co-located with antenatal services, run by doctors with limited experience and most did not offer any psychosocial training to staff specific to EPAS. Referrals for additional support were generally not offered for first trimester miscarriages, and follow-up typically focused on physical management rather than emotional wellbeing. All EPAS staff demonstrated a strong commitment to providing best possible care to women within their own clinical setting and acknowledged the need for improved psychosocial support. CONCLUSION This study provides the first exploration of Australian EPASs' provision of psychosocial support. It has shown that while health care professionals working in EPASs are dedicated to providing the best possible care to women within their clinical setting, psychosocial support is very limited and could be improved.
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Affiliation(s)
- Lily Claringbold
- Department of General Practice, University of Melbourne, Victoria, Australia
| | - Jade Bilardi
- Department of General Practice, University of Melbourne, Victoria, Australia; Central Clinical School, Monash University, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Victoria, Australia.
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Punches BE, Johnson KD, Acquavita SP, Felblinger DM, Gillespie GL. Patient perspectives of pregnancy loss in the emergency department. Int Emerg Nurs 2019; 43:61-66. [DOI: 10.1016/j.ienj.2018.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/04/2018] [Accepted: 10/11/2018] [Indexed: 11/16/2022]
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Edwards S, Birks M, Chapman Y, Yates K. Miscarriage in Australia: The geographical inequity of healthcare services. ACTA ACUST UNITED AC 2016; 19:106-11. [DOI: 10.1016/j.aenj.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/29/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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The profile of women who consult midwives in Australia. Women Birth 2013; 26:240-5. [DOI: 10.1016/j.wombi.2013.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/05/2013] [Accepted: 08/16/2013] [Indexed: 11/15/2022]
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Wendt K, Crilly J, May C, Bates K, Saxena R. An outcomes evaluation of an emergency department early pregnancy assessment service and early pregnancy assessment protocol. Emerg Med J 2013; 31:e50-4. [PMID: 24136123 PMCID: PMC4220894 DOI: 10.1136/emermed-2013-202887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Complications in early pregnancy, such as threatened or actual miscarriage is a common occurrence resulting in many women presenting to the emergency department (ED). Early pregnancy service delivery models described in the literature vary in terms of approach, setting and outcomes. Our objective was to determine outcomes of women who presented to an Australian regional ED with diagnoses consistent with early pregnancy complications following the implementation of an early pregnancy assessment service (EPAS) and early pregnancy assessment protocol (EPAP) in July 2011. METHODS A descriptive, comparative (6 months before and after) study was undertaken. Data were extracted from the hospital ED information system and medical healthcare records. Outcome measures included: time to see a clinician, ED length of stay, admission rate, re-presentation rate, hospital admission and types of pathology tests ordered. RESULTS Over the 12 -month period, 584 ED presentations were made to the ED with complications of early pregnancy (268 PRE and 316 POST EPAS-EPAP). Outcomes that improved statistically and clinically following implementation included: time to see a clinician (decreased by 6 min from 35 to 29 min), admission rate (decreased 6% from 14.5% to 8.5%), increase in β-human chorionic gonadotrophin ordering by 10% (up to 80% POST), increase in ultrasound (USS) performed by 10% (up to 73% POST) and increase in pain score documentation by 23% (up to 36% POST). CONCLUSIONS The results indicate that patient and service delivery improvements can be achieved following the implementation of targeted service delivery models such as EPAS and EPAP in the ED.
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Affiliation(s)
- Kim Wendt
- Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia Capricorn Coast Hospital and Health Services, Yeppoon, Queensland, Australia State Wide and CQ NP Network, Queensland, Australia
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia Clinical Access and Redesign Unit, Brisbane, Queensland, Australia Centre for Health Practice Innovation, Griffith University, Gold Coast, Queensland, Australia
| | - Chris May
- Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kym Bates
- Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia
| | - Rakhee Saxena
- Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia
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An evaluation of early pregnancy outcomes in one Australian Emergency Department: Part 2. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.aenj.2012.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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