Managing a work–life balance: the experiences of midwives working in a group practice setting

Barriers and facilitators when implementing midwifery continuity of carer: a narrative analysis of the international literature

BACKGROUND

Midwifery continuity of carer (MCoC) is a model of care in which the same midwife or small team of midwives supports women throughout pregnancy, birth and the postnatal period. The model has been prioritised by policy makers in a number of high-income countries, but widespread implementation and sustainability has proved challenging.

METHODS

In this narrative review and synthesis of the global literature on the implementation and sustainability of midwifery continuity of carer, we identify barriers to, and facilitators of, this model of delivering maternity care. By mapping existing research evidence onto the Consolidated Framework for Implementation Research (CFIR), we identify factors for organisations to consider when planning and implementing midwifery continuity of carer as well as gaps in the current research evidence.

RESULTS

Analysing international evidence using the CFIR shows that evidence around midwifery continuity of carer implementation is patchy and fragmented, and that the impetus for change is not critically examined. Existing literature pays insufficient attention to core aspects of the innovation such as the centrality of on call working arrangements and alignment with the professional values of midwifery. There is also limited attention to the political and structural contexts into which midwifery continuity of carer is introduced.

CONCLUSIONS

By synthesizing international research evidence with the CFIR, we identify factors for organisations to consider when planning and implementing midwifery continuity of carer. We also call for more systematic and contextual evidence to aid understanding of the implementation or non-implementation of midwifery continuity of carer. Existing evidence should be critically evaluated and used more cautiously in support of claims about the model of care and its implementation, especially when implementation is occurring in different settings and contexts to the research being cited.

Differential Relationships Between Work-Life Interface Constructs and Intention to Stay in or Leave the Profession: Evidence From Midwives in Canada

This paper investigates how positive and negative work-personal life interface constructs are differentially associated with intentions to stay in or leave the profession. The findings help map work-personal life interface constructs on the typology of determinants of intention to stay and intention to leave (disengagers, retainers, criticals, and neutrals). The ordered logistic regression (ologit) modelling of cross-sectional data from a representative sample (n = 601) of midwives in Canada shows that work interference with personal life is a disengager, which has a stronger association with intention to leave than with intention to stay in the profession. Among the work-personal life interface constructs, work enhancement of personal life seems to be the most critical determinant, showing the most substantive association with both intention to stay and intention to leave. This finding suggests that interventions to increase midwives' intention to stay and decrease their intention to leave should focus on amplifying the enhancing effects of working on midwives' personal lives. Interventions that aim to reduce work interference with personal life might be more effective in decreasing intention to leave the profession than increasing intention to stay.

A continuity of care programme for women at risk of preterm birth in the UK: Process evaluation of a hybrid randomised controlled pilot trial

BACKGROUND

The development and evaluation of specific maternity care packages designed to address preterm birth remains a public health priority. We aim to evaluate the implementation, context, and potential mechanisms of action, of a new care pathway that combined midwifery continuity of care with a specialist obstetric clinic for women at risk of preterm birth (POPPIE) in London (UK).

METHODS

We did a multiphase mixed method triangulation evaluation nested within a hybrid type 2, randomised controlled trial in London (United Kingdom). Pregnant women with identified risk factors for preterm birth were eligible for trial participation and randomly assigned (1:1) to either midwifery continuity of care linked to a specialist obstetric clinic (POPPIE group) or standard maternity care. The primary outcome was a composite of appropriate and timely interventions for the prevention and/or management of preterm labour and birth, analysed according to intention to treat. Clinical and process outcome data were abstracted from medical records and electronic data systems, and coded by study team members, who were masked to study group allocation. Implementation data were collected from meeting records and key documents, postnatal surveys (n = 164), semi-structured interviews with women (n = 30), healthcare providers and stakeholders (n = 24) pre-, mid and post implementation. Qualitative and quantitative data from meeting records and key documents were examined narratively. Qualitative data from interviews were analysed using three thematic frameworks: Proctor's (for implementation outcomes: appropriateness, adoption, feasibility, acceptability, fidelity, penetration, sustainability), the Consolidated Framework for Implementation Research (for determinants of implementation), and published program theories of continuity models (for potential mechanisms). Data triangulation followed a convergent parallel and pragmatic approach which brought quantitative and qualitative data together at the interpretation stage. We averaged individual implementation measures across all domains to give a single composite implementation strength score which was compared to the primary outcome.

RESULTS

Between May 9, 2017, and Sep 30, 2018, 553 women were assessed for eligibility and 334 were enrolled with less than 6% of loss to follow up (169 were assigned to the POPPIE group; 165 were to the standard group). There was no difference in the primary outcome (POPPIE group 83·3% versus standard group 84·7%; risk ratio 0·98 [95% CI 0·90 to 1·08]). Appropriateness and adoption: The introduction of the POPPIE model was perceived as a positive fundamental change for local maternity services. Partnership working and additional funding were crucial for adoption. Fidelity: More than 75% of antenatal and postnatal visits were provided by a named or partner midwife, and a POPPIE midwife was present in more than 80% of births. Acceptability: Nearly 98% of women who responded to the postnatal survey were very satisfied with POPPIE model. Quantitative fidelity and acceptability results were supported by the qualitative findings. Penetration and sustainability: Despite delays (likely associated with lack of existing continuity models at the hospital), the model was embedded within established services and a joint decision was made to sustain and adapt the model after the trial (strongly facilitated by national maternal policy on continuity pathways). Potential mechanisms of impact identified included e.g. access to care, advocacy and perceptions of safety and trust. There was no association between implementation measures and the primary outcome.

CONCLUSIONS

The POPPIE model of care was a feasible and acceptable model of care that was implemented with high fidelity and sustained in maternity services. Larger powered trials are feasible and needed in other settings, to evaluate the impact and implementation of continuity programmes in other communities affected by preterm birth and women who experience social disadvantage and vulnerability.

TRIAL REGISTRATION

UKCRN Portfolio Database (prospectively registered, 24 April 2017): 31951. ISRCTN registry (retrospectively registered, 21 August 2017): ISRCTN37733900.

Telework, Hybrid Work and the United Nation’s Sustainable Development Goals: Towards Policy Coherence

With increased participation in telework expected to continue, in the aftermath of COVID, it will be important to consider what long-term impact this practice could have on sustainability outcomes. This paper describes a scoping review and identifies connections between telework and sustainability outcomes from previous academic studies. These connections were categorised, and are discussed, based on their contributions to different United Nations Sustainable Development Goals. Most research was found to focus on countries classified as having a very high human development index status. The SWOT matrix technique was used to illustrate the strengths and weaknesses identified in the existing literature, and the threats and opportunities for future work. This aims to ensure policy coherence so that strategies to promote one outcome, such as economic productivity improvements, do not undermine another, such as improved health. Practical implications and research opportunities were identified across a range of SDG impact areas, including good health and well-being, gender equality, reduced inequality, climate mitigation, sustainable cities, and resilient communities. Overall, our impression is that increased rates of telework present an important opportunity to improve sustainability outcomes. However, it will be important that integrated and holistic policy is developed that mitigates key risks.

Job satisfaction and sustainability of midwives working in caseload models of care: An integrative literature review

BACKGROUND

Demand for caseload midwifery care continues to outstrip supply. We know little about what sustains midwives working in caseload models of care.

AIM

This review systematically identifies and synthesises research findings reporting on factors which contribute to job satisfaction, and therefore the sustainability of practice, of midwives working in caseload models of care.

METHODS

A comprehensive search strategy explored the electronic databases CINAHL Plus with Full Text, MEDLINE, PubMED, Cochrane Database of Systematic Reviews, and Scopus. Articles were assessed using the Crowe Critical Appraisal Tool. Data analysis and synthesis of these publications were conducted using a narrative synthesis approach.

FINDINGS

Twenty-two articles were reviewed. Factors which contribute to the job satisfaction and sustainability of practice of midwives working in caseload models are: the ability to build relationships with women; flexibility and control over own working arrangements; professional autonomy and identity; and, organisational and practice arrangements.

CONCLUSION

Insights into the factors which contribute to the job satisfaction and sustainability of practice of midwives in caseload models of care enables both midwives and healthcare administrators to more effectively implement and support midwifery-led caseload models of care which have been shown to improve outcomes for childbearing women.

Midwife experiences of providing continuity of carer: A qualitative systematic review

PROBLEM

Continuity of carer models present positives and challenges for midwives working in them, and are difficult to sustain.

BACKGROUND

Research shows midwifery continuity of carer improves perinatal outcomes and experiences, and is considered the optimal model of care.

AIM

To synthesise existing research on midwives' experiences of providing continuity of carer and generate further understanding of what sustains them in practice.

METHODS

Protocol for the review was developed using PRISMA guidelines and registered with PROSPERO. 22 studies were included with original themes and findings extracted using JBI tools and synthesised using meta-ethnographic techniques. GRADE CERQual assessment of review findings showed high confidence.

FINDINGS

Midwives identified working in continuity of carer models as both fulfilling and challenging. Professional autonomy and ability to develop meaningful relationships were the most commonly cited positives, while lack of work life balance and conflict with the wider maternity team were the main challenges. 15 studies identified strategies employed by midwives which sustained them in practice.

DISCUSSION

Midwife experiences of providing continuity are impacted by personal and professional factors. Of paramount importance to sustainability of the model is the support of the wider organisation, and their alignment with principles of person-centred, relational care.

CONCLUSION

Relational models of care are desired by midwives, service users and are recommended in policy. Relational models of care must be responsive to midwives needs as well as birthing people, and therefore need to be designed and managed by those working in them and supported by the whole organisation to be sustainable.

Understanding workforce experiences in the early career period of Australian midwives: insights into factors which strengthen job satisfaction

OBJECTIVE

The aim of this study was to explore the experiences of early career midwives in Australia and identify the organisational, work environment, personal factors and stressors that influence workforce participation.

DESIGN AND SETTING

A qualitative study, using in-depth semi-structured interviews, was undertaken with midwives 6 - 7 years post-qualification. Qualitative content analysis identified key themes and sub-themes.

PARTICIPANTS

Twenty-eight midwives from one Australian university (graduating years 2007 and 2008) were included. Their pre-registration education was via either a Bachelor of Midwifery (direct-entry) or a Gradate Diploma of Midwifery (post-nursing degree).

FINDINGS

Three themes were generated: (i) 'sinking and swimming'; (ii) 'needing a supportive helping hand'; and (iii) 'being a midwife … but'. The initial transition into midwifery was overwhelming for most participants, particularly when providing intrapartum care. Job satisfaction was strongly related to having a well-developed midwife-woman relationship in clinical care and being able to work to their full scope of practice. Dissatisfaction stemmed from remuneration concerns, inflexibility of rostering, high workloads, and poor managerial approaches. Experiences of bullying were ubiquitous. Factors inducing midwives to stay in their profession were not the absence of those that caused dissatisfaction. The midwife-woman relationship sustained their practice despite those factors that caused dissatisfaction.

KEY CONCLUSIONS

Building strategies that strengthen job satisfaction in midwives is vital. Strategies that provide relational aspects of midwifery practice, ongoing support, rostering flexibility, induce psychological wellbeing, and address workplace bullying, may assist in the early career transition. Access to continuity of midwifery care models as new graduates is warranted.

IMPLICATIONS FOR PRACTICE

Continued professional development and career progression strategies are needed for midwives to cultivate their midwifery skills and work to their potential.

Midwives' views of caseload midwifery - comparing the caseload and non-caseload midwives' opinions. A cross-sectional survey of Australian midwives

BACKGROUND

Midwife-led continuity of care has substantial benefits for women and infants and positive outcomes for midwives, yet access to these models remains limited. Caseload midwifery is associated with professional satisfaction and lower burnout, but also impacts on work-life boundaries. Few studies have explored caseload midwifery from the perspective of midwives working in caseload models compared to those in standard care models, understanding this is critical to sustainability and upscaling.

AIM

To compare views of caseload midwifery - those working in caseload models and those in standard care models in hospitals with and without caseload.

METHODS

A national cross-sectional survey of midwives working in Australian public hospitals providing birthing services.

FINDINGS

Responses were received from 542/3850 (14%) midwives from 111 hospitals - 20% worked in caseload, 39% worked in hospitals with caseload but did not work in the model, and 41% worked in hospitals without caseload. Regardless of exposure, midwives expressed support for caseload models, and for increased access to all women regardless of risk. Fifty percent of midwives not working in caseload expressed willingness to work in the model in the future. Flexibility, autonomy and building relationships were positive influencing factors, with on-call work the most common reason midwives did not want to work in caseload.

CONCLUSIONS

There was widespread support for and willingness to work in caseload. The findings suggest that the workforce could support increasing access to caseload models at existing and new caseload sites. Exposure to the model provides insight into understanding how the model works, which can positively or negatively influence midwives' views.

Normalisation process theory as a conceptual framework for continuity of carer implementation

PROBLEM

Despite long standing strategic level ambitions to increase access to continuity of carer (CoC) models in maternity services, implementation of CoC in the United Kingdom (UK) has been generally small-scale and short lived. This indicates problems in implementing and sustaining CoC as the main model of care provision, and as such a need to better understand the process of implementation itself.

AIM

To use normalisation process theory (NPT) to underpin development of a conceptual implementation framework for CoC in order to improve understanding of the implementation process.

METHODS

Literature review on CoC implementation and NPT development and use, combined with immersion in the implementation of CoC context.

RESULTS AND DISCUSSION

A conceptual framework for the implementation of CoC is developed and individual components discussed, with a view to better understanding the implementation process for CoC models. The will of a critical mass of midwives to work in a CoC model and the provision and maintenance of the 'organisational space' required for CoC within the National Health Service (NHS) emerge as key barriers to mainstreaming CoC in the UK.

CONCLUSION

There is utility in NPT as a means of understanding and conceptualising large scale implementation of CoC. With testing and further development into a practical tool, the conceptual framework developed here could become a useful aid to those involved in implementing and evaluating CoC in the context of renewed strategic direction and Governmental level support in the UK.

Prevalence and Predictors of Burnout in Midwives: A Systematic Review and Meta-Analysis

The prevalence of burnout in midwives has been briefly studied. Given the negative effects of burnout syndrome in the physical and mental health, and also related to the quality of care provided, rates of absenteeism and sick leave; identifying related factors for the syndrome are needed. The aim was to determine the prevalence, levels, and factors related to the burnout syndrome, measured with the Copenhagen Burnout Inventory in midwives. A systematic review and meta-analysis were selected from CINAHL, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus databases, with the search equation “burnout AND (midwife OR midwives OR nurses midwives)”. Fourteen articles were found with a total of 8959 midwives. Most of the studies showed moderate levels of personal burnout. The prevalence obtained was 50% (95% CI = 38–63) for personal burnout; 40% (95% CI = 32–49) for work-related burnout; and 10% (95% CI = 7–13) for client-related burnout. Midwives’ age, less experience, and living alone constitute the main related factors, as well as, the scarcity of resources, work environment, and the care model used. Most midwives present personal and work-related burnout, which indicates a high risk of developing burnout. Personal factors and working conditions should be taken into account when assessing burnout risk profiles of midwives.

Midwives' perspectives of continuity based working in the UK: A cross-sectional survey

OBJECTIVE

UK policy is advocating continuity of midwife throughout the antenatal, intrapartum and postnatal period in order to improve outcomes. We explored the working patterns that midwives are willing and able to adopt, barriers to change, and what would help midwives to work in continuity models of care.

DESIGN

A cross-sectional survey.

SETTING

27 English maternity providers in the seven geographically-based 'Early Adopter' sites, which have been chosen to fast-track national policy implementation.

PARTICIPANTS

All midwives working in the 'Early Adopter' sites were eligible to take part.

METHOD

Anonymous online survey disseminated by local and national leaders, and social media, in October 2017. Descriptive statistics were calculated for quantitative survey responses. Qualitative free text responses were analysed thematically.

FINDINGS

798 midwives participated (estimated response rate 20% calculated using local and national NHS workforce headcount data for participating sites). Being willing or able to work in a continuity model (caseloading and/or team) was lowest where this included intrapartum care in both hospital and home settings (35%, n = 279). Willingness to work in a continuity model of care increased as the range of intrapartum care settings covered decreased (home births only 45%, n = 359; no intrapartum care at all 54%, n = 426). A need to work on the same day each week was reported by 24% (n = 188). 31% (n = 246) were currently working 12 h shifts only, while 37% (n = 295) reported being unable to work any on-calls and/or nights. Qualitative analysis revealed multiple barriers to working in continuity models: the most prominent was caring responsibilities for children and others. Midwives suggested a range of approaches to facilitate working differently including concessions in the way midwife roles are organised, such as greater autonomy and choice in working patterns.

CONCLUSIONS

Findings suggest that many midwives are not currently able or willing to work in continuity models, which includes care across antenatal, intrapartum and postnatal periods as recommended by UK policy.

IMPLICATIONS FOR PRACTICE

A range of approaches to providing continuity models should be explored as the implementation of 'Better Births' takes place across England. This should include studies of the impact of the different models on women, babies and midwives, along with their practical scalability and cost.

National Athletic Trainers' Association Position Statement: Facilitating Work-Life Balance in Athletic Training Practice Settings

OBJECTIVE: 

To illustrate the concept of work-life balance and those factors that influence it and to provide recommendations to facilitate work-life balance in athletic training practice settings. To present the athletic trainer with information regarding work-life balance, including those factors that negatively and positively affect it within the profession.

BACKGROUND: 

Concerns for work-life balance have been growing within the health care sector, especially in athletic training, as it is continuously linked to professional commitment, burnout, job satisfaction, and career longevity. The term work-life balance reflects those practices used to facilitate the successful fulfillment of the responsibilities associated with all roles one may assume, including those of a parent, spouse, partner, friend, and employee. A host of organizational and individual factors (eg, hours worked, travel demands, flexibility of work schedules, relationship status, family values) negatively influence the fulfillment of work-life balance for the athletic trainer, but practical strategies are available to help improve work-life balance, regardless of the practice setting.

RECOMMENDATIONS: 

This position statement is charged with distributing information on work-life balance for athletic trainers working in a variety of employment settings. Recommendations include a blend of organizational and personal strategies designed to promote work-life balance. Establishing work-life balance requires organizations to have formal policies that are supported at the departmental and personal level, in addition to informal policies that reflect the organizational climate of the workplace. Individuals are also encouraged to consider their needs and responsibilities in order to determine which personal strategies will aid them in attaining work-life balance.

Becoming a midwife: A survey study of midwifery alumni

BACKGROUND

Becoming a competent midwife is a complex process. The aim of midwifery education is to support the development of competence in midwifery skills, knowledge and to prepare graduates to meet the responsibilities inherent in the midwifery role.

AIM

To explore the experiences of our alumni midwives, ask how well they perceived their midwifery programme had prepared them for beginning midwifery practice and to identify any curriculum changes, or postgraduate study topics, that would support the transition to midwifery practice.

METHODS

An online survey was conducted with alumni of a Bachelor of Midwifery programme (New Zealand) who graduated between 2011 and 2014. The quantitative data were analysed using descriptive statistics, and a general inductive approach was used to develop themes from the qualitative data in the comment boxes.

FINDINGS

Forty-two alumni viewed becoming a midwife as a blend/combination of: (1) gaining the knowledge and practical skills required for the profession; (2) management skills in areas of running a business, working with other people, navigating local procedures and processes effectively, and balancing work with personal life; (3) gaining confidence in one's competence, and (4) having support along the way.

DISCUSSION

Competence in current evidence-based midwifery knowledge and practice is important in educating midwifery students. However, to transition to practice, a supportive environment is needed to assist midwives to develop self-management, business skills, and the confidence to negotiate and collaborate with colleagues and other health professionals.

CONCLUSIONS

Not only did midwifery knowledge and practice skills matter for alumni, but also the acquisition of management skills, strategies for building confidence, and ongoing support. Content that facilitates these requirements should be included in midwifery programmes to support the transition from student to practitioner.

Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey

BACKGROUND

The health and wellbeing of midwives are important considerations for workforce retention and quality care. The occurrence and relationships among mental health conditions such as burnout and depression have received little attention. We investigated the prevalence of burnout, depression, anxiety and stress in Australian midwives.

METHODS

An online survey was conducted in September 2014. Participants were recruited through the Australian College of Midwives and professional networks. The survey sought personal and professional details. Standard measures included the Copenhagen Burnout Inventory (CBI) (Personal, Work and Client subscales), and Depression, Anxiety, and Stress Scale (DASS). The sample was collapsed into two groups according to DASS clinical cut-offs (normal/mild versus moderate/severe/extreme). Effect size statistics were calculated and judged according to Cohen's guidelines.

RESULTS

One thousand thirty-seven surveys were received. Respondents were predominantly female (98%), with an average age of 46.43 years, and 16.51 years of practice. Using a CBI subscale cut-off score of 50 and above (moderate and higher), 64.9% (n = 643) reported personal burnout; 43.8% (n = 428) reported work-related burnout; and 10.4% (n = 102) reported client-related burnout. All burnout subscales were significantly correlated with depression, anxiety and stress, particularly personal and work-related burnout with Spearman's rho correlations ranging from .51 to .63 (p < .001). Around 20% of midwives reported moderate/ severe/ extreme levels of depression (17.3%); anxiety (20.4%), and stress (22.1%) symptoms. Mann-Whitney U tests revealed significant differences between groups with depression (r = .43), anxiety (r = .41) and stress (r = 48) having a medium size effect on burnout.

CONCLUSION

Prevalence of personal and work-related burnout in Australian midwives was high. The physical and psychological exhaustion associated with the different types of burnout were reflected in symptoms of depression, anxiety and stress symptoms. Further research is needed to support the personal well-being of midwives and minimize workplace burnout by developing short and long term strategies.

Midwives’ Journey Through the First Year of a Hospital-Based Midwifery Group Practice

AIM:To explore the experiences of midwives involved in the first midwifery group practice situated at a Western Australian tertiary maternity hospital.

METHODS:A descriptive phenomenology study was undertaken to extract common themes from interview transcripts using the 6-step process by Braun and Clarke. Seven midwives participated in 2 interviews over 12 months.

FINDINGS:Six months into the midwifery group practice (MGP) journey, 5 themes were captured: “adapting to a new way of working,” “working out the glitches,” “work–life balance,” “opportunity to grow,” and “perceived benefits for women.” After 12 months, 2 themes emerged: “making progress into new ways of working” and “future sustainability.”

CONCLUSIONS:Midwives felt women must be realistically informed of what an MGP offers. Priorities were regular meetings for open communication, taking scheduled days off and leave, and providing mentoring. Insight around benefits and challenges encountered by MGP midwives can inform health services, considering offering a similar service and ensure its sustainability.

Experiences of Work-Life Conflict for the Athletic Trainer Employed Outside the National Collegiate Athletic Association Division I Clinical Setting

CONTEXT

The intercollegiate setting receives much of the scholarly attention related to work-life conflict (WLC). However research has been focused on the National Collegiate Athletic Association Division I setting. Multiple factors can lead to WLC for the athletic trainer (AT), including hours, travel, and lack of flexibility in work schedules.

OBJECTIVE

To investigate the experiences of WLC among ATs working in the non-Division I collegiate setting and to identify factors that contribute to fulfillment of work-life balance in this setting.

DESIGN

Qualitative study.

SETTING

Institutions in the National Collegiate Athletic Association Divisions II and III, the National Association of Intercollegiate Athletics, and the National Junior College Athletic Association.

PATIENTS OR OTHER PARTICIPANTS

A total of 244 ATs (128 women, 114 men; age = 37.5 ± 13.3 years, experience = 14 ± 12 years) completed phase I. Thirteen participants (8 women, 5 men; age = 38 ± 13 years, experience = 13.1 ± 11.4 years) completed phase II.

DATA COLLECTION AND ANALYSIS

For phase I, participants completed a previously validated and reliable (Cronbach α > .90) Web-based survey measuring their levels of WLC and work-family conflict (WFC). This phase included 2 WFC scales defining family; scale 1 defined family as having a partner or spouse with or without children, and scale 2 defined family as those individuals, including parents, siblings, grandparents, and any other close relatives, involved in one's life. Phase II consisted of an interview. Qualitative data were evaluated using content analysis. Data source and multiple-analyst triangulation secured credibility.

RESULTS

The WFC scores were 26.33 ± 7.37 for scale 1 and 20.46 ± 10.14 for scale 2, indicating a moderate level of WFC for scale 1 and a low level of WFC for scale 2. Qualitative analyses revealed that organizational dimensions, such as job demands and staffing issues, can negatively affect WLC, whereas a combination of organizational and personal dimensions can positively affect WLC.

CONCLUSIONS

Overload continues to be a prevalent factor in negatively influencing WLC and WFC. Supervisor and peer support, personal networks, and time away from the role positively influenced work-life balance and WFC. Athletic trainers are encouraged to support one another in the workplace, especially when providing flexibility in scheduling.

Comparing satisfaction and burnout between caseload and standard care midwives: findings from two cross-sectional surveys conducted in Victoria, Australia

Background

Caseload midwifery reduces childbirth interventions and increases women’s satisfaction with care. It is therefore important to understand the impact of caseload midwifery on midwives working in and alongside the model. While some studies have reported higher satisfaction for caseload compared with standard care midwives, others have suggested a need to explore midwives’ work-life balance as well as potential for stress and burnout. This study explored midwives’ attitudes to their professional role, and also measured burnout in caseload midwives compared to standard care midwives at two sites in Victoria, Australia with newly introduced caseload midwifery models.

Methods

All midwives providing maternity care at the study sites were sent questionnaires at the commencement of the caseload midwifery model and two years later. Data items included the Midwifery Process Questionnaire (MPQ) to examine midwives’ attitude to their professional role, the Copenhagen Burnout Inventory (CBI) to measure burnout, and questions about midwives’ views of caseload work. Data were pooled for the two sites and comparisons made between caseload and standard care midwives. The MPQ and CBI data were summarised as individual and group means.

Results

Twenty caseload midwives (88%) and 130 standard care midwives (41%) responded at baseline and 22 caseload midwives (95%) and 133 standard care midwives (45%) at two years. Caseload and standard care midwives were initially similar across all measures except client-related burnout, which was lower for caseload midwives (12.3 vs 22.4, p = 0.02). After two years, compared to midwives in standard care, caseload midwives had higher mean scores in professional satisfaction (1.08 vs 0.76, p = 0.01), professional support (1.06 vs 0.11, p <0.01) and client interaction (1.4 vs 0.09, p <0.01) and lower scores for personal burnout (35.7 vs 47.7, p < 0.01), work-related burnout (27.3 vs 42.7, p <0.01), and client-related burnout (11.3 vs 21.4, p < 0.01).

Conclusion

Caseload midwifery was associated with lower burnout scores and higher professional satisfaction. Further research should focus on understanding the key features of the caseload model that are related to these outcomes to help build a picture of what is required to ensure the long-term sustainability of the model.

Impact of work-life imbalance on job satisfaction and quality of life among hospital nurses in Japan

This study investigated the status of work-life imbalance among hospital nurses in Japan and impact of work-life imbalance on job satisfaction and quality of life. A cross-sectional survey of 1,202 nurses (81% response rate) was conducted in three Japanese acute care hospitals. Participants were divided into four groups for actual work-life balance (Group A: 50/50, including other lower working proportion groups [e.g., 40/50]; Group B: 60/40; Group C: 70/30; and Group D: 80/20, including other higher working proportion groups [e.g., 90/10]). We also asked participants about desired work-life balance, and private and work-related perspectives. Satisfactions (job, private life, and work-life balance), quality of life, and stress-coping ability were also measured. All data were compared among the four groups. Most nurses sensed that they had a greater proportion of working life than private life, and had a work-life imbalance. Actual WLB did not fit compared to desired WLB. When the actual working proportion greatly exceeds the private life proportion, nurses' health could be in danger, and they may resign due to lower job satisfaction and QOL. Simultaneous progress by both management and individual nurses is necessary to improve work-life imbalance.

Achieving work-life balance in the National Collegiate Athletic Association Division I setting, part II: perspectives from head athletic trainers

CONTEXT

Work-life balance has been examined at the collegiate level from multiple perspectives except for the athletic trainer (AT) serving in a managerial or leadership role.

OBJECTIVE

To investigate challenges and strategies used in achieving work-life balance from the perspective of the head AT at a National Collegiate Athletic Association Division I university.

DESIGN

Qualitative study.

SETTING

Web-based management system.

PATIENTS OR OTHER PARTICIPANTS

A total of 18 head ATs (13 men, 5 women; age = 44 ± 8 years, athletic training experience = 22 ± 7 years) volunteered.

DATA COLLECTION AND ANALYSIS

Participants journaled their thoughts and experiences in response to a series of questions. To establish data credibility, we included multiple-analyst triangulation, stakeholder checks, and peer review. We used a general inductive approach to analyze the data.

RESULTS

Two higher-order themes emerged from our analysis of the data: organizational challenges and work-life balance strategies. The organizational challenges theme contained 2 lower-order themes: lack of autonomy and role demands. The work-life balance strategies theme contained 3 lower-order themes: prioritization of commitments, strategic boundary setting, and work-family integration.

CONCLUSIONS

Head ATs are susceptible to experiencing work-life imbalance just as ATs in nonsupervisory roles are. Although not avoidable, the causes are manageable. Head ATs are encouraged to prioritize their personal time, make efforts to spend time away from their demanding positions, and reduce the number of additional responsibilities that can impede time available to spend away from work.

Female athletic training students' perceptions of motherhood and retention in athletic training

CONTEXT

Motherhood appears to be a catalyst in job turnover for female athletic trainers, especially those employed at the National Collegiate Athletic Association Division I level. However, most researchers examining this topic have investigated the perspectives of those who are currently employed rather than those who are preparing to enter the profession.

OBJECTIVE

To evaluate female athletic training students' perceptions of motherhood and retention.

DESIGN

Qualitative study.

SETTING

Athletic training education program.

PATIENTS OR OTHER PARTICIPANTS

A total of 18 female athletic training students volunteered to participate. They were enrolled in 1 Commission on Accrediting Athletic Training Education-accredited athletic training program and represented 3 levels of academic STUDY.

DATA COLLECTION AND ANALYSIS

The participants responded to a series of questions related to work-life balance and retention in athletic training. Analysis of the data followed a general inductive process. Credibility was established by interpretive member checks and peer review.

RESULTS

The first theme, clinical setting, speaks to the belief that work-life balance and retention in athletic training require an employment setting that fosters a family-friendly atmosphere and a work schedule (including travel) that allows for time at home. The second theme, mentorship, reflects the acknowledgment that a female mentor who is successful in balancing the roles of mother and athletic trainer can serve as a role model. The final theme, work-life balance strategies, illustrates the need to have a plan in place to meet the demands of both home and work life.

CONCLUSIONS

A female athletic trainer who is successfully balancing her career and family responsibilities may be the most helpful factor in retention, especially for female athletic training students. Young professionals need to be educated on the importance of developing successful work-life balance strategies, which can be helpful in reducing attrition from the profession.

Nationwide survey of work environment, work-life balance and burnout among psychiatrists in Japan

BACKGROUND

Psychiatry has been consistently shown to be a profession characterised by 'high-burnout'; however, no nationwide surveys on this topic have been conducted in Japan.

AIMS

The objective of this study was to estimate the prevalence of burnout and to ascertain the relationship between work environment satisfaction, work-life balance satisfaction and burnout among psychiatrists working in medical schools in Japan.

METHOD

We mailed anonymous questionnaires to all 80 psychiatry departments in medical schools throughout Japan. Work-life satisfaction, work-environment satisfaction and social support assessments, as well as the Maslach Burnout Inventory (MBI), were used.

RESULTS

Sixty psychiatric departments (75.0%) responded, and 704 psychiatrists provided answers to the assessments and MBI. Half of the respondents (n = 311, 46.0%) experienced difficulty with their work-life balance. Based on the responses to the MBI, 21.0% of the respondents had a high level of emotional exhaustion, 12.0% had a high level of depersonalisation, and 72.0% had a low level of personal accomplishment. Receiving little support, experiencing difficulty with work-life balance, and having less work-environment satisfaction were significantly associated with higher emotional exhaustion. A higher number of nights worked per month was significantly associated with higher depersonalisation.

CONCLUSIONS

A low level of personal accomplishment was quite prevalent among Japanese psychiatrists compared with the results of previous studies. Poor work-life balance was related to burnout, and social support was noted to mitigate the impact of burnout.

The feasibility of caseload midwifery in rural Australia: a literature review

BACKGROUND

Caseload midwifery is a continuity of care(r) model being implemented in an increasing number of Australian maternity settings. Question for review: is caseload midwifery a feasible model for introducing into the rural Australian context?

METHOD

Integrative literature review.

FINDINGS

Four main categories were identified and these include the evidence for caseload midwifery; applicability to the rural context; experiences of registered and student midwives and implementation of caseload midwifery models.

CONCLUSION

There is evidence to support caseload midwifery and its implementation in the rural setting. However, literature to date is limited by small participant size and possible selection bias. Further research, including rural midwives' expectations and experience of caseload midwifery may lead to improved sustainability of midwifery care for rural Australian women.

Exploring implementation and sustainability of models of care: can theory help?

OBJECTIVE

Research on new models of care in health service provision is complex, as is the introduction and embedding of such models, and positive research findings are only one factor in whether a new model of care will be implemented. In order to understand why this is the case, research design must not only take account of proposed changes in the clinical encounter, but the organisational context that must sustain and normalise any changed practices. We use two case studies where new models of maternity care were implemented and evaluated via randomised controlled trials (RCTs) to discuss how (or whether) the use of theory might inform implementation and sustainability strategies. The Normalisation Process Model is proposed as a suitable theoretical framework, and a comparison made using the two case studies - one where a theoretical framework was used, the other where it was not. CONTEXT AND APPROACH: In the maternity sector there is considerable debate about which model of care provides the best outcomes for women, while being sustainable in the organisational setting. We explore why a model of maternity care--team midwifery (where women have a small group of midwives providing their care)-- that was implemented and tested in an RCT was not continued after the RCT's conclusion, despite showing the same or better outcomes for women in the intervention group compared with women allocated to usual care. We then discuss the conceptualisation and rationale leading to the use of the 'Normalisation Process Model' as an aid to exploring aspects of implementation of a caseload midwifery model (where women are allocated a primary midwife for their care) that has recently been evaluated by RCT.

DISCUSSION

We demonstrate how the Normalisation Process Model was applied in planning of the evaluation phases of the RCT as a means of exploring the implementation of the caseload model of care. We argue that a theoretical understanding of issues related to implementation and sustainability can make a valuable contribution when researching complex interventions in complex settings such as hospitals.

CONCLUSION AND IMPLICATIONS

Application of a theoretical model in the research of a complex intervention enables a greater understanding of the organisational context into which new models of care are introduced and identification of factors that promote or challenge implementation of these models of care.

Actigraph estimates of the sleep of Australian midwives: the impact of shift work

Midwives often work night and rotating shift schedules, which can lead to sleep disturbances, increased fatigue, and greater likelihood of accidents or errors. This study investigated the sleep of midwives (n = 17) in an Australian metropolitan hospital. Midwives completed work and sleep logbooks and wore wrist actigraphs for 28 days. Midwives worked combinations of morning, afternoon, and/or night shifts on constant (n = 6) or rotating schedules (n = 11). They obtained less than recommended amounts of sleep, getting only 6-7 hr per 24-hr period. Morning shifts were associated with the lowest sleep durations, lowest subjective sleep quality, and highest postsleep fatigue ratings. Despite the significantly higher amount of wake after sleep onset (51 min), the sleep before afternoon shifts had significantly lower postsleep fatigue ratings and was rated as significantly higher quality than sleep before other shifts or days off. Those who were married or living with a partner reported significantly more sleep and lower postsleep fatigue than those who were separated or divorced (p < .05). Seventy-one percent of midwives took naps, primarily before night shifts, with nearly 40% of nightshifts preceded by a nap. Average nap durations were nearly 1.5 hr. Midwives reported feeling moderately to very physically or mentally exhausted on 22-50% of all shifts and days off. Exhaustion was most common on night shift. This study suggests that midwives may be suffering from chronic sleep loss and as a consequence may be at risk of impairments in functioning that accompany fatigue.

Chinese midwives' experience of providing continuity of care to labouring women

OBJECTIVE

to explore and describe Chinese midwives' experience of providing one-to-one continuity of care to labouring women.

DESIGN

a qualitative study using a phenomenological approach. Data were collected using open-ended, tape-recorded interviews. The analysis of the transcribed texts included searching for themes sorted into clusters for a final expression of the essential structure of the phenomenon.

SETTING

Obstetrics and gynaecology hospital of Fudan University, Shanghai, China.

PARTICIPANTS

12 midwives, providing one-to-one continuity of care to labouring women.

FINDINGS

two main categories were identified: (1) midwives' feelings on providing continuity of care, and (2) impact of on-call system on midwives providing continuity of care. Key themes emerged from each main category: (1) 'playing important roles in labour care', 'gaining a sense of self-achievement', 'falling into exhaustion and frustration' and 'coping with caring work'; and (2) 'on-call syndrome', 'affecting personal lives' and 'managing on-call shift'. The midwives experienced mixed feelings of being with women and expressed their adaptation to being on-call, which was the essence of this study. They played important roles in caring for women, gained a sense of self-achievement and developed suitable coping strategies. However, they also indicated the impact of the on-call system upon them in the process of providing continuity of care.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

midwives have gained both positive and negative experiences when providing continuity of care to labouring women. The positive aspects may facilitate other professional midwives working in a similar role, whereas the negative aspects may inform them of learning to live with this situation, and may also have implications for managers to develop new approaches to the organisation and provision of continuity of care to support midwives' practice, and to fully utilise 'flexibility' under an on-call system.