Exposure to traumatic events at work, posttraumatic symptoms and professional quality of life among midwives

Traumatic experiences, quality of life, and organizational commitment among midwives: A cross-sectional study

BACKGROUND

The work of midwives is emotionally challenging. Midwives share moments of joy, when a baby is born, and attend complex events of loss and trauma. Exposure to childbirth complications, emergencies, and loss can affect their professional quality of life and functioning. This aspect of midwives' practice has not been sufficiently researched.

AIM

To examine the associations between exposures to traumatic events, post-traumatic symptoms, and personal resilience with professional quality of life and organizational commitment among hospital midwives.

METHODS

Participants in this cross-sectional study conducted in 2020 included 131 midwives from three large hospitals in central Israel. Data were collected using a structured self-administered questionnaire that examined socio-demographic characteristics, exposure to traumatic events during childbirth, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment.

RESULTS

The three most traumatic events for midwives were: neonatal death or feared death, maternal death or feared death, and stillbirth. The more frequent the exposure to traumatic events, the more numerous and intense the post-traumatic symptoms. The more numerous and intense the post-traumatic symptoms, the higher the level of professional burnout and compassion fatigue and the lower the compassion satisfaction. Higher compassion satisfaction and lower professional burnout were associated with higher organizational commitment. Personal resilience, country of birth, post-traumatic symptoms, and organizational commitment predicted compassion satisfaction.

CONCLUSIONS

Midwives' exposure to traumatic events is associated with the onset of post-traumatic symptoms, impaired professional quality of life, and reduced organizational commitment, and is accompanied by burnout and compassion fatigue. There is a need to address this issue in training programs and to develop organizational support and policies to improve midwives' well-being and quality of care.

'It was horrible to watch, horrible to be a part of': Midwives' perspectives of obstetric violence

BACKGROUND

Obstetric violence, including unconsented interventions, coercion and disrespect, violates human rights; impacting the physical and psychosocial health of women. The perspective and experience of midwives related to obstetric violence have been explored in low and middle-income countries, with limited research into the experience of midwives in high income nations.

AIM

To explore Australian midwives' perspectives of obstetric violence.

METHODS

Thematic analysis of qualitative in-depth interviews with 15 midwives experienced in supporting women during birth. Critical feminist theory underpinned each stage of the research.

FINDINGS

Interviews with 15 Australian midwives from diverse care settings were analysed thematically. Four key themes were developed from the data: 'the operationalisation of obstetric violence', 'the impact of obstetric violence' 'the historical and situational context' and 'hope for the future'. Midwives considered entrenched patriarchal structures and gender inequity as fundamental to the occurrence of obstetric violence. This societal scaffold is intensified within health care systems where power imbalances facilitate maternal mistreatment through coercion and grooming women for compliance in the antenatal period. Fragmented care models expose women to mistreatment with continuity models being protective only to a point. Midwives experience their own trauma, as a result of what they have witnessed, and due to the lack of support they receive when advocating for women.

CONCLUSIONS

Obstetric violence occurs in Australian maternity systems with unconsented interventions, overmedicalisation, coercion, and disrespect observed by midwives. Care-related trauma impacts on the mental health of midwives, raising workforce concerns for policy makers, consumer advocates and professional bodies.

A cross-sectional survey of the mental health of midwives in Ontario, Canada: Burnout, depression, anxiety, stress, and associated factors

PROBLEM

Burnout and the psychological co-morbidities stress, anxiety and depression have a significant impact on healthcare providers, including midwives. These conditions impact the quality of care provided to women, and midwives' ability to remain in the profession.

BACKGROUND

There is growing concern regarding the retention of maternity care providers in Canada, particularly midwives. Nationally, 33% of Canadian midwives are seriously considering leaving practice; impacts of the profession on work-life-balance and mental health being commonly cited reasons. Burnout has been shown to contribute to workplace attrition, but little is known concerning burnout among Canadian midwives.

AIM

To assess levels of stress, anxiety, depression, and burnout among midwives in Ontario, Canada and potential factors associated with these conditions.

METHODS

A cross-sectional survey of Ontario midwives incorporating a series of well-validated tools including the Copenhagen Burnout Inventory and the Depression, Anxiety and Stress Scale.

FINDINGS

Between February 5, and April 14, 2021, 275 Ontario midwives completed the survey. More than 50% of respondents reported depression, anxiety, stress, and burnout. Factors associated with poor mental health outcomes included having less than 10-years practice experience, identifying as a midwife with a disability, the inability to work off-call, and having taken a prior mental health leave.

DISCUSSION & CONCLUSION

A significant proportion of Ontario midwives are experiencing high levels of stress, anxiety, depression, and burnout, which should be a serious concern for the profession, its leaders, and regulators. Investment in strategies aimed at retaining midwives that address underlying factors leading to attrition should be prioritized.

The role of self-criticism and self-compassion in the development of PTSD among midwives

OBJECTIVE

Healthcare providers might develop emotional distress following direct and indirect exposure to traumatic events. Evidence shows that midwives, who care for women in complicated situations, are often exposed to circumstances that have a potential to lead to a variety of psychological reactions, including symptoms identified with post-traumatic stress disorder (PTSD). Nevertheless, the positive-healthy context in which childbirth is mainly perceived raises questions regarding the protective role of personality traits, which are related to processing methods of stress and pain, in the development of PTSD among this unique population. This study aimed to explore the associations between traits such as self-compassion, self-criticism, resilience, cognitive thinking, and pain catastrophizing and PTSD symptoms among Israeli midwives.

SETTING

Using a quantitative cross-sectional study,123 midwives from ten hospitals in Israel anonymously reported their characteristics and severity of stress and/or PTSD symptoms by filling out the Psychopathy Checklist questionnaire. Analysis of personality traits was performed via the following questionnaires: Self-Compassion Scale - Short Form, Depressive Experiences Questionnaire - Self Criticism, and the Connor-Davidson Resilience Scale. Additionally, we measured the level of catastrophizing pain by employing the Pain Catastrophizing Scale questionnaire.

FINDINGS

Most of the midwives reported existing post-trauma symptoms, among them 11.38% had been diagnosed with PTSD. Severity of the PTSD correlated with their self-criticism and the pain catastrophizing rates. Additional examination of the involvement of personality traits showed that midwives with high self-criticism, low mental resilience, besides a high rate of pain catastrophizing, were more vulnerable to developing PTSD.

CONCLUSIONS

The findings can help to refine the understanding regarding the involvement of midwives' personality characteristics in the process of PTSD onset. Vulnerable midwives have been identified as those at risk to develop PTSD symptoms.

IMPLICATIONS FOR PRACTICE

The clinical significance of these insights is to promote the ability to identify midwives who are at risk to develop PTSD. Furthermore, this information might help to produce training programs and a support network to empower self-compassion and mental resilience, and to minimize self-criticism in order establish a support network, which would help to deal with the difficult experiences they face at work.

Predicting post-traumatic stress disorder: The complex relationship between burnout, intentions to leave and emotional support among health care professionals

BACKGROUND

Health care professionals working in delivery rooms often encounter stressful situations. Understanding their challenges and the support they receive is essential for improving their well-being and consequently patient care.

PURPOSE

Examining the relationship between burnout, intentions to leave, post-traumatic stress disorder (PTSD) symptoms, and complex PTSD among health care professionals, and identifying their predictors.

METHODS

A mixed methods design, including a survey among 196 midwives and gynecologists assessing burnout, intentions to leave, exposure to negative work experiences and PTSD, as well as 15 semi-structured interviews.

DISCUSSION

Most participants experienced multiple difficult events in the delivery room, reporting insufficient emotional support. Burnout and lack of emotional support were significant predictors of PTSD symptoms. Participants expressed a need for emotional support to cope with complex situations.

CONCLUSION

Burnout among midwives must be addressed through prevention and intervention programs. Emotional support is essential in mitigating PTSD symptoms among midwives and gynecologists, enhancing their resilience and well-being.

Exposure to Traumatic Events at Work, Post-Traumatic Symptoms, and Professional Quality of Life among Italian Midwives: A Cross-Sectional Study

BACKGROUND

The aim of this study is to investigate the potential occurrence of post-traumatic stress disorder (PTSD) symptoms, following exposure to traumatic events, in Italian midwives and their consequent influence on the quality of midwives' professional lives. In addition, data were collected on the major traumatic events described by midwives.

METHOD

A cross-sectional study related the socio-demographic characteristics of 286 midwives with the scores obtained on two assessment scales, one for post-traumatic stress disorder (IES-R) and the other for quality of life (ProQOL V). The percentage of midwives who obtained a score higher than the predetermined threshold value in both questionnaires was noted, and the correlations that emerged were highlighted. Through this qualitative method, their significant work-related traumatic events were investigated to finally detect the prevalence percentage of each category.

RESULTS

The proportion of midwives scoring higher than 33 on the IES-R scale, indicating a higher likelihood of PTSD, was 48.6%. Freelancers or outpatient clinic midwives had lower mean IES scores (p = 0.049). A significant inverse correlation was observed between age and IES-R score and between the compassion satisfaction subscale and time since completing education (p = 0.028). A comparison between the IES-R and ProQOL scales showed a statistically significant correlation (p < 0.001), in particular, between the burnout (BO) (p < 0.001) and secondary traumatic stress (STS) (p < 0.001) subscales. The thematic categorization of traumatic events included mother/child death, mother/child medical complications, relational problems with patients or team members, and organizational problems/medical staff's inexperience.

CONCLUSIONS

The emerging data may confirm the data in the literature, namely those showing that midwives are prone to developing work-related PTSD, particularly due to their exposure to traumatic events such as maternal and neonatal death.

What is known about midwives' well-being and resilience? An integrative review of the international literature

BACKGROUND

Internationally, the midwifery workforce is facing a professional crisis due to numerous organizational and individual factors that have led to midwives leaving the profession. These factors include high levels of workplace stress, systemic barriers to providing woman and person-centered care, trauma, and burnout. The COVID-19 pandemic magnified these pre-existing stressors and adversities and has further disrupted midwives' ability to practice within their professional norms. In order to understand how midwives can be better supported, there is a need to understand what contributes to and detracts from their well-being and resilience.

AIM

To investigate and synthesize the extant international knowledge on midwives' well-being and resilience in the context of workplace stress and adversity.

METHOD

Integrative review of the literature published in peer-reviewed journals.

RESULTS

Thematic analysis of the literature resulted in three core themes: (1) risk factors and adversity; (2) protective factors and resilience; and (3) sustaining factors and well-being in midwifery. Findings from this integrated review highlight that several factors associated with workplace adversity can also be sources of protection depending on their presence or absence. Within the included studies, there exists a broad use of concepts and definitions that are applied to well-being and resilience, resulting in a lack of uniformity and cohesion.

CONCLUSIONS

In this review, we identified a high level of workplace adversity and the subsequent impacts on midwives' well-being and resilience. A series of protective factors and strategies that can be used to improve the well-being of midwives and support resilience within the profession were also identified; however, further research of the population is required. In addition, the development of cohesive well-being and resilience concepts specific to midwifery is recommended, as is the development and application of uniform terminologies and definitions.

The impact on midwives and their practice after caring for women who have a traumatic childbirth: A systematic review

BACKGROUND

Women's birth experiences can range from positive and satisfying to negative and traumatizing. Midwives caring for women can also be exposed to these traumatic childbirth experiences. There is a paucity of research on the impact these experiences have on midwives and their practice. The PEO framework guided the research review question.

METHODS

Seven electronic databases were systematically searched. The quality of each included study was assessed using the tool appropriate to the study's methodological approach; Critical Appraisal Skills Program (CASP) criteria and the Mixed Methods Appraisal Tool (MMAT) Version 2018. The Consolidated Criteria for Reporting Qualitative Research (COREQ) tool was utilized to assess reported findings. Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to grade the confidence in the evidence of the qualitative research. Data were thematically analyzed to formalize the identification and development of themes.

RESULTS

A total of 12 studies were included. Synthesis of the evidence generated one overarching theme, "Midwives, the forgotten victims", and three themes describing the essences of midwives' experiences: "Bruised and battered but still smiling"; "Wearing armour to protect my soul"; "Members of my team are holding me up, others are pulling me down".

CONCLUSIONS

Midwives expressed feelings of shock, fear, responsibility, and powerlessness which may contribute to some experiencing serious mental illness. They reported a shaken belief in the normal physiologic birth process which consequently led to more defensive practice. Research is needed to identify high-quality interventions to support midwives after these events. This systematic review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; Registration CRD42021252033).

Compassion fatigue and moral sensitivity in midwives in COVID-19

BACKGROUND

The Covid-19 pandemic has impacted compassion fatigue and the mental health of health care providers, particularly midwives and nurses. Although there are studies involving health workers such as nurses and physicians affected by the pandemic's compassion fatigue, few studies include midwives.

RESEARCH OBJECTIVE

The present study seeks to investigate the effects of compassion fatigue experienced by midwives working under intense stress during the third wave of the COVID-19 pandemic on the level of moral sensitivity.

RESEARCH DESIGN

This is a descriptive-correlation study.

PARTICIPANTS

The statistical population consisted of all the midwives in Türkiye hospitals in 2021. This cross-sectional study was collected through a questionnaire using convenience sampling. Three hundred and ten midwives working in different units of the country participated in the study.

ETHICAL CONSIDERATIONS

Approval from the researcher's university Institutional Review Board for ethical review was obtained with the code of IRB 20/510.

FINDINGS

The average age of the midwives is 34.29 ± 8.39. It has been noticed that 43.5% of the midwives work in public hospitals and 38.1% in family health and community health centers. Midwives' mean MR-CS score is 67.11 ± 25.13, secondary trauma sub-dimension average 15.77 ± 6.23, and occupational burnout sub-dimension 40.69 ± 16.35. The mean moral sensitivity questionnaire score is determined as 93.86 ± 19.51. It has been observed that the working style and working time are effective on compassion fatigue. In the linear regression model, 98% of compassion fatigue was explained. Age, secondary trauma, and occupational burnout sub-dimensions affect the model.

DISCUSSION

Working year, working style, second trauma, age, and occupational burnout parameters may help explain some of the links between midwives' symptoms of compassion fatigue.

CONCLUSION

The pandemic affects the compassion fatigue of midwives. It is crucial to provide social support to midwives and health workers to prevent compassion fatigue and examine and control groups at risk in mental health.

A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in maternal-fetal medicine physicians in the United States

BACKGROUND

Compassion fatigue is secondary traumatic distress experienced by providers from ongoing contact with patients who are suffering. Compassion satisfaction is emotional fulfillment from caring for others. Burnout is distress related to dissonance between job demands and available resources. Although burnout is well-studied, compassion satisfaction and compassion fatigue are neglected components of physician well-being. Because of recurrent exposure to adverse outcomes, maternal-fetal medicine providers may be at particular risk for compassion fatigue.

OBJECTIVE

This study aimed to better characterize both clinical and nonclinical drivers of work-related distress vs satisfaction.

STUDY DESIGN

The modified Compassion Fatigue and Satisfaction Self-Test and a questionnaire of professional and personal characteristics were distributed electronically to maternal-fetal medicine providers nationally. Multivariable regression models were constructed for compassion fatigue, burnout, and compassion satisfaction as a function of potential predictors.

RESULTS

The survey response rate was 24% (n=366), primarily consisting of White physicians working in academic medical centers. Significant predictors of lower burnout scores included employment at 1 institution for >20 years, discussing work-related distress with friends, and having one's most recent involvement in decision-making for a periviable fetus >6 months ago; distress because of coworkers and personal factors predicted higher scores. Female sex, self-report of significant emotional depletion, use of mental health services, and having other maternal-fetal medicine physicians as part of the care team for a fetus with severe anomalies were significant predictors of higher compassion fatigue scores, whereas White race and having social work as part of the care team for a maternal mortality predicted lower scores. Personal spiritual practice was a significant predictor of higher compassion satisfaction score, whereas employment at current institution for <5 years predicted lower scores.

CONCLUSION

Compassion fatigue, compassion satisfaction, and burnout are associated with several modifiable risk factors, such as practice type, having a multidisciplinary team, and emotional support outside of the workplace; these are potential targets for intervention.

Compassion fatigue and compassion satisfaction among Chinese midwives working in the delivery room: A cross-sectional survey

BACKGROUND AND AIMS

Compassion fatigue can negatively affect not only healthcare professionals' physical and mental health but also the quality of care they provide and organizational outcomes. However, little is known about compassion fatigue among Chinese midwives working in the delivery room. This study aimed to examine compassion fatigue and compassion satisfaction levels among Chinese midwives working in the delivery room and correlate their compassion fatigue and compassion satisfaction.

METHODS

A multisite cross-sectional study with a convenience sampling approach was conducted at 62 hospitals in Henan Province, central China, from May to July 2020. The participants were recruited through an online survey. A self-designed sociodemographic and work-related data sheet, the Social Support Rating Scale (SSRS), and the Professional Quality of Life Scale (ProQoL) were used to measure the participants'basic information, level of social support, compassion fatigue(consists of burnout and secondary traumatic stress) and compassion satisfaction. Descriptive analysis was used to describe the characteristics of the participants' social support, compassion fatigue and compassion satisfaction. Multiple linear regression analysis was employed to identify associations with the participants' sociodemographic and professional characteristics, compassion fatigue and compassion satisfaction.

RESULTS

A total of 213 questionnaires were completed, 206 of which were valid (96.71%). The majority of the participants reported moderate risks for compassion satisfaction (75.24%) and burnout (59.71%) and low risks for secondary traumatic stress (61.65%). Higher job satisfaction as a midwife, lower average working hours per week in the past year, higher social support, extroverted personality, and work recognition in the past month were positively associated with compassion satisfaction, explaining 48.7% of the total variance. Always considering giving up a midwifery career, lower social support, working a day-night shift, poor health condition, more exposure to traumatic birth events per month on average in recent years, and lower job satisfaction as a midwife were negative factors for burnout, explaining 35.3% of the total variance. Four factors, including more exposure to traumatic birth events per month on average in recent years, always considering giving up a midwifery career, working a day-night shift and poor sleep quality, were negatively related to secondary traumatic stress, explaining 14.2% of the variance.

CONCLUSIONS

In this study, midwives showed moderate levels of compassion satisfaction and burnout and low levels of secondary traumatic stress which should attract the attention of health institutions. A healthy and supportive work environment is crucial to midwives' health, well-being and job satisfaction. Tailored strategies such as trauma management, emotional literacy, peer and social support networks should be implemented to support midwives' compassion satisfaction, while prevent and lower midwives' burnout and secondary traumatic stress.

A fuzzy intelligent system to assess midwives’ burnout conditions

INTRODUCTION

Midwives’ burnout affects their effectiveness and the quality of the services they provide to pregnant women as well as the quality of the collaboration with medical staff. The burnout depends on a number of factors that can exhibit high variability over time. This creates the necessity of introducing intelligent approaches that assess changes in behavior, environmental factors, working conditions, and to make decisions to optimize the physical and mental health of midwives. The aim of this study was to employ fuzzy logic to design a Fuzzy Intelligent or Inference System (FIS) that assesses midwives’ burnout level by emulating the reasoning of human experts.

METHODS

The proposed FIS addresses the assessment of midwives’ burnout comprehensively since it incorporates findings following a thorough analysis of the relevant literature, as well as assimilates experts’ knowledge elicited through semi-structured interviews. Additionally, fuzzy rules are more intuitive and thus easier to understand and modify by human users than dealing and translating numerical results. The FIS performance is compared and evaluated against experienced midwives.

RESULTS

Findings confirm the ability of the proposed FIS to produce judgments that are closer to experts’ consensus, as expressed by their aggregated assessment.

CONCLUSIONS

The proposed FIS is evaluated by comparing its results with judgments made by experts, suggesting that fuzzy logic allows precise and personalized assessment of midwives’ burnout levels. The proposed FIS can be used to evaluate burnout, support organizations to develop burnout policies as well as used as a research instrument to investigate interrelationships of burnout factors.

The BLOSSoM study: Burnout after perinatal LOSS in Midwifery. Results of a nation-wide investigation in Italy

BACKGROUND

Respectful care of bereaved parents after stillbirth plays a pivotal role in enabling the grieving process and reducing the traumatic impact of this life-changing event. Unfortunately, professionals and midwives, in particular, are often emotionally unprepared and frequently left alone when dealing with these stressful events.

AIM

The BLOSSoM (Burnout after perinatal LOSS in Midwifery) study aims to address the levels of professional burnout in Italian midwives and evaluate the psychological impact of bereavement care on professionals.

METHODS

Web-based cross-sectional study, including socio-demographic questionnaire, survey on the knowledge of guidelines for stillbirth management and two psychometric tests: Maslach Burnout Inventory (MBI) and Impact of Event Scale - Revised (IES-R).

FINDINGS

Of 445 female midwives, mean age 35.1 (SD 9.9), working years 11.2 (SD 10.2), 149 (33.4%) reported specific training on stillbirth and 420 (94.6%) highlighted the need for further training and support. Medium to high levels of burnout (Emotional Exhaustion) were present in 65 midwives (15.9%) with a high prevalence of Reduced Personal Accomplishment (292, 64.2%). 'Communicating the diagnosis of death' was considered the hardest task, followed by 'assisting the meeting with the baby'; 109 midwives (24.5%) reported high IES-R scores (>30), suggesting symptoms of PTSD related to stillbirth events; a good level of knowledge of guidelines favoured Personal Accomplishment (OR 0.3 [0.1 - 0.6]). The number of stillbirths assisted by midwives was not associated with burnout levels.

CONCLUSION

Midwives are particularly at risk of developing professional burnout, as early as after five years of work, with a significant association with the psychological impact exerted by stressful events (stillbirth).

Compassion Satisfaction, Secondary Traumatic Stress, and Burnout among Nurses Working in Trauma Centers: A Cross-Sectional Study

Due to the nature of their work, trauma nurses are exposed to traumatic situations and often experience burnout. We conducted a cross-sectional study examining compassion satisfaction, secondary traumatic stress, and burnout among trauma nurses to identify the predictors of burnout. Data were collected from 219 nurses in four trauma centers in South Korea from July to August 2019. We used the Traumatic Events Inventory to measure nurses’ traumatic experience and three Professional Quality of Life subscales to measure compassion satisfaction, secondary traumatic stress, and burnout. Multiple regression analysis confirmed that compassion satisfaction and secondary traumatic stress significantly predicted nurses’ burnout, with compassion satisfaction being the most potent predictor. The regression model explained 59.2% of the variance. Nurses with high job satisfaction, high compassion satisfaction, and low secondary traumatic stress tend to experience less burnout than their counterparts. Nurse managers should recognize that strategies to enhance job and compassion satisfaction and decrease secondary traumatic stress are required to decrease burnout among nurses in trauma centers.

Secondary traumatic stress among midwifery students

PURPOSE

This study aimed to examine the factors affecting secondary traumatic stress on midwifery students.

DESIGN AND METHODS

This descriptive study was conducted between November and December 2018. Data were collected using information form and the Secondary Traumatic Stress Scale.

FINDINGS

The study found that 22.2% of midwifery students met all the trauma criteria for posttraumatic stress disorder according to the Secondary Traumatic Stress Scale. Midwifery students who were unhappy to continue their education and those who wished to switch to another profession after graduation respectively showed a 2.8- and a 4-fold higher risk of meeting the trauma criteria (p < 0.05).

CONCLUSION

The secondary traumatic stress rate in midwifery students is particularly high considering the fact that one in five students fulfills all of the Secondary Traumatic Stress criteria. However, to reduce their secondary traumatic stress rate, students should be thoroughly assessed by the educators who could provide the support necessary.

IMPLICATIONS FOR NURSING PRACTICE

Before graduation from the midwifery departments, students traumatic stress symptoms could be assessed mental health nursing courses, which might enable to change their attitudes towards to cope with this situation. Especially after traumatic childbirths, midwifery students should be supported by mental health nurses to cope with traumatic stress. Midwifery students should be encouraged each and every possible moment to express their feelings when they experience traumatic stress and thus their skills for effective coping can be reinforced.

Spiritual care, compassion and associated factors of midwives working in delivery rooms

AIM

This study aimed to determine the level of spiritual care and compassion among midwives working in delivery rooms and associated factors.

METHODS

A descriptive design was utilized to collect data using self-report questionnaires from 181 midwives working in delivery rooms in Turkey. Data were collected between 1 February 2020 and 20 March 2020.

RESULTS

The mean Spiritual Care-Giving Scale (SCGS) (min: 25- max: 175) and Compassion Scale (CS) (min: 24- max: 120) scores were 147.88 ± 17.84 and 96.37 ± 12.84. It was determined that there was a significant difference between the SCGS and CS scores of the midwives based on age, working year, work schedule, job satisfaction and traumatic birth experiences. Furthermore, there were positive correlations between scores on certain SCGS and CS subdimensions.

CONCLUSION

Midwifery is a continuously evolving profession based on helping others. However, long working hours and their exposure to traumatic birth events negatively affect both spiritual caregiving and compassion levels of midwives. Working conditions of midwives need to improve and this would contribute to the quality of maternal healthcare. Also, studies should be conducted in different contexts, societies and cultures to identify barriers to compassionate and spiritual care during childbirth.

Shoulder dystocia: A panic station or an opportunity for post-traumatic growth?

BACKGROUND

Traumatic births are considered as challenging events in the professional life of midwives. Negative emotional and psychological consequences of these births on midwives are well-established. However, evidence suggests that in the aftermath of challenging events, such as birth traumas, positive outcomes may emerge as well. Based on the literature, shoulder dystocia (SD) is known as one of the most traumatic birth experiences for midwives. In this study we aimed to explore the impact of experiencing SD complicated births on clinical practice of midwives.

METHODS

A qualitative descriptive study was undertaken. Midwives who had an experience of at least one case of SD were invited to the study through the Australian College of Midwives. In-depth interviews were conducted with 25 midwives. Data were analysed using an inductive thematic approach.

RESULTS

Three themes were identified 1) Putting on a brave face 2) Towards the growth zone 3) I am resilient enough to recover, because of …. Experience of SD was described as a dreadful event in midwives' career. However, on reflection, this experience was considered as a benefit which developed midwives' clinical expertise and contributed to their professional empowerment. Having faith in birth normality, support from workplace, seniority/ years of experience and self-confidence were among the factors which helped midwives in overcoming the stress after SD.

CONCLUSION

There needs to be greater awareness about the consequences of traumatic births such as SD for midwives. Collegial support has a critical role in helping midwives to have a positive outlook on their traumatic experience and to ease their pathway of professional growth.

Factors associated with workplace fatigue among midwives in southern China: A multi-centre cross-sectional study

AIMS

To identify the level of workplace fatigue among midwives and factors influencing their fatigue.

BACKGROUND

Midwives who play an important role in medical care are prone to experience workplace fatigue, which negatively affects their well-being and work quality.

METHODS

A multi-centre cross-sectional study was conducted among 666 Chinese midwives from 38 hospitals in March 2019. Data were collected by four questionnaires of self-designed demographic questions, the Pittsburgh Sleep Quality Index, the Social Support Self-Rating Scale and the 14-item Fatigue Scale. Descriptive statistics, univariate analysis and multiple linear regression were used to analyse the data.

RESULTS

Midwives had moderate levels of fatigue with the mean scores of physical fatigue, mental fatigue and total fatigue being 9.53, 6.25 and 15.79, respectively. Multiple linear regression results showed that sleep quality, social support, job satisfaction, occupational injuries, adverse life events, frequency of irregular meals and employment type were statistically significant factors influencing fatigue among the participants.

CONCLUSIONS

Physical and mental fatigue were generally common among midwives and were affected by personal-related and work-related factors, sleep quality and social support.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators have the opportunity to advocate for improved health policy under the two children rule to prevent workplace fatigue amongst midwives.

Understanding and supporting law enforcement professionals working with distressing material: Findings from a qualitative study

This study aimed to extend previous research on the experiences and factors that impact law enforcement personnel when working with distressing materials such as child sexual abuse content. A sample of 22 law enforcement personnel working within one law enforcement organisation in England, United Kingdom participated in anonymous semi-structured interviews. Results were explored thematically and organised in the following headings: "Responses to the material", "Impact of working with distressing evidence", "Personal coping strategies" and "Risks and mitigating factors". Law enforcement professionals experienced heightened affective responses to personally relevant material, depictions of violence, victims' displays of emotions, norm violations and to various mediums. These responses dampened over time due to desensitisation. The stress experienced from exposure to the material sometimes led to psychological symptoms associated with Secondary Traumatic Stress. Job satisfaction, self-care activities, the coping strategies used when viewing evidence, detachment from work outside working hours, social support and reducing exposure to the material were found to mediate law enforcement professionals' resilience. Exposure to distressing material and the risks associated with this exposure were also influenced by specific organisational procedures implemented as a function of the funding available and workload. Recommendations for individual and organisational practices to foster resilience emerged from this research. These recommendations are relevant to all organisations where employees are required to view distressing content.

Catastrophic thinking: Is it the legacy of traumatic births? Midwives' experiences of shoulder dystocia complicated births

BACKGROUND

Shoulder dystocia (SD) is considered one of the most traumatic birth experiences not only for women, but for clinicians involved as well. Adverse effects of birth trauma on the emotions and psyche of midwives have been well established.

AIM

To explore the impact of SD, as a birth trauma, on midwives' orientation towards normal births and on their clinical practice and the factors which may deteriorate or improve the experience of SD.

METHODS

In a qualitative descriptive study design, 25 in-depth interviews were undertaken with Australian midwives who had experienced at least one case of SD. Data were analysed thematically.

FINDINGS

A total of four themes emerged: 1) an unforgettable birth; a wake-up call, 2) from passion to caution, 3) factors worsening the experience, and 4) factors soothing the experience. Fear, anxiety and doubt about their professional competence were the most common feelings experienced by midwives after SD. For many, the first exposure to SD left them contemplating their previous attitude towards normal birth. Disturbed orientation of normal birth shifted midwives towards hypervigilance in practice. Not having effective relationships with women and receiving poor support from colleagues were perceived to worsen the traumatic experience, whereas working in a midwifery continuity of care model and the sense of being appreciated improved midwives' experience after the trauma.

CONCLUSION

Shoulder dystocia is a birth emergency that midwives will inevitably experience. Involvement in such births can potentially direct midwives towards a 'worst case scenario' mentality and affect the way they provide care for women in future.

Scoping review of the impact of birth trauma on clinical decisions of midwives

OBJECTIVE

The psychological and emotional impact of a traumatic birth experience on clinicians is well-established. It is also known that emotions can generally influence decisions. However, it is not clear whether experiencing a birth trauma can affect the professional behaviour and decision-making of clinicians. This study explores the impact of birth trauma on clinical decision-making of midwives.

DATA SOURCES

Four databases (Medline, Scopus, CINAHL and ProQuest) were searched to identify English language studies published from 1990 to 2018. Due to the lack of studies with specific focus on clinical decision-making after birth trauma, we defined two main domains for our literature search. To be included, studies had to focus on either traumatic birth experience or clinical decision-making in midwifery. The findings of the two domains were then integrated.

STUDY SELECTION

Of a total 2104 studies identified, 70 received full-text screening with 40 included in the review. Twenty-two articles were about traumatic birth events and 18 examined decision-making in midwifery.

DATA EXTRACTION

Information were extracted on each article's purpose, study design, data collection, participants, definitions of birth trauma and the context in which clinical decisions were made.

RESULTS

Thematic analysis was conducted. The impact of birth trauma on midwives could be categorized into the following themes: psychological issues; professional concerns; changes in practice and positive impact. Review of literature indicated that clinical decision-making could be influenced through all these themes.

CONCLUSION

Decision-making can be impacted by the midwife's affective state related to previous experience of birth trauma. The continuum of impact may vary from increased defensiveness to increased personal and professional growth. Being aware of this impact can help midwives to better manage their emotions while making decision after traumatic birth experiences.

Temperament and professional quality of life among Japanese nurses

Aim

To investigate associations between temperament and professional quality of life among Japanese nurses.

Design

A descriptive-correlational study using self-administered anonymous questionnaires.

Methods

Questionnaires were collected from 1,267 nurses. We used analysis of covariance to examine associations between tendencies of temperament (depressive, cyclothymic, hyperthymic, irritable and anxious) and professional quality of life subscales (compassion satisfaction, burnout, compassion fatigue) first for all participants and then again after dividing the participants into two groups based on years of experience.

Results

Nurses' professional quality of life was associated with innate temperament and years of experience. Nurses with any of depressive, cyclothymic, irritable, or anxious tendencies showed significantly lower compassion satisfaction and higher burnout and compassion fatigue than those without these tendencies. Nurses with hyperthymic tendencies showed significantly higher compassion satisfaction and lower burnout than those without the tendency.

The Second Victim Phenomenon: How Are Midwives Affected?

Perinatal care providers are likely to encounter adverse events such as intrapartum emergencies, traumatic births, or maternal or fetal deaths. As a result of being directly or indirectly involved in an adverse event, health care providers can be considered second victims. The experience of the second victim phenomenon can lead to significant physical, psychological, and psychosocial sequelae that can negatively impact the provider's personal and professional life for either a short or long duration of time. When health care providers experience an adverse event, they may manifest symptoms of guilt, shame, blame, flashbacks, nightmares, insomnia, isolation, helplessness, and hopelessness, thereby becoming the second victim. Following an adverse event, health care providers who experience second victim phenomenon experience stages of recovery that influence subsequent professional and personal well-being. Persons who experience the second victim phenomenon can incorporate self-care behaviors to assist with recovery. Health care organizations have a responsibility to implement efficacious support programs that promote the provider's recovery and a return to safe and full function in the workplace.

Compassion Fatigue and Compassion Satisfaction Among Multisite Multisystem Nurses

Compassion fatigue is a phenomenon that might affect nurses of all specialties. Compassion fatigue occurrence could be profound and costly. The immediate impact could be disruption of the unit culture. This study investigated the prevalence and individual-level factors associated with compassion fatigue among nurses. An upsurge in patients' complexity today may leave nurses stressed with increasing practice demands and vulnerable to compassion fatigue. If ignored, compassion fatigue may compromise nurses' health and care outcomes. A sample of 1174 nurses from 2 large Southern California health care organizations completed an online survey measuring compassion fatigue, burnout, and compassion satisfaction. Overall, participants scored moderate to average (23-41) on compassion satisfaction, burnout, and compassion satisfaction. Experienced and working nights nurses experienced higher compassion satisfaction levels. Higher compassion fatigue means were associated with new graduates = 29.5, BSN nurses = 27.2, ICU nurses = 27.4, and working 12-hour shift nurses = 26.9, suggesting higher compassion fatigue vulnerability. Nurse leaders and managers can apply this baseline evidence to create tailored programs for specific nursing specialties and inexperienced nurses to tackle compassion fatigue and reduce related unit disorder. Seasoned nurses' perspective can be of value in enhancing those efforts.

Prevalence of and factors associated with burnout in midwifery: A scoping review

INTRODUCTION

Midwifery care meets the triple aims of health system improvement, i.e. good health outcomes, high client satisfaction, and low per capita costs. Scaling up access to midwifery care is a global priority yet the growth and sustainability of the profession is threatened by high levels of burnout and attrition. This scoping review provides a comprehensive review of the existing literature on burnout in midwifery, with a focus on prevalence, associated factors and potential solutions.

METHODS

Four electronic databases were searched to locate relevant literature up to July 2019. A total of 1034 articles were identified and reduced to 27 articles that met inclusion criteria. We summarize sample sizes, settings, study designs, burnout measures, prevalence of burnout, associated factors and potential solutions, and recommendations.

RESULTS

Prevalence of burnout was highest among Australian, Western Canadian and Senegalese midwives and lowest among Dutch and Norwegian midwives. Midwives working in caseload/continuity models reported significantly lower burnout compared to midwives working in other models. We identified 26 organizational and personal factors that were significantly associated with burnout, such as high workload, exposure to traumatic events, and fewer years in practices. Organizational support to improve work-life balance and emotional well-being, as well as more continuing education to raise awareness about burnout and how to cope with it, emerged as common strategies to prevent and address burnout.

CONCLUSIONS

Burnout is a serious and complex occupational phenomenon. More qualitative research is needed in this area, to better understand the lived experience of burnout.

Secondary Traumatic Stress in Maternal-Newborn Nurses: Secondary Qualitative Analysis

BACKGROUND: Secondary traumatic stress can be the cost for clinicians when caring for persons who have been traumatized. Secondary traumatic stress is a syndrome of symptoms similar to posttraumatic stress disorder (PTSD). AIMS: To conduct a secondary qualitative data analysis of three primary data sets of secondary traumatic stress in nurses. METHODS: Cross validation was the type of qualitative secondary analysis used to compare qualitative findings across these multiple data sets. In the three primary studies, the data were analyzed for themes. In this secondary qualitative analysis, a different defining unit was chosen. This time, the four categories of PTSD symptoms (intrusions, avoidance, arousal, and negative alterations in cognitions and mood) were used to analyze the data sets using content analysis. RESULTS: For all three groups of maternal-newborn nurses, the intrusions category was ranked first and the negative cognitions and mood category was ranked second. The remaining two symptom categories were where their rankings differed. The labor and delivery and neonatal intensive care unit nurses ranked arousal symptoms third and avoidance symptoms fourth. For the nurse-midwives, the rankings for these two categories were reversed. The neonatal intensive care unit nurses comprised the one group that did not report any avoidance symptoms. CONCLUSIONS: This secondary qualitative analysis confirmed the presence of PTSD symptoms that maternal-newborn nurses struggled with as a result of caring for either critically ill infants or women during traumatic births. Hospital preventive strategies and interventions for secondary traumatic stress in nurses are discussed.

Compassion fatigue in healthcare providers: A systematic review and meta-analysis

BACKGROUND

Compassion fatigue is recognized as impacting the health and effectiveness of healthcare providers, and consequently, patient care. Compassion fatigue is distinct from "burnout." Reliable measurement tools, such as the Professional Quality of Life scale, have been developed to measure the prevalence, and predict risk of compassion fatigue. This study reviews the prevalence of compassion fatigue among healthcare practitioners, and relationships to demographic variables.

METHODS

A systematic review was conducted using key words in MEDLINE, PubMed, and Ovid databases. Data were extracted from a total of 71 articles meeting inclusion criteria, from studies measuring compassion fatigue in healthcare providers using a validated instrument. Quantitative and qualitative data were extracted and compiled by three independent reviewers into an evidence table that included basic study characteristics, study strength and quality determination, measurements of compassion fatigue, and general findings. Meta-analysis, where data allowed, was stratified by Professional Quality of Life version, heterogeneity was quantified, and pooled means were reported with 95% confidence interval. A table of major study characteristics and results was created.

ETHICAL CONSIDERATION

This paper contains no primary data obtained directly from research participants. Data obtained from previously published resources have been acknowledged within references. Psychological distress, particularly compassion fatigue, can be insidious, no health profession is immune, and may significantly impact the ability to provide care.

RESULTS

A total of 71 studies were included. Compassion fatigue was reported across all practitioner groups studied. Relationships to most demographic variables such as years of experience and specialty were either not statistically significant or unclear. Variability in reporting of Professional Quality of Life results was found.

INTERPRETATION

Compassion fatigue exists across diverse practitioner groups. Prevalence is highly variable, and its relationship with demographic, personal, and/or professional variables is inconsistent. Questions are raised about how to mitigate compassion fatigue.

The compassion levels of midwives working in the delivery room

Background:

Compassion-based practices in midwifery are the most important expression of the depth of care quality. This concept is insufficiently represented in literature, therefore, studies on this subject are of utmost importance.

Objectives:

This study aims to determine the levels of compassion of midwives working in the delivery room and the factors affecting these levels. The study was carried out in Kocaeli, Turkey.

Methods:

This descriptive study was carried out from 1 February to 15 April 2019 in delivery rooms of six different hospitals located in the provincial centre of Kocaeli, Turkey, with 78 actively working midwives. Data were collected using a ‘Compassion Scale’ and analysed using the Mann–Whitney U test, the Kruskal–Wallis H test and the Spearman correlation test.

Ethical considerations:

This study was conducted according to ethical scientific guidelines.

Results:

The compassion score of the midwives were found to be 4.19 ± 0.39. The total compassion score was affected by professional factors such as number of patients, alternating shift work, number of traumatic births and work satisfaction. While the kindness subscores decreased depending on shift work and number of traumatic births, it was determined that the midwives who were satisfied with their work had higher kindness scores than those who were not. Also, as the age and professional experience of the midwives and the number of traumatic births increased, their indifference score also increased. Midwives who reported that they were not satisfied with their job had higher scores regarding separation and disengagement scores than those who were satisfied with their job.

Conclusion:

It was determined that the compassion levels of midwives were found to be negatively affected by factors such as age, professional experience, job satisfaction and number of monthly traumatic births in a month. They should be reminded that compassionate midwifery care for women is a basic human right.

Preparing midwifery students for traumatic workplace events: Findings from the POPPY (programme for the prevention of posttraumatic stress disorder in midwifery) feasibility study

BACKGROUND

Midwifery students can experience events on clinical placements that they perceive to be traumatic. There is currently no requirement to provide training about the nature of trauma, normal responses, or the most helpful ways of self-managing these. The POPPY programme, developed for qualified midwives, incorporates educational (the POPPY workshop) and supportive resources to prevent the development of Post-Traumatic Stress Disorder in midwives. As part of the feasibility evaluation of POPPY, the POPPY workshop element was adapted for pre-registration midwifery students (PreR-POPPY). Attention to this issue during pre-registration education could improve student experience and support student retention.

OBJECTIVES

To identify students' perspectives on the contents (clarity, understandability, organisation of the workshop, utility, relevance), their understanding of trauma and psychological responses, and confidence in recognising and managing early signs of distress following participation in a PreR-POPPY workshop. Perspectives on preferred timing in their midwifery programmes, and methods of delivery were also sought.

DESIGN

In keeping with educational evaluations, anonymous feedback was collected from students.

SETTING

Two higher education institutes.

PARTICIPANTS

Midwifery undergraduate students on the three year or shortened programme for registered nurses (n = 131), and midwifery educators (n = 5).

METHODS

Students participated in the workshop and provided feedback immediately. Midwifery educators participated in a meeting with the researchers to provide feedback.

RESULTS

High levels of satisfaction with the contents of the workshop were identified. Ninety-nine percent of students would recommend the workshop to other midwifery students. Provision of the workshop early in midwifery programmes, revisited at later points, was strongly endorsed. Learning outcomes were very positive for understanding trauma/early stress responses, and recognising and managing early responses to trauma. Strong endorsement for the provision of the workshop was received from the midwifery educators.

CONCLUSIONS

The pre-registration adapted POPPY workshop should be routinely provided in preregistration midwifery.

“Being With Woman”: Is There a Cost for Midwives and Students Attending Traumatic Births?

Witnessing and/or providing care during a traumatic birth increases vulnerability to secondary traumatic stress, with potential effects on mental health of and attrition among the midwifery workforce. With the global shortage of the midwifery workforce, retention and peak functioning are critical to the well-being of childbearing women and their infants. PubMed, Scopus, CINAHL, and PsycINFO databases were searched to identify studies that examined secondary traumatic stress in both midwives and midwifery students. Fifteen studies were located from eight different countries. Four of these studies examined secondary traumatic stress in midwifery students and 11 in practicing midwives. This article discusses the limited research on secondary traumatic stress among midwives and students who have attended or witnessed traumatic births. The vulnerability and potential workforce attrition of midwives and students experiencing secondary traumatic stress are highlighted. The development of a comprehensive body of literature is needed on prevalence, impact, clinical implications, and healing strategies addressing this workforce issue.

A programme for the prevention of post-traumatic stress disorder in midwifery (POPPY): indications of effectiveness from a feasibility study

Background: Midwives can experience events they perceive as traumatic when providingcare. As a result, some will develop post-traumatic stress disorder (PTSD), with adverse implications for their mental health, the quality of care provided for women and the employing organizations. POPPY (Programme for the prevention of PTSD in midwifery) is a package of educational and supportive resources comprising an educational workshop, information leaflet, peer support and access to trauma-focused clinical psychology intervention. A feasibility study of POPPY implementation was completed. Objective: This study aimed to identify potential impacts of POPPY on midwives' understandingof trauma, their psychological well-being and job satisfaction. Method: POPPY was implemented in one hospital site. Before taking part in the POPPY workshop (T1) midwives (N = 153) completed self-report questionnaires, which measured exposure to work-related trauma, knowledge and confidence of managing trauma responses, professional impacts, symptoms of PTSD, burnout and job satisfaction. Measures were repeated (T2) approximately 6 months after training (n = 91, 62%). Results: Midwives' confidence in recognizing (p = .001) and managing early traumaresponses in themselves and their colleagues significantly improved (both p < .001). There was a trend towards reduced levels of PTSD symptomatology, and fewer midwives reported sub clinical levels of PTSD (from 10% at T1 to 7% at T2). The proportion of midwives reporting high and moderate levels of depersonalization towards care was reduced (33% to 20%) and midwives reported significantly higher levels of job satisfaction at T2 (p < .001). Reductions in self-reported stress-related absenteeism (12% to 5%), long-term changes to clinical allocation (10% to 5%) and considerations about leaving midwifery (34% to 27%) were identified. Conclusions: In conclusion, POPPY  shows very positive potential to improve midwives' mental health and the sensitivity of care they provide, and reduce service disruption and costs for trusts. Large-scale longitudinal evaluation is required.