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Vermeulen J, Buyl R, Luyben A, Fleming V, Tency I, Fobelets M. The exploration of professional midwifery autonomy: Understanding and experiences of final-year midwifery students. NURSE EDUCATION TODAY 2024; 134:106101. [PMID: 38266429 DOI: 10.1016/j.nedt.2024.106101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/01/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The concept of professional midwifery autonomy holds great significance in midwifery education. Notably, clinical placements play a crucial role in introducing students to its concept. However, the understanding and experiences of students regarding midwifery autonomy are relatively unknown. OBJECTIVES This study aimed to examine the experiences and understanding of midwifery autonomy among final-year midwifery students. METHODS A qualitative exploratory study using three focus group interviews with final-year midwifery students from each of the three Belgian regions; Flanders, Walloon and the Brussels Capital Region. Focus groups were recorded, transcribed verbatim and analysed using a thematic analysis. RESULTS Upon data analysis, five key themes emerged; 1) working independently, 2) positive learning environment, 3) professional context, 4) actions and decisions of others and 5) beneficial for women. Students emphasized the importance of promoting professional midwifery autonomy through the ability to make their own professional decisions and take initiatives. They highlighted the need for a safe and supportive learning environment that encourages independent practice, nurtures self-governance and facilitates personal growth. Additionally, collaborative relationships with other maternity care professionals and increased awareness among women and the broader healthcare community were identified as essential factors in embracing and promoting professional midwifery autonomy. CONCLUSIONS Our study provides valuable insights into the significance of midwifery autonomy among final-year midwifery students. To empower midwifery students to truly understand and experience professional midwifery autonomy, educators and preceptors should adopt strategies that enhance comprehension, foster independent yet collaborative practice, establish supportive learning environments, and equip students to navigate challenges effectively, ultimately improving maternal and new-born health.
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Affiliation(s)
- Joeri Vermeulen
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium; Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ans Luyben
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, United Kingdom; Lindenhofgruppe, Bern, Switzerland
| | | | - Inge Tency
- Midwifery Department, Odisee University of Applied Sciences, Sint Niklaas, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Maaike Fobelets
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium; Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Teacher Education, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Kool L, Feijen-de Jong EI, Mastenbroek NJJM, Schellevis FG, Jaarsma DADC. Midwives' occupational wellbeing and its determinants. A cross-sectional study among newly qualified and experienced Dutch midwives. Midwifery 2023; 125:103776. [PMID: 37536117 DOI: 10.1016/j.midw.2023.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 05/26/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Internationally, about 40 percent of midwives report symptoms of burnout, with young and inexperienced midwives being most vulnerable. There is a lack of recent research on burnout among Dutch midwives. The aim of this study was to examine the occupational wellbeing and its determinants of newly qualified and inexperienced midwives in the Netherlands. The majority of practicing Dutch midwives are aged under 40, which could lead to premature turnover. DESIGN A cross-sectional study was conducted using an online questionnaire that consisted of validated scales measuring job demands, job and personal resources, burnout symptoms and work engagement. The Job Demands-Resources model was used as a theoretical model. SETTING AND PARTICIPANTS We recruited Dutch midwives who were actually working in midwifery practice. A total of N=896 midwives participated in this study, representing 28 percent of practicing Dutch midwives. MEASUREMENTS AND FINDINGS Data were analysed using regression analysis. Seven percent of Dutch midwives reported burnout symptoms and 19 percent scored high on exhaustion. Determinants of burnout were all measured job demands, except for experience level. Almost 40 percent of midwives showed high work engagement; newly qualified midwives had the highest odds of high work engagement. Master's or PhD-level qualifications and employment status were associated with high work engagement. All measured resources were associated with high work engagement. KEY CONCLUSIONS A relatively small percentage of Dutch midwives reported burnout symptoms, the work engagement of Dutch midwives was very high. However, a relatively large number reported symptoms of exhaustion, which is concerning because of the risk of increasing cynicism levels leading to burnout. In contrast to previous international research findings, being young and having less working experience was not related to burnout symptoms of Dutch newly qualified midwives. IMPLICATIONS FOR PRACTICE The recognition of job and personal resources for midwives' occupational wellbeing must be considered for a sustainable midwifery workforce. Midwifery Academies need to develop personal resources of their students that will help them in future practice.
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Affiliation(s)
- Liesbeth Kool
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, PO Box 196, 9700 AD, Groningen, the Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Groningen, the Netherlands; Midwifery Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Esther I Feijen-de Jong
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, PO Box 196, 9700 AD, Groningen, the Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Groningen, the Netherlands; Midwifery Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | | | - François G Schellevis
- Midwifery Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; NIVEL (Netherlands Institute for Health Services Research), Location VUmc, Utrecht, the Netherlands
| | - Debbie A D C Jaarsma
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; Wenckebach Institute for Education and Training, Center for Education Development and Research in Health Professions, LEARN, University Medical Center Groningen, University of Groningen, the Netherlands
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Vermeulen J, Fobelets M, Fleming V, Luyben A, Stas L, Buyl R. How Do Midwives View Their Professional Autonomy, Now and in Future? Healthcare (Basel) 2023; 11:1800. [PMID: 37372919 DOI: 10.3390/healthcare11121800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Internationally, midwives' professional autonomy is being challenged, resulting in their inability to practice to their full scope of practice. This situation contrasts with the increasing international calls for strengthening the midwifery profession. The aim of this study therefore is to explore Belgian midwives' views on their current and future autonomy. METHODS An online survey among Belgian midwives was performed. Data were collected and analyzed using a quantitative approach, while quotes from respondents were used to contextualize the quantitative data. RESULTS Three hundred and twelve midwives from different regions and professional settings in Belgium completed the questionnaire. Eighty-five percentage of respondents believe that they are mostly or completely autonomous. Brussels' midwives feel the most autonomous, while those in Wallonia feel the least. Primary care midwives feel more autonomous than hospital-based midwives. Older midwives and primary care midwives feel less recognized and respected by other professionals in maternity care. The majority of our respondents believe that in future midwives should be able to work more autonomously in constructive collaboration with other professionals. CONCLUSION While Belgian midwives generally rated their own professional autonomy as high, a significant majority of respondents desire more autonomy in future. In addition, our respondents want to be recognized and respected by society and other health professionals in maternity care. It is recommended to prioritize efforts in enhancing midwives' autonomy, while also addressing the need for increased recognition and respect from society and other maternity care professionals.
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Affiliation(s)
- Joeri Vermeulen
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, 1090 Brussels, Belgium
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Maaike Fobelets
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, 1090 Brussels, Belgium
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Department of Teacher Education, Vrije Universiteit Brussel (VUB), 1040 Brussels, Belgium
| | - Valerie Fleming
- Faculty of Health, Liverpool John Moores University, Liverpool L3 5UX, UK
| | - Ans Luyben
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth BH1 3LH, UK
- Frauenzentrum (Centre for Women's Health), Lindenhofgruppe, 3012 Bern, Switzerland
| | - Lara Stas
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Support for Quantitative and Qualitative Research (SQUARE), Core Facility of the Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Ronald Buyl
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
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Vermeulen J, Buyl R, Luyben A, Fleming V, Fobelets M. Key Maternity Care Stakeholders' Views on Midwives' Professional Autonomy. Healthcare (Basel) 2023; 11:healthcare11091231. [PMID: 37174773 PMCID: PMC10177750 DOI: 10.3390/healthcare11091231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Advancement towards the professionalism of midwifery is closely linked to midwives' professional autonomy. Although the perspectives of Belgian midwives on their professional autonomy have been studied, the views of other maternity care stakeholders are a blind spot. The aim of this study, therefore, was to explore maternity care stakeholders' views on Belgian midwives' professional autonomy. A qualitative exploratory study was performed using focus group interviews. A heterogenous group of 27 maternity care stakeholders participated. The variation between midwives, with different levels of autonomy, was reported. The analysis of the data resulted in five themes: (1) The autonomous midwife is adequately educated and committed to continuous professional further education, (2) The autonomous midwife is competent, (3) The autonomous midwife is experienced, (4) The autonomous midwife assures safe and qualitative care, and (5) The autonomous midwife collaborates with all stakeholders in maternity care. A maternity collaborative framework, where all maternity care professionals respect each other's competences and autonomy, is crucial for providing safe and quality care. To achieve this, it is recommended to implement interprofessional education to establish strong foundations for interprofessional collaboration. Additionally, a regulatory body with supervisory powers can help ensure safe and quality care, while also supporting midwives' professional autonomy and professionalisation.
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Affiliation(s)
- Joeri Vermeulen
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, 1090 Brussels, Belgium
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Ans Luyben
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth BH1 3LH, UK
- Frauenzentrum (Centre for Women's Health), Lindenhofgruppe, 3012 Bern, Switzerland
| | - Valerie Fleming
- Faculty of Health, Liverpool John Moores University, Liverpool L3 5UX, UK
| | - Maaike Fobelets
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, 1090 Brussels, Belgium
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Department of Teacher Education, Vrije Universiteit Brussel (VUB), 1040 Brussels, Belgium
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Laserna Jiménez C, Garrido Aguilar E, Casado Montañés I, Estrada Masllorens JM, Fabrellas N. Autonomous competences and quality of professional life of paediatric nurses in primary care, their relationship and associated factors: A cross-sectional study. J Clin Nurs 2023; 32:382-396. [PMID: 35146814 PMCID: PMC10078700 DOI: 10.1111/jocn.16244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/04/2022] [Accepted: 01/25/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To identify the autonomous competences and quality of professional life of paediatric nurses in primary care, their relationship and possible associated factors. BACKGROUND The autonomous competences of paediatric nurses vary among healthcare providers in Catalonia, Spain. Autonomy is related to quality of professional life, but little is known about autonomous competences and other factors contributing to paediatric nurses' quality of professional life. DESIGN A cross-sectional study following the STROBE statement. METHODS Data from 206 paediatric primary care nurses were analysed. A self-administered survey consisting of an ad hoc questionnaire and a validated instrument to measure quality of professional life (QPL-35 questionnaire) was conducted. Descriptive, bivariate and general multivariate regression analyses were used to identify the relationship between autonomous competences and quality of professional life, and its predicting factors. RESULTS 47.6% nurses reported a medium level of autonomous competences, 46.6% a high level, and 5.8% a low level. Quality of professional life was medium-high for the domains perception of managerial support and global perception of workload and for the item disconnect from work after work shift, and very high and high values for the domain intrinsic motivation and for the item quality of work life, respectively. Autonomous competences and perceived autonomy were factors associated with quality of professional life. Other associated factors were academic background, specific training and being a paediatric nurse specialist. CONCLUSIONS Paediatric nurses in primary care have a medium-high level of autonomous competences and they perceive a high level of autonomy. Autonomous competences and level of perceived autonomy are predictors of quality of professional life. RELEVANCE TO CLINICAL PRACTICE Enhancing paediatric nurses' autonomous competences and academic background, receiving specific training and being paediatric nurse specialists might improve their quality of professional life, healthcare quality and outcomes for the child population.
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Affiliation(s)
- Cristina Laserna Jiménez
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Eva Garrido Aguilar
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | | | | | - Núria Fabrellas
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Swedish midwives' experiences of collegial midwifery assistance during the second stage of labour: A qualitative study. Women Birth 2023; 36:72-79. [PMID: 35307300 DOI: 10.1016/j.wombi.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/12/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND There has been an increased focus on clinical practice that may reduce severe perineal trauma due to awareness of the associated morbidity. Knowledge regarding the best practice to reduce these injuries is limited. Collegial midwifery assistance during the second stage of labour that involves an additional midwife being present has recently been implemented into many Swedish birth units with the aim of reducing severe perineal trauma. However, no studies have been conducted to evaluate midwives' experiences and views of this practice. AIM The aim of this study was to explore midwives' experiences of collegial midwifery assistance during the second stage of labour. METHODS A qualitative study was undertaken with five focus groups conducted with 37 midwives who were part of a multisite randomised controlled trial. The data was analysed with reflexive thematic analysis. FINDINGS Four key themes were generated: (i) "challenging the professional role"; (ii) "a balancing act between different roles"; (iii) "not just why and how - but who"; (iv) "a potential arena for learning". CONCLUSION This practice enabled valuable collegial support and learning. The midwives' experiences were multifaceted and influenced by several factors, including norms and culture in the birth units as well as personal relationships and the midwives' views on their role and childbirth. Staffing should be adapted in clinical practice to optimise the conditions for collegial support and learning while avoiding unintended consequences.
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Mharapara TL, Clemons JH, Greenslade-Yeats J, Ewertowska T, Staniland NA, Ravenswood K. Toward a contextualized understanding of well-being in the midwifery profession: An integrative review. JOURNAL OF PROFESSIONS AND ORGANIZATION 2023. [DOI: 10.1093/jpo/joac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Our integrative review synthesizes and evaluates two decades of empirical research on well-being in the midwifery profession to reveal (1) how researchers have studied midwives’ well-being; (2) key findings of research on midwives’ well-being; (3) underlying assumptions of this research; and (4) limitations of this research. We find that research on midwives’ well-being is disproportionately focused on individual midwives, who are assumed to be largely responsible for their own well-being, and that well-being in the midwifery profession is generally equated with the absence of mental health problems such as burnout, anxiety, and stress. Researchers have largely taken a narrow and instrumental approach to study midwives’ well-being, focusing on work-related antecedents and consequences, and overlooking the influence of nonwork factors embedded in the broader socioeconomic and cultural environment. Drawing on more comprehensive and contextualized well-being frameworks, we propose a research model that (1) expands the well-being construct as it applies to midwives and (2) situates midwives’ well-being in broader social, economic, political, and cultural contexts. Although developed in the midwifery context, our proposed research model can be applied to a host of professions.
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Affiliation(s)
- Tago L Mharapara
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Janine H Clemons
- Midwifery Department , MH Building 640 Great South Road, Manukau, 2025 , New Zealand
| | - James Greenslade-Yeats
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Tanya Ewertowska
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Nimbus Awhina Staniland
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Katherine Ravenswood
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
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Engeltjes B, Rosman A, Scheele F, Vis C, Wouters E. Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion. JMIR Form Res 2022; 6:e33709. [PMID: 35616176 PMCID: PMC9250067 DOI: 10.2196/33709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/17/2022] [Accepted: 05/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background The Dutch Obstetric Telephone Triage System (DOTTS) was developed to improve the quality of acute obstetric care. To achieve optimal effect, the DOTTS should be adopted in the daily care process by triage staff. Objective The primary aim was to evaluate the degree of implementation (ie, normalization) of the DOTTS, and the secondary aim was to evaluate which lessons can be learned from its current implementation in Dutch hospitals. Methods An evaluation study with a mixed methods design was performed. All triage staff in 9 Dutch hospitals that implemented the DOTTS before September 1, 2019, were invited to complete the Normalization Measure Development (NoMAD) questionnaire between December 2019 and July 2020. The questionnaire is based on the Normalization Process Theory (NPT). This self-reported questionnaire provides insights into the work people do in order to integrate and embed new practice in routine care. The NPT is based on the following 4 constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Within the questionnaire, each construct is represented by 4-7 questions. Questions are scored on a 5-point normalization process scale. Descriptive statistics were used for analysis of questionnaire scores. Subsequently, the questionnaire findings were discussed during a focus group. Template analysis following the 4 constructs was used for analyzing the results of the focus group. Results Overall, 173 of 294 (58.8%) triage staff members completed the NoMAD questionnaire, and 90.2% (156/173) of the participants had used the DOTTS for over 6 months. The digital application was used as much as possible or always by 137 of 173 (79.2%) participants. The overall normalization process score was 3.77 (SD 0.36). The constructs coherence, cognitive participation, collective action, and reflexive monitoring scored 4.01 (SD 0.47), 4.05 (SD 0.45), 3.5 (SD 0.45), and 3.72 (SD 0.47), respectively. Analysis of the focus group discussion showed that the added value of the DOTTS was seen as a quality improvement for the care of pregnant women. Dedication of the complete multidisciplinary implementation team was important for facilitating normalization. Support from the medical staff and proper use by all disciplines involved in the triage were seen as facilitating factors. Participants appreciated training and evaluation, and indicated a need for ongoing training and evaluation in relation to goal achievement. Conclusions The DOTTS has been integrated into normal care in daily practice. Evaluation by the NoMAD questionnaire provided a positive overall score. These results are in line with or, in some aspects, better than the results of other evaluation studies. Key factors in the normalization process of the DOTTS in obstetric triage are the shared added value for stakeholders, the dedication of the complete multidisciplinary implementation team, and implementation plans that are tailor made in the practical context of the hospital.
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Affiliation(s)
- Bernice Engeltjes
- Athena Institute for Transdisciplinary Research, Faculty of Science, VU Amsterdam, Amsterdam, Netherlands
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Ageeth Rosman
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Fedde Scheele
- Athena Institute for Transdisciplinary Research, Faculty of Science, VU Amsterdam, Amsterdam, Netherlands
- Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, Netherlands
| | - Christiaan Vis
- Department of Neuro & Development Psychology, Faculty of Behavioral and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands
| | - Eveline Wouters
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Department of Allied Health Professions, Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands
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Vermeulen J, Buyl R, Luyben A, Fleming V, Fobelets M. Defining midwifery autonomy in Belgium: Consensus of a modified Delphi study. J Adv Nurs 2022; 78:2849-2860. [PMID: 35266191 DOI: 10.1111/jan.15209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
Abstract
AIMS Although there is substantial literature on autonomy of midwifery, the concept remains vague, and what it exactly constitutes is little clear. Attempts to define this have been carried out, but did not result in a communal understanding. The aim of this study therefore was to define a consistent definition of midwifery autonomy in Belgium. DESIGN A modified Delphi survey with content experts. METHODS Critical components of the available definitions on midwifery autonomy were retrieved from the literature, and translated into Dutch and French. An online Delphi panel of content expert assessed components of autonomy in midwifery on clarity and relevance between June and October 2021. From the validated components, a preliminary consolidated definition was generated, which was validated in a final Delphi round. RESULTS After round one, content experts (n = 27) evaluated 10 out of 17 components to be clear and relevant. Two components were judged inappropriate and therefore removed. After further adaptation four additional components were identified appropriate after the second round, and one component after a third Delphi round. Experts' suggestions for improving the clarity and relevance were taken into account. Finally, experts assessed the preliminary definition. After minor modifications the definition of midwifery autonomy in Belgium was confirmed valid. CONCLUSION We established a communal definition of midwifery autonomy in Belgium, the creation of such a definition results in a joint understanding of the concept of midwifery autonomy. IMPACT If midwives internationally want to successfully achieve autonomy, a clear understanding of the concept of midwifery autonomy is needed. The consensus definition of midwifery autonomy in Belgium comprises 15 components related to midwives' work content, professionalism and relationship with others. Our definition of midwifery autonomy has the potential to encourage an international dialogue, grounded in a common understanding of autonomy, enabling stakeholders in maternity care to strengthen professional midwifery autonomy.
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Affiliation(s)
- Joeri Vermeulen
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium.,Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ans Luyben
- Bournemouth University, Bournemouth, UK.,Lindenhofgruppe, Bern, Switzerland
| | | | - Maaike Fobelets
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium.,Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Laserna Jiménez C, Casado Montañés I, Carol M, Guix-Comellas EM, Fabrellas N. Quality of professional life of primary healthcare nurses: A systematic review. J Clin Nurs 2021; 31:1097-1112. [PMID: 34453386 DOI: 10.1111/jocn.16015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
AIMS To identify and critically appraise the available evidence on the overall quality of professional life of primary care nurses worldwide and its main influencing factors. BACKGROUND Quality of professional life of healthcare workers is a keystone that influences the quality of healthcare services provided by healthcare organisations. Nurses have a key role as healthcare services providers given the growing shortage of doctors in primary care. DESIGN A systematic review design in accordance with the PRISMA statement. METHODS The search was conducted through MEDLINE (PubMed), CINAHL, SCOPUS, Scientific Electronic Library Online (SciELO) and Web of Science databases. The grey literature was reviewed at OpenGrey. The search was limited to human studies published from April 2010-April 2020. No limit of original language publication was applied. Three independent reviewers analysed the methodological quality of the studies. RESULTS Ten studies were included from five countries. Five studies reported nurses were satisfied with their quality of professional life and the influencing factors identified were Workload, Job autonomy, Demographic variables, Management support, Recognition, Intrinsic motivation, Interpersonal relations, Compassion fatigue, Burnout, Turnover intention, and work was reported as a component of Quality of life. CONCLUSION Primary healthcare nurses reported a high level of quality of professional life, but the scarce studies found do not provide solid consistency to assess the overall quality of professional life. Perception of high workload was the most frequently identified factor to negatively influence the quality of professional life of nurses. RELEVANCE TO CLINICAL PRACTICE Quality of professional life of primary care nurses is a key issue because of nurses' important relation with patient's care and satisfaction. Healthcare organisations should strive to address primary care nurses' quality of professional life to enhance their well-being and consequently patients' safety and high-quality healthcare services.
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Affiliation(s)
- Cristina Laserna Jiménez
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | | | - Marta Carol
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Eva Maria Guix-Comellas
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Núria Fabrellas
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Mharapara TL, Staniland N, Stadler M, Clemons JH, Dixon L. Drivers of job satisfaction in midwifery-A work design approach. Women Birth 2021; 35:e348-e355. [PMID: 34312099 DOI: 10.1016/j.wombi.2021.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identifying common factors that influence job satisfaction for midwives working in diverse work settings is challenging. Applying a work design model developed in organisational behaviour to the midwifery context may help identify key antecedents of midwives job satisfaction. AIM To investigate three job characteristics - decision-making autonomy, empowerment, and professional recognition as antecedents of job satisfaction in New Zealand (NZ) midwives. METHODS Latent multiple regressions were performed on data from Lead Maternity Carer (LMC) midwives n = 327, employed midwives n = 255, and midwives working in 'mixed-roles' n = 123. FINDINGS We found that professional recognition is positively linked to job satisfaction for midwives in all three work settings. At the same time, decision-making autonomy and empowerment were shown to influence job satisfaction for midwives working as LMCs only. DISCUSSION Our main finding suggests that the esteem generated from being acknowledged as an expert and valuable contributor by maternity health colleagues is satisfying across all work contexts. Professional recognition encompasses the social dimension of midwifery work and influences midwives job satisfaction. Decision-making autonomy and empowerment are task and relational job characteristics that may not be similarly experienced by all midwives to noticeably influence job satisfaction. CONCLUSION Given that job satisfaction contributes to recruitment, retention, and sustainability, our findings show that drivers of job satisfaction differ by midwifery work context. We present evidence to support tailored efforts to bolster midwives job satisfaction, especially where resources are limited.
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Affiliation(s)
- Tago L Mharapara
- Auckland University of Technology, AUT Department of Management, Private Bag 92006, Victoria Street West, Auckland 1142, New Zealand.
| | - Nimbus Staniland
- Auckland University of Technology, AUT Department of Management, Private Bag 92006, Victoria Street West, Auckland 1142, New Zealand.
| | - Matthias Stadler
- Ludwig-Maximilians-Universität München, Faculty of Psychology, Raum 3432, Leopoldstr. 13, 80802 München, Germany.
| | - Janine H Clemons
- Auckland University of Technology, AUT Midwifery Department, Private Bag 92006, 640 Great South Road, Manukau, Auckland 2104, New Zealand.
| | - Lesley Dixon
- New Zealand College of Midwives, PO Box 21-106, Edgeware, Christchurch 8143, New Zealand.
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Clemons JH, Gilkison A, Mharapara TL, Dixon L, McAra-Couper J. Midwifery Job Autonomy in New Zealand: I do it all the time. Women Birth 2020; 34:30-37. [PMID: 32962945 DOI: 10.1016/j.wombi.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This research aimed to identify what supports and what hinders job autonomy for midwives in New Zealand. METHODS Registered midwives participated in an open-ended, online survey in 2019. Anonymised participants were asked to describe an incident when they felt they were using their professional judgement and/or initiative to make decisions and the resultant actions. The data was analysed thematically. FINDINGS The participants identified that autonomy is embedded within midwifery practice in New Zealand. Self-employed midwives who provide continuity of care as Lead Maternity Carers, identified they practice autonomously 'all the time'. The relationship with women and their family, and informed decision making, motivated the midwife to advocate for the woman - regardless of the midwife's work setting. Midwifery expertise, skills, and knowledge were intrinsic to autonomy. Collegial relationships could support or hinder the midwives' autonomy while a negative hospital work culture could hinder job autonomy. DISCUSSION Midwives identified that autonomous practice is embedded in their day to day work. It strengthens and is strengthened by their relationships with the woman/whanau and when their body of knowledge is acknowledged by their colleagues. Job autonomy was described when midwifery decisions were challenged by health professionals in hospital settings and these challenges could be viewed as obstructing job autonomy. CONCLUSION The high job autonomy that New Zealand midwives enjoy is supported by their expertise, the women and colleagues that understand and respect their scope of practice. When their autonomy is hindered by institutional culture and professional differences provision of woman-centred care can suffer.
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Affiliation(s)
- Janine H Clemons
- Department of Midwifery, Auckland University of Technology, South Campus, Auckland 2104, New Zealand.
| | - Andrea Gilkison
- Department of Midwifery, Auckland University of Technology, South Campus, Auckland 2104, New Zealand
| | - Tago L Mharapara
- Department of Management, Auckland University of Technology, City Campus, Auckland 1142, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch 8143, New Zealand
| | - Judith McAra-Couper
- Department of Midwifery, Auckland University of Technology, South Campus, Auckland 2104, New Zealand
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Barker M, Fenwick J, Gamble J. Midwives' Experiences of Transitioning Into Private Practice With Visiting Access in Australia: A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-19-00031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDA national review of maternity services in Australia in 2009 resulted in legislative changes which provided midwives with an unprecedented opportunity to offer continuity of care as a private practitioner with visiting access to a public maternity hospital. However, very few midwives have taken up this opportunity.AIMTo explore the experiences of midwives who transitioned into private practice with visiting access to a public hospital.METHODUsing a qualitative descriptive approach, six midwives participated in digitally recorded in-depth interviews. Data was analyzed using thematic analysis.FINDINGSTransitioning to private practice enabled midwives to align their core midwifery values with their practice. Midwives reported taking “a leap of faith” by venturing into private practice. Although seeking visiting access and running a small business was initially daunting, midwives were rewarded by being able to practice autonomously and provide continuity of woman centered care within a caseload model. The legislative restrictions, especially around employing other midwives posed significant challenges.DISCUSSION AND CONCLUSIONSPrivate practice with visiting access provided midwives with a service model that aligned their core midwifery values with their clinical practice. The model facilitated their ability to work as lead care professionals, provide woman centered care, and access a collaborative network of healthcare professions. However, the midwives continued to experience structural barriers that threaten the scalability and sustainability of the model. Structural barriers to midwives working to their full scope of practice and in alignment with a midwifery philosophy are a global issue. Further reforms are needed.
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Abstract
Objective To explore the definition of autonomy, its significant features and impacts on midwifery practice. Method Combined keywords searched were performed on electronic databases: Scopus, Science Direct and Medline within EBSCOhost and Google Scholar. Data were extracted and analysed corresponding to the objectives of this review. Findings A total of eight studies (n=8) were included (one quantitative and seven qualitative). Autonomy is the central element in midwifery that is commonly linked with informed choices; decision-making and power to control over a situation. In order for a midwife to be autonomous, important attributes include knowledge and skills (being confident, and the ability to think critically). It was also found that infrastructure and culture at work impacts autonomy in midwifery practice. Conclusion Albeit a limited number of studies were included in the review, this review provides an important platform for understanding the principles and concepts that underpin autonomy in midwifery practice.
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Affiliation(s)
| | | | - Deeni Rudita Idris
- Lecturer, PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam
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