A systematic integrative literature review of the factors influencing the professionalization of midwifery in the last decade (2009-2019)

The exploration of professional midwifery autonomy: Understanding and experiences of final-year midwifery students

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.

Newly graduated nurses' perceptions of their professional role and professional competency: a qualitative focus group study

BACKGROUND

In recent years, complex and rapidly changing healthcare settings have placed high demands on nursing graduates, who must effectively assume new professional roles with a wide variety of competencies. However, in an ever-altering environment it is impossible to teach students everything. This means that assessing nursing students' perceptions of their ability to practise their competencies and assume their professional roles is critical for faculty to further develop the nursing education curriculum and to assist healthcare organisations in supporting the transition of graduates. The aim of the study was to explore newly graduated nurses' perceptions of their new professional role and professional competency associated with this role.

METHODS

A qualitative study using the focus group method. The purposive sample included 18 nursing graduates with an average of 29 years, most of whom were female. The average time that had elapsed since graduation was 1.5 years. Four face-to-face focus group interviews were conducted. Thematic analysis was employed to identify themes and subthemes.

RESULTS

Three main themes describing newly graduated nurses' perceptions were found: (1) significance of the transition period; (2) commitment to the nursing profession; and (3) perceived needs and challenges to professional competency.

CONCLUSION

The transition from a safe academic environment to turbulent clinical practice is shaped by both graduates' expectations and reality. The results of the study indicate a high level of commitment to the profession immediately after graduation and point to groups of competencies that need greater emphasis in the nursing curriculum. Although the responsibility for adequately preparing and supporting nursing students for their new professional roles rests with faculty and healthcare organisations, the responsibility for professional development should also lie on the students themselves.

How Do Midwives View Their Professional Autonomy, Now and in Future?

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.

Key Maternity Care Stakeholders' Views on Midwives' Professional Autonomy

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.

The grounded theory of Coalescence of Perceptions, Practice and Power: An understanding of governance in midwifery practice

AIMS

This study aimed to understand midwifery care during labour, particularly decision-making processes, within Australian health systems.

BACKGROUND

Midwifery, founded on a wellness model of motherhood, is at risk of being medicalized. Whilst medical intervention is lifesaving, it requires judicious use. Governance provides oversight to care. Exploring decision-making contributes to understanding governance of practices.

METHOD

Straussian grounded theory using semi-structured interviews. Eighteen Australian registered midwives were interviewed about their practice when caring for women during labour.

RESULTS

Midwives were caught between divergent positions; birth as natural versus birth as risk. Experienced midwives discussed focussing on the woman, yet less experienced were preoccupied with mandatory protocols like early warning tools. Practice was governed by midwives approach within context of labour. The final theory: The Coalescence of Perceptions, Practice and Power, comprising three categories: perceptions and behaviour, shifting practice and power within practice, emerged.

CONCLUSIONS

Coalescence Theory elucidates how professional decision making by midwives during care provision is subject to power within practice, thereby governed by tensions, competing priorities and organizational mandates.

IMPLICATIONS FOR MIDWIFERY MANAGERS

Midwifery managers are well positioned to negotiate the nuanced space that envelopes birthing processes, namely, expert knowledge, policy mandates and staffing capability and resources, for effective collaborative governance. In this way, managers sustain good governance.