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Mengistie BA, Endale ZM, Azene ZN, Haile TT, Gebremichael Tsega A, Demeke M, Wassie YA, Abiy SA, Taye EB, Aragaw GM, Tsega NT. Predictors of burnout among midwives working at public hospitals in northwest Ethiopia, 2022: A multi-centred study. Women Birth 2024; 37:101654. [PMID: 39024981 DOI: 10.1016/j.wombi.2024.101654] [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: 11/24/2023] [Revised: 06/14/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024]
Abstract
PROBLEM Midwives are susceptible to burnout due to the physically and emotionally demanding nature of their job. Burnout is an occupational phenomenon with far-reaching consequences. AIM This study aimed to assess the magnitude of burnout and predictors among midwives working at public hospitals in northwest Ethiopia. METHODS An institutional-based cross-sectional study was conducted from February 7 to April 30, 2022. A simple random sampling method was employed to include 640 study participants. Data were collected using a self-administered questionnaire, entered into Epi-data 4.6 software, and exported to SPSS version 25 for analysis. A multivariable linear regression analysis model was fitted to identify factors contributing to midwives' burnout. FINDINGS The overall prevalence of midwives' burnout was 55.3 % (95 % CI = 51.7-58.9). The prevalence of personal, work-related, and client-related burnout was 58.3 %, 60.3 %, and 55.5 %, respectively. Factors that were significantly associated with burnout includes workplace violence (β = 5.02, CI: 2.90, 7.13), not receiving training (β = 4.32 CI: 1.81, 6.80), being exposed to blood and body fluids or needle stick injuries (β = 5.13 CI: 3.12, 7.13), low superior support (β = 5.13 CI: 1.94, 5.30), working in tertiary hospitals (β = 12.77 CI: 9.48, 16.06), and job rotation of six months or less (β = 16.75, CI: 13.12, 20.39). CONCLUSION This study found that the prevalence of burnout among midwives was significantly high. Addressing burnout requires implementing effective burnout prevention measures including enhancing management support, offering professional training, creating a conducive working environment, and adhering to standard precautions.
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Affiliation(s)
- Berihun Agegn Mengistie
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zerfu Mulaw Endale
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zelalem Nigussie Azene
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tsion Tadesse Haile
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Agnche Gebremichael Tsega
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Muluken Demeke
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.
| | - Yilkal Abebaw Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Saron Abeje Abiy
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Eden Bishaw Taye
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Getie Mihret Aragaw
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Nuhamin Tesfa Tsega
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Cummins A, Booth C, Lennon K, McLaughlin K, Prussing E, Newnham L. "A safe space"; A statewide evaluation of Midwifery Antenatal and Postnatal Service (MAPS) using the quality maternal newborn care, evidence informed framework. Women Birth 2024; 37:101642. [PMID: 38964229 DOI: 10.1016/j.wombi.2024.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The World Health Organization recommends Midwifery Continuity of Care (MCoC) due to the consistent improvements in outcomes for mothers and babies. Surveys from the United Kingdom and Australia reported large numbers of midwives are unable to commit to the on call component required to provide MCoC across the continuum. To address this challenge a modified MCoC model called Midwifery Antenatal and Postnatal Services (MAPS) has been introduced. The aim of this study was to evaluate MAPS services in six sites across one State in Australia. METHODS A multi-site qualitative descriptive study was undertaken framed by the Quality Maternal Newborn Care (QMNC) Framework. The QMNC framework was used to develop focus group questions for data collection, and as a lens for analysing data. Data were collected via focus groups from midwives and women at six sites ranging from metropolitan to regional and rural settings and thematically analysed. FINDINGS Participants (n=80) included women (n=28), midwives (n=44) and MAPS managers (n=8). This paper reports the findings from the women and midwives, presented under three themes: Getting onto the program, Knowing the story and Building confidence by sharing information. Each theme had subthemes and the findings were aligned either positively or negatively with the QMNC framework. CONCLUSION This study found the MAPS model aligns in positive ways with the QMNC quality care framework with some recommendations to improve quality care. Midwives want to provide continuity of care and MAPS is a useful model for providing continuity through the antenatal and postnatal periods.
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Affiliation(s)
- Allison Cummins
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia.
| | - Chelsea Booth
- Nursing and Midwifery Office, New South Wales Ministry of Health, Australia
| | - Kelley Lennon
- Nursing and Midwifery Office, New South Wales Ministry of Health, Australia
| | - Karen McLaughlin
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Elysse Prussing
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Liz Newnham
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
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Alemu SS, Hajure M, Agago MT, Hussein F, Gesisa HI, Teferi SM, Yohanes D, Wedajo LF. Prevalence of burnout and associated factors among midwives, 2023: institution-based cross-sectional study. Front Public Health 2024; 12:1422915. [PMID: 38979039 PMCID: PMC11228252 DOI: 10.3389/fpubh.2024.1422915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/14/2024] [Indexed: 07/10/2024] Open
Abstract
Background One of the main characteristics of the mental health condition known as burnout syndrome is an overwhelming feeling of physical and emotional tiredness, particularly with regard to one's work. Midwives are the group most prone to burnout because they work in emergency situations to save two lives at a time, share the stress of laboring women, and put in extra hours without enough payment. Besides this, there is little information on burnout among Ethiopian midwives. Objectives To assess burnout and associated factors among midwives working in public health facilities in West Arsi Zone, Ethiopia. Methods and materials A census method cross-sectional study was conducted among all 467 midwives working in public health facilities found in the West Arsi Zone, Ethiopia, from September 1 and 30, 2023. A pretested, validated face-to-face interviewer-administered structured questionnaire was used to collect data. Then, binary logistic regression was used for analysis. Bi-variable and multivariable logistic regression analyses were employed to identify factors associated with burnout. The level of statistical significance was declared at p < 0.05 with a 95% CI. Results Overall, the prevalence of burnout among midwives was 47.10% (95% CI: 42.55, 51.75%). Marital status not in union 2.03 (95% CI: 1.32-3.13), working more than 40 h per week 2.00 (95% CI: 1.29-3.08), conflict with their metron 2.33 (95% CI: 1.54-3.54), not satisfied with their current job 2.39 (95% CI: 1.56-3.66) and having depression symptoms 1.71 (95% CI: 1.06-2.74) were factors significantly associated with burnout. Conclusion This study found that in the study area, almost half of the midwives experienced burnout. Thus, it is recommended that midwives should develop respectful interactions with both their mentors and colleagues. Secondly, we suggest that zonal health offices set up systems that by shortening working hours and boost job satisfaction by creating conducive working environment, provide opportunities for career advancement and increase employee engagement.
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Affiliation(s)
- Solomon Seyife Alemu
- Department of Midwifery, College of Health Sciences, Madda Walabu University, Sheshemene, Ethiopia
| | - Mohammedamin Hajure
- Department of Psychiatry, College of Health Sciences, Madda Walabu University, Sheshemene, Ethiopia
| | - Mahlet Tesfaye Agago
- Department of Midwifery, College of Health Sciences, Madda Walabu University, Sheshemene, Ethiopia
| | - Feisal Hussein
- Department of Midwifery, College of Health Sciences, Madda Walabu University, Sheshemene, Ethiopia
| | - Hana Israel Gesisa
- Department of Midwifery, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | | | - Daniel Yohanes
- Department of Midwifery, College of Health Sciences, Madda Walabu University, Sheshemene, Ethiopia
| | - Lema Fikadu Wedajo
- Department of Midwifery, Institute of Health Sciences, Wollaga University, Nekemte, Ethiopia
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Talbot H, Peters S, Furber C, Smith DM. Midwives' experiences of discussing health behaviour change within routine maternity care: A qualitative systematic review and meta-synthesis. Women Birth 2024; 37:303-316. [PMID: 38195300 DOI: 10.1016/j.wombi.2024.01.002] [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: 09/06/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
PROBLEM Behaviours, such as smoking, alcohol use, unhealthy diet, lack of physical activity and vaccination non-adherence may lead to adverse pregnancy outcomes. BACKGROUND Pregnancy has been identified as an opportune time for midwives to support women to make health behaviour changes. AIM To synthesise existing qualitative research exploring midwives' experiences of discussing health behaviour change with women within routine care. METHODS A systematic search was conducted across: Maternity and Infant Care, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Applied Social Sciences Index and Abstracts. Thematic analysis was used to synthesise the data. A professional and public advisory group provided feedback during the synthesis stage. FINDINGS Twenty-two studies, published between 2005 and 2023, which represented findings from eight countries, were included in the review. The meta-synthesis revealed three themes: The midwife-woman relationship; Reflective and tailored behaviour change communication; Practical barriers to behaviour change conversations. This led to one overarching theme: Although midwives recognised the importance of behaviour change discussions, these conversations were not prioritised in clinical practice. CONCLUSION Health behaviour change discussions were de-prioritised in midwives' clinical practice. Future research should explore intervention development to support midwives with their health behaviour change communication.
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Affiliation(s)
- Hannah Talbot
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Christine Furber
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Debbie M Smith
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
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Hildingsson I, Fahlbeck H, Larsson B, Johansson M. Increasing levels of burnout in Swedish midwives - A ten-year comparative study. Women Birth 2024; 37:325-331. [PMID: 37914541 DOI: 10.1016/j.wombi.2023.10.010] [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: 07/06/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
PROBLEM Midwives' levels of burnout seem to be increasing worldwide. BACKGROUND Previous research show a high prevalence of burnout in midwives. AIM To compare levels of burnout in two national Swedish samples of midwives completing a similar survey. METHODS A comparative study of two cross-sectional national surveys directed at midwives in 2012 and 2022. To measure burnout in midwives, the Copenhagen Burnout Inventory with 19 items was used. FINDINGS The sample consisted of 2209 midwives: 466 from 2012 and 1743 from 2022. Personal burnout showed an increase from 39.5 % to 53.6 % over the years; work burnout increased from 15.5 % to 49.2 % and client burnout increased from 15 % to 20.9 %. Personal burnout was associated with working shift. Work burnout was associated with length of work experience and working rotating shifts; and client burnout was associated with shorter work experience. DISCUSSION The highest increase in burnout was found in the work domain in 2022 compared to 2012. Notable in the present study is the increase in client burnout, which could be a sign of midwives becoming less caring and more cynical. CONCLUSION This study showed that self-reported levels of burnout among Swedish midwives increased over the ten-year period studied. The largest increase was found in the subscale work burnout. Midwives with shorter work experience and those with shift work were the most vulnerable to burnout. Improved organisation of midwifery services needs to be designed to ensure healthy working conditions for midwives.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Hanna Fahlbeck
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Sophiahemmet University College, Stockholm, Sweden
| | - Margareta Johansson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Villadsen SF, Johnsen H, Damsted Rasmussen T, Ekstrøm CT, Sørensen J, Azria E, Rich-Edwards J, Essén B, Christensen U, Smith Jervelund S, Nybo Andersen AM. Unlocking the mechanisms of change in the MAMAACT intervention to reduce ethnic disparity in stillbirth and newborns' health: integration of evaluation findings. FRONTIERS IN HEALTH SERVICES 2024; 4:1233069. [PMID: 38433990 PMCID: PMC10904659 DOI: 10.3389/frhs.2024.1233069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
Ethnic disparities in stillbirth exist in Europe and suboptimal care due to miscommunication is one contributing cause. The MAMAACT intervention aimed to reduce ethnic disparity in stillbirth and newborns' health through improved management of pregnancy complications. The intervention encompassed training of antenatal care midwives in cultural competencies and intercultural communication combined with health education materials for the expecting parents about symptoms of pregnancy complications. The evaluation consisted of a qualitative in-depth implementation analysis and a process evaluation embedded in a cluster randomized trial including 19 of 20 maternity wards in Denmark. In this article, the findings from the different evaluation perspectives are integrated. The integration follows the principles of realist evaluation by analyzing to what extent the MAMAACT activities were generating mechanisms of change in interaction with the context. The integration analysis shows that the health education materials in the MAMAACT intervention contributed to heightened health literacy concerning pregnancy complications among pregnant women. Additionally, the training of midwives in cultural competency and intercultural communication raised awareness among midwives. Nonetheless, the exclusive emphasis on midwives and the inflexibility in care provision hindered them from changing their communication practices. To enhance the cultural competence in maternity care, it is essential to implement more comprehensive initiatives involving healthcare professionals in maternity care at all levels, from pregraduate to postgraduate. Adequate interpreter services and management support should also be ensured. Currently, the Danish antenatal care system faces challenges including inadequate information transfer between healthcare sectors, insufficient differentiation of care, and inflexibility in midwife scheduling. This results in a lack of responsiveness to the individual needs of women with immigrant backgrounds, potentially reproducing health inequities.
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Affiliation(s)
- Sarah Fredsted Villadsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Johnsen
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Copenhagen, Denmark
| | - Trine Damsted Rasmussen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Janne Sørensen
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elie Azria
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Paris, France
| | - Janet Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Birgitta Essén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Signe Smith Jervelund
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Mengistie BA, Azene ZN, Haile TT, Abiy SA, Abegaz MY, Taye EB, Alemu HN, Demeke M, Melese M, Tsega NT, Aragaw GM. Work-related burnout and its associated factors among midwives working at public hospitals in northwest Ethiopia: a multi-centered study. Front Psychiatry 2023; 14:1256063. [PMID: 38164420 PMCID: PMC10757949 DOI: 10.3389/fpsyt.2023.1256063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Work-related burnout (WRB) is defined as the degree of physical and psychological fatigue and exhaustion that is perceived by the person as related to work. Midwives are vulnerable to work-related burnout due to their physically and emotionally demanding nature of their job. It affects the health of professionals and the quality of care provided. However, there is limited evidence on the burden and predictors associated with work-related burnout among midwives in developing countries, including Ethiopia. This study investigated the burden and contributing factors of work-related burnout among midwives in northwest Ethiopia. Methods A facility-based cross-sectional study was conducted from February 7 to April 30, 2022. A simple random sampling method was used to enroll 640 study participants. The Copenhagen burnout inventory tool was used to assess the magnitude of work-related burnout. A self-administered questionnaire was used to collect data, which was then entered into Epi Data 4.6 software and exported to SPSS version 25 for analysis. A multivariable logistic regression analysis model was fitted to identify factors associated with work-related burnout. The Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) was reported to declare the factors that are significantly associated with work-related burnout. Results The prevalence of work-related burnout was found to be 60.47% (95% CI = 56.6-64.2). Workplace violence (AOR = 3.33, CI: 2.02, 5.48), working hours over 60 h a week (AOR = 4.55, CI: 2.78, 7.43), emotional demand of the job (AOR = 8.85, 95% CI: 4.48, 17.47), exposure to blood and body fluids/sharp injuries (AOR = 5.13, CI: 3.12, 7.13), good superior support (AOR = 0.38, CI: 0.23, 0.63), Job rotation of ≤6 months (AOR = 2.30, CI: 1.28, 4.14) and being stressed (AOR = 2.64, CI: 1.63, 4.26) were all found to be strongly linked to work-related burnout. Conclusion and recommendation This study found a significant level of work-related burnout among midwives working in public hospitals. Experiencing workplace violence, a job rotation of less than or equals to six months, working hours over 60 h a week, good superior support, exposure to blood and body fluids or needle stick injuries and experiencing stress were significant factors that influenced work-related burnout. Therefore, reducing prolonged working hours, promoting supportive management, creating a safe working environment, and applying effective stress prevention strategies are some of the interventions to prevent or alleviate work-related burnout.
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Affiliation(s)
- Berihun Agegn Mengistie
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Nigussie Azene
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsion Tadesse Haile
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Saron Abeje Abiy
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marta Yimam Abegaz
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eden Bishaw Taye
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haymanot Nigatu Alemu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Demeke
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Mihret Melese
- The Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Nuhamin Tesfa Tsega
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getie Mihret Aragaw
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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McLardie-Hore FE, McLachlan HL, Forster DA, Holmlund S, McCalman P, Newton MS. Comparing the views of caseload midwives working with First Nations families in an all-risk, culturally responsive model with midwives working in standard caseload models, using a cross-sectional survey design. Women Birth 2023; 36:469-480. [PMID: 37407296 DOI: 10.1016/j.wombi.2023.05.006] [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: 02/20/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 07/07/2023]
Abstract
PROBLEM Little is known about midwives' views and wellbeing when working in an all-risk caseload model. BACKGROUND Between March 2017 and December 2020 three maternity services in Victoria, Australia implemented culturally responsive caseload models for women having a First Nations baby. AIM Explore the views, experiences and wellbeing of midwives working in an all-risk culturally responsive model for First Nations families compared to midwives in standard caseload models in the same services. METHODS A survey was sent to all midwives in the culturally responsive (CR) model six-months and two years after commencement (or on exit), and to standard caseload (SC) midwives two years after the culturally responsive model commenced. Measures used included the Midwifery Process Questionnaire and Copenhagen Burnout Inventory (CBI). FINDINGS 35 caseload midwives (19 CR, 16 SC) participated. Both groups reported positive attitudes towards their professional role, trending towards higher median levels of satisfaction for the culturally responsive midwives. Midwives valued building close relationships with women and providing continuity of care. Around half reported difficulty maintaining work-life balance, however almost all preferred the flexible hours to shift work. All agreed that a reduced caseload is needed for an all-risk model and that supports around the model (e.g. nominated social workers, obstetricians) are important. Mean CBI scores showed no burnout in either group, with small numbers of individuals having burnout in both groups. DISCUSSION AND CONCLUSION Midwives were highly satisfied working in both caseload models, but decreased caseloads and more organisational supports are needed in all-risk models.
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Affiliation(s)
- Fiona E McLardie-Hore
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; The Royal Women's Hospital, Parkville, Victoria 3052 Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; The Royal Women's Hospital, Parkville, Victoria 3052 Australia
| | - Sophia Holmlund
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; Department of Nursing, Umeå University, Umeå, Sweden; Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Pamela McCalman
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
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Johnsen H, Lichtenberg VD, Rydahl E, Karentius SM, Dueholm SCH, Friis-Alstrup M, Backhausen MG, Røhder K, Schiøtz ML, Broberg L, Juhl M. The Feasibility and Acceptability of the Adverse Childhood Experiences Questionnaire in Danish Antenatal Care-A Qualitative Study of Midwives' Implementation Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105897. [PMID: 37239623 DOI: 10.3390/ijerph20105897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Adverse childhood experiences have a potential lifelong impact on health. A traumatic upbringing may increase antenatal health risks in mothers-to-be and impact child development in their offspring. Yet, little is known about the identification of adverse childhood experiences in antenatal care. The objective of this study was to explore the feasibility and acceptability of the adverse childhood experiences questionnaire among midwives and factors affecting its implementation. Three Danish maternity wards participated in the study. The data consisted of observations of midwifery visits and informal conversations with midwives, as well as mini group interviews and dialogue meetings with midwives. The data were analysed using systematic text condensation. Analysis of the data revealed three main categories; "Relevance of the adverse childhood experiences questionnaire", "Challenges related to use of the adverse childhood experiences questionnaire" and "Apprehensions, emotional strain, and professional support". The findings showed that the adverse childhood experiences questionnaire was feasible to implement in Danish antenatal care. Midwives' acceptability of the questionnaire was high. Training courses and dialogue meetings motivated the midwives to work with the questionnaire in practice. The main factors affecting the implementation process were time restrictions, worries of overstepping women's boundaries, and a lack of a specific intervention for women affected by their traumatic upbringing circumstances.
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Affiliation(s)
- Helle Johnsen
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Vibeke de Lichtenberg
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Eva Rydahl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Sara Mbaye Karentius
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | | | | | - Mette Grønbæk Backhausen
- Department of Gynecology and Obstetrics, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Katrine Røhder
- Institute for Psychology, Copenhagen University, Øster Farimagsgade 2A, 1350 Copenhagen K, Denmark
- The Family Clinic, Department of Obstetrics and Gynaecology, Amager and Hvidovre Hospital, Pavillon 4, Østre Hospitalsvej 5A, 2650 Hvidovre, Denmark
| | - Michaela Louise Schiøtz
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Lotte Broberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Mette Juhl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
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Moncrieff G, Martin CH, Norris G, MacVicar S. "It's no ordinary job": Factors that influence learning and working for midwifery students placed in continuity models of care. Women Birth 2023; 36:e328-e334. [PMID: 36208992 DOI: 10.1016/j.wombi.2022.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 04/24/2023]
Abstract
BACKGROUND Maternity policy and guidelines increasingly recommend or stipulate the increased provision of midwifery continuity of carer as a priority model of care. The scale up and sustainability of this model will require that student midwives are competent to provide continuity of carer at the point of qualification. Guidance relating to how to optimally prepare student midwives to work within continuity models is lacking. AIM To explore perspectives and experiences of working within and learning from student placement within continuity models of care. METHODS An online mixed methods survey aimed at midwifery students and qualified midwives with experience of working within or providing education relating to continuity models. Quantitative results were analysed through descriptive statistics while free text responses were brought together in themes. FINDINGS Benefits and challenges to placement within continuity models were identified. These provide recommendations that will enhance learning from and skill development within continuity models of care. CONCLUSION There is a need for continuity of mentorship and strong relationships between education and practice, and the provision of flexible curriculum content around this to enable students to prioritise appointments with women in their care. System level evaluation and support is needed to guide the optimal provision of continuity models, so that they are effective in improving outcomes and experiences. Foregrounding woman centred care as foundational to education and facilitating the critical deconstruction of dominant discourses that conflict with, and may prevent this form of practice, will promote the provision of care that is integral to these models.
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Affiliation(s)
- Gill Moncrieff
- School of Health & Social Care, Sighthill Campus, Edinburgh Napier University, EH11 4BN, United Kingdom.
| | - Caroline Hollins Martin
- School of Health & Social Care, Sighthill Campus, Edinburgh Napier University, EH11 4BN, United Kingdom
| | - Gail Norris
- School of Health & Social Care, Sighthill Campus, Edinburgh Napier University, EH11 4BN, United Kingdom
| | - Sonya MacVicar
- School of Health & Social Care, Sighthill Campus, Edinburgh Napier University, EH11 4BN, United Kingdom
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11
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Kuliukas L, Warland J, Cornell P, Thomson B, Godwin H, Bradfield Z. Embracing the continuity of care experience: A new Australian graduate entry master of midwifery course with a student caseload of 15 women per year. Women Birth 2023; 36:151-154. [PMID: 36456446 DOI: 10.1016/j.wombi.2022.11.011] [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: 08/30/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women receiving continuity of midwifery care have increased satisfaction and improved outcomes. Preparation of midwifery students to work in continuity models from the point of graduation may provide an ongoing midwifery workforce that meets rising demand from women for access to such care. AIM OF THE PAPER The aim of this paper is to describe an innovative midwifery course based on a continuity model, where students acquire more than 50 % of clinical hours through continuity of care experiences. Additional educational strategies incorporated in the course to enhance the CCE experience within the philosophy of midwifery care, include a virtual maternity centre, case-based learning and the Resources Activities Support Evaluation (RASE) pedagogical model of learning. DISCUSSION Australian accredited midwifery courses vary in structure, format and philosophy; this new course provides students with an alternative option of study for those who have a particular interest in continuity of midwifery care. CONCLUSION A midwifery course which provides the majority of clinical hours through continuity of care may prepare graduates for employment within midwifery group practice models by demonstrating the benefits of relationship building, improved outcomes and the reality of an on-call lifestyle.
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Affiliation(s)
- Lesley Kuliukas
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Jane Warland
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Peta Cornell
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Brooke Thomson
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Helen Godwin
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Zoe Bradfield
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
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12
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Hildingsson I, Fahlbeck H, Larsson B, Johansson M. 'A perfect fit' - Swedish midwives' interest in continuity models of midwifery care. Women Birth 2023; 36:e86-e92. [PMID: 35504815 DOI: 10.1016/j.wombi.2022.04.014] [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: 02/07/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Midwifery continuity models of care are highly recommended yet rare in Sweden, although approximately 50% of pregnant women request them. Before introducing and scaling up continuity models in Sweden, midwives' attitudes about working in continuity models must be investigated. OBJECTIVE to investigate Swedish midwives' interests in working in midwifery continuity models of care and factors influencing the midwifery workforce's readiness for such models. METHODS A cross-sectional online survey was utilised and information collected from a national sample of midwives recruited from two unions regarding background and work-related variables. Crude and adjusted odds ratios and logistic regression analysis were used in the analysis. RESULTS A total of 2084 midwives responded and 56.1% reported an interest. The logistic regression model showed that respondents' ages 24-35 years (OR 1.73) or 35-45 years (OR 1.46); years of work experience 0-3 years (OR 5.81) and 3-10 years (OR 2.04); rotating between wards or between tasks (OR 2.02) and working temporary (OR 1.99) were related to interest in continuity models. In addition, working daytime only (OR 1.59) or on a two-shift schedule (OR 1.93) was associated with such interest. CONCLUSION A sufficient number of midwives in Sweden appear to be interested in working in continuity models of midwifery care to align with women's interest in having a known midwife throughout pregnancy, birth and postpartum period. Developing strategies and continuity models that will address the preferences of women in various areas of Sweden is important for offering evidence-based maternity services.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Hanna Fahlbeck
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Margareta Johansson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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13
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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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Doherty J, O’Brien DD. Giving of the self and Midwife Burnout – An exploration of the consequences of being ‘with woman’ and how individual midwives can reduce or prevent burnout. Women Birth 2022:S1871-5192(22)00362-6. [DOI: 10.1016/j.wombi.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/25/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
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15
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Paul N, Limprecht-Heusner M, Eichenauer J, Scheichenbauer C, Bärnighausen T, Kohler S. Burnout among midwives and attitudes toward midwifery: A cross-sectional study from Baden-Württemberg, Germany. Eur J Midwifery 2022; 6:46. [PMID: 35974711 PMCID: PMC9330327 DOI: 10.18332/ejm/150582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION METHODS RESULTS CONCLUSIONS
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Affiliation(s)
- Nicolas Paul
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Marcus Limprecht-Heusner
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | | | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Stefan Kohler
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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16
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Johnsen H, Juhl M, Møller BK, de Lichtenberg V. Adult Daughters of Alcoholic Parents-A Qualitative Study of These Women's Pregnancy Experiences and the Potential Implications for Antenatal Care Provision. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063714. [PMID: 35329401 PMCID: PMC8950929 DOI: 10.3390/ijerph19063714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/10/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
The adult children of alcoholic parents are at increased risk of having health problems compared to the adult children of nonalcoholic parents. Little is known about how growing up with alcoholic parents affects women’s experiences when pregnant. The objectives of this study were to explore how adverse childhood experiences related to parental alcohol abuse affect women during their pregnancy and to assess the potential implications of women’s experiences for antenatal care provision. Twelve in-depth interviews were performed with women who were brought up by an alcoholic mother and/or father. Systematic text condensation was used to analyse the data. Two main categories were identified: ‘establishing relationships and having social support’ and ‘antenatal care encounters and concerns during pregnancy’. Women’s trust in others in adult life was impacted by their upbringing. Strained relationships with their parents and few friends meant that the women primarily relied on their partners for support. Neither antenatal care providers nor women talked about women’s childhood experiences at the visits. The women described concerns related to the baby’s health, lack of predictability and control during the pregnancy, as well as apprehensiveness regarding birth and motherhood. The potential implications for practice include systematic screening for adverse childhood experiences, antenatal preparation classes, parenting courses, and post-graduate training.
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17
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Barbounaki S, Vivilaki VG. A fuzzy intelligent system to assess midwives’ burnout conditions. Eur J Midwifery 2022; 6:7. [PMID: 35233514 PMCID: PMC8842086 DOI: 10.18332/ejm/143363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Stavroula Barbounaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Victoria G. Vivilaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
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18
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Bleijenbergh R, Mestdagh E, Kuipers YJ. Midwifery Practice and Education in Antwerp: Forecasting Its Future With Scenario Planning. J Contin Educ Nurs 2022; 53:21-29. [PMID: 34978478 DOI: 10.3928/00220124-20211210-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Midwifery across the world is facing changes and uncertainties. By recognizing plausible future options, a contemporary and strategic scope of midwifery practice and education can be established. The city of Antwerp, Belgium, was the indicative case for this study. Key drivers were identified to serve as input for scenarios. METHOD Structuration theory and intuitive logics scenario planning methods were used to structure contextual midwifery scenarios. RESULTS Six certain and six uncertain variables were identified. A two-dimensional framework showed these factors: (a) maternity care services and organization and (b) the society of child-bearing women and their families. Three scenarios described the plausible future of midwifery: (a) midwife-led care monitoring maternal health needs, (b) midwife-led holistic care, and (c) midwife/general practitioner-led integrated maternity care. CONCLUSION All of the scenarios show the direction of change with a strategic focus, the importance of midwifery authenticity, and digital adaptability in maternity services. Also, the coronavirus disease 2019 (COVID-19) pandemic cannot be ignored in future midwifery. [J Contin Educ Nurs. 2022;53(1):21-29.].
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19
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Thumm EB, Smith DC, Squires AP, Breedlove G, Meek PM. Burnout of the US midwifery workforce and the role of practice environment. Health Serv Res 2021; 57:351-363. [PMID: 34893977 PMCID: PMC8928036 DOI: 10.1111/1475-6773.13922] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/16/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine the prevalence of burnout among the midwifery workforce and the association between fixed personal and practice characteristics and modifiable organizational factors, specifically practice environment, to burnout among midwives in the United States. DATA SOURCE Primary data collection was conducted via online survey of the full national roster of certified nurse-midwives and certified midwives over three weeks in April 2017. STUDY DESIGN The study was a cross-sectional observational survey consisting of 95 items about personal and practice characteristics, respondents' practice environments, and professional burnout. DATA COLLECTION METHODS The inclusion criteria was actively practicing midwifery in the US. Data were analyzed with bivariate analyses to determine the association between personal and practice characteristics and burnout. A hierarchal multilinear regression evaluated to the inter-relationship between personal and practice characteristics, practice environment, and burnout. PRINCIPAL FINDINGS Of the almost one third (30.9%) of certified nurse-midwives and certified midwives who responded to the survey, 40.6% met criteria for burnout. Weak negative correlations existed between burnout and indicators of career longevity: age (r(2256)=-0.09, p<0.01), years as a midwife (r(2267)=-0.07, p=0.01), and years with employer (r(2271)=-0.05, p=0.02). There were significant relationships between burnout score and patient workload indicators: patients per day in out-patient setting [F(5,2292)=13.995, p<0.01], birth volume [F(3,1864)=8.35, p<0.01], and patient acuity [F(2,2295)=20.21, p<0.01]. When the practice environment was entered into the model with personal and practice characteristics, the explained variance increased from 6.4% to 26.5% (F(20,1478)=27.98, p<0.01). CONCLUSIONS Our findings suggested that a key driver of burnout among US midwives was practice environment, specifically practice leadership and participation and support for the midwifery model of care. Structural and personal characteristics contributed less to burnout score than the practice environment, implying that prevention of burnout may be achieved through organizational support and does not require structural changes to the provision of perinatal health.
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Affiliation(s)
- E Brie Thumm
- University of Colorado College of Nursing, 13120 E 19th Ave, Aurora, CO
| | - Denise C Smith
- University of Colorado College of Nursing, 13120 E 19th Ave, Aurora, CO
| | - Allison P Squires
- New York University Rory Meyers School of Nursing, 433 1st Ave., New York
| | | | - Paula M Meek
- University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT
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20
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Durán-Gómez N, Guerrero-Martín J, Pérez-Civantos D, López-Jurado CF, Montanero-Fernández J, Cáceres MC. Night Shift and Decreased Brain Activity of ICU Nurses: A Near-Infrared Spectroscopy Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211930. [PMID: 34831683 PMCID: PMC8623720 DOI: 10.3390/ijerph182211930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/02/2022]
Abstract
Background: Shift working is associated with a profound desynchronization of circadian rhythm and in particular, night-shift work disrupts normal circadian physiology. Sleep deprivation affects the functioning of certain brain areas and thus impairs cognitive performance. The purpose of this study was to investigate the effects of the night shift on cognitive performance and cerebral oxygenation/haemodynamics. Methods: A prospective, observational, comparative, randomized and cross-over study was carried out. A total of 74 intensive care unit nurses in Spain were included in the study. The following variables were measured: sociodemographic, burnout, anxiety, baseline cerebral oxygenation levels on night and day shift using a near-infrared spectroscopy system and cognitive task performance during a verbal fluency task to evaluate the alterations in the prefrontal cortex, assessed as changes in regional saturation index. Results: The average regional saturation index decreased significantly in the night shift (r = 0.560, p < 0.001). The ICU nurses showed a significant decrease in the verbal fluency test on average (8.53 ± 8.49, p < 0.001) and, in general, there was also a significant increase in anxiety score (3.17 ± 7.56, p = 0.001). Conclusions: Sleep deprivation during the night shift was considered to be related to decreased dorsolateral PFC reactivity. After the night shift, the nurses showed a decrease in prefrontal cortex activity and in cognitive performance.
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Affiliation(s)
- Noelia Durán-Gómez
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (J.G.-M.); (C.F.L.-J.); (M.C.C.)
- Correspondence: ; Tel.: +34-92-428-9466
| | - Jorge Guerrero-Martín
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (J.G.-M.); (C.F.L.-J.); (M.C.C.)
| | - Demetrio Pérez-Civantos
- Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Hospital Universitario de Badajoz, 06006 Badajoz, Spain;
| | - Casimiro Fermín López-Jurado
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (J.G.-M.); (C.F.L.-J.); (M.C.C.)
| | - Jesús Montanero-Fernández
- Departamento de Matemáticas, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain;
| | - Macarena C. Cáceres
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (J.G.-M.); (C.F.L.-J.); (M.C.C.)
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Hanley A, Davis D, Kurz E. Job satisfaction and sustainability of midwives working in caseload models of care: An integrative literature review. Women Birth 2021; 35:e397-e407. [PMID: 34257046 DOI: 10.1016/j.wombi.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Demand for caseload midwifery care continues to outstrip supply. We know little about what sustains midwives working in caseload models of care. AIM This review systematically identifies and synthesises research findings reporting on factors which contribute to job satisfaction, and therefore the sustainability of practice, of midwives working in caseload models of care. METHODS A comprehensive search strategy explored the electronic databases CINAHL Plus with Full Text, MEDLINE, PubMED, Cochrane Database of Systematic Reviews, and Scopus. Articles were assessed using the Crowe Critical Appraisal Tool. Data analysis and synthesis of these publications were conducted using a narrative synthesis approach. FINDINGS Twenty-two articles were reviewed. Factors which contribute to the job satisfaction and sustainability of practice of midwives working in caseload models are: the ability to build relationships with women; flexibility and control over own working arrangements; professional autonomy and identity; and, organisational and practice arrangements. CONCLUSION Insights into the factors which contribute to the job satisfaction and sustainability of practice of midwives in caseload models of care enables both midwives and healthcare administrators to more effectively implement and support midwifery-led caseload models of care which have been shown to improve outcomes for childbearing women.
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Affiliation(s)
- Andrea Hanley
- Faculty of Health, University of Canberra and ACT Government Health Directorate, ACT, Australia
| | - Deborah Davis
- Faculty of Health, University of Canberra and ACT Government Health Directorate, ACT, Australia
| | - Ella Kurz
- Faculty of Health, University of Canberra, University Drive, Belconnen, ACT 2617, Australia.
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Pace CA, Crowther S, Lau A. Midwife experiences of providing continuity of carer: A qualitative systematic review. Women Birth 2021; 35:e221-e232. [PMID: 34253467 DOI: 10.1016/j.wombi.2021.06.005] [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: 04/08/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Continuity of carer models present positives and challenges for midwives working in them, and are difficult to sustain. BACKGROUND Research shows midwifery continuity of carer improves perinatal outcomes and experiences, and is considered the optimal model of care. AIM To synthesise existing research on midwives' experiences of providing continuity of carer and generate further understanding of what sustains them in practice. METHODS Protocol for the review was developed using PRISMA guidelines and registered with PROSPERO. 22 studies were included with original themes and findings extracted using JBI tools and synthesised using meta-ethnographic techniques. GRADE CERQual assessment of review findings showed high confidence. FINDINGS Midwives identified working in continuity of carer models as both fulfilling and challenging. Professional autonomy and ability to develop meaningful relationships were the most commonly cited positives, while lack of work life balance and conflict with the wider maternity team were the main challenges. 15 studies identified strategies employed by midwives which sustained them in practice. DISCUSSION Midwife experiences of providing continuity are impacted by personal and professional factors. Of paramount importance to sustainability of the model is the support of the wider organisation, and their alignment with principles of person-centred, relational care. CONCLUSION Relational models of care are desired by midwives, service users and are recommended in policy. Relational models of care must be responsive to midwives needs as well as birthing people, and therefore need to be designed and managed by those working in them and supported by the whole organisation to be sustainable.
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Affiliation(s)
- Charlotte Ashley Pace
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK.
| | - Susan Crowther
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK; AUT University, Auckland, New Zealand.
| | - Annie Lau
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
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Rodríguez Coll P, Cabedo Ferreiro R, Palau Costafreda R, Cantó Codina L, García Perdomo S, Obregón Gutiérrez N, Escuriet Peiró R. Level of Job Burnout among Midwives Working in Labour Rooms in Barcelona Region: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2021; 9:215-224. [PMID: 34222542 PMCID: PMC8242408 DOI: 10.30476/ijcbnm.2021.88038.1504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nowadays, burnout syndrome (BS) symptoms appear to have increased in healthcare workers, specifically midwives, but there are no studies on burnout among midwives in Catalonia. The present study aimed to assess and describe the prevalence of BS in midwives working in labour rooms. METHODS A cross-sectional descriptive study was conducted on 122 midwives working in 24 maternity hospitals in the Barcelona (region) which were selected using purposive sampling from January to March 2017. Data were collected using two questionnaires (demographic information, job burnout using Spanish Burnout Inventory with 20 items and four subscales). Data analysis was performed using SPSS software version 21 and Chi-Square, U Mann-Whitney, and Kruskall-Wallis. P<0.05 was considered statistically significant. RESULTS None of the participants obtained a critical level of BS. 37 (30.33%) participants scored medium burnout and 47 (38.52%) recorded low burnout. Statistically, work stress (P=0.01), marital status (P=0.006), attendance of more than three women per shift (P=0.001), the number of children (P=0.01), parity (P=0.005), health status (P=0.04), and being on sick leave over last year (P=0.04) were significantly correlated with medium-high levels of burnout. Burnout scores were higher in midwives having a life partner and those without children. CONCLUSION Following the results, no participant obtained a critical level of BS; about one-third of them scored medium-high burnout. However, specific interventions are suggested to be conducted to maintain the midwives' motivation and prevent burnout development.
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Affiliation(s)
- Pablo Rodríguez Coll
- Ghenders Research Group, School of Health Sciences Blanquerna, University Ramon Llull, Padilla, Barcelona, Spain
- Research Department in the Midwives’ Section of the Barcelona Nursing College (COIB), Barcelona, Spain
| | - Rosa Cabedo Ferreiro
- Ghenders Research Group, School of Health Sciences Blanquerna, University Ramon Llull, Padilla, Barcelona, Spain
- Research Department in the Midwives’ Section of the Barcelona Nursing College (COIB), Barcelona, Spain
| | - Roser Palau Costafreda
- Ghenders Research Group, School of Health Sciences Blanquerna, University Ramon Llull, Padilla, Barcelona, Spain
- Research Department in the Midwives’ Section of the Barcelona Nursing College (COIB), Barcelona, Spain
| | - Laia Cantó Codina
- Ghenders Research Group, School of Health Sciences Blanquerna, University Ramon Llull, Padilla, Barcelona, Spain
- Research Department in the Midwives’ Section of the Barcelona Nursing College (COIB), Barcelona, Spain
| | - Sergio García Perdomo
- Ghenders Research Group, School of Health Sciences Blanquerna, University Ramon Llull, Padilla, Barcelona, Spain
- Research Department in the Midwives’ Section of the Barcelona Nursing College (COIB), Barcelona, Spain
| | - Noemí Obregón Gutiérrez
- Ghenders Research Group, School of Health Sciences Blanquerna, University Ramon Llull, Padilla, Barcelona, Spain
- Research Department in the Midwives’ Section of the Barcelona Nursing College (COIB), Barcelona, Spain
| | - Ramón Escuriet Peiró
- Ghenders Research Group, School of Health Sciences Blanquerna, University Ramon Llull, Padilla, Barcelona, Spain
- Research Department in the Midwives’ Section of the Barcelona Nursing College (COIB), Barcelona, Spain
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Vaičienė V, Blaževičienė A, Macijauskiene J, Sidebotham M. The prevalence of burnout, depression, anxiety and stress in the Lithuanian midwifery workforce and correlation with sociodemographic factors. Nurs Open 2021; 9:2209-2216. [PMID: 34110108 PMCID: PMC9190695 DOI: 10.1002/nop2.948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 12/05/2022] Open
Abstract
Aim To investigate the prevalence of burnout, depression, anxiety and stress of Lithuanian midwives. Design A descriptive, cross‐sectional survey design. Methods The Work Health and Emotional Wellbeing of Midwives (WHELM) survey instrument developed within the Australian maternity context was adapted and used in this research. The survey collects country‐specific demographic data and incorporates several validated measures including the Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS‐21). Results Three hundred and thirty‐eight completed surveys were received. Results obtained using a CBI subscale showed that 84.9% experienced personal burnout, 70.1% reported work‐related burnout and 41.1% had client‐related burnout. The results indicate that the midwives reported moderate to extreme levels of depression (16.3%), anxiety (28.4%) and stress (13.9%) symptoms.
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Affiliation(s)
- Vita Vaičienė
- Nursing and Care Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aurelija Blaževičienė
- Nursing and Care Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Mary Sidebotham
- Primary Maternity Care Programs, School of Nursing and Midwifery, Griffith University, Gold Coast, Qld, Australia.,Primary Maternity Care Programs, Transforming Maternity Care Collaborative, Gold Coast, Qld, Australia
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Adcock JE, Sidebotham M, Gamble J. What do midwifery leaders need in order to be effective in contributing to the reform of maternity services? Women Birth 2021; 35:e142-e152. [PMID: 33931350 DOI: 10.1016/j.wombi.2021.04.008] [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: 09/28/2020] [Revised: 03/10/2021] [Accepted: 04/18/2021] [Indexed: 01/17/2023]
Abstract
PROBLEM Little is known about what midwifery leaders need to effectively contribute to maternity services reform. BACKGROUND Despite evidence establishing midwifery continuity of care as the gold standard of maternity care, implementation of these models has been slow. Midwives in health service leadership roles are in an ideal position to re-orientate maternity services to midwifery continuity of care. QUESTION What do midwives in leadership positions need in order to be effective in contributing to the reform of maternity services in Australia? METHODS This qualitative descriptive study used purposive sampling to recruit 13 midwifery leaders from across Australia. Individual telephone interviews were conducted and analysed through line-by-line coding and identification of themes. FINDINGS Five main themes emerged from the data: 'core leadership skills and education are essential'; 'motivation and commitment to implementing evidence-based maternity care'; 'ability to create and sustain strategic relationships'; 'bringing the vision to life' which contained two sub-themes of 'changing the culture' and 'reaching midwifery's full potential'; and, 'organisational support and commitment are key to maternity reform'. DISCUSSION This study echoes findings from previous research emphasising the importance of leadership attributes and development opportunities for midwifery leaders. Additional needs of midwifery leaders were also revealed, which have not yet been extensively explored in the literature, including a strong commitment to continuity of care, effective relationships with key stakeholders and support from healthcare executives. CONCLUSION Midwifery leaders need to be equipped to contribute to maternity care reform through leadership development opportunities, effective relationships and support from healthcare executives.
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Affiliation(s)
- Joy E Adcock
- SoNM Griffith University, 68 University Drive, Meadowbrook, Queensland 4131, Australia; Transforming Maternity Care Collaborative, Australia.
| | - Mary Sidebotham
- SoNM Griffith University, 68 University Drive, Meadowbrook, Queensland 4131, Australia; Transforming Maternity Care Collaborative, Australia
| | - Jenny Gamble
- SoNM Griffith University, 68 University Drive, Meadowbrook, Queensland 4131, Australia; Transforming Maternity Care Collaborative, Australia
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26
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Larsson B, Thies-Lagergren L, Karlström A, Hildingsson I. Demanding and rewarding: Midwives experiences of starting a continuity of care project in rural Sweden. Eur J Midwifery 2021; 5:8. [PMID: 33768199 PMCID: PMC7983178 DOI: 10.18332/ejm/133573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/22/2020] [Accepted: 02/21/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The closure of a local labor ward enhanced the possibility to initiate a continuity of midwifery care model project. Continuity models of midwifery care are a cornerstone in midwifery and women-centered care, mainly accessible in metropolitan areas. Australian studies have found continuity of midwifery care to work well in rural areas. The aim of this study is to describe midwives' experiences of developing and working in a continuity of midwifery model of care in a rural setting in Sweden. METHODS We used a qualitative longitudinal interview with a participatory action research approach. The project was subjected to changes over time to allow the midwives to provide the best care options and to develop a model suitable for a rural area in northern Sweden. RESULTS The overarching theme, 'Developing a continuity model of midwifery care - demanding and rewarding with new insights', was based on three themes: 1) A challenging but evolving start, 2) Varying views within the midwifery group, and 3) Visions for the future. It was revealed that the midwives had to handle the grief process of the closure of the labor ward alongside their enthusiasm of being part of a continuity of midwifery care model project. CONCLUSIONS The establishment of the model in light of the labor ward closure was associated with conflict within the community and this had implications for the midwives. Midwives who are attracted to work in continuity models need to understand and incorporate the prerequisites of such models. In addition, long commuting to a labor ward requires enough midwives to maintain safety and security for the women at all times.
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Affiliation(s)
- Birgitta Larsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Li Thies-Lagergren
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Helsingborg Lasarett, Helsingborg, Sweden
| | | | - Ingegerd Hildingsson
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Mirosław Jasiński A. Perinatal stress events and burnout among midwives in Poland. The mediating role of self-efficacy. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2021.12.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kashani A, Ingberg JL, Hildingsson I. Caseload midwifery in a rural Australian setting: A qualitative descriptive study. Eur J Midwifery 2021; 5:2. [PMID: 33537651 PMCID: PMC7839082 DOI: 10.18332/ejm/131240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Midwifery-led continuity of care models are beneficial to women and babies, but might be challenging for midwives. Several studies have, however, shown that midwives report higher job satisfaction and less burnout when working with caseload. Another challenge is to staff such models in rural areas. The aim of this study was to describe midwives’ experiences of working in a caseload model in a rural region of Australia. METHODS A qualitative descriptive approach using interviews and thematic analysis was undertaken with eleven midwives. RESULTS The overarching theme, ‘A modified caseload model of care in rural Australia creates opportunities for increased job satisfaction despite the challenges involved with being on call’, comprised: two themes, ‘Increased job satisfaction’ and ‘Challenges’; one core theme, ‘Being on call’; and several subthemes. Working with caseload creates job satisfaction and increases vitality and positive feelings about being a midwife. The main difficulty, as well as the necessity with this model, is the challenging aspect of being on call. CONCLUSIONS Caseload midwifery builds partnership between the woman and her midwife, it allows flexible working hours and increased autonomy, even when the work affects the midwife’s social life. Being on call allows the midwife to work on the whole scope of midwifery practice and is a basis for the continuity model of care; however, being on call also represents a challenge to be overcome in order to make caseload work. Continuity models may be a means to attract midwives to work in rural areas.
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Affiliation(s)
- Alia Kashani
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jessica L Ingberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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Cull J, Hunter B, Henley J, Fenwick J, Sidebotham M. “Overwhelmed and out of my depth”: Responses from early career midwives in the United Kingdom to the Work, Health and Emotional Lives of Midwives study. Women Birth 2020; 33:e549-e557. [DOI: 10.1016/j.wombi.2020.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 12/17/2022]
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A continuity of care project with two on-call schedules: Findings from a rural area in Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 26:100551. [PMID: 32950811 DOI: 10.1016/j.srhc.2020.100551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In many countries, various continuity models of midwifery care arrangements have been developed to benefit women and babies. In Sweden, such models are rare. AIM To evaluate two on-call schedules for enabling continuity of midwifery care during labour and birth, in a rural area of Sweden. METHOD A participatory action research project where the project was discussed, planned and implemented in collaboration between researchers, midwives and the project leader, and refined during the project period. Questionnaires were collected from participating women, in mid pregnancy and two months after birth. RESULT One of the models resulted in a higher degree of continuity, especially for women with fear of birth. Having a known midwife was associated with higher satisfaction in the medical (aOR 2.02 (95% CI 1.14-4.22) and the emotional (aOR 2.05; 1.09-3.86) aspects of intrapartum care, regardless of the model. CONCLUSION This study presented and evaluated two models of continuity with different on-call schedules and different possibilities for women to have access to a known midwife during labour and birth. Women were satisfied with the intrapartum care, and those who had had a known midwife were the most satisfied. Introducing a new model of care in a rural area where the labour ward recently closed challenged both the midwives' working conditions and women's access to evidence-based care.
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Midwives’ views of changing to a Continuity of Midwifery Care (CMC) model in Scotland: A baseline survey. Women Birth 2020; 33:e409-e419. [DOI: 10.1016/j.wombi.2019.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/23/2022]
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Carter J, Dietsch E, Sidebotham M. The impact of pre-registration education on the motivation and preparation of midwifery students to work in continuity of midwifery care: An integrative review. Nurse Educ Pract 2020; 48:102859. [PMID: 32911209 DOI: 10.1016/j.nepr.2020.102859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/04/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
Access to continuity of midwifery care (CoMC) models in Australia is increasing but the capacity of the emerging midwifery workforce to provide this care remains largely unknown. The aim of this integrative literature review is to discover how well pre-registration midwifery education prepares and motivates Australian midwifery students to work in CoMC models when they enter practice. Following title review of 432 papers, removal of duplicates and review against the inclusion and exclusion criteria, nine papers were included for review. The results show that access to CoMC is a crucial component of midwifery education, equipping students with knowledge, skills, confidence and motivation to work in this way upon graduation. Existing methods of program delivery and institutional structures often present students with challenges that detract from the value of their CoMC experiences. A focus on CoMC placement - particularly with a continuity of midwifery mentor - may motivate graduates to work in this model of care. This strategy is recommended to better align Australian midwifery education with maternity care reform.
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Affiliation(s)
- Joanne Carter
- School of Nursing and Midwifery, Griffith University, Logan Campus, 68 University Dr, Meadowbrook, QLD, 4131, Australia; Transforming Maternity Care Collaborative, Griffith University, QLD, 4222, Australia.
| | - Elaine Dietsch
- School of Nursing and Midwifery, Griffith University, Logan Campus, 68 University Dr, Meadowbrook, QLD, 4131, Australia; Transforming Maternity Care Collaborative, Griffith University, QLD, 4222, Australia.
| | - Mary Sidebotham
- School of Nursing and Midwifery, Griffith University, Logan Campus, 68 University Dr, Meadowbrook, QLD, 4131, Australia; Transforming Maternity Care Collaborative, Griffith University, QLD, 4222, Australia.
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Mohammad KI, Al-Reda AN, Aldalaykeh M, Hayajneh W, Alafi KK, Creedy DK, Gamble J. Personal, professional and workplace factors associated with burnout in Jordanian midwives: A national study. Midwifery 2020; 89:102786. [PMID: 32619851 DOI: 10.1016/j.midw.2020.102786] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the prevalence of burnout and explore associated socio-demographic and work-related factors among Jordanian midwives. DESIGN A cross-sectional survey design. The survey tool included the Copenhagen Burnout Inventory (CBI) and socio-demographic and work-related data forms. SETTING All government-funded hospitals in Jordan (18 hospitals) that provide antenatal, labour and birth, or postnatal care for women. PARTICIPANTS A sample of 321 midwives participated. DATA ANALYSIS Frequencies, means, and standard deviations were calculated as appropriate on the demographic variables and scale scores. The CBI was assessed for internal consistency using Cronbach's alpha. Multiple regression analyses using backward elimination were undertaken to determine associations between variables and CBI subscales. An alpha level of 0.05 was used for all statistical tests. FINDINGS Over three-quarters of midwives reported personal (78.1%), work-related (82.2%), and client-related (71.3%) burnout (scored >50 on CBI). Compared to midwives aged between 21 - 30 years, those between 31 - 40 years of age scored on average a 11.75 (95% CI = 7.05 - 16.45) points lower personal burnout score. Married midwives had on average a 6.44 (95% CI = 1.57 - 11.31) points higher personal burnout score compared to single midwives. Midwives with ≥ 10 years' experience had on average a 4.29 (95% CI = 1.93 - 6.64), 5.27 (95% CI = 3.17 - 7.36), and 7.31 (95% CI = 4.84 - 9.78) points lower personal, work-related, and client-related burnout scores respectively compared to midwives with < 10 years' experience.Compared to midwives providing care for 1 - 5 women per shift, those providing care for > 10 women per shift reported 9.98 (95% CI = 6.06 - 13.90) and 5.35 (95% CI = 0.71 - 9.99) points higher work-related and client-related burnout scores respectively. Midwives who rotated between shifts had on average a 5.87 (95% CI = 1.27 - 10.48) and 11.2 (95% CI = 5.78 - 16.66) points higher work-related and client-related burnout scores respectively than those who did not rotate. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The high prevalence of burnout identifies the urgent need for a national plan to address midwives' psychological health in Jordan. Midwives should be appropriately trained to recognize the signs and symptoms of burnout in a timely way, and for support services to be offered. The government could consider implementing continuity of midwifery care models, reducing the administrative burden on midwives, and empowering them to work to their full scope of practice.
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Affiliation(s)
- K I Mohammad
- Maternal and Child Health and Midwifery Department, Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan.
| | - A N Al-Reda
- Maternal and Child Health and Midwifery Department, Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan.
| | - M Aldalaykeh
- Community and Mental Health Nursing Department, Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan.
| | - W Hayajneh
- Educational Science Department, Irbid University College, Al-Balqa Applied University.
| | - K K Alafi
- Department of Management, The World Islamic Sciences and Education University, Amman, Jordan.
| | - D K Creedy
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia.
| | - J Gamble
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia.
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Hildingsson I, Karlström A, Larsson B. Childbirth experience in women participating in a continuity of midwifery care project. Women Birth 2020; 34:e255-e261. [PMID: 32595033 DOI: 10.1016/j.wombi.2020.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuity models of care are rare in Sweden, despite the evidence of their benefit to women and babies. Previous studies have shown certain factors are associated with a positive birth experience, including continuity of midwifery care. AIM The aim was to investigate women's childbirth experiences in relation to background data, birth outcome and continuity with a known midwife, in a rural area of Sweden. METHODS An experimental cohort study. Participating women were offered continuity of midwifery care in pregnancy and birth, during selected time periods. Data were collected in mid-pregnancy and two months after birth. The Childbirth Experience Questionnaire was used to determine women's birth experiences. RESULT A total of 226 women responded to the follow-up questionnaire. Not living with a partner, fear of giving birth, and a birth preference other than vaginal were associated with a less positive birth experience. Having had a vaginal birth with no epidural, no augmentation and no birth complication all yield a better birth experience. Women who had had a known midwife were more likely to have had a positive birth experience overall, predominantly in the domain Professional support. CONCLUSIONS The results of this study showed that women who received care from a known midwife in labour were more likely to have a positive birth experience. The results also pointed out the benefits of a less medicalized birth as important for a good birth experience, and that some women may need extra support to avoid a less positive birth experience.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
| | | | - Birgitta Larsson
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden; Sophiahemmet University College, Stockholm, Sweden
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McInnes RJ, Aitken-Arbuckle A, Lake S, Hollins Martin C, MacArthur J. Implementing continuity of midwife carer - just a friendly face? A realist evaluation. BMC Health Serv Res 2020; 20:304. [PMID: 32293422 PMCID: PMC7158105 DOI: 10.1186/s12913-020-05159-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background Good quality midwifery care saves the lives of women and babies. Continuity of midwife carer (CMC), a key component of good quality midwifery care, results in better clinical outcomes, higher care satisfaction and enhanced caregiver experience. However, CMC uptake has tended to be small scale or transient. We used realist evaluation in one Scottish health board to explore implementation of CMC as part of the Scottish Government 2017 maternity plan. Methods Participatory research, quality improvement and iterative data collection methods were used to collect data from a range of sources including facilitated team meetings, local and national meetings, quality improvement and service evaluation surveys, audits, interviews and published literature. Data analysis developed context-mechanism-outcome configurations to explore and inform three initial programme theories, which were refined into an overarching theory of what works for whom and in what context. Results Trusting relationships across all organisational levels are the context in which CMC works. However, building these relationships during implementation requires good leadership and effective change management to drive whole system change and foster trust across all practice and organisational boundaries. Trusting relationships between midwives and women were valued and triggered a commitment to provide high quality care; CMC team relationships supported improvements in ways of working and sustained practice, and relationships between midwives and providers in different care models either sustained or constrained implementation. Continuity enabled midwives to work to full skillset and across women’s care journey, which in turn changed their perspective of how they provided care and of women’s care needs. In addition to building positive relationships, visible and supportive leadership encourages engagement by ensuring midwives feel safe, valued and informed. Conclusion Leadership that builds trusting relationships across all practice and organisational boundaries develops the context for successful implementation of CMC. These relationships then become the context that enables CMC to grow and flourish. Trusting relationships, working to full skill set and across women’s care journey trigger changes in midwifery practice. Implementing and sustaining CMC within NHS organisational settings requires significant reconfiguration of services at all levels, which requires effective leadership and cannot rely solely on ground-up change.
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Affiliation(s)
- Rhona J McInnes
- School of Nursing & Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia.
| | - Alix Aitken-Arbuckle
- School of Health, Edinburgh Napier University, Sighthill Campus, Edinburgh, Scotland
| | - Suzanne Lake
- Nursing, Midwifery & Allied Health Professions, NHS Education for Scotland, Westport, Edinburgh, Scotland
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A modified caseload midwifery model for women with fear of birth, women's and midwives' experiences: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 24:100504. [PMID: 32120329 DOI: 10.1016/j.srhc.2020.100504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/10/2020] [Accepted: 02/23/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Although fear of birth is common during pregnancy and childbirth, the best treatment for fear of birth in clinical care remain unclear. Strong evidence suggests that continuity models of midwifery care can benefit women and birth outcomes, though such models are rare in Sweden. Because women with fear of birth could benefit from such models, the aim of this qualitative study was to examine how women with fear of birth and their midwives experienced care in a modified caseload midwifery model. METHODS A qualitative interview study using thematic analysis. Participants were recruited from a pilot study in which women assessed to have fear of birth received antenatal and intrapartum care, from a midwife whom they knew. Eight women and four midwives were interviewed. RESULTS An overarching theme-"A mutual relationship instilled a sense of peace and security"-and three themes-"Closeness, continuity, and trust," "Preparation and counselling," and "Security, confidence, and reduced fear"-reflect the views and experiences of women with fear of birth and their midwives after participating in a modified caseload midwifery model. CONCLUSIONS For both women with fear of birth and their midwives, the caseload midwifery model generated trustful woman-midwife relationships, which increased women's confidence, reduced their fear, and contributed to their positive birth experiences. Moreover, the midwives felt better equipped to address women's needs, and their way of working with the women became more holistic. Altogether, offering a continuity model of midwifery care could be an option to support women with fear of birth.
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Corrigan AE, Lake S, McInnes RJ. Normalisation process theory as a conceptual framework for continuity of carer implementation. Women Birth 2020; 34:e204-e209. [PMID: 32139185 DOI: 10.1016/j.wombi.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Abstract
PROBLEM Despite long standing strategic level ambitions to increase access to continuity of carer (CoC) models in maternity services, implementation of CoC in the United Kingdom (UK) has been generally small-scale and short lived. This indicates problems in implementing and sustaining CoC as the main model of care provision, and as such a need to better understand the process of implementation itself. AIM To use normalisation process theory (NPT) to underpin development of a conceptual implementation framework for CoC in order to improve understanding of the implementation process. METHODS Literature review on CoC implementation and NPT development and use, combined with immersion in the implementation of CoC context. RESULTS AND DISCUSSION A conceptual framework for the implementation of CoC is developed and individual components discussed, with a view to better understanding the implementation process for CoC models. The will of a critical mass of midwives to work in a CoC model and the provision and maintenance of the 'organisational space' required for CoC within the National Health Service (NHS) emerge as key barriers to mainstreaming CoC in the UK. CONCLUSION There is utility in NPT as a means of understanding and conceptualising large scale implementation of CoC. With testing and further development into a practical tool, the conceptual framework developed here could become a useful aid to those involved in implementing and evaluating CoC in the context of renewed strategic direction and Governmental level support in the UK.
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Affiliation(s)
- Amy E Corrigan
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, 9 Sighthill Court, Midlothian, EH11 4BN, United Kingdom.
| | - Suzanne Lake
- NHS Education for Scotland, Stirling Community Hospital, PDU/ Admin Block Level 1, Livilands Gate, Stirling, FK8 2AU, United Kingdom
| | - Rhona J McInnes
- Professor of Maternal and Child Health and Clinical Chair, Gold Coast University Hospital, School of Nursing and Midwifery, Griffith University, Gold Coast Campus, QLD 4222, Australia
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Sidhu R, Su B, Shapiro KR, Stoll K. Prevalence of and factors associated with burnout in midwifery: A scoping review. Eur J Midwifery 2020; 4:4. [PMID: 33537606 PMCID: PMC7839164 DOI: 10.18332/ejm/115983] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Rawel Sidhu
- Vancouver Fraser Medical Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Bowen Su
- Vancouver Fraser Medical Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kate R Shapiro
- Division of Midwifery, Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Kathrin Stoll
- Division of Midwifery, Department of Family Practice, University of British Columbia, Vancouver, Canada
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Prevalence and Predictors of Burnout in Midwives: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020641. [PMID: 31963831 PMCID: PMC7013833 DOI: 10.3390/ijerph17020641] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/17/2022]
Abstract
The prevalence of burnout in midwives has been briefly studied. Given the negative effects of burnout syndrome in the physical and mental health, and also related to the quality of care provided, rates of absenteeism and sick leave; identifying related factors for the syndrome are needed. The aim was to determine the prevalence, levels, and factors related to the burnout syndrome, measured with the Copenhagen Burnout Inventory in midwives. A systematic review and meta-analysis were selected from CINAHL, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus databases, with the search equation “burnout AND (midwife OR midwives OR nurses midwives)”. Fourteen articles were found with a total of 8959 midwives. Most of the studies showed moderate levels of personal burnout. The prevalence obtained was 50% (95% CI = 38–63) for personal burnout; 40% (95% CI = 32–49) for work-related burnout; and 10% (95% CI = 7–13) for client-related burnout. Midwives’ age, less experience, and living alone constitute the main related factors, as well as, the scarcity of resources, work environment, and the care model used. Most midwives present personal and work-related burnout, which indicates a high risk of developing burnout. Personal factors and working conditions should be taken into account when assessing burnout risk profiles of midwives.
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Hunter B, Fenwick J, Sidebotham M, Henley J. Midwives in the United Kingdom: Levels of burnout, depression, anxiety and stress and associated predictors. Midwifery 2019; 79:102526. [PMID: 31473405 DOI: 10.1016/j.midw.2019.08.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The overall study aim was to explore the relationship between the emotional wellbeing of UK midwives and their work environment. Specific research questions were to: assess levels of burnout, depression, anxiety and stress experienced by UK midwives; compare levels of burnout, depression, anxiety and stress identified in this sample of UK midwives, with levels reported in Australia, New Zealand and Sweden; identify demographic and work-related factors associated with elevated levels of burnout, depression, anxiety and stress. DESIGN Cross sectional research design using an online survey. The WHELM survey tool was developed within the Australian maternity context and includes a number of validated measures: The Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS-21), as well as items from the Royal College of Midwives (RCM) 'Why Midwives Leave' study (Ball et al., 2002). SETTING United Kingdom. PARTICIPANTS An on-line survey was distributed via the RCM to all full midwife members in 2017 (n = 31,898). DATA ANALYSIS The demographic and work-related characteristics of the sample were analysed using descriptive analyses. Levels of depression, anxiety, stress and burnout, measured by the CBI and DASS scores, were analysed using non-parametric statistical tests. Comparisons were made between groups based on demographic and work characteristics. Mann-Whitney U tests were used for two group comparisons, and Kruskal Wallis tests were used for groups with 2+ groups. Given the large number of analyses undertaken, statistically significant comparisons were identified with a conservative alpha level (p < .01). FINDINGS A total of 1997 midwives responded to the survey, representing 16% of the RCM membership. The key results indicate that the UK's midwifery workforce is experiencing significant levels of emotional distress. 83% (n = 1464) of participants scored moderate and above for personal burnout and 67% (n = 1167) recorded moderate and above for work-related burnout. Client-related burnout was low at 15.5% (n = 268). Over one third of participants scored in the moderate/severe/extreme range for stress (36.7%), anxiety (38%) and depression (33%). Personal and work-related burnout scores, and stress, anxiety and depression scores were well above results from other countries in which the WHELM study has been conducted to date. Midwives were more likely to record high levels of burnout, depression, anxiety and stress if they were aged 40 and below; reported having a disability; had less than 10 years' experience; worked in a clinical midwifery setting, particularly if they worked in rotation in hospital and in integrated hospital/community settings. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Many UK midwives are experiencing high levels of stress, burnout, anxiety and depression, which should be of serious concern to the profession and its leaders. NHS employed clinical midwives are at much greater risk of emotional distress than others surveyed, which has serious implications for the delivery of high quality, safe maternity care. It is also of serious concern that younger, more recently qualified midwives recorded some of the highest burnout, stress, anxiety and depression scores, as did midwives who self-reported a disability. There is considerable scope for change across the service. Proactive support needs to be offered to younger, recently qualified midwives and midwives with a disability to help sustain their emotional wellbeing. The profession needs to lobby for systems level changes in how UK maternity care is resourced and provided. Making this happen will require support and commitment from a range of relevant stakeholders, at regional and national levels.
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Affiliation(s)
- Billie Hunter
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales CF24 0AB, UK.
| | - Jennifer Fenwick
- Griffith University and Gold Coast University Hospital, School of Nursing and Midwifery, Queensland, Australia
| | - Mary Sidebotham
- Griffith University and Gold Coast University Hospital, School of Nursing and Midwifery, Queensland, Australia
| | - Josie Henley
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales CF24 0AB, UK
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Ricchi A, Rossi F, Borgognoni P, Bassi MC, Artioli G, Foa C, Neri I. The midwifery-led care model: a continuity of care model in the birth path. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:41-52. [PMID: 31292414 PMCID: PMC6776178 DOI: 10.23750/abm.v90i6-s.8621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The birth path is affected by a fragmentation in the patient care process, creating a discontinuity of this last one. The pregnant woman has to interface with many professionals, both during the pregnancy, the childbirth and the puerperium. However, during the last ten years, there has been an increasing of the pregnancy care operated by the midwife, who is considered to be the operator with the right competences, who can take care of every pregnancy and may avail herself of other professionals' contributions in order to improve the outcomes of maternal and neonatal health. AIM To verify whether there are proofs of effectiveness that support the caseload midwifery care model, and if it is possible to apply this model in the birth path in Italy. METHODS A revision of literature has been done using some search engine (Google, Bing) and specific databases (MEDLINE, CINAHL, Embase, Home - ClinicalTrials.gov). There has also been a consultation of the Italian regulations, the national guidelines and the recommendations of WHO. RESULTS The search string, properly adapted to the three databases, has given the following results: MEDLINE 64 articles, CINAHL 94 articles, Embase 88 articles. From this selection, 14 articles have been extracted: 1 systematic review, 3 controlled random trial, 7 observational studies, 3 qualitative studies. CONCLUSIONS The caseload midwifery care seems to be an effective and reliable organisational/caring method. It responds to the criterions of quality and security, to the needs of women not only during the pregnancy but also during the post-partum phase. For these reasons, it seems very useful also for the birth path in the Italian reality.
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Midwifery students’ experiences of working within a midwifery caseload model. Midwifery 2019; 74:21-28. [DOI: 10.1016/j.midw.2019.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/28/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
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Mestdagh E, Timmermans O, Fontein-Kuipers Y, Van Rompaey B. Proactive behaviour in midwifery practice: A qualitative overview based on midwives’ perspectives. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 20:87-92. [DOI: 10.1016/j.srhc.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 03/11/2019] [Accepted: 04/01/2019] [Indexed: 01/06/2023]
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Taylor B, Cross-Sudworth F, Goodwin L, Kenyon S, MacArthur C. Midwives' perspectives of continuity based working in the UK: A cross-sectional survey. Midwifery 2019; 75:127-137. [PMID: 31100484 DOI: 10.1016/j.midw.2019.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE UK policy is advocating continuity of midwife throughout the antenatal, intrapartum and postnatal period in order to improve outcomes. We explored the working patterns that midwives are willing and able to adopt, barriers to change, and what would help midwives to work in continuity models of care. DESIGN A cross-sectional survey. SETTING 27 English maternity providers in the seven geographically-based 'Early Adopter' sites, which have been chosen to fast-track national policy implementation. PARTICIPANTS All midwives working in the 'Early Adopter' sites were eligible to take part. METHOD Anonymous online survey disseminated by local and national leaders, and social media, in October 2017. Descriptive statistics were calculated for quantitative survey responses. Qualitative free text responses were analysed thematically. FINDINGS 798 midwives participated (estimated response rate 20% calculated using local and national NHS workforce headcount data for participating sites). Being willing or able to work in a continuity model (caseloading and/or team) was lowest where this included intrapartum care in both hospital and home settings (35%, n = 279). Willingness to work in a continuity model of care increased as the range of intrapartum care settings covered decreased (home births only 45%, n = 359; no intrapartum care at all 54%, n = 426). A need to work on the same day each week was reported by 24% (n = 188). 31% (n = 246) were currently working 12 h shifts only, while 37% (n = 295) reported being unable to work any on-calls and/or nights. Qualitative analysis revealed multiple barriers to working in continuity models: the most prominent was caring responsibilities for children and others. Midwives suggested a range of approaches to facilitate working differently including concessions in the way midwife roles are organised, such as greater autonomy and choice in working patterns. CONCLUSIONS Findings suggest that many midwives are not currently able or willing to work in continuity models, which includes care across antenatal, intrapartum and postnatal periods as recommended by UK policy. IMPLICATIONS FOR PRACTICE A range of approaches to providing continuity models should be explored as the implementation of 'Better Births' takes place across England. This should include studies of the impact of the different models on women, babies and midwives, along with their practical scalability and cost.
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Affiliation(s)
- Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Laura Goodwin
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Christine MacArthur
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
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Cramer E, Hunter B. Relationships between working conditions and emotional wellbeing in midwives. Women Birth 2018; 32:521-532. [PMID: 30578019 DOI: 10.1016/j.wombi.2018.11.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Emotional distress in midwives contributes to high attrition. To safeguard midwives' wellbeing, there is a need to identify the impact of workplace variables. AIM To review the existing evidence on the relationships between working conditions and emotional wellbeing in midwives, and construct an analytic framework for understanding these relationships. METHODS Systematic search and selection procedures using a range of databases. Results of included studies were synthesised into a thematic literature review of qualitative and quantitative research. FINDINGS Various types of poor emotional wellbeing in midwives correlate with a variety of interrelated working conditions, including low staffing/high workload, low support from colleagues, lack of continuity of carer, challenging clinical situations and low clinical autonomy. Staffing levels seem to be able to modify the effects of many other variables, and the impact of challenging clinical situations is affected by several other variables. DISCUSSION These workplace variables can be categorised as modifiable and non-modifiable risk indicators. CONCLUSION While certain conditions that correlate with midwives' wellbeing are non-modifiable, several crucial variables, such as staffing levels and continuity of carer, are within the control of organisational leadership. Future research and interventions should focus on these modifiable risks. Research design should maximise the chance of establishing causation, while any innovations in this area should anticipate the interrelatedness of these risk factors to avoid unintended negative consequences.
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Midwifery continuity of carer: Developing a realist evaluation framework to evaluate the implementation of strategic change in Scotland. Midwifery 2018; 66:103-110. [DOI: 10.1016/j.midw.2018.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 11/21/2022]
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A survey of burnout and intentions to leave the profession among Western Canadian midwives. Women Birth 2018; 32:e441-e449. [PMID: 30341004 DOI: 10.1016/j.wombi.2018.10.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022]
Abstract
PROBLEM Midwives are at high risk for burnout and occupational stress. This has implications for workforce retention and quality of maternity care. AIM We set out to understand how burnout and occupational stress are experienced by midwives in Western Canada, and whether burnout is linked to intentions to leave the profession and other factors. METHODS Midwives were invited to participate in the international WHELM (work, health, and emotional lives of midwives) survey through invitations via their professional organizations. The survey included demographic questions and emotional wellbeing scales such as the Copenhagen Burnout Inventory and the Depression, Anxiety, and Stress Scale. RESULTS Of 158 midwives who participated, 51 (34.7%) had seriously considered leaving the profession, citing reasons such as the negative impact of an on-call schedule on personal life (n=84, 84.8%), as well as concerns about their mental (n=80, 80.8%) and physical health (n=57, 57.6%). Burnout scores were higher among midwives who planned to leave the profession, midwives with young children, those with higher caseloads and fewer days off. Quality of life was significantly lower among midwives who reported higher burnout scores. Midwives suggested many strategies to reduce stress, such as part-time work options, support for sick days/vacation coverage, more pay per course of care, more off-call career opportunities and initiatives to reduce bullying and interprofessional conflict. DISCUSSION/CONCLUSION The current study identified occupational stressors that are unique to the caseload model. Findings from this study can inform policies and strategies to support the growth and sustainability of caseload midwifery in Canada.
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Comparing caseload and non-caseload midwives’ burnout levels and professional attitudes: A national, cross-sectional survey of Australian midwives working in the public maternity system. Midwifery 2018; 63:60-67. [DOI: 10.1016/j.midw.2018.04.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/29/2018] [Accepted: 04/30/2018] [Indexed: 11/15/2022]
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Maimburg RD. Homebirth organised in a caseload midwifery model with affiliation to a Danish university hospital – A descriptive study. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:82-85. [DOI: 10.1016/j.srhc.2018.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 02/06/2023]
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Fenwick J, Sidebotham M, Gamble J, Creedy DK. The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity. Women Birth 2018; 31:38-43. [DOI: 10.1016/j.wombi.2017.06.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 11/26/2022]
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