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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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Anchors ZG, Arnold R, D Burnard S, Bressington CA, Moreton AE, Moore LJ. Effectiveness of interventions on occupational stress, health and well-being, performance, and job satisfaction for midwives: A systematic mixed methods review. Women Birth 2024; 37:101589. [PMID: 38580584 DOI: 10.1016/j.wombi.2024.02.005] [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: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Work-related stress is high in midwifery with negative implications for midwives' health and performance. This systematic review therefore examined which stress management interventions (SMIs) are most effective at reducing occupational stress and improving midwives' health and well-being, performance, and job satisfaction. METHODS A systematic review included studies if they were: investigating midwives or student midwives; examining an individual- or organisation-level intervention; reporting the intervention effects on at least one outcome (e.g., job performance); peer-reviewed; and published in English. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was conducted and data were presented by SMI level (i.e., individual vs. organisation) and modality type (e.g., mindfulness, care model). Sum codes were used to compare the effects of individual- and organisation-level SMIs on outcomes. FINDINGS From 2605 studies identified, 30 were eligible (18 individual- and 12 organisation-level SMIs). Eight studies were deemed low quality. While individual- and organisation-level SMIs were equally effective in improving job satisfaction and performance, there was a trend for organisation-level SMIs more effectively reducing work stress and improving health and well-being. Specific individual- (i.e., mindfulness, simulation training) and organisation-level (i.e., reflective groups, midwifery care models) SMIs were most beneficial. CONCLUSION It is recommended that health practitioners and policy makers implement interventions that target both individual- and organisation-levels to optimally support midwives' work stress, health, well-being, and performance. Notwithstanding these findings and implications, some studies had poor methodological quality; thus, future research should better follow intervention reporting guidelines.
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Affiliation(s)
- Zoe G Anchors
- School of Health and Social Wellbeing, University of the West of England, BS16 1DD, England.
| | - Rachel Arnold
- Department for Health, Claverton Down, University of Bath, Bath BA2 7PB, England
| | - Sara D Burnard
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, England
| | | | - Annette E Moreton
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, England
| | - Lee J Moore
- Department for Health, Claverton Down, University of Bath, Bath BA2 7PB, England
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Andina-Díaz E, Rodríguez-Puente Z, Arias-Gundín O, Pérez-Rivera FJ. Lack of autonomy and professional recognition as major factors for burnout in midwives: A systematic mixed-method review. J Adv Nurs 2024. [PMID: 38952254 DOI: 10.1111/jan.16279] [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: 12/16/2023] [Revised: 05/17/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024]
Abstract
AIM The aim of this study was to review the existing evidence on burnout levels in midwives and the main related factors. DESIGN Mixed studies systematic review. DATA SOURCES PubMed, Scopus and Web of Science were sourced from 2018 and 2023. REVIEW METHODS Inclusion criteria: quantitative cross-sectional or qualitative articles published in English within the last 5 years. EXCLUSION CRITERIA studies with undergraduate or trainee midwives, studies examining the factors in a pandemic setting and those not answering the research question. Potential risk of bias was assessed using the Mixed Methods Assessment Tool (MMAT). A convergent synthesis design was followed through a thematic synthesis using Thomas and Harden's three-step method: inductive coding of the text, development of descriptive themes and generation of analytical themes. Qualitative approaches adopted exploratory descriptive studies and participatory action research. RESULTS Thirty-six studies were included, with a total of 17,364 participants. There were higher levels of burnout in midwives who were single, under 35-40 years of age, with less than 10 years of experience and those with young children. Stress, anxiety and depression, as well as the emotional impact of traumatic events, have been described as related psychological factors. CONCLUSION Although extrinsic work factors such as shifts, workload, pay and interpersonal relationships increase burnout, intrinsic factors such as lack of autonomy and recognition are the main factors related to it. IMPACT What problem did the study address? Burnout among healthcare workers has been recognized as a global crisis requiring urgent attention, specifically in midwives. What were the main findings? There is a persistent shortage of midwives that is attributed in part to chronic retention difficulties related to job burnout expressed by these professionals. Where and on whom will the research have an impact? We seek to address the paucity of research on burnout in midwives in the current crisis in the profession. Work factors such as lack of autonomy or recognition in the profession carry an associated risk of burnout and job attrition. Understanding the factors that contribute to burnout will enable healthcare organizations to reduce the current problem. REPORTING METHOD PREFERRED: Reporting items for systematic review and meta-analyses (PRISMA). PATIENT OF PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Elena Andina-Díaz
- Department of Nursing and Physiotherapy, Universidad de León, León, Spain
| | - Zaida Rodríguez-Puente
- Department of Nursing and Physiotherapy, Universidad de León, León, Spain
- Hospital of León, León, Spain
| | - Olga Arias-Gundín
- Department of Psychology, Sociology and Philosophy, Universidad de León, León, Spain
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Donnelly E, Lee J, Donnellan-Fernandez R. Understanding attrition of early career midwives in Australia. Women Birth 2024; 37:101636. [PMID: 38917646 DOI: 10.1016/j.wombi.2024.101636] [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: 02/23/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
PROBLEM There is a lack of understanding of the experiences of early career midwives which lead to workforce attrition. BACKGROUND In the Australian midwifery setting, workforce attrition in conjunction with the ageing profile of the workforce is of increasing concern. Midwives in the earliest stages of their career are most vulnerable to career attrition, however limited research specifically engages with this cohort. AIM To understand the professional and social circumstances that led early career midwives to leave clinical practice, how their midwifery background influenced career trajectories, and what would compel them to return to clinical practice. METHODS Semi-structured interviews were conducted with 11 early career midwives who had left the profession within 5 years of qualification. Transcripts underwent thematic analysis. FINDINGS Three themes described early career midwives' experiences: transition to professional practice, an untenable workplace culture, mental health impacts of early clinical midwifery practice. Two further themes emerged about experiences post-midwifery careers: influence of midwifery on subsequent career, and conditions for re-entry. DISCUSSION Challenges with transitioning to professional midwifery practice in conjunction with untenable workplace culture led to such deterioration in wellbeing that remaining within the profession became unfeasible for early career midwives. Desire to remain within health care was apparent, however re-entry to the profession was deemed by most to be out of the question. CONCLUSION Early workforce retention strategies should be the focus of future workforce planning and policy. Larger scale inquiry foregrounding early career midwives is necessary to inform strategies for midwifery workforce retention in Australia.
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Affiliation(s)
- Eleanor Donnelly
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Queensland, Australia.
| | - Jessica Lee
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Queensland, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Australia
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Dent J, Smeeton N, Whiting L, Watson T. The importance of recovery and staffing on midwives' emotional wellbeing: A UK national survey. Midwifery 2024; 132:103961. [PMID: 38479151 DOI: 10.1016/j.midw.2024.103961] [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: 08/21/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND There is currently a gap in the evidence on how working practices, such as the ability to take rest breaks, finish on time or intershift recovery influence outcomes. AIM The aim of this study was to explore the association of individual characteristics, work-related factors and working practices on emotional wellbeing outcomes of UK midwives. METHODS An online cross-sectional survey collated data between September and October 2020. Outcomes explored were work-related stress, burnout, being pleased with their standard of care, job satisfaction and thoughts about leaving midwifery. Univariate analysis identified the explanatory variables to be investigated using multivariable logistic regression. FINDINGS A total of 2347 midwives from the four UK nations completed the survey. No standard approach in monitoring safe staffing or in-shift or intershift recovery was found. There were high levels of work-related stress, burnout and thoughts about leaving midwifery, and low levels of job satisfaction, with just half of midwives reporting they were satisfied with the standard of care they could provide. Multivariable regression revealed that working practices variables, generally related to impeded recovery or compounded by staffing issues, had a significant association with poorer emotional wellbeing outcomes. CONCLUSION This research has demonstrated an association between impeded recovery, including a lack of formal methods to monitor this, and poorer emotional wellbeing outcomes, and that staffing levels are highly influential in determining outcomes. There is a need to re-evaluate current approaches to job design and how midwives are expected to work.
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Affiliation(s)
- Jackie Dent
- School of Health and Social Work, University of Hertfordshire, England, UK.
| | - Nigel Smeeton
- Centre for Research in Public Health and Community Care, University of Hertfordshire, England, UK
| | - Lisa Whiting
- School of Health and Social Work, University of Hertfordshire, England, UK
| | - Tim Watson
- School of Health and Social Work, University of Hertfordshire, England, UK
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Kilpatrick ML, Venn AJ, Barnden KR, Newett K, Harrison CL, Skouteris H, Hills AP, Hill B, Lim SS, Jose KA. Health System and Individual Barriers to Supporting Healthy Gestational Weight Gain and Nutrition: A Qualitative Study of the Experiences of Midwives and Obstetricians in Publicly Funded Antenatal Care in Tasmania, Australia. Nutrients 2024; 16:1251. [PMID: 38732498 PMCID: PMC11085055 DOI: 10.3390/nu16091251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Individual and health system barriers can impede clinicians from supporting weight-related behaviour change for pregnant women, particularly in publicly funded antenatal care accessed by women from diverse socioeconomic backgrounds. The aim was to understand clinicians' experiences of supporting healthy gestational weight gain for pregnant women in a publicly funded antenatal setting. The work was undertaken to guide the implementation of systems changes, resource development, and workforce capacity building related to nutrition, physical activity, and gestational weight gain in the service. The qualitative descriptive study used purposive sampling and semi-structured interviews conducted between October 2019 and February 2020. Nine midwives and five obstetricians from a publicly funded hospital antenatal service in Tasmania, Australia participated. Interview transcripts were analysed using inductive thematic analysis. The three dominant themes were prioritising immediate needs, continuity of care support weight-related conversations, and limited service capacity for weight- and nutrition-related support. The subthemes were different practices for women according to weight and the need for appropriately tailored resources. Improving access to continuity of care and clinician training, and providing resources that appropriately consider women's socioeconomic circumstances and health literacy would enhance the ability and opportunities for clinicians to better support all women.
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Affiliation(s)
- Michelle L. Kilpatrick
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (A.J.V.); (K.A.J.)
- Centre for Mental Health Service Innovation, Advocate House, Hobart, TAS 7000, Australia
| | - Alison J. Venn
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (A.J.V.); (K.A.J.)
| | | | - Kristy Newett
- Royal Hobart Hospital, Hobart, TAS 7000, Australia; (K.R.B.)
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3168, Australia;
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (H.S.); (B.H.)
- Warwick Business School, University of Warwick, Coventry CV4 7AL, UK
| | - Andrew P. Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS 7248, Australia;
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (H.S.); (B.H.)
| | - Siew S. Lim
- Eastern Health Clinical School, Monash University, Melbourne, VIC 3128, Australia;
| | - Kim A. Jose
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (A.J.V.); (K.A.J.)
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Moran L, Bayes S, Foster K. How do professional connections and relationships impact midwives' well-being and career sustainability? A Grounded Theory study protocol. Eur J Midwifery 2024; 8:EJM-8-09. [PMID: 38440134 PMCID: PMC10910549 DOI: 10.18332/ejm/178385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/22/2023] [Accepted: 01/27/2024] [Indexed: 03/06/2024] Open
Abstract
Significant attrition and projected workforce shortages within the midwifery profession are global issues. Extensive research has identified that high levels of workplace adversity, chronic stress, and increasing rates of vicarious trauma and moral injury experienced by midwives, underpin this situation. Researchers have explored midwives' intention to stay in the midwifery workforce and identified ways to support students' transition to professional practice. Supportive collegial relationships have been reported to be protective for new and early career midwives' well-being and resilience. However, there is a gap in knowledge and understanding of the impact and significance of professional connections and relationships for midwives across their careers. This article describes a protocol for a study designed to explore and understand how professional connections and relationships impact midwives' well-being and career sustainability. Glaserian Grounded Theory (GT) methodology will be used to conduct the study. Constant comparison will be used to analyze data collected from in-depth interviews with midwives at various stages in their professional careers, with the aim of understanding the significance of professional connections and relationships on their well-being and career sustainability, and in understanding the potential protections and benefits. It is anticipated that the findings and theory generated from this study will have national and international implications and provide evidence about the impacts, including benefits and any potential disadvantages, of professional relationships in sustaining midwifery careers. This will be of significant value to, as well as inform, the development of midwife retention strategies.
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Affiliation(s)
- Lynnelle Moran
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Victoria, Australia
| | - Sara Bayes
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Victoria, Australia
- School of Nursing and Midwifery, Edith Cowen University, Western Australia, Australia
- South Metropolitan Health Service, Fiona Stanley Hospital, Western Australia, Australia
| | - Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Victoria, Australia
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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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9
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Hildingsson I, Fahlbeck H, Larsson B, Johansson M. Swedish midwives' attitudes towards continuity models-a cross-sectional survey. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100957. [PMID: 38430672 DOI: 10.1016/j.srhc.2024.100957] [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: 01/03/2024] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Midwifery continuity models are growing worldwide, but few such alternatives are available in Sweden. There is sparse knowledge about Swedish midwives' attitudes about midwifery continuity models. AIM The aim of this study was to explore Swedish midwives' attitudes toward continuity models. An additional aim was to evaluate the psychometric properties of a previously developed instrument measuring attitudes to continuity models. METHODS A cross-sectional survey of a national sample of 2537 midwives in Sweden. The participants completed a questionnaire online. A Principal component Analysis was performed to identify components in the instrument. RESULTS A fairly similar proportion of midwives worked in antenatal care (30.7%), intrapartum care (30.7%) and in other areas (31.1%). Many midwives (59%) agreed that continuity models should be available to women, but were not certain about if such models should be offered to all women or low risk women only. Two domains of the attitude scale were identified; Relationship-based Midwifery Continuity Models, and Practical and Organisational Aspects of Midwifery Continuity Models. Age, having children, marital status, length of work experience and place of work were associated with high agreement non the two components. CONCLUSION Many midwives in general held positive attitudes about continuity models. The relationship aspects were highly valued but midwives were also hesitant about the practical and organisational aspect of continuity models. Unbiased information to midwives about the pros and cons with continuity models should be offered, in order to limit misunderstandings about the model.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden; 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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Bayrı Bingöl F, Karaçam Yılmaz ZD, Topaloğlu S. Partners in Pain, Two Sides of a Zipper - Midwives' Experiences With Stillbirth: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241235429. [PMID: 38404056 DOI: 10.1177/00302228241235429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
This study was conducted to explore and understand the experiences of midwives who care for women experiencing stillbirth and the challenges they face in this process. A qualitative study was conducted with 11 midwives using the phenomenological method. Descriptive analysis of the data revealed four main themes: 1) Silent screams in the face of despair (women's reactions to stillbirth), 2) Being a partner in pain, "two sides of a zipper" (midwives' experience of stillbirth), 3) Efforts to cope with the pain, and 4) Just two words: "if only." The impact of stillbirths on midwives should not be disregarded. Emotions such as shock, horror, fear, guilt, and anger experienced by midwives following a stillbirth can adversely affect their mental health. The guilt experienced by midwives can also negatively impact their health and quality of life, as well as cause burnout and distancing from the profession.
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Affiliation(s)
- Fadime Bayrı Bingöl
- Midwifery Department, Health Sciences Faculty, Marmara University, Istanbul, Türkiye
| | - Zeynep Dilşah Karaçam Yılmaz
- Midwifery Department, Health Sciences Faculty, Marmara University, Istanbul, Türkiye
- Istanbul University-Cerrahpasa, Institute of Graduate Studies, Istanbul, Türkiye
| | - Seçil Topaloğlu
- Midwifery Department, Health Sciences Faculty, Istanbul Medipol University, Istanbul, Türkiye
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Matthews RP, Hyde RL, McLachlan HL, Llewelyn F, Forster DA. Midwifery workforce challenges in Victoria, Australia. A cross-sectional study of maternity managers. Women Birth 2024; 37:144-152. [PMID: 37553273 DOI: 10.1016/j.wombi.2023.07.130] [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: 03/21/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND In Australia, there is a lack of accurate data on midwifery workforce staffing and skill mix, which in turn hinders workforce policy and planning. AIM To describe the current staffing levels of the midwifery workforce in Victoria, Australia, explore workforce challenges and assess the impact of COVID-19 pandemic on staffing. DESIGN Cross-sectional. METHODS Midwifery managers in all public and private maternity services in Victoria, Australia were invited to complete a survey exploring midwifery staffing numbers and adequacy. Topics explored included midwifery turnover, recruitment, and skill mix. Descriptive statistics were used. FINDINGS The survey was open March to October 2021, and 56 % (38/68) of managers responded. Of these, 76 % reported inadequate midwifery staff levels, with deficits ranging from one to 19 estimated Full-Time Equivalent (EFT) midwives, with a combined total deficit of 135 EFT. In the 12 months prior to the survey, 73 % of services had found it difficult to recruit midwives, with increased difficulty during the COVID-19 pandemic. Managers were concerned about retaining and recruiting 'experienced' midwives due to an ageing workforce and high turnover due to work/life imbalance and job dissatisfaction. These issues have led to a predominantly early career midwifery workforce and created concern about skill mix. CONCLUSION Victorian maternity services have a midwifery workforce shortage and are experiencing significant skill mix issues. The pandemic has exacerbated these considerable gaps in the workforce. Urgent implementation of retention and recruitment schemes are needed, along with strategies to improve the working conditions for the current workforce.
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Affiliation(s)
- Robyn P Matthews
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia.
| | - Rebecca L Hyde
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Fleur Llewelyn
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
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12
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Parry N, Catling C, Cummins A. Early career midwives' job satisfaction, career goals and intention to leave midwifery: A scoping review. Women Birth 2024; 37:98-105. [PMID: 37827892 DOI: 10.1016/j.wombi.2023.09.007] [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: 06/01/2023] [Revised: 07/25/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To scope and synthesise literature around the job satisfaction of early career midwives - those in their first five years of post-qualification practice - including the effect on their career aspirations and intention to leave the profession. DESIGN Scoping review. METHODS Relevant databases were searched for published research studies and grey literature. Literature were selected through adherence to pre-set inclusion and exclusion criteria to ensure relevance. Literature was included that was published from 2012. Selected literature were tabled and common themes were mapped to look for similarities and differences in findings. FINDINGS Ten papers were included - seven original research studies, a fact sheet, a non peer-reviewed article, and a conference paper. Negative themes - lack of support, workload stress, and job dissatisfaction, and positive themes - passion for midwifery, collegial relationships, and autonomy - were found across many of the included papers. KEY CONCLUSIONS Many midwives are considering leaving their profession due to the stress of their work, role dissatisfaction, and a lack of support. This is more common amongst early career midwives. There were some protective factors such as having pride in the midwifery profession. More research is needed to identify and address the needs specific to early career midwives.
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Affiliation(s)
- Nicola Parry
- School of Nursing and Midwifery, University of Technology Sydney, Australia.
| | - Christine Catling
- School of Nursing and Midwifery, University of Technology Sydney, Australia
| | - Allison Cummins
- School of Nursing and Midwifery, University of Newcastle, Australia
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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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Moran L, Foster K, Bayes S. What is known about midwives' well-being and resilience? An integrative review of the international literature. Birth 2023; 50:672-688. [PMID: 37551623 DOI: 10.1111/birt.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Internationally, the midwifery workforce is facing a professional crisis due to numerous organizational and individual factors that have led to midwives leaving the profession. These factors include high levels of workplace stress, systemic barriers to providing woman and person-centered care, trauma, and burnout. The COVID-19 pandemic magnified these pre-existing stressors and adversities and has further disrupted midwives' ability to practice within their professional norms. In order to understand how midwives can be better supported, there is a need to understand what contributes to and detracts from their well-being and resilience. AIM To investigate and synthesize the extant international knowledge on midwives' well-being and resilience in the context of workplace stress and adversity. METHOD Integrative review of the literature published in peer-reviewed journals. RESULTS Thematic analysis of the literature resulted in three core themes: (1) risk factors and adversity; (2) protective factors and resilience; and (3) sustaining factors and well-being in midwifery. Findings from this integrated review highlight that several factors associated with workplace adversity can also be sources of protection depending on their presence or absence. Within the included studies, there exists a broad use of concepts and definitions that are applied to well-being and resilience, resulting in a lack of uniformity and cohesion. CONCLUSIONS In this review, we identified a high level of workplace adversity and the subsequent impacts on midwives' well-being and resilience. A series of protective factors and strategies that can be used to improve the well-being of midwives and support resilience within the profession were also identified; however, further research of the population is required. In addition, the development of cohesive well-being and resilience concepts specific to midwifery is recommended, as is the development and application of uniform terminologies and definitions.
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Affiliation(s)
- Lynnelle Moran
- Australian Catholic University, Fitzroy, Victoria, Australia
| | - Kim Foster
- Australian Catholic University, Fitzroy, Victoria, Australia
| | - Sara Bayes
- Australian Catholic University, Fitzroy, Victoria, Australia
- Edith Cowan University, Joondalup, Western Australia, Australia
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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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Thumm EB, Emeis CL, Snapp C, Doublestein L, Rees R, Vanderlaan J, Tanner T. American Midwifery Certification Board Certification Demographic and Employment Data, 2016 to 2020: The Certified Nurse-Midwife and Certified Midwife Workforce. J Midwifery Womens Health 2023; 68:563-574. [PMID: 37283414 DOI: 10.1111/jmwh.13511] [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] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Expansion and diversification of the midwifery workforce is a federal strategy to address the maternal health crisis in the United States. Understanding characteristics of the current midwifery workforce is essential to creating approaches to its development. Certified nurse-midwives and certified midwives (CNMs/CMs) certified by the American Midwifery Certification Board (AMCB) constitute the largest portion of the US midwifery workforce. This article aims to describe the current midwifery workforce based on data collected from all AMCB-certified midwives at the time of certification. METHODS Midwife initial certificants and recertificants were administered an electronic survey about personal and practice characteristics at the time of certification by AMCB between 2016 and 2020 for administrative purposes. Given the standard 5-year certification cycle, every midwife certified during this period completed the survey once. The AMCB Research Committee conducted a secondary data analysis of deidentified data to describe the CNM/CM workforce. RESULTS In 2020 there were 12,997 CNMs/CMs in the United States. The workforce was largely White and female with an average age of 49. There has been a slow increase (15% to 21%) of initial certificants identifying as midwives of color. The proportion of CMs to all AMCB-certified midwives remained less than 2%. Physician-owned practices were the most common employer. Approximately 60% of midwives attend births, and hospitals were the most common birth setting. Over 10% of those certified to practice reported not working within the discipline of midwifery. DISCUSSION Targeted recruitment and retention of midwives must take into consideration not just expansion but dispersion, scope of practice, and diversification. The proportion of midwives attending births was lower than reported in previous years. Expansion of the CM credential and accessible educational pathways are 2 potential solutions to workforce growth. Developing strategies to retain those who are trained but not practicing presents an opportunity for workforce maintenance.
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Affiliation(s)
- E Brie Thumm
- American Midwifery Certification Board Research Committee, College of Nursing, University of Colorado, Aurora, Colorado
| | - Cathy L Emeis
- School of Nursing, Oregon Health & Science University, Portland, Oregon
- College of Nursing and Public Health, Chamberlain University, Addison, Illinois
| | - Carol Snapp
- College of Nursing and Public Health, Chamberlain University, Addison, Illinois
- School of Nursing, University of Nevada, Las Vegas, Nevada
| | | | - Rebecca Rees
- American Midwifery Certification Board Research Committee, College of Nursing, University of Colorado, Aurora, Colorado
| | | | - Tanya Tanner
- American Midwifery Certification Board Research Committee, College of Nursing, University of Colorado, Aurora, Colorado
- Frontier Nursing University, Versailles, Kentucky
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González-de la Torre H, Hernández-Rodríguez MI, Moreno-Canino AM, Portela-Lomba AM, Berenguer-Pérez M, Verdú-Soriano J. Cross-Cultural Adaptation and Validation of the Perceptions of Empowerment in Midwifery Scale in the Spanish Context (PEMS-e). Healthcare (Basel) 2023; 11:healthcare11101464. [PMID: 37239750 DOI: 10.3390/healthcare11101464] [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: 04/01/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Midwifery empowerment is an important topic. The most widely used instrument to measure the perceived empowerment of midwives is the Perceptions of Empowerment in Midwifery Scale (PEMS), which has not been validated in Spain. The aim of this study was to translate and adapt the PEMS to the Spanish context. This research was carried out in two phases; Phase 1: Methodological study; translation, backtranslation and cross-cultural adaptation of the PEMS and pilot study on the target population (10 midwives) for evaluation of face validity. Phase 2: Cross-sectional observational study to obtain a sample for construct validation by Exploratory Factor Analysis and measurement of PEMS-e reliability. Additionally, an inferential analysis was carried out to study the possible association between several collected variables and PEMS-e subscale-scores. A total of 410 midwives from 18 Spanish regions participated in the study through an online questionnaire. An initial Spanish version of the PEMS scale was produced, demonstrating adequate face validity. A final model was produced for the PEMS-e, which included 17 items classified into two subscales ("Organizational support" and "Own skills and teamwork") with fit indexes RMSEA = 0.062 (95%CI: 0.048-0.065) and AGFI = 0.985 (95%CI: 0.983-0.989) and Cronbach's alpha 0.922 for the total scale. Results showed that one in four midwives had considered abandoning the profession in the last 6 months (p ≤ 0.001). This research suggests that Spanish midwives perceive their empowerment level as low. The PEMS-e is a valid tool with solid psychometric properties that can be used in future research to identify factors that contribute to increased empowerment among Spanish midwives and inform strategies to improve job satisfaction and retention in the profession.
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Affiliation(s)
- Héctor González-de la Torre
- Research Support Unit of Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, Avda Marítima del Sur S/N, 35016 Las Palmas de Gran Canaria-Canary Islands, Spain
- Department of Nursing, University of Las Palmas de Gran Canaria, Edificio Ciencias de la Salud, C/Blas Cabrera Felipe s/n, 35016 Las Palmas de Gran Canaria-Canary Islands, Spain
| | - María-Isabel Hernández-Rodríguez
- Department of Obstetrics and Gynaecology, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, Avda Marítima del Sur S/N, 35016 Las Palmas de Gran Canaria-Canary Islands, Spain
| | - Alba-María Moreno-Canino
- Department of Obstetrics and Gynaecology, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, Avda Marítima del Sur S/N, 35016 Las Palmas de Gran Canaria-Canary Islands, Spain
| | - Ana-María Portela-Lomba
- Department of Obstetrics and Gynaecology, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, Avda Marítima del Sur S/N, 35016 Las Palmas de Gran Canaria-Canary Islands, Spain
| | - Miriam Berenguer-Pérez
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante (UA), 03690 Alicante, Spain
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante (UA), 03690 Alicante, Spain
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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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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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Kuliukas L, Brown J, Bosco A, Bradfield Z. Continuity or team-teaching approach for midwifery education? An exploratory qualitative study of student and academic preferences. Women Birth 2023; 36:177-183. [PMID: 36336569 DOI: 10.1016/j.wombi.2022.10.005] [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: 06/14/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The content of midwifery courses is very similar across universities. The teaching approach is not, with universities adopting a variety of pedagogical methods. AIM To explore views of midwifery students, midwifery academics and senior academic managers comparing a continuity approach where one main academic provides the majority of midwifery content plus pastoral care compared with a team-teaching approach of midwifery education where lecturers change throughout the course. METHODS Semi-structured interviews and focus groups were used to discover thoughts, benefits and disadvantages of two teaching approaches. Data were analysed using thematic analysis. FINDINGS Midwifery students and academics valued relationship building, consistency of advice and assessment expectations of the continuity approach but also appreciated a variety of teaching styles and content found in the team-teaching approach. Senior academic managers favoured a team-teaching approach due to workload concerns. DISCUSSION Continuity and team-teaching pedagogical approaches offer different advantages. Continuity in midwifery education may provide students with a meaningful trusting relationship with their teacher and consistency of information, which could aid learning. A team-teaching approach provides students with diversity of teaching styles and midwifery 'stories'. A combination of both pedagogies offering both a mix of teachers and a named 'go-to' mentor might help meet student requirements for both continuity and variety. CONCLUSION Relationship building, consistency and trust, were all evident in the continuity approach whereas the team-teaching approach was considered to be a more sustainable workload model.
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Affiliation(s)
- Lesley Kuliukas
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Janie Brown
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Anna Bosco
- 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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McKellar L, Graham K, Sheehan A, Fleet JA, Sidebotham M, Sweet L. Examining the transformation of midwifery education in Australia to inform future directions: An integrative review. Women Birth 2023; 36:155-166. [PMID: 36473797 DOI: 10.1016/j.wombi.2022.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Integral to quality midwifery practice is the education of midwives. Like other countries, Australia faces ongoing challenges in delivering midwifery education programs. Reasons include escalating program costs, challenges in securing meaningful clinical experiences, subsumption of midwifery with nursing, and associated loss of identity in some institutions. AIM To critically examine the literature exploring the historical and current drivers, supports and impediments for entry-to-practice midwifery programs to identify strategies to strengthen midwifery education in Australia. METHODS A structured integrative literature review using Whittemore and Knafl's five-stage framework was undertaken; 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation of results. FINDINGS The literature search identified 50 articles for inclusion. The thematic analysis identified four key themes: i. a commitment to educational reform, ii. building a midwifery workforce, iii. quality maternity care through midwifery education, and iv. progressing excellence in midwifery education. DISCUSSION Extensive literature describes the evolution of midwifery education in Australia over the last 30 years. Through collaboration and amidst opposition, quality midwifery education has been established in Australia. Identification of midwifery as a distinct profession and transformative leadership have been integral to this evolution and must be grown and sustained to prevent a decline in standards or quality. CONCLUSION There is a need to address priorities in midwifery education and for the evaluation of midwifery programs and pedagogy. The provision and maintenance of quality education and practice require shared responsibility between education providers and health care services.
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Affiliation(s)
- Lois McKellar
- School of Health and Social Care, Edinburgh Napier University, UK.
| | - Kristen Graham
- College of Nursing and Health Sciences, Flinders University, Australia
| | - Athena Sheehan
- School of Nursing and Midwifery, Western Sydney University, Australia
| | - Julie-Anne Fleet
- Clinical & Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Australia
| | - Mary Sidebotham
- School of Nursing and Midwifery, Griffith University, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Australia
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Hopkinson D, Gray M, George K, Kearney L. Nurturing our new midwives: A qualitative enquiry of mentor's experiences of supporting new graduate midwives working in continuity of care models. Women Birth 2023:S1871-5192(22)00363-8. [PMID: 36754668 DOI: 10.1016/j.wombi.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/17/2022] [Accepted: 12/07/2022] [Indexed: 02/10/2023]
Abstract
PROBLEM Limited opportunity exists for new graduates in Australia to be employed in continuity of care midwifery models. AIM To explore the perspectives of midwifery mentors supporting new graduate midwives employed in continuity of care models. METHODS An interpretive, qualitative study was conducted. Semi-structured interviews and focus groups with senior midwifery staff who mentored new graduate midwives during their transition to practice within a continuity of care model were undertaken. Digitally recorded and transcribed verbatim, data were thematically analysed. Data collection ceased once theoretical saturation had been achieved. NVIVO software was used to assist with coding and data management. FINDINGS Twelve mentors participated. Mentors provided valuable feedback to optimise the supportive mechanisms to enable the success of the rotation of new graduate midwives in continuity of care models during their transition to practice period. Three key themes were constructed, including: Getting it right in the first place; Nurturing our new midwives; and The cultural void. DISCUSSION Consistent with the wider literature, effective implementation, sound support structures and wider acceptance of new graduate midwives transitioning to practice within continuity of care models is crucial to its success and sustainability. CONCLUSION Mentors are responsible to nurture, respect and guide new midwives through this crucial period, as they transition from midwifery student to registered midwife. Mentors believe in the transition of new graduate midwives in continuity of care models.
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Affiliation(s)
- Deyna Hopkinson
- Sunshine Coast Hospital and Health Service, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Australia.
| | - Michelle Gray
- School of Nursing and Midwifery, Edith Cowan University, Australia
| | | | - Lauren Kearney
- School of Nursing, Midwifery and Social Work, University of Queensland, Australia; Royal Brisbane Women's Hospital, Metro North Health, Australia
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Implementing midwifery continuity of care models in regional Australia: A constructivist grounded theory study. Women Birth 2023; 36:99-107. [PMID: 35410848 DOI: 10.1016/j.wombi.2022.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 01/25/2023]
Abstract
PROBLEM/BACKGROUND Strong international evidence demonstrates significantly improved outcomes for women and their babies when supported by midwifery continuity of care models. Despite this, widespread implementation has not been achieved, especially in regional settings. AIM To develop a theoretical understanding of the factors that facilitate or inhibit the implementation of midwifery continuity models within regional settings. METHODS A Constructivist Grounded Theory approach was used to collect and analyse data from 34 interviews with regional public hospital key informants. RESULTS Three concepts of theory emerged: 'engaging the gatekeepers', 'midwives lacking confidence' and 'women rallying together'. The concepts of theory and sub-categories generated a substantive theory: A partnership between midwives and women is required to build confidence and enable the promotion of current evidence; this is essential for engaging key hospital stakeholders to invest in the implementation of midwifery continuity of care models. DISCUSSION The findings from this research suggest that midwives and women can significantly influence the implementation of midwifery continuity models within their local maternity services, particularly in regional settings. Midwives' reluctance to transition is based on a lack of confidence and knowledge of what it is really like to work in midwifery continuity models. Similarly, women require education to increase awareness of continuity of care benefits, and a partnership between women and midwives can be a strong political force to overcome many of the barriers. CONCLUSION Implementation of midwifery continuity of care needs a coordinated ground up approach in which midwives partner with women and promote widespread dissemination of evidence for this model, directed towards consumers, midwives, and hospital management to increase awareness of the benefits.
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Haora P, Roe Y, Hickey S, Gao Y, Nelson C, Allen J, Briggs M, Worner F, Kruske S, Watego K, Maidment SJ, Hartz D, Sherwood J, Barclay L, Tracy S, Tracy M, Wilkes L, West R, Grant N, Kildea S. Developing and evaluating Birthing on Country services for First Nations Australians: the Building On Our Strengths (BOOSt) prospective mixed methods birth cohort study protocol. BMC Pregnancy Childbirth 2023; 23:77. [PMID: 36709265 PMCID: PMC9883816 DOI: 10.1186/s12884-022-05277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND With the impact of over two centuries of colonisation in Australia, First Nations families experience a disproportionate burden of adverse pregnancy and birthing outcomes. First Nations mothers are 3-5 times more likely than other mothers to experience maternal mortality; babies are 2-3 times more likely to be born preterm, low birth weight or not to survive their first year. 'Birthing on Country' incorporates a multiplicity of interpretations but conveys a resumption of maternity services in First Nations Communities with Community governance for the best start to life. Redesigned services offer women and families integrated, holistic care, including carer continuity from primary through tertiary services; services coordination and quality care including safe and supportive spaces. The overall aim of Building On Our Strengths (BOOSt) is to facilitate and assess Birthing on Country expansion into two settings - urban and rural; with scale-up to include First Nations-operated birth centres. This study will build on our team's earlier work - a Birthing on Country service established and evaluated in an urban setting, that reported significant perinatal (and organisational) benefits, including a 37% reduction in preterm births, among other improvements. METHODS Using community-based, participatory action research, we will collaborate to develop, implement and evaluate new Birthing on Country care models. We will conduct a mixed-methods, prospective birth cohort study in two settings, comparing outcomes for women having First Nations babies with historical controls. Our analysis of feasibility, acceptability, clinical and cultural safety, effectiveness and cost, will use data including (i) women's experiences collected through longitudinal surveys (three timepoints) and yarning interviews; (ii) clinical records; (iii) staff and stakeholder views and experiences; (iv) field notes and meeting minutes; and (v) costs data. The study includes a process, impact and outcome evaluation of this complex health services innovation. DISCUSSION Birthing on Country applies First Nations governance and cultural safety strategies to support optimum maternal, infant, and family health and wellbeing. Women's experiences, perinatal outcomes, costs and other operational implications will be reported for Communities, service providers, policy advisors, and for future scale-up. TRIAL REGISTRATION Australia & New Zealand Clinical Trial Registry # ACTRN12620000874910 (2 September 2020).
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Affiliation(s)
- Penny Haora
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Yvette Roe
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Darwin, Australia
| | - Sophie Hickey
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Yu Gao
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Carmel Nelson
- grid.492300.cInstitute for Urban Indigenous Health, Cox Road, Windsor, QLD 4030 Australia ,grid.1003.20000 0000 9320 7537Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD Australia
| | - Jyai Allen
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Melanie Briggs
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Faye Worner
- Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Sue Kruske
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Grevillea Drive, Sadadeen, NT 0870 Australia
| | - Kristie Watego
- grid.492300.cInstitute for Urban Indigenous Health, Cox Road, Windsor, QLD 4030 Australia
| | - Sarah-Jade Maidment
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Donna Hartz
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Juanita Sherwood
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Lesley Barclay
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Sally Tracy
- grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Mark Tracy
- grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Liz Wilkes
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,My Midwives Brisbane, Windsor Road, Red Hill, QLD 4059 Australia
| | - Roianne West
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Congress of Aboriginal & Torres Strait Islander Nurses and Midwives, Lytton Road, Murarrie, QLD 4172 Australia
| | - Nerida Grant
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Sue Kildea
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Grevillea Drive, Sadadeen, NT 0870 Australia
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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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Cibralic S, Pickup W, Diaz AM, Kohlhoff J, Karlov L, Stylianakis A, Schmied V, Barnett B, Eapen V. The impact of midwifery continuity of care on maternal mental health: A narrative systematic review. Midwifery 2023; 116:103546. [PMID: 36375410 DOI: 10.1016/j.midw.2022.103546] [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: 05/05/2022] [Revised: 10/29/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Systematic reviews have shown that midwifery continuity of care programs lead to improvements in birth outcomes for women and babies, but no reviews have focused specifically on the impact of midwifery continuity of care on maternal mental health outcomes. OBJECTIVE To systematically review the available evidence on the impact of midwifery continuity of care on maternal mental health during the perinatal period. METHOD A systematic search of published literature available through to March 2021 was conducted. A narrative approach was used to examine and synthesise the literature. RESULTS The search yielded eight articles that were grouped based on the mental health conditions they examined: fear of birth, anxiety, and depression. Findings indicate that midwifery continuity of care leads to improvements in maternal anxiety/worry and depression during the perinatal period. CONCLUSION There is preliminary evidence showing that midwifery continuity of care is beneficial in reducing anxiety/worry and depression in pregnant women during the antenatal period. As the evidence stands, midwifery continuity of care may be a preventative intervention to reduce maternal anxiety/worry and depression during the perinatal period.
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Affiliation(s)
- Sara Cibralic
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
| | - Wendy Pickup
- South Western Sydney Local Health District, New South Wales, Australia
| | | | - Jane Kohlhoff
- University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Karlov
- University of New South Wales, Sydney, New South Wales, Australia; South Western Sydney Local Health District, New South Wales, Australia
| | | | | | - Bryanne Barnett
- University of New South Wales, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; South Western Sydney Local Health District, New South Wales, Australia
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Nolan S, Baird K, McInnes RJ. What strategies facilitate & support the successful transition of newly qualified midwives into practice: An integrative literature review. NURSE EDUCATION TODAY 2022; 118:105497. [PMID: 35952415 DOI: 10.1016/j.nedt.2022.105497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this review was to identify strategies that facilitate newly qualified midwives to transition successfully from midwifery student to confident, competent practitioner. DESIGN Integrative literature review. DATA SOURCES The following databases were accessed: CINAHL complete, Medline complete, APA PsycINFO, Cochrane Library, Joanna Briggs Institute (JBI), Scopus and Google Scholar. REVIEW METHODS A systematic search of key terms across all data sources for the period January 1990 to September 2021 identified 316 papers whose titles/abstracts were screened against our inclusion/exclusion criteria. Thirty-six full texts were screened for eligibility and three papers were identified through ancestral searching. Ten papers were included in our final review. RESULTS Mentorship or preceptorship for newly qualified midwives by experienced midwives appears to enhance experiences, either as a standalone strategy, or component of structured programs of transition support. Supernumerary time, designated study days and planned rotations are also valued, particularly when rotating through clinical areas. Smaller teams providing continuity of midwifery care, or organisations that fund mentorship programs appear more able to facilitate support. Mechanisms of online support and learning may also enhance early transition but similarly, require organisational investment to aid success. Whilst most programs were described as helpful none of the studies used validated measures to assess this. CONCLUSION Whilst elements of tailored support programs and mentoring/preceptorship from experienced colleagues appear to offer valuable support to transitioning practitioners, it is important to note that the structure of maternity care appears fundamental to the success of many of these strategies. Consequently, maternity care reform which focuses on the adoption of sustainable models of midwifery continuity, alongside urgent investment in midwives, are likely the most promising, over-arching strategies required to support student to midwife transition.
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Affiliation(s)
- Samantha Nolan
- Gold Coast University Hospital, GCHHS, 1 Hospital Boulevard, Southport, QLD 4215, Australia.
| | - Kathleen Baird
- School of Nursing and Midwifery, Faculty of Health, Centre for Midwifery, Child and Family Health, University of Technology Sydney, Jones Street, Ultimo, NSW 2007, Australia.
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Pramono A, Smith J, Bourke S, Desborough J. "We All Believe in Breastfeeding": Australian Midwives' Experience of Implementing the Baby Friendly Hospital Initiative. J Hum Lact 2022; 38:780-791. [PMID: 35792378 DOI: 10.1177/08903344221106473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The education and support of new mothers during the in-hospital stay for childbirth is a critical time to establish breastfeeding. The Baby-Friendly Hospital Initiative was launched in 1991 to encourage maternity services to support and educate mothers to breastfeed by implementing Ten Steps to Successful Breastfeeding. RESEARCH AIM To explore midwives' experiences of implementing the Baby-Friendly Hospital Initiative in a Baby-Friendly accredited public hospital in Australia. METHODS In this prospective, cross-sectional qualitative study we used focus groups to explore midwives' experiences. Midwives (N = 26) participated in two focus groups conducted between October and November 2019. Data were analyzed using thematic analysis. RESULTS Time as a critical resource, and continuity of care, were crosscutting themes that framed midwives' experiences in supporting mothers to breastfeed their babies. Time constraints were experienced both through the health system structure and the BFHI accreditation process. Despite the challenges, the overarching theme-that we all believe in breastfeeding-fueled midwives' motivation. CONCLUSION Health services policy and practice need to consider ways to enable continuity of midwifery care and adequate time for midwives to support women to breastfeed their babies.
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Affiliation(s)
- Andini Pramono
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Julie Smith
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Siobhan Bourke
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
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Hewitt L, Dadich A, Hartz DL, Dahlen HG. Midwife-centred management: a qualitative study of midwifery group practice management and leadership in Australia. BMC Health Serv Res 2022; 22:1203. [PMID: 36163048 PMCID: PMC9513938 DOI: 10.1186/s12913-022-08532-y] [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: 06/18/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Midwifery group practice (MGP) has consistently demonstrated optimal health and wellbeing outcomes for childbearing women and their babies. In this model, women can form a relationship with a known midwife, improving both maternal and midwife satisfaction. Yet the model is not widely implemented and sustained, resulting in limited opportunities for women to access it. Little attention has been paid to how MGP is managed and led and how this impacts the sustainability of the model. This study clarifies what constitutes optimal management and leadership and how this influences sustainability. Methods This qualitative study forms part of a larger mixed methods study investigating the management of MGP in Australia. The interview findings presented in this study are part of phase one, where the findings informed a national survey. Nine interviews and one focus group were conducted with 23 MGP managers, clinical midwife consultants, and operational/strategic managers who led MGPs. Transcripts of the audio-recordings were analysed using inductive, reflexive, thematic analysis. Results Three themes were constructed, namely: The manager, the person, describing the ideal personal attributes of the MGP manager; midwifing the midwives, illustrating how the MGP manager supports, manages, and leads the group practice midwives; and gaining acceptance, explaining how the MGP manager can gain acceptance beyond group practice midwives. Participants described the need for MGP managers to display midwife-centred management. This requires the manager to have qualities that mirror what is generally accepted as requirements for good midwifery care namely: core beliefs in feminist values and woman-centred care; trust; inclusiveness; being an advocate; an ability to slow down or take time; an ability to form relationships; and exceptional communication skills. Since emotional labour is a large part of the role, it is also necessary for them to encourage and practice self-care. Conclusions Managers need to practice in a way that is midwife-centred and mimics good midwifery care. To offset the emotional burden and improve sustainability, encouraging and promoting self-care practices might be of value.
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Affiliation(s)
- Leonie Hewitt
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Ann Dadich
- School of Business, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Donna L Hartz
- School of Nursing and Midwifery, University of Newcastle, Gosford Hospital, Level 9, 77a Holden St, Gosford, NSW, 2250, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Mohammad KI, Al-Reda N, Alafi KK, ALBashtawy M, Hamadneh J, Alkawaldeh A, Abdalrahim A, Creedy DK, Gamble J. Depression, anxiety, and stress symptoms among Jordanian midwives: A hospital-based study. Midwifery 2022; 114:103456. [PMID: 35995007 DOI: 10.1016/j.midw.2022.103456] [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: 05/10/2022] [Revised: 07/02/2022] [Accepted: 08/09/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the prevalence of depression, anxiety, and stress symptoms in Jordanian midwives and identify associated factors. DESIGN Setting and participants: This descriptive, cross-sectional study was conducted with a sample of 321 registered midwives from 18 public hospitals in Jordan that provide antepartum, intrapartum, postpartum care, and family planning services. The survey included the Depression, Anxiety, and Stress Scale (DASS-21) and demographic and professional data forms. FINDINGS High rates of depression (76.2%); anxiety (85.3%) and stress (66.8%) symptoms were reported among midwives in Jordan. Midwives aged between 22 - 30 years reported more depression, anxiety, and stress symptoms than midwives in the other age groups. Married midwives had higher depression symptoms than single midwives. Midwives with < 10 years in practice had higher depression, anxiety, and stress symptoms compared to midwives with ≥ 10 years in practice. Midwives providing care for > 10 women per shift had higher anxiety and stress symptoms than midwives caring for five or less women per shift. Midwives who rotated between shifts had higher depression and stress symptoms than midwives who did not rotate. CONCLUSIONS Rates of depression, anxiety, and stress symptoms reported by Jordanian midwives were higher than rates reported by midwives in other countries. The high rates of distress highlight the urgent need for national strategies to support the emotional wellbeing and retention of midwives within Jordanian settings.
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Affiliation(s)
- Khitam I Mohammad
- Midwifery Department, Faculty of Nursing WHO Collaborating Center, Jordan University of Science & Technology, Irbid, Jordan.
| | - Noor Al-Reda
- Department of Maternal and Child Health Nursing, Faculty of Nursing WHO Collaborating Center, Jordan University of Science & Technology, Irbid, Jordan; Department of Applied Sciences/Nursing, Ajloun University College, Al - Balqa' Applied University, Jordan
| | - Khaled K Alafi
- Department of Management, The World Islamic Sciences and Education University, Amman, Jordan
| | - Mohammed ALBashtawy
- Community Health Nursing Department, Princess Salma -Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Jehan Hamadneh
- Obstetrics and Gynecology Department, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Abdullah Alkawaldeh
- Community Health Nursing Department, Princess Salma -Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Asem Abdalrahim
- Community Health Nursing Department, Princess Salma -Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Debra K Creedy
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia
| | - Jenny Gamble
- School of Nursing, Midwifery and Allied Health, Coventry University and University Hospitals of Coventry and Warwickshire, Griffith University, Brisbane, Australia
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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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Wang IKH. Toward an Ecological Understanding of Transnational Chinese Language Teachers' Professional Wellbeing in the United Kingdom. Front Psychol 2022; 13:877289. [PMID: 35558706 PMCID: PMC9087582 DOI: 10.3389/fpsyg.2022.877289] [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: 02/22/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Given the lack of reports of Chinese language teachers' wellbeing in the literature, this study aims to investigate the professional wellbeing of eight teachers of Chinese as a foreign language in the United Kingdom based on in-depth, semi-structured qualitative interviews. Interview data provided a rich picture of the rewarding aspects and challenges that they experienced in their professional lives. The main findings revealed the complex interplay of their professional wellbeing and different levels of ecology (i.e., cultural, institutional, classroom, and personal). The study also identified the specific strategies that the teachers deployed for (1) coping with work-related stress and for (2) maintaining wellbeing alongside professional productivity. The paper calls for further research to apply a close-up lens to the wellbeing of foreign language teachers across timescales. The implications for transnational language teachers' mentoring interventions are discussed.
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Affiliation(s)
- Isobel Kai-Hui Wang
- English Language Teaching (ELT) Research and Methodology, Institute of English Studies, University of Graz, Graz, Austria
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Levorstad T, Saue MS, Nilsen ABV, Vik ES. Midwives’ experiences of an organizational change in early postpartum care services in Norway: A qualitative study. Eur J Midwifery 2022; 6:24. [PMID: 35528266 PMCID: PMC9017021 DOI: 10.18332/ejm/147746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION METHODS RESULTS CONCLUSIONS
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Affiliation(s)
- Trude Levorstad
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - May-Sissel Saue
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne Britt V. Nilsen
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Eline S. Vik
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Catling C, Donovan H, Phipps H, Dale S, Chang S. Group Clinical Supervision for midwives and burnout: a cluster randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:309. [PMID: 35410189 PMCID: PMC8999988 DOI: 10.1186/s12884-022-04657-4] [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: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background There are major shortfalls in the midwifery workforce which has been exacerbated by the COVID 19 pandemic. Midwives have high levels of burnout and many, often early career midwives, are planning to leave the profession. There are reports of a poor workplace culture in maternity units, including bullying. Support is essential for the welfare of the workforce to be able to cope with the demands of their jobs. Supportive strategies, such as Clinical Supervision, a recognised approach in healthcare, enable reflection in a facilitated, structured way, and can enhance professional standards. The purpose of this research is to study burnout levels in midwives, those exiting their workplace and perceptions of workplace culture in relation to access to, and attendance of, monthly Clinical Supervision. Methods This study will be a cluster randomised controlled trial of maternity sites within Sydney and the surrounding districts. Twelve sites will be recruited and half will receive monthly Clinical Supervision for up to two years. Midwives from all sites will be requested to complete 6-monthly surveys comprising validated measurement tools: the Copenhagen Burnout Inventory (CBI), the Australian Midwifery Workplace Culture (AMWoC) tool and the Clinical Supervision Evaluation Questionnaire (CSEQ) (the latter for intervention sites only). Primary outcomes are the levels of burnout in midwives (using the CBI). Secondary outcomes will be the quality of the intervention (using the CSEQ), perceptions of workplace culture (using the AMWoC tool) and midwives’ intention to stay in their role/profession, as well as sick leave rates and numbers of exiting staff. We will also determine the dose effect – ie the impact in relation to how many Clinical Supervision sessions the midwives have attended, as well as other supportive workplace strategies such as mentoring/coaching on outcomes. Discussion Through attending monthly Clinical Supervision we hypothesise that midwives will report less burnout and more positive perceptions of workplace culture than those in the control sites. The potential implications of which are a productive workforce giving high quality care with the flow-on effect of having physically and psychologically well women and their babies. Trial registration The ACTRN Registration number is ACTRN12621000545864p, dated 10/05/2021,
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Affiliation(s)
- Christine Catling
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia.
| | - Helen Donovan
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Hala Phipps
- Sydney Institute for Women, Children & their Families, Sydney Local Health District, Camperdown, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Sungwon Chang
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, Australia
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HOPKINSON MD, KEARNEY DL, Gray DM, George DK. New Graduate Midwives’ transition to practice: a scoping review. Midwifery 2022; 111:103337. [DOI: 10.1016/j.midw.2022.103337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/10/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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Kuipers YJ. Exploring the uses of virtues in woman-centred care: A quest, synthesis and reflection. Nurs Philos 2022; 23:e12380. [PMID: 35191165 DOI: 10.1111/nup.12380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/18/2021] [Accepted: 02/05/2022] [Indexed: 11/28/2022]
Abstract
Woman-centred care is a philosophy authentic to the midwifery profession, scaffolding and preceding the capacity and utility of woman-centred care in daily practice. Through providing guidance on the philosophical capacities-the virtues-the practical capacity and utility of woman-centred care becomes more clear and more tangible. This paper discusses the virtues of woman-centred care in midwifery practice. Eighteen virtues, described by Compte-Sponville, serve as a philosophical lens to explore and understand how each specific virtue integrates into the woman-centred care concept or vice versa, herewith becoming woman-centred care virtuous acts. The virtues are politeness, fidelity, prudence, temperance, courage, justice, generosity, compassion, mercy, gratitude, humility, simplicity, tolerance, purity, gentleness, good faith, humour and love. Exploring these virtues provides a manageable view of the complexity of woman-centred care. In this paper, first each virtue is discussed in relation to the body of knowledge of woman-centred care in midwifery. Thereafter, a sketch of pragmatism is provided through translating the virtues into practical recommendations for the professional socialization and transformation of becoming, being and doing woman-centred care.
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Affiliation(s)
- Yvonne J Kuipers
- School of Health and Social Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK
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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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A qualitative study of early career Australian midwives' encounters with perinatal grief, loss and trauma. Women Birth 2022; 35:e539-e548. [PMID: 35115245 DOI: 10.1016/j.wombi.2022.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/21/2022]
Abstract
PROBLEM The health of women is dependent on midwifery workforce stability. Retaining new midwives is paramount, however without support, the early career can be a vulnerable time for midwives. BACKGROUND Midwives care for women who experience poor perinatal outcomes like stillbirth and neonatal death. Midwifery care in these sentinel events is complex. There is limited understanding of early career midwives' experiences within these encounters. AIM To understand the experiences of Australian early career midwives' clinical encounters with perinatal grief, loss and trauma. METHODS A qualitative descriptive/exploratory study using in-depth interviews. FINDINGS Four themes were identified from interview data: (1) all eyes on the skills; (2) support is of the essence; (3) enduring an emotional toll; (4) at all times, the woman. Most participants had minimal exposure to perinatal loss as a student. As a result, most felt unskilled and unprepared for this as a new midwife. DISCUSSION Types and degrees of support varied in these encounters. Early career midwives who were well supported reflected positively on working with grief and loss. In contrast, inadequate or absent support had detrimental effects on participant wellbeing. Poorly supported encounters with death (intrapartum fetal, early neonatal, and maternal) in the early career period were significantly distressful, giving rise to mental and emotional distress. CONCLUSION Pre-registration perinatal loss skill development and supported experiences are necessary for preparedness. Continued education, formalised debriefing and mentoring, institutional philosophies which promote collegial ethics of care, and the expansion of continuity of midwifery care models will improve new midwives' experiences.
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An overview of the implementation of the continuity of care model in maternal health services: A literature review. GACETA SANITARIA 2021; 35 Suppl 2:S388-S392. [PMID: 34929858 DOI: 10.1016/j.gaceta.2021.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aims to describe the implementation of continuity of care model in maternal health services starting from pregnancy, childbirth, and the puerperium. METHODS Literature is obtained from online journal databases, namely PubMed, EBSCO, and ScienceDirect, and other related sources, systematically from 2012 to 2019. RESULTS Sixteen articles on the implementation of the continuity of care model of antenatal, intranatal, and postnatal care were described by demographic characteristics, scope, and impact. Barriers and facilitators for three categories include process, communication, information and education, organization and human resources, caseload, burnout, psychological, expectation, and satisfaction. CONCLUSION The continuity of care model is useful for developing sustainability settings in all maternal health services. The practical implication is the feasibility of a midwife-led continuity of care model to avoid service dropouts. The quality of service is determined by the psychological comfort of women. Further considerations, need to include collaboration in this model.
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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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Chakroun M, Aribi L, Ellouz S, Aloulou J. [A longitudinal study about post-traumatic stress disorder after delivery in Tunisian primiparous]. Encephale 2021; 48:638-646. [PMID: 34801230 DOI: 10.1016/j.encep.2021.06.020] [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: 01/17/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aims of this study were to estimate the incidence of the post-partum post-traumatic stress disorder (PP-PTSD) in primiparous women, and to determine the profile of women at risk of developing this disorder. METHODS We conducted a descriptive, prospective and longitudinal study carried out at the maternity department of the Hedi Chaker Hospital, Sfax-Tunisia over a period of 15 months. At the first stage of the study, the Saint-Antoine pain questionnaire, the peri-traumatic dissociative experiences questionnaire and the peri-traumatic distress inventory were used respectively to assess the pain of delivery, the peri-traumatic dissociation and distress. At the second stage of the study, the questionnaires, perinatal post-traumatic stress disorder (PPQ), hospital anxiety and depression scale and the Edinburgh postnatal depression scale were used respectively for the PP-PTSD screening and the assessment of the post-partum anxious and depressive symptomatology. RESULTS The study population consisted of 183 parturients at the first stage of the study and 150 parturients at the second stage of the study. The incidence of the PP-PTSD was 9.3 %. In the multivariate study, some factors studied were significantly associated with the development of PTSD-PP, including a history of therapeutic termination of pregnancy, a history of miscarriage, exposure to a stressful event during pregnancy, prenatal hospitalization of the mother, instrumental delivery, pain intensity especially in the affective component, peri-traumatic dissociation and avoidance of sexual intercourse for fear of a new pregnancy. However the skin to skin contact with the new-born immediately after delivery was a significant protective factor. CONCLUSION The psychological consequences associated with the first birth, particularly the PP-PTSD, are common. The Identification of women at risk and a systematic screening of postpartum post-traumatic stress symptoms are desirable.
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Affiliation(s)
- M Chakroun
- Service de psychiatrie B CHU Hèdi Chaker, 3000 Sfax, Tunisie; Faculté de médecine de Tunis, 1007 Tunis, Tunisie.
| | - L Aribi
- Service de psychiatrie B CHU Hèdi Chaker, 3000 Sfax, Tunisie
| | - S Ellouz
- Service de psychiatrie B CHU Hèdi Chaker, 3000 Sfax, Tunisie
| | - J Aloulou
- Service de psychiatrie B CHU Hèdi Chaker, 3000 Sfax, Tunisie
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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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Catling C, Rossiter C, Cummins A, McIntyre E. Midwifery workplace culture in Sydney, Australia. Women Birth 2021; 35:e379-e388. [PMID: 34266786 DOI: 10.1016/j.wombi.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Aspects of the midwifery workplace culture have previously been measured as negative with limited leadership or support. Support for midwives is essential for them to face the complexity and workloads in Australian maternity units. BACKGROUND Understanding the culture of the midwifery workplace is important to develop strategies to stem workforce attrition and to optimise care of women and their families. AIMS This study aimed to assess midwives' perceptions of workplace culture in two maternity units in Sydney, Australia, and compare the results with a national study using the same validated instrument. METHOD This study reports results using the Australian Midwifery Workplace Culture instrument (n = 49 midwives) and stakeholder groups (n = 10). Simple descriptive statistics were used, and the qualitative responses were analysed thematically. FINDINGS Compared to the national sample, participants rated their workplace more favourably, especially their relationships with managers and colleagues. Over one-third (36.7%) considered that their workplace had a positive culture, compared with 27.9%e. However, they rated their workplaces more negatively on time constraints and staff resources, and reported limited autonomy. Workplaces were highly medicalised which impacted their philosophy of woman-centred care and their ability to work autonomously. DISCUSSION Factors related to collegiality in the workplace, relationship with managers, midwives' intention to leave the profession and time constraints are discussed in comparison to the national study, as well as other relevant research. Conclusion Workplace collaboration, support, respect and understanding were extremely important to midwives, as were adequate staffing levels, teamwork and opportunities for further education.
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Affiliation(s)
- Christine Catling
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia.
| | - Chris Rossiter
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia
| | - Allison Cummins
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia
| | - Erica McIntyre
- Institute for Sustainable Futures, University of Technology Sydney, Australia; School of Public Health, Faculty of Health, University of Technology Sydney, Australia
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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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Peter KA, Meier-Kaeppeli B, Pehlke-Milde J, Grylka-Baeschlin S. Work-related stress and intention to leave among midwives working in Swiss maternity hospitals - a cross-sectional study. BMC Health Serv Res 2021; 21:671. [PMID: 34238313 PMCID: PMC8264983 DOI: 10.1186/s12913-021-06706-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
Background Health systems around the globe are struggling to recruit qualified health professionals. Work-related stress plays an important role in why health professionals leave their profession prematurely. However, little is known about midwives’ working conditions and intentions to leave their profession, although this knowledge is key to work force retention. Therefore, we aimed to investigate work-related stress among midwives working in Swiss maternity hospitals, as well as differences between midwives and other health professionals and the stressors associated with midwives’ intention to leave the profession. Methods We conducted a data analysis of two cross-sectional studies encompassing midwives working in labour, postpartum and/or gynaecology wards of 12 public Swiss maternity hospitals. Data was collected by self-report questionnaire assessing potential stressors and long-term consequences of stress at work. Data were analysed using descriptive statistics, Kruskal Wallis tests and logistic regression modelling. Results A total of 98 midwives took part in the study and one in three midwives reported doing overtime sometimes-always. Also, the score for work-private life conflicts was significantly higher among midwives than among other health professionals, with the exception of physicians (M = 37.0 versus 50.2, p < .001). Midwives’ meaning of work score (M = 89.4) was significantly higher than that of other health professionals (e.g. nurses (M = 83.0, p < .001) or physicians (M = 82.5, p < .01)). Generation Y midwives showed a significantly higher intention to leave their organisation than did the baby boomers (Mean scores 29.3 versus 10.0, p < .01). Results of the regression model revealed that if midwives could compensate for their overtime in the same month, their intention to leave the profession was lower (OR = 0.23, p < .05). Additionally, the more midwives were affected by work-private life conflicts (OR = 3.01, p < .05) and thoughts about leaving their organisation (OR = 6.81, p < .05), the higher was their intention to leave their profession prematurely. Conclusions The comparison with other health professions and the higher intention to leave the profession of younger midwife generations are important findings for heads of institutions as well as policy makers, and should stimulate them to develop strategies for keeping midwives on their staff. More extensive studies should implement and test interventions for reducing work-related stress and increasing the job and occupational satisfaction of midwives.
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Affiliation(s)
- Karin Anne Peter
- Division of Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
| | - Barbara Meier-Kaeppeli
- Division of Women's Health and Newborn Care, Department of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, CH-8091, Zürich, Switzerland
| | - Jessica Pehlke-Milde
- Research Unit for Midwifery Science, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8401, Winterthur, Switzerland
| | - Susanne Grylka-Baeschlin
- Research Unit for Midwifery Science, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8401, Winterthur, Switzerland
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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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Midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies: A qualitative study. Women Birth 2021; 35:152-159. [PMID: 34074625 DOI: 10.1016/j.wombi.2021.05.005] [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: 02/22/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PROBLEM Childbearing women from ethnic minority groups in the United Kingdom (UK) have significantly poorer perinatal outcomes overall. BACKGROUND Childbearing women from ethnic minority groups report having poorer experiences and outcomes in perinatal care, and health professionals report having difficulty in providing effective care to them. Yet barriers in relation to providing such care remain underreported. AIM The aim of this study was to elicit midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies and how to overcome these barriers. METHODS A qualitative study was undertaken in a single obstetric led unit in London, UK. A thematic analysis was undertaken to identify themes from the data. FINDINGS A total of 20 midwives participated. They self-identified as White British (n=7), Black African (n=7), Black Caribbean (n=3) and Asian (n=3). Most (n=12) had more than 10 years' experience practising as a registered midwife (range 2 - 35 years). Four themes were identified: 1) Communication, 2) Continuity of carer, 3) Policy and 4) Social determinants. Racism and unconscious bias underpin many of the findings presented. DISCUSSION Co-created community hubs may improve access to more effective care for childbearing women from ethnic minority groups. A focus on robust anti-racism interventions, continuity of carer, staff wellbeing and education along with the provision of orientation and bespoke translation services are also suggested for the reduction of poorer outcomes and experiences. CONCLUSION Along with policies designed to promote equality and irradicate racism, there is a need for co-created community hubs and continuity of carer in perinatal services. Further research is also required to develop and evaluate culturally safe, and evidence-based interventions designed to address the current disparities apparent.
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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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Neely E, Dixon L, Bartle C, Raven B, Aspin C. Providing maternity care for disadvantaged women in Aotearoa New Zealand: The impact on midwives. Women Birth 2021; 35:144-151. [PMID: 33858787 DOI: 10.1016/j.wombi.2021.03.014] [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: 12/08/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health inequities and socio-economic disadvantage are causes for concern in Aotearoa New Zealand. Becoming pregnant can increase a woman's vulnerability to poverty, with the potential for an increase in multiple stressful life events. Providing midwifery care to women living in socio-economic deprivation has been found to add additional strains for midwives. Exploring the perspectives of the midwives providing care to women living with socio-economic deprivation can illuminate the complexities of maternity care. AIM To explore the impact on midwives when providing care for socio-economically disadvantaged women in Aotearoa New Zealand. METHOD Inductive thematic analysis was used to analyse an open-ended question from a survey that asked midwives to share a story around maternal disadvantage and midwifery care. FINDINGS A total of 214 stories were received from midwives who responded to the survey. Providing care to disadvantaged women had an impact on midwives by incurring increased personal costs (time, financial and emotional), requiring them to navigate threats and uncertainty and to feel the need to remedy structural inequities for women and their wider families. These three themes were moderated by the relationships midwives held with women and affected the way midwives worked across the different maternity settings. CONCLUSION Midwives carry a greater load when providing care to socio-economically deprived women. Enabling midwives to continue to provide the necessary support for women living in socio-economic deprivation is imperative and requires additional resources and funding.
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Affiliation(s)
- Eva Neely
- School of Health, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand; Maternity Equity Action, Hawkes Bay, New Zealand.
| | - Lesley Dixon
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch 8014, New Zealand.
| | - Carol Bartle
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch 8014, New Zealand.
| | - Briony Raven
- Maternity Equity Action, Hawkes Bay, New Zealand.
| | - Clive Aspin
- School of Health, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.
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Carter J, Sidebotham M, Dietsch E. Prepared and motivated to work in midwifery continuity of care? A descriptive analysis of midwifery students' perspectives. Women Birth 2021; 35:160-171. [PMID: 33832870 DOI: 10.1016/j.wombi.2021.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Internationally, midwifery education and maternity services are evolving to promote midwifery continuity of care. It is unclear whether current Australian midwifery education programs are graduating a midwifery workforce prepared and motivated to work in this way. AIM To discover how well midwifery students in Australia feel they have been prepared and motivated to work in midwifery continuity of care when they enter practice. METHODS A pragmatist approach was used. Participants were final year midwifery students at one Australian university participating in the Midwifery Student Evaluation of Practice (MidSTEP) project over three consecutive years. Descriptive analysis of selected scaled and free text responses was undertaken to ascertain how students' clinical practice experiences had influenced their learning, development and career aspirations. RESULTS Exposure to midwifery continuity of care had profound impact on students' learning, enabling them to provide woman-centred midwifery care whilst increasing confidence and preparedness for practice. The majority were motivated to work in midwifery continuity of care upon graduation. A small minority of participants felt unprepared to work in midwifery continuity of care, attributing this to their family commitments, a sense of needing more experience or unsupportive workplace cultures. SUMMARY Midwifery continuity of care experiences are highly valued by midwifery students and positively influence confidence, preparation and motivation for beginning practice. It is necessary to review education standards to ensure quality, consistency, and adequacy of these experiences throughout pre-registration midwifery education. This will assist in generating a midwifery workforce prepared and motivated to deliver the goals of maternity service reform.
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Affiliation(s)
- Joanne Carter
- School of Nursing and Midwifery, Griffith University, Logan Campus, 68 University Dr, Meadowbrook, Queensland 4131, Australia; Transforming Maternity Care Collaborative, Australia.
| | - Mary Sidebotham
- School of Nursing and Midwifery, Griffith University, Logan Campus, 68 University Dr, Meadowbrook, Queensland 4131, Australia; Transforming Maternity Care Collaborative, Australia
| | - Elaine Dietsch
- School of Nursing and Midwifery, Griffith University, Logan Campus, 68 University Dr, Meadowbrook, Queensland 4131, Australia; Transforming Maternity Care Collaborative, Australia
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