Working with private hospital midwives in Victoria, Australia to identify practice change priorities: Outcomes of a Delphi study

OBJECTIVE/AIM

In this study, we invited midwives working at one metropolitan private hospital in Victoria, Australia to identify their workplace change needs and priorities for research.

METHODS

In this two-round Delphi study, all midwifery staff within the maternity unit of a private hospital in Melbourne, Australia were invited to participate. In round one, participants joined face-to-face focus groups to put forward their ideas for workplace change and research ideas, and these data were developed into themes. In round two, participants ranked the themes in priority order.

FINDINGS

The top four themes identified by this cohort of midwives were: 'Ways of working - investigating alternate ways of working to enable greater flexibility and opportunities'; 'Understanding midwifery - working with the executive team to highlight the nuances of maternity care'; 'Education - increase in staff in the education team to provide a greater presence and opportunity for education'; and 'Postnatal specific - review ways of working in postnatal areas'.

KEY CONCLUSIONS

A number of priority research and change areas were identified which, if implemented, would strengthen both midwifery practice and midwife retention in this workplace. The findings will be of interest to midwife managers. Further research to evaluate the process and success of implementing the actions identified in this study would be valuable.

Maternity research priorities in country Western Australia: a Delphi study

Objective Health research priorities are commonly identified and resourced by strategic leaders. The importance of recognising the expertise of clinician-researchers is being prioritised by a national funding shift towards applied research. There is a dearth of evidence regarding research priorities for maternity care in rural and remote health in Australia. This study aimed to develop an evidence-based consensus of maternity research priorities in regional, rural, and remote areas of Australia's largest rural health service (by land area) in Western Australia. Methods A three-phased Delphi method was selected to achieve an interdisciplinary, evidence-based consensus on maternity research priorities within Western Australian Country Health Service. Results Across three study phases, 432 participants responded. Representation was from seven regions and all stakeholder roles within the regions. Phase 1 included 173 responses yielding 53 concepts categorised under five domains. Phase 2 involved 161 participants who prioritised concepts under domains of (i) workforce and education; (ii) health equity; (iii) Aboriginal health; (iv) logistics and health systems; and (v) clinical. Phase 3 included 96 participants revealing 15 maternity research priorities with the top four ranked concepts: 'recruitment and retention of staff'; 'care for women and families with vulnerabilities', 'models of care offering continuity' and 'systems efficiencies'. Conclusions The novel evidence provided in this study, in conjunction with a strong consensus on research priorities and an interdisciplinary approach, strengthens the findings of this study and amplifies the mandate of action without delay.

Graduating midwifery students' preferred model of practice and first job decisions: A qualitative study

OBJECTIVES

To explore and describe the preferred model of practice and first job decisions of final stage midwifery students from three Western Australian universities.

DESIGN

Qualitative descriptive.

SETTING

Three Western Australian (WA) universities offering courses leading to registration as a midwife.

PARTICIPANTS

Twenty-seven midwifery students from undergraduate and postgraduate (pre-registration) courses.

METHODS

Data were collected from recorded interviews and focus groups. Thematic analysis of interview transcripts was used to identify commonalities. Data saturation guided when recruitment ceased and final sample size was achieved.

FINDINGS

Participants' preferred model of maternity care was influenced by learning about and witnessing both autonomous midwifery practice and collaborative care during their studies. The greatest influence was clinical experience, with most preferring a continuity of midwifery model (CoM) but first consolidating their practice in a public hospital. Most students reported that they would not choose a private hospital as their first option. Work/life balance was also considered, with some accepting that family commitments and a need to work close to home may prevent them from choosing a CoM model.

CONCLUSION AND IMPLICATIONS

Although many Australian midwifery students start their midwifery course with preconceived ideology of their eventual workplace, the influences of their educators, clinical placement environment, preceptors and continuity of care experience relationships with women helped determine their final direction. To provide students with the experiences to become woman-centred autonomous practitioners it is important for universities and all maternity care providers to carefully consider their responsibility in how they influence midwifery students in education and practice.

The Effect of Stress Management Training through PRECEDE-PROCEED Model on Occupational Stress among Nurses and Midwives at Iran Hospital, Iranshahr

INTRODUCTION

Occupational stress is a major factor in hindering the performance of nurses and midwives and developing physical and mental complications in them. Given that these two groups are in direct contact with patients more than other medical staff and stress management training can be effective in the reduction of occupational stress among the nurses and midwives.

AIM

This study was set out to compare the effect of a PRECEDE-PROCEED based stress management training program on the occupational stress of the nurses and midwives.

MATERIALS AND METHODS

This quasi-experimental study was conducted on the aforementioned nurses and midwives. Data collection instruments included the Nursing Stress Scale (NSS). The training program was held in two 4-hour-long sessions for three months from 1^st January to 31^st March 2013.

RESULTS

The results showed a significant increase in the PRECEDE scores of both groups by the end of the program, as compared to the baseline. A significant decrease was also observed in the stress scores of both groups. There was no difference between groups in these regards.

CONCLUSION

The PRECEDE-based stress management training is effective in the reduction of occupational stress among the nurses and midwives.

A case study evaluation of an intervention aiming to strengthen the midwifery professional role in Morocco: anticipated barriers to reaching outcomes

BACKGROUND

In order to reduce the high maternal mortality ratio, Morocco is strongly committed to strengthen its midwifery professional role. This study aimed to identify barriers that could potentially hinder an action plan to strengthen the midwifery professional role from achieving desired outcomes. We used a conceptual framework, which is derived from Hatem-Asmar's (1997) framework on the interaction of educational, professional, and sociocultural systems in which a professional role evolves and from Damschroder et al's (2009) framework for the implementation analysis.

METHODS

This paper builds on a qualitative case study on the factors affecting the action plan's implementation process that also revealed rich data about anticipated barriers to reaching outcomes. Data were collected through training sessions, field observations, documents, focus groups (n=20), and semistructured interviews (n=11) with stakeholders pertaining to the three systems under study. Content analysis was used to identify themes related to barriers.

RESULTS

Seven barriers that may compromise the achievement of desired results were found. They relate to the legal framework, social representations, and media support in the sociocultural system and the practice environment, networks and communication mechanisms, and characteristics related to the role and the readiness in the professional system.

CONCLUSION

Disregarding sociocultural and professional system level, barriers may impede efforts to strengthen the midwife's role and to provide qualified midwives who can improve the quality of maternal care. Making changes in the educational system cannot be thought of as an isolated process. Its success is closely tied with multiple contextual factors pertaining to the two other systems. Activities recommended to address these barriers may have great potential to build a competent midwifery workforce that contributes to positive maternal and neonatal health outcomes.