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Vermeulen J, Buyl R, Luyben A, Fleming V, Tency I, Fobelets M. How to promote midwives' recognition and professional autonomy? A document analysis study. Midwifery 2024; 138:104138. [PMID: 39146900 DOI: 10.1016/j.midw.2024.104138] [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: 07/12/2023] [Revised: 07/12/2024] [Accepted: 08/07/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To identify challenges associated with midwives' professional autonomy in Belgium and develop recommendations to promote midwives' recognition and professional autonomy. DESIGN Through a document analysis study we identified challenges, categorized them into themes and linked them with Greenwood's sociological criteria for a profession. This involved an in-depth synthesis of findings from our published studies to comprehensively examine the challenges to optimizing midwifery autonomy and to develop corresponding recommendations. FINDINGS We identified challenges related to midwife-led continuity care models, regulation of the midwifery profession, collaboration with stakeholders, professional esteem and professional culture. Based on them, our recommendations include prioritizing midwife-led continuity of care, fostering collaboration, tailoring continuous professional development, increasing public awareness and advocating for policy changes. The attribute of a profession which is lacking the most in midwifery in Belgium is recognized authority, which may result in midwives being undervalued, underutilized and underpaid. KEY CONCLUSIONS In this paper we identified challenges in Belgian midwives' recognition and professional autonomy and provided recommendations to address them, emphasizing the importance of recognized authority in midwifery. Implementing these recommendations can positively impact midwives' recognition and autonomy in Belgium and potentially in other countries. IMPLICATIONS FOR PRACTICE It is essential for policy makers to address the issue of the lack of recognized authority in midwifery, as it plays a critical role in facilitating decision-making, policy development, and the professionalization of the field. Implementing the outlined recommendations can drive positive changes in midwifery recognition and autonomy in Belgium and beyond.
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Affiliation(s)
- Joeri Vermeulen
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Life Sciences and Medicine, Faculty of Sciences, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium.
| | - Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ans Luyben
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, UK; Frauenzentrum (Centre for Women's Health), Lindenhofgruppe, Bern, Switzerland
| | - Valerie Fleming
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Inge Tency
- Midwifery Department, Odisee University of Applied Sciences, Sint Niklaas, Belgium
| | - Maaike Fobelets
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium; Department of Teacher Education, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Maxwell D, Leat SR, Gallegos T, Praetorius RT. Sacred space: a qualitative interpretive meta-synthesis of women's experiences of supportive birthing environments. BMC Pregnancy Childbirth 2024; 24:372. [PMID: 38750419 PMCID: PMC11097458 DOI: 10.1186/s12884-024-06544-6] [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: 11/06/2023] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In the United States there are roughly three million births a year, ranging from cesarean to natural births. A major aspect of the birthing process is related to the healing environment, and how that helps or harms healing for the mother and child. Using the theoretical framework, Theory of Supportive Care Settings (TSCS), this study aimed to explore what is necessary to have a safe and sacred healing environment for mothers. METHOD This study utilized an updated Qualitative Interpretive Meta-synthesis (QIMS) design called QIMS-DTT [deductive theory testing] to answer the research question, What are mother's experiences of environmental factors contributing to a supportive birthing environment within healthcare settings? RESULTS Key terms were run through multiple databases, which resulted in 5,688 articles. After title and abstract screening, 43 were left for full-text, 12 were excluded, leaving 31 to be included in the final QIMS. Five main themes emerged from analysis: 1) Service in the environment, 2) Recognizing oneself within the birthing space, 3) Creating connections with support systems, 4) Being welcomed into the birthing space, and 5) Feeling safe within the birthing environment. CONCLUSIONS Providing a warm and welcoming birth space is crucial for people who give birth to have positive experiences. Providing spaces where the person can feel safe and supported allows them to find empowerment in the situation where they have limited control.
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Affiliation(s)
| | | | - Toni Gallegos
- The University of Texas at Arlington, Arlington, TX, USA
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Vermeulen J, Buyl R, Luyben A, Fleming V, Tency I, Fobelets M. The exploration of professional midwifery autonomy: Understanding and experiences of final-year midwifery students. NURSE EDUCATION TODAY 2024; 134:106101. [PMID: 38266429 DOI: 10.1016/j.nedt.2024.106101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/01/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The concept of professional midwifery autonomy holds great significance in midwifery education. Notably, clinical placements play a crucial role in introducing students to its concept. However, the understanding and experiences of students regarding midwifery autonomy are relatively unknown. OBJECTIVES This study aimed to examine the experiences and understanding of midwifery autonomy among final-year midwifery students. METHODS A qualitative exploratory study using three focus group interviews with final-year midwifery students from each of the three Belgian regions; Flanders, Walloon and the Brussels Capital Region. Focus groups were recorded, transcribed verbatim and analysed using a thematic analysis. RESULTS Upon data analysis, five key themes emerged; 1) working independently, 2) positive learning environment, 3) professional context, 4) actions and decisions of others and 5) beneficial for women. Students emphasized the importance of promoting professional midwifery autonomy through the ability to make their own professional decisions and take initiatives. They highlighted the need for a safe and supportive learning environment that encourages independent practice, nurtures self-governance and facilitates personal growth. Additionally, collaborative relationships with other maternity care professionals and increased awareness among women and the broader healthcare community were identified as essential factors in embracing and promoting professional midwifery autonomy. CONCLUSIONS Our study provides valuable insights into the significance of midwifery autonomy among final-year midwifery students. To empower midwifery students to truly understand and experience professional midwifery autonomy, educators and preceptors should adopt strategies that enhance comprehension, foster independent yet collaborative practice, establish supportive learning environments, and equip students to navigate challenges effectively, ultimately improving maternal and new-born health.
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Affiliation(s)
- Joeri Vermeulen
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium; Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ans Luyben
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, United Kingdom; Lindenhofgruppe, Bern, Switzerland
| | | | - Inge Tency
- Midwifery Department, Odisee University of Applied Sciences, Sint Niklaas, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Maaike Fobelets
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium; Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Teacher Education, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Kubota S, Ando M, Murray J, Khambounheuang S, Theppanya K, Nanthavong P, Tengbriacheu C, Sisavanh M, Khattiyod T, Asai D, Sobel H, Jimba M. A regulatory gap analysis of midwifery to deliver essential reproductive, maternal, newborn, child and adolescent health services in Lao People's Democratic Republic. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100960. [PMID: 38146489 PMCID: PMC10749282 DOI: 10.1016/j.lanwpc.2023.100960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/15/2023] [Accepted: 10/22/2023] [Indexed: 12/27/2023]
Abstract
Background In Lao Peoples Democratic Republic, midwives are the main providers of primary reproductive, maternal, newborn, child and adolescent (RMNCAH) services. We analyzed to what extent practice regulations allow midwives to provide nationally defined essential RMNCAH services. Methods Stakeholder consultations and document reviews were conducted to identify the essential RMNCAH interventions and care tasks midwives are expected to provide without physicians. These were defined in: 1) the Essential Health Service Package (EHSP) and 2) 18 national standards and guidelines. We then mapped whether midwifery regulations, which provide the legal framework for clinical service provision, supported delivery of these standards to identify regulatory gaps. Data were used to update regulations. Findings Midwives were expected to provide 39 RMNCAH interventions without physicians, representing 1100 care tasks. Midwifery practice regulations allowed eight of 39 interventions (20.5%) and 705 of 1100 care tasks (64.1%) at baseline. Of the 31 interventions not allowed for provision by midwives, 83.9% (26) required prescribing and giving medicines, 51.6% (16) ordering and conducting diagnostics, 38.7% (12) making a clinical diagnosis, and 22.6% (7) use of non-pharmacological interventions. The Ministry of Health convened a multi-stakeholder group to revise the midwifery practice regulations, which increased the legally supported interventions and care tasks to 37 (94.9%) and 1081 (98.3%), respectively. Interpretation This novel methodology enabled systematic identification and quantification of regulatory gaps in midwifery practice and data-driven revisions. Consequently, regulatory support for delivery of primary RMNCAH interventions vastly improved. The approach can be applied to other clinical cadres, service areas and countries. Funding Korea Foundation for International Health Care (KOFIH) supported research operation.
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Affiliation(s)
| | | | - John Murray
- WHO Western Pacific Region, Manilla, Philippines
| | | | | | | | - Chankham Tengbriacheu
- National Mother and Child Health Center, Department of Hygiene and Health Promotion, Ministry of Health, Vientiane, Lao PDR
| | | | | | | | - Howard Sobel
- WHO Western Pacific Region, Manilla, Philippines
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Vermeulen J, Fobelets M, Fleming V, Luyben A, Stas L, Buyl R. How Do Midwives View Their Professional Autonomy, Now and in Future? Healthcare (Basel) 2023; 11:1800. [PMID: 37372919 DOI: 10.3390/healthcare11121800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Internationally, midwives' professional autonomy is being challenged, resulting in their inability to practice to their full scope of practice. This situation contrasts with the increasing international calls for strengthening the midwifery profession. The aim of this study therefore is to explore Belgian midwives' views on their current and future autonomy. METHODS An online survey among Belgian midwives was performed. Data were collected and analyzed using a quantitative approach, while quotes from respondents were used to contextualize the quantitative data. RESULTS Three hundred and twelve midwives from different regions and professional settings in Belgium completed the questionnaire. Eighty-five percentage of respondents believe that they are mostly or completely autonomous. Brussels' midwives feel the most autonomous, while those in Wallonia feel the least. Primary care midwives feel more autonomous than hospital-based midwives. Older midwives and primary care midwives feel less recognized and respected by other professionals in maternity care. The majority of our respondents believe that in future midwives should be able to work more autonomously in constructive collaboration with other professionals. CONCLUSION While Belgian midwives generally rated their own professional autonomy as high, a significant majority of respondents desire more autonomy in future. In addition, our respondents want to be recognized and respected by society and other health professionals in maternity care. It is recommended to prioritize efforts in enhancing midwives' autonomy, while also addressing the need for increased recognition and respect from society and other maternity care professionals.
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Affiliation(s)
- Joeri Vermeulen
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, 1090 Brussels, Belgium
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Maaike Fobelets
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, 1090 Brussels, Belgium
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Department of Teacher Education, Vrije Universiteit Brussel (VUB), 1040 Brussels, Belgium
| | - Valerie Fleming
- Faculty of Health, Liverpool John Moores University, Liverpool L3 5UX, UK
| | - Ans Luyben
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth BH1 3LH, UK
- Frauenzentrum (Centre for Women's Health), Lindenhofgruppe, 3012 Bern, Switzerland
| | - Lara Stas
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Support for Quantitative and Qualitative Research (SQUARE), Core Facility of the Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Ronald Buyl
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
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Walker S, Spillane E, Stringer K, Meadowcroft A, Dasgupta T, Davies SM, Sandall J, Shennan A. The feasibility of team care for women seeking to plan a vaginal breech birth (OptiBreech 1): an observational implementation feasibility study in preparation for a pilot trial. Pilot Feasibility Stud 2023; 9:80. [PMID: 37173798 PMCID: PMC10175899 DOI: 10.1186/s40814-023-01299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND OptiBreech Care is a care pathway for breech presentation at term, including where chosen, physiological breech birth attended by professionals with advanced training and/or proficiency. We aimed to assess the feasibility of implementing OptiBreech team care prior to proceeding with a planned pilot randomised controlled trial. METHODS Our design was an observational implementation feasibility assessment across England and Wales, January 2021-June 2022. Our objectives were to determine whether Trusts could provide attendants with advanced training (implementation feasibility), who deliver protocol-consistent care (fidelity), within existing resources (costs), while maintaining low neonatal admission rates (safety) and adequate recruitment rates (trial feasibility). Participants included women > 37 weeks pregnant with a breech-presenting foetus, requesting support for a vaginal breech birth following standard counselling, and staff involved in the study. No randomisation occurred in this first stage of feasibility work. RESULTS Thirteen National Health Service sites were recruited. A total of 82 women planned births in the study. Sites with a breech specialist midwife recruited at double the rate of sites without (0.90/month, 95% CI 0.64-1.16 vs 0.40, 95% CI 0.12-0.68). Referrals into the study came from midwives (46%), obstetricians (34%) and women themselves (20%). Vaginal births were attended by staff with OptiBreech training at 87.5% (35/40, 95% CI 0.732-0.958) and by staff who met additional proficiency criteria at 67.5% (27/40, 95% CI 0.509-0.814). Fidelity criteria were more consistently met by staff who also met proficiency criteria. There were four neonatal admissions (4.9%, 4/82), including one serious adverse outcome (1.2%, 1/82). CONCLUSIONS A prospective observational cohort of OptiBreech collaborative care, which could potentially support nested or cluster randomisation, appears feasible in sites willing to establish a dedicated clinic and strategically develop further proficient members of staff, with back-up plans for supporting rapidly progressing births. Randomisation procedures remain to be feasibility tested. It is funded by the NIHR (NIHR300582).
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Affiliation(s)
- Shawn Walker
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK.
- Women's and Children's Services, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd, London, SW10 9NH, UK.
| | - Emma Spillane
- Kingston Hospital NHS Foundation Trust, Galsworthy Road, Surrey, Kingston upon Thames, KT2 7QB, UK
| | - Kate Stringer
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, UK
| | - Amy Meadowcroft
- Northern Care Alliance NHS Foundation Trust, Royal Oldham Hospital, Rochdale Road, Oldham, Greater Manchester, OL1 2JH, UK
| | - Tisha Dasgupta
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
| | - Siân M Davies
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
| | - Andrew Shennan
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, School of Life Course and Population Sciences, King's College London, London, SE1 7EH, UK
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Swedish midwives' experiences of collegial midwifery assistance during the second stage of labour: A qualitative study. Women Birth 2023; 36:72-79. [PMID: 35307300 DOI: 10.1016/j.wombi.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/12/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND There has been an increased focus on clinical practice that may reduce severe perineal trauma due to awareness of the associated morbidity. Knowledge regarding the best practice to reduce these injuries is limited. Collegial midwifery assistance during the second stage of labour that involves an additional midwife being present has recently been implemented into many Swedish birth units with the aim of reducing severe perineal trauma. However, no studies have been conducted to evaluate midwives' experiences and views of this practice. AIM The aim of this study was to explore midwives' experiences of collegial midwifery assistance during the second stage of labour. METHODS A qualitative study was undertaken with five focus groups conducted with 37 midwives who were part of a multisite randomised controlled trial. The data was analysed with reflexive thematic analysis. FINDINGS Four key themes were generated: (i) "challenging the professional role"; (ii) "a balancing act between different roles"; (iii) "not just why and how - but who"; (iv) "a potential arena for learning". CONCLUSION This practice enabled valuable collegial support and learning. The midwives' experiences were multifaceted and influenced by several factors, including norms and culture in the birth units as well as personal relationships and the midwives' views on their role and childbirth. Staffing should be adapted in clinical practice to optimise the conditions for collegial support and learning while avoiding unintended consequences.
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Kuipers YJ, Thomson G, Goberna-Tricas J, Zurera A, Hresanová E, Temesgenová N, Waldner I, Leinweber J. The social conception of space of birth narrated by women with negative and traumatic birth experiences. Women Birth 2023; 36:e78-e85. [PMID: 35514007 DOI: 10.1016/j.wombi.2022.04.013] [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: 01/27/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the importance of the social space of birth. AIM To explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth. METHODS A feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic. FINDINGS Three themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relationships, including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror. DISCUSSION/CONCLUSION The findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.
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Affiliation(s)
- Yvonne J Kuipers
- Artesis Plantijn University College, Noorderplaats 2, 2000 Antwerp, Belgium; Edinburgh Napier University, School of Health and Social Care, Sighthill Court, Edinburgh EH11 4BN, Scotland, United Kingdom.
| | - Gill Thomson
- School of Community Health & Midwifery, University of Central Lancashire, Preston, United Kingdom.
| | - Josefina Goberna-Tricas
- University of Barcelona, Faculty of Medicine and Health Sciences, Bellvitge Health Sciences Campus, Carrer de la Feixa Llarga, s/n. 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Alba Zurera
- University of Barcelona, Faculty of Law, Avinguda Diagonal, 684, 08028 Barcelona, Spain.
| | - Ema Hresanová
- Charles University, Faculty of Social Sciences, U Krize 8, 158 00 Prague, Czech Republic.
| | - Natálie Temesgenová
- Charles University, Faculty of Social Sciences, U Krize 8, 158 00 Prague, Czech Republic.
| | - Irmgard Waldner
- Universitätsklinik Graz, Auenbruggerplatz 14, 8036 Graz, Austria.
| | - Julia Leinweber
- Institute for Midwifery, Charite Universitätsmedizin Berlin, Berlin, Germany.
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Junttila K, Heikkilä A, Heikkilä A, Koivunen M, Lehtikunnas T, Mattila E, Meriläinen M, Peltokoski J, Sneck S, Tervo-Heikkinen T. The Impact of Leadership in the Autonomy and Engagement of Nurses: A Cross-sectional Multicenter Study Among Nurses Outside the United States. J Nurs Adm 2023; 53:19-26. [PMID: 36542440 DOI: 10.1097/nna.0000000000001237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To add to the body of evidence regarding nurse engagement and related factors from a non-US sample of nurses. BACKGROUND Leadership has a positive impact on nurses' autonomy and engagement experiences. It is necessary to explore the factors that explain the relationships between leadership, autonomy, and engagement level. METHODS Nurses (n = 4393) from 9 hospitals participated in a survey in March 2020. Multivariable logistic regression analysis was performed to identify engagement and autonomy predictors. RESULTS Of the respondents, 9% were engaged, 28% content, 29% ambivalent, and 34% disengaged. Respondents' separate background variables were not significant predictors in multivariate models, whereas the leadership- and autonomy-related variables were. CONCLUSIONS A manager's responsiveness, an organization's readiness to follow nurse suggestions for performance improvement, and receiving recognition and regular feedback promote engagement. Furthermore, engagement is enhanced when nurses have an active role in decision-making and their contributions are respected. Visible nurse managers and leaders who are effective advocates for nurses strengthen nurses' autonomy.
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Affiliation(s)
- Kristiina Junttila
- Authors Affiliations: Director (Dr Junttila), Nursing Research Center, and Development Manager, Nursing (Ms Heikkilä), Nursing Administrative Group, Helsinki University Hospital and University of Helsinki; Director of Nursing Excellence (Dr Heikkilä), Development Services, Hospital District of Southwest Finland, Turku; Nursing Director (Dr Koivunen), Research and Development Services, Satakunta Hospital District, Pori; Hospital Director of Nursing (Dr Lehtikunnas), Administrative Centre, Turku University Hospital, Turku; Chief Nursing Officer (Dr Mattila), Administrative Centre, Tampere University Hospital; Hospital Nursing Officer (Dr Meriläinen), Medical Research Center Oulu, Oulu University Hospital; Director of Nursing Excellence (Dr Peltokoski), Administration Services, Central Finland Health Care District, Jyväskylä; Director of Nursing Excellence (Dr Sneck), Oulu University Hospital; Clinical Nurse Consultant (Dr Tervo-Heikkinen), Clinical Development, Education and Research Centre of Nursing, Kuopio University Hospital; and Adjunct Professor (Dr Junttila, Dr Koivunen), Department of Nursing Science, University of Turku, Finland
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Ferguson B, Baldwin A, Henderson A, Harvey C. The grounded theory of Coalescence of Perceptions, Practice and Power: An understanding of governance in midwifery practice. J Nurs Manag 2022; 30:4587-4594. [PMID: 36325759 PMCID: PMC10099921 DOI: 10.1111/jonm.13892] [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: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIMS This study aimed to understand midwifery care during labour, particularly decision-making processes, within Australian health systems. BACKGROUND Midwifery, founded on a wellness model of motherhood, is at risk of being medicalized. Whilst medical intervention is lifesaving, it requires judicious use. Governance provides oversight to care. Exploring decision-making contributes to understanding governance of practices. METHOD Straussian grounded theory using semi-structured interviews. Eighteen Australian registered midwives were interviewed about their practice when caring for women during labour. RESULTS Midwives were caught between divergent positions; birth as natural versus birth as risk. Experienced midwives discussed focussing on the woman, yet less experienced were preoccupied with mandatory protocols like early warning tools. Practice was governed by midwives approach within context of labour. The final theory: The Coalescence of Perceptions, Practice and Power, comprising three categories: perceptions and behaviour, shifting practice and power within practice, emerged. CONCLUSIONS Coalescence Theory elucidates how professional decision making by midwives during care provision is subject to power within practice, thereby governed by tensions, competing priorities and organizational mandates. IMPLICATIONS FOR MIDWIFERY MANAGERS Midwifery managers are well positioned to negotiate the nuanced space that envelopes birthing processes, namely, expert knowledge, policy mandates and staffing capability and resources, for effective collaborative governance. In this way, managers sustain good governance.
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Affiliation(s)
- Bridget Ferguson
- Central Queensland University, North Rockhampton, Queensland, Australia
| | - Adele Baldwin
- Central Queensland University, Townsville, Queensland, Australia
| | - Amanda Henderson
- Central Queensland University, Brisbane City, Queensland, Australia
| | - Clare Harvey
- Central Queensland University, Townsville, Queensland, Australia.,Massey University, Wellington Campus, Wellington, New Zealand
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Vermeulen J, Buyl R, Luyben A, Fleming V, Fobelets M. Defining midwifery autonomy in Belgium: Consensus of a modified Delphi study. J Adv Nurs 2022; 78:2849-2860. [PMID: 35266191 DOI: 10.1111/jan.15209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
Abstract
AIMS Although there is substantial literature on autonomy of midwifery, the concept remains vague, and what it exactly constitutes is little clear. Attempts to define this have been carried out, but did not result in a communal understanding. The aim of this study therefore was to define a consistent definition of midwifery autonomy in Belgium. DESIGN A modified Delphi survey with content experts. METHODS Critical components of the available definitions on midwifery autonomy were retrieved from the literature, and translated into Dutch and French. An online Delphi panel of content expert assessed components of autonomy in midwifery on clarity and relevance between June and October 2021. From the validated components, a preliminary consolidated definition was generated, which was validated in a final Delphi round. RESULTS After round one, content experts (n = 27) evaluated 10 out of 17 components to be clear and relevant. Two components were judged inappropriate and therefore removed. After further adaptation four additional components were identified appropriate after the second round, and one component after a third Delphi round. Experts' suggestions for improving the clarity and relevance were taken into account. Finally, experts assessed the preliminary definition. After minor modifications the definition of midwifery autonomy in Belgium was confirmed valid. CONCLUSION We established a communal definition of midwifery autonomy in Belgium, the creation of such a definition results in a joint understanding of the concept of midwifery autonomy. IMPACT If midwives internationally want to successfully achieve autonomy, a clear understanding of the concept of midwifery autonomy is needed. The consensus definition of midwifery autonomy in Belgium comprises 15 components related to midwives' work content, professionalism and relationship with others. Our definition of midwifery autonomy has the potential to encourage an international dialogue, grounded in a common understanding of autonomy, enabling stakeholders in maternity care to strengthen professional midwifery autonomy.
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Affiliation(s)
- Joeri Vermeulen
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium.,Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ans Luyben
- Bournemouth University, Bournemouth, UK.,Lindenhofgruppe, Bern, Switzerland
| | | | - Maaike Fobelets
- Department Health Care, Brussels Centre for Healthcare Innovation, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium.,Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Mharapara TL, Staniland N, Stadler M, Clemons JH, Dixon L. Drivers of job satisfaction in midwifery-A work design approach. Women Birth 2021; 35:e348-e355. [PMID: 34312099 DOI: 10.1016/j.wombi.2021.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identifying common factors that influence job satisfaction for midwives working in diverse work settings is challenging. Applying a work design model developed in organisational behaviour to the midwifery context may help identify key antecedents of midwives job satisfaction. AIM To investigate three job characteristics - decision-making autonomy, empowerment, and professional recognition as antecedents of job satisfaction in New Zealand (NZ) midwives. METHODS Latent multiple regressions were performed on data from Lead Maternity Carer (LMC) midwives n = 327, employed midwives n = 255, and midwives working in 'mixed-roles' n = 123. FINDINGS We found that professional recognition is positively linked to job satisfaction for midwives in all three work settings. At the same time, decision-making autonomy and empowerment were shown to influence job satisfaction for midwives working as LMCs only. DISCUSSION Our main finding suggests that the esteem generated from being acknowledged as an expert and valuable contributor by maternity health colleagues is satisfying across all work contexts. Professional recognition encompasses the social dimension of midwifery work and influences midwives job satisfaction. Decision-making autonomy and empowerment are task and relational job characteristics that may not be similarly experienced by all midwives to noticeably influence job satisfaction. CONCLUSION Given that job satisfaction contributes to recruitment, retention, and sustainability, our findings show that drivers of job satisfaction differ by midwifery work context. We present evidence to support tailored efforts to bolster midwives job satisfaction, especially where resources are limited.
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Affiliation(s)
- Tago L Mharapara
- Auckland University of Technology, AUT Department of Management, Private Bag 92006, Victoria Street West, Auckland 1142, New Zealand.
| | - Nimbus Staniland
- Auckland University of Technology, AUT Department of Management, Private Bag 92006, Victoria Street West, Auckland 1142, New Zealand.
| | - Matthias Stadler
- Ludwig-Maximilians-Universität München, Faculty of Psychology, Raum 3432, Leopoldstr. 13, 80802 München, Germany.
| | - Janine H Clemons
- Auckland University of Technology, AUT Midwifery Department, Private Bag 92006, 640 Great South Road, Manukau, Auckland 2104, New Zealand.
| | - Lesley Dixon
- New Zealand College of Midwives, PO Box 21-106, Edgeware, Christchurch 8143, New Zealand.
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Clemons JH, Gilkison A, Mharapara TL, Dixon L, McAra-Couper J. Midwifery Job Autonomy in New Zealand: I do it all the time. Women Birth 2020; 34:30-37. [PMID: 32962945 DOI: 10.1016/j.wombi.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This research aimed to identify what supports and what hinders job autonomy for midwives in New Zealand. METHODS Registered midwives participated in an open-ended, online survey in 2019. Anonymised participants were asked to describe an incident when they felt they were using their professional judgement and/or initiative to make decisions and the resultant actions. The data was analysed thematically. FINDINGS The participants identified that autonomy is embedded within midwifery practice in New Zealand. Self-employed midwives who provide continuity of care as Lead Maternity Carers, identified they practice autonomously 'all the time'. The relationship with women and their family, and informed decision making, motivated the midwife to advocate for the woman - regardless of the midwife's work setting. Midwifery expertise, skills, and knowledge were intrinsic to autonomy. Collegial relationships could support or hinder the midwives' autonomy while a negative hospital work culture could hinder job autonomy. DISCUSSION Midwives identified that autonomous practice is embedded in their day to day work. It strengthens and is strengthened by their relationships with the woman/whanau and when their body of knowledge is acknowledged by their colleagues. Job autonomy was described when midwifery decisions were challenged by health professionals in hospital settings and these challenges could be viewed as obstructing job autonomy. CONCLUSION The high job autonomy that New Zealand midwives enjoy is supported by their expertise, the women and colleagues that understand and respect their scope of practice. When their autonomy is hindered by institutional culture and professional differences provision of woman-centred care can suffer.
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Affiliation(s)
- Janine H Clemons
- Department of Midwifery, Auckland University of Technology, South Campus, Auckland 2104, New Zealand.
| | - Andrea Gilkison
- Department of Midwifery, Auckland University of Technology, South Campus, Auckland 2104, New Zealand
| | - Tago L Mharapara
- Department of Management, Auckland University of Technology, City Campus, Auckland 1142, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch 8143, New Zealand
| | - Judith McAra-Couper
- Department of Midwifery, Auckland University of Technology, South Campus, Auckland 2104, New Zealand
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