The study explored the experiences of newly qualified midwives and described the factors that fac... more The study explored the experiences of newly qualified midwives and described the factors that facilitated or constrained their development during the transition from student to registered midwife. Knowledge of the transition to midwifery practice remains limited. A qualitative descriptive approach was used. Sixteen graduates from one Australian University participated in a tape-recorded interview. Thematic analysis was used to analyse the data set. The metaphor of 'The Pond', an environment that consists of layers of life and can be both clear and peaceful or murky and infested, was used to describe new midwives perceptions of the context and culture of hospital-based maternity care. For some, 'The Pond' was a harsh environment that often became toxic. The 'Life-raft' metaphor was used to describe the importance of midwife-to-midwife relationships. The theme of 'Swimming' captured the consequence of positive interactions with colleagues and a supportive environment, whilst 'Sinking' described the consequence of poor relationships with midwives and a difficult working environment. The study highlights the importance of positive midwife-to-midwife relationships on the transition from student to registered midwife. There was also evidence that continuity with women and midwifery colleagues enhanced confidence and restored faith in normal birth. At the same time, it was clear that the midwifery culture of some…
Nursing staff are an important source of support for parents of a hospitalized preterm infant. Th... more Nursing staff are an important source of support for parents of a hospitalized preterm infant. This study aimed to describe parents' and nurses' perceptions of communicating with each other in the context of the special care nursery. A qualitative descriptive design was employed. Thirty two parents with a newborn admitted to one of two special care nurseries in Queensland, Australia participated, and 12 nurses participated in semi-structured interviews. Thematic analysis was used to analyze the interviews. Nurses and parents focused on similar topics, but their perceptions differed. Provision of information and enabling parenting were central to effective communication, supported by an appropriate interpersonal style by nurses. Parents described difficulties accessing or engaging nurses. Managing enforcement of policies was a specific area of difficulty for both parents and nurses. The findings indicated a tension between providing family-centered care that is individualized and based on family needs and roles, and adhering to systemic nursery policies.
To describe the use of family conversations as a data collection strategy in a study that aimed t... more To describe the use of family conversations as a data collection strategy in a study that aimed to explore how 'social context' impacts on the infant feeding and early parenting choices of first-time mothers. Specifically, the authors aim to describe the challenges and benefits of facilitating 'family conversations' and the importance of considering the needs of the researcher and the research participants in the data collection process. Breastfeeding is endorsed by the World Health Organisation as a key health promotion strategy, and yet many women in Australia cease breastfeeding (either fully or partially) before the recommended time frame of six months. Engaging with and interviewing families is a well-established research strategy, but interviewing the family as a whole has rarely been used as a part of breastfeeding research. A component of a study, conducted in Sydney, Australia, was to use 'family conversations' to ascertain the views and beliefs that are held by those in the first-time mother's social network and how these impact on her experience of mothering and associated decision-making. Being able to balance the needs of the researcher and the research participants is an important challenge that is a core component of conducting ethical research. This paper highlights the viability of 'family conversations' as a data collection method for midwifery and nursing research and the need for midwives and child and family health nurses to more actively engage with a woman's support network with education and other strategies to assist in creating an environment for new mothers that is conducive to the continuation of breastfeeding and thriving as a mother.
the predicted midwifery workforce shortages in several countries have serious implications for th... more the predicted midwifery workforce shortages in several countries have serious implications for the care of women during pregnancy, birth and post partum. There are a number of factors known to contribute to midwifery shortages and work attrition. However, midwives assessment of their own professional identity and role (sense of empowerment) are perhaps among the most important. There are few international workforce comparisons. to compare midwives' sense of empowerment across Australia, New Zealand and Sweden using the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). a self-administered survey package was distributed to midwives through professional colleges and networks in each country. The surveys asked about personal, professional and employment details and included the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Descriptive statistics for the sample and PEMS were generated separately for the three countries. A series of analysis of variance with posthoc tests (Tukey's HSD) were conducted to compare scale scores across countries. Effect size statistics (partial eta squared) were also calculated. completed surveys were received from 2585 midwives (Australia 1037; New Zealand 1073 and Sweden 475). Respondents were predominantly female (98%), aged 50-59 years and had significant work experience as a midwife (+20 years). Statistically significant differences were recorded comparing scores on all four PEMS subscales across countries. Moderate effects were found on Professional Recognition, Skills and Resources and Autonomy/Empowerment comparisons. All pairwise comparisons between countries reached statistical significance (p<.001) except between Australia and New Zealand on the Manager Support subscale. Sweden recorded the highest score on three subscales except Skills and Resources which was the lowest score of the three countries. New Zealand midwives scored significantly better than both their Swedish and Australian counterparts in terms of these essential criteria. midwives in New Zealand and Sweden had a strong professional identity or sense of empowerment compared to their Australian counterparts. This is likely the result of working in more autonomous ways within a health system that is primary health care focused and a culture that constructs childbirth as a normal but significant life event. If midwifery is to reach its full potential globally then developing midwives sense of autonomy and subsequently their empowerment must be seen as a critical element to recruitment and retention that requires attention and strengthening.
Midwifery prescribing was introduced in Australia in 2010 and is available to those notated as Me... more Midwifery prescribing was introduced in Australia in 2010 and is available to those notated as Medicare Eligible. Only 59% of Medicare Eligible midwives are endorsed prescribers. To explore and describe Australian midwives views of prescribing including the barriers and enablers to prescribing. Online survey. Eligible participants were Australian midwives who had completed an educational programme required for endorsement as a midwifery prescriber (n=131). Descriptive statistics and content analysis were used to analyse the data set. Sixty-six midwives entered data (50% response rate). Twelve midwives (18%) had commenced prescribing. Prescribers agreed that being able to prescribe enhanced women's access to medicines and role satisfaction. The most common barriers to initiating prescribing were regulatory issues and processes, and no pathway to support midwifery prescribing in the public sector. The enabling factors most commonly reported were supportive relationships, education and personal factors such as motivation, knowledge and confidence. Prescribing was viewed positively by midwives, but only a small proportion of suitably educated midwives were able to translate this into prescribing. Prolonged and complicated registration processes, restrictive drug formularies, and a lack of prescribing roles for public sector midwives were clear barriers. Supportive professional relationships, quality education and personal motivation and confidence assisted midwives in overcoming these barriers. Offering mentoring may help midwives to move into prescribing practice and use it in a manner that best meets the health needs of women and infants in midwifery care.
The aim of this study was to identify the research priorities of midwives at Gold Coast Hospital ... more The aim of this study was to identify the research priorities of midwives at Gold Coast Hospital (GCH), South East Queensland, Australia. It was also hoped that the study would help foster a culture of inquiry and reflection. Establishing and maintaining a research culture is essential to the provision of high quality maternity services. A two phase Delphi design was used. Fifty eight midwives participated in round one (50 per cent response rate) and 54 in round two (60 per cent response rate). Midwives identified post dates induction of labour and work place culture as areas of research interest.
To cite this article: Burns, Elaine; Schmied, Virginia; Sheehan, Athena and Fenwick, Jennifer. Wo... more To cite this article: Burns, Elaine; Schmied, Virginia; Sheehan, Athena and Fenwick, Jennifer. Women's Health and Midwifery: Let Women Express Themselves - Breastfeeding Study [online]. Australian Nursing Journal: ANJ, The, Vol. 17, No. 2, Aug 2009: 44-45. ...
Midwifery is a research-informed profession with a mandated requirement to utilise latest best ev... more Midwifery is a research-informed profession with a mandated requirement to utilise latest best evidence. It is now recognised, however, that the introduction of new evidence into practice is complicated and uncertain. Growing awareness of this fact has led to the establishment of a new discipline, Implementation Science (IS), which is focused on developing ways to expedite the timely movement of evidence into practice. To date though, the wider midwifery profession has yet to make use of IS change-facilitation tools and methods. The aim of this study was to determine the fitness for use in midwifery of one established IS tool: the UK NHS Spread & Adoption tool, which is designed to enable clinicians to assess their organisational context for change readiness. A qualitative descriptive methodology was used for this study, which was set in two Australian states. Focus groups were used to collect data. The sample comprised ten Australian change-leader midwifery teams who had led evidence-based practice change initiatives in the previous 12 months. Three themes emerged from the data which together convey that although poor internet access was problematic for some, and some of the language was found to be inappropriate, the tool was ultimately viewed as very useful for helping the implementation of practice change in midwifery settings. This study provides valuable information about the broad suitability of the tested tool for Australian midwifery settings. Further research is required to evaluate a revised version.
High levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbei... more High levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbeing for around one in five women living in developed countries. Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention. Between May 2012 and June 2013 women in their second trimester of pregnancy were recruited. Women with a fear score ≥ 66 on the Wijma Delivery Expectancy / Experience Questionnaire (W-DEQ) were randomised to receive telephone psycho-education by a midwife, or usual maternity care. A two armed non-blinded parallel (1:1) multi-site randomised controlled trial with participants allocated in blocks of ten and stratified by hospital site and parity using an electronic centralised computer service. The outcomes of the RCT o...
Women and birth : journal of the Australian College of Midwives, Jan 8, 2015
The Practice Environment Scale (PES) has been used extensively to measure the quality of the prac... more The Practice Environment Scale (PES) has been used extensively to measure the quality of the practice environment of nurses working in a variety of work settings, and has been linked with quality of care, nurse wellbeing, job dissatisfaction and burnout. Although developed for nurses, many of the aspects addressed by the PES are also relevant to the midwifery profession, and may provide a tool to better understand midwives' decision to leave the profession. To adapt the PES for use with midwives and to assess its psychometric properties. An online survey containing the adapted version of the PES was distributed to a sample of hospital-employed New Zealand midwives (n=600). Exploratory factor analysis was conducted to identify subscales which were compared for midwives who had, versus had not considered, leaving the midwifery profession. Four subscales were identified, showing good internal consistency reliability (Quality of Management, Midwife-Doctor Relations, Resource Adequac...
The study explored the experiences of newly qualified midwives and described the factors that fac... more The study explored the experiences of newly qualified midwives and described the factors that facilitated or constrained their development during the transition from student to registered midwife. Knowledge of the transition to midwifery practice remains limited. A qualitative descriptive approach was used. Sixteen graduates from one Australian University participated in a tape-recorded interview. Thematic analysis was used to analyse the data set. The metaphor of 'The Pond', an environment that consists of layers of life and can be both clear and peaceful or murky and infested, was used to describe new midwives perceptions of the context and culture of hospital-based maternity care. For some, 'The Pond' was a harsh environment that often became toxic. The 'Life-raft' metaphor was used to describe the importance of midwife-to-midwife relationships. The theme of 'Swimming' captured the consequence of positive interactions with colleagues and a supportive environment, whilst 'Sinking' described the consequence of poor relationships with midwives and a difficult working environment. The study highlights the importance of positive midwife-to-midwife relationships on the transition from student to registered midwife. There was also evidence that continuity with women and midwifery colleagues enhanced confidence and restored faith in normal birth. At the same time, it was clear that the midwifery culture of some…
Nursing staff are an important source of support for parents of a hospitalized preterm infant. Th... more Nursing staff are an important source of support for parents of a hospitalized preterm infant. This study aimed to describe parents' and nurses' perceptions of communicating with each other in the context of the special care nursery. A qualitative descriptive design was employed. Thirty two parents with a newborn admitted to one of two special care nurseries in Queensland, Australia participated, and 12 nurses participated in semi-structured interviews. Thematic analysis was used to analyze the interviews. Nurses and parents focused on similar topics, but their perceptions differed. Provision of information and enabling parenting were central to effective communication, supported by an appropriate interpersonal style by nurses. Parents described difficulties accessing or engaging nurses. Managing enforcement of policies was a specific area of difficulty for both parents and nurses. The findings indicated a tension between providing family-centered care that is individualized and based on family needs and roles, and adhering to systemic nursery policies.
To describe the use of family conversations as a data collection strategy in a study that aimed t... more To describe the use of family conversations as a data collection strategy in a study that aimed to explore how 'social context' impacts on the infant feeding and early parenting choices of first-time mothers. Specifically, the authors aim to describe the challenges and benefits of facilitating 'family conversations' and the importance of considering the needs of the researcher and the research participants in the data collection process. Breastfeeding is endorsed by the World Health Organisation as a key health promotion strategy, and yet many women in Australia cease breastfeeding (either fully or partially) before the recommended time frame of six months. Engaging with and interviewing families is a well-established research strategy, but interviewing the family as a whole has rarely been used as a part of breastfeeding research. A component of a study, conducted in Sydney, Australia, was to use 'family conversations' to ascertain the views and beliefs that are held by those in the first-time mother's social network and how these impact on her experience of mothering and associated decision-making. Being able to balance the needs of the researcher and the research participants is an important challenge that is a core component of conducting ethical research. This paper highlights the viability of 'family conversations' as a data collection method for midwifery and nursing research and the need for midwives and child and family health nurses to more actively engage with a woman's support network with education and other strategies to assist in creating an environment for new mothers that is conducive to the continuation of breastfeeding and thriving as a mother.
the predicted midwifery workforce shortages in several countries have serious implications for th... more the predicted midwifery workforce shortages in several countries have serious implications for the care of women during pregnancy, birth and post partum. There are a number of factors known to contribute to midwifery shortages and work attrition. However, midwives assessment of their own professional identity and role (sense of empowerment) are perhaps among the most important. There are few international workforce comparisons. to compare midwives' sense of empowerment across Australia, New Zealand and Sweden using the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). a self-administered survey package was distributed to midwives through professional colleges and networks in each country. The surveys asked about personal, professional and employment details and included the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Descriptive statistics for the sample and PEMS were generated separately for the three countries. A series of analysis of variance with posthoc tests (Tukey's HSD) were conducted to compare scale scores across countries. Effect size statistics (partial eta squared) were also calculated. completed surveys were received from 2585 midwives (Australia 1037; New Zealand 1073 and Sweden 475). Respondents were predominantly female (98%), aged 50-59 years and had significant work experience as a midwife (+20 years). Statistically significant differences were recorded comparing scores on all four PEMS subscales across countries. Moderate effects were found on Professional Recognition, Skills and Resources and Autonomy/Empowerment comparisons. All pairwise comparisons between countries reached statistical significance (p<.001) except between Australia and New Zealand on the Manager Support subscale. Sweden recorded the highest score on three subscales except Skills and Resources which was the lowest score of the three countries. New Zealand midwives scored significantly better than both their Swedish and Australian counterparts in terms of these essential criteria. midwives in New Zealand and Sweden had a strong professional identity or sense of empowerment compared to their Australian counterparts. This is likely the result of working in more autonomous ways within a health system that is primary health care focused and a culture that constructs childbirth as a normal but significant life event. If midwifery is to reach its full potential globally then developing midwives sense of autonomy and subsequently their empowerment must be seen as a critical element to recruitment and retention that requires attention and strengthening.
Midwifery prescribing was introduced in Australia in 2010 and is available to those notated as Me... more Midwifery prescribing was introduced in Australia in 2010 and is available to those notated as Medicare Eligible. Only 59% of Medicare Eligible midwives are endorsed prescribers. To explore and describe Australian midwives views of prescribing including the barriers and enablers to prescribing. Online survey. Eligible participants were Australian midwives who had completed an educational programme required for endorsement as a midwifery prescriber (n=131). Descriptive statistics and content analysis were used to analyse the data set. Sixty-six midwives entered data (50% response rate). Twelve midwives (18%) had commenced prescribing. Prescribers agreed that being able to prescribe enhanced women's access to medicines and role satisfaction. The most common barriers to initiating prescribing were regulatory issues and processes, and no pathway to support midwifery prescribing in the public sector. The enabling factors most commonly reported were supportive relationships, education and personal factors such as motivation, knowledge and confidence. Prescribing was viewed positively by midwives, but only a small proportion of suitably educated midwives were able to translate this into prescribing. Prolonged and complicated registration processes, restrictive drug formularies, and a lack of prescribing roles for public sector midwives were clear barriers. Supportive professional relationships, quality education and personal motivation and confidence assisted midwives in overcoming these barriers. Offering mentoring may help midwives to move into prescribing practice and use it in a manner that best meets the health needs of women and infants in midwifery care.
The aim of this study was to identify the research priorities of midwives at Gold Coast Hospital ... more The aim of this study was to identify the research priorities of midwives at Gold Coast Hospital (GCH), South East Queensland, Australia. It was also hoped that the study would help foster a culture of inquiry and reflection. Establishing and maintaining a research culture is essential to the provision of high quality maternity services. A two phase Delphi design was used. Fifty eight midwives participated in round one (50 per cent response rate) and 54 in round two (60 per cent response rate). Midwives identified post dates induction of labour and work place culture as areas of research interest.
To cite this article: Burns, Elaine; Schmied, Virginia; Sheehan, Athena and Fenwick, Jennifer. Wo... more To cite this article: Burns, Elaine; Schmied, Virginia; Sheehan, Athena and Fenwick, Jennifer. Women's Health and Midwifery: Let Women Express Themselves - Breastfeeding Study [online]. Australian Nursing Journal: ANJ, The, Vol. 17, No. 2, Aug 2009: 44-45. ...
Midwifery is a research-informed profession with a mandated requirement to utilise latest best ev... more Midwifery is a research-informed profession with a mandated requirement to utilise latest best evidence. It is now recognised, however, that the introduction of new evidence into practice is complicated and uncertain. Growing awareness of this fact has led to the establishment of a new discipline, Implementation Science (IS), which is focused on developing ways to expedite the timely movement of evidence into practice. To date though, the wider midwifery profession has yet to make use of IS change-facilitation tools and methods. The aim of this study was to determine the fitness for use in midwifery of one established IS tool: the UK NHS Spread & Adoption tool, which is designed to enable clinicians to assess their organisational context for change readiness. A qualitative descriptive methodology was used for this study, which was set in two Australian states. Focus groups were used to collect data. The sample comprised ten Australian change-leader midwifery teams who had led evidence-based practice change initiatives in the previous 12 months. Three themes emerged from the data which together convey that although poor internet access was problematic for some, and some of the language was found to be inappropriate, the tool was ultimately viewed as very useful for helping the implementation of practice change in midwifery settings. This study provides valuable information about the broad suitability of the tested tool for Australian midwifery settings. Further research is required to evaluate a revised version.
High levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbei... more High levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbeing for around one in five women living in developed countries. Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention. Between May 2012 and June 2013 women in their second trimester of pregnancy were recruited. Women with a fear score ≥ 66 on the Wijma Delivery Expectancy / Experience Questionnaire (W-DEQ) were randomised to receive telephone psycho-education by a midwife, or usual maternity care. A two armed non-blinded parallel (1:1) multi-site randomised controlled trial with participants allocated in blocks of ten and stratified by hospital site and parity using an electronic centralised computer service. The outcomes of the RCT o...
Women and birth : journal of the Australian College of Midwives, Jan 8, 2015
The Practice Environment Scale (PES) has been used extensively to measure the quality of the prac... more The Practice Environment Scale (PES) has been used extensively to measure the quality of the practice environment of nurses working in a variety of work settings, and has been linked with quality of care, nurse wellbeing, job dissatisfaction and burnout. Although developed for nurses, many of the aspects addressed by the PES are also relevant to the midwifery profession, and may provide a tool to better understand midwives' decision to leave the profession. To adapt the PES for use with midwives and to assess its psychometric properties. An online survey containing the adapted version of the PES was distributed to a sample of hospital-employed New Zealand midwives (n=600). Exploratory factor analysis was conducted to identify subscales which were compared for midwives who had, versus had not considered, leaving the midwifery profession. Four subscales were identified, showing good internal consistency reliability (Quality of Management, Midwife-Doctor Relations, Resource Adequac...
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