Midwives’ perceived role in up referral of high-risk pregnancies in primary healthcare settings, eThekwini district, South Africa

Background: South African maternal and neonatal mortality rates remain unnecessarily high, which are considered avoidable through timeous identification, treatment and referral. An efficient referral process of high-risk pregnant women is dependent on the midwives’ ability to respond with relevance to the maternal and neonatal healthcare needs. The attainment of improved maternal and neonatal outcomes commences at the primary healthcare level, with the midwife, recognised as the first person responsible and accountable for pregnant women’s healthcare. Aim: To explore midwives’ perceptions of their role in the referral of high-risk pregnant women from primary health care clinics to expert-centred sites. Methods: A qualitative, exploratory, descriptive in nature approach, underpinned by a social constructivism paradigm, guided the methodology. Purposive sampling was used to select both the primary health care clinics in the feeder zone and the registered midwives working in these clinics. Data were collected through four focus group discussions and analysed using content analysis. The principles of trustworthiness were observed. Setting: Department of Health primary health care clinics in the eThekwini district, South Africa. Results: The midwives understood their role in the up referral of high-risk pregnant women but experienced many interruptions in its execution. Four categories emerged from the data, namely, enhanced by team support in the clinics, restrictions in transfer to expert-centred sites, impeding social determinants and midwifery competence facilitates referral process. Conclusion: Global initiatives cannot guarantee maternal and neonatal health because of the challenges experienced by the midwives in the execution of their roles as they interface with the healthcare team

Characteristics of strong midwifery leaders and enablers of strong midwifery leadership:An international appreciative inquiry

Objectives: This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. Design: In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022.Setting: Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. Participants: An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218).Measurements: Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. Findings: Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives’ clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. Key conclusions and implications for practice: This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools

Characteristics of Strong Midwifery Leaders and Enablers of Strong Midwifery Leadership: An International Appreciative Inquiry

Objectives This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. Design In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. Setting Responses were received from many countries (n=76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. Participants An international population (n=429) of English-speaking, and ethnically diverse midwives (n=211) and nurse-midwives (n=218). Measurements Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. Findings Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives’ clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. Key conclusions and implications for practice This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools

A middle-range theory for developing clinical reasoning skills in undergraduate midwifery students

Background: Clinical reasoning remains central in midwifery care in the light of uncontrollable high maternal mortality rates and errors in midwifery practice. However, there is no consensus, locally and internationally, on how clinical reasoning skills can be developed in undergraduate students particularly within midwifery context. Aim: This article present the middle-range-theory for developing clinical reasoning skills within undergraduate midwifery students. Methods and analysis: Qualitative and grounded theory approach, underpinned by Social Constructivism Paradigm, was used. Data were collected over twelve months, using multiple methods of observations, interviews and document analysis. The participants comprised of midwifery students, the 2016 and 2017 cohorts and midwifery educators. A total of 16 focus group discussions and 12 individual in-depth interviews were conducted. Data collection and initial data analysis occurred simultaneously using coding process, with constant comparative analysis at each phase. Ethical clearance was obtained from the University Ethics Committee, with the Protocol reference number HSS/1288/016D. Findings: Developing clinical reasoning skills emerged as the main concept in the middle-range theory that was generated in this study, supported by major concepts, which included context, nature of the curriculum, clinical reasoning process, pillars including individual and system related outcomes. Conclusion: The discussion in this study offers an opportunity to equip the midwifery educators with the necessary skills and knowledge necessary to produce midwifery graduates who are in line with the complexities of the healthcare system not only confined to the South African borders

A Model for Effective Nonverbal Communication between Nurses and Older Patients: A Grounded Theory Inquiry

Nonverbal communication is an inevitable art to be effectively mastered by nurses. Nurse nonverbal communication has many benefits when it is effective. For instance, nonverbal communication is important to convey affective and emotional information, and demonstrate respect for and build therapeutic relationships with older patients. As the older population is growing fast worldwide, effective nonverbal communication with older patients is an essential skill for nurses and will improve patients’ satisfaction and the quality of care. Therefore, this article presents a model to guide effective nonverbal communication between nurses and older patients. A Grounded Theory approach guided the study. Data were collected between July 2018 and January 2020 through overt participant observations and individual interviews. Purposive and theoretical sampling were used to select 13 clinically experienced nurses, 4 nursing students, and 8 older adults. Data analysis encompassed open coding, axial coding, and selective coding. The results showed that effective nonverbal communication emerged as the co-phenomenon hinged within context and/or environment and is influenced by certain factors. This model, which is in support of person-centered communication and care, advocates for effective nonverbal communication between nurses and older patients

Conditions Influencing Effective Nurse Nonverbal Communication With Hospitalized Older Adults in Cameroon

Effective communication between nurses and patients is an important factor to quality nursing care but ineffective nonverbal communication could take a toll on health care. Therefore, understanding the factors that influence nonverbal communication between nurses and hospitalized older adults could help solve communication problems, thus improve nursing care. A sample of 13 nurses and 4 student nurses from two hospitals in Cameroon participated in the study. Data were collected using participant observations and semi-structured interviews, and analyzed using open coding and constant comparative analysis. Three categories were identified as influencing factors: nurse views of hospitalized older adults, hospitalized older adult-related factors, and nurse intrinsic factors. Effective nurses’ nonverbal communication with hospitalized older adults relies mostly on nurses’ intrinsic factors. Identification and nurturing of the positive nurse intrinsic factors are important to develop effective nonverbal communication skills among nurses