Development of a tool to identify barriers and enablers to practice innovation in midwifery: A participatory action research study

Introduction: Transferring research evidence into midwifery practice is fraught with challenges and obstacles. Implementation tools can streamline the process and are most effective when they are discipline-specific; however, there are currently no midwifery specific implementation tools. The aim of this study was to develop a midwifery specific tool to identify barriers and enablers to evidence-informed practice change within the clinical setting. Methods: Participatory action research methodology was employed to ensure potential end-users contributed to content and format of the tool. Purposeful sampling ensured participants were selected from a range of midwifery practice settings in Western Australia and the United Kingdom. Data were collected through stakeholder advisory groups (SAGs) and online surveys. Results: Ten midwives participated in this project. Consultation occurred through face-to-face SAG meetings and online surveys until consensus was reached among participants about the content, format, and functionality of the end product which we called the ‘Midwifery Tool for Change’ (MT4C). Conclusions: To our knowledge, the MT4C is the first readiness for change context assessment tool specific to midwifery practice settings. Evaluation of the MT4C in realworld practice change implementation initiatives will enable further refinement of the tool

Understanding the barriers to Ghanaian midwives’ ability to provide quality care: Using classic grounded theory methodology in a new context

Background: Interpretive-naturalist methodologies, including Grounded Theory are increasingly being used in health research in Ghana however, none of the studies that have used Grounded Theory in the setting has used the methodology in full. Aim: The main aim of this article is to describe the experiences, the strengths and limitations of using Glaserian Grounded Theory methodology to understand the barriers to Ghanaian midwives’ ability to provide quality maternal and neonatal care. Design: Glaserian Grounded Theory methodological principles were adhered to in this study in relation to the use of literature, participant recruitment, data collection and analysis, and theory development. Data were collected through semi-structured interviews and non-participant observation. The study population comprised 33 participants, made up of 29 midwives and four other workers whose work was relevant to the functioning of the midwives that took part in the study. The midwives were recruited from 10 health facilities in seven districts in the Greater Accra Region of Ghana. Glaserian Grounded Theory was used in this study therefore constant comparison was employed in the data analysis. Findings: The study led to the discovery of a middle range grounded theory – “Doing magic with very little”, that explains the factors that affect the midwives’ ability to provide quality care to women and neonates. Conclusion: This paper contributes to the body of work on methodological knowledge. We provide new information about the factors that researchers planning to use Glaserian Grounded Theory in similar contexts could consider

What is known about midwives' well-being and resilience? An integrative review of the international literature

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

“I love being a midwife; it's who I am” : A Glaserian Grounded Theory Study of why midwives stay in midwifery

Aims and objectives To understand why Western Australian (WA) midwives choose to remain in the profession. Background Midwifery shortages and the inability to retain midwives in the midwifery profession is a global problem. The need for effective midwifery staff retention strategies to be implemented is therefore urgent, as is the need for evidence to inform those strategies. Design Glaserian grounded theory (GT) methodology was used with constant comparative analysis. Methods Fourteen midwives currently working clinically area were interviewed about why they remain in the profession. The GT process of constant comparative analysis resulted in an overarching core category emerging. The study is reported in accordance with Tong and associates’ (2007) Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The core category derived from the data was labelled—“I love being a midwife; it's who I am.” The three major categories that underpin the core category are labelled as follows: “The people I work with make all the difference”; “I want to be ‘with woman’ so I can make a difference”; and “I feel a responsibility to pass on my skills, knowledge and wisdom to the next generation.” Conclusion It emerged from the data that midwives’ ability to be “with woman” and the difference they feel they make to them, the people they work with and the opportunity to “grow” the next generation together underpin a compelling new middle‐range theory of the phenomenon of interest. Relevance to clinical practice The theory that emerged and the insights it provides will be of interest to healthcare leaders, who may wish to use it to help develop midwifery workforce policy and practice, and by extension to optimise midwives’ job satisfaction, and facilitate the retention of midwives both locally and across Australia

Communication surrounding initiation and withdrawal of non-invasive ventilation in adults with motor neuron(e) disease : Clinicians’ and family members’ perspectives

Introduction International guidelines recommend that health care clinicians communicate with people with MND and their family members about non-invasive ventilation (NIV) and percutaneous gastrostomy tube (PEG) prior to or at the onset of respiratory symptoms. This study sought to discover the degree to which these recommendations are followed in practice. Methods Interpretive Description methodology was employed. Nineteen clinicians experienced in caring for people with MND, six relatives of recently deceased people with MND and one person with MND participated in semi-structured in-depth interviews. Clinicians’ accounts of NIV and PEG related communications were compared to family member participants’ recollections of their own discussions with clinicians. Data were analysed thematically. Results Six major themes emerged that together capture the factors that impact practitioner-patient-family communications about NIV and PEG. Some clinicians were unaware of MND guidelines particularly communicating the burdens or possible withdrawal of NIV or found them challenging to implement. Consequently, family participants reported that they and their relatives with MND found clinicians’ communication on these topics inadequate. This led to them ‘topping up’ their knowledge from less authoritative sources, predominantly the internet. Discussion Clinicians’ lack of awareness of the international guidelines and discomfort about discussing the benefits and burdens of NIV and PEGs means some people with MND and their families may be unprepared for the consequences of using and ceasing NIV

“I believe…” - graduating midwifery students’ midwifery philosophies and intentions for their graduate year: A longitudinal descriptive study

Objective: Midwifery graduates may experience transition shock that makes them question their fit for their workplace and the profession and in extreme cases, may lead to them leaving. Understanding graduate midwives’ worldviews, job intentions and work experiences is important to inform retention strategies. Factors such as having a strong professional identity and experiencing strong job satisfaction are important for midwife retention. Conversely, stress, trauma and work-life imbalances are examples of factors that lead to attrition from midwifery. Transition shock experienced by some graduates can exacerbate these factors if not managed effectively. This study aimed to identify causes and impact of any changes in graduate and early career midwives’ philosophy, practice, and intention to stay in the profession. Design, setting and participants: We invited the 2021 and 2022 cohorts of graduating midwifery students from all educational pathways in Victoria, Australia to participate in a longitudinal descriptive study using a questionnaire with both closed and open -ended questions. This paper reports the findings from 16 participants that completed the first survey of a five-year longitudinal descriptive study. Findings: The sixteen participants predominantly held a woman centred philosophy and ideally wanted to work in a midwife-led model of care. Although excited about moving into practice, they also disclosed a sense of needing to ‘survive’ in a maternity care system that their beliefs were not fully in alignment with. Key conclusions: The hopes, expectations and concerns of midwifery students who are anticipating moving into practice in this study resonate with those previously reported and demonstrate the need to consider personality-job fit in supporting this vulnerable group to transition. Implications for practice: This study provides insights into graduating midwives’ hopes for, expectations of, and concerns about transitioning into practice that may inform the design of transition programs and support expansion of midwifery led models of care

How is organisational fit addressed in Australian entry level midwifery job advertisements

Background: Midwifery job retention is an ongoing global issue. Prior research has recognised that considering an individual’s attributes in relation to their work environment may assist in improving job satisfaction among midwives, leading to improved long-term job retention in the midwifery profession. The aim of this study was to evaluate whether, and how organisational fit is addressed in current entry level midwifery job advertisements within Australia. Methods: Midwifery jobs were searched for within 12 search engines, using the search term ‘midwife’, including Seek.com, Indeed.com, government employment websites for all Australian states and territories, and private health organisation websites. Data were extracted from eligible job advertisements by three independent researchers. Extracted data encompassed elements addressing person-job fit and person-organisation fit. Content analysis involving chi-square and Fischer exact tests were completed on extracted data. Results: Key findings demonstrate private health care organisations (29.2%) are more likely than public health care organisations (8.8%) to ask potential candidates to have additional qualifications, however, public health care organisations (34.1% vs. 16.7%) are more likely to ask for dual registration as a midwife and nurse. This is further supported by private health care organisations being more likely to refer to the candidate as a midwife (72.9% vs. 48.4%) than as a nurse. Private health care organisations more often noted access to support for employees and were more likely to mention access to employee assistance programs (41.7% vs. 13.2%), orientations (16.7% vs. 0%) and included benefits (72.9% vs. 42.9%). Clinical skills and personality traits were more frequently addressed in public health organisation advertisements; these included a requirement of employees to be accountable (49.5% vs. 6.3%), innovative (28.6% vs. 0%), have teamwork (69.2% vs. 52.1%) and conflict resolution skills (36.3% vs. 8.3%), and have knowledge of legislation (44.0% vs. 25.0%) and contemporary midwifery issues (28.6% vs. 4.2%). Conclusion: This study highlights that organisations employing midwives may be unwittingly contributing to the problem of midwife attrition through inattention to factors that endear midwives to workplaces in job advertisements. Further work developing employee selection and recruitment processes that are informed by the concept of person-job-organisation fit, is necessary

Communication surrounding initiation and withdrawal of non-invasive ventilation in adults with motor neuron(e) disease: Clinicians’ and family members’ perspectives

Introduction: International guidelines recommend that health care clinicians communicate with people with MND and their family members about non-invasive ventilation (NIV) and percutaneous gastrostomy tube (PEG) prior to or at the onset of respiratory symptoms. This study sought to discover the degree to which these recommendations are followed in practice. Methods: Interpretive Description methodology was employed. Nineteen clinicians experienced in caring for people with MND, six relatives of recently deceased people with MND and one person with MND participated in semi-structured in-depth interviews. Clinicians’ accounts of NIV and PEG related communications were compared to family member participants’ recollections of their own discussions with clinicians. Data were analysed thematically. Results: Six major themes emerged that together capture the factors that impact practitioner-patient-family communications about NIV and PEG. Some clinicians were unaware of MND guidelines particularly communicating the burdens or possible withdrawal of NIV or found them challenging to implement. Consequently, family participants reported that they and their relatives with MND found clinicians’ communication on these topics inadequate. This led to them ‘topping up’ their knowledge from less authoritative sources, predominantly the internet. Discussion: Clinicians’ lack of awareness of the international guidelines and discomfort about discussing the benefits and burdens of NIV and PEGs means some people with MND and their families may be unprepared for the consequences of using and ceasing NIV

They are friendly but they don\u27t want to be friends with you : A narrative inquiry into Chinese nursing students\u27 learning experiences in Australia

There is increasing interest in the phenomena of international student mobility and the growing global demand for skilled nurses. Little is known, however, about the learning experiences of Chinese nursing students at Australian universities. This study begins to address this gap. A narrative inquiry methodology was employed. In-depth interviews and focus group discussions, along with field notes and observations were conducted with six Chinese undergraduate nursing students studying undergraduate nursing in Western Australia. Chinese nursing students in Australia experienced fear and anxiety, driven by unfamiliarity with the hospital environment, education methods, and assessment expectations. Clinical placement experiences in Australian health services were identified by participants as the most stressful learning experience. Forming friendships with domestic students was difficult and rare for these students: none made friends with local students or joined university groups. Despite the challenges they experienced, the participants were motivated and adaptive to a new culture and learning methods, and all, demonstrated academic success. This study provides new knowledge about the learning experiences of Chinese nursing students at Australian universities. Many of the issues identified relate to the wider discussion around effective support for international students

Factors that enable midwives to stay in the profession : Why do midwives stay in midwifery?

Background: There is a global awareness regarding the challenges facing midwives to remain in the profession. Aim: The aim of this study was to understand why Western Australian (WA) midwives chose to remain in the profession. Methods: This study was undertaken using grounded theory (GT) methodology. Semi-structured interviews were conducted with 14 midwives working in the clinical area. Participants were interviewed about why and how they remain in the midwifery profession. Data were collected from December 2017 to November 2018 and were generated through open-ended semi-structured interviews, together with memos and field notes. The interviews were digitally recorded, transcribed verbatim and analysed and interpreted with the guidance of Glaser and Strauss’ (1967) coding stages. Ethical approval for this study was granted by the Human Research Ethics Committee at Edith Cowan University (record 18747) on 23 November 2017. Findings: The core category derived from the data was labelled: ‘I love being a midwife; it’s who I am’. The contextual factors that underpin the core category are labelled: ‘My rosters provide me with good work–life balance’; ‘You never know what’s going to happen [but] I can deal with the bad days because the good days outweigh them’; ‘I like my practice environment’; ‘It’s a juggling act but the women’s appreciation is worth it’ and ‘By looking after myself I’m a good midwife’. Bronfenbrenner’s (1997) theory was applied to the findings in the process of developing them into a middle-range theory of the phenomenon of interest. Conclusion: The findings of this study provide new insights into workplace and personal factors that contribute to enabling midwives to remain in their profession. Although this study represents midwives in only one geographical context it will be of value to professional and health care leaders