Clark, Kathryn Andersen; Mitchell, Ellen H. M.; Aboagye, Patrick Kuma
In Ghana, the provision of postabortion care (PAC) by trained midwives is critical to the efficient and cost-effective reduction of unsafe abortion morbidity and mortality. We performed a secondary analysis of provider data from a representative sample of Ghanaian health facilities in order to
Hargono, Rahmat; Qomarrudin, M. Bagus; Nawalah, Hoirun
“Desa Siaga” is the one of government's program for empowering community in health sector, especially to decrease maternal and infantmortality in village areas. This program actually plays as the implementation of empowerment concept. In this paper we elaborate the stephow to implementing the concepts of empowerment, and also make an explanation of the empowerment theory as a program and process whichis infl uence by the role of the midwives at village level. Some research revealed that facto...
Wood, Molly E; Mansoor, G Farooq; Hashemy, Pashton; Namey, Emily; Gohar, Fatima; Ayoubi, Saadia Fayeq; Todd, Catherine S
to examine factors that affect retention of public sector midwives throughout their career in Afghanistan. qualitative assessment using semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs). health clinics in eight provinces in Afghanistan, midwifery education schools in three provinces, and stakeholder organisations in Kabul. purposively sampled midwifery profession stakeholders in Kabul (n=14 IDIs); purposively selected community midwifery students in Kabul (n=3 FGDs), Parwan (n=1 FGD) and Wardak (n=1 FGD) provinces (six participants per FGD); public sector midwives, health facility managers, and community health workers from randomly selected clinics in eight provinces (n=48 IDIs); midwives who had left the public sector midwifery service (n=5 IDIs). several factors affect a midwife throughout her career in the public sector, including her selection as a trainee, the training itself, deployment to her pre-assigned post, and working in clinics. Overall, appropriate selection is the key to ensuring deployment and retention later on in a midwife's career. Other factors that affect retention of midwives include civil security concerns in rural areas, support of family and community, salary levels, professional development opportunities and workplace support, and inefficient human resources planning in the public sector. Factors affecting midwife retention are linked to problems within the community midwifery education (CME) programme and those reflecting the wider Afghan context. Civil insecurity and traditional attitudes towards women were major factors identified that negatively affect midwifery retention. Factors such as civil insecurity and traditional attitudes towards women require a multisectoral response and innovative strategies to reduce their impact. However, factors inherent to midwife career development also impact retention and may be more readily modified. © 2013 Elsevier Ltd. All rights reserved.
Hollins Martin, Caroline J.; Robb, Yvonne.; Forrest, Eleanor.
Background: Equipping student midwives with confidence to deliver bereavement care to childbearing women is a challenge for midwifery lecturers.Objective: To explore qualitative data provided by student midwives who evaluated the workbook Bereavement care for childbearing women and their families (Hollins Martin & Forrest, 2013) to explore their views of potential teaching strategies that could build their confidence to deliver real bereavement care.Method: An exploratory qualitative thematic...
Skirton, Heather; Stephen, Nicole; Doris, Faye; Cooper, Maggie; Avis, Mark; Fraser, Diane M
this study was part of a larger project commissioned to ascertain whether midwife teachers bring a unique contribution to the preparation of midwives for practice. The aim of this phase was to determine whether the student midwives' educational programme had equipped them to practise competently after entry to the professional register. this was a prospective, longitudinal qualitative study, using participant diaries to collect data. data were collected from newly qualified midwives during the initial six months after they commenced their first post as a qualified midwife. the potential participants were all student midwives who were completing their education at one of six Universities (three in England, one in Scotland, one in Wales and one in Northern Ireland). Diary data were submitted by 35 newly qualified midwives; 28 were graduates of the three year programme and seven of the shortened programme. diary entries were analysed using thematic analysis (Braun and Clarke, 2006), with a focus on identification of key events in the working lives of the newly qualified midwives. A total of 263 key events were identified, under three main themes: (1) impact of the event on confidence, (2) gaps in knowledge or experience and (3) articulated frustration, conflict or distress. essentially, pre-registration education, delivered largely by midwife teachers and supported by clinical mentors, has been shown to equip newly qualified midwives to work effectively as autonomous practitioners caring for mothers and babies. While newly qualified midwives are able to cope with a range of challenging clinical situations in a safe manner, they lack confidence in key areas. Positive reinforcement by supportive colleagues plays a significant role in enabling them to develop as practitioners. whilst acknowledging the importance of normality in childbearing there is a need within the curriculum to enable midwives to recognise and respond to complex care situations by providing theory
Martin, Caroline J Hollins; Robb, Yvonne; Forrest, Eleanor
Equipping student midwives with confidence to deliver bereavement care to childbearing women is a challenge for midwifery lecturers. To explore qualitative data provided by student midwives who evaluated the workbook Bereavement care for childbearing women and their families (Hollins Martin & Forrest, 2013) to explore their views of potential teaching strategies that could build their confidence to deliver real bereavement care. An exploratory qualitative thematic analysis was used to provide, analyse and report themes identified within data collected in a prior study. Participants were student midwives (n=179) in their second/third year of a midwifery degree program at 1 of 3 universities in the UK were included in the study. Data to evaluate effectiveness of the bereavement workbook as a teaching method was collected using a survey instrument. It was the comments written under questions by participants that were analysed in the present study. Three themes emerged: (1) increasing classroom interaction, (2) the importance of reflecting on emotions, and (3) need for experience. Although this study has addressed delivery of education that relates to midwives, the findings are cross transferable to other healthcare educators, practitioners, and students. Several solutions are proposed that could potentially build student confidence to deliver bereavement care: lecturers should (1) encourage group discussion in the classroom to help build student confidence to emotionally cope during real bereavement events; (2) ensure students gain exposure by encouraging qualified midwives to include them in real bereavement events early on in their training, and (3) develop packages of perinatal bereavement scenarios for simulation and rehearsal in the clinical skills laboratory. Post-implementation, it is recommended that these teaching strategies be evaluated. Copyright © 2016 Elsevier Ltd. All rights reserved.
Chiguzo, A N; Mugo, R W; Wacira, D G; Mwenda, J M; Njuguna, E W
To demonstrate that micro-franchising system is an effective way of improving access to effective health care such as the introduction of first line antimalarias in populations living in underserved rural areas in Kenya. A descriptive study. Child and family wellness (CFW) micro-franchised nurse run clinics in Kenya. In 2007, 39.3% of RDTs carried out were positive for malaria. All malaria positive (RDTs and microscopy) patients received artemether lumefantrine (AL) according to their weight in accordance with the Government approved treatment guidelines. During the same period a total of 3,248 community members were reached with malaria information, however, community expectations took longer to change as patients demanded AL even when the malaria diagnosis was negative. Initially, this led to the dispensing of other antimalarials to patients with malaria like symptoms even with a negative test. This demand decreased with more community education on the importance of the tests. Engaging the private sector though with challenges proved feasible and appropriate in accessing malaria treatment based on clinical diagnosis supported by RDTs to confirm the diagnosis instead of presumptive treatment based on fever. This led to a reduction of antimalarial prescriptions by more than 50%, implying better patient care, rational drug use as well as cost savings on malaria treatment. A micro-franchising system is an effective and sustainable way of improving access to effective health care by populations living in underserved rural areas of Africa. With appropriate supportive training and supervision, the system can adapt to changes in treatment guidelines and to new regimens.
Full Text Available The public sector has traditionally financed and operated infrastructure projects using resources from taxes and various levies (e.g. fuel taxes, road user charges. However, the rapid increase in human population growth coupled with extended globalisation complexities and associated social/political/economic challenges have placed new demands on the purveyors and operators of infrastructure projects. The importance of delivering quality infrastructure has been underlined by the United Nations declaration of the Millennium Development Goals; as has the provision of ‘adequate’ basic structures and facilities necessary for the well-being of urban populations in developing countries. Thus, in an effort to finance developing countries’ infrastructure needs, most countries have adopted some form of public-private collaboration strategy. This paper critically reviews these collaborative engagement approaches, identifies and highlights 10 critical themes that need to be appropriately captured and aligned to existing business models in order to successfully deliver sustainable infrastructure projects. Research findings show that infrastructure services can be delivered in many ways, and through various routes. For example, a purely public approach can cause problems such as slow and ineffective decision-making, inefficient organisational and institutional augmentation, and lack of competition and inefficiency (collectively known as government failure. On the other hand, adopting a purely private approach can cause problems such as inequalities in the distribution of infrastructure services (known as market failure. Thus, to overcome both government and market failures, a collaborative approach is advocated which incorporates the strengths of both of these polarised positions.
McManus, A.; Gaterell, M.R.; Coates, L.E.
Environmental concern in light of anthropogenic climate change will impact the housing sector as one of the major energy-consuming and carbon dioxide producing sectors. For new housing, currently the most important policy to combat this issue is the Code for Sustainable Homes. The social housing sector is under obligation to comply with these standards, which entails a significant increase in the cost of housing delivery. The sector is also under pressure to increase much-needed housebuilding, without increased funding being available. The quandary facing the sector is how to achieve both aims. Therefore any policy, such as the Code, which impacts on the ability of the sector to deliver unit numbers must be truly effective at delivering its own main aim. This paper explores the current situation, with a preliminary analysis of how the Code may not be able to deliver its 'sustainable energy' goals due to the ways in which 'low and zero carbon technologies' are assessed and how they behave in real world situations. It demonstrates that further research and policy changes are needed to deliver sustainable energy for this sector and ensure the delivery of crucial new housing is not hampered whilst also failing to meet energy goals. (author)
Independent t-test and contingency chi-square were used in testing the null hypotheses. Results: The result showed that women delivered by traditional midwives have more negative control of delivery pain caused by birth complication than their counterparts who are delivered by western trained midwives; On the basis of ...
Bakker, R.H.C.; Groenewegen, P.P.; Jabaaij, L.; Meijer, W.; Sixma, H.; Veer, A. de
OBJECTIVE: to determine the effect of workload on 'burnout' having considered work capacity. DESIGN: cross-sectional study. SETTING: Dutch community midwives in independent practice. PARTICIPANTS: 200 Dutch community midwives. MEASUREMENTS: three-week diary recordings, a questionnaire on practice
Kihl, Lisa A; Tainsky, Scott; Babiak, Kathy; Bang, Hyejin
Corporate community initiatives (CCI) are often established via cross-sector partnerships with nonprofit agencies to address critical social problems. While there is a growing body of literature exploring the effectiveness and social impact of these partnerships, there is a limited evaluative research on the implementation and execution processes of CCIs. In this paper, we examined the implementation and operational processes in the delivery of a professional sport organization's CCI initiative using program theory evaluation. The findings showed discrepancies between the associate organization and the implementers regarding understanding and fulfilling responsibilities with performing certain aspects (maintaining accurate records and program marketing) of the service delivery protocol. Despite program stakeholders being satisfied overall with the program delivery, contradictions between program stakeholders' satisfaction in the quality of program delivery was found in critical components (marketing and communications) of the service delivery. We conclude that ongoing evaluations are necessary to pinpoint the catalyst of the discrepancies along with all partners valuing process evaluation in addition to outcome evaluation. Copyright © 2014 Elsevier Ltd. All rights reserved.
Chinn, Teresa; Clarke, Jenny
Social media are playing a bigger and bigger part in our personal lives and what's more they are now infiltrating our professional lives, too. Moving from just 'being on' social media to using social media effectively as a midwife, is a huge challenge that many midwives are facing. To be effective and to really utilise social media to their full potential, midwives need to consider role-modelling, leading, social capital, digital footprint, visibility and continuing professional development. If all of these aspects are considered and midwives take a more considered approach to social media, they can really start to benefit from engaging in these online spaces.
Titaley, Christiana R; Wijayanti, Ratna U; Damayanti, Rita; Setiawan, Agus Dwi; Dadun; Dachlia, Dini; Siagian, Ferdinand; Suparno, Heru; Saputri, Dwi Astuti Yunita; Harlan, Sarah; Wahyuningrum, Yunita; Storey, Douglas
this analysis aims to explore midwives' insights into the provision of long-acting and permanent methods of contraception (LAPMs) in the selected areas of East Java and Nusa Tenggara Barat (NTB) Provinces, Indonesia. a qualitative study using in-depth interviews was conducted with 12 village midwives from 12 villages, to explore their perceptions and experiences in delivering family planning services. the study was carried out in May-June 2013, as part of the baseline assessment in the Improving Contraceptive Method Mix (ICMM) study. We interviewed 12 village midwives working in 12 villages in six study districts: Tuban, Kediri, and Lumajang Districts in East Java Province; and Lombok Barat, Lombok Timur, and Sumbawa Districts in NTB Province. an interview guideline was used in all interviews. It covered several topics, such as community perceptions of LAPMs, availability of contraception and related equipment, availability of human resources, and midwives' efforts to improve LAPM coverage. All interviews were recorded and transcribed. Content and thematic analyses were carried out by grouping and coding the information based on the identified themes and topics. according to village midwives interviewed in this study, community-level acceptance of LAPMs has increased over time; however, some still prefer using short-acting methods for a long period. The reasons include lack of awareness about the benefits and side effects of LAPMs, fear of surgical procedures, rumored consequences (for example, that LAPMs would limit women's ability to perform hard physical labor), and religious beliefs. There were several challenges reported by village midwives in delivering LAPM services, such as confusion about midwives' eligibility to provide LAPM services, lack of Contraceptive Technology Update (CTU) and counseling trainings, and shortage of supporting equipment (such as exam tables and IUD and implant insertion kits). There were several strategies implemented by village
Prinja, Shankar; Gupta, Aditi; Verma, Ramesh; Bahuguna, Pankaj; Kumar, Dinesh; Kaur, Manmeet; Kumar, Rajesh
With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630-10,294,065) and INR 26.9 million (95% CI: 22,225,159.3-32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6-208.3) and INR162.1 (95% CI: 112-219.1), respectively. The study estimates can be used
Græse, Line; Vilhelmsen, Charlotte; Larsen, Jesper
At a hospital in Denmark around 40 midwives support the pregnancy of approx. 6000 pregnant women every year. Their role is to monitor the pregnancies and prepare the women for labour. Based on the due date of a woman, authority guidelines prescribe specific and mostly rather narrow time windows...... at every consultation. Every week the newly arrived pregnant women are assigned an arbitrary free time slot belonging to a specific midwife. In turn this midwife is expected to have consultations with this woman in specific weeks according to the authority guidelines. This random assignment of pregnant...... a method that can make a fair distribution of pregnant women among the midwives. The distribution should result in a balanced work load for each midwife and a balanced work load among the midwives while at the same time making sure that the time windows for consultations are not violated....
Full Text Available A survey undertaken in 1977' demonstrated that 53,3 percent of women delivering in a rural obstetric unit had high risk factors demanding hospital delivery. The present shortage of medical staff available in such areas demands that even patients with high risk factors must often be delivered by midwives. Midwives are however, usually trained on the understanding that all patients with significant risk factors should be delivered by medical staff, and thus
A collaborative practice of maternity obstetric unit midwives and private midwives was established in Johannesburg in 2006/2007 as a response to women's requests for natural childbirth. The values and cultural practices of the private midwife differ from those of the maternity obstetric unit midwife which leads to conflict.
... Key MCH Publications Get Involved » TAZA Midwives - Twinning Association of Zambian & ACNM Midwives DGO Consultant Roster International Job Opportunities International Volunteer Opportunities International ...
The use of cell phone text messaging to improve access to continuing healthcare education in under-resourced settings is not well documented. We aimed to assess whether this method of education is acceptable to South African midwives in both the public and private sectors. Essential healthcare lessons from the ...
Warmelink, J Catja; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K
Inter-professional collaboration is considered essential in effective maternity care. National projects are being undertaken to enhance inter-professional relationships and improve communication between all maternity care providers in order to improve the quality of maternity care in the Netherlands. However, little is known about primary care midwives' satisfaction with collaboration with other maternity care providers, such as general practitioners, maternity care assistance organisations (MCAO), maternity care assistants (MCA), obstetricians, clinical midwives and paediatricians. More insight is needed into the professional working relations of primary care midwives in the Netherlands before major changes are made OBJECTIVE: To assess how satisfied primary care midwives are with collaboration with other maternity care providers and to assess the relationship between their 'satisfaction with collaboration' and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics (accessibility). The aim of this study was to provide insight into the professional working relations of primary care midwives in the Netherlands. Our descriptive cross-sectional study is part of the DELIVER study. Ninety nine midwives completed a written questionnaire in May 2010. A Friedman ANOVA test assessed differences in satisfaction with collaboration with six groups of maternity care providers. Bivariate analyses were carried out to assess the relationship between satisfaction with collaboration and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics. Satisfaction experienced by primary care midwives when collaborating with the different maternity care providers varies within and between primary and secondary/tertiary care. Interactions with non-physicians (clinical midwives and MCA(O)) are ranked consistently higher on satisfaction compared with
Homer, Caroline S E; Passant, Lyn; Brodie, Pat M; Kildea, Sue; Leap, Nicky; Pincombe, Jan; Thorogood, Carol
to research the role of midwives in Australia from the perspectives of women and midwives. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. a multi-method approach with qualitative data collected from surveys with women and interviews with midwives. participants represented each state and territory in Australia. midwives who were randomly selected by the regulatory authorities across the country and women who were consumers of midwifery care and involved in maternity activism. midwives and women identified a series of key elements that were required of a midwife. These included: being woman centred; providing safe and supportive care; and working in collaboration with others when necessary. These findings were consistent with much of the international literature. a number of barriers to achieving the full role of the midwife were identified. These included a lack of opportunity to practice across the full spectrum of maternity care, the invisibility of midwifery in regulation and practice, the domination of medicine, workforce shortages, the institutional system of maternity care, and the lack of a clear image of what midwifery is within the wider community. These barriers must be addressed if midwives in Australia are to be able to function according to the full potential of their role.
Zeliha Burcu Yurtsal
Conclusions: There were significant statistical differences between assertiveness levels and problem solving skills of midwives, and midwives who were assertive solved their problems better than did others. Assertiveness and problem-solving skills training will contribute to the success of the midwifery profession. Midwives able to solve problems, and display assertive behaviors will contribute to the development of midwifery profession.
Pugh, Judith D; Twigg, Diane E; Martin, Tracy L; Rai, Tapan
the ongoing attrition of the midwifery workforce frustrates future workforce planning and the provision of maternity services in Western Australia. This project determined factors contributing to the intention of the midwives to move jobs and/or leave the profession. a cross-sectional survey approach was taken for this descriptive research utilising a self-administered questionnaire developed by the Nursing and Midwifery Office, Department of Health, Western Australia. public and private health sectors in Western Australia, April-May 2010. 1,600 midwives employed in the public and private health sectors throughout Western Australia were invited to participate: 712 responded (44.5%), one-fifth of the state's registered midwives. most midwives worked part-time in a clinical role in public hospitals. Almost half intended moving jobs within 5 years and/or leaving midwifery. Excluding midwives of retirement age, the most common reasons for intending to move jobs were family commitments, working conditions and role dissatisfaction. Those intending to leave midwifery cited work-life balance, career change and family commitments. Midwives thought addressing the following issues would improve midwifery retention: flexible work arrangements, remuneration, staffing and caseload, workplace culture, professional development and models of care. retaining the midwifery workforce requires attention to workforce practices particularly flexible work arrangements and workloads; models of care to strengthen midwives' relationships with clients and colleagues; and accessible professional development. a review of workplace practices at unit and institution levels is urgently required in Western Australia so that midwives can achieve work-life balance and practice to the full extent of their professional role. These changes are necessary to forestall premature retirement of skilled and experienced midwives from the profession and workforce churn. Crown Copyright © 2012. Published by
Fenwick, J; Brittain, H; Gamble, J
Reporting the outcomes for women and newborns accessing private midwives with visiting rights in Australia is important, especially since this data cannot currently be disaggregated from routinely collected perinatal data. 1) Evaluate the outcomes of women and newborns cared for by midwives with visiting access at one Queensland facility and 2) explore private midwives views about the structures and processes contributing to clinical outcomes. Mixed methods. An audit of the 'all risk' 529 women receiving private midwifery care. Data were compared with national core maternity variables using Chi square statistics. Telephone interviews were conducted with six private midwives and data analysed using thematic analysis. Compared to national data, women with a private midwife were significantly more likely to be having a first baby (49.5% vs 43.6% p=0.007), to commence labour spontaneously (84.7% vs 52.7%, pfundamental to achieving quality outcomes. Midwives valued the governance processes embedded around the model. Private midwives with access to the public system is safe. Ensuring national data collection accurately captures outcomes relative to model of care in both the public and private sector should be prioritised. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Walker, Sandra B; Moore, Heather D; Eaton, Annie
This qualitative study investigated midwives' perception of a team midwifery model of care implemented in North Queensland, Australia. A midwifery model of care is the use of primary health care principles to deliver care throughout the woman's entire pregnancy and postpartum period in partnership with other members of the health care team. Four focus groups were undertaken with 22 midwives to determine their perception of the team midwifery model of care. The study found the experience of the team midwifery model of care for midwives had been influenced by organisational characteristics, team structures, and accountability. Recommendations from this study include the need for an appropriate environmental scan and implementation of planning process and team building before the introduction of any new model of care, transportability of health care services to any new model of care, and a shared governance to allow midwives to meet both organisational and professional goals.
Turkmani, Sabera; Homer, Caroline; Varol, Nesrin; Dawson, Angela
Female genital mutilation (FGM) involves partial or total removal of the external female genitalia or any other injury for non-medical reasons. Due to international migration patterns, health professionals in high income countries are increasingly caring for women with FGM. Few studies explored the knowledge and skills of midwives in high income countries. To explore the knowledge, experience and needs of midwives in relation to the care of women with FGM. An online self-administered descriptive survey was designed and advertised through the Australian College of Midwives' website. Of the 198 midwives (24%) did not know the correct classification of FGM. Almost half of the respondents (48%) reported they had not received FGM training during their midwifery education. Midwives (8%) had been asked, or knew of others who had been asked to perform FGM in Australia. Many midwives were not clear about the law or health data related to FGM and were not aware of referral paths for affected women. As frontline providers, midwives must have appropriate up-to-date clinical skills and knowledge to ensure they are able to provide women with FGM the care they need and deserve. Midwives have a critical role to play in the collection of FGM related data to assist with health service planning and to prevent FGM by working closely with women and communities they serve to educate and advocate for its abandonment. Therefore, addressing educational gaps and training needs are key strategies to deliver optimal quality of care. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Gender inequality and the harmful effects of patriarchy are sustaining the wide spread oppression of women across the world and this is also having an impact on maternity services with unacceptable rates of maternal mortality, the continued under investment in the midwifery profession and the limiting of women's place of birth options. However alongside these effects, the current zeitgeist is affirming an alignment of feminism and gender equality such that both have a high profile in public discourse. This presents a once in a generation opportunity for midwives to self-declare as feminists and commit to righting the wrongs of this most pernicious form of discrimination.
Castell, Emma; Stenfert Kroese, Biza
people with learning disabilities (LD) are increasingly likely to become parents and are entitled to have access to the right support to be able to be suitable parents. However, access to such support is affected by limited resources, attitudes towards people with LD becoming parents, and lack of training regarding caring for parents with learning disabilities for midwives. A learning disability (LD) is defined as a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), reduced skills to cope independently with everyday life, has an impact on most areas of a person's life and the difficulties started in early childhood. Little research has explored health professionals' experiences of their support of people with LD during their journey to become parents. Midwives are often the first professionals pregnant women come into contact with and therefore are key professionals in the support system for parents with LD. The principle objective of the current research is to develop an understanding of midwives' experiences of caring for women with a LD. the study explored midwives׳ experiences of caring for women with LD using an Interpretative Phenomenological Approach (IPA). nine qualified midwives employed by a single NHS trust participated in the study. a semi-structured interview schedule was utilised during one-to-one interviews with the midwives. The interview transcripts were analysed using IPA stages. Four superordinate themes were identified. The midwives reported receiving a lack of LD training and faced significant time constraints, which left them feeling that they could not spend the necessary time with the women to meet their pregnancy needs. The midwives felt unsupported in their attempts to deliver adequate midwifery care, speaking about a lack of accessible support for pregnant women with LD. They were left feeling responsible to fill the gaps in service provision. The midwives were dedicated
Mmajapi E.T. Masala-Chokwe
Full Text Available Background: In spite of caring being the core of midwifery and nursing, there is a constant public outcry about uncaring behaviours of midwives towards clients. Local media reports and recent discussion in the health system have highlighted the concerns regarding caring behaviours of midwives. Thus, there is a need to compare the meaning of caring from the perspectives of student midwives, midwives and educators.Aims: The aim of this article was to determine the meaning of caring from the perspectives of the undergraduate student midwives, the professional midwives, and the educators teaching midwifery in Tshwane.Setting: The study was conducted at healthcare institutions which the undergraduate studentmidwives attended for work integrated learning and at nursing education institutions inTshwane, South Africa.Methods: The strategy was qualitative and exploratory in nature. The population comprised student midwives, professional midwives and educators. Purposive sampling was done. Focus group discussions were held with student midwives and professional midwives, whilst the naïve sketch form was used as data-collection instrument for educators. Content data analysis was done. The total sample realised was 38.Results: The findings revealed that ‘caring’ was taken to mean being well conversant, up to-date and proficient in the field of work as well as considerate and respectful to others. The professional midwives indicated that they have seen colleagues demonstrate uncaring behaviour whilst educators emphasised respect as caring.Conclusion: The student midwives, professional midwives and educators described caring as being a competent nurse with compassion and respect for others.
Catling, Christine J; Reid, Fiona; Hunter, Billie
A number of adverse events in Australia and overseas have highlighted the need to examine the workplace culture in the maternity environment. Little attention has been paid to the midwifery workplace culture in Australia. The study aimed to explore the midwifery workplace culture from the perspective of midwives themselves. A qualitative descriptive design was used. Group and individual interviews were undertaken of urban, regional and rural-based midwives in Australia. Data were analysed thematically. The study showed that both new and experienced midwives felt frustrated by organisational environments and attitudes, and expressed strategies to cope with this. Five themes were identified from the data. These were: Bullying and resilience, Fatigued and powerless midwives, Being 'hampered by the environment', and The importance of support for midwifery. The study discusses the themes in depth. In particular, discussion focusses on how midwifery practise was affected by midwives' workplace culture and model of care, and the importance of supportive relationships from peers and managers. This study illuminated both positive and negative aspects of the midwifery workplace culture in Australia. One way to ensure the wellbeing and satisfaction of midwives in order to maintain the midwifery workforce and provide quality care to women and their families is to provide positive workplace cultures. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Wiegers, T.A.; Hukkelhoven, C.
Background: Most midwives in the Netherlands work in primary care where they are the lead professionals providing care to women with 'normal' or uncomplicated pregnancies, while some midwives work in hospitals ("clinical midwives"). The actual involvement of midwives in maternity care in hospitals
McLeish, Jenny; Redshaw, Maggie
to explore trained volunteer doulas' and mothers' experiences of doula support at birth and their perceptions of how this related to the midwife's role. a qualitative descriptive study, informed by phenomenological social psychology. semi-structured interviews were carried out between June 2015 and March 2016. Interview transcripts were analysed using inductive thematic analysis. three community volunteer doula projects run by third sector organisations in England. 19 volunteer doulas and 16 mothers who had received doula support during labour. three overarching themes emerged: (1) 'the doula as complementary to midwives', containing subthemes 'skilled physical and emotional support', 'continuous presence', 'woman-centred support', 'ensuring mothers understand and are understood' and 'creating a team for the mother'; (2)'the doula as a colleague to midwives', containing subthemes 'welcomed as a partner', 'co-opted to help the midwives', and 'doulas identify with the midwives'; and (3) 'the doula as challenge to midwives', containing subthemes 'confusion about the doula's role', 'defending informed choice', and 'counterbalancing disempowering treatment'. KEY CONCLUSIONS&IMPLICATIONS FOR PRACTICE: volunteer doulas can play an important role in improving women's birth experiences by offering continuous, empowering, woman-focused support that complements the role of midwives, particularly where the mothers are disadvantaged. Greater clarity is needed about the scope of legitimate volunteer doula advocacy on behalf of their clients, to maximise effective working relationships between midwives and doulas. Copyright © 2017. Published by Elsevier Ltd.
Full Text Available Aim: The aims of the literature review were to identify and analyze factors affecting job satisfaction of midwives. Design: A literature review. Methods: Included in the literature review were full texts of papers published in English language from 1990 to 2014. The search for relevant data was performed using the electronic databases CINAHL, Medline, Science Direct and Wiley Online Library. From a total of 43 studies found, 11were analyzed as quantitative studies that fulfilled the specified criteria. Results: Job satisfaction of midwives is affected by a lack of support from the management of healthcare facilities, low salary, understaffing, insufficient time for professional activities, work-family imbalance, high workload, physical demands, inadequate professional development, working environment, stress and low autonomy at work. Midwives showed signs of exhaustion, fatigue, hostility and depression, contributing to job turnover. Conclusion: The literature review presents the factors influencing job satisfaction of midwives. This is affected by many variable determinants, which create a feeling of job satisfaction of midwives, but can also lead to job dissatisfaction and, consequently, high turnover. Keywords: midwives, job satisfaction.
Freeney, Yseult; Fellenz, Martin R
Against a backdrop of increased work intensification within maternity hospitals, the purpose of this paper is to examine the role of work engagement in the quality of care delivered to patients and in general health of the midwives delivering care, as reported by midwives and nurses. Quantitative questionnaires consisting of standardised measures were distributed to midwives in two large maternity hospitals. These questionnaires assessed levels of work engagement, supervisor and colleague support, general health and quality of care. Structural equation modelling analysis revealed a best-fit model that demonstrated work engagement to be a significant partial mediator between organisational and supervisor support and quality of care, and as a significant predictor of self-reported general health. Together, supervisor support, social support and organisational resources, mediated by work engagement, explained 38 per cent of the variance in quality of care at the unit level and 23 per cent of variance in general health among midwives (chi2(67) = 113; p engagement and both health and self-reports of unit level quality of care. The results support the importance of health services organisations and managers deploying organisational resources to foster employee work engagement. The results also highlight the significant role of the immediate nurse manager and suggest training and development for such roles is a valuable investment. These results are the first to link work engagement and performance in health care contexts and point to the value of work engagement for both unit performance and for individual employee well-being in health organisations.
Floyd, Barbara O'Malley; Brunk, Nadene
The shortage of health workers worldwide has been identified as a barrier to achieving targeted health goals. Task shifting has been recommended by the World Health Organization to increase access to trained and skilled birth attendants. One example of task shifting is the use of cadres of health care workers, such as nurses and auxiliary nurse-midwives, who can successfully deliver skilled care to women and infants in low-resource areas where women would otherwise lack access to critical health interventions during the childbearing years. Midwives for Haiti is an organization demonstrating the use of task shifting in its education program for auxiliary midwives. Graduates of the Midwives for Haiti education program are employed and working with women in hospitals, birth centers, and clinics across Haiti. This article reviews the Midwives for Haiti education program and presents successes and challenges in task shifting as a strategy to increase access to skilled maternal and newborn care and to meet international health goals to reduce maternal and infant mortality in a low-resource country. © 2016 by the American College of Nurse-Midwives.
Yurtsal, Zeliha Burcu; Özdemir, Levent
Midwifery profession is required to bring solutions to problems and a midwife is expected to be an assertive person and to develop midwifery care. This study was planned to examine the relationship between assertiveness and problem-solving skills of midwives. This cross-sectional study was conducted with 201 midwives between July 2008 and February 2009 in the city center of Sivas. The Rathus Assertiveness Schedule (RAS) and Problem Solving Inventory (PSI) were used to determine the level of assertiveness and problem-solving skills of midwives. Statistical methods were used as mean, standard deviation, percentage, Student's T, ANOVA and Tukey HSD, Kruskal Wallis, Fisher Exact, Pearson Correlation and Chi-square tests and P < 0.05. The RAS mean scores and the PSI mean scores showed statistically significant differences in terms of a midwife's considering herself as a member of the health team, expressing herself within the health care team, being able to say "no" when necessary, cooperating with her colleagues, taking part in problem-solving skills training. A statistically significant negative correlation was found between the RAS and PSI scores. The RAS scores decreased while the problem-solving scores increased (r: -0451, P < 0.01). There were significant statistical differences between assertiveness levels and problem solving skills of midwives, and midwives who were assertive solved their problems better than did others. Assertiveness and problem-solving skills training will contribute to the success of the midwifery profession. Midwives able to solve problems, and display assertive behaviors will contribute to the development of midwifery profession.
This article outlines how shiatsu can be integrated into midwifery care by both midwives and shiatsu practitioners. It describes what shiatsu is and its value in maternity care. It concludes that there is much potential for the integration of shiatsu into midwifery practice although more research is needed.
Holland, Margaret L; Holland, Eliza S
Descriptive data on nurse-midwifery income, workload, job definitions, employment benefits, and clinical practices are limited. Information about nurse-midwifery practice today is important for the growth of the profession and for future policy initiatives. A survey of nurse-midwives in Connecticut was conducted in 2005. This article reports state-specific data about income, workload, job definitions, employment benefits, and clinical issues, such as vaginal birth after cesarean. Full-time midwives in Connecticut worked an average of 77 hours per week, had a mean salary of 79,554 dollars, and 87% had on-call responsibilities. A "typical" Connecticut midwife had an "average" full-time work week consisting of two 24-hour call days and three 7-hour office days, seeing 19 to 24 patients per office day. Most held Master of Science in Nursing degrees, worked in physician-owned practices, and attended births in hospitals or medical centers. Health insurance, paid sick time, and retirement plans were offered to most respondents. Almost all respondents provide gynecologic, antepartum, and postpartum care, but few offer newborn care. There is significant variation in restrictions on midwives offering vaginal birth after cesarean and on length of scheduled appointments. Data on expanded practices, such as first-assisting caesarean sections and endometrial biopsies, are reported for the first time.
Bedwell, Carol; McGowan, Linda; Lavender, Tina
midwives are frequently the lead providers of care for women throughout labour and birth. In order to perform their role effectively and provide women with the choices they require midwives need to be confident in their practice. This study explores factors which may affect midwives' confidence in their practice. hermeneutic phenomenology formed the theoretical basis for the study. Prospective longitudinal data collection was completed using diaries and semi-structured interviews. Twelve midwives providing intrapartum care in a variety of settings were recruited to ensure a variety of experiences in different contexts were captured. the principal factor affecting workplace confidence, both positively and negatively, was the influence of colleagues. Perceived autonomy and a sense of familiarity could also enhance confidence. However, conflict in the workplace was a critical factor in reducing midwives' confidence. Confidence was an important, but fragile, phenomenon to midwives and they used a variety of coping strategies, emotional intelligence and presentation management to maintain it. this is the first study to highlight both the factors influencing midwives' workplace confidence and the strategies midwives employed to maintain their confidence. Confidence is important in maintaining well-being and workplace culture may play a role in explaining the current low morale within the midwifery workforce. This may have implications for women's choices and care. Support, effective leadership and education may help midwives develop and sustain a positive sense of confidence. Copyright © 2014 Elsevier Ltd. All rights reserved.
Bradfield, Zoe; Duggan, Ravani; Hauck, Yvonne; Kelly, Michelle
Midwives being 'with woman' is embedded in professional philosophy, standards of practice and partnerships with women. In light of the centrality of being 'with woman' to the profession of midwifery, it is timely to review the literature to gain a contemporary understanding of this phenomenon. This review synthesises research and theoretical literature to report on what is known and published about being 'with woman'. A five step framework for conducting an integrative literature reviews was employed. A comprehensive search strategy was utilised that incorporated exploration in electronic databases CINAHL, Scopus, Proquest, Science Direct and Pubmed. The initial search resulted in the retrieval of 2057 publications which were reduced to 32 through a systematic process. The outcome of the review revealed three global themes and corresponding subthemes that encompassed 'with woman': (1) philosophy, incorporated two subthemes relating to midwifery philosophy and philosophy and models of care; (2) relationship, that included the relationship with women and the relationship with partners; and (3) practice, that captured midwifery presence, care across the childbirth continuum and practice that empowers women. Research and theoretical sources support the concept that being 'with woman' is a fundamental construct of midwifery practice as evident within the profession's philosophy. Findings suggest that the concept of midwives being 'with woman' is a dynamic and developing construct. The philosophy of being 'with woman' acts as an anchoring force to guide, inform and identify midwifery practice in the context of the rapidly changing modern maternity care landscapes. Gaps in knowledge and recommendations for further research are made. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
McNeill, Jenny; Doran, Jackie; Lynn, Fiona; Anderson, Gail; Alderdice, Fiona
capitalise on the role of the midwife in delivering public health interventions. It is clear that better understanding of midwifery public health roles and the visibility of public health within midwifery is required in order to maximise the potential contribution of midwives to achieving short and long term public health population goals.
midwifery education should be reviewed to capitalise on the role of the midwife in delivering public health interventions. It is clear that better understanding of midwifery public health roles and the visibility of public health within midwifery is required in order to maximise the potential contribution of midwives to achieving short and long term public health population goals. PMID:23216855
M.P. Fransen (Mirjam); H.I.J. Wildschut (Hajo); J.P. Mackenbach (Johan); E.A.P. Steegers (Eric); M.L.E. Essink-Bot (Marie-Louise)
textabstractBackground: The present study aims to explore to what extent midwives experience barriers in providing information about prenatal screening for Down syndrome to women from diverse ethnic backgrounds, and to assess their competences to overcome these barriers. Methods: Midwives from 24
Kolak, Mia; Jensen, Carina; Johansson, Marianne
To describe midwives' experiences of providing contraception counselling to immigrant women. The study was conducted with a qualitative design, based on interviews followed by inductive content analysis. Ten midwives were interviewed, working at midwife-led prenatal clinics in immigrant-dense areas in southern Sweden. Midwives require knowledge and understanding of cultures and religions in order to provide contraception counselling to immigrant women. It is important for the midwives to be aware that women have different values regarding sexual and reproductive health. The challenge for the midwives is to understand and to be curious about every woman's lifeworld perspective, culture and religion. The midwives knowledge and understanding of cultures and religions is acquired through experience and shared between them. Knowledge makes a midwife confident in her role as the contraception counselling provider to immigrant women. Cultural and religious factors affect contraception counselling. According to the midwives, knowledge and awareness of these factors is crucial and leads to improved understanding of midwives providing contraception counselling, better compliance, fewer unwanted pregnancies and improved sexual and reproductive health among women. Copyright © 2017 Elsevier B.V. All rights reserved.
South Africa's Choice on Termination of Pregnancy (CTOP) Act of 1996 allows provision of abortion on request up to 12 weeks of gestation and permits midwives who have completed required training to conduct termination of pregnancies. This unique codification of midwives' role in abortion care reflects legislators' ...
Seven doctors and nine midwives who were interviewed described their experiences and perceptions when working with mothers with pregnancy loss. It became clear that both midwives and doctors lack the know-how to support mothers with pregnancy loss, and that they are overwhelmed by problems like shortage of staff ...
This study explored the emic views of learner-midwives with regard to their experiential learning environment in the Limpopo Province using a qualitative descriptive phenomenological and contextual research design. The target population included all the learner-midwives pursuing their final year studies at the University of ...
Stewart, S; Sidebotham, M; Davis, D
This article reports on the 'Virtual International Day of the Midwife E-vent', an innovative initiative that uses social media to provide opportunities for learning and networking internationally. This e-vent was conceived of and initiated in 2009 by a small group of midwives with an interest in social media. The e-vent uses web conferencing software and schedules a presentation every hour for a 24-h period so as to reach midwives or other interested parties in all time zones of the globe. The authors draw on their experiences to describe the e-vent including the e-vent aims and organizing processes, and to report on participation trends over the 3-year period. The e-vent has seen significant growth over a 3-year period with participation increasing from an average of five participants per session to 50. The organizing committee has expanded to include an international team and they have extended the reach of the project by establishing a Facebook page. While the use of social media has its limitations, projects such as the International Day of the Midwife E-vent have real potential to increase access to educational materials and provide opportunities for international networking. © 2012 The Authors. International Nursing Review © 2012 International Council of Nurses.
Rhoda S. Muliira
Full Text Available A vaginal examination (VE is an essential part of midwifery care, and is routinely performed when assessing the progress of labour. As evidence shows that during labour women may find VEs unpleasant,embarrassing and sometimes painful, the aim of this article is to review literature on the use of VEs during labour and to synthesise information from the available literature on how to provide an effective VE. The studies considered were retrieved from three databases (the Cumulative Index to Nursing and Allied Health Literature [CINAHL], SCOPUS and MEDLINE using the following search terms: “VEs in labour”, “midwives and use of VEs” and “women experiences of VEs in labour”. The literature reviewed suggests that midwives are not careful about VEs. Therefore, a concerted effort is needed to pay attention to the frequency of VEs, the management ofpain and distress, information-giving and the preferences of the patient, so that the patient can feel in control during a VE.
Pollock, Alex; Campbell, Pauline; Deery, Ruth; Fleming, Mick; Rankin, Jean; Sloan, Graham; Cheyne, Helen
The aim of this study was to systematically review evidence relating to clinical supervision for nurses, midwives and allied health professionals. Since 1902 statutory supervision has been a requirement for UK midwives, but this is due to change. Evidence relating to clinical supervision for nurses and allied health professions could inform a new model of clinical supervision for midwives. A systematic review with a contingent design, comprising a broad map of research relating to clinical supervision and two focussed syntheses answering specific review questions. Electronic databases were searched from 2005 - September 2015, limited to English-language peer-reviewed publications. Systematic reviews evaluating the effectiveness of clinical supervision were included in Synthesis 1. Primary research studies including a description of a clinical supervision intervention were included in Synthesis 2. Quality of reviews were judged using a risk of bias tool and review results summarized in tables. Data describing the key components of clinical supervision interventions were extracted from studies included in Synthesis 2, categorized using a reporting framework and a narrative account provided. Ten reviews were included in Synthesis 1; these demonstrated an absence of convincing empirical evidence and lack of agreement over the nature of clinical supervision. Nineteen primary studies were included in Synthesis 2; these highlighted a lack of consistency and large variations between delivered interventions. Despite insufficient evidence to directly inform the selection and implementation of a framework, the limited available evidence can inform the design of a new model of clinical supervision for UK-based midwives. © 2017 John Wiley & Sons Ltd.
Alexander, Catherine R; Bogossian, Fiona
An allegation of negligence or an adverse outcome during childbirth can lead to clinical investigation of a midwife's practice. Anecdotal evidence suggests midwives find this stressful and disturbing. Synthesise the evidence relating to midwives' experiences of investigation and the effects on clinical practice and personal wellbeing. Two database searches were conducted between 2015 and 2016 to identify primary research published between 1990 and 2016. Studies were evaluated for quality using standard instruments. Despite numerous references to 'litigation' in peer-reviewed journals, little substantive research related specifically to midwives. 11 inclusions comprised three qualitative studies (one with two publications), reporting litigation experiences of midwives and seven quantitative studies (four research groups), identifying risk liability through cyclic surveys of midwives and law reports. Failure to identify deterioration in foetal well-being was a common finding among researchers examining reasons for litigation. Experienced midwives were at highest risk of litigation. Researchers found high levels of distress and abreaction among participants who either stopped working in birth suite or left midwifery. They also identified a level of ambiguity around defensive practices associated with fear of litigation. There is little research regarding experiences of midwives and clinical investigation. Midwives under investigation need appropriate support. Continuing to work during prolonged investigative processes is stressful as reported by midwives who described being "ill-equipped" and "unprepared." Midwives in the review preferred the support of colleagues over counsellors. Educators, employers and regulators need to work collaboratively and incorporate reflective practice in targeted support. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.
Full Text Available In response to the low levels of skilled birth attendance in rural Pakistan, the government introduced a new cadre of community midwives (CMWs in 2006. Assessments to-date have found that these CMWs have yet to emerge as significant providers for a number of sociocultural, geographic and financial reasons. However, a small number of CMWs have managed to establish functional practices in the private sector in conservative, infrastructure-challenged rural contexts. With an objective to highlight "what are the successful CMWs doing right given their context?" this paper adopts an asset-based approach to explore the experiences of the Pakistani CMWs who have managed to overcome the barriers and practice. We drew upon ethnographic data that was collected as part of a larger mixed methods study conducted in 2011-2012 in districts Jhelum and Layyah, Pakistan. Thirty eight CMWs, 45 other health care providers, 20 policymakers, 78 women, 35 husbands and 23 older women were interviewed. CMW clinics and practices were observed. Our data showed that only eight 8 out of 38 CMWs sampled were active providers. Poverty as a push factor to work and intrinsic individual-level characteristics that enabled the CMWs to respond successfully to the demands of the midwifery profession in the private sector emerged as the two key themes. Household poverty pushed the CMWs to work in this perceived low-status occupation. Their families supported them since they became the breadwinners. The successful CMWs also had an intrinsic sense of what was required to establish a private practice; they exhibited professionalism, had strong business sense and provided respectful maternity care. The study provides insight into how the program might improve its functioning by adapting its recruitment criteria to ensure selection of right candidates.
Jacoby, Susan D; Smith, Amy
In response to an increase in the number of women who immigrate to the United States from countries that practice female genital mutilation/cutting (FGM/C; infibulation), US clinicians can expand their knowledge and increase confidence in caring for women who have experienced infibulation. This article describes a comprehensive education program on FGM/C and the results of a pilot study that examined its effect on midwives' confidence in caring for women with infibulation. An education program was developed that included didactic information, case studies, a cultural roundtable, and a hands-on skills laboratory of deinfibulation and repair. Eleven certified nurse-midwives (CNMs) participated in this pilot study. Participants completed a measure-of-confidence survey tool before and after the education intervention. Participants reported increased confidence in their ability to provide culturally competent care to immigrant women with infibulation when comparisons of preeducation and posteducation survey confidence logs were completed. Following the education program and the knowledge gained from it, these midwives were more confident about their ability to perform anterior episiotomy and to deliver necessary care to women with FGM/C in a culturally competent context. This education program should be expanded as more women who have experienced infibulation immigrate to the United States. © 2013 by the American College of Nurse-Midwives.
Allotey, Janette C
As more midwives are becoming interested in the history of midwifery and carrying out historical research, it is opportune to consider some of the problems and pitfalls of this approach. The study and writing of history initially involves the collection of evidence, followed by its critical analysis and interpretation. The scarcity and reliability of sources poses the first problem. Even with the greatest of insight, it is impossible to fully reconstruct the past and eliminate bias. Evidence is open to manipulation and distortion, affecting the way in which findings are presented to a readership. This paper, aimed at novice researchers in the field, focuses on some of the fundamental principles of good research, and contains examples of ways in which the past may be misinterpreted or changed. The nature and construction of professional knowledge will also be briefly examined to establish whether objectivity is possible within historical research. Copyright © 2009 Elsevier Ltd. All rights reserved.
Kindberg, S; Stehouwer, M; Hvidman, L
was perineal pain 10 days after delivery. Secondary outcomes were wound healing, patient satisfaction, dyspareunia, need for resuturing, time elapsed during repair and amount of suture material used. RESULTS: A total of 400 women were randomised; 5 women withdrew their consent, leaving 395 for follow up...... = 0.03) and less suture material was used (one versus two packets, P leaving the skin unsutured appear to be equivalent to the continuous suture technique in relation to perineal pain, wound healing, patient satisfaction...... annually. POPULATION: A total of 400 healthy primiparous women with a vaginal delivery at term. METHOD Randomisation was computer-controlled. Structured interviews and systematic assessment of perineal healing were performed by research midwives blinded to treatment allocation at 24-48 hours, 10 days and 6...
Wennberg, Anna Lena; Hamberg, Katarina; Hörnsten, Asa
By enhancing maternal nutritional status, midwives can help women lower the risks of pregnancy complications and adverse birth outcomes as well as improve maternal health during pregnancy and in the long run. Dietary counselling is, on the other hand, not reported to be effective. Poor communication and conflicting messages are identified as possible barriers to adherence with recommendations. Midwives' experiences of providing dietary advice and counselling during pregnancy are sparsely reported. The aim of this study was therefore to explore midwives' strategies when faced with challenging dietary counselling situations. Seventeen midwives from different parts of Sweden and working within antenatal health care were interviewed by telephone. The interviews were analysed using qualitative content analysis. Challenges were commonly experienced when counselling women who were overweight, obese, had eating disorders or were from different cultures. The midwives talked in terms of "the problematic women" when addressing counselling problems. Strategies used in challenging counselling situations were Getting acquainted; Trying to support and motivate; Pressure to choose "correctly"; Controlling and mastering; and Resigning responsibility. The results indicate that Swedish midwives' counselling strategies are quite ambiguous and need to be questioned and that counselling of vulnerable groups of women should be highlighted. We could identify a need for education of practicing midwives to develop person-centred counselling skills. Copyright © 2014 Elsevier B.V. All rights reserved.
Arrish, Jamila; Yeatman, Heather; Williamson, Moira
This review explored the extent to which the role of midwives in nutrition education during pregnancy has been reported in the literature and areas requiring further research were identified. A review of the literature was undertaken. Articles included in the review were published in English, in scholarly journals, and provided information about the knowledge, education, and attitudes of midwives towards nutrition during pregnancy. Few studies were identified. The included studies were exploratory and descriptive. Studies had reported that midwives lacked a basic knowledge of nutrition requirements during pregnancy. This might be attributed to inadequate nutrition education provided in both undergraduate and postgraduate midwifery programmes. The nutrition education components of midwifery courses were not identified within the studies reviewed. Limited international or Australian research is available that reports on the role of midwives in nutrition education during pregnancy and the nutrition content of midwifery curricula. This represents an important omission in midwives capacity to support the health of pregnant women and their babies. More research is required to explore the educational needs of midwives to enhance nutritional care for pregnant women. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Arrish, Jamila; Yeatman, Heather; Williamson, Moira
Educating midwives to provide nutrition advice is essential. Limited research focuses on midwives' nutrition education. This paper explores self-reported nutrition education received by Australian midwives before and after registration. It draws on quantitative and qualitative data from a larger online survey conducted with the members of the Australian College of Midwives (response rate = 6.9%, n = 329). Descriptive and content analyses were used. Of the midwives, 79.3% (n = 261) reported re...
up of a woman through pregnancy, birth, postpartum and until 6 weeks after delivery. Methods. The research design was qualitative, descriptive, exploratory and contextual. Purposive sampling was used, and 21 student midwives consented to ...
' (Department of Public Service and. Administration 1997:15) should be implemented by the midwives in the labour ward; these principles maintain that citizens should be treated with courtesy and consideration, and that they ...
McCarthy, Rose; Nuttall, Janet; Smith, Joyce; Hollins Martin, Caroline J
The most recent Confidential Enquiry into Maternal Deaths (CMACE, 2011) identified human errors, specifically those of midwives and obstetricians/doctors as a fundamental component in contributing to maternal death in the U.K. This paper discusses these findings and outlines a project to provide training in Maternal-Acute Illness Management (M-AIM) to final year student midwives. Contents of the program are designed to educate and simulate AIM skills and increase confidence and clinical ability in early recognition, management and referral of the acutely ill woman. An outline of the Maternal-AIM program delivered at the University of Salford (Greater Manchester, UK) is presented to illustrate how this particular institution has responded to a perceived need voiced by local midwifery leaders. It is proposed that developing this area of expertise in the education system will better prepare student midwives for contemporary midwifery practice. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.
Hukkelhoven Chantal WPM
Full Text Available Abstract Background Most midwives in the Netherlands work in primary care where they are the lead professionals providing care to women with 'normal' or uncomplicated pregnancies, while some midwives work in hospitals ("clinical midwives". The actual involvement of midwives in maternity care in hospitals is unknown, because in all statistics births in secondary care are registered as births assisted by gynaecologists. The aim of this study is to gain insight in the involvement of midwives with births in secondary care, under supervision of a gynaecologist. This is done using data from the PRN (The Netherlands Perinatal Registry, a voluntary registration of births in the Netherlands. The PRN covers 97% to 99% of all births taking place under responsibility of a gynaecologist. Methods All births registered in secondary care in the period 1998-2007 (1,102,676, on average 61% of all births were selected. We analyzed trends in socio-demographic, obstetric and organisational characteristics, associated with the involvement of midwives, using frequency tables and uni- and multivariate logistic regression analyses. As main outcome measure the percentage of births in secondary care with a midwife 'catching' the baby was used. Results The proportion of births attended by a midwife in secondary care increased from 8.3% in 1998 to 26.06% in 2007, the largest increase involving spontaneous births of a second or later child, on weekdays during day shifts (8.00-20.00 hr from younger mothers with a gestational age (almost at term. After 2002, parallel to the growing numbers of midwives working in hospitals, the percentage of instrumental births decreased. Conclusions In 2007 more midwives are assisting with more births in secondary care than in 1998. Hospital-based midwives are primarily involved with uncomplicated births of women with relatively low risk demographical and obstetrical characteristics. However, they are still only involved with half of the less
Everett-Murphy, Katherine; Paijmans, Jeske; Steyn, Krisela; Matthews, Catherine; Emmelin, Maria; Peterson, Zaino
to investigate how midwives are currently communicating with women about smoking during pregnancy with a view to involving them in a smoking cessation intervention in antenatal clinics. a qualitative study using individual, in-depth interviews for data collection. 24 nurses providing antenatal care to pregnant smokers attending public sector clinics in five major cities in South Africa. three archetypes of midwives, characterised by different styles of communication and approaches to smoking cessation, emerged from the analysis of the interview data. These were described as the 'Angry Scolders', the 'Benign Carers' and the 'Enthusiastic Friends'. The first type conformed to the traditional, authoritarian style of communication, where the midwife assumed a dominant, expert role. When women failed to comply with their advice, these midwives typically became angry and confrontational. The second type of midwife used a paternalistic communication style and emphasised the role of education in changing behaviour. However, these midwives had little confidence that they could influence women to quit. The third type embraced a patient-centred approach, consciously encouraging more interaction with their patients and attempting to understand change from their point of view. These midwives were optimistic of women's capacity to change and more satisfied with their current health education efforts than the first two types. The Benign Carers and Enthusiastic Friends were more open to participation in the potential intervention than the Angry Scolders. the prevailing traditional, authoritarian style of communication is inappropriate for smoking cessation education and counselling as it provokes resistance and avoidance on the part of pregnant smokers. The paternalistic approach appears to be largely ineffectual, whereas the patient-centred approach elicits the most positive response from pregnant women and enhances the possibility of a trusting and cooperative relationship with
McKenna, Lisa; McLelland, Gayle
to report findings on midwives' use of the Internet drawn from a larger study that explored midwives' attitudes and experiences to online and computer-based learning. a descriptive, quantitative design using anonymous questionnaires was employed to obtain information from a sample of midwives in Victoria, Australia. questionnaires were forwarded by mail to a sample of 300 members of the Victorian branch of the Australian College of Midwives. A total of 169 questionnaires were returned by reply paid mail, representing a response rate of 56%. around 92.3% of respondents reported that they used the Internet. However, 31.5% did not find navigating it to be easy, 34.7% reported that finding information was not easy, and 27.2% were not confident using the Internet. many midwives have insufficient Internet competence to be able to access necessary evidence to support practice and to assist women with decision making. ongoing education and training is needed to ensure that midwives have the skills to source evidence to support practice, and are able to effectively critique Internet information. Crown Copyright © 2009. Published by Elsevier Ltd. All rights reserved.
Hall, Jenny S; Mitchell, Mary
There is currently limited information available on how midwifery students learn to provide care that promotes dignity and respect. In recent years the importance of dignity in healthcare and treating people with respect has received considerable emphasis in both a national and international context. The aim of this discussion paper is to describe an educational workshop that enables learning to promote dignity and respect in maternity care. An interactive workshop, using different creative methods as triggers for learning will be described. Provision of learning opportunities for students around dignity and respect is important to ensure appropriate care is provided in practice. The use of creative methods to inspire has contributed to deep learning within participants. An evaluation of the workshop illustrated how learning impacted on participants practice. Data to support this is presented in this paper. The use of creative teaching approaches in a workshop setting appears to provide an effective learning opportunity around dignified and respectful care. These workshops have evoked a deep emotional response for some participants, and facilitators must be prepared for this outcome to ensure a safe space for learning. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Adegoke, A A; Atiyaye, F B; Abubakar, A S; Auta, A; Aboda, A
Nigeria is one of the 57 countries with a critical shortage of human resources for health, especially in remote rural areas and in northern states. The National Midwifery Service Scheme (MSS) is one approach introduced by the Government of Nigeria to address the health workforce shortage in rural areas. Since 2009, unemployed, retired and newly graduated midwives are deployed to primary health care (PHC) facilities in rural areas of Nigeria. These midwives form the mainstay of the health system at the primary health care level especially as it relates to the provision of skilled attendance at birth. This study followed up and explored the job satisfaction and retention of the MSS midwives in three Northern states of Nigeria. this was a descriptive study. Data were collected using a mixed method approach which included a job satisfaction survey, focus group discussions (FGDs) and exit interviews to explore job satisfaction and retention factors. All 119 MSS midwives deployed by the National Primary Health Care Development Agency between 2010 and 2012 to the 51 Partnership for Reviving Routine Immunisation- Maternal and Child Health (PRRINN-MNCH) programme targeted PHC facilities were included in the study. MSS midwives were very satisfied with from the feeling of caring for women and children in the community (4.56), with the chance to help and care for others (Mean 4.50), the feeling of worthwhile accomplishment from doing the job (Mean 4.44) and the degree of respect and fair treatment they received from more senior staff and/or supervisor (Mean 4.39). MSS midwives were least satisfied with the lack of existence of a (established) career ladder (Mean 2.5), availability of promotional opportunities within the scheme (Mean 2.66), safety of accommodation (Mean 3.18), and with 'the degree to which they were fairly paid for what they contribute to the health facility' (Mean 3.41). When asked about future career plans, 38% (n=33) of the MSS midwives planned to leave the
Cappon, Sien; L'Ecluse, Charlotte; Clays, Els; Tency, Inge; Leye, Els
health professionals in Belgium are confronted with female genital mutilation (FGM). To date, no survey to assess knowledge, attitudes and practices on FGM was conducted among midwives in the Northern region of Belgium. the objective of this study was to assess the knowledge, attitude and practices of Flemish midwives regarding female genital mutilation (FGM). we used a quantitative design, using KAP study (semi-structured questionnaire). labour wards, maternity wards and maternal intensive care units (MIC) in 56 hospitals in Flemish region of Belgium. 820 midwives, actively working in labour wards, maternity wards and maternal intensive care units (MIC). 820 valid questionnaires (40.9%) were returned. More than 15% of the respondents were recently confronted with FGM. They were mostly faced with the psychological and sexual complications caused by FGM. Few respondents were aware of existing guidelines regarding FGM in their hospitals (3.5%). The results also showed that only 20.2% was aware of the exact content of the law. The majority of midwives condemned the harmful traditional practice: FGM was experienced as a form of violence against women or a violation of human rights. Only 25.9% declared that FGM forms a part of their midwifery program. The vast majority of respondents (92.5%) indicated a need for more information on the subject. this study indicated that midwives in Flanders are confronted with FGM and its complications and highlighted the gaps in the knowledge of Flemish midwives regarding FGM. This may interfere with the provision of adequate care and prevention of FGM for the new-born daughter. there is an important need for appropriate training of (student)midwives concerning FGM as well as for the development and dissemination of clear guidelines in Flemish hospitals. Copyright © 2014 Elsevier Ltd. All rights reserved.
Dubé, Eve; Vivion, Maryline; Valderrama, Alena; Sauvageau, Chantal
Vaccine acceptability among Quebec midwives is not well documented. The purpose of this study was to examine midwives' knowledge, attitudes and practices relating to immunization in Quebec. Semi-structured interviews were conducted with 25 participants (17 midwives and 8 midwifery students). The mean duration of the interviews was 1 hour. The interviews were conducted in 2010 and were audiotaped, transcribed and submitted to content analysis using NVivo 8 software. In addition to the laws regulating midwifery practice in Quebec, the findings suggest that most midwifery interventions are based on midwifery philosophy. Informed choice is one of the key principles of this philosophy. In order to help women make an informed decision about vaccination, midwives seek to outline the pros and cons of vaccination using government documentation, as well as other sources such as books on naturopathy. Most of the participating midwives recognized that vaccination has advantages, including disease prevention and free vaccines. Various arguments against vaccination were also identified. Most of these were related to the vaccination schedule and to combined vaccines. Some of the participants noted that it was difficult to find unbiased information about vaccination. This study highlights the key role of midwifery philosophy in midwifery practice. Most decisions (such as vaccination) are made on the basis of the principle of informed choice. Most of the participants noted that they lacked information on vaccination.
Christianson, Monica; Eriksson, Carola
To explore midwives' perceptions regarding virginity control and hymen 'reconstructions', and how these practices can be debated from a gender perspective. An international group of 266 midwives answered an open-ended question in a Web survey. The great majority came from the Western world, among them, the majority were from Europe. Data were analysed using qualitative content analysis. Three themes emerged: misogynistic practices that cement the gender order, which revealed how the respondents viewed virginity control and hymen 'reconstructions'; raising public awareness and combatting practices that demean women, which were suggested as strategies by which to combat these practices; and promoting agency in women and providing culturally sensitive care, which were considered to improve health care encounters. Virginity control and hymen 'reconstructions' are elements of patriarchy, whereby violence and control are employed to subordinate women. To counter these practices, macro and micro-level activities are needed to expand women's human rights in the private and the public spheres. Political activism, international debates, collaboration between sectors such as health care and law-makers may lead to increased gender equality. A women-centred approach whereby women are empowered with agency will make women more capable of combatting virginity control and hymen 'reconstruction'.
Konlan, Kennedy Diema; Kombat, Joseph M; Wuffele, Mary Gifty; Aarah-Bapuah, Milicent
The partogram is the most effective tool to use to monitor the progress of labour and complications associated with labour. The main objective of this study was to assess the knowledge level of midwives on the effective use of the partogram in monitoring the progress of labour in the Tamale Metropolis of Ghana. This study was a cross-sectional descriptive study conducted on 140 midwives selected using random sampling technique from March to July, 2011. The study revealed that all respondents had knowledge of the supposed use of the partogram. However, the study also identified inadequate knowledge on the proper use of the tool (as observation showed that some of the partogram sheets were inadequately filled). Inadequate knowledge, inadequate staffing (1.0 % of respondents) and extra workload on the few midwives (2.6 %) were some of the factors that militated against the effective use of the partogram. There were enough partogram sheets in the health facilities under study as 91.4 % of respondents had access to the partogram. Midwives in Ghana know about the supposed use of partogram as a monitoring tool for labour; however inadequate knowledge on the proper use of the tool and inadequate staffing militated against effective use. We recommended constant refresher training on the use of the partogram and also training of more midwives to enhance effective utilisation of the partogram.
Rouleau, Dominique; Fournier, Pierre; Philibert, Aline; Mbengue, Betty; Dumont, Alexandre
Despite working in a challenging environment plagued by persistent personnel shortages, public sector midwives in Senegal play a key role in tackling maternal mortality. A better understanding of how they are experiencing their work and how it is affecting them is needed in order to better address their needs and incite them to remain in their posts. This study aims to explore their job satisfaction and its effects on their burnout, intention to quit and professional mobility. A cohort of 226 midwives from 22 hospitals across Senegal participated in this longitudinal study. Their job satisfaction was measured from December 2007 to February 2008 using a multifaceted instrument developed in West Africa. Three expected effects were measured two years later: burnout, intention to quit and turnover. Descriptive statistics were reported for the midwives who stayed and left their posts during the study period. A series of multiple regressions investigated the correlations between the nine facets of job satisfaction and each effect variable, while controlling for individual and institutional characteristics. Despite nearly two thirds (58.9%) of midwives reporting the intention to quit within a year (mainly to pursue new professional training), only 9% annual turnover was found in the study (41/226 over 2 years). Departures were largely voluntary (92%) and entirely domestic. Overall the midwives reported themselves moderately satisfied; least contented with their "remuneration" and "work environment" and most satisfied with the "morale" and "job security" facets of their work. On the three dimensions of the Maslach Burnout Inventory, very high levels of emotional exhaustion (80.0%) and depersonalization (57.8%) were reported, while levels of diminished personal accomplishment were low (12.4%). Burnout was identified in more than half of the sample (55%). Experiencing emotional exhaustion was inversely associated with "remuneration" and "task" satisfaction, actively job
Martin, L.; Hutton, E.K.; Spelten, E.R.; Gitsels-van der Wal, J.T.; Dulmen, S. van
OBJECTIVE: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. DESIGN: a comparative (midwives versus clients) questionnaire survey.
Martin, L.; Hutton, E.K.; Spelten, E.R.; Gitsels-van der Wal, J.T.; Dulmen, S. van
Objective: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. Design: a comparative (midwives versus clients) questionnaire survey.
Jimenez, M Michelle; Bui, Anthony L; Mantilla, Eduardo; Miranda, J Jaime
Most analyses of gaps in human resources for health (HRH) do not consider training and the transition of graduates into the labour market. This study aims to explore the labour market for Peru's recent medical, nursing, and midwifery graduates as well as their transition into employment in the Ministry of Health's (MOH) system. Data from four different datasets, covering 2007-2013, was used to characterize the patterns of recently trained physicians, nurses, midwives, and postgraduate-trained physicians that enter employment in the MOH system, and scenario analyses were used to describe how this rate of entry needs to adapt in order to fill current HRH shortages. HRH graduates have been increasing from 2007 to 2011, but the proportions that enter employment in the MOH system 2 years later range from 8 to 45% and less than 10% of newly trained medical specialists. Scenario analyses indicate that the gap for physicians and nurses will be met in 2027 and 2024, respectively, while midwives in 2017. However, if the number of HRH graduates entering the MOH system doubles, these gaps could be filled as early as 2020 for physicians and 2019 for nurses. In this latter scenario, the MOH system would still only utilize 56% of newly qualified physicians, 74% of nurses, and 66% of midwives available in the labour market. At 2013 training rates, Peru has the number of physicians, nurses, and midwives it needs to address HRH shortages and meet estimated HRH gaps in the national MOH system during the next decade. However, a significant number of newly qualified health professionals do not work for the MOH system within 2 years of graduation. These analyses highlight the importance of building adequate incentive structures to improve the entry and retention of HRH into the public sector.
Objectives: This study sought to assess birth complications control between midwives among women in cross river ..... pains birth complication control. 1.7 .... shoulder dystocia. Most fetal birth injuries resolve without long term harm, but brachial plexus injury may lead to Erb's palsy. Neonatal infection: neonates are prone to.
A partograph is a graphical record of the progress of labour and salient conditions of the mother and foetus plotted against time in hours. ... recruitment of more qualified midwives, a continuous supply of partographs to improve use of partographs continuous supportive supervision, mentoring of staff and motivation schemes.
This study aims at measuring the attitudes of Nurses and Midwives toward people living with HIV/AIDS (PLWHA) in Minna Municipal and the extent to which academic qualification and years of experience influence their attitudes. With the aid of a structured 55 item – questionnaire, information was elicited from 195 randomly ...
A primary cause of Ghana's higher than global average maternal mortality rate is limited access to maternal care in rural areas. To date, few studies have examined how rural background/training of midwives impacts their future willingness to work in remote areas. The purpose of this paper is to describe the relationship ...
Minimal research was done on experiences of the newly qualified registered nurse and midwife during the compulsory community service years. The aim of this study was to describe the newly qualified registered nurses and midwives lived experiences of compulsory community service in public maternity care in Gauteng ...
Dubé, Eve; Vivion, Maryline; Sauvageau, Chantal; Gagneur, Arnaud; Gagnon, Raymonde; Guay, Maryse
Even if vaccination is often described as one of the great achievements of public health, results of recent studies have shown that parental acceptance of vaccination is eroding. Health providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines to patients and the vaccine uptake of their patients. The purpose of this article is to compare how midwives and physicians address vaccination with parents during pregnancy and in postpartum visits. Thirty semi-structured interviews were conducted with midwives and physicians practicing in the province of Quebec, Canada. Results of our analysis have shown that physicians adopt an "education-information" stance when discussing vaccination with parents in the attempt to "convince" parents to vaccinate. In contrast, midwives adopted a neutral stance and gave information on the pros and cons of vaccination to parents while leaving the final decision up to them. Findings of this study highlight the fact that physicians and midwives have different views regarding their role and responsibilities concerning vaccination. It may be that neither of these approaches is optimal in promoting vaccination uptake.
Mivšek, Polona; Pahor, Majda; Hlebec, Valentina; Hundley, Vanora
The aim of the study was to explore Slovenian midwives' views of their professional status. The influence of participants' educational background on their views was also examined, since higher education is related to professionalism. This was a quantitative descriptive survey, using postal data collection. The questionnaire comprised of six elements crucial for professionalism--three elements distinctive of 'old' professionalism (power, ethics, specific knowledge) and three characteristics of 'new' professionalism (reflective practice, inter-professional collaboration and partnership with users). A total of 300 midwives who were registered in a national register of nurses and midwives at the time of the study. The response rate was 50.7% (152 returned the questionnaire). Participants that were on a probationary period were excluded, leaving 128 questionnaires for analysis (43%). Some 40.9% participants had secondary midwifery education, 56.7% had higher midwifery education and only few (2.4%) finished postgraduate education. The majority of participants did not consider midwifery to be a specific profession. Midwives with secondary education were more likely to consider practical skills to be important than theoretical midwifery knowledge. In general midwives did not feel enabled to practice autonomously; and this caused them to face ethical dilemmas when aiming to fulfil women's wishes. All participants with midwifery secondary school education thought that obstetrics jeopardises midwifery scope of practice, but only half of the BSc participants thought this. One-fifth of all participants estimated that midwifery is also threatened by nursing. The respondents reported feeling a lack of control over their professional activity and policy making; however the majority of midwives claimed that they were willing to take on more responsibility for independent practice. Slovenian midwifery cannot be considered to be a profession yet. It faces several hindrances, due to
Ruby Angeline Pricilla
Full Text Available Background:India contributes to 19% of the global maternal deaths. Good quality antenatal care can prevent maternal deaths by early detection of complications and maintaining maternal health. There are few studies documenting quality of antenatal care in India. This study aimed to document the antenatal services provided by nurse midwives to low-risk pregnant mothers from an urban population. Aims: The primary objective was to describe the quality of the antenatal care provided by nurse midwives of an urban health centre with regard to low-risk mothers. The secondary objective was to document the maternal and early neonatal outcomes of the enrolled mothers during the period of study. Methods: This prospective cohort study was done on 200 pregnant women who had antenatal care by nurse midwives between April 2014 and November 2014. The quality of care was assessed by a checklist adapted from World Health Organization (WHO. Results: We report that the quality of antenatal care for all domains was above 90% except for the health education domain, which was poor with regard to breastfeeding and family planning in the enrolled 200 pregnant women. Conclusion: Our study concluded that trained nurse midwives when regularly monitored, audited and linked with reliable referral facilities can deliver good quality antenatal care.
Hopkinson, Yvonne; Hill, Denise M; Fellows, Lindsey; Fryer, Simon
to examine the current level of understanding held by midwives regarding the NICE physical activity guidelines in the UK, and to investigate the physical activity guidance given to women during pregnancy. an 11 question online survey comprising of a mixture of closed and open ended questions. data reflects participants sampled across the United Kingdom. fifty-nine midwives completed the online survey MEASUREMENTS AND FINDINGS: an electronic survey was used to explore the midwives understanding of physical activity guidelines during pregnancy, and the advice they offered to women in their care. Qualitative content analysis was used to gain a more in-depth understanding of midwife knowledge. Two per cent of midwives correctly identified the physical activity guidelines, with 44% giving partially correct responses, 25% giving incorrect responses and 29% unsure of what the guidelines are. Despite the low level of correct responses, 59% of respondents reported they were confident or very confident in answering questions regarding physical activity. Only 4% of respondents reported having access to continual professional development (CPD) in the area of PA guidance. there appears to be a misplaced confidence amongst midwives in their knowledge of the NICE PA guidelines for pregnancy. as physical inactivity can be detrimental for the health of both mother and baby, there is a clear need for better dissemination of the current and future NICE physical activity guidelines in primary health care settings. The current study determined a substantial lack of CPD in the area of PA guidance, which may be a contributing factor to the lack of knowledge of the guidelines. As such, increasing CPD may in turn improve the accuracy of the advice given to pregnant women and consequently benefit the health of both mother and baby. Copyright © 2018 Elsevier Ltd. All rights reserved.
Full Text Available OBJECTIVE: To describe sleep, stress and compensatory behaviors in nurses and midwives. METHODS: The study included 41 midwives and 21 nurses working in Australian hospitals between 2005 and 2009. Participation was voluntary. All participants recorded on a daily basis their work and sleep hours, levels of stress and exhaustion, caffeine intake and use of sleep aids for a month (1,736 days, 1,002 work shifts. RESULTS: Participants reported moderate to high levels of stress and exhaustion on 20-40% of work days; experienced sleep disruption on more than 50% of work days; struggled to remain awake on 27% of work days; and suffered extreme drowsiness or experienced a near accident while travelling home on 9% of workdays. Age, perceived sleep duration and work hours were significant predictors of caffeine intake. About 60% of participants reported using sleep aids (about 20% reported taking prescription medications and 44% of nurses and 9% of midwives reported alcohol use as a sleep aid at least once during the study. Stress and workdays were significant predictors of sedative use. Overall, 22% reported being indifferent or mildly dissatisfied with their job. CONCLUSIONS: Sleep problems, high levels of stress and exhaustion and low job satisfaction are prevalent among nurses and midwives. The use of alcohol and sleeping pills as sleep aids, and the use of caffeine to help maintain alertness is also common. Nurses and midwives may use caffeine to compensate for reduced sleep, especially on workdays, and sleeping pills to cope with their daily work-related stress.
McCarthy Carey F
Full Text Available Abstract Background More than thirty-five sub-Saharan African countries have severe health workforce shortages. Many also struggle with a mismatch between the knowledge and competencies of health professionals and the needs of the populations they serve. Addressing these workforce challenges requires collaboration among health and education stakeholders and reform of health worker regulations. Health professional regulatory bodies, such as nursing and midwifery councils, have the mandate to reform regulations yet often do not have the resources or expertise to do so. In 2011, the United States of America Centers for Disease Control and Prevention began a four-year initiative to increase the collaboration among national stakeholders and help strengthen the capacity of health professional regulatory bodies to reform national regulatory frameworks. The initiative is called the African Health Regulatory Collaborative for Nurses and Midwives. This article describes the African Health Regulatory Collaborative for Nurses and Midwives and discusses its importance in implementing and sustaining national, regional, and global workforce initiatives. Discussion The African Health Profession Regulatory Collaborative for Nurses and Midwives convenes leaders responsible for regulation from 14 countries in East, Central and Southern Africa. It provides a high profile, south-to-south collaboration to assist countries in implementing joint approaches to problems affecting the health workforce. Implemented in partnership with Emory University, the Commonwealth Secretariat, and the East, Central and Southern African College of Nursing, this initiative also supports four to five countries per year in implementing locally-designed regulation improvement projects. Over time, the African Health Regulatory Collaborative for Nurses and Midwives will help to increase the regulatory capacity of health professional organizations and ultimately improve regulation and
Full Text Available Abstract Background In the Netherlands, midwives are autonomous medical practitioners and 78% of pregnant women start their maternity care with a primary care midwife. Scientific research to support evidence-based practice in primary care midwifery in the Netherlands has been sparse. This paper describes the research design and methodology of the multicenter multidisciplinary prospective DELIVER study which is the first large-scale study evaluating the quality and provision of primary midwifery care. Methods/Design Between September 2009 and April 2011, data were collected from clients and their partners, midwives and other healthcare professionals across the Netherlands. Clients from twenty midwifery practices received up to three questionnaires to assess the expectations and experiences of clients (e.g. quality of care, prenatal screening, emotions, health, and lifestyle. These client data were linked to data from the Netherlands Perinatal Register and electronic client records kept by midwives. Midwives and practice assistants from the twenty participating practices recorded work-related activities in a diary for one week, to assess workload. Besides, the midwives were asked to complete a questionnaire, to gain insight into collaboration of midwives with other care providers, their tasks and attitude towards their job, and the quality of the care they provide. Another questionnaire was sent to all Dutch midwifery practices which reveals information regarding the organisation of midwifery practices, provision of preconception care, collaboration with other care providers, and provision of care to ethnic minorities. Data at client, midwife and practice level can be linked. Additionally, partners of pregnant women and other care providers were asked about their expectations and experiences regarding the care delivered by midwives and in six practices client consults were videotaped to objectively assess daily practice. Discussion In total, 7685
Manniën, Judith; Klomp, Trudy; Wiegers, Therese; Pereboom, Monique; Brug, Johannes; de Jonge, Ank; van der Meijde, Margreeth; Hutton, Eileen; Schellevis, Francois; Spelten, Evelien
In the Netherlands, midwives are autonomous medical practitioners and 78% of pregnant women start their maternity care with a primary care midwife. Scientific research to support evidence-based practice in primary care midwifery in the Netherlands has been sparse. This paper describes the research design and methodology of the multicenter multidisciplinary prospective DELIVER study which is the first large-scale study evaluating the quality and provision of primary midwifery care. Between September 2009 and April 2011, data were collected from clients and their partners, midwives and other healthcare professionals across the Netherlands. Clients from twenty midwifery practices received up to three questionnaires to assess the expectations and experiences of clients (e.g. quality of care, prenatal screening, emotions, health, and lifestyle). These client data were linked to data from the Netherlands Perinatal Register and electronic client records kept by midwives. Midwives and practice assistants from the twenty participating practices recorded work-related activities in a diary for one week, to assess workload. Besides, the midwives were asked to complete a questionnaire, to gain insight into collaboration of midwives with other care providers, their tasks and attitude towards their job, and the quality of the care they provide. Another questionnaire was sent to all Dutch midwifery practices which reveals information regarding the organisation of midwifery practices, provision of preconception care, collaboration with other care providers, and provision of care to ethnic minorities. Data at client, midwife and practice level can be linked. Additionally, partners of pregnant women and other care providers were asked about their expectations and experiences regarding the care delivered by midwives and in six practices client consults were videotaped to objectively assess daily practice. In total, 7685 clients completed at least one questionnaire, 136 midwives and
Background In the Netherlands, midwives are autonomous medical practitioners and 78% of pregnant women start their maternity care with a primary care midwife. Scientific research to support evidence-based practice in primary care midwifery in the Netherlands has been sparse. This paper describes the research design and methodology of the multicenter multidisciplinary prospective DELIVER study which is the first large-scale study evaluating the quality and provision of primary midwifery care. Methods/Design Between September 2009 and April 2011, data were collected from clients and their partners, midwives and other healthcare professionals across the Netherlands. Clients from twenty midwifery practices received up to three questionnaires to assess the expectations and experiences of clients (e.g. quality of care, prenatal screening, emotions, health, and lifestyle). These client data were linked to data from the Netherlands Perinatal Register and electronic client records kept by midwives. Midwives and practice assistants from the twenty participating practices recorded work-related activities in a diary for one week, to assess workload. Besides, the midwives were asked to complete a questionnaire, to gain insight into collaboration of midwives with other care providers, their tasks and attitude towards their job, and the quality of the care they provide. Another questionnaire was sent to all Dutch midwifery practices which reveals information regarding the organisation of midwifery practices, provision of preconception care, collaboration with other care providers, and provision of care to ethnic minorities. Data at client, midwife and practice level can be linked. Additionally, partners of pregnant women and other care providers were asked about their expectations and experiences regarding the care delivered by midwives and in six practices client consults were videotaped to objectively assess daily practice. Discussion In total, 7685 clients completed at least
GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING): a pilot cluster randomised controlled trial of a guideline implementation intervention for the management of maternal obesity by midwives.
Heslehurst, Nicola; Rankin, Judith; McParlin, Catherine; Sniehotta, Falko F; Howel, Denise; Rice, Stephen; McColl, Elaine
Weight management in pregnancy guidelines exist, although dissemination alone is an ineffective means of implementation. Midwives identify the need for support to overcome complex barriers to practice. An evaluation of an intervention to support midwives' guideline implementation would require a large-scale cluster randomised controlled trial. A pilot study is necessary to explore the feasibility of delivery and evaluation prior to a definitive trial. The GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING) trial aims to test whether it is feasible and acceptable to deliver a behaviour change intervention to support midwives' implementation of weight management guidelines. GLOWING is a multi-centre parallel group pilot cluster randomised controlled trial comparing the delivery of a behaviour change intervention for midwives versus usual practice. Four NHS Trusts (clusters) will be randomised to intervention and control arms, stratified by size of maternity services. The intervention uses social cognitive theory and consists of face-to-face midwifery training plus information resources for routine practice. The main outcomes are whether the intervention and trial procedures are feasible and acceptable to participants and the feasibility of recruitment and data collection for a definitive trial. Target recruitment involves all eligible midwives in the intervention arm recruited to receive the intervention, 30 midwives and pregnant women per arm for baseline and outcome questionnaire data collection and 20 midwives and women to provide qualitative data. All quantitative and qualitative analyses will be descriptive with the purpose of informing the development of the definitive trial. This pilot study has been developed to support community midwives' implementation of guidelines. Community midwives have been selected as they usually carry out the booking appointment which includes measuring and discussing maternal body mass index. A
Dalton, J A; Rodger, D L; Wilmore, M; Skuse, A J; Humphreys, S; Flabouris, M; Clifton, V L
Usage rates for information and communication technologies (ICTs) in healthcare have been increasing in recent years, but often lag behind general usage rates for populations as a whole. Research into such differential rates of ICT use across different segments of the population has identified a number of possible causal factors that limit usage. The research investigated midwives' attitudes and experiences of ICT use to identify potential causal factors that encourage or inhibit their usage in antenatal care. Semi-structured interviews, focus groups and short surveys were conducted with midwives who provide antenatal education at an Australian metropolitan hospital. Thematic and statistical analyses were used to interpret the data. Although midwives recognised the potential benefits of using ICTs to deliver pregnancy-related health information many had reservations about their use in everyday work. These reservations centred on lack of training in use of ICTs, the perceived legal risks associated with social media, potential violations of patient privacy, misdiagnosis and misunderstandings between midwife and client. Midwives face a number of barriers to effective use of ICTs in healthcare including material access, skills access, usage access and motivational access. Motivational access appears to be a key concern due to the high perception of risk associated with social media in particular. Reducing the motivational barriers through a range of interventions with midwifery staff may assist in overcoming other barriers to ICT use in antenatal care. Further research is required to determine whether these findings are generalisable to other healthcare contexts. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
haemorrhage >1000 ml, Diabetes, mental disorders. Both suture techniques were 2-layered using a polyglactin 910 multifilament suture (Vicryl Rapid or Vicryl). Treatment A was a continuous suture technique and treatment B was interrupted, inverted stitches. Primary outcomes: Perineal pain and wound healing......Midwives conducting perineal repair: The Danish Suture Trial. Background Suture techniques and materials for repair of 2nd degree perineal lacerations and episiotomies have been tested in several clinical trials. Danish midwives and obstetricians have developed a new, simple and time......-efficient suture technique which needed systematic evaluation. Objective To compare two standardized suture techniques for perineal repair of 2nd degree perineal lacerations or episiotomies. Design and setting A double-blind randomised clinical trial conducted in Aarhus University Hospital, Denmark. Initiated...
Full Text Available Background & aim: Job satisfaction is one of the important factors enhancing organizational efficiency and employees' performance. This study aimed to evaluate job satisfaction among midwives working in hospitals. Methods: This cross-sectional study included all midwives (N=100 working in hospitals affiliated to Abadan School of Medical Sciences, Abadan, Iran in 2016. To obtain data, we used a demographic as well as Herzberg's Job Satisfaction Questionnaire with α=0.96 in Iran. To analyze the data, independent t-test, Chi-square test, and Pearson correlation coefficient were run in SPSS, version 22. Results: The mean age and work experience of the subjects were 35.37±7.3 and 11.23±7.8 years, respectively. The mean job satisfaction score of the midwives was 302.41±19. The results showed that the subjects had moderate job satisfaction in the eight domains of occupational nature and position (48%, job security (46%, salary and benefits (61%, occupational and environmental conditions (90%, relationship with colleagues (87%, supervision (91%, management policy-making (80%, and personal relationships (85%. There was a significant correlation between work experience and job satisfaction, while there was no significant relationship between job satisfaction and other demographic variables. Conclusion: Considering the moderate level of job satisfaction among the midwives working in the hospitals affiliated to Abadan School of Medical Sciences, authorities should take effective steps to address job dissatisfaction by promoting occupational security, creating professional standards, and using midwives’ capabilities in building appropriate relationships with colleagues.
Mitchell, Mary; Hall, Jenny
The nature of midwifery both as an art and a science requires methods of teaching students that will enhance this understanding. A philosophy of holistic care of women should underpin education of student midwives and these concepts should be put across to the students in meaningful ways. In the formal midwifery curriculum this has been a neglected aspect (Hall, 2001) [Hall, J., 2001. Midwifery Mind and spirit: emerging issues of care. Books for Midwives, Oxford]. We have developed a teaching session on 'Spirituality and the meaning of birth'. A creative approach, using mediums of video, music, aroma and storytelling, combined with an opportunity for the students to express their selves through art have been utilised (Cameron, 1993) [Cameron, J., 1993. The Artists Way--A course in discovering and recovering your creative self. Pan Macmillan, London]. Although creative approaches in teaching arts based disciplines is well established, these approaches have not been evaluated for their effectiveness within midwifery education. We conducted a study which aimed to develop an understanding of student's views on the meaning of birth by examining creative work produced by the student midwives. This aspect is reported elsewhere. Further exploration through open-ended questionnaires was made of the effectiveness and value of the activity as a teaching method. This paper will describe the innovative teaching methods used. In addition student's views of birth established through their art and their views of the teaching session elicited through our research will be explored.
Barry, Michele J; Hauck, Yvonne L; O'Donoghue, Thomas; Clarke, Simon
Midwifery has developed its own philosophy to formalise its unique identity as a profession. Newly-graduated midwives are taught, and ideally embrace, this philosophy during their education. However, embarking in their career within a predominantly institutionalised and the medically focused health-care model may challenge this application. The research question guiding this study was as follows: 'How do newly graduated midwives deal with applying the philosophy of midwifery in their first six months of practice?' The aim was to generate a grounded theory around this social process. This Western Australian grounded theory study is conceptualised within the social theory of symbolic interactionism. Data were collected by means of in-depth, semi-structured interviews with 11 recent midwifery graduates. Participant and interviewer's journals provided supplementary data. The 'constant comparison' approach was used for data analysis. The substantive theory of transcending barriers was generated. Three stages in transcending barriers were identified: Addressing personal attributes, Understanding the 'bigger picture', and finally, 'Evaluating, planning and acting' to provide woman-centred care. An overview of these three stages provides the focus of this article. The theory of transcending barriers provides a new perspective on how newly-graduated midwives deal with applying the philosophy of midwifery in their first six months of practice. A number of implications for pre and post registration midwifery education and policy development are suggested, as well as recommendations for future research. Copyright © 2013 Elsevier Ltd. All rights reserved.
Silva, Tânia Maria de Almeida; Ferreira, Luiz Otávio
The article addresses an endeavor by Serviço Especial de Saúde Pública (Sesp) to train folk midwives who worked in rural communities and to exercise control over these women's activities. The task was entrusted to the agency's prenatal and child hygiene programs, established between the 1940s and 1960s. The agency believed this training and control initiative would be of major importance in helping ensure the success of its project to establish local sanitary services offering mother-child assistance. The goal of working directly with the folk midwives was not only to force them to employ strict hygiene standards when delivering and caring for newborns but especially to use their influence and prestige within these communities to convince the general population to adopt good health practices.
The Agriculture sectors comprise establishments primarily engaged in growing crops, raising animals, and harvesting fish and other animals. Find information on compliance, enforcement and guidance on EPA laws and regulations on the NAICS 111 & 112 sectors.
Jepsen, Ingrid; Juul, Svend; Foureur, Maralyn
Objective: To investigate the level of burnout among midwives working in caseloading practices compared to other models of midwifery care. Study design and setting: In this survey the Copenhagen Burnout Inventory was used to measure burnout among midwives working in a tertiary maternity unit...... Denmark. Main outcome measures: Mean burnout scores and the proportion of midwives with high burnout scores (a score >= 50). Results: The response rate was 82.0% as 50 out of 61 midwives answered the questionnaire. In caseload midwifery the burnout scores in personal, work-related and client......-related burnout were significantly lower when compared to ‘‘other models of care”. Among caseloading midwives, none had high scores of burnout in any of the measured domains. The proportions of high burnout scores among all of the participating midwives were 22% (95% CI: 12%–36%) in personal burnout, 20% (95% CI...
Hurley, Emily A; Warren, Nicole E; Doumbia, Seydou; Winch, Peter J
rural auxiliary midwives are central to clinical maternal care in Mali. However, little is known about their social role within the villages they serve. Exploring the social connectedness of midwives in their communities can reveal areas in which they need additional support, and ways they could benefit their communities beyond their clinical role. to examine rural auxiliary midwives' social connectedness to the communities they serve. embedded, mixed methods design combining social network case studies with semi-structured interviews. midwives were recruited for semi-structured interviews during technical trainings held in Koutiala in southern Mali. Social network analyses were conducted among all adult women in two small villages purposively sampled from the Koutiala region. 29 interviews were conducted, transcribed, and coded using NVivo (Version 9) to qualitatively assess social connectedness. In two villages, the complete social networks of women's friendships were analysed using UCINET Version 6 (n=142; 74). Rank-orders of actors according to multiple measures of their centrality within the network were constructed to assess the midwives' position among village women. both local and guest midwives reported feeling high levels of social integration, acceptance, and appreciation from the women in their communities. Specific challenges existed for guest or younger midwives, and in midwives' negotiations with men. In the two sociometric analyses, both the local and guest midwives ranked among the most influential social actors in their respective villages. though they hold a unique position among other rural women, this study suggests that midwives in Koutiala are well connected socially, and may be capable of becoming effective agents of network based-behavioural health interventions. Additional support is warranted to help midwives affirm a credible professional status in a male-dominated society, especially those of local status and younger age. Programme
Arrish, Jamila; Yeatman, Heather; Williamson, Moira
This study explored the Australian midwives' role in the provision of nutrition advice. Little is known about their perceptions of this role, the influence of the model of care, and the barriers and facilitators that may influence them providing quality nutrition advice to pregnant women. Semistructured telephone interviews were undertaken with a subsample (n = 16) of the members of the Australian College of Midwives who participated in an online survey about midwives' nutrition knowledge, at...
Yates, Karen; Usher, Kim; Kelly, Jenny
Nurses and midwives continue to make up the largest proportion of the health workforce. As a result, shortages of nurses and midwives have a significant impact on the delivery of effective health care. Shortages of nurses and midwives are known to be more pronounced in rural and remote areas where recruitment and retention remain problematic. However, rural nurses are often required to be multi-skilled, which has led to expectations that nurses who are also midwives, are required to work across areas of the hospital to help to address shortages. For midwives this issue is even more problematic as they may actually end up spending a very small percentage of their working day involved in the delivery of maternity care. This workforce strategy has the potential to seriously erode the skills of the midwives. Situations such as this are implicated in attrition of midwives because of the role stress that results when they are required to work in models of care where they experience the constant pull to work between departments and across roles. This paper addresses the requirement for midwives in some rural facilities to work across roles of general nurse and midwife and outlines the issues that arise as a result. In particular, the paper links the concepts of Role Theory to the requirement for midwives to work in dual roles and the potential for role stress to develop.
OBJECTIVE: to explore midwives\\' experiences of facilitating normal birth in an obstetric-led unit. DESIGN: a feminist approach using semi-structured interviews focusing on midwives\\' perceptions of normal birth and their ability to facilitate this birth option in an obstetric-led unit. SETTING: Ireland. PARTICIPATION: a purposeful sample of 10 midwives with 6-30 years of midwifery experience. All participants had worked for a minimum of 6 years in a labour ward setting, and had been in their current setting for the previous 2 years. FINDINGS: the midwives\\' narratives related to the following four concepts of patriarchy: \\'hierarchical thinking\\
Marangoni, P; Pozo, A; Faundes, A
The Asociacion Pro Bienestar de la Familia Ecuadoriana has employed since 1965 midwives to perform clinical services. This comparative study investigates 310 insertions of T Cu-200 done by physicians, and 297 insertions of the same IUD type done by midwives. Age and parity of acceptors were comparable in both groups. Insertions were executed by midwives with as much skill and knowledge as the doctors, and termination rates for medical reasons were almost similar in both groups. Several authors have confirmed the fact that experienced midwives can be successfully trained in performing IUD insertions.
Pezaro, Sally; Clyne, Wendy; Fulton, Emily A
within challenging work environments, midwives and student midwives can experience both organisational and occupational sources of work-related psychological distress. As the wellbeing of healthcare staff directly correlates with the quality of maternity care, this distress must be met with adequate support provision. As such, the identification and appraisal of interventions designed to support midwives and student midwives in work-related psychological distress will be important in the pursuit of excellence in maternity care. to identify interventions designed to support midwives and/or student midwives in work-related psychological distress, and explore any outcomes and experiences associated with their use. Data sources; study eligibility criteria, participants, and interventions This systematic mixed-methods review examined 6 articles which identified interventions designed to support midwives and/or student midwives in work-related psychological distress, and reports both the outcomes and experiences associated with their use. All relevant papers published internationally from the year 2000 to 2016, which evaluated and identified targeted interventions were included. the reporting of this review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The quality of each study has been appraised using a scoring system designed for appraising mixed-methods research, and concomitantly appraising qualitative, quantitative and mixed-methods primary studies in mixed reviews. Bias has been assessed using an assessment of methodological rigor tool. Whilst taking a segregated systematic mixed-methods review approach, findings have been synthesised narratively. this review identified mindfulness interventions, work-based resilience workshops partnered with a mentoring programme and the provision of clinical supervision, each reported to provide a variety of both personal and professional positive outcomes and experiences
Bentley, Suzanne; Hexom, Braden; Nelson, Bret P
Point-of-care ultrasound is an effective tool for clinical decision making in low- and middle-income countries, but lack of trained providers is a barrier to its utility in these settings. In Liberia, given that midwives provide most prenatal care, it is hypothesized that training them in prenatal ultrasound through an intensive condensed training course is both feasible and practical. This quantitative prospective study of preobservational and postobservational assessment evaluated a 1-week ultrasound curriculum consisting of 4 modules, each comprising a didactic component, a practical session, and supervised patient encounters. A knowledge-based pretest and presurvey addressing prior use and comfort were administered. At the intervention conclusion, identical posttests and postsurveys were administered with an objective structured clinical examination (OSCE). The test, survey, and OSCE were repeated after 1 year. All scores and responses were tabulated, and qualitative analysis with paired t tests was performed. Thirty-one midwives underwent intervention and written evaluation, with 14 followed up at 1 year. Seventeen underwent the OSCE, with 8 retained at 1 year. There was a significant increase between pretest and immediate and 1-year posttest scores (36.6% versus 90% and 66%; P .05). Average overall comfort using ultrasound increased from presurvey to immediate postsurvey scores (from 1.8 to 3.8; P .05). Midwives in Liberia had very low baseline knowledge and comfort using ultrasound. A 1-week curriculum increased both short- and long-term knowledge and comfort and led to adequate overall OSCE scores that were retained at 1 year. © 2015 by the American Institute of Ultrasound in Medicine.
Lawrence, Rachel; Kantrowitz-Gordon, Ira; Landis, Andrea
A growing body of literature has emerged describing the risks of extended-duty shifts and sleep deprivation. Worldwide, midwifery organizations have not adopted standards for practitioner or student duty shifts. This project reviews the literature related to extended-duty shifts in an effort to develop evidence-based recommendations for student nurse-midwives/student midwives (SNMs/SMs). A comprehensive literature search was conducted through electronic databases, major journals, and reference lists published in English since January 2001. Primary research studies evaluating sleep deprivation and shift duration were included. Studies that did not include the target population (shift workers) and those that formed conclusions related to extended-duty shifts greater than 30 hours were excluded. In addition, an extensive worldwide review of duty-hour recommendations from more than 300 health care organizations was conducted. A total of 40 studies met the inclusion criteria. Extended-duty shifts (those greater than 12 hours) increased the risk for cognitive and physical functional errors, safety concerns, and decreased quality of life from sleep deprivation. Cognitive function errors included attention lapses, visual tracking errors, decreased mentation and immediate recall, and decreased learning capacity. Physical errors included decreased motor skills and slowed reaction times in clinical simulations. These deficits led to an increased risk of motor vehicle accidents, needle sticks, and performance equivalent to unsafe blood alcohol concentrations. An overall decrease in quality of life and job satisfaction was linked to extended-duty shifts. Seven organizations for medical residents or advanced practice nurses have developed policy statements on duty shifts, with extended-duty shift limitations between 12 and 24 hours. The risks associated with extended-duty shifts may inhibit the development of SNMs/SMs into competent practitioners and place patients at risk. It
Abramsky, D; Swietnicki, C
140 women in El Salvador die giving birth for every 10,000 live births in the country. Poor sanitary conditions, the lack of sufficiently trained birth attendants, inadequate transportation, malnutrition, closely spaced and numerous pregnancies, and the lack of prenatal care therefore combine to make giving birth a real danger for most Salvadoran women. In 1993 there were 750 registered births in the rural communities surrounding the Guazapa volcano in the Department of Cuscatlan, El Salvador. Almost 70% of these births occurred in the home. Most were attended by community midwives; other women birthed alone. The International Medical Relief Fund (IMRF) Midwifery Training Project was launched June 1993 with the goal of training enough midwives and health promoters so that a qualified person is available to attend each birth. To be chosen for the training program, a woman must be actively working as a midwife or health promoter in her community, have her community's respect, have a strong commitment to the work, and be motivated to learn. The trainee must then be able to balance her generally unpaid community activities with those which are necessary for her family's survival. The IMRF provides trainees with a stipend to cover family expenses and missed work while they are in class, as well as their lodging and food in Suchitoto where classes are held. An in-country technical advisory committee helped develop the basic curriculum on sexual anatomy and physiology; prenatal, intrapartum, and postpartum care; family planning; sexually transmitted diseases, including AIDS; and an introduction to the subject of domestic violence against women and how to respond. Ten midwives graduated from the first class in Fall 1993, and 14 additional trainees from 14 different communities graduated in Spring 1994. The women are aged 24-63 years, and their level of formal education ranges from none to grade six. The Spring 1994 course was held for one week each in February, March, and
Tanaka, Nao; Horiuchi, Shigeko; Shimpuku, Yoko; Leshabari, Sebalda
Approaches to addressing the shortage of midwives are a great need especially in Sub-Saharan Africa including Tanzania. The midwifery shortage in Tanzania consists of two major causes; the first is the shortage of pre-service nursing training and the second is the low rate of retention as it is difficult to sustain midwives' career motivations. Lack of opportunities for career development, is one of the most related problems to keep midwives motivated. Continuing education as an approach to career development can heighten midwives' motivation and cultivate more skilled midwives who can educate other midwives or students and who could raise the status of midwives. Effective continuing education is ongoing, interactive, contextually relevant and based on needs assessment, however there is very limited research that describes Tanzanian midwives perspective of expectations for career development; hence this research is significant for revealing important and meaningful professional desires of midwives in Tanzania. This was a preliminary qualitative study, using snowball sampling to recruit 16 midwives in Tanzania. The researchers used a semi-structured interview including probing questions with both a focus group and several individuals. The data were collected from July to December 2013 and coded into categories and sub-categories. There were 14 midwives in the focus group interview and two midwives in the individual interviews. Through data analysis, four major categories (with subcategories) emerged: (1) motivation for learning (to achieve the MDGs, and to raise reproductive health), (2) knowledge is power (to provide good practice based on knowledge, to be a role model, knowledge gives higher position and courage, and knowledge enables one to approach to the government), (3) there is no end to learning (hunger for learning, and ripple effect). From findings, four major categories plainly showed midwives' desire for learning, however they experienced a number of
Love, Bev; Sidebotham, Mary; Fenwick, Jennifer; Harvey, Susan; Fairbrother, Greg
As a strategy to promote workforce sustainability a number of midwives working in one health district in New South Wales, Australia were trained to offer a reflective model of clinical supervision. The expectation was that these midwives would then be equipped to facilitate clinical supervision for their colleagues with the organisational aim of supporting professional development and promoting emotional well-being. To identify understanding, uptake, perceptions of impact, and the experiences of midwives accessing clinical supervision. Mixed Methods. In phase one 225 midwives were invited to complete a self-administered survey. Descriptive and inferential statistics were used to analyse the data. In phase two 12 midwives were interviewed. Thematic analysis was used to deepen understanding of midwives' experiences of receiving clinical supervision. Sixty percent of midwives responding in phase one had some experience of clinical supervision. Findings from both phases were complementary with midwives reporting a positive impact on their work, interpersonal skills, situational responses and career goals. Midwives described clinical supervision as a formal, structured and confidential space for 'safe reflection' that was valued as an opportunity for self-care. Barriers included misconceptions, perceived work related pressures and a sense that taking time out was unjustifiable. Education, awareness raising and further research into reflective clinical supervision, to support emotional well-being and professional midwifery practice is needed. In addition, health organisations need to design, implement and evaluate strategies that support the embedding of clinical supervision within midwives' clinical practice. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Nelson, Jenny; Emmott, Christopher J M
Solar power represents a vast resource which could, in principle, meet the world's needs for clean power generation. Recent growth in the use of photovoltaic (PV) technology has demonstrated the potential of solar power to deliver on a large scale. Whilst the dominant PV technology is based on crystalline silicon, a wide variety of alternative PV materials and device concepts have been explored in an attempt to decrease the cost of the photovoltaic electricity. This article explores the potential for such emerging technologies to deliver cost reductions, scalability of manufacture, rapid carbon mitigation and new science in order to accelerate the uptake of solar power technologies.
A study was conducted to measure the extent to which Finnish midwives accept the "mother myth," or the stereotypical beliefs of mothers who idealize motherhood. A set of 45 statements about motherhood was administered to 382 Finnish midwives who were given 30 minutes to read the statements and indicate the extent of their agreement on a…
Bourgeault, Ivy Lynn; Sutherns, Rebecca; Macdonald, Margaret; Luce, Jacquelyne
as the boundaries between public and private spaces become increasingly fluid, interest is growing in exploring how those spaces are used as work environments, how professionals both construct and convey themselves in those spaces, and how the lines dividing spaces traditionally along public and private lines are blurred. This paper draws on literature from critical geography, organisational studies, and feminist sociology to interpret the work experiences of midwives in Ontario, Canada who provide maternity care both in hospitals and in clients' homes. qualitative design involving in-depth semi-structured interviews content coded thematically. Ontario, Canada. community midwives who practice at home and in hospital. the accounts of practicing midwives illustrate the ways in which hospital and home work spaces are sites of both compromise and resistance. With the intention of making birthing women feel more `at home', midwives describe how they attempt to recreate the woman's home in the hospital. Similarly, midwives also reorient women's homes to a certain degree into a more standardised work space for home birth attendance. Many midwives also described how they like `guests' in both settings. there seems to be a conscious or unconscious convergence of midwifery work spaces to accommodate Ontario midwives' unique model of practice. we link these findings of midwives' place of work on their experiences as workers to professional work experiences in both public and private spaces and offer suggestions for further exploration of the concept of professionals as guests in their places of work. Copyright © 2012. Published by Elsevier Ltd.
..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS... nurse-midwives that is accredited by an accrediting body approved by the U.S. Department of Education; and (3) Be certified as a nurse-midwife by the American College of Nurse-Midwives or the American...
Jarosova, Darja; Gurkova, Elena; Palese, Alvisa; Godeas, Gloria; Ziakova, Katarina; Song, Mi Sook; Lee, Jongwon; Cordeiro, Raul; Chan, Sally Wai-Chi; Babiarczyk, Beata; Fras, Malgorzata; Nedvedova, Daniela
To investigate the relationship between turnover intentions and job satisfaction among hospital midwives from seven countries and to determine how the related variables differ between countries. Studies investigating professional turnover and job satisfaction among midwives are limited in scope. A cross-sectional descriptive survey was used to investigate the intended turnover and job satisfaction relationship among 1190 hospital midwives in European and Asian countries. Data were collected using a set of questionnaires that included questions regarding the leaving intentions of midwives and the McCloskey/Mueller satisfaction scale. Midwives were least satisfied with their extrinsic rewards and professional opportunities and with the balance between family and work. Significant differences were found in all domains of job satisfaction according to midwives' intentions to leave their current workplace in hospital or profession of midwife, and to work abroad. There are some general satisfying and dissatisfying elements for the profession of midwife across different countries. The results highlight the importance of understanding midwives' leaving intentions and related factors across different countries. To prevent midwife turnover, health-care managers should gain greater insight into the early stage of midwives' turnover intention. © 2015 John Wiley & Sons Ltd.
Warmelink, J.C.; Hoijtink, K.; Noppers, M.; Wiegers, T.A.; de Cock, T.P.; Klomp, T.; Hutton, E.K.
Objective: the main objectives of our study was to gain an understanding of how primary care midwives in the Netherlands feel about their work and to identify factors associated with primary care midwives' job satisfaction and areas for improvement. Design: a qualitative analysis was used, based on
Warmelink, J.C.; Hoijtink, K.; Noppers, M.; Wiegers, T.A.; Cock, T.P. de; Klomp, T.; Hutton, E.K.
Objective: the main objectives of our study was to gain an understanding of how primary care midwives in the Netherlands feel about their work and to identify factors associated with primary care midwives׳ job satisfaction and areas for improvement. Design: a qualitative analysis was used, based on
Objective: To demonstrate that micro-franchising system is an effective way of improving access to effective health care such as the introduction of first line antimalarias in populations living in underserved rural areas in Kenya. Design: A descriptive study. Setting: Child and family wellness (CFW) micro-franchised nurse run ...
Ahmed, Hamdia M
An episiotomy is one of the most common obstetric surgical procedures and is performed mainly by midwives. The decision to perform an episiotomy depends on related clinical factors. This study aimed to find out midwives' reasons for performing episiotomies and to identify the relationship between these reasons and the demographic characteristics of the midwives. This cross-sectional study was conducted between 1(st) July and 30(th) September 2013 in three governmental maternity teaching hospitals in the three main cities of the Kurdistan Region of Iraq. All of the midwives who had worked in the delivery rooms of these hospitals for at least one year were invited to participate in the study (n = 53). Data were collected through interviews with midwives as well as via a questionnaire constructed for the purpose of the study. The questionnaire sought to determine: midwives' demographic characteristics; type of episiotomy performed; authority of the decision to perform the procedure, and reasons for performing episiotomies. THE MAIN CLINICAL REASONS REPORTED BY MIDWIVES FOR PERFORMING AN EPISIOTOMY WERE: macrosomia/large fetus (38, 71.7%), breech delivery (31, 58.5%), shoulder dystocia (29, 54.7%), anticipated perineal tear (27, 50.9%) and fetal distress (27, 50.9%). There was a significant association between the frequency of these reasons and midwives' total experience in delivery rooms as well as their levels of education. Most of the reasons given by the midwives for performing episiotomies were not evidence-based. Age, years of experience, specialties and level of education also had an effect on midwives' reasons for performing episiotomies.
Infanti, Jennifer J; Lund, Ragnhild; Muzrif, Munas M; Schei, Berit; Wijewardena, Kumudu
Domestic violence in pregnancy is a significant health concern for women around the world. Globally, much has been written about how the health sector can respond effectively and comprehensively to domestic violence during pregnancy via antenatal services. The evidence from low-income settings is, however, limited. Sri Lanka is internationally acknowledged as a model amongst low-income countries for its maternal and child health statistics. Yet, very little research has considered the perspectives and experiences of the key front line health providers for pregnant women in Sri Lanka, public health midwives (PHMs). We address this gap by consulting PHMs about their experiences identifying and responding to pregnant women affected by domestic violence in an underserved area: the tea estate sector of Badulla district. Over two months in late 2014, our interdisciplinary team of social scientists and medical doctors met with 31 estate PHMs for group interviews and a participatory workshop at health clinics across Badulla district. In the paper, we propose a modified livelihoods model to conceptualise the physical, social and symbolic assets, strategies and constraints that simultaneously enable and limit the effectiveness of community-based health care responses to domestic violence. Our findings also highlight conceptual and practical strategies identified by PHMs to ensure improvements in this complex landscape of care. Such strategies include estate-based counselling services; basic training in family counselling and mediation for PHMs; greater surveillance of abusive men's behaviours by male community leaders; and performance evaluation and incentives for work undertaken to respond to domestic violence. The study contributes to international discussions on the meanings, frameworks, and identities constructed at the local levels of health care delivery in the global challenge to end domestic violence. In turn, such knowledge adds to international debates on the roles
Newman, Carol; Rand, John; Tarp, Finn
Much of the literature on industry evolution has found firm dynamics to be an important source of sector-level productivity growth. In this paper, we ask whether the delineation of entry and exit firms matters in assessing the impact of firm turnover. Using detailed firm level data from Vietnam......, it emerges that efficiency differences between sector switchers and exit/entry firms exist. Distinguishing between switchers and firm entry/exit is crucial for understanding the contribution of firm turnover to overall productivity growth. Moreover, we uncover distinct and illuminating firm and sector...
Cooper, Alannah L; Brown, Janie A
It is essential that nurses and midwives can understand and critically evaluate research to ensure the delivery of high-quality evidence-based care. Journal clubs are an educational method that helps to develop research capacity and assist with bridging the gap between research and clinical practice. To maintain competence and remain current with the latest evidence, a commitment to continuing professional education is required. This article describes how a successful journal club led to clinical nurses identifying a gap in their own practice, which resulted in a research project being conducted by the members of the journal club. J Contin Educ Nurs. 2018;49(3):141-144. Copyright 2018, SLACK Incorporated.
Benedita Celeste de Moraes Pinto
Full Text Available Through the oral reporting of memories of the descendants of old “quilombadas”, the present article analyzes the daily practices of midwives, healers and their descendants in the region of Tocantins, in Pará - north of the Amazon. Beside the attendance to childbirth, those women carried out a series of activities related to the processes of cures and manipulation of medicinal plants, as well as tasks for survival, many of them not always considered in other areas and cultures as being compatible with activities of the feminine sex. This article thus contributes to rethinking the importance of the study of daily practices for the knowledge of the different roles played by women and men in gender relations, including forms of domination in a specific society.
Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach. © 2016 by the American College of Nurse-Midwives.
Miles, Maureen; Francis, Karen; Chapman, Ysanne; Taylor, Beverley
Hermeneutic phenomenology has been used widely by researchers to understand lived experiences. This methodology asserts that individual people are as unique as their life stories. The practice of midwifery is underpinned by a philosophy that values women and the uniqueness of their child-bearing journey. The tenets of hermeneutics phenomenology align with those of contemporary midwifery practice, making it a useful research methodology for providing insights into issues relevant to the profession. The purpose of this paper is to unravel some foundational concepts of hermeneutic phenomenology and recommend it as a methodology of choice for midwives to apply to their application to midwifery-in-action. © 2013 Wiley Publishing Asia Pty Ltd.
Valdez-Santiago, Rosario; Arenas-Monreal, Luz; Hernández-Tezoquipa, Isabel
To explore the experiences of midwives in the identification of battered women during pregnancy and to describe the types of violence they identify most easily. A qualitative study was conducted between January and September 2001 among twelve midwives from a group of midwives ascribed to the Instituto Nacional de Antropología e Historia (INAH, National Institute of Anthropology and History), in Morelos, Mexico. Participants were selected from those living in Cuernavaca City and surrounding areas. Study findings show that: a) the identification of battered pregnant women in prenatal care should be triggered by a pattern of behaviors and attitudes of battered women, such as being unkempt, shyness, and above all, poor control over decisions on their health care; b) physical and emotional violence were the most frequently types of violence identified by midwives during prenatal care visits. Sexual violence was more difficult to identify. It is necessary to incorporate midwives in the national plans and programs to prevent domestic violence. Midwives' practices provide opportunities to care for battered women. Specialized training strategies must be directed to midwives caring for pregnant women in Mexico.
Martin, Linda; Gitsels-van der Wal, Janneke T; Pereboom, Monique T R; Spelten, Evelien R; Hutton, Eileen K; van Dulmen, Sandra
This study focuses on facilitation of clients' psychosocial communication during prenatal counseling for fetal anomaly screening. We assessed how psychosocial communication by clients is related to midwives' psychosocial and affective communication, client-directed gaze and counseling duration. During 184 videotaped prenatal counseling consultations with 20 Dutch midwives, verbal psychosocial and affective behavior was measured by the Roter Interaction Analysis System (RIAS). We rated the duration of client-directed gaze. We performed multilevel analyses to assess the relation between clients' psychosocial communication and midwives' psychosocial and affective communication, client-directed gaze and counseling duration. Clients' psychosocial communication was higher if midwives' asked more psychosocial questions and showed more affective behavior (β=0.90; CI: 0.45-1.35; pcommunication was not related to midwives" client-directed gaze. Additionally, psychosocial communication by clients was directly, positively related to the counseling duration (β=0.59; CI: 0.20-099; p=0.004). In contrast with our expectations, midwives' client-directed gaze was not related with psychosocial communication of clients. In addition to asking psychosocial questions, our study shows that midwives' affective behavior and counseling duration is likely to encourage client's psychosocial communication, known to be especially important for facilitating decision-making. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Oscarsson, Marie G; Dahlberg, Annica; Tydén, Tanja
To explore youth clinic midwives role in cervical cancer prevention and their attitude to HPV vaccination. Individual interviews with 13 midwives working at youth clinics in Sweden. The interviews were recorded, transcribed, and analysed by qualitative content analysis. Three themes were identified in the qualitative content analysis: "Cervical cancer prevention not a prioritised area", "Ambivalence to the HPV vaccine", and "Gender and socioeconomic controversies". Few midwives talked spontaneously about cervical cancer prevention. The responsibility for providing information about HPV vaccination was considered as primarily that of school health nurses and parents. Midwives were positive about the HPV vaccination, but recognised certain risks, such as its potential negative impact on cervical cancer screening and increased sexual risk taking. The midwives expressed concerns with medical risks, such as side effects and unknown long-term effects of the HPV vaccine. The midwives in the study had ethical concerns that boys were not included in the program and not all families had the financial resources to vaccinate their children. Thus, weak socioeconomic groups might be excluded. The midwives considered cervical cancer prevention as important, but did not integrate information on the HPV vaccine into their routine work, mainly because young people visiting youth clinics had had their sexual debut and they were concerned about the medical risks and that the vaccine was too expensive. Copyright Â© 2011 Elsevier B.V. All rights reserved.
Bäck, Lena; Hildingsson, Ingegerd; Sjöqvist, Carina; Karlström, Annika
Midwives have a significant impact on the clinical outcome and the birthing experience of women. However, there has been a lack of research focusing specifically on clinical midwives' learning and development of professional competence. The objective of the study was to describe how midwives reflect on learning and the development of professional competence and confidence. A qualitative study based on focus groups with midwives employed in maternity services. Four categories describe the results: (1) Feelings of professional safety evolve over time; (2) Personal qualities affect professional development; (3) Methods for expanding knowledge and competence; and (4) Competence as developing and demanding. The meaning of competence is to feel safe and secure in their professional role. There was a link between the amount of hands-on intrapartum experience and increasing confidence that is, assisting many births made midwives feel confident. Internal rotation was disliked because the midwives felt they had less time to deepen their knowledge and develop competence in a particular field. The midwives felt they were not seen as individuals, and this system made them feel split between different assignments. External factors that contribute to the development of knowledge and competence include the ability to practise hands-on skills in an organisation that is supportive and non-threatening. Internal factors include confidence, self-efficacy, and a curiosity for learning. Midwives working within an organisation should be supported to develop their professional role in order to become knowledgeable, competent and confident. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Sidebotham, Mary; Fenwick, Jennifer; Rath, Susan; Gamble, Jenny
In 2010 Australian Government reform of maternity services enabled midwives to access Medicare. This significant change provides midwives with new opportunities to engage in patterns of working that provide continuity of care to childbearing women. There remains limited evidence, however, on midwives perceptions of how the reforms impact them both personally and professionally. This research examined midwives' perceptions of their role and how, in light of the reform agenda, they might conceptualise a change in working patterns and environment to provide greater levels of continuity of care. A qualitative descriptive approach was employed using the four-stage Appreciative Inquiry model. Twenty-three midwives from three maternity units within south-east Queensland participated in one of six focus groups. Thematic iterative analysis was employed to identify empirical codes and examine relationships within and across the data. Midwives endorsed the reforms and considered the concept of continuity of midwifery care as fundamental to achieving a woman centred maternity system. Most participants, however, found it difficult to conceptualise how they might contribute to any level of system change. In addition the majority passively accepted the status quo of their employing organisation and believed they were powerless to effect change. In order to promote the growth of evidence based continuity of care models midwives need to work to their full scope of practice. Strong midwifery leadership is required to enable midwives to re-conceptualise roles and work patterns and identify how they can engage with and contribute to reform of maternity services. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
As regards the nuclear sector, Ingerop has acquired along the decades extensive experience in designing and calculating complex structures for nuclear facilities. Since 2002, Ingerop focused on more system- and process-oriented projects in this field. Nowadays, Ingerop offers integrated services based on its sound know-how, top-notch expertise and insight into the management of nuclear projects, for both revamping and new build activities. Ingerop has made the development of the energy sector one of its top priorities in particular for the nuclear sector along with NucAdvisor, the first French engineering practice specialising in civil nuclear power. NucAdvisor's main mission is to assist governments or their representatives in developing their nuclear programs offering expertise and consulting services on specific topics like siting, licensing and operation of nuclear power plants, as well as decommissioning and dismantling and radioactive waste management. In January 2016, a new subsidiary has been created - INGEROP Contracting - which provides a global EPC/turnkey offer covering all fields of energy and industry. Its goal is to deliver projects from the design up to the commissioning, while taking a clear commitment on the overall cost and schedule. This brochure presents the Ingerop Company, its offer of services and main fields of intervention, its IT tools for 3D modeling and design, its activities and main references in the nuclear sector
Knezevic, Bojana; Milosevic, Milan; Golubic, Rajna; Belosevic, Ljiljana; Russo, Andrea; Mustajbegovic, Jadranka
to explore the sources and levels of stress at work and work ability among Croatian midwives. midwives are subjected to multiple stressors. Among health-care professionals, psychological distress for a prolonged period of time has negative effects on the worker's health, work ability and quality of patient care. 'Work ability' is a term describing a worker's resources related to physical, mental and social demands at work. As a measure of work ability in midwifery, the Work Ability Index (WAI) is considered to be a very predictive instrument; midwives with a poor WAI score usually leave their current job within five years. university hospitals in Zagreb, Croatia. cross-sectional design survey. 300 health-care workers (105 qualified midwives and 195 paediatric nurses) were invited to complete the questionnaire. The total response rate was 53% (158/300). The sample included 14.7% of all hospital-based midwives in Zagreb hospitals. the Occupational Stress Assessment Questionnaire (OSAQ) for health-care workers and the WAI questionnaire. over three-quarters of the midwives (46/60, 76.7%) believed that their job was stressful, and considered that insufficient work resources caused the most stress. More than half of the midwives associated an insufficient number of coworkers, unexpected situations, inadequate income, night work, incurable patients and poor organisation at work with a high level of stress. The perceived specific stressors differed between midwives and paediatric nurses in the same hospital. Insufficient work resources and poor organisation at work were more common stressors among midwives than paediatric nurses (pworking in their current workplace compared with paediatric nurses (pwork ability. After adjusting for age, the difference in WAI score between the groups of workers was not significant. Croatian midwives experienced work-related stress due to: insufficient work resources, insufficient number of coworkers, poor organisation at work, communication
Lazarus, Jeffrey V; Rull, Kristiina; Wyn Huws, Dyfed
OBJECTIVE: to survey the views of midwives in Estonia about who they considered should have responsibility for carrying out certain aspects of antenatal care (ANC) in Estonia. DESIGN, SETTING AND STUDY POPULATION: in collaboration with key stakeholder organisations, the authors developed eight......, there is no consensus among Estonian midwives that all aspects of ANC should be their responsibility at present. Thorough research is required to establish which specific ANC roles Estonian midwives are not willing to take responsibility for, and to examine why they are not willing to take on such roles....
Lazarus, Jeffrey V; Rasch, Vibeke; Liljestrand, Jerker
were obtained by sending a 32-question questionnaire, based on an agenda developed through semistructured interviews, to all midwives in Estonia. A nominal group technique was employed with key stakeholders to determine the extent of their agreement with the questionnaire's major findings. RESULTS...... satisfaction and salary. The group process revealed that although there is no agreement on the role of family doctors and midwives in antenatal care, there is a general agreement that midwives should be more involved in postpartum care and that their tasks need to be better defined. CONCLUSIONS: Almost half...
Kornelsen, Jude; Dahinten, V Susan; Carty, Elaine
This study describes some of the results of a survey conducted shortly after the introduction of midwives as a regulated and publicly funded provider within the British Columbia health care system. The survey asked hospital-based perinatal nurses about their knowledge and attitudes of midwifery and their experiences with midwives. Results suggest that nurses, for the most part, had a negative view of midwives and their practice and that inattention to the necessary conditions for interprofessional collaboration and positive interprofessional relationships have resulted in parallel practice between the professions instead of interdisciplinary practice.
On Monday 20 February members of the AT Department marked the delivery of the 1000th superconducting dipole magnet to CERN. Only 232 more of the dipole magnets are needed for the LHC. The 35 tonne-dipoles are 15 meters long and are being manufactured by three companies: Babcock Noell Nuclear in Germany (which finished its contract in November 2005), Ansaldo Superconduttori in Italy and Alstom-Jeumont in France. "The production is proceeding well and we expect to be complete in October as previously foreseen," said Lucio Rossi, Head of the Magnets and Superconductors Group (AT-MAS). In total, 1650 main magnets are needed for the LHC, of which 1300 have been delivered.
On Monday 20 February members of the AT Department marked the delivery of the 1000th superconducting dipole magnet to CERN. Only 232 more of the dipole magnets are needed for the LHC. The 35-tonne-dipoles are 15 meters long and are being manufactured by three companies: Babcock Noell Nuclear in Germany (which completed its contract in November 2005), Ansaldo Superconduttori in Italy and Alstom-Jeumont in France. 'The production is proceeding well and we expect to be complete in October as foreseen,' said Lucio Rossi, Head of the Magnets and Superconductors Group (AT-MAS). In total, 1650 main magnets are needed for the LHC, of which 1300 have already been delivered.
Ainul Hayati Daud; Hazmimi Kasim
The industrial sector is categorized as related to among others, the provision of technical and engineering services, supply of products, testing and troubleshooting of parts, systems and industrial plants, quality control and assurance as well as manufacturing and processing. A total of 161 entities comprising 47 public agencies and 114 private companies were selected for the study in this sector. The majority of the public agencies, 87 %, operate in Peninsular Malaysia. The remainders were located in Sabah and Sarawak. The findings of the study on both public agencies and private companies are presented in subsequent sections of this chapter. (author)
Ainul Hayati Daud; Hazmimi Kasim
The applications of nuclear technology in agriculture sector cover the use of the technology at every aspects of agricultural activity, starting from the seed to harvesting as well as the management of plantations itself. In this sector, a total of 55 entities comprising 17 public agencies and 38 private companies were selected for the study. Almost all, 91 % of them are located in Peninsular Malaysia; the rest operates in Sabah and Sarawak. The findings of the study in the public agencies and private companies are presented in the next sections. (author)
Zacher Dixon, Lydia
Mexican midwives have long taken part in a broader Latin American trend to promote "humanized birth" as an alternative to medicalized interventions in hospital obstetrics. As midwives begin to regain authority in reproductive health and work within hospital units, they come to see the issue not as one of mere medicalization but of violence and violation. Based on ethnographic fieldwork with midwives from across Mexico during a time of widespread social violence, my research examines an emergent critique of hospital birth as a site of what is being called violencia obstétrica (obstetric violence). In this critique, women are discussed as victims of explicit abuse by hospital staff and by the broader health care infrastructures. By reframing obstetric practices as violent-as opposed to medicalized-these midwives seek to situate their concerns about women's health care in Mexico within broader regional discussions about violence, gender, and inequality. © 2015 by the American Anthropological Association.
Mullin, Linda; Alcantara, Joel; Barton, Derek; Dever, Lydia
A survey of midwives' knowledge and views about chiropractic. Cross-sectional descriptive survey. An anonymous on-line self-administered survey. United States midwives. Respondent demographics, professional training, personal and professional clinical experience, opinions on safety of chiropractic, and scope of chiropractic practice. A total of 187 midwife respondents completed the questionnaire resulting in a superficial response rate of 2.1%. Responders were certified nurse-midwives and had some form of training regarding chiropractic. The responders were aware that chiropractors worked with "birthing professionals" and attended to patients with both musculoskeletal and non-musculoskeletal disorders. A vast majority indicated a positive personal and professional clinical experience with chiropractic and that chiropractic was safe for pregnant patients and children. There is great awareness of and positive personal and professional experience with chiropractic on the part of midwives who participated in this survey. We encourage further research in this field. Copyright © 2010 Elsevier Ltd. All rights reserved.
Pereboom, M.T.R.; Manniën, J.; Rours, G.I.J.G.; Spelten, E.R.; Hutton, E.K.; Schellevis, F.G.
Background: Chlamydia trachomatis infection in pregnancy may lead to adverse pregnancy outcomes. In the Netherlands, testing for C. trachomatis is based on risk assessment. We assessed midwives' knowledge, test practices, assessment of risk behavior, and attitudes regarding testing for C.
Steen, Sue E
Little research has been published from a global perspective regarding needs of nurses and midwives related to perinatal bereavement. To identify needs and concerns of US and Spanish nurses and midwives who have worked with perinatal death and to identify the bereavement interventions they use to help families with this experience. A cross-sectional study was conducted. Data were collected in 2011 from US (n=44) and Spanish (n=15) nurses and midwives via a questionnaire. Statistically significant differences between the nurses/midwives in each country were found regarding needs relating to knowledge, communication skills and managing personal feelings. Interventions of accompanying, listening, offering keepsakes, baptism discussion, and funeral planning were also found to be significantly different between the two groups. These findings demonstrate a continued need to increase the standard and consistency of perinatal bereavement care worldwide. Bereavement education in nursing curricula and practice settings in both cultures is essential to increase the standard of care.
DeMaria Lisa M
Full Text Available Abstract Background In Mexico 87% of births are attended by physicians. However, the decline in the national maternal mortality rate has been slower than expected. The Mexican Ministry of Health’s 2009 strategy to reduce maternal mortality gives a role to two non-physician models that meet criteria for skilled attendants: obstetric nurses and professional midwives. This study compares and contrasts these two provider types with the medical model, analyzing perspectives on their respective training, scope of practice, and also their perception and/or experiences with integration into the public system as skilled birth attendants. Methodology This paper synthesizes qualitative research that was obtained as a component of the quantitative and qualitative study that evaluated three models of obstetric care: professional midwives (PM, obstetric nurses (ON and general physicians (GP. A total of 27 individual interviews using a semi-structured guide were carried out with PMs, ONs, GPs and specialists. Interviews were transcribed following the principles of grounded theory, codes and categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results All provider types interviewed expressed confidence in their professional training and acknowledge that both professional midwives and obstetric nurses have the necessary skills and knowledge to care for women during normal pregnancy and childbirth. The three types of providers recognize limits to their practice, namely in the area of managing complications. We found differences in how each type of practitioner perceived the concept and process of birth and their role in this process. The barriers to incorporation as a model to attend birth faced by PMs and ONs are at the individual, hospital and system level. GPs question their ability and training to handle deliveries, in particular those that become complicated, and the professional midwifery model particularly as it relates to
Full Text Available Abstract Background There is a shortfall in midwives in Indonesia (an estimated 26 per 100 000 people, which means that the quality of antenatal, perinatal and postnatal care varies widely. One consequence of this is the high rate of maternal and perinatal mortality, which has prompted a number of health initiatives. The current study was part of a review of the existing complex system of midwifery training and the development of a coherent programme of continuing professional development, tighter accreditation regulations and clearer professional roles. Its aims were to identify the occupational profiles and development needs of the participating midwives, and to establish whether any differences existed between grades, geographical location and hospital/community midwives. Methods A psychometrically valid training-needs instrument was administered to 332 midwives from three provinces, covering both hospital and community staff and a range of midwifery grades. The instrument had the capacity to identify occupational roles and education/training needs of the respondents. Results The occupational roles of the midwives varied significantly by province, indicating regional service delivery distinctions, but very little difference in the roles of hospital and community midwives. The most educated midwives attributed more importance to 35 out of the 40 tasks, suggesting an implicit role distinction in terms of level of activity. All midwives reported significant training needs for all 40 tasks. The most-educated midwives recorded training needs for 24 tasks, while the less-educated had training requirements for all tasks, which suggests that new training programmes are effective. Few differences in training needs were revealed between hospital and community midwives Conclusion The results from this survey suggest important regional differences in how the midwife's role is discharged and underline the importance of this sort of research, in order to
Nicholls, Sarah; Hauck, Yvonne L; Bayes, Sarah; Butt, Janice
the option of labouring and/or birthing immersed in warm water has become widely available throughout hospitals in the United Kingdom and Europe over the last two decades. The practice, which also occurs in New Zealand and interstate in Australia, has until recently only been available in Western Australia for women birthing at home with a small publically funded Community Midwifery Program. Despite its popularity and acceptance elsewhere, birth in water has only recently become an option for women attending some public health services in Western Australia. The Clinical Guidelines developed for the local context that support water birth require that the midwives be confident and competent to care for these women. The issue of competency can be addressed with relative ease by maternity care providers; however confidence is rather more difficult to teach, foster and attain. Clinical confidence is an integral element of clinical judgement and promotes patient safety and comfort. For this reason confident midwives are an essential requirement to support the option of water birth in Western Australia. The aim of this study was to capture midwives' perceptions of becoming and being confident in conducting water birth in addition to factors perceived to inhibit and facilitate the development of that confidence. a modified grounded theory methodology with thematic analysis. four public maternity services offering the option of water birth in the Perth metropolitan area. registered midwives employed at one of the four publicly funded maternity services that offered the option of water birth between June 2011 and June 2013. Sixteen midwives were interviewed on a one to one basis. An additional 10 midwives participated in a focus group interview. three main categories emerged from the data analysis: what came before the journey, becoming confident - the journey and staying confident. Each contained between three and five subcategories. Together they depicted how midwives
Floyd, Barbara O'Malley
Midwives for Haiti is an organization that focuses on the education and training of skilled birth attendants in Haiti, a country with a high rate of maternal and infant mortality and where only 26% of births are attended by skilled health workers. Following the 2010 earthquake, Midwives for Haiti received requests to expand services and numerous professional midwives answered the call to volunteer. This author was one of those volunteers. The purpose of the study was: 1) to develop a description of the program's strengths and its deficits in order to determine if there was a need to improve the preparation of volunteers prior to service and 2) to make recommendations aimed at strengthening the volunteers' contributions to the education of Haiti and auxiliary midwives. Three distinct but closely related questionnaires were developed to survey Haitian students, staff midwives, and volunteers who served with Midwives for Haiti. Questions were designed to elicit information about how well the volunteers were prepared for their experience, the effectiveness of translation services, and suggestions for improving the preparation of volunteers and strengthening the education program. Analysis of the surveys of volunteers, staff, midwives, and the Haitian students generated several common themes. The 3 groups agreed that the volunteers made an effective contribution to the program of education and that the volunteer midwives need more preparation prior to serving in Haiti. The 3 groups also agreed on the need for better translators and recommended more structure to the education program. The results of this study are significant to international health care organizations that use volunteer health care professionals to provide services. The results support a growing body of knowledge that international health aid organizations may use to strengthen the preparation, support, and effectiveness of volunteer health providers.
Spidsberg, Bente Dahl; Sørlie, Venke
This paper is a report of a descriptive study of midwives' lived experiences of caring for lesbian women and their partners. A growing body of qualitative studies describes lesbian women's experiences of maternity care. Studies about midwives' caring experiences in the encounter are needed to improve care for lesbian women and their partners. A qualitative study, using a phenomenological-hermeneutical method influenced by Ricoeur was conducted. Eleven midwives were recruited by snowball method. Interviews were conducted in 2009 and participants were encouraged to share events in their midwifery practice encountering lesbian women. The midwives described the lesbian love-relationship as strong and caring, but including elements of difference which could make the couple vulnerable. It was important for midwives to acknowledge their own attitudes and culturally sensitive non-verbal communication; also to consider the co-mother's needs and role as different compared with those of fathers. Although caring for lesbian couples was seen as unproblematic, midwives described experiences of ambivalence or anxiety in the encounter and they had noticed that some couples had had negative experiences with maternity care. Studies are required to map content, consequences and coping strategies regarding the ambivalent or uncertain caring situations and to assess a co-mother's particular role and needs during pregnancy, labour and the postnatal period to provide tailored care for lesbian couples. © 2011 Blackwell Publishing Ltd.
Fereday, Jennifer; Oster, Candice
To explore how a group of midwives achieved a work-life balance working within a caseload model of care with flexible work hours and on-call work. in-depth interviews were conducted and the data were analysed using a data-driven thematic analysis technique. Children, Youth and Women's Health Service (CYWHS) (previously Women's and Children's Hospital), Adelaide, where a midwifery service known as Midwifery Group Practice (MGP) offers a caseload model of care to women within a midwife-managed unit. 17 midwives who were currently working, or had previously worked, in MGP. analysis of the midwives' individual experiences provided insight into how midwives managed the flexible hours and on-call work to achieve a sustainable work-life balance within a caseload model of care. it is important for midwives working in MGP to actively manage the flexibility of their role with time on call. Organisational, team and individual structure influenced how flexibility of hours was managed; however, a period of adjustment was required to achieve this balance. the study findings offer a description of effective, sustainable strategies to manage flexible hours and on-call work that may assist other midwives working in a similar role or considering this type of work setting. Copyright 2008 Elsevier Ltd. All rights reserved.
Cummins, Allison M; Denney-Wilson, E; Homer, C S E
The aim of this paper was to explore the mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia. Most new graduates find employment in hospitals and undertake a new graduate program rotating through different wards. A limited number of new graduate midwives were found to be working in midwifery continuity of care. The new graduate midwives in this study were mentored by more experienced midwives. Mentoring in midwifery has been described as being concerned with confidence building based through a personal relationship. A qualitative descriptive study was undertaken and the data were analysed using continuity of care as a framework. We found having a mentor was important, knowing the mentor made it easier for the new graduate to call their mentor at any time. The new graduate midwives had respect for their mentors and the support helped build their confidence in transitioning from student to midwife. With the expansion of midwifery continuity of care models in Australia mentoring should be provided for transition midwives working in this way. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.
Full Text Available Aim. The aim of this study was to elucidate midwives experiences in providing care and counselling to women with FGM related problems. Setting. The study was conducted at a maternity clinic in Hargeisa, Somaliland. Method. A qualitative, inductive study were performed with eight midwives living in Somaliland. The interviews had semi-structured questions. Content analysis was used for the analysis. Findings. The main findings of the present study were how midwives are challenged by culture and religion when providing FGM counselling. The most prominent challenge is the perception that FGM is an important part of the culture and from this point of view the midwives work is apprehended as interfering and subverting the Somali culture. Having personal experience of FGM emerged as a benefit when counselling women. Conclusion. There is a contradiction between the professional actions of performing FGM despite a personal belief against FGM. Midwives as a professional group could be important agents of change and further research is needed about the midwives role in this process.
Avis, Mark; Mallik, Maggie; Fraser, Diane M
Transition experiences of newly qualified midwives were examined in depth during the third phase of a UK evaluation study of midwifery education. The fitness to practise and the retention of newly qualified nursing and midwifery graduates are pressing concerns for health care managers. The advantages of preceptorship are reported in the literature but the content and timing of schemes remain unclear. A semi-structured diary was kept for up to 6 months by 35 newly qualified midwives in 18 work sites covering all countries in the UK. The preceptor and supervisor of midwives for each newly qualified midwife completed short questionnaires about their preceptee's performance, and a further sub-sample of newly qualified midwives and preceptors participated in a semi-structured interview. Data were analysed to elicit aspects of newly qualified midwives transition experiences. Findings confirm that structured preceptorship schemes are not widely available. Newly qualified midwives primarily obtained transition support from members of the midwifery team. Although perceived as competent, there is no demarcation point in becoming confident to practise as a registered practitioner. Implications for managers include the importance of a supportive culture within clinical teams for successful transition and the introduction of structured preceptorship schemes facilitated by appropriate rotation patterns. © 2012 John Wiley & Sons Ltd.
Hall, Helen G; Griffiths, Debra; McKenna, Lisa G
Many pregnant women use complementary and alternative medicine. Although midwives are often supportive, how they communicate with women about the safe use of these therapies has received limited research attention. The aim of this study was to explore how midwives interact with women regarding use of complementary and alternative medicine during pregnancy. We utilised grounded theory methodology to collect and analyse data. Twenty-five midwives who worked in metropolitan hospitals situated in Melbourne, Australia, participated in the study. Data were collected from semi structured interviews and non-participant observations, over an 18-month period. How midwives communicate about complementary and alternative medicine is closely associated with the meaning they construct around the woman's role in decisionmaking. Most aim to work in a manner consistent with the midwifery partnership model and share the responsibility for decisions regarding complementary and alternative medicine. However, although various therapies were commonly discussed, usually the pregnant woman initiated the dialogue. A number of contextual conditions such as the biomedical discourse, lack of knowledge, language barriers and workplace constraints, limited communication in some situations. Midwives often interact with women interested in using CAM. Most value the woman's autonomy and aim to work in partnership. However, various contextual conditions restrain overt CAM communication in clinical practice. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Holcombe, Sarah Jane; Berhe, Aster; Cherie, Amsale
In 2005, Ethiopia liberalized its abortion law and subsequently authorized midwives to offer abortion services. Using a 2013 survey of 188 midwives and 12 interviews with third-year midwifery students, this cross-sectional research examines midwives' attitudes toward abortion to understand their decisions about service provision. Most midwives were willing to provide abortion services. This willingness was positively and significantly related to clinical experience with abortion, but negatively and significantly related to religiosity, belief that providers have the right to refuse to provide services, and care of patients from periurban as opposed to rural areas. No significant relationship was found with perceptions of abortion stigma, years of work as a midwife, or knowledge of the law. Interview data suggest complex dynamics underlying midwives' willingness to offer services, including conflicts between professional norms and religious beliefs. Findings can inform Ethiopia's efforts to reduce maternal mortality through task-shifting to midwives and can aid other countries that are confronting provider shortages and high levels of maternal mortality and morbidity, particularly due to unsafe abortion. © 2015 The Population Council, Inc.
Anderson, A L; Gilliss, C L
California's health care industry includes workers prepared in many ways to perform many jobs. One significant group of health care workers prepared to provide care that often overlaps with physician-generated services is known as "nonphysician providers." Commonly, this label refers to nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). In this article, we will describe this group in five main areas: (1) the characteristics of the current and projected workforce and programs preparing these professionals; (2) the current skill expectations and knowledge bases of each; (3) trends in the education of these health professionals; (4) innovative models of education of these health professionals; and (5) the inclusion of NPs, PAs, and CNMs in workforce planning in a changing health care system. We conclude that, particularly in light of the overlapping functions of this provider group with many physician functions, the NP, CNM, and NP workforces must be recognized and considered when planning for the future of the physician workforce.
Full Text Available OBJETIVO: Explorar las experiencias de las parteras en la detección de mujeres maltratadas durante el embarazo, además de conocer los tipos de violencia que identifican con mayor facilidad. MATERIAL Y MÉTODOS: Estudio cualitativo en donde se entrevistó, entre enero y septiembre de 2001, a 12 parteras que forman parte del grupo de parteras del Instituto Nacional de Antropología e Historia de Morelos, México. Se hizo una selección de aquellas que se ubicaban en Cuernavaca y sus alrededores. RESULTADOS: Se reporta: a el proceso de identificación de violencia realizado por las parteras en la atención prenatal, el cual se basa en un patrón de conductas y actitudes de las mujeres maltratadas tales como descuido en su persona, timidez y, sobre todo, una falta de control en las decisiones sobre el cuidado a su salud, lo cual permite a las parteras hacer preguntas directas sobre violencia; b las violencias que identifican las parteras con mayor facilidad son la física y la emocional. La violencia sexual fue más difícil para su identificación de manera directa. CONCLUSIONES: Incluir a las parteras dentro de los planes y programas para atender a la violencia intrafamiliar, debido a que su práctica permite una respuesta de apoyo directo a las mujeres maltratadas que lo solicitan. Se propone desarrollar estrategias de capacitación especializada para esta población que atiende a un sector importante de mujeres embarazadas en México.OBJECTIVE: To explore the experiences of midwives in the identification of battered women during pregnancy and to describe the types of violence they identify most easily. MATERIAL AND METHODS: A qualitative study was conducted between January and September 2001 among twelve midwives from a group of midwives ascribed to the Instituto Nacional de Antropología e Historia (INAH, National Institute of Anthropology and History, in Morelos, Mexico. Participants were selected from those living in Cuernavaca City and
To explore community midwives' views and experiences of their support needs in clinical practice, and then to identify how they would wish to receive such support. Further objectives were to redress the imbalance identified by planning and facilitating a model of clinical supervision devised by the participating midwives. A qualitative study using an action-research approach based on collaboration and participation. Action research has the potential to facilitate understanding of, and is able to adapt to, changing situations within clinical practice. Data were collected in three phases using in-depth interviews and focus groups. A large maternity unit in the north of England, UK. Eight National Health Service (NHS) community midwives working in the same team. Recent and ongoing organisational change and increased demands placed on the midwives by their managers were found to be detrimental to the process of clinical supervision and working relationships with their peers and clients. These pressures also inhibited the process of change. The midwives' behaviour and coping strategies revealed an apparent lack of understanding on their part, and that of their midwifery managers, of the regulation of emotion and the amount of energy this generated. Pseudo-cohesion and resistance to change were key defence mechanisms used by the participating midwives. A large amount of published literature supported the existence of stress and burnout in midwifery, but no research addressed ways of alleviating this situation. Effective facilitation of midwifery support is needed, which can be met through support mechanisms such as clinical supervision. During the process of clinical supervision, strong messages emerged about the necessity to ensure that midwives are prepared educationally for the difficult situations that are brought about through collaborative working. There are also messages about the cultural legacy of NHS midwifery and how this can inhibit autonomous behaviour by
Fenwick, Jennifer; Lubomski, Anna; Creedy, Debra K; Sidebotham, Mary
This study aimed to identify personal, professional and workplace factors that contribute to burnout in midwives. Burnout is prevalent in the midwifery workforce. Burnout adversely affects the well-being of midwives, diminishes the quality of care they provide and can shorten career duration. Self-administered online survey. The survey included the Copenhagen Burnout Inventory and personal and professional variables related to age, children, years of experience, role, model of care and satisfaction with work life. Midwives were invited to participate via an email sent from the Australian College of Midwives and through professional networks between June and July 2014. Variables associated with burnout were entered in a multinomial logistic regression. A total of 1,037 responses were received and 990 analysed. The prevalence of moderate to severe personal (N = 643; 64.9%) and work-related burnout (N = 428; 43.8%) were high. Having children, providing caseload midwifery care and working in a regional area were associated with low burnout. However, midwives registered for 5-10 years were more likely to report work and client-related burnout. Similarly, midwives reporting a lack of satisfaction with work-life balance were also more likely to report personal and work-related burnout. Family-friendly work environments that facilitate work-life balance can help to reduce the personal and organizational costs of burnout. Similarly, providing continuity of midwifery care in a caseload model can facilitate work-life balance and provide significant mental health benefits to participating midwives. © 2017 John Wiley & Sons Ltd.
Cummins, Allison M; Denney-Wilson, E; Homer, C S E
midwifery continuity of care has been shown to be beneficial to women through reducing interventions and other maternal and neonatal morbidity. In Australia, numerous government reports recognise the importance of midwifery models of care that provide continuity. Given the benefits, midwives, including new graduate midwives, should have the opportunity to work in these models of care. Historically, new graduates have been required to have a number of years׳ experience before they are able to work in these models of care although a small number have been able to move into these models as new graduates. to explore the experiences of the new graduate midwives who have worked in midwifery continuity of care, in particular, the support they received; and, to establish the facilitators and barriers to the expansion of new graduate positions in midwifery continuity of care models. a qualitative descriptive study was undertaken framed by the concept of continuity of care. the new graduate midwives valued the relationship with the women and with the group of midwives they worked alongside. The ability to develop trusting relationships, consolidate skills and knowledge, be supported by the group and finally feeling prepared to work in midwifery continuity of care from their degree were all sub-themes. All of these factors led to the participants feeling as though they were 'becoming a real midwife'. this is the first study to demonstrate that new graduate midwives value working in midwifery continuity of care - they felt well prepared to work in this way from their degree and were supported by midwives they worked alongside. The participants reported having more confidence to practice when they have a relationship with the woman, as occurs in these models. Copyright © 2015 Elsevier Ltd. All rights reserved.
Giessen, A.M. van der
The space and aeronautics sectors are high-technology sectors and belong to the most innovative sectors in Europe1. Analysis of CIS4 data shows that the space and aeronautics sectors continue to be very innovative. 85% of the firms is engaged in intramural R&D. Total R&D expenditures are between 21%
Otero-Garcia, Laura; Goicolea, Isabel; Gea-Sánchez, Montserrat; Sanz-Barbero, Belen
There insufficient information regarding access and participation of immigrant women in Spain in sexual and reproductive health programs. Recent studies show their lower participation rate in gynecological cancer screening programs; however, little is known about the participation in other sexual and reproductive health programs by immigrant women living in rural areas with high population dispersion. The objective of this study is to explore the perceptions of midwives who provide these services regarding immigrant women's access and participation in sexual and reproductive health programs offered in a rural area. A qualitative study was performed, within a larger ethnographic study about rural primary care, with data collection based on in-depth interviews and field notes. Participants were the midwives in primary care serving 13 rural basic health zones (BHZ) of Segovia, a region of Spain with high population dispersion. An interview script was designed to collect information about midwives' perceptions on immigrant women's access to and use of the healthcare services that they provide. Interviews were recorded and transcribed with participant informed consent. Data were analyzed based on the qualitative content analysis approach and triangulation of results with fieldwork notes. Midwives perceive that immigrants in general, and immigrant women in particular, underuse family planning services. This underutilization is associated with cultural differences and gender inequality. They also believe that the number of voluntary pregnancy interruptions among immigrant women is elevated and identify childbearing and childrearing-related tasks and the language barrier as obstacles to immigrant women accessing the available prenatal and postnatal healthcare services. Immigrant women's underutilization of midwifery services may be linked to the greater number of unintended pregnancies, pregnancy terminations, and the delay in the first prenatal visit, as discerned by
Gentry, Lonnie; Cox, Thomas R.
When physicians lack proper training, breaking bad news can lead to negative consequences for patients, families, and physicians. A questionnaire was used to determine whether a didactic program on delivering bad news was needed at our institution. Results revealed that 91% of respondents perceived delivering bad news as a very important skill, but only 40% felt they had the training to effectively deliver such news. We provide a brief review of different approaches to delivering bad news and advocate for training physicians in a comprehensive, structured model. PMID:26722188
Rambu Ngana, Frederika; Myers, Bronwyn A; Belton, Suzanne
to describe the system of health reporting by village midwives and two rural clinics in eastern Indonesia and solve some of the problems in this system through consultation. participatory action research model where problems are identified by those most affected and solutions sought. Clinic staff were observed and interviewed regarding their work roles and reporting duties. Allocation of work time to various tasks was recorded by all clinic staff before and after the implementation of a new health recording system. Several information sessions and focus group discussions were held with village midwives and other health staff to identify and address problems. Indonesia initiated a programme in 1989, aiming to place a midwife in every village, in response to high maternal mortality rates and low rates of births attended by trained birth assistants. Remote rural villages in eastern Indonesia have difficulty recruiting and retaining village midwives. These midwives play a crucial role in health reporting. During 2010 a new system of recording and reporting by clinics was implemented. village and clinic health staff in two rural subdistricts in eastern Indonesia. there was incomplete coverage by village midwives in the two subdistricts studied; 28% of villages had a resident midwife, 48% had a visiting midwife and 24% had only monthly visits by a mobile clinic. Village midwives performed duties additional to their official duties and training. Village midwives had problems associated with the reporting system including inconsistency in reporting, poor access to individual patient histories and poor access to clinics. These problems resulted in incompleteness and poor timeliness of data transfer. midwives in remote villages felt compelled to provide services for which they were not trained. Poor quality of data reporting resulted from inconsistent reporting methods. Local staff can successfully change and manage reporting systems if given appropriate support and training
Jepsen, Ingrid; Mark, Edith; Nøhr, Ellen Aagaard; Foureur, Maralyn; Sørensen, Erik Elgaard
the aim of this study is to advance knowledge about the working and living conditions of midwives in caseload midwifery and how this model of care is embedded in a standard maternity unit. This led to two research questions: 1) What constitutes caseload midwifery from the perspectives of the midwives? 2) How do midwives experience working in caseload midwifery? phenomenology of practice was the analytical approach to this qualitative study of caseload midwifery in Northern Denmark. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. thirteen midwives working in caseloads were observed during one or two days in the antenatal clinic and were interviewed at a later occasion. being recognised and the feeling of doing high quality care generate high job satisfaction. The obligation and pressure to perform well and the disadvantages to the midwives׳ personal lives are counterbalanced by the feeling of doing a meaningful and important job. Working in caseload midwifery creates a feeling of working in a self-governing model within the public hospital, without losing the technological benefits of a modern birth unit. Midwives in caseload midwifery worked on welcoming and including all pregnant women allocated to their care; even women/families where relationships with the midwives were challenging were recognised and respected. caseload midwifery is a work-form with an embedded and inevitable commitment and obligation that brings forward the midwife׳s desire to do her utmost and in return receive appreciation, social recognition and a meaningful job with great job satisfaction. There is a balance between the advantages of a meaningful job and the disadvantages for the personal life of the midwife, but benefits were found to outweigh disadvantages. In expanding caseload midwifery, it is necessary to understand that the midwives׳ personal lives need to be prepared for this work-form. The number of women per full
Igarashi, Toshiko; Wakita, Mariko; Miyazaki, Kikuko; Nakayama, Takeo
midwifery homes (similar to birth centres) are rich in midwifery wisdom and skills that differ from those in hospital obstetrical departments, and a certain percentage of pregnant women prefer birth in these settings. This study aimed to understand the organisation of the perinatal environment considered important by independent midwives in non-hospital settings and to clarify the processes involved. semi-structured qualitative interview study and constant comparative analysis. 14 independent midwives assisting at births in midwifery homes in Japan, and six independent midwives assisting at home births. Osaka, Kyoto, Nara, and Shiga, Japan. midwives assisting at non-hospital births organised the birth environment based on the following four categories: 'an environment where the mother and family are autonomous'; 'a physical environment that facilitates birth'; 'an environment that facilitates the movement of the mother for birth'; and 'scrupulous safety preparation'. These, along with their sub-categories, are presented in this paper. independent midwives considered it important to create a candid relationship between the midwife and the woman/family from the period of pregnancy to facilitate birth in which the woman and her family were autonomous. They also organised a distinctive environment for non-hospital birth, with preparations to guarantee safety. Experiential knowledge and skills played a major part in creating an environment to facilitate birth, and the effectiveness of this needs to be investigated objectively in future research. Copyright © 2014 Elsevier Ltd. All rights reserved.
Embo, M; Valcke, M
Midwifery education plays an important role in educating graduates about engaging in continuous professional development (CPD) but there is a lack of empirical research analysing student midwives' awareness of CPD beyond graduation. We aimed to explore student midwives' awareness of the need to become lifelong learners and to map their knowledge of CPD activities available after graduation. Therefore, forty-seven reflective documents, written in the last week of student midwives' training programme, were analysed in a thematic way. Content analysis confirmed student midwives' awareness of the importance of CPD before graduation. They mentioned different reasons for future involvement in CPD and described both, formal and informal CPD-activities. Respondents were especially aware of the importance of knowledge, to a lesser degree of skills-training and still less of the potential value of the Internet for individual and collective learning. Respondents perceived a need for a mandatory preceptorship. Supporting learning guides were highly valued and the importance of reflection on CPD was well-established. This could have resulted from an integrated reflective learning strategy during education. Undergraduate midwives are aware of the importance of CPD and the interplay of formal and informal learning activities. Virtual learning requires special attention to overcome CPD challenges. Copyright © 2015 Elsevier Ltd. All rights reserved.
Mauri, Paola Agnese; Ceriotti, Elisabetta; Soldi, Marta; Guerrini Contini, Norma Nilde
In this phenomenological-hermeneutic study, we explored how midwives perceive the burden of care, while assisting termination of pregnancy after 16 weeks' gestation. Between February and April 2013, 17 Italian midwives from three different units were interviewed. Data were collected using semistructured interviews. Four themes emerged from the interviews: influences, supports, empathy, and emotions. At the end of the study, researchers observed that midwives assert conscientious objection to the termination of pregnancy, which does not influence their experiences and memories. The midwives felt that it was important to share experiences with colleagues, discussing cases together and with the rest of the team. The midwives also suggested some strategies to improve this type of care: organize shifts in a way that could lead to improved and personalized care for women, continuous development, involvement of relatives, and special measures for these women's rooms. Moreover, they considered help from other professionals as fundamental in order to manage the clinical and emotional complexities related to these terminations. © 2014 Wiley Publishing Asia Pty Ltd.
Byrom, Sheena; Downe, Soo
to explore midwives' accounts of the characteristics of 'good' leadership and 'good' midwifery. a phenomenological interview survey. Participants were asked about what made both good and poor midwives and leaders. two maternity departments within National Health Service trusts in the North West of England. qualified midwives, selected by random sampling stratified to encompass senior and junior grades. thematic analysis, carried out manually. ten midwives were interviewed. Sixteen codes and six sub-themes were generated. Across the responses, two clear dimensions (themes) were identified, relating on the one hand to aspects of knowledge, skill and competence (termed 'skilled competence'), and on the other hand to specific personality characteristics (termed 'emotional intelligence'). This study suggests that the ability to act knowledgeably, safely and competently was seen as a basic requirement for both clinical midwives and midwife leaders. The added element which made both the midwife and the leader 'good' was the extent of their emotional capability. this small-scale in-depth study could form the basis for hypothesis generation for larger scale work in this area in future. The findings offer some reinforcement for the potential applicability of theories of transformational leadership to midwifery management and practice. Copyright 2008 Elsevier Ltd. All rights reserved.
Lau, Rosalind; McCauley, Kay; Barnfield, Jakqui; Moss, Cheryle; Cross, Wendy
Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses (MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross-sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives (n = 95) and MCHN (n = 86) from south-eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals. © 2015 Australian College of Mental Health Nurses Inc.
Forty-one per cent of the women who prefer to give birth at home do so because at home they receive African 'muti' and an abdominal massage; 22,5% deliver at home because they feel it is safer and more convenient. Most African women and commnunities are reluctant to entrust the sluicing oftheir placenta and other ...
Callaway, J.M.; Fenhann, J.; Gorham, R.; Makundi, W.; Sathaye, J.
This publication contains five papers that were written as a part of the GEF project, The Economics of Greenhouse Gas Limitations. The main goal of the project was to assess the greenhouse gas reductions and incremental costs of mitigation option sin Ecuador, Argentina, Senegal, Mauritius, Vietnam, Indonesia, Estonia and Hungary. In addition, regional studies were conducted for the Andean Pact nations and Southern Africa to assess various aspects of regional co-operation in reducing greenhouse gas emissions. The GEF study also involved the development of a methodological framework for climate change assessment, with a special emphasis on developing countries. These guidelines have been published in a separate document, Economics of Greenhouse Gas Limitations: Methodological Guidelines. The papers in this publication focus on various methodological and policy aspects of greenhouse gas mitigation at the sectoral level, and are outgrowth of work performed on other parts of the GEF project. (au)
Wilson-Liverman, Angela; Slager, Joan; Wage, Deborah
Certified nurse-midwives are teaching obstetrics and gynecology residents and medical students in major academic institutions across the United States. In these instances, the ability to appropriately document services rendered to support a billable service is paramount. This article explains the difference in requirements for midwives' documentation when working with residents compared with documentation required of an attending obstetrician-gynecologist. It also reviews the teaching physician guidelines developed by the Centers for Medicare and Medicaid Services (CMS) as well as current evaluation and management documentation requirements. Several examples of documentation are provided, as are suggestions for enhancement and simplification of the guidelines to include midwives. An important point to remember is that the CMS rules do not prohibit a certified nurse-midwife from teaching a resident.
Kassab, Manal; Alnuaimi, Karimeh; Mohammad, Khitam; Creedy, Debra; Hamadneh, Shereen
Newborns who are compromised at birth require rapid attention to stabilize their respiration attempts. Lack of knowledge regarding basic newborn resuscitation is a contributing factor to poor newborn health outcomes and increased mortality. The purpose of this study was to explore Jordanian midwives' experiences, education, and support needs to competently perform basic newborn resuscitation. Qualitative descriptive methodology was used to analyze a convenience sample of 20 midwives. A thematic approach was used to analyze the data. Participants discussed their experiences of basic newborn resuscitation including knowledge, skills, and barriers and suggested solutions to improve practice. Four themes were revealed: lack of knowledge and skills in newborn resuscitation, organizational constraints, inadequate teamwork, and educational needs. The midwives perceived that their ability to perform newborn resuscitation was hindered by lack of knowledge and skills in newborn resuscitation, organizational constraints (such as lack of equipment), and poor co-ordination and communication among team members. © The Author(s) 2015.
Purohit, Bhaskar; Vasava, Paul
Understanding Role Stress is important as health service providers, especially nurses experience high levels of Role Stress which is linked to burnout, poor quality of care and high turnover. The current study explicates the concept of Role Stress and assesses the Role Stress experienced by the Auxiliary Nurse Midwives (ANMs) working with rural government health centres from Gujarat, India. The study included 84 ANMs working with government health centres from one district in India. A structured instrument with established reliability and validity was used to measure 10 dimensions of Role Stress namely: Inter-role distance, role stagnation, role expectation conflict, role erosion: role overload, role isolation, personal inadequacy, self-role distance, role ambiguity and resource inadequacy. The study instrument was based on 5 point Likert rating scale that contained 50 unidirectional negative statements, 5 for each dimension. Kolmogorov-Smirnov and Shapiro-Wilk test were carried out to assess if the data were normally distributed. Cronbach's alpha test was carried out to assess reliability of the instrument. The study data was analyzed using descriptive statistics mainly using mean scores with higher scores indicating higher Role Stress and vice versa. The data was analyzed using SPSS version 19. Kolmogorov-Smirnov and Shapiro-Wilk test indicated that the data were normally distributed. Cronbach's alpha test indicated values of 0.852 suggesting high reliability of the tool. The highest Role Stress among ANMs was experienced for resource inadequacy. Role overload, role stagnation and inter-role distance were among the other important role stressors for ANMs. The study results suggests that ANMs frequently feel that: they do not have adequate amount of resources, facilities and financial support from the high levels authorities; people have too many expectations from their roles and as result they are overloaded with work and have very limited opportunities for
Binfa, Lorena; Pantoja, Loreto; Gonzalez, Hilda; Ransjö-Arvidson, Anna-Berit; Robertson, Eva
to determine Chilean midwives' views with regard to Chilean women's health-care needs in midlife. The aim was also to explore Chilean midwifery students' views on the clinical care provided to women in midlife. a qualitative study using focus group discussions and narratives which were analysed using thematic manifest and latent content analysis. 10 different primary health care (PHC) centres in Santiago, Chile. 22 midwives, working in PHC clinics and 13 (n = 13) midwifery students with PHC clinical experience, attending their fourth or fifth year of midwifery education at the School of Midwifery in Santiago. the midwives felt that women in midlife have special health-care service needs. They also considered themselves to be the most appropriate health staff to provide health care for women in midlife, but recognised that they lacked competence in attending psychological and social health-care needs of women in midlife such as violence, abuse and sexuality issues. The midwifery students remarked that many midwives focused their attention on fulfilling the biomedical requirements. Even if the midwives had knowledge about recent research on menopause, they had difficulties in approaching this issue and including it in their counselling. Some students also questioned the sometimes disrespectful attitude shown, especially towards Peruvian immigrants and women with psychosocial problems. the findings suggest that midwives need more education about women's health-care needs in midlife, and that more focus should be placed on the psychosocial aspects of midwifery. More reflections about the quality of the client-provider relationship in clinical practice are needed. Gender issues, the structure of power relationships, and empowerment should be incorporated and critically discussed during midwifery education and training, and also in clinics. Copyright © 2010 Elsevier Ltd. All rights reserved.
Psaila, Kim; Schmied, Virginia; Fowler, Cathrine; Kruske, Sue
To examine collaboration in the provision of universal health services for children and families in Australia from the perspective of midwives and child health and family health nurses. Collaboration is identified as a key concept contributing to families' smooth transition between maternity and child health services. However, evidence suggests that collaboration between services is often lacking. Few studies have explored how maternity and child health and family health services or professionals collaborate to facilitate a smooth transition. This study reports on data collected in phases 1 and 2 of a three-phase mixed-methods study investigating the feasibility of implementing a national approach to child health and family health services in Australia (Child Health: Researching Universal Services study). In phase 1, consultations (via discussion groups, focus groups and teleconferences) were held with 45 midwives and 60 child health and family health nurses. Themes identified were used to develop phase 2 surveys. In phase 2, 1098 child health and family health nurses and 655 midwives returned surveys. Midwives and child health and family health nurses reported 'some collaboration'. Midwives and child health and family health nurses indicated that collaboration was supported by having agreement on common goals and recognising and valuing the contributions of others. Organisational barriers such as poor communication and information transfer processes obstructed relationships. Good collaboration was reported more frequently when working with other professionals (such as allied health professionals) to support families with complex needs. This study provides information on the nature and extent of collaboration from the perspective of midwives and child health and family health nurses providing universal health services for children and families. Both professional groups emphasised the impact of service disconnection on families. However, their ability to negotiate
Ethelwynn L. Stellenberg
Full Text Available Background: Many factors or medical conditions may influence the outcome of pregnancy,which in turn, may increase infant and maternal morbidity and mortality. One such condition is an increase in blood pressure (BP. Setting: The study was conducted in maternity obstetrical units (MOUs in primary healthcare clinics (PHCs in the Eastern Cape, South Africa. Objectives: To determine the knowledge about hypertensive disorders during pregnancy (HDPs of registered midwives working in MOUs in PHCs. Methods: A quantitative descriptive correlation research design was applied. A simple random sample of 43 (44% rural and urban clinics was selected, and all registered midwives (n = 101 working in these clinics completed a self-administered questionnaire. Data were collected over a period of 1 month. The reliability and validity of the methodology were supported by experts and a pilot study. Descriptive statistics including various statistical tests to determine any associations between variables using a 95% confidence interval were applied. Results: A gap in the knowledge of midwives about HDPs was identified. Only 56.4% of the participants correctly answered the questions on the clinical manifestations of severe pre-eclampsia and 68.3% on the factors affecting BP, whereas 27.7% had no understanding about pre-eclampsia. Significant statistical differences were identified in the knowledge of staff in clinics where doctors visit regularly versus those in clinics where there are no visits (p = 0.04, and between experience of midwives and management of HDPs (p = 0.02. Conclusion: The knowledge of midwives is deficient regarding HDPs. Continuous professional development is critical in midwifery both in theory and in clinical practice. Keywords: Midwives; Hypertension; Eclampsia; Pre-eclampsia; Pregnancy
Halkoaho, Arja; Kirsi Vähäkangas; Häggman-Laitila, Arja; Pietilä, Anna-Maija
Little is known regarding the role of the midwife in recruiting mothers to participate in scientific research. To describe ethical aspects of participation of midwives in placental perfusion studies. Qualitative study involving thematic interviews and thematic content analysis. Two university hospitals in Finland in 2008-2009. Midwives (n=20) who had been involved in recruiting mothers for a placental perfusion study. Midwives felt that the situation, when inviting the mothers to donate their placentas, was restless and hasty because of the considerable number of tasks required during a birth. For recruitment, they explained how they tried their best to find a quiet opportunity to provide information about the placental perfusion study, so that the mother could take her time reading the written information. During a birth, it was difficult to give information to the mother in such a way that she would truly understand. Information for the mother was planned to be provided in an equal, dialogic conversation, with the subject of research introduced by the midwife. Placental perfusion studies as carried out in this setting were not seen to have any risks for the mothers, and midwives were under less strain in this study than in other medical research projects. The midwives considered it normal to use placentas in scientific research, and did not see any associated ethical problems. In their opinion, the use of placentas was acceptable and even desirable, provided that the mother was informed about the research and gave voluntary informed consent. Recruitment must be taken into account in management of the ward, and should be planned so that no recruitment is undertaken during medical procedures. Midwives need more education about the research including the important aspects of the creation of general knowledge about substances which may harm the fetus. Dialogue is needed between the mother and the midwife to ensure genuine informed consent. Copyright © 2011 Elsevier
Hatice Yildirim Sari
Full Text Available AIM/BACKGROUND: The purpose of this research is to determine the knowledge of nurses and midwives who are working at primary health care services. METHODS: The information regarding the research has been given to the nurses and midwives working at primary health centers of Manisa, and 70 nurses and midwives have accepted to attend the research. In collecting the data, two questionnaire forms prepared by the researchers have been used and these forms are composed of two parts. In the first part of the questionnaire, there are questions about the sociodemografhic characteristics of midwives and nurses; in the second one the questions are related to the symptoms and causes of mental-handicap and the attempts regarding the mentally-handicapped child and his family. RESULTS: The nurses and midwives have stated that the most important cause of mental handicap is marriages among relatives (92.9%. and that in a situation of not being able to fullfill mental motor skills in relation to age, they suspect mental handicap (90%. They have also stated that they mostly have or can have difficulty in communucating with the mentally-handicapped child (64%. CONCLUSION: As a result, the nurses and midwives have adequate knowledge about the causes and symptoms of mental handicap. On the other hand, their knowledge regarding the services to be planned in care of mentally-handicapped children is limited. At the primary health care services, educational studies can be planned in order to give better health service for mentally-handicapped individuals. [TAF Prev Med Bull 2008; 7(2.000: 127-132
Ethelwynn L. Stellenberg
Full Text Available Background: Many factors or medical conditions may influence the outcome of pregnancy,which in turn, may increase infant and maternal morbidity and mortality. One such condition is an increase in blood pressure (BP.Setting: The study was conducted in maternity obstetrical units (MOUs in primary healthcare clinics (PHCs in the Eastern Cape, South Africa.Objectives: To determine the knowledge about hypertensive disorders during pregnancy (HDPs of registered midwives working in MOUs in PHCs.Methods: A quantitative descriptive correlation research design was applied. A simple random sample of 43 (44% rural and urban clinics was selected, and all registered midwives (n = 101 working in these clinics completed a self-administered questionnaire. Data were collected over a period of 1 month. The reliability and validity of the methodology were supported by experts and a pilot study. Descriptive statistics including various statistical tests to determine any associations between variables using a 95% confidence interval were applied.Results: A gap in the knowledge of midwives about HDPs was identified. Only 56.4% of the participants correctly answered the questions on the clinical manifestations of severe pre-eclampsia and 68.3% on the factors affecting BP, whereas 27.7% had no understanding about pre-eclampsia. Significant statistical differences were identified in the knowledge of staff in clinics where doctors visit regularly versus those in clinics where there are no visits (p = 0.04, and between experience of midwives and management of HDPs (p = 0.02.Conclusion: The knowledge of midwives is deficient regarding HDPs. Continuous professional development is critical in midwifery both in theory and in clinical practice.Keywords: Midwives; Hypertension; Eclampsia; Pre-eclampsia; Pregnancy
Ross, Linda; van Leeuwen, René; Baldacchino, Donia; Giske, Tove; McSherry, Wilfred; Narayanasamy, Aru; Downes, Carmel; Jarvis, Paul; Schep-Akkerman, Annemiek
Spiritual care is expected of nurses, but it is not clear how undergraduates can achieve competency in spiritual care at point of registration as required by nursing/midwifery regulatory bodies. To describe undergraduate nurses'/midwives' perceptions of spirituality/spiritual care, their perceived competence in delivering spiritual care, and to test out the proposed method and suitability of measures for a larger multinational follow-on study. Cross-sectional, multinational, descriptive survey design. Author administered questionnaires were completed by 86% of the intended convenience sample of 618 undergraduate nurses/midwives from 6 universities in 4 European countries in 2010. Students held a broad view of spirituality/spiritual care and considered themselves to be marginally more competent than not in spiritual care. They were predominantly Christian and reported high levels of spiritual wellbeing and spiritual attitude and involvement. The proposed method and measures were appropriate and are being used in a follow-on study. The following are worthy of further investigation: whether the pilot study findings hold in student samples from more diverse cultural backgrounds; whether students' perceptions of spirituality can be broadened to include the full range of spiritual needs patients may encounter and whether their competence can be enhanced by education to better equip them to deliver spiritual care; identification of factors contributing to acquisition of spiritual caring skills and spiritual care competency. © 2013.
Cummins, Allison M; Catling, Christine; Homer, Caroline S E
High-level evidence demonstrates midwifery continuity of care is beneficial for women and babies. Women have limited access to midwifery continuity of care models in Australia. One of the factors limiting women's access is recruiting enough midwives to work in continuity. Our research found that newly graduated midwives felt well prepared to work in midwifery led continuity of care models, were well supported to work in the models and the main driver to employing them was a need to staff the models. However limited opportunities exist for new graduate midwives to work in midwifery continuity of care. The aim of this paper therefore is to describe a conceptual model developed to enable new graduate midwives to work in midwifery continuity of care models. The findings from a qualitative study were synthesised with the existing literature to develop a conceptual model that enables new graduate midwives to work in midwifery continuity of care. The model contains the essential elements to enable new graduate midwives to work in midwifery continuity of care models. Each of the essential elements discussed are to assist midwifery managers, educators and new graduates to facilitate the organisational changes required to accommodate new graduates. The conceptual model is useful to show maternity services how to enable new graduate midwives to work in midwifery continuity of care models. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Christensen, Anne Vinggaard; Hjøllund Christiansen, Anne; Petersson, Birgit
and is influenced by a growing personalisation of the aborted foetus. The midwives strongly supported women’s legal right to choose termination of pregnancy and considerations about the foetus’ right to live were suppressed. Midwives experienced a dilemma when faced with aborted foetuses that looked like newborns...... ethical status of the foetus and the emotional reactions of the women/couples going through late termination of pregnancy. Other professions as well as structural factors at the hospital highly influenced the midwives’ ability to organize their work with late terminations. There is a need for more...
Background The village midwife is a central element of Indonesia's strategy to improve maternal and child health and family planning services. Recently there has been concern that the midwives were not present in the villages to which they had been assigned. To determine the extent to which this was the case we conducted a field-based census and survey of village midwives in three districts in West Java Province, Indonesia. Findings In June 2009 we interviewed a random sample of village midwives from three districts - Ciamis, Garut and Sukabumi - in West Java Province. Trained interviewers visited all villages represented in the sample to interview the midwives. We also obtained information about the midwives and their professional activities in the last year. Thirty percent of village midwives had moved to another location in the 12 months between the end of 2008, when the sampling frame was constructed, and December 2009 when the survey was conducted; most had moved to a government health center or another village. Of those who were present, there was considerable variation between districts in age distribution and qualifications. The total number of services provided was modest, also with considerable variation between districts. The median number of deliveries assisted in the last year was 64; the amount and mix of family planning services provided varied between districts and were dominated by temporary methods. Conclusions Compared to an earlier survey in an adjacent province, the village midwives in these three districts were younger, had spent less time in the village and a higher proportion were permanent civil servants. A high proportion had moved in the previous year with most moving to a health center or another village. The decision to move, as well as the mix of services offered, seems to be largely driven by opportunities to increase their private practice income. These opportunities are greater in urban areas. As urbanization procedes the forces
Warmelink, J Catja; Hoijtink, Kirsten; Noppers, Marloes; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K
the main objectives of our study was to gain an understanding of how primary care midwives in the Netherlands feel about their work and to identify factors associated with primary care midwives׳ job satisfaction and areas for improvement. a qualitative analysis was used, based on the constructivist/interpretative paradigm. Three open-ended questions in written or online questionnaire, analysed to identify factors that are linked with job satisfaction, were as follows: 'What are you very satisfied with, in your work as a midwife?', 'What would you most like to change about your work as a midwife?' and 'What could be improved in your work?'. 20 of the 519 primary care practices in the Netherlands in May 2010 were included. at these participating practices 99 of 108 midwives returned a written or online questionnaire. in general, most of the participating primary care midwives were satisfied with their job. The factors positively associated with their job satisfaction were their direct contact with clients, the supportive co-operation and teamwork with immediate colleagues, the organisation of and innovation within their practice group and the independence, autonomy, freedom, variety and opportunities that they experienced in their work. Regarding improvements, the midwives desired a reduction in non-client-related activities, such as paperwork and meetings. They wanted a lower level of work pressure, and a reduced case-load in order to have more time to devote to individual clients׳ needs. Participants identified that co-operation with other partners in the health care system could also be improved. our knowledge, our study is the first explorative study on factors associated with job satisfaction of primary care midwives. While there are several studies on job satisfaction in health care; little is known about the working conditions of midwives in primary care settings. Although the participating primary care midwives in the Netherlands were satisfied with their
Christensen, Anne Vinggaard; Hjøllund Christiansen, Anne; Petersson, Birgit
and is influenced by a growing personalisation of the aborted foetus. The midwives strongly supported women’s legal right to choose termination of pregnancy and considerations about the foetus’ right to live were suppressed. Midwives experienced a dilemma when faced with aborted foetuses that looked like newborns...... and when aborted foetuses showed signs of life after a termination. Furthermore, they were critical of how physicians counsel women/couples after prenatal diagnosis. Conclusions: The midwives’ practice in relation to late termination of pregnancy was characterised by an acknowledgement of the growing...
Gualda, Dulce Maria Rosa; Narchi, Nádia Zanon; de Campos, Edemilson Antunes
This article describes Brazilian midwives' struggle to establish their professional field in the arena of maternal and child health in Brazil. Despite the obstacles, midwives continue trying to claim their social space, seeking to maintain and strengthen the profession, and legislative aspects of practice and regulation of their profession. They seek space in the job market, support from entities of civil society, representatives of judicial and political power, and from the movements organised for improvement and change in the birth care model in Brazil. © 2013 Elsevier Ltd. All rights reserved.
Vélez, Olivia; Okyere, Portia Boakye; Kanter, Andrew S; Bakken, Suzanne
Midwives in rural Ghana work at the frontline of the health care system, where they have access to essential data about the patient population. However, current methods of data capture, primarily pen and paper, make the data neither accessible nor usable for monitoring patient care or program evaluation. Electronic health (eHealth) systems present a potential mechanism for enhancing the roles of midwives by providing tools for collecting, exchanging, and viewing patient data as well as offering midwives the possibility for receiving information and decision support. Introducing such technology in low-resource settings has been challenging because of low levels of user acceptance, software design that does not match the end-user environment, and/or unforeseen challenges such as irregular power availability. These challenges are often attributable to a lack of understanding by the software developers of the end users' needs and work environment. A mobile health (mHealth) application known as mClinic was designed to support midwife access to the Millennium Village-Global Network, an eHealth delivery platform that captures data for managing patient care as well as program evaluation and monitoring, decision making, and management. We conducted a descriptive usability study composed of 3 phases to evaluate an mClinic prototype: 1) hybrid lab-live software evaluation of mClinic to identify usability issues; 2) completion of a usability questionnaire; and 3) interviews that included low-fidelity prototyping of new functionality proposed by midwives. The heuristic evaluation identified usability problems related to 4 of 8 usability categories. Analysis of usability questionnaire data indicated that the midwives perceived mClinic as useful but were more neutral about the ease of use. Analysis of midwives' reactions to low-fidelity prototypes during the interview process supported the applicability of mClinic to midwives' work and identified the need for additional
Jeffery, Justine; Hewison, Alistair; Goodwin, Laura; Kenyon, Sara
For the past decade, Maternal Mortality Reports, published in the United Kingdom every three years, have consistently raised concerns about maternal observations in maternity care. The reports identify that observations are not being done, not being completed fully, are not recorded on Early Warning Score systems, and/or are not escalated appropriately. This has resulted in delays in referral, intervention and increases the risk of maternal morbidity or mortality. However there has been little exploration of the possible reasons for non-completion of maternal observations. The aim of this study was to explore midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings in the West Midlands of England. A qualitative design involving a series of six focus groups with midwives and Supervisors of Midwives was employed to investigate the facilitators of, and barriers to the completion of maternal observations. Eighteen Midwives and 8 Supervisors of Midwives participated in a total of 6 focus groups. Three key themes emerged from the data: (1) Organisation of Maternal Observations (including delegation of tasks to Midwifery Support Workers, variation in their training, the care model used e.g. one to one care, and staffing issues); (2) Prioritisation of Maternal Observations (including the role of professional judgement and concerns expressed by midwives that they did not feel equipped to care for women with complex clinical needs; and (3) Negotiated Escalation (including the inappropriate response from senior staff to use of Modified Early Warning Score systems, and the emotional impact of escalation). A number of organisational and cultural barriers exist to the completion of maternal observations and the escalation of concerns. In order to address these the following actions are recommended: standardised training for Midwifery Support Workers, review of training of midwives to ensure it addresses the
Asha K Pratinidhi
Full Text Available Objectives: To study the feasibility of use of color-coded rings as a proxy for partograph for early identification of slow progress of labor. Materials and Methods: Color-coded rings were devised as a tool using appropriate technology to translate the partographic principles into simpler, easy to understand methodology. The rings were in pairs of 4 colors i.e., red, blue, yellow, and green, ranging from 3 cm to 10 cm in diameter with a difference of 4 cm between rings of the same color. The midwife performed p/v examination of the woman in labor to assess the initial cervical dilatation and identify corresponding ring. P/V was to be repeated after 4 hours to reassess the cervical dilatation and compare it with the bigger ring of the same color indicating expected cervical dilatation. If existing cervical dilatation measured lesser, it was interpreted as slow progress of labor indicating referral. Results: 44 women [23 (22.1% primis and 21 (13% multis] showed delayed progress of labor as judged by use of color-coded rings. 20 women (4 primis and 16 multis showed satisfactory progress or delivered by the time arrangements for referral were made. Conclusion: Use of color-coded rings may serve as a valuable tool based on appropriate technology to assess slow progress of labor not only in the hands of nurse midwives but it also can serve as a training tool for TBAs to help facilitate timely referral of such cases.
Maria Lúcia Mott
Full Text Available Este artigo analisa os cursos para formação de parteiras no Brasil, no século XIX. A documentação pesquisada é extremamente rica e levanta importantes questões referentes à formação das parteiras, ao perfil de alunas desejado, à freqüência e ao número de alunas matriculadas, ao papel de médicos e parteiras no atendimento ao parto, à disputa profissional, como ainda, às relações de gênero e raciais, no período.This articles analyzes the training courses for midwives in Brazil in the 19th century. The documentation studied is extremely rich and raises important issues referring to midwives' training; the characteristics of the desired student, the frequency and number of classes; the role of doctors and midwives in attending births; and the still present professional dispute over gender and race relations.
Arrish, Jamila; Yeatman, Heather; Williamson, Moira
Maternal nutrition during pregnancy affects the health of the mother and the baby. Midwives are ideally placed to provide nutrition education to pregnant women. There is limited published research evidence of Australian midwives' nutrition knowledge, attitudes and confidence. To investigate Australian midwives' nutrition knowledge, attitudes and confidence in providing nutrition education during pregnancy. Members of the Australian College of Midwives (n=4770) were sent an invitation email to participate in a web-based survey, followed by two reminders. The completion rate was 6.9% (329 of 4770). The majority (86.6% and 75.7%, respectively) highly rated the importance of nutrition during pregnancy and the significance of their role in nutrition education. Midwives' nutrition knowledge was inadequate in several areas such as weight gain, dairy serves and iodine requirements (73.3%, 73.2% and 79.9% incorrect responses, respectively). The level of confidence in discussing general and specific nutrition issues ranged mostly from moderate to low. The majority of the midwives (93%) provided nutrition advice to pregnant women. This advice was mostly described as 'general' and focused on general nutrition topics. Only half of the midwives reported receiving nutrition education during midwifery education (51.1%) or after registration (54.1%). Australian midwives' attitudes towards nutrition during pregnancy and their role in educating pregnant women about it were positive but their knowledge and confidence did not align with these attitudes. This could be due to minimal nutrition education during midwifery education or during practice. Continued education to improve midwives' nutrition knowledge and confidence is essential. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Robertson, Judith H; Thomson, Ann M
to explore how midwives' personal involvement in clinical negligence litigation affects their emotional and psychological well-being. descriptive phenomenological study using semi-structured interviews. in-depth interviews were conducted in participants' homes or at their place of work and focused on participants' experience of litigation. Participants were recruited from various regions of England. 22 National Health Service (NHS) midwives who had been alleged negligent. unfamiliarity with the legal process when writing statements, attending case conferences and being a witness in court provoked significant stress for midwives. This was exacerbated by the prolonged nature of maternity claims. Support ranged from good to inadequate. Participants who no longer worked for the defendant Trust felt unsupported. Stress could manifest as physical and mental ill-health. Some midwives internalised the allegations of negligence believing their whole career had become worthless. Previous knowledge of the legal process ameliorated the experience. Midwives also exhibited anger and resentment when litigation concluded and some took years to heal from the experience. midwives come from a caring and relational paradigm. When interfacing with the adversarial and contentious paradigm of tort law, midwives can abreact and suffer emotional, physical and psychological harm. Support for midwives experiencing litigation must be improved. Understanding the effects of personal involvement in litigation is important in order to improve the quality of support for this group of midwives. It will also aid development of targeted education for undergraduate, post-graduate and in-service midwives. In the longer term it may help policy makers when considering reform of clinical negligence litigation and NHS employers to structure support mechanisms for staff involved. Copyright © 2013 Elsevier Ltd. All rights reserved.
Macdonald, Danielle; Snelgrove-Clarke, Erna; Campbell-Yeo, Marsha; Aston, Megan; Helwig, Melissa; Baker, Kathy A
Collaboration has been associated with improved health outcomes in maternity care. Collaborative relationships between midwives and physicians have been a focus of literature regarding collaboration in maternity care. However despite the front line role of nurses in the provision of maternity care, there has not yet been a systematic review conducted about the experiences of midwives and nurses collaborating to provide birthing care. The objective of this review was to identify, appraise and synthesize qualitative evidence on the experiences of midwives and nurses collaborating to provide birthing care.Specifically, the review question was: what are the experiences of midwives and nurses collaborating to provide birthing care? This review considered studies that included educated and licensed midwives and nurses with any length of practice. Nurses who work in labor and delivery, postpartum care, prenatal care, public health and community health were included in this systematic review.This review considered studies that investigated the experiences of midwives and nurses collaborating during the provision of birthing care. Experiences, of any duration, included any interactions between midwives and nurses working in collaboration to provide birthing care.Birthing care referred to: (a) supportive care throughout the pregnancy, labor, delivery and postpartum, (b) administrative tasks throughout the pregnancy, labor, delivery and postpartum, and (c) clinical skills throughout the pregnancy, labor, delivery and postpartum. The postpartum period included the six weeks after delivery.The review considered English language studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.This review considered qualitative studies that explored the experiences of collaboration in areas where midwives and nurses work together. Examples of these areas included: hospitals
Takalani G. Tshitangano
Full Text Available Background: The ongoing worldwide phenomenon of a shortage of about 4.3 million nurses and midwives poses a threat to health service delivery. Limpopo province had the worst nurse shortage of over 60% in 2010. Authors attribute this shortage to turnover of nurses. The quest to describe factors contributing to nurses’ turnover led to this study in Limpopo province,South Africa. Objectives: To explore and describe factors that contribute to nurses’ turnover in Limpopo province of South Africa by assessing public sector nurses’ job satisfaction in relation to common determinants of job satisfaction. Method: A descriptive cross-sectional approach used primary quantitative data collected from 141 of 380 respondents (31.1% response rate contacted incidentally. Self-administered hand delivered questionnaires were used to gather ordinal data, which were analysed in terms off requency and percentage tables using the Statistical Package for Social Sciences version 6. The sum of positive and negative effects was used to determine satisfaction; if positive effects were greater than negative effects respondents were judged to be satisfied and vice versa. Results: Frequency and percentage tables revealed that nurses in Limpopo province were more dissatisfied (53.9% than satisfied (37.8% with their jobs. Factors which respondents were found to be dissatisfied with included staffing (85.2%, availability of workplace resources(83.7%, salaries (78.8%, workplace safety (73.7%, career development opportunities (64.5% and hours of work (47.6%. Conclusion: Nurses’ turnover is attributed to nurses’ dissatisfaction with staffing, resources, salaries and workplace safety. Attention needs to be given to these specific issues if retentionof nurses is to be achieved.
The scale and atrocity of domestic and family violence in Australia has come under the spotlight in 2015 largely due to the voice of Australian of the Year and family violence campaigner Rosie Batty. The implications of family violence are far reaching for many nurses and midwives, professionally and personally. Natalie Dragon reports.
Baird, Kathleen; Creedy, Debra K; Saito, Amornrat S; Eustace, Jennifer
Routine enquiry about domestic violence during pregnancy is accepted best practice. Training is essential to improve knowledge and practice. Few studies have undertaken a comprehensive evaluation of training impact over time. To evaluate the longitudinal impact of a domestic violence training and support program to promote midwives' routine antenatal enquiry for domestic violence using a mixed methods design. Data sources included (1) surveys of midwives at 6 months post-training, (2) interviews with key stakeholders at 12 months, (3) chart audit data of screening, risk, and disclosure rates (for 16 months). Measures included midwives' knowledge, preparation for routine enquiry, knowledge of domestic violence and perceptions of impact of the training and support for practice change. Forty (out of 83) participant surveys could be matched and responses compared to baseline and post-training scores. Wilcoxon signed-rank test identified that all 6-month follow-up scores were significantly higher than those at baseline. Level of preparedness increased from 42.3 to 51.05 (Z=4.88, p90%) reported improved confidence to undertake routine inquiry. A chart audit of screening rates revealed that of the 6671 women presenting for antenatal care, nearly 90% were screened. Disclosure of domestic violence was low (violence declining referral. Training, support processes, and referral pathways, contributed to midwives' sustained preparedness and knowledge to conduct routine enquiry and support women disclosing domestic violence. Copyright © 2018. Published by Elsevier Ltd.
To explore the role expectations of different stakeholders in the health care system on the roles and tasks that nurses and midwives perform, in order to clarify and strengthen these roles and shape the future of nursing education and practice in sub-Saharan Africa. Qualitative focus group discussions were held with different ...
Allaire, A D; Moos, M K; Wells, S R
To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina. Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine for their pregnant or postpartum patients. Eighty-two responses were received (68.3%). Seventy-seven (93.9%) reported recommending complementary and alternative medicine to their pregnant patients in the past year. Forty-seven (57.3%) reported recommending complementary and alternative medicine to more than 10% of patients. The percentage of nurse-midwives who recommended each type of complementary and alternative medicine was as follows: herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%), mind-body interventions (48.8%), aromatherapy (32.9%), homeopathy (30.5%), spiritual healing (23.2%), acupuncture (19.5%), and bioelectric or magnetic applications (14.6%). The 60 respondents who reported prescribing herbal therapies gave them for the following indications: nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation. Complementary and alternative medicine, especially herbal therapy, is commonly prescribed to pregnant women by nurse-midwives in North Carolina.
Conclusion: It is clear that the midwives in this study perceived FANC positive. FANC contributes to the quality of ANC delivery and subsequent improvement in the health status of pregnant women in Ghana. In addition, the findings contributed to existing knowledge and have the potential to guide future research in the field of ANC to improve maternal health and reduce maternal deaths.
Maryam Sadat Katebi
Full Text Available Background & aim: Communication is a fundamental human need. Medical students and healthcare professionals must be attuned to the needs of patients using effective communication skills. With regards to medical training, currently the focus is on theoretical matters and communication skills are taken for granted. This problem has caused miscommunication with patients referred to teaching hospitals. We conducted this study to assess communication skills of midwives from the perspective of parturient women. Methods: In this descriptive study, we evaluated 50 midwives working in maternity wards of Ghaem, Imam Reza, Omolbanin, and Hasheminejad hospitals in Mashhad, Iran. Three parturient women were selected per one midwife in a maternity ward. The parturient women participating in this study were in labor, delivery, admission or postpartum stages and completed the Interpersonal Communication Skills inventory by interview. To analyze the data, descriptive statistics, t-test, ANOVA, and Pearson product-moment correlation were performed, using SPSS 16. Results: The mean scores of communication behaviors of midwives with parturient in delivery, admission, and postpartum stages were 92.61±10.81, 93.31±10.59, and 94.19±8.26, respectively. Between the previous delivery of parturient, with communication behavior of midwives in the stage of admission or post-partum (P=0.015 and satisfaction of pregnancy with communication behavior of midwife in labor stage (P
Johanna M. Mathibe-Neke
Full Text Available Background: The physiological and psychological changes caused by pregnancy may increase a woman’s vulnerability to depression, which may in turn have adverse effects on both maternal and foetal wellbeing. Inadequate psychosocial risk assessment of women by midwives may lead to lack of psychosocial support during pregnancy and childbirth. Pregnant women who lack psychosocial support may experience stress, anxiety and depression that could possibly affect foetal wellbeing. Objective:The objective of this study was toexplore and describe the perception of psychosocial risk assessment and psychosocial care by midwives providing antenatal care to pregnant women. Method: An interpretive and descriptive qualitative approach was adopted. Three focus group interviews were conducted with midwives working in three Maternal Obstetric Units in Gauteng Province, using a semi-structured interview guide. The constant comparison data analysis approach was used. Results:Findings revealed that midwives are aware of and have encountered a high prevalence of psychosocial problems in pregnant women. Furthermore, they acknowledged the importance of psychosocial care for pregnant women although they stated that they were not equipped adequately to offer psychosocial assessment and psychosocial care. Conclusion:The findings provided a basis for incorporation of psychosocial care into routine antenatal care.
Midwives are working in federally funded health centers in increasing numbers. Health centers provide primary and preventive health care to almost 20 million people and are located in every US state and territory. While health centers serve the entire community, they also serve as a safety net for low-income and uninsured individuals. In 2010, 93% of health center patients had incomes below 200% of the Federal Poverty Guidelines, and 38% were uninsured. Health centers, including community health centers, migrant health centers, health care for the homeless programs, and public housing primary care programs, receive grant funding and enjoy other benefits due to status as federal grantees and designation as federally qualified health centers. Clinicians working in health centers are also eligible for financial and professional benefits because of their willingness to serve vulnerable populations and work in underserved areas. Midwives, midwifery students, and faculty working in, or interacting with, health centers need to be aware of the regulations that health centers must comply with in order to qualify for and maintain federal funding. This article provides an overview of health center regulations and policies affecting midwives, including health center program requirements, scope of project policy, provider credentialing and privileging, Federal Tort Claims Act malpractice coverage, the 340B Drug Pricing Program, and National Health Service Corps scholarship and loan repayment programs. © 2012 by the American College of Nurse-Midwives.
Ekelin, Maria; Svensson, Judith; Evehammar, Susanne; Kvist, Linda J
The use of intravenous artificial oxytocin for augmentation of labour is very common in midwifery care in Sweden. Studies have shown that oxytocin is often administered to women in labour who have no signs of labour dystocia. It was the aim of this study to examine Swedish midwives' views on and experiences of labour augmentation in the context of normal labour. Individual interviews were carried out with 15 midwives from southern Sweden. The material was analysed using qualitative content analysis, which resulted in one theme: sense and sensibility and four main categories: permissible situations, motivating the decision, intervening in the birth process and iatrogenic awareness. The results showed that midwives expressed ambiguity about augmentation of labour. They were of the opinion that oxytocin was used very often and sometimes unnecessarily. There is awareness that interventions to augment labour can result in undesirable effects on the birth process. Despite this, deeper discussion of this problem was avoided in the interviews. Further research should focus on the process involved when midwives weigh pros and cons when deciding to augment labour. More knowledge is also needed about the barriers for optimal care in labour that are inherent in health-care systems. Copyright © 2014 Elsevier Ltd. All rights reserved.
Sobczyk, Karolina; Woźniak-Holecka, Joanna; Holecki, Tomasz; Szałabska, Dorota
The main objective of the project was the evaluation of the organizational and financial aspects of midwives in primary health care (PHC), functioning under The Population Program for the Early Detection of Cervical Cancer two years after the implementation of new law regulations, which enable this occupational group to collect cytological material for screening. Under this project, the data of the Program's Coordinating Centre, affecting midwives' postgraduate education in the field of pap smear tests, was taken into analysis. Furthermore, The National Health Fund (NFZ) reports on contracts entered in the field of the discussed topics, taking into consideration the value of health services performed within the Program in respect of ambulatory care and primary care units. NFZ concluded contracts for the provision of PHC service with 6124 service providers in 2016, including the contracts in the field of providing health services under the cervical cancer prevention program by PHC midwifes, which were entered into by 358 institutions (5.85%). The value of the basic services under the Program, carried out under NFZ contracts in 2014, amounted to approx. PLN 12.3 million, while the value of services performed by PHC midwives represented only 0.38% of this sum. The introduction of legislative changes, allowing PHC midwives to collect cytological material for screening, did not cause, in the period of the observation on a national scale, the expected growth of availability of basic stage services within the cervical cancer prevention program.
Oyira, Emilia James; Mgbekem, Mary; Osuchukwu, Easther Chukwudi; Affiong, Ekpenyong Onoyom; Lukpata, Felicia E.; Ojong-Alasia, Mary Manyo
Objective: To examine background of midwives the effectiveness in delivery pain and anxiety/fear control of expectant mothers in Nigeria. Methods: Two null hypotheses were formulated. The survey design with sample of 360 post-natal women was selected from a population of 78,814 through the polio immunization registers of selected health center in…
Teunissen, Doreth A. M.; van Diem, Mariet Th.; Scheepers, Peer L. H.; Lagro-Janssen, Antoine L. M.
Aim. This paper is a report of a study to explore the views of midwives on women's positions during the second stage of labour. Background. Many authors recommend encouraging women to use positions that are most comfortable to them. Others advocate encouragement of non-supine positions, because
Full Text Available Carolyn L Tobin,1 Jo Murphy-Lawless2 1Department of Nursing, College of Health and Human Services, University of New Hampshire, Durham, NH, USA; 2School of Nursing and Midwifery, Trinity College, Dublin, Ireland Background: Immigration and asylum seeking has been an important social and political phenomenon in Ireland since the mid 1990s. Inward migration to Ireland was seen in unprecedented numbers from 1995 onward, peaking in 2002 with 11,634 applications for refugee status. Asylum and immigration is an issue of national and international relevance as the numbers of displaced people worldwide continues to grow, reaching the highest level in 20 years at 45.2 million in 2012. Midwives provide the majority of care to childbearing women around the world, whether working as autonomous practitioners or under the direction of an obstetrician. Limited data currently exist on the perspectives of midwives who provide care to childbearing women while they are in the process of seeking asylum. Such data are important to midwifery leaders, educators, and policy-makers. The aims of this study were to explore midwives' perceptions and experiences of providing care to women in the asylum process and to gain insight into how midwives can be equipped and supported to provide more effective care to this group in the future.Methods: Data were collected via indepth unstructured interviews with a purposive sample of ten midwives from two sites, one a large urban inner city hospital, and the second, a smaller more rural maternity hospital. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using content analysis. Results: Five themes emerged from the data, barriers to communication, understanding cultural difference, challenges of caring for women who were unbooked, the emotional cost of caring, and structural barriers to effective care. Conclusion: Findings highlight a need to focus on support and education for midwives, improved
Ali Abdel Aziem A
Full Text Available Abstract Background Female Genital Mutilation (FGM or cutting caries legal and bioethical debates and it is practiced in many developing countries. Methods Random selection of 154 midwives was used for the study during June 2012 and through July 2012 aiming to assess knowledge and attitudes of the midwives towards FGM in Eastern Sudan. Results A total of 157 midwives enrolled in this study. They had been practicing for 3 – 44 years (mean SD 19.2 ± 10.3. More than two third of them experienced practicing FGM sometime in their life (127/157, 80.9%. There was low level of awareness of types of FGM practice since only 7% (11/157 identified the four types correctly. 53.5% (84/157 identified type 1 correctly while 18.5% (29/157, 17.8% (28/157 and 15.9% (25/157 identified type 2, 3 and 4 as correct respectively. While 30 (19.1% of the midwives claimed that all types of FGM are harmful, 76.4% (120/157 were of the opinion that some forms are not harmful and 7 (4.5% reported that all types of FGM are not harmful. Likewise while 74.5% (117/157 of the interviewed midwives mentioned that the FGM is a legal practice only 25.5% (40/117 were of the opinion that FGM is illegal practice. The vast majority of the respondents (64.3%, 101/157 have an opinion that FGM decreases the sexual pleasure. More than half (53.5%, 84/157 of the participants affirmed that FGM does not increase the risk of HIV transmission. High proportion of the respondents (71.3%, 112/157 did not know whether or not infertility could complicate FGM. Conclusions Thus a substantial effort should be made to discourage the continuation of FGM practice among midwives in Sudan. This might be achieved by improving knowledge and awareness among the midwives and the community
Russell, Kim; Walsh, Denis; Scott, Ian; McIntosh, Tania
the use of water immersion for labour and birth has been shown to be beneficial for women in normal labour (Cluett et al, 2009). It was decided to use problem solving coordinator workshops to change in the way waterbirth practice was promoted and organised on labour ward. Findings from the first Action Research phase (Russell, 2011) led to the development of a waterbirth questionnaire to measure midwives' personal knowledge of waterbirth practice, waterbirth self-efficacy, social support and frequency of hydrotherapy and waterbirth practice. The aim of this paper is to share the questionnaire findings from an on-going action research study. prior to the first workshop 62 questionnaires were distributed to midwives (Bands 5, 6 and 7) working on labour ward. Subsequent questionnaires (n=53) were sent to Bands 5/6 midwives not involved in the workshops, at four (Group 2) and eight months (Group 3). N.B only Bands 5/6 midwives completed post workshop questionnaires. In total 169 questionnaires were distributed. One-way ANOVA with Tukey post-hoc test and the χ(2) test were used to determine statistical significance. 96 questionnaires were returned (57%). Midwives' personal knowledge of waterbirth practice differed significantly between groups, (F2,85=3.67, p0.05). However scores for social support did differ (F2,75=4.011, p=0.022), with midwives in Group 1 giving significantly lower scores (X¯=8.0, 95% CI [6.4, 9.5]) than those in Group 3 (X¯=10.5, 95% CI [9.4, 11.6]), p=0.016. Fifty-five per cent of Group 1 midwives facilitated a waterbirth in the previous three months compared with 87% in Group 3. Changes in the frequency of waterbirth for these groups were statistically significant (x(2)=4.369, paction research format have the potential to normalise midwifery care within medically dominated hospital birthing environments. © 2013 Elsevier Ltd. All rights reserved.
Bekru, Eyasu Tamru; Cherie, Amsale; Anjulo, Antehun Alemayehu
Midwives are the primary source of care and support for mothers and newborns at the most vulnerable time in their lives.The Ethiopian National Reproductive Health Strategy targeted reduction of Maternal Mortality rate to 267/100,000 live births in the years 2006-2015. Midwives play a crucial role in the care of pregnant women, from the first antenatal visit right through to the delivery and the postpartum period. Institution based cross-sectional study was carried out from March 2015 to April 2015 in Addis Ababa city, Ethiopia to assess job satisfaction and its determinants among midwives working at government health facilities. A total of 234 midwives were involved from 84 health centers and 8 governmental hospitals proportional to the size of health centers and hospitals using simple random sampling method. A total of 175 and 59 midwives were taken from health centers and government hospitals respectively. Different variables like Socio demographic, Job related domain and Organizational domain were collected using pre structured questionnaire after getting written consent. Data entry and analysis were done using SPSS 21.00. Binary logistic regression was used to determine factors affecting job satisfaction. P-values less than 0.05 were considered statistically significant. From 234 eligible respondents 221 midwives participated in this study which makes a response rate of 94.44%. The overall mean job satisfaction was 52.9%. Independent predictors of job satisfaction includes Sex [AOR = 4.07 (95%CI: 1.36-12.37)], working unit [AOR = 0.04 (95%CI:(0.001-0.45)], Educational status [AOR = 5.74(95%CI: 1.48-40.47)], Marital status [AOR = 3.48 [1.01-11.97)], supervision [AOR = 4.33 (95%CI: 1.53-20.22)], standard of care[AOR 4.80, (3.38-50.10)] and work load [AOR 8.94, (95%CI 2.37-22.65)]. Midwives were least satisfied from salary, extrinsic reward and professional opportunity subscales while they were most satisfied from coworker relation and the standard of care they
Munro, Sarah; Kornelsen, Jude; Grzybowski, Stefan
interprofessional primary maternity care has emerged as one potential solution to the current health human resource shortage in many developed nations. This study explores the barriers to and facilitators of interprofessional models of maternity care between physicians, nurses, and midwives in rural British Columbia, Canada, and the changes that need to occur to facilitate such models. a qualitative, exploratory framework guided data collection and analysis. four rural communities in British Columbia, Canada. Two rural communities had highly functional and collaborative interprofessional relationships between midwives and physicians, and two communities lacked interprofessional activities. 55 participants were interviewed and 18 focus groups were conducted with midwives, physicians, labour and delivery nurses, public health nurses, community-based providers, birthing women, administrators, and decision makers. in models of interprofessional collaboration, primary maternity care providers - physicians, midwives, nurses - work together to meet the needs of birthing women in their community. There are significant barriers to such collaboration given the disciplinary differences between care provider groups including skill sets, professional orientation, and funding models. Data analysis confirmed that interprofessional tensions are exacerbated in geographically isolated rural communities, due to the stress of practicing maternity care in a fee-for-service model with limited health resources and a small patient caseload. The participants we spoke with identified specific barriers to interprofessional collaboration, including physician and nurses' negative perceptions of midwifery and homebirth, inequities in payment between physicians and midwives, differences in scopes of practice, confusion about roles and responsibilities, and a lack of formal structures for supporting shared care practice. Participants expressed that successful interprofessional collaboration
Full Text Available Abstract Background Despite major policy initiatives in the United Kingdom to enhance women's experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought. Methods A Continuous Quality Improvement (CQI approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset. Results Questionnaires were received from 68 (46% of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women's physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required. Conclusions This was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their
Bekru, Eyasu Tamru; Cherie, Amsale; Anjulo, Antehun Alemayehu
Background Midwives are the primary source of care and support for mothers and newborns at the most vulnerable time in their lives.The Ethiopian National Reproductive Health Strategy targeted reduction of Maternal Mortality rate to 267/100,000 live births in the years 2006–2015. Midwives play a crucial role in the care of pregnant women, from the first antenatal visit right through to the delivery and the postpartum period. Methodology Institution based cross-sectional study was carried out from March 2015 to April 2015 in Addis Ababa city, Ethiopia to assess job satisfaction and its determinants among midwives working at government health facilities. A total of 234 midwives were involved from 84 health centers and 8 governmental hospitals proportional to the size of health centers and hospitals using simple random sampling method. A total of 175 and 59 midwives were taken from health centers and government hospitals respectively. Different variables like Socio demographic, Job related domain and Organizational domain were collected using pre structured questionnaire after getting written consent. Data entry and analysis were done using SPSS 21.00. Binary logistic regression was used to determine factors affecting job satisfaction. P-values less than 0.05 were considered statistically significant. Result From 234 eligible respondents 221 midwives participated in this study which makes a response rate of 94.44%. The overall mean job satisfaction was 52.9%. Independent predictors of job satisfaction includes Sex [AOR = 4.07 (95%CI: 1.36–12.37)], working unit [AOR = 0.04 (95%CI:(0.001–0.45)], Educational status [AOR = 5.74(95%CI: 1.48–40.47)], Marital status [AOR = 3.48 [1.01–11.97)], supervision [AOR = 4.33 (95%CI: 1.53–20.22)], standard of care[AOR 4.80, (3.38–50.10)] and work load [AOR 8.94, (95%CI 2.37–22.65)]. Midwives were least satisfied from salary, extrinsic reward and professional opportunity subscales while they were most satisfied from
Lopes, Sofia Castro; Titulaer, Patricia; Bokosi, Martha; Homer, Caroline S E; ten Hoope-Bender, Petra
a fit-for-purpose midwifery workforce is needed to respond to the current and future needs in sexual, reproductive, maternal and newborn health and to achieve universal health coverage. Evidence-based policy and planning that involves all stakeholders, including professional associations can assist with the development of such a workforce. The aim of the study was to explore how and when midwives' associations are involved in the planning processes for the midwifery workforce and which tools and approaches the associations perceived were used to support human resources for health policy. all 108 member associations of the International Confederation of Midwives were invited to participate. A questionnaire collected data including: the involvement of the association in the national planning dialogue, processes and methods for participation and engagement; mechanisms to guide and inform decision-making; and, the tools, data and evidence used to influence human resources for health policy. A descriptive analysis was conducted and comparisons were made by country group based on national income strata. 73 (68%) midwives' associations participated in the study, representing 67 (71%) countries. In most (95%) countries, the planning process to determine the provision of reproductive, maternal and newborn health was centralised at the ministry of health level and included midwives' associations amongst others. Less than two thirds of associations reported involvement in planning and policy. The planning processes in which they took part were the reproductive, maternal and newborn plan (63%), the national health plan (58%), and the human resources for health plan (52%). Planning was more frequently undertaken at national than sub-national levels in middle- and low-income countries than in high-income countries. Midwives associations were often unaware of the human resources for health approaches used to calculate the number of midwives required, and reported low use of
Eyasu Tamru Bekru
Full Text Available Midwives are the primary source of care and support for mothers and newborns at the most vulnerable time in their lives.The Ethiopian National Reproductive Health Strategy targeted reduction of Maternal Mortality rate to 267/100,000 live births in the years 2006-2015. Midwives play a crucial role in the care of pregnant women, from the first antenatal visit right through to the delivery and the postpartum period.Institution based cross-sectional study was carried out from March 2015 to April 2015 in Addis Ababa city, Ethiopia to assess job satisfaction and its determinants among midwives working at government health facilities. A total of 234 midwives were involved from 84 health centers and 8 governmental hospitals proportional to the size of health centers and hospitals using simple random sampling method. A total of 175 and 59 midwives were taken from health centers and government hospitals respectively. Different variables like Socio demographic, Job related domain and Organizational domain were collected using pre structured questionnaire after getting written consent. Data entry and analysis were done using SPSS 21.00. Binary logistic regression was used to determine factors affecting job satisfaction. P-values less than 0.05 were considered statistically significant.From 234 eligible respondents 221 midwives participated in this study which makes a response rate of 94.44%. The overall mean job satisfaction was 52.9%. Independent predictors of job satisfaction includes Sex [AOR = 4.07 (95%CI: 1.36-12.37], working unit [AOR = 0.04 (95%CI:(0.001-0.45], Educational status [AOR = 5.74(95%CI: 1.48-40.47], Marital status [AOR = 3.48 [1.01-11.97], supervision [AOR = 4.33 (95%CI: 1.53-20.22], standard of care[AOR 4.80, (3.38-50.10] and work load [AOR 8.94, (95%CI 2.37-22.65]. Midwives were least satisfied from salary, extrinsic reward and professional opportunity subscales while they were most satisfied from coworker relation and the standard of
Wrammert, Johan; Sapkota, Sabitri; Baral, Kedar; Kc, Ashish; Målqvist, Mats; Larsson, Margareta
The ability of health care providers to work together is essential for favourable outcomes in neonatal resuscitation, but perceptions of such teamwork have rarely been studied in low-income settings. Neonatal resuscitation is a proven intervention for reducing neonatal mortality globally, but the long-term effects of clinical training for this skill need further attention. Having an understanding of barriers to teamwork among nurse midwives can contribute to the sustainability of improved clinical practice. To explore nurse midwives' perceptions of teamwork when caring for newborns in need of resuscitation. Nurse midwives from a tertiary-level government hospital in Nepal participated in five focus groups of between 4 and 11 participants each. Qualitative Content Analysis was used for analysis. One overarching theme emerged: looking for comprehensive guidelines and shared responsibilities in neonatal resuscitation to avoid personal blame and learn from mistakes. Participants discussed the need for protocols relating to neonatal resuscitation and the importance of shared medical responsibility, and the importance of the presence of a strong and transparent leadership. The call for clear and comprehensive protocols relating to neonatal resuscitation corresponded with previous research from different contexts. Nurse midwives working at a maternity health care facility in Nepal discussed the benefits and challenges of teamwork in neonatal resuscitation. The findings suggest potential benefits can be made from clarifying guidelines and responsibilities in neonatal resuscitation. Furthermore, a structured process to deal with clinical incidents must be considered. Management must be involved in all processes. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Madden, Deirdre; Sliney, Annmarie; O'Friel, Aoife; McMackin, Barbara; O'Callaghan, Bernie; Casey, Kate; Courtney, Lisa; Fleming, Valerie; Brady, Vivienne
The aim of the research was to identify and develop midwives' skills to support women with mental health needs during pregnancy, using an action research approach. A review of perinatal mental health services in a large Dublin maternity unit revealed a high number of referred women who 'did not attend' the perinatal mental health service with few guidelines in place to support midwives in identifying and referring women for specialist help. Action research using cooperative inquiry involved a mental health nurse specialist and a team of midwives, who were drawn to each other in mutual concern about an area of practice. Data were gathered from three Cooperative Inquiry meetings, which incorporated one main Action Research Cycle of constructing, planning, taking and evaluating action. Data were analysed using a thematic content analysis framework. Participants experienced varying levels of uncertainty about how to support women with perinatal mental health needs. Cooperative inquiry supported participants in making sense of how they understood perinatal mental health and how they managed challenges experienced when caring for women with perinatal mental health issues. Participants developed a referral pathway, highlighted the significance of education to support women with perinatal mental health issues and identified the value of using open questions to promote conversation with pregnant women about mental health. Midwives value education and support to identify and refer women at risk of perinatal mental health issues. Cooperative inquiry, with a focus on action and shared reflection, facilitated the drawing together of two professional groups with diverse knowledge bases to work together to develop practice in an area of mutual concern. Perinatal mental health is a significant public health issue and midwives need support to make psychosocial assessments and to negotiate access to specialist services where available and when required. © 2017 John Wiley & Sons
Boyle, Sally; Thomas, Hilary; Brooks, Fiona
to explore whether the UK Government agenda for partnership working and choice was realised or desired for women during pregnancy and childbirth. a qualitative study was used to explore women's experience of partnership working with midwives. Data was generated using a diary interview method throughout pregnancy and birth. 16 women were recruited from two district general hospitals in the South East of England. three themes emerged from the data: organisation of care, relationships and choice. Women described their antenatal care as 'ticking the box', with midwives focusing on the bio-medical aspects of care but not meeting their psycho-social and emotional needs. Time poverty was a significant factor in this finding. Women rarely described developing a partnership relationship with midwives due to a lack of continuity of care and time in which to formulate such relationships. In contrast women attending birth centres for their antenatal care were able to form relationships with a group of midwives who shared a philosophy of care and had sufficient time in which to meet women's holistic needs. Most of the women in this study did not feel they were offered the choices as outlined in the national choice agenda (DoH, 2007). NHS Trusts should review the models of care available to women to ensure that these are not only safe but support women's psycho-social and emotional needs as well. Partnership case loading models enable midwives and women to form trusting relationships that empowers women to feel involved in decision making and to exercise choice. Group antenatal and postnatal care models also effectively utilise midwifery time whilst increasing maternal satisfaction and social engagement. Technology should also be used more effectively to facilitate inter-professional communication and to provide a more flexible service to women. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
Jenkinson, Bec; Kruske, Sue; Stapleton, Helen; Beckmann, Michael; Reynolds, Maree; Kildea, Sue
Ethical and professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy; the right to refuse care is well established. However, the existing literature is largely silent on the appropriate clinical responses when pregnant women refuse recommended care, and accounts of disrespectful interactions and conflict are numerous. Policies and processes to support women and maternity care providers are rare and unstudied. To document the perspectives of women, midwives and obstetricians following the introduction of a structured process (Maternity Care Plan; MCP) to document refusal of recommended maternity care in a large tertiary maternity unit. A qualitative, interpretive study involved thematic analysis of in-depth semi-structured interviews with women (n=9), midwives (n=12) and obstetricians (n=9). Four major themes were identified including: 'Reassuring and supporting clinicians'; 'Keeping the door open'; 'Varied awareness, criteria and use of the MCP process' and 'No guarantees'. Clinicians felt protected and reassured by the structured documentation and communication process and valued keeping women engaged in hospital care. This, in turn, protected women's access to maternity care. However, the process could not guarantee favourable responses from other clinicians subsequently involved in the woman's care. Ongoing discussions of risk, perceived by women and some midwives to be pressure to consent to recommended care, were still evident. These limitations may have been attributable to the absence of agreed criteria for initiating the MCP process and fragmented care. Varying awareness and use of the process also diminished women's access to it. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Wu, Lin Chieh; Lie, Désirée; Malhotra, Rahul; Allen, John C; Tay, Julie S L; Tan, Thiam Chye; Ostbye, Truls
to explore midwives' reasons for performing or avoiding episiotomies and motivation to change episiotomy practice in a large tertiary maternity hospital. using purposive sampling, three focus groups were conducted to achieve theme saturation. Open-ended questions elicited personal reasons for performing or avoiding episiotomy, information sources, and opinions about past and future practice trends. Sessions were audiotaped, and transcripts independently examined by three researchers who coded for themes. An iterative process was used to achieve consensus. Grounded theory was used to interpret data and to derive a theoretical framework for understanding the reasoning that influences episiotomy practice. a high volume delivery unit in Singapore. 20 of 79 licensed midwives, aged 28-70, who performed independent deliveries at the delivery unit. participants recognised maternal, fetal and other factors affecting their own decision to perform episiotomies. Patient request, better healing, midwife's reputation and job satisfaction were cited as main reasons to avoid episiotomy. Key sources informing practice were past training, delivery experience, anecdotal learning and lack of a protocol. There was no consensus on current trends in episiotomy practice. There was an absence of recognition of individual roles in reducing episiotomy rates. Clinicians were perceived as having both positive and negative influence. midwives' reasons for performing episiotomies were attributed to midwifery training, fear of doing harm and perceived clinician expectation, and were not consistent with current international practice guidelines. Reasons for avoiding episiotomies were associated with patient-centeredness and job satisfaction. Midwives agreed on the need to reduce episiotomy rates. with reduction in episiotomy rates as a goal, a combination of guideline education, feedback, peer coaching and collaborative care with doctors may be needed to achieve desired outcomes. Views and
Hauck, Yvonne L; Kelly, Georgina; Dragovic, Milan; Butt, Janice; Whittaker, Pamela; Badcock, Johanna C
a cross sectional survey was undertaken to explore midwives' knowledge of, and attitudes towards, mental health disorders in childbearing women vis-à-vis their perceived mental health learning needs. a 50.1% response rate included 238 midwives employed in the only public tertiary maternity hospital in Western Australia from March to June 2013. The survey comprised a mixture of custom-designed questions and vignettes presenting various disorders. Only 37.6% of midwives felt well-equipped to support women, whilst 50.2% reported insufficient access to information. Demand was highest for education on: personality disorders (77.8%); the impact of childbearing on mental health disorders (74.2%); and skills for handling stress and aggression (57.8%). Knowledge scores were variable: on average eight out of a maximum 13 questions were answered correctly, but few (2.7%) answered more than 11 correctly, and 3.7% scored ≤4 correct. Across disorders, recognition from vignettes was highest for depression (93.9%), and lowest for schizophrenia (65.6%). Surprisingly, there were no associations between general knowledge scores and previous mental health experience, recent professional development, or access to information around mental health. The majority endorsed positive beliefs about midwives' role in mental health assessment, and belief in women's recovery (83.5%), however, cluster analysis of warmth and competence ratings revealed negative stereotyping of mental health disorders. Midwives accept it is their role to assess the mental health status of women but many feel ill-equipped to do so and express a strong desire for further knowledge and skills across a range of perinatal mental health topics. Attitudes to recovery are positive but negative stereotypes exist; therefore awareness of potential bias is important to negate their influence on care. Learning needs may change due to trends in clinical practice. Strategies are needed to recognise negative beliefs and to
van der Wulp, Nickie Y; Hoving, Ciska; de Vries, Hein
two studies aimed to explore the advice Dutch midwives give and the information Dutch pregnant women and partners of pregnant women receive about alcohol consumption in pregnancy. study 1 included individual semi-structured interviews with midwives. Study 2 involved focus groups and individual semi-structured interviews with pregnant women and partners. Interview content was based on the I-Change Model. study 1 was conducted nation-wide; Study 2 was conducted in the central and southern regions of the Netherlands. 10 midwives in Study 1; 25 pregnant women and nine partners in Study 2. study 1 showed that midwives intended to advise complete abstinence, although this advice was mostly given when women indicated to consume alcohol. Midwives reported to lack good screening skills and sufficient knowledge about the mechanisms and consequences of antenatal alcohol use and did not involve partners in their alcohol advice. In Study 2, the views of pregnant women and partners were congruent to the findings reported in Study 1. In addition, pregnant women and partners considered midwives as an important source of information on alcohol in pregnancy. Partners were interested in the subject, had a liberal view on antenatal alcohol use and felt ignored by midwives and websites. Pregnant women indicated to receive conflicting alcohol advice from their health professionals. midwives' alcohol advice requires improvement with regard to screening, knowledge about mechanisms and consequences of antenatal alcohol use and the involvement of the partners in alcohol advice during pregnancy. training should be given to Dutch midwives to increase their screening skills and their alcohol related knowledge to pregnant women. Research is needed to determine how the midwife's alcohol advice to the partner should be framed in order to optimise the partner's involvement concerning alcohol abstinence in pregnancy. More attention to the topic at a national level, for example via mass media
The information given in this document is divided into two parts. In part I the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials delivered by Members up to 31 December 1964 in compliance with requests the Agency had made under Article IX. D. Part II contains information about materials which had not been delivered by 31 December but which had been allocated, in accordance with Article XI. F. 1 of the Statute, to approved Agency projects for which project arrangements were in force on that date
The information given in this document is divided into two parts. In part I the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials delivered by Members up to 30 June 1968 in compliance with requests the Agency had made under Article IX,D. Part II contains information about materials which had not been delivered by 30 June 1968 but which had been allocated, in accordance with Article XI.F.I of the Statute, to approved Agency projects for which project arrangements were in force on that date
The information given in this document is divided into two parts. In part I the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials delivered by Members up to 31 December 1965 in compliance with requests the Agency had made under Article IX. D. Part III contains information about materials which had not been delivered by 31 December but which had been allocated, in accordance with Article XI. F. 1 of the Statute, to approved Agency projects for which project arrangements were in force on that date
Sidebotham, Mary; Dalsgaard, Annette; Davis, Deborah
AIM: To examine the contribution of the Virtual International Day of the Midwife (VIDM) conference to midwives' continuing professional development (CPD). BACKGROUND: Knowledge and understanding of CPD for midwives as synchronous online learning is limited. Studies of e-learning programs for CPD...... have underlined the need for interaction with others. The VIDM is a synchronous online 24-hour conference freely available for midwives designed to provide a unique CPD opportunity. METHOD: An online survey with a mix of fixed-response, multiple-response, and open-ended freetext questions was available...
Chodzaza, Elizabeth; Haycock-Stuart, Elaine; Holloway, Aisha; Mander, Rosemary
to explore Malawian midwives decision making when caring for women during the first stage of labour in the hospital setting. this focused ethnographic study examined the decision making process of 9 nurse-midwives with varying years of clinical experience in the real world setting of an urban and semi urban hospital from October 2013 to May 2014.This was done using 27 participant observations and 27 post-observation in-depth interviews over a period of six months. Qualitative data analysis software, NVivo 10, was used to assist with data management for the analysis. All data was analysed using the principle of theme and category formation. analysis revealed a six-stage process of decision making that include a baseline for labour, deciding to admit a woman to labour ward, ascertaining the normal physiological progress of labour, supporting the normal physiological progress of labour, embracing uncertainty: the midwives' construction of unusual labour as normal, dealing with uncertainty and deciding to intervene in unusual labour. This six-stage process of decision making is conceptualised as the 'role of cue acquisition', illustrating the ways in which midwives utilise their assessment of labouring women to reason and make decisions on how to care for them in labour. Cue acquisition involved the midwives piecing together segments of information they obtained from the women to formulate an understanding of the woman's birthing progress and inform the midwives decision making process. This understanding of cue acquisition by midwives is significant for supporting safe care in the labour setting. When there was uncertainty in a woman's progress of labour, midwives used deductive reasoning, for example, by cross-checking and analysing the information obtained during the span of labour. Supporting normal labour physiological processes was identified as an underlying principle that shaped the midwives clinical judgement and decision making when they cared for women in
In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials which Members had delivered up to the end of 1972, in compliance with requests the Agency had made under Article IX. D
In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials which Members had delivered up to 30 June 1975, in compliance with requests the Agency had made under Article IX. D
In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials which Members had delivered up to 31 March 1974, in compliance with requests the Agency had made under Article IX. D
In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials delivered by Members up to 30 June 1969 in compliance with requests the Agency had made under Article IX. D
In this document the Director General is reporting to the Members of the Agency, under Article IX. G of the Statute, the quantities of materials which Members had delivered up to the end of 1970, in compliance with requests the Agency had made under Article IX. D
Full Text Available Background. Female genital mutilation/cutting (FGM/C has no medical benefits and is associated with serious health complications. FGM/C including medicalization is illegal in Kenya. Capacity building for nurse-midwives to manage and prevent FGM/C is therefore critical. Objective. Determine the current FGM/C knowledge and effect of training among nurse-midwives using an electronic tool derived from a paper-based quiz on FGM/C among nurse-midwives. Methods. Nurse-midwives n=26 were assessed pre- and post-FGM/C training using a quiz comprising 12 questions. The quiz assessed the following factors: definition, classification, determining factors, epidemiology, medicalization, prevention, health consequences, and nurse-midwives’ roles in FGM/C prevention themes. The scores for individuals and all the questions were computed and compared using SPSS V22. Results. The mean scores for the quiz were 64.8%, improving to 96.2% p<0.05 after training. Before the training, the following proportions of participants correctly answered questions demonstrating their knowledge of types of cutting (84.6%, link with health problems (96.2%, FGM/C-related complications (96.2%, communities that practice FGM/C (61.5%, medicalization (43.6%, reinfibulation (46.2%, dissociation from religion (46.2%, and the law as it relates to FGM/C (46.2%. The participants demonstrated knowledge of FGM/C-related complications with the proportion of nurse-midwives correctly answering questions relating to physical impact (69.2%, psychological impact (69.2%, sexual impact (57.7%, and social impact (38.5%. Additionally, participant awareness of NM roles in managing FGM/C included the following: knowledge of the nurse-midwife as counselor (69.2%, advocate (80.8%, leader (26.9%, role model (42.3%, and caregiver (34.6%. These scores improved significantly after training. Conclusion. Substantial FGM/C-related knowledge was demonstrated by nurse-midwives. They, however, showed challenges in
Mazur, Nicole; Zarzeka, Aleksander; Dąbrowski, Filip; Panczyk, Mariusz; Gałązkowski, Robert; Gotlib, Joanna
Due to the amendment of the Nurse and Midwife professions Act, since 1st of January 2016 Polish nurses and midwives with certain qualifications are able to prescribe medicines and referral for diagnostic tests. To analyse attitudes of physicians on new professional competencies of nurses and midwives regarding: prescribing medicines and referring patients for certain diagnostic tests. In the study took part 436 physicians (245 women, 193 man). The average age was 36,6 years old (min.: 21; max.: 76; SD: 11,65; median: 31). 274 people lived in a city with over 500 thousand citizens, 70 people - city below 100 thousand citizens, 54 people - city between 100-500 thousands citizens and 14 people lived in a country. Most of people lived in masovian district. Authors prepared and validated own questionnaire, which contained statements assessed in Likert scale (1-strongly disagree, 5-stronlgy agree). It contained 22 questions about opinions of new abilities of nurses and midwives. The questionnaire was sent three times to Regional Medical Chamber in Warsaw via an online questionnaire: https://docs.google.com/forms/d/1cxiaJFPxDVphByhBTk4gDIBsm6bQsxGLVXDK-RtpGnk/ The reliability of the questionnaire used was tested in a pilot study by the coefficient α-Cronbach, which amounted to 0.937. Due to the fact that the study was performed in a group of doctors they did not require the consent of the Bioethics Committee, of Medical University of Warsaw to carry them out. The results are presented using descriptive statistics, which were obtained through statistical analysis using Microsoft Excel and StatSoft Statistica 12.0 (license Medical University of Warsaw). 53% of doctors claim that the new powers do not improve patient care. 35% of respondents disagreed with the opinion that the new powers will raise the prestige of professional nurses and midwives. At the same time 49% believe that prescriptions for nurses and midwives reduce the responsibilities of doctors. Only 9% agreed
Cadée, Franka; Perdok, Hilde; Sam, Betty; de Geus, Myrte; Kweekel, Liselotte
midwives need professional support from a national midwifery organisation to be able to provide the services that are by regulatory mechanisms and accreditation expected of them. Not all midwives in the world are united in a professional organisation. The aim of this project was to strengthen the midwifery organisations of Sierra Leone and the Netherlands. During the process of the project it was realised that the development of a platform of exchange at organisational level would be enhanced by introducing personal exchange between individual midwives. In response to this new insight the original project plan was adjusted by incorporating the twin2twin method. twin2twin is a feminist methodology of mutual exchange between twenty pairs of midwives from different organisations (in this case Sierra Leone and the Netherlands). The method can be distinguished by 10 specific steps. It was developed, used and (re)evaluated through focus group discussions, storytelling and written evaluations. twinning of organisations was strengthened by adding a human component to the process. With the use of the 'twin2twin' method, midwives were encouraged to invested in a professional and personal bond with their 'twin sister'. This bond was independent and went beyond the relatively short four year project period. Through personal engagement and mutual exchange of knowledge and skills, midwives empowered each other to build and strengthen their midwifery organisations both in Sierra Leone and the Netherlands. (Empowerment refers to the expansion in people's ability to make strategic life choices in a context where this ability was previously denied to them (Narayan, 2005); organisational empowerment includes processes and structures that enhance members' skills and provides them with the mutual support necessary to effect community level change (Zimmerman, 1995).). despite challenges we are convinced that twin2twin can be of additional benefit for the success of other projects
Girotto, S; Zanichelli, A; Stevanella, G C; Fattorini, G; Santi, L; Chiossi, D; Rötzer, J
This paper synthesizes a six year collaboration between a natural family planning (NFP) non-governmental organization (NGO) and the National Health Service of the Emilia Romagna region in Italy. It also compares the public program experience with NFP services provided in the private sector in the adjacent region of Veneto. Midwives provided NFP services in government family health clinics while in the private sector NFP was taught by non-health laypersons in a church-based facility. The populations served by these two programs were different. Women in the public sector were slightly older and two-thirds were married. Forty percent of the clients had chosen to use NFP to achieve a pregnancy. The private sector client, recruited in part through premarriage counseling programs, was equally divided between married and single women, though the majority came for advice on avoiding or spacing pregnancies. In both regions NFP users were more highly educated than the general population.
Edwards, M E; Jepson, R G; McInnes, R J
to explore women's and midwives' expectations, knowledge and experiences of breastfeeding initiation using Social Cognitive Theory. a qualitative study using focus group discussions and individual interviews. Breastfeeding initiation was defined for this study as a process within the first 48hours after birth. Data were analysed using qualitative inductive analysis then further deductive analysis using Social Cognitive Theory (SCT). a purposefully selected sample of primigravid antenatal and postnatal women (n=18) and practising midwives (n=18) from one Health Board area in Scotland. attachment of the baby to the breast at birth was hindered by sleepy babies and the busy unfamiliar hospital environment. These resulted in mothers struggling to maintain their motivation to breastfeed and to develop low self-efficacy. Instinctive attachment was rare. Midwives who considered it was normal for babies to be sleepy and unable to attach or feed at birth did not facilitate instinctive baby behaviour. Midwives sometimes experienced lack of autonomy and environmental circumstances that made women centred care difficult. Furthermore caring for high numbers of women, dependent on their help, resulted in reduced self-efficacy for providing effective breastfeeding support. interviewing both women and midwives specifically about initiation of breastfeeding has allowed for deeper insights into this critical period and enabled a comparison between the data obtained from mothers and midwives. The findings suggest that instinctive attachment is not an expectation of either mothers or midwives and results in a loss of breastfeeding confidence in both. to facilitate initiation there is a need for more research to develop appropriate maternal and midwifery skills, and make changes to the cultural environment in hospitals. Social Cognitive Theory could be used as a framework in both the antenatal and immediate postnatal period to develop strategies and materials to increase women's and
Everitt, Louise; Fenwick, Jennifer; Homer, Caroline S E
A newborn baby is removed from his/her mother into formal care when he/she is considered at risk of serious harm and it is not in the best interests to go home with their parent(s) or carer(s). In New South Wales (NSW), this removal is known as an "assumption of care". This process is challenging for all involved especially when it occurs soon after birth. There is very limited research to inform midwives in this area of practice. To explore the experiences of midwives who had been involved in the assumption of care of a baby soon after birth or in the early postnatal period. A qualitative descriptive approach was used. Ten midwives involved with the assumption of care of a baby were interviewed. A thematic analysis was undertaken. There were two overarching themes. "Being in the head space" represented the activities, tasks and/or processes midwives engaged in when involved in an assumption of care. "Being in the heart space" described the emotional impact on midwives, as well as their perceptions on how women were affected. Midwives described feeling unprepared and unsupported, in both the processes and the impact of assumption of care. They were confronted by this profound emotional work and described experiencing professional grief, similar to that felt when caring for a woman experiencing a stillbirth. In the future, midwives need to be provided with support to ensure that they can effectively care for these women and also manage the emotional impact themselves. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Warmelink, J Catja; de Cock, T Paul; Combee, Yvonne; Rongen, Marloes; Wiegers, Therese A; Hutton, Eileen K
A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed. Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care. Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating
Menke, Jane; Fenwick, Jennifer; Gamble, Jenny; Brittain, Hazel; Creedy, Debra K
This study examined midwives' perceptions of organisational structures and processes of care when working in a caseload model (Midwifery Group Practice MGP) for socially disadvantaged and vulnerable childbearing women. This study used Donabedian's theoretical framework for evaluating the quality of health care provision. Of the 17 eligible midwives, 15 participated in focus group discussions and two others provided written comments. Thematic analysis was guided by three headings; clinical outcomes, processes of care and organisational structure. Midwives believed they provided an excellent service to socially disadvantaged and vulnerable childbearing women. Midwives gained satisfaction from working in partnership with women, working across their full scope of practice, and making a difference to the women. However the midwives perceived the MGP was situated within an organisation that was hostile to the caseload model of care. Midwives felt frustrated and distressed by a lack of organisational support for the model and a culture of blame dominated by medicine. A lack of material resources and no identified office space created feelings akin to 'homelessness'. Together these challenges threatened the cohesiveness of the MGP and undermined midwives' ability to advocate for women and keep birth normal. If access to caseload midwifery care for women with diverse backgrounds and circumstances is to be enhanced, then mechanisms need to be implemented to ensure organisational structures and processes are developed to sustain midwives in the provision of 'best practice' maternity care. Women accessing midwifery caseload care have excellent maternal and newborn outcomes. However there remains limited understanding of the impact of organisational structures and processes of care on clinical outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available The aim of this study is to describe how the work organization of midwives is related to their moral judgements concerning pregnant women. This analysis is based on material gathered during ethnographic research undertaken at a gynaecology and maternity ward at a hospital in Slovakia. The interpretations of the research findings are informed by the work of Mary Douglas and Moral Foundations Theory. Using the analytical tools of the grid-group, this article then shows that the working environment of midwives is a type of hierarchical group. Douglas predicted that such a type of social structure would be built on values such as subordination, respect for authority, and purity. An analysis of the material confirms this assertion: midwives’ narratives of pregnant women are in fact representations of moral values of authority and purity. Explicit statements of emotions of anger, contempt, disgust, and elevation serve as indicators of either the violation or observance of moral rules.
Schrøder, Katja; Larsen, Pia Veldt; Jørgensen, Jan Stener
(midwife or obstetrician) and self-reported psychosocial health and well-being both within the most recent four weeks and immediately following a traumatic childbirth. The association may partly be explained by gender. This knowledge may lead to better awareness of the possibility of differences related......Objective this study investigates the self-reported psychosocial health and well-being of obstetricians and midwives in Denmark during the most recent four weeks as well as their recall of their health and well-being immediately following their exposure to a traumatic childbirth. Material...... and methods a 2012 national survey of all Danish obstetricians and midwives (n=2098). The response rate was 59% of which 85% (n=1027) stated that they had been involved in a traumatic childbirth. The psychosocial health and well-being of the participants was investigated using six scales from the Copenhagen...
Jepsen, Ingrid; Mark, Edith; Nøhr, Ellen Aagaard
-form with an embedded and inevitable commitment and obligation that brings forward the midwife׳s desire to do her utmost and in return receive appreciation, social recognition and a meaningful job with great job satisfaction. There is a balance between the advantages of a meaningful job and the disadvantages...... followed by interviews. PARTICIPANTS: thirteen midwives working in caseloads were observed during one or two days in the antenatal clinic and were interviewed at a later occasion. FINDINGS: being recognised and the feeling of doing high quality care generate high job satisfaction. The obligation...... as job-satisfaction is dependent on the midwives׳ ability of fulfilling expectations of being present at women׳s births....
Parker, Vicki; Lieschke, Gena; Giles, Michelle
Improving health, patient and system outcomes through a practice-based research agenda requires infrastructural supports, leadership and capacity building approaches, at both the individual and organisational levels. Embedding research as normal nursing and midwifery practice requires a flexible approach that is responsive to the diverse clinical contexts within which care is delivered and the variable research skills and interest of clinicians. This paper reports the study protocol for research being undertaken in a Local Health District (LHD) in New South Wales (NSW) Australia. The study aims to evaluate existing nursing and midwifery research activity, culture, capacity and capability across the LHD. This information, in addition to input from key stakeholders will be used to develop a responsive, productive and sustainable research capacity building framework aimed at enculturating practice-based research activities within and across diverse clinical settings of the LHD. A three-phased, sequential mixed-methods action research design underpinned by Normalization Process Theory (NPT). Participants will be nursing and midwifery clinicians and managers across rural and metropolitan services. A combination of survey, focus group, individual interviews and peer supported action-learning groups will be used to gather data. Quantitative data will be analysed using descriptive statistics, correlation and regression, together with thematic analysis of qualitative data to produce an integrated report. Understanding the current research activity and capacity of nurses and midwives, together with organisational supports and culture is essential to developing a productive and sustainable research environment. However, knowledge alone will not bring about change. This study will move beyond description of barriers to research participation for nurses and midwives and the promulgation of various capacity building frameworks to employ a theory driven action-oriented approach
Fahdhy, Mohammad; Chongsuvivatwong, Virasakdi
to assess the effectiveness of promoting the use of the World Health Organization (WHO) partograph by midwives for labour in a maternity home by comparing outcomes after birth. Medan city, North Sumatera Province, Indonesia. 20 midwives who regularly conducted births in maternity homes, randomly allocated into two equal groups. cluster randomised-control trial. under supervision from a team of obstetricians, midwives in the intervention group were introduced to the WHO partograph, trained in its use and instructed to use it in subsequent labours. there were 304 eligible women with vertex presentations among 358 labouring women in the intervention group and 322 among 363 in the control group. Among the intervention group, 304 (92.4%) partographs were correctly completed. From 71 women with the graph beyond the alert line, 42 (65%) were referred to hospital. Introducing the partograph significantly increased referral rate, and reduced the number of vaginal examinations, oxytocin use and obstructed labour. The proportions of caesarean sections and prolonged labour were not significantly reduced. Apgar scores of less than 7 at 1min was reduced significantly, whereas Apgar scores at 5mins and requirement for neonatal resuscitation were not significantly different. Fetal death and early neonatal death rates were too low to compare. a training programme with follow-up supervision and monitoring may be of use when introducing the WHO partograph in other similar settings, and the findings of this study suggest that the appropriate time of referral needs more emphasis in continuing education. the WHO partograph should be promoted for use by midwives who care for labouring women in a maternity home.
Full Text Available Background & aim: Perinatal mental health problems have been demonstrated to impact upon maternal, and fetal/child outcomes. Despite the global evidence and a policy-driven responsibility for identification of these problems, research demonstrates that student midwives/midwives lack knowledge and confidence to assess, identify, and manage them. A similar context is evident for learning disabilities, despite the holistic care philosophy of midwifery. A brief assessment tool to identify knowledge and confidence defecits and strengths within a holistic care framework could support curriculum development. This study sought to develop a Perinatal Mental Health Awareness scale and evaluate its psychometric properties in student midwives. Methods: We employed a cross-sectional and exploratory instrument development and evaluation design to determine the measurement veracity of the new scale. Results: The scale demonstrated good psychometric properties, revealing three subscales mapping onto (i mental health symptoms, (ii physical/medical issues and (iii learning disability. Results indicated a clear differentiation in scores across the subscales, indicating comparative deficits in mental health domains. Conclusion: Our findings facilitate confidence in the psychometric robustness of the measure. The scale enables student midwives to assess and compare different domains of midwifery practice, in line with a holistic model of midwifery care. A focus on physical health in midwifery education appears to disadvantage knowledge and confidence for managing mental health problems in a midwifery context. This valuable finding highlights the potential need for curriculum rebalancing. The measure offers the opportunity to assess and develop curriculum/training provision and monitor the effectiveness of subsequent curricular developments.
Full Text Available Background and Aim: Occupational stress is one of the key factors in reducing staff productivity in organizations with physical and psychological impacts on employees. Nursing and midwifery are among the most stressful professions. Therefore, this study aimed to determine the relationship between occupational stress and work ability of midwives in Mashhad, Iran in 2011. Materials and Methods: This cross-sectional study was carried on 123 midwives employed in the public hospitals and health centres in Mashhad, Iran using two-stage sampling method. Demographic and work-related data were obtained through a self-structured questionnaire. Occupational stress and work ability were measured using Occupational Stress Assessment Questionnaire (OSAQ and Work Ability Index Questionnaire (WAIQ. The statistical analysis was performed using student’s t-test, One Way ANOVA, correlation coefficient, and linear regression model through SPSS statistical software (version 11.5. Results: The results showed that the mean score of occupational stress and work ability was 149 ± 0.01 and 38.81±0.05, respectively. There was a negative correlation between job-related stress and work ability. Midwives with higher occupational stress experienced poorer work ability (P=0.021, r=-0.061. Conclusion: Sever work stress is associated with reduced work ability. So it is recommended to eliminate or decrease occupational stress and increase work ability among Iranian midwives using preventive measures, although identification of sources of occupational stress seems necessary in order to adopt appropriate stress management strategies.
Kato, Chiho; Kataoka, Yaeko
To explore the effectiveness of a simulation training program for midwives in performance and knowledge for the management of postpartum hemorrhage (PPH). The study design was a randomized controlled trial. Midwives working at one obstetrics ward in an urban area were randomly assigned to simulation training program or no training. This "simulation program" included pre study e-learning and simulation. Inclusion criteria were midwives who: 1) had two or three years of clinical experience, 2) worked in an obstetrics ward, and 3) had experience with birth assistance. There was one exclusion criterion namely prior experience of simulation training for PPH. Change in performance was evaluated using a PPH scenario performance test at one month after the simulation training. Change in knowledge was evaluated by a 25-item multiple-choice questionnaire completed shortly before the training and one month after the training. The ethical review committee of St Luke's International University granted approval (No. 14-096). Eighty-one midwives were randomly assigned to either the intervention group (n=40) or the control group (n=41). Performance in the simulation training group was significantly better in comparison to the no training group; mean performance score was 23.85(SD 2.71) in the training group versus 18.00(SD 3.01) in the no training group (MD 5.85 95% CI 4.85-7.12, t=9.17, pmanagement of PPH were significantly improved after simulation training. However, assessments of long-term effects on performance, and knowledge and the clinical outcomes in managing of obstetric complications are necessary to adequately evaluate the effectiveness of simulation training. Copyright © 2017 Elsevier Ltd. All rights reserved.
Maryam Sadat Katebi; Talat Khadivzadeh; Zohre Sepehri Shamloo; Habibolah Esmaily
Background & aim: Communication is a fundamental human need. Medical students and healthcare professionals must be attuned to the needs of patients using effective communication skills. With regards to medical training, currently the focus is on theoretical matters and communication skills are taken for granted. This problem has caused miscommunication with patients referred to teaching hospitals. We conducted this study to assess communication skills of midwives from the perspective of partu...
Lamont, Scott; Brunero, Scott; Perry, Lin; Duffield, Christine; Sibbritt, David; Gallagher, Robyn; Nicholls, Rachel
To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as 'mental health days'. The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a 'mental health day' as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence. Online cross-sectional survey. Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses and midwives in New South Wales, Australia, between May 2014 - February 2015. Sample characteristics were reported using descriptive statistics. Factors independently predictive of 'mental health day' reportage were determined using logistic regression. Fifty-four percentage of the n = 5041 nurse and midwife respondents took 'mental health days'. Those affected were significantly more likely to be at younger ages, working shifts with less time sitting at work; to report workplace abuse and plans to leave; having been admitted to hospital in previous 12 months; to be current smokers; to report mental health problems, accomplishing less due to emotional problems and current psychotropic medication use. Specific characteristics of nurses and midwives who report taking 'mental health day' sickness absence offer healthcare administrators and managers opportunities for early identification and intervention with workplace measures and support frameworks to promote well-being, health promotion and safety. © 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.
Dearden Andy M
Full Text Available Abstract Background Twenty percent of pregnant women in the UK are obese (BMI ≥ 30 kg/m2, reflecting the growing public health challenge of obesity in the 21st century. Obesity increases the risk of adverse outcomes during pregnancy and birth and has significant cost implications for maternity services. Gestational weight management strategies are a high priority; however the evidence for effective, feasible and acceptable weight control interventions is limited and inconclusive. This qualitative study explored the experiences and perceptions of pregnant women and midwives regarding existing support for weight management in pregnancy and their ideas for service development. Methods A purposive sample of 6 women and 7 midwives from Doncaster, UK, participated in two separate focus groups. Transcripts were analysed thematically. Results Two overarching themes were identified, 'Explanations for obesity and weight management' and 'Best care for pregnant women'. 'Explanations' included a lack of knowledge about weight, diet and exercise during pregnancy; self-talk messages which excused overeating; difficulties maintaining motivation for a healthy lifestyle; the importance of social support; stigmatisation; and sensitivity surrounding communication about obesity between midwives and their clients. 'Best care' suggested that weight management required care which was consistent and continuous, supportive and non-judgemental, and which created opportunities for interaction and mutual support between obese pregnant women. Conclusions Women need unambiguous advice regarding healthy lifestyles, diet and exercise in pregnancy to address a lack of knowledge and a tendency towards unhelpful self-talk messages. Midwives expressed difficulties in communicating with their clients about their weight, given awareness that obesity is a sensitive and potentially stigmatising issue. This indicates more could be done to educate and support them in their work with
Coughlan, Linda Martina; Patton, Declan
The scarcity of appropriately qualified nurses and midwives is a major obstacle in achieving an effective health system. Neonatal nurses and midwives require a high level of skill and education to fulfil their role. It is also an area that sees high staff turnover rates. For this study a descriptive qualitative approach was used to ascertain early career neonatal nurses' and midwives' experiences of further education, their future career plans, and their perceived facilitators and barriers to further education and career progression. After receiving ethical approval, twelve nurses and midwives were recruited across three tertiary level neonatal units in Ireland. Semi structured interviews were carried out and interview transcripts were subsequently analysed using Attride-Stirling's (2001) Thematic Networks to deduce themes from the data. Support and involvement, mentoring, and career progression and retention were the three main themes identified upon analysis of the data. The majority of participants identified definitive career plans but some felt their goals were unachievable in their current workplace. Consequently a large number of participants have plans to leave their employment in neonates and pursue a career in other areas of nursing. Staff appraisals and succession planning programmes may assist early career nurses and midwives in focusing on their individual career goals, leading to a greater uptake of further specialised education and improved retention of neonatal nurses and midwives. Copyright © 2017 Elsevier Ltd. All rights reserved.
Oude Wesselink, Sandra F; Lingsma, Hester F; Robben, Paul B M; Mackenbach, Johan P
we aimed to evaluate the provision of quit-smoking counselling by midwives in the Netherlands and its effect on smoking behaviour and birth weight. quasi-experimental study in which we collected information from pregnant women who smoke throughout their pregnancy by extracting data from electronic patient files. primary care midwifery practices. 851 pregnant women who smoke, treated between 2011 and 2014. quit-smoking counselling. the midwives decided to provide quit-smoking counselling to the participant or not. Non-counselled women were used as the control group. The primary outcome parameter was quit smoking, defined as 'quit smoking by end of pregnancy'. At intake, 67% of the women smoked 1-9 cigarettes a day, 23% smoked 10-20 cigarettes a day and 4% more than 20 cigarettes a day. The midwives began counselling with 42% of the participants, but seldom completed all the counselling steps. The average quit rate was 10% and average birth weight of the babies was 3200g. We found no difference in quit rate or birth weight between counselled women and those who were not. However, the data suggested that counselling is more effective when more steps of counselling are completed. no effect was found of quit-smoking counselling on quit-smoking rate or birth weight. Possibly, counselling is effective when provided extensively throughout pregnancy. our study shows that provision of counselling can be improved. Copyright © 2015 Elsevier Ltd. All rights reserved.
Church, Sarah; Ekberg, Merryn
the aim of this study was to gain an understanding of how midwifery students respond to a range of ethical dilemmas which they may encounter in clinical practice in relation to the use of reproductive technologies. during a series of focus groups, student midwives were asked to consider four novel scenarios, which highlighted some of the most controversial issues in contemporary reproductive ethics. These included assisted reproduction for older women, surrogacy and mental health, sex selection and reproductive cloning. a University in the East Midlands, England. purposeful sampling was adopted which resulted in four focus groups with a total of 16 student midwives. a process of thematic analysis generated four key themes: choice and expectation, consumer society; distributive justice; parental rights and welfare of the child. our results suggest that student midwives are sensitive to the range of ethical dilemmas associated with the increased use of technology in human reproduction, and construct distinct boundaries in relation to what is considered of benefit or good to the mother, parents, the child and to society and what is considered harmful to the individual, the child and society. They also expressed their opposition to the excessive use of technological intervention, preferring instead to maintain a more naturalistic approach to reproduction. This is especially significant where concerns about the welfare of the child are articulated. Copyright © 2012 Elsevier Ltd. All rights reserved.
Carrington, Betty Watts; Burst, Helen Varney
Recognized continuously by the US Department of Education since 1982 as a specialized accrediting agency, the American College of Nurse-Midwives' Division of Accreditation (DOA) accredits not only nurse-midwifery education programs at the postbaccalaureate or higher academic level as certificate and graduate programs for registered nurses (RNs), but also precertification programs for professional midwives from other countries who are licensed as RNs in the United States. The DOA also accredits midwifery education programs for non-nurses at the postbaccalaureate or higher academic level as certificate and graduate programs, and precertification programs for professional midwives from other countries. The accreditation process is a voluntary activity involving both nurse-midwifery and/or midwifery education programs and the DOA. Present plans include another expansion of recognition: to become an institutional accreditation agency for independent and proprietary schools and to continue as a programmatic accrediting agency. Since its inception, the accreditation process has been viewed as a positive development in nurse-midwifery education.
McDonald, Glenda; Jackson, Debra; Wilkes, Lesley; Vickers, Margaret H
Nurses and midwives commonly face a variety of challenges and difficulties in their everyday work. Stress, pressure, fatigue and anxiety are acknowledged sources of workplace adversity, which causes decreased perceptions of health and wellbeing. This study reports the effects of a work-based, educational intervention to promote personal resilience in a group of 14 nurses and midwives working in a busy clinical environment. The intervention encouraged participants to focus on the key characteristics of a resilient person and the elements that assisted them in their maintenance of personal resilience. The intervention also explored potential strategies for the future. Opportunities were provided for experiential learning, creative self-expression and exposure to new ideas. Primary effects of the intervention were found to benefit the participants in personal and professional areas; by enhanced confidence, self-awareness, assertiveness and self-care. This intervention had implications for the education and practice of nurses and midwives in terms of building and maintaining their personal resilience, especially those exposed to workplace adversity.
Hsieh, Evelyn J; García, Patricia J; Roca, Sayda La Rosa
To describe demographic and practice characteristics of male and female midwives in private practice (MIPPs) in 10 cities of Peru, and their role in the delivery of reproductive health care, specifically management of sexually transmitted infections (STIs). As part of an intervention trial in 10 cities in the provinces of Peru designed to improve STI management, detailed information was collected regarding the number of midwives in each city working in various types of practices. A door-to-door survey of all medical offices and institutions in each city was conducted. Each MIPP encountered was asked to answer a questionnaire regarding demographics, training, practice type(s), number of STI cases seen per month, and average earnings per consultation. Of the 905 midwives surveyed, 442 reported having a private practice, either exclusively or concurrently with other clinical positions; 99.3% of these MIPPs reported managing STI cases. Andean cities had the highest density of MIPPs, followed by jungle and coastal cities, respectively. Jungle cities had the largest proportion of male MIPPs (35.5%). While both male and female MIPPs reported seeing male patients, male MIPPs saw a significantly greater number than their female counterparts. In areas of Peru where physicians are scarce, MIPPs provide needed reproductive health services, including STI management. Male MIPPs in particular appear to serve as health care providers for male patients with STIs. This trend, which may exist in other developing countries with similar healthcare workforce demographics, highlights the need for new areas of training and health services research.
Finnbogadóttir, Hafrún; Dykes, Anna-Karin
to explore midwives' awareness of and clinical experience regarding domestic violence among pregnant women in southern Sweden. an inductive qualitative design, using focus groups interviews. midwives with experience of working in antenatal care (ANC) units connected to two university hospitals in southern Sweden. Participants 16 midwives recruited by network sampling and purposive sampling, divided into four focus groups of three to five individuals. five categories emerged: 'Knowledge about 'the different faces' of violence', perpetrator and survivor behaviour, and violence-related consequences. 'Identified and visible vulnerable groups', 'at risk' groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. 'Barriers towards asking the right questions', the midwife herself could be an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, fear of the perpetrator and presence of the partner at visits to the midwife. 'Handling the delicate situation', e.g. the potential conflict between the midwife's professional obligation to protect the pregnant woman and the unborn baby who is exposed to domestic violence and the survivor's wish to avoid interference. 'The crucial role of the midwife', insufficient or non-existent support for the midwife, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category 'Failing both mother and the unborn baby' which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: avoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the
Moniz, Michelle H; Roosevelt, Lee; Crissman, Halley P; Kobernik, Emily K; Dalton, Vanessa K; Heisler, Michele H; Low, Lisa Kane
Immediate postpartum long-acting, reversible contraception (LARC)-providing intrauterine devices (IUDs) and contraceptive implants immediately following birth-is an effective strategy to prevent unintended pregnancies and improve birth spacing. We measured US certified nurse-midwives' (CNMs') and certified midwives' (CMs') knowledge, training needs, current practice, and perceived barriers to providing immediate postpartum LARC. We invited currently practicing CNM and CM members of the American College of Nurse-Midwives to complete an online survey about their knowledge and experience with the use of LARC and analyzed eligible questionnaires using descriptive statistics. Of 4609 eligible midwives, 794 responded (17% response rate). Most were female (99.5%) and non-Hispanic white (92.1%), with 45.0% attending births in urban settings. Responses revealed multiple knowledge gaps related to IUD expulsion rates and appropriateness of immediate postpartum LARC in certain clinical scenarios. Only 10.1% of respondents reported feeling confident to insert an immediate postpartum IUD and 43.3% an implant. Many reported desiring additional training in immediate postpartum IUD (63.5%) and implant (22.8%) insertion; few reported access to such training (IUD, 19.9%; implant, 15.2%). Most respondents had never inserted an immediate postpartum IUD (90.7%) or implant (86.8%). The most commonly cited barriers to immediate postpartum LARC provision were that it is not standard practice (IUD, 40.9%; implant, 39.0%) or is not available (IUD, 27.8%; implant, 34.8%) at one's institution and feeling inadequately trained (IUD, 26.5%; implant, 10.7%). Nine in 10 midwife respondents have never inserted an IUD or implant immediately postpartum, but more than half indicated they would like the opportunity to provide these services. Our findings highlight opportunities to enhance the immediate postpartum LARC-related knowledge and skills of the midwife workforce. They also suggest that logistic
Turkmani, Sabera; Currie, Sheena; Mungia, Jaime; Assefi, Nassim; Javed Rahmanzai, Ahmed; Azfar, Pashtun; Bartlett, Linda
over the last decade Afghanistan has made large investments in scaling up the number of midwives to address access to skilled care and the high burden of maternal and newborn mortality. at the request of the Ministry of Public Health (MOPH) an evaluation was undertaken to improve the pre-service midwifery education programme through identification of its strengths and weaknesses. The qualitative component of the evaluation specifically examined: (1) programme strengths; (2) programme weaknesses; (3) perceptions of the programme's community impact; (4) barriers to provision of care and challenges to impact; (5) perceptions of the recently graduated midwife's field experience, and (6) recommendations for programme improvement. the evaluation used a mixed methods approach that included qualitative and quantitative components. This paper focuses on the qualitative components which included in-depth interviews with 138 graduated midwives and 20 key informants as well as 24 focus group discussions with women. eight provinces in Afghanistan with functioning and accredited midwifery schools between June 2008 and November 2010. midwives graduated from one of the two national midwifery programmes: Institute of Health Sciences and Community Midwifery Education. Key informants comprised of stakeholders and female residents of the midwives catchment areas. midwives described overall satisfaction with the quality of their education. Midwives and stakeholders perceived that women were more likely to use maternal and child health services in communities where midwives had been deployed. Strengths included evidence-based content, standardised materials, clinical training, and supportive learning environment. Self-reported aspects of the quality education in respect to midwives empowerment included feeling competent and confident as demonstrated by respect shown by co-workers. Weaknesses of the programme included perceived low educational requirement to enter the programme and
Stern, J; Bodin, M; Grandahl, M; Segeblad, B; Axén, L; Larsson, M; Tydén, T
How is the reproductive life plan (RLP) adopted in midwifery contraceptive counselling? A majority of midwives adopted the RLP in their counselling, had predominantly positive experiences and considered it a feasible tool for promoting reproductive health. The RLP is a health-promoting tool recommended by the Centers for Disease Control and Prevention in the USA for improving preconception health. It was recently used in a clinical setting in Sweden and was found to increase women's knowledge about fertility and to influence women's wishes to have their last child earlier in life. An exploratory mixed methods study among 68 midwives who provided contraceptive counselling in primary health care to at least 20 women each during the study period. Midwives received an introduction and materials for using the RLP in contraceptive counselling. Three months later, in the spring of 2014, they were invited to complete a questionnaire and participate in a focus group interview about their adoption of the RLP. Data collection was through a questionnaire (n = 53 out of 68; participation rate 78%) and five focus group interviews (n = 22). Participants included both younger and older midwives with longer and shorter experiences of contraceptive counselling in public and private health care in one Swedish county. Quantitative data were analysed for differences between users and non-users, and qualitative data were analysed by qualitative content analysis to explore the midwives experiences and opinions of using the RLP. Sixty-eight per cent of midwives had used the RLP in their contraceptive counselling. Four categories emerged through the focus group interviews: (i) A predominantly positive experience; (ii) The RLP-a health-promoting tool; (iii) individual and societal factors influence the RLP counselling; and (4) long-term implementation comprises opportunities, risks and needs. The most common reason for not using the RLP was lack of information. There was general lack of
National Oceanic and Atmospheric Administration, Department of Commerce — Fishing sectors were established in the Greater Atlantic region in 2010 under catch share management initiatives. Sector data kept at GARFO is mostly a collection of...
McLachlan, Helen; McKay, Heather; Powell, Rhonda; Small, Rhonda; Davey, Mary-Ann; Cullinane, Fiona; Newton, Michelle; Forster, Della
to explore midwives' and doctors' views and experiences of publicly-funded homebirthing models. cross-sectional survey implemented two years after the introduction of publicly-funded homebirthing models. two public hospitals in Victoria, Australia. midwives and doctors (obstetric medical staff). midwives' and doctors' views regarding reasons women choose home birth; and views and experiences of a publicly-funded home birth program, including intrapartum transfers. of the 44% (74/167) of midwives who responded to the survey, the majority (86%) supported the introduction of a publicly-funded home birth model, and most considered that there was consumer demand for the model (83%). Most thought the model was safe for women (77%) and infants (78%). These views were stronger amongst midwives who had experience working in the program (compared with those who had not). Of the 25% (12/48) of doctors who responded, views were mixed; just under half-supported the introduction of a publicly-funded home birth model, and one was unsure. Doctors also had mixed views about the safety of the model. One third agreed it was safe for women, one third were neutral and one third disagreed. Half did not believe the home birth model was safe for infants. The majority of midwives (93%) and doctors (75%) believed that intrapartum transfers from home to hospital were easier when the homebirthing midwife was a member of the hospital staff (as is the case with these models). responding midwives were supportive of the introduction of publicly-funded home birth, whereas doctors had divergent views and some were concerned about safety. To ensure the success of such programs it is critical that all key stakeholders are engaged at the development and implementation stages as well as in the ongoing governance. Copyright © 2016 Elsevier Ltd. All rights reserved.
Jarosova, Darja; Gurkova, Elena; Ziakova, Katarina; Nedvedova, Daniela; Palese, Alvisa; Godeas, Gloria; Chan, Sally Wai-Chi; Song, Mi Sook; Lee, Jongwon; Cordeiro, Raul; Babiarczyk, Beata; Fras, Malgorzata
There is a considerable amount of empirical evidence to indicate a positive association between an employee's subjective well-being and workplace performance and job satisfaction. Compared with nursing research, there is a relative lack of consistent scientific evidence concerning midwives' subjective well-being and its determinants related to domains of job satisfaction. The purpose of the study was to examine the association between the domains of job satisfaction and components of subjective well-being in hospital midwives. This cross-sectional descriptive study involved 1190 hospital midwives from 7 countries. Job satisfaction was measured by the McCloskey/Mueller Satisfaction Scale. Subjective well-being was conceptualized in the study by the 2 components (the affective and the cognitive component). The affective component of subjective well-being (ie, emotional well-being) was assessed by the Positive and the Negative Affect Scale. The cognitive component of subjective well-being (ie, life satisfaction) was measured by the Personal Well-Being Index. Pearson correlations and multiple regression analyses were used to determine associations between variables. Findings from correlation and regression analyses indicated an overall weak association between the domains of job satisfaction and components of subjective well-being. Satisfaction with extrinsic rewards, coworkers, and interaction opportunities accounted for only 13% of variance in the cognitive component (life satisfaction). The affective component (emotional well-being) was weakly associated with satisfaction with control and responsibility. The low amount of variance suggests that neither component of subjective well-being is influenced by the domains of job satisfaction. Further studies should focus on identifying other predictors of subjective well-being among midwives. A better understanding of how specific job facets are related to the subjective well-being of midwives might assist employers in the
Calvert, Susan; Smythe, Elizabeth; McKenzie-Green, Barbara
to present a grounded theory research study explaining how New Zealand midwives maintain their ongoing competence to practise their profession. grounded theory, an interpretive emergent research methodology was used to examine the process of maintaining competence in midwifery practice. New Zealand urban and rural practice settings. twenty-six midwives from across New Zealand were interviewed and asked about maintaining their competence to practise. Five midwives were interviewed twice, to explore the emerging findings and as one method of member checking. the grounded theory of 'working towards being ready' describes a continuous process in which midwives engage as they work to maintain practice competence. The component parts comprise professional positioning, identifying needs, strategizing solutions and reflecting on practice. The process is contextual, diverse and is influenced by the practice setting where the salient conditions of resourcing, availability and opportunity for engagement in activities are significant. across the midwifery profession, midwives in New Zealand are currently working under the generic umbrella of midwifery practice. Midwives work across a range of practice arenas in diverse ways focussed on providing safe care and require a range of professional development activities germane to their area of practice. When the midwife has access to professional development pertinent to their practice, women and the profession benefit. As there is diversity of practice, then mandated processes for ongoing competence need to have flexibility to reflect that diversity. midwives engage in development that allows them to remain current in practice and that enables them to provide appropriate care to women and their babies. As a consequence they can develop expertise in certain aspects of midwifery. Mandated processes that require engagement in activities aimed at demonstration of competence should be evaluated and tailored to ensure they meet the needs
Davis, Deborah; Foureur, Maralyn; Clements, Vanessa; Brodie, Patricia; Herbison, Peter
Graduates from a new, 3-year Bachelor of Midwifery program joined those educated through the 1 year, postgraduate route (for those already qualified as nurses) for the first time in New South Wales (NSW) Australia in 2007. Many hospitals offer transition support programs for new graduates during their first year of practice though there is little evidence available to inform these programs. To establish the new midwife's confidence in working to the 14 "National Competency Standards for the Midwife"(1) and the International Confederation of Midwives (ICM) Definition of a Midwife and to explore whether the new midwife's confidence changed over the new graduate year. In particular the study set out to determine whether there were any differences in the confidence of new graduates from undergraduate or postgraduate programs. Pre and post survey with comparisons longitudinally and within undergraduate and postgraduate cohorts. Three Area Health Services in Sydney and surrounding areas, Australia. A convenience sample of all new graduate midwives employed in the three Area Health Services in the early months of 2008. New graduate midwives rated their level of confidence (1-10) in working to the 14 National Competency Standards for the Midwife and the ICM Definition of a Midwife during their first weeks of employment and after the completion of their first year of practice. Midwives prepared through the undergraduate and postgraduate routes commenced their first year of practice with similar levels of confidence. The confidence of these midwives increased modestly over the first year of practice. Those from postgraduate programs were significantly more confident than those from undergraduate programs on four competencies after the first year of practice. Participant's self reported confidence in working to the ICM Definition of a Midwife was low. Our profession and community need strong, confident midwives and it is in all our interests to look to ways we can best
Robertson, Judith H; Thomson, Ann M
to explore how midwives׳ personal involvement in clinical negligence litigation affects their midwifery practice. descriptive phenomenological study using semi-structured interviews. in 2006-2007 in-depth interviews were conducted in participants׳ homes or at their place of work and focused on participants׳ experience of litigation. Participants were recruited from various regions of England. 22 National Health Service (NHS) midwives who had been alleged negligent. clinical practice affected was an increase in documentation, fear of practising outside clinical guidelines and electronic fetal monitoring of women at low obstetric risk; these changes were not widespread. Changes in practice were sometimes perceived negatively and sometimes positively. Forming a good relationship with childbearing women was judged to promote effective midwifery care but litigation had affected the ability of a minority of midwives to advocate for women if this relationship had not been established. Litigation could result in loss of confidence leading to self-doubt, isolation, increased readiness to seek medical assistance and avoidance of working in the labour ward, perceived as an area with a high risk of litigation. A blame culture in the NHS was perceived by several midwives. In contrast an open non-punitive culture resulted in midwives readily reporting mistakes to risk managers. Litigation lowered midwifery morale and damaged professional reputations, particularly when reported in the newspapers. Some midwives expressed thoughts of leaving midwifery or taking time off work because of litigation but only one was actively seeking other employment, another took sick leave and one had left midwifery and returned to nursing. litigation can have a negative effect on midwives׳ clinical practice and morale and fosters a culture of blame within the NHS. education regarding appropriate documentation, use or non-use of electronic fetal monitoring and the legal status of clinical
Lyberg, Anne; Severinsson, Elisabeth
The aim of the present study was to describe the midwives' supervisory style and leadership role as experienced by pregnant women and new mothers in the context of a fear of childbirth. A service led by midwives can influence the quality of care. The sample consisted of 13 mothers. Data were interpreted by means of qualitative content analysis. The findings revealed that the midwives' supervisory styles were related to their ability to create a trusting and caring relationship, demonstrate problem-solving capacity, and showing willingness, preparedness and courage to support the women. The midwives' leadership role was described as involving a crucial set of professional management skills and techniques. The findings have strengthened the argument for the provision of continuity of care to women who are afraid of childbirth. Further studies should focus more specifically on the implementation of research in practice. It is necessary for midwives to demonstrate leadership in order to develop practice, predict challenges and changes, provide different care delivery models and acquire an evidence base for care. This also demands systematic supervision to improve care outcomes.
Blanco-Muñoz, J; Castañeda-Camey, X
An evaluation of the perception, resources and practices regarding abortion of traditional midwives in a rural area in the municipality of Yecapixtla, state of Morelos, located in the central region of Mexico. A qualitative methodology consisting of a detailed interview, focal groups and participating observation, was used. The subjects investigated were socio-cultural aspects, reproduction, sexuality and health related to abortion. Nine midwives were interviewed and a focal group was formed in which 16 midwives participated. The results demonstrated a profound rejection of abortion whether inducted or spontaneous. The former was considered a major sin and the latter a serious failure of a womańs reproductive function. Women who abort are called "pigs", "hogs" or "bitches" and the midwives are reluctant to attend them. However, a common practice among the women in the community is to "regulate the menstruation", that is, to use substances that provoke menstruation when this is delayed. This specific practice is not considered abortive by these women. Local popular beliefs about abortion are indispensible for the construction of effective strategies, which when provided by the institutional health services, reinforce the bonds between these and the traditional midwives in such a way as to increase accessibility to the health services as well as the quality of care to women.
Mcdonald, Glenda; Jackson, Debra; Vickers, Margaret H; Wilkes, Lesley
To explore the experiences of Australian nurses and midwives who perceived themselves as resilient. The focus of this paper is to report the strategies used by a group of nurses and midwives to develop and maintain their resilience, despite encountering serious workplace adversity. Despite the potentially adverse effects of nursing work, many nurses and midwives thrive through exercising self-efficacy and coping skills. The relationship between thriving and resilience is clear, as resilience refers to the ability to cope well with adversity and change. The participants were part of an instrumental, collective case study investigation of personal resilience amongst nurses and midwives. Prior to an innovative, work-based intervention including workshops and mentoring, participants were interviewed to collect baseline perceptions and experiences of personal resilience and workplace adversity. Interview transcripts were analysed thematically. Participants attributed their ability to thrive in the workplace to three major influences: support networks, personal characteristics and ability to organise work for personal resilience. Participant insights contributed to a deeper understanding of personal resilience and highlight future initiatives to enhance the ability of nurses and midwives to thrive within health organisations and systems. It is vital that resilience-enhancing initiatives, such as peer mentoring and tailored work options to increase autonomy, are implemented at earlier career phases. © 2015 John Wiley & Sons Ltd.
Turnbull, Deborah; Adelson, Pamela; Oster, Candice; Coffey, Judy; Coomblas, John; Bryce, Robert; Wilkinson, Chris
Induction of labour often begins with the application of a priming agent to soften the cervix, generally requiring women to stay in hospital overnight (inpatient priming). An alternative is outpatient priming by a midwife, where women are allowed to go home following priming. This approach has the potential to impact, either positively or negatively, on the midwives involved. To what extent did the introduction of outpatient priming influence midwives' work demands, work autonomy, stress and job satisfaction. A before-after study (with two separate cross-sectional samples) was conducted alongside a randomized controlled trial of outpatient versus inpatient priming, conducted at two metropolitan teaching hospitals in Australia. Midwives completed a questionnaire before the introduction of outpatient priming and again approximately two years later. 208 midwives participated (response rates-time 1:81% (87/108); time 2:78% (121/156)). A mixed model analysis test of pre-post intervention differences found no changes in work demand, work autonomy and satisfaction. At time 2, over 80% of midwives reported that the introduction of the practice had reduced or made no difference to their work stress and workload, and 93% reported that outpatient priming had increased or had no impact on their job satisfaction. Furthermore, 97% of respondents were of the opinion that the option of outpatient priming should continue to be offered. Results suggest that outpatient priming for induction of labour is viable from a midwifery practice perspective, although more research is needed. Copyright © 2013. Published by Elsevier Ltd.
Pratibha A Chandekar
Full Text Available Background: It is desirable to have skilled midwives to provide competent care in hospital and community setting. Aims and Objectives: The objectives were to assess curriculum adequacy, preparedness and job preferences of prospective nurses. Materials and Methods: A descriptive survey was used for the study. Thestudy was carried out at nursing institutes in Ahmednagar District, Maharashtra, India. The participants were the 200 prospective Nurses(final year Nursing students of General Nursing and B.Sc Nursing Programme, who had undergone midwifery examination. A semi structured questionnaire with self report technique method was used. Results: 20.57% and 89.1% students respectively felt that, thetheory input and allotted clinical hours were adequate. During the clinical posting, 29.7% felt that they did not get the opportunity to work in midwifery sections. 33.1% students expressed that they did not get cases as per the requirement prescribed by Indian NursingCouncil.13.7% and 33.7% students respectively agreed that they lacked confidence to perform abdominal palpation of antenatal cases & conduct deliveries independently. A few (26.2% expressed their inability to resuscitate the newborn. 89.1% said that they needed more experience to work independently as midwives. Everyone felt the need of in-service education and majority (77.2% felt that its duration should be either three months or more. Conclusion: Present study reveals that only 7% of the prospective nurses are ready to work in midwifery section. Only 13.7% of the prospective nurses are ready to work in rural area. Since there is a shortfall of 70.02% forspeciality of obstetrics and gynecology in rural health (GOI, 1997, and there are only 40 qualified nurse midwives per 100,000 births inIndia or only one midwife for 2500 births in rural areas, it is imperative to strengthen midwifery training to bridge this gap.
McLelland, Gayle; Hall, Helen; Gilmour, Carole; Cant, Robyn
to explore the views of midwives and maternal-child health nurses regarding factors that influence breast feeding initiation and continuation, focusing on how support for women could be improved to increase breast feeding duration. a focus group study. hospital or domiciliary (home-visiting) midwives and community-based maternal and child health (MCH) nurses in one region of Victoria, Australia. twelve MCH nurses and five midwives who provided supportive services to women in the immediate postnatal period attended one of three audio-recorded focus groups. Thematic findings were identified. four key themes were: 'Guiding women over breast-feeding hurdles', 'Timing, and time to care'; 'Continuity of women's care' and 'Imparting professional knowledge'. Given the a pattern of hospital discharge of mother and infant on day one or day two after birth, participants thought the timing of immediate postnatal breast-feeding support was critical to enable women to initiate and continue breast feeding. Community-based MCH nurses reported time gaps in uptake of new mother referrals and time-pressured face-to-face consultations. Both groups perceived barriers to continuity of women's care. health services subscribe to the Baby Friendly Health Initiative and government policies which support breast feeding, however providers described time pressures and a lack of continuity of women's care, including during transition from hospital to community services. there is a need to examine administration of service delivery and how domiciliary and community nurses can collaborate to establish and maintain supportive relationships with breast feeding women. Copyright © 2014 Elsevier Ltd. All rights reserved.
Drennan, Vari; Davis, Kathy; Goodman, Claire; Humphrey, Charlotte; Locke, Rachel; Mark, Annabelle; Murray, Susan F; Traynor, Michael
This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$''social enterprise$''mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors.
Butler, Michelle M
Rates of normal birth have been declining steadily over the past 20 years, despite the evidence of the benefits to mother and baby. This is most obvious in steadily increasing caesarean section rates across countries and studies of the factors involved suggest it may be more to do with the organization of maternity care and the preferences of healthcare providers than changes in maternal or demographic conditions. The proportion of women in British Columbia (BC) receiving care from a midwife continues to grow and there is a particular focus on promoting and supporting normal pregnancy and birth in the midwifery philosophy of care. In BC, women receiving care from a midwife are less likely to have a caesarean section and other birth interventions. An interpretive approach, based on interpretive phenomenology was used to explore the experiences of midwives in BC of normal birth and the strategies that they use to keep birth normal. Fourteen experienced midwives were purposively selected from across the range of practice, geographical, and rural/urban contexts to participate in depth interviews. Data were analyzed using Thematic Network Analysis. Seven key themes were identified in the data: working with women from the early pregnancy, informing choice, the birth environment, careful watching and waiting, managing early labour, helping the woman to cope with labour, and tools in the tool kit. Midwives in BC work closely with women from early pregnancy to prepare them for a normal birth, and as "instruments of care" they adopt a range of approaches to support women to achieve this. The emphasis on continuity of care in the BC model of midwifery care plays a vital role in this.
Full Text Available Background: According to the so called Transactional Model of Quality of Life, job satisfaction is a part of subjective well-being. The aim of this study was to explore the relationships between professional commitment, expressed as job satisfaction or dissatisfaction, consideration of leaving the profession or/and workplace, and subjective assessment of well-being among midwives working at hospitals. Materials and Methods: The study was a part of the international research project, coordinated by the University of Ostrava. The group of respondents consisted of 176 midwives working at selected hospitals in the Silesian region. The study was conducted using the method of diagnostic survey, questionnaire techniques and standardized research tools, such as McCloskey/Mueller Satisfaction Scale (MMSS, Personal Wellbeing Index-Adult (PWI-A and Subjective Emotional Habitual Wellbeing Scale (SEHP. Results: The overall midwives' job satisfaction was found to be at a medium level. Respondents less satisfied with various aspects of work (interaction, co-workers, professional opportunities, praise/recognition, control/responsibility and life (standard of living and achievements in life were significantly more often considering changing their jobs. Dissatisfaction with the extrinsic rewards (salary, vacation, benefits package had additionally influenced the frequency of considering changing the profession. The respondents were characterized by much lower sense of present and future security than that observed in Western countries, as well as by low satisfaction with standard of living and feeling part of the society. Conclusions: Job satisfaction and subjective well-being remain in strong relationship, and although it is difficult to determine the direction of these relationships, they seem to have a significant impact on each other. Med Pr 2014;65(1:99–108
Ross, Linda; Giske, Tove; van Leeuwen, René; Baldacchino, Donia; McSherry, Wilfred; Narayanasamy, Aru; Jarvis, Paul; Schep-Akkerman, Annemiek
The spiritual part of life is important to health, well-being and quality of life. Spiritual care is expected of nurses/midwives, but it is not clear how students can achieve competency in spiritual care at point of registration as required by regulatory bodies. To explore factors contributing to undergraduate nurses'/midwives' perceived competency in giving spiritual care. A pilot cross-sectional, multinational, correlational survey design. Questionnaires were completed by 86% (n=531) of a convenience sample of 618 undergraduate nurses/midwives from six universities in four countries in 2010. Bivariate and multivariate analyses were performed. Differences between groups were small. Two factors were significantly related to perceived spiritual care competency: perception of spirituality/spiritual care and student's personal spirituality. Students reporting higher perceived competency viewed spirituality/spiritual care broadly, not just in religious terms. This association between perceived competency and perception of spirituality is a new finding not previously reported. Further results reinforce findings in the literature that own spirituality was a strong predictor of perceived ability to provide spiritual care, as students reporting higher perceived competency engaged in spiritual activities, were from secular universities and had previous healthcare experience. They were also religious, practised their faith/belief and scored highly on spiritual well-being and spiritual attitude/involvement. The challenge for nurse/midwifery educators is how they might enhance spiritual care competency in students who are not religious and how they might encourage students who hold a narrow view of spirituality/spiritual care to broaden their perspective to include the full range of spiritual concerns that patients/clients may encounter. Statistical models created predicted factors contributing to spiritual care competency to some extent but the picture is complex requiring
Ament, L A; Hanson, L
In one model of the future, certified nurse-midwives (CNMs) replace most obstetric residents and house staff in hospitals. This model offers numerous benefits, such as cost containment and quality outcomes. Furthermore, its application could open opportunities for educating CNMs and residents in a truly collaborative model in an educational setting and begin to balance the ratio of physicians to CNMs in the care of low-risk populations. This model was used with some success in the late 1980s to early 1990s at an inner-city Midwestern medical center. By definition, CNMs are educated in the two disciplines of nursing and midwifery and possess evidence of certification according to the requirements of the American College of Nurse Midwives (ACNM, 1978). Nurse-midwifery practice is the independent management of care of normal newborns and women, antepartally, intrapartally, postpartally, and/or gynecologically. Certified Nurse Midwifery practice occurs within a health care system that provides for medical consultation, collaborative management, and referral (ACNM, 1978). Physician and CNM roles differ. Certified nurse-midwives focus on supporting the process of normal birth, whereas physicians focus more on the management of complications. There are data that suggest that CNM outcomes are equivalent to those of physicians (American Nurses Association, 1992; Thompson, 1986; Wilson, 1989); that CNM costs are less than those of physicians (Bell & Mills, 1989; Cherry & Foster, 1982; Gravely & Littlefield, 1992; Rooks, 1986); and that the cost of educating CNMs is much less than the cost of educating physicians (Safriet, 1992). Within an environment of health care reform and cost containment, CNMs can replace residents and house staff in hospitals in the care of low-risk clients and work in consultation with physicians for the care of high-risk clients. This article compares medical education and nurse-midwifery education, reviews nurse-midwifery outcome data, and discusses
Evelyn J. Hsieh
Full Text Available OBJECTIVES: To describe demographic and practice characteristics of male and female midwives in private practice (MIPPs in 10 cities of Peru, and their role in the delivery of reproductive health care, specifically management of sexually transmitted infections (STIs. METHODS: As part of an intervention trial in 10 cities in the provinces of Peru designed to improve STI management, detailed information was collected regarding the number of midwives in each city working in various types of practices. A door-to-door survey of all medical offices and institutions in each city was conducted. Each MIPP encountered was asked to answer a questionnaire regarding demographics, training, practice type(s, number of STI cases seen per month, and average earnings per consultation. RESULTS: Of the 905 midwives surveyed, 442 reported having a private practice, either exclusively or concurrently with other clinical positions; 99.3% of these MIPPs reported managing STI cases. Andean cities had the highest density of MIPPs, followed by jungle and coastal cities, respectively. Jungle cities had the largest proportion of male MIPPs (35.5%. While both male and female MIPPs reported seeing male patients, male MIPPs saw a significantly greater number than their female counterparts. CONCLUSIONS: In areas of Peru where physicians are scarce, MIPPs provide needed reproductive health services, including STI management. Male MIPPs in particular appear to serve as health care providers for male patients with STIs. This trend, which may exist in other developing countries with similar healthcare workforce demographics, highlights the need for new areas of training and health services research.
Background Australia has an enviable record of safety for women in childbirth. There is nevertheless growing concern at the increasing level of intervention and consequent morbidity amongst childbearing women. Not only do interventions impact on the cost of services, they carry with them the potential for serious morbidities for mother and infant. Models of midwifery have proliferated in an attempt to offer women less fragmented hospital care. One of these models that is gaining widespread consumer, disciplinary and political support is caseload midwifery care. Caseload midwives manage the care of approximately 35-40 a year within a small Midwifery Group Practice (usually 4-6 midwives who plan their on call and leave within the Group Practice.) We propose to compare the outcomes and costs of caseload midwifery care compared to standard or routine hospital care through a randomised controlled trial. Methods/design A two-arm RCT design will be used. Women will be recruited from tertiary women's hospitals in Sydney and Brisbane, Australia. Women allocated to the caseload intervention will receive care from a named caseload midwife within a Midwifery Group Practice. Control women will be allocated to standard or routine hospital care. Women allocated to standard care will receive their care from hospital rostered midwives, public hospital obstetric care and community based general medical practitioner care. All midwives will collaborate with obstetricians and other health professionals as necessary according to the woman's needs. Discussion Data will be collected at recruitment, 36 weeks antenatally, six weeks and six months postpartum by web based or postal survey. With 750 women or more in each of the intervention and control arms the study is powered (based on 80% power; alpha 0.05) to detect a difference in caesarean section rates of 29.4 to 22.9%; instrumental birth rates from 11.0% to 6.8%; and rates of admission to neonatal intensive care of all neonates from 9
Leis, M.; Gijsbers, G.; Zee, F. van der
The food and drinks manufacturing industry is a diverse and complex sector. There are ample possibilities for performance improvement and innovation in the food and drinks industry as well as a variety of challenges ranging from a lack of financial and human resources, fragmented consumer interests
At the beginning of July, cool-down is starting in the second LHC sector, sector 4-5. The cool down of sector 4-5 may occasionally generate mist at Point 4, like that produced last January (photo) during the cool-down of sector 7-8.Things are getting colder in the LHC. Sector 7-8 has been kept at 1.9 K for three weeks with excellent stability (see Bulletin No. 16-17 of 16 April 2007). The electrical tests in this sector have got opt to a successful start. At the beginning of July the cryogenic teams started to cool a second sector, sector 4-5. At Point 4 in Echenevex, where one of the LHC’s cryogenic plants is located, preparations for the first phase of the cool-down are underway. During this phase, the sector will first be cooled to 80 K (-193°C), the temperature of liquid nitrogen. As for the first sector, 1200 tonnes of liquid nitrogen will be used for the cool-down. In fact, the nitrogen circulates only at the surface in the ...
Quinn, Peter Joseph
The SKA will be capable of producing a stream of science data products that are Exa-scale in terms of their storage and processing requirements. This Google-scale enterprise is attracting considerable international interest and excitement from within the industrial and academic communities. In this paper we examine the data flow, storage and processing requirements of a number of key SKA survey science projects to be executed on the baseline SKA1 configuration. Based on a set of conservative assumptions about trends for HPC and storage costs, and the data flow process within the SKA Observatory, it is apparent that survey projects of the scale proposed will potentially drive construction and operations costs beyond the current anticipated SKA1 budget. This implies a sharing of the resources and costs to deliver SKA science between the community and what is contained within the SKA Observatory. A similar situation was apparent to the designers of the LHC more than 10 years ago. We propose that it is time for the SKA project and broader community to consider the effort and process needed to design and implement a distributed science data system that leans on the lessons of other projects and looks to recent developments in Cloud technologies to ensure an affordable, effective and global achievement of science goals.
Full Text Available The Maternity of Port-Royal, founded in Paris in 1795, was a model establishment which, besides specializing in childbirth, functioned as a school for midwives, being one of the few that provided clinical instruction. This article analyzes the first hundred years of the Maternity, showing the work of head-midwives as authorities both in teaching and in the care of patients. It emphasizes the special status of the head-midwives, who managed to maintain power over medical obstetricians in spite of their criticism and struggle for dominance, and of the growing importance of the latter in 19th-century medical and hospital organization. The analysis points to the need for further research about other French and European schools in order to better evaluate the experience of midwifery in those times.
Bagny, A; Bathaix Yao, F; Bangoura, D; Kouame, D H; Kacou Ya Kissi-Anzouan, H; De, O; Diallo, K; Lawson-Ananisoh, L M; Mahassadi, K A; Attia Koffi, A; Ndri-Yoman, T
Prevention of mother-to-child transmission of hepatitis B virus (HBV) assumes and requires good practices by midwives. The objective of this study was to evaluate their practices for this prevention. This prospective, descriptive study in Abidjan took place from January 2 to May 31, 2014 and included the midwives in Abidjan (recruited from university hospitals, general hospitals, and peripheral health care facilities) at the time of the survey who agreed to complete this written survey. Univariate analyses were done with Pearson Chi 2 tests or Fisher's test, as appropriate, Ppractices, including HBsAg testing (P = 0.023) and immunization of the newborn at birth (P = 0.005). Midwives' practices for the prevention of mother-to-child transmission of HBV in Abidjan are improving.
Casey, Mary; Cooney, Adeline; O' Connell, Rhona; Hegarty, Josephine-Mary; Brady, Anne-Marie; O' Reilly, Pauline; Kennedy, Catriona; Heffernan, Elizabeth; Fealy, Gerard; McNamara, Martin; O' Connor, Laserina
To present the qualitative findings from a study on the development of scheme(s) to give evidence of maintenance of professional competence for nurses and midwives. Key issues in maintenance of professional competence include notions of self- assessment, verification of engagement and practice hours, provision of an evidential record, the role of the employer and articulation of possible consequences for non-adherence with the requirements. Schemes to demonstrate the maintenance of professional competence have application to nurses, midwives and regulatory bodies and healthcare employers worldwide. A mixed methods approach was used. This included an online survey of nurses and midwives and focus groups with nurses and midwives and other key stakeholders. The qualitative data are reported in this study. Focus groups were conducted among a purposive sample of nurses, midwives and key stakeholders from January-May 2015. A total of 13 focus groups with 91 participants contributed to the study. Four major themes were identified: Definitions and Characteristics of Competence; Continuing Professional Development and Demonstrating Competence; Assessment of Competence; The Nursing and Midwifery Board of Ireland and employers as regulators and enablers of maintaining professional competence. Competence incorporates knowledge, skills, attitudes, professionalism, application of evidence and translating learning into practice. It is specific to the nurse's/midwife's role, organizational needs, patient's needs and the individual nurse's/midwife's learning needs. Competencies develop over time and change as nurses and midwives work in different practice areas. Thus, role-specific competence is linked to recent engagement in practice. © 2016 John Wiley & Sons Ltd.
Burns, E; Schmied, V; Fenwick, J; Sheehan, A
Midwives are the main health professional group providing support and assistance to women during the early establishment of breastfeeding. In published accounts of early breastfeeding experiences women report high levels of dissatisfaction with health professional support. To gain an understanding of this dissatisfaction, we examined the way in which midwives represent breastmilk and construct breastfeeding women in their interactions. Seventy seven women and seventy six midwives at two maternity units in NSW, Australia, participated in this study. Eighty five interactions between a midwife and a breastfeeding woman were observed and audio recorded during the first week after birth. In addition, data were collected through observation of nine parenting education sessions, interviews with 23 women following discharge, and 11 managers and lactation consultants (collected between October 2008 and September 2009). Discourse analysis was used to analyse the transcribed interactions, and interview data. The analysis revealed that midwives prioritised both colostrum and mature breastmilk as a 'precious resource', essential for the health and wellbeing of the infant and mother. References to breastmilk as 'liquid gold' were both verbal and implied. Within this discourse, the production and acquisition of 'liquid gold' appeared to be privileged over the process of breastfeeding and women were, at times, positioned as incompetent operators of their bodily 'equipment', lacking knowledge and skill in breastfeeding. In this context breastfeeding became constructed as a manufacturing process for a demanding consumer. The approach taken by midwives revealed an intensive focus on nutrition to the exclusion of relational communication and support. The findings indicate the need to challenge the current 'disciplinary' and 'technological' practices used by midwives when providing breastfeeding support and the need for a cultural change in postnatal care. Copyright © 2012 Elsevier
Dixon, Lesley; Calvert, Susan; Tumilty, Emma; Kensington, Mary; Gray, Elaine; Lennox, Sue; Campbell, Norma; Pairman, Sally
the transition from undergraduate midwifery student to working as a confident midwife can be challenging for many newly qualified midwives. Supporting a smooth transition may have a positive impact on the confidence and retention of the new graduates within the workforce. In New Zealand the Midwifery First Year of Practice programme (MFYP) was introduced in 2007 as a structured programme of support for new graduate midwives for the whole of their first year of practice. The main components of the programme include support during clinical practice, provision of a funded mentor midwife chosen by the new graduate midwife, financial assistance for education and a requirement to undertake a quality assessment and reflection process at the end of the first year. the aim of this study was to explore the retention of new graduates in midwifery practice following participation in the Midwifery First Year of Practice programme. data was obtained from the register of MFYP participants between the years 2007 and 2010. This data was cross referenced with the Midwifery Council of New Zealand register and workforce data for 2012. between the years 2007 and 2010 there were 441 midwives who graduated from a midwifery pre-registration education programme in New Zealand. Of these 415 participated in the MFYP programme. The majority were of New Zealand European ethnicity with 10% identifying as Māori. The mean age of participants reduced from 36.4 (SD 7.3) in 2007 to 33.4 (SD 8.1) in 2010. The overall retention rate for new graduate midwives who had participated in the MFYP programme was 86.3%, with 358 midwives still practising in 2012. there is good retention of new graduate midwives within New Zealand and the MFYP programme would appear to support retention. Copyright © 2015 Elsevier Ltd. All rights reserved.
Altinbilek, D.; Seelos, K.; Taylor, R.
equipment within existing infrastructure; this can extend the operating life by a further 30 to 50 years. Small-scale, decentralised development has been responsible for bringing light and power to remote communities. Such schemes have catalysed local commercial diversification and prosperity. The lower investment demand of smaller schemes has enabled private sector involvement through independent power production. Typically smaller schemes become grid connected if the power system is accessible, as this increases the security of supply. Furthermore, schemes at remote sites can assist transmission system stability. A further important role of smaller scale hydro is the recovery of energy at water infrastructure developed for other purposes. In many countries, large schemes play a significant role in national and regional supply security due to the flexibility of storage reservoirs and independence from fuel price fluctuations. Hydro also integrates well with other generation technologies, with its flexibility enabling thermal plants to operate steadily (saving fuel and reducing emissions). In addition, its responsiveness permits the back-up of the intermittent renewables. The question of storage is clearly a major issue in balancing supply and demand. Hydro reservoirs and pump-storage schemes offer security in the stability and reliability of power systems; they can absorb power when there is an excess and follow load demand instantaneously. A major challenge is that 'support' and 'storage' services are rarely understood and encouraged in the market-driven arena. The main arguments against hydropower concern its social impacts, such as land transformation, displacement of people, and environmental changes, i.e. fauna, flora, sedimentation and water quality. The social and environmental impacts can, however, be mitigated by taking appropriate steps according to established codes of good practice. As a tool for this purpose, the hydropower sector has recently developed and
Martin, L.; Gitsels–van der Wal, J.T.; Pereboom, M.T.R.; Spelten, E.R.; Hutton, E.K.; van Dulmen, S.
Objective: This study aimed to provide insight into Dutch midwives' self-evaluation of prenatal counseling for anomaly screening in real life practice and, the degree of congruence of midwives' self-assessments with clients' perceptions and with observed performance. Methods: Counseling sessions
Duke, Emon Umoe; Mgbekem, Mary Achi; Nsemo, Alberta David; Ojong-Alacia, Mary Manyo; Nkwonta, Chigozie A.; Mobolaji-Olajide, O. M.
This quantitative study investigated the influence of marital status on the midwives' attitude towards OSCE and how this affects their performance in the examination. Two hypotheses guided the study. HO 1 sort to find out if there exist a significant influence of marital status of midwives on their attitude towards OSCE as well as performance in…
Yigzaw, T; Ayalew, F; Kim, Y.M.; Gelagay, M; Dejene, D; Gibson, H; Teshome, A; Broerse, J.E.W.; Stekelenburg, J.
Background: Midwifery support and care led by midwives is the most appropriate strategy to improve maternal and newborn health. The Government of Ethiopia has recently improved the availability of midwives by scaling up pre-service education. However, the extent to which graduating students acquire
Yigzaw, Tegbar; Ayalew, Firew; Kim, Young-Mi; Gelagay, Mintwab; Dejene, Daniel; Gibson, Hannah; Teshome, Aster; Broerse, Jacqueline; Stekelenburg, Jelle
Background: Midwifery support and care led by midwives is the most appropriate strategy to improve maternal and newborn health. The Government of Ethiopia has recently improved the availability of midwives by scaling up pre-service education. However, the extent to which graduating students acquire
Widyawati, W.; Jans, S.M.P.J.; Utomo, S.; Dillen, J. van; Janssen, A.L.
BACKGROUND: Anemia in pregnancy remains a major problem in Indonesia over the past decade. Early detection of anaemia in pregnancy is one of the components which is unsuccessfully implemented by nurse-midwives. This study aims to explore nurse-midwives' experiences in managing pregnant women with
Vinayak, Sudhir; Sande, Joyce; Nisenbaum, Harvey
to 25 min. The unique mobile phone transmission was faultless and there was no degradation of image quality. We found excellent correlation between final outcomes of the pregnancies and diagnoses on the basis of reports generated by the midwives. Only 1 discrepancy was found in the midwives' reports...
Vermeulen, Joeri; Swinnen, Eva; D'haenens, Florence; Buyl, Ronald; Beeckman, Katrien
to explore women's preferences with regard to their preferred health professional during labour and childbirth in case of an uncomplicated pregnancy, and to gain insight into women's knowledge of the legal competences of midwives. a descriptive observational study. Brussels metropolitan region, Belgium. women in their reproductive age, living in the Brussels metropolitan region, with Dutch or French as their first language (n=830). a ten-item standardized questionnaire'Midwife Profiling Questionnaire' (MidProQ) was developed to determine which health professional respondents would prefer to assist them during labour and childbirth if there were no complications and to assess their knowledge about midwives' legal competences during pregnancy, labour and childbirth. Descriptive statistics were used to report the findings. To identify relationships between the socio-demographic variables of the women and her preferences, knowledge and opinion Chi² analysis were used. For 68.0% of the participants in an uncomplicated labour (n=564) and 66.3% of the participants with an uncomplicated childbirth (n=550), a midwife is the preferred health professional. Brussels women prefer an obstetrician in an uncomplicated labour (n=730, 88%) and for uncomplicated childbirth (n=756, 91.1%). Only 20.2% of the respondents (n=168) consider midwives to play a central role in an uncomplicated pregnancy. The knowledge of Brussels women about midwives' legal competences during pregnancy, labour and childbirth is rather poor, especially in youngsters and women who have never given birth. In general, for Brussels women, midwives are not the first preferred health professional for an uncomplicated labour or for childbirth, and they do not consider midwives to play a central role in an uncomplicated pregnancy. The legal competences of midwives are not known very well, especially by youngsters and women who have never given birth. The Belgian medical model of maternity care and women
Schytt, Erica; Waldenström, Ulla
midwifery education in many countries has been adapted to the academic system by a stronger focus on research methodology and scientific evidence. This development has often taken place without extending the programs. We were interested in exploring views about current content of midwifery education in Sweden with a focus on clinical competencies and the new research components. to investigate views about Swedish midwifery education held by students prior to graduation and after 1 year of practice, and by experienced midwives and obstetricians, with special focus on clinical competency. nationwide surveys conducted between June 2007 and January 2008, and 1 year later (follow-up of students). self-administered questionnaires completed by 171 (83%) students and 121 (59%) of these participants after 1 year of midwifery practice, and by 162 (54%) midwives and 108 (40%) obstetricians with at least 5 years of clinical experience. The responders were asked to assess predefined intrapartum competencies, which components of the education were allocated too little and too much time, and how well the education prepared for clinical practise overall. Content analysis of open-ended questions and descriptive analyses was used. most students, midwives and obstetricians were 'very' or 'fairly' satisfied with how the education prepared midwives for clinical practice and 1.8%, 4.7% and 17.6%, respectively, were dissatisfied. About half of the obstetricians and one-third of the experienced midwives rated new midwives' ability to identify deviations from normal progress as low or lacking, compared with 10% of the students. A majority found that too little time, of the 60 weeks programme, was allocated to intrapartum care and medical complications and too much time to research and writing a minor thesis. although few were dissatisfied with how midwifery education prepared for clinical practice in general, the majority of participants would have liked more time for medical complications
Shen, Jie; Cox, Annette; McBride, Anne
This study is a review of literature on the factors affecting the retention and turnover of hospital consultants and midwives. While there is widespread concern and acknowledgement of staff retention problems for professional occupations within the NHS, far less research has analysed the causes of the staff retention problems for the occupations in question. This study shows that there is a dearth of literature in this area and that systematic comparative analysis of retention and turnover factors through both primary and secondary research is urgently required in order that policy-making can take place on the basis of informed choice. Tentative initial findings were that lack of appreciation or perceptions of not being valued are key factors influencing turnover for both occupations. Working hours, workload and work schedules are also common concerns to both groups. In addition, career development, promotion and appreciation of contribution were important retention factors for midwives, while a supportive professional environment, reduction in workload and working hours and more flexible work patterns were important to consultants.
Full Text Available The incorporation of guidelines for the treatment of tobacco smoking into routine care requires positive attitudes, counselling skills and knowledge about additional help available for smokers.The study assesses performance of smoking cessation intervention, attitudes, training status and knowledge about additional help for smokers in the care for pregnant and parenting women by midwives, gynaecologists and paediatricians. A survey of all midwives, gynaecologists and paediatricians registered for primary medical care in the federal state Saarland, Germany, was conducted. Participation in the postal questionnaires was 85 %. Depending on profession, 90 % to 100 % see smoking cessation counselling as their assignment, 17 % to 80 % screen for, 48 % to 90 % document smoking status, and 55 % to 76 % offer brief or extensive counselling. 61 % to 87 % consider training to enhance their knowledge and/or counselling skills necessary. The compliance of providers with the necessity to give support in smoking cessation is very high. However, the current status of cessation counselling does not sufficiently correspond to the evidence based requirements. Reports in medical press and advanced training courses should support health care providers and establish smoking as an inherent topic of the anamnesis and treatment of current and former pregnant or parenting smokers.
Katvan, Eyal; Bartal, Nira
Until 1929, midwifery in Palestine was relatively open to anyone and only partially regulated by the 1918 Public Health Ordinance, legislated shortly after the beginning of British rule. This article describes the factors that guided the shaping of midwifery and suggests possible sources of inspiration for the British legislator in crafting the Midwives Ordinance in 1929, including American, local (Jews and Arabs), and British ones. The Midwives Ordinance reflects the adjustment of midwifery to changes in the society that evolved under the British Mandate. The ordinance shows how the modern midwife's role contracted relative to the traditional one, in the context of social processes in other countries, east and west. This historical research project is based on interviews, archive documents and research literature. It analyzes the British interests in regulating midwifery, including the rationale of preserving public health and reducing infant mortality, against a background of political power struggles as well as cultural, social and professional diversity in Palestine (the tensions between the powers of doctors, nurses, and pharmacists).
This study outlines how consensus in the development of an online intervention designed to support midwives in work-related psychological distress may be achieved. Study outcomes will steer the design and development of an intervention, and highlight the most salient themes and elements to be included within an online intervention to support midwives. Midwives are entitled to psychological support, yet this is an area in which a paucity of knowledge in relation to their needs resides. This early research is the first of its kind to highlight the needs of midwives. Its’ vision is to develop an evidence based solution to improve the health and well-being of midwives, as they, in turn, care for our mothers and babies.
This publication is a background document on the global chemical and petrochemical sector for the IEA publication Energy Technology Transitions in Industry (IEA, 2009). It provides further, more detailed information on the methodology and data issues for energy efficiency indicators for the sector. The indicators discussed offer insight regarding the energy efficiency improvement potential in the short- to medium-term (by proven technologies).
Würtz Jessen, Søren; Linnet, Andreas; Tscherning, Rasmus Wiinstedt
The aim of this handbook is to help improve your opportunities for getting started on innovative and business development projects that reach beyond your own sector, commonly known as ’Cross-sector innovation’, or ’Cross innovation’ for short. We believe that there is a need for an easily read in...
Contains Executive Summary and Chapters on: A changing energy sector; Rationale for the joint venture, merger or acquisition; Mergers, acquisitions and joint ventures by sector; The joint venture process; Key factors for success; Financing the venture; Case studies; The future outlook. (Author)
Full Text Available Background: There are many challenges women face to be able to give birth in health facilities in many parts of Indonesia. This study explores the roles and observations of close-to-community maternal health providers and other community members on potential barriers faced by women to deliver in health facilities in two districts within The Archipelago. Methods: Employing an explorative qualitative approach, 110 semi-structured interviews and 7 focus group discussions were conducted in 8 villages in Southwest Sumba, in the East Nusa Tenggara province, and in 8 villages in Cianjur, in the West Java province. The participants included village midwives, Posyandu kader (village health volunteers, traditional birth attendants (TBAs, mothers, men, village heads and district health officials. Results: The main findings were mostly similar in the two study areas. However, there were some key differences. Preference for TBA care, traditional beliefs, a lack of responsiveness of health providers to local traditions, distance, cost of travel and indirect costs of accompanying family members were all barriers to patients attending health facilities for the birth of their child. TBAs were the preferred health providers in most cases due to their close proximity at the time of childbirth and their adherence to traditional practices during pregnancy and delivery. Conclusions: Improving collaborations between midwives and TBAs, and responsiveness to traditional practices within health facilities and effective health promotion campaigns about the benefits of giving birth in health facilities may increase the use of health facilities in both study areas.
Schrøder, Katja; Larsen, Pia Veldt; Jørgensen, Jan Stener; Hjelmborg, Jacob V B; Lamont, Ronald F; Hvidt, Niels Christian
this study investigates the self-reported psychosocial health and well-being of obstetricians and midwives in Denmark during the most recent four weeks as well as their recall of their health and well-being immediately following their exposure to a traumatic childbirth. a 2012 national survey of all Danish obstetricians and midwives (n=2098). The response rate was 59% of which 85% (n=1027) stated that they had been involved in a traumatic childbirth. The psychosocial health and well-being of the participants was investigated using six scales from the Copenhagen Psychosocial Questionnaire (COPSOQII). Responses were assessed on six scales: burnout, sleep disorders, general stress, depressive symptoms, somatic stress and cognitive stress. Associations between COPSOQII scales and participant characteristics were analysed using linear regression. midwives reported significantly higher scores than obstetricians, to a minor extent during the most recent four weeks and to a greater extent immediately following a traumatic childbirth scale, indicating higher levels of self-reported psychosocial health problems. Sub-group analyses showed that this difference might be gender related. Respondents who had left the labour ward partly or primarily because they felt that the responsibility was too great a burden to carry reported significantly higher scores on all scales in the aftermath of the traumatic birth than did the group who still worked on the labour ward. None of the scales were associated with age or seniority in the time after the traumatic birth indicating that both junior and senior staff may experience similar levels of psychosocial health and well-being in the aftermath. KEY CONCLUSIONS AND IMPLICATIONS: this study shows an association between profession (midwife or obstetrician) and self-reported psychosocial health and well-being both within the most recent four weeks and immediately following a traumatic childbirth. The association may partly be explained by
Full Text Available Abstract Background Auxiliary Midwives (AMWs are community health volunteers supporting the work of midwives, especially maternal and child health services in hard to-reach areas in Myanmar. This paper assessed the contributions of AMW to maternal and child health services, factors influencing their productivity and their willingness to serve the community. Method The study applied quantitative cross-sectional survey using census method. Total of 1,185 AMWs belonging to three batches: trained prior to 2000, between 2000 and 2011, and in 2012, from 21 townships of 17 states and regions in Myanmar participated in the study. Multiple logit regression was used to examine the impact of age, marital status, education, domicile, recruitment pattern and ‘batch of training’, on AMW’s confidence level in providing care, and their intention to serve the community more than 5 years. Results All AMWs were able to provide essential maternal and child health services including antenatal care, normal delivery and post-natal care. They could identify and refer high-risk pregnancies to larger health facilities for proper management. On average, 9 deliveries, 11 antenatal and 9 postnatal cases were performed by an AMW during the six months prior to this study. AMWs had a comparative advantage for longer service in hard-to-reach villages where they lived, spoke the same dialect as the locals, understood the socio-cultural dimensions, and were well accepted by the community. Despite these contributions, 90 % of the respondents expressed receiving no adequate supervision, refresher training, replenishment of the AMW kits and transportation cost. AMWs in the elder age group are significantly more confident in taking care of the patients than those in the younger groups. Over 90 % of the respondents intended to stay more than five years in the community. The confidence in catering services appeared to have significant association with a longer period of stay
Projects supported by the Directorate for Population (S&T/POP) of the U.S. Agency for International Development and aimed at increasing for-profit private sector involvement in providing family planning services and products are described. Making products commercially available through social-marketing partnerships with the commercial sector, USAID has saved $1.1 million in commodity costs from Brazil, Dominican Republic, Ecuador, Indonesia, and Peru. Active private sector involvement benefits companies, consumers, and donors through increased corporate profits, healthier employees, improved consumer access at lower cost, and the possibility of sustained family planning programs. Moreover, private, for-profit companies will be able to meet service demands over the next 20 years where traditional government and donor agency sources would fail. Using employee surveys and cost-benefit analyses to demonstrate expected financial and health benefits for businesses and work forces, S&T/POP's Technical Information on Population for the Private Sector (TIPPS) project encourages private companies in developing countries to invest in family planning and maternal/child health care for their employees. 36 companies in 9 countries have responded thus far, which examples provided from Peru and Zimbabwe. The Enterprise program's objectives are also to increase the involvement of for-profit companies in delivering family planning services, and to improve the efficiency and effectiveness of private volunteer organizations in providing services. Projects have been started with mines, factories, banks, insurance companies, and parastatals in 27 countries, with examples cited from Ghana and Indonesia. Finally, the Social Marketing for Change project (SOMARC) builds demand and distributes low-cost contraceptives through commercial channels especially to low-income audiences. Partnerships have been initiated with the private sector in 17 developing countries, with examples provided from
Awodoyin, Anuoluwa; Adetoro, Niran; Osisanwo, Temitope
Technology has impacted positively on health care delivery and particularly medical personnel have had to embrace emerging technologies in order to provide safe, competent and quality health care. The study investigated self-efficacy for new technology adoption and use by trainee midwives at the school of midwifery, Ijebu-Ode. The study is a…
Warmelink, J.C.; Cock, T.P. de; Combee, Y.; Rongen, M.; Wiegers, T.A.; Hutton, E.K.
BACKGROUND: A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system
Engels, Y.; Verheijen, Nicole; Fleuren, M; Mokkink, Henk; Grol, R.
OBJECTIVE: To study the effects of small group continuous quality improvement (CQI) on the clinical practice of midwives in the Netherlands. DESIGN: Randomised pre-/post-test (balanced block). INTERVENTION: The CQI groups were assigned to either the set of peer review topics including 'perineal
Engels, Y.; Verheijen, N.; Fleuren, M.; Mokkink, H.; Grol, R.
Objective: To study the effects of small group continuous quality improvement (CQI) on the clinical practice of midwives in the Netherlands. Design: Randomised pre-/post-test (balanced block). Intervention: The CQI groups were assigned to either the set of peer review topics including 'perineal
This report presents a methodological framework to evaluate public sector financial risk exposure when : delivering transportation infrastructure through public-private partnership (PPP) agreements in the United : States (U.S.). The framework is base...
The energy sector is a key driver of the economic pillar of Vision 2030. As the economy grows, urbanization intensifies and incomes increase, corporate and household demand for energy also rises. To meet this growth in demand for energy, the sector needs to increase investments and diversify into more sources of energy such as geothermal and wind power. It is therefore critical that focus is directed towards development and sustainability of the energy sector to ensure delivery of least cost power that will improve Kenya's competitiveness and achieve the Vision 2030 objective of 10% average annual economic growth.
Academia is expanding beyond its traditional, institutional boundaries, as the perceived use value of research and knowledge production has highlighted the political incentive to look at how the higher education sector is organized. In Denmark, as well as in many countries, these challenges...... and pressures has led to the reorganization of knowledge production, e.g. by integrating new institutions into the research sector. The present paper reports initial findings from a study how the new “cousins” navigate demands from an institutionalized sector, and from the external environment. Focus is on how...... policy changes are translated and affects narratives of organizational identities....
Baird, Kathleen M; Saito, Amornrat S; Eustace, Jennifer; Creedy, Debra K
Asking women about experiences of domestic violence in the perinatal period is accepted best practice. However, midwives and nurses may be reluctant to engage with, or effectively respond to disclosures of domestic violence due a lack of knowledge and skills. To evaluate the impact of training on knowledge and preparedness of midwives and nurses to conduct routine enquiry about domestic violence with women during the perinatal period. A pre-post intervention design was used. Midwives and nurses (n=154) attended a full day workshop. Of these, 149 completed pre-post workshop measures of knowledge and preparedness. Additional questions at post-training explored participants' perceptions of organisational barriers to routine enquiry, as well as anticipated impact of training on their practice. Training occurred between July 2015 and October 2016. Using the Wilcoxon signed-rank test, all post intervention scores were significantly higher than pre intervention scores. Knowledge scores increased from a pre-training mean of 21.5-25.6 (Z=-9.56, pworkplace allowed adequate time to respond to disclosures of DV. Brief training can improve knowledge, preparedness, and confidence of midwives and nurses to conduct routine enquiry and support women during the perinatal period. Training can assist midwives and nurses to recognise signs of DV, ask women about what would be helpful to them, and address perceived organisational barriers to routine enquiry. Practice guidelines and clear referral pathways following DV disclosure need to be implemented to support gains made through training. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
Byrskog, Ulrika; Olsson, Pia; Essén, Birgitta; Allvin, Marie-Klingberg
Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis. The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women's' strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman's access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women. Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives' ability to identify Somali born woman's resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the
Zwedberg, Sofia; Blomquist, Josefin; Sigerstad, Emelie
to explore midwives' experiences and perceptions of skin-to-skin contact between mothers and their healthy full-term infants immediately and during the first day after caesarean section. qualitative interviews with semi-structured questions. eight midwives at three different hospitals in Stockholm participated in the study. All participants provided care for mothers and their newborn infants after caesarean birth. transcribed material was analysed and interpreted using qualitative content analysis. The analysis yielded the theme 'fighting an uphill battle'. skin-to-skin contact was considered to be important, and something that midwives strove to implement as a natural element of postnatal care. However, in daily practice, midwives experienced many obstacles to such care, such as lack of knowledge among parents and other professionals about the benefits of skin-to-skin contact, the mother's condition after the caesarean section, and other organisational difficulties (e.g. collaboration with other professionals, lack of time). Introducing more skin-to-skin care was a challenge for the midwives, who sometimes felt both dismissed and disappointed when they tried to communicate the benefits of this type of care. skin-to-skin contact is not prioritised because many health care practitioners are unaware of its positive effects, and their care reflects this lack of knowledge. There is a need for education among all health care practitioners involved in caesarean procedures. Another difficulty is that many parents are unaware of the benefits of skin-to-skin contact. Maternity outpatient clinics need to inform parents about the benefits of such care, so mothers will understand the importance of skin-to-skin contact. Copyright © 2014 Elsevier Ltd. All rights reserved.
Walker, Shawn; Batinelli, Laura; Rocca-Ihenacho, Lucia; McCourt, Christine
to gain understanding about how participants perceived the value and effectiveness of 'Keeping Birth Normal' training, barriers to implementing it in an along-side midwifery unit, and how the training might be enhanced in future iterations. exploratory interpretive. inner-city maternity service. 31 midwives attending a one-day training package on one of three occasions. data were collected using semi-structured observation of the training, a short feedback form (23/31 participants), and focus groups (28/31 participants). Feedback form data were analysed using summative content analysis, following which all data sets were pooled and thematically analysed using a template agreed by the researchers. We identified six themes contributing to the workshop's effectiveness as perceived by participants. Three related to the workshop design: (1) balanced content, (2) sharing stories and strategies and (3) 'less is more.' And three related to the workshop leaders: (4) inspiration and influence, (5) cultural safety and (6) managing expectations. Cultural focus on risk and low prioritisation of normal birth were identified as barriers to implementing evidence-based practice supporting normal birth. Building a community of practice and the role of consultant midwives were identified as potential opportunities. a review of evidence, local statistics and practical skills using active educational approaches was important to this training. Two factors not directly related to content appeared equally important: catalysing a community of practice and the perceived power of workshop leaders to influence organisational systems limiting the agency of individual midwives. Cyclic, interactive training involving consultant midwives, senior midwives and the multidisciplinary team may be recommended to be most effective. Copyright © 2018 Elsevier Ltd. All rights reserved.
Charles Ampong Adjei
Full Text Available Abstract Background Mother -to -Child transmission of hepatitis B infection remains a major public health concern particularly in Africa. Adequate knowledge of physicians and midwives is crucial in averting most of the hepatitis B viral transmissions from mothers to their new-borns. However, there is a dearth of evidence on extent of knowledge of physicians and midwives in Ghana inspite of the increasing incidence of hepatitis B infection in the country. This study therefore assessed the knowledge level of physicians and midwives regarding Mother-to-Child transmission of hepatitis B in the Eastern region of Ghana. Methods A Cross sectional survey was conducted between August to November, 2015 using semi-structured self-administered questionnaire. Study participants were recruited from five health facilities and their level of awareness and knowledge about Mother-to-Child transmission of hepatitis B were assessed. The level of statistical significance was set at 0.05 alpha level. Results The findings showed that both physicians and midwives had good knowledge on Mother-to-Child transmission of hepatitis B infection. However, there were some knowledge gaps regarding effective hepatitis B prevention from mother to their newborns such as the use of hepatitis B vaccine and immunoglobulin. Additionally, 49.2 % (n = 62 of the participants had never attended any workshop on Mother-to-Child transmission of hepatitis B since completion of formal training. Conclusions Developing appropriate periodic training programmes on current issues of hepatitis B for physicians and midwives in Eastern region will further enhance their knowledge. It is recommended that, further study examine if the knowledge of the respondents is translated into practice.
Bazirete, Oliva; Mbombo, Nomafrench; Adejumo, Oluyinka
Maternal mortality continues to be a global burden, with more than 200 million women becoming pregnant each year and a large number dying as a result of complications of pregnancy or childbirth. The World Health Organisation has recommended use of the partogram to monitor labour and delivery in order to improve healthcare and reduce maternal and foetal mortality rates. This study described factors affecting utilisation of the partogram among nurses and midwives in selected health facilities of Rwanda. A descriptive quantitative and cross-sectional research design was used. The population comprised 131 nurses and midwives providing obstetric care in 15 health institutions (1 hospital and 14 health centres). Data collection was through a self-administered questionnaire, and a pre-test of the data collection instrument was carried out to enhance validity and reliability. The Statistical Package for Social Sciences (version 21) was used to capture and analyse data. Ethical clearance was obtained from the University of the Western Cape (Republic of South Africa) and from the Institutional Review Board of Kigali Health Institute (Rwanda). Patricia Benner's model of nursing practice was used to guide the study. It was found that 36.6% of nurses and midwives did not receive any in-service training on how to manage women in labour. Despite fair knowledge of the partogram among nurses and midwives in this study, only 41.22% reported having used the partogram properly, while 58.78% reported not having done so. Nurses' and midwives' years of professional experience and training in managing pregnant women in labour were found to be predictors of the likelihood of proper use of the partogram. In-service training of obstetric caregivers in the Eastern Province of Rwanda is recommended to improve use of the partogram while managing women in labour.
Jepsen, Ingrid; Sørensen, Erik Elgaard; Nøhr, Ellen Ågaard
were field observations followed by interviews. Thirteen midwives working in caseloads were observed during one or two days in the antenatal clinic and interviewed afterwards. Key Findings: Being recognized and the feeling of doing high quality care generate high job satisfaction. The obligation...... and pressure to perform well and the disadvantages to the midwives’ personal lives are counterbalanced by the feeling of doing a meaningful and important job. Working in caseload midwifery creates a feeling of working in a self-governing model within the public hospital, without losing the technological...... of women per full time midwife has to be surveilled as job-satisfaction is dependent on the midwives’ ability of fulfilling expectations of being present at women’s births...
Christensen, Anne Vinggaard; Hjøllund Christiansen, Anne; Petersson, Birgit
ethical status of the foetus and the emotional reactions of the women/couples going through late termination of pregnancy. Other professions as well as structural factors at the hospital highly influenced the midwives’ ability to organize their work with late terminations. There is a need for more...... and when aborted foetuses showed signs of life after a termination. Furthermore, they were critical of how physicians counsel women/couples after prenatal diagnosis. Conclusions: The midwives’ practice in relation to late termination of pregnancy was characterised by an acknowledgement of the growing...... thorough investigation of how to secure the best possible working conditions for midwives and how to optimise the care for women/couples going through late termination of pregnancy....
Sheldon, Sally; Fletcher, Joanne
Some 40% of abortions carried out in England and Wales are done by vacuum aspiration. It is widely assumed that, in order to be lawful, these procedures must be performed by doctors. This study aimed to provide a detailed reassessment of the relevant law and the clinical evidence that supports this assumption. A close reading of relevant law reveals that this assumption is unfounded. On the contrary, it would be lawful for appropriately trained nurses or midwives, acting as part of a multidisciplinary team, to carry out vacuum aspiration procedures. This interpretation of the law offers the potential for developing more streamlined, cost-effective abortion services, which would be both safe and highly acceptable to patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Cadée, Franka; Nieuwenhuijze, Marianne J; Lagro-Janssen, Antoine L M; de Vries, Raymond
To gain consensus for Critical Success Factors associated with Twinning in Midwifery. International publications identify midwifery as important for improving maternity care worldwide. Midwifery is a team effort where midwives play a key role. Yet their power to take on this role is often lacking. Twinning has garnered potential to develop power in professionals, however, its success varies because implementation is not always optimal. Critical Success Factors have demonstrated positive results in the managerial context and can be helpful to build effective Twinning relationships. We approached 56 midwife Twinning experts from 19 countries to participate in three Delphi rounds between 2016 - 2017. In round 1, experts gave input through an open ended questionnaire and this was analysed to formulate Critical Success Factors statements that were scored on a 1-7 Likert scale aiming to gain consensus in rounds 2 and 3. These statements were operationalized for practical use such as a check list in planning, monitoring and evaluation in the field. Thirty-three experts from 14 countries took part in all three Delphi rounds, producing 58 initial statements. This resulted in 25 Critical Success Factors covering issues of management, communication, commitment and values, most focus on equity. The Critical Success Factors formulated represent the necessary ingredients for successful Twinning by providing a practical implementation framework and promote further research into the effect of Twinning. Findings show that making equity explicit in Twinning may contribute towards the power of midwives to take on their identified key role. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.
Di Giacomo, Patrizia; Cavallo, Alessandra; Bagnasco, AnnaMaria; Sartini, Marina; Sasso, Loredana
To describe the knowledge, attitudes and beliefs of nurses and midwives who have attended to women who suffered violence. This study further analyses the possible changes of attitude that have occurred over the past five years. Gender violence or violence against women is the largest problem with regard to public health and violated human rights all over the world. In Italy, it is estimated that 31·5% of women suffer physical or sexual violence during their life. Healthcare operators play a crucial role in recognising the signs of the violence suffered when taking care of victims. A cross-sectional study was conducted. A questionnaire was administered; this was used in a previous survey of a convenience sample of 51 nurses and midwives who work in an emergency room or in an obstetrics emergency room and gynaecological ward. Of the respondents, 51 (80·4%) have taken care of women who suffered violence, and 25 (49%) believe they can detect violence. The relational/communicative approach presents the most difficulty, and all the operators believe they need more knowledge. The number of operators who suggest women be observed in an emergency room and file a complaint or who primarily consider listening to women has decreased. A tendency to 'blame' women, although decreasing, persists; it is higher among male nurses and, in general, among male operators. Knowledge of this issue has not been completely recognised among operators despite training and the emergence of the phenomenon in the mass media. Difficulties in receiving and in relational procedures continue to exist, in addition to 'blaming' the woman. Awareness paths and cultural changes regarding the phenomenon of violence need to be developed, as does a specific training programme on the approach to and assessment of the abused woman. © 2016 John Wiley & Sons Ltd.
Gould, Dinah; Papadopoulos, Irena; Kelly, Daniel
Online learning is frequently used in continuing professional development for qualified nurses and midwives. It is frequently assumed that the same package is appropriate for different groups of learners and that by reducing the need for tutorial input, tutorial time is saved. We evaluated the suitability of an online learning resource for suitability in continuing professional development for midwives. Originally developed for use as part of a work-based package for a specific audience, there had always been plans for more general use of the resource with other groups of health workers. Sequential mixed methods study. English universities. Seventy university tutors. Online questionnaire and in-depth interviews. Tutors did not consider that the online learning materials would be suitable for a wider audience without significant adaptation. They thought that uptake would increase need for tutorial input. Our findings demonstrate the pitfalls of removing learning from the context of practice. Technology customised to meet the needs of one group of learners probably does not have the potential for transfer to another group without significant adaptation. Those responsible for designing e-learning should take into account the needs of all the different audiences for whom the resource is intended from the outset, with consideration for the context in which learning will be applied to practice and how students will be supported. If the same package is to be used by different audiences and in different settings, tutors and students will require explicit instructions of how they should use the resource and depth of knowledge and level of competency that should be attained at the conclusion of the programme. Copyright © 2013 Elsevier Ltd. All rights reserved.
Rankin, Jean; Brown, Val
Traditional ways of teaching in Higher Education are enhanced with adult-based approaches to learning within the curriculum. Adult-based learning enables students to take ownership of their own learning, working in independence using a holistic approach. Introducing creative activities promotes students to think in alternative ways to the traditional learning models. The study aimed to explore student midwives perceptions of a creative teaching method as a learning strategy. A qualitative design was used adopting a phenomenological approach to gain the lived experience of students within this learning culture. Purposive sampling was used to recruit student midwives (n=30). Individual interviews were conducted using semi-structured interviews with open-ended questions to gain subjective information. Data were transcribed and analyzed into useful and meaningful themes and emerging themes using Colaizzi's framework for analyzing qualitative data in a logical and systematic way. Over 500 meaningful statements were identified from the transcripts. Three key themes strongly emerged from the transcriptions. These included'meaningful learning','inspired to learn and achieve', and 'being connected'. A deep meaningful learning experience was found to be authentic in the context of theory and practice. Students were inspired to learn and achieve and positively highlighted the safe learning environment. The abilities of the facilitators were viewed positively in supporting student learning. This approach strengthened the relationships and social engagement with others in the peer group and the facilitators. On a less positive note, tensions and conflict were noted in group work and indirect negative comments about the approach from the teaching team. Incorporating creative teaching activities is a positive addition to the healthcare curriculum. Creativity is clearly an asset to the range of contemporary learning strategies. In doing so, higher education will continue to keep
Full Text Available Background & aim: Maintaining and improving the work ability are important social goals, which challenge the health care and rehabilitation systems as well as health providers. The physical and mental health status affect the work ability. Regarding this, the current study aimed to investigate the effect of aerobic training on the work ability of the midwives in the health care centers of Mashhad, Iran in 2013. Methods: This randomized clinical trial was conducted on 60 midwives working in the health centers of Mashhad, Iran, using purposeful sampling method. The health care centers were selected randomly, and then assigned into the intervention and control groups. Subsequently, the intervention group performed aerobic exercise for 24 sessions. Data collection was performed using the work ability index and the Bruce test (to compare the fitness of the participants at the pre- and post-intervention stages. For data analysis, the two-way ANOVA, Mann-Whitney U, and Chi-square tests as well as independent and paired sample t-tests were employed, using SPSS version 19. The P-value less than 0.05 was considered statistically significant. Results: According to the results of the study, the mean score of work ability was significantly higher in the intervention group than that in the control group (40.5±4.9 vs. 36.4± 5.3, respectively; P=0.004. Furthermore, there was a significant difference between the two groups regarding the two variables including work ability compared with life time best (P
Fenwick, Jennifer; Sidebotham, Mary; Gamble, Jenny; Creedy, Debra K
Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives. To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity. Online survey. Measures included; Copenhagen Burnout Inventory (CBI); Depression, Anxiety and Stress Scale-21; and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The sample (n=862) was divided into two groups; midwives working in continuity (n=214) and those not working in continuity (n=648). Mann Whitney U tests were used to compare the groups. The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p=.002; CBI Work pwork-life balance. Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Full Text Available El crecimiento del sector servicios en detrimento del sector primario, la flexibilidad del mercado laboral y la progresiva incorporación de la mujer a dicho mercado son los cambios más destacados del sector productivo español en los últimos 25 años. Las mujeres en España presentan tasas de desempleo, trabajo temporal y a tiempo parcial mucho mayores que los hombres. Además, las condiciones de acceso al mercado de trabajo y las condiciones en las que éste se desempeña están también muy relacionadas con la clase social. Las mujeres cubren la escasez de servicios públicos destinados al cuidado de las criaturas pequeñas y de las personas mayores o dependientes, y realizan una labor de cuidadoras informales sin reconocimiento social, lo cual les impide el acceso a un puesto de trabajo o su mantenimiento y limita de forma decisiva las posibilidades de desarrollo y progreso profesional. Todo ello indica una clara diferencia con respecto a los hombres en cuanto a la frecuencia de contratos temporales y de tiempo parcial, así como en la segregación laboral, tanto horizontal como vertical. Estos aspectos de segregación son más evidentes en las mujeres de clases sociales menos privilegiadas, en las que se concentran las peores condiciones de acceso al mercado laboral y de trabajo. En España es imprescindible llevar a cabo políticas que ofrezcan servicios que permitan compatibilizar la vida laboral y familiar en condiciones de mayor equidad, tanto en razón de género como de clase social.In the last 25 years, the production sector in Spain has undergone important changes. Among these changes, the important growth of the services sector at the expense of the primary sector, the increasing flexibility of the labour market, and the rise in the female workforce could be considered as the most relevant ones. Spanish women have higher rates of unemployment, temporary jobs and part time contracts than Spanish men. Moreover, job access and work
Broek, T. van den; Giessen, A.M. van der
The electrical and optical equipment sector is a high-tech manufacturing sector. It is one of the most innovative sectors in Europe with investments and advances in fundamental research, applied R&D and innovation in the actual use of equipment. This sector is also one of the most global sectors
Full Text Available Background: Professional midwives have an important role to play in midwifery training to produce a competent midwife. According to the social learning theory, professional midwives act as role models for students. When allocated for clinical learning experiences in the training hospitals, students will have the opportunity to observe the well-trained, skilled, and experienced professional midwives. The whole process will enable students to integrate theory with practice and they will become competent.Aim: The aim of this study was to determine the factors affecting integration of midwifery nursing science theory with clinical practice as perceived by midwives.Setting: The study was conducted at the training hospitals in Vhembe district of the Limpopo Province, South Africa. These hospitals were: Donald Fraser, Siloam, and Tshidzini.Methods: A qualitative explorative, descriptive and contextual design was used. A Nonprobability, convenient sampling method was used to select 11 midwives from the following hospitals: Donald Fraser, Siloam, and Tshidzini, in Vhembe district. In-depth individual interviews were conducted. Data were analysed through open coding method.Result: One theme and five sub-themes emerged from the analysed data, namely: shortage of midwives, attitudes towards student midwives, reluctance to perform teaching functions, language barriers, and declining midwifery practice standards.Conclusion: Shortage of midwives in the clinical areas led to fewer numbers of mentors whom the students could observe and imitate to acquire clinical skills. Some of the midwives were reluctant to teach students. Recommendations were made for both training institutions and hospitals to employ preceptors for students in the clinical practical.
McCann, Mary T; Newson, Lisa; Burden, Catriona; Rooney, Jane S; Charnley, Margaret S; Abayomi, Julie C
Midwives are responsible for providing advice regarding the complex issues of healthy eating and weight management during pregnancy. This study utilised an inductive data-driven thematic approach in order to determine midwives' perceptions, knowledge, and experiences of providing healthy eating and weight management advice to pregnant women. Semistructured interviews with 17 midwives were transcribed verbatim and data subjected to thematic analysis. The findings offer insight into the challenges facing midwives in their role trying to promote healthy eating and appropriate weight management to pregnant women. Three core themes were identified: (a) "If they eat healthily it will bring their weight down": Midwives Misunderstood; (b) "I don't think we are experienced enough": Midwives Lack Resources and Expertise; and (c) "BMI of 32 wouldn't bother me": Midwives Normalised Obesity. The midwives recognised the importance of providing healthy eating advice to pregnant women and the health risks associated with poor diet and obesity. However, they reported the normalisation of obesity in pregnant women and suggested that this, together with their high workload and lack of expertise, explained the reasons why systematic advice was not in standard antenatal care. In addition, the current lack of UK clinical guidance, and thus, possibly lack of clinical leadership are also preventing delivery of tailored advice. Implementation literature on understanding the barriers to optimal health care delivery and informing clinical practice through research evidence needs to be further investigated in this field. This study has recommendations for policy makers, commissioners, service providers, and midwives. © 2017 John Wiley & Sons Ltd.
The energy sector in Italy, as in Europe and in many other areas of the world, is undergoing rapid and profound changes. The 1986 ratification of the European Single Act was intended to create a European internal market, where circulation of people, capital, goods, and services would reach the highest possible liberalization. In 1988, in the document The Energy Internal Market, the European Union (EU) commission stressed the need for creation of an internal energy market--free of obstacles--to increase security of supply, to reduce costs, and to strengthen the competitiveness of the European economic system. In 1990, the Community Council adopted directives to implement the EU energy sector. This article describes Italy's role as part of the EU energy sector. It covers the following topics: the Italian energy sector; electricity vs gas transportation; project finance; recent developments advance Italian power industry; specifying powerplant components -- Italian stype; buyers' guide to Italian equipment, services
Fenner, Charles, R., Jr.; Selmer, Jan
. On the other hand, neither international experience nor the effectiveness of preparatory training had any association with the psychological adjustment of respondents. Surprisingly, these findings suggest a similar picture for the expatriates from the public and private sector. Implications of these findings......Although public sector expatriates are becoming increasingly common, research on them is very limited. There is reason to believe that the situation for expatriates from the public sector may be different than for those from the private sector. This study investigated U.S. Department of Defense...... administrators assigned to U.S. embassies worldwide. Results showed that self efficacy, role clarity and role discretion had a positive association with the psychological adjustment of the respondents while role conflict and role overload only had a marginal negative relationship with the criterion variable...
Find environmental regulatory information for the construction sector, including the construction of buildings or engineering projects. This includes RCRA information for hazardous waste, refrigeration compliance, asbestos, effluent guidelines & lead laws
Meyer, Renate; Leixnering, Stephan
and private sectors as well as the boundaries of single organizations. In addition, the complexity of the interlocking arrangements and relationships in this public organizational landscape has resulted in considerable governance problems with serious implications for coordination and policy coherence.......New public management-inspired reforms created numerous autonomous units with many different faces and labels. This variety of organizations and organizational forms precludes a straightforward definition of what constitutes a public sector organization and blurs the boundaries between the public...
Full Text Available This paper presents a project delivery model developed for use by public sector clients tasked with using innovative building technologies (IBTs) in lieu of conventional building technologies (CBTs) in the delivery of social infrastructure projects....
"The CCLRC Rutherford Appleton Laboratory (RAL) has delivered a system to CERN that will help to process the vast amounts of data generated by the silicon tracking detector within the Compact Muon Solenoid experiment." (1/2 page)
Margie A. Nolasco; Jonathan Dela Cruz
Tourism has benefits not just for travelers, but also to the local economy. Since, Bicol Region has natural and cultural attractions; it is a potential travel destination in the country. Technology in delivering information sources played vital role for the success of the tourism industry in the Region. This allows travel enthusiasts to get more information about various tourist attractions. This paper analyzes the effectiveness of delivering information sources such as web advert...
Campbell, David; Shepherd, Irwyn; McGrail, Matthew; Kassell, Lisa; Connolly, Marnie; Williams, Brett; Nestel, Debra
Procedural skills are a significant component of clinical practice. Doctors, nurses, midwives and paramedics are trained to use a variety of procedural skills. Rural clinicians in particular are often required to maintain competence in some procedural skills that are used infrequently, and which may require regular and repeated rehearsal. This paper reports on a research project conducted in Gippsland, Victoria, to ascertain the frequency of use, and relevance to clinical practice, of a range of skills in the fields of medicine, nursing, midwifery, and paramedic practice. The project also gathered data on the attitudes of clinicians regarding how frequently and by what means they thought they needed to practice these skills with a particular focus on the use of simulation as an educational method. The research was conducted following identification of a specific set of procedural skills for each professional group. Skills were identified by an expert steering committee. We developed online questionnaires that consisted of two parts: 1) demographic and professional characteristics, and 2) experience of procedural skills and perceived training needs. We sought to invite all practicing clinicians (doctors, nurses, midwives, paramedics) working in Gippsland. Online surveys were distributed between November 2011 and April 2012 with three follow-up attempts. The Monash University Human Research Ethics Committee approved the study. Valid responses were received from 58 doctors, 94 nurses, 46 midwives, and 30 paramedics, whom we estimate to represent not more than 20% of current clinicians within these professions. This response rate reflected some of the difficulties experienced in the conduct of the research. Results were tabulated for each professional group across the range of skills. There was significant correlation between the frequency of certain skills and confidence with maintenance of these skills. This did not necessarily correlate with perceptions of
The waste management section of this report deals with two sectors: land disposal of solid waste and wastewater treatment. It provides background information on the type of emissions that contribute to the greenhouse gases from these two sectors, presents both sector current status in Lebanon, describes the methodology followed to estimate the corresponding emissions, and presents the results obtained regarding greenhouse emissions. The total methane emissions from solid waste disposal on land are 42.804 Gg approximately. There are no emissions from wastewater and industrial handling systems because, for the target year 1994, there was no treatment facilities in Lebanon. The wastewater (municipal, commercial and industrial) was directly discharged into the sea, rivers, ravines or septic tanks which indicate that methane or nitrous oxide emissions are significant if not nonexistent. Note that this situation will change in the future as treatment plants are being constructed around the country and are expected to come into operation by the year 2000
McParlin, Catherine; Bell, Ruth; Robson, Stephen C; Muirhead, Colin R; Araújo-Soares, Vera
to investigate barriers and facilitators to physical activity (PA) guideline implementation for midwives when advising obese pregnant women. a cross-sectional, self-completion, anonymous questionnaire was designed using the Theoretical Domains Framework. this framework was developed to evaluate the implementation of guidelines by health care professionals. A total of 40 questions were included. These were informed by previous research on pregnant women's and midwives views, knowledge and attitudes to PA, and supported by national evidence based guidelines. Demographic information and free text comments were also collected. three diverse NHS Trusts in the North East of England. all midwives employed by two hospital Trusts and the community midwives from the third Trust (n=375) were invited to participate. mean domain scores were calculated. Factor and regression analysis were performed to describe which theoretical domains may be influencing practice. Free text comments were analysed thematically. 192 (53%) questionnaires were returned. Mean domain scores were highest for social professional role and knowledge, and lowest for skills, beliefs about capabilities and behaviour regulation. Regression analysis indicated that skills and memory/attention/decision domains had a statistically significant influence on midwives discussing PA with obese pregnant women and advising them accordingly. Midwives comments indicated that they felt it was part of their role to discuss PA with all pregnant women but felt they lacked the skills and resources to do so effectively. midwives seem to have the necessary knowledge about the need/importance of PA advice for obese women and believe it is part of their role, but perceive they lack necessary skills and resources, and do not plan or prioritise the discussion regarding PA with obese pregnant woman. designing interventions that improve skills, promote routine enquiry regarding PA and provide resources (eg. information, referral
Schrøder, Katja; Jørgensen, Jan S; Lamont, Ronald F
and proportions of obstetricians and midwives involved in such traumatic childbirth and explored their experiences with guilt, blame, shame and existential concerns. MATERIAL AND METHODS: A mixed methods study comprising a national survey of Danish obstetricians and midwives and a qualitative interview study...... with selected survey participants. RESULTS: The response rate was 59% (1237/2098), of which 85% stated that they had been involved in a traumatic childbirth. We formed five categories during the comparative mixed methods analysis: the patient, clinical peers, official complaints, guilt, and existential...... considerations. Although blame from patients, peers or official authorities was feared (and sometimes experienced), the inner struggles with guilt and existential considerations were dominant. Feelings of guilt were reported by 36-49%, and 50% agreed that the traumatic childbirth had made them think more about...
Cheer, Karen; MacLaren, David; Tsey, Komla
Researchers are increasingly using grounded theory methodologies to study the professional experience of nurses and midwives. To review common grounded theory characteristics and research design quality as described in grounded theory studies of coping strategies used by nurses and midwives. A systematic database search for 2005-2015 identified and assessed grounded theory characteristics from 16 studies. Study quality was assessed using a modified Critical Appraisal Skills Programme tool. Grounded theory was considered a methodology or a set of methods, able to be used within different nursing and midwifery contexts. Specific research requirements determined the common grounded theory characteristics used in different studies. Most researchers did not clarify their epistemological and theoretical perspectives. To improve research design and trustworthiness of grounded theory studies in nursing and midwifery, researchers need to state their theoretical stance and clearly articulate their use of grounded theory methodology and characteristics in research reporting.
This paper first reviews proposals for the design of sectoral and related market mechanisms currently debated, both in the UNFCCC negotiations, and in different domestic legislative contexts. Secondly, it addresses the possible principles and technical requirements that Parties may wish to consider as the foundations for further elaboration of the mechanisms. The third issue explored herein is domestic implementation of sectoral market mechanisms by host countries, incentives to move to new market mechanisms, as well as how the transition between current and future mechanisms could be managed.
Ko, Jean Y; Dietz, Patricia M; Conrey, Elizabeth J; Rodgers, Loren; Shellhaas, Cynthia; Farr, Sherry L; Robbins, Cheryl L
Postpartum screening for glucose intolerance among women with recent histories of gestational diabetes mellitus (GDM) is important for identifying women with continued glucose intolerance after birth, yet screening rates are suboptimal. In a thorough review of the literature, we found no studies of screening practices among certified nurse-midwives (CNMs). The objectives of our study were to estimate the prevalence of postpartum screening for abnormal glucose tolerance and related care by CNMs for women with recent histories of GDM and to identify strategies for improvement. From October through December 2010, the Ohio Department of Health sent a survey by mail and Internet to all licensed CNMs practicing in Ohio. We calculated prevalence estimates for knowledge, attitudes, clinical practices, and behaviors related to postpartum diabetes screening. Chi-square statistics were used to assess differences in self-reported clinical behaviors by frequency of postpartum screening. Of the 146 CNMs who provided postpartum care and responded to the survey (62.2% response rate), 50.4% reported screening women with GDM-affected pregnancies for abnormal glucose tolerance at the postpartum visit. Of CNMs who screened postpartum, only 48.4% used fasting blood sugar or the 2-hour oral glucose tolerance test. Although 86.2% of all responding CNMs reported that they inform women with recent histories of GDM of their increased risk for type 2 diabetes mellitus, only 63.1% counseled these women to exercise regularly and 23.3% reported referring overweight/obese women to a diet support group or other nutrition counseling. CNMs reported that identification of community resources for lifestyle interventions and additional training in postpartum screening guidelines may help to improve postpartum care. CNMs in Ohio reported suboptimal levels of postpartum diabetes testing and use of a recommended postpartum test. Providing CNMs with additional training and identifying community resources
Doherty, Mary Ellen
The Patient Protection and Affordable Care Act (ACA) is changing the health care landscape in the United States. It is now more important than ever to understand the needs of students who are preparing for roles as health care providers. The purpose of this study was to describe and analyze the American College of Nurse-Midwives (ACNM) Student Reports from 2005 through 2014 to acquire a better understanding of student needs in light of the historic change in health care reform. A document analysis was conducted to review and evaluate 10 student reports using qualitative content analysis. Data were coded, categories were formed, and themes were discovered. The interpretation of the student reports elicited meaning, gained understanding, and developed empirical knowledge. Eight themes emerged from the data contained in the 10 student reports. These were: 1) public awareness and marketing; 2) midwifery education; 3) funding for midwifery education; 4) preceptor issues; 5) communication and professional issues; 6) diversity and inclusion; 7) transition to practice; and 8) the ACNM Annual Meeting. Students bring a unique perspective to the profession of midwifery and ACNM. This study revealed 8 themes emanating from the student reports spanning 10 years. Each theme showcased in this study is presented through a student lens and was deemed important enough to be mentioned in the majority of the student reports. These themes identify key areas affecting students such as education program content and clinical experiences, diversity and inclusion, preceptor availability and relationships, funding for graduate school and for attending the ACNM Annual Meeting, and a myriad of other significant topics. These students will begin their new careers with the changing structure of the health care industry under the ACA. At this complex and vulnerable time, it is imperative that student voices be heard and that their professional organization remains receptive to their concerns. A
Wagner, Yvonne; Heinrich-Weltzien, Roswitha
Background Studies suggest that poor oral health during pregnancy can lead to perinatal complications, such as low birth weight and preterm delivery as well as poor oral health in children. Aim of this study was to assess the German midwives knowledge about oral health and preventive recommendations for pregnant women, infants and young children. Methods The nationwide online-survey was conducted with use of a self-developed, pretested and validated standardized questionnaire. The German asso...
Higgins, Agnes; Downes, Carmel; Monahan, Mark; Gill, Ailish; Lamb, Stephen A; Carroll, Margaret
To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period. Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period. The research used a descriptive design. A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care. Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers. Midwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice. Midwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with
Zhang, Jing; Haycock-Stuart, Elaine; Mander, Rosemary; Hamilton, Lorna
to explore the strategies Chinese midwives employed to work on their professional identity in hospital setting and the consequence of such identity work. this paper draws upon findings from a Constructivist Grounded Theory study that explored the professional identity construction of 15 Chinese midwives with a mixture of midwifery experiences, practising in three different types of hospital settings in a capital city in Southeast China. The accounts from participants in the form of in-depth individual interviews were collected. Work journals voluntarily provided by three participants were also included. in everyday practice, hospital midwives in China were working on their professional identity in relation to two definitions of the midwife: the external definition ('obstetric nurse'), bound up in the idea of risk management under the medical model of their work organisations; and the internal definition ('professional midwife'), associated with the philosophy of normal birth advocacy in the professional discourse. Six strategies for identity work were identified and grouped into two principle categories: 'compromise' and 'engagement'. The adoption of each strategy involved a constant negotiation between the external and internal definitions of the midwife, being influenced by midwifery experiences, relationships with women, opportunities for professional development and the definition of the situation. A 'hybrid identity', which demonstrated the dynamic nature of midwifery professional identity, was constructed as a result. this paper explored the dynamic nature of midwifery professional identity. This exploration contributes to the body of knowledge regarding understanding the professional identity of hospital midwives in China, while also extending the current theoretical knowledge of identity work by elaborating on the various strategies individuals use to work on their professional identity in the workplace. Copyright © 2014 Elsevier Ltd. All rights reserved.
Casey, Mary; Cooney, Adeline; O'Connell, Rhona; Hegarty, Josephine; Brady, Anne-Marie; O'Reilly, Pauline; Kennedy, Catriona; Heffernan, Elizabeth; Fealy, Gerard; Mcnamara, Martin; O'Connor, Laserina
Aim: To present the qualitative findings from a study on the development of scheme(s) to give evidence of maintenance of professional competence for nurses and midwives. Background: Key issues in maintenance of professional competence include notions of self- assessment, verification of engagement and practice hours, provision of an evidential record, the role of the employer and articulation of possible consequences for non-adherence with the requirements. Schemes to demonstrate the maintena...
Adeyemo F. Oluyemisi
Full Text Available Background: This study aims to ascertain pregnant women’s perceptions of the attitudes and practice of midwives during labour in a mission teaching hospital and a state hospital in Ogbomoso, Southwest Nigeria, and to determine whether or not a relationship exists between patients’perceptions of midwives practice during delivery and the occurrence of neonatal deaths.Methods: The survey was conducted by administering the questionnaire adapted from Caring Behaviour Inventory (CBI to a random sample of five hundred and seventy nine respondent mothers who gave birth in either a Mission teaching hospital or a state hospital in Ogbomoso, Southwest Nigeria. This standardised questionnaire collects demographic data and patient perceptions of nursing attitudes and practice, ranking patients’ responses to a series of statements about the midwives on a four point Likert scale. Data was analysed using Pearson product moment correlation analyses and multiple regression analyses.Results: Our study revealed that there was a positive response on the attitude and practise of midwives during delivery by the respondents. Secondly, there was a positive impression on the influence of the attitude and practice of midwives during delivery by the respondents.Conclusions: There was no evidence of a relationship between patients’ perceptions of midwives practice during delivery and the occurrence of neonatal deaths.
Rafferty, Rae; Fairbrother, Greg
To introduce a theory which describes the process of and explicates the factors moderating, the acquisition and integration of leadership coaching skills into the routine practice of senior nurses and midwives. Organizations invest significant resources in leadership coaching programs to ensure that coaching is embedded as a core function of the manager's role. However, even after training, many managers remain unable to undertake this role successfully. The process by which health professionals translate 'manager as coach' training into successful practice outcomes, has remained largely unexplored. A grounded theory study design. Data, collected between February 2012-May 2013, included in-depth interviews with 20 senior nurses and midwives who had attended a leadership coaching program and analysis of nine reflective practice journals. Multiple researchers coded and analysed the data using constant comparative techniques. The outcomes of coaching training ranged from inappropriate use of the coaching skills through to transformed managerial practice. These outcomes were influenced by the dynamic interaction of three central domains of the emergent theoretical model: pre-existing individual perceptions, program elements and contemporaneous experiences. Interactions occurred within the domains and between them, impacting on activators such as courage, motivation, commitment and confidence. The study offers new insights into how senior nurses and midwives acquire and integrate coaching skills into their routine practice. The process is described as multifactorial and dynamic and has implications for the training design, delivery and organizational support of future leadership coaching programs. © 2015 John Wiley & Sons Ltd.
Full Text Available Introduction: Abortion has always been a controversial issue and all religions, humanistic and medical communities have opposed it . The complications of illegal abortion are one of the most common reasons of hospital admission in developing countries. W.H.O estimates that the one eight of all pregnancy deaths is due to illegal abortion. Lack of knowledge of the medical team about the abortion regulations and rules can endanger the pregnant mothers life and also create certain problems for medical communities . Methods: This cross- sectional study was conducted in 2007 and included 110 gynecologists and midwives in Yazd who were studied by census method. Data was collected via self-made questionnaire and data analysis was done by software SPSS program and statistical tests included square K and T test. Results : Of the total of 110 patients, 16.4% were gynecologists and 83.3% were midwives, 31.8% worked in academic centers and 68.2% were employed at other centers. The awareness level of 25.5% was good. There was a meaningful difference between the awareness level of academic employed and nonacademic employed and also between those who had studied abortion rules regulations. Conclusion: As 74.5% of the study population had low levels of awareness about the abortion rules, education of midwives & gynecologists about rules & regulations is strongly recommended as it not only helps women's health, but also decreases their legal problems.
The aim of this article is to report the results of the greenhouse gas (GHG) emission inventory for the year 1994. The following GHG are of interest in the energy sector: Carbon dioxide CO 2 , methane CH 4 , nitrous oxide N 2 O, oxides of nitrogen NO x , carbon monoxide CO, sulphur dioxide SO 2 and non-methane volatile organic compounds (NMVOCs). The inventory has focused on the following GHG related sources: -Electricity generation through the electric utility. -Private generation of electricity -Manufacturing industries and construction -Transport: road, domestic aviation and national navigation -Energy use in the residential sector -Energy use in the commercial/institutional sector -Energy use in the agriculture/forestry/fishing sector The fuel types taken into consideration are:Gasoline, jet Kerosene, Kerosene for household use, gas oil, diesel oil, fuel oil, LPG, lubricating oil, coal, wood and charcoal (solid biomass). Care has been taken to eliminate the fuel used by international marine and aviation bunkers from the national inventory. The amount of GHG released to the atmosphere has been estimated using the IPCC methodology and emission factors .Where national emission factors differed from those of IPCC, the factors are discussed. Complete documentation of compiled information and data sources are attached to this article.Finally both the reference approach and analysis by source categories have been carried out and are reported in this inventory
As an engine of economic growth, private enterprise plays an impor- tant role in combatting poverty by creating jobs and livelihood opportunities. In helping develop- ing countries pursue private sector development strategies that benefit women, youth, and the poor, inno- vative research supported by IDRC is laying the ...
This Financial Sector Assessment (FSA) provides a summary of the policy priorities, and main findings intended to assist the Moroccan authorities in evaluating the country's financial system. It reviews the uneasy trade-off between concerns for stability, and development, suggesting Morocco's macroeconomic policies and practices as a whole tend to err more on the side of the concerns of pr...
World Bank; International Monetary Fund
A joint International Monetary Fund (IMF)-World Bank mission visited Rabat and Casablanca in 2015, to assess the soundness and resilience of the banking system, the state of play in financial inclusion and infrastructure, the oversight frameworks for banking, capital markets and financial market infrastructures, crisis preparedness, and update the findings of the Financial Sector Assessme...
Selaya, Pablo; Thiele, Rainer
This article examines empirically the proposition that aid to poor countries is detrimental for external competitiveness, giving rise to Dutch disease type effects. At the aggregate level, aid is found to have a positive effect on growth. A sectoral decomposition shows that the effect is (i) sign...
The performance of the public sector of national economies is a crucial factor in the race to achieve the goals in the Lisbon Agenda. It is therefore useful to relate differences in performance in education, health care, law and order, and public administration to differences in resource use and
Luiijf, H.A.M.; Brouwer, W.; Griffioen, A.
Using the so-called Quick Scan method and in consultation with the industry and government, it was determined in 2002 that the Netherlands’ critical infrastructure comprises 11 sectors and 31 critical products and services. That result was adjusted in the ensuing risk analysis phase. Since April
Hood, Laraine; Fenwick, Jennifer; Butt, Janice
to describe Australian midwives' experiences of an external review of obstetric services, involvement in legal proceedings and the impact on midwives' clinical practice and personal wellbeing. the external review process (commonly referred to as the 'Douglas Inquiry') was initiated by a state government and was in response to hospital staff and consumer complaints that focused on anomalies in client care and a significantly high rate of adverse outcomes and clinical errors. It took place within the context of a number of legal proceedings against medical practitioners. As a result, some midwives employed by the hospital were called to give evidence at a variety of legal forums. a qualitative study using an explorative descriptive design. Snowball sampling was used to invite 16 Australian midwives to participate in a tape-recorded interview. Thematic analysis and the techniques associated with constant comparison were used to analyse the data. Australian maternity tertiary referral centre. the analysis identified two overarching themes, 'A story of scrutiny' and 'A story of fear', each with a number of subthemes. 'A story of scrutiny' consists of three subthemes. 'A cloak and dagger affair' reflects the midwives' sense of being and feeling 'exposed' and 'vulnerable' whilst simultaneously being 'kept in the dark' and uninformed during the review process. The subtheme 'Being thrown to the wolves' describes the midwives' experiences of being involved, as witnesses, in medico-legal proceedings. The third subtheme, 'The Inquiry followed them home' outlines the effect on midwives' emotional wellbeing and personal relationships. The second major theme, 'A story of fear' again consists of a number of subthemes. 'Feeling unsafe at work: a culture of fear' describes the midwives' experiences of working within an environment they perceive as driven by the fear of litigation. In order to protect themselves and maintain a sense of control, the midwives adopted a number of
Edwards, Kasper; Nielsen, Anders Paarup; Hasle, Peter
. With no hope of getting substantial more resources healthcare managers and politicians has begun to look for alternative modes of organization. In doing so the healthcare sector is being exposed to industrial rationalization principles such as lean manufacturing. The question is whether lean opens......The Danish public healthcare sector is like other healthcare systems under pressure to deliver more and better services. The sector is especially facing three challenges: Firstly, they must increase their efficiency in order to free capacity and support budget reductions. Secondly, they must...... for discussing the implications of transferring such industrial engineering methods to the healthcare sector. The conclusion of the review suggest that is possible to use lean as an inspiration for improvements of both efficiency, quality and working conditions provided diligent consideration of the particulars...
Edwards, Kasper; Nielsen, Anders P.; Hasle, Peter
. With no hope of getting substantial more resources healthcare managers and politicians has begun to look for alternative modes of organization. In doing so the healthcare sector is being exposed to industrial rationalization principles such as lean manufacturing. The question is whether lean opens......The Danish public healthcare sector is like other healthcare systems under pressure to deliver more and better services. The sector is especially facing three challenges: Firstly, they must increase their efficiency in order to free capacity and support budget reductions. Secondly, they must...... for discussing the implications of transferring such industrial engineering methods to the healthcare sector. The conclusion of the review suggest that is possible to use lean as an inspiration for improvements of both efficiency, quality and working conditions provided diligent consideration of the particulars...
Anderheim, L; Holter, H; Bergh, C; Möller, A
The aim of this prospective, controlled study was to investigate the impact of participation in extended encounters with midwives on the psychological well-being of women undergoing IVF treatment and on their experience of treatment procedures. A total of 166 couples were studied during their first IVF treatment at the authors' IVF unit, of which 49 underwent intervention via extended midwife encounters. Participants answered questionnaires on three occasions. Psychological effects of infertility and questions regarding the relationship with the partner were considered. On the third occasion, two open-ended questions regarding perception of the treatment and the support by the staff were assessed. Regarding the psychological effects of infertility and the relationship with the partner, no significant differences were found between the intervention group versus the control group. Analysis of the open-ended questions resulted in the finding that significantly (P = 0.01) more women in the intervention group expressed satisfaction with the care. No impact of the intervention on psychological well-being was noted. However, the intervention seemed to be an effective method to give couples a feeling of security, continuity and an opportunity to be seen as individuals and as couples, for which the women expressed their appreciation.
Sawhney, N; Dayal, S M
A discussion of the training program for auxiliary nurse midwives (ANMs) connected with their role in the Family Welfare Programme. A World Bank Appraisal Mission had reviewed the existing training program under the Indian Population Project and cited poor quality of training, inadequate facilities, and irregular recruitment of students. The Population Centre was given responsibility for improving and revising the program. Existing curriculum was revised against the job functions of the ANMs, and the revision was pretested, further revised, and implemented in all Training Centres through the Project Implementation Unit. Main changes were made in the curriculum, field training, and orientation of trainers. Additional topics on family planning were added, and the family planning component of the training period was increased from 60 to 70 hours. Field work was increased, with 32 hours of classroom and 58 hours of practical field work. The required number of ANMs have been trained and placed in position; no position remains vacant. Additional inputs, in the form of buildings for all Training Centres, hotel accomodations for 10 trainees in each Rural Demonstration Area, and 1 extra Sister Tutor per trainee have been provided. Efforts have been made to fill all the training posts. In comparing project districts with nonproject districts, ANM training is more favorable in the project districts.
Boutigny, Hervé; de Moegen, Marie-Laure; Egea, Luc; Badran, Zahi; Boschin, François; Delcourt-Debruyne, Elisabeth; Soueidan, Assem
To establish an inventory of knowledge, attitudes and daily pratice of dental and medical practitioners in France regarding oral health care and its relationship to pregnancy, particularly to preterm delivery and low birth-weight infants. A questionnaire was distributed to health-care professionals (n= 460), consisting of 100 prenatal care practitioners (obstetricians, midwives) and 360 dentists, about their knowledge of oral alterations during pregnancy, the possible association between periodontal disorders and preterm/low birth weight, and their conduct toward their patients. Bleeding gums and pregnancy gingivitis were the oral manifestations most often cited by all the practitioners. In contrast, prenatal care practitioners were unaware of epulis and a greater percentage of them than dentists believed caries risk to increase during pregnancy. The most adverse pregnancy outcomes cited were risk of premature delivery and chorioamniotis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point out the lack of continuing education on this topic. The present results underline the need for a better initial professional education and continuing education regarding pregnancy and oral health conditions and emphasise the need to update the guidelines in health care practices for pregnant women for a more effective prevention of risk-related adverse pregnancy outcomes, such as pre-term birth or pre-eclampsia.
Full Text Available Abstract Background The protection, promotion and support of breastfeeding are now major public health priorities. It is well established that skilled support, voluntary or professional, proactively offered to women who want to breastfeed, can increase the initiation and/or duration of breastfeeding. Low levels of breastfeeding uptake and continuation amongst adolescent mothers in industrialised countries suggest that this is a group that is in particular need of breastfeeding support. Using qualitative methods, the present study aimed to investigate the similarities and differences in the approaches of midwives and qualified breastfeeding supporters (the Breastfeeding Network (BfN in supporting breastfeeding adolescent mothers. Methods The study was conducted in the North West of England between September 2001 and October 2002. The supportive approaches of 12 midwives and 12 BfN supporters were evaluated using vignettes, short descriptions of an event designed to obtain specific information from participants about their knowledge, perceptions and attitudes to a particular situation. Responses to vignettes were analysed using thematic networks analysis, involving the extraction of basic themes by analysing each script line by line. The basic themes were then grouped to form organising themes and finally central global themes. Discussion and consensus was reached related to the systematic development of the three levels of theme. Results Five components of support were identified: emotional, esteem, instrumental, informational and network support. Whilst the supportive approaches of both groups incorporated elements of each of the five components of support, BfN supporters placed greater emphasis upon providing emotional and esteem support and highlighted the need to elicit the mothers' existing knowledge, checking understanding through use of open questions and utilising more tentative language. Midwives were more directive and gave more
Moran, Victoria Hall; Dykes, Fiona; Burt, Susan; Shuck, Christina
The protection, promotion and support of breastfeeding are now major public health priorities. It is well established that skilled support, voluntary or professional, proactively offered to women who want to breastfeed, can increase the initiation and/or duration of breastfeeding. Low levels of breastfeeding uptake and continuation amongst adolescent mothers in industrialised countries suggest that this is a group that is in particular need of breastfeeding support. Using qualitative methods, the present study aimed to investigate the similarities and differences in the approaches of midwives and qualified breastfeeding supporters (the Breastfeeding Network (BfN)) in supporting breastfeeding adolescent mothers. The study was conducted in the North West of England between September 2001 and October 2002. The supportive approaches of 12 midwives and 12 BfN supporters were evaluated using vignettes, short descriptions of an event designed to obtain specific information from participants about their knowledge, perceptions and attitudes to a particular situation. Responses to vignettes were analysed using thematic networks analysis, involving the extraction of basic themes by analysing each script line by line. The basic themes were then grouped to form organising themes and finally central global themes. Discussion and consensus was reached related to the systematic development of the three levels of theme. Five components of support were identified: emotional, esteem, instrumental, informational and network support. Whilst the supportive approaches of both groups incorporated elements of each of the five components of support, BfN supporters placed greater emphasis upon providing emotional and esteem support and highlighted the need to elicit the mothers' existing knowledge, checking understanding through use of open questions and utilising more tentative language. Midwives were more directive and gave more examples of closed questions. These differences could reflect
Bennett, D.; Fawcett, P.; Hunt, C.; Long, J.
The Environment Agency is the principal environmental regulator in England and Wales. As part of its longer term strategic planning, it is developing 'Sector Plans' for the major industry sectors it regulates. The intent of Sector Plans is to promote improvement of the Industry's performance in order to deliver environmental benefit. One of the pilot Sector Plans developed has been for the nuclear sector. The Nuclear Sector Plan has been produced jointly with the nuclear industry as a rolling framework of agreed national environmental objectives and priorities. Operators of nuclear sites have agreed to use this framework as a basis in England and Wales for setting environmental performance targets, monitoring performance against the targets and publicly reporting on their performance. The paper describes the development of the Sector Plan, its content and further development. (Author) 3 refs
Bellanca, Raffaella; Wilson, Emma
The UN's Sustainable Energy for All initiative (SE4ALL) has a strong focus on the private sector to deliver universal energy access, improved efficiency and increased investment in renewable energy. Leading private sector associations have bought into SE4ALL, including the World Business Council for Sustainable Development (WBCSD) and the Global Compact. However, critics argue that SE4ALL is focusing too much on large-scale infrastructure investment and is missing opportunities to stimulate enterprise more locally and to benefit the poorest. The private sector – including large and smaller-scale businesses, both local and international – is keen to get involved in energy access in low-income markets and sees the value of an initiative such as SE4ALL. Yet some feel that SE4ALL is failing to engage all levels of the private sector effectively. To deliver universal energy access, SE4ALL needs to address the lack of finance for enterprises and end users, especially in untested markets; infrastructure and support services for new businesses; local skills, capacity and information about workable models; and favourable policy frameworks. With the right incentives, business can open up low-income markets by providing lifeimproving services to emerging middle class populations who are still excluded from energy access. To reach the poorest SE4ALL can promote private sector partnerships with government and NGOs, encourage corporate responsibility initiatives and support social entrepreneurs.
de Steiguer, J.E.
This paper reports on environmental economics that has made some important advances in the past two decades, a significant portion of which has relevance to forestry and related activities. The time has come, however, for the forest economics community to vigorously apply principles of environmental economics (especially empirical investigations) to a variety of environmental problems of importance to the nation's forestry sector. Strategic research directions of considerable merit include determination of the economic consequences of externalities imposed on, by, and within the forestry sector. Also important is furthering the forestry community's understanding of policy instruments appropriate to the management of environmental externalities and the consequences of population and economic growth as a source of forestry-related environmental concerns. Focusing economics research on strategic directions of such a nature could lead to an information base that will further public interest in environmentally sound management of the nation's forests
This paper explores the value dimension of public innovation in the light of practitioners’ values and asks why there seems to be a clash between innovation imperatives and workplace practices in the public sector. The paper contributes to the research on public innovation from a practice...... perspective by providing evidence from an ethnographic field study on innovation in social and health care studies in Denmark. These studies are part of the vocational education and training (VET) system, which combines coursework at a college and internship in the elder care sector. The study is thus cross...... initiate innovations grounded in their values. The main point put forward is that the value dimension of public innovation must be understood not only in terms of value creation (economic or non-economic), which frontline practitioners are required to contribute to, but also as value-based practices...
We introduce a new paradigm in Composite Dark Sectors, where the full Standard Model (including the Higgs boson) is extended with a strongly-interacting composite sector with global symmetry group G spontaneously broken to H is contained in G. We show that, under well-motivated conditions, the lightest neutral pseudo Nambu-Goldstone bosons are natural dark matter candidates for they are protected by a parity symmetry not even broken in the electroweak phase. These models are characterized by only two free parameters, namely the typical coupling g D and the scale f D of the composite sector, and are therefore very predictive. We consider in detail two minimal scenarios, SU(3)/[SU(2) x U(1)] and [SU(2) 2 x U(1)]/[SU(2) x U(1)], which provide a dynamical realization of the Inert Doublet and Triplet models, respectively. We show that the radiatively-induced potential can be computed in a five-dimensional description with modified boundary conditions with respect to Composite Higgs models. Finally, the dark matter candidates are shown to be compatible, in a large region of the parameter space, with current bounds from dark matter searches as well as electroweak and collider constraints on new resonances.
Herberts, Carolina; Sykes, Catherine
To identify and juxtapose midwives' perceptions of providing stop-smoking advice and pregnant smokers' perceptions of stop-smoking services. A qualitative design was used in an attempt to expose and compare in-depth perceptions of midwives and pregnant smokers. Three focus groups lasting approximately 1 hour and involving 15 midwives were carried out, and 10 pregnant smokers participated in semistructured interviews. The qualitative data were analyzed by using the full version of grounded theory. The perceptions of midwives regarding provision of advice were related to outcome of advice, the relationship with patients, personal experiences, attributes, perception of role, the impact of external factors, and aspects related to pregnant smokers and pregnancy. Pregnant smokers' perceived barriers and facilitators to approaching stop-smoking services were categorized into areas of smoking behavior, advice from health professionals, stop-smoking services, and negative perceptions of pregnant women who smoke. In theory, many of the perceived barriers to providing advice could be overcome by implementing effective mandatory training for midwives. However, real issues, such as lack of time, have a major impact on the provision of advice. Pregnant smokers expect and appreciate receiving stop-smoking advice from midwives. Yet, they tend to have negative expectations of stop-smoking services, although the experiences of those who have attended these services are positive. Raising awareness of stop-smoking support for pregnant women is crucial in empowering women to make informed choices about their health and the health of their children. © 2011 by the American College of Nurse-Midwives.
Larson, Paul D.
In a marketing course delivered using Lotus Notes, 32 students were randomly assigned to large or small groups with heavy or light coaching. No differences in interactivity appeared related to group size or gender. More coaching increased the quantity, not quality, of interactivity. Quality seemed to decrease as quantity increased. (Contains 35…
Jun 1, 2015 ... This consists of information on diagnosis, indication, safety, complications, pain management and addressing other concerns of the patient. ..... Principles of. Biomedical Ethics. 5th ed. New York: Oxford Univ Pr; 2001. Counseling Preferences of Parturients Recently Delivered by Caesarean Section.....121 ...
Mudge, Stephen M.
Discusses advantages and disadvantages of using the Internet for delivering teaching modules and makes recommendations for successful use of the Internet. Highlights include the availability of information at all times and from remote locations, multimedia capabilities, infrastructure needed, security issues, updating, needed skills, and…
Col Alan Finnegan, the fi rst Ministry of Defence professor of nursing, is driving forward research into preparing nurses for deployment and ensuring they deliver the best care possible in war and peace. Research topics range from the role of autonomous practitioners to the effects on soldiers of injuries to their genitalia.
Dobson, Kristine; Fischio, Shannon
Providing information and resources to support career exploration is key to the mission of career and technical education (CTE) in Utah. Utah CTE has responded in a variety of ways to meet the career exploration needs of students of all ages. This article discusses how the career and technical education in Utah delivers opportunities for career…
Full Text Available Delivering Online Examinations: A Case Study Jason HOWARTH John MESSING Irfan ALTAS Charles Sturt University Wagga Wagga-AUSTRALIA ABSTRACT This paper represents a brief case study of delivering online examinations to a worldwide audience. These examinations are delivered in partnership with a commercial online testing company as part of the Industry Masters degree at Charles Sturt University (CSU. The Industry Masters degree is an academic program for students currently employed in the IT industry. Using Internet Based Testing (IBT, these students are examined in test centres throughout the world. This offers many benefits. For example, students have the freedom of sitting exams at any time during a designated interval. Computer-based testing also provides instructors with valuable feedback through test statistics and student comments. In this paper, we document CSUs use of the IBT system, including how tests are built and delivered, and how both human and statistical feedback is used to evaluate and enhance the testing process.
The Indian Government is currently thinking of allowing private sector to participate in power sector inviting private sector to generate electricity mainly from coal. The main motivation is resource mobilization from private sector, since the Plan funds are diverted to rural development away from power sector; and yet the massive expansion has to be financed. The paper analyzes the inherent difficulties and contradictions in the Government's proposal, such as co-existence of high cost private power and low cost public power, the potential goal-conflicts of private and public utilities and the constraints in raising finance. It suggests a different model in order to make the privatization proposition feasible. 12 refs
Bekkers, R.H.F.P.; Brink Lund, A.
How do citizens in Europe view third sector organizations? How can differences in perceptions of the third sector among citizens in Europe be explained? And how is the third sector assessed therein with regard to its contribution to social innovation? Based on the limited scope of the evidence
Hishinuma, Yuri; Horiuchi, Shigeko; Yanai, Haruo
Midwives are always involved in educational activities whenever novice midwives are present. Although various scales for measuring the educational competencies of nurses have already been developed in previous studies, a scale for the educational competencies particular to midwives has yet to be developed, or even no previous studies have revealed their functions as clinical educators. The purpose of this study was to develop a scale to measure the mentoring competencies of clinical midwives (MCCM Scale) and to confirm its validity and reliability. An exploratory quantitative research study. Questionnaires were distributed to 1,645 midwives at 148 facilities who had previously instructed novice midwives. 1,004 midwives (61.0%) voluntarily returned valid responses and 296 (18.0%) voluntarily agreed to participate in the survey for test-retest reliability. Exploratory factor analyses were performed over 41 items and the following seven factors were extracted with a reliability coefficient (Cronbach's α) of 0.953: (i) supporting experimental study, (ii) personal characteristics particularly in clinical educators, (iii) thoughtfulness and empathy for new midwives, (iv) self-awareness and self-reflection for finding confidence, (v) making effective use of the new midwives' own experience, (vi) commitment to educational activities, and (vii) sharing their midwifery practice. Test-retest reliability was measured based on a convenience sample of 246 (83.1%). Pearson's test-retest correlation coefficient for the entire scale was r=0.863. The factor loadings of each item on its respective factor were 0.313-0.925. The total score of the MCCM Scale was positively correlated with that of the Quality of Nurses' Occupational Experience Scale (r=0.641, p=0.000) and was negatively correlated with the total score of the Japanese Burnout Scale (r=-0.480, p=0.000). The MCCM Scale is composed of 41 items and three subscales measured from a total of seven factors. The validity and
Yamaguchi, Kotomi; Ohashi, Kazutomo
Per the 2014 Japanese Midwives Association (JMA) guidelines, midwives were allowed to manage the deliveries for group B streptococcus (GBS)-positive pregnant women in labour at maternity homes without the supervision of a medical doctor if they complied with the guidelines of the Japan Society of Obstetrics and Gynecology (JSOG), wherein midwives working for maternity homes are expected to cooperate with commissioned obstetricians and paediatricians in cooperative medical facilities. We examined the rate of compliance with these JMA and JSOG guidelines regarding the management of GBS-positive pregnant women among midwives at maternity homes in Japan. Between October and December 2015, an anonymous questionnaire was distributed to 337 maternity homes registered with the JMA by mail. The questionnaire obtained information regarding the timing of GBS screening, specimen collection, transfer of GBS-positive pregnant women from a maternity home to a hospital, administration of intrapartum antibiotic prophylaxis, and collaboration between midwives and commissioned obstetricians. Data were analysed using descriptive statistics. We used frequency distribution as the statistical test. Responses were received from 246 (73.0%) maternity homes, of which complete responses from 204 maternity homes (valid response rate, 60.5%) were analysed. Of these 204 maternity homes, only 97 (47.5%) conducted a GBS screening test during 33-37 weeks of gestation as recommended by the JSOG guidelines. Although midwives alone managed GBS-positive pregnant women in labour at 135 maternity homes (66.2%), intrapartum antibiotic prophylaxis, as recommended by the JSOG guidelines, was conducted in only 111 (54.4%). Moreover, only 37.0% (50/135) and 82.2% (111/135) of maternity homes ensured that GBS-positive pregnant women in labour with an elapse of ≥18 h after PROM and a body temperature of ≥38.0 °C, respectively, were transferred to a hospital by ambulance. Only at 58.3% (119/204) of
Martin, Linda; Gitsels-van der Wal, Janneke T; de Boer, Marjon A; Vanstone, Meredith; Henneman, Lidewij
In 2014, non-invasive prenatal testing (NIPT) for trisomies 21, 18 and 13 was added to the Dutch prenatal screening program as part of the TRIDENT study. Most (85%) pregnant Dutch women are counselled for prenatal aneuploidy screening by primary care midwives. This will remain when NIPT is implemented as a first-tier screening test. We therefore investigated midwife counsellors': 1) Knowledge about NIPT; 2) Attitudes towards NIPT as first-tier screening test; and 3) Experiences with informing clients about NIPT. Between April-June 2015, an online questionnaire to assess knowledge about NIPT, attitudes towards NIPT, and experiences with NIPT was completed by 436 Dutch primary care midwives. We found that 59% midwives answered ≥7 of 8 knowledge questions correctly. Continuing professional education attendance and more positive attitudes towards prenatal screening for Down syndrome were positively associated with the total knowledge score (β = 0.261; p = 0.007 and β = 0.204; p = 0.015, respectively). The majority (67%) were in favor of replacing First trimester Combined Test with NIPT, although 41% preferred to maintain a nuchal translucency measurement alongside NIPT. We conclude that midwives demonstrated solid knowledge about NIPT that may still be improved in some areas. Dutch midwives overwhelmingly support the integration of NIPT as a first-tier screening test. Copyright © 2017 Elsevier Ltd. All rights reserved.
Mariana LUPAN; Mykola LYAKHOVYCH
The paper points to recent developments in the tourism sector and highlights the leading factors of the internationalization of tourists travel and of tourism services, including information technologies, as well as the internationalization of hotel and tourism enterprises. Without neglecting the huge subsector of small and medium-sized enterprises, it describes typical features related to the composition of the labour force and to working conditions. It raises questions concerning the diffic...
Kofoed, Jens Peter
This Handbook for Ocean Wave Energy aims at providing a guide into the field of ocean wave energy utilization. The handbook offers a concise yet comprehensive overview of the main aspects and disciplines involved in the development of wave energy converters (WECs). The idea for the book has been...... shaped by the development, research, and teaching that we have carried out at the Wave Energy Research Group at Aalborg University over the past decades. It is our belief and experience that it would be useful writing and compiling such a handbook in order to enhance the understanding of the sector...
Hansen, Annette Skovsted
New and independent donors are adding their own twist to the experiences of receiving ODA and their examples are already inspiring the DAC, UN, and other multiple- and bilateral aid relationships. Rather than competition among development paradigms, I see negotiations of ideas of development and ...... and a co-existence of a multiplicity of approaches. I will argue that a trend of new and old actors inspiring each other will continue and the explicit focus on private sector development is just a first outcome....
The construction sector is characterized by high complexity due to several factors. There are a lot of processes within the building sites and they need the use of different materials with the help of appropriate technologies. Traditional materials have evolved and diversified, meanwhile new products and materials appeared and still appear, offering services which meet user needs, but that often involve risks to the health of workers. Research in the field of materials, promoted and carried out at various levels, has led to interesting results, encoded in the form of rules and laws.
Goodwin, Laura; Hunter, Billie; Jones, Aled
In 2015, 27.5% of births in England and Wales were to mothers born outside of the UK. Compared to their White British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. Existing literature highlights the importance of midwife-woman relationships in care satisfaction and pregnancy outcomes; however, little research has explored midwife-woman relationships for migrant and minority ethnic women in the UK. A focused ethnography was conducted in South Wales, UK, including semi-structured interviews with 9 migrant Pakistani participants and 11 practising midwives, fieldwork in the local migrant Pakistani community and local maternity services, observations of antenatal appointments, and reviews of relevant media. Thematic data analysis was undertaken concurrently with data collection. The midwife-woman relationship was important for participants' experiences of care. Numerous social and ecological factors influenced this relationship, including family relationships, culture and religion, differing health-care systems, authoritative knowledge and communication of information. Marked differences were seen between midwives and women in the perceived importance of these factors. Findings provide new theoretical insights into the complex factors contributing to the health-care expectations of pregnant migrant Pakistani women in the UK. These findings may be used to create meaningful dialogue between women and midwives, encourage women's involvement in decisions about their health care and facilitate future midwifery education and research. Conclusions are relevant to a broad international audience, as achieving better outcomes for migrant and ethnic minority communities is of global concern. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
Maynard, Douglas W.
Forecasting is a strategy for delivering bad news and is compared to two other strategies, stalling and being blunt. Forecasting provides some warning that bad news is forthcoming without keeping the recipient in a state of indefinite suspense (stalling) or conveying the news abruptly (being blunt). Forecasting appears to be more effective than stalling or being blunt in helping a recipient to “realize” the bad news because it involves the deliverer and recipient in a particular social relati...
Swarbrick, Margaret; Gill, Kenneth J; Pratt, Carlos W
People receiving publicly funded behavioral health services for severe mental disorders have shorter lifespans and significantly impaired health-related quality of life compared to the general population. The aim of this article was to explore how peer wellness coaching (PWC), a manualized approach to pursue specific physical wellness goals, impacted goal attainment and overall health related quality of life. Deidentified archival program evaluation data were examined to explore whether peer delivered wellness coaching had an impact on 33 service recipients with regard to goal attainment and health-related quality of life. Participants were served by 1 of 12 wellness coach trainees from a transformation transfer initiative grant who had been trained in the manualized approach. Coaching participants and their coaches reported significant progress toward the attainment of individually chosen goals, 2 to 4 weeks after establishing their goals. After 8 to 10 weeks of peer delivered wellness coaching, improvements were evident in the self-report of physical health, general health, and perceived health. These improvements were sustained 90 days later. PWC is potentially a promising practice for helping people choose and pursue individual goals and facilitating positive health and wellness changes. Rigorous controlled research with larger samples is needed to evaluate the benefits of peer delivered wellness coaching. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Full Text Available The paper points to recent developments in the tourism sector and highlights the leading factors of the internationalization of tourists travel and of tourism services, including information technologies, as well as the internationalization of hotel and tourism enterprises. Without neglecting the huge subsector of small and medium-sized enterprises, it describes typical features related to the composition of the labour force and to working conditions. It raises questions concerning the difficulties faced by the sector in attracting and retaining skilled workers in enhancing the skills of newcomers to the labour market in order to stabilize the sector’s labour force, while increasing the productivity of enterprises and the quality of services. Particular emphasis is put on new forms of management entailing new skills requirements, with a general tendency towards increased worker responsibility in an environment of flat hierarchies, multiskilling and teamwork.
Vinayak, Sudhir; Sande, Joyce; Nisenbaum, Harvey
phone using a modem. Transmission times were short and quality of images transmitted was excellent. All reports were validated by two experienced radiologists in our department and returned to the centers using the same transmission software. The transmission times, quality of scans, quality of reports...... and other parameters were recorded and monitored. Analysis showed excellent correlation between provisional and validated reports. Reporting accuracy of scans performed by the midwives was 99.63%. Overall flow turnaround time (from patient presentation to validated report) was initially 35 min but reduced...... to 25 min. The unique mobile phone transmission was faultless and there was no degradation of image quality. We found excellent correlation between final outcomes of the pregnancies and diagnoses on the basis of reports generated by the midwives. Only 1 discrepancy was found in the midwives' reports...
Full Text Available The story of the growth of open source use in Canada has been far more a matter of evolution than revolution, so quiet in its pace that its progress has been difficult to measure. This has posed many challenges to Canadian open source advocates in their efforts to ensure that their country does not lag behind the rest of the world in understanding the social and business benefits open source provides. Perhaps some of the leading soldiers in the trenches might be our civil servants who protect the public purse. In addition to managing and minimizing the costs of delivering necessary services, public sector projects should also advance the social good through the delicate balance of transparency and efficiency.
Hallett, Andrew Hughes
Large-scale asset purchase programmes are a form of monetary policy in which market interest rates are reduced by different amounts at different maturities – and lower them at the long rates that affect investment and consumption decisions. They are designed to stimulate spending by increasing...... that can be used (itself a risk reducing measure that reduces the pressure on reserves); and make it easier to steer economic performance by reducing risk premia, that is sectoral or regional interest spreads. That not only reduces average borrowing costs; it delivers better economic performance where...... liquidity, raising asset prices, creating wealth effects, lowering borrowing costs and increasing investment. Corporate bond purchases (CSPP) are complementary to, not an alternative to standard QE policies. They increase the impact of QE policies; widen the pool of (potentially) high quality assets...
The author emphasises the most important problem facing Bulgarian energy sector during the transition period to market economy - pricing reform. He discusses the way of forming the price based on 'long-term marginal expenditures' (LTME) for delivering the services. LTME include 'short-term marginal expenditures'(STME), (operational expenditures, energy cost) and additional investments for modernization of existing units. The first step of the pricing reform should be an increase of the prices at least up to the level of STME. Eventually the pricing reform must change the tariff structure responsible for stimulation of energy savings and market principles adapted for domestic realities. An attempt to connect the monopolist economic theory at market conditions with particular price corrections proposed by the Committee of Energetics for 1994 is made. 9 figs. (author)
Cooper, Megan; Warland, Jane; McCutcheon, Helen
There is little published research that has examined practitioners' views and experiences of pain relieving measures commonly used during labour and birth, particularly for non-pharmacological measures such as water immersion. Furthermore, there is minimal published research examining the process of policy and guideline development, that is, the translation of published research to usable practice guidance. The aims of phase three of a larger study were to explore midwives knowledge, experiences and support for the option of water immersion for labour and birth in practice and their involvement, if any, in development of policy and guidelines pertaining to the option. Phase three of a three phased mixed methods study included a web based survey of 234 Australian midwives who had facilitated and/or been involved in the development of policies and/or guidelines relating to the practice of water immersion. Midwives who participated in this study were supportive of both water immersion for labour and birth reiterating documented benefits of reduced pain, maternal relaxation and a positive birth experience. The most significant concerns were maternal collapse, the difficulty of estimating blood loss and postpartum haemorrhage whilst barriers included lack of accredited staff, lifting equipment and negative attitudes. Midwives indicated that policy/guideline documents limited their ability to facilitate water immersion and did not always to support women's informed choice. Midwives who participated in this study supported the practice of water immersion reiterating the benefits documented in the literature and minimal risk to the woman and baby. The Human Research Ethics Committee of the University of South Australia approved the research. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Vakily, Masoomeh; Noroozi, Mahnaz; Yamani, Nikoo
Training the health personnel about domestic violence would cause them to investigate and evaluate this issue more than before. Considering the new educational approaches for transferring knowledge, the goal of this research was to compare the effect of group-based and compact disk (CD)-based training on midwives' knowledge and attitude toward domestic violence. In this clinical experiment, seventy midwives working at health centers and hospitals of Isfahan were randomly allocated into two classes of group-based and CD-based trainings and were trained in the fields of recognition, prevention, and management of domestic violence. Data were collected by questionnaires which were completed by the midwives for evaluation of their knowledge and attitude. The mean score of midwives' knowledge and attitude toward domestic violence had a meaningful increase after the training (16.1, 46.9) compared to the score of before the training (12.1, 39.1) in both of the classes (group-based training: 17.7, 45.4) (CD-based training: 11.7, 38.6). No meaningful difference was observed between the two groups regarding midwives' attitude toward domestic violence after the intervention; however, regarding their knowledge level, the difference was statistically meaningful ( P = 0.001), and this knowledge increase was more in the CD-based training group. In spite of the effectiveness of both of the training methods in promoting midwives' knowledge and attitude about domestic violence, training with CD was more effective in increasing their knowledge; as a result, considering the benefits of CD-based training such as cost-effectiveness and possibility of use at any time, it is advised to be used in training programs for the health personnel.
Namito, Y.; Nelson, W.R.; Benson, E.
The collimators at Sector 30 of the SLAC accelerator are designed to scrape off a significant fraction (e.g., ∼20%) of the SLC beam. The electromagnetic cascade shower that develops in the collimator, and in the scraper and waveguide downbeam, leads to very high radiation exposures of TV cameras (and other devices) located nearby. The collimator (point) source accounts for one-third of the dose and is best shielded by extending the radius of the copper scraper. Radiation from the waveguide accounts for the remaining two-thirds of the dose, and is difficult to shield since it is a line source. However, the spectrum from the waveguide is expected to be softer than that from the collimator. This paper discusses shielding of these sources
Arent, D.; Benioff, R.; Mosey, G.; Bird, L.; Brown, J.; Brown, E.; Vimmerstedt, L.; Aabakken, J.; Parks, K.; Lapsa, M.; Davis, S.; Olszewski, M.; Cox, D.; McElhaney, K.; Hadley, S.; Hostick, D.; Nicholls, A.; McDonald, S.; Holloman, B.
This paper presents the results of energy market analysis sponsored by the Department of Energy's (DOE) Weatherization and International Program (WIP) within the Office of Energy Efficiency and Renewable Energy (EERE). The analysis was conducted by a team of DOE laboratory experts from the National Renewable Energy Laboratory (NREL), Oak Ridge National Laboratory (ORNL), and Pacific Northwest National Laboratory (PNNL), with additional input from Lawrence Berkeley National Laboratory (LBNL). The analysis was structured to identify those markets and niches where government can create the biggest impact by informing management decisions in the private and public sectors. The analysis identifies those markets and niches where opportunities exist for increasing energy efficiency and renewable energy use.
Atkinson, Lou; French, David P; Ménage, Diane; Olander, Ellinor K
a variety of services to support women to undertake weight management behaviours during pregnancy have recently been implemented as a means to reduce the risks to mother and infant. In the UK, midwives lead the care of the majority of pregnant women and are seen as the ideal source of referral into antenatal services. However, midwives have reported concerns regarding raising the topic of weight with obese women and negative referral experiences have been cited as a reason not to engage with a service. This study explored midwives' experiences of referring women to one of two antenatal weight management services. qualitative, cross-sectional interview and focus group study, with data analysed thematically. midwifery teams in the West Midlands, England. midwives responsible for referring to either a home-based, one to one service (N=12), or a community-based, group service (N=11). four themes emerged from the data. Participants generally had a positive View of the service, but their Information needs were not fully met, as they wanted more detail about the service and feedback regarding the women they had referred. Approaches to referral differed, with some participants referring all women who met the eligibility criteria, and some offering women a choice to be referred or not. Occasionally the topic was not raised at all when a negative reception was anticipated. Reasons for poor uptake of the services included pragmatic barriers, and their perception of women's lack of interest in weight management. midwives' differing views on choice and gaining agreement to refer means referral practices vary, which could increase the risk that obese women have inequitable access to weight management services. However, midwives' confidence in the services on offer may be increased with more detailed information about the service and feedback on referrals, which would additionally act as prompts to refer. weight management services need to improve communication with their
Vinayak, Sudhir; Sande, Joyce; Nisenbaum, Harvey; Nolsøe, Christian Pállson
Point-of-care ultrasound (POCUS) has become a topical subject and can be applied in a variety of ways with differing outcomes. The cost of all diagnostic procedures including obstetric ultrasound examinations is a major factor in the developing world and POCUS is only useful if it can be equated to good outcomes at a lower cost than a routine obstetric examination. The aim of this study was to assess a number of processes including accuracy of images and reports generated by midwives, performance of a tablet-sized ultrasound scanner, training of midwives to complete ultrasounds, teleradiology solution transmissions of images via internet, review of images by a radiologist, communication between midwife and radiologist, use of this technique to identify high-risk patients and improvement of the education and teleradiology model components. The midwives had no previous experience in ultrasound. They were stationed in rural locations where POCUS was available for the first time. After scanning the patients, an interim report was generated by the midwives and sent electronically together with all images to the main hospital for validation. Unique software was used to send lossless images by mobile phone using a modem. Transmission times were short and quality of images transmitted was excellent. All reports were validated by two experienced radiologists in our department and returned to the centers using the same transmission software. The transmission times, quality of scans, quality of reports and other parameters were recorded and monitored. Analysis showed excellent correlation between provisional and validated reports. Reporting accuracy of scans performed by the midwives was 99.63%. Overall flow turnaround time (from patient presentation to validated report) was initially 35 min but reduced to 25 min. The unique mobile phone transmission was faultless and there was no degradation of image quality. We found excellent correlation between final outcomes of the
Chipps, Jennifer; Pimmer, Christoph; Brysiewicz, Petra; Walters, Fiona; Linxen, Sebastian; Ndebele, Thandi; Gröhbiel, Urs
Empirical studies show the value of mobile phones as effective educational tools to support learning in the nursing profession, predominantly in high income countries. The rapidly increasing prevalence of mobile phone technology in Africa nourishes hopes that these tools could be equally effective in lowly resourced contexts, specifically in efforts to achieve the health-related Millennium Development goals. The purpose of this study was to investigate the perception and use of mobile phones as educational and professional tools by nurses in lowly resourced settings. A quantitative survey using self-administered questionnaires was conducted of rural advanced midwives. Fifty-six nurses (49.6%) from the 113 rural-based midwives attending an advanced midwifery training programme at the University of KwaZulu-Natal, South Africa, filled in a questionnaire. The results showed that, whilst nurses regarded their technology competences as low and although they received very little official support from their educational and professional institutions, the majority frequently used mobile functions and applications to support their work and learning processes. They perceived mobile devices with their voice, text, and email functions as important tools for the educational and professional activities of searching for information and engaging with facilitators and peers from work and study contexts. To a lesser extent, the use of social networks, such as WhatsApp and Facebook, were also reported. It is concluded that educational institutions should support the appropriate use of mobile phones more systematically; particularly in relation to the development of mobile network literacy skills.
Toohill, Jocelyn; Fenwick, Jennifer; Gamble, Jenny; Creedy, Debra K; Buist, Anne; Turkstra, Erika; Ryding, Elsa-Lena
Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women's childbirth fear. Women (n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial. Participants reporting high fear were randomly allocated to intervention (n = 170) or control (n = 169) groups. All women received a decision-aid booklet on childbirth choices. The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy. The control group received usual care offered by public maternity services. Primary outcome was reduction in childbirth fear (WDEQ-A) from second trimester to 36 weeks' gestation. Secondary outcomes were improved childbirth self-efficacy, and reduced decisional conflict and depressive symptoms. Demographic, obstetric & psychometric measures were administered at recruitment, and 36 weeks of pregnancy. There were significant differences between groups on postintervention scores for fear of birth (p childbirth self-efficacy (p = 0.002). Decisional conflict and depressive symptoms reduced but were not significant. Psycho-education by trained midwives was effective in reducing high childbirth fear levels and increasing childbirth confidence in pregnant women. Improving antenatal emotional well-being may have wider positive social and maternity care implications for optimal childbirth experiences. © 2014 The Authors. Birth Published by Wiley Periodicals, Inc.
Full Text Available Reduction of the duration of postpartum hospital stay in western countries highlights the need for better support and continuity of care for expectant and new mothers. The aim of this study was to investigate strategies to improve continuity of care for expectant and new mothers. The study also aimed to elaborate on a preliminary substantive grounded theory model of “linkage in the chain of care” that had been developed earlier. Grounded theory methodology, which involved multiple data sources comprising structured interviews with midwives and child healthcare nurses (n=20, as well as mothers (n=21, participant observation, and written material, was used. Comparative analysis was used to analyse the data. To achieve continuity, three main strategies, transfer, establishing and maintaining a relation, and adjustment, were identified. These strategies for continuity formed the basis of the core category, joint action. In all the strategies for continuity, midwives and child healthcare nurses worked together. In addition, mothers benefited from the joint action and recognized continuity of care when strategies for continuity were implemented. The results are discussed in relation to the established concepts of continuity.
Reduction of the duration of postpartum hospital stay in western countries highlights the need for better support and continuity of care for expectant and new mothers. The aim of this study was to investigate strategies to improve continuity of care for expectant and new mothers. The study also aimed to elaborate on a preliminary substantive grounded theory model of “linkage in the chain of care” that had been developed earlier. Grounded theory methodology, which involved multiple data sources comprising structured interviews with midwives and child healthcare nurses (n=20), as well as mothers (n=21), participant observation, and written material, was used. Comparative analysis was used to analyse the data. To achieve continuity, three main strategies, transfer, establishing and maintaining a relation, and adjustment, were identified. These strategies for continuity formed the basis of the core category, joint action. In all the strategies for continuity, midwives and child healthcare nurses worked together. In addition, mothers benefited from the joint action and recognized continuity of care when strategies for continuity were implemented. The results are discussed in relation to the established concepts of continuity. PMID:22783367
McDonald, Glenda; Jackson, Debra; Wilkes, Lesley; Vickers, Margaret H
A work-based educational programme was the intervention used in a collective case study aiming to develop, strengthen and maintain personal resilience amongst fourteen nurses and midwives. The participants attended six, monthly workshops and formed a participatory learning group. Post-intervention, participants reported positive personal and professional outcomes, including enhanced self-confidence, self-awareness, communication and conflict resolution skills. They strengthened relationships with their colleagues, enabling them to build helpful support networks in the workplace. The intervention used new and innovative ways of engaging nurses and midwives exhibiting the effects of workplace adversity - fatigue, pressure, stress and emotional labour. Participants were removed from their usual workplace environment and brought together to engage in critical reflection, experiential learning and creativity whilst also learning about the key characteristics and strategies of personal resilience. Participants' experiences and skills were valued and respected; honest airing of the differences within the group regarding common workplace issues and concerns was encouraged. The new contribution of this intervention for nursing and midwifery education was supporting the learning experience with complementary therapies to improve participants' wellbeing and reduce stress. Copyright © 2011. Published by Elsevier Ltd.
To explore student midwives' experiences of caseloading to develop an understanding of how they perceive this educational strategy has impacted on their learning journey to becoming a midwife. A qualitative approach drawing upon the principles of grounded theory. Data were collected by in-depth semi-structured interviews. A university in the South of England providing undergraduate pre-registration midwifery education across Advanced Diploma and BSc (Hons) programmes. Eight Caucasian female final-year student midwives aged 23-50 years who had completed their caseloading experience. One core category ('making it good') and four major categories emerged: (1) 'developing and managing caseload', (2) 'learning partnerships', (3) 'feeling like a midwife' and (4) 'afterwards'. The core category was reflected in all the other categories and was dependent upon them. Students identified caseloading as a highly beneficial learning approach, facilitating application of theory to practice and acquisition of new skills promoting confidence and competence in practice. Students articulated an overwhelming desire and concern to meet and facilitate women's expectations. Perceptions of letting the woman down evoked feelings of inadequacy and failure. Flexible working practices, on-call commitment and carrying a caseload alongside academic and home commitments was, for many, emotionally stressful. Effective preparation of students for the realities of caseloading, the development of realistic caseloads that take account of the student's individual situation, and the provision of supportive frameworks are essential. Copyright © 2010 Elsevier Ltd. All rights reserved.
Ahmad, Nisar; Naveed, Amjad; Naz, Amber
believe that structural change is an unimportant side effect of the economic development. On the contrary, economists associated with the World Bank and some others posit that growth is brought about by the changes in sectoral composition. The objective of this study is to empirically test...... the relationship between sectoral shares and economic growth by using the panel data for 20 developed countries. The results of the granger causality suggest that both services and agriculture sectors do granger cause economic growth, whereas industrial sector does not granger cause growth. Reverse causality does...... not hold for any of the three sectors. The results of Barro and Non-Barro regressions along with the set of control variables have suggested that services sector is negatively affecting growth, whereas both industrial and agriculture shares are positively affect economic growth....
Zhou, Peter [EECG Consultants, Gaborone (Botswana)
The rationale for conducting climate change mitigation studies in the transport sector is on the premise that: The transport sector is the second largest consumer of fossil fuels in the region; The regional transport sector is an area with high opportunity for infrastructural development under UNFCCC financial mechanism; The regional transport sector is crucial in the SADC region for trade and coupled with the Trade Protocol will play a major role in development hence the need to make it efficient in terms of energy demand and provision of services; The sector offers many mitigation options but with a challenge to evaluate their energy saving and GHG saving potential and yet there is need to quantify possible emission reduction for possible future emission trading. This is also a sector with potential to qualify for financing through Clean Development Mechanism (CDM) recently stipulated in the Kyoto Protocol. (au)
The rationale for conducting climate change mitigation studies in the transport sector is on the premise that: The transport sector is the second largest consumer of fossil fuels in the region; The regional transport sector is an area with high opportunity for infrastructural development under UNFCCC financial mechanism; The regional transport sector is crucial in the SADC region for trade and coupled with the Trade Protocol will play a major role in development hence the need to make it efficient in terms of energy demand and provision of services; The sector offers many mitigation options but with a challenge to evaluate their energy saving and GHG saving potential and yet there is need to quantify possible emission reduction for possible future emission trading. This is also a sector with potential to qualify for financing through Clean Development Mechanism (CDM) recently stipulated in the Kyoto Protocol. (au)
Delivering Business Value from IT' is focused on the evaluation issue in IT and how IT evaluation can proceed across the life-cycle of any IT investment and be linked positively to improving business performance. .Chapters 1,2 and 3 detail an approach to IT evaluation whilst chapters 4 and 5 build on these by showing two distinctive approaches to linking IT to business performance. The remaining three chapters deal with a range of evaluation issues emerging as important - specifically Internet evaluation, Y2K and beyond, EMU, quality outsourcing, infrastructure, role of benchmarking, and cost
Subbarao, Srikanth; Lloyd, Bob
The paper investigates whether the Clean Development Mechanism (CDM) under the Kyoto Protocol has played a significant role in the development of rural communities, specifically investigating uptake of small-scale renewable energy projects. The investigation involved an assessment of 500 registered small-scale CDM projects under the Kyoto Protocol in terms of their potential impact on the envisaged sustainable development goals for rural communities. Five case studies from the Indian subcontinent were also examined. The paper concludes that the CDM in its current state and design has typically failed to deliver the promised benefits with regard to development objectives in rural areas. Successful projects were found to have had good community involvement and such projects were typically managed by cooperative ventures rather than money making corporations. The paper puts forward a new framework for the assessment of such benefits in the hope that future projects can be better assessed in this regard. The key problem, however, remains on how to deal with the inherent contradiction between development and sustainability. - Research Highlights: → Role of CDM towards sustainable development of rural communities. → Assessment of 500 registered small-scale CDM projects. → CDM in its current state and design has typically failed to deliver. → A new framework for sustainable development assessment of small-scale CDM projects. → Inherent contradiction between development and sustainability.
Margie A. Nolasco
Full Text Available Tourism has benefits not just for travelers, but also to the local economy. Since, Bicol Region has natural and cultural attractions; it is a potential travel destination in the country. Technology in delivering information sources played vital role for the success of the tourism industry in the Region. This allows travel enthusiasts to get more information about various tourist attractions. This paper analyzes the effectiveness of delivering information sources such as web advertisement and desktop publishing for tourist promotion in the Bicol Region. Specifically, it determined the status of tourism, and identified common forms of promotions for tourism development. The study adopted mixed method of research. This method was utilized to confirm and validate findings. Interviews and focus group discussions were used to gather data from the respondents of the selected Local Government Units, Department of Tourism, Travel Agencies and Hotel Agents in the Region. Based on the findings, of the total foreign visitors in the country, only 9.14% visited Bicol Region in 2014. That is why, domestic tourist showed high percentage against foreign visitors with 25.7%. Brochures with EZ maps as most commonly used desktop publishing materials and websites and social media for web advertisement. Thus, there is a need to reevaluate promotional activities by the DOT and other agencies. Adoption suggestive features for creative desktop publishing materials and web services should be considered to increase tourist visitors in the Region.
Producing science data products that can be used to extract science is the ultimate objective of astronomical observation. The complexity of modern instruments require highly specialized algorithms for data organization and data reduction. Data visualization and user interaction, both to fine tune individual algorithms and to modify the data flow itself, are essential for the production of science grade products that fully exploits the potential of the raw data. ESO has a long history of providing specialized algorithms called recipes for each of its instruments. ESOREFLEX is an environment to deliver complete data reduction workflows that include these recipes to the users. These workflows encapsulate the best practise data reduction for the data from a particular instrument, and at the same can easily be modified by the user. ESOREFLEX includes systems for automatic data organization and visualization, interaction with recipes, and the exploration of the provenance tree of intermediate and final data products. ESOREFLEX allows ESO to deliver recipes that are used in its unsupervised operational pipelines to [...
Viljoen, Adam Herman
The importance of management in the food and beverage sector as well as managing food and beverage service employees are crucial aspects that influence quality service delivery. The food and beverage sector is a large service orientated segment of the greater tourism industry, and effective management of employees is therefore necessary since employees are regarded as the primary resource through which establishments deliver services. One might further argue that an employee is...
multiple taxes which are inimical to the growth and development of the informal sector. KEY WORDS: .... been traced to so many factors such as economic distortions; urbanization, unemployment and low skills; heavy tax ... informal manufacturing sector in Durgapur, India as demand crunch, resource crunch, infrastructural ...
Nielsen, Rikke Skovgaard; Haagerup, Christian Deichmann
With Denmark faring reasonably well through the global financial crisis, the policy changes to the social housing sector caused by the crisis have been limited. Nevertheless, changes have taken place nonetheless both in terms of policy and in the residential composition of the sector which policies...
Houtman, I.L.D.; Andries, F.; Berg, R. van den; Dhondt, S.
This report looks at trends in working conditions across different sectors Over the period 1995-2000. Basing its findings on the Third European Survey on Working Conditions (2000) in the 15 EU Member States and Norway, it examines the quality of working life in eighteen different sectors. It
J.G.M. van Marrewijk (Charles); J.B.L.M. Verbeek (Jos)
textabstractWe investigate the effects of (i) profit distribution to either laborers or capital-owners, (ii) sector-specific or efficient rationing schemes, and (iii) government consumption in a two-sector disequilibrium growth model with sluggish real wage rate adjustment (which affects capital
Norberg, Carin; Vian, Taryn
This U4 Issue presents some essential resources for anyone promoting anti-corruption in the health sector, or otherwise wanting to learn about the challenges of corruption in the health sector. The text is originally developed as web pages by U4 based on research by Carin Norberg of Transparency International and were later updated by Taryn Vian () of Boston University.
Introduction of EDI in the public administration is apriority for the Danish Government. EDI is both seen as a catlyst for development towards an information society ans as a means for more efficient use of scarce resources. EDI in the banking sector and the retail sector is reviewed, drivers...
Puech, Paloma; Pitcho, Benjamin
The French Labour Code, which provides full protection against moral and sexual harassment, is not applicable to public sector workers. The public hospital is however not exempt from such behaviour, which could go unpunished. Public sector workers are therefore protected by the French General Civil Service Regulations and the penal code.
I. Stöteler (Ismaela); S. Reeder (Sabine); R.J.M. van Tulder (Rob)
textabstractA cross-sector partnership is a collaborative effort in which parties from different societal sectors pool resources to provide solutions to (perceived) common problems. These partnerships are often rather complex because of a number of reasons: (1) they address complex issues, (2) they
Full Text Available In 1997 a Health Resources and Services Administration (HRSA grant was awarded to the Department of Clinical Laboratory Sciences (CLS at The University of Texas Medical Branch - Galveston (UTMB for support of the Laboratory Education and Advancement Project (LEAP. The project entailed three primary objectives, targeting laboratory practitioners in rural and medically underserved areas of Texas for delivering a bachelor's degree, laboratory-intensive course of study via distance education. Several delivery mechanisms were utilized and evaluated for their effectiveness and friendliness to both the faculty and students. The authors discuss and describe the mechanisms utilized for delivery of courses, the advantages and disadvantages encountered with each mechanism, and subjective evaluation of the effectiveness of the courses. Also discussed are the lessons learned and plans for future development.
As a District Nursing Sister based at a small village surgery, this is a personal account of the author's experiences introducing a new approach for delivering holistic wound management to patients. It deals with the practical and emotional challenges of overcoming barriers to change and forging new working relationships, both within the nursing team and with the patients and wider community. With the encouragement and support of Ellie Lindsay, originator of the Lindsay Leg Club model, Combs Ford Leg Club was set up in 2000 to provide leg ulcer management in an empowered and stigma-free environment. Through the commitment and efforts of nurses, volunteers and patients working together, difficulties and resistance have been confronted and overcome, and Combs Ford Leg Club today is a thriving and vibrant resource, treating, supporting and educating those experiencing leg ulcers or other leg related conditions.
The IAEA’s technical cooperation programme is the primary mechanism for delivering the IAEA’s capacity-building services to its Member States. The programme supports the safe and secure application of nuclear technology for sustainable socioeconomic development in Member States. The overall strategic framework of the TC programme is determined by pertinent provisions laid down in key documents of the IAEA. Strategic direction for the multi-annual TC programme is provided by the Agency’s Members States and, more specifically, by relevant advisory and governance entities. The programme concentrates on: improving human health; supporting agriculture, rural development and food security; advancing water resource management; addressing environmental challenges; helping sustainable energy development, including the use of nuclear power for electricity; and promoting safety and security
Hosking, Ian; Cornish, Katie; Bradley, Mike; Clarkson, P. John
Abstract Dignity is a key value within healthcare. Technology is also recognized as being a fundamental part of healthcare delivery, but also a potential cause of dehumanization of the patient. Therefore, understanding how medical devices can be designed to help deliver dignity is important. This paper explores the role of empathy tools as a way of engendering empathy in engineers and designers to enable them to design for dignity. A framework is proposed that makes the link between empathy tools and outcomes of feelings of dignity. It represents a broad systems view that provides a structure for reviewing the evidence for the efficacy of empathy tools and also how dignity can be systematically understood for particular medical devices. PMID:26453036
Chikata, Yusuke; Onodera, Mutsuo; Imanaka, Hideaki; Nishimura, Masaji
Although heated humidifiers (HHs) are the most efficient humidifying device for mechanical ventilation, some HHs do not provide sufficient humidification when the inlet temperature to the water chamber is high. Because portable and home-care ventilators use turbines, blowers, pistons, or compressors to inhale in ambient air, they may have higher gas temperature than ventilators with piping systems. We carried out a bench study to investigate the temperature of gas delivered from portable and home-care ventilators, including the effects of distance from ventilator outlet, fraction of inspiratory oxygen (FIO2), and minute volume (MV). We evaluated five ventilators equipped with turbine, blower, piston, or compressor system. Ambient air temperature was adjusted to 24°C ± 0.5°C, and ventilation was set at FIO2 0.21, 0.6, and 1.0, at MV 5 and 10 L/min. We analyzed gas temperature at 0, 40, 80, and 120 cm from ventilator outlet and altered ventilator settings. While temperature varied according to ventilators, the outlet gas temperature of ventilators became stable after, at the most, 5 h. Gas temperature was 34.3°C ± 3.9°C at the ventilator outlet, 29.5°C ± 2.2°C after 40 cm, 25.4°C ± 1.2°C after 80 cm and 25.1°C ± 1.2°C after 120 cm (P < 0.01). FIO2 and MV did not affect gas temperature. Gas delivered from portable and home-care ventilator was not too hot to induce heated humidifier malfunctioning. Gas soon declined when passing through the limb.
Full Text Available Abstract Background Around 5,000 miscarriages and 300 perinatal deaths per year result from maternal smoking in the United Kingdom. In the northeast of England, 22% of women smoke at delivery compared to 14% nationally. Midwives have designated responsibilities to help pregnant women stop smoking. We aimed to assess perceived implementation difficulties regarding midwives’ roles in smoking cessation in pregnancy. Methods A self-completed, anonymous survey was sent to all midwives in northeast England (n = 1,358 that explores the theoretical explanations for implementation difficulties of four behaviours recommended in the National Institute for Health and Clinical Excellence (NICE guidance: (a asking a pregnant woman about her smoking behaviour, (b referring to the stop-smoking service, (c giving advice about smoking behaviour, and (d using a carbon monoxide monitor. Questions covering Michie et al.’s theoretical domain framework (TDF, describing 11 domains of hypothesised behavioural determinants (i.e., ‘knowledge’, ‘skills’, ‘social/professional role/identity’, ‘beliefs about capabilities’, ‘beliefs about consequences’, ‘motivation and goals’, ‘memory’, ‘attention and decision processes’, ‘environmental context and resources’, ‘social influences’, ‘emotion’, and ‘self-regulation/action planning’, were used to describe perceived implementation difficulties, predict self-reported implementation behaviours, and explore relationships with demographic and professional variables. Results The overall response rate was 43% (n = 589. The number of questionnaires analysed was 364, following removal of the delivery-unit midwives, who are not directly involved in providing smoking-cessation services. Participants reported few implementation difficulties, high levels of motivation for all four behaviours and identified smoking-cessation work with their role. Midwives were less certain about the
Ribeliene, Janina; Blazeviciene, Aurelija; Jolanta Nadisauskiene, Ruta; Tameliene, Rasa; Kudreviciene, Ausrele; Nedzelskiene, Irena; Macijauskiene, Jurate
Patients treated in healthcare facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events.The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a healthcare institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety. We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses' and midwives'opinion about patient safety issues. The overall response rate in the survey was 100% (n = 233). The analysis of the dimensions of safety on the unit level showed that the respondents' most positive evaluations were in the Organizational Learning - Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations- in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error dimensions. On the hospital level, the critical domains in healthcare facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across
Full Text Available Abstract Background Despite recent developments, health care provision in Indonesia remains suboptimal. Difficult terrain, economic crises, endemic diseases and high population numbers, coupled with limited availability of qualified health care professionals, all contribute to poor health status. In a country with a population of 220 million, there are currently an estimated 50 nurses and 26 midwives per 100 000 people. In line with government initiatives, this series of studies was undertaken to establish the training and development needs of nurses and midwives working within a variety of contexts in Indonesia, with the ultimate aim of enhancing care provision within these domains. Methods An established, psychometrically valid and reliable training needs instrument was modified for use within the Indonesian context. While this technique has had widespread international use in the developed world, its application for developing countries has not yet been established. The standard form consists of a biographical cover sheet and a core set of 30 items (all health-related tasks, which have to be rated along two seven-point scales. The first of these scales asks respondents to assess how important the task is to their job and the second scale is a self-assessment of respondents' current performance level of the task. By comparing the importance rating with the performance rating, an index of training need can be obtained (high importance and low performance indicating a significant training need. The modifications incorporated for use in this series of studies were a further 10 items, which were constructed following expert group and focus group discussions and a review of the relevant literature. Pilot trials with 109 respondents confirmed its feasibility and acceptability. The instrument was then administered to 524 nurses and 332 midwives across Indonesia. Results The data were subjected to a retrospective factor analysis, using a Varimax
Full Text Available Private sector institutions utilise many different business methods, some of which can selectively be adapted for use by organisations outside the private sector, to the benefit of their service delivery responsibilities. But the best of the appropriate practices from the private sector have often “not crossed over”. The Water Research Commission (WRC of South Africa, working in collaboration with the Council for Scientific and Industrial Research (CSIR, finds that the concept of franchising, so successfully used by the private sector to deliver many goods and services, if applied to water services operation and maintenance, could alleviate and address many challenges in the management of water services. At the same time, franchising could provide an ideal stimulus to support the development of local enterprises, all within the municipal service delivery environment. Franchisee water service providers, dependent for their livelihood on the success of their business, would have a strong incentive to perform, and would also enjoy the benefit of the franchisor’s expert guidance and quality assurance. Some areas for potential franchising include meter management, billing, plumbing, pressure management, sewer maintenance, and wastewater treatment processes. The help from the franchisor would be of particular value to water services authorities at a distance from the major urban centres. Few of these authorities can afford to employ competent qualified staff, and often non-compliance with the laid down performance standards is a direct consequence of this lack. Significant improvements would soon be seen if the generally under-qualified and under-resourced water services staff could have this ongoing support, mentoring and quality control — or if the authority could enter into partnerships with small local enterprises or NGOs which would, through franchising, enjoy the necessary ongoing support, mentoring and quality control, and would have
Boerleider, A.W.; Francke, A.L.; Manniën, J.; Wiegers, T.A.; Deville, W.L.J.M.
Background: Non-western women living in the Netherlands are diverse in origin, which implies diversity in their needs and expectations for midwifery care. Furthermore, it has also been shown that non-western women make suboptimal use of prenatal care. Midwives may therefore face difficulties when
Boerleider, A.W.; Francke, A.L.; Manniën, J.; Wiegers, T.A.; Devillé, W.L.J.M.
Background: Non-western women living in the Netherlands are diverse in origin, which implies diversity in their needs and expectations for midwifery care. Furthermore, it has also been shown that non-western women make suboptimal use of prenatal care. Midwives may therefore face difficulties when
Boerleider, A.W.; Francke, A.L.; Manniën, J.; Wiegers, T.A.; Devillé, W.L.J.M.
Background: Non-western women living in the Netherlands are diverse in origin, which implies diversity in their needs and expectations for midwifery care. Furthermore, it has also been shown that non-western women make suboptimal use of prenatal care. Midwives may therefore face difficulties when
Joanna Skręt- Magierło
There are some differences in Polish and Ukrainian obstetricians, midwives and parturients in respect of: – vaginal delivery after CS, – epidural analgesia, – CS on request, – anxiety connected with labour. The above may to some extend explain the difference in Cs rate in two countries.
The study about paraji (Traditional Birth Attendants - TBA) and bidan (Community Midwives -CMW) in Rancaekek, a subdistrict in West Java, Indonesia, aimed to contribute to the knowledge and understanding about the relationships between traditional and modern Maternal and Child Health (MCH) systems.
Oppong-Darko, Prince; Amponsa-Achiano, Kwame; Darj, Elisabeth
Unsafe abortion is a major preventable public health problem and contributes to high mortality among women. Ghana has ratified international conventions to prevent unwanted pregnancies and provide safe abortion services, legally authorizing midwives to provide induced abortion services in certain circumstances. The aim of the study was to understand midwives' readiness to be involved in legal induced abortions, should the law become less restricted in Ghana. A qualitative study design, with a topic guide for individual in-depth interviews of selected midwives, was adopted. The interviews were tape-recorded and analyzed using content analysis. Participants emphasized their willingness to reduce maternal mortalities, their experiences of maternal deaths, and their passion for the health of pregnant women. Knowledge of Ghana's abortion law was generally low. Different views were expressed regarding readiness to engage in abortion services. Some expressed it as being sinful and against their religion to assist in abortion care, whilst others felt it was good to save the lives of women. The midwives made it clear that unsafe abortions are common, stigmatizing and contributing to maternal mortality, issues that must be addressed. They made various suggestions to reduce this preventable tragedy.
Afhami, Narges; Bahadoran, Parvin; Taleghani, Hamid Reza; Nekuei, Nafisehsadat
Induced abortion is an important medical issue. Knowledge and attitude of midwives regarding legal and religious commandments on induced abortion can be useful in confronting this issue. The aim of this study was to assess the knowledge and attitudes of midwives of Isfahan regarding these rules and to find their relationship with demographic characteristics. This was a cross-sectional, descriptive, and analytical study. The study participants consisted of 189 midwives working in hospitals, health centers, private gynecology clinics, and university. Random quota sampling method was used. Data were collected using a researcher-made questionnaire. Data were analyzed using mean, frequency distribution tables, Pearson correlation, and Spearman's coefficient. For all tests, an error of less than 0.05 was considered. The majority of the participants had extremely low to moderate (73%) knowledge about the subject of the study. Their attitudes toward effective implementation of these rules were mostly extremely weak to moderate (68.72%). No correlation was observed between knowledge, age, work experience, and education. However, there was a relationship between the level of knowledge about these rules and the location of service. There was no significant correlation between attitude and demographic characteristics. Due to less knowledge of the midwives and their low attitude score in this regard, training them, improving their attitude toward these issues, and effective implementation of these laws are necessary. Therefore, by identifying the factors affecting the formation of attitudes and the level of knowledge, more constructive proceedings can be taken to promote them.
Alberto González García
Full Text Available Midwives are an example of women in health professions who strove for their visibility in a biomedical androcentric universe that has tended to ignore or hide them. The objective of this article is to analyze the incorporation process of midwives in the Municipal Charity institution of Cuenca (Spain to demonstrate how they were relegated to the background. The methodology includes the analysis of the process by using the gender perspective. The Municipal Archive of Cuenca and the Provincial Archive have been consulted; the main local newspapers of that time were analyzed; and epidemiological data were abstracted from the National Statistics Institute. While physicians and practitioners counted with a specific professional area within the municipality, midwives did not succeed that until 1915. Midwives in Cuenca exercised their functions in a specific place and not in the Casa de Socorro (assistance house, which was of exclusive domain of physicians and practitioners. They also dedicated to private assistance. It is very likely that attendance at childbirth was also carried out by mothers and women neighbors without qualification.
English National Board for Nursing, Midwifery and Health Visiting, London.
An evaluation investigated the effectiveness of midwifery education in preparing midwives to care for clients likely to experience inequalities in health and/or inequalities in health care provision in England. The study was undertaken in these three phases: (1) literature review of midwifery and relevant social policy literature; (2) national…
Shahla Nourani Saadoldin
Full Text Available Background & aim: Organizational citizenship behavior (OCB is a voluntary, organizationally desirable action that is not part of the employee’s formal job requirements. Job satisfaction and stress can affect mental health of midwives, and investigating the relationship between these variables can improve the quality of healthcare services. This study, therefore, was conducted to identify the relationship between OCB, occupational stress, and job satisfaction in Iranian midwives. Methods:This descriptive-correlational study was performed on 122 midwives working at healthcare centers of Mashhad, Iran, in 2014. The participants were chosen using a census approach. The tools for data collection included a demographic questionnaire, Podsakoff’s OCB Questionnaire, Minnesota Satisfaction Scale, and Karasek’s Job Content Questionnaire. Data analysis was carried out using Spearman and Pearson’s correlation, one-way ANOVA, and student t test were by SPSS version 20. Results: The mean age of the midwives was 38.46±7.22 years. OCB had a significant direct correlation with job satisfaction (r=0.223 and a significant negative correlation with job stress (r=-0.270(P
Henshall, Catherine; Taylor, Beck; Goodwin, Laura; Farre, Albert; Jones, Miss Eleanor; Kenyon, Sara
Women's planned place of birth is gaining increasing importance in the UK, however evidence suggests that there is variation in the content of community midwives' discussions with low risk women about their place of birth options. The objective of this study was to develop an intervention to improve the quality and content of place of birth discussions between midwives and low-risk women and to evaluate this intervention in practice. The study design comprised of three stages: (1) The first stage included focus groups with midwives to explore the barriers to carrying out place of birth discussions with women. (2) In the second stage, COM-B theory provided a structure for co-produced intervention development with midwives and women representatives; priority areas for change were agreed and the components of an intervention package to standardise the quality of these discussions were decided. (3) The third stage of the study adopted a mixed methods approach including questionnaires, focus groups and interviews with midwives to evaluate the implementation of the co-produced package in practice. A maternity NHS Trust in the West Midlands, UK. A total of 38 midwives took part in the first stage of the study. Intervention design (stage 2) included 58 midwives, and the evaluation (stage 3) involved 66 midwives. Four women were involved in the intervention design stage of the study in a Patient and Public Involvement role (not formally consented as participants). In the first study stage participants agreed that pragmatic, standardised information on the safety, intervention and transfer rates for each birth setting (obstetric unit, midwifery-led unit, home) was required. In the second stage of the study, co-production between researchers, women and midwives resulted in an intervention package designed to support the implementation of these changes and included an update session for midwives, a script, a leaflet, and ongoing support through a named lead midwife and regular
Full Text Available Abstract Background In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state. Methods Cross sectional analyses of the National Family Health Survey – 2 dataset. Setting Maharashtra state. The dataset had a sample size of 5391 ever-married females between the ages of 15 to 49 years. Data were abstracted for the most recent birth (n = 1510 and these were used in the analyses. Conceptual framework was the Andersen Behavioral Model. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery. Results A majority delivered at home (n = 559, 37%; with private and public facility deliveries accounting for 32% (n = 493 and 31% (n = 454 respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery. Conclusion As India's economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net.
Pezaro, Sally; Clyne, Wendy
Some midwives are known to experience both professional and organizational sources of psychological distress, which can manifest as a result of the emotionally demanding midwifery work, and the traumatic work environments they endure. An online intervention may be one option midwives may engage with in pursuit of effective support. However, the priorities for the development of an online intervention to effectively support midwives in work-related psychological distress have yet to be explored. The aim of this study was to explore priorities in the development of an online intervention to support midwives in work-related psychological distress. A two-round online Delphi study was conducted. This study invited both qualitative and quantitative data from experts recruited via a scoping literature search and social media channels. In total, 185 experts were invited to participate in this Delphi study. Of all participants invited to contribute, 35.7% (66/185) completed Round 1 and of those who participated in this first round, 67% (44/66) continued to complete Round 2. Out of 39 questions posed over two rounds, 18 statements (46%) achieved consensus, 21 (54%) did not. Participants were given the opportunity to write any additional comments as free text. In total, 1604 free text responses were collected and categorized into 2446 separate statements of opinion, creating a total of 442 themes. Overall, participants agreed that in order to effectively support midwives in work-related psychological distress, online interventions should make confidentiality and anonymity a high priority, along with 24-hour mobile access, effective moderation, an online discussion forum, and additional legal, educational, and therapeutic components. It was also agreed that midwives should be offered a simple user assessment to identify those people deemed to be at risk of either causing harm to others or experiencing harm themselves, and direct them to appropriate support. This study has
Shalala, Donna E
Millions more insured Americans. Increasing numbers of older patients. Higher rates of chronic illness. Fewer providers. How can our healthcare system not only manage these challenges but also improve performance and access to care while containing costs? The answer lies with our nurses. In some parts of the United States, nurses provide the full spectrum of primary and preventive care. They have successfully improved access and quality in rural areas. In other parts, nurses' hands are tied by antiquated laws and regulations that limit their ability to expand access to care. Our system cannot increase access when we have providers who are not allowed to perform to the top of their education, training, and capability. It is time to rethink how we deliver primary and preventive care and redefine the roles of doctors and nurses. This article examines the history of the Institute of Medicine's (IOM) Future of Nursing report (chaired by the author) and the resulting Future of Nursing Campaign for Action, which is working to institute the report's recommendations in all 50 states. The IOM report's recommendations are simple: 1. Remove outdated restrictions on nursing practice. 2. Promote nurse leadership on hospital boards and in all healthcare sectors. 3. Strengthen nurse education and training, and increase the number of nurses with advanced degrees. 4. Increase diversity in the nursing workforce to better reflect the patient population. 5. Improve data reporting and compilation to predict workforce needs. New York, Kentucky, and Minnesota are three recent states to remove barriers pre venting advanced practice registered nurses from practicing at the top of their license. Similar efforts in California, Florida, and Indiana failed initially but are expected to make progress in the near future. The article makes clear how and why the Center to Champion Nursing in America (an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation) is working to
Full Text Available Background: Midwives play an important role in the implementation of health programs in health care units. The objective of this study was to compare the professional role and task in curriculum with the ongoing role and task of midwives working in the health care units of Tabriz (East Azarbaijan, Iran, 2015. Methods: This cross-sectional study was done via census on all midwives working in rural and urban health units in Tabriz in 2015 (225 persons. The data was collected using a researcher-designed questionnaire based on the national midwifery curriculum approved in 2012. The questionnaire includes questions related to the use of specific teaching courses and their relevancy to the professional roles contained in the curriculum;a self-assessment of the midwives’ current performance was completed by midwives themselves. The validity and reliability of questionnaire were confirmed. Data were presented using mean (SD and n (% for numerical and categorical variables. Results: Professional roles and tasks contained in the curriculum were not fully relevant to current roles and tasks of midwives. The highest relevancy was related to the role of education and the lowest relevancy was seen in ongoing tasks related to disease diagnosis, care and intervention. Of the specialized courses, internships in pregnancy and childbirth and its pathology had the highest and lowest applications, respectively. Conclusion: This study showed that, midwifery specialized training courses content and professional role and tasks curriculum- based are not consistent with ongoing expected real world tasks. Therefore, it is essential that reforms are made to enhance the curriculum and efficiently align it with practical responsibilities and expectations.
Aune, Ingvild; Hoston, Mari A; Kolshus, Nora J; Larsen, Christel E G
to gain a deeper understanding of how midwives promote a normal birth in a home birth setting in Norway. a qualitative approach was chosen for data collection. In-depth interviews were conducted with nine midwives working in a home birth setting in different areas in Norway. The transcribed interviews were analysed with the help of systematic text condensation. the analysis generated two main themes: «The midwife's fundamental beliefs» and «Working in line with one's ideology». The midwives had a fundamental belief that childbirth is a normal event that women are able to manage. It is important that this attitude is transferred to the woman in order for her to believe in her own ability to give birth. The midwives in the study were able to work according to their ideology when promoting a normal birth at home. To avoid disturbing the natural birth process was described as an important factor. Also crucial was to approach the work in a patient manner. Staying at home in a safe environment and establishing a close relationship with the midwife also contributed positively to a normal birth. the midwife's attitude is important when trying to promote a normal birth. Patience was seen as essential to avoid interventions. Being in a safe environment with a familiar midwife provides a good foundation for a normal birth. The attitude of the midwives towards normal childbirth ought to be more emphasised, also in the context of maternity wards. Copyright © 2017 Elsevier Ltd. All rights reserved.
Bick, Debra E; Sandall, Jane; Furuta, Marie; Wee, Michael Y K; Isaacs, Richard; Smith, Gary B; Beake, Sarah
to identify the extent to which Early Warning Systems (EWS) are used by midwives in the United Kingdom (UK), the maternity settings they are used in, physiological parameters used to 'trigger' referral, training provision, barriers to implementation and role in preventing maternal morbidity. cross-sectional survey of heads of midwifery services. An email questionnaire was sent in September 2012. UK NHS secondary care organisations providing maternity care. heads of midwifery from 107 (68%) of 157 NHS organisations responded, with 108 questionnaires returned as two organisations had recently merged. All organisations, apart from one which only had a free-standing midwifery unit, had introduced EWS. Nearly all respondents (99%) reported EWS were used by midwives antenatally, 76% in labour and 100% on the postnatal ward. All EWS charts included body temperature, heart rate, respiratory rate, systolic blood pressure and oxygen saturation although parameters for escalation varied widely. Barriers to use of EWS by midwives included overlap with the partogram in labour, and staff shortages and delays obtaining clinical review when referral was triggered. Two-thirds considered EWS prevented maternal morbidity although few could provide supporting evidence, for example, audit findings. Training for midwives in use of EWS was available in 83% of organisations. most UK midwives are using EWS, with the highest use in obstetric units. The heterogeneity of EWS currently used potentially limits collation of evidence to inform appropriate system level responses. Research is needed to evaluate the role of EWS to prevent maternal morbidity during and after pregnancy in different maternity settings. Copyright © 2014 Elsevier Ltd. All rights reserved.
Pezaro, Sally; Clyne, Wendy
The development of an online intervention designed to effectively support midwives in work-related psychological distress will be challenging due to the ethical, practical, and therapeutic issues surrounding its design. Related literature suggests that midwives may require an anonymous, confidential, and therapeutic platform that facilitates amnesty and nonpunitive approaches to remedy ill health. However, it is unclear which requirements may be most salient to midwifery populations. The objective of this paper is to describe the design of a Delphi study, intended to achieve expert consensus on the needs of midwives in work-related psychological distress who may be supported via an online intervention. This protocol may also serve as a research framework for similar studies to be modeled upon. A heterogeneous sample of at least thirty experts on psychological well-being and distress associated with midwifery work will be recruited. Their opinions regarding the development of an online intervention designed to support midwives in work-related psychological distress will be collected through 2 rounds of questioning, via the Delphi Technique. When 60% (≥18, assuming the minimum is 30) of panelists score within 2 adjacent points on a 7-point scale, consensus will be acknowledged. This Delphi study protocol will invite both qualitative and quantitative outcomes. This study is currently in development. It is financially supported by a full-time scholarship at the Centre for Technology Enabled Health Research at Coventry University (Coventry, UK). The implementation of this Delphi study is anticipated to occur during the autumn of 2015. The results of this study will direct the development of an online intervention designed to support midwives in work-related psychological distress, summarize expert driven consensus, and direct future research.
Kyung Hye Lee
Full Text Available There is a decrease in the number of new midwives, resulting from the shutdown of midwifery education program in hospitals due to a decrease in birthrate in the Republic of Korea. To solve this problem, the current medical laws on midwifery education system in Korea should be revised; nurse-midwifery specialist programs must be established in educational institutes with nursing programs. To support this argument, the midwifery education programs of America, Europe, Australia, and Japan have been discussed, and a nurse-midwifery specialist curriculum at the master s level, based on the nurse-practitioner system of Korea, has been suggested. Since this assertion is very important and urgent for solving the future population problem of Korea and providing health care for women and children, it should be realized into action immediately.
Kindberg, Sara; Misan, Stehouwer; Hvidman, Lone
healing, patient satisfaction, dyspareunia or need for resuturing. The continuous suture technique was significantly faster (15 min. vs. 17 min, p=0.03) and less suture material was used (1 vs. 2 packets, pleaving the skin unsutured...... appears to be equivalent to the continuous suture technique in relation to perineal pain, wound healing, patient satisfaction, dyspareunia and need for resuturing. The continuous technique, however, is faster and requires less suture material thus leaving it the more cost-effective of the two techniques......Postpartum perineal repair performed by midwives: A randomised trial comparing two suture techniques leaving the skin unsutured. Objective To compare a continuous suture technique to interrupted stitches using inverted knots for postpartum perineal repair of second-degree lacerations...
Arabi, Ali M E; Ibrahim, Salah A; Manar, Abdel-Rahman; Abdalla, Mohamed S; Ahmed, Sami E; Dempsey, Eugene P; Ryan, C Anthony
Over 80% of deliveries in Sudan occur in rural areas, attended by village midwives (VMWs). To determine the impact of Helping Babies Breathe training and regular peer-peer skills practice (HBBT +RPPSP ) on VMW resuscitation practices and outcomes. In a prospective community-based intervention study, 71/82 VMWs, reporting to six East Nile rural medical centres, with previous experience in community health research, consented to HBBT +RPPSP . Outcomes included changes in the resuscitation practices, fresh stillbirths (FSB) and early neonatal deaths Sudan. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Cox, Kim J; Schlegel, Ruth; Payne, Pat; Teaf, Dusty; Albers, Leah
In this study, we examined the perinatal outcomes of planned home births over a 25-year period (1983-2008) in a group of primarily Amish women (98%) attended by certified nurse-midwives (CNMs) in southeastern Pennsylvania. This was a retrospective, descriptive analysis of data (N = 1836 births) from several CNM practices. Data were abstracted for 25 items, including demographics, labor, and birth. Initially, 2 investigators abstracted 15 records to compare assessments and standardize definitions. Charts were then divided and abstracted individually by one investigator. Several relationships were examined in 2 by 2 tables using the chi-square procedure for the difference in proportions. Maternal and newborn transfers to the hospital were included in the analysis. Of the women who planned home birth for 1836 pregnancies, 1733 of the births occurred at home. Although more than one-third of the women were of high parity (gravida 5-13), rates of postpartum hemorrhage were low (n = 96, 5.5%). There were no maternal deaths. Nearly half of the maternal transfers to the hospital (n = 103, 5.6%) were for ruptured membranes without labor (n = 25, 1.4%) and/or failure to progress (n = 23, 1.3%). The neonatal hospital admission rate also was low (n = 13, 0.75%). Of the 7 (0.4%) early neonatal deaths, all were attributed to lethal congenital anomalies that are common to this population. This study is the first to describe the outcomes of planned home births in a primarily Amish population cared for by CNMs. It also adds to the literature on planned home births in the United States and supports the findings from previous studies that women who have home births attended by CNMs have safety profiles equal to or better than profiles of women who had hospital births in similar populations. © 2013 by the American College of Nurse-Midwives.
Beck, Cheryl Tatano; LoGiudice, Jenna; Gable, Robert K
Secondary traumatic stress (STS) is an occupational hazard for clinicians who can experience symptoms of posttraumatic stress disorder (PTSD) from exposure to their traumatized patients. The purpose of this mixed-methods study was to determine the prevalence and severity of STS in certified nurse-midwives (CNMs) and to explore their experiences attending traumatic births. A convergent, parallel mixed-methods design was used. The American Midwifery Certification Board sent out e-mails to all their CNM members with a link to the SurveyMonkey study. The STS Scale was used to collect data for the quantitative strand. For the qualitative strand, participants were asked to describe their experiences of attending one or more traumatic births. IBM SPSS 21.0 (Version 21.0, Armonk, NY) was used to analyze the quantitative data, and Krippendorff content analysis was the method used to analyze the qualitative data. The sample consisted of 473 CNMs who completed the quantitative portion and 246 (52%) who completed the qualitative portion. In this sample, 29% of the CNMs reported high to severe STS, and 36% screened positive for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for PTSD due to attending traumatic births. The top 3 types of traumatic births described by the CNMs were fetal demise/neonatal death, shoulder dystocia, and infant resuscitation. Content analysis revealed 6 themes: 1) protecting my patients: agonizing sense of powerlessness and helplessness; 2) wreaking havoc: trio of posttraumatic stress symptoms; 3) circling the wagons: it takes a team to provide support … or not; 4) litigation: nowhere to go to unburden our souls; (5) shaken belief in the birth process: impacting midwifery practice; and 6 moving on: where do I go from here? The midwifery profession should acknowledge STS as a professional risk. © 2015 by the American College of Nurse-Midwives.
Full Text Available Background: Empirical studies show the value of mobile phones as effective educational tools to support learning in the nursing profession, predominantly in high income countries. Problem statement: The rapidly increasing prevalence of mobile phone technology in Africa nourishes hopes that these tools could be equally effective in lowly resourced contexts, specifically in efforts to achieve the health-related Millennium Development goals. The purpose of this study was to investigate the perception and use of mobile phones as educational and professional tools by nurses in lowly resourced settings. Methodology: A quantitative survey using self-administered questionnaires was conducted of rural advanced midwives. Results: Fifty-six nurses (49.6% from the 113 rural-based midwives attending an advanced midwifery training programme at the University of KwaZulu-Natal, South Africa, filled in a questionnaire. The results showed that, whilst nurses regarded their technology competences as low and although they received very little official support from their educational and professional institutions, the majority frequently used mobile functions and applications to support their work and learning processes. They perceived mobile devices with their voice, text, and email functions as important tools for the educational and professional activities of searching for information and engaging with facilitators and peers from work and study contexts. To a lesser extent, the use of social networks, such as WhatsApp and Facebook, were also reported. Conclusion and recommendation: It is concluded that educational institutions should support the appropriate use of mobile phones more systematically; particularly in relation to the development of mobile network literacy skills.
Marshall, Jayne E
universities in the United Kingdom are being challenged to modify policies and curricula that reflect the changing global reality through internationalisation. An aspect of internationalisation is study abroad which the European Commission Erasmus exchange programme is just one means of addressing this. to explore the experiences of student midwives who are engaged in the Erasmus exchange programme and the effect it has on their learning and working in an international context. approval for the small phenomenological cohort study was obtained from two participating universities: the University of Malta and University of Nottingham. Data were collected from 13 student midwives from a total of five cohorts in the form of diaries to explore their experiences of learning and working in another country. Thematic analysis supported by Computer-Assisted Qualitative Data Analysis Software was used to identify five recurrent themes emerging from the data: the findings of which have served further in developing this programme. students valued the opportunity of undertaking study and midwifery practice in another culture and healthcare system, extending their knowledge and development of clinical competence and confidence. For some, this was the first time outside of their home country and adaptation to a new environment took time. Support from their contemporaries, lecturers and midwife mentors however, was overwhelmingly positive, enabling the students to feel 'part of the local university / midwifery team' By the end of the programme, the students recognised that they had become more independent and felt empowered to facilitate developments in practice when they returned home. IMPLICATIONS FOR EDUCATION / PRACTICE: this innovative development embracing internationalisation within the curricula has the potential to increase students' employability and further study within Europe and beyond. It can be used as a vehicle to share best practice within an international context
Beaumont, Elaine; Durkin, Mark; Hollins Martin, Caroline J; Carson, Jerome
compassion fatigue and burnout can impact on the performance of midwives, with this quantitative paper exploring the relationship between self-compassion, burnout, compassion fatigue, self-judgement, self-kindness, compassion for others, professional quality of life and well-being of student midwives. a quantitative survey measured relationships using questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) Short Warwick and Edinburgh Mental Well-being Scale; (4) Compassion For Others Scale. a purposive and convenience sample of student midwives (n=103) studying at university participated in the study. just over half of the sample reported above average scores for burnout. The results indicate that student midwives who report higher scores on the self-judgement sub-scale are less compassionate towards both themselves and others, have reduced well-being, and report greater burnout and compassion fatigue. Student midwives who report high on measures of self-compassion and well-being report less compassion fatigue and burnout. student midwives may find benefit from 'being kinder to self' in times of suffering, which could potentially help them to prepare for the emotional demands of practice and study. developing, creating and cultivating environments that foster compassionate care for self and others may play a significant role in helping midwives face the rigours of education and clinical practice during their degree programme. Copyright © 2015 Elsevier Ltd. All rights reserved.
.... However, over the last ten years, the US military has begun to rely on commercially available products to meet many of its requirements in a variety of sectors including the commercial space sector...
Iraq's energy sector was rehabilitated from 2003 to 2005. The focus of rehabilitation was on restoring Iraq's electricity and oil infrastructure to pre-war production levels; delivering electricity and refined fuels for domestic consumption; and delivering electricity and oil security. This paper provided an analysis of the impact of Coalition efforts and insurgent activities on energy sector performance using time-series models. The paper presented a simple three-equation model consisting of an insurgent attack equation, an investment equation, and production function. The paper also discussed the phases of the insurgency in Iraq, with particular reference to the beginning of the insurgency; initial bombing campaign; escalation of the insurgency; and intra-Iraqi conflict. Key energy sector indicators and regression results were also presented for oil production; diesel production; gasoline production; oil exports; and production and consumption of electricity. It was concluded that expenditures by the United States on oil infrastructure appear to have been relatively efficiently spent. 16 refs., 9 tabs
Zinner Henriksen, Helle; Andersen, Kim Normann; Medaglia, Rony
citizenpublic interaction, such as in public education. In this paper we use a revised version of the Public Sector Process Rebuilding (PPR) maturity model for mapping 200 websites of public primary schools in Denmark. Findings reveal a much less favorable picture of the digitization of the Danish public sector...... compared to the high ranking it has received in the international benchmark studies. This paper aims at closing the gap between the predominant scope of maturity models and the frequency of citizen-public sector interaction, and calls for increased attention to the activities of government where the scale...
In EU the transport sector has an incident rate of accidents at work at 40 pr 1000 employees. The Danish insurance company CODAN has insured a big part of this sector concerning transport of gods on shore. The purpose of the project is to document the safety problems in the sector and to develop ...... is a simplification of safety management methods but adjusted into a new focus and awareness for the managers of small enterprises. What really matters is to teach the managers to manage and focus on both safety and quality connected with time schedules and costs...
Yuan Jiahai; Xu Yan; Hu Zhaoguang
This paper studies the transition to low carbon power systems in China. The methodology is built on the newly developed multi-level perspective (MLP) transitions, as well as literature on innovation systems. Three lines of thought on the transition process are integrated to probe the possible transition pathways in China's power sector. Five transition pathways, namely reproduction, transformation, substitution, reconfiguration, de-alignment/re-alignment and reconfiguration, with their possible technology options are presented. The requirements for a smart grid in the socio-technical transition process are addressed within the MLP framework. The paper goes further to propose an interactive framework for low carbon transition management in China. Representative technology options are appraised by employing innovation theory to demonstrate the logic of policy design within the framework. The work presented in this paper will be useful in informing policy-makers and other stakeholders in China and it may prove to be a valuable reference for other countries in energy transition management. - Highlights: ► The transition to low carbon power systems is studied from a multi-level perspective. ► Transition pathways with possible technology options are presented. ► An interactive framework is proposed for managing this transition. ► Representative technology options are appraised within the framework to show the logic of policy design.
Maynard, Douglas W
Forecasting is a strategy for delivering bad news and is compared to two other strategies, stalling and being blunt. Forecasting provides some warning that bad news is forthcoming without keeping the recipient in a state of indefinite suspense (stalling) or conveying the news abruptly (being blunt). Forecasting appears to be more effective than stalling or being blunt in helping a recipient to "realize" the bad news because it involves the deliverer and recipient in a particular social relation. The deliverer of bad news initiates the telling by giving an advance indication of the bad news to come; this allows the recipient to calculate the news in advance of its final presentation, when the deliverer confirms what the recipient has been led to anticipate. Thus, realization of bad news emerges from intimate collaboration, whereas stalling and being blunt require recipients to apprehend the news in a social vacuum. Exacerbating disruption to recipients' everyday world, stalling and being blunt increase the probability of misapprehension (denying, blaming, taking the situation as a joke, etc.) and thereby inhibit rather than facilitate realization. Particular attention is paid to the "perspective display sequence", a particular forecasting strategy that enables both confirming the recipient's perspective and using that perspective to affirm the clinical news. An example from acute or emergency medicine is examined at the close of the paper.
The speed with which the heavy ion run at the LHC is delivering new physics is impressive not only for the insights it is bringing to the early Universe, but also for the clear demonstration it gives of the value of competition and complementarity between the experiments. ALICE was the first off the mark to publish papers from the ion run, as you’d expect from the LHC’s dedicated ion experiment, but results emerging from ATLAS and CMS are bringing new understanding in their own right. Each collaboration’s result plays to the strengths of its detector, and it is by taking all the results together that our knowledge advances. The creation, observation and understanding of the hot dense matter that would have existed in the early Universe, normally known as Quark Gluon Plasma (QGP), is complex science and one of the ion programme’s key goals. Many signals for QGP exist, and like pieces of a puzzle, we must assemble all of them to get the full picture. At th...
Wang, Shengpeng; Zhang, Jinming; Chen, Meiwan; Wang, Yitao
Long-term epidemiological studies have demonstrated that regular ingestion of flavonoids contained in dietary sources is associated with a reduced risk for many chronic diseases including cancer. However, although flavonoids are largely consumed in the diet and high concentrations may exist in the intestine after oral administration, the plasma/tissue concentrations of flavonoids are lower than their effective therapeutic doses due to poor bioavailability, resulting in the limited efficacy of flavonoids in various clinical studies. Therefore, the application of nanotechnology to deliver flavonoids to tumor sites has received considerable attention in recent years. In this review, after a general review of the potential benefits of flavonoids in cancer therapy and several key factors affecting their bioavailability, the current efforts in improving the delivery efficacy of promising candidates that are particularly important in the human diet, namely quercetin, epigallocatechin-3-gallate (EGCG) and genistein were focused on. Finally, the challenges of developing flavonoid delivery systems that improve flavonoid bioavailability and their anticancer therapy potentials were summarized. The design of suitable molecular carriers for flavonoids is an area of research that is in rapid progress. A large number of unheeded promising favonoids are suffering from poor in vivo parameters, their potential benefits deserves further research. Furthermore, more effort should be placed on developing active targeting systems, evaluating the efficacy and toxicity of novel flavonoid delivery systems through small and large scale clinical trials.
Dansky, B.; Epifano, L.; Farella, R.
An apparatus for delivering and receiving gas to and from a patient, such as for lung ventilation studies. In accordance with the invention there is provided a restrictive breathing chamber adapted for coupling to the patient's breathing organs. A system, including a first check valve, is provided for coupling the breathing chamber to an inflatable gas receptacle so as to allow flow only toward the inflatable gas receptacle. Active gas input apparatus, including a second check valve, is also coupled to the breathing chamber, the second check valve allowing flow only toward the breathing chamber means. First and second auxiliary tubes and a gas filter are also provided. A system is provided for coupling the first auxiliary tube from the inflatable receptacle through the gas filter and to an ambient air environment. The second auxiliary tube is coupled from the inflatable receptacle to an ambient air environment. Finally, a gas pump is switchably coupled as between the first and second auxiliary tubes and operative to selectively cause gas flow in the first auxiliary tube toward the ambient environment, and in the second auxiliary tube toward the inflatable receptacle. A gas trap structure is also disclosed
Arent, Douglas J.; Tol, Richard S.J.; Faust, Eberhard; Hella, Joseph P.; Kumar, Surender; Strzepek, Kenneth M.; Tóth, Ferenc L.; Yan, Denghua; Abdulla, Amjad; Kheshgi, Haroon; Xu, He; Ngeh, Julius
Introduction and Context This chapter discusses the implications of climate change on key economic sectors and services, for example, economic activity. Other chapters discuss impacts from a physical, chemical, biological, or social perspective. Economic impacts cannot be isolated; therefore, there
Graham, Harry; Wallace, Virginia
Presents developments in grievance arbitration in government employment by examining all public sector arbitration cases from 1971 through 1979. Predicts that issues of employee discipline and discharge will comprise the largest number of cases proceeding to arbitration. (Author/MLF)
Find EPA regulatory information for the wood product and paper manufacturing sectors, including paper, pulp and lumber. Information includes NESHAPs and effluent guidelines for pulp and paper rulemaking, and compliance guidelines
Millennium Challenge Corporation — The objective of the Private Sector Development Project activities of the 2005-2010 Cabo Verde Compact was to support Cabo Verde's long-term economic transformation...
The dry cleaning sector includes establishments engaged in providing laundry services and industrial launderers. Find environmental regulatory information for perchloroethylene (PERC) cleaners as well as hazardous waste regulations for dry cleaners.
Abazi, Enika; Bumci, Aldo; Hide, Enri; Rakipi, Albert
International audience; This paper analyses security sector reform (SSR) in Albania. In all its enterprises in reforming the security sector,Albania is assisted by different initiatives and projects that provide expertise and financial support. To assesswhether reforms improved the overall security environment (national and human) of the country, it is necessaryto measure the effectiveness of the various initiatives and projects. This is gauged by how well the initiatives andprojects achieved...
Hearne, Lucy; Geary, Tom; Martin, Noelle
This paper will deliberate upon the relevance of guidance counselling as a "whole school" responsibility in the context of recent policy and practice changes in the Irish post primary sector since the Government of Ireland Budget 2012. Pertinent issues including the complexities of delivering a whole school approach to guidance…
Strategies and partnerships for delivering sustainable private sector-led urban development projects are yet to be effectuated. Despite the fact that actors in real estate development increasingly incorporate sustainability features into decision-making, it seems that developing sustainable urban
Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Zodpey, Sanjay P
India's Universal Immunization Programme (UIP) provides basic vaccines free-of-cost in the public sector, yet national vaccination coverage is poor. The Government of India has urged an expanded role for the private sector to help achieve universal immunization coverage. We conducted a state-by-state analysis of the role of the private sector in vaccinating Indian children against each of the six primary childhood diseases covered under India's UIP. We analyzed IMS Health data on Indian private-sector vaccine sales, 2011 Indian Census data and national household surveys (DHS/NFHS 2005-06 and UNICEF CES 2009) to estimate the percentage of vaccinated children among the 2009-12 birth cohort who received a given vaccine in the private sector in 16 Indian states. We also analyzed the estimated private-sector vaccine shares as function of state-specific socio-economic status. Overall in 16 states, the private sector contributed 4.7% towards tuberculosis (Bacillus Calmette-Guérin (BCG)), 3.5% towards measles, 2.3% towards diphtheria-pertussis-tetanus (DPT3) and 7.6% towards polio (OPV3) overall (both public and private sectors) vaccination coverage. Certain low income states (Uttar Pradesh, Rajasthan, Madhya Pradesh, Orissa, Assam and Bihar) have low private as well as public sector vaccination coverage. The private sector's role has been limited primarily to the high income states as opposed to these low income states where the majority of Indian children live. Urban areas with good access to the private sector and the ability to pay increases the Indian population's willingness to access private-sector vaccination services. In India, the public sector offers vaccination services to the majority of the population but the private sector should not be neglected as it could potentially improve overall vaccination coverage. The government could train and incentivize a wider range of private-sector health professionals to help deliver the vaccines, especially in the low
Liposcak, Marko; Afgan, Naim H.; Duic, Neven; Graca Carvalho, Maria da
The effective and rational energy generation and supply is one of the main presumptions of sustainable development. Combined heat and power production, or co-generation, has clear environmental advantages by increasing energy efficiency and decreasing carbon emissions. However, higher investment cost and more complicated design and maintenance sometimes-present disadvantages from the economical viability point of view. As in the case of most of economies in transition in Central and Eastern Europe, Croatia has a strong but not very efficient co-generation sector, delivering 12% of the final energy consumption. District heating systems in the country's capital Zagreb and in city of Osijek represent the large share of the overall co-generation capacity. Besides district heating, co-generation in industry sector is also relatively well developed. The paper presents an attempt to assess the sustainability of Croatian co-generation sector future development. The sustainability assessment requires multi-criteria assessment of specific scenarios to be taken into consideration. In this respect three scenarios of Croatian co-generation sector future development are taken into consideration and for each of them environmental, social and economic sustainability indicators are defined and calculated. The assessment of complex relationships between environmental, social and economic aspects of the system is based on the multi-criteria decision-making procedure. The sustainability assessment is based on the General Sustainability Index rating for different cases reflecting different criteria and their priority. The method of sustainability assessment is applied to the Croatian co-generation sector contributing to the evaluation of different strategies and definition of a foundation for policy related to the sustainable future cogeneration sector development
Hajizadeh, Shayesteh; Tehrani, Fahimeh Ramezani; Simbar, Masoumeh; Farzadfar, Farshad
The accepted rate rate of caesarean section is 15%. It is expected that an increase in the density of midwives in the family physician program lead to a decrease in this indicator. This study aimed to compare the rates of caesarean section and women's awareness and preference for mode of delivery before and after the implementation of the family physician program in health centres with and without an increase in midwives density. In this cross-sectional study, using multistage cluster sampling method a total of 668 mothers with two-month-old children were selected from among all mothers with two-month-old children who were living in rural areas of Kurdistan province. Using the difference-in-differences model and Matchit statistical model, the factors associated with caesarean section rates and women's awareness and preference for mode of delivery were compared in centres with and without an increase in midwives density after the implementation of the family physician program. To compare the changes before and after the program, we used the data collected from the same number of women in 2005 as the baseline. After adjusting for baseline data collected in 2005, the resutls showed no significant change in caesarean section rates and women's awareness and preference for mode of delivery in the centres with and without an increase in midwives density after the implementation of the family physician program. The Matchit model showed a significant mean increase 14%(0.03-0.25) in women's awareness of the benefits of natural childbirth between 2005 and 2013 in health centres where the density of midwives increased compared with health centres where it did not. The difference-in-differences model showed that the odds ratio of women's preference for caesarean section decreased by 41% among participants who were aware of the benefits of natural childbirth, (OR = 0.59, 95% CI: (0.22-0.85); P>0.001). The results of this study showed that an increase in the density of midwives
Melnic Elena- Lidia
Full Text Available This article explains the emergence of the marketing mix in the banking sector and the specificity of this field. Research has shown that the evolution of the marketing mix in banking is closely related to the evolution of the marketing mix for services. The modern approach of the marketing mix for services comes from Booms and Bitner, from 1981. They filled the traditional 4Ps of the marketing mix (coming from products: price, product, placement (distribution and promotion with specific intangible services components: personnel, presence (physical evidence and process. For the banking sector, the development of those three components nowadays represents the main challenge because they represent the most important way to differentiate from the competition and to deliver superior services to the customers who are more sophisticated and demanding
Lake, Robin; Hill, Paul T.; Maas, Tricia
Every sector of the U.S. economy is working on ways to deliver services in a more customized manner. If all goes well, education is headed in the same direction. Personalized learning and globally benchmarked academic standards (a.k.a. Common Core) are the focus of most major school districts and charter school networks. Educators and parents know…
van der Velden, T; Ping, C
The objectives of this study are to determine whether Norplant would be an acceptable contraceptive method for Cambodian women, given its technology and the socio-cultural context, and whether it can be delivered by a private sector clinic with good quality care. This is a prospective cohort study of the first 966 acceptors. It was found the one-year continuation rate was 90.5%, there were no pregnancies and client satisfaction was high. In general, Norplant was delivered with high quality of care. Findings indicate that Norplant suits the contraceptive needs of many Cambodian women and is appropriate for their socio-cultural context. Norplant can be introduced, with high quality care, in a private clinic in a developing country.
Daniela Angelina JELINČIĆ
Full Text Available Over the past few decades public-private partnership or PPP has become a new way for delivering and fi nancing public sector projects. It may involve investment in fully economic infrastructure such as highways, railways, airports, seaports, etc. up to the investments in social infrastructure projects, such as schools, hospitals, museums and other signifi cant and historic buildings of public interest. The main objective of this article is to analyze the situation in Croatia, Poland, Slovakia and Slovenia concerning the topic of public- private partnership (PPP in order to provide grounds for possible future investments in cultural heritage in these countries. For this purpose, a comparative analysis of legal and institutional frameworks was carried out as well as structured interviews with key stakeholders (public and private sector representatives. Special attention has been paid to the use of PPP projects in the revitalization of cultural heritage. The results of the analysis showed the lack of PPP investments in the cultural sector, and also identifi ed possible obstacles in public sector administrative procedures. The results of the analysis may be further used to stimulate both public authorities to set strategic directions for heritage revitalization plans based on PPP schemes as well as private investors who may seek feasible business models complemented with social responsibility benefits.
van den Belt, Marjan; Kenyan, Jennifer R; Krueger, Elizabeth; Maynard, Alison; Roy, Matthew Galen; Raphael, Ian
In today's climate of government outsourcing and multiple stakeholder involvement in public sector management and service delivery, it is more important than ever to rethink and redesign the structure of how policy decisions are made, implemented, monitored, and adapted to new realities. The traditional command-and-control approach is now less effective because an increasing amount of responsibility to deliver public goods and services falls on networks of nongovernment agencies. Even though public administrators are seeking new decision-making models in an increasingly more complex environment, the public sector currently only sparsely utilizes Mediated Modeling (MM). There is growing evidence, however, that by employing MM and similar tools, public interest networks can be better equipped to deal with their long-term viability while maintaining the short-term needs of their clients. However, it may require a shift in organizational culture within and between organizations to achieve the desired results. This paper explores the successes and barriers to implementing MM and similar tools in the public sector and offers insights into utilizing them through a review of case studies and interdisciplinary literature. We aim to raise a broader interest in MM and similar tools among public sector administrators at various administrative levels. We focus primarily, but not exclusively, on those cases operating at the interface of ecology and socio-economic systems.
This study takes stock on the main european markets to help the electric power companies in their decisions and investments. The first part presents the electric power sector structure in Europe. The second part is devoted to the market evolution for the different european markets (german, french, british, italian and spanish) with an analysis of the retail prices, the competition and the evolution perspectives. The third part presents the highlights in the electric power sector between 2001 and the middle of 2003. The enterprises management and strategies are presented in the fourth part. In the last part the document analyzes the financial performances of the sector and the electric power companies. (A.L.B.)
European Centre for the Development of Vocational Training, Berlin (Germany).
This document is composed of European synthesis reports on retail trade, the agro-food sector, and the motor vehicle sales and repair sector. They are based on the most important findings of the European report and the 12 national reports for each sector. Section 1, "Retail Sector," deals in part 1 with the structure of retailing in the…
Status of the reforms in Lithuania's energy sector and preparation of updated Energy Strategy is presented in this article. The new Strategy has been worked out considering the conclusions of different studies as well as the changes that have taken place in Lithuania and restructuring of its energy sector, the guidelines of the European Union. The principal objectives of the country's energy sector consists in reliable and safe energy supply with minimum expenses, increasing efficiency of energy utilisation, introducing principles of market economy within the sector, reducing environmental impacts, preparing Lithuania's energy sector for integration into the EU. In the field of nuclear energy the top priority is to ensure the safety of Ignalina NPP. Ignalina NPP will only be operated if and as long as it is safe. Two most likely scenarios for the future operation of Ignalina NPP are analysed in the draft Strategy. According to scenario 1, reactor 1 and 2 are to be operated half of the design service life, until 2005 and 2010 respectively, i.e. until the gap between the graphite and fuel channels reaches the critical margin. In accordance with the second scenario, the fuel channels are to be replaced as envisaged in the design, after which the reactors may be operated for another 10 - 15 years
Burrowes, Sahai; Holcombe, Sarah Jane; Jara, Dube; Carter, Danielle; Smith, Katheryn
It is increasingly recognized that disrespect and abuse of women during labor and delivery is a violation of a woman's rights and a deterrent to the use of life-saving, facility-based labor and delivery services. In Ethiopia, rates of skilled birth attendance are still only 28% despite a recent dramatic national scale up in the numbers of trained providers and facilities. Concerns have been raised that womens' perceptions of poor quality of care and fear of mistreatment might contribute to this low utilization. This study examines the experiences of disrespect and abuse in maternal care from the perspectives of both providers and patients. We conducted 45 in-depth interviews at four health facilities in Debre Markos, Ethiopia with midwives, midwifery students, and women who had given birth within the past year. Students and providers also took a brief quantitative survey on patients' rights during labor and delivery and responded to clinical scenarios regarding the provision of stigmatized reproductive health services. We find that both health care providers and patients report frequent physical and verbal abuse as well as non-consented care during labor and delivery. Providers report that most abuse is unintended and results from weaknesses in the health system or from medical necessity. We uncovered no evidence of more systematic types of abuse involving detention of patients, bribery, abandonment or ongoing discrimination against particular ethnic groups. Although health care providers showed good basic knowledge of confidentiality, privacy, and consent, training on the principles of responsive and respectful care, and on counseling, is largely absent. Providers indicated that they would welcome related practical instruction. Patient responses suggest that women are aware that their rights are being violated and avoid facilities with reputations for poor care. Our results suggest that training on respectful care, offered in the professional ethics modules of the
Ilott, Irene; Booth, Andrew; Rick, Jo; Patterson, Malcolm
To explore how nurses, midwives and health visitors contribute to the development, implementation and audit of protocol-based care. Protocol-based care refers to the use of documents that set standards for clinical care processes with the intent of reducing unacceptable variations in practice. Documents such as protocols, clinical guidelines and care pathways underpin evidence-based practice throughout the world. An interpretative review using the five-stage systematic literature review process. The data sources were the British Nursing Index, CINAHL, EMBASE, MEDLINE and Web of Science from onset to 2005. The Journal of Integrated Care Pathways was hand searched (1997-June 2006). Thirty three studies about protocol-based care in the United Kingdom were appraised using the Qualitative Assessment and Review Instrument (QARI version 2). The literature was synthesized inductively and deductively, using an official 12-step guide for development as a framework for the deductive synthesis. Most papers were descriptive, offering practitioner knowledge and positive findings about a locally developed and owned protocol-based care. The majority were instigated in response to clinical need or service re-design. Development of protocol-based care was a non-linear, idiosyncratic process, with steps omitted, repeated or completed in a different order. The context and the multiple purposes of protocol-based care influenced the development process. Implementation and sustainability were rarely mentioned, or theorised as a change. The roles and activities of nurses were so understated as to be almost invisible. There were notable gaps in the literature about the resource use costs, the engagement of patients in the decision-making process, leadership and the impact of formalisation and new roles on inter-professional relations. Documents that standardise clinical care are part of the history of nursing as well as contemporary evidence-based care and expanded roles. Considering the
Reviews the status of EDI in the sectors of health, public transport and taxation and public administration. The impact of this on the diffusion of EDI in other sectors is analysed.......Reviews the status of EDI in the sectors of health, public transport and taxation and public administration. The impact of this on the diffusion of EDI in other sectors is analysed....
Santoro, Emiliano; Petrella, Ivan; Rossi, Raffaele
We formulate a two-sector New Keynesian economy featuring sectoral heterogeneity along three dimensions: price stickiness, consumption goods durability, and the usage of input materials in production. These factors affect both inter-sectoral and intra-sectoral stabilization. We examine the welfare...
McKenna, Hugh; Richey, Roberta; Keeney, Sinead; Hasson, Felicity; Poulton, Brenda; Sinclair, Marlene
The number of innovative roles in nursing and midwifery has expanded considerably; however, the evidence base for the introduction of these roles is limited. This study aimed to identify the managerial and developmental issues affecting those in innovative roles. A self-completion postal questionnaire was distributed to all innovative role holders in Northern Ireland, 450 responses were analysed. This survey was the second phase of a larger investigation into innovative roles in nursing and midwifery. The questionnaire that had been developed for the 'Exploring New Roles in Practice' project was adapted for use in this study. The explanatory letter sent to potential participants clearly detailed that informed consent was assumed on receipt of a completed questionnaire and gave contact details for the research team. The confidentiality and anonymity of responses were assured. Most participants (65%) stated that their innovative role had commenced since the year 2000. There was evidence of preparation for these roles including the development of job descriptions and protocols. Nevertheless, there were issues noted relating to resource allocation and replacement when the role holder was absent. The importance of role evaluation was highlighted, with some participants noting their role had not been assessed since its inception. Support provided by managers and colleagues was key to ensuring role effectiveness. Participants reported high levels of job satisfaction. Innovative role holders were identified by managers in their employing organization: therefore the research team could not verify that all existing innovative roles were included in the study. Innovative roles in private and voluntary sectors were not included. The evolution of innovative nursing and midwifery roles has been considerable worldwide and they engender job satisfaction to those occupants them. Results support international literature showing that adequate support, especially from administrators
Regulation of the Power Sector is a unified, consistent and comprehensive treatment of the theories and practicalities of regulation in modern power-supply systems. The need for generation to occur at the time of use occasioned by the impracticality of large-scale electricity storage coupled with constant and often unpredictable changes in demand make electricity-supply systems large, dynamic and complex and their regulation a daunting task. Conceptually arranged in four parts, this book addresses both traditional regulatory frameworks and also liberalized and re-regulated environments. First, an introduction gives a full characterization of power supply including engineering, economic and regulatory viewpoints. The second part presents the fundamentals of regulation and the third looks at the regulation of particular components of the power sector in detail. Advanced topics and subjects still open or subject to dispute form the content of the fourth part. In a sector where regulatory design is the key driver...
Tarun Stephen Weeramanthri
Full Text Available Spatial information describes the physical location of either people or objects, and the measured relationships between them. In this article we offer the view that greater utilisation of spatial information and its related technology, as part of a broader redesign of the architecture of health information at local and national levels, could assist and speed up the process of health reform, which is taking place across the globe in richer and poorer countries alike.In making this point, we describe the impetus for health sector reform, recent developments in spatial information and analytics, and current Australasian spatial health research. We highlight examples of uptake of spatial information by the health sector, as well as missed opportunities. Our recommendations to spatially enable the health sector are applicable to high and low-resource settings.
A higienização das parteiras curiosas: o Serviço Especial de Saúde Pública e a assistência materno-infantil (1940-1960 The health education of folk midwives: the Serviço Especial de Saúde Pública and mother-child assistance (1940-1960
Tânia Maria de Almeida Silva
Full Text Available Discute as ações de treinamento e controle das parteiras curiosas promovidas pelo Serviço Especial de Saúde Pública, confiadas aos programas de higiene pré-natal e da criança, implantados entre as décadas de 1940 e 1960. Para os sanitaristas, o treinamento e controle das parteiras curiosas atuantes nas comunidades rurais brasileiras eram importantes para o sucesso do projeto de implantação de serviços sanitários locais de assistência materno-infantil. Ao atuar diretamente junto às parteiras curiosas, pretendia-se não somente lhes impor rigorosos padrões higiênicos na realização de partos e nos cuidados com os recém-nascidos, mas, sobretudo, recorrer a sua influência e seu prestígio naquelas comunidades para popularizar ações de saneamento.The article addresses an endeavor by Serviço Especial de Saúde Pública (Sesp to train folk midwives who worked in rural communities and to exercise control over these women's activities. The task was entrusted to the agency's prenatal and child hygiene programs, established between the 1940s and 1960s. The agency believed this training and control initiative would be of major importance in helping ensure the success of its project to establish local sanitary services offering mother-child assistance. The goal of working directly with the folk midwives was not only to force them to employ strict hygiene standards when delivering and caring for newborns but especially to use their influence and prestige within these communities to convince the general population to adopt good health practices.