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PubMed2000

Raising research awareness among midwives and nurses: does it work?

OBJECTIVE: The primary aim of the study was to evaluate the effectiveness of two approaches to increase research awareness among midwives and nurses. DESIGN: Quasi-experimental with the attitudes of staff in the two groups being measured at two points (January and October 1997). SAMPLE: All midwives and nurses working in four clinical areas in an acute NHS Trust. The intervention arm of the study involved all midwives and nurses in the Clinical Directorate of Obstetrics and Gynaecology, while the control arm involved all nurses working in a specialist oncology and haematology unit and in the children's directorate. ETHICS: The Joint Ethics Committee considered approval unnecessary because the study involved staff and not patients. DATA COLLECTION: Data were collected by self-complete questionnaires. INTERVENTIONS: A programme of education with policy and practice interventions targeted at ward sisters. OUTCOME MEASURES: Staff attitudes to, knowledge of, and level of involvement in, research. RESULTS: The study demonstrated a significant increase in both knowledge and use of research resources. Following the programme of education, staff in the intervention group were significantly more likely to use resources associated with research utilization and to report that they had read a research paper within the last month. STUDY LIMITATIONS: The time scale of the intervention was restricted by the funding available; a significant Hawthorne effect was evident with both groups showing an increase in knowledge; the pragmatic nature of the study meant that it was not possible to randomize the study groups; the scale of the study did not permit an economic evaluation. CONCLUSIONS: The introduction of clinical governance challenges healthcare providers to improve the care they deliver. There are huge opportunities for Trusts to invest in developing staff knowledge and use of research. However, staff will only seize these opportunities if there is an appropriate, enabling environment--an environment that delivers intensive interventions and is sensitive to the wider structural factors in the NHS affecting staff morale and commitment. In the absence of this environment, what may be seen as opportunities to managers may be regarded as just another burden by staff.

Attitude of Health Personnel↗
PubMed2002

Evaluation of the extended role of the midwife: the voices of midwives.

It is not uncommon for midwives in Australian hospitals to order and interpret tests and initiate medications. The National Health and Medical Research Council only formally acknowledged these practices through recommendations in 1998. Successful extension of the midwife's role is assumed to be advantageous to the health-care system in its ability to satisfy consumer demand for a less medicalized experience and to be cost effective. This paper presents the results of the first phase of a three-phase fourth generation evaluation of the extended role of the midwife in two acute care settings in the Northern Territory, Australia. The results suggest that recognition of the extended role of the midwife has the potential to deliver high level continuous midwifery care to women, to increase work satisfaction for the midwives and to enhance professional autonomy and responsibility in the workplace. However, when compared with their counterparts in the United Kingdom and New Zealand, midwives in Australia continue to practice with considerable limitations placed on their autonomy.

Cost-Benefit Analysis↗
PubMed1998

What determines quality in maternity care? Comparing the perceptions of childbearing women and midwives.

BACKGROUND: In the current climate of consumer orientation in health care services, a clear need has emerged to understand the extent of consumer focus among primary health care professionals. Few studies have compared the beliefs of health care staff with those of patients. This study sought to identify and compare the perceptions of women and midwives concerning women's beliefs about what constitutes quality in maternity services. METHODS: Focus groups were conducted from July 1994 to June 1997 with 38 pregnant and postnatal women, and 47 midwives who were based in two large maternity units in Yorkshire, England. Transcriptions of data were analyzed to identify broad themes. RESULTS: Ten dimensions of quality were identified. Similarities between midwives and women included beliefs about the importance of the relationship between the two parties, desired attributes of staff, and the environment of care. Key differences included underestimating the importance of information antenatally and postnatally, the importance of continuity during labor, need for control and confidence in adjusting to the maternal role, and involvement of the woman's partner in the delivery of care. CONCLUSIONS: An understanding of the concerns of women by maternity care staff is important in the development of a woman-focused service, in line with current policy recommendations, and has implications for risk management and improving the service quality for those who provide and experience the service.

Adult↗
PubMed1999

Seven years on: distance learning courses for first level registered nurses and midwives.

There is a recognized need to increase the accessibility and flexibility of post-registration course provision for first level registered nurses and midwives. Distance learning courses were developed and implemented at the University of Dundee in response to this need. The courses provide a range of learning opportunities from single module certificate courses to Bachelor, Honours and Masters level studies. The courses are well received by nurses and midwives and experience, over the last 7 years, has highlighted important aspects for distance learning education for both professional groups. Different educational strategies such as Work-based Learning and Problem-based Learning are incorporated into distance learning course design to facilitate the integration of theory and practice and develop cognitive and meta-cognitive skills. The relationship between course assessment and clinical environment is also a key feature of course design, with assessment methods built around work-based learning opportunities in clinical practice. Experience has shown that students require support throughout the learning process. This is achieved through text-based study guides and a range of other support strategies. It is concluded that distance learning can be individualized to meet the professional and personal needs of students and provide quality, flexible learning opportunities for nurses and midwives, facilitating practice development and benefiting patient care.

Education, Distance↗
PubMedDate not supplied

Views of health promotion among primary health care nurses and midwives in Jordan.

The purpose of this study was to explore the attitudes of Jordanian nurses and midwives working in primary care settings regarding health promotion. Views of health promotion were examined using a descriptive survey design to measure nurses' perceptions of constraints, responsibilities for health promotion, and client's response to health education. All nurses and midwives (n = 104) working in the Irbid Governorate primary health care (PHC) and maternal and child health care (MCH) centers were surveyed and 95% responded. The data revealed that respondents acknowledged their responsibility to provide health activities and that nurses believed that they were better suited than physicians to do so. Fifty percent of respondents did not believe that lack of time was a barrier to carry out health promotion effectively. However, more midwives than nurses were pessimistic about patient teaching, patient acceptance, and the ability of the provider to make a difference in the patient's health behaviors.

Adult↗
PubMed1996

Nurse midwives as primary care providers for women.

As we approach the 21st century, the prospect of a new healthcare system in the United States should prompt us to reopen the question of who can best meet the healthcare needs of women. Nurse midwives are advanced practice nurses educated in the field of primary health care for essentially normal women and newborns. Their focus is wellness and health education. Once patients are introduced to the concept of a nurse practitioner and the services provided, the majority are satisfied with the quality of the care received. Evidence suggests that women, if given a choice, prefer the ministrations of a female practitioner over that of a male for their intimate healthcare needs. As a predominantly female group, nurse midwives are an excellent source of qualified providers for women. In this article, the cost effectiveness of nurse practitioner care and the issue of provider gender are discussed. A case for the utilization of nurse midwives as primary healthcare providers for women is presented.

Cost-Benefit Analysis↗
PubMedDate not supplied

Breast cancer risk assessment and risk perception on nurses and midwives in Bornova Health District in Turkey.

Risk perception is a significant component of awareness of breast cancer risks. It can be helpful to reduce deaths of breast cancer via increasing awareness risk level. This study aimed to discuss the level of perceived and calculated breast cancer risk and to provide data on the practice of breast self-examination and use of mammography among 215 nurses and midwives working in the 23 primary healthcare centers in Turkey. Participants were asked to assess their personal lifetime breast cancer risk by a 4-item Likert scale ("no risk," "usual," "moderate," and "strong" risk), which determined "perceived breast cancer risk." Gail model was used to assess the "calculated breast cancer risk," which was calculated by the tool provided by the National Cancer Institute, version 7. Perceived and calculated risk levels were compared. The relation between sociodemographic and risk factors with "perceived risk" was examined. In addition, the influence of perceived risk on breast cancer screening practice was also assessed. The level of perceived risk of nurses and midwives was higher than that of calculated risk. Considering the fact that participants were healthcare professionals, the use of breast self-examination and mammography practices as a preventive behavior by nurses and midwives was lower than expected. Implications are discussed with regard to breast cancer risk and preventive behavior.

Adult↗
PubMed1996

The process of obstetric triage: management by certified nurse-midwives.

The roles for certified nurse-midwives are growing, changing, and becoming more varied with the reform of health care systems. Versatility of clinical knowledge in antepartum, intrapartum, postpartum, and gynecologic care along with advanced practice skills of assessment, diagnosis, and treatment make nurse-midwives ideal providers to perform triage for a busy obstetric service. With health care dollars more limited and more scrutinized than ever before, it becomes essential to prioritize patient needs and match them with the most appropriate resources. The article demonstrates the process of triage provided by certified nurse-midwives in a high-volume university hospital setting. It describes management guidelines and admission criteria for the birth center, high-risk labor and delivery, and the observation unit. Examples of clinical evaluations and judgments as well as scenarios are included to illustrate how triage is unique and differs from care provided in other settings.

Birthing Centers↗
PubMed1988

Midwive's assessment of the upper sensory level after epidural blockade.

The ability of midwives to assess accurately the level of epidural blockade after a short period of instruction was examined. Seventy-two midwives estimated the upper level bilaterally in 100 patients, by detection of the loss of sensation to a cold stimulus. The midwife and anaesthetist were in complete agreement over the level of block in 71.5% of cases; the midwife overestimated the height of the block in 9.5% of cases, and underestimated in 19%. The midwife underestimated by three spinal segments in 1.5% of cases, and never by more. The technique was acceptable to patients and midwives alike. This procedure should enable safe management of obstetric analgesia, whoever administers top-ups; accurate detection of a block that recedes below therapeutic levels should facilitate earlier top-ups and thus reduce pain for the patient in labour.

Anesthesia, Epidural↗
PubMed2006

Spectators & spectacles: nurses, midwives and visuality.

AIM: In this paper we reflect on how linear perspective vision influences the practice of nurses and midwives and to advance understanding of clinical practice in technologically intensive environments through examination of drawings by nurses and midwives and through critical analysis. BACKGROUND: There is increasing emphasis on vision in Western culture, and both nurses and midwives spend a great deal of time observing their clinical environment(s). Healthcare practitioners work increasingly in image-based realities and nurses rely on visual skills. Vision and visual representation are central to our practice and are important to examine because we look often at technology to assess people and care. DISCUSSION: The world in which we practise is one of meaning(s). Technological development is transformative in nature and produces changes that alter the way(s) we give care. Amongst all this change, it is unclear how we practise in environments characterized by increasing technology and it is unknown how nursing and midwifery practice alter as a result. CONCLUSION: Simple drawings included in this paper highlight an important and shared experience of clinical practice(s). They emphasize the importance and scope of the visual sense and expose practitioner behaviour that has enormous implications for current and future professional development and person-focussed care provision. Experiences described in this paper require further examination and highlight substantial changes to nurse-patient relationships, health care and the way we practise.

Attitude of Health Personnel↗
PubMed1994

Student midwives' learning experience on the wards.

This paper is based on an investigation into the learning experiences of student midwives in the clinical setting in one maternity unit in the Republic of Ireland. A questionnaire approach was adopted for the data collection and 42 student midwives participated in the study. A number of factors were identified which appear to influence students' experiences of 'learning on the job'. The quality of their clinical teaching and their observations of the way in which trained staff practise midwifery may influence their decision to continue practising midwifery following registration. These findings clearly point to the importance for midwives to reassert their true role as 'independent practitioners' of normal maternity care.

Adult↗
PubMed1989

Views of mothers and midwives participating in the Bristol randomized, controlled trial of active management of the third stage of labor.

Mothers and midwives who had participated in the Bristol randomized controlled trial of active versus physiologic management of the Third Stage of Labor were asked for their views. One hundred ninety-one mothers (11% of the total randomized) and 49 midwives completed self-administered questionnaires. Both mothers and midwives commented adversely about the length of the third stage under physiologic management. In general, their views were in accord with the conclusions of the main trial (based on clinical data, including maternal blood loss, length of third stage, need for therapeutic oxytocic agents, and specified neonatal morbidity) in favor of continuing with the current practice of active management.

Attitude of Health Personnel↗
PubMed1995

Cesarean delivery rates in women cared for by certified nurse-midwives in the United States: a review.

The frequency of cesarean deliveries for women attended by certified nurse-midwives in the United States (1.8-10.4%) is lower than the rate for the general population of woman who gave birth in the United States in 1990 (23%). This paper describes the research that reported cesarean birth rates for certified nurse-midwives. Major methodology limitations of the research suggest that significant information gaps exist regarding nurse-midwifery care and its effect on cesarean delivery. Issues surrounding this common clinical procedure are complex, with its high cost and controversy over determinant factors. It is important to develop convincing evidence about the influence of nurse-midwives' care on reducing the frequency of cesarean delivery in the United States.

Birth Rate↗
PubMedDate not supplied

The effect of social and care environments on the disclosure practices of nurse midwives relative to methods of pain management in childbirth.

A multivariable model of characteristics in the nurse-patient relationship that influence the disclosure practices of nurses was developed to investigate the effects that characteristics of the nurse midwife, the patient, and the setting have on the disclosure practices reported by nurse midwives. Data were collected by a mailed questionnaire using multiple-choice questions and patient case studies. The questionnaire was sent to a random sample of 500 certified nurse midwives. No association occurred between variations in patient characteristics and the content disclosed by nurse midwives. Many of the patient demographic characteristics were observed to be significantly related to the method and time of disclosure. Results of the study suggested that the social as well as the immediate health-care environment influenced the disclosure of information.

Female↗
PubMed1980

Evaluation of outcomes of non-nurse midwives: matched comparisons with physicians.

The purpose of this study was to assess the practice of a group of non-nurse midwives by comparing the outcomes of their deliveries to the standard of hospital-based physicians. This was done by means of a matching procedure designed to equate the populations on major medical risk factors. The first phase of the study used all physicians and found major differences favoring the midwives. The second phase of the study used the least interventionist half of the physician group and found minimal differences between midwives at home and physicians in the hospital. It is suggested that excessive intervention is not without risk regardless of who does it.

California↗
PubMed1996

Do birthplans empower women? A study of midwives' views.

Last week, we explored women's views of whether birthplans empower them in the birth process. This week, the second half of the study is presented. It explored the perceptions of empowerment from ten midwives, using the birthplan as a tool. Data were collected by semi-structured interviews. The findings indicated that several factors could disempower the women as well as the midwives. For women to be empowered, midwives need to provide open communication, adequate life skills, a nurturing and caring environment, and a democratic management structure. Advocacy and paternalism were found to be constraining factors for empowerment.

Female↗
PubMed1999

The influence of managed care on supply of certified nurse-midwives: an evaluation of the physician dominance thesis.

A key debate over the nature of professional power centers on the maintenance of physician dominance within the system of professions in health care. The changes in health care delivery and financing brought by managed care present a new context for evaluating the physician dominance thesis. I propose that increases in the supply of certified nurse-midwives, a "contending" health care professional group, are related to the expansion of managed care and may signal a decline in physician dominance. I analyze state-level data compiled from governmental, health professional, and industry sources to determine the influence of managed care market penetration, physician supply, state policy context, and demographic factors on the state-level supply of nurse-midwives. Results indicate that, despite high physician supply, nurse-midwife supply is higher in states with higher managed care penetration, as well as in those with more favorable state policy environments and a more educated demographic base. Outcomes from a series of hypothesis tests support my assertion that the expansion of managed care is altering the jurisdictional boundaries in the system of professions in health care, eroding the dominance of physicians while creating new openings for nurse-midwives.

Health Policy↗
PubMedDate not supplied

A model for the future. Certified nurse-midwives replace residents and house staff in hospitals.

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 the pros and cons of a practice model for the future.

Certification↗