Mobile technologies and communication strategies in an urban Midwifery Group Practice setting. An exploratory study

BackgroundAround-the-clock access to a known midwife is a distinct feature of Midwifery Group Practice (MGP) and caseload midwifery settings; although the literature suggests this aspect of working life may hinder recruitment and retention to this model of care. Mobile technologies, known as mHealth where they are used in health care, facilitate access and hence communication, however little is known about this area of midwifery practice.Research questionWhich communication modalities are used, and most frequently, by MGP midwives and clients?MethodsA prospective, cross sectional design included a purposive sample of MGP midwives from an Australian tertiary maternity hospital. Data on modes of midwife–client contact were collected 24 h/day, for two consecutive weeks, and included: visits, phone-calls, texts and emails. Demographic data were also collected.FindingsDetails about 1442 midwife–client contacts were obtained. The majority of contact was via text, between the hours of 07:00 and 14:59, with primiparous women, when the primary midwife was on-call. An average of 96 contacts per fortnight occurred.ConclusionThe majority of contact was between the midwife and their primary clients, reiterating a key tenet of caseload models and confirming mobile technologies as a significant and evolving aspect of practice. The pattern of contact within social (or daytime) hours is reassuring for midwives considering caseload midwifery, who are concerned about the on-call burden. The use of text as the preferred communication modality raises issues regarding data security and retrieval, accountability, confidentiality and text management during off-duty periods. The development of Australian-wide guidelines to inform local policies and best practice is recommended.     

International consensus definition of critical thinking in midwifery practice: A Delphi study

ProblemCurrently there is no discipline-specific definition of critical thinking in midwifery practice.BackgroundCritical thinking in midwifery practice is the cornerstone for safe, evidence based, and woman centred clinical decision-making. Available definitions of critical thinking in other disciplines do not align with midwifery practice which is distinctive, multidimensional and complex.AimTo develop an international consensus definition of critical thinking in midwifery practice.MethodsA two round Delphi study was used. Thirty-two international midwifery experts contributed to the first round which was qualitative in nature. Twenty one of these experts then ranked the relevance and clarity of concepts from round one.FindingsA consensus definition of critical thinking in midwifery practice was achieved. The expert panel identified and defined 14 ‘Habits of Mind’ and 12 Skills that are the core of critical thinking in midwifery practice. Skills included; analysis, constructive application and contextualisation of best available evidence, problem solving, discriminating, predicting, evaluation of care, collect and interpret clinical cues, collaboration/ negotiation, reflexivity, facilitates shared decision-making, communication, and transforming knowledge. Habits of Mind included; intellectual curiosity, reflective, holistic view, intellectual integrity, flexibility, questioning/challenging, participatory, open mindedness, listening with understanding and empathy, cultural humility, woman centred, being brave, confidence, and creativity.Discussion/conclusionThis study is an international first and delineates characteristics of critical thinking in midwifery. Development of a consensus definition provides a common and shared understanding of the skills and attributes required for critical thinking in midwifery practice and can also be applied in education and research.     

Unsettling moods in rural midwifery practice

Background

Rural midwifery and maternity care is vulnerable due to geographical isolation, staffing recruitment and retention. Highlighting the concerns within rural midwifery is important for safe sustainable service delivery.

Assessing quality of life in Singapore: An exploratory study

This article attempts an exploratory study of the quality of life in Singapore. The first objective of this study was to gauge how Singaporeans view the quality of their lives and the extent to which demographic characteristics affect life satisfaction. Secondly, the importance of the different pre-selected domains of life was also individually investigated. Finally, the levels of satisfaction with each of these domains were also assessed. It was found that there were no significant relationships found between life satisfaction and demographic characteristics. In addition, people in Singapore attached great importance to being healthy and having a happy family life. Finally, it was also determined that they were in general very satisfied with the various domains of life, particulary with family life and life in Singapore as a whole.     

Psychosocial correlates and antecedents of abortion: An exploratory study

Longitudinal data are used to examine the relation between young adult women's abortion experience and a variety of antecedent and subsequent personality, perceived environment, and behavior variables. About one-quarter of the women in two separate samples reported that they had had an abortion. Bivariate analyses show that young adult women who have had an abortion are characterized by greater psychosocial unconventionality than women who have not had an abortion. Similar differences along an underlying dimension of conventionality-unconventionality distinguish, antecedent to the abortion experience, women who would later have an abortion from those who would not. The findings are consistent with the expectations of Problem-Behavior Theory (Jessor & Jessor, 1977).This paper is a report from the Young Adult Follow-Up Study (R. Jessor, princial investigator) supported by Grant No. AA-03745 from the National Institute on Alcohol Abuse and Alcoholism.We are grateful to Dr. Lee Jessor for her contribution to the overall longitudinal project and to several of the measures employed in this report.     

Birth Territory: a theory for midwifery practice

The theory of Birth Territory describes, explains and predicts the relationships between the environment of the individual birth room, issues of power and control, and the way the woman experiences labour physiologically and emotionally. The theory was synthesised inductively from empirical data generated by the authors in their roles as midwives and researchers. It takes a critical post-structural feminist perspective and expands on some of the ideas of Michel Foucault. Theory synthesis was also informed by current research about the embodied self and the authors' scholarship in the fields of midwifery, human biology, sociology and psychology. In order to demonstrate the significance of the theory, it is applied to two clinical stories that both occur in hospital but are otherwise different. This analysis supports the central proposition that when midwives use 'midwifery guardianship' to create and maintain the ideal Birth Territory then the woman is most likely to give birth naturally, be satisfied with the experience and adapt with ease in the post-birth period. These benefits together with the reduction in medical interventions also benefit the baby. In addition, a positive Birth Territory is posited to have a broader impact on the woman's partner, family and society in general.     

Responding to catastrophe: A case study of learning from perinatal death in midwifery practice

Problem/BackgroundPerinatal death has far reaching emotional effects for all involved in this devastating event. The opportunity for learning as a result of this catastrophe, however, remains unexplored.AimTo explore midwives’ experiences of caring through, and learning from, perinatal death, to better inform the effective planning and delivery of education that optimises both midwifery and self-care.MethodsA naturalistic interpretive multiple case study design. Seventeen midwives, located in Australia, participated in an online group activity hosted as a blog, followed by telephonic focus groups and in-depth email interviews.FindingsThematic data analysis revealed seven major themes: Grappling with the reality of perinatal death; Struggling with personal and professional heartache; Seeking the space to grieve as a professional; Being with the woman and her family; Finding a new purpose; Strengthened through support; and Developing the courage to care.DiscussionThe initial turmoil and impact of loss reflected the catastrophic nature of perinatal death. Midwives uncovered a journey to acceptance and learning, realising a determination to enhance expertise and discovering value in experiential knowledge. Insecurity regarding competence and confidence to manage perinatal death and bereavement care was highlighted. However, sharing their stories revealed professional fulfilment, personal strength, and solidarity amongst midwives who have endured similar experiences.ConclusionA coordinated approach to support and the dissemination of experiential knowledge and learning could be developed within an online model of narrative sharing and discussion. Debriefing, support and sharing of expertise in this way may foster engagement within and beyond the workplace.     

Exploring moral distress in Australian midwifery practice

ProblemAustralian midwives are considering leaving the profession. Moral distress may be a contributing factor, yet there is limited research regarding the influence of moral distress on midwifery practice.BackgroundMoral distress was first used to describe the psychological harm incurred following actions or inactions that oppose an individuals’ moral values. Current research concerning moral distress in midwifery is varied and often focuses only on one aspect of practice.AimTo explore Australian midwives experience and consequences of moral distress.MethodsSemi-structured interviews were used to understand the experiences of moral distress of 14 Australian midwives. Interviews were recorded and transcribed verbatim. Data were analysed using thematic analysis and NVIVO12©.FindingsThree key themes were identified: experiencing moral compromise; experiencing moral constraints, dilemmas and uncertainties; and professional and personal consequences. Describing hierarchical and oppressive health services, midwives indicated they were unable to adequately advocate for themselves, their profession, and the women in their care.DiscussionIt is evident that some midwives experience significant and often ongoing moral compromise as a catalyst to moral distress. A difference in outcomes between early career midwives and those with more than five years experiences suggests the cumulative nature of moral distress is a significant concern. A possible trajectory across moral frustration, moral distress, and moral injury with repeated exposure to morally compromising situations could explain this finding.ConclusionThis study affirms the presence of moral distress in Australian midwives and identified the cumulative effect of moral compromise on the degree of moral distress experienced.     

Satisfaction with life among international students: An exploratory study

The study examines self-reported satisfaction with life and thefactors predicting it among 304 international students (159 malesand 145 females) at the University of Bergen, Norway. Thestudents had on the average lived 2.34 years (SD = 2.31) inNorway. The students reported on the whole good satisfactionwith life. However, students from Europe and North America wereon the whole more satisfied than their peers from Africa andAsia. It was also found that factors such as the number offriends, satisfaction with finances, perceived discrimination andinformation received prior to the foreign sojourn significantlyaffected the student's life satisfaction. The importance ofthese factors differed for students from developing and developedcountries where some paradoxical findings came out. Theseparadoxical findings may be the result of the Norwegian contextof the study. Language proficiency (with respect to host andEnglish languages), and having a host national friend did notshow significant effect on life satisfaction.     

Quality of life and city size: An exploratory study of Nigeria

This paper examines the variations in the quality of life at the relatively neglected inter-urban scale in a developing nation. Based on a sample survey of 3800 heads of households in Nigerian cities ranked into three categories: large, medium and small, the study found that level-of-living is related to city size, with the residents of large cities having a higher quality of life than those in the medium and small cities.     

Quality of life in Kwara State,Nigeria: An exploratory geographical study

An attempt is made to describe territorial social indicators for Kwara State, Nigeria, and to suggest how they might be used to map inequalities.