Invisibility of nurses and midwives in the public health response to child abuse and neglect: A policy review

BackgroundChild abuse and neglect need to be addressed through a public health approach that prioritises prevention and early intervention. Nurses and midwives are core to this public health response, yet little is known about how their roles are described in Australian policy.AimTo explore how nurses’ and midwives’ roles in a public health response to child abuse and neglect are described in Australian policies about child protection, health, welfare, or development.MethodsThis policy review used Internet searching to identify Australian policy documents relating to child protection, health, welfare, or development published from 2009 to 2021. Data were analysed using deductive coding and content analysis.FindingsNurses’ and midwives’ contributions to a public health response to child abuse and neglect were either absent or described in scant detail within Australian policy. The information that was available represented only a portion of nursing and midwifery practices from a limited range of practice contexts.DiscussionA lack of visibility and clarity of nurses’ and midwives’ roles in policy raises many challenges. This includes a lack of guidance for interdisciplinary collaboration, educational preparation of nurses and midwives, and appropriate resourcing for their interventions. Further research is urgently needed to guide future best-practice policy and practices for nurses’ and midwives’ contributions to a public health response to child abuse and neglect.ConclusionAn enhanced representation of nurses’ and midwives’ roles in Australian policy is required to guide a public health approach that promotes better outcomes for all children.     

Trainers' perception of the learning environment and student competency: A qualitative investigation of midwifery and anesthesia training programs in Ethiopia

BackgroundEthiopia has successfully expanded training for midwives and anesthetists in public institutions. This study explored the perceptions of trainers (instructors, clinical lab assistants and preceptors) towards the adequacy of students' learning experience and implications for achieving mastery of core competencies.MethodsIn-depth interviews with 96 trainers at 9 public universities and 17 regional health science colleges across Ethiopia were conducted to elicit their opinions about available resources, program curriculum suitability, and competence of graduating students. Using Dedoose, data were thematically analyzed using grounded theory.ResultsPerceptions of anesthesia and midwifery programs were similar. Common challenges included unpreparedness and poor motivation of students, shortages of skills lab space and equipment, difficulties ensuring students' exposure to sufficient and varied enough cases to develop competence, and lack of coordination between academic training institutions and clinical attachment sites. Additional logistical barriers included lack of student transport to clinical sites. Informants recommended improved recruitment strategies, curriculum adjustments, increased time in skills labs, and better communication across academic and clinical sites.ConclusionsAn adequate learning environment ensures that graduating midwives and anesthetists are competent to provide quality services. Minimizing the human resource, infrastructural and logistical gaps identified in this study requires continued, targeted investment in health systems strengthening.     

Perception of caring behavior and associated factors among nurses and midwives working in public hospitals in Southern Ethiopia

ObjectiveThis study aimed to assess the perception of caring behaviors and associated factors among nurses and midwives who provided maternal health care services at Sidama region public hospitals, Hawassa, Ethiopia.MethodsAn institutional-based cross-sectional study design was used on a sample of 269 nurses and midwives working in maternity wards in Sidama region public hospitals. A self-administered questionnaire was used to collect data. Bivariate and multivariable logistic regression analysis was used to identify factors associated with nurses’ and midwives’ perceptions of caring behaviors.ResultsTotally 261 nurses and midwives participated the survey. Based on the mean score, participants’ perception of caring behavior was classified as higher and lower. According to this study, 75.1% (196/261) of nurses and midwives demonstrated a higher perception of caring behavior. Respondents’ age, professional satisfaction, personal satisfaction, midwife/nurse-doctor relationship and workload were significantly associated with their perception of caring behavior.ConclusionsAssessing the nurses’ and midwives’ perception of caring behavior and related factors is crucial for providing high-quality nursing and midwifery interventions. It is suggested to create a positive and conducive caring behavior in the organization by reducing excessive workload of nurses and midwives, as well as enhancing nurse/midwife-doctor relationship, and increasing their job satisfaction by providing recognition and reward will improve nurses’ and midwives’ caring behavior.     

Culturally and linguistically diverse nurses’ experiences of how competence facilitates integration into the working environment: A qualitative study

AimThis study aims to describe culturally and linguistically diverse nurses’ experiences of how they transferred their competence to meet professional competence requirements in non-English speaking environment.BackgroundCompetence is one factor that affects culturally and linguistically diverse nurses’ integration into the working environment. In this study, knowledge, skills, values and personal traits are included in the holistic competence concept.DesignQualitative.MethodsA total of 24 culturally and linguistically diverse nurses involved in Finnish health care participated in this qualitative study. Data were collected through snowball sampling during the summer of 2021 using semi-structured interviews. The collected data were analysed using inductive content analysis.ResultsThe data analysis revealed a total of five main categories describing culturally and linguistically diverse nurses’ experiences: 1) before immigration; 2) competence requirements in the country of immigration; 3) assessment of competencies; 4) support factors; and 5) hardships.ConclusionDegree recognition, colleagues’ tolerance towards culturally and linguistically diverse nurses at the workplace and continuous education focusing on local language could improve culturally and linguistically diverse nurses’ integration into the working environment.     

Manejo de la hemorragia posparto por parte de las matronas en centros sanitarios del estado de Ekiti: estudio cualitativo exploratorio

ObjectivesMaternal mortality continues to pose a critical challenge in obstetric practice, with postpartum haemorrhage as one of the major causes. This study aimed to explore the lived experiences of midwives regarding the management of postpartum hemorrhage (PPH).MethodsThe study employed a qualitative phenomenological approach. Participants were selected using purposive sampling technique, and 15 participants were recruited for the study. Data collection was done using a semi-structured interview guide for in-depth interviews. The interviews were audio-recorded, and data analysis was done using thematic analysis.ResultsTwo themes emerged from the analysis, including 1) management practices adopted against PPH and 2) hospital protocol for the management of PPH. The major management practices adopted by the midwives were using uterotonics, especially oxytocin, and other management practices such as anti-shock garments, stimulation of contractions by rubbing the uterus, and assessment of the cause of bleeding and suturing of lacerations. It was also deduced that different healthcare facilities had policies for managing postpartum hemorrhage. Barriers affecting the effective management of PPH were understaffing, unavailability of suitable facilities and equipment, restrictions on nurses/midwives in managing PPH, unfavourable hospital policy and lack of communication among the healthcare team.ConclusionThe participants’ experiences suggest they are somewhat satisfied with PPH management in their facilities. However, barriers such as understaffing, unavailability of equipment, poor communication among healthcare teams and restrictions on nurses in PPH management should be addressed to improve midwives’ experiences in PPH management.     

Australian and Danish nurses’ and midwives’ wellbeing during COVID-19: A comparison study

BackgroundMost investigations of nurses’ and midwives’ psychological wellbeing during the COVID-19 pandemic have been conducted in a single setting.AimTo assess and compare the psychological wellbeing of nurses and midwives in Australia and Denmark during the COVID-19 pandemic.MethodsNurses and midwives employed at four metropolitan health services in Australia and one in Denmark completed an anonymous online survey, which assessed depression, anxiety, and stress symptoms (The Depression, Anxiety and Stress Scale - 21 Items (DASS-21)), and sociodemographic and employment factors.FindingsCompleted surveys were received from 3001 nurses and midwives (1611 Australian and 1390 Danish). Overall, approximately one in seven of the nurses and midwives surveyed reported moderate to extremely severe levels of depression (n = 399, 13.5%), anxiety (n = 381, 12.9%) and stress (n = 394, 13.4%). Australian nurses’ and midwives’ scores on all DASS-21 subscales were significantly higher (representing higher levels of depression, anxiety and stress) than the scores for the Danish nurses and midwives. Fewer years of clinical experience, living in Australia and being employed on a part-time basis were significantly associated with higher levels of psychological distress.DiscussionA considerable proportion of nurses and midwives experienced distress during the COVID-19 pandemic; however, the proportion and severity varied by country. Australian nurses and midwives experienced higher levels of distress than their Danish colleagues.ConclusionNurses and midwives working in countries with relatively low numbers of COVID-19 cases and deaths are also likely to experience psychological distress. Nurses and midwives would benefit from targeted country-specific support and wellbeing initiatives.     

Proactive rounding: Perspectives and experiences of nurses and midwives working in a large metropolitan hospital

BackgroundRounding by the Rapid Response team (RRT) is an integral part of safety and quality care of the deteriorating patient. Rounding enables Intensive Care Units (ICU) liaison nurses to proactively identify deteriorating patients in the general wards and minimize the time spent by general nursing staff to call for assistance.ObjectiveThe study examined nurses’ and midwives’ experiences of proactive rounding by a RRT/ICU Liaison service, including the impact on workflow and patient care as well as enablers and barriers to utilization of the service.MethodA mixed method approach was used: an online survey and semi-structured interviews with nurses and midwives in an acute care setting.Results52 respondents completed the online survey and 6 participated in a semi-structured interviews. The majority of survey respondents found the service useful and indicated that rounding by the ICU Liaison service improves patient care. Participants also believed that pro-active rounding increases staff confidence and builds rapport when utilizing the ICU Liaison service. Barriers to use of the service included the lack of out of normal business hours support and obtaining prompt support.ConclusionProactive rounding was perceived by nurses and midwives to be beneficial for both themselves and patients, and ensured that deteriorating patients were identified.     

Contextual factors influencing implementation of a university-based midwifery education programme in Central Africa: A qualitative study

AimTo investigate contextual factors and their influence on implementing a 90-credit midwifery education programme for nurses at a university in the eastern DRC.BackgroundTo improve maternal and neonatal health, there is a government policy in the Democratic Republic of Congo (DRC) to educate midwives at a higher education level according to international norms. This study investigates contextual factors and their influence on the implementation of a midwifery education programme which is based on national curriculum and has a profile of person-centred care, simulation-based learning pedagogy and information and communication technology.MethodA qualitative study was conducted with data collected through semi-structured interviews with 22 participants who were directly or indirectly involved in establishing the midwifery education programme. Transcribed interviews were analysed using content analysis.ResultsThe factors influencing the implementation of the new midwifery education programme comprise facilitating and hindering factors. Facilitating factors were: (i) awareness that midwives educated at a higher education level can deliver higher-quality health care, (ii) women are motivated to seek care from well-educated midwives, (iii) the planned programme is attractive and (iv) the university has a stable academic administration and established collaborations. Hindering factors were: (i) Students’ lack of prerequisites for study; (ii) objections to educating midwives at a higher education level; (iii) inadequate teaching resources; and (iv) inadequate working conditions for midwives.ConclusionThe facilitating factors strengthen the belief that it is possible to implement this midwifery education programme, while the hindering factors need to be addressed to run the programme successfully. The findings can guide higher education institutions starting similar midwifery education programmes in the DRC and elsewhere, although it is crucial to conduct a context study in those specific contexts.     

Registered nurses’ experience of care for adult patients with a temporary tracheostomy at general hospital wards. A phenomenological-hermeneutic explorative study

BackgroundCaring for adult patients with a temporary tracheostomy in general wards can be challenging and complex. Little research has explored registered nurses’ experiences with caring for these groups of patients.ObjectivesThis study sought to interpret and describe registered nurses’ lived experiences of caring for adult patients with a tracheostomy in general wards.Research design/methodologySix registered nurses were interviewed in this study. The interviews were analysed to gain comprehensive knowledge about caring for adult patients with a temporary tracheostomy. The interviews were transcribed, analysed, and interpreted by using Gadameŕs philosophical hermeneutics and Kvale and Brinkmann’s three steps of understanding.SettingThree different wards medical, surgical, and neurological of a teaching hospital in Norway.FindingsThree themes emerged from data analysis. These included experiencing clinically challenging patients, a lack of clinical support from the intensive care nurses, and a lack of professional confidence.ConclusionThis study highlighted the challenges surrounding the care of an adult patient with a tracheostomy in the general wards. Identifying these challenges would lead to further improvement in registered nurses’ experiences and, in turn, in the quality of competent care for adult patients with a tracheostomy in the general ward.Implications for Clinical PracticeUnderstanding the registered nurses’ experiences will assist the head nurses in planning and providing relevant information and education to provide safe and holistic patient care. Adequate support from intensive care unit nurses and professional development are required to ensure high-quality care. This study recommends that healthcare managers focus on establishing step-down units to improve patient outcomes, especially for high-risk patients and to increase the competencies of registered nurses in caring for adult patients with a tracheostomy as a whole person.     

Examining family and community nurses’ core competencies in continuing education programs offered in primary health care settings: An integrative literature review

AimTo identify gaps in existing family and community nurse (FCN) continuing education programs and to investigate whether FCN core competencies are covered in continuing education programs offered in primary health care settings.BackgroundIn global pandemics such as COVID-19, there is an urgent need for staff development using transformative learning and help registered nurses build up their competencies and form a new professional identity as family and community nurses (FCNs). Therefore, FCN education programs become of high importance to enhance nurses’ core competencies through continuing education.MethodsAn integrative review of the literature was conducted applying the Whittemore and Knafl methodological strategy for studies published between 2015– June 2021.ResultsFCN core competencies, including the “decision-making process, navigation as care coordinator and patient advocate and promoting individual and family health to support the quality of nursing care,” were poorly covered in the FCN programs. Specifically, e-health played a very limited role in FCN continuing education, while ethics, managing change, managing disparity and diversity and leadership skills, did not emerge at all.ConclusionThe identified gaps can be incorporated into future FCN continuing education programs and may help improve nurses’ competence and health care delivery and support new integrated models of care, namely, person-centered and community-based models.     

The perceived barriers and facilitators to implementation of early mobilisation within a multicentre,phase 3 randomised controlled trial: A qualitative process evaluation study

BackgroundProcess evaluation within clinical trials provides an assessment of the study implementation's accuracy and quality to explain causal mechanisms and highlight contextual factors associated with variation in outcomes.ObjectivesThis study aimed to identify the barriers and facilitators of implementing early mobilisation (EM) within a trial.MethodsThis is a qualitative process evaluation study within the Trial of Early Activity and Mobilisation (TEAM) phase 3 randomised controlled trial. Semistructured interviews were conducted remotely with multiprofessional clinicians (physiotherapists, medical staff, and nursing staff) involved in the delivery of the TEAM intervention at Australian hospitals participating in the TEAM study. Inductive coding was used to establish themes which were categorised into the Behaviour system involving domains of Capability, Opportunity, and Motivation (COM-B), which allowed barriers and enablers affecting EM to be identified.FindingsSemistructured interviews were conducted in three different states of Australia. There were 16 participants, including 10 physiotherapists, five physicians, and one nurse. The key themes that facilitated EM were mentoring, champions, additional staff, organisation of the environment, cultural changes, communication, and documented safety criteria. In contrast, the main factors that hindered EM were lack of expertise and confidence in delivering EM, heavy sedation, interdisciplinary conflicts, and perceived risks related to EM.ConclusionA wide range of barriers and facilitators that influenced EM within the TEAM study were identified using the COM-B framework. Many of these have been previously identified in the literature; however, participation in the study was viewed positively by multidisciplinary team members.     

A training intervention to enhance self-management support competencies among nurses: A non-randomized trial with mixed-methods evaluation

AimTo evaluate the process and outcomes of INTENSS, a training intervention grounded in Self-Determination Theory to enhance nurses’ competencies for self-management support.DesignNon-randomized intervention study with mixed-methods evaluation approach (2019–2020).MethodsThe multifaceted training was implemented in six groups. Cluster-assignment to study arm 1 or arm 2. Arm 1 received a basic training module and arm 2 the basic module with additional video-interaction guidance. Focus groups were held to detect what was helpful in competency enhancement. Intervention effectiveness was determined on trainees’ attitude, motivation, self-efficacy and skills for self-management support (multiple time-points by self-reports and observations).ResultsTrainees (N = 50) indicated the video-interaction guidance, the connectivity within the training group, the constructive feedback from trainers as well as from peers, as helpful for the acquisition of self-management support skills. At 2-month post-training, participants slightly improved in their competencies for the assess (p = .03), agree (p = .02), arrange (p < .01) phase and partnership skills (p < .01). Between the study arms, video-trained participants significantly reduced their use of controlling approaches (p = .03). Observations indicated that trainees mostly used an autonomy-supportive approach, seldom we observed the use of competence supportive, controlling or chaotic approaches. The interviews gave indications that obligatory training in this field needs to be questioned.ConclusionThe outcome evaluation of the INTENNS training indicated most improvement in nurses’ skills for collaborative goal setting and partnership with patients. The mixed-methods evaluation emerges transferable principles to implement the training amongst nurses and, by extension, other healthcare professions. A training intervention involving patient experts can add value to further pave the way towards a true partnership between patients and healthcare professionals.ImpactA training intervention taking into account the complexity of supporting patients towards self-management is available. Important elements for growth are: connectivity within training group, a safe learning climate where ‘failure’ is allowed and video-interaction guidance. Obligatory training participation can be questioned.     

Understanding the application of genomics knowledge in nursing and midwifery practice: A scoping study

BackgroundWith the increased realisation of the benefits of genomic testing, nurses and midwives are being exposed to genomic care as a part of normal clinical practice.AimTo explore how Queensland nurses and midwives are applying genomics knowledge in clinical practice to understand how best to support the workforce to meet patient needs in response to increased genomic testing rates.MethodsA scoping methodology was used whereby the research question was defined, relevant studies were identified for the purposes of a literature review, followed by interviews with 32 nurses and midwives to support the interpretation of the literature review and to understand the implications for practice.FindingsNurses and midwives are working in partnership with their patients and families to support genomic decision making. The emerging needs of patients to understand their diagnostic and treatment pathway is forcing nurses and midwives to self-educate to keep pace with current practice demands. This approach to upskilling is not adequate for those nurses and midwives currently who are regularly exposed to patients requiring genomic support.DiscussionDespite national and local policy documents identifying genomics workforce capacity as a strategic priority action and clinicians reporting their involvement in genomics care, there is a lack of succession planning, organisational support and educational opportunities to support these advances in practice.ConclusionThere is a need to address the emerging genomic workforce and education requirements to ensure nurses and midwives are capable of supporting patients undergoing genomic testing.     

Effectiveness of e-STORY App in clinical reasoning competency and self-directed learning among students in associate nursing program: A quasi experimental study

AimThe purpose of this study was to promote students’ clinical reasoning (CR) and self-directed learning (SDL). The specific aims were: (1) to examine effectiveness of the e-STORY App in promoting nursing students’ CR and SDL; and (2) to explore the relationships between levels of learning motivation and suitability of the e-STORY App.BackgroundCR and SDL are core competencies for nursing students. However, new graduates tend to be in adequately prepared in these competencies. Humanoid diagram uses diagrams to guide students in gaining a comprehensive view of the patient issues, which may promote attainment of these competencies. The Z generation students favor learning through smart devices for the feature of no time and spatial limitations. The e-STORY App was developed to overcome the setbacks of creating hard-copy drawings to promote learning effectiveness.DesignThis quasi-experimental study used two-group repeated measure design with a convenience sample.MethodsA total of 77 students from two sections of the “Seminar for Clinical Case Studies” course participated in the study (experimental group: 39 students; control group: 38 students). Data were collected before, one week after and four weeks after the teaching intervention. The instruments used were demographic information sheet, Huang et al.’s (in press) Clinical reasoning scale and Cheng et al. (2010) Self-directed learning instrument.ResultsThere were no significant differences in the CR and SDL scores between the experimental and control groups one week after the intervention (p＞.05). Analyses of the delay effects four weeks after the intervention found significantly higher CR scores in the experimental group than the control group (p < .05). However, there were no significant differences in the SDL scores between groups (p＞.05). Analysis of the findings from the experimental group found that students with moderate and low learning motivation showed significantly higher CR scores on the posttest and follow-up test (p < .05).ConclusionsApplication of the e-STORY App as a supplementary teaching strategy promoted nursing students’ CR ability, especially in students with moderate or low learning motivation. It is recommended to use the App in students with moderate or low learning motivation to promote learning effectiveness.     

Use of a flipped classroom in ophthalmology courses for nursing,dental and medical students: A quasi-experimental study using a mixed-methods approach

BackgroundTraditional teaching is associated with dilemmas, such as low motivation to learn and passive learning. In contrast, use of a flipped classroom with the proper learning design has the potential to promote accelerated learning, bolster transmission of competencies (i.e., critical thinking, communication and problem-solving skills) and improve teamwork capacity, all of which are of great significance in professional healthcare practice, including nursing, dentistry and medicine.ObjectiveThe aim of the study was to examine the effects of using a flipped classroom in ophthalmology courses for undergraduate nursing students, dental students and higher vocational medical students.DesignA quasi-experimental design was used with an intervention (n = 100) and a comparison group (n = 100), pre-/post-testing measures and a mixed-methods approach.SettingA university in China.ParticipantsA total of 200 students were included.MethodsStudents' self-rated learning ability was measured before and after the courses, and skill exams were performed after the courses. In addition, interviews were conducted with the clinical medical students concerning their experiences of the flipped classroom.ResultsStudents' self-rated learning ability improved significantly more in the intervention than in the comparison group, for the total scale and the three factors ‘learning goals’, ‘self-efficacy and social learning’ and ‘problem-solving’. Skill exam scores were statistically significantly better in the intervention than in the comparison group. On the whole, the clinical medicine students felt the flipped classroom had a positive impact and improved their learning ability as well as knowledge in ophthalmology.ConclusionsUse of a flipped classroom for nursing, dental and clinical medical students in ophthalmology courses shows promising results in the form of students' skill exam scores and self-rated learning ability.     

Development and assessment of the validity and reliability of a scale for measuring the mentoring competencies of Japanese clinical midwives: An exploratory quantitative research study

BackgroundMidwives 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.ObjectivesThe 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.DesignAn exploratory quantitative research study.MethodsQuestionnaires 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.ResultsExploratory 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).ConclusionThe MCCM Scale is composed of 41 items and three subscales measured from a total of seven factors. The validity and reliability of the MCCM Scale was supported by the statistical analyses.