What makes alongside midwifery-led units work? Lessons from a national research project

The findings of the Birthplace in England Research Programme showed that midwife-led units are providing the safest and most cost-effective care for low risk women in England. Since the publication of the updated National Institute for Health and Care Excellence (NICE) intrapartum guidelines, there is likely to be even more interest in the development of midwife-led units to promote birth outside obstetric units (OUs) for low-risk women. Professional bodies, policy makers and trusts have focused their energies on alongside midwife-led units (AMUs), which are seen to provide the 'best of both worlds' between home and an OU. Between 2012 and 2013, we carried out a study of the organisation of four AMUs in England and the experiences of midwives and women who worked and birthed there. Learning from their experiences, this article presents five key factors which help make AMUs work

"Engaging with birth stories in pregnancy: a hermeneutic phenomenological study of women's experiences across two generations"

BACKGROUND: The birth story has been widely understood as a crucial source of knowledge about childbirth. What has not been reported is the effect that birth stories may have on primigravid women's understandings of birth. Findings are presented from a qualitative study exploring how two generations of women came to understand birth in the milieu of other's stories. The prior assumption was that birth stories must surely have a positive or negative influence on listeners, steering them towards either medical or midwifery-led models of care. METHODS: A Heideggerian hermeneutic phenomenological approach was used. Twenty UK participants were purposively selected and interviewed. Findings from the initial sample of 10 women who were pregnant in 2012 indicated that virtual media was a primary source of birth stories. This led to recruitment of a second sample of 10 women who gave birth in the 1970s-1980s, to determine whether they were more able to translate information into knowledge via stories told through personal contact and not through virtual technologies RESULTS: Findings revealed the experience of 'being-in-the-world' of birth and of stories in that world. From a Heideggerian perspective, the birth story was constructed through 'idle talk' (the taken for granted assumptions of things, which come into being through language). Both oral stories and those told through technology were described as the 'modern birth story'. The first theme 'Stories are difficult like that', examines the birth story as problematic and considers how stories shape meaning. The second 'It's a generational thing', considers how women from two generations came to understand what their experience might be. The third 'Birth in the twilight of certainty,' examines women's experience of Being in a system of birth as constructed, portrayed and sustained in the stories being shared. CONCLUSIONS: The women pregnant in 2012 framed their expectations in the language of choice, whilst the women who birthed in the 1970s-1980s framed their experience in the language of safety. For both, however, the world of birth was the same; saturated with, and only legitimised by the birth of a healthy baby. Rather than creating meaningful understanding, the 'idle talk' of birth made both cohorts fearful of leaving the relative comfort of the 'system', and of claiming an alternative birth

Professional development short scale: Measurement invariance, stability, and validity in Brazil and Angola

Professional development is the vital process in the workplace that comprises the growth and maturation of knowledge, skills, and attitudes arising from formal and informal learning at work throughout one’s life. The goal of this research was to present validity evidence and accuracy of the Professional Development Short Scale (PDSS) for different occupational categories. The research was conducted using four cross-sectional questionnaire surveys with convenience samples of different occupational categories (N = 2,547) in 41 cities throughout Brazil and Angola. The first study aimed to explore the factorial structure and internal consistency of the PDSS. The second study aimed to evaluate the cross-cultural validity and measurement invariance of the scale. The third study was to assess concurrent validity and predictive validity. The fourth study was to assess the test–retest reliability. The results indicated a one-factor structure, with six items for both countries’ datasets. This research pointed out the validity of the PDSS as regards its convergence-discriminant pattern with the General Self-Efficacy and Job Self-Efficacy Scales, and also, the relationship of the PDSS with relevant constructs (Bases of Power/leadership styles, In-role performance, Job Satisfaction, and Career Promotion). In this study, we provide psychometric validity of the Professional Development Short Scale to offer it as a resource to measure the construct and allow researchers to apply it in research models easily integrated to other constructs. We covered several different incremental approaches to ensure the scale validity. Besides showing temporal stability to ensure it can be applied from time to time, as one dynamic construct should, we also indicated that social desirability did not influence the measurement of the PDSS. Furthermore, the results indicate that the effects of the method do not generate undue confusion on the scale. Thus, the psychometric properties of the PDSS allow for recommending the use of the scale in extensive studies. This scale therefore contributes to contemporary professional development literature through the comparison of the perceptions of professional development in different professional categories and by providing organizational researchers with a tool to evaluate the effects and predictors of such construct.info:eu-repo/semantics/publishedVersio

Working for patient safety: a qualitative study of women's help-seeking during acute perinatal events.

BACKGROUND: Women and their relatives can play an important role in early detection and help seeking for acute perinatal events. Recent UK reports indicate that patient-professional partnership in 'working for safety' can be difficult to achieve in practice, sometimes with catastrophic consequences. This research explored the experiences of women and relatives who had experienced early warning signs about their condition and sought help in escalating care. METHODS: Secondary analysis of case study data which included qualitative interviews with 22 women purposively sampled on account of experiencing a step up in care and 4 of their relatives from two NHS Trusts in England during 2010. Analysis focused on the type of safety work participants engaged in, and the opportunities and challenges reported by women and family members when negotiating safety at home and in hospital. RESULTS: Women and relatives took on a dual responsibility for self-diagnosis, self-care and seeking triage, whilst trying to avoid overburdening stretched services. Being informed, however, did not necessarily enable engagement from staff and services. The women's narratives highlighted the work that they engaged in to build a case for clinical attention, the negotiations that took place with health care professionals and the strategies women and partners drew on (such as objective signs and symptoms, use of verbal insistence and repetition) to secure clinical help. For some women, the events left them with a lasting feeling that their concerns had been disregarded. Some described a sense of betrayal and loss of trust in an institution they believed had failed to care for them. CONCLUSION: The notion of 'safety partnerships' which suggests a sense of equality and reciprocity was not borne out by our data, especially with regards to the experiences of teenage women. To enable women and families to secure a rapid response in clinical emergencies, strategies need to move beyond the provision of patient information about warning signs. Effective partnerships for safety may be supported by system level change such as improved triage, continuity of care, self-referral pathways and staff training to address asymmetries of power that persist within the health system

Caseload midwifery as organisational change:the interplay between professional and organisational projects in Denmark

BACKGROUND: The large obstetric units typical of industrialised countries have come under criticism for fragmented and depersonalised care and heavy bureaucracy. Interest in midwife-led continuity models of care is growing, but knowledge about the accompanying processes of organisational change is scarce. This study focuses on midwives’ role in introducing and developing caseload midwifery. Sociological studies of midwifery and organisational studies of professional groups were used to capture the strong interests of midwives in caseload midwifery and their key role together with management in negotiating organisational change. METHODS: We studied three hospitals in Denmark as arenas for negotiating the introduction and development of caseload midwifery and the processes, interests and resources involved. A qualitative multi-case design was used and the selection of hospitals aimed at maximising variance. Ten individual and 14 group interviews were conducted in spring 2013. Staff were represented by caseload midwives, ward midwives, obstetricians and health visitors, management by chief midwives and their deputies. Participants were recruited to maximise the diversity of experience. The data analysis adopted a thematic approach, using within- and across-case analysis. RESULTS: The analysis revealed a highly interdependent interplay between organisational and professional projects in the change processes involved in the introduction and development of caseload midwifery. This was reflected in three ways: first, in the key role of negotiations in all phases; second, in midwives’ and management’s engagement in both types of projects (as evident from their interests and resources); and third in a high capacity for resolving tensions between the two projects. The ward midwives’ role as a third party in organisational change further complicated the process. CONCLUSIONS: For managers tasked with the introduction and development of caseload midwifery, our study underscores the importance of understanding the complexity of the underlying change processes and of activating midwives’ and managers’ interests and resources in addressing the challenges. Further studies of female-dominated professions such as midwifery should offer good opportunities for detailed analysis of the deep-seated interdependence of professional and organisational projects and for identifying the key dimensions of this interdependence

Professional development short scale: Measurement invariance, stability, and validity in Brazil and Angola

Professional development is the vital process in the workplace that comprises the growth and maturation of knowledge, skills, and attitudes arising from formal and informal learning at work throughout one’s life. The goal of this research was to present validity evidence and accuracy of the Professional Development Short Scale (PDSS) for different occupational categories. The research was conducted using four cross-sectional questionnaire surveys with convenience samples of different occupational categories (N = 2,547) in 41 cities throughout Brazil and Angola. The first study aimed to explore the factorial structure and internal consistency of the PDSS. The second study aimed to evaluate the cross-cultural validity and measurement invariance of the scale. The third study was to assess concurrent validity and predictive validity. The fourth study was to assess the test–retest reliability. The results indicated a one-factor structure, with six items for both countries’ datasets. This research pointed out the validity of the PDSS as regards its convergence-discriminant pattern with the General Self-Efficacy and Job Self-Efficacy Scales, and also, the relationship of the PDSS with relevant constructs (Bases of Power/leadership styles, In-role performance, Job Satisfaction, and Career Promotion). In this study, we provide psychometric validity of the Professional Development Short Scale to offer it as a resource to measure the construct and allow researchers to apply it in research models easily integrated to other constructs. We covered several different incremental approaches to ensure the scale validity. Besides showing temporal stability to ensure it can be applied from time to time, as one dynamic construct should, we also indicated that social desirability did not influence the measurement of the PDSS. Furthermore, the results indicate that the effects of the method do not generate undue confusion on the scale. Thus, the psychometric properties of the PDSS allow for recommending the use of the scale in extensive studies. This scale therefore contributes to contemporary professional development literature through the comparison of the perceptions of professional development in different professional categories and by providing organizational researchers with a tool to evaluate the effects and predictors of such construct.info:eu-repo/semantics/publishedVersio

Correction: IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation (The IMPART Study).

The Original Article [1] contained incorrect Supplementary Materials due to typesetting errors. The original manuscript and a checklist were incorrectly processed as Supplementary Materials. The correct Supplementary Materials are included with this Correction. The Original Article has been corrected. The publishers apologize for this error and any inconvenience caused

IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation (The IMPART Study).

BACKGROUND: In the UK, 7.6% of babies are born preterm, which the Department of Health aims to decrease to 6% by 2025. To advance this, NHS England released Saving Babies Lives Care Bundle Version 2 Element 5, recommending the Preterm Birth Pathway for women at risk of preterm birth. The success of this new pathway depends on its implementation. The IMPART (IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation) study aimed to research how, why, for whom, to what extent and in what contexts the prediction and prevention aspects of Preterm Birth Surveillance Pathway is implemented through a realist evaluation. Realist implementation studies are growing in popularity. METHODS: Initial programme theories were developed through a realist informed literature scope, interviews with developers of the NHS England guidance, and a national questionnaire of current practice. Implementation theory was utilised in developing the programme theories. Data (interviews and observations with staff and women) were undertaken in 3 case sites in England to 'test' the programme theories. Substantive theory was utilised during data analysis to interpret and refine the theories on how implementation could be improved. RESULTS: Three explanatory areas were developed: risk assessing and referral; the preterm birth surveillance clinic; and women centred care. Explanatory area 1 dealt with the problems in correct risk assessment and referral to a preterm clinic. Explanatory area 2 focused on how once a correct referral has been made to a preterm clinic, knowledgeable and supported clinicians can deliver a well-functioning clinic. Explanatory area 3 concentrated on how the pathway delivers appropriate care to women. CONCLUSIONS: The IMPART study provides several areas where implementation could be improved. These include educating clinicians on knowledge of risk factors and the purpose of the preterm clinic, having a multidisciplinary preterm team (including a preterm midwife) with specialist preterm knowledge and skills (including transvaginal cervical scanning skills), and sites actively working with their local network. This multidisciplinary preterm team are placed to deliver continuity of care for women at high-risk of preterm birth, being attentive to their history but also ensuring they are not defined by their risk status. TRIAL REGISTRATION: ISRCTN57127874