1
|
Guyatt S, Ferguson M, Beckmann M, Wilkinson SA. Using the Consolidated Framework for Implementation Research to design and implement a perinatal education program in a large maternity hospital. BMC Health Serv Res 2021; 21:1077. [PMID: 34635125 PMCID: PMC8507156 DOI: 10.1186/s12913-021-07024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation science aims to embed evidence-based practice as 'usual care' using theoretical underpinnings to guide these processes. Conceptualising the complementary purpose and application of theoretical approaches through all stages of an implementation project is not well understood and is not routinely reported in implementation research, despite call for this. This paper presents the synthesis and a collective approach to application of a co-design model, a model for understanding need, theories of behaviour change with frameworks and tools to guide implementation and evaluation brought together with the Consolidated Framework for Implementation Research (CFIR). METHOD Using a determinant framework such as the CFIR provides a lens for understanding, influencing, and explaining the complex and multidimensional variables at play within a health service that contribute to planning for and delivering effective patient care. Complementary theories, models, frameworks, and tools support the research process by providing a theoretical and practical structure to understanding the local context and guiding successful local implementation. RESULTS This paper provides a rationale for conceptualising the multidimensional approach for implementation using the worked example of a pregnancy, birth, postnatal and early parenting education intervention for expectant and new parents at a large maternity hospital. CONCLUSION This multidimensional theoretical approach provides useful, practical guidance to health service researchers and clinicians to develop project specific rationale for their theoretical approach to implementation projects.
Collapse
Affiliation(s)
- Sheridan Guyatt
- Physiotherapy Department, Mater Misericordiae Ltd, Level 2 Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4006, Australia.
- Mater Research, The University of Queensland, Brisbane, Queensland, 4101, Australia.
| | - Megan Ferguson
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, 0810, Australia
| | - Michael Beckmann
- Physiotherapy Department, Mater Misericordiae Ltd, Level 2 Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Mater Research, The University of Queensland, Brisbane, Queensland, 4101, Australia
| | - Shelley A Wilkinson
- Mater Research, The University of Queensland, Brisbane, Queensland, 4101, Australia
- School of Human Movements and Nutrition Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, 4072, Australia
| |
Collapse
|
2
|
Eri TS, Berg M, Dahl B, Gottfreðsdóttir H, Sommerseth E, Prinds C. Models for midwifery care: A mapping review. Eur J Midwifery 2020; 4:30. [PMID: 33537631 PMCID: PMC7839165 DOI: 10.18332/ejm/124110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION According to WHO, midwives are found competent to provide evidencebased and normalcy-facilitating maternity care. Models for midwifery care exist, but seem to be lacking explicit epistemological status, mainly focusing on the practical and organizational level of care delivery. To make the values and attitudes of care visible, it is important to implement care models with explicit epistemological status. The aim of this paper is to identify and gain an overview of publications of theoretical models for midwifery care. METHODS A mapping review was conducted with systematic searches in nine databases for studies describing a theoretical model or theory for midwifery care that either did or was intended to impact clinical practice. Eligibility criteria were refined during the selection process. RESULTS Six models from six papers originating from different parts of the world were included in the study. The included models were developed using different methodologies and had different philosophical underpinnings and complexity gradients. Some characteristics were common, the most distinctive being the emphasis of the midwife-woman relationship, secondly the focus on woman-centeredness, and thirdly the salutogenic focus in care. CONCLUSIONS Overall, scarcity exists regarding theoretical models for midwifery care with explicit epistemological status. Further research is needed in order to develop generic theoretical models with an epistemological status to serve as a knowledge base for midwifery healthcare.
Collapse
Affiliation(s)
- Tine S. Eri
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marie Berg
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- The Obstretic Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Helga Gottfreðsdóttir
- Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland
- Women´s Clinic, Landspitali University Hospital, Reykjavík, Iceland
| | - Eva Sommerseth
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Christina Prinds
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Research, University College South Denmark, Haderslev, Denmark
| |
Collapse
|
3
|
The paradoxes of communication and collaboration in maternity care: A video-reflexivity study with professionals and parents. Women Birth 2020; 34:145-153. [PMID: 32063528 DOI: 10.1016/j.wombi.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Research on maternity care often focuses on factors that prevent good communication and collaboration and rarely includes important stakeholders - parents - as co-researchers. To understand how professionals and parents in Dutch maternity care accomplish constructive communication and collaboration, we examined their interactions in the clinic, looking for "good practice". METHODS We used the video-reflexive ethnographic method in 9 midwifery practices and 2 obstetric units. FINDINGS We conducted 16 meetings where participants reflected on video recordings of their clinical interactions. We found that informal strategies facilitate communication and collaboration: "talk work" - small talk and humour - and "work beyond words" - familiarity, use of sight, touch, sound, and non-verbal gestures. When using these strategies, participants noted that it is important to be sensitive to context, to the values and feelings of others, and to the timing of care. Our analysis of their ways of being sensitive shows that good communication and collaboration involves "paradoxical care", e.g., concurrent acts of "regulated spontaneity" and "informal formalities". DISCUSSION Acknowledging and reinforcing paradoxical care skills will help caregivers develop the competencies needed to address the changing demands of health care. The video-reflexive ethnographic method offers an innovative approach to studying everyday work, focusing on informal and implicit aspects of practice and providing a bottom up approach, integrating researchers, professionals and parents. CONCLUSION Good communication and collaboration in maternity care involves "paradoxical care" requiring social sensitivity and self-reflection, skills that should be included as part of professional training.
Collapse
|
4
|
Hildingsson I, Lindgren H, Karlström A, Christensson K, Bäck L, Mudokwenyu–Rawdon C, Maimbolwa MC, Laisser RM, Omoni G, Chimwaza A, Mwebaza E, Kiruja J, Sharma B. African midwifery students' self-assessed confidence in antenatal care: a multi-country study. Glob Health Action 2019; 12:1689721. [PMID: 31747850 PMCID: PMC6882463 DOI: 10.1080/16549716.2019.1689721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background: Evidence-based antenatal care is one cornerstone in Safe Motherhood and educated and confident midwives remain to be optimal caregivers in Africa. Confidence in antenatal midwifery skills is important and could differ depending on the provision of education among the training institutions across Africa.Objective: The aim of the study was to describe and compare midwifery students' confidence in basic antenatal skills, in relation to age, sex, program type and level of program.Methods: A survey in seven sub-Saharan African countries was conducted. Enrolled midwifery students from selected midwifery institutions in each country presented selfreported data on confidence to provide antenatal care. Data were collected using a selfadministered questionnaire. The questionnaire consisted of 22 antenatal skills based on the competency framework from the International Confederation of Midwives. The skills were grouped into three domains; Identify fetal and maternal risk factors and educate parents; Manage and document emergent complications and Physical assessment and nutrition.Results: In total, 1407 midwifery students from seven Sub-Saharan countries responded. Almost one third (25-32%) of the students reported high levels of confidence in all three domains. Direct entry programs were associated with higher levels of confidence in all three domains, compared to post-nursing and double degree programs. Students enrolled at education with diploma level presented with high levels of confidence in two out of three domains.Conclusions: A significant proportion of student midwives rated themselves low on confidence to provide ANC. Midwifery students enrolled in direct entry programs reported higher levels of confidence in all domains. It is important that local governments develop education standards, based on recommendations from the International Confederation of midwives. Further research is needed for the evaluation of actual competence.
Collapse
Affiliation(s)
- Ingegerd Hildingsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Helena Lindgren
- Department of Women’s and Children’s health, Karolinska Institutet, Stockholm, Sweden
| | | | - Kyllike Christensson
- Department of Women’s and Children’s health, Karolinska Institutet, Stockholm, Sweden
| | - Lena Bäck
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | | | - Rose Mjawa Laisser
- Archbishop Antony Malaya School of Nursing, Catholic University of Health and Allied Science, Mwanza, Tanzania
| | - Grace Omoni
- School of Nursing Science, University of Nairobi, Nairobi, Kenya
| | - Angela Chimwaza
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | | | - Jonah Kiruja
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Hargeisa, Somaliland
- Department of Nursing, Dalarna University, Falun, Sweden
| | | |
Collapse
|
5
|
Gottfreðsdóttir H, Nieuwenhuijze MJ. Midwifery education: Challenges for the future in a dynamic environment. Midwifery 2018; 59:78-80. [PMID: 29396384 DOI: 10.1016/j.midw.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
Iceland and the Netherlands both have a long history of midwifery education and midwifery practice. Starting as a midwife requires a direct entry BSc program in midwifery in The Netherlands, where Iceland requires a nurse-midwife model. This paper presents an overview of midwifery education and its dynamic in these countries. Subsequently, we explore two most notable components that were identified as important for the future of midwifery education. In the concluding section, we reflect how these components support the scope of practice as presented in the Lancet framework for quality maternal and newborn care.
Collapse
Affiliation(s)
- Helga Gottfreðsdóttir
- Faculty of Nursing, Department of Midwifery, University of Iceland, Reykjavík, Iceland; Women´s Clinic, Landspitali University Hospital, 101 Reykjavik, Iceland
| | | |
Collapse
|
6
|
Brainard J, Hunter PR. Do complexity-informed health interventions work? A scoping review. Implement Sci 2016; 11:127. [PMID: 27647152 PMCID: PMC5029105 DOI: 10.1186/s13012-016-0492-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/06/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The lens of complexity theory is widely advocated to improve health care delivery. However, empirical evidence that this lens has been useful in designing health care remains elusive. This review assesses whether it is possible to reliably capture evidence for efficacy in results or process within interventions that were informed by complexity science and closely related conceptual frameworks. METHODS Systematic searches of scientific and grey literature were undertaken in late 2015/early 2016. Titles and abstracts were screened for interventions (A) delivered by the health services, (B) that explicitly stated that complexity science provided theoretical underpinning, and (C) also reported specific outcomes. Outcomes had to relate to changes in actual practice, service delivery or patient clinical indicators. Data extraction and detailed analysis was undertaken for studies in three developed countries: Canada, UK and USA. Data were extracted for intervention format, barriers encountered and quality aspects (thoroughness or possible biases) of evaluation and reporting. RESULTS From 5067 initial finds in scientific literature and 171 items in grey literature, 22 interventions described in 29 articles were selected. Most interventions relied on facilitating collaboration to find solutions to specific or general problems. Many outcomes were very positive. However, some outcomes were measured only subjectively, one intervention was designed with complexity theory in mind but did not reiterate this in subsequent evaluation and other interventions were credited as compatible with complexity science but reported no relevant theoretical underpinning. Articles often omitted discussion on implementation barriers or unintended consequences, which suggests that complexity theory was not widely used in evaluation. CONCLUSIONS It is hard to establish cause and effect when attempting to leverage complex adaptive systems and perhaps even harder to reliably find evidence that confirms whether complexity-informed interventions are usually effective. While it is possible to show that interventions that are compatible with complexity science seem efficacious, it remains difficult to show that explicit planning with complexity in mind was particularly valuable. Recommendations are made to improve future evaluation reports, to establish a better evidence base about whether this conceptual framework is useful in intervention design and implementation.
Collapse
Affiliation(s)
- Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Paul R. Hunter
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| |
Collapse
|