Readiness for practice change: Evaluation of a tool for the Australian midwifery context

Midwives' readiness for midwife-led care: a mixed-methods study

BACKGROUND/PROBLEM

To integrate midwife-led care in Belgian maternity services, understanding whether midwives are primed of executing the change is needed.

AIM

To explore Belgian midwives' readiness for midwife-led care and understand the underlying processes.

METHODS

A mixed-methods sequential study: 1) A survey including 414 practising midwives and 2) individual interviews with 12 (student) midwives. General linear model analysis was used to examine the trend between knowledge, self-efficacy and performance mean scores - indicators of midwife-led care readiness - proposed in a 27-item questionnaire. The Readiness Assessment Framework served as a template for qualitative thematic analysis.

FINDINGS

Template analysis illustrated the underlying mechanisms of midwifery-led care readiness: Governmental and institutional steering and rule-making functions, regulation and reimbursement, awareness of midwife-led care among stakeholders, capacity to extend primary care postpartum services to antenatal and intrapartum care and healthcare professionals' lack of awareness of available data of women's experiences and midwife-led care efficacy in Belgium. These qualitative findings contribute to the understanding of the significant trend with decreasing function for knowledge, self-efficacy and performance mean scores of 25 midwife-led care readiness indicators, and the two non-significant indicators referring to a physiological postpartum period.

DISCUSSION/CONCLUSION

In determining midwife readiness for midwife-led care, we observed adequate knowledge mean scores, associated with low self-efficacy and even lower midwife-led care performance mean scores. Our findings suggest limited readiness for MLC in antenatal and intrapartum care. Belgian midwives are the domain experts of postpartum services but face challenges in extending midwife-led care to antenatal and intrapartum services.

Development of a tool to identify barriers and enablers to practice innovation in midwifery: A participatory action research study

INTRODUCTION

Transferring research evidence into midwifery practice is fraught with challenges and obstacles. Implementation tools can streamline the process and are most effective when they are discipline-specific; however, there are currently no midwifery specific implementation tools. The aim of this study was to develop a midwifery specific tool to identify barriers and enablers to evidence-informed practice change within the clinical setting.

METHODS

Participatory action research methodology was employed to ensure potential end-users contributed to content and format of the tool. Purposeful sampling ensured participants were selected from a range of midwifery practice settings in Western Australia and the United Kingdom. Data were collected through stakeholder advisory groups (SAGs) and online surveys.

RESULTS

Ten midwives participated in this project. Consultation occurred through face-to-face SAG meetings and online surveys until consensus was reached among participants about the content, format, and functionality of the end product which we called the 'Midwifery Tool for Change' (MT4C).

CONCLUSIONS

To our knowledge, the MT4C is the first readiness for change context assessment tool specific to midwifery practice settings. Evaluation of the MT4C in real-world practice change implementation initiatives will enable further refinement of the tool.

Factors that enhance midwifery students' learning and development of self-efficacy in clinical placement: A systematic qualitative review

AIM

To conduct a systematic review and synthesis of qualitative studies to explore the significant factors that enhance midwifery students' learning experiences and development of self-efficacy in clinical placement.

BACKGROUND

Midwifery education programs leading to registration as a midwife require students to achieve academic, clinical, and professional competence. Clinical placement comprises a significant part of the program as students work and are assessed under the direct supervision of the Registered Midwife or preceptor. This learning and teaching partnership aims to enable the transfer of knowledge, skills, and behavior, i.e., competence, while providing the opportunity for students to become socialized into the midwifery practice culture. Against this background, characterized by the shortage of midwives, declining fertility rates, and a stressful environment, students learn to become a midwife and develop self-efficacy. Self-efficacy is the belief in one's ability to master challenges, which is described as a component in learning theories. There seems to be a need to identify factors that contribute to this development.

DESIGN

A qualitative systematic literature review.

METHOD

A systematic database search was conducted to identify primary peer reviewed qualitative literature published between 2000 and 2021 that has explored what enhances midwifery students' learning during their clinical placement. The databases searched included CINAHL (EBSCO), Medline (Ovid), Embase (Ovid), PsycINFO (Ovid), JBI Joanna Briggs Institute (Ovid), SveMed+ , and Web of Science. The search yielded a total of 354 results, of which 22 met the inclusion criteria. The relevant findings from the 22 studies were thematically analyzed and presented in the results.

RESULTS

The analysis revealed two descriptive themes - 'A nurturing relationship' and 'Predictability in the learning process, contextual factors. In addition, one analytic theme emerged - 'Gaining access to and belonging in an enabling educational and working culture'.

CONCLUSION

The relationship with the preceptor is a prerequisite for midwife students learning process and achievement of self-efficacy. A learning culture appears to be the fertile ground in which midwife students thrive and where they develop the self-efficacy needed to meet the demands of clinical placement.

Knowledge, attitudes and use of evidence-based practice among midwives in Belgium: A cross-sectional survey

INTRODUCTION

Evidence-based practice (EBP) leads to improved health outcomes and reduces variability in the quality of care. However, literature on the knowledge, attitudes and use of EBP among midwives is scarce internationally and in Belgium.

METHODS

A cross-sectional study using an online semi-structured questionnaire explored practice, attitudes and barriers on EBP and clinical practice guidelines. Midwives (n=251) working in university and non-university hospitals, primary care, and midwifery education, in Flanders (Belgium) were included.

RESULTS

Midwives with a Master’s degree (57.7% vs 37.8%; p=0.004), ≤15 years since graduation (50.8% vs 35.5%; p=0.015) and aged <40 years (49.7% vs 34.6%; p=0.02), had better knowledge of the EBP-definition. The majority searched for literature (80.1%), mainly evidence-based (EB) clinical practice guidelines (50.6%), randomized controlled trials (45.0%) and systematic reviews (43.0%). Midwives found EBP necessary and realistic to apply in daily practice and support decision-making. They were willing to improve EBP-knowledge and skills but assumed to be competent in providing evidence-based care. Most respondents were convinced of the importance of EB clinical practice guidelines but did not believe guidelines facilitated their practices or enabled them to consider patient preferences adequately. Half of the midwives (55.8%) experienced barriers to EB clinical practice guideline use, mainly lack of time (35.9%), access (19.5%), and support (17.9%).

CONCLUSIONS

Although midwives showed a positive attitude towards EBP, education programs to promote EBP and improve EBP-related knowledge and skills are needed. Future efforts should focus on developing strategies for overcoming barriers and enhancing the consistency of EBP implementation.

Exploring the usability of the COM-B model and Theoretical Domains Framework (TDF) to define the helpers of and hindrances to evidence-based practice in midwifery

Background

Despite the advancement of scientific research in the field of maternity care, midwives face challenges translating latest evidence into evidence-based practice (EBP) and express reticence towards leading practice change in clinical areas. This study aimed to explore midwifery leaders’ views on what factors help or hinder midwives’ efforts to translate latest evidence into everyday practice and consider them in relation to both the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF).

Methods

This qualitative study formed part of a larger action research (AR) project that was designed to improve midwives’ EBP implementation capability. Data were obtained from eight Western Australian midwifery leaders who were employed in either managerial or executive positions within their organisation. Five midwives attended a focus group workshop and three opted for face-to-face interviews. Thematic analysis was used to code the transcribed data and group alike findings into sub-categories, which were collapsed to four major categories and one overarching core finding. These were mapped to a matrix combining the COM-B and TDF to establish the usability of these tools in midwifery contexts.

Results

Four major categories were developed from the data collected in this study. Three reported the hindrances midwives’ experienced when trying to initiate new EBPs: ‘For midwives, medical opposition and workplace culture are the biggest challenges’, ‘Fear can stop change: it’s personal for midwives’ and ‘Midwives are tired of fighting the battle for EBP; they need knowledge and the confidence to bring about practice change.’ The other major category highlighted factors midwives’ considered helpers of EBP: ‘Having stakeholder buy-in and strong midwifery leadership is a huge advantage.’ When mapped to the TDF and COM-B, these findings provided valuable insight into the helpers of and hindrances to evidence-based practice in midwifery.

Conclusion

Midwives are motivated to initiate evidence-based change yet have limited knowledge of implementation processes or the confidence to lead practice change. Factors such as inter-disciplinary buy-in, clear instruction for midwives and support from midwifery leaders were considered beneficial to implementing practice change in clinical areas. The TDF when used in combination with the COM-B was deemed useful to midwives wanting to lead practice change projects in clinical areas.

Midwifery leaders' views on the factors considered crucial to implementing evidence-based practice in clinical areas

PROBLEM

The evidence-to-practice gap continues to persist in healthcare and midwives report limited knowledge and use of effective intervention strategies to support the implementation of new evidence-based practices in clinical settings.

BACKGROUND

Despite ongoing development and dissemination of high quality research findings, the translation of latest research evidence by midwives into new evidence-based practices remains sub-optimal. This inefficiency places consumers at risk of obsolete or potentially dangerous healthcare interventions.

AIM

To explore midwifery leaders' views on what information and support midwives require to lead practice change initiatives in clinical areas.

METHODS

The study formed part of a broader Participatory Action Research (PAR) project designed to improve the processes by which midwives implement evidence-based practice change in clinical settings. The study employed a qualitative design and was guided by the methodological underpinnings of Action Research (AR).

FINDINGS

One core finding emerged to fulfil the aim and objectives of the study. To lead implementation of evidence-based practices, midwives need practical solutions and a map of the process, packaged into a centralised web-based resource.

DISCUSSION

The findings reported in this study provide valuable insight into the specific needs of midwives wanting to improve the uptake and longevity of new evidence based practices in clinical areas. This includes information specific to evidence implementation, support networks and knowledge of Implementation Science.

CONCLUSION

To lead practice change initiatives, midwives require a web-based resource that standardises the process of evidence implementation, while providing midwives with clear direction and the support needed to confidently champion for evidence base change in clinical areas.

Midwives' use of best available evidence in practice: An integrative review

AIMS AND OBJECTIVES

To synthesise international research that relates to midwives' use of best available evidence in practice settings and identify key issues relating to the translation of latest evidence into everyday maternity care.

BACKGROUND

Midwifery is a research-informed profession. However, a gap persists in the translation of best available evidence into practice settings, compromising gold standard maternity care and delaying the translation of new knowledge into everyday practice.

DESIGN

A five-step integrative review approach, based on a series of articles published by the Joanna Briggs Institute (JBI) for conducting systematic reviews, was used to facilitate development of a search strategy, selection criteria and quality appraisal process, and the extraction and synthesis of data to inform an integrative review.

METHODS

The databases CINAHL, MEDLINE, Web of Science, Implementation Science Journal and Scopus were searched for relevant articles. The screening and quality appraisal process complied with the PRISMA 2009 checklist. Narrative analysis was used to develop sub-categories and dimensions from the data, which were then synthesised to form two major categories that together answer the review question.

RESULTS

The six articles reviewed report on midwives' use of best available evidence in Australia, the UK and Asia. Two major categories emerged that confirm that although midwifery values evidence-based practice (EBP), evidence-informed maternity care is not always employed in clinical settings. Additionally, closure of the evidence-to-practice gap in maternity care requires a multidimensional approach.

CONCLUSION

Collaborative partnerships between midwives and researchers are necessary to initiate strategies that support midwives' efforts to facilitate the timely movement of best available evidence into practice.

RELEVANCE TO CLINICAL PRACTICE

Understanding midwives' use of best available evidence in practice will direct future efforts towards the development of mechanisms that facilitate the timely uptake of latest evidence by all maternity care providers working in clinical settings.