Exploring the uses of virtues in woman-centred care: A quest, synthesis and reflection

What is the woman's role in the clinical assessment of midwifery students? A scoping review

BACKGROUND

Midwifery student assessment tools have been validated to assess competence in practice-based maternity settings however, the inclusion of the woman in the clinical assessment of the midwifery student is not well understood.

AIM

To collate and report the evidence on the role of the woman in the clinical assessment of midwifery students.

METHODS

Using the five-step framework of Arksey and O'Malley (2005), with modifications from Levac et al. (2010), a scoping review was conducted across four databases: MEDLINE (via OVID); CINAHL (via OVID); EMCARE; and SCOPUS using controlled vocabulary and key words.

FINDINGS

Midwifery student clinical assessment in practice-based settings that included feedback from the student, midwife, and woman was not evident in any of the studies. The concepts of woman-centred care were well explored, particularly in terms of the continuity of care experience. Although the reciprocal benefits of the continuity of care experience for women and students were highlighted, there was no evidence of feedback from women on their involvement during midwifery student clinical assessment. When women did provide feedback, it was mostly in retrospect, using criteria-led evaluations (online survey, questionnaire), and not during midwifery student clinical assessment.

DISCUSSION

A clearer understanding of how woman-centred care is realised in midwifery student clinical assessment regardless of the model of care provision needs to be explored. Understanding how the woman is included, her role and how she can provide feedback on her experience will inform how woman-centred care is reflected in all practice settings.

CONCLUSION

The findings from this scoping review have identified gaps within the existing literature, foremost is the lack of evidence of inclusion of the woman in the clinical assessment of midwifery students. Re-orientating midwifery student clinical assessment that includes collaboration with and evidence of feedback from the woman would provide the woman a 'voice' to articulate and validate her experience - representing her journey towards woman-centred care.

Concept Analysis of Woman-Centered Care: Implications for Postpartum Care

ABSTRACT

Approximately two-thirds of pregnancy-related deaths in the United States occur during the postpartum period, yet there is minimal research focusing on the postpartum hospital stay, a critical point of contact between women and the health care system and an important opportunity for intervention. A new approach to postpartum care is needed. "Woman-centered" postpartum care is recommended to improve maternal outcomes, but the concept of woman-centered care is not well-defined. Using Walker & Avant's method of concept analysis, we identified four defining attributes of woman-centered care in the literature: 1) choice, control, and involvement in decision-making ; 2) communication and collaboration in the caregiver-woman relationship ; 3) individualized and holistic care ; and 4) continuity of care . Using these findings, we offer a conceptual definition of woman-centered care and apply the attributes to the postpartum hospitalization in the model and contrary cases. We discuss the potential of the concept to improve maternal health care during this critical period.

Professional identity: Students' learning from the attributes and behaviours of midwives on clinical placement

BACKGROUND

Midwifery practice experience is an important component of education to develop an understanding of professional identity in midwifery students. The responsibility of supporting student development in the clinical setting is predominantly undertaken by clinical midwives. There is minimal literature relating to the professional identity development of midwifery students.

AIM

To explore midwifery student experiences of the positive attributes of clinical midwives who supported the professional identity development of midwifery students in the clinical practice setting.

METHODS

An Appreciative Inquiry approach guided this study. The setting was a university in Sydney, Australia. Participants comprised thirteen students from a postgraduate midwifery course. Data were collected via individual interviews and analysed thematically. Students had two to six months of placement in the clinical setting.

FINDINGS

Data analysis identified three themes, Putting the woman at the centre of care; Supporting a woman-centred environment and Focusing on student success.

DISCUSSION

Findings from this study revealed that extended time spent with a midwife enabled the student to observe and reflect on the nuances of midwifery practice that are not overtly shared with students. Students were able to observe a midwife's tacit way of being. This paper reveals the positive attributes and behaviours of midwives whose practice the students want to emulate.

CONCLUSIONS

Midwifery students' exposure to positive clinical midwife role models on clinical placement enables them to develop a greater understanding of professional identity.

The future of midwife-led continuity of care: Call for a dialogue

Background/Purpose

Midwife-led continuity of care (MLCC) is an evidence-based care model positively influencing the health and wellbeing of women and their families. Despite the evidence, a sustainable future of the model is uncertain. The aim of this paper is to give an example of a theoretical exercise that enhances the understanding of the trends and developments impacting MLCC's future state.

Methods

The industrial complex theory scaffolded the theoretical approach. The intuitive logics scenario development methodology was used to structure the key variables that influence the utility of MLCC. Dimensionally structured scenarios representing the probable, possible and probable MLCC futures were written.

Results

Thirteen key variables that greatly impact the future MLCC, with varying degrees of certainty were identified. A theoretical framework representing two underlying meta dimensions of MLCC was constructed: identity system of midwife-led continuity of care (fixed vs fluid) and embodied orientation to the world (reasoning vs meaning making). Within the framework, four different storylines of possible, plausible prospective futures emerged: Sense & sensibility, The birth of mothers, Too many sisters and One-stop-shop.

Conclusion

The paper is an example of how to approach the future of MLCC, the method serving as a tool to establish a theoretical truth of how its future state may unfold, the scenarios facilitating a dialogue among stakeholders and informing the public.

"It's all about cultural understanding": A reflexive thematic analysis of women's experiences at a dedicated refugee midwifery group practice service

BACKGROUND

Inequitable maternity care provision in high-income countries contributes to ongoing poor outcomes for women of refugee backgrounds. To address barriers to quality maternity care and improve health equity, a co-designed maternity service incorporating community-based group antenatal care, onsite social worker and interpreters, continuity of midwifery carer through a caseload design with 24/7 phone access was implemented for women of refugee background.

OBJECTIVE

To explore and describe women's experiences and perceptions of care from a dedicated Refugee Midwifery Group Practice service.

DESIGN

Qualitative exploratory descriptive study using focus group discussions and interpreters.

SETTING

The study was conducted at a community-based Refugee Midwifery Group Practice service in a tertiary maternity hospital in Brisbane, Australia.

METHODS

We conducted three focus group discussions (June - December 2020) with 16 women, born in six different countries, in three language groups: Sudanese Arabic, Somali, and English. We used reflexive thematic analysis to interpret women's perspectives and generate informed meanings of experiences of care.

RESULTS

We generated four themes 1) accessibility of care, 2) women feeling accepted, 3) value of relationality, and 4), service expansion and promotion. Results demonstrate positive experiences and acceptability due to easy access, strong woman-midwife relationships, and culturally safe care.

CONCLUSION

The service addressed concerns raised in an early evaluation and provides evidence that redesigning maternity services to meet the needs of women with a refugee background speaking multiple languages from many countries is possible and promotes access, use, and satisfaction with care, contributing to improved health equity and perinatal outcomes.