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Buchanan K, Ross C, Bloxsome D, Hocking J, Bayes S. Development of a Midwifery Student Peer Debriefing Tool: An interpretive descriptive study. Nurse Education Today 2024; 137:106167. [PMID: 38513304 DOI: 10.1016/j.nedt.2024.106167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Psychosocial traumatisation associated with giving birth, can occur in those present with the woman giving birth, a phenomenon known as vicarious trauma. It has been identified that there are currently no interventions available for midwifery students who have experienced vicarious trauma following difficult birth experiences. OBJECTIVE To explore whether the counselling intervention developed by Gamble et al. (2005), can be adapted for midwifery students to be appropriately and feasibly used as a counselling intervention with peers who have experienced midwifery practice-related vicarious trauma. DESIGN Interpretive descriptive methodology. SETTING This study was set at two Australian universities from which pre-registration midwifery courses are delivered. PARTICIPANTS The work of reviewing the original tool and adapting it for use by and with midwifery students associated with this project was conducted by a key stakeholder group of seven representative midwifery students and five midwifery academics. METHODS Ethics were approved. Data were collected via one face to face and two online conversations using the Microsoft Teams™ platform. Reflexive Thematic analysis were applied to revise the tool following each round of data collection and to finalise the adaptation of the intervention for its new intended purpose. RESULTS The Midwifery Student Peer Debriefing Tool is presented as a six-step intervention that guides the midwifery student through a process of debriefing with their peer. The feasibility of the tool resulted in an overarching theme labelled "I want this to mean something" and captures the therapeutic power of peer debriefing toward a meaningful outcome that fostered growth, and a deeper understanding of the profession. CONCLUSION Vicarious trauma is widely recognised as a core reason for midwives and midwifery students leaving the workforce. The peer debriefing tool helps midwifery students move through the process of recovering from adversity but also fostered learnings about midwifery practice and the profession.
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Affiliation(s)
- Kate Buchanan
- Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia; Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia.
| | - Carolyn Ross
- Australian Catholic University, 8 - 14 Brunswick St, Fitzroy VIC 3065, Australia.
| | - Dianne Bloxsome
- Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia.
| | - Jen Hocking
- Australian Catholic University, 8 - 14 Brunswick St, Fitzroy VIC 3065, Australia.
| | - Sara Bayes
- Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia; Australian Catholic University, 8 - 14 Brunswick St, Fitzroy VIC 3065, Australia; Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia.
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Becker J, Becker C, Abeysekera R, Moir J, Gray M, Shimwela M, Oprescu F. Silent Tears of Midwives: 'I Want Every Mother Who Gives Birth to Have Her Baby Alive'-A Narrative Inquiry of Midwives Experiences of Very Early Neonatal Death from Tanzania. Children (Basel) 2023; 10:children10040705. [PMID: 37189954 DOI: 10.3390/children10040705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Midwives working in settings with limited clinical resources experience high rates of very early neonatal deaths. Midwives manage the impact of this grief and trauma almost daily, which may affect patient care and their own well-being. RESEARCH AIMS To explore how midwives are impacted by and cope with high rates of very early neonatal deaths. To document midwives' insights and local solutions that may reduce very early neonatal deaths in limited resource settings. To document the stories of midwives in order to create awareness and garner support for midwives and their critical work in low resource settings. METHODS Narrative inquiry utilizing semi structured interviews. Twenty-one midwives with at least six months experience who had experienced or witnessed very early neonatal death were interviewed. Data were audio recorded and transcribed, and reflexive thematic analysis of transcripts was conducted. RESULTS AND DISCUSSION Three themes were identified: (1) deep sadness resulting from very early neonatal deaths leading to internal struggles; (2) use of spirituality, including prayer and occasional beliefs that unexplainable deaths were 'God's plan'; and (3) development of resilience by seeking solutions, educating themselves, taking accountability and guiding mothers. Participating midwives noted that inadequate staff and high caseloads with limited basic supplies hindered their clinical practice. Participants articulated that they concentrated on active solutions to save babies during labour, such as vigilant foetal rate heart monitoring and partogram. Further, reduction and prevention of very early neonatal death is a complex problem requiring multidisciplinary teams and woman-centred care approaches to address issues contributing to the health of mothers and their new-borns. CONCLUSIONS Midwives' narratives highlighted ways of coping with grief and deep sadness, through prayer, and further education of both mothers and fellow colleagues to achieve better antenatal and intrapartum care and outcomes. This study gave midwives an opportunity for their voices to be heard and to generate solutions or insights that can be shared with colleagues in similar low-resource settings.
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Affiliation(s)
- Jan Becker
- Midwife Vision Global, Uhuru Street, Dar es Salaam 12101, Tanzania
| | - Chase Becker
- Midwife Vision Global, Uhuru Street, Dar es Salaam 12101, Tanzania
| | - Rachel Abeysekera
- Medical School, University of Nicosia in Partnership with St George's University of London, Makedonitissis 46, Nicosia 2417, Cyprus
| | - James Moir
- Midwife Vision Global, Uhuru Street, Dar es Salaam 12101, Tanzania
| | - Marion Gray
- Centre for Health Research, School of Health and Wellbeing, Faculty of Health, Engineering and Sciences, University of the Southern Queensland, Toowoomba, QLD 4300, Australia
| | - Meshack Shimwela
- Temeke Regional Referral Hospital, Dar es Salaam 15101, Tanzania
| | - Florin Oprescu
- Public Health, University of Sunshine Coast, Sippy Downs, QLD 4556, Australia
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Jaradeh K, Sergi F, Kivlahan C, Nava Gonzales C, Cury M, DeFries T. Implementing a Trauma-Informed Approach at a Student-Run Clinic for Individuals Seeking Asylum. Acad Med 2023; 98:332-336. [PMID: 36538690 DOI: 10.1097/acm.0000000000005064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PROBLEM Health care professionals complete forensic medical evaluations (FMEs) to corroborate evidence of persecution among individuals seeking asylum. Many FMEs are conducted at student-run clinics for individuals seeking asylum (or student-run asylum clinics; SRACs). Trauma-informed care (TIC) recognizes that trauma is pervasive and seeks to mitigate reexposure to trauma in health care interactions. Given that FMEs involve recalling trauma, TIC is an ideal model for supporting the individuals involved in an FME. APPROACH The authors operationalized TIC principles in an SRAC model (the Human Rights Cooperative) at the University of California, San Francisco. Between April 2019 and April 2022, the SRAC provided 3 to 10 pro bono FMEs per month, as well as community referrals for individuals seeking asylum, clinician and medical student training on FMEs and TIC, and research on FMEs. This report describes the SRAC operations, organized by the 10 implementation domains of the Substance Abuse and Mental Health Services Administration guidance to organizations for implementing a trauma-informed approach. OUTCOMES Between April 2019 and April 2022, the SRAC completed 160 FMEs. Sixty-nine clinicians performed FMEs, and 119 first-year medical students participated in the accompanying elective. Qualitative survey responses by clinicians, lawyers, students, and clients (individuals seeking asylum) highlighted the trauma-informed principles of safety; trustworthiness and transparency; empowerment, voice, and choice; peer support; collaboration and mutuality; and cultural, historical, and gender issues. All students who acted as leaders sustained their engagement with the SRAC over time. NEXT STEPS Future research should use validated tools to assess secondary trauma and resilience within SRACs. The SRAC concept, which engages medical students and experienced clinicians in learning skills that can be used in the pursuit of health justice and equity, should be expanded and supported in U.S. medical schools across the country, which is facing unprecedented levels of migration.
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Affiliation(s)
- Katrin Jaradeh
- K. Jaradeh is a medical student, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Francesco Sergi
- F. Sergi is a medical student, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Coleen Kivlahan
- C. Kivlahan is professor, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Cesar Nava Gonzales
- C. Nava Gonzales is a medical student, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Mar Cury
- M. Cury is lead client liaison, UCSF Health and Human Rights Initiative, San Francisco, California
| | - Triveni DeFries
- T. DeFries is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0002-3050-4811
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Sheehy A, Baird K. A qualitative study of early career Australian midwives' encounters with perinatal grief, loss and trauma. Women Birth 2022:S1871-5192(22)00012-9. [PMID: 35115245 DOI: 10.1016/j.wombi.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/21/2022]
Abstract
PROBLEM The health of women is dependent on midwifery workforce stability. Retaining new midwives is paramount, however without support, the early career can be a vulnerable time for midwives. BACKGROUND Midwives care for women who experience poor perinatal outcomes like stillbirth and neonatal death. Midwifery care in these sentinel events is complex. There is limited understanding of early career midwives' experiences within these encounters. AIM To understand the experiences of Australian early career midwives' clinical encounters with perinatal grief, loss and trauma. METHODS A qualitative descriptive/exploratory study using in-depth interviews. FINDINGS Four themes were identified from interview data: (1) all eyes on the skills; (2) support is of the essence; (3) enduring an emotional toll; (4) at all times, the woman. Most participants had minimal exposure to perinatal loss as a student. As a result, most felt unskilled and unprepared for this as a new midwife. DISCUSSION Types and degrees of support varied in these encounters. Early career midwives who were well supported reflected positively on working with grief and loss. In contrast, inadequate or absent support had detrimental effects on participant wellbeing. Poorly supported encounters with death (intrapartum fetal, early neonatal, and maternal) in the early career period were significantly distressful, giving rise to mental and emotional distress. CONCLUSION Pre-registration perinatal loss skill development and supported experiences are necessary for preparedness. Continued education, formalised debriefing and mentoring, institutional philosophies which promote collegial ethics of care, and the expansion of continuity of midwifery care models will improve new midwives' experiences.
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Bayri Bingol F, Demirgoz Bal M, Aygun M, Bilgic E. Secondary traumatic stress among midwifery students. Perspect Psychiatr Care 2021; 57:1195-1201. [PMID: 33135155 DOI: 10.1111/ppc.12674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study aimed to examine the factors affecting secondary traumatic stress on midwifery students. DESIGN AND METHODS This descriptive study was conducted between November and December 2018. Data were collected using information form and the Secondary Traumatic Stress Scale. FINDINGS The study found that 22.2% of midwifery students met all the trauma criteria for posttraumatic stress disorder according to the Secondary Traumatic Stress Scale. Midwifery students who were unhappy to continue their education and those who wished to switch to another profession after graduation respectively showed a 2.8- and a 4-fold higher risk of meeting the trauma criteria (p < 0.05). CONCLUSION The secondary traumatic stress rate in midwifery students is particularly high considering the fact that one in five students fulfills all of the Secondary Traumatic Stress criteria. However, to reduce their secondary traumatic stress rate, students should be thoroughly assessed by the educators who could provide the support necessary. IMPLICATIONS FOR NURSING PRACTICE Before graduation from the midwifery departments, students traumatic stress symptoms could be assessed mental health nursing courses, which might enable to change their attitudes towards to cope with this situation. Especially after traumatic childbirths, midwifery students should be supported by mental health nurses to cope with traumatic stress. Midwifery students should be encouraged each and every possible moment to express their feelings when they experience traumatic stress and thus their skills for effective coping can be reinforced.
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Affiliation(s)
- Fadime Bayri Bingol
- Midwifery Department, Health Sciences Faculty, Marmara University, Basıbuyuk Campus, Maltepe, Istanbul, Turkey
| | - Meltem Demirgoz Bal
- Midwifery Department, Health Sciences Faculty, Marmara University, Basıbuyuk Campus, Maltepe, Istanbul, Turkey
| | - Merve Aygun
- Midwifery Department, Health Sciences Faculty, Marmara University, Basıbuyuk Campus, Maltepe, Istanbul, Turkey
| | - Edanur Bilgic
- Midwifery Department, Health Sciences Faculty, Marmara University, Basıbuyuk Campus, Maltepe, Istanbul, Turkey
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Briley AL, Silverio SA, Singh C, Sandall J, Bewley S. "It's like a bus, going downhill, without a driver": A qualitative study of how postpartum haemorrhage is experienced by women, their birth partners, and healthcare professionals. Women Birth 2020; 34:e599-e607. [PMID: 33358131 DOI: 10.1016/j.wombi.2020.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
PROBLEM Postpartum haemorrhage [PPH] remains a major cause of maternal morbidity and mortality. Whilst low-resource settings bear the greatest burden of deaths, women live with associated morbidities in all healthcare settings. Limited data exists regarding the experience for women, their partners, or healthcare professionals [HCPs], affected by PPH. AIM To qualitatively investigate the experience of PPH, for women (n=9), birth partners (n=4), and HCPs (n=9) in an inner-city tertiary referral centre. To provide multi-faceted insight into PPH and improve understanding and future care practices. METHODS Participants were interviewed about their experiences within two weeks of a PPH. Data were analysed using thematic analysis. FINDINGS Four distinct, but related, themes were identified: 'Knowledge specific to PPH'; 'Effective and appropriate responses to PPH'; 'Communication of risk factors'; and 'Quantifying blood loss'; which collected around a central organising concept of 'Explaining the indescribable'. DISCUSSION PPH was viewed as a 'crisis-style emergency', generating respectful fear in HCPs, whilst women and partners had little-to-no prior knowledge. Specific PPH knowledge dictated HCPs' response and risk communication. PPH risks were typically linked to quantification of blood loss, assessment of which varied with acknowledged questionable accuracy. Women's and partners' confidence in HCPs' ability to deal with PPH was unquestionable. Non-verbal communication was highlighted, with HCP body language betraying professional confidence. CONCLUSION Information about blood loss during childbirth must be imparted in a sensitive, timely manner. Whilst training for HCPs results in effective PPH management, consideration should be given to their non-verbal cues and the impact of dealing with this stressful, 'everyday emergency'.
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Affiliation(s)
- Annette L Briley
- Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, Adelaide, Australia; Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, United Kingdom. https://twitter.com/Silverio_SA_?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor
| | - Claire Singh
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, University of Technology, Sydney, Australia. https://twitter.com/SandallJane?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor
| | - Susan Bewley
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom. https://twitter.com/susan_bewley?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor
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BİNGÖL F, DEMİRGÖZ BAL M, AYGÜN M, BİLGİÇ E. Effect of midwifery students’ negative clinical experiences on their emotional labor behaviors. Clinical and Experimental Health Sciences 2020. [DOI: 10.33808/clinexphealthsci.679565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wright EM. The Ethical Imperative of Self-Care: A Call to Action. J Midwifery Womens Health 2020; 65:733-736. [PMID: 32869946 DOI: 10.1111/jmwh.13150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Erin M Wright
- Johns Hopkins School of Nursing, Baltimore, Maryland
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Sheen K, Slade P. Grounded theory approach describes individual and external factors implicated in processing a work-related traumatic event in midwives and obstetricians. Evid Based Nurs 2019; 22:58-59. [PMID: 30914399 DOI: 10.1136/ebnurs-2018-103015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Kayleigh Sheen
- Natural Sciences and Psychology, Liverpool John Moores University Faculty of Science, Liverpool, UK
| | - Pauline Slade
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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