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Item Nurse and midwife navigator resilience, well-being, burnout, and turnover intent: A multi-methods study.(Wiley Periodicals LLC, 2023-10-03) Brown JA; Harvey CL; Byrne A-L; Hegney DGPURPOSE: To explore levels of Navigator resilience, well-being, burnout, and turnover intent. DESIGN: A longitudinal, multi-methods study concurrently collected quantitative and qualitative data over three years. METHODS: A survey and Action Learning Groups. FINDINGS: No statistically significant change in resilience, well-being, burnout, or turnover intent. Supports, self-care and leaving the position, were used to maintain well-being. CONCLUSIONS: While quantitative measures did not change, qualitative data demonstrated how adaptive coping mechanisms maintain well-being. Recommendations for nurses working in Navigator, or similar community/public health roles include work-based programs targeting support, good leadership, governance systems including their impact on turnover intent. CLINICAL EVIDENCE: Job turnover intent can be used as a mechanism to monitor resilience and well-being.Item Developing a community-based nursing and midwifery career pathway - A narrative systematic review(PLOS, 2019-03-28) Harvey C; Hegney D; Sobolewska A; Chamberlain D; Wood E; Wirihana L; Mclellan S; Hendricks J; Wake T; Brownie SMINTRODUCTION: Community nursing and midwifery is changing in response to a shift in care from hospital to home, brought about by increasing costs to care because of an aging population and increasing chronicity. Until now, community nursing positions and scope of practice has been dependent on service focus and location, which has led to the role being unclearly defined. Lack of appeal for a career in community practice and a looming workforce shortage necessitates a review into how community nursing and midwifery transition to practice is supported. METHODS: This review sought to identify, assess and summarize available evidence relating to transitioning into community nursing and midwifery practice as a speciality. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A narrative synthesis was then undertaken on papers that examined community nursing and midwifery pathway perspectives which define, and enable or inhibit a contemporary pathway. Thematic analysis used a theoretical framework developed for early career and rapid transition to nursing specialty practice. RESULTS: There is a paucity of research that identifies community nursing and midwifery as a discreet scope of practice. Twelve papers were eventually included in the review. Verbatim findings were extracted from the papers and clustered into categories based on the chosen theoretical framework. Major themes were 'the self' (professional and personal); 'transition processes'; and, a 'sense of belonging'. Sub themes included narrative identifying inhibitors and enablers in each theme. DISCUSSION: No definition of community practice or pathway was identified in nursing, although midwifery was clearly defined. Community nursing practice was described as generalist in nature although specialist knowledge is required. Being part of the community in the professional sense and personal sense was considered important. The importance of transition was identified where pre-entry exposure to community practice was seen as important. Stages in transition to practice were recognised as pre-entry; incomer; insider; and, a sense of belonging. The process of transition should be planned and individualised acknowledging past experience whilst acknowledging the specialist nature of community-based practice.Item Evaluation of a nursing and midwifery exchange between rural and metropolitan hospitals: A mixed methods study(Public Library of Science, 2020) Byrne A-L; Harvey C; Chamberlain D; Baldwin A; Heritage B; Wood EIntroduction This paper reports on the findings of the Nursing and Midwifery Exchange Program, initiated to promote rural and remote nursing and midwifery, and to facilitate clinical skills development and clinical collaboration between health services in Queensland, Australia. The project was undertaken over an 18-month period in one state of Australia, offering structured, temporary exchange of personnel between metropolitan and rural health services. Background Globally, there is an increasing awareness of nursing shortages, and with it, the need to ensure that nurses and midwives are prepared for specialist roles and practice. This is particularly important in rural and remote areas, where there are pre-existing barriers to access to services, and difficulties in attracting suitably qualified, permanent staff. Methods A mixed methods approach to the evaluation was undertaken with two cohorts. One cohort was the nurses and midwives who participated in the exchange (n = 24) and the other cohort were managers of the participating health services (n = 10). The nurses and midwives who participated in the exchange were asked to complete a questionnaire that included questions related to embeddedness and job satisfaction. The managers participated in a Delphi series of interviews. Results Those who participated in exchange reporting a higher score on the reported degree of understanding of rural client, which was accompanied with a moderate-to-large effect size estimate (d = 0.61). Nurses/midwives in the exchange group reported higher scores on their perceptions of aspects of their home community that would be lost if they had to leave, which was accompanied with a large effect size (d = 0.83). Overall, NMEP was reported by the participants to be a positive way to improve professional development opportunities for nurses and midwives. The findings also show the program supported practical collaboration and raised the profile of nursing and midwifery in rural areas. Conclusion Exchange programs support clinical and professional development, raising the awareness of different contexts of practice and related skills requirements, and thereby supporting a greater understanding of different nursing roles. In the light of increasingly complex care required by patients with chronic conditions being managed in community-based services, programs such as NMEP provide the opportunity to build collaborative networks between referring and referral centres as well as contribute to the ongoing skills development.Item Promoting nurses' and midwives' ethical responsibilities towards vulnerable people: An alignment of research and clinical practice(John Wiley and Sons, Ltd, 2022-10) Baldwin A; Capper T; Harvey C; Willis E; Ferguson B; Browning NAIM: To stimulate discussion and debate about the inclusion of vulnerable populations in primary research to inform practice change and improve health outcomes. BACKGROUND: Current research practices to safeguard vulnerable people from potential harms related to power imbalances may in fact limit the generation of evidence-based practice. EVALUATION: The authors draw on their experience working and researching with a recognized group of vulnerable people, incarcerated pregnant women, to provide insight into the application of ethics in both research and clinical practice. In a novel approach, the ethical principles are presented in both contexts, articulating the synergies between them. Suggestions are presented for how individuals, managers and organizations may improve research opportunities for clinical practitioners and enhance the engagement of vulnerable people to contribute to meaningful practice and policy change. KEY ISSUES: Ethical practice guidelines may limit the ability to create meaningful change for vulnerable populations, who need authentic system change to achieve good health outcomes. CONCLUSION: Inclusive research and practice are essential to ensuring a strengths-based approach to healthcare and addressing health needs of the whole population. Health systems and models of care recognizing the diverse lives and health needs of the broader population demand practical, sustainable support from clinical managers. IMPLICATIONS FOR NURSING MANAGEMENT: Practical suggestions for clinical managers to support point of care research is provided, embedding vulnerable voices in policy, practice development and care provision.Item The grounded theory of Coalescence of Perceptions, Practice and Power: An understanding of governance in midwifery practice(John Wiley & Sons Ltd, 2022-11) Ferguson B; Baldwin A; Henderson A; Harvey CAims This study aimed to understand midwifery care during labour, particularly decision-making processes, within Australian health systems. Background Midwifery, founded on a wellness model of motherhood, is at risk of being medicalized. Whilst medical intervention is lifesaving, it requires judicious use. Governance provides oversight to care. Exploring decision-making contributes to understanding governance of practices. Method Straussian grounded theory using semi-structured interviews. Eighteen Australian registered midwives were interviewed about their practice when caring for women during labour. Results Midwives were caught between divergent positions; birth as natural versus birth as risk. Experienced midwives discussed focussing on the woman, yet less experienced were preoccupied with mandatory protocols like early warning tools. Practice was governed by midwives approach within context of labour. The final theory: The Coalescence of Perceptions, Practice and Power, comprising three categories: perceptions and behaviour, shifting practice and power within practice, emerged. Conclusions Coalescence Theory elucidates how professional decision making by midwives during care provision is subject to power within practice, thereby governed by tensions, competing priorities and organizational mandates. Implications for Midwifery Managers Midwifery managers are well positioned to negotiate the nuanced space that envelopes birthing processes, namely, expert knowledge, policy mandates and staffing capability and resources, for effective collaborative governance. In this way, managers sustain good governance.Item Approaching labour : the 'events' that women experience in the last two weeks of pregnancy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Midwifery at Massey University(Massey University, 2001) Gunn, JacquelineThe 'everyday' events that women experience in the final fortnight of pregnancy as their bodies prepare for labour, is not well reported in the research. This preliminary' descriptive study was designed to answer the question: are there specific events in late pregnancy that are associated with the onset of labour? One hundred and nineteen women used the daily diary that was specifically developed for the study. They recorded the events they experienced between 38 weeks gestation and the onset of their labour. Women were eligible to participate if they had an uncomplicated singleton pregnancy, and were cared for by an independent midwife. Fifteen events were identified that women either commonly experienced or that were important for individual women. These were: cervical 'needling' sensations, fluctuation in fetal movements, uterine activity, mood and energy fluctuations, broken sleep, disturbed bowel and bladder patterns, alterations to vaginal secretions, appetite and mood, nesting/deadline urges, raised libido and enhanced sense of smell and hearing acuity. The study results do not demonstrate any statistically significant relationships between any of the variables with the onset of labour. However, clinically significant frequencies and patterns have been identified for cervical' needling sensations, fluctuations in fetal movements, uterine activity, a 'show', disturbances to bowel activity, mood lability and broken sleep. The study findings provide evidence for the patterns of occurrence of these events that, apart from uterine activity and broken sleep, have hitherto rested on anecdotal, traditional information rather than research. Specific findings from the study indicate that in the final two weeks of pregnancy, cervical needling sensations were experienced by 74% of the study sample that may mirror the physiological process of cervical softening or effacement. A 'normal' range of fetal movement variation that is not associated with fetal compromise was experienced by 79% of the study participants. Half of the study population experienced mood fluctuations in the fifteen days preceding the onset of labour, whilst two thirds of the sample did not experience a 'show' before the onset of labour. Several events such as broken sleep and disturbances of bowel activity occur in more complex patterns and over a longer period than is commonly reported in the literature examined for this study. Midwives help women to stay calm and confident about childbirth by sharing information that can enable each woman to anticipate the normal experiences of childbirth. Providing such 'anticipatory information' is a key midwifery activity. The results of this study provide evidence for the 'anticipatory information ' related to the final weeks of pregnancy that midwives share with women. Multiple questions for further research have been generated by the study. In particular, seven events occurred in a synchronous pattern six days prior to the onset of labour, and three of the four post-dates multigravidae whose babies were in an occipito-posterior position at the onset of labour had an operative outcome. These interesting findings need further study to determine whether the findings have significance.Item Choices of care in the third stage of labour : a Foucauldian discourse analysis : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Health Science at Massey University(Massey University, 2004) Spenceley, KatherineFor the majority of women, the culmination of pregnancy and birth is the arrival of the baby. The third stage of labour, or the birth of the whenua, is the completion of labour and the end of the pregnancy. This time of birth is largely disregarded but can be decisive in the postnatal health of the women. This study examines the third stage of labour focussing on the choices made by women regarding their care with particular reference to the information used by women and midwives to assist choice. The project places the birth of the whenua within the labour continuum, and within the context of the participant's life experience. The philosophy of Michel Foucault suggests that power and knowledge within discourse gives rise to truths and provides authority for statements and actions within the discourse. This project utilises Foucault's definition of discourse and is used to discern the varying discourses, and to locate possible dominant and emergent discourses, within the specific data collected and presented in the thesis.Item First antenatal visit : meeting now for the future : a grounded theory study of the meeting between the independent midwife and the pregnant woman : a thesis submitted in partial fulfillment of the requirements for the degree of Masters of Arts in Midwifery(Massey University, 1999) Sylvester, Mary RThis is a study of what happens between independent midwives and women at the first antenatal visit. Six experienced midwives and six pregnant women participated in the research. Data were gathered through the observation of six first antenatal visits, individual interviews with the women and midwives and a review of the literature. Grounded theory was used to conduct the study, and a descriptive model of the first antenatal visit emerged. Up until the change to the Nurses Act in 1990 midwives predominately practiced within the hospital system. Since 1990 and the legalising of independent midwifery practice in New Zealand, midwives have taken up the challenge to practice independently. A few guidelines have been set to assist independent midwives in practice; some of the guidelines being used have been taken from the hospital system into independent practice. The first antenatal visit is the beginning point of the relationship between the pregnant woman and the midwife. It is a key element for determining the quality and effectiveness of a mother's subsequent maternity care (Methven, 1990). The midwife and the woman each have an important part to play in the first antenatal visit which sets the stage for future care. The data from the study revealed a number of paradoxes that exist when independent midwives deliver midwifery-only care. The basic social process to emerge from the study was "meeting now for the future" but the study identified that the midwife and the woman are meeting for different reasons.Item Towards the professionalisation of New Zealand midwifery, 1840-1921 : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Midwifery at Massey University(Massey University, 1998) Cooper, Marion AThis thesis examines the reasons behind the move to formalise New Zealand European midwifery care in 1904 and the impact this had on midwifery practice. 'The Midwives Act, 1904' concentrated on providing a training system for midwives, hence traditional midwives found their duties circumscribed by their lack of knowledge and training. While women were seen as the appropriate case managers for women during parturition, the Midwifery Act set in place regulations that required advanced knowledge and set standards of practice. The setting up of a nation-wide structure at St Helens Hospitals1 St Helens hospitals does not have an apostrophe. for the training of midwives reinforced the role of the trained midwife, who in some instances was also a trained nurse, and began the move towards the hospitalisation of maternity patients which came to fruition around 1938. The contention of this thesis is that the Midwifery Act contributed to the development of professional standards of midwifery practice leading to a more professionalised midwifery service in place of that which had, until 1904, been unstructured and informal. Through the inclusion of scientific developments into the syllabus of instruction the Midwifery Act gave formal direction to the training, examination and practices of midwives. Finally, it brought to the fore the trained midwife and single woman who replaced the traditional married midwife. The developments and changes in midwifery that occurred following the 1904 Midwifery Act had their beginnings well in advance of the Act. Maternal and infant mortality and morbidity rates had become a concern in England during the 1860s. As early as 1867 maternity lying-in hospitals were beginning to develop protective mechanisms to prevent infection. In New Zealand an unstructured midwifery service comprised mainly of traditional midwives developed from 1840. Stringent use of antisepsis and advanced, professional, midwifery knowledge did not influence these midwives' practices until 1904 when the Midwives Act was implemented leading to the demise of the traditional midwife.Item Autonomy, clinical freedom and responsibility : the paradoxes of providing intrapartum midwifery care in a small maternity unit as compared with a large obstetric hospital : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Midwifery at Massey University(Massey University, 2000) Hunter, MarionSmall maternity units are an important historical feature within New Zealand. Over time many of these facilities have been closed and birth has increasingly occurred in large obstetric hospitals with the availability of technology and on-site specialists. A qualitative study using Van Manen's (1990) method of hermeneutic thematic analysis has been designed to answer the question: How is the provision of intrapartum care by independent midwives different in a small maternity unit, as compared with a large obstetric hospital? Ten independent midwives were interviewed, and data were analysed to uncover the meaning of the differences when providing intrapartum care in both small and large maternity settings. There are two data chapters that contain substantial extracts from the midwives' transcripts in order to illustrate the themes identified from the analysis of their narratives. 'Real midwifery' shows that independent midwives feel more autonomous and are able to let the labour 'be' when practising in the small maternity units. The midwives use their embodied knowledge and skills to support women to labour and birth without technological interference. In contrast, the midwives feel that employing technology such as fetal monitoring and epidurals at the large hospital, places the focus on the machines and the midwife does not use all of her skills. The second data chapter, called 'carrying the can', illustrates the additional responsibility that can at times be a worrying responsibility in the small maternity unit. When practising in the large obstetric hospital, specialist assistance is nearly always at hand and the midwives are considered to be practising in the safest place according to the dominant medical model. The paradox for midwives practising in small maternity units is that while these are a setting for natural birth, the midwives need foresight and confidence to avert or manage any problems that might arise. When midwives practise in the setting of small maternity units, they are more autonomous and have the clinical freedom to practise unshackled by technology. The art of midwifery might be lost if midwives continue to practise midwifery only in medicalised environments.