Introducing sensitive issues and self-care strategies to first year midwifery students.

OBJECTIVE: first year midwifery students learn early in semester about situations in midwifery where a high level of emotion is expressed, such as taking a sexual history, being faced with the body image changes of pregnancy and working with women in the extreme pain of labour. Commencing students usually have not had exposure to the realities of studying and working in midwifery, and often have an idealised view of midwifery that may lead to attrition from the course. We aimed to equip students with personal and professional tools to discuss sensitive issues in midwifery and promote self-care through the development of two workshops. The first workshop focussed on sensitive issues in midwifery and the second on self-care strategies. DESIGN: quantitative and qualitative data were collected pre and post workshops using a survey. SETTING: the workshops were developed at one university in New South Wales, Australia. PARTICIPANTS: Beginning first year midwifery students MEASUREMENTS: feeling more comfortable, confident and knowledgeable was measured using a paired t-test from the responses on a pre and post workshop survey. Content analysis was performed on the qualitative survey responses. FINDINGS: there were significant increases in the students feeling more comfortable to discuss sensitive issues in midwifery following the first workshop. They found meeting new people, respecting opinions, normalizing confronting topics to be valuable and useful. The second workshop found significant differences in being more confident and knowledgeable to access and try new self-care strategies in both their personal and professional life. Students discussed learning to be more mindful in order to prepare for stressful situations. They became aware of their feeling and thoughts when under stress and said they would practice techniques including meditation. CONCLUSION: the workshops assisted the students to develop peer support, self-care strategies and coping mechanisms when faced with the intimate and sometimes confronting nature of midwifery practice. Through embedding these first year workshops early in the degree we hope to address attrition rates and facilitate the students' to become the compassionate, caring, woman-centred midwives that they envisioned. IMPLICATIONS FOR PRACTICE: the workshops have the potential for replication in other universities to support and nurture beginning midwifery students.

Enabling new graduate midwives to work in midwifery continuity of care models: A conceptual model for implementation.

BACKGROUND: High-level evidence demonstrates midwifery continuity of care is beneficial for women and babies. Women have limited access to midwifery continuity of care models in Australia. One of the factors limiting women's access is recruiting enough midwives to work in continuity. Our research found that newly graduated midwives felt well prepared to work in midwifery led continuity of care models, were well supported to work in the models and the main driver to employing them was a need to staff the models. However limited opportunities exist for new graduate midwives to work in midwifery continuity of care. AIM: The aim of this paper therefore is to describe a conceptual model developed to enable new graduate midwives to work in midwifery continuity of care models. METHOD: The findings from a qualitative study were synthesised with the existing literature to develop a conceptual model that enables new graduate midwives to work in midwifery continuity of care. FINDINGS: The model contains the essential elements to enable new graduate midwives to work in midwifery continuity of care models. DISCUSSION: Each of the essential elements discussed are to assist midwifery managers, educators and new graduates to facilitate the organisational changes required to accommodate new graduates. CONCLUSION: The conceptual model is useful to show maternity services how to enable new graduate midwives to work in midwifery continuity of care models.

The mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia.

The aim of this paper was to explore the mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia. Most new graduates find employment in hospitals and undertake a new graduate program rotating through different wards. A limited number of new graduate midwives were found to be working in midwifery continuity of care. The new graduate midwives in this study were mentored by more experienced midwives. Mentoring in midwifery has been described as being concerned with confidence building based through a personal relationship. A qualitative descriptive study was undertaken and the data were analysed using continuity of care as a framework. We found having a mentor was important, knowing the mentor made it easier for the new graduate to call their mentor at any time. The new graduate midwives had respect for their mentors and the support helped build their confidence in transitioning from student to midwife. With the expansion of midwifery continuity of care models in Australia mentoring should be provided for transition midwives working in this way.

The challenge of employing and managing new graduate midwives in midwifery group practices in hospitals.

AIM(S): This study explores the views of midwifery managers and key stakeholders, regarding the facilitators and barriers to employing new graduate midwives in midwifery continuity of care models. BACKGROUND: Maternity services in Australia are shifting towards midwifery continuity of care models, where midwives work in small group practices, requiring a change to the management of staff. Public policy in Australia supports maternity services to be reconfigured in this way. Historically, experienced midwives work in these models, as demand grows; new graduates are employed to staff the models. METHOD(S): A qualitative descriptive approach exploring the manager's experience of employing new graduate's in the models. Managers, clinical educators and hospital midwifery consultants (n = 15) were recruited by purposeful sampling. RESULTS: Drivers, enablers, facilitators and barriers to employing new graduates in the models were identified. Visionary leadership enabled the managers to employ new graduates in the models through initial and ongoing support. Managing the myths stemming from fear of employing new graduates to work in midwifery continuity of care models was challenging. CONCLUSION: Managers and other key stakeholders provide initial and ongoing support through orientation and providing a reduced workload. IMPLICATIONS FOR NURSING MANAGEMENT: Visionary leadership can be seen as critical to supporting new graduates into midwifery continuity of care models. The challenges for management to overcome include managing the myths stemming from fear of employing new graduates to work in a flexible way around the needs of the women within an organisation culture.

The experiences of new graduate midwives working in midwifery continuity of care models in Australia.

BACKGROUND: midwifery continuity of care has been shown to be beneficial to women through reducing interventions and other maternal and neonatal morbidity. In Australia, numerous government reports recognise the importance of midwifery models of care that provide continuity. Given the benefits, midwives, including new graduate midwives, should have the opportunity to work in these models of care. Historically, new graduates have been required to have a number of years׳ experience before they are able to work in these models of care although a small number have been able to move into these models as new graduates. AIM: to explore the experiences of the new graduate midwives who have worked in midwifery continuity of care, in particular, the support they received; and, to establish the facilitators and barriers to the expansion of new graduate positions in midwifery continuity of care models. METHOD: a qualitative descriptive study was undertaken framed by the concept of continuity of care. FINDINGS: the new graduate midwives valued the relationship with the women and with the group of midwives they worked alongside. The ability to develop trusting relationships, consolidate skills and knowledge, be supported by the group and finally feeling prepared to work in midwifery continuity of care from their degree were all sub-themes. All of these factors led to the participants feeling as though they were 'becoming a real midwife'. CONCLUSIONS: this is the first study to demonstrate that new graduate midwives value working in midwifery continuity of care - they felt well prepared to work in this way from their degree and were supported by midwives they worked alongside. The participants reported having more confidence to practice when they have a relationship with the woman, as occurs in these models.

Addressing culture shock in first year midwifery students: Maximising the initial clinical experience.

BACKGROUND: Many Bachelor of Midwifery students have not had any exposure to the hospital setting prior to their clinical placement. Students have reported their placements are foreign to them, with a specialised confusing 'language'. It is important to provide support to students to prevent culture shock that may lead to them leaving the course. AIM: To assist first year midwifery students with the transition into clinical practice by providing a preparatory workshop. METHODS: An action research project developed resources for a workshop held prior to students' first clinical placement. Four phases were held: Phase one involved holding discussion groups with students returning from clinical practice; Phase two was the creation of vodcasts; Phase three was integration of resources into the clinical subject and phase four was the evaluation and reflection on the action research project. Evaluations of the workshops were undertaken through surveying the students after they returned from their clinical placement. A descriptive analysis of the evaluations was performed. FINDINGS: Students rated the workshop, vodcasts and the simulated handover positively. Further recommendations were that complications of labour and birth be included in their first semester as students were unexpectedly exposed to this in their first clinical placement. CONCLUSION: The students evaluated the workshop positively in reducing the amount of culture shock experienced on the first clinical placement. In addition the students provided further recommendations of strategies that would assist with clinical placement.