Competencies for respectful maternity care: Identifying those most important to midwives worldwide.

BACKGROUND: A respectful, person-centered philosophy of maternity care has been emerging over several decades. Research conducted on behalf of the International Confederation of Midwives (ICM) to identify essential competencies for midwifery practice also identified the knowledge, skills, and professional behaviors that should be hallmarks of respectful maternity care practices among the global community of midwives. METHODS: A three-round, online, modified Delphi survey was conducted between April 2016 and October 2016. A total of 895 individuals from 90 of the then-current 105 ICM member countries participated, with good representation across English, French, and Spanish speakers, high-income, medium-income, and low-income countries, and educators and clinicians. RESULTS: A total of 115 respectful maternity care (RMC)-related items were endorsed by participants in Round 1 or 2. These items received average scores of between 90.24% and 99.10%, well above the 85% threshold required to be identified as within the scope of global midwifery practice. These items were compared with the 12 domains of RMC identified by Shakibazadeh and colleagues that defined respectful care during childbirth in health facilities globally, and with similar RMC frameworks, and were found to be highly congruent, thus demonstrating the high value of RMC within the core of midwifery practice. DISCUSSION: ICM survey items were endorsed across all 12 RMC domains proposed by Shakibazadeh et al, and the findings affirmed that across ICM countries and regions, the philosophy of RMC was integrally related to the knowledge, skills, and professional behaviors that emerged as essential for basic midwifery practice.

Assessment of provider competence and quality of maternal/newborn care in selected Latin American and Caribbean countries.

OBJECTIVE: To obtain a snapshot of the maternal and newborn care provided by different types of maternal and child health providers in Latin America and the Caribbean (LAC) to 1) better inform advocacy and programmatic strategies and interventions to improve the quality of those services in the region, and 2) determine the need for more rigorous study of the issues. METHODS: A rapid assessment of 83 health workers providing antepartum, intrapartum, and immediate postpartum and newborn care (within two hours of birth) in eight LAC countries was conducted in November and December of 2011. Health workers were observed by two-person expert maternal/newborn clinician teams using pretested forms based on international quality-of-care standards. A total of 105 care encounters were observed, primarily in urban, public, referral-level settings. Providers of care included obstetricians, midwives, generalist physicians, medical residents, registered nurses, auxiliary nurses, and students of medicine, midwifery, and nursing. RESULTS: Hand washing, as an indicator of quality of antepartum care, was observed in only 41% of the observed encounters. Labor management often lacked certain elements of respectful maternity care across all provider groups. Several clinical tasks of high importance in the identification and prevention of common complications of antepartum, intrapartum, and immediate postpartum/newborn care were not documented as performed during the observation periods. Providers self-reported limited competence (ability to perform to a defined level of proficiency) in manual removal of the placenta, bimanual compression of the uterus, and newborn resuscitation. CONCLUSIONS: The findings suggest that 1) the quality of maternal and newborn care and 2) the competence of maternal and child health providers in the diverse selection of LAC countries that were studied require substantial attention.

Assessment of the nursing skill mix in Mozambique using a task analysis methodology.

BACKGROUND: The density of the nursing and maternal child health nursing workforce in Mozambique (0.32/1000) is well below the WHO minimum standard of 1 nurse per 1000. Two levels of education were being offered for both nurses and maternal child health nurses, in programmes ranging from 18 to 30 months in length. The health care workforce in Mozambique also includes Medical Technicians and Medical Agents, who are also educated at either basic or mid-level. The Ministry of Health determined the need to document the tasks that each of the six cadres was performing within various health facilities to identify gaps, and duplications, in order to identify strategies for streamlining workforce production, while retaining highest educational and competency standards. The methodology of task analysis (TA) was used to achieve this objective. This article provides information about the TA methodology, and selected outcomes of the very broad study. METHODS: A cross-sectional descriptive task analysis survey was conducted over a 15 month period (2008-2009). A stratified sample of 1295 individuals was recruited from every type of health facility in all of Mozambique's 10 provinces and in Maputo City. Respondents indicated how frequently they performed any of 233 patient care tasks. Data analysis focused on identifying areas where identical tasks were performed by the various cadres. Analyses addressed frequency of performance, grouped by level of educational preparation, within various types of health facilities. RESULTS: Task sharing ranged from 74% to 88% between basic and general nurse cadres and from 54% to 88% between maternal and child health nurse cadres, within various health facility types. Conversely, there was distinction between scope of practice for nursing and maternal/child health nursing cadres. CONCLUSION: The educational pathways to general nursing and maternal/child health nursing careers were consolidated into one 24 month programme for each career. The scopes of practice were affirmed based on task analysis survey data.

Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date.

BACKGROUND: Hemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births. METHODS: We conducted an integrative review of published research studies and evaluation reports from programs that distributed misoprostol at the community level for prevention of PPH at home births. We reviewed methods and cadres involved in education of end-users, drug administration, distribution, and coverage, correct and incorrect usage, and serious adverse events. RESULTS: Eighteen programs were identified; only seven reported all data of interest. Programs utilized a range of strategies and timings for distributing misoprostol. Distribution rates were higher when misoprostol was distributed at a home visit during late pregnancy (54.5-96.9%) or at birth (22.5-83.6%), compared to antenatal care (ANC) distribution at any ANC visit (22.5-49.1%) or late ANC visit (21.0-26.7%). Coverage rates were highest when CHWs and traditional birth attendants distributed misoprostol and lower when health workers/ANC providers distributed the medication. The highest distribution and coverage rates were achieved by programs that allowed self-administration. Seven women took misoprostol prior to delivery out of more than 12,000 women who were followed-up. Facility birth rates increased in the three programs for which this information was available. Fifty-one (51) maternal deaths were reported among 86,732 women taking misoprostol: 24 were attributed to perceived PPH; none were directly attributed to use of misoprostol. Even if all deaths were attributable to PPH, the equivalent ratio (59 maternal deaths/100,000 live births) is substantially lower than the reported maternal mortality ratio in any of these countries. CONCLUSIONS: Community-based programs for prevention of PPH at home birth using misoprostol can achieve high distribution and use of the medication, using diverse program strategies. Coverage was greatest when misoprostol was distributed by community health agents at home visits. Programs appear to be safe, with an extremely low rate of ante- or intrapartum administration of the medication.

An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management.

BACKGROUND: Pre-eclampsia/eclampsia is one of the most common causes of maternal and perinatal morbidity and mortality in low and middle income countries. Magnesium sulfate is the drug of choice for prevention of seizures as part of comprehensive management of the disease. Despite the compelling evidence for the effectiveness of magnesium sulfate, concern has been expressed about its safety and potential for toxicity, particularly among providers in low- and middle-income countries. The purpose of this review was to determine whether the literature published in these global settings supports the concerns about the safety of use of magnesium sulfate. METHODS: An integrative review of the literature was conducted to document the known incidences of severe adverse reactions to magnesium sulphate, and specific outcomes of interest related to its use. All types of prospective clinical studies were included if magnesium sulfate was used to manage pre-eclampsia or eclampsia, the study was conducted in a low- or middle-income country, and the study included the recording of the incidence of any adverse side effect resulting from magnesium sulfate use. RESULTS: A total of 24 studies that compared a magnesium sulfate regimen against other drug regimens and examined side effects among 34 subject groups were included. The overall rate of absent patellar reflex among all 9556 aggregated women was 1.6%, with a range of 0-57%. The overall rate of respiratory depression in 25 subject groups in which this outcome was reported was 1.3%, with a range of 0-8.2%. Delay in repeat administration of magnesium sulfate occurred in 3.6% of cases, with a range of 0-65%. Calcium gluconate was administered at an overall rate of less than 0.2%. There was only one maternal death that was attributed by the study authors to the use of magnesium sulfate among the 9556 women in the 24 studies. CONCLUSION: Concerns about safety and toxicity from the use of magnesium sulfate should be mitigated by findings from this integrative review, which indicates a low incidence of the most severe side effects, documented in studies that used a wide variety of standard and modified drug regimens. Adverse effects of concern to providers occur infrequently, and when they occurred, a delay of repeat administration was generally sufficient to mitigate the effect. Early screening and diagnosis of the disease, appropriate treatment with proven drugs, and reasonable vigilance for women under treatment should be adopted as global policy and practice.

Effective in-service training design and delivery: evidence from an integrative literature review.

BACKGROUND: In-service training represents a significant financial investment for supporting continued competence of the health care workforce. An integrative review of the education and training literature was conducted to identify effective training approaches for health worker continuing professional education (CPE) and what evidence exists of outcomes derived from CPE. METHODS: A literature review was conducted from multiple databases including PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between May and June 2011. The initial review of titles and abstracts produced 244 results. Articles selected for analysis after two quality reviews consisted of systematic reviews, randomized controlled trials (RCTs) and programme evaluations published in peer-reviewed journals from 2000 to 2011 in the English language. The articles analysed included 37 systematic reviews and 32 RCTs. The research questions focused on the evidence supporting educational techniques, frequency, setting and media used to deliver instruction for continuing health professional education. RESULTS: The evidence suggests the use of multiple techniques that allow for interaction and enable learners to process and apply information. Case-based learning, clinical simulations, practice and feedback are identified as effective educational techniques. Didactic techniques that involve passive instruction, such as reading or lecture, have been found to have little or no impact on learning outcomes. Repetitive interventions, rather than single interventions, were shown to be superior for learning outcomes. Settings similar to the workplace improved skill acquisition and performance. Computer-based learning can be equally or more effective than live instruction and more cost efficient if effective techniques are used. Effective techniques can lead to improvements in knowledge and skill outcomes and clinical practice behaviours, but there is less evidence directly linking CPE to improved clinical outcomes. Very limited quality data are available from low- to middle-income countries. CONCLUSIONS: Educational techniques are critical to learning outcomes. Targeted, repetitive interventions can result in better learning outcomes. Setting should be selected to support relevant and realistic practice and increase efficiency. Media should be selected based on the potential to support effective educational techniques and efficiency of instruction. CPE can lead to improved learning outcomes if effective techniques are used. Limited data indicate that there may also be an effect on improving clinical practice behaviours. The research agenda calls for well-constructed evaluations of culturally appropriate combinations of technique, setting, frequency and media, developed for and tested among all levels of health workers in low- and middle-income countries.

An integrative review and evidence-based conceptual model of the essential components of pre-service education.

BACKGROUND: With decreasing global resources, a pervasive critical shortage of skilled health workers, and a growing disease burden in many countries, the need to maximize the effectiveness and efficiency of pre-service education in low-and middle-income countries has never been greater. METHODS: We performed an integrative review of the literature to analyse factors contributing to quality pre-service education and created a conceptual model that shows the links between essential elements of quality pre-service education and desired outcomes. RESULTS: The literature contains a rich discussion of factors that contribute to quality pre-service education, including the following: (1) targeted recruitment of qualified students from rural and low-resource settings appears to be a particularly effective strategy for retaining students in vulnerable communities after graduation; (2) evidence supports a competency-based curriculum, but there is no clear evidence supporting specific curricular models such as problem-based learning; (3) the health workforce must be well prepared to address national health priorities; (4) the role of the preceptor and preceptors' skills in clinical teaching, identifying student learning needs, assessing student learning, and prioritizing and time management are particularly important; (5) modern, Internet-enabled medical libraries, skills and simulation laboratories, and computer laboratories to support computer-aided instruction are elements of infrastructure meriting strong consideration; and (6) all students must receive sufficient clinical practice opportunities in high-quality clinical learning environments in order to graduate with the competencies required for effective practice. Few studies make a link between PSE and impact on the health system. Nevertheless, it is logical that the production of a trained and competent staff through high-quality pre-service education and continuing professional development activities is the foundation required to achieve the desired health outcomes. Professional regulation, deployment practices, workplace environment upon graduation and other service delivery contextual factors were analysed as influencing factors that affect educational outcomes and health impact. CONCLUSIONS: Our model for pre-service education reflects the investments that must be made by countries into programmes capable of leading to graduates who are competent for the health occupations and professions at the time of their entry into the workforce.

Assessing impact and sustainability of health, water, and sanitation interventions in Bolivia six years post-project.

OBJECTIVE: To assess the impact and sustainability of health, water, and sanitation interventions in Bolivia six years post-project. METHODS: A mixed-method (qualitative-quantitative) study was conducted in 14 rural intervention and control communities in Bolivia in November 2008, six years after the completion of interventions designed to improve knowledge and practices related to maternal and child health and nutrition, community water systems, and household water and sanitation facilities. The degree to which participants had sustained the community and household practices promoted by the interventions was a particular focus. Community site visits were made to evaluate the status (functional condition) and sustainability (state of maintenance and repair) of community and household water and sanitation infrastructure. Key informant interviews and focus group discussions were conducted to assess knowledge and practices, and perceptions about the value of the interventions to the community. RESULTS: Six years post-project, participants remained committed to sustaining the practices promoted in the interventions. The average rating for the functional condition of community water systems was 42% higher than the average rating in control communities. In addition, more than two-thirds of households continued to practice selected maternal and child health behaviors promoted by the interventions (compared to less than half of the households in the control communities). Communities that received integrated investments (development and health) seemed to sustain the practices promoted in the interventions better than communities that received assistance in only one of the two sectors. CONCLUSIONS: Infrastructure for community water systems and household water and sanitation facilities was better built and maintained, and selected maternal and child health behaviors practiced more frequently, in intervention communities versus control communities.

Mobile-Social Learning for Continuing Professional Development in Low- and Middle-Income Countries: Integrative Review.

BACKGROUND: Access to continuing professional development (CPD) for health care workers in low- and middle-income countries (LMICs) is severely limited. Digital technology serves as a promising platform for supporting CPD for health care workers by providing educational content virtually and enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs. OBJECTIVE: The objective of this integrative review was to evaluate the evidence on which digital platforms were used to provide CPD to health care workers and clinical students in LMICs, which was complemented with virtual peer-to-peer or mentor interaction. We phrased this intersection of virtual learning and virtual interaction as mobile-social learning. METHODS: A comprehensive database and gray literature search was conducted to identify qualitative, quantitative, and mixed methods studies, along with empirical evidence, that used digital technology to provide CPD and virtual interaction with peers or mentors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, conducted in an LMIC, and used a mobile device to provide CPD and facilitate virtual peer-to-peer or mentor interaction. Titles, abstracts, and full texts were screened, followed by an assessment of the quality of evidence and an appraisal of the articles. A content analysis was then used to deductively code the data into emerging themes. RESULTS: A total of 750 articles were identified, and 31 (4.1%) were included in the review. SMS text messaging and mobile instant messaging were the most common methods used to provide continuing education and virtual interaction between peers and mentors (25/31, 81%). Across the included articles, participants had high acceptability for using digital platforms for learning and interaction. Virtual peer interaction and mentorship were found to contribute to positive learning outcomes in most studies (27/31, 87%) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction were found to improve social support and reduce feelings of isolation (9/31, 29%). There were several challenges in the implementation and use of digital technology for mobile-social learning, including limited access to resources (eg, internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students. CONCLUSIONS: The summary suggests that mobile-social learning is a useful modality for curriculum dissemination and skill training and that the interface of mobile and social learning serves as a catalyst for improved learning outcomes coupled with increased social capital.

Recruitment of hard-to-reach population subgroups via adaptations of the snowball sampling strategy.

Nurse researchers and educators often engage in outreach to narrowly defined populations. This article offers examples of how variations on the snowball sampling recruitment strategy can be applied in the creation of culturally appropriate, community-based information dissemination efforts related to recruitment to health education programs and research studies. Examples from the primary author's program of research are provided to demonstrate how adaptations of snowball sampling can be used effectively in the recruitment of members of traditionally underserved or vulnerable populations. The adaptation of snowball sampling techniques, as described in this article, helped the authors to gain access to each of the more-vulnerable population groups of interest. The use of culturally sensitive recruitment strategies is both appropriate and effective in enlisting the involvement of members of vulnerable populations. Adaptations of snowball sampling strategies should be considered when recruiting participants for education programs or for research studies when the recruitment of a population-based sample is not essential.

Interdisciplinary Peer Mentorship: An Innovative Strategy to Enhance Writing Competency.

BACKGROUND: Writing competency is imperative for Doctor of Nursing Practice (DNP)-prepared advanced practice nurses (APNs), who serve as clinical leaders and educators of the nursing workforce. METHOD: As part of a writing quality improvement project, a Writing Tutor Round Table program was developed. Interdisciplinary tutors from the campus writing center worked with groups of three to four DNP students to enhance the quality of their written assignments. At an open table in a quiet room, tutors critiqued the writing of one student while the other students listened. Financial records were used to determine the direct cost of the intervention, and participant survey data provided evidence for acceptability. RESULTS: This intervention was a cost effective and highly acceptable experience for both tutors and students. CONCLUSION: A Writing Tutor Round Table intervention is an acceptable, low-cost, low-faculty burden intervention for improving the quality of writing among APNs. [J Nurs Educ. 2020;59(3):173-175.].

Developing advanced practice nurse writing competencies as a corequisite for evidence-based practice.

Writing competency is increasingly recognized as imperative for advanced practice nurses (APNs) who are engaged in evidence-based practice (EBP). Writing skills are an implied expectation inherent in many APN evidence-based practice competencies, such as "formulating evidence based policies and procedures," and "communicates best evidence …." A quality improvement project was implemented for APN's within a post-Master's Doctor of Nursing Practice program, to create a novel set of low-cost, high-impact strategies that could be embedded into a program of study to improve APN writing skills. Prior work has indicated that mentorship and peer support are useful strategies that can contribute to the enhancement of APN writing skills. This study builds on prior work to develop a quantitative evaluation of a peer-supported writing intervention for APNs. Read Aloud innovation was one of two strategies chosen from among many writing improvement strategies identified in the literature because of easy implementation, even by faculty who lacked confidence in providing traditional writing instruction. If explicit development of writing competencies is not elevated to a higher priority in APN education, suboptimal writing confidence is likely to continue across the professional lifetime and will present as a recurring challenge for APNs who pursue higher educational degrees, transition into faculty roles, or seek to fully develop APN EBP competencies. Findings from this study indicate that feedback received from peers during the structured Read Aloud innovation, with emphasis on hierarchy of paragraph sentences (i.e., explicit examination for overarching quality of the leading sentence), is effective in improving clarity and brevity of writing among APNs.

Process and outcomes evaluation of retention strategies within a nursing workforce diversity project.

A commitment to enhancing the diversity of the nursing workforce is reflected in the recruitment and retention strategies designed by Stony Brook University with support of a grant received from the Department of Health and Human Services, Health Resources and Services Administration. Three specific student retention strategies are evaluated in terms of their influence on student inclusion and promotion of student success. A review of the cultural competence of teaching and learning strategies and the promotion of cultural self-awareness underpinned these strategies. A mentorship program designed to provide individual support for students, particularly for those engaged in distance learning, proved to be challenging to implement and underused by students. Students found other means of support in their workplace and through individual connections with the faculty. Instructional programs that enhanced individual skills in the use of computer hardware and software were particularly effective in promoting student success.

Effects of a programme to advance scholarly writing.

BACKGROUND: Scholarly writing, although central to the completion of doctoral studies, is often not supported by systematic teaching/learning approaches that specifically help students to convey scholarship through writing. The purpose of this project was to promote writing as an essential component of scholarship, provide opportunities for students to develop a self-awareness of confidence in writing and challenges to writing, and to improve writing competence. METHODS: An innovative set of peer-supported interventions was embedded within a core foundational course in a Doctor of Nursing Practice (DNP) programme during the first academic semester as part of a continuing quality improvement process to improve DNP student writing. The first curriculum innovation was a substantive writing assignment, in which students exchanged papers with a classmate and were required to critique both writing conventions (e.g. criteria such as punctuation and citation) and structural and thesis-driven aspects of writing (e.g. criteria such as clarity, organisation and the use of paragraph leading sentences). Students then read their papers aloud, without hesitation while reading, in order to identify any discrepancies between the written words and the audible 'plain language' that would be necessary to enhance clarity. The second innovation was an optional writing workshop in which students received coaching from interdisciplinary mentors and from their peers. RESULTS: Evaluation of the implementation of this innovation suggests that mentorship, peer support and the use of commonly spoken language may be useful tools for improving the writing competencies of DNP students. DISCUSSION: Students with broad diversity in writing competency, including low levels of proficiency, benefitted from a writing-enriched curriculum given at the start of the course of study. DNP faculty may not themselves be prepared to mentor students for doctoral-level writing.

The doctorate of nursing practice and entry into midwifery practice: Issues for consideration and debate.

The American College of Nurse-Midwives represents two cadres of midwifery professionals: certified nurse-midwives who are educated in both midwifery and nursing, and certified midwives who are educated in the discipline of midwifery. Certified nurse-midwives are designated by nursing professional organizations as advanced practice nurses. The United States nursing profession is advancing toward adoption of the Doctor of Nursing Practice degree, as the entry into practice credential for advanced practice nursing. There is no evidence to date to demonstrate differences in clinical practice outcomes between certified nurse-midwives and certified midwives. A secondary analysis of data from a series of compensation and benefits surveys did not demonstrate differences in salaries between respondents who held a practice-focused doctoral degree compared to a master's degree. The requirement of the practice-focused nursing doctoral degree for entry into midwifery practice for certified nurse-midwives would require additional evidence to support both a professional and a business case for such a change in policy. It would also require consideration of the professional and business impact that such a policy would have on certified midwives who do not hold the nursing credential. Equivalent entry into practice pathways would need to be developed.

Global competencies for midwives: external cephalic version; ultrasonography, and tobacco cessation intervention.

PROBLEM AND BACKGROUND: The International Confederation of Midwives (ICM) conducts regular updates to the Essential Competencies for Basic Midwifery Practice to determine the introduction or retention of items in the global scope of midwifery practice guidance document. AIM: This article presents the review process that underpinned the deliberation about three specific clinical practices: external cephalic version, prenatal ultrasonography, and tobacco cessation interventions that occurred during the 2016-2017 global update study. METHODS: A brief outline of the research methodology used in the 2016-2017 study is provided. Literature summaries about safety and effectiveness of three clinical skills are offered. Data addressing global and regional variations in support of each practice and final disposition of the items are documented. FINDINGS: External cephalic version did not receive sufficient document support for inclusion in the initial list of items to be tested in the study. Prenatal ultrasonography was supported as an advanced (76.6%) or country-specific (18.8%) skill that midwives could acquire, to promote wider global access for pregnant women. Midwives' participation in tobacco cessation counselling was supported (≥85%) in each of ICM's regions. Knowledge about World Health Organization recommendations for nicotine replacement therapy was endorsed as an additional (62.4%) or country-specific (29.3%) skill. DISCUSSION AND CONCLUSION: The current evidence of safety of midwives performing external cephalic version led to the recommendation that it be considered in the next document update. Conflicting views of midwives' role in acquiring skills to conduct prenatal ultrasound were evident. There was strong support for participation in smoking cessation counselling, but knowledge of World Health Organization recommendations was not highly endorsed.

Transitioning veterans to nursing careers: A model program.

BACKGROUND: A commitment to increase the enrollment, retention and educational success of United States veterans admitted to a baccalaureate degree nursing program was established through the support of a grant received from HRSA in collaboration with the US Departments of Defense and Veteran Affairs. METHOD: Challenges encountered by the student veterans were identified and programs of mentorship, tutoring, equine therapy and interface with services offered by the University Office of Veteran Affairs were developed. RESULTS: Thirty-two student veterans provided positive feedback about their perceptions of academic and personal support provided during their program. Sixteen faculty and staff also described positive experiences about working with the student veteran population. CONCLUSION: The continuous assessment of all program elements indicates that the program is meeting its intended outcomes and serves the purpose of providing the opportunity for returning veterans to choose nursing as a professional healthcare career.

Competence for basic midwifery practice: Updating the ICM essential competencies.

OBJECTIVE: To obtain consensus amongst midwifery experts globally about the essential competencies for basic midwifery practice. DESIGN: A modified Delphi approach, involving a three-round online survey. PARTICIPANTS: Midwifery leaders, educators and regulators in all ICM regions, along with representatives of organisations affiliated to ICM. METHODS: The research team worked closely with a Core Working Group and a Task Force. An initial set of competencies and components was developed through a content analysis of existing competency documents and presented to participants in Round 1 of the survey. Items identified as essential by at least 85% of participants were endorsed. Remaining items and new items identified by participants were returned to participants in Rounds 2 and 3 for further rating. FINDINGS: The study achieved a wide sample representative of midwifery experts across all ICM regions and countries, language groups, and income categories. Only a small number of competencies relating to the wider role of the midwife were endorsed as essential competencies. Competencies and components relating to professional and personal attributes were extended. Although most competencies and components relating to core midwifery practice were endorsed as essential competencies, several were rejected relating to abortion-related care, cancer screening, infertility, and gynaecology. Findings are, nevertheless, highly consistent with the scope of practice delineated in the current 2010/2013 version of the ICM Essential Competencies for Basic Midwifery Practice. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The extension of professional and personal attributes reflects the recent emphasis on respectful midwifery care. The rejection of most of the additional competencies and components relating to the wider role of the midwife and endorsement of most of those considered to relate to core midwifery practice indicates that the scope of midwifery practice remains essentially unchanged through 2017.

Abortion-related care and the role of the midwife: a global perspective.

INTRODUCTION: The International Confederation of Midwives (ICM) represents 132 midwifery associations in 113 countries. The ICM disseminates the Essential Competencies for Basic Midwifery Practice (EC) that describes the global scope of midwifery practice. The basic (core) and expanded (additional or optional) role of midwives in providing abortion-related care services was first described in 2010. A literature review about three items that are particularly critical to access to abortion services was conducted. Findings that emerged in the recent 2016-2017 update study about these three items are presented. METHODS: A modified Delphi study was administered via the Internet in a series of three rounds. Thirty-seven statements of abortion-related knowledge and skill were presented. RESULTS: A total of 895 individuals participated. The total of respondents across all three rounds represented 90 of the 105 member countries at the time of the study. The role of midwives in providing comprehensive abortion care, including referral for abortion and provision of postabortion family planning, achieved the necessary 85% agreement to be designated as essential (basic) knowledge or skill for the global scope of midwifery practice. The provision of medication abortion and performance of manual vacuum aspiration abortion were designated as optional for midwives who wished to provide these services. Endorsement of these latter practices was highest in both Francophone and Anglophone regions of Africa, Asian Pacific countries, and countries at a lower state of economic development. CONCLUSION: The role of midwives in provision of abortion-related care services was reaffirmed in the recent Delphi study to inform the update to the EC. The role of midwives as direct providers of medical and vacuum aspiration abortions was reaffirmed for those individual midwives who wish to obtain the requisite competency to provide those services, in jurisdictions where these services are legally authorized.