Evaluation of the effectiveness of a video-based educational intervention on perinatal mental health related stigma reduction strategies for healthcare professionals: A single group pre-test-post-test pilot study.

BACKGROUND: Healthcare professionals have a role to play in reducing perinatal mental health related stigma. AIM: To assess the effectiveness of a video-based educational intervention developed to provide guidance to healthcare professionals on perinatal mental health related stigma reduction strategies. DESIGN: A single group pre-test-post-test pilot study with no control group. SETTING(S): A university affiliated maternity hospital in Ireland PARTICIPANTS: A convenience sample of registered midwives, nurses and doctors (n = 60) recruited from October 2020-January 2021. INTERVENTION: A twenty-minute video-based educational intervention. METHODS: Respondents (n = 60) completed a pre-test (time point one) and post-test (time point-two) questionnaire, and a three-month follow-up post-test questionnaire (time point-three) (n = 39). The questionnaire included the Mental Illness Clinicians' Attitudes Scale, Reported and Intended Behaviour Scale, Reynolds Empathy Scale and open-ended questions. Wilcoxon Signed Rank Test was selected to evaluate the pre-test post-test scores. RESULTS: The difference in mean Mental Illness: Clinicians' Attitudes-4 scores were statistically significant between time points one and three (z = 3.27, df=36, P = 0.0007) suggesting more positive attitudes towards people with mental health conditions after the intervention. The mean total score for the Reported and Intended Behaviour Scale increased from 18.7 (SD 1.87) at time point one to 19.2 (SD 1.60) at time point two (z= -3.368, df=59, P = 0.0004) suggesting an increase in positive intended behaviours towards those with mental health issues immediately following the intervention. These findings were also corroborated by responses to open-ended survey questions. CONCLUSIONS: Further research with a larger sample of healthcare professionals evaluated over a longer period would provide further evidence for the sustainability of the intervention. TWEETABLEABSTRACT: A video-based intervention can increase healthcare professionals' knowledge of perinatal #mentalhealth related stigma reduction strategies @Journal. Link to article.

Parents experiences of pregnancy following perinatal loss: An integrative review.

BACKGROUND: Pregnancy following perinatal loss has a profound effect on parents and may contribute to intense psychological distress including grief, post-traumatic stress disorder, anxiety and depression. The subsequent pregnancy may also be perceived as more stressful due to the fear of recurrent loss. Midwives and other health care professionals need to be sensitive and empathetic to the needs of these parents when providing care in a pregnancy subsequent to a loss. METHODOLOGY: The aim of this integrated literature review was to explore parents' experiences of pregnancy following a previous perinatal loss using a systematic approach. This is presented in a five-stage process that includes problem identification, literature search, data extraction and evaluation, data analysis and presentation of results. A systematic search of seven electronic databases was conducted (Jan 2009 -Jan 2023) to identify relevant primary research which addressed parents' experiences of pregnancy following a previous perinatal loss. Seven papers met the eligibility criteria and were assessed for quality using Crowe's Critical Appraisal Tool (CCAT). Thematic analysis identified two themes. FINDINGS: The key themes identified from the literature were; the psychosocial needs and challenges faced by previously bereaved parents in subsequent pregnancies; and the need for specialist care and support in a subsequent pregnancy. Psychological needs and challenges included continued grief, depression, anxiety, and disparities in the grief process between men and women. The importance of specialist care with an increased level of support from competent, confident and compassionate health care providers was highlighted. CONCLUSION: The experience of pregnancy following a perinatal loss can be a complex emotional experience for parents. The review identifies the need for post pregnancy loss debriefing and counselling and care pathways specific to caring for women and their partners in a pregnancy subsequent to a perinatal loss. Care in pregnancy subsequent to loss should be provided by empathetic, competent health care providers and include additional antenatal clinic appointments, pregnancy monitoring and psychological support in order to meet the needs of these expectant parents.

Midwifery students' experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study.

OBJECTIVE: To explore the impact of the COVID-19 global pandemic on midwifery students' experiences of clinical internship placement in the final year of their midwifery programme. DESIGN: A qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated. SETTING AND PARTICIPANTS: To prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study. FINDINGS: Four overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students' ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Midwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.

Nursing students' views of clinical competence assessment.

This paper reports on some outcomes of a research study evaluating a new assessment framework of clinical competence used in undergraduate nursing programmes in the Mid West Region of Ireland. First, this paper presents both the strengths and weaknesses of the present model, as articulated by student nurses. Second, it generates a broader critical debate around the concept of competency assessment. The model of competence in question was developed by the Irish Nursing Board then elaborated on by the University of Limerick in partnership with local health service providers in 2002. Methodology involved a triangulated approach, comprising a series of focus group interviews with students (n=13) and preceptors (n=16) followed by a survey of students (n=232) and preceptors (n=837). Findings from the student focus groups are reported here. Themes identified using Burnard's (1991) framework for analysis are preparation for competency assessment, competency documentation, supporting assessment in practice, organisational and resource factors and the competency assessment structure and process. Results from this research have implications for refinement and revision of the present competency assessment framework, for student and staff preparation and for collaboration between stakeholders.

The Paternal Experience of Fear of Childbirth: An Integrative Review.

BACKGROUND: It is estimated that approximately 13% of expectant fathers experience a pathological and debilitating fear of childbirth. OBJECTIVE: The aim of this integrative review was to examine and synthesise the current body of research relating to paternal experience of fear of childbirth. METHODS: A systematic literature search of five databases-CINAHL, Cochrane Library, MEDLINE, PsycArticles and PsycInfo-identified seventeen papers. Methodological quality of studies was assessed using the Crowe Critical Appraisal Tool. RESULTS: Thematic data analysis identified three themes: the focus of fathers' childbirth-related fears, the impact of fear of childbirth on health and wellbeing, and fear of childbirth as a private burden. DISCUSSION: Fear of childbirth is a significant and distressing experience for expectant fathers who may benefit from an opportunity to express their childbirth-related fears in an environment where they feel validated and supported. Antenatal education is recommended to enhance fathers' childbirth-related self-efficacy to reduce fear of childbirth. CONCLUSIONS: Fear of childbirth may negatively impact the lives of men and consequently their families. Further investigation into methods and models for identifying and supporting men at risk of or experiencing fear of childbirth is required to improve outcomes for this population of men.

Interventions to reduce work-related musculoskeletal disorders among healthcare staff in nursing homes; An integrative literature review.

Background: : The incidence of work-related musculoskeletal disorders have been consistently high in nursing sectors and are a significant cost to the health service due to absenteeism. Work-related musculoskeletal disorders are more common among healthcare workers in nursing homes due to the high dependency needs of older persons which often include need for help with self-care and mobility. Therefore, staff are exposed to potential injury associated with moving and handling patients. Work-related musculoskeletal disorders significantly impact on the quality of life of affected individuals, can cause economic hardship and affect service provision. Aim: : To identify, review, and discuss interventions that may be effective in reducing the prevalence and consequences of work-related musculoskeletal disorders in nursing homes. Design: : An integrative literature review. Method: : A systematic search of Embase, Science direct, Web of science and EBSCO Host was conducted and an ancestry search of the references of the reviewed articles were also reviewed. Peer reviewed primary research published between 2000 and 2020 were selected. The quality of these studies was appraised with Crowe Quality Appraisal Tool and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The components of the interventions were categorised using Burnard (2011) framework for content analysis. Results: : Fifteen studies met the criteria for inclusion in the review. Interventions reported in the literature were in four categories; (i) Specialised equipment (ii) Staff training (iii) Policies and procedures to reduce work-related musculoskeletal disorders and (iv) Support and follow up. A ceiling lift is the intervention of choice to reduce work-related musculoskeletal disorders, as it reduces the stress associated with pushing and pulling. Risk assessment is vital to determine the individual needs of clients for safe handling. Train-the-trainer roles could be used to implement training interventions where resources limit the employment of a designated lead to facilitate injury prevention. A multifaceted approach to prevent and reduce work-related musculoskeletal disorders is recommended. Further research is required to ascertain the effectiveness of Cognitive Behavioural Therapy on injury reduction in nursing homes. Conclusion: : These findings have the potential to inform the development and adherence to injury prevention policies and regulations by healthcare managers and staff which could reduce injuries. Identifying the appropriate interventions to prevent and reduce work-related musculoskeletal disorders is significant for staff wellbeing, has economic implications in terms of reduced work-related musculoskeletal disorder absenteeism and ultimately will positively impact on the care of mobility impaired clients.

A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice.

Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theory 4: Relates to nurses' and midwives' knowledge and beliefs. Program Theory 5: Builds on the staff theme of Programme Theory four, extending the culture of organizational learning, and highlights the meaningful engagement of nurses and midwives in the implementation process as a key characteristic of success. Program Theory 6: Relates to patient needs. The results provide nursing and midwifery policymakers and professionals with evidence-based program theory that can be translated into action-orientated strategies to help guide successful QCP-M implementation.

Women's experience of obstetric anal sphincter injury following childbirth: An integrated review.

BACKGROUND: Perineal injury during childbirth is a very common event which affect women during childbirth. Significant morbidities are associated with third-and-fourth degree perineal tears in particular, also referred to as obstetric anal sphincter injuries (OASIS). With an increasing global birth rate and rising interventions in birth, the incidence of perineal trauma following vaginal birth is increasing on an international scale, impacted also by more accurate classification and definitions of OASIS and increased pre-existing co morbidities amongst affected women. The consequences of OASIS can be physically and psychologically distressing for affected women and have significant impact on quality of life. METHODOLOGY: The aim of this integrative review was to examine women's experience of OASIS following childbirth using a systematic approach. This is presented in a five-stage process that includes problem identification, literature search, data extraction and evaluation, data analysis and presentation of results. A number of academic electronic databases were systematically searched and results are presented and analysed. Results of the complete search are presented in PRISMA format. Eight papers, which were assessed for quality using an appropriate appraisal tool, are included in the review and thematic analysis used to identify themes. FINDINGS: The themes identified were; psychological consequences, the role of the health care professionals and implications for future pregnancies. Psychological consequences included anxiety, loneliness, isolation, shame, fear, many of which were associated with physical ramifications of OASIS and how these feelings affect activities of daily living. The importance of access to and support from health care professionals was highlighted. The impact the experience of OASIS had on women's decisions about future pregnancies was also evident. CONCLUSION: The association between OASIS and maternal quality of life following childbirth can be substantial as evidenced by this literature review. The review identifies the need for improvement in the care and management of these women to alleviate the physical and psychological consequences of OASIS, including decisions in relation to future pregnancies and childbirth. Health care professionals caring for women in pregnancy and childbirth need to be educated and informed on the sequelae of OASIS, to ensure appropriate information and support is provided to these women and their families. Such knowledge may enable health care professionals to alleviate symptoms associated with OASIS and help women make sense and cope with their experiences.

Culturally Sensitive Care in the Neonatal Setting to Infants Born to Parents From the Traveler Community: An Exploration of the Perspectives of Neonatal Staff.

Introduction: Culture and traditions influence people's health beliefs and these influence their actions and behaviors to prevent ill health and promote health and well-being. This qualitative study explored nurses'/midwives perspectives of culturally sensitive care in a neonatal setting to infants born to parents from the Traveler community. Method: A descriptive qualitative approach was used to interview 10 nurses/midwives from a neonatal unit in Ireland. Data were analyzed using Burnard's framework. Results: Themes identified were as follows: (a) barriers to breastfeeding for women from the Traveler community, (b) cultural issues affecting care provision to Traveler families in the neonatal unit, and (c) concerns of neonatal staff for infants born within the Traveler community. Discussion: The culture of the Traveler group was recognized as a major influence on decision making and interactions within the neonatal unit. Strategies are identified that could enhance the care of this group and the care of other ethnic groups.

Quality care process metrics (QCP-Ms) in nursing and midwifery care processes: a rapid realist review (RRR) protocol.

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QC-Ms) and respective indicators for the practice areas - acute care, midwifery, children's, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QC-M in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods : The review will explore if there are benefits of using the QC-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QC-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into realism as a framework and how nursing and midwifery QC-Ms have been implemented previously.

Safety first: Factors affecting preceptor midwives experiences of competency assessment failure among midwifery students.

BACKGROUND: Assessment of clinical practice is a core component of midwifery education. Clinical assessment is challenging and affected by a number of factors. Preceptor midwives are reported to be reluctant to fail students in clinical assessments. This is worrying as preceptor midwives are gatekeepers to the profession of midwifery and need to ensure midwifery students are safe and competent practitioners of midwifery on completion of their programmes. METHODS: This qualitative descriptive study explores preceptor midwives experiences of clinical assessment of midwifery students in four maternity units in the Republic of Ireland. Following ethical approval, twenty-nine preceptor midwives were interviewed. Content analysis was used to analyse the data and two themes with associated subthemes identified. FINDINGS: Competency assessment in practice was supported by a robust, clearly delineated process, considered vital to ensure effective and fair assessment of midwifery students. The process in place had many advantages but attracted some criticism too, most notably language, documentation and lack of continuity of the preceptor. The challenges of clinical assessment were multifaceted but the most pressing concern was dealing with students who were struggling in practice where the outcome of an assessment was potentially a fail. Preceptor midwives expressed reluctance to fail students but balanced this with ensuring safety for women and their babies. A number of other challenges hampered decisions in clinical assessments. These included the confidence of the preceptor, juggling the competing demands of clinical practice with effective assessment in an increasingly complex and fiscally challenging environment, operationalising the competency assessment process and the emotional toll associated with failing a student. CONCLUSION: Preceptors' primary focus is on ensuring that graduate midwives are safe and competent practitioners and it is this which guides their decision making on the outcome of clinical assessments. However, more support is required for the onerous responsibility of clinical assessment, particularly for less experienced midwives but also when failure of clinical assessment is a potential outcome. Preceptorship needs to be valued more at a strategic level.

Midwifery students' experiences of their clinical internship: A qualitative descriptive study.

BACKGROUND: Globally the safety of mothers and babies is fundamental in maternity care. Central to ensuring this safety is appropriate preparation of midwifery students' to ensure graduates are equipped to assume the responsibilities of delivering safe and effective maternity care. In preparation for autonomous practice Irish midwifery students' undertake a 36 week internship in the final year of the BSc Midwifery programme. Within this paid internship midwifery students' have the opportunity to develop professional behaviours, consolidate knowledge and learn necessary skills to fulfil the role of midwife under the supervision of registered midwives. OBJECTIVE: To explore midwifery students' experiences of the internship period. DESIGN AND METHOD: A descriptive qualitative study using focus groups with ethical approval. SETTING AND PARTICIPANTS: BSc Midwifery students' in the final year of their programme (n = 17) in an Irish University were invited to participate in a focus group interview midway through their internship. All participants (n = 13) had experience of working in two sites used for internship at the time of data collection. RESULTS: Key findings include the importance of the internship period in consolidating clinical skills and building confidence and competence for midwifery practice. Midwifery students' experience considerable stress during the internship period. Demands identified as stressors include providing care in increasingly complex clinical areas, meeting academic deadlines and maintaining a work life balance. Negative interpersonal experiences and dismissive attitudes to reflection on practice were barriers to learning. Midwifery students' articulated the importance of learning through doing, a supportive learning culture and philosophy in the unit, protected time for reflection and being included and valued as part of the midwifery team. CONCLUSIONS: The benefits and challenges associated with internship in midwifery are apparent, particularly when students' are contending with two geographically distant sites. Support mechanisms and suggestions for improvements are considered.

Preparing midwifery students for practice: The value of elective placements in enhancing midwifery practice.

An elective placement where students are facilitated to access different models of midwifery care was included in the 18 month Higher Diploma Midwifery programme in 2008 in a university in Ireland. All students since then have had the opportunity to experience this placement which is advocated by the regulatory board for Nursing and Midwifery in Ireland (NMBI). This paper details the integration of an elective placement referred to as an 'observation week' into the 18 month midwifery programme. It includes a description of the organisation of the observation week, a summary of services accessed by midwifery students, student evaluation of their experience and mechanisms for feedback of these experiences to our partners in clinical practice. The benefits and the challenges of the observation week are considered with reference to the published literature.

Employing a Qualitative Description Approach in Health Care Research.

A qualitative description design is particularly relevant where information is required directly from those experiencing the phenomenon under investigation and where time and resources are limited. Nurses and midwives often have clinical questions suitable to a qualitative approach but little time to develop an exhaustive comprehension of qualitative methodological approaches. Qualitative description research is sometimes considered a less sophisticated approach for epistemological reasons. Another challenge when considering qualitative description design is differentiating qualitative description from other qualitative approaches. This article provides a systematic and robust journey through the philosophical, ontological, and epistemological perspectives, which evidences the purpose of qualitative description research. Methods and rigor issues underpinning qualitative description research are also appraised to provide the researcher with a systematic approach to conduct research utilizing this approach. The key attributes and value of qualitative description research in the health care professions will be highlighted with the aim of extending its usage.

Exploring perinatal death with midwifery students' using a collaborative art project.

OBJECTIVE: To explore the influence of the Amulet artwork and exhibition on midwifery students' perceptions of caring for parents experiencing perinatal death. DESIGN: A descriptive qualitative design involving face-to-face semi-structured interviews following institutional ethical approval. SETTING: A regional Maternity Hospital in Ireland which hosted the National Artwork and Exhibition exploring the hidden world of infant death. PARTICIPANTS: A purposive sample of six consenting post registration midwifery students who had attended the Amulet artwork and exhibition. FINDINGS: Four core themes emerged and these were i) entering the mother's world and hearing her pain; ii) the journey of grief and connecting with the bereaved parent's unique experience; iii) facing the challenge of providing effective perinatal bereavement care; and iv) maintaining a journey of compassionate practice. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Exposure to, and reflection on the Amulet artwork and exhibition increased students' awareness and insight into the non-linear nature of the grieving process, and to the importance of maintaining a journey of compassionate care for parents experiencing perinatal death. The findings suggest that the use of creative women-centered strategies promote affective learning in relation to perinatal death and so may be of use to educators and maternity care providers.

Midwifery education in Ireland--The quest for modernity.

Midwifery education in Ireland has undergone significant changes in recent years including the introduction of direct entry midwifery programmes and a transfer of education to the university sector. While this has provided increased educational opportunities for midwives, the challenge for midwife educators is to prepare students for the increasing complexities of maternity care with a focus on obstetric risk and maternal morbidities with the need to educate midwifery students to support normality and provide woman centred care. The Nursing and Midwifery Board of Ireland has recently produced new Standards and Requirements for midwifery education and Practice Standards for midwives. This article provides information on midwifery education in Ireland and the documents that support the development of the profession.

Peer-supported review of teaching: making the grade in midwifery and nursing education.

This paper outlines the value of peer-supported review of teaching for nurse and midwifery educators in an academic environment. Reflection and continuing professional development are important tenets of an educators' practice and can be addressed via peer observation. Definitions and models of peer observation are presented. The strengths and challenges associated with peer-supported review of teaching are discussed. The reasons why peer observation is underutilised are explored with some suggestions on how to overcome these challenges. Recent developments in relation to peer observation and peer-supported review are outlined. The need for tangible evidence of development and enhancement of existing teaching expertise is very pronounced in the current economic climate, it is concluded that peer-supported review of teaching can provide such evidence.

Improving the content and face validity of OSCE assessment marking criteria on an undergraduate midwifery programme: a quality initiative.

UNLABELLED: Objective Structured Clinical Examinations (OSCE's) have been adopted as a means of assessing midwifery students' clinical skills. The purpose of the OSCE is to provide a standardised method for the evaluation of clinical skill performance in a simulated environment. This paper describes how a quality improvement initiative using both internal and external expert review was utilised to improve OSCE assessment marking criteria. The purpose of the quality initiative was to review the content and face validity of the marking criteria for assessing performance. The design and choice of tools used to score students' performance is central to reliability and validity. 20 videos of students from year one of a midwifery preregistration programme undertaking an OSCE assessment on abdominal examination and 18 videos of students response to obstetric emergencies e.g. PPH, and shoulder dystocia were available for review. The quality initiative aimed to strengthen the reliability and validity of the OSCE in assessing student performance. CONCLUSION: the use of global rating scales allows for the capturing of elements of professional competency that do not appear on specific criteria for skills performance checklists.