A cross-sectional study quantifies the independent contribution of nurses and midwives in child health outcomes.

INTRODUCTION: As the largest profession within the healthcare industry, nursing and midwifery workforce (NMW) provides comprehensive healthcare to children and their families. This study quantified the independent role of NMW in reducing under-5 mortality rate (U5MR) worldwide. DESIGN: A retrospective, observational and correlational study to examine the independent role of NMW in protecting against U5MR. METHODS: Within 266 "countries", the cross-sectional correlations between NMW and U5MR were examined with scatter plots, Pearson's r, nonparametric, partial correlation and multiple regression. The affluence, education and urban advantages were considered as the potential competing factors for the NMW-U5MR relationship. The NMW-U5MR correlations in both developing and developed countries were explored and compared. RESULTS: Bivariate correlations revealed that NMW negatively and significantly correlated to U5MR worldwide. When the contributing effects of economic affluence, urbanization and education were removed, the independent NMW role in reducing U5MR remained significant. NMW independently explained 9.36% U5MR variance. Multilinear regression selected NMW as a significant factor contributing an extra 3% of explanation to U5MR variance when NMW, affluence, education and urban advantage were incorporated as the predicting variables. NMW correlated with U5MR significantly more strongly in developing countries than in developed countries. CONCLUSION: NMW, indexing nursing and midwifery service, was a significant factor for reducing U5MR worldwide. This beneficial effect explained 9.36% of U5MR variance which was independent of economic affluence, urbanization and education. The NMW may be a more significant risk factor for protecting children from dying under 5 years old in developing countries. As a strategic response to the advocacy of the United Nations to reduce child mortality, it is worthy for health authorities to consider a further extension of nurses and midwives' practice scope to enable communities to have more access to NMW healthcare services.

Safety culture in maternity hospital: Perception of nurse-midwives.

AIM: To explore nurse-midwives' perceptions of safety culture in maternity hospitals. DESIGN: A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research. METHODS: Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis. FINDINGS: Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication. CONCLUSION: The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential. IMPACT: Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves.

Nurses' and midwives' experiences of managing parental postnatal depression: A scoping review.

AIM: To describe the current state of the literature on nurses' and midwives' knowledge, perceptions and experiences of managing parental postnatal depression (PPND). DESIGN: The Joanna Briggs Institute scoping review method and the PRISMA extension for Scoping Reviews guided the work. DATA SOURCES: A systematic search of PubMed, CINAHL, Embase, MEDLINE, PsycINFO and Scopus databases was conducted in January and February 2023. REVIEW METHODS: Peer-reviewed primary research articles published in English between 2012 and 2023 that involved nurses or midwives managing PPND were included. Rayyan was used to screen titles, abstracts and full-text articles. A spreadsheet was used to organize extracted data and synthesize results. RESULTS: Twenty-nine articles met the inclusion criteria. Most study samples were of mothers, and few were from middle- and lower-income countries. Nurses and midwives lacked knowledge about PPND, yet they felt responsible for its management. Nurses and midwives faced significant organizational and systems-level challenges in managing PPND. However, nurses and midwives facilitated PPND care in collaboration with other healthcare providers. CONCLUSION: The review highlights significant gaps in the nurses' and midwives' care of PPND. Educational programmes are necessary to increase nurse and midwife knowledge of PPND and strategies for its management, including facilitating collaboration across the healthcare system and eliminating organizational and systemic-related barriers. Additional focused research is needed on nurses' and midwives' knowledge, perception of and experience with PPND beyond mothers, such as with fathers, sexually and gender-minoritized parents and surrogate mothers. Finally, additional research is needed in middle- and lower-income countries where nurses and midwives may face a higher burden of and unique cultural considerations in managing PPND. IMPACT: PPND can affect the parent's mental and physical health and relationship with their child. If left untreated, PPND can lead to long-term consequences, including child developmental delays, behavioural problems and difficulties with parental-child attachment. REPORTING METHOD: This scoping review adheres to PRISMA Extension for Scoping Review guidelines and the Joanna Briggs Institute scoping review method. PATIENT OR PUBLIC CONTRIBUTION: This research is a scoping review of published peer-reviewed studies.

Enhancing new graduate nurses and midwives person-centredness through clinical supervision during COVID-19; evaluation of a non-randomized intervention study.

AIM: The aim of the study was to evaluate a person-centred model of clinical supervision to enhance person-centredness. DESIGN: Experimental, quantitative. METHODS: One hundred and three New Graduates were supported to reflect through a person-centred lens (July-December 2020). Evaluation was undertaken at 6 months using: the Manchester Clinical Supervision Scale-26 (effectiveness of supervision) and the Person-centred Practice Inventory (measures attributes of the nurse/midwife, the care environment and person-centred processes). Due to participation difficulties, scores were calculated by attendance rates using descriptive and inferential statistics. RESULTS: Regular attendees scored higher on the supervision's effectiveness; however, this did not reach efficacy. 'Finding time' to attend contributed to low scores. Supervision scored well on its supportive function when attended. Many New Graduates perceived a decline in their care environment. Attendance aside, New Graduates averaged an increased in their person-centred attributes and processes. Greater participation was found in those who scored higher at baseline on their person-centred attributes and processes, and this higher scoring continued at 6 months than those who attended less. CONCLUSION: New Graduates who perceive themselves as person-centred and reflective at baseline are more likely to attend a person-centred clinical supervision and score higher at 6 months than those who attended less often. New Graduates found support within supervision during challenging times. IMPLICATIONS FOR PRACTICE FOR PROFESSIONAL AND/OR PATIENT CARE: For successful implementation of Person-centred Clinical Supervision, New Graduates need support to attend, as attendance supports them to begin seeing value in the process. IMPACT: This intervention kept person-centred practice at the forefront of New Graduates reflection, in a time of extreme change. The research has implications for nursing and midwifery management with the imperative to deliver person-centred care and create the person-centred cultures for staff to feel supported and empowered. REPORTING METHOD: Transparent Evaluation of Non-randomized Designs (TREND). PATIENT OF PUBLIC CONTRIBUTION: No patient or public contribution. CONTRIBUTION TO WIDER COMMUNITY: New Graduates grow their person-centredness over their transitioning year; however, this can be enhanced with regular clinical supervision underpinned by person-centred theory. Clinical supervisors can provide support to New Graduates when the environment is challenged.

Supporting older nurses and midwives in the Australian healthcare workplace-A qualitative descriptive study.

AIM: To explore support strategies for older nurses and midwives in Australian healthcare workplaces. DESIGN: A qualitative descriptive study. METHOD: Participants were 50 older nurses and midwives and 20 healthcare managers recruited from a broad range of Australian healthcare settings. Data were collected using semi-structured interviews from November 2018 to April 2021. The interviews were recorded, transcribed and thematically analysed. RESULTS: The limited number of identified sedentary roles and inequitable distribution of workload responsibilities were identified as constraints that impact the provision of workplace support for older nurses and midwives in healthcare settings. Three major themes were identified: Workplace support, Personal support and Doing more. A small number of participants reported support was available at work, but most said there was not. Of the reported strategies some were offered exclusively to a cohort that met an age criterion, while others were open to all staff regardless of age. Personal support strategies were employed outside of the workplace while others used strategies during working hours. Doing more related to suggestions about how organizations could do more to support older nurses and midwives at work. CONCLUSION: Support mechanisms like adjustments in workload, employment fraction, practice location, upskilling and wellness programs in workplaces are limited. To facilitate retention and support older nurses and midwives in the workforce, health workplaces should consider implementing support mechanisms that can be tailored to the individual needs of the nurse or midwife over the life course of their career. IMPACT: The findings of this study highlight the lack of support for many older nurses and midwives in Australian healthcare workplaces, emphasizing the need for further research into innovative practices on how to better support healthcare staff as they age. REPORTING METHOD: This study adhered to the COREQ reporting method. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

'We aren't valued for who we are': Australian nurses' and midwives' perceptions of challenges and barriers to safeguarding children.

PURPOSE: Professionals working with children, including nurses and midwives, are foundational to effectively safeguarding children from maltreatment. However, little is known about the full nature and scope of nurses' and midwives' roles in safeguarding children in Australia presenting barriers to effective workforce preparation and support. DESIGN AND METHODS: This study reports an inductive analysis of qualitative responses (n = 51 Round 1, n = 17 Round 2) from a two-round Delphi study. The Delphi study aimed to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children, and this manuscript presents findings of an inductive analysis of qualitative responses beyond the scope of the Delphi study. Participants were Australian nurses and midwives (n = 51, n = 17) from diverse child-focussed settings. RESULTS: Nurses and midwives experienced many factors outside of their control that restricted their capacity to safeguard children. Influences included high workloads, burnout, lack of support, poor collaboration, structural barriers and inaccessible services for children. CONCLUSIONS: Nurses and midwives are advocates for children but experienced many factors preventing them from effectively safeguarding children. Future approaches to reducing child maltreatment must be underpinned by support for frontline professionals to promote workforce capacity and sustainability. PRACTICE IMPLICATIONS: Despite nurses' and midwives' best intentions, their attempts to prevent and respond to child maltreatment were hampered by systemic factors beyond their control. This study highlighted the need to address broader influences on nursing and midwifery practice to reduce the impacts of child maltreatment and support children to thrive.

Exploring Nurse perceptions of structural empowerment in midwifery practice in Saudi Arabia: A qualitative study.

Perceptions and experiences of midwives regarding structural empowerment during practice in Saudi Arabia were explored using a qualitative, constructive, descriptive design. Data was gathered using individual semi-structured interviews with ten midwives employed in delivery rooms, and prenatal and postnatal units of governmental hospitals in Saudi Arabia's eastern province. Data was analyzed with assistance of NVivo software, Version 12. Five themes emerged from our study: the meaning of structural empowerment, ambiguous hospital policies, the insufficient numbers of midwives, midwife-physician dynamics, and continuing education and training. Structural empowerment of midwives in maternity units may be useful in improving midwifery services in Saudi Arabia and worldwide.

What is the further research?Further studies on this topic should expand the current study's sample and include participants from more regions of Saudi Arabia. In addition, research on the psychological empowerment of midwives is needed.What is known on the subject?Midwives are educated to care for women during pregnancy, birth, and postnatal, and midwives must be empowered to fulfill this professional role. The evidence showed the importance of structural empowerment for midwives to perform their professional function and provide quality care for women during pregnancy, birth, and postnatal.What does this paper add to existing knowledge?In Saudi Arabia, there is little research evidence on how to explore the perceptions and experiences of structural empowerment among midwives. Our study provided valuable recommendations for identifying environmental practices, positive workplace characteristics, and promoting higher-quality midwifery in the workplace.What are the implications for practice?Midwife workplace empowerment is correlated with the quality of care, job satisfaction, staff effectiveness, and the positivity of the work environment. The results of this study suggest that every healthcare organization must work to bring about structural empowerment for midwives to facilitate successful practice.

The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives unemployment crisis in Ghana.

Following periods of health workforce crisis characterised by a severe shortage of nurses, midwives and doctors due to low production rates and excessive out-migration, the Government of Ghana through the Ministry of Health (MOH) responded by expanding training and allowing private sector involvement in the training of health workers especially nurses and midwives. This resulted in substantial increases in the production levels of nurses and midwives even above the projections of the MOH. In this paper, we discuss how a strategy that was seemingly well planned suffered a decade of uncorrected implementation lapses resulting in a lingering need-based shortage of nurses and midwives at service delivery points whilst thousands of trained nurses and midwives remained unemployed for up to 4 years and constantly protesting for jobs. In the short term, we argue that the Government of Ghana would need to increase investment to recruit trained and unemployed nurses and midwives whilst a comprehensive health labour market analysis is conducted to provide robust evidence towards the development of a long-term health workforce plan that would guide future production of nurses and midwives. The Government of Ghana may also explore the option of a managed migration programme to export nurses/midwives to countries that are already destinations to individual migration initiatives in a bid to mitigate the potential skill loss associated with long periods of unemployment after training, especially for those who trained from the private institutions.

Midwives' challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo-an interview study.

BACKGROUND: The Democratic Republic of Congo (DRC) has high maternal mortality and a low number of midwives, which undermines the achievement of goal 3 of the Sustainable Development Goals (SDGs) for 2030, specifically the health of the mother and newborn. Scaling up the midwifery workforce in relation to number, quality of healthcare, and retention in service is therefore critical. The aim of this study was to investigate midwives' challenges and factors that motivate them to remain in their workplace in the DRC. METHODS: Data were collected in two out of 26 provinces in the DRC through ten focus group discussions with a total of 63 midwives working at ten different healthcare facilities. Transcribed discussions were inductively analysed using content analysis. RESULTS: The midwives' challenges and the factors motivating them to remain in their workplace in the DRC are summarised in one main category-Loving one's work makes it worthwhile to remain in one's workplace, despite a difficult work environment and low professional status-consisting of three generic categories: Midwifery is not just a profession; it's a calling is described in the subcategories Saving lives through midwifery skills, Building relationships with the women and the community, and Professional pride; Unsupportive organisational system is expressed in the subcategories Insufficient work-related security and No equitable remuneration system, within Hierarchical management structures; and Inadequate pre-conditions in the work environment includes the subcategories Lack of resources and equipment and Insufficient competence for difficult working conditions. CONCLUSION: Midwives in the DRC are driven by a strong professional conscience to provide the best possible care for women during childbirth, despite a difficult work environment and low professional status. To attract and retain midwives and ensure that they are working to their full scope of practice, we suggest coordinated actions at the regional and national levels in the DRC and in other low-income countries with similar challenges, including (i) conducting midwifery education programmes following international standards, (ii) prioritising and enforcing policies to include adequate remuneration for midwives, (iii) involving midwives' associations in policy and planning about the midwifery workforce, and (iv) ensuring that midwives' working environments are safe and well equipped.

Knowledge, attitude, and preparedness toward IPV care provision among nurses and midwives in Tanzania.

BACKGROUND: With increasing recognition of intimate partner violence (IPV) as a public health challenge, nurses and midwives are recognized for their crucial role in providing front-line healthcare services for IPV. This study aimed to evaluate knowledge, attitude, and preparedness related to IPV care provision in health facilities among nurses and midwives in Tanzania. METHODS: A self-administered anonymous questionnaire survey was conducted among nurses and midwives working in health facilities in the Mbeya region between December 2018 and January 2019. The questionnaire consisted of questions on their perceived and actual knowledge, attitudes, and preparedness to provide care in relation to IPV. RESULTS: A total of 662 (50.1%) of 1321 nurses and midwives who worked in hospitals and/or health centers in the Mbeya region participated in this study, and 461 (69.6%) completed questionnaires were included in the analysis. The proportion of nurses and midwives with high scores in IPV perceived knowledge, actual knowledge, attitude, and preparedness to provide care was 59.9%, 53.1%, 54.2%, and 54.0%, respectively. Regardless of the type of facility, gender, educational level, and work experience, the use of IPV guidelines was significantly associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.004), and preparedness to provide care (P < 0.001), but not attitude, which was negatively associated (P = 0.048). Regardless of the type of facility, gender, educational level, and work experience, receiving preservice IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.049), and preparedness to provide care (P = 0.002), but not attitude (P = 0.192). Regardless of the type of facility, gender, educational level, and work experience, in-service IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.043), and preparedness to provide care (P = 0.001), but not attitude (P = 0.063). CONCLUSIONS: Although guidelines and training could improve nurses' and midwives' knowledge and preparedness to provide care regarding IPV, attitudes against IPV care are a challenge. To improve attitudes regarding IPV among front-line nurses and midwives, it is necessary to address concepts of IPV care and sympathy with potential and actual victims of IPV in pre- and in-service training in addition to providing recall-level knowledge.

Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 being implemented in countries? Findings from a cross-sectional analysis.

BACKGROUND: Nurses and midwives are the largest component of the health workforce in many countries. The World Health Organization (WHO) together with its partners facilitates the joint development of strategic policy guidance for countries to support the optimization of their nursing and midwifery workforce. The Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 (SDNM) is a global policy guidance tool that provides a framework for Member States, the WHO and its partners to adapt, develop, implement and evaluate nursing and midwifery policy interventions in Member States. As part of the broader monitoring and accountability functions of the WHO, assessing the progress of the SDNM implementation at a country level is key to ensuring that countries stay on track towards achieving universal health coverage (UHC) and the sustainable development goals (SDGs). METHODS: This is a cross-sectional mixed methods study involving the analysis of quantitative and qualitative data on the implementation of country-level interventions in the SDNM. Data was provided by government chief nursing and midwifery officers or their representatives using an online self-reported questionnaire. The quantitative data was assessed using a three-level scale and descriptive statistics while qualitative comments were analysed and presented narratively. RESULTS: Thirty-five countries completed the survey. Summing up the implementation frequency of interventions across all thematic areas, 19% of responses were in the category of "completed"; 55% were reportedly "in progress" and 26% indicated a status of "not started". Findings reveal a stronger level of implementation for areas of nursing and midwifery development related to enhancing regulation and education, creating stronger roles for professional associations and policy strengthening. Leadership and interprofessional collaboration are intervention areas that were less implemented. CONCLUSION: Monitoring and accountability of countries' commitments towards implementing nursing and midwifery interventions, as outlined in the SDNM, contributes to strengthening the evidence base for policy reforms in countries. This stock-taking can inform policy- and decision-makers' deliberations on strengthening the contributions of nurses and midwives to achieving UHC and the SDGs.

The role and scope of practice of midwives in humanitarian settings: a systematic review and content analysis.

BACKGROUND: Midwives have an essential role to play in preparing for and providing sexual and reproductive health (SRH) services in humanitarian settings due to their unique knowledge and skills, position as frontline providers and geographic and social proximity to the communities they serve. There are considerable gaps in the international guidance that defines the scope of practice of midwives in crises, particularly for the mitigation and preparedness, and recovery phases. We undertook a systematic review to provide further clarification of this scope of practice and insights to optimise midwifery performance. The review aimed to determine what SRH services midwives are involved in delivering across the emergency management cycle in humanitarian contexts, and how they are working with other professionals to deliver health care. METHODS: Four electronic databases and the websites of 33 organisations were searched between January and March 2017. Papers were eligible for inclusion if they were published in English between 2007 and 2017 and reported primary research pertaining to the role of midwives in delivering and performing any component of sexual and/or reproductive health in humanitarian settings. Content analysis was used to map the study findings to the Minimum Initial Service Package (MISP) for SRH across the three phases of the disaster management cycle and identify how midwives work with other members of the health care team. RESULTS: Fourteen studies from ten countries were included. Twelve studies were undertaken in conflict settings, and two were conducted in the context of the aftermath of natural disasters. We found a paucity of evidence from the research literature that examines the activities and roles undertaken by midwives across the disaster management cycle. This lack of evidence was more apparent during the mitigation and preparedness, and recovery phases than the response phase of the disaster management cycle. CONCLUSION: Research-informed guidelines and strategies are required to better align the scope of practice of midwives with the objectives of multi-agency guidelines and agreements, as well as the activities of the MISP, to ensure that the potential of midwives can be acknowledged and optimised across the disaster management cycle.

Functioning and time utilisation by female multi-purpose health workers in South India: a time and motion study.

BACKGROUND: Auxillary nurse midwives (ANMs) are the most important frontline multi-purpose workers in rural India. This study was conducted to assess the spectrum of service delivery, time utilisation, work planning, and factors affecting functioning of ANMs in South India. METHODS: We conducted a time and motion study in three districts across two states in South India. The districts selected in such a manner that they had a considerable tribal population. We conducted multi-stage sampling to select ANMs. We directly observed 43 ANMs consecutively for six working days and in-depth interviewed all selected ANMs, their supervisors, medical officers, and district health officials. We conducted an FGD to substantiate the findings from observations and interviews. Observation findings were analysed under three broad domains: (i) programme activities, (ii) programme support activities, and (iii) other work. Time spent was calculated in median (interquartile range, IQR) minutes/ANM per week or day. Qualitative data were coded and analysed using grounded theory, and appropriate themes and sub-themes were identified. RESULTS: ANMs worked for median 7 h a day (7:10 h, non-tribal; 6:20 h, tribal). There is variation in the hours of work, the pattern of service provided and time utilisation across days of a week. ANMs spent 60% of their on-job time on programmatic activities (median 22:38 h; IQR, 20:48-27:01 h) in a week. Emphasis is more on home visits, universal immunisation, antenatal care, school health, and seasonal diseases. ANMs spent negligible time on non-communicable diseases, adolescent health, nutrition, etc. ANMs spent the remaining time in program support activities, such as meetings with seniors, community meetings, and other non-health related work. There are no renewed job description, work plans, and supervision guidelines, even with newly added programs and tasks. ANMs prioritised work as per the priorities set by the supervisors and leaders. Health administration often disrupts the regular functioning of ANMs for training, meetings and other ad hoc work. CONCLUSION: ANMs are overworked; they often multi-task and fail to deliver efficiently. The administration needs to re-assess the workload. The administration may reduce expected work, provide strong supervisory support, and make conscious efforts to pose fewer disruptions in regular working of ANMs.

Human resources for health in Peru: recent trends (2007-2013) in the labour market for physicians, nurses and midwives.

BACKGROUND: Most analyses of gaps in human resources for health (HRH) do not consider training and the transition of graduates into the labour market. This study aims to explore the labour market for Peru's recent medical, nursing, and midwifery graduates as well as their transition into employment in the Ministry of Health's (MOH) system. METHODS: Data from four different datasets, covering 2007-2013, was used to characterize the patterns of recently trained physicians, nurses, midwives, and postgraduate-trained physicians that enter employment in the MOH system, and scenario analyses were used to describe how this rate of entry needs to adapt in order to fill current HRH shortages. RESULTS: HRH graduates have been increasing from 2007 to 2011, but the proportions that enter employment in the MOH system 2 years later range from 8 to 45% and less than 10% of newly trained medical specialists. Scenario analyses indicate that the gap for physicians and nurses will be met in 2027 and 2024, respectively, while midwives in 2017. However, if the number of HRH graduates entering the MOH system doubles, these gaps could be filled as early as 2020 for physicians and 2019 for nurses. In this latter scenario, the MOH system would still only utilize 56% of newly qualified physicians, 74% of nurses, and 66% of midwives available in the labour market. CONCLUSION: At 2013 training rates, Peru has the number of physicians, nurses, and midwives it needs to address HRH shortages and meet estimated HRH gaps in the national MOH system during the next decade. However, a significant number of newly qualified health professionals do not work for the MOH system within 2 years of graduation. These analyses highlight the importance of building adequate incentive structures to improve the entry and retention of HRH into the public sector.

A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals.

AIM: The aim of this study was to systematically review evidence relating to clinical supervision for nurses, midwives and allied health professionals. BACKGROUND: Since 1902 statutory supervision has been a requirement for UK midwives, but this is due to change. Evidence relating to clinical supervision for nurses and allied health professions could inform a new model of clinical supervision for midwives. DESIGN: A systematic review with a contingent design, comprising a broad map of research relating to clinical supervision and two focussed syntheses answering specific review questions. DATA SOURCES: Electronic databases were searched from 2005 - September 2015, limited to English-language peer-reviewed publications. REVIEW METHODS: Systematic reviews evaluating the effectiveness of clinical supervision were included in Synthesis 1. Primary research studies including a description of a clinical supervision intervention were included in Synthesis 2. Quality of reviews were judged using a risk of bias tool and review results summarized in tables. Data describing the key components of clinical supervision interventions were extracted from studies included in Synthesis 2, categorized using a reporting framework and a narrative account provided. RESULTS: Ten reviews were included in Synthesis 1; these demonstrated an absence of convincing empirical evidence and lack of agreement over the nature of clinical supervision. Nineteen primary studies were included in Synthesis 2; these highlighted a lack of consistency and large variations between delivered interventions. CONCLUSION: Despite insufficient evidence to directly inform the selection and implementation of a framework, the limited available evidence can inform the design of a new model of clinical supervision for UK-based midwives.

A model for upscaling global partnerships and building nurse and midwifery capacity.

AIM: To provide a unique model for use in guiding global collaboration and policy to upscale nursing and midwifery partnerships. BACKGROUND AND INTRODUCTION: Nurses and midwives across nations need skills reaching beyond the bedside and unit level in today's complex, global, multifaceted healthcare milieu. Thoughtful consideration, research and concomitant development of models to guide appropriate upscaling of nurse and midwifery capacity within and between nations are needed. DISCUSSION: This article explores an integrated global approach to upscaling nurse and midwifery capacity using examples of partnerships between nursing and midwifery programmes across multiple continents. CONCLUSION AND IMPLICATIONS FOR NURSING: Global nurse and midwifery capacity is effectively being developed using a myriad of approaches. A new model is presented to illustrate supports, strategies and activities to achieve intermediate and long-term goals for capacity building through strong and sustainable global partnerships. IMPLICATION FOR NURSING POLICY: Development of global skills can focus the nurse and midwife to influence policy-level decisions. Human resource planning that can impact countrywide provision of health care begins in the preservice setting for both nurses and midwives. A global experience can be a value-added component to the well-rounded education of future nurses. Education during preparation for entry into practice is a strategic way to develop a worldview. Incorporating reflective practice can build skills and shape attitudes to prepare the new nurse to be comfortable as a global healthcare provider. An expanded world view is the springboard to more robust and informed involvement and inclusion in policy-level discussions.

Nursing regulation reforms win backing.

The Department of Health (DH) has backed proposals to overhaul the 'outdated' legal framework of the Nursing and Midwifery Council (NMC).

Examining the influence of country-level and health system factors on nursing and physician personnel production.

BACKGROUND: A key component to achieving good patient outcomes is having the right type and number of healthcare professionals with the right resources. Lack of investment in infrastructure required for producing and retaining adequate numbers of health professionals is one reason, and contextual factors related to socioeconomic development may further explain the trend. Therefore, this study sought to explore the relationships between country-level contextual factors and healthcare human resource production (defined as worker-to-population ratio) across 184 countries. METHODS: This exploratory observational study is grounded in complexity theory as a guiding framework. Variables were selected through a process that attempted to choose macro-level indicators identified by the interdisciplinary literature as known or likely to affect the number of healthcare workers in a country. The combination of these variables attempts to account for the gender- and class-sensitive identities of physicians and nurses. The analysis consisted of 1 year of publicly available data, using the most recently available year for each country where multiple regressions assessed how context may influence health worker production. Missing data were imputed using the ICE technique in STATA and the analyses rerun in R as an additional validity and rigor check. RESULTS: The models explained 63 % of the nurse/midwife-to-population ratio (pseudo R (2) = 0.627, p = 0.0000) and 73 % of the physician-to-population ratio (pseudo R (2) = 0.729, p = 0.0000). Average years of school in a country's population, emigration rates, beds-per-1000 population, and low-income country statuses were consistently statistically significant predictors of production, with percentage of public and private sector financing of healthcare showing mixed effects. CONCLUSIONS: Our study demonstrates that the strength of political, social, and economic institutions does impact human resources for health production and lays a foundation for studying how macro-level contextual factors influence physician and nurse workforce supply. In particular, the results suggest that public and private investments in the education sector would provide the greatest rate of return to countries. The study offers a foundation from which longitudinal analyses can be conducted and identifies additional data that may help enhance the robustness of the models.

A descriptive analysis of midwifery education, regulation and association in 73 countries: the baseline for a post-2015 pathway.

BACKGROUND: Education, regulation and association (ERA) are the supporting pillars of an enabling environment for midwives to provide quality care. This study explores these three pillars in the 73 low- and middle-income countries who participated in the State of the World's Midwifery (SoWMy) 2014 report. It also examines the progress made since the previous report in 2011. METHODS: A self-completion questionnaire collected quantitative and qualitative data on ERA characteristics and organisation in the 73 countries. The countries were grouped according to World Health Organization (WHO) regions. A descriptive analysis was conducted. RESULTS: In 82% of the participating countries, the minimum education level requirement to start midwifery training was grade 12 or above. The average length of training was higher for direct-entry programmes at 3.1 years than for post-nursing/healthcare provider programmes at 1.9 years. The median number of supervised births that must be conducted before graduation was 33 (range 0 to 240). Fewer than half of the countries had legislation recognising midwifery as an independent profession. This legislation was particularly lacking in the Western Pacific and South-East Asia regions. In most (90%) of the participating countries, governments were reported to have a regulatory role, but some reported challenges to the role being performed effectively. Professional associations were widely available to midwives in all regions although not all were exclusive to midwives. CONCLUSIONS: Compared with the 2011 SoWMy report, there is evidence of increasing effort in low- and middle-income countries to improve midwifery education, to strengthen the profession and to follow international ERA standards and guidelines. However, not all elements are being implemented equally; some variability persists between and within regions. The education pillar showed more systematic improvement in the type of programme and length of training. The reinforcement of regulation through the development of legislation for midwifery, a recognised definition and the strengthening of midwives' associations would benefit the development of other ERA elements and the profession generally.

What do health workers in Timor-Leste want, know and do? Findings from a national health labour market survey.

BACKGROUND: The objectives of this study were to understand the labour market dynamics among health workers, including their preferences and concerns, and to assess the skills, competence and performance (i.e. the 'know-do gap') of doctors working in Timor-Leste. METHODS: This cross-sectional survey was implemented in all 13 districts of Timor-Leste in 2014. We surveyed 443 health workers, including 175 doctors, 150 nurses and 118 midwives (about 20% of the health workers in the country). We also observed 632 clinical consultations with doctors, including 442 direct clinical observations, and tested 190 vignettes. RESULTS: The study highlights some positive findings, including the gender balance of health workers overall, the concentration of doctors in rural areas, the high overall reported satisfaction of staff with their work and high motivation, the positive intention to stay in the public sector, the feeling of being well prepared by training for work, the relatively frequent and satisfactory supervisions, and the good attitudes towards patients as identified in observations and vignettes. However, some areas require more investigations and investments. The overall clinical performance of the doctors was very good in terms of attitude and moderate in regard to history taking, health education and treatment. However, the average physical examination performance score was low. Doctors performed better with simulated cases than the real cases in general, which means they have better knowledge and skills than they actually demonstrated. The factors that were significantly associated with the clinical performance of doctors were location of the health facility (urban doctors were better) and consultation time (cases with more consultation time were better). Regression analysis suggests that lack of knowledge was significantly associated with lack of performance, while lack of motivation and equipment were not significant. CONCLUSIONS: The survey provides essential information for workforce planning and for developing training policies and terms and conditions that will attract and retain health workers in rural service. Improving the work environment and performance of doctors working in rural health facilities and ensuring compliance with clinical protocols are two priority areas needed to improve the performance of doctors in Timor-Leste.