"Thai Nurses' and Midwives' Perceptions Regarding Barriers, Facilitators, and Competence in Neonatal Pain Management".

BACKGROUND: Effective neonatal pain management is reliant upon the expert care of nurses and midwives working in neonatal intensive care units (NICUs). Previous research has explored barriers, facilitators, and some aspects of nurse competence in managing neonatal pain; however, this research has been predominantly performed in Western countries. To date, little is known about the barriers, facilitators, and perceived competence of Thai nurses and midwives in relation to neonatal pain management in NICUs. Exploring Thai nurses' and midwives' perceptions in these areas is crucial for understanding the contextual nuances of neonatal pain management, which can guide the provision of care for these high-risk neonates. PURPOSE: To investigate nurses' and midwives' perceptions of barriers, facilitators, and competence regarding effective neonatal pain management in Thai NICUs. METHODS: Data were collected using virtual one-to-one, semistructured interviews with 12 neonatal nurses and midwives between July and August 2021 in 3 units of 2 tertiary hospitals in Southern Thailand. Inductive thematic analysis was used to examine interview data. RESULTS: These data revealed following 3 major themes: ( a ) barriers to effective neonatal pain management, ( b ) facilitators of effective neonatal pain management, and ( c ) perceptions of competence. IMPLICATIONS FOR PRACTICE: Assisting nurses and midwives in overcoming barriers and strengthening facilitators while enhancing their competence may result in better neonatal pain management. IMPLICATIONS FOR RESEARCH: This study adds to our understanding that further research is needed to develop the interventions designed to change at individual, unit, and organizational levels, particularly implementing parent-friendly visitation and ongoing professional development in neonatal pain management.

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.

A pre-post interventional study to reduce time spent on clinical documentation by nurses and midwives.

AIM: To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care. DESIGN: A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines. METHODS: An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity. RESULTS: Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete post-intervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced. CONCLUSION: The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care. IMPACT: This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, The intervention reduced time spent on clinical documentation and increased time for direct patient care, This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care. REPORTING METHOD: The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines. PATIENT OR PUBLIC CONTRIBUTION: The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript.

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.

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.

Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis.

AIM: To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care. DESIGN: A qualitative interpretative phenomenological analysis. METHODS: A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis. RESULTS: Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice. CONCLUSION: There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care. IMPACT AND IMPLICATIONS: The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY: As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care. REPORTING METHOD: Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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.

Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review.

AIM: To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care. DESIGN: This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCE/REVIEW METHODS: Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models. RESULTS: One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy. CONCLUSION: Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective. IMPACT: Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally. REPORTING METHOD: This review is reported against the PRISMA-ScR criteria. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. PROTOCOL REGISTRATION: The study protocol is published in BJGP Open (Moulton et al., 2022).

'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.

Managing uncertainty in forecasting health workforce demand using the Robust Workforce Planning Framework: the example of midwives in Belgium.

BACKGROUND: In Belgium, the Planning Commission for Medical Supply is responsible for monitoring human resources for health (HRH) and ultimately proposing workforce quotas. It is supported by the Planning Unit for the Supply of the Health Professions. This Unit quantifies and forecasts the workforce in the healthcare professions on the basis of a stock and flow model, based on trends observed in the past. In 2019, the Planning Unit asked the KCE (Belgian Health Care Knowledge Centre) to develop additional forecasting scenarios for the midwifery workforce, to complement the standard historical trend approach. The aim of this paper is to present the development of such forecasting scenarios. METHODS: The Robust Workforce Planning Framework, developed by the Centre for Workforce Intelligence in the UK was used to develop alternative midwifery workforce scenarios. The framework consists of four steps (Horizon scanning, Scenario generation, Workforce modelling, and Policy analysis), the first two of which were undertaken by KCE, using two online surveys and five workshops with stakeholders. RESULTS: Three alternative scenarios are proposed. The first scenario (close to the current situation) envisages pregnancy and maternity care centred on gynaecologists working either in a hospital or in private practice. The second scenario describes an organisation of midwife-led care in hospitals. In the third scenario, care is primarily organised by primary care practitioners (midwives and general practitioners) in outpatient settings. CONCLUSIONS: The Robust Workforce Planning Framework provides an opportunity to adjust the modelling of the health workforce and inform decision-makers about the impact of their future decisions on the health workforce.

A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh.

BACKGROUND: Expanding the health workforce to increase the availability of skilled birth attendants (SBAs) presents an opportunity to expand the power and well-being of frontline health workers. The role of the SBA holds enormous potential to transform the relationship between women, birthing caregivers, and the broader health care delivery system. This paper will present a novel approach to the community-based skilled birth attendant (SBA) role, the Skilled Health Entrepreneur (SHE) program implemented in rural Sylhet District, Bangladesh. CASE PRESENTATION: The SHE model developed a public-private approach to developing and supporting a cadre of SBAs. The program focused on economic empowerment, skills building, and formal linkage to the health system for self-employed SBAs among women residents. The SHEs comprise a cadre of frontline health workers in remote, underserved areas with a stable strategy to earn adequate income and are likely to remain in practice in the area. The program design included capacity-building for the SHEs covering traditional techno-managerial training and supervision in programmatic skills and for developing their entrepreneurial skills, professional confidence, and individual decision-making. The program supported women from the community who were social peers of their clients and long-term residents of the community in becoming recognized, respected health workers linked to the public system and securing their livelihood while improving quality and access to maternal health services. This paper will describe the SHE program's design elements to enhance SHE empowerment in the context of discourse on social power and FLHWs. CONCLUSION: The SHE model successfully established a private SBA cadre that improved birth outcomes and enhanced their social power and technical skills in challenging settings through the mainstream health system. Strengthening the agency, voice, and well-being of the SHEs has transformative potential. Designing SBA interventions that increase their power in their social context could expand their economic independence and reinforce positive gender and power norms in the community, addressing long-standing issues of poor remuneration, overburdened workloads, and poor retention. Witnessing the introduction of peer or near-peer women with well-respected, well-compensated roles among their neighbors can significantly expand the effectiveness of frontline health workers and offer a model for other women in their own lives.

Patient Targeted Googling by nurses and midwives in Poland.

INTRODUCTION: Patient Targeted Googling (PTG) is not a new phenomenon, but in Poland - according to the information available to the authors - there has been no research in this area among nurses and midwives. The above-mentioned activity is associated with many doubts and concerns of legal and ethical issues, and therefore there is a need to explore it. OBJECTIVE: The aim of this study was to assess the prevalence of PTG among nurses and midwives in Poland. MATERIAL AND METHODS: The study conducted among 300 working nurses and midwives used a diagnostic survey based on the author's survey questionnaire. Statistical analysis was performed using PQStat version: 1.8.4.142. Mann-Whitney U tests, chi-square and Fisher's correlations were used. The significance level was adopted at p <0.05 and highly significant at p <0.01. RESULTS: The respondents' reasons for patient targeted googling were mainly lack of other sources of information, controlling adherence to recommendations, ascertaining the patient's mental disorders, behavior, substance abuse status and physical appearance. PTG without informing the patient was considered unethical and likely to violate the principle of informed consent and privacy. Respondents expressed the need for PTG training. CONCLUSIONS: The study presents the prevalence of PTG phenomenon among Polish nurses and midwives along with the different determinants of this activity.

Accreditation of private midwifery and nursing schools in Mali: a local sustainable solution to increasing the supply of qualified health workers.

BACKGROUND: The World Health Organization's Global Strategy on Human Resources for Health (HRH) emphasizes the importance of dynamic and effective health worker regulation for achieving the health-related Sustainable Development Goals, with the establishment of education standards and quality assurance of education programs being critical. Governments in West Africa have struggled to address the problems within their higher education systems for health professionals, and it is now generally acknowledged that private institutions can play a crucial role in revitalizing the region's outdated universities. However, the rapid expansion of private schools raises concerns about the quality of education and adequacy of regulatory mechanisms. The USAID-funded Mali HRH Strengthening Activity, led by IntraHealth International, assisted Mali's Ministry of Health and Social Development to deliver targeted HRH interventions to improve the quality of education in private universities, better manage available health workers, and initiate a decentralized strategy for health worker recruitment and motivation. CASE PRESENTATION: In 2018, the HRH activity leveraged the West African Health Organization (WAHO)'s accreditation system to support 10 private nursing schools to introduce WAHO's regionally accepted, competency-based curriculum in reproductive, maternal, newborn, and child health. The project undertook a 10-step process to work alongside private nursing and midwifery schools to assess their current status against WAHO regional standards, implement action plans to address identified gaps, and support the institutions toward accreditation. As a result, eight schools in Mali are now accredited compared to only three at project inception. CONCLUSIONS: This case study underscores the importance of private school accreditation in Mali to improve the quality of health worker training through a standardized local curriculum. By supporting existing regulatory bodies that oversee accreditation, local capacity for initial accreditation of private nursing schools has been increased. Engaging universities in a partnership that shows the benefits of accreditation while maintaining a focus on the need to protect communities is critical to success. If the global community is to meet the WHO's predicted health worker shortfall, then private education providers will need to be part of the solution. Robust and engaging health worker education accreditation systems are an essential part of that future.

Working towards universal health coverage: a qualitative study to identify strategies for improving student enrolment for the pre-service training of nurses, midwives and community health workers in Nigerian health training institutions.

BACKGROUND: Student enrolment processes and practices can affect the quality of pre-service training programmes. These processes and practices may have serious implications for the quality and quantity of students within health training institutions, the quality of education for prospective health workers and consequently health workforce performance. This study assessed current student enrolment processes and practices for nurses, midwives and community health workers within health training institutions in two Nigerian states, so as to identify strategies for improving student enrolment for these key cadres of frontline health workers. METHODS: This study was carried out in Bauchi and Cross-River States, which are the two Human Resources for Health (HRH) project focal states in Nigeria. Utilizing a qualitative research design, 55 in-depth interviews and 13 focus group discussions were conducted with key stakeholders including students and tutors from pre-service health training institutions as well as policy-makers and public sector decision-makers from Ministries of Health, Government Agencies and Regulatory Bodies. Study participants were purposively sampled and the qualitative data were audio-recorded, transcribed and then thematically analysed. RESULTS: Study participants broadly described the application process to include the purchase, completion and submission of application forms by prospective students prior to participation in entrance examinations and oral interviews. The use of 'weeding examinations' during the student enrolment process, especially in Bauchi state, was identified as a useful quality assurance mechanism for the pre-service training programmes of frontline health workers. Other strategies identified by stakeholders to address challenges with student enrolment include sustained advocacy to counter-cultural norms and gender stereotypes vis-à-vis certain professions, provision of scholarships for trainee frontline health workers and ultimately the development as well as effective implementation of national and state-specific policy and implementation guidelines for the student enrolment of key frontline health workers. CONCLUSION: While there are challenges which currently affect student enrolment for nurses, midwives and community health workers in Nigeria, this study has proposed key strategies which if carefully considered and implemented can substantially improve the status quo. These will probably have far-reaching implications for improving health workforce performance, population health outcomes and efforts to achieve universal health coverage.

The effect of an mLearning application on nurses' and midwives' knowledge and skills for the management of postpartum hemorrhage and neonatal resuscitation: pre-post intervention study.

BACKGROUND: Globally, mobile learning (mLearning) tools have attracted considerable attention as a means of continuous training for healthcare workers. Rwanda like other low-resource settings with scarce in-service training opportunities requires innovative approaches that adapt technology to context to improve healthcare workers' knowledge and skills. One such innovation is the safe delivery application (SDA), a smartphone mLearning application for Basic Emergency Obstetric and Neonatal Care (BEmONC) content. This study assessed the effect of the SDA intervention on nurses' and midwives' knowledge and skills for the management of postpartum hemorrhage (PPH) and neonatal resuscitation (NR). METHODS: The study used a pre-post test design to compare knowledge and skills of nurses and midwives in the management of PPH and NR at two measurement points: immediately prior to SDA intervention and after 6 months of SDA intervention. The intervention took place in two district hospitals in Rwanda and included 54 participants. A paired-sample t-test was used to measure the pre-post intervention, mean knowledge and skills scores differences. Confidence intervals (CIs) and effect size were calculated. A t-test and a one-way Anova were used to test for potential confounders. RESULTS: The analysis included 54 participants. Knowledge scores and skills scores on PPH management and NR increased significantly from baseline to endline measurements. The mean difference for PPH knowledge is 17.1 out of 100; 95% CI 14.69 to 19.49 and 2.6% for PPH skills; 95% CI 1.01 to 4.25. The mean difference for NR knowledge is 19.1 out of 100; 95% CI 16.31 to 21.76 and 5.5% for NR skills; 95% CI 3.66 to 7.41. Increases were unaffected by participants' attendance to in-service training 6 months prior and during SDA intervention and previous smartphone use. However, pre- and post-intervention skills scores were significantly different by years of experience in obstetric care. CONCLUSION: The SDA intervention improved the knowledge and skills of nurses and midwives on the management of PPH and NR as long as 6 months after SDA introduction. The results are highly relevant in low-income countries like Rwanda, where quality of delivery care is challenged by a lack of in-service continuous training for healthcare providers.

A systematic review of the profile and density of the maternal and child health workforce in China.

BACKGROUND: To track progress in maternal and child health (MCH), understanding the health workforce is important. This study seeks to systematically review evidence on the profile and density of MCH workers in China. METHODS: We searched 6 English and 2 Chinese databases for studies published between 1 October 1949 and 20 July 2020. We included studies that reported on the level of education or the certification status of all the MCH workers in one or more health facilities and studies reporting the density of MCH workers per 100 000 population or per 1000 births. MCH workers were defined as those who provided MCH services in mainland China and had been trained formally or informally. RESULTS: Meta-analysis of 35 studies found that only two-thirds of obstetricians and paediatricians (67%, 95% CI: 59.6-74.3%) had a bachelor or higher degree. This proportion was lower in primary-level facilities (28% (1.5-53.9%)). For nurses involved in MCH care the proportions with a bachelor or higher degree were lower (20.0% (12.0-30.0%) in any health facility and 1% (0.0-5.0%) in primary care facilities). Based on 18 studies, the average density of MCH doctors and nurses was 11.8 (95% CI: 7.5-16.2) and 11.4 (7.6-15.2) per 100 000 population, respectively. The average density of obstetricians was 9.0 (7.9-10.2) per 1000 births and that of obstetric nurses 16.0 (14.8-17.2) per 1000 births. The density of MCH workers is much higher than what has been recommended internationally (three doctors and 20 midwives per 3600 births). CONCLUSIONS: Our review suggests that the high density of MCH workers in China is achieved through a mix of workers with high and low educational profiles. Many workers labelled as "obstetricians" or "paediatrician" have lower qualifications than expected. China compensates for these low educational levels through task-shifting, in-service training and supervision.

The State of the World's Midwifery 2021 report: findings to drive global policy and practice.

The third global State of the World's Midwifery report (SoWMy 2021) provides an updated evidence base on the sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce. For the first time, SoWMy includes high-income countries (HICs) as well as low- and middle-income countries. This paper describes the similarities and differences between regions and income groups, and discusses the policy implications of these variations. SoWMy 2021 estimates a global shortage of 900,000 midwives, which is particularly acute in low-income countries (LICs) and in Africa. The shortage is projected to improve only slightly by 2030 unless additional investments are made. The evidence suggests that these investments would yield important returns, including: more positive birth experiences, improved health outcomes, and inclusive and equitable economic growth. Most HICs have sufficient SRMNAH workers to meet the need for essential interventions, and their education and regulatory environments tend to be strong. Upper-middle-income countries also tend to have strong policy environments. LICs and lower-middle-income countries tend to have a broader scope of practice for midwives, and many also have midwives in leadership positions within national government. Key regional variations include: major midwife shortages in Africa and South-East Asia but more promising signs of growth in South-East Asia than in Africa; a strong focus in Africa on professional midwives (rather than associate professionals: the norm in many South-East Asian countries); heavy reliance on medical doctors rather than midwives in the Americas and Eastern Mediterranean regions and parts of the Western Pacific; and a strong educational and regulatory environment in Europe but a lack of midwife leaders at national level. SoWMy 2021 provides stakeholders with the latest data and information to inform their efforts to build back better and fairer after COVID-19. This paper provides a number of policy responses to SoWMy 2021 that are tailored to different contexts, and suggests a variety of issues to consider in these contexts. These suggestions are supported by the inclusion of all countries in the report, because it is clear which countries have strong SRMNAH workforces and enabling environments and can be viewed as exemplars within regions and income groups.

The experiences of new graduate nurses and midwives going through a virtual interview recruitment process during the COVID-19 crisis: a cross-sectional study.

BACKGROUND: The annual recruitment of new graduate nurses and midwives is key to recruiting large numbers of staff with the right attitude, skills and knowledge who are the best fit for the organisation. Virtual interviews were undertaken in 2020 due to the surge worldwide in the COVID-19 crisis. This study evaluates those virtual interviews and explores the sustainability of the model. METHODS: A cross-sectional study was conducted at a large health organisation in New South Wales, Australia. Data were collected over 3 weeks using two online surveys, one for interviewees (n = 512) and the other for interviewers (n = 68). Quantitative data were analysed using descriptive statistics and frequency distributions, and additional free-text comments were analysed using content analysis. RESULTS: Response rates were 55% (n = 280) interviewees and 54% (n = 37) for interviewers. The majority of interviewees (58%, n = 184) and interviewers (78%, n = 29) stated the interview was seamless or very seamless and 55% (n = 156) of interviewees and 73% (n = 27) of interviewers agreed interviewees conveyed themselves well during interviews. Over half of interviewees (65%, n = 182) and interviewers (51%, n = 18) agreed the virtual interview was fair or very fair for interviewee performance, regardless of age, race, or socio-economic status. However, many expressed a need for better internet access, equipment, and support, and a longer interview time to personally connect. Both new graduate interviewees (60%) and interviewers (75%) agreed virtual interviews are a suitable model for future use. However, some respondents indicated they preferred face-to-face interviews. CONCLUSIONS: The use of virtual interviews to select new graduates is considered acceptable, cost-effective and sustainable, as well as fair by the majority of participants. Study findings inform policy development, future planning, support the use of flexible selection practices and provide other health care professionals with a virtual recruitment model to consider when developing strategies to grow their future health workforce.

Experiences of a new cadre of midwives in Bangladesh: findings from a mixed method study.

BACKGROUND: Bangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives. The objective of the findings presented in this paper, which is part of a larger study, was to better understand the experience of the midwives of their education programme and first posting as a qualified midwife and to assess their midwifery knowledge and skills. METHODS: We applied a mixed method approach, which included interviewing 329 midwives and conducting 6 focus group discussions with 43 midwives and midwifery students. Sampling weights were used to generate representative statistics for the entire cohort of the midwives deployed in the public sector health facilities. RESULTS: Most of the midwives were satisfied with different dimensions of their education programme, with the exception of the level of exposure they had to the rural communities during their programme. Out of 329 midwives, 50% received tuition fee waivers, while 46% received funding for educational materials and 40% received free accommodation. The satisfaction with the various aspects of the current posting was high and nearly all midwives reported that a desire to work in the public sector in the long run. However, a significant proportion of the midwives expressed concerns with equipment, accommodation, transport and prospect of transfers. The scores on the knowledge test and self-reported skill levels were varied but reasonably high. CONCLUSION: While the midwives are highly motivated, satisfied with many aspects of their current jobs and have adequate knowledge and skills, there are some bottlenecks and concerns that, if unaddressed, may derail the success of this programme. To capture the career progress of these midwives, additional research, including a follow-up study with the same cohort of midwives, would be beneficial to this programme.