Implementing midwifery continuity of care models in regional Australia: A constructivist grounded theory study.

PROBLEM/BACKGROUND: Strong international evidence demonstrates significantly improved outcomes for women and their babies when supported by midwifery continuity of care models. Despite this, widespread implementation has not been achieved, especially in regional settings. AIM: To develop a theoretical understanding of the factors that facilitate or inhibit the implementation of midwifery continuity models within regional settings. METHODS: A Constructivist Grounded Theory approach was used to collect and analyse data from 34 interviews with regional public hospital key informants. RESULTS: Three concepts of theory emerged: 'engaging the gatekeepers', 'midwives lacking confidence' and 'women rallying together'. The concepts of theory and sub-categories generated a substantive theory: A partnership between midwives and women is required to build confidence and enable the promotion of current evidence; this is essential for engaging key hospital stakeholders to invest in the implementation of midwifery continuity of care models. DISCUSSION: The findings from this research suggest that midwives and women can significantly influence the implementation of midwifery continuity models within their local maternity services, particularly in regional settings. Midwives' reluctance to transition is based on a lack of confidence and knowledge of what it is really like to work in midwifery continuity models. Similarly, women require education to increase awareness of continuity of care benefits, and a partnership between women and midwives can be a strong political force to overcome many of the barriers. CONCLUSION: Implementation of midwifery continuity of care needs a coordinated ground up approach in which midwives partner with women and promote widespread dissemination of evidence for this model, directed towards consumers, midwives, and hospital management to increase awareness of the benefits.

An integrative review of supportive relationships between child-bearing women and midwives.

AIMS: To review and evaluate the literature on the factors related to developing supportive relationships between women and midwives, including facilitators and barriers. DESIGN: An integrative review. METHOD: The search used CINAHL, MEDLINE, Embase, EMcare, Maternity and Infant Care, PsycINFO, and Google Scholar from January 2009-June 2020. Two reviewers screened the eligible studies, and 2,399 records were identified. Quality was assessed with the mixed methods appraisal tool, and 14 articles were included. RESULTS: The findings highlight that successful relationships require therapeutic communication, trust, respect, partnership, and shared decision-making. Supportive relationships improve women's satisfaction and birth outcomes, and continuity of care model is an enabling factor. Further research is required to understand supportive relationships in non-continuity of care models and when different cultural backgrounds exist.

Heutagogy: A self-determined learning approach for Midwifery Continuity of Care experiences.

AIM: The aim of this discussion paper is to discuss learning theories in midwifery education, as related to the Midwifery Continuity of Care Experience and to propose an original conceptual framework based on Heutagogy. BACKGROUND: Midwifery education curricula include a number of midwifery practice experiences. One of the requirements is for students to provide Midwifery Continuity of Care. To achieve these experiences, students in Australia are required to provide care to at least ten (10) women through pregnancy, be on call for the woman's birth and provide at least two visits post-birth. Continuity of care experiences appear to have been incorporated without sufficient consideration of the educational purpose of the experience, or how the experiences contribute to the development of the profession. Although we do know midwifery practice embraces woman-centred care as its philosophical underpinning, a learning approach that is congruent with this philosophy needs to be clearly articulated. DESIGN: A discussion paper that compared and contrasted learning theories to align with Midwifery Continuity of Care experiences. METHODS: A review of the literature on learning theories was conducted before comparing and contrasting the theories to arrive at a conceptual framework focused on learning theory and its application to the Midwifery Continuity of Care Experience. RESULTS: Heutagogy provides a potentially congruent educational learning approach to underpin the continuity of care experiences, in comparison to traditional learning theories of pedagogy and andragogy. With a paucity of research in the application of heutagogy to midwifery education, it's conceptual underpinnings and the possible application to the Continuity of Care Experience, this paper explores the possible theoretical applications of heutagogy to midwifery education. CONCLUSION: As a learning theory, heutagogy is well - aligned with woman-centred care. Heutagogy provides a theoretical framework suitable to underpin strategies, including the conceptual framework proposed, that may assist in empowering students to participate in their own education by giving them the ability to be self-determined in both their approach to learning and to evaluate their own learning needs.

Students together with academics ensures retention and success: The STARS project.

BACKGROUND: Approximately 23% of Australian undergraduate students who commenced a degree in 2018 will not complete their program of study. Of these students, approximately 25% cite their 'study is too hard' or 'too much' when withdrawing from their degree. Research has identified that the most common group of students to struggle with completing their program of study are those from equity groups. OBJECTIVES: This paper explores a support strategy aimed at improving the first-year student experience and progression rates. DESIGN: A proof of concept project was undertaken to explore undergraduate midwifery students' experiences of an Expectation Led Planned Organisational teaching strategy into a course. SETTINGS: The study was undertaken at two sites of a regional University in New South Wales, Australia. PARTICIPANTS: All students (n42) enrolled in a core course, in the first year of a Bachelor of Midwifery program. METHODS: A mixed methods approach was used. Quantitative data was collected through the university's program and course management systems and analysed using descriptive statistics to find patterns. Qualitative data were collected via a focus group to provide greater knowledge of the acceptability of the strategy and analysed using content analysis. RESULTS: The inclusion of sequenced email reminders for upcoming assessment tasks was valued by students. There were greater retention and progression rates and a shift in the grade distribution towards higher course grades overall. Student satisfaction with learning activities increased along with course assessment satisfaction. CONCLUSION: Student engagement in learning is enhanced and retention and success rates are increased when academics use technology in a student focused manner. Further research is required to further explore and evaluate strategies that are student focused and acceptable as well as sustainable for the higher education context.

'Continuity of Care Experiences' within pre-registration midwifery education programs: A scoping review.

BACKGROUND: Midwifery is based on the philosophy of woman-centred care. The continuity of care experience in pre-registration education programs exemplifies this philosophy. Wide variation in how education providers implement 'Continuity of Care Experiences' into their programs of study can challenge this valuable learning opportunity. AIM: To provide a comprehensive analysis of the governance and empirical evidence of knowledge, practice and enablers to support continuity of care experiences within pre-registration midwifery education. METHOD: A scoping review of research, policy and professional documents pertaining to the continuity of care experience in pre-registration education programs was conducted with 46 articles meeting the inclusion criteria. FINDINGS: Several factors were identified that support the implementation, facilitation and evaluation of the continuity of care experience within pre-registration midwifery education. These include: a woman-centred model of maternity care; enabling midwifery students and women to develop 'relational continuity'; tripartite support models; optimising the sequencing of these experiences within the program and, woman-led evaluations of student performance. There was little consensus regarding the pedagogical intent and, therefore, an inability to clearly define and measure the learning outcomes of the continuity of care experience. CONCLUSION: In countries where the predominant model of maternity care is fragmented and not woman-centred, further research is required to understand the pedagogical intent of the continuity of care experience.