Translation and validation of the Czech Republic version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: Satisfaction with the birth experience has been established to be critical for the wellbeing of the mother. The Birth Satisfaction Scale-Revised (BSS-R) is a brief and psychometrically robust multi-dimensional self-report tool designed to assess birth experience. The current investigation sought to translate and validate a Czech Republic version of the BSS-R (CZ-BSS-R). METHODS: Following translation psychometric assessment of the CZ-BSS-R was undertaken using a cross-sectional design. A between-subjects design was incorporated in order to evaluate known-groups validity evaluation of the translated measure. Four hundred and sixty-five Czech-speaking women within the Czech Republic took part in the study. Confirmatory factor analysis was undertaken and divergent and convergent validity and internal consistency characteristics also evaluated. RESULTS: The CZ-BSS-R was observed to have excellent psychometric properties and conceptually and measurement faithful to the original English-language measure. Consistent with previous investigations using the BSS-R significant differences were found in scores as a function of delivery type. CONCLUSIONS: The CZ-BSS-R is a valid, robust and reliable measure of birth experience and suitable for use with Czech-speaking women in the Czech Republic. The study highlighted that instrument and emergency Caesarean section were associated with a lower level of birth satisfaction compared to vaginal delivery.

Translation and validation of Vietnamese version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: The 10-item Birth Satisfaction Scale-Revised (BSS-R) is a quick and easy survey instrument recommended by the International Consortium for Health Outcome Measures as the tool of choice for measuring women's birth satisfaction. AIM: To translate and validate a Vietnamese-language version of the BSS-R. METHOD: A quantitative cross-sectional method was used to gather data post translation and back-translation of a Vietnamese version of the BSS-R (VN-BSS-R). Data collected were psychometrically evaluated using key indices of validity and reliability. PARTICIPANTS: Vietnamese women who were within one month postpartum of birth (N = 383) took part in the study. RESULTS: Findings illustrate that a two-factor model offered excellent psychometric properties. With the two-factor VN-BSS-R, five items loaded onto a subscale 'Positive birth experiences' and the other five onto a second subscale 'Negative birth experiences'. This two-factor model offered a fit to data (root mean square error of approximation [RMSEA] = 0.07, 90% confidence interval [CI] [0.05, 0.09], root square mean residual [RMSE] = 0.04 and comparative fit index [CFI] = 0.97). Mean scores for the exploratory factor analysis [EFA]-derived 'positive' and 'negative' sub-scales were 17.12 (SD 2.34) and 8.40 (SD 4.18) respectively. CONCLUSION: The translated and validated VN-BSS-R is a psychometrically robust tool for measuring birth satisfaction in Vietnamese postpartum women.The VN-BSS-R is available for use to measure experiences and perceptions of intrapartum care received by Vietnamese women.

Translation and validation of the Hindi-Indian version of the Birth Satisfaction Scale-Revised.

AIM: Critical to maternal outcome and development of a healthy and relationship between mother and baby, is the woman's perception of her birth experience. The Birth Satisfaction Scale-Revised (BSS-R) has been demonstrated to be psychometrically robust, easily administered, and scored self-report measure of birth experience. Aim of the study was to translate the UK-BSS-R into Hindi, collect data, and psychometrically validate an Indian (Hindi)-BSS-R. METHODS: Psychometric assessment of the Indian (Hindi)-BSS-R was undertaken following translation using a cross-sectional design. Evaluation of known-groups validity was undertaken using an embedded between-subjects component. Data were collected from (n = 312) postnatal Hindi speaking women in India. Measurement characteristics were assessed using confirmatory factor analysis, divergent validity and internal consistency analysis. RESULTS: The measurement properties of the Indian (Hindi)-BSS-R were observed to be equivocal, with the established tri-dimensional measurement model not achieving best fit to data. Instead, an alternative two-factor model offered an excellent fit to data. Significant differences were observed between Indian (Hindi)-BSS-R scores and family type and gestation term status, which highlights the relevance of these contextual aspects to the Indian birth experience. Internal consistency was observed to be low on some sub-scales, indicating the potential need for future revision. CONCLUSIONS: The Indian (Hindi)-BSS-R is a measure of birth experience, which accepting some measurement caveats, is acceptable for use with Hindi speaking women in India. Further research is required to determine if modification of some of the items is required to improve internal consistency.

A scoping review of therapies used to treat psychological trauma post perinatal bereavement.

BACKGROUND: Up to 39% of women who experience perinatal bereavement proceed to develop Post-Traumatic-Stress-Disorder (PTSD), with this large proportion meriting treatment. Before setting-up a treatment service for postnatal women who are experiencing psychological trauma, it is important to identify what therapies have been used in-the-past to address this problem. AIM: To scope for research that has implemented therapies to treat psychological trauma post perinatal bereavement, for potential inclusion in a flexible treatment package. METHOD: A scoping review mapped coverage, range, and type of research that has reported on prior therapies used to treat psychological trauma post perinatal bereavement. FINDINGS: Due to the dearth of papers that directly addressed perinatal bereavement, we widened the scope of the review to view what treatments had been used to treat psychological trauma post-childbirth. Out of 23 studies that report on effectiveness of therapies used to treat psychological trauma post-childbirth, only 4-focused upon treating PTSD post perinatal bereavement (3 effective/1 ineffective). Successful treatments were reported by Kersting et al. (2013), who found CBT effective at reducing PTSD symptoms post-miscarriage, termination for medical reasons, and stillbirth (n = 33 & n = 115), and Navidian et al. (2s017)) found that 4-sessions of grief-counselling reduced trauma symptoms post-stillbirth in (n = 50) women. One study by Huberty et al. (2020found on-line yoga to be ineffective at reducing PTSD symptoms post-stillbirth. CONCLUSIONS: A dearth of research has explored effectiveness of therapies for treating psychological trauma post perinatal bereavement and post-childbirth, with need to develop and test a research informed flexible counselling package.

Factor structure and psychometric properties of the Birth Satisfaction Scale-Revised in Portuguese postpartum women.

OBJECTIVE: This study aims to develop a Portuguese-language version of the Birth Satisfaction Scale-Revised (BSS-R) for clinical and research use in Portugal (PT-BSS-R). The factor structure, its invariance across depression levels, and the internal consistency of the PT-BSS-R were analysed. METHOD: A sample of 1373 Portuguese-speaking postpartum women completed a sociodemographic and clinical form, the PT-BSS-R, and the Edinburgh Postnatal Depression Scale through an online survey tool. Four competing models were tested through confirmatory factor analyses and bifactor model-based psychometric indices were calculated. The internal consistency and the divergent/convergent validity are analysed. RESULTS: The psychometric properties of PT-BSS-R were found to be generally excellent. Both the original correlated three-factor model and the bifactor model exhibited a good fit to the data. Results from the bifactor model support the use of both the BSS-R total score and the subscale scores. Exemplary invariance findings were observed between groups stratified on the basis of depression screening. PT-BSS-R has demonstrated both divergent and convergent validity as well as internal consistency. CONCLUSION: PT-BSS-R is a psychometrically robust measure of birth satisfaction appropriate for clinical and research use in Portugal.

Translation and validation of the Dutch version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: Recent observations suggest birth satisfaction may be significantly associated with postpartum post-traumatic stress disorder (PP-PTSD). The Birth Satisfaction Scale-Revised (BSS-R) is increasingly used Internationally as a short, valid and reliable multi-dimensional measure of birth experience. The current study sought to develop a Dutch version of the BSS-R (D-BSS-R) for clinical and research application in the Netherlands. METHODS: Post-translation, a cross-sectional design with an embedded between-subjects component was used to evaluate key indices of validity and reliability of the D-BSS-R in a purposive sampled cohort of 244 Dutch-speaking women in the Netherlands. Confirmatory factor analysis, divergent, convergent and known-groups discriminant validity were evaluated as was the internal consistency of the measure. RESULTS: The D-BSS-R was found to be a generally valid and reliable measure of birth experience with the key measurement characteristics of the original English-language measure transferring well to the Dutch context. Statistically significant negative correlations were observed between all D-BSS-R sub-scales and a validated measure of PTSD. CONCLUSIONS: The D-BSS-R represents a valid and reliable measure of birth experience suitable and appropriate for use in the Netherlands. The study corroborates previous suggestions of linkage between birth satisfaction and PP-PTSD using a robust and diagnostically valid measure of trauma.

Psychometric properties of the birth satisfaction scale-revised (BSS-R) in a sample of postpartum Iranian women.

Childbirth satisfaction may positively affect maternal intention to have a future pregnancy and preference to have a cesarean. We translate the UK-Birth-Satisfaction-Scale-Revised (UK-BSS-R) into Persian and validate an Iranian-BSS-R for future use in this population. In total, 784 mothers who were hospitalized in postpartum wards completed the Persian version of the BSS-R. The confirmatory factor analysis on 10-items scale confirmed the conventional three-factor structure. The Cronbach's alpha of the Iranian-BSS-R subscales and the total score were within the range of 0.53-0.76. Our findings provide further evidence that the BSS-R is an internationally reliable and valid instrument to measure birth satisfaction.

Validation and factor structure of the Italian version of the Birth Satisfaction Scale-Revised (BSS-R).

OBJECTIVE: To validate the Italian-language version of the Birth Satisfaction Scale-Revised (BSS-R) and report key measurement properties of the tool. To evaluate the impact of antenatal class attendance on BSS-R assessed birth satisfaction. BACKGROUND: Maternal satisfaction is one of the standards of care defined by the World Health Organisation (WHO) to improve the quality of services. The BSS-R is a multi-dimensional self-report measure of the experience of labour and birth. METHODS: Cross-sectional instrument evaluation design examining factor structure and key aspects of validity and reliability. Embedded between-subjects design to examine known-group discriminant validity and the impact of antenatal class attendance on BSS-R sub-scale and total scores as dependent variables. After giving birth, 297 women provided data for analysis. RESULTS: The Italian version of the BSS-R (I-BSS-R) was the key study measure. The established three-factor and bi-factor models of the BSS-R were found to offer an excellent fit to the data. Comparison of the tri-dimensional measurement model and the bi-factor model of the BSS-R found no significant differences between models. Women who attended antenatal classes had significantly lower stress experienced during childbearing sub-scale scores (I-BSS-R SE), compared to those who did not. Good convergent, divergent validity and known-groups discriminant validity were established for the I-BSS-R. Internal consistency observations were found to be sub-optimal in this population. CONCLUSIONS: On all key psychometric indices, with the exception of internal consistency that requires further investigation, the I-BSS-R was found to be a valid translation of the original BSS-R. The impact of antenatal classes on birth satisfaction warrants further research.

Pre- and during-labour predictors of low birth satisfaction among Iranian women: a prospective analytical study.

BACKGROUND: Maternal childbirth dissatisfaction has short- and long-term negative effects on the mothers' health and life, as well as on relation with her child and family. Due to lack of studies in Iran and other counties, we aimed to determine pre- and during- labour predictors of low birth satisfaction. METHODS: Seven hundred women with low risk singleton pregnancy participated in this prospective analytical study. The participants were hospitalized for vaginal delivery with fetus in cephalic presentation and gestational age of 370-416 at two teaching centers in Tabriz (Iran). Woman characteristics, anxiety state (using Spielberger inventory) and dehydration were assessed at cervical dilatation of 4-6 cm. Iranian (Persian) birth satisfaction scale-revised was applied 12-24 h after birth. Multiple linear regression was used to determine the predictors. RESULTS: Excluding 26 women who were outliers, 674 women were analyzed. The mean birth satisfaction score was 23.8 (SD 6.5) from an attainable score of 0-40. The during-labour predictors of low birth satisfaction score were severe and moderate anxiety, labour dystocia, insufficient support by staff, vaginal birth with episiotomy and tear, emergency cesarean section, labour induction and labour augmentation with oxytocin, and woman dehydration. The pre-labour predictors included being primiparous, sexual and emotional violence during pregnancy, gestational age of 400-416, preference for cesarean section, no attendance at pregnancy classes, and insufficient household income. The proportion of the variance explained by the during-labour variables was 75%, by pre-labour variables was 14% and by overall was 76%. CONCLUSIONS: The controllable during-labour predictors explains most of the variance of the satisfaction score. It seems that responding to women's physical and psychological needs during labour and applying less interventions could improve women's childbirth satisfaction.

Validation of the Hebrew Birth Satisfaction Scale - Revised (BSS-R) and its relationship to perceived traumatic labour.

Objective and background: The Birth Satisfaction Scale-Revised (BSS-R) is a multi-dimensional measure which is recommended by international clinical guidelines for global use as the birth satisfaction outcome measure of choice. The current investigation sought to develop a Hebrew version of the BSS-R for use in the Jewish-Israeli context and examine the relationship between BSS-R domains and the perception of the experience of labour as traumatic.Methods: Following review, translation, and back-translation for linguistic equivalence, a Hebrew version of the BSS-R (H-BSS-R) was prepared and psychometrically evaluated using key indices of validity and reliability. Complete multivariate normal data from 288 first-time Jewish Israeli mothers within two years after childbirth was entered into the analysis.Results: The H-BSS-R was found to have a good fit to the BSS-R tridimensional measurement model, excellent internal consistency, divergent and known-group discriminant validity. Moreover, women who experienced their labour as traumatic had significantly lower H-BSS-R subscale scores than women who reported that their birth experience was non-traumatic.Conclusion: The H-BSS-R is a robust and valid measure suitable for use with Jewish-Israeli women, as well as for investigating the relationship between traumatic labour and birth satisfaction.

A scoping review to determine themes that represent perceptions of self as mother ('ideal mother' vs 'real mother').

Background: Postnatal depression (PND) is a key cause of maternal morbidity, with current systems of initial recognition in the UK detecting only 50% of cases. In attempts to predict those potentially at risk, this review suggests a novel approach. Aim: Implementing the concept of 'ideal mother' versus 'real mother', and asking the woman to compare their 'ideal self' against 'existent self', the aim of this instrument development review was to determine themes from the literature that relate to women's perceptions of self as a mother, and from this identification develop questions for inclusion within a proposed new measure entitled the Self-Image as Mother Scale (SIMS). Method: A scoping review of the literature was carried out to identify themes considered to affect perception of self as mother, and from this identification, evidence-based questions for inclusion in the SIMS were developed. Findings: Themes identified included (1) marital dissatisfaction, (2) inadequate partner support, (3) lack of family support, (4) socioeconomic status and associated poverty, (5) concern about infant, (6) antenatal/postnatal complications, (7) acceptance of infant gender, (8) history of mental health problems, (9) unplanned pregnancy. Conclusions: From this scoping review 18 questions were developed for inclusion in the SIMS, which will then be evaluated for psychometric properties, scale refinement and validation.

Development and validation of the Australian version of the Birth Satisfaction Scale-Revised (BSS-R).

OBJECTIVE AND BACKGROUND: The 10-item Birth Satisfaction Scale-Revised (BSS-R) has recently been endorsed by international expert consensus for global use as the birth satisfaction outcome measure of choice. English-language versions of the tool include validated UK and US versions; however, the instrument has not, to date, been contextualised and validated in an Australian English-language version. The current investigation sought to develop and validate an English-language version of the tool for use within the Australian context. METHODS: A two-stage study. Following review and modification by expert panel, the Australian BSS-R (A-BSS-R) was (Stage 1) evaluated for factor structure, internal consistency, known-groups discriminant validity and divergent validity. Stage 2 directly compared the A-BSS-R data set with the original UK data set to determine the invariance characteristics of the new instrument. Participants were a purposive sample of Australian postnatal women (n = 198). RESULTS: The A-BSS-R offered a good fit to data consistent with the BSS-R tridimensional measurement model and was found to be conceptually and measurement equivalent to the UK version. The A-BSS-R demonstrated excellent known-groups discriminant validity, generally good divergent validity and overall good internal consistency. CONCLUSION: The A-BSS-R represents a robust and valid measure of the birth satisfaction concept suitable for use within Australia and appropriate for application to International comparative studies.

Construct and content validity of the Turkish Birth Satisfaction Scale - Revised (T-BSS-R).

BACKGROUND: The Birth Satisfaction Scale - Revised (BSS-R) is a valid and reliable scale designed to assess women's experiences of labour and childbirth. OBJECTIVE: To assess factor structure, validity, and reliability of the Turkish Birth Satisfaction Scale - Revised (T-BSS-R) using data collected from a Turkish population. SETTING: Istanbul Ministry of Health Zeynep Kamil Women's and Children's Training and Research Hospital. PARTICIPANTS: A convenience sample of healthy child-bearing women (n = 120) who had experienced a spontaneous vertex delivery at full term. METHOD: A survey was conducted post backtranslating the T-BSS-R, with survey data analysed using confirmatory factor analysis. RESULTS: Factor modelling found three subscales embedded in the T-BSS-R, which indicated a good model fit, χ2 = 44.67, CFI = .94; RMSEA = .057; SRMR = .075. A Chi-square value of 1.33 also indicated a good fit. Means for the T-BSS-R subdimensions (1) Stress Experienced (T-BSS-SE-R) = 6.86 ± 3.10, (2) Women's Attributes (T-BSS-WA-R) = 2.84 ± 1.89, (3) Quality of Care (T-BSS-QC-R) = 10.69 ± 3.19 and total scale = 20.39 ± 5.98. The Cronbach alpha coefficient for total scale = 0.71 and for subdimensions T-BSS-SE-R = 0.55, T-BSS-WA-R = 0.44 and T-BSS-QC-R = -0.74. CONCLUSION: Data analysis determined that the T-BSS-R is a valid and reliable instrument to measure birth satisfaction in a population of Turkish women. The T-BSS-R is available for use from c.hollinsmartin@napier.ac.uk .

The Birth Satisfaction Scale - Revised (BSS-R): should the subscale scores or the total score be used?

OBJECTIVE AND BACKGROUND: The 10-item Birth Satisfaction Scale - Revised (BSS-R) is increasingly being used internationally as the instrument of choice for the assessment of birth satisfaction. There remains conjecture over the most appropriate way to score the instrument; subscale scores overall total score, or both approaches. The current study sought to clarify this issue by examining the measurement characteristics of the United States version of the BSS-R from a large data set. METHODS: Secondary analysis of a data matrix from a large sample US BSS-R validation study (N = 2116) using structural equation modelling. RESULTS: A bi-factor model revealed an excellent fit to data (χ2(df = 25) = 208.21, p < 0.001, CFI = 0.98, RMSEA = 0.06, SRMR = 0.04), demonstrating relative independence of the BSS-R quality of care subscale, while in contrast the women's attributes and stress experienced during childbearing subscales could be explained more plausibly by a general factor of experience of childbirth. CONCLUSION: Consistent with the recommendations of the original BSS-R validation study, the current investigation found robust empirical evidence to support the use of both the subscale scoring system and the total score. Researchers and clinicians can therefore select either approach (or both) with confidence.

Cross-cultural invariance of the Birth Satisfaction Scale-Revised (BSS-R): comparing UK and US samples.

OBJECTIVE: This research sought to test the measurement invariance of the Birth Satisfaction Scale-Revised (BSS-R) across United States (US) and United Kingdom (UK) samples. Multiple-group measurement was tested and latent means analysis compared levels of birth satisfaction across the samples. METHOD: Using Confirmatory Factor Analysis (CFA), data previously collected from 409 mothers (181 US mothers; 228 UK mothers) were used to examine the multiple-group measurement invariance of the BSS-R across US and UK samples. RESULTS: A correlated factors BSS-R model demonstrated partial measurement invariance. US mothers had significantly lower birth satisfaction levels on the three BSS-R subscales. CONCLUSIONS: This research demonstrates that the BSS-R is a robust tool that can be used to reliably measure women's birth satisfaction within and across the US and UK.

A qualitative descriptive training needs analysis of midwives perceived continuous professional development in providing intranatal respectful maternal care.

BACKGROUND: The Vietnam midwifery report acknowledges that while health services are available in Vietnam, there is growing need to increase levels of respectful maternal care provided to women in labour. OBJECTIVE: In conjunction with newborns Vietnam charity, our objective was to assess the perceived continuous professional development needs of midwives working in Vietnam to inform development of an intranatal respectful maternal care education resource. METHOD: A qualitative exploratory descriptive method was used to conduct a training needs analysis, which identified perceived education requirements of midwives in Vietnam in relation to providing respectful maternal care. PARTICIPANTS: A convenience sample of midwives (n = 49) participated in the study. DATA-COLLECTION: Eight on-line focus groups were carried out in four hospitals (maternity units) across Vietnam using WebEx, with the interview schedule informed by the World Health Organization guide for delivering intrapartum care for a positive birth experience. DATA-ANALYSIS: Data were transcribed into English and analysed using the 6-steps of thematic analysis outlined by Braun and Clark. FINDINGS: Three themes and 9 sub-themes were developed from the data. The first theme addressed aspects that contribute towards creating a positive birth experience; the second theme observed barriers to changing practice; and the third theme noted that there are a variety of preferred teaching methods. CONCLUSIONS: In response to the training needs analysis, a respectful maternal care education resource has been designed to transform selected areas of intranatal care in Vietnam. Integrating the respectful maternal care educational resource into midwives' continuous professional development in Vietnam is intended to increase women's rights to have safe childbirth, which accommodates choice and control, and promotes a positive birth experience. RECOMMENDATIONS FOR PRACTICE: Post-completion and evaluation, we hope that the intranatal respectful maternal care educational resource will be rolled out to all practising midwives in Vietnam.

Translation and validation of the Hungarian version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: Evidence relating maternal birth experience to a range of maternal and neonatal outcomes is increasingly compelling. Consequently valid and reliable self-report of birth experience from the mothers perspective is critical. AIM: The current study sought to translate and validate a Hungarian-language version of the Birth Satisfaction Scale-Revised (BSS-R). METHOD: Following forward and backwards translation into Hungarian, the Hungarian BSS-R (HU-BSS-R) was administered to women in a major Transylvanian hospital maternity unit within 72 h postpartum. Key psychometric characteristics were then examined in relation to factor structure, divergent and convergent validity, internal consistency, and known-groups discriminant validity. RESULTS: Two-hundred and thirty-two women completed the HU-BSS-R. Confirmatory factor analysis revealed the HU-BSS-R to offer an excellent fit to data for the established tri-dimensional measurement model. The HU-BSS-R was also found to offer excellent convergent and divergent validity and known-groups discriminant validity. No significant differences were observed between internal consistency observations between the current study and the original UK validation study. CONCLUSIONS: The HU-BSS-R is a valid and reliable translation of the original BSS-R, it has proved itself to have excellent psychometric properties and is suitable for use in the Hungarian maternity context.

Factors that influence father's experiences of childbirth and their implications upon postnatal mental health: A narrative systematic review.

AIM: To explore factors that influence fathers' experiences of childbirth and implications for their subsequent postnatal mental health. BACKGROUND: Fathers who attend the birth of their baby often have very rewarding experiences. However, those who witness a difficult birth may progress to develop subsequent mental health problems, e.g., trauma symptoms that can affect future relationships with partner and infant. METHOD: A narrative systematic review of literature was carried out. Two overarching themes were identified, each with 3 underpinning sub-themes: (1) Interpersonal relationships with maternity care professionals; (1b) Communication; (1b) Feeling isolated during labour; (1c) Being prepared; (2) The aftermath; (2a) Support provision; (2b) Effects on relationships; (2c) Psychological trauma. CONCLUSIONS: Findings emphasise that good communication between fathers and midwives is a fundamental part of providing excellent care before, during and post-childbirth, as it can reduce partners' feelings of isolation, improve their relationships and limit development and impact of psychological trauma. RECOMMENDATIONS FOR PRACTICE: It is important to develop more on-line partner sites, parenthood education programmes and support groups, which include education about how to prevent, recognise, support and treat mental health complications. Also, further in-depth qualitative studies would enhance understanding of specific aspects of labour that traumatise fathers.

Nutritional intervention and quality of life in palliative care patients.

Quality of life measures can be used by health professionals to assess effectiveness of nutritional interventions administered to palliative care patients. Stabilizing, maintaining and attempting to increase weight in palliative care patients through the support of oral feeding, and provision of artificial feeding, has been shown to mediate the metabolic and physical wasting effects of the disease process and improve general comfort. A quality of life instrument is a multi-dimensional questionnaire that health professionals can use to measure domains relating to physical, psychological and social aspects of living, and health and disease outcomes. There are three instruments specifically designed to assess quality of life in patients receiving palliative care. These are: The Palliative Care Quality of life Instrument, The Assessment of Quality of Life at the End of Life (AQEL), and The Spitzer Quality of Life Index (SQLI). General use quality of life measures are multifaceted; however, for use with palliative care patients, they have added dimensions of spirituality, existential issues (purpose and meaning of life), family members' perceptions of quality of care, symptom control and family support. Use of quality of life scales provides health professionals and organizations with an ideal measure for planning, targeting and evaluating health interventions.

Optimising the continuity experiences of student midwives: an integrative review.

BACKGROUND: In several countries, midwifery students undertake continuity of care experiences as part of their pre-registration education. This is thought to enable the development of a woman-centred approach, as well as providing students with the skills to work in continuity models. A comprehensive overview of factors that may promote optimal learning within continuity experiences is lacking. AIM: To identify barriers and facilitators to optimal learning within continuity experiences, in order to provide a holistic overview of factors that may impact on, modify and determine learning within this educational model. METHODS: An integrative literature review was undertaken using a five-step framework which established the search strategy, screening and eligibility assessment, and data evaluation processes. Quality of included literature was critically appraised and extracted data were analysed thematically. FINDINGS: Three key themes were identified. A central theme was relationships, which are instrumental in learning within continuity experiences. Conflict or coherence represents the different models of care in which the continuity experience is situated, which may conflict with or cohere to the intentions of this educational model. The final theme is setting the standards, which emerged from the lack of evidence and guidance to inform the implementation of student placements within continuity experiences. CONCLUSION: The learning from continuity experiences must be optimised to prepare students to be confident, competent and enthusiastic to work in continuity models, ultimately at the point of graduation. This will require an evidence-based approach to inform clear guidance around the intent, implementation, documentation and assessment of continuity experiences.