- Title
- Factors influencing the implementation of midwifery continuity of care models in regional areas
- Creator
- Prussing, Elysse
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Evidence demonstrates significantly improved outcomes for women and their babies when supported by Midwifery Continuity of Care (MCC) models. Despite this research and current Australian health directives, widespread implementation of MCC has not been achieved. This is especially true in regional areas. Aim: The aim of this research was to develop a theoretical understanding of the factors that may facilitate or inhibit the implementation of MCC models within regional New South Wales public hospital settings. Methods: A Constructivist Grounded theory approach was used to collect and analyse data from interviews with key public hospital informants. Three phases of interviews were conducted, which included Phase one (midwifery advisory roles), Phase Two (midwives) and Phase Three (women). Findings: Three concepts of theory emerged from within the data analysis that demonstrate a substantial influence over the implementation of MCC models. These included ‘engaging the gatekeepers’, ‘midwives lacking confidence’ and ‘women rallying together’. A substantive theory was generated which strongly recommends that: 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 MCC models. Discussion: This substantive theory recommends that a partnership needs to be enabled between women and midwives as this was a key facilitator for engaging necessary organisational support for MCC implementation. These elements need to be considered in light of the categories and sub-categories from which they were raised. Firstly, ‘engaging the gatekeepers’ identified the need to acknowledge midwives as the biggest barrier to the implementation of MCC models; concerns were raised about a need for workplace culture change and, a funding for a project officer role. A project officer was essential to facilitating change and staff engagement that is required for successful MCC implementation. The concept ‘midwives lacking confidence’ demonstrated that although midwives are wanting to be woman centred carers, they are hindered by a system which they identify as subordinating. Participants also observed the need to support student and new graduate midwives as they are an invaluable resource of knowledge and MCC experience. Lastly, ‘rallying together with women’ represents a gap which reveals women do not realise their power to make changes to their health care services and, a lack of MCC awareness is a barrier preventing women from requesting access to MCC. Additionally, women participants felt undervalued by a health system not meeting their needs, further preventing their engagement in service changes such as MCC. Despite this, in some regional areas the closure of maternity services was a crisis that triggered women to advocate for access to MCC models, by seeking out midwifery champions and rallying together. These recounts demonstrated the powerful influence a partnership between midwives and women could have over facilitating the implementation of MCC in regional areas. Conclusion: It has now been 16 years since the Australian Maternity Action Plan recommended that state and federal government supported increased access to midwifery continuity of care. Although an increase in the number of MCC models is evident, the number of women with access to them remains limited and widespread implementation and up-scaling of models has not yet been achieved. This thesis contributes to the existing body of knowledge that supports these implementation goals. The findings from this study draw attention to issues that the midwifery workforce face when transitioning into MCC models. Education opportunities are needed to better prepare midwives, to understand MCC ways of working and to address skill issues. Student and new graduates were valued for bridging the evidence-practice gap by role modelling continuity values and current MCC evidence in the clinical environment. Implementation was identified as a coordinated ground up approach that requires widespread dissemination of MCC evidence, directed at hospital executive level management. A partnership between women and midwives facilitated engagement with these key hospital stakeholders, who in turn, showed support by funding a project officer, essential to successful implementation of MCC. Participants identified the project officer was a critical factor that ensured cultural and practical concerns of all stakeholders were resolved. Efforts moving forward need to focus on valuing a midwifery partnership with women and increasing stakeholders (midwives, women and hospital management) awareness of the evidence for MCC. Implications for Practice and Policy: The findings of this study will supplement current evidence and inform future policy directives relating to: the implementation and upscaling of MCC models across regional settings, enabling a ground up approach to the design and planning of maternity services, promoting autonomy for midwifery practice, staff education and support mechanisms to enable transition into MCC ways of working. These factors will assist with increasing maternity care options that improve vital outcomes for women and their babies. Relevance of this work to audience: For midwives and birthing services, this research provides insight into the barriers to the implementation of a service model that values midwives and improves outcomes for women, babies and their families. The findings offer a number of strategies to address issues that are currently preventing implementation of MCC models in regional NSW. Some studies also indicate significant cost savings to health services with the implementation of this model as well as improved wellbeing and work satisfaction for the midwifery workforce.
- Subject
- midwifery; continuity of care; women; regional areas
- Identifier
- http://hdl.handle.net/1959.13/1430015
- Identifier
- uon:38795
- Rights
- Copyright 2021 Elysse Prussing
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 4 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 380 KB | Adobe Acrobat PDF | View Details Download |