Satisfaction and continuity of care: Staff views of care in a midwife-managed delivery unit
ABSTRACT to examine whether there are differences in the midwife's role in, and satisfaction with, intrapartum care and delivery of women at low obstetric risk in a midwife-managed delivery unit compared to a consultant-led labour ward.
a pragmatic randomised controlled trial. Subjects were randomised in a 2:1 ratio between the midwives' unit and the labour ward.
Aberdeen Maternity Hospital, Grampian, UK.
midwives within the delivery suite who cared for the 2844 women at low obstetric risk receiving care in a pragmatic randomised controlled trial of the two delivery areas.
continuity of carer and midwife satisfaction.
midwives looking after women in the midwives' unit group were significantly more likely to be of a higher grade, more qualified and have a longer length of experience than those in the labour ward group. There was greater continuity of carer both during labour and after delivery in the midwives' unit group. Despite a small but statistically significant difference in overall satisfaction between the groups, area of 'booking' or area of delivery were not important in predicting midwife satisfaction. Autonomy and continuity of carer were the best predictors of midwife satisfaction.
midwife-managed intrapartum care increases continuity of carer and, therefore, midwife satisfaction. Extending this outside the delivery suite requires a system of care that is acceptable to midwives as well as women. Such systems will depend to a large extent on geography, consumer demand and availability of resources. However, midwife satisfaction should also be considered. In order to do this further research is required to fully evaluate the effect these systems have on the midwives working in them.
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ABSTRACT: to explore, in-depth, the views of midwives working in maternity services about birth setting, models of care and philosophy of care. an Appreciative Inquiry approach was adopted utilising focus group interviews as the method of data collection. 15 focus group interviews were conducted at 14 sites in England. a purposive sample of 120 midwives and six student midwives who were serving women in different birth settings (home, free-standing maternity units, midwife-led units, and traditional obstetric units) participated, in 2001/2002. the main themes generated by the midwives were: cultural changes; midwifery leadership; appropriate role models; training in normality; appropriate responsibility of care divisions; choice for women; equity of care provision between women considered to be at high or low risk; and staff morale. this study highlighted the consistency of views amongst midwives working in different settings. Midwives wanted support to practice autonomously in an environment that facilitated equity of care for women and job satisfaction for midwives. Suggestions were put forward by midwives on how to improve maternity services. A unified approach is required to develop these suggestions into strategies, that will remove the identified barriers and promote normality.Midwifery 01/2005; 20(4):324-34. DOI:10.1016/j.midw.2004.01.005 · 1.71 Impact Factor
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ABSTRACT: Until now, end results within the scope of perinatal statistics have been taken more into consideration rather than the quality assurance. Within the boundaries of retrospective questioning of 251 post-natal patients, their experience and satisfaction were recorded and supplemented with item of extend perinatal statistics. On the one side, there is a connection between the experience during delivery and the intervention, equality, care and the feeling of being in control, the duration and the pain determined by fear and expectations on the other side. Linked psycho-social orientated care modules taking the whole process of pregnancy and delivery into account, could improve the quality of experience.
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ABSTRACT: To assess how nurse to patient ratios and nurse work hours were associated with patient outcomes in acute care hospitals, factors that influence nurse staffing policies, and nurse staffing strategies that improved patient outcomes. MEDLINE (PubMed), CINAHL, Cochrane Databases, EBSCO research database, BioMed Central, Federal reports, National Database of Nursing Quality Indicators, National Center for Workforce Analysis, American Nurses Association, American Academy of Nurse Practitioners, and Digital Dissertations. In the absence of randomized controlled trials, observational studies were reviewed to examine the relationship between nurse staffing and outcomes. Meta-analysis tested the consistency of the association between nurse staffing and patient outcomes; classes of patient and hospital characteristics were analyzed separately. Higher registered nurse staffing was associated with less hospital-related mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other adverse events. The effect of increased registered nurse staffing on patients safety was strong and consistent in intensive care units and in surgical patients. Greater registered nurse hours spent on direct patient care were associated with decreased risk of hospital-related death and shorter lengths of stay. Limited evidence suggests that the higher proportion of registered nurses with BSN degrees was associated with lower mortality and failure to rescue. More overtime hours were associated with an increase in hospital related mortality, nosocomial infections, shock, and bloodstream infections. No studies directly examined the factors that influence nurse staffing policy. Few studies addressed the role of agency staff. No studies evaluated the role of internationally educated nurse staffing policies. Increased nursing staffing in hospitals was associated with lower hospital-related mortality, failure to rescue, and other patient outcomes, but the association is not necessarily causal. The effect size varied with the nurse staffing measure, the reduction in relative risk was greater and more consistent across the studies, corresponding to an increased registered nurse to patient ratio but not hours and skill mix. Estimates of the size of the nursing effect must be tempered by provider characteristics including hospital commitment to high quality care not considered in most of the studies. Greater nurse staffing was associated with better outcomes in intensive care units and in surgical patients.Evidence report/technology assessment 04/2007;