Exploring the key elements required for midwives to develop a new model of postnatal care within an acute care setting
- Publication Type:
- Thesis
- Issue Date:
- 2012
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Aim
This research aimed to explore the key elements to improve the quality of postnatal
care provided to women in a public hospital postnatal ward in Sydney and to attempt
to implement a new model of postnatal care.
Background
Reports, internationally and nationally, indicate that women are least satisfied with
hospital-based postnatal care when compared with antenatal, labour and birth care.
Many researchers have identified the components of postnatal care that women find
most helpful however, there continues to be barriers to develop and test innovative
approaches or models of postnatal care within hospital settings.
The focus of this project was to try to move the postnatal ward to a culture that is
woman and baby centred rather than illness or institution-centred. The development
process drew on Practice Development approaches that would enable midwives to
facilitate change in the environment and culture of the postnatal ward with a view to
improving postnatal care for women and their families.
Method
A qualitative descriptive study, using a three phased approach, was adopted for this
research. Phase one was to identify the issues and concerns by conducting focus
groups with staff. Phase two challenged usual practices and explored new ways of
providing care in the postnatal ward. This phase incorporated working with the staff
utilising Practice Development approaches. The third phase explored with key
stakeholders the outcomes and issues of phase two including the barriers and
limitations to enable midwives to implement a new model of postnatal care.
Findings
There were a number of barriers for change to occur including the current system of
maternity care provided to women. This has also been reported by others over the
past few decades. Within an acute care hospital environment, the midwives struggled
to provide quality midwifery care with a philosophy of care counter to that which had
been imbedded over many years. Midwives were caught up managing the day to day
issues and most were unable to reflect on the care women received or to have the
time to contemplate changes.
Challenging the usual rituals and routines with the midwives generated some
attainable changes that included providing women with more information about what
to expect following birth and updated policies for healthy women and babies. The
policies reflect the latest evidence and a more woman and baby centred approach to a
daily assessment. This research also explored ways for midwives to be able to spend
more time with women, and included challenging the everyday non-midwifery tasks
undertaken by midwives working within the hospital system. These non-midwifery
tasks included managing administration, security, catering and domestic duties.
Barriers towards providing a more woman and baby centred way of providing
postnatal care included the need for further professional development of the midwives
and more professional support. There was also a need for role modelling of womancentred
approaches to care and the development of a different way of providing care
that included midwifery continuity of care.
Conclusion
Maternity services in hospitals have been subsumed into the general wards often
governed by sickness priorities and it is acknowledged changing to a more womancentred
approach was challenging. Without support from leaders, the change towards
a woman-centred approach may not happen within the constraints of the medicalised
model.
Implications for Practice
My research found a number of implications for others planning improved postnatal
care for women in an acute care setting. Key elements included the need for midwives
to have a clear articulation of their vision for the ward. Change may not happen if
midwives do not believe the benefits of providing individualised care that meets the
needs of the women. For this to be realistic and achievable, strong visionary leadership
is key to moving the ward vision forward and implementing a new model of care.
The timing for change in this setting is critical. It is unreasonable to implement change
with midwives during a period of restructure. This can have a negative impact on
successful change by threatening the midwives personal sense of control.
In summary, this research found that effective leadership, adopting a shared vision,
providing high support and high challenge were all important elements to support
moving towards a more woman-centred care approach. Threatening the midwives
sense of control over their professional world was also found to be an important factor
when attempting to bring about change and will be discussed in this thesis.
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