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How does patient and public involvement work in research? An example exploring midwives’ workplace wellbeing.

Patient and public involvement or #PPI is defined by INVOLVE (part of, and funded by, the National Institute for Health Research) as: 

“Research being carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them. This includes, for example, working with research funders to prioritise research, offering advice as members of a project steering group, commenting on and developing research materials and undertaking interviews with research participants.”

three person pointing the silver laptop computer

In our latest publication, we explain how patient and public involvement works in maternity service research. Here, we asked childbearing women about their experiences in relation to the workplace wellbeing of midwives. We also asked them how they felt about new research looking to create and test an online intervention designed to support midwives. We did this via a discussion group, where participants were offered refreshments and remuneration for their time. Our aim was to answer the following questions:

  1. What are the perceptions of new mothers in relation to the barriers to receiving high quality maternity care?
  2. What are the perceptions of new mothers in relation to the psychological wellbeing of midwives working in maternity services?
  3. What are the perceptions of new mothers in relation to a research proposal outlining the development and evaluation of an online intervention designed to support midwives in work-related psychological distress?

These PPI activities helped us as researchers to do the following:

  • Better understand this research problem from the perspectives of new mothers
  • Validate the direction of future research plans
  • Explore new areas for data collection based on what really mattered to mothers and their babies
  • Improve upon the design of the proposed online intervention based on what really mattered to mothers and babies.

You can read our full methodology via the linked citation below:

Pezaro, Sally, Gemma Pearce, and Elizabeth Bailey. “Childbearing women’s experiences of midwives’ workplace distress: Patient and public involvement.” British Journal of Midwifery 26.10 (2018): 659-669.

This article was launched in the October edition of the British Journal of Midwifery at the Royal College of Midwives annual conference in 2018 .

white and black Together We Create graffiti wall decor

Put simply, the findings in relation to what participants said were analysed thematically and turned into meaningful insights or ‘PPI coutcomes’. In this sense, we used a co-design approach to inform the direction of new research. How did this work exactly? See figure below.

Figure 1. Overall findings

Initially, we considered that it may have been useful to include midwives in PPI activities, as they were to be the intended recipients of the intervention proposed. However, INVOLVE briefing notes state that:

“When using the term ‘public’ we include patients, potential patients, carers and people who use health and social care services as well as people from organisations that represent people who use services. Whilst all of us are actual, former or indeed potential users of health and social care services, there is an important distinction to be made between the perspectives of the public and the perspectives of people who have a professional role in health and social care services.”

A such, we could not include midwives in these PPI activities due to them have a ‘professional role in health and social care services’. Nevertheless, as midwives were the intended end users and direct beneficiary of the intervention proposed, we argued that they should “not necessarily be excluded from PPI activities simply because they treat patients”. This debate lends itself to further academic discussion and we welcome ideas on this going forward.

two person standing on gray tile paving

Both national and international strategies and frameworks relating to healthcare services tend to focus on putting the care and safety of patients first , yet these findings suggest that to deliver the best care to new mothers effectively, the care of the midwife must equally be prioritised. As such, we now intend to seek further funding to continue this work and secure excellence in maternity care.

If you would like to follow the progress of work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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Highlights from the Third Annual #BirthTrauma conference #birthtrauma18

birth trauma study day

Image credit: Scriberia Ltd (@scriberian).

The first week back in January and I am invited by the wonderful becca moore @dr_bjm to share some research thoughts and ideas at the 3rd annual birth trauma study day in London = 

First of all..thank you for arranging and facilitating this day. It really is growing in strength and popularity year on year as this topic gathers momentum. You are a true #maternityleader for making this happen. Thank you also to those who participated in such important debates and discussion…and to those supported me to present my work as a new mum (baby Loveday is now 6 weeks old and as you can see….she was able to join her mum on stage 🙂

Image may contain: 1 person

The discussions that followed on Twitter were also pretty awesome and continue to thrive online. I can see may collaborations being born out of this day…what change may come I wonder? – #BirthTrauma19 will be even bigger and better…that’s for sure!

What struck me most about the speakers involved in this conference, is that every one of us was drawing from some kind of personal experience. Our past traumas had been turned into passion…fire and fury to make a change in the world…to make is better for the next person in some way.

“We had turned our wounds into wisdom.” – Me

Thank you to those who engaged in my presentation. I was thrilled to share some of my PhD work and the findings of other research studies to raise awareness of psychological distress in midwifery populations. The beautiful images below capture some of the key messages from my slides.

selfcare

Image credit: Scriberia Ltd (@scriberian).

small things

Image credit: Scriberia Ltd (@scriberian).

64%

Image credit: Scriberia Ltd (@scriberian).

Further statistics around midwives at work can be found here.

Traumatised midwives

Image credit: Scriberia Ltd (@scriberian).

compassion fatigue

Image credit: Scriberia Ltd (@scriberian).

I also really enjoyed the ethical debates around providing online anonymity and confidentiality for midwives in psychological distress who wish to seek help. You can read the wider arguments for this here. Do you have any further thoughts on this? I would love to hear them!

Once again…Thank you so much to everyone for making this event so amazing. The quote that I believe summed up the vibe in the room was this…shared by @millihill .

 

“If we can find ways of harvesting the energy in women’s oceanic grief we shall move mountains.” –Germaine Greer

🎓🌟😀

Overall take home messages…

  • Tailored care is needed for every family
  • A healthy baby is not ALL that matters
  • Good outcomes include good psychological outcomes
  • Kindness and compassion cost nothing yet can really make a difference
  • Appropriate use of language can make or break the birthing experience
  • The power of listening can never be underestimated
  • We must remember that fathers and wider family members may also be affected by trauma in the birth room.
  • A traumatic experience is always subjective. What is traumatic for some, may be unremarkable for others.
  • Mothers can have a positive experience of a clinically complicated birth, or a traumatic experience of a seemingly straightforward birth.
  • Any past trauma can always be re-awoken
  • The best care is delivered by a workforce that is healthy and cared for.

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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What makes a good midwifery manager? Satisfaction vs Dissatisfaction in the workplace

Reducing stress and fatigue among maternity staff is key to reducing baby deaths and brain injuries during childbirth, according to a detailed new analysis published by the Royal College of Obstetricians and Gynecologists.

This ‘each baby counts’ initiative confirms that “Decision-making is more difficult when staff feel stressed or tired”.

“This report shows that there is a need for additional support for our maternity staff and units so that every mother and every family has the healthiest possible outcome from pregnancy and birth,” said Judy Ledger, founder and chief executive of the charity Baby LifeLine.

This news supports my own research quest, as I work to find new interventions to support midwives in work-related psychological distress.

This state of affairs also suggests that it may be prudent to do all that we can to ensure midwife satisfaction in the workplace. In fact, anything good in the workplace has to be safer/better than the bad stuff right?

At the 31st International Confederation of Midwives’ Triennial Congress held in June 2017, I stumbled upon an interesting research presentation on what could promote satisfaction/dissatisfaction in the midwifery workplace. More specifically, the characteristics of midwifery management behaviors were used to demonstrate what might promote satisfaction and dissatisfaction in managerial relationships. I will translate my brief notes from the session here:

In promoting workplace satisfaction, a midwifery manager:

  • Is supportive
  • Respects, values and appreciates midwives
  • Is an advocate for staff
  • Follows through on promises
  • Facilitates new ventures and learning
  • Cares for staff
  • Is aware of stressors

In promoting workplace dissatisfaction, a midwifery manager:

  • Is punitive
  • Is demanding
  • Is inconsistent
  • Is ineffectual
  • Is ‘Terrible’
  • Tolerates or perpetrates bullying
  • Does not listen

Not a big shock here right?…I mean it’s not rocket science. Nevertheless, this knowledge must be shared in order to promote healthy workplace cultures in the pursuit of excellence in maternity care.

The best midwifery care can only be delivered by midwives at their best…. Can we all begin to set our working day by these rules? Can we all be a little kinder? caring?..respectful to one another?

fist pump

This was just one of the many things learnt at this year’s 

In time, I will try to share more about why 

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

 

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“Midwifery…It’s about the birth of humanity…” #zepherinalecture17

This is just a short post to summarise this year’s  hosted by the . What an inspiring day in midwifery it was.

Zepherina Veitch (1836-1894) was a midwife who put her energies into the cause of midwifery reform. I can identify with this, as my own work focuses largely on supporting the midwifery profession. As we improve….we make reforms. I whole heartedly want midwives to become leaders and agents of change for a better future. I just happen to believe that the midwifery profession will only reach it’s true potential once midwives are adequately supported in the workplace.

Much of the lecture given by the inspiring   was focused upon ‘the woman’s experience’. Whilst we all aspire to deliver the best experiences for the women we care for, I couldn’t help but add on these words to each phrase ‘and midwives too’…

cover image for caring to change reportBut then this document appeared.

Caring to change

How compassionate leadership can stimulate innovation in health care…

Here, we begin to see how compassion in the workplace can stimulate excellence in the healthcare services….If we care to change. Compassionate leadership turns into a compassionate workplace culture…

This lecture also focused on the development of humanised care in favour of medicalised care. A no brainer right?…Perhaps we can ‘humanise’ the workplace for midwives too?

After all….We need more midwives right?

But the pinnacle of this event was seeing the pinnard being handed from today with her final flourish and welcome to  …the new president of the Royal College of Midwives

Also…a huge congratulations go to Onya,   and – new fellows of the . 👏🏽👏🏽😀💜

But at the end of the day…I got to meet some of the most inspirational midwives…one of those being the wonderful  …I can certainly recommend next year’s  ..come along and be inspired!.. Because we all need a little positivity in our lives! You get it with midwifery….”It’s about the birth of humanity…” after all…

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 💚💙💜❤

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Debunking Midwifery Myths

New article published here: Oh baby: seven things you probably didn’t know about midwives

…please share it widely!

dad with baby

As I am now coming to the end of my PhD (With lot’s of new and exciting things on the horizon I hope), I have been delving into the depths of the largest global online survey of midwives to date – the voices of over 2470 midwives in 93 countries!

Not only is this really an awesome and very important piece of work… it also holds some quite harrowing findings for our beloved midwifery profession. Yet this report also indicates that – if the voices of midwives are listened to, and if midwives are enabled to overcome gender inequalities and assume positions of leadership – quality of care can be improved for women and newborns globally. Wow….OK…we had better get to work then!

ALSO…

“Professionally, 89% of respondents reported that a clear understanding of what midwifery involves is critical for change to take place. Concerns were also expressed over the perceived devaluing of midwifery combined with the increasing medicalisation of birth.”

 

baby on blue

Professionally, the participants expressed concern about a lack of understanding of what “midwifery” is, the devaluing of the midwifery profession combined with the increasing medicalisation of birth, and the underlying weakness in midwifery education and regulation.

Now, I don’t claim to be able to fix the world in a day..but there was one thing that I thought I may be able to do from behind my PC. I could get an article published in @ConversationUK about the midwifery profession…perhaps I could even debunk some myths and set the record straight!…

I had my article published…please share it widely via the link below:

Oh baby: seven things you probably didn’t know about midwives

Now I was limited in this article. Limited in words and in how many points I was able to make in one article…editors need to keep their publications engaging!..and so yes…I did not manage to publish everything in this article as I would have liked to…and yes there are many many more myths about midwives that need to be debunked. But I am hoping that this will the a start of a new conversation.

Midwifery is defined as “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life” and it should be celebrated at every opportunity.

Let’s keep the conversation going around the importance of the midwifery profession. Midwives are crucial to the delivery of high quality maternal and newborn care and subsequent reductions in maternal and newborn mortality around the world. Yet they must be celebrated, respected and supported.

The core characteristics of midwifery include “optimising normal biological, psychological, social and cultural processes of reproduction and early life, timely prevention and management of complications, consultation with and referral to other services, respecting women’s individual circumstances and views, and working in partnership with women to strengthen women’s own capabilities to care for themselves and their families” – Can we start to spread the word on this now please?

baby on back

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 💚💙💜❤

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A reflection on #internationaldayofthemidwife (#IDM2017)

International day of the midwife

Happy #internationaldayofthemidwife or () as it is indeed the 5th of May 2017. I wanted to do a quick reflection (and a little dance of happiness) about the fact that the focus of this year’s International Day of the Midwife is…

 “Midwives, Mothers and Families: Partners for Life!”

With messages coming from the International Confederation such as…”It is very important that midwives and mothers both acknowledge the reciprocity of their relationship” – Scarlett

Yes…..we work in PARTNERSHIP with women and their families!…mothers, families and midwives are all equal partners….this means that we can finally break the mold and state openly that we, as midwives can also be prioritised!…Fabulous!

I have often wondered whether terms such as ‘Patient comes first’ is really healthy…as it is terms like this which often infer that midwives come second at best. What do you think?

service and sacrifice

I have also been picking up on some other great messages, pictures and videos this ..such as…..

 

 

I have also been dipping in and out of the Virtual International Day of the Midwife conference sessions a FREE conference that happens online every year….I have presented my work at  () before, and it is such a great opportunity to get people together in one place from all over the world!

This year for  I have recorded a podcast ‘Made by midwives for midwives’. Hosted by London based midwives Anthonissa Moger and Kate Whatmough….  (The Midwifery Podcast: Os closed, go home.)..I will be sharing this in an upcoming blog post…but for now..I am off to enjoy the rest of …there is such positivity in the midwifery world today…Let’s keep the momentum going ❣🎓❣

 

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 💚💙💜❤

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Mindfulness and Self-Care in Midwifery

As my main research interests are firmly rooted within supporting a positive staff experience for healthcare workers, especially midwives in work-related psychological distress, I am always looking for new opportunities to share knowledge with others in this area. …The Global Alliance for Nursing and Midwifery (GANM) is a joint project sponsored by the Pan American Health Organization (PAHO) and the World Health Organization (WHO) Collaborating Center for Nursing Knowledge, Information Management & Sharing at the Johns Hopkins School of Nursing. This blog post provides an overview of a webinar session hosted by GANM entitled “Mindfulness and Self-Care in Midwifery:  Review of Current Evidence and Guided Mindfulness Practice.

For a preliminary introduction to this topic – check out an earlier blog post on this topic entitled “Midwife Burnout: A Brief Summary“.

downtimes

Erin Wright, DNP, CNM, APRN-BC, led the conversation…Participants were diverse, and originated from Canada, Peru, US (Baltimore, Urbana, Birmingham, Atlanta, Buffalo), Ireland, UK (Coventry University and School of Healthcare Sciences Cardiff), Brazil, Montserrat, and Trinidad.

The full webinar can be accessed here.

Much of the research covered, has also been captured within my earlier narrative review: Pezaro, Sally, et al. “‘Midwives Overboard!’Inside their hearts are breaking, their makeup may be flaking but their smile still stays on.” Women and Birth 29.3 (2016): e59-e66.

However, there were some new and interesting comparisons made with more recent research here…

“Four common themes have been identified that traverse the different models of care. The NZ study provides insight into how case load midwifery can be sustainable enabling long term sustainability. The UK study highlights healthy resilient practices that enable practice. What remains uncertain is how models of care enable or disable sustainable long term practice and nurture healthy resilient behaviours within the different models of care”.

comparisons

“The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking as the notion may be interpreted as expecting midwives ‘to toughen up’ in a working setting that is socially, economically and culturally challenging.”

Sources (Crowther, Susan, et al. “Sustainability and resilience in midwifery: A discussion paper.” Midwifery 40 (2016): 40-48.)

So we are now much enlightened as to how and why midwives are experiencing distress, we also have some insights into how they try to cope (or not)…and where this distress may affect maternity services…but what we are yet to learn, is what may be most effective in supporting midwives in work-related psychological distress…although a few clues are emerging….

Mindfulness is coming forward as a potential tool of support..stress management, education and clinical supervision may also be of benefit to midwives in distress…But how, why and how much is not yet clear.

After exploring the literature in relation to psychological distress in midwifery populations, we were all invited to join in some mindfulness practice..What is mindfulness?

Image result for mindfulness

 

Feeling overwhelmed?…TRY….R.A.I.N

RRecognize What’s Going On

AAllowing: Taking a Life-Giving Pause

I—Investigating with Kindness

NNatural Loving Awareness

Source: Mindful.org

relation-ships

Recommended further reading

Youtube presenters:

  • Jon Kabat Zinn
  • Elisha Goldstein
  • Tara Brach
  • Sharon Salzberg

Websites/Audio Links:

Books: 

  • A Mindfulness Based Stress Reduction Workbook (Goldstein and Stahl)
  • Everyday Catastrophe Living (Jon Kabat Zinn)
  • Wherever you go there you are (Jon Kabat Zinn)
  • Mindfulness for Beginners (Jon Kabat Zinn)
  • Real Happiness (Sharon Salzberg)
  • The Mindful Nurse (Carmel Sheridan)

For more mindfulness exercises, visit the UCLA Mindfulness Awareness Research Center.

book-mark

Thanks for a very insightful and informative session!

Until next time…Look after yourselves & each other 🦄💫🎓