ADVANCED MIDWIFERY PRACTICE AN EVOLUTIONARY CONCEPT ANALYSIS

Transcription

1 Midwifery in International Perspective ADVANCED MIDWIFERY PRACTICE AN EVOLUTIONARY CONCEPT ANALYSIS Régine Goemaes 10 October 2016 CONTENT 1. Introduction 2. Methods 3. Results 1. Definition 2. Attributes 3. Titles 4. Roles 5. Related terms 6. Antecedents 7. Consequences 4. Discussion 5. Take home message 2 1

2 INTRODUCTION DIETETICS NURSING OCCUPA- TIONAL THERAPY knowledge specialisation (Broome 2015, Bryant-Lukosius et al. 2004, Steer et al. 2015) expansion of skills role autonomy 3 INTRODUCTION NURSING Definition: A level of nursing practice that utilizes extended and expanded skills, experience and knowledge in assessment, diagnosis, planning, implementation and evaluation of the care required (ANMC, 2009) Advanced nursing practice (ANP) roles o Nurse practitioners o Clinical nurse specialists o Certified registered nurse anesthetists o Certified nurse midwives 4 2

3 INTRODUCTION MIDWIFERY??? - Advanced practice : more recent development controversial notion necessity and desirability for midwives/midwifery - Importance of conceptual clarity (Begley et al. 2007, Lessing-Turner 2001, Lewis 2000, Smith et al. 2010) 5 METHODS - Concept analysis using the evolutionary method developed by Beth Rodgers (1989) Attributes Consequences Concept of interest References Antecedents Related terms 6 3

4 METHODS - Literature search: key concepts: o midwifery o advanced practice o advanced practitioner titles databases: Pubmed, Web of Science, CINAHL, EMBASE, Cochrane Library, Invert limits: language (English, French, Dutch) grey literature 7 1. Definition of advanced midwife practitioners (AMPs): AMPs promote wellness, offer healthcare interventions and advocate healthy lifestyle choices for patients/clients, their families and carers in a wide variety of settings in collaboration with other healthcare professionals, according to agreed scope of practice guidelines. They utilise advanced midwifery knowledge and critical thinking skills to independently provide optimum patient/client care through caseload management and acute and/or chronic illness (NCNM, 2008) 2. Attributes of AMPs: - Autonomous practice - Leadership - Expertise - Research skills 8 4

5 Attributes of AMPs: - Autonomous practice Independent practice Responsability and accountability for practice Focus on midwifery management vs. obstetric management - Leadership Clinical leadership: activities supporting the development of practice in the service Professional leadership: activities supporting the development outside of the service at national and international level (Elliott et al. 2013) (Elliott et al. 2013, Glover 1999, MacLellan 2007, Queensland Nurses Union 1999, Sookhoo and Butler 1999) 9 C L I N I C A L L E A D E R S H I P o Optimisation of client care through practice development o Introduction and development of client care services o Responsability for policy, guideline development and implementation o Coordination of activities of the multidisciplinary team (MDT) o Education and coaching of / mentorship for the MDT o Stimulation of professional development of the MDT o Creation of optimal learning environment for the MDT o Role model of autonomous clinical decision-making P R O F E S S I O N A L L E A D E R S H I P o Engagement in education at a national and international level (e.g. curriculum development and evaluation) o Policy development at a national and international level through membership of committees, advisory groups o Engagement in professional organisations and committees on a national and international level (Elliott et al. 2013) 10 5

6 Attributes of AMPs: - Expertise Practice experience Integration of theoretical knowledge and practice experience - Research skills Advancement in midwifery as a profession and science Provision of holistic, evidence-based care Dissemination of knowledge and reflection (Elliott et al. 2013, Glover 1999, MacLellan 2007, Queensland Nurses Union 1999, Sookhoo and Butler 1999) Titles Advanced midwife(ry) practitioner Advanced midwife Advanced practice midwife Consultant midwife Midwife practitioner Midwife consultant Fahy 2010, Humphreys et al. 2007, Lesia and Roets 2013, Smith et al. 2010) Certified nurse midwife 12 6

7 4. Roles - Clinician - Clinical leader - Professional leader - Educator - Expert / consultant - Manager - Change agent - Researcher - Auditor (Begley et al. 2015, Elliott et al. 2013, Lesia and Roets 2013, Walker et al. 2014) Related terms Midwife / midwifery led care Advanced neonatal nurse practitioners Advanced obstetrical nurse practitioners Clinical midwife specialist 14 7

8 5. Related terms (Begley et al. 2015) Antecedents - North America USA o Specialised and advanced practice roles > 40 years o Debate on certified nurse midwives/certified midwives as advanced nurse/midwife practitioners o Entry level requirement for practice: min. graduate level Canada - Australasia Australia New Zealand - Africa South Africa o Goal: Millenium Development Goals 4 and 5 o Entry level requirement for practice: graduate level (Avery 2010, Begley et al. 2013, Burkhardt 1996, Lesia and Roets 2013, Smith et al. 2010, Walker et al. 2014) 16 8

9 6. Antecedents - Europe Ireland o Goal: encouragement of experienced midwives to remain in clinical practice through a clinical career pathway o Entry level requirement for practice: Master s degree or higher United Kingdom o Advanced practitioners vs. consultant midwives o Goal: recruitment and retention of experienced midwives, strengthening primary care, modernization in healthcare, reduction of inequalities in healthcare o Drivers: expectations of health service users, new European Commission Working Time Directive o Entry level requirement for practice: Master degree level equivalent Begley et al. 2015, Booth et al. 2006, Humphreys et al. 2007, MacLellan 2007, Smith et al. 2010, Sookhoo and Butler 1999) Consequences - Operational / strategic outcomes Care quality Continuity of care Innovation in care Audit and policy Education of staff - Obstetric care Interventions during labour and birth Labour / birth complications Breastfeeding - Gynaecologic care Abortion care (American College of Nurse-Midwives 2012, Begley et al. 2014, Newhouse et al. 2011, Walker et al. 2014, Weitz et al. 2013) 18 9

10 DISCUSSION - Lack of international / consensus definition Elements: o Specialisation o Extension of practice o Advancement Starting points: o NCNM definition (2008) o ICM Essential Competencies for Basic Midwifery Practice (Fullerton et al. 2011) o New proposal: Advanced midwifery practice is characterized by a level of midwifery practice at which midwives use their expertise, management and clinical leadership skills to provide evidence-based, tailored care for women and their families independently and autonomously. Professional leadership and research skills are used to evaluate and improve practice, and to advance midwifery as a profession and science (Goemaes et al. 2016) 19 DISCUSSION - Educational requirements for AMPs - Research agenda Evaluation of AMPs practice Desirability of the implementation of AMPs Barriers and facilitators for the implementation of AMPs - Advanced Midwifery Practice in Belgium? Bron afbeelding:

11 TAKE HOME MESSAGE 1. AMPs are implemented in healthcare systems in several countries. A wide variety in the emergence, titles, roles, and scope of practice of AMPs is found. Four major attributes are identified: autonomous practice, leadership, expertise, and research skills. 2. More research examining the impact of AMPs on perinatal, gynaecologic, and strategic outcomes is desirable. 3. AMP might offer clinical career opportunities for midwives. 21 REFERENCES American College of Nurse Midwives. (2012) Midwifery: Evidence-Based Practice. A summary of Research on Midwifery Practice in the United States. Retrieved from on 25 August Anderson, A.L. & Gilliss, C.L. (1998) Nurse practitioners, certified nurse midwives, and physician assistants in California. Western Journal of Medicine, 168(5), Australian Nursing and Midwifery Council. (2009) Nurse Practitioners. Standards and Criteria for the Accreditation of Nursing and Midwifery Courses leading to Registration, Enrolment, Endorsement and Authorisation in Australia. Retrieved from on 25 August Avery, M.D. (2010) Let's call it "doctoral" advanced practice nursing. Journal of continuing education in nursing, 41(6), 239; author reply Avery, M.D. & Howe, C. (2007) The DNP and entry into midwifery practice: an analysis. Journal of Midwifery & Women's Health, 52(1), Begley, C., Elliott, N., Lalor, J., Coyne, I., Higgins, A. & Comiskey, C.M. (2013) Differences between clinical specialist and advanced practitioner clinical practice, leadership, and research roles, responsibilities, and perceived outcomes (the SCAPE study). Journal of Advanced Nursing, 69(6), Begley, C., Elliott, N., Lalor, J.G. & Higgins, A. (2015) Perceived Outcomes of Research and Audit Activities of Clinical Specialists in Ireland. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 29(2), Begley, C., Murphy, K., Higgins, A. & Cooney, A. (2014) Policy-makers' views on impact of specialist and advanced practitioner roles in Ireland: the SCAPE study. Journal of Nursing Management, 22(4), Begley, C.M. (2008) Nursing and midwifery in Ireland: rising to the challenge of a changing health service. Nursing & Health Sciences, 10(1),

12 REFERENCES Begley, C.M., Oboyle, C., Carroll, M. & Devane, D. (2007) Educating advanced midwife practitioners: a collaborative venture. Journal of Nursing Management, 15(6), Booth, J., Hutchison, C., Beech, C. & Robertson, K. (2006) New nursing roles: The experience of Scotland's consultant nurse/midwives. Journal of Nursing Management, 14(2), Boyd, L. (2000) Advanced practice nursing today. RN, 63(9), Broome, K. (2015) Is it time for an Australian advanced practice framework for occupational therapists? Australian Occupational Therapy Journal, 62(3), Brucker, M.C. & Reedy, N.J. (2000) Nurse-midwifery: yesterday, today, and tomorrow. MCN: The American Journal of Maternal Child Nursing, 25(6), Bryant-Lukosius, D., Dicenso, A., Browne, G. & Pinelli, J. (2004) Advanced practice nursing roles: development, implementation and evaluation. Journal of Advanced Nursing, 48(5), Burkhardt, P. (1996) Nurse midwifery: advanced practice nursing? Nursing Clinics of North America, 31(3), Centers for Disease Control and Prevention. (2015) Pregnancy Mortality Surveillance System. Retrieved from on 16 October Clements, J. & Parrinello, K. (1998) Climbing higher. Nursing Management, 29(12), De Geest, S., Moons, P., Callens, B., Gut, C., Lindpaintner, L. & Spirig, R. (2008) Introducing Advanced Practice Nurses / Nurse Practitioners in health care systems: a framework for reflection and analysis. Swiss Medical Weekly, 138(43-44), Dole, D.M. & Nypaver, C.F. (2012) Nurse-midwifery: art and science. Nursing Clinics of North America, 47(2), Dowling, M., Beauchesne, M., Farrelly, F. & Murphy, K. (2013) Advanced practice nursing: a concept analysis. International Journal of Nursing Practice, 19(2), Elliott, N., Begley, C., Kleinpell, R. & Higgins, A. (2014) The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis. Journal of Advanced Nursing, 70(5), REFERENCES Elliott, N., Higgins, A., Begley, C., Lalor, J., Sheerin, F., Coyne, I. & Murphy, K. (2013) The identification of clinical and professional leadership activities of advanced practitioners: findings from the Specialist Clinical and Advanced Practitioner Evaluation study in Ireland. Journal of Advanced Nursing, 69(5), Fahy, K.M. (2010) Rejoinder to Smith, R., Leap, N. & Homer, C Advanced midwifery practice or advancing midwifery practice? Women and Birth, 23(3), 121. Fullerton, J.T., Thompson, J.B. & Severino, R. (2011) The International Confederation of Midwives Essential Competencies for Basic Midwifery Practice. An update study: Midwifery, 27(4), Furlong, E. & Smith, R. (2005) Advanced nursing practice: policy, education and role development. Journal of Clinical Nursing, 14(9), Gabay, M. & Wolfe, S.M. (1997) Nurse-midwifery: the beneficial alternative... including commentary by Lawrence HC. Public Health Reports, 112(5), Glover, P.A. (1999) The midwifery curriculum -- preparing beginning or advanced practitioners? Australian College of Midwives Incorporated Journal, 12(1), Goemaes, R., Beeckman, D., Goossens, J., Shawe, J., Verhaeghe, S. & Van Hecke, A. (2016). Advanced midwifery practice: an evolutionary concept analysis. Midwifery [In press]. DOI: Hanson, C.M. & Hamric, A.B. (2003) Reflections on the continuing evolution of advanced practice nursing. Nursing Outlook, 51(5), Higgins, A., Begley, C., Lalor, J., Coyne, I., Murphy, K. & Elliott, N. (2014) Factors influencing advanced practitioners' ability to enact leadership: a case study within Irish healthcare. Journal of Nursing Management, 22(7), Humphreys, A., Johnson, S., Richardson, J., Stenhouse, E. & Watkins, M. (2007) A systematic review and meta-synthesis: evaluating the effectiveness of nurse, midwife/allied health professional consultants. Journal of Clinical Nursing, 16(10), Kendrick, J.M. (1997) The advanced practice movement in nursing: impact on perinatal care. The Journal of perinatal & neonatal nursing, 10(4),

13 REFERENCES Larkin, P., Begley, C.M. & Devane, D. (2009) Women's experiences of labour and birth: an evolutionary concept analysis. Midwifery, 25(2), e Lesia, N.G. & Roets, L. (2013) The utilisation of advanced midwives in the Free State province of South Africa. Africa Journal of Nursing & Midwifery, 15(2), Lessing-Turner, G. (2001) A higher-level of practice: are we throwing the baby out with the bathwater? Practising Midwife, 4(9), Lewis, P. (2000) Is there a need to regulate excellence?. Practising Midwife, 3(9), 4-5. Luck, J. & Tornoe, J. (1996) Who are advanced practice nurses: the certified nurse midwife. Minnesota Nursing Accent, 68(9), MacLellan, K. (2007) Expanding practice: developments in nursing and midwifery career pathways. Nursing Management - UK, 14(3), National Council for the Professional Development of Nursing and Midwifery. (2008). Framework for the Establishment of Advanced Nurse Practitioner and Advanced Midwife Practitioner Posts (4 th ed.). NCNM, Dublin. Newhouse, R.R., Stanik-Hutt, J., White, K.M., Johantgen, M., Bass, E.B., Zangaro, G., Wilson, R.F., Fountain, L., Steinwachs, D.M., Heindel, L. & Weiner, J.P. (2011) Advanced Practice Nurse Outcomes : A Systematic Review. Nursing Economics, 29(5), Nursing and Midwifery Board of Australia. (2015) Midwife practitioners. Position Statement. Retrieved from on 25 August Qin, J., Liu, X., Sheng, X., Wang, H. & Gao, S. (2016) Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertility and Sterility, 105(1), e6. 25 REFERENCES Queensland Nurses Union. (2012) Advanced nursing and midwifery practice. Queensland Nurse, 31(4), Ray, G.L. & Hardin, S. (1995) Advanced practice nursing: playing a vital role. Nursing Management, 26(2), Rodgers, B.L. (1989) Concepts, analysis and the development of nursing knowledge: the evolutionary cycle. Journal of Advanced Nursing, 14(4), Ruel, J. & Motyka, C. (2009) Advanced practice nursing: A principle-based concept analysis. Journal of the American Academy of Nurse Practitioners, 21(7), Silva, M.C. & Sorrell, J.M. (1992) Testing of nursing theory: critique and philosophical expansion. ANS Advances in Nursing Science, 14(4), Smith, R., Leap, N. & Homer, C. (2010) Advanced midwifery practice or advancing midwifery practice? Women & Birth, 23(3), Sookhoo, M.L. & Butler, M.S. (1999) Professional issues. An analysis of the concept of advanced midwifery practice. British Journal of Midwifery, 7(11), Spatz, D. (1996) Women's health: the role of advanced practice nurses in the 21st century. Nursing Clinics of North America, 31(2), Steer, B., Loeliger, J., Kiss, N. & Gilliland, S. (2015) Changing our ways: developing an advanced practice role for dietitians. Asia-Pacific Journal of Clinical Oncology, 11, Walker, D., Lannen, B. & Rossie, D. (2014) Midwifery Practice and Education: Current Challenges and Opportunities. Online Journal of Issues in Nursing, 19(2), Manuscript 4. DOI: /OJIN.Vol19No02Man04 Weitz, T.A., Taylor, D., Desai, S., Upadhyay, U.D., Waldman, J., Battistelli, M.F. & Drey, E.A. (2013) Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver. American Journal of Public Health, 103(3),