Development of a tool to identify barriers and enablers to practice innovation in midwifery: A participatory action research study (original) (raw)
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2020
BackgroundDespite the ongoing production of new scientific evidence in the field of maternity care, midwives continue to face challenges when translating latest evidence into evidence-informed care, and report uncertainty in both knowledge and confidence to implement sustained evidence-based change in clinical areas. This study aimed toexplore midwifery leaders’ views on what factors help or hinder midwives’ efforts to implement evidence-based practices, and test the usability of the Capability, Opportunity, Motivation and Behaviour model and Transtheoretical Domains Framework to analyse the barriers and facilitators of evidence-based change.MethodsThis qualitative study formed part of a larger Participatory Action Research (PAR) project designed to improve the processes by which midwives implement evidence-based practice change in clinical areas. Data were obtained by a nominal group workshop and individual face-to-face interviews between July – September 2019. Thematic analysis wa...
Readiness for practice change: Evaluation of a tool for the Australian midwifery context
Women and Birth, 2016
The uptake of research evidence into midwifery practice is slow and uncertain. What is already known A range of processes and tools have been developed within the emerging Implementation Science discipline to enable assessment of health care settings for their readiness to take up new evidence. These have worked well in assisting the movement of new knowledge into some professions' practice in a timely manner, however midwifery has yet to make use of them. What this paper adds Information about how adaptation of one existing evidencebased instrument for assessing health care practice settings' readiness to accept and use new evidence would improve its suitability for use in midwifery. Women and Birth xxx (2015) xxx-xxx
Australian midwives' experiences of implementing practice change
Midwifery, 2018
Objective: The introduction of the best available evidence into health care practice is a complicated and uncertain process. Attempts to translate even highly reliable evidence into care provision are known to flounder. The objective of this study was to investigate midwives' experiences of leading practice change. Design: This study was conducted using Glaserian Grounded Theory methodology. Setting: Australian midwifery practice contexts provided the setting for this study. Participants: Midwives who had led practice change initiatives. Findings: Sixteen Australian midwife change leaders participated in this study. Each had sought to implement a workplace practice change. The core problem experienced by the participants was labelled 'So many barriers on so many levels'. Key conclusions: Although some participants were encouraged, supported and enabled to enact change to some degree, even when the change was initiated by the practice site, all participants experienced a number of obstacles at many levels in their implementation efforts. For most, this meant that their endeavours to move the best available evidence into practice took many years or did not progress at all. Implications for practice: The findings of this study will be of interest to midwives, midwifery leaders and midwifery educators. Understanding the factors in midwifery care environments that support or limit the uptake of best evidence into practice will help to inform and develop midwifery context-specific mechanisms to expedite sustained practice innovation.
2020
Background Despite the ongoing production of new scientific evidence in the field of maternity care, midwives continue to face challenges when translating latest evidence into evidence-informed care, and report reticence towards implementing evidence-based change in clinical areas. This study aimed to explore midwifery leaders’ views on what factors help or hinder midwives’ efforts to implement evidence-based practice, and test the usability of the Capability, Opportunity, Motivation and Behaviour model and Transtheoretical Domains Framework to analyse the barriers and facilitators to evidence-based change. Methods This qualitative study formed part of a larger Participatory Action Research (PAR) project designed to improve the processes by which midwives implement evidence-based practice change in clinical areas. Data were obtained from a focus group workshop and individual face-to-face interviews between July – September 2019. Thematic analysis was used to interpret the transcribe...
2020
Evidence-based practice (EBP) is well-established as the gold standard for service delivery of quality healthcare around the world, yet there remains a significant gap between best available evidence and its everyday use in maternity services. The numerous benefits of EBP are therefore never realised and although a considerable body of knowledge has evolved on how to promote the uptake of new EBPs, little is known about midwives' experience of implementing EBP or leading practice change projects in clinical areas. The aim of this study was to work collaboratively with midwives towards the co-development of an evidence implementation resource, designed to provide clear direction and support to midwives wanting to implement new EBPs in clinical areas. This led to the design of a blueprint for an eTool(KIT) for midwives, outlining a stepby-step approach to leading practice change projects in clinical areas. A qualitative approach to the study design was adopted and critical realism employed as the philosophical underpinning for this research inquiry. Seventeen Australian midwives consented to participate in either a focus group discussion or face-to-face interview, which were audio recorded, transcribed and combined with additional field notes to provide a collection of data that was analysed and reported. Three higher order codes were synthesised from the findings to make overall meaning of the factors that contribute to the adoption of EBP in midwifery: "It's hard to overcome the resistance towards new EBP, midwives are passionate yet reticent towards leading practice change", "Inter-disciplinary collaboration and organisations supportive of change are key to improving implementation processes for midwives", and " To lead practice change initiatives, midwives require knowledge of system-level change and a clear process for evidence implementation". The findings revealed that although midwives are passionate iv about EBP, they express reticence towards leading practice change for numerous reasons. These reasons contribute to the inconsistent and sub-optimal use of EBP in Australian maternity services. As such, this study offers a pragmatic approach to organisational change and demonstrates the potential for midwives to be leader of evidence-based change and key stakeholders in all future practice change projects in Australian maternity services. v vi Research Outputs This thesis is presented in a "with publication" format. Three manuscripts were prepared for publication. Chapter two includes the first published paper. Chapter five comprises the second published paper, and a manuscript currently under review.
2020
Background Despite the advancement of scientific research in the field of maternity care, midwives face challenges translating latest evidence into evidence-based practice (EBP) and express reticence towards leading practice change in clinical areas. This study aimed to explore midwifery leaders’ views on what factors help or hinder midwives’ efforts to translate latest evidence into everyday practice and consider them in relation to both the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF).Methods This qualitative study formed part of a larger Action Research (AR) project that was designed to improve midwives’ EBP implementation capability. Data were obtained from eight Western Australian midwifery leaders who were employed in either managerial or executive positions within their organisation. Five midwives attended a focus group workshop and three opted for face-to-face interviews. Thematic analysis was used to code the transc...
Nursing and midwifery use, perceptions and barriers to evidence-based practice
International Journal of Evidence-Based Healthcare, 2017
The study aimed to explore how nurses and midwives obtain, use and embed evidence in everyday practice. Methods: The study design was cross-sectional survey method. The setting was one local health district in metropolitan Sydney, Australia. All nurses and midwives working within the local health district, with access to an email account, were invited to participate in the study. An online survey questionnaire was distributed to explore how evidence is obtained, used and embedded within the clinical setting. The data were analysed using descriptive statistics (frequency and percentages). Pearson's Chi-square tests were used for comparison between groups. Results: There were 204 survey respondents. The findings identified that the majority (n ¼ 157; 76.96%) of respondents obtained evidence primarily from clinical practice guidelines. The majority (n ¼ 149; 73.04%) of respondents reportedly searched databases and used evidence related to general clinical practice. There was a statistical difference (x 2 ¼ 17.069; df ¼ 8; P ¼ 0.029) when comparing leadership positions and other registered practitioner groups in the frequency of searching for evidence. Most respondents (n ¼ 138; 67.65%) were confident in their ability to change practice on the basis of available evidence. Thematic analysis identified four barriers to sustaining evidence-based practice, which included: the need for time; the need for organizational and management support; the need for educational opportunities and challenges to accessing evidence. Conclusion: The study provided an understanding of how nurses and midwives obtain, use and embed evidence into everyday practice. More importantly, the role of leadership is significant to support a process of knowledge generation, research translation and the implementation of evidence into clinical settings.
International Journal of Evidence-Based Healthcare, 2018
Aim: The study aimed to explore how nurses and midwives obtain, use and embed evidence in everyday practice. Methods: The study design was cross-sectional survey method. The setting was one local health district in metropolitan Sydney, Australia. All nurses and midwives working within the local health district, with access to an email account, were invited to participate in the study. An online survey questionnaire was distributed to explore how evidence is obtained, used and embedded within the clinical setting. The data were analysed using descriptive statistics (frequency and percentages). Pearson's Chi-square tests were used for comparison between groups. Results: There were 204 survey respondents. The findings identified that the majority (n ¼ 157; 76.96%) of respondents obtained evidence primarily from clinical practice guidelines. The majority (n ¼ 149; 73.04%) of respondents reportedly searched databases and used evidence related to general clinical practice. There was a statistical difference (x 2 ¼ 17.069; df ¼ 8; P ¼ 0.029) when comparing leadership positions and other registered practitioner groups in the frequency of searching for evidence. Most respondents (n ¼ 138; 67.65%) were confident in their ability to change practice on the basis of available evidence. Thematic analysis identified four barriers to sustaining evidence-based practice, which included: the need for time; the need for organizational and management support; the need for educational opportunities and challenges to accessing evidence. Conclusion: The study provided an understanding of how nurses and midwives obtain, use and embed evidence into everyday practice. More importantly, the role of leadership is significant to support a process of knowledge generation, research translation and the implementation of evidence into clinical settings.