This paper seeks to deconstruct the place of midwives as professionals using the novel interdisciplinary lens of the Place Model—an innovative analytical device which originated in education and has ...been previously applied to both teachers and teacher educators. The Place Model allows us to map the metaphorical professional landscape of the midwife and to consider how and where midwives are located in the combined context of two senses of place: in the sociological sense of public esteem and also the humanistic geography tradition of place as a cumulative process of professional learning. A range of exemplars will bring this map to life uncovering both the dystopias and potentially utopian places in which midwives find their various professional places in the world. The Model can be used to help student midwives to consider and take charge of their learning and status trajectories within the profession.
Background
Bullying has been identified as one of the leading workplace stressors, with adverse consequences for the individual employee, groups of employees, and whole organisations. Employees who ...have been bullied have lower levels of job satisfaction, higher levels of anxiety and depression, and are more likely to leave their place of work. Organisations face increased risk of skill depletion and absenteeism, leading to loss of profit, potential legal fees, and tribunal cases. It is unclear to what extent these risks can be addressed through interventions to prevent bullying.
Objectives
To explore the effectiveness of workplace interventions to prevent bullying in the workplace.
Search methods
We searched: the Cochrane Work Group Trials Register (August 2014); Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1); PUBMED (1946 to January 2016); EMBASE (1980 to January 2016); PsycINFO (1967 to January 2016); Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus; 1937 to January 2016); International Bibliography of the Social Sciences (IBSS; 1951 to January 2016); Applied Social Sciences Index and s (ASSIA; 1987 to January 2016); ABI Global (earliest record to January 2016); Business Source Premier (BSP; earliest record to January 2016); OpenGrey (previously known as OpenSIGLE‐System for Information on Grey Literature in Europe; 1980 to December 2014); and reference lists of articles.
Selection criteria
Randomised and cluster‐randomised controlled trials of employee‐directed interventions, controlled before and after studies, and interrupted time‐series studies of interventions of any type, aimed at preventing bullying in the workplace, targeted at an individual employee, a group of employees, or an organisation.
Data collection and analysis
Three authors independently screened and selected studies. We extracted data from included studies on victimisation, perpetration, and absenteeism associated with workplace bullying. We contacted study authors to gather additional data. We used the internal validity items from the Downs and Black quality assessment tool to evaluate included studies' risk of bias.
Main results
Five studies met the inclusion criteria. They had altogether 4116 participants. They were underpinned by theory and measured behaviour change in relation to bullying and related absenteeism. The included studies measured the effectiveness of interventions on the number of cases of self‐reported bullying either as perpetrator or victim or both. Some studies referred to bullying using common synonyms such as mobbing and incivility and antonyms such as civility.
Organisational/employer level interventions
Two studies with 2969 participants found that the Civility, Respect, and Engagement in the Workforce (CREW) intervention produced a small increase in civility that translates to a 5% increase from baseline to follow‐up, measured at 6 to 12 months (mean difference (MD) 0.17; 95% CI 0.07 to 0.28).
One of the two studies reported that the CREW intervention produced a small decrease in supervisor incivility victimisation (MD ‐0.17; 95% CI ‐0.33 to ‐0.01) but not in co‐worker incivility victimisation (MD ‐0.08; 95% CI ‐0.22 to 0.08) or in self‐reported incivility perpetration (MD ‐0.05 95% CI ‐0.15 to 0.05). The study did find a decrease in the number of days absent during the previous month (MD ‐0.63; 95% CI ‐0.92 to ‐0.34) at 6‐month follow‐up.
Individual/job interface level interventions
One controlled before‐after study with 49 participants compared expressive writing with a control writing exercise at two weeks follow‐up. Participants in the intervention arm scored significantly lower on bullying measured as incivility perpetration (MD ‐3.52; 95% CI ‐6.24 to ‐0.80). There was no difference in bullying measured as incivility victimisation (MD ‐3.30 95% CI ‐6.89 to 0.29).
One controlled before‐after study with 60 employees who had learning disabilities compared a cognitive‐behavioural intervention with no intervention. There was no significant difference in bullying victimisation after the intervention (risk ratio (RR) 0.55; 95% CI 0.24 to 1.25), or at the three‐month follow‐up (RR 0.49; 95% CI 0.21 to 1.15), nor was there a significant difference in bullying perpetration following the intervention (RR 0.64; 95% CI 0.27 to 1.54), or at the three‐month follow‐up (RR 0.69; 95% CI 0.26 to 1.81).
Multilevel Interventions
A five‐site cluster‐RCT with 1041 participants compared the effectiveness of combinations of policy communication, stress management training, and negative behaviours awareness training. The authors reported that bullying victimisation did not change (13.6% before intervention and 14.3% following intervention). The authors reported insufficient data for us to conduct our own analysis.
Due to high risk of bias and imprecision, we graded the evidence for all outcomes as very low quality.
Authors' conclusions
There is very low quality evidence that organisational and individual interventions may prevent bullying behaviours in the workplace. We need large well‐designed controlled trials of bullying prevention interventions operating on the levels of society/policy, organisation/employer, job/task and individual/job interface. Future studies should employ validated and reliable outcome measures of bullying and a minimum of 6 months follow‐up.
The coronavirus disease 2019 (COVID-19) was declared a global pandemic in early 2020. Due to the rapid spread of the virus and limited availability of effective treatments, health and social care ...systems worldwide quickly became overwhelmed. Such stressful circumstances are likely to have negative impacts on health and social care workers' wellbeing. The current study examined the relationship between coping strategies and wellbeing and quality of working life in nurses, midwives, allied health professionals, social care workers and social workers who worked in health and social care in the UK during its first wave of COVID-19. Data were collected using an anonymous online survey (
= 3425), and regression analyses were used to examine the associations of coping strategies and demographic characteristics with staff wellbeing and quality of working life. The results showed that positive coping strategies, particularly active coping and help-seeking, were associated with higher wellbeing and better quality of working life. Negative coping strategies, such as avoidance, were risk factors for low wellbeing and worse quality of working life. The results point to the importance of organizational and management support during stressful times, which could include psycho-education and training about active coping and might take the form of workshops designed to equip staff with better coping skills.
Technological advancements and ease of Internet accessibility have made using Internet-based audiovisual software a viable option for researchers conducting focus groups. Online platforms overcome ...any geographical limitations placed on sampling by the location of potential participants and so enhance opportunities for real-time discussions and data collection in groups that otherwise might not be feasible. Although researchers have been adopting Internet-based options for some time, empirical evaluations and published examples of focus groups conducted using audiovisual technology are sparse. It therefore cannot yet be established whether conducting focus groups in this way can truly mirror face-to-face discussions in achieving the authentic interaction to generate data. We use our experiences to add to the developing body of literature by analyzing our critical reflections on how procedural aspects had the potential to influence the data we collected using audiovisual technology to conduct synchronous focus groups. As part of a mixed methods study, we chose to conduct focus groups in this way to access geographically dispersed populations and to enhance sample variation. We conducted eight online focus groups using audiovisual technology with both academic researchers and health-care practitioners across the four regions of the United Kingdom. A reflexive journal was completed throughout the planning, conduct and analysis of the focus groups. Content analysis of journal entries was carried out to identify procedural factors that had the potential to affect the data collected during this study. Five themes were identified (Stability of group numbers, Technology, Environment, Evaluation, and Recruitment), incorporating several categories of issues for consideration. Combined with the reflections of the researcher and published experiences of others, suggested actions to minimize any potential impacts of issues which could affect interactions are presented to assist others who are contemplating this method of data collection.
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DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Nurse, Midwives and Allied Health Professionals (AHPs), along with other health and social care colleagues are the backbone of healthcare services. They have played a key role in responding to the ...increased demands on healthcare during the COVID-19 pandemic. This paper compares cross-sectional data on quality of working life, wellbeing, coping and burnout of nurses, midwives and AHPs in the United Kingdom (UK) at two time points during the COVID-19 pandemic. An anonymous online repeated cross-sectional survey was conducted at two timepoints, Phase 1 (7.sup.th May 2020-3.sup.rd July 2020); Phase 2 (17.sup.th November 2020-1.sup.st February 2021). The survey consisted of the Short Warwick-Edinburgh Mental Wellbeing Scale, the Work-Related Quality of Life Scale, and the Copenhagen Burnout Inventory (Phase 2 only) to measure wellbeing, quality of working life and burnout. The Brief COPE scale and Strategies for Coping with Work and Family Stressors scale assessed coping strategies. Descriptive statistics and multiple linear regressions examined the effects of coping strategies and demographic and work-related variables on wellbeing and quality of working life. A total of 1839 nurses, midwives and AHPs responded to the first or second survey, with a final sample of 1410 respondents -586 from Phase 1; 824 from Phase 2, (422 nurses, 192 midwives and 796 AHPs). Wellbeing and quality of working life scores were significantly lower in the Phase 2 sample compared to respondents in Phase 1 (p<0.001). The COVID-19 pandemic had a significant effect on psychological wellbeing and quality of working life which decreased while the use of negative coping and burnout of these healthcare professionals increased. Health services are now trying to respond to the needs of patients with COVID-19 variants while rebuilding services and tackling the backlog of normal care provision. This workforce would benefit from additional support/services to prevent further deterioration in mental health and wellbeing and optimise workforce retention.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Antimicrobial resistance is a serious threat to public health. To reduce antimicrobial resistance, interventions to reduce gram-negative infections, specifically urinary tract infections, are vital. ...Early evidence suggests increased fluid intake is linked with a reduction in UTIs and subsequently has potential to reduce antibiotic usage. Care homes have a high prevalence of UTIs and provide an opportunity in a closed setting to deliver an intervention focused on increasing fluid intake, where it is supported and monitored by health care workers. The study aimed to evaluate the impact and feasibility of an online staff focused intervention over a 30 day period to increase the hydration of care home residents with a view to reducing the burden of AMR in this setting.
The study was a pre and post intervention with a sequential explanatory mixed methods design. The intervention was delivered online in 3 care homes, containing 3 main components underpinned by the COM-B model including hydration training, 7 structured drinks rounds and a hydration champion to change behaviour of care home staff. A pre and post questionnaire assessed the impact of the intervention on staff and data was collected on fluid intake, drinks rounds delivered to residents, UTIs, antibiotic used to treat UTIs, falls and hospitalisation. Descriptive statistics summarised and assessed the impact of the study. Focus groups with care home staff provided qualitative data which was thematically analysed.
Staff increased in self-perceived knowledge across the six components of hydration care. 59% of residents had an increase in median fluid intake post intervention. During the time of the intervention, a 13% decrease in UTIs and antibiotic usage to treat UTIs across the 3 care homes was recorded, however falls and hospitalisations increased. Themes arising from focus groups included the role of information for action, accessibility of online training, online training content.
This study demonstrates that a brief, low cost, online multi-component intervention focused on care home staff can increase the fluid intake of residents. A reduction in UTIs and antibiotic consumption was observed overall. Empowering care home staff could be a way of reducing the burden of infection in this setting.
Caesarean section (CS) rates throughout Europe have risen significantly over the last two decades. As well as being an important clinical issue, these changes in mode of birth may have substantial ...resource implications. Policy initiatives to curb this rise have had to contend with the multiplier effect of women who had a CS for their first birth having a greater likelihood of requiring one during subsequent births, thus making it difficult to decrease CS rates in the short term. Our study examines the long-term resource implications of reducing CS rates among first-time mothers, as well as improving rates of vaginal birth after caesarean section (VBAC), among an annual cohort of women over the course of their most active childbearing years (18 to 44 years) in two public health systems in Europe. We found that the economic benefit of improvements in these two outcomes is considerable, with the net present value of the savings associated with a five-percentage-point change in nulliparous CS rates and VBAC rates being €1.1million and £9.8million per annual cohort of 18-year-olds in Ireland and England/Wales, respectively. Reductions in CS rates among first-time mothers are associated with a greater payoff than comparable increases in VBAC rates. The net present value of achieving CS rates comparable to those currently observed in the best performing Scandinavian countries was €3.5M and £23.0M per annual cohort in Ireland and England/Wales, respectively.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Eye movement desensitisation and reprocessing (EMDR) therapy is a transdiagnostic, comprehensive, integrative, evidence‐based treatment intervention for post‐traumatic stress disorder (PTSD), complex ...PTSD, and perinatal PTSD. PTSD can arise from an experience of pregnancy or birth related trauma. Despite this, there is limited availability and access to EMDR therapy within the United Kingdom National Health Service. EMDR is a psychotherapeutic intervention which is usually delivered by highly specialist mental health professionals. However, with such a robust protocol, it is appropriate to consider if other health professionals should be trained to deliver EMDR. Humanitarian trauma capacity‐building projects in a global context have shown that task shifting can assist with addressing unmet mental health therapy needs. Midwives are highly skilled graduates working in the perinatal period who understand that women's emotional health is as important as their physical health. Therefore, it was proposed that EMDR knowledge and skills could be efficiently task shifted to midwives. The aim and objectives were to train midwives to deliver modified EMDR scripted protocols and techniques and explore qualitative and quantitative outcomes of a bespoke EMDR for midwives (EMDR‐m) educational programme. The online training was delivered to the midwives over 4 days with clinical practicums incorporated throughout. Pre and post‐tests demonstrated an increase in their EMDR knowledge, skills and confidence. EMDR Group Supervision provided by three experienced EMDR Accredited Practitioners was mandatory for 6 weeks post‐training and ongoing one‐to‐one supervision was made available. Midwives scored the course 9.6/10 (range 8–10) and described it as ‘amazing’ and ‘invaluable’. Challenges for the future include ring‐fenced time and an appropriate space to deliver the therapy. Those midwives who completed the training have progressed to deliver early EMDR‐m interventions in a perinatal mental health research study in their own Health and Social Care Trust (reported elsewhere).
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Many health and social care (HSC) professionals have faced overwhelming pressures throughout the COVID-19 pandemic. As the current situation is constantly changing, and some restrictions across the ...UK countries such as social distancing and mask wearing in this period (May-July 2021) began to ease, it is important to examine how this workforce has been affected and how employers can help rebuild their services. The aim of this study was to compare cross-sectional data collected from the HSC workforce in the UK at three time points during the COVID-19 pandemic: Phase 1 (May-July 2020), Phase 2 (November 2020-January 2021) and Phase 3 (May-July 2021). Respondents surveyed across the UK (England, Wales, Scotland, Northern Ireland) consisted of nurses, midwives, allied health professionals, social care workers and social workers. Wellbeing and work-related quality of life significantly declined from Phase 1 to 3 (
< 0.001); however, no significant difference occurred between Phases 2 and 3 (
> 0.05). Respondents increasingly used negative coping strategies between Phase 1 (May-July 2020) and Phase 3 (May-July 2021), suggesting that the HSC workforce has been negatively impacted by the pandemic. These results have the potential to inform HSC employers' policies, practices, and interventions as the workforce continues to respond to the COVID-19 virus and its legacy.
As the COVID-19 pandemic continues to evolve around the world, it is important to examine its effect on societies and individuals, including health and social care (HSC) professionals. The aim of ...this study was to compare cross-sectional data collected from HSC staff in the UK at two time points during the COVID-19 pandemic: Phase 1 (May-July 2020) and Phase 2 (November 2020-January 2021). The HSC staff surveyed consisted of nurses, midwives, allied health professionals, social care workers and social workers from across the UK (England, Wales, Scotland, Northern Ireland). Multiple regressions were used to examine the effects of different coping strategies and demographic and work-related variables on participants' wellbeing and quality of working life to see how and if the predictors changed over time. An additional multiple regression was used to directly examine the effects of time (Phase 1 vs. Phase 2) on the outcome variables. Findings suggested that both wellbeing and quality of working life deteriorated from Phase 1 to Phase 2. The results have the potential to inform interventions for HSC staff during future waves of the COVID-19 pandemic, other infectious outbreaks or even other circumstances putting long-term pressures on HSC systems.
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