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Objective: To examine and summarise available literature on maternity care practitioners having experienced primary trauma during their childbirthing journey and whether this impacts their mental well-being and/or care provision when subsequently caring for childbearing women. Background: Birth trauma affects 1 in 3 women; 1 in 20 women show post-traumatic stress disorder symptoms by 12 weeks after birth. However, what is not known is what percentage of these women are maternity care providers experiencing or having experienced personal trauma during their child birthing journey. This scoping review aims to examine and summarise available literature on maternity care practitioners having experienced primary trauma during their childbirthing journey and whether this impacts their mental well-being and/or care provision when subsequently caring for childbearing women. Methods: Arksey and O'Malley (2005) six-stage scoping review framework was revised and utilised. A search of the relevant databases (MEDLINE Embase, CINAHL, APA PsycInfo, Scopus) was undertaken with several keywords related to trauma and personal experience. Reference lists were also searched of studies identified for reading the full text. Findings: The search strategy identified 2983 articles. The studies excluded were considered to be unrelated to the topic directly. A total of 352 articles were reviewed by abstract, and 29 additional studies were identified from reference lists; 32 were reviewed by full text. A total of 0 studies met the inclusion criteria for the scoping review. Conclusions and implications for practice: The scoping review identified a gap in the literature as maternity care practitioners personal experience of trauma during the child birthing journey has not been researched. Research is needed to explore and conceptualise the experiences of maternity care practitioners having experienced trauma and the ongoing implications this may have on their personal and professional lives. Refereed/Peer-reviewed

BACKGROUND: People with diabetes need to make regular choices that influence their long-term morbidity and mortality. Patient decision aids are validated tools and when used collaboratively between healthcare professionals, patients and carers, can help guide value-based discussions which encourage choices that are well informed and personally relevant. OBJECTIVE: To explore the use and effect of patient decision aids in the management of diabetes. METHOD: A scoping review design was used. Medline, ProQuest, PsycINFO, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases were searched for peer-reviewed articles published between January 1998 and December 2018. RESULTS: Patient decision aids are not commonly or widely used in diabetes management. They offer a suitable adjunct to practice within the domains of healthcare knowledge, active participation, and communication, and shared decision-making between patients and healthcare professionals. CONCLUSION: Patient decision aids can offer a simple and easy-to-use method to potentially improve diabetes health literacy, through the process of shared decision-making and two-way conversations. However, there are current limitations on using them to positively influence clinical outcomes or long-term changes in self-care behaviors within the management of diabetes. Further research to explore the validity of using patient decision aids long term in these areas is required. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13340-020-00429-7) contains supplementary material, which is available to authorized users.

This chapter presents decision-making theories/models and frameworks/tools: medical clinical reasoning, a non-midwifery specific shared decision-making model, a midwifery-specific decision-making model, decision-making tool, decision-making flowchart and Page’s several steps of evidence-based midwifery. Medical clinical reasoning derives from the analytical or rational approach to decision-making – hypothetico-deductive theory. The three-talk model for shared decision-making has three key steps embedded within an active listening and deliberation ethos: Team Talk, Option Talk and Decision Talk. Enhancing Decision-making and Assessment in Midwifery has two domains: Clinical Reasoning and Midwifery Practice. The rationale is that in order to provide evidence-informed care, a midwife must enter into a relationship whereby a sharing of information occurs, thus enabling the woman to be the decision-maker about her care. Decision-making is complex, multi-dimensional and influenced by multiple factors. The evidence from research area, within the Menage model, relies upon midwives having the capability to seek and critically analyse both quantitative and qualitative research.

usc Research has identified midwifery as key to improving maternal and child health globally. Consequently, increasing the numbers, access, and quality of midwives is paramount as attention, funding, education, and support increases. Yet what a midwife and midwifery are is often misunderstood. The terms midwife and midwifery are often used interchangeably. Other cadres such as nurses, doulas, Skilled Birth Attendant, traditional birth attendant, and nurses with obstetric/perinatal experience are often referred to as midwives or providers of midwifery care. As health systems work to integrate midwives and midwifery, global clarity and understanding must exist on what midwives are and what they are not, and what midwifery is and is not. As the first step to establishing clarity; we undertook a critical comparison of existing different countries, ‘not for profit and professional organizations’ definitions and interpretation of a midwife and midwifery philosophy. The International Confederation of Midwives' definition of a midwife and midwifery philosophy, and their Global Standards for Midwifery Education acted as the baseline. A global consensus and commitment to educational systems and culture that teaches the midwifery model and the philosophy behind that care can positively impact and improve outcomes for women and babies. Refereed/Peer-reviewed

Decision-making pervades all aspects of midwifery practice across the world. Midwifery is informed by a number of decision-making theories, but it is sometimes difficult to marry these theories with practice. This book provides a comprehensive exploration of decision-making for midwives irrespective of where in the world they practice or in which model of care. The first part critically reviews decision-making theories, including the Enhancing Decision-making Assessment in Midwifery (EDAM) tool, and their relevance to midwifery. It explores the links between midwifery governance, including professional regulation and the law, risk and safety and decision-making as well as how critical thinking and reflection are essential elements of decision-making. It then goes on to present a number of diverse case studies, demonstrating how they interrelate to and impact upon optimal midwifery decision-making. Each chapter presents examples that show how the theory translates into practice and includes activities to reinforce learning points. Bringing together a diverse range of contributors, this volume will be essential reading for midwifery students, practising midwives and midwifery academics.

© 2018 Wiley Periodicals, Inc. Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the first weeks of life, while continuing to work to minimize adverse outcomes, signals a critical change in the maternal and newborn health care conversation and research prioritization. This paper presents “different research questions” drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization. The results indicated that future research investment in maternal and newborn health should be on “right care,” which is quality care that is tailored to individuals, weighs benefits and harms, is person-centered, works across the whole continuum of care, advances equity, and is informed by evidence, including cost-effectiveness. Three inter-related research themes were identified: examination and implementation of models of care that enhance both well-being and safety; investigating and optimizing physiological, psychological, and social processes in pregnancy, childbirth, and the postnatal period; and development and validation of outcome measures that capture short and longer term well-being. New, transformative research approaches should account for the underlying social and political-economic mechanisms that enhance or constrain the well-being of women, newborns, families, and societies. Investment in research capacity and capability building across all settings is critical, but especially in those countries that bear the greatest burden of poor outcomes. We believe this call to action for investment in the three research priorities identified in this paper has the potential to achieve these benefits and to realize the ambitions of Sustainable Development Goal Three of good health and well-being for all.

BACKGROUND:Good clinical reasoning in midwifery is essential for the safety and quality of the care for women and babies. Midwives, as autonomous practitioners, are held legally and professionally accountable for their clinical reasoning, decisions, and the care they provide. Yet there is contested space between being accountable to the woman (and her birth experience) and being accountable to legal and professional frameworks and regulations. This places the midwife in a vulnerable position. This vulnerability is explored in this article.METHODOLOGY:The narratives of 6 midwives who were interviewed as part of a larger study were subjected to an inductive thematic analysis. Trustworthiness and rigor of the study was assured by careful monitoring of the research process and data checking.RESULTS:Although potentially unpalatable to the midwifery profession, we feel it is important to acknowledge that a concept calledMidwifery Abdicationdoes perhaps exist. Our assertion is underpinned by 3 key themes: “internalized perceptions of midwifery practice,” “knowing but failing to act,” and “prioritization of the woman’s needs.” Although this may be an unconscious act, it may be part of a conscious thought process which is influenced by internal and external factors. The result is loss of one’s professional voice. Midwifery Abdication introduces a level of risk, in changing clinical situations, which require a reconsideration and potential renegotiation of maternal choices and decisions.CONCLUSION:Some midwives appear to abdicate their professional decision-making role. Midwives must practice within their country’s legislative framework, which is complemented by their regulatory authority codes of professional conduct, standards, and ethics. Midwifery Abdication undermines the safety and efficacy of midwifery practice and thus destabilizes our right to claim professional autonomy.

Background: clinical reasoning was once thought to be the exclusive domain of medicine – setting it apart from ‘non-scientific’ occupations like midwifery. Poor assessment, clinical reasoning and decision-making skills are well known contributors to adverse outcomes in maternity care. Midwifery decision-making models share a common deficit: they are insufficiently detailed to guide reasoning processes for midwives in practice. For these reasons we wanted to explore if midwives actively engaged in clinical reasoning processes within their clinical practice and if so to what extent. The study was conducted using post structural, feminist methodology. Question: to what extent do midwives engage in clinical reasoning processes when making decisions in the second stage labour? Methods: twenty-six practising midwives were interviewed. Feminist interpretive analysis was conducted by two researchers guided by the steps of a model of clinical reasoning process. Six narratives were excluded from analysis because they did not sufficiently address the research question. The midwives narratives were prepared via data reduction. A theoretically informed analysis and interpretation was conducted. Findings: using a feminist, interpretive approach we created a model of midwifery clinical reasoning grounded in the literature and consistent with the data. Thirteen of the 20 participant narratives demonstrate analytical clinical reasoning abilities but only nine completed the process and implemented the decision. Seven midwives used non-analytical decision-making without adequately checking against assessment data. Conclusion: over half of the participants demonstrated the ability to use clinical reasoning skills. Less than half of the midwives demonstrated clinical reasoning as their way of making decisions. The new model of Midwifery Clinical Reasoning includes ‘intuition’ as a valued way of knowing. Using intuition, however, should not replace clinical reasoning which promotes through decision-making that can be made transparent and be consensually validated. Refereed/Peer-reviewed

LDL-Apheresis is a new, exciting, highly computerised treatment which is currently being researched. It selectively removes the harmful lipoproteins, in particular Low Density Lipoprotein (LDL) to which is attributed accelerated coronary artery disease 2-3 years after cardiac transplantation. Accepting the rather unique nursing role caring for patients receiving this treatment, the author has found that the research programme has opened up a challenging and very interesting variation in her career using advanced computerised technology. But it has also provided increased opportunity for her to use nursing skills, particularly in the area of communication, to enhance her relationship with the patients and raise the standard of care given.

Summary Background Clinical decision-making was initially studied in medicine where hypothetico-deductive reasoning is the model for decision-making. The nursing perspective on clinical decision-making has largely been shaped by Patricia Benner's ground breaking work. Benner claimed expert nurses use humanistic-intuitive ways of making clinical decisions rather than the ‘rational reasoning’ as claimed by medicine. Clinical decision-making in midwifery is not the same as either nursing or medical decision-making because of the woman–midwife partnership where the woman is the ultimate decision-maker. Method CINHAL, Medline and Cochrane databases were systematically searched using key words derived from the guiding question. A review of the decision-making research literature in midwifery was undertaken where studies were published in English. The selection criteria for papers were: only research papers of direct relevance to the guiding research question were included in the review. Findings Decision-making is under-researched in midwifery and more specifically birth, as only 4 research articles met the inclusion criteria in this review. Three of the studies involved qualified midwives, and one involved student midwives. Two studies were undertaken in England, one in Scotland and one in Sweden. The major findings synthesised from this review, are that; (1) midwifery decision-making during birth is socially negotiated involving hierarchies of surveillance and control; (2) the role of the woman in shared decision-making during birth has not been explored by midwifery research; (3) clinical decision-making encompasses clinical reasoning as essential but not sufficient for midwives to actually implement their preferred decision. Conclusion We argue that existing research does not inform the discipline of the complexity of midwifery clinical decision-making during birth. A well-designed study would involve investigating the clinical reasoning skills of the midwife, her relationship with the woman, the context of the particular birthing unit and the employment status of the midwife. The role of the woman as decision-maker in her own care during birth also needs careful research attention.