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Women with threatened preterm labor in remote Australia often require tocolysis in the prevention of in-flight birth during air medical retrieval. However, debate exists over the tocolytic choice.A retrospective analysis was undertaken on data containing women who required air medical retrieval for threatened preterm labor within Western Australia between the years 2013 and 2018.A total number of 236 air medical retrievals were deemed suitable for inclusion; 141 received nifedipine, and 95 women received salbutamol + nifedipine. Tocolytic efficaciousness was reported in 151 cases, proportionally more (P.05) from the women who received salbutamol + nifedipine (n = 68, 71.6%) compared with the women who received nifedipine only (n = 83, 58.9%). Those receiving salbutamol + nifedipine were more likely to suffer maternal tachycardia (n = 87 [91.6%] vs. n = 62 [44.0%]), fetal tachycardia (n = 26 [27.4%] vs. n = 13 [9.2%]), nausea (n = 17 [17.9] vs. n = 5 [3.55%]), and vomiting (n = 12 [12.6%] vs. n = 2 [1.4%]). Three women who received salbutamol + nifedipine had serious side effects including echocardiographic changes, chest pain, and metabolic and lactic acidosis.Salbutamol + nifedipine tocolysis was proven to be more effective than nifedipine only. Although salbutamol + nifedipine had increased temporary side effects, most were nonsevere and managed in-flight.

Aim The aim of this study was to investigate whether an International two-week clinical maternity placement enhances, and is beneficial, to midwifery students’ future practice and employment decisions during the final year of an undergraduate degree. Background International placements are common in undergraduate pre-registration nursing midwifery university curricula, with the emphasis on preparing students to work with diverse women in multicultural environments whilst incorporating cultural competence. However, little is known as to whether an International placement influences future graduate’s work place choice. Methods Using a qualitative approach, focus groups were undertaken with 16 final year midwifery students from a University in Western Australia who had experienced a two-week International clinical midwifery placement in Tanzania (Africa) or Manilla (Philippines). Data was analysed using thematic analysis. Findings The results of the study revealed eight over-arching themes that revealed an increase in midwifery student’s confidence; an awareness of the need to consolidate knowledge and skills, reinforcement of their own career aspirations, midwifery beliefs and trust in women and physiological birth. Conclusion This study confirms the benefits of overseas clinical placements, which provide opportunities beyond developing cultural sensitivity. Midwifery students are challenged to develop not only practical competence, but confidence to trust in themselves and the process of physiological birth. These experiences validate theoretical learning and provide opportunity to reflect on the possibilities of future employment and decision making as a midwife.

Aims and objectives To understand why Western Australian (WA) midwives choose to remain in the profession. Background Midwifery shortages and the inability to retain midwives in the midwifery profession is a global problem. The need for effective midwifery staff retention strategies to be implemented is therefore urgent, as is the need for evidence to inform those strategies. Design Glaserian grounded theory (GT) methodology was used with constant comparative analysis. Methods Fourteen midwives currently working clinically area were interviewed about why they remain in the profession. The GT process of constant comparative analysis resulted in an overarching core category emerging. The study is reported in accordance with Tong and associates’ (2007) Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The core category derived from the data was labelled—“I love being a midwife; it's who I am.” The three major categories that underpin the core category are labelled as follows: “The people I work with make all the difference”; “I want to be ‘with woman’ so I can make a difference”; and “I feel a responsibility to pass on my skills, knowledge and wisdom to the next generation.” Conclusion It emerged from the data that midwives’ ability to be “with woman” and the difference they feel they make to them, the people they work with and the opportunity to “grow” the next generation together underpin a compelling new middle‐range theory of the phenomenon of interest. Relevance to clinical practice The theory that emerged and the insights it provides will be of interest to healthcare leaders, who may wish to use it to help develop midwifery workforce policy and practice, and by extension to optimise midwives’ job satisfaction, and facilitate the retention of midwives both locally and across Australia.

Objectives To review the current evidence on the relationship between specialty nurse certification and outcomes. Design A structured and comprehensive systematic review was undertaken using the Joanna Briggs Institute framework to include both published research studies and expert opinion papers. Data sources Four electronic databases CINAHL, MEDLINE, PubMed, and PsychINFO were searched between 2000 and 2018. The search for expert opinion papers included nursing organizations, OaLster, Grey Literature Report, and The National Database of Nursing Quality Indicators. Review methods The records generated through the search were exported to EndNote X8 and duplicates were removed. Title and abstracts of the records were screened by three reviewers for eligibility using the selection criteria. In the absence of an abstract, records were retained for full text review. Full text assessment of each paper was conducted by two reviewers with a third referee, if necessary, to review any discrepancies. In the case of multiple articles drawing on one set of primary data, only one article was included. A review of each article was completed using the JBI Quality Appraisal checklists to assess internal and external reliability and validity. Both quality appraisal and data extraction were conducted by the review team independently and were validated by one other member of the team. Discrepancies were resolved through rigorous discussion between the reviewers. Results Forty one original research studies were included in the final analysis of the literature. The findings from the included articles were synthesized into three major categories and subsequent sub-categories: Patient outcomes, nurse outcomes and organizational outcomes. Twenty seven findings contributed to the sub-category of specialty nurse certification and patient outcomes. Patient outcomes were further classified into nurse sensitive outcomes, patient mortality and patient satisfaction. Fifty-four findings related to nurse outcomes with the sub-categories: personal and professional factors, knowledge and skills, organizational commitment, job satisfaction, empowerment and confidence. Six findings related to organizational benefits: including the sub-categories of nursing turnover and vacancy rates, perception of healthcare, and costs to the organization. Conclusions The current model risks driving further proliferation of specialty certifications and certifying organizations without questioning the assumptions underlying the goals of certification. The challenges of measuring impact and the cost and value to individual nurses and healthcare organizations are key areas for consideration.

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 transcribed data and group alike findings into sub-categories, which were collapsed to four major categories and one overarching core finding. These were mapped to a matrix combining the COM-B and TDF to establish the usability of these tools in midwifery contexts. Results Four major categories were developed from the data collected in this study. Three reported the hindrances midwives’ experienced when trying to initiate new EBPs: ‘For midwives, medical opposition and workplace culture are the biggest challenges’, ‘Fear can stop change: it’s personal for midwives’ and ‘Midwives are tired of fighting the battle for EBP; they need knowledge and the confidence to bring about practice change.’ The other major category highlighted factors midwives’ considered helpers of EBP: ‘Having stakeholder buy-in and strong midwifery leadership is a huge advantage.’ When mapped to the TDF and COM-B, these findings provided valuable insight into the helpers of and hindrances to evidence-based practice in midwifery. Conclusion Midwives are motivated to initiate evidence-based change yet have limited knowledge of implementation processes or the confidence to lead practice change. Factors such as inter-disciplinary buy-in, clear instruction for midwives and support from midwifery leaders were considered beneficial to implementing practice change in clinical areas. The TDF when used in combination with the COM-B was deemed useful to midwives wanting to lead practice change projects in clinical areas.

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 transcribed data, which were then coded and categorised into meaningful themes. Results One overarching core finding emerged from four major categories: Fear can stop change and midwives are reticent towards evidence-based change; however, inter-disciplinary collaboration and midwives in leadership roles is a huge advantage. Conclusion This study confirms what is known about the helpers and hinderances of evidence-based change, and provides valuable insight into the usability of behavioural theories and context assessment tools to both diagnose and develop implementation strategies applicable to midwives in clinical areas.

Problem The evidence-to-practice gap continues to persist in healthcare and midwives report limited knowledge and use of effective intervention strategies to support the implementation of new evidence-based practices in clinical settings. Background Despite ongoing development and dissemination of high quality research findings, the translation of latest research evidence by midwives into new evidence-based practices remains sub-optimal. This inefficiency places consumers at risk of obsolete or potentially dangerous healthcare interventions. Aim To explore midwifery leaders’ views on what information and support midwives require to lead practice change initiatives in clinical areas. Methods The study formed part of a broader Participatory Action Research (PAR) project designed to improve the processes by which midwives implement evidence-based practice change in clinical settings. The study employed a qualitative design and was guided by the methodological underpinnings of Action Research (AR). Findings One core finding emerged to fulfil the aim and objectives of the study. To lead implementation of evidence-based practices, midwives need practical solutions and a map of the process, packaged into a centralised web-based resource. Discussion The findings reported in this study provide valuable insight into the specific needs of midwives wanting to improve the uptake and longevity of new evidence based practices in clinical areas. This includes information specific to evidence implementation, support networks and knowledge of Implementation Science. Conclusion To lead practice change initiatives, midwives require a web-based resource that standardises the process of evidence implementation, while providing midwives with clear direction and the support needed to confidently champion for evidence base change in clinical areas.

Aims and objectives To conduct an integrative review of the factors associated with why midwives stay in midwifery. Background Midwifery retention and attrition are globally acknowledged as an issue. However, little is known as to why midwives stay in midwifery as the focus has previously focussed on why they leave. Design A structured six-step integrative review approach was used, and this involved the development of a search strategy, study selection and critical appraisal, data abstraction and synthesis, interpretation of findings and recommendations for future practice. Methods The review was conducted using the databases MEDLINE, CINAHL and PsychInfo. Included studies were in the English language with an unlimited publication date. Results Six studies were included in this review: one qualitative, two quantitative and three using mixed methods. Seven themes emerged from synthesisation of the data reported for the six included studies that together help answer the question of why midwives stay in midwifery. Conclusion This integrative review has highlighted some important factors that assist in answering the question why midwives stay in midwifery. However, it has also highlighted the need for quality data that reflects the range of contexts in which midwifery is practised. Relevance to clinical practice There is an abundance of literature focussing on why midwives leave the profession; however, the gap exists in the reasons why midwives stay. If we can uncover this important detail, then changes within the profession can begin to be implemented, addressing the shortage of midwives issue that has been seen globally for a large number of years.