An evaluation of the satisfaction of midwives' working in midwifery group practice.
OBJECTIVE
to examine changes in midwives' attitudes to their professional role following the introduction of midwifery group practice (MGP) (a caseload model of midwifery continuity of care provided to women of all risk levels) and to explore aspects of the model that were working well and those that were not working well.


METHODS
the questionnaire 'Attitudes to Professional Role' was used to measure midwives' satisfaction in terms of professional satisfaction, professional support, client interaction, and professional development. Open-ended questions were also included to offer an opportunity for midwives to expand on their experiences of working in the MGP model. The questionnaire was administered at five time points over the 18-month evaluation period. Round 1 was prior to the implementation of MGP, Rounds 2-4 were at three-month intervals, with Round 5 six months later. Analysis of the structured part of the questionnaire was undertaken by comparing mean scores of satisfaction ranging from -2 (very negative attitudes) to +2 (very positive attitudes), and the open-ended questions were analysed using qualitative content analysis.


METHODS
the Women's and Children's Hospital, Adelaide, South Australia.


METHODS
questionnaires were distributed to all midwives (n=15) working in MGP in Rounds 1, 2 and 3, and to the 12 midwives remaining from the original sample in Rounds 4 and 5. Fourteen questionnaires were returned in Round 1, 12 in Round 2, 10 in Round 3, nine in Round 4, and 10 in Round 5.


RESULTS
overall, a positive change in attitudes to professional role was reflected in all sub-scales in the period between start-up and 18 months later; a reduction in scores occurred in Round 3. The mean increases were significant for all sub-scales apart from professional development. Five main themes were identified across the rounds in the content analysis: 'continuity of care', 'working pattern', 'working environment', 'collegiality' and 'issues relating to midwifery practice'. Midwives gained particular satisfaction from providing continuity of care and building relationships with women and their families, and through practising autonomously as a midwife. While there was a struggle to manage the hours worked and being on call, high levels of professional satisfaction were maintained.


CONCLUSIONS
while there were aspects of MGP that midwives were not satisfied with and wanted to change, overall they were satisfied with the model.


CONCLUSIONS
there is a need for ongoing evaluation in order to monitor the short- and long-term impact on midwives of working in a caseload model of continuity of midwifery care.
Faculty of Health Sciences, Child Nutrition Research Centre, Women's and Children's Health Research Institute, and Discipline of Paediatrics, Flinders Medical Centre, The University of Adelaide, Bedford Park, SA 5042, Australia.
Carmel T
CT
Collins
Jennifer
J
Fereday
Jan
J
Pincombe
Candice
C
Oster
Deborah
D
Turnbull
D000328:Adult; D001315:Australia; D003266:Continuity of Patient Care; D005260:Female; D006123:Group Practice / Q000458:organization & administration*; D019538:Health Care Surveys; D006801:Humans; D007400:Interprofessional Relations; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration; D017009:Professional Autonomy; D036301:Qualitative Research; D012944:Social Support; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance; D016526:Workload / Q000523:psychology*; D055815:Young Adult