Caseload seminar

Aim

To explore the areas of care I gave during my caseload

Aim

Learning outcomes

1. Discuss the theme of increasing confidence within a caseloading model

2. Critically evaluate advantages and disadvantages of a caseloading model

3. Critically examine ways in which policy can be put into practice

Learning outcomes

Confidence

in competence

Confidence in competence

• Added sense of responsibility (Rawnson, 2008; Fry et al, 2008)

• Felt a duty to undertake a lead role

Confidence

in communication

Confidence in communication

• Need for effective communication

• Unreliable communication can impact the quality of care (Redley et al, 2017)

• NMC code (2018) 8.2: Maintain effective communication with colleagues

Importance of confidence

• Students' experience of caseloading increases confidence (Yanti et al, 2015; Aune, 2013; Rawnson, 2011)

• Allows midwives to believe in own capabilities (Back et al, 2017)

• Self reported confidence is low among newly qualified midwives (Davis, Fourer & Clements, 2012)

Medical model

Double click to edit

Social model

Continuity model

Bryers & Van Teijlingen (2010)

Healy, Humphreys & Kennedy (2016)

Social

Medical

Shift in focus

Van Teijlingen (2003)

Improved safety and outcomes

Improved safety and outcomes

- 7 times more likely to be attended at birth by a known midwife

- 16% less likely to lose their baby

- 19% less likely to lose their baby before 24 weeks

- 15% less likely to experience regional anesthesia

- 16% less likely to have an episiotomy

(Sandall, Soltani, Gates, Shennan & Devane, 2016)

What do midwives value?

What do women value?

1. Reciprocal relationship

(McCourt et al, 2006)

2. Autonomy

(Walsh & Devane, 2012)

3.Cost effectiveness

(Devane et al, 2010)

Satisfaction with continuity

1. Personalised care

2. Building trust

3. Empowerment

4. Midwife-woman relationship

(Perriman, Davis & Ferguson, 2018)

Disadvantages

For women:-

• 'Let down'
• Reassured by different opinions
• Personality conflicts

Andrews et al (2006)

For midwives:-

• Work life balance
• Unpredictable hours
• Unable to switch off

Keygan (2012)

Double click to edit

Maternity Transformation Programme

Maternity transformation programme

Why does continuity work?

• Ongoing relationship of trust

• Greater empathy

• Care co-ordination

• Less missed care

• However, more research is needed (NHS England, 2017; Sandall, 2016)

Challenges in implementing

• Adjustment of midwives' perspectives (Van Teijlingen, 2005)

• Care needs to be reorganised (Homer, 2016)
• Close collaboration with MDT
• Professional respect for central role of midwives

a

Dixon, L., Skinner, J., & Fourer, M. (2013). The emotional and hormonal pathways of labour and birth: integrating mind, body and behaviour. New Zealand College of Midwives Journal, 48, 15-19.

Fry, J., Rawnson, S., & Lewis, P. (2008). Student midwife caseloading- preapring and supporting students. British Journal of Midwifery, 16(9), 559-568. doi:10.12968/bjom.2008.16.9.30879

Healy, S., Humphreys, E., & Kennedy, C. (2016). Midwives' and obstetricians' perceptions of risk and its impact on clinical practice and decision-making in labour: An integrative review. Women and Birth, 29(2), 107-116. doi:10.1016/j.wombi.2015.08.010

Homer, C. (2016). Models of maternity care: evidence for midwifery continuity of care. Medical Journal of Australia, 205(8). doi:10.5694/mja16.00844

Ireland, J., & Van Teijlingen, E. (2013). Normal birth: social-medical model. Practising Midwife, 16(11), p17-20.

Keygan, J. (2012). Models of maternity care: a caseload midwifery perspective. Nuritinga(11), 3-16.

Luo, Z., Wilkins, R., & Kramer, M. (2006). Effect of neighbourhood income and maternal education on birth outcomes: a population-based study. Canadian Medical Association Journal, 174(10), 1415-1420. doi:10.1503/cmaj.051096

MacKenzie, B., & Van Teijlingen, E. (2010). Risk, theory, social and medical models: a critical analysis of the concept of risk in maternity care. Midwifery, 26(5), 488-496.

McCourt, C., Stevens, T., Sandall, J., & Brodie, P. (2006). Working with women: developing continuity of care in practice. In New Midwifery: Science and sensitivity in practice (pp. 141-270). Churchill Livingstone Elsevier.

National Health Service England. (2016). Better Births: Improving outcomes of maternity services in England. Retrieved February 13, 2019, from National Maternity Review: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf

National Health Service England. (2017, 21 December). Implementing Better Births: Continuity of Carer. Retrieved 4 March, 2019, from https:://www.england.nhs.uk/publication/implementing-better-births-continuity-of-care

Nursing & Midwifery Council (2018). The code: Professional standards of practice and behaviour for nurses and midwives. London: NMC.

Pairman, S. (2010). Midwifery partnership: A professionalizing strategy for midwives. In M. Kirkham, The midwife-mother relationship (pp. p208-231). London: Palgrave Macmillan.

Perriman, N., Davis, D., & Ferguson, S. (2018). What women value in the midwifery continuity of care model: A systematic review with meta-synthesis. Midwifery, 62, 220-229. doi:10.1016/j.midw.2018.04.011

Raleigh, V., Hussey, D., Seccombe, I., & Hallt, K. (2010). Ethnic and social inequalities in women's experience of maternity care in England: results of a national survey. Journal of the Royal Society of Medicine, 103(5), 188-198. doi:10.1258/jrsm.2010.090460

Rawnson, S. (2011). A qualitative study exploring student midwives' experiences of carrying a caseload as part of their midwifery education in England. Midwifery, 27(6), 786-792. doi:10.1016/j.midw.2010.07.004

Rayment-Jones, H., Murrells, T., & Sandall, J. (2015). An investigation of the relationship between the caseload model of midwifery for socially disadvantaged women and childbirth outcomes using routine data- a retrospective, observational study. Midwifery, 31(4), 409-417. doi:10.1016/j.midw.2015.01.003

Redley, B., Botti, M., Wood, B., & Bucknall, T. (2017). Interprofessional communication supporting clinical handover in emergency departments: An observation study. Australasian emergency nursing journal, 20(3), 122-130. doi:10.1016/j.aenj.2017.05.003

Sandall, J. (2014). The contribution of continuity of midwifery care to high quality maternity care. London: Royal College of Midwives. Retrieved February 2019, 28

Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews(4). doi:10.1002/14651858.CD004667.pub5

Thomas, G. (2009, January 6). Learning to be a midwife: the need to believe. Retrieved March 4, 2019, from Royal College of Midwives: https://www.rcm.org.uk/learning-and-career/learning-and-research/ebm-articles/learning-to-be-a-midwife-the-need-to-believe

Tierney, O., Sweet, L., Houston, D., & Ebert, L. (2017). The Continuity of Care Experience in Australian midwifery education- What have we achieved? Women and Birth, 30(3), 200-205. doi:10.1016/j.wombi.2016.10.006

Van Teijlingen, E. (2003). Dutch Midwives: The difference between image and reality. In S. Early, & G. Letherby, Gender, Identity and Reproduction: Social Perspectives. London: Palgrave.

Van Teijlingen, E. (2005). A critical analysis of the medical model as used in the study of pregnancy and childbirth. Sociological Research Online, 10(2). doi:10.5153/sro.1034

Walsh, D., & Devane, D. (2012). A metasynthesis of midwife-led care. Qualitative Health Research, 22(7), 897-910. doi:10.1177/1049732312440330

Yanti, Y., Claramita, M., Emilia, O., & Hakimi, M. (2015). Students' understanding of 'Women-Centred Care Philosophy' in midwifery care through Continuity of Care (CoC) learning model: a quasi-experimental study. BMC Nursing, 14(22). doi:10.1186/s12912-015-0072-