Impact

Influencing Ireland’s Community Nursing and Midwifery Strategy

POLICY IMPACTS

We are all as a population heavily reliant on our vital primary and community healthcare services, but a vision to re-organise the existing nursing and midwifery workforce in the community, to provide a proactive rather than reactive model of care, has been identified by our researchers.

The Department of Health-backed project, which led to our evidence based review, is now guiding and informing national policy for nursing and midwifery in the community in Ireland. The process, which commenced with a national public consultation programme in 2017, is ongoing.

A draft policy has been developed in which the model of care is one that offers the individual, family and community a range of choices, which includes the vision to re-organise the existing nursing and midwifery workforce in the community. Primary and community health services are the universal points of access for all members of the population. It is acknowledged that there is an increasing need to match health workforce supply to the changing demographic and epidemiological profiles. Successful models of nursing and midwifery in the community – delivering healthcare throughout the lifespan and across a health and illness continuum and sectors - are limited. Our project involved a team of researchers from our School of Nursing and Midwifery and our Department of General Practice, together with National University of Ireland, Galway (NUIG) and University College Dublin (UCD) and with an input from community health, academic and clinical expertise. This evidence review found no single overarching model of nursing and midwifery practice in the community; key components were identified, however. These include: the need for the right nurse or midwife providing the right care to the right people in the right setting. A model of generalist nursing supported by specialist nursing and midwifery providing client care at all levels will result in better health outcomes. This approach will ensure that clinical outcomes are meaningful, lasting, and more sustainable. Putting such a model for nursing and midwifery in the community into operation demands a need for strong leadership and effective clinical governance.

Source  https://www.ucc.ie/en/media/academic/medicineandhealth/UCCCollegeofMedicineandHealth_ResearchImpactAnthology_FINAL(1).pdf 

Aims & Objectives

Aim:

The aim of the Maternity, Families and Primary Care research team within the SoN&M is to lead and collaborate in developing multidisciplinary research. The purpose of our research is to support women, children, fathers and families throughout the perinatal period from preconception to the early years of a child’s life in diverse social community settings.

Specific Objectives:

1. To Improve the Health and Wellbeing of women, men, children and their families
2. To engage in research which reflects international and national policy ensuring research projects positively influence public health priorities.
3. Promote research areas of expertise of team members and attract Post Graduate students to study in these areas to build research capacity in specific contexts to provide evidence based knowledge that will influence policy and practice..
4. To provide an opportunity for collaborative multidisciplinary research reflecting complexity of care for families in the community, ensuring excellence in evidence base translational health outcomes.
5. To conduct research that will influence and promote better health for women, men, children, mother/father infant dyads and families.
6. To advance nursing and midwifery knowledge and expertise that contributes to international clinical best practice
7. To work in a co-operative manner with Health Service Providers to provide empirical findings to guide the care and support of women, new mothers, fathers and families, through all stages of the perinatal period.

Projects

Sample of Projects Demonstrating MF&PC Collaborations

Women’s Experience of Maternity Care in the South /South West Hospital Group (Study funded by SSWHG)

In Ireland maternity services are changing as is the population of women and families served. There is thus a need to collect evidence regarding the views and experiences of women who have used such services. The launch of the Maternity Strategy in 2016 will see the maternity services restructured and evolve further. The aim of this study was to examine women’s experiences of maternity care in the South/South West Hospital Group. A two-part survey was carried out with a Part-one being completed by a sample of women (n=1277, response rate 71.9%) in the postnatal wards of which 596 (46.7%) completed Part 2 at home after 12 weeks. Results indicated that overall the majority of women reported being satisfied or very satisfied with their pregnancy care; their labour and birth their hospital care after birth and their care in the community after discharge. In terms of labour and childbirth, the majority of women were satisfied with their pain relief; however, most women reported having more than one midwife to care for them in labour with only a small proportion having previously met the midwives before childbirth. Choice in relation to midwifery-led care was limited and there were significant variations. In terms of care at home, findings indicated that the PHN and maternity services in the postnatal period are utilised and positively evaluated by the majority of women. Women’s physical health and psychological well-being was impacted by childbirth and most availed of GP services at 2 and 6 weeks, with significant geographical differences in the former. Risk for postnatal depression revealed a higher than usual prevalence which varied significantly by hospital.

A Skills Based Programme of Education for The Provision of Breastfeeding Support: A curriculum Based on Development, Design and Evaluation Evidence (Study funded by HSE/NURTURE).

It is well established scientifically that breastfeeding is the optimum infant feeing method both from an individual and population health perspective. However, breastfeeding rates in Ireland are among the lowest in Europe and may be due in some part to the model of breastfeeding education and training of health care professionals.  The current effectiveness of breastfeeding education for HCPs is unknown. Empirical evidence suggests that there is poor breastfeeding competence and confidence among HCPs. Therefore, it is timely to examine systematically the provision of breastfeeding education, review the underpinning pedagogy and develop its curriculum to meet the needs of population. The Nurture Programme is already committed to enhancing health of young children and their families by supporting early and effective interventions. The purpose of this project was to develop a level 3 skills based programme of education for the provision of breastfeeding support relevant to nurse/midwives, public health nurses, practices nurses and community medical doctors. There were three phases to this project: A systematic review of empirical literature: a mapping of all education breastfeeding education programmes nationally; Informed by phase 1 & 2 was the drafting of an evidence-based curriculum. The final curriculum was informed by consultation with key national stakeholders already engaged in skills based breastfeeding training programmes.

Father’s perceptions and experiences of support in the perinatal period: A meta Synthesis (study being undertaken with colleagues in School of Nursing & Midwifery, Western Sydney University, Australia)

The aim of this metasynthesis is to synthesis qualitative studies on men’s/fathers perceptions and experiences of support in the perinatal period. The purpose of the synthesis is to explicate the core elements of support (formal informal) as defined/described by men who are becoming or are new fathers (first or subsequent children). This will inform further investigations through a systematic review of interventions and outcomes of supports specifically related fathers in the perinatal period. This potentially could identify interventions that enhance support at different time points, before and after birth up to one year following birth.

A systematic review of self- efficacy and social support interventions for prevention of maternal perinatal mental health problems (Study being undertaken in collaboration with colleagues at the Sports Science Exercise & Health Faculty at The University of Western Australia and the School of Nursing & Midwifery, Deakin University, Melbourne, Australia).

The purpose of this review is to examine the effect of social support interventions to reduce the risk of perinatal depression compared with usual care. This review will form the basis for an intervention study to be developed and designed and conducted in Eastern and Western Australia and Ireland.

Empowerment of women in the perinatal period: A systematic Review (Study being undertaken in collaboration with colleagues at the Research Centre for Midwifery Science, Maastricht University, The Netherlands).

Empowerment is expected to have a beneficial effect on a woman’s well-being during the perinatal period and her readiness to face the challenges of motherhood. The purpose of this review is to establish the contribution of women’s empowerment throughout the perinatal period in preparing women for childbirth and their subsequent transition to motherhood.

A Survey of Midwives’ Experiences of Traumatic Birth Within Their Work Setting (Study being undertaken with colleagues across Europe and Trinity College, Dublin).

Although childbirth is usually joyful; sadly, up to 40% of women may experience giving birth as a traumatic event. As many midwives will have cared for women after this experience, it is important to explore if there is any impact on the midwife. The study, which uses an online anonymous survey design, will seek data from midwives in the first instance. The study will be expanded to other clinicians in the future. The questionnaire we are using is validated internationally and will allow for a comparison of midwives’ experiences in Ireland with other countries.

Practice Enhancement for Exclusive Breastfeeding (PEEB) HRB APA 2019-029

The School of Nursing and Midwifery are working with hospital, general practice and primary care settings to enhance the practice of exclusive breastfeeding and improve the supports available to women who wish to breastfeed.

The project is jointly funded by the Health Research Board (HRB) with support from the Nursing and Midwifery Planning and Development Unit South (NMPDU-S) and the South/South West Hospital Group (SSWHG).

Despite the extensive health, economic and environmental benefits of breastfeeding, Ireland’s breastfeeding rates remain amongst the lowest in Europe. The National Maternity Strategy reported inconsistent and contradictory advice in relation to breastfeeding support, and a disconnect in communication during transition of care.

Breastfeeding interventions need to be multifaceted, in order to effectively support women and their partners throughout pregnancy and to three months postpartum.

PEEB employs Participatory Action Research methodology, and is utilising Work Based Learning Groups (WBLGs) to internally instigate and drive change across the participating sites.

We are working with all staff that interact with women who may wish to breastfeed, and aim to identify ways to enhance their knowledge, attitudes, and skills, as well as site policy and environmental factors.

The study is also following the breastfeeding journey of women and their partners, through validated surveys, diary entries and focus groups.

There has been strong engagement in the project to date, despite the challenges of COVID-19, cyber-attacks and staff shortages. This has been driven by a collective desire to enhance practice, and ultimately optimise the supports for women who choose to breastfeed.

People

Research Student Projects

Current PhD Students

Mary Curtin: Thesis entitled: ‘Humanisation in Pregnancy and Childbirth’

Roisin Bradley: Thesis entitled: 'An eHealth intervention to improve psychosocial outcomes for women in the perinatal period'

Elizabeth Greene Thesis entitled ‘Development and Validation of a Tool to Assess Health Care Professional’s Performance of the Complete Examination and Screening of the Newborn (Ceson).’

Ann Cummins: Thesis entitled: 'Knowledge and information needs of young people with epilepsy and their Parents- Development of an e-health Nurse led intervention'

Niamh Ryan: Thesis entitled: 'Child Obesity Prevention in Primary Care to Improve Family Health and Wellbeing.'

Current DN Students

Sinead Heffernan: Thesis entitled ‘Trauma Informed care’

Past Research Student Projects

Dr Margaret Murphy: Thesis entitled ‘Experiences of couples in pregnancy after stillbirth: an interpretative phenomenological analysis’

Dr Lynne Marsh: Thesis entitled ‘‘Becoming a father of a child with an intellectual disability- the early years’

Dr Joan Murphy: Thesis entitled ‘Individual experiences of hope in mental health recover: An Interpretative Phenomenological Study’

Ms Amanda Aher: Thesis entitled ‘A Study to Explore Adolescent Decision Making in Pregnancy’

Ms Fionnuala Hunt: Thesis entitled ‘Grandmother/Mother Dyad Experiences of Breastfeeding: An IPA Study’

Ms Chelsea Coleman: Thesis entitled ‘The Relationship Between Mother-Preterm Infant Attachment, Social Support and Postnatal Depression’

Staff

Prof Patricia Leahy-Warren, PhD, MSc (Research), BSc (Honours), HDip PHN, RPHN, RM, RGN.

Head of the School of Nursing and Midwifery. Her current and past research projects are focused on perinatal mental health of women, their infants and partners with particular interest in Social Support, Self-Efficacy and Postnatal Depression and breastfeeding.

Dr Helen Mulcahy DN, MSc (Nursing), BSc (Nursing), HDip PHN, RPHN, RM, RGN.

College Lecturer and Director of External Relations and Communications at the School of Nursing & Midwifery. Her area of research and clinical expertise relates to developmental surveillance and public health nursing. Her doctoral study was entitled Parents’ experiences of child growth and development concerns: An Interpretative Phenomenological Analysis.

Dr Margaret Murphy DN, MSc, BSc, RM, RGN, IBCLC

College Lecturer in Midwifery, BSc Year 4 Coordinator and has extensive experience in clinical maternity and intensive care. Her doctoral thesis qualitatively investigated the experiences of couples during pregnancy following perinatal loss, utilising an Interpretative Phenomenological Analysis methodology

Dr Geraldine Mc Loughlin PhD, MSc, H.Dip in Ed, BSc, RM, RGN

College Lecturer in Midwifery and BSc (Hons) Midwifery Programme Co-Ordinator. Her research interests include Teaching and Learning in Higher Education and Preparation for Parenthood. Her PhD thesis was entitled: Women’s Experiences of Maternal Foetal/Infant Attachment during the Transition to New Motherhood using Interpretative Phenomenological Analysis.

Dr. Rhona O’Connell,PhD MEd, RMT, RM, RGN

College Midwifery Lecturer with a number of research interests on midwifery practice, midwifery education, neonatology and maternity care, with a focus on the experiences and needs of childbearing women including the development of women centred care, midwifery led services, normal birth, models of midwifery care and home birth.

Ms Agnes Phelan, MComm, RMT RM, RGN,

College Midwifery lecturer and Doctorate of Social Sciences student. Her doctoral thesis is focused on ‘Midwives experience of their work environment; to investigate the barriers that influence a productive and fulfilling work space and to explore whether ‘resilience’ is meaningful as a model/tool to address these barriers’.

Dr Lloyd Philpott, PhD, MPH, PGDip PHN, PGDip EN, PGDip HP, PGC HP, BSc, Dip Nurs, RGN, RPHN.

College lecturer and programme coordinator of the postgraduate diploma in Public Health Nursing. He is a registered nurse and public health nurse. His doctoral thesis is focused on paternal perinatal mental health and is titled “Correlates of stress, anxiety and depression among fathers in the perinatal period”. 

Collaborators

Dr Paul Corcoran, PhD, Senior Lecturer in Perinatal Epidemiology with the National Perinatal Epidemiology Centre in the Department of Obstetrics and Gynaecology and with the Department of Epidemiology and Public Health 

Dr Ali Khashan, PhD, Senior Lecturer in Epidemiology and Public Health in the Department of Epidemiology and Public Health, UCC. He leads several perinatal epidemiology projects in the Irish Centre for Fetal and Neonatal Transnational Research (INFANT) 

Professor Deirdre Murray, PhD Consultant Paediatrician, Prof of Paediatrics, Dept of Paediatrics & Child Health, Principal Investigator, INFANT centre. Her research interest is the study of neonatal brain injury and in particular hypoxic-ischaemic encephalopathy (HIE). 

Dr Keelin O’Donoghue, MBChB(Hons), PhD, FRCOG, Consultant Obstetrician and Gynaecologist, Cork University Maternity Hospital; Senior Lecturer University College Cork; PI, Pregnancy Loss Research Group, INFANT Centre. 

Dr Barbara Coughlan, PhD, MA, RM, RGN, Lecturer/Assistant Professor, School of Nursing, Midwifery and Health Systems, University College Dublin. 

Professor Joan Lalor, School of Nursing & Midwifery, Trinity College Dublin 

Professor Virginia Schmied, PhD, RM, RGN Professor in the School of Nursing and Midwifery and the Family and Community Health (FaCH) research group; Deputy Dean Research and Engagement, Deans’ Unit-School of Nursing and Midwifery, Western Sydney University Sydney, Australia  

Professor Marianne Nieuwenhuijze, PhD MPH RM, Professor of Midwifery at the Research Centre for Midwifery Science, Maastricht University, Netherlands  

Dr Karen Wynter, Research Fellow at School of Nursing and Midwifery, Deakin University, Melbourne, Australia  

Dr James Dimmock, BSc BCom PhD Associate Professor, Faculty of Science, School of Human Sciences  

Dr Joann O Leary PhD, MPH, MS, parent-infant specialist in the area of parenting during pregnancy after loss.

Professor Vicki Flenady, Director of the Centre of Research Excellence in Stillbirth (Stillbirth CRE), based at Mater Research – The University of Queensland, Australia. Internationally renowned clinical perinatal epidemiologist with specific expertise in stillbirth. 

Professor Alexander Heazell MBChB(Hons) PhD MRCOG Professor of Obstetrics, Maternal and Fetal Health Research Centre in the School of Medical Sciences, Manchester, UK. Director of the Tommy's Stillbirth Research Centre