Characteristics of participants
The median age of participants of the surveys was 33.5 years (range = 25.0–64.0 years, Table 1). Two third of the midwives (n = 28) were born in Switzerland and more than half had a Bachelor’s degree (n = 24). The midwives had worked for a median of 9.2 years in the profession.
Table 1
Characteristics of participants
Variable | Participants n = 421 |
Age, md (min-max) | 33.5 (25–64) |
Country of birth Switzerland, n (%) Germany, n (%) Serbia, n (%) Italy, n (%) Other, n (%) | 28 (66.7) 6 (14.3) 2 (4.8) 1 (2.4) 5 (11.9) |
Living in Switzerland < 5 years, n (%) 5–14 years, n (%) 15–24 years, n (%) 25–34 years, n (%) ≥ 35 years, n (%) | 3 (21.4) 4 (28.6) 2 (14.3) 3 (21.4) 2 (14.3) |
Education Vocational training, n (%) Bachelor’s degree, n (%) Master’s degree, n (%) | 13 (30.1) 24 (57.1) 5 (11.9) |
Work years in health sector, md (min-max) | 14.5 (4–43) |
Work years as a midwife, md (min-max) | 9.2 (0.2–43) |
Work years at USZ2, md (min-max) | 9.5 (0.2–37.5) |
Workload < 50% of full time equivalent, n (%) 50–70% of full time equivalent, n (%) 80–100 of full time equivalent, n (%) | 1 (2.3) 12 (27.9) 30 (69.8) |
1 Missing values for n = 1 participant; 2 USZ-University hospital of Zurich |
Job situation
Midwives indicated caring for a median of three women during one shift. Six midwives (14.3%) stated that they sometimes or often needed to work overtime. All the midwives working overtime rarely, sometimes or often (n = 24) were able to record these extra hours. Almost half of them (n = 11, 45.8%) could compensate time during the same month and two participants (8.3%) mentioned that overtime was paid. Nearly all midwives (n = 37, 97.4%) worked in shifts and most of them (n = 29, 78.4%) worked all shifts (early, late and night shift). In a median, participants worked five night shifts per month (range = 0–6).
Attitude toward telephone debriefing
More than half of the midwives had an open attitude towards the telephone debriefing sessions before their implementation (54.3% absolutely or mostly agreed at t0, Table 2). The proportion of midwives recognising the telephone debriefing sessions as an additional stress increased slightly without significant difference between t0, t1 and t2. However, participants acknowledging the project being important for the women decreased significantly between t0 and t2 (p = 0.035).
Table 2
Attitude toward telephone debriefing before and after the implementation of the telephone debriefing sessions
Question | Before imple-mentation of debriefing sessions (t0) n = 35 | 2 months after implementation of debriefing sessions (t1) n = 30 | 7 months after implementation of debriefing sessions (t2) n = 30 |
I have an open attitude towards the telephone debriefing sessions Absolutely, n (%) Mostly, n (%) Partly, n (%) Not at all, n (%) | 9 (25.7) 10 (28.6) 14 (40.0) 2 (5.7) | 11 (36.7) 10 (33.3) 8 (26.7) 1 (3.3) | 10 (33.3) 8 (26.7) 11 (36.7) 1 (3.3) |
Contacting women at home is an additional stress for me Absolutely, n (%) Mostly, n (%) Partly, n (%) Not at all, n (%) | 9 (25.7) 8 (22.9) 10 (28.6) 8 (22.9) | 9 (30.0) 5 (16.7) 11 (36.7) 5 (16.7) | 8 (26.7) 11 (36.7) 7 (23.3) 4 (13.3) |
Debriefing sessions with the midwife who attended birth are important for women Absolutely, n (%) Mostly, n (%) Partly, n (%) Not at all, n (%) | 11 (31.4) 15 (42.9) 8 (22.9) 1 (2.9) | 5 (16.7) 15 (50.0) 10 (33.3) 0 | 2 (6.7)a* 15 (50.0) 13 (43.3) 0 |
a significant difference between t0 and t3; *p < 0.05 |
Development of job satisfaction of midwives
The midwife-specific instrument [18] showed a decrease and subsequently increases in the mean of the ‘Professional satisfaction subscale’, the ‘Professional support subscales’ and the Professional support’ between t0 and t1 respectively t2 (Table 3). The mean scores of the ‘Client interaction subscale’ in contrast, increased slightly between t0 and t1 and more clearly between t1 and t2.
Table 3
Job satisfaction before and after the implementation of the debriefing (Turnbull et al. 1995)
Question Coding − 2 to + 2 | Before imple-mentation of debriefing sessions (t0) n = 35 mean (SD) | 2 months after implementation of debriefing sessions (t1) n = 30 mean (SD) | 7 months after implementation of debriefing sessions (t2) n = 30 mean (SD) |
Professional satisfaction subscale |
Generally speaking, I am satisfied with my current role as a midwife | 1.34 (0.76) | 1.10 (0.76) | 1.30 (0.53) |
I feel I am in a rut1 | 0.17 (1.27) | 0.23 (1.14) | 0.47 (1.01) |
I feel frustrated with my current role1 | 0.91 (0.92) | 0.73 (0.83) | 0.97 (0.67) |
I have enough opportunities to make decisions about care | 0.20 (0.93) | 0.13 (0.78) | 0.40 (0.77) |
I have limited opportunities for professional development1 | 0.46 (1.17) | 0.33 (1.03) | 0.13 (1.04) |
I am confident that I have the skills for my current role. | 1.54 (0.78) | 1.43 (0.57) | 1.60 (0.56) |
Mean professional satisfaction | 0.77 (0.59) | 0.66 (0.56) | 0.81 (0.43) |
Professional support subscale |
I have enough time to give women the care they need | 0.14 (0.94) | -0.13 (1.14) | 0.17 (0.91) |
I get professional support from my midwife colleagues | 1.46 (0.56) | 1.23 (0.43) | 1.33 (0.48) |
I get enough support from other clinical colleagues (e.g. GPs and obstetricians) | 0.63 (1.00) | 0.47 (1.04) | 0.73 (0.74) |
There is not enough time to do my job properly1 | 0.83 (1.12) | 0.43 (0.90) | 0.33 (1.15) |
My current role is very stressful1 | 0.11 (1.02) | –0.17 (0.79) | − 0.27 (0.74) |
Mean professional support | 0.63 (0.55) | 0.37 (0.50) | 0.46 (0.52) |
Client interaction subscale |
My current role allows me to provide women with choice about their care | 0.29 (0.96) | 0.20 (0.85) | 0.43 (0.86) |
My current role allows me to plan care with women | 0.51 (0.85) | 0.50 (0.86) | 0.53 (0.78) |
I need greater scope to provide women with information about their care1 | -0.46 (0.89) | -0.33 (0.99) | 0.10 (0.92) |
I have limited opportunities to provide women with individualised care1 | -0.17 (1.01) | -0.20 (0.89) | 0.07 (0.91) |
I have limited opportunities to provide continuity of care1 | -0.46 (0.98) | -0.30 (0.88) | -0.27 (0.87) |
Mean client interaction | -0.06 (0.76) | -0.03 (0.55) | 0.17 (0.64) |
Professional development subscale |
I have enough professional independence | 0.26 (1.01) | –0.13 (0.90) | 0.03 (0.89) |
I have few opportunities to develop my skills as a midwife1 | 0.74 (1.04) | 0.83 (0.91) | 0.57 (1.07) |
I have plenty of opportunities to further my professional education | 0.89 (0.96) | 0.83 (0.87) | 0.43 (1.01) |
I lack professional support from my managers1 | 1.49 (0.89) | 1.20 (1.10) | 1.57 (0.77) |
Mean professional development | 0.72 (0.70) | 0.44 (0.66) | 0.52 (0.55) |
1 Negative questions, which were recoded. Higher values signify higher satisfaction |
Repeat measure prediction for scores of subscales were adjusted for age, work years in the institution, number of women cared for per shift and workload. The adjusted predicted scores of the ‘Professional satisfaction subscale’ neither differed significantly between t0 and t1 (0.71, 95% CI [0.53, 0.88] versus 0.69 95% CI [0.49, 0.89, p = 0.906) nor between t0 and t2 (0.71, 95% CI [0.53, 0.88] versus 0.74, 95% CI [0.55, 0.94], p = 0.745, Fig. 1). In contrast, those of the ‘Professional support subscales’ declined significantly between t0 and t1 (0.65, 95% CI [0.45, 0.86] versus 0.26 95% CI [0.08, 0.45], p = 0.005) and t0 and t2 (0.65, 95% CI [0.45, 0.86] versus 0.29, 95% CI [0.12, 0.47], p = 0.004). Regarding the ‘Client interaction subscale’, the adjusted predicted scores did not differ significantly either between t0 and t1 (-0.01, 95% CI [-0.22, 0.20] versus − 0.01, 95% CI [-0.25, 0.23], p = 0.995) or between t0 and t2 (-0.01, 95% CI [-0.22, 0.20] versus 0.09, 95% CI [-0.14, 0.32], p = 0.460). A significant decrease was also observed for the adjusted predicted scores of the ‘Professional development subscale’ between t0 and t1 (0.77, 95% CI [0.55, 0.99], versus 0.40, 95% CI [0.15, 0.64], p < 0.001) as well as t0 and t2 (0.77, 95% CI [0.55, 0.99] versus 0.41, 95% CI [0.17, 0.64], p < 0.01).
Other job and occupational related factors
Significant differences were found for adjusted predictions for the ‘Meaning of work’ subscale of the COPSOQ, which were lower at t1 compared to t0 and for the ‘Job satisfaction’ subscale, which showed a decrease between t0 and t2 (Table 4). The ‘Intention to leave the profession’ subscale increased significantly between t0 and t2.
Table 4
Results of adjusted work-related assessments before and after the implementation of the debriefing
Question | Before imple-mentation of debriefing sessions (t0) n = 35 | 2 months after implementation of debriefing sessions (t1) n = 30 | 7 months after implementation of debriefing sessions (t2) n = 30 |
LQWLQ-N1 |
Subscale “Autonomy”, AP2 [95% CI] | 2.6 [2.6, 2.8] | 2.6 [2.4, 2.7] | 2.5 [2.4, 2.7] |
COPSOQ3 (from 0=’to a very small extent’ to 100=’to a very large extent’) |
Meaning of work, AP2 [95% CI] | 87.4 [82.9, 91.9] | 80.8 [75.7, 85.9] | 83.9 [79.0, 88.8] a* |
Bond with organisation, AP2 [95% CI] | 65.3 [59.9, 70.6] | 61.7 [55.7, 67.8] | 64.0 [58.2, 69.8] |
Work privacy conflict, AP2 [95% CI] | 34.7 [28.3, 41.0] | 36.3 [29.3, 43.2] | 34.4 [27.7, 41.0] |
Demarcation, AP2 [95% CI] | 26.5 [20.1, 32.9] | 30.1 [22.9, 37.4] | 20.8 [13.9, 27.7] |
Job satisfaction, AP2 [95% CI] | 65.7 [61.1, 70.2] | 63.3 [58.3, 68.4] | 60.2 [55.4, 65.1] b* |
Intention to leave the organisation, AP2 [95% CI] | 17.1 [11.0, 23.2] | 18.4 [11.5, 25.3] | 21.1 14.4, 27.8] |
Intention to leave the profession, AP2 [95% CI] | 11.3 [5.9, 16.7] | 9.8 [4.0, 15.6] | 17.5 [11.5, 23.4] b |
1 LQWLQ-N = self-translated Leiden Quality of Work Life Questionnaire for Nurses; 2 AP [95% CI] = adjusted predictions with corresponding 95% confidence interval; 3 COPSOQ = Copenhagen Psychosocial Questionnaire; a significant adjusted difference between t0 and t1; b significant adjusted difference between t0 and t3; *p < 0.05; **p < 0.001 |
Figure 1: Adjusted trajectory of sub scores over measurements |
Focus group discussions
A total of eleven midwives participated in one or two of the three focus group discussions, seven in the first, five in the second and seven in the third one. The focus group discussions revealed three themes, which were important for the job situation: “Job satisfaction”, ”Challenges with the implementation” and “Continuity of care”.
The theme “Job satisfaction” comprised general aspects. Most midwives mentioned being very satisfied with their job. Having a secure job and working in a good team were experienced as very important factors.
“I experience that we are a really good team and help each other…” (before the implementation)
Factors negatively affecting job satisfaction were working shifts but also the request to complete an increasing number of tasks. A trend toward negative quotations was higher two and seven months after the implementation of the debriefing session, when interviews were conducted during periods with high workloads.
“Working shifts makes it nearly impossible to work 100 percent. Thus, working several years full time and keep the social environment intact is not possible.” (two months after the implementation)
Regarding the ”Challenges of the implementation”, midwives highlighted the additional workload of conducting the telephone debriefing sessions, which should be completed during their working time. They experienced it as stressful, but even so, some of them point out the good feeling it gives them afterwards.
“Once I’ve done it, I’m happy about it, but it is the same as for her (comment: name of the colleague), that it is always breathing down my neck.” (two months after)
The organisation of the telephone debriefing sessions was especially challenging. Women were difficult to reach, and several calls or emails were needed to make contact. Midwives also pointed out their need to know if women profited from the telephone calls in order to find a sense in the additional workload.
“This (comment: the debriefing sessions) is really difficult to plan, this is a major challenge for me.” (seven months after)
“Continuity of care” was a controversial issue. Many participating midwives worked in a university hospital because they wanted demarcation from work. However, seven months after the implementation of the telephone debriefing sessions, some midwives came to appreciate the follow-up contact with the women which rounded off their care.
“And then, I’m coming back again after two, three months (…) This is nice for me, that work is not already finished but we return to the birth situation.” (seven months after)