Thumm E Brie, Flynn Linda
J Midwifery Womens Health. 2018 Jan;63(1):90-103. doi: 10.1111/jmwh.12707. Epub 2018 Jan 27.
A supportive work climate is associated with decreased burnout and attrition, and increased job satisfaction and employee health. A review of the literature was conducted in order to determine the unique attributes of a supportive practice climate for midwives.
The midwifery literature was reviewed and synthesized using concept analysis technique guided by literature from related professions. The search was conducted primarily in PubMed, CINAHL, Web of Science, and Google Scholar. Articles were included if they were conducted between 2006 and 2016 and addressed perceptions of the midwifery practice climate as it related to patient, provider, and organizational outcomes.
The literature identified 5 attributes consistent with a supportive midwifery practice climate: effective leadership, adequate resources, collaboration, control of one's work, and support of the midwifery model of care. Effective leadership styles include situational and transformational, and 9 traits of effective leaders are specified. Resources consist of time, personnel, supplies, and equipment. Collaboration encompasses relationships with all members of the health care team, including midwives inside and outside of one's practice. Additionally, the patients are considered collaborating members of the team. Characteristics of effective collaboration include a shared vision, role clarity, and respectful communication. Support for the midwifery model of care includes value congruence, developing relationships with women, and providing high-quality care.
The attributes of a supportive midwifery practice climate are generally consistent with theoretical models of supportive practice climates of advanced practice nurses and physicians, with the exception of a more inclusive definition of collaboration and support of the midwifery model of care. The proposed Midwifery Practice Climate Model can guide instrument development, determining relationships between the attributes of the practice climate and outcomes, and creating interventions to improve the practice climate, workforce stability, and patient outcomes.
支持性的工作氛围与职业倦怠和人员流失的减少、工作满意度和员工健康状况的提高相关。为了确定助产士支持性执业氛围的独特属性，我们对相关文献进行了综述。
运用概念分析技术，以相关专业的文献为指导，对助产领域的文献进行了综述和综合分析。搜索主要在PubMed、CINAHL、科学网和谷歌学术上进行。纳入2006年至2016年期间发表的、涉及助产执业氛围与患者、提供者和组织结果相关认知的文章。
文献确定了与支持性助产执业氛围一致的5个属性：有效的领导、充足的资源、协作、工作掌控以及对助产护理模式的支持。有效的领导风格包括情境型和变革型，并明确了有效领导者的9个特质。资源包括时间、人员、物资和设备。协作涵盖与医疗团队所有成员的关系，包括执业内外的助产士。此外，患者也被视为团队的协作成员。有效协作的特征包括共同愿景、角色明确和尊重性沟通。对助产护理模式的支持包括价值契合、与女性建立关系以及提供高质量护理。
支持性助产执业氛围的属性总体上与高级执业护士和医生支持性执业氛围的理论模型一致，但协作的定义更具包容性，且对助产护理模式的支持有所不同。所提出的助产执业氛围模型可指导工具开发、确定执业氛围属性与结果之间的关系，以及制定改善执业氛围、劳动力稳定性和患者结局的干预措施。
