Louise Herrington School of Nursing, Baylor University, Dallas, Texas.
Parkland Health & Hospital System, Dallas, Texas.
J Clin Nurs. 2018 Nov;27(21-22):4000-4017. doi: 10.1111/jocn.14489. Epub 2018 Jun 20.
To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers.
Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice.
Mixed methods research utilising prospective descriptive survey and interview.
An online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed.
The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years.
An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice.
Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.
描述德克萨斯州的助产士实践的性质和范围，并确定立法重点和实践障碍。
在全球范围内，尽管对助产士实践知之甚少，但助产士是最大的产妇护理提供者群体。由于助产士短缺迫在眉睫，因此迫切需要了解助产士的工作环境和实践范围。
利用前瞻性描述性调查和访谈的混合方法研究。
向在德克萨斯州执业的助产士（N=449）进行了在线调查，并对 10 名助产士进行了电话访谈。进行了描述性和推断性统计分析和内容分析。
有 141 名助产士完成了调查，其中 8 人接受了电话采访。大多数是年龄较大的白人，拥有硕士学位。大多数人全职工作，在较大的城市地区从事临床实践，受雇于医院或医生团体。护理主要针对西班牙裔和白人妇女；大约四分之一的人可以照顾更多的患者。大多数人没有在临床教授助产士学生。医生执业协议被认为是不必要的，而规定性授权要求是限制性的。立法问题通常通过专业组织或社交媒体网站来解决；大多数人认为自己缺乏影响卫生政策决策的能力。尽管大多数人对当前的临床实践感到满意，但大多数人计划在未来 3 到 5 年内做出改变。
劳动力老龄化的助产士群体，与所服务人群的种族/族裔不相符，未得到充分利用，并且实践要求限制了服务的提供。需要进行卫生政策改革，以确保不受限制的实践。
需要有强大的助产士劳动力数据，以及一个跟踪助产士可用性和可及性的助产士委员会。教育者应考虑培训模式，促进在服务不足地区的长期服务，并培养对影响卫生政策变革至关重要的技能。
