Explain stress management programme in reducing stress of midwives



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They are used in searching for last updated data, e-books and journals that related to assignment topic. Additionally, some books was found via manual type of searching through libraries, such as Oman nursing Specialized Institute library and Grant Mosque library in Oman. Published Journals in English language within specific time between 2005-2015 included which talk about stress in nursing and midwifery only. Throughout searching, 128 articles were found, however, 108 articles were canceled according to specific exclusion criteria : not in English, more than 10 years , stress not for nurses and midwives and not published journals. As a result 38 articles have been involved in dissertation. They were ranged within quantitative, qualitative, systematic review, explorative and cross-sectional types of literature review. The key words that have been used are: stress, work-related stress, nursing, midwifer, midwives, burnout, turnover, coping strategy and stress management. Throughout searching process, developing of three themes was occurred: causes of work-related stress, effect of work-related stress for midwives and effect of coping strategy and stress management.


As for being a transformational leader, it is vital to communicate, educate, train, motivate and share the task and provide a supportive climate to move the actual change process onwards. Supervision is needed, however, to assess the task, illuminate the enquiry; help the midwives when necessary and encourage them. Generally, effective communication skills are imperative for the leader to overcome conflict to carry on the change process.

Effective communication helps in building interpersonal relationships which allow the leader to identify the barriers. These barriers should be discussed between the team members. For example, midwives have a negative response to reporting WRS, long working hours, fatigue (Lim et al. 2010a). It may also be derived from fear, insecurity, biases, prejudices, loss of power, financial, social, cultural and religious barriers, time and refusal to accept any change. In this dissertation, the leader predicts all the barriers to overcome to increase the productivity and job satisfaction to reduce WRS and burnout. The leader can utilise some approaches to conquer these barriers such as setting effective objectives, cost effectiveness and an economic setting to promote the organisation to implement the change (Marquis and Huston 2012 ; Roussel 2012).

Moreover, uncertainty of the role can exaggerate the conflict. Therefore, the leader could use Powerpoint presentations to develop members’ knowledge, skills and to converse about ideas, responsibilities and decisions (vhYoder-Wise 2011). The National Institute for Health and Clinical Excellence (NHS) (2007) stated that awareness is a useful concept throughout the change plan accordingly; education materials such as research papers will be useful (NHS 2007). In fact, supporting the change with evidence will aid in improving midwives’ well-being and satisfaction with the organisation.

3.3.3 Norming stage

In this stage, a feeling of team members’ cohesion develops and the change is sustained at the same level (Kelly 2012). The team masters the capability to resolve conflict to facilitate the change. Although comprehensive resolution and agreement may perhaps not be achieved all the time, leader and group members learn to respect others opinions and can work together to attain team goals. They have to keep the change advanced and if restraints arise the leader has to identify the effective solution to minimise it.

The planned change will be implemented in this stage. This stage is similar to Lewins moving phase where the driving and restraining forces take place. Besides this,’Lewin’s model underlined that the accurate balance is vital among those forces for change to arise. In this proposal, evidence-based practice is the driving force which comes across at the causes, effects and coping strategies of WRS stressed in the above literature review (Lim et al. 2010a; Kalicinska et al. 2012). Additionally, this change idea is to build a support team and to keep midwives away from damage.

In this stage, team unity, teamwork and harmony are obvious. Team members know their roles and responsibilities and they also rely on each other to accomplish the task. Moreover, continuing and improving interpersonal relationships is one of the strengths for this stage. ONMC (2011) highlights the importance of teamwork among midwives in facilitating positive outcome. The transformational leader can use this opportunity to delegate the task to the followers and encourages their creation of new ideas. Particularly, team work, task distribution and work organisation aid in the driving force. This will aid the leader to move to the fourth stage.

3.3.4 Performing stage

This is the final stage where team cohesion, collaboration and maturity are obvious (Kelly 2012). Moreover, the leader of the team is working to achieve the goals without any disagreement. The team members adjust and take part in roles that will improve the task activities. Roles become more flexible and practical, and team energy is directed to the task.

Lewin’s refreezing phase concerns the evaluation of the accomplished task and outcomes to make sure the change is in the organisational plan. Evaluation considers that the whole thing is done according to the plan (Marquis and Huston 2012). In the evaluation, the effectiveness of the performance is assessed and modifications are arranged to ensure the goals achievement (Kelly 2012). Reports, questionnaires and records are examples of evaluation that aid the successful progress and use of suitable resources. Evaluation also maintains the change as stable and effective due to its continuous process. Here the transformational leader’s role is to summarise the team’s accomplishments and should provide feedback about team process to ensure a sense of task accomplishment in the team members. As well as reporting any midwives’ absenteeism, turnover and burnout to compare to earlier reports and this also benchmarks all health institutions where the change is not practised. The setting will be reassessed and checked for any misplaced materials to re-evaluate midwives’ satisfaction and provide more education if required.

The evaluation will be carried out after three months to ensure the effectiveness of the introduced changes. The primary outcome will be minimising WRS following using the team support as a coping strategy. This will increase midwives’ efficiency, job satisfaction and reduce burnout within the ward. The feedback will be discussed with the team members to maintain the introduced changes. Obviously, evaluation is a continuous process where the leader has to express specific goals, expectations principles and also plans to formulate a successful change. All team members must know the vision and mission as well as the anticipated outcomes (Ellis and Abbott 2011). Finally, this process will compare the reduction of midwives’ burnout and sickness rate and increase job satisfaction.

3.10 Conclusion

The reviewed literature showed the value of following a change process to minimise stress. Tuckman’s Model has been used as a framework to build a team and implement change. Additionally, informing the team regarding the change and using driving force could help in overcoming the barriers (Huber 2006). Moreover, change is necessary to provide the best midwifery care based on evidence-based practice.

Chapter Four

4.1 Conclusion

Stress has been known as a vital problem that influences midwives in organisations. The midwives suffer from stress because of recurring exposure to stressful events which according to the literature are conflict, workload, night shift, and long working hours. These influence the midwives’ well-being, physical and psychological conditions which in turn affect the organisation. The evidenced literature suggested some strategies to minimise WRS among midwives. These include support and early training and education about stress to overcome it. Gates and Gillespie (2008) stated that early training and education can be done through assigning different responsibilities to staff, supervisors and administration.

Tuckman’s Model, Lewin’s theory and transformational style to leadership was utilised for the change to take place. Leadership style, effective communication, suitable environment, adequate support, appropriate selection of approaches and use of the change model are essential components to guarantee that the change takes place. Tuckman’s model of change was clearly utilised and its application was explained. The four stages were used to agree with the accomplishment of a change (forming, storming, norming and performing) were used. The leader was recognised to lead the change throughout the change process. The change plan was explained in detail and the change process was identified. Conflict to change was anticipated throughout the change process and conversely the leader will invest in the actual change and adjust it according to the requirements.

This dissertation developed the knowledge and skills in leadership and change management and helped in application of leadership style, change model and strategies in the healthcare setting to improve midwifery practice and empower evidence-based practice. The proposed plan of change will be submitted to the local hospital administration for approval to implement the change in the DS.

The reviewed literature suggested that the organisation ought to pay attention to midwives’ health and well-being. Moreover, it is recommended that the midwives should receive continuous education and training. Finally, a leader is a change facilitator and may face many challenges and resistance in the change process.




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