Abstract
Aims: To understand the perspectives and experiences of healthcare providers who have experience working with an enhanced recovery care after elective caesarean birth pathway with next-day discharge and home midwifery.
Design: This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post-positivist philosophy.
Methods: The work was conducted in South Australia, Australia between May and October 2019. Twenty-three semi-structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six-phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed.
Results: Four main themes and 11 sub-themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system.
Conclusion: Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements
that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility.
Impact: Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care.
Patient or Public Contribution: The health service and health providers were involved with the initiation and development of the research aims and design.
Design: This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post-positivist philosophy.
Methods: The work was conducted in South Australia, Australia between May and October 2019. Twenty-three semi-structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six-phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed.
Results: Four main themes and 11 sub-themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system.
Conclusion: Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements
that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility.
Impact: Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care.
Patient or Public Contribution: The health service and health providers were involved with the initiation and development of the research aims and design.
| Original language | English |
|---|---|
| Pages (from-to) | 4228-4240 |
| Number of pages | 13 |
| Journal | Journal of Advanced Nursing |
| Volume | 81 |
| Issue number | 7 |
| Early online date | 18 Dec 2024 |
| DOIs | |
| Publication status | Published - Jul 2025 |
| Externally published | Yes |
Keywords
- caesarean section
- enhanced recovery
- ERAS
- healthcare provider
- midwife
- nurse
- obstetrician
- qualitative
- staff
