The development of a transition support programme was based on Duchscher’s (2009) transition theory as well as ADDIE’s model of training (Cutler et al., 2012). The programme was organised in three phases following the stages of Duchscher’s (2009) transition theory, which are: the stage of doing, stage of being and stage of knowing.
Activities to be covered in all the phases were identified based on the performance gaps identified in the analysis phase, which is the first phase of ADDIE’s framework;
performance objectives were formulated during the second phase of ADDIE’s framework; development of a programme was done during the third phase of ADDIE’s framework. Implementation and evaluation of a developed transition support programme were not covered as they fall beyond the scope of this study.
Figure 5.6, is the schematic presentation of transition support programme based on Duchscher’s (2009) transition theory as well as ADDIE’s training model (Cutler et al., 2012).
To ensure effective implementation of the programme, a foundation should be laid in order to prepare both the newly graduated as well as the experienced midwives.
Foundation laying covers clarification of objectives transition support programme aims to achieve; which were formulated during the design phase of ADDIE’s framework.
CHAPTER 5 | 5.4.3.1.2 Phases in a Transition Support Programme
Figure 5.6: Transition support programme
CHAPTER 5 | 5.4.3.1.2 Phases in a Transition Support Programme
Guidelines of the programme should also be made known to all members involved in the transition support process. Activities in the programme are addressing the performance gaps identified during the analysis phase. Development of a transion support programme was done in the third phase of ADDIE’s training model, based on the stages of Duscher’s (2009) transition theory.
❖
Phase 1: The Stage of Doing (0-4 Months)
During this stage, newly graduated midwives are expected to learn how to cope, adapt and adjust themselves to the new environment; whereby they are no longer students but professional midwives. Therefore, newly graduated midwives have to be orientated to the surrounding as well as the new role. They have little strength to face and accommodate the responsibilities set before them. This is because they experience transition shock and all the energy is being consumed as they anxiously try to perform in their new roles, without revealing how difficult this is for them.
Therefore, supervision and mentoring are necessary. It becomes more difficult for them to cope if their relationship with the senior members of staff is poor or if they feel unwelcomed. It is during this stage whereby newly graduated midwives require more prescriptive directives about what should be done in particular clinical situations, therefore they have to be delegated with a senior member of staff.
During the first phase of a transition support programme, orientation, supervision, mentoring, positive collegial relationship and delegation will be catered for.
❖
Orientation
Based on concept analysis, orientation of newly graduated midwives forms the foundation for effective transition support, and therefore acts as a baseline for an effective transition support programme. As it provides a foundation, orientation of
CHAPTER 5 | 5.4.3.1.2 Phases in a Transition Support Programme
newly graduated midwives must be done during the first three to four months of transition, and should include the following:
❖
Introduction to the Organization
One of the responsibilities of newly graduated midwives is to effectively interact their midwifery services with the services provided by different sections within the hospital.
Therefore, graduates must be introduced to different sections as soon after commencement of their transition period as possible. Introduction of graduates to the organization should be done as follows:
• Hospital tour should be conducted in order to familiarize newly graduated midwives with different sections in an organization (this should be done during the first week of arrival in an organization).
• Institutional policies should also be clarified to newly graduated midwives, so that they become conversant with effective functioning of the institution.
❖
Introduction to Maternity Unit
• For newly graduated midwives to function effectively, they must be orientated to the surroundings of a maternity unit including all the sub-units.
• A tour to Theatre should also be taken so that newly graduated midwives can familiarize themselves with a particular theatre in preparation for Caesarean births. Where possible, orientation should be done during the first week of arrival in an institution and should be done by a senior member of staff.
• For effective management of midwifery emergencies, newly graduated midwives should be orientated to important aspects of provision of care such
CHAPTER 5 | 5.4.3.1.2 Phases in a Transition Support Programme
as, an emergency trolley, eclamptic box and a resuscitation unit. Graduates should be orientated to the routine of a maternity unit. This will facilitate effective provision and management of midwifery services.
• Policies, protocols, procedures and guidelines governing provision of midwifery services should be clarified to the graduates.
❖
Supervision
Supervision of newly graduated midwives should be done by all experienced midwives working with graduates during their transition period. As part of supervision, experienced midwives must confirm the findings made by newly graduated midwives regarding patients’ observations, to ensure patients’ safety. Newly graduated midwives must not perform procedures such as conduction of deliveries, suturing of episiotomies alone without any supervision by experienced midwives. Where necessary, supervision must be accompanied by teaching on the spot in order to address performance gaps.
❖
Mentoring
Formal mentoring process should be put in place with an aim of provision of effective support and development of newly graduated midwives. It is imperative that a mentor be assigned to each graduate; and such a mentor should be committed, passionate and having an interest in a role in order to facilitate mentoring process. A mentor should have an understanding of a role as support and guidance, enabling the new practitioner to adapt and grow into his/her professional role. Modelling, supporting best practice and provision of positive feedback should be the strong ingredients of a mentoring process. A mentee should be prepared and committed to the mentoring process to enhance development of knowledge and skills. Both a mentor and a
CHAPTER 5 | 5.4.3.1.2 Phases in a Transition Support Programme
mentee should be responsible for establishment and maintenance of positive mentor- mentee relationship.
❖
Positive Collegial Relationship
There is no way in which effective transition support can be possible without establishment and maintenance of positive collegial relationship. Therapeutic sessions should be established and conducted on such days that are less busy and well-staffed, e.g. Wednesdays as the majority of personnel are on duty. It is in these sessions whereby discussions are held regarding effective transition support, and graduates are encouraged to air their views regarding the topic, such as: their views and feelings regarding transition, the kind of support they need and whether they are ready and committed to participate in their support process or not.
Effective communication is regarded as one of the pillars for positive collegial relationship, hence, discussions are held regarding promotion of effective communication amongst experienced as well as newly graduated midwives. Such discussions must cover issues as; what effective communication involves including the value thereof. One of the cornerstones of positive collegial relationship is respect for one another; therefore, both experienced as well as newly graduated midwives are encouraged to treat each other with respect.
❖
Delegation
Tasks should be delegated to graduates in order to prevent them from rooming around being jobless, as they are not yet used to activities that are carried out by professional practitioners. Delegation should be formal and should be written down, and the delegated graduates should sign for acceptance of the delegated tasks. It is mandatory that graduates are delegated with a senior member of staff to assist and
CHAPTER 5 | 5.4.3.1.2 Phases in a Transition Support Programme
oversee the performance of delegated tasks; particularly in tasks that demand high levels of responsibility and accountability such as; management of highly scheduled drugs, management of a woman in labour, management of caesarean births in theatre and resuscitation of a newborn baby. Consideration of orientation, supervision, mentoring, positive collegial relationship and delegation may have a positive impact in graduates’ performance during the first phase of transition support programme.
The next phase covers the discussion of the second stage of a transition support programme, which is the stage of being.
❖
Phase 2: The Stage of Being (5-8 Months)
During the stage of being, newly graduated midwives are confronted with inconsistencies and inadequacies within the health care system that serve to challenge their somewhat idealistic pre-graduate notions of the profession. They begin to get used to their professional roles and responsibilities; even though they are still faced with challenges regarding a lot of uncertainties within the health care system.
They ask themselves a lot of questions as they try to correlate their roles and express a strong desire for clarification and confirmation of their own thoughts and actions.
Newly graduated midwives try to integrate their professional nurses’ role with the roles of other professionals within the institution. They feel confident as they realize that they could make decisions and implement midwifery actions that are not only appropriate but also safe; as a result, mentoring should continue but should be minimised.
❖
Delegation
Newly graduated midwives are beginning to get used to their professional roles and responsibilities but are still not certain regarding some issues related to provision of
CHAPTER 5 | 5.4.3.1.2 Phases in a Transition Support Programme
care; therefore delegation of tasks should still continue. Delegation should continue to be done formally and should be written down, but a senior member of staff should be gradually withdrawn.
❖
Environment Conducive for Learning
Formal teaching should be done especially during less busy and well-staffed days, such as on Wednesdays as the majority of nursing personnel are on duty. For facilitation of effective teaching and learning, a teaching programme should be prepared based on graduates’ learning needs. Graduates should also participate in peer teaching, but should be allowed to choose the topics of interest in which they feel competent to teach, in order to boost their confidence.
Reflection should also be practised whereby graduates are given the opportunity to explore the situations they have been faced with including actions taken to manage such situations. Based on these reflections, identification of potential areas for personal development should be done. Graduates should be empowered so that they are able to provide high level of care and manage emergency situations that demand expertise on the use of:
• An emergency trolley
• An eclamptic box
• A resuscitation unit
❖
Phase 3: The Stage of Knowing (9-12 Months)
Newly graduated midwives are more familiar and comfortable with their professional positions; and their relationship with the colleagues is improved. These enable them
CHAPTER 5 | 5.4.4 Summary
to explore their professional environment with a critical eye. They also begin taking notice of the more troubling aspects of their socio-cultural and political environments.
It is during this time whereby everybody starts feeling their impossible way of thinking and doing things as it is the way they have been socialized. Mentoring should be withdrawn gradually but positive collegial relationship continued as a lifelong commitment. Environment conducive for learning should continue to be maintained but newly graduated midwives should be mostly involved in teaching. Table 5.2, presents a developed transition support programme.
5.4.4 Summary
The above discussion covered the details of the developed transition support programme based on Duchscher’s transition theory as well as ADDIE’s training model.
Activities to be carried out to promote effective support of newly graduated midwives during their transition period, were highlighted. Implementation and evaluation phases of the developed programme fall beyond this study, and therefore were not covered.
The section that follows focuses on a description of validation process of a developed transition support programme.