Themes and Sub-Themes on Which the Literature Review Was Based Table 2.1 summarizes the themes and sub-themes on which the literature review was

CHAPTER 2 | 2.2 Themes and Sub-Themes on Which the Literature Review Was Based

midwives who have undergone a comprehensive programme (SANC Regulation, R425 of 19 February 1985, as amended) be placed in public hospitals to complete one year of compulsory service. It is during this compulsory placement where they need to be orientated, supervised and mentored in their new role before they are registered as professional nurses by SANC.

2.2 Themes and Sub-Themes on Which the Literature Review Was Based

CHAPTER 2 | 2.2.1.1 Reality of clinical practice

Table 2.1: Themes and sub-themes on which the literature review was based 2.2.1 Experiences of newly graduated midwives regarding provision of midwifery

services during their transition period 2.2.1.1 Reality of clinical practice

2.1.1.1.1 Emotional factors 2.1.1.1.2 Physical factors

2.1.1.1.3 Sociocultural and developmental factors 2.1.1.1.4 Intellectual factors

2.2.1.2 Incongruence between theory and clinical practice 2.2.1.3 The context of hospital maternity care

2.2.1.4 Negative attitudes of experienced midwives

2.2.1.5 A workplace learning environment

2.2.2 Expectations of experienced midwives from newly graduated midwives 2.2.2.1 Autonomy in clinical practice

2.2.2.2 Inability to relieve midwifery professionals

2.2.3 Support provided by experienced midwives to newly graduated midwives 2.2.3.1 Clinical support through mentorship

2.2.3.2 Positive and supportive midwife to midwife relationship

In a study entitled ‘Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses,’ Duchscher (2009) described the shock which emerged as the experience of moving from the known and familiar role of a student to the relatively less familiar role of a professionally practising midwife. Important to this experience for the new graduate is the apparent contrast between the relationships, roles, responsibilities, knowledge and performance expectations required within the more familiar academic environment to those required in the professional practice setting. Kramer (1974) as well as Marquis and Huston (2009) revealed that newly qualified professionals experience specific shock-like reactions when they find themselves in a work situation for which they have spent several years preparing and

CHAPTER 2 | 2.2.1.1 Reality of clinical practice

thought they were fully prepared, but suddenly realize they were not. Stacey and Hardy (2011) described the four phases of role transition from being a student to a registered professional as the honeymoon, shock, recovery and resolution. These phases are also applicable to this study as the newly graduated midwives start by undergoing orientation which only lasts for a few days.

During this period, they are not held accountable for patient care. After a few days of orientation, newly graduated midwives become shocked as they are expected to adjust themselves to the new environment where they are expected to function as professional midwives. It is during this stage whereby they are expected to provide care to patients and at the same time, play their administrative as well as teaching roles. All these result in shock as they fail to cope with the reality of clinical practice.

Towards the end of transition, graduates become more familiar and comfortable with their professional positions; and their relationship with the colleagues is improved. The model is applicable to this study as newly graduated midwives at this stage are more familiar and comfortable with their professional positions. As a result, they are able to explore their professional environment with a critical eye. Panzavecchia and Pearce (2014) further reported that participants seemed ill-prepared for the toll this initial transition would take on both their personal energy and time and on their evolving professional self-concepts.

According to the study conducted by Kramer (1974), formal education equips learners with ‘visionary ideals,’ and this makes new workers to feel completely unprepared for the reality of clinical practice; the author further indicated that shock or reaction to the contrast between expectations of practice and reality can be so marked that the individual may not cope with the situation. On the other hand, van der Putten (2008) found that the stress experienced was frequently associated with the sudden and often

CHAPTER 2 | 2.2.1.1 Reality of clinical practice

unexpected increase in responsibility together with a heightened burden of awareness of their individual accountability. This was supported by Coulm et al. (2012) who reported about the study they conducted regarding the perceptions of newly qualified registered midwives in which she revealed that the transition period from a student to a registered professional is a difficult time in which practitioners manifest in feelings of trepidation, fear and anxiety when faced with the reality of clinical practice. In their studies, Stacey and Hardy (2011), as well as Young (2012) described how new graduates struggled with their changing role and new-found responsibilities.

Schytt and Waldenström (2013), who undertook a grounded theory study in the UK on 18 newly qualified midwives’ experiences, discussed how the newly qualified midwives expressed their feelings of stress and anxiety regarding the registered midwifery role. The new graduates expressed concerns regarding their level of knowledge and skills, but also found the workplace challenging in terms of workload and staff shortages. Many believed they had been sheltered from the realities of the midwifery role, during their training period (Schytt and Waldenström, 2013).

Similarly, Schroeder, Petrou, Hollowell, Redshaw and Brockelhurst (2014) who interviewed ten newly qualified midwives in Connecticut, USA, described new graduates’ feelings of anxiety and insecurity as they took up their new role. In their analysis, the authors clustered a number of concepts under the pertinent heading of

“welcome to the real world” (Schroeder et al., 2014).

In a study about newly qualified midwives’ transition to qualified status and role, Hobbs (2012) contended that ‘reality of clinical practice’ may be implicated in transition reversibility, and lead to abandonment of the chosen career pathway. This view was supported by Young (2012) who found that newly qualified midwives experienced domains of thrownness from being faced with a certain situation to the threatening

CHAPTER 2 | 2.2.1.1.1 Emotional Factors

experience that is a catalyst for rejecting the nursing and midwifery profession altogether. Bernitz, Øian, Rolland, Sandvik and Blix (2014) reported that participants expressed shock, stress and vulnerability when they were given the title “Sister”. They desired the title, but were apprehensive because they believed the title implied that they should know what to do under any circumstances, a goal they considered unrealistic. Doody et al. (2012) reported shock as expressed by participants when experienced midwives did not welcome them and also presented with an unprofessional behaviour2.2.1.1 Reality of clinical practice

In the phenomenological study of the lived experiences of newly qualified midwives in Ireland, Van der Putten (2008) identified two main themes that represented the experiences of newly graduated midwives, and such were reality shock and living up to the expectations. Furthermore, Van der Putten (2008) described frustration encountered by graduates. This occurred as they were expected to familiarize themselves with the new environment; at the same time, had to meet the expectations of the experienced midwives as well as those of the patients (Van der Putten, 2008)..

According to Duchscher (2009), participants’ expressions of transition reality shock were experienced as emotional, physical, intellectual as well as socio-cultural and developmental.