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C McCourt

Publications and source records attributed to C McCourt.

17 recordsLinked to original sources
PubMed2001

Evaluation of a problem-based curriculum in midwifery.

OBJECTIVE: to evaluate the implementation of a 'problem-based' learning (PBL) curriculum within midwifery. DESIGN: a 'realistic evaluation' model based on cost-effectiveness models of economics, and incorporating both qualitative and quantitative methodology. The design used historical comparison, comparing students following the new curriculum with a baseline of previous student cohorts and exploring staff and student experiences. SETTING: a 'new' university, providing a degree-level 18 month pre-registration midwifery programme for an intake of about 40 students per cohort. PARTICIPANTS: all students in the cohort qualifying immediately before the implementation and all those in the first cohort following the new curriculum were invited to participate fully. Assessment outcomes for three cohorts of students qualifying before and the first three cohorts qualifying following the change were analysed. All clinical staff directly involved in mentoring the relevant student groups, all academic staff involved in delivering the new curriculum and the course external examiner were invited to participate. INTERVENTION: the evaluation studied a major change in the way the overall midwifery curriculum was delivered, widely described as PBL. MEASUREMENTS: students' experiences and perspectives were sought through review of routine evaluation documents, nominal group technique exercises and focus group discussions at about six months following qualification. Clinical staff experiences and perspectives were sought through written structured questionnaires. Academic staff views were sought through personal semi-structured interviews. Participant observation of the process, review of course documents and of staff reflective commentaries were also conducted. Data on student completion rates and final grade were analysed. FINDINGS: although students' views of the curriculum were generally positive, they experienced some discomfort and difficulty in adjustment to a new style of learning. Small group learning, independence and skills in using and conveying information and research evidence were valued aspects of the new approach. Quality of clinical placement experience and university-practice links were an important area of positive experience or concern. Clinical staff views of the curriculum showed considerable stability, with major concerns being the balance of theory and practice time and skills which were not influenced by the curriculum change. At both points, ability to critically evaluate and use evidence in practice was regarded highly. Student outcomes showed some evidence of possible divergence of grades in the new curriculum. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the manner and context of implementation of educational change may have important implications for student experiences and outcomes and the experiences of educators. Adequate preparation at all levels for a different, more independent style of learning is important and students are likely to need clear guidance and feedback on their progress in the early stages of the curriculum, to monitor progress and to provide reassurance. Longer-term research is needed to assess the impact of PBL on theory-practice links and on the midwives as practitioners.

Attitude↗
PubMed2000

Does continuity of carer matter to women from minority ethnic groups?

OBJECTIVE: To explore the maternity care views and experiences of minority ethnic women who did not respond to a postal survey of mothers' responses to care and to assess whether the concept of continuity mattered to them. DESIGN: A semi-structured narrative interview, at about six months following birth, designed to encourage women to describe their experiences of pregnancy, birth and maternity care in their own words and according to their own perspectives. SETTING: Maternity care in a London NHS Trust with two teaching hospital units, where women in a specific neighbourhood received caseload midwifery care as part of a pilot scheme and other women received conventional (normally 'shared') maternity care. PARTICIPANTS: 20 women, half receiving caseload midwifery care and half conventional maternity care. MEASUREMENTS AND FINDINGS: The interviews were transcribed in full and the texts analysed by open coding and grouping into conceptual areas and linking themes. Key findings related to continuity of carer are highlighted in this paper but related concepts, such as that of control will be reported in more detail elsewhere. Although detailed views and requirements were specific to these women, underlying values and priorities were similar to those reported widely in consumer research in maternity care. The women valued concepts such as communication, support, and control highly but those receiving conventional care were disappointed with their care, particularly in hospital settings and did not feel it was focused on them as a person. Women receiving caseload midwifery care held more positive views and emphasised the role of having 'their own' midwife in supporting such concepts. They showed greater trust and confidence in the professionals and in the personal transition of giving birth. KEY CONCLUSIONS: This small study adds to an existing body of evidence that minority ethnic women do not receive a high quality of maternity care in conventional services and suggests that this is related to the institutional organisation of care. It does not support the assumption that the principles of Changing Childbirth, in particular that of continuity of carer, do not matter to them. Conversely, this group of women shared similar fundamental values and hopes of the service with the wider population of which they are a part but experience a greater dissonance between expectations and experience. IMPLICATIONS FOR PRACTICE: Organisation of maternity care should make caseload midwifery available as a choice for such women to facilitate more woman-centred care.

Continuity of Patient Care↗
PubMed1999

Clinical interventions and outcomes of One-to-One midwifery practice.

BACKGROUND: Changing Childbirth became policy for the maternity services in England in 1994 and remains policy. One-to-One midwifery was implemented to achieve the targets set. It was the first time such a service had been implemented in the Health Service. An evaluation was undertaken to compare its performance with conventional maternity care. METHODS: This was a prospective comparative study of women receiving One-to-One care and women receiving the system of care that One-to-One replaced (conventional care) to compare achievement of continuity of carer and clinical outcomes. The evaluation took place in The Hammersmith Hospitals NHS Trust, the Queen Charlotte's and Hammersmith Hospitals. This was part of a larger study, which included the evaluation of women's responses, cost implications, and clinical standards and staff reactions. The participants were all those receiving One-to-One midwifery practice (728 women), which was confined to two postal districts, and all women receiving care in the system that One-to-One replaced, in two adjacent postal districts (675 women), and expecting to give birth between 15 August 1994 and 14 August 1995. Main outcome measures were achievement of continuity of care, rates of interventions in labour, length of labour, maternal and infant morbidity, and breastfeeding rates. RESULTS: A high degree of continuity was achieved through the whole process of maternity care. One-to-One women saw fewer staff at each stage of their care, knew more of the staff who they did see, and had a high level of constant support in labour. One-to-One practice was associated with a significant reduction in the use of epidural anaesthesia (odds ratio (OR) 95 per cent confidence interval (CI) = 0.59 (0.44, 0.80)), with lower rates of episiotomy and perineal lacerations (OR 95 per cent CI = 0.70 (0.50, 0.98)), and with shorter second stage labour (median 40 min vs 48 min). There were no statistically significant differences in operative and assisted delivery or breastfeeding rates. CONCLUSIONS: This study confirms that One-to-One midwifery practice can provide a high degree of continuity of carer, and is associated with a reduction in the rate of a number of interventions, without compromising safety of care. It should be extended locally and replicated in other services under continuing evaluation.

Adult↗
PubMed1998

The use of clinical audit in evaluating maternity services reform: a critical reflection.

The clinical evaluation described here, using a casenote study, was part of a larger study evaluating the changes made to part of the maternity services in one NHS Trust, in response to the recommendations of Changing Childbirth (Department of Health 1993a). Results of the audit showed no evidence of a lowering of clinical standards within the study group and provided reassurance that a radical change in the model of care, with greatly enhanced continuity of career, an emphasis on community-based and midwifery-led care, and some reductions in labour interventions, could be implemented without compromising safety of care. The audit process raised a number of methodological problems which will need to be addressed in developing audit approaches which are able to reflect quality of care. It is important to recognize that the record of care is not a direct mirror of the care provided but a secondary source, kept for different purposes and designed to cover a different set of priorities from those which audit may seek to capture. The audit approach used in this study will be modified in continuing evaluation of the service as it moves from a pilot stage towards providing a mainstream service. Additional methods, including direct observation of care, will be employed in a sample of cases in order to assist in interpretation of audit findings.

Continuity of Patient Care↗
PubMed1998

Evaluation of one-to-one midwifery: women's responses to care.

BACKGROUND: One-to-one midwifery was a demonstration project introduced into a London-based maternity service in 1993 to put into practice the new government policy for maternity services in England. Evaluation was integral to the development of the project. METHODS: The evaluation of women's responses was conducted between August 1994 and August 1995 based on a longitudinal, self-completion questionnaire, interviews, and focus groups. Women in the study group (n = 728) received the new service and women in the control group (n = 675) received conventional care. The study design integrated quantitative and qualitative methods and went beyond a simple estimation of satisfaction with care. RESULTS: Satisfaction with antenatal and birth care was generally high, but study group women showed more positive responses overall. Both groups showed a preference for continuity of caregiver, but expectations were higher in the study group (72% of the study group and 42% of the control group preferred to see one caregiver). Both groups had less satisfied responses to hospital postnatal care (50% study and 54% control group were very satisfied). Study group women showed greater preparedness for birth than control group women (18% vs 12% "very well prepared") and for the time after the baby's birth (26% vs 15% "very prepared"). CONCLUSIONS: The study demonstrated that women were more satisfied with the one-to-one model of care. Taken together with the results of clinical and economic audit and professional responses, the evaluation suggests that this model should be developed and evaluated further to gain a greater understanding of women's needs of the maternity service.

Adult↗
PubMed1986

Legalization of midwifery and the issue of home births.

The issue of legalization of midwifery is distinct from that of sanctioning of home births. Ontario should seriously consider establishing midwifery as an independent profession for nondomiciliary care. I hope that such a decision would not be considered in isolation from the rest of the health care system.

Attitude↗
PubMedDate not supplied

Increased neonatal readmission rate associated with decreased length of hospital stay at birth in Canada.

PURPOSE: To assess the potential impact of early post birth discharge in Canada. METHODS: Neonatal readmission was examined, based on hospital discharge data from the Canadian Institute for Health Information, with a total of 2,144,205 infants from fiscal year 1989/90 to fiscal year 1996/97. RESULTS: Neonatal readmission rates increased from 27.3 per 1,000 in 1989/90 to 38.0 per 1,000 in 1996/97, while mean length of hospital stay at birth decreased from 4.2 days to 2.7 days during the same period. The increase in readmission rate was more evident for dehydration and jaundice. The provinces and territories with decreased length of hospital stay at birth usually had increased neonatal readmission rate and earlier age at readmission. Between 1994/95 and 1996/97, compared with Newfoundland, the risks for neonatal readmission for dehydration were 5.7 and 5.5, and for jaundice were 4.5 and 2.7, respectively, for Alberta and Ontario. CONCLUSION: Neonatal readmission rates for several conditions have increased substantially, associated with early post birth discharge policies adopted in Canada.

Canada↗