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PubMed2004

Lecturer practitioners in UK nursing and midwifery: what is the evidence? A systematic review of the research literature.

BACKGROUND: Lecturer practitioner roles have been widely established in the UK, and are seen as having the ability to overcome the theory-practice gap in nursing, as well as offering other benefits including functioning as a link between education and practice. AIMS AND OBJECTIVES: This article systematically reviews the research literature on UK lecturer practitioner roles in nursing and midwifery, in order to construct a picture of the themes that emerge from their national implementation. CONCLUSIONS: Only eight published research studies meeting the inclusion criteria were identified in journals, and five more included from the 'grey literature', totalling 13 suitable research reports. Of these 13 papers, six involved nurses and midwives. Key themes from the literature are outlined and discussed. There is an overwhelming preference for qualitative methodologies, although there is a strong argument for quantitative work in mixed-methods studies. RELEVANCE TO CLINICAL PRACTICE: Lecturer practitioner roles can make an important contribution to nursing and midwifery education, but this is problematic. It is essential that managers clarify the purpose, responsibilities, support and review of lecturer practitioner roles if they are to be successful.

Evidence-Based Medicine↗
PubMed2005

Nursing, midwifery and allied health education programmes in Afghanistan.

BACKGROUND: In 2001, Afghanistan was the centre of the world's attention. By 2002, following 23 years of internal conflict - including Soviet invasion, civil war and Taliban rule, plus 3 years of drought, the country was just beginning the process of re-establishing its internal structures and processes. In the health sector, this included the revival of the Ministry of Health (MOH). The MOH was assisted in its efforts by multiple partners, including the UN, donor and aid agencies, and a variety of non-governmental organizations. The author served as a consultant to the Aga Khan University School of Nursing, in partnership with the World Health Organization and the MOH, as it took on the work of strengthening nursing, midwifery and allied health education programmes for Afghanistan. AIM: This paper will focus on the initial assessment of that sector. It will describe the situation as it existed in 2002, by examining the Kabul Institute of Health Sciences (IHS) and then turn briefly to the current state of affairs. CONCLUSIONS: Despite the uncertainties of daily life in Afghanistan, the country has successfully initiated the reconstruction process. In the health sector, this can be seen in the work done at the Kabul IHS. Progress has been made in a number of areas, most notably in development and implementation of nursing and midwifery curricula. However, no one would deny that much more work is needed.

Afghanistan↗
PubMed1996

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands.

OBJECTIVE: To investigate the relation between the intended place of birth (home or hospital) and perinatal outcome in women with low risk pregnancies after controlling for parity and social, medical, and obstetric background. DESIGN: Analysis of prospective data from midwives and their clients. SETTING: 54 midwifery practices in the province of Gelderland, Netherlands. SUBJECTS: 97 midwives and 1836 women with low risk pregnancies who had planned to give birth at home or in hospital. MAIN OUTCOME MEASURE: Perinatal outcome index based on "maximal result with minimal intervention" and incorporating 22 items on childbirth, 9 on the condition of the newborn, and 5 on the mother after the birth. RESULTS: There was no relation between the planned place of birth and perinatal outcome in primiparous women when controlling for a favourable or less favourable background. In multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables. CONCLUSIONS: The outcome of planned home births is at least as good as that of planned hospital births in women at low risk receiving midwifery care in the Netherlands.

Choice Behavior↗
PubMed2001

Vitamin K policies and midwifery practice: questionnaire survey.

OBJECTIVES: To investigate policies on neonatal vitamin K and their implementation. DESIGN: Two phase postal survey. SETTING: United Kingdom. PARTICIPANTS: A 10% random sample of midwives registered with the United Kingdom Central Council for nursing, midwifery, and health visiting. Of 3191 midwives in the sample, 2515 (79%) responded to phase one and 2294 (72%) completed questionnaires on their current jobs (November 1998 to May 1999). In phase two, 853 (62%) of 1383 eligible midwives gave details on 2179 of their earliest jobs (start dates before 1990). RESULTS: All the midwives in clinical practice at the time of the survey (2271, 99%) reported that they were working in areas with official policies on neonatal vitamin K. Seven distinct policies were described: intramuscular vitamin K for all babies (1159, 51.0%); intramuscular vitamin K for babies at "high risk," oral for others (470, 20.7%); oral vitamin K for all babies (323, 14.2%); parental choice for all (124, 5.5%); parental choice for all except babies at high risk, (119, 5.2%); intramuscular vitamin K for babies at high risk only (33, 1.5%); oral vitamin K for babies at high risk only (17, 0.7%); and a disparate group of policies including intravenous vitamin K for some babies (26, 1.1%). Previous policies were (and some may still be) open to individual interpretation and were not always followed. CONCLUSIONS: Hospital policy is not necessarily a good guide to individual practice. The primary purpose of clinical records is to document patient care, and recording practices reflect this. There is considerable variation in vitamin K policies and midwifery practice in the United Kingdom, and there is no clear consensus on which babies should receive vitamin K intramuscularly.

Administration, Oral↗
PubMed1999

Domiciliary midwifery support in high-risk pregnancy incorporating telephonic fetal heart rate monitoring: a health technology randomized assessment.

We conducted a health technology assessment of the care of women with high-risk pregnancies in the South Wales valleys. Women in the control arm were intended to receive conventional care with standard midwifery visits. Women in the intervention arm received additional or longer visits and domiciliary fetal heart rate telemonitoring. Eighty-one mothers were randomized. There were significant differences in midwifery intervention resources between domiciliary and control groups, with the former receiving a mean of 3.7 visits lasting 33.5 min, compared with 1.4 visits lasting 12.8 min for the latter. There were slightly more spontaneous labours and fewer Caesarean sections in the domiciliary group. Maternal satisfaction and anxiety were high in both groups. Domiciliary care increased the service costs by 21.02 Pounds per woman in terms of extra midwife travel and visiting time, and by a further 18.38 Pounds per woman in home monitoring equipment costs. This, however, was more than offset by health service savings from fewer clinic visits (35.60 Pounds) and fewer clinic ultrasound scans (9.01 Pounds). Adding the reductions in lost productivity to women and their partners (34.51 Pounds) suggests that domiciliary care was cheaper than conventional care, even if it did not greatly reduce inpatient days (a reduction nonetheless saving 184.24 Pounds). While clinical processes were similar in both groups, there were useful practical advantages and savings for patients and the health service from the domiciliary intervention.

Anxiety↗
PubMedDate not supplied

Consumerism 2: preregistration nursing and midwifery curricula.

This article, the second of two parts, presents findings from a four-stage study exploring the extent to which consumerism and its related aspects have been incorporated into the preregistration nursing and midwifery curriculum. The study was undertaken in recognition that NHS policy (as considered in the first article: Vol 12(5): 321-6) increasingly gave emphasis to the development of a health service that was more consumer and user focused. The study involved use of a Delphi panel, postal questionnaire, review of curriculum documentation, and timetables, together with a small focused group discussion. Findings indicate some aspects relevant to consumerism in health care, e.g. communication and ethical principles were included in the curriculum. Other aspects, such as advocacy, quality assurance, and lay health beliefs, were viewed logically from the perspective of the professional role. In essence, no curriculum transparently addressed consumerism in a central and focused way, although midwifery--and to some extent mental health, learning disabilities, and child branches--gave more overt attention to consumerism than adult branches.

Consumer Behavior↗
PubMedDate not supplied

Midwifery Records and legal issues surrounding them.

Midwives are subject to statutory supervision and the Midwives' Rules. The Nursing and Midwifery Council has set out very special and very strict rules on how midwives records should be kept, stored, handled and supervised. Rule 9 sets out stipulations in relation to the keeping of midwifery records. Rule 10 requires them to permit the inspection of their records by the supervisor, the local supervising authority and the NMC.

Humans↗
PubMed1988

State laws and the practice of lay midwifery.

A national survey was conducted to assess the current status and characteristics of state legislation regulating the practice of lay midwives. As of July 1987, 10 states have prohibitory laws, five states have grandmother clauses authorizing practicing midwives under repealed statutes, five states have enabling laws which are not used, and 10 states explicitly permit lay midwives to practice. In the 21 remaining states, the legal status of midwives is unclear. Much of the enabling legislation restricts midwifery practice often resulting in situations similar to those in states with prohibitory laws. Given the growth of an extensive grassroots movement of lay midwives committed to quality of care, this outcome suggests that 21 states with no legislation may provide better opportunities for midwifery practice than states with enabling laws.

Data Collection↗
PubMed1992

The transformation of American midwifery: 1975 to 1988.

BACKGROUND: The use of midwives is a natural solution to the problem of improving access to skilled perinatal services while lowering costs. The number of midwife-attended births has grown from 0.9% of all births in 1975 to 3.4% of all births in 1988. The purpose of the study was to determine how mothers served by midwives and the settings in which they are served have changed in that period. METHODS: The analysis is based on birth certificate data from 1975 to 1988 from the Natality, Marriage and Divorce Statistics Branch of the National Center for Health Statistics, Centers for Disease Control. RESULTS: Almost all of the growth (93.2%) in midwife-attended births from 1975 to 1988 was in hospitals; 87.3% of all births attended by midwives occurred in hospitals. Pronounced differences exist between mothers served by midwives in and outside of hospitals, and there are strong regional patterns in midwife attendance at birth. CONCLUSIONS: Given the positive outcomes associated with midwifery practice, further research into the content of midwifery care is recommended.

Adult↗
PubMed1994

The trials of Hanna Porn: the campaign to abolish midwifery in Massachusetts.

The case of Hanna Porn affords an opportunity to examine how the laws that led to the abolition of midwifery in Massachusetts evolved and were applied to the midwife whose case set the state legal precedent. Mrs Porn served primarily a Finnish-Swedish clientele of wives of laborers. The outcomes of the births she attended appear to have been positive, and she maintained a neonatal mortality rate of less than half that of local physicians. She also repeatedly defied court orders to stop practicing. Her case exemplifies the efforts that occurred nationally to abolish midwifery in the United States.

Female↗
PubMed2002

Delivering the city's children: municipal programs and midwifery in Los Angeles.

In 1915, at the height of a movement in the United States to regulate midwifery, health officials in the city of Los Angeles devised an unusual plan for doing so: they put the city itself in the midwifery business. At the same time that public health officials in Los Angeles enacted traditional regulatory legislation to deal with the "midwife problem," they also established a Division of Obstetrics within the city's health department to provide prenatal and postnatal care for the poor. Unlike the maternity dispensaries of other municipalities, Los Angeles provided physicians to attend home-births. Thus, rather than trying to move the delivery room out of the home, Los Angeles moved physicians in.

Female↗
PubMed1993

Student nurses' perception of the clinical midwifery experience as a learning environment.

The student nurse may have a different perception of her learning environment from that which the instructor intended. The purpose of the study was to determine the perception of student nurses of clinical midwifery experience as a learning milieu. Student nurses in their third and fourth year at a nursing college in Transvaal were involved in the research. A literature study regarding factors that can influence clinical learning of student nurses in the midwifery units was done. Questionnaires were used to collect data regarding personal information, the learning environment, and problems regarding clinical skills. Data were analysed by means of a SAS computer programme. Certain problem areas, for example the need for clinical lecturers to attend units on a more regular basis, as well as the more negative attitude of fourth year respondents compared to third years, were indicated. The necessary recommendations were made and reported to the nursing college concerned.

Adult↗
PubMedDate not supplied

Dr John Clarke: licentiate in midwifery of the Royal College of Physicians of London.

John Clarke was one of ten licentiates in midwifery created by the College of Physicians in the late eighteenth century to regularise the growing involvement of medical men in obstetrics. He was an excellent clinician and a popular teacher. His publications included original observations about puerperal fever, nausea and other complications of pregnancy and the management of labour. He opposed the attitude of the College that prevented its Fellows from practising midwifery and he stridently criticised the College's neglect of the diseases of children. Part one of his book on the diseases of children contained the first exact description of tetany. Part two was never published because of his early death.

England↗
PubMedDate not supplied

The midwifery model of care.

The midwifery and medical models for the care of pregnant women are based on particular perspectives on pregnancy and birth. The approaches resulting from these perspectives are complementary and, as a result of midwives and physicians working together, there has been significant merging of the models. Instead of two mutually exclusive ways of managing birth, there is wide variation. Nevertheless, there are important differences between the two models, including differences in philosophy and focus, in the relationship between the care provider and the pregnant woman, in the main focus of prenatal care, in use of obstetric interventions and other aspects of care during labor, and in the goals and objectives of care. The midwifery model has advantages for many women because it avoids unnecessary interventions during labor, thus helping the process remain normal, and because it addresses needs that are often not adequately met by the medical management model.

Female↗
PubMed1995

Midwifery in England and Wales before 1936: handywomen and doctors.

The social history of medicine incorporates a respectable body of research on maternity care in Britain, but illegal midwifery in the 1920s and 1930s remains inadequately understood. Midwives' statutory regulation began with the Midwives Act of 1902, which was implemented over the eight years to 1910. The licensing body for England and Wales was the Central Midwives Board, which enrolled midwives with approved qualifications and, initially, others who were untrained but who were accepted as having been in 'bona fide' practice before the legislation. Its effect was to prohibit midwifery by the untrained 'handywomen' on whom many poorer women had formerly relied (1). The 'bona fide' enrolments covered some such practice, but it otherwise became illegal.

Accreditation↗
PubMed1999

"You worked on your own, making your own decisions and coping on your own": midwifery knowledge, practice and independence in the workplace in Britain, 1936 to the early 1950s.

Midwifery knowledge is a complex entity-comprising of training and experiential elements-not fixed but mutable, both informed and altered by practice. This study uses oral history accounts to explore how midwives viewed themselves and how they interacted with widwifery knowledge in an attempt to gain a greater understanding of their power and independence in the workplace and, as a result, of their professional status. Midwifery knowledge cannot simply be defined as the technical skills taught in training; it was also shaped by the environment in which practice took place and midwife's relationships with women and with doctors.

History, 20th Century↗
PubMed1994

[Dutch midwives: image and occupation. Developments in midwifery in Leiden, Arnhem, 's-Hertogenbosch and Leeuwarden, 1650-1865].

My study on the social position of Dutch midwives in early modern Europe was induced by the consistently negative image in the literature at the time. Medical doctors and accoucheurs (obstetricians) expressed critical opinions on both the occupation of midwifery and the midwives themselves. They disparaged the behaviour, activities, training, income, additional jobs and social background of midwives. Later, medical doctors and historians reproduced and promulgated this negative image of midwives. At issue is the extent to which the attitudes of medical doctors and accoucheurs corresponded to those of the broader population, and how these attitudes were related to the actual place in society. The question is if midwives took a marginal position in urban society. My work focusses on four Dutch cities: Arnhem, Leeuwarden, Leiden and 's-Hertogenbosch. It deals with the period 1650-1685. The criticism of medical practitioners and of a accoucheurs on midwives are described. The occupation itself is discussed: the activities of midwives and the development of the profession (regulation, training and rivalry). At the end of the seventeenth and the beginning of the eighteenth century, the medical profession began to show an interest in childbirth. Rivalry between accoucheurs and midwives, competition between legal and illegal practitioners of midwifery, and in-fighting within the profession tell us something about the development of the profession. From the eighteenth century on, attending problematic births was claimed as a privilege of accoucheurs. Data from municipal archives were used to find out if and to what extent midwives were marginalised. Their geographical mobility, social background (occupations of parents), occupations of husbands, income and domicile are discussed. Analysis of this material indicates that midwives belonged to the common urban labouring class (consisting of artisans and workers), and were not very different from other members of this class. Certainly they were not marginalised, instead they had a relatively privileged position within the common labouring class. Five motives can be distinguished for the negative image expressed by medical doctors and accoucheurs in their publications: 1) professional rivalry, 2) division of theoretical and practical knowledge, 3) class differences, 4) gender, and 5) 'polluting' activities. Studies on ideas of pollution and 'infamous' occupations might lead one to conclude that midwives in the Dutch Republic were stigmatised. I found no evidence, however, that the opinions of medical doctors and accoucheurs were shared by the broader public. Official recognition of midwives - the regulation of their practice and education - protected tham. This has contributed to their position as independent practitioners in the Netherlands up to today.

History, Modern 1601-↗
PubMed2002

Administration of medicines. Midwifery basics.

Midwifery Basics is a series of articles that cover the main clinical skills underpinning midwifery practice. The series uses National Occupational Standards (Care Sector Consortium 1998) as a framework to identify the areas of competence that students need to achieve in order to master clinical skills. This format is combined with the use of 'triggers' to prompt the student to identify what she needs to know in order to care for a client in such a situation. The information that follows then enables the student to fill in the gaps in her knowledge.

Clinical Competence↗