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PubMedDate not supplied

Creating off-campus/distance learning courses for midwifery education. A brief introduction.

Midwifery education is undergoing a curriculum revolution that is reflective of current trends in other fields. Distance learning programs have developed in response to these changes. This article provides an overview of a student-centered transactional educational model, discusses the role of faculty as midwife-teachers, and reviews the factors influencing technology decisions for distance education. Curricular structure is discussed and ideas for learning activities are presented to assist faculty considering the development of off-campus, distance learning courses.

Curriculum↗
PubMed1995

Establishing priorities for research in education within one college of nursing and midwifery.

The educational provision for nurses and midwives is currently undergoing immense change. These innovations encompass the organizational structure, the process of delivery and the projected outcomes for professional education within the UK. There is, however, a dearth of published research evidence designed to evaluate these educational changes. Nevertheless, anecdotal evidence suggests that within individual institutions small-scale, educationally-focused research is currently being conducted. These are usually 'one off' studies which address questions of personal interest to individual researchers rather than issues of importance to the organization or to the professions as a whole. the net result is a diverse research portfolio which, by its very nature, is wasteful in terms of lost opportunity to commission larger-scale research which might influence educational practice and in failing to direct effectively the energies and skills of researchers. In an attempt to address these issues and to set an agenda for research priorities within one college of nursing and midwifery, a four-round Delphi survey was conducted. This is the first of its kind to be reported in the UK literature. Fifty six of the teaching staff (77% of the total number of teaching staff) initially identified 213 issues which were grouped into 14 categories. The interrater reliability of the categorization process was checked on three separate occasions. In successive rounds, high response rates were maintained. To test for the manipulative effect of providing respondents with controlled feedback of their score in round 2, the third questionnaire was completed "blind' to previous scores. In the final round, participants were provided with feedback and invited to re-score and rank the items. The final round yielded 28 prioritized items. It was notable that the top ten issues primarily focused upon the pre-registration (Project 2000) provision encompassing both the preparation of students for professional practice and the changing role of the nurse/midwife teacher. This paper explores the implications of these findings for setting a research agenda within the organization.

Curriculum↗
PubMed1997

A survey of community placements for educational programmes in nursing and midwifery.

In this paper preliminary findings from the first stage of an English National Board (ENB) commissioned study investigating the educational needs of community practitioners in relation to their responsibilities for student learning are presented. A national postal survey of all educational centres offering nurse and/or midwifery education was undertaken in the latter half of 1993. Information was collected regarding the nature and planning of the community practice components of courses. The main methods of support for practitioners included the provision of the ENB 998/997 courses and liaison meetings between educational centres and community practice areas. Practitioners were often required to both supervise and assess students on practice placements, the length of these placements varying enormously. For those centres offering the mental health and learning disability branches of the Diploma in Higher Education in Nursing Studies (Project 2000), a significant proportion lacked teachers with specialist community qualifications. The investigation took place at a time of great upheaval, with 42% of centres reporting that they were in the process of amalgamation. The findings demonstrate that community nurses and midwives undoubtedly contribute to the education of nurse and midwife students and consequently have educational needs which must be addressed if they are to continue to supervise students.

Community Health Nursing↗
PubMed1998

Professional knowledge, midwifery and the role of the external examiner.

Following the move of midwifery education into institutions of higher education (IHE), professional sources have voiced some concern over the apparent 'cultural conflict' between IHE and the midwives. In order to investigate this, a 1-day conference was convened for midwife teachers and external examiners in the south of England, during which data were collected from recorded discussions and interviews. The findings confirm the existence of conflict which polarized around two issues: first, the centrality of practice for midwives and the perceived undermining of that practice by the academically orientated IHE; and second, the somewhat ambiguous role of the external examiner. These findings are explained in terms of recent work on professionalization which suggests that professional knowledge can be legitimized where the emphasis is placed on the indeterminate elements of the work and where knowledge originates from abstractions and conceptualizations derived from working practice. Such a knowledge base would be rather more resistant to undermining by the deductive, rationalist approach employed by IHE academics. It is suggested that external examiners are best placed to represent practice based knowledge to IHE examiners.

Conflict, Psychological↗
PubMed1992

The value of clinical experience to a non-clinician: combining midwifery practice with teaching.

This paper explores the value of clinical experience to midwives and other health care providers who work in other than clinical situations. The value of this experience may relate to personal or educational goals. Due to the lack of attention to this topic in the midwifery literature, the author recounts her own experience and compares it with the nursing and health visiting literature. Differing expectations feature as an issue. The value of this arrangement, for teaching, research and personal development more than compensate for the difficulties identified.

Clinical Competence↗
PubMed1991

Students of midwifery: 'doing the obs' and other coping strategies.

The paper is based on qualitative research on the early experiences of student midwives in one school of midwifery. During their initial encounters the students go through a status passage from experienced nurse to novice midwife. Student diaries and ethnographic data were used to explore how students manage the transition and to document their coping strategies. In particular it is shown how, in response to the uncertainties of their new status, student midwives may revert to routinised nursing activities.

Adaptation, Psychological↗
PubMed1992

Research in midwifery: are midwives their own worst enemies?

This study investigated the hypothesis that midwives will undervalue research they believed to have been undertaken by a midwife as compared with that believed to have been undertaken by an obstetrician. Eighteen midwives were asked to assess two comparable research articles on 5 criteria. Half the sample were informed that the first article was written by a midwife and the second by an obstetrician. The order of authorship was reversed for the remainder of the sample. A related t-test was carried out to compare the midwife's paper with the obstetrician's on each of the 5 criteria. These suggested that no difference was perceived between the midwife's and obstetrician's clarity of expression or expertise on the topic in question, but significant differences were found on attributed grasp of research methodology, understanding of statistical analysis and contribution to current understanding, with the midwife emerging worse on all three (t = 1.99, p less than 0.05, t = 2.28, p less than 0.025, t = 1.8, p less than 0.05 respectively). Comparison of the overall scores also revealed that the general quality of the midwife's paper was also perceived to be poorer than the obstetrician's (t = 2.24, p less than 0.025). The findings are partially explained in terms of the gender influences that operate in midwifery.

Attitude of Health Personnel↗
PubMed1992

Scoring and setting pass/fail standards for an essay certification examination in nurse-midwifery.

Examination for certification or licensure of health professionals (credentialing) in the United States is almost exclusively of the multiple choice format. The certification examination for entry into the practice of the profession of nurse-midwifery has, however, used a modified essay format throughout its twenty-year history. The examination has recently undergone a revision in the method for score interpretation and for pass/fail decision-making. The revised method, described in this paper, has important implications for all health professional credentialing agencies which use modified essay, oral or practical methods of competency assessment. This paper describes criterion-referenced scoring, the process of constructing the essay items, the methods for assuring validity and reliability for the examination, and the manner of standard setting. In addition, two alternative methods for increasing the validity of the pass/fail decision are evaluated, and the rationale for decision-making about marginal candidates is described.

Certification↗
PubMed1992

An evaluation of pre-registration midwifery education in England. Research design: a case study approach.

In this paper some aspects of research design are described and discussed. A national study to evaluate pre-registration midwifery education in England is currently in progress. As part of that study six case study sites have been selected. How those sites were selected and the theory and method of the case study approach are discussed in this paper. The value of the case study approach is discussed as are methodological issues of the case study method. What is a case? Are case studies representative? How can you generalise from case studies? What is theoretical sampling? What is the difference between statistical and logical inference? These are some of the questions raised and examined. It is suggested that an understanding of these theoretical issues and the research process is important to understand the research findings. By making the research design explicit and describing the research process the study also adopts a reflexive approach.

Education, Nursing↗
PubMed1998

Education for clinical decision making in midwifery practice.

OBJECTIVE: To present an approach to developing clinical decision-making skills in midwifery students. DESCRIPTION: Use of simulations, 'thinking aloud' technique, reflection and the decision rules of experienced midwives are proposed for developing clinical-reasoning skills and acquiring skilled clinical knowledge. IMPLICATIONS: Educators are encouraged to recognise that skill acquisition in clinical decision making requires practise before students engage fully in the clinical setting. The process of decision making is emphasised as essential for students to experience so they develop an understanding of the clinical information attended to, the sequence in which the information is processed and the rules used to combine information to reach clinical judgements. By using clinical simulations developed from 'real cases' the process of decision making is able to be experienced by students. Further, if these simulations are accompanied by the collection of verbal protocols, students have opportunities to retrospectively explore their decision making with reflection. In addition, the presentation and use of decision rules of experienced midwives has the potential to enhance the development of skills in students.

Clinical Competence↗
PubMed1996

Trial of scar--team midwifery makes a difference.

'Once, and certainly twice, a caesar always a caesar.' Where is the evidence to support this often expressed belief? As discussed by Roberts (1991) this is simply an opinion and not based on any form of scientific inquiry. This article describes two women requesting a vaginal delivery, one having had two, and the other, three previous Caesarean Sections. The doctors they had approached were unwilling to support them in their request and they had been told they would be unable to have a vaginal delivery. Both women decided to utilise the hospital's Team Midwifery service for their antenatal and intrapartum care and found the team, together with one of the hospital Registrars, sympathetic to their wishes. Carefully coordinated communication between these groups, and a supportive working relationship, enabled both women to have their vaginal delivery, one of which involved a twin birth. These are the type of services and support that should be available to all women.

Adult↗
PubMed1998

Mothering and midwifery: sometimes a challenge.

This paper attempts to present two levels of argument. Firstly it argues that the use of story, in its entirety, is a valid, relevant and useful tool for informing personal and professional knowing. The second level of debate is elicited by the story itself and the discourse surrounding the challenges of implementing continuity of midwifery care models within the mainstream maternity care system. The author hopes that the telling of the story provides a window through which others can share her experience. It is argued that 'identification' with the challenges involved in implementing innovative models of care is an important and vital step in the process, if these models are to begin, survive and achieve their aim of providing women-centred health care.

Adaptation, Psychological↗
PubMedDate not supplied

Diabetes in pregnancy: the midwifery role in management.

Although the primary focus of midwifery is on uncomplicated pregnancy, all midwives must screen for and, in some cases, comanage the care of women with diabetes mellitus and gestational diabetes. This article will review the types of diabetes, implications for preconceptional and pregnancy care, the changing recommendations relative to diabetes in pregnancy, and the role of the midwife in providing antepartal and intrapartal care for women with diabetes in collaboration with other health care professionals and in accordance with the philosophy and standards of the American College of Nurse-Midwives. A specific case study will highlight the role of the midwife, with an overall focus on medical consultation, collaboration, and referral, as well as client involvement in the planning of care.

Adult↗
PubMedDate not supplied

Primary care in nurse-midwifery practice: a national survey.

Providing primary health care is a relatively new addition to the scope of practice for certified nurse-midwives (CNMs)/certified midwives (CMs); thus, not much is known about how this component has been integrated into midwifery practice. The purpose of this descriptive study was to examine the type and extent of primary care education among CNMs/CMs and how various common health conditions are managed. In addition, perceptions of barriers to incorporating primary care into their practice were gathered. A small national survey was conducted among randomly selected members of the American College of Nurse-Midwives. No CMs participated. Although the sample size (n = 63) precludes generalizing the findings, 65% of CNMs reported lack of formal education in primary care. However, when asked about specific health conditions, more than 50% stated that they had some form of education in treating 30 of 37 common health problems. It is noteworthy that 54% of the CNM respondents indicated that they do not provide newborn care despite the fact that more than 85% of them received newborn education. Barriers such as lack of insurance reimbursement, institutional rules, and a lack of understanding of the CNM's scope of practice were cited by respondents as contributing factors. Unfamiliarity with primary care may be the most important factor in the reluctance of CNMs to incorporate primary care into practice.

Adult↗
PubMed1998

The role of personal tutor in nurse education: towards an understanding of practice in a college of nursing and midwifery at a particular point in time.

This paper describes an inquiry to increase understanding of the role of personal tutor in a college of nursing and midwifery. Concepts of tutor and role are discussed in relation to their historical influences and an over view is provided of the research process which included document analysis and reflective audio-taped interviews with student nurses, teachers and education managers. Five conceptual categories are identified and critically analysed in relation to personal, institutional and social contexts and the factors which influence them. The first two categories identified reflect the concepts discussed in the literature. The third category reflects the uncertainties and confusion which surround differing perceptions of the role. The fourth category suggests the misunderstandings which may occur through taking for granted apparently shared concepts. The fifth category suggests the significance of personal theory in practice and the extent to which roles are taken or made. Traditional values concerning theory and practice are thus challenged. The reflective evidence provided by the participants suggests a theory, generated by them through the meanings they give to their views and actions, concerning their roles and the situation in which they find themselves at a particular point in time.

Education, Nursing, Baccalaureate↗
PubMed1998

Team midwifery: the influence of the midwife-woman relationship on women's experiences and perceptions of maternity care.

The need to provide woman-centred maternity services which take account of womens' views and specifically address their need for choice, control and continuity has been advocated and team midwifery has been suggested as one of the ways to achieve these objectives. This paper explores women's descriptions of their maternity care experiences in England, specifically focusing on: their experiences of communication; being informed and making choices; being involved in the process of care; and their own perceptions of care. It is suggested that the midwife-woman relationship is an important aspect of satisfaction which needs greater recognition. Analysis of the data highlighted the importance of the quality of women's relationships with caregivers. Findings revealed how positive relationships facilitated conditions which influenced satisfaction with care and suggest that, for the development of genuine woman-centred services where women exercise informed choice, and are involved in, and have some control over, the process of care, the nature and quality of the midwife-woman relationship must be accepted as an integral and crucial aspect of the service.

Female↗
PubMed1998

Protectionism or competition in managing British nursing research? Current debate among nurse and midwifery teachers.

AIM: The intention is to highlight key issues related to research by nurse and midwifery teachers. BACKGROUND: The debate centres on the 'culture change' facing teachers from traditional colleges moving to universities where a more formal research requirement prevails. ORIGINS OF INFORMATION: Data were drawn from selected official reports and other literature informing the introductory discussion. Emerging themes were discussed by 25 nurse and midwife teachers at Forresterhill College, Aberdeen in March 1996 and their views were recorded and analysed. DATA ANALYSIS: Selected documents and discussion records were reviewed, using a thematic approach. KEY ISSUES: Main themes concerned nursing as art and science, balance between multidisciplinary and unidisciplinary research and ring-fencing nursing research funds. CONCLUSIONS: Anxieties among teachers centred on the increased research requirement in universities with possible neglect of teaching excellence.

Attitude of Health Personnel↗
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↗