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Balancing stakeholder needs: a review of ENB 100 and 415 courses. English National Board for Nursing, Midwifery and Health Visiting.

This paper reports the findings of a documentary analysis and literature review of general and paediatric intensive care unit (ICU) courses (ENB 100 and ENB 415). The findings are part of a larger review of critical care courses commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB), also incorporating operating department, coronary care and accident and emergency courses. It was important to set the curriculum review in the context of intensive care practice and education, hence the study also comprised interviews with lecturers and ICU managers. The study findings reveal diversity in major aspects of the critical care courses, including the academic level of the programmes and credits they attracted; the assessment strategies for theory and practice, the extent of shared learning and the amount of student effort. Many factors influenced this diversity including contrary opinion among stakeholders about the purpose of the course: to prime the students for working in the specialty; or to consolidate previous experience (in some cases up to 15 years). Course structure and content have changed in response to local university requirements and directives from the statutory bodies, as well as in response to the higher level of academic credit awarded for pre-registration programmes (qualification inflation). The perceived shift in course content as well as the diversity across programmes had led a group of ICU managers to define their own list of competencies (Crunden 1998). However, the majority of the managers interviewed for this study (63% of General ICU managers (n = 19) and 83% (n = 6) of Paediatric ICU managers) were generally satisfied with the competencies and skills of the nurses who had undertaken the ENB course. The authors conclude from the diverse nature of the courses that there is little national comparability in the courses although this finding might be an artefact of documentary analysis. The extent to which this (apparent) diversity results in different levels of competence in practice requires further exploration.

Attitude of Health Personnel↗

Issues in the delivery of midwifery care.

The current study was designed to further knowledge of the immediate, short and long-term effects of Caesarean delivery for both the woman and her baby. A study group of 50 low-risk primigravidae of normal stature delivered by emergency Caesarean section were compared with a closely matched control group of 50 primigravidae delivered vaginally. The study generated a large amount of both quantitative and qualitative data. From the analysis of the comments made by the women in both the study and control groups at the time of both the hospital and home interviews, it was apparent that there were a number of deficiencies in the care received. This paper examines some of the issues related to the delivery of midwifery care round the themes of lack of realistic preparation for labour, delivery and parenthood; lack of support and conflicting advice from midwives, especially in the postnatal wards; failure of communication between women and staff, and it was apparent that this occurred in all areas from antenatal care to the postnatal wards.

Cesarean Section↗

Research-based practice: some problems illustrated by the discussion of evidence concerning the use of a pressure-relieving device in nursing and midwifery.

This paper investigates the evidence presented in the literature concerning the use of ring cushions in nursing and midwifery practice, as a case study of the relationship between research-based knowledge and practice. It explains the origins of the claims that these aids cause pressure sores, urinary tract infection and expose postpartum mothers to the risk of thrombosis. It demonstrates that the empirical evidence on which these claims are based is very slight and that re-interpretation of the evidence by successive authors has raised its status considerably. Practical steps to avoid this type of occurrence are suggested.

Clinical Nursing Research↗

Amalgamating colleges of nursing and midwifery: staff perceptions of issues and their importance.

This research aimed to identify the issues considered important by primary stakeholders in the amalgamation of two college of nursing and midwifery and to explore differences in issue perceptions between stakeholder groups. The purpose was to provide data which would facilitate the amalgamation process. The research was carried out in two stages, the first of which was issue identification, whereby a qualitative approach to exploration was employed. This was followed by the stage of issue validation, carried out using a quantitatively oriented questionnaire. Stage 1 identified 38 specific issues relating to 13 separate issue topics. These could be further categorized into structural, teaching/learning/curricular and affective themes. Stage 2 demonstrated that these 38 issues were all considered important by all staff groups, but highlighted important, significant differences in the perceptions of how well these issues were perceived to be addressed.

Attitude↗

Priorities for midwifery research in Perth, Western Australia: a Delphi study.

This paper reports a two-round Delphi study undertaken to identify the research priorities of midwives at five public maternity hospitals in Western Australia's metropolitan area of Perth. In round one, 117 midwives identified 64 different problems or issues for research. Using thematic content analysis, these problems were grouped together and then collapsed to develop 17 specific research topics within four major categories. In round two, 152 midwives were asked to rank how important each of the topic statements were to women, their families and midwives. Research focusing on 'the postnatal experience' was ranked by midwives as the most important to the care of women and their families. From a midwife's perspective, the highest ranked topic was 'examining the professional issues that impact on midwives' clinical practice' (e.g. midwifery and medical collaboration, potential litigation and horizontal violence in the workplace). The results of the study show that Western Australian midwives, like their national and international colleagues, are concerned about the delivery and organization of maternity services, the invisibility of the postnatal experience and how to operationalize evidence-based care in the clinical area.

Adult↗

Research priorities for nursing and midwifery in Southern Ireland.

AIM: To identify research priorities for nursing and midwifery in the Southern Health Board area in Ireland for the immediate and long term. METHOD: Ten focus groups were conducted over a 2-month period with 70 nurses and midwives working in clinical, managerial and educational roles participating. Based on focus group findings and a literature review a multi-item Likert type questionnaire was constructed and administered to 520 nurses and midwives (response rate 95%n=494). RESULTS: Research priorities were identified as: (1) impact of staff shortages on retention of RNs/RM's (80%); (2) quality of life of chronically ill patients (76%); (3) stress and bullying in the workplace (76%); (4) assessment and management of pain (75%); (5) skill mix and staff burnout (73%); (6) cardio-pulmonary resuscitation decision making (72%); (7) coordination of care between hospital and primary care settings (69%); (8) medication errors (67%); and (9) promoting healthy lifestyles (64%). Respondents also indicated that these priorities warranted immediate attention. Implications for practice include the need for: (1) emphasis on quality pain control; (2) recognition and exploration of the ethical issues relating to resuscitation; and (3) management of the context within which clinical care is given.

Attitude of Health Personnel↗

Nursing and midwifery: Millennium Development Goals and the global human resource crisis.

The World Health Organization Global Advisory Group for Nurses and Midwives and wider stakeholders met in May 2005 against a background of concern over the disappointing progress being made towards the Millennium Development Goals (MDGs). The meeting considered the urgent need to address human resource issues, particularly those related to nursing and midwifery, if the MDGs are to be achieved.

Forecasting↗

Change and power in midwifery.

Midwives are experiencing problems in playing their full part in the maternity services and the communities in which they practice. Mothers, babies, and families require greater care from these caregivers for healthier pregnancy and birth outcomes. Change to renew the power, skills, and knowledge of midwives is evident in many parts of the world. Processes of change require an examination of the purpose of midwifery. The starting point of change is an awareness of the meaning of birth to individuals and society, and of the role of midwives in supporting families around the time of birth. Midwives should use their power to resolve the considerable problems facing childbearing families, and to enrich the event.

Female↗

[Care for parturient women by obstetrical nurses in the Midwifery project: an experience report].

This study focuses on the nursing care models that value the woman in childbirth process. Authors described the humanized care provided to the parturient by obstetric nurses in the "Midwifery Project" developed at a University Maternity Hospital. They emphasized that the practice of these models enable the nurse's active participation in the childbirth process, resulting in the satisfaction of the parturient and of the professional.

Delivery, Obstetric↗

American nurse-midwifery practice in 1976-1977: reflections of 50 years of growth and development.

Nurse-Midwifery was introduced into the United States in 1925 as a means of meeting the maternal and infant care needs of specific rural and urban poor populations. Four studies of US nurse-midwives conducted between 1963 and 1977 describe recent changes and practice in the profession. Approximately 1,000 nurse-midwives employed in the US responded to a questionnaire in late 1976; about 650 of them were in clinical practice. Of those in practice, two-thirds had graduated as nurse-midwives during the prior six years. At least 90 per cent of them provided prenatal care and family planning, and 85 per cent managed labor and delivery and performed postpartum physical examinations. Working collaboratively with physicians, most nurse-midwives manage the care of prenatal patients with some complications. However, relatively few manage multiple gestation or breech deliveries. The 78 per cent of clinical nurse-midwives who provide gynecologic care to non-pregnant women are likely to diagnose gynecologic conditions and treat common problems such as vaginal infections, gonorrhea, condylomata, and lower urinary tract infections. Those who work in small communities are more likely to assume greater responsibility for complicated deliveries and for care of the newborn from birth through infancy. (Am J Puiblic Health 1980; 70:990-996.)

Female↗

Nurse-midwifery practice in the United States, 1982.

During 1982 the American College of Nurse-Midwives conducted a national survey of certified nurse-midwives residing in the United States. About 68 per cent of the 1,584 respondents (response rate 76 per cent) were practicing nurse-midwifery. Most of them were providing prenatal and family planning care. The 937 participants who were conducting deliveries reported that they conducted about 1.8 per cent of the estimated 3,704,000 deliveries which took place in the United States during 1982.

Delivery, Obstetric↗

A pilot study to investigate the effect of a simulation strategy on the clinical decision making of midwifery students.

The actual effect of the use of simulations on clinical decision making is inconclusive. This pilot study used a posttest design to determine the effect of a simulation strategy on the clinical decision-making process of midwifery students. Thirty-six graduate diploma students volunteered and were randomly assigned to two groups, with the experimental group receiving two simulation sessions (normal labor and physiological jaundice), and the control group receiving the two usual lectures. The main findings were that students who received the simulation strategy collected more clinical information, revisited collected clinical information less, made fewer formative inferences, reported higher confidence levels, and for the posttest normal labor simulation, reached a final decision more quickly. Such effects are reasonable for this type of intervention with the existent variability in each group. Further research with a larger sample size and more rigorous data collection strategies is required.

Attitude of Health Personnel↗

The utilization of a Midwifery Obstetrical Unit (MOU) in a Metropolitan area.

In this study an explorative, descriptive design which is contextual in nature, is utilized. The objective of the study is three-fold: Firstly, to describe the opinions of members of the community about the reasons for the under-utilization of the Midwifery Obstetrical Unit (MOU); secondly, to describe the suggestions of the community for improving the utilization of the MOU and thirdly, to describe intervention strategies for community nurses to improve the utilization of the MOU. Data was collected by means of focus group interviews, and was analysed using Tesch's (in Cresswell, 1994: 154-155) method of data analysis. Trustworthiness was ensured by using the method of Guba and Lincoln (1985). The respondents were mothers who delivered their babies at the hospital, mothers who delivered their babies at the MOU, members of the Community Health Committee and MOU nurses. Data was collected in two phases. Phase I dealt with the first question: What is your opinion about the reasons for the under-utilization of the MOU? Phase II dealt with the second question: What are your suggestions for improving the utilization of the MOU? The four groups participated in Phase I as well as in Phase II, the reason being to involve the groups in identifying problems and finding solutions with which they would be comfortable, since it would be their ideas. This whole exercise was, however, carried out in line with the RDP principle of people driven approach or community involvement. The investigation revealed that the community was not utilizing the MOU because of the following reasons: Negative attitudes of nurses. Lack of material and human resources. Poor safety and security measures. Lack of community involvement/participation. The focus groups then identified the following suggestions for improving the utilization of the MOU: Change of attitudes by nurses towards the patients. Availability of material and human resources. Proper safety and security measures in the MOU. Community involvement/participation. Integration of health services. Intervention strategies for community nurses to improve the utilization of the MOU were based on the literature as well as the suggestions made by the focus group respondents because the researcher found the suggestions to be realistic.

Attitude of Health Personnel↗

Assessment of learning needs and the development of an educational programme for registered nurses in advanced midwifery and neonatology.

A key step in the development of any educational programme is learning needs assessment. This is however often neglected. The purpose of this research was to identify learning needs of potential students in order to develop a relevant educational programme for registered nurses in advanced midwifery and neonatology. A survey design was used, and the population of the study was the registered nurses in the Free State. Two thousand questionnaires were mailed to respondents, selected by means of simple random sampling. Advanced educational programmes emphasize the teaching of advanced knowledge and skills and accept that the students entering these programmes already have specific knowledge and skills included in the curricula for basic programmes. This is contrary to the findings of this study. The results underline the importance of learning needs assessment in the development of relevant educational programmes.

Attitude of Health Personnel↗

Educational support for nursing and midwifery students with dyslexia.

AIM: This article sets out to begin the process of discussing and investigating the support of nursing students and midwives with dyslexia. METHOD: The method is informed by grounded theory using a survey of universities through email contact with members of the Council of Deans (CoD). RESULTS: Twenty eight universities responded to the survey, representing 46 per cent of the CoD membership and 40 per cent of the universities offering nursing and midwifery courses. The results show a wide variation of support available to students within financial constraints. Many universities offer support funded by top-slicing or goodwill gestures. CONCLUSION: Although concentrating on academic support, there are implications for practitioners who support students on clinical placements.

Disability Evaluation↗

Obstacles to using a database in midwifery.

The increasing emphasis on evidence-based care poses a range of practical problems, not least of which is access to the information on which care is to be based. This article reports on a Scottish study that examined the impact of giving midwifery units access to the Cochrane pregnancy and childbirth database. The results suggest that installing the database had little effect on practice. A key issue was computer use. Although the midwives had a positive attitude towards computers, they did not feel they had the necessary skills to find information on the databases. Given that 70% of those questioned used computers regularly, the cause of their uncertainty is not clear.

Databases as Topic↗

One-to-one midwifery care at the Wessex Maternity Centre.

Independent midwifery practice can offer women greater choice, flexibility and more personalised care than may be available in NHS maternity units. The Wessex Maternity Centre offers continuity of care through paired caseloading by midwives. If women need to go into hospital, there is an arrangement whereby their midwife goes with them and continues to provide care in hospital. 50% of clients at the Centre are primiparae. The Centre's midwives have their own clinical protocols based on up-to-date research and practice.

Birthing Centers↗

Cost-effectiveness of midwifery services vs. medical services in Quebec. LEquipe dEvaluation des Projets-Pilotes Sages-Femmes.

This study compared the cost-effectiveness of midwife services provided in birth centres operating as pilot projects with current hospital-based medical services in the province of Quebec. One thousand midwives' clients were matched with 1,000 physicians' clients on the basis of socio-demographic characteristics and obstetrical risk. Direct costs for the prenatal, intrapartum and postpartum periods were estimated. Effectiveness was assessed on the basis of three clinical indicators and four indices related to the individualization of care as assessed by women. Results show that the costs of midwife services were barely lower than or equal to those of physician services, but cost-effectiveness ratios were to the advantage of the midwife group, except for one clinical indicator (neonatal ventilation). Overall, this study provides rational support for the process of legalizing midwifery in the province.

Birthing Centers↗