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PubMed2007

Predicting stress in pre-registration midwifery students attending a university in Northern England.

OBJECTIVE: to determine which variables predict stress (psychological distress) in pre-registration midwifery students. DESIGN: a cross-sectional survey, using a range of self-report measures bound together in a 'questionnaire pack'. SETTING: the study reported here is taken from a wider investigation into stress among nursing and midwifery students, undertaken in the nursing and midwifery department of a large university in Northern England. PARTICIPANTS: 120 pre-registration midwifery students pursuing one of three diploma programmes: 'standard', 'enhanced' and 'short'. MEASUREMENTS: multivariate logistic regression was used as the analytical technique. The variables used in the analyses undertaken were all derived from formal and study-specific, self-report measures included in the questionnaire pack. 'Stress' (whether a participant was psychologically distressed or not) was obtained via the General Health Questionnaire. Potential predictors of stress were collected from two formal measures (the Student Nurse Stress Index and the Coping Inventory for Stressful Situations) and from questions in the questionnaire pack designed to elicit demographic data and data of specific interest to nurse and midwife educators. FINDINGS: 102 questionnaire packs (85%) were returned. The prevalence of stress among participants was over 40%. A series of logistic regression analyses resulted in five competing regression models. Through a systematic selection process, two of these models were chosen for discussion. These models suggested that the key predictors of psychological distress in the population studied were self-report of stress levels, the type of midwifery programme being pursued, the use of 'task-oriented' coping and, possibly, whether or not a student smokes cigarettes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: despite the prevalence rate of 40%, the prevalence of stress among midwifery students is generally no better or worse than that of other students or of qualified health-care professionals. Those involved in midwifery education need to know how to manage student stress effectively. This can be achieved by ensuring that personal teachers (continue to) play a key role in supporting students, especially when students self-report high levels of stress. Incorporating formal stress-management training into pre-registration midwifery programmes may also be useful. Sound knowledge of the issues associated with student stress during curriculum design, however, may ultimately prove to be the most effective way of managing student stress. In a discipline such as midwifery, these issues are as divergent as the politics of midwifery, the processes used in recruitment and selection, the role of women in society, and the nature, quality and quantity of the learning experiences and the assessment strategies used.

Adaptation, Psychological↗
PubMed2002

Perspectives on the past, view of the present: relationship between nurse-midwifery and nursing in the United States.

Relationships between U.S. nurses and nurse-midwives developed during the Progressive Era around two major points: the knowledge that lower maternal and infant mortality in England and Europe was associated with well-educated midwives, and the desire of some nursing leaders to substitute nurse-midwives for traditional midwives. In the process, traditional midwives were labeled dirty and dangerous and the practice of nurse-midwifery was marginalized. At the same time, research on nurse-midwifery showed excellent maternal and infant outcomes at the only two demonstration sites where nurse-midwifery was practiced between 1925 and 1941. This data helped the Children's Bureau and MCA push the expansion of nurse-midwifery in the South and Southwest. As their numbers expanded, nurse-midwives organized nationally within the national public-health nursing association. When the association merged with other nursing organizations, however, nurse-midwives were denied their request to maintain an autonomous section on the grounds that they practiced medicine. This rejection caused a split between nursing and nurse-midwifery that continues to affect interactions between the two groups of professionals. In the 1970s, the ANA, which by now supported the nurse practitioner role, embraced nurse-midwifery as an extension of nursing practice. This permitted regulation of nurse-midwifery under nurse-practice acts in all but a handful of states. Unfortunately, in the majority of these states nurse-midwives were not named in statute and their practice became legally invisible. Today, many state boards require a master's of nursing for licensure even though research has shown no difference in certification exam scores between master's- and nonmaster's-prepared nurse-midwives. During the 1970s, middle-class women began to seek the services of a new group of apprentice-trained midwives, and, eventually, these midwives created their own national organization. In the early 1990s, the two national midwifery organizations met formally to craft recommendations for the education and certification of non-nurse midwives and a single standard of midwifery care. Although both organizations had developed processes for accrediting educational programs and certifying non-nurse midwives, the job of drafting a single standard of care remains incomplete. As a result, one of the major tasks facing U.S. nurse-midwives is the need to redefine their relationships with both nursing and apprentice-trained direct-entry midwives. Completion of this task holds the promise of boosting the public image of midwifery, elevating the place of midwives in the care of women and infants, and improving maternal and child health outcomes in America.

Education, Nursing↗
PubMed2001

Contemporary issues in Australian midwifery regulation.

This paper reports on research that examined the Nurses' Acts, regulations and current policies of each state and territory in Australia, in order to determine their adequacy in regulating the education and practice of midwifery. This is part of a three-year study (Australian Midwifery Action Project) set up to identify and investigate barriers to midwifery within the provision of mainstream maternity services in Australia. Through an in-depth examination and comparison of key factors in the various statutes, the paper identifies their effect on contemporary midwifery roles and practices. The work assessed whether the current regulatory system that subsumes midwifery into nursing is adequate in protecting the public appropriately and ensuring that minimum professional standards are met. This is of particular importance in Australia, where many maternity health care services are seeking to maximise midwives' contributions through the development of new models of care that increase midwives' autonomy and level of accountability. A lack of consistency and evidence of discrepancies in the standards of midwifery education and practice regulation nationally are identified. When these are considered alongside the planned development of a three-year Bachelor of Midwifery, due to be introduced into Australia in mid-2002, there exists an urgent need for regulatory change. The need is also identified for appropriate national midwifery competency standards that meet consumer, employer and practitioner expectations, which can be used to guide state and territory regulations. We argue the importance of a need for change in the view and legal positioning of the Australian Nursing Council and all Nurses Boards regarding the identification of midwifery as distinct from nursing, and substantiate it with a rationale for a national and consistent approach to midwifery regulation.

Australia↗
PubMedDate not supplied

Midwifery in Germany. Its past and present.

This article introduces midwifery in Germany to the North American midwife. The development of the midwifery profession since the 12th century is presented. Some regulations that govern midwifery practice today were initiated by the clergy, city government, and physicians during past centuries. Present-day midwifery training and professional opportunities are described. The organization and peculiarities of the German health care system and some effects of German reunification that are relevant to midwifery practice are also discussed. Midwives work in several areas and are regulated by federal and state laws which support and secure their practice. The promotion of midwifery interests frequently encounters resistance by obstetricians. There is a long-standing conflict related to an overlap of skills and services that both professions claim as their own. In recent years, more women have demanded and used midwifery services. In 1992, 811,774 deliveries were performed by midwives in 1,176 German hospitals with varying styles of labor management. This variety ranged from university hospitals, which emphasized modern technologies, to institutions that supported a comprehensive midwifery approach. The author challenges the classical practice of midwifery and contrasts it with a delivery that incorporates several features in a comprehensive approach.

Clergy↗
PubMed1997

Integrating lay and nurse-midwifery into the U.S. and Canadian health care systems.

The integration of midwifery into the health care systems in the U.S. and Canada has invoked scholars to speak of a "rise of midwifery". Despite the gains that the profession of midwifery has made in both countries, there are some interesting differences in how midwifery is organized and practised in these two settings. Briefly, in the U.S. midwifery currently exists as a profession divided between nurse- and non-nurse-midwives, or "lay" midwives, with greater acceptance and legitimacy garnered by the former, whereas midwifery in some jurisdictions in Canada has gained legitimacy as a unified profession separate from nursing. An analysis of the differences in the development and organization of lay and nurse-midwifery in Canada and the U.S. highlights the importance of differences in the system of health professions in these two countries, the role of the state in this system, and the relationship between feminism, midwifery and the state on the outcome of efforts to integrate midwifery.

Canada↗
PubMedDate not supplied

The 1999-2000 ACC task analysis of nurse-midwifery/midwifery practice: a consideration of the concept of professional issues.

The American College of Nurse-Midwives (ACNM) Certification Council periodically conducts a task analysis study as evidence supporting the content validity of the national certification examination in nurse-midwifery and midwifery. The purpose of this article is to report findings related to the examination of the relationship between professional issues and safe beginning-level midwifery as measured by the 1999-2000 Task Analysis of American Nurse Midwifery and Midwifery Practice. Study findings suggest that newly certified midwives place strong emphasis on the importance of tasks related to the ACNM "Hallmarks of Midwifery," which characterize the art and science of the profession: these include tasks dealing with health promotion and cultural competency. The beginning midwives, however, gave consistently low ratings to tasks related to ACNM "Core Competencies" that mirror the professional responsibilities of midwives; these include tasks related to the history of midwifery, research, or health policy. The study has implications for nurse-midwifery/midwifery educators, experienced midwifery mentors, and other persons interested in reinforcing the relevance of these important professional issues to the new midwife.

Adult↗