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At least 145 records · Page 8Linked to original sources
PubMed2000

'Everyone is scared of it inside so they start being a bit irrational': HIV/AIDS education within midwifery.

OBJECTIVE: To describe views put forward by student midwives and lecturers about education on the human immunodeficiency virus (HIV). DESIGN: Multi-method. Participants completed a questionnaire containing open and closed questions, and took part in focus-group discussions. SETTING: All institutions providing pre-registration midwifery education in the South Thames Region of the UK. PARTICIPANTS: Students (n = 336) and lecturers of midwifery (n = 51). MEASUREMENTS: Closed questions from the questionnaire were analysed for frequency distributions, intra-group cross tabulations of selected variables and inter-group comparisons. Open questions from the questionnaire and transcripts of focus group discussions were investigated using thematic analysis and constant comparative techniques. FINDINGS: Recent structural changes within midwifery education had increased lecturers' workloads. Curriculum pressures led to lecturers making assumptions about students' existing levels of knowledge, particularly regarding universal precautions, although both lecturers' and students' weakest areas of knowledge in relation to HIV were those specifically related to midwifery. The perceived risk of occupational infection was relatively high and linked to individual perceptions of the virus. However, neither anxiety nor knowledge levels were reflected by consistent use of universal precautions. KEY CONCLUSIONS: Knowledge obtained within midwifery education may be difficult to translate into clinical practice. Underlying issues such as perceptions of the virus and orthodoxies of midwifery practice inhibited students from using universal precautions, even when they recognised that consistent use of universal precautions could help reduce the risk of occupational transmission of HIV. The social construction of HIV and ideological constructions of midwifery practice, such as the client/midwife relationship, may be sufficiently powerful to have an effect on clinical practice and reduce the use of universal precautions. IMPLICATIONS FOR PRACTICE: Emphasising the place of clinical knowledge within a broader issue-based context may help lecturers and students address the challenge of implementing safe, non-discriminatory use of universal precautions.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The history and evolution of the Core Competencies for basic midwifery practice.

The Core Competencies in Nurse-Midwifery were first published in 1978 to provide a standard approach to nurse-midwifery education and now serve as the template for curriculum in nurse-midwifery/midwifery education. This article is an expansion of an earlier publication documenting the development of the Core Competencies document and describes its history and use in midwifery education and professional practice. The development and continued revision of this document are a significant part of ACNM and midwifery history in the United States. It defines the competencies essential to basic practice and can be used to define the scope of midwifery practice in both professional and policy arenas.

Accreditation↗
PubMedDate not supplied

Voices of diversity in midwifery: a qualitative research study.

The practice of midwifery reflects the spectrum of diversity among midwives and the women they serve, yet the composition of midwives in ACNM does not reflect the diversity of the women for whom they provide care. Providing culturally appropriate care for women requires our best understanding of their beliefs, needs, and desires; it also requires a wide range of diverse clinicians. This study proposed to learn more about the practice of midwifery from a diverse sample of midwives. A qualitative research design, which included small group interviews, videotape collection of data, and content analysis, was used. Four major themes were identified: 1) the worldview of midwifery through the lens of diversity, 2) the experience of diversity, 3) midwifery strategies rooted in diversity, and 4) the legacy for the profession of midwifery. There must be purposeful action by every individual in the profession, as well as the collective voice of midwifery, to identify barriers to inclusiveness and to foster a culture of diversity through respect, recruitment, and mentoring.

Adult↗
PubMed2006

Childbirth policies and practices in Ireland and the journey towards midwifery-led care.

OBJECTIVE: To describe the dominant policies and practices that have governed childbirth in Ireland, and to outline the progress made towards the introduction of midwifery-led care in one health region. LITERATURE REVIEW: A review of maternity-care policies in Ireland was conducted using government and regional health-authority documents and two historical reviews of government policies. A search was also carried out in PubMed and cinahl databases, using the keywords 'maternity care', 'childbirth', 'policy', 'midwifery-led', 'Ireland/Irish', with relevant Boolean and string operands. Childbirth as a social process is influenced by the model of care, and affects the physical and psychological outcomes for the woman and her family. In Ireland, routine intervention in labour is common, but, since the early 1990s, some changes in the Irish maternity services have taken place. Pilot projects on community midwifery have been introduced in some areas. Challenges to the provision of maternity care in the Health Service Executive, North Eastern area (formerly the North-Eastern Health Board) led to the production of the Kinder report, which included a recommendation to introduce pilot midwifery-led units (MLUs). THE INTRODUCTION OF MIDWIFERY-LED CARE: A Maternity Services Taskforce was established in January 2002 with a wide remit, including facilitation of the establishment of MLUs in Cavan General Hospital, Cavan and Our Lady of Lourdes Hospital, Drogheda, Co. Louth. The MLUs are being evaluated within the context of a randomised trial known as 'the MidU study', which compares midwife-led care with the present system of medical-led care for women who are at low risk of complications during pregnancy and labour. CONCLUSION: The journey to midwifery-led care in Ireland has been a long one. The phased introduction of MLUs, which are subject to rigorous evaluation, will provide quality evidence upon which to base the future development of maternity care across Ireland.

Adult↗
PubMedDate not supplied

Direct entry midwifery education. Evaluation of program innovations.

During the 1996-1997 academic year, the State University of New York Health Science Center at Brooklyn, in partnership with North Central Bronx Hospital, implemented the first direct entry (DE) midwifery education program to be preaccredited by the American College of Nurse-Midwives. Five DE midwifery students were admitted and graduated. During their one-year course of studies, these students were provided supplementary didactic and clinical instruction in the medical sciences and basic health skills in addition to the identical course of midwifery studies offered to their registered nurse-student peers. The experience of students and faculty during this first year was that there was no significant difference in academic performance between the DE and nurse-midwifery students. Moreover, once oriented to the clinical environment, DE students progressed through the clinical practicums, and acquired entry-level midwifery skills, at a pace equivalent to that of their nurse peers and consonant with all expectations of safe practice. In addition, the Basic Health Skills and Integrated Medical Science course offerings served as effective instructional supplements to the curriculum by providing DE students with an opportunity to equalize their knowledge base with that previously acquired by registered nurse-prepared students; an unanticipated discovery was that some nurse-midwifery students could equally benefit from enrollment in these courses.

Clinical Competence↗
PubMedDate not supplied

A model of exemplary midwifery practice: results of a Delphi study.

What is unique and exemplary about the midwifery model of care? Does exemplary midwifery care result in improved outcomes for the recipient(s) of that care? These are the questions that the profession of midwifery grapples with today within the context of a changing health care arena. Exemplary midwives, and women who had received their care, came to consensus about these issues in a Delphi study. A model of exemplary midwifery care is presented based on the identification of essential elements aligned within three dimensions: therapeutics, caring, and the profession of midwifery. Supporting the normalcy of pregnancy and birth, vigilance and attention to detail, and respecting the uniqueness of the woman, were several of many processes of care identified. The critical difference that emerged was the art of doing "nothing" well. By ensuring that normalcy continued through vigilant and attentive care, the midwives were content to foster the normal processes of labor and birth, intervening and using technology only when the individual situation required. Health care, whether in the gynecologic setting or during pregnancy, was geared to help the woman achieve a level of control of the process and outcome. The ultimate outcomes were optimal health in the given situation, and the experience of health care that is both respectful and empowering. The model provides structure for future research on the unique aspects of midwifery care to support its correlation with excellent outcomes and value in health care economics.

Delphi Technique↗
PubMedDate not supplied

The 1999 ACC task analysis of nurse-midwifery/midwifery practice phase I: the instrument development study.

The national certification examination (NCE) in nurse-midwifery and midwifery is developed, administered, and evaluated by the ACNM Certification Council (ACC). The blueprint for the NCE is based upon a comprehensive list of tasks that describe the knowledge, skills, and abilities expected of the midwifery practitioner at entry into the profession. In 1999, the ACC initiated the third in a series of task analysis studies to ensure the currency and relevance of the task list. This study was considered particularly timely, given that the professional organization, the American College of Nurse-Midwives, had approved pathways to midwifery for individuals whose first degree was not in nursing (the certified midwife) and also had expanded the core competencies for midwifery practice to include responsibilities in the domain of primary care. This manuscript reports the results of the pilot study, in which the specific list of tasks was developed. Three hundred and six ACNM members responded to a preliminary list of tasks, indicating their opinion about whether each specific task was relevant to entry-level midwifery practice. The task list finally derived consists of 219 tasks and 177 clinical conditions, dispersed among seven domains of practice (antepartum, intrapartum, newborn, postpartum, well-woman/gynecology, primary care/health assessment, and professional issues.) The task list represents a comprehensive profile of entry-level practice for nurse-midwives and midwives certified by the ACC.

Adult↗
PubMed2001

Emotion work in midwifery: a review of current knowledge.

AIM OF THE PAPER: To review the literature relating to emotional labour in the workplace and identify potential sources of emotion within midwifery work. RATIONALE: There is substantial evidence to indicate that the quality of the relationship between midwife and woman is significant in determining the quality of the childbirth experience for women. Despite this, there is a notable lack of research regarding midwives' experiences of participating in this relationship, and even less regarding the emotional issues involved. METHOD: Literature review of relevant midwifery, nursing and sociological literature. Discussion of the theoretical perspectives provided by sociological and nursing research relating to the management of emotion at work and critical consideration of their application to an analysis of midwifery work. FINDINGS: Although these theoretical perspectives may offer significant insights of relevance to midwifery, there is much more that needs to be uncovered. Midwifery work has the potential for creating high levels of emotion work and current changes in the organization of United Kingdom (UK) maternity care may further increase this. CONCLUSION: It is essential that midwives develop their understanding of emotion at work in order to improve their own working lives, and to meet the needs of childbearing women and their families. More research is needed in this field to develop a body of knowledge to inform midwifery education and practice.

Adaptation, Psychological↗
PubMed2002

Competencies for midwifery teachers.

Saving women's lives with cost-quality effective midwifery care is based on sound pre-service and ongoing education. Effective midwifery education requires competent, caring, and compassionate teachers. In this paper, I address the basic competencies required of midwives who teach others to be midwives. These competencies are important regardless of level of student taught, type of educational programme, or number of years of midwifery experience that learners bring to the educational setting. The competencies are based on the midwifery philosophy, values and model of care. Competent midwifery teachers must be competent midwifery clinicians for their primary role is to set the boundaries of safety for each level of learner. Formal preparation for teaching, understanding how adults learn, understanding how to develop an appropriate plan for learning (curriculum), and developing competency in a variety of teaching methods for both theory and clinical practice are included in the competencies discussed in this paper.

Adult↗
PubMed1998

Quality of midwifery led care: assessing the effects of different models of continuity for women's satisfaction.

BACKGROUND: Changing Childbirth (1993), a report on the future of maternity services in the United Kingdom, endorsed the development of a primarily community based midwifery led service for normal pregnancy, with priority given to the provision of "woman centred care". This has led to the development of local schemes emphasising continuity of midwifery care and increased choice and control for women. AIMS: To compare two models of midwifery group practices (shared caseload and personal caseload) in terms of: (a) the extent to which women see the same midwife antenatally and know the delivery midwife, and (b) women's preference for continuity and satisfaction with their care. METHODS: A review of maternity case notes and survey of a cohort of women at 36 weeks of gestation and 2 weeks postpartum who attended the two midwifery group practices. Questionnaires were completed by 247 women antenatally (72% response) and 222 (68%) postnatally. Outcome measures were the level of continuity experienced during antenatal, intrapartum, and postnatal care, women's preferences for continuity of carer, and ratings of satisfaction with care. RESULTS: The higher level of antenatal continuity of carer with personal caseload midwifery was associated with a lower percentage having previously met their main delivery midwife (60% v 74%). Women's preferences for antenatal continuity were significantly associated with their experiences. Postnatal rating of knowing the delivery midwife as "very important indeed" was associated with both previous antenatal ratings of its importance, and women's actual experiences. Personal continuity of carer was not a clear predictor of women's satisfaction with care. Of greater importance were women's expectations, their relations with midwives, communication, and involvement in decision making. CONCLUSIONS: Midwifery led schemes based on both shared and personal caseloads are acceptable to women. More important determinants of quality and women's satisfaction are the ethos of care consistency of care, good communication, and participation in decisions.

Cohort Studies↗
PubMed1998

General practitioners' attitudes to the development of midwifery group practices.

BACKGROUND: The report Changing childbirth (1993) has led to the development of midwifery-led schemes that aim to increase the continuity of maternity care. AIM: To determine the impact of midwifery group practices on the work of general practitioners (GPs) and their perceptions of midwifery group practice care. METHOD: Postal questionnaires were sent to 58 GPs referring women to the care of midwifery group practices (group-practice GPs), and a shorter questionnaire was sent to the remaining 67 GPs (non-group-practice GPs) within the same postcode area as a comparison group. In-depth interviews were conducted with 12 GPs. RESULTS: Questionnaires were returned by 71% of group-practice GPs and 81% of non-group practice GPs. One third of the group practice GPs felt that they were seeing group practice women too few times, and 50% thought midwives discouraged women from visiting their GP for antenatal checks. Over 80% of group practice GPs believed that midwives had the skills to detect deviation from the normal, and 66% would confidently refer women to their care. However, only 14% of group practice GPs believed that their own role was clear, while 64% agreed that communication with group practice midwives was poor, and concerns were expressed about the level of consultation before establishing schemes. Of the non-group practice GPs, 87% said they would consider referring women to the care of a midwifery group practice in the future. CONCLUSIONS: General practitioners were generally positive about the quality of care provided by midwifery group practices but identified issues that require addressing in developing this model of care.

Attitude of Health Personnel↗
PubMed1996

Marketing midwifery education: findings from a survey.

OBJECTIVE: to collect information from a sample of identified customers (midwives and midwifery managers employed by health authorities and trusts) in order to develop a marketing strategy for a Department of Nursing, Midwifery and Health Care. DESIGN: two descriptive and analytical surveys using questionnaires. SETTING: mid- and west Wales, UK. SUBJECTS: randomly selected sample of 75 midwives and census sample of eight midwifery managers working within the National Health Service. MEASUREMENTS AND FINDINGS: quantitative and qualitative data collection methods. KEY CONCLUSIONS: organisations have to define, and listen carefully, to their customers and offer courses which are appropriate, related to clinical midwifery practice and have titles that accurately reflect the content. Midwives are enthusiastically committed to continuing education despite the current difficulties. Word of mouth and personal recommendation remains the most effective form of advertising. University departments of nursing and midwifery can easily become removed from clinical practice. Education assists practitioners in changing and adapting to a new order; it is also crucial in developing skills in critical thinking and analysis. New skills are needed if practice is to improve. IMPLICATIONS FOR PRACTICE: academic departments can easily become remote and out of touch with the needs of clinicians and midwifery managers. Departments must take steps to define the customer, listen carefully to what they want and make every effort to provide continuing education for midwives that is relevant, responsive, accessible and attainable. The benefits of education also must be marketed.

Adult↗
PubMed1998

Team midwifery: the views and job satisfaction of midwives.

OBJECTIVE: As part of an evaluation of a team midwifery scheme we assessed the satisfaction of community and hospital midwives and their views about working practices and care provided. DESIGN: Survey of complete enumeration of community midwives (most working in teams) and hospital midwives providing antenatal, intrapartum and postnatal care to a population of women. SETTING: Community and district general hospital, in the UK. MEASUREMENTS: Socio-demographic data about midwives, ratings on Likert-type scales of job satisfaction, quality of care variables, relationships with other professionals and women; Glasgow Midwifery Process Questionnaire. FINDINGS: 80 out of 92 midwives (87%) responded. Community midwives were younger, more recently qualified, employed on lower grades, less likely to be married and have children than hospital midwives. The Glasgow Midwifery Process Questionnaire revealed that midwives, particularly hospital midwives, had low morale. Community midwives were more likely to report that their job was satisfying, offered a variety of work, enabled them to use skills and knowledge fully, and offered opportunities for professional development. Hospital midwives were more likely to report following strict guidelines. Community midwives, however, disliked the long on call and unsociable hours, and reported disruption to family/social life. Forty-one per cent of hospital midwives (12) and 28% of community midwives (14) reported regularly working beyond their shift. Whilst midwives thought that team midwifery was, in theory, a good idea, in practice it was not working well because of the size of teams and caseload. About half the community midwives felt that teams had detrimentally affected the quality and continuity of care. CONCLUSIONS: Whilst team midwifery aims to improve continuity of maternity care, in this instance, it does not appear to achieve this aim. Many midwives reported it had adversely affected care. Team midwifery is a source of disillusionment for midwives, since the continuity of carer ideal is unachievable in a system based on teams of seven or more. Attendance at the delivery may be a luxury provided at the expense of antenatal and postnatal continuity. IMPLICATIONS: Midwives recommended remedial measures: reducing team sizes, reducing caseloads, ensuring teams were fully staffed, reducing 'on call' and labour ward hours. It remains to be seen whether these will have the desired effects on continuity of care.

Adult↗
PubMed2002

A critical ethnographic approach to facilitating cultural shift in midwifery.

OBJECTIVE: to improve understanding of local midwifery morale, inform development and reorganisation of a maternity unit, and enhance midwifery involvement in strategic planning. PARTICIPANTS: a randomised stratified sample of 20 midwives working in a UK National Health Service (NHS) hospital and its surrounding community area. METHOD: within a critical ethnographic framework, focus groups were tape-recorded and transcribed, and analysed using a thematic content analysis approach. FINDINGS: key areas affecting midwifery morale were identified, in particular staffing levels, working relationships and organisational issues. One year later, despite many changes having taken place, midwifery morale was still low but participants were more politically analytical of, and actively involved in changing their situation. The findings of the study indicate that there are complex and long-standing cultural inhibitions to the effective development of midwifery care but, if these are made explicit through a planned collaborative process, such as in this study, a process of cultural shift can be seen to begin. IMPLICATIONS FOR PRACTICE: focus groups can be a useful tool in moving midwifery culture forward within a local context.

Anecdotes as Topic↗
PubMed2000

Quality assurance for nursing and midwifery education: an analysis of the approach in England.

The main purpose of this paper is to discuss conceptual and policy developments for external quality assurance for nurse and midwifery education in England. The current framework was implemented in the academic year 1998/99, and is the subject of a three year evaluation commissioned by the English National Board for Nursing, Midwifery & Health Visiting (ENB). The methods which are being used to evaluate the quality assurance arrangements will be discussed within the context of nursing and midwifery education and practice. The ultimate aim of professionally accredited nursing and midwifery education is to ensure the development of practitioners who are fit for purpose, practice and award. It follows that the quality assurance processes should have the capacity to demonstrate the extent to which professional education meets this aim. This paper will discuss this issue, with particular emphasis on the collaborative review process which is being undertaken by the Quality Assurance Agency and the statutory body for nursing, midwifery and health visiting education. The paper concludes with a discussion of the changes proposed by the government for nursing and midwifery education, and considers the potential impact for quality assurance of health care education.

Curriculum↗
PubMed2005

An exploratory study of complementary and alternative medicine in hospital midwifery: models of care and professional struggle.

Complementary and alternative medicine (CAM) is increasingly popular amongst midwives in Australia. A growing number of hospital midwives are personally integrating one or a range of CAM within their midwifery practice. Despite this trend we still know little about CAM in midwifery, particularly at a grass-roots level. This paper reports findings from one section of a larger exploratory study examining grass-root practitioners' understandings and experiences of complementary therapies in nursing and midwifery. Thirteen in-depth interviews were conducted with midwives working in New South Wales public hospitals and currently integrating CAM within their general midwifery practice. Analysis illustrates how midwives' explanations of, and affinity claims regarding, CAM feed into wider ongoing issues relating to professional autonomy and the relationship between midwifery and obstetrics.

Attitude of Health Personnel↗
PubMedDate not supplied

The landscape of caring for women: a narrative study of midwifery practice.

Our purpose was to expand knowledge on the process and outcomes of midwifery care. Narrative analysis was used to interpret stories provided by midwives to illustrate their practice and recipients of midwifery care about their experience. A purposive sample of 14 midwives and four recipients of midwifery care was recruited as a subsample from a prior Delphi study on midwifery practice. Three broad themes were identified: 1) the midwife in relationship with the woman, 2) orchestration of an environment of care, and 3) the outcomes of care, called "life journeys" for the woman and the midwife. The findings are discussed from the perspectives of therapeutic landscapes described in cultural geography and prior research on midwifery practice. The challenge is to confirm the associations between the processes of care identified in these narratives with both short- and long-term outcomes in the health of women and their families. These appear to go well beyond the usual perinatal measures currently used in health care research and hold implications for how care is delivered, measured, and evaluated.

Anecdotes as Topic↗
PubMedDate not supplied

Vaginal birth after cesarean section: a pilot study of outcomes in women receiving midwifery care.

A recent trend discouraging or not offering women a choice to labor after a cesarean birth has resulted in higher cesarean birth rates and lower rates of vaginal birth after cesarean birth (VBAC). The few studies describing midwifery practice have demonstrated favorable outcomes; however, the studies are too small to thoroughly evaluate critical outcomes. In this retrospective descriptive study, clinical outcome data were obtained from eight midwifery practices. The aims were to collect, aggregate, and analyze data from multiple midwifery practices and then describe outcomes. Usable data representing 649 trials of labor were submitted. Overall, 72% (range 64%-100%) of women gave birth vaginally. Mean infant birth weight was 3,501 (SD = 534) g, and the mean Apgar scores were 7.99 (SD = 1.4; median 8) at 1 minute and 8.84 (SD = 0.8; median 9) at 5 minutes. Only 5.3% (n = 14) of infants were admitted to the neonatal intensive care unit. This small retrospective study demonstrates similar outcomes to those reported in the current literature. A larger prospective study to carefully describe midwifery care outcomes using a common data collection method is needed to provide evidence for determining the continuation of VBAC as part of midwifery care.

Adult↗