Carolyn Hicks

A survey of midwives' attitudes to, and involvement in, research: the first stage in identifying needs for a staff development programme

Despite top-down directives in the UK to increase the research base of various of the paramedical professions, there is some evidence to suggest that there remains a serious shortfall in published research in these domains. Until this is increased, much clinical practice will continue to be founded on time-honoured tradition rather than on empirical evidence. Of special concern to the present study is the situation within midwifery. To investigate possible reasons for the limited research output in this area, a national questionnaire survey of 550 randomly selected midwives was undertaken. The questionnaire comprised sections on biographical/occupational details and research activities, together with a 13-item attitude-to research scale. The responses were analysed using techniques of descriptive and inferential statistics. The findings suggest that a major reason for the low overall publication rate was not a failure to undertake research in the first place, but instead, a reluctance to submit the findings for publication. This reluctance seemed to be a function of a prevailing diffidence amongst the majority of respondents. The findings are interpreted within a context of developing future staff training programmes.

What Do Clinical Educators Look for in Physiotherapy Students

Summary Attempts to achieve greater objectivity in the assessment of students on clinical placement may be complicated by differing perceptions of professional competence and the extent to which implicit criteria contribute to decision making. This study used a triadic repertory grid procedure to reveal the criteria used by 20 clinical educators to differentiate between good and bad clinical performance by undergraduate physiotherapy students. The data were subjected to factor analysis and content analysis. The results indicated that a broad range of assessment criteria was applied by the clinical educators in the study, but from their individual bioplar constructs eight common dimensions were identified as being used to differentiate between students. Of these, the most influential were least amenable to objective assessment. On further analysis using an unrelated t-test, the eight dimensions were found to be consistently sensitive as discriminators of clinical performance (p

Development of a psychometrically valid training needs analysis instrument for use with primary health care teams.

The growing demand for professional updating and training within the health service has created a proliferation of post-registration courses, many of which fail to reach the appropriate personnel or the real training objectives of the participants and their managers. One reason behind this problem relates to the fact that many such courses are constructed and delivered in a haphazard way, without systematic reference to the direct and indirect consumers of the educational programmes. A more rational approach to post-experience provision of this sort might involve the methodical collection of information regarding the training needs of target health professional populations. Such a data base would afford a global overview of competencies and deficiencies, both within and between individuals. From this the content, level and focus of training could be customized to meet the reported needs, thereby streamlining the commissioning process to enhance efficiency and effectiveness. Previous attempts to rationalize provision through the prior use of training needs analysis instruments have been compromised by the shortcomings of the analysis tool. This study, then, was an attempt to redress this problem, using a training needs analysis instrument developed along traditional psychometric principles. The tool was intended to be used with primary health care teams because of the increasing role this sector of the health service will play in the future delivery of care, although this would not preclude its use with other health care professionals (following appropriate modification), since the principles behind its construction and format are transferable. The instrument has demonstrable construct, content and face validity and significant reliability. Moreover, preliminary investigations suggest that it also has criterion validity in the areas tested. These findings suggest that the instrument is unique of its kind. Early use of the tool has demonstrated its value in a variety of ways, such as in team building exercises and skill mix reviews as well as in precise and effective commissioning of training and education in a range of areas.

The training and development needs of nurses in Indonesia: paper 3 of 3

BackgroundIndonesias recent economic and political history has left a legacy of widespread poverty and serious health problems, and has contributed to marked inequalities in health care. One means of responding to these challenges has been through a reconsideration of the professional roles of nurses, to enable them to deal with the range and complexity of health problems. However, there are currently a number of obstacles to achieving these aims: there is a serious shortfall in trained nurses; the majority of nurses have only limited education and preparation for the role; and there is no central registration of nurses, which means that it is impossible to regulate either the profession or the standards of care. This study aimed to establish the occupational profiles of each grade of nurse, identify their training and development needs and ascertain whether any differences existed between nurses working in different regions or within hospital or community settings.MethodsAn established and psychometrically valid questionnaire was administered to 524 nurses, covering three grades and coming from five provinces.ResultsSignificant differences in job profile were found in nurses from different provinces, suggesting that the nature of the role is determined to some degree by the geographical location of practice. The roles of hospital and community nurses, and the different grades of nurse, were fairly similar. All nurses reported significant training needs for all 40 tasks, although these did not vary greatly between grade of nurse. The training needs of nurses from each of the provinces were quite distinct, while those of hospital nurses were greater than those of community nurses.ConclusionThe results suggest that the role of the nurse is not as diverse as might be expected, given the different levels of preparation and training and the diversity of their work environments. This may reflect the lack of a central registration system and quality framework, which would normally regulate clinical activities according to qualifications. The differences in training needs between subsections of the sample highlight the importance of identifying skills deficits and using this information to develop customized post-registration education programmes. Together, these results provide a rigorous and reliable approach to defining the occupational roles and continuing education needs of Indonesian nurses.

Perceptions of the learning environment in higher specialist training of doctors: implications for recruitment and retention

Introduction  Career choice, sense of professional identity and career behaviour are influenced, subject to change and capable of development through interaction with the learning environment. In this paper workplace learning discourses are used to frame ongoing concerns associated with higher specialist training. Data from the first stage of a multimethods investigation into recruitment into and retention in specialties in the West Midlands is used to consider some possible effects of the specialist learning environment on recruitment and retention.

The training and development needs of midwives in Indonesia: paper 2 of 3

BackgroundThere is a shortfall in midwives in Indonesia (an estimated 26 per 100 000 people), which means that the quality of antenatal, perinatal and postnatal care varies widely. One consequence of this is the high rate of maternal and perinatal mortality, which has prompted a number of health initiatives. The current study was part of a review of the existing complex system of midwifery training and the development of a coherent programme of continuing professional development, tighter accreditation regulations and clearer professional roles. Its aims were to identify the occupational profiles and development needs of the participating midwives, and to establish whether any differences existed between grades, geographical location and hospital/community midwives.MethodsA psychometrically valid training-needs instrument was administered to 332 midwives from three provinces, covering both hospital and community staff and a range of midwifery grades. The instrument had the capacity to identify occupational roles and education/training needs of the respondents.ResultsThe occupational roles of the midwives varied significantly by province, indicating regional service delivery distinctions, but very little difference in the roles of hospital and community midwives. The most educated midwives attributed more importance to 35 out of the 40 tasks, suggesting an implicit role distinction in terms of level of activity. All midwives reported significant training needs for all 40 tasks. The most-educated midwives recorded training needs for 24 tasks, while the less-educated had training requirements for all tasks, which suggests that new training programmes are effective. Few differences in training needs were revealed between hospital and community midwivesConclusionThe results from this survey suggest important regional differences in how the midwifes role is discharged and underline the importance of this sort of research, in order to ensure the suitability of basic and postbasic educational provision. The study also highlights the need for further development and training of midwives in a wide range of tasks. These results provide a systematic and reliable overview of current midwifery roles and development needs and could serve to inform future training.

Applying psychometric principles to the development of a training needs analysis questionnaire for use with health visitors, district and practice nurses:

Much health service research relies on the use of questionnaires, some of which are poorly constructed and therefore have the potential for yielding unreliable databases1 . The application of the formal principles of psychometrics to questionnaire design can eliminate many of these problems. This paper reports the development of a training needs analysis tool following some of these essential parameters. The overall aim of the exercise was to identify the nature and extent of the training and education required by health visitors, practice and district nurses in a range of occupational areas, but with specific reference to research competencies. The results demonstrated that within the domain of post-basic training needs, there is a need to employ data collection techniques which go beyond the standard wish-list approach typically adopted, and to use, instead, questionnaires which embrace some of the guiding principles of psychometric science. In this way, educational provision can be more reliably informed and limited budgets more systematically targeted.

An alternative technique for evaluating the effectiveness of continuing professional development courses for health care professionals: a pilot study with practice nurses

BACKGROUND Increasing recognition of the need for continuing professional development (CPD) for health professionals has created an inevitable expansion in course provision. One criterion of a successful course demands that CPD must meet local health service needs, as well as the personal and professional requirements of the participants. At a more general level, a key pedagogical requirement of any educational course is that the content and process must meet the stipulated aims and objectives, and this requires appropriate evaluation procedures. Within health care CPD, very little course evaluation routinely takes place, possibly because the area is relatively new, and secondly because relevant evaluation may be difficult to operationalize. AIMS The current study reports a small exploratory pilot investigation into the use of a valid and reliable training needs analysis questionnaire as a means of evaluating a nurse practitioner (NP) training scheme for practice nurses (PN). METHODS Using a before/after design, the instrument involved the participants in a pre and post course self-assessment on a range of tasks. These assessments were made according to three criteria: how critical each task is considered to be to the effective delivery of the respondents current PN role; how critical each task is considered to be to the effective delivery of the role of the NP; and how well each task is currently performed. Various comparisons of the ratings provide a considerable amount of information that may be of use to the nurse manager in planning NP programmes. Of particular relevance to the current paper, however, are the comparisons between salience of tasks for the NP role and performance on these, before and after the course. This provides an assessment of the extent to which the course has met educational requirements. RESULTS The present study demonstrated that overall, the course reduced skill deficits in all but seven of the tasks. Of these, six related to research and audit and the seventh to clinical examination of patients. CONCLUSION The study is discussed in terms of the implications of the technique for course development and planning to take account of local needs, as well the instruments reliability and validity, for use in this way.Background Increasing recognition of the need for continuing professional development (CPD) for health professionals has created an inevitable expansion in course provision. One criterion of a successful course demands that CPD must meet local health service needs, as well as the personal and professional requirements of the participants. At a more general level, a key pedagogical requirement of any educational course is that the content and process must meet the stipulated aims and objectives, and this requires appropriate evaluation procedures. Within health care CPD, very little course evaluation routinely takes place, possibly because the area is relatively new, and secondly because relevant evaluation may be difficult to operationalize. Aims The current study reports a small exploratory pilot investigation into the use of a valid and reliable training needs analysis questionnaire as a means of evaluating a nurse practitioner (NP) training scheme for practice nurses (PN). Methods Using a before/after design, the instrument involved the participants in a pre and post course self-assessment on a range of tasks. These assessments were made according to three criteria: how critical each task is considered to be to the effective delivery of the respondents current PN role; how critical each task is considered to be to the effective delivery of the role of the NP; and how well each task is currently performed. Various comparisons of the ratings provide a considerable amount of information that may be of use to the nurse manager in planning NP programmes. Of particular relevance to the current paper, however, are the comparisons between salience of tasks for the NP role and performance on these, before and after the course. This provides an assessment of the extent to which the course has met educational requirements. Results The present study demonstrated that overall, the course reduced skill deficits in all but seven of the tasks. Of these, six related to research and audit and the seventh to clinical examination of patients. Conclusion The study is discussed in terms of the implications of the technique for course development and planning to take account of local needs, as well the instruments reliability and validity, for use in this way.

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 midwifes paper with the obstetricians on each of the 5 criteria. These suggested that no difference was perceived between the midwifes and obstetricians 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 midwifes paper was also perceived to be poorer than the obstetricians (t = 2.24, p less than 0.025). The findings are partially explained in terms of the gender influences that operate in midwifery.

Barriers to Evidence-Based Care in Nursing: Historical Legacies and Conflicting Cultures

The British National Health Service (NHS) has witnessed many fundamental changes over the last decade, one of the most significant of which is the imperative for health-care professionals to ensure that their clinical practice can be supported by research evidence. This move from intuition and historical ritual to scientific justification has not been fully successful in either the medical or non-medical professions, with the result that a great deal of research has been sponsored at both the national and local levels to investigate the reasons underlying the research/practice divide. Within nursing the problem has been particularly exacerbated by its ideological framework, the culture and tradition of the profession itself and the recent reforms that were intended to raise its professional status and autonomy. This paper considers the impact of nursing traditions and stereotypes and the bureaucratic structures of the NHS on the introduction of evidence-based nursing care. It is suggested that the essential nature of nursing, its legacy and philosophy, together with the health services hidden agendas, have conspired to keep nursing in a subordinated, quasi-professional role as one means by which the workforce can be controlled. Because the nursing profession has colluded with this, albeit inadvertently, it now needs to re-establish its complementary functions, in order to salvage its position and truly establish nursing as a profession in its own right.