Diane M. Fraser

Towards an integrated model of competence in midwifery

Currently in the UK, there is no consensus as to what constitutes an adequate definition of a competent midwife. Yet, given the rapidly changing midwifery needs of childbearing women and society, such clarification has never been more important. In this paper some concepts of competence taken from a review of midwifery, nursing, educational and industrial literature are reviewed, and it is hoped that discussion leading to conceptualisation of an integrated model of competence in midwifery will be stimulated. Questions raised include--What is it that makes midwives competent? Can competence be inferred from performance? How can capability be recognised? Can competence be broken into elements for assessment without losing meaning?

Presenting and discussing nuchal translucency screening for fetal abnormality in the UK.

OBJECTIVE to investigate the relationship between information giving by midwives and decision-making by women offered nuchal translucency (NT) screening. To establish how risk figures are discussed in practice, with the intention of relating this to the existing, and often critical, literature on womens accounts of antenatal screening. DESIGN a qualitative study following women through the process of being offered and deciding to undergo NT screening. Tape recording of consultations, analysed in their entirety, was combined with post-screening interviews. SETTING a large teaching hospital in the UK. PARTICIPANTS fourteen pregnant women eligible for NT screening at the time of recruitment. DATA COLLECTION (i) tape recordings of consultations between community midwives and pregnant women where nuchal translucency screening was offered; (ii) tape recordings of consultations between hospital midwives and pregnant women immediately post-screening; (iii) individual face-to-face interviews with pregnant women between two and six weeks after the screening, carried out by the first author. FINDINGS NT screening was in general well received, particularly by those women who had undergone serum screening with previous pregnancies. However, communicating the nature of a risk figure is an interactionally complex process. A large amount of interactional work is required by midwives both before and after screening to ensure that women comprehend this information. Despite the emphasis placed in these consultations on understanding the purpose of NT screening and the status of the results, women often framed their decision to undergo NT screening in terms of it being a formality, or of presuming that all was well. This sometimes created practical and personal difficulties in terms of decision-making. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE previous sociological and psychological research has tended to be critical of midwives in terms of ensuring informed choice in screening, but this research is often based on post hoc accounts. Examining actual consultations with these accounts helps to illustrate the other factors that affect womens perceptions of testing, and the way in which risk, choice and decision-making are introduced and discussed in practice. Encouraging women to consider what action they might take on the basis of a personally unfavourable NT result in advance of undergoing the scan may help them to decide whether the information gained will be useful to them. Recognising the complex interactional work required in making sure that women understand the nature of the results that will be obtained is an important issue for the education and training of midwives.

Strategies for interprofessional education: the Interprofessional Team Objective Structured Clinical Examination for midwifery and medical students.

This paper provides an overview of the processes involved in implementing an interprofessional education (IPE) strategy in a recently established School of Human Development at the University of Nottingham. The merger of the academic divisions of child health, midwifery, obstetrics and gynaecology was a deliberate initiative to create an organisational infrastructure intended to enhance opportunities for interprofessional collaborations in research and education. As a first step, a small group of academic midwives and obstetricians formed a project group to find the best way of facilitating IPE for medical and midwifery students at undergraduate level. A discussion is provided of the work the project group undertook to: determine an agreed definition of IPE; decide an action research approach was needed; determine the ways in which teaching and learning strategies were to be implemented, evaluated and compared; and identify the factors inhibiting and enhancing developments. Evaluations have demonstrated that the Interprofessional Team Objective Structured Clinical Examination (ITOSCE) focusing on intrapartum scenarios is effective in promoting interprofessional learning. Both medical and midwifery students and facilitators agree that team working and understanding each others roles has been enhanced and that although resource intensive, IPE is worth the time and effort involved.

Ethical dilemmas and practical problems for the practitioner researcher

Abstract This paper explores the ethical dilemmas and problems encountered when undertaking an action research study in my own school. The study was designed to evaluate a contentious part of a new midwifery programme as it was being implemented. A range of potentially problematic issues are discussed from the practitioner researcher perspective. Some of these problems were anticipated but others had not been addressed and had to be responded to as they arose, More careful thought at the planning stage about the potential effects on others, as well as action-in-reflection are presented as important considerations for other practitioners contemplating action research in their own place of work.

‘Practising under your own Pin’– a description of the transition experiences of newly qualified midwives

AIM Transition experiences of newly qualified midwives were examined in depth during the third phase of a UK evaluation study of midwifery education. BACKGROUND The fitness to practise and the retention of newly qualified nursing and midwifery graduates are pressing concerns for health care managers. The advantages of preceptorship are reported in the literature but the content and timing of schemes remain unclear. METHODS A semi-structured diary was kept for up to 6 months by 35 newly qualified midwives in 18 work sites covering all countries in the UK. The preceptor and supervisor of midwives for each newly qualified midwife completed short questionnaires about their preceptees performance, and a further sub-sample of newly qualified midwives and preceptors participated in a semi-structured interview. Data were analysed to elicit aspects of newly qualified midwives transition experiences. RESULTS Findings confirm that structured preceptorship schemes are not widely available. Newly qualified midwives primarily obtained transition support from members of the midwifery team. CONCLUSION Although perceived as competent, there is no demarcation point in becoming confident to practise as a registered practitioner. Implications for managers include the importance of a supportive culture within clinical teams for successful transition and the introduction of structured preceptorship schemes facilitated by appropriate rotation patterns.

A university department merger of midwifery and obstetrics: a step on the journey to enhancing interprofessional learning

A first-class maternity service requires effective team working and opportunities for multiprofessional learning. However, it has been found that collaboration and cohesive working between doctors and midwives is not always evident. This paper describes the context for a unique merger of two academic departments, obstetrics/gynaecology and midwifery, with a view to enhancing interprofessional collaboration in teaching and research. Although interprofessional learning, particularly at undergraduate level, can be difficult to design and implement it is argued that it is necessary to enhance multiprofessional teamwork. It was found that a staged programme of action is needed to develop and evaluate curricular initiatives in interprofessional learning. Whilst learning about and valuing each others roles is as important as sharing curriculum content it can involve an element of risk and considerable resources. Pilot work locally suggests that it is well worth the time and effort involved but long-term success will be dependent upon staff commitment and evaluation of the process as well as the outcomes.A first-class maternity service requires effective team working and opportunities for multiprofessional learning. However, it has been found that collaboration and cohesive working between doctors and midwives is not always evident. This paper describes the context for a unique merger of two academic departments, obstetrics/gynaecology and midwifery, with a view to enhancing interprofessional collaboration in teaching and research. Although interprofessional learning, particularly at undergraduate level, can be difficult to design and implement it is argued that it is necessary to enhance multiprofessional teamwork. It was found that a staged programme of action is needed to develop and evaluate curricular initiatives in interprofessional learning. Whilst learning about and valuing each others roles is as important as sharing curriculum content it can involve an element of risk and considerable resources. Pilot work locally suggests that it is well worth the time and effort involved but long-term success...

The impact of the establishment of a midwife managed unit on women in a rural setting in England

OBJECTIVE to determine what impact the changes from consultant-led care to midwife-led care in a local maternity service have had on women using that service. DESIGN case study, data were collected by postal questionnaire, semi-structured, tape-recorded interviews, observations and scrutiny of records. SETTING a small town in rural England. PARTICIPANTS all pregnant women eligible for a midwife-managed unit (MMU) birth in a small rural town in England. FINDINGS the women using the MMU were satisfied with the care they received and the MMU style of care. Women giving birth at the MMU and at home required less pain relief and were more likely to have an intact perineum than a similar group of women giving birth in hospital. Continuity of carer did not appear to be an issue for women as long as they felt supported by a known team of midwives. Transfer for complications during the birthing process was a cause for anxiety and stress for women and their partners. Women, whilst satisfied with the MMU, would prefer the consultant-led maternity hospital to be re-established in the town. The home-birth rate rose by 28% when the consultant unit closed. IMPLICATIONS FOR PRACTICE while the establishment of a midwife-managed unit has provided increased choice for a minority of women, the removal of the consultant unit in the town has disadvantaged the majority of pregnant women. While guidelines are needed when establishing these units the application of restrictive inclusion and exclusion criteria can sometimes force women to make less appropriate birth choices.

Pre-registration midwifery programmes: a case study evaluation of the non-midwifery placements

OBJECTIVE to evaluate the effectiveness of non-midwifery placements in enabling pre-registration (direct entry) student midwives to learn about caring for childbearing women with medical, surgical or mental health problems and needs. DESIGN case study. SETTING a large midwifery education department and three acute general hospitals in England. PARTICIPANTS 15 student midwives in the first intake of one colleges three-year diploma programme in midwifery plus the practitioners involved in their education. MAIN OUTCOME MEASURES the learning needs of student midwives, who have no previous health-care experience, to enable them to care effectively for women with medical/surgical/mental health problems; the teaching processes and learning opportunities related to these aspects of care; how the views of teachers and practice placement staff compare with those of the students; the factors that influence the teaching and learning processes and experiences for pre-registration student midwives. FINDINGS the broad range of experiences in medical/surgical/metal health placements enabled students to increase in maturity, and confidence and develop their communication skills. The variety of placements enhanced student understanding of the multi-disciplinary teams contribution to health care, students learned new practical skills which were transferable to maternity care contexts and all students had opportunities to care for adults with most of the medical/surgical/mental health problems seen in childbearing women. CONCLUSION this action research project provided data for curriculum development and helped to avoid premature reaction to individual staff and student response. The value of the medical/surgical/mental health placements and the importance of staff and student preparation for effective learning was established. Whilst it might be essential to identify what and where student midwives should learn, it would appear that developing each student must be an equal, if not greater, priority for curriculum designers.

The MINT project--an evaluation of the impact of midwife teachers on the outcomes of pre-registration midwifery education in the UK.

OBJECTIVE to explore the contribution of midwife teachers in preparing student midwives for competent practice. DESIGN a three phase design using qualitative and quantitative approaches. Phase one involved UK wide on-line questionnaire surveys, phase two was a case study method in six UK approved education institutions and phase three was a diary study with newly qualified midwives. PARTICIPANTS phase one included all UK Lead Midwives for Education (LMEs), midwife teachers and Local Supervising Authority Midwifery Officers; phase two participants were three year and shortened programme student midwives, midwife teachers, LMEs and programme leads from each of the four countries; and phase three included a sample of newly qualified midwives graduating from the case study sites and their preceptors and supervisors of midwives. FINDINGS midwife teachers were valued for their unique and crucial role in supporting the application of knowledge to midwifery practice. Visibility and credibility were two key concepts that can explain the unique contribution of midwife teachers. These concepts included being able to support skills acquisition, understanding of contemporary midwifery practice, having a role in practice contexts and able to offer personal support. Visibility of teachers in practice was vital for students and mentors to assist students put their learning into practice and monitor learning and assessment decisions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE given the complexity of midwifery education a team approach is essential in ensuring the effectiveness of these programmes. This requires a sufficient differentiation of midwife teacher roles to deliver the pre-registration curriculum. A set of resource quality indicators is proposed to support midwife teacher teams achieving sufficient clinical and academic expertise to deliver effective education programmes.

Postnatal management and breastfeeding

Abstract Postnatal care is often described as the ‘Cinderella’ of the maternity services. It is now becoming recognised that inadequate support, advice and treatment can impact quite considerably upon a woman’s daily life, her relationships with family and friends and her parenting abilities. This review provides an overview of the management of postnatal care and breastfeeding, and the factors most likely to promote mothers’ health and well-being.