Kenda Crozier

Innovations and action research to develop research skills for nursing and midwifery practice: the Innovations in Nursing and Midwifery Practice Project study

AIMS AND OBJECTIVES To develop sustainable resources and activity in one hospital to encourage, support and build research activity and innovation among nurses and midwives. BACKGROUND Much resource is spent internationally to enable nurses and midwives to critique and quote research papers. The evidence suggests that little resource is focussed on enabling staff to conduct structured interventions that implement research as a service improvement activity, or enable nurses and midwives to undertake research in their clinical areas. DESIGN Two cycles of action research took place in the hospital led by a steering group of insiders and outsiders. Each cycle was evaluated through interviews with participants and analysis of steering group meeting records. METHOD Action research methodology was used to develop partnership working between the hospital and university. A steering group of participants in the project led the development and made decisions based on findings from the evaluation stages of each cycle. RESULTS The data demonstrate that the process is one of the slow snowball effects that gathered momentum. Key skills such as leadership, resourcing and time management are required alongside research skills. CONCLUSIONS Nursing research capacity can be developed in institutions where there are individuals with an enthusiasm to drive the agenda. Structures and processes need to be clear and transparent as well as supportive at the individual level. Change of this nature takes time and sustained effort. RELEVANCE TO CLINICAL PRACTICE This study demonstrates that a combination of strong leadership, partnership working and development of clear infrastructure enabled nurses and midwives who provide direct patient care to develop, implement and evaluate their own service improvement/research initiatives. Enabling nurses and midwives to use research methods in their practice increases the amount of nurse/midwife-led evidence-based innovation.

An action research approach for developing research and innovation in nursing and midwifery practice: Building research capacity in one NHS foundation trust

The National Health Service in the United Kingdom is committed to a process of reform centred on quality care and innovative practice. Central to this process is the need for research capacity building within the workforce. The aim of this study was to develop an infrastructure for research capacity building within one National Health Service Foundation Trust. Using an Action Research methodology, sixteen individuals were purposefully selected from a population of nurses and midwives to participate in the study. This nonprobability sampling method enabled the researchers to select participants on the basis of who would be most informative about existing research capacity building structures and processes within the Trust. Data were collected in the form of semi-structured individual interviews with each participant. The main findings were that research activity was not embedded in the culture of the organisation, and initiating and undertaking change was a complex process. As a result, a range of structures and processes which were considered necessary to enable the Trust move forward in developing capacity and capability for research were developed and implemented. This paper reports the first two stages of this process, namely: the findings from the pre-step and an outline of how these findings were used to create an infrastructure to support research capacity building within one NHS Foundation Trust Hospital in the United Kingdom.

Interprofessional education in maternity care: shared learning for women‐centred care

There is a general agreement that the potential of shared learning is great in terms of interprofessional working and client care. Despite the fact that interprofessional education has been a key area of professional education and practice policies for the last decade there is a dearth of evidence of its successful implementation in maternity care. Doctors and midwives are often educated in separate faculties within universities and rarely given the opportunity for shared learning activities, particularly at postgraduate level. Barriers to implementing interprofessional learning are identified within the literature and these include a difference in perception of the status each profession holds and different ways of working and learning which impedes the development of interprofessional relationships. It is argued that through interprofessional education, doctors and midwives should be enabled to develop skills of collaborative working, thus making referrals between professionals more effective. The exploration of the differences of professional cultures in a shared learning environment will enable professionals to formulate agreement on best practice in the clinical areas, based on current best evidence. Thus, interprofessional education aims to dispel the stereotypes and prejudice which often act as a barrier to effective collaborative working. The implications of interprofessional education on three main areas of practice are explored using a review of the literature: professional roles; conflict and collaboration between professions; and the sharing of knowledge and skills. Recommendations are made for the development of post‐registration shared learning that address these key areas.

Standards for midwife practitioners of external cephalic version: A Delphi study

INTRODUCTION expansion of advanced and specialist midwifery practitioner roles across professional boundaries requires an evidence-based framework to evaluate achievement and maintenance of competency. In order to develop the role of Breech Specialist Midwife to include the autonomous performance of external cephalic version within one hospital, guidance was required on standards of training and skill development, particularly in the use of ultrasound. METHODS a three-round Delphi survey was used to determine consensus among an expert panel, including highly experienced obstetric and midwife practitioners, as well as sonographers. The first round used mostly open-ended questions to gather data, from which statements were formed and returned to the panel for evaluation in subsequent rounds. FINDINGS standards for achieving and maintaining competence to perform ECV, and in the use of basic third trimester ultrasound as part of this practice, should be the same for midwives and doctors. The maintenance of proficiency requires regular practice. CONCLUSIONS midwives can appropriately expand their sphere of practice to include ECV and basic third trimester ultrasound, according to internal guidelines, following the completion of a competency-based training programme roughly equivalent to those used to guide obstetric training. Ideally, ECV services should be offered in organised clinics where individual practitioners in either profession are able to perform approximately 30 or more ECVs per year in order to maintain an appropriate level of skill.

How do informal information sources influence women’s decision-making for birth? A meta-synthesis of qualitative studies

BackgroundWomen approach birth using various methods of preparation drawing from conventional healthcare providers alongside informal information sources (IIS) outside the professional healthcare context. An investigation of the forms in which these informal information sources are accessed and negotiated by women, and how these disconnected and often conflicting elements influence women’s decision-making process for birth have yet to be evaluated. The level of antenatal preparedness women feel can have significant and long lasting implications on their birth experience and transition into motherhood and beyond. The aim of this study was to provide a deeper understanding of how informal information sources influence women’s preparation for birth.MethodsSeven electronic databases were searched with predetermined search terms. No limitations were imposed for year of publication. English language studies using qualitative methods exploring women’s experiences of informal information sources and their impact upon women’s birth preparation were included, subject to a quality appraisal framework. Searches were initiated in February 2016 and completed by March 2016. Studies were synthesised using an interpretive meta-ethnographic approach.ResultsFourteen studies were included for the final synthesis from Great Britain, Australia, Canada and the United States. Four main themes were identified: Menu Birth; Information Heaven/Hell; Spheres of Support; and Trust. It is evident that women do not enter pregnancy as empty vessels devoid of a conceptual framework, but rather have a pre-constructed embodied knowledge base upon which other information is superimposed. Allied to this, it is clear that informal information was sought to mitigate against the widespread experience of discordant information provided by maternity professionals.ConclusionWomen’s access to the deluge of informal information sources in mainstream media during pregnancy have significant impact on decision making for birth. These informal sources redefine the power dynamic between women and maternal healthcare providers, simultaneously increasing levels of anxiety and challenging women’s pre-existing ideations and aspirations of personal birth processes. A lack of awareness by some professionals of women’s information seeking behaviours generates barriers to women-centred support, leaving an experience expectation mismatch unchecked.Trial registrationCRD42016041491 17/06/16.

Midwifery one-to-one support in labour: More than a ratio.

OBJECTIVE To explore midwifery one-to-one support in labour in a real world context of midwife-led birth environments. DESIGN Ethnographic study. Data was collected from 30 observations inside and outside the birth environments in three different birth settings. Semi-structured interviews were completed following the births with 29 low-risk women and 30 midwives with at least one year labour support experience to gain their perspectives. Twenty-seven maternity records were also analysed. SETTING An alongside midwife-led unit, freestanding midwife-led unit and womens homes in England. FINDINGS Six components of care were identified that required balance inside midwife-led birth environments: (1) presence, (2) midwife-woman relationships, (3) coping strategies, (4) labour progress, (5) birthing partners and (6) midwifery support. Midwives used their knowledge, experience and intuitive skills to synchronise their care for the six components to work in balance. Balancing of the six components have been translated into continuums representing the labour care and requirements. CONCLUSION AND IMPLICATIONS FOR PRACTICE Midwifery one-to-one support in labour is more than a ratio when translated into clinical practice. When the balance of the six components were tuned into the needs of women, women were satisfied with their labour and birth experience, even when it did not go to plan. A one midwife to one woman ratio should be available for all women in labour.

Living with a Gastric Band: A Qualitative Study

Gastric banding is an established and effective form of weightloss surgery. Semi-structured interviews explored the experiences of gastric banding of twenty purposively recruited patients one year after surgery. Data was analysed using thematic analysis. Results: Three themes emerged. They included ‘Exercising choice’ (restriction by the band was counterbalanced by new food-related choices.); ‘Rediscovering life’ (improved health, physical ability and energy enabled the patients to re-discover life.) and ‘Goals achieved with no regrets’ (patients had nearly achieved their self-set goals.) Conclusion: Beyond achieving weight loss and improved health, the participants had improved quality of life as defined by patients. Knowledge about this active process informs the care of these patients.

Factors influencing HIV screening decisions for pregnant migrant women in South East Asia

BACKGROUND universal screening in pregnancy for HIV is common and migrant women are an identified high risk group. The increasing mobility within countries and migration across borders affects the growing prevalence of HIV, but little is understood about how migrant women view risk of HIV in relation to pregnancy. OBJECTIVES to explore factors that relate to HIV screening decisions for migrant women. DESIGN the HIV antenatal counselling experiences of pregnant migrant women were explored in a Grounded Theory study. SETTINGS the four settings were antenatal care units of border hospitals in northern Thailand PARTICIPANTS 38 migrant pregnant women who had been through the HIV screening process at participating antenatal clinics as well as 26 health personnel at the units were purposively recruited and interviewed about their experiences and attitudes to HIV counselling and testing for this group. METHODS in-depth interviews were conducted from January to March 2008. The grounded theory technique of open coding was employed and constant comparison took place throughout until saturation was achieved. FINDINGS four themes were identified as common to the women and the health professionals: ineffective provision of information; internal and external barriers to information; implications of migrant status; and perception of risk. CONCLUSIONS where language barriers exist interpreters are required and creative approaches to information giving that do not rely on text are necessary. The organisation of clinics does not currently meet the needs of migrant women and causes stress for health staff due to time constraints. Extra resources should be focussed where there are large numbers of migrants.

Managing Childbirth Emergencies in the community and low tech settings

Health care professionals need to make rapid decisions under pressure to prevent and manage adverse outcomes during childbirth. Using an problem-based learning approach, this book offers a straightforward but comprehensive guide to emergency care, with scenarios throughout and expert commentary from a Supervisor of Midwives.

Making Decisions in Pregnancy About HIV Testing and Treatment: The Experience of Burmese Migrant Women in Northern Thailand

This chapter presents a number of case studies which will be discussed to illustrate the decision-making processes for migrant women when considering HIV testing and treatment in pregnancy. The case studies are drawn from research which was conducted among 38 Burmese migrant pregnant women and 26 health-care workers in the Thai-Burmese border provinces in the northern part of Thailand during 2008 and 2009. With its high rate of HIV infections and high numbers of Burmese migrants, this area was selected in order to access the desired group of participants. The complex issues that surround decisions to accept or refuse HIV testing and treatment are presented from the point of view of women and also the health-care workers who are engaged in caring for them in the antenatal period. We make suggestions for improved communication and information sharing to enable the women to be actively involved in decisions at this time.