Linda Sweet

Telephone interviewing: is it compatible with interpretive phenomenological research?

Abstract The telephone has long been used as a medium of communication. In more recent years the telephone has become a legitimate tool in marketing and survey research (Barriball et al. 1996). Telephone interviewing is becoming an increasingly popular form of interview for qualitative research (Carr & Worth 2001). Whilst there have been discussions in the literature on logistical advantages and disadvantages of telephone interviewing, there has been little debate as to whether this form of interview is compatible with qualitative health research. Much of the literature reporting this interview method is based on quantitative or structured questionnaire style research under the guise of ‘qualitative’ research. So the question remains: Is the telephone interview compatible with interpretive phenomenological research? This paper describes how telephone interviewing was used in a recently conducted interpretive phenomenological study, and argues that this is a methodologically and economically valuable data collection technique in qualitative research. Qualitative researchers should not rely exclusively on the face-to-face interview, as the telephone interview can be an equally valuable data collection approach.

Integration of primary health services: being put together does not mean they will work together.

BackgroundThis paper reports on an Australian experience of co-locating a range of different primary health services into one building, with the aim of providing integrated services. It discusses some of the early challenges involved with moving services together and reasons why collaborative and integrated working relationships to improve the clients’ journey, may remain elusive.MethodsEthnographic observational data was collected within a GP plus site as part of day-to-day interactions between the research officer and health professionals. This involved observations of team processes within and across teams at the site. Observations were thematically analysed using a social anthropological approach.ResultsThree main themes arose from the analysis: Infrastructural impediments to collaboration; Territorialism; and Interprofessional practice (IPP) simply not on the agenda. The experience of this setting demonstrates that dedicated staff and resources are needed to keep IPP on the agenda of health service organisations. This is especially important where organisations are attempting to implement new models of collaborative and co-located services. Furthermore, it shows that establishing IPP within newly co-located services is a process that needs time to develop, as part of teams building trust with each other in new circumstances, in order to eventually build a new cultural identity for the co-located services.ConclusionsCo-located health service systems can be complex, with competing priorities and differing strategic plans and performance indicators to meet. This, coupled with the tendency for policy makers to move on to their next issue of focus, and to shift resources in the process, means that adequate time and resources for IPP are often overlooked. Shared interprofessional student placements may be one way forward.

Psychomotor Skills in Medical Ultrasound Imaging An Analysis of the Core Skill Set

Sonographers use psychomotor skills to perform medical ultrasound examinations. Psychomotor skills describe voluntary movements of the limb, joints, and muscles in response to sensory stimuli and are regulated by the motor neural cortex in the brain. We define a psychomotor skill in relation to medical ultrasound imaging as “the unique mental and motor activities required to execute a manual task safely and efficiently for each clinical situation.” Skills in clinical ultrasound practice may be open or closed; most skills used in medical ultrasound imaging are open. Open skills are both complex and multidimensional. Visuomotor and visuospatial psychomotor skills are central components of medical ultrasound imaging. Both types of skills rely on learners having a visual exemplar or standard of performance with which to reference their skill performance and evaluate anatomic structures. These are imperative instructional design principles when teaching psychomotor skills.

An exploration of the midwifery continuity of care program at one Australian University as a symbiotic clinical education model.

OBJECTIVE This discussion paper analyses a midwifery Continuity of Care program at an Australian University with the symbiotic clinical education model, to identify strengths and weakness, and identify ways in which this new pedagogical approach can be improved. BACKGROUND In 2002 a major change in Australian midwifery curricula was the introduction of a pedagogical innovation known as the Continuity of Care experience. This innovation contributes a significant portion of clinical experience for midwifery students. It is intended as a way to give midwifery students the opportunity to provide continuity of care in partnership with women, through their pregnancy and childbirth, thus imitating a model of continuity of care and continuity of carer. METHODS A qualitative study was conducted in 2008/9 as part of an Australian Learning and Teaching Council Associate Fellowship. Evidence and findings from this project (reported elsewhere) are used in this paper to illustrate the evaluation of midwifery Continuity of Care experience program at an Australian university with the symbiotic clinical education model. FINDINGS Strengths of the current Continuity of Care experience are the strong focus on relationships between midwifery students and women, and early clinical exposure to professional practice. Improved facilitation through the development of stronger relationships with clinicians will improve learning, and result in improved access to authentic supported learning and increased provision of formative feedback. This paper presents a timely review of the Continuity of Care experience for midwifery student learning and highlights the potential of applying the symbiotic clinical education model to enhance learning. CONCLUSION Applying the symbiotic clinical education framework to evidence gathered about the Continuity of Care experience in Australian midwifery education highlights strengths and weaknesses which may be used to guide curricula and pedagogical improvements.

Optimising the Follow-through Experience for Midwifery Learning

This chapter is based on research that sought to understand the midwifery learning that occurs through a continuity clinical practice model called the follow-through experience. The follow-through experience is a core component of the midwifery curriculum and students are required to undertake 30 of these experiences over the 3-year Bachelor of Midwifery programme. Midwifery students engage with pregnant women and negotiate to observe and participate in their antenatal, birth, and postnatal experience. This continuity of care practice model enables the midwifery student to enact the intended curriculum, resulting in rich experiential learning. This research has also identified unintended learning that arose from a hidden curriculum. A conceptual model to support learning before, during, and after the follow-through experience is proposed.

Teaching psychomotor skills in the twenty-first century: Revisiting and reviewing instructional approaches through the lens of contemporary literature

Abstract A diverse range of health professionals use psychomotor skills as part of their professional practice roles. Most health disciplines use large or complex psychomotor skills. These skills are first taught by the educator then acquired, performed, and lastly learned. Psychomotor skills may be taught using a variety of widely-accepted and published teaching models. The number of teaching steps used in these models varies from two to seven. However, the utility of these models to teach skill acquisition and skill retention are disputable when teaching complex skills, in contrast to simple skills. Contemporary motor learning and cognition literature frames instructional practices which may assist the teaching and learning of complex task-based skills. This paper reports 11 steps to be considered when teaching psychomotor skills.

Analysis of Breastfeeding Policies and Practices in Childcare Centres in Adelaide, South Australia

Breastfeeding policies and practices were analysed in childcare settings in the metropolitan area of Adelaide, South Australia. Childcare centres were purposively selected based on their geographical location, type and socioeconomic score of the area. Qualitative inquiry approach was employed by undertaking interviews with childcare centres’ director or baby house coordinator to explore their perception towards breastfeeding practice and support within their centre. Breastfeeding related policy documents, where available, were also collected during the interviews to triangulate data. A total of 15 face-to-face interviews were conducted. Six childcare centres had a written policy specifically on breastfeeding support, although the technical issues of handling breastmilk were included in most centres’ food and nutrition guidelines. Most participants believed that decision to breastfeed is the personal choice of parents, and hence saw the childcare centre’s role as supporting parental choice whether it is breastfeeding or not. The provision of physical space to breastfeed and facilities to store the expressed breast milk were the most common practices in support of parents who had chosen to continue breastfeeding. Participants perceived mothers’ work-related issues such as distance from the centre, time, and unsupportive workplace the most important barriers that led to early introduction of bottle feeding or breastfeeding cessation. Most childcare centres support breastfeeding in a more passive than active way. Breastfeeding promotion needs to be an integral part of childcare centres training, policy and practice if an increased rate of breastfeeding is to be achieved particularly amongst working mothers.

Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management

Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.

Family Law as a determinant of child health and welfare: Shared parenting, breastfeeding and the best interests of the child

Abstract Breastfeeding is the optimal nutrition for infants and requires the infant and mother to spend significant time together. In July 2006 the Australian Government introduced the Family Law Amendment (Shared Parental Responsibility) Act 2006 (Cth) (the Shared Parental Responsibility Act 2006) which puts in place a legal presumption of shared parental responsibility for children after separation and which emphasises ‘equal time’ parenting arrangements. The expectation of ‘equal time’ or substantial and significant parenting arrangements becomes problematic when considering breastfed children. Decisions about parenting of children under the Family Law Act 1975 (Cth) are required to be made with the ‘best interests of the child’ as the paramount consideration; a central tenet of the Act which remains in place following the Shared Parental Responsibility Act 2006. There appears to be a tension in determining the best interests of the child in cases where children are breastfed and their father is seeking equal or substantial shared care arrangements. This article begins a discussion about the decisions regarding ‘shared parenting’ of breastfed children that do not always appear to be in the best interests of children’s health and well-being. Two cases from an on-going study to investigate breastfeeding women’s experiences of the implementation of the Act will be used to illustrate that the court made decisions for breastfeeding mothers are not consistent and compromise the ability of women to continue breast feeding. The paper argues that the Shared Parental Responsibility Act 2006, and the decisions made, can work at a macro-level to produce social and health disparities for these children. Further questions are raised about the best interests of children when domestic violence and/or abuse are present. The impact of this new law on the continued breastfeeding of very young children is an unacknowledged consequence and a public health concern.

The midwifery miniCEX – A valuable clinical assessment tool for midwifery education

BACKGROUND Midwifery students, clinicians and educators in Australia identified the need for improved feedback for midwifery students whilst they are on clinical placement; in particular formative assessment. The miniCEX or mini-clinical evaluation exercise is one approach to assessment that has been proven valid and reliable in medical education. The aim of this research was to develop, implement and evaluate a miniCEX tool for midwifery education. METHODS Using an action research approach, this project engaged midwifery clinicians and midwifery students to adapt and implement the miniCEX in a postnatal ward environment. Focus groups were held to establish the clinical expectations and develop performance guidelines of students across the domains of midwifery practice, as well as evaluate their use in practice. FINDINGS Evaluation of the midwifery miniCEX, including its applicability from the perspective of staff and students was positive. The miniCEX was found to be easy to use, time efficient and valuable for learning. DISCUSSION The miniCEX is an innovative approach to assessment and feedback in midwifery education, and there is currently no identified evidence of its use in midwifery education despite broad use globally in medical education. CONCLUSION The implementation of the midwifery miniCEX offers broad benefit to both midwifery students and midwifery clinicians and educators globally.