Pauline Glover

The enculturation of our nursing graduates

Abstract The transition from undergraduate nursing student to employment as a registered nurse is fraught with difficulties for a neophyte. This qualitative study used interviews and focus groups with graduate nurses from the Flinders University of South Australia in their first year of practice to ascertain their experiences as new graduates. The results reveal an enculturation of graduates not conducive to ongoing learning, consolidation of skills and application to practice. A rushed environment that was unpredictable, together with a lack of support, were recurrent themes from the graduates ‘perspective. Graduate nurse programs are run by institutions focused on outcomes and expenditure. There is little or no collaboration with the tertiary sector in providing appropriate programs according to graduates’ needs. The graduates, as beginning practitioners, focused on not having the time to nurse holistically, an unrealistic workload, and the need for backup and continuous support on an individual basis. The wards, although possibly efficient and effective in providing health care, provided a culture where the graduates felt inadequate, rushed, overworked and unsupported, which is contrary to the aims and objectives of the graduate nurse programs. The nursing profession as a whole needs to develop a culture that is nurturing, enabling, supportive and protective of our young.

Blood loss at delivery: how accurate is your estimation?

This paper will examine the literature on blood loss at delivery and report the findings of a small pilot study where midwives and doctors were asked to estimate blood loss at simulated stations. The results were analysed using simple frequency distribution. This simple study demonstrated that midwives and other health professionals underestimate blood loss at delivery by 30-50%. The implication for midwives is that there is a need to double their estimated blood loss at delivery when it is over 500 ml.

The partograph. Used daily but rarely questioned

The partograph is part of the midwifery tools of practice, used everyday, but rarely questioned. This paper explores the history of the partograph and describes its development from 1954. It examines the components of the partograph and discusses when one should be commenced. The value of the partograph in practice today is questioned.

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.

THE MIDWIFERY CURRICULUM - PREPARING BEGINNING OR ADVANCED PRACTITIONERS?

Midwifery education in Australia has undergone rapid change in the last decade. It has been transferred from a traditional hospital based program developed to suit the service needs of an organisation, to a tertiary course of studies. This move has not been completed in all States/Territories and some still have hospital based courses. A diverse range of University awards for midwifery education have been developed. The curriculum, in the majority of these courses, has been developed by the academic staff based on their expertise and experience in the field of midwifery. This paper will give a brief overview of midwifery education in Australia and report the findings of a small study to define beginning and advanced midwifery practice as a curriculum development exercise and identify that beginning and advanced midwifery practice are different. It will also demonstrate the need for Universities to provide midwifery programs that are flexible, creative and appropriate for the learner.

An implementation framework for using OSCEs in nursing curricula

The implementation framework outlined in this paper has been developed from feedback of a trial across three different nursing and midwifery programmes and is designed to assist educators to incorporate OSCEs within their curricula. There is value in flagging the pedagogical principles embodied in the framework and alerting educators to their importance for more meaningful student learning. For each step practical advice is provided contributing to the utility of this approach. Considerations are systematic ensuring that the use of OSCEs in health care curricula assures judicious use of resources to achieve desired student outcomes.

ACMI competency standards for midwives — What they mean for your practice

The introduction of the Australian College of Midwives Inc (ACMI) Competency Standards for Midwives in late 1998, has implications for every midwife in Australia. This paper will provide a brief history of the development of nursing and midwifery competencies in Australia, examine what the competencies mean for practice and suggest ways that the competencies can be used for assessment. It is well to remember that the competencies must be considered in context and midwifery legislation and education form a triad for the implementation and use of the competencies.

Talking to pregnant women about stillbirth

It is recognised that consumer awareness of stillbirth is one strategy, in raft of measures, which may reduce stillbirth cases [1]. Raising awareness of the existence of a health issue is often an important first step to take in reducing cases. For example, as a result of the SIDS risk reduction awareness campaigns, the rate of SIDS in high income countries has reduced by as much as 83% [2]. The outstanding success of the SIDS public education campaigns demonstrates that increasing public awareness, alongside an education campaign about protective behaviors, can result in dramatic reduction in prevalence [3]. Therefore, educating women about incidence of stillbirth and encouraging them to be more aware of protecting their unborn baby in order to minimise their risk, is both a potentially feasible and sensible next step in attempting to reduce the occurrence of stillbirth. Maternal awareness of stillbirth is pre-dedicated on someone making them aware. This responsibility naturally rests with maternity care providers such as midwives and obstetricians. Stillbirth is generally considered a taboo subject in society but also, of concern, by those providing antenatal care [4]. Unfortunately maternity care-providers often avoid discussing the possibility of stillbirth with women in their care. The reluctance to discuss this kind of poor outcome could be to try to avoid “scaring the woman” however, not to do so is missing an opportunity to educate and alert the woman to adopt behaviours to help keep her unborn baby safe [5]. This presentation reported the results of a research project which aimed to educate midwifery care providers about stillbirth incidence, common risk factors as well as how to raise and discuss stillbirth with women during prenatal care. This was done through the delivery of a half-day education package for midwives which provided participants with information about stillbirth. The workshop also provided an opportunity to practice a range of strategies to assist participants to become confident in raising and discussing the topic of stillbirth. The project used a quasi-experimental approach through use of pre and post intervention surveys to determine the effectiveness of the midwife education campaign. Seventy-two participants completed the pre-workshop questionnaire with 69 participants completing the post workshop questionnaire and 25 completing the 3-month follow-up questionnaire. Responses at the three times points (pre, post, and 3 months) were compared using either Kruskal-Wallis (interval data) Wilcoxon (ordinal data) or Chi–Square (Nominal data) with significance set at p ≤0.05. There was significant improvement in knowledge of the definition of stillbirth, causes and modifiable risk factors as well as knowledge about fetal movements across the participant group. Regarding participant willingness to discuss stillbirth with pregnant women in their care, prior to the workshop 28% of the participants confessed that they never raised or discussed stillbirth with women in their care with a further 64% revealing that they only discussed this with women “sometimes”. Only 4% stated that they “usually” discussed stillbirth with women and no-one indicated that they “always” did. When asked if they planned to change this answer immediately following the workshop 86% replied “yes” with 4% saying no and another 10% unsure. Three months following the workshop there was a statistically significant change (p≤0.001) in attitude to discussing stillbirth with pregnant women with 16% stating that they always did, 12% citing usually and 56 % selecting sometimes with only 4% stating that they still never did. The project was very effective in raising awareness of the incidence of stillbirth as well as knowledge of risk factors for stillbirth. We anticipate this type of education could ultimately make a difference to stillbirth rates, because if midwives and other maternity care providers raise and discuss stillbirth with women when they are providing antenatal care then this will in turn result in improved maternal awareness of the possibility of stillbirth. This may well lead to women adopting protective behaviors, such as closely monitoring fetal movements and immediately reporting concerns whilst pregnant.

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.