Teaching evidence based practice and research through blended learning to undergraduate midwifery students from a practice based perspective

The international world of higher education is changing with universities now offering students flexible delivery options that allow them to study away from campus and at a time convenient to them. Some students prefer on line learning while others prefer face to face contact offered through a traditional lecture and tutorial delivery modes. The response by many universities is to offer a blend of both. While online and blended mode of delivery may be suitable for some subjects there is little knowledge of the efficacy of blended learning models to teach evidence based practice and research (EBPR) to undergraduate midwifery students. EBPR is a challenging, threshold level subject upon which deeper knowledge and skills are built. This paper describes the design, delivery, and evaluation of an undergraduate EBPR course delivered in blended mode to first year midwifery students. Components of the blended learning innovation included: novel teaching strategies, engaging practical activities, role play, and e-learning strategies to maintain engagement. University-based course evaluation outcomes revealed very positive scores and the course was rated within the top ten percent of all courses offered within the Health Group at the host University.     

What helps or hinders midwives to implement physical activity guidelines for obese pregnant women? A questionnaire survey using the Theoretical Domains Framework

Objectiveto investigate barriers and facilitators to physical activity (PA) guideline implementation for midwives when advising obese pregnant women.Designa cross-sectional, self-completion, anonymous questionnaire was designed using the Theoretical Domains Framework. this framework was developed to evaluate the implementation of guidelines by health care professionals. A total of 40 questions were included. These were informed by previous research on pregnant women's and midwives views, knowledge and attitudes to PA, and supported by national evidence based guidelines. Demographic information and free text comments were also collected.Settingthree diverse NHS Trusts in the North East of England.Participantsall midwives employed by two hospital Trusts and the community midwives from the third Trust (n=375) were invited to participate.Measurementsmean domain scores were calculated. Factor and regression analysis were performed to describe which theoretical domains may be influencing practice. Free text comments were analysed thematically.Findings192 (53%) questionnaires were returned. Mean domain scores were highest for social professional role and knowledge, and lowest for skills, beliefs about capabilities and behaviour regulation. Regression analysis indicated that skills and memory/attention/decision domains had a statistically significant influence on midwives discussing PA with obese pregnant women and advising them accordingly. Midwives comments indicated that they felt it was part of their role to discuss PA with all pregnant women but felt they lacked the skills and resources to do so effectively.Key conclusionsmidwives seem to have the necessary knowledge about the need/importance of PA advice for obese women and believe it is part of their role, but perceive they lack necessary skills and resources, and do not plan or prioritise the discussion regarding PA with obese pregnant woman.Implications for practicedesigning interventions that improve skills, promote routine enquiry regarding PA and provide resources (eg. information, referral pathways) may help improve midwives’ PA advice.     

Midwives’ experiences of working in an obstetric high dependency unit: A qualitative study

Objectivesto understand the challenges experienced by midwives providing obstetric high dependency care and identify the training they perceive is needed for work in an obstetric high dependency unit.Designsixteen midwives who worked in the obstetric high dependency unit participated in one of three focus groups. Focus groups lasted 60–90 minutes and were conducted in the workplace and facilitated by author (IE). Data were digitally recorded, transcribed and analysed manually by author (IE), specifically using a ‘codebook’ model to generate codes, categories and themes.Settinga purpose built, two-bed obstetric high dependency unit located in the delivery suite of a large, urban tertiary teaching hospital in New Zealand.Findingsfive themes were conceptualised: Theme 1: ‘high dependency care is not our bread and butter’; the midwives felt that working in the obstetric high dependency work did not constitute ‘normal’ midwifery work. Theme 2: ‘we are family… embracing the baby and partner in HDU’; the midwives recognised that an obstetric high dependency unit enabled the mother and infant to be cared for together, was beneficial for maternal psychosocial wellbeing, and supported mother-infant bonding and breastfeeding. Theme 3: ‘primum non nocere; First, do no harm’; the midwives voiced concern that they lacked the skills and training to provide obstetric high dependency care and considered this a potential risk to sick women in their care. Theme 4: ‘graceful swans and headless chickens’; the midwives reported feelings of stress, anxiety, fear and of being overwhelmed by the demands of obstetric high dependency care. The more experienced midwives were able to portray calmness and poise despite lots going on beneath the surface. This was in contrast to other, often less experienced midwives, who appeared confused and less organised. Theme 5: ‘please sir, can I have some more training?’; the midwives unanimously sought training in the provision of obstetric high dependency care and saw facilitation of training to be a responsibility of the hospital.Key conclusionsmidwives who are competent in obstetric high dependency care are well placed to provide holistic care to sick women within an obstetric high dependency unit. Midwives found this work challenging and identified the need for specific knowledge and skills beyond those required in the provision of care to well women. The midwives sought post-registration training in obstetric high dependency care. These findings are consistent with other studies reported in the literature.Implications for practicepost-registration training must be made available to midwives providing high dependency care to sick women to ensure they have the specialised skills and knowledge for practice. Responsibility to facilitate training rests with hospitals providing this service.     

Maternal influenza vaccination and child mortality: Longitudinal,population-based linked cohort study

Influenza vaccination is recommended to protect mothers and their infants from influenza. Few studies have evaluated the association between maternal influenza vaccination and child mortality. We aimed to evaluate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and mortality among young children. This longitudinal, population-based cohort study included 191,247 maternal-child pairs in Western Australia between April 2012 and December 2017. Maternal vaccine information was obtained from a state-wide antenatal vaccination database. Mortality was defined as a record of a death registration. We used Cox proportional hazard models, weighted by the inverse-probability of treatment (vaccination), to estimate the hazard ratio of child mortality associated with in utero exposure to seasonal IIV. This study found no association between in utero exposure to seasonal IIV and mortality through age five years.     

Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study

BackgroundThe process of delivery entails potentially traumatic events in which the mother or child becomes injured or dies. Midwives and obstetricians are sometimes responsible for these events and can be negatively affected by them as well as by the resulting investigation or complaints procedure (clinical negligence).ObjectiveTo assess the self-reported exposure rate of severe events among midwives and obstetricians on the delivery ward and the cumulative risk by professional years and subsequent investigations and complaints.DesignCross-sectional survey.ParticipantsMembers of the Swedish Association of Midwives (SFB) and the Swedish Society of Obstetrics and Gynaecology (SFOG).MethodsA questionnaire covering demographic characteristics, experiences of self-reported severe events on the delivery ward, and complaints of medical negligence was developed. Potential consequences of the complaint was not reported. A severe event was defined as: 1) the death of an infant due to delivery-related causes during childbirth or while on the neonatal ward; 2) an infant being severely asphyxiated or injured at delivery; 3) maternal death; 4) very severe or life threatening maternal morbidity; or 5) other stressful events during delivery, such as exposure to violence or aggression.ResultsThe response rate was 39.9% (n = 1459) for midwives and 47.1% (n = 706) for obstetricians. Eighty-four percent of the obstetricians and almost 71% of responding midwives had experienced one or more self-reported severe obstetric event with detrimental consequences for the woman or the new-born. Fourteen percent of the midwives and 22.4% of the obstetricians had faced complaints of medical negligence from the patient or the family of the patient.ConclusionsA considerable proportion of midwives and obstetricians will, in the course of their working life, experience severe obstetric events in which the mother or the new-born is injured or dies. Preparedness for such exposure should be part of the training, as should managerial and peer support for those in need. This could prevent serious consequences for the health care professionals involved and their subsequent careers.     

A qualitative study of how caseload midwifery is constituted and experienced by Danish midwives

Objectivethe aim of this study is to advance knowledge about the working and living conditions of midwives in caseload midwifery and how this model of care is embedded in a standard maternity unit. This led to two research questions: 1) What constitutes caseload midwifery from the perspectives of the midwives? 2) How do midwives experience working in caseload midwifery?Design and settingphenomenology of practice was the analytical approach to this qualitative study of caseload midwifery in Northern Denmark. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews.Participantsthirteen midwives working in caseloads were observed during one or two days in the antenatal clinic and were interviewed at a later occasion.Findingsbeing recognised and the feeling of doing high quality care generate high job satisfaction. The obligation and pressure to perform well and the disadvantages to the midwives׳ personal lives are counterbalanced by the feeling of doing a meaningful and important job. Working in caseload midwifery creates a feeling of working in a self-governing model within the public hospital, without losing the technological benefits of a modern birth unit. Midwives in caseload midwifery worked on welcoming and including all pregnant women allocated to their care; even women/families where relationships with the midwives were challenging were recognised and respected.Key conclusionscaseload midwifery is a work-form with an embedded and inevitable commitment and obligation that brings forward the midwife׳s desire to do her utmost and in return receive appreciation, social recognition and a meaningful job with great job satisfaction. There is a balance between the advantages of a meaningful job and the disadvantages for the personal life of the midwife, but benefits were found to outweigh disadvantages.Implications for practiceIn expanding caseload midwifery, it is necessary to understand that the midwives׳ personal lives need to be prepared for this work-form. The number of women per full time midwife has to be surveilled as job-satisfaction is dependent on the midwives׳ ability of fulfilling expectations of being present at women׳s births.     

Midwives’ attitudes,beliefs and concerns about childhood vaccination: A review of the global literature

Vaccine hesitancy in industrialised countries is an area of concern. Health professionals play a significant role in parental vaccination decisions, however, to date the role of midwives has not been widely explored. This review sought to describe the attitudes and communication practices of midwives in developed countries towards childhood vaccines.Medline, Cinahl, PsychInfo, Embase and the grey literature were searched. Inclusion criteria were qualitative and quantitative studies reporting midwives’ beliefs, attitudes and communication practices toward childhood vaccination.The search returned 366 articles, of which 359 were excluded by abstract. Two additional articles were identified from the grey literature and references, resulting in nine studies from five countries included in the review.Across the studies, the majority of midwives supported vaccination, although a spectrum of beliefs and concerns emerged. A minority expressed reservations about the scientific justification for vaccination, which focussed on what is not yet known rather than mistrust of current evidence. Most midwives felt that vaccines were safe; a minority were unsure, or believed they were unsafe. The majority of midwives agreed that childhood vaccines are necessary. Among those who expressed doubt, a commonly held opinion was that vaccine preventable diseases such as measles are relatively benign and didn’t warrant vaccination against them. Finally, the midwifery model of care was shown to focus on providing individualised care, with parental choice being placed at a premium.The midwifery model care appears to differ in approach from others, possibly due to a difference in the underpinning philosophies. Research is needed to understand how midwives see vaccination, and why there appears to be a spectrum of views on the subject. This information will inform the development of resources tailored to the midwifery model of care, supporting midwives in advocating for childhood vaccination.     

Caring for women undergoing second-trimester medical termination of pregnancy

Objective

The objective was to explore the experiences and perceptions of nurses/midwives caring for women undergoing second-trimester medical termination of pregnancy (MTOP).

Study design

The study had a qualitative design using semistructured interviews. It took place in three wards at one gynecological clinic in a general hospital in Stockholm. Twenty-one nurses/midwives with experience in second-trimester abortion care were interviewed following a semistructured interview guide. The interviews were recorded, transcribed verbatim and then analyzed using qualitative content analysis to identify common themes.

Results

The analysis revealed two themes: “The professional self,” with six subthemes describing the experiences and perceptions described in terms of professional behavior, and “The personal self,” with four subthemes containing the experiences and perceptions described in terms of personal values.

Conclusions

Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge, empathy and the ability to reflect on ethical attitudes and considerations. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. The feeling of supporting women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second-trimester MTOP. The findings of this study support the need for training, mentoring and support by experienced colleagues to help nurses/midwives feel secure in their professional role in difficult situations and feel confident in their personal life situation.

Implications statement

Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge and empathy. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. Mentorship from experienced colleagues and structured opportunities for reflection on ethical issues enable the nurses/midwives to develop security in their professional roles and also feel confident in their personal life situation. The feeling of doing something good for women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second-trimester MTOP.     

Pre-service midwifery education in sub-Saharan Africa: A scoping review

BackgroundIn response to a global call for more midwives, maternal health stakeholders have called for increased investment in midwifery pre-service education. Given the already long list of challenges and the increasing burden on health care systems due to the COVID-19 pandemic, the need to prioritize investment is acute, particularly in sub-Saharan Africa. An important first step is to examine the current evidence.MethodsWe conducted a scoping review of the peer-reviewed literature about pre-service midwifery education in sub-Saharan Africa. A search of studies published between 2015 and 2021 in French or English was conducted using six databases (PubMed, CINAHL, Embase, Scopus, Web of Science and African Index Medicus).ResultsThe search yielded 3061 citations, of which 72 were included. Most were a mix of qualitative and quantitative cross-sectional, country-specific studies. Organized by pre-service educational domain, the literature reflected a misalignment between international standards for midwifery education and what schools and clinical sites and the larger administrative systems where they operate, reliably provide. Inadequate infrastructure, teaching capacity in school and clinical settings and clinical site environment were factors that commonly impede learning. Literature related to faculty development and deployment were limited.ConclusionSchools, faculty and clinical sites are overwhelmed yet recommendations by key stakeholders for change are substantive and complex. Efforts are needed to help schools map their current status by pre-service education domain and prioritize where scarce resources should be directed. These results can inform research and investments in pre-service midwifery education in sub-Saharan Africa.