Educational relationships : a study in midwifery

At its inception in 1902, formal midwifery training developed within hospital midwifery services. With the development of a theoretical base, training became education during the 1980s. During a period of economic and societal changes in the 1990s, midwifery education was incorporated into higher education, separating education from health service practice. There were consequences for midwifery education especially the structure of pedagogical relationships. This thesis looks at key sets of relationships in midwifery education between the three main groups of actors: academics, clinicians and students. In so doing, the inquiry utilises a grounded theory approach and embraces disciplines of education, social sciences, social psychology, management and philosophy. The study confirms the importance of relationships between the key actors as part of a student's learning experiences. However, these relationships have become more problematic as a result of the organisational separation between the academic and professional components. A framework is proposed to describe educational relationships in midwifery. The framework has six dimensions; (i) a core component of personal traits, (ii) a secondary component of social and communication abilities and four subsidiary components of (iii) professional expertise, (iv) personal knowledge, (v) education knowledge and skills and (vi) a vision for practice. Realisation of the components by one person of another within the three groups aids mutuality in understanding. General principles are offered that include notions of encounter, exchange, rules, boundaries, reciprocity and reinforcement that aid in constructions of relationships. Though these conditions, in themselves, aid the formation of learning relationships, two processes occur in these relationships through encounters, that is, complementation (a unity of meanings between actors) and complementarity (a matching of understandings). These require a forum for encounters. A model of education is proposed that offers just such a forum aiding positive encounters to promote learning between the three groups of actors. Features of this model are the development of teachers within clinical practice, accreditation of practitioners as educators and the education of students primarily in clinical situations with interactive learning

Proportions of BMI and waist circumference categories at baseline and 3-year follow-up, cross-sectional analysis.

<p>^a Column percentage unless otherwise stated.</p><p>^b P value from paired t-test between baseline and 3-year follow-up.</p><p>^c P value from signed-rank test between baseline and 3-year follow-up.</p><p>Proportions of BMI and waist circumference categories at baseline and 3-year follow-up, cross-sectional analysis.</p

Changes in waist circumference from baseline to 3-year follow-up (row %).

<p>^a P value was calculated from signed-rank test between baseline and 3-year follow-up.</p><p>^b Maintained same WC category at baseline and follow-up.</p><p>^c Increased WC from baseline to follow-up.</p><p>^d Decreased WC from baseline to follow-up.</p><p>Changes in waist circumference from baseline to 3-year follow-up (row %).</p

Adjusted odds ratios for SHS exposure and medical services use in current and never-smokers.

a<p>Adjusting for sex, age, highest parental education, housing type, school clustering effects, mutually adjusted for SHS at home and outside home, and additionally adjusted for cigarette consumption per day and years of smoking in current smokers.</p>b<p>Only students who had been exposed to SHS outside home ≤2 days/wk were included.</p>c<p>P for interaction between any SHS exposure in current and never-smokers.</p>d<p>Only students who had been exposed to SHS at home ≤2 days/wk were included.</p

Prevalence of medical consultation and hospitalisation by basic characteristics.

a<p>χ² value and degree of freedom.</p

Changes in weight status from baseline to 3-year follow-up (row %).

<p>^a P value from signed-rank test between baseline and 3-year follow-up.</p><p>^b Maintained same weight status at baseline and follow-up.</p><p>^c Increased BMI from baseline to follow-up.</p><p>^d Decreased BMI from baseline to follow-up.</p><p>Changes in weight status from baseline to 3-year follow-up (row %).</p

Odds ratios (ORs) of poor SRH by socio-demographic characteristics.

<p> Adjusting for year and mutually adjusted for variables in the table.</p><p>**P <0.01, ***P <0.001. P <0.05, </p

Basic characteristics of subjects by poor self-rated health (SRH).

<p> Weighted by sex and age of 2011 census data.</p

Mediation effects of information seeking from newspapers/magazines and Internet on disparities in poor SRH ^†.

<p>^† All figures are β-coefficients. ***P<0.001. Total effect of educational attainment on poor self-rated health was 17.4% (SE 0.017, 95% CI 14.1%–20.8%); indirect effect of information seeking on self-rated health was 1.6% (SE 0.5%, 95% CI 0.7%–2.6%), which yielded 9.2% of the total effect was mediated through health information seeking from newspapers/magazines and Internet (Sobel test P<0.01). Total effect of household income on poor self-rated health was 16.9% (SE 0.018, 95%CI: 13.7%–20.5%); indirect effect of information seeking on self-rated health was 1.3% (SE 0.3%, 95% CI 0.7%–2.0%), which yielded 7.9% of the total effect was mediated through health information seeking from newspapers/magazines and Internet (Sobel test P<0.01).</p

Odds ratios of poor SRH by health information seeking.

<p> Adjusting for sex, age, education, household income, chronic disease and years, and mutually adjusted for sources of health information seeking.</p><p> Combining frequency of health information seeking from newspapers/magazines and Internet. The aOR were adjusted for sex, age, education, household income, chronic disease, year, health information seeking from television and radio.</p><p>–3 times/month and ≥1 time/month as continuous scales. Treating the original frequency categories of never/no, seldom, 1 time/month, 1</p><p>**P <0.01, ***P <0.001. P <0.05, </p