Exchanging ideas and good practice globally: reciprocal learning in the context of a twinning project

Between August and November 2019, I had the pleasure of making two trips to Bangladesh to support the Royal College of Midwives’ (RCM) twinning project with the Bangladesh Midwifery Society (BMS). The partnership between the RCM and the BMS aims to strengthen the BMS to advocate for the midwifery profession and to create demand for midwifery services. The project is part of a wider programme of midwifery strengthening activities, managed by the United Nations Population Fund (UNFPA) Bangladesh, and funded by donors, the Department for International Development (DFID) and the Swedish International Development Cooperation Agency (Sida)

Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context

© 2016 Jefford et al. Background: The ability to act on and justify clinical decisions as autonomous accountable midwifery practitioners, is encompassed within many international regulatory frameworks, yet decision-making within midwifery is poorly defined. Decision-making theories from medicine and nursing may have something to offer, but fail to take into consideration midwifery context and philosophy and the decisional autonomy of women. Using an underpinning qualitative methodology, a decision-making framework was developed, which identified Good Clinical Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery decision-making during 2nd stage labour. This study aims to confirm the robustness of the framework and describe the development of Enhancing Decision-making Assessment in Midwifery (EDAM) as a measurement tool through testing of its factor structure, validity and reliability. Method: A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two 'expert' maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 midwifery real care episode vignettes using the empirically derived 26 item framework. Each item was answered on a 5 point likert scale based on the level of agreement to which the participant felt each item was present in each of the vignettes. Participants were then asked to rate the overall decision-making (optimal/sub-optimal). Findings: Post factor analysis the framework was reduced to a 19 item EDAM measure, and confirmed as two distinct scales of 'Clinical Reasoning' (CR) and 'Midwifery Practice' (MP). The CR scale comprised of two subscales; 'the clinical reasoning process' and 'integration and intervention'. The MP scale also comprised two subscales; women's relationship with the midwife' and 'general midwifery practice'. Conclusion: EDAM would generally appear to be a robust, valid and reliable psychometric instrument for measuring midwifery decision-making, which performs consistently across differing international contexts. The 'women's relationship with midwife' subscale marginally failed to meet the threshold for determining good instrument reliability, which may be due to its brevity. Further research using larger samples and in a wider international context to confirm the veracity of the instrument's measurement properties and its wider global utility, would be advantageous

An appreciative inquiry to midwifery education in Aotearoa

Background: Education is a transformative process, that promotes both self and professional development, and has rewards and challenges (Griffiths, 2012). For women, choosing a career pathway that gives meaning and purpose is an integral element of their decision making (Elley-Brown, 2015). The themes from our literature review identify midwifery educators as helping to sustain the profession by inspiring others, and promoting self and professional development through higher education. The role of the educator is identified as highly relational and often assumes an advisory and mentoring role (Elly-Brown, 2015). Midwifery educators promote growth and development of the profession (Albarran & Rosser, 2014). When considering recruitment of students into midwifery as a profession and midwives into education, it was clear that this is strongly linked to internal drivers; these include the feeling of making a difference, inspiring educational role models, having particular attributes, and encouragement from others (Albarran, & Rosser, 2014; Crowther, Hunter, McAra-Couper, Warren, Gilkison, Hunter, Fielder, & Kirkam, 2016; Doherty, M, 2010; Elley-Brown, 2015; Gilkison, Pairman, McAra-Couper, Kensington, & James, 2016; Gui, Barriball, & While, 2009). The credibility and impact of midwifery teachers was explored by Fraser, Avis & Mallik (2013) who found that teachers were valued for their unique and crucial role in the support of student’s application of knowledge into practice. Briscoe & Clarke, (2018) also commented that midwifery education needs to be dynamic and responsive to societal changes, showing authenticity within a curriculum that is evidence-based and supports students to reach their full potential as a health professional. Reciprocity of relationship between women and midwives, midwifery colleagues, students and teachers are also valued (Crowther, Hunter, McAra-Couper, Warren, Gilkison, Hunter, Feilder, Kirkham, 2016). He aha te mea nui? He tāngata, He tāngata, He tāngata! What is the greatest thing? It is people, it is people, it is people

Grade inflation in the assessment of clinical practice

Assessment of performance and achievement in the work place is integral to pre-registration midwifery programmes. The value of hands-on clinical care is so essential to midwifery practice that the professional regulatory body, the Nursing and Midwifery Council (NMC), stated that practice should be graded and contribute to the final award (NMC, 2009). The NMC confirmed the importance of work based learning by stating that a minimum of fifty per cent of a full time course must be situated within the practice environment compared with a minimum of forty per cent in theory (NMC, 2008). Assessment of student performance will be a key component of any programme that has a large work based element (Wilson & Scammell, 2011). The grading of practice in midwifery at this institution contributes to half of the final grade and thus the overall degree classification (NMC, 2009). Assessment in healthcare education is becoming increasingly important for public accountability and safety (Holomboe et al, 2010). As educators, we must therefore seek to reassure ourselves, students, professional regulators and the public that the assessment processes we use are valid and reliable

Mentorship from the student perspective

Midwifery Basics: Mentorship 3 When undertaking a programme of pre-registration midwifery education, student midwives are working towards responsible and accountable practice at the point of registration. In order to facilitate this, mentors are required to support learning in a range of clinical settings and contribute to the development of the students ability to practice as a safe and competent midwife (Nursing and Midwifery Council, 2008, 2011). Experiences of mentorship can influence how a student midwife's confidence and competence develops and may shape how they will subsequently practice once qualified (Hughes and Fraser, 2011; Licqurish and Seibold, 2008). Consequently, supportive and positive mentorship is essential to enhance student learning experiences in practice and to promote their personal and professional developmen

Trends in nursing and midwifery research and the need for change in complementary therapy research

In recent years there has been a change in nursing and midwifery research. Whilst many of the subjects being studied remain the same, nurses and midwives have started to employ a range of data collection methods that are relatively new to the profession. Predominantly quantitative research, which concentrates on reduction, objectivity, manipulation, categorization, passivity, control, prediction, causality and generalizability (Munhall & Oiler 1986), is starting to be replaced by other approaches perhaps more congruent with nursing, midwifery and caring. As Moody (1990) stated, ‘the 1980s ushered in an array of diverse, sophisticated research methods…’ with other authors adding that ‘nursing is just beginning to authenticate new territory that incorporates a plurality of methods’ (Nagle & Mitchell 1991). The following is an exploration of the recent apparent shift away from a focus on quantitative research in nursing and midwifery towards the use of qualitative methods which emphasize a greater degree of individuality, humanism, participation and interaction. It is suggested that the traditional quantitative research paradigm still exists in the field of complementary therapy research and that the shift that has taken place in nursing and midwifery research needs to be considered more seriously in the field of research in complementary therapies

The development and initial validation of the Perinatal Mental Health Awareness scale in student midwives

Background & aim: Perinatal mental health problems have been demonstrated to impact upon maternal, and fetal/child outcomes. Despite the global evidence and a policy-driven responsibility for identification of these problems, research demonstrates that student midwives/midwives lack knowledge and confidence to assess, identify, and manage them. A similar context is evident for learning disabilities, despite the holistic care philosophy of midwifery. A brief assessment tool to identify knowledge and confidence defecits and strengths within a holistic care framework could support curriculum development. This study sought to develop a Perinatal Mental Health Awareness scale and evaluate its psychometric properties in student midwives.Methods: We employed a cross-sectional and exploratory instrument development and evaluation design to determine the measurement veracity of the new scale.Results: The scale demonstrated good psychometric properties, revealing three subscales mapping onto (i) mental health symptoms, (ii) physical/medical issues and (iii) learning disability. Results indicated a clear differentiation in scores across the subscales, indicating comparative deficits in mental health domains.Conclusion: Our findings facilitate confidence in the psychometric robustness of the measure. The scale enables student midwives to assess and compare different domains of midwifery practice, in line with a holistic model of midwifery care. A focus on physical health in midwifery education appears to disadvantage knowledge and confidence for managing mental health problems in a midwifery context. This valuable finding highlights the potential need for curriculum rebalancing. The measure offers the opportunity to assess and develop curriculum/training provision and monitor the effectiveness of subsequent curricular developments

A Delphi study to validate competency-based criteria to assess undergraduate midwifery students' competencies in the maternity ward

Background: workplace learning plays a crucial role in midwifery education. Twelve midwifery schools in Flanders (Belgium) aimed to implement a standardised and evidence-based method to learn and assess competencies in practice. This study focuses on the validation of competency-based criteria to guide and assess undergraduate midwifery students’ postnatal care competencies in the maternity ward. Method: an online Delphi study was carried out. During three consecutive sessions, experts from workplaces and schools were invited to score the assessment criteria as to their relevance and feasibility, and to comment on the content and their formulation. A descriptive quantitative analysis, and a qualitative thematic content analysis of the comments were carried out. A Mann-Whitney U-test was used to investigate diferences between expert groups. Findings:eleven competencies and fifty-six assessment criteria were found appropriate to assess midwifery students’ competencies in the maternity ward. Overall median scores were high and consensus was obtained for all criteria, except for one during the first round. Although all initial assessment criteria (N=89) were scored as relevant, some of them appeared not feasible in practice. Little difference was found between the expert groups. Comments mainly included remarks about concreteness and measurability. Conclusion: this study resulted in validated criteria to assess postnatal care competencies in the maternity ward

Perinatal mental health : preparing the future nursing workforce

Perinatal mental health (PMH) problems occur during pregnancy and up to a year after giving birth. They can have a significant effect on the mother and family, and can affect the social, emotional and cognitive development of the child. PMH nursing is gaining increasing recognition in national policy; additional funding has been announced to align national perinatal services with agreed standards and the perinatal workforce has been identified as an area of growth. The PMH competency framework published by Health Education England and the Tavistock and Portman NHS Foundation Trust, London, is aimed at training staff to deliver high-quality care to women who experience mental health problems during the perinatal period. However, the framework does not address the competencies required from the emerging workforce: nursing students. The pre-registration nursing curriculum must align with PMH competencies to ensure that nursing students become competent practitioners who are adequately prepared to care for the PMH needs of the mother and family

Skills to facilitate learning in clinical practice

Midwifery Basics: Mentorship 2 Mentorship is the 14th series of 'Midwifery basics' targeted at practising midwives. The aim of these articles is to provide information to raise awareness of the impact of the work of midwives on women's experience, and encourage midwives to seek further information through a series of activities relating to the topic. In this second article Jayne Samples and Joyce Marshall consider some of the key issues that can affect student learning in clinical practice