Evaluation of an innovative approach to enhancing midwives' understanding of breastfeeding physiology through the use of animation

Background: Supporting women to breastfeed requires knowledge of the physiology, including the complex interplay of both endocrine and autocrine systems. The use of e-learning provides an alternative platform for customising and diversifying content to appeal to a variety of learning styles. While the evidence addressing the effectiveness of instructional animation is equivocal, an innovative approach utilising the application of animation in enhancing midwives' knowledge regarding lactation is warranted. Drawing on expertise in lactation, midwifery education and video design and production, a seven-minute animated video was produced. In this presentation we will showcase the video and present the results of the evaluation. Methods: The aim of this study was to evaluate registered midwives' understanding of breastfeeding physiology and the acceptability and usability of the animated resource. In February/March 2018, registered midwives across Australia were offered the opportunity to review and evaluate the video by completing a cross-sectional anonymous online survey consisting of 29 items containing 4-point Likert scales and free-text responses. Invitation was via the Australian College of Midwives national newsletter. Ethics approval from Deakin University was obtained. Descriptive statistics were used to analyse quantitative data and free-text was coded. Results: Results of the registered midwife evaluation will be presented that will demonstrate midwives' opinions of the animation as a teaching modality. The presentation will include midwives' views on how the resource impacted on their breastfeeding knowledge and understanding and their views of the animation as a learning resource. Comparison will be made to the students' evaluation where 85-95% of respondents reported that the resource enhanced their learning. Discussion and Conclusion: Evidence to inform the use of innovative approaches to support traditional teaching methods will be provided. These results will provide valuable data to inform further innovation in the area of professional development education in breastfeeding and other complex midwifery concepts

Nurturing yourself and each other: the value of emotional intelligence

Background: Emotional intelligence refers to the individual's capacity to identify, use, understand and respond appropriately to emotions in themselves and others. The nursing and midwifery literature recommends emotional intelligence as an important construct for enhancing well-being amongst nurses and midwives. Despite this, how nursing and midwifery students perceive emotional intelligence is not well understood. Emotional intelligence capabilities are seen as fundamental to the student nurse or midwifes ability to negotiate the emotional complexities of clinical practice as well as support their own emotional well-being. Objective: The study aimed to explore final year undergraduate nursing and midwifery students' perceptions of emotional intelligence. Method: Qualitative data were collected via face to face semi-structured interviews with final year Bachelor of Nursing and Bachelor of Nursing and Bachelor of Midwifery enrolled at Deakin University, Victoria. Interviews were digitally recorded with participants' written and informed consent and professionally transcribed. Data was analysed using thematic analysis. Key Findings: Emotional intelligence was valued as an important concept, yet the application of emotional intelligence to their undergraduate curriculum was not well-defined. Participants appeared to be caught between competing paradigms; their perceptions of emotional intelligence and the reality of the clinical environment. Participants acknowledged the emotional aspects of their classroom and clinical learning, but were ill equipped and/or were not supported in linking their coping strategies to emotional intelligence. Suppression or denial of emotions, or distancing themselves behind tasks and policies were some of the strategies employed by participants in their attempt to impose emotional control within the clinical environment. Conclusion: Explicitly nurturing emotional intelligence in their undergraduate years would convey to nursing and midwifery students the importance of emotional well-being and may better equip them to manage the emotional complexities of their professional life

Using animation to teach breastfeeding physiology: a proof of concept study

Background: Breastfeeding provides the optimal nourishment for infant and child health and supporting mothers to breastfeed is a global health priority. Midwives are uniquely placed to provide breastfeeding education and support to the woman and it is imperative that they have a sound understanding of the physiological underpinnings of breastfeeding. However, midwifery students and some midwives continue to struggle with the complex physiology of lactation. The purpose of this study was to evaluate an instructional animation resource to teach breastfeeding physiology to student and practicing midwives. Further, this study also offers insights into how student and practicing midwives accept novel approaches to learning. Methods: A cross-sectional survey design using both quantitative and qualitative approaches was employed in this proof of concept study. The setting was online with midwifery students recruited from Deakin University and registered midwives recruited from the Australian College of Midwives membership. Snowball sampling was also employed to recruit midwives through professional networks of the research team. The quantitative part of this study included a structured online questionnaire for midwives and midwifery students and descriptive statistics were used to present the quantitative data. The qualitative data were collected from open-ended questions on the questionnaire and a deductive approach was used for analysing the data. Results: This proof of concept study collected data from 110 participants and provides evidence for the use of animation as an effective pedagogical tool to explain complex concepts. The animated instructional resource was viewed favorably by both the midwifery students and practicing midwives. Conclusions: The findings from this study, support the pedagogical advantages of animated instructional resources for teaching complex physiology. Further, educators should be encouraged and feel confident to develop and use animation technology as both an engaging and effective teaching resource especially for complex concepts

Incorporating emotional intelligence in nursing and midwifery education

[Extract] Emotions permeate nursing and midwifery practice, understanding one's own emotions is the basis of understanding the emotions of others, a critical skill for healthcare professionals (Freshwater & Stickley, 2004). Historically, the emotional aspects of clinical practice were deemed far too perilous for the nursing and midwifery student which resulted in a task orientated approach to the delivery of care (Menzies, 1960)

Critical thinking development in undergraduate midwifery students: An Australian validation study using Rasch analysis

Background: Well-developed critical thinking skills are required to provide midwifery care that is safe, evidence-based, and woman-centred. A valid, reliable tool to measure is required the application of critical thinking in midwifery practice. The Carter Assessment of Critical Thinking in Midwifery (CACTiM) has previously been psychometrically assessed using classical methods at a single site. This study aims to further evaluate the properties of CACTiM tools using Rasch analysis in a diverse group of midwifery students and preceptors. Methods: The CACTiM tools were completed by undergraduate midwifery students studying at three Australian universities and their preceptors. Midwifery students’ critical thinking was evaluated separately through student self-assessment and preceptor assessment and then matched. Rasch analysis was used to evaluate the validity of the tools. Results: Rasch analysis confirmed both the preceptor and student CACTiM tools demonstrated good reliability and unidimensionality. The items can differentiate between students’ ability to apply critical thinking in midwifery practice. Person reliability and item reliability were above.92 for both scales indicating excellent reliability and internal consistency. Several improvements were identified to the tools, including enhanced wording to some items, and reduction to a 5-point Likert scale. Through analysis of lower-scoring items, midwifery programs can identify curricula enhancements. Conclusion: The CACTiM student and preceptor tools are valid and reliable measures of critical thinking in midwifery practice. The tools can assess students’ critical thinking abilities and identify areas for development for individuals and across student cohorts through curricula enhancements

The Complete Ethical Framework for End-of-Life Care

The Ethical Framework for End-of-life Care is part of a national programme, the Hospice Friendly Hospitals Programme (HfH) of the Irish Hospice Foundation, which is intended to improve the culture of care and organization regarding dying, death and bereavement in Irish hospitals. The Framework is an educational resource that consists of eight Modules of Learning for health professionals, patients, families and the general public. The Framework is the outcome of a unique collaboration between University College Cork, the Royal College of Surgeons in Ireland and the Irish Hospice Foundation, with contributions from ethicists, legal experts, theologians, sociologists and clinicians. It draws on a range of values and principles that have been identified as important considerations in end-oflife decision making by international experts in bioethics and by professional codes of conduct, policy documents and laws. It is also informed by extensive international research on patients’ and families’ experiences of death and dying and the contribution of health professionals and organizations to quality end-of-life care. In order to ensure that the Framework addresses the concerns of the Irish public and that it is relevant and useful to the work of health professionals involved in end-of-life care in Irish hospitals, the Framework is informed by reviews and studies involving hospice, palliative and acute care services especially commissioned by the Irish Hospice Foundation in the last decade. It also draws on a significant body of research, undertaken in 2007/2008, which specifically addresses ethical issues in relation to end-of-life care in Irish hospitals

A realist analysis of hospital patient safety in Wales:Applied learning for alternative contexts from a multisite case study

Background: Hospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms. Objectives: This study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes. Design: We used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+ patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction. Setting: Welsh Government and NHS Wales. Participants: Interviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety. Main outcome measures: Identification of the contextual factors pertinent to the local implementation of the 1000 Lives+ patient safety programme in Welsh NHS hospitals. Results: An innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme. Conclusions: Heightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented. Funding: The National Institute for Health Research Health Services and Delivery Research programme