Applying interprofessional education to the practice setting.

Interprofessional education is a key requirement identified in various professional and regulatory body education standards in the UK. However, recent high-profile investigatory reports into adverse incidents in NHS organisations have demonstrated failures of translating interprofessional education into practice. This paper explores how a university in the south of England uses service improvement projects to address this. Working with key senior clinicians, small groups of students from a variety of professional backgrounds collaborate to address an identified problem in practice to bring about better, safer practice to benefit patients. This style of learning enables students to acquire essential attributes in preparation for employment, such as critical thinking, teamworking, ethical practice and leadership

Demographic profile of 266 mother-infant dyads presenting to a multidisciplinary breast-feeding clinic: a descriptive study

Worldwide, sustained breastfeeding rates are lower than optimal. Mothers and infants with suboptimal breastfeeding present to a wide variety of practitioners to assist their goal of total breastfeeding. To support these mother-infant dyads, a multi-disciplinary chiropractic and midwifery feeding clinic was opened alongside a chiropractic teaching clinic in England. To improve understanding of the presentation and clinical needs of these nursing dyads, a descriptive study was developed. This paper provides an overview of the cases that presented to this clinic over nine months, with a focus on feeding difficulties, birth and musculoskeletal problems in the infant. Mothers frequently reported more than one type of feeding problem, which most commonly included difficulty attaching, painful feeding, and a one sided feeding preference. Birth intervention was more common in this population than the national averages, particularly forceps deliveries. Musculoskeletal problems were prevalent in the babies presented to the feeding clinic, most commonly of the thoracic spine, cervical spine and sternocleidomastoid. Although causation cannot be established from this type of study, intervention at birth, feeding difficulties and musculoskeletal problems frequently coexisted in these infants. Therefore, including musculoskeletal care for infants as part of support for suboptimal breastfeeding may be appropriate

Structural Study of the Hunton Lime of the Wilzetta Field T12-13N, R5E, Lincoln County, Oklahoma, Pertaining to the Exploration for Hydrocarbons

This study deals with the Hunton Group of the Wilzetta Field in Lincoln County, Oklahoma. The depositional environment was inferred from studying the outcrop areas in southern and northeastern Oklahoma. Geologic history was based on studies of electric logs, core and sample descriptions, seismic data, correlation cross sections, structure contour maps, and an isopach interval thickness map.Geolog

Evaluating the student experience of introducing newborn infant physical theory into a pre-registration midwifery programme in the UK

Background: Newborn infant physical examination (NIPE) is a screening process that usually takes place between six to 72 hours (Davis & Elliman 2003) from birth, a period of time when all well, newborn infants in the UK are under the care of the midwife. The midwife is in an ideal position to undertake this examination but only 13% of midwives are NIPE practitioners (Rogers et al 2015). Also, only a few universities provide opportunities for NIPE to be taught in an undergraduate programme as it is not a requirement of the regulatory body (NMC 2009). For those that do, there is the challenge of not having enough NIPE practitioners to assess students in practice. Aim: explore the experiences of students regarding the impact and effectiveness of introducing the theoretical elements of NIPE into their programme and its application in practice when opportunities arose. Ethics: approval granted from the host university Methods: All third year student midwives were invited to participate in focus group discussions, which were audio taped and transcribed verbatim. An interview proforma guided the discussion under three main areas: additional theoretical content in the curriculum; practice related experience and what next. Descriptive analysis was used to identify common themes. Results: Ten students attended the focus groups. Three themes emerged: i) timing of theoretical content; ii) applying theory to practice and, iii) holistic care. Conclusion: students felt they benefited from learning about NIPE and recognised it offered continuity of care. For some, even though they may not have seen NIPE being undertaken in practice, this was not a barrier for them to utilise the knowledge and apply it in a slightly different way in practice

Defining the latent phase of labour: is it important?

Background and rationale: The latent phase of labour is recognised as a period of uncertainty for both women and midwives. There is evidence from the literature of considerable variation in labour definitions and practice. Stimulated by discussion at an international maternity research conference, we set out to explore opinions regarding the need for labour stage definitions. Aim: to identify health professionals’ views regarding the need for a definition of the onset and the end of the latent phase of labour. Methods: This was an opportunistic, semi-structured, online survey of attendees at a maternity care research conference, which included midwives, other clinicians, academics, advocates and user representatives. Attendees (approximately 100) were invited to participate through a single email invitation sent by the conference committee and containing a link to the survey. Consent was sought on the landing page. Ethical approval was obtained from Bournemouth University’s research ethics committee. Quantitative questions were analysed using simple descriptive statistics using IBM SPSS Statistics Version 24. Open questions were analysed using content analysis and where participants gave a more detailed answer, these were analysed using a thematic approach. Findings: Participants in the survey (n = 21) came from twelve countries. Most of the participants thought that there was a need to define the onset of the latent phase (n = 15, 71%). Common characteristics were cited, but the main theme in the open comments referred to the importance of women’s perceptions of labour onset. Most participants (n = 18, 86%) thought that there was a need to define the end of the latent phase. This was felt necessary because current practice within facilities is usually dictated by a definition. The characteristics suggested were also not unexpected and there was some consensus; but the degree of cervical dilatation that signified the end of the latent phase varied among participants. There was significant debate about whether a prolonged latent phase was important; for example, was it associated with adverse consequences. Most participants thought it was important (n = 15, 71%), but comments indicated that the reasons for this were complex. Themes included the value that women attached to knowing the duration of labour and the need to support women in the latent phase. Implications for practice: The findings from this small, opportunistic survey reflect the current debate within the maternal health community regarding the latent phase of labour. There is a need for more clarity around latent phase labour (in terms of both the definition and the support offered) if midwives are to provide care that is both woman centred and evidence-based. The findings will inform the development of a larger survey to explore attitudes towards labour definitions

Can an educational web-intervention, co-created by service users alongside self-efficacy theory, affect nulliparous women’s experiences of early labour? A study protocol for a randomised control trial (the L-TEL Trial)

Background. ‘Early labour’ refers to the beginning phase of a woman’s labour. It is the period of time where there are painful contractions and the cervix changes in preparation for active labour and subsequent childbirth. In UK clinical practice, cervical dilatation of four centimetres is commonly accepted as when active labour begins. Low-risk women, with uncomplicated pregnancies, have less unnecessary medical intervention if they remain at home in early labour. Despite recent efforts to improve labour triage, assessment and diagnosis in an attempt to reduce early-labour admission rates, women remain fearful and under-confident to remain at home during this time and continue to seek admission to their birth place. Thus, further research is required to evaluate new interventions aimed at improving women’s experiences of remaining at home in early labour. Methods. This trial is a pragmatic, randomised control trial with mixed-method data collection. The trial will evaluate the effect of a co-created, educational web-intervention on women’s early labour experiences. The trial aims to recruit 140 low-risk, pregnant nulliparous women from a single National Health Service (NHS) Hospital Trust in England. Participants randomised to the intervention group will receive a link to the web-intervention, alongside routine maternity care provisions. The control group will receive only routine maternity care provisions. Discussion. It is hypothesised that the group that receive the intervention will score higher in the Early Labour Experience Questionnaire (ELEQ, Janssen and Desmarais, 2013), indicating an improved early labour experience when compared with those in the control group. It is anticipated that findings from this trial will contribute to the knowledge base around how to improve first time mothers’ experiences of early labour, particularly the time spent at home prior to admission. Keywords. Pregnancy, childbirth, early labour, latent, self-efficacy, experience, education, website, online, protocol, randomised control trial, evidence-based midwifer

How are fitness to practise processes applied in UK higher education institutions? - A systematic review.

AIM: This systematic review will establish how Fitness to Practise (FtP) processes are applied in UK Higher Education Institutions (HEI), in relation to both Health and Care Profession Council or Nursing and Midwifery Council approved programmes. BACKGROUND: Healthcare students are required to complete both practice and theory elements, in order to gain their degree and qualify as a healthcare practitioner such as a nurse. It is a requirement of UK HEIs which provide healthcare programmes, to provide evidence to the appropriate regulatory body that FtP policies and processes are in place, and that they review and manage any concerns in relation to a student's standard of practice. Regulatory bodies provide HEIs with strategic guidance on policy which can be interpreted and incorporated into existing policies; this means that there is no standard approach to the FtP process in HEI settings, allowing individual policies and procedures to exist. DESIGN: A systematic review, registered on PROSPERO (CRD42022291532 on the 21st January 2022). DATA SOURCES: Peer reviewed studies published in ten databases were used which included: Medline, Cochrane Library, PubMed, ScienceDirect, Education Source, PsycInfo and Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete. Citation searching also occurred. REVIEW METHODS: This systematic review utilised Preferred Reporting items for Systematic reviews and Meta-Analysis (PRISMA) techniques. The Critical Appraisal Skills Programme (CASP) checklists were used to appraise the quality of the research. RESULTS: In total twenty-five articles were retrieved including five papers that were finally selected for review. A thematic analysis identified three themes: a lack of identification of what FtP expectations are; the importance of collaborative working between Higher Education Institutions and practice; the inconsistencies with Higher Education Institution processes in managing FtP concerns. CONCLUSIONS: A lack of understanding of what FtP expectations are for students was identified. Collaborative working between Higher Education Institutions and practice is necessary to ensure healthcare students meet FtP requirements consistently in order to protect the public. Although HEIs FtP processes contain similar principles, it has been identified that there are inconsistencies in this process across universities in the UK. These differences include: what initiates the FtP process, to the outcomes. This could have an impact on patient care and safety, the need for review of national guidance, and potential amendments being required to the policies and procedures of both NHS Trusts and private organisations

Using a birth ball to reduce pain perception in the latent phase of labour: a randomised controlled trial.

BACKGROUND: Admission in the latent phase of labour is associated with higher rates of obstetric intervention. Women are frequently admitted due to pain. This study aimed to determine whether using a birth ball at home in the latent phase of labour reduces pain perception on admission. METHOD: A prospective, pragmatic randomised controlled trial of 294 low risk pregnant women aged 18 and over planning a hospital birth. An animated educational video was offered at 36 weeks' gestation along with a birth ball. The primary outcome was pain on a Visual Analogue Scale on admission in labour. Participants who experienced a spontaneous labour were invited to respond to an online questionnaire 6 weeks' postpartum. RESULTS: There were no differences in the mean pain scores; (6.3 versus 6.5; 90%CI -0.72 to 0.37 p = 0.6) or mean cervical dilatation on admission (4.7 cm versus 5.0 cm; 95% CI -1.1 to 0.5 p = 0.58). More Intervention participants were admitted in active labour (63.6% versus 55.7%; p = 0.28) and experienced an unassisted vaginal birth (70.3% v. 65.8%; p = 0.07) with fewer intrapartum caesarean sections (7.5% v. 17.9%; p = 0.07) although the trial was not powered to detect these differences in secondary outcomes. Most participants found the birth ball helpful (89.2%) and would use it in a future labour (92.5%). CONCLUSION: Using the birth ball at home in the latent phase is a safe and acceptable strategy for labouring women to manage their labour, potentially postpone admission and reduce caesarean section. Further research is warranted

Introduction to Appreciative Inquiry: A case study of maternity services

AI was first developed by Cooperrider and Srivastva1 and sits within action research approaches that aims to create practical and collaborative change. It has a distinctive and deliberate strengths-based approach to achieve emancipatory learning and change, rooted in the experiences of stakeholders. AI has a strong theoretical base drawing on social constructionism, neuroscience, and positive psychology. Its assumptions include that: every society, organisation or group/team have strengths or things that work well and can be elaborated and expanded; our realities can be co-created through the quality of language, relationships, interactions and actions with one another. The original model uses a four step or ‘4-D process’ (Fig. 1) to take participants through an in-depth exploration of their organisation, team or individual roles. Starting with discovering and appreciating best experiences (discovery), imagining the ideal - how it would be if those valued experiences happened most of the time (dream), defining the dream more clearly and discussing steps towards realising it (design), to wide ranging actions, improvisation, learning, adjustments (destiny). Deciding what to study, or the ‘affirmative topic’, is important because ‘human systems move in the direction of what they study’. Hence, some have added an extra step, ‘definition’ (see Figure 1). Appreciative Inquiry was undertaken in an NHS maternity unit in England. This AI approach aimed to provide a space for participants to reflect on meaning in their work. It has the potential to generate novel insights, encapsulate creativity, and co-create change. AI was particularly appropriate during the COVID-19 pandemic as taking part could offer a therapeutic effect. Thirty-nine individual interviews were conducted with a broad range of clinical staff including midwives of all grades, an obstetrician, trainee doctors, student midwives, and maternity support workers. Four group discussions were also held with mixed professional groups. Staff were asked to reflect on what made a good day and what made a difference to their wellbeing. Interviews were digitally recorded, transcribed, initially analysed thematically by the research team but then analysed further by the maternity team. Feedback was provided to management and staff through clinical governance meetings, social media, newsletters, and informal conversations. Various changes were initiated by staff and supported by management. We contributed to the book Appreciating Health and Care: A Practical Appreciative Inquiry Resource for the Health & Social Care Sector.4-5 Rachel Arnold is the lead author of our contribution ‘Let’s get messy! Where to start with using Appreciative Inquiry’. Here we explain how we adapted and overcame some of the challenges, strategies that worked, and practical ideas for anyone interested in using Appreciative Inquiry in health or social care