Block learning: Evaluation of a new teaching approach for nursing and midwifery education.

AIM: The aim is to present outcome and engagement data from the initial years of the implementation of a new teaching approach in entry to practice nursing and midwifery education. BACKGROUND: The Block Model (TBM) is a teaching approach that involves studying one unit of study at a time over a four-week period, as opposed to the traditional semester model. This paper presents data revealing the impact of TBM on student engagement and overall experience in entry to practice Bachelor of Nursing and Midwifery programs. DESIGN: The evaluation retrospectively compared key indicators pre- Block Model implementation with outcomes for nursing and midwifery students using TBM approach using standard data sets and external comparators such as the Student Experience Survey and National Employability Survey. METHODS: The study presents a comparative analysis of key indicators and graduate outcomes for students. We use reportable data and two external comparators, the Student Experience Survey and the National Employability Survey, to gauge student learning and graduate employability. The evaluation was conducted in a tertiary institution in Australia with for nursing and midwifery students who completed their studies using TBM approach at the university. RESULTS: The implementation of TBM in nursing and midwifery programs resulted in improvements in learner engagement, retention rates and pass rates. Improvements were also noted graduate outcomes, with an increase in full-time graduate employment. CONCLUSIONS: The results suggest the Block Model is a promising new teaching approach in nursing and midwifery education, with potential benefits for learner engagement, retention and pass rates.

Continuity of care experiences: A national cross-sectional survey exploring the views and experiences of Australian students and academics.

BACKGROUND: Continuity of Care Experiences (CoCEs) are a component of all entry-to-practice midwifery programs in Australia and facilitate an understanding of the central midwifery philosophy of woman-centred care and continuity of the therapeutic relationship. The aim of this research was to explore how CoCEs are viewed and experienced by students and academics across Australia. METHODS: Students enrolled in Australian midwifery programs and academics who teach into these programs were invited to participate in a cross sectional, web-based survey. Data were analysed using descriptive statistics and free text responses were analysed using content analysis. FINDINGS: Four hundred and five students and 61 academics responded to the survey. The CoCE was viewed as a positive and unique learning experience, preparing students to work in midwifery-led continuity models and developing confidence in their midwifery role. Challenges in recruitment, participation in care, and balancing the workload with other course requirements were evident in reports from students, but less understood by academics. Significant personal impact on finances, health and wellbeing of students were also reported. DISCUSSION: The value of CoCEs as an experiential learning opportunity is clear, however, many students report being challenged by elements of the CoCE within current models as they try to maintain study-work-life balance. CONCLUSION: Innovative course structure that considers and embeds the CoCE requirements within the curricula, in addition to a collective commitment from regulatory bodies, the maternity care sector and Universities to facilitate CoCEs for students may address some of the significant student impacts that are reported by this research.

Informing the development midwifery standards for practice: A literature review for policy development.

AIM: To critically appraise and synthesise the literature regarding the role and scope of midwifery practice, specifically to inform the evidence based development of standards for practice for all midwives in Australia. DESIGN: A structured scoping review of the literature DATA SOURCES: CINAHL Complete, MEDLINE Complete and Cochrane Libraries databases, online and grey literature databases REVIEW METHODS: Comprehensive searches of databases used key words and controlled vocabulary for each database to search for publications 2006-2016. Studies were not restricted by research method. FINDINGS: There is no substantive body of literature on midwifery competency standards or standards for practice. From 1648 papers screened, twenty-eight papers were identified to inform this review. Eight studies including systematic reviews were annotated with three research papers further assessed as having direct application to this review. To inform the development of Midwife standards for practice, the comprehensive role of the midwife across multiple settings was seen to include: woman centred and primary health care; safe supportive and collaborative practice; clinical knowledge and skills with interpersonal and cultural competence. KEY CONCLUSIONS: Midwifery practice is not restricted to the provision of direct clinical care and extends to any role where the midwife uses midwifery skills and knowledge. This practice includes working in clinical and non-clinical relationships with the woman and other clients as well as working in management, administration, education, research, advisory, regulatory, and policy development roles. IMPLICATIONS FOR PRACTICE: This review articulates the definition, role and scope of midwifery practice to inform the development of contemporary standards for practice for the Australian midwife.

Communicating out loud: Midwifery students' experiences of a simulation exercise for neonatal resuscitation.

Midwifery students feel unprepared to deal with commonly encountered emergencies, such as neonatal resuscitation. Clinical simulation of emergencies may provide a safe forum for students to develop necessary skills. A simulation exercise, for neonatal resuscitation, was developed and evaluated using qualitative methods. Pre and post-simulation questions focussed on student confidence and knowledge of resuscitation. Data were analysed using a thematic analysis approach. Pre-simulation questions revealed that most students considered themselves not very confident/unsure about their level of confidence in undertaking neonatal resuscitation. Most correctly identified features of the neonate requiring resuscitation. Post-simulation, students indicated that their confidence and knowledge of neonatal resuscitation had improved. Themes included: gaining confidence; understanding when to call for help; understanding the principles of resuscitation; tailoring simulation/education approaches to student needs. Students benefits included improved knowledge, confidence and skills. Participants unanimously suggested a program of simulation exercises, over a longer period of time, to reinforce knowledge and confidence gains. Ideally, students would like to actively participate in the simulation, rather than observe.

Development and evaluation of a simulation exercise to prepare midwifery students for neonatal resuscitation.

BACKGROUND: Simulation provides opportunities for midwifery students to enhance their performance in emergency situations. Neonatal resuscitation is one such emergency and its management is a major concern for midwifery students. OBJECTIVES: This project aimed to develop and evaluate a simulation exercise, for neonatal resuscitation, for 3rd year midwifery students. DESIGN: A quantitative survey design was employed using questions from two previously validated questionnaires: (1.) Student Satisfaction and Self-Confidence in Learning and (2.) the Clinical Teamwork Scale (CTS). SETTING: Australian university. PARTICIPANTS: 40 final year midwifery students were invited to participate and 36 agreed to take part in the project. RESULTS: In pre-simulation questionnaires, students reported low levels of confidence in initiating care of an infant requiring resuscitation. Most anticipated that the simulation exercise would be useful to better prepare them respond to a neonatal emergency. Post-simulation questionnaires reported an increase in student confidence, with 30 of 36 students agreeing/ strongly agreeing that their confidence levels had improved. Nonetheless, an unexpected number of students reported a lack of familiarity with the equipment. CONCLUSIONS: The single simulation exercise evaluated in this project resulted in improved student confidence and greater knowledge and skills in neonatal resuscitation. However, deficits in handling emergency equipment, and in understanding the role of the student midwife/midwife in neonatal resuscitation, were also noted. For the future, the development and evaluation of a programme of simulation exercises, over a longer period, is warranted. This approach may reduce stress and better address student learning needs.

Midwives' experiences of the factors that facilitate normal birth among low risk women at a public hospital in Australia.

BACKGROUND: normal birth has major advantages for mothers and infants. Nonetheless, in the developed world, rates of normal birth have declined significantly over the past 20 years, and many women currently have caesarean section births for unclear reasons. Midwives are interested in ameliorating this trend and aim to facilitate women to have meaningful birth experiences and to achieve the best possible birth. OBJECTIVES: this project aimed to explore midwives' experiences and views of the factors that facilitate or impede normal birth. SETTING: one maternity setting in Melbourne, Australia. PARTICIPANTS: a purposive sample of 22 midwives, all with recent birthing experience, participated in in-depth interviews. METHODS: a qualitative study using an Interpretative Phenomenological approach. Interviews were audio-recorded and transcribed verbatim. Analysis was guided by Smith and Osborn's (2008) approach. FINDINGS: midwives identified a number of factors that complicated their task of facilitating normal birth. Barriers included: (1) time pressures; (2) a risk adverse culture, and; (3) women's expectations. Factors facilitating normal birth included: (1) a supporting environment, and (2) midwifery attributes and a desire to promote normal birth. KEY CONCLUSIONS: in Australia, most births take place in obstetric models of care, in which the majority of midwives are employed. The birth environment, in these units, is often risk-adverse with high rates of intervention and caesarean section. Midwives, wishing to promote normal birth in obstetric led units, face a number of challenges and often feel unsupported by senior colleagues. This situation causes conflict and gives rise to stress and unmet support needs.

Final year students' experiences of the Bachelor of Midwifery course.

AIM: : the aim of the study was to explore the experiences of final year Bachelor of Midwifery students. BACKGROUND: earlier research indicates that midwifery students experience a number of difficulties and concerns during their studentship. These difficulties can lead to a lack of confidence and poorer integration and socialisation into the profession. Ultimately, poorer integration may lead to dissatisfaction and attrition from the profession. METHODS: a qualitative approach, informed by interpretative phenomenological analysis (IPA), was used in this study. Ten completing Bachelor of Midwifery students participated in in-depth interviews and reflected on their experiences over their three year course. Data were subjected to IPA analytic steps as proposed by Smith and Osborn (2008). KEY FINDINGS: demographics revealed that participants were generally aged more than 35 years and worked 16 hours or less per week. Most had two or more children and lived with a spouse/partner. Four main themes emerged from the analysis: (1) a challenging start; (2) coming to terms with course requirements; (3) developing strategies; and (4) overall satisfaction with the course. Participants generally considered that their individual strengths and determination helped them to negotiate the many challenges they encountered during the course. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study indicates that students undergo a process of adjustment as they travel through the Bachelor of Midwifery course. The most critical transition phase appears to occur in the first year and students may require additional supports to assist their socialisation into both the university and their course. Particular needs identified include return to study skills for mature-aged students and counselling and support group needs generally. The provision of such supports may assist with the retention of students within the course and may contribute to overall student satisfaction.

Final year students' learning experiences of the Bachelor of Midwifery course.

AIM: the aim of the study was to explore the concerns of 3rd year Bachelor of Midwifery students. BACKGROUND: earlier research indicates that midwifery students experience a number of conflicting learning demands and expectations, during their student years. These difficulties can lead to anxiety and a lack of confidence, which have implications for student integration and socialisation into the profession. METHODS: a qualitative method was used, underpinned by Smith and Osborn's (2008) approach to interpretative phenomenological analysis IPA. In-depth interviews were conducted among 10 senior midwifery students as they looked back over their three year course. Data were analysed using steps proposed by Smith and Osborn (2008). KEY FINDINGS: more than two-thirds of participants were over 35 years, and had two or more children. More than half were living with a spouse/partner and the majority worked 16 hours or less per week. Themes emerging from the data included (1) linking theory to practice; (2) a focus on clinical skills; (3) learning expectations and experiences; and (4) the role of midwifery lecturers/educators. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwifery students experience a number of challenges associated with their pre-registration midwifery education, including difficulty understanding the relevance of some study units to midwifery practice. A strong focus on practical skills may inhibit the development of cognitive skills such as critical evaluation and reflection.

Exploring the 'follow-through experience': a statewide survey of midwifery students and academics conducted in Victoria, Australia.

OBJECTIVE: Follow-through experiences (which enable midwifery students to experience continuity of care with individual women through pregnancy, labour and birth and the postnatal period) are a component of midwifery education programmes in Australia and the United Kingdom. Current accreditation standards in Australia require midwifery students to have a total of 20 continuity of care experiences with an average of 20 hours per woman over the duration of their course. There has been limited research regarding students' and academics' experiences of follow-through experiences; and there has been debate regarding the appropriate number of follow-through experiences in midwifery curricula. This study aimed to explore the follow-through experience from the perspective of midwifery students and academics in Victoria, Australia. DESIGN: cross-sectional design using a web-based survey. SETTING: Victoria, Australia. PARTICIPANTS: Students (n=401) and academics (n=35) from all seven universities in Victoria that offer accredited midwifery programmes including the Bachelor of Midwifery, Bachelor of Nursing/Bachelor of Midwifery double degree, Postgraduate Diploma of Midwifery and Masters of Midwifery (entry to practice). FINDINGS: Students and academics were in agreement that continuity of care is important to women. They considered the follow-through experience to be a unique and valuable learning opportunity and agreed that follow-through experiences should be included in midwifery education programmes. However, students and academics raised major concerns about the impact of follow-through experiences on students' capacity to meet university course requirements (such as missing lectures/tutorials and clinical placements), and spending extensive periods of time on-call both within and outside the university semester. Students and academics also reported concerns about the impact of follow-through experiences on students' personal lives, including paid employment and family responsibilities (such as childcare or caring for family members). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: In settings where continuity of care options for women are relatively limited, prescriptive requirements regarding the number and hours of follow-through experiences can present significant challenges for midwifery students. Midwifery regulatory bodies should consider these findings when developing or revising standards for midwifery education.

Concerns among first year midwifery students: towards addressing attrition rates.

Since 2000, there has been a shift to undergraduate midwifery education in Australia. Midwifery students are generally highly motivated, however attrition rates remain high among first-year students. This study was undertaken in one Australian University against a background of high course demand and high student attrition. Thirty-two first-year midwifery students completed a demographic questionnaire and wrote a reflection in response to the question: What if anything, would make your experience as a first year student better? Data were subjected to thematic content analysis. Findings indicated a need for: greater opportunities to prepare; for more time to study; for greater student supports; and outlined difficulties such as financial and childcare. In conclusion, undergraduate midwifery courses and local conditions vary among institutions. Student feedback is a useful way of identifying local concerns that may impact on student completion rates. This is a necessary first step to the provision of meaningful student support.

Undertaking midwifery studies: commencing students' views.

OBJECTIVE: to explore the motivations and beliefs of commencing midwifery students against a background of high course demand and high student attrition. DESIGN: a qualitative analysis of student reflective essays. SETTING: Melbourne, Australia. PARTICIPANTS: all commencing midwifery students, in 2008, were invited to participate (n = 41). MEASUREMENTS AND FINDINGS: three primary motivations for choosing midwifery were identified, including: notions of altruism (wanting to help), a fascination with pregnancy and birth, and a view of midwifery as a personally satisfying career. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Bachelor of Midwifery programmes attract students with idealised views about midwifery practice. Such views may lead to student disillusionment, tensions with educators and clinicians, and higher rates of student attrition. Students need greater support to examine their views about midwifery practice. More meaningful support may assist the students' successful socialisation into clinical practice.

Out of the ashes: the new bachelor of midwifery curriculum at Victoria University.

In the past decade, midwifery education has changed significantly in Australia. Previously, a nursing qualification (division 1) was required for entry into midwifery programs and on completion, graduands obtained a postgraduate diploma of midwifery. More recently, bachelor of midwifery programs have also been offered in Australia and currently, a considerable percentage of midwives are prepared for practice in this way. In Victoria, the bachelor of midwifery has been available since 2002, and at this time the third group of graduands are poised to enter the field. Implementation of the bachelor of midwifery program has given rise to many concerns about the development and applicability of this course. Concerns include: complexities of registration with a regulatory board set up primarily for nursing registration; concerns about readiness for practice among bachelor of midwifery graduands; escalating requirements within midwifery courses; and difficulties with meeting course requirements. As this course comes of age in Victoria, it is useful to reflect on some of the challenges encountered along the way. Thus, this paper reports on the journey of one university as it approaches the end of a first year of implementing an independent bachelor of midwifery program, following 5 years involvement as a consortium partner. In particular, it addresses concerns and difficulties encountered during early implementation of the program and then outlines strategies used to improve and strengthen the course. The basic premise of the paper is lessons learnt along the way.