RESUMO
Background: The study explored factors influencing implementation of simulation-based education (SBE) in nursing and midwifery education in Malawi. Aim: This study aimed to identify factors influencing nursing and midwifery educators in selected training institutions and clinical sites. Setting: The study covered one district and four central hospitals, five professional training institutions, Ministry of Health and Nurses and Midwives Council of Malawi officials. Methods: Using mixed-methods approach, quantitative data were gathered from 293 participants, including 149 final-year nursing and midwifery students, and 144 clinical instructors. Qualitative data were obtained from 24 faculty members, 11 clinical instructors and two key informants. Researchers conducted 37 in-depth interviews, 10 focus group discussions and eight desk reviews. Descriptive statistics were used to analyse the quantitative data, while content analysis was used for qualitative findings. Results: Five themes emerged from qualitative data: absence of simulation in regulatory body syllabi, insufficient formal training, demand for knowledgeable clinical instructors, inadequate human and material resources, and resistance to change. Survey results indicated that 83% of the participants had theoretical SBE knowledge but lacked practical skills, with only 13% considering SBE as a current teaching method. Educators emphasised lack of infrastructure, skills laboratories, teaching hospitals, equipment, and a deficit in formal training as critical barriers to SBE implementation. Conclusion: The study concluded that skilled educators, appropriate infrastructure and resources could facilitate SBE implementation in Malawi. Contribution: Recommendations included regulatory body support, formal training for educators, utilisation of low-fidelity simulators, and establishment of SBE centres and corners in health facilities.
RESUMO
AIM: To explore and describe the verbal communication patterns in antenatal consultations between pregnant women with diabetes and their midwives. BACKGROUND: Few studies have focused on the efficacy of communication during consultations between midwives and their clients, especially in a high-risk context. DESIGN: An explorative and descriptive study of antenatal consultations between midwives and their clients at four antenatal diabetes clinics in Norway. METHODS: Thematic analysis was used to study verbal communication in ten woman-midwife consultations that were audio recorded and transcribed. The analysis was based on the following questions: (1) who talks and to what degree? (2) What are the topics discussed and who is the initiator? and (3) What characterises the dialogue in the consultations? RESULTS: The results suggest that there was a predominantly medical focus in the consultations, with the communication style characterised by a combination of informal and formal talk. The consultations were structured into three phases, each with its own conversation style. CONCLUSIONS: The communication patterns adopted appeared to limit the opportunities of mothers-to-be to express freely any concerns. It is suggested that a larger degree of openness to the emotional and psychological aspects of pregnancy should be incorporated into the consultations. To take advantage of the different competencies in this multidisciplinary diabetes team, the contribution of the midwife to this specialised antenatal care should be both recognised and defined. RELEVANCE TO CLINICAL PRACTICE: Awareness of each midwife's own communication style, as well as their attentiveness to a woman's implicit concerns, is required for the satisfactory support and understanding of the individual pregnant woman. It is necessary to support midwives in the continuous development of their communication skills, a task that should be included as part of midwifery education and undertaken by practitioners in the clinical environment.