Midwives' perspectives of their ability to promote the oral health of pregnant women in Victoria, Australia.

BACKGROUND: Midwives have a potential role in promoting the oral health of pregnant women although they have little formal training in this area. The aim of this study was to explore the perspectives of midwives in Victoria towards incorporating oral health promotion into their antenatal practice after undergoing training through the Midwifery Initiated Oral Health (MIOH) online education program. METHODS: A purposive sample of thirty-nine midwives from maternity services across Victoria, Australia were invited to participate in an online MIOH education program in October 2012. The program included three self-paced modules covering oral health screening, referral processes, and theoretical and practical skill assessments. A mixed methods design was used to capture midwives perspectives. Evaluation questionnaires, completed pre- and post-training, captured knowledge and confidence (confidence likert scale), and also included five opened-ended questions post-training. Open-ended questions, feedback forms and unsolicited emails formed the data for qualitative analysis. Data were analysed using content and thematic analysis and descriptive statistics. RESULTS: Thirty-three midwives completed the MIOH education program and demonstrated a significant increase (51.5%) in their confidence to promote oral health. All participants viewed the program as suitable, acceptable and useful for their practice and were happy to recommend the course to other Victorian midwives. Participants indicated that it would be feasible to incorporate oral health into the first antenatal booking visit and recognised that oral health promotion was within their scope of practice. CONCLUSIONS: This study has shown that the MIOH education program is a valued resource that can assist midwives to increase their confidence and skills to incorporate oral health promotion into their practice. A key barrier identified was time constraints during antenatal care booking visits. However, it is evident that with relevant training it would be feasible and acceptable for Victorian midwives to incorporate oral health promotion within their practice. The current engagement with midwives in Victoria and other parts of Australia provides an opportunity to continue to explore and define the role of antenatal health care professionals in oral health promotion at a state and national level.

Can we teach core clinical obstetrics and gynaecology skills using low fidelity simulation in an interprofessional setting?

Core clinical skills acquisition is an essential component of undergraduate medical and midwifery education. Although interprofessional education is an increasingly common format for learning efficient teamwork in clinical medicine, its value in undergraduate education is less clear. We present a collaborative effort from the medical and midwifery schools of Monash University, Melbourne, towards the development of an educational package centred around a core skills-based workshop using low fidelity simulation models in an interprofessional setting. Detailed feedback on the package was positive with respect to the relevance of the teaching content, whether the topic was well taught by task trainers and simulation models used, pitch of level of teaching and perception of confidence gained in performing the skill on a real patient after attending the workshop. Overall, interprofessional core skills training using low fidelity simulation models introduced at an undergraduate level in medicine and midwifery had a good acceptance.

Breastfeeding mothers returning to work: experiences of women at one university in Victoria, Australia.

Working women need to juggle work, child care and family to continue to breastfeed. This qualitative study's aim was to explore women's experiences of returning to work following the birth of their baby. Focus groups were held with women within one multi-campus university, who had commenced breastfeeding at birth and had returned to work or study within 12 months. In addition, educators working with babies in childcare centres on two of the campuses were interviewed. Thematic analysis was employed used Rogoff's (2003) three planes of analysis, the individual, the interpersonal and the cultural-institutional. Three themes, proximity, flexibility, and communication, were identified relating to the factors impacting on women and their choices to breastfeed or wean on returning to work. From a socio-cultural perspective these themes can be understood as situated within the interrelated contexts of workplace, child care and family. Limitations of the study include the small number of participants and recruitment from one university.

Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment.

BACKGROUND: This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration. METHODS: Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis. RESULTS: The students' clinical management of the situation varied considerably. Students struggled to prioritize their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error. CONCLUSIONS: The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the students to evaluate their interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the students' or help them plan care prospectively. The limitations of the study are critically explored along with the pedagogic implications for initial training and continuing professional development.

Exploring a pedagogical approach to integrating research, practice and teaching.

Application of evidence is accepted as an important component of clinical practice. Teaching research to undergraduate students has been reported internationally as a challenge, particularly for nurse educators. In this paper, reported is a strategy designed to enhance research learning for undergraduate midwifery students at one university, which formed part of a larger, international investigation into women's responses to caesarean birth. Following theory classes and briefings, students worked with their clinical educators in practice to interview women using existing tools, and were engaged in qualitative data analysis. A number of challenges were encountered throughout the process, both for the educators and students. However, the teaching approach provided benefits for students in learning about midwifery research. Recommended as essential is for continued development of pedagogical approaches that make research tangible for students. Furthermore, provision of support for clinical staff working with students is important for success of such approaches.

Factors associated with early breastfeeding cessation in Frankston, Victoria: a descriptive study.

Current exclusive breastfeeding rates in Victoria do not meet World Health Organization (WHO) recommended standards. This study describes the reasons for early cessation of breastfeeding from the perspectives of the mothers, midwives and maternal and child health (M&CH) nurses in Frankston, Victoria. Interviews were conducted with women who had ceased to breastfeed within three weeks of birth. Midwives who regularly worked in the home visiting program and M&CH nurses participated in focus groups. The main aim was to describe local factors associated with early breastfeeding cessation. Themes identified included: midwifery assistance; knowledge, expectations and reality; social influences; influence of health professionals. These findings support previous evidence of factors that inhibit establishment of breastfeeding and suggest that failure to successfully establish breastfeeding is complex. Collaboration between health and social services, health professionals and community is required to improve the breastfeeding experience for women and their babies.

Support needs of breast-feeding women: views of Australian midwives and health nurses.

OBJECTIVE: to explore the views of midwives and maternal-child health nurses regarding factors that influence breast feeding initiation and continuation, focusing on how support for women could be improved to increase breast feeding duration. DESIGN: a focus group study. SETTING: hospital or domiciliary (home-visiting) midwives and community-based maternal and child health (MCH) nurses in one region of Victoria, Australia. METHODS: twelve MCH nurses and five midwives who provided supportive services to women in the immediate postnatal period attended one of three audio-recorded focus groups. Thematic findings were identified. FINDINGS: four key themes were: 'Guiding women over breast-feeding hurdles', 'Timing, and time to care'; 'Continuity of women's care' and 'Imparting professional knowledge'. Given the a pattern of hospital discharge of mother and infant on day one or day two after birth, participants thought the timing of immediate postnatal breast-feeding support was critical to enable women to initiate and continue breast feeding. Community-based MCH nurses reported time gaps in uptake of new mother referrals and time-pressured face-to-face consultations. Both groups perceived barriers to continuity of women's care. CONCLUSIONS: health services subscribe to the Baby Friendly Health Initiative and government policies which support breast feeding, however providers described time pressures and a lack of continuity of women's care, including during transition from hospital to community services. IMPLICATIONS FOR PRACTICE: there is a need to examine administration of service delivery and how domiciliary and community nurses can collaborate to establish and maintain supportive relationships with breast feeding women.

'It's those first few weeks': Women's views about breastfeeding support in an Australian outer metropolitan region.

OBJECTIVE: To examine factors that influence the establishment and continuation of breastfeeding among women living in a southern region of Victoria. METHOD: Sequential mixed methods design including paper-based survey and focus group enquiry. FINDING: Women who had breastfed their infants (n=170) reported reliance on midwives, lactation consultants and maternal and child health nurses for breastfeeding advice and support in the immediate and medium postnatal periods. Women who chose a private hospital appeared to receive less immediate postnatal support than those in a public hospital. Access to individual guidance from midwives and MCH nurses was regarded as critical to overcoming breastfeeding difficulties, in the face of the alternative suggested by people to 'give up'. They described themes of: 'Women's experience of nurses/midwives', 'Expectations versus reality', 'Not giving up despite difficulties', and 'Breastfeeding support'. Sources of lay support were not universal. CONCLUSION: The duration of breastfeeding might be extended by early problem resolution. To enhance breastfeeding participation, further examination of the extent and timeliness of service provision by health service providers is necessary.

Exploring the impact of clinical placement models on undergraduate midwifery students.

BACKGROUND: Learning undertaken through clinical placements provides up to 50% of the educational experience for students in pre-registration midwifery courses. However little is known about of the impact various models of clinical placement have on the learning experiences of undergraduate midwifery students. Two clinical placement models have been employed for undergraduate midwifery students at Monash University, including the block placement model and the continuous two days per week model. OBJECTIVE: This project sought to explore the learning experiences of students in these two models of placement. METHOD: Focus groups were held on two campuses with a total of 17 students from different cohorts and programs. DISCUSSION: No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model. CONCLUSION: No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model.

Undergraduate midwifery students' sense of belongingness in clinical practice.

BACKGROUND: Clinical placements form a large and integral part of midwifery education. While much has been written about nursing students' clinical placements, less is known about clinical experiences of undergraduate midwifery students. In nursing, belongingness has been demonstrated to be a key factor in clinical learning but little is known about this in midwifery education. OBJECTIVES: This study sought to examine undergraduate midwifery students' sense of belongingness in their clinical practice. DESIGN: A quantitative design using an online questionnaire was employed. A tool adapted by Levett-Jones (2009a), and previously used with nursing students, was utilised to examine sense of belonging in undergraduate midwifery students. PARTICIPANTS: Sixty undergraduate midwifery students from two campuses at one Australian university participated in the study. Students were drawn from a single Bachelor of Midwifery degree and a double Bachelor of Nursing/Bachelor of Midwifery degree. METHODS: On completion of a scheduled lecture, students were invited by one of the researchers to participate in the study by completing the online questionnaire and the link provided. Data were analysed using descriptive statistics. RESULTS: Midwifery students generally reported similar perceptions of belongingness with previous studies on nursing students. However, a few differences were noted that require further exploration to fully understand. CONCLUSIONS: Midwifery students experienced a sense of belonging in their clinical placements. The findings contribute to understandings of the experiences for midwifery students and provide a foundation on which to develop future clinical placement experiences.

Managing women with acute physiological deterioration: student midwives performance in a simulated setting.

OBJECTIVE: Midwives' ability to manage maternal deterioration and 'failure to rescue' are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives' ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance. METHODS: An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a 'birthing suit' simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data. FINDINGS: The mean total knowledge score was 75% (range 46-91%) with low skill performance, means for both scenarios 54% (range 39-70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32)=2.247, p=0.032), in the second and more difficult APH scenario. CONCLUSION: Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation.

Is history taking a dying skill? An exploration using a simulated learning environment.

History taking is a vital component of patient assessment. Nurses need sound interviewing skills to identify care priorities. Verbal and non-verbal cues provide triggers to follow-up with appropriate questions during health assessment for development of appropriate care plans. This skill, however, is a difficult one for students to learn and develop. This paper reports on a study that explored the value of video-recording, facilitated review and debriefing following a simulated patient experience to enhance final year nursing students' history taking and assessment skills. Scenarios, from commonly encountered situations, with imbedded cues were developed. Actors were employed as simulated patients from whom students took histories while being videotaped. Video-recordings were then reviewed by each student with a lecturer to highlight missed cues or areas where questioning could be developed. These were later analysed to explore cue identification. Finally, a focus group was conducted with participants to elicit feedback on the experience. Findings suggested that it was a valuable exercise. Students lacked prior appreciation for many aspects, such as lifestyle, on planning care. Some reported never having had opportunity during clinical placement to take a full history. Analysis of recordings identified commonly missed social cues and failure to fully explore emerging data.

Postnatal care in hospitals: ritual, routine or individualized.

Postnatal care in hospital continues to include routine recording of observations of temperature, pulse, blood pressure, fundal height, lochia and perineal injury on clinical pathways that allow little if any leeway for individualizing care. This paper discusses the issues of designing a new clinical pathway that encompasses best practice, is woman friendly and allows for individualized care rather than routine rituals.