Exploring and developing student midwives' experiences (ESME)-An appreciative inquiry study.

BACKGROUND: There is increased focus on investing in midwifery students as our future workforce. Inquiring into what helps to support an enriched learning experience for student midwives in clinical placements is timely. AIM: To work collaboratively with key stakeholders (student midwives, midwives) in clinical placements to generate an experience-based understanding of what works well in relation to the student midwife experience and from this understanding, co-create ways to enhance students' experiences. DESIGN: An appreciative inquiry approach was used to discover what matters and what works well at present in the student midwife experience from the perspective of student midwives, midwives, and midwifery managers and to use this knowledge to create enhanced experiences in the future. Data were generated across four local health districts in New South Wales, Australia. Data were analysed using immersion crystallisation and then mapped to the 'Senses Framework'. SETTING: Four midwifery units in tertiary teaching public hospitals in NSW. PARTICIPANTS: There were 124 participants in this study: 45 midwifery students and 76 employed midwives. MEASUREMENTS AND FINDINGS: The data culminated in the refinement of the 'Senses Framework' for use in the midwifery learning context. Student midwives and midwives valued experiences that helped them to feel safe, to feel that they belong, to experience continuity in their learning and work, to have a sense of purpose, to have their achievements and their contributions to be recognised and to feel that they matter. Furthermore, the midwives themselves valued the experience of these senses in supporting them to be facilitators of learning in the workplace. The relational framework for learning together in the workplace has the potential to support achievement of the sense of security, belonging, continuity, purpose, achievement and significance for all involved. KEY CONCLUSIONS: There is much to celebrate in what is being achieved currently in promoting excellence in learning experiences in the midwifery context. In particular this study has made conscious the contribution that student midwives and midwives can and do make to enable the positive and reciprocal relationships that develop in the student midwife experience that support the nurturing of enriched learning environments. This study emphasised that learning in the workplace is a relational endeavour, rooted in the day to day engagement between student midwives, midwives and others. By mapping these positive processes to the senses framework these processes are made more explicit and provide guidance for enhancing the learning experience in the midwifery context. IMPLICATIONS FOR PRACTICE: The framework and related inquiry tools developed from the study may be useful in other settings to further test out the impact of this relational approach to learning for student midwives.

Barriers to implementing an integrated care pathway for the last days of life in nursing homes.

AIM: this paper explores the barriers that needed to be overcome during the process of implementing an integrated care pathway for the last days of life as a way of developing quality end-of-life care in nursing homes. METHODS: an action research methodology underpinned the study. Qualitative and quantitative data were collected in eight nursing homes before, during and after the implementation of the care pathway. FINDINGS: six main barriers were identified: a lack of knowledge of palliative care drugs and control of symptoms at the end of life; lack of preparation for approaching death; not knowing when someone is dying or understanding the dying process; lack of multidisciplinary team working in nursing homes; lack of confidence in communicating about dying; some nursing homes are not ready or able to change. These findings highlight a functional 'rehabilitative' culture that may not be so appropriate in the current context of nursing home care, and one that makes implementing an integrated care pathway for the last days of life less straightforward than in other settings. CONCLUSION: it cannot be presumed that the implementation of a care pathway for the last days of life in nursing homes is straightforward. This study suggests that an action research framework was extremely useful in highlighting and overcoming some obstacles when developing evidence-based practice. Action at both local and public policy level is required to fully address barriers that prevent quality end-of-life care in nursing homes.