Managing support for newly qualified practitioners: lessons learnt from one health care region in the UK.

AIM: The study mapped the support provided for newly qualified practitioners across Kent, Surrey and Sussex. BACKGROUND: Newly qualified practitioners require support and guidance to facilitate their transition from student to their new role as qualified practitioner. Professional bodies advocate that programmes be provided but the type and intensity of that support is variable. METHODS: Telephone interviews were conducted with 24 people delivering support for newly qualified practitioners across professions in 13 different health care trusts. Documents (n = 41) related to support programmes were analysed. Two case study site visits and a knowledge exchange conference of 45 delegates completed the data collection. Data were analysed using the constant comparative method of analysis. RESULTS: Support for newly qualified practitioners was largely idiosyncratic to profession and Trust. Evidence emerged of a conceptual shift from basic competency acquisition toward a corporate induction programme. CONCLUSIONS: Interdisciplinary programmes can provide generic transitional support, but the newly qualified practitioners favoured skill acquisition to help them to be effective in their new role. Measuring the impact of newly qualified practitioner support on patient outcome and the practitioner is required. IMPLICATIONS FOR NURSING MANAGEMENT: A career pathway for those who support newly qualified practitioners and one that includes specific preparation for the role is proposed.

Midwives' rules: professional safeguard or relic of a bygone era?

It appears likely that, as a result of the dismantling of the system of statutory midwifery supervision by the Nursing and Midwifery Council, the Midwives' rules are also likely to disappear. This article explores the development and meaning of the Rules and wonders whether they are a necessary part of modern midwifery practice or an historical relic that no longer serves a purpose. It argues that they were designed to serve, control and discipline midwives and that there may be better ways for midwifery to delineate and develop the profession.

From public to private: the history of domestic abuse in Britain.

Today all midwives are expected to be able to ask women about domestic abuse, and to respond appropriately to any disclosure. However, it is only in the last twenty years that health professionals, including midwives, have begun to appreciate both the scale and effect of domestic abuse. This article delves into the hidden history of this most secret aspect of family relationships and explores why midwives finally began to 'ask the question'.

Using historical research to make sense of our past, our present and our future. 2. Uncovering source material.

This article is the second of a series of four looking at the use of historical research to explore midwifery. It focuses on the identification and use of source material to answer historical questions. There are a huge variety of sources that can be used in order to do this, ranging from old textbooks, hospital records or midwives' registers, to paintings, emails and objects. Several different types of sources can be used to study a particular question, and are valuable in demonstrating change over time, as well as different opinions on issues.

Using historical research to make sense of our past, our present and our future. 4. History in context and disseminating findings.

This is the last in a series of four pieces looking at the use of historical research to explore midwifery. This final part looks at how historical findings can be placed in a theoretical framework and how they may be disseminated. History can shed new light on contemporary research projects as well as being fascinating in its own right, and can be used not just for academic work but to tell the story of people and places connected with our profession.

Using historical research to make sense of our past, our present and our future. 3. Finding and using historical sources.

This article is the third of a series of four pieces looking at the use of historical research to explore midwifery. It considers the practicalities of finding and using historical sources, and at some of the ethical implications involved. Midwifery sources can be hard to track down as they range from catalogued collections to papers stored in shoe boxes under peoples' beds. Oral history can be a powerful way of capturing stories and memories that were never written down. Care needs to taken in using sources sensitively, particularly when they involve people who are still alive.

Prison Nurses' Professional Identity.

In the United Kingdom, health and justice services nurses are a diverse group working across a range of contexts and settings such as police custody, sexual assault referral centers, young offenders' institutes, and prisons and probation. Recruitment and retention to the specialist field of health and justice services nursing, specifically prison nursing, is problematic in the United Kingdom. In this article, we consider the background to the current situation in prison nursing and summarize some of the existing literature and research relating to this specialty to raise, for discussion and debate, issues that are pertinent to the concept of professional identity and professionalism. Role definition, resilience and burnout, and education within prison nursing are identified in relation to the development of professional identity. It could be that professional identity is the missing link to recruitment and retention.

Changing messages about place of birth in Mother and Baby magazine between 1956 and 1992.

OBJECTIVE: this paper explores changing messages about place of birth offered to women by Mother and Baby magazine, a UK publication aimed at a general readership DESIGN: the research uses an historical perspective to explore changing messages about place of birth in Mother and Baby magazine between 1956-1992. It analyses the content and medium of the magazine through a narrative and semiotic approach. SETTING: the UK between the mid-1950s and 1990s. The period was a time of significant change in the maternity services, at both a philosophical and organisational level with a move towards hospital rather than home birth and a dominant discourse which privileged medical models of care over social ones. PARTICIPANTS: producers and consumers of Mother and Baby magazine FINDINGS: Mother and Baby moved from an assumption of home birth to a focus on hospital birth, reflecting national changes in policy. The magazine moved from a social to a risk focused medical view of birth, with an emphasis on the safety of the baby and the sacrifice of the mother. These changes can be traced through both the organisation and the language of content between 1956 and 1992. However, home birth was always offered to readers as a viable, if increasingly niche, option. This reflected the magazine's need to appeal to its readers as consumers; both in consumption of the magazine and of maternity care. CONCLUSIONS: the evidence suggests that Mother and Baby magazine mirrored elements of the prevailing policy discourse around place of birth. However, it always gave space to other narratives. In doing so it reminds us of the complexity about how messages about labour and birth are told and received. It gives insight into ways in which the media lead and reflect change and the impact this might have on decision making by women.

The unified approach of management and critical incident stress management: helping flight attendants and pilots in the aftermath of September 11.

Experience suggests that effective and appropriate responses of an organization's management after a traumatic incident can help mitigate the reactions of primary, secondary, and tertiary victims. This commentary addresses the managerial response of Southwest Airlines to the trauma induced by September 11. It highlights the effectiveness of the unity between the company, the unions, and the Critical Incident Response Team, as well as the types of interventions that were highly regarded by flight attendants and pilots who received such services. This commentary also defines the phenomenon known as fear of flight.

Attrition from midwifery programmes at a midwifery school in the English midlands 1939-1973: A historical study.

OBJECTIVE: This paper explores the features of attrition from a Midwifery Training programme in mid-twentieth century England. DESIGN: The research uses an historical methodology to explore rates of attrition from a Midwifery Training School in the English Midlands between 1939 and 1973. It uses principally the record books of the Training School which gave details about pupils across the period. This evidence is contextualised through national written and oral archive material. SETTING: Mid-twentieth century England. The period was a time of significant change in the maternity services, at both a philosophical and organisational level with the creation of the National Health Service and a move towards institutional rather than community based maternity care. Midwifery pupils were regulated by the Central Midwives Board, the national body which governed midwifery, and sat national exams based on national syllabi. PARTICIPANTS: Pupil midwives based at the Midwifery Training School whose records are being explored. These included pupils who were had nursing qualifications and those who did not. FINDINGS: Numbers of pupils entering training varied across the period in relation to external workforce factors. The greatest proportions of those in training were pupils who already held a nursing qualification, although numbers of untrained pupils rose across the period. Rates of attrition were particularly high within this group, but across all groups rates rose across the period. CONCLUSIONS: The evidence suggests that despite the very different organisation of midwifery training and care across the period in comparison to contemporary practice, rates of attrition from training programmes appear remarkably consistent.

Effecting change in midwives' waterbirth practice behaviours on labour ward: an action research study.

INTRODUCTION: the use of water immersion for labour and birth has been shown to be beneficial for women in normal labour (Cluett et al, 2009). It was decided to use problem solving coordinator workshops to change in the way waterbirth practice was promoted and organised on labour ward. Findings from the first Action Research phase (Russell, 2011) led to the development of a waterbirth questionnaire to measure midwives' personal knowledge of waterbirth practice, waterbirth self-efficacy, social support and frequency of hydrotherapy and waterbirth practice. The aim of this paper is to share the questionnaire findings from an on-going action research study. METHOD: prior to the first workshop 62 questionnaires were distributed to midwives (Bands 5, 6 and 7) working on labour ward. Subsequent questionnaires (n=53) were sent to Bands 5/6 midwives not involved in the workshops, at four (Group 2) and eight months (Group 3). N.B only Bands 5/6 midwives completed post workshop questionnaires. In total 169 questionnaires were distributed. One-way ANOVA with Tukey post-hoc test and the χ(2) test were used to determine statistical significance. FINDINGS: 96 questionnaires were returned (57%). Midwives' personal knowledge of waterbirth practice differed significantly between groups, (F2,85=3.67, p<0.05) with midwives in Group 1 giving significantly higher scores (X¯=45.6, 95% CI [43.0, 48.2]), than those in Group 3, (X¯=41.7, 95% CI [40.0, 43.3]), p<0.05. Midwives' waterbirth self-efficacy did not differ significantly between groups (F2,88=3.15, p>0.05). However scores for social support did differ (F2,75=4.011, p=0.022), with midwives in Group 1 giving significantly lower scores (X¯=8.0, 95% CI [6.4, 9.5]) than those in Group 3 (X¯=10.5, 95% CI [9.4, 11.6]), p=0.016. Fifty-five per cent of Group 1 midwives facilitated a waterbirth in the previous three months compared with 87% in Group 3. Changes in the frequency of waterbirth for these groups were statistically significant (x(2)=4.369, p<0.05, df=1). CONCLUSIONS: it appears that the co-ordinators were able to influence waterbirth practice because of changes in social support and frequency of waterbirth practice. Given the widespread and continued impact of the intervention, on midwives who attended workshops and those that did not, we feel it likely that a significant proportion of this change could be attributed to the introduction of problem solving waterbirth workshop. The findings from this study suggest that problem solving waterbirth workshops based on an action research format have the potential to normalise midwifery care within medically dominated hospital birthing environments.

The concept of early labour in the experience of maternity in twentieth century Britain.

OBJECTIVE: This paper explores perceptions of time and experience in midwifery with particular reference to the concept of early labour. Health professionals and lay people are used to describing labour in terms of 'stages' which correspond to agreed notions of progress based on physiological features. However the understanding of labour which underpins them is not a static entity but is a product of a particular era and set of circumstances which are primarily socially rather than biologically mediated. DESIGN: The research uses a historical methodology to describe understanding of, and strategies around, the management of early labour. It includes a variety of source material, including midwifery and obstetric textbooks, midwifery casebooks, books of advice to women and the oral testimony of midwives and mothers. SETTING: Twentieth century Britain. The twentieth century was a period of significant philosophical and concrete change in maternity in Britain, with occupational hegemony developing around both midwifery and obstetrics, and with the concomitant institutionalisation of labour and birth. PARTICIPANTS: Mothers, midwives and doctors. FINDINGS: The evidence suggests that during the first half of the twentieth century early labour was not seen as a discrete period within the first stage of labour with specific features or associated issues. Instead it was a private and individual experience, which rarely involved the presence of either doctors or midwives. Women, and those around them, made the decision about what early labour meant and how they should respond to it. The development of divisions in labour and notions of what constituted 'normality' or 'abnormality' as regards the length of each stage, based on time and clinical features, developed as the setting for labour and birth moved from home to hospital in the second half of the twentieth century. Labour became more described and more proscribed, with a rash of textbooks aimed at both midwives and doctors, and with the growing visibility of the entire process of labour through the use of technological surveillance and through the fact that women labouring on a hospital bed were observable in a way that women labouring at home were not. KEY CONCLUSIONS AND IMPLICATIONS: To look for historical strategies around the management of entities such as early labour is to assume, ahistorically, that similar beliefs and issues existed in an earlier period, and that there perhaps existed strategies for management which could profitably be rediscovered for use in current maternity care. The evidence suggests that such divisions were not described or managed features of labour before the second half of the twentieth century. The use of history does, however, give insights into breaks and continuities in beliefs and practice over time, and demonstrates that beliefs about stages of labour and their management are, like other aspects of maternity, multi-faceted and complex in both origin and effect.

Final year students' perceptions of learning to be a midwife in six British universities.

Midwifery education in the UK has been delivered through the University sector since the mid-1990s, with the requirement to create safe, effective clinicians who are equipped to engage with research and evidence based practice. This paper presents an in-depth analysis of focus group data from 120 senior midwifery students at six British universities to explore the experience of learning to be a midwife. Thematic analysis of the data suggests the following themes pertain to the experience of a number of students: 'teach yourself midwifery', knowing it all, right way of doing things, the importance of physical skills. These themes suggest a dissonance for some students between the andragogical methods of learning espoused by universities, and the expectations of students, who express the belief that there is a fixed and finite body of knowledge, without which they feel disempowered, anxious and ill-prepared for clinical practice. This paper argues that there are unresolved tensions between the perceived demands of practice environments and regulatory bodies and the philosophical stance of universities. For some students the concept of a broad discursive education is a distraction from training in discrete clinical skills.