Midwifery students' experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study.

OBJECTIVE: To explore the impact of the COVID-19 global pandemic on midwifery students' experiences of clinical internship placement in the final year of their midwifery programme. DESIGN: A qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated. SETTING AND PARTICIPANTS: To prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study. FINDINGS: Four overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students' ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Midwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.

Final year undergraduate nursing and midwifery students' perspectives on simulation-based education: a cross-sectional study.

BACKGROUND: Simulation-based education is a teaching and learning approach that can enhance learning experiences for students on healthcare programmes. Within undergraduate nursing and midwifery education, simulation can support students in developing graduate attributes necessary to become practice-ready professionals. This paper reports on the evaluation of a simulation-based education initiative, which was introduced to support final year undergraduate nursing and midwifery students in preparation for their upcoming clinical internship in practice. METHODS: This study aimed to evaluate a simulation-based education initiative from the perspectives of final year undergraduate nursing and midwifery students (N = 95). An online survey, using the validated Simulation Effectiveness Tool - Modified (SET-M), was distributed to final year nursing and midwifery students at one university in Ireland. This study was conducted and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). RESULTS: The results of the study highlight final year nursing and midwifery students' perceptions, experiences, and satisfaction with learning in a simulated environment. Students reported their simulation-based learning experiences as worthwhile, motivating, and as important opportunities to build on previous learning, increase confidence and gain experience in preparation for real-life practice. Students reported feeling more confident in their assessment skills, in providing care and interventions in responding to changes in a person's health status. All students reported that the simulation-based learning experiences enabled them to think more critically about the clinical case scenarios and critically question their actions and decision-making processes. Pre-briefing and debriefing sessions were highlighted as important aspects of the simulation which helped to increase student confidence and cultivate meaningful learning. CONCLUSION: Simulation-based education is a valuable teaching and learning modality, particularly for final year students who are transitioning to real-life clinical practice. Student-centred simulation-based learning experiences can cultivate professional development and support learners in their transition from university student to healthcare professional.

"Stranger in a mask" midwives' experiences of providing perinatal bereavement care to parents during the COVID-19 pandemic in Ireland: A qualitative descriptive study.

OBJECTIVE: To explore the experiences and perceptions of midwives providing perinatal bereavement care during the COVID-19 pandemic and to identify the barriers and facilitators to providing compassionate bereavement care. DESIGN: A qualitative descriptive design was utilized to address the research question. Following ethical approval, in depth, semi structured interviews were undertaken to explore midwives' experiences of providing care to parents following perinatal bereavement. Narrative data was analyzed using thematic analysis. SETTING: A standalone regional maternity hospital located in a large metropolitan center in the Republic of Ireland. PARTICIPANTS: A purposeful sample of eleven midwives, who cared for bereaved parents during the COVID-19 pandemic volunteered to participate in the study. FINDINGS: Two main themes were identified, each with associated subthemes (1) Challenges of providing compassionate bereavement care during a pandemic (2) Psychological effect and coping strategies utilised by midwives during a pandemic. CONCLUSION: The COVID-19 pandemic brought unprecedented challenges when providing perinatal bereavement care. The mandatory infection prevention and control measures significantly disrupted human communication and connections. Participants in the study utilized techniques to optimize care while adhering to COVID-19 guidelines, and simultaneously putting their own fear and anxieties aside.

Women's experience of obstetric anal sphincter injury following childbirth: An integrated review.

BACKGROUND: Perineal injury during childbirth is a very common event which affect women during childbirth. Significant morbidities are associated with third-and-fourth degree perineal tears in particular, also referred to as obstetric anal sphincter injuries (OASIS). With an increasing global birth rate and rising interventions in birth, the incidence of perineal trauma following vaginal birth is increasing on an international scale, impacted also by more accurate classification and definitions of OASIS and increased pre-existing co morbidities amongst affected women. The consequences of OASIS can be physically and psychologically distressing for affected women and have significant impact on quality of life. METHODOLOGY: The aim of this integrative review was to examine women's experience of OASIS following childbirth using a systematic approach. This is presented in a five-stage process that includes problem identification, literature search, data extraction and evaluation, data analysis and presentation of results. A number of academic electronic databases were systematically searched and results are presented and analysed. Results of the complete search are presented in PRISMA format. Eight papers, which were assessed for quality using an appropriate appraisal tool, are included in the review and thematic analysis used to identify themes. FINDINGS: The themes identified were; psychological consequences, the role of the health care professionals and implications for future pregnancies. Psychological consequences included anxiety, loneliness, isolation, shame, fear, many of which were associated with physical ramifications of OASIS and how these feelings affect activities of daily living. The importance of access to and support from health care professionals was highlighted. The impact the experience of OASIS had on women's decisions about future pregnancies was also evident. CONCLUSION: The association between OASIS and maternal quality of life following childbirth can be substantial as evidenced by this literature review. The review identifies the need for improvement in the care and management of these women to alleviate the physical and psychological consequences of OASIS, including decisions in relation to future pregnancies and childbirth. Health care professionals caring for women in pregnancy and childbirth need to be educated and informed on the sequelae of OASIS, to ensure appropriate information and support is provided to these women and their families. Such knowledge may enable health care professionals to alleviate symptoms associated with OASIS and help women make sense and cope with their experiences.

Preparing midwifery students for practice: The value of elective placements in enhancing midwifery practice.

An elective placement where students are facilitated to access different models of midwifery care was included in the 18 month Higher Diploma Midwifery programme in 2008 in a university in Ireland. All students since then have had the opportunity to experience this placement which is advocated by the regulatory board for Nursing and Midwifery in Ireland (NMBI). This paper details the integration of an elective placement referred to as an 'observation week' into the 18 month midwifery programme. It includes a description of the organisation of the observation week, a summary of services accessed by midwifery students, student evaluation of their experience and mechanisms for feedback of these experiences to our partners in clinical practice. The benefits and the challenges of the observation week are considered with reference to the published literature.

Employing a Qualitative Description Approach in Health Care Research.

A qualitative description design is particularly relevant where information is required directly from those experiencing the phenomenon under investigation and where time and resources are limited. Nurses and midwives often have clinical questions suitable to a qualitative approach but little time to develop an exhaustive comprehension of qualitative methodological approaches. Qualitative description research is sometimes considered a less sophisticated approach for epistemological reasons. Another challenge when considering qualitative description design is differentiating qualitative description from other qualitative approaches. This article provides a systematic and robust journey through the philosophical, ontological, and epistemological perspectives, which evidences the purpose of qualitative description research. Methods and rigor issues underpinning qualitative description research are also appraised to provide the researcher with a systematic approach to conduct research utilizing this approach. The key attributes and value of qualitative description research in the health care professions will be highlighted with the aim of extending its usage.

Unconscious collusion: An interpretative phenomenological analysis of the maternity care experiences of women with obesity (BMI≥30kg/m²).

BACKGROUND: obstetric and midwifery literature continually emphasise incidence and consequence of obesity in pregnancy. However, they offer less consensus on how best to support women who are obese. Therefore, this study explores in depth the lived experience of women who have a Body Mass Index (BMI) ≥30kg/m². This exploration provides a bio-psycho-social understanding of the lived experience of women to identify how best to support them throughout their childbirth experience. METHODS: an Interpretative Phenomenological Analysis (IPA) design was adopted for this qualitative study. Purposive sampling of participants was conducted on the postnatal wards of a maternity hospital in the Republic of Ireland. In total, 15 participants volunteered to take part in semi-structured interviews conducted at six to ten weeks postnatally. Data were analysed utilising the IPA framework. FINDINGS: the results indicate that participants were conscious of the problematics of communicating obesity in pregnancy. The narrative data revealed an unconscious collusion between healthcare professionals and women as they navigate obesity related conversations. The behaviours related to unconscious collusion are incorporated in the sub-ordinate themes; 'just recorded and that's all', 'but what's eating healthy? 'pussy footing around' and 'I hate that word obesity. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings highlight a lack of information received by participants from healthcare professionals regarding increased BMI or weight management. The data suggests that healthcare professionals appeared to collude with women to avoid challenging discussions regarding obesity. This may be related to avoidance on participants' part and/or may be linked with healthcare professionals' reluctance to communicate issues relating to increased BMI. Although participants were generally unhappy with the communication skills of health professionals, they readily acknowledged the sensitive nature of obesity related communications. The findings provide healthcare professionals with an important insight into issues of effective communication and obesity related healthcare promotion from the woman's perspective in order to enhance provision of appropriate health information and maternity care to women who have an increased BMI.

Exploring perinatal death with midwifery students' using a collaborative art project.

OBJECTIVE: To explore the influence of the Amulet artwork and exhibition on midwifery students' perceptions of caring for parents experiencing perinatal death. DESIGN: A descriptive qualitative design involving face-to-face semi-structured interviews following institutional ethical approval. SETTING: A regional Maternity Hospital in Ireland which hosted the National Artwork and Exhibition exploring the hidden world of infant death. PARTICIPANTS: A purposive sample of six consenting post registration midwifery students who had attended the Amulet artwork and exhibition. FINDINGS: Four core themes emerged and these were i) entering the mother's world and hearing her pain; ii) the journey of grief and connecting with the bereaved parent's unique experience; iii) facing the challenge of providing effective perinatal bereavement care; and iv) maintaining a journey of compassionate practice. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Exposure to, and reflection on the Amulet artwork and exhibition increased students' awareness and insight into the non-linear nature of the grieving process, and to the importance of maintaining a journey of compassionate care for parents experiencing perinatal death. The findings suggest that the use of creative women-centered strategies promote affective learning in relation to perinatal death and so may be of use to educators and maternity care providers.

Gas-Phase Structures of Ketene and Acetic Acid from Acetic Anhydride Using Very-High-Temperature Gas Electron Diffraction.

The gas-phase molecular structure of ketene has been determined using samples generated by the pyrolysis of acetic anhydride (giving acetic acid and ketene), using one permutation of the very-high-temperature (VHT) inlet nozzle system designed and constructed for the gas electron diffraction (GED) apparatus based at the University of Canterbury. The gas-phase structures of acetic anhydride, acetic acid, and ketene are presented and compared to previous electron diffraction and microwave spectroscopy data to show improvements in data extraction and manipulation with current methods. Acetic anhydride was modeled with two conformers, rather than a complex dynamic model as in the previous study, to allow for inclusion of multiple pyrolysis products. The redetermined gas-phase structure of acetic anhydride (obtained using the structure analysis restrained by ab initio calculations for electron diffraction method) was compared to that from the original study, providing an improvement on the description of the low vibrational torsions compared to the dynamic model. Parameters for ketene and acetic acid (both generated by the pyrolysis of acetic anhydride) were also refined with higher accuracy than previously reported in GED studies, with structural parameter comparisons being made to prior experimental and theoretical studies.

Working and learning: post-registration student midwives' experience of the competency assessment process.

AIM: to explore student midwives experiences of the Clinical Competency Assessment process utilised on the Higher Diploma in Midwifery (18 month) programme. BACKGROUND: the assessment of clinical skills and practice has traditionally been an integral part of midwifery educational programmes; however the method of clinical assessment has changed and developed. Similar to other countries, in Ireland assessment of clinical practice is achieved through the utilisation of a broad competency framework provided by the regulatory body, An Bord Altranais (2005) which is yet to be evaluated from a midwifery perspective. METHOD: a descriptive qualitative study was undertaken once ethical approval had been granted by the University's Ethics Committee. All student midwives (n=20) in one cohort were invited to participate and nine students were interviewed. Interviews were tape recorded. Data were analysed using Burnard's (2006) framework. FINDINGS: the process of competency assessment was perceived by many of the students to facilitate continuous assessment of clinical practice but there were issues in relation to the language and the number of competencies to be assessed. There were challenges also associated with the written evidence required as part of the assessment with many of the students questioning the usefulness of this in a clinical assessment. A variety of supports were identified and utilised by the students. Continuity and availability of preceptors were noted to be factors impacting on completion of the assessment as were the competing demands of clinical care. RECOMMENDATIONS: the findings of this small study are congruent with much of the international literature focusing on clinical competency models. Consideration needs to be given to identifying and integrating into practice, a clearly defined process for competency assessment, by all the relevant stakeholders. An opportunity for feedback throughout the process is considered very significant and the mechanism for this needs to be made explicit in any competency assessment documentation Competency documentation currently in use needs to be reviewed in light of the findings of this study and the rationale for inclusion of a written evidence component needs to be carefully considered. Further research is warranted in relation to the effectiveness of the competency tool in assessing competency in practice.

Investigation of Staphylococcus aureus isolates identified as erythromycin intermediate by the Vitek-1 System: comparison with results obtained with the Vitek-2 and Phoenix systems.

We identified 69 Staphylococcus aureus isolates that were erythromycin intermediate as reported by the Vitek-1 system using the GPS-105 card. Of the 57 strains that were available for further testing, all were erythromycin resistant by broth microdilution and the Phoenix system, while the Vitek-2 system identified 55 of 57 strains (96%) as erythromycin resistant. The majority of isolates (54 of 57 [95%]) exhibited the inducible MLS (macrolide-lincosamide-streptogramin family) phenotype, as shown by the double-disk test. We recommend that all S. aureus strains determined as erythromycin intermediate by the Vitek-1 system be interpreted as resistant to erythromycin.