Exploring and developing student midwives’ experiences (ESME)—An appreciative inquiry study

A qualitative evaluation of a student midwife placement teaching English to speakers of other languages (ESOL)

INTRODUCTION

A shortage of UK midwives has put pressure on clinical placements and supervision of student midwives. Alternative placement solutions are needed to provide students with meaningful learning experiences. One such learning experience was a placement undertaken by student midwives who attended a program teaching English to speakers of other languages (ESOL). This study evaluated the impact of the placement on student midwife learning and experiences of the ESOL participants.

METHODS

The 2022 study employed a qualitative design using Kolb's model of experiential learning as a framework. Ten student midwives placed with the ESOL program and three women enrolled in the program participated. Data were collected via online focus groups with the student midwives and a face-to-face focus group with the women. Data were analyzed using thematic analysis and Kolb's model of experiential learning.

RESULTS

Four themes were constructed: 'Putting the scripts aside: expectations versus the reality of being an educator', 'Adapting and personalizing teaching', 'We are learning too: an environment for mutual learning', and 'Taking our learning forwards'. Students faced barriers during their placement and had to adapt their teaching accordingly. They gained crucial knowledge of the challenges faced by women who speak other languages. The women valued the students' input and together they forged a reciprocal learning environment.

CONCLUSIONS

This study demonstrates how placing student midwives in a unique non-maternity setting has benefits for student learning which are transferrable to future practice. Importantly, it confirms that quality of learning during a novel placement is not compromised for students or participants.

Strategies used by midwives to enhance knowledge and skill development in midwifery students: an appreciative inquiry study

BACKGROUND

Midwifery practice experience for midwifery students is an important component of education to enhance knowledge and skill development. Practicing midwives provide student support in the clinical setting, there is minimal literature relating to strategies midwives use to support students.

OBJECTIVE

To explore midwifery student experiences of the strategies used by midwives to facilitate knowledge and skill development in the clinical practice setting.

METHODS

Qualitative approach based on Appreciative Inquiry. The setting is one University in Australia. Participants, thirteen Graduate Diploma in Midwifery students. Individual interviews followed by thematic analysis.

RESULTS

Data analysis identified six themes, Willingness to share knowledge and develop skills; The positive use of questioning; Moderating support; Teaching through the woman; Learning through problematisation and Providing constructive affirmation.

CONCLUSIONS

Midwives incorporated varied strategies to support student development in the clinical setting. For an equitable clinical experience, all midwives need support to develop skills and confidence in facilitating student learning.

Midwifery professional placement: Undergraduate students' experiences with novice and expert preceptors

BACKGROUND

In recent decades, increased midwifery university places have been offered to address midwifery workforce shortages. As a result, more graduate midwives entered the workforce, in turn leading to more midwifery students precepted by novice midwives when on professional placement. It is not known whether this more junior midwifery workforce impacts student experience.

AIMS

To explore undergraduate midwifery students' experiences with novice and expert midwifery preceptors, and to identify the benefits and challenges of working with novice and expert preceptors, from the perspective of undergraduate student midwives.

METHOD

This study used a qualitative descriptive approach. Nineteen third/fourth-year Bachelor of Nursing/Bachelor of Midwifery (Honours) students attended six focus groups (ranging from 2 to 5 participants). Data were analysed thematically.

RESULTS

Three overarching themes were identified: 'Building relationships'; 'Teaching and learning'; and 'Improvements to professional placement'. Benefits and challenges existed with both novice and expert preceptors. Importantly, feeling welcomed and receiving critical feedback were identified.

CONCLUSION

The student/preceptor relationship is based upon feeling welcomed, and relatability, and is developed more easily with novice preceptors. Expert preceptors provide insightful and valuable feedback and are more able to actively teach. Novice preceptors' consolidation of practice can impact student learning opportunities. Including students in decision-making aids development of critical thinking. Allocation practices which address student learning needs will improve the student professional practice experience. Midwifery students benefit from working with midwifery preceptors of all experience levels. Translating the findings from this project into preceptorship training programs for midwives will improve student satisfaction and outcomes.

The implementation and evaluation of a mentoring program for Bachelor of Midwifery students in the clinical practice environment

AIM

To describe the implementation and evaluation of a midwife/midwifery student-mentoring program in one Local Health District in Sydney NSW Australia.

BACKGROUND

Evidence suggests well designed and supported midwife/midwifery student mentorship programs can make a difference to the clinical placement experiences and attrition rates of midwifery students.

DESIGN

In the evaluation of the mentoring program, we used surveys, focus groups and individual interviews.

METHODS

Eighty-six participants, including midwife mentors, midwifery students, non-mentor midwives and midwifery managers participated in the evaluation. Quantitative data were analysed using descriptive statistics and qualitative data, content analysis.

RESULTS

The mentoring program increased midwives' mentoring skills and was beneficial to their professional growth and leadership skills. Students reported positive outcomes including someone to talk to, emotional support and a sense of belonging. Mentoring programs require structure, mentor training, organisational support and transparency.

CONCLUSION

The mentoring program provided benefits to both midwifery mentors and students and demonstrated the value of a structured and supported mentoring program for midwifery students.

"One of those things the student is left to do". Student midwives' experience of infant feeding education. A phenomenological study

AIM/OBJECTIVE

To explore final year student midwives' experiences of breastfeeding education and clinical experience during their three year pre-registration midwifery degree course.

BACKGROUND

Despite an increasing research base about what helps or hinders breastfeeding, there is a dramatic drop in breastfeeding prevalence within the first six weeks of birth. Breastfeeding support and education have been identified as influencing factors associated with breastfeeding prevalence, yet there is a paucity of evidence exploring infant feeding education for pre-registration student midwives.

DESIGN

Qualitative data was gathered using semi-structured interviews with seventeen final year midwifery students in a Higher Education Institution in the North of England.

METHODS

Interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis.

RESULTS

Three core themes were identified: The Mentor-Student Relationship, Midwives and student midwives' attitudes towards breastfeeding and Theory-Practice Disassociation. University-based input provided them with underpinning knowledge but provided little opportunity to develop skills. Attitudes towards breastfeeding were predominantly negative, and these negative descriptions were frequently linked by students to time constraints and workload pressures. The relationship between students and mentors had a direct impact on students' development of breastfeeding support skills and confidence: students who had mentors who were enthusiastic about their role in facilitating learning in clinical practice were confident in supporting women with infant feeding. However, many students described the hospital environment as too busy for infant feeding skills teaching and guidance.

CONCLUSIONS

Although few participants were dissatisfied with how their pre-registration midwifery education prepared them for clinical practice in general, the majority would have liked more opportunities to support women with infant feeding in complex and challenging cases, both in University and in clinical practice. There is a need for midwifery students to be provided with a variety of educational experiences such as theoretical classroom-based learning, simulation-based learning, peer learning, clinical care practice and direct service user engagement. These learning experiences need to include artificial feeding and breastfeeding.

"They hold your fate in their hands": Exploring the power dynamic in the midwifery student-preceptor relationship

AIM

To examine (1) what role preceptors play in students' learning; (2) how student-preceptor relationships can impact students' views of the profession and their decision to leave the program; and (3) what strategies can be used to improve the preceptor-student relationship to facilitate student retention.

RESEARCH DESIGN AND PARTICIPANTS

We used a qualitative methodological approach utilising semi-structure interviews with 31 midwifery students across Canada. Participants were recruited from all midwifery education programs and were in various stages of their educational journey. The interviews were conducted in English and French. Inductive analysis followed Charmaz's guidelines moving from line-by-line to focused coding and development of analytical categories.

FINDINGS

The results show that positive relationships with preceptors boosted students' confidence and contributed to the constructive learning experiences among trainees. Students pointed out that their best learning experiences were facilitated by preceptors who created a safe space to make mistakes and were knowledgeable and invested in students' learning. Students also suggested that power imbalance is embedded in student-preceptor relationships and can negatively impact students' learning experiences and their decision to stay in the program.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

It is important to consider how to mitigate the power imbalance embedded in preceptor-student relationship. Offering more training to preceptors, oversight of preceptors' mentorship skills by midwifery educators, and creation of ombudsperson's position might mitigate some of the power differential and facilitate students' ability to complete midwifery training.

Why use Appreciative Inquiry? Lessons learned during COVID-19 in a UK maternity service

Choosing the ‘right’ research method is always an important decision. It affects the type of study questions that can be answered. In addition, the research method will have an impact on the participants – how much of their time it takes, whether the questions seem important to them and whether there is any benefit in taking part. This is especially important when conducting research with staff in health services. This article is a reflection on the process of using Appreciative Inquiry (AI) in a study that explored staff wellbeing in a UK maternity unit. We share our key learnings to help others decide if AI will fit their research aims, as well as highlight issues in its design and conduct. We discuss our experience of using AI,the strengths and limitations of this approach, and conclude with points to consider if you are thinking about using AI. Although a study team was actively involved in decisions, this paper is largely based on reflections by the first author, the researcher conducting the field work in the maternity services.

A literature review to determine midwifery students' perceived essential qualities of preceptors to increase confidence and competence in the clinical environment

BACKGROUND

Midwifery students' experiences with preceptors in the clinical environment plays an integral role in developing the confidence and competence of students. As up to 50% of the midwifery program is taught in the clinical environment, an analysis of the preceptorship role in the context of midwifery student confidence and competence may be important to inform future practice and policy.

AIM

To discover, whilst on clinical placement, what is required by preceptors to suitably equip midwifery students to develop confidence and competence in the clinical environment.

METHODS

A search of the literature was undertaken using health and midwifery related electronic databases of PubMed, CINAHL, Intermid, SCOPUS and Web of Science. Grey literature, and reference lists from studies were also part of the thorough search process.

FINDINGS

After critical reading of the 15 included studies, there were a number of themes identified as the preceptor qualities that contributed to student confidence and competence. Those themes include 'belongingness', 'hands on experience/skill development', 'students' development of professional identity' and 'preceptor characteristics that impact student learning'.

DISCUSSION

Student confidence and competence can be dependent on the preceptor who supports them. There are preceptors who enable students to flourish in their confidence and competence, and there also appears to be preceptors who do not possess these qualities, which requires further enquiry.

CONCLUSION

As the evidence appears to find that trained preceptors are optimal for student confidence and competence, further enquiry is warranted to inform policy and practice around the concept of preceptorship training for midwives.

Exploring the STEP-uP to practice: A survey of UK Lead Midwives for Education views of the STudent midwife Extended Practice Placement during the first wave of the COVID-19 pandemic

OBJECTIVE

to assess the effect of implementation of the extended placement option available to midwifery students during the first wave of the COVID-19 pandemic.

DESIGN

Online survey open from 2nd June 2020 to 15th July 2020.

SETTING

United Kingdom.

PARTICIPANTS

Lead Midwives for Education (LMEs).

FINDINGS

A total of 38 of 55 LMEs responded (response rate 69%). The majority of Approved Education Institutions (AEIs) offered an extended placement to students, but with some variation in the choices offered, unrelated to geographical location or size of student cohort. AEIs appeared to provide the majority of decisional support for students. Many practice learning environments became unavailable, particularly community, gynaecology/medical wards and neonatal units. LMEs experienced both internal and external pressures to instigate rapid change.

KEY CONCLUSIONS

The impact of COVID-19 on midwifery education is significant and will need continual scrutiny to minimise future detriment. The pressures of providing midwifery education throughout the early phase of COVID-19 were substantial, but it is important that we learn from the immediate changes made, value and pursue the changes that have been beneficial, and learn from those that were not.

IMPLICATIONS FOR PRACTICE/RESEARCH

Student learning experiences have undergone significant change during the pandemic. It is essential to assess what effect the extended placement has had on student readiness for practice, their confidence, resilience, mental health, and attrition and retention. Educators transitioned to remote working, and rapidly assimilated new skills for online education; exploration of the impact of this is recommended.

What matters, what is valued and what is important in mentorship through the Appreciative Inquiry process of co-created knowledge

BACKGROUND

A key element in the provision of safe and competent midwifery care is how learning experiences are construed and translated into practice. This process can be supported through clinical/professional mentoring. What constitutes 'good mentorship' has been the topic of much debate. While research exploring mentorship exists, there is less research exploring co-created perceptions of mentorship by the mentee and mentor.

OBJECTIVES

To explore student and registered midwives' co-created perspectives of what matters, what is valued and what is important in mentorship.

DESIGN

An adapted Appreciative Inquiry methodology guided this study with thematic analysis used for data analysis.

SETTINGS

One regional Australian university.

PARTICIPANTS

A convenience sampling, from a population of 39 third-year Bachelor of midwifery students and 39 registered midwives providing clinical supervision for students enrolled in a specific unit of study and concurrently undertaking midwifery practice experience were recruited into this study.

METHODS

Following the four-step process of Appreciative Inquiry; Appreciate, Envision, Co-create and Embed, imagery cards were provided, and participants selected the image that resonated with their understanding of mentorship. Shared understandings were cultivated to co-create what worked well and what was valued in facilitating a positive learning experience.

RESULTS

Trust developed over time is a valued component of mentorship relationships. Similarly valued is the sense of belonging and feeling safe, elements reliant on the establishment of effective and respectful communication.

CONCLUSION

What matters, what is valued and what is important in midwifery mentorship is a mutually respectful relationship between mentee and mentor. This requires time and trust and the creation of a space where the student can develop a sense of professional belonging and feel safe to learn. Further research is needed to explore ways to co-create safe learning environments. Appreciative Inquiry is a method suited to studying this area.

Appreciative inquiry as an intervention to improve nursing and midwifery students transitioning into becoming new graduates: An integrative review

OBJECTIVE

To identify, critique and synthesise the evidence about the impact of Appreciative Inquiry on improving nursing and midwifery students as they transition into becoming new graduates.

DESIGN

An integrative review.

DATA SOURCES

The databases were: Pubmed, Ovid Medline, Cumulative Index of Nursing and Allied Health and Scopus.

REVIEW METHODS

A Whittemore and Knafl's (2005) five stage approach was used to appraise the primary literature related to nursing and midwifery students transitioning into becoming new graduates.

RESULTS

A total of 805 articles were retrieved and six studies met the inclusion criteria and included in this review. These studies have shown that Appreciative Inquiry as an intervention can be used to improve nursing and midwifery students' experiences as they transition into becoming new graduates. Three overarching themes were identified: caring, connecting and nurturing, transforming the workplace and work practices and appreciating and enabling nurses and midwives as a profession.

CONCLUSION

Appreciative Inquiry offers a creative, exploratory and compassionate method to improve positive change for nursing and midwifery students as they transition into becoming new graduates. The impact of caring, nurturing nurses and midwives who mentor nursing and midwifery students makes a difference in increasing the likelihood that graduates will remain in the profession and establish fulfilling relationships with both colleagues and people.