Midwifery students learning experiences in labor wards: a grounded theory

What it takes to develop self-confidence and competence in midwifery students for midwifery practice

BACKGROUND

Midwifery practice is multidimensional and complex in supporting women's reproductive health. Midwives provide care through pregnancy, birth, and the puerperium and may extend to sexual and reproductive health. Midwifery education must develop self-confidence and competence within each midwifery student. This must be learned before registering as a midwife and entering midwifery practice. Little is known about how educational experiences influence midwifery students' confidence.

AIM

The aim of this study was to understand the educational experiences that influence self-confidence and competence development among midwifery students.

DESIGN AND METHODS

A qualitative descriptive design was used in this study. Data were collected through seven focus group discussions with 37 midwifery students. The discussions were recorded and professionally transcribed. Data were analysed using thematic analysis.

RESULTS

The analysis resulted in four themes: (1) Understanding the concept of competence, (2) developing competence in midwifery practice, (3) obstacles to developing competence, and (4) the importance of self-confidence to be competent. The development of self-confidence and competence is gained through acquiring knowledge and skills, participating in research, undertaking clinical and simulated practice, attending seminars, and engaging in independent learning.

CONCLUSION

Midwifery students described how the increase in self-confidence can lead to an increase in competence, enabling the provision of high-quality midwifery services.

Midwives views about preceptorship and peer-learning in a birth unit: A cross-sectional study

BACKGROUND

Practical training in a birthing unit is an important part of midwifery education. Previous research on the preceptor role predominantly consists of qualitative interview studies and have not explored pedagogical models like peer learning.

OBJECTIVES

The purpose of this study was to quantitatively describe midwives' experiences, conditions, and needs in their role as preceptors in a birthing unit, as well as their attitudes towards and experiences of peer-learning.

DESIGN

A cross-sectional study, using a web-survey.

SETTINGS

The survey was distributed to all midwives working in a birthing unit in Sweden.

PARTICIPANTS

A total of 573 valid responses were obtained.

METHODS

A questionnaire consisting of 22 questions, which included background questions, questions to be answered on a four-point Likert scale, and open-ended questions, was sent out from November 2022 to March 2023. The collected data were analysed using descriptive statistics, Chi-square, and Mann Whitney U test analyses. The open-ended responses were analysed using quantitative content analysis.

RESULTS

Midwives with ≤10 years of experience were more hesitant about taking on the preceptor role. They also described a lack of support and found it more challenging to integrate supervision into their working hours than midwives with >10 years of experience. Time for supervision and time for reflection with midwifery students were identified as areas that could improve the quality of supervision. Of the respondents, 42.8 % had experience of peer learning. "Students learn from each other" was identified as the most common advantage of peer learning.

CONCLUSIONS

Long-term experience as a midwife plays a crucial role in how midwives perceive their role as a preceptor and the conditions they experience. The midwives in this study had started supervising students earlier than they deemed advantageous. As the preceptor plays a critical role in the midwifery student's learning process, it is important to have experienced preceptors.

A model for improving the learning environment in high-stress and emotion-bound clinical settings

INTRODUCTION

In clinical settings, it is necessary to create a clinical learning environment that provides the ground for the learners to acquire competencies especially in high-stress and emotion-bound clinical settings.

METHODS

In the present study, a model for improving the learning environment in high-stress and emotion-bound clinical settings was designed by conducting a multi-method study in the form of three sub-studies.

RESULTS

This model was designed with 3 pivotal concepts; organizing learning opportunities around safe care, fair participation in learning opportunities and creating a positive emotional climate and 6 peripheral concepts; designing physical space and appropriate equipment for education and care, preparing learners to attend the clinical setting, preparing learners to participate in learning opportunities, balancing the learner role and the care provided by the learners, the presence of a competent educator and providing education to all learners, and acquiring the ability to manage emotions by learners, faculty and staff.

CONCLUSIONS

The implementation of the model obtained from this study provides the basis for solving the challenges of clinical learning environments, especially in high-stress and emotion-bound clinical settings, and improves clinical education and the realization of educational and care outcomes.

Assessment of the psychometric properties of the italian version of the midwifery student evaluation of practice (MIDSTEP-IT): A validity and reliability study

BACKGROUND

Clinical learning is a crucial component of the midwifery education program, necessary to support the acquisition of professional abilities through the integration of theoretical and practical learning experiences. Evaluating Bachelor of Midwifery students' perception of their clinical learning experiences is important to improve midwifery educational programs.

AIM

the objective of this study was the translation, cultural adaptation, and validation of the Midwifery Student Evaluation of Practice (MidSTEP) in a group of Italian midwives' students.

METHODS

"Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice" guidelines were adopted to achieve the MidSTEP Italian version. Exploratory Factor Analysis was performed. Internal consistency for reliability was assessed using Cronbach's alpha reliability coefficient (α) and Omega coefficient (ω), while Intraclass Correlation Coefficients (ICC) were used to determine if the tool was stable over time.

FINDINGS

The Italian version of MidSTEP (MidSTEP-IT) has good internal consistency: considering the Clinical Learning Environment Scale, Cronbach's α was 0.839 (for the "Skill Development" subscale α was equal to 0.739 and for the "Philosophy of Midwifery Practice" subscale α was equal to 0.825) while considering the Midwifery Preceptor Scale, Cronbach's α was 0.920. Factor analysis does not fully reflect the factorial analysis of the original version.

CONCLUSION

The MidSTEP-IT had been proven to be a valid and reliable tool, easy and fast to administer, that could be effectively helpful for investigating and measuring the Italian midwifery students' perception of their clinical learning experiences, according to the setting and impact of mentors on their professional growth. It is an innovative tool, valuable in both clinical practice and research to highlight the importance of encouraging a supportive clinical learning environment and an efficient preceptorship.

The exploration of professional midwifery autonomy: Understanding and experiences of final-year midwifery students

BACKGROUND

The concept of professional midwifery autonomy holds great significance in midwifery education. Notably, clinical placements play a crucial role in introducing students to its concept. However, the understanding and experiences of students regarding midwifery autonomy are relatively unknown.

OBJECTIVES

This study aimed to examine the experiences and understanding of midwifery autonomy among final-year midwifery students.

METHODS

A qualitative exploratory study using three focus group interviews with final-year midwifery students from each of the three Belgian regions; Flanders, Walloon and the Brussels Capital Region. Focus groups were recorded, transcribed verbatim and analysed using a thematic analysis.

RESULTS

Upon data analysis, five key themes emerged; 1) working independently, 2) positive learning environment, 3) professional context, 4) actions and decisions of others and 5) beneficial for women. Students emphasized the importance of promoting professional midwifery autonomy through the ability to make their own professional decisions and take initiatives. They highlighted the need for a safe and supportive learning environment that encourages independent practice, nurtures self-governance and facilitates personal growth. Additionally, collaborative relationships with other maternity care professionals and increased awareness among women and the broader healthcare community were identified as essential factors in embracing and promoting professional midwifery autonomy.

CONCLUSIONS

Our study provides valuable insights into the significance of midwifery autonomy among final-year midwifery students. To empower midwifery students to truly understand and experience professional midwifery autonomy, educators and preceptors should adopt strategies that enhance comprehension, foster independent yet collaborative practice, establish supportive learning environments, and equip students to navigate challenges effectively, ultimately improving maternal and new-born health.

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.

Factors that enhance midwifery students' learning and development of self-efficacy in clinical placement: A systematic qualitative review

AIM

To conduct a systematic review and synthesis of qualitative studies to explore the significant factors that enhance midwifery students' learning experiences and development of self-efficacy in clinical placement.

BACKGROUND

Midwifery education programs leading to registration as a midwife require students to achieve academic, clinical, and professional competence. Clinical placement comprises a significant part of the program as students work and are assessed under the direct supervision of the Registered Midwife or preceptor. This learning and teaching partnership aims to enable the transfer of knowledge, skills, and behavior, i.e., competence, while providing the opportunity for students to become socialized into the midwifery practice culture. Against this background, characterized by the shortage of midwives, declining fertility rates, and a stressful environment, students learn to become a midwife and develop self-efficacy. Self-efficacy is the belief in one's ability to master challenges, which is described as a component in learning theories. There seems to be a need to identify factors that contribute to this development.

DESIGN

A qualitative systematic literature review.

METHOD

A systematic database search was conducted to identify primary peer reviewed qualitative literature published between 2000 and 2021 that has explored what enhances midwifery students' learning during their clinical placement. The databases searched included CINAHL (EBSCO), Medline (Ovid), Embase (Ovid), PsycINFO (Ovid), JBI Joanna Briggs Institute (Ovid), SveMed+ , and Web of Science. The search yielded a total of 354 results, of which 22 met the inclusion criteria. The relevant findings from the 22 studies were thematically analyzed and presented in the results.

RESULTS

The analysis revealed two descriptive themes - 'A nurturing relationship' and 'Predictability in the learning process, contextual factors. In addition, one analytic theme emerged - 'Gaining access to and belonging in an enabling educational and working culture'.

CONCLUSION

The relationship with the preceptor is a prerequisite for midwife students learning process and achievement of self-efficacy. A learning culture appears to be the fertile ground in which midwife students thrive and where they develop the self-efficacy needed to meet the demands of clinical placement.

"Nursing and speech and language students' perspectives of reflection as a clinical learning strategy in undergraduate healthcare education: A qualitative study"

AIM

The aim of this study was to explore nursing and speech and language students' perspectives of reflection as a clinical learning strategy during years three and four of their undergraduate education programmes.

BACKGROUND

Reflection is recognised as a core student learning activity which is widely used in undergraduate healthcare education for clinical practice. Studies indicate that structured models and frameworks do help novice students to develop the process of reflection-on-practice particularly in years one and two. However, there is limited research on healthcare students' perspectives of reflection as a clinical learning strategy in the latter years of their undergraduate healthcare education (years 3 and 4).

DESIGN

A qualitative descriptive design was used.

METHODS

Using a self-reporting method whereby students respond to a series of questions posed by the researchers, data were collected from nursing (n = 20) and speech and language students (n = 26) in one university in Ireland and analysed using thematic analysis.

RESULTS

The findings from both nursing and speech and language students were similar. Three themes identified included: description of reflection, undertaking reflection and contribution to clinical learning. Most students expressed beneficial effects of reflection for personal and professional clinical learning. Some students reported negativities to the written reflections, expressing a preference for more diverse and less structured strategies and more face-to-face reflective discussions with clinical educators.

CONCLUSIONS

Whilst the benefits of reflection for clinical practice are well versed in this study, the authors suggest that academic and clinical educators employ more diverse and innovative reflective tools for healthcare students who are at a more competent level of their undergraduate education programme. Further interprofessional research in relation to different clinical reflective strategies for healthcare students in years three and four of their undergraduate education programmes is warranted.

Developing and conducting appreciative inquiry interviews

BACKGROUND

The appreciative inquiry (AI) interview follows a specific format and needs to be planned and developed before implementation. AI questions are designed to draw on the interviewee's experiences, commencing with general questioning and progressing to more focused questioning.

AIM

To explain how to plan and undertake AI interviews, and to discuss issues that nurse researchers might encounter.

DISCUSSION

This article is based on the first author's experience of undertaking an AI doctoral study. The primary method of collecting data for the study was AI interviews. The more focused questioning related to participants' experiences of positive actions or behaviours. Although questioning was positive in nature and participant-centric, conducting the interviews was more problematic than the first author anticipated. Some participants struggled to recall positive memories to share.

CONCLUSION

The unexpected response to the interview questions required the first author to examine her practices, as well as beliefs and judgements relating to AI. This reflexivity assisted in implementing changes to the study's process, resulting in a more positive experience for her and the participants.

IMPLICATIONS FOR PRACTICE

Researchers using the AI interview require the capacity to be self-critical and change the process if necessary to enrich the outcome.

Midwifery students' expectations of and experiences with ethics education: A qualitative study

BACKGROUND

Instruction in ethics is an essential component of midwifery education. However, the evidence for how midwifery students experience ethics instruction in the classroom and via clinical experience is limited.

OBJECTIVE

This study explores midwifery students' perceptions of ethics education and their opinions about essential components of ethics education.

DESIGN

This was a qualitative descriptive thematic study, exploring student midwives' experiences of ethics education in their midwifery programs. We conducted focus group interviews with students from three midwifery programs in the United States (U.S.).

SETTING

Graduate midwifery educational programs in the United States.

PARTICIPANTS

Thirty-nine students from three graduate midwifery programs participated in four focus group discussions.

RESULTS

Thematic analysis identified three primary themes and associated subthemes: 1) current experience and identified needs, 2) the preceptor dilemma, with subthemes the critical role of modeling ethics and powerlessness within interprofessional conflicts, and 3) complicated relationships: advocacy, autonomy and choice. Students relied primarily upon clinical preceptors rather than classroom discussion as a significant source of learning ethics content and ethical behavior. Students called for explicit identification of ethics learning when it occurs, particularly midwifery-specific content, as well as increased opportunities for reflection and integration of their experiences.

CONCLUSION

This study shows the need for intentional inclusion of midwifery-specific ethics content into the overall midwifery education program content, in both classroom and clinical experiences. Midwifery programs should integrate ethics content in their curricula in a way that complements other midwifery content. This study also demonstrates the key role of clinical preceptors in student ethics learning.

Medical interns; the neglected learners of the maternity ward learning environment

BACKGROUND

Clinical training during internship is an important part of medical education. The maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology internship to obtain competencies in this field. The present study was conducted to explain medical interns' manner of learning in the maternity ward.

MATERIAL AND METHODS

The present study was conducted using a qualitative approach with the inductive content analysis method. This study observed the maternity wards of teaching hospitals affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through observation and semi-structured individual interviews.

RESULTS

Two main categories and seven subcategories emerged from the analysis of the data. Inadequate participation in learning opportunities included the following three subcategories: the incongruousness of the learning opportunities with the educational goals, inadequate readiness for participation in learning opportunities, and the overlap between learning opportunities and diminished autonomous practice. Inadequate formal and structured education included the following four subcategories: inadequate learning support and direction, subordinate roles and aimless presence, the pale educational role played by the attendants and senior residents, and learning through the support of midwifery educators.

CONCLUSION

Participation in and access to learning opportunities in the maternity ward are very difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and in the company of training supervisors or competent educators to obtain the required competencies in pregnancy and childbirth.

Student midwives' perception of peer learning during their clinical practice in an obstetric unit: A qualitative study

BACKGROUND

Evidence supports peer learning in clinical settings, but it has not been studied in obstetric units. In Sweden, obstetric units are a challenging learning area for student midwives because of the lack of attention to student needs and the stress of attaining the final number of 50 assisted births.

OBJECTIVES

To explore how student midwives experienced peer learning during clinical placement in an obstetric unit.

DESIGN

Qualitative approach.

SETTINGS

Three hospitals and obstetric units in Stockholm, Sweden.

PARTICIPANTS

Fifteen student midwives in a peer-learning model during clinical placement.

METHODS

Individual interviews followed by deductive content analysis using Boud's (2001) theoretical descriptions of peer learning.

RESULTS

The students shared skills, experience, and knowledge as equals and took responsibility for their peers' learning while supporting women in labor and childbirth. Students shared ideas, thoughts, and knowledge and gained perspective while learning as peers on an equal level. Students used each other to work independently without much involvement from the preceptor. Feedback was welcomed as encouragement.

CONCLUSIONS

Peer learning had positive consequences as an educational model in the clinical context in obstetric units.

Exploring the internship experiences of Swedish final term student midwives: A cross-sectional survey

Today, student midwives in Sweden spend half of their midwifery education at various internships. Practice reality demonstrates that there is an insufficient number of preceptors for the students, and the workload is demanding. Therefore, the present study aimed to explore the experiences of final term Swedish students during their midwifery internship and whether other paedagogical learning experiences beyond the apprenticeship model were included. A cross-sectional survey was distributed to 288 final year midwifery students at all universities offering the midwifery programme in Sweden. This paper focuses on open-ended questions, which were answered by 108 students, and analysed inductively via thematic analysis. Students described an intensive period with pressure during their internship. They expressed a desire for fewer parallel tasks and a better-structured internship. Students revealed that it was both a challenge and stressful to be under constant high performance while practising clinically. Furthermore, students described feelings of competition towards fellow peers in regard to attaining the final number of 50 assisted births. As to the paedagogical methods, the classical preceptorship model with a one-to-one student-preceptor relationship was predominately used. Preceptors were perceived as crucial role models. However, this learning experience was considered suboptimal for learning in the event where preceptors were not engaged or felt insecure regarding their knowledge, or if the preceptor was changed. For the students, the most optimal setting would be if preceptors were selected, trained, and supported in their role to supervise students, instead of being assigned any available preceptor, who was, at times, not a midwife.

Clustering clinical learning environment and mentoring perceptions of nursing and midwifery students: A cross-sectional study

AIMS

This study aimed to explore nursing and midwifery students' evaluation of the clinical learning environment and mentoring and to identify distinct student profiles relating to their perceptions.

DESIGN

This study employed a cross-sectional design.

SETTINGS

The study population included nursing and midwifery students in a university hospital in Finland.

PARTICIPANTS

All nursing and midwifery students who completed their clinical placement were invited to take part in the study in the academic year 2017-2018.

METHODS

The data (N = 2,609) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale. The data were analysed using a K-mean cluster algorithm to identify nursing and midwifery students' profiles.

RESULTS

The findings from this study indicate four distinct profiles (A, B, C, & D) of nursing and midwifery students in relation to the clinical learning environment and mentoring. Profile A (N = 1,352) students evaluated their clinical learning environment and mentoring to the highest level (mean varied from 9.44-8.38); and Profile D (N = 151)- to the lowest (mean varied from 5.93-4.00).

CONCLUSION

The findings highlight that nursing and midwifery students evaluate their clinical learning environment and mentoring more highly when: they have a named mentor, student and mentor discuss learning goals, there is a final assessment in clinical learning, the mentor's guidance skills support student learning, the clinical learning supports the student's professional development and pre-clinical teaching in an educational institution supports learning in the clinical placement.

IMPACT

Clinical learning plays an important role in nurse and midwifery education. Mentoring of clinical practice was shown to have a great influence on students' perceptions of their success in clinical learning. We suggest that clinical practice should be strengthened by the building of collaboration between nursing teachers and registered nurses.

Developing confidence during midwifery training: The experience of Swedish final year students

OBJECTIVES

Confidence is essential in performing midwifery care since the profession places great demands on the ability to work independently with a scientific approach and professional responsibility. Clinical training is extensive during midwifery education and is essential for the development of midwifery student's confidence and competence. The aim of the study was to describe the factors that increased and decreased confidence for midwifery students in clinical practice.

STUDY DESIGN

A qualitative design was used. Data was collected by a questionnaire that measured Swedish students' self-reported assessment of selected midwifery competencies. Two open questions gave the students the possibility to comment on what affected confidence during clinical practice. There were 401 comments analyzed by manifest content analysis.

RESULTS

Five categories described the experience of the students. Supervision during clinical training and the relationship with the midwives were most important factors for developing confidence. Further, to be theoretically and practically prepared before entering clinical practice. Regardless of activity the environment has to be learning and give time for reflection. Personal factors could affect professional confidence but above all it takes time to learn and practice midwifery. Factors that decreased confidence were stressed and uninterested supervisors. Patronizing attitudes towards students and the fear of doing something wrong also decreased confidence.

CONCLUSIONS

Several factors contributes to enhance confidence among midwifery students in clinical training. The most important factor was supervision and the role as supervisor must be emphasized and sufficient time must be allocated to supervising midwives for them to fulfil their commitment.

'The rollercoaster': A qualitative study of midwifery students' experiences affecting their mental wellbeing

OBJECTIVE

Midwifery student mental wellbeing is an important consideration for the sustainability of the profession, however it has seldom been the subject of empirical research. Previous studies of the lived experience of midwifery students have focused on the impact of transition experiences and student satisfaction, rather than specifically on mental health and students' views on support for their mental wellbeing.

DESIGN

A qualitative descriptive study using semi-structured interviews.

SETTING

A midwifery undergraduate programme in one university in the South of England.

PARTICIPANTS

20 BSc midwifery students.

FINDINGS

Two inductive themes were developed from our analysis. The theme of 'the rollercoaster' encapsulated students' experience over the length of the course, characterised by multiple culture shocks of being in different worlds, from one clinical placement to the next, from university to clinical placement. This experience was emotionally taxing. The theme of 'being noticed, feeling connected' encapsulated midwifery students' views on what could help them enjoy their training. They wanted to be seen as individuals by at least one educator, they wanted opportunities to connect with their peers and they wanted the support available to them to be consistent.

CONCLUSIONS

Listening to students' insights into the lived experience of being a midwifery student can enable midwifery educators to improve the way courses are designed and support structures are put in place. The importance of having consistent contact with peers and educators cannot be underestimated.

IMPLICATIONS FOR PRACTICE

The emotional demands of midwifery training must be acknowledged. Educators should identify ways in which they can provide students with consistent individualised support and regular opportunities to meet with their peers.

Being bullied as a midwifery student: does age matter?

Clinical placement is a compulsory component of midwifery education and a time when some midwifery students become targets of workplace bullying. An anonymous, online qualitative survey was used to collect data from two contrasting groups of purposively recruited UK and Australian midwifery students that responded to a call for experiences of bullying while on clinical placement. Participants in group were either aged between 18–21 years (n=20) or over 43 years of age (n=20). The data collected from each group was thematically analysed and compared. While younger midwifery students have an additional power disadvantage compared to their older counterparts, the pattern of bullying experience between the two groups was remarkably similar. Younger students however, experience more verbal and overt forms, and are more likely to respond passively to the experience. Results are discussed in terms of impact on individual welfare and the viability of the profession.

Holding momentum: a grounded theory study of strategies for sustaining living at home in older persons

Purpose: Government strategies are putting increasing emphasis on sustaining the capacity of older persons to continue living independently in their own homes to ease strain on aged care services. The aim of this study was to understand the experiences and strategies that older people utilize to remain living at home from their own perspective. Methods: A grounded theory methodology was used to explore the actions and strategies used by persons over the age of 65 to enable them to remain living in their own homes. Data were collected from 21 women and men in three focus group discussions and 10 in-depth semi-structured interviews. Results: The data revealed that the central process participants used to hold momentum and sustain living at home involves a circular process in which older people acknowledge change and make ongoing evaluations and decisions about ageing at home. Conclusion: These findings have implications for informing policy and service provision by identifying appropriate resources and services to promote successful ageing at home.

Learning experiences of final-year student midwives in labor wards: A qualitative exploratory study

INTRODUCTION

Clinical placements are an integral part of midwifery education and are crucial for achieving professional competencies. Although students' experiences on placements have been shown to play a meaningful role in their learning, they have received scant attention in the literature. The aim of this paper is to describe the learning experiences of final-year student midwives in labor wards within the Brussels metropolitan region, Belgium.

METHODS

A qualitative exploratory study was conducted using two focus groups (N=20). Data analysis included: transcription of audio recordings, thematic content analysis with coding into recurrent and common themes, and broader categories. Discussions among researchers were incorporated in all phases of the analysis for integrity and data fit.

RESULTS

Data analysis identified the following categories as determining student learning experiences in labor wards: 1) managing opportunities, 2) being supported, and 3) dealing with the environment. Overall, respondents were positive and enthusiastic about their learning experiences, although some felt tense and unprepared. Students expressed concerns about differences in learning opportunities between placements and found it challenging to achieve all competencies. Student learning experiences were enhanced when they had placements for longer periods with the same supportive mentors.

CONCLUSIONS

Factors related to students' functioning, the healthcare professional, midwifery education and hospital environment affected their learning in labor wards. The combination of a more persevered preparation of students and mentors, together with a student-centered organization of placements, is crucial to create a positive learning experience for midwifery students in labor wards.

Exploring the Perspectives of Older People on the Concept of Home

Objectives

Continuing to live at home is arguably one of the most important challenges older persons face as they age. The aim of this study was to clarify how older adults conceptualise home through age-related lifestyle changes.

Methods

Principles from grounded theory were used to examine the perspectives of 21 older adults obtained from three focus group discussions and 10 in-depth semistructured interviews.

Results

Four major categories were developed: “anchoring self,” “enabling freedom,” “being comfortable,” and “staying in touch.” Discussion. For the participants in this study remaining at home enabled a sense of independence and freedom, self-worth and identity, comfort, and an ongoing active role in the community. However, some aspects of home could be renegotiated despite changes to living location, with new social connections able to be forged and personal comforts being transferrable. This holds important implications for supporting older persons to both sustain living at home and to adjust to changing circumstances, suggesting the importance of drawing on the experiences of older persons themselves in developing strategies to promote successful aging.

Workplace culture and the practice experience of midwifery students: A meta-synthesis

AIM

To describe midwifery students' practice experience and to explore facilitators and barriers to positive clinical learning experiences.

BACKGROUND

Practice experience is a vital component of every midwifery course. Course dissatisfaction and attrition of midwifery students has been attributed to sub-optimal practice experiences. Events or actions experienced by midwifery students that trigger dissatisfaction and attrition need to be identified.

EVALUATION

A meta-synthesis was based on that developed by Noblit and Hare.

KEY ISSUES

Students perceive workplaces as poorly prepared for their arrival and subsequent support. Students' experience in the practice setting is influenced by the existing workplace culture. Workplace culture influences institutional functioning and individuals within the culture. Enculturation of students into the midwifery culture and subsequent learning is affected by the support received.

CONCLUSIONS

The practice experience of midwifery students was profoundly influenced by workplace culture. Students tended to have polarized accounts of their experience that were predominantly negative.

IMPLICATIONS FOR NURSING (MIDWIFERY) MANAGEMENT

To provide an optimal environment for midwifery students; midwifery managers and individual midwives need to be aware of the facilitators and barriers to midwifery student development in the practice setting.

Norwegian midwives' opinion of their midwifery education - a mixed methods study

BACKGROUND

Midwifery education in Norway has undergone radical reforms in the past few decades. In 2004, the compulsory year of paid internship was removed from the requirement to become an authorised midwife. Since then, authorisation as a midwife depends on the successful completion of a two-year full-time academic course, consisting of 50% clinical practice and 50% theoretical education. Our objective was to examine midwives' opinion of their Norwegian midwifery education in relation to their midwifery practice, comparing those educated with internship to those without.

METHODS

We performed a mixed-methods study based on data from a nationwide cross-sectional survey. A sample of 547 midwives completed a postal questionnaire, autumn 2014. Midwives were asked how they were educated, how their education prepared them for practice (multiple choice) and to freely comment on their midwifery education. Thematic analysis and descriptive and comparative analysis was used. Data sets were analysed independently and jointly interpreted.

RESULTS

Of our sample, 154 (28.2%) were educated through a two-year midwifery education without internship, while 393 (71.8%) had a one-year midwifery education with internship. Compared to midwives who had internship, midwives without were four times more likely to report that their education did not, or only partially prepare them for their work as a midwife. The association lost its significance when adjusted for experience as a midwife. According to the qualitative data, the primary reason for the association was insufficient clinical practice during education. Relevant clinical placement, ample practice time with good preceptorship and internship were proposed as methods to prepare for practice as a midwife. The theory-practice gap was highlighted as another hindrance to being prepared for practice.

CONCLUSIONS

Academisation of the midwifery education has resulted in newly qualified midwives feeling less prepared for practice. Midwives would have liked more time for clinical practice and simulation training of core midwifery clinical skills included in the education. Midwifery educations need to explore ways to achieve a good balance between practice and theory. Workplaces need to explore alternative ways to internship to assist new graduates to become confident midwives with a strong midwifery identity.