A study of student midwives' experiences during their two-year education programme

Using diaries to explore midwives' experiences in intrapartum care: an evaluation of the method in a phenomenological study

AIM

finding appropriate ways of obtaining contemporaneous data in acute settings is an ethical and practical dilemma for researchers. Our aim was to evaluate the use of diaries by midwives in a research study informed by a phenomenological approach.

SETTING AND SAMPLE

a purposive sample of 12 midwives working across three Trusts in the North West of England.

METHOD

a phenomenological approach was used to guide a study exploring midwives views of confidence when providing intrapartum care. Two methods of data collection were used; diaries and semi-structured interviews. This is a methodological paper reporting on the usefulness of diaries used with participants who were health professionals in a health-care setting.

RESULTS

participants completing qualitative diaries provided rich data, recording not only a description of events but also their emotional response to such events. A high degree of self-reflection and analysis was also evident. The participants provided contextual and time situated data although remaining focused on the phenomena being explored. Furthermore, the diaries highlighted the data that may not have been uncovered by interview alone.

CONCLUSION

use of diaries for qualitative data collection is feasible and well received by health professionals. Individuals completing diaries were engaged in a reflective process enabling them to address significant events. Hence, diaries may provide benefits to both the researcher and the participant. They proved appropriate to a study requiring an exploration of the lived experience of the participants. Researchers conducting research informed by a phenomenological perspective should consider diaries as a valuable data collection tool.

A review of nursing and midwifery education research in the Republic of Ireland

This literature review aims to (a) provide a summary of the research conducted in the Irish nurse/midwifery education field, (b) identify key recommendations from the research reviewed and (c) examine the policy, theory and methodological implications of the research conducted. The electronic databases of CINAHL (EBSCO host 1982-2006) and PubMed (1950-2006) were searched for the relevant literature. Sixty-one studies satisfied the criteria for inclusion which were based on; quality of research design, sampling, data analysis, scientific merit, and authorship (registered nurse/midwife who conducted research in the Republic of Ireland). Findings demonstrated diversity in relation to aims, methods and results highlighting a need to formulate a collaborative research agenda in nurse and midwifery education.

Who am I now? The experience of being a post-registration children's student nurse in the first clinical placement

Role transition from staff nurse to post-registration student is not a well researched area of nursing. Two previous Irish studies have been reported of the experiences of post-registration midwifery students [McCrea, H., Thompson, K., Carswell, L., Whittington, D., 1994. Student midwives' learning experience on the wards. Journal of Clinical Nursing 3, 97-102; Begley, C., 1997. Midwives in the making: a longitudinal study of the experiences of student midwives during their two-year training in Ireland. Unpublished PhD Thesis, School of Nursing and Midwifery, Trinity College, Dublin.] but there is limited research into post-registration children's student nurses experiences. A broadly phenomenological approach was employed to interpret what it means to be a post-registration children's student nurse during the first clinical placement. Data was collected from a purposive sample of six students, using unstructured tape recorded interviews. Thematic content analysis was utilised to produce an interpretation of nurses' experience within the first clinical placement. The findings reflect the participants' role confusion when changing from being a staff nurse in one discipline of nursing to being a post-registration student in another. They find previous experience is not recognised and that students originating from different disciplines in nursing have different experiences within the first placement. Coping mechanisms are discussed along with preparation for and supports available in the clinical area.

Emotion work and boundary maintenance in hospital-based midwifery

OBJECTIVE

To identify and explore the emotion work of hospital-based midwives.

DESIGN

An ethnographic approach using focus groups, observations and interviews.

SETTING

South Wales, UK.

PARTICIPANTS

Phase one of the study: self-selected convenience sample of 27 student midwives in first and final years of 3-year (direct entry) and 18-month (post-nursing) programmes. Phase two: opportunistic sample of seven qualified hospital-based midwives. Phase three: Purposive sample of 10 hospital-based midwives working within one National Health Service Trust. Sample representative of a range of clinical locations, length of clinical experience and clinical grades.

FINDINGS

The emotion work of midwives was strongly influenced by the context of practice. For hospital-based midwives, relationships with midwifery colleagues were of key importance, providing the main source of feedback on individual practice. Negotiating these relationships was a major source of emotion work. Although collegial relationships could provide support and affirmation, they were also a frequent source of conflict, particularly between junior and senior midwives. This discord was underpinned by conflicting ideologies of midwifery practice.

KEY CONCLUSIONS

The theoretical framework of boundary maintenance was used to interpret the findings. Senior and junior midwives frequently held contradictory models of practice, resulting in competing claims for occupational jurisdiction. Midwives made use of a variety of devices in order to establish and maintain intra-occupational boundaries. Senior midwives attempted to maintain their position through unwritten rules and sanctions, supported by their claim to greater clinical expertise and experience. Junior midwives rarely challenged this authority; their responses were often subversive and designed to create an appearance of compliance.

IMPLICATIONS FOR PRACTICE

These findings contribute to our understanding of inter-collegial conflict in UK midwifery, providing insights into workplace harassment and low staff morale, which are likely to exacerbate workforce attrition. The underpinning ideological dissonance experienced by midwives must be acknowledged and tackled for these issues to be effectively addressed.

Midwifery practice and the crisis of modernity: implications for the role of the midwife

Almost since its inception, the concept of modernity was found to display tensions between its emancipatory potential to liberate the human subject from the manacles of tradition, and the application of reason to co-ordinate and control the natural world through scientific knowledge. This paper presents a qualitative analysis of in-depth interviews with 12 midwives about their role in the Irish maternity services and argues that, in a period of late modernity, these tensions continue to manifest themselves in the context of the midwife's role. Although the contemporary period is marked by a loss of faith in scientific truths, widely contested obstetric knowledge and practices continue to exercise mastery over nature while undermining a central feature of the midwife's role-the liberation of the autonomous subject. Drawing on the theory of communicative action developed by the critical theorist Jürgen Habermas, it is argued that the midwife's role in facilitating the autonomous choices of women through communicative action is impeded by the colonization of the lifeworld of labour and childbirth by the technocratic system of obstetrics. Although participants reported that their role involved empowering women and facilitating choices through dialogue congruent with communicative action, data also suggested that participants used strategic communication with clients aimed at achieving particular ends. The use of strategic communication was linked to the way in which the midwife's role is determined to a large extent by the practices and protocols of obstetrics, and also to the notion of client passivity. The instrumental rationality of obstetrics is linked to an outcome orientation to power and money, and a political economy perspective of medicine. It appears that communicative action between midwives and obstetricians is important in bringing about structural changes to facilitate the conditions for communicative action between midwives and their clients.

Identifying the midwifery practice component of Australian Midwifery Education Programs. Results of the Australian Midwifery Action Project (AMAP) Education Survey

This paper is the first in a series of papers reporting on the findings of the AMAP Education Survey of the 27 universities providing a program for initial authorization to practise midwifery. It concentrates on issues related to the practice component of courses. Subsequent papers will present findings related to workforce issues and the barriers to effective midwifery education as identified by the midwifery course coordinators. Serious concerns are raised about the standards of Australian midwifery education, particularly when international comparisons are made, in terms of the length of courses, clinical practice requirements and the opportunities for students to engage with contemporary midwifery practice across community and acute settings.

'Knowing your place': student midwives' views of relationships in midwifery in Ireland

OBJECTIVE

to explore the feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences.

DESIGN

phenomenology, using the technique of triangulation in a number of ways.

SETTING

all seven midwifery schools in Southern Ireland.

PARTICIPANTS

all students in the first intake of 1995 in every midwifery school in Ireland (n=125).

DATA COLLECTION

individual and group interviews, diary-keeping and questionnaires.

KEY CONCLUSIONS

the findings presented in this paper illustrate the students' views of their relationships with qualified midwives and obstetricians.

IMPLICATIONS FOR PRACTICE

an attitude of respect for all students needs to be fostered in hospitals educating midwives if we are to produce caring midwives in the future. The new, extended programme of midwifery education in Ireland should include an emphasis on communication skills and conflict management. A re-organisation of the hierarchical structures evident in midwifery management would lead to an improvement in the experiences of students and childbearing women alike.

'Giving midwifery care: student midwives' views of their working role

OBJECTIVE

to explore the opinions, feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences.

DESIGN

using quantitative and qualitative methods. A phenomenological approach was used to guide the qualitative section of the study reported here.

SETTING

all seven midwifery schools in Southern Ireland.

PARTICIPANTS

all students in the first intake of 1995 in every midwifery school in Ireland (n = 125).

DATA COLLECTION

individual and group interviews, diary-keeping and questionnaires.

KEY CONCLUSIONS

the findings presented here illustrate the students' views of their working role. The environment appeared to be one of work, rather than learning, and the students' status that of junior employee rather than 'learner' They perceived themselves as 'thrown in the deep end' without much support or guidance from qualified staff. They were frightened, unsure of themselves and suffered from role conflict and loss of status. There appeared to be an acute shortage of staff and the care given was seen to be the basic minimum, fulfilling women's physical needs but ignoring their emotional ones. The care given appeared to be planned according to routine and economic necessity rather than for sound midwifery, medical or social reasons.

IMPLICATIONS FOR PRACTICE

the education of students needs to focus on the development of autonomous practice and the use of routines and non-research based care should be phased out. Students need to be assisted, with support from educated mentors, to plan care in a holistic way that will enable them to develop their midwifery skills in the future.

Student midwives' views of 'learning to be a midwife' in Ireland

OBJECTIVE

To explore the opinions, feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences.

DESIGN

Quantitative and qualitative methods. A phenomenological approach was used to guide the qualitative section of the study.

SETTING

All seven midwifery schools in Southern Ireland.

PARTICIPANTS

All students in the first intake of 1995 in every midwifery school in Ireland (n = 125).

DATA COLLECTION

Individual and group interviews, diary-keeping and questionnaires.

KEY CONCLUSIONS

The findings presented in this paper illustrate the students' views of their education. Students perceived themselves as part of the workforce and believed that their educational needs were denied. They were given little clinical teaching and guidance and were not assisted to learn the skills of decision-making or judgement. Much of their learning took place by trial and error. The 13 weeks allocated for theoretical input in the midwifery education programme in Southern Ireland is far too short and many students thought that time was wasted. Relationships with the teaching staff were good, although some authoritarian attitudes were evident and teaching did not appear to be student-focused.

IMPLICATIONS FOR PRACTICE

Theoretical teaching needs to be broadened and thought given to the integration of theory and practice. Clinical teaching is a necessity throughout the two-year programme and opportunities to teach while giving care should be identified and utilised. The use of prepared mentors, sufficient support staff and longer allocations to each area are recommended.