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Mramel M, El Alaoui M, El Janati Idrissi R. Barriers to clinical learning skills development among midwifery students and newly qualified midwives in Morocco: A qualitative study. BELITUNG NURSING JOURNAL 2024; 10:160-168. [PMID: 38690298 PMCID: PMC11056836 DOI: 10.33546/bnj.3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/01/2024] [Accepted: 03/17/2024] [Indexed: 05/02/2024] Open
Abstract
Background In Morocco, despite various initiatives to improve the quality of reproductive healthcare, the indicators remain unfavorable. To strengthen the skills of midwives and support the achievement of Millennium Development Goals (MDGs) 4 and 5 by 2030, Morocco has developed and implemented a competency-based training framework. However, there is a lack of information on the successful implementation of this program and its impact on the quality of student midwives' preparation for practice. Objective This study aimed to gain a deeper understanding and explore the barriers affecting the development of clinical learning skills among midwifery students and newly qualified midwives. Methods This study employed a descriptive, exploratory qualitative approach. Data were collected through nine focus group discussions with 30 midwifery students and 24 newly graduated midwives between April and June 2023 from six higher education institutions in northern and central Morocco. Inductive content analysis was used to analyze the transcribed discussions. Results The barriers varied between locations. Overall, the internship design was inadequate, and the clinical environment was insufficient. Participants highlighted limited opportunities to experience the full range of midwifery skills. However, most midwifery students and new graduates had deficient competencies in managing high-risk situations and emergencies. Conclusion This work provides an overview of the nature and extent of the challenges faced by many student midwives in Morocco, resulting in newly graduated midwives being poorly prepared for the full range of midwifery practice. These findings can inform various initiatives to strengthen midwifery education at the global, regional, and national levels.
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Affiliation(s)
- Majida Mramel
- Higher Normal School, Abdelmalek Essâadi University, Tetouan, Morocco
- Higher Institute of Nursing Professions and Health Techniques, Fes, Morocco
| | - Mustafa El Alaoui
- Higher Normal School, Abdelmalek Essâadi University, Tetouan, Morocco
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Kubota S, Ando M, Khambounheuang S, Theppanya K, Nanthavong P, Tengbriacheu C, Sisavanh M, Khattiyod T, Asai D, Murray J, Sobel H. A gap analysis of midwifery competency, pre- and in-service education for reproductive, maternal, newborn, child and, adolescent health in Lao People's Democratic Republic. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100959. [PMID: 38144445 PMCID: PMC10746507 DOI: 10.1016/j.lanwpc.2023.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/15/2023] [Accepted: 10/22/2023] [Indexed: 12/26/2023]
Abstract
Background Ensuring midwives deliver quality essential services requires systematic and timely updates to midwifery education based on constantly evolving global evidence and local needs. However, midwifery curricula are often not updated to incorporate new evidence, consistent with national standards. This study supported the Ministry of Health of Lao People's Democratic Republic to identify gaps in the midwifery competency framework and training packages. Methods Stakeholder consultations and a document review were conducted to define a core package of RMNCAH interventions and care tasks that midwives should provide based on the national Essential Health Service Package (EHSP). Nationally defined midwifery competencies, the higher diploma midwifery curriculum, and in-service training packages were mapped against required interventions and care tasks. Data were used to revise midwifery education standards. Findings Midwives were expected to provide 47 RMNCAH interventions based on the EHSP. At baseline, 7 (14.9%), 11 (23.4%) and 35 (74.5%) of the 47 interventions were included in the midwifery competency, higher diploma in midwifery curriculum, and in-service training materials, respectively. After revision, the midwifery competency framework included 42 of 47 interventions (89.4%). The data are currently being used to review and update the national midwifery pre-service diploma curriculum. Interpretation This analysis enabled the Ministry to identify RMNCAH content gaps in national midwifery education standards and align them with the EHSP. Regular use of a quantitative approach to review educational content is essential to ensure standards are consistent with changing evidence. The approach has potential application to other service areas, cadres, and countries. Funding Korea Foundation for International Healthcare (KOFIH) supported research operation.
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Affiliation(s)
| | | | | | | | | | - Chankham Tengbriacheu
- National Mother and Child Health Center, Department of Hygiene and Health Promotion, Ministry of Health, Vientiane, Lao PDR
| | | | | | | | - John Murray
- WHO Western Pacific Region, Manilla, Philippines
| | - Howard Sobel
- WHO Western Pacific Region, Manilla, Philippines
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Garti I, Gray M, Bromley A, Tan JYB. Pre-eclampsia training needs of midwives in a Ghanaian tertiary hospital: A cross-sectional study. Nurse Educ Pract 2024; 75:103872. [PMID: 38244337 DOI: 10.1016/j.nepr.2024.103872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/26/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024]
Abstract
AIM This study aimed to assess the specific clinical and non-clinical training needs of midwives and determine their preferred approach to enhancing performance. BACKGROUND Pre-eclampsia remains one of the leading causes of maternal deaths in low and middle-income countries. Pre-eclampsia-related deaths may be due to reduced midwifery knowledge and inadequate management. Therefore, a training needs assessment is vital in identifying gaps in practice, especially, in poorly resourced settings for maximal use of training resources. DESIGN A hospital-based cross-sectional study. SETTING The largest tertiary hospital in Ghana. METHODS An online version of the validated WHO Hennessy-Hicks Training Needs Analysis questionnaire was used to assess midwives' training needs on the management of pre-eclampsia. The tool has good psychometric properties and was used to assess 1) midwives' confidence in performing tasks, 2) the importance of the task to their role and 3) their preferred performance improvement approach. Data analysis adhered to the guidelines specified in the Hennessy-Hicks Training Needs Analysis Questionnaire and the priority training requirements of the midwives were assessed through descriptive statistics and a series of independent t-tests. RESULTS Among the 250 midwives who responded, most possessed 1-5 years of experience (74.7 %). All 28 tasks were viewed by midwives as essential responsibilities in pre-eclampsia management. Midwives had the greatest need for training in research/audit and clinical skills domains respectively (p < 0.001, 95 % confidence interval: 1.08-1.47, Cohen's-D = 1.27; and p < 0.001, 95 % confidence interval: 0.69-1.06, Cohen's-D = 0.87). The foremost primary training necessity, as recognised by midwives, was undertaking health promotion activities, including antenatal health education (MD= 0.43, 95 % confidence interval: 0.29-0.57). Training courses were identified as the preferred approach to address training needs and improve overall proficiency. CONCLUSION Midwives in Ghana require comprehensive training covering research and clinical-based competencies to improve pre-eclampsia management. Considering the pivotal role of Ghanaian midwives in safeguarding maternal well-being, there is a compelling need to enhance the calibre of midwifery services. These findings can guide stakeholders in countries with comparable healthcare contexts in creating effective, resource-efficient training programs that avoid counterproductivity, ultimately supporting national initiatives to enhance pre-eclampsia management and the quality of care.
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Affiliation(s)
- Isabella Garti
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia.
| | - Michelle Gray
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Angela Bromley
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Jing-Yu Benjamin Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia; School of Nursing and Midwifery, University of Southern Queensland, Ipswich Campus, Ipswich QLD 4305 Australia
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Moller AB, Welsh J, Agossou C, Ayebare E, Chipeta E, Dossou JP, Gross MM, Houngbo G, Hounkpatin H, Kandeya B, Mwilike B, Petzold M, Hanson C. Midwifery care providers' childbirth and immediate newborn care competencies: A cross-sectional study in Benin, Malawi, Tanzania and Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001399. [PMID: 37279204 DOI: 10.1371/journal.pgph.0001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 06/08/2023]
Abstract
Evidence-based quality care is essential for reducing sub-Saharan Africa's high burden of maternal and newborn mortality and morbidity. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers and the working environment. We assessed midwifery care providers' ability to provide quality intrapartum and newborn care and selected aspects of the working environment as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) project in Benin, Malawi, Tanzania, and Uganda. We used a self-administered questionnaire to assess provider knowledge and their working environment and skills drills simulations to assess skills and behaviours. All midwifery care providers including doctors providing midwifery care in the maternity units were invited to take part in the knowledge assessment and one third of the midwifery care providers who took part in the knowledge assessment were randomly selected and invited to take part in the skills and behaviour simulation assessment. Descriptive statistics of interest were calculated. A total of 302 participants took part in the knowledge assessment and 113 skills drills simulations were conducted. The assessments revealed knowledge gaps in frequency of fetal heart rate monitoring and timing of umbilical cord clamping. Over half of the participants scored poorly on aspects related to routine admission tasks, clinical history-taking and rapid and initial assessment of the newborn, while higher scores were achieved in active management of the third stage of labour. The assessment also identified a lack of involvement of women in clinical decision-making. Inadequate competency level of the midwifery care providers may be due to gaps in pre-service training but possibly related to the structural and operational facility characteristics including continuing professional development. Investment and action on these findings are needed when developing and designing pre-service and in-service training. Trial registration: PACTR202006793783148-June 17th, 2020.
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Affiliation(s)
- Ann-Beth Moller
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joanne Welsh
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Christian Agossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Elizabeth Ayebare
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Effie Chipeta
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Gisele Houngbo
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Hashim Hounkpatin
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Bianca Kandeya
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi
| | - Beatrice Mwilike
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claudia Hanson
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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İsbir GG, Guner S, Beşen MA, Thomson G. Evaluation of labour and birth education by midwifery educators: A qualitative study from Turkey. Nurse Educ Pract 2023; 66:103515. [PMID: 36481496 DOI: 10.1016/j.nepr.2022.103515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Midwifery students' education regarding labor and birth is crucial because it directly affects the quality of care provided to women in labor. AIMS Exploring educators' experiences of delivering labor and birth education to midwifery students and evaluating the circumstances that affect the quality of labor and birth education METHODS: This was a qualitative study. Semi-structured interviews were conducted with 16 educators teaching midwifery in 16 midwifery departments at universities in Turkey. Inductive thematic analysis was conducted. All transcripts were evaluated by two researchers, and codes were created. The codes formed the subthemes in terms of similarities and differences; themes were created based on combining subthemes. FINDINGS Three themes were identified. The first - "impacts of global changes on labor and birth education"- shows how labor and birth is affected by changing policies, philosophies, individuals, and cultures. The second theme - "opportunities/obstacles in labor and birth education"- shows how sources of information, as well as individual and systemic factors, create opportunities or obstacles for the quality of labor and birth education. The final theme - "recommendations for quality labor and birth education"- presents participants' suggestions for the effective integration of courses, use of sources of information, and updating of curriculum. DISCUSSION Changing policies, philosophies, individuals, and cultures affect labor and birth education. Individual and systemic factors and information sources create opportunities or barriers for the quality of labor and birth education. CONCLUSION A positive childbirth experience is a basic human right for both women and newborns. This can be made possible by professionals who have received quality labor and birth education. Thus, investment in midwifery education is an important cost-effective approach to improving health outcomes.
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Affiliation(s)
| | - Sevil Guner
- Mersin University, School of Health, Midwifery Department, Turkey.
| | | | - Gillian Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston PR1 2NE, UK.
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