Professional identity: Students' learning from the attributes and behaviours of midwives on clinical placement.

BACKGROUND: Midwifery practice experience is an important component of education to develop an understanding of professional identity in midwifery students. The responsibility of supporting student development in the clinical setting is predominantly undertaken by clinical midwives. There is minimal literature relating to the professional identity development of midwifery students. AIM: To explore midwifery student experiences of the positive attributes of clinical midwives who supported the professional identity development of midwifery students in the clinical practice setting. METHODS: An Appreciative Inquiry approach guided this study. The setting was a university in Sydney, Australia. Participants comprised thirteen students from a postgraduate midwifery course. Data were collected via individual interviews and analysed thematically. Students had two to six months of placement in the clinical setting. FINDINGS: Data analysis identified three themes, Putting the woman at the centre of care; Supporting a woman-centred environment and Focusing on student success. DISCUSSION: Findings from this study revealed that extended time spent with a midwife enabled the student to observe and reflect on the nuances of midwifery practice that are not overtly shared with students. Students were able to observe a midwife's tacit way of being. This paper reveals the positive attributes and behaviours of midwives whose practice the students want to emulate. CONCLUSIONS: Midwifery students' exposure to positive clinical midwife role models on clinical placement enables them to develop a greater understanding of professional identity.

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.

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.

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.

The decision to suture after childbirth: cues, related factors, knowledge and experience used by midwives.

OBJECTIVE: to present critical cues, related factors, knowledge and experience used by midwives when deciding whether or not to suture perineal and associated trauma after childbirth. DESIGN: an exploratory descriptive study using in-depth interviews to collect data using the Critical Decision Method. SETTING: birth units in Greater Western Sydney. PARTICIPANTS: 19 volunteer midwives experienced in deciding whether or not to suture or in making referrals to suture childbirth trauma. FINDINGS: the main findings were the cues of bleeding and trauma with their accompanying specific attributes, and woman- and midwife-centred factors considered when deciding whether or not to suture perineal and associated trauma. Furthermore, the knowledge and experience that supported decision-making, such as detailed knowledge of anatomical structures, workshops and observing highly skilled clinicians, were identified. CONCLUSION: the cues and related factors can be formed into an inventory and tested for content validity using a panel of expert midwives. IMPLICATIONS FOR PRACTICE: such an inventory has the potential to minimise inappropriate intervention and alleviate unnecessary discomfort, thus increasing safety and quality of care for women following childbirth. In addition, midwifery educators and those coaching less-experienced midwives can use the collected clinical information to aid the development of students' and midwives' decision-making skills regarding whether or not to suture childbirth trauma.

Clinical decision-making for repair of spontaneous childbirth trauma: validation of cues and related factors.

From recalled childbirth cases, a series of cues and related factors were previously identified that were used by midwives when making decisions to suture or not suture perineal and associated trauma incurred during spontaneous vaginal delivery. This study aimed to determine the validity of these cues and related factors. A panel of 18 experienced midwives evaluated their content validity using the criteria of "necessity" and "sufficiency." The two main cue categories-"bleeding" and "birth trauma"-were considered by 18 (100%) of the panel members to be necessary to assess. At least 16 (89%) panel members considered the following specific cues necessary to assess: in the bleeding category-type, flow, amount, and effect of application of pressure or ice; in the birth trauma category-trauma sites, trauma types, dimensions of trauma, types of tissue, alignment of tissue, edema, and bruising. Seventeen (94%) panel members considered seven woman-centred related factors that were necessary to assess and 14 (78%) considered the combination of all cues in bleeding, birth trauma, and related factors sufficient for making the decision to suture or not. The availability of these validated cues and related factors has the potential to guide a comprehensive assessment on which the decision to suture or not suture depends. This addition to the domain of midwifery knowledge enables educational preparation of midwives who will have the capacity to more adequately support women in childbirth.

A pilot study to investigate the effect of a simulation strategy on the clinical decision making of midwifery students.

The actual effect of the use of simulations on clinical decision making is inconclusive. This pilot study used a posttest design to determine the effect of a simulation strategy on the clinical decision-making process of midwifery students. Thirty-six graduate diploma students volunteered and were randomly assigned to two groups, with the experimental group receiving two simulation sessions (normal labor and physiological jaundice), and the control group receiving the two usual lectures. The main findings were that students who received the simulation strategy collected more clinical information, revisited collected clinical information less, made fewer formative inferences, reported higher confidence levels, and for the posttest normal labor simulation, reached a final decision more quickly. Such effects are reasonable for this type of intervention with the existent variability in each group. Further research with a larger sample size and more rigorous data collection strategies is required.

Using a simulation strategy: An educator's experience.

As students are expected to apply their knowledge in clinical settings educators need to use learning strategies that provide students with experiences that facilitate knowledge application. The use of simulations has been identified to be such a strategy. However, their use in the classroom has been described as burdensome for educators. Consequently educators may avoid using them. This paper describes the experience of an educator preparing, implementing and evaluating the use of simulations with midwifery students. In conclusion, the educator found the experience to be worthwhile and well received by students.