ABSTRACT
Background: The purpose of midwifery education is to produce clinically competent midwives. However, clinical training in Malawi faces multiple challenges, and the concept of Clinical Competency (CC) has not been analysed in this context. This article analyses CC during undergraduate midwifery training in Malawi to elucidate its attributes, antecedents, consequences, and empirical referents. Methods: A literature search was performed on data bases, Google Scholar, PubMed, and CINAHL, using the following terms: clinical competency, midwifery competency, nursing competency, nursing and midwifery competency. Published articles were retrieved and clinical competency analysis was guided by Walker and Avant's strategy. Results: CC attributes were knowledge, skills, attitudes, performance level, professionalism, and entrustable professional activity. Antecedents included motivation, role models, learning environment and personal traits. The consequences of CC include confidence, client safety, and quality of care. CC can be measured through a combination of four strategies: observing a student practising it in clinical area, simulation or Objective Structured Clinical Examination (OSCE), application through written essays or case presentations, and knowledge-based assessment. Conclusion: CC is a multidimensional concept and its definition and defining attributes are contextual. Similarly, clinical competencies are a major determinant of educational decisions such as curriculum nucleus, length of clinical placement, teaching strategies, and student assessment methods. However, CC and its attributes have not been fully utilised in Malawi, especially in clinical teaching and student clinical assessments. There is a need to adequately prepare midwifery educators, clinical staff, and students to deliver quality clinical competencies consistent with competency-based education. Adoption of different assessment strategies and development of valid and reliable tools is necessary to comprehensively measure CC among midwifery students in Malawi.
ABSTRACT
INTRODUCTION: Globally, magnesium sulfate (MgSO4) has been recognized as the drug of choice for preventing and controlling fits among women with severe pre-eclampsia and eclampsia, respectively. Improper use of magnesium sulfate has been reported globally. Therefore, actionable findings for improving magnesium sulfate use are needed. This study aims at understanding the views of midwives towards MgSO4 use to inform an intervention whose objective is to improve MgSO4 use among the midwives. METHODS: An exploratory qualitative study was conducted from July to September 2018. We conducted 10 in-depth interviews and a focus group discussion with midwives. All the interviews were audio taped and transcribed verbatim. Data were managed by NVivo version 10.0 and analyzed thematically. RESULTS: We identified one overarching theme: "Inadequate governing approaches on management of clients on MgSO4" with corresponding subthemes; in adequate preparation on magnesium sulfate administration; inconsistent formula, regimen and guidelines/protocols on magnesium sulfate use and lack of resources. CONCLUSION: Midwives perceived MgSO4 use as a demanding activity due to inadequate training, inconsistent tools, and lack of resources. While periodic in-service training should be intensified to improve MgSO4 use, necessary resources should be provided, such as blood pressure machines, more midwives, and protocols.
