Team-based learning in Indonesian midwifery education: Implementation research.

AIM: This study aims to implement team-based learning (TBL) and assess the impact on faculty members and students within midwifery education in Indonesia. METHODS: Proctor's Framework for Implementation Research serves as the guiding approach in investigating the role of implementation strategies in implementing TBL within the context of midwifery education. The RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was utilized to assess the outcome. RESULTS: In this study, the implementation of TBL has demonstrated significant reach, with broad participation among both faculty and students in two schools. The efficacy of TBL is evident through enhanced student knowledge, engagement and active learning. Adoption of TBL was observed in both schools, with faculty and students expressing interest and active participation. High levels of implementation fidelity were maintained, even though with challenges related to preparation and implementation. These findings suggest that TBL can be successfully integrated into midwifery education, with positive implications. Regarding maintenance, faculty members have expressed their intention to continue using TBL in various topics for future lectures. CONCLUSIONS: The implementation of TBL in Indonesian midwifery education has shown substantial reach and efficacy. Faculty and students are highly interested in adopting TBL for future use. Despite some implementation challenges, the study suggests that TBL can be effectively incorporated with minor adjustments, emphasizing its feasibility and potential impact. This research contributes to understanding TBL's applicability in various educational settings, especially in low-resource institutions.

Early initiation of breastfeeding up to six months among mothers after cesarean section or vaginal birth: A scoping review.

Background: Early initiation of breastfeeding is important for establishing continued breastfeeding. However, previous research report that cesarean section (C-section) may hinder early initiation of breastfeeding. Despite this, there is currently a lack of literature that examines the rates of breastfeeding after both cesarean section and vaginal birth globally. Research aims: The objective of this scoping review was to systematically assess the available literature on the rate of early initiation of breastfeeding within the first hour and exclusive breastfeeding up to 6 months after C-section and vaginal birth, as well as any other factors associated with initiation and exclusive breastfeeding. Methods: We adhered to the PRISMA extension guidelines for scoping reviews in conducting our review. In August 2022, we carried out an electronic database search on CINALH, PubMed, EMBASE, and Cochrane Library, and also manually searched the reference list. Results: A total of 55 articles were included in the scoping review. The majority of these studies found that mothers who delivered vaginally had higher rates of breastfeeding compared to those who underwent a C-section, at various time points such as breastfeeding initiation, hospital discharge, one month, three months, and six months postpartum. Notably, there was a significant difference in the rate of early initiation of breastfeeding between the two groups. However, at 3 and 6 months after delivery the gap of exclusive breastfeeding rate between C-section and vaginal delivery is narrow. Breastfeeding education, health care providers support, and mother and baby bonding are other factors associate with initiation and exclusive breastfeeding. Conclusions: The rate of breastfeeding initiation after C-section has remained low to date. This is due in part to insufficient knowledge about and support for breastfeeding from healthcare providers.

Women's experiences of breastfeeding after a cesarean section: A meta-synthesis.

AIM: The World Health Organization and United Nations Children's Fund recommend the early initiation of breastfeeding within the first hour postpartum for successful exclusive breastfeeding. However, cesarean section is a risk factor for unsuccessful early initiation of breastfeeding. Herein, we aim to explore women's experiences of breastfeeding after a cesarean section. METHODS: We used the Joanna Briggs Institute framework in this meta-synthesis. We searched articles published from 1990 to 2022 on PubMed, CINAHL, Cochrane library, PsycInfo, and EMBASE to identify qualitative studies on women's experiences of breastfeeding after a cesarean section. We used the Critical Appraisal Skills Programme checklist for qualitative studies to assess the quality of the included studies. RESULTS: Seven qualitative studies from five countries met the inclusion criteria, representing the views of 194 women who underwent cesarean sections. Six new categories were integrated into the women's experiences of breastfeeding after a cesarean section as follows: (i) Perceived values of breastfeeding, (ii) Emotional vulnerability in breastfeeding, (iii) Physical difficulties in breastfeeding, (iv) Inconvenient conditions in breastfeeding, (v) Inadequate resources for breastfeeding, and (vi) Support systems to enable breastfeeding. CONCLUSIONS: We provide evidence showing that knowledge of the specific breastfeeding mechanism and provision of the most appropriate postsurgical care by healthcare providers just after a cesarean section can reduce the barriers to post-cesarean breastfeeding. Moreover, effective hospital policies and family support can result in the initiation of positive breastfeeding outcomes. Future studies that consider the cultural aspects of breastfeeding practice may generate additional insights into providing optimal postpartum care.

A comparison of team-based learning and lecture-based learning on clinical reasoning and classroom engagement: a cluster randomized controlled trial.

BACKGROUND: The lecture-based learning (LBL) implemented in most Indonesian nursing/midwifery schools underlies the students' lack of ability in clinical reasoning. Team-based learning (TBL) was proposed to improve the students' ability in clinical reasoning as it is applying a course concept of real complex scenarios. In this study, we aimed to assess and compare the effects of TBL and LBL of postpartum hemorrhage topics on the clinical reasoning and classroom engagement of midwifery students in Indonesia. METHODS: We conducted a cluster randomized controlled trial to compare the effects of TBL and LBL. The unit was schools and random allocation was conducted using a simple random sampling method (i.e., coin flipping). There was 1 cluster in the intervention group (n = 62 students) and 1 cluster in the control group (n = 53 students). The students in the intervention group participated in a TBL class (90 min) three times, whereas the students in the control group attended an LBL class on postpartum hemorrhage topics. The primary outcome was the clinical reasoning on postpartum hemorrhage score measured at pre-test, post-test, and 2 weeks post-test. The secondary outcome was Classroom Engagement Survey (CES) score measured after each class finished. We used an unpaired t-test to evaluate the differences between the two groups. The baseline characteristics of the participants were compared using standardized difference. RESULTS: We evaluated a total of 115 participants. Regarding the baseline characteristics, there was a small difference in the age, Grade Point Average and knowledge at pre-test between the intervention and control groups. The mean clinical reasoning on postpartum hemorrhage scores were significantly higher in the TBL students than in the LBL students at post-test (p < .001; Cohen's d = 1.41) and 2 weeks post-test (p < .001; Cohen's d = 1.50). The CES showed a significantly higher in the intervention group than in the control group. CONCLUSIONS: TBL is an effective learning method for enhancing the clinical reasoning ability of students. This learning method allows for more independent and active learning. Having a strong background knowledge, and discussing cases comprehensively with peers can sharpen the clinical reasoning ability of students.

Effectiveness of team-based learning on postpartum hemorrhage in midwifery students in Indonesia: A quasi-experimental study.

BACKGROUND: Poor quality of care by midwives in Indonesia has become a barrier to improving maternal health. To eliminate this barrier, reforming the educational system (i.e., teaching and learning processes) is an urgent concern. Herein, we propose the use of team-based learning (TBL) as an active learning strategy to enhance knowledge of postpartum hemorrhage (PPH) and learning satisfaction of midwifery students in Indonesia. OBJECTIVES: To assess and compare knowledge of PPH, long-term retention of knowledge, and learning satisfaction of midwifery students attending a TBL class versus a didactic lecture on PPH topics. METHODS: A quasi-experimental design was used. The participants were second-year diploma level midwifery students who have (a) no TBL experience, (b) completed the previous semester, and (c) graduated from senior high school (without nursing background). We recruited 118 participants. The midwifery students in the intervention group participated 3 times in the TBL class (90 min), whereas those in the control group participated in the didactic lecture on PPH topics. An unpaired t-test was used to evaluate differences between groups. ANOVA was used to evaluate differences within groups. RESULTS: A total of 115 participants (intervention = 62, control = 53) were finally evaluated. The demographic data and pre-test scores were not significantly different between the 2 groups. The mean knowledge of PPH scores were significantly higher in the TBL students than in the control students at post-test, 2 weeks post-test, 6 weeks post-test, and 12 weeks post-test (all p < .001). The nursing student satisfaction scale score was significantly higher in the intervention group than in the control group. CONCLUSION: The findings showed that TBL is an effective active learning strategy to improve knowledge of PPH of Indonesian midwifery students before clinical practice exposure. Further long-term evaluation (e.g., 1 semester) of the effectiveness of TBL is warranted.

Effects of team-based learning about postpartum haemorrhage on learning outcomes and experience of midwifery students in Indonesia: A pilot study.

Aim: This pilot study aimed to evaluate the effects of team-based learning about postpartum haemorrhage on the learning outcomes and experience of midwifery students in Indonesia. Design: One-group pre-test-post-test study. Methods: This study enrolled 64 midwifery students as participants from an Indonesian health polytechnic school. This group attended two team-based learning class sessions (90 min weekly for 2 weeks) on postpartum haemorrhage. Student learning outcomes and experience were assessed quantitatively. Results: The mean knowledge score (0-100) was significantly higher at post-test (mean = 85.9, SD 9.8) than at pre-test (mean = 61.4, SD 12.9) (p < .001). There was a significant difference in the mean clinical reasoning score (12-60) between post-test (mean = 35.4, SD 5.8) and pre-test (mean = 21.3, SD 7.9) (p < .001). Most students (98.4%) engaged in classroom activities.