Consent during labour and birth as observed by midwifery students: A mixed methods study.

BACKGROUND: While consent is an integral part of respectful maternity care, how this is obtained during labour and birth presents conflicting understandings between midwives' and women's experiences. Midwifery students are well placed to observe interactions between women and midwives during the consent process. AIM: The purpose of this study was to explore the observations and experiences of final year midwifery students of how midwives obtain consent during labour and birth. METHODS: An online survey was distributed via universities and social media to final year midwifery students across Australia. Likert scale questions based on the principles of informed consent (indications, outcomes, risks, alternatives, and voluntariness) were posed for intrapartum care in general and for specific clinical procedures. Students could also record verbal descriptions of their observations via the survey app. Recorded responses were analysed thematically. FINDINGS: 225 students responded with 195 completed surveys; 20 students provided audio recorded data. Student's observations suggested that the consent process varied considerably depending on the clinical procedure. Discussions of risks and alternatives during labour were frequently omitted. DISCUSSION: The student's accounts suggest that in many instances during labour and birth the principles of informed consent are not being applied consistently. Presenting interventions as routine care subverted choice for women in favour of the midwives' preferences. CONCLUSIONS: Consent during labour and birth is invalidated by a lack of disclosure of risks and alternatives. Health and education institutions should include information in guidelines, theoretical and practice training on minimum consent standards for specific procedures inclusive of risks and alternatives.

A literature review to determine midwifery students' perceived essential qualities of preceptors to increase confidence and competence in the clinical environment.

BACKGROUND: Midwifery students' experiences with preceptors in the clinical environment plays an integral role in developing the confidence and competence of students. As up to 50% of the midwifery program is taught in the clinical environment, an analysis of the preceptorship role in the context of midwifery student confidence and competence may be important to inform future practice and policy. AIM: To discover, whilst on clinical placement, what is required by preceptors to suitably equip midwifery students to develop confidence and competence in the clinical environment. METHODS: A search of the literature was undertaken using health and midwifery related electronic databases of PubMed, CINAHL, Intermid, SCOPUS and Web of Science. Grey literature, and reference lists from studies were also part of the thorough search process. FINDINGS: After critical reading of the 15 included studies, there were a number of themes identified as the preceptor qualities that contributed to student confidence and competence. Those themes include 'belongingness', 'hands on experience/skill development', 'students' development of professional identity' and 'preceptor characteristics that impact student learning'. DISCUSSION: Student confidence and competence can be dependent on the preceptor who supports them. There are preceptors who enable students to flourish in their confidence and competence, and there also appears to be preceptors who do not possess these qualities, which requires further enquiry. CONCLUSION: As the evidence appears to find that trained preceptors are optimal for student confidence and competence, further enquiry is warranted to inform policy and practice around the concept of preceptorship training for midwives.

'Why nurses are leaving the profession lack of support from managers': What nurses from an e-cohort study said.

The shortage of nurses is known. We explored nurses' reasons for leaving the profession based on responses from an e-newsletter of the Nurses and Midwives e-cohort Study. Qualitative content analysis of data from email responses (n = 66) showed 'Lack of support' as a social work value describing their manager's lack of support, unsupportive relationships within their work group, and a health-care system putting business principles before care resulting in job dissatisfaction and nurse turnover. These findings are examples of a 'complex'/'wicked' problem and as such will resist simple solutions to the presenting issues. The dialogic process such as Open Space Technology and Talking Circles should be considered as potentially suitable to the needs of nurses.

"The pure hard slog that nursing is . . .": a qualitative analysis of nursing work.

PURPOSE: To explore nurses' perceptions of the nature of nursing work as a factor that contributes to attrition from the profession. DESIGN: A nonpurposive sample of nurses from the Nurses and Midwives e-cohort Study in Australia, New Zealand, and the United Kingdom provided electronic responses about reasons for leaving the profession. Data were then subjected to qualitative content analysis. FINDINGS: Nurses at the "coal face," that is, those who actually do the work of nursing, in real working conditions, express dissatisfaction in relation to hygiene factors relating to the nature of nursing work and attribute these to nurses leaving the profession: workload, shift work, violence, and financial remuneration. CONCLUSIONS: Nurses' satisfaction with work and motivation to work are being sorely tested. There is manifest tension between the core concepts of nursing-compassion and care-and a system of work that actively precludes nurses from being able to exhibit these virtues and fails to reward them. Workload, shift work, violence, and financial remuneration are drivers of attrition and need to be addressed. CLINICAL RELEVANCE: Implications from this study are fourfold: determination of nursing workload, mitigating the impact of shift work, providing safe work environments, and adequate financial remuneration.