Showing items 1 - 11 of 11

Australian rural and remote registered nurses' experiences of learning to provide antenatal services in general practice : A pilot study

- Mills, Jane, Birks, Melanie, Francis, Karen, Miles, Maureen, Jones, Janet

  • Authors: Mills, Jane , Birks, Melanie , Francis, Karen , Miles, Maureen , Jones, Janet
  • Date: 2010
  • Type: Text , Journal article
  • Relation: International Journal of Nursing Practice Vol. 16, no. 4 (2010), p. 319-325
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  • Description: This article reports on a pilot vocational study programme for provision of antenatal services in the general practice environment. The concurrent evaluation study assessed practice nurses' experiences of undertaking the pilot programme, the level and applicability of the content, and the mode of delivery. General practitioners' understanding of the role of the nurse in providing antenatal services, and the actual and potential impact of this new role on models of service delivery and care were also investigated. Women receiving care from practice nurses within this new model of service delivery and care were also of interest in this study. Findings showed that the current role of the general practice nurse in caring for pregnant women is restricted to assisting the general practitioner to complete their assessment of clients. Organizing clinical placement with a midwife was a major barrier to completing the pilot programme.

Australian rural maternity services: Creating a future or putting the last nail in the coffin

- Francis, Karen, McLeo, Margaret, McIntyre, Meredith, Mills, Jane, Miles, Maureen, Bradley, Angela

  • Authors: Francis, Karen , McLeo, Margaret , McIntyre, Meredith , Mills, Jane , Miles, Maureen , Bradley, Angela
  • Date: 2012
  • Type: Text , Journal article
  • Relation: Australian Journal of Rural Health Vol. 20, no. 5 (2012), p. 281-284
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  • Description: Nurses and midwives are the largest group of health providers in Australia (60%), and with increasing remoteness, this proportion increases substantially.1 The recruitment and retention of nurses, and more specifically midwives in rural health services, is at crisis point. Sustainable birthing services will be reliant on a stable, regenerative workforce. Key to this goal is the education of nurses, midwives and doctors, all of whom have stringent pre-service professional placement quotas in order to meet required competencies to practice. The rural workforce crisis in maternity care has been a driving force in health care reform.2 Rural innovation has involved negotiating the space between increased medical risk and the need for a healthy pregnant woman to have the option of staying within her local community to have her baby.3,4 Rural nurses and midwives together with rural doctors agree that continuity of care, irrespective of how it is achieved, is associated with the best outcomes for women and their families in rural locations.4–6 Continuity of care can be achieved using a shared-care medical model involving obstetricians and general practitioners, or midwifery-led primary maternity care services. In the process of securing maternity services that provide continuity of care, the influence of specialist obstetricians, a limited resource in rural locations, has been moderated, and unique solutions to local problems have resulted in the formation of collaborative relationships involving rural nurses, midwives and general practitioners. This polemic makes an argument for a review of the current regulatory requirements for both the education of undergraduate rural nurses and midwives, and the continuing registration of rural midwives who work predominantly in nursing roles. In doing so, the authors provide an overview of the dilemmas facing policymakers, educators, health services managers and clinicians in the provision of sustainable maternity services in rural and remote Australia.

Challenges for midwives : pregnant women and illicit drug use

- Miles, Maureen, Francis, Karen, Chapman, Ysanne

  • Authors: Miles, Maureen , Francis, Karen , Chapman, Ysanne
  • Date: 2010
  • Type: Text , Journal article
  • Relation: The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation Vol. 28, no. 1 (2010 2010), p. 83-89
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  • Description: Objective The purpose of the paper is to introduce illicit drug use as a societal problem and describes the response of the Australian Government. Specifically the paper examines the use of illicit drugs by pregnant women and the role of midwives in supporting these women throughout pregnancy and birth. Setting Maternity services, specifically antenatal care clinics. Conclusion In Australia the rate of pregnant women who use illicit drugs is escalating. These pregnancies are high obstetric risk with potential for harm to both the mother and the baby. Pregnancy however is seen as 'window of opportunity'; a time to provide education, choices and support. The literature describes that for health professionals working with pregnant women who are illicit drug users is challenging and for some health professionals their interaction can be negative. Australia advocates harm minimisation and encourages harm reduction strategies. Midwives are in a position to implement these strategies within the maternity setting. Further research is recommended as well as professional development programs for midwives to upgrade knowledge and cultivate engagement skills to enable appropriate and positive interaction with pregnant women who use illicit drugs.

Clinical decision-making: midwifery students' recognition of, and response to, postpartum haemorrhage in the simulation environment

- Scholes, Julie, Endacott, Ruth, Biro, Mary Anne, Bulle, Bree, Cooper, Simon J., Miles, Maureen, Gilmour, Carole, Buykx, Penny, Kinsman, Leigh, Boland, Rosemarie, Jones, Janet, Zaidi, Fawzia

  • Authors: Scholes, Julie , Endacott, Ruth , Biro, Mary Anne , Bulle, Bree , Cooper, Simon J. , Miles, Maureen , Gilmour, Carole , Buykx, Penny , Kinsman, Leigh , Boland, Rosemarie , Jones, Janet , Zaidi, Fawzia
  • Date: 2012
  • Type: Text , Journal article
  • Relation: BMC Pregnancy and Childbirth Vol. 12, no. 19 (2012), p. 1-12
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  • Description: Background This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration. Methods Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis. Results The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error. Conclusions The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the students to evaluate their interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the students' or help them plan care prospectively. The limitations of the study are critically explored along with the pedagogic implications for initial training and continuing professional development.

Exploring Heideggerian hermeneutic phenomenology: a perfect fit for midwifery research

- Miles, Maureen, Chapman, Ysanne, Francis, Karen, Taylor, Beverley

  • Authors: Miles, Maureen , Chapman, Ysanne , Francis, Karen , Taylor, Beverley
  • Date: 2013
  • Type: Text , Journal article
  • Relation: Women and Birth Vol. 26, no. 4 (2013), p. 273-276
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  • Description: Background Heideggerian hermeneutic phenomenology has been used widely to understand the meaning of lived experiences in health research. For midwifery scholars this approach enables deep understanding of women's and midwives’ lived experiences of specific phenomena. However, for beginning researchers this is not a methodology for the faint hearted. It requires a period of deep immersion to come to terms with at times impenetrable language and perplexing concepts. Objectives This paper aims to assist midwives to untangle and examine some of the choices they face when they first come to terms with an understanding of this methodology and highlights the methodology's capacity to reveal midwifery authenticity and holistic practice. Discussion The illumination of a selection of various concepts underpinning hermeneutic phenomenology will inform midwives considering this methodology as suitable framework for exploring contemporary midwifery phenomena.

Hermeneutic phenomenology: a methodology of choice for midwives

- Miles, Maureen, Francis, Karen, Chapman, Ysanne, Taylor, Beverley

  • Authors: Miles, Maureen , Francis, Karen , Chapman, Ysanne , Taylor, Beverley
  • Date: 2013
  • Type: Text , Journal article
  • Relation: International journal of nursing practice Vol. 19, no. 4 (2013), p. 409-414
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  • Description: Hermeneutic phenomenology has been used widely by researchers to understand lived experiences. This methodology asserts that individual people are as unique as their life stories. The practice of midwifery is underpinned by a philosophy that values women and the uniqueness of their child-bearing journey. The tenets of hermeneutics phenomenology align with those of contemporary midwifery practice, making it a useful research methodology for providing insights into issues relevant to the profession. The purpose of this paper is to unravel some foundational concepts of hermeneutic phenomenology and recommend it as a methodology of choice for midwives to apply to their application to midwifery-in-action.

Making a difference: the experiences of midwives working with women who use illicit drugs

- Miles, Maureen, Chapman, Ysanne, Francis, Karen

  • Authors: Miles, Maureen , Chapman, Ysanne , Francis, Karen
  • Date: 2012
  • Type: Text , Journal article
  • Relation: International Journal of Childbirth Vol. 2, no. 4 (2012), p. 245-254
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  • Description: AIM: This article describes the experiences of midwives who choose to work with pregnant women who use illicit drugs. BACKGROUND: Pregnant women who use illicit drugs present complex challenges for those who choose to work with them. Society's views on illicit drug use fluctuate from acceptance and harm minimization to reprimand and retribution. METHOD: Qualitative interviews were conducted between June and August 2009 with 12 Australian midwives. A thematic analysis method informed by hermeneutic phenomenology was applied to interpret this data to explicate lived experiences and gain deeper understanding and meanings of this phenomenon. FINDINGS: Three major themes encapsulated the experience: making a difference, making partnerships, and learning to let go. The focus of this article, “making a difference,” included two subthemes of “working on the margins” and “transition and transformation.” The midwives were both rewarded and challenged by the needs of women who use illicit drugs and by the systems in which they worked. CONCLUSIONS: The midwives acknowledged that their aspirations “to make a difference” was not always sufficient when working with women who use illicit drugs. They also require the establishment of maternity services that are compassionate and accessible, including woman–care provider partnerships and continuity of the care environments.

Managing women with acute physiological deterioration: student midwives performance in a simulated setting

- Cooper, Simon J., Bulle, Bree, Biro, Mary Anne, Jones, Janet, Miles, Maureen, Gilmour, Carole, Buykx, Penny, Boland, Rosemarie, Kinsman, Leigh, Scholes, Julie, Endacott, Ruth

  • Authors: Cooper, Simon J. , Bulle, Bree , Biro, Mary Anne , Jones, Janet , Miles, Maureen , Gilmour, Carole , Buykx, Penny , Boland, Rosemarie , Kinsman, Leigh , Scholes, Julie , Endacott, Ruth
  • Date: 2012
  • Type: Text , Journal article
  • Relation: Women and Birth Vol. 25, no. 3 (2012), p. e27-e36
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  • Description: Abstract Objective Midwives’ ability to manage maternal deterioration and ‘failure to rescue’ are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives’ ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance. Methods An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a ‘birthing suit’ simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data. Findings The mean total knowledge score was 75% (range 46–91%) with low skill performance, means for both scenarios 54% (range 39–70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32) = 2.247, p = 0.032), in the second and more difficult APH scenario. Conclusion Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation.

Responding to a rural health workforce shortfall : Double degree preparation of the nurse midwife

- Francis, Karen, Birks, Melanie, Al-Motlaq, Mohammad, Davis, Jenny, Miles, Maureen, Bailey, Carolyn

  • Authors: Francis, Karen , Birks, Melanie , Al-Motlaq, Mohammad , Davis, Jenny , Miles, Maureen , Bailey, Carolyn
  • Date: 2010
  • Type: Text , Journal article
  • Relation: Australian Journal of Rural Health Vol. 18, no. 5 (2010), p. 210-211
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  • Description: Nursing education in Australia has been provided in the tertiary sector since the mid 1980s although the complete transfer of hospital based programs was not finalised until 1993.1,2 Pre-service nursing programs produce and graduate nurses who are generalist prepared and able to work in any practice context as novice registered nurses. Specialist education that traditionally incorporated midwifery was undertaken following registration and after a period of practice as a nurse.3 In recent years, views regarding midwifery as a specialism of nursing have been challenged by champions including the peak professional body representing midwifery, the Australian College of Midwives. Advocates maintained that women desire choices regarding birthing options and that midwives have, and continue to be dissatisfied with the current health care system that restricts their practice.4 By the beginning of the 21st Century, direct entry midwifery programs were part of the educational landscape

The decision-making processes adopted by rurally located mandated professionals when child abuse or neglect is suspected

- Francis, Karen, Chapman, Ysanne, Sellick, Kenneth, James, Ainsley, Miles, Maureen, Jones, Janet, Grant, Julie

Undergraduate midwifery students' sense of belongingness in clinical practice

- McKenna, Lisa, Gilmour, Carole, Biro, Mary Anne, McIntyre, Meredith, Bailey, Carolyn, Jones, Janet, Miles, Maureen, Hall, Helen, McLelland, Gayle

  • Authors: McKenna, Lisa , Gilmour, Carole , Biro, Mary Anne , McIntyre, Meredith , Bailey, Carolyn , Jones, Janet , Miles, Maureen , Hall, Helen , McLelland, Gayle
  • Date: 2013
  • Type: Text , Journal article
  • Relation: Nurse Education Today Vol. 33, no. 8 (2013), p.880-883
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  • Description: Summary Background Clinical placements form a large and integral part of midwifery education. While much has been written about nursing students' clinical placements, less is known about clinical experiences of undergraduate midwifery students. In nursing, belongingness has been demonstrated to be a key factor in clinical learning but little is known about this in midwifery education. Objectives This study sought to examine undergraduate midwifery students' sense of belongingness in their clinical practice. Design A quantitative design using an online questionnaire was employed. A tool adapted by Levett-Jones (2009a), and previously used with nursing students, was utilised to examine sense of belonging in undergraduate midwifery students. Participants Sixty undergraduate midwifery students from two campuses at one Australian university participated in the study. Students were drawn from a single Bachelor of Midwifery degree and a double Bachelor of Nursing/Bachelor of Midwifery degree. Methods On completion of a scheduled lecture, students were invited by one of the researchers to participate in the study by completing the online questionnaire and the link provided. Data were analysed using descriptive statistics. Results Midwifery students generally reported similar perceptions of belongingness with previous studies on nursing students. However, a few differences were noted that require further exploration to fully understand. Conclusions Midwifery students experienced a sense of belonging in their clinical placements. The findings contribute to understandings of the experiences for midwifery students and provide a foundation on which to develop future clinical placement experiences.
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