Learning through relationships: The transformative learning experience of midwifery continuity of care for students: A qualitative study

The Continuity of Care Experience in Australian midwifery education - Where are we heading now?

PROBLEM OR BACKGROUND

The Continuity of Care Experience (CoCE) is a mandated practice-based learning model for all pre-registration midwifery students in Australia. Evidence confirming the value of the learning experience continues to grow, and recommendations for improving the learning model have yet to be addressed using a standardised approach.

AIM

This integrative review provides an updated synthesis of the literature detailing the outcomes of the CoCE as an educational model since a previous review published in 2017.

METHODS

This updated review replicated the methods used in the original review, including the search strategy, screening, extraction, and synthesis of newly identified studies. The results were synthesised to determine alignment with previous themes and identify emerging themes relevant to the midwifery student CoCE.

FINDINGS

Since the original search, 29 additional publications were identified. The themes were consistent with the original review, with the addition of two new themes with five sub-themes, including clarifying the value of CoCE and recommendations to optimise learning.

DISCUSSION

The CoCE's value is increasingly recognised as a critical inclusion in midwifery curricula. Adopting a coordinated approach to integrate the CoCE into core curriculum design, prioritising practice-based learning, and adopting standardised learning objectives and outcomes will overcome challenges and optimise the learning.

CONCLUSION

This updated review confirmed that the CoCE is a unique and valuable learning model that fosters woman-centred care. Implementing the key recommendations from internationally published research can significantly enhance midwifery education and prepare a future workforce capable of providing woman-centred care to improve women's outcomes.

Midwives' perceptions of the support they provide to new graduates and the role of the health service in Australia: A survey of midwives

PROBLEM

Evidence suggests new midwifery graduates are leaving the profession prematurely during the initial graduate years due to workplace stress.

BACKGROUND

Graduate midwives are essential to provide a future midwifery workforce. Support for new graduates in the initial years of practice is essential in retaining them in the midwifery profession.

AIM

The aim of this study was to explore midwives' perspectives of the support they provide new graduates within existing midwifery graduate programs, and their experiences and perceptions of the health service processes to support midwifery graduates.

METHODS

A cross-sectional study was undertaken with a purposive sample of Australian midwives. Descriptive statistics were used to analyse frequencies and percentages of responses. Spearman's correlational analyses were used to determine associations between the variables. Responses to open-ended questions were analysed by content analysis.

FINDINGS

In total, 167 midwives responded to the survey. Just over a third (34.1 %) of midwives felt they had sufficient resources to support a midwifery graduate. Half (50.9 %) of the midwives engaged in reflective practice with midwifery graduates. The majority (97 %) of midwives reported that they felt it was important for midwifery graduates to have a mentor.

DISCUSSION

A lack of protected time to provide mentoring opportunities and support new graduates to gain further experience and education was identified. These findings support the need for a formal mentorship program to be introduced.

CONCLUSION

This study offers insights into the perspective of midwives dealing with the realities of striving to support midwifery graduates in their initial years of practice.

Learning from perinatal grief and loss: Insights from midwifery student focus groups

AIM

To explore Australian midwifery students' learning experiences with death and their learning needs for these encounters.

BACKGROUND

Midwives care for women who experience perinatal grief and loss. The care required in these events is complex and clinically challenging. There is limited understanding of midwifery student learning requirements regarding bereavement care and preparation for clinical encounters involving perinatal death.

METHOD

A descriptive qualitative study was undertaken. Four focus groups were conducted with student participants. Data were collected using an audio-recorded and then transcribed verbatim. Data were analysed using the Braun and Clarke framework, reflexive thematic analysis drew coherent stories from the raw data.

RESULTS

The data of 17 participants was analysed. Unified meaning-patterns across the four student cohorts emerged as three themes: 1) Ill-equipped for perinatal mortality; 2) Caught amidst divergent viewpoints of perinatal mortality; and 3) Identifying learning needs for death-related clinical care. Variations across the cohorts were evident.

DISCUSSION

Participants felt unprepared for perinatal mortality due to gaps in academic learning, practical skills and exposure to death experiences during placements. They often faced restrictions on involvement in perinatal death care. Participants strongly desired specific training on perinatal death and better-supported clinical experiences. The findings highlight the need for support and resources to create meaningful learning opportunities in this area.

CONCLUSIONS

This study highlights the perceived inadequacies in the preparedness of midwifery students for clinical encounters of perinatal mortality. It calls for comprehensive and tailored educational interventions to address the identified gaps and better equip students for future practice.

Discovering the invisible: Transformative learning experiences of midwifery students to support physiological birth during continuity of care placements in Québec's freestanding birth centres

BACKGROUND

Despite international consensus advocating a physiological approach to childbirth, there are inconsistent opinions on how to acquire the competencies needed to successfully carry out this approach. While continuity of care experiences (CoCE) within placements is a valued educational strategy, there are limited studies that focus on the learning experiences to support physiological birth.

AIM

To describe and understand the learning experiences related to physiological birth, as well as the transformations required to become a midwife who supports physiological birth, during the CoCE placement process in a birth centre.

METHODS

An interpretive description study design was adopted. Data were collected through audio diaries (n=126) with midwifery students and preceptors (n=14) across four level of placements in birth centres, in Québec, Canada, and discussion groups with students who kept the audio diaries.

RESULTS

Three main themes were identified: 1) appropriating culture: relational autonomy; 2) developing competencies: acknowledging attitude, enabling behaviours and narrative skills; 3) constructing identity: coherence and resistance.

DISCUSSION

The findings demonstrated the importance of CoCE, along with the continuity of preceptorship and a low-tech environment as optimal educational strategies for the acquisition of a culture and competencies that promote physiological childbirth. Resistance is part of identity transformation and represents an opportunity for critical questioning and safe feedback.

CONCLUSION

This study contributes to the understanding of the nature of the competencies developed and the transformations experienced to support physiological childbirth. It recognises the primacy of CoCE within extended placements, embedded in a workplace culture and environment that support relational autonomy.

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.

Development of the essential learning outcomes for the midwifery student continuity of care learning model: A Delphi study

BACKGROUND

In Australia, midwifery students are required to undertake at least ten Continuity of Care Experiences (CoCE) during their education. The learning outcomes of this experience have never been explicit or standardised resulting in inconsistent assessment.

AIM

To develop and identify standardised learning outcomes for the CoCE.

METHODS

A modified Delphi survey was conducted with an expert panel. Intended learning outcome statements were developed, reflecting the learning objectives identified in a previous study. Bloom's taxonomy levels of thinking complexities guided the wording of the outcomes. Participants were asked to rank and rate their level of agreement with each statement over two survey rounds.

FINDINGS

Round one was completed by 32 participants, with 92.5% of the 40 statements reaching consensus. The second round was completed by 23 participants, with 70.7% of the 33 statements reaching consensus. Content analysis of participant comments from each round identified duplicates that were removed and informed refining the wording of some statements. A final set of 15 learning outcomes were agreed upon. The outcomes were broadly grouped within the themes of accountability, advocacy, and autonomy.

DISCUSSION

This study has identified agreed learning outcomes for midwifery students undertaking CoCE. The consensus agreement of experts reinforced the learning model enables the development of woman-centred practice that is underpinned by accountability, advocacy, and autonomy.

CONCLUSION

Purposeful learning outcomes for the CoCE have been developed, informing how the model can be embedded in curricula, guide student learning and assessment to standardise the pedagogy of the model to prepare future midwives.

The effect of a midwifery continuity of care program on clinical competence of midwifery students and delivery outcomes: a mixed-methods protocol

BACKGROUND

The midwifery continuity of care model is one of the care models that have not been evaluated well in some countries including Iran. We aimed to assess the effect of a program based on this model on the clinical competence of midwifery students and delivery outcomes in Ahvaz, Iran.

METHODS

This sequential embedded mixed-methods study will include a quantitative and a qualitative phase. In the first stage, based on the Iranian midwifery curriculum and review of seminal midwifery texts, a questionnaire will be developed to assess midwifery students' clinical competence. Then, in the second stage, the quantitative phase (randomized clinical trial) will be conducted to see the effect of continuity of care provided by students on maternal and neonatal outcomes. In the third stage, a qualitative study (conventional content analysis) will be carried out to investigate the students' and mothers' perception of continuity of care. Finally, the results of the quantitative and qualitative phases will be integrated.

DISCUSSION

According to the nature of the study, the findings of this research can be effectively used in providing conventional midwifery services in public centers and in midwifery education.

TRIAL REGISTRATION

This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1401.460). Also, the study protocol was registered in the Iranian Registry for Randomized Controlled Trials (IRCT20221227056938N1).

Advocacy, accountability and autonomy; the learning intention of the midwifery student continuity of care experience

PROBLEM

The Continuity of Care Experience is a mandated inclusion in midwifery education programs leading to registration as a midwife in Australia. The practice-based learning experience has evolved over time, yet there remains no standardised learning intentions, objectives, or outcomes for the model.

AIM

To identify the key learning intentions of the Continuity of Care Experience by an expert panel to support the development of learning outcomes.

METHODS

A descriptive qualitative study with two focus groups were conducted with an expert panel (n = 15). Participants were midwifery education subject matter experts on the Continuity of Care Experience with backgrounds in academia, policy development, curriculum design, accreditation, or clinical education. The discussions were transcribed and thematically analysed.

FINDINGS

Three main themes and six sub-themes describe the learning intentions of the Continuity of Care Experience. The main themes were: (1) advocacy for women; (2) accountability of care; and (3) autonomy in practice.

DISCUSSION

The education model of continuity of care enables students to develop midwifery practice that involves advocating for women, being accountable for their care and being autonomous in practice. We have established that during the experience students practice in partnership with women and are exposed to the full scope of midwifery care. Importantly students learn holistic woman-centred practice.

CONCLUSION

The learning intentions of the Continuity of Care Experience reflects woman-centred practice. Having identified a common understanding of the learning intention, these can now be used to design learning, and assessment, through the development of measurable learning outcomes.