The challenge of implementing an undergraduate midwifery course within a three university consortium

The Werna Naloo Bachelor of Midwfery Consortium was formed between three universities in Victoria in 2000 to deliver a three-year Bachelor of Midwifery course. This paper describes the challenges experienced in implementing a multi-university consortium course, some of the steps taken to address course issues, as well as identifying the positive aspects of working within a consortium. Challenges related to administration of the course within the three universities and on-line subject delivery. Steps take to address challenges included establishment of a committee structure, including a curriculum implementation committee, ongoing dialogue between the course coordinators involved and being pro active in ensuring smooth delivery of the on-line content of the course. Some of the concerns expressed by the academics involved in the consortium reflected the findings of other reports of consortium education courses. These were insufficient time for ongoing sharing of ideas because of geographical distance resulting in some overlap of subject content, as well as the time taken to travel between institutions for meetings. Consortium benefits were the collegial sharing of ideas and resources, and the conversion of competition into alliance.

Emergency Department care of women experiencing intimate partner violence: Are we doing all we can?

A significant proportion of Australian women experience intimate partner violence (IPV), many of them unidentified and thus not necessarily supported when they seek assistance in Emergency Departments. This article reviews the literature on IPV with a view to establishing the extent of the problem and the cost of IPV to the women, their families and the community. Electronic databases were searched using the keywords 'intimate partner violence', 'domestic violence', 'nursing' and 'emergency department'. The information obtained may inform health care professionals and assist with management, in the Emergency Department, of those who have experienced IPV. We explore the influence and impact of different types of care on women and the way women understand their experiences of care. From this review the following issues were identified as requiring further investigation: 1. the need to understand IPV from the women's perspective; 2. the factors influencing disclosure to ED staff; and 3. the type and consequent impact of care received in the ED.

Nurses on the move: Evaluation of a program to assist international students undertaking an accelerated Bachelor of Nursing Program

This paper reports on an evaluation of a Teaching and Learning Enhancement Scheme (TALES) program designed to meet the unique need of the 2005 cohort of international nursing students undertaking an accelerated Bachelor of Nursing (BN) program at the Victorian campus of Australian Catholic University (ACU) National. The program involved a team approach with three academic mentors and the international students working together to produce satisfactory learning outcomes through fortnightly meetings and provision of additional assistance including compiling a portfolio, reflective writing, English, including colloquial English and pronunciation, as well as familiarisation with handover and abbreviations common in the clinical field, general communication, assistance with preparing a resume and participation in simulated interviews. This relatively small group of international students (20) confirmed the findings of other studies from other countries of international nursing students' in terms of concerns in regard to studying in a foreign country, namely English proficiency, communication difficulties, cultural differences and unfamiliarity with the health care environment. The assistance provided by the program was identified by the completing students as invaluable in helping them settle into study and successfully complete the theoretical and clinical components of the course.

Emergency healthcare experiences of women living with intimate partner violence

AIM AND OBJECTIVES

To explore healthcare experiences of Australian women living with intimate partner violence (IPV) and consider how these influence their understanding of IPV and sense of self.

BACKGROUND

Despite international campaigns condemning violence against women, IPV remains a worldwide problem and recent Australian community attitudes demonstrate ongoing beliefs condemning women in abusive relationships. Women experiencing IPV are over-represented in healthcare-seeking populations; however, they are rarely identified as experiencing abuse and are often not provided care directed towards achieving ongoing safety. While women seek empathetic healthcare, disclosure of abuse often results in being judged negatively or blamed.

DESIGN

A grounded theory study drawing on Clarke's (Sage Publications, London, 2005) analytic approach of situational analysis.

METHODS

Semi-structured interviews conducted with seven women. Data was analysed using NVIVO 8 software within a Situational Analysis framework.

RESULTS

Four major categories were identified: Accessing healthcare: challenges and barriers; Care women need vs. care women receive; Discourses of IPV and constructions of self; and Acknowledging IPV: moving on and re-constructing self. Women faced significant challenges in accessing emergency healthcare and healthcare then often lacked empathy. Women created an understanding of self from a world dominated by an abusive partner and needed assistance re-labelling their experiences as IPV. Healthcare professionals who provided empathetic care were instrumental in assisting this process, enhancing women's abilities to explore options for limiting abuse and assisting them to enhance their self-efficacy and reconstruct a positive sense of self.

CONCLUSIONS

Healthcare is one of the few avenues women living with IPV have to receive emotional and physical support. Healthcare that ignores psychosocial issues further damages women's sense of self.

RELEVANCE TO CLINICAL PRACTICE

Women require timely information and empathetic support from healthcare professionals to assist them in understanding and labelling their experiences as IPV. This enhances women's ability to feel deserving of, and ideally achieve, a life without violence.

Drugs and having babies: an exploration of how a specialist clinic meets the needs of chemically dependent pregnant women

OBJECTIVES

to explore the extent to which a specialist clinic meets the needs of chemically dependent women.

DESIGN

a critical ethnography informed by theorists such as Habermas and feminists' interpretation of Foucault.

SETTING

a specialist antenatal clinic for chemically dependent pregnant women at a major metropolitan women's hospital in Melbourne, Australia.

PARTICIPANTS

a purposive sample of twenty (20) chemically dependent pregnant women who attended the clinic. Data collection and analysis included three taped interviews (two preceding the birth and one post birth), observation of the interactions between the women and the clinic staff over a 25-month period and chart audits.

FINDINGS

similar to other studies there were multiple factors influencing development and maintenance of chemical dependency in this group of women, including family instability, family history of drug and alcohol abuse, childhood sexual abuse, having a chemically dependent partner and having a dual diagnosis of both drug addiction and mental illness. Initially there was considerable variation between the women and the clinic staff's expectations with regard to attending for antenatal care and conforming to a set regime as the women struggled with the contradictions inherent in their lifestyle and that of the 'normal' expectant mother. Aspects of that struggle included their belief that their opinions and knowledge of their lives was largely ignored, leading to episodes of resistance. Several women alleged the clinics staff's relationship with them was influenced by a belief that the women were 'hopeless addicts in need of expert medical and midwifery care' and that the clinic staff exercised control in an authoritarian manner. However, as they explored possibilities for collaboration, they realised they could exercise power and work towards a more equal relationship with staff. The quality of relationships in most instances improved over time, and if not always strictly collaborative, was situated at various points along a continuum from minimal to full co-operation, with concomitant varying levels of success in terms of outcomes. It was often the attitude of individual staff members, particularly midwives, that was the key to the way in which the women responded to care.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

comprehensive history-taking and engaging women as early as possible in pregnancy; providing continuity of care - particularly midwife care - to assist in developing a collaborative approach to care; provision of an extended period of postnatal support to at least six months for those women able to parent their children was a key recommendation.

Applying a contemporary grounded theory methodology

AIM

The aim of this paper is to discuss the application of a contemporary grounded theory methodology to a research project exploring the experiences of students studying for a degree in midwifery.

BACKGROUND

Grounded theory is a qualitative research approach developed by Glaser and Strauss in the 1950s but the methodology for this study was modelled on Clarke's (2005) approach and was underpinned by a symbolic interactionist theoretical perspective, post-structuralist theories of Michel Foucault and a constructionist epistemology.

REVIEW METHODS

The study participants were 19 midwifery students completing their final placement. Data were collected through individual in-depth interviews and participant observation, and analysed using the grounded theory analysis techniques of coding, constant comparative analysis and theoretical sampling, as well as situational maps. The analysis focused on social action and interaction and the operation of power in the students' environment. The social process in which the students were involved, as well as the actors and discourses that affected the students' competency development, were highlighted.

CONCLUSION

The methodology allowed a thorough exploration of the students' experiences of achieving competency. However, some difficulties were encountered. One of the major issues related to the understanding and application of complex sociological theories that challenged positivist notions of truth and power. Furthermore, the mapping processes were complex. Despite these minor challenges, the authors recommend applying this methodology to other similar research projects.

'Lending the space': midwives' perceptions of birth space and clinical risk management

OBJECTIVES

to explore and describe midwives perceptions of birth space and clinical risk management and their impact on practice both before and after a move to a new facility.

DESIGN

an exploratory descriptive study utilising a modified participatory approach and observation and focus groups for data collection.

SETTING

a major metropolitan maternity hospital in Victoria, Australia.

PARTICIPANTS

18 midwives, including graduate year midwives, caseload midwives and hospital midwives working normal shifts, employed within a hospital.

FINDINGS

the major themes identified were perceptions of birth space, perceptions of risk management, influence of birth space and risk management on practice and moving but not changing: geographical space and practice. Midwives desire to create the ideal birth space was hampered by a prevailing biomedical discourse which emphasised risk. Midwives in all three groups saw themselves as the gatekeepers, 'holding the space' or 'providing a bridge' for women, often in the face of a hierarchical hospital structure with obstetricians governing practice. This situation did not differ significantly after the relocation to the new hospital. Despite a warmer, more spacious and private birth space midwives felt the care was still influenced by the old hierarchical hospital culture. Caseload midwives felt they had the best opportunity to make a difference to women's experience because they were able, through continuity of care, to build trusting relationships with women during the antenatal period.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

although the physical environment can make a marginal contribution to an optimal birth space, it has little effect on clinical risk management practices within a major public hospital and the way in which this impacts midwives' practice. The importance of place and people are the key to providing an optimal birth space, as are women centred midwifery models of care and reasonable workloads.

The supervisor-student relationship in developing methodology

In this article, Carmel Seibold explores the unique relationship between supervisor and student in one aspect of the supervision process: choosing a methodology. It outlines the journey of discovery made by two of her higher degree research students, Susan White and Sonia Reisenhofer, in choosing an appropriate methodology for their respective qualitative studies.

Discourse analysis: integrating theoretical and methodological approaches

This article by Carmel Seibold describes a study of 20 single midlife women undertaken in Melbourne, Australia, and an approach to analysis that fuses theoretical and methodological approaches and might best be described as discourses analysis which includes consideration of embodiment and materialism.

Young single women's experiences of pregnancy, adjustment, decision-making and ongoing identity construction

OBJECTIVE

To explore young pregnant women's experiences of embodiment, ongoing identity construction, decision-making processes and the way in which these are influenced by contemporary discourse, information sources and interaction with health professionals and others.

DESIGN

An exploratory descriptive pilot study. Data were collected via diaries kept during pregnancy, two face-to-face, open-ended interviews, one in the second trimester of pregnancy and one six to eight weeks after the birth of the baby, and a brief telephone interview conducted six months post birth.

SETTING

A major metropolitan hospital for women in Melbourne, Victoria, Australia, and the community.

PARTICIPANTS

Five English speaking participants, aged between 17 and 23 years.

FINDINGS

All the young women accepted, even welcomed, the physical changes of pregnancy. Acceptance of pregnancy and an evolving positive sense of identity was assisted by support from families, particularly mothers, access to sympathetic and expert health professionals, exposure to a range of opinions through classes, books and the media, general acceptance from society at large, support from friends, and choices and opportunities in relation to ongoing education and employment.

Werna Naloo -'We Us Together': the birth of a midwifery education consortium

AIM

The metaphor of a journey will be used to describe the process covering 2 years of development of a Bachelor of Midwifery curriculum shared between a consortium of three universities in Victoria, Australia.

BACKGROUND

The landscape or background against which this journey took place is described, providing a context for understanding the political and pragmatic steps necessary to achieve common vision and processes. This journey has necessitated a convergence of our thinking about what constitutes the living theory and philosophy of the new midwifery in the Australian context, and how this fits with international trends.

PROCESS

The journey took midwife academics from one paradigm to another, forging partnerships between universities to develop an innovative undergraduate midwifery curriculum that shares academic expertise and resources. Consultation between a multitude of competing interests and voices became one of our biggest challenges, but this process itself has helped to change the very landscape in which we travel. In the end, we had to examine our baggage, and much that was excess had to be abandoned. In particular, our emphasis on language and the politics of the midwifery partnership with women became the subject of much debate and contention, and reflects the competing philosophies developing in the midwifery profession. Despite this, there were many who suggested that we had left behind too much, and others who would have us pack even more. Compromises were inevitable if we were to proceed and set up the next stage of a journey that would open a new and challenging frontier to working with Australian childbearing women.

Midwives and women in partnership: the ideal and the real

This qualitative study sought to identify the strategies used by hospital based midwives in assisting women to manage pain in labour, as well as the support they offer in all aspects of the birth process. Data were collected via participant observation of five birthing mothers and their midwives, and pre and post birth interviews. Analysis was by means of the software package QSR NUD.IST (Non numerical, Unstructured, Data, Indexing, Search and Theorizing) Version 3. Analysis of observation of labour and pre and post birth interviews revealed that all women wanted a birth with minimal intervention, however safety was an overriding consideration. During labour women relied on the midwife to oversee and direct care, and trust in care by a midwife was established as a result of prior experience, or during antenatal care. Factors inhibiting full partnership between women and midwives, and also the use of alternative pain strategies, included staffing levels, lack of emphasis on evidence based care and environmental constraints such as the room set up.

[Recurrent abdominal colic, myalgia and mononeuritis multiplex]

The case of a 30-year-old male, who presented with a three months history of fever, night sweats, weight loss and myalgia is reported. Subsequently abdominal cramps, bloody diarrhea and mononeuropathy multiplex developed. An abdominal and renal angiogram showed changes of vascular structures diagnostic for polyarteritis nodosa. An immunosuppressive treatment (Prednisolon 100 mg/day and Cyclophosphamid 200 mg/day) was started. However, diffuse peritonitis as the aftermath of bowel infarction, which comprised the total length of the jejunum and the proximal parts of the ileum, developed at the third week of this treatment. Despite immediate surgical resection of the ischemic bowel septic complications occurred and the patient died.

Nurses' definitions of and attitudes towards euthanasia

A major impetus for this study was recent literature that assumed that nurses' definitions of euthanasia and consequent opinions on decision making are unproblematic. The purpose of this study was to identify nurses' definitions of and attitudes towards euthanasia. Ten semi-structured interviews were conducted with nurses working in a variety of clinical practice settings. The majority of nurses could distinguish between active and passive euthanasia, but it was only in terms of active euthanasia that the debate was seen as significant. It was considered that the term passive euthanasia, particularly in relation to withdrawal of treatment, has served to confuse the real debate centring around active euthanasia. Only two participants were in favour of active euthanasia, but emphasized the need for 'a community of shared responsibility' in decision making. The major finding of the study was the commitment of all participants to caring for and ensuring the comfort of the dying patient. The concepts of ordinary and extraordinary forms of treatment and heroic measures were seen as worthy of debate in the context of dying with dignity rather than of euthanasia. There was an associated aversion to inappropriate heroic measures, which were perceived as prolonging death and interfering with 'dying with dignity'. The development of a personal and moral/ethical stance (in relation to euthanasia) was shown to be an evolving process embedded in a caring philosophy and emphasizing the contextual nature of providing appropriate care.

Feminist method and qualitative research about midlife

This paper identifies criteria seen as essential to feminist research. In light of these criteria, issues which have arisen during our current research on women and their experiences of midlife and menopause are discussed. Issues considered include the researchers' responsibilities to participants when exploring sensitive and highly personal issues relating to participants' life experiences, and less clear cut issues such as knowledge construction, power and control. In relation to the latter the balance of power in the research-participant relationship, and the role and responsibilities of the researcher in knowledge construction, are explored. Foucault's notions of knowledge construction and power and control and the feminist researcher's position, are considered in terms of rigour in feminist research and dissemination of research reports. Issues which are seen as problematic and worthy of further debate are: the relations between interviewer and interviewee; the intellectual (the researcher) as the bearer of universal values and as truth teller; and the level of critical activism possible in research studies of this nature.