Search

On September 28, 1981, Great Britain's Central Council produced a consultation paper in which certain proposals are made for election to the recently constituted National Boards for Nursing, Midwifery and Health Visiting. The purpose of the election is to elect nurses, midwives and health visitors as members of the National Boards for Nursing, Midwifery and Health Visiting in England, Scotland, Wales and Northern Ireland. It is proposed that there should be three categories of candidates--nurses, midwives and health visitors. To be eligible to stand as a candidate a person must be either a practising nurse, practising midwife or a practising health visitor.

devane d., begley c.m. & clarke m. (2004) Journal of Advanced Nursing 47(3), 297–302 How many do I need? Basic principles of sample size estimation In conducting randomized trials, formal estimations of sample size are required to ensure that the probability of missing an important difference is small, to reduce unnecessary cost and to reduce wastage. Nevertheless, this aspect of research design often causes confusion for the novice researcher. This paper attempts to demystify the process of sample size estimation by explaining some of the basic concepts and issues to consider in determining appropriate sample sizes. Using a hypothetical two group, randomized trial as an example, we examine each of the basic issues that require consideration in estimating appropriate sample sizes. Issues discussed include: the ethics of randomized trials, the randomized trial, the null hypothesis, effect size, probability, significance level and type I error, and power and type II error. The paper concludes with examples of sample size estimations with varying effect size, power and alpha levels. Health care researchers should carefully consider each of the aspects inherent in sample size estimations. Such consideration is essential if care is to be based on sound evidence, which has been collected with due consideration of resource use, clinically important differences and the need to avoid, as far as possible, types I and II errors. If the techniques they employ are not appropriate, researchers run the risk of misinterpreting findings due to inappropriate, unrepresentative and biased samples. [ABSTRACT FROM AUTHOR]

Midwives’ perceptions of the use of technology in assisting childbirth in Northern Ireland Aim of the paper. The aim of this paper is to report a survey of midwives’ views on the use of technology in assisting births. Background. The research was designed to provide a deeper understanding of the integration of technology into midwives’ practice and to identify and examine aspects of training needs. Methods. Over 400 midwives responded to a questionnaire seeking information on their experiences and perceived competence with labour ward technology, with a particular focus on the use of cardiotocograph machines (CTGs) for electronic foetal monitoring. The survey sought views on the extent to which midwives trust the technology, their perceived levels of training and competence, their awareness of policy relating to technological intervention and the issue of women’s choice in whether the progress of their delivery is technologically monitored. Findings. The majority of midwives in this survey trust the use of technology but have concerns about issues of safety in relation to potential faults, and to their perceived lack of training in technology usage. The majority also indicated that they prefer a nontechnological birth although many point to the benefits of technological support when difficulties are encountered. The use of technology is seen as multi-professional and there was much support among the respondents for multi-disciplinary training in the use of technologies in future curricula. Conclusions. If the various findings of this sample survey were to be consolidated for midwives as a whole, they suggest that provisions for continuing professional development may need to address technological awareness and competence in a more focused manner than is discernible at present. [ABSTRACT FROM AUTHOR]

The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations’ data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy Background. This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as ‘attendance at birth by trained personnel’ (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. Aim. To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR.

Introduction of Aims and Scope for the Journal of Advanced Nursing with emphasis on inclusiveness and diversity among nurses and midwives. Issues and innovations in nursing practice; Aspects of motherhood and maternity; Studies of diabetic populations.

The diagnosis of foetal distress is complex: it is influenced by a number of factors which range from the physical examination of the mother and foetus to the psychological and social world in which the mother, the midwife and other health care professionals work. The consequences of an incorrect diagnosis of normality or foetal distress are potentially serious for both mother and baby. Recent changes in the practice and delivery of midwifery care have placed more responsibility on midwives. It is therefore imperative that midwives become more aware of the complexity of the diagnosis as well as of some of the factors which can improve the quality of their diagnosis. This paper reviews the literature associated with the diagnosis of foetal distress, physiological and pathological changes during pregnancy and labour, and the usefulness and limitation of the tools readily available to midwives for the diagnosis. It also examines the limits of the relationship that exists between intra-uterine and neonatal markers. The purpose of this paper is to provide background information that would support midwives in the diagnosis of foetal distress in the hope that the false positive diagnoses can be reduced for the benefit of mothers and babies. Ultimately an improvement in outcome should be reflected in the more efficient and effective use of resources available to maternity services. [ABSTRACT FROM AUTHOR]

The section comments on the article "Protective Steering: A Grounded Theory Study of the Processes by Which Midwives Facilitate Informed Choices During Pregnancy," by V. Levy, which appeared in the 1999 issue of the "Journal of Advanced Nursing." It discusses the focus of the paper, which is on the relationship between the childbearing woman and the midwife. It characterizes the midwives in Levy's sample in terms of making decisions about their maternity care.

Aim. This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. Background. Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. Methods. Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$' 'social enterprise$' 'mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. Results. Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. Conclusion. Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors. [ABSTRACT FROM AUTHOR]

'Great fleas have little fleas': Irish student midwives' views of the hierarchy in midwifery Background. Many studies have investigated the world of the student nurse, but there is little work into the lives and experiences of student midwives. Studies of Irish midwives' provision of care have demonstrated that they are not fulfilling their complete role, and research into their education was deemed to be necessary. Aim. To explore the opinions, feelings and views of student midwives as they progressed through their 2-year education programme in Ireland. Methods. Both quantitative and qualitative methods were used and the qualitative sections of the study were guided by the phenomenological approach. Ethical approval was granted. All students in the first intake of 1995 in all seven midwifery schools in Southern Ireland agreed to take part (n=125). Individual and group interviews, diary-keeping and questionnaires collected data. Results. The findings presented in this paper describe the students' views of the hierarchical structures in midwifery, and the role and behaviours of the 'Matron'. The data describes a subculture of nursing/midwifery subordination. Discussion. One reason for the hierarchical nature of the midwifery profession may be because it is an almost totally female-dominated profession, with the female hierarchy exercising control over other women within a male-based power structure. Many hospitals preferred to employ their own students as staff, ensuring a continuation of the hierarchical regime. Conclusion. The recurring nature of this problem may be because midwives now fear change more than they desire it. Further research is required to ascertain whether the reason for the strong hierarchy is because of the continuation of midwifery from the male-dominated profession of nursing, to the existence of the industrial/economic model of maternity care or to the impact of the medicalization of childbirth. [ABSTRACT FROM AUTHOR]

Midwives’ attitudes to the use of the cardiotocograph machine Background. The literature would suggest that midwives’ attitudes towards the use of birth technology are mainly focused around issues of ‘trust and dependence’ yet there has been no published research to refute or substantiate these beliefs. Aim. This paper reports on an empirical study that aimed to identify midwives’ attitudes to technology usage in the labour ward and specifically the use of the cardiotocograph machine (CTG) for electronic foetal monitoring. Design. A postal survey was conducted and the questionnaire included a 25-item attitude scale, which was designed to assess attitudes towards the use of the CTG machine. All midwives (1086) on the United Kingdom Central Council register for Northern Ireland were surveyed. The data were factor analysed and compared using several categorical groupings including age, perceived skill, prior training with computers and trust in the machines. Results. The results indicate that midwives reject any notion of them being, or becoming, dependent on machines in their practice. However, midwives who trust machines are more disposed to their use and trust is affected by perceived competence. Conclusion. The paper concludes with a recommendation for the future education of midwives to develop and maintain competence based craft skills in natural birth as well as high-tech birth. [ABSTRACT FROM AUTHOR]

This paper comprises essentially a discussion of the pilot of a study currently being undertaken to compare the practice styles of graduate and non-graduate nurses. The background to the main study is described and discussed, as is the methodology. The problems encountered in the planning and executing of the data collection are particularly highlighted. The paper does not present data from the pilot study, but evaluates the methodology used and considers the implications for the main study. [ABSTRACT FROM AUTHOR]

During the past decade, the professional journals have contained numerous papers authored by nurses and nurse -- researchers describing the gap which persists between research and clinical practice. Problems have been highlighted and challenges explored in the quest to discover ways of encouraging practitioners to become more aware of research evidence as a knowledge base for practice. Many of the identified issues may be transposed into a midwifery setting but other factors may be recognized which are specific to the practice of midwifery. This paper considers both conceptual and pragmatic issues in an attempt to explore the complexity of the influences which may affect the integration of research into midwifery practice. [ABSTRACT FROM AUTHOR]

Title. Nurses’ attitudes towards perinatal bereavement care. Aim. This paper is a report of a study conducted to explore the factors associated with nurses and midwives’ attitudes towards perinatal bereavement care. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. In some situations nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they feel unable to deal with the enormity of the parental feelings of loss. Method. A correlational questionnaire study using convenience sampling was carried out in Singapore in 2007 with 185 nurses/midwives in one obstetrics and gynaecology unit. Results. Regression models showed that nurses/midwives with religious beliefs and those with more positive attitudes to the importance of hospital policy and training for bereavement care were statistically significantly more likely to have a positive attitude towards perinatal bereavement care. Nurses emphasized their need for increased knowledge and training on how to cope with bereaved parents and requested greater support from team members and the hospital. Conclusion. Bereavement counselling education and preceptorship supervision are recommended to reduce this stressful experience, increase the confidence and expertise of novices, and lead to increased quality of care for bereaved parents. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of lesbian parents' experience of antenatal care, childbirth and postnatal care. Background. In a strictly heteronormative-based care system, 'parents' naturally implies a man and a woman, and all communication and routines are based on heterosexual couples. Method. A qualitative interview study was carried out in 2008. Ten mothers, eight of whom were in a relationship with another woman, participated. The participants had experience from several care facilities from three different cities in central Sweden. Findings. Most participants had positive experiences but also complained that the focus was not always on the pregnancy and that no parenthood education had been offered. Heteronormativity was communicated by midwives and nursing staff throughout the process - from antenatal care to postnatal care, via forms, journals, verbal communication and orientation visits. This was experienced as embarrassing for the participant parents, and they also described encountering what they interpreted as embarrassment on the part of care providers. Participants called for increased knowledge about lesbian parenting, since they believed this would influence and facilitate communication, not least with midwives in antenatal care. Conclusion. Midwives educated in lesbian issues could ask questions and communicate in a more neutral way at the first meeting, and thereby make prospective parents feel less insecure. Special parenthood education groups for lesbians are recommended so that lesbian couple can meet others with similar experiences and so that the focus will be on prospective parenthood and not on their sexual orientation. [ABSTRACT FROM AUTHOR]

Title. Women’s positions during the second stage of labour: views of primary care midwives. Aim. This paper is a report of a study to explore the views of midwives on women’s positions during the second stage of labour. Background. Many authors recommend encouraging women to use positions that are most comfortable to them. Others advocate encouragement of non-supine positions, because offering ‘choice’ is not enough to reverse the strong cultural norm of giving birth in the supine position. Midwives’ views on women’s positions have rarely been explored. Method. Six focus groups were conducted in 2006–2007 with a purposive sample of 31 midwives. The data were interpreted using Thachuk’s models of informed consent and informed choice. Findings. The models were useful in distinguishing between two different approaches of midwives to women’s positions during labour. When giving informed consent, midwives implicitly or explicitly ask a woman’s consent for what they themselves prefer. When offering informed choice, a woman’s preference is the starting point, but midwives will suggest other options if this is in the woman’s interest. Obstetric factors and working conditions are reasons to deviate from women’s preferences. Conclusions. To give women an informed choice about birthing positions, midwives need to give them information during pregnancy and discuss their position preferences. Women should be prepared for the unpredictability of their feelings in labour and for obstetric factors that may interfere with their choice of position. Equipment for non-supine births should be more midwife-friendly. In addition, midwives and students need to be able to gain experience in assisting births in non-supine positions. [ABSTRACT FROM AUTHOR]

Title. New midwifery? A qualitative analysis of midwives’ decision-making strategies Aim. This paper is a report of a study to explore the reasons why midwives decided to adopt observed decision-making strategies relating to the use of technology. Background. Literature on the development of midwifery and nursing has suggested that they are developing more egalitarian relationships with clients in decision-making processes. Methods. A qualitative approach was adopted, using participant observation with a convenience sample of midwives ( n = 16), and a focus group of midwives ( n = 8). Data collection took place over 9 months in 2004. Findings. The dominant mode of decision-making was bureaucratic decision-making, which involved adherence to written policies and procedures. The least frequently used was ‘new professional’ decision-making, which involved collaboration with clients. The reasons for midwives’ approaches could be categorized under three main headings: first, context, including possible litigation, management strategies, workload pressures, and medical dominance; second, midwives’ characteristics, including both lack of experience and the reliance on tradition of some experienced midwives; and third, women’s perceived characteristics, some of whom were seen by midwives as either unwilling or unable to participate in decision-making. There was also implicit evidence that some midwives were uncomfortable with the new professional rebalancing of power relations between professionals and the laity. Conclusion. Managers need to question whether the strategies they adopt hinder or support clinicians in their efforts to involve women in decisions. Clinicians need to consider whether they wish to be selective or universal in their use of new professional strategies. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study examining midwives’ perceptions of the way in which they diagnose labour. Background. Diagnosis of active labour is often problematic. A midwifery workforce planning tool identified that up to 30% of women admitted to United Kingdom labour wards subsequently turned out not to have been in labour. There is evidence that if a woman is admitted to a labour ward in early labour, she is more likely to have some form of medical intervention. However, despite the impact of misdiagnosis, there is little research on the process of decision-making by midwives in relation to diagnosis of labour. Methods. This was a qualitative study, employing focus group methods. Participants were a convenience sample of midwives working in a maternity unit in the North of England during 2002. They were asked to discuss their experience of admission of women in labour. Data were analysed using latent content analysis. Findings. Thirteen midwives participated in one of two groups. They described using information cues, which could be separated into two categories: those arising from the woman ( Physical signs, Distress and coping, Woman's expectations and Social factors) and those from the institution ( Midwifery care, Organizational factors and Justifying actions). Midwives’ decision-making process could be divided into two stages. The diagnostic judgement was based on the physical signs of labour: the management decision would then be made by considering the diagnostic judgement as well as cues such as how the woman was coping, her expectations and those of her family and the requirements of the institution. Conclusions. Midwives may experience more difficulty with the management decision than with the initial diagnosis. It may be that the number of inappropriate admissions to labour wards could be reduced by supporting midwives to negotiate the complex management hurdles, which accompany diagnosis of labour. [ABSTRACT FROM AUTHOR]

stewart m. (2005) Journal of Advanced Nursing 51(6), 587–594 ‘I'm just going to wash you down’: sanitizing the vaginal examination This paper reports findings from an ongoing study exploring the qualitative experiences of midwives and women in relation to vaginal examination in labour, focusing on how vaginal examination is discussed and on the wash-down procedure used by some midwives. The body is a source of considerable ambivalence in sociological terms. Women's bodies, in particular, have been viewed as problematic and as a potential source of dirt and pollution. It has been suggested that vaginal examinations during labour are used, at least in part, as a ritual procedure by which healthcare professionals demonstrate that they are in control of both the labouring woman and the process of labour itself. In-depth interviews were undertaken during 2003 with six childbearing women and 10 midwives who had been involved in these women's care. Non-participant observation was also carried out of each woman's labour and birth. During interviews, when discussing vaginal examination, midwives persistently used abbreviations or euphemisms as a means of distancing themselves from the realities of the procedure. Some midwives were observed washing women's genitals in a highly ritualized manner prior to vaginal examination, apparently as a strategy for establishing power differentials. Midwives commonly state that they are advocates for woman-centred care but their behaviour in relation to vaginal examination belies this and suggests that they regard women's bodies as contaminated and polluting. Healthcare students need to be taught specific communication skills to enable them to discuss vaginal examination more fully with women so that they feel less need to resort to euphemisms and abbreviations when discussing the procedure. It is also important to carry out vaginal examination in a way that is not demeaning and does not reinforce notions that women's bodies are dirty. [ABSTRACT FROM AUTHOR]

timmins f.&mccabe c. (2005) Journal of Advanced Nursing51(1), 38–45Nurses’ and midwives’ assertive behaviour in the workplaceThis paper reports a study describing the assertive behaviour of a group of professional nurses and midwives and exploring potential barriers and facilitators to the use of assertiveness skills in the workplace.As nurses and midwives move away from traditional roles, it is increasingly being recognized that they need to behave in an assertive manner. Much literature supports the use of assertive behaviour in clinical practice. Although specific individual assertive behaviours and skills have been examined in many settings, little empirical evidence exists about the frequency and use of assertiveness skills by nurses and midwives in the workplace. While there is evidence on barriers to the use of assertive skills, there is little information about factors that may facilitate their use.A survey design was adopted, using a 44-item questionnaire to collect data from a 2·5% random sample of nurses/midwives registered with the National Nursing Board of Ireland. The data were collected in 2003.While respondents frequently complimented their colleagues and often allowed them to express opinions, they were less accomplished at expressing their own opinions or making requests. Assertive behaviours were used more frequently with nursing/midwifery colleagues than with management/medical colleagues. Most used assertiveness skills with other grades of staff in their own profession. Responsibility to patients/clients emerged as a supporting factor for using assertive behaviour. Managers, the work atmosphere and fear were viewed as obstacles.Nurses and midwives needs to learn how to behave assertively, and this should be included in both pre- and post-registration education programmes. As use of assertiveness skills was reported to be least frequent with nurse/midwife managers, local policies and guidelines may be needed to encourage clinical practitioners to act autonomously and as client advocates. [ABSTRACT FROM AUTHOR]

keeney s., hasson f., mckenna h.& gillen p. (2005) Journal of Advanced Nursing 50(4), 345–355 Nurses’, midwives’ and patients’ perceptions of trained health care assistants This paper reports on part of a larger study and outlines Registered Nurses’ and Midwives’ perceptions of, and satisfaction with, trained health care assistants in a regional hospital setting in the Republic of Ireland. An increased reliance upon health care assistants in the clinical setting has highlighted the need to consider how staff and patients perceive the health care assistant role. Nurses were satisfied with the work undertaken by trained health care assistants and considered that they contributed positively to patient care and supported nurses/midwives by undertaking non-professional duties. However, maternity clients reported that health care assistants were mostly giving direct care, and their availability was perceived to be better than that of qualified staff. Some nurses/midwives were reluctant to assume responsibility for delegation of direct care duties to health care assistants. The employment of health care assistants yields positive outcomes for staff and female clients but consideration must be given to role clarity. Further research into how qualified staff perceive health care assistants is important as such perceptions influence delegation, integration, role development and acceptance of health care assistants. [ABSTRACT FROM AUTHOR]

AIM: With the recognition that environmental health has relevance to all nursing and midwifery activities, the aim of this paper is to discuss nurses' and midwives' past and present involvement in environmental health in the UK, where the international situation demonstrates good practice, and the challenges and possibilities for greater and more effective UK-based activity in the future. BACKGROUND: The association between environmental hazards and adverse health effects has received increasing attention over recent years. In the United States of America (USA), the importance of developing an environmental health role for nurses outside of the 'traditional' occupational and environmental health nursing specialty has been recognized and acted upon through education, information programmes and policy developments. In the United Kingdom (UK), the same degree of interest, commitment and activity is somewhat lacking. DISCUSSION: Little nursing and midwifery activity on environmental health issues has taken place in the UK over recent years. The lack of development in this field may relate to the problems of an already overstretched disease treatment service and the lack of an upstream approach to public health. Theoretical and philosophical influences, as well as individual and organizational obstacles or constraints, exist and may hinder nurses and midwives in their efforts to address the subject. Yet nurses and midwives are the largest group in the National Health Service workforce and this gives enormous potential for effective interventions in environmental health. CONCLUSIONS: Whilst barriers and obstacles to nursing and midwifery involvement in environmental health in the UK exist, they are all surmountable and appropriate interventions could prove cost-effective in the middle and long-term. Additionally, they may be viewed as a necessary activity for nurses and midwives in response to real health threats and the expressed worries and concerns of patients and communities. [ABSTRACT FROM AUTHOR]

cutter j & jordan s. (2004) Journal of Advanced Nursing 46(4), 441–452 Uptake of guidelines to avoid and report exposure to blood and body fluids Mucocutaneous and percutaneous exposure to blood and body fluids (inoculation injury) are major risk factors for occupational acquisition of bloodborne infection in health care professionals. Compliance with prescribed ‘universal precautions’ during exposure-prone procedures has been shown to reduce the risk of acquiring bloodborne viral infection. In addition, reporting such exposures facilitates prophylaxis. The aim of this paper is to report a study to identify strategies to minimize professionals’ risks of acquiring bloodborne infections during exposure-prone procedures. All surgeons, theatre nurses who scrub for surgery and midwives employed in general operating theatres and delivery suites within one UK National Health Service trust ( n = 276) were surveyed by postal questionnaire. Data were analysed using univariate and bivariate techniques in SPSS version 10. Content analysis was undertaken on the one open-ended question. The response rate was 72·5% (200/276). Only 1·5% (3/200) of respondents adopted universal precautions for all patients irrespective of whether their bloodborne viral status was known. On average, only half the recommended theatre-specific precautions were always adopted (mean 3·725/7, sd = 1·385). Most respondents (63·3%) admitted making judgements related to nationality, lifestyle or sexual orientation when making decisions about protective clothing. Many respondents (74%, 145/196) reported sustaining an inoculation injury in the 10 years prior to the study. However, under-reporting of injuries was common, and 32·4% (47/145) admitted failing to report injuries. Guideline adherence was influenced by profession, but not by time since qualification. The findings suggest that strategies must be developed to improve compliance with universal precautions and reporting guidelines by all health care professionals. The extent of, and reasons for, non-compliance with both local and national guidelines remain relatively unexplored. [ABSTRACT FROM AUTHOR]

BACKGROUND: While skill mix studies are quite commonplace in health care, most have focused on the most effective use of staff and skill distribution in the field of nursing; few relate specifically to the midwifery profession. In Ireland there is no recognized midwifery assistant grade. AIMS: This paper describes a study that investigated the skill mix requirements of a midwifery service based in the Republic of Ireland. The project was built on previous research, which showed that due to undertaking a number of 'nonmidwifery duties', midwives were unable to undertake fully the work for which they were trained. RESEARCH METHODS: Data were collected using a variety of methods. These included postal questionnaires and the Delphi technique. The 'Delphi' was used to gain a level of consensus from hospital midwives (all grades) (n=194) and student midwives (n=79) on what are and what are not nonmidwifery duties. Analysis of secondary data (duty rotas and staff turnover data) was also undertaken. RESULTS: Findings indicate that the respondents spent a large proportion of their time undertaking clerical, domestic, portering and stock duties. They would welcome the introduction of midwifery assistants into the ward team and were able to identify those duties that such persons could undertake. CONCLUSIONS: Skill mix requirements and organizational strategies to deal with the workforce changes are highlighted. Due to the current shortage of midwives in many countries and the dearth of extant research in this area, the results and recommendations have implications for midwives nationally and internationally. [ABSTRACT FROM AUTHOR]

This paper reports on midwives' support needs as they were described by midwives in a large study of the supervision of midwives in England. The data are derived from six sites: five, very different, National Health Service (NHS) sites, and one composed of midwives outside the NHS. In-depth, ethnographic interviews were conducted with 168 midwives and a grounded theory approach was used for the analysis. The findings identified midwives' many and varied support needs. Midwives also clearly described the culture of midwifery in the NHS. This culture inhibited midwives from arranging to have their support needs met and acted as an obstacle to progress in developing midwifery practice. The dilemmas and tensions inherent in this situation are explored and suggestions made as to the way forward. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The primary aim of the study was to evaluate the effectiveness of two approaches to increase research awareness among midwives and nurses. DESIGN: Quasi-experimental with the attitudes of staff in the two groups being measured at two points (January and October 1997). SAMPLE: All midwives and nurses working in four clinical areas in an acute NHS Trust. The intervention arm of the study involved all midwives and nurses in the Clinical Directorate of Obstetrics and Gynaecology, while the control arm involved all nurses working in a specialist oncology and haematology unit and in the children's directorate. ETHICS: The Joint Ethics Committee considered approval unnecessary because the study involved staff and not patients. DATA COLLECTION: Data were collected by self-complete questionnaires. INTERVENTIONS: A programme of education with policy and practice interventions targeted at ward sisters. OUTCOME MEASURES: Staff attitudes to, knowledge of, and level of involvement in, research. RESULTS: The study demonstrated a significant increase in both knowledge and use of research resources. Following the programme of education, staff in the intervention group were significantly more likely to use resources associated with research utilization and to report that they had read a research paper within the last month. STUDY LIMITATIONS: The time scale of the intervention was restricted by the funding available; a significant Hawthorne effect was evident with both groups showing an increase in knowledge; the pragmatic nature of the study meant that it was not possible to randomize the study groups; the scale of the study did not permit an economic evaluation. CONCLUSIONS: The introduction of clinical governance challenges healthcare providers to improve the care they deliver. There are huge opportunities for Trusts to invest in developing staff knowledge and use of research. However, staff will only seize these opportunities if there is an appropriate, enabling environment--an environment that delivers intensive interventions and is sensitive to the wider structural factors in the NHS affecting staff morale and commitment. In the absence of this environment, what may be seen as opportunities to managers may be regarded as just another burden by staff. [ABSTRACT FROM AUTHOR]

A discussion of the legal aspects of female genital mutilation The purpose of this paper is to examine the position of the nurse/midwife in the United Kingdom when involved with the care of a woman or female child who has suffered genital mutilation, which is an illegal practice in this country and most other areas of the world. The types of circumcision commonly practised are introduced, the prevalent reasons for the continuation of the practice among certain ethnic groups are presented, and the range of issues to be considered by the nurse is examined. These include international and national legal aspects which do not exist in isolation and are considered in context with cultural, medical, human rights and gender issues. Nursing legal issues include child protection, consent, advocacy and confidentiality, which invoke the Code Of Professional Conduct of the United Kingdom Central Council for Nursing Midwifery & Health Visiting. Midwives and nurses working in the field of gynaecology have raised questions regarding possible courses of action to take when presented with this issue. Increased knowledge can help to inform those decisions. Therefore, implications for future practice are addressed, together with recommendations to assist nurses with decision making when faced with this scenario in the future. [ABSTRACT FROM AUTHOR]

Health promotion is widely accepted as part of the role of the nurse, midwife and health visitor. Theoretical definitions of health promotion and health education are presented. The author suggests that a variety of different approaches to health promotion can be adopted by nurses in practice, including education, persuasion, manipulation and attempts to promote an environment where healthy decisions about lifestyle can be made. Each strategy is examined and the advantages and the ethical limitations are explored. It is suggested that nurses may theoretically accept the notion of being a health promoter, but that in the reality of practice, their role may be primarily that of the health educator. The importance of recognizing that there are a variety of determinants of health, including social and environmental factors, as well as individual lifestyle, is emphasized throughout the paper. [ABSTRACT FROM AUTHOR]

This paper outlines a survey which was carried out in the Swansea District of the West Glamorgan Area Health Authority. Midwives and health visitors working in hospitals and the community were asked to participate. The former since the survey was instigated by the midwifery division and the latter because of their close involvement and cooperation in offering advice regarding infant feeding. Other media communicating information on this topic were not disregarded but specific advice given by these particular professional personnel was analysed in detail. It was hoped that by looking at the content of such advice, if it differed widely, certain important criteria could be decided upon. This would only be possible by arriving at a consensus of opinion on certain issues and investigating principles or reliable experience from which such advice apparently originated. The survey enabled a detailed examination of the prevailing conditions within a limited geographical area. Recommendations followed as a result of the investigation and enabled further decisions to be made to clarify the situation. [ABSTRACT FROM AUTHOR]

Many educational research projects start from a wide and nonoperational statement of the problem causing concern, and a difficult task for the research worker is to so refine the area of enquiry that useful and effective results of the research are produced within the constraints imposed by limited resources. An evaluative research project into the role and preparation of the midwife teacher, undertaken in 1974-5 by the authors, at the request of the Royal College of Midwives, presented such a problem (Kilty & Potter 1975). This paper illustrates the methodology employed to establish priorities in order to resolve what was an entirely open-ended brief into a research that could be undertaken with limited resources. [ABSTRACT FROM AUTHOR]

Accepted definitions of the midwife suggest that she is a woman trained to care for other women during the normal childbirth process; a complementary role to that of the obstetrician who is concerned primarily with the application of scientific knowledge to ensure as far as possible the physical wellbeing of mother and infant. In this paper the relationship between midwives and the medical profession is examined, with particular reference to their perception of the role of the midwife and her responsibility in maternity care. It is argued that the claim of midwives to be practitioners in their own right within a limited field is rarely recognized in practice and some implications of this finding are discussed. [ABSTRACT FROM AUTHOR]

This paper looks at the use of a computer program (QSR.NUD.IST) to analyse qualitative data. The data are derived from interviews with clinical midwife mentors as part of an evaluation of a midwifery educational programme. An account is given of the content analysis of the data with reference to the literature, and then the way the programme was used to analyse the data a second time. A description is given of the way this programme in particular functions using the textual data as an example. The use of computers in general for analysing qualitative data is discussed in terms of their advantages and disadvantages. The results of the study are described briefly showing how the mentors view their role and responsibilities. [ABSTRACT FROM AUTHOR]

The article offers perspectives regarding the negative impact a caesarean section (CS) may have on a woman's perception of her childbirth experience. It suggests that users of midwifery services must warrant the safety of mothers and the fetus. It provides the stimulation for midwives and others involved in maternal and neonatal services to reflect on the matter of high rising rates of CS.

The section comments on the article "Protective Steering: A Grounded Theory Study of the Processes by Which Midwives Facilitate Informed Choices During Pregnancy," by V. Levy, which appeared in the 1999 issue of the "Journal of Advanced Nursing." It comments on Levy's description of how the values of midwives tended to influence the decisions being made by pregnant women. It points out how Levy's study will be useful in the field of healthcare. It asserts that the study draws attention to the importance of communication and the opportunities that may facilitate informed choice.

The article presents information on a liaison meeting with Nursing/Midwifery Associations on World Health Organization's (WHO) European Nursing/Midwifery Programme, convened by the WHO Regional Office for Europe in Copenhagen, Denmark, from June 26-28, 1974. The purposes of the meeting were: To consider the basic concepts which underlie the effective development of nursing/midwifery services and education and to suggest ways in which the Regional Office could contribute to their application; To identify nursing functions more clearly and, concurrently, the major problems and constraints confronting the profession in discharging them; To suggest ways in which the inter-country associations could best communicate among themselves and with the Regional Office.

Comments on several health-related issues in nursing profession, as of February 1998. Importanc eof critical thinking in nursing practice; Discussion on skin prick testing in general practice; Information on HIV and AIDS awareness among midwives.

AIM: The project Addressing Inequalities in Health: new directions in midwifery education and practice (Hart et al. 2001) was commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB). Here, we draw on those research findings to consider current midwifery policy and practice in England. BACKGROUND: Little guidance on providing equality of care exists for midwives. The Code of Conduct [United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) 1992] makes no specific requirement for midwives to address issues of inequalities of health in their practice. Recent policy documents emphasize the need to work towards reducing inequalities and to target practice to 'disadvantaged clients' without giving guidelines on how to identify and care for target groups. METHODS: In-depth studies of midwifery education and service provision were conducted in three very different parts of England. Three months of fieldwork were undertaken at each site, comprising a series of interviews with midwifery educators, managers, students, midwives and service users. Focus groups were also held and observation of classroom sessions and midwifery practice undertaken. Findings. A lack of clear and specific strategies concerning inequalities in health was evident at managerial level. Patchy knowledge of current policy was also evident amongst practising midwives. Specific projects with disadvantaged clients usually resulted from a particular midwife's personal interest or evident local need. All midwives emphasized the importance of 'equality of care'. How this was operationalized varied, and 'individualized' or 'woman-centred' care was assumed to encompass the concept. In the few examples where care was systematically targeted in accordance with policy directives, the midwife's public health role was increased. CONCLUSION: In the absence of a co-ordinated strategic vision driven by managers, practitioners find difficulty in prioritizing care and targeting resources to disadvantaged clients in line with policy directives. Tensions between policy and practice in the care of 'disadvantaged' women clearly exist. Successful implementation of policy at practice level needs: commitment from managers; clarity of purpose in documentation; and provision of specific targets for practitioners. However, the latter should remain flexible enough for the delivery of care to be appropriate and sensitive to individual needs. [ABSTRACT FROM AUTHOR]

In response to a Department of Health, England, circular encouraging policies of named voluntary antenatal HIV antibody testing, one West Midlands health authority in England introduced a policy of raising the issue proactively at the first antenatal attendance. In order to facilitate this policy a short staff education programme was provided for midwives. This paper reports on part of a study which aimed to evaluate the impact of the HIV awareness training programme. A sample of midwives (n = 65) was randomly selected for inclusion in the study. Thirty-three had attended training and 32 had not. Data were collected using a self-administered questionnaire exploring knowledge of aetiology of HIV/AIDS, knowledge of transmission, knowledge of obstetric and paediatric HIV, attitudes to HIV, issues related to antenatal HIV antibody testing and opinions about the HIV awareness training programme. Results indicated no significant difference in levels of knowledge or in attitude between those who had attended the training programme and those who had not. Similarly, no significant difference was found in terms of how midwives would react to women requesting HIV antibody testing. Many of the results contradict the current literature and as a conclusion it is suggested that there is a need to review HIV-related training for midwives. [ABSTRACT FROM AUTHOR]

This article presents information about some events and news related to nursing. It congratulates Ruth Ashton on being confirmed in the post of general secretary of the Royal College of Midwives. She very valiantly took up the difficult role of acting general secretary following the sudden and untimely death of her predecessor. Miss Ashton is committed to promoting and fostering the midwife and the midwifery profession. The article then reports on International Psychiatric Nursing Conference. The first week long international conference presented by psychiatric nurses for psychiatric nurses will be held at Imperial College, London, from September 8 to 12, 1980.

Reports on the 23rd Congress of the International Confederation of Midwives held in Vancouver, British Columbia, in May 1993. Papers presented in the congress; Workshops held in addition to concurrent sessions.

The article discusses issues relevant to the "Journal of Advanced Nursing," as it celebrates its 30th anniversary in 2006. It recognizes nurses and midwives around the globe for their support and encouragement over the years. It also details the author's involvement with the journal which began when she was appointed editor in July 1997. Changes that occurred since the journal's inception are also identified.

Presents the response on the research paper about Midwives support needs as childbirth changes as written by M. Kikham and H. Stapleton. Additional discussion on the role of leadership on midwives; Suggestion on knowledge for evidence-based practice in Third Level Education as foundation on need of midwives; Challenges on expanding range of choices available to women.

Helping women to make informed choices during pregnancy is an important and complex part of a midwife's role that does not appear as yet to have been investigated in depth. The purpose of this study was to use a grounded theory approach to investigate the processes involved when midwives engage in facilitating the making of informed choices for women in the United Kingdom. Interactions between midwives and pregnant women were observed and recorded and focused interviews were conducted with the midwives. Data were analysed according to the grounded theory method. The core category was identified as protective steering, whereby midwives were concerned to protect the women in their care, as well as themselves, when choices were made. Substantive categories were orienting, protective gatekeeping and raising awareness. [ABSTRACT FROM AUTHOR]

kennedy h.p. (2004) Journal of Advanced Nursing 45(5), 504–511 Enhancing Delphi research: methods and results The Delphi method provides an opportunity for experts (panelists) to communicate their opinions and knowledge anonymously about a complex problem, to see how their evaluation of the issue aligns with others, and to change their opinions, if desired, after reconsideration of the findings of the group's work. Delphi studies have the potential to provide valuable information, yet few researchers have taken further steps to support or refine their findings. Without this step there is a potential threat to the applicability, or external validity, of the results. The purpose of this article is to present an argument for further inquiry to enhance and support Delphi findings, and specific approaches to this will be considered. Methods to enhance, expand, or refine Delphi study findings are described. Mixed method design within a Delphi study on midwifery practice is described, and a follow-up narrative study to examine the findings is presented. Selected results from the follow up narrative study are presented to convey how the narrative data clarified the Delphi findings. Together, the studies provide a more robust depiction of midwifery practice, process, and outcomes. Although there were similarities to the dimensions identified previously, there was a more dynamic focus and explanation of the interaction between the midwife, the woman who had received midwifery care, and the health care system. Lack of diversity in the sample and the midwives’ familiarity with the author's past research represent a potential threat to the findings. Prolonged interviews and multiple narratives were gathered in an effort to control for this. Delphi studies are research exercises conducted by a panel of experts. Designing studies to further enhance, clarify, or refine their findings from the context of practice holds promise for their ability to influence clinical care. [ABSTRACT FROM AUTHOR]

metcalfe a. & burton h. (2003) Journal of Advanced Nursing 44(4), 350–359 Postregistration genetics education provision for nurses, midwives and health visitors in the UK Rapid advances in genetics following the sequencing of the human genome will progressively reach all aspects of health care. Developments in genetics will increasingly having a significant influence on the work of nurses, midwives and health visitors. Therefore, these practitioners need to understand the impact that genetics will have for their patients and should be able to incorporate this new knowledge into their clinical practice to ensure that they continue to offer holistic care and influence the strategic development of health care. An earlier survey of higher education institutions in the United Kingdom (UK) offering preregistration courses for nurses, midwives and health visitors showed that the teaching of genetics was very limited in most curricula. To assess the provision of education on genetics for postregistration and postgraduate nurses, midwives and health visitors in the UK, as these practitioners are mostly likely to influence current health care provision and initiate changes in clinical practice. A total of 38 higher education institutions from 11 regions were surveyed via telephone or e-mail, using a semi-structured interview schedule. The findings showed that the inclusion of genetics in the curriculum was highly variable. A small number of institutions ( n = 3) offered courses with whole modules on genetics, whereas 19 of the 38 responding did not include any genetics in their curriculum at a postregistration level. The findings suggest that there is lack of recognition of the impact genetics is likely to have on health care. It is, therefore, recommended that the profile and relevance of genetics to nurses, midwives and health visitors should be promoted by the major organizations responsible for developing, commissioning and providing health care education. [ABSTRACT FROM AUTHOR]

mckenna h., hasson f. & smith m. (2003) Journal of Advanced Nursing 44(3), 308–317 Training needs of midwifery assistants Increasingly in the United Kingdom (UK) assistants are being introduced as part of the midwifery workforce. However, there appears to be little standardization in the qualifications and training provided. The aim of this study was to investigate what an educational programme for midwifery assistants should contain. A total of 100 qualified midwives and 58 midwifery students were asked to complete a mailed questionnaire and subsequently 20 of these respondents were interviewed. Respondents identified three levels of competencies that midwifery assistants should possess. They also acknowledged that midwives required specific training in how best to supervise assistants. Respondents maintained that each assistant should have a clinically-based midwifery mentor and that rotation around different clinical areas should be included as part of a training programme. Furthermore, it was stressed that because midwives initiate, teach and supervise assistants, they should have a key role in planning training programmes and in the teaching and assessment processes. Nonetheless, it was accepted that such a role could divert the midwife from valuable contact time with the mother and baby, the opposite of what the introduction of assistants was intended to do. Before working in clinical areas midwifery assistants need practice-based training that focuses on skills development. Communications and interpersonal skills should be included in the training as should placement experience in a variety of clinical settings. Midwives have a role in providing this training, and in mentoring and supervising midwifery assistants, but it is accepted that this could add to their workloads. Developments of this kind need to be evaluated, especially in terms of the impact on direct care by midwives. [ABSTRACT FROM AUTHOR]