Dissertations / Theses on the topic 'Midwives Education'

Mothers around the world experience preventable medical complications during labor and delivery that can lead to maternal and newborn mortality. In addition, some expectant mothers can experience abuse, neglect, and discrimination from attending midwives. This lack of quality care has more connection to maternal mortality than lack of access to health services itself, and it is shown that the most effective way to improve care is through training and continuous education of the midwife, the primary obstetric care-giver. Laerdal Global Health [LGH], was collaborated with in this thesis, a not-for-profit company whose work is dedicated to saving the lives of mothers and newborns in low income regions, through high-impact, low-cost solutions involving educational materials and training programs for midwives. The aim of the partnership with LGH was to support competency development for labor management, with a focus on continuous training and education for midwives in Tanzania, sub Saharan Africa. Continuous training is on-going education of midwives through various methods of training and learning, with the goal of keeping skill sets current and evolving with best practice knowledge. Around the world, as well as in in sub Saharan Africa, medical systems can be stressed by a range of factors, including lack of resources and lack experienced midwives, which leads to challenges to follow standardized obstetric guidelines and an over-burdening workload for the midwife. (LGH, 2019). There is also a high frequency of midwife turnover within clinics and hospitals, making it difficult to train a fluctuating staff of varying competencies and knowledge sets. (LGH, 2019). The net effect of these challenges and beyond, made it imperative to address how midwives could be supported in their efforts to engage in continuous education and training. To facilitate and support continuous education, a hybrid chat and professional education platform, Rio, was created, powered by social interaction, knowledge exchange, and democratization of information. This platform’s aim was to give form and body to existing digital and social behaviors, and midwives’ continuous education efforts, something that comes in many shapes and sizes, and levels of tangibility. A proposal in the digital space was determined to be optimal due to its ability to increase access to information, and its adaptability to user needs and environments. Rio also challenges the ubiquitous nature of WhatsApp in the medical context by addressing and rethinking the generation, use, and storage of patient data. In tandem, Rio maintains the successful social platform use patterns, while utilizing these traits to propel and facilitate professional education and knowledge exchange.

The main aim of this study was to work collaboratively with a group of practice development midwives in their National Health Service workplace and to examine the impact of their role on their working lives. The study took an action research approach that involved working with a group of practice development midwives and their replacements as some left the organisation during the time of the study. The study was participative and educative, using action learning as a vehicle for learning and development. The wider policy context is encompassed, taking into account the modernisation of the NHS, including clinical governance, continuing professional development and human and social capital. Three action research spirals are depicted and the data collection consists of one to one interviews with each midwife, a group interview with midwives and stakeholders, minutes of monthly meetings which record the action learning effort and field notes. The main findings were that culture, leadership, time and learning to develop were the keys to successful practice development and change in this particular maternity unit setting. The group endeavour as critical friends sustained the practice innovations when resistance was manifest. Moreover, the practice development midwives became empowered as they evolved their roles during spirals of action research activity. Vital messages emerge about the requirement for time, facilitation and support to underpin the NHS agenda for modernising, improving and changing. This group of midwives were motivated by the needs of their client group within each project they did. They were encouraged over time and armed with new skills and knowledge to work at the forefront of their profession in implementing and sustaining change. Recommendations are made for the use of the approaches adopted within this study to empower midwives in the field as they try to take a strategic approach to implementing maternity policy which encourages the drive for woman centred care.

A confident midwife has an impact on a pregnant woman’s clinical outcome and birth experience. Knowledge acquisition, competence, and confidence develops over a lifetime and is of great importance in developing and forming personal skills and allowing the personal traits to grow and mature. Previous international studies have shown that midwifery students do not feel confident in many areas in which they are supposed to practice independently. The aim of this thesis was to investigate confidence levels in basic midwifery skills in Swedish midwifery students in their final semester just before entering the midwifery profession. An additional aim was to describe clinical midwives’ reflections about learning and what factors that developes professional competence, and confidence. Study I was a cross-sectional survey with Swedish midwifery students (n=238). They assessed their own confidence in all competencies that a midwife should have and could practice independently. The results of study I confirmed that Swedish midwifery students feel confident in dealing with the most common procedures during normal pregnancy, childbirth, and postpartum and newborn care. However, they do not feel fully confident in cases in which there are deviations from the normal procedures and obstetric emergencies. When comparing groups of midwifery students, the younger group of midwifery students felt more confident in general compared to the older group. Students at a university with a medical faculty were also more confident than the students at a university without a medical faculty. In study II, focus group discussions were held with 14 midwives emphasizing the way in which midwives reflect on learning and the development of competence and confidence. Content analysis was used to analyze the focus group discussions. Four categories were identified as a result of study II: 1.) feelings of professional safety evolve over time; 2.) personal qualities affect professional development; 3.) methods for knowledge and competence expansion; and 4.) competence as developing and demanding. The conclusion of this thesis is that more practical and clinical training during education is desirable. Midwifery students need to have access and the opportunity to practice obstetrical emergencies within a team of obstetricians and pediatricians. Learning takes time, and one improvement is to extend midwifery education to include and increase in clinical training. This would strengthen the students theoretical, scientific, and clinical confidence. Clinical midwives claim that it takes time to feel confident and that there is a need to develop professionalism.
En trygg barnmorska har en positiv inverkan för förlossningsutfall samt förlossningsupplevelse. Kunskap, kompetens och trygghet är ett livslångt lärande och har stor betydelse för att utveckla och forma personliga färdigheter, att låta de personliga egenskaperna växa och mogna. Tidigare internationella studier har påvisat att barnmorskestudenter känner sig otrygga inom områden där förväntas vara självständiga. Syftet med denna avhandling var att undersöka graden av trygghet hos svenska barnmorskstudenter strax innan de var färdigutbildade. Ett annat syfte var att utforska hur kliniskt verksamma barnmorskor reflekterar över lärande och vilka faktorer som bidrar till att utveckla yrkesmässig kompetens och trygghet. Studie I var en tvärsnittsundersökning med svenska barnmorskestudenter (n = 238). De bedömde egen trygghet inom alla kompetenser som en barnmorska förväntas kunna samt utföra självständigt. Resultaten av studie I bekräftade att svenska barnmorskestudenter känner sig trygga att hantera de vanligaste rutinerna vid normal graviditet, förlossning, eftervård samt nyföddhets vård. De känner sig emellertid inte fullt så trygga när något avviker från det normala samt vid obstetriska nödsituationer. Vid jämförelse mellan yngre och äldre barnmorskestudenter samt grad av trygghet, var det den yngre gruppen av barnmorskestudenter som kände sig tryggare i allmänhet jämfört med den äldre gruppen. Studenter vid ett universitet med en medicinsk fakultet var också mer trygga än studenterna vid ett universitet utan en medicinsk fakultet. I studie II hölls fokusgrupper med 14 barnmorskor, de diskuterade och reflekterade över hur barnmorskor utvecklar kompetens. Metod för att analysera var innehållsanalys, i resultatet framkom fyra kategorier 1.) känslor av professionell trygghet utvecklas över tid ; 2.) Personliga kvaliteter påverkar yrkesutveckling. 3.) metoder för kunskap och kompetensutveckling; och 4.) Kompetens som utveckling och krävande. Slutsatsen av denna avhandling är att mer klinisk träning under utbildning är önskvärt. Barnmorskestudenter behöver tillgång och möjlighet att öva obstetriska nödsituationer tillsammans i team bestående av förlossningspersonal och barnläkare. Det tar tid att lära samt att känna trygghet, en möjlighet att underlätta för studenter vore att utöka samt förlänga barnmorskeutbildningen, att inkludera mer klinisk träning. Detta skulle innebära att stärka studenters möjligheter till en utökad klinisk trygghet. Kliniska barnmorskor hävdar att det tar tid att känna sig trygg och att det ett finns behov av att utveckla professionalism.

Substance misuse is a complex issue, fraught with many challenges for those affected. Whilst the literature suggests that pregnancy may be a ‘window of opportunity’ for substance misusing women, it also suggests that there are several barriers to women engaging with health care. One of these is the fear of being judged and stigmatised by healthcare professionals, including midwives. Previous research indicates that midwives have negative regard toward substance users and that this in turn may lead to stigmatising behaviours and consequential substandard care provision. Midwives however, stress that they do not have appropriate training to be able to effectively provide appropriate care for substance misusers. Research suggests that education (formal training) is needed in this area to improve attitudes. In this study, the role of education in changing attitude toward substance use in pregnancy was explored using case study methodology. The case was a single delivery of a university degree programme distance learning module ‘Substance Misusing Parents,’ undertaken by 48 final year student midwives across 8 NHS Trusts. The research was carried out in 3 phases, using a mixture of Likert style questionnaires (Jefferson Scale of Physician Empathy and Medical Condition Regard Scale), Virtual Learning Environment discussion board qualitative data and semi structured interviews. The findings of the questionnaires showed that whilst general empathy levels showed no significant change (p=0.539), empathy toward pregnant drug using women showed a statistically significant improvement following the module (p=0.012). Furthermore, exploration of the students’ experiences of the module demonstrated the importance of sharing and reflecting on practice with peers; the experiences of drug users, both positive and negative; and having an opportunity to make sense of these experiences, thus bridging the ‘theory-practice divide,’ as key in influencing their views. Furthermore the findings indicated value in the mode of delivery of such education, suggesting e-learning to be an effective approach, offering not only knowledge gain in terms of the content, but in wider research and critical thinking skills. This research demonstrates the potential of education in this area but also offers suggestions for effective methods of educational delivery to potentially help reduce stigma in other areas of practice.

Substance misuse is a complex issue, fraught with many challenges for those affected. Whilst the literature suggests that pregnancy may be a ‘window of opportunity’ for substance misusing women, it also suggests that there are several barriers to women engaging with health care. One of these is the fear of being judged and stigmatised by healthcare professionals, including midwives. Previous research indicates that midwives have negative regard toward substance users and that this in turn may lead to stigmatising behaviours and consequential substandard care provision. Midwives however, stress that they do not have appropriate training to be able to effectively provide appropriate care for substance misusers. Research suggests that education (formal training) is needed in this area to improve attitudes. In this study, the role of education in changing attitude toward substance use in pregnancy was explored using case study methodology. The case was a single delivery of a university degree programme distance learning module ‘Substance Misusing Parents,’ undertaken by 48 final year student midwives across 8 NHS Trusts. The research was carried out in 3 phases, using a mixture of Likert style questionnaires (Jefferson Scale of Physician Empathy and Medical Condition Regard Scale), Virtual Learning Environment discussion board qualitative data and semi structured interviews. The findings of the questionnaires showed that whilst general empathy levels showed no significant change (p=0.539), empathy toward pregnant drug using women showed a statistically significant improvement following the module (p=0.012). Furthermore, exploration of the students’ experiences of the module demonstrated the importance of sharing and reflecting on practice with peers; the experiences of drug users, both positive and negative; and having an opportunity to make sense of these experiences, thus bridging the ‘theory-practice divide,’ as key in influencing their views. Furthermore the findings indicated value in the mode of delivery of such education, suggesting e-learning to be an effective approach, offering not only knowledge gain in terms of the content, but in wider research and critical thinking skills. This research demonstrates the potential of education in this area but also offers suggestions for effective methods of educational delivery to potentially help reduce stigma in other areas of practice.

Background: Half a million women died during pregnancy or childbirth in 2005. Bleeding, infections, high blood pressure, obstructed labor, unsafe abortions, malaria and HIV/Aids were the main causes. Tanzania is a highly affected country with 460 maternal deaths per 100 000 live births. Nurses and midwives play an important role in preventing maternal mortality. Purpose: The aim of this study was to explore and analyze nurses’ and midwives’ experiences of maternal mortality prevention on the Tanzanian island of Unguja. Method: Interviews with nine nurses and midwifes from four different hospitals and health care facilities were conducted with the assistance of an interpreter. A structural analysis designed by Ricoeur was undertaken. Results: The findings suggest that family planning, a more accessible health care, referral of severe cases, medical interventions, health education, community resource persons and involving fathers in maternal health care are preventive strategies that can reduce maternal mortality. Conclusion: To further improve the quality of maternal mortality prevention further knowledge aboutindividual differences in learning from health education is needed.  Involvement of all fathers in maternal health care should also be considered. Training of unskilled personnel is believed to improve early identification of life-threatening complications and thereby reduce maternal mortality.
Bakgrund: En halv miljon kvinnor i världen dog under graviditet eller förlossning under 2005. Huvudorsaker var blödningar, infektioner, högt blodtryck, långdragna förlossningar, osäkra aborter, malaria samt HIV/Aids. Tanzania är ett drabbat land med 460 fall av mödradödlighet per 100 000 levande födda barn. Sjuksköterskor och barnmorskor spelar en viktig roll i det preventiva arbetet mot mödradödlighet. Syfte:  Syftet med studien var att utforska och analysera sjuksköterskors och barnmorskors upplevelser och erfarenhet av  arbetet mot mödradödlighet på ön Unguja, Tanzania. Metod: Intervjuer med nio sjuksköterskor och barnmorskor från fyra olika sjukhus/hälsocentraler genomfördes med hjälp av en tolk. En strukturanalys utformad av Ricoeur genomfördes. Resultat: Resultatet visar att familjeplanering, en mer tillgänglig hälso- och sjukvård, remitterande av patienter med allvarliga komplikationer, medicinska interventioner, hälsoutbildning, resurspersoner i samhället och att involvera pappor i mödrahälsovården var preventiva strategier som kan minska mödradödlighet. Slutsats: För att ytterligare förbättra arbetet mot mödradödlighet tycks mer kunskap om individers förmåga att ta till sig hälsoutbildning behövas. Att i ännu större utsträckning även välkomna alla blivande pappor till mödrahälsovården föreslås också kunna fungera preventivt. Utbildning för outbildade kvinnor som hjälper till vid förlossningar (Traditional Birth Attendants) tros kunna förbättra tidig identifikation av livshotande komplikationer och därmed kunna minska mödradödligheten.

The rationale for interprofessional education (IPE) is based on the assumption that it will result in improved interprofessional practice. Despite the evidence that prequalifying IPE will modify attitudes and provide knowledge and skills for collaboration, this evidence tells us little about whether these new skills and attitudes can be applied and sustained in professional practice. The aim of this research project was to explore how midwifery students who participate in pre-qualification interprofessional education apply their learning to the context of professional practice, and what elements facilitate this application. A purposive sample of midwifery students, midwifery educators, Heads of Midwifery and newly qualified midwives from four universities in the UK participated in semi-structured interviews, focus groups and qualitative questionnaires. Using the principles of Grounded Theory, the emerging findings highlight how professional and systemic factors both promote and prevent newly qualified midwives from turning their interprofessional theory into practice. Graduates appear better able to apply their training when interprofessional working and learning is made explicit within both the university learning environment and the workplace. This understanding of how newly qualified midwives apply IPE to practice is useful for advancing IPE curriculum development and for encouraging effective interprofessional relationships between midwives and other health professionals.

Background: Indonesia is a republic in Southeast Asia, consisting of approximately 13 600 islands and is the home for 239 million inhabitants. The country was governed by a dictator but has since 1998 had democratic elections. The majority of the population, 88 percentages, are Muslims which makes the country the largest Muslim nation in the world. The structure of the health system in Indonesia is built on districts with sub-districts which are supported by sub-centres. Problem: The health care is improving and more women are attended by professional health care workers when giving birth, despite this child birth still is a common problem. Yet there is a lack of human resources which contributes to the problem. Since the children are the future of Indonesia it is important that the health development policy is adequate and that it has a great compliance in order for the children to stay healthy. Aim: The aim of the study was to describe nurses/midwives work with health promoting education to parents to prevent ill-health among children in the district of Yogyakarta, Indonesia. Method: The method that has been used for the seven interviews is a qualitative content analysis. The interviews were carried out in the Dr. Sardjito Central General Hospital in Yogyakarta and in Puskesmas NGAWEN, Gungng Kidul district, Yogyakarta Province and Puskesmas Mlati II, Sleman district which are placed in the rural areas of Yogyakarta. Result: The result shows that there is a constant work with increasing the knowledge level among nurses and health workers on grassroots level in the district of Yogyakarta, to prevent ill-health among the children. Regarding the health promoting education a crucial finding was made that revealed the most common reason why parents did not apply the health implications that they received, was related to culture and tradition. Positively, there is a great will among health workers and nurses to learn more and increase the health level among the children. Nurses and midwives in the hospital had to rely on their experience when educating the parents while the nurses and midwives working in the puskesmas used the Mother and Child health handbook as a guideline. Discussion: To increase the chance of implementation among the families the health promoting education has to include culture and socioeconomic factors.
Program: Sjuksköterskeutbildning

This study investigates the perceptions of key stakeholders in midwifery education concerning the involvement of service users in student assessment. It identifies the key stakeholders in specific interest groups, as expert professional and expert lay people, parents, student midwives, qualified midwives who mentor students in clinical practice and the heads of midwifery education in University Departments. The work starts from the premise that assessment is an underestimated means of enhancing students' learning and the development of competence to practise as a registered midwife. The inquiry opens by examining the professional context in which maternity services are provided. It identifies the relationships that midwives form with the women and their families for whom they care. These considerations are followed by an interrogation of the literature that reveals a rich variety of interlocking concepts that are apposite considerations in terms of the assessment of student midwives and the involvement of women in it. This finely links the problem to previous research and provides a sound rationale for the conduct of the study. Interpretivism is advanced as a suitable philosophical framework for the prosecution of the study that offers a methodological rationale for a pragmatic, mixed methods investigation. The study design presents a raison d'dtre for a phased approach to the work and data are accrued variously from qualitative and quantitative sources. Although the focus of the work concerned the role of users of maternity services in student assessment and found considerable support for their involvement, what emerged has wider consequences for teaching and learning, the overall student experience and also for women as health service consumers. Having examined the principle dynamics that influence student learning in clinical placements, the study concludes that there is a superficial disharmony between learning and assessment yet it claims the two are mutually complimentary. The inclusion of women in teaching and learning is seen as a potent means to add an extra element to the definition of competence and to add to the authenticity of its assessment.

Background: Breastfeeding is crucial in providing optimum nutrition and health for babies' to develop into healthy adults and has important emotional, physical and psychological benefits on maternal health. The UK has stubbornly low breastfeeding initiation and continuation rates. To address this, the government has policies targeting maternity and public health services. Furthermore, UNICEF UK introduced Baby Friendly Initiative (BFI) Hospital Standards in 1998 and Midwifery Education Standards in 2002. The University of Nottingham adopted BFI Education Standards in 2005 and have maintained accreditation since 2008. The BFI curriculum changes incorporated a knowledge, skills and attitude framework for teaching, learning and assessing. The embedding of positive attitudinal and skills facilitation of breastfeeding within the curriculum changes was essential. The influence of Trust's organisational culture on student learning was considered critical due to its impact on midwives working practises and pre-registration midwifery curricula having a minimum of 50% clinical practice. There is a lack of information about the efficacy of BFI Education Standards on student learning and application to practice. The aim of this study was to explore factors affecting student midwives competence and confidence when incorporating BFI Education Standards into clinical practice. Methodology and methods: A three year longitudinal multiple educational case study of a Bachelor of Midwifery programme commenced in 2009. Ethical and R&D approval were gained from the University and five Trusts, each at different stages of BFI clinical accreditation. The inclusion criteria were any student in the September 2009 midwifery cohort and their allocated midwife mentors. From a cohort of 32 students, 22 consented and 16 supplied data at each collection point throughout the three years. Students identified 92 midwife mentors, they had worked with, who were then invited to participate; 16 consented and 6 supplied data at each collection point throughout the three years. A total of 92 questionnaires and 70 one hour interviews were conducted. Data collected from students included questionnaire, individual interview and documentary evidence at 6, 18 and 30 months into the programme. Data from midwife mentors was questionnaire and individual interview at each stage. Documentary evidence was obtained from the students' NMC record of clinical skills and second year biology examination question on infant feeding. Data analysis used NVivo for qualitative data management, and PAWS for quantitative data analysis. Verbatim transcription of interviews was followed by thematic analysis. Findings: Findings are presented using BFI 'Ten Steps' Standards with the underpinning knowledge, skills and attitude framework. All students considered themselves to be competent and confident in 'normal' aspects of infant feeding but only competent in 'complex' feeding scenarios. Students self reported the theoretical component was most important to their learning in years 1 and 3 and clinical placements in year 2. Students who were mothers and students working in BFI accredited units had better examination results. Changes in workforce skill mix and reduced community midwife visits were factors in reported gaps of 'complex' breastfeeding learning opportunities. These were addressed by scenario role play. Reductions in Infant Feeding Advisor hours were found to correlate with increased formula supplementation. Mentors praised students' enhanced theoretical knowledge from their first year, and assessment and planning in the third year. They attributed this to the BFI curriculum. More prescriptive and structured organisational documentation facilitated student learning. Theory practice gaps existed at all five case study sites. At BFI accredited sites mothers and babies were statistically more likely to experience skin-to-skin following any mode of birth (n=1462 p<0.001 phi=0.21). At all sites a normal birth statistically increased the opportunity of mother-baby skin-to-skin (n=1462 p<0.001 phi=0.57) and initiation of breastfeeding (n=1462 p<0.001 phi=0.52). Students embraced a 'hands-off' technique to support breastfeeding and hand expression of the breast against prevailing clinical role modelling. Techniques students developed were 'shadowing', use of props, use of feeding cues and increasing the accessibility of their knowledge to women through facilitative communication skills. Use of infant feeding tools provided through the curriculum supported student learning. Detail provided within the postnatal data was poor and mirrored by mentors reporting poor use of relevant organisational documentation. Students had little opportunity to develop constructive formula feeding support, sterilisation of feeding equipment and reconstitution of formula milk. Anxiety was expressed by mentors and students in providing support to formula feeding women within a BFI framework. The use of interactive teaching methods and individual assessment through a workshop in year 3 were identified by students as significant to their learning. Students desire to support women to breastfeed grew over the 3 years. This was independent of personal feeding experiences of students who were mothers and the non-mothers embedded norms. The reinforcement and incremental delivery of the BFI curriculum in each year was identified as essential in this process. Conclusion: A BFI accredited midwifery curriculum positively impacts on student learning in infant feeding, raises the profile of infant feeding within postnatal care and enables students to create positive experiences for women. This study's findings would recommend that all midwifery curricula embrace BFI Education Standards within a knowledge, skills and attitudes framework.

Background: The relationship between interpersonal trauma (IPT) and substance misuse is complex and multi-factorial, but has not been examined fully in the existing few studies involving pregnant women who misuse substances. UK based midwifery education and practice is unique, but there is limited evidence regarding midwives experiences and perceptions of supporting this client group. Aims: The aim of this study was to chronologically map out pregnant women's past experiences of abuse and substance use, explore their experiences and perceptions of their journey to motherhood and explore midwives' experiences and perceptions of supporting this client group. Methods: A qualitative study was conducted. Five eligible pregnant women supported by specialist midwifery services in Central Scotland were recruited. Data were collected using a life history calendar (LHC), followed by an in-depth, semi-structured interview. Six eligible midwives were recruited from one NHS board in Central Scotland. In depth, semi-structured interviews were carried out. Findings: Individual LHCs were converted into chronological timelines. Transcribed interviews were analysed using Interpretative Phenomenological Analysis. The life history calendars revealed the pregnant participants' experiences of IPT and substance misuse as complex, interconnected and ongoing, including during pregnancy and motherhood. Three major overarching themes emerged from the pregnant participants' interview transcripts: “psychological trauma”, “dabbling to addiction” and “addiction and the identity of pregnancy and motherhood”. Three major overarching themes emerged from the midwifery participants' interview transcripts: “psychological trauma”, “stigma” and “managing unmanageable situations”. Conclusions: This study sheds new light on the lived experiences and perceptions of a previously under-researched and largely misunderstood group of vulnerable women. It highlights some of the challenges faced by midwives in clinical practice. Important areas for future research are highlighted, along with implications for multi-disciplinary education, policy and practice.

Background: Antenatal care is essential care that assists in maintaining a state of good health for the woman and her unborn baby. Globally the use of antenatal care services remains a challenge and this tendency is closely associated with maternal and neonatal mortalities and morbidities. South Africa has adopted a free service policy for pregnant women, their infants and for children up to the age of six. Despite this policy, the problem of limited utilisation of antenatal care services by pregnant women is still observed in this country and is associated with increased maternal and neonatal mortalities and morbidities.The purpose of the current proposed study was to explore and describe the reasons for limited utilisation of antenatal care services in the Mnquma sub-district, and to develop guidelines to assist the midwives to encourage the use of antenatal care services. Objectives:To explore and describe the reasons for the limited utilisation of antenatal care services by pregnant women at Mnquma sub-district.To explore and describe the knowledge of antenatal care services by the pregnant women.To develop guidelines to facilitate empowerment of midwives to enhance utilisation of antenatal care services by pregnant women in the Mnquma sub-district in Eastern Cape Province. The study was conducted in Mnquma sub-district during the months of July to January in 2016 using a qualitative, exploratory, descriptive and contextual research design. The research population were post-delivery women and the purposive sampling was used to identify women who met the stated criteria. One-on-one audio-taped semi-structured interviews were conducted and field notes were kept to justify some of the themes identified. Thirteen interviews were conducted and transcribed verbatim. Collected data was analysed using Tesch’s data analysis method. Trustworthiness was maintained through the standards of truth value, credibility, transferability, dependability and conformability. The ethical considerations of beneficence, justice, autonomy, non-maleficence and veracity were maintained. From the findings it emerged that the participants raised various concerns with regard to barriers influencing limited utilization of antenatal care services. The participants had limited knowledge of antenatal care services. Furthermore, participants recommended some solutions to enhance utilization of antenatal care services. Recommendations were made with regard to clinical practice, nursing education and nursing research. Guidelines were formulated to assist midwives to enhance the utilization of antenatal care services by pregnant women in the Mnquma sub-district in the Eastern Cape.

Pregnancies and childbirths are not just biological or medical events. Childbirths are also emotionally intense situations, not only for the parents-to-be but also for those who work in delivery care. In addition, pregnancies and childbirths are sociocultural situations; there are norms regarding the normal birth. The study investigates how future midwives learn about the interactive and emotional work involved in supporting women in delivery care. It focuses on norms about the normal birthing trajectory and on how a midwife should encounter patients’ feelings and handle her own feelings in a “proper” way. Based on observations of collaborative group discussions within Swedish universitybased midwifery education, the study shows how students negotiate the appropriate feeling norms in normal birth, as well as in complicated and even tragic situations. In focus are their discussions on how to support the birthing women, their partners, and the babies, and the categorization work needed to recognize potential deviations from the normal birth. The study is based on a situated learning perspective on education, and combines sociological and anthropological approaches to emotions to elucidate how students within midwifery education negotiate the professional handling of normal and complicated births and the attendant feeling norms.
Graviditeter och förlossningar är inte bara biologiska eller medicinska händelser. Förlossningar är också känslomässigt intensiva situationer, både för de blivande föräldrarna och för dem som arbetar inom förlossningsvård. Graviditeter och förlossningar kan dessutom ses som sociokulturella händelser och det finns normer om den normala förlossningen. I avhandlingen undersöks hur framtida barnmorskor lär sig att stödja kvinnor inom förlossningsvården och det interaktiva och emotionella arbete som det innebär. Avhandlingen fokuserar på normer om den normala  förlossningstrajektorian samt hur en barnmorska ska bemöta patienternas känslor och hantera sina egna känslor på ett ”korrekt” sätt. Baserat på observationer av basgruppsgruppdiskussioner under den universitetsförlagda delen av en barnmorskeutbildning, visar studien hur barnmorskestudenter förhandlar känslonormer i relation till normal förlossning samt till komplicerade och även tragiska situationer. I fokus är studenternas diskussioner om hur de kan stödja de födande kvinnor, deras partners och barn samt den kategorisering som behövs för att identifiera eventuella avvikelser från den normala förlossningen. Studien bygger på ett situerat lärandeperspektiv på utbildning och kombinerar sociologiska och antropologiska förhållningssätt till känslor för att på så sätt belysa hur studenter inom en barnmorskeutbildning förhandlar hur normala och komplicerade förlossningar bör hanteras och de känslonormer som framkommer.

Background: Malnutrition is a major public health problem in Ethiopia contributing to half of infant and child mortality. The 2014 mini Ethiopian Demographic and Health Survey revealed that four out of ten children under five are stunted, nearly one out of ten are wasted, and a quarter are underweight. One of the factors that contributed to the high stunting rate is the shortage of capable providers who are competent to provide nutrition services. The purpose of this study was to assess graduating midwifery and nursing students’ nutrition competence and explore the factors that influence their competence. Methods: A cross-sectional survey was employed in June 2015. Students’ knowledge was assessed using objective written assessment questions; and their skills were assessed using a five-station objectively structured clinical examination. Students’ perception of the nutrition learning environment and their learning experience was obtained by administering a structured questionnaire using interviews. Bivariate and multivariable analysis, including Chi-square test and independent sample t-test, were used to detect statistically significant associations or differences. Results: A total of 113 students from four public universities in Ethiopia participated in the study. Only 38.1% of students demonstrated adequate competency in nutrition. The mean percentage score for nutrition knowledge and skills were 63.8% and 46.6% respectively. There was no statistically significant difference between midwifery and nursing students’ nutrition competence (P>0.05). Both cadres scored a mean value above 50% in the knowledge assessment, except in the competency areas of nutrition and HIV. However, both showed lesser competence in performing basic nutrition skills such as anthropometry. Midwives scored higher than nurses on counseling mothers on optimal breast feeding (p=0.001). The majority (98.2%) of students reported that they had no access to nutrition skills laboratory when they took the nutrition course. In multivariable analysis, students who perceived the practice sites as conducive for nutrition skills learning achieved higher levels of competence. Conclusions: The target students were deficient in nutrition competencies. The study suggests revision of midwifery and nursing curricula for adequacy and relevance of nutrition contents, learning and assessment techniques. Nutrition skills learning both in skills lab and at clinical and practical settings need to be strengthened.

Este trabalho é fruto das inquietações da trajetória profissional da pesquisadora que, ao longo de sua carreira profissional, acompanhou as políticas de saúde reprodutiva no país e, como docente, se envolveu com a titulação e qualificação de enfermeiras obstétricas. Diante destas experiências surgiu a necessidade de levantar os fatores facilitadores e dificultadores para formar e inserir enfermeiras obstétricas na prática da assistência ao parto, e como formar profissionais para enfrentar a situação de assistência vigente. Foram entrevistadas profissionais que participam da Associação Brasileira de Obstetrizes e Enfermeiros Obstetras (ABENFO), da elaboração de políticas de saúde no Ministério da Saúde e que atuaram na área como coordenadoras e docentes de cursos de especialização em enfermagem obstétrica. Para subsidiar o trabalho, foi feito uma revisão de literatura sobre as políticas de saúde da mulher, um breve levantamento da história da assistência ao parto e sobre o ensino da enfermagem no Brasil. A seguir, realizou-se 11 entrevistas com profissionais, utilizando-se a História Oral. Este método de investigação possibilita compreender como os indivíduos experimentam e interpretam os acontecimentos, e mostra a percepção do passado como algo que tem continuidade no presente. Após a transcrição, textualização e transcriação dos discursos, foram criadas 4 categorias: Atores e a história, em que as entrevistadas falam da sua trajetória profissional e da história da enfermagem obstétrica; Coadjuvantes das mudanças no contexto do ensino e da prática, onde foram levantados os fatores que contribuíram para a formação e inserção das profissionais na assistência; Barreiras para a formação profissional e para a prática da assistência, em que as entrevistadas mostram alguns dificultadores para a formação e inserção das profissionais e, Desafios na qual foram sintetizados os caminhos que as profissionais devem percorrer para implementar a formação e inserção das profissionais na assistência. Conclui-se que a trajetória percorrida foi importante para a continuidade da formação e da atuação das profissionais e que as políticas ministeriais (portarias e financiamento de cursos) contribuíram para impulsionar a profissão; que tem-se que buscar parcerias com outras categorias profissionais, em especial a médica, com instituições e gestores, e fortalecer os órgãos de classe. Tem-se ainda que titular com qualidade um número maior de profissionais, para que juntas, tenham mais condições de lutar pelas causas da profissão e por mudanças no modelo de assistência. Percebe-se que nos últimos 20 anos a profissão cresceu e foi valorizada, porém, ainda há muito o que conquistar.
This work is a consequence of the uneasiness of the researchers professional path who, throughout her professional career has worked in the country reproductive health policies and, as a teacher, has been involved in the graduation and qualifications of obstetrician nurses. In face of these experiences the need to know the process of graduation and insertion rescue of the obstetrician nurse in the care to women in their reproduction period, within the context of Brazilian reality has emerged. Professionals who have participated in ABENFO (Brazilian Association of Obstetricians and Obstetrician Nurses), in the elaboration of health policies in Ministry of Health and who have acted in the field as coordinators and teachers in graduate specialization in obstetric nursing courses were interviewed. To sustain the study, a review of the literature on women health policies and a brief survey of the history of childbirth care and of Brazilian nursing schools were carried out. Then, 11 interviews with those professionals were done, using Oral History. This investigation method allows the understanding of how individuals feel and interpret the occurrences, and shows the perception of the past as something that extends to the present. After the transcription, textualization and trans-creation of the speeches, 4 categories were defined: Actors and history, in which the interviewed approach their professional path and the obstetric nursing history; Supporters of the changes in context of teaching and practice, in which the factors that contributed to the graduation and insertion of the professionals in care practice are discussed; Obstacles against professional graduation and care practice, in which the interviewed show some difficulties to the graduation and insertion of professionals and, Challenges, in which the ways professionals should go to implement the graduation and insertion of obstetrician nurses in childbirth care are discussed. Finally it is concluded that the path covered was important to the continuation of graduation and actuation of professionals; that the ministry policies (decrees and financing of courses) have contributed to improve the profession; that it is advisable to look for partnership with other professional categories, specially the medical one, with institutions and managers, and that it is necessary to strengthen class organs. It is also necessary to graduate with quality a greater number of professionals, so that together they have more conditions to fight for the profession causes and for changes in the assistance model. It is also observed that in the last 20 years the profession has grown and became more recognized, however, there is still a lot to achieve.

Objetivos: Avaliar o conhecimento adquirido pela grávida durante as consultas de vigilância da gravidez; Avaliar o conhecimento adquirido pelo pai durante a vigilância da gravidez e Avaliar a satisfação da grávida com a assistência de enfermagem. Método: Tipo de estudo quantitativo descritivo. A seleção da amostra foi não probabilística acidental. A população abrangeu cerca de 196 casais. Para a recolha de dados foi usado um questionário sobre os conhecimentos adquiridos pelos pais na consulta de enfermagem e uma escala de satisfação dos pacientes com a assistência de enfermagem. Para o tratamento de dados recorreu-se ao Software IBM® SPSS® Statistic, versão 24. Resultados: A pesquisa revelou altos níveis de conhecimento do casal após as consultas com o EEESMO e de satisfação da grávida com a assistência de enfermagem. Conclusão: A pesquisa demonstra que o nível de satisfação do casal com a assistência do EEESMO influencia os conhecimentos adquiridos pelo casal; The father's presence in pregnancy vigilance: the couple's perspective ABSTRACT: Goals: To evaluate the knowledge acquired by the couple during the pregnancy vigilance nursing consultations, as well as to evaluate the pregnant women’s satisfaction with nursing care. Method: Descriptive quantitative-qualitative study. Sample selection was accidental non-probabilistic (for convenience). The population include 196 couples. For data collection, a questionnaire on the knowledge acquired by parents in the nursing consultation/expectations they had, and a scale of patient satisfaction with nursing care were used. For data processing, the IBM® SPSS® Statistic Software, version 24 was used. Results: The survey revealed hight levels of knowledge of the couple after consultations with midwifes and the pregnant woman's satisfaction with nursing care. Conclusion: The research demonstrates that the couple's level of satisfaction with the midwifes assistance influences the knowledge acquired by the couple.

La recherche se situe dans le champ de l’éducation pour la santé en périnatalité. Les sages-femmes en sont les acteurs privilégiés, notamment de la préparation à la naissance et à la parentalité (PNP) en période prénatale. Leur formation initiale se fait en alternance entre enseignements théoriques et stages. Elles assurent donc parfois une double mission : éducative auprès des femmes enceintes et formative auprès du stagiaire. Faisant l’hypothèse que les ancrages théoriques des pratiques éducatives et formatives des sages-femmes sont identiques, l’objectif de recherche est d’identifier ces ancrages en situation de PNP et d’encadrement d’un étudiant. La méthode de l’auto-confrontation simple et l’entretien de compréhension ont été utilisés. 14 sages-femmes volontaires ont participé à l’étude. Les données ont été traitées selon la méthode de l’analyse du contenu à partir d’une modélisation combinant des modèles d’éducation, d’apprentissage et de santé. Les principaux résultats valident l’hypothèse, avec cependant quelques exceptions. Les pratiques de transmission des recommandations et savoirs médicaux ou d’activité corporelle s’inscrivent majoritairement dans les combinatoires à la croisée des modèles béhavioristes, de l’éducation centrée sur l’instruction et de la santé biomédicale. Les modèles du développement du sujet ou de la santé biopsychosociale sont ponctuellement présents, alternant avec ceux qui sont prédominants. Les combinatoires basées sur le constructivisme et le modèle de santé du sujet autonome n’apparaissent qu’exceptionnellement. Les mêmes tendances sont retrouvées pour les modélisations éducation/apprentissage sous-jacentes aux pratiques formatives
Our research lies in the field of perinatal health education in which midwives are key players, most notably for their roles in Childbirth and Parenting Education (CPE) during the prenatal period. Their initial training combines theoretical and vocational training immersion. They therefore are charged with fulfilling a dual mission: an educational one with pregnant women and a formative one with students. Based on the assumption that theoretical backgrounds of health education and of midwives’ training practices are identical, our objective is to identify and examine these models during the CPE and during the supervision of students. We resorted to the method of self-confrontation and to the method of the interview of understanding. To do so, we interviewed 14 volunteer midwives, who agreed to participate in the study, about their general skills. The data was collected and processed using the content analysis methodology based on a framework combining education, learning and health models.With a few exceptions, the main results largely validate our hypothesis: the practices of the transmission of medical knowledge and recommendations, as well as of physical activity, lie at the crossroads of the behaviorist models, of the education-centered instruction and of the biomedical health model. Models such as the development of the subject model and the bio psychosocial health model have been highlighted, along with other prevailing models. The combinatorial theories built upon constructivism and the health model of the autonomous subject have also been exposed, albeit very rarely. The same trends appear in the modeling of education/learning underlying training practices

Reconhece-se à mulher a influência no sucesso do trabalho de parto, devido a Dick Read que concluiu que o ciclo medo-tensão-dor leva a complicações físicas e psicológicas que interferem na evolução deste. A Preparação para o Nascimento permite prevenir este tipo de complicações. O objetivo geral deste relatório é demonstrar a influência da Pre-paração para o Nascimento no trabalho de parto e parto. Para conhecer as necessidades da população-alvo no local do estágio final, realizou-se um estudo qualiquantitativo não experimental, descritivo. Participaram as puérperas internadas através de um questioná-rio. Foram também entrevistados os Enfermeiros Especialistas em Saúde Materna e Obs-tétrica do Bloco de Partos. O estudo de ambas as amostras revela existir ganhos na reali-zação deste tipo de cursos, porém em alguns pode haver necessidade de reestruturação de forma a otimizá-los. Conclui-se que a Preparação para o Nascimento influencia de forma positiva o trabalho de parto e parto; ABSTRACT: Birth Preparation - influences on labour and delivery The woman is known to influence the success of labour, due to Dick Read who con-cluded that the fear-strain-pain cycle leads to physical and psychological complications that interfere with the evolution of labour. Birth preparation allows to prevent this type of complications. The overall objective of this report is to demonstrate the influence of Birth Preparation in labour and delivery. This is a non-experimental quali-quantitative descrip-tive study. Puerperas admitted in Portimão’s hospital participated through a question-naire. Midwives in Labour ward of the same hospital were interviewed. The study of both samples reveals that there are gains in the realization of this type of course, but in certain courses there may be a need for restructuring to optimize them. It is concluded that Birth Preparation influences positively labour and delivery.

INTRODUCCIÓ: L'Educació Maternal/ Preparació al Naixement (EM/PN) és una de les activitats educatives grupals que les llevadores realitzen dins de la cartera de serveis tant pública com privada i són variats els programes emergents que plantegen una educació que millori la vivència, per part de la dona i la seva parella, de la maternitat-paternitat, el part i la criança. A Catalunya, el 2009, el Departament de Salut va elaborar un programa estructural d'EM/PN per homogeneïtzar la intervenció grupal en els serveis d' Atenció a la Salut Sexual i Reproductiva (ASSIR). El programa es va posar en marxa a la fi dels anys 2011 i 2012 i no va incloure l'avaluació de la implementació en la practica clínica. Un dels problemes dels programes d'EM/PN rau en com conceptualitzar i avaluar la seva implementació. És important per poder distingir l'eficàcia de l'aplicació, de l'efectivitat d'un determinat programa, i és fonamental per la replicació de las intervencions. Aquests aspectes han motivat una avaluació de la implementació del programa d'EM/PN a Catalunya. OBJECTIU: Avaluar la implementació i desenvolupament del programa d'EM/PN en la pràctica assistencial deis ASSIR de Catalunya des de la perspectiva de les llevadores. MÈTODE: Metodologia mixta en dues fases: Fase 1 -quantitativa- que inclou l'estudi observacional descriptiu i transversal, amb la participació de 334 llevadores pertanyents a 38 unitats ASSIR de Catalunya que van respondre un qüestionari ad-hoc i Fase 11 -qualitativa- que inclou l'estudi qualitatiu interpretatiu, ambla participació en grups focals de 65 llevadores de diferents ASSIR. RESULTATS: El qüestionari va ser enviat a 451 llevadores, 334 de les quals el van respondre, la qual cosa significa un 74,1% de resposta. El programa el coneixien el 97,6% de les llevadores i el 81,4% d'aquestes l'estan utilitzant. El 49,4% de les llevadores realitza les sessions recomanades en el programa i el 85,3% procura per la participació activa de las gestants, tot i que el 51,5% continua utilitzant sessions expositives i mostra resistències pel canvi. El 64,1% de les llevadores no pot ajustar-se al temps establert en el programa per cada sessió i tan sols un 11,4% avalua el programa. El 70,1% de les llevadores considera que el programa satisfà les expectatives de les participants i el 66,5% opina que la metodologia del programa és acceptada per les persones assistents. Tan sols un 13,2% de les llevadores porten a terme reunions de seguiment del programa amb d'altres companyes. Les llevadores aporten propostes de mil lora al programa pel que fa la captació de les dones, l'actualització de material audiovisual, la manera d'augmentar les sessions i tenir en compte les minories socials i la seva millor adaptació als grups oberts. CONCLUSIONS: Les llevadores que utilitzen el programa i tenen més anys d'experiència mantenen una millor fidelitat als continguts i metodologia. Quasi la meitat de les llevadores han incorporal al programa noves activitats i sessions o materials audiovisuals, fent-ne una re-adaptació a les necessitats detectades a l'entorn assistencial. La metodologia participativa és un element que les llevadores identifiquen com molt positiu. La formació prèvia a la implantació del programa és clau pel coneixement i utilització, però requereix ser mantinguda al llarg del temps. Existeixen diferencies entre els ASSIR pel que fa la fidelitat al programa, i la participació deis homes en els grups és heterogènia. La majoria de llevadores destaquen la inexistència de grups de discussió que permetin compartir les estratègies de dinamització deis grups d'EM/PN. Les llevadores no avaluen sistemàticament, per la qual cosa cal que hi hagi una implicació institucional per la seva execució.
INTRODUCTION: Group Prenatal Care (GPC) is one of the group's educational activities carried out by midwives in the public and private services. A variety of emerging programs offer an education that improves the experience of woman and their partners for maternity-paternity, birth and parenting. In Catalonia in 2009, a Department of Health program was developed by the GPC to standardize the group's intervention in the services of Attention to Sexual and Reproductive Health (ASRH). The program was launched at the end of 2011 and 2012 and did not include any evaluation of the implementation in clinical practice, One of the problems of GPC programs is how to conceptualize and evaluate its implementation, since it is important to distinguish between the effectiveness of the application and the effectiveness of a specific program, and is essential for the replication of the interventions. These aspects have led to the evaluation of the implementation of the GPC program in Catalonia. OBJECTIVE: To evaluate the implementation and development of the GPC program in the assistance practice of the ASRH in Catalonia from the midwives perspective. METHOD: Mixed methodology with two phases: Quantitative Phase I with a descriptive and cross-sectional observational study in which 334 midwives participated belonging to 38 ASRH units in Catalonia and who responded toan ad- hoc questionnaire, and Phase 11, a qualitative interpretative study, with the participation of 65 midwives in focal groups. RESULTS: The questionnaire was sent to 451 midwives and 334 of them answered, which meant a 74,1% of participation. The program is known to 97.6% of midwives and 81.4% are using it. About the fidelity to the program, 49.4% of midwives performed the recommended number of sessions, and 85.3% managed the active participation of the pregnant women, although 51.5% continue to use exhibition sessions existing resistance to change. The 64.1% couldn't adjust to the timeline established for each session and only 11.4% evaluate the program. 70.1% of midwives believe that the program fulfills the expectations of the participants and 66.5% believe that the methodology of the program is accepted by the people in attendance. Only 13.2% ofthe midwives carry out follow-up meetings ofthe program with other colleages. Midwives provide proposals to improve the program regarding women's uptake to update audiovisual material, to increase sessions, to take into account social minorities and better adapt the program to open groups. CONCLUSIONS: The midwives who use the program and have more years of experience, maintain the fidelity to content and methodology better. Almost hall of the midwives have incorporated ínto the program new actívítíes, sessions or audiovisual materials by re-adapting the program to the needs detected in the healthcare environment. Participatory methodology is an element that midwives identify as very posítive. Pre-program training is key to knowledge and use, but it requires to be mantained over time. There are differences between ASRH as regards of fidelity to the program, and the partícipation of men in the groups is heterogeneous. The majority of midwives emphasize the non-existece of discussion groups that would allow sharing the strategies of dynamization of GPC. The midwives do not systematically evaluate it so there must be an institutional involvement for its execution.

Aims of the research The main aim of this study was to evaluate the effectiveness of a work-based module and in-service educational programme in perineal repair for midwives on their perceived level of competency undertaking this skill in clinical practice. Background The reduction in the practice of episiotomy, lack of formal instruction in perineal repair and inconsistency in perineal trauma management amongst midwives and students has resulted in the lack of perceived confidence and competency in perineal repair locally, necessitating a structured training programme in perineal repair. Methodology A Quasi-experimental pre-post intervention case study design combining a nonequivalent comparison group undertaken in six NHS consultant/midwifery led Trusts in South East England between December 2001 and January 2006. Main findings significantly greater numbers of midwives were able to practise perineal repair at higher levels of competency following an educational intervention in five experimental trusts (P < .006). There was a non-significant difference in the comparison Trust (P < .535). Decisions taken to undertake specific perineal trauma management were largely influenced by the midwives' professional expertise, clinical judgement, reference to the newly developed trauma proforma and National RCOG (2004) guidelines. In addition, an educational programme for midwives was also successful in increasing the numbers of senior student midwives who were able to participate in perineal repair confidently under the direct supervision of their mentor when they perceived that their mentor was confident and competent undertaking the procedure. Conclusion The outcomes of this study make an original contribution towards a new body of expert knowledge in pre- and post-registration midwifery education surrounding the midwives' and students' confidence, competency and decision making process associated with the assessment and management of perineal trauma. It has provided a greater understanding and insight into the complex nature of workplace learning, competency development and assessment alongside the multiple factors influencing the midwives' and students' perceived competency in perineal repair.

My research explored student experiences of becoming midwives. It focused specifically on understanding their lived world experiences. The research is located in a hermeneutic framework as described by van Manen (1990). I chose to undertake a longitudinal study as the length of the students’ course of study was three years. My study recruited two cohorts of student midwives from two universities in the North West of England (n=90). Each university had a different recruitment target for their midwifery programme of study; University A (n=60), University B (n=30). I prepared a PowerPoint presentation and an information leaflet which supported the recruitment strategy (Appendix B). My approach proved successful as the study originally consisted of a purposive sample of student midwives (n=22); University A (n=10) which equated to 20% of the cohort and University B (n=12) equated to 33% of the cohort. Four students from University B dropped out of the research following the first focus group, thereby reducing the total sample to 18. This reduced the sample size of university B (n=8) which equated to 27% of the cohort. My use of narrative inquiry within focus groups enabled a hermeneutic cyclical process of gathering and interpreting the student holistic experiences in a constructivist paradigm (Clandinin and Connelly, 2000). I also used reflective diaries which enabled the students to reflect on their personal experiences. This added richness to the empirical data (Berg, 2009). The interviews were recorded and transcribed verbatim. Thematic analysis was undertaken using the principles of van Manen (1990). I gained ethical approval from LJMU and the two universities where the students were studying. The aims of my research directed the focus of the study. Discovering their interpretations of their experiences of becoming midwives brought an understanding of the influences the working environment had on the process. The findings of my study brought new knowledge in respect of the education of student midwives. It also highlighted some of the restrictions imposed on their training within a medical model of care in an NHS Trust. The research also highlighted some of the challenges experienced by the students as they progressed through their training. The findings suggested there were many tension experienced by the students. The broad themes were related to: the students’ understandings of their learning and development, the ideology of the role of the midwife and the role of the midwife within the philosophy of the medical model of care in NHS Trusts. This brings new knowledge in respect of the education of student midwives.

This study examines the maternal metaphors of midwife and mother used to describe instructors and teaching practices in the composition classroom. In the introduction the author describes her interest in the topic based on her own experiences as a mother and as a beginning composition instructor. The paper explains the initiation of the metaphors, what the metaphors and maternal pedagogy mean in terms of classroom practices and philosophies, criticisms of maternal practices, and the relevancy and legitimacy of the metaphors and maternal pedagogy in classrooms today. Section one explores the development of the metaphors to describe composition teachers related to the composition and literature agendas created in the nineteenth century American university system. Other influences discussed in the metaphors usage and in the development of a maternal pedagogy are the 1970s revitalization of the women's rights movement and of the process pedagogy revolution. Section II surveys literature describing the philosophies of maternal pedagogy and maternal metaphors and their translations into classroom practices. Section III outlines the criticisms developed in reaction to maternal practices. Section IV details the results of surveys completed by freshmen composition students and composition instructors at Western Kentucky University. In the conclusion, the author considers the information and opinions presented and the survey results and draws conclusions about the relevancy of maternal metaphors and maternal pedagogy to the composition field and for her own teaching practices and philosophies.

INTRODUCCIÓN. La violencia de género es un grave problema de salud en el mundo, por su elevada prevalencia y por las complicaciones que puede tener en la salud de las mujeres. Especialmente si la mujer está embarazada, puesto que la violencia puede ocasionar complicaciones del curso del embarazo, parto y/o posparto y repercutir a su vez en la salud del feto y el futuro/a hijo/a. Las matronas son a menudo el primer punto de contacto asistencial de las mujeres gestantes, por ello se encuentran en una posición que favorece la detección y el abordaje de la violencia de género. Pero para ello necesitan la formación adecuada y superar las posibles dificultades que puedan surgir durante la asistencia a estas mujeres. OBJETIVOS. Los objetivos fueron: (1) Conocer las características y la realidad de la formación inicial y continuada de las matronas en el ámbito de la detección y abordaje de la violencia de género. (2) Promover cambios de mejora en la detección y abordaje de la violencia de género en el embarazo por parte de las matronas. METODOLOGÍA. Se realizó un estudio de investigación acción participativa. En un primer momento, se procedió a realizar un análisis documental de los planes de estudio del grado de Enfermería de todas las Facultades y Escuelas de Enfermería, así como del programa de especialización de Matrona en Cataluña. Con posteriores entrevistas semiestructuradas a dieciséis profesores/as universitarios/as. Seguidamente, se realizó un estudio de caso en una comunidad de práctica (dos centros de atención primaria en L´Hospitalet de Llobregat- Barcelona), donde se realizó entrevistas semiestructuradas a las doce matronas asistenciales, se diseñaron e implementaron sus propuestas de mejora y se valoró su utilidad. El desarrollo de la investigación mostró la pertinencia de conocer la prevalencia de la violencia de género y los factores asociados a la misma entre las mujeres gestantes que continúan el embarazo y aquellas que solicitan una interrupción del mismo en el ámbito de estudio. Para ello se realizó un estudio cuantitativo observacional, longitudinal, analítico, prospectivo de cohortes. La investigación guio el diseño de un programa de formación continuada sobre detección y abordaje de violencia de género en el embarazo, el cual se validó siguiendo la metodología de juicios de expertos. RESULTADOS. En Cataluña se imparte formación inicial en violencia de género con una media de 5.5 horas en el grado de Enfermería y con 2 horas en la especialidad de Matrona. La metodología de enseñanza principal es la activa. El profesorado se siente personalmente comprometido con la capacitación sobre violencia de género del alumnado pero solicitan más tiempo para tal fin. Todas las matronas entrevistadas habían recibido formación inicial y continuada sobre violencia de género, pero no se sienten seguras a la hora de detectar y abordar los casos y demandan ampliar su formación en el tema. Durante la investigación se diseñaron e implementaron dos acciones de mejora: (1) una actividad formativa sobre violencia de género; (2) la aplicación de un instrumento validado para la detección de la violencia de género (el Index of Spousal Abuse). Ambas acciones fueron valoradas como útiles tanto por aumentar los casos detectados de violencia de género por parte de las matronas como por mejorar sus habilidades y su seguridad en la asistencia de los casos. La prevalencia de violencia de género según el cuestionario validado empleado fue del 25% entre las mujeres que solicitan una interrupción del embarazo (n=120) y del 8.92% entre las mujeres que continúan con la gestación (n=381), existiendo una asociación estadísticamente significativa entre exposición a la violencia y complicaciones durante el parto (p=0.025). La exposición a la violencia incrementa de forma significativa el riesgo de realizar una interrupción del embarazo (OR=4.06; IC=2.23-7.48; p<0.001) y que el/la recién nacido/a tenga complicaciones de salud (OR=2.68; IC= 1.02-6.48; p=0.035). El programa de formación continuada diseñado fue valorado de forma positiva por los seis expertos/as con puntuaciones medias en los ítems evaluados entre 5.8 y 10 (sobre 10) y un coeficiente de concordancia de Kendall= 0.44. CONCLUSIONES. Es necesario dedicar más tiempo a la formación de estudiantes de Enfermería y Matrona en violencia de género de una forma transversal y sistematizada, que incluya la práctica clínica, desde las perspectivas sanitaria, psicológica, social, ética y legal. De igual forma, es conveniente responder a la demanda de las matronas en cuanto a desarrollar la formación desde una perspectiva multidisciplinar, con metodologías activas que proporcionen conocimientos específicos y habilidades comunicativas. Es necesario incorporar el cribado sistemático tanto a las mujeres que continúan con el embarazo, como a las que deciden interrumpirlo.
INTRODUCTION: The high prevalence of domestic violence and the health complications it creates for women make it a severe public health problem throughout the world. Complications increase when the woman in question is pregnant; violence can provoke complications during pregnancy, childbirth and/or the post- partum period, as well as compromise the health of the child before and after birth. Because midwives are often the first point of contact for pregnant women seeking assistance, they are well-positioned to detect and address domestic violence over the course of a pregnancy. However, midwives need adequate training and to be able to overcome the difficulties that may arise while helping these women. OBJECTIVES: The objectives were to: (1) Observe the defining features and the practical reality of midwives’ basic and continuous education on detecting and addressing domestic violence. (2) Encourage actions that improve midwives’ abilities to detect and address domestic violence during pregnancy. METHODOLOGY: A participatory action research study was performed. First, the curricular plans for nursing degrees at all university nursing departments and nursing schools, as well as midwifery specialisation programmes in Catalonia, Spain were analysed. Sixteen university professors then participated in semi- structured interviews wherein they provided information on the degree to which domestic violence issues are addressed, suggestions for improving health care personnel’s skills and suitable teaching-learning methodologies to that end. Next, a case study was performed in communities of practice (two primary care centres in L’Hospitalet de Llobregat, Barcelona) where twelve midwives underwent semi-structured interviews. During these interviews, factors that facilitate or obstruct the detection and address of domestic violence during pregnancy were discussed in-depth and proposals for improvement based on the midwives’ experiences were designed and implemented. Their proposals were evaluated based on usefulness (through focus groups involving the participating midwives and by comparing the cases of domestic violence detected before and after improvements were implemented). Within the context of a study, this participatory action research project demonstrated that it is important to know how prevalent domestic violence is and to be able to identify its presence and associated factors among pregnant women who carry their pregnancies to term as well as those who request termination. A quantitative, observational, longitudinal and analytical prospective cohort study was performed for that purpose. Likewise, this research study steered the design of a continuous development programme for midwives and other health care professionals that focuses on detecting and addressing domestic violence during pregnancy. The programme was validated according to expert judgement. RESULTS: In Catalonia, an average of 5.5 hours of basic training on domestic violence is given during undergraduate nursing programmes with 2 dedicated hours during the midwifery specialisation programme. The primary pedagogical methodology employed is active learning. Professors feel personally committed to enhancing students’ skills in relation to domestic violence but would like to be able to dedicate more time to this goal. They believe that it is very important for students to acquire not only biomedical knowledge, but also psychological and social skills. All midwives interviewed had received basic training and continuous development on domestic violence, yet they do not feel confident about detecting and addressing these situations. They have little experience assisting women who have experienced domestic violence and want to reinforce their training in this regard. Midwives believe that as they monitor pregnancies, they develop relationships of trust with these women that contribute to their ability to detect and address domestic violence. However, time limitations, language barriers and their own fears constitute obstacles for them. Some suggestions made by midwives include improving time management and scheduling, having interpreters available, implementing objective tools for detection, availing of informative materials during consultations and incorporating information on domestic violence into health education group activities. Two plans of actions for improvement were designed and implemented during this research project: (1) a training activity on domestic violence (based on the experiences of university professors and the needs perceived by practicing midwives); (2) the implementation of a validated tool for detecting domestic violence (the Index of Spousal Abuse) with prior training on how to use it, as well as the development of a circuit for helping women in domestic violence situations. Both actions were deemed useful for both increasing the number of cases of domestic violence detected by midwives and enhancing their skills and confidence level when assisting in these cases. The validated survey used indicated that, in terms of the prevalence of domestic violence, 25% of women who requested that their pregnancy be terminated and 8.92% of women who continued with their pregnancy (n=381) were exposed to domestic violence (n=120). The relationship between exposure to domestic violence and complications during childbirth (p=0.025) was statistically significant. Similarly, exposure to violence significantly increased the risk of miscarriage or termination of the pregnancy (OR=4.06; CI=2.23-7.48; p<0.001) and health complications for the new-born (OR=2.68; CI=1.02-6.48; p=0.035). The continuous development programme designed was positively evaluated by the six experts. Their average scores for the items evaluated ranged between 8.3 and 10 (out of 10) except for one item, which had an average score of 5.8 and a Kendall's coefficient of concordance (W) of 0.44. CONCLUSIONS: More time must be dedicated to training nursing and midwifery students about domestic violence from healthcare, psychological, social, ethical and legal perspectives in a systematic, transversal way that includes clinical practice. Likewise, a response to midwives’ requests concerning training from a multidisciplinary perspective should be provided using active learning methodologies that endow students with a specific knowledge set and communication skills. The Index of Spousal Abuse survey has been shown to be useful for detecting violence during a pregnancy when prior training on its use and on approaching cases of domestic violence has been provided. Systematic screening must be implemented for both women who carry their pregnancies to term and who decide to terminate them.

There is a large indigence for more maternity homes in Mozambique. Pregnant women often have to walk long distances to get assistance giving birth. The conditions are hard to improve because of the shortage of educated staff. The maternity home and education center is a combined program for women in Maputo, Mozambique. The purpose for this is – apart from improving opportunities and help for pregnant women – to create a connection between education and practice so that the pupils can do their practice at the maternity home before working out in the country. The two instances are therefore closely integrated with each other. We want to develop a program that is also long-term giving, a kind of pay-forward effect. The supposed consequence of the pay-forward effect is for graduated women to spread the knowledge to less educated midwifes in the countryside and at a long term improve health care for women.
Det finns ett stort behov av fler mödravårdscentraler i Mocambique. Gravida kvinnor går oftast långa sträckor för att få hjälp att föda. Förhållandena är svåra att förbättra i avsaknad av utbildad personal. Mödravårdscentralen och barnmorskeutbildningen är ett kombinerat program för kvinnor i Maputo, Mocambique. Målet med vårt projekt är att hjälpa gravida kvinnor och att skapa ett utbyte mellan utbildning och praktik. Därför är programmen tätt integrerade med varandra. Programmet ska skapa insikt om graviditet, födsel, sexualitet, en slags ”pay-forward effect”. Verkningarna av ”pay-forward” är att utbildade kvinnor ska sprida kunskap till mindre utbildade barnmorskor på landsbygden och på lång sikt bidra till en bättre sjukvård för kvinnor.

Introdução: A Organização Mundial de Saúde propõe características menos intervencionistas da assistência ao parto, enfatizando o papel das obstetrizes e enfermeiras obstétricas como as profissionais mais apropriadas para o acompanhamento das mulheres com gestação e parto normais. A Universidade de São Paulo (USP) iniciou, em 2005, o Curso de Graduação em Obstetrícia da Escola de Artes, Ciências e Humanidades (EACH-USP). Esse Curso nasceu com o desafio de reativar a formação do profissional obstetriz, visando a mudanças no modelo assistencial ao parto vigente. Objetivo: Conhecer a vivência acadêmica e a inserção profissional das(os) obstetrizes egressas(os) da primeira turma do Curso de Obstetrícia da EACH-USP. Método: Pesquisa de caráter exploratório e descritivo, com uma abordagem quantitativa e qualitativa. Para a abordagem qualitativa foi utilizado o Estudo de Caso. A amostra foi composta por 24 egressas(os) da primeira turma do Curso, de um universo de 44 formandas(os) que ingressaram em 2005. Os dados foram coletados no período de maio a agosto de 2010, por meio de entrevista gravada. O instrumento de coleta de dados foi composto por perguntas abertas e fechadas. A análise compreendeu a caracterização do perfil sócio-demográfico e econômico das(os) egressas(os) e sua trajetória acadêmica e profissional. Para análise dos dados foram utilizadas a estatística descritiva e a análise de conteúdo, adotando as concepções pedagógicas da EACH-USP, o Projeto Político-Pedagógico do Curso de Obstetrícia e os estudos sobre egressos como marcos teóricos. Resultados: Identificou-se que a maioria das(os) egressas(os) eram mulheres, solteiras, jovens e residentes na cidade de São Paulo, com renda familiar em torno de três a dez salários mínimos, com formação escolar anterior em escolas privadas. Após a conclusão da graduação, 17 egressas(os) voltaram a estudar, sendo seis em cursos de mestrado ou doutorado, seis em outro curso de graduação e os demais em cursos de atualização. Havia 14 egressas(os) inseridas(os) no mercado de trabalho, mas apenas quatro atuando na Obstetrícia, devido aos impedimentos legais para obter o registro profissional de Obstetriz. Da análise qualitativa dos dados, extraíram-se as seguintes categorias: Curso de Obstetrícia; Opção pelo Curso de Obstetrícia; Vivência Acadêmica; Formação Acadêmica; Inserção no Mercado de Trabalho, Sugestões para Melhorar a Formação dos Alunos; Sugestões para Aproximar Ex e Atuais Alunos. Ao final do estudo, considerou-se que as(os) obstetrizes perceberam sua formação acadêmica como adequada para enfrentar o mercado de trabalho, mas destacaram limitações como a falta de maiores contatos profissionais durante o curso, a carga horária reduzida em disciplinas práticas e a infra-estrutura deficiente da EACH-USP, que foram parcialmente superadas ao longo do Curso. Os itens mais valorizados na vivência acadêmica foram a realização de estágios, a iniciação científica e o contato com os professores. Em relação à inserção profissional, prevalece o discurso carregado de revolta e indignação com o Conselho Regional de Enfermagem, devido à resistência do órgão em reconhecer seu diploma para fins de registro profissional. Considerações Finais: O Curso de Obstetrícia da EACH-USP oferece um ensino de qualidade e forma obstetrizes com potencial para contribuir para a transformação da assistência obstétrica. Embora venham sendo feitas mudanças para aprimoramento do Curso, dificuldades relativas ao reconhecimento legal do exercício profissional das egressas representam ameaças à sua continuidade.
Introduction: The World Health Organization proposes less interventionist characteristics of childbirth care, emphasizing the role of midwives and nurse-midwives as the professionals best suited to the monitoring of women with normal pregnancy and delivery. The University of São Paulo (USP) began in 2005, the Undergraduate Program in Midwifery at the School of Arts, Sciences and Humanities (EACH-USP). This course was created with the challenge to revive the training of professional midwife in order to change the current model of care delivery. Objective: To know the academic experience and professional inclusion of (the) egresses midwives of the first class of midwifery course EACH-USP. Method: Research on exploratory and descriptive, with a quantitative and qualitative approach. For the qualitative approach was used the case study. The sample was composed of 24 egresses (the) the first class of course, a universe of 44 graduates who were admitted in 2005. Data were collected between May to August 2010, through recorded interviews. The data collection instrument consisted of open and closed questions. The analysis included the characterization of sociodemographic and econimic profile of (the) egresses and his academic and professional trajectories. For data analysis we used descriptive statistics and content analysis, adopting the pedagogical conceptions of EACH-USP, the Pedagogical Policy Project of the midwifery Course and studies of egresses as theoretical frameworks. Results: We identified that the majority of (the) egresses were women, single, young and living in the city of São Paulo, with a family income of around three to ten minimum salary, previous schooling in private schools. After completion of graduation, 17 egresses (the) returned to study, six courses in master\'s or doctorate, six another undergraduate and other in courses to upgrade. There were 14 egresses (the) inserted (the) labor market, but only four working in obstetrics, on account of legal impediments for the registration of professional midwives. The qualitative analysis of data, we extracted the following categories: Midwifery Course, Choice of Midwifery Course, Academic Experience, Academic training; Entering the Labor Market, Suggestions for Improving the Training of Students; Suggestions for bringing Past and Present Students . At the end of the study it was considered that (the) midwives perceived their academic training as appropriate to meet the labor market, but highlighted limitations such as lack of major professional contacts during the course, reduced the workload in practical subjects and deficient infrastructure of the EACH-USP, which were partially overcome throughout the course. Items valued at more academic experience were the realization of stages, the basic scientific research and contact with teachers. In relation to professional inclusion, the prevailing discourse laden with anger and indignation with the Regional Nursing Council, because of resistance of the organ to recognize their qualifications for professional registration. Conclusion: The Midwifery Course EACH-USP offers a quality education and prepares midwives with the potential to contribute to the transformation of obstetrical care. Although changes may be made for improvement of course, difficulties relating to legal recognition of professional practice of the egresses represent threats to its continuity.

There is a large indigence for more maternity homes in Mozambique. Pregnant women often have to walk long distances to get assistance giving birth. The conditions are hard to improve because of the shortage of educated staff. The maternity home and education center is a combined program for women in Maputo, Mozambique. The purpose for this is – apart from improving opportunities and help for pregnant women – to create a connection between education and practice so that the pupils can do their practice at the maternity home before working out in the country. The two instances are therefore closely integrated with each other. We want to develop a program that is also long-term giving, a kind of pay-forward-effect. The supposed consequence of the pay-forward effect is for graduated women to spread the knowledge to less educated midwifes in the countryside and at a long term improve health care for women.
Det finns ett stort behov av fler mödravårdscentraler i Mocambique. Gravida kvinnor går oftast långa sträckor för att få hjälp att föda. Förhållandena är svåra att förbättra i avsaknad av utbildad personal. Mödravårdscentralen och barnmorskeutbildningen är ett kombinerat program för kvinnor i Maputo, Mocambique. Målet med vårt projekt är att hjälpa gravida kvinnor och att skapa ett utbyte mellan utbildning och praktik. Därför är programmen tätt integrerade med varandra. Programmet ska skapa insikt om graviditet, födsel, sexualitet, en slags ”pay-forward effect”. Verkningarna av ”pay-forward” är att utbildade kvinnor ska sprida kunskap till mindre utbildade barnmorskor på landsbygden och på lång sikt bidra till en bättre sjukvård för kvinnor.

Philosophiae Doctor - PhD
Literature has shown that Malawi is experiencing a shortage of qualified healthcare providers, with the greatest burden on maternal and neonatal health. The majority of health service providers are Nurse-Midwife Technicians (NMT), contributing to 87% of the nursing and midwifery workforce. However, research has shown that the NMTs lack the ability to transfer skills into different clinical settings. It was not known what competencies were taught in Christian Health Association of Malawi colleges to equip the NMTs with clinical competence in neonatal nursing practice and how the clinical teachers assisted these NMTs to acquire the competencies. Furthermore, there was no documentation on the availability of a clinical competency-based assessment tool to validate the NMTs’ achievement of clinical competence in neonatal nursing. The purpose of this study was to develop a neonatal nursing care clinical competency-based assessment tool to validate NMTs’ achievement of clinical competence in CHAM nursing colleges. The competency, outcomes and performance assessment (COPA) model and the skills acquisition model were the conceptual frameworks used as the foundation of the study. The study adopted a sequential mixed method approach in which both qualitative and quantitative methods were utilized. Data collection was conducted using focus group discussions, document review and cross-sectional survey. The design and development model developed by Reeves (2006) and steps to development of assessment tools identified by the Department of Training and Workforce Development (2012) guided the study and development of the competency-based assessment tool. The study was conducted in eight CHAM nursing colleges. The researcher employed purposive, convenient and proportional stratified sampling to select the participants. Ethics clearance was obtained from the University of Western Cape and the National Health Sciences Ethical Research Committee in Malawi, prior to data collection. The data collection involved 31 midwifery clinical teachers and 140 third year students for the FGD and 48 midwifery clinical teachers and 195 third year students for the cross section survey. Document analysis was conducted at all the eight nursing colleges. The qualitative data was analysed using content analysis with Atlas.ti 7 and the quantitative data was analysed using descriptive analysis with SPSS 22. The research findings showed that the NMTs were taught basic nursing skills to enable them provide basic care to the health newborn baby. However, there were inadequate clinical assessments done to validate the NMT’s achievement of clinical competence in this setting. In addition, the clinical teachers used skills checklists to evaluate the NMTs clinical performance on specific procedures. The outcome of this study was the establishment of neonatal nursing clinical competencies, and development of a neonatal nursing care clinical competency-based assessment tool for the validation of NMT’s achievement of clinical competence. The tool provides a framework for neonatal nursing clinical teaching and assessments as well as tracking of the NMT’s clinical performance in this setting. It is recommended that training institutions should reinforce mechanisms to track the students’ clinical experience and performance assessments using this tool to ensure quality student outcomes. Furthermore, the clinical teachers should be oriented on the use of the developed assessment tool for familiarisation; thereby enhancing consistency and objectivity in the students’ performance assessments.
ICAP-NEPI Project Malawi

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CNPQ – Conselho Nacional de Desenvolvimento Científico e Tecnológico
A tese objetiva compreender a construção de saberes envolvidos e desenvolvidos em uma cosmologia de parto/nascimento “na tradição”, presente em um espaço alternativo ao modelo médico-hospitalar predominante na sociedade contemporânea. A base empírica dessa tese embasou-se no acompanhamento das atividades desenvolvidas pela roda de casais e gestantes do espaço Flor da Vida, em Porto Alegre, Rio Grande do Sul. A proposta conhecida como parto “na tradição” envolve a realização de um parto/nascimento que considera tanto a experiência de quem pare quanto a de quem nasce como um evento espiritual. Sua definição como “na tradição” é uma referência ao modelo de ensinamentos e procedimentos a partir de uma parteira tradicional, que ensina seus conhecimentos, vinculados à prática de “ajudar a parir/nascer” a outras parteiras que seguem “na” sua tradição. Os resultados dessa trajetória investigativa estão organizados da seguinte forma: inicialmente apresento a discussão teórico conceitual que embasa as análise realizadas, especialmente a noção de cosmologia do parto/nascimento e apresento as categorias analíticas orientadoras da pesquisa: Intervencionismo, tecnicismo e medicalização do parto; as relações entre Ecofeminismo e Educação e a noção de empoderamento em perspectiva feminista. Na sequência, abordo a atuação do Centro Ativo de Integração do Ser/CAIS do Parto e da Escola de Saberes, Cultura e Tradição Ancestral/ESCTA, procurando analisar o impacto de seu ativismo na defesa da parteria tradicional e na formação inicial e continuada de parteiras e doulas “na tradição”. A seguir, apresento as considerações sobre o acompanhamento realizado no campo empírico, abordando a trajetória formativa de parteiras e doulas “na tradição” da ESCTA; a concepção de missão espiritual dessa parteria; as concepções e vivências dessa cosmologia e sua abrangência para além do parto; a organização da parteira tradicional no Rio Grande do Sul e finalizo procurando analisar os novos horizontes de outra cultura do parto e do nascimento em difusão no ambiente urbano contemporâneo. Conclui-se que o parto e o nascimento, assim como a gestação dentro das reflexões a partir da roda Flor da Vida ampliam as percepções dos pensamentos e das práticas da área da 8 Educação, mas que os seus saberes e conhecimentos educativos se encontram no fazer de um pensamento interdisciplinar que é também um saber pedagógico, considerando o olhar sobre a espiritualidade, e a inteireza do ser no momento do parto e do nascimento.
The thesis aims to understand the construction of knowledge involved and developed in a birth cosmology “in tradition”, present in an alternative space to the predominant medical-hospital model in contemporary society. The empirical basis of this thesis was based on the monitoring of the activities developed by the wheel of couples and pregnant women in the Flor da Vida space, in Porto Alegre, Rio Grande do Sul. The proposal known as childbirth "in tradition" involves the realization of a birth that considers both the experience of those of the gestate and the baby born as a spiritual event. Its definition as "in tradition" is a reference to the model of teachings and procedures from a traditional midwife who teaches her knowledge, linked to the practice of "helping to give birth" to other midwives who follow "in" their tradition. The results of this investigative trajectory are organized as follows: I first present the theoretical conceptual discussion that bases the analyzes performed, especially the notion of birth cosmology and present the analytical categories guiding the research: Interventionism, technicalism and medicalization of childbirth; the relationship between Ecofeminism and Education and the notion of empowerment in a feminist perspective. Following, I discuss the proceeding of the Center for the Integration of the Being/CAIS of Childbirth and the School of Knowledge, Culture and Ancestral Tradition/ESCTA, trying to analyze the impact of their activism in the defense of the traditional childbirth and in the initial and continued formation of midwives and doulas “in tradition”. Next I present the considerations about the accompaniment in the search location, approaching the formative trajectory of midwives and doulas "in tradition" of ESCTA; the conception of the spiritual mission of this birth; the conceptions and experiences of this cosmology and its reach beyond childbirth; the organization of the traditional midwife in Rio Grande do Sul and I finish trying to analyze the new horizons of another birth culture and diffusing traditional birth in the contemporary urban environment. As a conclusion, the study shows that childbirth and birth, as well as gestation within reflections from the Flor da Vida space, amplify the perceptions and the practices of the Education area. The knowledge about childbirth and birth and the educational knowledge are 10 interconnected in the development of an interdisciplinary thought that is also a pedagogical knowledge, taking into account the spirituality and the full presence of being at the time of childbirth and birth.

SAMMANFATTNING Amningsfrekvensen i Sverige är lägre än vad som rekommenderas enligt Livsmedelverket och WHO. Sett ur ett folkhälsoperspektiv skulle mödrars och barns hälsa kunna förbättras om fler kvinnor ammade sina spädbarn mer exklusivt och under längre tid, varför bra metoder för amningsförberedelse bland blivande spädbarnsfamiljer behövs. Det amningsförberedande arbetet bör initieras av mödravårdsbarnmorskan redan under graviditeten.   Syfte: Att utforma en standardiserad mall för utförandet av amningsförberedande samtal under graviditet.   Metod: En kvalitativ pilotstudie genomförd med litteraturgranskning och fokusgruppintervju med barnmorskor, analyserade med innehållsanalys.   Resultat: Utifrån identifierade faktorer med visad positiv påverkan på amningsfrekvens samt barnmorskors kliniska erfarenhet utformades en standardiserad mall för amningsförberedande samtal. Mallen innehåller en individanpassad och en generell del. Den individanpassade delen behandlar tidigare amningserfarenheter, förväntningar inför kommande amning samt tankar kring brösten och deras funktion. Den generella delen behandlar information om bröst och bröstmjölk, amningsinformation, övriga tankar/frågor, EDS-screening samt fortsatt planering gällande amning.   Slutsats: Resultaten från litteraturgranskningen och fokusgruppsintervjustudien, med förslag på vad amningsförberedelse kan innehålla, överensstämmer till stor del. Barnmorskorna i fokusgruppsintervjustudien ger dock mer utförliga beskrivningar än de faktorer som sammanställts i litteraturgranskningen. Tillsammans har det gett en grund för utarbetandet av en standardiserad mall för amningsförberedande samtal. Fortsatt forskning får visa om samtalsmallen kan ge positiv effekt på amningsfrekvensen. Mallens användbarhet bör också vidare utvärderas.
ABSTRACT The breastfeeding frequency in Sweden is lower than the recommendation by the Swedish National Food Agency and WHO. From a public health perspective mothers´ and their children´s health would be improved if more women breastfed their infants more exclusively and during a longer period. Therefore good methods for breastfeeding preparation among parents to be is needed. The breastfeeding preparation should be initiated by the midwife at the maternity health care already during the women’s pregnancy.   Aim: To design a standardised guide for performing an anamnesis and care plan for breastfeeding during pregnancy.   Method: A qualitative pilot project based on literature review and focus group interviews with midwives, analysed by content analysis.   Results: A standardised guide for performing an anamnesis and care plan for breastfeeding were designed based on identified factors with proved positive impact on breastfeeding frequency and midwives´ clinical experiences in the interviews. The guide includes an individualised and a general part. The individualised part deals with previous breastfeeding experience, expectations for the coming breastfeeding and thoughts about breasts and their function. The general part deals with information about breasts and breast milk, information about breastfeeding, other thoughts/questions, EDS-screening and continued planning regarding breastfeeding.   Conclusion: The results of the literature review and the focus group interviews with suggestions on what breastfeeding preparation can include correspond to a large extent. Though the midwives in the focus group interviews gives more detailed and wide-ranging descriptions than the factors presented in the literature review. Altogether this has given a base for designing a standardised guide. Coming research will show if the guide can have positive impact on breastfeeding frequency. The usability of the guide should also be further evaluated.

SAMMANFATTNING Bakgrund: syftet med mödrahälsovård är att erbjuda föräldrar som väntar barn frekventa undersökningar under graviditeten samt en förberedelse inför deras kommande föräldraroll. Mödrahälsovården erbjuder föräldrautbildning till föräldrarna. Fördelar med föräldrautbildningar grundar sig i att familjer skapar ett socialt nätverk, samhörighet och igenkännande med andra i samma situation. Syftet: att undersöka om blivande föräldrar skapade nätverk utifrån att de lärt känna varandra vid en föräldrautbildning under graviditeten. Metod: en deskriptiv enkätstudie utifrån kvantitativ och kvalitativ ansats. Enkäten bestod av 24 frågor, varav fyra bakgrundsfrågor, 19 frågor om föräldrautbildning och sista delen i enkäten var ett öppet fält där föräldrar kunde kommentera med egna ord. Chitvåtest användes i analys av kvantitativa variabler. Den öppna frågan analyserades med kvalitativ innehållsanalys. Resultat: majoriteten av föräldrarna ansåg att föräldragruppsträffarna var en inspirationskälla till att skapa nätverk med andra föräldrar. En del av föräldrarna ansåg att det geografiska avståndet inte hade en negativ inverkan på ett nätverk, medan andra ansåg att det hade en negativ inverkan. Vänner och BVC betydde mycket för föräldrar i deras nätverk. Drygt hälften av föräldrarna ansåg att det var viktigt/mycket viktigt att ha ett nätverk i sitt föräldraskap. De viktigaste anledningarna för föräldrarna var att delge varandra erfarenheter, utbyte av kunskap och socialt umgänge. Majoriteteten av föräldrarna ansåg att de kommer att ha ett fungerade nätverk med dessa föräldrar i framtiden. Slutsats: Föräldrautbildningarna ansågs vara meningsfulla och gav möjlighet för föräldrarna att skapa ett nätverk med andra föräldrar. Föräldrarna utbytte kunskap, erfarenhet, stöd och hade möjlighet till socialt umgänge.
ABSTRACT Background: the purpose of antenatal care is to offer parents who are expecting a child frequent examinations during pregnancy and preparation for their future role as parents. Maternal health services offer parent education to the parents. Advantages of parent training based on that families create a social network, belonging and identification with others in the same situation. Aim: was to investigate if prospective parents had created network on the basis that they got to know each other in a prenatal education during pregnancy. Method: a descriptive questionnaire study based on quantitative and qualitative approach. The questionnaire consisted of 24 questions, four background questions, 19 questions about parent education and final part of the questionnaire was an open field where parents have been able to comment with their own words. Chi two test was used in the analyze of quantitative variables. The open – ended question was analyzed with qualitative content analysis. Results: the majority of parents felt that parents' meetings were an inspiration to create a network with other parents. Some of the parents felt that the geographic distance did not have a negative impact on a network, while others felt that it had had a negative impact. Friends and BVC meant a lot for parents in their network. More than half of the parents felt that it was important/ very important to have a network in their parenting. The major reasons for the parents was to share experiences, exchange of knowledge and social interaction. The majority of parents felt that they will have a working network with these parents in the future. Conclusion: Prenatal education was considered to bemeaningful andgave the opportunityfor the parents tocreate a networkwith other parents. Parentsexchangedknowledge, experience, support andhad the opportunityto interact socially.

Bakgrund: Tidigare forskning beskriver hur olika livsval påverkar ungdomars aktuella och framtida sexuella hälsa. Idag får ungdomar kunskap om sex både via skolan, ungdomsmottagningen samt via internet. Detta ställer helt nya krav på barnmorskor och lärare som ska bemöta den information ungdomarna har tillgång till och de frågor det väcker. Genom denna studie önskar författarna klargöra vilka frågor ungdomar ställer om sex genom att studera öppna forum på internet. Syfte: Att studera ungdomars frågeställningar om sex på internetforum Metod: En kvalitativ metod med induktiv ansats har använts till studien. Data inhämtades via umo.se under forumet fråga varandra. Totalt analyserades 48 trådar. Datamaterialet har analyserats enligt Graneheim, Lindgren & Lundmans analysmetod. Resultat: Resultatet utmynnade i 5 underkategorier, 2 kategorier samt ett övergripande tema. Känsla av sårbarhet Konklusion: Internet fungerar som en självklar informationskälla för ungdomar och kan komplettera skolans och ungdomsmottagningens sexualundervisning.  Studien visar att obesvarade frågor om sex väcker både negativa och positiva känslor hos ungdomarna.
Background: Previous research describes how different life choices affect young people's current and future sexual health. Today, young people get to know about sex both through school, youth clinics, as well as via the internet. This places entirely new demands on midwives and teachers to respond to the information available to young people and the issues it raises. Through this study, the authors wish to clarify the questions young people ask about sex by studying the open forums on the internet. Objective: To study young people´s issues about sex on internet forums. Method: A qualitative method with inductive approach has been used to the study. Data was collected through umo.se under the forum “Question each other”. A total of 48 threads were analysed. The data have been analysed according to Graneheim, Lindgren & Lundmans analysis method. Results: The results culminated in 5 subcategories, 2 categories as well as an overall theme: Sense of vulnerability. Conclusion: The Internet works as a natural source of information for young people and can supplement the school's sex education and the youth clinics. The study shows that unanswered questions about sex evokes both negative and positive feelings among the young people.

Forskning har visat att blivande pappor, som i denna studie även benämns som män eller förstagångspappa, har svårt att känslomässigt knyta an till graviditeten innan den blir synlig. Informationen och stödet från Mödrahälsovården under graviditeten är främst riktat till kvinnan, vilket gör att män ges en känsla av utanförskap. De beskriver känslor som att bli åsidosatt av barnmorskan vilket ökar känslan av oro. I Sverige har alla föräldrar rätt till föräldrastöd och individuellt anpassat stöd. Hur upplever blivande förstagångspappor sin delaktighet och vad är delaktighet för dem? Syftet med studien är att belysa förstagångspappors upplevelse av delaktighet i alla tänkbara aspekter av graviditet. En kvalitativ intervjustudie med åtta blivande förstagångspappor utfördes i Västra Götaland, Sverige under hösten 2013. Intervjuerna genomfördes när deras partner var i graviditetsvecka 31 till 40. Resultatet tydliggörs genom tre kategorier: Att vara inkluderad men stå vid sidan av, Relationens trygghetsskapande betydelse och Föreställningar om det okända. Resultatet redogör för mäns tankar och känslor om att vara delaktig under graviditeten. Barnmorskan ses som en kunskapskälla och inkluderar pappan genom ett gott bemötande, trots detta upplever pappor ett utanförskap. Under graviditeten antar männen en stödjande roll och har tankar om samhörighet och föräldraskap. För att män skall kunna uppleva delaktighet i alla tänkbara aspekter av graviditet behöver graviditeten förkroppsligas, vilket synliggörs i studiens övergripande tema: Frånvaro av förkroppsligande- ett hinder för delaktighet. Samhället har en föråldrad syn på graviditet och föräldraskap. Barnmorskan behöver få ökad kunskap om mäns behov av stöd under en graviditet, för att möjliggöra transitionen mot faderskapet och ge alla män rätt till lika föräldrastöd. Abstract: Research shows that expecting fathers, which in this study also referred to as male or first-time fathers’, have difficulties to emotionally connect to the pregnancy before it is visible. Information and support from the maternity care during pregnancy is mainly directed towards the women, this makes men feel left out. They describe feelings like being neglected by the midwife, which increases their feelings of anxiety. In Sweden all parents have the right to attend childbirth education and are entitled to individual support. What possibilities do men have for participating and how are they participating in the pregnancy? The aim of the study is to illuminate first-time fathers’ experiences of participating in all possible aspects of pregnancy. A qualitative study with eight expectant first-time fathers’ was conducted in Västra Götaland, Sweden in the autumn of 2013. The interviews occurred between 31th to 40th weeks of pregnancy. The result is illuminated through three categories: To be included but stand beside, The relationship that enhances security significance and Preconceptions about the unknown. The result describes men´s thoughts and feelings about being included in the pregnancy. Midwifes is seen as a source of knowledge and includes the father with her good care. Despite this, fathers experience being side lined. During pregnancy men takes on a supporting role and has thoughts about togetherness and parenting. If men shall be able to experience participation in all aspects of pregnancy, the pregnancy requires to be embodied, which get visible in the study´s main theme: Absence of embodiment- an impediment to participation. The midwife needs knowledge about men’s need for support during pregnancy in order to enable the transition to fatherhood and give all men the right to equal childbirth education.
Program: Barnmorskeutbildning

Background: Today, most of the sex education takes place in school. Studies shows shortcomings in this education and that students experience shortage of the knowledge wanted regarding this subject. Research has also shown that young people prefer to accomplish sex education with someone who feels comfortable and has good knowledge of the subject. The main subject of midwifery is sexual and reproductive health and rights. However, there is a limited amount of studies conducted regarding midwives involvement in sex education in schools. Purpose: The aim of this study was to highlight the role of the midwife in health-promoting public health work with sex education for adolescents in school. Method: Semi-structured telephone interviews were conducted with four teachers who taught sex education at high school and five midwives with experience of sex education. The collected material was analyzed according to Malterud's systematic text condensation. Result: The result showed that the midwife's health promotion work in school was conducted in a few different ways. Partly through lectures and partly by students visiting the youth health center (ungdomsmottagning). The way in which the work was done was due partly to the school's demand and partly to the availability of the midwife. The average time that the midwife was teaching students were between 30-120 minutes, which were distributed on one and the same occasion. The midwife's role in school was described as being proficient, competent and comfortable talking about sex. The fact that the midwife was unacquainted meant that the students felt comfortable and it was easier to ask questions about sensitive subjects. Conclusion: The conclusion of the study is that there is a need for midwifery skills at school and that, in spite of this, there is no clear and obvious role of the midwife in school education. Clinical applicability: This study can be used to support the midwife's work in sexual education in school. The study can also be used as a basis for establishing cooperation between midwife and school.
Bakgrund: Idag sker den övervägande delen av sex- och samlevnadsundervisningen i skolan och undersökningar visar på brister i denna undervisning samt att elever inte upplever sig få de kunskaper de önskar inom ämnet från skolan. Forskning har också visat att ungdomar föredrar att prata om sex och samlevnad med någon som känner sig bekväm och besitter goda kunskaper i ämnet. Barnmorskans huvudämne är sexuell och reproduktiv hälsa och rättigheter. Det finns dock begränsat med studier gjorda på hur barnmorskan involveras i skolans sex- och samlevnadsundervisning. Syfte: Syftet med den här studien var att belysa barnmorskans roll i det hälsofrämjande folkhälsoarbetet med sex och samlevnadsundervisning för ungdomar i skolan. Metod: Semistrukturerade telefonintervjuer gjordes med fyra lärare som undervisade i sex och samlevnad på högstadiet och fem barnmorskor med erfarenhet av sex och samlevnadsundervisning. Det insamlade materialet analyserades enligt Malteruds systematiska textkondensering. Resultat: Resultatet visade att barnmorskans hälsofrämjande arbete i skolan genomfördes på lite olika sätt. Dels genom föreläsningar och dels genom att elever kom på besök till ungdomsmottagningen. Hur arbetet var upplagt berodde dels på skolans efterfrågan och dels på hur tillgången till barnmorskan såg ut. Tiden som barnmorskan lade på att undervisa elever var i genomsnitt mellan 30-120 minuter som låg fördelat på ett och samma tillfälle. Barnmorskan beskrevs som kunnig och hade spetskompetens inom sitt område samt kände sig bekväm att prata om sex och samlevnad. Att barnmorskan var utomstående gjorde att eleverna också kände sig bekväma och hade lättare att ställa frågor angående känsliga ämnen. Slutsats: Slutsatsen av studien är att det finns ett behov av barnmorskans kompetens i skolan men att det inte finns någon tydlig och självklar roll för barnmorskan i skolans sexualundervisning. Klinisk tillämpbarhet: Denna studie kan användas som stöd för att främja barnmorskans insatser i skolans sex- och samlevnadsundervisning. Studien kan också användas som underlag vid upprättande av samarbetsformer mellan barnmorska och skola.

Bakgrund: Sexuella och reproduktiva rättigheter baseras på mänskliga rättigheter. En central insats för att öka tillgången till den sexuella och reproduktiva hälsan är en allsidig och omfattande sexualundervisning. Skolan och ungdomsmottagningar anses vara viktiga arenor för sexualundervisning. Många unga i Sverige anser dock att de inte har tillräckligt med kunskaper för att ta hand om sin sexuella hälsa. Barnmorskan har ett ansvar för utbildning av både kvinnor och samhället och utbildningen omfattar sexuell och reproduktiv hälsa. Syfte: Syftet var att sammanställa aktuell forskning kring ungas och lärares erfarenheter av sex- och samlevnadsundervisningen för att därigenom bidra till en breddad kunskapsbas för barnmorskan i det hälsofrämjande och sjukdomsförebyggande arbetet. Metod: Kvalitativ metasyntes med metaetnografi som analysmetod. Totalt kvalitetsgranskades och sammanställdes 16 vetenskapliga artiklar. Resultat: De unga i studien hade tydliga önskemål kring undervisningens innehåll, vilka kvalitéer personen som undervisade skulle ha och miljön de undervisades i. De önskade en bred och nyanserad kunskap om sex och samlevnad, relationer, känslor, sociala och kulturella normer. Lärarna i studien fokuserade i störst utsträckning på hur läroplaner, ledarstöd och politik påverkade undervisningen och i mindre utsträckning undervisningens innehåll. Slutsats: Resultatet av denna metasyntes visar att det finns olikheter i erfarenheter hos både unga och lärare när det gäller sex- och samlevnadsundervisningen. Barnmorskans ansvarsområde, kunskapsbas och uppdaterad förståelse kring sex och samlevnad kan med fördel användas för att hjälpa och stödja i ämnet 2 och därmed bli en del av skolans sex- och samlevnadsundervisning. Klinisk tillämpbarhet: Denna metasyntes kan vara ett underlag för att skapa ett utökat samarbete mellan skolor och barnmorskor för att förbättra sex- och samlevnadsundervisningen och ungas kontroll över egen sexuell hälsa. Denna metasyntes kan även ge stöd och utveckla utbildningen inom pedagogik för barnmorskor, skolsköterskor och distriktsköterskor då alla dessa yrkeskategorier träffar unga. Lärarutbildningens fokus på sex- och samlevnadsundervisning kan genom metasyntesen utvecklas. Slutligen kan beslutsfattare inom skolan få insikt i glappet mellan ungas och vuxnas perspektiv och aktualisera sex- och samlevnadsundervisning och sexuell hälsa inom skolan.
Background: Sexual and reproductive health rights are based on human rights. A major input to rise availability to sexual and reproductive health is a comprehensive and extensive sexual education. Many young people in Sweden consider though that they lack the necessary knowledge to care about their own sexual health. The midwife has a responsibility for the education of both women and society, and education includes sexual and reproductive health. Purpose: The purpose of this study was to compile the current research on the experience of both young people and the teaching staff in the area of sex and sex education to create a knowledge base for the midwife in the health promotion and disease prevention work. Methods: The method of analysis used is a qualitative metasynthesis with a metaethnographic approach. In total 16 scientific articles were juxtaposed and examined. Results: The young people in this study expressed clear wishes not only as to the contents of their studies, but also the personality of the teaching staff and the environment where they are taught. They desired a broad and more balanced knowledge about sexuality and cohabitation, relations, emotions, social and cultural norms. The teaching staff in the study focused mostly on how the school curriculum, organizations and politics affected teaching and less on the contents. Conclusion: The result of this metasynthesis shows that there are differences in the required experience among both young people and teachers when it comes to sexuality and sex education. The midwife’s area of responsibility, knowledge and the revised understanding of sexuality and sex education can with advantage be used to better off the teaching of sex 3 education. Clinical applicability: This metasynthesis can become a basis to create an expanded cooperation between schools and midwives in order to first ameliorate sex education and second to boost the young people’s control of their own sexual health. This metasynthesis can also provide support and develop education in pedagogy for midwives, school nurses and district nurses as all these occupational categories meet young people. Teacher education's focus on sex and cohabitation education can be developed through this metasynthesis. Finally, decision makers within the schoolsystem can gain insight into the gap between young people's and adults' perspectives and actualize sex and cohabitation and sexual health within the schools.

Documented as serving in the midwife capacity from the 1880s to the 1930s, the “granny-woman,” often was the only line of defense regarding childbirth support practices for many childbearing age women living in the region during the late nineteenth and early twentieth centuries. The early twentieth century saw the granny-women discredited and subject to elimination as a result of a purposeful campaign conducted by the male-dominated medical profession. Using knowledge of herbal remedies, the granny-woman played an integral part in the survival of the inhabitants of the region, especially related to childbirth. These centuries-old, herbal-based ministrations have been explored to aid in dispelling the erroneous conclusions related to the vital community role fulfilled by the Southern Appalachian granny-woman. Possessing knowledge of herbal-based childbirth prevention measures, the Southern Appalachian granny-woman rarely provided specifics related to the use of these measures by the women living in the region during that era.

Thesis (Ph.D.)--University of Alberta, 2009.
A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Faculty of Nursing. Title from pdf file main screen (viewed on October 10, 2009). Includes bibliographical references.

D.Cur.
Since 1994, the government has engaged in extensive transformative processes that included the reviewing and restructuring of all relevant legislation, organisations, institutions and statutory bodies. These transformative demands resulted in the development and implementation of a new constitution and ensuing transformative legislation and policies. It is for this reason that the Department of Health, in attempting to transform the health system in South Africa, developed a strategy known as the Health Sector Strategic Framework, which sets out a 10-point plan. This plan states amongst others, that health professions and professional bodies develop Continuing Professional Development (CPD) systems/programmes. Over and above this other transformative developments in the education and labour frameworks, professional conduct hearings and national and international benchmarking influenced the need for a CPD system for nurses and midwives in South Africa. The problem statement is that there is no formalised and regulated CPD system for nurses and midwives in South Africa. The following research questions are relevant: • What is the international trend with regard to CPD for nurses and midwives? • What is the national trend with regard to CPD for healthcare professionals in South Africa? • What will a CPD system for nurses and midwives in South Africa comprise? • How will a CPD system for nurses and midwives in South Africa be implemented to ensure credibility? The overall aim of this study was to develop a CPD system for nurses and midwives in South Africa. To accomplish this overall aim the following objectives were formulated: • To explore and describe existing knowledge frameworks on Continuing Professional Development for nurses and midwives in selected countries, internationally and for health professionals in South Africa • To describe the draft CPD system for nurses and midwives in South Africa • To describe a final CPD system for nurses and midwives in South Africa. This study was conducted within the context of the South African professional, ethical and legal framework for Continuing Professional Development for nurses and midwives in South Africa. A descriptive, exploratory and contextual design was conducted. The description of a draft CPD system was based on the theoretical framework. The draft CPD system was developed from 9 June 2000 until May 2003 and exposed to critical reflection by the stakeholders of the SANC, the profession at large and the human resource directorates in each of the nine (9) provinces in South Africa. The researcher developed the final CPD system for nurses and midwives in South Africa. This final CPD system was exposed to critical reflection to confirm face and content validity, followed by a refinement of the CPD system. Emerging from this research and based on the feedback of the validators/appraisers, recommendations are made with reference to practice, nursing and midwifery education and research: The implementation of a formal, coordinated and regulated CPD system for nurses and midwives in South Africa is necessary as part of a quality promotion initiative and to meet the requirements of the transformative legislation especially pertaining to the labour and education legal framework.

Summaries in English, Afrikaans and Tswana
The purpose of this study was to explore and develop understanding of nurses and midwives’ perceptions and attitudes towards the implementation of CPD, aiming to provide them with a platform to make recommendations to enhance the attendance of CPD.The study was conducted in a public regional hospital in Limpopo Province, South Africa. The purposive exploratory descriptive qualitative research method was used. Data was collected through Focus Group Discussions. Participants comprised of three focus group discussions. A semi-structured guide with open –ended questions was used and discussions were recorded with an audio recorder which were transcribed verbatim. Content analysis of the data was done. The study yielded themes, sub-themes and codes during analysis. Participants perceived CPD to have benefits to keep nurses updated with knowledge, skills and improvement of attitudes. It improves quality patient care. However, they identified staff shortage, time constraints and lack of internet connection as the major challenges.
Die doel van hierdie studie was om ‘n begrip van die houdings en persepsies teenoor die implementering van voortgesette professionele ontwikkeling (VPO) van verpleegkundiges en vroedvroue te verken, ten einde ‘n platform vir aanbevelings daar te stel om die bywoning van VPO te bevorder. Die studie was in 'n openbare streekshospitaal in die provinsie Limpopo, Suid-Afrika gedoen. ‘n Kwalitatiewe, doelgerigte, verkennende en beskrywende navorsingsmetode was gebruik om data is deur middel van drie fokusgroepbesprekings in te samel. ‘n Semi-gestruktureerde onderhoudegids met oop vrae was gebruik om klankopnames van gesprekke, verbatim te transkribeer. Data was ontleed deur middel van inhoudsanalise. Temas, subtemas en kodes is tydens die analise geïdentifiseer. Die deelnemers het VPO as voordelig beskou in terme van die opdatering van verpleegkundiges se kennis, vaardighede en houdings. Gehalte pasiëntsorg word sodoende verbeter. Hulle het egter personeeltekort, 'n gebrek aan tyd, en toegang tot die internet as ‘n struikelblok geïdentifiseer.
Maikaelelo a dipatlisiso tse (research), e ne e le go sekaseka le go tlhabolola kutlwisiso ya baoki le babelegisi ka ga tebo le maikutlo a bona mabapi le tshimololo ya go thlabolola dithuto bale tirong “CPD”. Maikaelelo e ne e le go ba neela tšhono ya go dira ditshwaelo go oketsa dipalo tse di tsenang dithuto tsa CPD. Dipatlisiso tse di diretswe kwa dipetleleng tsa kgaolo tsa botlhe, Porofenseng ya Limpopo mo Aforikaborwa. Go dirisitswe mokgwa wa dipatlisiso wa ‘purposive exploratory descriptive qualitative research’ mo di patlisisong tse. Dikitso di kgobokantswe go ya ka mokgwa wa lekgotla ‘Focus Group Discussion’. Batsayakarolo ba ne ba arogantswe ka ditlhopha tse tharo tsa ‘focus group discussions’. Kaedi e e rulagantsweng e e nang le dipotso tsa boitlhalosi- ka- botlalo e dirisitswe mme dipuisano tsa gatiswa ka rekhoto ya kgatiso-modumo morago tsa kwalwa fatshe ka mokgwa o di builweng. Tshekatsheko ya diteng tsa dikitso tse e dirilwe ka go latela mokgwa wa ‘content analysis’. Dipatlisiso tse dineetse molaetsa mogolo, melaetsanyana le melao ka nako ya ditshekatsheko. Batsayakarolo ba bone gothlabolola dithuto bale tirong ‘CPD’ go nale mosola mo tsweletsong ya go neela baoki kitso, bokgoni le tokafatso ya maitshwaro. E tokafaditse boleng ba tlhokomelo ya balwetse. Le fa go ntse jalo, ba supile fa tlhaelo ya baoki, dinako tsa go dira le go tlhoka kgokelelo ya enthanete e le dikgwetlho tse kgolo.
Health Studies
M.A. (Nursing Science)

University of Technology Sydney. Faculty of Health.
[Background] There are workforce shortages in the nursing and midwifery professions in Australia. Many factors have been associated with these shortages such as high workloads, an inadequate skill mix, low nurse/midwife-to-patient/woman ratios, and heightened acuity, all of which can lead to professional burnout for staff. Connected to these shortages are perceptions of inadequate remuneration, experiences of bullying and work-related stresses, the lack of managerial action to tackle these issues and a perceived lack of opportunities for career diversity and progression. Much of this is well known in the nursing discipline, however it is unclear how these factors are similarly impacting midwifery and therefore, research into the workforce experiences of Australian midwives is timely. [Objective / Purpose] To explore early workforce participation trends, experiences and choices of midwives who graduated from one Australian university (graduating years 2007 and 2008). Participants were educated either in Bachelor of Midwifery or Graduate Diploma of Midwifery programs (n = 113). Further objectives of the study were to identify work environment and personal factors that may influence workforce experiences, and to compare any workforce trends by midwifery course. [Methods] A sequential explanatory mixed methods design was conducted. Phase 1 survey collected mainly quantitative demographic and workforce participation data. Three validated instruments were also used: Maslach Burnout Inventory (MBI); Practice Environment Scale of the Nursing Work Index (PES-NWI); and Perceptions of Empowerment in Midwifery scale (PEMS). Due to sample size restrictions, analysis was restricted to non-parametric measures including frequency distribution and simple correlations (p ≤ 0.01). Phase 2 was a qualitative study using semi-structured interviews with qualitative content and contextual analysis. [Results] In Phase 1, the survey response rate was 66 percent (n = 75). Fifty-nine were working as midwives, half of them in full-time employment. Personal factors contributing to workforce choices were only a cause of concern for a small number of midwives. The main reason for having exited from the profession was child rearing. There was a low degree of burnout and high levels of empowerment. Inadequate clinical resources and ineffective managerial support in the workplace were also identified. Bachelor of Midwifery participants were older than the Graduate Diploma midwives but no other relationship between the midwifery course and any of workforce measure existed. In Phase 2, 28 participants were interviewed. Three themes, each comprising of subthemes, were generated: (i) ‘sinking and swimming’; (ii) ‘needing a helping hand’; and (iii) ‘being a midwife… but’. The initial transition into midwifery was overwhelming for most participants, particularly when providing intrapartum care. Coping within the experience was dependent upon support. Job satisfaction was strongly related to the midwife-woman relationship and working to the full scope of practice ability, both which encouraged midwives to remain in midwifery. Dissatisfaction stemmed from poor remuneration, inflexibility of rostering, high workloads and poor managerial approaches. Experiences of bullying were ubiquitous. Factors inducing midwives to stay in the midwifery profession were not the absence of those that caused dissatisfaction. The midwife-woman relationship sustained their practice despite those factors that generated job dissatisfaction. [Conclusion] Elements of the early workforce experiences of these midwives paralleled many of those evident in the Australian nursing profession and similar workforce factors contributing to job satisfaction and dissatisfaction were identified. The midwife-woman relationship was a source of job satisfaction and inspired these midwives to remain in midwifery. Exiting the profession- temporarily or permanently- was mainly due to child rearing. [Implications for practice] Any vacuum created by eliminating factors of job dissatisfaction will require an amplified investment of factors that bring job satisfaction in order to have genuine content in midwives. Strategies that deliver transitional support, rostering flexibility, leadership training and address workplace bullying, will be ameliorative in the face of staffing shortages. Employment models that enhance relational aspects of midwifery are integral for job satisfaction in midwives. Health systems and services have a duty to support the continued professional development and accessibility of career progression for midwives, to allow individuals to cultivate their midwifery skills and work to their potential.