MSc. Thesis / Introduction: In 2018, the College of Midwives of Ontario expanded the scope of practice for registered midwives to include performing point of care ultrasound (POCUS) to aid their obstetrical clinical assessments. This project evaluated learner sonography knowledge, skill acquisitions, and integration of this technology following an innovative POCUS curriculum developed for midwives to understand the impacts of this training. Methods: Concurrent triangulation with mixed methods was used in this study through surveys and interviews. First, the surveys were used to collect data across four time points including before and after the intervention. Five- and seven-point Likert scale questions were analyzed through descriptive statistics. Open-ended questions were qualitatively analyzed using thematic analyses. Second, the semi-structured interviews were conducted to better understand participants’ attitudes and clinical behaviours. Interviews were coded and analyzed using a combination of Corbin and Strauss as well as Charmaz approaches to grounded theory. Results: The findings demonstrated how there was a positive growth in learner comfort with POCUS and a desire to continue using it during clinical practice. The frequency of POCUS use within antenatal care increased with common applications including fetal presentation and assessment of pregnancy viability. The interviews highlighted five themes: facilitating learning, improving care, refining the role of the midwife, serving community, and maintaining competency. Access to clinical placements and the cost of a device were identified as barriers to promoting POCUS skill sets. Participants who had access to a device and completed the clinical practicum are continuing to use sonography within their clinics to provide more comprehensive client care. Conclusions: This project demonstrates how POCUS training can positively impact midwives particularly with aiding clinical decision making such as those regarding fetal viability and presentation. However, the challenges with obtaining a clinical practicum to ensure competency and the cost and access to a device, are significant barriers that unless they are addressed, may result in minimal integration within community practices. / Thesis / Master of Health Sciences (MSc) / The ability to conduct ultrasounds has recently been included in Ontario midwives’ scope of practice. This project evaluated a newly developed Point of Care Ultrasound (POCUS) curriculum for practicing midwives to understand how midwives can learn and apply POCUS into their clinical work. Learners completed surveys at four time points from pre-course to one-year post-course to share their experiences of knowledge and skill acquisition and applying this training to their clinical work. Five midwives also participated in an interview to share their perspectives about the course more in-depth. It was found that Ontario midwives were very interested to learn POCUS to improve client care. Unfortunately, they struggled finding time and opportunities to refine their sonography skills such as securing a clinical practicum or the funds to purchase a device. However overall, POCUS in midwifery was well received, this technology and its respective education should continue to be supported in Ontario.

No description available.

Yes / Pregnant women seeking asylum in the United Kingdom appear particularly vulnerable, having complex health and social care needs and could benefit from a woman centred approach to midwifery care. This article is the second of three parts and reports on the findings from one objective of a wider doctorate study. It focuses on exploring midwifery students' perceptions of how to approach the care of pregnant women seeking asylum. Although the design of the study is explored in article one, in this context, the data was subject to critical discourse analysis to meet this objective. Key words and phrases were highlighted which appeared to reveal power and ideology implicit in the language used when discussing midwifery care of the pregnant woman seeking asylum. Dominant discourses were identified which appeared to influence the way in which care was approached and the possible sources of these discourses critically analysed. The findings suggest an underpinning ideology around following policies and guidelines to meet the physical needs of the woman at the expense of her other holistic needs. Despite learning to adopt a woman centred approach in theory, once in practice some students appear to be socialised into (re)producing these dominant medical and managerial discourses with “midwifery discourse” being marginalised. In addition, some students appeared to have difficulty understanding how to adopt a woman centred approach and the importance of considering the woman's context and its impact on care. These findings have implications for midwifery educators and this article identifies that the recent Nursing and Midwifery Council requirement for students to undertake a caseloading activity could provide the opportunity for them to adopt a consistent woman centred approach in practice, rejecting dominant medical and managerial discourses. However, these discourses appear to influence midwives caring for women more widely and will be difficult to challenge.

Students diagnosed with long-term mental health conditions have been the focus of policy development for over a decade. Student mental health is on the increase and universities are legally obliged to make reasonable adjustments for disabled students. Therefore it is crucial that nursing and midwifery education provides an inclusive learning environment, while maintaining fitness to practice standards. The focus of this study was to explore how discourses of mental health, reasonable adjustments and fitness standards influence nursing and midwifery education for students with a mental health condition. Principles of Wodak’s (2001) critical discourse analysis approach, which gives prominence to dominant discourses, their justifications and persuasive nature was utilised. Ten key written texts and 23 semi-structured interviews with students, lecturers and clinical mentors were conducted to acquire the constructions of mental health, reasonable adjustments and fitness requirements. The findings show that the dominant discourses attributed to students experiencing mental ill health were around medicine, difference and blame, all of which reinforced mental health stigma. In addition, mental health discourses within both verbal and written texts were not underpinned by disability discourses, allowing the exclusion of students who disclose mental ill health from accessing reasonable adjustments. In conclusion, students considered to have a mental health label faced discriminatory barriers and legislative and regulatory requirements of equality were not implemented.

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.

Attrition in Higher Education continues to present academics, researchers and professionals with an ongoing dilemma. Achieving a fair balance between the academic rigour of meritocracy and the wider access agenda of social inclusion, demands that entrance criteria incorporates measures beyond the traditional prior academic attainment. Emotional Intelligence has been presented in the literature as a valid and reliable predictor of retention and performance in industry and researchers have suggested that similar benefits may be found in education. In this dissertation, the construct of Emotional Intelligence was explored, reviewing contemporary models and their respective measurement tools. A self report tool for measuring ‘trait’ Emotional Intelligence was selected from the review and used to examine the predictive relationship between emotional intelligence and the outcomes at the end of the first year of undergraduate nurse education namely: clinical practice performance; academic performance and course attrition by nursing and midwifery students. The sample group consisted of a cohort of student nurses and midwives (N = 178) who commenced their training in 2007. A significant predictive relationship was found between emotional intelligence and clinical practice performance (r = 0.75, N = 116, p < 0.05); emotional intelligence and academic performance (r = 0.16, N = 168, p < 0.05) and emotional intelligence and attrition (r = 0.31, N = 178, p < 0.05). Age was also found to predict attrition (r = 0.25, N = 178, p < 0.05) while prior academic attainment was found to predict academic performance (r = 0.20, N = 168, p < 0.05). The dissertation proposes the inclusion of measures of emotional intelligence as an aid to recruitment and selection processes in nurse and midwifery education. It also recommends that other practice based vocational programmes, within the higher education sector, consider exploring emotional intelligence in their recruitment and selection processes.

Students diagnosed with long-term mental health conditions have been the focus of policy development for over a decade. Student mental health is on the increase and universities are legally obliged to make reasonable adjustments for disabled students. Therefore it is crucial that nursing and midwifery education provides an inclusive learning environment, while maintaining fitness to practice standards. The focus of this study was to explore how discourses of mental health, reasonable adjustments and fitness standards influence nursing and midwifery education for students with a mental health condition. Principles of Wodak’s (2001) critical discourse analysis approach, which gives prominence to dominant discourses, their justifications and persuasive nature was utilised. Ten key written texts and 23 semi-structured interviews with students, lecturers and clinical mentors were conducted to acquire the constructions of mental health, reasonable adjustments and fitness requirements. The findings show that the dominant discourses attributed to students experiencing mental ill health were around medicine, difference and blame, all of which reinforced mental health stigma. In addition, mental health discourses within both verbal and written texts were not underpinned by disability discourses, allowing the exclusion of students who disclose mental ill health from accessing reasonable adjustments. In conclusion, students considered to have a mental health label faced discriminatory barriers and legislative and regulatory requirements of equality were not implemented.

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.

This thesis explores the pedagogical potential of images shared during intra-professional conversations held on the social media platform, Twitter. Twitter chats are loosely synchronous exchanges of tweets sharing a unique, identifying keyword or hashtag. They are increasingly being used among professionals to create professional networks in which practice-knowledge and opinion might be shared and where communal connections may be created. As such, they may serve as sites in which professional learning unfolds, both in relation to workplace practices and in relation to the development of new forms of professional practice around social media use. Because the exchanges and broadcasts on Twitter are, for the most part, public, and the conversations are ongoing, they also provide open, freely-accessible, and constantly renewing resources for use in pre-service learning contexts. The research focused on two example chats, one held among midwives and the other among teachers. Inspired by the increasing use of images in new forms of digital communication, the research used images tweeted during the chats as starting points from which to explore flows of knowledge and affect. Data were generated from observations of the two Twitter chats over extended periods, together with interviews with practising professionals, student professionals and their educators in which images were used as elicitation devices. The research combined an approach to reading and “being with” data inspired by ideas drawn from the work of Deleuze (1994; Williams 2013) and Deleuze and Guattari (1988; Massumi 1992), with approaches to reading images drawn from visual social semiotics (Kress and van Leeuwen 1996). The findings suggest that Twitter chats such as those studied here can provide rich opportunities for professional learning. Practice knowledge can flow from one participant to many others, and flows of affect can be used to remoralize individuals and communities. Both chats seemed to serve as sites in which professionals could experience a positivity and affirmation that was not always available in the workplace. However, the forces and intensities at play in these spaces influence both what is said and what is not said, creating new norms of online interaction that generally seemed to avoid negative comments or open disagreement. Educators saw potential to use images such as those shared in the chats in a variety of ways. For example, images could be used as prompts for examination and critique of practices. The educators I interviewed also suggested that the images could be used to help student professionals develop their sensitivity to the forces and intensities that produce particular practices. Group interviews with student professionals suggested that the former happened spontaneously when students encountered and discussed such images, but that the latter might need deliberate facilitation or prompting. The thesis concludes with some recommendations for: (i) educators considering using such images in pre-service professional learning; (ii) professional developers considering using Twitter chats; and (iii) policy-makers involved in drafting guidelines for professionals’ use of social media.