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Confidence in Midwifery: Midwifery students and midwives’ perspectives
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.ORCID iD: 0000-0002-7684-1100
2018 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Abstract [sv]

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.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University , 2018. , p. 40
Series
Mid Sweden University licentiate thesis, ISSN 1652-8948 ; 138
Keywords [en]
Clinical Practice, Competence, Confidence, Knowledge, Learning, Midwifery, Midwifery education, Midwifery students
Keywords [sv]
Barnmorskestudenter, Barnmorskeutbildning, Klinisk träning, Kompetens, Trygghet, Kunskap, Lärande
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-33560ISBN: 978-91-88527-47-9 (print)OAI: oai:DiVA.org:miun-33560DiVA, id: diva2:1203814
Presentation
2018-04-11, F217, Östersund, 13:00 (Swedish)
Supervisors
Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-05-04Bibliographically approved
List of papers
1. Professional confidence among Swedish final year midwifery students: A cross-sectional study
Open this publication in new window or tab >>Professional confidence among Swedish final year midwifery students: A cross-sectional study
Show others...
2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 14, no December 2017, p. 69-78Article in journal (Refereed) Published
Abstract [en]

Objective

Previous international studies have shown that midwifery students do not feel confident in many areas where they are supposed to practice independently.

The knowledge about Swedish midwifery students’ confidence is fairly under investigated. The purpose of the present study was to explore final years’ midwifery students’ professional confidence in basic midwifery skills according to ICM competencies and associated factors.

Methods

A cross-sectional survey where all midwifery programs in Sweden were invited to participate. Data was collected by a questionnaire that measured midwifery students self-reported assessment of confidence against four selected domains of ICM competencies; antenatal, intrapartum, postpartum and new-born care.

Result

The main findings of this study showed that Swedish midwifery students were confident in managing normal pregnancy, labour and birth. Midwifery students at a school with a medical faculty were more confident in handling obstetric emergency situations. Some background variables were also associated with confidence.

Conclusion

This study highlighted some midwifery skills that needs further training and reflection. More training and developing confidence in complicated and emergency situations are needed. There seem to be a need of midwifery education reforms if we believe that high levels of confidence at the time of graduation is equal to competent and skilled midwives in the future.

Keywords
Clinical practice, Confidence, Midwifery education, Midwifery students
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-32059 (URN)10.1016/j.srhc.2017.10.003 (DOI)000418966300011 ()29195637 (PubMedID)2-s2.0-85031503652 (Scopus ID)
Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2018-05-04Bibliographically approved
2. Developing competence and confidence in midwifery: focus groups with Swedish midwives
Open this publication in new window or tab >>Developing competence and confidence in midwifery: focus groups with Swedish midwives
2017 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 1, p. E32-E38Article in journal (Refereed) Published
Abstract [en]

Background

Midwives have a significant impact on the clinical outcome and the birthing experience of women. However, there has been a lack of research focusing specifically on clinical midwives’ learning and development of professional competence.

Aim

The objective of the study was to describe how midwives reflect on learning and the development of professional competence and confidence.

Methods

A qualitative study based on focus groups with midwives employed in maternity services.

Findings

Four categories describe the results: (1) Feelings of professional safety evolve over time; (2) Personal qualities affect professional development; (3) Methods for expanding knowledge and competence; and (4) Competence as developing and demanding. The meaning of competence is to feel safe and secure in their professional role. There was a link between the amount of hands-on intrapartum experience and increasing confidence that is, assisting many births made midwives feel confident. Internal rotation was disliked because the midwives felt they had less time to deepen their knowledge and develop competence in a particular field. The midwives felt they were not seen as individuals, and this system made them feel split between different assignments.

Discussion

External factors that contribute to the development of knowledge and competence include the ability to practise hands-on skills in an organisation that is supportive and non-threatening. Internal factors include confidence, self-efficacy, and a curiosity for learning.

Conclusions

Midwives working within an organisation should be supported to develop their professional role in order to become knowledgeable, competent and confident.

Keywords
Competence, Confidence, Midwifery, Knowledge, Learning
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-29444 (URN)10.1016/j.wombi.2016.08.004 (DOI)000397042900016 ()27562606 (PubMedID)2-s2.0-84997281848 (Scopus ID)
Available from: 2016-12-07 Created: 2016-12-07 Last updated: 2018-05-04Bibliographically approved

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