Competencies and skills for remote and rural maternity care: A review of the literature

School of Nursing & Midwifery, The Robert Gordon University, Aberdeen, UK.
Journal of Advanced Nursing (Impact Factor: 1.74). 05/2007; 58(2):105-15. DOI: 10.1111/j.1365-2648.2007.04246.x
Source: PubMed


This paper reports a review of the literature on skills, competencies and continuing professional development necessary for sustainable remote and rural maternity care.
There is a general sense that maternity care providers in rural areas need specific skills and competencies. However, how these differ from generic skills and competencies is often unclear.
Approaches used to access the research studies included a comprehensive search in relevant electronic databases using relevant keywords (e.g. 'remote', 'midwifery', 'obstetrics', 'nurse-midwives', education', 'hospitals', 'skills', 'competencies', etc.). Experts were approached for (un-)published literature, and books and journals known to the authors were also used. Key journals were hand searched and references were followed up. The original search was conducted in 2004 and updated in 2006.
Little published literature exists on professional education, training or continuous professional development in maternity care in remote and rural settings. Although we found a large literature on competency, little was specific to competencies for rural practice or for maternity care. 'Hands-on' skills courses such as Advanced Life Support in Obstetrics and the Neonatal Resuscitation Programme increase confidence in practice, but no published evidence of effectiveness of such courses exists.
Educators need to be aware of the barriers facing rural practitioners, and there is potential for increasing distant learning facilitated by videoconferencing or Internet access. They should also consider other assessment methods than portfolios. More research is needed on the levels of skills and competencies required for maternity care professionals practising in remote and rural areas.

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    • "For too long it has been accepted that as long as the health workers received some (often too little) training in midwifery, this was sufficient [17]. There has to be clarity as to the understanding of competence- ability to perform aspects of the job and competencies, the basic knowledge skills and behaviours required of a midwife to practice safely in any setting [18]. "
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    • "Furthermore, there is a lack of appropriate professional and community role models (cf. Marginson 2004) and therefore a lack of understanding of the skills and competencies required to succeed (Ireland et al. 2007). Finally, there is reduced access to appropriate educational opportunities within their regions (Alston 2004; Evans 2004). "
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    • "Shortages of nurses and midwives, as other health professionals, are more pronounced in rural and remote areas where recruitment and retention remain problematic (International Council of Nurses, 2006). However, expectations for staff in specialty areas, such as mental health or midwifery, to be multiskilled (Ireland et al., 2007) in order to help to address shortages across the rural workplace, places further stress on rural health workers resulting in job stress and dissatisfaction ; a known influence on retention (Duffield & O'Brien-Pallas, 2002; Jackson, Mannix, & Daly, 2001; Stroth, 2010). For midwives this issue is more pronounced as they may actually spend a very small percentage of their working day involved in maternity care yet remain acutely aware of the expectation that they maintain their competency in the event a pregnant or birthing woman presents to the service (Monaghan & Walker, 2001). "
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