Competencies and skills for remote and rural maternity care: a review of the literature.
ABSTRACT 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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ABSTRACT: We employed grounded theory to explain how Canadian pregnant women and care providers manage birth. The sample comprised 9 pregnant women and 56 intrapartum care providers (family doctors, midwives, nurses, obstetricians, and doulas [individuals providing labor support]). We collected data from 2008 to 2009, using focus groups that included care providers and pregnant women. Using concurrent data collection and analysis, we generated the core category: minimizing risk while maximizing integrity. Women and providers used strategies to minimize risk and maximize integrity, which included accepting or resisting recommendations for surveillance and recommendations for interventions, and plotting courses vs. letting events unfold. Strategies were influenced by evidence, relationships, and local health cultures, and led to feelings of weakness or strength, confidence or uncertainty, and differing power- and responsibility-sharing arrangements. The findings highlight difficulties resisting surveillance and interventions in a risk-adverse culture, and the need for attention to processes of giving birth.Qualitative Health Research 09/2011; 22(5):575-86. · 2.19 Impact Factor
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ABSTRACT: OBJECTIVE: To explore and describe the experiences of working in the dual role as nurse and midwife in rural areas of far north Queensland, Australia. METHOD: The methodology was informed by Heidegger's interpretive phenomenological philosophy and data analysis was guided by van Manen's analytical approach. Data was generated by conversational interviews. Eight midwives working in a dual role as midwife and nurse were interviewed individually. FINDINGS: Three themes were identified: Making choices between professional role and lifestyle: "Because I choose to live here"; Integration of maternity and general nursing: "All in together this fine weather" and: "That's part of working in a small place". CONCLUSION: Participants recognized that in rural areas it is important to be a multi-skilled generalist; however they were concerned that midwifery skills could be eroded or even lost with the diminishing amounts of midwifery work available. Appropriate re-structuring of maternity services could provide better use of the midwifery workforce in rural centres, and reduce the current problems associated with transferring birthing mothers to larger facilities. Further research is needed to examine the extent to which the requirement to work in a dual, or multifaceted role is an impediment to the recruitment and retention of midwives to rural areas.Women and Birth 04/2012;
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ABSTRACT: Achieving the Millennium Development Goal (MDG) of improving maternal health has become a focus in recent times for the majority of countries in sub-Saharan Africa. Ghana's maternal mortality is still high indicating that there are challenges in the provision of quality maternal health care at the facility level. This study examined the implementation challenges of maternal health care services in the Tamale Metropolis of Ghana. Purposive sampling was used to select study participants and qualitative strategies, including in-depth interviews, focus group discussions and review of documents employed for data collection. The study participants included midwives (24) and health managers (4) at the facility level. The study revealed inadequate in-service training, limited knowledge of health policies by midwives, increased workload, risks of infection, low motivation, inadequate labour wards, problems with transportation, and difficulties in following the procurement act, among others as some of the challenges confronting the successful implementation of the MDGs targeting maternal and child health in the Tamale Metropolis. Implementation of maternal health interventions should take into consideration the environment or the context under which the interventions are implemented by health care providers to ensure they are successful. The study recommends involving midwives in the health policy development process to secure their support and commitment towards successful implementation of maternal health interventions.BMC Health Services Research 01/2014; 14(1):7. · 1.77 Impact Factor