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

University of Aberdeen, Aberdeen, Scotland, United Kingdom
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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    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.
    Full-text · Article · Jan 2014 · BMC Health Services Research
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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). "

    Full-text · Conference Paper · Jan 2012
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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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    ABSTRACT: Nurses and midwives continue to make up the largest proportion of the health workforce. As a result, shortages of nurses and midwives have a significant impact on the delivery of effective health care. Shortages of nurses and midwives are known to be more pronounced in rural and remote areas where recruitment and retention remain problematic. However, rural nurses are often required to be multi-skilled, which has led to expectations that nurses who are also midwives, are required to work across areas of the hospital to help to address shortages. For midwives this issue is even more problematic as they may actually end up spending a very small percentage of their working day involved in the delivery of maternity care. This workforce strategy has the potential to seriously erode the skills of the midwives. Situations such as this are implicated in attrition of midwives because of the role stress that results when they are required to work in models of care where they experience the constant pull to work between departments and across roles. This paper addresses the requirement for midwives in some rural facilities to work across roles of general nurse and midwife and outlines the issues that arise as a result. In particular, the paper links the concepts of Role Theory to the requirement for midwives to work in dual roles and the potential for role stress to develop.
    Full-text · Article · Sep 2011 · Collegian Journal of the Royal College of Nursing Australia
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