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Why be a midwife?

As I recently watched lots of eager new midwifery students find their way through the first term of their midwifery courses, I found myself reflecting on why we all chose to be midwives in the first place. Not everybody can be a midwife of course, and we are all very lucky to have such wonderful training available here in the United Kingdom…But midwifery is not always an easy professional path to take.

‼️ 😎

It is wonderful to see so many eager new student midwives around, they are indeed precious diamonds who must be nurtured as the world tries to recruit and retain a high quality midwifery workforce in the face of global shortages..

The bravery that is required to be an NHS midwife cannot be exaggerated.

Why did you want to become a midwife?

✨🌟✨

(Comments welcome below!)

What is it like being a midwife? – ‘The Secret Community for Midwives in the Making’ is full of aspiring midwives wanting to join the profession. Some of whom are really struggling to. I applaud you all for your enthusiasm and efforts, and I wish you all the very best in your endeavors…. However, it is not always a bed of roses.

So you want to become a midwife?...Midwives all over the world experience work-related psychological distress. Causes of psychological distress can include hostile behaviour towards staff, either from other staff or patients, workplace bullying, toxic organisational cultures, medical errors, traumatic ‘never events’, critical incidents, occupational stress, workplace suspension, whistleblowing, investigations via professional regulatory bodies and employers, and/or pre-existing mental health conditions.

The consequences of psychological distress in midwifery populations can result in death by suicide, death anxiety, depression, burnout, depersonalisation, compassion fatigue, shame, guilt, substance abuse disorders, and symptomatic displays of self-destructive and unethical behaviour. This situation is highly significant as it is incompatible with safe, high quality maternity care.

This situation is further reflected in the following academic paper -> ‘Midwives Overboard!’ Inside their hearts are breaking, their makeup may be flaking but their smile still stays on. This latest output was kindly co-authored by Wendy ClyneAndrew TurnerEmily A. Fulton, and Clare Gerada.

So as our new student midwives may well be facing this reality soon, why do they still want to sign up?

Hint -> It is certainly not for the cash!

“If nobody comes from the future to stop you, how bad can the decision really be?”

Midwives do not enter the midwifery profession to fail, overwhelmingly they pursue midwifery because they want to achieve, contribute and be of value to the maternity services (Spitz, Sermeus and Thomson 2013). If we can remember this, then we can be kinder to ourselves and each other as our maternity services become ever more challenging.

Why did you become a midwife?

I became a midwife because I have always been fascinated by pregnancy, birth and human biology. Think about it.. its amazing! When my brother was born (I was 4 years old), I read my mums pregnancy books from cover to cover..the midwifery profession was then the only profession in which I have ever really felt at home. I wanted to make the experience for everyone.. magical.

As I am now an academic midwife, doing less and less clinical work, I find myself wanting to contribute to the profession in a variety of new ways. I am now a part of the midwifery profession because I want to improve the psychological well being of midwives in a quest for safer and higher quality maternity services. This does not mean that my original reasons for joining the midwifery profession have changed or disappeared. However, it does mean that I now realise that both excellence in maternity care and joyful midwifery practice cannot happen unless the psychological well being of midwives is adequately supported. I believe that I am now a part of the midwifery profession so that I can help to create psychologically safe professional journeys for all midwives.

What is the best thing about being a midwife?

  1. For me, the best thing about being a midwife is that every day I have a new opportunity to do something meaningful, make a real difference to people’s lives and make a positive change in the world…

    (however big or small)!

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Midwives enter the profession to shine and deliver great things. Lets not let their professional ‘sparkle’ fade out.

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A photo by Morgan Sessions. unsplash.com/photos/YIN4xUBaqnk

Other research (2007) reports that ‘within 2 years in practice the newly qualified nurses could be categorised as sustained idealists, compromised idealists, or crushed idealists. The majority experienced frustration and some level of ‘burnout’ as a consequence of their ideals and values being thwarted. This led to disillusionment, ‘job-hopping’ and, in some cases, a decision to leave the profession.’ – Let’s all ensure that the same does not happen within our midwifery profession.

Keep the midwifery profession’s spark alive!!!

 How?

  • Let’s be kind to ourselves and our colleagues.
  • Let’s remember why we joined the midwifery profession
  • Let’s remember that nobody joins the midwifery profession to fail
  • As failure remains unintentional, remember that punishment and blame serve no real purpose.
  • Let’s nurture new talent
  • Express gratitude whenever possible
  • Take every opportunity to learn, mentor, share knowledge and lead with courage.
  • Listen.

Also see this blog post -> 20 Ways to Create a Thriving #NHS workforce

Join the midwifery profession because it is fabulous…. (The midwife diaries can help you with your application)… Then look after yourself because it can be a challenging ride. Stay because you want to, and then care because your fellow midwives need caring for. When we are all cared for, we can work effectively in partnership with women and each other to achieve excellence within the maternity services..

..(excellence for midwives as well as for mothers and babies!)..

Until next time, be kind to yourselves, and each other 💛💙💜💚

References:

Maben, Jill, Sue Latter, and Jill Macleod Clark. “The sustainability of ideals, values and the nursing mandate: evidence from a longitudinal qualitative study.” Nursing Inquiry 14.2 (2007): 99-113.

Spitz, Bernard, Walter Sermeus, and Ann M. Thomson. “Student midwives’ views on maternity care just before their graduation.” Journal of advanced nursing 69.3 (2013): 600-609.

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Midwives can change the world…what is your superpower?

As I read the latest Executive Summary on Global Maternal Health  from The Lancet’s Series, I (as I am sure all other midwives did) wondered how we could improve the health of women around the world.

Countdown to 2030 Officially Launches

There is indeed a countdown to 2030 to improve reproductive, maternal, newborn, child, and adolescent health and nutrition around the world. #IC2030. I have been working toward the Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) through research and by supporting midwives to be the very best they can be. Yet I am well aware that there is still so much work to be done, and midwives are in the very best position to do it.

@Countdown2030

The current challenges to address:

  • Lack of evidence-based guidelines
  • Lack of equipment, supplies, and medicines
  • Inadequate numbers of skilled providers
  • Women delivering alone
  • Lack of emergency medical services and delayed interfacility referrals Too much, too soon
  • Unnecessary caesarean section
  • Routine induced or augmented labour
  • Routine continuous electronic fetal monitoring
  • Routine episiotomy
  • Routine antibiotics postpartum

Women often left out of good quality care:

  • Adolescents and unmarried women
  • Immigrants
  • Refugees and internally displaced women
  • Indigenous women and ethnic or religious minorities
  • Women living in poverty
  • Women living in informal urban settlements
  • Women living in fragile states
  • Women affected by humanitarian crises

Whilst reading the reports, I saw that a number of global experts had been invited to share, build and deliver new innovations. This is wonderful. However, we as midwives are right at the mouth piece of change. We are there at the beginning of new life. This is a time where the opportunities for change are most prevalent. People are looking to bring new life into a better world, and we are a part of that. How amazing!

And so looking at the challenges listed, what will you tackle or address? Women and their babies trust us, they are ready to be led toward a brighter future…they look up to us..Being able to influence change at the very start of human life is a both a gift and a super power.

Midwives are superheros…what is your superpower?

With Fab Change Day coming up on the 19th October 2016…there has never been a better time to make your pledge for change (however big or small)!

(Please note that although this post is predominantly about midwives, obstetricians and other birth attendants are also a huge part of the superhero team!)

You may think that you are a small fish in a small pond, but I am telling you that there is a global pond where you, as either a small or big fish, can make a real difference!

One charity (close to my heart) is really making a difference to mothers and babies around the world ->> Maternity Worldwide. I often give them a shout out, because they really are awesome (and a fun bunch too!)…#GetInvolved with them here and here -> @maternityww.

I will continue to contribute towards evidence based guidelines and research in my quest to improve the well-being of women, babies and midwives around the world. So until next time, be the superheros I always knew you were 💛💙💜💚.

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Following #Expo16NHS..I could be replaced… ‘technically’

And so another NHS Expo conference comes to an end. It was a lively 2 days with lots of amazing people coming together to share new ideas about the future of health and social care.

The conference was largely dominated by the digital and technical innovations that may help to create the NHS of the future (and make it better presumably)… I have always been interested in how technology may make a variety of health care improvements…I have written about one of my ideas here.

Sir @DrBruceKeogh providing a broad outline on recent ground breaking digital innovations

The digital news as reported by @keithgrimes was as follows:

  • Patients will be able to book appointments, order medications, and download records, US ‘Blue Button’ style, on a revamped http://www.nhs.uk to be launched at Expo 2017.
  • Anyone will be able to access detailed stats on performance in key areas such as dementia, diabetes, and learning disabilities
  • There will be online access to 111, which can lead to direct appointment, signposting, or callbacks.
  • By March 2017 there will be a directory of approved apps from March 2017, with subsequent support for wearables
  • 12 hospitals to become “Digital Exemplars” – each receiving £10m funding, matched by trust, and partnering with world leader organisations.
  • The creation of a second round of ‘national’ excellence centres, with more detail to follow.
  • The creation of an NHS Digital Academy to teach Informatics skills to NHS staff and create the next generation of Clinical Chief Information Officers and Digital Health Leaders.

And for more digital ideas….

MY DIGITAL FOOD FOR THOUGHT…

Often, whilst working clinically as a midwife, I also find myself behaving like a robot… (Don’t worry… I obviously use my gut and intuition too)!…but really, as midwives we are calculating risk at all times….like a computer. Also…we follow certain pathways as midwives…if a blood pressure becomes out of range…we take the next prescribed step in making a referral or delivering a new treatment to fix it. A computer could do this.

Imagine a woman coming into a clinic to see a robot (of sorts). She is scanned, measured and given the full M.O.T that she would normally receive from a midwife, but it is the robot who calculates the risks and the next steps to take. At the end of the exam.. the robot gives the woman a print out report, which outlines what should be done next in light of any new findings. The robot can answer questions too…

…(hopefully better than google can)

…or it can tap into a Skype call with a registered health professional. Imagine a future like this..better or worse? In a pressured maternity service, this could indeed be the new way of things. Could I be replaced as a midwife?…’technically’?

I think not. But a digital future like this could certainly support midwives in practice. Would it be safer? are human errors more common than digital ones?… Certainly worth exploring I think.

What do women want from their midwife? A human face? compassion? Human touch?…None of these could be delivered by a robot (probably)… and so perhaps a digital future like this would afford midwives more time to be compassionate and ‘human’..

MOVING ON…

Also at Expo.. there was @roylilley….with @JaneMCummings

Singing ‘Always look on the bright side of life…’

🌅🌻⭐️👀🙊👍

Obviously they were doing this to celebrate and introduce 

..not far away now (19th October 2016)

And we also heard more singing as we enjoyed a very moving rendition of “I will try to fix you”…

💉💐💊🏥🚑

By the @NHSChoir for the  at

from with bonus live sessions from

My colleagues and I also presented our #ShowsWorkplaceCompassion research for the first time and some of the other work we have been doing in partnership with @NHSEngland to commission for a positive staff experience. Thank you to everyone who came along and shared thoughts and ideas to help us shape this project.

I was also invited to join sessions on the

Maternity Transformation programme: Delivering the 2020 Vision at #Expo16NHS #MatImp #MatExp #BetterBirths #BUMP

and the …

@empathymuseum at #Expo16NHS #WalkAMileInMyShoes via @HealthFdn.

Click the links to read more….

Next year, I hope to be sharing more research and ideas. No doubt I will still be on my quest to improve the staff experience within health and social care..after all… patient experience and staff experience are both sides of the same coin..

2-sides-of-the-same-coin

See the Twitter activity from#Expo16NHS here

Until next time…be kind to yourselves, and eachother 💛💙💜💚❤

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A Guide to Literature Reviewing for Student Midwives & Student Nurses

Recently, I have had some midwifery (and nursing) students ask me about how to write their dissertation (Usually a literature review)…

Frequent questions included:

  • How to write a midwifery dissertation
  • How to write a nursing dissertation
  • How to structure a literature review
  • How to do research in midwifery
  • How to do research in nursing
  • How to bring the evidence together
  • How to make a well structured argument

This fairly long blog post may answer some of these questions for nursing and midwifery students…

See also my 15 Top Essay Writing Tips for Midwifery and Nursing Students here

Part of my work involves being a facilitator for problem based learning. Through this role, I enjoy supporting undergraduate health care students to study and develop their skills in evidence based practice. I do not claim to be an academic genius, and many of the rules in academia seem to be subjective in any case. However, in response to students asking for some suggestions and guidance, I hope that this simple and loose guide to literature reviewing may act as reference material for some student nurses and midwives working towards their dissertations or indeed any other essays and beyond.

Literature reviewing for dummies

(except you are not a dummy!)

Below I have written a very simplified example of a literature review. This is based upon a fictional subject which holds no relation to either midwifery or nursing practice. However, these methods may be applied to any subject in either nursing or midwifery practice.. you just need to replace my words with nursing or midwifery words as required.

Note: Although this may be a starting point to get you thinking about structuring an essay, literature review or dissertation please be mindful that one size may not fit all situations. Also, please do not take this example as a literal quick fix that will magically translate your work into A* material… always speak to your own tutors throughout the process of your writing in order to make sure that you are staying right on track.

type writer.jpg

Title: Make sure it states clearly what your essay will be about, what it will do and explore, and how you went about doing what you have done:

How do 20 to 30 year old’s experience vintage tea parties? A narrative literature review.

With this title I am clearly setting up the parameters of what I am going to be looking at. I am also presenting a clear and answerable question which chooses a population of 20 to 30 year old’s to look at, and an ‘intervention’ or ‘interaction’ with a vintage tea party to explore. I am also telling my reader straight away that I will be exploring this topic and trying to answer my question by reviewing the relevant literature (a literature review).

Introduction: Make sure that you tell the reader exactly what this essay is going to do and produce. You will also want to set out a little bit about why you have chosen to look at your particular topic.

Introduction

Vintage tea parties are becoming increasingly popular among 20 to 30 year old’s (Vintage quarterly, 2016). This may suggest that populations within this age group enjoy hosting and attending tea parties, yet it is not yet known how this particular population experience vintage tea parties around the world. As 20 to 30 year old’s look to enjoy more social activities and enhance their social well-being, it will be important to understand how and why they may experience vintage tea parties as either a negative or positive social venture. This review aims to unite the evidence in relation to how 20 to 30 year old’s experience tea parties around the world. It will do this by reviewing the relevant literature and presenting it’s findings narratively in order to produce a global overview of current understanding.

Background: Give the reader a little bit of history to the topic in focus. Set the scene and entice your reader to learn more.

Background

Humans have enjoyed socialising with other humans for approximately 200,000 years (Human socialisation journal, 2014). Many of these social activities have often involved food and drink (Food and drink journal, 2013). They have also been used as a means to unify various groups of people, and allow new generations of humans to meet new tribes of people (Tribal weekly, 2015). Along with food and drink, social events in history have often involved music making, artworks and entertainments (Entertainment journal, 2013). More recently, these social events have introduced the concept of ‘themed’ social events where participants often enjoy a changed reality for a short period of time (Party time monthly, 2014). However, it is not yet known which particular components in combination enhance the experience of event participants.

Tea parties are one way that humans often come together in a bid to enjoy social interaction with food, drink and merriment (International Tea Party Journal 2015). The concept of a vintage themed tea party is a relatively new one, and is an activity currently most popular within social groups aged between 20 to 30 years old (Vintage parties quarterly, 2016). This age group is typically one which looks to enjoy a healthy work/life balance and frolic with similar social groups (Frolicking International, 2016). Vintage tea parties may be one way in which this group may enjoy a fruitful social life, yet it is not known which particular elements of a vintage tea party are most efficacious when brought together in unison. Therefore, it will be important to explore the literature in relation to how this particular age group experiences vintage tea parties, and which particular elements of a vintage tea party may come together to optimise this experience for future social occasions of this type.

Methodology: How did you search for your answers? Give as much detail as you can. What did you do? How? Where did your results and answers come from? How did you extract what you wanted from what you found? How are you going to share this and make your argument? Why?

Methodology

The literature in relation to how 20 to 30 year old’s experience vintage tea parties was reviewed narratively in order to gain a current overview of global understanding. The overriding question for this review was:

How do 20 to 30 year old’s experience vintage tea parties as a social activity?

You may want to use the SPIDER tool to formulate your own question: The SPIDER tool was developed by adapting the PICO tool, I will apply this hypothetical research question to this tool as follows:

  • (S) Sample: Populations aged between 20 and 30 year’s old.
  • (PI) Phenomenon of Interest: The experience of either attending or hosting a vintage tea party as a social activity.
  • (D) Design: Any study type (surveys/focus groups/cohort studies/interviews etc).
  • (E) Evaluation: The views, attitudes and opinions of 20 to 30 year old’s who either attend or host vintage tea parties as a social activity.
  • (R) Research type: qualitative, quantitative and mixed-methods research will be searched for.

Search strategy

Initially, the CINHAL, Medline and PsycINFO electronic databases were used to retrieve relevant papers in relation to the subject matter. Several key terms which were considered to be of relevance were entered into these databases simultaneously. These terms were entered together, and united using either the word ‘and’ or ‘or’. The search terms were used in the following format:

Vintage tea parties ‘and’ social occasions ‘or’ parties ‘and’ young people and’ tea ‘and’ cake ‘or’ lace doilies ‘or’ old fashioned ‘and’ antiques ‘or’ social gatherings ‘or’ cupcakes.

Inclusion criteria:

Papers were included if they specifically focused on the experiences of people aged between 20 and 30. Papers had to have a particular focus upon the experience of vintage tea parties in order to be included within this literature review. As the ‘vintage’ era was considered to be between the 1930’s and 1940’s, only papers published from 1960 onward were considered for this review. It was considered that from this period, the traditional tea party would indeed be classified as ‘vintage’ in retrospect.

(Please note that this is an extremely crude search strategy. These can be made much more efficient and systematic in more advanced papers – See an example here.)

This search strategy resulted in 27 separate searches and retrieved 1720 papers. Duplicate articles were then removed to reveal 808 papers. The abstracts of these remaining papers were then scanned reviewed and against the inclusion criteria, leaving 235 papers for further review. These remaining papers were read in their entirety and assessed for their suitability for inclusion. Following these assessments, 88 papers were removed as they did not focus upon the experience of tea parties, only the process of hosting them. Additionally, 92 papers were removed as they referred to the experiences of populations either over the age of 30 or under the age of 20. Lastly, 52 papers were removed as although they did refer to the experience of attending and hosting tea parties, these parties were not considered to be vintage in nature. This left 3 papers for inclusion. The reference lists of these papers were scanned for any further papers suitable for inclusion. Through this scanning, 1 further paper was included, resulting in a total of 4 papers to be included within this review. The paper selection process is represented within figure 1.

Figure 1: Paper selection process – This should leave the reader with no doubt about what you did, how you selected your papers for inclusion or exclusion and why. It also allows you to reflect upon your process.

Note (n=) Just means ‘number of’ ..e.g. (n=1).

Figure 1: Paper selection process

Records identified through database searching
(n =1720)

                                    ∇

Additional records identified through other sources
(n = 1)

                                    ∇

Records after duplicates removed
(n =912)

                                    ∇

Records screened
(n = 235)

                                    ∇

Records excluded
(n = 231)

                                    ∇

Studies included
(n = 4)

                                    ∇

Full-text articles excluded:

Paper does not focus upon the experience of tea parties (n =88)

Out of age range criteria (n=92)

Tea party not vintage in nature∇ (n=52)

Papers included: This should be some sort of table where you present which papers you are including within your review. You can go into further detail of each one as appropriate… But for this example it might look something like this:

Table 2: Study overview and characteristics

Paper  Sample number  Sample Type Study Design Findings
 

The mad Hatters tea party (Carroll, 2015)

4 Alice in wonderland (aged 21), The Mad Hatter, the March Hare, and the Dormouse  

Participants self reported their experiences to an interviewer.

 

Tea, iced cakes and singing are ‘enjoyable’. Can be enjoyed during either a birthday or an ‘un-birthday’.

 

Tea for two, and two for tea (Sinatra, 2012). 2 Doris Day (aged 25) and Frank Sinatra (aged 29). Focus group discussion Tea parties in solitude (2 people) with sugar cake make them ‘happy’. Also knee sitting is enjoyable in this context.
A tea party on the ceiling (Poppins, 1964) 2 adults aged 29. A nanny and a chimney sweep  

Questionnaire survey.

Laughing is key to a successful vintage tea party.
The queens tea party (Buckingham palace, 2010). 2500/8000 attendees aged between 20 and 30. A cross-section of honoured British society Online survey Cupcakes, doilies and finger sandwiches served with a variety of tea made the tea party ‘special’. Especially in the presence of queens and princesses.

 

At this point you may want to comment on the quality of the studies or papers you have selected. You can either do this by adding an extra column within the table above, or comment on the quality of studies within another subsection. If the quality of studies is poor, don’t worry…just acknowledge that the study is poor, and recognise that any results or recommendations you draw from those studies should probably be given less authority than the more rigorous studies.  

A basic guide as to which studies are considered to be academically superior is outlined within the pyramid below….

Image result for hierarchy of research studies

There are many published academic tools for assessing and appraising the quality of each particular study, and also for assessing any risk of bias that might be apparent. I have included a very basic quality assessment tool for assessing qualitative studies below. Feel free to use this or any more advanced ones you may find.

Image result for quality checklist for research studies systematic review

You may also want to report whether the studies that you have chosen to include are either qualitative or quantitative (or a mixture of both)

(sometimes called mixed method)!

Image result for qualitative and quantitative research

Image result for qualitative and quantitative research

(Images from: https://uxdesign.cc & http://www.slideshare.net/engelby/media-quantitative-and-qualitative-research-2012)

Data Extraction: Now that you have chosen the studies/papers with which you will address your own research questions, you will need to describe exactly how you have drawn out the knowledge or ‘data’ from those papers. This can be simple, or again, it can be a very detailed process with the use of complex data extraction tools.

Something like this tool below may help you to draw out knowledge from a paper…

Image result for research data extraction tools

(Tool from http://www.rrh.org.au/articles/subviewnthamer.asp?ArticleID=1523)

But equally, you may want to describe a simpler approach to your own data extraction method as follows…

Data Extraction

Each paper was read and re-read, whilst themes relating to the experience of either being a host or a guest at a vintage tea party were annotated throughout. Any numerical or ‘quantitative’ data was noted and will be reported narratively in order to build a broad picture of how 20 to 30 year old’s experience vintage tea parties.

Limitations: You may want to state what the limitations of your chosen studies were. Samples too small? only partial results available? not widely representative? – Bare in mind that some different types of essays will want the limitations section presented towards the end of the essay rather than just before the results section..

Limitations

This review has retrieved a small amount of papers, therefore the findings of this review may not be representative of a wider population. Also, due to the small amount of papers retrieved, it will not be possible to perform a meta-analysis of results (A meta-analysis is basically where you compare lots of similar data from a number of similar studies in order to see if the findings match closely or not. This will tell you if you can be really sure that what the evidence is telling you is really reliable and true… or not).

None of the studies selected used any verified tools to measure either a participants negative or positive experience of interacting with a vintage tea party. Therefore, these findings rely upon participant ratings, words and observations. Additionally, the studies retrieved can only be related to experiences of vintage tea parties within the western world, therefore we cannot be sure that this review is representative of other experiences around the world.

See here for a more detailed power point presentation on how to critique studies

You may also want to touch upon the limitations within your review….Did you really do everything you could have done to find all papers? What limited or prohibited you from creating the very best review of all time?

Results: Here you need to state what you actually found, what you interpreted from these findings and how these findings may related to each other.

Results

This literature review has retrieved 4 papers which illuminate how 20 to 30 year old’s within the western world experience both hosting and attending vintage tea parties as a social activity. These studies used a variety of data collection methods such as interviews (Carroll, 2015), focus groups (Sinatra, 2012), Questionnaires (Poppins, 1964), and online surveys (Buckingham palace, 2010). All studies reported that the experiences of 20 to 30 year old’s either attending or hosting vintage tea parties were positive overall. None of these studies reported any negative effects for any of their participants. Ultimately, vintage tea parties were found to be a jolly social activity for all attendees and hosts.

Synthesis of findings

(This is where you bring your results together and make sense of them, there are many different ways to synthesize your results: These methodologies can include meta-narrative, critical interpretive synthesis, meta-study, meta-ethnography, grounded formal theory, thematic synthesis, textual narrative synthesis, content analysis, qualitative metasummaries, framework synthesis and ecological triangulation) – Read more about this stuff here.

But let’s not over complicate things here. We will start by  examining all aspects of, and the context of each paper, whilst comparing and contrasting the results of each paper with the others. In doing so, we may use a mixture of the methodologies described above.

In terms of finding a suitable location for a vintage tea party, both Carroll and Buckingham palace chose to locate their vintage tea parties within a garden setting (Carroll, 2015 and Buckingham Palace, 2010). Although the setting of Carroll’s tea party was in a wooded clearing, it was set behind the mad hatters house, and therefore considered to be a back garden, in the same way that the queens garden party is hosted behind the queens properties. Conversely, Poppins (1964) explores the experiences of those present at a tea party hosted in a living room, and more specifically, upon a ceiling. Both of these settings were reported to be enjoyable for guests, as those interviewed following the Mad hatters tea party reported experiences of ‘merriment’, ‘joy’ and ‘enjoyment’ in response to being in these locations (Carroll, 2015). Equally, those who completed the surveys and questionnaires posed by Buckingham Palace (2010) rated their experiences of ‘merriment’, ‘joy’ and ‘enjoyment’ as “9 out of 10” on a positive rating scale when the tea party was held outdoors, with access to the garden rooms indoors. Sinatra (2012) did not specify a location for their tea party.

Opinions and experiences surrounding the display of appropriate etiquette appears to form some conflict within the studies. Sinatra (2012) encourages two guests to sit on one another’s knees, whilst serving tea. Whilst one guest at the tea party on the ceiling expressed some distaste at the ‘excessive laughter’ and the location of the tea party being hosted upon the ceiling (Poppins, 1964). The guests and hosts of the Mad Hatter’s tea party felt that it was very important to be officially invited to the tea party, rather than simply turn up unannounced (Carroll, 2015). Equally, the queen’s tea party hosted by Buckingham Palace (2010) requires all guests to present an official invitation before entry is permitted to the garden tea party. This tea party also requires its guests to wear a particular and suitable attire. Burping, belching, trumping and swearing is never permitted, and it is expected that one holds one pinky finger out whilst drinking tea (Buckingham Palace , 2010).

Food and other beverages form an important part of each of the tea parties referred to within this review. For the Mad Hatter’s tea party, it was a focus on tea and iced cake that contributed towards both the guests and hosts having a ‘jolly’ time (Carroll, 2015). Indeed, tea and cake feature heavily within each of the studies presented, and are often commented upon as a the source of an enjoyable experience (Sinatra, 2012, Poppins, 1964, Buckingham palace, 2010, Carroll, 2015). However, a variety of finger sandwiches, petit fours and other pastries were also rated highly (10 out of 10) as the ‘delight’ of the vintage tea party, making it more ‘special’ (Buckingham Palace, 2010, Poppins, 1964). Participants within each of these studies also reported that the presentation of this food is important, as the use of doilies, tea pots, cake tiers and napkins can enhance the experience of a vintage tea party (Sinatra, 2012, Poppins, 1964, Buckingham palace, 2010, Carroll, 2015).

The timing of hosting a vintage tea party was preferred in the afternoon as ‘afternoon tea’ by all studies (Sinatra, 2012, Poppins, 1964, Buckingham palace, 2010, Carroll, 2015). Additionally, the hosts and guests at the Mad Hatters tea party suggested that the vintage tea party could be enjoyed during either a birthday or an ‘un-birthday’ (Carroll, 2010). Those who completed the surveys and questionnaires posed by Buckingham Palace (2010) and Poppins (1964) rated their experiences more highly “9 out of 10” if a tea party hosted at any time included laughter, pleasant conversation and singing. These components were also apparent within the findings of  both the ‘Tea for Two’ tea party, and the Mad Hatters tea party (Sinatra, 2012, Carroll, 2015).

Discussion: This is an opportunity to interpret these results, and share what they might mean in a wider context.

  • What was interesting?
  • What was surprising?
  • Did you find what you expected to find?
  • How will this new knowledge change things in the future?
  • What are the implications of finding this new knowledge?
  • How will it affect your, and others practice?

Let’s shine a new light on things!…

SHINE A TORCH

Discussion 

(Start with a summary of your results)

Overall, participants aged between 20 and 30 reported positive experiences in relation to both hosting and attending vintage tea parties. Experiences were reported via a number of sentiments including ‘Joy’, ‘Merriment, ‘enjoyment’ and were described as being ‘special’. Questionnaires and surveys also highlighted that vintage tea parties were enjoyed both outdoors and indoors, mainly during the afternoon. Tea served from teapots with fine china, cake, sandwiches and pastries placed upon doilies and tiered plate displays can enhance ones experience of a vintage tea party, as can singing, laughing and pleasant conversation. As such, vintage tea parties can be considered a positive social activity for those aged between 20 and 30.

It was interesting to note that conversation and laughter in particular played a key factor in how this population enjoyed vintage tea parties. This would suggest that the success of such tea parties rely upon more than just the location of the event or the practicalities of hosting them. As such, part planners may wish to consider the implementation of conversation catalysts or ‘ice breakers’ to create the atmosphere required for success.

Etiquette is also an important factor to consider when creating an enjoyable vintage tea party, as gatecrashers can cause distaste among both hosts and guests. It is clear that invitations provide confidence and a certain formality to events as apposed to a spontaneous vintage tea party, which may become more informal as a result.

As many 20 to 30 year old’s already attend vintage tea parties, it was anticipated that they would indeed find these experiences to be enjoyable. The results of this review provide new and united evidence to strengthen this notion, and illuminate the particular reasons why these experiences may be enjoyable. This new evidence will be important to new hosts and party planners wishing to organise enjoyable vintage tea parties as social activity.

Implications for future practice

(What are you going to do or recommend in light of what you have found??)

Future tea parties would be enhanced by the application of these findings, as party hosts look to create enjoyable activities for those aged between 20 and 30. Party planners may wish to consider ‘vintage’ as a theme, and encourage guests to fully embrace this theme, concept and event as an alternative to the modern tea party. Future research may wish to explore these vintage tea parties in more detail with progression towards a large and adequately powered randomised controlled trial (RCT), as this would enable party planners and party goers to create the ultimate vintage tea party, as guided by a more rigorous evidence base.

“What is an RCT?” I hear you cry…

(See simplified info-graphic below)

Image result for what is a randomised controlled trial?

 

Conclusions: This is where you recap what you have done and found. It should match closely with the introduction in which stated what you were going to do. You should leave the reader with a final impact statement and your own final reflections.

In every day party creation, it is important to create an enjoyable social activity. As 20 to 30 year old’s seek to attend such activities, it is important to explore which social activities are experienced positively by this population group. This paper has reviewed the evidence in relation to how 20 to 30 year old’s experience vintage tea parties. Following a review of 4 academic papers, the evidence presented here suggest that vintage tea parties are indeed a jolly event for 20 to 30 year old’s.

As well as discovering that this population enjoy vintage tea parties as a social activity, this review has also unearthed which components may be most contributory to the success of such an event. As such, the hosts of future vintage tea parties should plan to include tea served from teapots with fine china, cake, sandwiches and pastries placed upon doilies and tiered plate displays, singing, laughing and pleasant conversation.

You may also want to include a subsection here that specifically outlines how you have met the learning outcomes set out by whichever module or dissertation/thesis it is that you are completing.

 

happy book

And there we are, a guide to writing a literature review. This guide is supposed to be a reference tool for you all to create your own masterpiece essays and dissertations. The review I present here may be much shorter than what you are required to produce, however, I hope it will serve as reference material as you progress in your academic writing. Although the subject matter here is vintage tea parties, I do hope that many nurses and midwives will easily be able to apply nursing and midwifery topics in place of the tea party.

The principles of writing a literature review are virtually the same within any subject matter. Here for instance, you just replace the vintage tea parties with diabetes, and boom…you have a literature review on how a certain population experiences diabetes or diabetic care. Whatever your academic question is, a literature review is a great way to help you find answers, improve your clinical practice and discover new evidence based practices to apply in the real world. Many clinical guidelines are constructed by reviewing the available literature. As you complete your literature reviews, you will also be able to make recommendations, based upon what you have found.

Although I have presented a loose structure for a literature review here, please be aware that there are many other structures, methodologies and reporting styles available. Yet I hope that this example will fit loosely around any essay topic if applied appropriately.

If you have any questions or comments, please feel free to add these to the comments section below. I really hope that this makes academia a little less scary for student midwives and nurses. For further hints and tips for essay writing, see my other article here.

Until next time…take care of yourselves, and each other ❤💚💜

 

 

 

 

 

 

 

 

 

 

 

 

1

Reflections from a session in the @empathymuseum at #Expo16NHS #WalkAMileInMyShoes via @HealthFdn

One of the best things I experienced at this years NHS Expo 2016 was the @empathymuseum …where I was invited to #WalkAMileInMyShoes via the @HealthFdn. It was rather strange to be invited into a giant shoe box, but nevertheless… Just like Alice in Wonderland I found myself uttering….’curiouser and curiouser’..

As I wondered in to the cozy shoe box to sit on the sofa, I was asked to put on a pair of shoes.. Theatre shoes…(See below)…

I walked around and listened via headphones to the man who had kindly donated his shoes and his story to this project. He was a specialist nurse working in A & E. He spoke about how he had to face the reality of death at work every day. Not only did he have to do this, he then also had to engage loved ones and relatives in incredibly difficult conversations and help them to make the best decisions in the darkest hours.

This nurse was able to celebrate the incredible gifts people were able to give as organ doners, and see joy in how a family was able to see a part of their departed loved ones go on… All of this was very uplifting…and there was no doubt in my mind that this nurse was indeed a superb example of the profession. However…as I walked on…I found my self wondering whether anyone asked the nurse how he was? How long could he maintain this uplifting approach whilst dealing with death and emotional pain on a daily basis? Would cracks start to appear?

I often see examples of how we celebrate this service and self sacrifice…and to nearly quote Paul Simon… every generation throws healthcare hero up the award charts!.. and so we celebrate this eternal culture of giving. I certainly empathize with this nurse, and greatly admired his approach to his work… He is a hero..but he is also very vulnerable, both psychologically and physically as he continues to give all of himself to provide the best service possible.

My worry is that the more we place service and sacrifice upon a pedestal…the further our heroes have to fall…

 

As you can see from the film above…this really is an amazing and thought provoking project, as those who visit are asked to write messages to those they now share a new found empathy with.

I would have liked to have walked a mile in all of these shoes…and perhaps some day I will have time to…as you can soon also experience this project online here. So as a lasting thought on this amazing project…I would like to repeat my mantra…which is…always be kind to yourselves… and each other….

Until next time 💛💙💜💚❤

1

Maternity Transformation programme: Delivering the 2020 Vision at #Expo16NHS #MatImp #MatExp #BetterBirths #BUMP

Two experiences really stuck out for me at this years NHS Expo (2016) and one of these experiences, was a session looking at how we now move on to make the Maternity Transformation programme a reality. I was honored to be invited to join this session, and was keen to see how things were progressing. The session was hosted by Sarah-Jane Marsh (@BCHBoss), CEO of Birmingham Children’s Hospital and now Birmingham Women’s too, Sarah-Jane is now also leading the work on the NHS England Maternity Transformation programme delivery.

Throughout the session, Sarah-Jane spoke passionately about how we might now see real change….All of us in the room were no longer talking about change…we were signing up to make it happen.

See programme here: Maternity Transformation programme: Delivering the 2020 Vision

Following Sarah-Janes introductions and visions for the programme, we were invited to join a live panel debate. This was very much an interactive question and answer session with some very highly motivated maternity experts (as you can see below!)

live-debate

This session was  filled with new ideas about how we can all come together using primary care and social services as key partners to implement #BetterBirths for all. Recommendations were that local maternity systems should support women’s participation in making new changes. Clinical networks and community hubs were also cited as ways to create and spread change. But at the heart of all this, it was clear that everyone can do their own little bit to implement the recommendations from the Better Births report. 

panel

As you know…for me, I do not believe that excellence in maternity care is achievable without the provision of a thriving and healthy maternity workforce, who can enjoy a psychologically safe professional journey. Therefore, I shall keep working towards effective support for midwives in order to create better births for women and their babies.

As a lived example of how one maternity unit is implementing real change, we were also introduced to the B.U.M.P @Project_BUMP

First…we see where we are… what do we have and what do we want to change…what is working? What is failing us?…Lets make a realistic plan!

As women’s circumstances change throughout pregnancy (as may also their decisions and choices)…any new system must be flexible enough to respond quickly to the needs of both women and staff. This model ensures that the journey through maternity services can be enjoyed in partnership with the right staff, with access to the right support.

In revising the pathways of maternity care, we are ensuring that we can provide services that meet the needs of every woman and staff member. Yet women must be able to move freely between these pathways as required. We must also move towards and help women to engage with the most appropriate pathways for them and their families. Often we know that the most appropriate pathway for women is midwifery led care….and so here we must increase capacity. We must also engage, educate and empower women to embrace this midwifery led model of care (where appropriate) as we work in partnership with them to achieve the very best in maternity care outcomes.

 

pdca_cycle

We also heard wonderful success stories from the University Hospitals of Morecambe Bay who were really using the ‘Plan, Do, check, Act’ tool to snowball their improvement activities…

And of course the  team were also rocking out the session in their usual style. However, I was personally most touched by the women who came along to this session in order to share their stories.

A powerful poem by ….

A poem inspired by @HeartMummy….

These experiences are always so powerful to hear, and really reinforce how the ripples of everything we do can resonate in both the smallest and largest ways. We must keep sharing…Thank you.

File 06-09-2016, 22 56 47

#MATEXP COMPETITION – WIN A ‘WHOSE SHOES?’ WORKSHOP!

Great quotes from the session…

‘Pizzas are Delivered, Babies are Birthed’

‘We all have a part in bringing to life’

‘There are 28 recommendations. All important. Don’t cherry pick!’

‘Failure to dilate ? Incompetent cervix ? What do such words do to women ?’

‘The energy in Birmingham for & is infectious! programme’

Hashtags:    

The Maternity Transformation team are are now calling for expressions of interest from local maternity systems to test models of care to improve maternity services. Local maternity systems will need to align with Sustainability and Transformation Plan (STP) footprints, and so applications will need to be supported and approved by the identified leads for the STP footprint areas. Completed applications should be submitted to the Maternity Transformation Programme team by email to england.maternitytransformation@nhs.net by Monday 19 September 2016.

Have you signed up?

There is a real enthusiasm here for real change in the maternity services. It is where life begins, and it is here that we have the largest opportunity to get things right for our future. Let’s make sure we take every opportunity to get things right.

Until next time…Look after yourselves..and each other 💛💙💜💚❤

5

15 Top Essay Writing Tips for Midwifery and Nursing Students

Every September will see a new intake of enthusiastic  &  embarking upon a new and exciting journey which will test their abilities in every sense. They will soon find out if they are suited to both complex and simple clinical tasks, compassionate care, skills drills, regulatory guidance, evidence based practice and the academic demands required to actually pass the course.

My experience as a midwife tells me that student midwives and nurses are more than capable of thriving in a clinical environment if they are afforded the provision of both effective and compassionate mentorship. To lead a student midwife or nurse into the profession with hope and optimism is an extremely rewarding task, and the bonds we can build within our profession will serve us all well as we continue to provide quality care throughout turbulent times.

Although there is undoubtedly effective leadership within the midwifery profession that prepares students for the clinical task of delivering excellence in maternity/nursing care, there is often a paucity of mentors who can spend time developing a student’s academic and research capabilities. This blog post is a response to those student midwives and nurses who have expressed to me their worry, concerns and a lack of knowledge in relation to the academic outputs required of them in order to pass the undergraduate courses.

I do not claim to be an academic genius, but I am a midwife with a passion for academia, evidence informed change and evidence based practice. I also cannot bare the fact that some clinically competent and compassionate student midwives/nurses may be lost to the profession due to the academic pressures they may face. Students may feel that these pressures are insurmountable. They are not.

Questions I have heard from students:

  • How do I write a student nursing essay?
  • How do I write a student midwife essay?
  • What does a good nursing essay look like?
  • What does a good midwifery essay look like?
  • What are the different types of essay?
  • Can you show me some essay templates?
  • How should I structure my essay?
  • I don’t know what they want from me?
  • How to do a literature review?

Part of my work involves being a facilitator for problem based learning. Through this role, I enjoy supporting undergraduate health care students to study and develop their skills in evidence based practice. As I was marking undergraduate essays recently, the same problems and conversations kept coming up. I was giving the same advice to each student. They were all having the same issues and were all in fact growing into wonderful academics and learning throughout the process.

It was magical to watch…. But what does this tell you? 

“You are not alone in your struggle…Be kind to yourself”.

Library books

15 Top Tips for Midwifery and Nursing Students on Essay Writing:

  1. Read around your subject before you start, and make sure you have the most up to date info on the topic before you begin.
  2. Use the online databases (You should have one made available to you in your university) to search for articles relevant to your topic.
  3. Read your learning outcomes and indicative content – address each one thoroughly, ticking them off as you go. Better still, explain how you have met each one within your essay. Its hard to fail someone who has demonstrated how they have met the goals they were set.
  4. Avoid making outright claims without a good reference to back it up. An example might be… “Diabetes affects millions of people worldwide” – Well yes, we know this to be true, but unfortunately, you are not a leading expert in diabetes (yet!)..and so you must instead quote the facts and figures in relation to diabetes and credit the expert who has published this knowledge….So instead you should perhaps write and cite… “Diabetes affects around 422 million people around the world” (Professor Diabetes, 2014) in your universities referencing style.
  5. If you want to be a fancy pants with your referencing (and make it easier and faster to reference your essay), you may want to consider using some academic referencing software such as Ref Works, Mendeley or EndNote. References should be restricted to within the last 5 years where possible.
  6. Look at examples of published papers. How do they present themselves? How are they structured? Your essay may not be too different from a published paper..learn from the best (or choose to emulate the academic style you like best)!
  7. Watch your grammar, spelling, punctuation and writing style throughout. Sentences should be short, clear and to the point. Each paragraph should focus upon a different point you are trying to make. They should not be too long either.
  8. Section headings make your essay easier to read and understand, it also helps you clarify what you are trying to say within each section.
  9. Know or decide on the type of paper you are writing before you begin. Is this a critical analysis? A literature review? Is it narrative? Descriptive? Look at your end goal. What do you want or need to produce?
  10. Take a fresh eyes approach to your essay every few days. Re read it. Does it still make sense to you? Have you missed anything out? Can you make it better or clearer in any way? Is it logical?
  11. Ask friends, colleagues and family to read it. Does it make sense to them? Use their fresh eyes too, they may help you improve it or spot mistakes.
  12. Use your tutors, that’s what they are there for. They can look at drafts for you, comment on the work you have already started and point you in the right direction. Don’t struggle alone. Always ask for help.
  13. Always relate your work back to how this would make you a better nurse or midwife. How do you reflect on what you find through your work? How does any new evidence you find change your practice? How might you relate it back to the NMC code?
  14. Lastly, start early. Do not leave anything until the last minute. You will need time to take a ‘fresh eyes’ approach every few days.
  15. As you regularly revisit your essay, make sure you also save your work regularly – email it to yourself to be extra safe!

pen writing

I hope that some student midwives and nurses can make use of these tips as they move forward in their academic journey. Please feel free to add more tips below in the comments section.

See here for my Guide to Literature Reviewing for Student Midwives & Student Nurses

Until next time…take care of yourselves, and each other ❤💚💜