Speaker: Carolyn McIntoshSpeaker: Carolyn McIntosh

Master in Midwifery Master in Midwifery thesis presentationthesis presentation

Currently:Currently:Rural midwife Rural midwife Midwifery Lecturer Midwifery Lecturer Otago New Zealand.Otago New Zealand.

• Funding support from Otago Polytechnic research grants

• Ethical approval from Otago Polytechnic ethics committee

• Qualitative descriptive study• Four focus groups from around the South

Island of New Zealand

Outline of presentationOutline of presentation• Aims of my study• Diversity of rural practice in NZ• Common experiences of rural midwifery• Some of my study finding related to social

learning theory• Communities of practice• Rural networks and what is happening

elsewhere• What if anything do we want to do?

Aim of studyAim of study• To identify how particular

groups of rural midwives from around the South Island of New Zealand informed their practice

• to discover if they had any issues with informing practice

• what they would like to see in the future

Reality of rural midwifery practice Reality of rural midwifery practice in New Zealandin New Zealand

• Diverse - no real ‘norm’- evolved and evolving• Local service meets needs of the local

community and developed around the service providers in the area.

• Might be:– Local practice groups

• Or

– Individual midwives or midwives working in pairs

• Limited opportunities to meet with other midwives or other health professionals

• Geographical isolation

Commonality in rural practiceCommonality in rural practice

• Part of a rural community• Always seen in that community as the midwife• Geographically distant from specialist services and

learning resources• Need skills to support women birthing at a distance from

specialist services– Working with normal– Early recognition of problems– Stabilisation and transfer– Working with women in the community requiring specialist care

(Baird, 2006; Patterson, 2007; Tucker et al, 2005)

Informing practiceInforming practice

• Journals – Midirs– NZCOM

• Books• Formal study /

workshops

– Practice groups– Other groups

On study daysOn study days

• “The greatest benefit of it for me was sharing things with, other midwives, midwives in a room, partly through not having that, was one of the inspirations for starting to convene these meetings here, I was not really meeting many other midwives otherwise, which is the best way of getting information”

On connecting with colleaguesOn connecting with colleagues

• “I have to say personally I gain most of my knowledge from my colleagues, from working with more experienced, or highly experienced, other midwives”

• “Even from team to team we often learn different things from each other, which is good, it’s all knowledge sharing”

Social learning theorySocial learning theory

• Vgotsky• Social interaction plays a fundamental role in learning.

• Bandura• We learn through modeling others behaviour, attitudes

and outcomes of this behaviour.

• Lave• Learning is embedded within activity, context and culture.

Communities of practiceCommunities of practiceLave and Wenger (1991);• understanding the technology of practice is more

than learning to use tools; it is a way to connect with the history of the practice and to participate more directly in its cultural life (p.101).

• participation in the cultural practice in which any knowledge exists is an epistemological principle of learning. The social structure of this practice, its power relations, and its conditions for legitimacy define possibilities for learning (p.98).

Communities of practiceCommunities of practice

Communities of practice are groups of people who share a concern or passion for something they do and learn how to do it better as they interact regularly.

(Wenger, 2008)

– Wenger, E. (2008). Communities of practice: a brief introduction. Retrieved May 14, 2008, from

http://www.ewenger.com/theory/communities_of_practice_intro.htm

Sharing the learningSharing the learning

• “And so really for myself, it would be nice to go with your colleagues so you can disseminate the information together, but we can’t do that because we would leave the place empty”

Networking through the internet.Networking through the internet.

• “But certainly a rural midwives network would be fantastic, that we could ring other people and say what do you think about this? “

• “Just share over the internet, a case study from our area, this is what we found and how we managed it”

Web tools to support networkingWeb tools to support networking

• Blogs – online journals• Wikis – co development of online resource• Delicious – shareable bookmarks (share good

things you find online)• Youtube – video journal• Second life – real time meeting in a virtual

ennvironment• Webinars – Elluminate, skype, and lots of

others.

Supporting shared learning and Supporting shared learning and communities of practicecommunities of practice

• Web 2.0 facilitates social networking in an online environment through various online tools

• Facilitates connections between individuals who have a shared understanding and shared interests

• Online resources facilitate information sharing and collaboration in a variety of ways– Otago Polytechnic have recently won funding to

produce an online resource to develop a midwifery community of practice

http://onlineprofessionaldevelopment.wikispaces.com/2008+Program

What is happening elsewhereWhat is happening elsewhere

• New Zealand– Rural GP network

• Scotland:– Researched what was required to maintain confidence and

competence in rural maternity. – Established a rural network providing local training and

networking for rural midwives. (Tucker et al, 2005)• Australia

– Rural and remote nurses and midwives forum• NZ Midwives

– Do we need or want something like this? Contact

Carolyn McIntosh

Cardacs@gmail.com

ConclusionConclusion• Rural midwives inform practice in a variety of ways but

prefer to share and acquire new information through communities of practice

• Rural midwives have limited opportunities to engage with or develop communities of practice

• Online networking may provide new and exciting opportunities to facilitate networks for rural midwives

• Links can be forged nationally and internationally

• Do we want to establish a rural midwives network in New Zealand?

ReferencesReferences

Bandura, A. (1977). Social learning theory. New Jersey: Prentice HallBaird. M. ( 2005). Sustaining rural midwifery practice: New Zealand

midwives' experiences. A qualitative descriptive study. Masters of midwifery thesis, Otago Polytchnic, Dunedin.

Lave, J. Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge: Cambridge University Press

Patterson, J. (2007). Rural midwifery and the sense of difference. NZCOM journal. (37) 15-19.

McIntosh, C. (2007). Wise women’s Web: Rural midwives communities of practice. Master of midwifery thesis, Otago Polytechnic, Dunedin.

Tucker, J., Hundley, V., Kiger, A., Bryers, H., Caldow, J., Farmer, J., Harris, F., Ireland, J., Van Teijlingen, E. (2005). Sustainable maternity services in remote and rural Scotland? A qualitative survey of staff views on required skills, competencies and training. Quality and safety in health care. (14) 34-40.

Vgotsky, L., S. (1978). Mind in society (ed. M. Cole, V. John-Steiner, S. Scribner and E. Souberman). Cambridge, MA: Harvard University Press.