Wise women's web: Rural midwives' communities of practice. A qualitative descriptive study
7 December 2007
The focus of this study is informing rural midwifery practice in the South Island of New Zealand. Using a qualitative descriptive methodology four focus groups of rural midwives discussed how they currently inform their practice, identified issues with midwives obtaining and evaluating information and identified what might help in the future. Rural midwives share the issues of lack of locum relief, lack of continuing professional education, excessive on-call work and a shortage of rural midwives with other health professionals providing services to women and families in rural and remote New Zealand (Health Workforce Advisory Committee, 2001; Hendry, 2003; Goodyear-Smith & Janes, 2006). Rural midwives need support to continue to provide midwifery services to women in rural New Zealand. To provide support to rural midwives it is essential to understand the issues and aspirations from the perspective of rural midwives in the field. This study adds another dimension to the recent surveys that have been conducted on rural midwifery practice (Hendry, 2003; Goodyear-Smith and Janes, 2006) and builds on previous studies of New Zealand rural midwifery (Hendry, 2003; Patterson, 2003).
Rural midwives have mechanisms which they use to inform their practice. Amongst these are, accessing continuing professional development opportunities, journals and clinical practice guidelines. However the midwives in this study preferred sharing and acquiring information with their own practice group, networking with other midwives at workshops and sharing and acquiring information with other colleagues. The midwives were mostly familiar with the use of communication technology both for accessing evidence and for keeping in touch with each other and other health professionals.
Barriers were lack of time, difficulty in accessing cover for practice, and problems with accessing relevant information. Their principal concern was lack of financial aid to support with access to study or evidence. This has recently been addressed to some degree by extra funding for rural midwives from the Ministry of Health. Lack of consistency in practice guidelines and relevance to the context of practice was also a problem. The midwives generally have good relationships with other health professionals. For a few these relationships did not work well leaving the midwives feeling unsupported.
The midwives wanted more local continuing professional development opportunities. Possibilities exist for utilising the midwives local practice groups to disseminate evidence and to deliver continuing professional development. The midwives also spoke of the perceived value in a network of rural midwives throughout New Zealand. For geographically isolated rural midwives, there are communication tools that could be utilised, to provide opportunities to expand their midwifery networks and develop diversified ‘Communities of Practice’. Both midwives in this study and the existing evidence identify this as a useful mechanism, or disseminating evidence and creating opportunities to develop practice information. These possibilities are worthy of further investigation. An action research project may be an appropriate way to evaluate the possibilities of some or all of these initiatives in the future.
Carolyn McIntosh's thesis was supervised by Jean Patterson.
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