Diane Fraser - Academia.edu (original) (raw)

Papers by Diane Fraser

Http Www Libreriasaulamedica Com, 2008

British Journal of Midwifery, 2000

Background. Reflexivity is a popular, yet complex process, which attempts to analyse personal, in... more Background. Reflexivity is a popular, yet complex process, which attempts to analyse personal, intersubjective and social processes that influence research projects, particularly those using a qualitative approach. With the rising popularity of qualitative methods being used to examine health care and midwifery practice, as well as the increased public and professional scrutiny of research, reflexivity provides a means of strengthening greater transparency and quality in this type of research. Aim. This paper examines the concept of reflexivity and highlights specific issues that researchers need to consider when undertaking ethnographic studies involving participant observation. Reference will be made to personal experience of undertaking an observational study examining informed consent to intrapartum procedures. Methods. Application to undertake the study was approved by the local research ethics committee. Data were collected by fieldnotes, which were made through participant observation, followed by semi-structured interviews with each woman observed and the corresponding midwives within 24 hours of the baby's birth. In addition, notes pertaining to personal thoughts and experiences before, during and after the data collection and analysis were recorded in a research diary to add to the reflexive account. Findings and conclusion. Each way of approaching reflexivity has strengths and limitations and will be dependent on the research methods used in respect of fulfilling the aims of the study. Each researcher is responsible in deciding how best to exploit the reflexive potential of the research to ensure their final account is authentic, trustworthy and of good quality.

Midwifery, 1996

Findings: the response rate to the questionnaires was 75%. In the group discussion the PMAN membe... more Findings: the response rate to the questionnaires was 75%. In the group discussion the PMAN members commented particularly on: the large number of items identified as needing assessment in practice and by written work; lack of total agreement on the assessment in practice of normal delivery; differences in practitioners' perceptions of assessment; the number and range of areas to be assessed; differences in expectation of 'task' assessment versus 'holistic ' assessment; lack of assessment in simulation; heavy reliance on written work in assessment. Conclusions: the group's discussion of the questionnaire data revealed further interesting data, which added considerably to the initial analysis and overview. Some participants had misinterpreted the instructions and found that what they had filled in did not accurately reflect their beliefs about assessment. General consensus was reached on the need for a national standard or framework for assessment and more emphasis to be placed on assessing students in the practice setting whilst ensuring this includes knowledge and understanding and not merely psycho-motor skills. The major implications include effective preparation of assessors and more teacher involvement in practice to support the midwife assessors.

Midwifery, 2008

Objective: to identify the essential competencies required of a midwife at the point of registrat... more Objective: to identify the essential competencies required of a midwife at the point of registration. Design: qualitative, descriptive, extended case study and depth interviews. Setting: pre-registration midwifery education in England. Participants: 39 qualifying midwives, their assessors, midwives and midwife teachers across six higher education institutions, and 20 experienced midwives at two sites. Findings: essential competencies were identified relating to (1) being a safe practitioner; (2) having the right attitude; and (3) being an effective communicator. In order to be a safe practitioner, it was proposed that a midwife must have a reasonable degree of self-sufficiency, use up-to-date knowledge in practice, and have self and professional awareness. It was suggested that having the right attitude involves being motivated, being committed to midwifery and being caring and kind. Participants highlighted the importance of effective communication so that midwives can relate to and work in partnership with women and provide truly informed choice. Essential communication skills include active listening, providing appropriate information and flexibility. Key conclusions: the most important requirement at registration is that a midwife is safe and will practise safely. However, this capability to be safe is further mediated by attitudes and communication skills. Implications for practice: models of midwifery competence should always include personal attributes and effective communication in addition to the competencies required to be able to practise safely, and there should be an explicit focus in curriculum content, skills training and assessment on attitudes and communication.

Midwifery, 2004

to investigate the relationship between information giving by midwives and decision-making by wom... more to investigate the relationship between information giving by midwives and decision-making by women offered nuchal translucency (NT) screening. To establish how risk figures are discussed in practice, with the intention of relating this to the existing, and often critical, literature on women's accounts of antenatal screening. a qualitative study following women through the process of being offered and deciding to undergo NT screening. Tape recording of consultations, analysed in their entirety, was combined with post-screening interviews. a large teaching hospital in the UK. fourteen pregnant women eligible for NT screening at the time of recruitment. (i) tape recordings of consultations between community midwives and pregnant women where nuchal translucency screening was offered; (ii) tape recordings of consultations between hospital midwives and pregnant women immediately post-screening; (iii) individual face-to-face interviews with pregnant women between two and six weeks after the screening, carried out by the first author. NT screening was in general well received, particularly by those women who had undergone serum screening with previous pregnancies. However, communicating the nature of a risk figure is an interactionally complex process. A large amount of interactional work is required by midwives both before and after screening to ensure that women comprehend this information. Despite the emphasis placed in these consultations on understanding the purpose of NT screening and the status of the results, women often framed their decision to undergo NT screening in terms of it being a formality, or of presuming that all was well. This sometimes created practical and personal difficulties in terms of decision-making. previous sociological and psychological research has tended to be critical of midwives in terms of ensuring informed choice in screening, but this research is often based on post hoc accounts. Examining actual consultations with these accounts helps to illustrate the other factors that affect women's perceptions of testing, and the way in which risk, choice and decision-making are introduced and discussed in practice. Encouraging women to consider what action they might take on the basis of a personally unfavourable NT result in advance of undergoing the scan may help them to decide whether the information gained will be useful to them. Recognising the complex interactional work required in making sure that women understand the nature of the results that will be obtained is an important issue for the education and training of midwives.

Community Practitioner the Journal of the Community Practitioners Health Visitors Association, Sep 1, 2010

The primary purpose of practice improvement is to improve clinical practice through changing the ... more The primary purpose of practice improvement is to improve clinical practice through changing the behaviour of healthcare professionals. Breastfeeding is a key public health issue, conferring benefits associated with both infant and maternal health, yet breastfeeding rates in the U.K. and Ireland are among the lowest in Western Europe. In this paper, the ways in which practice improvement can be utilised to enhance both efficiency and effectiveness are described, using a case study of the potential contribution of health visitors to increasing breastfeeding duration in primary care in order to illustrate this in clinical practice.

Background Previous research on neonatal outcomes in teenage women has focused on primiparous or ... more Background Previous research on neonatal outcomes in teenage women has focused on primiparous or multiparous teenagers separately thus failing to examine outcomes for all teenager groups. This study has addressed this shortfall.AimTo compare three neonatal birth outcomes: between teenagers (primiparous and multiparous) and women aged 20–25 years; between primiparous and multiparous teenagers; and between multiparous teenagers having a rapid repeat birth (≤18 months) and those not.MethodologyAfter gaining ethical approval, a retrospective cohort study using secondary analysis of hospital episode data was undertaken on 32 895 births to women aged

Evidence Based Midwifery

The authors would like to acknowledge and thank the women who gave of their time and honesty in s... more The authors would like to acknowledge and thank the women who gave of their time and honesty in sharing their experiences.

Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association, 2010

The primary purpose of practice improvement is to improve clinical practice through changing the ... more The primary purpose of practice improvement is to improve clinical practice through changing the behaviour of healthcare professionals. Breastfeeding is a key public health issue, conferring benefits associated with both infant and maternal health, yet breastfeeding rates in the U.K. and Ireland are among the lowest in Western Europe. In this paper, the ways in which practice improvement can be utilised to enhance both efficiency and effectiveness are described, using a case study of the potential contribution of health visitors to increasing breastfeeding duration in primary care in order to illustrate this in clinical practice.

Medical Teacher, 2003

Shared learning at undergraduate level provides a potential means of promoting a more multi-profe... more Shared learning at undergraduate level provides a potential means of promoting a more multi-professional approach to maternity care. Interprofessional education uses shared interactive sessions to promote different professional groups' understanding of each other and working together. This paper describes the use of a formative objective structured clinical examination as a method of interprofessional education. Mixed groups of student doctors and student midwives rotate through a series of clinical stations based on common labour ward scenarios. After completing each station they are given feedback by a facilitator on their problem-solving skills, knowledge and attitude to team working. The interactive nature of the sessions encourages deep learning, is student centred and promotes a positive attitude to multidisciplinary working. Both student groups felt they benefited from shared learning in this way and that the formative OSCE was an effective method of developing their clinical skills.

Journal of Advanced Nursing, 2014

The Obstetrician & Gynaecologist, 2005

Nurse Education Today, 2012

It is essential that Approved Education Institutions (AEIs) support practice learning to the educ... more It is essential that Approved Education Institutions (AEIs) support practice learning to the education standards required by the Nursing and Midwifery Council (NMC, 2009). Evaluating whether midwife lecturers bring a unique contribution to the outcomes of preregistration midwifery education programmes was investigated through a national research project (Fraser et al., 2011). The study task addressed in this paper was to establish which roles and responsibilities of lecturers have most impact on student learning and capability as midwives and provide best support for mentors' teaching and assessment decisions. Data were collected through United Kingdom (UK) wide survey of Lead Midwives for Education, midwife lecturers and questionnaires and focus groups of student midwives from six case study sites. An activity analysis tool was completed by lecturers in these sites, as well as individual interviews with LMEs and Programme Leads. The nature of midwife lecturers' engagement with practice is variable and is determined by the particular organisation model used. There is an overall agreement that midwife lecturers have a vital role in supporting the practice based curriculum. Key findings highlight the link lecturer role in supporting students, participating in assessments, supporting mentors and maintaining clinical credibility. Enhancements and deterrents to undertaking the link role are also outlined. These findings are relevant to health care programmes worldwide where clinical practice is an essential component. contribution to knowledge development about models to support and enhance practice-based learning.

Nurse Education Today, 2013

Midwifery education in the UK has been delivered through the University sector since the mid-1990... more Midwifery education in the UK has been delivered through the University sector since the mid-1990s, with the requirement to create safe, effective clinicians who are equipped to engage with research and evidence based practice. This paper presents an in-depth analysis of focus group data from 120 senior midwifery students at six British universities to explore the experience of learning to be a midwife. Thematic analysis of the data suggests the following themes pertain to the experience of a number of students: 'teach yourself midwifery', knowing it all, right way of doing things, the importance of physical skills. These themes suggest a dissonance for some students between the andragogical methods of learning espoused by universities, and the expectations of students, who express the belief that there is a fixed and finite body of knowledge, without which they feel disempowered, anxious and ill-prepared for clinical practice. This paper argues that there are unresolved tensions between the perceived demands of practice environments and regulatory bodies and the philosophical stance of universities. For some students the concept of a broad discursive education is a distraction from training in discrete clinical skills.

Nurse Education Today, 2000

Http Www Libreriasaulamedica Com, 2008

British Journal of Midwifery, 2000

Background. Reflexivity is a popular, yet complex process, which attempts to analyse personal, in... more Background. Reflexivity is a popular, yet complex process, which attempts to analyse personal, intersubjective and social processes that influence research projects, particularly those using a qualitative approach. With the rising popularity of qualitative methods being used to examine health care and midwifery practice, as well as the increased public and professional scrutiny of research, reflexivity provides a means of strengthening greater transparency and quality in this type of research. Aim. This paper examines the concept of reflexivity and highlights specific issues that researchers need to consider when undertaking ethnographic studies involving participant observation. Reference will be made to personal experience of undertaking an observational study examining informed consent to intrapartum procedures. Methods. Application to undertake the study was approved by the local research ethics committee. Data were collected by fieldnotes, which were made through participant observation, followed by semi-structured interviews with each woman observed and the corresponding midwives within 24 hours of the baby's birth. In addition, notes pertaining to personal thoughts and experiences before, during and after the data collection and analysis were recorded in a research diary to add to the reflexive account. Findings and conclusion. Each way of approaching reflexivity has strengths and limitations and will be dependent on the research methods used in respect of fulfilling the aims of the study. Each researcher is responsible in deciding how best to exploit the reflexive potential of the research to ensure their final account is authentic, trustworthy and of good quality.

Midwifery, 1996

Findings: the response rate to the questionnaires was 75%. In the group discussion the PMAN membe... more Findings: the response rate to the questionnaires was 75%. In the group discussion the PMAN members commented particularly on: the large number of items identified as needing assessment in practice and by written work; lack of total agreement on the assessment in practice of normal delivery; differences in practitioners' perceptions of assessment; the number and range of areas to be assessed; differences in expectation of 'task' assessment versus 'holistic ' assessment; lack of assessment in simulation; heavy reliance on written work in assessment. Conclusions: the group's discussion of the questionnaire data revealed further interesting data, which added considerably to the initial analysis and overview. Some participants had misinterpreted the instructions and found that what they had filled in did not accurately reflect their beliefs about assessment. General consensus was reached on the need for a national standard or framework for assessment and more emphasis to be placed on assessing students in the practice setting whilst ensuring this includes knowledge and understanding and not merely psycho-motor skills. The major implications include effective preparation of assessors and more teacher involvement in practice to support the midwife assessors.

Midwifery, 2008

Objective: to identify the essential competencies required of a midwife at the point of registrat... more Objective: to identify the essential competencies required of a midwife at the point of registration. Design: qualitative, descriptive, extended case study and depth interviews. Setting: pre-registration midwifery education in England. Participants: 39 qualifying midwives, their assessors, midwives and midwife teachers across six higher education institutions, and 20 experienced midwives at two sites. Findings: essential competencies were identified relating to (1) being a safe practitioner; (2) having the right attitude; and (3) being an effective communicator. In order to be a safe practitioner, it was proposed that a midwife must have a reasonable degree of self-sufficiency, use up-to-date knowledge in practice, and have self and professional awareness. It was suggested that having the right attitude involves being motivated, being committed to midwifery and being caring and kind. Participants highlighted the importance of effective communication so that midwives can relate to and work in partnership with women and provide truly informed choice. Essential communication skills include active listening, providing appropriate information and flexibility. Key conclusions: the most important requirement at registration is that a midwife is safe and will practise safely. However, this capability to be safe is further mediated by attitudes and communication skills. Implications for practice: models of midwifery competence should always include personal attributes and effective communication in addition to the competencies required to be able to practise safely, and there should be an explicit focus in curriculum content, skills training and assessment on attitudes and communication.

Midwifery, 2004

to investigate the relationship between information giving by midwives and decision-making by wom... more to investigate the relationship between information giving by midwives and decision-making by women offered nuchal translucency (NT) screening. To establish how risk figures are discussed in practice, with the intention of relating this to the existing, and often critical, literature on women's accounts of antenatal screening. a qualitative study following women through the process of being offered and deciding to undergo NT screening. Tape recording of consultations, analysed in their entirety, was combined with post-screening interviews. a large teaching hospital in the UK. fourteen pregnant women eligible for NT screening at the time of recruitment. (i) tape recordings of consultations between community midwives and pregnant women where nuchal translucency screening was offered; (ii) tape recordings of consultations between hospital midwives and pregnant women immediately post-screening; (iii) individual face-to-face interviews with pregnant women between two and six weeks after the screening, carried out by the first author. NT screening was in general well received, particularly by those women who had undergone serum screening with previous pregnancies. However, communicating the nature of a risk figure is an interactionally complex process. A large amount of interactional work is required by midwives both before and after screening to ensure that women comprehend this information. Despite the emphasis placed in these consultations on understanding the purpose of NT screening and the status of the results, women often framed their decision to undergo NT screening in terms of it being a formality, or of presuming that all was well. This sometimes created practical and personal difficulties in terms of decision-making. previous sociological and psychological research has tended to be critical of midwives in terms of ensuring informed choice in screening, but this research is often based on post hoc accounts. Examining actual consultations with these accounts helps to illustrate the other factors that affect women's perceptions of testing, and the way in which risk, choice and decision-making are introduced and discussed in practice. Encouraging women to consider what action they might take on the basis of a personally unfavourable NT result in advance of undergoing the scan may help them to decide whether the information gained will be useful to them. Recognising the complex interactional work required in making sure that women understand the nature of the results that will be obtained is an important issue for the education and training of midwives.

Community Practitioner the Journal of the Community Practitioners Health Visitors Association, Sep 1, 2010

The primary purpose of practice improvement is to improve clinical practice through changing the ... more The primary purpose of practice improvement is to improve clinical practice through changing the behaviour of healthcare professionals. Breastfeeding is a key public health issue, conferring benefits associated with both infant and maternal health, yet breastfeeding rates in the U.K. and Ireland are among the lowest in Western Europe. In this paper, the ways in which practice improvement can be utilised to enhance both efficiency and effectiveness are described, using a case study of the potential contribution of health visitors to increasing breastfeeding duration in primary care in order to illustrate this in clinical practice.

Background Previous research on neonatal outcomes in teenage women has focused on primiparous or ... more Background Previous research on neonatal outcomes in teenage women has focused on primiparous or multiparous teenagers separately thus failing to examine outcomes for all teenager groups. This study has addressed this shortfall.AimTo compare three neonatal birth outcomes: between teenagers (primiparous and multiparous) and women aged 20–25 years; between primiparous and multiparous teenagers; and between multiparous teenagers having a rapid repeat birth (≤18 months) and those not.MethodologyAfter gaining ethical approval, a retrospective cohort study using secondary analysis of hospital episode data was undertaken on 32 895 births to women aged

Evidence Based Midwifery

The authors would like to acknowledge and thank the women who gave of their time and honesty in s... more The authors would like to acknowledge and thank the women who gave of their time and honesty in sharing their experiences.

Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association, 2010

The primary purpose of practice improvement is to improve clinical practice through changing the ... more The primary purpose of practice improvement is to improve clinical practice through changing the behaviour of healthcare professionals. Breastfeeding is a key public health issue, conferring benefits associated with both infant and maternal health, yet breastfeeding rates in the U.K. and Ireland are among the lowest in Western Europe. In this paper, the ways in which practice improvement can be utilised to enhance both efficiency and effectiveness are described, using a case study of the potential contribution of health visitors to increasing breastfeeding duration in primary care in order to illustrate this in clinical practice.

Medical Teacher, 2003

Shared learning at undergraduate level provides a potential means of promoting a more multi-profe... more Shared learning at undergraduate level provides a potential means of promoting a more multi-professional approach to maternity care. Interprofessional education uses shared interactive sessions to promote different professional groups' understanding of each other and working together. This paper describes the use of a formative objective structured clinical examination as a method of interprofessional education. Mixed groups of student doctors and student midwives rotate through a series of clinical stations based on common labour ward scenarios. After completing each station they are given feedback by a facilitator on their problem-solving skills, knowledge and attitude to team working. The interactive nature of the sessions encourages deep learning, is student centred and promotes a positive attitude to multidisciplinary working. Both student groups felt they benefited from shared learning in this way and that the formative OSCE was an effective method of developing their clinical skills.

Journal of Advanced Nursing, 2014

The Obstetrician & Gynaecologist, 2005

Nurse Education Today, 2012

It is essential that Approved Education Institutions (AEIs) support practice learning to the educ... more It is essential that Approved Education Institutions (AEIs) support practice learning to the education standards required by the Nursing and Midwifery Council (NMC, 2009). Evaluating whether midwife lecturers bring a unique contribution to the outcomes of preregistration midwifery education programmes was investigated through a national research project (Fraser et al., 2011). The study task addressed in this paper was to establish which roles and responsibilities of lecturers have most impact on student learning and capability as midwives and provide best support for mentors' teaching and assessment decisions. Data were collected through United Kingdom (UK) wide survey of Lead Midwives for Education, midwife lecturers and questionnaires and focus groups of student midwives from six case study sites. An activity analysis tool was completed by lecturers in these sites, as well as individual interviews with LMEs and Programme Leads. The nature of midwife lecturers' engagement with practice is variable and is determined by the particular organisation model used. There is an overall agreement that midwife lecturers have a vital role in supporting the practice based curriculum. Key findings highlight the link lecturer role in supporting students, participating in assessments, supporting mentors and maintaining clinical credibility. Enhancements and deterrents to undertaking the link role are also outlined. These findings are relevant to health care programmes worldwide where clinical practice is an essential component. contribution to knowledge development about models to support and enhance practice-based learning.

Nurse Education Today, 2013

Midwifery education in the UK has been delivered through the University sector since the mid-1990... more Midwifery education in the UK has been delivered through the University sector since the mid-1990s, with the requirement to create safe, effective clinicians who are equipped to engage with research and evidence based practice. This paper presents an in-depth analysis of focus group data from 120 senior midwifery students at six British universities to explore the experience of learning to be a midwife. Thematic analysis of the data suggests the following themes pertain to the experience of a number of students: 'teach yourself midwifery', knowing it all, right way of doing things, the importance of physical skills. These themes suggest a dissonance for some students between the andragogical methods of learning espoused by universities, and the expectations of students, who express the belief that there is a fixed and finite body of knowledge, without which they feel disempowered, anxious and ill-prepared for clinical practice. This paper argues that there are unresolved tensions between the perceived demands of practice environments and regulatory bodies and the philosophical stance of universities. For some students the concept of a broad discursive education is a distraction from training in discrete clinical skills.

Nurse Education Today, 2000