Midwives magazine February/March 2009
By Kenda Crozier a research fellow at the RCM’s learning, research and practice development department and Sue Macdonald the RCM’s education and research manager
Midwives are increasingly interested in making changes to their practice and exploring the effect of these changes. However, the formal process of research training to enable them to develop the necessary skills in this area often appears daunting.
New opportunities for research training are becoming available for nurses and midwives through the National Institute for Health Research (NIHR) and it is important that midwives are aware of opportunities in order to be ready to apply for these. As a result of the Finch report (UK Clinical Research Collaboration, 2006), new career structures in nursing will enable nurses to work clinically while developing research interests, and work is currently underway to explore how midwifery career structures may develop. There are opportunities for midwives to apply for funding for research and training in research skills.
Introduction
In maternity services up and down the UK, midwives are making small but significant changes in their practice or care to see what the outcome will be. This innovative approach to working or providing care for women is the basis on which research grows. But midwives are so often scared off by the term research – remembering dry lectures in the classroom that involved complicated words and statistical measures that were not remotely related to them. But the process of research is, and must be, relevant to midwifery. All midwives work according to an evidence base, but more midwives need to contribute to that evidence base.
Midwives will often discuss what they would like to see changed in their working environment or ask the question: ‘why do we need to do it this way?’ In the care of women how many times have you thought: ‘I wonder if the fact that she is obese, or that she has had a caesarean section, is the reason why she is experiencing difficulties in breastfeeding, healing… or whatever’.
Research in midwifery is described by Sinclair (2008: 3) as: ‘a rigorous process of inquiry that aims to provide knowledge of, and insights into, the efficacy and effectiveness of midwifery practice; its effects on women, babies, parents, family and society. It includes research on the education and training of midwives, the use of information and communication technologies, the organisation and delivery of maternity services and employment conditions and terms affecting midwives’ working lives.’
Midwifery research is growing – there are now more than 20 midwifery professors in the UK. The number of midwives undertaking study at doctoral level is also increasing steadily. The recent International Confederation of Midwives triennial congress in Glasgow was the most research focused ever, delivering excellent and wide ranging presentations, including quantitative and qualitative studies. An impressive number of the presentations were from midwives’ doctoral research.
For those midwives interested in research, the need for appropriate and robust research training is crucial. The emphasis on research in undergraduate programmes tends to be focused on utilising evidence for practice rather than on generating it. Therefore, qualified midwives who want to embark on research need to access postgraduate courses to gain research training. Managers are not always sympathetic to research training as they see more immediate value in other types of skills training that can have an instant visible application to practice, such as training in examination of the newborn or advanced skills in emergency management. Therefore, the funding and time allocated for research training is sometimes limited.
The careers of professionals in the health service have been the focus of a number of reports over recent years. There has been a great deal of discussion in the press about modernising medical careers. The new system of training introduced since 2005, culminated in a great deal of confusion about the process of applying for postgraduate training in 2007. The House of Commons Health Committee (2008) reported on this and made recommendations for the future. Following the plans to modernise medical careers, the nursing profession began to explore the career paths for nurses following qualification and the NMC consulted on both pre- and post-registration nursing education. The education and training of midwives in relation to their career structure is also currently under review.
Finch Report
In August 2007 the UK Clinical Research Collaboration (UKCRC) issued the report ‘
Developing the Best Research Professionals’ (led by Janet Finch and often referred to as the Finch Report), which set out plans for clinical academic careers for nurses in clinical practice and in education. The final report, after an extensive consultation process, set out plans for the development of research training in the form of Masters, Doctoral and Postdoctoral education for nurses to ensure that professionals have the skills to develop and lead research. The RCM contributed to the consultation process and registered significant disappointment that it had not been invited to help develop the proposals. However, the College supported the recommendations for a career structure including specialist research training.
Key points from the Finch report:
‘Recommended capacity and capability building and four awards schemes as follows:
•
MRes or MClinRes (Award Scheme 1) – up to 100 career clinical academic training posts be funded annually for graduate nurses (part time).
•
PhD/Professional Doctorate (Award Scheme 2) – recommended up to 50 early career clinical academic appointments are funded annually.
•
Postdoctoral Career Fellowships (Award Scheme 3) – recommended up to 20 Postdoctoral Career Fellowships are funded annually.
•
Senior Clinical Academic Fellowships (Award Scheme 4) – recommended that up to ten Senior Clinical Academic Fellowships for nurses are funded annually.’
How can midwives benefit from the recommendations of the Finch report?
Midwives in maternity services and in universities should be preparing themselves to take advantage of the opportunities for studentships or fellowships that may arise from this report. Individuals with the potential and interest to develop themselves in research should be identified and encouraged.
Mentorship and training will be important elements to ensure success. There are many midwives who would welcome the opportunity to develop their research skills, but the current climate of understaffing and lack of funding for post registration education in some parts of the country make it difficult to find the funding or time allocation to undertake Masters in Research or Masters in Clinical Research or Doctoral studies. Midwives working at consultant level are ideally placed to develop midwifery research within their organisations and such formalised training may enhance their roles. In turn they can support other midwives in clinical practice to develop their research knowledge and skills.
Funding opportunities for full-time study have often been in short supply and the Finch report recommends a limited number of opportunities, for example, up to 100 funded Masters opportunities, 50 Doctoral and 20 Postdoctoral places. The proposal includes the option of full-time or part-time training. The number of training places proposed is limited and it is as yet unclear whether these will be available only within selected research institutes or more widely. Information should soon be available through the NIHR website:
www.nihr.ac.uk/.
RCM Scotland has recently funded an opportunity for a midwife to undertake research in the area of normality, with a fellowship which offers full salary and support in research training for a PhD.
Research funding
Funding for research in any field is always competitive and the process can be daunting for the novice researcher. But there are funding streams available. For example the NIHR has a funding stream called Research for Patient Benefit (
www.nihr-ccf.org.uk/site/programmes/rfpb/default.cfm), which is targeted at collaborative projects between higher education and NHS Trusts. Therefore, midwives working in the NHS should not feel that research is only the preserve of elite university research departments. These larger national funding streams enable the researchers to access support from local R&D offices to recruit participants and in some cases collect data.
Smaller awards such as the RCM Ruth Davies award sponsored by the parent club Bounty will provide funding for small scale or pilot studies. Previous award winners have conducted a range of midwifery-led research, including women’s experiences of being transferred in labour, analysis of fetal position at the onset of labour and labour outcome Other research includes breastfeeding images, the focus, content and duration of home postnatal visiting, midwives experiences of spontaneous vaginal breech birth, mental health promotion in maternity services, latent phase of labour algorithm and postnatal care.
The development of research training is a huge and crucial opportunity, which midwives must be ready to take up. We pride ourselves on our evidence-based approach to care, but the research needed to develop the evidence base needs to be growing continuously, with special reference to midwives and the care they provide to women and their babies.
Database of midwifery research
The RCM is developing an online database of completed and in progress research projects in midwifery. This will be an important resource for midwives to find out ‘who is doing what and where’, to both know what is in progress, and also to enable links and collaborations to be developed among experienced midwifery researchers, and those who are in the earlier stages of their research career. We would invite those interested in putting their projects onto the database to send brief details to Kenda Crozier at the RCM. For further details please contact by email:
kenda.crozier@rcm.org.uk
References
House of Commons Health Committee. (2008) Modernising medical careers, third report. HMSO: London.
Sinclair M. (2008) The Doctoral Midwifery Research Society: a concrete structure for supporting doctoral midwifery research. The Royal College of Midwives.
Evidence Based Midwifery 6(1): 3.
UK Clinical Research Collaboration. (2006)
Developing the Best Research Professionals. Report of the UKCRC Subcommittee for Nurses in Clinical Research (Workforce) Chair Janet Finch. UKCRC: London.
