This is the research blog of Dr Sally Pezaro. Sally is 'The Academic Midwife' working to secure excellence in teaching and maternity services. Specialist interests include maternity services, workforce and midwifery research.
The 16 Days of Activism against Gender-Based Violence is an annual international campaign which will kick off on the 25th of November, the International Day for the Elimination of Violence against Women, and will run until the 10th of December, Human Rights Day. #16DaysOfActivism
During these 16 days we will be launching and inviting people (predominantly health professionals) around the globe to enrol onto our Massive Open Online Learning Course (MOOC) entitled: Identifying and Responding to Domestic Violence and Abuse (DVA) in Pregnancy
Around 1 in 12 people are exposed to domestic violence and abuse (DVA) during pregnancy. This MOOC is free to access and will offer evidence-based training to professionals around the globe looking to improve their skills in supporting those affected by domestic violence and abuse (DVA) during pregnancy. On this course, students will discover the research, guidelines and techniques for screening for DVA. Students will have the opportunity to enhance their ability to support safe disclosure in maternity settings and empower victims of DVA to explore options and seek further support.
Applications for babies to be taken in to care at birth are at a national high. This results in significantly impaired life outcomes for the birthing community and their babies. So what barriers and facilitators are at play here? We have produced the following review of the literature published in @BJMidwifery to uncover therapeutic mechanisms and interventions to support those at risk of having their baby removed from them at birth.
The development of strong professional relationships
Early and sustained interventions
Uniquely, using the themes presented within this review, we have been
able to model the cycle of maltreatment which needs to be broken in Figure 1.
As this review only yielded eight studies in total, further research could usefully inform a richer provision of research inspired teaching and training in this area.
Looking at the lives of healthcare workers through the first wave of the COVID-19 pandemic, this project explores their ‘human’ experiences – in contrast to the public and media portrayal of them as ‘heroes’.
The audio artwork is the representation of the stories, experiences and emotions of eight healthcare workers from Coventry and across the UK, gathered during an online creative workshop. From this, we identified seven themes, including the theme of the ‘hero’ narrative. While some might consider the label of ‘hero’ as praise, many of our healthcare worker participants explained that it sometimes caused feelings of guilt. A shift in focus is needed to recognise the emotional and physical toll for individuals. Adequate support is needed to help healthcare workers find meaning in their experiences.
For some years now I have had the pleasure of marking student essays and reading their interesting ideas and arguments in relation to a number of healthcare topics. Yet repeatedly, I see the same mistakes being made. These mistakes mean that I cannot assign a higher mark to the work, and that makes me sad. So, I’ve tried to consolidate and explain how to avoid the top 10 essay mistakes.
Want to know how to get higher marks in your essay? Read on…
Top 10 Mistakes Students Make in Their Essays…
Always explain acronyms the first time you use them
Many students simply start using acronyms without explaining what they mean. How to fix this? You explain and write first that you are speaking in relation to the United Kingdom (UK)….THEN you can use ‘UK’ throughout the rest of the essay. If you don’t explain it first then I am left guessing as to what you mean throughout the rest of the work.
This word is often spelled incorrectly. How do you know when to add an ‘S’ or a ‘C’? Try replacing the same sentence with the word ADVICE or ADVISE. The one which sounds more appropriate tells you which to use. For example:
Fitness to ‘advise’ sounds more appropriate than Fitness to ‘advice’. Therefore in this sentence you would spell practice with an ‘S’ so… the correct spelling in this case would be…
Fitness to PractiSe
3. avoid getting your essay structure back to front
Sometimes things can get higgledy piggledy. Your work should flow logically like a story, and it’s structure will depend largely on your own assignment guide….but broadly, appendices will go after reference lists and be labelled and named. You will also need to mention appendices, tables and figures in the main body of the text in order to direct the reader as to where to find things.
A story – a beginning, a middle and an end. Try to follow a narrative structure and your discussions and arguments will follow suit…the best way to do this is with structured assignment planning; each concept and new idea should link together or follow a new introduction.
One single sentence alone does not make a paragraph, yet too often I see this in essays, and it is not particularly useful. Also, I have yet to see anyone make a strong and well reasoned and evidence based argument in only one sentence. More often than not, this will be a single statement, best avoided unless coupled with other meaningful text.
5. Avoid huge chunks of text
A large chunk of text will likely have several points and arguments within it which can get lost overall. If you can break up such large chunks of text into smaller paragraphs, your overall structure will be far stronger. Each paragraph should encompass one argument concisely.
When an essay gets a low grade, it is often because the reader is unconvinced of the arguments being made. Sometimes arguments do not go far enough, they are often not concluded. Ensure that you conclude each argument, after you have cited the evidence which lays out your case. For example, you may start the paragraph by saying….
“Johns et al (2020) explain how you can scald yourself by not wearing oven gloves when baking. Equally, Kent et al (2020) emphasize the need to wear oven gloves in the context of cooking in the kitchen. Nevertheless, another study proved that simply letting the oven dish cool down is effective enough in preventing burns in this context (Frog et al, 2020).”
The above example is similar to what I see in a lot of essays. Yet in itself, it does not round up an argument or make a case. It simply states what the evidence is in relation to the topic. To complete the argument, the author needs to draw a conclusion on this. What does this mean? what implications does it have? How strong or weak is the evidence in this regard. This paragraph does not go far enough, and ultimately needs concluding with another sentence or two beginning (for example) with… Therefore… or…As such…(insert very insightful conclusion here).
7.AVOID MAKING LARGE STATEMENTS WITHOUT BACKING THEM UP
Unless you are a world leader or significant and respected public figure, I am afraid you must avoid making large sweeping statements in a sentence without citation. For example, poverty may be a well known issue in many parts of the world. Yet you cannot simply say this (obvious though it may be) without citing a reference which points to the evidence for it. I frequently see this occurring in student essays – I can never assign positive marks to this.
8.ENSURE YOU ARE USING APPROPRIATE REFERENCES
The appropriate use of citations and references is a good thing. It demonstrates evidence of wider reading and makes your arguments stronger. However, the references used must be appropriate in the context of your work and field. In academia, it is generally most appropriate to cite peer reviewed articles from academic journals. Magazines and newspapers may be appropriate to cite in some cases, especially in some specialist fields. However, in nursing and midwifery for example, articles from publications such as ‘The Nursing Times’ will often be secondary sources reporting on the evidence, rather than the primary source of evidence itself. It is always best to cite the primary source of evidence in such cases.
In terms of referencing style, it is important to get this right too. See your own institutions style guide for the particulars.
Top Tip: Google Scholar will give you the top referencing style formats by clicking on the ‘cite’ button under each item listed. Click the ‘ “ ‘ symbol.
Too often I see students relying too heavily on the work of others. You should only be referring to the work of others in order to strengthen your own insights and arguments. I cannot give you marks for only telling me what other people say.
10.AVOID BEING OVERLY DESCRIPTIVE
All too often, I see entire paragraphs describing what happened in a particular research study. I can give no marks for this as it is ultimately description. Moreover, I can read the study for myself, so you only really need to give a small description of the study to set the context for what you are trying to say. For example, if you want to talk about the rigor of a study design, all I really need to know is the study design in question. The marks come where you critique, rather than simply describe.
A useful paragraph may begin…
The study by Arthur et al, (2020) included a randomized controlled trial (RCT). RCT’s are generally considered rigorous when….(insightful critique continues)…
Problematic substance use in midwifery populations is an uncomfortable topic to explore, yet:
There are human and financial costs associated with problematic substance use (PSU) among the healthcare workforce, which also has a significant role in medical negligence.This systematic integrative review presents an international summary of the evidence in relation to PSU in midwifery populations.There is limited evidence available in relation to PSU in midwifery populations in comparison to that available for other healthcare populations.As midwives form a part of the general healthcare workforce and are exposed to similar workplace stressors, it is likely that they would be similarly affected by PSU in the healthcare workplace.Future research could usefully capture contemporary data in relation to PSU in distinct midwifery populations.
Our latest review on this topic is the first of it’s kind. We hope this work will act as a useful foundation for future work in this area.
“Healthcare professionals who engage in PSU have indicated that they worry about their PSU, have trouble getting along with others, provide less than their best patient care, have limited their commitment to patient care and seriously consider suicide (Kenna and Wood, 2004). Whilst it has not been possible to identify midwifery populations within such larger data sets, we concur with Weenink et al. (2017), who suggest that it is unlikely midwives are immune from such similar effects.”
“Being the first international systematic integrative review of PSU in midwifery populations, this article presents findings in relation to both midwives and student midwives working in three separate countries, identified from a total of three empirical studies (Deasy et al., 2014; Schluter et al., 2012; Watson et al., 2006). Substances used included tobacco, alcohol and cannabis. Problem substance use was broadly linked to longer working hours and coping with work-related stress via escape avoidance. Whilst the reasons for PSU remained unclear in the survey study by Watson et al. (2006), inferences are made by the authors that this coincided with local promotional ‘student nights’, where alcohol is discounted in price.”
To follow on from this review, we have collected data on PSU from midwives practising in the United kingdom. We hope to publish our results from this soon. You can follow our work on substance use in midwifery populations via this project page.
Until next time…Look after yourselves and each other 💚💙💜❤
References
Deasy et al., 2014 – C. Deasy, B. Coughlan, J. Pironom, D. Jourdan, P. Mannix-McNamaraPsychological distress and coping amongst higher education students: a mixed method enquiry. PLoS ONE, 9 (2014), pp. 1-23
Kenna and Wood, 2004 – G.A. Kenna, M.D. WoodAlcohol use by healthcare professionals. Drug Alcohol Depend., 75 (2004), pp. 107-116
Schluter et al., 2012 – P.J. Schluter, C. Turner, C. BeneferLong working hours and alcohol risk among Australian and New Zealand nurses and midwives: a cross-sectional study. Int. J. Nurs. Stud., 49 (2012), pp. 701-709
Watson et al., 2006 – H. Watson, R. Whyte, E. Schartau, E. JamiesonSurvey of student nurses and midwives: smoking and alcohol use. Br. J. Nurs., 15 (2006), pp. 1212-1216
Weenink et al., 2017 – J.W. Weenink, R.B. Kool, R.H. Bartels, G.P. WestertGetting back on track: a systematic review of the outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns. BMJ Qual. Saf., 26 (2017), pp. 1004-1014
🎓…. have you always dreamed about doing your PhD? We have an exciting PAID studentship opportunity for you!
Start your exciting #PhD journey with myself & Professor Louise Moody 🎓
“Exploring healthcare workers’ experiences & ethical dilemmas faced during the COVID-19 Pandemic through arts-based practice”
Coventry University (CU) is inviting applications from suitably-qualified graduates for a fully-funded PhD studentship within the multi-disciplinary ‘Well-being and the Arts’ theme within the Centre for Arts, Memory and Communities.
The British Medical Association and Health Foundation have drawn attention to the impact the COVID19 pandemic is, and will continue to have in a variety of ways on NHS staff. The specific focus of this PhD research will be the difficult, ethical decisions healthcare workers have had to make when managing patients during the pandemic. Some examples of this include who to prioritise for treatment, whether to treat if PPE is unavailable, whether to return to NHS roles for those who have left the profession, and the need to separate patients from loved ones.
The project will explore the challenges and emotional impacts experienced by health care workers in relation to ethical decision making. The successful candidate will respond to these experiences through arts-practise as well as developing evidence-based recommendations for the support needs of staff.
The project is anticipated to involve the following activities:
– A scoping review of the literature
– Qualitative research to explore ethical dilemmas and the associated emotional impact using social media
– Arts-based practice to represent and communicate healthcare worker experiences
– Formation of recommendations regarding the support needs of healthcare workers
Training and Development
The successful candidate will receive comprehensive research training including technical, personal and professional skills.
All researchers at Coventry University (from PhD to Professor) are part of the Doctoral College and Centre for Research Capability and Development, which provides support with high-quality training and career development activities.
Entry criteria for applicants to PHD
• A minimum of a 2:1 first degree in a relevant discipline/subject area with a minimum 60% mark in the project element or equivalent with a minimum 60% overall module average.
PLUS
the potential to engage in innovative research and to complete the PhD within a 3.5 years
• a minimum of English language proficiency (IELTS overall minimum score of 7.0 with a minimum of 6.5 in each component)
Hypermobile #EhlersDanlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) have profound and life-threatening consequences in childbearing, and it is now estimated that hEDS/HSD affect 6 million (4.6%) pregnancies globally per year..rounded up, this equates to almost 1 in 20 pregnancies!
What did participants describe?
A worsening of symptoms during pregnancy
Postnatal complications
Ineffective anaesthesia
Long latent phases of labour quickly developing into rapidly progressing active labours and births (precipitate labour/precipitate birth)
Maternity staff panicked by unexpected outcomes
Healthcare professionals lacking knowledge and understanding
Poor maternity care resulting in a disengagement from services
Birth Trauma
Stress
Anxiety
An avoidance of future childbearing
Difficulties in holding, caring for, bonding with and breastfeeding their babies
A maternity tool has been co-create to support both professionals and pregnant people in decision making. It is freely available for download and wider use
“Don’t clap for me” “The health service is not staffed by heroes” and “’We are fragile, tearful, afraid, and we are human” are recent accounts voiced by healthcare workers, working through the COVID-19 pandemic (Anonymous 2020; Watson 2020).
In contrast to the common portrayal as invincible “heroes” or “saints”, it is increasingly recognised that healthcare workers (HCWs) working through the COVID-19 pandemic may be experiencing negative emotions and moral distress related to certain situations (Williamson et al. 2020). These situations may include: Being redeployed, witnessing the suffering of patients or colleagues, ethical decisions related to care, delivering bad news or making the decision to distance oneself from family or children. The wellbeing of HCWs, as well as having an impact on individuals and families, is intrinsically linked to the quality and safety of healthcare services so there is a pressing need to understand more, including how we can help (Pezaro et al. 2015; The Royal College of Physicians, 2015).
We know that even the smallest demonstrations of compassion can make a difference to individual HCWs: Small acts of kindness, caring language or the opportunity to be listened to for example (Clyne et al. 2018). Williamson et al. (2020) state the importance of informal support and opportunities for discussion of events that may have caused moral distress to allow HCWs to process and make sense of events.
We are commencing a research study to explore the real narratives and experiences of HCWs working through the COVID-19 Pandemic, as well as where HCWs have experienced self and workplace compassion, using an arts-based research approach which includes creative writing, storytelling & theatre. Participants will contribute to the script for a piece of audio art-work that will creatively depict the emotions and experiences of healthcare professionals contrasted against the social celebration of them as ‘heroes’ during this Covid-19 pandemic. The recording aims to both give a truthful account of the HCW narrative during this crisis, whilst also being relatable, hopeful and human. It is hoped that it will be a point of stimuli for discussion for the general public and inform the development of additional resources to help HCWs debrief and recover.
Aspects of the arts-based research process itself, such as the opportunity to make sense of experiences through creativity, reflection and commonality with other participants, have been noted as “transformative” (Beltran and Begun 2014). Lennette et al. (2019) describe this type of research as an ongoing reflective process, in which the researcher and participants collaborate to expand the meaning of each individuals’ story and find links and common themes with those of other participants.
We are recruiting a small group of 4-6 healthcare workers to explore their experiences and narratives of COVID-19, within a 1-hour online workshop, taking place at the end of June. The group of HCWs will discuss their experiences and work with a writer, Nick Walker and theatre professionals from China Plate Theatre Company to create a piece of creative writing and a script for the audio artwork, which will be exhibited at a digital exhibition for Coventry City of Culture 2021. If you wish to take part, your information will be kept anonymous & confidential. You are under no obligation to take part.
China Plate are independent contemporary theatre producers of adventurous and imaginative new work with popular appeal and a social purpose. Their mission is to challenge the way performance is made, who it’s made by and who gets to experience it. Lead artist, Nick Walker is a Coventry-based writer, producer, and director. He was co-founder of theatre company, Talking Birds whose work has been presented across the UK, Europe, and the USA. He has worked with some of the country’s leading new work theatre companies including Stan’s Cafe, Insomniac, Action Hero and Theatre Absolute. His plays and short stories are regularly featured on BBC Radio 4, including 3 series of The First King of Mars (starring Peter Capaldi), and 6 series of Annika Stranded with Nicola Walker. He has a great deal of experience in writing plays and stories that are based on conversations/workshops with people around their real-life experiences, for example, exploring stories of male suicide with Coventry Men’s Shed. His writing has successfully fictionalised these experiences and made them relevant to a wider audience without losing their essence and truthfulness.
Date/time for workshop confirmed as: Wednesday 17th June 19:30
To request a Participant Information Sheet please email Kerry Wykes: ad3078@coventry.ac.uk.
Beltran, R., & Begun, S. (2014). “It is medicine”: Narratives of healing from the Aotearoa Digital Storytelling as Indigenous Media Project (ADSIMP). Psychology and Developing Societies, 26, 155-179.
Clyne, W., Pezaro, S., Deeny, K., & Kneafsey, R. (2018). Using social media to generate and collect primary data: The #ShowsWorkplaceCompassion twitter research campaign. JMIR Public Health and Surveillance, 4(2), e41.
Pezaro, S., Clyne, W., Turner, A., Fulton, E. A., & Gerada, C. (2015). ‘Midwives overboard!’ inside their hearts are breaking, their makeup may be flaking but their smile still stays on. Women and Birth: Journal of the Australian College of Midwives, 29(3), 59-66
The Royal College of Physicians. (2015). Work and wellbeing in the NHS: Why staff health matters to patient care.
Lenette C, Brough M, Schweitzer R et al. (2019) ‘Better than a pill’: digital storytelling as a narrative process for refugee women, Media Practice and Education, 20:1, 67-86, DOI: 10.1080/25741136.2018.1464740
Williamson, V., Murphy, D., Greenberg, N (2020) COVID-19 and experiences of moral injury in front-line key workers, Occupational Medicine, kqaa052, https://doi.org/10.1093/occmed/kqaa052
Further reading…
Watson, C (2020) Nurses are no heroes – they’re just finally beginning to be recognised as they should. The Telegraph.
On the 5th of May (International Day of the Midwife – #IDM2020) 2020 – The year of the nurse and the midwife, the @hEDStogether team launched new educational tools to support childbearing with hypermobile Ehlers Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD). Co-incidentally, May is also Ehlers Danlos Syndromes and Hypermobility Spectrum Disorders awareness month. You can view the online launch of these tools along with our other @GOLDMidwifery presentations here at the GOLD Online Education Midwifery Conference 2019/2020.
An i-learn module launched by the Royal College of Midwives to their members (search under the letter ‘H’ for hypermobility in the online library)
A maternity tool freely available for download and wider use
An infomercial to raise awareness and mobilise knowledge in relation childbearing with hEDS/HSD
We were also able to launch our own website – hEDSTogether.com and keep everyone up to date with the project via @hEDStogether
We have made these tools freely available where possible. You can visit the project page to learn more. If you are using them to create an impact in the world, please tell us about it via the contact pages hosted at hEDSTogether.com.
Today, ‘Make Birth Better’ (@birthbetter) published it’s new report outlining the circle of Trauma for both parents and professionals. I am immensely proud to have contributed to this report and to work with other esteemed colleagues looking to make a difference in this context.
It really is so important that we recognise the trauma birth workers can experience as a result of their work. Many midwifery and obstetric staff are affected by vicarious trauma because of the events they have seen, the conditions they are working in and a lack of emotional support. This is significant because as well as birth workers being entitled to a psychologically safe professional journey, such psychological distress can also result in poorer maternity care.
As a result of this report, the following calls to action have been made:
1. Address trauma prevention for maternity staff and parents.
2. Think long-term about trauma treatment for maternity staff and parents in the future.
