The Handbook of Midwifery Research

Mary Steen, Taniya Roberts

• Publisher: Wiley-Blackwell
• Year: 2011
• ISBN:
  9781118276228
• Edition: 1
• Topic: Medicina
• Subtopic: Infermieristica

Research is a fundamental part of midwifery practice. However, not everyone finds it easy to understand the basic principles, and particularly the language of research. This accessible handbook enables midwives and student midwives to firstly understand how to search and make sense of research evidence, how to write a research proposal and finally how to undertake a research study.

The Handbook of Midwifery Research specifically focuses on the needs of midwives and students and helps increase the knowledge and understanding of midwifery research, enabling the reader to undertake research with confidence. With case studies, learning objectives and clear examples throughout, this is an essential purchase for any midwife or student wanting to understand or undertake research. This handbook includes useful tools and techniques to assist midwives and students to keep themselves up-to-date with the best available evidence, enabling them to apply this evidence to their own clinical practice.

• An essential resource for midwifery students as well as qualified midwives
• Clear, straightforward, and accessible in style
• Provides midwives and students with the skills to undertake research with confidence
• Provides examples throughout to apply research to midwifery practice
• Includes a glossary of research terms

PART I

Understanding research

CHAPTER 1

Introduction to midwifery research

Introducing research

The focus of this chapter is to introduce midwifery research, types of knowledge, audit and research, the differences between qualitative and quantitative research and the importance of evidence-based practice. This chapter will assist midwives and students to gain basic knowledge and understanding of what research is and why it is important. This new knowledge will enable midwives and students to understand and appreciate the need for evidence-based practice when caring for childbearing women, their babies and their families. The importance of evidence-based practice will be stressed to promote good standards of care.

Aim

To introduce midwives and students to different research approaches that will help them develop an understanding of types of knowledge, the differences between audit and research and the importance of evidence-based practice.

Learning outcomes

By the end of this introductory chapter, midwives and students:

• will be able to recognise different types of knowledge;
• will be able to distinguish between qualitative and quantitative approaches;
• will know the difference between audit and research;
• will understand the importance of evidence-based practice.

Research questions – what, where, when, why, who and how?

When undertaking research, you firstly have to ask yourself the questions what, where, when, why, who and how? This will help you decide the research approach you need to apply, either quantitative (measures/numbers/counts/ frequencies) or qualitative (understanding of words/phrases/language). It will also help you to develop a research question or hypothesis (theory) that needs asking and is relevant to something you are curious or concerned about in midwifery education, policy, management or practice. The first task, when you have an idea of the research question you would like to ask, is to find out about any existing evidence there is available on the subject matter.

Ideally, you should choose something you are passionate about or some burning issue you would like to address. Once you have made a decision about what you would like to investigate or explore and have a preliminary research question, you will need to undertake a literature search to see if the research question has already been asked or not. Using a search strategy and structuring the review in some way (which is covered in the next chapter) can be helpful in organising the evidence or identifying a lack of evidence you may find. The search strategy and literature review can be influenced by the research approach adopted and this chapter introduces the different approaches to research.

Midwifery and research

Midwifery-led research has not had a long history, in fact as late as the 1980s there was a paucity of research in this area. Some early midwifery research studies, such as the routine shaving of women in labour (Romney, 1980), the routine use of enemas during labour (Romney & Gordon, 1981), the use of episiotomies (Sleep et al., 1984) and the routine admission of women in labour (Garforth & Garcia, 1987), are examples of traditional midwifery practices that were found to be of little benefit to women. The publication of Effective Care in Pregnancy and Childbirth, which provided details of several systematic reviews, initially assisted in the dissemination of research evidence to the midwifery profession (Chalmers et al., 1989).

The Midwifery Research Database (MIRIAD) had 393 studies recorded in 1995, whereas at its inception period, 1976-1980, only 21 studies were recorded (McCormick & Renfrew, 1997). Presently it is difficult to determine exactly how many midwifery studies are in the public domain, but an internet search using the term ‘UK midwifery research studies’ on Google Scholar resulted in 38800 hits (not all necessarily research studies); this does suggest that the body of knowledge has increased significantly. More midwives are now in possession of PhDs, both in the academic and clinical environments, and this means that they have conducted a significant and valid research study.

It was not until the 1980s that the concept of research was included in the midwifery curriculum (Macdonald, 2004). Since then it has become an integral element to student midwives’ studies with assignments being based on research critiques or the formulation of research proposals. Post-registration students who are studying at Master’ s level in most universities have to conduct and write up their research study as part of their dissertation.

Students can add to the body of knowledge of midwifery by conducting a research study. An understanding of the research process is therefore essential from an academic viewpoint. However, it is not the academic viewpoint, but evidence-based clinical practice that drives this educational research awareness. In the UK the Nursing and Midwifery Council (NMC) Code (2008) states that practice and care should be underpinned by the best available evidence (Box 1.1).

Box 1.1 The Code: Standards of conduct, performance and ethics for nurses and midwives (NMC, 2008, p. 4).

• Provide a high standard of practice and care at all times.
• Use the best available evidence.
• You must deliver care based on the best available evidence or best practice.
• You must ensure any advice you give is evidence based if you are suggesting healthcare products or service.

Types of research knowledge

As mentioned previously a process needs to be followed and this starts with trying to determine ‘what you want to know’. This sounds easy, but the reality is that this starting point does take time. It is your thinking time, time to put your thoughts into reality. What burning issues do you want to address? What subject or topic are you passionate about? What have you observed in practice that merits further research? At the beginning of each research module, these are the questions we put to the students and the response we usually receive from them is ’it’s not as easy as you think’. Rees (2003) refers to this as the ‘conceptual phase’, where the potential researcher, or in this case the student, embarking on a research proposal is trying to determine ‘what they want to know’ and to refine that further into ‘how do I find out what I want to know’ and so the research process begins.

The next step is trying to work out how you are going to go about obtaining that information. You might want to find out about people’s feelings, experiences of events or circumstances, such as Women’s experiences of obstetric emergencies (Mapp & Hudson, 2005); or how an intervention/treatment can improve care, e.g. Ice packs and cooling gel pads versus no localised treatment for relief of perineal pain: a randomised controlled trial (Steen & Marchant, 2007). Or you might have a general idea but want the focus/theory of the study to be generated by the information you collect (Furber & Thomson, 2006).

The type of knowledge that you want to obtain then determines the type of research approach that you will follow which is also referred to as a research paradigm (or the ‘philosophical underpinnings’!). This essentially refers to the school of thought or beliefs which forms the basis of your research and determines the type of knowledge you want to acquire (Parahoo, 2006). The following terms are associated with this step in the process – paradigms and qualitative and quantitative approaches (Mackenzie & Knipe, 2006). These terms and their definitions can be intertwined and can therefore be confusing to understand, however the following should address any confusion.

Key research paradigms are positivism, post-positivism, interpretivism, naturalism, constructivism, critical and postmodern (Grix, 2004; Blaxter et al., 2006; Mackenzie & Knipe, 2006). The paradigms which appear to be used mostly in midwifery research are the positivist and naturalistic paradigms. They appear to be the two paradigms which hold the most opposing views. The positivist paradigm is considered to be the traditional paradigm u...