The Nursing and Midwifery Order 2001 created the Nursing and Midwifery Council (NMC), whose primary function is to establish standards of education, training, conduct and performance for nurses and midwives and to ensure the maintenance of those standards to safeguard the health and wellbeing of the public. There are specific standards for pre-registration student midwives (NMC, 2009) and student nurses (NMC, 2010) to ensure competency at the point of registration.
The NMC requires student midwives to achieve competence in ‘effective midwifery prac tice; professional and ethical practice; developing the individual midwife and others and achieving quality care through evaluation and research’ (NMC, 2009: 23). In relation to evaluation and research, the student is expected to keep up to date with evidence and, more importantly, should have the skills to critically evaluate research to appropriately apply findings to his or her practice. There is also an expectation to share best practice and disseminate evidence to others for the benefit of women and their babies.
Similarly, nursing students are expected to achieve competence in domains that inform their field of nursing, these being: ‘professional values, communication and interpersonal skills, nursing practice and decision making and leadership, management and team working’ (NMC, 2010: 7). This is against a backdrop that sees health care environments undergoing rapid and ever-present change. The NMC (2010) stipulates that its nursing workforce must be able to respond to the needs of a complex society with a diverse population; employing technological advances to benefit practice development and be part of leading ongoing service redesign. Graduates' skills, learned as part of nurse education, enable them to ‘think analytically, use problem solving approaches and evidence in decision making’ (NMC, 2010: 5) in their role of safeguarding the public.
The research-aware student
The midwifery profession in England and Wales was unrecognised and unregulated until the introduction of the Midwives Act 1902, which led to the setting up of the first Central Midwives Board, whose responsibilities included regulating, supervising and restricting the practice of midwives. The requirement to comply with rules and regulations to gain certification to practice and be admitted to the roll of midwives gradually raised the status of the profession, as new entrants were required to receive hospital training and examination, and women and babies were now legally protected from the practices of uneducated and untrained practitioners. With the introduction of the NHS in 1945 came free and comprehensive maternity care and, in turn, free midwifery training.
During the 1980s, there was growing concern about the direction of midwifery education and reduced recruitment. Research by Radford and Thompson (1988) led to the piloting of seven direct-entry programmes at Diploma in Higher Education (DipHE) level linked to higher education institutes (HEIs). These programmes proved to be very successful and, by 2000, three quarters of midwifery registrants were trained through the direct-entry route (United Kingdom Central Council (UKCC), 1999). All pre-registration midwifery pro grammes are now degree level and, as a graduate profession, newly qualified midwives are expected to have the ability to think critically, evaluate, analyse and reflect on their practice. As the lead professional in providing care and support to women throughout the childbirth continuum, and coordinator of care in complex cases where a multiprofessional approach is required, the midwife must ensure his or her practice is current. In preparation for this responsibility—and to meet the requirements of the revalidation process, once qualified (NMC, 2016)—it is also essential that student midwives acknowledge the importance of lifelong learning.
Likewise, professional nurse education was established as an apprenticeship model in 1860, where student nurses were paid employees, taught in stand-alone schools of nursing linked to local hospitals; with clinical expertise derived from senior colleagues (Bradford, 2001). Teaching was largely focused on rote learning, with little or no scientific underpinning, and where a questioning mind was yet to be seen of value. The status quo remained unchanged until an increasing need arose for nursing to be perceived as a discipline in its own right, to enhance self-awareness and evidence-based practice to inform complex care delivery (Willis, 2012). The solution was to change the nursing workforce and the care delivered via its educational basis, proposing a wide-reaching reform, known as Project 2000 (UKCC, 1986). It was established in 1986 by the UKCC and heralded the move of nurse education into higher education. As a form of nurse education, it ceased to exist following review by the UKCC in 1999, as nurse registrants' fitness to practise at the point of qualification was questioned. The review caused a realignment of curricula to the needs of service provision, with an increased emphasis on practical skills training, multiple routes of entry and the opportunity for continued professional development of practitioners (UKCC, 1999; Lord, 2002). Retrospectively, research indicates that Project 2000 registrants were more evidential in their thinking, with the ability to adapt to and implement change more readily than peers trained under the apprenticeship model; this reaffirmed the value of moving nursing to higher education, despite misgivings (UKCC, 1999; Willis, 2012). More recently, we have seen the introduction of a graduate-only profession where, since 2013, all pre-registration nursing students have been educated to degree level, making this the foundation for nursing practice (Council for Healthcare Regulation (CHRE) and NMC, 2009; NMC, 2010), and perceived as a necessary component to meet the requirements of the contemporary health care agenda.
Students' reflections on studying research methods
The authors of this article, as lecturers, know the importance of studying research methods as part of under-graduate nursing and midwifery programmes, not only to meet the academic requirements of both courses but also because the skills students develop during research methods modules are relevant and transferable to practice. With this in mind, we asked second- and third-year nursing and midwifery students the following questions:
A selection of responses are shown in Table 1.
| Midwifery students | Nursing students |
|---|---|
| ‘Research methods were a tough aspect of the course to begin with. I think the majority of the cohort struggled to grasp the importance of research in midwifery. However, the passion of our tutors soon got through to us and we started to see the application of research in every aspect of our practice. Everything you do as an autonomous practitioner is around evidence-based practice and the only way this comes to light is through research. Research is certainly not to be underestimated.’ |
‘Everyone involved in evidence-based care needs to understand research methods before implementation of research into practice. It is vital for service improvement as care cannot be improved unless a solid argument has been made for a new way of working. Furthermore, being able to understand research methods enables us to undertake research which is vital in the progression of care and treatment development.’ |
| ‘For me, research studies were a bit of a foreign topic. The last time I had done anything like that was 8 years ago during A-level psychology! It took a while to get my head around all the different terms, but as my lecturer suggested, I stuck definitions of some of them around my flat so I would see them frequently. I think nurses and midwives need an appreciation of research methods as it enables us to deduce whether a piece of research is of a high enough standard to apply it to our practice. You wouldn't want to base an area of your practice on a study that only had two participants who were heavily influenced by the researchers themselves, would you? In this way, studying research methods has enabled me to appreciate the critiquing skills that I use now, and will continue to [use], to deduce whether research should influence my clinical practice.’ |
‘Evidence-based practice has been one of the most-used phrases from day one throughout my nursing education. Lecturers explain what being “evidence-based” means and how important it is as a tool in academic work as well as in practice. In year two, you become the critical thinker that the first year was preparing you to be, and to analyse the information that you are given and you are finding, while developing your confidence and using the knowledge to make clinical judgements. Nursing is a never-ending learning curve—nursing education gives you the skills to know what to do in situations where you are unsure of what to do, and also the ability to keep up with new evidence and approaches that aim for better quality of care and health outcomes throughout your career.’ |
| ‘At the beginning of our research module it felt that the topic was so far away from what I had expected to be learning in my midwifery degree. However, as the module progressed, the importance of being able to distinguish quality research became clear. As midwives, we must base our practice on the best available evidence and learn to use the skills we develop as students to critique pieces of research. This ultimately allows us to decide what is credible and can be incorporated into the care we provide alongside guidelines and policies. In this sense, I also believe that having these skills helps us to protect and promote a midwife's autonomy.’ |
‘I feel that the skills learned through doing the literature review have prepared me for my dissertation as well as going into practice. I feel it has enabled me to look and think about the research from a different perspective and how patient care can be improved upon. An example of this could be as small as providing the patient with appropriate additional information to help the individual understand the treatment and care being given. This in itself provides both education and reassurance to the patient regarding their health and wellbeing.’ |
Conclusion
Service users expect and deserve high-quality care delivered by well-trained health professionals. By being educated to degree level, nurses and midwives have been trained not to practise by rote or tradition; rather their pre-registration education has equipped them to question the practice of self and others in order to ensure it is always based on best evidence. How do they know it's the best evidence? The inclusion of research methods modules in both undergraduate programmes provides student midwives and nurses with transferable skills, giving them the tools and confidence to be critical, to analyse, to evaluate, to question, and to be autonomous practitioners. As a result, service users can be reassured that they are receiving high-quality care based on the best available evidence. It is reassuring that the responses from student midwives and nurses in this article validate the inclusion of research methods modules in their programmes of study. For some, the link between theory and practice was not immediately obvious; however, in time, students from both disciplines realised that the skills acquired by studying research methods inform and enhance their clinical practice and, as a consequence, have a positive impact on the experiences of service users.
Research methods modules provide student midwives and nurses with transferable skills, giving them the tools and confidence to be critical, to analyse, to evaluate, to question, and to be autonomous practitioners