Thursday, October 30, 2008

Beyond today - shaping the future

I have been asked to give a presentation next week in Surfers Paradise, Queensland at the 2008 Community Care Conference. The conference delegates are people who work in aged and community care. The invitation comes following a presentation I gave to Aged Care Queensland, back in July when I talked about setting up an e-mentoring program for supporting staff. On Thursday my talk is titled "Are you networked? The potential of computer-mediated social networking for supporting practice."

I have 30 minutes including time for questions, to introduce people to the concept of 'web 2.0' and how they can use it for professional development, life-long learning, communication and collaboration. I don't have a lot of time, so thought I'd talk about:
  • the principles of web 2.0 ie sharing, collaboration, freedom, collective wisdom/intelligence, participation, networking and openness;
  • how the tools can be used - advantages of social networking in terms of professional development, support, life-long learning, connections, development of communities of practice which all hopefully lead to greater job satisfaction and increase of recruitment and retention, especially for people who work in rural areas;
  • challenges that need to be overcome in terms of computer and Internet access (infrastructure and policies), attitudes, skill levels, quality of information, confidentiality and privacy.
Concluding advice
I thought I would conclude my presentation with five top tips for health professionals and five top tools to use. These are my thoughts based on the work of Sue Waters "Listen to the wisdom of your network", Clinical Cases and Images "5 Tips to Stay Up-to-Date with Medical Literature" and Maged Boulos "e-health and web 2.0/3-D Web: Looking to the future with sociable technologies and social software".

5 top tips for newbies
  • Takes time to build up a network.
  • Social networking isn't 'playing' but is legitimate 'work' and learning.
  • Takes time to see the value of the tools and become competent at using them. Worth becoming reasonably competent them before you introduce them in the work setting.
  • Start introducing social networking by using tools that people quickly can see a direct benefit eg wiki or Google documents for collaborative work such as policy development.
  • Give it a go, keep an open mind, don't be frightened of it.
5 tops tools to get you started
  • Blog - start your own, read and comment on other people's blogs.
  • Wiki -collaborative platform.
  • Delicious - social bookmarking, sharing resources.
  • RSS feeds using readers - keeping up to date.
  • Skype - synchronous communication, free, web cam.
What tips or tools would you recommend for health professionals who are new to web 2.0 and social networking? Do you agree with the list, or would you suggest other tools and tips?


Wednesday, October 29, 2008

History of midwifery

I am really loving Holly Tucker's blog: Wonders and Marvels which deals with historical information about things like midwifery, childbirth, contraception and early medical experiments. One of her latest posts talks about early midwifery and how the umbilical cord was viewed.

Monday, October 27, 2008

Midwifery and ePortfolios

Last night I facilitated an online discussion about portfolios, ePortfolios and midwifery as part of the M503.7 'Reflection on Practice' Course. I advertised the session as an open session and we were lucky to have Alison Miller, Lenva Shearing and a midwife from the UK (who is moving to New Zealand and wanted to connect with local midwives) attend the meeting.

Sharing and caring
There wasn't a firm agenda other than to discuss the issues related to keeping a portfolio and the conversation quickly turned to ePortfolios. We agreed that a professional portfolio was a great central point for storing information and underpinning reflective practice. But there seemed to be a theme about time - we find it difficult to find the time to quietly sort out material and reflect. Or rather, we're not motivated to do it, and lack of time is an excuse? So it was suggested that we might be more motivated to keep our portfolios up to date so that they are more effective learning tools if we shared our reflections, experiences, learning and portfolios. And this is where one starts to see the advantages of an ePortfolio because sharing is possible in a way that it isn't with paper portfolios.

Developing midwifery ePortfolios

A few of us have started developing our own ePortfolios and blogs using platforms like Wikispaces. At the moment in New Zealand, there is no national ePortfolio system for midwives, although I understand Midwifery Council is starting to think about how an ePortfolio system can be implemented. Any such system would have to be carefully integrated into Midwifery Council's present systems and some thought would need to be put into issues such as storage space, access and funding. Further to that, if ePortfolios are brought into undergraduate midwifery education, I feel we need to make sure there is consistency between education and the profession so that students are able to seamlessly integrate the portfolio they have developed as a student into their lives as registered midwives.

ePortfolios for life-long learning
Following the theme of seamless integration of portfolios and life-long learning, it was fascinating to hear from Lenva, who is an assistant principle of a primary school in Auckland. Lenva talked about how ePortfolios are being brought into New Zealand primary schools so that every pupil will eventually have their own online space. So while we're thinking about integration of the ePortfolio from undergraduate midwifery education to professional life, what actually needs to happen on a national level is discussions about how ePortfolios can be integrated from kindergarten onwards. And I would think that the implication of these discussions will have to be addressed at government level. So whilst I have no direct contact with child education at the moment, I can see why it is important to monitor what is happening at school because it will have flow on effects for me as an educator in the tertiary sector.

Emergence of a community of practice
Alison, who is very involved in ePortfolio development in Australia, challenged us as a group about how we will continue to work together on developing our ePortfolios once the 'Reflection on Practice' course has ended in two weeks. There appears to be some enthusiasm for this which looks like developing into a community of practice. This is a most unexpected outcome of the course, but one I sincerely welcome. Alison has recommended that we look at Skillsbook, which is a free ePortfolio platform that would encourage group sharing. I am wondering about platforms such as Facebook, Ning, Wetpaint and Elgg - how would these platforms work in our midwifery context?

National experts
Personally, I am happy to do my own thing and not be tied into a specific platform or format. But I also understand that concerns about privacy and confidentiality will drive moves to a particular platform. If this new community of practice wishes to become involved in national discussions about ePortfolios, then it is important that we look at the issues from all angles, and 'have a play' with different models.

What are your experiences of ePortfolios? What issues do you feel we, as health professionals, need to consider?

Meeting link
If you are interested, here is the link to the recording of the Elluminate meeting:

Image: 'Tickler File and A-Z reference' Stephanie Booth

How spontaneous and serendipitous can we be online?

Next year marks the start of our new midwifery program that is to be delivered in a blended mode. We will have several face-to-face 'intensive' sessions during the year with students, but the rest of the material will be delivered online.

Implications for work
This will mean that we, as lecturers, will have the ability to be more flexible about when and where we 'work'. With the cost of petrol and maintaining a car, as well as the increasing difficulties of finding a parking space, I suspect we'll find it very attractive to spend more time working at home.

Losing spontaneous and serendipitous communication
But there are concerns about how that will affect the way we work and interact. In particular, there are concerns about the loss of elements of face-to-face communication that we take so much for granted - those spontaneous and serendipitous moments that happen as we pass a colleague's desk, meet in the tea room, or a bump into a student in the toilet. For example, the other day I was concerned that I was losing control of an online discussion with students - it was heading in a direction that I didn't want it to go. This was at the back of my mind when I was talking to a colleague about a presentation she was giving at an upcoming midwifery conference. And it dawned on me that I could take the approach with my students to re-focus their thinking that she was taking with her presentation. But would that have happened if we were at separate locations, working in an online environment?

Different way of being?
I would say that we have to re-think the way we are and the way we 'work'. This will include re-thinking the way we communicate online and the tools we use. It will mean that we have to move from asynchronous communication with email and discussions boards to synchronous communication using tools such as Twitter, Gmail, MSN, and Skype. And that means keeping those communication tools open all the time we are 'working' - keeping the web cam attached to the computer and headphones alongside us.

Talking to nurses in the USA
A wonderful example of this spontaneous, online 'way of being' happened the other day. I was sitting at home, still in my pajamas mucking around on the computer and I was called by Bill Perry on Skype. One of Bill's roles is to teach health informatics to student nurses at the Wright State University College of Nursing and Health, Dayton, Ohio. He wanted to illustrate how Skype worked to his students and asked me if I could spare five minutes to talk to them with web cam about how I envisioned Skype working in my midwifery context. So that's what I did. I had fun because we ended up talking about midwifery in New Zealand, and Bill appreciated the help with giving a context to Skype which I am sure was interesting for the students. It was a spur of the moment, spontaneous event that would not have happened if I hadn't had Skype open.

Setting boundaries
I acknowledge that there has to be some boundaries around this 'availability'. When I am working in the office, there will be times when I make it quite clear I do not want to talk to anyone, colleagues or students, because I am concentrating on a particular task. And the same will apply to working online.

Nevertheless, I firmly believe that it is possible for computer-mediated communication to be as engaging as face-to-face communication, but it doesn't just happen by itself. We have to change our attitudes about how we use our computers to communicate; become familiar with the tools that support synchronous communication, and get out there and network with people who it is worth being spontaneous with.

What tools for synchronous communication do you like to use? What's your favorite online spontaneous /serendipitous moment that you can recall? If you are a person who does a lot of online teaching, what tips would you give me as I move from face-to-face classrooms to an online environment, especially around maintaining relationships with colleagues and students, and getting the most out of synchronous communication?

Sunday, October 26, 2008

Reflection, philosophy, midwifery and Wordle

I love Wordle but have been racking my brain to think how I could use it. Rodd Lucifer has kindly produced some suggestions on his blog "The Clever Sheep".

Wordle and comments
Rodd's second suggestion was to paste an online discussion into Wordle to see what the themes are. So, here are the themes from a couple of online discussions I have been having with midwives about reflection and philosophy of practice.

The words that stand out to me are believe, feel, time, work, women, professional, care and think. The biggest surprise to me is there is no mention of 'partnership'. Yet, that is seen to be the core tenant of midwifery practice in New Zealand.

What words would you have expected to have seen there, if you are a midwife? What about your philosophy of living or working if you're not a midwife - what are key words for you?

Saturday, October 25, 2008

Putting a professional portfolio together

Here are a few slides about how to put a professional portfolio together. The presentation is targeted at midwives but is relevant to anyone interested in portfolios, particularly in health.

About professional portfolios

I am hosting an online session about professional portfolios on Monday 27th 7.30pm New Zealand. Click here for international times.

The session will deal with how to put a portfolio together, and share tips and advice. The meeting is aimed at midwives, but anyone is welcome to come if they have an interest in portfolios, ePortfolios and professional development.

The meeting link is:

What happens when you let a man get his hands on a chain saw

It's all my fault!... I take the blame!... I should have known better!

I know what men are like when they get their hands on big mechanical tools that make lots of noise.

But no...I let my hubby and next-door neighbor go out into the garden...with a chain prune a tree, and supposedly just lop off a couple of branches.

The next thing I know, the whole tree has disappeared and now there's a great gap in the middle of the garden!

Ladies, what do you think men should be banned from having access to?

Monday, October 20, 2008

Reflection on Practice: end of week three

I cannot believe how fast time has flown and that we're nearly half way through the 'Reflection on Practice' course. This week has been an interesting week in which we have explored what reflective practice means on a personal level in relation to theory.

Theoretical perspectives

One of the main resources I have pointed students to is the Preceptor Education Program. This is an online program that prepares health professionals for working with students in the clinical context. The modules I have incorporated into my course are modules 5a Fostering Reflective Practice and 5b Advanced Topics in Reflective Practice. These modules work you through the theoretical frameworks, shows video exemplars and works you through reflective exercises. I think these modules are extremely useful - it will be interesting to get feedback about them.

Telling stories
We had another enjoyable online discussion last Monday in which we discussed reflective practice and three types of reflection: technical, practice and emancipatory. The thing that struck me about the session was the total honesty of the midwives, and the stories they told illustrated the different types of reflection so well. I was concerned that I would not have interesting stories to illustrate the theory, but actually the midwives told their own stories which made life so much easier for me to 'teach' the theory.

But again, I wondered about the issues of privacy and confidentiality in an open environment. I advertised the session on this blog but no 'outsiders' attended. I made the decision not to openly publish the recording because I felt the discussions were too personal. What I found particularly interesting was the results of a quick poll following the session in which I asked how the students would feel about the discussion being in an open environment: one person felt that it would be a good way to teach/learn; two students didn't like the potential of consumers or media joining the discussion; and two students had mixed feelings about it. None of the students replied that they would have been happy if other midwives or students had joined the session. I was expecting for 100% of the students to say that they wouldn't have liked the discussions in an open environment, but actually opinions were divided.

I think what this shows is that there are open minds about the whole issue of 'openness', and that we should not automatically fence ourselves in when it comes to talking about midwifery practice online. I believe there is a time and place for open reflection, and what we have to do is work out our boundaries around what is open and what we do in a more restricted, private place.

E-portfolios and blogs
The other thing that this week has been exciting is that a couple of students have set up their own blogs which they are planning to make into e-Portfolios. So please pop along and say hello to:
What I am loving is seeing how they are flying with their ideas and use of technology. For example, they have been playing with Glogster, which I had never heard of, but I really like how it works in a portfolio format.

Random thoughts

  1. Sending texts the day of the Elluminate session acted as effective reminder for people.
  2. Need to do some reading around assessing comments and online participation in a course.
  3. Need to start thinking about privacy issues of an open online professional portfolio, and how midwives can deal with them.
  4. Connecting people to my blog as well as the course blog has been a little confusing, and some people have been unsure exactly which was the course blog and where they should be commenting. Will have to keep this in mind another time.

Image: 'Seeing You' sgs_1019

Being a responsible gardener

A couple of months ago I was thinking about what I should do with my garden. I had a number of grand schemes but my darling husband said that I had to prove I was a responsible with the little bit of garden I had before he would 'allow' me to become a kiwi version of Percy Thrower.

Not too ambitious
So I got out in the garden yesterday because it was such a beautiful day, and had a good old tidy up. I've planted some bedding plants, lettuce and parsley. And in the next couple of weeks I'm going to plant some potatoes, tomatoes and rhubarb. That should be enough to keep me out of mischief.

The fun thing about yesterday's gardening session was that the tools I used were given to me (by way of gift vouchers) by various women and families I have looked after over the years as a midwife. So I had a lovely afternoon communing with nature and reflecting on life as a midwife.

Now I have to concentrate on keeping the slugs and weeds at bay. Any tips on how I can protect the plants from slugs without harming my local hedgehogs?

Friday, October 17, 2008

Understanding deafness

I'd be the first to admit that I take my health for granted. And I guess the things I pay least attention to are my five senses. I don't even have to wear glasses for reading, which is weird because my two children have terrible eye sight and wear glasses/contact lens all the time.

Taking my hearing for granted
But I have become very aware of my hearing over the last few days. I have an ear infection that shows no signs of abating despite two different types of antibiotics. This has left me with severe tinnitus and deafness. It has also left me with a much greater awareness of the problems that deaf or partially-hearing people must suffer.

Feeling sorry for myself
I am finding it difficult to use the telephone and cannot use headphones to communicate on Skype, Elluminate and Second Life. I cannot hear unless people talk loudly and face me when they talk. I cannot bear noise from more than one source, and I cannot cope with noisy crowds. But the thing that perturbs me most is the impatience people show me when they have to repeat what they say, and the way people make fun of me. It's as if they think I have suddenly become stupid or mentally-deficient, and treat me accordingly.

Lucky one
Of course, I'm lucky. My hearing will eventually return once I get better. But deaf and partially-hearing people have to live with this all the time. This illness has certainly made me think very carefully how I communicate with deaf people. And it's made me really appreciate a gift that I cannot see, but I rely on so much.

Has there ever been a situation that has happened to you which has changed your attitude to your health? What do you really take for granted?

Image: 'Transmission' CarbonNYC

Wednesday, October 15, 2008

Blog Action Day 2008: poverty and invisible death

Today is Blog Action Day 2008 and bloggers all over the world will be focusing their thoughts on poverty in an attempt to raise awareness.

When I first heard about this action I wasn't going to join in. But I have been following various discussions on the Global Alliance for Nursing and Midwifery, sponsored by the World Health Organization. And an email allerted me to an article that really struck a cord with me.

A mother's final look at life
The article is written by Kevin Sullivan and published in the Washington Post. The article describes the death of an 18 year-old woman in Sierra Leone following the birth of her first child - she died of severe bleeding following the birth.

According to this article, the chances of a woman dying during childbirth in the USA is 1: 4,800. In Ireland it is 1:48,000. In Sierra Leone, it is 1;8.

Worrying about chickens
There's been a lot of publicity and television programs led by people such as Jamie Oliver, urging us to think about the conditions that chickens and animals are kept in. And only the other day I went out and bought free-range eggs, although I did moan about the price. But made me feel very good - I am doing my 'bit'.

But I wonder...if we in the developed world put half as much of our thoughts, energy and resources into saving women's lives as we do into saving chickens, I wonder how much better life would be for impoverished women.

Invisible death
The point Sullivan makes is that money is poured into projects combating malaria, TB and HIV-AIDS. But little attention is paid to maternal death. Sullivan goes on to quote Thoraya A. Obaid, executive director of the U.N. Population Fund:

Maternal death is an almost invisible death

So have a read of the article and watch the accompanying video, and consider all the woman who lose their lives in childbirth, so that their deaths do not stay invisible.

Thank you to Patricia Abbott who drew my attention to the article.

Monday, October 13, 2008

Is midwifery a word?

Those of you who have been following this blog for a while will know I am currently boycotting 'Private Practice'.

This is why!

Am I about to become a video star?

Only one more sleep before I find out if I'm going to be a video star or not in the New Zealand YouTube political debate. I thought I was in with a chance a week ago, but I'm not holding my breath now.

If you haven't voted for me yet, pop along to my video where I ask a question about health care, even if you think I'm rubbish (and the question is rubbish)! Please do your bit to help me find my dream.....of being on TV! Cos the chances of me being on 'Wife Swap', 'Who wants to be a millionaire' or 'New Zealand has talent' are getting more and more remote.

(That is the end of the political party broadcast on behalf of Sarah Stewart. At no time has she accepted bribes, although she would, if she were offered one!)

Sunday, October 12, 2008

Role of the doula in today's maternity services

This month's free online seminar is looking at one aspect of provision of maternity care and is of interest to anyone involved in maternity and childbirth either as health professional or consumer.

Despite the superior care that women and their families receive during the childbearing year from a midwifery model of care, a doula can be a great asset to the family and their care provider. Many people question the choice of using a doula. The phrase "have a doctor, get a doula!" is well understood. But "have a midwife, get a doula?" Why? The reasons are many.

Unfortunately, I am coming from a country where the ‘norm’ is the medical model of care during the childbearing year. I hope to elaborate that even if we are lucky enough to have obtained midwifery care, a doula can be invaluable not only to the mother and her family but to the midwives as well.

Kirsten, who lives in Canada says: I am a mother to three, my first child turned to breech (bottom first) during labour. He was taken by cesarean section which was a very difficult recovery, both mentally and physically. My next two children were born at home with registered midwives and a doula. I took up doula training with CAPPA during my third pregnancy and have been attending births since before and after my daughter was born. I also took training through the Manitoba Association for Childbirth and Family Education where I attend education evenings on a variety of subjects throughout the year. I have presented on the troubling trend in cesarean birth for one of these educational evenings. I am fiercely passionate about reversing this trend here of surgery as birth in North America . I have about ¾ of my university degree in Comparative Religion and have also worked extensively in Hospice Care before having my children. I just bought a new spinning wheel, Ashford Kiwi to be specific... so a New Zealander will be in attendance at the meeting from my dining room in Canada.

Date and Time: October 16th 3pm New Zealand Time: International Time

Meeting Link:

You do not need a password - just add your name.

The meeting room is currently open so please feel free to go and have a 'play'. For more information about how to use Elluminate, please click here.

Reflection on Practice: starting to rock

This is the end of the second week of M503.7 Reflection on Practice, which is the online course I am running for registered midwives: we have been exploring our philosophies of practice. I have felt rather disconnected from things this week because I have been unwell. But at least I haven't needed to struggle to a face-to-face class to deliver material.

Elluminate meeting
The week started off with a hiss and a roar, with our first Elluminate (online web conference) meeting.
  • Used cellphone text to remind everyone about the meeting
  • Rang the students before the meeting I knew had not previously connected with Elluminate to offer technical support, but in fact all offers were declined.
  • I chose to have the meeting in the evening, hoping that this would better suit people who worked during the day. Everyone was able to attend apart from one midwife who got caught up at work.
Computer skills
I was totally blown away by the ease with which the students took to Elluminate. We did not have one technological problem. YEY! At this point I would like to thank David McQuillan who volunteered to stand by on Skype in case I needed a hand.

In the previous week's survey I asked students about their computer skills. One student felt very confident; four students had basic skills but felt they would need help with Elluminate; one student felt she would need help with everything. But the way the students took to Elluminate makes me think they under estimated their abilities. Having said that, a few students have had previous experience with Skype, so they were able to transfer their skills.

This leaves me with the question: is computer literacy for midwives more about confidence than competence?

The first session
Instant messaging was no problem. Nearly all the students had microphones so could talk, and those who didn't have one said they'd get one. We had a play with the white board to brainstorm our philosophy and we uploaded photos of ourselves.
  • I went over time and finished nearer 9pm than 8.30. By that time I was getting tired, and I think the midwives were as well. Action: Keep to time because I think one hour is more than long enough for an online session without break.
  • I used a class whiteboard brainstorming session to try and break things up, and appeal to visual learners in the group. I didn't feel the whiteboard exercise went as well as it could - the result wasn't half as pretty as I have seen when experts like Nancy White has done it. But then, this is the first time I have used this exercise. I might need to give better instructions and have a clearer idea of what I want to achieve next time. I left this segment to the end and ran out of the time to do the session justice. I also have to recognize that I am not a very artistic person; I see things in words as opposed to pictures, so I don't feel as comfortable with this teaching method. Action: Learn more about facilitating online whiteboard, brainstorming sessions, and keep honing my skills.
  • Need to learn how to capture the whiteboard as a screen shot.
  • I advertised the session at the last minute on my blog, and was surprised that the session was attended by an undergraduate midwifery student. From my point of view, I thought that worked really well. The midwifery student was able to add a fresh perspective which I found uplifting, speaking as an 'old' midwife who gets quite tired and cynical at times. I think the other midwives enjoyed this as well. I haven't had any feedback to gainsay that. But then again, would the midwives feel able to give that feedback knowing that I am so keen to promote open networking? The motivation for the student attending the session was that she had an assignment on reflective practice coming up, and wanted to know a little more. I am not sure how helpful she found it, but she stayed for the whole meeting which was fabulous as far as I was concerned.
  • I recorded the session for the midwife who was unable to attend. But I haven't published the recording to the open environment because we did talk about some personal things, which is what you'd expect in a discussion about personal philosophy of practice. I'm the first to admit that some things just must stay within the class.
  • Anonymous feedback from the survey shows three students thought the session was great and cannot wait until the next one.
Developing a community of practice?
I don't think we are developing a community of practice, but I thought there was a community feel to our meeting, which I do not see so much in our asynchronous blog discussions. Everyone joined in with discussion and chat, whereas the course blog discussions are mostly between two or three people. It will be very interesting to see what form of communication the midwives feel more comfortable with, and most beneficial for their learning.

What form of communication do you prefer as student and teacher, particularly in regards to the facilitation of learning; synchronous (voice/video) or asynchronous (email/blog/discussion board)?

Image: 'group airtime' *vlad*

Saturday, October 11, 2008

Journaling and reflective practice

Here are a few thoughts on how keeping a journal can help you develop reflective practice skills.

Is there anything you would add to this presentation? Do you journal? What do you feel are the benefits? What would be the barriers? How does your blog take the place of a paper journal?

Midwives rock!

Carolyn and I have both blogged about the latest Cochrane Review that has come out firmly in support of midwifery-led care, showing that we have the best outcomes compared to other forms of maternity care.

I illustrated my post with a photo of me holding a cute baby. But Carolyn went one further and posted an absolutely gorgeous video. So, I make no apologies for nicking her resources and idea.

Cochrane and midwifery-led care

The Cochrane Collaboration is widely considered to be one of the gold standard tools for evidence-based practice. It is a charity organization based in the UK that regularly carries out systematic reviews on health care practices and interventions. In other words, a panel of experts looks at all the research published (and sometimes unpublished) pertaining to a particular issue or treatment, evaluates all the results to come to a definitive decision about its effectiveness. Often that decision is that there is not enough research to be able to say one way or another. Other times, the way forward is clear.

Highly regarded

The idea is that the Cochrane is completely neutral and carries out unbiased reviews, which in turn can be used as evidence for health professionals and consumers when they are making decisions about health care. Now, I am not sure that there is a completely bias-free 'anything', but that's another conversation. Cochrane Reviews are highly regarded internationally, so they are one place to start when you are researching the effectiveness of particular treatments.

Free access
In New Zealand, free access is provided to the Cochrane Library via the Ministry of Health. I would highly recommend that you have a look at it. And for health consumers (and me), the reviews are summarized in 'plain language' so that we get past the difficult medical and statistical terms to reach the message of the review.

Midwifery-led care
For as long as I can remember there have been discussions, research studies and arguments about the effectiveness of midwifery-led care compared to doctor-led care. And as you can imagine, midwives say midwife-led care is safe, and doctors maintain that every pregnant woman should be overseen by a doctor. OK, that is a over-simplification, but it isn't too far from the truth.

What is midwife-led care?
By midwife-led care, I mean that the midwife is the primary care giver, as in the maternity system in New Zealand. In other words, when you or your partner get pregnant, you come to me as a midwife and I organize and provide your care from confirmation of pregnancy to discharge after the baby is born. If you are fit and healthy, and you have no complications during your pregnancy or when you have the baby, you may not get even a flying glimpse of another health professional. But if you have a medical condition, or if you or your baby develop complications then I would refer you to whatever health professional is appropriate.

At the center is the concept of midwife-led care is continuity of care and career. You have the same few people look after you throughout your birthing experience instead of a merry-go-round of health professionals who you do not know from one clinic visit to the next.

Midwife-led care is safe
So it is very heartening to see that the latest Cochrane Review which looks at midwife-led care concludes that it is safe and should be recommended for all women.

The main finding was that women are less likely to have a miscarriage before 24 weeks pregnancy, which I must admit I don't quite understand. The other findings are that women are more likely to have normal births and initiate breastfeeding when they have a midwife looking after them. And they are less likely to have regional anesthetics like epidural, instrumental deliveries ie forceps and ventouse, and less likely to have episiotomies.

Challenge for New Zealand midwives
This will be especially good news for women and midwives in Australia who working to implement more midwife-led schemes. As for us midwives in New Zealand, we need to keep looking at our practice and how we can work to lower intervention rates and an ever-increasing cesarean section rate.

More funding for midwives

This week it has been announced that there will be an additional $1.7 million funding for midwives, to cover professional development, post-graduate education, support for overseas midwives and promotion of midwifery as a career.

Support for ongoing education
I am a little behind with the play this week because I've been sick, but I am sure that midwives will be very happy to hear about this move. In the past we have been woefully ignored eg the Clinical Training Agency funds on-going training and education for doctors and nurses, but we have barely figured on their agenda. However, this initiative alongside the funded program for new graduate midwives will hopefully go some way to level the playing field.

Recruitment campaign
What I am wondering is what form the recruitment campaign will take to encourage young women into the profession. I am especially interested because I have a daughter who has been playing with the idea of becoming a midwife for some time, so I am cognizant of the issues involved.

If you are a young (or not so young) woman (or chap, for that matter), what would attract you to the midwifery profession? And what would prevent you?

Wednesday, October 8, 2008

What is reflective practice?

I am going to be facilitating an online discussion about reflective practice as part of the postgraduate course I am running for registered midwives. We'll be looking at what reflective practice is, and briefly discussing some of the theoretical perspectives.

You are very welcome to join us at 7.30pm Monday 13th October New Zealand - International Time.

Meeting link:

Please click here if you need information about how to use Elluminate which is the web conferencing program we will be using.

Image: 'Hope springs eternal' Pandiyan

Monday, October 6, 2008

What is your midwifery philosophy?

This is probably too short notice, but I'll go ahead anyway and extend an invitation to join me and the students taking part in M503.7 Reflection on Practice. We will be discussing what our midwifery philosophy is and how we have come to develop it.

The meeting is being held tonight, 6th October 7.30pm New Zealand: International Time.

The meeting link is:

You do not need a password, just add your name.

Sunday, October 5, 2008

YouTube and the New Zealand Election 2008

The election in New Zealand is coming up, and One News have collaborated with YouTube for the leaders' debate.

All you have to do is shoot a 30 second video asking a question for the political leaders, and upload it to the special site here. If your question gets lots of votes, it will then be put to the politicians on TV in a couple of weeks. Have a go - I dare you!

Here's my video. It took ages to think of a question, and even longer to film it. It's not a very exciting question, but I hope you'll vote for it so that I can become famous on TV!!

Saturday, October 4, 2008

Reflection on Practice: up and running

The first week of the online course I am teaching M503.7 'Reflection on Practice' is coming to a close and everything seems to be on track. Nearly everyone has logged into the course blog, and already people are 'playing' with Elluminate and Skype.

The future for midwifery
I have been surprised but thrilled at how willing the midwives have been to engage with the blog and technology. And a strong theme has been an acceptance (even if it is a reluctant one) that the Internet and computer-mediated communication is the future for midwifery professional development. At the same time, there are a couple of students who only have very basic computer skills at the moment.

Thoughts for consideration
A couple of things have struck me in the lead up to this course and over the last few days.
  • Computer skills. Not everyone has my level of computer skills so it is really important to provide information about the most basic of tasks like making an account, logging in and commenting on a blog. I have tried to keep things as simple as possible and not bombard people with too many technologies. I have provided access to different tools such as a Delicious tag that provides access to resources, YouTube and Slideshare but I have not made it a course requirement that students have to engage with all these tools. What I am hoping is that students will recognize the benefits of some of these tools as I model them in the course, and go on to explore them in greater depth once the course has ended.
  • Scaffolding. Essential to check in with students by phone to make sure they have connected with the course and are able to engage with the technology. This may mean talking them through things step-by-step. At the beginning of the course, that also may mean a degree of flexibility on my part, ensuring I am available in the evenings when students are able to look at the course.
  • Pre-existing knowledge. It's really useful to survey students as you go along to get a feel for where they are at with their computer skills and understanding of the subject. Last week's survey was about students' use of portfolios: nearly all of the students had portfolios but they needed to be updated.
  • Lowest common denominator. Look at things from a student's point of view. This means checking on things like appearance of course blog on different screens and computers; making allowances for poor Internet connection; checking to see how long videos and slidecasts take to download on a slow Internet connection.
  • Time schedules. Being mindful of students' time frames for online meetings. For midwives, this means being flexible and probably having meetings in the evening as opposed to during the day when they are busy with clinics, home visits etc. It is also essential to record online meetings for people who can't get to them, especially when midiwves get called out unexpectedly to births etc.
  • Learning styles. I have provided a widget that allows students to make a web page into a pdf so they can print it off. This is in response to a learner who prefers to read from paper as opposed to the computer screen.
  • Monitoring progress. I have found it useful to keep a basic database to monitor people's progress with regards to engaging with the technology, as well as their learning activities.
Podcasts and Twitter
One of the tools I haven't looked at are podcasts. I am thinking that they would be really valuable for midwives because they are so mobile. Audio podcasts could be an extremely effective way to get information across to midiwves, especially those who spend so much time driving around in the car. The other tool that may be useful is Twitter as it is a tool that can be used on a mobile phone which is one technology that all midwives are familiar with. But that is a thought for another day.

Plans for next week

The next hurdle is getting everyone into Elluminate. And I would like to see the midwives who are more experienced with technology and e-learning hook up with those who are less confident. That is already starting to happen, but I need to make sure that everyone has the chance to participate in this form of peer-to-peer mentoring if they wish.

I'd love to hear any comments about from people who are designing and facilitating online courses - what would be your best tip? If you are a student, what helps enhance your experience of online learning?

Image: 'A Brand New Day' Thomas Hawk

CCK08: When connectivism doesn't work

I have been thinking all week about connectivisim, and acknowledge that my online network plays a huge part in my learning these days. However, I am also conscious that there are a lot of people who do not want to engage with the concept for whatever reason.

Pre-conditions required for networked learning
Shelly Q has done a great job of summarizing some of the pre-conditions that need to exist before networked learning can flourish including a willingness to trust the other nodes of the network, willingness to fail as well as admit when you are wrong.

When people cannot network
I have gone a step or two further and would like to ask how learning can be supported in environments where networking, especially online networking, just will not be allowed. In particular, I am thinking about the prison environment.

Learning in prisons
There is a desperate need for education to be provided to prisoners because so many of them have only very basic literacy skills. And certainly that appears to be a focus in New Zealand prisons. But how would you use connectivist principles to support education in an environment where people are not allowed access to the Internet and are actively discouraged from networking. And how would you 'teach' if you could not access the tools that connectivism relies on such as email, Skype, YouTube and so on.

Any ideas?

Images: Alcatraz, San Fransisco

CCK08: Learning networks for health professionals

I have been asked to give a presentation at the 2008 Community Care Conference in Surfers Paradise, Queensland in November. The conference theme is 'Beyond Today-Shaping the Future'. I have been asked to talk about how Web 2.0 and networking can be used for professional development and life-long learning. The premise being that if health professionals feel supported and feel they are learning and growing in their jobs, they will feel greater job satisfaction which will turn will improve recruitment and retention.

Using my network
So I was going to put a question out to my network asking what people thought should be included in my presentation, keeping in mind I only have 30 minutes. But Sue Waters has beaten me to it by asking similar questions.

So you'd be doing me and Sue a huge favor if you answered her quick and easy survey about how you have built your personal learning networks - click here to do the survey. Sue will be feeding back the results of the survey on her blog: Mobile Technology in TAFE.

Meanwhile, I'd love to hear from you and what you think about the benefits of networking for health professionals, how you do it yourself and what tools you would recommend for newbies. I'd also appreciate any suggestions for how I can wow the audience, visually.

Wednesday, October 1, 2008

CCK08: Who owns the knowledge?

If my experiences in open courses like 'Facilitating Online Communities' and 'Connectivism and Connective Knowledge' are anything to go by, I could be forgiven for saying that online open access education had well and truly arrived. Indeed, educators such as Graham Attwell, who has talked about the 'explosion of open learning' in his latest blog post, appear to agree. And my own boss, Phil Ker has recently announced that my institution, Otago Polytechnic, will be anchoring an International Centre for Open Access Educational Resources.

But I am wondering if we are deluding ourselves about open access in the formal education context?

Concerns about open access courses
Over the last few weeks I have heard a number of comments about open access courses.

There are what I considered to be superficial concerns like students being overloaded with information if the course gets too big eg too many emails. That is an issue that can be managed, which in itself is part of the learning experience. Another concern is about the extra work that having an increased number of students, formal or otherwise, may place on the teacher. Certainly I don't want to take on extra 'work' that I am not being 'paid' for. And we may need to re-think what we consider to be 'work' and 'teaching', and that will have to be debated at an institution level.

More significant are the concerns about privacy and confidentiality in health education. I have talked a number of times on this blog about the issues we face as health professionals, and how the legal and professional requirements for confidentiality between practitioner and patient reduces what we can do in an open environment. For example, how safe would our undergraduate midwifery students feel to explore their beliefs and attitudes, knowledge and experiences if they knew they were exposing themselves to people other than their classmates? Those very personal learning experiences that student midwives have in the clinical setting are miles apart from the undergraduate English student who is exploring his understanding of a written text. At the same time, being open to completely different perspectives could be a hugely beneficial in terms of learning and reflection.

Impact on fee-paying students
A large concern about open access courses is the impact on fee-paying students. I think the concern is that fee-paying students will feel disadvantaged compared to the people who are receiving the education, but not paying for it. The implication being that if you are a paying student, you somehow own the knowledge or at least, you own access to it. But the problem is, if you refuse to 'share' and network, you limit your opportunities to connect and learn. And if you refuse to be a node in the network you will be bypassed, to your detriment.

What are students paying for?
What I suggest we need to do to do is change how we see the provision of education. What students are paying for in open access courses is the provision of assessment and accreditation; they are not paying for the knowledge. Knowledge does not belong to any one person - it is freely available to everyone. Indeed, the course I am currently teaching is about reflective practice, and anyone can freely access the material on the Internet that I am using, in books and journals.

The other thing the student is paying for is the name and reputation of the institution they receive their qualification from.

Working with the challenge
I have benefited hugely from open access education. I joined an open access course last year and eventually ended up enrolling in the course, completing the assessments and receiving the qualification. I cannot see open access courses becoming main stream until attitudes have changed about knowledge being something that is bought.

But I am convinced that networking, and in particular online networking is vital for health professionals to keep up to date so that they can provide evidence-based practice and provide support to each other. And that should be modeled in our education programs, at both undergraduate and postgraduate levels.

Feedback from students and educators
I would really appreciate hearing from students who have been fee-paying students in open access courses. How have you felt about being in the same course as non-paying students? What were the advantages and disadvantages.

As for teachers, what feedback have you received from students? How have you felt as a teacher in an open access course. Has it been extra work for you? Any other comments?