Helen Godwin - ECU* Professor Sandra Carr - UWA Associate Professor Annette Mercer - UWA Faculty of Medicine, Dentistry and Health Sciences: Education Centre * This research was undertaken as a Masters student at UWA. Is midwifery competence afected by working in a Western Australian rural health area? Aim a bachelor degree qualiication. Over 68 per cent of WA midwives have more than 15 years experience, suggesting an ageing workforce. The study revealed subtle differences between midwives in urban and rural settings in self-assessed competence and conidence for essential midwifery skills. To describe Western Australian (WA) midwives’ perceptions of competence and continuing competence and contrast these perceptions for midwives practicing in rural and low risk urban settings. Background WA midwives regularly attend professional development education. Rural midwives favour multi-professional emergency skills courses. Urban midwives were more likely to complete annual mandatory competencies (statistically signiicant difference at p=<0.001). Dispersal of health service providers is uneven throughout this geographically isolated State. Budget constraints, stafing issues and distance could mean rural midwives may ind it dificult to attend appropriate education programs required for registration. Western Australia (WA) is a geographically isolated state. It is the largest state in Australia, covering 2,526,786 square kilometres, and is the fourth highest populated state of Australia. On average 23 per cent of babies are born in the rural area. In 2012 over 7,000 babies out of 33,920 births in WA were born in a rural location. Implications for education, practice and policy Rural midwives are generalist nurse-midwives who practise in isolated, small, low risk maternity centres. The transfer of high-risk women to a tertiary centre minimises midwifery exposure to complex maternity care. The study suggests the issue is not whether competence and conidence differs between the urban and rural setting but that the comparison groups have different needs. Recommendations include a standardisation of annual mandatory competencies across all public hospitals, implementation of mentoring models of education for less experienced midwives to beneit from the wealth of knowledge gained by experienced midwives. Methods This study used descriptive research and a mixed method approach. A questionnaire gathered the information from the participants. The response rate from the urban midwives was 28 per cent (n=66) and rural 32 per cent (n= 63). Information included the characteristics of WA midwives and perceptions of competence. Methodology and instrument This descriptive mixed method study was based on a previous study conducted in Scotland 2007: Hundley, V. A., Tucker, J. S., van Teijlingen, E., Kiger, A., Ireland, J. C., Harris, F., Farmer, J., Caldow, J. L.,Bryers, H. Midwives’ competence: is it affected by working in a rural location? Key indings Contrary to current literature, slightly more rural midwives (51 per cent) than urban midwives (45 per cent) reported having Perceived Competence in Antenatal Skills. Midwives Perceived Competence in Intrapartum Skills Midwives Perceived Competence in Postnatal Skills Midwives Perceived Competence in Newborn Skills While no statistically signiicant difference was found for perceived competence for antenatal skills between urban and rural midwives, there are some noteworthy indings. See the graph below. While no statistically signiicant difference was found for perceived competence for antenatal skills between urban and rural midwives there are some noteworthy indings. See the graph below. Midwives perceived competence in postnatal skills revealed no statistically signiicant difference for the comparison groups. See the graph below. Midwives perceived competence in newborn skills revealed no statistically signiicant difference for the two groups. See graph below. 120 120 120 120 100 100 100 100 80 80 80 80 60 60 60 60 40 SIDS prevention Fluid requirements Discharge 40 67 31 52 36 62 17 31 13 24 80 70 Urban Rural 60 50 40 30 20 10 2. Further qualitative research projects to examine inter-hospital communication issues. 3. Explore future direction in education and training for midwives in different settings. Lack of appropriate training Lack of support from management Staff not sharing the information from courses Negative attitude of senior staff in the unit Getting staff cover 0 Recommendations 1. Standardisation of mandatory competency requirements across WA hospital sites. At CS Initial exam Resuscitation Contraception Debriefing parents PN exercises The results showed a statistically signiicant difference in distance to training of p <0.001, with more rural midwives (70 per cent n=44) than urban midwives (19 per cent n=12) believing distance to training was a barrier. See graph on the right. 46 Lack of motivation/interest Attendance at three speciic multidisciplinary courses. Barriers to Continuous Professional Development (CPD) Attendance by rural midwives n % 27 Distance to training Attendance at an external venue within the last 12 months: • Urban midwives 88 per cent (n=58) had attended an external session and 81 per cent (n=57) of the rural midwives. Advanced Life Support Obstetrics (ALSO) Statistically signiicantly different p=0.022 Neonatal Resuscitation Program (NRP) Advanced Foetal Monitoring Course at King Edward Memorial Hospital (AFM) Getting funding to attend Attendance at education sessions within their own facility within last 12 months: • Urban midwives reporting 86 per cent (n=57) and 86 per cent (n=52) of the rural midwives. Attendance by urban midwives n % Family commitments Professional Development Course CPD is not seen as a priority for me A statistically signiicant difference at p <0.0001 was show in completion of annual mandatory competencies in the previous 12 months. Urban midwives were more likely 82 per cent (n=54) than rural midwives 48 per cent (n=300 to complete mandatory competency requirements within their facility. 20 Number of midwives attending ALSO, NRP and AFM courses Lack of time Annual Mandatory Competencies Urban Rural 0 Breastfeeding Support person support Repair of perineum PPH Foetal monitoring interpretation Non - pharmacology pain relief Breech birth Shoulder dystocia Pre-term birth Pre-term labour Using a Pinnard 0 Parent education classes 0 S&S of pre-eclampsia 0 Transferring out 20 Management of APH 20 Identifying at risk patient 20 40 Urban Rural Self care post CS Urban Rural 40 Scrub at CS Urban Rural 40