Genetics in midwifery : exploring the midwives’ views and educational needs in clinical practice

Abstract

Genetics is becoming increasingly important within healthcare, but evidence indicates that midwives may not feel confident in dealing with the genetics need of patients and thus education is often inadequate. In Malta no studies have ever been conducted on genetics in midwifery. This study was useful to understand how it is best to enhance genetics education in this profession and served as an initial step towards the creation of continuous educational material targeted to midwives. The aim of this study was to explore the midwives’ views on genetics and in addition to assess the educational needs of midwives in the field of genetics in Malta. The main objectives were to explore the current status of midwives’ knowledge and its applicability in practice; to assess the attitudes of the midwives regarding genetics and its importance in their clinical role; to identify the barriers of integrating genetics into practice and to determine the genetic education needs of midwives in relation to their clinical settings. To fulfil the study’s aim, a ‘needs assessment analysis’ using a mixed method approach, combining both quantitative and qualitative methods, was used. Data was collected in the first phase, by means of a questionnaire, which focused on the current status of midwives’ knowledge, their attitudes, the identification of any barriers in integrating genetics and the educational needs of midwives. This was combined with a focus group interview, where midwives were allowed to discuss their views on how to implement improvement in genetics education. There was a presentation seminar at the end, with the aim of serving as the first continuous professional development (CPD) event on genetics. This was targeted to practicing and student midwives. Data collection took place in all the maternity settings within the state local public hospital. The sample consisted of 150 midwives and the sampling technique chosen was a purposive sampling. Frequencies, percentages and three non-parametric tests were used in this study. The data from the focus group was analysed using Burnard (1991) thematic-content analysis, where eight themes emerged and within each theme, further categories were elicited. Ninety-eight midwives participated in the questionnaire, resulting in a response rate of 65.3%. From these 98, five midwives agreed to exchange and share their ideas through the focus group interview. The majority of midwives felt that genetics is an important and an essential component of midwifery practice, however, the majority did not feel confident enough to undertake certain activities to integrate genetics into their clinical practice. The majority were found to have inadequate knowledge on genetic information, genetic services and epigenetics. In fact, the need for educational preparations in genetics at both pre- and post- graduate levels was highlighted. Most midwives agreed that lack of knowledge about genetics among educators and practitioners; lack of understanding of relevance to practice; limited number of clinical mentors and limited number of educators to explain difficult concepts, were considered as barriers for integrating genetics into their daily clinical practice. The midwives’ preferred learning approach was the workshops with a mixture of presentations and group activities. A need for a clear description of responsibilities to enable effective use of genetics in the midwives’ clinical practice was also identified. One main limitation of the study is that 59 out of 150 midwives did not attempt to answer the questionnaire and thus there may be bias. As an outcome of the study several recommendations were proposed. Continuous awareness should be made to student midwives and qualified midwives about the midwife's role in genetics. Hence, it is best to continue the current teaching of genetics in the undergraduate curriculum, and possibly expanding it even to the postgraduate programme, with the introduction of study days as part of every midwife’s CPD.