Effectiveness of an Activity Package to Enhance Midwifery Clinical Leadership among Nursing Students: A Quasi-Experimental Study

doi:10.21203/rs.3.rs-1616619/v1

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Research Article

Effectiveness of an Activity Package to Enhance Midwifery Clinical Leadership among Nursing Students: A Quasi-Experimental Study

https://doi.org/10.21203/rs.3.rs-1616619/v1

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Background: Current health crises have effects on maternal and child nursing. The healthcare system needs midwifery with good clinical leadership. The safety of mothers and infants is dependent on decisions made by midwifery to provide help if unexpected events occur. This quasi-experimental research was aimed at studying the effectiveness of an activity package for enhancing midwifery clinical leadership on nursing students.

Methods: The quasi-experimental research with a one–group pretest–posttest design was conducted among Thirty undergraduate nursing students in fourth years were selected by randomly sampling and were allocated to one group. An activity package based on leadership skill approach theory. Data were collected before, immediately after, and six weeks after the intervention using “midwifery clinical leadership knowledge” “midwifery clinical leadership skills” and “satisfaction” Questionnaires. Data were analyzed using SPSS 22; Descriptive statistics, Paired t-test, and Analysis of Variances with Repeated Measures were used to analyze the data.

Results: The mean score of midwifery clinical leadership knowledge in participants before the intervention was 9.56±1.52 that increased to 16.00±1.11 after the intervention (p<.001), midwifery clinical leadership skills before, immediately after, and 6 weeks after training, it was statistically significantly higher than before training at .05 and the trainees had maximum satisfaction with the training package

Conclusion: Midwifery clinical leadership among nursing students increased in every area after training. Therefore, the promotion of midwifery clinical leadership among nursing students is essential. Supporting course activities can develop learning processes in nursing students while enhancing professional midwifery skills.

activity package

midwifery clinical leadership

nursing students

Leadership is important to professional nursing and midwifery because professional nursing and midwifery is a subject that requires teamwork with multidisciplinary teams. Nurses who possess leadership skills also possess the skills of persuasion, advice or gaining the acceptance from other people to follow them for the success of the organization together. ^1,2,3,4 Furthermore, professional nursing organizations need nurses with leadership skills for the development of work and the profession. Leadership is an essential quality for all professional nurses.

The main mission of the Faculty of Nursing is to produce nursing personnel who are knowledgeable about their profession and other fields. The objectives of the curriculum are focused on ensuring that graduates are capable of properly and efficiently applying their knowledge in nursing and midwifery practice with good attitudes about the profession, as well as professional ethics and morals. Graduates need to be leaders with discretion in analyzing problems and making the right decisions. Furthermore, professional nurses working in labor/delivery departments need to be people who have passed testing in midwifery with competency in line with the announcement of Midwifery Practice Standards 2019.⁵ Labor/delivery rooms are departments that require particular monitoring. Some women giving birth rapidly undergo clinical changes and midwives are the providers who are closest to these women. Therefore, apart from nursing practice compliant with good practice guidelines, midwives need to have leadership, clinical decision-making processes, and efficient coordination skills when unexpected events occur.

According to research by Scammell al., (2020), who conducted a study by systematically reviewing related literature published between 2009–2019 with nine studies about learning leading to leadership in organizing graduate nursing student curriculum, the following three main themes emerged: 1)studies about leadership have found students to require leadership training and positive attitudes with sources for practice, so studies of theory and practice can be integrated; 2)the placement of senior nurses at training sources, which means that the good examples of professionals at training sources can help increase the leadership competency of nursing students and 3)in managing instruction, it was found that leadership theories and competence should be taught from the commencement of studies and developed in nursing students throughout the entire course of study.⁶ Therefore, if midwifery clinical leadership needs to be enhanced, it needs to be enhanced while nursing students are still studying.

Nursing education management is currently focused on having nursing students gain leadership skills⁷ in combination with the development of professional skills. Moreover, the current health service system has undergone changes requiring reliance on new concepts, new work processes and the growing complexity of the health problems of service recipients. Based on experience in teaching numerous classes of nursing students in clinical theory and practice in antenatal departments, labor/delivery rooms and postpartum units, it has been found that nursing students lack confidence/self-efficacy and do not dare to make decisions about nursing practice, particularly in the labor/delivery department, which requires reliance on skills in the decision-making process. Therefore, apart from developing knowledge and professional skills, developing nursing students requires enhancement of leadership among nursing students in combination with studies of both theory and practice in order to prepare nursing students for leadership with readiness to work as professionals in the future.

This article was written for the purpose of investigating the effectiveness of an activity package to enhance midwifery clinical leadership among nursing students based on leadership skill approach theory⁸ and the concept of teamwork as the guideline for developing the training activities⁹ and using an active learning process as the guideline for this training.¹⁰ The aim was to develop nursing graduates with midwifery clinical leadership, quality and capacity in the future.

This study of the effectiveness of an activity package to enhance midwifery clinical leadership among nursing students was based on a quasi-experimental, one group, pretest-posttest design as follows:

Participants: The study participants were, G*Power software was used to determine the sample size with a power of 0.80, alpha of 0.05, and an effect size of 0.80. The sample size was calculated at 27. An extra 10% was added to allow for losses, resulting in 30 samples, were select fourth-year nursing students in the Faculty of Nursing Rajamangala University of Technology Thanyaburi who registered to study mother and child nursing practice and midwifery during the 2021 academic year, selected by randomly sampling and were allocated to one group in the training. Research Instrumentation: Divided into the following two parts:

Part 1 – The testing instruments were activity package based on leadership skill approach theory⁸ and the concept of teamwork as the guideline for developing the training activities⁹ composed of the following five activities: 1) management activities for developing “self-management”, which developed goal-setting skills, time management, planning and problem-solving; 2) a management activity for “developing cognitive processes”, which developed cognitive, listening and speaking skills; 3) a management activity for “developing leader-follower skills”, which developed teamwork skills; 4) a teamwork activity, “team quality” using simulated situations in caring for giving birth in labor will prolapsed cords; 5) a reflective thinking activity, “think reflectively and change perspectives”.

Part 2 – The instruments used for data collection were the pretest and posttest midwifery clinical leadership assessment form containing a total of four component concepts defined by Katz⁸ and Standards Midwifery Practice⁹ were used to build items for a midwifery clinical leadership instrument. This study also used Netemeyer’s¹⁰ “Guidelines in Scale Development” to develop an instrument for midwifery clinical leadership among Nursing students. The responses to the questions were rated on 5-point Likert scales (1–5 points) with the following ratings: lowest, low, moderate, high and highest. The interpretation of the scores was divided into the following five levels of leadership: lowest (1.00-1.50 points); low (1.51–2.50 points); moderate (2.51–3.50 points); high (3.51–4.50 points) and highest (4.51-5.00 points). The instrument was examined by five qualified experts who tested for validity and item-objective congruence (IOC), which yielded a score of .94. The assessment form for midwifery clinical leadership that was revised based on the recommendations of the qualified experts was tried out with a sample of 30 people possessing characteristics similar to the actual sample for the study in order to determine the reliability of the instrument by finding Cronbach’s alpha coefficient (α–coefficient), which equaled .975.

Procedure

This quasi-experimental research used a one-group pretest–posttest design for the purpose of investigating the effectiveness of an activity package to enhance midwifery clinical leadership among nursing students. Data were collected before, immediately after, and six weeks after the intervention using “midwifery clinical leadership knowledge” “midwifery clinical leadership skills” and “satisfaction” Questionnaires. Data were collected between September and December 2021 as follows: 1) The research team had the nursing students complete a questionnaire to assess midwifery clinical leadership based on the pretest perspectives of the nursing students by giving them 60 minutes to finish; 2) The research team had the nursing students participate in developing midwifery clinical leadership based on the activity package for enhancing midwifery clinical leadership for nursing students by having the participants join in all five activities, which took approximately two days for a total of twelve hours; 3) The nursing students practiced in individual nursing subjects in mother and child nursing and midwifery in various designated training sources. The students were divided into group of eight and practiced at clinics for five days per week. The students practiced in antenatal, labor/delivery room and postpartum departments for two weeks in each department for a total of six weeks under the supervision of a nursing instructor in the mother and child nursing and midwifery departments; 4)The research team had the nursing students complete the assessment of midwifery clinical leadership based on the perspectives of the nursing students at posttest after completing the training of the nursing students in each group, giving them sixty minutes to finish, then had them complete the form for measuring their satisfaction about the training. Data were analyzed using SPSS 22; Descriptive statistics, Paired t-test, and Analysis of Variances with Repeated Measures were used to analyze the data.

The results of using the activity package for enhancing midwifery clinical leadership among nursing students revealed that the sample had knowledge higher mean posttest scores in midwifery clinical leadership that pretest scores, Table 1

Table 1

Compare knowledge of midwifery clinical leadership in nursing students Before - After Training
	n	\(\stackrel{-}{x}\)	S.D.	t	p
Before Training	30	9.56	1.52	-23.83	.000
After Training	30	16.00	1.11

The results of using the activity package for enhancing midwifery clinical leadership among nursing students revealed that the sample had higher mean posttest scores in midwifery clinical leadership that pretest scores in every aspect, Table 2

Table 2

Comparison of pre- and posttest mean scores for midwifery clinical leadership among nursing students.
Midwifery Clinical Leadership skills	Pretest (n = 30)			Posttest (n = 30)
Midwifery Clinical Leadership skills	\(\stackrel{-}{x}\)	S.D.	Level	\(\stackrel{-}{x}\)	S.D.	Level
Professional Values in Caring	3.68	.26	High	4.40	.45	High
Caring Relationships	3.76	.57	High	4.48	.45	High
Quality and Safety	3.76	.57	High	4.53	.44	Highest
Self-management	3.68	.24	High	4.37	.53	High
Overall	3.72	.04	High	4.44	.07	High

Comparing clinical leadership in midwifery of nursing students before, immediately after, and 6 weeks after training, it was found that immediate after and 6 weeks after training was statistically significantly higher than before training at .05 Table 3.

Table 3

Comparison of Midwifery Clinical Leadership of Nursing Students Before – After training
	Before the intervention	Immediately after the intervention	Six weeks after the intervention	F	P value (within group)
Professional Values in Caring	3.68 ± .26	4.40 ± .45	4.54 ± .26	82.57	.000
Caring Relationships	3.76 ± .57	4.48 ± .45	4.53 ± .38	29.13	.000
Quality and Safety	3.76 ± .57	4.53 ± .44	4.62 ± .24	33.50	.000
Self-management	3.68 ± .24	4.37 ± .53	4.52 ± .26	75.61	.000

The results of the analysis of satisfaction the participants in the training in relation to the training activities revealed that the participants had the highest level of satisfaction overall with a mean of 4.74. When individual aspects were considered, the satisfaction was also found to be at the highest level with a mean of 4.92. The aspect with the lowest level of satisfaction was “Training Activity Media”, as shown in Table 4

Table 4

Satisfaction about Training Activities
Training Activity	n = 30		Level of Satisfaction
Training Activity	\(\stackrel{-}{x}\)	S.D.	Level of Satisfaction
Training Content	4.92	.27	Highest
Learning Activities Held	4.68	.47	Highest
Training Activity Media	4.56	.50	Highest
Learning Assessment	4.76	.43	Highest
Lecturer’s Instruction	4.72	.45	Highest
Training Environment	4.80	.40	Highest
Mean of All Aspects	4.74	.12	Highest

The purpose of this study was to investigate the effectiveness of using an activity package for enhancing midwifery clinical leadership among nursing students. The author designed activities for enhancing midwifery clinical leadership among nursing students composed of the following five activities: 1) a management game for developing “self-management”; 2) a management game for “developing cognitive processes”; 3) a management game for “developing leader-follower skills”; 4) a teamwork game for “team quality”; 5) reflective thinking, “think reflectively and change your perspectives”. based on leadership skill approach theory⁸ and the concept of teamwork as the guideline for developing the training activities¹¹, as the guidelines for developing the training activities and active learning. ¹² A variety of models and techniques were used, namely team-based learning, game-based learning, simulation-based learning and reflection, which corresponded with 21st Century Skills to promote and support learners in learning from real practice with instructors as leaders to advise and help with the design of learning activities, so learners can benefit from hands-on learning. This finding corresponds with the findings of a study by Zenobia C.Y. Chan, who stated that nursing education should design course curriculum with enthusiastic education management, promotion of students in creative thinking and real, hands-on practice.¹³ Enthusiastic learning is the development of cognitive processes, which will cause learners to succeed academically and professionally.^14,15 In this organization of activities to supplement course curriculum, procedures were followed by holding training activities on a continual basis, beginning with self-management activities for the participants to receive training and develop skills in goal-setting, time management, planning and problem-solving. Next were the activities for developing cognitive processes, helping develop listening, cognitive and communication skills. When the participants joined in the training and had practiced self-management and cognitive thinking, they began to practice teamwork activities in order to develop leader-follower skills and followed the simulated situation, “Nursing for Women with Prolapsed Cord”, so the training participants could learn about teamwork, management and problem-solving together in addition to summarizing with a reflective thinking activity. These activities resulted in the learners learning together, solving problems together and even contributed to enhanced leadership. Furthermore, having the nursing students work together as a team resulted in learning exchanges among the students.¹⁶ This finding corresponds with the findings of a study by Worangkhana Khumsuk (2021), who investigated simulation-based learning in preparing nursing students for practice in the subject of nursing practice for mothers, infants and midwifery. According to the findings, the nursing students gained more knowledge and self-efficacy before engaging in clinical practice.¹⁷ This finding corresponded with the findings of a study by Phunthip Chubkhuntod, Prangthip Thasanoh Elter, Nuchamart Gaewgoontol, Rutchanee Potchana (2019), who studied the effects of a simulation-based learning model on knowledge, self-efficacy and abilities in applying nursing process skills during the intrapartum care of nursing students. According to the findings, simulation-based learning helped increase self-efficacy and ability in the use of nursing processes among the nursing students.¹⁸ Therefore, if nursing students have self-efficacy in clinical nursing practice, they will dare to think, dare to decide, efficiently communicate with health care teams and enhance leadership for nursing students.¹⁹

Concerning the effectiveness of the activity package for enhancing midwifery clinical leadership among nursing students, the students were found to have better posttest midwifery clinical leadership than pretest with statistical significance at .05. It can be said, therefore, that midwifery clinical leadership among nursing students gained added development due to the effectiveness of the activity package to enhance midwifery clinical leadership. Active learning was used, which supports the research hypothesis. Due to the fact that, before engaging in practice, the nursing students enhanced leadership through various activities such as a management game for developing self-management; a management game for developing cognitive processes; a game for developing leader-follower skills; development of leader-follower skills; teamwork activities and reflective thinking activities, resulted in the nursing students becoming familiar with themselves, learning how to work as a team and gaining self-efficacy in expressing increased leadership. This finding corresponded with the findings of a study by Towle A. (2015), who organized active learning to enhance leadership among nursing students. According to the findings, the active learning exercises were able to enhance leadership for the nursing students.²⁰ The above findings also correspond with the findings of a study by Marath U. & Ramachandra R. (2015), who enhanced the leadership of nursing students by using activities to supplement course curriculum. According to the findings, the activities were also able to enhance the leadership of the nursing students.²¹ Obviously, therefore, the effectiveness of the activity package to enhance midwifery clinical leadership for nursing students before they engage in clinical practice can enhance the leadership of nursing students.²² After the training, the nursing students engaged in clinical practice in antenatal departments, labor/delivery rooms, and postpartum units where they took on the role of head nurse. Thus, the nursing students were able to fully act out the role based on their duties, while they worked as a team and solved problems together in acting out their roles in leading self and others, which corresponds with the leadership competencies of professional nurses at the ANA Leadership Institute in leading self and others. In other words, nursing students need to have self-awareness, self-motivation, self-management, flexibility, adaptability, good relationships, efficient communication, conflict management, empowerment and the ability to build good relationships among colleagues on multidisciplinary teams.²³ Similarly, a study by Akbar MA, Juniarti N, Yamin A.(2021), who investigated the roles of community nurse practitioners in management to prevent Covid-19 outbreaks in communities and found that collaborating was the heart of Covid-19 prevention and management.²⁴ Collaboration is a leadership skill. Based on the findings of this study, community nurse practitioners with good leadership can efficiently manage the prevention of Covid-19 outbreaks.

This study discovered that most nursing students are unaware of how important leadership is to the nursing profession. If nursing students possess knowledge about leadership and awareness of its importance, they will improve their leadership skills, which is similar to a leadership development program for nursing students in Western Australia that enhanced knowledge about leadership, leadership skills and practices involved wit leadership. The findings of the study revealed that the nursing students had increased leadership.²⁵ Nevertheless, the management of graduate nursing courses at every educational institution should promote and support every nursing student in receiving leadership practice and development for professional development and future advancement.

Midwifery clinical leadership can be enhanced among nursing students by using activities to supplement courses for the development of nursing students, so the learning process can occur before actual practice in a clinical setting, which will give the students self-efficacy and ability to apply what they have gained from the learning process in work. If nursing students gain self-efficacy in nursing practice in the care of mothers and infants, the fear and anxiety of nursing students can be reduced as they practice in the labor/delivery. As a result, the students will have pride in their profession and positive attitudes in working in labor/delivery rooms. Furthermore, if the nursing instructors or senior nurses at each training source are good examples, the nursing students will see that good example and want to be midwives even more. The activity package for enhancing midwifery clinical leadership can be executed in combination with developing professional nursing and midwifery skills. Executives at education institutes should set guidelines for holding training activities to enhance midwifery clinical leadership for nursing students before they engage in clinical practice in the subject of mother and child nursing and midwifery.

Ethical approval and consent to participate

All the participants voluntarily participated in this study and provided written informed consent. The Ethics Committee of the Rajamangala University of Technology Thanyaburi approved this study Project Code: RMUTT_REC No. Exp 32/64 on 3 September 2021. We confirm that all methods were carried out in accordance with guidelines and regulations of Biomedical Research Ethics Committee in the Rajamangala University of Technology Thanyaburi.

Consent for publication

Not applicable

Availability of Data and Material (ADM)

The datasets used during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declared that they have no competing interests

Funding

This study has no funding.

Authors’ contribution

UC reviewed the literature, designed the research, collected, and analyzed the data and approved the final manuscript. NC collected and analyzed the data DD collected the data JS collected the data

Acknowledgment

The author would like to thank the Research and Development Institute of the Rajamangala University of Technology Thanyaburi, for approving the ethics for research involving human subjects for this study. The author would also like to express her appreciation to Assoc. Pfr. Poonsuk Hingkanon, Dean of the Faculty of Nursing, Rajamangala University of Technology Thanyaburi, who helped and promoted the research. Lastly, the author would like to thank everyone on the research team who helped conduct the research to its successful completion, and each of the experts who provided suggestions and offered guidelines for conducting this study until its successful completion.

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No competing interests reported.

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Effectiveness of an Activity Package to Enhance Midwifery Clinical Leadership among Nursing Students: A Quasi-Experimental Study

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Abstract

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Methods

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Discussion

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References

Competing Interests

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