Abstract
Aims of the research The main aim of this study was to evaluate the effectiveness of a work-based module and in-service educational programme in perineal repair for midwives on their perceived level of competency undertaking this skill in clinical practice. Background The reduction in the practice of episiotomy, lack of formal instruction in perineal repair and inconsistency in perineal trauma management amongst midwives and students has resulted in the lack of perceived confidence and competency in perineal repair locally, necessitating a structured training programme in perineal repair. Methodology A Quasi-experimental pre-post intervention case study design combining a nonequivalent comparison group undertaken in six NHS consultant/midwifery led Trusts in South East England between December 2001 and January 2006. Main findings significantly greater numbers of midwives were able to practise perineal repair at higher levels of competency following an educational intervention in five experimental trusts (P < .006). There was a non-significant difference in the comparison Trust (P < .535). Decisions taken to undertake specific perineal trauma management were largely influenced by the midwives' professional expertise, clinical judgement, reference to the newly developed trauma proforma and National RCOG (2004) guidelines. In addition, an educational programme for midwives was also successful in increasing the numbers of senior student midwives who were able to participate in perineal repair confidently under the direct supervision of their mentor when they perceived that their mentor was confident and competent undertaking the procedure. Conclusion The outcomes of this study make an original contribution towards a new body of expert knowledge in pre- and post-registration midwifery education surrounding the midwives' and students' confidence, competency and decision making process associated with the assessment and management of perineal trauma. It has provided a greater understanding and insight into the complex nature of workplace learning, competency development and assessment alongside the multiple factors influencing the midwives' and students' perceived competency in perineal repair.