Factors that characterise clinical decision making among midwifery students in Malawi

Abstract

Background/Aims Professional knowledge and competencies related to decision making and lessons learnt during midwifery education influence midwives' clinical decision making. The midwifery curriculum for student midwives includes the decision-making process during nursing training and midwives are expected to apply this knowledge and skill during midwifery practice. Factors that positively or negatively affect clinical decision making among midwives in Malawi are not well understood. This study aimed to identify factors that characterise clinical decision making among midwifery students in Malawi. Methods This was a cross-sectional descriptive study that used quantitative methods underpinned by a positivist paradigm. Proportional stratified sampling was used to select 124 fourth year student midwives from two public universities. A questionnaire was used to gather data from respondents on how strongly they agreed or disagreed that certain factors affect clinical decision making. Data were analysed using descriptive and inferential statistics, and Pearson's chi-squared was calculated to determine differences in respondents' mean scores. Significance was set at P=0.05. Results Factors found to positively affect clinical decision making were skills and knowledge, collaboration with other health workers, confidence, supportive supervision, positive feedback, a conducive working environment, mentoring by senior midwives, availability of clear guidelines and frameworks, clinical reasoning and intuition. Respondents' mean scores on factors that positively or negatively affect clinical decision making varied significantly (P<0.001) in relation to age, institution and department. Conclusions Although students are taught about decision making during their training, there are factors that hinder their capability to implement the skill. Therefore, it is necessary for training institutions to find ways to evaluate students' clinical decision making both before and after they join the workforce to identify and bridge any gaps in knowledge.