My choice of topic emerged whilst I was searching for my research paper to critique. In the September 2009 edition of the British Journal of Midwifery there was an article titled ‘Clinical Skills: issues affecting left-handed midwives’ (Chapman, 2009) and being left-handed myself, I felt I could relate to this. On searching for previous studies and literature related to this topic, I could not find any midwifery based studies. Therefore, I have a general interest in the topic and believe there is a lack of research in this area and feel it would be beneficial for some research to be done on the subject
The aim is to explore the issues surrounding left-handed student midwives, if they feel discriminated against and how their fellow health professionals can reduce this. As a result, we may be able to fill the gap in the theory.
Left handed people are a minority. Between 8% and 15% of Western populations are left handed (BMJ, 1999). In a survey carried out by Left Hander’s Day they were surprised to find that 39% had been discouraged in some way from using their left hand (Left Hander’s Day, 2009). Left handers are expected to carry out procedures the same way their right-handed colleagues do. It is not only midwives that are faced with these issues, dental practitioners, surgeons and GP’s among others could be included.
It should be acknowledged that left-handers may require specialist instruments and the examination bed in the middle of the room, to gain access to the opposite side a right handed person would use. I know resources are limited but provisions should be made to accommodate the left-handed professionals.
After analysing the topic area, it can be said without doubt that it is time to explore the feelings and attitudes of left-handed student midwives. As health professionals, we need to know their preferences and whether they feel, being able to practice clinical skills with their left hand are important to them.
Do left handed student midwives feel discriminated against?
I have searched through several online databases for previous literature relating to this topic. I found a few articles on Science Direct, PubMed, British Medical Journal and Evidence Based Midwifery. There has been research carried out about left-handed surgeons and dental students, both of which were very interesting to read. However, I could not find any previous research specific to midwifery.
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Left-handers should not feel discriminated against so measures should be used to improve how they practice. I believe this problem has always been present but people have expected others to perform exactly as themselves and due to the larger numbers of right-handed professionals, this has just been the normal way for things to be done. In my opinion, this is an important factor in a student’s learning and their midwifery practice.
Some left-handed people probably feel they can adapt to using their right hand for certain procedures, however this should not automatically be assumed. I worked alongside one right-handed mentor who frowned upon me standing on the right side of a woman (as I was facing her) so that I could carry out a vaginal examination using my left hand. This made me feel very uncomfortable. Provision of a left-handed mentor and other environmental modifications could be used to minimise the recurring difficulties for left-handed learners (Dobson, 2005).
All left-handed student midwives, and even registered midwives and other health professionals who experience similar problems, would be interested in this particular study. As we do not know much about the topic, and more specifically for midwifery practice, I feel this would be a valuable piece of research.
The basis of my proposal is formed by the lack of research which explores the feelings and attitudes of left-handed midwives, concerning their clinical skills. I could not find any current research articles or books that explored this issue, however research has been carried out regarding surgeons and dental students. No time has been spent to investigate how student midwives feel and whether it would be beneficial to them to be supplied with left-handed instruments.
Would left handed midwives benefit from using left handed instruments? Do left handed midwives feel discriminated against? What problems do left-handed student midwives face when carrying out clinical skills?
Midwifery presents various questions requiring answers. There is no one research approach that will cover and suit such a diverse range of subjects (Rees, 1996). Fortunately, there are many research designs to choose from to obtain answers.
The NHS Executive (1998) states there are two types of approaches which are used in nursing research. These are qualitative and quantitative research methods. For my proposed research question I am taking a phenomenological approach using a qualitative design.
Comments and statements are produced from qualitative research, rather than statistics which would be gained from quantitative research (Rees, 1997).The aim is to find out people’s feelings and experiences from their own point of view rather than from that of the researcher.
Since qualitative research uses a holistic approach, it seems to have a greater validity. Therefore, over the last ten years it has become more acceptable in nursing and midwifery (Bates, 1995 & Morse, 1996).
The idea of qualitative research is not to collate numbers but able to understand how left handed students feel and what they want achieved (Bluff, 1997). I am going to do this by using the qualitative method, with the tool being semi-structured interviews.
If the students were presented with a questionnaire, which has set questions, I feel this could restrict their answers, therefore limiting their views and opinions. I need to be clear about my chosen qualitative methodology so it is rigorous and systematic with the emphasis on the processes and meanings (Cutliffe, 1997).
Pure phenomenological research seeks essentially to describe rather than explain, and to start from a perspective free from hypotheses or preconceptions (Husserl 1970). Phenomenological research can be robust in indicating the presence of factors and their effects in individual cases, but must be tentative in suggesting their extent in relation to the population from which the participants or cases were drawn. (Lester 2009)
With this approach, the findings will not be generalised but build upon limited research and form a unique interpretation of events (Creswell, 1994). Phenomenology therefore attempts to understand all aspects of phenomena in preference to concentrating on one specific concept and therefore has a reverence for caring for the whole that is admirably suited to midwifery (Robinson, 2000)
For the reason discussed, a qualitative design is very much suited to obtain the relevant information on what the needs are of left handed students.
The phenomenological approach underpins qualitative research. In this study, the interview method will be used to gather information about the left-handers experience of practising their clinical skills. The aim of the interview will be to take an unstructured, exploratory approach to gathering information from participants about their experiences. The interview will consist of a small set of open-ended questions to provide the opportunity to discover themes and issues about the student’s experiences. Qualitative analysis of the interview data provided will interpret the accounts their experiences and identify successful design elements.
The semi-structured interview will be based on my own clinical experiences. While I will have tried to be as comprehensive as possible, there will most likely be further experiences yet to be described.
There are two types of sampling techniques used by social researchers. Probability sampling is the first, and non-probability, the second.
Probability sampling is based on the idea that the people or events that are chosen as the sample because the researcher has some notion of the probability that these will be representative cross-section of the people or events in the whole population being studied. On the other hand non-probability sampling is conducted without such knowledge about whether those included in the sample are representative of the overall population.
A form of non-probability sampling is purposive sampling (Polit & Hungler, 1999, P284). This is the type of sampling I will use to select the participants. With this type, the sample is “hand-picked” for the research. The students will be left-handed so in effect, they are selected with this specific purpose in mind and their relevance to the topic of investigation.
The advantage of purposive sampling is it will allow me to gain an insight into student’s experiences, and their opinion of how things could be improved for them, which will be critical for the research (Dane, 1990). It is not feasible to include a sufficiently large number of examples in the study with a non-probability sampling methods, and this fits in with qualitative research. The aim of the study is to explore the quality of the data not the quantity (Nachmias, 1996).
Phenomenology is well suited to purposeful sampling. This type of sampling permits the selection of interviewees whose qualities or experiences permit an understanding of the phenomena in question, and are therefore valuable. This is the strength of purposive sampling.
A semi-structured interview schedule will be utilised to facilitate in-depth exploration of whether left-handed students would like left handed instruments. The interview schedule will be designed specially for this study as no previous available research reports in this area.
I have tried to be as non-directive as possible in my instructions. Unlike a survey or questionnaire, in a phenomenological study I will ask the participants to describe their experience of practising their clinical skills, without directing or suggesting their description in any way. I will also encourage my participants to give a full description of their experiences, including their thoughts, feelings, images, sensations, memories, along with a description of the situation in which the experience occurred.
I would carry out the interviews myself in the hope it would promote a comfortable, safe, relaxed environment in which the students may feel safe to reveal their feelings, anxieties and experiences. Robson (1993) states this be can enhanced by the provision of privacy and confidentiality.
The students will be told about the research study and what it will entail via email, so that they are well informed to make a choice. They will be given a full explanation about the interview process. All midwifery students, at any level, within my trust would be emailed and those who are left handed would be asked to respond.
Interviews are very time consuming but they provide the researcher with quality rich data. The interviews will be conducted at university, whilst the student is completing theory hours, so it would not have to be done in her own time. Great care will be taken to ensure that privacy is maintained and disruptions minimised.
Consent will be obtained for the student for participate in the interview and also to tape record the conversation rather than taking notes. Smith (1992) argues that informed consent is considered one of the means by which people’s rights are protected. The students will also be assured that the interviews will be entirely confidential and the results will be published anonymously. Informed consent will also include the provision for the study subject to withdraw at any time during the interview and to feel free to ask for further explanations when the need arises.
As the researcher, I reserve the right to modify or change the plan as needed during the conduct of the study. (Sandelowski et al., 1989).
As I discussed earlier, a semi-structured interview will take place to gather qualitative data. However, once the interviews have ended the data needs to be analysed. As soon the data has been collected it is best to start analysing it as soon as possible (Mills, 1994).
Qualitative data is hard work to analyse and it requires insight, ingenuity, creativity and conceptual sensitivity (Polit & Hungler 1999, P573). It is more demanding than quantitative analysis. However, there are a number of ways qualitative data can be analysed. Nevertheless, whatever method is chosen, the researcher has to keep in mind ‘bracketing’. This enables the researcher to analyse the data without trying to confirm her/his own presuppositions (Clarke, 1999 & Appleton, 1995).
To become immersed in the data (comprehending) I will read the transcribed interviews thoroughly. I would also invite another researcher to read them and analyse them with me to minimise any bias I may have.
I will then identify and study any significant statements and phrases directly relating to left-handed issues (synthesising) in an attempt to spell out the meaning of them. These significant statements will then be collected and organised into clusters of themes (theorising). The themes will be used to produce a full description of an experience. Then I will return the description to the student to confirm whether it accurately reflects the essence of their actual experiences, therefore enhancing trustworthiness of data.
The researcher is able to to elicit meanings and insights from the words of the respondents as the data collected is reduced and therefore a clear picture gain be obtained (Sandelowski, 1995), and this approach can be evaluated effectively. Not only is data analysis time consuming but the trustworthiness of data also needs to be considered.
Trustworthiness is an essential component of qualitative research. Findings should reflect the reality of the experience. Lincoln and Guba (1985) advise carrying out member checks to maximise the trustworthiness of the the finding. This will involve taking analysis back to the students to ensure it represents reasonable account of their experience (Parahoo, 1997) thus, minimising researcher bias and determining trustworthiness of the data collected. In this way biased results can be avoided and a reliable description of a given phenomena provided (Beck, 1994).
Before any studies can start, ethical approval will be granted from the appropriate ethics committee. The community manager will be consulted about the study to gain approval, consent, authorisation and also their support.
There will be a simple inclusion criteria: to be a left-handed student midwife, studying within my local trust. Once the students have volunteered to take part in the study, a verbal explanation will be given to them. They will be made aware that it is not compulsory for them to participate and they can withdraw from the study at any time.
The maintenance of privacy is paramount as phenomenological enquiries are often personal and intimate (Morse & Field, 1996). It is important to guarantee that all data is maintained securely and pseudonyms are used throughout to protect identity.
In order that a particular phenomena may be truly visualised, phenomenological enquiry is largely dependent on the participation of carefully selected individuals. As with all research participants, harm and exploitation must be avoided (Polit & Hungler, 1997) and consequently, beneficence needs careful consideration.
For basic resources, such as travelling to the research site, tape recorder, cassettes, basic stationery and analysis of data collected by the second researcher, funding will be needed to carry out the research study.
Once the findings have been established and analysed, positive steps should be taken to put research into practice. If the students have voiced their particular needs with respect to their clinical skills, things should be changed within practice to accommodate these needs. Copies of findings of the study will be distributed locally and nationally so that health professionals understand and become aware of the importance of left-handers being able to practice using their dominant hand. The health professionals may also wish to replicate the study in their areas to see if there is a comparison in results.
To conclude, the lack of research surrounding this topic makes it difficult for health professionals to meet the student’s needs. In effect, the researcher proposed a research study which will attempt to highlight the views and opinions of these student midwives to elicit the required data so that health professionals could give the best possible learning experience.
On completion of the study the findings will be made available to the local maternity units and universities. Sharing the findings of this study would not mean that it represents the whole of the population but will provide a foundation to build upon.
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