School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, Scotland.
Department of Maternal, Child, and Adolescent Health and Office of the Chief Nurse, World Health Organization, Geneva, Switzerland.
Midwifery. 2019 Nov;78:104-113. doi: 10.1016/j.midw.2019.08.007. Epub 2019 Aug 10.
Good quality midwifery care has the potential to reduce both maternal and newborn mortality and morbidity in high, low, and lower-middle income countries (LMIC) and needs to be underpinned by effective education. There is considerable variation in the quality of midwifery education provided globally.
To determine what are the most efficient and effective ways for LMICs to conduct pre-service and in-service education and training in order to adequately equip care providers to provide quality maternal and newborn care.
Rapid Systematic Evidence Review METHODS: A systematic search of the following databases was conducted: Medline, CINAHL, LILACs, PsycInfo, ERIC, and MIDIRs. Studies that evaluated the effects of pre-service and in-service education that were specifically designed to train, educate or upskill care providers in order to provide quality maternal and newborn care were included. Data was extracted and presented narratively.
Nineteen studies were included in the review. Of these seven were evaluations of pre-service education programmes and 12 were evaluations of in-service education programmes. Whilst studies demonstrated positive effects on knowledge and skills, there was a lack of information on whether this translated into behaviour change and positive effects for women and babies. Moreover, the level of the evidence was low and studies often lacked an educational framework and theoretical basis. Mapping the skills taught in each of the programmes to the Quality Maternal and Newborn Care framework (Renfrew et al., 2014) identified that interventions focused on very specific or individual clinical skills and not on the broader scope of midwifery.
There is a very limited quantity and quality of peer reviewed published studies of the effectiveness of pre service and in service midwifery education in LMICs; this is at odds with the importance of the topic to survival, health and well-being. There is a preponderance of studies which focus on training for specific emergencies during labour and birth. None of the in-service programmes considered the education of midwives to international standards with the full scope of competencies needed. There is an urgent need for the development of theoretically informed pre-service and in-service midwifery education programmes, and well-conducted evaluations of such programmes. Upscaling quality midwifery care for all women and newborn infants is of critical importance to accelerate progress towards Sustainable Development Goal 3. Quality midwifery education is an essential pre-requisite for quality care. To deliver SDG 3, the startling underinvestment in midwifery education identified in this review must be reversed.
高质量的助产护理有可能降低高、中、低收入国家（LMIC）产妇和新生儿的死亡率和发病率，并且需要有效的教育作为支撑。全球提供的助产教育质量存在相当大的差异。
确定 LMIC 进行岗前和在职教育和培训的最有效和最有效的方法，以便为护理提供者提供足够的装备，以提供优质的孕产妇和新生儿护理。
快速系统证据综述
对以下数据库进行了系统搜索：Medline、CINAHL、LILACs、PsycInfo、ERIC 和 MIDIRs。纳入了专门旨在培训、教育或提高护理提供者技能以提供优质孕产妇和新生儿护理的岗前和在职教育效果评估研究。提取并以叙述方式呈现数据。
本综述纳入了 19 项研究。其中 7 项是对岗前教育项目的评估，12 项是对在职教育项目的评估。虽然研究表明这些教育对知识和技能有积极影响，但缺乏有关这是否转化为行为改变以及对妇女和婴儿产生积极影响的信息。此外，证据水平较低，而且研究往往缺乏教育框架和理论基础。将每个项目中教授的技能映射到《孕产妇和新生儿优质护理框架》（Renfrew 等人，2014 年）中，发现干预措施侧重于非常具体或单独的临床技能，而不是助产的更广泛范围。
LMIC 中关于岗前和在职助产教育有效性的同行评审出版研究数量和质量非常有限；这与该主题对生存、健康和福祉的重要性不符。有大量研究侧重于分娩期间和分娩期间的特定紧急情况培训。没有一个在职项目考虑到按照国际标准对助产士进行全面的能力教育。迫切需要制定理论化的岗前和在职助产教育计划，并对这些计划进行良好的评估。为所有妇女和新生儿提供优质的助产护理对于加快实现可持续发展目标 3 的进展至关重要。优质助产教育是优质护理的重要前提。为了实现可持续发展目标 3，必须扭转本综述中确定的对助产教育投资不足的局面。
