Japanese midwifery preservice professionals’ journal reflections on practicum experiences working with mothers and infants

4.1 Reflective journals

Reflective journaling is a data collection method used in qualitative research (Janesick 1999), that is considered to be an effective way to obtain information about students’ feelings (Bashan and Holsblat 2017; Cohen et al. 2007). Reflective journaling allows students to learn and participate in educational activities, and then reflect on their experiences and related behaviors, developing their critical thinking skills by thoughtfully and comprehensively processing the various facets of their experience (Jasper 2005). When students write down and reflect on their perceptions and experiences, researchers can utilize this data to broaden their perspectives and discover new knowledge and thoughts through qualitative discovery. In the present study, the participants were asked to maintain self-reflective journals, where they voluntarily responded to a series of tri-weekly journal reflection prompts.

4.2 Electronic portfolio

An electronic portfolio is a purposeful collection of preservice professionals’ work that demonstrates their lesson plans and instructional materials, including documentation of student effort, progress, and achievement (Sato and Hodge 2017). Electronic portfolios may include photographs of preservice professional’s performance based on the goals, objectives, and assessment of student learning. An electronic portfolio uses multimedia technology, which allows preservice professionals to collect and organize portfolio artifacts in many media types (e.g., graphic, PowerPoint software, and text). In this study, electronic portfolios were utilized to gather and showcase materials associated with the midwifery practicum experience, including but not limited to lesson plans, powerpoint slides, group meeting notes, and correspondence between the mothers and the practicum students.

4.3 Research site and participants

All participants were female students (ages 23 to 27) enrolled in a midwifery certification program at one private university located in central Tokyo in Japan. Each of the participants earned a bachelor’s degree in nursing and held a nursing license (registered nurse) in Japan prior to enrolling in their respective programs. There were no male participants in this study, likely because in Japan, midwifery is considered a desirable, respectable, well-paid, female profession and is popular among women entering the work force (Iimura 2015).

Midwifery education was a new field of study for all participants upon entering the post-bachelor program, and none had substantial previous experience with interacting with mothers and infants. Furthermore, prior to this practicum experience, the participants had not had any interactions with newborn babies (birth through six months) in a professional setting. Pseudonyms were assigned to all participants (Asahina, Kura, Aki, Konishi, Morishige, Waku, Hamaki, Nakagawa, Degawa, and Oikawa) and the university to ensure anonymity and protect identity.

4.4 Practicum experience content

The research site (university midwifery program) in this study offers various practicum opportunities for students in the midwifery program. Students enrolled in the program gain knowledge and skills regarding perinatal care and women’s health care aligning with lecture and practicum courses. More specifically, the program is unique in that the practicum courses focus on comprehensive support for mothers and children from pregnancy to child rearing through a series of courses (total of two credit hours) titled the “Infant Practicum” and the “Pregnancy Practicum”. This study focused on the “Infant Practicum”, where students worked with infants and their mothers continuously for 12 weeks, taking part in 12 one-hundred minute sessions. These sessions allowed the students to work with the mothers and infants, confirming the growth and development of the infants, and supporting the mothers and infants with educational activities ranging from accident prevention to play-based activities. Table 1 provides descriptive information about the weekly sessions.

This study included ten preservice professionals and five pairs of mothers and infants, thus the preservice professionals worked in partner pairs for the practicum experience.

At the beginning of the practicum experience, all preservice professionals were required to complete a home visit and execute lesson preparation with a partner that included three lessons. These three lessons were divided between a sensory focused accident prevention lesson (choking, burning, reducing the risk of the infant falling, and drowning), and two play-based lessons (one ball manipulative activity with color identification, and one activity utilizing rhythmic movement) with the mothers and infants.

4.5 Procedure

Prior to initiating participant data collection, the lead researcher explained the details of the study to the participants, including the study’s purpose, the procedures to be used for data collection and analysis, how the information would be used, and how the names and data would be treated during and after completion of the research. Participants were introduced to the reflective journal process and were able to ask questions about the process. At the end of the study, all participants provided the lead researcher with their tri-weekly self-reflective journal entries and electronic portfolios. Table 2 provides details about the tri-weekly journal agenda.

Later, all analyzed journal entries were returned to the respective participants for member checking through e-mail attachments. This process was used to ensure that the analysis of the journal reflections accurately represented the participants’ description of their practicum experiences working with mothers and infants.

4.6 Translation process

To prepare the data collected in Japanese for analysis and reporting in English, a cross-cultural translation technique developed by Banville et al. (2000) was applied. The technique involved a group of researchers proficient in both languages working individually and collaboratively to ensure that meaning is retained through the translation process. In this case, the process began with three Japanese–English bilingual researchers individually translating the journal reflection entries and electronic portfolios. After this, they formed a committee with an established researcher to critically compare and discuss their translations to ensure that the meanings of the original items were preserved, making edits as recommended. Finally, all members were sent a copy of the completed translation for final comments and critique.

4.7 Data analysis

A constant comparative method (Boeije 2010) was used to systematically examine, refine, and interpret the data. Researchers conducted three different steps in the data analysis process, including category construction, step by step process, and naming of categories. During categorical construction, researchers used the data to stimulate thinking and found important pieces of stand out information (Lincoln and Guba 1985). In the step by step process, the researchers reviewed the data, jotting down notes, comments, and queries (LeCompte and Preissle 1993). Finally, in the naming category step, researchers considered both sensitivity and congruence, reading the categories with the same levels of abstraction across the themes. More specifically, the journal reflections from each participant were coded independently by the researchers, and then the researchers discussed the differences and named the thematic categories until agreement was reached. In addition, two peer debriefers reviewed the codes to avoid potential researcher bias. Further coded data from the sets of data from each participant were compared to identify similarities and differences. For example, after peer debriefing, the researchers conducted a second round of coding key terms (e.g., reality shock, behaviors, responses) in the transcripts of the data. Some codes were combined during this process, whereas others were split into subcategories (subthemes). Finally, the researchers examined the final codes to organize them into a hierarchical structure using individual and group coding percentage (how many times key terms appear in the data). Then all data and definitions of key terms were sent back to all participants for member checking.

5.1 Theme one: struggling to make decisions related to lesson procedures

Theme one represented participant’s thoughts, feelings, and experiences related to valuing their work with the mothers and infants, while also struggling to prepare and revise lesson and activity plans in a timely manner. While all participants utilized the same lesson content, they were required to arrange their lesson and activity procedures based on the mothers’ and infants’ characteristics and needs. As such, participants often revised their plans and procedures at the last minute, before the lessons and activities began. Participants felt that they could make decisions regarding developmentally appropriate procedures for their mothers and infants, however they would like to have made modifications in a timelier fashion. For example, Ms. Konishi explained:

I think that I needed to improve the lesson delivery plans. I did not think about time schedule of lesson preparation and simulations, I planned lessons in last minutes before I met mother and infant. I should make decisions and spend more time for simulating lessons and activities at least several days prior to practicum experiences. I also think that I should receive various feedback from the instructor of practicum courses for improving and enhancing the lesson quality. When I was not confident enough to teach lessons and activities, I should not hesitate and seek help from a partner or others (Ms. Konishi, journal reflection).

Ms. Konishi explained that she felt that she should ask her instructor to provide frequent and constant feedback when she prepared the lessons. After receiving feedback from her instructor, she felt that she could efficiently revise and modify her plans in a timely manner. Another student, Ms. Waku, shared that all the midwifery students decided to conduct the same lessons and activities for the mothers and infants. She felt that there were various challenges, because infants show unpredictable and unexpected behaviors. She wrote:

All students decided rhythmic play-based activities. We discussed about content of lessons and activities that include safety components. All students exchange lesson and activities procedures and they understood the contents clearly. However, we did not have chances to talk about infants’ unpredictable behaviors (e.g., crying, or communication issues), so on. I think we should talk more about how to adjust lessons and activities than just delivering the lessons and activities. My group there were no flow and smooth transition between one to another activities. I think it was important to write what and how to say in the lesson plans based on cases (Ms. Waku, journal reflection).

Ms. Waku believed that all students should be prepared and trained to learn mothers’ and infants’ characteristics including behavioral patterns and family backgrounds. Ms. Hamaki raised additional problems based on responding to infants’ unpredictable and unexpected behaviors that do not align with the lesson purpose, goals, and/or objectives. She wrote:

When I revise and modified activities, I think I lost alignment of purpose, goals, and objectives of lessons and activities. It seemed that I should write the detailed information using qualitative and quantitative factors I would be able to assess. I think purpose, goals, and objectives must be concise and behaviorally objective focused. I think there is another issue that this was first time to interacting with mothers and infants, so everyone focused on their own tasks and duties, and were not able to pay attention to other classmates for extra or additional support during practicum experiences. I believe this was the reason that we forgot purpose, goals, and objectives (Ms. Hamaki, journal reflection).

Ms. Hamaki learned that it was important that she should not be self-contained and singularly focus on her own tasks. She felt that exchanging feedback, opinions, and thoughts were extremely important for personal and professional growth.

5.2 Theme two: adjusting lesson content to meet mothers’ and infants’ unique needs

Theme two showcased the participants’ focus on adjusting lesson content to meet the unique needs of the mother and infant with whom they were assigned. The participants believed that it was beneficial to use sensory activities in relation to accident prevention lessons, as well as physical activities during the practicum experience, as these types of lessons were most engaging for the mothers and infants. For example, all participants taught four different sensory related accident prevention lessons including choking, burning, reducing the risk of the infant falling, and drowning. The most common place for young children to be injured is in or around their homes, and injuries impact babies of all ages (UNICEF 2023). With a strong focus on accident prevention, the participants shared their instructional experiences. For example, Ms. Oikawa explained:

I thought that I introduced accident prevention content, but it seems that my lesson did not stimulate the mother’s interests and motivation, because I used factual information what to do and not to do. I think that the mother already knew the information. I did not search mother’s backgrounds, challenges, and concerns about raising her infant. I think direct instruction may not work for the mothers and infants. Plus, when I plan lessons, I should use my observation of home visit and investigate the risk factors. It should be experiential learning opportunities that engage with her risk factors of accidents at home (Ms. Oikawa, journal reflection).

On the other hand, Ms. Nakagawa received positive feedback from the mother with whom she was working, sharing:

I used various images, photos, and graphics in my lessons. After the sessions, I gave an opportunity to have conversations with another mother in the other group. That was helpful to reflect their learning and shared their risk factors of their infants’ accidents at homes. When I visited home of mothers, I thought it was important to take photos or pictures that I need to investigate risk factors at home. I think it was important (Ms. Nakagawa, journal reflection).

She wrote that communicating with mothers openly and effectively may have been a key factor that allowed her to maximize her learning during the practicum experience, because she felt she was respected and understood by the mother with whom she was working, which boosted her self-confidence and self-esteem. Another participant, Ms. Degawa shared her experience regarding utilizing manipulative skills (holding a towel ball) in the session. She described:

It was important to focus on sensory activities in relation to manipulative skills. Mother was going to purchase a ball for her kid, but we allowed her to create a ball with a towel, because there were some families who have financial issues. We did color identification which is visual part of five sides and touching the ball. Stimulating child reflexes is an important practice for the child in the early months. The mother understood that sensory activities were important practices for the child, and it was easy to find developmentally appropriate practices and meet mother’s and child’s unique needs (Ms. Degawa, journal reflection).

She also wrote that the practicum experience helped her gain cultural fluency, so as to provide effective instruction that relates to the mother’s socioeconomic background and living conditions.

5.3 Theme three: paying less attention to partners’ roles and responsibilities

Theme three captured participant feelings related to a lack of collaboration and check for understanding between practicum partners. This lack of collaboration included discussing partner roles and responsibilities in the lesson planning and development, and rehearsing the lesson flow and pace prior to offering it to the mothers and infants. Participants discussed the way they became perfectionists, as it was their first time working on lessons for mothers and infants, and they were anxious and focused on their assignments, tasks, and duties. Ms. Aki explained:

I think I have to do better job communicating with my partner in the practicum experiences. We did not do check for understanding when we developed lesson content. When we conducted the presentation, there was no flow in the content. I was in panic mode and revised content independently, so another issue was that we did not conduct any rehearsals and pilot presentations that check for roles and responsibilities of other partners before initiating lessons and activities for mother and infant. If there is a chance, I hope that the supervisor (instructor of practicum course) offers her expectation, goals, and objectives working with a partner in the beginning of this course (Ms. Aki, journal reflection).

She also wrote that it was important to plan in reverse, starting with goals, objectives, and expected outcomes and then move backwards from there to develop a plan and action as a team. Another participant, Ms. Kura explained that there was no team leader for each partner group or for the preservice professionals as a whole, so no one was in charge of guiding, monitoring and leading the group. She wrote that:

The team leader should be responsible for motivating their teammates as well as inspiring positive communication within them so that they can work together toward achieving goals. This was bad situation that preservice professionals with strong knowledge and skills of computer were relied heavily by the classmates. I think that there were strengths and weakness of management skills in preparing the lessons and activities, but the team leader needs to check for understanding with other students’ progress (Ms. Kura, electric portfolio).

Ms. Kura explained that in order to better collaborate and communicate, the instructor and classmates need to decide roles and responsibilities, and select a team leader.

5.4 Theme four: applying knowledge and skills to future midwifery settings

Theme four captured participants’ experiences and feelings related to utilizing skills gained in the practicum by applying their learning and growth in future practicum and professional settings. Ideally after a practicum experience, participants apply and demonstrate what they learned during the practicum in real world experiences. This application helps midwifery professionals avoid the “washout effect” phenomena, which indicates that preservice professionals experience an aspect of transition shock in reaction to the overwhelming complexity of applying their skills to new practicum experiences or professional settings (Shoval et al. 2010; Stokking et al. 2003). Ms. Konishi explained her future plans regarding post practicum experiences:

I learned that all lessons and activities I taught should be lessons that all mothers remember. I think we need to effectively practice how to offer lessons and activities in face to face and online versions. I want all mothers and infants to use five senses and experiential learning through an online practicum. These are my next goals and objectives. I also think that I need to assess and evaluate their learning outcomes. I think I am motivated to apply these lessons and activities from infants to toddlers. I appreciate that I have opportunity to take this course (Ms. Konishi, journal reflection).

Ms. Konishi explained that she would continuously gain knowledge and skills in relation to sensory activities and apply her learning to toddlers. Another participant, Ms. Asahina, shared:

What I learned from the practicum experiences is that I would like all mothers and infants to enjoy the lessons and activities, but I think it is not enough. We need to focus on their learning outcomes and satisfaction that lead to motivation. I think that is important, but it is a challenge. I think that we all should apply this knowledge and skills outside of this practicum experience. For example, we need to pay attention to fathers’ satisfaction in lessons and activities. Should we do things differently? I do not know, but we need to practice. I am motivated to take the challenge and offer lessons to a different audience (Ms. Asahina, journal reflection).

Ms. Asahina felt that activities and lessons should be focused on educating both the mothers and the fathers in the future, and she was self-motivated to design lessons and activities for fathers and infants, extending her knowledge and experience. Finally, Ms. Morishige explained:

I visited various book stores and studied play-based activity books and selected books about infants’ behaviors and child reflexes. I also checked online and web-based study. I think my motivation of self-directed learning is important for my professional development. Self-directed learning may be applicable to other practicum experience courses. I am glad that I joined in this course (Ms. Morishige, journal reflection).

Ms. Morishige wrote that when she prepared lesson and activity plans, she believed that she would be able to grow and develop as a midwife and see positive results in her skillset if she put in the effort and time outside of class to creatively plan and prepare.

6.1 Study limitations

This study has three major limitations. First, the participants were selected from one private university in Japan. Having more than one university would have enabled this study to adopt an efficient cross-case analysis, which could extend the investigator’s expertise beyond the single number of cases (Stretton 1969). Second, generalizability may be limited with this study. While qualitative research findings are not necessarily intended to be generalizable, as they instead focus on in-depth meanings and explanations, generalizability is still limited. In this study, the findings are specific to ten participants in one practicum course but may provide insights that are useful for preservice professionals in similar locations (Eckstein 2002). Third, the number of participants was small, and while they had a wide range of backgrounds and experiences in midwifery education, additional participants would strengthen the study, and expand the breadth of the understanding of experiences related to interacting with mothers and infants.