The History of Midwifery - UCVV Gent · Consultant Midwifery Practice o Rationale for the Study ......

The Role of Consultant Midwife: An exploration of the expectations, experiences and intricacies

Dr Ann Robinson

University of Southampton

2013

Principal Supervisor Professor Judith Lathlean

Co Supervisors Professor Andree le May, Dr Jane Rogers

Consultant Midwifery Practice

o The Aim and Objectives of the Study

The primary aim was to consider the effect that consultant midwives were having on the provision of care to childbearing women.

o To establish consultant midwife participants’ expectations and understanding of their role as a consultant midwife;

o To place the consultant midwife role in its political and professional context during a period of ongoing professional change;

o To ascertain how consultant midwives are developing the body of midwifery knowledge;

o To examine how consultant midwives have influenced midwifery practice, as viewed by the consultant midwives and members of the multi-professional team.


o Rationale for the Study

o Research studies had been undertaken on the first generation of consultant nurses and midwives (Guest et al 2001, 2004), but nursing consultants had been the predominate focus.

o Midwives continue to focus on increasing excellence in practice through broadening their role and visibly leading practice development.

o Personal interest in focusing on new roles within healthcare


Background

o Nurse, Midwife and Health Visiting Consultant roles were implemented in the latter part of the last decade (NHS Executive, HSC1998/045)

o A new strategy was sought which reflected a more flexible, innovative and collaborative workforce, where senior practitioners were given authority to develop practice and strengthen their leadership (NHS Executive, HSC1998/045)

o Detailed proposals were published in the document Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare (DH, 1999).


Background Continued:

o The NHS Plan had, amongst its core principles, a promise to “reward and invest in individuals and organizations, providing opportunities for individual staff to progress in their education, training and personal development” (DH 2000:4).

o As with Lord Darzi’s (DH 2008) recommendations, problems identified included poor interprofessional relationships, leadership difficulties and communication breakdown. Improved organisation, leadership, management and skill-mix were seen as essential for collaborative working to be effective.


o The four key features of the consultant role are -

o expert practice;

o professional leadership and consultancy;

o education, training and development;

o practice and service development;

o research and evaluation (NHS Executive, HSC1999/217).

o It was anticipated that these practitioners would be

practice based and that partnerships and collaborative

working arrangements would be formulated between

practice and higher education


Strategic Health Authority

Number of Consultant Midwives in England (Nov. 09)

East of England 2

East Midlands 2London 17

North East 0

North West 7

South Central 5

South East Coast 4

South West 0

West Midlands 5Yorkshire and The Humber 6Total 48


o Conceptual Framework

o A qualitative paradigm using a constructivist approach closely represented the objectives and ideas relating to research design.

o The constructivist believes that knowledge is constructed out of experience and believes that reality is socially constructed.

o Ontological Positiono Reality is subjective and based on multiple perspectives.

o Epistemological Assumptiono Reflexivity - The researcher interacts with that being

researched.

Trustworthiness

Qualitative Terminology Quantitative Terminology

a Credibility Internal validity

b Transferability Generalizability

c Dependability Reliability

d Confirmability Objectivity

Lincoln and Guba’s 1985 criteria

Trustworthiness

o a) credibility (in preference to internal validity);

o How ‘true’ are the findings?

o the adoption of well established research methods

o familiarity with the culture being observed

o random sampling

o triangulation

o reflexivity

o iterative questioning

o peer scrutiny of the research project

o member checks

o thick description of the phenomenon under scrutiny

(Shenton, A.K. 2004)

Trustworthiness

o b) transferability (in preference to generalisability);

Using quantitative methodology, effort is taken to ensure that the results can be applied to a wider population

Since the findings of a qualitative study are specific to a

particular set of individuals it is not so easy to ensure

transferability


Trustworthiness

o Consider the parameters of the study

o a) the number of sites taking part in the study and

where they are located;

o b) any restrictions in the type of people who contributed data;

o c) the number of participants involved;

o d) the data collection methods that were employed;

o e) the number and length of the data collection

sessions;

o f) the time period over which the data was collected.


Trustworthiness

o c) dependability (in preference to reliability)

o the research design and its implementation, describing

meticulous planning b) the operational detail of data

gathering, addressing the minutiae of what was done in

the field

o c) reflective appraisal of the project, evaluating the

effectiveness of the process of inquiry undertaken.

o d) confirmability (in preference to objectivity).

o Objectivity

o Reducing Bias AUDIT TRAIL



o Methodology

o Qualitative

o Research Approach

o Case Study

o Reflexivity

o Sampling

o Purposive

o Methods of Data Collection

o Interviews

o Observation

o Documentary analysis

o Method of Analysis

o Thematico Conversational

o Narrative

o Comparative

o Content

o Computer Assisted


o Case Studyo Facilitates systematic inquiry, whereby an

unexplained phenomena may be described;

o enables a complete description of the case and is usually used prospectively (Yin, 2003);

o Case study may support focus on an individual or individuals and facilitates comprehensive understanding (Stake, 2000);

o Data comes from a variety of sources e.g. archival records, interviews, observation (Yin,2003);

o Case study questions are central to the method and to the phenomena under examination (Yin, 2003).


o Participants fell into the following three

categories:

o Consultant Midwives (8)

o Heads of Maternity Services (8)

o Medical Practitioners (7)


The applicationof preliminary descriptors to an extract of data

Part No

ID No Data Extract Preliminary Descriptors

8 2 You do need to be a competent midwife, to be credible in the eyes of your clinical colleagues. To have academic achievement and to be credible is a real achievement.

As an individual you need to

be self motivated, you have to

organise yourself.

Competency

Credibility

Academic Achievement

Self Motivation


An example of how preliminary descriptors across interview transcripts were colour coded andgrouped

Part No

ID No Data Extract Broader

Descriptors

2

------

8

2

------

2

I think its vital if the consultant midwife has a considerable amount of clinical experience, to have credibility as a clinical practitioner

You do need to be a competent midwife, to be credible in the eyes of your clinical colleagues, to have academic achievement and to be credible is a real achievement.

Clinical Credibility

Clinical Credibility


Having Clinical Wisdom

Being Clinically

Competent

Being a Role Model

Understandin

g the Meaning of

Practice

Having Clinical

Credibility

Providing Expert Practice

Having Good

Clinical Judgement

Being Visible

50% Practice

Others Interpretati

on of Practice

Working in Collaboratio

n

Developing Midwives


Taking Control

Influence without Power

Providing Strong

Midwifery Leadership

Coping with Frustrations

Being independent of the management structure

Being Free to Focus on the Ethos of Midwifery Care

Managing the Workload

ManagingConflicts

Pushing Boundaries

Being seen to have Impact

Role Isolation


Shaping the Future

Role Sustainability Being

Gatekeepers

A Maternity Service for the

Future

Role Feasibility

Succession Planning

Promoting quality

Retaining Midwives

Having a Clear Vision for the

Service

Having a National Presence


Department of Health (DH). (1999) Making a Difference:

Strengthening the Nursing, Midwifery and Health Visiting

Contribution to Health and Healthcare, London, DH.

Department of Health (DH). (1999) Saving Lives: Our HealthierNation, London, Stationary Office.

Department of Health (DH). (2000) The NHS Plan, Norwich, The

Stationary Office.

Department of Health (DH). (2008) High Quality Care for All,

London, DH.


Department of Health (DH). (2009) Delivering High Quality

Midwifery Care: the priorities opportunities and challenges for

midwives, London, DH.

Guest, D.E., Redfern, S., Wilson-Barnett, J., Dewe, P., Peccei, R., Rosenthal, P., A., Evans., Young, C., Montgomery, J., Oakley, P.

(2001) A Preliminary Evaluation of the Establishment of Nurse,

Midwife and Health Visitor Consultants, London, King’s College

London.

Guest, D.E., Peccei, R., Rosenthal, P., Redfern, S., Wilson-Barnett,

J., Dewe, P., Coster, A., Evans,A., Sudbury, A.(2004) AnEvaluation of the Impact of Nurse, Midwife and Health Visitor

Consultants, London, King’s College London.


NHS Executive. (1998) Health Service Circular (HSC) 1998/045

Nursing, Midwifery and Health Visiting Strategy, Department of

Health (DH).

NHS Executive. (1999) Health Service Circular (HSC)

1999/217 Nurse, Midwife, and Health Visitor Consultants:

Establishing Posts and Making Appointments, London, DH.

Redfern, S., Guest, D., Wilson-Barnett, J., Peccei, R.,

Rosenthal, P., Dewe, P., Evans, A. (2003) Role innovations in the

NHS in Leading health care organizations Dopson, S., Mark, A.L.

(Editors) Basingstoke, Palgrave Macmillan.


Stake, R.E. (2000) Case Studies in Denzin, N.K., Lincoln, Y.S

(Editors) Handbook of Qualitative Research Second Edition,

Thousand Oaks, Sage Publications Inc.

Yin, R.K. (2003) Case Study Research: Design and Methods,

Third Edition, Thousand Oaks California, Sage.

Reflexivity

Darawsheh W (2014) Reflexivity in research: Promoting rigour,

reliability and validity in qualitative research. International Journal

Therapy Rehabilitation, Vol 21, No 12 p. 560-568.

Findlay, L (2002) Negotiating the swamp: the opportunity and

challenge of reflexivity in research Practice. Qualitative Research Vol

2 (2) p.209-230.

Green H (2014) Use of theoretical and conceptual frameworks in

qualitative research. Nurse Researcher, Vol. 21, (6) 34-38.

Lipscomb, M (2012) Questioning the use value of qualitative research

findings. Nursing Philosophy, Vol. 13, p. 112–125.

Shenton, A.K. (2004) Strategies for ensuring trustworthiness in qualitative research

projects, Education for Information 22 (2004) 63–75

Case Study

Baxter, P., & Jack, S. (2008). Qualitative Case Study Methodology:

Study Design and Implementation for Novice Researchers. The

Qualitative Report, 13(4), 544-559.

Bowling, A. (2014) Research Methods in Health: Investigating Health

and Health Services. 4th Edition. Open University Press:

Maidenhead. Pgs. 422-425.

Cresswell, K., Howe, A., Steven A. (2013) Patient safety in

healthcare preregistration educational Curricula: multiple case study-

based investigations of eight, medicine, nursing, pharmacy and

physiotherapy university courses. British Medical Journal Quality and

Safety 22:843-54.

Case Study

Gomm, R., Hammersley, M., Foster, P. (Editors) (2000) Case Study

Method. London: Sage Publications Inc.

Hancock, D. R., & Algozzine, B. (2006). Doing case study research:

A practical guide for beginning researchers. New York: Teachers

College Press.

Merriam, S.B. (1988) Case study research in education: A qualitative

approach. San Francisco, CA, US: Jossey-Bass.

Moule, P and Goodman, M. (2014) Nursing Research An

Introduction. Los Angeles: Sage publications. Pgs. 267-264

Simons, H. (2009) Case Study Research in Practice Thousand Oaks,

CA: Sage. Sage Publications.

Case Study

Stake, R.E. (2000) Case Studies in Denzin, N.K., Lincoln, Y.S (Editors)

Handbook of Qualitative Research. Second Edition. Thousand Oaks:

Sage Publications Inc.

Stake, R. E. (1995). The art of case study research. Thousand Oaks, CA:

Sage.

Thomas, G., Myers, K. (2016) The Anatomy of the Case Study.

Thousand Oaks, CA: Sage.

Yin, R. K. (2013). Case study research: Design and methods (5th ed.).

Thousand Oaks, CA: Sage.

The History of Midwifery - UCVV Gent · Consultant Midwifery Practice o Rationale for the Study ......

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