Fundamentals of Midwifery: A Textbook for Students (6 page)

Partnership with women to promote self-care and the health of mothers, infants, and families.

Respect for human dignity and for women as persons with full human rights.

Advocacy for women so that their voices are heard.

Cultural sensitivity, including working with women and healthcare providers to overcome thosecultural practices that harm women and babies.

A focus on health promotion and disease prevention that views pregnancy as a normal life event.
Activity 1.2 After thinking about why you wanted to become a midwife, identify how this links to the role,responsibilities and regulation of the midwife.
Interpersonal skills and attributes
Preparedness to learn, accept, and not judge, to give advice and support are key characteristicsof all healthcare professionals today. Emotional maturity to facilitate trust, respect and confi- dence from the women and families being cared for is also crucial. Maturity does not mean age. It is now recognised that to be a midwife requires in-depth tacit knowledge, competence and confidence to undertake the activities of a midwife, which are, as evidenced laid down in statute. In recognition of this, all midwifery programmes are now at a minimum level of degree. However, midwifery, although demanding and requiring a diverse knowledge base also needs compas- sion, caring and commitment. These are harder to measure.Emotional intelligence (EI) as a concept has been researched extensively within other profes- sions, but not within midwifery. It has been a major topic of debate since its appearance in the psychological literature in 1990 (Salovey and Mayer 1990). The interest in EI seems to stem from the view that despite seemingly average intelligence, some individuals appear to do well in life, whereas others with a seemingly high intelligence quotient (IQ), struggle with life challenges (Goldenberg et al. 2006). EI is defined as:
. . . the capacity to reason about emotions to enhance thinking. It includes the ability to accu- rately perceive emotions, to access and generate emotions so as to assist thought, to under- stand emotions and emotional knowledge, and to reflectively regulate emotions as to promote emotional and intellectual growth...
(Mayer et al. 2004, p. 197)Patterson and Bagley (2011) believe that raising the profile of EI will increase effectiveness and capacity in midwives to manage the constant change and challenges facing the profession. To be emotionally intelligent appears to evidence higher coping strategies, successful problem solving, higher academic achievement, improved interpersonal relationships and the ability to feel less anxious and to be more resilient (Kun et al. 2012). Attributes deemed desirable within a highly emotive and challenging profession such as midwifery.These attributes are arguably as individual as the women with whom midwives provide care.
8 How your own emotions and those of others are managed, combined with empathy and com- munication skills, without provoking conflict in a practice situation that is becoming increas-ingly challenging, are important components that must be considered in midwifery practice. However, these are profound concepts; therefore the challenge to identify, measure and apply meaning to them, in an attempt to facilitate appropriate recruitment and retention to a profes- sion that is currently at the height of media attention and scrutiny is one that must now be faced.Healthcare education has evolved beyond recognition since the NHS was formed. With the move into Higher Education in the early 1990s for all midwifery education, the emphasis on academic achievement is consistently in the spotlight. With the decision for all pre-registration midwifery programmes to be at degree level by 2009 (NMC 2009) academic entry and degree classifications are now seen as key to a university’s success. Academic achievement is naturally aligned with IQ; however midwifery is more naturally aligned with care and compassion. There- fore it is reasonable to assume that a successful midwife today should possess a high IQ, should aim for academic success, and have the personality to care for and cope with the demands of the nature of midwifery practice. However, as the literature disputes the association between EI and IQ (Cherniss et al, 2006; Davis 2012; Faguy 2012), recruitment and retention strategies have limited evidence on which to be based.Performance in practice is largely observable and constitutes a minimum of 50% of the midwifery programme; it must be undertaken in clinical practice. The reliability of the practice assessments undertaken by clinical midwives has been scrutinised since their intro- duction by the NMC and continues to be open to criticism of subjectivity, unreliability and inequity.Working within the NHS is a unique experience, and many studies have considered socialisa- tion to the culture of midwifery and the NHS as both a barrier and a coping mechanism for those working within it. Even those with experience as healthcare support workers have reported experiencing a culture and reality shock (Brennan and McSherry 2007). Socialisation can lead to a loss of idealism and identification of negative aspects of care, which can decrease the ability to cope (Mackintosh 2006). Organisational socialisation, where interpersonal relation- ships are to be maintained, together with adaptation to the ward rules and culture, can create frustration and stress (Feng and Tsai 2012). However, resilience and mental toughness (Clough and Strycharczyk 2012), can foster clinical reasoning and critical decision-making abilities, which are vital in this profession. Midwives must have the ability to question and challenge practices and make difficult decisions based on available evidence and the preferences of women in their care (Parsons and Griffiths 2007).There is currently a great deal in the press about the kind of skills and attitudes healthcare professionals need to have. This is related to the recent Francis Report (2010) and the Care Quality Commission (CQC) (2013) report into maternity services at Barrow in Furness. This has led to the Department of Health (DH) strategy to set out the requirement for care and compas- sion around those who are in the caring profession (DH 2012).
Further reading activityRead: The vision for midwifery care within the Department of Health strategy.[Available online] http://www.england.nhs.uk/wp-content/uploads/2012/12/6c-midwifery.pdf
Activity 1.3 ‌Think about how you can be caring and compassionate at all times and what aspects of the 9caring environment could challenge this?Effective communication is crucial. Midwives work in a multidisciplinary environment and therefore must be able to consistently communicate accurately and clearly with women, their families and to other professionals. Being able to communicate effectively both verbally, and in writing to ensure that all care provided is safe, is essential. The NMC (2009) standards reflect this requirement and assessment aims to reduce and challenge barriers.
Professional expectations
As soon as a person commences a professional programme that on completion will allow entryonto the NMC register, then their behaviour is under scrutiny. This behaviour is set out in NMC documents, which are periodically updated. The code of practice and the NMC guide for stu- dents sets out clearly what is classed as acceptable and unacceptable behaviour.
Further reading activityRead: The Code (NMC 2008a) and student guidance on professional conduct (NMC 2011a) andthink about what aspects of your behaviour you might need to change in order to meet these codes.One of these aspects of behaviour may be the use of social networking sites. Practitioners and students must not put anything on these sites that they would not be happy for the entire world to see. This has implications in relation to the confidentiality of patients and other health- care workers, as well as to appropriate language and comments (Jones and Hayter 2013). The transition to a student midwife can be a challenging one and it is useful to revisit the code and student guidance, as well as discussing this with midwifery lecturers and midwives.
Life as a student midwife