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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.
Consultant Midwifery Practice
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
Consultant Midwifery Practice
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).
Consultant Midwifery Practice
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.
Consultant Midwifery Practice
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
Consultant Midwifery Practice
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
Consultant Midwifery Practice
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
(Shenton, A.K. 2004)
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.
(Shenton, A.K. 2004)
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
(Shenton, A.K. 2004)
Consultant Midwifery Practice
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
Consultant Midwifery Practice
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).
Consultant Midwifery Practice
o Participants fell into the following three
categories:
o Consultant Midwives (8)
o Heads of Maternity Services (8)
o Medical Practitioners (7)
Consultant Midwifery Practice
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
Consultant Midwifery Practice
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
Consultant Midwifery Practice
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
Consultant Midwifery Practice
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
Consultant Midwifery Practice
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
Consultant Midwifery Practice
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Strengthening the Nursing, Midwifery and Health Visiting
Contribution to Health and Healthcare, London, DH.
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Department of Health (DH). (2000) The NHS Plan, Norwich, The
Stationary Office.
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Consultant Midwifery Practice
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Consultants, London, King’s College London.
Consultant Midwifery Practice
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