Introduction:
Reflection is considered to promote and is known to be effective in developing critical thinking, experiential learning, and the integration of practice and theory. Taking into account a large body of research, the aim here is to ascertain students’ and midwives’ views on how critical reflection contributes to practice and the educational context. The role of reflection in improving learning is broadly debated. As a reflective process, it offers methods for examining actions in practice. Some affirm that the use of a reflective diary helps students assimilate their experiences into professional learning. Reflection is one of the fundamental learning strategies supported by professional, statutory, and regulatory frameworks to advance the development of knowledgeable and competent practitioners. Some contend that reflection needs structure to empower the restrained movement to happen (Smeltzer, S. C., 2007). Moon defines light of the distinctive utilizations of reflection found in writing, translating reflection as ‘a type of mental preparing with a reason as well as an expected result that is connected to mind processing or complex thoughts for which there isn’t an obvious solution. Realizing that midwife studies in this study context used diaries to create intelligent abilities and that there might be varieties among birthing assistants as reflective practitioners, this article will expand the discoveries of an examination of endeavors to promote reflection.
Reflective Practice For Decision-Making In Nursing Or Midwifery Practice:
Preface:
In a dynamic healthcare environment, such as in the US, change is a constant component; nurses and midwives are required to be adaptable and to react to change in ways that benefit patients. Reflective decision-making in nursing or midwifery care is an important tool and part of the National Board professional practice framework, ensuring that nursing and midwifery care is provided in the public interest (King et al., 2015; Stuart & Oshio, 2002; Dole & Nypaver, 2012; Cragin & Kennedy, 2006).
Reflective decision-making:
Decisions about nursing or midwifery care using these reflective tools are therefore made by the individuals who are best qualified and able to do so: registered nurses and midwives. Since the reflective tools are based on principle, they are manageable after some time.
Choices made utilizing these reflective tools are grounded in a professional direction, guided by standards. Differences in education, the individual’s experience and ability, and the setting in which they practise are considered when using the reflective tool (Dole, D. M., & Nypaver, C. F., 2012). Registered midwives and nurses have an essential role in coordinating and supervising other individuals who may help them in the provision of care to patients.
The reflective tools, therefore, provide guidance not only for individual practice decisions by registered nurses and midwives but also for decisions about whether and when it is appropriate for registered nurses or midwives to delegate parts of patient care to others, such as support workers.
Organizations in which midwives practise are responsible for ensuring that there are adequate resources to enable safe and competent care for those to whom healthcare services are provided (Durham & Pollard, 2010).
This includes policies and supports that help the development of midwifery practice to address the needs and expectations of patients within a risk-management framework, with the support of reflective studies (Willson et al., 2001).
These reflective tools establish a structure for critical decision-making that is grounded in competence. They do not support or approve the substitution of less-qualified health workers for midwives when the knowledge and skills of midwives are required.
No midwife should be directed, forced, or compelled by an employer or another individual to participate in any practice that falls short of, or breaches, any professional standard, rule, code of conduct, ethical principle, or practice for the profession.
Use of the template tools:
The reflective studies promote a predictable way to deal with choices about midwives’ practice across all areas of practice. The reflective tools are most applicable to the clinical practice setting; however, they might be modified or adapted for critical decision-making in different regions of nursing or midwifery practice, for example, training, research, and management.
Decision-making in midwifery is complex and depends on current circumstances and interrelated factors. The use of critical reflection helps midwives understand and consider these factors in decisions and discussions about practice.
The reflective tools provide mechanisms for:
• Midwives should keep their previous practice in mind to utilize while considering, deciding and self-evaluating their practice
• Conversation with patients, policymakers, and managers in interpreting and planning for changing practice
Competent decision-making regarding professional issues and raising concerns about the scope of decision-making and practice (Hastings-Tolsma & Vincent, 2013).
• Educators in developing the standards and ideas supporting the reflective thinking inside instructive projects that get ready midwives for practice.
The National Board can use the tools to identify practice that falls outside the recognized scope of nursing or midwifery practice or critical decision-making processes that are inconsistent with the principles stated in the reflective tools.
The reflective study should be used as part of professional practice tools and standards, such as competency standards, policies, controls, legislation, and regulations relating to nursing or midwifery and the organization.
If a dispute arises over the use of the guide for practice decisions and cannot be resolved by the parties, advice may be sought from senior management, the National Board, or a professional or industrial association to aid resolution.
The rationale for developing the reflective study:
Decisions about maternity care practice in response to rapid and dynamic changes occurring within nursing, midwifery, and the practice environment should be coordinated rather than made on an ad hoc basis. Unplanned responses could result in wide variations in practice between individuals with equivalent backgrounds and experience and between comparable settings.
Sound critical-reflection approaches provide a structure in which quality and safety are central considerations in decisions about maternity care practice, allowing (Steel et al., 2012):
- • New organizations/practices to be introduced safely and deliberately
- • Routine practice to be attempted competently and confidently
- • Appointment choices to be protected.
- This reflective thinking has been created to aid rational decision-making in midwifery practice changes. Impacts for change in nursing or maternity care practice may emerge from, among different components:
- • Authoritative or innovative change
- • Group formations, including an expanded accentuation on the security and nature of medicinal services
- • Professional developments
- • Midwifery practice changes including:
- • Changes in the model of care started by associations or professional teams
- • Changes in other midwifery health professionals
- • The development of new medicinal services parts
- • Changes in the structure and financing of training
- • Resource changes include changes in the numbers of available healthcare practitioners, including nurses and midwives, and an ageing workforce.
The Board-endorsed National competency standards for midwives provide clear measures for practice concerning scope and delegation. Some contend that reflection needs structure to empower the restrained movement to happen. Moon defines light of the distinctive utilizations of reflection found in writing, translating reflection as ‘a type of mental preparing with a reason as well as an expected result that is connected to mind processing or complex thoughts for which there isn’t an obvious solution. Realizing that midwife studies in this study context used diaries to create intelligent abilities and that there might be varieties among birthing assistants as reflective practitioners, this article will expand the discoveries of an examination of endeavors to promote reflection. All of these aspects are vital regarding training and financing of activities aimed at the development of the case and other areas in a comprehensive manner (Piotrowski, K., & Snell, L., 2007). At that point, the woman or infant should be referred to an appropriate health professional or midwifery service, and the midwife should establish a collaborative relationship with that individual or service to ensure the provision of ongoing midwifery care for the woman and her infant. Such will reveal many diversified aspects at the substantial level and vice versa.
Midwifery practice decision flowchart narrative by reflective impact:
Any action planned to accomplish beneficial and desired results for the newborn or woman is based on a complete health assessment by midwives and is resolved in the organization with the lady (Simmonds, K. E., & Likis, F. E., 2005). Practice changes may also emerge from assessments of administrations and a want to enhance access to or productivity of administrations to gatherings of customers. The main choice that the midwife should make is whether the action is inside the present, contemporary extent of midwife practices imagined in proficient practice measures and legislation (Piotrowski & Snell, 2007).
If a midwife decides, based on any of the above factors, that a midwife should perform the activity, the competence and confidence of the midwife should be determined, as should their understanding of their level of responsibility. Whether training, skills assessment, support, or clinically focused supervision from a more experienced midwife is required should also be established in light of what is required and available.
The midwife will also need to conduct a risk assessment to determine the appropriate individual to perform the activity. Factors to be considered in making this decision include whether midwives should perform the activity because:
The health status of the woman or infant is such that the activity should be performed by a midwife.
- • The complexity of care required by the woman or infant indicates that midwives should perform the activity because specific knowledge or skills are required (Simmonds & Likis, 2005; Callister & Vega, 1998; Smeltzer, 2007)
- • Professional standards for midwives indicate that the activity should be performed by trained midwives (Gaffney & Smith, 2004)
- • There is evidence that the activity is best performed by a midwife
- • Any state, territory, or Commonwealth legislation requires a midwife to perform the activity
- • Any local or organizational policy, rule, or protocol requires the activity to be performed by a midwife
- • The model of care commands that the activity be performed by an experienced midwife.
If the activity is not currently within the scope of midwifery practice, the midwife should consider whether she/he (or another midwife) wishes to incorporate the activity into their practice or whether the employer wishes to initiate a practice change (Stuart, D., & Oshio, S., 2002). If not, the woman or infant should be referred to an appropriate health professional or midwifery service, and the midwife should establish a collaborative relationship with that individual or service to ensure the provision of ongoing midwifery care for the woman and her infant.
If midwives want to incorporate the practice into their maternity care organization, or the organization wishes to initiate a practice change, they should consider various factors, such as legal authority, professional consensus, risk management, organizational support, and the preparation and experience of the midwife before proceeding. These variables incorporate whether:
- • The activity can legally be performed by a midwife, with due consideration given to the requirement for the woman to consent to the activity being performed by a midwife
- • Professional standards would support a midwife performing the activity
- • A risk assessment has identified no risks indicating that the activity should be performed by another qualified individual or service
- • The organization in which the activity is to be performed is prepared to support the midwife performing the activity
- • Consultation and planning with all relevant stakeholders have taken place
- • The midwife has the education, authorization, experience, competence, and confidence to perform the activity safely.
Results:
If these factors are positive, the midwife can delegate activities and ensure that the appropriate level of supervision is provided. If any of these factors is negative, the activity should not be delegated. If there is no other competent non-midwife, or if necessary additional support (training, competence assessment, supervision, and so on) cannot be provided, the activity must either be performed by a midwife or referred to another service provider.
In the latter case, the midwife would continue collaborating to ensure the provision of any ongoing midwifery care required by the woman or infant. Further consultation and planning might be necessary to achieve changes at the organizational or professional level to allow delegation in the future if this is considered appropriate.
Whatever the decision, documentation and evaluation of its outcomes must be completed. All parties to the decision, including the woman, the midwife, the individual performing the activity, and other healthcare colleagues, should participate in the evaluation whenever possible. The employer may also be involved in the evaluation of an organizational change.
The evaluation should consider outcomes for the woman or infant, the individual performing the activity, the individual delegating the activity, and any others affected by the decision.
References:
{1} King, T. L., Brucker, M. C., Fahey, J., Kriebs, J. M., & Gegor, C. L. (Eds.). (2015). Varney’s midwifery (p. 3). Burlington, MA: Jones & Bartlett Learning.
{2} Stuart, D., & Oshio, S. (2002). PRIMARY CARE IN NURSE‐MIDWIFERY PRACTICE: A NATIONAL SURVEY. Journal of Midwifery & Women’s Health, 47(2), 104-109.
{3} Gaffney, L., & Smith, C. A. (2004). Use of complementary therapies in pregnancy: the perceptions of obstetricians and midwives in South Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology, 44(1), 24-29.
{4} Simmonds, K. E., & Likis, F. E. (2005). Providing options counseling for women with unintended pregnancies. Journal of Obstetric, Gynecologic & Neonatal Nursing, 34(3), 373-379.
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{6} Piotrowski, K., & Snell, L. (2007). Health needs of women with disabilities across the lifespan. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 36(1), 79-87.
{7} Piotrowski, K., & Snell, L. (2007). Health needs of women with disabilities across the lifespan. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 36(1), 79-87.
{8} Hastings-Tolsma, M., & Vincent, D. (2013). Decision-making for the use of complementary and alternative therapies by pregnant women and nurse midwives during pregnancy: An exploratory qualitative study. International Journal of Nursing and Midwifery, 5(4), 76-89.
{9} Smeltzer, S. C. (2007). Pregnancy in women with physical disabilities. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 36(1), 88-96.
{10} Steel, A., Adams, J., Sibbritt, D., Broom, A., Gallois, C., & Frawley, J. (2012). Utilisation of complementary and alternative medicine (CAM) practitioners within maternity care provision: results from a nationally representative cohort study of 1,835 pregnant women. BMC pregnancy and childbirth, 12(1), 146.
{11} Dole, D. M., & Nypaver, C. F. (2012). Nurse-Midwifery: art and science. Nursing Clinics, 47(2), 205-213.
{12} Willson, P., Cesario, S., Fredland, N., Walsh, T., McFarlane, J., Gist, J., … & Schultz, P. N. (2001). Primary healthcare provider’s lost opportunity to help abused women. Journal of the American Association of Nurse Practitioners, 13(12), 565-570.
{13} Willson, P., Cesario, S., Fredland, N., Walsh, T., McFarlane, J., Gist, J., … & Schultz, P. N. (2001). Primary healthcare provider’s lost opportunity to help abused women. Journal of the American Association of Nurse Practitioners, 13(12), 565-570.
{14} Durham, K., & Pollard, D. (2010). Experiences of certified nurse midwives in providing culturally competent care for Hispanic women. Southern Online Journal of Nursing Research, 10(1), 1-14.
{15} Cragin, L., & Kennedy, H. P. (2006). Linking obstetric and midwifery practice with optimal outcomes. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35(6), 779-785.
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