Fundamentals of Midwifery: A Textbook for Students (17 page)

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Activity 2.10 Read: McCormack, B., McCance, T. (2006) Development of a framework for person centrednursing
Journal of Advanced Nursing
56(5), pp. 472–479.Look at the framework on page 476 and think about how you could apply this to your practice.McCormack (2003) lists 29 ‘principles for action’ of these there are four which are key:

Listen to women and allow them to tell their story as a legitimate part of assessment processes.

Suspend the use of prior knowledge about a woman and their social context until they have been enabled to tell their story.

Adopt a woman-centred approach to risk assessment and risk taking.

Help women to see beyond their own limited expectations of their involvement in care and their deference to others.It is important to share power and knowledge appropriately. The issue is not whether there exists a hierarchy and power dynamic, but how this is managed and reflected in the care. Molyneux (2001) describes how a new team can be developed where team members work in a collaborative manner, with the importance of commitment, communication and development of a team working culture at the heart.
Activity 2.11 Think about where as a student midwife you fit within the midwifery team? What impact doesthis have on you day-to-day?
Regulation
Accountability
Key areas around effective team working include the culture within the team and leadership. The recent Francis Report (2013) talked about how the failure of the leadership of a Trust led to an environment where poor care became acceptable. Accountability is a key issue within all teams, but particularly within healthcare teams. Whilst leadership is important and can have a significant influence on how a team works, the people within the teams must be accountable for their own actions, and cannot pass this accountability on to others (NMC 2008; Griffith 2011). This is a fundamental principle of the role and responsibilities of the midwife. Richard Griffith has written several articles around accountability in midwifery, which discuss the key principles of who is answerable to whom (Griffith 2011; 2012a; 2012b; 2012c). He identifies the ‘Pillars of Accountability’, as society, the woman and baby, employer and profession (Griffith 2012a). The current focus on poor care in the press is related to an individual’s accountability to society and the profession.
There has been justifiable outrage about the findings of the Francis Report (2013), and demand for professionals to go before their regulatory bodies, to be called to account and be prevented from practising. 33A fundamental responsibility for the midwife is to ensure the mother, her baby and herpartner remain the focus of all care and that any care given is always safe (NMC 2009). In order to provide women-centred care within a family environment, the needs of the mother, baby and her partner and family must be the midwives’ first concern. Indeed the Department of Health indicates that the views of the patient must be paramount in any decisions made about their care (DH 2012a; 2012b). There should be a focus on seeking the views of patients, giving information and being honest and truthful. Such a philosophy can be challenging and difficult as Brass (2012) identifies occasions when women make choices against professional advice. This re-emphasises the role of the woman as the lead for effective team working and the importance of good communication for sound decision-making.The NHS Constitution (DH 2013a, p. 128) makes clear its expectations of staff, stating that [you must] ‘
take responsibility not only for the care you personally provide, but also for your wider contribution to the aims of your team and the NHS as a whole
’. The NMC (2008) sets out standards for team working and patient inclusion:‘make the care of people your first concern’. This includes working effectively as part of a team and sharing information appropriately.
Escalating concerns
It is clear that anyone who works in the NHS must take action if they see inappropriate or poorcare. The process for how midwives should do this is within the document raising concerns (NMC 2013), with which all midwives and student midwives should be familiar. It is not just about the care that a midwife herself gives, but also the care that she sees given by others. In order to protect and safeguard women and babies, it is essential that if there are concerns about the practice of others then we must act. Healthcare practitioners and students cannot sit back and think,‘My care is good; I am not responsible for anyone else’s care.’ Midwives are responsible for the environment in which they work, including the teams they are members of. This is where the importance of leadership and management of the team is crucial, since its leader and manager set the tone of the quality of the care offered by the team. Student midwives and midwives also have an extra support in the Supervisor of Midwives framework, which can assist in raising and dealing with concerns (NMC 2012). Students should find out who their named Supervisor of Midwives is in their area of practice. The NMC (2011a; 2013) also provide specific guidance to healthcare practitioners and students about how to deal with concerns about practice with which all practitioners and students should become familiar.
Further reading activityRead: The NMC document Raising Concerns and think about how you would feel if you had tofollow this process and where you could get support.[Available online] http://www.nmc-uk.org/Nurses-and-midwives/Raising-and-escalating-concerns/It is well documented what can happen if concerns are not expressed or are not managed appropriately (Francis 2013, DH 2013b). Therefore, it is essential that all healthcare workers and students take responsibility for expressing their concerns and taking appropriate action, as theNMC states ‘
if you don’t do something who will?
’ (NMC 2011b). Courage is one of the 6 C’s which is now part of the vision for the NHS; this is required when taking action about concerns
34 that a healthcare worker or student might have about care (Cummings and Bennett 2012; DH 2012c).
Team player
A team of people working together in harmony towards a shared goal (see Figure 2.3), wherethe individual characteristics each team member brings complements those of others, is a powerful and effective entity. There can be much gained from team working, as members enjoy the support and comradeship of each other. The more positive staff feel about their team and their work the better their work is and this can have a positive effect on others around them. Bargagliotti (2011) terms this as ‘
work engagement
’ and sees this as a state of mind that workers can have about their team and what they do (see Figure 2.4). The ability and opportunity to work with staff from other disciplines and backgrounds adds a richness to team working in the NHS which is interesting and exciting.
Activity 2.12 What characteristics can you bring to a team which will facilitate good team working?What can you do to develop these skills?
Figure 2.3
Team of people committed to a common goal. Source: Reproduced with permission from J. Green.(a)Commitment Equality OptimismCommunication Collaboration MotivationAccountability Constructive critci ism Compassion and caringClear vision Flexibility