HIP3001-Interprofessional Practice

HIP3001-Interprofessional Practice

Assessment 2

Reflective Report

Word Count: 1,084

Number of Pages: 9

INTRODUCTION

To facilitate learning from experience (Sweet et al., 2019), this reflective report will utilise Gibbs Reflective Cycle (Gibbs,1988), to analyse a witnessed clinical practice event. Non-technical skills will be evaluated and contributing factors analysed through an interprofessional practice lens. By recognising gaps in clinical interprofessional practice, the reflection aims to positively shape collaborative behaviours within my future provision of care (Hauck et al., 2016; Meffe et al., 2012).

DESCRIPTION

In a Melbourne hospital birth suite, I was a student midwife assigned to a buddy midwife. The previous midwife on shift stayed back overtime to deliver continuity of care, as birth seemed near. Both midwives were graduate midwives. Shortly after completing handover, the obstetrician entered and signs of fetal compromise began, indicating the need for an assisted vaginal birth (Hotton et al., 2019). He began setting up, ordered the previous midwife to get ventouse equipment ready, my midwife to palpate contractions and myself to scribe. After returning to the room the midwife was informed by the obstetrician it was the wrong one and was told to get the other one. Sometime later, the midwife returned with the correct equipment. The ventouse that the obstetrician selected required the midwifes assistance in pumping and maintaining suction pressure. After quickly telling the midwife his desired suction, the obstetrician maintained focus on his task, and began the ventouse application. Looking bewildered, the midwife began to attempt her role in assisting the obstetrician. After three failed ventouse attempts, the baby was then delivered by forceps. After the event, the midwife debriefed her feelings with my buddy midwife and myself, expressing she had never seen one of the selected instruments before and had absolutely no idea what she was doing.

FEELINGS

I felt awkward and sorry for the graduate midwife during the delivery. As a student I can relate to a lack of experience in unexpected clinical situations. Also, feeling dominated and uneasy around highly skilled healthcare professionals. In reflection I felt sorry for the birthing woman, as the lack of effective collaboration impacted her birth environment and birth outcome.

EVALUATION

Interprofessional practice is paramount for delivering safe, woman-centred care in maternity settings (Watson et al., 2016). Along with technical skills, non-technical skills in task management, situational awareness, communication and teamwork are necessary during operative deliveries; and when used effectively, can reduce maternal morbidity (Hotton et al., 2019). Although multi-professional teams including obstetricians and midwives provide intrapartum care together, individual healthcare workers for each team can vary shift to shift (Bahl et al., 2010). The obstetrician selected an instrument requiring another healthcare professional for its use. He should have been aware of the clinical circumstances including his present teams skill sets and capabilities (Hotton et al., 2019). This action showed a lack of situational awareness as he inappropriately delegated roles to the graduate midwives on assumption of experience. The lack of knowledge around his team members (the graduate midwives), both led to and was a result of dysfunctional communication (Watson et al., 2016). The graduate midwife didnt speak up and voice her skill level and inexperience with the instrument, so the obstetrician was unaware, consequently assuming she was experienced. Focused primarily on his aspect of care, the obstetrician failed to pick up further non-verbal communication cues from the midwife, apparent to others in the room. This ineffective communication was related to repeat ventouse delivery failure and a delay in subsequent forceps delivery, an adverse outcome for both the woman and her baby (Hastie, 2008). Lack of adequate communication and situational awareness negatively influenced collaborative team work, contributing to the adverse outcome (Bahl et al., 2010; Adams et al., 2017). Clinically the situation was resolved through a forceps delivery, however improvement for future collaborative practice could have been established through interprofessional debriefing.

ANALYSIS

Hindering the situation was a background of conflict between beliefs and specialties in healthcare professionals. This variation in approach to intrapartum care can pose challenges when exposed to varying scenarios, effecting communication (Watson et al., 2016). The graduate midwifes prior studies would have focussed on providing women centred physiological care, however once in the birth suite she was required to assist in a delivery using a medical model (Barry et al., 2013).

Midwives feel it is less difficult to communicate within their own group compared to with doctors, impacting on interprofessional collaborative teamwork (Watson et al., 2016). Evident in the situation, as the midwife was comfortable engaging in an intraprofessional debrief but not interprofessional debriefing.

The culture within Australian maternity care, generally involves a hierarchal dominance of obstetricians over midwives whereby midwives experience a power imbalance and lack of mutual trust and acquaintanceship (Watson et al., 2016: van der Lee et al., 2016). Further compounded by feelings of insecurity, fear and stress (commonly felt during the graduate transition from a student midwife to a confident clinical midwife) (Dixon et al., 2015), the workplace culture and inexperience influenced the midwifes ability to confidently communicate effectively.

CONCLUSION

Collaborative care could be better facilitated by having a shared handover (Hastie & Fahy, 2011). This would allow introduction of team members and skill sets, fostering initial situational awareness, that was not present in the reflected situation. Next time, if a handover had not been done and I were in a situation similar to the graduate midwife; I would be open and honest, communicating clearly to the obstetrician. This reflection experience of interprofessional practice has positively helped me understand the importance of non-technical skills and the impact they can hold on patient outcomes. Being subdued due to skill level and hierarchy needs to be overcome, so that patient outcomes are not sacrificed. Working in a multidisciplinary team post-graduation, the knowledge of interprofessional practice will help me to overcome challenges within the healthcare system (Burns et al., 2020).

ACTION PLAN

As a graduate midwife, I will instigate where possible joint handovers with care teams. So that not only patient plans for care can be collaboratively made, but so that introductions of healthcare professionals can be made. This initial communication will set up the foundations for ongoing trust and communication, further positively influencing our abilities to work effectively as a collaborative team.

IN SUMMARY

Due to cultures within the healthcare system, current interprofessional conflict discourse occurs. It is important that with interprofessional education, we shift thinking and talking towards improving interprofessional collaboration (Burns et al., 2020). Healthcare professionals working in intrapartum care need to be provided culturally safe environments that promote professional integration, better fostering the provision of true collaborative care (Hastie & Fahy, 2011).

REFERENCES

Adams, C., Dawson, A., & Foureur, M. (2017). Competing Values Framework: A useful tool to define the predominant culture in a maternity setting in Australia.Women and Birth,30(2), 107113. https://doi.org/10.1016/j.wombi.2016.09.005

Bahl, R., Murphy, D. J., & Strachan, B. (2010). Non-technical skills for obstetricians conducting forceps and vacuum deliveries: qualitative analysis by interviews and video recordings.European Journal of Obstetrics, Gynecology, and Reproductive Biology,150(2), 147151. https://doi.org/10.1016/j.ejogrb.2010.03.004

Barry, M. J., Hauck, Y. L., O, D. T., & Clarke, S. (2013). Newly-graduated midwives transcending barriers: A grounded theory study.Midwifery,29(12), 13521357. https://doi.org/10.1016/j.midw.2012.12.016

Burns, E. S., Duff, M., Leggett, J., & Schmied, V. (2020). Emergency scenarios in maternity: An exploratory study of a midwifery and medical student simulation-based learning collaboration.Women and Birth. https://doi.org/10.1016/j.wombi.2020.10.005

Dixon, L., Gray, E., Campbell, N., Calvert, S., Tumilty, E., Kensington, M., Lennox, S., & Pairman, S. (2015). Supporting New Zealand graduate midwives to stay in the profession: An evaluation of the Midwifery First Year of Practice programme.Midwifery,31(6), 633639. https://doi.org/10.1016/j.midw.2015.02.010

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. London: Further Education Unit.

Hastie, C. (2008).Putting women first: Interprofessional Integrative Power.

Hastie, C., & Fahy, K. (2011). Inter-professional collaboration in delivery suite: A qualitative study.Women & Birth,24(2), 7279. https://doi.org/10.1016/j.wombi.2010.10.001

Hauck, Y., Lewis, L., Kuliukas, L., Wood, J., & Butt, J. (2016). Graduate midwives perception of their preparation and support in using evidence to advocate for womens choice: A Western Australian study.Nurse Education in Practice,16(1), 305311. https://doi.org/10.1016/j.nepr.2015.06.004

Hotton, E., OBrien, S., & Draycott, T. J. (2019). Skills training for operative vaginal birth.Best Practice & Research Clinical Obstetrics & Gynaecology,56, 1122. https://doi.org/10.1016/j.bpobgyn.2018.10.001

Meffe, F., Claire Moravac, C., & Espin, S. (2012). An interprofessional education pilot program in maternity care: Findings from an exploratory case study of undergraduate students.Journal of Interprofessional Care,26(3), 183188. https://doi.org/10.3109/13561820.2011.645089

Sweet, L., Bass, J., Sidebotham, M., Fenwick, J., & Graham, K. (2019). Developing reflective capacities in midwifery students: Enhancing learning through reflective writing. Women and Birth, 32(2), 119126. https://doi.org/10.1016/j.wombi.2018.06.004 Retrieved from https://go.openathens.net/redirector/vu.edu.au?url=https%3A%2F%2Fwww.sciencedirect.com%2Fsearch%3Fqs%3D10.1016%252Fj.wombi.2018.06.004%26qs_cid%3D

van der Lee, N., Driessen, E. W., & Scheele, F. (2016). How the past influences interprofessional collaboration between obstetricians and midwives in the Netherlands: Findings from a secondary analysis.Journal of Interprofessional Care,30(1), 7176. https://doi.org/10.3109/13561820.2015.1064876

Watson, B. M., Heatley, M. L., Gallois, C., & Kruske, S. (2016). The importance of effective communication in interprofessional practice: perspectives of maternity clinicians.Health Communication,31(4), 400407. https://doi.org/10.1080/10410236.2014.960992